Men’s sexual dysfunction refers to male sexual function and sexual satisfaction incompetence, often manifested as libido disorder, Yang thinning, premature ejaculation, seminal emission, non-ejaculation and retrograde ejaculation. Sexual behavior is both instinctive and physiological activities based on psychological activities, so men’s sexual dysfunction in addition to some due to systemic diseases and reproductive system diseases and other organic lesions, most patients belong to the psychosexual dysfunction. As different individuals, or the same individual at different ages, different cultural backgrounds and different other conditions sexual function itself or the requirements of sexual function exist very different. Therefore, when diagnosing this disease, it is important to find out the exact meaning of the symptoms described by the patient in order to make the correct diagnosis.
1, men’s sexual dysfunction etiology etiology classification
The etiology of this disease is very complex, at this stage of the pathophysiological processes that cause sexual dysfunction is still lacking sufficient understanding, but sexual dysfunction is not only due to functional disorders, there are many organic diseases that cause sexual dysfunction.
According to its etiology classification as follows.
A, sexual psychology and sexual response physiological dysfunction
1, sexual desire arousal disorder cerebral cortical sexual excitation or inhibition abnormal, manifested as low sexual desire, lack of, aversion, hyperactivity or inversion.
2, penile erectile dysfunction impotence or abnormal sustained erection.
3.Ejaculation disorder premature ejaculation, seminal emission, non-ejaculation or retrograde ejaculation.
4.Sensory disorders painful erection, painful ejaculation, diminished, absent or inappropriately delayed erotic orgasm.
Second, the organic diseases related to sexual dysfunction
1, systemic diseases Some systemic, chronic wasting diseases can cause hypersexuality. Such as heart disease, tuberculosis, severe malnutrition, chronic renal failure, hypertension, malignant tumors, etc.
2, neurological diseases tumors, injuries, inflammation of the nervous system, resulting in sensory, motor, ejection and other functional disorders and affect sexual function.
3, endocrine system diseases diabetes, hypogonadism, hypothalamic pituitary lesions, adrenal cortical lesions, thyroid lesions, etc.
4, reproductive system diseases genital development abnormalities, hypospadias, penile cavernous sclerosis, penile scrotal elephantiasis and chronic inflammatory diseases such as prostatitis, vesiculitis and spermatorrhea.
5, other long-term excessive alcohol consumption, smoking, narcotics into disease a large number of anti-hypertensive drugs, anticholinergic drugs, estrogen and other anti-androgen drugs, as well as lead or deodorant poisoning.
Mechanisms
Normal male sexual function includes the processes of libido impulse, sexual intercourse action, erotic orgasm and ejaculation. To accomplish normal sexual activity, there must be a sound sexual function of the central nervous system, sex hormone regulation and reproductive organs. Any of these organs, any of the links of dysfunction or deficiency, can lead to male sexual dysfunction.
Male functional centers include the erectile center and ejaculatory center in the cerebral cortex, limbic system and spinal cord. Stimuli related to sexual arousal are transmitted to the cerebral cortex and other sexual function centers through visual, auditory, taste, smell and tactile nerve endings to cause sexual arousal, especially direct stimulation of the genital organs and other erogenous zones, which can unconditionally excite the sexual centers. The hypothalamus-pituitary*gonadal (testicular) axis regulates the secretion of sex hormones. In males, androgens promote and maintain the development and maturation of the reproductive organs, and in adult males, they keep the sexual centers and organs in a state of readiness to respond to appropriate stimulation.
The control of erection and ejaculation in the spinal cord is mainly accomplished by the following structural components: the first is the afferent nerve, whose role is to transmit various stimuli received by the genitalia to the spinal cord; the second is the erection and ejaculation center of the spinal cord, located in the S2-S4. segment of the spinal cord is the parasympathetic erection center, which receives external stimuli and instructs the corresponding sexual organs to respond. The sympathetic erectile center, located in the T11-L2 segment of the spinal cord, is thought to transmit central sexual information stimuli from the brain. The ejaculatory center of the spinal cord also has a dual locus: one is the sympathetic segment located in the T11-L2 segment of the spinal cord, where the first stage of orgasm and ejaculation of semen are controlled; the second is the S2-S4. segment of the spinal cord, but here it is autonomic or called somatic nervous system innervation.
The third part of the reflex arc consists of the effectors, the efferent nerves. The efferent nerve can be either a sympathetic post-sympathetic or somatic nerve. When the sexual impulse is transmitted, the parasympathetic erectile center of the spinal cord sends nerve impulses via the parasympathetic nerve to the cavernous arteries of the penis, causing a large amount of blood to fill the penile tissue and causing an erection. In turn, the penile erection subsides. If sexual stimulation is sufficient to cause orgasm, another reflex mechanism comes into play. The sympathetic centers from T11 to L2, via the sympathetic nerves in the lower abdomen, cause the seminal vesicles, vas deferens and prostate to contract, expelling their respective contents and mixing them into seminal fluid. At the same time nerve impulses cause contraction of the internal bladder sphincter to prevent semen from entering the bladder or urine from entering the urethra. In addition, the sciatic cavernosus, bulbocavernosus, urethral and perineal muscles contract strongly and rhythmically to eject semen.
If some functional or organic causes cause the brain sexual arousal inhibition, sexual afferent or efferent nerve transmission dysfunction, spinal cord pathological injury, or endocrine dysfunction caused by androgen secretion deficiency, etc., in clinical manifestation can be a decrease in libido, and in severe cases impotence; if the brain sexual excitation or inhibition of ejaculation center dysfunction, can show premature ejaculation or non-ejaculation. If the nerve regulation of the ejaculatory center is disordered, retrograde ejaculation may occur due to urethral obstruction.
2.Clinical manifestations
(1) Impotence means that the penis does not have erection or erection is not firm and cannot have normal intercourse. Impotence can be caused by organic lesions or mental factors. Impotence caused by organic lesions is manifested by the penis not being erected at any time, while impotence caused by mental factors is only when the penis is not erected during sexual excitement or sexual intercourse, but it is possible to have an erection in the usual or sleep state.
(2) Premature ejaculation means that although the penis can be erected, ejaculation during sexual intercourse when the penis is inserted into the vagina before or immediately after contact with the vagina, and normal sexual intercourse activities cannot be carried out. There is no certain standard for early or late ejaculation during sexual intercourse, and individual differences are great. A person with normal sexual function can differ greatly in the speed of ejaculation under different conditions, so the occasional premature ejaculation during sexual intercourse in normal people should not be considered a pathological phenomenon. Only when the ejaculation is often too early to complete the process of sexual intercourse, it can be considered pathological. Therefore, you should not judge whether it is premature ejaculation by the early or late ejaculation during sexual intercourse or whether the woman reaches erotic orgasm.
(3) Seminal emission refers to ejaculation that occurs when there is no sexual activity. Seminal emission is a phenomenon that occurs in more than 80% of unmarried young adults and is not necessarily a pathology. Only frequent seminal emission over a long period of time is considered a disease. It is not a disease, but it is a disease of the body. Non-ejaculation should be distinguished from retrograde ejaculation, which has no semen ejaculation in clinical manifestation but erotic orgasm, only semen flowing backwards into the bladder.
(4) No libido, reduced libido Sexual desire refers to the desire for sexual excitement and sexual intercourse under certain conditions of stimulation. Sexual desire is a very general concept, the alleged change in sexual desire is difficult to have a unified standard, often are my own judgment. The change of libido should be measured from the frequent response to sexual life, and can only be considered abnormal if it does not cause sexual desire even under appropriate conditions of stimulation for a long period of time, or if there is a significant change in sexual desire under the same conditions. Under normal circumstances, changes in sexual desire are influenced by many factors such as age, mental and disease. Therefore, the absence of libido and reduced libido should not all be considered as sexual dysfunction.
Diagnosis of sexual dysfunction in men
I. Medical history
Male sexual function can vary with age, sexual activity experience, health status, environment and personal psychological factors, patients can be due to the lack of proper knowledge of normal sexual knowledge, often based on subjective feelings and judgments to assess their sexual function status. Therefore, it is necessary to ask the patient’s health history and sexual life history in detail to find out the exact meaning of the symptoms mentioned. To understand the patient’s sexual desire, frequency of sexual change, erection and duration of penis, ejaculation and history of masturbation and seminal emission. To understand the patient’s working environment, living conditions, marital status, couple’s relationship and sexual life cooperation. In order to make a comprehensive estimate of the patient’s mental, psychological and sexual function, which is conducive to further examination and confirmation of the diagnosis.
Second, physical examination
First of all, we should observe the appearance of the patient, check the development of the secondary sexual characteristics; check the external genitalia for deformities and trauma, the size and texture of the pellets, and the presence of deformities. If inflammation of the genital tract is suspected, rectal examination should be done to check the size of the prostate and seminal vesicles. The size and texture of the prostate and seminal vesicles, and the presence of pressure pain.
Laboratory tests
Plasma testosterone, estradiol, prolactin, luteinizing hormone, follicle stimulating hormone, thyroid hormone and blood glucose should be measured. If plasma luteinizing hormone is increased and kuromone is decreased, the lesion is in the testis; if plasma luteinizing hormone and testosterone are decreased, prolactin is increased and the lesion is in the suboptic thalamus; if plasma testosterone and thyroid hormone (T3, T4) are increased at the same time, it is related to hyperthyroidism. If inflammation of the genital tract is suspected, a microscopic examination of the prostate fluid can be done.
Neurological examination and others
Check the sensation or reflexes in the vulva and perineum. Measurement of intravesical pressure, bulbocavernosus reflex and nocturnal penile erection.
1, ball cavernosus muscle reflex “squeezing the head of the penis and stimulating the perianal skin can cause contraction reflexes of the ball cavernosus muscle, sciatic cavernosus muscle, perineal random muscle, superficial transverse perineal muscle and anal sphincter, etc., and can be recorded by electromyography. The normal conduction time is 28-42 ms. The reflex time is prolonged in patients with neurogenic phimosis and inferior neuron lesions.
2. Nocturnal penile erection measurement The size change of the penis at night is measured with a volumetric tracer, which reflects the degree of erection, the number of erections and the duration of erection at night. The maximum erection difference of normal penile circumference is 1.36-4.8 cm, and when the circumference increases by 1.6-2.ocm, an effective erection firmness can be obtained. Normal nocturnal erection of the penis in functional Yang layer.
Differential diagnosis of male sexual dysfunction
I. Sexual desire arousal disorder
The main manifestation is hypersexuality or absence of sexual desire, and very few patients have hyper sexual desire or inversion. It is sometimes very difficult to judge whether the libido is normal or not, and its measurement cannot be based on certain phenomena in individual cases. Only if the libido is not aroused under proper stimulation for a long time, or if the libido changes significantly under the same conditions, can it be called libido disorder. Sexual desire and age, health status, habitat assessment changes have a great sheep Xi. Individual differences are also great, generally men in 50 years of age after the libido gradually decline, excessive fatigue so that sexual excitement is weakened. Systemic, elimination of salary step taste clear mountain can cause a decrease in libido. Low libido refers to the previous normal libido, for some reason caused by a significant decrease in libido, known as low libido, but the sexual life of the couple’s requirements are not consistent or realm nymph one libido reduction is not included.
Second, erectile dysfunction
Also known as impotence, usually refers to men’s penis can not be erected under the demand of sexual desire and intercourse, or the penis can be erected but can not maintain sufficient hardness, so that the penis can not be placed in the vagina during sexual intercourse, or placed in the vagina that is weak. It is the most serious male dysfunction. Impotence can be divided into primary and secondary, with the latter being more common and 10 times more common than primary impotence. Occasional erectile dysfunction is a fairly common phenomenon, especially when one is older, mentally stressed, or overworked. This temporary erectile dysfunction is not a pathological phenomenon. Penile erectile dysfunction caused by organic lesions is characterized by progressive aggravation of the disease, no nocturnal or early morning erections, and inability to erect the penis under sexual stimulation, although sexual excitement can be aroused. In contrast, functional erectile dysfunction caused by psychological factors such as over-indulgence, anxiety, depression, panic, and suspicion is more common. Functional phallic exhibition can start suddenly, often with nocturnal or early morning erections, and can also be positive for functional phallic exhibition erections with a poppy base test. Caution should be exercised when judging the results of the poppy booster test, as vascular lesions can be excluded in cases of satisfactory erections. Those with poor results are not completely sure that it is a vascular positive exhibition, and must be repeated injections or a combination of other methods to determine.
Ejaculation disorder
Premature ejaculation, delayed ejaculation, non-ejaculation and retrograde ejaculation are all ejaculation disorders. While premature ejaculation is a common type of ejaculation disorder, there is no satisfactory and exact definition of premature ejaculation in clinical practice. Therefore, there are different diagnostic criteria for premature ejaculation. For example, some people call the occurrence of ejaculation within 30 seconds after penile insertion into the vagina as premature ejaculation. However, it is generally called premature ejaculation when the penis ejaculates before, during or immediately after entering the vagina during sexual intercourse, resulting in penile weakness. It has been reported that 3/4 of men ejaculate within 2 min after penile insertion into the vagina, and newlyweds are excited and nervous. Lack of sexual experience, premature ejaculation symptoms are not uncommon. The vast majority of premature ejaculation is due to dysfunction. The majority of premature ejaculation is due to dysfunction. Due to the eagerness for sexual life, the sexual center excitement increases when the erection is easy and premature ejaculation can occur. The fact that the sexual excitement is increased due to weakened internal inhibition can also make premature ejaculation occur. The actual fact is that you can find a lot of people who are not able to get a good deal on a lot of things. However, neuropathy or inflammation of the genital tract may be the organic cause of premature ejaculation, such as posterior urethritis, prostatitis or vesiculitis.
The opposite of premature ejaculation is delayed ejaculation or non-ejaculation, which manifests as difficulty in ejaculating vaginally. This is the least common of all male sexual dysfunctions and has only been considered a disorder in recent years. Many men occasionally experience temporary ejaculation disorders due to excessive force during intercourse or other forms of high arousal. The complete inability to ejaculate vaginally or to achieve orgasm is generally referred to as ejaculatory impotence. Most of these patients can achieve orgasm through masturbation, while 15% cannot ejaculate even outside the vagina. The etiology is mostly functional. A few can be caused by lumbar sympathetic neuropathy, surgery, or ganglion blocking drugs. There is another type of ejaculation disorder called retrograde ejaculation. It is due to the loss of contraction of the internal sphincter of the bladder, resulting in retrograde ejaculation of semen into the bladder during ejaculation. It is characterized by the absence of a history of ejaculation, sexual activity, orgasm and pleasure, but no ejaculation. Retrograde ejaculation is caused by organic lesions, such as congenital developmental abnormalities, urethral stricture, retrograde ejaculation can occur after urethral prostatectomy or bladder neck dissection. Local sympathetic innervation disorders can also cause retrograde ejaculation. Retrograde ejaculation can be detected by post-coital urinalysis, which can reveal a large number of sperm in the urine. In this way, it can be differentiated from non-ejaculation.
Seminal emission
Seminal emission refers to ejaculation during non-coital intercourse. Generally, after sexual maturity of unmarried men, spermatorrhea can occur l to 2 times a month, called “sperm full of self overflow” belongs to the normal physiological category. This kind of seminal emission mostly occurs during sleep, or in erotic dreams, or after excessive fatigue. In some cases, due to long-term masturbation, excessive sexual intercourse, or neurasthenia, the sexual center of the patient is easily provoked, and the seminal emission can occur during waking hours due to a momentary sexual urge. This seminal emission may be an early symptom of sexual dysfunction such as premature ejaculation and impotence. Spermatorrhea is a functional disorder caused by mental factors and is not accompanied by organic lesions.
4, men’s sexual dysfunction prevention
The perfect sexual life needs to be accomplished through both physical and mental aspects, which complement each other and are indispensable. Therefore, to achieve a happy marriage and room coordination, need from the spirit and physical, male and female, two pairs of contradictions, four aspects, the key is ” mutual motivation ” and ” mutual coordination “, otherwise it may produce sexual frustration and sexual dysfunction.
To achieve these requirements, it is necessary to pay attention to some of the following factors.
(1) establish the correct understanding of sex Because our country is influenced by thousands of years of feudal thought, the sex knowledge mystified, or as dirty obscene, never openly discussed, only private circulation, and even less research. In fact, sex and diet, urination and defecation, are the same life behavior, are normal physiological phenomenon. Think that sexual behavior is dishonorable, dirty, sexual intercourse is nothing more than childbirth, breeding, sexual intercourse is detrimental to health and other misconceptions, need to be discarded in the mind, otherwise it will have a negative impact on the normal sex life.
(2) remove mental pressure In addition to the above-mentioned many misconceptions, there are a variety of fears, which can generate strong mental pressure, inhibit sexual excitement response. Such as normal sexual response before sexual intercourse, good erection of the penis, and once acting, the penis immediately shriveled, fear of sexual partner dissatisfaction, fear of sexual partner discomfort, etc.
(3) create a stable environment for sexual intercourse The environment of sexual intercourse has a very important impact on the development of sexual response, should avoid any dry worry outside of sexual intercourse.
(4) create a very relaxed and happy atmosphere before and during sexual intercourse, must maintain a cordial and harmonious atmosphere and emotions.
(5) mutual care of their respective preferences sexual intercourse is often the highest expression of love between men and women, in the process of lovemaking and sexual intercourse, such as mutual care, each taking the initiative to pitch in, can enhance love, growth of pleasure.
(6) pay attention to the art of expressing sexual requirements When you want to put forward sexual requirements to your partner, it is best not to speak directly, pay attention to the art of expression.
(7) familiar with the physiological functions of the sexual organs before sex and during intercourse, should be fully aware of the parts most likely to induce sexual excitement.
Treatment of sexual dysfunction in men
In the treatment of male sexual dysfunction “six-union therapy” is very scientific, here using a combination of Chinese medicine treatment, is worthy of respect. The company’s products and services are designed to meet the needs of the market.
1.Special detection
For the complex etiology of sexual dysfunction, Doppler penile artery blood flow analyzer and various items related to male sexual dysfunction are used for special testing, including sex hormone level, prostate, erection measurement, penile blood flow, blood sugar, blood pressure, etc., which can accurately identify the causes of sexual dysfunction.
2.Psychological treatment
By the sexual psychology experts and patients for deep psychological communication, really clear patient subconscious in the root of the obstacle, and targeted to take the corresponding psychological barriers, increase the patient’s confidence in sexual function recovery.
3.Drug infiltration
Using a combination of Chinese and Western medicine therapy, targeted regulation of the sexual nerve and gonadal axis, while regulating the function of the epithelial cells of the penile arteries, so that the blood vessels moderate expansion, increase blood flow two, activate the cavernous body power, significantly improve the hardness of the erection, so that the erection time is prolonged, restore the normal ejaculation threshold of the human body.
4, sexual dysfunction treatment also need to coordinate couple sex life
In the treatment of sexual physiological dysfunction before, we must first conduct the corresponding exclusion, to see whether it is caused by the organic aspects of sexual dysfunction, if necessary, surgical treatment can be used. If it belongs to the mental aspect, psychological treatment should be carried out, and then supplemented with medication. The treatment process requires mutual understanding and cooperation between men and women, and can selectively carry out “sexy concentration training”, in order to achieve faster and better results. In addition, to try to do less alcohol, less smoking, more exercise.
5, older male sexual dysfunction
After people enter old age, the sexual organs and their functions are gradually declining like other organs in the body. However, although male fertility decline, but there is no obvious termination boundary, more than 90 years old can still continue to produce sperm. Although the sexual physiological response of the elderly is weakened, it does not mean that the sexual function of a person is necessarily lost after entering old age.