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Premature Ejaculation

Premature Ejaculation. Abdel-Hamid M. Abdel-Aziz Professor of Dermatology & Venereology Al-Azhar University. An English professor wrote the words: “A woman without her man worth nothing” On the chalkboard he asked his students to punctuate it correctly All the males in the class wrote:

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Premature Ejaculation

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  1. Premature Ejaculation Abdel-Hamid M. Abdel-Aziz Professor of Dermatology & Venereology Al-Azhar University

  2. An English professor wrote the words: • “A woman without her man worth nothing” • On the chalkboard he asked his students to punctuate it correctly • All the males in the class wrote: • “A woman: without her man, worth nothing” • All the females in the class wrote: • “A woman , without her: man worth nothing” .

  3. Premature ejaculation will be discussed under the following items: • @ Premature ejaculation in Ancient Egyptians. • @ Mechanism of ejaculation. • @ Sexual response cycle. • @ Classification. • @ Etiology • @ Diagnosis • @ Treatment: • * Exercises to cure PE. • *Desensitization creams • *Antidepressants

  4. Sex, sexuality & love in AncientEgypt

  5. Sex in Ancient Egypt(What a marvelous art from great people)

  6. Phallus worship in Ancient Egypt • Did the ancient Egyptians know the premature ejaculation? • A: Yes. Magic is part of their medicine. The problems associated with ejaculation : premature, delayed, priapism,.. Could be attributed to a worship in the penis send his spells on the act of coitus.

  7. Erectile dysfunction (ED) is also called impotence is defined as the inability of a man to achieve & maintain an erection firm enough for sex. Having erection trouble from time to time is not necessarily , a cause of concern. But if, it is an ongoing problem, it may cause stress, relationship problems &/or affect his self confidence. • Premature ejaculation is a condition in which the entire sexual process of arousal, erection, ejaculation & climax occur more rapidly ,often in just a few minutes or even seconds , leaving the partner unsatisfied.

  8. Premature ejaculation • P.E. was considered a complaint if the patient ejaculated within 3O seconds after vaginal penetration • - Masterr & Johnoson (197O) considered P.E. is a disease if the patient cannot control his ejaculation long enough to get his female partner to have an orgasm in > 5O% of intercourses • Because of the variations in the ILET ( intravaginal ejaculation latency) which in some men may be 1O -2O minutes without fulfilling the needs of the partner to acquire an orgasm, so in P.E. there must be a cut off point of IELT for any further study.

  9. Intravaginal ejaculatory latency (IELT) in 491 men aged 19 to 73 years in five countries • Median intravaginal ejaculatory latency (IELT) time by age. It is 6.5 minutes in 18- 3O years old (normal)

  10. Mechanism of ejaculation

  11. Mechanism of ejaculation1.Emision phase • 1. Emission phase: Deposition of seminal fluid from the ampullary deferens, seminal vesicles ,&prostates into the posterior urethra.

  12. Mechanism of ejaculationpelvic floor muscles

  13. 2.Expulsion phase: It involves closure of bladder neck, followed by rhythmic contraction of urethra by pelvic-perineal & bulbospongiosus muscle & intermittent relaxation of external urethral sphincter

  14. Bulbocavernosus muscle

  15. Sexual response cycle

  16. Sexual arousal in animals

  17. Classification of premature ejaculation • Schapiro (1934) was the first to classify P.E. into two types A & B. • Godpadinoff (1989) considered type A to be acquired P.E.& type B to be life long premature ejaculation • Waldinger (2OO2) added two other types to P. E. syndromes: natural variable P.E. & premature like ejaculation dysfunction

  18. Causes of premature ejaculation • 1. Psychological: • @ Fear often stems from previous experience of premature ejaculation • @ stress, anxiety or relationship problems. • 2. Biological : • @ inflammation or infection of prostate. • @ Abnormal levels of brain chemicals called neurotransmitters. • @ Abnormal reflex activity of ejaculatory system. • @ Inherited traits. • @ abnormal hormone level e.g. testosterone • @ Side effect of the use of some drugs e.g. antihypertensive or from withdrawal from certain medications to treat mental health problems. • @ Rarely from nervous system damage resulting from surgery or trauma.

  19. Diagnosis of premature ejaculation • The apparatus is for providing vibratory stimulus to the penis at predetermined or variable frequency . There is also sensor means to detect ejaculation & to calculate the time period between the commencement of stimulation & ejaculation.

  20. Treatment of premature ejaculation • Mental control: • @Treating sex as novelty. • @Fear & performance anxiety. • @ The 3 C’s: • * confidence • * Calmness • * Clear minded.

  21. Exercises to cure premature ejaculation • 1.Stop start method with a squeeze • 2.Pelvic floormuscles. Stop the flow of urine (several times) while you are peeing intentionally

  22. Exercises to cure premature ejaculation (cont.) • 3.Squeeze technique • 4.Condom

  23. Practicing the squeeze technique when masturbating • The aim of these pelvic floor muscle exercises is to restore erectile function by strengthening the bulbocavernousus muscle & ischiocavernousus muscle.

  24. Long loved condomIt contains a local anesthetic ( benzocaine) inside it .

  25. Desensitization cream @Marathon cream @Enhance male performance @7.5 % benzocaine @For climax control @Durex play gel

  26. Lidocaine cream

  27. Antidepressents • The common types of antidepressant drugs include: selective serotonin inhibitors (SSRI), tricycles, serotonin nor epinephrine reuptake inhibitors (SNRI),& monoamine oxidase inhibitors. • The most standard type of antidepressant drugs is SSRI. Serotonin is a chemical name as “happy hormone” because it produces a feeling of happiness . A lack of serotonin in the body occurs when a neuron- receptors reabsorb or “reuptake” the serotonin which can result in depression . The SSRI presents the reuptake of serotonin & provides adequate amounts of the chemical . Common drugs under the classification of SSRI include: fluoxetine, sertraline, & escitalopram.

  28. SSRI drug e.g. blocks the reuptake of serotonin thus causing the concentration in the synaptic cleft to be increased . Consequently more serotonin makes it to the receptor sites & the next nerve cell & the functioning returns to normal

  29. Fluoxetine

  30. Sertraline

  31. Lustral tablet • Lustral tablet contains the active ingredient sertraline hydrochloride which is a type of SSRI . It prevents serotonin from being reabsorbed. This helps to prolong the mood lightening effect of any released serotonin

  32. Escitaltalopram

  33. Escitaltopram (Cont.) Citalo tablet

  34. Paroxetine tablet

  35. Dapoxetine

  36. Viagra+ Dapoxitine (SSRI) in one tabletMarketed in USA & Europe for treatment of premature ejaculation

  37. Antidepressants (SSRI)& premature ejaculation • The antidepressant paroxetine exerts the strongest effect on delaying the ejaculation in comparison with other SSRI (selectiveserotonin reuptake inhibitor)e.g.clomipramine, or sertarline in continuous daily treatment. • On demand treatmentsuperior paroxetine does not lead to similar impressive ejaculation delay as has been found on daily treatment & however, equivalent to other antidepressant drugs i.e. clomipramine & sertraline . However, paroxetine is superior to squeeze technique in terms of efficency • Sildenafil (viagra ) is superior over the 3 antidepressents (paroxetine, sertraline & clomipramine) intreatment of premature ejaculation whether the daily use or on demand .(Abdel-hamid , El-Naggar & El-Gilany, 2OO7). • Both Viagra & Dapoxetine are marketed in one tablet for treatment of premature ejaculation

  38. Cialis (Tadalafil) + Dapoxitine (SSRI) in one tablet

  39. Clomipramine (Tricyclic antidepressant)

  40. Tramadol tabletIt is opioid analgesic, analog to alkaloid codeine (codeine is metabolised to morphine). It is banned in Egyptian market & considered as narcotic

  41. Delayed Ejaculation • Normally, a man can achieve orgasm within the time needed to finish smoking a cigarette or 2-4 minutes of active thrusting during sexual intercourse. • Delayed ejaculation occurs when a man cannot have an orgasm at all or have an orgasm after prolonged intercourse for 3O -45 minutes or more. • Causes: • 1. Psychological: anxiety or distraction from environment. • 2. Physical: @ adaptation to certain masturbation technique • @ Diabetes @ Hypertension @ stroke or damage to spinal cord @ after pelvic surgery. • 3. Side effect of medication e.g. antihypertensive, @ antidepressant • 4. excessive use of alcohol

  42. Treatment is only needed when a man wants to father a child. Ephedrine tablet is effective or having sperms taken from the urine for use in artificialinsemination or in vitro fertilization

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