The International Society for Sexual Medicine, has adopted a new definition of premature ejaculation. Premature ejaculation is a male sexual dysfunction characterized by ejaculation always or almost always before, or within about one minute after, vaginal entry, inability to delay ejaculation after full or almost full vaginal entry and negative personal outcomes such as distress, apprehension, frustration and/or avoidance of sexual intercourse.
Treatment of premature ejaculation includes
I. Psychological/behavioral treatment
1. Psychological counseling, patient education is very important to make them realize that the actual harm of premature ejaculation is not serious to human beings.
2. Behavioral treatment, the treatment methods mainly include.
(1) The “move-stop” method, in which the partner stimulates the penis, and when the patient has the urge to ejaculate, the partner is told to suspend the stimulation, and then re-stimulate the penis after the urge to ejaculate disappears completely.
② Squeeze method, similar to the former, but requires the partner to use the technique to compress the penis head when the patient has the urge to ejaculate, until the patient’s urge to ejaculate completely disappears, and the two methods of operation are repeated three times before reaching orgasm.
Masturbation for ejaculation before sexual intercourse, or multiple intercourse, is the method available to most young men. The short-term success rate of behavioral therapy is 50% to 60%, but its efficacy is difficult to maintain in the long term.
Second, premature ejaculation drug treatment
The main drugs are local anaesthetic drugs and selective pentothal reuptake inhibitors, two drugs.
1, local anesthetic drug treatment
The local application of anesthetics can reduce penile head sensitivity and delay ejaculation latency, which does not have an adverse effect on ejaculatory pleasure.
Usage: It can be applied to the penis head and its surrounding sensitive area when 20 to 30 minutes before sexual intercourse. Local anesthetics can result in a few patients, who are unable to get an erection due to numbness of the penis. A condom may be used during sexual intercourse, or the penis may be washed to avoid spreading the local anesthetic into the vaginal wall and causing the partner to feel numbness. Contraindicated in patients or partners with allergies to the ingredients.
2.Selective pentazocine reuptake inhibitor
Used in the treatment of premature ejaculation because they can delay ejaculation. Commonly used drugs include: dapoxetine, paroxetine, fluoxetine, and sertraline. The doses are 20 to 40 mg for paroxetine and 25 to 200 mg for sertraline.
Delayed ejaculation usually occurs within a few days, with more pronounced effects after 1-2 weeks, reaching the strongest effect in 1-2 months. The efficacy of long-term administration can be maintained for several years, but drug tolerance can develop after 6 to 3 months of treatment in a few cases. Common adverse reactions include fatigue, drowsiness, yawning, nausea, vomiting, dry mouth, diarrhea, and sweating, usually mild and mild reactions that may resolve gradually after 2 to 3 weeks.
Other patients report decreased libido, lack of sexual pleasure, non-ejaculation, and erectile difficulties.
Attempts to reduce the drug are usually made after six to eight weeks of application, but do not stop taking the drug abruptly to prevent withdrawal syndrome, which is characterized by tremor-like symptoms, nausea, and dizziness.
3, type V phosphodiesterase inhibitors
Such as sildenafil and tadalafil can improve erectile function. The combined application of selective pentraxin reuptake inhibitors is more effective than selective pentraxin reuptake inhibitors alone.