A few days ago, a patient came to our male specialist clinic, saying that he suffered from premature ejaculation and had been treated with the popular online method of cleaning the glans for a period of time, but the effect was average, and he felt unsure of himself and asked for a detailed examination. After a detailed medical history and physical examination, we found that the patient had no clear concept of premature ejaculation, and had only had sex with his girlfriend once and ejaculated quickly, which is not premature ejaculation at all. In fact, this situation is more common, some people are blindly worried about premature ejaculation, once ejaculation is faster, they worry about it and seek medical advice everywhere, and some people confuse premature ejaculation with erectile dysfunction. From the biological point of view, those who can ejaculate quickly during sexual intercourse are classified as superior. However, humans are higher animals with thoughts and emotions and need to enjoy the pleasure of sex. One of the major factors affecting the quality of sexual life is the time to ejaculate. Research shows that the incidence of premature ejaculation is about 30%, which is a small problem but can seriously affect the quality of sex life and may further cause erectile dysfunction, so it needs to be taken seriously and treated early. So, what exactly is considered premature ejaculation? According to the 2007 International Society for Sexual Medicine (ISSM), the latest definition of premature ejaculation is a sexual dysfunction with three characteristics: (1) ejaculation almost or always within about 1 minute of vaginal penetration; (2) no ability to prolong or control ejaculation; (3) negative consequences such as annoyance, distress, frustration or /(3) resulting negative consequences, such as annoyance, distress, frustration, or avoidance of sexual contact. The clinician uses these characteristics, combined with the patient’s sex life, ejaculatory latency (i.e., time to ejaculation after vaginal penetration), and a rating scale, to make the final diagnosis of premature ejaculation. The commonly used clinical scales are the Premature Ejaculation Diagnostic Tool (PEDT) and the Chinese Premature Ejaculation Patient Sexual Function Evaluation Scale (CIPE-10, CIPE-5). The “Premature Ejaculation Self-Test Form” circulating on the Internet is the CIPE-10 (10 questions), but the ejaculation time in it has been altered, and the evaluation index of CIPE-5 (5 questions) is used as the scoring standard, which is not self-testable at all, but misleading. There are even self-testing methods that define mild premature ejaculation as ejaculation 6-15 minutes after penile insertion into the vagina, which will make many gay men wear the “hat” of premature ejaculation! In addition, if you have premature ejaculation from the first sexual intercourse, you are diagnosed with primary premature ejaculation. If you have a normal ejaculation, and then you have a fast ejaculation because of some problems, you are secondary premature ejaculation. There are many intricate causes of premature ejaculation, such as emotional problems, genitourinary tract sensation, etc., and there may be a mutual causal relationship between various causes. If you suspect that you have premature ejaculation, you need to go to the hospital as soon as possible to communicate with a specialist and undergo the appropriate tests. The actual fact is that some men and women are too shy to go to the doctor and look for treatment on the internet, so there is a scene at the beginning of this article. The first thing you need to do is to get a good idea of what you’re looking for, and you can choose from medication, psychological and behavioral treatment, and surgery. The first choice is medication, including pentothal reuptake inhibitors (SSRI) and surface anesthetics. Dapoxetine, an SSRI, is the only FDA-approved antidepressant for the treatment of premature ejaculation, which can effectively suppress the central nervous system and prolong the ejaculation time of patients. While surface anesthetics are sprayed on the glans to delay ejaculation by numbing the nerves, they are more convenient to use but require the use of condoms to avoid numbing the vaginal mucosa. At present, there is indeed a rumor on the Internet that toothpaste is used to clean the glans, saying that it can numb the nerves and prolong ejaculation without side effects. But what is the truth? As we know, toothpaste is formulated mainly with rubbing agents, washing foam agents, adhesives, sweeteners, fragrances (mint, amine leaves, etc.) and water. One of the things that works on the glans is the mint in it. Theoretically, mint does have an inhibitory and numbing effect on the peripheral nerves, and acting on the glans can delay ejaculation. On the surface, this method does appear to be an alternative to surface anesthetics, and is affordable and easy to use. However, in essence, there are certain risks and side effects. Mint in addition to numbness is also at the same time irritating, repeated application, may lead to glans congestion, some people may also have allergic reactions. If you have sex without cleaning it, it may irritate the vaginal mucosa and cause discomfort to the female partner. At the same time, the rubbing agent component of toothpaste (talcum powder, etc.), which has a certain frictional force, may cause slight abrasions by repeatedly rubbing the glans. And certain chemical components in toothpaste (such as fluoride agents, etc.) may affect male semen and female fertility, resulting in low pregnancy rates or infertility. Therefore, clinicians do not recommend this method and suggest that patients choose a treatment after a diagnosis at the hospital. Many patients with secondary premature ejaculation attribute the cause to their masturbation in their youth after they develop faster ejaculation, causing a huge psychological burden to themselves and even subsequent erectile dysfunction. Frequent masturbation during adolescence, after forming the habit of rapid ejaculation, is indeed an important cause of premature ejaculation after marriage. However, this problem has been expanded and even demonized with the lack of understanding of patients and the circulation of the Internet, causing psychological distress to many premature ejaculation patients who do not have the habit of rapid ejaculation. Imagine if premature ejaculation was caused by masturbation, then it would be impossible for these patients to have previously normal ejaculation. For secondary premature ejaculation, the cause is mostly genitourinary tract infection or psychological disorder during sex, which requires going to a regular hospital for the right cause, the right medicine, and some psychological behavioral treatment by the doctor to solve the doubts and inner conflicts in the patient’s mind. For patients with primary premature ejaculation, in addition to first-line medication, psycho-behavioral treatment can also be used to further improve ejaculation time. This method is one of the two recognized behavioral treatment methods, but it requires the woman to master certain skills, otherwise it may damage the patient’s penis, and may also lead to penile weakness and inability to continue sexual life. Here we introduce a “stop-motion 2-step training method”, which was improved from the stop-motion training method proposed by Siemens in 1956. After the penis is erect, open the foreskin to expose the entire glans and apply an appropriate amount of vaginal lubricant. Use the right index finger from the coronal sulcus to the urethral opening spiral up to stimulate the glans, after the emergence of ejaculation feeling, immediately stop stimulation, week after week for about 10 minutes; the second group of actions by the right thumb and index finger clasp into a ring, from the urethral opening to the coronal sulcus direction, squeeze friction glans, squeeze force and friction speed from slow to fast, after the emergence of ejaculation feeling as before, about 10 minutes to increase the stimulation intensity, and finally ejaculation. Training 2 to 4 times a week, initially by the patient himself for 2 to 4 weeks, some patients can obviously feel the ejaculation control ability increased. After that, the female partner can replace the patient to carry out the stop-motion training, after the patient appears to feel ejaculation, that is, to tell the female partner to stop stimulation, the frequency and period of training as in the previous stage. This method is often used in clinical work and can also be used in conjunction with pharmacological treatment at the same time. Some patients may have doubts that this method is disguised as “masturbation” and will hurt the male’s vitality. In fact, too little sex, or too little ejaculation is one of the causes of premature ejaculation. In addition, with the development of “selective dorsal penile neurectomy” for premature ejaculation, many private hospitals are using this as a gimmick to recruit patients. There are also some patients who come to our clinic and strongly request for surgical treatment. First of all, this surgery is only applicable to married patients with primary premature ejaculation, and they must have ejaculation with minimal stimulation after long-term medication and psychological behavior treatment. At the same time, the vibration threshold of the penis needs to be measured to obtain objective data for a comprehensive judgment, and our department has now carried out the relevant tests. Surgery is not considered for patients whose ejaculation time can be improved by medication or for patients with secondary premature ejaculation. At the same time, surgery carries certain risks, including poor postoperative results, postoperative psychological disorders, postoperative glans numbness, and unknown effects on erectile function. Therefore, physicians are also extremely cautious when choosing whether or not to perform the procedure. Patients are advised not to go to private hospitals for “convenience” because they are not treated surgically in regular hospitals. Finally, we propose a few precautions to avoid and treat premature ejaculation: 1, avoid using repeated sexual intercourse to prolong the second sexual intercourse, which is harmful to health and should not be used for a long time; 2, the mood before sex has a great impact on the speed of ejaculation, should avoid anxiety, excitement and tension, to build self-confidence; 3, foreplay to do enough, so that the woman first into the excitement period or even the platform period, it is easier to meet 4, the penis into the vagina, reduce the amplitude and speed of pumping, reduce the stimulation of the penis, through the “nine shallow a deep” method to extend the ejaculation time; 5, in the emergence of ejaculation feeling, distracted from the sexual stimulation, the penis feeling to think about other issues, will help delay ejaculation; 6, can take Female superiority sexual intercourse method to relieve the tension during sex and increase the adaptability to vaginal stimulation; 7, strengthen the exchange of ideas and feelings between husband and wife, eliminate the gap and misunderstanding, understand the husband’s premature ejaculation and actively cooperate with the treatment, will help to overcome the bad psychology; 8, the female partner should be considerate and comforting, not to blame, threaten, otherwise things will not be as desired, not conducive to the recovery of premature ejaculation. The last thing you need to remember is that there is no uniform standard for ejaculation time, do not deliberately pursue the length of time, as long as both sides feel satisfied is your success.