What are the diagnosis and treatment methods for premature ejaculation?

Many men are suffering from premature ejaculation. If they ejaculate very quickly during sex, neither the husband nor the wife can get sexual pleasure. If this continues for a long time, it will affect the relationship between the couple and seriously undermine the man's self-confidence. Many men cannot hold their heads up in front of their wives. This will also directly affect the man's ambition. He may have no pursuit in his career and become decadent. Such examples are everywhere in life, so I would like to remind all men that premature ejaculation is not terrible. What is most terrible is self-abandonment. Premature ejaculation is not incurable. Therefore, what you need to do is go to the hospital for a detailed examination, fully diagnose the condition, and then cooperate with the doctor for active treatment.

First, examination and diagnosis

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

1. Specialist physical examination

This includes examination of male secondary sexual characteristics, penis, testicles and epididymis, and sometimes even requires prostate and seminal vesicle color Doppler ultrasound examinations to identify premature ejaculation or other sexual dysfunctions, especially underlying diseases related to erectile dysfunction.

2. Psycho-psychological analysis

Psychological analysis can be performed using the psychiatric personality test SCL-90-R, which helps to understand the patient's mental and psychological condition.

3. Neuroelectrophysiological examination

Using penile vibration sensitivity measurement, dorsal penile nerve evoked potential measurement, glans penile sensory evoked potential measurement, and bulbocavernous reflex latency measurement to measure changes in penile sensitivity threshold and other conditions helps to understand penile sensitivity and the function of sensory nerves.

4. Others

Routine urological examinations can determine whether there are other induced causes such as balanitis, prostatitis, seminal vesiculourethritis, etc. If necessary, sex hormone levels such as testosterone and prolactin can be tested.

Second, psychological treatment

The cooperation of both husband and wife is required, especially the wife's participation in the treatment is very important. The psychological treatment of premature ejaculation requires the cooperation of the patient's wife. Because the woman's misunderstanding or complaint will increase the man's tension and anxiety, and increase the psychological burden. The woman should be considerate and caring, give verbal and behavioral comfort, relieve the man's tension, and help him build confidence in the cure. The couple should be informed that premature ejaculation is a relatively common problem. Both husband and wife need to understand the necessity and possibility of rebuilding the conditioned reflex of ejaculation, eliminate the patient's abnormal psychology such as anxiety, uneasiness, and guilt, and build confidence in curing the disease. As long as both parties cooperate with the treatment, it can still be cured.

Third, behavioral method guidance

The purpose of the sexual concentration training therapy is to teach patients to experience and enjoy sexual pleasure and overcome psychological barriers through tactile stimulation such as hugging, caressing, and massage. You can also pull the scrotum and testicles downward before reaching orgasm, or use the thumb and index finger to press and squeeze the glans to reduce sexual excitement, and the erection hardness can also be reduced by 10% to 25%. After long-term training, sexual intercourse is performed in the woman-on-top position, and the training is still repeated in the form of twitching-stopping-twitching again, gradually improving the ejaculation stimulation threshold, so that ejaculation can be achieved only after a more satisfactory artificial control.

(1) Semans technique training is a stop-and-start therapy. When the woman stimulates the penis until she is about to ejaculate, the man signals to stop stimulation immediately. When the premonition of ejaculation disappears completely, stimulation is resumed. This is repeated until the man can accept a large amount of stimulation, and then he is allowed to ejaculate. This method can increase the ejaculation threshold. After successful treatment, control training should be performed once a week.

(2) Penis head squeezing method is also called tolerance training. When the woman stimulates the penis until she feels that ejaculation is imminent, she places the tip of her thumb on the frenulum of the penis, and the tip of her index and middle fingers on the upper and lower edges of the coronal sulcus on the other side of the penis, applying pressure from front to back, to the extent that the man can tolerate, for about 3 to 4 seconds each time, which can relieve the urgency of ejaculation. If the treatment is continued for 3 to 6 months, a long-lasting and stable therapeutic effect can be achieved.

Fourth, oral medication treatment

At present, drug treatment mainly includes 5-hydroxytryptamine reuptake inhibitors such as sertraline and paroxetine; tricyclic antidepressants such as clomipramine and fluoxetine, etc. However, these drugs have certain side effects and must be taken under the guidance of a doctor.

5. Topical medication

It is mainly a local anesthetic, which can be applied to the glans penis before sexual intercourse to delay the latent period of ejaculation through local anesthetic effect. Topical drugs include 1% dyclonine solution, 1% tetracaine solution, 2% lidocaine gel, 3% ethyl aminobenzoate, etc. After using local anesthetics, condoms can be used or not. If condoms are not used, wash the residual drugs on the penis. It should be noted that excessive extension of anesthesia time (30-45 minutes) can lead to the disappearance of erection, because too long anesthesia time will make a considerable number of people feel numb in the penis. If the residual drugs on the penis are not thoroughly washed before sex (without condoms), the diffusion of the local anesthetic residues of the penis can also cause numbness of the female's vaginal wall and reduce sexual pleasure. This treatment is contraindicated if the patient or sexual partner is allergic to local anesthetics.