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Introduction: A wide variety of therapeutic modalities have been tried for treatment of premature ejaculation. Selective serotonin reuptake inhibitors are from the latest and most effective medical agents. Among these drugs, fluoxetine hydrochloride has been used for some years in our institutions with considerable drug untoward effects and significant failure rates. We tried to salvage treatment process by using citalopram in fluoxetine-resistant patients. Materials and Methods: In a prospective clinical trial, we used citalopram hydrobromide as a salvage agent in 16 newly married men with premature ejaculation who experienced a history of unsuccessful treatment with fluoxetine hydrochloride. Intravaginal ejaculation latency time (IVELT) was recorded by a stopwatch before and after the treatment, and a 5-stage visual scale was designed and used to compare patients’ sexual satisfaction levels during the 1-month treatment period. Results: The IVELT and sexual satisfaction levels both significantly improved after citalopram prescription. The mean measured IVELT was 0.388 +/- 0.212 minutes before the treatment, which increased to 4.313 +/- 2.886 minutes after the treatment. The reported drug untoward effects were mild. Citalopram was ineffective only in 1 patient, which was discontinued after 4 weeks. Conclusion: Our study showed that citalopram is effective and safe in the treatment of premature ejaculation in newly married men after failed treatment with fluoxetine.

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Introduction: A wide variety of therapeutic modalities have been tried for treatment of premature ejaculation. Selective serotonin reuptake inhibitors are from the latest and most effective medical agents. Among these drugs, fluoxetine hydrochloride has been used for some years in our institutions with considerable drug untoward effects and significant failure rates. We tried to salvage treatment process by using citalopram in fluoxetine-resistant patients. Materials and Methods: In a prospective clinical trial, we used citalopram hydrobromide as a salvage agent in 16 newly married men with premature ejaculation who experienced a history of unsuccessful treatment with fluoxetine hydrochloride. Intravaginal ejaculation latency time (IVELT) was recorded by a stopwatch before and after the treatment, and a 5-stage visual scale was designed and used to compare patients’ sexual satisfaction levels during the 1-month treatment period. Results: The IVELT and sexual satisfaction levels both significantly improved after citalopram prescription. The mean measured IVELT was 0.388 +/- 0.212 minutes before the treatment, which increased to 4.313 +/- 2.886 minutes after the treatment. The reported drug untoward effects were mild. Citalopram was ineffective only in 1 patient, which was discontinued after 4 weeks. Conclusion: Our study showed that citalopram is effective and safe in the treatment of premature ejaculation in newly married men after failed treatment with fluoxetine.

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OBJECTIVE: Primary premature ejaculation (PPE) is a prevalent sexual dysfunction among men while its precise pathologic mechanism has remained poorly understood. In current study the correlation between excitability of bulbocavernosus reflex (BCR) to stimulation of prostatic urethra and primary premature ejaculation was studied. METHODS: Forty-two patients with PPE and 20 normal potent male volunteers were studied by inserting a specially designed Foley catheter with two electrodes mounted on its distal surface (intraurethral catheter electrode) into bladder to evoke the BCR to stimulation of prostatic urethra to record the sensory thresholds of BCR to stimulation of prostatic urethra, thresholds to evoke stable BCR and latencies of BCR. Also the sensitivity of glans penis to electrical stimulation was detected by two surface electrodes. RESULTS: The mean sensory thresholds of BCR to stimulation of prostatic urethra, thresholds to evoke stable BCR, latencies of BCR and sensory thresholds of glans penis were (18.2 +/- 2.7) mA (0.2 ms in duration, 1 Hz), (34.8 +/- 4.2) mA (0.2 ms, 1 Hz), (71.2 +/- 5.8) ms and (14.2 +/- 1.9) mA (0.04 ms in duration, 3 Hz) in normal potent men respectively and were (12.4 +/- 3.7) mA (0.2 ms, 1 Hz), (23.8 +/- 5.6) mA (0.2 ms, 1 Hz), (70.5 +/- 6.3) ms and (11.9 +/- 2.3) mA (0.04 ms, 3 Hz) in patients with PPE respectively. Statistically significant differences were seen regarding the sensory thresholds of BCR to stimulation of prostatic urethra, the thresholds to evoke stable BCR and the sensory thresholds of glans penis between two groups (all P 0.05). CONCLUSION: Patients with PPE have hyperexcitable BCR to stimulation of prostatic urethra. It is probably one of the important etiological factors. Moreover the findings may provide new therapeutic modalities of PPE.

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CONTEXT: Erectile dysfunction (ED) and premature ejaculation (PE) are the two most prevalent male sexual dysfunctions. OBJECTIVE: To present the updated version of 2009 European Association of Urology (EAU) guidelines on ED and PE. EVIDENCE ACQUISITION: A systematic review of the recent literature on the epidemiology, diagnosis, and treatment of ED and PE was performed. Levels of evidence and grades of recommendation were assigned. EVIDENCE SYNTHESIS: ED is highly prevalent, and 5-20% of men have moderate to severe ED. ED shares common risk factors with cardiovascular disease. Diagnosis is based on medical and sexual history, including validated questionnaires. Physical examination and laboratory testing must be tailored to the patient’s complaints and risk factors. Treatment is based on phosphodiesterase type 5 inhibitors (PDE5-Is), including sildenafil, tadalafil, and vardenafil. PDE5-Is have high efficacy and safety rates, even in difficult-to-treat populations such as patients with diabetes mellitus. Treatment options for patients who do not respond to PDE5-Is or for whom PDE5-Is are contraindicated include intracavernous injections, intraurethral alprostadil, vacuum constriction devices, or implantation of a penile prosthesis. PE has prevalence rates of 20-30%. PE may be classified as lifelong (primary) or acquired (secondary). Diagnosis is based on medical and sexual history assessing intravaginal ejaculatory latency time, perceived control, distress, and interpersonal difficulty related to the ejaculatory dysfunction. Physical examination and laboratory testing may be needed in selected patients only. Pharmacotherapy is the basis of treatment in lifelong PE, including daily dosing of selective serotonin reuptake inhibitors and topical anaesthetics. Dapoxetine is the only drug approved for the on-demand treatment of PE in Europe. Behavioural techniques may be efficacious as a monotherapy or in combination with pharmacotherapy. Recurrence is likely to occur after treatment withdrawal. CONCLUSIONS: These EAU guidelines summarise the present information on ED and PE. The extended version of the guidelines is available at the EAU Web site (http://www.uroweb.org/nc/professional-resources/guidelines/online/).

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The various sexual problems, which are common among men, can be penned down as

Lack of desire

Ejaculation Problems

Infertility

Erectile dysfunction or Impotence

The causes, which can lead to, the above-mentioned problems are:

Physical Health

These conditions include diabetes, heart disease, neurological diseases, hormonal imbalances, and kidney disease, liver failure that can cause impotence.

Lifestyle

Drinking and smoking can lead to erection problems. Alcohol often increases the desire by reducing inhibitions, but it leads to erectile dysfunction. These can also reduce your desire for sex. Being physically inactive also contributes to the chances of impotency.

Medications

The side effects of medicines like antidepressant drugs, medicines to treat hypertension, anxiety and benign prostate enlargement can affect sexual desire, can cause impotence and can also lead to problems related to ejaculation and orgasm.

Psychological factors

Stress, anxiety, concern about sexual performance, relationship problems, depression, feelings of guilt, depression and fatigue are some of the psychological factors which leads to sexual problems. Regular sexual routines may also contribute to a lack of enthusiasm for sex.

Obesity/Over Weight

Obesity is another major factor, which increases the risk sexual problems. Being overweight is often overlooked as a cause of sexual difficulties but can lead to serious problems such as lack of desire and erectile dysfunction.

Age

Levels of testosterone, the male hormone, decrease slowly with age, which may affect sexual function and can cause lack of desire, ejaculation problem and impotence.

A sexual problem prevents a man from experiencing satisfaction from sexual activity. Sexuality is a complex process also related to personal and social experience, which keeps changing with time and age. Any disturbance in any of these areas leads to sexual problems.

The various sexual problems, which are common among men, are lack of desire, ejaculation problems, infertility, erectile dysfunction and impotence.

Few Ayurvedic Remedies are:

a). Vajikarna is one of the disciplines which deals with vitality, men seek rejuvenation mainly with the object of reactivating their sexual vigour and drive which can be achieved by the concept of rasayana (rejuvenation) and vajikarna (virilization). The best agent of virilification being an exhilarating sexual partner. Drink milk after a meal of swastika rice (a kind of Indian rice which is of high nutritional value) mixed with ghee (clarified butter) and with black gram gruel.

b). Pumpkin seeds, Brazil nuts and almonds are rich in the amino acid, boosting levels of blood to the genitals, making them natural viagra. Oysters, the richest source of Zinc, nourish the prostate gland and boost testosterone production.

c). For some common problems in men the remedies have been listed below:

1. Premature ejaculation & unsatisfactory erections or sexual deficiency: In most cases the root cause for this is very psychological. Herbal remedies- shilajit, stress guard medicines, taila oil – for gentle massage, Narasimha rasyan, Musli power extra capsules, Addyzoa capsules, Tentex royal capsule and Vigomax forte.

2. Male infertility is often due to the sperm count falling below the fertility level. Herbal remedies- Shilajit – with milk or butter , Promotil capsules, Narasimha rasayan, Sathavaree gulam,Makaradhwaj vati, Swarna Bhasma, Kaminividrawan ras, Pushpdhanwa ras, Stimulex+ , Musli power extra capsules and Addyzoa.

3. Nocturnal emissions: It is an involuntary discharge of semen without undergoing orgasm. Herbal remedies- Chandraprabha bati, Aswagandharishta, Bhringaraja ras, Shri gopal tail, Kaminidugdh ras and Neo tablet, .

4. Impotency: It is directly related to anxiety regarding sexual performance. Herbal remedies- Ashwagandha churna, Kaminidugdh ras, Shri gopal tail, Shilajith gold, Aswagandharishta, Bhringaraj ras, Makaradhwaj vati, Swarna Bhasma, Kaminividrawan ras, Pushpdhanwa ras, Stimulex+ and Lakshadi oil.

It is quite essential and natural that a common family man must adopt the perfect combination of ayurveda and sex to practice blissful actual sex act following the ayurveda concept of vigor and vitality.

Dr Rajesh Nair is the consultant of world’s largest online Ayurvedic store http://www.ayurvedaforall.com. Please check his favourite male sex herbal medicines and premature ejaculation medicines.

Article Source: ArticleSpan

OBJECTIVE: The aim of this study is to measure the ejaculation latency time (ELT) and to evaluate the effects of vardenafil on ELT and rigidity parameters of patients with lifelong premature ejaculation (PE) in a laboratory setting. MATERIALS AND METHODS: Double-blind, placebo-controlled, cross-over laboratory study was performed with 40 males with lifelong PE. As the subject ingested the placebo or vardenafil, real-time penile tumescence and rigidity monitoring began. Audiovisual sexual stimulation (AVSS) was performed 45 min later. The patient began vibratory stimulation to the frenular area at 8th minute of AVSS till ejaculation. A button has been placed under the cover where the patient presses to operate the vibrator. ELT was calculated in seconds with a chronometer. Following ejaculation, AVSS was stopped. The test was repeated with second medication in 7-15 days. RESULTS: Among 40 patients, the results of 17 could be evaluated. When the patient took placebo and vardenafil, mean ELTs were 62.7 and 189.5 s, respectively. When compared with placebo, vardenafil improved ELT significantly (P = 0.04). After the beginning of AVSS, time to first recorded base or tip rigidities was shorter and time to last recorded tip or base rigidities following ejaculation was longer than placebo; however, these differences were not significant (P > 0.05 for each). CONCLUSIONS: This laboratory design might be used to evaluate the effects of drugs on patients with ejaculation disorders. In this laboratory setting study, vardenafil exerted a threefold increase in ejaculation delay outside the vagina in patients with lifelong PE.

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Sexual dysfunctions and difficulties are common experiences that may impact importantly on the perceived quality of life, but prevalence estimates are highly sensitive to the definitions used. We used questionnaire data for 4415 sexually active Danes aged 16-95 years who participated in a national health and morbidity survey in 2005 to estimate the prevalence of sexual dysfunctions and difficulties and to identify associated sociodemographic factors. Overall, 11% (95% CI, 10-13%) of men and 11% (10-13%) of women reported at least one sexual dysfunction (i.e., a frequent sexual difficulty that was perceived as a problem) in the last year, while another 68% (66-70%) of men and 69% (67-71%) of women reported infrequent or less severe sexual difficulties. Estimated overall frequencies of sexual dysfunctions among men were: premature ejaculation (7%), erectile dysfunction (5%), anorgasmia (2%), and dyspareunia (0.1%); among women: lubrication insufficiency (7%), anorgasmia (6%), dyspareunia (3%), and vaginismus (0.4%). Highest frequencies of sexual dysfunction were seen in men above age 60 years and women below age 30 years or above age 50 years. In logistic regression analysis, indicators of economic hardship in the family were positively associated with sexual dysfunctions, notably among women. In conclusion, while a majority of sexually active adults in Denmark experience sexual difficulties with their partner once in a while, approximately one in nine suffer from frequent sexual difficulties that constitute a threat to their well-being. Sexual dysfunctions seem to be more common among persons who experience economic hardship in the family.

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Sexual dysfunctions and difficulties are common experiences that may impact importantly on the perceived quality of life, but prevalence estimates are highly sensitive to the definitions used. We used questionnaire data for 4415 sexually active Danes aged 16-95 years who participated in a national health and morbidity survey in 2005 to estimate the prevalence of sexual dysfunctions and difficulties and to identify associated sociodemographic factors. Overall, 11% (95% CI, 10-13%) of men and 11% (10-13%) of women reported at least one sexual dysfunction (i.e., a frequent sexual difficulty that was perceived as a problem) in the last year, while another 68% (66-70%) of men and 69% (67-71%) of women reported infrequent or less severe sexual difficulties. Estimated overall frequencies of sexual dysfunctions among men were: premature ejaculation (7%), erectile dysfunction (5%), anorgasmia (2%), and dyspareunia (0.1%); among women: lubrication insufficiency (7%), anorgasmia (6%), dyspareunia (3%), and vaginismus (0.4%). Highest frequencies of sexual dysfunction were seen in men above age 60 years and women below age 30 years or above age 50 years. In logistic regression analysis, indicators of economic hardship in the family were positively associated with sexual dysfunctions, notably among women. In conclusion, while a majority of sexually active adults in Denmark experience sexual difficulties with their partner once in a while, approximately one in nine suffer from frequent sexual difficulties that constitute a threat to their well-being. Sexual dysfunctions seem to be more common among persons who experience economic hardship in the family.

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OBJECTIVES: To discuss a concept about the current definition and treatment of premature ejaculation. METHODS: A detailed review was performed on the current definition and treatment of premature ejaculation. RESULTS: Several definitions were found, however a consensus on how to define premature ejaculation is lacking. In addition, there are several treatments: daily, on demand and topical agents. CONCLUSIONS: Premature ejaculation implicated three specific characteristics: short intravaginal ejaculatory latency time, lack of control, and sexual dissatisfaction.

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