Causes of premature ejaculation and management

1. Premature Ejaculation
DR BADMUS A.M
UROLOGY DIVISION
LASUTH

2. •An English professor wrote the words:
•“A woman without her man worth nothing”
•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” .

3. •Outline
•Premature ejaculation in Ancient Egyptians
•Mechanism of ejaculation.
•Sexual response cycle
•Classification.
•Etiology
•Diagnosis
•Treatment:
•*Exercises to cure PE.
•*Desensitization creams
•*Antidepressants

4. 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.

5. •Erectile dysfunction (ED) is also called impotence 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.

6. Premature ejaculation
–P.E. was considered a complaint if the patient ejaculated
within 3Oseconds after vaginal penetration
–
–Masterr & Johnson (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.

7. •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 18- 3O years
old (normal)

8. Mechanism of ejaculation

9. Mechanism of ejaculation
1.Emision phase
•1.Emission phase:
Deposition of seminal fluid
from the ampullary
deferens, seminal
vesicles ,&prostates into
the posterior urethra.

10. Mechanism of ejaculation
pelvic floor muscles

11. 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

12. Bulbocavernosus muscle

13. Sexual response cycle

15. 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.

20. 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.

21. 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.

22. Treatment of premature ejaculation
•Mental control:
•Treating sex as novelty.
•Fear & performance anxiety.
•The 3 C’s:
•*confidence
•*Calmness
•*Clear minded.

23. 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

24. Exercises to cure premature ejaculation
(cont.)
•3.Squeeze
technique
•4.Condom

25. 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.

27. Long loved condom
It contains a local anesthetic ( benzocaine) inside it.

29. Desensitization cream
•Marathon cream
•Enhance male
performance
•7.5%benzocaine
•For climax control
•Durex play gel

30. Lidocaine cream

31. 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..

32. •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

33. 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

34. Fluoxetine

35. Sertraline

36. 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

37. Escitaltalopram

38. Escitaltopram (Cont.(
•Citalo tablet

39. Paroxetine tablet

40. Dapoxetine

41. Viagra+ Dapoxitine (SSRI( in one tablet
Marketed in USA & Europe for treatment of premature
ejaculation

42. Antidepressants
•Paroxetine exerts the strongest effect on delaying the ejaculation in
comparison with other SSRI (selective serotonin reuptake inhibitor(
e.g. clomipramine, or sertraline 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

43. •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 , El-Naggar & El-Gilany, 2OO7(.
•Both Viagra & Dapoxetine are marketed in one tablet for
treatment of premature ejaculation

44. Cialis (Tadalafil( + Dapoxetine (SSRI( in one tablet

45. Clomipramine
(Tricyclic antidepressant(

46. Tramadol tablet
It is opioid analgesic, analog to alkaloid codeine (codeine is
metabolised to morphine(. It is banned in Egyptian market
& considered as narcotic

48. THANK YOU FOR LISTENING