Nils Beckman and colleagues from the University of Gothenburg in Sweden, studied attitudes to sex in later life among four groups of  70 year olds in Sweden, who they interviewed in 1971-1972, 1976-1977, 1992-1993, and 2000-2001. In total, over 1,500 people aged 70 years were interviewed about different aspects of their sex lives including sexual dysfunctions, marital satisfaction and sexual activity. The authors found that over the thirty year period the number of 70 year olds of both sexes reporting sexual intercourse increased: married men from 52% to 68%, married women from 38% to 56%, unmarried men from 30% to 54%, and unmarried women from 0.8% to 12%.  In addition, the number of women reporting high sexual satisfaction increased, more women reported having an orgasm during sex and fewer reported never having had an orgasm.  While the proportion of women reporting low satisfaction with their sex lives decreased, the proportion of men reporting low satisfaction increased. The authors suggest that this might be because it is now more acceptable for men to admit “failure” in sexual matters.  Interestingly, both men and women blame men when sexual intercourse stops between them. This finding replicates the results of other studies in the 1950s and 2005-2006.  They also note that the number of men reporting erectile dysfunction decreased, whereas the proportion reporting ejaculation dysfunction increased, but the proportion reporting premature ejaculation did not change.  This study shows that most elderly people consider sexual activity and associated feelings a natural part of later life.  It will hopefully highlight the need for doctors to be trained to ask all patients, regardless of age, about their sexual concerns.

About 30 percent of men climax sooner than they want. For some it only happens once in a while; for others it occurs every time they have sex.   To make matters worse, the more anxious men get about the problem, the less control they have.  Coming early is not always an issue in a relationship. In fact, some men have told me that they have always been quick to ejaculate, and it was never a big deal with a past partner, but that with their current partner, the problem can’t be ignored.
There are several different techniques to treat PE.  Many men say that they think about baseball scores to distract themselves in order to last longer. This is the wrong thing to do. Instead of trying to distract themselves, they need to start focusing on their sensations and learn to monitor their sexual arousal and how close they get to ejaculating.  It’s a skill that’s usually not acquired overnight, but one that’s possible to learn. The start–stop technique is something men can do to help on their own.   It’s a masturbation exercise where a man learns to monitor his sexual arousal more closely. He starts masturbating but stops stimulating him when he has reached a point near ejaculation. Once he has “cooled down” sufficiently, he starts masturbating again.

The International Society for Sexual Medicine (ISSM) convened a meeting of the world
s leading experts on sexual dysfunction in

While an evidence-based definition of premature ejaculation can come only from studies of men with lifelong premature ejaculation engaging in vaginal intercourse, the following definition is likely to apply to men with premature ejaculation who engage in sexual activities other than vaginal intercourse. The panel concluded that there are insufficient objective data to propose an evidence-based definition of acquired premature ejaculation. By the end of the meeting, there was unanimous agreement on the following evidence-based definition of premature ejaculation.

ISSM Definition of Premature Ejaculation: Premature ejaculation is a male sexual dysfunction characterized by ejaculation which always or nearly always occurs prior to or within about one minute of vaginal penetration; and, inability to delay ejaculation on all or nearly all vaginal penetrations; and, negative personal consequences, such as distress, bother, frustration and/or the avoidance of sexual intimacy.

Dr DK Kim and Associates reported in the International Brazil Journal of Urology that hyperforin, a natural supplement can be formulated to help men last longer during sexual intercourse.  Ten male volunteers took the rapid release formulation of hyperforin for eight weeks and assessed their sexual intercourse duration and sexual satisfaction.  In five men with mean ejaculatory duration at baseline of less than 90 seconds (mean age 39 years old), four reported lasting longer (mean time to ejaculation before and after treatment, 58±12 seconds to 131±23 seconds, respectively (p<0.01)).   Equally interesting, the mean sexual intercourse duration increased from 266±39 to 391±34 seconds (p=0.02) after Hyperforin extract treatment in three of five men with ejaculation greater than 3 minutes at baseline (mean age 43 years old).  No adverse effect on sexual function and no systemic side effects were reported.  Seven of 10 couples reported subjective global sexual satisfaction improvement for both the men and his partner after hyperforin.  Five couples reported more frequent female orgasm.  Rapid onset of action, ease of use and safety make hyperforin an option for men who wish to last longer. 

We received an interested question:  Can active relaxation of the penile and pelvic floor muscles delay the ejaculation response by inhibiting the ejaculation reflex? 

One doctor expressed the opinion that the ability of an individual to control a given group of muscles and thereby control the tension (contraction as well as relaxation) is extremely difficult and will need the special skills of the therapist to master this control.  Another expert in the field, with experience in pelvic floor rehabilitation stated that, contraction as well as relaxation exercises are routinely a first step in the treatment of premature ejaculation. His experience is a high improvement on the ejaculatory control soon after treatment but at 1 year the cure rate is around 30%. The younger the age the greater is the chance to be cured.

We asked three experts in the field of sexual medicine about a condition we been asked recently and seek help for.  The problem is retarded ejaculation or the difficulty and inability to ejaculate during sex.

One doctor noted that he uses Buproprion 150mg x 2 or x 3 daily off label, which seems more consistently to improve arousal and interest over time, with additional sex therapy techniques in a couple based task-oriented format wherever possible, or masturbation tasks in single patients.

Another expert mentioned that his experience with sympathomimetics such as pseudoephedrine has only been successful in the neurogenic population (taking care of blood pressure increase). He has not found Viagra helpful unless there was altered genital sensation. Minor improvement with Viagra was observed among women with multiple sclerosis). He added that the other often missed etiology of delayed ejaculation especially with aging, is lowered testosterone, which had good results on replacement.
 

Finally a third doctor reported that he found bupropion, buspirone and yohimbine valuable in anorgasmia in clinical practice, while the use of sympathomimetics were valuable in inhibited/delayed ejaculation. He added that any cause of peripheral neuropathy must be excluded in both conditions.

 Topical anesthetic EMLA cream is commonly used in doctor’s office to numb up the skin before needle or minor procedure.  Recently EMILA cream was shown to be effective in treating premature ejaculation, according to a report in a 2008 issue of the medical journal UROLOGY. Dr. Tuncel and colleagues from Ankara Numune Research and Training Hospital, Ankara, Turkey compared the efficacy of sildenafil (Viagra), sildenafil plus topical EMLA, and EMLA-only in 84 men with premature ejaculation. The effectiveness rates were 40% (8/20) for placebo, 55% (11/20) for sildenafil-only, 86.4% (19/22) for the combination of sildenafil plus EMLA, and 77.3% (17/22) for EMLA-only, the authors report. The differences between placebo and sildenafil-only and between the combination of sildenafil plus EMLA and EMLA-only were not statistically significant, the results indicate. However, the latter two treatments were significantly better than the former two treatments. Headache and flushing were observed in patients taking sildenafil as part of their treatment, the researchers note, but no side effects were reported by patients taking placebo or EMLA-only. Although the sildenafil plus topical EMLA cream and topical EMLA cream-only treatments were superior to placebo and sildenafil-only treatment of premature ejaculation, topical EMLA cream alone had effectiveness equal to that of the combination treatment, the authors note. Topical EMLA cream alone appears to be a reasonable, inexpensive, effective, and easily applicable treatment modality for premature ejaculation treatment.

A study was recently presented at the annual meeting of the American Urological Association reviewing female partner sexual satisfaction in men with premature ejaculation (PE) treated with dapoxetine. Data were from an integrated analysis of three large trials including over 3,700 subjects.. These double-blind, parallel-group studies randomized men 18 years of age, diagnosed with PE, with intravaginal ejaculatory latency time 75% of intercourse episodes, to receive placebo, dapoxetine 30 mg, or dapoxetine 60 mg, on-demand for 12-24 weeks. At baseline 26% of partners reported good, very good satisfaction with sexual intercourse at baseline, which increased to 39.1% and 47.4% with dapoxetine 30 mg and 60 mg.  Partners reported improvements in the man’s control over ejaculation and their own ejaculation-related personal distress and interpersonal difficulty.  Similar to results in men with PE, partners of dapoxetine-treated men with PE reported improvements in their perception of the man’s control over ejaculation and their satisfaction with sexual intercourse.

Five European countries collaborated together to determine the commonality of premature ejaculation (PE).  The doctors diagnosed premature ejaculation (PE) in 201 of 1,115 men.  Intravaginal ejaculatory latency time (IELT) was lower in the PE vs. the non-PE group (3.3 vs. 10.0 minutes respectively), but a substantial overlap was observed.   Men with PE and their partners reported significantly worse control over ejaculation, ejaculation-related personal distress, satisfaction with sexual intercourse, and ejaculation-related interpersonal difficulty than men without PE and their partners.  

Control over ejaculation had a significant effect on personal distress and satisfaction with sexual intercourse; IELT had an effect on control over ejaculation, but no direct effect on satisfaction with sexual intercourse, and a small direct effect on personal distress.

The International Society for Sexual Medicine (ISSM) The ISSM convened a 21 member panel of world experts who met in Amsterdam in the fall of 2007. The panelists were tasked with creating a new definition of premature ejaculation (PE) based on currently available clinical evidence. Definitions of PE have previously been based on group consensus and not meeting new standards for evidence-based medicine.  PE affects 20-30% of men. Although less commonly reported than erectile dysfunction, PE may co-exist in a third of men complaining of ED. The etiology of PE is multifactorial with both biologic and psychologic factors.  Despite its significant prevalence there are no FDA approved drugs specifically for PE. Multiple treatments have been described including behavioral, sexual exercises and medical therapies. Current clinical trials are focusing on medical management with either oral selective serotonin re-uptake inhibitors (SSRI’s) or topical anesthetics applied as creams or sprays.  Looking at the world’s literature, the ISSM panel agreed that several constructs were needed to characterize PE: time to ejaculation, inability to delay ejaculation, and negative consequences from PE. The panelists concluded that the available objective evidence to define PE was at this time limited to men with lifelong PE who engage in vaginal intercourse.  The ISSM definition of PE: “Premature ejaculation is a male dysfunction characterized by ejaculation which always or nearly always occurs prior to or within about one minute of vaginal penetration; and, inability to delay ejaculation on all or nearly all vaginal penetrations; and, negative personal consequences, such as distress, bother, frustration and or the avoidance of sexual intimacy.”