Can anything improve rapid ejaculation? And are electric toothbrushes really best for your teeth?

All too soon

All too soon

Q. Do any treatments for premature ejaculation work? I have tried anaesthetic creams, thinking about something unrelated to sex, and the "squeeze" technique. They all help a bit, but not brilliantly.

A. Ejaculating too early certainly doesn't improve sexual satisfaction for either partner. I was surprised to discover that the "official" name for premature ejaculation seems to have been changed to "rapid ejaculation" or "early ejaculation". I suppose these names are more objective and less judgemental. Whatever you choose to call it, it used to be said that men who came too quickly were simply anxious, or had had unsatisfactory early sexual experiences. Now there is a theory that men who ejaculate rapidly are evolutionarily superior to men who spend a long time at it. Thousands of years ago, so the theory goes, if you were able to impregnate your partner quickly, you were less likely to be gobbled up by a passing lion or tiger, and were therefore more successful in the reproductive stakes. The antidepressants called SSRIs (Prozac, Seroxat and Sertraline are the best known) can all delay ejaculation. They work by interfering with brain neurotransmitter chemicals, which play a role in controlling ejaculation. A single dose of one of these antidepressants a few hours before sex is often effective. The pharmaceutical industry is working furiously to develop a drug that specifically delays ejaculation without any side-effects. Nothing is available on the market yet, but within a couple of years I predict that there will be a new drug treatment available. Studies in the America claim that between 30 and 70 per cent of men are early ejaculators. So remember that you're not alone.

The best brush

Q. Are electric toothbrushes any more effective than manual ones? My three-year-old Braun electric has just died, and I am considering going back to an ordinary toothbrush.

A. When electric toothbrushes first came into common use, research showed that they were more effective than manual ones. They wiggle their bristles much faster than you could ever brush manually, and they are able to remove more plaque than manual brushes. Electric-toothbrush users also seem to get less gingivitis - inflammation of the gums. But it is quite possible to keep your teeth healthy with a manual toothbrush, although you may have to be more painstaking. If you're not keen to get a new electric brush, try using a manual one for a year or so. Then ask your dentist how you are doing. If you are managing to keep plaque down and your gums healthy, there's no reason not to carry on.

Elusive supervision

Q. To treat my Reiter's syndrome, the rheumatologist suggests I take methotrexate. I understand this drug needs supervision, and regular blood tests are indicated. But the rheumatology clinic I attend provides only one appointment every nine months, and I have never made an appointment that was not later cancelled "due to doctor absence". Can patients have confidence in taking a medicine needing supervision, when doctors are not able to supervise?

A. Reiter's syndrome is a collection of symptoms that seem unrelated. The first is arthritis - inflammation of the joints. Lots of different joints can be affected - the feet, the hands, even the spine. The second is conjunctivitis, or inflammation of the eyes. This can be quite nasty, with a heavy discharge, or may just cause a little redness in the whites of the eyes. The final symptom, urethritis, causes a discharge from the penis in men, but may be silent in women. No one knows exactly what causes Reiter's, but it sometimes follows an intestinal infection such as dysentery, or a sexually transmitted infection such as chlamydia. It iscommonest among sexually active men between 20 and 30. Methotrexate is a heavy-duty drug and definitely needs monitoring. When you start taking it you should have weekly blood tests. Once the dose is stabilised, you'll need to have blood tests every two to three months. There have been serious blood reactions, and even deaths, among people who have taken methotrexate without monitoring. Any doctor who prescribes it without arranging for this type of monitoring is acting recklessly and probably negligently. If you can't be monitored adequately by your GP or current rheumatologist, you should either find a new doctor or stop taking the drug.

Have your say: Readers write

In common with our our recent correspondent, BS, from Sussex, found that, though otherwise healthy, he had to constantly clear his throat. But when he took the problem to his GP, he found that he got short shrift:

I have had the same problem as your recent correspondent almost continuously for about 10 years now.

I'm 66 and it has affected my work, my sleep and my life. After some five years of it, I, too, went to my GP, who gave me a "why are you bothering a busy man like me with such trivia?" sort of look, and said that it was "probably just a cold". I've never bothered to go back to him.

I have tried varying my diet in case the condition might be caused by a food allergy, and giving up coffee and dairy products, which has alleviated the condition, but not cured it. I've also lost some weight and don't smoke, and it all helps.

I feel more positive after your description of laryngopharyngeal reflux, and I may seek access to omeprazole. Thanks and congratulations to a health column that deals with the sort of problems that many people suspect their GPs would be quick to ridicule (and ridicule they do!).