Premature Ejaculation
Premature ejaculation: ejaculation occurs sooner than desired, either before or shortly after penetration. 
Up to 30% of patients may report concomitant erectile dysfunction.
Along with Erectile dysfunction, premature ejaculation makes up for 90% of sexual dysfunction in Men
Causes & Diagnosis

reason for PME is complex and multifactorial 

Any painful focus over the penis (tight frenulum) and Prostatitis can result in PME.

Detailed history taking and examination by Urologist/ Andrologist is must.
Treatment of PME
1- Reducing stimulation: Usage of condoms, local anaesthetic sprays and Circumcision and in extreme cases dorsal neurectomy is helpful.
2- Correction of erectile dysfunction
3- Medical therapy with selective serotonin reuptake inhibitors (SSRI) & tricyclic antidepressant 
4- Specialized delay techniques 

Retrograde ejaculation
Backward flow of semen into the Urinary bladder. 
 maybe caused by 
1-anatomic abnormalities of the bladder neck,
a-transurethral prostate surgery, 
b-urethral strictures, 
2-Neurological Factors Affecting the bladder neck sphincter. 
a-spinal cord injury, 
b-diabetes mellitus, 
c-retroperitoneal surgery
d-multiple sclerosis, 
e-peripheral neuropathy 
a-alpha-blocker therapy, 
It depends on the presentation and cause.
1- If caused by medications then removal of medication and changing dosage may correct it
2- in case of presentation with infertility semen sample can be retrieved from post-coital urine can be utilized for fertilization.
3- Medical therapy may be useful in some neurological causes.
Blood in Semen.
Causes & Diagnosis
1- Bacterial Infection
2- Tuberculosis
3- Genitourinary malignancy
Investigations required
1- Semen analysis
2- Semen Culture
3- PSA test
4- Special tests for TB
5- MRI Pelvis
6- Flexible Cystoscopy
1- Cases caused for Bacterial Infection will need specially tailored Cocktail therapy as this condition is resistant to standard antibiotic therapy.
2- cases which fail to respond to standard therapy need to be evaluated extensively for genitourinary tuberculosis which needs to be treated by antituberculosis therapy.
3- Patients with suspected cancer needs to be treated based on site of malignancy.
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