Treatment of Premature Ejaculation
Premature Ejaculation is probably the most common male sexual dysfunction with prevalence upto 30% among men aged between 18 and 60 years. This can lead to mental distress and anxiety in performance.
Premature Ejaculation is defined as ejaculation that occurs sooner than desired, either before or shortly after penetration. This can cause distress to either one or both partners. The intra vaginal ejaculation latency time (IELT) ranges from 2 to 5 minutes. In men with premature ejaculation, the IELT is less than 2 minutes. This can also be associated with erectile dysfunction.
Topical Treatment Topical treatments (anesthetics) appear to increase IELT, but are associated with mild local adverse effects.
PDE5 inhibitors are effective in the treatment of secondary PE when caused by mild ED. By improving a man’s failing erections, it is hypothesized that his anxiety is reduced, thereby alleviation his secondary PE.
Pharmacologic Treatment Selective serotonin reuptake inhibitors (SSRIs) which were found to delay ejaculation, have been used off-label for the treatment of PE for the last 1 to 2 decades. The optimal dose and regimens for these agents for the treatment of PE have not been established; however, data show greater success with chronic vs on-demand (PRN) dosing. However, chronic use of SSRIs is associated with dry mouth, nervousness, gastrointestinal upset, diarrhea, headache, drowsiness, and restlessness.
Ejaculation often occurs normally and is an intensely pleasurable sensation for most men, it is an extremely complex phenomenon that is regulated by many different systems.
Retrograde Ejaculation
Retrograde ejaculation , as its name implies, is a condition where the seminal fluid is ejaculated backward (retrograde) into the urinary bladder instead of forward (antegrade). This usually occurs because the neck of the urinary bladder, which normally closes to block such retrograde flow, is unable to do so. Such inability usually results from neurological or physical damage to the bladder neck, which in turn can result from a variety of clinical condition.
Patients with retrograde ejaculation usually achieve orgasm normally and feel the sensation of having ejaculated. However, little or no seminal fluid emerges from the penis. Instead, the patient often notices that the post-ejaculatory urine, i.e. the urine passed after sexual intercourse, is cloudy with semen.
Diabetes is an extremely common cause of retrograde ejaculation. Other causes of retrograde ejaculation are spinal cord lesions and injuries, operations on the spine, retroperitoneum or pelvic organs, surgery on the bladder neck and prostate and again, many, many, drugs that affect the neurological control of the bladder neck.
For men who want to father children, however, retrograde ejaculation becomes a serious mater since these men cannot deposit their semen inside the vagina. These men can be treated by retrieval of sperms from the urinary bladder followed assisted reproduction – with good results.