The time has not yet come

Now we talk of an issue of national consequence: Premature ejaculation.

It is a problem that no one saw coming.

But Dr. Dennis Serrano, urologist, sees it coming most, if not all, of the time. Thankfully, he is on the correct side of the problem.

Dr. Serrano, a past president of the Philippine Urological Association who specializes in urologic surgery and kidney transplantation, tells us the whys, the hows, and the why-now-not-laters of a problem that comes before its time. 

RJ LEDESMA: So, Doc, you’re a urologist?

DR. SERRANO: Yes. Unfortunately, people confuse my specialty with neurology. Neurology deals with the brain and the nerves. Urology deals with the other head, which is the urinary tract and the male genital tract.

As long as you are dealing with the head that needs the most help, doc. So, being a urologist, you’ve seen many penises in your lifetime?

More than I’d care to. But, correct: we see a lot.

I’m sure that you always handle with care. Seeing penises of many shapes, sizes and religious affiliations, does it — I don’t know — give you an inferiority complex? Psychological trauma? Eyestrain?

So far, I feel superior naman. No complexes yet.

But you haven’t had the pleasure of examining me just yet. Speaking of examining my pink parts, can you just diagnose by observation? Or does it require, well, for you to get a bit more intimate?

We go inside the penis. A lot. And the urethra and the prostate and the bladder. Somebody has to do the dirty job.

Before you do this, do you have a couple of drinks first with the patient?

Usually, we drink after because we have to wash it down. (Laughs)

What — exactly — are you washing down? Anyway, let’s get to the meat of the discussion. What exactly do you mean when you say premature ejaculation? And, please remember, the CBCP could be reading this.

There are several definitions out there. Some even have to do with timing — you look at how long the penis has been inserted into the vagina and you time that duration. We call it the “intravaginal ejaculatory latency time.”

Is that time a quarter past 12?

It is the time during which you do not ejaculate when you are inside the vagina.

Who does the timing? The yaya? Mine’s like 5.4 minutes or so.

RJ’s YAYA: Ser, as per your record, mukhang—

Somebody shoot yaya with the tranquilizer gun, please.

DR. SERRANO: It can be as precise as that. And we can tell you that it’s three minutes and below or one minute and below to ejaculation. But on a more practical note, premature ejaculation is ejaculating when you don’t want to yet, except that you cannot control it. So it’s really more of a loss of control.

Most men are hopeless without a remote control.

(Premature ejaculation is) not something that makes you sick, but it’s something that gives you distress. The distress is both emotional and psychological. It’s a distress that not only affects the man, but even more so, the partner.

(No Girlfriend Since Birth representative: Does it matter if your partner is real, imaginary, digital or inflatable?)

In the past, (premature ejaculation) did not get much attention because it is not a life-threatening condition.

(Dirty Old Man representative: But my partner has threatened me many times.)

In the past, it wasn’t the men who were coming forward (to discuss the problem), rather it was their partners. It’s the Filipino male psyche: “I’m a macho guy. I don’t need to consult. It’s not really a problem for me”—

(DOM representative: Because everything can be solved with Viagra and Elmer’s Glue.)

But it distresses the females because it is something they don’t really understand. So they end up asking their family physician or ob-gyn. What we want to do now is to demystify premature ejaculation.

I didn’t realize that premature ejaculation had a mystique about it.

We know that it can cause distress and discord in a relationship. Remember that the objective of intercourse is to ejaculate at a time that is mutually—

Exclusive?

Satisfactory with his partner. If the male is a silent sufferer, you’ll be surprised at how stoic the female can be (when it comes to this problem). There are some women out there who don’t even know that her husband (suffers from) premature ejaculation. She doesn’t know that (her sex life) could actually be better. Nobody will usually come to (urologists) in hysterics (over this problem).

YAYA: Usually.

DR. SERRANO: But now there is treatment (for premature ejaculation). If there was something that could address (your distress), wouldn’t you try?

(DOM representative and Yaya in unison: Amen.)

So how do you know what is the average time for one to reach ejaculation? Do you calibrate versus your friend? Your dog? Porn movies?

Premature ejaculation cannot be diagnosed with a solitary sexual experience.

(NGSB: So all the studies I have done on premature ejaculation are all for naught!?)

If premature ejaculation is defined as a loss of control, then technically speaking it can happen in five seconds or — in the case of Sting — five hours? 

Well, strictly speaking, if you’re there for 15 minutes and then you ejaculated when you did not want to, then that is still a loss of control.

(NGSB representative: That’s 15 minutes more than I’ll ever have.)

But as far as physicians are concerned, we’d like to put precision and a scoring system to what we do.

I didn’t realize that ejaculation was so competitive.

That’s why we have a tool. 

What kind of tool? Screwdrivers? Pliers? A hammer?

It’s a premature ejaculation diagnostic tool (PEDT), (a questionnaire) that will evaluate your (ability to) control ejaculation. It is not only the time (to ejaculation), but also the degree of distress. After answering the questionnaire, you get a score. If the score is 11 and higher—

You get a medal?

Then you have premature ejaculation. (The questionnaire) provides a standardized way of talking about it. Did your premature ejaculation (time) improve? “Well, Doc, my previous PEDT score was now 13 and my current score is 8. So I must be improving.” That’s the value of the tool.

(DOM representative: Wala bang fixer diyan para tumaas yung score ko sa PEDT?)

So your patients don’t have to demonstrate their premature ejaculation problem in front of you?

Heavens, no.

(NGSB representative: Not that I would have a problem with that.)

Although it’s been done in the past by some sex therapists. This is a condition that has been around for some time,

(DOM representative: Tell me about it.)

Except that people don’t come forward (to talk about it). Take Viagra, for example. Back in 1990s, do you think people would go to their physician and say “I’m 35 years old and I’m having trouble getting an erection”?

(NGSB representative: My goodness, how did they address that problem back in those days? With plastic straws and masking tape?)

But now you’ve got yuppies asking for Viagra because they have problems getting erections. You can now see the degree of nonchalance (in the way) people discuss erectile dysfunction, not like two decades ago.

(DOM representative: I’ve stockpiled enough Viagra to last me ‘til the next Ice Age.)

That’s what the (premature ejaculation) medicine brought about. It’s a more liberalized way of looking at the condition.  For those who have been suffering silently, they can now come forward—

Or come in due time.

We give them a better sexual experience and, eventually, a better quality of life.

I’m sure that your quality of life is vastly improved when you don’t have to demonstrate your problem in front of a therapist. Doc, does premature ejaculation occur only during intimate situations, or can it happen outside the realm of sexual contact? For example, like taking a bath or commuting or while relieving yourself in a public urinal?

Here’s the thing. There are two types of premature ejaculation.

Really? I haven’t really been keeping count.

One (type) is “acquired” — that is, suddenly developed. Let’s say you never had that problem as a teenager up to when you were a twenty-something guy who was “wise in the ways of the world.” Now, you’re 35 years old, you have kids, a business to run and deadlines to meet. Suddenly, there’s a problem.

What’s the problem? You can’t meet your deadline?

It could be psychogenic or emotionally related or situational (like you have a new partner).

If you acquire it, can’t you just return it?

(The second type) is the premature ejaculation that is life-long. This is sad because when these teenagers start becoming “wise in the ways of the world” and have their first “encounter,” they experience premature ejaculation and they don’t know any better.

(DOM representative: So that’s what happened when I dirtied my saber-toothed tiger skinned loincloth!)

They’ll think it’s because I was young and really excited, that’s why it happened. But it happens when they are newly married, it happens throughout their marriage, and — heaven forbid — it happens when they have an (extra marital affair) because they think they might have a better sexual experience (with someone else). (Premature ejaculation) factors into a lot of other emotional and psychological aspects such as self-image and self-esteem.

(DOM representative: Maybe I suffer from premature ejaculation because I think I’m forever young?)

Doc, are there some people who are more prone to premature ejaculation than others?

Well, there’s no profile to say that you are more prone to it, like say if you have an impulsive behavior or you’re a high-profile businessman—

Or a politican.

It’s not like erectile dysfunction (which can be caused by) diabetes or hypertension or a coronary artery disease (wherein you are also most likely to have vascular disease of the penis). We once thought that (premature ejaculation) was mainly psychological or emotional or situational. Now we know it’s a condition that involves neurotransmitters in the brain.

So one head isn’t being cooperative with the other head?

There is an organic basis for premature ejaculation. And there is a science to modify the neurotransmitters in your brain called serotonin — the “happy drug” of the brain — so you get better control of your ejaculation. Serotonin is the “feel good” chemical of the brain. Let’s say that there are two nerves in your brain, one that tells you “Enjoy! Don’t ejaculate just yet.” The other (nerve) tells you “I can’t control it anymore! I have to ejaculate!”

(DOM representative: Doc, it’s like you can read my mind.)

What these nerves do is to secrete the serotonin. Serotoin is in a synapse (which is in between the two nerves) and it makes it easier for the nerves to hold off ejaculation. Unfortunately, serotonin gets broken down and taken up again to be used by the nerves. If your nerves take it up too fast and you deplete the serotonin in the synapse, then you lose control. (What the new medication, Dapoxetine, does) is to keep the serotonin from being taken up by the nerve again. So you have a good supply of serotonin in the synapse so that you can still maintain control of the remaining part of the cascade.

Doc, I think if you explain this to people while they are in the middle of their “encounter,” it will most definitely delay the onset of premature ejaculation.

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For comments, suggestions or if you want to calibrate, please email ledesma.rj@gmail.com or visit www.rjledesma.com. Follow @rjled on Twitter and @rjled610 on Instagram.

If you’re interested to take the Premature Ejaculation Diagnostic Tool (PEDT), please visit www.controlPE.ph.