L.A. Times

Targeting that other male sex problem
By Melissa Healy, Times Staff Writer
May 30, 2005

Makers of drugs for erectile dysfunction have struck gold in recent years asking men if they'll be ready when "the time is right."

But in the field of men's sexual health, at least one pharmaceutical company is focusing on a different problem of timing — premature ejaculation.

At a meeting last week of the American Urological Society in San Antonio, physicians gathered to hear news of a potential new drug, dapoxetine, for premature ejaculation — which researchers believe plagues more than twice as many men as those suffering from erectile dysfunction.

The Food and Drug Administration could decide within the year whether to approve the drug.

The late-stage clinical trial found that premature ejaculators who took dapoxetine, at doses of 30 or 60 milligrams, were able, on average, to triple or quadruple the time they could engage in sexual intercourse before reaching orgasm — bringing them "in the ballpark," according to lead study author Dr. Jon L. Pryor, with men not suffering from the disorder.

At least as important, added Pryor, who is chairman of the University of Minnesota's department of urologic surgery, men suffering from premature ejaculation who took dapoxetine reported significantly greater control over their ejaculation and far more satisfaction with their sexual experience.

"That's a big thing for guys," said Pryor. "They want to feel like they have some control."

For years, many scientists and healthcare professionals have scratched their heads over whether a man who reached climax too early had a psychological or a medical dysfunction, and if so, how precisely to measure its symptoms and render a diagnosis. Now they've settled on a definition: Ejaculation can be deemed premature if it comes on so fast as to cause "distress and embarrassment to one or both partners."

Those suffering premature ejaculation, on average, can last 1.8 minutes following penetration before reaching climax. By comparison, men not suffering from premature ejaculation can have intercourse for about 7.3 minutes before orgasm.

In all, the American Urological Assn. estimates that 27% to 34% of men in the United States may suffer from premature ejaculation, compared with 10% to 12% of men who suffer erectile dysfunction. That makes the problem the most common male sexual dysfunction— and a significant source of stress in relationships.

It is also a condition that has been closeted in shame and secrecy and treated historically as a psychological problem.

Men who live with the condition, says Ian Kerner, a New York-based sex therapist and author of "She Comes First: The Thinking Man's Guide to Pleasuring a Woman," are "living lives of quiet desperation" with little more to help them than behavioral treatments — such as stop-and-start and squeeze exercises, which are not always effective. Not surprisingly, the American Urological Assn. estimates that between 1% and 12% of sufferers now seek help from a healthcare professional.

And unlike sufferers of erectile dysfunction — the disorder that has made the manufacturers of Viagra, Cialis and Levitra scads of money — those suffering from premature ejaculation cover the age spectrum, meaning that young and old alike could become lifelong customers.

Now investigators, usually with strong interest from pharmaceutical companies, have been busy finding a prescription remedy for the problem that Sigmund Freud once attributed to castration anxiety.

In recent years, physicians have tried prescribing antidepressants to treat premature ejaculation. The fact that many of the most widely used antidepressants tend to suppress sexual desire was, in fact, part of their reasoning: If sexual enthusiasm could be dialed back a bit, and anxiety over performance could be blunted, then perhaps antidepressants would help.

As medical researchers have entered the field, they have also found some origins of premature ejaculation in disease. For some men, a sudden onset of premature ejaculation can be a symptom of an infection of the prostate, which is easily treated with antibiotics. For a small group, premature ejaculation may be an early symptom of epilepsy.

Dapoxetine, developed by Johnson & Johnson Pharmaceutical Services, acts in much the same way as those antidepressants that increase the availability of the chemical serotonin in the brain.

But unlike those medications, it is taken only one to three hours before a man expects to have sexual intercourse, making it an "on demand" drug, and it passes through the system extremely quickly.

Pryor called dapoxetine a "very safe" drug, which comes with a very low risk of side effects such as headache and nausea and does not appear to suppress sexual desire or carry risks such as suicidal ideation — concerns that in recent months have prompted the FDA to issue warnings associated with some antidepressants.

For premature ejaculators who participated in the Pryor study — whose average length of intercourse before climax was 55 seconds — dapoxetine had a profound effect, said Pryor, who is author of a book on men's health titled "It's in the Male." These subjects, he said, "were devastated by premature ejaculation: It affects how they feel about themselves."

But psychologists like Michael E. Metz, who is among those advising the developers of dapoxetine, caution that premature ejaculation is a problem with many sources and many effects — difficult to untangle and not always resolved with a pill. Whether or not dapoxetine works for a man, premature ejaculation can roil a relationship or be borne of preexisting relationship problems. Men and their sexual partners often need to work those problems out even if they are helped by medication, said Metz.

While Pryor foresees potentially wide use of a drug like dapoxetine, he played down the likelihood that — like erectile dysfunction drugs — this potential new medication would win a wide following among men with no sexual dysfunction.

Taken by men who are not plagued by premature ejaculation, dapoxetine could result in no climax at all, or a climax that takes too long to achieve, said Pryor.

"It's going to make it difficult to ejaculate," Pryor added. "You're going to have one unhappy man if he doesn't ejaculate."