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 the prevalence, which shows that many men suffer from this disease. Other reports have been presented from 5 to 30%, producing such a big difference, probably due to different understanding of the definition of premature ejaculation.
1. Definition of premature ejaculation
It is difficult to give an appropriate definition of premature ejaculation, and the definition of premature ejaculation that can be widely accepted so far is yet to be determined.
The American Urological Association published a guideline on premature ejaculation in 2005, which defines premature ejaculation as the ejaculation of the penis before or shortly after entering the vagina, regardless of the sexual dysfunction of the sexual partner, before the desired ejaculation, which causes a sense of loss for oneself or the sexual partner or both.
2. Classification of premature ejaculation
(1) Primary premature ejaculation
That is, from the first sexual experience, there is a continuous situation of premature ejaculation, and the delay time of ball cavernous reflex (BCR) is short. These patients often have some characteristics, including fear of failure, self-restraint of sexual impulses, role substitution (from participants to observers of sexual life), reduced frequency of sexual behavior, etc., and the breakdown of the partner relationship will aggravate the situation of premature ejaculation, but all patients are not found to have organic lesions.
(2) Secondary premature ejaculation
Premature ejaculation is a condition in which there was a period of normal sexual function before the onset of premature ejaculation, with a longer delay in the bulbocavernosal reflex. This type of patient is generally older and often combined with erectile dysfunction or more difficult to achieve orgasm, will seek treatment earlier.
3, the cause of premature ejaculation
To date, the real cause of premature ejaculation is still a mystery, including from the physiological, psychological, behavioral and even socio-cultural background, there are a lot of studies and research.
There are some arguments that premature ejaculation is a problem on a purely psychological level, as men’s early sexual experiences (including masturbation) are often done under the tension of fear of being discovered, and a pattern of fast-action sexual behavior develops, which is difficult to change in later sexual behavior in marital relationships.
Some scholars have found that premature ejaculation patients really have different performance in terms of nerve conduction and sex hormone levels than normal people, and they believe that premature ejaculation patients have a physiological response that is easily aroused and overly sensitive.
Some scholars even believe that premature ejaculation represents an evolutionary behavioral pattern of the species. From an evolutionary point of view, males who are able to ejaculate within a shorter period of time have a higher chance of fertilizing females and reproducing offspring. In contrast, males who take longer to ejaculate and mate are more likely to be invaded or killed by other males or even other species during the mating process, so premature ejaculation may be the result of evolutionary selection.
4, the 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.
What are the key points that doctors should pay attention to when asking patients about their medical history? The questioning should include the frequency and duration of premature ejaculation, the intensity of sexual stimulation at the time of premature ejaculation, the specific external environment or even the specific sexual partner that is prone to premature ejaculation, and the impact of premature ejaculation on sexual behavior, etc. These are the main points of the medical history. In addition, the patient’s general health condition is also important to inquire about. For example, patients with coronary artery disease may have premature ejaculation because they are afraid that excessive sexual stimulation will cause a myocardial infarction, which often resolves naturally after treatment of the myocardial infarction. When taking a medical history, we should also understand some of the patient’s usual sexual life, including foreplay, masturbation, the relationship and interaction between sexual partners, as well as the patient’s interpersonal relationships and work situation, etc. We should ask and evaluate them separately. 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 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 the diagnosis of premature ejaculation. When patients with premature ejaculation undergo physical and laboratory examinations, the findings are usually normal. Nevertheless, a simple external genital examination is necessary. If a patient has erectile dysfunction in addition to premature ejaculation, necessary auxiliary examinations should be performed according to organic erectile dysfunction, such as sex hormone examination, neuromyography and penile vascular examination, in order to find the exact cause of erectile dysfunction and to provide targeted treatment. Many patients with premature ejaculation and erectile dysfunction co-exist. 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.
5.Treatment of premature ejaculation
There are many treatments for premature ejaculation, but one thing is certain, namely that premature ejaculation can be cured! This is undoubtedly 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 given priority.
(1) Behavioral therapy
Behavioral therapy includes increasing the frequency of ejaculation, adopting a female on male position, stop and start ejaculation, squeeze technique, pelvic floor muscle contraction exercises, etc. The short-term success rate is 95%, but the long-term follow-up results found that 75% of patients are still the same as before treatment after 3 years, therefore, behavioral therapy is still only effective for a small percentage of patients. Therefore, behavioral therapy still only has long-term effects on a small percentage of premature ejaculation patients.
Masters and Johnson proposed a male-under-female position, in which the man pauses when he feels he is about to ejaculate, and the woman lifts her body off the man’s and even presses three to four times below the glans. The woman can even press on the underside of the glans for three to four seconds to reduce arousal, and then continue after a break of 15 to 30 seconds. Other methods include distraction, change of position, etc. can also be used. In addition, the improvement of the relationship between husband and wife or sexual partners, the rapport, open communication, mutual understanding of the sexual sensitive areas of both parties, as much as possible more sexual foreplay and care after sex, can improve the satisfaction of sexual life, naturally can solve the tension and impact of premature ejaculation on the sexual life of both parties.
(2) Drug treatment
Traditionally, male doctors believe that premature ejaculation is almost always caused by mental factors, and therefore promote the concept of behavioral therapy. For patients with premature ejaculation, a comprehensive and detailed assessment of their physiological and psychological factors is necessary before appropriate treatment can be given.
Research in basic medicine, especially advances in neuropharmacology, can provide several effective medications to treat premature ejaculation caused by physiological factors or other diseases, in the hope that patients with premature ejaculation can return to a normal sexual life. With the discovery of the efficacy of selective pentraxin reuptake inhibitors (SSRIs) in prolonging ejaculation, the problem of premature ejaculation in men has been brought to a new era where the psychological and physical components are no longer separate, but complement each other to provide a more complete and personalized assessment and treatment strategy for premature ejaculation, which is a groundbreaking page in the treatment of male sexual function!
At present, the drugs commonly used to treat premature ejaculation are divided into two categories: oral drugs and topical drugs.
①Oral drugs
The main is selective pentothal reuptake inhibitor (SSRI), this type of drug was originally used to treat depression, but after long-term clinical application found that several drugs after taking the phenomenon of delayed ejaculation will be obvious, male experts have become interested in the side effects of this drug, and soon used it for the treatment of premature ejaculation. The commonly used ones are Zoloft, Prozac, Seroquel, etc. Dapoxetine also belongs to selective pentoxifylline reuptake inhibitors, and this drug has now been adopted by the American Urological Association as the drug of choice for the treatment of premature ejaculation, and this drug has the potential to become the first antidepressant drug for premature ejaculation certified by the U.S. Food and Drug Administration (FDA).
②Topical topical drugs
It is mainly a local anesthetic. Applying local anesthetics (commonly used gels) to sensitive parts of the penis such as the glans, coronal groove and ties for the first 20 to 30 minutes can prolong the ejaculatory latency and there are no obvious side effects. After applying local anesthetics, it is possible to use condoms or not. If a condom is not used, wash the residual drug from the penis. It is important to note that excessively prolonged anesthesia (30 to 45 minutes) can lead to loss of erection, the reason being that too much anesthesia can make the penis feel numb in a significant number of people. If the residual medication on the penis is not thoroughly washed before the room (without a condom), the spread of local anesthetic residue on the penis can also lead to numbness of the vaginal wall of the female partner and reduce sexual pleasure. This treatment is contraindicated if the patient or sexual partner is allergic to local anesthetic drugs.
(3) Premature ejaculation drug treatment options
(3) Surgical treatment
If the above treatments are not effective, surgical treatment can also be considered. Commonly used surgical methods include 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 other sexual dysfunction, it is challenging for both the patient and the male surgeon. Patients must unburden themselves psychologically 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 in nature, 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.