Award-winning urologist - and pioneer in Men’s Health - Dr. Paul Turek blogs weekly about issues such as infertility, vasectomy and vasectomy reversal, sexual and hormonal dysfunction and more. Keep up with latest in this fascinating field of medicine.

Getting There Early or On Time: Which is Better?

Is faster better? Not always.

Is faster better? Not always.

What is the most common sexual health problem affecting men? That’s easy, it’s erectile dysfunction, right? Nope. Try premature ejaculation. Hands down more common than erection issues, affecting 25-40% of men in the U.S.

Variably called early ejaculation, or early or rapid climax, it is defined as male ejaculation earlier than the subject or his partner desires. It used to be defined as ejaculation within 2 minutes of sexual intercourse, until it was realized that 75% of men ejaculate within 2 minutes in over half of their sexual encounters. What the definition really implies is that is some element of poor control over ejaculation that is stressful and may result in interpersonal difficulty.

Is this a medical disorder? In some cases, yes. Think of ejaculation as a reflex, like sneezing. There is a point of no return and this is what comes too soon in men with early ejaculation. The problem has two forms: lifelong and recent. The former is believed to result from low levels of the neurotransmitter serotonin (5HT) that normally modulates the ejaculation reflex. The recent form does not have as clear a biological basis, but may occur from psychological stress or from the need to overcome an erection problem.

The good news is that there are treatments available, and more treatments being reviewed by the FDA. Currently, the most effective treatments are pills called SSRIs, which elevate 5-HT levels and include anti-depressants such as Prozac, Zoloft, Celexa, and Lexapro. A newer form of SSRI drug, called Priligy, is now available in nine countries but has still not been FDA approved in the states. Also, a metered-dose aerosol spray has been developed to increase time to ejaculation by numbing the skin on the penis and decreasing sensation. Maybe this will help. Unfortunately, with all drug treatments for this condition, when the drugs are stopped, the issue generally returns.

What I find interesting is that companies are vigorously trying to drum up sympathy and attention for premature ejaculation as a widespread medical disorder, when in many cases it may be only an occasional annoyance that does not need constant treatment. Treatment might be perfect for a few men with debilitating disease, but it appears that they are trying to create and market a whole new category of disease. Good idea: create a “huge unmet need,” an epidemic that is perfect for a blockbuster, quality of life drug. Well what about a pill for shyness, or talking too fast? Where does it end? The larger issue here might be the “medicalization” of our daily lives in which there is a healthy and wide variation of normal.

Do I believe that some men have debilitating early ejaculation? You bet, and I see them every day. Do I think that a pill will treat this issue? Sure, for many, but only while you take it. Will blockbuster pills be the cure-all for early ejaculation? No way. The cure will come with more holistic treatment, by empowering men through behavioral changes that teach them to control and “own” the problem. Works superbly for my patients, pill or no pill.

Related posts:

  1. You Are The Pill That You Eat
  2. Pop Quiz on Men’s Sexual Health
  3. What Comes After the Pill?
  4. Once Upon a Time in Barcelona
  5. Sexual Health Pop Quiz #2
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About Dr. Turek

A founder of the male fertility and male sexual healthcare movement, Dr. Paul Turek is also an internationally recognized master microsurgeon who specializes in vasectomy and vasectomy reversal, FNA testicular mapping, sperm retrieval and male erectile and sexual dysfunction.

He is a former Academy of Medical Educators Endowed Chair Professor of Urology, Obstetrics & Gynecology at UCSF and while there, directed a National Institutes of Health (NIH) grant for training new leaders in men's reproductive health. He has authored more than 175 publications on genetic, urological and epidemiological issues in men's reproductive health and regularly consults for the Centers for Disease Control and Prevention (CDC) and the NIH and other branches of the US government and industry on matters relating to men's reproductive health. He currently holds an NIH grant to create a human artificial testicle to make sperm.

He is Past-President of the American Society of Andrology, a Fellow of the American College of Surgeons, the Société Internationale d'Urologie and the Royal Society of Medicine (London). Dr Turek is also Editor of the Reproductive Volume of Netter's Images, 2nd Edition. His hobbies include vintage cars and long board surfing.

Twitter

  • February 3, 2012 20:57

    Here are some common, basic reasons why men have a lower sex drive and that have nothing to do with testosterone... http://t.co/he94nCCt

  • February 2, 2012 19:01

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  • February 1, 2012 23:17

    Happy early Valentine’s Day everyone! Next time, consider the surest form of contraception ever developed- vasectomy! http://t.co/InHZa4yS

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  • January 31, 2012 19:32

    Dr Turek comments today on ABC News about a new form of male birth control: http://t.co/yhEHwQL7

  • January 30, 2012 16:47

    New DrTurek Post: Your Hair or Your Hormones - It’s the perfect drug for 40 million men in America who are goin... http://t.co/jpVecb7D

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