Prematr ejaklasyon snflama ve nrobiyolojide gncel bilgilerDr.Ege Can erefoluAtatrk Eitim ve Aratrma Hastanesi, Ankara

Prematr Ejaklasyon

Sk rastlanan erkek cinsel fonksiyon bozukluklarndan biri ( %30)

Tanm ? Epidemiyoloji ? Hastalar semptomlarn anlatmakta isteksiz Yanl tan tedavi Onaylanm farmakolojik tedavi yok

Erkek cinsel salndaki karanlk blge!!!

Rosenberg ve Sadovsky (2007) Int J Clin Pract 61(6):903-8.Waldinger ve Schweitzer (2008) J Sex Med 5(5):1079-87.

PresenterPresentation NotesPE may be the most common male sexual dysfunction, with as many as 30% of adult males self-reporting complaints of the condition. Reported prevalence is influenced by the definition used most studies to date (e.g. Rosen, 2000) are based on the DSM-IV criteria.However, rates of treatment seeking are very low. There are various barriers to treatment seeking are discussed later: stigma and embarrassment are among the most important barriers. Despite the high self-reported prevalence, factors contributing to PE remain unconfirmed: Several psychological and biological theories exist.The high prevalence rates of PE, coupled with the absence of approved treatments, make PE a major unmet therapeutic need.

TANIM - SINIFLAMA Eski tanmlar IELT almalar ISSM tanm ICD-11/DSM-V

nerileri

NROBYOLOJ Erkek cinsel yantnn

fazlar Ejaklasyon

nrobiyolojisi Nrotrasmitterler

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TANIM SINIFLAMA

J & J Pharmaceutical Services LLC, 2007

Eski Tanmlar

Vakitsiz inzal Bel geveklii Orgasmus Bel gelii

Erkek uzvunu rahimyoluna sokar sokmaz,hatta sokmateebbsndebulunur bulunmaz vetenasli teheyybeyine eriir erimezinzal olmas.

Ord. Prof. Dr. Tevfik Remzi Kazancgil (1971) Tenasl Hayatmz, 166-167

1. Masters & Johnson, 1970 - Kaplan, 1974 (reviewed in Jannini et al. (2006) EAU-EBU Updates. Series 4: 141-149); 2. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 4th Edition. Washington, DC, 2000;3. World Health Organization. International Classification of Diseases and Related Health Problems, 10th Edition. Geneva: World Health Organization, 1994; 4. Montague et al (2004) J Urol. 172: 290294;5. McMahon CG et al (2004) J Sex Med 1: 58-65

Eski Tanmlar

PE almalarnda en sk kullanlan tanmlar:

1. Klasik seksolojik tanmlamalar1

2. Diagnostic and Statistical Manual of Mental Disorders 4th Edition (DSM-IV)2

3. International Classification of Diseases 10th Edition (ICD-10)34. American Urological Association (AUA) guidelines45. 2nd International Consultation on Sexual Dysfunctions (ICSD) /

International Consultation on Urological Disease (ICUD) 20045

1. Klasik seksolojik tanmlamalar PE klinik durum veya sendrom (Schapiro 1943)

Cinsel ilikilerinin %50sinde kadnn orgazma ulamasna yetecek kadar ejaklasyonu geciktirememe (Master & Johnson 1970).

Ejaklasyonun zamanlanmasndaki istemli kontroln bozukluu (Kaplan1974)

lk snflama: Tip-A (yaam boyu) ve Tip B (kazanlm) (Godpodinoff 1989)

Jannini et al. (2006) EAU-EBU Updates. Series 4: 141-149Godpodinoff ML J Sex Marital Ther 1989; 15: 130-4.Schapiro B J Urol 1943, 50: 693-705.

2. DSM-IV-TR

Minimal cinsel uyaryla, penetrayon ncesi, an ve ya hemen sonrasnda ve kiinin isteinden nce kalc veya tekrarlayc ejaklasyon

Rahatszlk, belirgin sknt veya kiileraras zorlua yol aar.

American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 4th Edition. Washington, DC, 2000

PresenterPresentation NotesKey features of the DSM-IV definition are the persons desire and distress.

3. ICD-10

F52.4: Cinsel ilikinin balamasndan nce veya

hemen sonrasnda (15 sn) gerekleen ejaklasyon

ilikiyi gerekletirmek iin yeterli ereksiyon olmadan gerekleen ejaklasyon

sevimeden zevk almak iin yeterli olacak ekilde ejaklasyonu kontrol etmedeki bozukluk.

World Health Organization. International Classification of Diseases and Related Health Problems, 10th Edition. Geneva, 1994

PresenterPresentation NotesControl is also a feature of the WHO ICD-10 definition.

4. AUA guidelines

Penetrasyondan nce veya hemen sonra ejaklasyonun istenilenden nce ejaklasyonun olmas ve partnerlerden biri ya da ikisinde sknt dourmas

Montague et al (2004) J Urol. 172: 290294

PresenterPresentation NotesDistress is a feature of the AUA guidelines.

5. ICSD/ICUD

A. Minimal cinsel uyaryla, penetrayon ncesi, an ve ya hemen sonrasnda ve kiinin isteinden nce kalc veya tekrarlayc ejaklasyon

B. Hastann ejaklasyon zerinde kontrol az veya hi yok

C. Hasta ve/veya partnerde sknt veya rahatszlk yaratr.

ICSD = International Committee on Sexual Disorders/ICUD = International Consultation on Urological DiseasesMcMahon CG et al (2004) J Sex Med 1: 58-65

PresenterPresentation NotesDSM-IVe benziyor. Kontrol ekli hali. ICSD/ICUD definition includes desire, control and distress.

Eski TanmlarEski PE tanmlarnn ortak ynleri:1. Ksa ejaklasyon sresi

penetrasyon ncesi, an veya hemen sonrasnda ICD-10: < 15 sn

2. Kontrol eksiklii hissi Kiinin isteinden nce

3. Negatif sonular Cinsel ilikiden tatmin olamama Kiisel sknt Kiiler arasnda veya ilikide problem

American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 4th Edition. Washington, DC, American Psychiatric Association, 2000; World Health Organization. International Classification of Diseases and Related Health Problems, 10th Edition. Geneva: World Health Organization, 1994; Montague et al (2004) J Urol. 172: 290294; McMahon CG et al (2004) J Sex Med 1:58-65

PresenterPresentation NotesThe advances made in the understanding of PE in recent years have been aided by the traditional definitions of PE. They each share common elements that experts in PE still consider to be important features of the condition, including:

However, it is now recognised that each definition has shortcomings, not least because they are based on expert opinion rather than controlled clinical studies.

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Eski Tanmlar

PEyi tanmlamada faydal olsalar da, eksiklikleri var

Sadece uzman grlerine dayanr ve kanta dayal deildir

ntravajinal ejakulatuar gecikme zaman = IELT

Vajene giriten intavajinal ejaklasyon olana kadar geen sre

Kronometre kullanan partner tarafndan llr

Klinik almalarda kullanlan ejaklasyon zamannn objektif lsdr

1. Waldinger et al (1994) Am J Psych 151:13771379; 2. Waldinger (2003) Int J Impot Res 15:309313

0

5

10

15

20

25

30

0-10

11-20

21-30

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111-1

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121-1

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151-1

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IELT(sn)

Den

ekle

rin S

ays

Klinik alma

Yaam boyu PE (n=110)

Yaam-boyu PE hastalarnda IELT ne kadar?

Waldinger et al. (2002) J Urology 168: 23592367

PE tansnda DSM-IV kriterleri kullanlmtr

%90 60 sn iinde boalyor

PresenterPresentation NotesThis slide shows part of the evidence base for the ISSM definition of premature ejaculation as about a minute

The study involved 110 consecutively enrolled men with lifelong premature ejaculation with IELT measured by their partners using a stopwatch. DSM-IV criteria were used to identify PE.

Chart1

29

24

24

14

5

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1

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No. of subjects

IELT(sn)

Deneklerin Says

Sheet1

No. of subjects

0-1029

11-2024

21-3024

31-4014

41-505

51-603

61-702

71-801

81-902

91-1001

101-1101

111-1201

121-1302

131-1400

141-1500

151-1600

161-1700

171-1801

Sheet1

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Age Group (Years)

Prevalance (%)

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100

150

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250

10 20 30 40 50 60 70 80 90 100 110 120 130 140 150 160 170 180

IELT (sn)

Den

ek S

ays

PE hastalarnda IELT (n=989)

McMahon (2002) Int J Imp Res 14(Suppl.3):S19

ORTALAMA43,5 sn

MEDYAN30 sn

PresenterPresentation NotesThis slide shows part of the evidence base for the ISSM definition of premature ejaculation as about a minute.

IELT was recorded from a retrospective, consecutive case series of men with PE.

Chart1

205

177

210

75

30

30

45

32

23

48

30

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6

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IELT (sn)

Denek Says

Sheet1

ELT

10205

20177

30210

4075

5030

6030

7045

8032

9023

10048

11030

1206

1306

14010

15018

16016

1706

18010

Sheet1

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Prevalance (%)

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0

10

20

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01.0

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001.8

002.0

002.2

002.4

002.6

002.8

00

Ortalama IELT (sn)

Den

ekle

rin Y

zde

s

Klinik alma

500 ift (N, UK, USA, ES, TR)

Waldinger et al. (2005) J Sex Med 2:492497

Toplum genelinde IELT nasl? Normali ka?

MEDYAN5,4 dk

Trkiye 3,7 dk

PresenterPresentation NotesThis slide shows part of the evidence base for the ISSM definition of premature ejaculation as about a minute.

This survey aimed to assess the distribution of IELT in the general male population. A total of 500 couples wererecruited from the Netherlands, United Kingdom, United States, Spain, and Turkey. IELT was measured by the partner using a stopwatch.

Chart1

2

70

97

98

58

40

22

36

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20

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8

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Ortalama IELT (sn)

Deneklerin Yzdesi

Sheet1

Percentage of men

02

10070

20097

30098

40058

50040

60022

70036

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1,00010

1,1009

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1,6008

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de (%

)

Patrick et al. (2005) J Sex Med 2:358-367

US observational study (PE tansnda DSM-IV-TR kriterleri)PEsi olan ve olmayanlarn IELT deerleri akyor

(zellikle 1-4 dk aralnda)

PE tansnda IELT kriteri kullanlmamtr.

PE (n=190)

Non PE (n=1215)

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20

PE (+): medyan IELT 1.8 dk (025 dk)%26 < 1 dk%52 < 2 dk%35 25 dk%13 525 dk

PE (-): medyan IELT 7.3 dk (025 min)%6 < 2 dk

PresenterPresentation NotesData from a US observational study (discussed in more detail) shows that IELT alone is not sufficient to identify men with PE, as there was a non-negligible overlap of IELTs in patients with and without PE (diagnosed using DSM-IV criteria).

Chart1

0.758

1.7518.2

1.4515.75

2.511.75

2.7511.75

4.54.9

4.95.9

45.9

5.13.3

5.41.1

3.62.2

4.72.2

5.252.2

41.1

3.81.75

3.30

4.31.1

41.1

2.350.6

2.750

2.20

2.350

3.20

2.50.6

1.80

10

1.50

1.90

1.40

2.10.7

0.90

1.10

1.10

0.90.5

0.60

0.60

0.20

0.750

0.50

0.30.75

0.90

Yzde (%)

Sheet1

IELTnonPEPE

0.00.758.00

0.51.7518.20

1.01.4515.75

1.52.5011.75

2.02.7511.75

2.54.504.90

3.04.905.90

3.54.005.90

4.05.103.30

4.55.401.10

5.03.602.20

5.54.702.20

6.05.252.20

6.54.001.10

7.03.801.75

7.53.300.00

8.04.301.10

8.54.001.10

9.02.350.60

9.52.750.00

10.02.200.00

10.52.350.00

11.03.200.00

11.52.500.60

12.01.800.00

12.51.000.00

13.01.500.00

13.51.900.00

14.01.400.00

14.52.100.70

15.00.900.00

15.51.100.00

16.01.100.00

16.50.900.50

17.00.600.00

17.50.600.00

18.00.200.00

18.50.750.00

19.00.500.00

19.50.300.75

20.00.900.00

Sheet1

nonPE

Age Group (Years)

Prevalance (%)

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ISSM toplants

19-20 Ekim 2007, Amsterdam 21 PE uzman

PEye dair objektif kantlar sadece yaam-boyu PE hastalar iin mevcut

PEnin kanta dayal tanm yalnz yaam-boyu PE iin yaplabilir

PresenterPresentation NotesIn an effort to overcome the limitations of traditional definitions of PE, the ISSM has developed a definition based on clinical evidence, as outlined in the following slides. Like other definitions of PE, the ISSM definition includes three components: time to ejaculation, inability to control ejaculation and negative impact on the man and his partner.

The definition was developed by an Ad Hoc Committee of international experts in PE appointed by the ISSM. The committee met in Amsterdam in October 2007 to evaluate the strengths and weaknesses of current definitions of PE, to critique the evidence in support of the constructs of ejaculatory latency, ejaculatory control, sexual satisfaction, and personal/interpersonal distress, and to propose a new evidence-based definition of PE.

Yaam-boyu PE iin ISSMnin kanta dayal tanm Ejaklasyon her zaman veya ou zaman

vajinal penetrasyon ncesi veya yaklak 1 dakika sresinde gerekleir

Vajinal penetrasyonlarn tm veya tama yaknnda ejaklasyonu geciktirememe

Sknt, rahatszlk ve/veya cinsel ilikiden kanma gibi negatif kiisel etkiler grlr

McMahon et al (2008) J Sex Med 5:15901606

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ICD-11 ve DSM-V nerileri

semptom olan PE ile sendrom olan PE ayrm yaplmal

PE Sendromlar1. Yaam boyu PE2. Kazanlm PE3. Doal deikenli PE4. Prematr benzeri

ejaklasyon bozukluu

Waldinger (2008) Sexologies 17:3035

1. Yaam boyu PE

Tahmini prevelans %2-5 lk cinsel ilikiden beri / btn kadnlarla PE IELT %80 < 60 sn (%20 = 1-2 dk)%70 yaam boyu ayn (%30 ya ile artar)Nrobiyolojik temele dayanr (medikal tedavi)

2. Kazanlm PE Tahmini prevelans %2-5 yaamn belli bir dneminde geliir, yaknmalar balamadan nce normal ejaklasyon, Altta yatan somatik/psikolojik problem mevcut

ED, prostatit Tiroid bozukluklar Psikolojik veya iliki sorunlar

Altta yatan nedenin dzeltilmesi ile tedavi olabilir

3. Doal Deikenli PE

Tahmini prevelans %10-20Ejaklasyon zaman srekli ksa deildir Tesadfen ve baz hallerde PE olur (irregler)Gerek bir patoloji olarak grlmemeli (cinsel

performansta normal varyasyon)bozulmu ejaklasyonu geciktirme hissiPsikoterapi etkili (medikal tedavi verilmemeli)

4. Prematr benzeri ejaklatuar disfonksiyon

Tahmini prevelans %10-20Gerek bir medikal patoloji deil (psikolojik) cinsel iliki srasnda, devaml veya devaml

olmakszn erken ejaklasyon subjektif algs, Hayali erken ejaklasyon veya ejaklasyon kontrol

eksiklii durumu, IELT normal veya uzun (5-25 dk), ejaklasyonu geciktirme becerisi azalm olabilir. Psikolojik temele dayanr (psikoterapi uygun)

Yeni snflamann bekledikleri

Patofizyoloji aydnlatlmal Epidemiyolojik almalar yaplmal Tedavi modalitelerinin sonular

Medikal vs Psikoterapi vs Kombinasyon

Tanm Snflama ZET PE sk grlen bir erkek cinsel fonksiyon bozukluudur

(%30) Birok tanm 3 komponent (Sre-Kontrol-Sknt) Kanta dayal tanm sadece yaam-boyu PE iin mevcut

(IELT

NROBYOLOJ

J & J Pharmaceutical Services LLC, 2007

Normal erkek cinsel yant

Zaman

Cinsel ilgi/uyar

Penil Tmesans

Artan heyecan Ereksiyon

Penetrasyon

Plato

Orgazm EjaklasyonOrgazm

Penil Detumesans

Rezolsyon

Donatucci den adapte edilmitir (2006) J Sex Med 3(suppl 4):303308

Uyarlma

PresenterPresentation NotesThe normal male sexual response is a sequential process, starting with sexual stimulation, penile tumescence and erection, and culminating in ejaculationnormally associated with orgasmfollowed by detumescence. This can be expressed graphically as a cycle of four phases: excitement, plateau, orgasm (and associated ejaculation), and resolution.

PE

Zaman

Hzl ejaklasyon ve orgazm

Normal yant

Donatucci den adapte edilmitir (2006) J Sex Med 3(suppl 4):303308

Ksa plato faz

Daha dik uyarlma faz

PEde yanl giden nedir?

PresenterPresentation NotesIn men with PE, the entire ejaculatory sequence is curtailed compared with the normal sequence. A very steep excitement phase with a normal erection, is followed by a shorter plateau and a rapid ejaculation and associated orgasm. Although these features are well established, the exact etiology of PE is unknown.

BYOLOJK

FAKTRLER

PSKOLOJK

FAKTRLER

Penil hipersensitiviteHipereksitabilite

Genetik predispozisyonSantral 5-HT sensitivitesi

Erken cinsel deneyimCinsel koullanmaAnksiyetePsikodinamik

Ejaklasyonun nral kontrol: Anahtar supraspinal merkezler

Genital blgeden duysal uyaranlar

Eksitatr & inhibitr kontrol

Hipotalamus:PVN: Paraventrikler nkleusMPOA: Medial preoptik alan

Pons:nPGi: nucleus paragigantocellularis

Talamus

Orta beyin:PAG: Periaquaduktal gri

Korteks

Giuliano & Clement (2006) Eur Urol 50(3):454466

Emisyon ve ejaklasyonla ilgili blgeler

L3-L4

Galanin

Birleik

Truitt & Coolen den adapte edilmitir (2002) Science 297:1566-1569

Spinal Ejaklasyon reteci (L3-L4)

Ejaklasyonu tetiklemek iin gerekli duysal uyaranlar entegre eder

Ejaklasyon refleksi iin sempatik, parasempatik ve somatik ak koordine eder

1. Emisyon SV ve prostat salglaryla semenin oluturulmas

2. Eksplsyon pudental sinir kontrolnde bulbokavernz kas ieren ritmik kaslmalar

PresenterPresentation NotesSchematic representation of the control of the prostate and the bulbospongiosus (BS) muscle by the spinal ejaculation generator (LSt cells) in the rat.

The spinal ejaculation generator projects to the parasympathetic (L5S1) and sympathetic (T13L2) preganglionic neurons, and DM motoneurons (L5L6). The parasympathetic centres project to the prostate via the major pelvic ganglion (MPG) and the pelvic nerve (PN). The sympathetic centres project to the prostate through the intermesenteric ganglion (IMG) and the hypogastric nerve (HN). The motoneurons of the BS muscle project to the muscle through the motor branch of the pudendal nerve. Further evidence for the pivotal role of the lumbar spinothalamic (LSt) neurons as the spinal ejaculation generator comes from studies in the rat. Electrical microstimulation of these neurons activated the entire sequence of ejaculation in anesthetized adult rats: sequential activation of the emission and expulsion phases.

The presence of motile spermatozoa in the ejaculate indicates prostatic secretion, known to be crucial for sperm motility.

Ejaklasyonun nrofizyolojisi

Giuliano & Clement (2005) Ann Rev Sex Res 16:190216

nPGi

Spinal Ejak reteciL3-L4

Ejaklasyon inhibisyonu(5-HT)

Penis dorsal sinir

PresenterPresentation NotesCNS control of ejaculation is mediated via spinal ejaculation centres including lumbar spinothalamic (LSt) cells. These cells integrate peripheral signals from the genital areas with excitatory and inhibitory control from supraspinal centres such as the nucleus paragigantocellularis (nPGi).

The spinal ejaculation generators send co-ordinated outputs to the anatomic structures that allow ejaculation to occur.

The lumbar spinothalamic cells constitute the spinal ejaculation generator, which integrates the sensory inputs and outputs necessary to trigger ejaculation. The spinal ejaculation generator is discussed in more detail on the following two slides (which may be too technical for some audiences). Research in the rat identified a population of neurones in the spinal cord with projections to the thalamus in the brain known as lumbar spinothalamic (LSt) cells.

These cells are specifically activated with ejaculation but not with other components of male sexual behaviour.

Ejaklasyonun nral kontrol: Anahtar supraspinal merkezler

Eksitatr & inhibitr kontrol

Hipotalamus:PVNMPOA

Pons:nPGi

Giuliano & Clement (2006) Eur Urol 50(3):454466

Emisyon ve ejaklasyonla ilgili blgeler

L3-L4

5-HT

nPGi: Ejaklasyon inhibisyonu

PVN / MPOA: Ejaklasyon stimlasyonu

KorteksTalamus

Genital blgeden duysal uyaranlar

PresenterPresentation NotesEmission and ejaculation are centrally integrated and highly co-ordinated processes.

Brain structures involved in the control of ejaculation include:The thalamusStructures in the hypothalamus such as the medial preoptic area (MPOA) and the paraventricular thalamic nucleus (PVN)Structures in the midbrain such as the periaqueductal grey nucleus (PAG)Structures in the pons such as the paragigantocellular nucleus (nPGi)

These structures integrate sensory ejaculation-related inputs from the genital areas with higher excitatory and inhibitory controls.

Ejaklasyonun nrofizyolojisi

Bulbospongiz kasn motor uyars

Giuliano & Clement (2005) Ann Rev Sex Res 16:190216

nPGi

Spinal Ejak reteciL3-L4

Ejaklasyon inhibisyonu(5-HT)

Penis dorsal sinir

Hipogastrik pleks. (T12-L1)

EMSYON

Sempatik Uyar(Epididim, VD, SV, Prostat)

Spinal refleks (S1-S3)EKSPLSYON

PresenterPresentation NotesCNS control of ejaculation is mediated via spinal ejaculation centres including lumbar spinothalamic (LSt) cells. These cells integrate peripheral signals from the genital areas with excitatory and inhibitory control from supraspinal centres such as the nucleus paragigantocellularis (nPGi).

The spinal ejaculation generators send co-ordinated outputs to the anatomic structures that allow ejaculation to occur.

The ejaculation reflex consists of:Emission the generation of semen by structures including the seminal vesicles and the prostat glandExpulsion rhythmic muscular contractions involving the bulbocavernosus muscle controlled by the pudendal nerves

The lumbar spinothalamic cells constitute the spinal ejaculation generator, which integrates the sensory inputs and outputs necessary to trigger ejaculation. The spinal ejaculation generator is discussed in more detail on the following two slides (which may be too technical for some audiences). Research in the rat identified a population of neurones in the spinal cord with projections to the thalamus in the brain known as lumbar spinothalamic (LSt) cells.

These cells are specifically activated with ejaculation but not with other components of male sexual behaviour.

The LSt cells are located within the spinal cord and integrate the sensory inputs and outputs necessary to trigger ejaculation.

McMahon et al, Disorders of orgasm and ejaculation in men. In Sexual Medicine: Sexual dysfunctions in men and women. 2nd International Consultation on Sexual Dysfunctions, Paris, 2004; Donatucci (2006) J Sex Med 3(suppl 4):303308

Ejaklasyondaki nrotransmitterler Serotonin (5-HT) Dopamin (DA) Gama-aminobutirik asit (GABA) Noradrenalin

Ejaklasyonda 5-HT anahtar nrotransmitterdir.

Hipotalamus, beyin sap ve spinal kordda ok sayda 5-HT reseptr var

PresenterPresentation NotesCentral control of ejaculation involved many neurotransmitter systems including serotonin (5-HT), dopamine (DA), gamma-amino butyric acid (GABA) and norepinephrine (NE). Of these, 5-HT is a major player.

Serotonin cell bodies are located in distinct clusters in the brainstem and send extensive projections throughout the brain and spinal cord.

The actions of serotonin are mediated via one of the most extensive receptor systems known. Seven 5-HT receptor classes, encompassing some 14 different receptors, are currently recognized. These receptors and the serotonin transporter are widely distributed with particularly high density in the hypothalamus, brainstem and spinal cord.

Koe & Weismann (1966) Pharmacol Exp Ther 154:499-516; Ahlenius et al. (1971) Psychopharmacologia 20: 383-388; Salis & Dewsbury (1971) Nature 232:400-401; Sdersten et al. (1976) Pharmacol Biochem. Behav 5:319-327; Larsson et al. (1978) Brain Res141:293-303; Giuliano (2007) Trends Neurosci 30(2):79-84

5-HTnin cinsel etkileri

Preklinik aratrmalar erkek ratlarn cinsel davranlarnda 5-HT etkisini ortaya koymuturSantral 5-HTnin erkek ratlarn cinsel davranlar zerinde inhibitr etkisi olduu varsaylr

PresenterPresentation NotesSerotonergic neurons use a variety of mechanisms to regulate their own activity. Serotonin neurotransmission is controlled by several negative feedback mechanisms, including the 5-HT transporter re-uptake system. As 5-HT is released, 5-HT transporters are activated to remove 5-HT from the synaptic cleft, and thus prevent over-stimulation and desensitization of postsynaptic receptors.

The observation that chronic treatment with selective serotonin reuptake inhibitors (SSRIs) is associated with sexual dysfunction, including delay of ejaculation, suggests that serotonergic pathways are involved in central control of ejaculation.

The actions of serotonin are mediated via one of the most extensive receptor systems known. Seven 5-HT receptor classes, encompassing some 14 different receptors, are currently recognized. These receptors and the serotonin transporter are widely distributed with particularly high density in the hypothalamus, brainstem and spinal cord.

Nrobiyoloji zet Ejaklasyon, spinal ejaklasyon reteci (spinotalamik

nronlarL3-L4) olarak bilinen hcrelerce koordine edilen bir reflekstir

Ejaklasyon beynin st merkezlerince kontrol edilir nPGi nhibe (5-HT) MPOA ve PVN Stimle

Seratonin ve seratonerjik yolaklar beyinden gelen uyarlar regle etmede anahtar rol oynar

SSSde seratonin seviyesinin ykselmesi ejaklasyonu geciktirir

Erkek cinsel salndaki karanlk blge!!!

Teekkrler

Prematr ejaklasyon snflama ve nrobiyolojide gncel bilgilerPrematr EjaklasyonSlide Number 3TANIM SINIFLAMAEski TanmlarEski Tanmlar1. Klasik seksolojik tanmlamalar2. DSM-IV-TR3. ICD-104. AUA guidelines5. ICSD/ICUDEski TanmlarEski Tanmlarntravajinal ejakulatuar gecikme zaman = IELTYaam-boyu PE hastalarnda IELT ne kadar?PE hastalarnda IELT (n=989)Toplum genelinde IELT nasl? Normali ka?US observational study (PE tansnda DSM-IV-TR kriterleri)ISSM toplantsYaam-boyu PE iin ISSMnin kanta dayal tanmICD-11 ve DSM-V nerileri1. Yaam boyu PE2. Kazanlm PE3. Doal Deikenli PE4. Prematr benzeri ejaklatuar disfonksiyonYeni snflamann bekledikleriTanm Snflama ZETNROBYOLOJNormal erkek cinsel yantPEde yanl giden nedir?Slide Number 31Ejaklasyonun nral kontrol: Anahtar supraspinal merkezlerSpinal Ejaklasyon reteci (L3-L4)Ejaklasyonun nrofizyolojisiEjaklasyonun nral kontrol: Anahtar supraspinal merkezlerSlide Number 36Ejaklasyonun nrofizyolojisiSlide Number 38Ejaklasyondaki nrotransmitterler5-HTnin cinsel etkileriNrobiyoloji zetSlide Number 42