Definition, pathogenesis and behavioral treatment of premature ejaculation

Premature ejaculation

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**2.1//How to understand premature ejaculation?**

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The great educator Confucius once said, "Food and sex are human nature," and indeed, sex is human nature.

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A harmonious sex life is a good medicine for prolonging life, and premature ejaculation does indeed bring pain to many men and their families.

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In 2015-2016, a survey of nearly 200,000 people in 29 countries around the world was conducted on their sexual activities and health status. The survey found that premature ejaculation is the most common sexual dysfunction among men worldwide, while erectile dysfunction ranks second.

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Premature ejaculation (PE) is the most common ejaculatory dysfunction, characterized by ejaculation at the beginning of intercourse or even before intercourse, making it impossible to have normal sexual intercourse. Its incidence rate is more than one-third of adult men.

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The definition of premature ejaculation is still controversial. It is usually evaluated by the male's ejaculation latency or the frequency of female orgasm during intercourse. For example, it is defined as the male losing the ability to control ejaculation during intercourse, and ejaculating before or immediately after penile penetration; or it is defined as the female achieving orgasm less than 50% of the time during intercourse. However, these definitions are not universally accepted.

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Because male ejaculation latency is affected by factors such as age, length of abstinence, physical condition, and emotional state, the frequency of female orgasm is also affected by factors such as physical condition, emotional changes, and the surrounding environment.

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In addition, the length of the ejaculation latency period varies from person to person. Generally speaking, it is considered normal for a healthy man to ejaculate 2 to 6 minutes after penile insertion into the vagina.

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The duration of sexual intercourse varies from person to person. It is related to a person's physique, genetics, and sexual partner. A small number of people can have intercourse lasting more than 30 minutes, but the vast majority of people cannot achieve this, and it is certainly not as intense as described in novels, television, movies, and other media.

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The duration of sexual intercourse cannot be forced. Many healthy men who come to the doctor because of short intercourse time are actually not diagnosed with premature ejaculation.

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Premature ejaculation is the most common type of male sexual dysfunction. The pathogenesis of premature ejaculation can be summarized as follows.

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First, psychological factors, such as high levels of mental stress, can lead to ejaculation during kissing or hugging, mainly caused by over-excitation of the spinal ejaculation center.

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In addition, sexual intercourse during the honeymoon period, or hasty intercourse under anxious conditions, or the first intercourse after a long period of abstinence, cannot be strictly understood as premature ejaculation; these three situations are overreactions to sexual intercourse, and most of them will heal on their own with changes in time, environment, and conditions.

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Secondly, the sensitivity of the glans penis is increased. Studies have shown that the latency period for sensory stimulation of the glans penis in patients with premature ejaculation is significantly shorter than that in normal individuals.

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Third, diseases of the external genitalia or prostate, such as seminal vesiculitis or prostatitis.

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Since the seminal vesicles are where semen is stored and also the area that induces ejaculation, inflammatory stimulation can cause ejaculation to occur prematurely, resulting in premature ejaculation.

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> Hypersensitivity of the male penis

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**2.2//How to prevent and treat premature ejaculation?**

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Premature ejaculation, the most common male sexual dysfunction, brings disharmony to sexual life. Severe premature ejaculation, especially premature ejaculation that occurs before vaginal penetration, should be taken seriously as it can be a cause of infertility.

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Currently, it is 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.

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There are many psychological factors that can cause premature ejaculation. For example, many people experience premature ejaculation due to fear of sexual failure and anxiety; those who habitually masturbate in their youth with the goal of quickly reaching orgasm; lack of sexual knowledge, focusing only on male satisfaction; poor coordination between partners; emotional discord, aversion to the spouse, and intentional or unintentional sadistic tendencies; concerns that sexual activity will harm health or exacerbate pre-existing conditions; infrequent sexual intercourse or prolonged sexual repression; and the female partner's aversion to intercourse, anxiety, and pressure to end intercourse quickly.

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All of these factors can lead to premature ejaculation and even trigger a chain reaction, affecting erectile function.

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> **2.1.1** **Behavioral Therapy**

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A harmonious marital relationship is the emotional foundation for treating premature ejaculation.

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The husband often faces complaints because his wife is unable to reach orgasm due to premature ejaculation.

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There are two possible reasons for this situation. One is premature ejaculation, and the other is that the woman's sexual response is slower and her orgasm is also slower, leading to inconsistent orgasms between the couple. To address this, the couple can stimulate each other multiple times a day. The man should stimulate his penis until he feels the urge to ejaculate, then stop stimulation or pinch the head of the penis to eliminate the urge. Repeat this stimulation repeatedly without causing ejaculation. The goal is to control the onset of orgasm. Because the man does not ejaculate, his libido will not decrease. After several rounds of sexual stimulation without reaching orgasm, the man will experience a strong sexual urge and desire. Engaging in intercourse at this point can often prolong the duration of intercourse.

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The second situation is not caused by premature ejaculation, but by female sexual characteristics.

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Women's orgasms come slowly, and they can experience multiple orgasms in one sexual encounter. However, it is difficult for women to initiate orgasms, and they often cannot coordinate with their male partners. Sometimes, the man has already ejaculated while the woman's orgasm is just beginning, which inevitably leads to complaints. However, scientific research on sexual response behavior shows that most women prefer to achieve orgasm through direct clitoral stimulation. Although penile penetration can also lead to sexual arousal and pleasure, only clitoral stimulation can give women the greatest pleasure.

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The clitoris is the most sensitive erogenous zone for women. Anatomically speaking, it is equivalent to the penis in men. Therefore, for women who have difficulty reaching orgasm or whose female orgasm is slow to come, direct stimulation of the clitoris can help induce an earlier female orgasm and achieve a harmonious sex life for both partners.