Sex and reproduction are inseparable, so some sexual dysfunctions may affect fertility or even cause infertility. In the whole animal world except human beings, sexuality and reproduction are mixed together. After the emergence of human beings, sexuality has the function of pleasure for body and mind in addition to reproduction of offspring, even so, sexual function has a close relationship with human fertility, so some sexual dysfunction may affect human fertility.
Men play a leading role in the process of sexual life, and if sexual dysfunction occurs, it may affect fertility and even lead to male infertility. To understand which male sexual dysfunction can lead to infertility, we must first understand the state of normal male sexual function. Male normal sexual process mainly has five links, namely sexual arousal, penile erection, penile insertion into the vagina, ejaculation (orgasm) and sexual satisfaction, any one of these links is a problem, there will be sexual dysfunction, so male sexual dysfunction is mainly divided into sexual desire disorder (low libido, sexual aversion and sexual desire inversion), erectile dysfunction (penile erectile dysfunction, i.e. ED and abnormal penile erection ) and ejaculatory dysfunction (premature ejaculation, non-ejaculation and retrograde ejaculation), many of which can affect male fertility. Unlike other organs, there are many factors that affect male sexual function, both by organic factors (such as nerves and related hormones, etc.) and psychological factors, and even by social environment and cultural background, etc. Therefore, to clearly understand the relationship between male sexual dysfunction and male fertility, we must consider these aspects together.
In the following, the relationship between male sexual dysfunction and male fertility will be introduced in detail from the aspects of sexual desire disorder, erectile dysfunction and ejaculatory dysfunction.
Sexual desire disorder and male infertility
I. Understanding sexual desire
Sexual desire refers to the desire to have sex under the appropriate sexual stimulation, causing sexual excitement, and the desire to have sex, is a kind of impulse for sexual activities, but also the pursuit of sexual satisfaction.
Sexual desire is a human instinct, is a normal physiological and psychological phenomenon, more than 2000 years ago Confucius said in the “Book of Rites” “food and men and women, the great desire of man exists”, which shows that our ancient people believe that sexual desire and appetite is the basic needs of human beings, the modern Freud also believes that sexual desire is the internal drive of sexual instinct, is a normal Physiological and psychological phenomenon.
Second, the influence of sexual desire factors
There are many factors affecting sexual desire, including organic factors (neurological, endocrine and other factors), psychological factors, social factors and cultural background factors.
The brain has a “sex center” (located in the gray matter of the brain and hypothalamus and other parts), because the thinking about sex, scenarios, etc. can cause the “sex center” excitement, and then cause sexual desire and penile erection, so the center is also known as ” Pleasure center”. Sex hormones, including androgens, are very important for the production of sexual desire and the maintenance of normal sexual function in men. Various stimuli, the most important of which is the sense of touch, foreign sexy concentration therapy is mainly tactile training, coupled with visual and olfactory aids, can improve the sexual function of patients with erectile dysfunction; followed by visual stimulation, in ancient China, sexual desire and lust, sex and color is a concept; in addition, smell, taste and hearing can also stimulate sexual desire.
Psychological factors, social factors and cultural background factors will also affect sexual desire.
Third, sexual desire disorder and male infertility
Sexual desire disorder closely related to male infertility is low libido and asexual desire. Low libido refers to the patient’s lack of subjective desire for sexual life. Significant hypoactive sexual desire is also known as frigidity. A person who fails to elicit sexual desire despite repeated appropriate sexual stimulation is asexual. Asexual desire in men is rare, and those who report a lack of sexual desire are often seen clinically as patients with low sexual desire.
There are many factors that can cause low libido or no libido. Some male patients with hypoactive libido or asexual desire should first go to a regular hospital to exclude some organic diseases. Reproductive hormones including androgens and prolactin can be checked to exclude diseases such as kallmann syndrome (often with abnormal smell), klinefelter syndrome (microtestoidism), hyperprolactinemia and hypopituitarism, etc. In addition, there are some diseases that can cause libido hypogonadism, such as cirrhosis of the liver, tuberculosis and tumors of the reproductive system. In addition to organic diseases, the most common factors that cause hypersexuality in men are non-organic factors, mainly the relationship between partners, bad emotions, bad habits, drugs, age, health status and living environment, etc.: Problems in the relationship between partners can cause hypersexuality. Unlike other animals, human sexual desire has both animal instinct and love components, so sex and love combined together to form a fixed pair of sex, if the relationship between the partners have problems, every day because of petty quarrels, or between the two sides ignore the cold war, may lead to decreased libido; bad emotions will lead to decreased libido, a harmonious sex life should be in The situation of the mood, so as to maintain a normal libido, to bring pleasure, bad mood, will cause libido, these cases are mainly bad sex life history, incorrect understanding of the past masturbation history of crime, career setbacks and family changes, bad mood can temporarily suppress libido, resulting in libido, with the recovery of bad mood, libido will gradually recover; bad hobbies Alcoholism and long-term smoking may affect male androgen secretion, thus affecting libido; some drugs may lead to decreased libido, such as cold medicine (containing benadryl, pseudoephedrine, etc.), sedatives (such as barbiturates, etc.), hypnotics (such as Valium, etc.) and anti-hypertensive drugs (reducing heart rate and blood flow, which may affect the blood supply to the sexual organs); as we grow older, libido will appear The male libido reaches its peak at puberty, starts to decline at the age of 30-40, and decreases significantly after the age of 50; poor health and poor living environment can also affect libido.
As mentioned above, there are many factors that affect libido, and the requirements of normal men for sexual life vary greatly from person to person, just like drinking, good drinkers can drink more than 1 pound of liquor without changing their faces, while those who are not good drinkers may not be able to drink 1 or 2, so whether libido is reduced can only compare themselves, but not with others for horizontal comparison, so the clinical criteria for diagnosing libido disorder is not clear, it is generally believed that If you don’t have a sex life within half a month, you can consider low libido. Foreign data reported that 16%-20% of adult men have low libido.
Low libido or absence of libido leading to low or no sexual intercourse may cause male infertility. The World Health Organization Standardized Male Infertility Examination and Treatment Manual clearly states that if the average monthly frequency of vaginal intercourse is equal to or less than 2 times, it is recorded as insufficient sexual life, which can be considered as an etiological factor of male infertility; of course, if some couples focus their sexual life on the fertile period according to female ovulation, the low frequency of sexual life caused in this case can be considered normal. Therefore, low or no libido leading to low or no sexual intercourse may cause male infertility.
As long as the libido is improved and the number of sexual intercourse is increased appropriately, the problem of fertility will be solved for patients with low libido and asexual male infertility. If the low libido or asexuality is caused by organic diseases and drugs, treatment can be directed at the cause; if it is caused by low androgens, exogenous androgens can be supplemented under the guidance of a doctor; most of the low libido or asexuality is due to psychological or social factors, and psycho-psychological treatment should be carried out.
Regarding the optimal number of sexual intercourse to increase the probability of pregnancy, foreign data show that it is most likely for infertile couples to have sex every 2 days before ovulation to make the woman pregnant, but sex after ovulation is ineffective. Because sperm have limited survival time in the female reproductive tract, current data indicate that sperm survive for more than 48 hours in the posterior vaginal vault and cervix of women (some reports indicate that sperm survive approximately 0.5 to 2.5 hours in the vagina, 48 hours in the cervix, 24 hours in the uterus and 48 hours in the fallopian tubes, and the loss of sperm fertilization ability may be earlier), so having sex every 2 days before ovulation to keep The presence of sperm in the fallopian tube for 12 to 24 hours, this situation of sperm waiting for the egg cell to be expelled has the highest probability of pregnancy, just like young people dating, it is usually the young man waiting for his sweetheart that is perfect, and there are studies that confirm that sex 5 days before ovulation can make the female partner pregnant.
Erectile dysfunction and male infertility
I. Introduction to erectile dysfunction
Erectile dysfunction is a sexual dysfunction in which the male penis cannot achieve or maintain a full erection for satisfactory sexual intercourse. Erectile dysfunction not only refers to the inability of the penis to erect, but also includes the inability of the penis to maintain an erection, i.e., insufficient erection time during sexual life. Foreign data show that the prevalence of erectile dysfunction among men aged 40 to 70 is 52.0±1.3%, and some domestic data show that its prevalence in adult men is 10%.
The risk factors for erectile dysfunction are mainly age, psychological factors, physical diseases, medications, medical factors such as trauma and surgery, and poor lifestyle. As age increases, in addition to a decrease in libido, erectile function will also change significantly; the sensitivity of the penis will also decrease, and the time required for the penis to achieve an erection will increase; the influence of psychological stimulation on penile erection will decrease, and penile erection will rely more on somatic stimulation; the frequency and duration of penile erection at night will also decrease; it is generally believed that the prevalence of erectile dysfunction tends to increase as age increases. Psychological factors lead to the occurrence of erectile dysfunction through special mechanisms, and the long-term lack of effective treatment of organic erectile dysfunction will increase the psychological burden of patients, the latter of which will further aggravate the condition and even transform it into the main aspect of the conflict. Physical diseases closely related to erectile dysfunction are: cardiovascular disease itself risk factors such as age, high blood lipids, smoking, etc. are also risk factors for erectile dysfunction, which suggests that the cardiovascular status of patients should be evaluated before starting treatment for erectile dysfunction, because erectile dysfunction may be a local manifestation of systemic atherosclerosis; diabetes can lead to systemic vascular and neurological lesions, which may cause erectile Studies have found that the higher the total serum cholesterol and the lower the HDL, the greater the likelihood of erectile dysfunction; chronic renal insufficiency, hyperprolactinemia, adrenal disease, thyroid disease, penile sclerosis and other somatic diseases can lead to erectile dysfunction. Drug-related erectile dysfunction accounts for 25%. Any trauma or surgery that damages the penile innervation, vascular supply and androgen source, including the resulting psychological factors, can lead to erectile dysfunction. Some studies suggest that smoking is an independent risk factor for erectile dysfunction and may synergize or enhance the effects of other risk factors, but the incidence of erectile dysfunction is not dependent on current or lifetime smoking; alcohol consumption can increase desire but may decrease sexual function; and men who have been using drugs for a long time are also more likely to develop erectile dysfunction.
Before the 1970s, people mostly used psychotherapy and some medication empirical treatment, but with little success; in the 1970s, penile prosthesis implantation began to be used in clinical practice, which promoted the treatment of erectile dysfunction; in the 1980s, local injection of vasoactive drugs opened a new page in the treatment of erectile dysfunction; in the 1990s, Pfizer’s Sildenafil was marketed, which became a historic milestone in the treatment of erectile dysfunction. The first-line treatment of modern erectile dysfunction is psychotherapy, oral medication and negative pressure suction device; the second-line treatment is transurethral drug delivery and intracavernosal injection therapy; penile prosthesis implantation is the third-line therapy. Before the 1960s, psychotherapy mainly used the psychoanalytic method for psychotherapy, which comes from Freud’s theory that sexual dysfunction is caused by psychological conflicts in the subconscious mind, so only through free association, dream interpretation and other methods to expose the psychological conflicts in the subconscious mind can these potential conflicts be solved, so as to cure the disease, and currently the most important psychotherapy is sexy The most important psychological treatment is sexy concentration training, the purpose of which is to lift the anxiety of both sides, improve communication and exchange between the two sides, so as to gradually improve the sexual function of both sides. Oral drugs are mainly phosphodiesterase 5 inhibitors, which can be divided into two categories: short-acting and long-acting, the former such as sildenafil and vardenafil, and the latter such as tadalafil. Psychotherapy and oral medications are currently the most important treatment methods for erectile dysfunction, and the rest of the treatment methods have limited application.
Second, erectile dysfunction and male infertility
Patients with erectile dysfunction not only affect the quality of sexual life, but also sometimes cause male infertility. If patients with erectile dysfunction cannot ejaculate in the vagina, or cannot have sex during their spouse’s ovulation period, or cannot successfully retrieve sperm when receiving assisted reproductive technology treatment in the hospital, all of these conditions may affect male fertility.
1. Erectile dysfunction and male fertility that cannot ejaculate in the vagina
If the problem of erectile dysfunction can be solved, the problem of male infertility can be solved at the same time. The specific psychological adjustment and medication mentioned above can be used.
If temporary erectile dysfunction is difficult to adjust and fertility problems have to be solved first, in vitro ejaculation can be performed in a clean container and then injected into the woman’s vagina with a syringe, which is equivalent to artificial insemination at home by yourself. If a period of time still can not achieve the purpose of fertility, then to the regular hospital for consultation and treatment
2, ovulation erectile dysfunction and male fertility
As we all know, having sex during ovulation will increase the probability of pregnancy, but this will cause a small number of men to have a psychological burden, the usual performance can be, once the ovulation fell off the chain phenomenon, we call it erectile dysfunction during ovulation, at this time the treatment method or psychological adjustment and drug treatment.
3, in the hospital to receive assisted reproductive technology treatment can not be successful sperm retrieval and male fertility
Most of the patients in this part of male infertility have no difficulty in masturbating to retrieve sperm at home or outside the hospital, but when masturbating to retrieve sperm in a specific hospital environment, they cannot successfully retrieve sperm due to high psychological pressure and environmental changes. Our experience in solving this problem is: first of all, we instruct patients to come to the hospital before the best practice at home more, this is like troop training, the usual exercises for the actual battle is very important, usually do not practice, the war is bound to appear a touch of the situation, sperm retrieval difficulties patients are the same, if they do not practice, to the hospital a nervous more unlikely to succeed; secondly, also auxiliary drugs, drug treatment program as described above If the first two find are not effective, the patient will have to undergo testicular sperm retrieval surgery, which will increase the trauma of the patient.
Ejaculatory dysfunction and male infertility
The main ejaculatory dysfunctions are premature ejaculation, delayed ejaculation, non-ejaculation, retrograde ejaculation and painful ejaculation. Among them, those closely related to male infertility are premature ejaculation, non-ejaculation and retrograde ejaculation.
I. Premature ejaculation and male infertility
1.Overview
Premature ejaculation is the most common sexual dysfunction. 75% of men have experienced premature ejaculation in their lifetime, and large-scale studies have shown that the incidence of premature ejaculation is 14% to 41%. At present, premature ejaculation is considered to be a condition in which a man ejaculates before, during or shortly after penetration under minimal sexual stimulation, either continuously or repeatedly during sexual intercourse, earlier than he wishes.
First of all, let’s understand the causes of premature ejaculation. The onset of many diseases is not only related to the organ itself, but also closely related to the psychological relationship, which is the same as many things in our daily life, for example, we all encounter bicycle axle is broken, then not only need to change the axle, but also point on the lubricant, the car can be restored to a good state, the onset of premature ejaculation is also the same, not only involving organic factors, but also involving psychological factors The first two factors are currently the most likely factors for premature ejaculation; regarding psychological factors, the main ones are insufficient ejaculation control skills, poor sexual experience in early years, anxiety and psychodynamic aspects. There is no evidence that masturbation can cause premature ejaculation. Some patients who masturbate develop the habit of ejaculating too quickly may have something to do with premature ejaculation, but there is no evidence that it is related to premature ejaculation; even some patients who masturbate pursue sexual pleasure, the intensity of stimulation during masturbation far exceeds that of the sexual process and can even lead to non-ejaculation.
The treatment of premature ejaculation is mainly behavioral therapy and medication (mainly oral medication). The actual fact is that you can get rid of the problem of premature ejaculation by using this method. The first choice of drugs for premature ejaculation is sertraline and other 5-hydroxytryptamine reuptake inhibitors, these drugs were originally neurological treatment for depression, during the treatment of depression, it was found that these drugs can significantly delay ejaculation, so clinicians use it as the first choice of drugs for premature ejaculation, there are two ways to take these drugs: continuously; or on demand, generally about 4 hours before sex, after the drug is absorbed Sexual intercourse is performed when the concentration is maximum. The current new drug Dapoxetine is the drug of choice for premature ejaculation.
2. Premature ejaculation and male infertility
If the patient can ejaculate in the vagina, it generally does not affect fertility.
If the patient has not yet inserted the vagina that ejaculation occurs, it may affect fertility, in this case, you can use the above-mentioned treatment for premature ejaculation; if it is difficult to improve the symptoms of temporary premature ejaculation, and to solve the fertility problem first, you can ejaculate in vitro in a clean container, and then use a syringe to hit into the vagina of the woman, equivalent to their own artificial insemination at home.
II. Non-ejaculation and male infertility
1.Overview
Ejaculation is the inability to ejaculate during sex, making it difficult to achieve orgasm, or even no orgasm. Ejaculation may be caused by psychological and organic factors: psychological factors such as lack of cooperation from the female partner, insufficient intensity of stimulation during sex, etc.; organic factors are usually trauma, such as spinal injury, etc. In addition, diabetes, chronic alcoholism and overdose of sleeping pills can also inhibit ejaculation.
2, non-ejaculation and male infertility
The treatment for male infertility patients who do not ejaculate are: psychological aspects of treatment; due to diabetes, chronic alcoholism and taking an overdose of sleeping pills, treatment can be given for the original cause; penile vibrators can also be used; if the previous measures do not work, male infertility patients who do not ejaculate during the treatment with assistive technology may have to undergo testicular puncture for sperm extraction.
III. Retrograde ejaculation and male infertility
1.Overview
Retrograde ejaculation is the retrograde ejaculation of semen into the bladder instead of ejaculating from the urethra during ejaculation due to insufficiency of the internal bladder sphincter (bladder neck). Retrograde ejaculation is one of the causes of male infertility, and its causes account for 0.3% to 2.0% of the male infertility population, and about 18% of patients with azoospermia. Classically, patients with retrograde ejaculation have orgasm and ejaculatory sensation but no semen. A few patients have 0.1~0.2 ml of semen due to the secretion from the urethral bulbous glands.
Patients with retrograde ejaculation are less common clinically, and the main reasons may be related to surgery, neuroendocrine diseases, urethral sphincter closure dysfunction and drugs.
2. Retrograde ejaculation and male infertility
Generally speaking, it is difficult to correct retrograde ejaculation patients to positive ejaculation, and their fertility problems can be solved by recovering sperm from urine for artificial insemination or IVF’s. However, human urine is hypertonic and acidic, while the appropriate pH of sperm is 7.2 to 8.0, which is alkaline, so the urine needs to be alkalized before sperm retrieval, otherwise it will affect sperm viability. There are two ways to reduce the damage of hyperosmolar and acidic urine to sperm: one is to leave a urinary catheter in place and instill a specific fluid into the bladder before sperm retrieval, but this method requires an indwelling urinary catheter and carries the risk of infection; the other method is to improve the pH of urine by taking alkaline drugs or alkaline drinks orally, the osmotic pressure of urine will change quickly after the drugs are taken orally, but it will return to the pre-treatment state after 120-150 minutes, and the pH will also be improved. to the pre-treatment state, and the pH will also change, and after some time it will also return to the pre-treatment state. Our experience is generally that patients take sodium bicarbonate orally three days in advance, 1 gram three times a day, and again orally on the morning of sperm extraction.