Premature Ejaculation Treatment
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Anything as important as weak erections in older men will get attention - and for young men, or even men of all ages, it seems that premature ejaculation is becoming an issue of equal importance. Once a problem confined to the secrecy of the bedroom, lack of staying power is rapidly becoming a talking point everywhere in society, including Internet forums, television programs, newspaper columns - and perhaps even gaining respectability as a dinner party conversation topic, at least among close male friends. So why is a man's inability to last longer during sex receiving this level of attention? Part of the reason is undoubtedly the fact that people are no longer prepared to put up with a sex life that is less than fulfilling. The widespread information surge about sexual issues that has occurred in recent years, thanks partly due to the easy availability of porn on the internet, and the lessening of sexual inhibitions that this has produced, means that topics such as premature ejaculation have become more commonplace, easier to deal with, and certainly easier for people to discuss - even if few men still seek treatment. For research has demonstrated over and over again that many men fail to seek any effective premature ejaculation treatment - and it's a really disruptive sexual dysfunction. As we shall see on other pages of this website, for men it is a self-esteem issue; for women it represents a real break in intimacy during lovemaking. It's not so much about the fact that a woman can't reach orgasm through sexual intercourse, because this is comparatively uncommon anyway, but more about the fact that lovemaking doesn't last as long as it otherwise might; the intimacy of the union is abruptly broken before a woman has gained a sense of true connection with her partner. We should also be aware that one of the reasons why there's so much information about sexual dysfunction around at the moment is that many drug companies have been funding research into sexual dysfunction with the objective of achieving greater profit through the medicalization of what may be social or psychological issues. It follows that controlling premature ejaculation could represent a massive income stream for any drug company, and that may explain the persistent efforts of Johnson & Johnson to win approval from the FDA for Dapoxetine, an SSRI, aka "selective serotonin re-uptake inhibitor", a class of drugs originally developed for the treatment of psychological issues such as depression. It's no coincidence, perhaps, that premature ejaculation has been recast in the form of a neutral set of initials - PE. This way of referring to a sexual dysfunction that can be both socially embarrassing and destructive to a man's sexual self-confidence causes less shame and makes it sound more like a neutral condition that is both socially acceptable and can be treated. (This perhaps mirrors the way you erectile dysfunction has become known as ED: the neutrality of that term makes ED seem less shameful, potentially less difficult to deal with, and more socially acceptable.) But the interesting thing of course is that it's not until as though there haven't been any premature ejaculation treatments up till now: anesthetic creams which are applied to the glans of the penis have been around for decades, and Masters and Johnson were talking about sexual psychotherapy back in the 1950s and 60s. Another interesting thing is that these treatments - commonly known as a stop start technique and the squeeze technique - are very effective. The reason they don't achieve more widespread acceptance (and use) is because couples don't have the persistence to keep on using them. Partly this is a motivational question: it's a lot easier for a man just to relinquish his self-control and give in to the desire to ejaculate at the point where he reaches ejaculatory inevitability during intercourse. Heck, all men know how irresistible and compelling the desire to ejaculate is at this point during sex. It's the product of millennia of human evolution - Mother Nature wants the woman pregnant, so at the point where you're about to ejaculate, it's an instinctive response; but like many instinctive responses, we men can control it - by taking a decision to actually develop staying-power, the desire to ejaculate can be overcome, put aside, and sacrificed for the longer term benefits of achieving greater self-control during intercourse. The desire for a simple rapid and easy solution for every sexual affliction, without perhaps much effort on one's own part, has caused the off label use of SSRIs to control premature ejaculation to mushroom in recent years. Whether this is ethical, or even acceptable is another question: it's certainly not a rewarding way to achieve a higher level of masculine self-acceptance, self-esteem and sexual self-control. But maybe any way to prevent premature ejaculation makes men feel so much better that they overlook the fact that they demean their own masculinity and their own power by accepting a solution that is pharmacological and affects the brain in other ways. Furthermore, if anyone or any entity - a drug company, for example - publicizes something hard enough and long enough, with a point of view that seems superficially reasonable, people will eventually begin to believe what they say. Perhaps this is why Dapoxetine has gained so much acceptance: it works quickly, it has a short half life, and it can be taken as needed. Wow! Surely this has to be the answer for all cases of PE? Well, maybe, but let's bear in mind that this drug affects brain chemistry; it's not a chemically or biologically neutral product; it's interfering with the fundamental chemical activity of the brain of every man who takes it. And the bizarre thing about all this of course is that as we've repeatedly said on this website there isn't actually a clear definition of premature ejaculation. If you can't even define a condition, you can have no real idea how widespread it is. Therefore it's in the drug companies' interests to define PE with as low a threshold as possible so that by implication more men are caught in the definition, more men who represent the potential market for treatment. Has anyone actually researched the question as to what constitutes a normal time between vaginal penetration and ejaculation? Well, of course many people have, and the fact that there is still no clear answer may indicate that despite the statements made above, sexual repression and sexual inhibition do still prevent us discussing how long sex should last with honesty or clarity. At least, with enough honesty and clarity for a clear picture of what is "normal" to emerge! Something so fundamental as sexual intercourse to human relationships could hardly avoid being influenced by cultural and social factors. So, while some studies have indicated that an average duration of intercourse is about seven minutes, the time regarded as average for intercourse in other cultures is very different. Another problem is that the time between penetration and ejaculation is measured with the use of a stop watch - and this is during one of the most intimate interactions that a male and female couple can have! So what degree of reliability are we expected to ascribe to measurements taken on a stop watch by a woman while her male partner thrusts into her vagina, unless she's totally detached from what he's doing? And if she's detached enough to operate a stop watch accurately, how is that attitude likely to affect her partner's willingness to control his ejaculation? It all begins to seem like an absurdity! Hoping an experimental protocol such as this will produce any kind of reasonable data -- leaving aside the possibility that people lie to save themselves embarrassment and shame -- seems ludicrously optimistic. And even if we did accept seven minutes as the average length of time for intercourse (and seven minutes is a lot longer than many studies have demonstrated as an average duration of intercourse), then how are we to interpret the fact that in the Middle East rapid ejaculation is apparently viewed as a sign of virility, so the reported frequency of premature ejaculation is significantly lower than in, say, Latin America, where presumably men regard long-lasting lovemaking as a sign of masculinity? The definition of PE is subjective. One man who has spent a lot of time researching premature ejaculation is Dr. Marcel Waldinger, a neuropsychiatrist in the Netherlands, who also runs a sexual health clinic. He takes the view that the number of men in the population who are actually experiencing premature ejaculation is a lot lower than reports from studies sponsored by drug companies might lead us to believe. His methodology is to measure the intra-vaginal ejaculatory latency time as he believes that this is the only objective measure of whether a man is a premature ejaculator or not. However the interesting thing about this approach is that although he disregards other factors such as issues of sexual satisfaction and the men's subjective judgments about their level of self-control, many people would regard those things as absolutely fundamental to defining PE. Indeed, premature ejaculation has traditionally been defined in a way that requires either one or both of the partners in a sexual relationship to be experiencing emotional distress because of the man's rapid sexual responses. The implication is that even if a couple only achieve thirty seconds of lovemaking but both are fulfilled and happy with this, than the man is not a premature ejaculate in terms of the classical definition. Does this matter? Yes, I think it does, for several reasons. First of all, it's actually interesting and useful for men to have a benchmark against which to judge themselves as lovers. The absence of such information can only cause distress and confusion when a man has no sense of how he performs sexually compared to all his peers. Unless his friends are being honest about their sexual performance, and talking about it openly, he won't know whether two minutes, five minutes or ten minutes is satisfactory. And even if he does manage to make love for ten minutes but his partner doesn't reach orgasm, he still won't know if he's achieving a satisfactory sexual performance or not. Clearly the implication is that reliable and accurate information is essential for men to decide whether or not they wish to seek treatment for premature ejaculation. But in addition, Dr. Waldinger points out that for as long as drug companies are sponsoring research, and as long as there is a potentially great financial reward for the medicalization of sexual dysfunction, then the prospect of objective and realistic research being conducted may be considerably diminished. That may be a trend compounded by the difficulty of obtaining government financing for valid sexual health research where either social or economic trends mitigate against the distribution of funds for that work. It's even been observed by one researcher that Johnson & Johnson employed so many urologists, psychologists and other scientists that when the FDA looked at their application for the licensing of Dapoxetine as a premature ejaculation drug, they may have been unable to find any researchers in the field who didn't have a conflict of interest! And the other aspect of learning to stop premature ejaculation we should keep in mind is that men who believe they are affected may actually feel bad about themselves because of their sexual performance. Premature ejaculation is commonly a problem for men in the early stages of their sexual careers: a scene in the original American Pie film where the lusty teenager ejaculates before he gets anywhere near the shapely and desirable body of the Swedish au pair might be less of a joke we would like to believe! But there are men much older than this who also ejaculate with minimal sexual stimulation, or consistently reach orgasm before they wish to do so, and many of them would probably be willing to consider stopping premature ejaculation by any means, including the use of drugs like Dapoxetine. PE is sometimes associated with relationships which are experiencing difficulties, but whether it's the disappointing sex or the interpersonal problems that come first is unclear. Not that this means PE doesn't need to be tackled. In fact, all sexual psychotherapists and clinicians dealing with men who consistently ejaculate too early during lovemaking agree that the consequences of it can be serious both for the men concerned and their partners. Premature ejaculation is not just some kind of lifestyle issue - it's a serious sexual problem, at least for some couples. Men who have little sexual experience or who are single maybe reluctant to date women because they feel shamed by their lack of sexual control; couples may experience disruption of the intimacy of lovemaking due to the man climaxing early. A 30 year old man who came to see me because of his tendency to climax too early explained that he had been completely humiliated by a woman who he dated, took back to his apartment, and with whom he came after only a few seconds of lovemaking; she simply got up, dressed, and left his apartment without uttering another word. Another man, aged 42, who is married and in a satisfactory, fulfilling relationship explained to me that every time he made love to his partner, his tendency to ejaculate too soon was on his mind, and his quick-fire trigger response to sexual stimulation had been a massive burden all his adult life. Even though he and his wife had great sex, and although he was able to make her orgasm during intercourse, their lovemaking always took the same form: he stimulated her to orgasm with mouth or fingers, then entered her after she had reached orgasm, so they could enjoy a brief moment of physical intimacy. One of the difficulties in stopping rapid ejaculation is that sex is so variable between couples. What is satisfactory for one couple may certainly not be for another, and what constitutes a fulfilling relationship for a particular couple may barely begin to fulfill the needs of another. In this context it's easy to see how the prospect of prescribing a man a drug for the rest of his sexually active life might be a far from desirable solution to a condition that perhaps could be resolved with only some short-term psychotherapy. Dr. Sidney Wolfe, director of the Citizen's Health Research Group in Washington certainly questions the need for prescribing Dapoxetine for men who are quick off the mark in bed: "Why," he says, " would you wish to take a drug for the rest of your life..... this is all a massive hype." But despite Johnson & Johnson's efforts to obtain a license for Dapoxetine for the treatment of premature ejaculation, it remains unlicensed in the United States at the time of writing. It seems that those experts who are propounding the view that lifestyle issues and psychotherapy are more important in curing rapid ejaculation will hold the upper hand for some time yet. The largest study conducted as at April 2005 was reported in the Journal of Sexual Medicine. Even this study was partly supported by Johnson & Johnson, which possibly shows how far their influence has extended in this field. We review this paper elsewhere on this website. The results of two other clinical trials which involved 2,614 men, showed that Dapoxetine increased the duration of intercourse from under one minute to 2.78 minutes and 3.33 minutes for men given doses of 30 milligrams or 60 milligrams. (Once again, stopwatches were used to record the duration of intercourse. And the optimism with which intercourse was recoded to the hundredth of a second suggests that the authors might have overlooked a few fundamental issues around scientific research, like only reporting to the level of accuracy which is actually achievable.) But in any event, even three minutes' intercourse is less than half the length regarded as average in other studies. And while some couples' satisfaction with sex also increased, nearly half the men did not report much increase in sexual satisfaction. Even more interesting, these two studies showed strong placebo effects and many side effects including nausea. So, even the men receiving a placebo could last much longer during sex - double the time, in fact - before they ejaculated, and one man in five among those taking the largest dose of Dapoxetine said he felt nauseous. Clearly this is a problem which has many aspects other than purely physiological! And what of Masters and Johnson's behavioral techniques? Well, they work, but for those men who cannot be bothered to learn how to prolong their time to ejaculation, it's easy to see why drugs might represent a quick and easy cure.
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Premature Ejaculation Treatment ]
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