Best Treatments to Cure Premature Ejaculation
Diminished or absent testicular pain has been described as an early sign of autonomic neuropathy. Retrograde ejaculation from the prostatic urethra into the bladder might occur occasionally and follows loss of sympathetic innervation of the internal sphincter, which normally contracts during ejaculation. Complete loss of ejaculation probably indicates widespread pelvic sympathetic involvement and, like retrograde ejaculation, causes infertility, which may be treated by insemination (70).
A good clinical history and physical examination are the basis of assessment. It is important to establish the nature of the erectile problem and to distinguish it from other forms of sexual difficulty such as penile curvature or premature ejaculation. An interview with the partner is advisable and will confirm the problem but may also reveal other causes of the difficulties, e.g., vaginal dryness. The relative importance of psychological and organic factors may be determined from the history. Drugs which may be associated with ED include tranquillizers (phenothiazines, benzodiazepines), antidepressants (tricyclics, SSRI), and antihypertensives (P-blockers, vasodilators, central sympathomimetics, ganglion blockers, diuretics, ACE inhibitors) (100). In most patients sophisticated investigation is not indicated. A three-step diagnostic approach is shown in Table 9. A detailed history is most important, and for many patients examination can be limited to the regular monitoring of...
Dysfunction, particularly antidepressant agents, should, when possible, be reduced or replaced with drugs having less propensity toward sexual dysfunction. There are currently multiple medications available for the treatment of erectile dysfunction. Pharmaceutical agents such as sildenafil and tadalafil are effective in 50 to 60 of the patients (86,87). These must not be given with organic nitrates as hypotension and fatal cardiac events may occur. Other options include prostacyclin injections, yohimbine, suction devices, and prosthetic devices. Retrograde ejaculation has been successfully treated with antihistamines. Female sexual dysfunction, commonly decreased lubrication of the vaginal walls, is treated with vaginal lubricants and estrogen creams.
Phentolamine or prostaglandin E (alprostadil, 20 g) will result in an increase of blood flow into the penis, resulting in tumescence and rigidity. A constricting band must then be applied to the base of the penis, which must be immediately removed after intercourse. Sustained erections in excess of 2 h may require immediate medical therapy with epinephrine to avoid priapism. Retrograde ejaculation, a cause of infertility, has been successfully treated with an antihistamine (159). Treatment for female sexual dysfunction involves recognition, vaginal lubricants, and estrogen creams (160).
Apart from erectile dysfunction, diabetes can also produce problems with ejaculation, especially retrograde ejaculation as the so-called 'dry orgasm' (a dysfunction of the autonomic and somatic nervous system) which occurs in 1-4 of male diabetics, most particularly in those with the longest history of the disease and those who are most metabolically compromised. Ejaculation without orgasm and indeed failure to achieve ejaculation (reflecting a compromised sympathetic nervous system) are also commoner among diabetics than in the general population, accounting for 8 of ejacula-tory disorders. By contrast, the incidence of premature ejaculation is almost Patient compliance with this system is generally good. However the device should not be used for more than 30 min at a time, since it can create a feeling of chill in the penis. Furthermore, ejaculation is generally impeded and this may make for a less satisfying orgasm. The vacuum device can be used to potentiate the effect of drug...
Apart from erectile dysfunction, one out of three men with DM can manifest ejaculation disturbances. The most frequent disturbance is retrograde ejaculation, during which some sperm, instead of exiting through the urethra, regresses into the urinary bladder. This condition is due to
Genitourinary abnormalities, including cystopathy, neurogenic bladder, defective vaginal lubrication, retrograde ejaculation, and erectile dysfunction. Often, erectile dysfunction may be the first manifestation of a developing autonomic neuropathy, followed by episodes of diminished ejaculation, loss of ejaculatory effort, or retrograde ejaculation. Poor glycemic control has shown to be the chief risk factor for autonomic neuropathy, although, in the Pittsburgh Epidemiology Study, increased low-density lipoproteins and hypertension were also contributing factors. Other data has implied associations between neuropathies and systolic and diastolic blood pressure or lipid disturbances (31).
These have the merit of being non-invasive and may be effective in all men. They create a vacuum around the penis and blood is drawn into the corporal spaces. A band is slipped off the plastic cylinder around the base of the penis to maintain penile tumescence without rigidity in the crura. The disadvantages are that they require some degree of dexterity in handling them, and some time spent in application of the device. They should only be used for 30 minutes at a time, and require the willing cooperation of the partner. There are few side effects although there is some degree of discomfort and the penis feels cold. Ejaculation is usually blocked and some men find this makes orgasm less satisfactory. Bruising can occur in 10 to 15 of men. Vacuum devices are particularly useful in older men in stable relationships and when other treatment options are ineffective. They may also be used to augment the result of pharmacotherapy. Some men find that the constrictive ring is a useful aid in...
5 Secrets to Lasting Longer In The Bedroom
How to increase your staying power to extend your pleasure-and hers. There are many techniques, exercises and even devices, aids, and drugs to help you last longer in the bedroom. However, in most cases, the main reason most guys don't last long is due to what's going on in their minds, not their bodies.