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- 14. Prematür ejakülasyon tanı ve tedavisi Dr. Ahmet Metin Abant İzzet Baysal Tıp Fakültesi Üroloji AD
- 19. Hastanın bildirdiği sonuçlar(PRO=PEP+CGI) Ejakülasyon kontrolünde 2 kategori ↑/sıkıntıda 1 kategori ↓ tam cevap olarak değerlendirilmekte Değerlendirilen parametr Soru Cevap seçenekleri Ejakülasyonun kontrolü “ Son bir aydaki cinsel ilişkilerinizde; boşalma üzerine olan kontrolünüz” 0: Çok zayıf 1: Zayıf 2: Orta 3: İyi 4: Çok iyi Cinsel tatmin ““ Son bir aydaki cinsel ilişkilerinizde cinsel yönden tatmininiz” PE nin kişiye verdiği sıkıntı ““ Son bir aydaki cinsel ilişkilerinizdeki erken boşalma sizi ne kadar sıkıntıya soktu?” 0: Hiç 1: Çok az 2: Orta derecede 3: Oldukça 4: Çok fazla Partnerle ilişkiler ““ Son bir aydaki cinsel ilişkilerinizdeki erken boşalma partnerle olan ilişkilerinizi ne kadar etkiledi? ” PE deki global değişim “ Çalışmanın/tedavinin başlangıcına göre erken boşalmanızı nasıl tanımlamaktasınız ” – 3: Daha kötü – 2: Kötü – 1: Oldukça kötü 0: Aynı 1: Oldukça iyi 2: Daha iyi 3: Çok iyi
- 32. EAU 2010 Guideline’ı Dapoksetini (PRILIGY) 1A kanıt düzeyi ve A öneri derecesiyle prematür ejakülasyonda ihtiyaç halinde kullanım için önermekte
Editor's Notes
- In an effort to overcome the limitations of traditional definitions of PE, the ISSM has developed a definition based on clinical evidence, as outlined in the following slides. Like other definitions of PE, the ISSM definition includes three components: time to ejaculation, inability to control ejaculation and negative impact on the man and his partner. The definition was developed by an Ad Hoc Committee of international experts in PE appointed by the ISSM. The committee met in Amsterdam in October 2007 to evaluate the strengths and weaknesses of current definitions of PE, to critique the evidence in support of the constructs of ejaculatory latency, ejaculatory control, sexual satisfaction, and personal/interpersonal distress, and to propose a new evidence-based definition of PE.
- Psychobehavioral therapy has long been a mainstay of treatment for PE. Semans was the first to advocate the squeeze technique (withdrawal and squeeze of the glans penis to abort ejaculation), which was more extensively popularized by Masters and Johnson in the 1970s. The stop-start technique, which requires the man to pause during sexual stimulation just prior to impending ejaculation, has also been used (with variations) for over 30 years. While behavioral and/or psychotherapeutic approaches are commonly used, they are associated with significant drawbacks. Despite success rates of approximately 60% in the short term, long-term effectiveness is much lower, leading to unsatisfactory treatment outcomes for many patients. Furthermore, these techniques work best in stable relationships, as they require the committed assistance and understanding of the partner, and require time and patience to become effective. Moreover, relapse is a problem and PE may return once the sex therapist sessions are concluded although relapse prevention techniques may help in this respect.
- Historically, premature ejaculation (PE) was thought of as a psychological problem. However, the observation that chronic treatment with selective serotonin reuptake inhibitors (SSRIs) delays ejaculation helped lead to the realisation that there is a neurophysiological basis for PE, and particularly for serotonergic pathways involved in central control of ejaculation. The actions of serotonin are mediated via one of the most extensive receptor systems known. Seven 5-HT receptor classes, encompassing some 14 different receptors, are currently recognized. These receptors and the serotonin transporter are widely distributed with particularly high density in the hypothalamus, brainstem and spinal cord. Pharmacological agents, such as dapoxetine, that inhibit the action of the serotonin transporter system, increase the levels of serotonin in the synaptic space, leading to greater stimulation of postsynaptic receptors and to delayed ejaculation.