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Inhibited ejaculation (IE) is less common than PE The prevalence of IE in the general male population was found to be 15 in 1000 [73] The prevalence of acquired IE in men below the age of 65 years was 3 to 4% [73] IE can be classi ed as either lifelong or acquired It may be global, occurring with every sexual encounter and all sexual partners, or it may be intermittent and situational Some men with acquired IE can masturbate to orgasm, whereas others will or cannot Approximately 75% of a recent clinical sample could reach orgasm through masturbation [74] As is the case with other types of sexual dysfunction, men with IE may report signi cantly higher levels of personal and relationship distress, sexual dissatisfaction, sexual performance anxiety and general health issues compared to sexually-functional controls [10,75] A distinguishing characteristic of these men is that they typically have no dif culty attaining or keeping their erections, yet report lower levels of subjective sexual arousal compared with sexuallyfunctional controls [76]

Social Entrepreneurs Social entrepreneurs prove that a worldwide impact can be made by relatively few individuals Some of these efforts are modest For example, Soraya Salti, a 37-year-old Jordanian woman is trying to transform the Arab world by teaching entrepreneurship in schools Her organization, Injaz, is now training 100,000 Arab students each year to nd a market niche, construct a business plan, and then launch and nurture a business The program has spread to 12 Arab countries and is aiming to teach one million students a year Girls, in particular, have ourished in the program, which has had excellent reviews and is getting support from the US Agency for International Development Or consider Cinepop, the brainchild of Ariel Zylbersztejn, a 27-year-old Mexican Ninety percent of Mexicans can t afford to go to movies, so he started his own Cinepop, which shows movies on in atable screens in public parks for free He sells sponsorships to companies to advertise to the thousands of viewers who come to watch the free entertainment Cinepop is only three years old, but already 250,000 people a year watch movies on his screens and his goal is to take the model to Brazil, India, China, and other countries But perhaps the most far-reaching and global of the social entrepreneurial projects is Kivaorg In 2005, more than 20 years after Grameen Bank pioneered the idea of microlending, Matt (Continued )

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ent or efferent nerve supply to the vas, bladder neck, pelvic oor or penis, can result in IE, anejaculation and anorgasmia (Table 161) However, the majority of men with IE have no clear somatic etiology Rather than assuming a psychogenic etiology for these men, their classi cation should be veri ed through an appropriate psychosexual history Similar to other sexual problems, most cases of IE result from a mix of organogenic and psychogenic factors

In the discussion of organogenic causes of IE, it is essential to distinguish between physiologic and pathophysiologic factors Physiologic refers to those that are biologically inherent to the system, perhaps hardwired through genetic and normal maturational processes Pathophysiologic refers to

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Any single or combination of psychologic or medical diseases, surgical procedure or drugs that interfere with either central control of ejaculation, the affer-

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44 Crenshaw TL, Goldberg JP, Stern WC Pharmacologic modi cation of psychosexual dysfunction J Sex Marital Ther 1987;13(4):239 252 45 Wang C, Swerdloff RS, Iranmanesh A, Dobs A, Snyder PJ, Cunningham G, Matsumoto AM, Weber T, Berman N, and the testosterone gel study group Transdermal testosterone gel improves sexual function, mood, mus-

(Continued ) and Jessica Flannery brought a touch of Silicon Valley innovation to the practice Kiva is the world s rst person-to-person micro-lending web site, empowering individuals to lend directly to unique entrepreneurs in the developing world Its model is simple: Kiva partners with existing microlending organizations that choose quali ed entrepreneurs The organizations use kiva org to post pro les of these entrepreneurs and their projects The stories of the people found on Kiva are often very detailed A random perusal of the site brings up Grace from Uganda, whose $500 loan allowed her to buy refrigeration equipment for her peanut butter business; and Angel, a Roma gypsy from Bulgaria, who used $850 to start his own bicycle repair shop On the giving side, potential lenders are able to browse potential recipients, then lend using a credit card or Pay Pal account Over time, the entrepreneur repays the loan (without interest) Repayment and other updates are posted on Kiva and e-mailed to lenders if they chose When lenders get their money back, they can re-lend to someone else in need, donate their funds to Kiva for operational expenses, or withdraw their funds In only a couple of short years, Kiva has become an extremely popular tool The web site gives statistics on the loans made and repaid in the last week A typical week looks like this: $680,600 was lent; 1,574 entrepreneurs funded; 9,103 lenders made a loan; and 644 loans were completely repaid Not only has Kiva brought a new degree of transparency to microlending, it has fostered a personal rapport between lenders and recipients, reinforcing the sentiment that, through technology, it really has become a small world, after all The increasing prominence of social entrepreneurs has the potential to generate huge bene ts by spreading capitalist culture abroad and identifying unful lled societal needs America Forward (wwwamericanforwardorg), a consortium of social.

cle strength, and body composition parameters in hypogonadal men J Clin Endocrinol Metab 2000;85: 839 853 46 Rosen RC Psychogenic erectile dysfunction Classi cation and management Urol Clin North Am 2001 May;28(2):269 278

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