Types of psychosexual dysfunction, scientific criteria for diagnosing premature ejaculation, and common misconceptions.

The characteristic of paraphilia is that the patient does not have normal sexual behavior. Some men specifically like to rub their genitals against the buttocks or other parts of the body of women in crowded public places (such as shops and buses) to achieve ejaculation and obtain satisfaction. Some men like to suddenly expose their external genitalia to women and get satisfaction from the woman's fear or cursing. These people are often beaten and punished by the public, and even punished by law, but they often do not change their bad habits and repeatedly relapse. Common types of paraphilia include: (1) Fetishism: It is manifested by liking to use inanimate objects or only inanimate objects to express sexual excitement, often taking pleasure in stealing women's bras, underwear or cutting women's braids. Then, they secretly feel sexual urges in front of the stolen clothes and seek sexual satisfaction through masturbation. (2) Pedophilia: Adult men are not interested in adult women, but are only interested in immature children, often causing serious psychological trauma to children. (3) Animalism: It refers to patients liking or specifically using animals to obtain sexual excitement during sexual activities and when having sexual hallucinations. (4) Heterophobia: Finding satisfaction in wearing clothing of the opposite sex or imitating female actions, without seeking to change gender. (5) Exhibitionism: Repeatedly exposing one's genitals to unsuspecting women to generate sexual arousal. (6) Voyeurism: Repeatedly watching unsuspecting naked people and people undressing or having sex, without wanting to have sexual relations with the person being watched, mainly achieving sexual arousal through watching others. (7) Sadism: Mainly achieving sexual arousal through physical or mental torture of others. (8) Masochism: Corresponding to sadism, sexual arousal occurs after being sexually abused. (9) Atypical paraphilias: Including coprophagia, obscene language, filth fetishism, necrophilia, and friction fetishism.

Treatment for paraphilia should begin with psychotherapy. Paraphilia is essentially caused by immature sexual psychological development, excessive shyness, and a lack of opportunities or ability to interact with the opposite sex in society. The patient fears to pursue love or have sex in a normal way, thus exhibiting abnormal or childish sexual behaviors. Psychotherapy also includes insight therapy and behavioral therapy. For example, aversion therapy involves showing the patient photos or objects related to paraphilia after administering emetics, which will cause the patient to abhor the abnormal behavior. However, the effect is not consolidated and needs to be combined with psychotherapy. Only when the patient understands what normal sexual psychology is and what abnormal sexual psychology is, and helps them recognize the serious harm their pathological behavior brings to their family, society, and themselves, and feel remorse and regret for this sexual behavior, can a strong desire for treatment be aroused, and a good therapeutic effect be hoped for. In addition, some anti-androgen drugs can be used to help control symptoms.

Premature ejaculation refers to ejaculation occurring before or shortly after penile contact with the female partner during sexual intercourse. In reality, there is no definitive medical definition of premature ejaculation because a uniform standard for timing cannot be established. The speed of ejaculation depends on various factors, including the couple's age, physical condition, frequency of sexual activity, sexual experience, and the woman's feelings, making the issue quite complex. However, to provide a general timeframe, modern medicine considers the normal physiological process of penile insertion into the vagina, the commencement of intercourse, and ejaculation to take approximately 2-6 minutes. Roughly speaking, a time of less than 2 minutes can be considered premature ejaculation, while a time exceeding 2 minutes is generally not considered premature ejaculation. Factors contributing to premature ejaculation include: (1) Mistaking premature ejaculation for a biologically superior condition. Some men prioritize their own sexual satisfaction, leading to a misunderstanding of sexual behavior patterns and a neglect of female sexual responses. (2) First sexual intercourse often takes place before marriage in an unfavorable environment and under tension due to fear of being discovered. The desire to ejaculate quickly and end it early becomes a habit, making it difficult to change the established ejaculation pattern even in a relaxed and pleasant atmosphere later on. (3) Some people experience premature ejaculation because they have too few sexual intercourses. Once they have intercourse, their reaction is too strong, leading to premature ejaculation. (4) Interrupted intercourse can easily lead to premature ejaculation. If withdrawal is used as a form of contraception, both partners are very nervous and focus on when to withdraw the penis in time, so the woman cannot pay attention to her sexual feelings, and the man is too nervous, which makes it easy to ejaculate prematurely. (5) Some people experience premature ejaculation due to a history of masturbation. Although masturbation itself does not directly cause premature ejaculation, teenagers are often afraid of being discovered when masturbating and always want to end it as soon as possible, thus developing a seemingly hurried habit, which leads to ejaculation with the slightest stimulation after marriage. (6) Some people experience premature ejaculation due to limited interaction with women, excessive restraint in social situations, unsuccessful marriages and relationships, lack of sexual knowledge and intercourse skills, and fear. (7) Some people, due to their self-perception of being "physically weak" or "having insufficient kidney yang," worry that sexual activity will damage their health and exacerbate their physical weakness. They may even be influenced by the fallacy that "one drop of semen is worth ten drops of blood," leading to significant pressure during intercourse and thus causing premature ejaculation. (8) Some men engage in excessive sexual activity for a long period, and premature ejaculation is an early sign of sexual dysfunction. (9) Poor living conditions, such as two generations living together in the same room, can cause tension during intercourse, leading to a desire to end the act prematurely and thus causing premature ejaculation. (10) Some organic causes, such as local irritation, phimosis, tight underwear, strong stimulation from audiovisual pornography and sexual fantasies, as well as a short frenulum, prostatitis, posterior urethritis, seminal colliculitis, and spinal nerve diseases, can all cause premature ejaculation.

(1) Treating the inability to arouse female sexual climax and sexual pleasure as premature ejaculation: One of the characteristics of male and female sexual function is "men are fast and women are slow". Once sexual intercourse begins, men's penises become erect quickly and they reach orgasm and ejaculate quickly during intercourse. On the contrary, even if sexual intercourse begins with sexual stimulation, women's sexual arousal is slower and usually takes more than ten minutes to reach orgasm. There is a natural "time difference" here, so it is common for men to ejaculate before women reach orgasm. In this case, it is at most a sexual harmony issue. Through long-term adjustment between husband and wife, especially before intercourse, the husband should give his wife more sexual guidance so that they can gradually reach a satisfactory level of cooperation and gradually reduce this "time difference". This situation should not be regarded as premature ejaculation, and the wife should not be dissatisfied because she did not reach orgasm, thinking that the husband has premature ejaculation. (2) Premature ejaculation in the early stages of marriage will lead to premature ejaculation for life: This is another fallacy, because premature ejaculation in the early stages of marriage is very common. There are several reasons for this: First, sexual excitement is particularly high during the honeymoon phase. In fact, for a long time before marriage, one is already full of anticipation and longing for sex. It is both novel and curious. Both the sexual organs and nerve control functions are in a state of high excitement, so once there is sex, it is easy to trigger ejaculation. Second, the semen in the sexual organs of unmarried men has accumulated to a considerable amount, which can produce a certain degree of saturation stimulation. This stimulation will stimulate sexual desire and also promote ejaculation. When the honeymoon coincides with sex, it is easy to ejaculate quickly. Third, at the beginning of sex, the couple has not yet reached a satisfactory level of cooperation, and the sexual function has not fully entered a normal state. The nerve and endocrine regulation functions are not fully sorted out. In the initial stage, premature ejaculation will occur. Later, they will adapt and get used to it, and eventually enter a normal state. It can be seen that as the number of sex lives increases, the novelty fades relatively, and with the experience of sex life, the premature ejaculation that once occurred will disappear completely after the honeymoon phase. (3) Premature ejaculation will definitely occur after a long separation: There is an inverse relationship between the speed of male ejaculation and the length of the interval between intercourse. The longer the interval between two sexual encounters, the faster the ejaculation occurs; conversely, the shorter the interval between two sexual encounters, the slower the ejaculation occurs. After a long separation, in a state of "sexual hunger" where there has been no sexual activity for many days, once they meet, sexual excitement will suddenly increase, and it is not surprising that ejaculation occurs quickly. People often say that "absence makes the heart grow fonder," and couples with good feelings will naturally have increased sexual excitement after a long separation, and it is not uncommon for ejaculation to be faster. This occasional premature ejaculation should not be regarded as a problem with sexual function, nor should it be regarded as pathological premature ejaculation. As long as they live together in the future, the problem of faster ejaculation will be solved. (4) Ejaculating quickly is premature ejaculation: This is even more wrong. It is completely unnecessary to compare with others, because everyone's sexual physiological activities are different, and their sexual experience and frequency of sexual activity are not exactly the same, so there is no comparability. Furthermore, people's physical strength and constitution vary from person to person, so comparisons should not be made in this way. As long as the time pattern of 2 to 6 minutes mentioned above is generally met, it should be considered normal.