Recent Progress in the Diagnosis and Treatment of Premature Ejaculation

1. Recent Progress in the Diagnosis and Treatment of Premature Ejaculation 2000级七年制二班 邱浩

2. Premature ejaculation is a very common sexual problem. it affects about one quarter of all men of all ages throughout the world. • The impact of premature ejaculation ,not only for the patient, but frequently for the patient's partner. • patient :distress, bother, dissatisfaction, and anxiety,lose self-confidence ,self-esteem • Partner: confusion ,feelings of isolation , lose self-esteem and self-satisfaction

3. Epidemiology Definition Classfication Diagnosis Pathophysiology Etiology Therapy Content

4. The Epidemiology of PE

8. The Epidemiology of PE • IELT (Intravaginal ejaculatory latency time ) • It is a very important parameter in investigating PE.

11. The Epidemiology of PE • In normal man ,IELT typically range from 2 to 10 minutes, about 7 minutes or more • In men with PE, IELT usnally within 2 minutes (95%) • No definitive agreement on best PE vs non-PE ---------breakpoint

12. The Epidemiology of PE • Condom have no specific effect on IELT in some large population studies. • circumcision appeared to have no effect on IELT.

13. The Epidemiology of PE • prevalence is in the range of 20% to 30%. • Normal IELT is about 7 minutes or more • The IELT in premature ejaculation is usually, but not always, less than 2minutes.

14. The definition of PE

16. The definition of PE • EAU ,simplest, but lacks control and distress • AUA , most contemporary brief, but it does lack mention of control. • DSM IV(Diagnostic and Statistical Manual of Mental Disorders IV) , the most convoluted and complex ,

17. The definition of PE • Three key elements • diminished intravaginal ejaculatory latency time( IELT ) • lack of voluntary control • dissatisfaction or distress

18. The classfication of PE

19. Primary PE:have had the condition since the earliest age of sexual maturity. Secondary PE :have previously had acceptable level of ejaculatory control. simple PE Complex PE: combine with erectile dysfunction The classfication of PE

20. The diagnosis of PE

21. The diagnosis of PE • Diagnosis is made by history alone • Not require any laboratory studies or even a physical examination.

23. The diagnosis of PE • Attention: • Other diseases • If PE and DE coxist, treat the ED first

24. The Pathophysiology of PE

25. Normal Ejaculation Reflex • 非接触刺激（视，听）→大脑射精中枢→脊髓泌精中枢（T12-l2)射精中枢(s2-s4) 传出N射精器官 • 接触性刺激→脊髓泌精中枢（T12-l2)射精中枢(s2-s4) 传出N射精器官

27. The Etiology of PE

28. The Etiology of PE • psychological theories ,a learned behavior, conditioned response • organic etiology: • Penile hypersensitivity • hyperexcitability of the ejaculatory reflux • 5-HT • 外生殖器及前尿道疾病，糖尿病，体质差 • Others:sex hormones

29. Waldinger's theory • PE may be due to alterations in the sensitivity of certain 5-HTreceptors located in various places in the CNS • hyposensitivity of the 5-HT2c receptors or hypersensitivity of the 5HT1a receptors are the cause of premature ejaculation. • low serotonin and/or alterations of receptors in these locations may have their ejaculatory threshold genetically set at a lower point and therefore ejaculate quickly.

30. The Therapy of PE

31. The Therapy of PE • psychological counselling • Behavioral Therapy • Pharmacologic Therapy: • Topical Therapy • SSRIs • PDE-5 Inhibitors • Intracavernous injection • others

32. Behavioral Therapy • squeeze technique ,Masters and Johnson 1970s. • the start-stop technique semans1950s,kaplan1983 • Sensate focus Masters and Johnson • The quiet vagina • Masturbatingbefore having intercourse

33. Behavioral Therapy • It would seem rational to apply such techniques when PE is thought to be predominately psychological. • require an active participating and committed partner,lots of times and exercises. • there are limited data to suggest that some of the maneuvers recommended are actually effective and the limited data that do exist suggest that there is a high relapse rate once the focused exercises come to an end.

34. Topical anesthetics desensitize the penis • EMLA cream恩纳 • SS cream

35. SSRIs and PDE-5 Inhibitors

39. The SSRIs have a relatively long time to maximum concentration and relatively long half-life, limit on-demand dosing • daily dosing better than situational dosing.

41. dapoxetine • rapid-acting short half-life SSRIs • Dapoxetine is dosed 1-2 hours prior to intercourse • IELTs increased ,2.78 minutes and 3.32 minutes at the study endpoint with either 30 mg or 60 mg , a 3- or 4-fold increase • Improvement of controlling over ejaculation • Improvement of satisfaction with sexual intercourse • dosage-dependent: nausea, diarrhea, headache, and dizziness

43. others • Intracavernous injection • penile implants • penile dorsal neurectomy

44. conclusion • prevalence is in the range of 20% to 30% • IELT • Three key elements: diminished IELT, lack of voluntary control ,dissatisfaction or distress • Diagnosis is made by history alone • Behavioral therapy, topical therapy ,SSRIs

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