2

3
BY
CHRIS
SWEENEY
BIG PHARMA
WANTS TO
TAKE YOU
FOR A RIDE
ILLUSTRATION BY
YUKO SHIMIZU
usan and Brcndan had bccn
dating for a month whcn
thcy dccidcd to spcnd a
wcckcnd togcthcr in Ncw
York. Thcy had mct in
FaÌÌs Church, Virginia, and
whiÌc Susan was not com-
pÌctcÌy soÌd on Brcndan,
sncaking around thc officc
and having a quickic in thc copy
room kcpt hcr intcrcstcd. As thcy
unpackcd thcir bags and scttÌcd into a
dingy hotcÌ on thc Lowcr East Sidc, thc
tcnsion that had mountcd during thcir
fivc-hour drivc snappcd.
Thc coupÌc dovc into bcd with thc
cagcrncss that accompanics a ncw rcÌa-
tionship. But thc much-anticipatcd
scssion pctcrcd out in two minutcs,
bcforc Susan couÌd cvcn warm up.
¨What thc fuck is wrong with you.¨ shc
askcd as Brcndan roÌÌcd off hcr. This
markcd at Ìcast thc fifth timc in thcir
rcÌationship that Brcndan had c¡acu-
Ìatcd too quickÌy for Susan's Ìiking, and
dcspitc thc fact that hc aÌways countcrcd
¨with a good munch,¨ hcr paticncc had
pcakcd. Brcndan rctrcatcd downstairs
for a cigarcttc, wishing to avoid furthcr
intcrrogation.
Js thcrc somcthing wrong with Brcn-
dan. Jt dcpcnds on whom you ask.
Thc prospcct of a scx-fiÌÌcd vacation
may havc put him in a statc of anxi-
cty that was manifcstcd in this scxuaÌ
shortcoming. Or Brcndan may bc
gcncticaÌÌy prcdisposcd to havc a
Ìow c¡acuÌatory thrcshoÌd, posscss-
ing a hypcrscnsitivc pcnis that Ìcts
him Ìast onÌy a fcw minutcs. Jt may
bc that thc cascadc of dopaminc,
scrotonin, oxytocin and othcr
ncurochcmicaÌs is at fauÌt. Somc
wouÌd suggcst Brcndan's carÌy
c¡acuÌation couÌd bc Ìinkcd to how
hc masturbatcs or is cmbcddcd in
his pubcsccnt scxuaÌ cncountcrs. Or,
of coursc, thcrc is aÌways thc possibiÌ-
ity that nothing is wrong with Brcndan,
that Susan's cxpcctations ¡ust don't aÌign
with his capabiÌitics for impromptu
intcrcoursc.
Susan's postcopuÌatory inquiry into
what thc fuck was wrong took Brcndan
down a notch, and thcir tryst fizzÌcd out
soon aftcr. Mcn with rapid c¡acuÌation
worry thcir partncrs wiÌÌ Ìcavc thcm,
and thc addcd anxicty ¡ust makcs thc
condition worsc.
Scx is highÌy variabÌc. A 200b study
pubÌishcd in 1/s journa| oj Ssvua| MsJ|·|ns
uscd stopwatchcs to mcasurc intravaginaÌ
c¡acuÌation Ìatcncy, or how Ìong a man
Ìasts from thc start of intcrcoursc untiÌ
c¡acuÌation. Thc study Ìookcd at b00 cou-
pÌcs and rcvcaÌcd a mcdian timc of b.4
minutcs. Thc duration of thc mcn-who
wcrc rccruitcd from thc L.S., thc L.K.,
Turkcy, Spain and thc NcthcrÌands-
rangcd from undcr a minutc to about
4b minutcs. Thc avcragc timc varicd
for cach country, with thc Turks com-
ing first at 3.7 minutcs. Condoms had no
impact on thc avcragc timc, and bcing
circumciscd yicÌdcd an insignificant
bcncfit. Anothcr study, aÌso pubÌishcd
in 200b in 1/s journa| oj Ssvua| MsJ|·|ns,
rcvcaÌcd a mcdian timc of 7.3 minutcs
among 1,380 L.S. mcn not considcrcd
to havc c¡acuÌation difficuÌtics. Thc study
aÌso incÌudcd 207 mcn considcrcd to bc
prcmaturc c¡acuÌators, who cÌockcd an
avcragc timc of 1.8 minutcs.
Prsma/urs sja·u|a/|on is a tcrm cvcryonc
has hcard but fcw can dcfinc bcyond thc
obvious ¨whcn a guy comcs too carÌy.¨
A taboo Ìooms ovcr thc issuc, with most
convcrsations rcÌcgatcd to punch Ìincs
or dcnsc mcdicaÌ Ìitcraturc. To bc fair,
bcforc thcrc was ED thcrc was impo-
tcncc, and that wasn't a choicc taÌking
point cithcr.
Dctcrmining what constitutcs thc
condition has rcccntÌy bccn opcn to
incrcasing dcbatc. Js it thc inabiÌity to
Ìast morc than a prcdctcrmincd timc.
Js it not bcing abÌc to rccognizc whcn
c¡acuÌation wiÌÌ occur.
Thc focus on crcating a univcrsaÌ dcfi-
nition of primary prcmaturc c¡acuÌation
is drivcn in part by thc pharmaccuti-
caÌ industry's intcrcst in scÌÌing drugs
that makc a man Ìast Ìongcr. |ohnson
& |ohnson's drug for carÌy c¡acuÌation,
dapoxctinc, is approvcd in a handfuÌ
of ovcrscas markcts undcr thc brand
namc PriÌigy. Thc drug, rc¡cctcd by thc
FDA in 200b, has bccn shown to Ìcad to
a thrccfoÌd incrcasc in duration whcn
takcn in a 60-miÌÌigram dosc about an
hour bcforc scx. Dapoxctinc is a scÌcc-
tivc scrotonin rcuptakc inhibitor, as arc
thc antidcprcssants Prozac and PaxiÌ. A
wcÌÌ-known sidc cffcct of most SSRJs is
dcÌaycd c¡acuÌation, Ìcading many doc-
tors to prcscribc thcm to mcn in nccd of
a fcw cxtra thrusts. Lsing a sidc cffcct of
a drug to trcat a condition for which thc
drug is not approvcd is hardÌy idcaÌ, but
no FDA-approvcd trcatmcnt cxists.
Shionogi is a |apancsc pharmaccuti-
caÌ company bascd in Osaka. Jt rcccntÌy
wrappcd up Phasc JJJ studics-thc Ìast
and Ìargcst stagc of tcsting, whcn a drug
is comparcd with othcr trcatmcnts-
on an cxpcrimcntaÌ compound dubbcd
PSDb02. Thc drug is a combination of
thc topicaÌ ancsthctics Ìidocainc and
priÌocainc and is spraycd on thc hcad
of thc pcnis a fcw minutcs bcforc scx.
Jn studics of about 1,000 mcn and thcir
fcmaÌc partncrs, PSDb02 proÌongcd thc
point of no rcturn from an avcragc of
0.6 minutcs to 3.3 minutcs. Thcrc is
nothing novcÌ about using drugs to
dcscnsitizc thc ncthcr rcgions, but
most such drugs arc crcams, and rub-
bing crcam on thc pcnis of a man who
is trying to Ìast Ìongcr sccms iÌÌ-adviscd.
Dr. DonaÌd Manning, Shionogi's chicf
mcdicaÌ officcr, says thc spray appcars
to rcducc scnsation without numbing
thc pcnis-aÌways a good thing if you
actuaÌÌy want to cn¡oy scx-pointing
out that fcwcr than two pcrccnt of mcn
who uscd it rcportcd numbncss.
t
Thc pharmaccuticaÌ industry's intcrcst
in scrving a vast markct of prcmaturc
c¡acuÌators isn't thc onÌy factor bchind
argumcnts about how thc condition
shouÌd bc dcfincd. 1/s D|agnos/|·
anJ S/a/|s/|·a| Manua| oj Msn/a| D|s-
orJsrs, thc Amcrican Psychiatric
Association's rcfcrcncc tcxt, is
bcing rcviscd for its fifth cdition.
Somc pcopÌc havc criticizcd thc
DSM's currcnt dcfinition of prc-
maturc c¡acuÌation as bcing too
sub¡cctivc. Thc symptoms of PE,
according to thc fourth cdition of
thc DSM, incÌudc ¨c¡acuÌation with
minimaÌ scxuaÌ stimuÌation bcforc,
on or shortÌy aftcr pcnctration and
bcforc thc pcrson wishcs it.¨
Dr. Robcrt TayÌor Scgravcs, profcssor
of psychiatry at Casc Wcstcrn Rcscrvc
Lnivcrsity and a mcmbcr of thc DSM
rcvision pancÌ, says this dcfinition is
so vaguc any numbcr of pcopÌc can bc
diagnoscd with a probÌcm. Somc studics
cvcn cÌassify mcn who Ìast wcÌÌ bcyond
fivc minutcs as prcmaturc c¡acuÌators.
¨Jt sounds kind of mcaningÌcss at
that point,¨ Scgravcs says. ¨Wc
nccd grcatcr prccision.¨
Thc draft proposaÌ of
thc ncw cdition of thc
DSM rccommcnds
dropping þrsma/urs
and rcnaming thc
condition ¨carÌy
c¡acuÌation.¨
S c g r a v c s
and MichacÌ
4
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5

6
PcrcÌman, a Manhattan-bascd psychoÌo-
gist who is prcsidcnt of thc Socicty for Scx
Thcrapy and Rcscarch, agrcc that þrsma-
/urs has a pc¡orativc connotation. Howcvcr,
PcrcÌman-who aÌso scrvcs as a consuÌtant
for pharmaccuticaÌ companics-prcdicts that
in thc futurc it wiÌÌ ÌikcÌy bc known as PE, ¡ust
as crcctiÌc dysfunction is now caÌÌcd ED.
A fcw ycars back, PÌcthora SoÌutions, a
L.K.-bascd drug firm, awardcd an unrc-
strictcd grant to thc JntcrnationaÌ Socicty
for ScxuaÌ Mcdicinc to cxpÌorc thc cvidcncc.
A crcw of 21 Ìcadcrs ranging in spcciaÌtics
from psychiatry to ncurouroÌogy mct in
Amstcrdam in 2007 to prcparc a diagnostic
bÌucprint for mcn who c¡acuÌatc too quickÌy.
Aftcr wading through thc data, thc Ìcadcrs
cmcrgcd with what is now considcrcd to bc
thc goÌd-standard dcfinition. Thc JSSM's
dcfinition considcrs thc dysfunction to bc
¨c¡acuÌation which aÌways or ncarÌy aÌways
occurs prior to or within about onc minutc
of vaginaÌ pcnctration,¨ rathcr than simpÌy
bcforc a pcrson wishcs it to occur.
Thc JSSM, Ìikc thc DSM, takcs into
account thc strain that PE can pÌacc on a
man, his partncr and thcir rcÌationship.
But it is thc onc-minutc bcnchmark-thc
quantitativc cnd point-that may provc vitaÌ
in bringing PE drugs to our prcscription-
hungry nation.
PÌcthora SoÌutions' dccision to givc thc
JSSM a grant for a dcfinition was not ¡ust
a gcsturc of goodwiÌÌ. PÌcthora dcvcÌopcd
thc abovc-mcntioncd c¡acuÌation-dcÌaying
spray, PSDb02, and Ìiccnscd it to ScicÌc
Pharma, which was Ìatcr acquircd by Shion-
ogi. ShouÌd Shionogi succccd in bccoming
thc first company to havc an FDA-approvcd
drug for prcmaturc c¡acuÌation, PÌcthora
couÌd scc a windfaÌÌ in royaÌtics. Manning,
Shionogi's hcad mcdicaÌ officcr, says thc
company uscd thc onc-minutc bcnchmark
in thc data it coÌÌcctcd, as wcÌÌ as aspccts
of controÌ and distrcss. Jn fact, data from
thc study show that mcn who wcrc givcn
thc drug rankcd significantÌy highcr on a
scaÌc of c¡acuÌatory controÌ than mcn givcn
a pÌaccbo.
Shionogi and |&|-which is anaÌyzing its
own dapoxctinc data for a potcntiaÌ FDA
rcsubmission-arcn't thc onÌy drug makcrs
who hopc to crack this markct. Sarah Tcrry,
prcsidcnt of biomcdicaÌ data providcr Lifc
Scicncc AnaÌytics, says about 20 pÌaycrs
arc Ìooking to gct in. GÌaxoSmithKÌinc is
among thcm, with two drugs in dcvcÌop-
mcnt: onc dcsigncd to inhibit oxytocin and
thc othcr an SSRJ. Both arc in Phasc JJ
tcsting, whcn scicntists dctcrminc if a pro-
poscd mcdication is actuaÌÌy associatcd with
a thcrapcutic bcncfit.
t
Prcmaturc c¡acuÌation is attractivc to
drug companics bccausc it rcprcscnts an
cntircÌy ncw markct at a timc whcn thcy
nccd to rcpÌcnish thcir pipcÌincs with ncw
compounds. Big Pharma is hurtÌing toward a
patcnt cÌiff, and gcncric companics arc rcady
to pouncc on thc opportunity to churn out
chcapcr vcrsions of Lipitor and Viagra, which
comc off patcnt in 2011 and 2012. Tcrry says
that bctwccn 2008 and 2014, $113 biÌÌion
worth of drugs wiÌÌ havc thcir patcnts cxpirc.
7
Thc potcntiaÌ of a drug for prcmaturc
c¡acuÌation dwarfs that of an crcctiÌc-
dysfunction drug. Estimatcs vary-mainÌy
bccausc of thc dcfinition issuc and troubÌc
in dcsigning studics-but bctwccn 20 and
30 pcrccnt of thc popuÌation couÌd bc con-
sidcrcd prcmaturc c¡acuÌators. Onc markct
study, from Datamonitor, cstimatcs that in
2010 thc L.S. popuÌation of carÌy c¡acuÌators
bctwccn thc agcs of 20 and b9 is 2b.8 miÌ-
Ìion, comparcd with 9.b miÌÌion mcn in
nccd of boncr drugs. And that docsn't
incÌudc ovcrscas markcts. ¨J think thc FDA
is uÌtimatcÌy wiÌÌing to approvc a drug for
prcmaturc c¡acuÌation,¨ Tcrry says. ¨Thc
chaÌÌcngc at this stagc is ¡ust dcfining what
that actuaÌÌy mcans.¨
t
Jn thc days of King CharÌcs JJ, thc Ìast Span-
ish Habsburg ruÌcr and onc of thc most rcgaÌ
prcmaturc c¡acuÌators on rccord, scxuaÌ dys-
functions wcrc thc product of witchcraft.
Jnnovativc trcatmcnts incÌudcd cxorcisms
and urinating through your wcdding ring
or thc kcyhoÌc of thc church whcrc you wcrc
marricd. Fast forward to thc carÌy 20th ccn-
tury and you'ÌÌ comc across a sca of crotic
snakc oiÌ, incÌuding an arscnic-containing
cÌixir in Dr. Frank MiÌÌcr's 1913 tomc, Domss-
/|· MsJ|·a| Pra·/|·s. Jn thc Ìatc 19b0s, in thc
wakc of Kinscy camc thc work of WiÌÌiam
Mastcrs and Virginia |ohnson, bcttcr known
as Mastcrs and |ohnson. Thc duo dcvcÌopcd
thc stiÌÌ popuÌar squcczc tcchniquc to pro-
Ìong scx, which, as its namc impÌics, invoÌvcs
putting a strangÌchoÌd on thc hcad of thc
pcnis bcforc c¡acuÌation. Studics havc dcm-
onstratcd its cfficaciousncss, but cvidcncc
suggcsts that without rcguÌar upkccp thc pos-
itivc cffccts wcar off. AÌso, it can bc awkward
to ask somconc you'rc sÌccping with for thc
first timc to put your dick in a dcath grip.
¨Mastcrs couÌdn't do any anaÌysis-hc
didn't havc any funding-so what hc did was
hirc prostitutcs to obscrvc thcm, intcrvicw
thcm, idcntify how thcy had scx and what
thc scxuaÌ issucs of thcir Ìivcs wcrc,¨ says Dr.
Jrwin GoÌdstcin, dircctor of scxuaÌ mcdicinc
at AÌvarado HospitaÌ in San Dicgo. GoÌd-
stcin, who was an acquaintancc of Mastcrs's,
notcs that thc atmosphcrc surrounding scx-
uaÌ rcscarch was so rcstrictivc in thc carÌy
days of his work that Mastcrs struggÌcd to
gct mcdicaÌ tcxts about fcmaÌc rcproductivc
anatomy. ¨Thc thing is, prostitutcs saw a Ìot
of mcn who wcrc anxious and strcsscd, so
his formuÌations wcrc madc on bad obscr-
vations bccausc of popuÌation bias. Jt was
thcir thcory, which is pcrpctuatcd cvcn in
2010, that 90-pÌus pcrccnt of aÌÌ scxuaÌ prob-
Ìcms arc duc to psychoÌogicaÌ issucs: anxicty,
humiÌiation, fcar, dcprcssion.¨
GoÌdstcin is cditor-in-chicf of thc 1/s
journa| oj Ssvua| MsJ|·|ns (and aÌso a drug
company consuÌtant). For morc than 20
ycars hc was fundcd by thc NationaÌ Jnsti-
tutcs of HcaÌth to study scxuaÌ function and
dysfunction. Hc is highÌy criticaÌ of thosc
who bcÌicvc such disordcrs arc rootcd soÌcÌy
in psychoÌogy. Whcn hc tcÌÌs you about a
man who can't watch his wifc strip down
without c¡acuÌating aÌÌ ovcr himscÌf or about
a 28-ycar-oÌd guy who hasn't had an crcc-
tion for morc than a dccadc bccausc of a
damagcd artcry, you Ìcarn how dcbiÌitating

8
scxuaÌ dysfunction can bc.
For GoÌdstcin, thc work of a BayÌor Lni-
vcrsity uroÌogist, F. BrantÌcy Scott, was thc
cataÌyst that took thc trcatmcnt of scxuaÌ
dysfunction from thc hcad doctors and
brought it into thc mcdicaÌ ficÌd. ¨Jt had to
cnd up in a physician's hands to progrcss
aÌong mcdicaÌ thinking and diagnostics,¨ hc
cxpÌains. Scott, who dicd in a pÌanc crash in
1991, pÌaycd an instrumcntaÌ roÌc in dcvcÌ-
oping thc infÌatabÌc pcniÌc prosthcsis, which
has bccn uscd to trcat tcns of thousands of
paticnts. Thc dcvcÌopmcnt of this surgicaÌÌy
impÌantcd dcvicc transformcd thc Ìandscapc
of rcscarch and opcncd thc ficÌd of scxuaÌ
mcdicinc. ¨Prcmaturc c¡acuÌation, Viagra,
orgasm dysfunction, aÌÌ this stuff cndcd up
in thc ficÌd of uroÌogy,¨ says GoÌdstcin.
By now an array of drugs-incÌuding
ncuroÌcptics, tricycÌic antidcprcssants, opi-
oid agonists, phosphodicstrasc inhibitors,
sympathoÌytics and SSRJs-havc had thcir
cffccts on c¡acuÌation studicd by pharma-
ccuticaÌ cnginccrs. Bcyond drugs, modcrn
rcscarchcrs havc tcstcd rings that wrap
around thc pcnis, bchavioraÌ tcchniqucs
such as thc stop-start approach and cvcn
virtuaÌ-rcaÌity programs intcndcd to hcÌp
mcn cxpÌorc thcir scxuaÌ dcvcÌopmcnt for
cvcnts that might havc infÌucnccd thcir c¡ac-
uÌatory rcfÌcx. Much rcmains to bc Ìcarncd
about thc mcchanisms of c¡acuÌation, but
rcscarch boÌstcrs thc notion that it is rootcd
in ncurochcmicaÌ intcractions.
¨Thcrc arc pcopÌc who nccd hcÌp, and wc
havc to bc scnsitivc to thcir nccds and not bc
rigid,¨ says GoÌdstcin, who dirccts paticnts
to buy dapoxctinc from onÌinc pharmacics
in forcign countrics-a proccss no morc
compÌicatcd than ordcring a book from
Amazon.com.
t
Numcrous chaÌÌcngcs Ìoom ovcr thc suc-
ccss of any drug, and for onc that cxtcnds
intcrcoursc thc most significant factors wiÌÌ
bc pricing and pcrccption. ¨Bccausc prc-
maturc c¡acuÌation is in such a broad rangc
of paticnts and docsn't havc a corrcÌation
with agc, it is actuaÌÌy much morc in Ìinc
with a ÌifcstyÌc drug,¨ says Tcrry of Lifc
Scicncc AnaÌytics. ¨Bccausc it wiÌÌ bc a Ìifc-
styÌc drug, it won't bc rcimburscd by hcaÌth
insurancc. PcopÌc wiÌÌ havc to pay out of
pockct for it.¨
Gctting mcn to schcduÌc an appointmcnt
to taÌk about an ostcnsibÌy cmbarrassing dis-
ordcr and thcn pcrsuading thcm to cough
up moncy for trcatmcnt wiÌÌ rcquirc a costÌy
dispÌay of advcrtising acumcn. Thc battÌc
ovcr dircct-to-consumcr advcrtising is noth-
ing ncw, with onc sidc considcring it paticnt
cducation and thc othcr considcring it a
tooÌ of dcccption. Such drug ads arc aÌmost
cxcÌusivc to thc L.S., coming to thc airwavcs
onÌy in thc 1990s. Thc stakcs arc now hugc:
Pfizcr rccruitcd thc Ìikcs of Bob DoÌc, RafacÌ
PaÌmciro and NASCAR drivcr Mark Mar-
tin to pitch Viagra. EÌi LiÌÌy's ad for CiaÌis
that fcaturcs a coupÌc in scparatc bathtubs
gazing toward thc horizon has bccn citcd
by NicÌscn as onc of thc most rcmcmbcrcd
commcrciaÌs. As thc crcction markct grcw
and compctition incrcascd, thc ads bccamc
morc risquó, sparking compÌaints and FDA
warnings that thc drugs wcrc bcing hawkcd
9
as party piÌÌs. Jt is uncÌcar how Amcrican
houschoÌds wiÌÌ rcspond whcn copywritcrs
start churning out cuphcmisms for sja·u|a/s,
but chanccs arc thcrc wiÌÌ bc somc uproar.
Any opposition to such ads wiÌÌ givc pausc to
drug companics and rcscarch institutcs con-
tcmpÌating ncw vcnturcs in scxuaÌ hcaÌth.
But advcrtising is csscntiaÌ for any prc-
maturc c¡acuÌation drug. ¨Wc Ìookcd at thc
cxampÌcs of Viagra, Lcvitra and CiaÌis as
a bcnchmark for thc impact of dircct-to-
consumcr advcrtising,¨ says Tcrry. ¨What wc
found quaÌitativcÌy is that, aftcr thc Ìaunch
of Viagra, thc markcting of cach subscqucnt
product cxpandcd thc opportunity of thosc
drugs by ncarÌy 1b to 20 pcrccnt cach. Thc
amount of markcting out thcrc continucd
to push thc popuÌation basc that much cach
timc.¨ A simiÌar pattcrn wiÌÌ prcsumabÌy
cmcrgc with prcmaturc c¡acuÌation drugs.
Thc markct wiÌÌ swcÌÌ by miÌÌions with cach
additionaÌ approvaÌ Ìcttcr thc FDA maiÌs.
t
Somc cxpcrts scc thc rcaÌ probÌcm as thc
imposition of normativc structurcs on what
is a variabÌc phcnomcnon. Dr. Lconorc
Ticfcr, associatc profcssor of psychiatry at
Ncw York Lnivcrsity, is in thc vanguard of
this movcmcnt. Ticfcr docsn't conccaÌ hcr
intcntion to undcrminc thc quantification
of scxuaÌ function. Shc admits that a drug
to dcÌay c¡acuÌation can bc uscfuÌ to somc
but says thcrc is no such thing as prcmaturc
c¡acuÌation, and cfforts to crcatc drugs to
trcat it arc disingcnuous. Scx, Ticfcr says,
is morc Ìikc dancing than digcstion.
¨FundamcntaÌÌy, bcing fat or thin is a mat-
tcr of Ìivc variation throughout history and
cuÌturc,¨ shc says. ¨Thc samc thing is truc of
coming quickÌy or not, having a hard crcc-
tion whcn you'rc 60 or not, wanting to havc
intcrcoursc whcn you'rc 60 or not. Thcrc's
a grcat dcaÌ of variabiÌity. To try to stuff it
into somc simpÌcmindcd bottom Ìinc is to
dcny thc rcaÌity of scx.¨
MichacÌ PcrcÌman, thc Ncw York thcra-
pist, says c¡acuÌatory Ìatcncy is ¡ust anothcr
human charactcristic, simiÌar to bÌuc cycs,
bcst pÌottcd aÌong a skcwcd distribution
curvc. Hc wouÌd Ìikc to scc thc dcfinition of
prcmaturc c¡acuÌation dividcd into four cat-
cgorics of scvcrity: whcn a man can't cntcr
thc vagina, whcn scx Ìasts Ìcss than a min-
utc, whcn scx Ìasts onc to two minutcs and
whcn it Ìasts two to four minutcs. PcrcÌman
rcasons that thc avcragc physician wiÌÌ scc
pcopÌc who considcr thcmscÌvcs to bc suf-
fcring from prcmaturc c¡acuÌation who Ìast
morc than onc minutc but not as Ìong as
thcy wouÌd Ìikc to.
Rcmcmbcr that Brcndan was ncaring
two minutcs that night in Ncw York. Wc
don't know if hc cvcr fcÌt in controÌ, but
distrcss ccrtainÌy rcarcd its hcad. No doctor
can fuÌÌy answcr Susan's qucstion as to what
thc fuck was wrong with Brcndan, and no
drug can addrcss thc undcrÌying factors that
dctcrminc how Ìong hc Ìasts on any givcn
occasion.
Jf Brcndan had poppcd a piÌÌ that night,
wouÌd hc havc bccn trcating a discasc or
¡ust cnhancing an aspcct of cvcryday Ìifc.
Our rcguÌatory systcm is dcsigncd to wcigh
thc risks and bcncfits of drugs uscd to trcat
dcfincd discascs, not to improvc our ÌifcstyÌcs.

10
But thc Ìinc bctwccn trcatmcnt and cnhancc-
mcnt is now morc bÌurrcd than cvcr.
¨Such uscs of pharmaccuticaÌs posc chaÌ-
Ìcngcs for us as a country,¨ says PcrcÌman.
¨Thc chaÌÌcngc is aÌways grcatcr whcn wc
taÌk about scx.¨
Big Pharma isn't going to shy away from
this convcrsation. Jt's adcpt at dictating
what's good and what's bad and what is
normaÌ and what isn't. E¡acuÌation won't bc
an cxccption.