The Guide to Getting It On (117 page)

If you and your healthcare provider are okay to give the boner drugs a go, it’s best to get samples and try each one.

Clomipramine (brand name is Anafranil):
This is a tricyclic antidepressant that has been used for a long time to help people with obsessive compulsive disorders. One of the side effects has been that it delays ejaculation, which is why they started to use it for men with PE. A 25-mg dose taken 4 to 24 hours before intercourse is sometimes recommended. This can be raised to 50 mg, but with that can come increased side effects. A study was done in which a 10-30 mg dose was given on a long-term basis with satisfactory results.

As with SSRI antidepressants, be sure to understand the side effects, as there could be an increased risk for suicide among young men, although it’s not known if that would be the case for young men who are taking it for PE and who are using it on demand as opposed to daily. Do not take this if you are bipolar or have erection problems.

Tramadol (brand name is Ultram):
This is a centrally-acting opioid analgesic that appears to have few side effects in the kind of low doses being used to treat PE. The doses of tramadol used in PE studies is between 25 mg and 89 mg (the drug is approved for 400 mgs a day)
.

Research with an on-demand dose of 50 mg of tramadol had guys who came in 19 seconds lasting four minutes, and a 25-mg dose had men who normally ejaculated in a minute going for more than six minutes. It is optimally taken two hours before intercourse. While studies in 2007, 2008 and 2011 found tramadol to be effective for PE, a 2010 study comparing the on-demand use of tramadol for PE with daily use of the SSRI antidepressant paroxetine (Paxil) found paroxetine shredding tramadol when it came to delaying ejaculation at 12 weeks. In the latter study, tramadol was found to have a negative effect on erections, while paroxetine had a positive effect. However, the senior author of one of the tramadol studies insists that tramadol humbles paroxetine as a drug for PE and claims his team never saw erection problems with men in their studies having erection problems as a result of using tramadol for PE. Plus, it’s hard to find ED listed as a side effect for men taking 400 mg a day of tramadol, let alone only 50 mgs every couple of days. However, ED is a known side effect of other opioids. At the same time, paroxetine can have some wicked side effects for some people.

Be sure to look up the side effects of any drug you are taking. Also be aware that if your healthcare professional prescribes these or any other drugs for PE, it would currently be an off-label use.

Little is known about the effectiveness of tramadol on PE after being used for extended periods of time. Tramadol is one of the only opioid drugs that is not a controlled substance. It has been around since the late 1970s and is even sold over-the-counter in some countries. However, in 2010 the FDA listed some new side effect warnings for tramadol, including not to take tramadol with alcohol. It is unlikely tramadol will ever be approved for use as a PE drug because it is an opioid. But it’s still fine for backaches in much higher doses.

WARNING — Three weeks before this edition went to press, a European physician and PE researcher indicated that tramadol has become a highly abused drug in his country. He said he does not feel it is worth the risk of giving young men prescriptions for tramadol given its potential for abuse as a recreational drug. While the dose used for PE is a fraction of that which is needed to get a pain-killing effect, this is an important warning and should be taken into consideration. Tramadol has a reputation for being a bear of a drug to get off of if you become addicted

Treatments—Penis Injections (DO NOT USE THESE FOR PE!)

Penis injections can be helpful for men with erectile dysfunction who don’t respond to the usual array of boner drugs. However, unscrupulous healthcare providers have been advertising the use of these injections for premature ejaculation. The
Journal of Sexual Medicine
has strongly warned against using penis injections for PE. Long-term penis damage can result.

Treatments—Creams, Sprays and Special Condoms

PSD502:
This is a penis-head spray for PE. It used to be called Tempe, and will probably have a new name by the time it reaches the marketplace in 2013 or 2014. Plethora Solutions, which is the company that makes PSD502, submitted an application for PSD502 to the European Medicines Agency a month before this book went to press. They expect approval within 12 to 18 months, which would allow the sale of PSD502 in 27 countries. One reason why they appear to be marketing it as a prescription drug is so they can charge more for it. They are also using PSD502 for pain relief for burn victims, although not necessarily burn victims with premature ejaculation. Because they are trying to sell PSD502 by prescription to hospitals for severe burn cases, it would be difficult to justify selling the same medication over the counter for premature ejaculation.

PSD502 contains the numbing agents lidocaine and prilocaine. While lidocaine, prilocaine and benzocaine have been commonly used as numbing agents in PE creams, the problem so far has been with the delivery system. Most of the numbing agent molecules stay evenly distributed throughout the cream they are mixed in and do not make contact with the skin. As a result, they are not quickly absorbed and the man has to wear a condom to keep the numbing cream from touching his partner’s clitoris.

PSD502 supposedly puts all of the lidocaine/prilocaine numbing molecules against the surface of the skin in a single layer where they are rapidly absorbed. Nothing is left after five minutes to numb out a partner, or at least the company claims it’s no problem for 90% or more of female partners. The company states that PSD502 does not leave the penis feeling numbed out for men if they begin intercourse no later than five minutes after application.

NOTE:
When this spray was in Phase II clinical trials, it seemed like the researchers were having to move heaven and earth to squeeze significance out of the results. However, Phase III trial results looked much more promising. The proof will be in the ejaculating.

SS-CREAM:
This is an herbal mixture that contains the extracts of nine natural products. You apply it an hour before intercourse. Korean researchers have been touting it for years. And that would be the problem. Korean researchers are the only ones who have ever seen it or used it.

Trojan Extended Pleasure and Durex Performax Condoms:
These condoms have benzocaine gel on the inside to desensitize or numb out your penis. It is fascinating to read user reviews. They tend to either be 5 stars or 1 star, with guys and their partners either loving them or hating them. The biggest complaint is that they numb out your penis so much that you lose all sensation, and your erection as well. The biggest praise is that they numb out your penis enough so you can last longer than you normally do. The beauty is in the eye, or penis, of the beholder. If you don’t like one brand, try the other. There are reports by men who have tried both brands and prefer one over the other. You might not want to put these condoms on too soon before intercourse. Otherwise, your penis could feel like your gums after getting novocaine at the dentist’s office. Do read the instructions, and be careful not to get the gel from the inside of the condom on a woman’s genitals. And as one woman with a numb mouth flamed on a user forum:
Do not give a blow job after a man takes one of these bad boys off.

Recommended Reading for the Academically Brave:
If you are looking for the latest and greatest on premature ejaculation from the researchers and clinicians who are most experienced, ask your librarian for a copy of “Premature Ejaculation: From Etiology to Diagnosis and Treatment” edited by Emmanuele Jannini, Chris McMahon, and Marcel Waldinger, Springer, 2012. Beware, the print version is a whopping $189 USD.

A Special Thanks to:
Patrick Jern of the Åbo Akademi University in Finland and the Sahlgrenska Academy in Sweden; New York City psychiatrist and sex therapist Stephen Snyder; Jason Feifer, an editor at Men’s Health, Donald Strassberg of the University of Utah; David Rowland of Valparaiso University; Marcel D. Waldinger of University of Utrecht; Joseph Marzucco, urology specialist; Stan Althof of the Center for Marital and Sexual Health in South Florida; and Michael Metz, co-author with Barry McCarthy of
Coping With Premature Ejaculation
. Hopefully you are having an exceptionally good laugh from wherever in the cosmos you now looking down from, Michael. May you rest each night in emerald meadows surrounded by naked women on all sides.

CHAPTER

55

Delayed Ejaculation

D
elayed ejaculation is when a guy can get a rock-hard erection and have intercourse for a really long time, but can’t ejaculate. It doesn’t matter if he’s having oral, vaginal, or anal sex, or if his partner is giving him a handjob — either he can’t ejaculate or it takes him close to forever to come. The problem is not in getting an erection and keeping an erection; rather it’s with having an orgasm and ejaculation.

For those of you who have delayed ejaculation or are dealing with it in your relationship, be aware that very little research has been done on this subject and virtually none of it is the double-blind kind that you can take to the bank. Delayed ejaculation (DE) is poorly understood. No one has been able to come up with a universal set of causes, physical or emotional.

There appear to be two different types of delayed ejaculation: the primary type, where a man has always had it, and the secondary type, where he was perfectly fine and then it starts to occur. If you have the secondary type, be sure to rule out physical causes such as diabetes, multiple sclerosis, pelvic surgery, spinal cord injuries, or a big old whopping tumor. Fortunately, these are rare causes of delayed ejaculation. Medication side effects are more likely to be culprits behind secondary DE. We’ll discuss this in a few more pages.

Delayed Ejaculation: A Partner Speaks

It’s unusual for a chapter in this book to begin with a long reader comment. But a sex educator who uses
The Guide
in her college course has been married for more than thirty years to a man who has delayed ejaculation. She offered to write this section for partners of men with DE. If you’ve done any research on delayed ejaculation, you’ll appreciate that what she has to say is far more helpful than most of what’s been written on the subject to date. Here goes:

I’ve been married to a man for 31 years who has never been able to ejaculate with me in the ordinary way. I married him knowing this was true, but thought that we would be able to solve the problem. I didn’t know at the time that delayed ejaculation is the most difficult of the sexual problems to solve or change, even more difficult than desire discrepancy.

Early in our relationship, I looked this up in a book on sexual problems by Masters and Johnson who were famous sex researchers. I discovered that they had only worked with a handful of men with this problem; mostly couples who were worried about whether the women could become pregnant. They used the technique of the man masturbating to the “point of no return” and then the woman would get on top and the man would ejaculate inside her. If the couple was able to do this, then this was considered a successful outcome.

We were able to do this and have two beautiful daughters who are now grown. However, that did not feel like a success to me and my husband was not really interested in doing this for recreational sex. We have explored a lot of sex therapy and psychotherapy, individually and together trying to come to terms with this problem.

As Paul describes in this chapter, my husband has a style of masturbation that is very hard to duplicate with my hand, let alone with my vagina. It is very, very fast and very hard. He has had some success changing his masturbation style, but because it is difficult for him to orgasm, even when masturbating, it is hard for him to want to change his style. Because of this, I have never been able to bring him to orgasm in any way, orally, anally, vaginally or manually.

Overall, I think my husband has come to see this as normal for him; he has never been any different with any other partner. I have had to accept that this sexual style is not something that he really wants to spend a lot more time or energy worrying about. After all these years, we still like to be sexual together, and I count my blessings. He really likes intercourse and has no problem with erections. Unfortunately, I am one of those women who don’t come with vaginal stimulation only, so I don’t get the benefit of having a partner with this problem that some women do.