What is Normal What is Not?

1. Premature Ejaculation What’s normal? What’s not?

2. KNOW ABOUT EJACULATION • Ejaculation isthe final phase of the sexual responsecycleinthemalewhich is accompanied by orgasm • It is areflex that includes sensorystimuli,cerebralandspinal controlcenters,andneuronalpathways.

3. KNOW ABOUT EJACULATION • Ejaculationisaneuronal reflex involving acomplex interplay between somatic, sympathetic, and parasympathetic pathways involving a mainly central nervous system. • Sexual response cycle comprises of 4 phases. Sexual response cycle in males

5. PREMATURE EJACULATION (PE) DEFINED • ISSM(2007) defined PE as having three components: • Ejaculationthatalwaysornearlyalwaysoccurs before or within about one minute of vaginal penetration, • Inabilitytodelayejaculationonallornearly all vaginal penetrations,and • Negativepersonalconsequenceslike distress, bother, frustration, and/or the avoidance of sexualintimacy.

7. FACTOR DEFINING PE • PE is defined by multiple factors • Definitionshould take into picture factors like- • Time • Perceived control over ejaculation • Personal and partner distress • Reduced sexual satisfaction • Relationshipdifficulty Time is measured by intravaginal ejaculatory latency time (IELT, also called IVELT). It is the duration in seconds or minutes that pass from the first moment of vaginal penetration toejaculation/orgasm.

8. CLASSIFICATION OF PE

10. HOW COMMON IS PE AMONG MALES? • Most common male sexual dysfunction(as per DSM- IV) • PE affectsup to 30% of men of all ages. • PE is more common in younger men when adjusted for acquired premature ejaculation in older men resulting from erectile dysfunction. • Self-reported time taken for an average man to ejaculate varied greatly from 7 to 14 minutes.

11. IMPACT OF PE ON QUALITY OF LIFE • Menhaveasenseofshameandembarrassmentatnot beingabletosatisfytheirpartner. • Low self-esteem andfeelings of inferiority. • Erosion of sexual self-confidence, & generalconfidence. Anxiety &depression. • Significant negative impact on the psychologic status & interpersonalrelationshipofthesuffererandhispartner.

12. DISEASE MECHANISM OF PE • A complete pathophysiology is know yet known • Disease mechanism involves following 2 common pathways.

13. CAUSES OF PE • Geneticetiologies • Psychologicalcauses • Hormonalaberrations • Penile sensory changes,and • Chronicprostatitis

14. TREATMENT STRATEGIES

15. MEDICATIONS • Topical Anaesthetics like benzocaine, lidocaine, etc. are sometimes used in the treatment of PE. Applied normally 10-15 minutes before sexual intercourse. • Oral medication may be prescribed to combat PE like • Antidepressants like fluoxetine, paroxetine, SSRI’s are useful to delay ejaculation. Usually take 5-10 days to show its action. • Analgesics like Tramadol which is usually used as pain relief medication has effects which delay semen ejaculation. • PDE5 inhibitors like Sildenafil, Vardenafil, etc. might also help in treatment of PE. • Combination therapies like PDE5 inhibitor + Duloxetine – Tadapox is also used in treatment of both PE and ED.

16. LIFESTYLE CHANGES

17. HOME REMEDIES • Start and stop method • Squeeze method

18. SUPERFOODS FOR PE

19. Psychological Counselling • Individual Psychotherapy • Couples Psychotherapy • Psychotherapy With Medication

20. Contact US at : • Website : https://www.medexpressrx.com/tadapox.aspx • Email Us : customersupport@medexpressrx.com • Call us At : +1-800-808-3375