Microtia

Disease Description (Causes and Symptoms)

• Definition summary: A condition in which ejaculation occurs persistently and recurrently before, during, or immediately after penetration, or with minimal stimulation (premature ejaculation). It is the most common male sexual dysfunction (a prevalence of approximately 30–50% has been reported regardless of age).
• Main pathophysiology and causes
  • Lifelong (congenital/ongoing from the early stages): Psychological factors (anxiety, past psychological trauma, etc.) and neurophysiological factors (sensitivity of the glans penis, abnormalities in ejaculation-related neural circuits and neurotransmitters—particularly dysfunction of the serotonin system, etc.) are thought to be involved.
  • Acquired (symptoms that develop later after not having been present previously): Compensatory premature ejaculation after erectile dysfunction, prostatitis, urethritis, nerve damage, neuritis, alcoholism, diabetes, and other physical causes.
• Main symptoms
  • Ejaculation occurs immediately before or shortly after vaginal penetration (the time from penetration to ejaculation is very short).
  • Guilt, shame, and frustration caused by being unable to delay ejaculation, decreased sexual satisfaction, and relationship problems with a partner.

Treatment Methods

• Nonpharmacological treatment (recommended first)
  • Sex therapy/psychotherapy: Anxiety management, resolving expectation and role issues, and couples therapy.
  • Behavioral therapy: Start–stop technique, squeeze technique, and repeated training and mutual communication exercises.
  • Pelvic floor muscle (Kegel) exercises: Help with pelvic muscle control and ejaculation control.
• Pharmacological treatment
  • Selective serotonin reuptake inhibitors (SSRIs): Used because they can delay ejaculation (long-term medications: paroxetine, sertraline, fluoxetine, etc.; short-term/on-demand medication: dapoxetine is approved for the indication of premature ejaculation in many countries). Consider side effects (nausea, dizziness, changes in libido and erections, etc.) and drug interactions.
  • Topical anesthetics: Apply lidocaine/prilocaine cream or spray to the glans penis to reduce sensation (possible decreased sexual sensation and decreased vaginal sensation in the partner—condom use is recommended).
• Devices, procedures, and surgery
  • Dorsal penile nerve transection (sensory nerve blocking) is extremely selective and has limited application because of concerns about the evidence and safety, as well as the permanence of sensory loss. Current guidelines give it a low level of recommendation.
• Treatment of underlying diseases
  • If there are secondary causes such as prostatitis, urethritis, diabetes, alcoholism, or nerve damage, treating the underlying condition may improve premature ejaculation.
• Lifestyle management and precautions (points to note for self-management)
  • Avoid excessive alcohol consumption and drugs, and properly manage chronic diseases such as diabetes and hypertension.
  • Excessive use of topical anesthetics may cause reduced sexual sensation and skin irritation, so follow the instructions.
  • When taking SSRIs, monitor for drowsiness, nausea, and changes in sexual function, and be aware of interactions with other medications (especially MAOIs and some antibiotics).
  • Make a careful decision about a surgical approach after sufficient consultation.
• Risk of complications
  • Relationship conflict, the partner’s sexual dissatisfaction, worsening depression and anxiety, and medication side effects.

Outpatient Visit Checklist (Including Example Questions)

• Items/records to prepare
  • List of currently taken medications (including prescription drugs, OTC medications, and supplements)
  • Underlying diseases (diabetes, cardiovascular disease, neurological disease, history of alcohol use, etc.) and previous surgical history
  • When the symptoms began and their progression (distinguishing lifelong from acquired), and specific situations in which the problem occurs (before penetration/immediately after penetration/always)
  • Time from penetration to ejaculation (if possible, the average; an IELT record can be useful)
  • Recent urinary tract symptoms (painful urination, discharge) and whether there have been changes in erectile function
  • Relationship situation with the partner and psychological stress factors
  • Previous treatment attempts and their effects (behavioral therapy, medications/topical agents, etc.)
• What to show the doctor during the outpatient visit
  • Medication records, recent test results (blood glucose, hormone tests, prostate-related tests, etc.), and a symptom diary

General Example Questions to Ask the Doctor

• "What are the advantages and disadvantages of the recommended treatment options, and what effects can I expect?"
• "Are there any interactions with the other medications I am taking? What are the side effects?"
• "What prognosis can I expect with treatment? How likely is recurrence?"
• "What should I change in my lifestyle? Is partner treatment (couples counseling) necessary?"

Examples of Condition-Specific Questions

• "What is the average ejaculation time after penetration (or the most recently measured IELT), and which treatment would you recommend first based on this?"
• "When the symptoms appeared, did I have other urological symptoms such as erectile dysfunction or prostatitis? (If so, is there a possibility that premature ejaculation could improve by treating the underlying cause?)"