Sexual Medicine Presentations / ESSM Science

Premature ejaculation (PE) is a common male sexual dysfunction affecting 5-40% of sexually active men. Definitions for PE have been subjective and lack standardisation. This led to a more recent and objective definition of premature ejaculation which depends upon the intra-vaginal ejaculation latency time (IVELT).

However several cut-off points ranging from 1 to 7 minutes have been suggested by different studies. A recent study based on normative data suggested a cut off point of 60 seconds for definite PE and 60-90 seconds for probable PE. Understanding the physiology of ejaculation is essential in order develop targeted therapies for premature ejaculation. We present an overview of the theories of premature ejaculation.

Novel therapies for ED – Soluble Guanylate Cyclase (sGC) activators

Jas Kalsi, BSc(Hons), FRCS(Urol), Post CCT Fellow in Andrology
Asif Muneer, MD, FRCS(Urol), Consultant Uro-Andrologist
Suks Minhas, MD, FRCS(Urol), Consultant Uro-Andrologist

Introduction

Despite major advances in the understanding of the physiology of penile erection and the pathophysiology of erectile dysfunction (ED), it remains a significant global male health problem. The PDE5 inhibitors, sildenafil (Viagra; Pfizer), tadalafil (Cialis; Lilly), and vardenafil (Levitra; Bayer) have revolutionalised the treatment of ED. However, up to 30% of patients fail to respond including long-term diabetics. It is known that Nitric Oxide (NO) release from nitrergic nerves is impaired in patients with diabetes, giving rise to diabetes-induced erectile dysfunction.

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Unravelling the pathophysiology

Amr Abdel Raheem, Clinical Fellow in Andrology, Institute of Urology, London, UK
Asif Muneer. Science Editor

Phases of ejaculation

(i) Emission::
During this phase there is sequential contraction of the epididymi, vasa, seminal vesicles and prostate to propel the semen in the posterior urethra and closure of the bladder neck to prevent reflux in the bladder.

Afferent: pudendal nerve (S2,3,4)
Efferent: sympathetic fifibres (T10-L2) -> inferior mesenteric ganglion -> hypogastric nerve.

This phase can be voluntary controlled and is influenced by inhibitory and facilitatory cortical centres.

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