Author Ian Kerner admits to a PE problem...

...while urologist John Mulhall says 50% of his PE patients avoid taking prescribed drugs due to their anti-depressant branding.

In search of staying power
An experimental drug that treats premature ejaculation
raises the curtain on a formerly taboo subject
By JULIAN KESNER

Originally published on June 21, 2005

What's the difference between two minutes and seven minutes?

At first thought, only five minutes. Three hundred seconds. Not much time at all, really. But for men who suffer from premature ejaculation — the most common sexual dysfunction among men of all age groups — it can mean the world.

"Five minutes doesn't sound like a long time, but it is. If you were to stare at a clock for five minutes, that would seem like a long time. If you were having sex, that time would seem even more valuable," muses Stacey Grenrock Woods, the Esquire sex columnist and author of the upcoming book "I, California."

According to a recent observational study published in the Journal of Sexual Medicine, premature ejaculators last about 1.8 minutes or less after commencing intercourse. The average among "normal" men is somewhere at just over seven minutes.

Yes, five minutes might turn an insecure man into a happy, confident one — perhaps change the path of history, depending on the man. "It could mean the difference between a man buying a Hummer or not buying a Hummer," quips Grenrock Woods. "It could decrease our dependence on foreign oil!"

Joking aside, premature ejaculation (PE) has long been a taboo subject. Estimates from the American Urological Association and medical studies say 20% to 34% of men of all ages suffer from premature ejaculation, but reports suggest that less than 12% ever receive any sort of treatment for it.

Underlying causes still a mystery

David Rowland, Ph.D., a psychology professor and dean of graduate students at Valparaiso University in Indiana, was one of nine researchers involved in the observational study, which had couples use stopwatches and keep log books to track men's lasting times. Rowland says the reasons some men reach orgasm during intercourse sooner than others are not entirely known.

"Part of it is inherently biologically wired," says Rowland. "But there's also variation for every individual, for every situation and partner. It's based upon context — level of arousal, novelty, familiarity and past experiences are all factors." Rowland says that PE can also be an adaptive trait; nature may have selected simian ancestors who were able to release their sperm more quickly than others, minimizing their vulnerability to attack from other males during coitus.

It may be adaptive in a more contemporary sense, too: While two-thirds of men with PE have always had it, the other third acquire it, including many men with erectile dysfunction (ED) who train their bodies to ejaculate before they lose an erection.

Americans aren't the only guys concerned with their lasting power. A recent survey at the University of Holland found that British men last an average of seven minutes and 36 seconds during sex, followed closely by U.S. men at seven minutes flat. Turkish men were probably horrified to learn that the study has them lasting less than four minutes on average.

Then again, maybe they weren't. Some experts believe that premature ejaculation is more of a Western idea than anything else; in some regions, being able to ejaculate quickly may be viewed as a sign of virility and reproductive dominance.

"You've got to think of cultural issues as opposed to country," says Stanley Althof, Ph.D., a Case Western Reserve University psychology professor and executive director of the Center for Marital & Sexual Health of South Florida, who joined Rowland on the observational study. "I have heard when I lecture internationally that men in Asian countries tend to ejaculate rapidly — it may be more macho. There is anecdotal data around."

Still, most experts have seen little variation across the pond — meaning those infamous European playboys probably have the same problems as us. "The rates in the U.S. are minimally different from other Western European countries," says Rowland. "They all tend to be somewhere between 20% and 30%. I would find it very different to believe that French men are more afflicted by this than American men."

A new approach to the problem

Part of the reason why PE has remained under the radar for so long is that therapy options have traditionally been limited, notably on the pharmaceutical side. Aside from talk therapy and mind-body techniques known as the "stop-start" or "squeeze" methods, physicians have generally resorted to prescribing SSRI anti-depressants like Paxil or Zoloft for "off-label" use (taking a drug for reasons other than an approved indication).

This has proved far from ideal. "In my clinical practice, 50% of my PE patients will not want to try these drugs because it's an anti-depressant drug, there's a stigma associated with it and there's daily dosing," says Dr. John Mulhall, an urologist at Weill-Cornell Medical Center and Memorial Sloan-Kettering Hospital.

Now under review by the Food and Drug Administration is the first drug developed specifically for the treatment of premature ejaculation. Called dapoxetine hydrochloride, it's technically a serotonin transporter inhibitor, or STI. (Serotonin is a chemical involved in transmitting signals in the brain and is thought to play a role in depression.) Mulhall says that rather than affecting the serotonin receptors in the brain like an SSRI, dapoxetine works earlier in the process to inhibit the protein responsible for transporting serotonin in the first place. The result: If approved, dapoxetine could be taken on an as-needed basis, one to three hours before a sexual encounter — and it would also lack the anti-depressant branding.

"Can you imagine the commercials for this thing?" says Grenrock Woods. "What guys are they going to choose to be the face of premature ejaculation — 25-year-old data entry clerks?" But despite the stereotype of PE afflicting only young, horny guys, it's almost always a life-long issue affecting all age groups of men. That means dapoxetine could, if approved, cause a pharmaceutical boom that could match, or surpass, Pfizer's success with Viagra.

Thus far, dapoxetine is living up to the hype. A recent Phase III clinical trial by drug developer Ortho Urology, a unit of Ortho-McNeil Pharmaceutical, proved remarkably promising. In a double-blind Âtrial using two drug strengths, there was a quantitative three- to fourfold increase in lasting time among most subjects.

Perhaps even more important were the qualitative results. Only 2.5% of men rated their control over ejaculation as "fair" or "very good" beforehand, but this rose to over 50% after 12 weeks on dapoxetine, about twice the placebo's increase. And similar sexual satisfaction increases were reported among partners at the receiving end. The FDA could approve the drug by the end of the year.

Yes, the horizon indeed looks bright for men, not just PE sufferers but also "normal" guys who could soon be taking dapoxetine recreationally. But "three- to fourfold" may just mean five more minutes of sex. Is that really going to make a difference for a woman?

It takes two to be intimate

"The average healthy woman takes 15 to 20 minutes to orgasm," says Laura Berman, Ph.D., relationship "sexpert" and director of the Berman Center in Chicago. "If you're expecting women to reach orgasm in seven minutes alone, that's a tall order." Berman is still enthusiastic about dapoxetine, though. "Certainly, the more stimulation a woman can receive, the better," she says.

Althof agrees. "It will be better sex for women, but that's not what upsets them. You've got to broaden your lens here. What occurs is abrupt breaks in intimacy," says Althof. "If you're just asking me if dapoxetine will cause fantastic sex, the answer is probably not, but I think what it will do is improve both the sexual and relational aspects."

"I always would say that the more tools there are in the toolbox, the more likely you'll be able to build what you want to build," says Rowland. "This is one more tool in that toolbox."

Still, aspiring sex marathoners need to remember that for most women, 70 minutes of intercourse can be no different than seven. "Almost every single study on female sexuality points to the 'Intercourse-Orgasm Discrepancy' — women do not consistently orgasm from intercourse," says Ian Kerner, Ph.D., the author of "She Comes First" and an admitted PE sufferer. "It's not enough on its own. The vast majority of surveys that talk about women who can orgasm consistently from intercourse also have some sort of clitoral assistance."

So remember, guys, popping dapoxetine a year from now may make you feel better about yourself, but don't forget about your partner.

"Whether it's a guy going on Viagra or a guy going on a PE pill, just because a guy can ... last longer doesn't mean that his partner is going to be satisfied," says Kerner. "I'd like men to develop a fuller understanding of their sexuality and not feel as pressured to perform solely on the Âbasis of their penis."

A 37-year-old television writer from Los Angeles shares his thoughts on a life-long struggle with premature ejaculation

Always on his mind

My entire memory and history of my sex life is tainted by being more concerned with not [ejaculating] than enjoying the experience. Certainly when I was dating in my 20s it was always on my mind. It would take away from the simple pleasure of being with someone — I'd be thinking about it. It Ânever kept me out of relationships, but it's definitely a big annoyance.

I remember [an early sexual experience]; it was about three seconds. Certainly having a few drinks slows things down a bit. There was sort of a period where I always made sure I was a little drunk or tipsy when having sex. That definitely helped. But it's never taken that long.

There have been times when you have an orgasm when you didn't want to. My wife understands and knows about it. It's something I'm still dealing with, but you find ways. I've learned to take care of her first. That's always been the strategy.

Working through it

Since I was 16, I always had girlfriends and had women interested in me. In every other aspect of my life, I'm very confident. I've been successful enough to feel good about myself. If I were an unattractive, fat guy who felt like crap about myself generally in life, and I had this problem, that's a double whammy. It hasn't been a front burner for me lately because I've been married for more than five years and my wife gets it, and we have this way of going about sex that works for us.

A different theory

There are times in my life where I'd rather be the guy with erectile dysfunction. It's something like, you're not a man if you can't hold your semen in your body. It's not like me or anyone else with this issue is broken. Maybe we're more normal — maybe this is the way nature wants things in order to carry on. Maybe there is something wrong with the guys who take 20 minutes. It's sort of a wonderful defect. But I think nature does care about taking care of a woman's pleasure, because it's an incentive to have sex.

Dapoxetine

I'm kind of over [PE] now — I'm married and I please my wife, and I'm pleased too. We're fine. Me personally, I'm not a pill popper. I also have a bald spot — I'm the perfect candidate for Propecia and all that stuff, and I won't do it. I take Tylenol when I have a headache; I'll take drugs when I need them, but that's it.

I might try it, though. Certainly if there had been something like this 10 or 15 years ago I might have tried it. I'm concerned about side effects, but it might be fun to try it.

I think there are people out there who think that PE isn't a real thing, that drug companies are just inventing it. That couldn't be further from the truth. I think this drug is going to be a big hit. I think it's going to be bigger than Viagra.

Taboo

It's mortifying for a guy. People just don't talk about it. Not only do guys not talk about it with each other, I have barely even talked about it with women I've been with.

I guess I kind of hid it in a way, well enough because I always insisted on taking care of [my wife] first, but we have had problems where I've come and she wasn't satisfied. She felt bad when we've had those times. But we never talked about it. Isn't that crazy? We're very expressive people. It's insane we never talked. That's how big of a stigma it is.

What others can do

What's even more important than the drug is to create a dialogue about this. That's the biggest problem. I don't talk about this issue with anybody. Honestly, I'm tempted to go on the record about it. But I'm not there yet. I believe in my heart that this is something people should talk about, but I'm not going to do it. I won't talk to people about it. There's too big of a stigma. But even though I won't go on record with my name, I want to do what I can to help the cause.