Best Sex Writing 2012: The State of Today's Sexual Culture (6 page)

The potential of a drug for premature ejaculation dwarfs that of an erectile dysfunction drug. Estimates vary—mainly because of the definition issue and trouble in designing studies—but between 20 and 30 percent of the population could be considered premature ejaculators. One market study, from Datamonitor, estimates that in 2010 the US population of early ejaculators between the ages of 20 and 59 was 25.8 million, compared with 9.5 million men in need of bonder drugs. “I think the FDA is ultimately willing to approve a drug for premature ejaculation,” Terry says. “The challenge at this stage is just defining what that actually means.”

Research Pioneers

In the days of King Charles II, the last Spanish Hapsburg ruler and one of the most regal premature ejaculators on record, sexual dysfunctions were the product of witchcraft. Innovative treatments included exorcisms and urinating through your wedding ring or through the keyhole of the church where you were married. Fast forward to the early 20th century and you’ll come across a sea of erotic snake oil, including an arsenic-containing elixir in Dr. Frank Miller’s 1913 tome,
Domestic Medical Practice
. In the wake of Kinsey in the late 1950s came the work of William Masters and Virginia Johnson, better known as Masters and Johnson. The duo developed the still popular squeeze technique to prolong sex, which, as its name implies, involves putting a stranglehold on the head of the penis before ejaculation. Studies have demonstrated its efficacy, but evidence suggests that without regular reapplication the positive effects wear off. Also, it can be awkward to ask someone you’re sleeping with for the first time to put your dick in a death grip.

“Masters couldn’t do any analysis—he didn’t have any funding—so what he did was hire prostitutes and observe them, interview them, identify how they had sex and what the sexual issues of their lives were,” says Dr. Irwin Goldstein, director of sexual medicine at Alvarado Hospital in San Diego. Goldstein, who was an acquaintance of Masters’s, notes that the atmosphere surrounding sexual research was so restrictive in the early days of his work that Masters struggled to get medical texts about female reproductive anatomy. “The thing is, prostitutes saw a lot of men who were anxious and stressed, so his formulations were made on bad observations because of a biased population. It was their theory, which is perpetuated even in 2010, that 90-plus percent of all sexual problems are due to psychological issues: anxiety, humiliation, fear, depression.”

Goldstein is editor in chief of the
Journal of Sexual Medicine
and also a drug company consultant. For more than 20 years he was funded by the National Institutes of Health to study sexual function and dysfunction. He is highly critical of those who believe such disorders are rooted solely in psychology. When he tells you about a man who can’t watch his wife strip down without ejaculating all over himself or about a 28-year-old guy who hasn’t had an erection for more than a decade because of a damaged artery, you learn how debilitating sexual dysfunction can be.

For Goldstein, the work of a Baylor University urologist, F. Brantley Scott, was the catalyst that took the treatment of sexual dysfunction from the head doctors and brought it into the medical field. “It had to end up in a physician’s hands to progress along medical thinking and diagnostics,” he explains. Scott, who died in a plane crash in 1991, played an instrumental role in developing the inflatable penile prosthesis, which has been used to treat tens of thousands of patients. The development of this surgically implanted device transformed the landscape of research and opened the field of sexual medicine. “Premature ejaculation, Viagra, orgasm dysfunction, all this stuff ended up in the field of urology,” says Goldstein.

By now pharmaceutical engineers have studied the effects on ejaculation of an array of drugs—including neuroleptics, tricyclic antidepressants, opioid agonists, phosphodiestrase inhibitors, sym-patholytics, and SSRIs. Beyond drugs, modern researchers have tested rings that wrap around the penis, behavioral techniques such as the stop–start approach, and even virtual-reality programs intended to help men explore their sexual development for events that might have influenced their ejaculatory reflex. Much remains to be learned about the mechanisms of ejaculation, but research bolsters the notion that it is rooted in neurochemical interactions.

“These are people who need help, and we have to be sensitive to their needs and not be rigid,” says Goldstein, who directs patients to buy dapoxetine from online pharmacies in foreign countries—a process no more complicated than ordering a book from
Amazon.com
.

PE Drugs as Lifestyle Drugs

Numerous challenges loom over the success of any drug, and for one that extends intercourse the most significant factors will be pricing and efficacy. “Because premature ejaculation is in such a broad range of patients and doesn’t have a correlation with age, it is actually much more in line with a lifestyle drug,” says Sarah Terry, of Life Science Analytics. “As a lifestyle drug, it won’t be reimbursed by health insurance. People will have to pay out of pocket for it.”

Getting men to schedule an appointment to talk about an ostensibly embarrassing disorder and then persuading them to cough up money for treatment will require a costly display of advertising acumen. The battle over direct-to-consumer advertising is nothing new, with one side considering it patient education and the other considering it a tool of deception. Such drug ads are almost exclusive to the United States, coming to the airwaves only in the 1990s. The stakes are now huge: Pfizer has recruited the likes of Bob Dole, Rafael Palmeiro, and NASCAR driver Mark Martin to pitch Viagra. Eli Lilly’s ad for Cialis that features a couple in separate bathtubs gazing toward the horizon has been cited by Nielsen as one of the most remembered commercials. As the erection market has grown and competition increased, the ads have became more risqué, sparking complaints and FDA warnings that the drugs are being hawked as party pills. It is unclear how American households will respond when copywriters start churning out euphemisms for
ejaculate
, but chances are there will be some uproar. Any opposition to such ads will give pause to drug companies and research institutes contemplating new ventures in sexual health.

But advertising is essential for any premature ejaculation drug. “We looked at the examples of Viagra, Levitra, and Cialis as a benchmark for the impact of direct-to-consumer advertising,” Sarah Terry says. “What we found qualitatively is that, after the launch of Viagra, the marketing of each subsequent product expanded the opportunity of those drugs by nearly 15 to 20 percent each. The amount of marketing out there continued to push the population base that much each time.” A similar pattern will presumably emerge with premature ejaculation drugs. The market will swell by millions with each additional approval letter the FDA mails.

Some experts see the real problem as the imposition of normative structures on what is a variable phenomenon. Dr. Leonore Tiefer, associate professor of psychiatry at New York University, is in the vanguard of a movement to undermine the quantification of sexual function. She admits that a drug to delay ejaculation can be useful to some but says there is no such thing as premature ejaculation, and efforts to create drugs to treat it are disingenuous. Sex, Tiefer says, is more like dancing than digestion.

“Fundamentally, being fat or thin is a matter of live variation throughout history and culture,” she says. “The same thing is true of coming quickly or not, having a hard erection when you’re 60 or not. There’s a great deal of variability. To try to stuff it into some simple-minded bottom line is to deny the reality of sex.”

Michael Perelman, the New York psychologist, says ejaculatory latency is just another human characteristic, similar to blue eyes, best plotted along a skewed distribution curve. He would like to see the definition of premature ejaculation divided into four categories of severity: when a man can’t enter the vagina, when sex lasts less than a minute, when sex lasts one to two minutes, and when it lasts two to four minutes. Perelman reasons that the average physician will see people who consider themselves to be suffering from premature ejaculation who last more than one minute but not as long as they would like to.

Remember that Brendan was nearing two minutes that night in New York. We don’t know if he ever felt in control, but distress certainly reared its head. No doctor can fully answer Susan’s question as to what the fuck was wrong with Brendan, and no drug can address the underlying factors that determine how long he lasts on any given occasion.

If Brendan had popped a pill that night, would he have been treating a disease or just enhancing an aspect of everyday life? Our regulatory system is designed to weigh the risks and benefits of drugs used to treat defined diseases, not to improve our lifestyles. But the line between treatment and enhancement is now more blurred than ever.

“Such uses of pharmaceuticals pose challenges for us as a country,” says Perelman. “The challenge is always greater when we talk about sex.”

Big Pharma isn’t going to shy away from this conversation. It’s adept at dictating what’s good and what’s bad and what is normal and what isn’t. Ejaculation won’t be an exception.

Atheists Do It Better: Why Leaving Religion Leads to Better Sex

Greta Christina

Do atheists have better sex? Yes, according to science—more specifically, according to the recently released study “Sex and Secularism.”

In January 2011, organizational psychologist Darrel Ray Ed.D. (a psychologist for 30 years and author of
The God Virus
as well as two books on psychology) and Amanda Brown (an undergraduate at the University of Kansas who focuses on sexuality and sex therapy) conducted a sex survey of over 14,500 subjects—atheists, agnostics, and other people in the secular community. The survey looked at religion, atheism, and sex: how religion affects sex, how leaving religion affects sex, whether lifelong atheists feel differently about sex than people who have recently deconverted, and so on. The report—“Sex and Secularism: What Happens When You Leave Religion?”—is on the Internet, and if you want all 46 pages of the naughty details, including the charts and graphs and personal stories, you can download it free; you only have to register on the website.

But if you just want to know the gist: leaving religion improves people’s sex lives. A lot.

Atheists and other nonbelievers, as a whole, experience a lot more satisfaction in their sex lives than they did when they were believers. They feel much less guilt about their sex lives and their sexuality. The sexual guilt instilled by so many religions tends to fade, and indeed disappear, when people leave religion—much more thoroughly than you might expect. And, according to the respondents of this study, nonbelievers give their children significantly better sex education than believers do.

Now, when it comes to people’s actual sexual behavior, religion doesn’t have nearly as much impact as you might think. Religious and nonreligious people have pretty much the same kinds of sex, at pretty much the same age of onset, and at pretty much the same rate. Believers are just as likely to masturbate, watch porn, have oral sex, have sex outside marriage, and so on, as nonbelievers, and they start at about the same ages. So it’s not that religious sexual guilt is actually making people abstain from forbidden sexual activity. All it’s doing is making people feel crummy about it. And when people leave religion, this crumminess decreases—at a dramatic rate. Believers and atheists are having pretty much the same kinds of sex—but when it comes to the pleasure and satisfaction experienced during this sex, it’s like night and day.

Okay. Before anyone squawks, I’ll start the squawking myself : there are some demographic problems with this study, and it shouldn’t be relied on as the final word on this topic. In particular, the participants in the study aren’t statistically representative of the population; they’re statistically representative of whoever heard about it on the Internet, and they’re disproportionately represented by readers of the hugely popular atheist blog
Pharyngula
. (In fact, in several places throughout the report, the researchers themselves freely acknowledge the limitations of their research.)

But the results of this report are entirely consistent with the results of other research. Lots of other research, both on human sexuality and on religion/atheism. And that makes these results much more plausible. As researcher Darrel Ray told me, “Our data is virtually identical to other national surveys on the basics of when and how people start sexual behavior.” (Citations of those surveys are in the report.) Yes, it’s virtually impossible to get completely accurate, statistically representative information about human sexuality under any circumstances; there’s not really any ethical way to get information about sex other than relying on people’s self-reporting, and it’s a topic that people tend to, you know, lie about. But on the reliability scale for human sex research, this report seems to rank at the high end.

You might also argue—as I did when I first saw this research—that atheists are often pretty hostile to religion, and they aren’t going to give a fair assessment of their sex lives when they were religious. I think this is a valid point, and one that’s worth investigating. In fact, I hope this report marks the beginning of research into this topic rather than the end of it; I would be very interested to see studies about how religious people see their sex lives. I would be especially interested to compare the “Sex and Secularism” results to data from people who have converted from one religion to another, and whether they view their sex lives differently in light of their new religion.

But I’d also point out that the atheists who responded to this survey gave answers that were far from homogeneous. Their responses varied depending on which religion they used to belong to and how intensely religious their upbringing was. They ranged from “ZOMG, my sex life totally sucked and now it’s beyond awesome—I was blind but now I see” to “Meh, it’s a little better, but it’s really not all that different.” So the idea that this report simply reflects a knee-jerk atheist hostility to religion is worth considering, but it’s probably not what’s going on here.