Transcript PowerPoint Presentation - Abdel Hamid Derm Atlas

Premature Ejaculation
Abdel-Hamid M. Abdel-Aziz
Professor of Dermatology & Venereology
Al-Azhar University
www. Abelhamiddermatlas.com
• 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
• Premature ejaculation will be discussed under the
following items:
• @ Premature ejaculation in Ancient Egyptians.
• @ Mechanism of ejaculation.
• @ Sexual response cycle.
• @ Classification.
• @ Etiology
• @ Diagnosis
• @ Treatment:
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* Exercises to cure PE.
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*Desensitization creams
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*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.
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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.
"How to Stop Premature Ejaculation"
Treatment of premature ejaculation
• Mental control:
• @Treating sex as
novelty.
• @Fear &
performance anxiety.
• @ The 3 C’s:
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* confidence
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* Calmness
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* 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.
Kagel excersizes
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
Male impotence treatment
Some side effects of viagra, cialis and levitra
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@Headaches: This can occur with all three
@ Hot flushes : This can occur with all three.
@ Dyspepsia : This can occur with all three.
@ Nasal congestion: This can occur with all three.
@ Abnormal vision: Blue tinge to objects. This can occur with viagra & levitra.
@ Muscle aches: This can occur with cialis.
@ Other side effects include: diarrhea, dizziness & skin rash.
One has to know that tablets do not have an immediate effect & that it takes about one hour for
absorption into the blood stream. This absorption is delayedfor up to two hours if the tablet are
taken in proximity to large meal
The main contraindications to viagra:
- Concurrent use with sublingual glyceryl trinitrate.
- Concurrent use with alpha blockers
When phosphodiastrase inhibitors fails, alternative treatment include:
-intracorporeal injections vasoactive substances. Drugs used include papaverine, prostaglandin &
phentolamine. The safety ratio of prostaglandin is higher to papaverine. The main risk of
intracorporeal injections is priapism.
- Vacuum devices.
-As a last resort, surgical implantation of penile prostheses.
Venous leakage surgery is now less commonly performed.
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.
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• 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.
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• 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
Diagnosis of priapism
Treatment if priapism
• Aspiration should
be performed from
both sides
• Send the aspirated
blood for blood gas
to confirm low flow
(venous) priapism.
Once confirmed
sympathomimetic
drugs such as
phenylphrine may
be injected if
priapism, persisted
"walk of shame."