Premature ejaculation refers to a condition where ejaculation occurs before the penis makes contact, immediately upon touching the female external genitalia, or shortly after entering the vagina, followed by the penis becoming limp and unable to sustain normal sexual activity. It is a relatively common male sexual dysfunction disorder.

bubble_chart Etiology

The causes of premature ejaculation are complex and vary from person to person. Most cases are psychological (mental), influenced by pathological excitement in the brain or increased excitability of the spinal cord centers, while a minority are caused by organic diseases.

1. Psychological causes of premature ejaculation
   1. Anxiety and depression: Because anxiety and premature ejaculation are both regulated by the sympathetic nervous system.
      1. Hasty premarital intercourse often occurs under nervousness, and once the conditioned reflex of striving for rapid ejaculation (premature ejaculation) is formed, it becomes difficult to change the habit of early ejaculation even after marriage.
      2. Infrequent sexual intercourse can lead to excessively intense sexual excitement (sympathetic nervous excitement) and easily result in premature ejaculation.
      3. Poor interpersonal relationships, family relationships, or marital discord, leading to anxiety, tension, and fear, can all cause premature ejaculation.
      4. Low self-esteem, frustration, guilt, shame, or feelings of inferiority—these depressive moods can contribute to premature ejaculation.
      5. Lack of sexual knowledge, skills, and experience.
   2. Masturbation habits: Due to the fear of being discovered or ridiculed during masturbation, individuals often feel nervous and strive for quick ejaculation, gradually developing the habit of premature ejaculation.
   3. Excessive fatigue: Engaging in sexual activity when physically or mentally exhausted, with insufficient energy, can also easily lead to premature ejaculation.
2. Organic causes of premature ejaculation
   1. Differences in physical constitution: The reflex of the penile corpus cavernosum muscles in individuals with premature ejaculation is faster than in those without. This may be due to higher levels of testosterone in the blood, which increases the excitability of the ejaculation center, lowers the threshold, and makes the ejaculation center more prone to excitement, leading to early ejaculation.
   2. Diseases causing organic injury to the sympathetic nervous system: Such as pelvic fractures, prostate enlargement, arterial sclerosis, diabetes, etc. These directly affect the control of the sexual center, reducing the ability to control the ejaculation center and resulting in premature ejaculation.
   3. Diseases of the reproductive organs: A short penile frenulum that hinders full erection; chronic congestion and edema of the seminal colliculus, where even slight sexual stimulation can quickly lead to sexual excitement and rapid ejaculation.

bubble_chart Clinical Manifestations

1. During sexual intercourse, there is no contact or only brief contact with the female external genitalia, or the insertion into the vagina involves short thrusting movements, leading to ejaculation before reaching orgasm, followed by the softening of the penis. This may be accompanied by symptoms such as mental depression, anxiety, dizziness, mental fatigue, lack of strength, and memory decline.
2. In cases of organic sexually transmitted diseases, symptoms and signs of the primary disease are present.
3. Classification of symptoms
   1. Situational premature ejaculation: The condition of premature ejaculation may change when switching sexual partners.
   2. True premature ejaculation: Premature ejaculation occurs with different partners in various settings, also known as complete premature ejaculation.
   3. Primary premature ejaculation: There has never been good control over ejaculation, while other aspects of health are normal. Often caused by psychological factors.
   4. Secondary premature ejaculation: There was previously good control over ejaculation, but premature ejaculation occurs later, mostly due to organic factors.

bubble_chart Diagnosis

1. Already prepared for sexual intercourse, ejaculation occurs before the penis enters the vagina, or after entering the vagina, but the intercourse is brief and ejaculation occurs before reaching orgasm.
2. There is a history of psychological factors leading to premature ejaculation, or a history of chronic inflammation of the genital organs.

bubble_chart Treatment Measures

1. Drug therapy: Mainly involves the use of antidepressants and sedatives. For organic sexually transmitted diseases, antibiotics are used to treat the underlying condition.
2. Psychological therapy: Primarily analyzes the psychological factors leading to premature ejaculation, followed by psychological counseling to eliminate the disease cause and establish a normal ejaculatory reflex.
3. Behavioral therapy
   1. Using anesthetics or similar drugs to reduce the sensitivity of the glans.
   2. Through repeated training by the wife on the penis, the urgency to ejaculate is delayed, and the ejaculatory threshold is increased.
      1. Intermittent intercourse method: During sexual activity, when the male senses the urge to ejaculate, he immediately stops thrusting and keeps the penis inside the vagina. When the female is sexually aroused, the vagina expands, and the glans does not touch the vaginal wall, reducing stimulation to the glans and lowering sexual arousal. Once the urge to ejaculate completely subsides, intercourse can resume. Repeated intermittent intercourse in this manner can prevent premature ejaculation.
      2. Physical therapy: Ultra-short wave diathermy in the lumbosacral region, warm baths, mineral baths, etc., can also assist in treatment.
      3. Scrotum and testicle pull-down method: During sexual activity, when the male senses the urge to ejaculate, the scrotum contracts, and the testicles rise. At this point, the female can gently pull the male's scrotum and testicles downward, reducing male sexual arousal and delaying ejaculation to achieve the effect of preventing premature ejaculation.
      4. Condom use method: The male wears a condom during intercourse to reduce penile friction, thereby lowering the sensitivity of male sexual arousal, prolonging intercourse time, and avoiding premature ejaculation.
      5. Squeeze technique: This is the best non-drug treatment for premature ejaculation. It can increase the male's ejaculatory stimulus threshold, alleviate the urgency to ejaculate, enhance sexual excitement, improve the ejaculatory reflex state, and rebuild or restore normal ejaculation time. Both partners can perform the squeeze technique, but it is more effective when performed by the female than by the male alone.
   3. Change the pace of intercourse from slow to fast, reducing large movements to delay ejaculation.