I. Introduction of the disease
Ejaculation, also known as inability to ejaculate, refers to having a normal sexual desire, normal penile erection, being able to maintain erection and intercourse in the vagina for a period of time, or even for a long time, but no orgasm occurs and ejaculation cannot occur.
This disease is caused by the dysfunction of a link in the sexual physiological reflex process in which the central nervous system and peripheral nervous system, endocrine system and reproductive organs participate together, so that the stimulation of sexual excitement is not enough to produce the ejaculatory reflex.
According to the survey of the famous western sexologist Masters and Johnson, 450 male sexual dysfunction patients, 17 of them do not ejaculate, accounting for 8%; Shanghai study reported 2087 cases of male infertility patients, not ejaculate accounted for 32.39%; more than 70% of these people are caused by the lack of sexual knowledge and incorrect methods of intercourse, indicating that the degree of poverty of domestic mass sexual knowledge is It is worth to pay attention to.
Second, the disease classification
According to the nature of the disease, the disease is divided into primary and secondary ejaculation.
Primary ejaculation, which is characterized by never having ejaculation, whether in the waking state or in sleep, is mostly caused by congenital organic diseases; this condition is relatively rare.
Secondary ejaculation is more common and there are usually two types of cases: one is when you have experienced ejaculation in the vagina and for some reason you cannot ejaculate in the vagina at present; the other is when you cannot ejaculate in the vagina and you can ejaculate by masturbation or other means.
III. Causes of Eruption
There are many causes of non-ejaculation, which are mainly divided into two categories: functional and organic.
The main causes of functional ejaculation are as follows.
(1) Mental and emotional factors, also known as psychogenic ejaculation disorders, are the most numerous clinically. It is mainly the result of sexual dysfunction, strengthening of the inhibition of the ejaculatory center and the inability to get excited. Sometimes ejaculatory premonition may occur, but it is extinguished instantly. The causes are from the psychological aspect, such as frequent masturbation before marriage, so that after marriage, sexual intercourse does not reach sufficient strength and not ejaculate; education received from childhood distorts sex into a dirty, dirty, obscene thing; or dissatisfied with the spouse, loss of interest in the opposite sex, decreased libido, avoiding sexual intercourse; some are afraid of wife pregnancy after marriage, long-term restraint of sex, forming the conditioned reflex of non-ejaculation.
(2) Lack of sexual knowledge: incorrect sexual position, or improper method, stagnation after penile insertion into the vagina, no friction or insufficient friction intensity, not aroused or not reached the required intensity of ejaculation center excitement often leads to non-ejaculation.
(3) Female factors: the female partner is afraid of painful intercourse, fear of pregnancy or sexual desire, limiting the male partner’s pumping; the female partner has poor physical fitness and is bored with sexual activity, frustrating the male partner’s sexual impulse.
(4) Medication factors: mainly because of taking drugs that affect sympathetic tone, such as guanethidine and reserpine for hypertension; Librium, methiodiazide, phenothiazines, monoamine oxidase inhibitors for neurasthenia or insomnia, etc. Excessive use of bitter-cold Chinese medicine and alcohol abuse can also cause non-ejaculation.
(5) Objective factors: such as narrow housing and noisy environment, forming sexual inhibition; different work of both parties, different commuting time, uncoordinated sexual activities, etc.
(6) Anatomical factors: long foreskin, friction in the vagina, itchy penis head; foreskin embedded, painful, forced to interrupt sexual intercourse; severe seminitis so that atrophic changes occur, can not effectively participate in the ejaculation process.
Other factors: too frequent sexual intercourse, overwork, excessive use of bitter cold Chinese medicine, alcoholism and other reasons can also cause non-ejaculation.
The main causes of organic non-ejaculation are as follows.
(1) Genital anatomical abnormalities: congenital defects of the genitourinary tract, such as congenital lack of seminal vesicles, congenital absence of vas deferens; obstruction of the genital tract such as vas deferens, seminal vesicles and epididymis caused by injury or inflammation.
(2) Neurological lesions: such as lateral lobe disease and resection, spinal cord injury, lumbar sympathectomy, and post-pelvic radical surgery.
(3) Endocrine hypofunction: such as pituitary, gonadal, thyroid and other lesions.
IV. Clinical manifestations
1.Normal sexual desire and normal penile erection.
2.No orgasm and pleasure during sexual intercourse, i.e. no paroxysmal jerking sensation of genitalia at all times during sexual intercourse.
3.No random ejaculation action during sexual intercourse, no semen ejaculation.
4. There is ejaculation in functional non-ejaculation and no ejaculation in organic non-ejaculation.
V. Differential diagnosis.
1. Retrograde ejaculation: the same as non-ejaculation is that no semen is ejected from the urethral orifice during intercourse. However, retrograde ejaculators have normal intercourse time, orgasm during intercourse, and also ejaculatory action, and white flocculent material in the first urine after intercourse, and a large number of sperm and fructose are visible on microscopic examination.
2.Azoospermia: normal intercourse, ejaculation and orgasm, semen discharge, no sperm on laboratory test.
3, abnormal penile erection: the penis is continuously erect for more than 6 hours or even for several days, and does not become soft even after ejaculation, accompanied by penile pain.
VI. Treatment of non-ejaculation
(I) General treatment.
① Sexual knowledge education and psychotherapy: correcting wrong sexual concepts, coordinating the relationship between husband and wife, and encouraging the female partner to take the initiative to cooperate in assisting the male partner in treatment.
(ii) Develop good habits, quit frequent masturbation; quit smoking and drinking; increase nutrition, strengthen the body and improve the quality of the whole body.
③ strengthen physical exercise, you can use traditional fitness therapy, such as qigong, taijiquan, etc., to maintain a happy body and mind.
④Improve the living room environment and create a good sexual environment.
⑤ Circumcision in case of excessively long foreskin.
(B) Surgical treatment.
Organogenic non-ejaculation, mostly requires surgical treatment.
(C) drug treatment.
1, Western medicine treatment: the use of ephedrine, levodopa, stilbene, neostigmine, etc.; endocrine abnormalities using testosterone propionate, human chorionic gonadotropin and other drugs.
2, Chinese medicine treatment: need to dialectical prescription according to the specific conditions of the patient.
(D) Head acupuncture with acupuncture treatment.
Head acupuncture with three lines beside the frontal area is the main treatment; with Daher and Sanyinjiao, adding Tai Chong and Zhongji through Qu bone for those who are real; adding Tai Xi and Guan Yuan through Zhongji for those who are deficient. Acupuncture is performed once a day or every other day, and 10 times is a course of treatment.
(E) Electrical vibration and electrical stimulation therapy.
The use of electric massager to stimulate the glans tether at the glans to induce ejaculation can often obtain better results. It has also been reported that the effect was obtained with electrode insertion therapy in the rectum.
Seven, expert opinion
1, non-ejaculation can not only lead to infertility, long-term existence can even lead to changes in libido and erectile dysfunction. Therefore, it needs to be taken seriously and treated actively.
2, the treatment of non-ejaculation, need the understanding and cooperation of the patient’s wife. Therefore, the wife should be sympathetic to the husband, more relief, it is advisable to seek medical help together with the couple, collaborative treatment.
3, both husband and wife should fully understand the anatomy and physiological function of the sexual organs, the process of sexual response and other knowledge, master the correct sexual intercourse posture and method, so that the ejaculation center is subject to sufficient sexual stimulation.
4.Behavioral therapy: during sexual intercourse, the frequency and amplitude of penis thrusting in the vagina should be increased continuously, while the female partner can control the contraction of vaginal sphincter to increase the intensity of friction and stimulation of the penis, and use her hand to hold up the scrotum to press the male partner’s pubic symphysis to promote the arrival of male orgasm to achieve the purpose of ejaculation. If you still can’t reach ejaculation, you can first set the penis out of the vagina and have the female partner use her hand for strong stimulation. When there is a sense of urgency to ejaculate, then reinsert the penis into the vagina and lift the thrusts significantly at a high frequency until ejaculation. If the above method still cannot achieve intravaginal ejaculation, you can masturbate by yourself or with the help of the female partner, adopt the most stimulating sexual method to promote extra-vaginal ejaculation and experience the feeling of ejaculation, and then gradually transition to intravaginal ejaculation with the above method.
5. In patients with organic ejaculation, drug treatment is ineffective. Therefore, it is advisable for patients who do not ejaculate to first go to a specialist in a regular public hospital for imaging examinations such as vasectomy and seminal vesicle imaging, or even CT or MRI, to clarify the cause. Otherwise, blind treatment just delays time and wastes money.
6, functional non-ejaculation, Chinese medicine treatment has better efficacy (especially with acupuncture). However, the specific prescription and treatment plan need to be based on the patient’s specific evidence, and cannot be treated with a fixed prescription of Chinese medicine. Patients with long-standing ejaculation may want to try Chinese medicine therapy.