Future sex: on the horizon

By Ian Kerner, Ph.D., LMFT

Sooner or later every guy deals with some type of mechanical "male-function," such as premature ejaculation (PE) or erectile dysfunction (ED). Being quick on the trigger might work great in Westerns, but it's not such a benefit in between the sheets.

Likewise, the laws of physics are a little skewed in the bedroom, where what should go up doesn't always stay up.

If you're dealing with PE or ED, you're not alone. They're two of the most common male sexual health issues. Despite their frequency, though, these conditions remain undertreated. While some men with ED have found temporary help through drugs like Viagra, Levitra and Cialis, it's estimated that more than half of them won't continue using the drug for very long.

Meanwhile, there's been little to no help for men with PE. As I discuss in my new book, Overcoming Premature Ejaculation, we're just starting to understand that PE is less of a psychological issue than a physiological one.

Fortunately, new research is leading to new potential treatments for both conditions. For ED, approaches on the horizon include:

Dopamine boosters. This class of medications, including a drug called apomorphine (Uprima), appears to raise levels of the brain chemical dopamine, which increases sexual interest and sensations. Uprima is currently available in Europe, but not the United States.

Melanocortin inhibitors. Early studies suggest that this class of drugs may trigger erections in men with psychological causes of ED.

Topiglan. This topical form of aprostidal (the same drug found in penile injections and suppositories) is being studied for ED, and so far appears safe and effective.

As for PE, there are two interesting treatments on the near horizon:

Dapoxetine (Priligy). Just as Viagra helps treat ED, a pill is in the works for PE. Dapoxetine is a selective serotonin reuptake inhibitor, a type of medication usually used to treat depression by boosting levels of the brain chemical serotonin, which are also typically lower in guys with PE. SSRIs like Prozac and Zoloft are already prescribed "off label" to treat PE, but dapoxetine is being tested and marketed specifically as a treatment for PE.

Unlike other SSRIs, dapoxetine is short-acting, so you only take it "on demand" an hour or so before sex, similarly to Viagra. Studies suggest that dapoxetine can delay orgasm and increase Intravaginal Ejaculatory Latency Time (IELT), which measures how long a man can have intercourse before he ejaculates. Dapoxetine has also been shown to reduce distress and relationship difficulties associated with PE. Despite such benefits, dapoxetine isn't yet available in the United States. The drug, which is made by Johnson & Johnson, is sold in over 50 other countries under the brand name Priligy.

PSD502. Also known as TEMPE spray, this topical treatment contains an aerosol version of lidocaine and prilocaine, two numbing agents. Studies suggest that, when sprayed on the penis, PSD502 appears to significantly increase IELT and improve ejaculatory control and sexual satisfaction, with minimal side effects. Like dapoxetine, PSD502 isn't currently available in the US.

Although these future treatments are exciting, it's important to remember that both PE and ED are best treated with a combination of measures, including counseling, behavioral changes, and sexual approaches. Medications are just one more important weapon in our arsenal against these issues.

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