Ejaculation (AE) is a condition in which the penis can have normal erection and sexual intercourse, but cannot reach orgasm and obtain sexual pleasure and cannot ejaculate; or in other cases, semen can be ejaculated, but not in the vagina. The main manifestation is that no semen is ejaculated when the couple has orgasm together, but the man will have a history of masturbatory ejaculation or seminal emission, and will mostly go to the hospital for causing infertility.
At present, the clinical treatment of ejaculation is mainly divided into psychological and sexual education treatment, sexual behavior treatment, medication, physical therapy, and Chinese medicine treatment.
I. Psychological and sexual education treatment
Most AE patients are suffering from functional ejaculation, which is caused by excessive psychological stress and lack of knowledge about sex. When treating this type of patients, it is necessary to teach both husband and wife about sexual organs, physiology and sexual reactions, and pay attention to sexual intercourse posture and methods, eliminate wrong ideology and coordinate the relationship between husband and wife.
Both husband and wife should actively cooperate, and the wife should encourage her husband more, help him eliminate sexual anxiety, make him have sex in a fully relaxed and passionate psychological state, strengthen the intensity of stimulation, so that the penis can receive more sexual stimulation, so as to achieve the purpose of treatment.
Second, sexual behavior therapy
Sexual behavior therapy, mainly through sexy concentration training, so that patients gradually adapt to, familiar with the process of sexual intercourse, improve the patient’s own feeling of sexual response, reduce the anxiety and fear of sexual intercourse.
Sexual behavior therapy mainly includes 4 processes: non-genital sensual concentration training, genital sensual concentration training, vaginal accommodation and vaginal pumping, so that patients can fully enjoy the pleasure of sexual intercourse and thus achieve the purpose of treating AE.
In addition, in order to strengthen the stimulation of the penis, ejaculation can be further induced by masturbation, adjusting the frequency and time of intercourse and changing the position, such as female superior position, squatting position, where the female partner takes the initiative to move up and down to rub the penis with force.
Third, drug treatment
There are fewer types of oral medications used to treat AE, and the efficacy of medication for the treatment of ejaculation is still controversial internationally. Clinical studies have found that levodopa can activate the dopa system in the brain and inhibit the 5-hydroxytryptamine system to increase the excitability of the ejaculatory center, which is used for high ejaculatory center abnormalities.
And ephedrine taken half an hour before sexual intercourse can enhance the contraction of smooth muscle of the vas deferens and has the effect of promoting ejaculation, but it is prohibited in patients with hypertension, coronary heart disease and hyperthyroidism.
A recent study by Soler et al. found that oral administration of Midodrine (Midolphine) in patients with ejaculation improved the success rate of sperm retrieval. Patients were gradually increased from 7.5 mg to 15 mg per day and ejaculation was found to occur in more than 50% of patients.
IV. Physiotherapy
Ejaculation is induced by physiotherapy. It mainly includes PVS to induce ejaculation and EEJ to induce ejaculation.
PVS was first applied clinically in 1965 for ejaculation disorders where a complete ejaculatory reflex arc (above the T-o level) exists. By vibrating the dorsal penile nerve, the ejaculatory reflex arc located in the thoracolumbar segment of the spinal cord is stimulated to induce ejaculation, and its efficiency has been reported to be as high as 80%.
EEJ is suitable for patients with any ejaculatory disorder that affects the ejaculatory mechanism of the central and/or peripheral nervous system, and was first applied to humans in 1948 for the treatment of ejaculation. The electro ejaculator commonly used in clinical practice is a hand-carried rectal probe electro ejaculator, the principle of which is to insert electrodes from the anus to electrically stimulate the seminal vesicles and prostate to induce ejaculation.
PVS is very simple and non-invasive to use and does not require anesthesia compared to EEJ, therefore PVS is recommended as the first choice for patients with ejaculation disorders.
V. Traditional Chinese medicine treatment
In traditional Chinese medicine, the term “ejaculation disorder” is used to refer to sperm stagnation, which is mainly caused by Yin deficiency and fire, heart and kidney disorder, liver stagnation and fire, sperm shutdown, spleen and kidney deficiency, qi stagnation and blood stasis, and sperm channel blockage, and it is advocated to perform dialectical treatment. However, at present, Chinese medicine is mostly used clinically as an adjunct to treatment, or a combination of Chinese and Western medicine is used for the treatment of non-ejaculation.
References.
[1]Liu Guizhong,Bai Wenjun. Ejaculatory dysfunction and male infertility [J]. Chinese sex science. 2021,30(5): 49-51
[2] Meng X.H., Fan L.C., et al. Diagnosis and treatment of ejaculation[J]. Chinese Journal of Male Science. 2010,24(12): 56-58