Physiological premature ejaculation is hopefully curable and is not a terrible disease for men. Among them are sexual physiological sexual impulses are too high, the desire for sexual intercourse is too urgent, lack of sexual experience, lack of sexual knowledge problems, especially no suitable environment, the woman is too shy and nervous more drive men premature ejaculation. The two sexes, once the premature ejaculation, should not be afraid to ask questions, more communication with relatives, especially to go to the regular hospital to seek advice from sex specialists, or psychologists, to give the right guidance. This includes psychological, drug and sexual rational exercise, the main thing is to rely on yourself: “a combination of active physical and mental self-regulation and passive drug treatment”. Emphasis on comprehensive treatment, the complexity of the etiology and pathogenesis of male diseases determines that any single treatment is difficult to obtain satisfactory results, so the combined use of specialist treatment measures and drugs can mostly achieve satisfactory results.
Behavioral treatment of premature ejaculation
1.Stopping a moving a stopping training and squeezing technique
Also known as tolerance training, the woman should sit in the middle of the man’s legs, facing the man’s head, by the wife with the right hand stroking the glans penis and penis body, until the degree of ejaculation imminent, then stop stimulation, the woman quickly with the right thumb on the tethered part of the penis, show the finger and middle finger on the other side of the penis, just below the coronal edge, respectively, squeeze pressure for 4 seconds, and then suddenly relax. The direction of pressure is backward and forward rather than left and right, and the woman should use the fingers of her fingers and avoid pinching or scratching the penis with her nails. After the ejaculatory sensation of high excitement has disappeared, the penis is restimulated again. As this is repeated, the patient will gradually be able to tolerate a lot of stimulation without ejaculation. As time passes, the duration and number of stimulation intervals can be gradually reduced in order to delay the occurrence of ejaculation, and finally reach the point where it is possible to withstand continuous stimulation for a long enough time without premature ejaculation without the need for a midway interval. When the female partner stimulates, the male partner’s attention should be focused on the sensations generated by the stimulation of the penis, and do not pay too much attention to when will ejaculate, once ejaculation occurs, there should not be any uneasiness, guilt, but should focus on the feeling of orgasm. Stroking stimulation is most effective when undertaken by the female partner, while it is obviously much less effective if done by the male partner himself. The squeezing force should be proportional to the degree of erection, the harder the erection, the greater the pressure used. Generally about 2 weeks to see results, continue for 3-6 months to consolidate the effect.
2, pubococcygeus muscle exercise method (interrupted urination method)
Since both male ejaculation and urination are via the urethra, many of the muscles involved in these two phenomena are the same, but of course there are many that are different. Therefore, it is beneficial to practice interrupting urination. When urinating, first expel part of the urine, pause, contract the abdomen and lift the anus, then expel, pause again, contract the abdomen and lift the anus, and finish the urine in several times. Do 20 retractions of the abdomen and anus 20 times a day in the morning and before going to bed, and close your breath for 30 seconds while each retraction of the abdomen and anus. Premature ejaculation is caused by weak muscles and poor control, as long as it is persistent and persistent especially in the volume of urine, urine flow is better when the effect is urgent. This training can be practiced day and night, as long as you urinate, and most people can do it effectively. When not urinating can also do similar actions, poor physical fitness should strengthen physical exercise to improve the quality of the whole body.
3.Women on top sex
The man lies on his back and relaxes completely, the woman rides on top of the man and guides the penis into the vagina with her hand, while understanding that this is not sexual intercourse, so don’t make too many demands, just stay relatively calm, when the penis is inserted, the man should remain still, keep the penis erect, avoid shrinking the abdomen, raise the testicles, and try to experience the warmth and wetness of the penis in the vagina, the pressure of the tight grip, the organ fit brings to the vaginal wall texture, etc. This exercise usually takes less than 5 minutes. If the erection fades, have the woman contract the vagina several times to stimulate a full erection again. If you feel that you are about to ejaculate, the woman lifts up and withdraws the penis from the vagina. The purpose of this stage is to try to insert the penis into the vagina and to simply notice what it feels like when there is no movement or pumping. This is followed by up and down pumping by the female partner, but the female partner should pump gently and slowly. Once the male partner has an aura of ejaculation, the female partner immediately stops pumping, the male partner closes his breath to keep quiet, and when the urge has passed, the female partner then performs the pumping operation two or three times a week for two weeks.
4.Oral drug treatment
(1) antidepressants application of antidepressants for premature ejaculation has nothing to do with depression, nor is it aimed at the patient’s bad mood, but such drugs have the best effect of raising the ejaculation threshold and delaying ejaculation. Clinically commonly used are paroxetine (Loyola) 20-50mg/day and fluoxetine (Benadryl) 5-20-40mg/day taken. There are three broad regimens of medication: regular daily dosing, on-demand dosing (3-4 hours before intercourse), and on-demand dosing based on regular daily dosing for a period of time with the option of on-demand dosing based on efficacy. Generally speaking, the third regimen is effective, has few side effects, is economical, and is taken after meals to reduce gastrointestinal irritation. The course of treatment for premature ejaculation is different from psychiatric long-term heavy medication, the time to obtain disease improvement is 1 to 2 months, so the course of treatment is mostly one month, and those who are effective can be used continuously for 2-3 months and gradually reduce the maintenance.
(2) α1-adrenergic receptor blocking drugs ejaculation and sympathetic nervous system, α1-adrenergic receptor blocking drugs block sympathetic nerves to delay ejaculation, theoretically valid, clinically effective about 50%, Terazosin 5-10mg/day, for premature ejaculation with benign prostatic hyperplasia, chronic prostatitis and lower urinary tract symptoms is effective.
(3) Tramadol Tramadol is a central analgesic that is both an opioid receptor agonist and a pentraxin and norepinephrine reuptake inhibitor. Tramadol 50 mg, taken as needed 2 hours before intercourse, can produce delayed ejaculation in patients with premature ejaculation. Adverse effects include nausea, vomiting, and dizziness. Long-term application for addiction needs to be followed up and observed.
(4) Sildenafil (Viagra), a PDE-5 inhibitor, is effective in patients with premature ejaculation combined with erectile dysfunction.
(5) Chinese medicine treatment
In the course of long-term practice, premature ejaculation is closely related to the heart, kidney and liver. In terms of etiology, excessive pressure from work and study, tension between husband and wife and lack of sexual knowledge are related to the heart; the original congenital deficiency, weak constitution, yin and yang deficiency, or excessive masturbation and frequent sexual intercourse cause excessive dissipation of kidney qi and loss of sealing, which are related to the kidney; the liver meridians go around the The liver’s drainage function has a close relationship with the normal discharge of semen, such as liver depression, liver loss of stripes and drainage, qi stagnation, blood stasis, loss of nourishment of the tendons, loss of spirit, drainage disorder and premature ejaculation. The majority of Chinese medicine’s understanding of premature ejaculation is that there is less disease occurring in a single internal organ, and more disease is intermingled with each other.
Premature ejaculation is most closely related to yin and yang, and is often accompanied by introversion, palpitations and timidity, often with psychological disorders, distraction and insomnia, seminal emission and slippage. Treatment is based on tonifying the heart and kidney yin and yang, and supplemented with solid astringency. Sour jujube yang plus flavor is commonly used.
②Nourishing Yin and clearing heat, consolidating and astringing spermatozoa are often seen in hyperactive sexual desire, easy to raise the Yang, spermatorrhea, soreness and weakness of the waist and knees, irritable heat in the five hearts, red tongue with less coating. Zhi Bai Di Huang Tang with flavour is often used.
(3) Strengthening the spleen, tranquilizing the mind and benefiting the kidneys, with tiredness and weakness of the limbs, palpitation and shortness of breath, dullness and abdominal distension.
④Benefit the kidneys and consolidate astringency, clear the liver fire method of the liver qi directly affects the production and excretion of semen.
(5) The method of activating blood circulation and resolving blood stasis is mostly seen in blood sperm, tingling pain in the pubic area or perineum and falling, dry mouth, or with night fever and inconvenient urination, etc. It is often used to add flavor to Tao Ren Cheng Qi Tang.
(6) Warming the kidney and fixing astringency method is mostly seen in middle-aged and elderly people, commonly seen with decreased libido, soreness and weakness of the waist and knees, slippery sperm and nocturnal urination, or impotence, commonly used with Jin Kui Kidney Qi Pill with addition.
5.Local treatment
Local anesthetics applied to the penis before sexual intercourse can delay ejaculation. After the application of anesthetics with or without condoms, condoms can also be removed before intercourse to wash the residual drugs on the penis. If worn to avoid vaginal numbness in the female partner. Lidocaine applied 20-30 minutes before intercourse can prolong the ejaculatory latency.
The external treatment method of Chinese medicine is more blooming, including secret essence tincture application, fumigation method of fumigation of glans, massage, acupuncture, especially the Chinese medicine navel method carried out by our department in recent years has satisfactory clinical efficacy.
6. Combination of Chinese and Western medicine, complementary advantages
Modern medicine believes that the exact cause of premature ejaculation is unknown. The proposed causes are psychological, behavioral and biological factors. The treatment of premature ejaculation emphasizes psychological, behavioral and pharmacological interventions. According to traditional Chinese medicine, premature ejaculation is mostly caused by internal injury of emotions, dampness and heat, excessive indulgence in sexual desire, and deficiency of the body due to prolonged illness. The basic pathogenesis is that the kidneys are out of seal and the essence is not taken care of. The location of the disease is in the kidney and is related to the heart, liver and spleen. The pathological nature of deficiency is more than real, and mixed symptoms of deficiency and real are also common in clinical practice. The effect of single treatment is not good, and some of the drugs have large side effects and hurt the vital energy, so it is very important that Chinese and Western medicine complement each other and have obvious advantages. From the treatment of the pathogenesis of Western medicine has been proposed glans local stimulation valve is low, the cerebral cortex sexual ejaculation center control ability is low, so we can examine the disease to seek the cause, for local and central targeted treatment. For example, local treatment of western medicine can be with double penis condom, pre-sex local anesthetic topical application, and behavioral therapy. In the treatment of the center, western medicine uses antidepressants to enhance the activity of pentazocine by promoting its transport to prolong the ejaculatory latency, representing drugs such as paroxetine and fluoxetine. The Chinese medicine has a close relationship with the heart and liver in terms of central medication, which can prolong the ejaculation time by nourishing the heart and tranquilizing the mind, draining the liver and regulating the qi, and nourishing the yin and lowering the fire. In addition, acupuncture and massage, through the adjustment of meridians, have a good therapeutic effect on the local and central. Therefore, the combination of Chinese and Western medicine can not only treat correctly for the cause, avoiding blindness, but also reduce and avoid side effects from a holistic view, without hurting the righteousness and with definite efficacy.