Premature Ejaculation
Premature ejaculation: ejaculation occurs sooner than desired, either before or shortly after penetration.
Up to 30% of patients may report concomitant erectile dysfunction.
Along with Erectile dysfunction, premature ejaculation makes up for 90% of sexual dysfunction in Men
Causes & Diagnosis
reason for PME is complex and multifactorial
Any painful focus over the penis (tight frenulum) and Prostatitis can result in PME.
Detailed history taking and examination by Urologist/ Andrologist is must.
Treatment of PME
1- Reducing stimulation: Usage of condoms, local anaesthetic sprays and Circumcision and in extreme cases dorsal neurectomy is helpful.
2- Correction of erectile dysfunction
3- Medical therapy with selective serotonin reuptake inhibitors (SSRI) & tricyclic antidepressant
4- Specialized delay techniques
Retrograde ejaculation
Backward flow of semen into the Urinary bladder.
Cause
maybe caused by
1-anatomic abnormalities of the bladder neck,
a-transurethral prostate surgery,
b-urethral strictures,
2-Neurological Factors Affecting the bladder neck sphincter.
a-spinal cord injury,
b-diabetes mellitus,
c-retroperitoneal surgery
d-multiple sclerosis,
e-peripheral neuropathy
3-Medications
a-alpha-blocker therapy,
b-antipsychotics,
Treatment
It depends on the presentation and cause.
1- If caused by medications then removal of medication and changing dosage may correct it
2- in case of presentation with infertility semen sample can be retrieved from post-coital urine can be utilized for fertilization.
3- Medical therapy may be useful in some neurological causes.
Hematospermia
Blood in Semen.
Causes & Diagnosis
causes
1- Bacterial Infection
2- Tuberculosis
3- Genitourinary malignancy
Investigations required
1- Semen analysis
2- Semen Culture
3- PSA test
4- Special tests for TB
5- MRI Pelvis
6- Flexible Cystoscopy
Treatment
1- Cases caused for Bacterial Infection will need specially tailored Cocktail therapy as this condition is resistant to standard antibiotic therapy.
2- cases which fail to respond to standard therapy need to be evaluated extensively for genitourinary tuberculosis which needs to be treated by antituberculosis therapy.
3- Patients with suspected cancer needs to be treated based on site of malignancy.
