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Premature Ejaculation, Advanced Medical Institute (AMI) and BBC Watchdog

March 24th, 2009

Dr Petra

Last night BBC Watchdog looked at the very serious but rarely discussed issue of premature ejaculation (PE). Or more specifically a company called Advanced Medical Institute (AMI) who sell medication to men with ejaculation problems. The programme focused on AMI’s products for PE (a nasal spray containing the antidepressant Clomipramine).

This is a long blog, but may be useful if you have problems with ejaculation, want to know what to do about it, or have had problems with AMI.

Recent controversy
AMI recently hit the headlines in Australia and New Zealand following complaints regarding the company’s sales techniques and lack of support or follow up care. Meanwhile in the UK the Advertising Standards Association recently forced the company to remove billboard advertising stating ‘want longer lasting sex?’ because of the wording of the advert, size of billboards, and promoting prescription only medication (direct to consumer advertising isn’t permissible in the UK).

Media pundits speculated the ill-fated AMI campaign may have been an attempt to generate more publicity by using a controversial message. AMI hit back by stating they had a right to inform men about premature ejaculation and were providing a service to men with sexual dysfunction.

Additional issues
Other recent concerns with AMI include their sales technique and messaging around sexual functioning (more on this in a bit); encouraging people to self diagnose premature ejaculation while offering telephone consultations with medics that focus on medical history and don’t represent full sexual history taking. Questions have also been raised about the effectiveness of the products sold and the money back guarantee offer (raised here by CounterKnowledge) and whether the information AMI’s salespeople (referred to as ‘Clinical Coordinators’) is accurate.

What is Premature Ejaculation?
It’s worth knowing how PE is actually diagnosed as companies like AMI often don’t rely on this information and may as a result mislead men and their partner about what’s ‘normal’.

Premature Ejaculation has most recently been defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) as:
“Clinical description and diagnostic guidelines:
“The inability to control ejaculation sufficiently for both partners to enjoy sexual interaction . . . Minimum duration of symptoms of 6 months”
Diagnostic criteria for research:
1. General criteria for sexual dysfunction, including being unable to participate in a sexual relationship as he would wish, frequent occurrence, present for 6 months (or more), and not entirely attributable to another disorder or drug treatment
2. Inability to delay ejaculation sufficiently to enjoy lovemaking, either due to ejaculation before or very soon after the beginning of intercourse (if a time limit is required: 15 seconds or less), or in the absence of sufficient erection to make intercourse possible
3. Not the result of prolonged abstinence”
[1]
“persistent or recurrent ejaculation with minimal sexual stimulation before, on, or shortly after penetration and before the person wishes it. The clinician must take into account factors that affect duration of the excitement phase such as age, novelty of the sexual partner or stimulation, and recent frequency of sexual activity…[PE can only be diagnosed if] the disturbance causes marked distress or interpersonal difficulty”[2]

While the World Health Organisation’s ICD 10 classifies it as “the inability to delay ejaculation sufficiently to enjoy lovemaking, which is manifested by either an occurrence of ejaculation before or very soon after the beginning of intercourse (if a time limit is required before or within 15 seconds of the beginning of intercourse) or ejaculation occurs in the absence of sufficient erection to make intercourse possible”[2]

What this means in plain English is ejaculation is only considered premature if it happens very quickly (15 seconds or less) after intercourse is attempted, if it happens consistently over a six month period or longer, and if you can’t attribute the quick ejaculation to being very sexually excited, sexually inexperienced, or not having sex for a while. It only becomes a recognised clinical problem if these factors exist AND the person is distressed by them. For more information about PE there’s a useful summary about the condition from evidence based medicine site Bandolier.

This background information is useful when you consider how AMI go about selling their products to callers. I was able to see this in practice as the Watchdog team taped and transcribed the calls they made to AMI which I read and/or listened to.

You can see a summary of the programme here with information about AMI, quotes from the telephone conversation with their salespeople, responses from professionals working in this area (including my take) and a response from the company.

Why is AMI’s sales technique problematic?

After reading the quotes in the Watchdog report above you probably don’t need me to spell it out, but here’s why it’s an issue. Aside from the inaccurate health messaging and fear techniques there was no attempt in any of the calls/transcripts I was aware of to take a genuine sexual history. [click here for a fantastic guide from the British Medical Journal by my esteemed colleague John Tomlinson which shows not only how this should be done but explains the whole process of sexual history taking].

Instead of letting the caller talk and offering a sympathetic hearing callers are frightened with ‘facts’ which become more belligerent as they try and exit the conversation. My concern is that people calling AMI may believe it is a helpline or advisory service and may well be convinced that any sources of help/advice would treat them similarly.

For the record no professional practitioner – medic or therapist – would belittle or threaten you into taking medication or pressure you into or try and talk you out of having therapy. Indeed, most practitioners know it takes patients several attempts to bring up this condition and the path to treatment/therapy is often characterised by periods of ‘time out’. So it’s important men don’t think, having seen how AMI operate, that a healthcare practitioner or therapist would act like this.

We know that men find PE very embarrassing to deal with[3,4]. Many men assume there is nowhere to get help, are too ashamed to ask for it, or believe nothing can be done for them. Fears over losing their masculinity and/or their partner often prevent men from talking about this issue, and unlike women it is difficult for men to confide in friends and family about their sexual problems.

PE is an anxiety-related condition. Men worry about their performance and those worries create a cycle of fear and low-self confidence that causes the problem to repeat. Given that knowledge one has to question the ethics of a company like AMI using anxiety increasing techniques when talking to callers. We have no idea of the damage this has caused to men’s self esteem – or to their premature ejaculation problems.

So if you have PE, what help is available?

First of all, work out if you really do have a problem. As we’ve seen it’s usual for men to ejaculate pretty soon after penetration – particularly if you’ve not had sex for a while, are with a new partner, or are doing something very arousing. There are other things you can do to prolong sexual activity too.

You can use a condom with a desensitising lubricant (e.g. Durex Performa). There are also techniques like the squeeze and stop-start techniques you could try. There is some suggestion that meditation can help, although research on this is still underway. I’ve summarised some of these approaches over at Mansized.

Some men and their partners find revising their whole sexual approach can also work wonders for tackling PE. A man who is anxious about performance tends to reinforce this each time he comes too quickly. So if you make his orgasm secondary to the process it can reduce those worries. By that I mean if you focus on many other activities – massage, sharing fantasies, giving your partner oral sex, solo or mutual masturbation etc then this can build your confidence so you know your partner is turned on. If you come during this activity you can continue to pleasure your partner. You don’t have to make your orgasm part of the activity at all, or you may decide that even if you do come it doesn’t mean sex stops.

You can get confidential advice by phone from the Sexual Dysfunction Association on 0870 7743571. They have a free handout about ejaculation problems you may find useful.

You could also speak to someone in confidence at NHS Direct on 0845 4647, NHS Choices also has some information about ejaculation problems.

Your GP can do an initial check to see what’s wrong and if you need counselling can refer you to a psychosexual therapist (this is free on the NHS but there can be waiting lists in some areas). Alternatively you can refer yourself directly to a therapist via the British Association of Sex and Relationship Therapy (although it’s worth still seeing your doc as any reputable therapist will get you to have a medical checkup anyway). If the problem is linked to relationship difficulties you can talk to Relate.

What to do if you’ve had a problem with AMI

If you have been taking their products and experienced any side-effects/adverse events, tell your GP or report it using the Yellow Card system.

If you have a problem with the way AMI advertises contact the Advertising Standards Association

If you’ve had a problem with the company or their sales team let BBC Watchdog know what happened (in confidence).

If you’ve had problem with doctor working for AMI, report to the General Medical Council (GMC).

Or if you want to let me know any difficulties you’ve had, feel free to email me in confidence and I will pass your problem on to the relevant organisation. If you want me to anonymise your case before I do so, then state this in your email. You can reach me at info@drpetra.co.uk.

I’m sure Watchdog will continue to keep an eye on this story. AMI seem to have blamed this on overzealous salespeople, who they claim they will retrain/discipline/sack. Presumably that means their service will now change, so if you find it hasn’t, notify the sources above.


References*

1.Shabsigh R and Rowland D (2007) The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision as an Appropriate Diagnostic for Premature Ejaculation. Journal of Sexual Medicine. Vol.4, 1468–1478
2. Waldinger MD (2007) Premature Ejaculation Definition and Drug Treatment Drugs Vol.67 (4), 547-568
3. Sadeghi-Nejad H and Watson R (2008) Premature Ejaculation: Current Medical Treatment and New Directions. Journal of Sexual Medicine. Vol. 5, 1037–1050.
4.Althof SE (2006) Prevalence, Characteristics and Implications of Premature Ejaculation/Rapid Ejaculation. Journal of Urology. Vol. 175, 842-848.

* Unfortunately these papers aren’t open access, but I’m sure if you email the authors and ask nicely they’d send you a copy of the paper.

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