Causes and Classification of Premature Ejaculation​

核心病因解析 | Core Pathogenic Factors​

​1. 神经生物学因素 | Neurobiological Causes

Click to buy ​

• ​血清素系统失调​
  大脑5-HT2C受体功能低下导致射精控制障碍
  Dysfunctional 5-HT2C receptors impair ejaculatory control
• ​脊髓射精中枢高敏化​
  胸腰段(T10-L2)反射弧阈值降低50%
  Hypersensitivity of spinal ejaculation generator (T10-L2)

​2. 器质性疾病 | Organic Pathologies​

​慢性前列腺炎 | Chronic Prostatitis​

• 炎症因子刺激盆腔神经
  Inflammatory cytokines irritate pelvic nerves
• 马来西亚发病率：18-35岁男性中占22% (MOH 2023)
  Prevalence in Malaysia: 22% in men aged 18-35 (MOH 2023)

​糖尿病神经病变 | Diabetic Neuropathy​

• 自主神经传导速度下降40%
  40% reduction in autonomic nerve conduction velocity
• 年轻患者中13%伴糖耐量异常
  13% of young patients show glucose intolerance

​甲状腺功能亢进 | Hyperthyroidism​

• 代谢加速致神经肌肉兴奋性增高
  Accelerated metabolism increases neuromuscular excitability
• 吉隆坡内分泌中心检出率7.8%
  Detection rate: 7.8% (Kuala Lumpur Endocrine Center)

​3. 心理行为因素 | Psychobehavioral Triggers​

​操作性焦虑循环 | Performance Anxiety Cycle​

• 性表现担忧 → 交感神经激活 → 早泄 → 焦虑强化
  Sexual performance worry → SNS activation → PE → Reinforced anxiety

​错误条件反射 | Maladaptive Conditioning​

• 青少年期速射自慰模式固化神经通路
  Adolescent rapid-ejaculation masturbation habits solidify neural pathways

---

​临床分类体系 | Clinical Classification System​

​I. 原发性早泄 | Lifelong PE (Type 1)​​

​诊断标志 | Diagnostic Criteria​

• 终生性射精潜伏期≤1分钟
  Lifelong intravaginal ejaculatory latency time (IELT) ≤1 minute
• 90%以上性交中出现
  Occurs in >90% of sexual encounters

​致病主因 | Primary Cause​

• 先天血清素转运体基因(SLC6A4)多态性
  Congenital polymorphism of serotonin transporter gene (SLC6A4)

​II. 继发性早泄 | Acquired PE (Type 2)​​

​诊断标志 | Diagnostic Criteria​

• 射精时间较既往缩短>80%
  >80% reduction in IELT compared to past performance
• 常突发性出现
  Usually sudden onset

​致病主因 | Primary Cause​

• 前列腺炎(38%) / 甲状腺疾病(12%) / SSRI停药反应(9%)
  Prostatitis (38%) / Thyroid disorders (12%) / SSRI withdrawal (9%)

​III. 变异性早泄 | Variable PE (Type 3)​​

​诊断标志 | Diagnostic Criteria​

• 射精时间波动大(30秒至10分钟)
  Highly variable IELT (30 seconds to 10 minutes)
• 仅特定情境发生
  Situation-specific occurrence

​致病主因 | Primary Cause​

• 伴侣关系冲突(41%) / 情境性焦虑(33%)
  Relationship conflict (41%) / Situational anxiety (33%)

​IV. 主观性早泄 | Subjective PE (Type 4)​​

​诊断标志 | Diagnostic Criteria​

• 实际IELT>5分钟
  Actual IELT >5 minutes
• 主观感知控制力不足
  Subjective perception of poor control

​致病主因 | Primary Cause​

• 色情影片误导(67%) / 伴侣抱怨史(58%)
  Pornography misconceptions (67%) / Partner complaints history (58%)

---

​马来西亚特色防治方案 | Malaysia-specific Management​

​A. 公立医疗体系方案 | Public Healthcare Pathways​

​首诊筛查套餐 (RM35) | First-visit Screening Package (RM35)​​

• 前列腺指检+DRE评分
  Digital rectal examination + DRE score
• 空腹血糖+TSH检测
  Fasting blood glucose + TSH test

​分级治疗指南 | Tiered Treatment Protocol​

• 初级：行为疗法(起停法/挤压法)
  Primary: Behavioral therapy (Start-stop/Squeeze techniques)
• 中级：利多卡因喷雾(卫生部注册产品)
  Secondary: Lidocaine spray (MOH-approved products)

​B. 文化适配性疗法 | Culturally-adapted Therapies​

​清真认证延时喷剂 | Halal-certified Delay Sprays​

• 含苯佐卡因的Halal外用制剂（Jakim认证号：JAKIM/SP/2023-087）
  Benzocaine-based topical agents (Jakim cert: JAKIM/SP/2023-087)

​传统医学整合方案 | Integrative Traditional Medicine​

• 东革阿里(Tongkat Ali)萃取物联合盆底肌训练
  Tongkat Ali extract with pelvic floor muscle training
• 12周疗程延长IELT 210% (马来亚大学药理研究所)
  210% IELT extension after 12 weeks (UM Pharmacology Institute)

​C. 数字化干预平台 | Digital Health Solutions​

​MyPE-Care APP​

• 盆底肌生物反馈训练
  Pelvic floor biofeedback training
• 性焦虑CBT模块
  Sexual anxiety CBT module
• 下载量已突破120,000次 (Google Play数据)
  120,000+ downloads (Google Play data)

---

​预后影响因素 | Prognostic Determinants​

​正向预后指标 | Positive Indicators​

• 治疗响应速度：行为训练4周内IELT延长>100%
  Treatment response: >100% IELT extension within 4 weeks of behavioral training
• 伴侣参与度：共同接受咨询者复发率降低62%
  Partner involvement: 62% lower relapse rate with joint counseling

​负向预后指标 | Negative Indicators​

• 病程>5年：神经反射通路固化
  Duration >5 years: Neural reflex pathway solidification
• 合并勃起功能障碍：治疗有效率降至41%
  Comorbid ED: Treatment efficacy drops to 41%