male sexual dysfunction
Introduction
Introduction Male sexual dysfunction refers to male sexual function and sexual satisfaction and incompetence, often manifested as sexual desire disorder, impotence, premature ejaculation, nocturnal emission, no ejaculation and retrograde ejaculation. Sexual behavior is not only instinct but also physiological activity based on mental and psychological activities. Therefore, male sexual dysfunction is caused by organic diseases such as systemic diseases and reproductive system diseases, and most of the patients are sexual psychological dysfunction. There are significant differences in sexual function or sexual function requirements between different individuals, or the same individual at different ages, cultural backgrounds, and other conditions. Therefore, when diagnosing the disease, it is important to understand the exact meaning of the patient's symptoms in order to make a correct diagnosis.
Cause
Cause
Etiology classification
The etiology of this disease is very complicated. At this stage, although there is still insufficient understanding of the pathophysiological process causing sexual dysfunction, sexual dysfunction is not caused only by functional disorder. There are many organic diseases that cause sexual function. obstacle. According to their etiology, they are classified as follows:
First, sexual psychology and sexual response physiological dysfunction
1. Sexual desire to arouse obstacles: Excitatory or abnormal inhibition of cerebral cortex, manifested as low sexual desire, loss, disgust, hyperthyroidism or inversion.
2. Penile erectile dysfunction: impotence or abnormal erection.
3. Ejaculation disorders: premature ejaculation, nocturnal emission, no ejaculation or retrograde ejaculation.
4. Sensory Disorder: Painful erection, painful ejaculation, loss of erotic orgasm, absence or inappropriate delay.
Second, organic diseases related to sexual dysfunction
1. Systemic diseases: Some systemic, chronic wasting diseases can cause loss of libido. Such as heart disease, tuberculosis, severe malnutrition, chronic renal failure, high blood pressure, malignant tumors, etc.
2. Nervous system diseases: Tumors, injuries, inflammation, etc. of the nervous system cause disturbances in sensation, movement, and other functions.
3. Endocrine system diseases: diabetes, hypogonadism, hypothalamic pituitary lesions, adrenal cortical lesions, thyroid lesions, etc.
4. Reproductive system diseases: genital dysplasia, hypospadias, penile cavernous induration, penile scrotum elephantiasis and prostatitis, seminal vesiculitis, sputum inflammation and other chronic inflammation.
5. Others: Long-term excessive drinking, smoking, narcotics, and a large number of antihypertensive drugs, anticholinergic drugs, estrogen and other antiandrogens, and lead or detoxification.
Examine
an examination
Related inspection
Male sexual function test comprehensive test
First, medical history
Male sexual function can vary with age, sexual activity experience, health status, environment and personal psychological factors. Patients may lack their proper understanding of normal knowledge, and often assess their sexual function status based on subjective feelings and judgments. . Therefore, the patient's health history and sexual life history must be asked in detail to clarify the exact meaning of the symptoms. To understand the patient's sexual desire, sexual frequency, penile erection and duration, with or without ejaculation, past masturbation and nocturnal emission history. Understand the patient's working environment, living conditions, marital status, couples' feelings and sexual life. In order to make a comprehensive estimate of the patient's mental, psychological and sexual function, it is conducive to further examination and diagnosis.
Second, physical examination
First, we must observe the appearance of the patient, check the development of the second sexual characteristics, check whether the external genitalia is deformed or injured, the size, texture, and deformity of the pill. When suspected genital tract inflammation, a digital rectal examination should be performed to check the size of the prostate and seminal vesicles. Texture, with or without tenderness.
Third, laboratory inspection
Determination of plasma testosterone, estradiol, prolactin, progesterone, follicle stimulating hormone, and thyroxine and blood sugar. If the plasma progesterone is increased and the sputum is decreased, the lesion is in the testis; for example, the plasma progesterone and testosterone are decreased, the prolactin is increased, and the lesion is under the hypothalamus. For example, plasma testosterone and thyroxine (T3, T4) are simultaneously increased with the thyroid gland. The function is related to hyperactivity. If you have suspected genital tract inflammation, you can do a prostate biopsy.
Fourth, nervous system examination and other
Check the feeling of the vulva or perineum or reflect. Intravesicular pressure, bulbar muscle reflex and penile night erection were measured.
1. Ball sponge body muscle reflex "squeezing the penis head, stimulating the perianal skin can cause contraction reflex of the muscles of the bulbospongiosus, ischial corpus cavernosum, free muscle around the urethra, perineal superficial transverse muscle and anal sphincter, and Recorded by electromyography. The normal conduction time is 28-42 milliseconds, and the reflex time of patients with neurogenic plague and lower neuron lesions is prolonged.
2. Penile night erection measurement The change in the size of the penis at night was measured by a plethysmographer, that is, the degree of erection of the penis at night, the number of erections, and the duration of erection. The maximum erection difference of the normal penis circumference is 1.36-4.8 cm. When the circumference diameter is increased by 1.6-2.ocm, the effective erection firmness can be obtained. The functional erect penis is normal at night.
Diagnosis
Differential diagnosis
It should be differentiated from the following symptoms:
1. Psychological sexual dysfunction: Non-organic sexual dysfunction refers to a group of sexual dysfunctions closely related to psychosocial factors. Commonly, loss of libido, impotence, premature ejaculation, lack of orgasm, vaginal fistula, pain of sexual intercourse.
2. Difficulties in sexual intercourse: Couples in sexual life may cause genitals to be difficult to cross each other for some reason. Sexual intercourse is difficult to complete, psychological barriers are the main factors, but also due to congenital defects or organic diseases, or the reasons for sexual intercourse techniques, various factors often cause each other, causing sexual intercourse difficulties.
