Premature ejaculation is the most common ejaculatory dysfunction, with an incidence of more than 1/3 of adult men. The definition of premature ejaculation is still controversial and is usually evaluated by the ejaculatory latency of men or the frequency of women reaching orgasm during sexual intercourse, such as the standard of men losing the ability to control ejaculation during sexual intercourse and ejaculating before or just after penile insertion into the vagina; or the standard of women reaching orgasm less than 50% of the time during sexual intercourse to define premature ejaculation, but these are not universally accepted. The ejaculatory latency of men is affected by age, length of abstinence, physical condition, emotional psychology and other factors, while the frequency of female orgasm is also affected by physical state, emotional changes and the surrounding environment. In addition, there are individual differences in the length of ejaculation latency, and it is generally considered normal for a healthy male to ejaculate within 2-6 minutes of penile insertion into the vagina.
Etiology
At present, it is believed that the causes of premature ejaculation are not only psychological and local penile factors, but also urological, endocrine and neurological factors.
There are many psychological factors that cause premature ejaculation, such as the fear of failure of sexual intercourse and emotional anxiety that many people fall into premature ejaculation for various reasons; those who habitually masturbate when they are young, always aiming to achieve orgasm quickly; lack of sexual knowledge and only aiming to satisfy men; couples are not good at tacit cooperation; poor emotional integration, aversion to spouse, intentional or unintentional sadistic consciousness; fear that sexual behavior is detrimental to health and aggravates some inherent physical The disease; the frequency of sexual intercourse is too little or a long time sexual repression; and the female aversion to sexual intercourse, worry, forced to request a quick end room, etc.. All of these can lead to premature ejaculation and even a chain reaction that can affect erectile capacity.
Some people believe that spinal cord system diseases such as multiple sclerosis or spinal cord tumors, epileptic seizures or organic lesions of the cerebral cortex such as cerebrovascular accidents can cause uncontrolled ejaculation. There are also reports suggesting that diabetes mellitus, cardiovascular disease, pelvic fractures, genitourinary system diseases such as urethritis, prostatitis, vesiculitis, and prostatic hyperplasia, are associated with premature ejaculation.
Diagnosis
Preliminary diagnosis can be made through detailed medical history and sexual life investigation, and understanding the causes of its development can be a guide and help in treatment. Psycho-psychological analysis can be performed using psycho-psychological personality testing method SCL-90-R, etc., which helps to understand the psycho-psychological condition of the patient. Using penile vibratory sensory sensation measurement, penile dorsal nerve evoked potential and penile head sensory evoked potential measurement, and ball cavernous reflex latency measurement method to measure changes in penile sensory sensation threshold and other changes can help to understand penile sensory sensation and the function of sensory nerves. Routine urological examinations can determine the presence of other precipitating causes such as glans penis, prostatitis, and vesicourethritis.
Treatment
Most patients try to prolong the latency of ejaculation by turning their thoughts to other aspects during sexual intercourse such as diet and play in an attempt to delay the latency of ejaculation, or by using condoms and drinking alcohol, but the effect is not good, but instead it often leads to decreased libido, sexual pleasure disorder, and can even cause erectile dysfunction, thus aggravating the condition. Therefore, the treatment of premature ejaculation should be based on the causes of its onset, and appropriate treatment methods should be chosen.
1. Psychological treatment
Both husband and wife need to cooperate. Both husband and wife should be informed that premature ejaculation is a common problem, and both husband and wife need to know the necessity and possibility of rebuilding the conditioned ejaculatory reflex, eliminating the patient’s anxiety, anxiety, self-guilt and other abnormal psychology, and building confidence in curing the disease.
2. Behavioral method guidance
The basic treatment method of sexy concentration training aims to teach patients to experience and enjoy sexual pleasure and overcome psychological barriers by means of tactile stimulation such as hugging, touching and massaging. You can also pull the scrotum and testicles downward before reaching orgasm, or squeeze the glans with the thumb and index finger to reduce sexual excitement and erectile hardness by 10% to 25%. After a long period of training and then intercourse in the female superior position, still using the form of pumping – stop – pumping again repeated training, gradually improve the ejaculatory stimulation threshold, so as to achieve a more satisfactory artificial control before ejaculation.
3. Oral medication
The current drug treatment is mainly 5-hydroxytryptamine reuptake inhibitors, the domestic has been marketed is dapoxetine hydrochloride, the trade name is bilirubin. 30 mg, 3 hours before sex orally, it is mainly to extend the ejaculation latency, it has certain side effects, and indications, must be taken under the guidance of a doctor. It is more expensive. Other similar drugs such as Paroxetine should be applied under the guidance of a doctor.
4. Local medication
It can be applied to the head of the penis before sexual intercourse to delay the latency of ejaculation through local anesthesia.
5. Cavernous drug injection therapy
Although premature ejaculation still exists in this method, the erection of the penis can be maintained for a certain period of time after ejaculation, which may be helpful to improve the sexual satisfaction of the spouse.
6. Transurethral drug delivery (MUSE)
It can also be used for the treatment of premature ejaculation.
7. Penile prosthesis implantation
It is suitable for patients with abnormal penile erection with premature ejaculation.
8. Dorsal penile nerve dissection
This method is still in the trial stage in foreign countries. Although the effect is recognized to a certain extent, its safety and effectiveness still need to be studied.