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    The (Too) Fast Lane

    Breaking the Pattern

    Solving the Problem

    When the cause is physical, the treatment can be simple and swift. Such was the case with a 31-year-old man who was receiving counseling from Anthony Jerome Brown, CSW, a New York social worker. The man told Brown he had an infected prostate gland (prostatitis) and had been given the antibiotic Cipro. What he hadn't told the physician who diagnosed the infection -- but did tell Brown -- was that he also suffered from premature ejaculation.

    After taking the antibiotic twice daily for a month, his three-year bout with the ejaculation problem was over. Brown wrote up the case report for the Journal of Sex & Marital Therapy, suggesting that more research might be conducted on how often the infectious condition and premature ejaculation might coexist.

    Other medical treatments are even simpler, says Pryor. He and others have had success prescribing antidepressants, taking advantage of a known side effect of the drugs to balance the problem: in some men they can block ejaculation. The most thoroughly studied of these, Pryor says, is Anafranil. A man can take a single dose 12 hours before planning to have sex, he says, and "you don't have to take it continuously." But it doesn't work for everyone, either.

    If an antidepressant doesn't do the job, Pryor recommends other measures. "Condoms can help a lot, too," he says. "They dull the sensation." Lidocaine jelly, a topical anesthetic available by prescription, can be used to numb the skin of the penis. But that numbness can be transferred to the partner and quickly zap the romance, he says.

    If a man focuses too much on his partner's reactions -- thus ignoring his own -- Pryor often will recommend sensual awareness training to learn to better keep his state of arousal under control and last longer. (Forget the old "think about football" distraction. This works better, Pryor says.)

    Some remedies that have been mentioned for years are often not effective, or not effective on their own without some behavioral retraining, too, says Metz. The squeeze technique -- in which the man's partner squeezes the tip of the penis when the man is on the verge of orgasm -- has limited effectiveness, Metz and Pryor say. And a pacing strategy known as the stop-start technique is best used with other techniques, Metz says.

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