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Fast Track to Disappointment
Premature Ejaculation Is Disheartening Reality For Men Everywhere, But Simple Exercises and New Drugs Can Make A Big Difference.

June 25th, 2004

By Louis Wittig : eCureMe Staff Writer
June 23th, 2004 : Physician Reviewed

For too many couples, sex is like a roller coaster: exciting, even breathtaking, but in the end, the ride’s over almost before it begins. When it is, premature ejaculation (PE) is often the culprit. PE, occasionally known as rapid ejaculation, occurs when a man reaches orgasm before he’d like to. The scope of the problem is on par with erectile dysfunction: studies have indicated that anywhere from 21% to 75% of men grapple with the condition. And while public awareness of PE has lagged behind that of erectile dysfunction in the last couple years, thanks to big budget ad blitzes for Viagra, Levitra and Cialis, that may soon change. PE is easier to treat without drugs than impotence, and recent pharmaceutical innovations make is possible that ad blitzes for PE drugs may be a part of the not-too-distant future.

Fast Track to Disappointment

Problematic Recognition

There isn’t a good definition of erectile dysfunction, so for many men, it may not be easy to recognize. The American Urological Association defines it as "the inability to maintain an erection long enough for mutual satisfaction" while others in the field define it as the tendency of a male to ejaculate "sooner than desired." Neither helps very much: "mutual satisfaction" is a vague standard, and given the option, most men would likely want to keep thrusting all night long, so in a sense any ejaculation is premature.

Some in the medical community have suggested that premature ejaculation can be diagnosed by the number of thrusts a man can perform after he penetrates his partner, anywhere from 8 to 15 being abnormally low. Others have suggested that anything less than 1 to 2 minutes of penetration before ejaculation is too little.

According to Ira Sharlip, MD, the director of Pan Pacific Urology Associates in San Francisco and a former president of the Sexual Medicine Society of North America, the real problem is that "there are no studies to show how much intravaginal time is normal [during sex]." Without knowing normal, it’s hard to define abnormal.

The best diagnostic tool is likely the patient’s intuition. If you feel like you’re capable of lasting longer than you usually do, it might be time to talk to a doctor.

Many Causes, Many Therapies

Complicating things, the exact causes of PE can vary from man to man, and none of them can be easily or definitely identified by tests. In some cases, PE may be caused by a hypersensitivity of the nerve endings in the penis. In other cases it’s possible that feelings of anxiety or overexcitement could cause a man to rush through sex and cross the orgasmic finish line before he should. In still others, a low level of sexual experience - in general, or with a new partner - can mean that a man hasn’t learned to coordinate his actions with his body’s reactions. If the problem is chronic and left unexamined, consistent dissatisfaction can build between partners and become a contentious issue in a relationship.

Approaches to treating PE are as varied as the causes. Where psychological factors are thought to be at play, it has been standard practice to seek out counseling from a sex therapist, however some doctors are skeptical about the efficacy of therapy, pointing out its relatively high cost and limited success.

For many men, less formal treatment is the way to go. One of the simplest techniques is "mind over matter". Instead of focusing on the intense experience of sex, a man distracts himself by thinking about mundane topics (i.e. baseball, work, etc.) and thus takes his excitement level down a notch. Wearing a condom can also diminish sensation. Some go as far as spreading lidocaine jelly, a numbing lubricant, on their penis or condom before sex. Unfortunately, once the lidocaine enters the vagina, it can have the same icy effect there as it has on the penis, potentially making the sex less comfortable for the female partner.

Other methods succeed by bringing the man’s partner into the process. The "stop and start" method involves the woman stimulating the man until he’s about to ejaculate. When he gets to that point of no return, the man tells his partner to back off the stimulation for thirty seconds, and once he’s cooled off, begin it again. Repeating the process until he’s ready to reach orgasm can help acclimate the man to a sustained sexual reaction.

The same principle is behind the "squeeze" exercise. Just like "stop and start" the man is stimulated until he nears ejaculation. Then, his partner squeezes the head of his penis, stops stimulation and then resumes it when he’s less sensitive.

The Next Viagra?

Spoonfuls of lidocaine and a little patience may be effective for many, but a pill threatens to make both obsolete.

"The most important development in treating premature ejaculation in the past several years has been the use of Selective Seratonin Reuptake Inhibitors [SSRIs]. Two thirds of men who try them increase the length of intercourse," says Sharlip.

SSRIs are a class of drugs that include the popular brands Paxil and Zoloft. Approved for the treatment of depression, doctors have been recommending them to their PE patients for one notable side effect: delayed ejaculation.

Though it would seem to be the silver bullet, even SSRIs have their drawbacks. In order to feel the drug’s effects, patients would have to take them hours before sex, thus robbing the experience of some of its alluring spontaneity. Some researchers have even looked at combining Paxil with Viagra, hoping to create a knock out PE combination. While the results were impressive - 56 of 58 men who took the combo upped their endurance - it still requires beginning the medication cycle up to 7 hours in advance.

A much more convenient drug is in development, and its makers are hoping that if and when it hits the market, it will do for PE what Viagra has done for erectile dysfunction. Currently known as LI-301, the drug, under development by Enhance Biotech, is the first specifically geared towards treating PE. LI-301 aims to provide the delaying action of SSRIs, but without the need for impeccable timing. It’s makers are also quick to point out that it prevents another possible side effect of SSRIs: if the drugs build up in the system, they can lead to a drop in libido, thus undermining the point of their use. According to reports from Enhance management, initial trials involving 30 couples delayed ejaculation in all the men who took it.

More trials still need to be done, however, and pending their outcome, and FDA review, it’s likely that the drug won’t be available to consumers until 2007.

Contact Louis Wittig at

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