I've just started having sex with my girlfriend, and things are great ... for about 45 seconds. Is premature ejaculation common? Is it true that some anti-depressants can help? -- "John"
Although premature ejaculation is the most common sexual disorder in men, it's rarely discussed candidly. Despite brief but memorable cameos in movies like "40 Year-Old Virgin" and "American Pie," PE gets little attention outside of the bedroom. This is partially because it isn't well-understood. Even for healthcare professionals, defining PE can be tricky. Some doctors focus on the exact time spent in intercourse before ejaculation, with som time between zero and five minutes often representing the diagnostic cutoff. Others are more concerned with quality rather than quantity, diagnosing PE based on the patient's failure to measure up to his own or his partner's sexual expectations.
Like its definition, the cause of premature ejaculation is unclear. Some believe evolution played a hand in PE, arguing that in the precarious times of our ancestors, early ejaculation endowed a man with a degree of genetic fitness by allowing him to fertilize a woman quickly. (Presumably, the other guy was picked off by a saber-toothed tiger before he could please his cave-woman, so a lot of good it did him.) However, given the decreased number of predatory cats and increased attention to the female orgasm in our society, this explanation is unlikely to leave anyone satisfied.
Others attribute PE to behavioral factors, suggesting it occurs after years of pressure to climax rapidly because of the fear of being caught during masturbation and fumbling sexual escapades in the backseat of the family Ford. Even after the dread of being busted in the bathroom fades away, this pattern can be difficult to alter.
A number of psychological factors also contribute to PE, including underlying attitudes about sex, previous negative sexual experiences and interactions with past sexual partners. Addressing these issues should be the priority in dealing with PE.
Though this perspective on PE is crucial, many question a pure psychological basis for the disorder. It is well-known that various brain chemicals are involved in mediating ejaculation, and sensitivity to these substances may vary considerably among men. One such substance is serotonin, best known for its role in depression. Many anti-depressants are thought to work by increasing serotonin in the brain, which can have side-effects of decreased libido and erectile dysfunction.
Recent evidence, however, suggests that these drugs aren't complete enemies of sex: In patients with PE, they may actually help improve ejaculatory control, particularly when combined with other substances that also act like serotonin. A friend of mine who wanted to go into urology spent hundreds of hours in medical school watching the mounting behavior of lab rats to discover this. He no longer wants to be a urologist, but the girl rats are very grateful.
So my friend's lab rats are happy, but are drugs like this recommended for people with PE? Technically not yet, but in the near future, these -- as well as other medicines such as topical anesthetics -- are likely to receive federal approval for management of PE. Until then, you can test out tried-but-true techniques like the old "Pause/Squeeze" (stopping thrusting just as ejaculation seems inevitable, squeezing the end of the penis with fingers and resuming intercourse when the urge subsides) and the "Stop/Start" technique (just what it sounds like). Perhaps more appealing is the "Multiple Sexual Sessions" method, which recommends intercourse several times in one day and night, as ejaculatory latency tends to increase with each session. Hey, it beats thinking about baseball.
Anne Mills is a Cavalier Daily Health & Sexuality Columnist. She can be reached at mills@cavalierdaily.com or through the Sex & Balances submission page at cavalierdaily.com/sex.asp. This column should be used for educational purposes only and is not meant to substitute advice from your doctor.
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