Transcript - Abdel Hamid Derm Atlas

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: •
“A woman: without her man, worth nothing” •
All the females in the class wrote: •
“A woman , without her: man worth nothing” . •
•
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 •
•
Sex, sexuality & love in Ancient
Egypt
Sex in Ancient Egypt
(What a marvelous art from great people)
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.
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.
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.
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 183O years old (normal)
Mechanism of ejaculation
Mechanism of ejaculation
1.Emision phase
1. Emission phase: •
Deposition of seminal
fluid from the
ampullary deferens,
seminal vesicles
,&prostates into the
posterior urethra.
Mechanism of ejaculation
pelvic floor muscles
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
Bulbocavernosus muscle
Sexual response cycle
Sexual arousal in animals
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
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.
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.
Treatment of premature ejaculation
Mental control: •
@Treating sex as •
novelty.
@Fear & •
performance anxiety.
@ The 3 C’s: •
* confidence •
* Calmness •
* Clear minded. •
Exercises to cure premature ejaculation
1.Stop start •
method with a
squeeze
2.Pelvic floor •
muscles. Stop the
flow of urine (several
times) while you are
peeing intentionally
Exercises to cure premature ejaculation
(cont.)
3.Squeeze •
technique
4.Condom •
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.
Long loved condom
It contains a local anesthetic ( benzocaine) inside it
.
Desensitization cream
@Marathon cream •
@Enhance male •
performance
@7.5 % benzocaine •
@For climax control •
@Durex play gel •
Lidocaine cream
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.
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
Fluoxetine
Sertraline
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
•
Escitaltalopram
Escitaltopram (Cont.)
Citalo tablet •
Paroxetine tablet
Dapoxetine
Viagra+ Dapoxitine (SSRI) in one tablet
Marketed in USA & Europe for treatment of premature
ejaculation
Antidepressants (SSRI)
& premature ejaculation
The antidepressant paroxetine exerts the strongest effect on •
delaying the ejaculation in comparison with other SSRI (selective
serotonin reuptake inhibitor) e.g. clomipramine, or sertarline in
continuous daily treatment.
On demand treatment superior 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) in treatment of premature
ejaculation whether the daily use or on demand .(Abdel-hamid , ElNaggar & El-Gilany, 2OO7).
Both Viagra & Dapoxetine are marketed in one tablet for treatment •
of premature ejaculation
Cialis (Tadalafil) + Dapoxitine
(SSRI) in one tablet
Clomipramine
(Tricyclic antidepressant)
Tramadol tablet
It is opioid analgesic, analog to alkaloid codeine (codeine is
metabolised to morphine). It is banned in Egyptian market
& considered as narcotic
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 •
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 artificial insemination or in vitro
fertilization
Priapism
Priapism is defined as a •
prolonged & persistent
penile erection > 4 hours
unassociated with sexual
interest or stimulation . It
is a medical emergency.
Therapeutic aspiration of •
blood with
intracavernosal injection
of diluted alpha
adrenergic
sympathomimetic agents