Sections

Services

Information

UK United Kingdom

Premature ejaculation: experts arrive at a definition

Experts in sexual medicine from around the world have, for the first time, defined lifelong and acquired premature ejaculation…

Premature ejaculation is a distressing condition that men usually suffer in silence. Flickr:leahbeequilts, CC BY-NC-ND

Experts in sexual medicine from around the world have, for the first time, defined lifelong and acquired premature ejaculation, paving the way for clear medical recognition and the development of better treatment.

Acquired premature ejaculation is when men who have had normal sexual function during their lifetime experience sex that lasts less than three minutes, while lifelong premature ejaculation is when sex lasts for a minute or less.

This is the first time the conditions have been given uniform classifications.

The new definition for acquired premature ejaculation specifically refers to intravaginal sex between a man and a woman that results in distress, frustration or avoidance of sexual intimacy.

Patrick Jern, post-doctoral researcher of psychology at Abo Akademi University, said premature ejaculation was a common sexual complaint.

“We don’t have a very good understanding of its causes,” he said.

Dr Jern said current diagnostic criteria for lifelong premature ejaculation were quite stringent, meaning a lot of men experiencing problems with their ejaculatory control did not fulfil them.

Lead author of the new guidelines for the diagnosis and treatment of premature ejaculation, emeritus professor Stanley E. Althof, said previous definitions had been mostly based on expert opinion rather than evidence.

This had, in turn, affected research efforts because in designing their studies, researchers in the field had been using different definitions and groups.

“The experimental group for one author might be the control group for another paper. It all became very confusing,” he said.

Professor Althof said having a conservative, evidenced-based definition would allow recognition of the condition by regulatory agencies and development of new therapies.

“With a conservative-evidenced based definition, regulatory agencies will view premature ejaculation as a genuine condition, rather than a lifestyle disorder,” he said.

Dr Michael Lowy, a sexual health physician specialising in premature ejaculation who wasn’t involved in the recommendations, said the condition was very distressing but men usually suffered in silence.

Treatment guidelines include psychotherapy for men alone as well as couples; behavioural techniques that enable men to build up confidence; and online treatment programs. They also include a number of drugs such as oxytocin, topical anesthetics and a common class of antidepressants known as SSRIs, among others.

Dr Lowy said researchers had a lot of experience treating premature ejaculation with selective serotonin reuptake inhibitors (SSRI), which raises serotonin levels and, as a side effect, delays ejaculation.

Due to a lack of research into populations of homosexual and bisexual men, acquired premature ejaculation has not been defined for men who have sex with men.

Articles also by These Authors

Sign in to Favourite

Join the conversation

73 Comments sorted by

  1. Michael Wilbur-Ham (MWH)

    Writer (ex telecommunications engineer)

    The second paragraph is very confusing.

    Perhaps it should read:

    "Acquired premature ejaculation is when men who have had normal sexual function during their lifetime experience sex that lasts less than three minutes, while premature ejaculation is when sex lasts for a minute or less."

    Perhaps I've got it the wrong way around?

    report
    1. Pat Moore

      gardener

      In reply to Michael Wilbur-Ham (MWH)

      Finally, a definition to separate lifelong and acquired PE that is difficult to understand. I think Michael a comma after "lifetime" and the clarifying addition of the words... begin to..... experience sex that lasts less than three minutes....." while the minute or less duration defines the lifelong propensity?

      And why/how the arbitrary three minute/one minute line is arrived at is not explained....presumably from collations of anecdotal evidence. One would think that this tendency would be…

      Read more
  2. Martin Quirke

    Architect (UK Registered), PhD Candidate at University of Newcastle

    Might it be the case that our ancient forefathers' rates of survival were improved by any biological measures that improved the efficiency of reproductive processes?

    Perhaps in an ancient world where competition for mates was less civil than today, a biological pre-disposition for a shorter build up to copulative climax may have permitted the smaller, weaker, or invading males to produce offspring that they may not have managed otherwise.

    Is part of why we see this as a problem more to do with our modern view of sex as a pleasurably activity over and above the ancient functional reproductive processes occurring underneath?

    report
    1. Michael Wilbur-Ham (MWH)

      Writer (ex telecommunications engineer)

      In reply to Martin Quirke

      When I told a female friend about this new definition, she replied "What's wrong with the occasional quicky?"

      Most men are able to ejaculate quickly if that is what is best for that moment.

      PE is also about the distress, frustration, etc that comes from always not lasting long. This affects the human bonding (and recreational) parts of sex, which has been a part of human sexuality for probably hundreds of thousands of years.

      report
    2. Paul Prociv

      ex medical academic; botanical engineer at University of Queensland

      In reply to Martin Quirke

      Interesting comment, Martin. When one observes other primates, or monkeys, at it, it's often all over almost before it started. One wonders if the female even noticed, sometimes.

      report
  3. Michael Shand

    Software Tester

    So only straight men that are having PIV can have premature ejaculation?

    it doesn't affect gay men nor does it affect men who are having anal sex with women?

    women can't ejaculate prematurely? this is some crazy nonsense

    report
    1. Dean Taylor

      Pharmacist

      In reply to Michael Shand

      I could cynically add that it also only affects men with middle-high incomes or access to insurance or government subsidies.

      No active discrimination or crazy nonsense, just business!

      report
    2. Dean Taylor

      Pharmacist

      In reply to Michael Shand

      Absolutely. Some medical conditions are easy to define. No such thing as "a little bit pregnant". Others, such as premature ejaculation, are more difficult. I chose the term medical condition rather than disease because the first isn't one, and arguably neither is the second.

      Men being concerned about their sexual performance is hardly new. While we have progressed from rhino horn and tiger penis to the more humane, but arguably equally useless, horny goat weed, and endless self help books…

      Read more
  4. Matty Silver
    Matty Silver is a Friend of The Conversation.

    Sex Therapist / Sex Commentator at Self Em

    Researchers have defined, by using a stopwatch, the average intra-vaginal ejaculation latency time of men, to be between 3 and 7 minutes. Therefore men who ejaculate within 3 minutes are diagnosed as having premature ejaculation.
    I am a sex therapist and see many young men who suffer from premature ejaculation, which was diagnosed by their doctors as ‘life long’ and were sometimes prescribed anti-depressants, which they were very unhappy about because of the many side effects, even when they lasted…

    Read more
    1. Michael Shand

      Software Tester

      In reply to Matty Silver

      Seems to me men do not need help orgasming

      If you could instead work with women to help treat their immature ejaculates that would be appreciated

      maybe study gay males, they appear not to be able to prematurely ejaculate

      report
    2. Michael Shand

      Software Tester

      In reply to Michael Wilbur-Ham (MWH)

      doesn't bother me, apparently about 60% of women are capable of ejaculation anywhere from a tes spoon to half a pint

      WIth all this focus on hetero-sexual males having PIV sex, surely we could pay a little attention to the females amongst us as they seem to have a bigger problem which is not enjoying themselves too quickly but many struggling to reach climax at all

      Yes, men have it hard with all those easy orgasms, but this seems less important that womens issues who have difficult orgasm and difficulty ejaculating at all - most women do not even know that they are capable of it

      report
    3. Michael Shand

      Software Tester

      In reply to Michael Wilbur-Ham (MWH)

      If you read the article you will see this definition only applies to hetero sexual males have vaginal sex....doesn't cover gay men, doesn't cover oral, anal, mutual masturbation, doesn't cover females at all

      it seems odd to me that this condition would only exist for CIS Males performing PIV

      report
    4. Michael Wilbur-Ham (MWH)

      Writer (ex telecommunications engineer)

      In reply to Michael Shand

      There is no implication anywhere in the article that there are not other sexual problems deserving of research.

      What has been achieved here is that by agreeing on two definitions (which of course are arbitrary) it now becomes possible to properly compare different studies.

      report
    5. Michael Shand

      Software Tester

      In reply to Michael Wilbur-Ham (MWH)

      Forgive me if I think a definition of a medical issue that can only apply to CIS Males having Penis in Vagina sex only is less than scientific

      Another commenter added that it should probably also include Western Middle class CIS Males having Penis in Vagina Sex but lets stick with the definition these genius came up with

      CIS Male having PIV only

      report
    6. Michael Shand

      Software Tester

      In reply to Michael Wilbur-Ham (MWH)

      For a bit more context, if you start with bad definitions....your studies are probably going to be much less than perfect

      as in incomplete, like trying to understand cancer by only looking at white males that work in IT

      report
    7. Michael Wilbur-Ham (MWH)

      Writer (ex telecommunications engineer)

      In reply to Michael Shand

      For science the definitions are very good - as I said, for this very real problem they will now be able to compare studies and solutions because they will now all be talking about the same thing.

      The problem is your non-science. You want to expand this definition to include lots of other problems. As I said before, there is nothing in this definition that excludes the existence of other problems nor the need for these to also be studied. But these other studies will give what they study a different name (which still might include PE in the name).

      The world is changing, and who knows where the next breakthrough may come. If it comes from say China then all the fuss about white western males etc will obviously be wrong.

      report
    8. Michael Shand

      Software Tester

      In reply to Michael Wilbur-Ham (MWH)

      If you are studying male ejaculation why would exclude gay men from your study?

      If anyone knows about male ejaculate it would be gay men, why does leaving gay men out of the definition help?

      report
    9. Michael Shand

      Software Tester

      In reply to Michael Wilbur-Ham (MWH)

      Heres the thing Mike

      You can study CIS Male PIV Performance in relation to premature ejaculate

      you could specify that if your study was worth the paper it is printed on

      you could specify all sorts of things instead of trying wrangle the definition of a word

      report
    10. Michael Wilbur-Ham (MWH)

      Writer (ex telecommunications engineer)

      In reply to Michael Shand

      Because masturbation, oral sex, and anal sex are different activities - and these activities are excluded for hetrosexuals as well.

      report
    11. Michael Shand

      Software Tester

      In reply to Michael Wilbur-Ham (MWH)

      my guess - give it a few years before they expand the definition and look down upon the patriachal scientists of the day who actually changed the definition of premature ejaculation to only apply to CIS Males

      So by definition if you partner wanted a satisfying session of anal sex, by definition there is no such thing as cumming pre-maturely?

      no, there is, hence why the definition is insufficiant and if they are really interested in understanding male ejaculation you wouldn't confine your studies let alone your definition to CIS Males having CIS

      Some people like giving head - that can't end prematuraly now?

      my guess - give it a few years before they expand the definition and look down upon the patriachal scientists of the day who actually changed the definition of premature ejaculation to only apply to CIS Males

      report
    12. Michael Wilbur-Ham (MWH)

      Writer (ex telecommunications engineer)

      In reply to Michael Shand

      Michael, once again you have missed the key point of the article.

      Before, when each group made up their own definition - “The experimental group for one author might be the control group for another paper. It all became very confusing.”

      The new definition will not only make it easier to compare research papers on the topic, but it will enable meta-analysis where the results of lots of studies can be combined.

      report
    13. Michael Shand

      Software Tester

      In reply to Michael Wilbur-Ham (MWH)

      Specify that in the study - done

      no need to wrangle definitions

      I work in software testing and we have similar challanges, what we do not do is change the definition of words that would exclude significant portions of the data.

      Ie. This only applies to coloured objects......all the data we have looked at so far have been no colour or blue, therefore we wilchange the definition of colour to mean blue

      this is a fail, what you should do is specify the sample data used and go out of your way to get some reds and greens - not change the definition of the word colour

      report
    14. Michael Wilbur-Ham (MWH)

      Writer (ex telecommunications engineer)

      In reply to Michael Shand

      Those working on PE are not working on solving world hunger either.

      There is nothing stopping someone doing research on anal PE, and this might even be called "anal premature ejaculation". But the results from a study of anal PE cannot be lumped together with studies of PE (defined as in the article).

      report
    15. Michael Shand

      Software Tester

      In reply to Michael Wilbur-Ham (MWH)

      Well it can't be anal premature ejaculation because premature ejaculation by definition only applies to CIS Males having PIV

      see the issue? they could do it the other way round instead of changing the definitions of words

      ie. premature ejaculation - a study of CIS Males PIV
      Premature Ejaculation - a study of Gay men only

      see how you don't need to change the definition of words, just be accurate in describing your study

      report
    16. Michael Wilbur-Ham (MWH)

      Writer (ex telecommunications engineer)

      In reply to Michael Shand

      You know perfectly well that within professions words used in general speech can have well defined and well understood technical meanings.

      PE has always been penis in vagina within medical research. It is the timing that defines when it is and isn't PE that has varied.

      report
    17. Michael Shand

      Software Tester

      In reply to Michael Wilbur-Ham (MWH)

      "PE has always been penis in vagina within medical research"

      Argument from Tradition? a bad tradition at that, a one of subtle bigotry and bias against non normative sex

      report
    18. Michael Wilbur-Ham (MWH)

      Writer (ex telecommunications engineer)

      In reply to Michael Shand

      Michael - this is getting silly.

      Do I need to do a cut and paste from my earlier posts to post all the same rebuttals yet again?

      report
    19. Michael Shand

      Software Tester

      In reply to Michael Wilbur-Ham (MWH)

      I don't think we will agree, I don't think your responses are convincing

      my position is that the definition of any medical issue should not exclude signicant segments of the population

      Hysteria shouldn't only apply to women
      Premature Ejaculation shouldn't only apply to CIS Male PIV
      Depression shouldn't only apply to adults

      report
    20. Michael Wilbur-Ham (MWH)

      Writer (ex telecommunications engineer)

      In reply to Michael Shand

      Michael - Please read the article and stop trolling.

      The article defines two things:
      1 - premature ejacualation
      2 - Acquired premature ejaculation

      Yes, the above two apply to penis in vagina.

      But there is nothing stopping people from creating other definitions, such as Anal PE,

      report
    21. Michael Wilbur-Ham (MWH)

      Writer (ex telecommunications engineer)

      In reply to Michael Shand

      Apologies to readers of this for replying to Michael Shand so often.

      It is now obvious that nothing I've said to Michael has got through.

      I've wasted your time and mine. Sorry.

      report
    22. Michael Shand

      Software Tester

      In reply to Michael Wilbur-Ham (MWH)

      Calm down mate, we disagree no need to flip out about it and procalim to the world that I am some sort of idiot

      I disagree with you but I don't think your an idiot, I just think we disagree

      Also, we agree on the important things like climate change, politics, etc

      I just think changing the definitions of words to fit prejudice is a dumb idea

      you don't see this way, that's cool, it's cool man, we can still be friends

      report
    23. Michael Wilbur-Ham (MWH)

      Writer (ex telecommunications engineer)

      In reply to Sandor von Kontz

      A great book is The Multi-Orgasmic Man by M. Chai, which teaches the taoist technique of a male having an orgasm without ejaculating.
      (It works!).

      There is another book where the author teaches basically the same technique but primarily as a way to avoid PE.

      The technique I write about has the male not ejaculate most times there is sexual activity, and the result is he learns to last longer and there is a huge increase in intimacy.

      I'm not saying drugs are never needed, but it would be wonderful if more options for enjoying sex were better known.

      report
    24. Dean Taylor

      Pharmacist

      In reply to Michael Shand

      I think that you are being too idealistic in your approach to this issue.

      I completely agree that we should be looking at all aspects of PE, including homosexual sex, some forms of PGAD, and oral sex (does anyone really want their partner to take longer?). However, for now at least, research in the area is being driven by commercial goals, not scientific curiosity, and everything will be designed around smoothing the path to regulatory approval for new products.

      As a silver lining, once these treatments have regulatory approval based on trials of straight men under 70 with no other medical conditions, doctors will start prescribing it for everyone, making research involving other groups far cheaper and easier to conduct.

      report
    25. Michael Shand

      Software Tester

      In reply to Dean Taylor

      "now at least, research in the area is being driven by commercial goals, not scientific curiosity"

      I think that nails it and is the spot where it erks me, thanks for the measured response

      report
    26. Michael Wilbur-Ham (MWH)

      Writer (ex telecommunications engineer)

      In reply to Henriette Vanechop

      I feel very sorry for anyone who, because of religious indoctrination, thinks that sex without procreation is immoral.

      If the withdrawal method is allowed by a group who are against birth control then I would have thought that the man not ejaculating at all would also be allowed as just as withdrawal, there are no pills or condoms, etc involved.

      report
  5. harry oblong

    tree surgeon

    lucky i last precisely 3 minutes and 2 seconds then...

    report
  6. Matty Silver
    Matty Silver is a Friend of The Conversation.

    Sex Therapist / Sex Commentator at Self Em

    What you guys seem to forget, is the fact that the only reason premature ejaculation is a problem for males having intercourse with women, that it is not very pleasurable for a woman to have her partner ejaculate within three minutes into her vagina.
    It is quite difficult for a woman to achieve an orgasm during penis/vagina intercourse anyway and trying to do that in such a short time is almost impossible. Men with PE are often very good at given foreplay and finding other ways to make their partner orgasm. But understandable they would be a lot happier if they good last a bit longer.
    It is perfectly OK for men these days to take Viagra or Cialis, so why shouldn’t there be a drug to help with premature ejaculation?
    There are many men on daily anti-depressant just for their PE surely that is worse?

    report
    1. Sam Papillo

      Landscaper

      In reply to Matty Silver

      Does the PE clock start only when the penis-vagina penetration starts? I.e., other sexual acts that might precede the penetration aren't included in the times given? It's clear that the clock stops upon penile ejaculation

      report
    2. Sam Papillo

      Landscaper

      In reply to Matty Silver

      OK, thanks, it wasn't clear to me in the article. I think sex could be enjoyable for all involved when the penis-vagina penetration lasts less than 3minutes if there's sufficient activity before and/or after. But, I suspect that a man who has trouble controlling his ejaculation, whereby it happens sooner than he wants during penis-vagina penetration, would also have trouble controlling ejaculation during other activities, which would be frustrating and thus requiring remedy. I think I'm stating the obvious here, but <3min penetration ejaculation is only a problem if there's dissatisfaction with the overall sex.
      For example, a woman might be more satisfied with a man who gives excellent cunnilingus for a good amount of time then ejaculates after <3mins of penis-vagina penetration than she would be with a man who's wont to spend >3mins penetrating without much else.
      I understand that there is, broadly, a correlation between PE and sexual dissatisfaction.

      report
    3. Sam Papillo

      Landscaper

      In reply to Sam Papillo

      "The new definition for acquired premature ejaculation specifically refers to intravaginal sex between a man and a woman that results in distress, frustration or avoidance of sexual intimacy."
      Sorry! I think what I wrote doesn't add much to the conversation, as the article already addressed this much more succinctly.

      report
    4. Matty Silver
      Matty Silver is a Friend of The Conversation.

      Sex Therapist / Sex Commentator at Self Em

      In reply to Sam Papillo

      That's right Sam - guys with PE are usually very good at given oral sex etc. Not all women need a partner who lasts for a very long time, if they are both happy there is no problem.
      And with some other psycho-sexual education he can learn how to last longer. For example having sex soon after again can help. Lots of other "tricks" available.

      report
    5. Jacqui Olliver

      Solutionist at EndTheProblem.com

      In reply to Sam Papillo

      Something else to keep in mind Sam, is that for a woman the emotional connection with her partner during sex is paramount.

      Regardless of how good he is at giving her foreplay, when her partner has PE, the act of intercourse becomes unfulfilling for her because her partner is so focused on trying to stay in control he is unable to make that connection with her emotionally.

      Therefore the act becomes all about him desperately trying to stay in control. There is no giving and receiving to keep the woman's interest engaged. There is no emotional connection felt by either. There is only the feeling of disconnection and disappointment - for both of them.

      It is these feelings of anxiety, disconnection and disappointment which puts a woman off having sex with a man who suffers from sexual problems. Just as his feelings of anxiety contribute to preventing him from staying in control - and can lead to erectile dysfunction problems as well as loss of libido.

      report
    6. Jacqui Olliver

      Solutionist at EndTheProblem.com

      In reply to Matty Silver

      That's right Matty - it's not about quantity of sex, it's all about quality of sex. And if a man can last for 10-20 minutes during intercourse and focus on his woman as much as he does himself, then most women are happy with that.

      report
    7. Sam Papillo

      Landscaper

      In reply to Jacqui Olliver

      Well said Jacqui, I completely agree.
      For some individuals with sexual problems, a fundamental understanding of what you've articulated would be a good first step in their remedy.
      Some PE sufferers might be ignorant of the emotional and interpersonal necessities of sex. Some PE sufferers might be fully appreciative of these necessities, yet still suffer poor performance.

      report
    8. Jacqui Olliver

      Solutionist at EndTheProblem.com

      In reply to Matty Silver

      Average is vastly different from a man's potential when he gains understanding of how to focus correctly during sex. The only reason that women don't want sex to last for 20 minutes is because their partner's TECHNIQUE is not fulfilling them.

      Technique isn't just about body position. Technique encompasses a man's focus and attention on the woman before, during and after the sexual act.

      It's not enough to just solve a premature ejaculation or erectile dyfuction problem, you must also provide a focusing strategy to ensure the partner is completely fulfilled through out the sexual act. This increases her ability to orgasm as well as exponentially increasing the emotional connection - which is what every woman needs to feel fulfilled.

      After all, what's the point in solving a PE problem if your partner still doesn't want to have sex with you?

      report
    9. Jacqui Olliver

      Solutionist at EndTheProblem.com

      In reply to Sam Papillo

      Something to keep in mind Sam, is that the conscious mind can only focus on one task at a time. A man is either focused on his sexual problem (or the feelings in his penis) or he is focused on his woman in such a way that he stays in control of the sexual act.

      report
    10. Sam Papillo

      Landscaper

      In reply to Jacqui Olliver

      Yes, so an understanding of the nature of the problem should be followed by an implementation of a remedy: to focus on his woman rather than his personal problem. I think most of those who fail to focus properly would happily change if they knew how; or perhaps I'm being too generous.

      report
    11. Jacqui Olliver

      Solutionist at EndTheProblem.com

      In reply to Sam Papillo

      In my experience in working with these clients, most are absolutely delighted that they now have a sequence to follow (instead of their usual experience of anxiety and panic) and their women are thrilled with their new technique.

      One of my clients reported: “My partner said it felt like it was the first time she has made love to me instead of someone off in the distance. She was wondering how long it was going to last before I zoned out but I never did. She and I are over the moon.. Wow what a difference. She now knows I truly love her.”

      The correct sequence (and timing) of focus is very important. Because if he focuses on his woman for too long, it can cause him to lose his erection.

      report
  7. David Martin

    Naturally talented sleeper and eater

    There is the strong smell of the pharmaceutical companies pathologizing another normal human condition that otherwise falls into a rather large range.
    In the animal world it is probably wise to get copulation over with pretty bloody quick because while you're at it you're also not out finding food and you're compromised if something wishes to eat you. Dogs sex seems strangely long when they get "locked" but in the wild if you are a wolf and a top predator it may not matter that much.
    If your aim is to spread your seed far and wide you'd better get the job over quickly and move on to the next female.
    So successful males in the real world may well be the PE's.

    report
    1. Michael Wilbur-Ham (MWH)

      Writer (ex telecommunications engineer)

      In reply to David Martin

      David, if you read the article they you would know that PM isn't just ejaculating quickly, it is doing this AND it must "results in distress, frustration or avoidance of sexual intimacy."

      And the idea that with humans sex is primarily about reproduction is just plain silly.

      report
  8. Jacqui Olliver

    Solutionist at EndTheProblem.com

    The timing of early ejaculation is inconsequential. It is imperative however, that a man learns how to focus correctly during sex so he only activates the ejaculation program in his brain when both him AND his partner are ready.

    report
    1. Jacqui Olliver

      Solutionist at EndTheProblem.com

      In reply to Matty Silver

      Hi Matty, the fact that there is a problem indicates that men aren't being properly educated on the subject of ejaculatory control.

      If a man focuses too much on the feelings in his penis he will activate the ejaculation program. This is just one of the ways he causes himself to ejaculate early. Most men who suffer from premature ejaculation have overstimulated their brain with sexual thoughts and feelings before they even insert their penis into their partner. How soon they ejaculate is determined…

      Read more
    2. Matty Silver
      Matty Silver is a Friend of The Conversation.

      Sex Therapist / Sex Commentator at Self Em

      In reply to Jacqui Olliver

      Hi Jacqui, No offence but looking at the promises you make on your website you should be the Key-note speaker at all future Sexual Dysfunction conferences. The medical profession could learn a lot from you. A bit curious that you also provide massages as one of your clients states:
      “Being a medical specialist, I was amazed at Jacqui’s knowledge and insights regarding this subject matter – I know for sure there is no-one else teaching this! It is amazing! Jacqui is a true problem solver. Great massage too. Every male should have this education!” Sam

      report
    3. Jacqui Olliver

      Solutionist at EndTheProblem.com

      In reply to Matty Silver

      Hi Matty,
      As you would have noted from the testimonials written by my medical specialist clients, I offer a completely different perspective when it comes to permanently solving sexual problems.

      Since you appear to have made assumptions about the massage element of the session I provide (the massage element is optional, I also solve these problems online via Skype) perhaps it would be beneficial for you to read the session FAQ which is the third option under "Solutions" on my website.

      It would be my pleasure to be the Keynote speaker at all future Sexual Dysfunction conferences. Considering I address factors which are frequently overlooked by the medical profession and other current therapies AND I am able to offer a unique perspective on solving these problems - I am sure the fresh perspective would be appreciated.

      report
  9. Comment removed by moderator.