When Is Ejaculation 'Premature,' and When Should a Penis Be Made Numb?

With personal lidocaine spray, anesthetized genitals are just a "please excuse me for a moment" away.

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How long is sex supposed to last? One consensus of sex therapists said 3 to 7 minutes of penis-in-vagina is "adequate," while 7 to 13 minutes is "desirable." 

If three minutes is adequate, then when does being a little quick on the trigger become an actual medical diagnosis?

The International Society of Sexual Medicine defines premature ejaculation as meeting all of three criteria: finishing most of the time within one minute and having it result in personal distress.

It's difficult to imagine a situation in which that wouldn't result in distress, personal and otherwise. What relationship could smilingly endure it? But there's also clearly a continuum, on the side beyond a minute but short of ideal -- often well within the ranges therapists might consider adequate or desirable -- where distress may be milder but still entirely relevant to confidence and relationships. 

Luckily, medical science is on the case. I spoke with Dr. John Mulhall, a urologist and the director of the Male Sexual and Reproductive Medicine Program at Memorial Sloan-Kettering in Manhattan. According to him, when we talk casually about premature ejaculation (people talk casually about premature ejaculation, right?) we're usually talking about what the medical community would consider "premature-ejaculatory-like syndrome," or simply "rapid ejaculation." It's not as severe as the strict premature ejaculation diagnosis, but it can have the same divisive result. About one in four guys experience it regularly. 

Looking for a down-to-the-minute definition of rapid ejaculation is a natural impulse, but not an ideal way of looking at it. Mulhall says it comes down to whether the guy lasts long enough. If his partner is made wholly replete in 90 seconds, then a man who lasts 95 seconds can be fine. But if another guy lasts 15 minutes, and that's not cutting it, then it's a problem and can be considered rapid. 

***

In the late 1980s, when physicians started prescribing SSRI medications to treat depression (now known as Zoloft, Paxil, Prozac, etc.), some patients taking them noticed that they were also taking longer to ejaculate. So doctors started prescribing SSRIs for non-depressed patients, to treat premature ejaculation. And, largely, it worked. 

Still a lot of people don't like the idea of taking a pill. Costs, side effects -- especially for people tangentially on the rapid ejaculation spectrum, it's not always easy to justify being on an SSRI. That's where topical numbing treatments can come in.

Dr. Ronald Gilbert, a urologist in Newport Beach, California, is the Chief Medical Officer of a company that makes a lidocaine spray used in situations like these. Gilbert personally sees it beyond that, as a first-line therapy for premature ejaculation.

The concept isn't new, and these lidocaine sprays have received a thoroughly mixed bag of reviews. That may be because they don't address the psychological component of the problem (which, some argue, is the only component). But Gilbert believes that his formula, called Promescent, works. He told me about it in flowing jargon involving binary eutectic, a pKa very near the pH of lidocaine, and a two-phase meld system that drives lidocaine through the stratum corneum of the skin of the penis.

Presented by

James Hamblin, MD, is a senior editor at The Atlantic. He writes the health column for the monthly magazine and hosts the video series If Our Bodies Could Talk.

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