Matt knows how to close the deal. He can meet a woman, charm her, land her in bed... and that's when the worrying begins. More often than not, he reaches orgasm too soon. He desperately wants his body to be cooler and calmer, to handle the great gift he's been rewarded with. When it doesn't, he feels inadequate, defective.
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"I can't control it," the 23-year-old Iowan says, "and I can't figure out why."
Science has a name for Matt's problem, one that sounds both sterile and judgmental: premature ejaculation. As a study in the Archives of Sexual Behavior notes, PE is the most common male sexual dysfunction. According to estimates, somewhere between 20 percent and 30 percent of men experience it, with many men doing almost anything to last longer in the sack. Those we spoke with said they've downed beers, undergone hypnosis, and even tied elastic bands around their penises.
It's easy to see why Big Pharma is betting they'd also pop a pill.
Last year in Europe, Johnson & Johnson began selling the first prescription drug designed specifically for treating PE. It's called Priligy, and clinical trials reveal that it can triple the time to ejaculation for men who normally last just a minute or two. Right now it's available in a handful of countries, including Germany, Spain, and Italy. Matt, however, is out of luck — Priligy isn't for sale in the United States. In 2005, the FDA rejected Johnson & Johnson's application for approval, although a company officer says it has a raft of new research and plans to renew discussions with the FDA.
If the FDA eventually does approve Priligy, it will be a watershed moment for a condition that received little attention from researchers until a decade ago. Doctors will have a proven solution for men who've been robbed of sexual satisfaction. As Priligy advertising infiltrates the media and PE becomes acknowledged as common and treatable, the stigma surrounding it will fade. A conversation will begin, and suffering men will become emboldened with the knowledge that they're not alone.
But a much-heralded, mass-marketed release of a PE drug could also have an entirely different, more dangerous effect. Some researchers believe that a Priligy advertising blitz could bend men's expectations by stressing stamina as their sole measure of sexual prowess, sowing self-doubt and fears of PE in the minds and beds of perfectly normal guys.
In other words, they worry that the treatment could cause the condition.
Doctors still don't fully understand PE, nor can they pinpoint what leads to it or who has it. Some say it can be the result of psychological problems. Others liken ejaculation to sneezing after a sniff of pepper; everyone eventually lets out an achoo! but some people can hold theirs in longer. In fact, some experts believe that many men — and perhaps even most men — who say they suffer from PE have completely normal levels of sexual stamina.
Case in point: The average guy lasts about 6 minutes during sex. Matt says he sometimes lasts 5, but usually goes 15.
The problem is that the "P" in PE may often be a matter of perspective: Some men believe they're supposed to last longer, says Marcel Waldinger, M.D., Ph.D., a neuropsychiatrist at HagaHospital Leyenburg, in the Netherlands, and one of the world's leading PE researchers. "The majority of men who complain of PE just aren't satisfied with the way they have sex," he says. "I call these men premature-like ejaculators. They may have a psychological, cultural, or relationship problem, and we should not treat them with medication at first. We should talk with them."
Last year, Dr. Waldinger provided timers to about 500 couples in five different countries, and asked them to time themselves having sex. Self-timing is typical in PE research; such glorified stopwatches may not be the sexiest items brought into bed, but they sure beat a guy in a lab coat peeking out of the closet.
After the men had sex on the clock for a month, Dr. Waldinger asked them if they were dissatisfied with their time to ejaculation. Almost 40 percent said yes. Then he asked if they'd be willing to take medication to make themselves last longer; 23 percent said they would. The men who wanted drugs lasted an average of 4.9 minutes. The average time for all 474 men in the study? Six minutes.
"There's nothing medically wrong with most men, but so many think they have PE," says Dr. Waldinger. "It's wonderful for the pharmaceutical companies, but it's not really a medical issue."
That's why many experts say premature ejaculation needs a strict, universally accepted definition. The only diagnostic criteria doctors have to go by were published in 2008 by the International Society for Sexual Medicine: A man with lifelong PE cannot last longer than 1 minute, and his time to ejaculation is harming his relationships.
Even though the 1-minute threshold would address what Dr. Waldinger says are the distorted perceptions of men like Matt, some doctors argue that this definition takes the discussion in the wrong direction. In their minds, PE should never be diagnosed with a watch.
"It's not so much the length of time that matters," says Derek Polonsky, M.D., a psychiatrist in private practice in Brookline, Massachusetts, "but the satisfaction for men and their partners."
Urologist Michael Werner, M.D., agrees. He believes a man can have PE whether he lasts 1 minute or 5. When he opened his first practice in Purchase, New York, 15 years ago, about 5 percent of his patients complained of PE. Today, that number is about 30 percent. For Dr. Werner, the matter is simple: "If you spend the whole time during sex thinking about not ejaculating, that's PE, and that's not the way sex is supposed to be."
It seems natural that a man would want to last longer during sex. Why wouldn't we be hardwired to prolong something so pleasurable? But in reality, men's sexual desires are malleable, influenced by external factors that scientists are only beginning to understand.
"There's some cultural expectation that the longer you last, the better you are," says Gale Golden, L.I.C.S.W., a clinical associate professor of psychiatry at the University of Vermont and the author of "In the Grip of Desire." And yet different cultures have different expectations, as shown by the results of a 2002 survey from the pharmaceutical firm Alza (owned by Johnson & Johnson). In the survey, American men said they should last about 14 minutes, but British blokes thought 10 was plenty, and German guys figured 7 was enough.
"The difference is that Americans receive less-accurate sex education but probably more exposure to glamorized, inaccurate messages," says Martha Kempner, M.A., a vice president at the Sexuality Information and Education Council of the United States, which is a nonprofit organization promoting access to sexual health services. "A guy in porn can supposedly go at it for 45 minutes. That's not realistic! Even if Europeans have the same cultural references to sexuality, they have the education to break it down and realize it's not real."
Another and perhaps even more important factor is how men think their partners want to be pleased in the bedroom — that is, the means to the orgasmic end.
"They believe that if they last longer, they'll be better able to bring a woman to orgasm," Golden says. But for women, sex is far more complicated than that. Most can't reach orgasm through intercourse alone, so to be a truly great lover, a man needs to know what else turns her on. Foreplay is huge, clitoral stimulation is important, and not surprisingly, women report more orgasms when a vibrator is in the mix. In fact, women are far less likely than men to care (or perhaps even notice) how long intercourse lasts. Of couples surveyed in a 2003 study published in the Archives of Sexual Behavior, 24 percent of men claimed they had a PE problem — but only 10 percent of their partners agreed. The rest were unbothered.
The difference was more dramatic when Men's Health surveyed couples who typically have intercourse for about 6 minutes. Asked if that time was satisfying, only 34 percent of the men said yes — but 82 percent of the women said their sex lives were perfectly fine. That may not be a scientific sampling, but it does reflect what PE experts like Stanley Althof, Ph.D., hear when they talk with clients.
"Everything can become so focused on how quickly the man ejaculates rather than on being loving and sensual," says Althof, a psychologist in private practice in West Palm Beach, Florida. He says it doesn't matter if a man lasts a minute or far longer: If the man believes there's trouble, he needs to talk with his partner about it and learn what she wants. That's the first step in making sex more satisfying.
Althof's prescription for communication before chemicals sounds sensible, if not exactly in his own best fiscal interests: He serves as an advisor to pharmaceutical companies, including Johnson & Johnson.
If a man wants to increase his staying power, he doesn't have to wait for Priligy. For the past 10 years, physicians have been prescribing certain types of antidepressants for the off-label treatment of premature ejaculation. Prozac and Paxil, both selective serotonin reuptake inhibitors (SSRIs), are two of the most popular choices. This isn't because PE is making men depressed (although it probably is, in many cases); it's because delayed ejaculation can be one of the side effects of SSRI use.
Both Prozac and Paxil (and Priligy) boost levels of serotonin, a neurotransmitter that affects such basic body functions as appetite, sleep, and sexual desire. When there isn't enough serotonin in a small area of your brain stem known as the (get ready now) nucleus paragigantocellularis, your time to ejaculation speeds up, says Dr. Waldinger. In one study review, Prozac was shown to increase men's time threefold. Paxil increased their time eightfold, although that drug comes with a higher risk of side effects, such as drowsiness and nausea.
So if Prozac and Paxil work on PE, why do we need Priligy? Because Priligy seems to be better tolerated than the other two, and because of its faster absorption into the bloodstream, it works more quickly than they do. You can take it an hour or two before sex instead of having to pop it regularly; plus, the effects wear off a few hours later.
More notably, if Johnson & Johnson resubmits Priligy for FDA approval and receives it, the company would be the first manufacturer allowed to market a drug for the treatment of PE. Its advertisements could then set the tone for how future PE drugs are advertised — and researchers who work on PE drug trials say it's only a matter of time before Priligy has company. (Althof says he's been helping other pharmaceutical companies develop PE drugs, and although he can't provide details, he notes that none are as far along in the process as Johnson & Johnson is.)
So what would a Priligy campaign look like, and what kind of men would it target — those who struggle to last a minute, or those who already last an average amount of time? It's impossible to say; there are no examples to go by, because prescription drugs can't be advertised to consumers in the countries where Priligy is now sold. But Johnson & Johnson may be dropping some clues. It has already sponsored at least two studies that document the emotional toll PE takes on a man. And at its June conference for investors and analysts, a company presenter stressed that PE creates "difficulty in a man's ability to manage his relationships, and directly impacts self-esteem."
That focus on self-esteem may sound familiar. When Viagra went on sale in 1998, its first public face was a 75-year-old Bob Dole. And although it's doubtful anybody wanted to think much about the former senator's sex life, choosing him as a spokesman made a lot of sense: Viagra was being targeted to older men because they're the ones most likely to be stricken with erectile dysfunction.
But 4 years later, in 2002, Dole's gig was taken by Rafael Palmeiro, then a 38-year-old slugger for the Texas Rangers. "Let's just say it works for me," he said in commercials, delivering a coy, swaggering line that matched a shift in ad strategy: Instead of focusing on the lack of an erection, ads targeted the quality of an erection. Men were convinced, and the fastest-growing segment of users that year became men between 18 and 45 — an age range in which erectile dysfunction is rare, according to a study in the International Journal of Impotence Research.
Some experts worry that Johnson & Johnson will follow the same game plan.
"There are tons of men out there who think they should be doing better and who will buy into a PE campaign," says Joel Lexchin, M.D., a professor of health policy at the York University school of health policy and management, in Toronto, who has studied the Viagra campaign. "It could implicitly or explicitly define what PE means so that any man could identify with the condition." And if that happens, he says, even more men will have exaggerated expectations of how long sex should last. The mirage of those 45-minute romps in porn would seem even more attainable.
But that's not to say that drugs for PE are inherently bad. Stephen Lefrak, M.D., a professor of medicine who teaches medical ethics at the Washington University in St. Louis school of medicine, argues that from an ethical standpoint, SSRIs (and Priligy by extension) offer a perfectly legitimate treatment for PE. "I don't see a problem, provided that the patient knows the upsides and downsides to taking a drug," he says. "If someone's unhappy in life, we give them SSRIs to treat depression anyway, no? To me, that's part of medicine. We treat chronic pain, even when it's hard to determine its exact cause."
Johnson & Johnson says it understands the complexities of PE and knows that not every man with time-sensitive desires actually has a medical problem or should be treated. That's as much as the company will say, though. "It would be premature — no pun intended — to discuss how we might or might not approach a conversation with a consumer for a product that is not yet approved," says company spokesman Greg Panico.
Althof, the Johnson & Johnson consultant, says doctors should be responsible for determining which patients need a PE drug and which ones don't. But he doesn't believe a drug will ever be a complete solution, which is why, when he recommends SSRIs, he also encourages his patients to go through counseling. "It's too simplistic to think that people who have a lifelong problem can take a tablet and make everything better," he says. "You have to deal with the impact PE has had on your relationship."
Matt hasn't yet taken any drugs to extend his time. He does regularly use condoms with an anesthetic cream that slightly numbs his penis, but they don't give him the kind of control he craves. And so he continues to worry and to flounder, and he's come to see this problem as a measure of his manhood: He can entice a woman to bed, sure, but that's no success on its own.
"I want to last until she orgasms," he says.
It's that simple. He figures 25 to 35 minutes should be long enough.
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