1

*this material is free to be used in any educational procedure, downloaded , copied or shared once used without any content modification.*

Premature ejaculation
Definition & Symptoms:
Premature ejaculation occurs when a man ejaculates sooner during sexual intercourse than they or their partner would like. As long as it happens infrequently, it's not cause for concern. However, if you regularly ejaculate sooner than you and your partner wish such as before intercourse begins or shortly afterward it can be considered premature ejaculation.

Causes :
1. Psychological causes
Erectile dysfunction. Men who are anxious about obtaining or maintaining their erection during sexual intercourse may form a pattern of rushing to ejaculate, which can be difficult to change. Anxiety. Many men with premature ejaculation also have problems with anxiety either specifically about sexual performance or related to other issues. Relationship problems. If you have had satisfying sexual relationships with other partners in which premature ejaculation happened infrequently or not at all, it's likely that interpersonal issues between you and your current partner are contributing to the problem.

2. Biological causes:
Abnormal hormone levels Abnormal levels of brain chemicals called neurotransmitters Abnormal reflex activity of the ejaculatory system Certain thyroid problems Inflammation and infection of the prostate or urethra Inherited traits Rarely, premature ejaculation is caused by: Nervous system damage resulting from surgery or trauma Withdrawal from certain medications used to treat mental health problems

Complications
Relationship strains.

*this material is free to be used in any educational procedure, downloaded , copied or shared once used without any content modification.*
Fertility problems

Diagnosis

There usually are no abnormal findings with the condition. Physician may order blood tests to check the male hormone (testosterone) levels.

Treatments

A) Behavioral methods:
1. the start-and-stop method
you or your partner will stimulate your penis until you feel like you are about to have an orgasm. Then the stimulation stops for about 30 seconds. Once you regain control of your response, stimulation begins again. This process is repeated 3 or 4 times before you allow yourself to have an orgasm

2. The squeeze method

Step 1. Begin sexual activity as usual, including stimulation of the penis, until you feel almost ready to ejaculate. Step 2. Have your partner squeeze the end of your penis, at the point where the head (glans) joins the shaft, and maintain the squeeze for several seconds, until the urge to ejaculate passes. Step 3. After the squeeze is released, wait for about 30 seconds, then go back to foreplay. You may notice that squeezing the penis causes it to become less erect, but when sexual stimulation is resumed, it soon regains full erection. Step 4. If you again feel you're about to ejaculate, have your partner repeat the squeeze process. By repeating this as many times as necessary, you can reach the point of entering your partner without ejaculating. After a few practice sessions, the feeling of knowing how to delay ejaculation may become a habit that no longer requires the squeeze technique.

B) Medications

A) Antidepressants (selective serotonin reuptake inhibitors (SSRIs) / tricyclic

antidepressant) selective serotonin reuptake inhibitors (SSRIs) -tricyclic antidepressant antimuscarinic effect

Selective serotonin reuptake inhibitors (SSRIs)

*this material is free to be used in any educational procedure, downloaded , copied or shared once used without any content modification.*

M.O.A:
SSRIs block the reabsorption (reuptake) of the neurotransmitter serotonin in the brain. Changing the balance of serotonin seems to help brain cells send and receive chemical messages, which in turn boosts mood. SSRIs are called selective because they seem to primarily affect serotonin, not other neurotransmitters
Reduced sexual desire or difficulty reaching orgasm Inability to maintain an erection (erectile dysfunction)

Fluoxetine
Depreban Durazac Fluoxetine

Flutin

Octozac

Philozac

*this material is free to be used in any educational procedure, downloaded , copied or shared once used without any content modification.*

Prozac

Citalopram

Ceropram

Cipram

Cipramax

Citalo

Depram

Ramdeep

*this material is free to be used in any educational procedure, downloaded , copied or shared once used without any content modification.*

Sedopram

Talopram

Escitalopram
Cipralex Cipra-pro Escita

*this material is free to be used in any educational procedure, downloaded , copied or shared once used without any content modification.*

Estikan

Paroxsetine
Paroxetine Seroxat Xandol

*this material is free to be used in any educational procedure, downloaded , copied or shared once used without any content modification.*

Sertraline
Deprestat Lustral Moodapex

Serlift

Serpass

Sertral

*this material is free to be used in any educational procedure, downloaded , copied or shared once used without any content modification.*

Seserine

Sirto

Venlafaxine
its SNRI...serotonin and noradrenaline reuptake inhibitor

*this material is free to be used in any educational procedure, downloaded , copied or shared once used without any content modification.*

Efexor

Idixor

Tricyclic antidepressants M.O.A:

10

*this material is free to be used in any educational procedure, downloaded , copied or shared once used without any content modification.* Act by inhibiting uptake of the biogenic amines noradrenaline and 5-hydroxytryptamine (serotonin).

Amitriptyline
TRYPTAZOLE PARNETIL

11

*this material is free to be used in any educational procedure, downloaded , copied or shared once used without any content modification.*

Clomepramine
Anafranil* most commonly used Anapramine Supranil

B)

Topical anesthetic creams

on the delay

Topical anesthetic creams containing lidocaine or prilocaine dull the sensation penis to help delay ejaculation. Applied a short time before intercourse, these creams are wiped off when your penis has lost enough sensation to help you ejaculation. Some men using topical anesthetic creams report reduced sexual pleasure because of lessened sensitivity. Although the cream is wiped off before intercourse, in some studies female partners reported that it also reduced their genital sensitivity and sexual pleasure. In rare cases lidocaine or prilocaine can cause an allergic reaction

Reference
http://www.mayoclinic.com

12

*this material is free to be used in any educational procedure, downloaded , copied or shared once used without any content modification.* http://health.nytimes.com http://www.aurorahealthcare.org