Monday 11 December 2017

'PE' - The dysfunction that dare not speak its name

For too long, premature ejaculation has been the ultimate taboo. But talking to a doctor is the first step

One in five men experience premature ejaculation.
One in five men experience premature ejaculation.
Christian Jessen, best known as the in-house medic from the UK television series ‘Embarrassing Bodies’
Ed Power

Ed Power

FOR men, it is the ultimate taboo – the dysfunction that dares not utter its name. "One in five men experience premature ejaculation. They don't want to talk about it. However, it is likely we all know someone who suffers from it," says Dr Wallace Dinsmore, a sexual health specialist and chair of the Irish Association of Sexual Medicine.

Men aren't the only ones unwilling to speak up, he adds. "Women typically do not wish to talk about it either – even with friends."

There's a temptation to giggle. However, 'PE' can have a devastating impact on sufferers. It can harm self-esteem and decrease their chances of entering into a long-term relationship.

"Men may have it all their lives, others can develop it," says Dinsmore. "It can destroy their [personal lives]. The consequences are often extremely serious."

Some men are so self-conscious they may avoid romantic relationships altogether. Loneliness, they may calculate, is a small price to pay if it means avoiding humiliation. It sounds extreme – but often it makes perfect sense to them.

"Their previous relationship may have broken up in part or in total due to premature ejaculation," says Dinsmore. "So it's a big issue."

Historically, PE was rarely discussed and it was unusual – unheard of, in fact – for men to present at their GP seeking help. However, with the success of the erectile dysfunction (ED) drug Viagra, men have become more open about their sexual wellbeing, says Dr Dinsmore.

The hope now is that, with treatment of PE becoming more mainstream, patients will show a greater willingness to look for help. The first step is visiting their GP and speaking frankly about the issue.

"A lot of patients who have been given Viagra will talk to a pal about it and report on their positive experiences. We are going to see a move towards that in this area too," Dinsmore believes.

Premature ejaculation is by some distance the most commonplace sexual dysfunction. Some experts theorise that the problem may actually be on the increase as portrayals of sex in the media lead to unrealistic expectations – and new pressures.

Generally the condition falls into two categories: life-long and acquired premature.

The first occurs throughout the man's life and will have been a long-term issue for them.

In the case of acquired PE, it will have developed as the man ages and his relationship with his significant other changes. They may have had children and their sex life may have cooled off slightly. And, then, out of the blue, they may discover they have 'performance' issues.

According to studies, for a man with PE, sex lasts around 1.8 minutes, against 7.3 minutes for non-sufferers. The causes of premature ejaculation are manyfold, so that no two cases are necessarily the same.

Sometimes psychological reasons are at play; often, however, the problem is physical. Across the decades, many wild theories have been advanced for the condition – shame about sex, unresolved childhood issues, an unwillingness to commit emotionally. All have been more or less debunked.

"It is perceived by a lot of people as strictly psychological," says Dinsmore.

"But it can have physical causes too. Some therapists do treat with psychological intervention, however, the results of psychosexual therapy are variable."

There are a number of possible physical factors. Though by no means definitive, the list includes infections of the prostrate or urethra, an uncommon degree of sensitivity and an overly tight foreskin (for which circumcision may be recommended).

In contrast to ED, premature ejaculation tends to affect younger men with the problem understood to diminish later in life.

That isn't to say that anxiety doesn't become its own problem too. Indeed, it is not by coincidence that premature ejaculation is often a problem in the early phase of a relationship, when men may be at their most insecure.

In certain cases, lifestyle changes can help with the issue. Cutting back on consumption of alcohol, cigarettes or drugs may help improve ejaculation.

Using a condom may also be of use. Internationally, some medics have recommended certain anti-depressants, which have the side-effect of affecting sexual function – though this is considered 'off-label' use.

A GP may be able to recommend treatments to a patient. If, however, he feels he cannot help, he will recommend they visit a specialist, usually a urologist.

The reluctance to speak about sexual dysfunction is part of a wider trend among men not to talk about their health, believes Christian Jessen, best known as the in-house medic from the UK television series Embarrassing Bodies.

"Men have always been rubbish about talking about their health," he says. "It's in our nature. For a lot of our lives we don't have cause to access healthcare. Women need to have smear tests, have issues with fertility, babies, all the rest. We tend not to interact with medicine.

"So it is no surprise that we are reluctant to go to the doctor when the need arises, particularly in the area of sex.

"Hopefully with treatments increasingly available, men will show greater willingness to come forward."

If you feel you have a problem in this regard, Dinsmore recommends you consult your GP in the first instance.

Granted, family doctors may not always be aware of the range of treatment available.

However, he believes that as awareness of the issue increases, more and more men are going to go to the family doctor looking for assistance.

This will inevitably create a greater understanding of PE in the medical community here.

"If they're not aware they are likely to become aware, as patients approach looking for solutions," he says.

"Lots of research has been done and we know this is a common condition that happens everywhere in the world. I suspect doctors will be seeing a lot more patients complaining of premature ejaculation in the future."

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