Cure for Premature Ejaculation Discovered

Ejaculation Guru

In This Video You'll Discover: How I personally went from lasting less than 10 seconds in bed to over 30 minutes in bed. The real reason so many men suffer from premature ejaculation. And exactly what to do about it. How long you should be lasting if you want to truly satisfy a woman This, by the way, comes from a study carried out by a major University. The number #1 thing holding most men back from getting control over their orgasms and how you can change it. (By the way, most guys don't even realize this is holding them back, but it's critical to understand if you want to learn to last long in bed) What most porn stars will Never tell you about porn and its influence on your sexual stamina. The truth about penis size and its links with how long you last. What the number #1 reason is for relationships ending. and how premature ejaculation is critically linked to it. Why you should Avoid 99% of people trying to sell you long lasting condoms, creams or pills. Read more...

Ejaculation Guru Summary


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Ejaculation By Command

Everything is explained here in clear, concise and easy-to-understand instructions. The insights, tools and techniques in this program have been rigorously tried, tested and proven effective not only by me, but by thousands of other men who are now enjoying lovemaking that lasts so much longer than before. Here's a Very partial list of what you're going to learn inside this exciting new program: How to overcome mental barriers to sexual endurance develop iron-clad stamina and confidence by using these 9 specific techniques I am going to give you. A primal sexual technique that adds massive control to your arousal. and puts a woman over the edge with sexual excitement. she'll have to have you Right Then And There. and nothing will be able to stop her. 4 powerful breathing strategies that will amplify your staying power and prolong your orgasm for as long as you desire (97% of men screw up their breathing and end up ejaculating too soon) Specific guided love muscle exercises to skyrocket your ejaculatory control and your ability to withstand intense sexual stimulation (The secret is in the step-by-step process, which you'll learn in detail) The Pleasure Acclimatizing technique to train and condition your ejaculation reflexes so that you will Automatically last longer without tipping over in a hurry (this is one of the stamina secrets that Top porn actors use All The Time ) Have you ever blown your load even Before penetration starts. and wondered how the hell that happened? Here's the little-known and closely-guarded Total Immersion technique you can use to Outlast her during sex (it's much easier than you think. when you know the secret) Read more...

Ejaculation By Command Summary

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Ejaculation and male orgasm

Most of the experimental work done so far for the investigation of ejaculation is based on behavioral experiments. Ejaculations in rats can be studied much the same way they are studied in humans, with the latency from first mount or intromission to ejaculation being the key variables (Fig. 1.3). Male rats typically ejaculate following several penile intromissions, and can ejaculate several times before becoming sexually exhausted, in which the male no longer responds to estrous odors or female solicitations. During successive ejaculatory series, the refractory period or post ejaculatory interval between each ejaculation and the subsequent resumption of copulation increases progressively. Penile intromission requires erection, and ejaculation typically requires sensory feedback from the penis that accumulates with multiple intromissions. The number of intromissions before ejaculation, the number of ejaculations achieved in a timed test, and the length of the post ejaculatory interval,...

Neurophysiology of ejaculation

Both the central and peripheral neural system is involved in the ejaculatory process. Central Nervous System The brain, brainstem and lumbospinal cord contain various areas that are involved in ejaculation. These areas have been identified in male rat studies. Specific information on areas in the human brain leading to ejaculation is mostly lacking. However, one positron electron tomography (PET) scan study in normal male volunteers has shown that during ejaculation a dopamine-rich area, the ventral tegmental area (VTA), becomes strongly stimulated 1 . (peripheral) nervous system, and particularly the sympathetic nervous system, mediates ejaculation. The mechanism of ejaculation is divided into two phases emission and expulsion. Expulsion (or true ejaculation) Emission is immediately followed by expulsion. During expulsion, semen is forcefully propelled along the urethra and out of the penis by clonic contractions of striated muscles of the pelvic floor. It should be noted that...

Psychotherapy with rapid ejaculation

Cognitive behavioral therapy, as well as multimodal, psychodynamic and behavioral treatment is described in review papers however, there are no controlled outcome studies that examine the efficacy of these methods 13 . Masters and Johnson 3 utilizing multiple treatment techniques including the squeeze technique in combination with sensate focus and interpersonal therapy, reported failure rates of 2.2 immediately after treatment and 2.7 at the five-year follow-up. Other researchers have been unable to replicate Masters & Johnson's success rates. For instance, only 64 of men in Hawton's 14 study were characterized as successful in overcoming rapid ejaculation.

Ejaculation and Orgasm

Anorgasmia has been reported with all the commonly employed TCAs including clomipramine, imipramine, desipramine, nortriptyline and doxepine81,82 and MAOIs such as phenelzine.80 Rates of anorgasmia also vary widely in these studies. For example, in a study of sexual dysfunction in obsessive-compulsive disorder, 96 of patients treated with clomipramine described problems with orgasm 94 In another study 8.8 of patients treated with amitriptyline described delay in ejaculation.95 Clomipramine and SSRIs have been used with reported success to treat premature ejaculation (e.g., ref. 96). Other treatments for fluoxetine-induced anorgasmia that have been reported include yohimbine,78 and a number of direct and indirect dopaminergic agonists. These effects are probably a result of functional antagonism of the serotonergic action of fluoxetine (or other SSRIs). By blockade of a2-autoreceptors, yohimbine facilitates noradrenergic neurotransmission. The importance of dopaminergic input in...

Premature Ejaculation

Although premature ejaculation (PE) is considered the most frequent self-reported male sexual dysfunction, there is a lack of a universally accepted definition 5 . This has led to a wide range of prevalence estimates and the development of proposed guidelines for the use of the varied psychologic and pharmacologic therapeutic interventions 6 . Premature ejaculation may affect the level of sexual satisfaction of both men and or their partners. However, few studies have examined the impact of PE on the man, his partner, and or their relationship 7,8 . Many patients are reluctant to seek help and to discuss this issue with their physician out of embarrassment and uncertainty whether effective treatment options are available. In many relationships, PE causes few if any problems. Couples may reach an accommodation of the problem through various strategies young men with a short refractory period may often experience a second and more controlled ejaculation during a subsequent episode of...

Pharmacologic treatment of premature ejaculation

Reverse Testicular Atrophy

Pharmacologic modulation of ejaculatory threshold represents a novel and refreshing approach to the treatment of PE and a radical departure from the psy-chosexual model of treatment, previously regarded as the cornerstone of treatment. The introduction of SSRIs has revolutionized the approach to, and treatment of, PE. Selective serotonin reuptake inhibitors encompass five compounds citalopram, fluoxetine, fluvoxamine, paroxetine and sertraline with a similar pharmacologic mechanism of action. Although the methodology of the initial drug treatment studies was rather poor, later doubleblind and placebo-controlled studies replicated the genuine effect of clomipramine and SSRIs to delay ejaculation. In spite of a development towards more evidence-based drug treatment research, the majority of studies still lack adequate design and methodology 44 . A recent meta-analysis of all drug treatment studies demonstrated that only 14.4 had been performed according to the established criteria of...

Male Orgasm

Male orgasm is a two-stage process involving emission (the movement of sperm into the urethra) and ejaculation (the explosive propulsion of the semen out of the urethra). How it is triggered is poorly understood although the inhibitory involvement of 5-HT is increasingly suggested by the pharmacology (described below). Neurons originating in the reticular paragigantocellularis nucleus of the ventral medulla (Fig. 6.1) and projecting to pudendal motor neurons and interneuronal areas of the lumbar cord appear to mediate inhibition of sexual reflexes and the majority of these fibers have been demonstrated to be serotonergic. Emission is a sympathetic response, integrated in the upper lumbar segments of the spinal cord it involves a sequence of contractions of smooth muscles of the epididymus, vas deferens, seminal vesicles and prostate to expel seminal fluid into the prostatic urethra. Various studies have demonstrated noradrenergic and cholinergic fibers in the epididymus, vas deferens...

Painful ejaculation

Painful ejaculation or odynorgasmia is a poorly- characterized syndrome and may be associated with benign prostatic hypertrophy (BPH), infection, or inflammation from acute prostatitis, chronic pro-statitis chronic pelvic pain syndrome, seminal vesi-culitis, seminal vesicular calculi, or ejaculatory duct obstruction, a treatable cause of male infertility 122-125 . Nickel reported that 18.6 of men with lower urinary tract symptoms (LUTS) diagnosed with clinical benign prostatic hyperplasia reported painful ejaculation 123 . Men with BPH and painful ejaculation have more severe LUTS and reported greater bother, and had a higher prevalence of erectile dysfunction and reduced ejaculation, than men with LUTS only 78 . Treatment of men with LUTS with a-blocking drugs may be associated with painful ejaculation. A lower incidence of pain has been reported with the uroselective a-1 blocking drug, alfuzosin 126 . Painful ejaculation is a rarely reported side-effect of tricyclic and SSRI class...


Coolen LM, Allard J, Truitt WA, McKenna KE. Central regulation of ejaculation. Physiol Behav 2004 83 203-215. McKenna KE. Ejaculation. In Knobil E, Neill J.D, eds. Encyclopedia of Reproduction. Academic Press, 1998, pp. Renyi L. Ejaculations induced by p-chloroamphetamine in the rat. Neuropharmacol 1985 24 697-704. Waldinger MD, Olivier B. Animal models of premature and retarded ejaculation. World J Urol 2005 23 115-118.

Hypoactive sexual desireconditioned inhibition

Erences are typically examined on a final test, when the drug is not administered (thus revealing the necessity of opioid reward during paced copulation). However, during this final test without the drug, females previously treated with naloxone display a conditioned disruption of solicitation and lordosis relative to saline-treated females, despite being primed fully with estrogen and progesterone. As a result, males engage in fewer intromissions and achieve fewer ejaculations with those females. A pattern of diminished sexual solicitation and receptivity, which leads to more restricted sexual contact with males, is analogous in many ways to the pattern of sexual behavior displayed by women with hypoactive sexual desire disorder. It is not yet known if this pattern of disrupted appetitive sexual behavior can be restored by pharmacologic or experiential treatments that increase desire in women.

Sexual function assessment in the male

The essential components of sexual function assessment in the male always include erectile response (onset, duration, progression, severity of the problem, nocturnal morning erections, self-stimulatory and visually erotic-induced erections), sexual desire, ejaculation, orgasm, sexually related genital pain disorders and partner sexual function, if available. Often, a dysfunction in one phase may precipitate a dysfunction in another. For instance, men with erectile dysfunction may report a loss of sexual desire or the onset of premature ejaculation.

Peter A Sargent and Guy M Goodwin Introduction

F52.4 Premature ejaculation F52.8 Other sexual dysfunction, not caused by organic disorder or disease F52.9 Unspecified sexual dysfunction, not caused by organic disorder or disease The pitfalls of medicalizing sexual dysfunction should be noticed here and have been illuminated in the lampoon by Szaz 2 he has interesting things to say in this area. Accepting the more conventional medical view, nevertheless, epidemiological studies suggest that sexual dysfunction is not uncommon in the general population. An analysis of 22 surveys of psychosexual dysfunction found inhibited sexual desire in 1-15 of men and in 1-35 of women, inhibited sexual excitement in 10-20 of men, premature ejaculation in 35 of men and inhibited orgasm in 5 of men and 5-30 of women.3 The scale and also the variability of these rates provides a potentially confounding background for the interpretation of findings of sexual dysfunction in specific disorders such as depression or as a consequence of treatment with...

Cell Divisions During Spermatogenesis

Cross Sectional Seminiferous Tubules

-Seminal vesicle -Ejaculatory duct After formation in the seminiferous tubules, the sperm require several days to pass through the 6-meter-long tubule of the epididymis. Sperm removed from the seminiferous tubules and from the early portions of the epididymis are nonmotile, and they cannot fertilize an ovum. However, after the sperm have been in the epididymis for some 18 to 24 hours, they develop the capability of motility, even though several inhibitory proteins in the epididymal fluid still prevent final motility until after ejaculation. Storage of Sperm. The two testes of the human adult form up to 120 million sperm each day. A small quantity of these can be stored in the epididymis, but most are stored in the vas deferens. They can remain stored, maintaining their fertility, for at least a month. During this time, they are kept in a deeply suppressed inactive state by multiple inhibitory substances in the secretions of the ducts. Conversely, with a high level of sexual activity...

Cellular Biology Of Prostatic Epithelium

The prostate of a 65-yr-old patient with benign prostatic hyperplasia (BPH) is shown. The prostate gland is composed of three anatomical zones. The central zone (C) located between ejaculatory ducts (D), and the proximal urethral segment (PU) accounts for about 25 of normal prostatic volume. Only about 10 of carcinomas arise in this zone. The transition zone (T) located around the proximal urethral segment accounts for about 5 of normal prostatic volume but steadily increases with age. Virtually all forms of BPH arise here. Transition zone cancer accounts for about 15-20 of prostatic adenocarcinoma and is commonly diagnosed in transurethral resection specimens from patients with BPH (incidental carcinoma). The peripheral zone (P) located around the distal urethral (DU) segment represents approx 70 of the normal gland. The majority (70-75 ) of prostatic adenocarcinomas and high-grade prostatic intraepithelial neoplasias (HGPINs) arise in this zone. CS,...

Risk Of The Other Guys Sperm

Semen Retention Drug

Males to 'scoop out' semen left by others before ejaculating. 55 Their results demonstrated that a model penis with a glans and coronal ridge which most closely resembled a real human penis displaced significantly more simulated semen (91 percent) than did a model without a glans and coronal ridge (35 percent), suggesting that the penis is physically designed to act like a plunger, displacing the sperm of other men (figure 2.4). The study drew on key assumptions of human sperm competition theory in attempting to demonstrate that men can and do use their penises that, in fact, the shape of the penis itself has evolved to try and displace other men's semen when they suspect their mate has been unfaithful.

Rectification of terms

Noncontact erections ( psychogenic erectile function responses to primary or secondary conditioned sexual cues) Copulatory measures latency to mount, intromit or ejaculate (shorter latency greater arousal) Enforced interval effect (model of premature ejaculation) Coolidge effect (increased arousal by changing sexual stimuli) Females and males (to examine what aspect of sexual responding is rewarding, e.g. copulatory stimulation vs. ejaculation in males, or the ability to control sexual interaction in females) Operant responding for primary or secondary sexual reinforcers Conditioned place preference Unconditioned or conditioned partner preference Copulatory behavior after several ejaculatory series Estrus termination

Reproductive and Hormonal Functions of the Male and Function of the Pineal Gland

Two seminal vesicles, one located on each side of the prostate, empty into the pro-static end of the ampulla, and the contents from both the ampulla and the seminal vesicles pass into an ejaculatory duct leading through the body of the prostate gland and then emptying into the internal urethra. Prostatic ducts, too, empty from the prostate gland into the ejaculatory duct and from there into the prostatic urethra.

The squeeze technique

Concurrent with practicing the stop-start process, the couple is encouraged to spend time in mutual pleasuring involving non-genital massage and caressing, following the programme known as sensate focus . This is essential to reduce the genital-focused interaction of the ejaculatory control process. It is also essential for the man to be encouraged to satisfy the sexual needs of his partner during the training programme. Although success rates in the short term from 60 to almost 100 have been reported 11,69 , the methodology and design of these studies have been weak and fail to meet the criteria of evidence-based research. In addition, long-term maintenance of ejaculatory control induced by these treatment has shown to be very low 70 .

History and Epidemiology of Male Sexual Dysfunction

Proceeding into the beginning of the 21st century, new trends in sexual medicine promise to promote more popular interest and public discussion. A new and specific treatment for premature ejaculation, one of the most common forms of male sexual dysfunction, is in the final stages of clinical development and may be approved in 2007 19 . And an entirely new method of treating erectile dysfunction using the cutting-edge technique of gene therapy has just entered the initial stages of clinical development 20 . Importantly, progress in both male and female sexual health has been aided by the World Health Organization (W.H.O.) which has designated the years 2004 to 2009 for worldwide public emphasis on sexual health using the campaign slogan, Sexual Health a new focus for W.H.O. . The recognition by W.H.O. of the importance of sexual health is another signal of the vital role that sexual medicine is likely to play in the future.

Overlapping Diseases and Points of Confusion

Many men also confuse ejaculatory dysfunction (EjD), such as rapid or delayed ejaculation, with ED. Thus, the clinician must be keen and tease out the specific male sexual dysfunction. Indeed, EjD and ED may overlap, as depicted by Rosen et al. (Table 6.1) in the Multinational Study of the Aging Male 13 . This survey, which included postal questionnaires to men aged 50-80 in seven countries, demonstrated that EjD and ED were both highly prevalent and highly bothersome (Figs 6.1 and 6.2).

Type 5 Phosphodiesterase PDE5 inhibitors

Several authors have reported their experience with PDE5 inhibitors alone or in combination with SSRIs as a treatment for PE 62-66 . The proposed mechanisms for the effect of sildenafil on ejaculatory latencies include a central effect involving increased NO and reduced sympathetic tone, smooth muscle dilatation of the vas deferens and seminal vesicles, which may oppose sympathetic vasoconstriction and delay ejaculation, reduced performance anxiety due to better erections, and down-regulation of the erectile threshold to a lower level of arousal so that increased levels of arousal are required to achieve the ejaculation threshold. Most of these studies are uncontrolled and the results are confusing and difficult to interpret. The only double-blind placebo-controlled multicenter study showed no significant difference in the IELT of sildenafil-treated subjects compared to placebo, but did demonstrate significant improvements in the ejaculatory control domain and the ejaculatory function...

Models of male sexual dysfunctions

Male rats that do not perform sexually are typically taken out of behavioral studies, so there is very little known about their actual erectile responsiveness. This proportion is generally low, especially if the males are pre-exposed to the test chambers prior to their initial sexual experiences. Some of these males do not display any interest in the female, and do not initiate any kind of sexual activity. However, other males display sexual interest and mount repeatedly, but do not achieve vaginal intromission. The lack of intromission may stem from an inability to achieve erection. Indeed, erectile responses in isolation and intromissions during copulation are both very sensitive to disruption by several classes of drug, including psychomotor stimulants, dopamine and noradren-ergic antagonists, and opioid agonists. Acute or chronic treatment with selective serotonin reuptake inhibitors (SSRIs) does not appear to alter erectile responses or the number of intromissions prior to...

Ondemand treatment with selective serotonin reuptake inhibitors

Associated with less ejaculatory delay than daily treatment. Daily administration of an SSRI is associated with superior fold-increases in IELT compared to on-demand administration, due to greatly enhanced 5-HT neurotransmission resulting from several adaptive processes, which may include pre-synaptic 5-HT1A and 5-HT1B receptor desensitiza-tion 20 . On-demand treatment may be combined with either an initial trial of daily treatment or concomitant low-dose daily treatment 47-49 . A number of rapid acting short half-life SSRIs (Dapoxetine-Johnson & Johnson, UK-369,003-Pfizer) are under investigation as on-demand treatments for PE. Preliminary data suggest that dapoxetine (Johnson & Johnson) administered one to two hours prior to planned intercourse, is effective and well-tolerated, superior to placebo, and increases IELT two- to three-fold over baseline in a dose-dependent fashion 50 . In randomized, double-blind, placebo-controlled, multicenter, phase III, 12-week clinical trials...

The role of anxiety in sexual dysfunction

Men with premature rapid ejaculation try to distract themselves in an effort to prevent early ejaculation. They fear focusing on arousal, yet distraction does not effectively solve their problem. Counter intuitively, sex therapists teach men to focus on their arousal as a means of controlling ejaculation.

Responsibility of hypogonadism

Data accumulated in such men show that T is required for pubertal acquisition of gender characteristics as well as adult sexual behavior and functional capacity, including libido, ejaculation, and spontaneous erections. Administration of T during placebo-controlled studies demonstrated that sexual desire and arousal are T-dependent 13,29,30 and represent the main impact of T on sexual function of men. The frequency of sexual activity 13,30,31 and spontaneous erections (especially sleep related, i.e. morning and nocturnal) 13,29,32 are also clearly T-dependent. The psychic erections (i.e. in response to erotic stimuli) were initially thought to be androgen-independent 33 , but are in fact partly T-dependent 34 . Ejaculations 31 and orgasm 35 are also partly androgen-dependent.

Prevalence of hyperprolactinemia in other sexual dysfunctions

Routine determination of serum PRL in men consecutively seen for hypoactive sexual desire without ED (n 53), anorgasmia retarded ejaculation (n 74), and premature ejaculation (n 124) 210,249 found no HPRL in the two former sexual dysfunctions. However Schwartz etal. 250 reported on some male HPRLs revealed by isolated hypoac-tive sexual desire or anorgasmia. In contrast, serum PRL was mildly elevated (20-35ng mL) in 13 men with premature ejaculation (10 ). This was not the cause of sexual dysfunction since bromocriptine failed in every case to prolong the time to ejaculation. In addition serum T was normal in every case and no pituitary adenoma was detected in any patient.

Diagnosis of Hypoactive Sexual Desire

Some patients present themselves as having low sexual desire, which in fact is a result of another sexual dysfunction. Erectile dysfunction is sometimes confused by the patient as a sign of diminished desire. Likewise, the avoidance pattern that follows the frustration generated by a persistent dysfunction, like severe premature ejaculation or erectile dysfunction, can also be reported as absence of desire. These clinical situations demand a careful evaluation from the clinician before arriving at a clinical diagnosis.

Effects of Chemotherapy

PVB (cisplatin, vinblastine and bleomycin), which is used in patients with germ cell tumors, is a standard chemotherapy and results in minimal effects on long-term testicular function. Patients, however, can be affected by ejaculatory failure, caused by damage to the thoracolumbar sympathetic plexus during retroperitoneal lymph node dissection, and by preexisting germ cell defects. Hansen et al. found that whether patients were treated with orchiectomy, or with orchiectomy plus PVB, sperm production 1.5 years after treatment was similar. Approximately half in each group had sperm counts below the normal control reference level 28 . Lampe et al. analyzed the data on 170 patients with testicular germ cell cancers who had undergone treatment with either cisplatin or carboplatin-based chemotherapy 44 .After median of 30 months from the completion of chemotherapy, they discovered that azoospermia occurred in 54 (32 ) of the patients and oligospermia occurred in 43 (25 ). The probability of...

Diagnosis and Evaluation

The diagnostic evaluation of ejaculatory dysfunction focuses on finding potential physical and specific psychologic learned causes of the disorder. A medical (particularly genito-urinary) examination and history are critical, as these may uncover physical anomalies, various pathophysiologies, and iatrogenic procedures associated with the IE. In addition, concomitant or contributory neurologic, endo-crinergic, or erectile disorders can be identified and addressed. Particular attention should be given to identifying reversible urethral, prostatic, epididy-mal, and testicular infections. Given the lack of understanding of basic physiologic mechanisms responsible for the timing of ejaculation, assessment procedures tapping into the basic physiology of the ejaculatory reflex (e.g. sensory thresholds or efferent reactivity) have to date not been particularly meaningful or useful for the management of this dysfunction.

Actions of Drugs at 5HT1 Receptors

Systemic administration of 5-HT1A receptor agonists such as 8-OH-DPAT in rats reduces penile erections induced by 5-HT2C agonists36 and facilitates ejaculation by decreasing ejaculatory threshold and latency (Table 6.1).37 Administration of 8-OH-DPAT causes a Reduces erection & increases ejaculation Increases erection & reduces ejaculation biphasic dose-response pattern in the rhesus monkey. Low doses facilitated ejaculation by reducing ejaculatory threshold and latency, perhaps by a preferential presynaptic action as seen in other models of 5-HT1A receptor function,38 and high doses interfered with copulation and ejaculation.39 Intrathecal administration of lisuride40 and the more selective 5-HT1A receptor agonist 8-OH-DPAT,35 however, has a facilitatory effect on male sexual behavior with reduced number of mounts and intromissions before ejaculation, and reduced ejaculation latency.

Germ Layer Lineage Stem Cells

Because of its developmental lineage (see Fig. 1), the germ layer lineage mesodermal stem cell has the potential to form cells of the adrenal cortex, Sertoli cells, interstitial cells of Leydig, ovarian stroma, follicular cells granulosa cells, thecal cells, skeletal muscle, smooth muscle, cardiac muscle, unilocular adipocytes, multilocular adipocytes, fibrous connective tissues, dermis, tendons, ligaments, dura mater, arachnoid mater, pia mater, organ capsules, organ stroma, tunica adventitia, tunica serosa, fibrous scar tissue, hyaline cartilage, articular cartilage, elastic cartilage, growth plate cartilage, fibrocartilage, endochondral bone, intramembranous bone, arterial endothelial cells, venous endothelial cells, capillary endothelial cells, lymphoidal endothelial cells, sinusoidal endothelial cells, erythrocytes, monocytes, macrophages, T-lymphocytes, B-lymphocytes, plasma cells, eosinophils, basophils, Langerhans cells, dendritic cells, natural killer cells, bone marrow...

Prevention of Testicular Damage

Ejaculatory azoospermia is not the same as testicular azoospermia 14 . Hence,studies on the gonado- toxicity of chemotherapy have to be interpreted in light of the fact that assisted reproductive technology makes it possible to use testis sperm to conceive. The level of sperm necessary for sperm to exist in the testis is far less than the level required for sperm in the ejaculate 14 . As a result, testis sperm extraction (TESE), followed by ICSI, now makes it possible for patients who have azoospermia on semen analysis, and did not sperm bank, to father children. A retrospective study by Damani et al. evaluated 23 men with ejaculatory azoospermia and a history of chemotherapy. All men underwent TESE in search of usable sperm. Spermatozoa were found in 15 (65 ). The subsequent fertility rate was 65 and pregnancy occurred in 31 of cycles 21 . This illustrates the importance of performing a full evaluation on men with post-chemotherapy azoospermia before diagnosing them as sterile.

The Use of SSRIs to Treat Conditions Other Than Depression

One of the major spin-offs to occur as a result of the overwhelming commercial success of the SSRIs has been the spread of their use not only for severe depression to mild dysthymia, but also to other psychiatric, e.g., bulimia, panic disorder, obsessive-compulsive disorder, anxiety, and non-psychiatric conditions, e.g., obesity, premature ejaculation, Raynaud's syndrome, headache. Finally, the pharmaceutical industry, ever adept at turning a disadvantage into an asset, have responded to the increased reporting of SSRI-induced male sexual dysfunction by putting these drugs into clinical development for the treatment of premature ejaculation.

Origins of Multibonding

Teachings of Mutual Criticism, Male Continence, and Complex Marriage, meaning that marriage and private property were abolished and the community included all property of family living and associations. Mutual Criticism meant that all members of the community were subject to criticisms of either a committee or the whole community. These criticisms, which focused on an individual's bad traits, were intended to assure conformity to community morality. The principle of Male Continence maintained that a male and female were to engage in sexual intercourse without the male ejaculating, in order to avoid unwanted pregnancy and the waste of sperm.

Methods of assisted conception

For example, for a man who, at the time ofentering an assisted conception programme with his partner, is ejaculating moderate number of motile spermatozoa and from whose ejaculates at least five million motile sperm per millilitre can be prepared, a relatively simple procedure such as IUI using freshly ejaculated sperm would seem most appropriate. Whereas in a man whose ejaculates have been consistently azoospermic but who has frozen samples from which at least 10 or 20 motile sperm can be identified, then ICSI would certainly be required. However, in reality this is a somewhat simple way of looking at the decision as in each case account needs to be taken of the biology of the man's partner and there are many circumstances where the aggressiveness ofthe assisted conception treatment has to be increased because of pathological factors on the female side. For example, previous disease or damage to the Fallopian tubes will almost certainly require the couple to use IVF even if the...

Girls Gone Wild For Sperm

There is a new niche market of seminal ejaculate films that expand on the glorification of men's ejaculate. Unlike other pornographic genres, these movies focus on semen as the central theme of the narrative and the action, not solely the denouement. Titles such as Semen Demons, Desperately Seeking Semen, The Cum Cocktail, We Swallow, Sperm Overdose (volumes 1-6), Sperm Dreams, Sperm Burpers (volumes 1-5), A Splash of Sperm, and Feeding Frenzy (volumes 1-3) venture beyond the money shot toward eroticizing seminal ingestion. The contents of the promotional descriptions of the videos, as well as the videos themselves, depict a variety of women drinking and bathing in semen from diverse male partners. Women appear to be insatiable and competitive about their desire for ingesting the semen as they rush to get to the ejaculating penis, the full shot glass, or residual ejaculate on a sheet. What does it mean to see women completely overcome with their desire to drink semen To smear it all...

Male infertility

Approximately 98 per cent of males with CF are infertile. The genetic abnormality that results in CF is associated with aberrant embryological development of the reproductive portion of the mesonephric (wolffian) duct. At birth, this results in variable absence of the vas deferens, seminal vesicle, ejaculatory duct and body and tail of the epididymis3 (see Figure 11.2). While active spermatogenesis occurs in the testis, sperm are unable to be transported from the testis due to congenital absence of the vas deferens (Kaplan etal. 1968 McCallum etal. 2000). Neither sex hormone production nor sexual function are affected.

Future aspects

Inhibited ejaculation has been less well researched than PE, probably because fewer cases are seen. The etiology of inhibited ejaculation is multifactorial and includes organic and psychologic distur-bances pharmacologic agents are also implicated. Improved techniques for clinical evaluation are required. Except where a treatable organic cause has been identified or a drug known to impair ejaculatory function has been withdrawn, the mainstay of treatment is by psychotherapy, but this is not evidence-based, as the most successful psychotherapeutic intervention has not been established. Future research should address this shortcoming. A number of pharmacologic agents are reported to treat drug-induced delayed (inhibited) ejaculation, but these observations are not based on well-controlled and adequately powered studies, but rather on single cases or small series of cases. The pharma-cotherapy of inhibited ejaculation requires proper evaluation.


Table 16.2 Correlation of erection, ejaculation and intercourse with level and severity of spinal cord injury 81 . those that are medical and occur through disruption of the normal physiologic processes, through disease, trauma, surgery, medication and so on. Pathophysiologic causes of RE are far more readily identifiable and generally surface during a medical history and examination. They typically stem from predictable sources anomalous anatomic, surgical, neuropathic, endocrine, and medication (iatrogenic). For example, surgical therapy for prostatic obstruction is likely to disrupt bladder neck competence during emission. All types of IE show an age-related increase in prevalence and increased severity, with lower urinary tract symptoms independent of age 77,78 . Commonly-used medications, particularly antidepressants, may centrally inhibit or delay ejaculation as well 79 . The ability to ejaculate is severely impaired by spinal cord injury (SCI) and is dependent upon the level...


Apfelbaum labels this as a desire disorder specific to partnered sex 89 . Consistent with this idea, recent data indicate that, unlike sexually-functional men, or men with other sexual dysfunctions, men with IE report better erections during masturbation than during foreplay or intercourse 75 . Disparity between the reality of sex with the partner and the sexual fantasy (whether or not unconventional) used during masturbation, is another potential cause of IE 90 . This disparity takes many forms, such as partner attractiveness and body type, sexual orientation, and the specific sex activity performed. In summary, high-frequency, idiosyncratic masturbation, combined with fantasy partner disparity, may well predispose men to experiencing problems with arousal and ejaculation 76 . The above patterns suggest that IE men, rather than withholding ejaculation as suggested by earlier psychoanalytic interpretations, may lack sufficient psychosexual arousal...

Thyroid hormones

330 found ED in 64 and 15 , respectively (associated with hypoactive sexual desire and retarded ejaculation in most of the hypothyroid patients), and premature ejaculation in 7 and 50 , respectively. After return to normal levels of serum thyroid hormones for eight to 12 weeks, the prevalence of premature ejaculation fell from 50 to 15 in the hyperthyroid patients, while that of retarded ejaculation was reduced by half in those with hypothy-roidism. The mean ejaculation latency time doubled in the former and significantly decreased in the latter, suggesting the possibility of a direct involvement of thyroid hormones in the physiology of ejaculation. In 38 patients referred for ED and found to be hypothyroid, Baskin 331 reported that erectile function returned in the majority following thyroid hormone substitution. Conversely Wortsman et al. 332 did not observe any sexual improvement following thy-roxin treatment in a short series of ED patients with primary hypothyroidism. In...


The man who presents with inhibited ejaculation, in whom organic and pharmacologic causes have been eliminated by careful medical assessment and investigation, requires thorough psychosexual assessment. If he is in a relationship, his partner, and the quality of the relationship, also require evaluation. Numerous psychotherapeutic processes are described for the management of inhibited ejaculation, but none has been properly evaluated 11,18,89,93 . 2 Reduction of goal-focused anxiety. Prohibition of ejaculation during masturbation and or partner-related sexual activity. 4 Patient role-playing an exaggerated ejaculatory response on his own and in front of his partner. This can be especially helpful where the man's inability to ejaculate arises from the embarrassment the patient thinks he will experience when he loses emotional control during ejaculation. The man with situational inhibited ejaculation who is able to ejaculate on his own but not with a partner undergoes a desensitizing...


However, in a research setting, objective measurement of IELT by stopwatch and subjectively validated, reliable and consistent patient-reported outcome measures (PROs) of ejaculatory control, sexual satisfaction, and bother distress, are essential in studies assessing treatment 26-28 . Intravaginal Ejaculation Latency Time (IELT) The length of time between penetration and ejaculation the IELT forms the basis of most current clinical studies on PE 29 . The IELT is measured with a stopwatch operated by the female partner, is expressed in seconds or minutes and in case of ante-portal ejaculation, is equal to zero. Although it is not clear nowadays whether the use of a stopwatch is influenced by the cultural background of women, various studies, mainly conducted in Western countries, have shown that in general this assessment tool is accepted by study participants. There has been considerable variance of the latencies used to identify men with PE, with IELTs ranging from one to seven...


It is likely that only some men seeking treatment for PE require in-depth psychotherapy. In spite of hard evidence on the efficacy of psychotherapy, behavioral retraining is still often practiced by sexologists. Behavioral treatment is distinguished in the stop-start and the squeeze 11,68 . The basis of behavioral retraining is the hypothesis that PE occurs because the man fails to appreciate the sensations of heightened arousal and recognize the feelings of ejaculatory inevitability.


The patient (and partner) histories are the key toward the successful diagnosis of male ED. ED is highly prevalent in men with a variety of medical diseases, including depression, and is often confused with ejaculatory disorders. The clinician should have a high index of suspicion when evaluating men with these medical diseases for ED. The clinician must also be aware of the psychologic aspects of male ED, with a referral to a sex or marital therapist indicated as necessary. Finally, there is an evolving paradigm that ED may be a predictor

Closing Comments

Although recent neuropharmacologic studies and animal research has deepened our understanding of neurobiology of PE and the mechanism of pharma-cotherapy, a genuine understanding of the etiology of lifelong and acquired premature ejaculation is still lacking. Despite high levels of evidence from multiple well-controlled studies to support the efficacy of drug treatment strategies in lifelong PE, there is little or no evidence to support the role and longitudinal efficacy of behavioral therapy. As such, the place of behavioral therapy must be limited to a supportive role of pharmacotherapy in selected men and not as a first-line treatment. First-line treatment of lifelong PE is off-label daily use of some SSRIs particularly paroxetine, sertraline and fluoxetine, and clomipramine, and the on-demand use of some SSRIs, clomipramine, and topical anesthetics, although the latter exert less ejaculation-delaying effects. Ejaculation-specific selective serotonin re-uptake inhibitors (ESSRIs),...


Premature ejaculation is claimed to be the most common male sexual disorder, affecting 5-40 of sexually-active men 9 . It is believed that there is a higher frequency of PE in adolescents or young adults. Premature ejaculation is more frequently reported by men in East Asia (China, Indonesia, Japan, The current knowledge of the epidemiology of PE is limited by both the lack of a consensus definition of lifelong PE and a failure to consistently distinguish lifelong and acquired PE in most earlier studies. Medical literature contains several univariate and multivariate operational definitions of premature ejaculation. The lack of agreement as to what constitutes premature ejaculation has hampered basic and clinical research into the etiology and management of this condition. Premature ejaculation has been defined in various ways. Masters and Johnson defined PE as . . . the inability to delay ejaculation long enough for the woman to achieve orgasm fifty per cent of the time 11 . On the...


In males and females, orgasm is characterized by a peak in sexual pleasure that is accompanied by rhythmic contractions of the genital and reproductive organs, cardiovascular and respiratory changes, and a release of sexual tension. In males, orgasm generally occurs in two stages emission, which refers to rhythmic muscular contractions that force semen into the ejaculatory ducts, and expulsion, which is the release of semen through the urethra (ejaculation). Unlike males, some females (approximately 15 ) are able to experience multiple orgasms, and some women experience orgasm and perhaps ejaculation when the Grafenberg spot, an area along the anterior wall of the vagina, is stimulated. Contrary to Freud's assertion of two distinct types of orgasm in females, clitoral (the infantile orgasm) and vaginal (the mature orgasm), Masters and Johnson (1966) found no physiological differences in orgasm produced by vaginal versus clitoral stimulation. Other researchers note that intensity of...

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