Premature ejaculation: can it be controlled?

The misery of premature ejaculation affects one man in three. Now doctors have developed a new treatment - but are drugs really the answer? Suzy Black investigates

Delay isn't something we usually pursue, but for many men, during sex, it's an unobtainable dream. "Just the thought of sex can make me pop my cork," says John Wilson, 53, of London. "I've tried silently reciting the Brentford football team, but nothing works; I've got no control over when I ejaculate."

This has had a disastrous effect on Wilson's love life and self-esteem. "I feel powerless because I can't satisfy my girlfriend. She says it's OK, but I can tell it's not and I feel pathetic. What kind of man am I if I haven't enough stamina to bring her to orgasm?"

Visualising dead people was one of the methods Ian Kerner, 39, tried to delay climax. "I also relied on condoms, sometimes three at once, to desensitise my penis, as well as cream to numb it. Sex wasn't pleasurable, but at least I could last for longer than a few seconds. I thought I was cursed, that I was the only man who had this problem."

An estimated one in three men suffers from premature ejaculation (PE), but this prevalence has done little to further scientific understanding of the disorder. "We're in the very early stages of understanding rapid ejaculation," says Paula Hall, a psychotherapist and Relate counsellor. "For some men, it's physiological; for others, it's psychological."

From an evolutionary perspective, speedy ejaculation is advantageous - copulating exposed early humans to danger, so getting the job done quickly was good. "We need to differentiate between the type of men who have quick reflexes, such great tennis players, who would be more naturally inclined to rapid ejaculation, and those who suffer from a feeling of ejaculating too soon because of psychological reasons," Hall says. "We know anxiety can make men orgasm before they plan to, so it often becomes a vicious circle. But, as with any psychological issue, the treatment needs to be tailored to the individual's needs; there's no cure-all."

A quick web search will lead men to adverts for devices designed to delay orgasm, anaesthetic creams that dull penile sensation (causing a female partner to lose clitoral sensation, too), and herbal "remedies". "There's scant evidence to back up the claims," Hall says. "Some creams numb the penis, but who wants sex where you can't feel anything?"

If a man plucks up the courage to see his GP, there are few options. Treatments include the Masters-Johnson method (below), or antidepressants. These can be effective, but they generally need to be taken well in advance or daily. And with regular use comes a risk of side effects - one of which is loss of libido.

There is hope, however. A new drug is in clinical trials, and if it gets approval from the US Federal Drugs Administration, dapoxetine hydrochloride will be the first prescription treatment designed to increase ejaculatory control.

Dapoxetine is based on a treatment originally intended for use in relieving symptoms of depression. Patients reported more control over ejaculation - or, at least, a delay. Researchers at Alza, a subsidiary of Johnson & Johnson, recognised the potential for a PE treatment and began clinical trials.

For men who suffer severe PE, dapoxetine could be the answer. Initial trial results were positive: many participants increased the duration of sex by three or four times when using the drug, with half rating their control of ejaculation as fair to good. The treatment could be available within the next year or so if it is approved.

Competition to create a PE drug is strong; it would produce profits to rival those of Viagra, which earned Pfizer $1bn in its first year of production. Drugs firms make their biggest profits from medications that must be taken regularly and affect wealthier people. And targeting a psychological issue such as PE offers an even wider spectrum of patients, as it is hard to define. "The problem with any treatment for a psychological disorder is that its definition is often subjective and some may end up taking medication they don't really need," says Keith Hopcroft, a GP.

"Depression is a good example - for many, antidepressants have literally been a life-saver; for others, the depression would have been better resolved with approaches such as lifestyle changes or therapy." Medication is often an easy, time- and money-saving option.

"Medicalisaton" of disorders is a worrying trend in health, and sexual "problems" are on the agenda. Our understanding of sex, problematic or not, is in its infancy, yet drugs companies are racing to produce "cures" for everything from premature ejaculation to low female libido.

"My concern is that GPs would be faced with huge numbers of men claiming they suffer from PE when their time to ejaculation is average," Hopcroft says. "We class PE as being when it causes dissatisfaction in either partner, but this is open to interpretation. Furthermore, the solution often lies in explanation and instruction involving both partners, rather than using the illness model."

Men's reluctance to discuss sexual concerns honestly can lead to a mistaken belief that there is a problem, leading to emotional stress and perhaps unnecessary treatment. A study by the University of Köln, Germany, concluded that the notion of PE is more strongly linked to partner satisfaction than duration of sex.

"Men are concerned about PE because they want to be able to bring their girlfriend or wife to orgasm during sex - if they come too soon, they can't," says Kerner. Most women, however, don't orgasm through penetrative sex alone, so these men may be chasing an elusive dream.

Kerner is now a sex therapist. He chose his career in part because of his experiences involving lack of ejaculatory control. "PE has been the single greatest factor in the formation of my character," he says.

"Using techniques to delay orgasm helped, but discovering that I could satisfy a woman sexually without penetrative sex is what finally cured me. It made me want to be able to do the same for other men."

Three ways to last longer

* GET A GRIP

Squeeze the penis just below the ridge of the glans (head) between the thumb and two fingers when close to climax. This was pioneered by the sex scientists Masters and Johnson. If it's done properly, many men find they can delay ejaculation almost indefinitely. Contact Relate (0845 456 1310) for information.

* TAKE CONTROL

Practice makes perfect. Note how you feel as you near climax, then stop, breathing deeply, before you continue. Repeat several times. This way, you can train yourself to slow the process to orgasm. "Control over rapid ejaculation is about becoming more tuned in to the process, not less," says Paula Hall.

* SEXERCISE

Kegel exercises - strengthening your "love muscle", the puboccoccygeus muscle - will help to control ejaculation. Next time you pee, use your puboccoccygeus muscle to hold the flow of urine. Practise halting the flow several times each time you pee. Eventually you will be able to isolate the muscle and flex it.