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 aged 18-59 years had a prevalence rate, which shows that a lot of men suffer from this disease. Other reports have suggested from 5-30%, and such a big difference may be due to different understanding of the definition of premature ejaculation.
Definition of premature ejaculation
It is difficult to give an appropriate definition of premature ejaculation, and a widely accepted definition of premature ejaculation has yet to be established.
The American Urological Association’s guidelines on premature ejaculation published in 2005 define premature ejaculation as the ejaculation of the penis before or shortly after entry into the vagina, before the desire to ejaculate, resulting in a sense of loss for oneself, one’s partner or both partners, provided that sexual dysfunction of the partner is excluded.
Classification of premature ejaculation
I. Primary premature ejaculation.
That is, from the first sexual experience, there is a continuous situation of premature ejaculation with a short delay of the bulbocavernosal reflex (BCR). These patients often have some characteristics, including fear of failure, self-restraint of sexual impulses, role substitution (from a participant to an observer of sexual life), reduced frequency of sexual behavior, etc. The breakdown of the partnership can aggravate the situation of premature ejaculation, but no organic pathology can be found in all patients.
Second, secondary premature ejaculation.
It means that before the occurrence of premature ejaculation, there was a period of time when sexual function was normal and the delay in its bulbocavernosal reflex was longer. This group of patients is generally older and often combined with erectile dysfunction or difficulty in achieving orgasm and will seek treatment earlier.
Causes of Premature Ejaculation
To date, the true cause of premature ejaculation remains a difficult mystery, with a great deal of research and study, including from physiological, psychological, behavioral and even sociocultural backgrounds.
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 that take longer to ejaculate to 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.
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 the 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 relationship and work situation, and so on, and we should ask them separately for evaluation. For patients with primary premature ejaculation, special questions should be asked about the family history and growth history of the patient, as the background of growing up 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 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 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 has to be put first.
I. Behavioral therapy.
Behavioral therapy includes increasing the frequency of ejaculation, adopting a woman-on-man** position, stop and start ejaculation, squeeze technique, pelvic floor muscle contraction exercises, etc. The short-term success rate is 95%, but 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 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, 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.
Second, drug treatment.
Traditionally, male doctors believe that premature ejaculation is almost always caused by mental factors, and therefore promote the concept of behavioral therapy, whether this view is right or not is open to question; in fact, in addition to mental factors, physical factors also often cause premature ejaculation. 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!
The drugs commonly used to treat premature ejaculation are divided into two categories: oral drugs and local topical drugs.
1, oral drugs are mainly selective pentazocine reuptake inhibitors (SSRI), these drugs were originally used to treat depression, but after long-term clinical application, it was found that there are several drugs after taking a significant delay in ejaculation phenomenon, male experts have become interested in the side effects of this drug, and soon used it for the treatment of premature ejaculation. Dapoxetine also belongs to selective pentothal reuptake inhibitors, this drug has now been adopted by the American Urological Association as the drug of choice for the treatment of premature ejaculation, the drug has the potential to become the first antidepressant drug for premature ejaculation certified by the U.S. Food and Drug Administration (FDA).
2, topical topical drugs are mainly local anesthetics. **Apply local anesthetics (commonly used gels) to sensitive areas such as the glans, coronal sulcus and ties of the penis 20 to 30 minutes before ejaculation, which can prolong the ejaculation latency and has no obvious side effects. After applying local anesthetics, it is possible to use condoms or not. If a condom is not used, the residual drug can be washed off the penis before**. It should be noted that excessively prolonged anesthesia (30 to 45 minutes) can lead to loss of erection because 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 ** (without the use of a condom), the spread of local anesthetic residue on the penis can also lead to numbness of the vaginal wall of the female partner, reducing sexual pleasure. This treatment is contraindicated if the patient or sexual partner is allergic to local anesthetic drugs.
Premature ejaculation drug treatment options.
Oral medications Trade names Recommended use
Non-selective pentraxin reuptake inhibitors
Clomipramine Anafranil 20-50mg/day or
25mg **4 to 24 hours before
Selective pentothal reuptake inhibitors
Fluoxetine Prozac 5-20mg/day
Paroxetine Celete 10, 20, 40mg/day or
20mg** 3 to 4 hours before
Sertraline Zoloft 25-200mg/day or
50mg** 4 to 8 hours before
Topical drugs
Lidocaine/proparacaine emulsion Ena (EMLA) 2.5% lidocaine/2.5% proparacaine emulsion
First 20 to 30 minutes Topical application
Note: The American Urological Association (AUA) 2004 guidelines for the pharmacological treatment of premature ejaculation recommended medication regimen
III. Surgical treatment.
If all the above treatments are ineffective, surgical treatment can also be considered. Commonly used surgical methods include selective dorsal penile neurectomy and penile prosthesis implantation. Because surgical treatment is 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.