Premature ejaculation: assessed properly, treated to the pattern.

早泄（PE) is reaching climax sooner than desired during sexual activity, on a persistent basis, causing distress to one or both partners. The AUA/SMSNA Guideline defines lifelong (primary) PE using two criteria: ejaculation within about 2 minutes of initiation of penetrative sex and the perceived inability to delay it.⁵

早泄是男性最常见的性健康问题。大约三分之一的男性在生命中某个阶段经历过早泄，约20-30%的人长期受此困扰。¹ 尽管这种情况很普遍，但只有一小部分人寻求治疗——部分原因是尴尬，部分原因是许多人没有意识到有效的治疗方法存在。

早泄（PE）分为四种类型： lifelong (primary) PE, present from first sexual experiences, acquired (secondary) PE, which develops after a period of normal control, 变异型 PE (irregular occurrence in otherwise normal-functioning men), and 主观型 PE (perceived PE in men with objectively normal ejaculation time). The type matters, because treatment approaches differ.

The distinction that changes management most is primary versus secondary. Primary (lifelong) PE has been present since a man became sexually active and is more biologically driven, so treatment is directed at ejaculatory control itself: behavioural techniques, topical anaesthetics and on-demand dapoxetine. Secondary (acquired) PE represents a change from previously normal control, and usually has an identifiable medical or psychological cause. In secondary PE the first step is to find and treat that cause.⁵

早泄（PE）是可以有效治疗的。大多数患者在接受循证治疗后会有显著改善，特别是当行为疗法与药物治疗相结合时。

早泄既有生理因素也有心理因素，大多数病例是两者共同作用的结果。了解主导因素有助于制定治疗方案。

血清素差异 are the strongest biological contributor to lifelong (primary) PE. Lower serotonin signalling in specific brain regions reduces the threshold for ejaculation. This is why 选择性血清素再摄取抑制剂（SSRIs） such as on-demand dapoxetine, which raise serotonin signalling, are used for PE.

阴茎敏感度 can contribute to lifelong (primary) PE, because heightened sensory feedback triggers ejaculation more readily. Topical anaesthetics directly address this mechanism.

焦虑与心理因素 are the strongest contributors to acquired (secondary) PE. Performance anxiety, relationship stress, depression, and life pressure all reduce ejaculatory control. The pattern is often "fast → anxious → faster" - a self-reinforcing cycle that responds well to combined behavioural and pharmacological treatment.

共存 erectile dysfunction is present in a meaningful proportion of patients with acquired (secondary) PE. Treating ED often improves the PE, and treating one without the other can worsen the other. Clinical evaluation always considers both.

激素因素 包括 testosterone deficiency and thyroid dysfunction can contribute. Hyperthyroidism in particular is associated with PE, so thyroid function is included in evaluation where indicated.⁶

前列腺炎症（prostatitis) is associated with acquired (secondary) PE in some patients. Where pelvic discomfort or urinary symptoms accompany PE, prostatic evaluation is part of the workup.

物质使用 包括某些娱乐性药物和过量饮酒，可能会影响射精控制。药物审查是每次咨询的一部分。

General health factors matter too, so comprehensive health screening is part of the men's sexual health workup, particularly for acquired (secondary) PE in patients over 40.

就诊前。 Your personal health concierge shares a brief intake form covering symptom history, type of PE (primary or secondary), sexual history including partner context, current medications, and any co-occurring concerns. The intake helps focus consultation time on assessment rather than data collection.

就诊期间。 The consultation lasts 30-45 minutes. Our medical team takes a focused history covering symptom pattern, onset, situational variability, partner perspective if helpful, and screening for co-occurring conditions (ED, anxiety, depression, prostatic symptoms). Physical examination is brief and usually limited to general assessment unless other concerns emerge.

Investigations are not usually needed for straightforward primary PE. Where secondary PE or co-occurring concerns are present, bloodwork may be added (testosterone, thyroid function, prolactin, glucose). Urinalysis if prostatic symptoms.

就诊后。 首次咨询时会讨论治疗方案，并通常立即开始初步治疗。后续随访安排在4周（评估反应）、12周（调整方案）以及根据需要进行长期随访。行为疗法将在随访中得到强化。

保密性。 Records are encrypted. Hisential does not share information with employers, family, or insurers without your explicit consent, except where required by regulations or law. Partner involvement is encouraged but always at your discretion.