I. Introduction
Premature ejaculation is a disorder of sexual intercourse that occurs when the penis is inserted into the vagina before the woman reaches orgasm and the man’s intercourse time is shorter than 2 minutes and he ejaculates early. Generally, 30% of men have this condition. Although the problem is small, it makes the quality of sex life poor and may cause other sexual dysfunction such as impotence, which has serious consequences and should be taken seriously and treated early. It is generally believed that premature ejaculation is a phenomenon in which a man ejaculates after his penis is erect, before it enters the vagina, or just before it is incorporated, or just before it enters and is not yet pumped, and the penis naturally weakens and enters a period of inactivity. Clinically, ejaculation is diagnosed as premature ejaculation when the penis is erect before entering the vagina. For those who can enter the vagina for sexual intercourse, if they ejaculate quickly without moving a few times, it is also defined as premature ejaculation.
It should be noted that you are not prematurely ejaculated if you masturbate for too short a time only. Premature ejaculation must occur during sexual intercourse. Masturbation is not a direct cause of premature ejaculation. Moderate masturbation is normal, while excessive masturbation can lead to a decrease in sexual performance to some extent. Many people are misled to believe that just having masturbated can lead to premature ejaculation and many other problems, and this logic is incorrect. The truth is that premature ejaculation is just as likely to occur even if masturbation is stopped. On the contrary, masturbation can be a cure for premature ejaculation. If you make a habit of masturbating for a short time each time, the conditioned reflex, the time of intercourse in the future may also be short. So when you masturbate in the future, you should extend the time and stop immediately when you are about to climax, and repeat many times to improve the masturbation time. In this way, you can learn how to control the duration of sexual intercourse. Before sexual intercourse, you can also masturbate first, which can also prevent premature ejaculation.
The first thing you should do is to take a look at the actual site and see if you can find out how to get the most out of it. Gopla believes that premature ejaculation can be judged as discordant intercourse after penile insertion into the vagina, when the woman has not yet reached orgasm and the man’s intercourse time is shorter than 3 minutes and early ejaculation occurs.
According to the latest survey in April 2008, the duration of intercourse between heterosexuals is generally 3 to 13 minutes, with 3 – 7 minutes being acceptable and the ideal time being 7 – 13 minutes.
It is not surprising that normal men occasionally experience this phenomenon, but frequent premature ejaculation, which cannot complete the whole process of sexual intercourse, is pathological and can be diagnosed as premature ejaculation in the medical sense.
Are impotence and premature ejaculation the same thing? Many people compare impotence with premature ejaculation, and even say in newspapers and advertisements that xxxx medicine treats both impotence and premature ejaculation, which actually sells both spears and shields. The real scientific name for impotence is “erectile dysfunction”, which refers to a condition in which the penis cannot get an erection during sexual intercourse or can get an erection but it is not firm, or the erection cannot be maintained, so that the whole process of sexual intercourse cannot be completed. Therefore, impotence is mainly to solve the erection problem. Premature ejaculation, on the other hand, is too rapid ejaculation or called early-onset ejaculation. Some people ejaculate in less than a minute after penile insertion into the vagina, while others ejaculate before penile insertion into the vagina. This is due to the patient’s excessive excitability and low ejaculatory threshold related to ejaculation, that is, over-sensitivity and impaired central regulation of ejaculation by the cerebral cortex. If a couple has not had intercourse for a long time, it is normal for the first intercourse to be a little faster, the penis is more sensitive, a little sex-starved, and the phenomenon of premature ejaculation occurs. Premature ejaculation patients are almost always due to psychological factors, mental anxiety, tension are not easy to control ejaculation this reflex action.
1, having intercourse without feeling safe.
2, eagerness, or the desire to have a quick battle, is also likely to lead to premature ejaculation.
3, excessive excitement and impulsiveness, it is difficult to hold yourself, do not know how to control the reflex action of ejaculation, resulting in premature ejaculation.
4, some women do not understand the frustration of men to ridicule each other with words, which will aggravate the psychological burden of men and make premature ejaculation more and more intense.
The treatment of premature ejaculation mainly reduces excitability, breaks the original threshold, re-establishing a new reflex arc is very important, mainly with sedative and tranquilizing drugs, drugs plus behavior modification will receive good results. In addition, circumcision, chronic prostatitis and posterior urethritis can lead to rapid ejaculation, so it is necessary to find the cause and treat the primary lesion.
Some people call a premature ejaculation patient a fast shooter in bed, while an impotence patient is a gun that can’t stand up. Or the gun is delivered without going into battle.
Impotence is a condition in which the penis cannot get an erection during sexual intercourse, or the erection is not firm, or firm but not long enough to complete normal sexual intercourse as one of the most common male sexual dysfunctions.
I. Etiology
(a) Western medical etiology: there are many causes of impotence, in summary, mainly divided into psychological, organic impotence two kinds of impotence.
1, the psychological factors that cause impotence: each person is in a different environment, experience, psychological state and personality characteristics, the response to the same mental and social factors also differ. The psychological frustration that may not cause impotence for most people. For some people it can be a causative factor for impotence. Several common psychological factors that affect erectile function are: the influence suffered during development; the influence caused by incompatible relationships between people; emotional reasons; reasons for the perception of sex, etc.
2, organic factors that cause impotence: there are many organic factors that cause impotence, with different etiologies and pathologies, the main factors include endocrine diseases, neurological diseases, vascular diseases, genitourinary diseases, certain internal diseases, trauma and surgical trauma, old age and physical decline and drug effects.
(B) Chinese medical etiology: The etiology of impotence is complex, both singular and possibly mixed. Generally speaking, they can be divided into the following aspects.
1. Emotional and moral factors: The emotional and moral etiology of impotence is mainly in three aspects: fright, depression and thought. If you’re scared, you’ll have a disruption in your qi; if you’re overly stressed, you’ll have a disturbed shape and spirit, which can easily lead to impotence. Excessive depression or grief, loss of love between husband and wife, loss of harmony in the family, loss of smooth career, all easily lead to loss of liver qi, and the Yang thing does not work.
2, life factors.
(1) Excessive sexual intercourse: unrestrained sexual life, excessive frequency, damage to the kidney essence, exhaustion over time to physical weakness, gradually to impotence.
(2) Dietary habits and hobbies: Dietary disorder leads to damage to the spleen and stomach, and weakness of the spleen and stomach leads to impotence due to loss of vital energy and blood, and loss of nourishment and filling of the tendons.
(3) Overwork: overworking and overexertion, consuming a lot of physical strength, leading to impotence due to liver and kidney deficiency.
(3) Bad hobbies and behaviors: certain bad hobbies and bad behaviors of male individuals are also likely to induce impotence. Mainly such as non-marital or unclean sex, tobacco and alcohol addiction, etc.
II. Classification.
(I) According to the cause of the onset can be divided into.
1, psychogenic (functional) impotence: mostly caused by psychogenic factors, such as abnormal psychosexual development and emotions, indulgence, inappropriate environment for sexual intercourse, excessive fatigue, excessive alcohol consumption, heavy smoking and medical factors.
2, organic impotence: caused by certain organic factors, such as endocrine diseases, psycho-vascular lesions, genitourinary diseases, trauma surgery, drug abuse, etc.
(II) Classified according to whether there has been the ability to have sexual intercourse.
1, primary impotence: never had an erection to enter the vagina for successful sexual intercourse, mostly caused by sexual dysfunction in adolescence.
2.Secondary impotence: There has been successful sexual intercourse or sexual activity, but later impotence occurs due to various reasons.
III. Main symptoms.
1.Psychogenic impotence: The onset of impotence is urgent, the penis has spontaneous erection, at night during sleep or first awakening, there will be erection during masturbation or erotic association, but not erection when wanting to have intercourse; or the penis can be hard and erect when just touching the female body, but there is atrophy when attempting to penetrate. In addition, accompanied by mental symptoms, such as anxiety, anxiety, depression, mental discomfort, etc. Some may be accompanied by premature ejaculation or sexual intercourse without ejaculation.
2, organic impotence: the main symptom is that the penis can not be erected under any circumstances, the onset of more slowly, and is progressively aggravated. In addition, accompanied by the symptoms of the corresponding organic disease, such as diabetes mellitus of three more and one less (drinking more, urinating more, eating more, weight loss), etc.
IV. Diagnostic points.
1.History of mental and psychological factors, or history of organic diseases, or history of using drugs that affect sexual function.
2, the penis can not be effectively erected, so that it can not complete normal sexual intercourse, the history of the disease for more than three months.
3, Organic impotence with corresponding signs of organic disease.
4. Relevant laboratory tests and other examinations, such as serum sex hormone test and penile erection test, can help the diagnosis of organic diseases.
Second, the causes of premature ejaculation
1, mental factors
This type of premature ejaculation patients can also be called psychological premature ejaculation, and the mental factors that trigger premature ejaculation in men include many aspects.
It is important to note that men’s nervousness about sexual life will continue and will not change immediately due to changes in the sexual environment, while long-term sexual failure will backfire, causing a vicious circle in the patient’s psyche.
2, organic lesions
Many male diseases can make men’s ejaculatory center excitement lower, that is, more likely to ejaculate, such as urethritis, vesiculitis, prostatitis and other inflammatory diseases.
3, other causes
Over-stimulation of the glans by male penile foreskin and tight underwear can lead to premature ejaculation in men.
There are various causes of premature ejaculation, but they can be summarized into two categories.
(1) due to psychological factors (psychogenic): more than 80% of premature ejaculation patients are caused by psychogenic factors. nadels on (1978) reported that psychogenic people account for 85% of premature ejaculation patients. For example, long goodbye, newlywed honeymoon, excessive excitement or tension, excessive fatigue, depression, after drinking, indiscretion in intercourse, poor relationship between husband and wife, potential hostility, resentment and irritation of the husband towards his wife, or excessive fear, worship and inferiority complex of the wife are all factors that trigger premature ejaculation. The common psychological reasons are as follows, some people are fearful during sexual intercourse, lest ejaculation too early, causing wife dissatisfaction; some people out of the misunderstanding of sexual knowledge, unwarranted suspicion of their sexual ability is low, sexual intercourse is always ashamed of themselves, this situation is mostly seen in those who think their penis is short or think they are physically weak. Poor relationship between husband and wife, such as suspicion, jealousy or excessive respect for the wife, can also lead to premature ejaculation. Some people place too much importance on sexual life, expect too much, or worry too much about having had one or two occasional premature ejaculation, which may increase the psychological burden, forming a vicious circle of tension, premature ejaculation, more tension, continuing premature ejaculation and making premature ejaculation fixed.
The first time a couple has sex on their wedding night, the mood is exciting, the nerves are highly excited, the groom may ejaculate just when he touches the sexual organs or the penis is just put into the vagina, and the couple is reunited for a long time, the sexual excitement is faster, the man ejaculates some early, these situations cannot be diagnosed as premature ejaculation. With the couple living together, it will gradually become normal and no treatment is necessary. After marriage, excessive indulgence, excessive mental tension, emotional overexcitement or fear of ejaculation too soon makes sexual intercourse fail. Excessive physical fatigue and lack of energy can also weaken the control of the ejaculation center. Premature ejaculation can also occur in cases of neurasthenia due to the weakened inhibitory capacity of the brain.
(2) There are organic diseases: for example, congenital malformation of the external genitalia, prepuce, inflammation of the glans or foreskin, urethritis, phimosis, multiple sclerosis, spinal cord tumors, cerebrovascular accidents, epididymitis, chronic prostatitis, etc. can reflexively affect the spinal cord center and cause premature ejaculation. Some kind of systemic disease and weakness can also cause sexual dysfunction and premature ejaculation.
One of them is habitual premature ejaculation, which refers to those who consistently ejaculate prematurely during sexual intercourse after adulthood, and this kind of people have normal sexual physiological function and strong penile erection. The symptoms are strong sexual desire, strong penis erection and impatience for coitus, mostly seen in young and strong people;
The second is old age premature ejaculation, which is caused by sexual function decline; the early ejaculation time occurs gradually after middle age or in the elderly, often accompanied by decreased sexual desire and weak penile erection.
The third is occasional premature ejaculation, which mostly occurs when the body and mind are tired and emotionally volatile. The original premature ejaculation does not occur, but occurs acutely after some mental or physical stressful situation, often accompanied by weak erection.
At present, psychological treatment, especially behavioral treatment, is highly recommended at home and abroad, and the efficacy is considered more certain. Through general psychotherapy, patients can be taught about sex, help them to relieve their worries and reduce anxiety and tension, and teach them to master the method of muscle relaxation to eliminate fear and anxiety before sexual intercourse. In behavioral therapy, the method adopted by Masters and Johnson is more commonly used abroad. The Soviet sex psychologist Koladokhvir developed a set of homework therapy according to its therapeutic principles, requiring patients to complete it according to quality and quantity, divided into seven sets: mutual touching of sexually sensitive areas, establishment of female organ excitement, stimulation of penile feelings, prolongation of penile excitement, feelings when sexual organs touch, penile entry feeling of clitoral stimulation after vaginal stimulation, feeling of sexual excitement.
The treatment of premature ejaculation is a matter for both spouses, especially the participation of the wife in the treatment is very important. The psychological treatment of premature ejaculation requires the cooperation of the patient’s wife. Because of the misunderstanding or complaint of the female partner, it will make the male partner’s tension and anxiety rise and increase the psychological burden. The female partner should have a sympathetic and caring attitude and give comfort to the male partner with words and behaviors to ease his tension and help him establish confidence in the cure.
Diagnosis of premature ejaculation
The diagnosis of premature ejaculation is mainly based on the patient’s statement of medical history. Detailed medical history inquiry is fundamental to the diagnosis and treatment of premature ejaculation, and the diagnosis of premature ejaculation is derived from a complete medical history. Any patient with rapid ejaculation should have a detailed medical history. From the medical history, premature ejaculation can be simply divided into two types: primary premature ejaculation and secondary premature ejaculation. Primary premature ejaculation means that the patient has been having problems with premature ejaculation since he or she has had sexual experience, while secondary premature ejaculation means that the patient has had previous successful sexual experience. Generally speaking, secondary premature ejaculation is easier to find and treat the cause and has a better prognosis.
What are the key points that doctors should pay attention to when asking patients about their medical history? The questioning should include the frequency and duration of premature ejaculation, the strength of sexual stimulation at the time of premature ejaculation, the specific external environment or even the specific sexual partner that is prone to premature ejaculation, and the impact of premature ejaculation on sexual behavior, etc. These are the main points of the medical history. In addition, the general health condition of the patient is also important to ask. For example, patients with coronary artery disease may have premature ejaculation because they are afraid that excessive sexual stimulation will cause a myocardial infarction, which often resolves naturally after treatment of the myocardial infarction. When taking a medical history, we also need to understand some aspects of the patient’s usual sexual life, including foreplay, masturbation and intercourse, the relationship and interaction between sexual partners, as well as the patient’s interpersonal relationships and work situation, and so on, and we should ask them separately for evaluation. For patients with primary premature ejaculation, special questions should be asked about the patient’s family history and growth history, as the background of growth and trauma suffered during early childhood often affects the sexual life in adulthood. For patients with secondary premature ejaculation, special attention should be paid to identify whether the disease is premature ejaculation or erectile dysfunction, although there are many patients with both premature ejaculation and erectile dysfunction.
Physical examination and laboratory tests are not as important as medical history in the diagnosis of premature ejaculation. When patients with premature ejaculation undergo physical and laboratory examinations, the findings are usually normal. Nevertheless, a simple external genital examination is necessary. If a patient has erectile dysfunction in addition to premature ejaculation, necessary auxiliary examinations such as sex hormone examination, neuromyography and penile vascular examination should be performed according to organic erectile dysfunction in order to find the exact cause of erectile dysfunction and to provide targeted treatment. In many patients with premature ejaculation and erectile dysfunction coexisting, once erectile dysfunction is effectively treated, the patient’s confidence and ability to maintain erection will be enhanced and the problem of premature ejaculation will be solved.