Drug to curb early ejac­u­la­tion

A new drug is now avail­able to as­sist men with pre­ma­ture ejac­u­la­tion.

The Star Malaysia - Star2 - - FRONT PAGE - By AL­LAN KOAY starhealth@thes­tar.com.my

IT HAS been said that Vi­a­gra kick­started the first sex­ual revo­lu­tion for men. Be­fore the days of the lit­tle blue pill, erec­tile dys­func­tion (ED) was plagued with myths and mis­con­cep­tions that led to much con­fu­sion among men.

Some even con­fused ED with pre­ma­ture ejac­u­la­tion (PE).

Now that a new med­i­cal so­lu­tion for PE has been found, the sec­ond sex­ual revo­lu­tion can take off.

Pre­vi­ously, anaes­thetic cream, which numbs the pe­nis, and an­tide­pres­sants were used to help men over­come PE.

But now, with PE recog­nised as a med­i­cal con­di­tion, there is an oral med­i­ca­tion called Pili­gry – the first in the world to be ap­proved for treat­ment of the prob­lem.

PE has long been a con­di­tion that has been un­der-re­ported and un­der-di­ag­nosed, mainly be­cause of the em­bar­rass­ment faced by suf­fer­ers, who have to put up with the so­cial stigma re­lated to the con­di­tion.

But few know that it is a very com­mon con­di­tion – re­ports show that as many as 29% of Malaysian men suf­fer from PE.

The Asia-Pa­cific Pre­ma­ture Ejac­u­la­tion Preva­lence and At­ti­tude Study car­ried out among more than 5,000 het­ero­sex­ual men found aware­ness of the con­di­tion to be low.

The study also found that most men are re­luc­tant to talk about it, while the ma­jor­ity of cou­ples do not com­pletely un­der­stand the con­di­tion.

Solv­ing PE

PE has been de­fined by the In­ter­na­tional So­ci­ety Of Sex­ual Medicine as “ejac­u­la­tion which al­ways, or nearly al­ways, oc­curs prior to, or within about one minute of, vagi­nal pen­e­tra­tion.”

Women who are happy with the way things are should not in­sist that their man take Priligy just to pro­long sex­ual in­ter­course, says urol­o­gist Prof Datuk Dr Tan Hui Meng (pic inset).

Pre­vi­ously, PE was largely thought to be psy­cho­log­i­cal, but now it is known to have neu­ro­bi­o­log­i­cal causes.

The cen­tral ner­vous sys­tem is con­trolled by the sero­tonin sys­tem, which con­trols mood, ap­petite, anger, pain and sex­ual plea­sure.

When sero­tonin in­hibitors are manipulated, the thresh­old of sex­ual cli­max can be el­e­vated. That is why anti-de­pres­sants are found to be ef­fec­tive in treat­ing PE.

How­ever, anti-de­pres­sants are long-act­ing, and there are none li­censed for treat­ing PE.

Priligy works in the same way, but is short-act­ing, and clears out of the body af­ter around 24 hours.

The drug was eval­u­ated in placebo-con­trolled clin­i­cal tri­als that in­volved more than 6,000 men with PE, and their part­ners.

“We have specif­i­cally de­signed and de­vel­oped a short-act­ing SSRI (se­lec­tive sero­tonin re­up­take in­hibitor), so it has the ef­fect of ex­tend­ing the time be­fore ejac­u­la­tion; but at the same time, it is rapidly cleared from the body,” said JanssenCi­lag med­i­cal af­fairs man­ager Joyce Seak.

“The pa­tient needs to take the tablet one to three hours be­fore sex­ual ac­tiv­ity. Af­ter 24 hours, less than 5% of the med­i­ca­tion re­mains in the body.”

Priligy is a pre­scrip­tion drug, pro­duced by Janssen-Ci­lag.

Both the 30mg and 60mg packs come with three tablets per pack. Each 30mg tablet is sold at the rec­om­mended re­tail price of RM39, while the 60mg tablet is RM55.

Seak added that pa­tients with sig­nif­i­cant patho­log­i­cal heart con­di­tions, mod­er­ate to se­vere liver prob­lems, schizophre­nia or mental dis­or­ders, should not take the med­i­ca­tion.

Treat the prob­lem

PE can af­fect a cou­ple’s sex life and re­la­tion­ship, and lead to dis­tress, anx­i­ety and dis­ap­point­ment, not just for the man, but also for the woman.

How­ever, if a cou­ple is happy de­spite the man ex­pe­ri­enc­ing PE, then no treat­ment is nec­es­sary.

Con­sul­tant urol­o­gist Prof Datuk Dr Tan Hui Meng ex­plained: “You must also con­sider if the cou­ple treats sex as only for pro­cre­ation, not for recre­ation.

“Ac­cord­ing to their own un­der­stand­ing, they have in­fre­quent sex­ual ac­tiv­ity, it’s fast and there is no prob­lem.

“But things may change. When their chil­dren grow up and leave the house, the cou­ple will have more time to them­selves.

“So, if they re­alise that this is a med­i­cal con­di­tion, and that the man has been hav­ing pre­ma­ture ejac­u­la­tion his whole life, then there’s no harm in tak­ing med­i­ca­tion.”

The Malaysian So­ci­ety of An­drol­ogy and The Study Of The Ag­ing Male hon­orary pres­i­dent added that while the man’s part- ner may feel that med­i­ca­tion is not nec­es­sary, the cou­ple can get treat­ment if they want to be more in­ti­mate and a bet­ter sex life.

“But you should never treat a pa­tient when there is no prob­lem; you’ll only be ask­ing for trou­ble,” he said.

Can Priligy also be used to treat those whose PE is sec­ondary, and due to psy­cho­log­i­cal rea­sons, such as per­for­mance anx­i­ety?

“If you im­prove their sero­tonin path­way and sig­nals, you would prob­a­bly still help them,” said Prof Tan.

“It is akin to peo­ple with ED who have it as a psy­cho­log­i­cal prob­lem, and are on med­i­ca­tion. No mat­ter what the un­der­ly­ing causes, they will still achieve a good erec­tion.

“So it is the same thing with those hav­ing PE.

“If it is just tran­sient PE, which hap­pens once in a while, then as a doc­tor, I would just coun­sel the pa­tient and tell him to avoid sit­u­a­tions that cause PE. But if it hap­pens too fre­quently, you can treat it.”

Of course, the drug has to be used ju­di­ciously and prop­erly, and the doc­tor plays a key role in se­lect­ing the pa­tients for the best re­sults, Prof Tan added.

Ex­pec­ta­tions of the PE suf­ferer’s part­ner could some­times be a fac­tor in lead­ing a man to think he needs treat­ment.

Prof Tan cau­tioned that a man should not be en­cour­aged to seek med­i­cal treat­ment just be­cause his part­ner has cer­tain ex­pec­ta­tions about how long sex­ual ac­tiv­ity should last.

The sit­u­a­tion is dif­fer­ent with ED, which has been recog­nised to be the pre­lude to car­dio­vas­cu­lar dis­ease, and must be treated.

“If nor­mal du­ra­tion is five min­utes, and there is noth­ing wrong with the man, you can­not push him to take med­i­ca­tion just to en­able him to last 30 min­utes,” he said.

“So we must take into con­sid­er­a­tion the cou­ple’s ex­pec­ta­tions.”

How­ever, many men ac­tu­ally ejac­u­late very fast with­out even know­ing it is a prob­lem. Their part­ners may also not be aware of the prob­lem.

“The man still achieves or­gasm and is re­laxed and grat­i­fied,” said Prof Tan.

“Both part­ners are happy and do not need help.

“But stud­ies have shown that women do not cli­max eas­ily. Many men are aware of that. So it is the man’s sen­si­tiv­ity to his part­ner as well.”

Prof Tan said that sex­ual medicine is now a recog­nised med­i­cal dis­ci­pline, and he ex­pects it to be­come even more prom­i­nent in the com­ing years.

“There will be peo­ple in the fu­ture who are sex­ual medicine physi­cians, and deal with noth­ing but sex­ual medicine,” he said.

“It is not un­usual or em­bar­rass­ing to walk in and see a sex­ual medicine physi­cian be­cause sex­ual health is a very, very im­por­tant as­pect of life.”

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