What is Premature Ejaculation? What are the Causes? A Comprehensive Analysis by a Malaysian Urologist​

引言：认识问题，消除误区 | Introduction: Understanding the Issue, Dispelling Myths​

早泄（Premature Ejaculation, PE）是男性最常见的性功能障碍之一，影响着众多马来西亚男性的性生活质量和自信心。许多男性因尴尬、误解或不知向何处求助而默默承受。然而，重要的是认识到：​早泄是一种明确的医学状况，绝非个人失败或羞耻之事，并且它是可以理解和有效管理的！​​ 本文旨在为您清晰解析早泄的科学定义，并系统阐述其背后复杂多样的原因，为您迈出寻求帮助的第一步奠定知识基础。 | Premature Ejaculation (PE) is one of the most common male sexual dysfunctions, affecting the quality of sex life and confidence of many men in Malaysia. Many men suffer silently due to embarrassment, misconceptions, or not knowing where to turn for help. However, it is crucial to recognize: ​Premature ejaculation is a defined medical condition, not a personal failure or a matter of shame, and it is understandable and manageable!​​ This article aims to clearly explain the scientific definition of PE and systematically detail its complex and varied causes, laying the knowledge foundation for you to take the first step towards seeking help.

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​第一部分：科学认识早泄 – 不仅仅是“快” | Part 1: Scientifically Understanding PE – It’s Not Just About Being “Fast”​​

医学上，早泄的诊断基于以下三个核心要素，需同时满足​： | Medically, the diagnosis of premature ejaculation is based on the following three core elements, which must ​all be met:

1. ​射精时间持续短 (Consistently Short Ejaculation Time):​​
   • 主要指阴道内射精潜伏期（IELT）​​ 短，即从阴茎插入阴道到射精的时间持续性地短。 | Mainly refers to a short ​Intravaginal Ejaculatory Latency Time (IELT)​, meaning the time from vaginal penetration to ejaculation is consistently short.
   • ​常见标准 (Common Benchmark):​​ 对于原发性（终身性）早泄，IELT 通常短于1分钟。对于继发性（获得性）早泄，IELT 显著缩短，通常短于3分钟。 | For primary (lifelong) PE, IELT is usually ​less than 1 minute. For secondary (acquired) PE, IELT is significantly reduced, usually ​less than 3 minutes.
   • ​重要提示 (Important Note):​​ 单纯时间短（如 IELT 为2-3分钟）​未必就是早泄​！关键在于是否同时满足下面两个条件。 | Short time alone (e.g., IELT of 2-3 minutes) ​is not necessarily PE!​​ The key is whether the following two conditions are also met.
2. ​无法延迟或控制射精 (Inability to Delay or Control Ejaculation):​​
   • 在射精紧迫感（Point of Inevitability）来临时，​总是或几乎总是难以通过主观意志努力来延迟或控制射精的过程。 | When the sense of ejaculatory inevitability occurs, it is ​always or nearly always​ difficult to voluntarily delay or control the process of ejaculation.
3. ​引起负面后果 (Causes Negative Consequences):​​
   • 这种状况给患者本人带来显著的苦恼、沮丧、焦虑、挫败感或逃避性行为等负面情绪。 | This situation causes ​significant distress, frustration, anxiety, a sense of failure, or avoidance of sexual activity​ in the individual.
   • 并且/或者对伴侣关系造成负面影响，如伴侣不满、沟通障碍或关系紧张。 | And/or ​negatively impacts the partner relationship, such as partner dissatisfaction, communication barriers, or relationship tension.

​早泄的常见类型 | Common Types of Premature Ejaculation​

1. ​终身性（原发性）早泄 (Lifelong (Primary) Premature Ejaculation):​​
   • ​特征 (Characteristics):​​ 从第一次性经历开始就存在，几乎在每一次或绝大多数（>90%）的性尝试中发生。 | Has been present since the first sexual experiences, occurs in nearly every or the vast majority (>90%) of sexual attempts.
2. ​获得性（继发性）早泄 (Acquired (Secondary) Premature Ejaculation):​​
   • ​特征 (Characteristics):​​ 在男性过去曾拥有一段时间正常的射精控制能力之后才发生。 | Develops after a period where the man previously had normal ejaculatory control.

​第二部分：深入探究早泄的原因 – 多因素交织 | Part 2: In-Depth Look at the Causes of PE – A Multifaceted Interplay​

早泄并非由单一原因引起，它通常是生理、心理、行为习惯和关系因素复杂交织、共同作用的结果。 | Premature ejaculation is not caused by a single factor; it typically results from a complex interplay of ​biological, psychological, behavioral, and relational factors.

​一、生物与生理因素 (Biological & Physiological Factors)​​

1. ​神经生物学因素 (Neurobiological Factors):​​
   • ​射精反射超敏 (Hypersensitive Ejaculatory Reflex):​​ 这是目前认为导致终身性早泄的主要原因。控制射精的神经反射通路天生过于敏感或兴奋阈值较低，导致轻微的性刺激就能快速触发射精。 | This is currently considered the primary cause of ​lifelong PE. The neural reflex pathways controlling ejaculation are inherently hypersensitive or have a low excitation threshold, meaning minimal sexual stimulation can rapidly trigger ejaculation.
   • ​神经递质失衡 (Neurotransmitter Imbalance):​​ 大脑中的化学信使，特别是血清素（5-HT）​，在调节射精过程中起着关键作用。研究表明，早泄男性可能存在中枢血清素能系统功能异常，导致抑制射精的能力减弱。 | Brain chemicals, particularly ​serotonin (5-HT)​, play a key role in regulating ejaculation. Research suggests men with PE may have dysfunction in the central serotonergic system, leading to a reduced ability to inhibit ejaculation.
   • ​遗传倾向 (Genetic Predisposition):​​ 家族研究显示早泄可能有遗传倾向，可能与影响上述神经系统的基因有关。 | Family studies suggest a possible genetic predisposition to PE, potentially linked to genes affecting the aforementioned neural systems.
2. ​激素因素 (Hormonal Factors):​​
   • ​甲状腺功能亢进（甲亢）(Hyperthyroidism):​​ 甲状腺激素水平过高可能加速新陈代谢和神经反射，与早泄有关联。 | Overactive thyroid may accelerate metabolism and neural reflexes, associated with PE.
   • ​性激素 (Sex Hormones):​​ 研究不如勃起功能障碍与睾酮的关系明确，但严重的低睾酮水平有时可能与整体性功能障碍相关。 | The link is less clear than with erectile dysfunction and testosterone, but severely low testosterone levels can sometimes be associated with general sexual dysfunction.
3. ​泌尿生殖系统问题 (Urogenital Issues):​​
   • ​前列腺炎 (Prostatitis):​​ 前列腺的炎症可能增加局部敏感性，有时与获得性早泄相关。 | Inflammation of the prostate may increase local sensitivity and is sometimes associated with ​acquired PE.
   • ​包皮过长/包茎 (Phimosis/Redundant Prepuce):​​ 可能导致龟头长期被包裹，敏感性增高，但其作为主要原因的证据不足。 | May cause increased glans sensitivity due to long-term coverage, but evidence as a primary cause is insufficient.
4. ​神经系统疾病 (Neurological Disorders):​​ 如多发性硬化症、脊髓损伤、糖尿病神经病变等，可能干扰正常的射精控制神经通路。 | e.g., Multiple sclerosis, spinal cord injuries, diabetic neuropathy can disrupt normal neural pathways for ejaculatory control.

​二、心理与情绪因素 (Psychological & Emotional Factors)​​

这是导致或加重获得性早泄的最常见原因之一。 | This is one of the most common causes or exacerbating factors for ​acquired PE.

1. ​表现焦虑 (Performance Anxiety):​​ ​这是核心心理原因。​​ 对性表现（如持续时间、满足伴侣）的过度担忧和恐惧会形成巨大压力。这种焦虑本身会激活“战斗或逃跑”反应（交感神经兴奋），从而直接抑制控制射精的“休息与消化”反应（副交感神经主导）​，导致更快射精，形成“越怕越快，越快越怕”的恶性循环。 | ​This is the core psychological cause.​​ Excessive worry and fear about sexual performance (e.g., duration, satisfying partner) creates immense pressure. This anxiety itself activates the “fight or flight” response (sympathetic dominance), thereby ​directly inhibiting the “rest and digest” response (parasympathetic)​​ needed for ejaculatory control, leading to faster ejaculation and a vicious cycle of “the more you fear, the faster it happens; the faster it happens, the more you fear.”
2. ​压力与抑郁 (Stress and Depression):​​ 工作、经济、生活重大变故导致的慢性压力，以及抑郁症的情绪低落、精力不足状态，均可严重影响性功能和对射精的控制能力。 | Chronic stress from work, finances, major life events, and the low mood, lack of energy state of depression can severely affect sexual function and ejaculatory control.
3. ​身体意象与自卑 (Body Image and Low Self-Esteem):​​ 对自身身体或性能力感到自卑和缺乏信心。 | Feeling insecure about one’s body or sexual abilities, lacking confidence.
4. ​性心理创伤或负面经历 (Psychosexual Trauma or Negative Experiences):​​ 早期仓促、紧张、有负罪感或受到惩罚的性经历可能形成条件反射。 | Early rushed, tense, guilt-ridden, or punished sexual experiences can create conditioned reflexes.

​三、行为与关系因素 (Behavioral & Relational Factors)​​

1. ​长期形成的快速射精模式 (Long-Established Habit of Rapid Ejaculation):​​
   • 在青春期或早期性经历中，因环境限制（如怕被发现）、时间紧迫或习惯，养成了追求快速达到高潮的射精模式（常见于手淫或早期性行为中）。身体“学习”并习惯了这种快速反应。 | During adolescence or early sexual experiences, due to environmental constraints (e.g., fear of being caught), time pressure, or habit, a pattern of seeking rapid orgasm develops (common in masturbation or early sexual encounters). The body “learns” and becomes accustomed to this rapid response.
2. ​伴侣关系问题 (Relationship Problems):​​
   • 沟通不良、情感疏离、冲突、缺乏信任、对伴侣的愤怒或不满等情绪，都会在性生活中造成紧张和压力，可能成为早泄的诱因或加重因素。 | Poor communication, emotional distance, conflict, lack of trust, anger or resentment towards a partner can create tension and pressure during sex, potentially triggering or worsening PE.

​四、其他因素 (Other Factors)​​

1. ​药物副作用 (Medication Side Effects):​​ 极少情况下，某些药物（如抗抑郁药停药反应）可能影响射精控制。 | Rarely, certain medications (e.g., antidepressant withdrawal) may affect ejaculatory control.
2. ​勃起功能障碍（ED）(Erectile Dysfunction – ED):​​ 当男性同时存在勃起困难时，可能会在勃起后急于射精，以免勃起消失，从而表现为早泄。 | When a man also has difficulty achieving or maintaining an erection, he may rush to ejaculate once erect to avoid losing the erection, thus presenting as PE.

​给马来西亚读者的重要建议 | Important Advice for Malaysian Readers​

1. ​这不是你的错 (It’s Not Your Fault):​​ 请理解早泄是多种因素导致的医学状况，放下不必要的羞耻和自责。 | Please understand that PE is a medical condition with multiple causes; let go of unnecessary shame and self-blame.
2. ​寻求专业帮助是关键 (Seeking Professional Help is Key):​​ 如果早泄持续困扰您，​请咨询医生。这是最重要、最正确的一步。 | If PE persistently troubles you, ​please consult a doctor. This is the most important and correct step.
   • ​可以咨询谁？(Who to consult?):​​ ​政府诊所（Klinik Kesihatan）​​ 的医生、您的家庭医生（GP）​​ 或医院的泌尿科医生（Urologist）​。 | Doctors at ​Government Clinics (Klinik Kesihatan)​, your ​GP, or ​Urologists​ at hospitals.
3. ​坦诚沟通 (Communicate Openly):​​ 与医生坦诚沟通您的症状、困扰、病史和用药史。与伴侣坦诚交流，寻求理解和支持。 | Communicate openly with your doctor about your symptoms, distress, medical history, and medication history. Communicate honestly with your partner, seeking understanding and support.
4. ​善用本地资源 (Utilize Local Resources):​​
   • ​马来西亚卫生部（MOH）MyHealth 门户:​​ 提供可靠的健康信息。 | Provides reliable health information.
   • ​马来西亚泌尿科协会（MUA）:​​ 可查询专业医生信息。 | Can find information on specialist doctors.

​结语：原因明晰，希望在前 | Conclusion: Causes Clarified, Hope Ahead​

早泄的原因复杂多样，涉及神经生物学、心理、行为、关系等多个层面，且常相互影响。了解这些原因，有助于您更客观、科学地认识这一问题，并认识到：​早泄绝非不治之症！​​ 无论是通过行为训练、心理干预、药物治疗还是综合策略，绝大多数情况都能得到显著改善。在马来西亚完善的医疗体系下，请勇敢迈出寻求专业帮助的第一步，您完全有能力重获满意的性福生活与自信！ | The causes of premature ejaculation are complex and diverse, involving neurobiological, psychological, behavioral, relational, and other aspects, often interacting. Understanding these causes helps you view this issue more objectively and scientifically, and recognize that ​PE is by no means incurable!​​ Whether through behavioral training, psychological intervention, medication, or a combined strategy, the vast majority of cases can be significantly improved. Within Malaysia’s healthcare system, bravely take the first step to seek professional help – you have the full ability to regain a satisfying sex life and confidence!