Premature ejaculation is one of the most common symptoms of sexual dysfunction in men, and it is also one of the most misunderstood problems of normal sexual function. Different scholars have different interpretations of premature ejaculation; different patients have different meanings of premature ejaculation; different sexual partners have different opinions about the speed of orgasm in different states and environments. According to a large questionnaire survey, the prevalence of premature ejaculation in adult men is close to 30%.
(A) Definition of premature ejaculation
At present, the definition of premature ejaculation has not yet been precisely and universally accepted at home and abroad. In 1970, Masters and Johnson defined premature ejaculation as “the ratio of ejaculation maintenance time to the satisfaction of the sexual desire of the spouse during sexual intercourse is less than 50%”. In 1984, the Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R) defined premature ejaculation as “ejaculation without desired penile penetration or ejaculation with minimal sexual stimulation. “In 1996, the American Urological Association (AUA) proposed that “premature ejaculation can be considered when one of the two partners is dissatisfied with the ejaculatory latency, or when the male is unable to achieve a sufficiently long ejaculatory latency”. The more accepted diagnosis of premature ejaculation is defined by the DSM-IV-R as “ejaculation before, during, or shortly after penetration, either continuously or repeatedly with minimal sexual stimulation, earlier than the person desires (in the physician’s judgment, due to various factors affecting the duration of sexual excitement, such as age, sexual partner, sexual environment, and frequency of sexual intercourse), premature ejaculation significantly causes the person Premature ejaculation obviously causes distress and interpersonal (between partners) tension, and the condition is not caused by withdrawal from a certain psychoactive substance (e.g. heroin)”.
According to Wu Jieping, one of the country’s leading urologists, it is still normal for a strong, healthy adult to ejaculate at 2-6 minutes of intercourse, or within a shorter period of time. Rapid ejaculation at first intercourse is almost a very common physiological phenomenon and cannot be considered premature ejaculation. From an evolutionary point of view, rapid ejaculation in animals has a positive meaning, and the behavior is superior, progressive, and worth encouraging. Because animals are most vulnerable to the dangerous moment of attack by natural enemies during coitus, the shorter the intercourse time, the better for their survival. But in humans, because of the thought and emotion (i.e. love) based on the process of sexual intercourse, the male partner always wants to give more sexual pleasure to his beloved female partner, try to reach the ejaculation time to extend some. And the woman often to their own whether to get sexual satisfaction and orgasm, as a measure of the man’s sexual ability ruler. The definition of premature ejaculation from the point of view of sexual harmony should be “premature ejaculation when the female partner fails to obtain a satisfactory sexual life”. Some women’s orgasms take more than 40-50 minutes to reach, so it’s not scientific to judge premature ejaculation solely on the basis of female orgasm. An image analogy is that men are like light bulbs, a pull on the light, a shut off; while women are like electric irons, always hot after the electricity, once hot, even if the power is off, will not immediately cool down. Sexual intercourse duration and age, physical strength, sexual life experience, sexual intercourse environment and mood are related. The speed of ejaculation is related to the position of intercourse, the amplitude and speed of penile pumping, and the intentional contraction of the female vagina to tighten the grip on the penis. Therefore, the definition of premature ejaculation needs to be further clarified through a large number of well-designed evidence-based medical studies.
(2) Classification of premature ejaculation
1.Shapiro (1943)
Type A: Premature ejaculation accompanied by penile erectile dysfunction, mostly seen in the elderly.
Type B: Premature ejaculation is not accompanied by libido and penile erectile dysfunction, mostly seen in young people.
2.Cooper (1969)
Type I: primary premature ejaculation occurring after puberty, not accompanied by erectile dysfunction, and premature ejaculation associated with psychological uneasiness.
Type II: Premature ejaculation that occurs suddenly, but is accompanied by erectile dysfunction, and is related to psychological uneasiness.
Type III: Premature ejaculation that is not obviously related to psychological uneasiness but is accompanied by hypoactive sexual desire and erectile dysfunction, and premature ejaculation occurs gradually and progresses.
3.Godpodinoff (1989)
Primary premature ejaculation: It refers to the occurrence of premature ejaculation from the beginning of the first sexual intercourse.
Secondary premature ejaculation: It refers to premature ejaculation that occurs gradually after having had normal ejaculation in the vagina in the past.
In addition, there is also situational premature ejaculation: premature ejaculation occurs due to people, time and place.
(3) Etiology of premature ejaculation
The etiology of premature ejaculation is very complex, and there are different causes for different ages, personalities and health states. Most premature ejaculation is psychological, and a few are caused by organic diseases.
1.Anxiety and depression
① hasty intercourse before marriage; ② too few times of intercourse; ③ interpersonal, family and conjugal relationships are not harmonious; ④ lack of self-esteem, frustration, feeling guilty and inferiority; ⑤ lack of sexual knowledge, sexual intercourse skills and experience.
2, long-term excessive masturbation
3.Lack of fatigue and energy
4.Difference of physical quality
5, diseases causing organic damage to the sympathetic nerve such as pelvic fractures, diabetes, arteriosclerosis, BPH
6, diseases of the reproductive organs such as short circumcision, chronic prostatitis
7. Dysfunction of the central 5-hydroxytryptamine system in the brain
(D) Clinical manifestations of premature ejaculation
There is no need to elaborate. Regardless of the type of premature ejaculation, it will have a great impact on the normal life of the couple, and both parties will be distressed by the lack of sexual satisfaction, which will often lead to marital tragedy in the long run.
(E) Diagnosis of premature ejaculation
1, medical history can understand the causes of premature ejaculation, which has certain guiding significance for its treatment.
(1) Past history Acute or chronic diseases, surgery, trauma, history of medication, bad habits.
(2) Sexual history Early sexual experience, history of previous sexual intercourse, history of masturbation (frequency and view).
(3) Marital and reproductive history Relationship and communication with spouse Reproductive status.
(4) current sexual life frequency of sexual intercourse, orgasm, and sexual satisfaction of both partners
(5) Current mental stress
2. Laboratory tests
(1) Blood tests such as routine blood, liver and kidney function, blood glucose, blood lipids, blood electrolytes, T3, T4, cortisol, sex hormones, etc.
(2) Urine examination urine routine, urine sediment, urine flow rate, etc.
(3) Prostate, semen examination
3.Nervous system examination The purpose is to distinguish between functional and organic premature ejaculation
(1) Penile vibration sensation measurement
It can evaluate the centripetal conduction function of the dorsal penile nerve and the excitability of the brain nerve center. This method is simple and inexpensive, and can be used as a screening test to help analyze the condition.
(2) Dorsal penile nerve somatosensory evoked potential measurement
By stimulating the dorsal nerve endings of the penis and recording the changes in brain waves, we can evaluate the centripetal conduction function of the dorsal penile nerve and the excitability of the brain nerve center. This method is more objective.
(3) Sacral reflex arc test
By stimulating the dorsal penile nerve, the response of the penile bulbocavernosus muscle is recorded.
4.Psychological examination
Psychological investigations are conducted through psychological scales and psychological counseling, and question and answer scores are used to determine whether premature ejaculation is psychological.
At present, there is no specific examination method for premature ejaculation.
(6) Treatment of premature ejaculation
Several mistakes should be corrected: the female partner cannot be judged by the appearance of sexual pleasure; premature ejaculation will always be premature if you are newly married; premature ejaculation is pathological after prolonged abstinence from sexual intercourse; premature ejaculation is bound to lead to penile erection disorder; fast ejaculation is premature ejaculation compared with others.
1.General treatment
(1) Psychological treatment Learn about male and female physiology, eliminate fear and enhance intentional control.
(2) Regular life to ensure sufficient sleep
(3) Female care and change the position of sexual intercourse
(4) timing of sexual intercourse such as weekends, holidays, non-fatigue state, masturbation before intercourse.
(5) urinary and reproductive tract inflammation treatment such as prostatitis.
(6) condom use
(7) pubococcygeus muscle exercise
2.Behavioral therapy
(1) sexy concentration training method
The purpose of treatment: is to transfer the goal of spousal sex to give and receive pleasure and sexual pleasure to each other. The attention of both parties is no longer placed on penile erection and orgasm, but focused on the experience of sexy feelings, in order to improve the destructive tendency to separate or spectator attitude.
Principles: Recognize that premature ejaculation is not only a matter for the male partner, but for both partners; at the same time, both partners should be convinced in the training that they have a sincere willingness to face and solve this problem of premature ejaculation with each other.
Conditions for training: suitable time, good environment and mood.
The basic program of training: four stages of non-genital sensual concentration training, genital sensual concentration training, vaginal accommodation, vaginal accommodation and activity.
Both parties should be consulted before the treatment arrangement, and various problems arising during the treatment should be discussed and constantly modified. For issues involving the patient’s privacy, the doctor should follow medical ethics and keep the patient’s confidentiality.
(2) Move-stop-move technique
(3) Squeeze and pinch glans technique
(4) Pulling technique
3.Local drug treatment
Purpose: Apply drugs to the head of the penis before sexual intercourse to reduce the afferent of sexual stimulation through the effect of local anesthesia and achieve the effect of prolonging the latency of ejaculation. The use of the process due to pay attention to the amount and concentration of anesthetics.
Drugs: such as procaine – lidocaine cream, 1% dacronin ointment, 3% ethyl aminobenzoate cold cream, 9.6% lidocaine spray, Chinese medicine SS – cream, Enner cream (Swedish Astor
(produced by Astra, Sweden), etc.
4.Oral medication
Antidepressants are the most commonly used drugs for premature ejaculation, and most of their pathways of action are related to increasing the content of central 5-hydroxytryptamine in the brain. These drugs should be taken orally one hour before sexual intercourse
(1) Chlorpromazine (Clomipramine) 25~50 mg/dose Side effects: nausea, vomiting, dry throat, drowsiness, decreased erectile function, etc.
(2) Paroxetine 20~40 mg/dose Side effects: non-ejaculation, nausea, vomiting, loss of libido, anorexia, drowsiness, erectile dysfunction, sensory confusion, etc.
(3) Sertraline 25~100 mg/dose Side effects: non-ejaculation, drowsiness, dry throat, nausea, vomiting.
(4) Cloxetine 20~40 mg/dose Side effects: nausea, vomiting, drowsiness, decreased erectile function, dry throat, etc.
(5) Phenoxybenzamine 20~30 mg/day It is an alpha-blocker, and the effect of delaying ejaculation time can reach 66%.
(6) Phenoxybenzamine 5~10 mg/day It can prolong the time of ejaculation.
(7) Trazodone 25~50 mg/dose The anticholinergic effect delays the ejaculatory reflex.
(8) Doxepin 75 mg/dose Anti-dopamine receptors and reduce sympathetic excitability.
(9) Sildenafil 25~100 mg prolongs the ejaculation time by rapidly obtaining another erection after rapid ejaculation.
(10) Chinese herbal medicine Add or subtract with the evidence by combining Sihuiwan San and Liuwei Dihuang Tang.
5.Surgical treatment
(1) Circumcision
(2) Partial dissection of the dorsal penile nerve A transverse incision of 1~2 cm is made in the skin at the coronal groove on the back of the penis to reach the penile fascia and expose the radial distribution of the dorsal penile nerve, preserving the main trunk and cutting off about 80% of the nerve. This procedure is limited to patients with extreme penile sensitivity and premature ejaculation.