Xiao Wang is 32 years old and is an IT worker. After the Spring Festival, he found that when he had sex, the time was significantly shorter than before, and he also had a feeling of difficulty in controlling it. At first he did not pay attention to it, thinking that he could recover by improving his diet and enhancing his exercise. After a period of time, his sex life became shorter and shorter, and then he realized that he might be premature ejaculation, so he came to our department in depression. The actual history of the company reveals that Xiao Wang often has back pain. The first thing you need to do is to get a CT scan of your lumbar spine and find out that the “original culprit” for your premature ejaculation is a herniated lumbar disc. The cause of premature ejaculation is generally considered to be closely related to psychological factors and organic diseases. The organic disease refers to the inflammatory stimulation of the genitourinary tract that increases sensitivity; cranio-cerebral disease, crestal disease and other diseases that affect the ejaculatory center. In recent years, the team of Professor Jin Baofang of the Affiliated Hospital of Southeast University first reported that disc herniation can also cause premature ejaculation. Why does a herniated disc cause premature ejaculation? A herniated disc (nucleus pulposus) that protrudes to the front and back can compress the dural sac and affect the function of the cauda equina nerve in the spinal canal. The cauda equina nerve is involved in the ejaculatory reflex pathway and its dysfunction may lead to premature ejaculation if it causes an increase in the sensitivity of the ejaculatory reflex. It is important to note that premature ejaculation and low back pain do not occur in all patients with disc herniation. It is the radiating pain in the lower extremities that is the most significant clinical manifestation of disc herniation. Nor do all patients with premature ejaculation have herniated discs. Only when the intervertebral disc protrudes toward the front and back, compressing the dural sac, may it lead to premature ejaculation. The problem of premature ejaculation caused by lumbar spine disease is not uncommon in male clinics because of long-term sedentary, lack of exercise and more and more young adults are suffering from lumbar spine disease. It should be reminded that many young patients are prone to ignore lumbar spine problems because their back pain is not obvious. What about the treatment of premature ejaculation caused by a herniated disc? Regarding the treatment of premature ejaculation, 5-hydroxytryptamine reuptake inhibitors (commonly known as antidepressants) are clinically preferred. These drugs include fluoxetine, paroxetine, sertraline, fluvoxamine and citalopram, which we used to call the “five gold flowers”. They prolong sex by increasing the concentration of 5-hydroxytryptamine in the synaptic gap of the brain. These drugs can take effect in 1 to 2 weeks, but need to be taken continuously for 3 months to 6 months or even longer. Since it needs to be taken for a long time, there will be a certain incidence of adverse reactions, and the instructions are not marked with indications for the treatment of premature ejaculation, so most patients are reluctant to take them. The newly marketed dapoxetine is the only drug approved for the treatment of premature ejaculation in the world and does not need to be taken orally every day, making it extremely convenient for patients to take it. However, once these drugs are discontinued, most patients return to their pre-treatment state, which is the biggest problem it faces. The cause of Xiao Wang’s disease is clear, it is caused by a herniated disc, so it needs to be treated. The most commonly used methods are acupuncture and massage, pelvic traction and so on. Acupuncture and massage can relieve muscle spasm in the back and reduce pressure within the disc; pelvic traction can increase the width of the intervertebral space, reduce the internal pressure of the disc, promote the retraction of the herniated disc and reduce the stimulation and pressure on the dural sac. For patients with more severe conditions, surgery is required. Eventually Xiao Wang’s condition slowly recovered through a combination of medication, acupuncture and traction. Early detection and treatment will lead to a good outcome. As the course of the disease lengthens, the more severely the lesion involves damaged nerves, and the less effective the treatment will be.