At the same time, CREW filed a companion complaint with the Federal Election Commission (FEC), asserting that the $96,000 payment was an illegal campaign contribution. In March 2010, the FEC’s general counsel urged the commission to investigate the matter, but in November of that year the recommendation was rejected.
Nonetheless, the Ethics Committee, chaired by Senator Boxer, took CREW’s complaint seriously and opened an investigation. Two years later, the damning report it released stated that, had Ensign not resigned, the special counsel was confident that the evidence would have warranted Ensign’s possible expulsion from Congress. He would have been the first senator since 1862 to be so disgraced.
The committee found substantial credible evidence that Ensign conspired to violate (and aided and abetted violations of) federal lobbying law, made false statements to cover up severance payments to the Hamptons, obstructed the Ethics Committee’s investigation, and sexually harassed an employee. The report also found that Ensign violated his own Senate office policies, including those regarding sexual harassment. Since that would have been cause for termination of one of his employees, the rules should have been applied to Ensign as well. In other words, he should have fired himself.
The fact that the committee’s report characterized Ensign’s violation of his office policies as discrimination and sexual harassment is a significant outcome of the investigation. In effect, says Melanie Sloan, the report elevates the importance of sexual harassment as a violation of Senate rules.
“I think what is striking about this is the levels that people went to to help Ensign cover up this affair,” says Debra Katz, a Washington DC lawyer who specializes in sexual harassment cases. “If this were a civil case, these clowns would be legally responsible for aiding and abetting the type of sexual harassment that took place.”
So Ensign is gone from the Senate. Now what?
As of this writing, the Department of Justice has not indicated whether it will act on the Ethics Committee’s referral that it investigate and consider criminally prosecuting the former senator. It had halted its investigation in December 2010, but now a wealth of new evidence is available, thanks to the committee’s investigation.
Also, the Federal Election Commission has not indicated whether it will consider reopening its investigation of Senator Ensign, as the Ethics Committee has urged. Finally, the Ethics Committee itself has not yet acted on CREW’s separate October 2009 complaint to investigate Senator Tom Coburn for his role in allegedly covering up Ensign’s affair and for perhaps knowingly allowing Doug Hampton to lobby him in violation of the one-year post-employment ban. “It’s incumbent on the committee to do something,” says Sloan. “By the way, none of the other senators have said anything about Coburn’s behavior either, including the Democrats. It’s the clubby Senate.”
Asked about his role in the matter in July 2009, when the story first broke in the national media, Coburn said he only counseled Ensign as a doctor and as a deacon, and he considered that counsel a “privileged communication that I will never reveal to anybody.” It should be said here that Senator Coburn is indeed a doctor: a family practitioner specializing in obstetrics and allergies.
As for Coburn’s role as a deacon, Sloan has this to say: “First of all, a deacon doesn’t have legal confidentiality, and second, Ensign wasn’t in his church.” And, she points out, “Presumably Ensign didn’t need medical advice, so he wasn’t a patient.”
Coburn has emphatically challenged the Ethics Committee report’s portrait of his role in negotiating compensation for Hampton. “That’s a totally inaccurate characterization of what happened,” he told C-SPAN recently. “The story you hear is not an accurate reflection of what happened.” He said he feels good about what he did, and that he would do it again in the same way if given the chance. “We put two families back together with multiple children—both marriages are stable right now,” he says.
Hardly. Doug and Cynthia Hampton are in the process of getting divorced. Cynthia has filed for bankruptcy.
Meanwhile, the only person facing criminal prosecution by the Department of Justice so far is Doug Hampton. In March, he was indicted on seven counts stemming from the lobbying activity he undertook after Ensign fired him. “Why have laws that only apply to the less powerful?” asks Melanie Sloan. “The Department of Justice ought to be trying really hard to prosecute Ensign. The only people who are suffering in this story are the ones who blew the whistle. There’s an incredible unfairness here.”
The Dynamics of Sexual Acceleration
Chris Sweeney
Susan and Brendan had been dating for a month when they decided to spend a weekend together in New York. They had met in Falls Church, Virginia, and while Susan was not completely sold on Brendan, sneaking around the office and having a quickie in the copy room kept her interested. As they unpacked their bags and settled into a dingy hotel on the Lower East Side, the tension that had mounted during their five-hour drive snapped.
The couple dived into bed with the eagerness that accompanies a new relationship. But the much-anticipated session petered out in two minutes, before Susan could even warm up. “What the fuck is wrong with you?” she asked as Brendan rolled off her. This marked at least the fifth time in their relationship that Brendan had ejaculated too quickly for Susan’s liking, and despite the fact that he always reciprocated “with a good munch,” her patience had peaked. Brendan retreated downstairs for a cigarette, wishing to avoid further interrogation.
Is there something wrong with Brendan? It depends on whom you ask. The prospect of a sex-filled vacation may have put him in a state of anxiety that was manifested in this sexual shortcoming. Or Brendan may be genetically predisposed to having a low ejaculatory threshold, possessing a hypersensitive penis that lets him last only a few minutes. It may be that the cascade of dopamine, serotonin, oxytocin, and other neurochemicals is at fault. Some would suggest Brendan’s early ejaculation could be linked to how he masturbates or is embedded in his pubescent sexual encounters. Or, of course, there is always the possibility that nothing is wrong with Brendan, that Susan’s expectations just don’t align with his capabilities for impromptu intercourse.
Susan’s postcopulatory inquiry into what the fuck was wrong took Brendan down a notch, and their tryst fizzled out soon after. Men with rapid ejaculation worry that their partners will leave them, and the added anxiety just makes the condition worse.
The length of time to orgasm is highly variable in men. A 2005 study published in The Journal of Sexual Medicine used stopwatches to measure intravaginal ejaculation latency, or how long a man lasts from the start of intercourse until ejaculation. The study looked at 5,600 couples from the United States, the United Kingdom, Turkey, Spain, and the Netherlands, and revealed a median time of 5.4 minutes, and a range from under a minute to about 45 minutes. The average time varied for each country, with the Turks coming first at 3.7 minutes. Condoms had no impact on the average time, and being circumcised yielded an insignificant benefit. Another study, also published in 2005 in The Journal of Sexual Medicine, revealed a median time of 7.5 minutes among 1,380 American men not considered to have ejaculation difficulties. The study also included 207 men considered to be premature ejaculators, who clocked an average of 1.8 minutes.
Premature ejaculation is a term everyone has heard but few can define beyond the obvious “when a guy comes too early.” A taboo looms over the issue, with most conversations relegated to punch lines or dense medical literature. To be fair, before there was ED there was impotence, and that wasn’t a choice talking point either.
Determining what constitutes premature ejaculation has recently been the occasion of increasing debate. Is it the inability to last more than a predetermined time? Is it not being able to recognize when ejaculation will occur?
The focus on creating a universal definition of primary premature ejaculation is driven in part by the pharmaceutical industry’s interest in selling drugs that make a man last longer. Johnson
& Johnson’s drug for early ejaculation, dapoxetine, is approved in a handful of overseas markets under the brand name Priligy. The drug, rejected by the FDA in 2005, has been shown to lead to a threefold increase in duration when taken in a 60-milligram dose about an hour before sex. Dapoxetine is a selective serotonin reuptake inhibitor, as are the antidepressants Prozac and Paxil. A well-known side effect of most SSRIs is delayed ejaculation, leading many doctors to prescribe them to men in need of a few extra thrusts. Using a side effect of a drug to treat a condition for which the drug is not approved is hardly ideal, but no FDA-approved treatment exists.
Shionogi is a Japanese pharmaceutical company based in Osaka. It recently wrapped up Phase III studies—the last and largest stage of testing, when a drug is compared with other treatments—on an experimental compound dubbed PSD502. The drug is a combination of the topical anesthetics lidocaine and prilocaine and is sprayed on the head of the penis a few minutes before sex. In studies of about 1,000 men and their female partners, PSD502 prolonged the point of no return from an average of 0.6 minutes to 3.5 minutes. There is nothing novel about using drugs to desensitize the nether regions, but most such drugs are creams, and rubbing cream on the penis of a man who is trying to last longer is ill-advised. Dr. Donald Manning, Shionogi’s chief medical officer, says the spray appears to reduce sensation without numbing the penis—always a good thing if you actually want to enjoy sex—and claims that fewer than two percent of men who used it reported numbness.
Redefining Premature Ejaculation
The pharmaceutical industry’s interest in serving a vast market of premature ejaculators isn’t the only factor behind arguments about how the condition should be defined. The Diagnostic and Statistical Manual of Mental Disorders, the American Psychiatric Association’s reference text, is being revised for the publication of its fifth edition in 2013. Some people have criticized the DSM’s current definition of premature ejaculation as being too subjective. The symptoms of PE, according to the fourth edition of the DSM, include “ejaculation with minimal sexual stimulation before, on or shortly after penetration and before the person wishes it.”
Dr. Robert Taylor Segraves, professor of psychiatry at Case Western Reserve University and a member of the DSM revision panel, says this definition is so vague any number of people can be diagnosed with the problem. Some studies even classify men who last well beyond five minutes as premature ejaculators. “It sounds kind of meaningless at that point,” Segraves says. “We need greater precision.”
The draft proposal of the new edition of the DSM recommends dropping premature and renaming the condition early ejaculation. Segraves and Michael Perelman, a Manhattan-based psychologist who is president of the Society for Sex Therapy and Research, agree that premature has a pejorative connotation. However, Perelman—who also serves as a consultant for pharmaceutical companies—predicts that in the future it will likely be known as PE, just as erectile dysfunction is now called ED.
A few years back, Plethora Solutions, a UK-based drug firm, awarded an unrestricted grant to the International Society for Sexual Medicine to explore the evidence. A crew of 21 leaders ranging in specialties from psychiatry to neurourology met in Amsterdam in 2007 to prepare a diagnostic blueprint for men who ejaculate too quickly. After looking at the data, the leaders emerged with what is now considered to be the gold-standard definition. The ISSM’s definition regards the dysfunction as “ejaculation which always or nearly always occurs prior to or within about one minute of vaginal penetration,” rather than simply before a person wishes it to occur.
The ISSM, like the DSM, takes into account the strain that PE can place on a man, his partner, and their relationship. But it is the one-minute benchmark—the quantitative end point—that may prove vital in bringing PE drugs to our prescription-hungry nation.
Plethora Solutions’s decision to give the ISSM a grant for a definition was not just a gesture of goodwill. Plethora developed the above-mentioned ejaculation-delaying spray, PSD502, and licensed it to Sciele Pharma, which was later acquired by Shionogi. Should Shionogi succeed in becoming the first company to have an FDA-approved drug for premature ejaculation, Plethora could see a windfall in royalties. Manning, Shionogi’s chief medical officer, says the company used the one-minute benchmark in the data it collected, as well as aspects of control and distress. In fact, data from the study show that men who were given the drug ranked significantly higher on a scale of ejaculatory control than men given a placebo.
Shionogi and J&J—which is analyzing its own dapoxetine data for a potential FDA resubmission—aren’t the only drug makers who hope to crack this market. Sarah Terry, president of biomedical data provider Life Science Analytics, says about 20 players are looking to get in. GlaxoSmithKline is among them, with two drugs in development: one designed to inhibit oxytocin and the other an SSRI. Both are in Phase II testing, when scientists determine if a proposed medication is actually associated with a therapeutic benefit.
Patent Gold Mine
Premature ejaculation is attractive to drug companies because it represents an entirely new market at a time when they need to replenish their pipelines with new compounds. Big Pharma is hurtling toward a patent cliff, and generic companies are ready to pounce on the opportunity to churn out cheaper versions of Lipitor and Viagra, which come off patent in 2011 and 2012. Terry says that between 2008 and 2014, $113 billion worth of drugs will have their patents expire.
The potential of a drug for premature ejaculation dwarfs that of an erectile dysfunction drug. Estimates vary—mainly because of the definition issue and trouble in designing studies—but between 20 and 30 percent of the population could be considered premature ejaculators. One market study, from Datamonitor, estimates that in 2010 the US population of early ejaculators between the ages of 20 and 59 was 25.8 million, compared with 9.5 million men in need of bonder drugs. “I think the FDA is ultimately willing to approve a drug for premature ejaculation,” Terry says. “The challenge at this stage is just defining what that actually means.”
Research Pioneers
In the days of King Charles II, the last Spanish Hapsburg ruler and one of the most regal premature ejaculators on record, sexual dysfunctions were the product of witchcraft. Innovative treatments included exorcisms and urinating through your wedding ring or through the keyhole of the church where you were married. Fast forward to the early 20th century and you’ll come across a sea of erotic snake oil, including an arsenic-containing elixir in Dr. Frank Miller’s 1913 tome, Domestic Medical Practice. In the wake of Kinsey in the late 1950s came the work of William Masters and Virginia Johnson, better known as Masters and Johnson. The duo developed the still popular squeeze technique to prolong sex, which, as its name implies, involves putting a stranglehold on the head of the penis before ejaculation. Studies have demonstrated its efficacy, but evidence suggests that without regular reapplication the positive effects wear off. Also, it can be awkward to ask someone you’re sleeping with for the first time to put your dick in a death grip.
“Masters couldn’t do any analysis—he didn’t have any funding—so what he did was hire prostitutes and observe them, interview them, identify how they had sex and what the sexual issues of their lives were,” says Dr. Irwin Goldstein, director of sexual medicine at Alvarado Hospital in San Diego. Goldstein, who was an acquaintance of Masters’s, notes that the atmosphere surrounding sexual research was so restrictive in the early days of his work that Masters struggled to get medical texts about female reproductive anatomy. “The thing is, prostitutes saw a lot of men who were anxious and stressed, so his formulations were made on bad observations because of a biased population. It was their theory, which is perpetuated even in 2010, that 90-plus percent of all sexual problems are due to psychological issues: anxiety, humiliation, fear, depression.”
Goldstein is editor in chief of the Journal of Sexual Medicine and also a drug company consultant. For more than 20 years he was funded by the National Institutes of Health to st
udy sexual function and dysfunction. He is highly critical of those who believe such disorders are rooted solely in psychology. When he tells you about a man who can’t watch his wife strip down without ejaculating all over himself or about a 28-year-old guy who hasn’t had an erection for more than a decade because of a damaged artery, you learn how debilitating sexual dysfunction can be.
For Goldstein, the work of a Baylor University urologist, F. Brantley Scott, was the catalyst that took the treatment of sexual dysfunction from the head doctors and brought it into the medical field. “It had to end up in a physician’s hands to progress along medical thinking and diagnostics,” he explains. Scott, who died in a plane crash in 1991, played an instrumental role in developing the inflatable penile prosthesis, which has been used to treat tens of thousands of patients. The development of this surgically implanted device transformed the landscape of research and opened the field of sexual medicine. “Premature ejaculation, Viagra, orgasm dysfunction, all this stuff ended up in the field of urology,” says Goldstein.
By now pharmaceutical engineers have studied the effects on ejaculation of an array of drugs—including neuroleptics, tricyclic antidepressants, opioid agonists, phosphodiestrase inhibitors, sym-patholytics, and SSRIs. Beyond drugs, modern researchers have tested rings that wrap around the penis, behavioral techniques such as the stop–start approach, and even virtual-reality programs intended to help men explore their sexual development for events that might have influenced their ejaculatory reflex. Much remains to be learned about the mechanisms of ejaculation, but research bolsters the notion that it is rooted in neurochemical interactions.
“These are people who need help, and we have to be sensitive to their needs and not be rigid,” says Goldstein, who directs patients to buy dapoxetine from online pharmacies in foreign countries—a process no more complicated than ordering a book from Amazon.com.
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