1. What is premature ejaculation (PE)? The definition of premature ejaculation is still controversial. In the past, premature ejaculation was usually judged by the latency of ejaculation or by whether women could achieve sexual gc, but this criterion was not satisfactory. In 2008, the International Academy of Medicine adopted the first evidence-based definition of premature ejaculation, stating that premature ejaculation is a sexual dysfunction with the following characteristics: (1) ejaculation often or always occurs within about 1 minute of vaginal penetration; (2) the ability to prolong ejaculation after repeated or each vaginal penetration; (3) negative consequences, such as annoyance, painful frustration and/or avoidance of sexual intimacy. intimate contact, etc. This criterion still does not identify the presence or absence of premature ejaculation, taking into account individualized differences. The patient’s ability to control ejaculation and whether the couple can achieve sexual satisfaction should also be taken into consideration. 2. What are the treatment measures for premature ejaculation? (1) Psychological treatment Sex is a psychosomatic act that requires close cooperation between men and women, so it is necessary to correct the wrong sexual concept and learn the knowledge of sexual harmony as the basis; deepen the relationship between husband and wife and get the wife’s cooperation as the key; reduce the anxiety, worry and high expectation psychological implication is the prerequisite; implement the calm and gentle mind in sex is the key to success, any excessive excitement, excitement, worry and anxiety can only speed up ejaculation. Any excessive excitement, excitement, worry, anxiety can only speed up the speed of ejaculation. (2) Drug treatment: including surface local anesthesia, 5-hydroxytryptamine inhibitors, etc. (3) Surgical treatment: dorsal penile nerve dissection, which should be carefully chosen because of its irreversible characteristics. It should be reminded that at present, various professional societies and treatment guidelines at home and abroad do not recommend surgery for premature ejaculation; the “dorsal penile nerve block” advertised on the Internet has not been carried out for too long in China, and has certain therapeutic effects on severe and persistent premature ejaculation, but also has some side effects, and requires strict surgical indications and scientific standards. The actual fact is that it is usually considered to be used only if the conservative treatment in regular hospitals is not effective. 3, premature ejaculation local anesthesia y the principle of the use of lidocaine? The current medical drugs for premature ejaculation are selective 5 hydroxytryptamine reuptake inhibitors (SSRIs) long-term treatment and local anesthetic y on-demand treatment two options can effectively treat PE, SSRIs are used for PE treatment because they can delay ejaculation, commonly used SSRIs preparations include dapoxetine, fluoxetine, paroxetine and sertraline, all of which have similar pharmacological mechanisms of action. Local anesthetic drugs for topical penile use for PE began in 1943 and were the earliest pharmacological therapy for PE. Local anesthetics can reduce penile sensitivity and prolong ejaculatory latency without affecting ejaculation. Commonly used local anesthetic drugs include compounded lidocaine cream. The combination of oral SSRIs and topical local anesthetics is often used clinically and is very effective. The ejaculatory activity is a very complex neural reflex process, controlled and coordinated by the ejaculatory center of the brain. The contact impulse felt from the head of the penis is transmitted through the afferent nerve, dorsal penile nerve, pubic nerve, sacral nerve. The ejaculation is induced by the contact impulses felt from the head of the penis through the afferent nerve, the dorsal penile nerve, the pubic nerve, the sacral nerve, and the spinal ejaculatory center (sacral 2, sacral 4), and then through the efferent nerve to innervate the ejaculatory organ. At the same time, the ejaculation activity needs to be completed by the synergistic action of many perineal muscles, urethral sphincter and prostate gland. The sympathetic excitability plays a dominant role in this process. In men, the peripheral nerves in the coronal sulcus, penile head and foreskin ties are rich and sensitive, and the higher their sensitivity, the shorter the ejaculatory latency. Local anesthetic drugs are used to block the nerve endings located under the mucous membrane. By reducing the excitability of sensory receptors or sensory nerve endings in the head of the penis, the purpose of delaying ejaculation can be achieved. 4.The correct way to use compound lidocaine cream? Primary receptors are mainly KrauseFinger vesicles within the mucosal layer of the penile head; secondary receptors are located in the corpora penis and scrotum, and stimulation of secondary receptors can increase the sensory information of Krause-Finger vesicles. Local anesthetic applied to the head of the penis can be used through the mucous membrane of the head of the penis for Krause-Finger vesicles, temporarily, partially and reversibly blocking the generation and conduction of nerve impulses. The local anesthetic applied to the penile body can act on the secondary receptors and weaken the sensory information of Krause-Finger vesicles. It is applied to the head and body of the penis 30 to 40 minutes before intercourse, and the foreskin should be sufficiently turned up before application. Use a condom or wash off the excess drug with warm water before sexual intercourse to avoid the drug entering the vagina during sexual intercourse, resulting in the lack of sexual kg due to the numbness of the woman’s vagina. Its effective time is 1.5 hours to 3 hours for skin surface and 1 hour to 1.5 hours for mucous membrane surface. So it is usually effective within 3 hours and varies from person to person. Several studies have shown that local anesthetic medications are 80% effective in the treatment of PE, but there is still a lack of large sample multicenter randomized double-blind controlled studies. By penile neurophysiological examination, about 60% of patients with primary PE exhibit penile sensory hyperexcitability, and local anesthetic drugs used locally on the penis in such patients can achieve an efficiency of more than 90%. The dose of local anesthetic drug treatment: when the dose is too large, it may cause numbness of the penile head, a decrease in sexual kg, and in patients with erectile dysfunction, it may aggravate erectile difficulties; the time to calculate the drug application before sexual intercourse, interrupting the environment of sexual excitement, which is not conducive to the play of foreplay and poor patient experience. In order to achieve better results, the clinical combination of oral sertraline or dapoxetine to help patients correct self-confidence and get rid of distress. However, local anesthesia y is still prohibited for patients or partners who are allergic to any of the product ingredients. At the same time, patients’ subjective judgment of the thickness of drug application varies, and when the dose is too large, it may cause numbness of the penile head, and patients will have difficulty in getting an erection. Therefore, it is important to develop a treatment plan that adjusts the dose under the guidance of a doctor according to the improvement of the patient’s sex life after using the drug. The first time evenly apply a thin layer on the head and body of the penis, according to the feeling of this sex to adjust, if it is too sensitive, the next sex to apply a slightly increased amount, if the feeling of numbness, affecting erection, the next time to reduce the amount, depending on the person and the specific situation, and to the time to ask the patient to wash the cream, to terminate the absorption of the drug by the local skin mucosa of the patient’s penis. Premature ejaculation patients in the absence of sexual life, sy is also available, through the regular and prolonged time of ejaculation, to build the patient’s self-confidence and lower penile sensitivity, so as to play a therapeutic effect.