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Hereditary, Hormones or Hair Dryers: What’s Causing Your Hair Loss?

Posted Thursday 16 May 2019 14:04 by in Hair Loss by Tim Deakin

hair loss treatment

Hair loss is rarely something to worry about from a medical standpoint. Losing hair to some degree is normal for everybody. We tend to lose between 50 and 100 hairs a day without noticing.[1]

But for many people, the onset of balding can be emotionally distressing. High levels of hair loss can take its toll on your confidence and overall wellbeing, and you may be left feeling powerless and confused.

Understanding what’s behind your hair loss is the first step to overcoming these feelings. We’re going to take a closer look at this condition, including many of the myths that surround it and the possible treatments available.

What is hair loss?

Hair loss can often be a distressing experience, and in many instances it has a significant detrimental effect on the sufferer’s quality of life[2] with people suggesting that it contributes to low self-esteem. The most common form of hair loss is male pattern baldness, or male pattern hair loss.

In the case of male pattern hair loss, high levels of androgens, including DHT, can shrink your hair follicles and shorten the growth cycle, which can cause hair to appear thinner and more brittle.[3] DHT (dihydrotestosterone) is a by-product of testosterone.

What causes hair loss?

Hair loss can be the result of many different factors, from stress and family history to nutrition and diet.[4] In certain situations, hair loss can be the sign of a larger health concern, such as iron deficiency, extreme weight loss or cancer treatment.[5]

But with so many factors involved in hair loss, a great deal of misinformation gets spread about the condition. This makes it even more confusing to work out exactly what is behind your symptoms. Let’s explore some of the widely regarded facts and myths surrounding hair loss.

Swimming?

For a long time, people have held the belief that continuously exposing your hair to pool-water can lead to baldness. This is largely based on the course, dry feeling of your hair after using a pool treated with chlorine.

However, evidence suggests that in order for swimming to be the sole cause of hair loss, the swimmer would have to be allergic to the pool’s chemicals, or the chlorine levels would need to be dangerously high.[6]

Hats?

Another common untruth surrounding hair loss is that wearing a hat can make it more likely. However, while it is true that frequent hat wearing can lead to the loss of hairs, these hairs would have to be vulnerable to shedding already in order to be affected. In other words, you need to already be at risk of hair loss in order to lose your hair as a result of wearing a hat, meaning your hat isn’t to be held responsible.[7]

Hair dryers?

Similarly, drying your hair with a hair dryer is unlikely to be the sole cause of significant hair loss. However, hair loss can occur as a result of overtreating your hair.

This form of hair loss, known as traumatic alopecia, is caused by potentially damaging hairdressing techniques. These include pulling the hair into tight braids, twisting the hair, exposing the hair to extreme heat or bleaching the hair with strong chemicals.[8]

Stress?

Anxiety can lead to hair loss. This connection may present itself in several different ways. For example, stress may cause you to pull at your hair as a nervous habit, or your diet may suffer meaning your hair becomes weaker and more susceptible to falling out.

Telogen effluvium is a specific form of hair loss which occurs following a major body stress, such as major surgery, serious infection or a prolonged illness. It can also happen after a significant change in hormones, such as for women after giving birth.[9]

Hormones?

It is thought that, overall, hormones do have a role to play in hair loss. In the past, the level of testosterone itself has been thought to have an impact on male baldness. However, more recent studies appear to contradict this theory. One German study found that total testosterone was not significantly associated with general hair loss in male participants.[10]

In fact, as outlined earlier, it is a particular by-product of testosterone – DHT – which is at the root of much male pattern baldness.

Female pattern hair loss (FPHL) can occur at any age, although it is most common during the menopause. This does not necessarily mean that hormones are solely responsible, but oestrogen may have a protective role. Genetics are thought to be an important factor in FPHL.[11]

Genes?

A family history of hair loss can increase your risk of suffering from hair loss, particularly male pattern baldness. Male pattern baldness or male pattern hair loss (MPHL) is the most common type of hair loss among men, affecting as many as half of men over the age of 50.[12] It is also known as androgenetic alopecia. It is thought that men are more susceptible to the symptoms of MPHL if they have a family history of the condition.

How to prevent or reverse hair loss

There are many different factors which have been suggested as ways to avoid hair loss, from changing your hair products to investing in technology like a laser comb.[13] Sometimes, studies occur which seem to offer hope to sufferers of hair loss. For example, a 2016 Japanese study found that scalp massages increased hair thickness in 24 weeks.[14] While encouraging, results like these do not necessarily mean that such treatments will work in all cases of hair loss.

Some of the more extreme treatments for hair loss include hair transplantation, scalp expansion or reduction, flap surgery and skin lifts and grafts.[15]

Medications like Propecia and its generic equivalent, Finasteride, have been proven to effectively slow and even reverse the symptoms of male pattern baldness. After two years of treatment, 99% of men had visible results – 66% had hair growth and 33% had no further hair loss.[16]

As such, many men suffering from hair loss find medication to be the safest and most effective way to treat their symptoms.

Discover effective hair loss treatment at Express Pharmacy. If you have any queries about your health, don’t hesitate to get in touch. Contact our NHS-approved pharmacists today by calling 0208 123 07 03 or leave your enquiry by using our discreet online Live Chat service.

[1] NHS UK. Hair Loss. 2018.

[2] Phillips, TG., Slomiany, WP., Allison, R. Hair Loss: Common Causes and Treatments. American Family Physician. 2017.

[3] Healthline. What You Need to Know About DHT and Hair Loss. 2019.

[4] MedicinePlus. Hair Loss. U.S. National Library of Medicine. 2019.

[5] NHS UK. Hair Loss. 2018.

[6] Belgravia Centre. Can Swimming Pools Cause Hair Loss? 2013.

[7] LiveStrong. How Do Hats Cause Thinning Hair? 2017.

[8] Harvard Health Publishing. Hair Loss: What is it? 2018.

[9] Harvard Health Publishing. Hair Loss: What is it? 2018.

[10] Kische, H. Arnold, A., Gross, S., Wallaschofski, H., Volzke, H., Matthias, N., Haring, R. Sex Hormones and Hair Loss in Men from the General Population of North-Eastern Germany. JAMA Dermatology. 2017.

[11] Women’s Health Concern. Menopausal Hair Loss. 2018.

[12] British Association of Dermatologists. Male Pattern Hair Loss (Androgenetic Alopecia). 2012 [Reviewed 2019]

[13] The Guardian. Seven ways… to avoid hair loss. 2018.

[14] Koyama, T., Kobayashi, K., Hama, T., Murakami, K., Ogawa, R. Standardized Scalp Massage Results in Increased Hair Thickness by Inducing Stretching Forces to Dermal Papilla Cells in the Subcutaneous Tissue. Eplasty. 2016.

[15] UCLA Health. Hair Loss. UCLA Dermatology. 2018.

[16] Kaufman, K. et al. Finasteride in the treatment of men with androgenetic alopecia. Finasteride Male Pattern Hair Loss Study Group. Journal of the American Academy of Dermatology. 1998.

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Is the Common Cold More Common in Spring?

Posted Tuesday 07 May 2019 16:32 by in Hay Fever and Allergy Relief by Tim Deakin

common cold

As its name suggests, the common cold is one of the most prevalent health conditions around the globe. Almost all UK adults will experience a cold at some point int their lifetime, but luckily, the condition tends to be mild. Usually lasting no more than a week or two, the common cold can generally be treated with rest, sleep and plenty of fluids.[1]

Although we tend to think of a cold as something that strikes in winter, research shows that the condition can easily catch us off guard as the weather gets warmer.

Are colds more common in spring?

A study published in the American Society for Microbiology found that, although the common cold is most dominant in winter, the arrival of spring sees it get a second wind.[2] So though the cold can be seen as a winter condition, it can still strike as the temperature rises.

This is partly because any shift in climate and season can leave us more vulnerable to illness. Our bodies get used to dealing with a certain kind of environment, so when that changes it can force the body into a period of adjustment. This is a view shared by Dr Bradley Chipps, president of the American College of Allergy, Asthma and Immunology, who states that changes in barometric pressure, temperature and wind can compromise your immune system’s built-in defences against cold and flu.[3]

It’s also possible that people are more likely to venture outside in spring and interact with others. This is good for our overall health, but potentially risky when it comes to colds. The weather may have warmed up a bit but could still be cool enough to encourage the spread of cold viruses. Factors like these may account for studies that have found spring to be an even more important time for rhinovirus transmission than the early autumn.[4]

Are spring and summer colds worse than their winter counterparts?

The rhinovirus is the most common cause of the cold, responsible for as many as 50% of cold infections.[5] Rhinovirus has been shown to thrive best in colder, drier climates[6] but other causes of cold-like symptoms, such as enteroviruses, are more common in the summer and can lead to more severe symptoms.[7]

A study published in Health Psychology found that spring and summer colds can feel worse than winter ones because they’re unexpected, and patients feel like they’re suffering alone. In other words, feeling like your missing out on fun in the sun can actually make your symptoms feel worse.[8]

In some cases, people may experience cold-like symptoms when they’re actually suffering from common springtime health concerns – typically hay fever. Allergic rhinitis, or hay fever, is an allergic reaction to pollen, which starts to become more prevalent in the atmosphere during spring. Between 10 and 30% of all adults suffer from hay fever[9], and symptoms can include sneezing, coughing, a blocked nose, itchy eyes, headaches and lethargy, all of which are also common in colds.[10]

So while the common cold may be at its most common in winter, it’s a good idea to take precaution against the condition all year round.

Find safe and effective antihistamine medication here at Express Pharmacy. Click here to see our hay fever treatments for yourself or get in touch with our team today by calling 0208 123 07 03. You can also use our discreet Live Chat system to discuss your health concerns.

[1] NHS UK. Common Cold. 2017

[2] Jacobs, SE., Lamson, DM., George, KS. & Walsh, TJ. Human Rhinovirus. American Society for Microbiology. 2013.

[3] Heid, M. Why are you more likely to get sick when the seasons change? TIME Magazine. 2018.

[4] Monto, AS. The seasonality of rhinovirus infections and its implications for clinical recognition. Clinical Therapeutics. 2002

[5] Annamalay, AA. et al. Prevalence of and Risk Factors for Human Rhinovirus Infection in Healthy Aboriginal and Non-Aboriginal Western Australian Children. 2013.

[6] Ikäheimo, TM. et al. A Decrease in Temperature and Humidity Precedes Human Rhinovirus Infections in a Cold Climate. 2016.

[7] NIH. Catching a Cold When It’s Warm. 2012

[8] LeRoy, AS., Murdock, KW., Jaremka, LM., Loya, A. Loneliness Predicts Self-Reported Cold Symptoms After a Viral Challeneg. Health Psychology. 2017.

[9] Allergy UK. Allergic Rhinitis (Hay fever). 2013

[10] NHS UK. Hay Fever. 2017

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Your Common Sense Guide to Malaria

Posted Friday 03 May 2019 12:44 by in Anti Malaria by Johanna Galyen

High Fevers. Bone-breaking Chills. Abdominal Pain. And, oh, those muscles aches. Like you’ve just hiked 10 kilometres straight uphill with no relief! With symptoms like these, should you even visit countries that are at risk for malaria? Is it worth taking the chances? What should you do? Should you even travel?

The answer is a cautious maybe. Careful planning and taking the right precautions can help to ease any fears you have about travelling abroad. And it is always wise to “think about health in advance of your trip," says Bradley Connor, MD, a travel health specialist at Weill Medical College of Cornell University.

Here is some common sense advice to help keep you free of malaria:

1. Understand What Malaria Is

According to the World Health Organisation (WHO), malaria is caused by the Plasmodium parasite that the female Anopheles mosquito is infected with; this incredibly tiny parasite attaches itself to the mother mosquito and when she bites humans to feed her growing eggs, she injects the parasite into the human host as well.

The parasite makes its way through the bloodstream and eventually lands within the liver to grow. Each little parasite attaches itself to red blood cells, and produces more parasites until the red blood cell bursts open. When this happens, it releases all the growing parasites to attach themselves to even more red blood cells, and you start to feel very, very sick.

There are five specific species of the Plasmodium parasite that a mosquito can carry:

Plasmodium falciparum

Plasmodium malariae

Plasmodium vivax

Plasmodium ovale

Plasmodium knowlesi

Of the five types, plasmodium knowlesi is rarely contracted by humans, as it typically only infects monkeys. The deadliest of the types is Plasmodium falciparum. Scientists Against Malaria say, “Almost every malarial death is caused by P. falciparum” as it has a unique ability during the multiplication of the parasite to make the red blood cells become very sticky in the veins and capillaries. If the parasite is not treated (and killed) by medication, it can kill the person by clogging the blood supply that feeds the brain or other vital organs.

The other three types of malaria (malariae, vivax, ovale) can cause a great deal of misery, but they are rarely fatal.

2. Know the Hotspots for Malaria

When considering places to visit, remember, mosquitoes like warm and moist areas. Warm areas that have lakes, streams, rivers, and jungles. Most notably these will be in the tropics and subtropical areas where mosquito populations are greatest. Deserts typically have much lower mosquito populations due to the dry, arid conditions but in areas with water, such as an oasis, malaria-carrying mosquitos may be found.

According to the Centers for Disease Control, “The highest transmission is found in Africa, South of the Sahara, and in parts of Oceania such as Papua New Guinea.” If you are travelling anywhere along the equator, it is good to research your trip’s locations to see if you are at risk of contracting malaria. Fit for Travel is one such excellent website that can provide you with the most up-to-date information.

3. Be Prepared

Anti-malarial medications can help to kill the Plasmodium parasite within your body, and there are three main options to choose from:

Malarone – This medicine is started two days before your trip and continues for one week after you return. Side effects are usually minimal as this medicine is well tolerated in most people, but they can include coughing, headache, nausea, dizziness, and weakness.

Doxycycline – The medicine is taken two days prior to the beginning of your travels, and it continues until four weeks after your return. Side effects can be a heightened sensitivity to sunlight (you can get a nasty sunburn), and it can also cause blurred vision, headache, thrush, and diarrhoea.

Lariam – A once-a-week table to prevent malaria; this medicine is started (preferably) two weeks prior to your trip and continued until four weeks after your return. Lariam can cause some noticeable side effects like nausea, headache, abdominal pain, convulsions, nightmares and even depression.

4. Understand Your Current Health

Dr. Bradley Connor also says “If you have a chronic health problem, get a check-up before you leave." Travelling can bring out the best and worst in your health, so it is good to know what you are dealing with prior to leaving to ensure that you will feel great on your trip.

There are some travellers who should not visit areas that are endemic with malaria. Women who are currently pregnant should avoid travelling to areas with malaria if at all possible. The CDC states “infection in pregnant women can be more severe than in nonpregnant women. Malaria can increase the risk for adverse pregnancy outcomes, including prematurity, abortion, and stillbirth.”

Those who previously lived in endemic malaria areas, moved away, and want to return should also carefully reassess their health. For some types of malaria, the body can create immunities against the parasite. However, this immunity can quickly lessen over time, and they will be at the same risk as a first-time traveller.

Who else should be cautious about their health in areas with malaria?

Those on immune-suppressing drugs

Organ transplant patients

People undergoing chemotherapy or radiation therapy

Those who have recently undergone surgery or suffered a heart attack or stroke

5. Prevention 101: Don’t Get Bitten!

One of the best ways to avoid being bitten by the mosquito is to keep it away from your skin. Try these easy steps:

Stay inside during the late evening and early morning hours when mosquitoes are most active.

Wearing long sleeved clothing, trousers, and long skirts can help to shield you from the bites. Note: keep those shirt-tails tucked in to protect your back and stomach areas.

Wear socks and shoes; no sandals. It also helps to tuck your trousers into your socks to ensure that no skin is exposed.

Always sleep under a mosquito net – preferably one that has been treated with an insecticide.

Use bug spray that has 20-40% DEET in it. Picaridin and Lemon Eucalyptus oil are DEET-free options that can be used, but remember, they should be applied more frequently to provide the right protection.

6. Know The Symptoms

Most children and travellers know the sight of a mosquito bite; it is a red, raised itchy bump on your skin. However, the female Anopheles mosquito does not leave a mark at all. Additionally, the mosquito’s saliva can act as an anaesthetic, so most people do not even know that they were bitten by the mosquito until the symptoms start showing. Because of this, it is important to know the symptoms of malaria. The treatment of the disease works better and faster when it is first discovered versus waiting until you are extremely sick.

According to WebMD, the symptoms are shaking chills, high fever, profuse sweating, headache, nausea, vomiting, abdominal pain, yellowing skin, diarrhoea, muscle pain, convulsions (like a seizure), and bloody stools.

7. Keep Your GP Informed

Your general practitioner (GP) should be informed of your travels to areas that have malaria. This information can help them prepare you for the trip and keep you healthier. Additionally after, returning from these areas, you may want to have a follow-up appointment as well. This may seem as if you are overdoing it, but malaria can mimic many different illnesses initially. It can appear as flu-like symptoms, migraines, gastrointestinal illness (stomach bug), and even worse conditions like seizures or bleeding in the intestines. If your GP knows that you have visited areas with malaria, they can be vigilant to order the right tests if you do become ill.

Another important consideration is Plasmodium vivax. This type of malaria is one of the more confusing types. It can lie dormant (asleep) within your body for months or years, and then suddenly arise causing many symptoms. While it is typically not fatal in of itself, it can interfere with your current health problems and worsen them. If you already have difficult, chronic health conditions, you may struggle more than usual

It is our goal here at Express Pharmacy that you return from your travels with happy memories and are as healthy (or even healthier!) than when you left. Being prepared for malaria is very important, and we are here to help you get ready in the most effective way possible. Discover medications for your anti-malarial needs – here at Express Pharmacy. We can help you gain access to effective treatment swiftly and discreetly. Contact us today by calling 0208 123 07 03 or by using our online Live Chat service.

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Can Kegel Exercises Prevent Premature Ejaculation?

Posted Friday 26 April 2019 13:17 by in Premature Ejaculation by Tim Deakin

kegel for premature ejaculation

Premature ejaculation is the term used to describe a situation in which a man reaches climax too quickly during sexual intercourse. It’s the most common ejaculation problem in the UK[1] and estimates of how many men are impacted by premature ejaculation vary widely, ranging from just 5% to 31%.[2] This is largely due to the fact that it can be difficult to define how soon is too soon when it comes to reaching orgasm.

But one potential way to help treat the condition is with kegel exercises. We’re going to take a closer look at these exercises and determine whether they truly are the best way to tackle premature ejaculation.

What are kegel exercises and how can they help?

Kegel exercises are designed to strengthen your pelvic floor muscles, which can impact your sexual function and performance. Generally speaking, your pelvic floor muscles are the muscles on your thighs, buttocks and lower abdomen.

Common kegel exercises involve simply contracting these muscles, holding for five seconds and then relaxing them. Repeat this up to ten times, pausing in between for five seconds of relaxation. These are known as slow kegels.

Over time, you can start to increase the length of time you contract your muscles for. You can also move on to fast kegels, which involve the exact same movements but carried out at a faster speed. Good times to practice kegel exercises include when you wake up in the morning, after going to the toilet and before going to bed.

Pelvic floor rehabilitation such as kegel exercises have been shown to be an effective means of delaying premature ejaculation, as they help to strengthen the pubococcygeus muscle. One study found that, after 12 weeks of pelvic floor muscle rehabilitation, 82.5% of participants had gained greater control of their ejaculatory reflex.[3]

Other ways to treat the condition

Although kegel exercises have proven to be an effective means of treatment for some premature ejaculation sufferers, their effectiveness has not been officially established and they are not guaranteed to prevent premature ejaculation in everybody.

Other treatment options include the “stop-start technique”, in which the male sex partner pauses sexual interaction or masturbation if they feel they are close to orgasm, and waits until the feeling passes before continuing.[4] If the sufferer is in a relationship, talking openly with your partner about your concerns and working around the issue together is highly recommended. Behavioural therapy is thought to help 60-90% of men with the condition, but it requires cooperation from both partners.[5]

What is the most effective way to tackle premature ejaculation?

Finding the right treatment for premature ejaculation depends largely on the individual case, and particularly what has caused the problem. If the issue is psychological, it may be that therapy is the best course of action. For many people, effective medication is the most dependable means of treatment.

Studies have revealed the effectiveness of medication options like Priligy. In one study, sexual satisfaction of participants increased from 50% at the beginning of the study to 80% at the end of the study, compared to 55% from participants using a placebo drug.[6]

Discover effective premature ejaculation treatment from Express Pharmacy by clicking here. For more information on the condition, get in touch with our team by calling 0208 123 07 03 or by using our discreet online Live Chat service.


[1] NHS UK. Ejaculation problems. 2016

[2] Sexual Advice Association. Ejaculation problems. 2016

[3] Pastore, AL. et al. Pelvic floor muscle rehabilitation for patients with lifelong premature ejaculation: a novel therapeutic approach. 2014. Therapeutic Advances in Urology. 2014.

[4] NHS Lanarkshire. Sexual Difficulties: Premature Ejaculation. Lanarkshire Sexual Health. 2019

[5] Harvard Health Publishing. Premature Ejaculation. Harvard Medical School. 2017

[6] McCarty, EJ. And Dinsmore, WW. Dapoxetine: an evidence-based review of its effectiveness in treatment of premature ejaculation. Core Evidence. 2012

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Can Premature Ejaculation Be Controlled?

Posted Sunday 21 April 2019 12:52 by in Premature Ejaculation by Tim Deakin

premature ejaculation medication

You may not always hear men admit it, but premature ejaculation is one of the most widespread sexual health concerns amongst males in the UK, along with erectile dysfunction. As many as one in three men suffer from premature ejaculation, although less than a quarter of men with the condition actually seek medical help for it.[1]

And because men find the condition difficult to talk about, it’s common for those suffering with premature ejaculation to feel completely alone and almost powerless. But this doesn’t have to be the case. We’re exploring the different means and methods involved in controlling this condition, from potential home remedies to psychological factors and effective medications.

Self-Help for premature ejaculation

There is no guaranteed way to determine how soon is too soon when it comes to ejaculation. This makes it difficult to define what we mean by premature ejaculation. Often, it comes down to sufferers of the condition finding a treatment which helps them last as long as they feel comfortable with, rather than aiming for a specific time.[2]

There are some simple precautions and measures you can undertake yourself at home which have shown signs of improving symptoms of premature ejaculation for some sufferers. These are listed as self-help treatments by the NHS[3] and include:

  • Using a thick condom in order to decrease the stimulation caused by intercourse
  • Taking a deep breath to briefly stop the ejaculatory reflex
  • Having sex with your partner on top, allowing them to pull away when you are close to climax
  • Masturbating oneto-two hours before engaging in sexual intercourse
  • Taking breaks during sex and thinking about other things to distract yourself

Treating the psychology of premature ejaculation

It’s common for psychological factors to be involved in many cases of premature ejaculation. Some health professionals believe that early sexual experiences can establish a pattern that becomes difficult to change, such as situations where climax had to be hurried in order to avoid being discovered.[4]

Factors like anxiety and relationship problems are also thought to make sexual conditions like premature ejaculation more likely to occur, so dealing with these wider issues through means such as couples’ therapy can often help to lessen symptoms. Often, premature ejaculation can increase symptoms of anxiety and depression, which can in turn make premature ejaculation even worse, creating a vicious cycle.[5]

Working together with your partner to prolong the sexual experience can be helpful, such as increasing foreplay or making use of the ‘start-stop’ technique.[6]

Premature ejaculation medication

Medical treatment for premature ejaculation is often found to be the most reliable and long-lasting of options for sufferers. These treatments can range from oral medication in the form of SSRIs to topical anaesthetic creams.

Priligy, or dapoxetine, is the first pharmacological treatment for premature ejaculation to be licensed in the UK. Results from clinical trials found that many more men reported that their symptoms were ‘better’ or ‘much better’ with Priligy than with a placebo drug.[7]

Safe and effective medication for premature ejaculation is available from Express Pharmacy. Discover Priligy and the topical cream Emla on our site today. If you have any further queries about your condition, don’t hesitate to get in touch by calling 0208 123 07 03 or by using our discreet online Live Chat service.


[1] The British Association of Urological Surgeons. Premature Ejaculation. 2019

[2] Waldinger, MD. Relevance of an evidence-based ejaculation time cut off point for neurobiological research of premature ejaculation. J.Comp. Neurol. 2005

[3] NHS UK. Can premature ejaculation be controlled? 2017

[4] Psychology Today. Premature Ejaculation: Causes and 10 Tips for Treatment. 2015

[5] Patrick, DL., Althof, SE., Pryor, JL. et al. Premature ejaculation: an observational study of men and their partners. J. Sex. Med. 2005.

[6] Cooper K., Martyn-St James M., Kaltenthaler, E. et al. Behavioural therapies for management of premature ejaculation: a systematic review. Sex. Med. 2015

[7] National Institute for Health and Care Excellence. Premature ejaculation: dapoxetine. 2014

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