Premature ejaculation is the most common ejaculatory dysfunction, with an incidence rate of more than 1/3 of adult men. Such a high incidence has caused deep pain to patients and numerous problems to doctors. In male clinics, there are often patients who ask the question: “Doctor, am I premature ejaculation or not? What is the cause? What should I pay attention to in general? Can premature ejaculation be cured? The actual fact is that you can find a lot of people who are not able to get a good deal on this. However, in the usual consultation, due to the large number of patients, doctors often do not have time to answer one by one, in order to facilitate the majority of patients, save consultation time, reduce the patient’s doubts, now combined with the “Premature Ejaculation Treatment International Update Guide” and my treatment experience, on premature ejaculation clinical FAQ unified answer as follows: 1.
1. How is premature ejaculation defined?
The International Society of Sexual Medicine (ISSM) has a new evidence-based definition of
(1) Ejaculation after the penis enters the vagina, always or usually within about one minute (primary), or less than 3 minutes, with significant distress (secondary).
(2) Inability to delay ejaculation after partial or complete entry of the penis into the vagina.
(3) accompanied by negative psychology, such as distress, worry, frustration, and avoidance of sexual contact.
2. How many minutes is ejaculation considered premature ejaculation?
The truth is that medical science does not use specific minutes to determine whether it is premature ejaculation or not; it is the feelings of you and your lover that are the most genuine. The definition of premature ejaculation as 1 minute or as 10 minutes does not change anything about your own feelings. If you insist on asking how many minutes is normal, I can only say that taking into account international standards, Asian specificities and my years of experience in medicine, I believe that it is normal for a healthy male to have ejaculation within 3-6 minutes of penile penetration into the vagina. If ejaculation occurs within 3 minutes in more than 50% of cases, it is recommended to see a doctor.
3. How is premature ejaculation classified?
Premature ejaculation is mainly divided into two categories: ejaculation from the first sexual contact always or usually within about one minute is called primary, and ejaculation of less than 3 minutes with obvious distress is called secondary; in addition, two types of premature ejaculation have been newly proposed.
Variable: irregular, non-continuous occurrence, within the normal fluctuation of sexual life.
Subjective: subjective description with continuous or non-continuous ejaculation earlier than expected, but the latency period is in the normal range and can be prolonged.
4. What tests are needed for premature ejaculation?
Premature ejaculation may be related to inflammation of the genital tract and over-sensitivity of the glans, so routine prostatic fluid and erectile nerve examination of the penis can be done. The results of these tests are available on the same day.
5.What is the cause of premature ejaculation?
It is not clear at present. Possible factors are: physiological-psychological hypothesis such as anxiety, over-sensitive penile head, 5-HT receptor dysfunction, etc. However, there is limited information to support the above theories.
6.What are the risk factors for premature ejaculation?
The incidence of premature ejaculation is higher in patients with anxiety disorders, and genetics, poor general health, obesity, prostatitis, thyroid hormone disorders, psychological factors, and excessive stress, and a history of traumatic sexual experiences are all risk factors for premature ejaculation.
7.What are the current treatments for premature ejaculation?
(1) Psychological behavior therapy.
(2) Western medical treatment Currently commonly used are: A Dapoxetine Dapoxetine (treated as needed, used before intercourse); B selective pentazocine reuptake inhibitors (such as sertraline) and chlorpromazine (tricyclic antidepressants); C local topical anesthetics (compound lidocaine gel); D Tramadol; E phosphorus; acid diesterase 5 inhibitors PDE5 inhibitors (tadalafil).
(3) Chinese medicine treatment: according to the specific situation of the patient, combined with the tongue and pulse, the diagnosis and treatment.
8.Is behavioral therapy for premature ejaculation reliable?
Behavioral therapy has its value and is suitable for those who take medication with obvious side effects. Because it is time-consuming and requires close cooperation with the partner; it is difficult to implement for a long time; and the long-term efficacy is uncertain, so it is only used as an auxiliary treatment for premature ejaculation.
9.How does behavioral therapy work?
Behavioral therapy mainly includes Semans “moving-stopping” method and Masers-Johnson “squeezing and pinching method”.
(1) “Move-stop” method
The partner helps to 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. All of the above methods usually require 3 cycles before orgasm is completed.
(3) Pre-coital masturbation
Used by young men. The mechanism is a decrease in penile sensitivity after ejaculation by the masturbation method and a prolongation of the ejaculatory latency period after the non-return period.
10.Does the treatment of premature ejaculation need the cooperation of the spouse?
Sexual life is an activity that brings pleasure to both spouses and requires the cooperation of both parties to achieve satisfactory results. And sex should be based on the good feelings of the couple, if the couple’s feelings are bad or poor cooperation, or even negative words or behavioral stimulation can easily lead to the occurrence of premature ejaculation. The first thing you need to do is to have a good emotional foundation and a tacit understanding of your sexual life to prevent premature ejaculation.
11, what are the considerations for the treatment of premature ejaculation?
(1) Premature ejaculation is judged by vaginal intercourse, and masturbation, oral sex or anal sex cannot be used as a diagnosis of premature ejaculation.
(2) The ejaculation time is inversely proportional to the time between two coital intervals, and the ejaculation time during irregular sex cannot be used as the diagnosis of premature ejaculation. It is recommended that normal adult men around 30 years old have sex about twice a week. Regular sexual life is also recommended during the treatment of premature ejaculation.
(3) Appropriate control of the frequency and amplitude of thrusting during sex can help prolong the ejaculation time.
(4) Position has an effect on the duration of sexual life. Generally speaking, the ejaculation time will be prolonged in the female superior position.
12.Is dorsal nerve block effective in treating premature ejaculation?
Dorsal nerve block is a new method of treating premature ejaculation in recent years. It is an invasive treatment method and the post-operative nerve damage is irreversible, so it should only be considered if the regular medication is not effective for three months. According to the data: the efficiency of microscopic dorsal nerve blocking in regular hospitals is about 70%.
13.Will dorsal nerve block cause erectile dysfunction?
Dorsal nerve block is to block the sensory nerve of the penis, not the erectile nerve, so theoretically it will not lead to erectile dysfunction. It is true that some patients can be seen to have erectile dysfunction after surgery, but after examination, they are all psychological in nature and have nothing to do with dorsal nerve block.