Premature ejaculation (PE) is the most common sexual dysfunction in men, and occurs in about 20% to 40% of men at some point in their lives.
The definition of PE is currently varied. There are many definitions of PE, and there is still no clear conclusion. However, it is usually evaluated by the ejaculatory latency of men or the frequency of women reaching orgasm during sexual intercourse. The American Psychiatric Association issued the
The Diagnostic and Statistical Manual of Mental Disorders I, Fourth Edition (DSM-TR.IV)
The diagnostic criteria for PE are (1) persistent or repeated ejaculation before, during, or shortly after penetration with very little sexual stimulation, earlier than the person desires, and various factors affecting the duration of sexual arousal should be considered, such as age, new sexual partners, new environment, and frequency of recent intercourse; (2) significant distress and interpersonal
(between partners) tension; (3) this PE condition is not caused by a substance
(e.g., alcohol, opioids, and other drugs). Premature ejaculation can be divided into primary and secondary premature ejaculation, and more recently, the International Medical Association has more precisely defined primary premature ejaculation as a condition in which ejaculation always or almost always occurs before or within approximately 1 minute after vaginal penetration; an inability to artificially delay all or almost all intravaginal ejaculation; and negative personal emotions such as pain, worry, frustration, and/or
(or) avoidance of sex. Patients with premature ejaculation are often associated with varying degrees of psychological disorders and are receiving increasing attention from male physicians and researchers. A psychological factor and the onset of premature ejaculation Premature ejaculation is caused by a variety of reasons. (1) Psychological causes: due to
(2) organic causes: caused by penile sensory allergy or increased excitability of sensory nerves and dysfunction of the ejaculatory center to distinguish penile sensation; (3) others: prostatitis, prepuce, vesiculitis, priapism, sympathetic ganglion injury, diabetes, etc. The traditional view is that premature ejaculation is mostly a psychological factor
It is generally believed that the persistence of psychological factors may aggravate the underlying organic factors and cause premature ejaculation.
The prevalence of premature ejaculation is high. Although the prevalence of premature ejaculation is high, the consultation rate of premature ejaculation patients is very low, and foreign studies have investigated more than 12,000 men with premature ejaculation symptoms, of which only 9% chose to seek help from a doctor.
Only 9% of these men chose to seek help from a doctor. Although there is no information on this in China, the situation may be worse, due to traditional concepts and other factors, the popularity of sexual knowledge in China is worrying, and many teenagers even talk about sex. It is generally believed that anxiety, fear and tension during sexual intercourse, lack of sexual knowledge and misunderstanding are the main causes of premature ejaculation, which can make sexual intercourse an overpowering psychological stimulus, rapid progress of sexual excitement, thus the ejaculation process is greatly accelerated and premature ejaculation occurs. In the past, people thought that premature ejaculation was caused by masturbation, but a study found that the incidence of masturbation among premature ejaculators was not high but low, and the rate of masturbation among men in the normal population was over 90.95%, while in premature ejaculators, except for 6% of people who absolutely do not masturbate, 25% of people rarely masturbate, and premature ejaculators have a late age of onset of masturbation, on average after the age of 18, and the frequency of masturbation is also low, and the peak of masturbation is also late. The belief that premature ejaculation is associated with masturbation may be the result of social propaganda, which patients also tend to use to explain
their own premature ejaculation, and patients are thus caught in extremely bad anxiety and other uneasy emotions. Second, the mechanism of the role of psychological factors in the development of premature ejaculation Anxiety, tension, uneasiness and other mental factors play an important role in premature ejaculation
It has been suggested that because sympathetic nerves play a key role in ejaculation, mental factors such as anxiety can increase the activity of sympathetic nerves and lower the ejaculation threshold of the penile nerves, but there is no strong evidence to confirm this. Some studies have shown that anxiety and depression have their pathophysiological basis and further cause changes in the body’s internal environment. In patients with anxiety, there is a certain defect in the aminobutyric acid system in the brain, resulting in poor control of anxiety. In contrast, in the depressed state
In addition, the secretion of certain neuropeptides in the central nervous system is abnormal, which in turn affects the hypothalamus and pituitary gland. The function of the adrenal axis is altered, which further leads to abnormal immune function. The ejaculatory reflex is regulated by the ejaculatory center of the spinal cord and also by the ejaculatory center of the brain, which plays a controlling role on the former. Patients with premature ejaculation often suffer from dysregulation of the ejaculatory center of the brain due to lack of sexual knowledge, excessive tension, excitement and poor cooperation between husband and wife, leading to ejaculatory dysfunction and manifesting as anxiety, depression, tension and disappointment. The cerebral cortex is affected by human mental and emotional activities, so various mental and psychological factors in humans can interfere with the normal reflex process of the brain center. Foreign scholars believe that
Occasional rapid ejaculation cannot be defined as premature ejaculation, and sporadic rapid ejaculation should be regarded as a normal fluctuation of sexual activity; a hasty diagnosis will increase the patient’s psychological burden. Patients with repeated unsuccessful intercourse will gradually develop
“operational anxiety”, for premature ejaculation patients, the fear of failure of sexual intercourse and unsatisfactory sexual life of the spouse also causes anxiety and fear, long-term low sexual function and excessive worry about physical condition can cause “loss of manhood”. Third, the performance of psychological disorders in premature ejaculation premature ejaculation patients are often accompanied by varying degrees of psychological disorders, patients often have obvious pain and interpersonal (between partners) tension, as well as personal negative emotions, such as pain, worry, frustration and
(or) avoidance of sexual life, but psychosomatic factors are difficult to quantify, and we need a unified measure for psychological disorders. Fourth, the role of psychotherapy for patients with premature ejaculation Comprehensive psycho-behavioral therapy can significantly improve the ejaculatory latency of patients
The psycho-behavioral interventions play an important role in the treatment of premature ejaculation, making it easier to control ejaculation, significantly increasing the satisfaction of both spouses with sexual life, and significantly reducing anxiety, tension or uneasiness during sexual life. By adjusting the psychological state of patients and guiding patients and spouses to cooperate effectively in sexual life based on pharmacological treatment can significantly improve the clinical efficacy. First of all, we should obtain the trust of patients and their wives, so that both spouses can establish a good relationship of cooperation, intimacy and trust, strengthen the education about sexual knowledge, and provide guidance, comfort, and good mood for patients’ anxiety, depression, pessimism and disappointment.
To help patients overcome psychological barriers and build up confidence, we should provide psychological treatment measures such as guidance, comfort, support and encouragement. Establish
The wife’s cooperation, understanding and support in the patient’s sexual treatment play an important role in reducing sexual anxiety and fear.