Hello everyone, the issue we are talking to you about today is how to look at premature ejaculation. It is clinically found that many patients take premature ejaculation particularly seriously, often causing their own anxiety, depression, lack of self-confidence and other psychological problems, but is premature ejaculation considered a disease in the strict sense? What kind of attitude should we take towards premature ejaculation? This is a question that needs to be thought about in depth. In fact, the debate on premature ejaculation has been going on for a long time. For example, at the 2006 American Academic Urology Conference, some experts believed that medication was the most effective treatment for premature ejaculation, while others believed that the best treatment was psychological and behavioral therapy. “Professor Cleveland E Althef believes that the problem of premature ejaculation is much more than a simple genital nerve reflex problem, that treatment that simply prolongs time ignores the entire male psychosexual health, confidence and harmony, and that 5-hydroxytryptamine abnormalities are only a hypothesis. The pathophysiology of premature ejaculation has not been clarified so far, and depression, anxiety and lack of self-confidence cannot be solved by taking a piece of medication. In contrast, professors such as Aarada in New York, Sharlip in San Francisco, and Pryor in Minnesota believe that premature ejaculation is a problem of the reproductive nerve reflex in which the central SSRI plays a key role and that pharmacological treatment is effective. Objective evidence of premature ejaculation is available through intravaginal ejaculatory latency time (IELT) measurements, where the average IELT is >7 minutes in normal subjects and <2 minutes in patients with premature ejaculation." (The above is from the conference proceedings.) In the following analysis, experts who believe that abnormal 5-hydroxytryptamine causes premature ejaculation and requires pharmacological treatment, base their opinion mainly on the IELT. however, whether the length of the IELT is abnormal or not again needs to be combined with the definition of premature ejaculation, i.e., first determining who is a premature ejaculator; and who is normal. These two are first distinguished then the IELT of premature ejaculation patients is tested, while the IELT of normal people is tested, and then the two are compared with statistical significance. But how are patients with premature ejaculation determined, is it based on the testers own judgment or is it based on one of the diagnostic criteria? As I mentioned in my previous article, the diagnostic criteria for premature ejaculation are actually indeterminate. And IELT alone does not provide a correct diagnosis of premature ejaculation, and to determine that a certain group of people should take medication for treatment based on a statistical result with an unclear diagnosis does not seem to be a serious attitude, or at least poorly persuasive. Let's take a look at some statistics mentioned in a foreign review on premature ejaculation in 2008: Ejaculation latency and ejaculation control statistical results time of men who think they have poor or very poor ejaculation control think they have good control 67.7% of men who ejaculate within 1 minute 32.41-2 minutes 56.4% of men who ejaculate within 2-4 minutes 43.6% of men who ejaculate within 2-4 minutes 20% of men who ejaculate within 1 minute In other words, the majority of those who ejaculated within 2 minutes felt that they had less control over ejaculation, but 32-44% felt very good control. For those who ejaculated more than 2 minutes, the majority felt that they had very good control, but there were still some who felt that they had diminished control. Statistical results of ejaculatory latency and sexual satisfaction time perceived low sexual satisfaction feeling very or very satisfied with sex 25.4% of men who ejaculated within 1 minute 74.7% of men who ejaculated within 1-2 minutes 24.4% of men who ejaculated within 2-4 minutes 75.5% of men who ejaculated within 2-4 minutes only 7.4% 92.6% of men who ejaculated more than 4 minutes IELT is no longer an influence on sexual satisfaction The results interestingly show that intravaginal latency is not a very important factor in the satisfaction of sexual intercourse. It is clear from the above statistics that among men who also ejaculate within 1 minute, some are satisfied with their sex life while others are not, some think they have good control while others think they have poor control, so IELT alone does not tell us anything. In my personal opinion, premature ejaculation is not considered a disease, even if it is considered to be different in some aspects between premature ejaculation patients and normal people according to some tests. For example, we can divide fast runners and slow runners into two groups and then test the relevant indicators for statistics, but regardless of whether or not there is a difference or how much of a difference there is in the statistical results, we cannot consider slow running to be a disease. It only affects people mentally and psychologically, and although this effect is certainly annoying or painful, it can only be considered a mental and psychological problem at best, but far from being a "disease". From the animal kingdom, the shorter the ejaculation time, the less attacked the species is, and the easier it is to reproduce. So from the point of view of biological evolution, a short ejaculation time is an advantage, a biological evolutionary choice. With the progress of human civilization, human beings have become more demanding and sex has gone beyond the primitive animal instincts (racial reproduction) to focus more on the enjoyment of sex. This shift is what makes the length of ejaculation a very important issue. Therefore, despite the progress in research on the pathogenesis and treatment of this disease, there are still many scholars who insist that premature ejaculation is "not a disease". When I treat premature ejaculation clinically, I also make it clear to my patients that they should not consider premature ejaculation as a disease. Sometimes even jokingly say: "Men who ejaculate quickly are a good breed." Oh. The debate about premature ejaculation will continue and there won't be a clear conclusion anytime soon, but that's a matter for the experts, and what kind of attitude should we use to treat premature ejaculation? I believe that premature ejaculation should be treated like how tall or how fast you run. Some kids are born to run faster, some are born to run slower. Maybe you are born slow and it makes you feel embarrassed and ashamed, which is normal, people want to save face, but you must know that it is not a disease! If you want to run faster, you can, but don't go to a doctor, you should go to a trainer, and through training you will be able to run faster. If you think it does not matter how fast or slow you run, then even the coach is exempt. This is the mindset you need to have when dealing with premature ejaculation. In fact, most people don't come to the hospital because of short ejaculation time, after all, they are the minority. So what should some people do who do suffer from rapid ejaculation and are distressed and want to improve the quality of their sex life by prolonging intercourse? I would suggest that these people seek consultation with a specialist in urology or male medicine. The treatment should start with behavioral training and psychotherapy, both of which are treatments without any harm or side effects and should be preferred. If the effect is not good, you can combine with herbal or western medicine treatment, after all, drug treatment all have certain side effects. Surgical treatment should be the last choice. I often find in the clinic that many patients are accompanied by varying degrees of psychological problems, which should not and need not be. It is very important to keep a relaxed and confident mind during sex, otherwise it will greatly affect the quality of sex life, so you easily don't think you have a disease and make yourself carry too much psychological burden. Finally, I wish you all can face sex with a relaxed mindset to enjoy sex.