The etiology and epidemiology of premature ejaculation
Prevalence: Premature ejaculation is the most common sexual dysfunction disease, with a prevalence of about 20-30%. Premature ejaculation occurs in 75% of men throughout their lives.
2. Pathophysiology: It was previously thought that PE may be due to psychological and interpersonal factors, but recent studies have shown that PE may be due to somatic diseases or neurophysiological disorders. The psychological/environmental factors may maintain or reinforce the occurrence of PE. High sensitivity of the glans, localization of pubic nerves in the cerebral cortex, disorders of central 5 hydroxytryptaminergic neurotransmission, erectile difficulties, prostatitis, certain drug factors, chronic pelvic pain syndrome, and abnormal thyroid function may all contribute to the occurrence of PE.
Treatment of premature ejaculation: Adult men are plagued by rapid ejaculation, many of which are caused by psychological factors, so their treatment should not be limited to sexual life guidance and psychological interventions, such as reducing operational anxiety and improving self-confidence. It is also necessary to clarify whether it is accompanied by ED or other sexual dysfunction, and to treat the combined ED, chronic prostatitis, genital tract infection, circumcision, hyperthyroidism and other related diseases first or at the same time. Medication is the first choice for premature ejaculation treatment.
I. Medication treatment
1. Selective 5-hydroxytryptamine reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs)
SSRIs including dapoxetine, sertraline, paroxetine and TCAs such as clomipramine are the drugs of choice.
2.Local anesthetic drugs: It is one of the first methods used for PE drug treatment. It is used for the treatment of premature ejaculation because it can reduce penile sensitivity and prolong ejaculatory latency, and it does not affect the ejaculatory sensation.
3, phosphodiesterase type V (PDE5) inhibitors: Many studies support the effectiveness of PDE5 inhibitors in the treatment of PE. For patients with premature ejaculation in combination with ED, PDE5 inhibitors or combination therapy can be used. For patients with premature ejaculation without ED, this guideline does not recommend PDE5 inhibitors as the treatment of choice.
II. Psychological/behavioral treatment
The goal of psycho-behavioral interventions is to help patients and sexual partners improve ejaculatory control by.
① Learning to control and/or delay ejaculation;
②Increasing confidence in sexual life;
③Reducing anxiety about sexual life;
④Changing the stereotypical sexual routine;
⑤ Eliminate barriers related to intimacy;
(6) Resolve interpersonal problems that promote and maintain premature ejaculation;
(7) Adapt to experiences and ideas that interfere with sexual life;
⑧Improve communication and exchange with sexual partners.
Psychological treatment is suitable for patients in whom psychosocial factors are clearly contributing factors to the development and maintenance of premature ejaculation and for whom medication alone is not effective. Combined with medication, it can help improve the efficacy of medication, patients learn to control ejaculation after stopping medication, enhance their sexual confidence and improve the sexual satisfaction of both partners. Therefore, some scholars suggest that combined drug and psychological treatment should be the first-line treatment plan for premature ejaculation.
1. General psychotherapy: It includes psychological education, creating a warm environment for sexual life to relieve anxiety as an important sustaining factor of premature ejaculation and reduce the intensity of sympathetic nerve activity, thus lowering the ejaculation threshold.
Behavioral therapy: Behavioral therapy began in the 1950s and includes Semans’ pause training, Masters and Johnson’s “pause – squeeze” technique and Kaplan’s “stop – move” technique, which are all standard treatment techniques for PE. These are the standard treatment techniques for PE. The patient goes through a series of progressive exercises to build ejaculatory control. The approach starts with self-stimulation, moves to partner stimulation, then to non-repulsive intercourse, and finally to the “stop-motion-stop” technique. This repeated training will weaken the patient’s response to sexual stimulation so that he or she can receive more stimulation, maintain the appropriate intensity of stimulation at the ejaculatory threshold and prolong the duration of stimulation.
The purpose of the “stop-and-go” technique is to increase the ejaculatory stimulation threshold. The partner stimulates the patient’s penis until the patient feels ejaculation approaching, then immediately stops stimulation, waits until the ejaculation anticipation has completely disappeared, then re-stimulates, and repeats this three times, and then completes ejaculation. This raises the ejaculatory stimulation threshold, thereby relieving the urgency of ejaculation, strengthening the ability to inhibit ejaculation, and prolonging the ejaculatory latency. Training should be done 3 times a week until the patient is able to control ejaculation better.
The specific method of the “squeeze and pinch” technique is for the woman to place her thumb at the tether of the penis and her index finger and middle finger below the coronal sulcus, squeeze and press the head of the penis for 3 to 4 seconds, and when the ejaculation threshold is reached, the spouse holds the body of the penis with force until the ejaculation sensation disappears.
Recently, some people use sexual function therapy devices to desensitize patients with premature ejaculation, through physical stimulation in order to train the patient’s ability to control ejaculation, so that the patient can master the intensity of stimulation to reach his or her ejaculatory threshold to delay ejaculation, the principle of which is similar to behavioral therapy and is effective in about half of patients. The guidelines recommend considering a combination for patients for whom pharmacological treatment is ineffective and less effective.
Masturbation before sexual intercourse is a frequent method used by many young PE patients. Masturbation decreases penile sensitivity after ejaculation and prolongs the ejaculatory latency during the inactivity period. Behavioral therapy for PE, although in the short term to achieve a certain degree of effectiveness, but because of the need for long-term close cooperation with the female partner, many patients because of the difficulty of persistence and affect the long-term results. Behavioral therapy is generally effective in about 2 weeks and can be continued for 3-6 months to consolidate the effect.
3, cognitive therapy: cognitive therapy is mainly targeted perception and experience, improve sexual communication between sexual partners, improve sexual skills and self-confidence, reduce the anxiety associated with sexual activity. Psychodynamic, muscle relaxation and other therapies are also available.
What are the behavioral therapies for male premature ejaculation? The following behavioral therapies for premature ejaculation are commonly used.
1, intermittent method: also called the color manners pause technique. It is a treatment method proposed by James and Shemans in 1959. The woman strokes the penis with her hand to the extent that she is about to ejaculate, then stops stimulating, and after the feeling of ejaculation from the excitement high disappears, stimulates the penis again, and so on repeatedly until the man can tolerate a lot of stimulation without ejaculating.
2, the process of sexual intercourse to suspend the pumping method, also known as “moving – stopping technology”: intercourse can be similar training, such as reducing the amplitude of penis pumping, speed or suspend pumping, moving stop alternately, so that the sexual excitement is reduced, and so the penis will be weak when pumping, so the penis hardened again, so repeatedly, you can extend the time of sexual intercourse.
3, penis squeezing method, also known as tolerance training: is the famous sexual medicine practitioners Masters and Johnson proposed squeezing techniques. This is a first aid method for the male partner when he feels he is about to ejaculate during intercourse. When the male partner feels that he is about to ejaculate, he hastily pulls his penis out of the vagina, and the female partner squeezes the head of the penis with appropriate force, puts the thumb on the part of the penis tether, and the index and middle fingers on the dorsal side of the penis, so that it is located just above and below the coronal groove, squeezes and presses for 15-20 seconds and then relaxes.
4, change the position of sexual intercourse, with men under the woman on top, or side sex method: this method because the male can be in a passive state, excitability can be significantly reduced, and prolong the time of sexual intercourse, and promote the emergence of the female orgasm.
5, change the time of intercourse: such as from bedtime to the early morning, due to a night’s rest, energetic, quiet environment, to facilitate the sexual coordination of both sides.
6, sexual intercourse, the penis using a double condom to reduce the head of the penis is overly sensitive to extend the time of intercourse.
The above introduced several behavioral therapies, these behavioral therapies although can have some effect on premature ejaculation treatment, but not the fundamental method of treating the disease, and may not be suitable for patients of various etiologies, need to be treated under the guidance of a doctor.