I. Erectionlessness.
(I) Definition.
Ejaculation disorder is a condition in which the patient can maintain normal sexual desire and erectile function, but the duration of intercourse is excessively prolonged due to the inability to ejaculate, so that it is difficult to reach orgasm, or even no orgasm. It can be divided into primary and secondary. If the patient has never ejaculated in the waking state, it is called primary ejaculation; if the patient has experienced normal ejaculation in the vagina and later does not ejaculate due to other factors, it is called secondary ejaculation.
(B) Etiology.
1.Functional etiology.
(1) Psychological factors: more common, such as mental trauma, marital discord, noisy environment, newlywed tension and anxiety can affect all aspects of sexual life, leading to the occurrence of non-ejaculation.
(2) lack of sexual knowledge: inadequate sexual knowledge and insufficient sexual stimulation to reach the threshold of ejaculation can lead to non-ejaculation, such as the female fear of pregnancy or fear of pain in the sexual act and restrict the male substantial, rapid pumping, or because of receiving the wrong sex education that sex is dirty and inhibit sexual desire leads to non-ejaculation.
(3) sexual fatigue: sexual life is too frequent and long-term masturbation is also a common cause of non-ejaculation, there are also anatomical factors such as circumcision, foreskin inlay that lead to sexual intercourse disorder and cause non-ejaculation.
2.Organic factors.
(1) neurogenic: such as lateral lobe lesions of the brain, spinal cord injury, sympathetic ganglion injury, wide range of retroperitoneal lymph node dissection in patients with testicular tumors, diabetes mellitus and other neurological diseases.
(2) Drug-related: long-term application of certain anti-hypertensive drugs, or overdose of sedative tranquilizers or a-adrenergic blockers [3], etc., or chronic alcoholism or nicotine intoxication can inhibit ejaculation.
(3) Other organic lesions: such as congenital or acquired internal genital abnormalities, such as ejaculatory duct obstruction, urethral stricture, bilateral testicular torsion, pituitary tumors and specific systemic diseases such as iron-containing hemoglobinopathies can lead to ejaculation.
(iii) Treatment.
1.Sexual and psychological treatment.
(1) Sexual treatment.
(1) Sexual concentration training, through hugging, touching, massage and other tactile stimulation means to experience and enjoy the pleasure of sex, to relieve the patient’s anxiety and fear of sexual intercourse, to establish and restore the natural response of sex.
(2) Adjustment of sexual intercourse, such as changing the environment and time of intercourse, adjusting the frequency of intercourse, changing the position, inducing ejaculation through masturbation and other methods.
(2) Psychological treatment: Applicable to various psychological causes of non-ejaculation, through the elimination of adverse psychological effects and misconceptions, coordination of the relationship between husband and wife, alleviate mental trauma can achieve significant results. For some of the lack of sexual knowledge and caused by non-ejaculation, through sex education, so that both men and women understand the anatomy and physiology of the reproductive system and the sexual physiological process, understand the skills of sexual life, so that the penis can receive more sexual stimulation, and achieve the purpose of treatment.
2.Medication.
Oral drug therapy is not recommended as the first choice treatment for ejaculation, and its efficacy is still controversial internationally.
(1) ephedrine: act on a and p receptors, excite the central nervous system and promote muscle tone, 50-60mg orally 1 hour before intercourse, help restore ejaculatory function.
(2) Yohimbine: Amano et al. reported the application of treatment for 33 cases of ejaculation, the efficiency was 59.1%, especially for functional ejaculation, the efficiency reached 64.3%, but some scholars have different views
(3) Neostigmine and levodopa: activation of ejaculation may be associated with stimulation of the dopamine system in the anterior hypothalamus.
(4) Traditional Chinese medicine treatment: It also has good efficacy in functional ejaculation, and there are reports of significant effect of Tongjing Tang with the formula of Astragalus, Red Ginseng and Semen Cuscutae.
3.Physical therapy.
Mainly applicable to assisted reproduction and functional non-ejaculation, there are currently two methods of mechanical vibration stimulation or electric massage stimulation. The electric massager is caused by electric current to vibrate the head of the instrument, and after contact stimulation of the glans and coronal groove area, ejaculation and erotic orgasm occur within 5 to 6 minutes. This artificially induced ejaculation can make the patient aware of the feeling of ejaculation and help establish a normal ejaculatory reflex. For patients with functional non-ejaculation, half of them can be restored to normal after 1 electric vibration treatment. It is also effective for patients with organic injury, but patients with high spinal cord injury may have complications such as increased blood pressure.
4. Other treatments.
Ejaculation disorders caused by endocrine disorders or drugs can be treated with hormone supplementation or discontinuation of drugs affecting ejaculation, and other congenital or acquired internal genital abnormalities can be treated with plastic surgery.