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Orgasm is a totally separate eventa sensory experience with considerable subjective variationit can occur independently of ejaculation and even erectionAfter ejaculationdetumescence occursfollowed by a refractory period that lengthens with age and with repeated ejaculationsResearchers have demonstrated that the ejaculatory mechanism consists of two distinct reflexesthe glans-vasal and the urethromuscularwhich are responsible for the emission and expulsion phases of ejaculationrespectivelyShafik 1998This is consistent with the report by Yang and Bradley1999of an electrically distinct pathway localized to the dorsal nerve of the articulo 71. penis and running from the anterior urethra to the bulbocavernous musclethis is distinct from the penile shaft afferent fibersThe cortical representation of the dorsal nerve of the penis now appears both larger and in a different location than was previously conceivedBradley et al 1998
Althoughmany studies have been published on costco pharmacy cialis prices. the use SSRIs in the treatment of PEWaldinger et al were the first to evaluate these studies methodologically in light of evidence-based criteriaWaldinger 2003Waldinger et al 2004bThe results revealed that from 79 publications on drug treatment of PE35 studies involved serotonergic antidepressantsHe clearly documented that in both single-blind and open-design studiesas well as studies using a questionnaire or subjective report on ejaculation timethere was a high variabilityand that there was over-estimated responses in the degree of ejaculatory delayOnly 8 studies18.5fulfilled all criteria of evidence-based medicineegdouble-blind studies prospectively using real-time stopwatch assessments at each intercourse both at baseline and during the drug trialWaldinger 20032005Waldinger et al 2004bFor daily treatmenta rank order of efficacy of the SSRIs was establishedwith clomipramine being the bestfollowed by paroxetinesertralineand fluoxetine.
Patient is in a stablemonogamous sexual relationship with the same woman for at least 6 months and plans to maintain this relationship for the duration of the study history of premature ejaculation in the 6 months before study initiation not due to distressinterpersonal difficulty or medication withdrawal history of intravaginal ejaculatory latency timeIELTof.
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