bubble_chart Overview

Male sexual function is a complex physiological process, accomplished through a series of conditioned and unconditioned reflex activities. Normal sexual function includes aspects such as sexual desire, penile erection, intercourse, ejaculation, and orgasm. Any abnormality in these aspects can affect normal sexual function, which is referred to as male sexual dysfunction. Common manifestations include:

1. **Erectile Dysfunction (ED)**: Refers to the inability to achieve or maintain an erection sufficient for normal intercourse. ED can be caused by organic diseases or psychological factors. Organic disease-induced ED is characterized by the inability to achieve an erection at any time, whereas psychologically induced ED may manifest as the inability to achieve an erection during sexual arousal or intercourse, while erections may still occur during non-sexual states or sleep.
2. **Premature Ejaculation (PE)**: Refers to the condition where the penis can achieve an erection, but ejaculation occurs either before penetration or immediately after contact with the vagina, making normal intercourse impossible. There is no strict standard for the timing of ejaculation during intercourse, as individual differences are significant. A person with normal sexual function may experience varying ejaculation speeds under different conditions, so occasional premature ejaculation in healthy individuals should not be considered pathological. Only frequent premature ejaculation that prevents the completion of intercourse should be regarded as pathological. Therefore, PE should not be judged solely based on the timing of ejaculation or whether the female partner reaches orgasm.
3. **Nocturnal Emission**: Refers to ejaculation occurring without sexual activity. Over 80% of unmarried young men experience this phenomenon, which is not necessarily pathological. Only frequent and prolonged nocturnal emissions are considered a disorder. Symptoms include ejaculation upon waking due to sexual thoughts or emissions occurring immediately upon falling asleep. Sometimes, secretions from the urethral glands and prostate due to sexual arousal are not nocturnal emissions and should be distinguished.
4. **Anejaculation**: Refers to the inability to ejaculate or achieve orgasm during intercourse despite prolonged activity, almost always caused by psychological factors. Anejaculation should be distinguished from retrograde ejaculation, where the latter presents clinically as the absence of ejaculate but with orgasm, as semen flows backward into the bladder.
5. **Loss of Libido or Decreased Libido**: Libido refers to the desire for sexual excitement and intercourse under certain stimuli. Libido is a broad concept, and changes in libido are difficult to standardize, often relying on personal judgment. Changes in libido should be assessed based on regular sexual responses. Only when there is a prolonged absence of sexual desire despite appropriate stimuli or significant changes under the same conditions should it be considered abnormal.

Under normal circumstances, libido fluctuates due to factors such as age, mental state, and illness. Therefore, loss of libido or decreased libido should not always be regarded as sexual dysfunction.

bubble_chart Diagnosis

Male sexual dysfunction can generally be divided into two major categories: psychological factors and organic diseases. During diagnosis, a detailed medical history should first be obtained. Misunderstandings about normal sexual function and a lack of scientific knowledge about sexuality are important causes of sexual dysfunction. The medical history should focus on sexual experiences, libido, penile erection, intercourse, ejaculation, orgasm, as well as the frequency and duration of sexual activity. If necessary, the spouse's account should also be sought and considered. Psychological erectile dysfunction often lacks positive signs during physical examination, and in most cases, no further tests are required for a definitive diagnosis. Next, understanding and examining morning penile erection is crucial. Organic erectile dysfunction cases show no morning erection, whereas 86% of psychological erectile dysfunction cases exhibit positive morning erection, with 14% showing false negatives, necessitating further examination. Methods such as the stamp test or erection ruler can be used to measure nocturnal penile tumescence. An artificial erection test may also be performed: injecting 30mg of papaverine and 0.5–1mg of tolazoline into one corpus cavernosum. Psychological erectile dysfunction typically results in a firm erection within 10 minutes, lasting several hours or longer, whereas organic erectile dysfunction does not. For organic erectile dysfunction, in addition to a thorough examination of the reproductive system, further evaluation of penile vascular conditions is necessary, as vasculogenic erectile dysfunction is a significant cause of organic erectile dysfunction. If required, detailed examinations of the nervous system and endocrine function should also be conducted.

During the diagnostic process, it is essential to gather as many specific details as possible about the symptoms, explore potential triggers and mechanisms, and avoid hasty conclusions—especially regarding diagnoses such as "sexual neurasthenia Guanneng ," "erectile dysfunction," or "premature ejaculation."

bubble_chart Treatment Measures

For sexual dysfunction caused by psychological factors, treatment should be tailored to each patient's specific {|###|}disease cause{|###|} and psychological factors. Helping patients understand the normal variations in sexual function and providing detailed explanations of the causes of their dysfunction are essential. Eliminating misunderstandings, alleviating concerns, and boosting confidence in recovery are critical therapeutic approaches. With patient-specific guidance and careful attention to each step of treatment, most patients can regain normal sexual function, sometimes even achieving immediate improvement with just the right words.

In psychotherapy, the doctor's serious, dedicated attitude and deep empathy are crucial. The patient's trust in the doctor holds special significance in treatment. A doctor's indifferent demeanor or careless conclusions can increase treatment difficulties, worsen the condition, and undermine the patient's confidence.

Male patients with sexual dysfunction may not experience physical pain, but they often bear immense psychological burdens. Spousal criticism can exacerbate the condition, making it essential to counsel both partners and secure the wife's active cooperation.

In terms of treatment, besides sex therapy, intracavernosal injection of vasoactive substances can achieve an efficacy rate of 80–100%. In rare cases, prosthetic implantation surgery may also be performed.

For organic erectile dysfunction, treatment should target the underlying disease. However, the impact of psychological factors should not be overlooked. Combining treatment for organic conditions with psychotherapy yields better results. For {|###|}stirred pulse{|###|} -related erectile dysfunction, vascular reconstruction surgeries—such as anastomosing the inferior epigastric {|###|}stirred pulse{|###|} with the dorsal penile {|###|}stirred pulse{|###|} or directly with the corpus cavernosum—can be effective. For venous leakage-related erectile dysfunction, ligation of the venous fistula may also produce certain therapeutic benefits.