Adult Version: Criteria for Premature Ejaculation, Differentiation between Erectile Dysfunction and Lower Back Pain/Kidney Deficiency

**49. How long should one hold back before it's considered premature ejaculation?**

Premature ejaculation (PE) is the most common ejaculatory dysfunction, affecting more than one-third of adult men and severely impacting the quality of their sex lives. The definition of PE is still debated, as male ejaculation latency is influenced by factors such as age, duration of abstinence, physical condition, and emotional state. Similarly, the frequency of female orgasm is affected by physical condition, emotional changes, and the surrounding environment. Furthermore, the length of the ejaculation latency varies from person to person. Currently, it is generally accepted that ejaculation within 2-6 minutes of penile penetration is normal for healthy men, while ejaculation within 2 minutes is considered premature ejaculation.

The causes of premature ejaculation include psychological and organic factors. Psychological factors are numerous, such as fear of sexual failure and anxiety leading to premature ejaculation; habitual masturbation in youth with the aim of quickly reaching orgasm; lack of sexual knowledge, focusing solely on male satisfaction; poor coordination between partners; emotional discord, aversion to the partner, and intentional or unintentional sadistic tendencies; fear that sexual activity will harm health or exacerbate pre-existing conditions; infrequent sexual intercourse or prolonged sexual repression; and female partners' aversion to intercourse, anxiety, and pressure to end intercourse quickly. All of these can lead to premature ejaculation and even trigger a chain reaction, affecting erectile function. Organic factors causing premature ejaculation include spinal cord diseases such as multiple sclerosis or spinal cord tumors, epileptic seizures, or organic lesions of the cerebral cortex such as cerebrovascular accidents, which can cause loss of ejaculatory control. Diabetes, cardiovascular disease, pelvic fractures, urogenital diseases such as urethritis, prostatitis, seminal vesiculitis, and benign prostatic hyperplasia are also related to premature ejaculation to varying degrees.

Treatment for premature ejaculation should be based on the underlying cause, and an appropriate treatment method should be chosen. The most common treatment methods include:

(1) Psychotherapy requires the cooperation of both partners. Both partners should be informed that premature ejaculation is a relatively common problem, and the patient's anxiety, unease, guilt and other abnormal psychological states should be eliminated to build their confidence in curing the disease.

(2) Behavioral guidance: Through tactile stimulation methods such as hugging, touching, and massaging, patients are taught to experience and enjoy sexual pleasure and overcome psychological barriers.

(3) Oral medications: Antidepressants, alpha-adrenergic receptor blockers and serotonin reuptake inhibitors are currently used to treat premature ejaculation. However, although these drugs have an efficacy rate of about 50%, they also have many side effects. They should be used rationally in clinical applications.

(4) The main topical medication is a local anesthetic, which can be applied to the glans penis before intercourse to delay the ejaculation latency period through local anesthesia.

**50. What should I do if I always go soft during intercourse?**

Many married men experience erectile dysfunction during intercourse, which can severely impact the quality of their sex life over time. However, they often don't recognize this as erectile dysfunction because they feel they can engage in intercourse normally at the beginning. In fact, this is a symptom of erectile dysfunction and requires treatment.

Erectile dysfunction, also known as impotence, refers to the inability to achieve or maintain an erection sufficient for satisfactory sexual intercourse. The causes of erectile dysfunction are complex and are mainly divided into psychogenic erectile dysfunction and organic erectile dysfunction.

The key to treating erectile dysfunction lies in changing unhealthy lifestyle habits and preventing high-risk factors, such as increasing exercise, losing weight, and actively treating primary diseases such as diabetes and hypertension. For primary testicular diseases caused by insufficient testosterone secretion, or secondary to pituitary or hypothalamic diseases, as well as late-onset gonadal dysfunction in middle-aged and elderly individuals, testosterone replacement therapy can be used. For patients with significant mental or psychological issues, sex therapy can be conducted alone or in conjunction with other treatment methods.

If the above methods are ineffective, drug treatment should be considered. Currently, drug treatment for penile erection involves highly selective phosphodiester-5 inhibitors, such as sildenafil (Viagra), tadalafil (Cialis), and vardenafil (Viagra). If drug treatment is still ineffective, vacuum pressure therapy or intracavernosal injection therapy can be considered. Vacuum pressure therapy involves placing a negative pressure ring at the base of the penis to prevent blood backflow; the negative pressure acts on the corpora cavernosa, drawing blood into the penis and causing a passive erection. Intracavernosal injection therapy involves injecting vasodilators such as prostaglandins, papaverine, and phentolamine into the corpora cavernosa, inducing penile erection through local vasodilation. For severe ED (erectile dysfunction), penile implantation surgery can also be considered.

**51. Is lower back pain always a sign of kidney deficiency?**

Many people equate lower back pain with kidney deficiency, believing that lower back pain is a sign of kidney deficiency, and therefore consume large amounts of kidney-tonifying foods and medications. While some may experience relief from their lower back pain, others find their pain worsens. Why is this?

Kidney deficiency, in Traditional Chinese Medicine (TCM), refers to insufficient essence, qi, yin, and yang in the kidneys. It can be divided into kidney yin deficiency and kidney yang deficiency. Symptoms of kidney yang deficiency include lower back pain, cold limbs, aversion to cold, and even edema-symptoms of "cold." Poor sexual function can also lead to kidney yang deficiency. Symptoms of kidney yin deficiency are "heat," mainly including lower back pain, hot flashes, night sweats, spontaneous sweating, dizziness, and tinnitus. Kidney deficiency can lead to a weakened immune system. Treatment for kidney deficiency focuses on prevention. If the onset of kidney deficiency is related to excessive sexual activity, one should cultivate a calm mind and reduce desires, abstaining from masturbation. If it is related to general weakness, malnutrition, or overwork, one should appropriately increase nutrition or pay attention to the balance between work and rest, and moderate sexual desire. Kidney deficiency is often an accumulated condition; one should not rush into treatment with strong tonics but rather gradually regulate the body.

Lower back pain is a condition characterized by pain on one or both sides of the lower back. There are many causes of lower back pain, dozens of them, the more common ones being kidney deficiency, lumbar osteophyte formation, bone spurs, herniated discs, lumbar hypertrophy, spinal stenosis, lumbar fractures, spinal tumors, acute or chronic lumbar injuries or strains, lumbar muscle strain, ankylosing spondylitis, etc.

In other words, kidney deficiency can cause lower back pain, but lower back pain is not necessarily caused by kidney deficiency. Lower back pain is a symptom, not an independent disease. The causes of lower back pain are quite complex, so if you experience persistent and unexplained lower back pain, do not take it lightly. You should go to the hospital for a diagnosis as soon as possible and not assume it is simply kidney deficiency, thus delaying the diagnosis and treatment of the underlying disease.