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Guide
With the increasing demand for a better life, the diagnosis and treatment of premature ejaculation related fields have made rapid
progress.
The Andrology Branch of the Chinese Medical Association organized the compilation of a new edition of the guidelines for the diagnosis and treatment of premature ejaculation, adjusted part of the structure of the guidelines, focused on clinical diagnosis and treatment, and was suitable for the clinical application of the majority of andrologists, hoping to provide useful guidance and help
for clinicians to diagnose and treat premature ejaculation.
The main points of Yimaitong are as follows for the readers
.
Premature ejaculation classification
Premature ejaculation is divided into 4 categories: primary premature ejaculation, secondary premature ejaculation, naturally variable premature ejaculation, and subjective premature ejaculation
.
This classification covers different pathophysiological bases and facilitates the provision of different treatment options
for patients.
Table 1 Classification of premature ejaculation
Diagnosis and evaluation
of premature ejaculation01 Medical history
The diagnosis of premature ejaculation is based on the history, particularly sexual history
.
A detailed history can distinguish primary, secondary, natural variability, and subjective premature ejaculation
.
Questions should include the latency of intravaginal ejaculation (IELT), the timing of premature ejaculation (premature ejaculation from the first sexual intercourse or after a certain point in time), and whether it is natural variability (in a particular setting or with a particular partner).
In addition, attention should be paid to the control of ejaculation, satisfaction of both parties, the degree of sexual stimulation, the impact on sexual activity and quality of life, drug use and abuse
.
When collecting medical history, it is necessary to ask about other sexual function characteristics such as erectile function, sexual desire, orgasm, etc.
, and also need to ask about urination status, perineal pain and other symptoms, which are different from erectile dysfunction (ED), chronic prostatitis and other diseases, and pay attention to ED and chronic prostatitis are often combined with premature ejaculation, and pay attention to asking about premature ejaculation in
these patients.
Definition of IIELT: that is, the time from the insertion of the penis into the vagina to the start of ejaculation, which can be measured
by a stopwatch.
In daily outpatient work, self-assessed IELT (eIELT) or stopwatch-measured IELT (sIELT) can be used to distinguish the type of premature ejaculation, but in the evaluation of normal male sexual life time, eIELT has a tendency to be too high than sIELT, and direct replacement is
not recommended.
At present, there are 3 types of questionnaires commonly used, namely the Premature Ejaculation Summary Form (PEP), the Premature Ejaculation Index (IPE), and the Premature Ejaculation Diagnostic Tool (PEDT).
Of the three scales, PEDT is more widely
used.
Premature ejaculation patients often have psychological abnormalities, and a mental health questionnaire for premature ejaculation patients is also necessary
.
Various psychological scales can be applied if conditions permit, and for patients with premature ejaculation accompanied by serious mental illness, it is recommended to go to a professional or psychologist for further evaluation and treatment
.
Figure 1 Flow chart of premature ejaculation diagnosis
Table 2 Evidence-based and recommended levels for the diagnosis of premature ejaculation
Treatment of premature ejaculation
Treatment of premature ejaculation includes medication, behavioral therapy, psychosexual interventions, and comprehensive treatment should receive more attention
to improve efficacy and adherence.
From a clinical experience, psychological counseling and education for patients and spouses should be the first priority in the treatment of premature ejaculation, and all patients seeking treatment for premature ejaculation should receive basic psychosexual education or counseling
.
Including: (1) the prevalence of premature ejaculation in the general population and the average IELT to eliminate the misunderstanding of premature ejaculation; (2) Depict a harmonious and satisfying sexual process to improve the sexual interest of premature ejaculation patients and their partners, while encouraging good communication
between patients and partners about sexual life.
Although there is insufficient evidence to support the efficacy of psycho-behavioral therapy alone, there have been multiple controlled studies comparing pharmacological combination psycho-behavioral therapy with medical therapy alone to support the superiority
of combination therapy.
Includes treatments for premature ejaculation for approved indications, such as on-demand dapoxetine, topical lidocaine cream or spray (topical desensitizer), or other selective 5-HT reuptake inhibitors (SSRIs).
(1) Dapooxetine: Dapooxetine is the first and only oral drug approved for premature ejaculation in China, the initial dose of treatment is recommended to be 30 mg, which can be taken with a glass of water 1~3h before sexual intercourse, up to 1 time a day, generally evaluated
after 6 times of use within 4 weeks.
(2) Other SSRIs: including citalopram, fluoxetine, clofloxamine, paroxetine, and sertraline, all of which have common pharmacological effects but are not approved for the treatment of premature ejaculation
.
(3) Local anesthetic: At present, there are gels, creams, sprays and other dosage forms, including lidocaine, propylacaine or different combinations of other drugs, commonly used are compound chamomile lidocaine cream/gel, lidocaine/prilocaine spray, etc
.
It is generally used 5~10 minutes before sexual life, applied or sprayed on the front of the penis and around
the frenulum area.
(4) Other drug treatments: including phosphodiesterase inhibitor type 5 (PDE5i), α1 adrenergic blocker, tramadol, etc
.
Table 3 Recommended levels of medication for premature ejaculation
Based on dialectical treatment, it can also be combined with external treatment methods such as acupuncture and external washing of traditional Chinese medicine
.
(1) Dialectical treatment: liver qi depression type, kidney qi inconsolidation type, kidney yin deficiency type, lower scorching and humid heat type, heart and kidney non-communion type and kidney deficiency liver depression type
.
Table 4 Dialectical treatment of premature ejaculation
(2) External treatment: (1) Acupuncture therapy mainly emphasizes the same treatment of the heart and kidneys, and acupuncture points are mainly based on the heart and kidney meridians, Ren Du pulse, and attach importance to the role of
toning the mind.
Choose the main acupuncture: Kidney Yu, Qi Hai, Guan Yuan, Sanyin Sex, Neiguan, Shenmen, if accompanied by kidney yin deficiency plus He, Taixi, if the moist heat bet plus Zhongji, Yin Ling Spring, kidney yang deficiency plus life gate, Yang Pool, liver qi depression plus Tai Chong, Hegu, 1 acupuncture per day or every other day, twisting and replenishing laxative method, leaving needles for 30 minutes, can also be combined with moxibustion therapy, simple to operate, easy to implement
。 (2) Chinese medicine commonly used for external use of five-fold seed, Cnidium monnieri and cloves after frying with hot air to smoke the head of the penis, soak the penis after the temperature is suitable, soak the drug once a day or use alcohol for 3~7 days, take the supernatant for storage, spray on the head of the penis, coronal groove, frenulum and other parts 30 minutes before sexual life, and spray evenly to make it naturally absorbed, and clean it with water before sexual life
.
20 days is 1 course of treatment
.
(3) Combination therapy with traditional Chinese and Western medicine can be considered on the basis of traditional Chinese medicine treatment, such as dapoxetine combined with imusak tablets, peony square, chai hu evacuation liver scattering and liver evacuation Yiyang capsules, etc.
, there is evidence that dapoxetine combined with traditional Chinese medicine has better therapeutic effect and good
safety tolerance.
The surgical treatment of premature ejaculation mainly refers to selective extomy of the dorsal nerve of the penis, and its treatment principle is to reduce sensory afferent and improve the patient's sensory threshold during ejaculation, so as to prolong IELT and improve the sexual life satisfaction
of patients and their partners.
The indications for this operation are patients with primary premature ejaculation, stable partner, regular sexual life for more than 6 months, stable psychological state, and the following conditions: (1) normal erectile function; (2) increased excitability/sensitivity of the head of the penis; (3) Sexual life seriously affects the feelings of husband and wife; (4) Those who
voluntarily give up conservative therapy and have a strong willingness to undergo surgical treatment.
References:
1.
Premature Ejaculation Diagnosis and Treatment Writing Group, Andrology Branch of Chinese Medical Association.
Guidelines for diagnosis and treatment of premature ejaculation[J].
Chinese Journal of Andrology,2022,28(7):656-665.
)
