Premature ejaculation also belongs to a kind of male sexual dysfunction, and epidemiological surveys show that premature ejaculation is the most common male sexual dysfunction. Data from a survey conducted by the Center for Health and Social Life in the United States showed that 21% of American men between the ages of 18 and 59 had a prevalence rate, which shows that a lot of men suffer from this disease. Other reports have suggested from 5-30%, which may be the reason for the difference in the definition of premature ejaculation. Definition of premature ejaculation In 2005, the American Urological Association published a guideline on premature ejaculation that defines premature ejaculation in three ways: (1) ejaculation before or shortly after the penis enters the vagina, (2) inability of the male partner to control the desire to ejaculate, and (3) dissatisfaction of both partners with sexual life, provided that sexual dysfunction of the sexual partner is excluded. Diagnosis of premature ejaculation The diagnosis of premature ejaculation is mainly based on the patient’s statement of medical history. Detailed medical history inquiry is fundamental to the diagnosis and treatment of premature ejaculation, and the diagnosis of premature ejaculation is derived from a complete medical history. Any patient with rapid ejaculation should have a detailed medical history. From the medical history, premature ejaculation can be simply divided into two types: primary premature ejaculation and secondary premature ejaculation. Primary premature ejaculation means that the patient has been having problems with premature ejaculation since he or she has had sexual experience, while secondary premature ejaculation means that the patient has had previous successful sexual experience. Generally speaking, secondary premature ejaculation is easier to find and treat the cause and has a better prognosis. The main points to mention during the consultation should include the duration of the disease, the frequency of occurrence, the intensity of sexual stimulation at the time of premature ejaculation, specific environmental factors or even specific sexual partners that are prone to premature ejaculation, and the impact of premature ejaculation on sexual behavior, all of which are the main points of the medical history. For example, patients with coronary artery disease may have premature ejaculation because they are afraid that excessive sexual stimulation will cause a myocardial infarction. It is also important to understand and evaluate some of the circumstances of the usual sexual life, including foreplay, masturbation, the relationship and interaction between the couple, as well as the patient’s interpersonal relationship and work situation. For patients with primary premature ejaculation, it is important to inquire about the family history and growth history of the patient, as the background of growth in early childhood and the mental trauma suffered will often affect the sexual life in adulthood. For patients with secondary premature ejaculation, special attention should be paid to identify whether the disease is premature ejaculation or erectile dysfunction, although there are many patients with both premature ejaculation and erectile dysfunction. Physical examination and laboratory tests are not as important as medical history in diagnosing premature ejaculation. Most patients usually have normal findings on physical and laboratory examinations. Nevertheless, a simple external genital examination is necessary. If a patient has erectile dysfunction in addition to premature ejaculation performance, necessary auxiliary examinations such as sex hormone examination, neuromyography and penile vascular examination should be performed according to organic erectile dysfunction in order to find the exact cause of erectile dysfunction and to provide targeted treatment. In many patients with premature ejaculation and erectile dysfunction coexisting, once erectile dysfunction is effectively treated, the patient’s confidence and ability to maintain erection will be enhanced and the problem of premature ejaculation will be solved. Treatment of Premature Ejaculation There are many treatments for premature ejaculation, but one thing is for sure, premature ejaculation can be cured! This is certainly a cause for rejoicing for the majority of premature ejaculation patients. Before treatment, it is important to discuss all the treatment options with the patient, as well as the benefits and disadvantages of the various treatment methods. The success of the treatment should also be evaluated by the satisfaction of the patient and the sexual partner. More importantly, since premature ejaculation is not a life-threatening condition, the safety of the treatment should be put first. Behavioral therapy: Behavioral therapy includes increasing the frequency of ejaculation, adopting a female on male position, stop and start ejaculation, squeeze technique, and pelvic floor muscle contraction.
(technique), pelvic floor muscle contraction exercises, etc., short-term success rate of 95%, but long-term follow-up results found that behavioral therapy still only a small proportion of patients have long-term results. Sexual behavior therapy includes pausing when the man feels he is about to ejaculate, disengaging both partners, and even compressing the underside of the glans for three to four seconds to reduce arousal, and then continuing after a 15- to 30-second break. Other methods include distraction and changing the position of the action can also be used. In addition, the improvement of the relationship between husband and wife or sexual partners, emotional rapport, open communication, mutual understanding of the sexual sensitive areas of both sides, as much as possible some sexual foreplay and care after sex, can improve sexual life satisfaction, natural solution to premature ejaculation on both sides of the sexual life caused by the tension and impact. If the above treatments are not effective, surgical treatment can also be considered. The commonly used surgical methods are selective dorsal penile nerve amputation and penile prosthesis implantation. Since surgical treatment is somewhat invasive, doctors and patients should be cautious before choosing surgical treatment. Whether it is premature ejaculation or any other sexual dysfunction, it is challenging for both the patient and the male surgeon. Patients must unload their psychological baggage and discuss their hidden problems with their physicians, while physicians must listen carefully to the patient and perform the necessary tests to understand the real cause of premature ejaculation, whether it is organic or psychological, whether it is due to the patient’s own factors or to the social and cultural background, etc. If the cause of premature ejaculation is organic, the primary lesion should be actively treated and the problem can be solved. If it is functional, the factors that cause sexual tension should be excluded and the patient should be kept in a happy mood with correct sexual knowledge education and guidance, and both sides should cooperate and understand each other to achieve a harmonious interaction between the two sides in sexual life and normal life.