Published: Sunday December 8, 2013 MYT 12:00:00 AM
Updated: Thursday December 12, 2013 MYT 11:16:24 AM

Coming too quickly

Dr McMahon... PE is an under-reported, under-diagnosed and undertreated condition that has great impact on both men and their partners. -M. AZHAR ARIF/The Star

Dr McMahon... PE is an under-reported, under-diagnosed and undertreated condition that has great impact on both men and their partners. -M. AZHAR ARIF/The Star

Many guys suffer in silence from premature ejaculation, even though there is a highly effective drug to treat it.

Even in our modern enlightened age, a man’s self-image is still often tied up with his ability to perform in bed.

Crucially, this includes his ability to control his orgasm or ejaculation.

This is because men, in general, tend to climax faster than women during intercourse, and the ability to delay their ejaculation allows them more time to stimulate their partners to orgasm.

That is why premature ejaculation (PE) can be such a big problem in a relationship.

In fact, consultant sexual health physician Dr Chris McMahon defines PE as “simply when a man is unable to delay ejaculation for a sufficient period of time to guarantee his partner gets an adequate response”.

The International Society for Sexual Medicine president shares that large community-based studies have found that the average amount of time from penetration to ejaculation for males is around 5.4 minutes.

However, he adds that there is a range from very fast to very slow, with some not experiencing ejaculation at all.

“We generally regard PE as ejaculation that occurs within about one minute,” he says, adding that this is the time reported by around 80% of males who come in to see the doctor about this problem. The remaining 20% report a time of one to two minutes.

But PE is not just about how long (or short) you last.

Dr McMahon explains: “There are three dimensions of PE: time or latency, a lack of control or inability to delay or defer ejaculation, and most important, (the) presence of what we call negative psychological consequences, such as patients feeling bothered, frustrated, annoyed (and) developing a pattern of avoiding sex.

“Each of these dimensions must be present to secure a diagnosis of PE.”

So, for example, a man who ejaculates within 30 seconds and has no control over his ejaculation, but is not bothered about it, is not really considered to have PE.

Similarly, someone who has little control, is very bothered about it, but ejaculates in about five minutes, is also not considered to have PE.

Root causes

There are essentially two types of PE: lifelong and acquired.

Patients with lifelong PE experience rapid ejaculation right from their very first sexual experience, with every one of their sexual partners, and in virtually all their sexual encounters.

Says Dr McMahon: “There is a compelling amount of evidence to suggest that some of us are born with a genetic predisposition to PE.”

Research has shown that first-degree relatives of a man with PE – father, sons, brothers – are 25 times more likely to have PE as well. Male identical twins are also likely to both have PE.

In addition, it was recently found that one variation of the gene that controls the production of serotonin – a chemical messenger in our nervous system that helps regulate ejaculation – was associated with PE, while the other type was not.

“So, it may be that some of us were doomed to have PE from the moment of conception,” says Dr McMahon.

Meanwhile, there are those males who initially had normal ejaculatory times, but developed PE over time. These patients have acquired PE.

The two most common causes for acquired PE are psychological – basically, performance anxiety, and erectile dysfunction (ED).

Commenting on performance anxiety, Dr McMahon says: “Most of the things that we do in life, the harder we try, the better we do. Except for sex, where the harder you try, the worse you do.

“The more you fail, the more negative you become about the chances of success the next time.

“Eventually, it becomes a bit of a runaway train, and you get to a point where you’re failing before you start.”

Meanwhile, he explains that there is a two-way link between PE and ED.

“For example, a man who has got ED might rush intercourse, for fear that if he kicks back and takes his time, he will lose his erection, and hence, he ejaculates quickly.

“Similarly, a man who has got PE might intentionally limit the amount of arousal during foreplay (to stop from ejaculating too quickly), and fail to get an erection.”

Around 30-50% of men with ED will develop PE, and specifically in the Asia-Pacific region, the chances of an ED patient developing PE is 6.9 times higher than someone without ED.

A single, effective solution

Unfortunately, the effect of having this condition goes far beyond the bedroom walls.

“These are not happy men.

“There is a substantial psychological burden from having PE; it can destroy relationships, and it can be an obstacle to forming new relationships.

“In the Asia-Pacific Pepa (Premature Ejaculation Perceptions and Attitude) study conducted about three years ago, there was a significant increase in the prospect of divorce for men with PE, because of the stress it places upon the relationship.

“So, these are men and (their) partners who have a reduced quality of life, and they’re not happy,” Dr McMahon says, adding that links between chronic anxiety and chronic depression with PE respectively, have also been found.

It doesn’t help that men either tend to avoid talking about this problem or go into denial mode, while their partners are equally loath to bring up the subject for fear of embarrassing or upsetting their men.

“Many men will choose to seek treatment only at a crisis point in their relationship, and usually the factor that instigates treatment-seeking is an ultimatum from the wife.”

The irony is that there is an easy and effective solution for PE.

While there are a few different options for managing PE, including behavioural therapy, anaesthetic creams and certain drugs that do help with PE as a side effect, but are not officially approved to treat it, there is one oral medication that was directly developed and approved to treat this condition.

According to Dr McMahon, dapoxetine, a short-acting selective serotonin reuptake inhibitor, has an over 95% success rate of treating PE.

It works by increasing the amount of serotonin in the body, thus, enabling patients to exert greater control over their ejaculation.

“Men will respond very, very quickly to this medication, and once their PE resolves, all of the psychological burden just dissipates.

“Their relationship improves, their quality of life improves, everyone’s happy.”

He explains: “It is an on-demand drug, so it is taken with a glass of water anywhere from one to three hours prior to intercourse.

“And the data we have shows it is effective from the first dose.

“There is an average threefold increase in ejaculatory time on the first dose, and with continued dosing, at six months, the threefold increase will go up to a fourfold increase.”

He adds that the lack of control and psychological distress caused by PE will also decrease, and the patient’s sexual satisfaction will naturally increase.

The key to managing this condition is recognition, says Dr McMahon.

He shares that even though 20-30% of men will admit to having PE when specifically asked, very few of them actually seek treatment for it.

“We can educate men to understand that this is a surprisingly common condition, that it is totally treatable, (and) that no man should suffer in silence.”

If you think you might have PE, go to and take the PEDT (Premature Ejaculation Diagnostic Tool) questionnaire to see if you have this common sexual condition.

Tags / Keywords: Health, Health, Premature ejaculation, erectile dysfunction, sexual health, sex


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