Ejaculation disorder
Ejaculation is a condition in which the penis can have normal erection and intercourse, but cannot ejaculate, or can ejaculate under other circumstances, but does not ejaculate in the vagina, and therefore cannot reach orgasm and obtain sexual pleasure. Normal ejaculation is a complex physiological process, a complex physiological reflex process involving the nervous system, endocrine system and urogenital system, and if functional or organic disorders occur in any part of the process, it can lead to ejaculation disorder. Ejaculation can cause male infertility, affect the relationship between husband and wife, and even lead to family breakdown.
Etiology
During sexual intercourse, the sexual organs (mainly the head of the penis) feel sexual impulses, which are transmitted through the afferent nerves to the spinal ejaculatory center and the ejaculatory center, and then through the efferent nerves to the effectors (vas deferens, seminal vesicles, jugular, bladder neck and prostate), inducing ejaculation and accompanying pleasure. This ejaculatory reflex is controlled by the brain. If functional or organic disorders occur in any part of the ejaculatory pathway, it can lead to ejaculatory disorders.
1.Functional non-ejaculation
(1) Psychological factors are common causes. If you are not satisfied with your spouse, the couple’s relationship is not harmonious, the pressure of thought, the sexual environment is not good, etc., can make the man take a restrained attitude towards sex, which will lead to non-ejaculation in the long run.
(2) lack of sexual knowledge couples lack of sexual knowledge, do not know how to have intercourse, or have fear of sex (such as the female fear of pregnancy or pain) and restrict the male partner to a large, rapid pumping, so that the male partner can not reach the threshold of ejaculation leads to non-ejaculation disorder.
(3) Sexual fatigue or ejaculatory failure Sexual intercourse or masturbation too often can easily cause dysfunction of the spinal ejaculatory center, triggering ejaculation.
(4) Long-term masturbation Long-term masturbators may cause non-ejaculation. As the intensity of sexual stimulation during masturbation mostly exceeds that during intercourse, the ejaculatory center is accustomed to the strong stimulation of masturbation and may not reach the ejaculatory threshold during intercourse. On the other hand, due to the influence of traditional concepts, masturbators usually have a sense of guilt and shame, which can also play an inhibiting role in ejaculation.
2, organic non-ejaculation
(1) Neurological lesions and injuries, such as lesions in the lateral lobes of the brain and spinal cord injuries, can cause ejaculation.
(2) Medical factors such as thoracolumbar sympathectomy and retroperitoneal lymph node dissection can damage the nerves and cause ejaculation.
(3) Local lesions of the genitourinary system such as hypertrophy of the seminal mound, prepuce or prepuce with narrowing of the prepuce opening, penile trauma, sclerosis, scarring, fibrosis, and severe hypospadias can cause ejaculation.
(4) Endocrine abnormalities diabetes mellitus, hypopituitarism, hyperthyroidism, etc. can cause ejaculation disorders.
(5) Pharmacological factors anti-hypertensive drugs, sedative and tranquilizing drugs or adrenaline blockers, as well as long-term alcohol or drug abuse, can induce ejaculation.
Clinical manifestations
During sexual intercourse, the patient’s penis erection can be maintained for a longer period of time without weakness, but cannot reach orgasm, there is no ejaculatory action, and no semen is discharged from the body. According to whether the patient usually has seminal emission and whether he can ejaculate through masturbation stimulation, he can be divided into functional and organic ejaculation. In functional ejaculation, which accounts for about 90% of cases, the patient has no semen discharge during sexual intercourse, but can normally ejaculate during masturbation or ejaculate during non-sexual intercourse. Organic ejaculation does not occur under any circumstances and can be accompanied by symptoms and signs corresponding to the primary disease.
Examination
It includes psychosexual evaluation, blood glucose, endocrine hormone measurement, post-ejaculatory urinalysis, urodynamic examination, and transrectal ultrasound, cystoscopy, and CT examination if necessary.
Diagnosis
The diagnosis of ejaculation is mainly based on the patient’s medical history, and the diagnosis is relatively easy. Combined with the physical examination and the results of the special tests mentioned above, the etiology can mostly be clarified. The disease should be differentiated from retrograde ejaculation and male erectile dysfunction.
Treatment
Ejaculation is mainly divided into psychological and sexual education treatment, sexual behavior treatment, medication, physiotherapy (mechanical or electrical stimulation to induce ejaculation), surgical treatment, and Chinese medicine treatment. For those with a clear cause, timely treatment of the primary cause is the primary factor in treatment.
1. Psychological and sexual education treatment
It is mainly used for those with functional ejaculation. In the treatment of this type of patients, both men and women should be taught the anatomy of sexual organs, general knowledge of physiology and sexual response, and pay attention to the sexual intercourse posture and method, eliminate wrong ideology and coordinate the relationship between husband and wife. The female partner should cooperate with the male partner, help the male partner eliminate sexual anxiety, make the male partner 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.
2.Sexual behavior treatment
Mainly through sexy concentration training, the patient gradually adapt to and familiar with the process of sexual intercourse, improve the patient’s own feeling of sexual response, fully enjoy the pleasure of sexual intercourse, and reduce anxiety and fear of sexual intercourse. In addition, in order to strengthen the stimulation of the penis, you can further induce ejaculation by masturbation beforehand, adjusting the frequency and time of intercourse, changing the position, and contracting the perineal muscles on the female side after male insertion.
3.Medication
There are fewer types of drugs used to treat ejaculation, and their efficacy is still controversial in the international arena. It has been clinically found that oral levodopa and ephedrine have a role in promoting ejaculation, but they are contraindicated in patients with hypertension, coronary heart disease and hyperthyroidism. The latest study found that more than 50% of patients could have ejaculation after taking Midodrine orally.
4.Physical therapy
It mainly includes mechanical and electrical stimulation to induce ejaculation. Physiotherapy combined with assisted reproductive technology is an effective method for treating patients with infertility due to ejaculation.
5.Surgical treatment
Mainly for diseases of the penis itself, such as circumcision and prepuce patients with narrow foreskin opening, surgical treatment can be used to remove the foreskin to reveal the glans can increase its sensitivity to stimulation and facilitate ejaculation.
6.Chinese medicine treatment
Chinese medicine treatment and acupuncture treatment have certain effect on ejaculation, and at present, Chinese medicine treatment is mostly used as an auxiliary means in clinical practice.