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 a guideline on premature ejaculation in 2005, which defines premature ejaculation as the ejaculation of the penis before or shortly after entry into the vagina, either before the desired ejaculation or shortly after entry into the vagina, resulting in a sense of loss for oneself or one 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 a number of characteristics, including fear of failure, self-restraint of sexual impulses, role replacement (from participants in sexual life to observers), reduced frequency of sexual behavior, etc. The breakdown of the partnership can aggravate the situation of premature ejaculation, but all patients are not found to have organic pathology.
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 of its bulbospongiosus 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 strength 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 also need to understand some aspects of the patient’s usual sexual life, including foreplay, masturbation and intercourse, the relationship and interaction between sexual partners, as well as the patient’s interpersonal relationships 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 patient’s family history and growth history, as the background of growth and trauma suffered during early childhood often affects 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 certain, namely that 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 each treatment method. 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 effects 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, physiological factors also often cause premature ejaculation. For patients with premature ejaculation, a comprehensive and detailed assessment of their physiological and psychological factors is required 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 (SSRIs) 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 main categories.
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 that can cause significant delayed ejaculation after taking them, 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 pentazocine 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. Local anesthetics (commonly used gels) are applied to the sensitive parts of the penis such as the glans, coronal sulcus and tether 20 to 30 minutes before sexual intercourse to 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, 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 is not thoroughly washed from the penis 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, reducing 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 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.