Table 7 Summary: Diagnosis and Treatment of Patients with Premature Ejaculation

Premature ejaculation (PE) is one of the most common male sexual dysfunctions.
Due to the complex pathogenesis of PE, the relative lack of treatment methods, and the uncertainty of efficacy, it is difficult for urologists or sexual medicine physicians
.

Therefore, the Chinese Society of Sexuality took the lead in formulating the "Guidelines for Outpatient Procedures for Premature Ejaculation Patients in China", which aims to standardize the outpatient diagnosis and treatment procedures for PE, and better improve the effect of PE diagnosis and treatment through standardized and standardized diagnosis and treatment paths
.

At present, the elements that constitute the definition of PE include: intravaginal ejaculation latency time (IELT), ejaculation control ability, personal distress, sexual partner distress, and interpersonal barriers
.

1.
Diagnosis of PE Figure 1 The flow of PE inquiries 2.
Diagnosis of PE Diagnosis of PE is mainly based on medical history, diagnostic scale, physical examination and laboratory examination
.

 Figure 2 PE diagnostic process 3.
Evaluation of PE efficacy The evaluation of PE efficacy is based on the classification of primary PE and secondary PE
.

①Primary PE: IELT is the main criterion for efficacy evaluation.
After treatment, the IELT is more than 2.
5 times longer than the baseline average, which is considered to be effective, and 2.
0 to 2.
5 times is likely to be effective
.

②Secondary PE: The improvement of IELT and the change of any PE assessment scale score should be comprehensively assessed.
If the IELT is prolonged compared with the baseline average after treatment, and the PE assessment scale score changes positively, it can be comprehensively judged that the treatment is effective.

.

In general, the efficacy evaluation should take into account the changes in IELT and the subjective feelings of patients and sexual partners, but the subjective feelings should be analyzed in detail
.

Fourth, the treatment of PE Drug treatment PE is a disease mediated by various factors such as central, hormone, drug-induced and/or mental and psychological factors, so the principle of treatment is individualized comprehensive treatment
.

Drugs are the basis of PE treatment, and are the Class A recommendation evidence in the current domestic and foreign guidelines for the diagnosis and treatment of PE
.

①Dapoxetine hydrochloride is the first-choice basic drug for the comprehensive treatment of PE, and it is also the only prescription drug approved by the State Drug Administration for the treatment of PE
.

② Long-acting selective serotonin reuptake inhibitors (SSRIs), such as sertraline, paroxetine, fluoxetine, duloxetine, citalopram, fluvoxamine, etc.
, the drug inserts have no indication of treating PE , belongs to the off-indication drug and is not recommended for use
.

③ Local anesthetics, including lidocaine/prilocaine creams and sprays, may reduce the sensitivity of the glans penis and prolong the IELT, thereby improving PE symptoms, but the possible impact on erectile function needs to be explained
.

④Phosphodiesterase-5 inhibitor (PDE5i) is the first-line drug for the treatment of ED.
Sildenafil, vardenafil, and tadalafil can be used alone to treat PE caused by ED, such as combined with dapoxetine hydrochloride.
The curative effect is better; for ED caused by PE, or if the causal relationship cannot be determined, it is recommended to combine therapy with dapoxetine hydrochloride
.

⑤ Tramadol is a potent centrally acting analgesic.
A small number of studies have shown that tramadol can prolong IELT in PE patients
.

⑥ Other drugs, including traditional Chinese medicine, can be selected on the basis of syndrome differentiation
.

Psychological counseling and sexual health education Psychological counseling should run through the diagnosis and treatment of PE, through psychological counseling or effective communication with patients and sexual partners to understand the potential causes of PE, so as to formulate a comprehensive treatment plan combining psychology, skill counseling and drugs
.

For PE patients with anxiety and depression (endogenous depression), it is recommended to first refer to a psychiatric department for treatment; the current psychological treatment for PE is mainly aimed at patients with PE complicated by reactive depression and anxiety.
Corresponding sexual health education should also pay attention to the same diagnosis and treatment of both men and women, and tracking and treatment feedback
.

Sexual health education for PE is shown in Figure 3
.

Figure 3 Non-drug treatments such as sexual health education, behavioral therapy, and physical therapy for PE.
On the basis of drug therapy, the combination of non-drug therapy (behavior/psychotherapy, physical therapy, etc.
) embodies the principles of comprehensive PE treatment and is necessary; Behavioral therapy includes stop-start and squeeze techniques, pelvic floor rehabilitation training (Kegel exercise), ancient Chinese acupuncture, penis root training behavioral therapy, etc.
Biofeedback, acupuncture, etc.
can also be used physical therapy
.

Comorbidity treatment of PE is often accompanied by some clinical diseases, such as chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), erectile dysfunction (ED) and infertility, etc.
These patients generally require simultaneous diagnosis and treatment of PE and associated comorbidities.
In order to obtain the best curative effect, it is recommended to choose an individualized treatment plan according to the specific situation of the patient
.

The diagnosis and treatment process of PE combined with CP/CPPS, ED, infertility, anxiety/depression is shown in Figure 4-7
.

Fig.
4 Flow chart of diagnosis and treatment of PE combined with CP/CPPS .
1672-1993.
2021.
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