In male clinics, we often see that some patients are not clear about the concept of erectile dysfunction (commonly known as impotence, abbreviated as ED in English) and premature ejaculation (abbreviated as PE in English) and are confused with each other. The unclear understanding of the concepts leads to poor implementation of the diagnosis and treatment plan proposed by the doctor; especially when the doctor asks the patient to fill out some scales, often due to the misunderstanding, the actual condition is not reflected truthfully, affecting the diagnosis and treatment. So, what is the difference between impotence and premature ejaculation? First, the definition is different 1. What is erectile dysfunction? According to the definition of the 2015 European Society of Urology guidelines, erectile dysfunction (commonly known as impotence in the past, but this title is not recommended at present) refers to the inability of the penis to achieve or maintain an erection sufficient to complete a satisfactory sexual life, and the course of the disease lasts for more than three months. In layman’s terms, impotence means that the penis is not hard enough during sex, which affects the process of vaginal penetration and its maintenance. 2.What is premature ejaculation? According to the definition of premature ejaculation by the International Society of Sexual Medicine in 2014, there are three main aspects: first, shortened ejaculatory latency (ejaculatory latency refers to the time from penile insertion into the vagina to ejaculation): for patients with primary premature ejaculation (primary premature ejaculation refers to premature ejaculation from the first time of sexual intercourse), ejaculation often or always occurs around one minute after vaginal insertion; for patients with secondary premature ejaculation (secondary premature ejaculation refers to no previous In patients with secondary premature ejaculation (secondary premature ejaculation means that there was no previous premature ejaculation and that premature ejaculation occurred at some time or at some stage), there is a significant reduction in ejaculation latency, usually less than three minutes. It should be noted that the time mentioned in the definition is only relative, and different versions of the definition define it differently; the feelings, experience and satisfaction of the patient himself and his sexual partner during sexual intercourse are more important. Second, it is always or almost always impossible to delay ejaculation. This refers to the male’s control over ejaculation, which is the core and most important factor in the whole definition and diagnosis of premature ejaculation. Third, negative physical and psychological effects such as distress, worry, frustration, and/or avoidance of sex. If these three factors were ranked in order of importance, it would be control over ejaculation that would be most important, with physical and mental effects second and ejaculatory latency time third. Therefore, patients do not need to be too obsessed with the issue of ejaculation time; control and personal feelings are more important. As seen above, the definitions of impotence and premature ejaculation are completely different; moreover, erection and ejaculation are different physiological processes and are innervated by different nerves; therefore, they are completely different diseases, and the diagnosis and treatment methods are also different. Second, different diagnostic methods 1, the diagnosis of erectile dysfunction: the diagnosis of erectile dysfunction, first of all, according to the patient’s medical history, recommended questioning and physical examination, and the use of the International Index of Erectile Function (IIEF-5) for quantitative assessment. If necessary, further tests such as nocturnal erectile function test (NPT), sex hormone level test, and penile color Doppler ultrasound can be performed as appropriate. A history of hypertension, diabetes, and hyperlipidemia is also required for diagnosis. 2, the diagnosis of premature ejaculation: the diagnosis of premature ejaculation, first of all, also based on the patient’s medical history, recommended questioning and physical examination, and quantitative assessment using scales such as the Premature Ejaculation Diagnostic Tool scale (PEDT). If necessary, patients can be arranged for dorsal penile nerve sensory evoked potentials, neuromyography, etc., as appropriate. When checking the body, pay special attention to the presence of circumcision. Different treatment methods 1. Treatment of erectile dysfunction: Oral medication, lifestyle adjustment and psychotherapy, local injection therapy of penile corpus cavernosum, vacuum pump negative pressure therapy, vascular surgery therapy, prosthesis implantation surgery therapy and other methods can be chosen. The first choice is oral medication, which includes sildenafil (Viagra), tadalafil (Cialis) and vardenafil (Elidel), etc. 2. Treatment of premature ejaculation: Oral medication, psychological/behavioral therapy, local anesthetic medication, surgery, etc. can be chosen. The first choice is oral medication, and the recommended first-line drug is dapoxetine (trade name Bilirubicin). If the patient is circumcised, circumcision may be considered; however, for dorsal penile nerve amputation, it must be chosen carefully.