By Rhonda B. Graham
InteliHealth Staff Writer
Robert Simms, a 21-year-old guitarist, thinks he has a secret. But actually, millions of guys his age know about it.
When he and his girlfriend become intimate, the experience either ends before or just as it begins.
Although there have been pop songs written about it, premature ejaculation is a taboo subject for many men, especially those in Simms' generation. Other generations suffer from the problem also, and in roughly the same numbers. But experts say men in the 18-to-29 age bracket are the least experienced, and thus the least likely to seek help, or to know where to look for it.
"If you had an embarrassing problem, would you openly discuss it?" asks Simms, who asked that his real name not be used for this article. "Guys are expected to be tough. By opening yourself up, you're vulnerable."
According to the Journal of the American Medical Association, 30% of males 18 to 29 years old complain of climaxing too early.
Most are too humiliated to discuss their frustration with their partners, their doctor or their friends.
This keep-it-private approach is likely why most young guys don't realize that premature ejaculation is the most commonly reported sexual problem among American men.
Since the approval of the drug Viagra in 1998, many assume that distinction belongs to erectile dysfunction, the inability to achieve or maintain an erection, commonly called impotence.
But the JAMA study says only 5% of young men complain of erectile dysfunction, compared to 21% who say they ejaculate before or soon after penetration. The American Academy of Family Physicians (AAFP) estimates that number could be as high as 40%.
Unlike premature ejaculation, "erectile dysfunction is kind of out of the closet," explains Boston urologist Michael P. O'Leary M.D., M.P.H.
"Everybody is sympathetic to those problems. But the patients who have early ejaculation problems, nobody is paying attention to them. It's not that they are not out there. They don't come forward with it."
How soon is too soon?
At its simplest, premature ejaculation is defined as climaxing before desired.
Edward O. Laumann, a sociology professor at the University of Chicago and co-author of the JAMA study, says most men will achieve orgasm before their partners because of a natural physiological difference. For men it takes about 4 minutes, compared to 10 to 11 minutes for women, he says, citing the findings of a 1999 study in Scientific American.
But Laumann also believes premature ejaculation may be an indication of someone who is likely to have a lot of sexual interest. For example his research shows that sexual athletes, men who have a number of partners, are nearly two times more likely to have problems with early ejaculation.
"People who are very interested in having sexual experiences with multiple partners are those who take sex very seriously in their life, and among other things they expect to have high performance, which might include giving satisfaction to their opposite sex partners," he says.
"Because they are concentrating on their performance, anxiety compromises their ability to perform."
Anxiety is the primary culprit for the less sexually active as well, especially since the sexual revolution of the '60s and '70s when the "joy of sex" was redefined as making the experience pleasurable for both partners.
"In the old days the idea was the man satisfying his own needs. There was very little interest in the partner," Laumann says. "Now they need to feel they are a competent performer."
Personal preferences make it difficult to completely define early or rapid ejaculation simply by lifestyle, circumstances or even time. "The guy who has a problem is the guy who says, 'Within seconds of penetrating I climax,' " Dr. O'Leary says. "That's a problem for him and may be a problem for his partner. For some people that may be satisfactory. That's the reason I don't have any strict rule."
For guys like Simms, the loss of mutual pleasure is not what's most aggravating about premature ejaculation.
"My partner's disappointment to me is the most frustrating. I would feel obligated to make up for it," he says.
But not disappointing enough that Simms would mention the problem during an annual checkup. "No way, that's too personal," he says.
So he sifts through the questionable remedies heard on the street or over the Internet. Among the popular folklore is the idea that wearing condoms even doubling up on them will slow down the sensations that stimulate ejaculation. Increasingly condom makers are promoting "extended pleasure" products promising special "climax control" lubrication. There are no respected medical studies to prove this is effective, O'Leary says.
A more popular myth encourages guys to think about something other than sex during intercourse as a way to reduce the nervous energy that has been linked to rapid ejaculation. Experts agree this does not work.
In addition, "that violates the emotional bond between you and your partner," Simms says. "Neither one of you could fully enjoy the experience in my opinion."
There are two medically respected therapies with high percentages of success: behavioral techniques and the use of certain prescription antidepressants.
The behavioral methods are designed to help you sense when an orgasm is about to occur and delay it by developing a habit of "squeezing" and "pausing" so that sexual relations can continue. These therapies require the cooperation of both partners.
Certainly they are easy to do and they avoid the need to take drugs, Dr. O'Leary says, but he cautions that everyone does not have the patience to try these techniques routinely. "By the time they get to me they have already tried that."
The U. S. Food and Drug Administration has yet to approve a prescription drug to specifically treat premature ejaculation or climax-control problems.
Increasingly, however, doctors are prescribing antidepressant drugs such as Anafranil, Prozac and Zoloft for premature-ejaculation patients. To control the ejaculation process and decrease side effects, like dry mouth or drowsiness, premature-ejaculation patients take the prescription medication only as needed, usually a few hours before intercourse.
On the horizon
Pharmaceutical companies and doctors like O'Leary are researching other options or at least trying to refine the effectiveness of existing treatments.
Vivus Inc. has won a patent to develop an "on-demand" pill that would reduce the time for taking the SSRI antidepressants from a few hours to one hour before sexual intercourse.
O' Leary, an associate professor of surgery at Harvard Medical School, is among a group of researchers who recently won a patent to develop a testing device to determine whether medical therapy is effective in treating early ejaculation conditions.
Regardless of the option you pursue, The AAFP says relationship counseling is of "paramount importance," because premature ejaculation can create conflict and increase the tension surrounding sexual intercourse.
Time is on your side
In his research, Laumann found that premature ejaculation was the only sexual complaint that men of all ages did not link to overall poor quality of life.
Laumann thinks this is because sexual dysfunction can be a flip side of healthy sexual function. In other words: Premature ejaculation causes you to stop to consider how you want to function sexually, which means taking into account your partner's desires as well. Learning more about the normal sexual response of males and females desire, arousal and orgasm helps in this decision making.
So too will discussing your problem with your doctor, a urologist (a specialist in male urinary-tract and reproduction conditions) or a sex therapist. All are can help you figure out what behavioral changes to make or what medical therapy will work for you.
Above all, remember that occasional rapid or early ejaculation is a normal occurrence over your sexually active lifetime. It's when it happens consistently that you should seek medical attention.
"It may be easier to overcome for younger men as they become more sexually experienced," Dr. O'Leary says. "With the older men it's a different problem; more experience doesn't make them better."