April 16, 2010
The latest news about premature ejaculation has come in from Europe: PRNewswire’s “Men slow to talk about fast sex”. It cites data from a new survey on PE, which confirmed something that we sex therapists have always known: Premature ejaculation is a serious matter that adversely affects millions of men’s lives, and the lives of their partners.
The study being reported evidently surveyed thousands of men and women to reach this important conclusion. But it wasn’t really news at all to anyone familiar with PE.
What was news was that the study was sponsored by a pharmaceutical company: Janssen-Cilag, together apparently with several European patient support groups. Janssen-Cilag, a part of the Johnson & Johnson family of companies, has since February 2009 been winning approval for its new premature ejaculation drug, dapoxetine (marketed in Europe as Priligy), in countries in Europe and around the world, but not yet in the United States.
I’m a fan of this drug, even though since I’m a physician and sex therapist practicing in the United States I can’t yet prescribe it. I was a medical advisor to Johnson & Johnson in 2005, when the company attempted unsuccessfully to gain FDA approval for the drug. And I sincerely hope that the FDA will someday reconsider dapoxetine and allow the drug to be prescribed by US physicians.
Dapoxetine is conceptually not that new. It’s a short-acting serotonin reuptake inhibitor (SRI), a member of the Prozac family. We physicians in sexual medicine have prescribed SRI’s for years for men with prematurity, generally with good results.
What’s new is that this is the first time a pharmaceutical company has sought an FDA drug approval specifically for PE. There is currently in the US no medication that’s FDA-approved for PE. Treatment of PE with medication is currently “off-label” and therefore still somewhat in the shadows.
Here’s the reason I’m hoping that the FDA will approve dapoxetine soon: When it does, premature ejaculation will finally get some publicity as a serious condition with serious negative effects on men’s lives. Maybe dapoxetine will do for premature ejaculation what Viagra did for erectile dysfunction: bring it out of the shadows, and inform men that they don’t have to suffer in silence.
Despite the sheer number of men with premature ejaculation in the world, PE doesn’t currently get much publicity. When the FDA turned down dapoxetine in 2005, I waited for some public outcry, but there was none. The matter passed almost unnoticed.
To this day, I continue to see men in my office who have no idea that effective treatments for PE exist. Many have tried behavioral treatments, which may help some men with milder forms of PE; but I have yet to meet a man with really serious PE who is genuinely satisfied with the results of behavioral treatment.
In my office, the most successful treatments for serious PE usually combine medication and some variation on traditional behavioral treatment. When such treatments are successful, I count them among my most gratifying experiences as a physician and sex therapist. Successful treatment for PE often literally changes the course of a man’s life.
But there are not many physicians who have the skill to prescribe SRI’s optimally. The major health risks to men taking SRI’s for PE are erectile dysfunction and worsening the course of bipolar disorder. Since SRI treatment for PE is still “in the shadows,” physicians are generally not educated about such hazards.
Approval of dapoxetine in the US could change all that. Marketing would surely result in more publicity and education about PE treatment, both for patients and for their physicians. There will inevitably be controversy, as there was with Viagra, about the so-called “medicalization of sex therapy,” and in a larger sense about the medicalization of everything from beauty to athletics to school performance. There will be arguments about whether taking a drug to help with PE might increase the pressure on men to perform. And arguments about who should pay for it.
But I’m hoping we get a chance to hear these arguments soon. There’s been silence for too long about PE. Let’s get PE on the front page of Newsweek where it belongs. That would be the best news of all about premature ejaculation.
© Stephen Snyder, MD 2010
New York City