Premature ejaculation - surrender at the first sign of failure

Patient A: Doctor, I just got married, and every time I have sex, I ejaculate after just a few thrusts. Is this considered premature ejaculation?

Doctor: Ejaculating quickly after getting married is a symptom of premature ejaculation. It can only be diagnosed as premature ejaculation if regular sex does not improve for a period of time. Most young people have insufficient sexual experience. So it cannot be diagnosed as premature ejaculation at present.

Patient A: Doctor, I have had premature ejaculation for more than two years. I ejaculate after just a few strokes every time, and my wife is not satisfied. But I heard that it is too troublesome to treat. Considering that this disease does not affect my life, can I not treat it?

Doctor: Long-term premature ejaculation will affect the relationship and physical and mental health of couples. Because they are always worried about poor sexual performance, each sexual life will be full of pressure. It is often combined with psychogenic erectile dysfunction, causing a series of psychological symptoms such as anxiety and depression, affecting the quality of life. Therefore, premature ejaculation still needs to be treated.

I. Definition

Premature ejaculation is when the penis often or always ejaculates before or within a short period of time (<1 minute) after the penis is inserted into the vagina, and it is always or almost always unable to delay ejaculation, which gradually produces negative effects, such as distress, anxiety, depression, and even avoidance of sexual life. More and more scholars believe that the concept of premature ejaculation should not only emphasize the length of sexual intercourse, but should focus on the satisfaction of both parties in sexual life.

2. Cause Analysis

There is still controversy over the cause of premature ejaculation. Traditionally, it was believed to be caused by psychological factors. It is currently believed that it may be related to the following factors: 1. Anxious and nervous mental state; 2. Too few sexual intercourses; 3. Erectile dysfunction; 4. Prostatitis; 5. Discontinuation or use of certain drugs; 6. Pathological conditions such as thyroid disease.

Treatment

The treatment of premature ejaculation should first end the separation of the two places, appropriately increase the frequency of sexual intercourse, gradually improve the ability to control ejaculation, enhance self-confidence, assist with drug treatment, and prolong the latent time of ejaculation. Behavioral therapy, psychological therapy and drug treatment are the main treatments. Those who are ineffective or unsuitable for medication can choose injection therapy or surgical treatment.

1. Behavioral therapy. High tension during sex can easily lead to premature ejaculation. Distracting attention can prolong the latent time of ejaculation. Use the "interval-stop method", that is, before ejaculation, stop the penis twitching artificially, and continue to thrust the penis after the strong feeling of ejaculation has passed. Repeat this 3-5 times before ejaculation; "penis root squeeze method", squeeze the penis root when ejaculation is approaching, stop the penis twitching at the same time, and continue the "piston movement" after the strong feeling of ejaculation has passed; regular sex and pelvic floor muscle training are also effective means to control ejaculation and improve premature ejaculation. The key is to persist in practicing, and sperm control and delay training is recommended.

2. Psychological treatment. Choose a comfortable environment, enhance self-confidence, avoid excessive tension, self-regulate to reduce psychological pressure, cooperate tacitly and encourage each other. Increase the frequency of sexual life, share sexual feelings and experiences, gradually improve self-confidence in "actual combat", and improve ejaculation control ability.

3. Drug treatment. Drug treatment for possible causes of premature ejaculation includes topical application of drugs to the glans penis and oral drug treatment. For topical medication, it is recommended to apply lidocaine cream to the glans penis 15 minutes before intercourse to reduce the sensitivity of the glans penis. The side effects are numbness of the glans penis and difficulty in ejaculation. Systemic medication includes short-acting dapoxetine and long-acting sertraline, fluoxetine and paroxetine. Drugs increase the inhibitory neurotransmitter 5-HT in the synaptic cleft to reduce the excitability of the central nervous system and achieve the effect of delaying ejaculation. Long-term use may lead to decreased libido.

4. Injection treatment. The biggest trouble for patients with premature ejaculation is that the medication is effective, but the patient has to stop taking the medication repeatedly. Injecting hyaluronic acid into the coronal sulcus of the penis can thicken the glans penis, reduce nerve sensitivity, effectively prolong the patient's ejaculation latency time, and obtain a more satisfactory therapeutic effect.

5. Surgery

(1) Penile isolation: also known as penis enlargement surgery, a circular incision is made in the coronal sulcus, freeing the deep and superficial fascia, removing the penis from the glove to the base, placing an allogeneic dermal patch, fixing it to the deep fascia, embedding the dorsal nerve of the penis, isolating the nerve to reduce nerve sensitivity. The use of the patch during the operation also has the effect of penis enlargement surgery.

Before and After Penis Enlargement Surgery

(2) Dorsal penile nerve division. After the penis is ungloved, the dorsal penile nerve is exposed. During the operation, 3 to 4 dorsal penile nerves are retained, and the rest are cut and removed. If the retained dorsal penile nerve is still thick, continue to separate it distally to the glans penis, and then cut off 3 to 4 small branches. Insufficient dorsal penile nerve division will lead to poor postoperative efficacy, and excessive resection may cause erectile dysfunction. Therefore, dorsal penile nerve division should strictly follow the surgical indications. Please be sure to choose carefully.