Patient's question:
Always has beenDoctor's answer:
Okay, here is the translation of the provided text into English, following your instructions regarding line breaks and translation of Chinese content:I. What is Premature Ejaculation?
Premature Ejaculation (PE), a type of male sexual dysfunction. The causes of PE can mainly be divided into two major parts: psychological and physiological (habitual PE and pathological PE).
Premature Ejaculation is defined as a sexual intercourse disorder characterized by intercourse that is unsatisfying for one or both partners, where the male reaches orgasm and ejaculates earlier than desired (typically before the female reaches orgasm) and/or within a short duration of intercourse (often less than 2 minutes after vaginal penetration). It is estimated that approximately 30% of men experience this condition. Although seemingly minor, it can lead to low sexual quality and may potentially cause other sexual dysfunctions such as erectile dysfunction. The consequences can be serious, warranting attention and prompt treatment.
Generally, PE is understood as the phenomenon where a man, after achieving penile erection, either fails to enter the vagina or enters it shortly thereafter (or during the initial stages of penetration) and then prematurely ejaculates, followed by natural penile flaccidity and the refractory period. Clinically, ejaculation occurring before penile insertion into the vagina is diagnosed as premature ejaculation. Additionally, entering the vagina for intercourse but achieving rapid ejaculation after minimal stimulation is also defined as premature ejaculation.
II. Causes of Premature Ejaculation
There are primarily two types of PE:
1. Habitual Premature Ejaculation: This refers to men who have consistently experienced premature ejaculation since adulthood. These individuals typically have normal sexual physiological function and strong penile erections. Symptoms may include high libido, strong erections, and a strong urge to engage in intercourse (often wanting to ejaculate quickly, leading to ejaculation under the control of the nervous system). If this is due to long-term excessive sexual activity (e.g., frequent masturbation), it can lead to the second type.
(Desire to ejaculate quickly, so it occurs under nervous system control.)
2. Pathological Premature Ejaculation: This includes conditions like excessive prostatic hyperemia and hypertrophy (often resulting from excessive masturbation in young and middle-aged men), which can be termed "masturbation-induced PE." In older adults, it involves prostatic hyperplasia and hypertrophy, termed "age-related PE." In summary, both types are fundamentally linked to prostatic hypertrophy. Due to this hypertrophy, excessive prostatic fluid is secreted into the urethra, leading to induced ejaculation.
(The neurological mechanism of ejaculation is complex and not elaborated upon here.)
Therefore, individuals with premature ejaculation may experience a significant flow of prostatic fluid into their urethra, sometimes even expelling it externally. Some may mistakenly call this lubricating fluid and feel pleased, but this is a sign of ignorance. The lubricating fluid for intercourse should be provided by the female partner, not the male.
III. Treatment for Premature Ejaculation
Based on the causes of PE, the following treatment methods are proposed:
1. Treatment for Habitual Premature Ejaculation: During intercourse, it is important to control the rhythm, relax mentally, avoid urgency, and enjoy the process gradually.
2. Treatment for Pathological Premature Ejaculation: We know that the root cause of pathological PE is excessive prostatic fluid secretion. Since excessive prostatic fluid secretion is related to prostatic hypertrophy, treating PE requires restoring the prostate to a normal state.
Since the causes of masturbation-induced PE and age-related PE differ, the medication composition used in treatment will also differ. Treatment for masturbation-induced PE focuses on promoting blood circulation to remove stagnation, astringent and consolidating essence, supplemented by warming and tonifying kidney yang. Treatment for age-related PE focuses on tonifying kidney yang and consolidating yang and essence.
IV. Treatment Effects
Based on this theory, indeed very good effects have been achieved in practice.
I. What is Erectile Dysfunction (ED)?
Erectile Dysfunction (ED) refers to the inability to achieve or maintain penile erection sufficient for satisfactory sexual intercourse when there is a sexual desire. It can manifest as an inability to achieve an erection, an erection that is not firm enough, or an erection that is firm enough but cannot be maintained for a sufficient duration to complete intercourse, thereby hindering or preventing sexual activity.
II. Causes of Erectile Dysfunction
There are many causes of ED. Firstly, psychological factors play a role, such as emotional coldness between partners, high stress (depression-related ED); or due to reasons like grief, fear, or anger can also lead to ED (kidney yang injury ED). If sexual activity is excessively frequent (e.g., due to frequent masturbation), the erection center may remain in a state of constant excitement and tension, potentially leading to ED over time (excessive indulgence ED). Aging can also cause ED due to insufficient secretion of sex hormones (Ming Men fire decline ED, also known as yang decline ED). Other causes include obesity ED, damp-heat ED, and alcohol-induced ED. Of course, there is also organic ED, such as that caused by venous occlusion or varicocele leading to insufficient blood supply, or ED resulting from drug damage.
III. Manifestations of Erectile Dysfunction
In sexual medicine, ED can be classified into early, middle, and late stages:
1. Early ED: The penis can achieve spontaneous erection, but it is not firm or lasts for a short time.
2. Middle ED: The penis cannot achieve spontaneous erection, there is a lack of libido, sexual impulses are weak, and the penis becomes flaccid during intercourse.
3. Late ED: The penis becomes shrunken, there is no libido, and the penis cannot achieve any erection.
IV. Self-Assessment of ED Severity:
ED is characterized by the inability to achieve an erection, or an erection that is not firm enough to allow for intercourse, representing a dysfunction of penile erection. ED is classified into mild, moderate, and severe degrees. Patients can refer to the following situations for self-assessment of ED severity.
Mild: Sexual desire is basically normal; the penis can become erect relatively quickly upon exposure to sexual stimulation from a partner; masturbation can induce erection; during intercourse, the penis can become erect but not sustain it, or manual assistance is needed to enter the vagina; the erection is not firm; sexual frequency decreases; sexual pleasure is still acceptable.
Moderate: Sexual desire decreases; the penis responds slowly to stimulation of sensitive areas; the penis does not become erect immediately upon exposure to sexual stimulation from a partner; masturbation results in only a weak or reluctant erection; during intercourse, the penis frequently fails to become erect, or although it does, it cannot sustain it; the penis cannot enter the vagina during intercourse; the erection angle is less than 90°, and hardness is very poor; sexual frequency decreases significantly, and sexual pleasure is markedly reduced.
Severe: Sexual desire is absent; regardless of stimulation of sensitive areas, exposure to sexual stimulation from a partner, or masturbation, the penis shows no erection response; the penis cannot become erect during intercourse and cannot enter the vagina; the penis has no erection angle or hardness; sexual activity basically ceases, and there is no sexual pleasure.
It is clear that judging the severity of ED based solely on whether an erection can be achieved and whether it is firm after achieving it is insufficient. It should also include factors such as sexual desire, sexual response, and sexual pleasure, requiring a comprehensive consideration of these aspects for a more complete assessment.
V. Treatment for Erectile Dysfunction
Research has shown that ED is rarely caused by a single factor and is rather comprehensive (i.e., pure depression ED or pure excessive indulgence ED is rare). Statistical analysis indicates that over 96.5% of ED cases are comprehensive, with complex etiologies. The most common type of ED results from a combination of factors such as depression and excessive indulgence, accounting for 85.7% of total ED cases. Treatment for such comprehensive ED needs to address five aspects: Qi (strengthening and tonifying Qi), Blood (nourishing Blood), Yang (tonifying Yang), (promoting smooth flow), and (consolidating and astringing). Qi refers to strengthening and tonifying Qi; only with sufficient Qi can one have good (spirit) and avoid exhaustion during activity. Blood refers to nourishing Blood; Blood promotes penile erection.