Etiology, diagnosis and assessment tools for premature ejaculation

Primary premature ejaculation is more often caused by neurophysiological reasons. Its clinical characteristics are: ① It has been present since the first sexual intercourse; ② It occurs in almost every sexual intercourse; ③ It occurs in almost any sexual partner; ④ In the vast majority (90%) cases, the intravaginal ejaculation latency period is less than 1 minute, and in a small number of cases it is 1 to 2 minutes; ⑤ Poor ability to control ejaculation, with low or no ability to inhibit ejaculation when it is about to occur.

Secondary premature ejaculation is characterized by: ① premature ejaculation occurring at some stage in life, with normal ejaculation latency in the vagina in most previous cases; ② premature ejaculation appearing suddenly or gradually; ③ poor ability to control ejaculation, with low or absent ability to suppress ejaculation when it is about to occur; ④ the occurrence of ejaculatory disorders may be related to diseases such as erectile dysfunction, chronic prostatitis, and hypothyroidism, as well as psychological or interpersonal relationship problems.

Natural variant premature ejaculation is characterized by premature ejaculation occurring only occasionally or under certain conditions, and is a variation in the normal ejaculation process. Its clinical features include: ① irregular occurrence of premature ejaculation; ② poor ability to control ejaculation, with a low or absent ability to suppress ejaculation just before it occurs; ③ this reduced ability to control ejaculation may be accompanied by a short or normal vaginal ejaculation latency period.

Premature ejaculation-like ejaculatory dysfunction refers to a man's perception that he ejaculates too quickly, when in fact the vaginal ejaculation latency is within the normal or even higher range. Its clinical characteristics are: ① subjective feeling of premature ejaculation and lack of ejaculation control during intercourse; ② actual vaginal ejaculation latency within the normal range; ③ the perception of his ejaculatory control ability is not caused by other diseases, but psychological and/or interpersonal problems may be the underlying causes.

The purpose of accurate classification of premature ejaculation is to refine the diagnosis and treatment of patients. Because everyone's expectations of sexual life are different, their understanding and perception of premature ejaculation vary. Strictly speaking, premature ejaculation is merely a subjective complaint; sometimes it represents sexual dysfunction, and sometimes it falls within the normal range. Therefore, correct classification of premature ejaculation can deepen the understanding of the disease and help to further clarify its causes and provide appropriate treatment.

What factors can cause premature ejaculation?

Although there is extensive research and discussion on the physiological, psychological, behavioral, and even socio-cultural levels, the true cause of primary premature ejaculation remains a mystery. One view holds that primary premature ejaculation is purely a psychological issue: because early sexual experiences in men (including masturbation) are often conducted under the tension of fear of being discovered, striving for rapid ejaculation, this over time forms a pattern of premature ejaculation, which is difficult to change in later sexual activity. However, some scholars disagree with this view, finding that some patients with premature ejaculation differ from normal individuals in nerve conduction and sex hormone levels, suggesting that they may have physiological issues such as easy excitation and hypersensitivity of the external genitalia.

In general, the causes of premature ejaculation are complex and vary from person to person. Most are due to psychological factors, influenced by pathological excitation of the brain or increased excitation of the spinal cord center; a minority are caused by organic diseases.

(1) Psychological factors: 1) Anxiety and depression: Fear of being discovered and ridiculed during hasty intercourse or masturbation before marriage, resulting in tension and a desire for rapid ejaculation, gradually developing a habit of premature ejaculation. Infrequent intercourse can lead to excessive sexual excitement and premature ejaculation. Disharmony in interpersonal, family, and marital relationships can cause anxiety, tension, and fear. Lack of self-esteem and setbacks can lead to feelings of guilt, shame, and inferiority. Lack of sexual knowledge, intercourse skills, and experience. Premature ejaculation can lead to dissatisfaction between sexual partners, which can exacerbate anxiety, and anxiety, in turn, can worsen premature ejaculation, creating a vicious cycle. 2) Excessive fatigue: Engaging in sexual activity when feeling fatigued after physical or mental labor can also easily lead to premature ejaculation.

(2) Organic factors: 1) Differences in physical condition: Studies have found that the penile cavernous muscle reflex is faster in men with premature ejaculation than in men without premature ejaculation. Some believe this may be due to high levels of testosterone in the blood, which increases the excitability of the ejaculation center, lowers the threshold, and makes the ejaculation center more easily excited, leading to premature ejaculation. 2) Diseases that cause damage to the nervous system: such as pelvic fractures, chronic prostatitis, arteriosclerosis, and diabetes, can directly affect the ejaculation center, reducing its control ability and causing premature ejaculation. 3) Diseases of the reproductive organs themselves: such as a short frenulum or a tight foreskin opening, can hinder full penile erection and may also cause pain during intercourse, leading to premature ejaculation. Chronic urinary tract infections cause long-term chronic congestion and edema of the perineal muscles related to the ejaculation reflex, making them easily irritated and prone to sexual arousal and rapid ejaculation with slight sexual stimulation.

(3) Other factors: The duration of intercourse is related to the man's age, physical strength, sexual experience, and the environment of intercourse. For example, during the first intercourse after marriage, the first intercourse after a long separation, or the first intercourse after a long period of abstinence, the male's excessive excitement may shorten the ejaculation latency period, and he may even ejaculate immediately upon touching the penis, which is a normal phenomenon. In addition, the speed of ejaculation is related to the sexual position, the amplitude and speed of penile thrusting, and the female's response.

How is premature ejaculation diagnosed?

Generally, as long as you have the above-mentioned objective indicators or subjective feelings, premature ejaculation can be diagnosed, and most diagnoses are relatively easy. However, the most important thing in diagnosing premature ejaculation is to classify it, because the treatment and prognosis of different types of premature ejaculation are completely different. Therefore, patients who suspect they have premature ejaculation should go to the hospital to see a specialist for diagnosis and treatment.

The diagnosis of premature ejaculation is primarily based on medical history. A detailed and complete medical history is fundamental to the diagnosis and treatment of premature ejaculation; in fact, the diagnosis of premature ejaculation relies on a comprehensive medical history. This history is obtained by the doctor from you and your sexual partner, including the frequency of premature ejaculation, the duration of the condition, the intensity of sexual stimulation during premature ejaculation, specific environments that predispose to premature ejaculation, details of your usual sexual life, and the psychological impact of premature ejaculation on both partners.

Because the diagnosis of premature ejaculation is highly subjective, various scales are used both domestically and internationally to assess the sexual function of patients with premature ejaculation and provide more objective quantitative indicators. Internationally, the Premature Ejaculation Diagnostic Tool (PEDT) is widely used, while domestically, the Chinese Premature Ejaculation Patient Sexual Function Evaluation Scale (CIPE) is frequently employed. The usage of these two scales is the same as the International Erectile Function Index Questionnaire-5.

It should be noted that while the above questionnaires are valuable for diagnosing premature ejaculation, these scales are primarily based on the patient's subjective feelings, and therefore their accuracy cannot be fully guaranteed. Furthermore, detailed and thorough doctor-patient communication is crucial for patients with premature ejaculation; for some, the communication itself is a form of treatment.

Can premature ejaculation be determined by the duration of masturbation?

In andrology clinics, it's common to see young men seeking treatment for "premature ejaculation." However, upon questioning, it turns out they haven't had sexual intercourse at all; they simply believe their rapid ejaculation is premature ejaculation because they experience short durations during masturbation. In reality, masturbation time is an inaccurate indicator of ejaculation speed. This is because ejaculation time is influenced by numerous physiological, psychological, and environmental factors. Real sexual intercourse differs significantly from masturbation; the latter cannot replace the former, nor does it fully reflect a man's true sexual ability.

First, masturbation and sexual intercourse have drastically different psychological effects on men. Sexual intercourse is a way for men and women to enjoy each other's sexual experiences, while masturbation is a method used by an individual to achieve sexual satisfaction. During normal sexual intercourse, both men and women are usually more relaxed, with foreplay, so men naturally spend more time before ejaculating. However, during masturbation, men only want to enjoy the pleasure of ejaculation, skipping many steps. In addition, many people masturbate secretly and are eager to finish, which over time can lead to a habit of premature ejaculation.

Secondly, sexual intercourse involves friction and stimulation between the penis and vagina, which is relatively gentle and lubricated. Masturbation provides a higher intensity of stimulation to the penis, resulting in a more intense sexual sensation and naturally leading to faster ejaculation than during normal sexual intercourse. A study conducted abroad on a group of sexually functional men found that their average ejaculation time during normal sexual intercourse was 8.25 minutes; however, under the same conditions, their average ejaculation time during masturbation was only 4.89 minutes.

In short, masturbation and actual sexual intercourse are very different, and there are many different ways to masturbate, so it is difficult to make a correct judgment on whether premature ejaculation has occurred based on the duration of masturbation.