How Do I Treat Premature Ejaculation?

Premature ejaculation (prospermia) is the most common ejaculation dysfunction. It is mainly performed at the beginning of sexual intercourse, and even ejaculates before sexual intercourse. It is the main manifestation of inability to have normal sexual life. The definition of premature ejaculation is still controversial. It is usually evaluated by the incubation period of male ejaculation or the frequency of female orgasm during sexual intercourse. Criteria; or the definition of premature ejaculation with women reaching orgasm less than 50% during intercourse, but these are not generally accepted. Because men's ejaculation latency is affected by factors such as age, length of abstinence, physical condition, emotions and psychology, the frequency of female orgasms is also affected by factors such as physical state, emotional changes, and surrounding environment. In addition, the length of the ejaculation incubation period also varies from individual to individual. It is generally considered that it is normal for healthy men to ejaculate 2 to 6 minutes after the penis is inserted into the vagina.

Basic Information

English name

prospermia

Visiting department

Andrology, Urology

Common causes

Psychological and penile local factors, endocrine and neurological factors

Common symptoms

Unable to control ejaculation or sexual intercourse for less than 2 minutes during sexual intercourse

Causes of premature ejaculation

At present, it is believed that the cause of premature ejaculation is not only psychological and local penile factors, but also factors such as urinary, endocrine and nervous system diseases.

There are many psychological factors that cause premature ejaculation. For example, many people fear premature ejaculation due to various reasons for fear of failed sexual intercourse and emotional anxiety. Those who used to masturbate and masturbate when they were young, always aim to reach orgasm quickly; lack of sexual knowledge, only for the purpose of satisfying men ; Husband and wife are not good at tacit cooperation; emotional discomfort, aversion to spouse, intentional or unintentional sadism; fear of sexual behavior harms health, exacerbate some inherent diseases of the body; sexual intercourse frequency is too low or prolonged sexual depression; As well as the woman's aversion to sexual intercourse, she was worried, and urged to end the intercourse quickly. All of these can lead to premature ejaculation, or even a chain reaction, affecting the ability to erect.

The organic factors that cause premature ejaculation are under discussion. Some people believe that spinal system diseases such as multiple sclerosis or spinal tumors, seizures, or organic lesions of the cerebral cortex such as cerebrovascular accidents can cause uncontrolled ejaculation. There are also reports suggesting that diabetes, cardiovascular disease, pelvic fractures, and urogenital diseases such as urethritis, prostatitis, seminal vesiculitis, and prostatic hyperplasia are all related to premature ejaculation.

Premature ejaculation classification

Primary premature ejaculation

That is, from the first sexual experience, premature ejaculation has continued to occur, almost every time there is sexual intercourse, and ejaculation will occur with each partner, and the delay time of bulbous cavernous body reflex (BCR) is short.

2. Secondary premature ejaculation

It means that before the occurrence of premature ejaculation, the sexual function was normal for a period of time, which may gradually appear or suddenly appear, which may be secondary to urological diseases, thyroid diseases, or psychological diseases, etc., and the delay time of the corpus cavernosum reflex is longer. .

3. Situational premature ejaculation

The ejaculation time of this kind of patients is long or short, and ejaculation occurs prematurely. This premature ejaculation is not necessarily a pathological process.

Clinical manifestations of premature ejaculation

The clinical manifestations of premature ejaculation are mainly excessive ejaculation. Based on time: the time from penis insertion to vagina to ejaculation is generally considered to be less than 2 minutes for premature ejaculation. Based on the number of tic strokes: less than 10 to 30 tic strokes inserted into the vagina are premature ejaculation. According to the response of the sexual partner: in sexual activities, if there are more than half of the opportunities for sexual life, the woman can not reach orgasm can also be called premature ejaculation. Patients often have symptoms such as anxiety, depression, dizziness, and fatigue.

Premature ejaculation examination and diagnosis

A preliminary diagnosis can be made through detailed medical history and sexual life survey, and understanding the cause of the disease can provide some guidance and help for treatment.

1. Specialist Physical Examination

Including male secondary sexual characteristics, penis, testis and epididymis examinations, and sometimes even prostate, seminal vesicle color ultrasonography. In order to identify premature ejaculation or other sexual dysfunction, especially the underlying diseases associated with erectile dysfunction.

2. Psycho-Psychological Analysis

Can use the psychological personality test SCL-90-R, etc., to conduct psychological analysis, which is helpful to understand the patient's mental condition.

3. Neurophysiological examination

Use penile vibration sensation measurement, dorsal penile nerve evoked potential and penis head sensory evoked potential measurement, bulbocavernosus reflex latency measurement to determine penile sensory threshold and other changes, which is helpful to understand penile sensory and sensory nerve functions .

4. Other

Routine examination of urology can determine whether there are other causes of foreskin balanitis, prostatitis, seminal vesicle urethritis and so on. If necessary, testosterone, prolactin and other sex hormone levels can be detected.

Premature ejaculation treatment

In order to prolong the ejaculation incubation period, most patients turn their thinking to other aspects during the sexual intercourse, such as diet, play, etc., trying to delay the ejaculation incubation period, or using condoms, alcohol and other methods, but the results are not good. On the contrary, it often leads to hyposexuality, sexual pleasure disorder, and even Can cause erectile dysfunction, etc., thereby aggravating the condition. Therefore, the treatment of premature ejaculation should be based on the cause of the disease, choose an appropriate treatment.

Psychotherapy

The cooperation of both husband and wife is needed, especially the wife's participation in treatment is very important. The psychological treatment of premature ejaculation should be coordinated with the patient's wife. Because the woman's misunderstanding or complaining will increase the man's sense of tension and anxiety, and increase the psychological burden. The woman should be considerate and caring, give verbal and behavioral comfort, relieve the man's nervousness, and help her build confidence in healing. Both husband and wife should be informed that premature ejaculation is a relatively common problem. Both husband and wife need to understand the necessity and possibility of rebuilding ejaculation conditioning, eliminate the patient's anxiety, anxiety, and guilt and other abnormal psychology, and build confidence in curing the disease. With treatment, it can still be cured.

2. Guidance on behavioral methods

The purpose of sexy concentration training therapy is to teach patients to experience and enjoy sexual pleasure through tactile stimulation such as hug, touch, and massage, and overcome psychological obstacles. You can also pull down the scrotum and testicles before reaching orgasm, or squeeze the glans with the thumb and the index finger to reduce sexual excitement, and reduce the erectile stiffness by 10% to 25%. After long-term training, sexual intercourse was performed in the female upper position. Repeated training was still used in the form of twitch-stop-re-twist, and the ejaculation stimulation threshold was gradually raised, so that ejaculation was achieved after satisfactory artificial control was reached.

(1) Semans technical training : pause and start therapy. When the woman stimulates the penis until the ejaculation is about to occur, the man indicates to stop the stimulation immediately. After the ejaculation premonition has completely disappeared, re-stimulation is repeated until the man can receive a lot of stimulation before allowing the last ejaculation. This method can increase the ejaculation threshold. After successful treatment, adhere to the control training once a week.

(2) The method of squeezing the penis head is also called tolerance training. When the woman stimulates the penis until the ejaculation is imminent, the woman places the thumb's abdomen on the penis lacing part, and the index and middle fingers are placed on the upper and lower sides of the coronal sulcus on the other side of the penis. The degree of acceptance is about 3 to 4 seconds each time, which can relieve the urgency of ejaculation. If you persist in treatment for 3 to 6 months, you can obtain a long-lasting and stable effect.

3. Oral medication

At present, drug treatment is mainly serotonin reuptake inhibitors such as sertraline and paroxetine; tricyclic antidepressants such as clomipramine and fluoxetine. However, these drugs have certain side effects and must be taken under the guidance of a doctor.

In recent years, selective serotonin reuptake inhibitors such as dapoxetine have achieved good results.

4. Topical application

It is mainly a local anesthetic, which can be applied to the head of the penis before intercourse, and the latency of ejaculation can be delayed by the local anesthetic effect. Topical drugs such as 1% dacronin solution, 1% tetracaine solution, 2% lidocaine gel, 3% aminobenzoate, and so on. After using a local anesthetic, condoms can be used. If you do not use a condom, wash away any residual medication from your penis. It should be noted that excessively prolonged anesthesia time (30-45 minutes) can cause the erection to disappear, because the prolonged anesthesia time can make a considerable part of the penis feel numb. If the residual medicine on the penis is not thoroughly washed before the intercourse (without condoms), the diffusion of the local anesthesia residue from the penis can also cause the woman's vaginal wall to numb and reduce sexual pleasure. If patients or sexual partners are allergic to local anesthetics, this treatment is contraindicated.

5. Transurethral administration (MUSE)

Can also be used for the treatment of premature ejaculation.

6. Dorsal penile neurotomy

This method is still in a trial phase abroad. Although the effect is recognized to a certain extent, its safety and effectiveness remain to be studied. It is only applicable to married patients with primary premature ejaculation, and the patient must have received long-term drug and psychological and behavioral therapy with little effect. For patients who can improve ejaculation time with drugs or patients with secondary premature ejaculation, surgery is not considered.