接受正統療法 改善早洩問題 2015-12-17 09:32:01 經濟日報 劉靜君 最近門診來了位近40歲的已婚男性求診，面容沮喪，邊搖頭邊訴苦說快被老婆「辭頭路」了。一問之下原來老婆每次跟他在一起都嫌他「沒凍頭」，強迫他到泌尿科求診，威脅若再沒改善就要離婚。經過幾次門診心理治療及建設後，病人同意接受行為療法及藥物治療，才重獲老婆「芳心」，免除一場悲劇發生。新竹縣東元綜合醫院泌尿科主任戴順慶醫師表示，國內男性每3位就有1位有早洩困擾，但接受治療的比例不到10％。早洩是指男性陰莖準備進入陰道前或剛進入陰道，在1分鐘內就發生無法控制的射精，導致伴侶對性生活不滿意。早洩會引發自信心低落、焦慮羞愧及性伴侶間的關係惡化，也會讓患者逃避性生活，形成惡性循環。根據調查，早洩盛行率在30％左右，估計國內約有200萬男性有此困擾。治療早洩的方法有口服藥物、麻醉軟膏、行為療法及陰莖背面部分神經截斷術等。過去，醫師只能建議患者採用行為療法避免龜頭過度興奮或服用抗憂鬱症藥物，以延長射精時間，但這些都缺乏大規模臨床試驗證實療效，也缺乏長期追蹤。2014年2月，台灣醫學中心通過大型臨床試驗及衛福部核可的藥物已在台上市。戴順慶醫師說，有早洩困擾者應勇於尋求正統療法，諮詢專業泌尿科醫生提供最有效的藥物建議，使用經臨床研究、主管機關核可的治療藥物才能根本改善，也不會影響自身健康。早洩的治療必須要有耐心，通常療程經過4周或6次的藥物治療後，由醫師評估療效，以達到最適當的治療成果。對於無法控制射精時間的男性，請盡快到各大醫療院所找泌尿科醫師治療，讓您與伴侶擁有持久的幸福。
專剋「膛炸」拯救20歲到70歲男的陰影 2015-05-1414:59 〔記者王駿杰／竹縣報導〕新竹縣一名20多歲的男大生，每次才觸碰、親吻女友，連褲子都還沒脫就「膛炸」，提早繳械，不但被女友翻白眼、遭嗆「凍嘸久」，他也因過度自卑，再也不敢和女友發生親密關係，形容自己罹患「早洩的五十道陰影」，最後只好就醫求助。 東元綜合醫院泌尿中心主任戴順慶說，早洩的問題在於體質，主要為男性生殖器龜頭過敏感，導致性愛時間短於兩分鐘，門診幾乎每3名男性就有一位是早洩求診者，其中以20至40歲的年輕人最多。幸運的是，台灣去年已核准第一個專門治療早洩的藥物－必利勁（Priligy），他的門診去年共收治66名男性，年齡涵蓋20歲至80歲，治療時間從一週到一個月都有，結果顯示，有53人的性愛時間明顯延長至少4倍，不再「一觸即發」！ 戴順慶指出，必利勁的主成分為Dapoxetine，能增加血清素在大腦停留，只需要一小時前服用，就能有效延長射精時間，成功率約八成，比坊間相傳戴兩層保險套、做愛前先瘋狂自慰一次、塗抹麻醉藥膏在龜頭上、性交中斷法及服用傳統抗憂鬱藥物等都來的有效。 必利勁現為醫師處方用藥，須在醫生囑咐下服用，屬錠劑，一盒3粒，原則上以一週3顆為一個療程，但食用後會有輕微頭暈、嘔吐等副作用，待年底衛生福利部評估許可後，就可在各大藥房鋪貨。
Dapoxetine, marketed as Priligy and Westoxetin, among and other brands, is the first compound developed specially for the treatment of premature ejaculation (PE) in men 18–64 years old. Dapoxetine works by inhibiting the serotonin transporter, increasing serotonin's action at the post synaptic cleft, and as a consequence promoting ejaculatory delay. As a member of selective serotonin reuptake inhibitor (SSRI) family, dapoxetine was initially created as an antidepressant. However, unlike other SSRIs, dapoxetine is absorbed and eliminated rapidly in the body. Its fast acting property makes it suitable for the treatment of PE but not as an antidepressant.
Originally created by Eli Lilly pharmaceutical company, dapoxetine was sold to Johnson & Johnson in 2003 and submitted as a New Drug Application to the Food and Drug Administration (FDA) for the treatment of PE in 2004. Dapoxetine has been sold in several European and Asian countries, and lately in Mexico. In the US, dapoxetine has been stuck in phase III development since 2003. However, it is expected to be marketed soon. In 2012, Menarini acquired the rights to commercialise Priligy in Europe, most of Asia, Africa, Latin America and the Middle East. The mechanism through which dapoxetine affects premature ejaculation is still unclear. However, it is presumed that dapoxetine works by inhibiting serotonin transporter and subsequently increasing serotonin's action at pre and postsynaptic receptors. Human ejaculation is regulated by various areas in the central nervous system (CNS). The ejaculatory pathway originates from spinal reflex at the thoracolumbar and lumbosacral level of spinal cord activated by stimuli from male genital. These signals are relayed to the brain stem, which then is influenced by a number of nuclei in the brain such as medial preoptic and paraventricular nulcei. Clement's study performed on anaesthetized male rats showed that acute administration of dapoxetine inhibits ejaculatory expulsion reflex at supraspinal level by modulating activity of lateral paragigantocellular nucleus (LPGi) neurons. These effects cause an increase in pudendal motoneuron reflex discharge (PMRD) latency. However, it is unclear whether dapoxetine acts directly on LPGi or on the descending pathway in which LPGi located. Quoted from Wikipedia
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