THE QUESTION has tormented men — and their partners — for generations, and now we have a precise and scientific answer: 7.3 minutes.This is the average length of time between penetration and orgasm for a man. We know it is 7.3 minutes thanks to exhaustive research published recently by the pharmaceutical company Johnson & Johnson, which persuaded 1,587 couples to have stopwatch-timed sex (the women held the watch).
The aim of the venture was not to put men’s minds at rest but to come up with a definition of premature ejaculation (PE), for which there seems to be a new remedy, a drug called dapoxetine. What emerged from the Johnson & Johnson research was that men with PE were able to keep going for an average of only 1.8 minutes.
US research suggests that between 20 per cent and 30 per cent of men suffer from this problem. Impotence affects less than 10 per cent of the male population, and sales of Viagra-like drugs are now worth more than $2.5 billion a year worldwide. A treatment that treated PE effectively could be a new pharmaceutical blockbuster.
Like most other sexual problems, PE is normally shrouded in shame and silence. However, its torments have been vividly described by a Manhattan sexologist and self-confessed PE sufferer, Dr Ian Kerner. In Men’s Health he tells of the girlfriend who issued the ultimatum, “Slow down or I’m leaving”, and his vain attempts to deaden sensitivity with drink or by using double-thickness condoms, sometimes packed with a numbing agent Lidocaine (Lignocaine in the UK), which left him unable to feel anything at all.
Equally ineffective was his attempt to use the technique immortalised by Woody Allen in Play it Again, Sam — thinking of the names of famous baseball stars. And his use of the “stop-start-squeeze” technique pioneered by Masters and Johnson — repeatedly apply firm pressure just below the head of the penis at the crucial moment to push blood out of the organ — prompted another exasperated outburst from his girlfriend. “I’d been going ‘Slow down, easy, easy, go ahead, stop, I said stop’,” he says, “when she blurted out: ‘Are we having sex or parking the car?’ ”
At least, dapoxetine offers a different approach. It is one of the selective serotonin reuptake inhibitors (SSRIs). A potential side-effect of these antidepressants is their effect on libido — “absent, delayed, or dulled orgasm and emotional blunting”. The sort of effects that may prove a godsend to those with PE.
Some psychiatrists and sexologists have been prescribing SSRIs to PE patients for several years on the ground that this may help.
The difference between dapoxetine and SSRIs such as Prozac or Seroxat is that it has a shorter “half-life”, which means it is cleared out of the body faster.
Trials by Dr John Pryor, a urologist at the University of Minnesota, found that it could add a few minutes to a patient’s performance, at least doubling if not tripling their staying power. The results of the trials (just published in The Journal of Sexual Medicine) showed that the higher the dose, the stronger the effect, but that the benefit also came with worse side-effects: 20 per cent reported nausea and 7 per cent headaches, diarrhoea or dizziness. Fewer than 50 per cent reported some or a lot of satisfaction with their sex at the end of the study.
But though some men are clearly prepared to put up with much to regain a feeling of control over their lovemaking, one surprising finding of the stopwatch trials was that several seemed unconcerned by their PE. They enjoyed sex; what was the problem? A 1990s study showed that PE may not have the same corrosive effect on physical satisfaction as impotence. Unlike impotence, PE does not affect performance.
Edward Laumann, a sociologist at the University of Chicago, says: “Premature ejaculation simply doesn’t shake men’s timbers in quite the way that erectile dysfunction is likely to do.” Some researchers suggest that PE may actually have benefited our distant ancestors. Dr Mark Noble, of the Cleveland Clinic Glickman Urological Institute, explains: “From an evolutionary point of view, you could say that males who can ejaculate rapidly would be more likely to succeed in fertilising a female than those males who require prolonged stimulation to reach climax.”
Exactly why some people have PE is still something of a mystery. The Freudians claimed that, like many other forms of self-defeating behaviour, PE stemmed from unconscious fears of castration. Later the behaviourists said that it was all about early learning: the masturbating circle among school boys, where there was a race to be the first, was one culprit. Another was having a number of early experiences of quick sex, still thought to be a factor in cultures where sex before marriage attracts strongly disapproval. In the brain, the chemical messenger serotonin must play a role — the SSRI drugs give you more of it — but how the system works has not quite been figured out.
So there’s a degree of scepticism about dapoxetine’s chances of becoming a second Viagra. And, says, Dr David Goldmeier, consultant in genito-urinary and sexual medicine at St Mary’s Hospital, Paddington, there is also a question about its clinical benefit. “And even if it was absolutely brilliant,” he adds, “it seems unlikely that the NHS would pay for it. The Government just does not take sexual problems seriously.”
He and other sexologists also worry that a pill will be seen as an instant cure, making sufferers less likely to work on more long-term ways of improving their sex life and facing any emotional issues behind the problem. Kerner says: “Overcoming PE is not just about taking a pill; it’s also about engaging in meaningful dialogue around your intimate life.”
There is also the issue of just how great a problem PE is. The American Urology Society estimates that it affects between 27 per cent and 34 per cent of men of all ages, but that begins to sound exaggerated when you learn that these figures include anyone who admits in a survey to having suffered from a PE experience in the past month. Goldmeier comments: “That could include someone who had recently had sex with someone for the first time, when men often get over-excited.”
In a UK study published in the BMJ last year, the researchers went on to ask whether this was a problem that had lasted for more than six months and was causing distress. Then the incidence came out much lower: 3 per cent. Goldmeier says: “I think it’s a mistake to concentrate on time when talking about premature ejaculation. What counts is how much control the man feels he has and whether his sex life makes him happy or unhappy.”
On the technique side, Dr Goldmeier advocates a male version of the “pelvic floor exercises”, which strengthen the muscles that can clamp down on the release of both urine and semen. “Some physiotherapists do a real Rolls-Royce job of training men to improve control over these pubococcygeal muscles,” he says. (Ask for referral to a “pelvic floor” physiotherapist who commonly works on patients who have had a prostatectomy.)
Dr Kerner, who became a sexologist after he had been helped to overcome his own PE, favours a combination of techniques; muscle training, along with a psychological technique that involves learning to notice how your body is responding during sex, and becoming aware of the “spectrum of feelings” that exists between becoming excited and having an orgasm.
When dapoxetine comes on the market, maybe some time next year, it is not clear whether it will unleash a pent-up demand in the way that Viagra did, nor whether it will create a market for men without problems who nevertheless want to improve their staying power. But it seems unlikely to put the more old-fashioned methods out of business just yet.
