When sex is out of the category of “heirloom” and becomes an indispensable part of people’s real life, “sexual happiness, beauty and harmony” become the common pursuit of people, once the discordant notes appear in this beautiful music, as the main sex life Once the discordant notes appear in this beautiful music, as the main initiator of sex life men, set up the “culprit”, a “premature ejaculation” hat consciously or unconsciously on the head, to bear the “women’s despised eyes”, to bear The “useless”, “useless” these terms hurt self-esteem, to deep self-blame and guilt, a vicious circle is formed, worry, fear, and even escape, the next sex life is not only premature ejaculation, may be impotent. The two partners are the two sex partners, that wonderful music needs two people to write together, there is a note of sexual disharmony, is the joint responsibility of both sides, simply with premature ejaculation definition of sexual disharmony, the responsibility is completely put on the male party, not only unfair, but also limited significance to the treatment.
1.Reason for consultation
Although the main complaints of patients at the time of consultation are mostly: premature ejaculation and short sexual life, the real reasons that prompt the patients to consult the doctor are: the female partner’s dissatisfaction with sexual life, most of the sexual life or never reaching orgasm, the accumulated sexual energy is not fully released; or the male partner feels or worries about the female partner’s dissatisfaction (the female partner may not show it). The “short time” is mainly the patient’s self-interpretation of the cause of unsatisfactory sexual life – “sexual harmony disorder”.
2.The purpose of consultation
To get a harmonious and satisfactory sex life is the ultimate purpose of the patient’s consultation, the length of time and the number of times are only the means to achieve the purpose.
3.Definition
Which name is more appropriate to define this kind of unsatisfactory sexual life, “premature ejaculation” or “sexual harmony disorder”?
We have been using the term “premature ejaculation” to define the patient couple’s dissatisfaction with sexual life, but there is not a recognized appropriate definition until now. 1970, Masters and Johnson’s definition is: Premature ejaculation is defined as the frequency of ejaculation lasting until the spouse is satisfied is less than 50%; 1974, Kaplan’s definition is: Premature ejaculation is defined as the frequency of ejaculation lasting until the spouse is satisfied. In 1974, Kaplan defined premature ejaculation as the inability to achieve orgasm as desired due to a man’s lack of ability to regulate ejaculation at will; in 1984, the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, 3rd edition (DSM-III-R) criteria defined premature ejaculation as the occurrence of ejaculation upon vaginal penetration as desired or with minimal sexual stimulation. In 1997, the definition proposed by the American Urological Association was that premature ejaculation can be considered when one of the two partners is not satisfied with the ejaculatory latency or tries to prolong it; some people set the time as less than 30 seconds, and some people count ejaculation before the penis touches the woman as true premature ejaculation. Professor Wu Jieping believes that in healthy men of prime age, the ejaculatory latency period is 2-6 minutes, and as long as the man ejaculates 2 minutes after the start of sexual intercourse pumping, it is not considered premature ejaculation. The Diagnostic and Statistical Manual of Mental Disorders IV – Text Revision (DSM-IV-TR) defines premature ejaculation as “unwanted ejaculation with minimal stimulation, always or often before, during, or just after vaginal penetration. Clinicians must take into account various factors that can affect the duration of the arousal phase, such as age, novelty to the partner, changes in the environment of intercourse, and the frequency of recent intercourse”; and the International Society for Sexual Medicine’s (ISSM) new definition, the first evidence-based definition, “Premature ejaculation is a male sexual dysfunction characterized by the fact that it is always or almost always before or within approximately 1 minute of vaginal entry, the inability to delay ejaculation after full or almost full vaginal entry, and negative personal outcomes such as distress, apprehension, frustration, and/or avoidance of sexual activity”.
Almost all of these definitions, except for Masters and Johnson’s definition of “frequency of partner satisfaction”, are based on time, which seems to suggest that as long as time is sufficient, other factors can be disregarded to achieve the desired harmonious quality of sexual life, but this is not the case clinically, as many women partners take much longer than 2 minutes and are more dependent on the environment, atmosphere, and mood; and some women will orgasm more than once in 2 minutes. I am glad to see that in some definitions, the words “as desired” and “not as desired” appear, expressing the intention that premature ejaculation is more of an unsatisfactory sexual life for both partners. If we use the term “sexual harmony disorder” as the definition of this kind of sexual dissatisfaction, we only need to give a value of “frequency of spouse’s dissatisfaction in sexual life”, for example, 50%, which will not be more controversial. The advantage of using the term “sexual harmony disorder” to define the dissatisfaction of sexual life is that it can make doctors and patients (especially women) realize that sexual life is a problem of both parties, and have a broader vision in finding, diagnosing and treating the causes, not only focusing on the male party, which is beneficial to the diagnosis and treatment on the one hand; on the other hand, it can reduce the pressure of men and increase the awareness of women. The pressure of the female partner, increase the awareness of the female partner, and promote the cooperation of the female partner.
4. Etiology
For premature ejaculation, we are only concerned about the causes of the male partner. For “sexual harmony disorder”, we need to consider the male partner, female partner, mutual cooperation, environment, atmosphere, mood, frequency of sexual life and other influencing factors, more conducive to finding the cause of the disease.
(1) Male factors
Psychological factors: mainly manifested by the patient’s lack of self-confidence, always think that their sexual excitement is high, especially the first time sex or to a new sexual partner, long-term masturbation patients. Psychological factors are the main common factors.
Pathological factors: neurological diseases, such as: injury to the brain, brain tumor, epilepsy, multiple sclerosis of the spinal cord, spinal cord tumor, peripheral neuritis of peripheral nerves, etc.; genitourinary system diseases, such as: glansitis of the foreskin, prostatitis, seminal vesicle adenitis, urethritis, spermatorrhea, short circumcision or painful erection, etc. Nerve excitability is too high, penile sensory threshold is reduced, etc.
(2) Female factor
We can exclude sexual aversion, sexual phobia and painful intercourse, but we should at least classify low libido, sexual arousal disorder and orgasmic disorder in women among sexual harmony disorders. The common causes of these disorders are
Psychological factors: doubts, guilt, fear, anxiety, shyness, conflict, uneasiness, tension, dislike, irritation, hatred, grief, hostility towards partner, receiving harsh lectures during upbringing, history of sexual abuse or trauma.
Pathological factors: brain and neurological factors, endocrine factors, anatomical factors of the reproductive organs, diseases or medication effects, etc.
(3) Mutual factors
Mainly seen in sexual partners who have sex for the first time or have poor sexual skills, especially the male partner lacks sexual experience, insufficient knowledge of female sexual requirements, sensitive parts, insufficient stimulation time and inappropriate intensity. The female partner is nervous, painful and other reasons, the vagina is overly contracted and the stimulation of the penis is too strong. The position of sexual intercourse, the amplitude and speed of penis pumping, etc. The environment and atmosphere of sex life, the fear of being discovered by others and the inability to completely relax are also common reasons for unsatisfactory sex life. The frequency of sex is also a cause of satisfaction, the interval is too long, although both sides are easily excited, but the male party is easy to ejaculate early; the interval is too short, the male party although the intercourse time can be extended, but the female party is not easily excited.
5.Diagnosis
Due to the uncertainty of the definition of “premature ejaculation”, it is difficult to ask the patient (in fact, it is difficult for the patient to do so) to record the time of sex with a stopwatch, or to record the number of strokes with “one, two, three, four, two, three, four”. When we use the term “sexual harmony disorder” to define this kind of sexual life dissatisfaction, together with all become simple, only need both sex partners after sex together to evaluate whether the sexual life of the satisfaction on the line.
As for other evaluations and examinations, we are mainly looking for the causes of sexual harmony disorder, such as: sexual life environment, frequency, sexual experience, medical history, personal history and other inquiries, Chinese premature ejaculation patient sexual function evaluation form (CI premature ejaculation), dorsal penile nerve sensory evoked potential examination (DNSEP), penile head sensory evoked potential (GPSEP), sex hormone six items, thyroid function, genitourinary system The examination of genitourinary system infection, etc. But consider to exclude: male erectile dysfunction, non-ejaculation; female anatomical factors, sexual aversion, sexual phobia, painful sexual intercourse and other causes of the inability of both partners to have sex.
6.Treatment
Premature ejaculation treatment is aimed at the male partner. Sexual harmony disorder treatment for both sides and the process of sexual life, sexual disharmony is no longer a problem for the male partner, the female partner is the other half of the sexual life, the time, frequency, environment, atmosphere of sexual life, sexual life “arousal – sustained – climax -It is more necessary to cooperate with and encourage (encouragement may be more necessary) the male partner after the treatment of various causes, to explore together the environment, time and frequency of sexual intercourse suitable for both parties, to find the sexual excitement point of both parties, to accumulate the experience of sexual life, and to compose a wonderful and harmonious sexual concerto.
(1) Treatment for the male partner
Psychological adaptation: men should have “to force the top of the sky (field)” of the atmosphere, to have enough self-confidence; it is necessary to learn some sexual skills, learn to create a suitable environment and atmosphere for sex, learn to improve the sexual excitement of women, shorten the time of the female to orgasm, know that the male orgasm is like a light switch, come quickly to go The woman’s orgasm is like an electric iron, it takes some time to warm up, and after a while it will be hot.
Behavioral therapy: James-Seman method; pulling the scrotum method; penile squeeze method; change the position; appropriate to increase the number of sexual life.
Pharmacotherapy: Chlorpromazine; Trazodone; selective 5-hydroxytryptamine reuptake inhibitors such as: fluoxetine, sertraline, paroxetine, dapoxetine; PDE-5 inhibitors, such as sildenafil, vardenafil, etc., are more effective for those with erectile dysfunction, full erection and hardness of the penis is more stimulating to women, more conducive to women to reach orgasm, and at the same time can prolong sexual intercourse; Finasteride; Tandospirone; alpha-adrenergic receptor inhibitors, such as: doxazosin, terazosin, alfuzosin, etc.
Topical drugs: compound lidocaine cream, lidocaine-proparacaine cream, TEMPE(35) aerosol, etc.
Chinese medicine: Zhi Bai Di Huang Wan can reduce the excitability of sexual nerve, improve the ejaculation threshold and prolong sexual life; SS cream can be used topically to improve the threshold of penile vibration sensation and reduce sensitivity.
Surgery: selective excision of the dorsal penile nerve. Treatment for the cause.
(2) Treatment for the female partner
Psychological adjustment: first of all, we should make the woman realize her position in sexual life, not only passive acceptance, sexual harmony disorder women also have to pay a considerable responsibility. The male partner should be more encouragement, appropriate cooperation. You can adjust the female sexual psychology by eliminating concerns, talking about inner feelings, desensitization, support, advice and guidance.
Behavioral training: including sexy concentration training, demand-free pleasure experience, genital stimulation, demand-free intercourse to achieve the purpose of treatment.
Sex hormones: estrogen, testosterone, progesterone. Vasodilators.
Antidepressants: amantadine, cycloheximide leaf, yohimbine, etc. Clitoral therapies.