Another Step Towards the Medicalization of Sex

The New York Times has an article about yet another pharmaceutical intervention to “improve” sex. This one is for premature ejaculation (aka PE), a notoriously difficult-to-define situation

Throughout the history of sexology, different researchers have tried to come up with a good working definition of the term. Masters and Johnson (that’s a photo of them, BTW. Click on it for more info about them) used it if the guy came before his (female) partner. Others have set the minimum sufficient time for intercourse at two minutes, while Sciele Parma, the folks who are manufacturing this new drug peg it at one minute. By comparison, many sex therapists say that premature ejaculation is when the situation causes distress for either or both partners.

Now, I want to be clear that I totally get that ejaculating so quickly can cause distress. I’ve spoken with lots of men and their partners about this and I see the effects it can have. Of course, some of that stems from men struggling with a model of male sexuality that includes “rock hard penis that lasts all night long”. There’s a lot of pressure to perform. And that very word shows, I think, what this model is all about: a performance is something done for an audience.

That audience might be your partner, yourself, or the internalized voices in your head that tell you what a “real man” is. But because it’s about performing, rather than an authentic enjoyment of sex, the focus is external instead of internal. And that makes you easy prey for the marketing departments of pharmaceutical companies.

It’s also worth noting that (according to the NY Times article), Sciele‚Äôs spray-on drug contains lidocaine and prilocaine. Basically, it’s a pharmaceutical-grade version of Mandelay and other numbing creams. It desensitizes the penis, which reduces sensation and presumably makes it take longer to orgasm. But this approach neglects the many other factors that can influence time to ejaculation.

For example, anxiety can be a factor in premature ejaculation. One obvious scenario is that any anxiety about “performance” can lead to erectile difficulty or fast ejaculation, with the ironic effect of causing the very situation that the guy is feeling anxious about. But another likely situation is that anxiety from a stressful life, with emails to answer, chores to do, and traffic to navigate, can also cause some of the same effects. As far as your body’s response is concerned, it doesn’t matter where the anxiety comes from. And numbing your penis with a spray (whether a prescription or over the counter) isn’t going to address the root cause. At best, it’ll mask it. But my observation is that it just comes out somewhere else.

Several years ago, I was chatting with a friend who was a sex worker who specialized in erotic massage. She told me about a client who was convinced that he had premature ejaculation. So she had him lie down and massaged his erection for over 30 minutes before he orgasmed. It was the first time someone didn’t try to get him to orgasm as quickly as possible and it showed him that, in fact, how long he lasted had more to do with his anxiety and what type of sex he was having than any medical problem he had.

Similarly, I’ve spoken with lots of sex therapists, coaches and educators and many of them have said that when they help their clients learn to deal with their anxieties, especially their sexual anxieties, problems like premature ejaculation and erectile difficulties often resolve. Granted, there are medical issues that this approach can’t address, but I have to ask why we rush to assume that a medical problem is the cause.

Joseph Kramer, among others, points out that when we shame youth and young adults for masturbating, we create an atmosphere in which boys learn to masturbate as quickly and quietly as possible. Doesn’t it seem plausible that this anxiety- and secrecy-ridden scenario trains them to have later problems with sex?

Of course, there’s a lot of money to be made by telling us that we have a sexual problem that some new drug can fix. People have so many fears and shames around sex that it’s no surprise that lots of people want a quick and easy fix. It can seem a lot simpler to take a pill or use a spray than to work through whatever issues are the real cause. But when it comes to sex, a quick fix is rarely the solution. So while I’m not at all surprised to see this latest development in the medicalization of sex, I can’t say that I think it’s a good thing.

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