The treatment of premature ejaculation is still a medical challenge. Although there are some methods and drugs for premature ejaculation at home and abroad, there is no method or drug that is suitable for curing most of premature ejaculation. This is partly because these treatments or drugs are not perfect, and partly because of the complex etiology of premature ejaculation. The doctor needs to use the principle of personalized treatment according to the different conditions of different premature ejaculation patients, and the integrated treatment of multiple methods is more effective. The author’s treatment for premature ejaculation is mainly non-surgical, mostly using a combination of medication (Chinese and Western medicine) and guidance for patient health care (general health care and sexual life guidance), and has achieved very good results. Most patients are treated for one or two months, and a few for a little longer. After treatment, most patients have intercourse for 2 to 20 minutes (a few patients, especially those who do not cooperate well with health care, do not do well). As long as the patient cooperates and insists on health care, the effect can be maintained for a long time after stopping the medicine.
1, Chinese medicine
There are many Chinese herbs in China that have the effect of tonifying the kidneys and helping the yang to fix the essence. The systematic evidence-based treatment using Chinese medicine or the combined treatment of Chinese and Western medicine can be the most important method of treating premature ejaculation. The most recommended method!
2.Psycho-behavioral therapy for premature ejaculation
It is suitable for the treatment of premature ejaculation caused by psychological factors such as guilt, anxiety and nervousness, lack of sexual confidence, etc. In 1956, Semans, an American urologist, introduced the “stop–start” method, in which the patient or spouse stimulates the penis when the feeling of ejaculation is about to occur. In 1970, Masters and Johnson created the sensate focus exercise based on this method. This method is used to experience and enjoy the pleasure of sex by means of tactile stimulation such as hugging, touching and massaging by both men and women, to overcome the fear and anxiety of sexual intercourse, and to establish and restore the natural response to sexual life. It is suitable for the treatment of psychological erectile dysfunction and premature ejaculation. This therapy is divided into two stages: the non-genital sensual concentration training method and the genital sensual concentration training method. In 1983, Kaplan introduced the “stop-pause method,” which involves pausing stimulation instead of squeezing the head of the penis when ejaculation is imminent during sexual concentration training. This behavioral therapy simulates the natural behavior of prolonging the ejaculation latency during sexual intercourse.
3, oral western medicine for premature ejaculation
Selective 5-hydroxytryptamine reuptake inhibitors (SSRIs)
Fluoxetine (Prozac) 5–20mg/day
Paroxetine (Paxil) 10,20,40mg/day or 20mg 3-4 hours before intercourse
Sertraline (Zoloft) 25-200mg/day or 50mg 4-8 hours before intercourse
Non-selective 5-hydroxytryptamine reuptake inhibitors
Clomipramine (Anafenil) 10-50mg/day or 25mg 4-24 hours before intercourse
All of the above drugs are antidepressants and are used for the treatment of premature ejaculation using their side effects of delayed ejaculation (most of them have not been officially approved by the authorities for the treatment of premature ejaculation for this indication). They can be used as needed before sexual intercourse or daily. Its efficiency has been reported differently in the literature, with most being around 50-70%, and generally the heavier the premature ejaculation the worse the effect. Moreover, its efficacy is mainly reflected in the fact that the duration of intercourse is prolonged to varying degrees during the use of the drug, and then returns to the previous state after stopping the drug, i.e. the long-term efficacy is not good. The use of each drug may have some adverse side effects (such as fatigue, nausea, loose stools, sweating, dry mouth, etc.), and sometimes may also cause reversible libido loss or erectile hardness decline. The actual fact is that you need to use it under the guidance of experts.
4, topical medication for premature ejaculation
Surface local anesthetics such as ointments, gels or sprays of lidocaine and/or proparacaine. Apply it to the glans about 20 minutes before sexual intercourse, some patients have some effect of delaying ejaculation. Of course, the efficacy is also present at the time of application and is not present after discontinuation of use. Possible adverse effects are significant penile numbness and/or vaginal numbness, which can be avoided by using a condom.
ss-cream, reported by Prof. Sin Jong Sung in 1995 and 1997, is a natural compound made from 9 herbal extracts that partially contain local anesthetic effects. It is applied to the head of the penis one hour before sexual intercourse and then washed. 89.2% of patients showed significant improvement in ejaculatory control. 5.9% of patients experienced adverse effects, including mild local irritation and delayed ejaculation. This drug is currently not available in our hospitals or on the market.
5.PDE-5 inhibitors for premature ejaculation
Including sildenafil, tadalafil and vardenafil. It is suitable for premature ejaculation with erectile dysfunction. There are reports in the literature that it is also effective for primary premature ejaculation, but there are also different opinions.
6.Surgery for premature ejaculation
Partial excision of the dorsal penile nerve, first reported by Tullii RE in 1993 and carried out in a few units in China in the last decade or so, is suitable for young and middle-aged patients with premature ejaculation who have severe premature ejaculation and poor results of non-surgical treatment and normal erectile function. Complications of the procedure include pain, infection, penile numbness, and erectile dysfunction. Its efficacy has been reported differently by different units, and more clinical summaries are needed. This treatment is invasive, the nerve cut is not renewable, and the clinical application is not long, the number of cases is limited, and it needs to be carefully selected by experienced specialists. It is less recommended clinically. At present, it is mostly utilized by private or contracted hospitals.
7, accompanied by erectile dysfunction, urethritis, chronic prostatitis and other diseases, should be treated separately.