I. You are not alone in this fight! The NHSLS (USA) study showed that the prevalence of premature ejaculation by age group was 30% (18-29 years), 32% (30-39 years), 28% (40-49 years) and 55% (50-59 years). The prevalence is so high! The three dimensions of modern premature ejaculation diagnosis: 1. time: ejaculation after the penis enters the vagina is always or usually within a minute (primary), or less than 3 minutes with significant distress (secondary); 2. stress: accompanied by negative psychology, such as distress, worry, frustration, avoidance of sexual contact; 3. control: weak ejaculatory control; the above three points, the most concerned about time, are precisely not the most important indicators of premature ejaculation! the most important indicator for the diagnosis! According to the literature, the average ejaculatory latency time is 5.4 minutes; however, 52% of men misestimate their ejaculatory latency time, of which 37.6% overestimate and 14.2% underestimate the intravaginal ejaculatory latency time (concept of intravaginal ejaculatory latency time: the time between the start of vaginal penetration and the start of ejaculation in the vagina). So what is the most important factor in the diagnosis of premature ejaculation, is control! Sex is a matter of “time and rhythm”, so how do you define a partner who has “no male control over ejaculation”? This is the case of the “out of sync” partner, a partner who may still have a certain amount of sex with each other, but has lost the quality of sex. Although the mechanism of loss of ejaculation control is male-dominated, it is almost exclusively female-related or partner-related. Thus, “asynchronous” partners are partners in which the male is unable to control ejaculation, which is related to the physiological pleasure of the female partner (the timing of female orgasm varies widely), so ejaculatory control is the key to assessing the treatment of premature ejaculation. Third, five risk factors leading to premature ejaculation 1, psychological related: anxiety, gender problems; 2, neurophysiological 5-HT overactivity, high penile sensitivity (multiple sclerosis); 3, prostate inflammation; 4, hormonal abnormalities: hyperthyroidism; 5, erectile dysfunction; Fourth, neurotransmitters involved in ejaculation 1, 5-hydroxytryptamine is the key transmitter, which plays a role in the neural control of male sexual behavior Inhibitory role of the central nervous system, 5-ht low activity leads to poor control, resulting in premature ejaculation. 2, CFDA’s only approved listing: Bilirubicin , oral 6 tablets before assessing the efficacy. According to statistics, oral administration of BILIJIN can increase the ejaculatory latency by 4 times. Psychological behavior therapy for premature ejaculation: Behavior therapy mainly includes Semans “move-stop” method and Masers-Johnson (see Note 1 for introduction) “squeeze and pinch method”. The partner helps stimulate the penis, and the patient signals to stop when he feels the urge to ejaculate, and then starts again when the urge disappears. 2. “Squeeze and pinch” method: Before the patient ejaculates, the partner squeezes the glans with his or her hand. The above methods usually take 3 cycles before completing orgasm. 3.Masturbation before intercourse Young men use it. The mechanism is a decrease in penile sensitivity after ejaculation by the masturbation method and a prolongation of the ejaculatory latency after the non-return period. If psychological factors are present, treat accordingly. Overall the short-term success rate of psycho-behavioral treatment is 50-60%. VI. Topical topical anesthetics The longest history of drug use. Can reduce penile glans sensitivity, delay ejaculation treatment, and does not affect ejaculation satisfaction. 1, lidocaine/procaine cream A randomized, double-blind, placebo-controlled trial, lidocaine/procaine cream increased IELT9 (1 min in the placebo group and 6.7 min in the treatment group). Another randomized, double-blind, controlled trial with lidocaine/procaine cream, IELT went from 1.49 to 8.45 minutes. The 5% lidocaine/procaine cream was appropriate for application 20 -30 minutes prior to intercourse. If the drug is applied topically for more than 30-45 minutes, erection will be hindered by a numbing sensation in the penis. It is recommended to use a condom after medication to avoid the anesthetic entering the vaginal wall of the partner and affecting his sensitivity. If the condom is to be removed for sex, the glans anesthetic needs to be removed first. It is contraindicated in patients or partners who are allergic to any component of the anesthetic. 2. Lidocaine (7.5 mg) + proparacaine (2.5 mg) (TEMPE, aerosol formulation) With Premature Ejaculation Self-Assessment Form: Read the above 5 questions and select the one option that best matches according to sexual intercourse within 6 months. If the total score is ≥11, it means there is a problem of premature ejaculation (ejaculatory control dysfunction); if the total score is between 9 and 10, it means there is a possible problem of premature ejaculation; if the total score is ≤8, it means there is no problem of premature ejaculation.