• Premature Ejaculation
The premature ejaculation is a very frequent psychological background in men and probably the most common psychological background disorder. The definition of this disorder made by the World Health Organization does not quantify the time as a criterion leaving the concept of "early" somewhat subject. The duration of the excitement phase takes into account factors such as age, frequency of recent sexual intercourses, anxiety with the new partner and different from the ordinary sexual situation.
The are many types of medications to control the penile hyper sensibility. In order to do that, it's necessary to know if it's primary origin (since the first sexual intercourses) or secondary (started after a long period of sexual activity) which changes completely the treatment.
The treatment may be done with therapy medications, drugs that helps the erection (only in cases which can be associated with erection disorders), sexual therapy or psychological therapy.
When this disorder occurs since the first sexual intercourses, it's called from primary cause, and, when it occurs only after some time of sexual life, secondary.
The surgical treatments, as “neurotripsia”, self-applications with medications to erection and implants of penile prosthesis are currently not-indicated as treatments for premature ejaculation. (I Brazilian Consence of Erectile Dysfunction, 1998).
The use of oral medications to erectile dysfunction with intravenous or vasoactive drugs is not recommended to patients with exclusive premature ejaculation. In our site www.tudosobreejaculacaoprecoce.com.br this issue is addressed more broadly.
Delayed ejaculation is less common in men than premature ejaculation. The prevalence of acquiring a delayed ejaculation in men under 65 years old is from 3% to 4%. The delayed ejaculation may occur during all of the men's life or can appear in some certain time. It might occur during all the sexual intercourses with several partners or might be intermittent in special occasions. A large part of men with delayed ejaculation (about 75%) can masturbate themselves to have the orgasm but many can't achieve orgasms not even in that way. As all the cases of sexual dysfunction, men with delayed ejaculation can have high levels of personal stress, sexual disinterested and anxiety in the sexual performance. Many men with delayed ejaculation, however, have the characteristic of not having difficulty maintaining the erections normally but even though this, they are not satisfied with the sexual life.
It's known some causes that leads to delayed ejaculation:
- • Psychogenic
- Anatomic causes: such as the capacity to ejaculate is very reduced in patients with raquimedular injuries and depends on the level and degree of the injury.
- Neurogenic Causes
- Endocrine Problems
- Side Effects of Medications
- Cultural questions and/or religious
For the treatment, it seeks to find the biological causes to this dysfunction, with medications, diabetes mellitus or recent pelvic surgery and with that optimize treatments. An indicator of this problem is the fact that the man cannot achieve an ejaculation after 20 or 30 minutes of sexual intercourse or comes to a stop by fatigue and irritation. After that all the possible organic causes are studied, may be necessary a support of sexual therapy for the issues solution.
Pharmacological causes - side effect of some medication. This type of erection disorder can be confirmed by the history of any surgical procedure as well as sperm evidence in simple urine test done after ejaculation. As the source of the problem may be indicated a pharmacist treatment, or surgical. Ref: Standard Practice in Sexual Medicine - Hartmut Porst and Jacques Buvat Drug treatment aims to produce contraction of the bladder neck during ejaculation.
Absence of orgasm - Anorgasmia
The anorgasmia is relatively rare. If primary, almost certainly is psychogenic, but secondary anorgasmia may occur in patients with spinal cord injury or other neurological diseases.
Absence of Ejaculation
The absence of ejaculation may occur due to a abnormality in the production or storage of sperm, or conditions that affect the expulsion process. Psychological causes are common, but, if the man never ejaculated, you should suspect of organic causes. Congenital anomalies such as absence of seminal vesicles and prostate gland may be responsible, although this is very rare. There are cases which this absence comes from side effects from surgeries (such as cancer surgeries) with damage to the sympathetic trunk. Radical prostatectomy usually results in the loss of ejaculation, despite the secretions from glands for urethral can cause small emissions. The orgasmic sensations are normal, but there is no expulsion of the semen. Patients with distal neuropathy, especially diabetics and patients with other neuromuscular diseases such as multiple sclerosis, can present “aspermia” lack of contraction of the epididymis, vas deferens, seminal vesicles and prostate. The absence of ejaculate may also be due to not training material needed for ejaculation. In case of absence of ejaculate or decrease of the same should be evaluated retrograde ejaculation hypothesis.
The presence of blood in the ejaculate often bring much concern to the patient, but is usually benign. In young men, younger than 40 years may be due to an infection of the genital tract and then must be treated accordingly. In older men, may be associated with cysts, seminal tract calculations, polyps ejaculatory duct and seminal vesicles. Fortunately, the incidence of prostate adenocarcinoma hemospermia is detected with only 1 to 3%. (*) Sexual dysfunction - Diagnosis and treatment - Prof. Dr. Miguel Srougi and Prof. Dr. Mario Paranhos.