c



 

   


 
 c


‘(
c) is an inability to control the ejaculatory
reflex. Also known as ›
 
3 ›

  3
›
›  3 or  ›  
.

‘ „ defines as the condition in which a man

ejaculates before his sex partner achieves orgasm3
in more than fifty percent of their sexual
encounters. Other sex researchers have defined
premature ejaculation as occurring if the man
ejaculates within two minutes of penetration.

 


 
 

‘

 
 
„remature ejaculation can be caused by temporary
depression3 stress over financial matters3
unrealistic expectations about performance3 a
history of sexual repression3 or an overall lack of
confidence. Interpersonal dynamics strongly
contribute to sexual function3 and premature
ejaculation can be caused by a lack of
communication between partners3 hurt feelings3 or
unresolved conflicts that interfere with the ability
to achieve emotional intimacy
‘

 


    
 



he physical process of ejaculation

requires two sequential actions: emission
and expulsion.
Gechanism of jaculation
‘ In one study3 ninety-one percent of men
who have had premature ejaculation for
their entire lives also had a first-relative
with lifelong premature ejaculation. Other
researchers have noted that men who have
premature ejaculation have a faster
neurological response in the pelvic muscles
Ô 

    

‘ 6elayed ejaculation - jaculation takes a

long time
‘ Retrograde ejaculation - Semen flows from
the prostate gland into the bladder rather
than exiting out of the penis.
‘ Inhibited orgasm in males

 
‘ reatments are focused on gradually training and
improving mental habituation to sex and physical
development of stimulation control. In clinical
cases3 various medications are being tested to help
slow down the speed of the arousal response.

‘ Another method is that of control instead of

prevention. „erforming routines such as Kegel
exercises.

‘ reatment modalities depend upon the nature and

severity of the ejaculation problem such as
behavioral therapies.
G 

‘ Serotonergic medications3 such as SSRI (  
   
 3
can delay ejaculation. SSRIs are commonly used
as anti-depressants. xamples include „rozac3 Zoloft3
Celexa3 and Lexapro. Clinical trials indicate that
„aroxetine gives the largest increase in intravaginal
ejaculation latency time.
‘ Clomipramine often helps with serious cases that are
related to the central nervous system. he drug has the
added benefit of also improving erection quality in
some patients.
‘ ramadol has been shown to be effective in delaying
ejaculation.



 ‘

 is a potentially harmful and
painful medical condition in which the erect
penis or clitoris does not return to its flaccid
state3 despite the absence of both physical
and psychological stimulation3 within four
hours.
Õ
 
‘ he causative mechanisms are poorly
understood but involve complex
neurological and vascular factors. „riapism
may be associated with haematological
disorders3 especially sickle-cell disease3 and
other conditions such as leukemia3
thalassemia3 and Fabry's disease3 and
neurologic disorders such as spinal cord
lesions and spinal cord trauma.
‘ „riapism can also be caused by reactions to
medications. he most common
medications that cause priapism are intra-
cavernous injections for treatment of
erectile dysfunction (papaverine3
alprostadil). Other groups reported are
antihypertensives3 antipsychotics (e.g.3
chlorpromazine3 clozapine)3 antidepressants
(most notably trazodone)3 anticoagulants3
cantharides and recreational drugs (alcohol
and cocaine).
©  
‘ rection is harder than normal.
‘ 6iscoloration of the „enis
‘ „enile pain
‘ Urinary retention
‘ Bladder retention

` G

  
‘ Analgesic3 icepack
‘ Sedation3 hydration and surgery
‘ 6iscuss concerns and prognosis with his sexual
partner
Õ

‘ „otential complications include ischemia3
clotting of the blood retained in the penis
(thrombosis)3 and damage to the blood
vessels of the penis which may result in an
impaired erectile function or impotence. In
serious cases3 the ischemia may result in
gangrene3 which could necessitate penis
removal.

 
‘ Gedical advice should be sought immediately for
cases of erection beyond four hours. Orally
administered pseudoephedrine may be effective.
Otherwise3 the therapy at this stage is to aspirate
blood from the corpus cavernosum under local
anaesthetic. If this is still insufficient3 then
intracavernosal injections of phenylephrine are
administered. his should only be performed by a
trained urologist3 with the patient under constant
hemodynamic monitoring3 as phenylephrine can
cause severe hypertension3 bradycardia3
tachycardia3 and arrhythmia.