Table of Contents

Ejaculation Disorders

A Resource and Reference Guide

for

Patients and Health Care Professionals

Copyright and Limited Release

This publication is the copyright of the author and publisher and is subject to any and all relevant United States and international copyright laws, regulations, treaties, and agreements. While the original content of this book and its organization, evaluation, and collection of information appearing within these pages are the property of the author and publisher, the authors and creators of the works cited herein may have additional restrictions on the use and distribution of their work(s) under applicable intellectual property laws and regulations. For copyrighted content within this book (i.e. "the written word") owned by the author and publisher, the author and publisher hereby grant permission to any person to copy or reproduce limited passages of this book for personal, educational, medical, or other non-commercial use without prior permission.

Disclaimers

This publication is provided as a resource reference for patients, physicians, researchers, students, policymakers and any and all persons interested in finding the best research on health-related conditions. As a reference document, this publication provides an overview of, and links to historical and current developments in the understanding of specified illnesses and disease. Necessarily, this publication contains references to research conclusions that are both generally accepted and unconventional to the understanding and treatment of specified health conditions and disease. While every attempt has been made by the author and publisher to provide a comprehensive list of relevant resources and factual information pertaining to specific diseases and disorders, the author and publisher are not responsible for any omissions in research, or for the research conclusions or recommendations made by individuals referenced herein. As a result this publication should not be used to diagnosis or treat any health or medical condition without first consulting with a qualified health care professional. This publication is sold with the understanding that the author and publisher are not endorsing particular research conclusions or providing professional medical, legal, financial, or psychological advice and that the reader assumes all responsibility for the use of information contained herein.

Important Note to Reader

This book is one in a series of books on researching specific health conditions and disease.

The purpose of this series is twofold.

First, these books provide specific information on critical aspects of different diseases, disorders, and health conditions. The purpose of providing this information is to supply the reader with the most noteworthy, reliable, and important background on a variety of health conditions and concerns.

Second, these books provide a basic primer on researching health conditions and disease. This is accomplished by not only identifying the best available health and disease resources but also by teaching the reader the skills necessary to perform independent and thoughtful research to answer specific questions related to their unique health information needs.

As such, this book is both informational and instructional .

As an informational text, each book is totally unique and independent from any other book in this series. This is true because the resource information in each book is presented for a specific disease or health condition. Thus, each volume is unique from another based the particular characteristics of the health concern being discussed.

As a manual for instruction, each book in the series is similar, and in many places identical to the other books in the series in that each incorporates the same research principles, database sources, reference archives, and similar approaches to finding and utilizing the most reliable and current health information available today.

The dual nature of this book therefore begs the question:

"If I am interested in research about more than one disease or health condition should I purchase a separate volume for each disease?"

The honest answer is… "It depends."

If your primary purpose for reading for this book is the same as the primary reason this publication was written, that being to better understand a particular physical disease or psychological disorder then the answer is "Yes," you should consider purchasing additional volumes as each book only provides factual information about the particular health condition or disease identified in the book title.

However, if you are purchasing this volume for bibliographic and reference information or to learn how to engage in professional-quality health care research by understanding what constitutes a reliable and current resource and research best practices, then the answer is a "No," you should not purchase more than one volume in this series. This is because each volume will teach you the identical skills and empower you to research any disease or health condition on your own, therefore bypassing the need for the information resources found in the additional series volumes.

J.G.E.

C HAPTER 1

INTRODUCTION

Free Bonus Downloads

We have included 18 FREE health and medical ebooks at the end of the book just for our readers. If you are reading this right now you belong to those who have access to these special free bonuses. Collectively, these ebooks constitute an entire health and medical library covering all types of disease and each aspect of health-related research.

Each ebook contains a detailed and fully functional Table of Contents to ensure you are able to simply and quickly navigate to your destination and access the precise information you need. Collectively, the ebooks include contributions from more than 1,000 of the most highly-esteemed medical, health, and research professionals. Since each is provided under either a Creative Commons or public domain license you are free to edit or adapt each book based on your individual needs.

The FREE ebooks included in your download bonus are:

The Encyclopedia of Disease (14 volumes, 4,625 pages)
Dictionary of Clinical Research Terms (268 pages)
Dictionary of Psychiatry Terminology (167 pages)
The Complete Guide to Alternative and Complementary Medicine (135 pages)
The Truth About Herbal Cures (106 pages)

Each ebook is formatted to enable you to read your library anytime, anywhere in all of the formats listed below:

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Your ebook collection can be accessed using either one of the two links found at the end of this book . To ensure your privacy and security NO password or access code is required and NO cookies will be stored on your computer or other device.

Encyclopedia of Disease (14 volumes, 4,625 pages Volume I shown )

Dictionary of Clinical Research Terms (268 pages)

Dictionary of Psychiatry Terminology (167 pages)

The Complete Guide to Alternative and Complementary Medicine (135 pages)

The Truth About Herbal Cures (106 pages)

Introduction

Broadly speaking, this book and the other volumes in this series are about health literacy. More specifically this book is about understanding the basic medical components and physiological nuance of your health condition (signs, symptoms, treatment, prognosis, etc.), researching and identifying the most authoritative and reliable information given your unique health needs (i.e. medical/physical/emotional circumstances), synthesizing this knowledge into a coherent whole, and applying your knowledge to your daily healthy living regime, or to the care of your patient or loved one.

Since this book is fundamentally about both the process and techniques involved in researching the characteristics of Ejaculation Disorders and providing high quality bibliographic references about this condition, it is ideal for both the patient and the student of medicine and the life sciences, as well as others in need of authoritative, valid, and sound health information. U.S. government health experts define health literacy as "the degree to which an individual has the capacity to obtain, communicate, process, and understand basic health information and services to make appropriate health decisions." Experts agree that more than half of the adult population in the U.S. can be termed "health illiterate" and that 9 out of 10 adults are unable to understand and correctly apply even the most basic health instructions recommended by a doctor or other health care professionals. The result is that 90 million Americans are unable to take even the most basic steps to prevent disease and manage their own health conditions. Sadly, the deficiency of health knowledge is not limited to the U.S., but is widespread worldwide. This lack of health literacy, or "health illiteracy," has serious consequences; including increases in preventable deaths, increases in personal health care costs, and poor health outcomes for a majority of adults and their children.

Active Patients and Shared Decision Making

Research has demonstrated that patients who take an active role in their medical care maintain more healthy lives, recover more quickly from illness and disease, and live longer. In addition to improving health outcomes, patients who actively participate in medical decision making report increased satisfaction with their treatment, their doctors, and the health care system in general. Research has further shown that more than half of all patients are dissatisfied with the role they play in making decisions about their own personal health care.

Rather than taking a passive or subordinate role in health care, active patients partner with doctors, nurses, specialists, and other health care professionals by assuming a leadership role in managing their personal health care. These patients schedule routine medical visits, follow through on doctor recommendations and, equally as important, stay informed about health trends and health conditions that impact them. By becoming educated, these patients take the personal responsibility to learn about disease and disorders, follow evidence-based medical guidelines communicated to them by health care professionals, and strive to become knowledgeable enough to find, understand, and follow the best and most current information about illness and chronic disease management.

Because of the overall benefits of active participation in health care decision making by patients, a new health care delivery paradigm known as Shared Decision Making, or SDM, is being advocated by hospitals, researchers, and patient advocacy groups worldwide. In study after study, research has consistently and conclusively demonstrated the effectiveness of this health care model in medical disciplines ranging from preventative care, to chronic disease management (such as diabetes), to pain management, and beyond. Moreover, studies have concluded that SDM is especially effective in combating the most deadly health conditions, including the screening and treatment of cancer and heart disease.

To become an active patient, it is critical that you first know where to find reliable health information and then understand how to apply this information to your own lifestyle, health conditions, and unique set of values and personal beliefs.

This, however, isn't always as simple as it sounds. Routinely, a patient's primary (if not only) resource for medical information is the World Wide Web. Unregulated and saturated with unscrupulous "charlatans," much of the health-related information on the Web is not only inaccurate but potentially dangerous and even life-threatening. Moreover, just as technological innovation has opened up Web publishing to anyone with a network connection and a little extra time, new self-publishing platforms are making it likewise as easy for these same people to publish important looking books, regardless of the author's credentials or expertise. It is for these reasons that this book has been written with one over-arching goal in mind, to give all patients the tools and resources to become "active" patients in the care and treatment of their particular disease, disorder, or other health condition.

However, becoming an active, informed patient is only half the equation. The other half involves holding health care professionals to this same high standard of knowledge. Today physicians, nurses, and other health care professionals face numerous challenges in keeping abreast of the latest research in illness and disease and current and appropriate clinical guidelines for delivering high quality health care to patients. Popular news is replete with stories of the "crisis" in health care caused by the diminishing number of medical students choosing careers in primary care and instead opting for more lucrative specializations such as orthopedic surgery, cardiology, gastroenterology, urology, dermatology, or radiology. The result is that fewer primary care physicians are seeing more patients, spending less time with each patient, and treating more ailments, all the while struggling to manage larger caseloads and having virtually no time to stay informed on the most critical research concerning the myriad of health conditions they treat on a daily basis.

Coupled with overburdened primary care physicians, health care delivery writ large has become increasingly fragmented and it is this fragmentation that has contributed to more and more medical errors as doctors fail to adequately diagnose and communicate life-threatening conditions to both patients and other members of the health care team responsible for patient care. In 1970, the American Board of Medical Specialties (ABMS) issued certificates in only 10 medical specialties and sub-specialties. Less than 20 years later this number increased to 66 and today approximately 145 medical specialties and sub-specialties are recognized by the ABMS. The consequence is that instead of seeing one or two doctors for a particular ailment, a patient may now see four or five different physicians and specialists to treat the same condition. While all this specialization can have a positive impact on patient health, this will only be true when each member of the health care team adequately and accurately communicates test results, patient observations, and other important medical information to all the other members of the team. When communication is lacking and information is not made available to the entire team, the consequences to the patient can be catastrophic, or even life-threatening in some instances.

Finally, in America the recent expansion of the number of persons seeking and receiving health care as a result of the Affordable Care Act (ACA or "Obamacare") has overwhelmed a system already bursting at its resource seams, resulting in still more patients seeking more care from the already stressed health care system. For many of the more than eight (8) million new ACA patients, this is the first time in their lives they have had access to routine health care, including periodic check-ups, preventative care, and other basic health services. Due to the poor health care histories for these individuals and in contrast to the average patient in the pre-ACA health care population, this new group of patients is likely to enter the system with more chronic health conditions like diabetes, obesity, and high blood pressure (conditions that could have been prevented if they only had access to health care earlier). Therefore, while the ACA has increased the number of new patients by only about 3%, from approximately 256 million patients to 264 million patients, per capita it is anticipated that these patients will require more health care services than the existing patient population.

Given our beleaguered and disjointed health care system, it is no wonder that physicians and other health care professionals have virtually no time and even less energy to adequately stay informed on the most recent developments in their field. Furthermore, the sheer amount of new health information available today is immense, doubling in volume once every five (5) years. Advances in science (most notably in the study of human DNA and progress made in identifying and mapping all genes in the human genome) and technology (such as the ability to manipulate massive amounts of study data in near real-time) has rapidly increased the rate of medical advancement and made seemingly new medical innovations quickly obsolete. The cumulative effect is some doctors basing important medical decisions on outdated medical guidelines and best practices.

Because of the current state of affairs, this book is also for the health care professional. Using the same resources for patients and health professionals the goal of this book is twofold. First, this book will identify the best books, journals, journal articles, and Web resources about Ejaculation Disorders available to the patient and the health care provider, therefore giving the reader a quick inventory of current research and a convenient reference during times when performing firsthand research is simply not practical, such as during a patient's appointment with her doctor. Second, it explains the most basic "mechanics" of health research and how to find and use the most trustworthy and comprehensive health care journals, databases, books, and electronic resources available in the world today. In this regard, the author hopes that this book empowers both the patient and health care professional by making each a more informed, educated, and responsible user of timely and cutting edge health information.

Though not its primary purpose, this book is in some respects a do-it-yourself guide to health-related research and resources and, as such, it is important to note this book is not prescriptive; meaning that while this book does identify limited information about causes or risk factors of Ejaculation Disorders, recommend diagnostic or treatment procedures, etc., this is NOT the primary purpose of this book. Instead, this book should be used as a tool for the reader to explore and find information about Ejaculation Disorders on her or his own based on their specific circumstances as patient, loved one, health care professional, researcher, or public policy-maker; keeping foremost in mind the needs and value-systems of the patient. Since health information is constantly updated and rapid medical innovation the rule rather than the exception, the author hopes this volume is not used once and forgotten to collect dust on the bookshelf, but continually and routinely referred to in order to stay abreast on the latest medical developments and apply the most recent best practices over the long-term.

Further, for patients or other "lay-persons" using this reference it is vital to understand that the knowledge gained by applying the recommendations and practices found in this book do not replace the advice and recommendations of your physician. Instead, in the spirit of SDM, the research gathered from methods used in this book should be shared with your physician and health care team to collectively determine the best course of action for a health condition keeping foremost in your specific circumstances and needs.

Finally, the author recognizes that the value of this book is based less on its content and more on its application to real-world health questions. It is therefore expected that a patient or a patient’s loved one will find different utility in its pages than a health care professional. For the former, it is the author’s hope that this book reduces the mystery surrounding scientific medical research and empowers the patient through knowledge and confident health care decision making. For the latter, and particularly the more highly educated health care professional, some of this material may be remedial and some simply a refresher of things you once knew but have forgotten. Since this book has also been written for the student researcher, it is the hope that this edition proves to be a valuable introduction to researching Ejaculation Disorders and studying disease and health conditions in general.

Medical Errors

If you're a patient or have a loved-one receiving medical treatment and are still not convinced about the importance about being active in your health care treatment consider a 2013 article entitled A New, Evidence-based Estimate of Patient Harms Associated with Hospital Care , authored by John T. James, PhD, and published in the well-regarded Journal of Patient Safety. In this research article Dr. James estimates that between 210,000 and 440,000 patients die each year from preventable medical errors. If these estimates are accurate, then medical errors are the third leading cause of death in America, behind only heart disease and cancer. Similarly, other health care data suggests that 17% of all deaths in America each year can attributed to medical errors. What's as disturbing, is that these estimates only include medical errors resulting in death and do not include other harmful consequences of preventable medical errors; including permanent physical or biological damage to the patient, longer periods of hospitalization, and a lower overall quality of life. Many experts agree that if these secondary consequences of medical errors were considered the true devastation caused by medical errors would be significantly higher.

Reinforcing James’ findings, another report, this one by the Office of the Inspector General for Department of Health and Human Services, studied patient care for individuals on Medicare. This 2010 study concluded that 180,000 Medicare-only patients die each year as a result of poor hospital care.

In his study, Dr. James cites five (5) types of preventable medical errors: errors of commission, errors of omission, errors of communication, errors of context, and diagnostic errors. Errors of commission occur when a health professional administers a procedure that was either performed improperly or should not have been performed at all. On the other hand errors of omission simply means that, based on the best medical evidence, a procedure that should have been administered, wasn't performed at all. Communication errors occur between two or more health professionals or between health professionals and a patient and, as the name implies, happen when critical information is not shared with members of the health care team or the patient. Communication errors can lead to a misunderstanding by medical staff as to the correct patient diagnosis or prescribed treatment regime or cause a patient to unintentionally engage in activities that are contrary to acceptable established medical recommendations for their particular disease or disorder. Similarly, errors of context occur when a health professional fails to consider the unique circumstances of a patient in their "post-discharge" treatment. The example used by James is the patient who lacks the mental capacity to follow an ongoing, complex treatment plan or the patient who does not have access to follow-up medical care due to financial or geographical restrictions. Finally, diagnostic errors occur when the incorrect diagnosis is given to a patient. Diagnosis errors often result in inappropriate treatment, ineffective treatment, and a delay in the administration of the correct treatment.

Given the troubling prevalence of medical errors, it is obvious that current diagnostic and treatment shortcomings in our health care delivery system have very real, frequently deadly implications, for the unenlightened patient and the ill-informed health care professional. Thus, it is no exaggeration to strongly caution the uninformed, un-involved patient to proceed at her own risk.

Evidence-Based Medicine

Evidence-based medicine is currently the most widely accepted and applied model of patient care in Western medicine. The most commonly accepted definition of evidence-based (EBM) medicine is one offered by Dr. David Sackett who defines EBM as "the conscientious, explicit and judicious use of current best evidence in making decisions about the care of the individual patient. It means integrating individual clinical expertise with the best available external clinical evidence from systematic research."(Sackett, Rosenberg, Gray, Haynes, & Richardson, 1996).

Therefore, EBM is the integration of the best medical evidence, as found through literature reviews and research, the clinical expertise and experience of the doctor, and a constant recognition of patient values and concerns. Fundamental to the EBM model is its reliance on research and literature reviews to give the doctor and patient the best possible benchmark or baseline information to begin to answer relevant clinical questions and formulate a treatment plan both appropriate and acceptable to the patient. It is the goal of this book to provide the reader with both the basic medical literature research tools, as well as a bibliography of some of the important research itself. However, it is important to remember that even though evidence and research are primary in the EBM decision making process, it is not the sole deciding factor in determining patient care and on a case-by-case basis may in some instances not even be the most important consideration.

The EBM process begins by identifying a clinical problem and then applying this problem to a specific question about treating and caring for the individual patient. Based on the question, the doctor or researcher then determines the best available resource or resources to answer that question. Next, the literature is reviewed keeping in mind two important questions. First, is the literature valid , meaning does it accurately represent the truth as we know it today and does it have a sound basis in reason and fact. Second, does the literature offer advice and recommendations that are applicable to the patient and therefore will, if followed, offer a reasonable expectation of a successful patient outcome. Once the doctor has made her evaluation and formed a recommendation or alternative recommendations, she presents her conclusions and recommendations to the patient and in consult together they examine the evidence and discuss the patient’s preferences and values to agree on a course of medical treatment.

Health Information on the Internet

Since most disease and health-related information is accessed by both patients and medical professionals via the Internet, either through general queries using search engines like Google or by directly accessing professional databases and information repositories, it is important be able to determine what constitutes quality health information. A 2013 survey by the Pew Research Center found that "59% of U.S. adults have looked online for information about a range of health related topics in the past year", and "35% of U.S. adults say they have gone online specifically to try to figure out what medical condition they or someone else might have." While the Internet can be a quality resource to find information quickly and easily, there are many important questions to answer to evaluate the information you find online, such as:

Which websites and databases are most reliable?

How do you analyze the information you’ve found?

How current is the information you’ve found?

Unfortunately, not everyone reading this book is a medical professional and everyone doesn’t possess the same background or knowledge base to understand and filter all the information found online. This section will therefore examine some factors to consider when evaluating health information on the Internet.

More often than not, your first foray into researching all but the most basic health information online will end in confusion. While there is no shortage of health information on the Internet, at best much of what you will find will consist of over-generalizations of complex conditions, and analysis and recommendations not tailored to your specific concerns. At worst some of the information you find online will be founded upon baseless scientific conclusions, and downright dangerous home remedies. Certainly, your first rule of thumb needs to be that under no circumstance should you trust the veracity of everything written online. To make sense of what you find it is critical to keep a number of questions in mind prior to acting on any online health advice:

First, consider the source .

Look for an "about us" page. What is the original source of the information and what are the credentials of the person or organization that provided it? This information could be very telling.

Notice whether or not the website providing health related information shares its source(s)? If it does, is it a reliable source? Remember, much (if not most) information posted on websites actually originates from a third-party source. If the organization or person that owns or administers the website did not author the content the actual source should be conspicuously identified. Also, if the information wasn’t written by a medical expert, was the information reviewed and approved for quality by an expert with professional credentials in that field?

If a non-medical person or organization wrote the article is it reliable? You should limit your research to only reliable sources. A reliable source could include websites published published by the U.S. government, non-for-profit entities, and universities or other institutions of higher learning. Respectively, these websites can be identified with dot gov, dot org or dot edu URL extensions. Does information on the website appear to be more opinion than fact? If it is opinion-based, does it come from a an expert area of study or unbiased and objective organization such as a medical association or research institute? These sites are generally the most trustworty as they are not affiliated with insurance or pharmaceutical companies, and therefore have no profit-based motive (or appearance of one) in providing certain conclusions or advice. Having said that, it is still recommended you to dig deeper to discover exactly where the information originated.

Today, most web search engines like Google make it easy to limit your searches to .org or .gov websites. Simply type in your search term (enclosed in quotations for multiple words) followed by "site:.org" or "site:.gov" without the quotations here of course. Always remember to include the dot after the colon in "site."

For example, to search the broad topic of Ejaculation Disorders simply type:

"Ejaculation Disorders" site:.org

or

"Ejaculation Disorders" site:.gov

Domain names with the .com web extension generally represent businesses or other for profit companies. Business websites have the primary purpose of selling products or services, instead of providing reliable health information. If this is the case, the health information could be skewed to make their product or service more appealing.

While commercial sites may offer some useful and accurate information you will want to remain vigilant and be sure to cross-check any of the information you find with a more reliable source. While it is possible that the information can be trusted, if it seems to be provided only to make a certain product or service more appealing it is best to be skeptical and move on to the next resource.

Finally, a third source of online information is websites published by individuals. Many of these sites offer support and advice about coping with certain conditions and their treatments. While these websites can contain reliable and useful information, it is necessarily biased by only one person's experience. Additionally, diseases and health conditions impact different people differently and there are numerous factors that need to be considered before relying wholesale on one person's experience. These factors may be demographic, such as age or gender, physical, including the person's overall health or other aggravating health conditions, or even the quality of health care the individual received.

Second, how current is the information?

Rapid advances in research means health information is continually changing. Daily, research discoveries and advancements change the landscapes in our understanding of countless diseases. As such, it is critical that a website clearly idenifies the date it was last updated. Most reliable web pages will include information about when the information was last updated or reviewed, in addition to a statement about how information is reviewed to stay current. The date is usually located towards the end of an article. If no date is posted, located the copyright notice. This will tell you the date the article was originally published or written and the publishing organization, if applicable. If the article is more than a year or two old, you are likely better off finding more current information.

Third, does the site present facts and not opinion?

Information should be clearly written, based in fact and present the full scope of the issue being studied, and not just selective anecdotes. The content should be easily verified from a trustworthy information source such as professional journal articles, abstracts, or doctors and other medical professionals.

Fourth, who is the intended audience?

It should be clearly stated on the website whether the information is intended for the consumer, or the health professional. Many websites have separate web pages for patients and doctors or health care professionals. Be sure to use the information that is most relevant to your information needs.

Fifth, be skeptical .

Claims that sound too good to be true often are. Your goal should be to find current, unbiased information based on scientifically valid research. If you're a patient, it is important to remember that no matter how confident you are in your online research it can not replace the advice of your doctor, as she is most familiar with your specific medical circumstances. Your doctor is the best person to answer questions about your personal health. She not only understands your health history and any medication you take, she also understands the plethora of other health factors that may be involved and interact and she’s committed to providing the best possible care and treatment.

Book Organization and Scope

This book begins by providing the reader with background information and definitions related to Ejaculation Disorders. Importantly, the second chapter also identifies and explains specific high-quality resources the reader can trust when performing individual health research on specific topics and sub-topics. Chapters 3 through 9 proceed to discuss the individual components of all health-related conditions, including epidemiology, risk factors and cause, signs and symptoms, diagnosis, pathophysiology, treatment, and prognosis. Importantly, each of these chapters begin by explaining precisely what is a meant by a doctor when she discusses each of these concepts and ends with an examination of how each applies to the medical condition of Ejaculation Disorders. While this book focuses on the "nut-and-bolts" of Ejaculation Disorders, Chapter 10 concludes by providing the the interested reader with additional resources to expand their research to other areas, including but not limited to the role nutrition in preventing or treating Ejaculation Disorders, alternative therapies, and biotechnology.

Importantly, as a research reference, throughout this book hundreds of articles are identified to enable the reader examine particular issues in depth. Each list of references contains a wide assortment of articles and includes research studies and articles geared towards readers of all levels of sophistication, from research novices and patients to and medical and health-care professionals. Each article is hyperlinked directly to the source allowing the reader to access without leaving the book. Additionally, each reference is linked directly and not hidden beneath confusing anchor text thereby allowing the reader to identify the precise source and location of the article for further future reference.

While this book is organized in a manner that most closely resembles the order of disease or disorder progression, from pre-disability considerations to symptoms, treatment, and eventual outcome, it is first and foremost a reference book. This means a reader can read chapters and sections in isolation and without first reading a preceding chapter or section, as the entire book is written in a manner making it easy for the reader to refer to areas of immediate interest without fear of losing meaning or nuance that may have been discussed earlier in the book.

C HAPTER 2

BACKGROUND

&

DEFINITIONS

The purpose of this chapter is to provide the reader with resources to find high-level definitions of terminology associated with Ejaculation Disorders. The easiest way to begin your understanding of complex health concepts is to first understand the definitions of key words and phrases commonly associated with a disease or illness. It is helpful to look up the words you are unfamiliar with, and keep a list of definitions for your reference. Often, a common term in a non-scientific context has a completely different meaning than the same term has in medicine, so be prepared to investigate and find words that are more familiar to you if you cannot understand a term or make the standard definition work in your particular context. As you become more familiar with your topic, the vocabulary will become less daunting and difficult ideas will be more understandable. Once you have a grasp of the content of your research, spend some time thinking about the research. Critically interpret what the results mean and how they are relevant to the disease. Keep in mind that in contrast to words used in everyday writing or conversation, scientific and medical terms have very precise meanings. In this regard, you will frequently encounter two or more medical terms that seem to have identical meanings, only to discover later that the distinction between these terms is critically important in a medical context.

This chapter will first identify the best sources for finding reliable definitions and explanations for complex health and medical terms and introduce the concept of a "controlled vocabularly." This chapter will conclude with definitions of the most commonly used terms associated with Ejaculation Disorders.

NCI Dictionary of Cancer Terms

The National Cancer Institute (NCI) Dictionary of Cancer Terms contains definition and information for 7,665 medical terms. While developed and hosted by the NCI, the dictionary contains definitions for both cancer- and non-cancer-related medical concepts. To search, simply type in your search term and click the go button. To find all words in the dictionary that include your search term, click the radio button Contains and all definitions with your search term will be available. For example, searching the term "thyroid" will return results for 28 terms containing the word "thyroid" including "anaplastic thyroid cancer" "autoimmune thyroiditis," "familial isolated hyperparathyroidism," etc. You can also select the letter your term begins with and scroll to the term you are looking up. The search box contains an autosuggest feature so after you type in the first three letters of the word, you will be presented with the first 10 terms that begin with those letters. If your word doesn't appear within the first 10 suggestions simply continue to type in additional letters and eventually the dictionary will narrow its suggestions to the term you need. This is particularly helpful for longer terms and words difficult to spell. If you want to turn the autosuggest feature off simply hit escape or click close within the autosuggest box. The results include the definition for your selected terms as well as a pronunciation guide. If you want to hear how the word sounds, simply click the audio radio icon button next to the term name. The NCI Dictionary of Cancer Terms can be accessed at: http://www.cancer.gov/dictionary

NCI Drug Dictionary

The NCI Drug Dictionary defines terms and alternative research links for medications and drug agents used for cancer theryapy, as well as countless other health conditions. The search engine operates in a manner identical to the one used by the NCI Dictionary of Cancer Terms so the same tips apply. All definitions include synonyms and generic and brand names for the drug. One excellent feature of the the NCI Drug Dictionary is that it also includes links to both open and closed clinical research trials related to that medication. The NCI Drug Dictionary can be found at: http://www.cancer.gov/drugdictionary

NCI Thesaurus

The NCI Thesaurus (NCIt) is a database of reference terms for many health-related from the NCI and other health databases.

The NCIt is updated frequently by a team of medical experts and contains more than 200,000 links and cross-references to other research information related to your term. Most people believe that a thesaurus is used only to identify synonyms for individual words or phrases. This is not totally correct as the more important purpose of a good thesaurus is to identify related concepts and ideas. In this regard the NCI Thesaurus and the NCI Metathesaurus (discussed below) are wonderful resources to reference when defining terms and determining the scope of your information needs.

The thesaurus can be searched at: http://ncit.nci.nih.gov .

If you prefer to work offline, the entire thesaurus can also be downloaded at: http://evs.nci.nih.gov/ftp1/NCI_Thesaurus .

NCI Metathesaurus

The NCI Metathesaurus (NCIm) is a vast medical research terminology database that provides definition and conceptual information for more than 4 million terms related to clinical care, biomedical research, and health care administration in general. The NCIm also has more than 22 million links and cross-references to additional concepts and information related to health and disease. To search the NCIm simply go to: http://ncim.nci.nih.gov/ncimbrowser .

Controlled Vocabularies in Health

The single most important purpose of a controlled vocabulary is to make searching a database easier. The Library Archives of Canada defines a controlled vocabulary as an "established list of standardized terminology for use in indexing and retrieval of information." Controlled vocabularies are used to capture, store, organize, search, analyze, and normalize information allowing for the exchange of information across different platforms.

While the term controlled vocabulary may seem foreign, you are likely already familiar with applications of the concept of in other contexts. Using a series of cross-references, the Yellow Page listings in a telephone book use a controlled vocabulary to make searching for specific types of businesses or organizations easier. For example, a Yellow Page search for "Doctors" doesn’t list doctors at all but instead says " see Chiropractors; Physicians - MD & DO; Podiatrists; Psychologists" thereby directing the reader to search for a doctor or type of doctor under these headings instead. This alternative listing for "Doctors" is a controlled vocabulary and like all controlled vocabularies serves three very important purposes.

The first is to keep the size of a database manageable. Imagine the amount of needless repetition that would occur if under the heading "Doctors" a complete listing of doctors was shown and the identical list appeared again under the subject heading "Physicians - MD & DO." Consider then the additional clutter created for duplicate listings for "Cars" and "Automobiles," "Grocery" and "Supermarkets," "Churches" and "Worship Services," "Job Services," and "Employment" and on and on. If this were done, it wouldn’t take long for the size of the Yellow Pages in even communities of modest size to exceed that of a complete set of the old Encyclopedia Britannica. This concept of managing the size of information also holds true for computerized databases where the space needed to store duplicate entries is prohibitive in terms of bandwidth and storage costs.

The second, and more important purpose of the controlled vocabulary, is to make your search more efficient and more precise. Using our Yellow Pages example, imagine if a search under the term "Doctor" yielded nothing and the term itself wasn’t even listed and you were expected to know to look under "Physicians - MD & DO" instead. While many people may have the wherewithal to look to the "Physician" listing this may not be true for people looking for contact information for businesses or organization in more esoteric fields. Thus, the controlled vocabulary makes it easy to find what you need by essentially saying "you’re close, good try but go here instead and you will find exactly what you need."

Finally, controlled vocabularies make complex topics like medicine accessible to novices and other non-subject-matter-expert researchers. Have you ever had a rough concept of what you were you trying to locate but either didn’t know its precise term or were unable to recall it? In instances like this a controlled vocabulary can be indispensable allowing you to enter a term close to the one needed but not exact and then returning a list of related concepts and terms where one is likely to meet your precise needs. In this way, a controlled vocabulary acts like a thesaurus of words or phrases. While some believe a thesaurus returns a list of exact synonyms for a chosen word, in truth the meanings for words in a thesaurus are most often similar but not exact. Therefore, when searching a thesaurus you really aren’t trying to find a fancier word with the same meaning but a word that most precisely communicates the the idea you are attempting to convey in terms of meaning, magnitude, or degree.

In the online world, most websites and databases that store large sets of information incorporate at least a basic form controlled vocabularies. If you are familiar with the online concept of "keyword tagging" (like the use of the hash tag "#" in twitter "tweets" to affiliate messages with other message on the same topic), this is exactly what controlled vocabularies attempt to accomplish, albeit in a more sophisticated and organized manner. Like keyword tagging, establishing a controlled vocabulary is not a one-time endeavor, but a constant and ongoing exercise where categories and search words and phrases are updated continuously to accommodate new terms, ideas, and discoveries.

In the age of technology, it is important to point out that contrary to our Yellow Pages example the use of controlled vocabulary today is almost exclusively the province of the Internet. In Health and Medicine, the international gold standard of controlled vocabularies is known as MeSH, or Medical Subject Headings. MeSH is discussed further below.

Medical Subject Headings (MeSH)

MeSH or Medical Subject Headings is the U.S. National Library of Medicine’s thesaurus. Use MeSH as a starting point for your research to collect relevant keywords and terms for further searches in the databases discussed later in this book. Since MeSH is both a controlled vocabulary and thesaurus the terms that appear in a MeSH search also include term definitions. These definitions should be recorded together with the MeSH search terms. Use MeSH definitions to understand important concepts and MeSH terms to establish a list of keywords for more in-depth and precise research.

MeSH is used by the NLM to catalogue all MEDLINE and PubMED databases, as well as NLM database of documents, books, and video and other NLM holdings. MeSH can be accessed by going to http://www.ncbi.nlm.nih.gov/mesh .

Ejaculation Disorders Journal Articles

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Balon, R. (2007). Depression, antidepressants, and human sexuality. Primary Psychiatry , 14 (2), 42–50. Retrieved from http://www.embase.com/search/results?subaction=viewrecord&from=export&id=L46294493\nhttp://dd8gh5yx7k.search.serialssolutions.com?sid=EMBASE&issn=10826319&id=doi:&atitle=Depression,+antidepressants,+and+human+sexuality&stitle=Prim.+Psychiatry&title=Primary+Psychiatry&volume=14&issue=2&spage=&epage=&aulast=Balon&aufirst=Richard&auinit=R.&aufull=Balon+R.&coden=PPRSC&isbn=&pages=-&date=2007&auinit1=R&auinitm=

Beh, S. C., Greenberg, B. M., Frohman, T., & Frohman, E. M. (2013). Transverse Myelitis. Neurologic Clinics , 31 (1), 79–138. http://doi.org/http://dx.doi.org/10.1016/j.ncl.2012.09.008

Bollmann, W., & Schill, W. B. Successful andrologic-gynecological treatment of sterility caused by an ejaculation disorder after retroperitoneal lymphadenectomy, 43 Geburtshilfe und Frauenheilkunde 573–574 (1983).

Burke, W. J. (2002). Escitalopram. Expert Opinion on Investigational Drugs , 11 (10), 1477–1486. http://doi.org/10.1517/13543784.11.10.1477

Evans, H. C., & Goa, K. L. (2003). Dutasteride. Drugs & Aging , 20 (12), 905–916; discussion 917–918. http://doi.org/10.2165/00002512-200320120-00005

Grasso, M., Fortuna, F., Lania, C., & Blanco, S. (2006). “Ejaculatory disorders and alpha1-adrenoceptor antagonists therapy: clinical and experimental researches”. Journal of Translational Medicine , 4 , 31. http://doi.org/10.1186/1479-5876-4-31

Hackett, G. (2011). Cardiovascular drugs and sexual dysfunction. Primary Care Cardiovascular Journal , 4 (3), 124–126. Retrieved from http://www.embase.com/search/results?subaction=viewrecord&from=export&id=L362583187\nhttp://dx.doi.org/10.3132/pccj.2011.021\nhttp://sfx.library.uu.nl/sfx?sid=EMBASE&issn=17565138&id=doi:10.3132/pccj.2011.021&atitle=Cardiovascular+drugs+and+sexual+dysfunction&stitle=Prim.+Care+Cardiovasc.+J.&title=Primary+Care+Cardiovascular+Journal&volume=4&issue=3&spage=124&epage=126&aulast=Hackett&aufirst=Geoff&auinit=G.&aufull=Hackett+G.&coden=&isbn=&pages=124-126&date=2011&auinit1=G&auinitm=

Heidenreich, a, Thuer, D., & Polyakov, S. (2008). Postchemotherapy Retroperitoneal Lymph Node Dissection in Advanced Germ Cell Tumours of the Testis. European Urology , 53 (2), 260–274. http://doi.org/10.1016/j.eururo.2007.10.033

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Homma, Y., Kawabe, K., Takeda, M., & Yoshida, M. (2010). Ejaculation disorder is associated with increased efficacy of silodosin for benign prostatic hyperplasia. Urology , 76 (6), 1446–1450. http://doi.org/10.1016/j.urology.2010.03.015

Hovav, Y., Almagor, M., & Yaffe, H. (2002). Comparison of semen quality obtained by electroejaculation and spontaneous ejaculation in men suffering from ejaculation disorder. Human Reproduction (Oxford, England) , 17 (12), 3170–3172.

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Iannitelli, A., & Pancheri, P. (2002). Citalopram: Pharmacological profile and clinical efficacy of the most selective among SSRI. Italian Journal of Psychopathology , 8 (4), 435–459. Retrieved from http://www.embase.com/search/results?subaction=viewrecord&from=export&id=L36330182\nhttp://dd8gh5yx7k.search.serialssolutions.com?sid=EMBASE&issn=15921107&id=doi:&atitle=Citalopram:+Pharmacological+profile+and+clinical+efficacy+of+the+most+selective+among+SSRI&stitle=Ital.+J.+Psychopatol.&title=Italian+Journal+of+Psychopathology&volume=8&issue=4&spage=435&epage=459&aulast=Iannitelli&aufirst=&auinit=A.&aufull=Iannitelli+A.&coden=IJPTA&isbn=&pages=435-459&date=2002&auinit1=A&auinitm=

Jannini, E. A., Simonelli, C., & Lenzi, A. (2002). Disorders of ejaculation. Journal of Endocrinological Investigation . http://doi.org/5797 [pii]

Jung, J. H., Kam, S. C., Choi, S. M., Jae, S. U., Lee, S. H., & Hyun, J. S. (2008). Sexual dysfunction in male stroke patients: correlation between brain lesions and sexual function. Urology , 71 (1), 99–103. http://doi.org/S0090-4295(07)02047-X [pii]\r10.1016/j.urology.2007.08.045

Jung, J.-H., Kam, S.-C., Choi, S.-M., Jae, S.-U., Lee, S.-H., & Hyun, J.-S. (2008). Sexual dysfunction in male stroke patients: correlation between brain lesions and sexual function. Urology , 71 (1), 99–103. http://doi.org/10.1016/j.urology.2007.08.045

Kam, S. C., Han, D. H., & Lee, S. W. (2011). The diagnostic value of the premature ejaculation diagnostic tool and its association with intravaginal ejaculatory latency time. Journal of Sexual Medicine , 8 (3), 865–871. http://doi.org/10.1111/j.1743-6109.2010.02151.x

Kameya, Y., Deguchi, A., & Yokota, Y. (1997). Analysis of measured values of ejaculation time in healthy males. Journal of Sex & Marital Therapy , 23 (1), 25–28. http://doi.org/10.1080/00926239708404414

Keating, G. M. (2013). Dutasteride/tamsulosin: A guide to its use in benign prostatic hyperplasia. Drugs and Therapy Perspectives , 29 (4), 91–96. Retrieved from http://www.embase.com/search/results?subaction=viewrecord&from=export&id=L368822554\nhttp://dx.doi.org/10.1007/s40267-013-0021-4\nhttps://gsk.worldcat.org/openurlresolver?sid=EMBASE&issn=11720360&id=doi:10.1007/s40267-013-0021-4&atitle=Dutasteride/tamsulosin:+A+guide+to+its+use+in+benign+prostatic+hyperplasia&stitle=Drugs+Ther.+Perspect.&title=Drugs+and+Therapy+Perspectives&volume=29&issue=4&spage=91&epage=96&aulast=Keating&aufirst=Gillian+M.&auinit=G.M.&aufull=Keating+G.M.&coden=DTHPE&isbn=&pages

L., I. (2005). Changes in sexual function after treatment of male cancer. Journal of Men’s Health and Gender . Retrieved from http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=reference&D=emed7&NEWS=N&AN=2005560314

M.A., P. (2011). Erectile Dysfunction and Depression: Screening and Treatment. Urologic Clinics of North America , 38 (2), 125–139. Retrieved from http://www.embase.com/search/results?subaction=viewrecord&from=export&id=L361823002\nhttp://dx.doi.org/10.1016/j.ucl.2011.03.004

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Ejaculation Disorders Internet Articles and Research

Current Concepts in Ejaculatory Dysfunction . (2015). Retrieved on January 27, 2015, from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1765044/ .

Delayed Ejaculation Treatment Cures And Causes . (2015). Retrieved on January 27, 2015, from http://www.make-love-easily.com/ .

Delayed Ejaculation: Causes, Symptoms & Diagnosis . (2015). Retrieved on January 27, 2015, from http://www.healthline.com/health/delayed-ejaculation .

Ejaculation Disorders | Cornell Urology . (2015). Retrieved on January 27, 2015, from https://www.cornellurology.com/clinical-conditions/sexual-medicine-program/ejaculation-disorders/ .

Ejaculation Problems: Too Fast, Too Slow or Not at All? » Sexual .... (2015). Retrieved on January 27, 2015, from http://www.bumc.bu.edu/sexualmedicine/informationsessions/ejaculation-problems-too-fast-too-slow-or-not-at-all/ .

Ejaculation Problems . (2015). Retrieved on January 27, 2015, from http://www.nhs.uk/conditions/ejaculation-problems/Pages/Introduction.aspx .

Ejaculatory Disorders and Ejaculation Problems . (2015). Retrieved on January 27, 2015, from http://theturekclinic.com/services/male-mens-sexual-health/ejaculatory-disorders-premature-ejaculation-ejaculation-problems-anejaculation-treatment-aspermia-problems-retrograde-ejaculation-no-ejaculate-failure/ .

Ejaculatory dysfunction . (2015). Retrieved on January 27, 2015, from http://medical-dictionary.thefreedictionary.com/Ejaculatory+dysfunction .

Ejaculatory dysfunction . (2015). Retrieved on January 27, 2015, from http://www.thefreedictionary.com/Ejaculatory+dysfunction .

Male Ejaculation Problems: Retrograde Ejaculation, Inhibited .... (2015). Retrieved on January 27, 2015, from http://www.webmd.com/sexual-conditions/mens-sexual-problems .

Male orgasmic disorder . (2015). Retrieved on January 27, 2015, from http://www.minddisorders.com/Kau-Nu/Male-orgasmic-disorder.html .

Overview of Male Sexual Function: Male Sexual Dysfunction: Merck .... (2015). Retrieved on January 27, 2015, from http://www.merckmanuals.com/professional/genitourinary_disorders/male_sexual_dysfunction/overview_of_male_sexual_function.html .

Premature (Early) Ejaculation DSM . (2015). Retrieved on January 27, 2015, from http://www.theravive.com/therapedia/Premature-(Early)-Ejaculation-DSM--5-302.75-(F52.4) .

Premature Ejaculation | Doctor | Patient.co.uk . (2015). Retrieved on January 27, 2015, from http://www.patient.co.uk/doctor/premature-ejaculation-pro .

Premature Ejaculation . (2015). Retrieved on January 27, 2015, from http://emedicine.medscape.com/article/435884-overview .

Premature Ejaculation . (2015). Retrieved on January 27, 2015, from http://www.nytimes.com/health/guides/disease/premature-ejaculation/overview.html .

Premature ejaculation . (2015). Retrieved on January 27, 2015, from http://www.minddisorders.com/Ob-Ps/Premature-ejaculation.html .

Retrograde ejaculation . (2015). Retrieved on January 27, 2015, from http://en.wikipedia.org/wiki/Retrograde_ejaculation .

Sexual Dysfunction . (2015). Retrieved on January 27, 2015, from http://family.jrank.org/pages/1504/Sexual-Dysfunction-Orgasm-Disorders.html .

Understanding and Treating Retarded Ejaculation: A Sex Therapist's .... (2015). Retrieved on January 27, 2015, from http://www.issm.info/news/review-reports/understanding-and-treating-retarded-ejaculation/ .

What is premature ejaculation? When is PE a problem? . (2015). Retrieved on January 27, 2015, from http://www.medicalnewstoday.com/articles/188527.php .

What is retrograde ejaculation, and how is it treated? . (2015). Retrieved on January 27, 2015, from http://www.medicinenet.com/sexual_health_overview/page4.htm .

premature ejaculation . (2015). Retrieved on January 27, 2015, from http://medical-dictionary.thefreedictionary.com/premature+ejaculation .

Rage-India. (2015). Ejaculatory Disturbances . Retrieved on January 27, 2015, from http://www.andrology.com/ejaculatorydisorders.htm .

C HAPTER 3

EPIDEMIOLOGY

Epidemiology is the branch of medicine concerned with researching factors related to the distribution of disease in human populations. Important components of epidemiological research include studying the cause, incidence, prevalence, behavior, and transmission of disease affecting groups of people. Epidemiology is most often associated with public health since it is primarily concerned with disease outbreaks in human populations, in contrast to disease manifestation in individuals. Depending on research needs, the population studied can be of any size and composition as long members of the group share specific characteristics important to the researcher. For instance, study populations can be based on geography, where populations as large as individual nations or entire continents are examined. Conversely, populations may be as small a remote village or a single work site where all individuals are exposed to identical environmental toxins, such as airborne coal dust inhaled by workers at a local coal mine. While geography is often an important consideration in epidemiological research, groups can also be studied based on numerous factors unrelated to physical location, such as age, gender, race or nationality, diet, and so on.

Since epidemiology and pathology both study disease, people often find it difficult to distinguish between the two scientific disciplines. One easy, albeit vastly oversimplified way to distinguish between the two disciplines, is that epidemiology is the study of disease in groups of people while pathology studies disease in an individual person or organism.

Morbidity and Disease

Two of the most basic and important concepts in Epidemiology are incidence and prevalence. Incidence and prevalence are both measures of morbidity. Quite simply, morbidity is the extent of illness, injury or disability in a defined population . In epidemiology, incidence and prevalence are important in that both statistics attempt to measure risk, where risk is the likelihood that an individual within a population will contract a disease . While both incidence and prevalence attempt to estimate the occurrence of a health condition during a specified period of time, many people confuse incidence and prevalence and use them interchangeably falsely assuming that one is simply a synonym for the other. However, when researching Ejaculation Disorders it is important to remember that each term has its own distinct meaning.

The term incidence refers to the number of new cases of a health condition in a given time period. In other words, incidence most closely resembles the number of new diagnoses. Conversely, prevalence means the number of persons currently suffering from a health condition. In this regard, a person diagnosed with a chronic health condition (where chronic describes an illness persisting over a long time period) will be included in incidence statistics in only one year, that being the year they were diagnosed but this same individual will be included prevalence reports each year they suffer this health condition. Taken one step further, a newly diagnosed patient will be counted in both incidence and prevalence statistics during the patient's first year of a health condition but in subsequent years will only be included in prevalence statistics. The important takeaway, therefore, is that for any given timeframe the prevalance of a health condition will always be equal or greater than the incidence of the same condition. Most of the time incidence and prevalence statistics are reported on an annual basis, though for health conditions like Influenza seasonal or monthly morbidity may be more important.

Because these two concepts have distinct meanings they are most revealing taken together and often the two numbers can vary dramatically from one another. For short-lived health conditions like Influenza incidence can be very high during years with large outbreaks as large populations may suffer from a vaccine resistant Influenza strain but the overall prevalence may be quite low in subsequent years. On the other hand, for some chronic illnesses the incidence rate may be low when compared to the prevalence rate. An example is when public health researchers introduce new preventative treatment strategies for a certain health condition. Currently, enormous resources are being used to prevent Type II Diabetes. Why? Because in recent years there has been a dramatic rise in the number of individuals diagnosed with this disease, resulting in a large number of individuals managing Diabetes in any given year. However, if preventative efforts are successful we can expect the number of new diagnoses in the first "successful" year to decline dramatically. Therefore, in that year the incidence of the disease will significantly decline but those already afflicted with the disease may still keep the prevalence statistics high.

Thus, when reviewing incidence and prevalence statistics it is worthwhile to compare the figures over more than one year. If, for example, you notice that incidence and prevalence rates are both high for nine (9) consecutive years but the incidence rate drops dramatically in the tenth year you may rightly hypothesize that a new preventative treatment was introduced in the tenth year therefore leading you to research your assumption further.

It is also important to remember that incidence and prevalence statistics do not attempt to measure the entire population. Instead these statistics generally only measure populations at risk. To illustrate, incidence and prevalence measures of Cervical Cancer only include women. Likewise, Testicular Cancer is only calculated for men. While this is important to remember, the research you will discover will clearly report the population the estimate is intended to reflect.

Mathematically, with "/" meaning "divided by" the calculations for incidence and prevalence can be expressed as follows:

Incidence Rate = Number of New Cases within a Given Time Period / Number of People at Risk of Getting the Disease

Prevalence Rate = Total Number of Cases at a Single Point in Time / Number of People at Risk of Getting the Disease

Multiply the the result by 100 or 1000 to get the number of person to get the number of cases per 100 or 1000, respectively.

Finally, remember that incidence and prevalence statistics are only estimates and a not a perfectly exact reflection of the population being measured. For example, for some health disorders the the incidence rate can be greater than the actual number of people affected by a health condition. A typical example is incidence reports for the common cold. Many individuals may get a common cold two or more times in a given year and therefore will be counted multiple times in incidence statistics even though they are only one person. Likewise, some prevalence measures estimating the occurrence of a particular cancer type, for instance, may include persons in remission where other prevalence estimates do not. Thus, when reviewing incidence and prevalence reports it is important to not only understand the limitations of each but also the methodology researchers used to report a final estimate.

Sources of Morbidity Statistics

Morbidity statistics are aggregated and collected by a number of organizations. Some organizations that collect this data include:

Hospitals and clinics
Disease and cancer registries
Communicable disease reporting surveillance public health agencies
Vital statistics
Surveys
Health and life insurance plans

Mortality and Disease

One final important indicator of the health status of populations is mortality. Mortality literally means "death" and therefore a mortality rate is the percentage of death in a population in any given time. Importantly, there are a number of mortality rates including, but not limited to, the child mortality rate, infant mortality rate, maternal mortality rate, and age-specific mortality. The crude mortality rate is simply the total number of deaths per 1,000 people, regardless of age, gender, disease, etc. Therefore, the calculation of the crude mortality rate is:

Annual Mortality Rate from All Causes = (Total Number of Deaths in One Year from All Causes / Number of Persons in Population at Mid-Year) x 1,000

Where "/" means "divided by" and "*" means "multiplied by" and the part of formula enclosed in parentheses "( )" is to be performed first.

Sources of Mortality Statistics

The Centers for Disease Control and Prevention (CDC) is the agency that oversees public health in the United States. While the National Institutes of Health is the nation's primary health care research agency, the CDC primary focus is on the health of the population as a whole, and instead of researching disease concentrates instead on the prevention and control of disease outbreaks by primarily studying disease transmission. CDC online resources provide basic information about illness and disease but focus on communicating information about the impact of health conditions on large populations. A vast amount of text and data are available on the CDC website at http://www.cdc.gov/

Most mortality statistics are derived from data from individual death certificates. Primary on death certificates is the identification of the cause of death, frequently abbreviated as COD. Death certificates in the United States generally report two CODs, an immediate COD and an underlying COD . For example, for leukemia patients a common immediate cause of death is sepsis caused by the underlying cause of death, leukemia.

In the United States, aggregated mortality data and statistics can be found by searching:

The National Death Index (NDI) from the National Center for Health Statistics http://www.cdc.gov/nchs/ndi.htm
The Morbidity and Mortality Weekly Report from the Centers for Disease Control and Prevention (CDC) http://www.cdc.gov/mmwr/
State vital records. Links to each state agency responsible for that state's vital records can be found at http://www.cdc.gov/nchs/w2w.htm
Tumor registries. Links to tumor registries can be found at http://apps.nccd.cdc.gov/dcpc_Programs

Ejaculation Disorders Journal Articles

A., C., A., M., & O.K., A. (2013). Atypical antipsychotics from scratch to the present. International Journal of Pharmaceutical Sciences and Research . Retrieved from http://www.ijpsr.com/V4I1/20 Vol. 4, Issue 1, January 2013, IJPSR, RE 2032, Paper 20.pdf\nhttp://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=reference&D=emed11&NEWS=N&AN=2013123880

Ahmed, I., & Thorpy, M. (2010). Clinical features, diagnosis and treatment of narcolepsy. Clinics in Chest Medicine , 31 (2), 371–381. http://doi.org/http://dx.doi.org/10.1016/j.ccm.2010.02.014

Breggin, P. R. (2002). Fluvoxamine as a cause of stimulation, mania, and aggression: A critical analysis of the FDA-approved label. Ethical Human Sciences and Services , 4 (3), 211–227. Retrieved from http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=emed5&AN=2003063953\nhttp://lshtmsfx.hosted.exlibrisgroup.com/lshtm?sid=OVID:embase&id=pmid:&id=doi:&issn=1523-150X&isbn=&volume=4&issue=3&spage=211&pages=211-227&date=2002&title=Ethical+Human+Sciences+and+Services&atitle=Fluvoxamine+as+a+cause+of+stimulation,+mania,+and+aggression:+A+critical+analysis+of+the+FDA-approved+label&aulast=Breggin&pid=<author>Breggin+P.R.</author><AN>2003063953</AN><DT>Journal:+Review</DT>

H., S.-N., M., W., W., W., D., R., D., G., Sadeghi-Nejad, H., … Goldmeier, D. (2010). Sexually transmitted diseases and sexual function. The Journal of Sexual Medicine . Retrieved from http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=reference&D=medl&NEWS=N&AN=20092446\nhttp://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=reference&D=emed9&NEWS=N&AN=2010042279

H.R., K. (2013). Posttraumatic stress disorder: The pharmacological treatment plan. Consultant . Retrieved from http://www.consultant360.com/articles/posttraumatic-stress-disorder-pharmacological-treatment-plan\nhttp://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=reference&D=emed11&NEWS=N&AN=2013620004

Homma, Y. G. (2011). JUA clinical guidelines for benign prostatic hyperplasia. International Journal of Urology , 18 (11), e1–e33.

I., A., & M., T. (2010). Clinical features, diagnosis and treatment of narcolepsy. Clinics in Chest Medicine . Retrieved from http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=reference&D=emed9&NEWS=N&AN=2010306332

J., L. L. L. L., D., H. H., S., B. B. B. B. B. B. B. B. B., S., T. T. T. T., B., S. S. S. S. S. S.-D. S., A., M. M. M. M. M. M. M. M. M. M. M. M. M. M. M. M., … L.B., K. (2013). Tremor and HIV infection. Journal of NeuroVirology , 18 (1), 5. Retrieved from http://www.embase.com/search/results?subaction=viewrecord&from=export&id=L70607612\nhttp://dx.doi.org/10.1038/npp.2011.292\nhttp://www.embase.com/search/results?subaction=viewrecord&from=export&id=L40260357\nhttp://dx.doi.org/10.1016/j.neuroimage.2004.07.067\nhttp://www.embase.com/search/results?subaction=viewrecord&from=export&id=L22025975\nhttp://www.embase.com/search/results?subaction=viewrecord&from=export&id=L70077113\nhttp://dx.doi.org/10.1080/13550280903016074\nhttp://www.embase.com/searc

J., N., & S., W. (2011). Alzheimer’s disease: Diagnosis and treatment across the spectrum of disease severity. Mount Sinai Journal of Medicine . Retrieved from http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=reference&D=emed10&NEWS=N&AN=2011383827

K.P., G.-J., & P.L., M. (2010). Escitalopram: A review of its use in the management of major depressive disorder in adults. CNS Drugs . Retrieved from http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=reference&D=emed9&NEWS=N&AN=2010475835

Kamijima, K., Murasaki, M., Asai, M., Higuchi, T., Nakajima, T., Taga, C., & Matsunaga, H. (2004). Paroxetine in the treatment of obsessive-compulsive disorder: Randomized, double-blind, placebo-controlled study in Japanese patients. Psychiatry and Clinical Neurosciences . Retrieved from http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=emed6&AN=2004359161

Khouzam, H. R. (2013). Posttraumatic stress disorder: The pharmacological treatment plan. Consultant , 53 (9), 643–646. Retrieved from http://www.embase.com/search/results?subaction=viewrecord&from=export&id=L369941559\nhttp://www.consultant360.com/articles/posttraumatic-stress-disorder-pharmacological-treatment-plan\nhttp://elvis.ubvu.vu.nl:9003/vulink?sid=EMBASE&issn=00107069&id=doi:&atitle=Posttraumatic+stress+disorder:+The+pharmacological+treatment+plan&stitle=Consultant&title=Consultant&volume=53&issue=9&spage=643&epage=646&aulast=Khouzam&aufirst=Hani+Raoul&auinit=H.R.&aufull=Khouzam+H.R.&coden=CNSLA&isbn=&pages=643-646&date

Kuritzky, L. (2005). Noninvasive management of lower urinary tract symptoms and sexual dysfunction associated with benign prostatic hyperplasia in the primary care setting. Comprehensive Therapy , 31 (3), 194–208.

M., T. (2007). Therapeutic advances in narcolepsy. Sleep Medicine . Retrieved from http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=reference&D=emed8&NEWS=N&AN=2007225226

Malik, P., Kemmler, G., Hummer, M., Riecher-Roessler, A., Kahn, R. S., & Fleischhacker, W. W. (2011). Sexual dysfunction in first-episode schizophrenia patients: Results from european first episode schizophrenia trial. Journal of Clinical Psychopharmacology . http://doi.org/10.1097/JCP.0b013e3182199bcc

Paolone, D. R. (2010). Benign prostatic hyperplasia. Clinics in Geriatric Medicine , 26 (2), 223–239. Retrieved from http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=emed9&AN=2010317416\nhttp://202.115.54.14:3210/scu?sid=OVID:embase&id=pmid:&id=doi:10.1016/j.cger.2010.02.010&issn=07490690&isbn=&volume=26&issue=2&spage=223&pages=223-239&date=2010&title=Clinics+in+Geriatric+Medicine&atitle=Benign+prostatic+hyperplasia&aulast=Paolone&pid=<author>Paolone+D.R.</author><AN>2010317416</AN><DT>Journal:+Review</DT><83. >

Perelman, M. A. (2006). A new combination treatment for premature ejaculation: A sex therapist’s perspective. Journal of Sexual Medicine , 3 (6), 1004–1012. http://doi.org/http://dx.doi.org/10.1111/j.1743-6109.2006.00238.x

R., B., P., R., R., W., A.L., M., & L., I. (2010). Sexual function in chronic illness. Journal of Sexual Medicine . Retrieved from http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=reference&D=emed9&NEWS=N&AN=2010042278

Roehrborn, C. G. (2011). Male lower urinary tract symptoms (LUTS) and benign prostatic hyperplasia (BPH). Medical Clinics of North America , 95 (1), 87–100. Retrieved from http://www.embase.com/search/results?subaction=viewrecord&from=export&id=L360029796\nhttp://dx.doi.org/10.1016/j.mcna.2010.08.013

S.S., G., N.F., G.-C., C.-S., L., J., R., & T.F., L. (2003). Peyronie’s disease: A review. Journal of Urology . Retrieved from http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=reference&D=emed6&NEWS=N&AN=2003116852

Sadeghi-Nejad, H., Wasserman, M., Weidner, W., Richardson, D., & Goldmeier, D. (2010). Sexually transmitted diseases and sexual function. Journal of Sexual Medicine , 7 (1 PART 2), 389–413. http://doi.org/http://dx.doi.org/10.1111/j.1743-6109.2009.01622.x

Sadeghi-Nejad, H., & Watson, R. (2008). Premature ejaculation: Current medical treatment and new directions (CME). Journal of Sexual Medicine , 5 (5), 1037–1050. http://doi.org/http://dx.doi.org/10.1111/j.1743-6109.2008.00831.x

Santosh, P., Sattar, S., & Canagaratnam, M. (2011). Efficacy and tolerability of pharmacotherapies for attention-deficit hyperactivity disorder in adults. CNS Drugs , 25 (9), 737–763. Retrieved from http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=emed10&AN=2011477885\nhttp://sfx.med.nyu.edu/sfxlcl3?sid=OVID:embase&id=pmid:&id=doi:10.2165%2F11593070-000000000-00000&issn=1172-7047&isbn=&volume=25&issue=9&spage=737&pages=737-763&date=2011&title=CNS+Drugs&atitle=Efficacy+and+tolerability+of+pharmacotherapies+for+attention-deficit+hyperactivity+disorder+in+adults&aulast=Santosh&pid=%3Cauthor%3ESantosh+P.J.%3BSattar+S.%3BCanagaratnam+M.%3C%2Fauthor%3E&%3CAN%3E2011477885%3C%2FA

Seftel, A. D., Mohammed, M. A., & Althof, S. E. (2004). Erectile dysfunction: Etiology, evaluation, and treatment options. Medical Clinics of North America , 88 (2), 387–416. http://doi.org/http://dx.doi.org/10.1016/S0025-7125%2803%2900187-1

Srulevich, M., & Chopra, A. (2007). Urinary incontinence in older men. Clinical Geriatrics , 15 , 38–45. Retrieved from http://www.embase.com/search/results?subaction=viewrecord&from=export&id=L47571952

U.B., C., & J.S., T. (2010). Finasteride. Expert Opinion on Drug Metabolism and Toxicology . Retrieved from http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=reference&D=emed9&NEWS=N&AN=2010355388

Yoon, J. S., Kim, J. C., Lee, S.-K. Y., Jankovic, J., Adler, C. H., Charles, P. D., … R.P., P. (2011). Transcranial magnetic brain stimulation modulates blepharospasm: A randomized controlled study - Commentary. Movement Disorders . Retrieved from http://docstore.ingenta.com/cgi-bin/ds_deliver/1/u/d/ISIS/26046965.1/adis/dsf/2006/00000029/00000001/art00003/C5CC0F411772A85F113944773784573EAF00689D6E.pdf?link=http://www.ingentaconnect.com/error/delivery&format=pdf\nhttp://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=reference&D=emed7&NEWS=N&AN=2006074306\nhttp://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=reference&D=emed7&NEWS=N&AN=2006070013\nhttp://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=reference&D=emed7&NEWS=N&AN=2006057993\nhttp://ovidsp.ovid.com/ovi

Ejaculation Disorders Internet Articles and Research

An Overview of Sexual Dysfunction . (2015). Retrieved on January 27, 2015, from http://my.clevelandclinic.org/health/diseases_conditions/hic_An_Overview_of_Sexual_Dysfunction .

Depression and sexual dysfunction . (2015). Retrieved on January 27, 2015, from http://bmb.oxfordjournals.org/content/57/1/81.full .

Ejaculatory Disorders (Male) . (2015). Retrieved on January 27, 2015, from http://www.sexualityandu.ca/health-care-professionals/sexual-dysfunction/ejaculatory-disorders-men .

Men's Sex Problems Go Beyond Erectile Dysfunction | Ejaculation .... (2015). Retrieved on January 27, 2015, from http://www.livescience.com/15750-erectile-dysfunction-sexual-problems.html .

ORIGINAL RESEARCH—EJACULATORY DISORDERS: Thyroid .... (2015). Retrieved on January 27, 2015, from http://onlinelibrary.wiley.com/doi/10.1111/j.1743-6109.2005.00142.x/abstract .

Premature Ejaculation Treatment | Psych Central . (2015). Retrieved on January 27, 2015, from http://psychcentral.com/disorders/premature-ejaculation-treatment/ .

Premature Ejaculation | Doctor | Patient.co.uk . (2015). Retrieved on January 27, 2015, from http://www.patient.co.uk/doctor/premature-ejaculation-pro .

Premature Ejaculation: American Urological Association . (2015). Retrieved on January 27, 2015, from https://www.auanet.org/education/guidelines/premature-ejaculation.cfm .

Premature Ejaculation . (2015). Retrieved on January 27, 2015, from http://emedicine.medscape.com/article/435884-overview .

Premature ejaculation: A review :Gajjala SR, Khalidi A, Indian J Sex .... (2015). Retrieved on January 27, 2015, from http://www.ijstd.org/article.asp?issn=0253-7184;year=2014;volume=35;issue=2;spage=92;epage=95;aulast=Gajjala .

Premature ejaculation . (2015). Retrieved on January 27, 2015, from http://en.wikipedia.org/wiki/Premature_ejaculation .

Prevalence of Sexual Dysfunctions: Results from a Decade of .... (2015). Retrieved on January 27, 2015, from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2426773/ .

Propecia – Side Effects of Hair Loss Drug Include Erectile Dysfunction . (2015). Retrieved on January 27, 2015, from http://www.drugwatch.com/propecia/side-effects/ .

Rage-India. (2015). Ejaculatory Disturbances . Retrieved on January 27, 2015, from http://www.andrology.com/ejaculatorydisorders.htm .

C HAPTER 4

RISK FACTORS

&

CAUSES

During the course of researching health conditions many people use the the concepts of risk factors and causes interchangeably. However, it is important to remember in medicine these concepts have unique meanings. This Chapter will define these commonly confused concepts and explain the risk factors and causes of Ejaculation Disorders.

Risk Factors for Disease

A risk factor is any aspect or circumstance in a person's life that predisposes or makes it more likely that the person will acquire a particular health condition. Essentially, risk factors are anything that increases the chance of developing a disease. Some examples of risk factors for many diseases include age, a family history of certain conditions, use of tobacco products, being exposed to radiation or certain chemicals, infection with certain viruses or bacteria, and certain genetic makeups.

If you discover you have a risk factor for a certain condition it doesn't necessarily mean that you will get that disease. It only means your chances of the getting the disease are higher when compared to other individuals similar to yourself who are not exposed to the stated risk factor(s). In this regard, it is important to note that risk factors and causes are essentially measures of correlation or causation . The distinction between correlation and causation is very important in medical research.

Correlation means two factors are related and also expresses in statistical terms how closely the two factors are related. For example, there exists a correlation between age and food allergies, as children are about twice as likely as adults of having food allergies. However, this doesn't mean that being a child causes food allergies.

Causes of Disease

This leads us to the definition of causation and the dual nature of cause and effect. In medicine causation essentially implies change in the normal constitution or functioning of the body as the result of the introduction of a second factor (the cause). To return to the the previous example, food allergies are most commonly due to an allergen-antibody interaction, therefore the cause can be said to be the allergen-antibody interaction and the effect (or manifestation of the cause) is the food allergy (and not being a child). Researchers have discovered the reason that children are more likely to have food allergies is because their immune systems are not as well-developed as adults and their bodies are more likely to mistakenly identify certain foods as "harmful" and trigger the allergen-antibody reaction.

Similarly, when studying risk factors, another important terminology distinction is between effect and association . Both effect and association are quantitative measures of the increased or decreased prevalence, rate, or risk for disease in an exposed population but epidemiologists use the term effect when the risk factor can be changed and association when it cannot be changed. For example, one effect of obesity may be uterine cancer but this risk factor can be reduced or eliminated by losing weight. On the other hand, uterine cancer is only associated with women, but even though a hysterectomy will remove the uterus the patient will still remain a woman.

Most research you come across will clearly distinguish between correlation/causation and effect/association. Further, as you will soon discover, nearly all advances in research into illness and disease first establish correlation or association but only later establish causation or effect. For example, through observation researchers were able to quickly ascertain that smokers were more likely to develop lung cancer, meaning that there exists a correlation between smoking and lung cancer and was higher than between non-smoking and lung cancer. However, further research was needed to determine that smoking, and not some other attribute common among smokers, was a cause of lung cancer.

An extreme, and intuitively far-fetched but common example to illustrate our point is the story of Inept Researcher A. Among office workers, Inept Researcher A notices that workers who take many rest breaks have more sick days due to respiratory illness than workers who take fewer breaks. Inept Researcher A quickly concludes that "work breaks cause respiratory disease" and in his haste forgoes peer-reviewed journals and publishes his "landmark discovery" on his own, including a recommendation that government move quickly to establish laws prohibiting all work rest breaks. Soon, however, All-Star Researcher B reads the article and does her own analysis of the data. In no time at all, All-Star Researcher B is able to debunk Inept Researcher A's conclusions by correctly determining that work breaks do not cause respiratory illness. She further hypothesizes (and is later proven correct) it is not the break itself causing respiratory illness; but what people do on these work breaks, namely smoking cigarettes that is the real cause of respiratory illness in persons taking frequent work breaks.

While Inept Researcher A's "discovery" may seem intuitively false, it is not always this easy to correctly identify incorrect or illogical conclusions of cause and effect. Therefore, during the course of your research take special note to distinguish statements of correlation with assertions of cause and effect or be prepared to suffer consequences of falsely jumping to erroneous conclusions.

Ejaculation Disorders Journal Articles

Auffenberg, G. B., Helfand, B. T., & McVary, K. T. (2009). Established Medical Therapy for Benign Prostatic Hyperplasia. Urologic Clinics of North America , 36 (4), 443–459. Retrieved from http://www.embase.com/search/results?subaction=viewrecord&from=export&id=L355664309\nhttp://dx.doi.org/10.1016/j.ucl.2009.07.004

Beh, S. C., Greenberg, B. M., Frohman, T., & Frohman, E. M. (2013). Transverse Myelitis. Neurologic Clinics , 31 (1), 79–138. http://doi.org/http://dx.doi.org/10.1016/j.ncl.2012.09.008

Djavan, B., Eckersberger, E., Finkelstein, J., Espinosa, G., Sadri, H., Brandner, R., … Lepor, H. (2010). Benign Prostatic Hyperplasia: Current Clinical Practice. Primary Care - Clinics in Office Practice , 37 (3), 583–597. Retrieved from http://www.embase.com/search/results?subaction=viewrecord&from=export&id=L359338357\nhttp://dx.doi.org/10.1016/j.pop.2010.04.004\nhttp://sfx.libis.be/sfxlcl3?sid=EMBASE&issn=00954543&id=doi:10.1016/j.pop.2010.04.004&atitle=Benign+Prostatic+Hyperplasia:+Current+Clinical+Practice&stitle=Prim.+Care+Clin.+Off.+Pract.&title=Primary+Care+-+Clinics+in+Office+Practice&volume=37&issue=3&spage=583&epage=597&aulast=Djavan&aufirst=Bob&auinit=B.&aufull=Djavan+B.&coden=PRCAD&isbn=&pages=583-597&date=2010&auinit

Fletcher, S. G., Castro-Borrero, W., Remington, G., Treadaway, K., Lemack, G. E., & Frohman, E. M. (2009). Sexual dysfunction in patients with multiple sclerosis: A multidisciplinary approach to evaluation and management. Nature Clinical Practice Urology , 6 (2), 96–107. Retrieved from http://www.embase.com/search/results?subaction=viewrecord&from=export&id=L354175525\nhttp://dx.doi.org/10.1038/ncpuro1298\nhttp://dd8gh5yx7k.search.serialssolutions.com?sid=EMBASE&issn=17434270&id=doi:10.1038/ncpuro1298&atitle=Sexual+dysfunction+in+patients+with+multiple+sclerosis:+A+multidisciplinary+approach+to+evaluation+and+management&stitle=Nat.+Clin.+Pract.+Urol.&title=Nature+Clinical+Practice+Urology&volume=6&issue=2&spage=96&epage=107&aulast=Fletcher&aufirst=Sophie+G.&auinit=S.G.&aufull=Fl

Gareri, P., De Fazio, P., De Fazio, S., Marigliano, N., Ibbadu, G. F., & De Sarro, G. (2006). Adverse effects of atypical antipsychotics in the elderly: A review. Drugs and Aging , 23 (12), 937–956. Retrieved from http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=emed7&AN=2006618850\nhttp://202.115.54.14:3210/scu?sid=OVID:embase&id=pmid:&id=doi:10.2165/00002512-200623120-00002&issn=1170229X&isbn=&volume=23&issue=12&spage=937&pages=937-956&date=2006&title=Drugs+and+Aging&atitle=Adverse+effects+of+atypical+antipsychotics+in+the+elderly:+A+review&aulast=Gareri&pid=<author>Gareri+P.;De+Fazio+P.;De+Fazio+S.;Marigliano+N.;Ibbadu+G.F.;De+Sarro+G.</author><AN>2006618850</AN><DT>Journal:+Review</

Grasso, M., Fortuna, F., Lania, C., & Blanco, S. (2006a). “Ejaculatory disorders and alpha1-adrenoceptor antagonists therapy: clinical and experimental researches”. Journal of Translational Medicine , 4 , 31. http://doi.org/10.1186/1479-5876-4-31

Grasso, M., Fortuna, F., Lania, C., & Blanco, S. (2006b). “Ejaculatory disorders and α1-adrenoceptor antagonists therapy: clinical and experimental researches.” Journal of Translational Medicine , 4 , 31. http://doi.org/10.1186/1479-5876-4-31

H., S.-N., M., W., W., W., D., R., & D., G. (2010). Sexually transmitted diseases and sexual function. Journal of Sexual Medicine , 7 (1 PART 2), 389–413. Retrieved from http://www.embase.com/search/results?subaction=viewrecord&from=export&id=L358114672\nhttp://dx.doi.org/10.1111/j.1743-6109.2009.01622.x

Hashim, H., & Abrams, P. (2010). Emerging drugs for the treatment of benign prostatic obstruction. Expert Opinion on Emerging Drugs.15 (2) ()(pp 159-174), 2010.Date of Publication: June 2010. , (United Kingdom RF - 96 CN - NCT00284518/ClinicalTrials.gov NCT00381108/ClinicalTrials.gov NCT00408954/ClinicalTrials.gov NCT00457457/ClinicalTrials.gov NCT00527488/ClinicalTrials.gov NCT00651807/ClinicalTrials.gov NCT00657839/ClinicalTrials.gov NCT0074318), 159–174.

K., P. (2012). Schizophrenia: Managing symptoms with antipsychotics. U.S. Pharmacist . Retrieved from http://www.uspharmacist.com/content/d/web exclusive/i/2181/c/37743/\nhttp://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=reference&D=emed10&NEWS=N&AN=2012693886

Lange, M. M., & Van De Velde, C. J. H. (2011). Urinary and sexual dysfunction after rectal cancer treatment. Nature Reviews Urology , 8 (1), 51–57. http://doi.org/10.1038/nrurol.2010.206\r10.1002/14651858.CD005200.pub2; Buunen, M., COLOR II. A randomized clinical trial comparing laparoscopic and open surgery for rectal cancer (2009) Dan. Med. Bull., 56, pp. 89-91; Guillou, P.J., Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): Multicentre, randomised controlled trial (2005) Lancet, 365, pp. 1718-1726; Breukink, S.O., Prospective evaluation of quality of life and sexual functio

M.R., S. (2009). Midodrine for the treatment of organic anejaculation but not spinal cord injury: A prospective randomized placebo-controlled double-blind clinical study. International Journal of Impotence Research . Retrieved from http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=reference&D=emed9&NEWS=N&AN=2009407459

McNaughton-Collins, M., & Barry, M. J. (2005). Managing patients with lower urinary tract symptoms suggestive of benign prostatic hyperplasia. American Journal of Medicine , 118 (12), 1331–1339. Retrieved from http://www.embase.com/search/results?subaction=viewrecord&from=export&id=L41832322\nhttp://dx.doi.org/10.1016/j.amjmed.2004.12.033\nhttp://sfx.unimi.it:9003/unimi?sid=EMBASE &issn=00029343&id=doi:10.1016/j.amjmed.2004.12.033&atitle=Managing+patients+with+lower+urinary+tract+symptoms+suggestive+of+benign+prostatic+hyperplasia&stitle=Am.+J.+Med.&title=American+Journal+of+Medicine&volume=118&issue=12&spage=1331&epage=1339&aulast=McNaughton-Collins&aufirst=Mary&auinit=M.&aufull=McNaughton-Collins+M.&c

P., D., M., S., V.R., C., V., U. R., & B., V. R. (2014). Traction alopecia: A review. Journal of Global Trends in Pharmaceutical Sciences . Retrieved from http://www.jgtps.com/admin/uploads/L84E7J.pdf\nhttp://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=reference&D=emed11&NEWS=N&AN=2014139336

Patel, A. K., & Chapple, C. R. (2008). Medical management of lower urinary tract symptoms in men: Current treatment and future approaches. Nature Clinical Practice Urology , 5 (4), 211–219. Retrieved from http://www.embase.com/search/results?subaction=viewrecord&from=export&id=L351517129\nhttp://dx.doi.org/10.1038/ncpuro1060

Rittenberg, V., & El-Toukhy, T. (2010). Medical treatment of male infertility. Human Fertility , 13 (4), 208–216. Retrieved from http://www.embase.com/search/results?subaction=viewrecord&from=export&id=L360123159\nhttp://dx.doi.org/10.3109/14647273.2010.534833

Robinson, R. G., Jorge, R. E., Moser, D. J., Acion, L., Solodkin, A., Small, S. L., … Arndt, S. (2008). Escitalopram and problem-solving therapy for prevention of poststroke depression: A randomized controlled trial. JAMA - Journal of the American Medical Association , 299 (20), 2391–2400. Retrieved from http://www.embase.com/search/results?subaction=viewrecord&from=export&id=L351749237\nhttp://jama.ama-assn.org/cgi/reprint/299/20/2391\nhttp://dx.doi.org/10.1001/jama.299.20.2391\nhttp://dd8gh5yx7k.search.serialssolutions.com?sid=EMBASE&issn=00987484&id=doi:10.1001/jama.299.20.2391&atitle=Escitalopram+and+problem-solving+therapy+for+prevention+of+poststroke+depression:+A+randomized+controlled+trial&stitle=J.+Am.+Med.+Assoc.&title=JAMA+-+Journal+of+the+American+Medical+Association&volume=299&issue=20

Stephenson, A. J., & Sheinfeld, J. (2005). Management of patients with low-stage nonseminomatous germ cell testicular cancer. Current Treatment Options in Oncology , 6 (5), 367–377. Retrieved from http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=emed7&AN=2005534195\nhttp://sfx.ucl.ac.uk/sfx_local?sid=OVID:embase&id=pmid:&id=doi:&issn=1527-2729&isbn=<p05/>&volume=6&issue=5&spage=<p08/>&pages=<p09/>&date=2005&title=Current+Treatment+Options+in+Oncology<p12/>&atitle=Management+of+patients+with+low-stage+nonseminomatous+germ+cell+testicular+cancer&aulast=<p14/>&pid=<author>Stephenson+A.J.</author><AN><p16/></AN><DT><p17/></DT>

T.M.T., N., & G.D., E. (2012). Systematic review: The treatment of noncardiac chest pain with antidepressants. Alimentary Pharmacology and Therapeutics . http://doi.org/http://dx.doi.org/10.1111/j.1365-2036.2011.04978.x

Tarter, T. H., & Vaughan Jr., E. D. (2006). Inhibitors of 5(alpha)-reductase in the treatment of benign prostatic hyperplasia. Current Pharmaceutical Design , 12 (7), 775–783. Retrieved from http://www.embase.com/search/results?subaction=viewrecord&from=export&id=L43596810\nhttp://www.ingentaconnect.com/content/ben/cpd/2006/00000012/00000007/art00002\nhttp://dx.doi.org/10.2174/138161206776056010

Tatemichi, S., Kobayashi, K., Yokoi, R., Kobayashi, K., Maruyama, K., Hoyano, Y., … Kusama, H. (2012). Comparison of the effects of four α 1-adrenoceptor antagonists on ejaculatory function in rats. Urology , 80 (2). http://doi.org/10.1016/j.urology.2012.01.039

Terrone, C., Castelli, E., Aveta, P., Cugudda, A., & Rocca Rossetti, S. (2001). Iatrogenic ejaculation disorders and their prevention. Minerva Urologica E Nefrologica .

Westenberg, H. G. M., Stein, D. J., Yang, H., Li, D., & Barbato, L. M. (2004). A Double-Blind Placebo-Controlled Study of Controlled Release Fluvoxamine for the Treatment of Generalized Social Anxiety Disorder. Journal of Clinical Psychopharmacology , 24 (1), 49–55. Retrieved from http://www.embase.com/search/results?subaction=viewrecord&from=export&id=L38134166\nhttp://dx.doi.org/10.1097/01.jcp.0000104906.75206.8b\nhttp://dd8gh5yx7k.search.serialssolutions.com?sid=EMBASE&issn=02710749&id=doi:10.1097/01.jcp.0000104906.75206.8b&atitle=A+Double-Blind+Placebo-Controlled+Study+of+Controlled+Release+Fluvoxamine+for+the+Treatment+of+Generalized+Social+Anxiety+Disorder&stitle=J.+Clin.+Psychopharmacol.&title=Journal+of+Clinical+Psychopharmacology&volume=24&issue=1&spage=49&epage=55

Ejaculation Disorders Internet Articles and Research

Benign prostatic hyperplasia | University of Maryland Medical Center . (2015). Retrieved on January 27, 2015, from http://umm.edu/health/medical/reports/articles/benign-prostatic-hyperplasia .

Current Concepts in Ejaculatory Dysfunction . (2015). Retrieved on January 27, 2015, from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1765044/ .

Delayed Ejaculation Treatment, Causes . (2015). Retrieved on January 27, 2015, from http://www.andropausespecialist.com/delayed_ejaculation.php .

Erectile Dysfunction | Doctor | Patient.co.uk . (2015). Retrieved on January 27, 2015, from http://www.patient.co.uk/doctor/erectile-dysfunction .

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Infertility Causes . (2015). Retrieved on January 27, 2015, from http://www.nytimes.com/health/guides/disease/infertility-in-men/causes.html .

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Male Fertility Issues . (2015). Retrieved on January 27, 2015, from http://www.healthline.com/health/fertility/male-infertility .

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Premature Ejaculation Causes & Risk Factors . (2015). Retrieved on January 27, 2015, from http://www.mensexmd.com/premature-ejaculation/premature-ejaculation-causes-risk-factors/ .

Premature Ejaculation . (2015). Retrieved on January 27, 2015, from http://medicine.med.nyu.edu/conditions-we-treat/conditions/premature-ejaculation .

Premature Ejaculation . (2015). Retrieved on January 27, 2015, from http://my.clevelandclinic.org/services/urology-kidney/diseases-conditions/premature-ejaculation .

Retrograde Ejaculation . (2015). Retrieved on January 27, 2015, from http://www.webmd.com/sexual-conditions/retrograde-ejaculation .

What is erectile dysfunction? What causes erection problems .... (2015). Retrieved on January 27, 2015, from http://www.medicalnewstoday.com/articles/5702.php .

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C HAPTER 5

SYMPTOMS

&

SIGNS

Distinguishing Symtoms from Signs

According to the National Institutes of Health, a symptom is a "physical or mental problem that a person experiences that may indicate a disease or condition." While a sign can mean the same thing noteworthy to the definition of symptom is that symptoms are typically not seen (observed) by other people and generally can not be independently identified (for diagnosis) by doctors using medical tests. Signs, on the other hand, can be both observed and used to independently diagnosis a condition without patient input. Therefore, while the presence or absence of a symptom can not conclusively be used to determine the presence or absence of disease, a sign can be, or cynically speaking, a patient can claim nonexistent symptoms that can not be refuted by doctors but signs can be identified and measured independent of patient input. Common symptoms for many health conditions include fatigue, pain, nausea, and headache. On the other hand, signs of disease often include skin rashes, sweating, uncontrollable bleeding, and difficulties with speech. Notwithstanding "provability," both the accurate portrayl of symptoms and observable signs are critical in disease diagnosis, treatment, and management.

Types of Symptoms

Symptoms of disease can be characterized in a number of ways. First, they can be described by their presence or absence. In this regard, symptoms may be persistent or long-lasting (chronic) , ebb and flow at regular or irregular intervals (relapsing) , or disappear completely even though the underlying disease may still be present (remitting) . Further, some diseases may be asymptomatic meaning the underlying disease condition presents no symptoms whatsoever. Frequently, conditions like diabetes and high blood pressure are asymptomatic in that they can be present with no symptoms.

Symptoms can also be classified by the way they impact the "total person." In describing mental disorders in particular, symptoms can be described as positive or negative . Many people mistakenly imply positive and negative symptoms to mean good and bad symptoms. Instead, positive and negative symptoms should be considered in a more mathematical plus or minus sense. Thus, positive symptoms are feelings (stimulus) in addition to or added to a person’s normal spectrum of feelings/stimulus and negative symptoms are feelings/stimulus taken away from the normal spectrum. Therefore, for a mental health disorder like schizophrenia a positive symptom may include hallucinations where a person sees things in addition to things actually present. Conversely, a negative symptom may include a "flat affect" where facial expressions and typical speaking rhythms and changes in tone found in a normal person are absent in a person with Ejaculation Disorders. Other negative symptoms commonly found in patients with mental health illnesses include taking less pleasure in life, speaking less , or engaging in fewer activities all when compared to persons without mental illness.

Ejaculation Disorders Journal Articles

Ahmed, I., & Thorpy, M. (2010). Clinical features, diagnosis and treatment of narcolepsy. Clinics in Chest Medicine , 31 (2), 371–381. http://doi.org/http://dx.doi.org/10.1016/j.ccm.2010.02.014

Anderson, R. U., Wise, D., Sawyer, T., & Chan, C. A. (2006). Sexual Dysfunction in Men With Chronic Prostatitis/Chronic Pelvic Pain Syndrome: Improvement After Trigger Point Release and Paradoxical Relaxation Training. Journal of Urology , 176 (4), 1534–1539. Retrieved from http://www.embase.com/search/results?subaction=viewrecord&from=export&id=L44307197\nhttp://dx.doi.org/10.1016/j.juro.2006.06.010

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Bellantuono C., Migliarese G., & Imperadore G. (2006). Pharmacological treatment of depression during pregnancy. Recenti Progressi in Medicina , 97 (2), 94–107. Retrieved from http://www.embase.com/search/results?subaction=viewrecord&from=export&id=L43401451

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Burke, W. J. (2002). Escitalopram. Expert Opinion on Investigational Drugs , 11 (10), 1477–1486. http://doi.org/10.1517/13543784.11.10.1477

Burke, W. J. (2002c). Escitalopram. [Review] [45 refs]. Expert Opinion on Investigational Drugs , 11 (10), 1477–1486.

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Elhilali, M. M. (2006). Alfuzosin: An (alpha)1-receptor blocker for the treatment of lower urinary tract symptoms associated with benign prostatic hyperplasia. Expert Opinion on Pharmacotherapy , 7 (5), 583–596. Retrieved from http://www.embase.com/search/results?subaction=viewrecord&from=export&id=L43567101\nhttp://dx.doi.org/10.1517/14656566.7.5.583

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Heidbreder, A., Muller, T., & Young, P. (2008). Clinical features of narcolepsy. Klinische Neurophysiologie , 39 (4), 249–255. http://doi.org/10.1055/s-0028-1112120

Homma, Y., Gotoh, M., Yokoyama, O., Masumori, N., Kawauchi, A., Yamanishi, T., … Ozono, S. (2011). JUA clinical guidelines for benign prostatic hyperplasia. International Journal of Urology , 18 (11), e1–e33. Retrieved from http://www.embase.com/search/results?subaction=viewrecord&from=export&id=L362863082\nhttp://dx.doi.org/10.1111/j.1442-2042.2011.02861.x\nhttp://findit.library.jhu.edu/resolve?sid=EMBASE&issn=09198172&id=doi:10.1111/j.1442-2042.2011.02861.x&atitle=JUA+clinical+guidelines+for+benign+prostatic+hyperplasia&stitle=Int.+J.+Urol.&title=International+Journal+of+Urology&volume=18&issue=11&spage=&epage=&aulast=Homma&aufirst=Yukio&auinit=Y.&aufull=Homma+Y.&coden=IJURF&isbn=&pages=-&date=2011&auinit1=Y&auinit

Kang, S. H., Kim, J. W., Bae, J. H., Park, H. S., Moon, D. G., Yoon, D. K., … Kim, J. J. (2006). Targeted-cryosurgical ablation of the prostate with androgen deprivation therapy: Quality of life in high-risk prostate cancer patients. Asian J Androl , 8 (5), 629–636. Retrieved from http://www.embase.com/search/results?subaction=viewrecord&from=export&id=L44263438\nhttp://dx.doi.org/10.1111/j.1745-7262.2006.00176.x\nhttp://sfx.libis.be/sfxlcl3?sid=EMBASE&issn=1008682X&id=doi:10.1111%2Fj.1745-7262.2006.00176.x&atitle=Targeted-cryosurgical+ablation+of+the+prostate+with+androgen+deprivation+therapy%3A+Quality+of+life+in+high-risk+prostate+cancer+patients&stitle=Asian+J.+Androl.&title=Asian+Journal+of+Andrology&volume=8&issue=5&spage=629&epage=636&aulast=Kang&aufirst=Seok-Ho&auin

M.T., F., J., R., A., R., G., D., & G., R. (2006). Efficacy and safety of tamsulosin for benign prostatic hyperplasia: Clinical experience in the primary care setting. Current Medical Research and Opinion , 22 (4), 721–730. Retrieved from http://www.embase.com/search/results?subaction=viewrecord&from=export&id=L43653210\nhttp://dx.doi.org/10.1185/030079906X96443

Maccagnano, C., Salonia, A., Briganti, A., Teillac, P., Schulman, C., Montorsi, F., & Rigatti, P. (2006). A critical analysis of Permixon(trademark) in the treatment of lower urinary tract symptoms due to benign prostatic enlargement. European Urology, Supplements , 5 (4 SPEC. ISS.), 430–440. Retrieved from http://www.embase.com/search/results?subaction=viewrecord&from=export&id=L43340417\nhttp://dx.doi.org/10.1016/j.eursup.2006.02.006\nhttp://elvis.ubvu.vu.nl:9003/vulink?sid=EMBASE&issn=15699056&id=doi:10.1016/j.eursup.2006.02.006&atitle=A+critical+analysis+of+Permixon^TM +in+the+treatment+of+lower+urinary+tract+symptoms+due+to+benign+prostatic+enlargement&stitle=Eur.+Urol.+Suppl.&title=European+Urology,+Supplements&volume=5&issue=4+SPEC.+ISS.&spage=430&epage=440&aulast=Maccagnano&aufirst=Carmen&auinit

Owen, R. T. (2008). Controlled-release fluvoxamine in obsessive-compulsive disorder and social phobia. Drugs of Today , 44 (12), 887–893. Retrieved from http://www.embase.com/search/results?subaction=viewrecord&from=export&id=L354291135\nhttp://dx.doi.org/10.1358/dot.2008.44.12.1299291\nhttp://dd8gh5yx7k.search.serialssolutions.com?sid=EMBASE&issn=16994019&id=doi:10.1358/dot.2008.44.12.1299291&atitle=Controlled-release+fluvoxamine+in+obsessive-compulsive+disorder+and+social+phobia&stitle=Drugs+Today&title=Drugs+of+Today&volume=44&issue=12&spage=887&epage=893&aulast=Owen&aufirst=Richard+T.&auinit=R.T.&aufull=Owen+R.T.&coden=MDACA&isbn=&pages=887-89

P., M., G., K., M., H., A., R.-R., R.S., K., & W.W., F. (2011). Sexual dysfunction in first-episode schizophrenia patients: Results from european first episode schizophrenia trial. Journal of Clinical Psychopharmacology . Retrieved from http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=reference&D=emed10&NEWS=N&AN=2011244037

Parissis, J., Fountoulaki, K., Paraskevaidis, I., & Kremastinos, D. T. (2007). Sertraline for the treatment of depression in coronary artery disease and heart failure. Expert Opinion on Pharmacotherapy , 8 (10), 1529–1537. Retrieved from http://www.embase.com/search/results?subaction=viewrecord&from=export&id=L47082701\nhttp://dx.doi.org/10.1517/14656566.8.10.1529\nhttp://sfx.galib.uga.edu/sfx_emu1?sid=EMBASE&issn=14656566&id=doi:10.1517/14656566.8.10.1529&atitle=Sertraline+for+the+treatment+of+depression+in+coronary+artery+disease+and+heart+failure&stitle=Expert+Opin.+Pharmacother.&title=Expert+Opinion+on+Pharmacotherapy&volume=8&issue=10&spage=1529&epage=1537&aulast=Parissis&aufirst=John&auinit=J.&aufull=Parissis+J.&coden=EOPHF&

Praharaj, S. K., Arora, M., & Sarkhel, S. (2010). Sensory disturbances associated with serotonin reuptake inhibitors: Brief review. Human Psychopharmacology , 25 (3), 216–221. Retrieved from http://www.embase.com/search/results?subaction=viewrecord&from=export&id=L358627243\nhttp://www3.interscience.wiley.com/cgi-bin/fulltext/123337300/PDFSTART\nhttp://dx.doi.org/10.1002/hup.1109\nhttp://dd8gh5yx7k.search.serialssolutions.com?sid=EMBASE&issn=08856222&id=doi:10.1002/hup.1109&atitle=Sensory+disturbances+associated+with+serotonin+reuptake+inhibitors:+Brief+review&stitle=Hum.+Psychopharmacol.&title=Human+Psychopharmacology&volume=25&issue=3&spage=216&epage=221&aulast=Praharaj&aufirst=Samir

Tiihonen, J., Hallikainen, T., Ryynanen, O.-P., Repo-Tiihonen, E., Kotilainen, I., Eronen, M., … A., P. (2003). Lamotrigine in treatment-resistant schizophrenia: A randomized placebo-controlled crossover trial. Biological Psychiatry , 54 (11), 1241–1248. Retrieved from http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=reference&D=emed6&NEWS=N&AN=2003486472\nhttp://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=reference&D=med4&NEWS=N&AN=14643092

Tiihonen, J., Hallikainen, T., Ryynanen, O.-P., Repo-Tiihonen, E., Kotilainen, I., Eronen, M., … Putkonen, A. (2003). Lamotrigine in treatment-resistant schizophrenia: A randomized placebo-controlled crossover trial. Biological Psychiatry , 54 (11), 1241–1248. Retrieved from http://www.embase.com/search/results?subaction=viewrecord&from=export&id=L37464870\nhttp://dx.doi.org/10.1016/S0006-3223(03)00524-9\nhttp://periodicos.homologacao.saude.gov.br/periodicos/index.php?view=principal&sid=EMBASE&issn=00063223&id=doi:10.1016/S0006-3223(03)00524-9&atitle=Lamotrigine+in+treatment-resistant+schizophrenia:+A+randomized+placebo-controlled+crossover+trial&stitle=Biol.+Psychiatry&title=Biological+Psychiatry&volume=54&issue=11&spage=1241&epage=1248&aulast=Tiihonen&aufirst=Jari&a

Vieweg, W. V. R., Julius, D. A., Fernandez, A., Wulsin, L. R., Mohanty, P. K., Beatty-Brooks, M., … Pandurangi, A. K. (2006). Treatment of Depression in Patients with Coronary Heart Disease. American Journal of Medicine , 119 (7), 567–573. http://doi.org/http://dx.doi.org/10.1016/j.amjmed.2006.02.037

Wietecha, L., Young, J., Ruff, D., Dunn, D., Findling, R. L., & Saylor, K. (2012). Atomoxetine once daily for 24 weeks in adults with attention-deficit/ hyperactivity disorder (ADHD): Impact of treatment on family functioning. Clinical Neuropharmacology , 35 (3), 125–133. http://doi.org/http://dx.doi.org/10.1097/WNF.0b013e3182560315

Ejaculation Disorders Internet Articles and Research

Current Concepts in Ejaculatory Dysfunction . (2015). Retrieved on January 27, 2015, from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1765044/ .

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Nature Clinical Practice Urology | Ejaculatory disorders .... (2015). Retrieved on January 27, 2015, from http://www.nature.com/articles/ncpuro1016 .

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Premature ejaculation . (2015). Retrieved on January 27, 2015, from http://en.wikipedia.org/wiki/Premature_ejaculation .

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Sexual problems in men . (2015). Retrieved on January 27, 2015, from http://www.webmd.boots.com/sexual-conditions/guide/mens-sexual-problems .

Treatment for Premature Ejaculation, Erectile Dysfunction issues .... (2015). Retrieved on January 27, 2015, from http://www.amiaustralia.com.au/ .

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Amber Johnson. (2015). What Causes Male Infertility? . Retrieved on January 27, 2015, from https://web.stanford.edu/class/siw198q/websites/reprotech/New%20Ways%20of%20Making%20Babies/causemal.htm .

Rage-India. (2015). Ejaculatory Disturbances . Retrieved on January 27, 2015, from http://www.andrology.com/ejaculatorydisorders.htm .

C HAPTER 6

DIAGNOSIS

This Chapter will discuss the concept of diagnosis, including the difference between health conditions that are misdiagnosed and those that are undiagnosed . This Chapter will also examine the difference between common diagnosis and a differential diagnoses.

The Diagnostic and Differential Diagnostic Process

The term diagnosis refers to the process of identifying a disease, based on the signs and symptoms of disease, and a diagnostic procedure is a method used to arrive at a diagnosis. Most frequently, doctors base diagnostic determinations on medical tests and observation to identify a disease or condition. Through test and observation the doctor is attempting to either identify a physical, biological, chemical, emotional, or psychological condition not normally present in a healthy person OR one that is present in a healthy person but absent in a person with a particular illness or disease. In this regard, the diagnostic process generally begins with the doctor making an educated guess as to which condition is most likely present, and through tests and observation confirming or denying the presence or absence of disease or illness.

When a doctor fails to diagnosis a disease that is actually present the disease has gone undiagnosed and when the doctor determines one disease is present when in fact it is another the health condition is misdiagnosed . Obviously, both concepts can go hand-in-hand as the the disease that is present but not identified is undiagnosed and the disease that is identified but not present is misdiagnosed.

On the other hand, a process of differential diagnosis is one that, based on the signs and symptoms, a doctor determines that two or more alternative diseases or conditions are nearly equally likely to be present. In essence, the differential diagnostic procedure is a "process of elimination" where a list of possible diseases and disorders is constructed, and possible diseases are removed one-by-one. To eliminate alternative health problems, a physician will use a combination of medical tests, observation, intuition, and past experience to rule-out individual health conditions until only a single condition remains on the list. Because a differential diagnosis attempts to distinguish health disorders that present themselves in a very similar manner, the differential diagnostic process is typically more involved and time-consuming than normal diagnostic protocols. For the same reason and for some conditions, the differential diagnostic process may result in fewer instances of undiagnosed disease but more instances of misdiagnosis.

Medical tests are used to screen for or diagnose health conditions that may be present in a patient or monitor conditions that already exist. Diagnostic tests are generally performed only after a patient reports symptoms of a disease or health condition or in response to signs observed by a medical professional. The most methods to diagnose Ejaculation Disorders are discussed below.

Ejaculation Disorders Journal Articles

A.J., G., D.L., D., A.J., R., R., P., K.M., D., P.T., N., … Ninan, P. T. (2013). Sexual functioning in patients with recurrent major depressive disorder enrolled in the prevent study. Journal of Nervous and Mental Disease , 201 (4), 266–273. http://doi.org/10.1097/NMD.0b013e318288d298

A.L., M. G., F., R.-V., M., T., L., A., J.-C., A., C., A., … P.-A., S. (2005). A 6-month prospective observational study on the effects of quetiapine on sexual functioning. Journal of Clinical Psychopharmacology . Retrieved from http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=reference&D=emed7&NEWS=N&AN=2005529274

Ahmed, I., & Thorpy, M. (2010). Clinical features, diagnosis and treatment of narcolepsy. Clinics in Chest Medicine , 31 (2), 371–381. http://doi.org/http://dx.doi.org/10.1016/j.ccm.2010.02.014

Baldinger, S. L., & Yogman, M. W. (2003). Atomoxetine. Formulary . Retrieved from http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=emed6&AN=2003275246

Barry, J. J., Ettinger, A. B., Friel, P., Gilliam, F. G., Harden, C. L., Hermann, B., … Jones, J. (2008). Consensus statement: The evaluation and treatment of people with epilepsy and affective disorders. Epilepsy and Behavior . http://doi.org/10.1016/j.yebeh.2008.04.005

Beh, S. C., Greenberg, B. M., Frohman, T., & Frohman, E. M. (2013). Transverse Myelitis. Neurologic Clinics , 31 (1), 79–138. http://doi.org/http://dx.doi.org/10.1016/j.ncl.2012.09.008

Birrer, R. B., & Vemuri, S. P. (2004). Depression in later life: A diagnostic and therapeutic challenge. American Family Physician , 69 (10), 2375–2382. Retrieved from http://www.embase.com/search/results?subaction=viewrecord&from=export&id=L38668130

Chouinard, G., Kopala, L., Labelle, A., Beauclair, L., Johnson, S. V, & Singh, K. I. (1998a). Phase-IV multicentre clinical study of risperidone in the treatment of outpatients with schizophrenia. Canadian Journal of Psychiatry-Revue Canadienne de Psychiatrie . Retrieved from WOS:000077615000007

Chouinard, G., Kopala, L., Labelle, A., Beauclair, L., Johnson, S. V, & Singh, K. I. (1998b). Phase-IV multicentre clinical study of risperidone in the treatment of outpatients with schizophrenia. The RIS-CAN-3 Study Group. Canadian journal of psychiatry. Revue canadienne de psychiatrie (Vol. 43).

Demaerschalk, B. M., & Aguilar, M. I. (2008). Treatment of acute intracerebral hemorrhage. Current Treatment Options in Neurology , 10 (6), 455–467. Retrieved from http://www.embase.com/search/results?subaction=viewrecord&from=export&id=L354109253\nhttp://dx.doi.org/10.1007/s11940-008-0048-3\nhttp://sfxhosted.exlibrisgroup.com/medtronic?sid=EMBASE&issn=10928480&id=doi:10.1007/s11940-008-0048-3&atitle=Treatment+of+acute+intracerebral+hemorrhage&stitle=Curr.+Treat.+Options+Neurol.&title=Current+Treatment+Options+in+Neurology&volume=10&issue=6&spage=455&epage=467&aulast=Demaerschalk&aufirst=Bart+M.&auinit=B.M.&aufull=Demaerschalk+B.M.&coden=CTONB&isbn=&pages=45

F., O., & C., O. (2004). Adverse effects of new antiepileptic drugs. Drugs of Today , 40 (4), 325–342. Retrieved from http://www.embase.com/search/results?subaction=viewrecord&from=export&id=L38724776\nhttp://dx.doi.org/10.1358/dot.2004.40.4.820079\nhttp://elvis.ubvu.vu.nl:9003/vulink?sid=EMBASE&issn=00257656&id=doi:10.1358%2Fdot.2004.40.4.820079&atitle=Adverse+effects+of+new+antiepileptic+drugs&stitle=Drugs+Today&title=Drugs+of+Today&volume=40&issue=4&spage=325&epage=342&aulast=Onat&aufirst=Filiz&auinit=F.&aufull=Onat+F.&coden=MDACA&isbn=&pages=325-342&date=2004&auinit1=F&auinitm=

H., R., & M.M., K. (2003). Depressive Disorder: Diagnosis and Management in General Practice in Pakistan. Journal of the Pakistan Medical Association . Retrieved from http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=reference&D=emed6&NEWS=N&AN=2003518082

H.M., R., & S.D., H. (2007). Social anxiety disorder - A review of pharmacological treatments. Current Psychiatry Reviews . Retrieved from http://www.ingentaconnect.com/content/ben/cpsr/2007/00000003/00000002/art00002\nhttp://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=reference&D=emed8&NEWS=N&AN=2007245543

Heidbreder, A., Muller, T., & Young, P. (2008). Clinical features of narcolepsy. Klinische Neurophysiologie , 39 (4), 249–255. http://doi.org/10.1055/s-0028-1112120

Hollander, E., Allen, A., Steiner, M., Wheadon, D. E., Oakes, R., & Burnham, D. B. (2003). Acute and long-term treatment and prevention of relapse of obsessive-compulsive disorder with paroxetine. Journal of Clinical Psychiatry . Retrieved from http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=emed6&AN=2003383271

Homma, Y. G. (2011). JUA clinical guidelines for benign prostatic hyperplasia. International Journal of Urology , 18 (11), e1–e33.

J.E., M. (2004). Urinary incontinence and the community-dwelling elder: A practical approach to diagnosis and management for the primary care geriatrician. Clinics in Geriatric Medicine . Retrieved from http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=reference&D=emed6&NEWS=N&AN=2004348747

J.L., E. (2008). Diagnosis and management of benign prostatic hyperplasia. American Family Physician . Retrieved from http://www.aafp.org/afp/20080515/1403.pdf\nhttp://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=reference&D=emed8&NEWS=N&AN=2009302163

J.L., E., & Edwards, J. L. (2008). Diagnosis and management of benign prostatic hyperplasia. American Family Physician , 77 (10), 1403–1410. Retrieved from http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=reference&D=medl&NEWS=N&AN=18533373\nhttp://www.aafp.org/afp/20080515/1403.pdf\nhttp://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=reference&D=emed8&NEWS=N&AN=2009302163

Jannini, E. A., Simonelli, C., & Lenzi, A. (2002). Disorders of ejaculation. Journal of Endocrinological Investigation . http://doi.org/5797 [pii]

Kendirci, M., Salem, E., & Hellstrom, W. J. G. (2007). Dapoxetine, a novel selective serotonin transport inhibitor for the treatment of premature ejaculation. Therapeutics and Clinical Risk Management , 3 (2), 277–289. Retrieved from http://www.embase.com/search/results?subaction=viewrecord&from=export&id=L46881455\nhttp://dx.doi.org/10.2147/tcrm.2007.3.2.277

Kesicky, D., Kesicka, M., & Novotny, V. (2010). Gender differences in changes of sexual behaviour in depressive disorder. Ceska a Slovenska Psychiatrie , 106 (4), 213–219. Retrieved from http://www.embase.com/search/results?subaction=viewrecord&from=export&id=L359620779\nhttp://dd8gh5yx7k.search.serialssolutions.com?sid=EMBASE&issn=12120383&id=doi:&atitle=Gender+differences+in+changes+of+sexual+behaviour+in+depressive+disorder&stitle=Ceska+Slov.+Psychiatr.&title=Ceska+a+Slovenska+Psychiatrie&volume=106&issue=4&spage=213&epage=219&aulast=Kešický&aufirst=Dušan&auinit=D.&aufull=Kešický+D.&coden=CSLPF&isbn=&pages=213-219&date=2010&auinit1=D&auinitm=

M., T. (2007). Therapeutic advances in narcolepsy. Sleep Medicine . Retrieved from http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=reference&D=emed8&NEWS=N&AN=2007225226

M.A., D., & J.C., L. (2005). Update on the treatment of benign prostatic hyperplasia. Formulary . Retrieved from http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=reference&D=emed7&NEWS=N&AN=2005099895

Novara, G., Galfano, A., Gardi, M., Ficarra, V., Boccon-Gibod, L., & Artibani, W. (2006). Critical review of guidelines for BPH diagnosis and treatment strategy. European Urology, Supplements , 5 (4 SPEC. ISS.), 418–429. http://doi.org/http://dx.doi.org/10.1016/j.eursup.2006.02.005

R., I., L., F., B., W., L., S., A., B., & H.-J., M. (2011). World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for the biological treatment of Alzheimer’s disease and other dementias. World Journal of Biological Psychiatry . Retrieved from http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=reference&D=emed10&NEWS=N&AN=2011073561

Robinson, H. M., & Hood, S. D. (2007). Social anxiety disorder - A review of pharmacological treatments. Current Psychiatry Reviews , 3 (2), 95–122. Retrieved from http://www.scopus.com/inward/record.url?eid=2-s2.0-34248678464&partnerID=40&md5=f4837e538fe8f7ba3edb4c34fbb2af37\nhttp://www.ingentaconnect.com/content/ben/cpsr/2007/00000003/00000002/art00002\nhttp://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=reference&D=emed8&NEWS=N&AN=2007245543

Sharlip, I. (2005). Diagnosis and treatment of premature ejaculation: The physician’s perspective. Journal of Sexual Medicine , 2 (SUPPL. 2), 103–109. Retrieved from http://www.embase.com/search/results?subaction=viewrecord&from=export&id=L40740369\nhttp://dx.doi.org/10.1111/j.1743-6109.2005.20370.x\nhttp://dd8gh5yx7k.search.serialssolutions.com?sid=EMBASE&issn=17436095&id=doi:10.1111/j.1743-6109.2005.20370.x&atitle=Diagnosis+and+treatment+of+premature+ejaculation:+The+physician’s+perspective&stitle=J.+Sex.+Med.&title=Journal+of+Sexual+Medicine&volume=2&issue=SUPPL.+2&spage=103&epage=109&aulast=Sharlip&aufirst=Ira&auinit=I.&aufull=Sharlip+I.&coden=&isbn=&pages

Sharma, A., & Couture, J. (2014). A Review of the Pathophysiology, Etiology, and Treatment of Attention-Deficit Hyperactivity Disorder (ADHD). Annals of Pharmacotherapy . http://doi.org/10.1177/1060028013510699

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Ejaculation Disorders Internet Articles and Research

Benign Prostatic Hyperplasia. BPH Symptoms. Patient | Patient.co.uk . (2015). Retrieved on January 27, 2015, from http://www.patient.co.uk/doctor/benign-prostatic-hyperplasia .

Current Concepts in Ejaculatory Dysfunction . (2015). Retrieved on January 27, 2015, from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1765044/ .

Delayed Ejaculation DSM . (2015). Retrieved on January 27, 2015, from http://www.theravive.com/therapedia/Delayed-Ejaculation-DSM--5-302.74-(N53.11) .

Delayed Ejaculation: Causes, Symptoms & Diagnosis . (2015). Retrieved on January 27, 2015, from http://www.healthline.com/health/delayed-ejaculation .

Delayed ejaculation . (2015). Retrieved on January 27, 2015, from http://en.wikipedia.org/wiki/Delayed_ejaculation .

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CODE Internet Applications. (2015). EAU Guidelines on Ejaculatory Dysfunction . Retrieved on January 27, 2015, from http://www.europeanurology.com/article/S0302-2838(04)00374-4/fulltext/eau-guidelines-on-ejaculatory-dysfunction .

C HAPTER 7

PATHOPHYSIOLOGY

Understanding Pathophysiology

Pathophysiology is used to describe the changes that occur in the body in response to injury or disease. The term pathophysiology is actually the combination of two words, pathology and physiology .

The human body constantly works to maintain homeostasis, meaning an internal stability between all the interdependent functions and processes that combine to keep human biological processes functioning in a normal, healthy manner. When activities of the body can not maintain homeostasis, disease ensues. Pathology is the scientific study of disease and pathologists are medical professionals who specialize in diagnosing disease. More specifically, the field of pathology is concerned with identifying the nature and physical origin and course of disease. Within the framework of pathology, the related concept pathogenesis focuses exclusively on the origin of disease.

On the other hand, physiology is the branch of biology that studies the physical and chemical functions and processes in living organisms. In this regard, human physiologists research the growth and development requirements of the human body, the absorption and use of nutrients to to fuel energy, and the healthy functioning of organs, tissues, and other anatomical structures. For our purposes, the most important distinction between the fields of human pathology and physiology is the former is concerned with the study of the body in a diseased state and the latter is concerned with the body in a healthy state. Therefore, pathophysiology can be thought of as the study of how disease alters the normal biological and chemical processes in a healthy human body.

Ejaculation Disorders Journal Articles

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Bernt, W. D., Stark, K. H., & Baguhl, F. (1989). Diagnostic value of the hypo-osmotic swelling test in pathologic ejaculation findings. Zentralblatt Fur Gynakologie , 111 (24), 1604–1609.

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Blanchard, T. L., Varner, D. D., Brinsko, S. P., & Love, C. C. (2012). Azoospermia in stallions: determining the cause. Compendium (Yardley, PA) , 34 (2), E2. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/22488664

Buvat, J. (2011). Pathophysiology of Premature Ejaculation. Journal of Sexual Medicine , 8 (SUPPL. 4), 316–327. http://doi.org/10.1111/j.1743-6109.2011.02384.x

Chan, J. S. W., Olivier, B., de Jong, T. R., Snoeren, E. M. S., Kooijman, E., van Hasselt, F. N., … Oosting, R. S. (2008). Translational research into sexual disorders: Pharmacology and genomics. European Journal of Pharmacology . http://doi.org/10.1016/j.ejphar.2008.02.098

Corona, G., Jannini, E. A., Lotti, F., Boddi, V., De Vita, G., Forti, G., … Maggi, M. (2011). Premature and delayed ejaculation: Two ends of a single continuum influenced by hormonal milieu. International Journal of Andrology , 34 (1), 41–48. http://doi.org/10.1111/j.1365-2605.2010.01059.x

Corona, G., Jannini, E. A., Mannucci, E., Fisher, A. D., Lotti, F., Petrone, L., … Maggi, M. (2008). Different testosterone levels are associated with ejaculatory dysfunction. Journal of Sexual Medicine , 5 (8), 1991–1998. http://doi.org/10.1111/j.1743-6109.2008.00803.x

Del Noce, G., & Abraham, G. (2010). A confrontation between premature ejaculation and difficult ejaculation. Revue Medicale Suisse , 6 (241), 610–612.

Donatucci, C. F. (2006). Etiology of ejaculation and pathophysiology of premature ejaculation. Journal of Sexual Medicine . http://doi.org/10.1111/j.1743-6109.2006.00305.x

Giuliano, F., & Clément, P. (2006). Serotonin and Premature Ejaculation: From Physiology to Patient Management. European Urology . http://doi.org/10.1016/j.eururo.2006.05.055

Glezerman, M., Lunenfeld, B., Potashnik, G., Oelsner, G., & Beer, R. Retrograde ejaculation: pathophysiologic aspects and report of two successfully treated cases., 27 Fertility and sterility 796–800 (1976).

Gonen, M., Kalkan, M., Cenker, A., & Ozkardes, H. (2005). Prevalence of premature ejaculation in Turkish men with chronic pelvic pain syndrome. J Androl , 26 (5), 601–603. Retrieved from http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=16088036

Gonen, M., Kalkan, M., Cenker, A., & Ozkardes, H. (2005a). Prevalence of Premature Ejaculation in Turkish Men With Chronic Pelvic Pain Syndrome. J Androl , 26 (5), 601–603. http://doi.org/10.2164/jandrol.04159

Gonen, M., Kalkan, M., Cenker, A., & Ozkardes, H. (2005b). Prevalence of premature ejaculation in Turkish men with chronic pelvic pain syndrome. Journal of Andrology , 26 (5), 601–3. http://doi.org/10.2164/jandrol.04159

Hartmann, U., & Waldinger, M. D. (2007). Treatment of delayed ejaculation. In Principles and practice of sex therapy (4th ed.). (pp. 241–276). Retrieved from http://search.ebscohost.com/login.aspx?direct=true&db=psyh&AN=2006-23373-009&site=ehost-live&scope=site

Hellstrom, W. J. G., Giuliano, F., & Rosen, R. C. (2009). Ejaculatory Dysfunction and Its Association With Lower Urinary Tract Symptoms of Benign Prostatic Hyperplasia and BPH Treatment. Urology . http://doi.org/10.1016/j.urology.2008.06.048

Henry, N., Rouprêt, M., Ciofu, C., Gattegno, B., Thibault, P., Haab, F., & Beley, S. (2008a). Management of premature ejaculation in adults. Progres En Urologie : Journal de l’Association Francaise D'urologie et de La Societe Francaise D'urologie , 18 (9), 566–569. http://doi.org/10.1016/j.purol.2008.03.030

Henry, N., Rouprêt, M., Ciofu, C., Gattegno, B., Thibault, P., Haab, F., & Beley, S. (2008b). Prise en charge de l’éjaculation prématurée chez le sujet adulte. Progres En Urologie . http://doi.org/10.1016/j.purol.2008.03.030

Hsu, Y.-C., Huang, H.-C., & Huang, S.-T. (2013). Treatment of premature ejaculation. Urological Science , 24 (1), 2–6. http://doi.org/10.1016/j.urols.2013.01.004

Jannini, E. A., Carosa, E., Pepe, M., Lombardo, F., & Lenzi, A. (2006). Update on Pathophysiology of Premature Ejaculation: The Bases for New Pharmacological Treatments. EAU-EBU Update Series . http://doi.org/10.1016/j.eeus.2006.05.002

Jannini, E. A., McMahon, C., Chen, J., Aversa, A., & Perelman, M. (2011). The controversial role of phosphodiesterase type 5 inhibitors in the treatment of premature ejaculation. The Journal of Sexual Medicine , 8 (8), 2135–2143. http://doi.org/10.1111/j.1743-6109.2011.02401.x

Jannini, E. A., Simonelli, C., & Lenzi, A. (2002). Disorders of ejaculation. Journal of Endocrinological Investigation . http://doi.org/5797 [pii]

Jannini, E. A., Simonelli, C., & Lenzi, A. (2002). Sexological approach to ejaculatory dysfunction. International Journal of Andrology . http://doi.org/10.1046/j.1365-2605.2002.00371.x

Jern, P., Westberg, L., Johansson, A., Gunst, A., Eriksson, E., Sandnabba, K., & Santtila, P. (2012). A study of possible associations between single nucleotide polymorphisms in the serotonin receptor 1A, 1B, and 2C genes and self-reported ejaculation latency time. Journal of Sexual Medicine , 9 (3), 866–872. http://doi.org/10.1111/j.1743-6109.2011.02618.x

Jiang, X., Zhou, C., Guo, L., Chen, J., Wang, H., Zhang, D., … Xu, Z. (2009). Role of bulbocavernosus reflex to stimulation of prostatic urethra in pathologic mechanism of primary premature ejaculation. Zhonghua Yi Xue Za Zhi , 89 (46), 3249–3252. http://doi.org/10.3760/cma.j.issn.0376-2491.2009.46.004

Levine, S. B. Premature ejaculation: some thoughts about its pathogenesis., 1 Journal of sex & marital therapy 326–334 (1975). http://doi.org/10.1080/00926237508403707

Levine, S. B. (1976). Marital sexual dysfunction: ejaculation disturbances. Annals of Internal Medicine , 84 (5), 575–579.

Malossini, G., Ficarra, V., & Caleffi, G. (1999). Retrograde ejaculation. Archivio Italiano Di Urologia, Andrologia : Organo Ufficiale [di] Societa Italiana Di Ecografia Urologica E Nefrologica / Associazione Ricerche in Urologia , 71 (3), 185–196.

Morrison, J. F. B., Dhanasekaran, S., Sheen, R., Frampton, C. M., & Mensah-Brown, E. (2006). The effect of streptozotocin-induced diabetes on the rat seminal vesicle: A possible pathophysiological basis for disorders of ejaculation. In Annals of the New York Academy of Sciences (Vol. 1084, pp. 267–279). http://doi.org/10.1196/annals.1372.013

Öznur, T., Akarsu, S., Karaahmetoǧlu, B., & Doruk, A. (2014). A rare symptom in posttraumatic stress disorder: Spontaneous ejaculation. American Journal of Case Reports , 15 , 69–73. http://doi.org/10.12659/AJCR.889658

Pastor, Z. (2013). Female ejaculation orgasm vs. coital incontinence: A systematic review. Journal of Sexual Medicine . http://doi.org/10.1111/jsm.12166

Peng, H., Chen, Q., & Tan, Y. (2009). Frequent ejaculation associated free radical and lactic acid accumulation cause noninfectious inflammation and muscle dysfunction: A potential mechanism for symptoms in Chronic Prostatitis/Chronic Pelvic Pain Syndrome. Medical Hypotheses , 73 (3), 372–373. http://doi.org/10.1016/j.mehy.2009.03.044

Perelman, M. A., & Rowland, D. L. (2006). Retarded ejaculation. World Journal of Urology , 24 (6), 645–652. http://doi.org/10.1007/s00345-006-0127-6

Pettus, J. A., Carver, B. S., Masterson, T., Stasi, J., & Sheinfeld, J. (2009). Preservation of Ejaculation in Patients Undergoing Nerve-Sparing Postchemotherapy Retroperitoneal Lymph Node Dissection for Metastatic Testicular Cancer. Urology , 73 (2), 328–331. http://doi.org/10.1016/j.urology.2008.08.501

Pizzocaro, G., & Guarneri, A. (2009). Consequences of Missed Nodes during Retroperitoneal Lymph Node Dissection and How to Avoid Them. European Urology, Supplements . http://doi.org/10.1016/j.eursup.2009.01.008

Ramadan, A. E., el-Demiry, M. I., & Ramadan, A. E. (1985). Surgical correction of post-operative retrograde ejaculation. British Journal of Urology , 57 (4), 458–461.

Screponi, E., Carosa, E., Di Stasi, S. M., Pepe, M., Carruba, G., & Jannini, E. A. (2001). Prevalence of chronic prostatitis in men with premature ejaculation. Urology (Vol. 58).

Seftel, A. D., & Althof, S. E. (2000). Rapid ejaculation. Current Urology Reports , 1 (4), 302–306. http://doi.org/10.1007/s11934-000-0011-7

Serefoglu, E. C., & Silay, M. S. (2010). Botulinum toxin-A injection may be beneficial in the treatment of life-long premature ejaculation. Medical Hypotheses , 74 (1), 83–84. http://doi.org/10.1016/j.mehy.2009.07.038

Vardi, Y., McMahon, C. G., Waldinger, M. D., Rubio-Aurioles, E., & Rabinowitz, D. (2008). Are premature ejaculation symptoms curable? Journal of Sexual Medicine , 5 (7), 1546–1551. http://doi.org/10.1111/j.1743-6109.2008.00900.x

Vaucher, L., Bolyakov, A., & Paduch, D. A. (2009). Evolving techniques to evaluate ejaculatory function. Current Opinion in Urology , 19 (6), 606–614. http://doi.org/10.1097/MOU.0b013e3283318ee2

Waldinger, M. (2008). Recent advances in the classification, neurobiology and treatment of premature ejaculation. Advances in Psychosomatic Medicine . http://doi.org/10.1159/000126624

Waldinger, M. D. (2007). Premature ejaculation: state of the art. The Urologic Clinics of North America , 34 (4), 591–599, vii–viii. http://doi.org/10.1016/j.ucl.2007.08.011

Waldinger, M. D. (2008). Premature ejaculation: different pathophysiologies and etiologies determine its treatment. Journal of Sex & Marital Therapy , 34 (1), 1–13. http://doi.org/10.1080/00926230701640355

Waldinger, M. D. (2011). Toward evidence-based genetic research on lifelong premature ejaculation: A critical evaluation of methodology. Korean Journal of Urology . http://doi.org/10.4111/kju.2011.52.1.1

Waldinger, M. D., & Schweitzer, D. H. (2006). Changing paradigms from a historical DSM-III and DSM-IV view toward an evidence-based definition of premature ejaculation. Part II - Proposals for DSM-V and ICD-11. Journal of Sexual Medicine , 3 (4), 693–705. http://doi.org/10.1111/j.1743-6109.2006.00276.x

Xing, J. P., Fan, J. H., Wang, M. Z., Chen, X. F., & Yang, Z. S. (2003). [Survey of the prevalence of chronic prostatitis in men with premature ejaculation]. Zhonghua Nan Ke Xue , 9 (6), 451–453. Retrieved from http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=14574813

Xing, J.-P., Fan, J.-H., Wang, M.-Z., Chen, X.-F., & Yang, Z.-S. (2003). Survey of the prevalence of chronic prostatitis in men with premature ejaculation. Zhonghua Nan Ke Xue = National Journal of Andrology , 9 (6), 451–453.

Zhou, C., Jiang, X., Xu, Z., Guo, L., Chen, J., Wang, H., … Shi, B. (2010). Bulbocavernosus reflex to stimulation of prostatic urethra in patients with lifelong premature ejaculation. Journal of Sexual Medicine , 7 (11), 3750–3757. http://doi.org/10.1111/j.1743-6109.2009.01646.x

Ejaculation Disorders Internet Articles and Research

ESSM: Unravelling the pathophysiology . (2015). Retrieved on January 27, 2015, from http://www.essm.org/sexual-medicine/literaturereview/literaturereview0/pastlitreview/unravelling-the-pathophysiology.html .

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Ejaculatory physiology and pathophysiology: assessment and .... (2015). Retrieved on January 27, 2015, from http://www.amepc.org/tau/article/view/3515/4361 .

Erectile dysfunction and premature ejaculation: underlying causes .... (2015). Retrieved on January 27, 2015, from http://formularyjournal.modernmedicine.com/formulary-journal/news/clinical/clinical-pharmacology/erectile-dysfunction-and-premature-ejaculation?page=full .

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Integrating psychotherapy and pharmacotherapy in the treatment of .... (2015). Retrieved on January 27, 2015, from http://www.sciencedirect.com/science/article/pii/S2090598X13000910 .

Nature Clinical Practice Urology | Ejaculatory disorders .... (2015). Retrieved on January 27, 2015, from http://www.nature.com/articles/ncpuro1016 .

Post Orgasmic Illness Syndrome (POIS) . (2015). Retrieved on January 27, 2015, from http://www.thenakedscientists.com/forum/?topic=6576.0 .

Premature Ejaculation: American Urological Association . (2015). Retrieved on January 27, 2015, from https://www.auanet.org/education/guidelines/premature-ejaculation.cfm .

Premature Ejaculation . (2015). Retrieved on January 27, 2015, from http://emedicine.medscape.com/article/435884-overview .

Retrograde Ejaculation . (2015). Retrieved on January 27, 2015, from http://www.webmd.com/sexual-conditions/retrograde-ejaculation .

Sperm Disorders: Infertility: Merck Manual Professional . (2015). Retrieved on January 27, 2015, from http://www.merckmanuals.com/professional/gynecology_and_obstetrics/infertility/sperm_disorders.html .

The Central Mechanisms of Sexual Function » Sexual Medicine .... (2015). Retrieved on January 27, 2015, from http://www.bumc.bu.edu/sexualmedicine/publications/the-central-mechanisms-of-sexual-function/ .

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CODE Internet Applications. (2015). Take a PAUSE for the Premature Ejaculation Cause . Retrieved on January 27, 2015, from http://www.europeanurology.com/article/S0302-2838(13)01014-2/fulltext/take-a-pause-for-the-premature-ejaculation-cause .

C HAPTER 8

TREATMENT

Once a diagnosis Ejaculation Disorders has been confirmed, a patient generally begins a treatment regime under the supervision of a doctor or other medical specialist. This Chapter defines the terms treatment and therapy and discusses the most common treatment protocols for Ejaculation Disorders.

Treatment and Therapy

The term treatment refers to any method used by a person to remedy a health problem. Treatment can also mean doing nothing at all, often termed to "wath and wait." In medicine, treatment is often referred to as therapy and for our purposes the terms treatment and therapy will be used synonymously, both being based on the Greek origin of the word "therapy," to mean "curing or healing."

Treatment or therapy can be applied both to a person’s biological being as well to their psychological state. Additionally, treatment can be used to remedy or halt the progression of an existing health condition (abortive therapy) , prevent the manifestation of a condition in an otherwise healthy person (prophylatic therapy) , or increase the comfort or emotional well-being of a patient when an underlying condition can not be completely eliminated (palliative therapy) .

During the course of your research, you will discover that the administration of certain treatments, particularly drug treatments, are often qualified by the terms indications and contraindications . Indications simply describe the circumstances and conditions that should be present before a particular treatment is administered to a patient. One common indication for drug therapies is that a patient avoid alcohol or refrain from eating for a certain period of time prior to taking a medication. Conversely, a contraindication are circumstances where a treatment should not be administered. For example, some drug treatments or physical therapy activities should not be administered in persons with high blood pressure.

There are two types of contraindications, relative contraindications and absolute contraindications . Relative contraindications occur if caution should be taken when using two or more therapies simultaneously. For therapies with relative contraindications multiple treatments should only be employed if the benefits of using more than one treatment are likely to outweigh the risks. As the term suggests, absolute contraindications means two or more treatments should not be simultaneously administred under any circumstance, as the result could cause death or serious and permanent damage. Obviously, depending on how the treatment instructions are worded some indications for treatment can become contraindications with the addition of words like "not" or "don’t."

Unlike indications and contraindications, side effects of treatment or therapy refers to any effect in addition to, or on top of, the intended effect of the treatment. The term side effect is most commonly used when referring to drug therapies and while effects can be positive, they are most commonly negative or harmful but seldom cause serious or permanent biological or psychological damage.

Finally, therapies are also referred to as either being first-line therapies or second-line therapies . Quite simply, first-line therapies refer to the first or preferred treatment options and second-line therapies are commonly employed only when the first-line therapy doesn’t produce the desirable outcome or if the patient has other health concerns that make the first-line therapy ill-advised because of complications or contraindications.