biological causes include vascular diseases, neurological diseases, smoking, medications (such as SSRIs and antihypertensives), and alcohol abuse. Psychological factors involve sexual abuse/rape, relationship issues, exhaustion, stress, and mental illness. Depression must always be screened for as this is a highly-correlated factor. The different treatments for male hypoactive sexual desire disorder include psychotherapy and hormone replacement therapy with testosterone. There are several ways to get testosterone, including by skin patch, creams, or suppositories. Mindfulness techniques will help in psychologically-based cases. Drugs that may also help but are less shown to be beneficial include bupropion, olanzapine, and phosphodiesterase-5 inhibitors like tadalafil and sildenafil.
PREMATURE (EARLY) EJACULATION (302.75) Premature ejaculation is defined as early ejaculation during vaginal intercourse (but not for other types of sexual activity). It involves ejaculating within one minute of vaginal penetration. The man feels unable to control his ejaculation and is frustrated by the event. Causes can be related to self-esteem, anxiety, penile hypersensitivity, and inexperience in sexual matters. Worry about the woman achieving orgasm can actually make the problem worse so that it becomes a conditioned response. While there is a strict definition of premature ejaculation, it can be more loosely defined as having a lack of control over ejaculation that is unsatisfying to the other person. The average time in normal males is three minutes. The disorder must persist for a minimum of six month and must be experienced at least 75 percent of the time. It should be distressful or frustrating and cannot be caused by another mental disorder, medication, or medical problem. There are several specifiers to consider, including primary or lifelong, acquired, generalized, and situational, with mild, moderate, or severe disease (based on how long it takes to have an ejaculation after penetration). The prevalence is 1-3 percent in the US. The major risk factors for premature (early) ejaculation include anxiety disorder (particularly social anxiety disorder) and PTSD from sexual trauma. There is a frequent comorbidity with
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