男性怎样治疗严重早泄

男性如何治疗严重早泄配图，仅供参考

Treatment
Treatment approaches to PE,other than selective serotonin re‐uptake inhibitors (SSRIs),can be broadly categorized into behavioral therapy,oral agents and topical agents ). We have introduced the most widely used treatment options below.
# Behavioral therapy
Behavioral psychosexual therapies predate the use of pharmacologic agents by decades ).
One early approach was referred to as the stop‐start technique ). It involves partner stimulation of the mans penis until the sensation of near climaxing at which time stimulation is abruptly stopped until the sensation of imminent orgasm disappears. This exercise is repeated until the patient learns to voluntarily control his ejaculations.
Masters and Johnson reported a similar maneuver in which the partner squeezes the penis and stops penile stimulation ). After a short interval,the female partner restarts the stimulation. This is referred to as the squeeze technique.
The common feature of both approaches is distraction and the reduction of sexual excitement. It is intended to help men recognize the early signs for ejaculation/orgasm and work with their partner in improving self‐control.
# Oral agents
Clomipramine: a tricyclic antidepressant that inhibits the uptake of norepinephrine and serotonin. Findings of several randomized controlled trials (RCTs) summarized in systematic reviews and meta‐analyses indicate that the daily use of clomipramine increases IELT ).
Tramadol: a synthetic opiate analgesic that is primarily used for pain control. Its mechanism of action in PE is not fully understood. Several RCTs and reviews suggest that it results in an increase in IELT ).
Phosphodiesterase‐5 inhibitors: the primary role of this therapy is in treating ED. However,ED is also common among men with PE and there appears to be a benefit with sildenafil or tadalafil treatment )
Alfa‐adrenoreceptor antagonists: this drug class is primarily used to treat lower urinary tract symptoms associated with benign prostatic hyperplasia,but there are studies that have shown that it can improve PE ).
# Topical agents
Topical agents decrease the sensitivity of the penis to sexual stimulation. Perceived advantages of these agents are the absence of systemic adverse effects.
Lidocaine‐prilocaine (marketed as EMLA) is a local anesthetic cream for topical use that can anesthetize intact skin. Several trials indicate an increase in IELT ). Adverse effects include some loss of penile sensitivity,ED and female genital anesthesia.
SSRIs are oral drugs primarily used to treat depression. Their effect on delaying ejaculation was first identified as an adverse effect in this setting ). Depending on the type of agent and its half‐life,these drugs are used either daily or on‐demand.
The most common short‐term adverse effects are reported to be drowsiness,weight gain,dry mouth,insomnia,fatigue and nausea ).
Sexual adverse effects such as reduced libido and new‐onset or worsening ED have been reported ).
Stopping long‐term treatment of SSRIs may lead to SSRI discontinuation syndrome, beginning one to three days after drug cessation and possibly continuing for more than one week. Symptoms include nausea,vomiting,dizziness,headache,ataxia,drowsiness,anxiety and insomnia. Therefore,it is recommended that SSRIs be gradually withdrawn over several weeks ).
Multiple drug interactions exist and can potentially lead to serotonin syndrome, a group of serious,persistent symptoms including myoclonus,hyper‐reflexia,sweating,shivering,and motor co‐ordination and mental status changes ).
Studies of depressed people treated with SSRIs have indicated a small increase in the risk of suicide ideation or suicide attempts,especially in younger age groups,but the evidence remains weak ). Nonetheless,caution is urged in younger people with PE and concomitant depression or suicidal ideation,or both. Based on current guidelines,patients should also be advised to avoid sudden cessation or rapid dose reduction of daily dose SSRIs.
The role of 5‐hydroxytryptamine (5‐HT) (also known as serotonin) in the process of ejaculation appears to be inhibitory. SSRIs work by the blockage of serotonin transporters at the level of the synapse resulting in increased concentrations (; ; [Waldinger 2005a](https://ncbi.nlm.nih.gov/pmc/articles/PMC8094926/#CD012799-bbs2-0186) ). Based on a study of monkeys,administration of sertraline 20 mg/kg (an SSRI) resulted in the serotonin concentration in cerebrospinal fluid increasing by nearly 300% within hours of administration ). Due to increased serotonin levels in the synapse,5‐HT1A and 5‐HT1B receptors on the postsynaptic and presynaptic membranes become activated,causing a reduction in secretion of serotonin into the synapse (). These receptors ultimately become desensitized,resulting in the serotonin release into the synapse,but this time because of transport inhibition by the SSRI,the synaptic serotonin levels remain high,causing persistent activation of postsynaptic receptors,which is thought to mediate the clinical effects of SSRI including the prolongation of IELT ).
SSRIs are among the most widely used drugs for PE ),but others have also argued that PE is not a disease at all ),or have raised the notion that the fairly recent availability of pharmacologic treatment of PE,including SSRIs,has reinforced stereotypes of normal sexual conduct and thereby reinforced social norms that cause men distress ). While most use of these agents is off‐label,dapoxetine,a short‐acting SSRI,is also approved for the treatment of PE in many countries outside the USA. Therefore,it is important for clinicians to fully understand both the benefits and potential harms associated with these agents as [Feys 2014](https://ncbi.nlm.nih.gov/pmc/articles/PMC8094926/#CD012799-bbs2-0130) raised the concern that dapoxetine may be a costly and dangerous placebo. Although multiple systematic reviews have been conducted on the treatment of PE,including the use of SSRIs ),these have not been performed in a methodologically rigorous manner. This review distinguishes itself by virtue of a published,a priori protocol governing all aspects of this study (New Reference),a comprehensive search of the literature not limited by publication status or language and its focus on patient‐important outcomes with rating of the certainty of evidence using the GRADE approach on a per‐outcome basis. Cochrane Reviews such as ours are also governed by a strict conflict of interest policy. Therefore,we expect this review to provide important,evidence‐based information for patients,clinicians,guideline developers and health policy makers.","department":"