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Sexual dysfunctions are diagnosed differently in women and men. Diagnoses for women include female sexual interest/arousal disorder, female orgasmic disorder, and genito-pelvic pain/penetration disorder. Diagnoses for men include hypoactive sexual desire disorder, erectile disorder, delayed ejaculation, and premature ejaculation. Research on treatments is limited. Common components of psychological treatments include psychoeducation, cognitive restructuring/emotional regulation, stimulus control/desensitization, contextual modifications, mindfulness, and relationship skill building. A sidebar describes comprehensive sex education for youth.
Recent findings indicate that men with premature ejaculation report more frequent sexual problems associated with increased anxiety and interpersonal difficulties. Also the neuroendocrine changes were examined and compared to other indicators of stressful experiences.
Objectives
Premature Ejaculation (PE) is defined as an ejaculation occurring within one minute after the start of sexual intercourse and occurs in 20-30% of men. They report frequent problems with partnerships and increased anxiety, irritability and orgasmic dysfunction. Premature ejaculation is likely to be associated with decreased serotonergic neurotransmission and higher levels of leptin. Also the role of hyperactive thyroid and prostate disease was investigated. On the other hand there is no evidence as to how previous stressful experience and distrubed partnership might contribute PE.
Methods
Our study comprised 60 male outpatients diagnosed as having secondary premature ejaculation. Clinical examinations were focused on biochemical analysis of cortisol and psychometric scoring using a diagnostic tool for premature ejaculation, traumatic stress and somatoform dissociation. The control group consisted of a 60 healthy men.
Results
The results showed significant Spearman correlations of the Premature Ejaculation Diagnostic Tool score with Trauma symptoms checklist score (R=0.86), cortisol level (R=0.47) and Somatoform dissociation questionnaire score (R=0.61). In the control group, the results did not reach statistical significance. Spearman correlations of the Premature Ejaculation Diagnostic Tool score with Trauma symptoms checklist score was (R=0.21), cortisol (R=0.27) and with Somatoform dissociation questionnaire score (R=0.25).
Conclusions
These results represent the first reported findings documenting the relationship of traumatic stress indicators with the experience of secondary premature ejaculation and cortisol levels.
According to psychoanalytic theory performing circumcision on a boy in phallic phase may aggravate this fear and cause sexual dysfunctions later in life. However this hypothesis is an unverified common-view rather than a scientifically proven conclusion.
Objectives
We hypothesized that being circumcised during phallic phase is not a risk factor for sexual dysfunction. We also took a peak at how the experience of circumcision is being perceived and its psychological effects. Our secondary hypothesis was, sexual dysfunctions are more frequent among men who had a traumatic circumcision experience.
Methods
For this cross-sectional study, a total of 2768 sexually active, circumcised and voluntary men were recruited from 20 different urology outpatient clinics around Turkey.
Results
There was no significant difference for PEDT and IIEF scores between participants who were circumcised at different ages (Graph-1,2). When participants were divided into 3 groups according to their circumcision age in accordance with psychoanalytic theory (before, after and during phallic phase) mean IIEF and PEDT scores did not differ. PEDT scores did not differ either by which emotion the participant describe their experience of circumcision or how vividly he remembered it. However participants who remembered their circumcision experience more vividly and had who describe their circumcision experience with fear/anxiety had a higher IIEF score (Graph-3).
Conclusions
The age of circumcision does not affect the risk of PE. This is one of the very few studies that challenges psychoanalytic theory with a scientific method. Remembering the circumcision experience with fear or anxiety did not increase the risk of sexual dysfunctions.
There is a complex interplay between male sexual dysfunction and male factor infertility, including ejaculatory dysfunctions which are the most common male sexual dysfunction. It is divided into four categories: premature ejaculation (PE), delayed ejaculation (DE), retrograde ejaculation (RE), and anejaculation/anorgasmia (AE). Unfortunately, some of these ejaculatory dysfunctions are less studied and not as well understood. Various pharmacologic treatments and surgical procedures can be offered for patients with ejaculatory dysfunctions seeking fertility. These include the off-label use of SSRIs (selective serotonin reuptake inhibitors) for PE, surgical (testicular sperm aspiration, testicular sperm extraction, and microsurgical epididymal sperm aspiration) and nonsurgical methods (medications, positive predictive value, and electroejaculation) for patients with RE and AE. The interaction between chemical impulses and the modulation of the ejaculation process in an individual patient is necessary to conclude the clinical status of the patient and feasibility of the available treatment techniques. Ultimately, this can help in deciding the best sperm retrieval technique to increase pregnancy outcomes.
Premature ejaculation (PE) and erectile dysfunction (ED) are prevalent sexual problems, with evidence to suggest variation across sexual orientation. Contributing factors have traditionally been divided into organic and psychological categories. While limited research has found support for the influence of metacognitive beliefs, these studies did not investigate potential differences in sexual orientation.
Aim:
The current study aimed to investigate the differences in metacognitive beliefs in men with or without PE and/or ED and whether these varied according to sexual orientation.
Method:
A sample of 531 men was recruited (65 met criteria for PE only, 147 for ED, 83 with PE and ED, and 236 healthy controls). Within this sample, 188 men identified as heterosexual, 144 as bisexual, and 199 as homosexual. Participants completed a cross-sectional online survey consisting of psychometric measures.
Results:
Participants with PE and ED were significantly higher in cognitive confidence, thoughts concerning uncontrollability and danger, and need to control thoughts than PE only, ED only, and healthy controls. Furthermore, the PE only group was significantly higher than healthy controls for cognitive confidence, with the ED significantly higher for thoughts concerning uncontrollability and danger. There were no significant differences between differing sexual orientations for men with/or without PE and/or ED.
Conclusions:
Congruent with previous research, metacognitive beliefs play a role in PE and/or ED, although this is not exclusive to sexual orientation. The findings highlight that assessment and intervention regarding metacognitive beliefs may be beneficial for men of all sexual orientations with PE and/or ED.
Encompassing a broad spectrum of conditions, ejaculatory dysfunction (EjD) includes premature ejaculation (PE), anejaculation(AE), and retrograde ejaculation (RE). This chapter discusses the incidence rate, diagnosis methods and treatment options available for treating EjD. Behavioral/psychological treatments, topical anesthetic agents, serotonin reuptake inhibitors (SSRIS) and phosphodiesterase (PDE)-5 inhibitors are the treatment options available for PE. Penile vibratory stimulation, electroejaculation, and surgical sperm extraction from the epididymis or testes are all successful methods for obtaining sperm for later use with ART in AE where the success rates of other methods are low. Common causes of RE can be categorized as anatomic, neurogenic, pharmacological, or idiopathic in origin. Anticholinergics, alpha-adrenergic agonists, or similar combinations may be used to modulate bladder neck activity but are not as effective as imipramine, which should be considered the first-line therapeutic agent for RE.
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