The history of medicine has never been short of some groundbreaking ideas and bold doctrines, but very few of them have actually entered the hall of science and become classical theories for the benefit of mankind, and more often than not, the doctrines that looked beautiful at the logical level were brutally slaughtered by the ugly facts at the empirical stage. In September 2001, urologists in China started to perform the procedure, and soon the procedure became so widespread in China that even a search using relevant keywords in English yielded articles written by Chinese authors. However, in contrast to this apparent “boom”, neither the Guidelines for the Diagnosis and Treatment of Premature Ejaculation (2011) issued by the Chinese Society of Sexual Medicine and the Special Committee on the Definition of Premature Ejaculation and the Guidelines for the Diagnosis and Treatment of Premature Ejaculation (2014) issued by the International Society for the Definition of Premature Ejaculation and the Guidelines for the Diagnosis and Treatment of Premature Ejaculation (2014) recommend dorsal penile neurectomy as a treatment modality for premature ejaculation. Can premature ejaculation patients be treated with this procedure or not? Let’s start with the basic concepts and principles. If we catch a random person on the street and ask you (or your spouse) if you have premature ejaculation, and the other party does not directly beat you up but seriously answer the question, you will find that the answers may be varied, and even what exactly is considered premature ejaculation is also unclear, of course, what exactly is premature ejaculation, this is actually an academic question, you have to let the academic community to answer, but what makes everyone dizzy is The problem is that the academic community was once very confused about this issue. It’s not just a diagnostic problem, is it? The actual fact is that you can’t even figure out if it’s premature ejaculation, so you doctors are all quacks. You do not say, the diagnosis of premature ejaculation is really a bit of a problem, it is not like the diagnosis of a fracture, an X-ray film in front of the reading light, as long as the doctor is not blind, basically can confirm the diagnosis. But the same man’s condition may be determined as premature ejaculation and non-premature ejaculation at different times in history, because the definition of premature ejaculation is actually always changing. For a considerable period of history, what is known today as premature ejaculation would not have been classified as a disease, but rather than being a disease, it might have fallen under some kind of advantage. Compared to the long history of mankind, the history of people wearing pants is just a moment in the light of stone and fire, and the instinctive behavior of mating has to find an undisturbed private space is also a very recent habit, the pre-civilizational history of human love between the sexes, naturally, with the same wild animals, the sky as a quilt to the ground as a bed, nature in all its pleasures. For people in today’s civilized world, wild warfare is probably only a special excitement outside of regular sexual activities, and it is fine to do it occasionally, but for our ancestors, it was a reproductive activity that had to be risked. As the saying goes, “survival of the fittest”, the habit of rapid ejaculation has been written into the genes of men from generation to generation. In this sense, we are all descendants of speed shooters. But with the improvement of human living environment, people have developed the stink that mating must be done in private space, especially when women’s sexual awareness gradually awakened, women’s sexual satisfaction has become a factor that must be considered in sexual activities, then rapid ejaculation has become a problem that must be faced, oh, from this point on, we should use the term premature ejaculation (PE) From this point on, we should use the term premature ejaculation (PE). According to the World Health Organization’s definition of health, “Health means not only the absence of disease or illness, but also a state of complete physical, mental and social well-being. This means that a healthy person has a strong body and an optimistic mental state and is able to maintain a harmonious relationship with the social and natural environment in which he or she lives.” Sexual relationships are obviously important social relationships, so it is not difficult to understand that premature ejaculation is treated as a disease, but it is also because the determination of premature ejaculation is easily influenced by social relationships that the definition of premature ejaculation was once very confusing. If you break a bone, no matter who your wife is you this is a fracture, but this is not the case with premature ejaculation. Premature ejaculation has been considered a clinical syndrome for over a century, but the criteria for its definition have varied. In the early literature we found that some scholars believed that the incidence of premature ejaculation accounted for 35% to 50% of adult males, a figure that is far from the common knowledge of most of us, which disease would have such a high incidence? This is actually related to the definition of premature ejaculation in the United States. In 1994, the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, the diagnostic criteria for premature ejaculation are: A. Prolonged or recurrent ejaculation occurs after mild sexual stimulation, or before, just before or within a short period of time after penile penetration, significantly earlier than the person wishes. Various factors affecting the duration of sexual excitement, such as age, new sexual partners, new environment and frequency of recent sexual intercourse, should be considered in the physician’s judgment. B. This dysfunction obviously causes distress or interpersonal tension to the person. C. This premature ejaculation is not caused by the direct action of a substance (e.g., opium). This definition obviously does not only consider men, but both men and women, especially reflecting the transformation of sexual behavior from reproduction-centered to pleasure-centered, fully taking into account the proportion of pleasure factors in the diagnostic criteria, transforming the sexual dysfunction of men alone into a sexual problem common to both men and women, not only the diagnosis needs to consider the feelings of both parties, but also the treatment needs to refer to the feelings of both parties, in a word, premature ejaculation is In a word, premature ejaculation is a disease whose diagnostic criteria need to take into account the sexual feelings of women. However, more than ten years after the release of this concept, the medical community found many problems, because this definition will lead to a high incidence, but the actual consultation rate is very low, which is not conducive to the detection and solution of the real problem, such as a short time after penetration (shortly after penetration), how short is it? How long do you want it to be earlier than you want it to be, and what if some people have to do it for an hour to be satisfied? Because the diagnostic criteria are too broad, without a specific concept of time, relying mainly on the subjective feelings of the person, and the typing is relatively simple, so it is not conducive to in-depth research on PE. In 2000, the American Psychiatric Association revised the diagnostic criteria for premature ejaculation, proposing several subtypes and introducing the concept of time, for example, one of the diagnostic criteria for the most severe lifelong premature ejaculation is that ejaculation occurs in 30-60 seconds in most cases (80%) or between 1 and 2 minutes (20%). For example, if a man’s ejaculation latency is 6 minutes and his partner’s orgasm latency is 4 minutes, and both of them will be happy, then the man is not prematurely ejaculated. The same man, his partner’s orgasm latency if 15 minutes? Since the woman can’t reach orgasm, huh? That’s premature ejaculation? In 2010, the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders made significant adjustments to the diagnostic criteria for premature ejaculation, a significant feature of this edition was the change from premature ejaculation to early ejaculation. A word difference, the meaning is very different, obviously the latter is more objective, accurately specify the concept of time advance. When I was writing this article, I did a survey in a small area, and all the netizens who left comments were more in favor of premature ejaculation than early ejaculation, which also shows that ordinary people’s understanding of premature ejaculation actually tends to be an idealized concept, and this idealization is precisely where the previous versions of the definition of premature ejaculation were inadequate. According to the latest version of the definition of premature ejaculation, the incidence of lifelong premature ejaculation, which should be treated most, is no more than 4%, and according to studies in several countries, the median time of male ejaculatory latency is 5.4 minutes. Shouldn’t that be a relief? Actually, you are not that easy to be prematurely ejaculated. Some scholars claim that lifelong premature ejaculation (primary premature ejaculation according to the Chinese classification method) is an indication for dorsal penile nerve amputation. The principle is that the dorsal penile nerve is a sensory branch of the pubic nerve that conducts nerve impulses felt by sensory nerve receptors. The free nerve endings of the dorsal penile nerve are located at the head of the penis, the penis and the skin of the scrotum. The nerve impulses required for ejaculation are mainly transmitted by the dorsal penile nerve. Sexual stimulation is transmitted via the dorsal penile nerve to the higher ejaculatory center in the brain, and when the stimulation accumulates to a certain level, the ejaculatory impulse is transmitted down to the sacral nerve and induces the contraction of the bulbocavernosus muscle, resulting in ejaculation. In patients with primary premature ejaculation, the excitability of the dorsal penile nerve, especially the sensory nerve excitability of the penile head, is higher than normal, so that the ejaculatory reflex is easy to be induced during sexual intercourse. By partially cutting the sensory nerve endings of the penis, the nerve impulses transmitted to the dorsal penile nerve are reduced in “quantity” and the sensation of the penile head is dulled, thus prolonging the ejaculatory latency and treating primary premature ejaculation. Therefore, theoretically, after dorsal penile nerve amputation, the sensitivity of the penile head can be reduced, the ejaculatory latency can be prolonged, and the quality of the patient’s sexual life can be improved. Also according to an anatomical study done by Dr. Xing-Hua Li the mean number of dorsal penile nerves in 47 cadavers was 3.49 ± 1.23, which is significantly different from the number of dorsal penile nerves observed clinically in patients with primary premature ejaculation (mean 7.69 ± 1.77), also suggesting that the procedure may help improve premature ejaculation. This theory seems to be perfect, but since the invention of the procedure by Tulli, a Brazilian, in 1993, the clinical application of the procedure has not been very satisfactory, with the foreign literature suggesting an efficiency rate of less than 50%, while a professor in China concluded that the efficiency rate could reach 81.25% after performing the procedure on 32 patients with primary premature ejaculation (6 cases were invalid). In my opinion, the most important thing is that all clinical trials on this procedure are missing an important part, namely the sham control group. Based on the previous narrative and our common sense and experience, it should not be difficult to understand that the occurrence of premature ejaculation is greatly related to psychological factors, and in the known clinical trials, are unable to shield the strong placebo effect brought about by the operation, some domestic scholars believe that selective dorsal penile neurectomy has an advantage in terms of efficacy, but according to a study from Xinjiang, selective and non-selective dorsal penile neurectomy However, according to a study from Xinjiang, there was no significant difference between selective and non-selective dorsal penile neurectomy in terms of efficacy, which makes me wonder what clinical effect would be achieved if the dorsal penile nerve is simply not cut and the patient is simply made to think that the operation has been done in terms of appearance. In clinical practice, we often observe substances that are not supposed to have any drug effect, but in reality produce the same “therapeutic effect” as drugs, which is called the placebo effect. But can fake surgery also cure the disease? In 2002 surgeon J. Bruce Moseley published an article in the prestigious medical journal The New England Journal of Medicine entitled A CONTROLLED TRIAL OF ARTHROSCOPIC SURGERY FOR OSTEOARTHRITIS OF THE KNEE, was a beautiful theory that was shattered using a sham surgical control group. What happened was that decades ago, it was thought that the pain of osteoarthritis (i.e., osteophytes) was primarily due to increased inflammatory factors in the joint cavity caused by synovial proliferation and cartilage exfoliation within the joint. Therefore, if surgery was used to clean out these exfoliations and flush out the inflammatory factors, the patient’s condition would improve. In the 1980s, as arthroscopy became more popular, doctors used arthroscopy to perform “knee debridement”. Patients were pleased with the results and felt relief from pain after the procedure, so it quickly became popular. In the United States alone, 650,000 people have the procedure done each year, and orthopedic surgeons have a multibillion-dollar business that makes a lot of money each year. But the well-fed Moseley did a study that blew his fellow surgeons away. He divided 180 patients into 3 groups: 60 had joint irrigation, 60 had joint cartilage smoothed out on top of the joint irrigation, and the other 60 had incisions made only on the skin surface without any intervention on the structures inside the joint cavity. Since then, different doctors have evaluated the procedure and the results are basically the same as Moseley’s, which means that this complex and costly procedure is actually no better than simply taking some painkillers. (This procedure, which has been shown to be ineffective, is still popular in some of China’s major formal hospitals, so this is an aside.) Moseley is not alone in trashing his own business and that of his peers; in fact, the placebo effect of this sham procedure is not uncommon, as a large review published in the BMJ in May 2014 (Use of placebo controls in the evaluation of surgery: systematic review) showed. controls in the evaluation of surgery: systematic review) searched the decades-old medical literature and found 53 (sham) surgery trials with randomized double-blind controls in which 51% of the sham surgery results were equivalent to those obtained with real surgery. Therefore, if this dorsal penile neurectomy, based on the pretty theory, is to be truly accepted by the medical community, no matter how pretty the data (ridiculously higher than foreign counterparts) are from Chinese scholars with only a blank control group (i.e., no treatment), it will not be accepted by their peers unless they can prove that the procedure is better than the sham procedure.