By: Ayman Rashed,MD
ejaculatory disorders are always bothering. premature, delayed ejaculation, or anejaculation are all challenging both in diagnosis or treatment
Invited lecture by Dr Sujoy Dasgupta in the Webinar on "Sexual Dysfunction" organized by the BOGS (Bengal Obstetric and Gynaecological Society) and the Sexual Medicine Committee of FOGSI (federation of Obstetric and Gynaecological Societies of India) held in September, 2021
Invited lecture delivered by Dr Sujoy Dasgupta in a Webinar organized by Sexual medicine Committee of FOGSI (Federation of Obstetric and Gynaecological Societies of India), held in February, 2022
Invited lecture by Dr Sujoy Dasgupta in the Webinar on "Sexual Dysfunction" organized by the BOGS (Bengal Obstetric and Gynaecological Society) and the Sexual Medicine Committee of FOGSI (federation of Obstetric and Gynaecological Societies of India) held in September, 2021
Invited lecture delivered by Dr Sujoy Dasgupta in a Webinar organized by Sexual medicine Committee of FOGSI (Federation of Obstetric and Gynaecological Societies of India), held in February, 2022
GnRH Agonist in Endometriosis- An Old Good FriendSujoy Dasgupta
Invited Lecture delivered by Dr Sujoy Dasgupta in the "Dream City Meet"- the East Zone Conference of Endometriosis Society of India, held on 24 December 2019 at Durgapur
Erectile Dysfunction: New Paradigms in Treatment Ranjith Ramasamy
1. Discuss diagnosis of erectile dysfunction
2. Treatments of ED using Viagra, Cialis, Trimix (intracavernosal injections)
3. Evaluate penile prosthesis and implant as ED surgical therapy options
female sexual dysfunction
For More Medicine Free PPT - http://playnever.blogspot.com/
For Health benefits and medicine videos Subscribe youtube channel - https://www.youtube.com/playlist?list=PLKg-H-sMh9G01zEg4YpndngXODW2bq92w
ED is the inability to get or keep an
erection firm enough for sexual intercourse. ED can be a total inability to
achieve an erection, an inconsistent ability to do so, or a tendency to sustain
only brief erections.
ED is sometimes called impotence, but that
word is being used less often so that it will not be confused with other,
nonmedical meanings of the term.
The National Institutes of Health estimates
that ED affects as many as 30 million men in the United States. Incidence
increases with age: About 4 percent of men in their 50s and nearly 17 percent
of men in their 60s experience a total inability to achieve an erection. The
incidence jumps to 47 percent for men older than 75. But ED is not an
inevitable part of aging. ED is treatable at any age.
Premature Ejaculation Treatment in Delhi | Clinical Management of Premature E...Vijayant Govinda Gupta
This presentation discusses clinical case scenarios for management of premature ejaculation in Delhi India.
This slides contain
1. Definition of Premature Ejacualtion
2. Management Aids
3. Clinical algorithm
4. Novel treatment modalities
GnRH Agonist in Endometriosis- An Old Good FriendSujoy Dasgupta
Invited Lecture delivered by Dr Sujoy Dasgupta in the "Dream City Meet"- the East Zone Conference of Endometriosis Society of India, held on 24 December 2019 at Durgapur
Erectile Dysfunction: New Paradigms in Treatment Ranjith Ramasamy
1. Discuss diagnosis of erectile dysfunction
2. Treatments of ED using Viagra, Cialis, Trimix (intracavernosal injections)
3. Evaluate penile prosthesis and implant as ED surgical therapy options
female sexual dysfunction
For More Medicine Free PPT - http://playnever.blogspot.com/
For Health benefits and medicine videos Subscribe youtube channel - https://www.youtube.com/playlist?list=PLKg-H-sMh9G01zEg4YpndngXODW2bq92w
ED is the inability to get or keep an
erection firm enough for sexual intercourse. ED can be a total inability to
achieve an erection, an inconsistent ability to do so, or a tendency to sustain
only brief erections.
ED is sometimes called impotence, but that
word is being used less often so that it will not be confused with other,
nonmedical meanings of the term.
The National Institutes of Health estimates
that ED affects as many as 30 million men in the United States. Incidence
increases with age: About 4 percent of men in their 50s and nearly 17 percent
of men in their 60s experience a total inability to achieve an erection. The
incidence jumps to 47 percent for men older than 75. But ED is not an
inevitable part of aging. ED is treatable at any age.
Premature Ejaculation Treatment in Delhi | Clinical Management of Premature E...Vijayant Govinda Gupta
This presentation discusses clinical case scenarios for management of premature ejaculation in Delhi India.
This slides contain
1. Definition of Premature Ejacualtion
2. Management Aids
3. Clinical algorithm
4. Novel treatment modalities
Premature ejaculation (PE), the most common male health disorder found now a days. It can be defined as Lack of control of ejaculation which always occurs prior to or within about 1 minute of conjugation. Pre mature ejaculation is ejaculation that occur too early on slightest excitement. It can make a unhappy and frustrated married life. In severe cases it can even ruin the mirage life. Occasionally loss of control does not mean he has the problem of premature ejaculation. But every time ejaculation in 1 minute cannot be considered as normal. In young age group of nightly emission after dream or nocturnal emission is also considered as a part of early ejaculation. Dribbling of prostatic fluid during urination or stool is also considered under premature ejaculation. Premature Ejaculation may co occur with erectile dysfunction, with almost half of men suffering from premature ejaculation experiencing erectile dysfunction as well.
Ejaculation is comprised of three stages of the male sexual response cycle, namely emission, ejection, and orgasm.
1. Emission - Bladder neck closure & deposition of seminal fluid into posterior urethra
2. Ejection - Expulsion of seminal fluid from the urethra
3. Orgasm - A sensory experience associated with all these events
There is no such strict ejaculation time period. But still if the ejaculation is occuring in 5 to 8 minutes can be considered as normal ejaculation. But if the ejaculation is occurring within 1 minute cannot be called as healthy and normal ejaculation. Another thing if both the partner are happy in that short period also cannot be called as pre mature.
• Ejaculation time more than 4 minutes - Normal
• Ejaculation time less than 1 minute - Pre mature ejaculation
• Ejaculation time 1 - 1.5 minutes - Probable pre mature ejaculation
Causes of premature ejaculation
There are various pre disposing factors that causes premature ejaculation.
• Infrequent mixing of couple
• Over anxiety and depression state of mind
• Bad habits of artificial way of ejaculation in teen age is also one of the most common cause of premature ejaculation
• Living in a stress full and pressure packed life style
• Person’s feeling of guilty or self -reproach and blame.
• Certain drugs used for psychiatric or behavioural problem
Homeopathic Treatment for Premature ejaculation
• Homeopathy has an effective and promising treatment in pre mature ejaculation or early ejaculation problem. It is because homeopathy treats the cause of any health problems rather than the symptoms.
• Homeopathic treatment lengthens the ejaculation time.
• It also helps to cure the other health problem associated to Pre mature ejaculation.
• It also cure the physical and mental exhaustion associated with PE due to over mental stressed condition
• Homeopathic treatment cures the anxiety condition and guilty feeling symptoms associated with PE
• Homeopathic treatment cures the night emission too occurs in young mass.
Sex is not just going backs and force, we need to understand its physiology and neural concepts, here is a detailed presentation about the physiology of sexual human response and the intercourse, in addition to the benefits and some clinical aspects
Medical Information and treatment on Erectile Dysfunction and men's sexual health. A list of some of the available treatment solutions available to men who are suffering from blood flow issues and erectile dysfunction
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
3. Terminology
Desire:
This is what we call Libido
Arousal:
Is the sexual excitation
Orgasm: "Sexual Climax”
Is the peak of sexual Excitation featured with rhythmic contraction of
pelvic ms. Including bulbospongiousus and ischiocavernosus ms.
Ejaculation: “Resolution”
Is the discharge of the seminal fluid at end of the sexual cycle,
normally through external meatus
4. Classification of Ejaculatory Disorders
Anejaculation “Dry Ejaculation”
• This include absent production or negligible ejaculation
• May be due to organic or iatrogenic, reasons or even psychogenic associated
with “anhedonia”
• Most common (90%) with RPLND and SCI
Retrograde Ejaculation
Dys-ejaculation
Delayed Ejaculation
• More than 25 to 30 minutes of IELT considered delayed ejaculation by some
investigators
Premature Ejaculation
???????????????????
5. What is the Ejaculate consists of ?
Spermatozoa
From the vas deference and constitutes 10% of the ejaculate
Seminal vesicle secretion
It constitutes > 75% of the ejaculate. Its fructose containing fluid
alkalinizes the ejaculate
Prostatic secretion
It constitutes 10% of the ejaculate containing acid phosphatase,
citric acid and zinc
Cowper's gld. & Periurethral glds.
They produce < 5% of the ejaculate
6. Ejaculatory process is mediated mainly by autonomic nervous
system.
It consists of two main phases, namely:
Emission and Expulsion phases
Physiology
7. Physiology
This the phase includes production and discharge of the seminal
fluid
Organs involved in this phase include: Vas deference, Epididymis,
Seminal Vesicles, Bladder neck, Prostate and Prostatic Urethra
These organs have dense sympathetic and parasympathetic
innervation mainly from pelvic plexus
Emission Phase
8. This is the phase where the ejection of the seminal fluid takes
place from the external urethral meatus through the urethra
Organs involved in this phase include: Bladder neck, Urethra and
Pelvic striated muscles
It is a spinal cord reflex that occurs when the ejaculate discharged
at the bulbous urethra. "Point of NO RETURN"
Expulsion Phase Physiology
9. Control of Ejaculation Process
The ejaculation process is under physiologic control of:
• Neuronal
• Neurochemical transmitters
• Hormonal
Physiology
10. Neurogenic Control of Ejaculation
The organs involved in emission and expulsion are heavily
innervated with sympathetic and parasympathetic nerves
Both Peripheral and Central nervous systems are integrated to
provoke normal ejaculatory function
Physiology
11. Peripheral Nervous System
• Afferents: are through sensory Dorsal nerve of the penis to the
upper and lower segments of the sacral spinal cord
• Efferents:
• Sympathetic: T12-L1
• Parasympathetic: via Hypogastric n. which join the pelvic n. to
form Pelvic Plexus
• Motor: Located in Onuf’s nucleus in Sacral spinal cord through
pudendal n. to reach pelvic ms. Including bulbospongiosis and
ischiocavernosus ms.
Neurogenic Control of Ejaculation Physiology
12. Neurogenic Control
Central Nervous System
Spinal Ejaculatory Generator (SEG) :
• Located in L3-4 proved to play important role in integration of
peripheral and central inputs and outputs to the pelvi-perineal
structures in addition to the aforementioned peripheral network
• This proved by the ability of peripheral stimuli to induce
ejaculation in patients with spinal cord injury
Cerebral Network:
• Studies using PET during ejaculation in animals proved that
certain areas in the brain have a role in normal ejaculation
13. Neurochemical Mediators
Dopamines
• There are two families of dopamines;
D1- like (D1& D5) and D2 – like (D2,3,4)
• D2 – like agonists are known to stimulate ejaculation and blockage of their
receptors inhibits it
Serotonins (5HT)
• Selective 5HT reuptake inhibitors increases 5HT tone resulting in
ejaculatory impairment centrally
• While, Peripherally these inhibitors have stimulatory effect
Nitric Oxide (NO)
• It has inhibitory effect on ejaculatory process
• PDE-5 inhibitors found to increase NO & C-GMP. This decreases
peripheral sympathetic tone and inhibition of ejaculation
14. Hormonal Control
Androgens
• Low s. Testosterone level is associated with delayed ejaculation and vice
versa. This is because the emission phase depends upon NO/PDE-5
system
Estrogens
• E2 plays an important role in emission phase through epididymal
contraction and increasing sperm concentration.
• Furthermore, L. E2 / L. Testosterone contribute in decreased libido and ED
Prolactin
• Hyperprolactinemia is known to have negative effect on Libido
• On the other hand, low s. Prolactin is associated with premature
ejaculation as suggested by some studies
15. Hormonal Control
Oxytocin
• This hormone released from post. Pituitary
• Some studies proved that oxytocin receptor antagonists inhibit ejaculation
• It has been suggested that intra-nasal inhalation of oxytocin may facilitates
orgasm in anorgasmic patients
Thyroid Hormones
• It has been proven that 50% of patients with hyperthyroidism had premature
ejaculation, and, only 15% of them still has premature ejaculation after ttt
• Studies showed that administration of L-thyroxin in rats would increase
bulbospongiousus contractions
Glucocorticoids
• Replacement of cortisol in Addison's disease is associated with improvement of
overall sexual function including orgasm
16. Premature Ejaculation
The absence of a consensus medical definition for PE urges
a “patient-dependent” definition and a “patient-decided”
diagnosis
This is a risky approach, because diagnosis and possible
therapy would then be based exclusively on subjective
parameters, which are clearly influenced by culture, religion,
policy, society, and the media. all aspects that greatly deviate
from a medical definition
17. Epidemiology
PE is most frequently reported by adolescents or young adults, and
affects about 30% of men
PE affects more men from East Asia and fewer men from
Middle Eastern and African countries than in other regions.
The European prevalence seems to lie between that of East
Asia and Middle Eastern and African countries.
Still, epidemiological data on PE have been difficult to define
due to the lack of a globally accepted definition of the disorder
18. Premature Ejaculation
2nd
2nd
The ISSM has adopted a completely new definition of
PE which is the first evidence-based definition
PE (lifelong and acquired) is a male sexual dysfunction
characterized by the following:
1. Ejaculation that always or nearly always occurs prior to
or within about 1 min. of vaginal penetration (lifelong
PE) or a clinically significant and bothersome reduction
in IELT, often to about 3 mins. or less (acquired PE)
2. The inability to delay ejaculation on all or nearly all
vaginal penetrations
3. Negative personal consequences, such as distress,
bother, frustration, and/or the avoidance of sexual
intimacy.
19. Pathophysiology of PE
The pathophysiology of PE can be differentiated into five
distinct areas:
Psycho-relational, neurobiological, urological, hormonal and
andrological
Consequently, this will suggests five different therapeutic approaches,
each according to the pathology behind
20. Conclusions
Understanding the physiology of ejaculation is essential issue in
tracking the ejaculatory pathogenesis
Ejaculation is a complex process involving several anatomical structures
and under extensive neurogenic, neurochemical and hormonal
regulation in addition to psychogenic component
Extensive history taking, clinical assessment and investigation work up
according to the history and clinical data e.g. Hormonal assay in
deceased libido, will assist greatly in diagnosis and hence the proper
treatment of the patient
Orgasm, although associated with ejaculation, is a distinct physiological
process, different from ejaculation.
21.
22.
23.
24. Ejaculation before Penetration: Ante portas “before the gates” ejaculation that
occurs before vaginal penetration
Other PE-like Sexual Concerns: Two other experiences of ejaculation have
been described that are sometimes mistaken for PE, which have been termed
Natural Variable PE and Subjective PE; neither is a sexual dysfunction. Natural
Variable PE is characterized by early ejaculations which occur irregularly and
inconsistently with some subjective sense of diminished control of ejaculation.
This subtype is considered a variant of normal experience. Subjective PE is
characterized by preoccupation with an imagined early ejaculation or lack of
control of ejaculation when, in reality, the period of time from vaginal penetration
to ejaculation is five minutes or longer.
25. The ISSM has adopted a completely new definition of
PE which is the first evidence-based definition
PE (lifelong and acquired) is a male sexual dysfunction
characterized by the following:
1. Ejaculation that always or nearly always occurs prior to
or within about 1 min. of vaginal penetration (lifelong
PE) or a clinically significant and bothersome reduction
in IELT, often to about 3 mins. or less (acquired PE)
2. The inability to delay ejaculation on all or nearly all
vaginal penetrations
3. Negative personal consequences, such as distress,
bother, frustration, and/or the avoidance of sexual
intimacy.
Editor's Notes
First of all we have to differentiate between
Desire, Arousal, Orgasm and Ejaculation.
These are The normal sexual response cycle. Usually, the orgasm is coincides with ejaculation
Some terms to be fulfilled in order to understand the mechanism of ejaculation, so…
Arabic comment on DESIRE is always mistaken with PE or ED
Orgasm is generally associated with ejaculation, although the two processes are physiologically different
Quality and intensity of orgasms are variable. For instance, short fast buildup of sexual stimulation toward orgasm is associated with less intense orgasms. Early orgasms are less satisfying than later orgasms in life as the person learns to accept the pleasure associated with orgasms. Lower levels of androgen are associated with weaker orgasms, such as in hypogonadism or in older age
Ejaculatory Disorders can be classified into….
Anhedonia which is inability to feel pleasure
90% of cases are due to RPLND and Spinal Cord Injuries
As we know, The ejaculate consists of
How is the control of ejaculatory process, this can be su
Many neurotransmitters are involved in ejaculatory process with different sites of action within spinal and supra-spinal pathways and different types of receptors.
This makes it difficult to define the specific role of each neurotransmitter
Also, many hormones have an important role in the ejaculatory process. The most prominent hormones are:
Knowledge about hormonal control is deficient, however, some hormones paying attention to their role in ejaculatory process