Premature Ejaculation: Causes and Treatment Options - Urology

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Premature ejaculation (PE) is a common condition affecting many men, and it can be particularly distressing for those experiencing it. Based on your description, it seems you are facing a combination of symptoms that may suggest a form of PE, potentially exacerbated by psychological factors or hormonal imbalances.

Understanding Premature Ejaculation
PE is typically defined as ejaculation that occurs with minimal sexual stimulation before, during, or shortly after penetration, and it can lead to significant distress or interpersonal difficulties. The causes of PE can be multifactorial, including:
1. Psychological Factors: Anxiety, stress, or past traumatic sexual experiences can contribute to premature ejaculation. Performance anxiety, in particular, can create a cycle of fear and anxiety that exacerbates the condition.

2. Physiological Factors: Hormonal imbalances, particularly low testosterone levels, can affect sexual function. Additionally, neurological conditions or issues with the pelvic floor muscles may also play a role.

3. Medical Conditions: Certain medical conditions, such as prostatitis or thyroid issues, can impact ejaculation.
4. Substance Use: Alcohol and certain medications can affect sexual performance and ejaculation.


Treatment Options
Given your experience with hormonal assessments and medications, it’s important to explore various treatment avenues. Here are some common approaches:
1. Behavioral Techniques: Techniques such as the "stop-start" method or the "squeeze" technique can help you gain better control over ejaculation. These methods involve practicing control during sexual activity to help delay ejaculation.

2. Medications:
- Selective Serotonin Reuptake Inhibitors (SSRIs): Medications like paroxetine or sertraline are often prescribed off-label for PE because they can delay ejaculation.

- Topical Anesthetics: Creams or sprays containing lidocaine or prilocaine can reduce sensitivity and help delay ejaculation.

- Hormonal Therapy: If low testosterone is confirmed, testosterone replacement therapy may be considered.

3. Counseling or Therapy: Speaking with a psychologist or sex therapist can help address any underlying psychological issues contributing to PE. Cognitive-behavioral therapy (CBT) can be particularly effective.

4. Lifestyle Changes: Regular exercise, a balanced diet, and stress management techniques can improve overall sexual health and function.


Next Steps
It’s crucial to consult with a healthcare professional who specializes in sexual health or urology. In Taipei, you might consider visiting a urologist or a sexual health clinic. Here are a couple of recommendations:
- Taipei Medical University Hospital: They have a urology department with specialists experienced in sexual health issues.

- National Taiwan University Hospital: Known for its comprehensive care, they also have specialists in urology and sexual medicine.


Conclusion
Your symptoms are concerning, and it’s understandable that you feel distressed. It’s essential to continue seeking help from qualified healthcare providers who can offer a thorough evaluation and tailored treatment plan. Remember, PE is a common issue, and with the right approach, it can be effectively managed. Don’t hesitate to reach out to specialists who can provide the support and treatment you need.