Other ED fixes are made to last. Vacuum pumps put negative pressure on the penis, creating an erection that can be maintained for about 30 minutes by placing an elastic band around its base. Studies report success rates of 70 to 94 percent with the devices, but side effects can include pain, numbness, bruising, and obstructed ejaculation. Surgical implants are pricier but have upsides. Men can inflate the implants at will, using a pump placed in the scrotum. Satisfaction rates are high.
Yet despite the availability of solutions, many harried doctors are not as aggressive as they could be about sleuthing out sexual problems. That puts the burden of speaking up on men.
Pacing Performance
Is premature ejaculation the most common form of male sexual dysfunction? The answer is debated, but one thing is clear: For men who have the problem, it can be a showstopper. "I see young guys who simply cannot establish a relationship with a woman because of this," says Ira Sharlip, a spokesperson for the American Urological Association.
The past few years have brought a surge of interest from pharmaceutical researchers aiming to relieve the problem with a pill. So far, no medication has been approved for the purpose; the Food and Drug Administration turned down a drug called dapoxetine in 2005. Yet doctors can and often do prescribe drugs that are approved for other conditions, such as the antidepressants paroxetine (Paxil) and fluoxetine (Prozac), which have been shown to lengthen intercourse by a few minutes. Potential downsides, experts say, include diminished intensity of a man's orgasm and libido and a hampered ability to maintain an erection.
Creams and gels that numb the sensitivity of the penis are another option. They usually contain lidocaine or prilocaine. Studies have shown them to be effective, but some couples find them difficult to use. They generally involve a messy application within a condom and can numb a partner.
A man's mind-set can play a role. "It's pretty unusual to see premature ejaculation without some degree of psychological component," says Fagin, the Prostate Center of Austin urologist. Therapists can work with men to address anxiety, stress, guilt, and depression—and can impart techniques like the "stop and go" method or the "squeeze" method to help men slow down. Honest partner-to-partner communication is also critical, says Barry McCarthy, coauthor of Coping With Premature Ejaculation. For example, he says, some women simply can't achieve orgasm through vaginal penetration, yet a partner might blame himself unless the couple discusses how the woman can reach a climax.
More often than not, the only real problem may be outsize hopes. In various surveys, between 20 and 40 percent of men complain about the short duration of intercourse. But fewer than 5 percent have a sustained disorder in which they consistently ejaculate in a minute or less, estimates Marcel Waldinger, associate professor in sexual psychopharmacology at the Hague Leyenburg Hospital in the Netherlands.
"Nobody really knows how long is normal. It's very subjective," says Martin Miner, a clinical assistant professor of family medicine at Brown University Medical School. In a March survey, sex therapists typically said satisfactory intercourse should last three to 13 minutes. That's a far cry from the 30-plus minutes that many men say they want.
Overcoming an Anticlimax
It begins as a swelling of excitement and tension. Then, it's like falling off a cliff. That's how Linda Banner, 59, describes an orgasm, the deli-cious sensation that she couldn't experience for the first decade of her sex life.
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