Thursday, 22 November 2012

When Is Ejaculation ‘Premature,’ and what to do about it?

Article by James Hamblin, MD, is The Atlantic‘s Health editor.

With personal lidocaine spray, anesthetized genitals are just a “please excuse me for a moment” away.

How long is sex supposed to last? One consensus of sex therapists said 3 to 7 minutes of penis-in-vagina is “adequate,” while 7 to 13 minutes is “desirable.”

If three minutes is adequate, then when does being a little quick on the trigger become an actual medical diagnosis?

The International Society of Sexual Medicine defines premature ejaculation as meeting all of three criteria: finishing most of the time within one minute and having it result in personal distress.

It’s difficult to imagine a situation in which that wouldn’t result in distress, personal and otherwise. What relationship could smilingly endure it? But there’s also clearly a continuum, on the side beyond a minute but short of ideal — often well within the ranges therapists might consider adequate or desirable – where distress may be milder but still entirely relevant to confidence and relationships.

Luckily, medical science is on the case. I spoke with Dr. John Mulhall, a urologist and the director of the Male Sexual and Reproductive Medicine Program at Memorial Sloan-Kettering in Manhattan. According to him, when we talk casually about premature ejaculation (people talk casually about premature ejaculation, right?) we’re usually talking about what the medical community would consider “premature-ejaculatory-like syndrome,” or simply “rapid ejaculation.” It’s not as severe as the strict premature ejaculation diagnosis, but it can have the same divisive result. About one in four guys experience it regularly.

Looking for a down-to-the-minute definition of rapid ejaculation is a natural impulse, but not an ideal way of looking at it. Mulhall says it comes down to whether the guy lasts long enough. If his partner is made wholly replete in 90 seconds, then a man who lasts 95 seconds can be fine. But if another guy lasts 15 minutes, and that’s not cutting it, then it’s a problem and can be considered rapid.

In the late 1980s, when physicians started prescribing SSRI medications to treat depression (now known as Zoloft, Paxil, Prozac, etc.), some patients taking them noticed that they were also taking longer to ejaculate. So doctors started prescribing SSRIs for non-depressed patients, to treat premature ejaculation. And, largely, it worked.

Still a lot of people don’t like the idea of taking a pill. Costs, side effects — especially for people tangentially on the rapid ejaculation spectrum, it’s not always easy to justify being on an SSRI. That’s where topical numbing treatments can come in.

Dr. Ronald Gilbert, a urologist in Newport Beach, California, is the Chief Medical Officer of a company that makes a lidocaine spray used in situations like these. Gilbert personally sees it beyond that, as a first-line therapy for premature ejaculation.

The concept isn’t new, and these lidocaine sprays have received a thoroughly mixed bag of reviews. That may be because they don’t address the psychological component of the problem (which, some argue, is the only component). But Gilbert believes that his formula, called Promescent, works. He told me about it in flowing jargon involving binary eutectic, a pKa very near the pH of lidocaine, and a two-phase meld system that drives lidocaine through the stratum corneum of the skin of the penis.

The numbing spray idea immediately struck me as one that makes perfect sense to scientifically-minded people but sounds absurd to everyone else. It’s a coldly rational approach. But the problem is nuanced, and this solution involves making a man who already feels insecure in sexual situations excuse himself during a heated moment, get out a (secret) vial of penis spray, and numb up his genitals — all in anticipation of a sexual endeavor that, even if it goes well, may still leave him conflicted in the way Lance Armstrong must have felt in a yellow jersey on the Champs-Élysées.

It’s a suboptimal scenario, but so is an unsatisfying sexual relationship. Gilbert recommends the topical treatment to his patients before he prescribes an SSRI, and so does Mulhall.

In the interest of science and curiosity, I tried the lidocaine spray on one of my hands. A few points of note:

It makes you smell like a new iPhone. This seems like it would be a giveaway — a numb penis tell, if you will. It does feel strange, but not at all like you’re existentially detached from yourself. If you’re envisioning a total numbness (which I was — like your unfeeling lip after a dental procedure, or Krang remotely operating a detached body), you’ll be disappointed. You do lose fine sensory details. If someone lightly brushed your penis with a feather, you probably wouldn’t know it. It could be likened to wearing two condoms — or, as the proverb goes, eating a steak with a balloon on your tongue.

When I was going around the office showing off my numb hand, shaking other people’s hands, some asked about the possibility of the numbing liquid rubbing off onto one’s partner. That’s entirely valid. The options of wiping it off after giving it time for some to absorb into your skin or, more hastily, hooding it under a condom come to mind as possible solutions.

Treatments like this are widely known in the urology community, but they’re not commonly discussed among people who don’t have an extreme problem or clinical diagnosis — and are far from consulting a urologist — but could benefit from a few extra sex minutes. They are increasingly available over the counter at most pharmacies.

Gilbert concedes that we do not have major clinical studies to attest to whether or how well topical sprays work, but the risk of side effects and adverse reactions is remote. The medical community has safely used topical lidocaine in various ways for decades — it’s effectively used all the time to treat the pain of zoster — it’s not expensive, it’s FDA-approved under the “genital desensitization” monograph, and it’s easier (for some) than a prescription pill.

In any case, it is worth knowing this is out there as an option. If you or your partner fall somewhere on the rapid spectrum, and penis numbing spray makes a positive difference in your relationship, that’s great. If you just use it as a novelty — so you can endure some sort of Pompeiian love fest, or as an extremely awkward stocking stuffer for your teenager — that’s probably fine, too.


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