DEFINED: Persistent or recurrent ejaculation with minimal sexual stimulation before, upon, or shortly after penetration and before the person wishes it. The clinician must take into account factors that affect duration of the arousal phase, such as age, novelty of the sexual partner or situation, and frequency of sexual activity. (Principles of Ambulatory Medicine. 4th Ed).

More prevalent than erectile dysfunction, it is undertreated and underdiagnosed, likely because the patient often avoid the topic, and for physicians, a malady there is not much he can do about. Too often, it is dumped into the purview of the sex therapist, this frustrating malady often dies in the embarassed confines of the bedroom; or, brought up only as a hushed topic in alcohol-fueled conversations.

A drug is under investigation that might put the brakes on premature ejaculation. . . Hope for Speedy Gonzales.

Currently, there are no FDA-approved drugs for the treatment of premature ejaculation or ejaculatory dysfunction. SSRIs (selective serotonin reuptake inhibitors: prozac, paxil,et al) have been used off-label but requires chronic daily dosing. Local anesthetics, alas, often cause numbness to both user and partner.

Dapoxetine, a rapidly acting serotonin transporter inhibitor improves the ejaculatory latency. In one study, the baseline IELT (intravaginal ejaculatory latency time) of 0.90 minutes (54 seconds!) was increased to 1.87 minutes with a 30 mg dose, and increased to 2.43 minutes with a 60 mg dose of dapoxetine, compared to placebo increase of 0.84 minutes. The increases in both doses were statistically significant.

Another study showed dapoxetine to triple or quadruple the duration of sexual activity before orgasm.

Side effects: Most common was nausea, in 20% of the men, 75% of them rating it mild. Other side effects were headaches, dizziness, diarrhea. Less than 5% of the study patients quit because of side effects.

Unlike SSRIs, it is rapidly absorbed and rapidly eliminated, with a half-life of 12 hours, with the boon of an 'as-needed' use.

Under development by Azla and Johnson & Johnson, It might find approval in less than a year.