Premature ejaculation is a common male sexual dysfunction characterized by the inability to delay ejaculation and can cause distress. It is classified as lifelong or acquired and has prevalence rates ranging from 2-33% depending on age and region. While the exact etiology is unknown, potential contributing factors include anxiety, penile hypersensitivity, serotonin receptor dysfunction, and multifactorial biological and psychosocial influences. Diagnosis involves assessing ejaculation latency, distress levels, and ruling out other conditions. Treatment options include behavioral techniques, pharmacotherapy like SSRIs, and counseling with success rates over 85% depending on commitment to therapy. Prognosis is generally good but relapse can occur without ongoing management.
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
female sexual dysfunction
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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
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
Polycystic Ovarian Syndrome is heterogeneous, multisystem endocrinopathy in women of reproductive age characterized by chronic anovulation resulting in infertility, irregular bleeding, obesity and hirsutism. Most common, although the least understood, cause of androgen excess. Initially it was described in 1935.Also known as Stein-Leventhal syndrome
The slide includes:
Introduction
Incidence
Pathophysiology
Pathology
Clinical features
Investigation
Treatment
CHRONIC PELVIC PAIN can affect men, MORE common (60%) in women, lifelong vs. acquired, generalized vs. situational, psychological factors, physical Contact SlenderImage@gmail.com for Consulting & Speaking - P.Anderson 323-486-3770
what is endometriosis? Theories in endometriosis, sites of endometriosis. types and clinical presentation. signs and symptoms.
Investigations :TVS, CA125
laparoscopic findings
chocolate cyst and extrapelvic endometriosis.
Classification of endometiosis
Diffential diagnosis
Management :of asymptomatic and symptomatic cases
drugs and minimally invasive surgery
surgey and preventive measures in endometiosis.
Polycystic Ovarian Syndrome is heterogeneous, multisystem endocrinopathy in women of reproductive age characterized by chronic anovulation resulting in infertility, irregular bleeding, obesity and hirsutism. Most common, although the least understood, cause of androgen excess. Initially it was described in 1935.Also known as Stein-Leventhal syndrome
The slide includes:
Introduction
Incidence
Pathophysiology
Pathology
Clinical features
Investigation
Treatment
CHRONIC PELVIC PAIN can affect men, MORE common (60%) in women, lifelong vs. acquired, generalized vs. situational, psychological factors, physical Contact SlenderImage@gmail.com for Consulting & Speaking - P.Anderson 323-486-3770
what is endometriosis? Theories in endometriosis, sites of endometriosis. types and clinical presentation. signs and symptoms.
Investigations :TVS, CA125
laparoscopic findings
chocolate cyst and extrapelvic endometriosis.
Classification of endometiosis
Diffential diagnosis
Management :of asymptomatic and symptomatic cases
drugs and minimally invasive surgery
surgey and preventive measures in endometiosis.
By: Ayman Rashed,MD
ejaculatory disorders are always bothering. premature, delayed ejaculation, or anejaculation are all challenging both in diagnosis or treatment
Different kinds of sexual dysfunction and their management.
Sexual difficulties in Spinal cord injury patients
Evaluation of sexual problems and differentials
New pharmacologic agents in management of sexual dysfunctions
Premature ejaculation is defined as persistent or recurrent ejaculation with minimal sexual stimulation before, upon, or shortly after penetration and before it is wished by the man or his partner
Premature Ejaculation seems to be a neurobiological problem that is related to low serotonin levels in those regions of the central nervous system that regulate ejaculation (brain and spinal cord).
In this infographic we try to answer the questions "What happens in Premature Ejaculation (PE)", "What are the features of PE?", |How many types there are" and finally "Can a man with PE be helped"
HUMAN SEXUALITY AND SEXUAL DYSFUNCTIONS (1).pptxIshneetKaur41
Human Sexuality - Normal sexuality, normal sexual response, sexual identity and orientation and sexual dysfunctions with treatment - female sexual arousal disorder, anorgasmia, ejaculatory dysfunction, male hypoactive sexual desire disorder
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
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- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
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Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
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.
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
2. Definition
• Premature ejaculation is male sexual dysfunction characterized by :
• perceived inability to control ejaculation that occurs sooner than desired,
or expected,
• either before or shortly after vaginal penetration, and
• causes emotional distress for patient and/or sexual partner
1. Althof SE, McMahon CG, Waldinger MD, et al. An update of the International Society of Sexual Medicine's guidelines for the diagnosis and treatment of premature ejaculation (PE). J Sex Med. 2014
Jun;11(6):1392-422
2. Hellstrom WJ. Update on treatments for premature ejaculation. Int J Clin Pract. 2011 Jan;65(1):16-26
3. Epidemiology
• Most common sexual disorder in men younger than 40 years
• Prevalence of PE were 30% (18-29 yrs), 32% (30-39 yrs), 28% (40-49 yrs)
and 55% (50-59 yrs).
• Prevalence rates were 2.3% (lifelong PE), 3.9% (acquired PE), 8.5% (natural
variable PE) and 5.1% (premature-like ejaculatory dysfunction).
• 3%-33% prevalence of PEDT-diagnosed premature ejaculation reported
among men in Asia-Pacific region
1. Hatzimouratidis K, Giuliano F, Moncada I, Muneer A, Salonia A, Verze P. EAU Guideline on Erectile Dysfunction, Premature Ejaculation, Penile Curvature and Priapism. European Association of Urology. 2019;26-7
2. McMahon CG, Lee G, Park JK, Adaikan PG. Premature ejaculation and erectile dysfunction prevalence and attitudes in the Asia-Pacific region. J Sex Med. 2012 Feb;9(2):454-65
4. Etiology and Pathophysiology
• The etiology of PE is unknown, but little data suggested several underlying cause
• Anxiety
• penile hypersensitivity
• 5-HT receptor dysfunction
• The pathophysiology of PE is largely unknown, but including multifactorial:
• Biological, organ systems directly affected by premature ejaculation
• Male reproductive tract (penis, prostat, seminal vesicles, testicles, and their appendages)
• Portion of central and peripheral nervous system controlling male reproductive tract
• Reproductive organ systems of sexual partner that may not be stimulated sufficiently
• hyposensitivity of 5-HT2C receptor, hypersensitivity of 5-HT1A/5-HT1B receptor,
hypersensitivity of the glans, psychosocial and relational factors, etc
1. Wyllie MG, Hellstorm WJ. The link between penile hypersensitivity and premature ejaculation. BJU Int. 2011 Feb;107(3):452-7
2. Buvat J. Pathophysiology of premature ejaculation. J Sex Med. 2011 Oct;8(4):316-27
5. Lifelong PE
• PE at all or nearly all intercourse
• With all or nearly all women
• In Majority case within 1 minute
• Consistent during life
• Inability to control ejaculation
Waldinger. Premature ejaculation; state of the art. UrolClin NorthAm 2007; 34:591-9, vii-viii
6. Acquired PE
• Rapid ejaculation occurring at some point in life
• Normal onset before
• Often source of problem identifiable
• Inability to control ejaculation
Waldinger. Premature ejaculation; state of the art. UrolClin NorthAm 2007; 34:591-9, vii-viii
7. Diagnostic Criteria
Based onThe International Society for Sexual Medicine (ISSM):
• Ejaculation from the time he began or within about 1 minute of vaginal
penetration (Lifelong Premature Ejaculation) OR clinically significant and
bothersome reduction in latency time, about 3 minutes or less (Acquired
Premature Ejaculation)
• Inability to delay ejaculation on all or nearly all vaginal penetrations
• Negative personal consequences (distress, bother, frustration, avoidance of sexual
intimacy)
Serefoglu, E.C., et al. An evidence-based unified definition of lifelong and acquired premature ejaculation: report of the second International Society for Sexual Medicine Ad Hoc
Committee for the Definition of Premature Ejaculation. J Sex Med, 2014. 11: 1423.
8. DSM-5 Criteria
• Sexual dysfunction disorders characterized by a significant inability to respond
sexually or to experience sexual pleasure
• The specific DSM-5 criteria for premature (early) ejaculation are as follows :
• In almost all or all (75-100%) sexual activity, the experience of a pattern of ejaculation
occurring during partnered sexual activity within 1 minute after vaginal penetration and
before the individual wishes it
• The symptoms above have persisted for at least 6 months
• The symptoms above cause significant distress to the individual
• The dysfunction cannot be better explained by nonsexual mental disorder, a medical
condition, the effects of a drug or medication, or severe relationship distress or other
significant stressors
9. Proposed PE Syndrome
• Variable PE is characterised by inconsistent and irregular early ejaculations,
representing a normal variation in sexual performance.
• Subjective PE is characterised by subjective perception of consistent or
inconsistent rapid ejaculation during intercourse, while ejaculation latency time is
in the normal range or can even last longer. It should not be regarded as a
symptom or manifestation of true medical pathology
Serefoglu, E.C., et al. An evidence-based unified definition of lifelong and acquired premature ejaculation: report of the second International Society for Sexual Medicine Ad Hoc
Committee for the Definition of Premature Ejaculation. J Sex Med, 2014. 11: 1423.
10.
11. Differential Diagnostic
• Important to distinguish Premature Ejaculation from Erectile Dysfunction
• Many patients with ED secondary PE
• chronic bacterial prostatitis
• Hyperthyroidism
• alcohol and/or other substance use
Althof SE, McMahon CG,Waldinger MD, et al. An update of the International Society of Sexual Medicine's guidelines for the diagnosis and treatment of
premature ejaculation (PE). J Sex Med. 2014 Jun;11(6):1392-422, commentary can be found in Nat Rev Urol 2014 Sep;11(9):496
12. Diagnostic Evaluation
• History should classify PE (lifelong or acquired) & determine (situasional or consistent)
• Several overlapping definitions of PE
Intravaginal Ejaculatory LatencyTime (IELT)
IELT alone is not sufficient to define PE
PE assessment quistionnaires : Premature Ejaculation DiagnosticTool
Physical examination and investigation
Recommendation for the diagnostic evaluation of PE
EAU 2019. Althof, S.E., et al. Patient reported outcomes used in the assessment of premature ejaculation. UrolClin NorthAm, 2007. 34: 581.
17. LueTF, Basson R, Rosen RC, et
al. Sexual medicine-sexual
dysfunctions in men and
women. Health Publications: Paris;
2004.
Algorithm for
the office
management of
premature
ejaculation
19. Pharmacotherapy
• SSRi
• Paroxetine 20-40 mg (Paxil)
• Sertraline 25 – 200 mg (Zolov)
• Clomipramine 25 – 50 mg
• Short acting SSRi
• Dapoxetin (on demand) 30 mg 1– 2 h prior (Poxet, tdk ada di Indonesia)
• Topical Cream
• Lidocaine – prilocaine cream 5% 20 – 30 min prior
20.
21. Prognosis
• Great majority of men (>85%) can be treated successfully with the squeeze-pause
technique between 3 month of therapy
• Squeeze-pause technique combined with SSRI can improve or cure most cases of
PE if both the couple committed to work on the problem
• Reported relapse rate ranges from 20-50%
• Several males may need to make long-term periodic repetition of behavioral
therapy
• Some men who achieve success with SSRI might need to use life-long medication
• No known direct morbidity or mortality form PE but self-esteem maybe affected
and may resulted to depression
Masters WH, Johnson VE. Premature ejaculation. Human Sexual Inadequacy. Boston, Mass: Little Brown & Company; 1970. 92-115.