Richard G. Petty, MD

Premature Ejaculation

I was pleased to see an article in this week’s medical journal, The Lancet, that the drug dapoxetine lengthened the duration of intercourse by three to four times in an American study of 2,614 men, of whom 1958 completed the trial. There is currently no medication on the market for a condition that may affect up to a third of all men at some time in their lives. It can be frustrating for both partners in a relationship, and it can put a lot of strain on a family.

The researchers from University of Minnesota found that taking the drug increases the average duration of sex from less than a minute to three minutes 19 seconds. Up to now, many clinicians have used other medicines “off label,” to try and help the problem, but most of those treatments have carried many side effects with them.

This report leads to two other considerations.

First, is that the field of sexual health is being revolutionized by a new approach. One of the worst problems for many men has been the comparison culture, often fostered by the popular media. There used to be a joke that if a man wasn’t having 2.3 orgasms a week he would feel cheated. But what, exactly, is 0.3 of an orgasm anyway??

The “New View” of sexuality starts with a re-appraisal of what is normal in terms of sexual behavior and also in terms of aging. Trying to standardize sex is the cause of many problems for men and women because it leads to unhelpful comparisons. The “new view” asks a person quite different questions about their levels of happiness with their sex lives. This is a considerable advance on trying to medicalize everything.

The second point is this. For many centuries entire schools in China, India and Tibet have taught natural methods for delaying and enhancing ejaculation, primarily by strengthening and gaining control of the pubococcygeus muscle in the floor of the pelvis. Women have also been taught similar exercises to enhance their sexual pleasure, usually as part of a program of spiritual training. Some of these practices are included in this reading list that I put up at Amazon a few months ago.

It is not difficult to learn these exercises. There is surprisingly little research on these non-pharmacological approaches to improving people’s sex lives, so they are often dismissed by experts. But the fact remains that simple Kegel type exercise can often help people greatly.

I’ll happily detail some of these methods if people are interested.

Sex Drive and Relationships

The BBC is reporting on an article published in the journal Human Nature.

According to the report – and I haven’t yet seen a copy of the original research – investigators from the Hamburg-Eppendorf University in Germany found that the sex drive of many women begins to plummet once they are in a secure relationship. They found that four years into a relationship, less than half of 30-year-old women wanted regular sex.

Conversely, they found that a man’s libido remained the same regardless of how long he had been in a relationship. The researchers interviewed 530 men and women about their relationships.

They found 60% of 30-year-old women wanted sex "often" at the beginning of a relationship, but that within four years of the relationship this figure fell to under 50%, and after 20 years it dropped to about 20%.

And here’s a shock: The study also revealed tenderness was important for women in a relationship. About 90% of women wanted tenderness, regardless of how long they had been in a relationship, but only 25% of men who had been in a relationship for 10 years said they were still seeking tenderness from their partner.

The researchers then start talking about the evolutionary implications of all this: that women evolved to have a high sex drive when they are initially in a relationship in order to form a "pair bond" with their partner.

That is all quite plausible, but it is a usually a mistake to try and reduce human behavior to hormones, neurotransmitters and evolutionary drives.

Most men and most women may well have different sex drives, and the duration of a relationship may play a part. But it is just as likely that we are seeing the effects of having children who need lots of a couple’s attention and a natural reaction to one or both partners focusing more on their careers and outside activities rather than on the relationship.

In Healing, Meaning and Purpose I talk about the best solution to tired relationships: it’s not a matter of trying every variation in the Kama Sutra. The most valuable thing to ensure the viability of intimate relationships is not so much to try to learn lots of different techniques, but instead to make the time together really count. There is nothing quite as attractive as an intimate occasion marked by complete focus on and awareness of the other person. Feeling the dance of the duality, focusing on all your senses, and, if you can, feeling the subtle systems of the other person.

Simple things that have rescued countless relationships. And a lot cheaper than hours of therapy.

Sexual Health

One of the principles of integrated medicine is that anything that is really good for you should impact more than one system of the body. So for example omega-3 fatty acids will, in moderation, help your cardiovascular system, brain, mood and skin.

There is a good example of this in a study published this month in the Journal of Urology. The research was orchestrated by the Harvard University School of Public Health in Boston, and involved 22,086 American men followed over fourteen years. The findings confirm the importance of lifestyle choices to the risk of developing erectile impotence. Some of the same things that are bad for the heart also dramatically increase the risk of developing impotence. Men who were obese at the beginning of the study were 90 percent more likely to develop erectile dysfunction (ED) than were normal-weight men. Similarly, smokers had a 50 percent greater risk than non-smokers of developing ED. On the positive side, regular exercise appeared to protect against erectile problems. Men who reported the highest exercise levels at entry into the study’ were 30 percent less likely than their inactive peers to develop ED over the next 14 years.

The reason for these associations is primarily to do with blood flow. Anything that impedes blood flow increases the risk of ED, and anything that improves it will likely have a beneficial effect. We already know that people with diabetes mellitus and hypertension are far more likely to develop ED.

The message is very straightforward. If we ever needed any more evidence that smoking and obesity are bad for you, this is it. Stopping smoking, losing weight and taking regular exercise will all reduce your risk of developing ED. And if stopping smoking is a problem, not only do we have new medicines coming along, but I’ve also had some good results with homeopathy and the tapping therapies.

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