The history of medicine has never been short of some groundbreaking ideas and bold doctrines, but very few of them have actually entered the hall of science and become classical theories for the benefit of mankind, and more often than not, the doctrines that looked beautiful at the logical level were brutally slaughtered by the ugly facts at the empirical stage. In September 2001, urologists in China began to perform the procedure, and it soon became so widespread in China that even a search using relevant keywords in English yielded articles written by Chinese authors, but in stark contrast to this apparent “boom,” neither the “Diagnosis of Premature Ejaculation” nor the “Diagnosis of Premature Ejaculation” published by the Male Sexual Medicine Committee of the Chinese Society of Sexual Medicine were published. However, in contrast to this apparent “boom”, neither the Guidelines for the Diagnosis and Treatment of Premature Ejaculation (2011) issued by the Chinese Sexual Medicine Committee (2011) nor the Guidelines for the Diagnosis and Treatment of Premature Ejaculation (2014) issued by the Special Committee on the Definition of Premature Ejaculation and the International Society for Premature Ejaculation Guidelines Committee recommended dorsal penile neurectomy as a treatment for premature ejaculation. Can premature ejaculation patients be treated with this procedure or not? Let’s start with the basic concepts and principles. If we catch a random person on the street and ask you (or your spouse) if you have premature ejaculation, and the other party does not directly beat you up but seriously answer the question, you will find that the answers may be varied, and even what exactly is considered premature ejaculation is also unclear, of course, what exactly is premature ejaculation, this is actually an academic question, you have to let the academic community to answer, but what makes everyone dizzy is The problem is that the academic community was once very confused about this issue. It’s not just a diagnostic issue, is it? The actual fact is that you can’t even figure out if it’s premature ejaculation, so you doctors are all quacks. You do not say, the diagnosis of premature ejaculation is really a bit of a problem, it is not like the diagnosis of a fracture, an X-ray film in front of the reading light, as long as the doctor is not blind, basically can confirm the diagnosis. But the same man’s condition may be determined as premature ejaculation and non-premature ejaculation at different times in history, because the definition of premature ejaculation is actually always changing. For a considerable period of history, what is known today as premature ejaculation would not have been classified as a disease, but rather than being a disease, it might have fallen under some kind of advantage. Compared to the long history of mankind, the history of people wearing pants is just a moment in the light of stone and fire, and the instinctive behavior of mating has to find an undisturbed private space is also a very recent habit, the pre-civilizational history of human love between the sexes, naturally, with the same wild animals, the sky as a quilt to the ground as a bed, nature in all its pleasures. For people in today’s civilized world, wild warfare is probably only a special excitement outside of regular sexual activities, and it is fine to do it occasionally, but for our ancestors, it was a reproductive activity that had to be risked. As the saying goes, “survival of the fittest”, the habit of rapid ejaculation has been written into the genes of men from generation to generation. In this sense, we are all descendants of speed shooters. But with the improvement of human living environment, people have developed the stink that mating must be done in private space, especially when women’s sexual awareness gradually awakened, women’s sexual satisfaction has become a factor that must be considered in sexual activities, then rapid ejaculation has become a problem that must be faced, oh, from this point on, we should use the term premature ejaculation (PE) From this point on, we should use the term premature ejaculation (PE). According to the World Health Organization’s definition of health, “Health means not only the absence of disease or illness, but also a state of complete physical, mental and social well-being. This means that a healthy person has a strong body and an optimistic mental state and is able to maintain a harmonious relationship with the social and natural environment in which he or she lives.” Sexual relations are obviously important social relations, so it is not difficult to understand that premature ejaculation is treated as a disease, but it is also because the determination of premature ejaculation is easily influenced by social relations that the definition of premature ejaculation was once very confusing. If you break a bone, no matter who your wife is you this is a fracture, but this is not the case with premature ejaculation. Premature ejaculation has been considered a clinical syndrome for over a century, but the criteria for its definition have varied. In the early literature we found that some scholars believed that the incidence of premature ejaculation accounted for 35% to 50% of adult males, a figure that is far from the common knowledge of most of us, which disease would have such a high incidence? This is actually related to the definition of premature ejaculation in the United States. In 1994, the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, the diagnostic criteria for premature ejaculation are: 1. Various factors affecting the duration of sexual excitement, such as age, new sexual partners, new environment and frequency of recent sexual intercourse, should be considered in the doctor’s judgment. 2.This dysfunction obviously causes distress or interpersonal tension to the person. 3. The premature ejaculation is not caused by the direct action of a substance (e.g., opium). This definition obviously does not only consider men, but also both men and women, especially reflecting the change of sexual behavior from reproduction-centered to pleasure-centered, fully taking into account the proportion of pleasure factors in the diagnostic criteria, changing the sexual dysfunction of men alone into a sexual problem shared by both men and women, not only the diagnosis needs to consider the feelings of both parties, but also the treatment needs to refer to the feelings of both parties, in a word, premature ejaculation is In a word, premature ejaculation is a disease whose diagnostic criteria need to take into account the sexual feelings of women. However, more than 10 years after the release of this concept, the medical community has found many problems, because this definition leads to a high incidence, but the actual attendance is very low, which is not conducive to detecting and solving the real problems, such as shortly after penetration, how short is the time? How long do you want it to be earlier than you want it to be, and what if some people have to do it for an hour before they are satisfied? Because the diagnostic criteria are too broad, no specific concept of time, relying mainly on the subjective feelings of the person, and relatively simple typing, so it is not conducive to in-depth research on PE. The American Psychiatric Association revised the diagnostic criteria for premature ejaculation, proposing several subtypes and introducing the concept of time, for example, one of the diagnostic criteria for the most severe lifelong premature ejaculation is that in most cases (80%) the ejaculation is between 30 and 60 seconds, or between 1 and 2 minutes (20%). For example, if a man’s ejaculatory latency is 6 minutes and his partner’s orgasmic latency is 4 minutes, and both of them will be happy, then the man is not prematurely ejaculated. The same man, his partner’s orgasm latency if 15 minutes? Since the woman can’t reach orgasm, huh? That’s premature ejaculation? In 2010, the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders made significant adjustments to the diagnostic criteria for premature ejaculation, a significant feature of this edition was to change premature ejaculation to early ejaculation, which is still premature ejaculation in Chinese, but the former highlights the premature early, while the latter refers to the early time, a word difference, the meaning is very different, obviously the latter is more objective and accurately specifies the time early concept. When I was writing this article, I did a survey in a small area, and all the users who left comments recognized premature ejaculation more than early ejaculation, which also shows that ordinary people’s understanding of premature ejaculation actually tends to be an idealized concept, and this idealization is precisely where the previous versions of the definition of premature ejaculation were inadequate. According to the latest version of the definition of premature ejaculation, the incidence of lifelong premature ejaculation, which should be treated most, is no more than 4%, and according to studies in several countries, the median time of male ejaculatory latency is 5.4 minutes. Shouldn’t many people be relieved? In fact, you are not that easy to be prematurely ejaculated. Some scholars claim that lifelong premature ejaculation (primary premature ejaculation according to the Chinese classification) is an indication for dorsal penile neurectomy. The principle is that the dorsal penile nerve is a sensory branch of the pubic nerve that conducts nerve impulses felt by sensory nerve receptors. The free nerve endings of the dorsal penile nerve are located at the head of the penis, the penis and the skin of the scrotum. The nerve impulses required for ejaculation are mainly transmitted by the dorsal penile nerve. Sexual stimulation is transmitted via the dorsal penile nerve to the higher ejaculatory center in the brain, and when the stimulation accumulates to a certain level, the ejaculatory impulse is transmitted down to the sacral nerve and induces the contraction of the bulbocavernosus muscle, resulting in ejaculation. In patients with primary premature ejaculation, the excitability of the dorsal penile nerve, especially the sensory nerve excitability of the penile head, is higher than normal, so that the ejaculatory reflex is easy to be induced during sexual intercourse. By partially cutting the sensory nerve endings of the penis, the nerve impulses transmitted to the dorsal penile nerve are reduced in “quantity” and the sensation of the penile head is dulled, thus prolonging the ejaculatory latency and treating primary premature ejaculation. Therefore, theoretically, after dorsal penile nerve amputation, the sensitivity of the penile head can be reduced, the ejaculatory latency can be prolonged, and the quality of the patient’s sexual life can be improved. Also according to an anatomical study done by Dr. Xing-Hua Li the mean number of dorsal penile nerves in 47 cadavers was 3.49 ± 1.23, which is significantly different from the number of dorsal penile nerves observed clinically in patients with primary premature ejaculation (mean 7.69 ± 1.77), also suggesting that the procedure may help improve premature ejaculation. This theory seems to be perfect, but since the invention of the procedure by Tulli in Brazil in 1993, the clinical application of the procedure has not been very satisfactory, with the foreign literature suggesting an efficiency rate of less than 50%, while a professor in China concluded that the efficiency rate could reach 81.25% after performing the procedure on 32 patients with primary premature ejaculation (6 cases were invalid). In my opinion, the most important thing is that all clinical trials on this procedure are missing an important part, namely the sham control group. Based on the previous narrative and our common sense and experience, it should not be difficult to understand that the occurrence of premature ejaculation is greatly related to psychological factors, and in the known clinical trials, none of them can shield the interference of the strong placebo effect brought about by surgery. However, according to a study from Xinjiang, there was no significant difference between selective and non-selective dorsal penile neurectomy in terms of efficacy, which makes me wonder what clinical effect would be achieved if the dorsal penile nerve is simply not cut and the patient is simply made to think that the operation has been done in terms of appearance. In clinical practice, we often observe substances that are not supposed to have any drug effect, but in reality produce the same “therapeutic effect” as drugs, which is called the placebo effect. But can fake surgery also cure the disease? The answer is yes, and it works well. 2002 Surgeon J. Bruce Moseley published an article entitled A CONTROLLED TRIAL OF ARTHROSCOPIC SURGERY FOR OSTEOARTHRITIS OF THE KNEE in the prestigious medical journal The New England Journal of Medicine, using a sham surgery control group to shatter a beautiful theory. What happened was that decades ago, it was thought that the pain of osteoarthritis (i.e., osteophytes) was primarily due to increased inflammatory factors in the joint cavity caused by synovial proliferation and cartilage exfoliation within the joint. Therefore, if surgery was used to clean out these exfoliations and flush out the inflammatory factors, the patient’s condition would improve. In the 1980s, as arthroscopy became more popular, doctors used it to perform “knee debridement”. Patients were pleased with the results and felt relief from pain after the procedure, so it quickly became popular. In the United States alone, 650,000 people have the procedure done each year, and orthopedic surgeons have a multibillion-dollar business that makes a lot of money each year. But the well-fed Moseley did a study that blew his fellow surgeons away. He divided 180 patients into three groups: 60 had joint irrigation, 60 had joint cartilage smoothed out on top of the joint irrigation, and the other 60 had incisions made only on the skin surface without any intervention on the structures inside the joint cavity. The results were consistent with Moseley’s, meaning that this complex and costly procedure was no better than simply taking some painkillers. (This procedure, which has been proven to be ineffective, is still popular in some of China’s major formal hospitals, so this is an aside.) Moseley’s clinical trial is not the only one that has ruined his own business and that of his peers, and in fact the placebo effect of this sham procedure is not uncommon. found 53 (sham) surgical trials with randomized double-blind controls, in which 51% of the sham surgeries had results equivalent to those obtained with real surgery. Therefore, if this dorsal penile neurectomy based on the beautiful theory is to be truly accepted by the medical community, no matter how beautiful the data (ridiculously higher than foreign counterparts) that Chinese scholars produce with only a blank control group (i.e., no treatment), it will not be accepted by their peers unless they can prove that the procedure is superior to the sham procedure. End of testimony. The last nonsense: my ideal science article is not necessary to have nonsense, but some words that are not suitable to be expressed in the text, might as well be put here. In the articles I retrieved, there are quite a few articles with Chinese characteristics that play on top of this surgery, such as “Chinese herbal infusion combined with modified dorsal penile neurectomy for primary recalcitrant premature ejaculation” “Selective dorsal penile neurectomy combined with penile tethering buried thread for Primary Premature Ejaculation” …… readers who are in a position to search may wish to download and see, it really makes people laugh and cry, a procedure of questionable efficacy overlaid with another measure of unknown efficacy, can it be negative and positive? The so-called exploration and innovation, it is better to stop. I believe this article can make people take a cautious look at this surgery, but there may still be patients who intend to try this surgery, and with the current regulation in China, this surgery is still widely performed. If you are willing to take the risks including but not limited to “permanent loss of sexual function”, after fully understanding the risks/benefits of the procedure, then try this life-saving procedure. Based on the theory that hypersensitivity or hyperexcitability of penile sensory nerves is one of the causes of premature ejaculation, if the sensitivity of the penis is reduced by cutting off part of the dorsal penile nerve, the purpose of treating premature ejaculation may be achieved. In China, Professor Zhang Chunying of the Second Hospital of Harbin Medical University was the first to carry out this procedure in September 2001, and then the procedure was spread throughout the country like a spring, mostly limited to private male hospitals. The efficacy and safety of the surgery has not been recognized by the industry, and the results of domestic and foreign research on this surgery are contrary to each other, with effective domestic literature claiming an efficiency of up to 90% and foreign literature having an efficiency of less than 50%. Domestic academics are good at faking, you know. The International Society for Sexual Medicine clearly states in its newly released 2014 Guidelines for the Diagnosis and Treatment of Premature Ejaculation that “dorsal penile nerve excision may result in permanent loss of sexual function and is not recommended for the treatment of premature ejaculation.” Professor Zhang Chunying painfully concluded: I am the inventor of dorsal penile nerve selective dissection (sic), this surgery is only for the treatment of primary premature ejaculation patients with strict surgical indications and scientific standards, however, individual advertising hospitals, in order to unilaterally pursue economic benefits, deceive many patients who should not have the surgery to have the surgery through improper means, causing lifelong regrets, and the doctors who do the surgery are Doctors are the black sheep of the team, the hospital also has an unshirkable responsibility, the main responsibility is also in the national health care regulatory departments do not work hard enough. Special reminder of sick patients, should open their eyes to consult, scientific treatment of their condition, can not be some moral corruption of the doctor fooled, choose the wrong treatment. Baidu is the world’s most shameless Internet company, nearly half of its advertising revenue from false pharmaceutical advertising, when you open Baidu to enter the key words of disease, the more the top-ranked hospitals do not go! Premature ejaculation patients, please love your penis, to this as a gimmick to solicit patients, the dorsal nerve dissection of the penis as the first choice for treatment of male hospitals, firmly say: I do not do this surgery, I will never! Premature ejaculation patients, please go to a regular hospital.