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Handbook of sexual dysfunction - part 8

IS xuất tinh thường không thể đảo ngược và bệnh nhân nên tư vấn để tối ưu hóa của ông Bé và hưởng thụ tình dục của đối tác của ông từ chức năng còn lại. Yêu cầu điều trị thiếu hụt androgen thích hợp thay thế testosterone. Trong trường hợp không đủ kích thích, các bài tập khung xương chậu May Be hữu ích | 238 Waldinger of ejaculation is usually irreversible and the patient should be counseled to optimize his and his partner s enjoyment from the residual sexual functioning. Androgen deficiency requires appropriate testosterone replacement therapy. In the case of inadequate stimulation pelvic floor exercises may be helpful. Most patients require general advice on reducing precipitating factors reduction in alcohol use finding more time for sexual activity when not fatigued. Research and Methodology Research on lifelong delayed ejaculation is scarce. Most of the literature consists of hypotheses that have not been investigated according to methodological well-designed studies. Several factors may have contributed to this state of affairs. Delayed ejaculation is a relatively rare condition. Both in the general population and in the clinical practice the prevalence of delayed ejaculation is rather low 84 . Furthermore delayed ejaculation is known as a disorder that is relatively difficult to treat 92 . Although controlled studies do not exist clinical experience suggests that the outcome is rather poor 92 . A major problem in the research of lifelong delayed ejaculation is the absence of an empirically derived operational definition of delayed ejaculation. The DSM-IV criteria are arbitrary and not based on quantified research. For example consider the sentence orgasm in a male following a normal sexual excitement phase during sexual activity that the clinician taking into account the person s age judges to be adequate in focus intensity and duration what one wonders is meant by normal and how may a clinician judge that the excitement phase has been adequate in focus intensity and duration. There are no well-controlled studies regarding average or normal time of stimulation and therefore it is difficult to determine what is a delayed time of stimulation. In the absence of objective standards on orgasmic latency the clinician must rely on the subjective judgment of the .