Premature ejaculation is also a type 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 a range from 5-30%. Such a large difference may also be due to the different definitions of premature ejaculation in various studies.
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 published guidelines on premature ejaculation in 2005 that define premature ejaculation as ejaculation before the desire to ejaculate, either before or shortly after entry into the vagina, and resulting in a sense of loss for oneself or one or both partners, provided that sexual partner dysfunction is excluded.
Classification of premature ejaculation
I. Primary premature ejaculation
Premature ejaculation is a condition that occurs continuously from the first sexual experience, with a short delay in 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), and reduced frequency of sexual behavior, etc. The breakdown of the partner relationship can aggravate the situation of premature ejaculation, but no organic pathology can be found in all patients.
Second, secondary premature ejaculation
It refers to a period of normal sexual function before the occurrence of premature ejaculation, with a longer delay of the bulbocavernosal reflex. Patients in this category are generally older and often have combined erectile dysfunction or have difficulty achieving orgasm and will seek treatment earlier.
Causes of Premature Ejaculation
To date, the true cause of premature ejaculation remains a mystery, with a great deal of research and study, including physiological, psychological, behavioral and even sociocultural backgrounds.
Some scholars have found that premature ejaculation patients really have different 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 points should the doctor pay attention to when asking the patient’s medical history?
The questioning should include the frequency and duration of premature ejaculation, the strength of sexual stimulation when premature ejaculation occurs, 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. Find out if there are any other diseases that can easily trigger or cause premature ejaculation. For patients with primary premature ejaculation, it is important to ask 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 who have 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 female on male sexual position, stopping and starting ejaculation again, squeezing method, pelvic floor muscle contraction exercise, 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 still only has long-term effect on a small percentage of premature ejaculation patients.
Masters and Johnson propose 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 the glans 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 pentazocine reuptake inhibitors in prolonging ejaculation time, 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 patients.
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, these drugs were originally used to treat depression, but after long-term clinical application, it was found that there are 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, Sellett, etc.
2, local topical drugs are mainly local anesthetics. Local anesthetics (commonly used gels) are applied to the sensitive parts of the penis such as the glans, coronal groove and tether 20-30 minutes before sexual intercourse to prolong the ejaculation 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, the residual drug can be washed off the penis before intercourse. It should be noted that excessively prolonged anesthesia (30 to 45 minutes) can lead to loss of erection, because prolonged 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 intercourse (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 and reduce sexual pleasure. If the patient or sexual partner is allergic to local anesthetic drugs, the treatment is contraindicated.
III. Surgical treatment.
If all the above treatments are ineffective, surgical treatment can also be considered. Commonly used surgical methods are selective dorsal penile nerve amputation (good short-term effect, general long-term effect) and penile prosthesis implantation. Since surgical treatment is somewhat invasive, doctors and patients should be cautious before choosing surgical treatment.
Conclusion
Whether it is premature ejaculation or any other sexual dysfunction, it is a challenge for both the patient and the male physician. 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.