Definition, causes, and treatment of premature ejaculation; classification and treatment of ejaculatory dysfunction.

Premature ejaculation (PE) is the most common ejaculatory dysfunction, affecting more than one-third of adult men. The definition of PE is still controversial, but it is usually assessed based on the man's ejaculatory latency or the frequency of female orgasm during intercourse. One standard is defined as the man losing control of ejaculation during intercourse, ejaculating before or immediately after penetration; another is defined as the woman achieving orgasm less than 50% of the time during intercourse. However, these definitions are not universally accepted. This is because male ejaculatory latency is affected by factors such as age, duration of abstinence, physical condition, and emotional state, while the frequency of female orgasm is also influenced by physical condition, emotional changes, and the surrounding environment. Furthermore, the length of ejaculatory latency varies from person to person. Generally, it is considered normal for healthy men to ejaculate 2-6 minutes or more after penetration.

It is currently believed that the causes of premature ejaculation are not only psychological and penile local factors, but also include diseases of the urinary, endocrine and nervous systems.

Many psychological factors can cause premature ejaculation. These include fear of sexual failure and anxiety, leading to premature ejaculation; frequent masturbation in youth aimed at achieving rapid orgasm; lack of sexual knowledge, focusing solely on male satisfaction; poor coordination between partners; emotional discord, aversion to one's partner, and intentional or unintentional sadistic tendencies; concerns about the health effects of sexual activity, potentially exacerbating pre-existing conditions; infrequent sexual activity or prolonged sexual repression; and female partners' aversion to intercourse, anxiety, and pressure to end intercourse quickly. All of these can contribute to premature ejaculation and even trigger a chain reaction, affecting erectile function.

Regarding organic factors that cause premature ejaculation, some believe that spinal cord diseases such as multiple sclerosis or spinal cord tumors, epileptic seizures, or organic lesions of the cerebral cortex such as cerebrovascular accidents can cause loss of ejaculatory control. Other reports suggest that diabetes, cardiovascular disease, pelvic fractures, urogenital diseases such as urethritis, prostatitis, seminal vesiculitis, and benign prostatic hyperplasia are all associated with premature ejaculation.

Some people try to prolong intercourse by drinking alcohol or having sex a second time that day, but doing so regularly can affect their physical and mental health. In addition, men often lack pleasure during a second intercourse.

Many patients try to prolong ejaculation by distracting themselves during intercourse with activities like eating or playing, attempting to delay the ejaculation latency period. They may also use condoms or drink alcohol, which can be effective for some. However, these methods are ineffective for others and often lead to decreased libido, impaired sexual pleasure, or even erectile dysfunction, thus worsening the condition. Therefore, the treatment of premature ejaculation should be based on the underlying cause, selecting an appropriate treatment method.

(1) Psychotherapy: This requires the cooperation of both partners. Both partners should be informed that premature ejaculation is a relatively common problem, and that they need to understand the necessity and possibility of rebuilding the ejaculatory reflex. This will help eliminate the patient's anxiety, unease, guilt, and other abnormal psychological states, and build their confidence in curing the disease. As long as both partners cooperate with the treatment, it is still curable.

(2) Behavioral guidance: Sensate focus training is a basic treatment method. Its purpose is to guide patients to experience and enjoy sexual pleasure and overcome psychological barriers through tactile stimulation methods such as hugging, touching, and massage. Before reaching orgasm, the scrotum and testicles can be pulled downwards, or the glans penis can be squeezed with the thumb and forefinger to reduce sexual arousal and erectile hardness by 10% to 25%. After prolonged training, intercourse can be performed in the female-superior position, using a repeated thrusting-stopping-re-thrusting pattern to gradually increase the ejaculation threshold, thereby achieving more satisfactory voluntary control before ejaculation.

(3) Oral medication: Currently, the main medication is a serotonin reuptake inhibitor, such as daparoxetine hydrochloride, 30mg, taken orally 3 hours before sexual intercourse. It mainly prolongs the ejaculation latency period. It has certain adverse reactions and indications, and must be taken under the guidance of a doctor. Other similar drugs include paroxetine and sertraline hydrochloride, all of which should be used under the guidance of a doctor.

(4) Local medication: mainly local anesthetics, which can be applied to the glans penis before intercourse to delay the ejaculation latency period through local anesthetic effect.

(5) Intracavernosal injection therapy: Although premature ejaculation still exists after treatment, penile erection can be maintained for a certain period of time after ejaculation, which may help improve the sexual satisfaction of the partner.

(6) Administration via urethra: It can also be used to treat premature ejaculation.

(7) Penile prosthesis implantation: suitable for patients with penile erectile dysfunction and premature ejaculation.

(8) Dorsal penile nerve resection: This method is still in the trial stage both domestically and internationally. Although its effectiveness has been recognized to a certain extent, its safety and efficacy still need to be studied.

Under the guidance of a doctor, most patients with premature ejaculation can treat themselves, but this requires cooperation between both partners to achieve better results. Specifically, this includes the following methods.

(1) Pause method: When you feel you are about to ejaculate during sexual intercourse, deliberately slow down or stop the amplitude and frequency of penile thrusting in the vagina, and use some methods to distract yourself so that the urge to ejaculate disappears. Then resume thrusting. Repeat the above operation until both partners are satisfied before ejaculation.

(2) Frequent ejaculation: This means prolonging the duration of sexual intercourse by increasing the number of ejaculations. The method involves masturbating to ejaculation first, and then engaging in sexual intercourse, or increasing the frequency of sexual intercourse. However, this method is suitable for young patients with premature ejaculation, but not for middle-aged and elderly patients with declining function or those showing signs of decline.

(3) Condoms: Covering the glans penis with a condom can reduce stimulation and thus delay ejaculation. Men can use condoms to treat premature ejaculation. If one condom is not sufficient, a looser one can be added.

(4) Changing positions: This mainly refers to changing sexual positions. In the missionary position, the man is in the active position, and larger movements make ejaculation easier. In the woman-on-top or side-lying position, the man is in the passive position, and smaller movements will delay ejaculation.

(5) Stimulation method: This mainly improves the penis's tolerance to stimulation, and can be achieved by using the penile squeeze method. This method can increase the ejaculation threshold when the penis is stimulated, thereby enabling it to tolerate stronger stimulation during sexual intercourse and delaying ejaculation.

To date, premature ejaculation is the most effectively treated of all sexual dysfunctions. With appropriate treatment, patients with premature ejaculation can generally achieve varying degrees of improvement.