Eiaculazione precoce aggiornamenti.
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Eiaculazione Precoce:
nuove prospettive nel trattamento
medico, farmacologico e psicologico
Giovanni BerettaResponsabile Unità di Andrologia
Centro medico Cerva - CMC - Milano
Centro Italiano Fertilità Sessualità - Demetra - Firenze
Centro Riproduzione Art Umana - CRUA – Roma
www.andrologiamedica.org
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IELT
MELT
AELT
OELT
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Andrologia. 1986 Nov-Dec;18(6):583-6.
Evoked sacral potentials in subjects with true premature ejaculation.
G.M.Colpi, F Fanciullacci, G.Beretta , L. Negri L, A. Zanollo.
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Andrologia. 1986 Nov-Dec;18(6):583-6.
Evoked sacral potentials in subjects with true premature ejaculation.
G.M.Colpi, F Fanciullacci, G.Beretta, L. Negri L, A. Zanollo.
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La leptina interagisce con le vie serotoninergiche
del Sistema Nervoso Centrale (SNC).
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0 10 20 30 40
Rosen RC et al (2004) The Premature Ejaculation Prevalence and Attitudes (PEPA) Survey: A Multi-National Survey.
J. Sex Med 1 (Supp 1): 57-58
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capacità sessuali
0 10 20 30 40 50 60
Rosen RC et al (2004) The Premature Ejaculation Prevalence and Attitudes (PEPA) Survey: A Multi-National Survey.
J. Sex Med 1 (Supp 1): 57-58
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Le persone con EP sono frustrate e
rassegnate
0 10 20 30 40 50 60 70
Rosen RC et al (2004) The Premature Ejaculation Prevalence and Attitudes (PEPA) Survey: A Multi-National Survey.
J. Sex Med 1 (Supp 1): 57-58
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Uomini con EP riportano che la loro partner gode meno ed arriva
0
10
20
30
40
50
60
70
80
Partner gode
durante
il sesso
Partner raggiunge
sempre
Perc
entu
ale
delle
ris
poste Uomini
con EP
Uomini
senza EP
Rosen RC et al (2004) The Premature Ejaculation Prevalence and Attitudes (PEPA) Survey: A Multi-National Survey.
J. Sex Med 1 (Supp 1): 57-58
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* Hypoactive Sexual Desire Disorder
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Cosa si deve ottenere con una terapia
mirata?
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Effetti collaterali
Astenia Nausea VertiginiSecchezza
fauciD.E. Aneiaculazione
Clomipramina 3 30% 30% 14% 10 23% 20%
Paroxetina 0% 3% 6 7% 6% 3 8%
Fluoxetina 11% 8 22% 3 9% 4 8%
Sertralina 0 13% 3 12% 0 12% 0 19% 0 4% 0 22%
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* LPGi: Lateral ParaGigantocellular nucleus
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Raccomandazioni EAU sulla terapia
farmacologica
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Terapie locali:
Efficaci rispetto a placebo
Utili in combinazione con
farmaci orali
Assenza di effetti sistemici
Frequenti effetti collaterali
locali (ipoestesia genitale,
irritazioni, dolore)
Spesso mal tollerate dal
paziente o dalla partner
Morales A et al., BJU Int. 2007 Sep;100(3):493-501
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EAU Guidelines
Terapie locali
valida alternativa agli SSRIs (off-label)
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Acta Eur Fertil 1986 jan-Feb;
17(1):43-5
Effect of alpha-blocking agent
(Phenoxibenzamina) in the
management of premature
ejaculation.
G. Beretta, E. Chelo, F.
Fanciullacci, A. Zanollo
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Nei pazienti con EP e DE, la Disfunzione
Erettile deve essere trattata per prima !!!
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Terapie non farmacologiche
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Grazie per l’attenzione!EP Primaria situazionale