Late Ejaculation

Late ejaculation (XTM) is a phenomenon with full sexual desire, stimulation, sufficient penile erection but having difficulty reaching ejaculation (XT).

Sexual intercourse becomes too stimulating. Both sides are tired, bored and no longer excited to receive pleasure. XTM rate accounts for 2 - 6% in XT disorders. Need to master the process of XT as well as the causes of XTM that we have the most appropriate and proper treatment

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Ejaculation process like?
For men, XT is the end of intercourse. Time is calculated from the start of intercourse until the average ejaculation is 5 - 15 minutes. The process to achieve such pleasure the body undergoes a series of complex phenomena At the end of the intercourse, at least three phenomena occur in succession with semen discharge, forming pressure in the seminal vesicles, ejection and ejaculation.




The seminal discharge phase: from the command receptor in the cerebral cortex to the sympathetic nervous system, semen has sperm from the testes, the epididymis empties into the vas deferens and then to the seminal vesicles, thanks to the continuous contraction of the vas deferens, at the same time the fluid from the prostate gland and seminal vesicle is simultaneously supported by excretion and excreted strongly into the ejaculation tube during XT.

The stage of ejection and ejaculation outside the urethra: during intercourse, sensory stimuli are transmitted from the external genitalia, through the sensory part of the shy nerve and to the nerve The spinal cord, goes to the control center in the brain and transmits stimulating impulses to the sympathetic nerve chain to the XT apparatus, while stimulating sympathetic nerve activity in the bladder neck, causing constriction. .
This is a factor to prevent retrograde XT phenomenon. Neural signals stimulate the pelvic muscles to contract each beat of the ejaculation.
Reason
The study of physiology helps us to analyze the mechanism of general XT in sexual activity. But according to the recommendations of the American Psychiatric Association scientists, it is necessary to pay attention to the objective circumstances affecting the promotion such as age, novelty of the situation or partner, the frequency of sexual activities

sex.



The causes of XTM usually focus on the following main causes:
- Psychological reasons, still not beyond the obsessive reasons of inferiority complex, anxiety, fear of pregnancy, reduction of sexual excitement (sexual partners lacking sexiness, feelings of fear or conflict) with a partner). Gradually into a conditioned reflex.
- Loss of penis sensitivity due to a number of sensory nervous system diseases or surgeries that destroy the sensory nerve area in the penis making the sensory stimulation from the penis disappear, leading to XTM .
- In some drug addicts, alcoholism also reduces the process of sexual excitement.
- Some adrenergic drugs, including some used to treat early XT, can also cause XTM. In addition, conditions such as diabetes, prostate surgery can be XTM.
Diagnose

The diagnosis of XTM, we must pay attention to the history of internal medicine, surgery, and the symptoms that the patient recounts help the physician to guide the type of disease and the direction of treatment.
Clinical examination should be noted in size and density of 2 testicles (testicular atrophy may be a condition of hypogonadism, no XT or very little XT), palpation of no bilateral vas deferens (in combination with ultrasound through rectal dilatation) in the 2-sided vasectomy pathology, the volume of XT is also very small, helping us to distinguish differentially with a condition of impotence due to deadlock.




The determination is based on normal sexual intercourse, euphoria and extreme euphoria, but the patient does not experience ejaculation outside or after 30-45 minutes of sexual intercourse ends, during rest. or after a tired sleep, semen will flow out slowly. This phenomenon does not affect the couple's satisfaction much, but it does affect the birth.
Treatment
Psychological treatment, XTM disease affected by anxiety, relationship with partner. Therefore, the initial contact attitude of the physician must create a comfortable and discreet atmosphere tactfully. Physicians should create trust with patients, guide patients with self-corrective and confident measures.
Psychological treatment is aimed at addressing the obstacles in sexual intercourse to maintain a harmonious life for the couple. Each party needs to be encouraged and shared openly, need to face the situation to find reasonable measures for both parties to hope for success.




Drug treatment: on the principle of taking drugs that increase the adrenergic euphoria process. All antagonists for early treatment of XT can be used as ephedrine. The release of the horsetail nerve region of the vertebrae, can be used because it regulates the rhythmic balance operation between the sympathetic and parasympathetic nervous system by acupuncture.
In addition, surgical methods may be used.

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