Guidelines For The Diagnosis And Treatment Of Premature Ejaculation With Integrated Chinese And Western Medicine
Nov 04, 2024
5 Western medicine treatment of PE
The treatment of PE requires doctors to fully evaluate the patient's condition, including IELT, the time and frequency of PE symptoms, the patient's control over ejaculation and satisfaction with sexual life, and whether there are other physiological or psychological diseases. Doctors should choose appropriate treatment plans for different types of PE patients. Selective serotonin reuptake inhibitors (SSＲI) are recommended for primary PE. Such drugs can effectively prolong the patient's IELT, increase the ability to control ejaculation, and improve sexual satisfaction. Psychological/behavioral treatment is not recommended first for primary PE patients, but it is necessary to receive correct sexual health education, and patients who take drugs for a long time should be reviewed regularly. Secondary PE patients often have other diseases, such as erectile dysfunction, chronic prostatitis, depression, etc.
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Patients need to treat physiological or psychological diseases, and SSRIs and local anesthetics are also recommended. Psychological treatment is recommended first for patients with natural variant PE and PE-like ejaculatory dysfunction. Sexual health education and psychological counseling are provided to help patients and their sexual partners have a correct understanding of sexual life and eliminate tension and anxiety during sexual activities. If these measures are ineffective or ineffective, drugs that delay ejaculation can be used as an auxiliary.
5.1 Psychological/behavioral therapy
Psychological treatment is very important for some PE patients, especially those with PE induced by psychosocial factors. The purpose of psychological counseling is to help patients correctly understand sexual life, learn to control and delay ejaculation, enhance their confidence in sexual life, eliminate tension and anxiety about sexual life, and enhance communication and exchanges with their sexual partners.
The most commonly used behavioral treatments are the "stop-start technique" and the "squeeze technique" [25-26]. However, the effectiveness of psychological/behavioral therapy is still controversial.
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5. 2 Local anesthetic treatment
Using local anesthetics on the surface of the penis, such as lidocaine, prilocaine, and benzocaine, alone or in combination, can reduce the sensitivity of the penis and prolong IELT. However, local anesthetics may cause penile numbness in some patients and affect erection. When condoms are not used, it may also cause vaginal numbness in sexual partners and loss of interest in sex. If the patient or his sexual partner is allergic to the local anesthetic, it is absolutely prohibited.
5. 3 SSＲI
SSＲI is a commonly used antidepressant in clinical practice. It has been found that this type of drug has a certain therapeutic effect on PE. SSＲI drugs include two categories:
① On-demand treatment drug dapoxetine;
② Regular treatment drugs such as citalopram, paroxetine, sertraline, etc.
5. 3. 1 On-demand treatment
Dapoxetine is currently the only drug approved for the treatment of PE and is the most widely used in clinical practice. Dapoxetine has a rapid onset of action, a short half-life, and a fast clearance rate from the body, making it a first-line recommended drug for on-demand treatment of SSRIs [27-28]. Studies have shown that the IELT of the 30 mg group and the 60 mg group was 2.5 times and 3.0 times that before treatment, respectively. Both dapoxetine regimens were effective at the first dose. Common adverse events are: nausea, diarrhea, headache, and dizziness [29].
5.3.2 Regular treatment
SSRI daily treatment takes effect after about 5 to 10 days, reaches the best effect after 2 to 3 weeks, and requires long-term maintenance. Common adverse reactions include weakness, fatigue, nausea, diarrhea, etc. For patients who take medication for a long time, doctors should warn them to avoid sudden discontinuation of medication because SSRI withdrawal reactions may occur.
5.4 Phosphodiesterase 5 inhibitor (PDE5i)
The efficacy of PDE5i alone in treating PE is controversial, but there is evidence that the combined use of sildenafil and sertraline in treating PE is more effective than sertraline alone [30]. For PE patients with erectile dysfunction, PDE5i can be used in combination; for PE patients without erectile dysfunction, PDE5i is not recommended as the first choice of treatment. 6 Traditional Chinese medicine and ethnic medicine treatment of PE Traditional Chinese medicine treatment should distinguish between deficiency and excess. In the early stage, it is mostly excess syndrome, and purgation is mostly used, with clearing and purging as the main method. PE has been around for a long time, and the body is weak due to long-term illness. It is mostly deficiency syndrome, and tonic method is mostly used, with kidney tonic as the main method. There are also cases of mixed deficiency and excess, and it is advisable to attack and tonify at the same time.
6.1 Internal treatment method
6.1.1 Damp-heat syndrome
Treatment principle: Clear damp-heat. Prescription: Longdan Xiegan Decoction (from Yifang Jijie). Drugs: Gentiana scabra, Bupleurum, Scutellaria baicalensis, stir-fried Gardenia jasminoides, Alisma orientalis, Caulis Akebiae, Plantago asiatica, Angelica sinensis, Radix Rehmanniae, roasted
Glycyrrhiza uralensis, etc. Chinese patent medicine: Longdan Xiegan Pills, Bazheng Granules.
Thinking of combining Chinese and Western medicine: For patients with urogenital system infections such as prostatitis and urethritis, appropriate antibacterial drugs can be selected for combined treatment according to drug sensitivity tests. Pay attention to avoiding living and eating habits that aggravate dampness and heat.
6.1.2 Yin deficiency and hyperactivity of fire syndrome
Therapeutic principle: nourishing yin and reducing fire. Prescription: Zhibai Dihuang Decoction (from Yizong Jinjian). Drugs: Anemarrhena, Phellodendron chinense, Radix Rehmanniae Preparata, Fructus Corni, Dioscorea batatas, Peony bark, Poria cocos, Alisma orientalis, etc. Chinese patent medicine: Zhibai Dihuang Pills, Erzhi Pills, Dabuyin Pills.
Thinking of combining Chinese and Western medicine: Patients with hyperthyroidism and diabetes often show symptoms of Yin deficiency and hyperactivity of fire, and the primary disease should be actively treated.
6.1.3 Syndrome of Kidney Qi Insufficiency
Treatment principle: Strengthen the kidney and consolidate the essence. Prescription: Jinkui Shenqi Pill (prescription of "Jinkui Yaolue") with added ingredients. Drugs: Dry Rehmannia, Cornus officinalis, Chinese Yam, Poria, Alisma, Cortex Moutan, Cinnamon, Aconite, Morinda officinalis, Epimedium, Cistanche deserticola, Cherry Laevigata, etc. Chinese patent medicine: Jinsuo Gujing Pill, Guilingji.
Thinking of combining Chinese and Western medicine: Patients with obvious low libido and no abnormal reproductive hormones should be treated with Chinese medicine as the main treatment; patients with low androgen levels can be given testosterone supplementation.
6.1 Internal treatment
6.1.1 Syndrome of damp-heat
Treatment principle: Clear damp-heat. Prescription: Longdan Xiegan Decoction (from Yifang Jijie). Drugs: Gentiana scabra, Bupleurum, Scutellaria baicalensis, stir-fried Gardenia jasminoides, Alisma orientalis, Caulis ternata, Plantago asiatica, Angelica sinensis, Radix Rehmanniae, roasted
Glycyrrhiza uralensis, etc. Chinese patent medicine: Longdan Xiegan Pills, Bazheng Granules.
Thinking of combining Chinese and Western medicine: For patients with urogenital system infections such as prostatitis and urethritis, appropriate antibacterial drugs can be selected for combined treatment according to drug sensitivity tests. Pay attention to avoid living and eating habits that aggravate damp-heat.
6.1.2 Syndrome of Yin deficiency and hyperactivity of fire
Treatment principle: Nourish yin and reduce fire. Prescription: Zhibai Dihuang Decoction (from Yizong Jinjian). Drugs: Anemarrhena asphodeloides, Phellodendron chinense, Radix Rehmanniae glutinosae, Fructus Corni, Dioscorea batatas, Peony bark, Poria cocos, Alisma orientalis, etc. Chinese patent medicine: Zhibai Dihuang Wan, Erzhi Wan, Dabuyin Wan.
Thinking of combining Chinese and Western medicine: Patients with hyperthyroidism and diabetes often show symptoms of Yin deficiency and hyperactivity of fire, and the primary disease should be actively treated.
6. 1. 3 Syndrome of insufficient kidney qi
Treatment principle: tonify the kidney and consolidate essence. Prescription: Jinkui Shenqi Wan (prescription of "Jinkui Yaolue") with added flavor. Drugs: dried Rehmannia root, Cornus officinalis, Chinese yam, Poria, Alisma orientalis, Cortex Moutan, Cinnamon bark, Aconite, Morinda officinalis, Epimedium, Cistanche deserticola, Cherry laevigata, etc. Chinese patent medicine: Jinsuo Gujing Wan, Guilingji.
Thinking of combining Chinese and Western medicine: Patients with obvious low libido and no abnormal reproductive hormones should be treated with Chinese medicine as the main treatment; patients with low androgen levels can be given testosterone supplementation.
6. 1. 4 Syndrome of deficiency of both heart and spleen
Treatment principle: tonify the heart and spleen. Prescription: Miaoxiang Powder (Taiping Huimin Hejijufang). Drugs: Codonopsis, stir-fried Atractylodes macrocephala, roasted Licorice root, roasted Astragalus, Poria, processed Polygala tenuifolia, stir-fried Ziziphus jujuba seeds, longan pulp, Angelica sinensis, costusroot, jujube. Chinese patent medicine: Buzhong Yiqi Pills, Guipi Pills.
Thinking of combining Chinese and Western medicine: This type of syndrome usually manifests as physical weakness, and is mainly treated with Chinese medicine; those with obvious mental tension and sleep disorders can be treated with sedative hypnotic drugs as appropriate.
6.1.5 Liver depression and fire syndrome
Treatment principle: Soothe the liver and purge fire. Prescription: Danzhi Xiaoyao Powder (Yibu Quanlu). Drugs: Peony bark, Gardenia, Bupleurum, stir-fried Angelica sinensis, stir-fried Peony root with wine, Poria, stir-fried Atractylodes macrocephala, roasted Licorice root, etc. Chinese patent medicine: Jiawei Xiaoyao Pills, Longhui Pills.
The idea of combining Chinese and Western medicine: Patients with obvious anxiety and depression symptoms can be treated with anti-anxiety and anti-depressant drugs.
6. 1. 6 Spleen and kidney deficiency syndrome
Treatment principle: tonify the kidney and strengthen the spleen. Prescription: Jiawei Shuilu Erxiandan (prescription from "Men's Compendium"). Drugs: Golden Cherry, Euryale, Chinese Yam, Codonopsis, Stir-fried Atractylodes, Poria, Alisma, Stewed Aucklandia, Xuanmugua,
Glycyrrhiza, etc. Chinese patent medicine: Qilin Pills, Fuzi Lizhong Pills.
The idea of combining Chinese and Western medicine: Patients with obvious anxiety and depression symptoms can be treated with anti-anxiety and anti-depressant drugs; if there is obvious low libido and low androgen levels, testosterone supplementation can be given.
6. 2 External treatment
6. 2. 1 Fumigation and washing
Chinese medicines such as Cnidium monnieri, Kochia scoparia, Clove, and Asarum are commonly used for local fumigation and washing.
6. 2. 2 Acupuncture treatment
The acupoints are divided into 2 groups: the first group is Qihai, Guanyuan, Zhongji, Sanyinjiao. The second group is Shenshu, Qihaishu, Guanyuanshu, Huiyangshu. Add or subtract: add Dahe and Taixi for kidney yin deficiency; add Mingmen and Yangchi for kidney yang deficiency; add Ligou and Zhibian for severe dampness and heat; add Taichong and Ganshu for liver qi disharmony; add Baihui and Neiguan for insomnia and dreaminess; add Huiyinshu for perineum distension and discomfort. The two groups of acupoints are used alternately, once a day or every other day. Generally, the method of equal supplementation and equal drainage is used, and the needle is retained for 20 to 30 minutes each time, and 15 times is a course of treatment.
For those with obvious deficiency, the method of supplementation is used, and for those with qi stagnation and blood stasis or severe dampness and heat, the method of drainage is used. It can also be combined with moxibustion therapy.
6. 2. 3 Massage and traction treatment
In recent years, studies have shown [31-33] that PE in some patients is correlated with central disc herniation. Therefore, for patients diagnosed with disc herniation by imaging, massage or lumbar traction can be selected, once every other day, 30 minutes each time, and 15 times as a course of treatment.
6. 3 Ethnic medicine treatment
Some ethnic medicines have a certain effect on PE, such as Imusak tablets [34].
7 Surgical treatment of PE
Surgical treatment of PE mainly refers to selective dorsal penile nerve resection, which is a supplementary treatment for patients who are ineffective with psychological/behavioral therapy and drug therapy. Selective dorsal penile nerve resection is one of the most commonly used surgical methods for treating PE in China. Its treatment principle is to reduce sensory input during ejaculation, increase the patient's sensory threshold, and thus achieve the purpose of prolonging IELT and improving the sexual satisfaction of patients and their partners [35].
Since the principle of surgical treatment of PE is relatively clear, the only surgical indication for selective dorsal penile nerve resection is primary PE patients. Patients who meet the diagnostic criteria for primary PE and meet the following conditions:
① Since the beginning of sexual life, IELT ≤ 2 min, and the course of the disease exceeds 6 months;
② Good mental state and poor ability to control ejaculation;
③ Negative psychological and psychological effects such as anxiety, worry, depression and avoidance of sexual life caused by this;
④ Normal erectile function and high sensitivity of the glans penis;
⑤ Strong willingness for surgical treatment;
⑥ Voluntary abandonment of conservative treatment [36].
In general, selective penile dorsal nerve resection is currently a surgical method that is widely used to treat PE, but there is a lack of large-sample research, and further clinical research is needed to verify its efficacy. Questions such as how many nerve branches should be cut during surgery also need further discussion.
The intervention of microsurgical technology is expected to make the operation more refined and reduce the occurrence of complications. However, PE is not a life-threatening disease, so the harm and benefits of surgical treatment should be evaluated more carefully.
8 Treatment of PE with associated diseases
The treatment of PE with chronic prostatitis and erectile dysfunction can refer to the diagnosis and treatment guidelines of chronic prostatitis and erectile dysfunction combined with traditional Chinese and Western medicine. If accompanied by psychological disorders or other diseases, relevant specialists should be sought for joint treatment.
9 Health education for PE
Correctly understand PE, and do not attribute premature ejaculation in newly married, unmarried, or long-term sexual abstinence to PE; scientifically deal with PE and premature ejaculation under fatigue conditions, and pay attention to the combination of work and rest, which is conducive to improving ejaculation control; learning sexual knowledge, mastering sexual skills, and combining movement and rest can help delay the latent time of ejaculation; attach importance to the value of sexual partners in diagnosis and treatment, and the preparation of sexual partners, vaginal and systemic reactions are also important factors affecting the speed of male ejaculation. Research data show that PE has a higher incidence in patients with diabetes [37] and depression [38]. Actively treating the underlying disease, controlling blood sugar, and regulating emotions are of great significance for the prevention and treatment of PE.
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