PATIENTS are more likely to complain to doctors about impotence than premature ejaculation, although the latter is two or three times more commonly a bar to a successful sex life.

It would be unkind to assume that this is because extreme premature ejaculation denies only the woman the choice of the way in which she experiences an orgasm. On the other hand, the man may be feeling extremely foolish, but he is still sexually satisfied.

I always thought that the reason men were so reluctant even to talk to their doctors about premature ejaculation was that it undermines their sexual esteem to an even greater extent than impotency, which tends to be a chronic rather than an acute problem.

Furthermore, premature ejaculation disappoints a woman who has already reached a stage of excitement where a precipitate end to activities produces such frustration that there can be a tinge of anger and rejection with it. The frequently expressed premise is that premature ejaculation is the result of excessive anxiety engendered by a fear of failure. The more often there is failure, the more likely another disastrous liaison.

I have found that athletic, vigorous, over-eager, and zealous young men are another group even more likely to suffer from it. I always cite the example of some footballers I knew. A generation ago I was consulted by the captain of a celebrated football team and his wife about his premature ejaculation. The husband was an international and few men could have been either fitter, or apparently less anxious. This was before the days of selective serotonin re-uptake inhibitors (SSRIs), one of the groups of antidepressants that in small doses happens to have the power to delay ejaculation as one of its side-effects.

When the footballer came back to report on progress, he was accompanied by four or five of his team, all of whom had the same trouble. Standard advice about technique — including choice of position and the need to take each step slowly — coupled with small doses of clomipramine, an older tricyclic antidepressant, had revolutionised the captain’s sex life. Once it was first discovered that SSRIs had this ability, the treatment of premature ejaculation was revolutionised. In Whitechapel, among the Bangladeshi community, it is a common problem, and sociologists ponder why this should be. Bangladeshi men are too reticent to discuss it but use a splendid euphemism to describe both it and or impotence: “I am weak doctor, so weak that I need your help.”

New and unwary doctors assume that the patient may be suffering from some dread, debilitating disease and spend hours carrying out complex investigations. They soon learn that the only question needed is one that determines whether the patient is impotent or a premature ejaculator.

When I first discovered the power of the SSRIs to put this problem right, the queue stretched from my basement consulting room, up the steps and across the yard into the street. The hospital administrators and the boss of the clinic soon paid me a visit. The patients and their wives may have been happy, but I had wrecked the clinic’s pharmaceutical budget.

The standard SSRIs used to treat premature ejaculation are Faverin fluvoxamine or Seroxat paroxetine. Only small doses are needed and the SSRI is taken an hour or so before bed. The difficulty is to find an SSRI that is short-acting, not so inclined to delay ejaculation as to prevent it and to come to orgasm altogether, and to try to select a dose that achieves its object but does not leave the patient half asleep.

Recently, Zispin mirtazapine, has also proved to be a well-balanced treatment. It is rapidly absorbed.

As well as inhibiting the re-uptake of serotonin, it also does the same for noradrenaline — which means that the drug is less likely to cause a complete loss of sexual response, and undesirable drowsiness.

Treating premature ejaculation, and treating it correctly, is not something that is designed only to restore male esteem. It gives younger and vigorous men the quality that older men acquire with advancing years and deteriorating libido of being able to climax at a time to suit and satisfy their partners. Though there are many women who never reach orgasm through penile penetrative sex, there are others who can do so only that way. Certainly, most younger women want this, but they are unfortunately at just an age when many of their partners are unable to achieve it. Conversely, if the doctor overdoes the dose, or the man is too old, their partners may become bored waiting for the earth to move. Not all women are good actors.

Psychotherapy helps some premature ejaculators but it is largely a physical problem related to extreme sensitivity of youthful penile skin, and this needs treatment with SSRI medication.