Impotence

Introduction to Yangshuo Impotence refers to males in sexual life, the penis can not be erect or erection is not strong or strong and soon, can not complete normal sexual life, or the penis can not be inserted into the vagina for sexual intercourse, impotence is also known as "yang do not lift", etc., is the most common Male sexual dysfunction, occasionally 1 or 2 times of sexual intercourse failure, can not be considered to be suffering from impotence. Only when the failure rate of sexual intercourse exceeds 25% can it be diagnosed as impotence. According to foreign statistics, impotence patients account for 37% to 42% of all male sexual dysfunction. Domestic surveys show that about 10% of adult males have impotence. The incidence of impotence increases with age. basic knowledge The proportion of sickness: 0.01% Susceptible people: male Mode of infection: non-infectious Complications: anxiety disorder premature ejaculation

Cause of impotence

Neurological factors (30%):

If the sexual psychology in childhood is traumatized, or the lack of sexual knowledge in new marriage, the tension and anxiety, or the marital relationship is not harmonious, the family relationship is not harmonious; or bad habits, such as excessive masturbation, so the sensitivity of the penis is reduced, Mental stress, excessive mental burden, etc. can lead to impotence; excessive mental or physical strength, or bad mental stimulation, such as excessive depression, sorrow, fear, etc., or lyrical indulgence, excessive sexual life can cause cerebral cortical dysfunction and impotence.

Nervous system lesions (25%):

Hypothalamic-pituitary tumor or other parts of the tumor, local brain damage, such as localized epilepsy, encephalitis, brain blood pressure, spinal cord injury, spinal cord tumor, chronic alcoholism, multiple sclerosis, pelvic surgery injury surrounding autonomic nerves, etc. Impotence can occur.

Chronic fatigue (30%):

The reason why fatigue can cause impotence is because the muscles are over-tired or the mental fatigue caused by excessive use of the brain, depression, nervousness, etc. interferes with the arousal of sexual desire, including the reduction of brain function and inhibits sexual interest, the emotional center of the cortical limbic system. Decreased excitability, as well as decreased secretion of androgen in the pituitary gland and testes, reduces sexual excitement.

Penile erection is a process of hemodynamic changes in the corpus cavernosum under neuro-endocrine regulation. When stimulated by sex, non-adrenergic non-cholinergic neurons secrete a neurotransmitter such as nitric oxide (NO), and nitric oxide enters the penis sponge. In the smooth muscle cells, guanylate cyclase is activated to convert the guanosine triphosphate into the second messenger-cyclic guanosine monophosphate (cGMP), and the intracellular cGMP concentration is increased, resulting in relaxation of the smooth muscle of the cavernous body and swelling of the corpus cavernosum. The arterial blood flow increases, the volume of the corpus cavernosum increases, and the white membrane around the corpus cavernosum is passively extended and elongated, so that the subdural venous vein of the draining corpus cavernosum is extended and narrowed by the pressure, the venous return resistance is increased, and the penis enlargement hardness is increased. , causing penile erection, with cGMP being degraded by phosphodiesterase V (PDE5) in smooth muscle cells, losing its activity and restoring tension after ejaculation, the penis turns into a weak state, due to the selective distribution of PDE5 in the corpus cavernosum Smooth muscle, so cGMP-specific PDE5 inhibitor is currently the preferred oral drug for the treatment of erectile dysfunction, prostaglandin E1 penile intracavernosal injection Treatment of erectile dysfunction, the mechanism of action is to increase cAMP synthesis by activating adenylate cyclase, which can induce relaxation of the corpus cavernosum smooth muscle, induce penile erection, in addition, adrenergic neurotransmitter mediates the corpus cavernosum Smooth muscle cell contraction, decreased penile blood flow, open venous return, resulting in penile weakness, phentolamine is an adrenergic receptor blocker for corpus cavernosum injection therapy for erectile dysfunction.

The etiology of impotence is complicated, and the study of pathological mechanism is in the process of gradual improvement. The exact pathogenesis is still not very clear. According to the causes of impotence, it can be divided into three categories: psychological, organic and iatrogenic. .

1. Psychological (cardiac, psychogenic): Psychological impotence accounts for 85-90% of the total number of impotence. It is the most common sexual dysfunction disease. The patient has no organic disease that causes sexual dysfunction. While the penis does not erect when sexual intercourse, but in some non-sexual activities, such as dreams or see some sexually stimulated books, movies, and bladder urine filled, the penis can be erect when masturbating, psychological impotence The mechanism may be due to a variety of mental and psychological factors that interfere with the cerebral central nervous system, so that the cerebral nerve center can not get enough excitement, and various psychological factors that cause impotence are more detailed in the following content.

2, organic: although organic impotence only accounts for 10 to 15% of the total number of impotence, but its cause is more, the pathology is complex, in general, congenital abnormalities, diseases, drug effects, iatrogenic and so on Caused by aspects.

1 genitourinary malformation: congenital penile curvature, double penis, small penis, penile scrotum displacement, bladder varus, urethral fissure, congenital testicular loss or dysplasia, penile cavernous fibrous scar formation, varicocele, etc. Malformation, bending, dysfunction of the cavern, etc., and not erection.

2 genitourinary diseases: genitourinary chronic inflammation secondary to impotence are more common, such as orchitis, epididymitis, urethritis, cystitis, prostatitis, etc., among which chronic impotence is most common in impotence, genitourinary surgery and Some injuries, such as benign prostatic hyperplasia, prostatectomy and urethral rupture, penis, testicular injury, etc. can cause impotence. Chronic renal failure patients often suffer from impotence due to testicular atrophy and testosterone decline.

3 endocrine diseases: impotence caused by endocrine diseases, mainly found in diabetes, hypothalamic-pituitary abnormalities and primary gonadal insufficiency, according to foreign reports, about 23% to 60% of male diabetic patients have different degrees of impotence, Its mechanism is mainly related to autonomic nerve fiber lesions on the corpus cavernosum, penile vascular stenosis, endocrine abnormalities and mental factors.

4 neuropsychiatric diseases: stroke sequelae, craniocerebral injury, cerebral palsy, myasthenia gravis, advanced syphilis, spinal cord injury, paraplegia, multiple sclerosis, lumbar disc herniation, chronic alcoholism, etc. can lead to impotence, mental insufficiency, schizophrenia Impotence, neurosis, depression, epilepsy, etc. can also occur impotence.

5 cardiovascular disease and drug effects can also lead to the occurrence of impotence, such as antihypertensive drugs methyldopa, reserpine, phenothiazine, cimetidine, metoclopramide, tricyclic antidepressants and hormone preparations (Estrogen, progesterone) has this effect.

3, iatrogenic: due to the doctor's reasons, the patient's impotence also occurs in the clinic, which may be due to the doctor's carelessness or explanation of the erectile dysfunction, or the patient may have misunderstood the doctor's explanation. Because of the guidance, some people have impotence in the process of treating other diseases. In addition, the patient's misunderstanding of the sexual knowledge introduced by the relevant books and magazines and some misleading can also cause impotence.

Impotence prevention

1. Eliminate psychological factors, have a full understanding of sexual knowledge, fully understand the influence of mental factors on sexual function, correctly treat "sexual desire", can not be seen as a disgusting thing and disgust and fear; can not be because of one or two times Frustration and frustration, lack of confidence; husband and wife should increase emotional exchanges, eliminate disharmony factors, tacit cooperation, the woman should care, caress, encourage her husband, try to avoid dissatisfaction, avoid stress on her husband; Concentration; especially when reaching the peak of sexual pleasure, when ejaculation, it is more concentrated.

2. Festival affairs, long-term sexual intercourse, immersed in pornography, excessive masturbation leads to mental fatigue, is one of the reasons for impotence, practice has proved that couples bed, stop sex for a period of time, avoid all types of sexual stimulation, let The central nervous system and sexual organs are fully rested and are effective measures to prevent impotence.

3. Diet nursed back to health.

(1) Eat more aphrodisiac food: Aphrodisiac food mainly includes dog meat, lamb, sparrow, walnut, bullwhip, sheep kidney, etc.; animal internal organs contain a lot of sex hormones and adrenocortical hormones, can enhance sperm motility, improve sexual desire, also belong to impotence In addition, zinc-containing foods such as mutton, beef, chicken liver, eggs, peanuts, pork, chicken, etc., arginine-containing foods such as yam, ginkgo, frozen tofu, squid, sea cucumber, cuttlefish, octopus, etc. Helps improve sexual function.

(2) Do not taboo: Some folk sayings, such as eating loofah will get impotence, etc., there is no scientific basis, prevention of impotence, premature ejaculation do not have to avoid taboo, avoid everywhere to prevent, increase psychological burden, but also avoid nutrient deficiency, physical weakness.

4. Improve physical fitness, physical weakness, excessive fatigue, lack of sleep, and long-lasting mental work are all factors of the disease. They should actively engage in physical exercise, enhance physical fitness, and pay attention to rest, prevent overwork, and adjust the functional imbalance of the central nervous system. .

5. Use medication with caution.

[Do more exercise can prevent impotence]

There are many benefits to exercise. In addition to being able to have a good body, cardiovascular help is also great. For men, exercise has a wonderful advantage: it can enhance sexual ability, according to Boston Medical University, Gordonstein. According to a large-scale study conducted by the Ph.D., a man who consumes at least 2,000 calories per day through exercise has a much lower risk of developing impotence than those who do not exercise.

The study selected nearly 600 men as subjects, and it took nine years. These 600 subjects initially had no sexual dysfunction. Then Dr. Gordonstein traced the lifestyle of these people and focused on some traditional It is believed that the factors related to impotence, such as smoking, alcoholism, non-exercise and overweight, have found that men with exercise habits have a lower chance of developing impotence.

Exercise can avoid cardiovascular disease and impotence, in fact, based on the same principle - this is related to whether there is enough blood flow to the organ needed, and exercise can keep the blood vessels open. In fact, impotence can be regarded as cardiovascular disease Early warnings, because the blood in the body can not be unblocked, the reaction of the penis erection is more obvious.

After many middle-aged men enter middle age, their work and family are very stable. They are easy to indulge in ease and gradually lose their interest in sports. Or they think that only those who have headache, brain heat, backache and leg pain. Need to exercise, but I don't know if regular exercise is closely related to the strength of sexual ability.

There are many types of sports that help "Aphrodisiac". Playing, walking, swimming, fitness, etc. are all good. The only "wrong" exercise is cycling - it will increase the chance of suffering from impotence.

Impotence complications Complications, anxiety, premature ejaculation

First, affect male fertility: the vast majority of impotence patients' genitals are difficult to normal erection, unable to carry out normal sexual life, can not let sperm lose to the female cervix, obviously can not give birth to the next generation. In patients with milder conditions, the common symptom is that the erection is not strong and can barely complete sex life. However, at this time, the patient's physiological function is in an unhealthy state, and the sperm quality is poor, and it is impossible to ensure a healthy small life. It can be seen that ED conditions can seriously affect the fertility of patients. Fertility is a big problem for male compatriots, so this problem is quite serious and patients must pay attention to it.

Second, trigger related mental illness: a large number of clinical cases show that male impotence is easy to lead to the emergence of depression. Many patients suffer from anxiety, inferiority, and marijuana loss due to impotence, which can lead to depression; in addition, depression and many treatments of yao can cause impotence. Impotence and depression have become two common diseases in modern men, and they are accompanied by each other, causing a vicious circle. Depression affects the normal life and work of patients and, in severe cases, endangers life.

Impotence symptoms Common symptoms Urine has white precipitate pleasure Lack of erection time Short fatigue anxiety Testicular atrophy Depression No testicles

First, the penis can not be fully erect or erect, so that it can not satisfactorily carry out normal sexual life.

Second, young people are anxious and impatient with impotence due to inadequate communication with their sexual partners or inconsistent sexual behaviors.

Third, occasional impotence, completely normal in the next one-time life, may be caused by temporary tension or fatigue, not morbid.

Fourth, although impotence occurs frequently, in the early morning or masturbation, the penis can be erected and can be maintained for a period of time, mostly caused by psychological factors.

Fifth, impotence persists and continues to progress, mostly caused by organic lesions.

Yangshuo inspection

Laboratory inspection

In addition to blood, urine analysis, prostatic fluid and semen routine, liver and kidney function, blood electrolytes, blood sugar, blood lipids, thyroid function, serum testosterone (TE), thyroid stimulating hormone (LSH), luteinizing hormone (LH) should also be measured. , prolactin (PRL), etc., at least one serum testosterone test should be done in patients with impotence. If there is no need to further examine other hormones in the normal range, the testosterone value will decrease in the case of gonadal function. If the serum testosterone level is low for the first time, It is best to repeat it again, and measure LSH, LH, PRL, etc. If the second testosterone value is still low, the patient may have hypogonadism. If the serum LSH and LH are normal or increased, the hypogonadism is primary. Testicular abnormalities, physical examination should pay attention to whether there is testicular or testicular atrophy, and whether the texture of the testis changes, hypogonadism secondary to pituitary disease, testicular size can be normal or slightly smaller, which is related to the length of pituitary disease, Increased serum PRL also indicates a problem with the pituitary gland, often accompanied by hypogonadism, patients with impotence, serum testosterone is not necessarily low, suspected of paralysis For patients with body tumors, a brain X-ray or CT tomography scan is needed to confirm the diagnosis.

Special inspection

When necessary, in conditional hospitals or specialists, mainly including penile vibration quantification, penile dorsal nerve somatosensory excitation potential test, nighttime penile erection test and other neurological examinations, as well as penile erection hardness, penile systolic pressure, penile blood flow measurement Vascular examination such as internal penile artery angiography, and further clear diagnosis of the degree of diseased lesions of impotence.

Diagnostic diagnosis of impotence

diagnosis

It should be emphasized that there are physiological fluctuations in the sexual function of normal males. When sexual function is stimulated by factors such as mental, emotional instability, fatigue, poor health or the womans cold or anti-sexual attitude. There may be a temporary "yangshuo". This kind of accidental phenomenon cannot be regarded as morbid. Only by excluding the influence of the above factors, under normal sexual stimulation, repeated sexual intercourse failures can be considered as impotence. Yangshuo or suspect that you are suffering from this disease, you should go to the regular hospital to find a specialist in a timely manner, and do not worry about medical treatment, delay the pathogenesis.

The diagnosis of impotence includes medical history, physical examination, laboratory examination and special examination. Because the etiology of impotence is complicated, the diagnosis of impotence should be cautious. The general procedure should be to first determine whether impotence exists and preliminarily assess the function. Sexuality or organicity, if necessary, through special examination to clarify the cause of organic impotence, individual cases need to organize multidisciplinary expert consultation.

1. Understanding the medical history is an important part of the doctor's diagnosis of impotence. Patients often only know that they are not able to do it. As for why they can't, it is not clear. When the doctor understands the medical history, the patient can ask for a quiet room because of personal privacy. And doctors should care about patients, get the trust and cooperation of patients and their families, some patients can not describe them actively, need doctors to inspire explanations, as patients should treat diseases correctly, overcome shyness, and hide their own development process of impotence. And related issues are told to the doctor so that the doctor can have more comprehensive and detailed information in order to make the correct diagnosis and treatment. The doctor should abide by professional ethics, keep the patient strictly confidential, and maintain the patient's privacy.

When asking about medical history, we should pay attention to the patient's marriage history, sexual life history, frequency of sexual intercourse, ability, impotence, whether it is sudden or gradual, whether there is night erection, the cause of sexual intercourse failure, what are the concerns, how is the wife's reaction? , culture, education, economic status, living conditions, etc., what diseases, what medicine to take, whether there is history of trauma, history of trauma, history of diabetes or other chronic history, such as atherosclerosis, hypertension, renal insufficiency, Hypothyroidism, such as masturbation habits, whether there is smoking, alcoholism and other hobbies, whether there is prostate removal, sterilization or other surgical history, with or without chronic prostatitis or epididymitis, seminal vesiculitis, varicocele history, Without taking a history of drugs that affect sexual function, it is basically possible to distinguish between mental impotence and organic impotence through medical history analysis.

2, patients should cooperate with the doctor to check the body, physical conditions such as blood pressure, nutrition and health status, secondary sexual development and male breast development and nipple secretion, etc., should also be checked to check for the presence or absence of testes. The size of the testicle changes in texture; whether there is abnormality in the scrotum and scrotum; whether the penis is deformed, phimosis, balanitis, dermatitis, etc., whether it has been circumcision; whether the penis has no nodules or curvature, how hard, rectal examination will be careful Check the size, texture and nodules of the prostate to see if there is benign hypertrophy, cancer or prostatitis. The normal seminal vesicles are generally undetectable. They can be touched during chronic infection and cancer. When these diseases are thickened, the walls of the seminal vesicle become thicker. And the toughness, gonorrhea, tuberculosis, or non-specific infection of the seminal vesiculitis and the formation of abscesses, the examination of the lower limbs can mainly provide information on genital blood supply, such as erectile dysfunction caused by vascular obstruction of penile blood flow obstruction, etc. The palpation of the femoral artery, radial artery, and dorsal artery can basically understand the blood supply of the penis. In addition, the penis should be directly palpated on both sides when the penis is not erect. Moving situation.

3, laboratory tests in addition to blood, urine analysis, prostatic fluid and semen routine, liver and kidney function, blood electrolytes, blood sugar, blood lipids, thyroid function, should also determine serum testosterone (TE), thyroid stimulating hormone (LSH), corpus luteum Producing hormone (LH), prolactin (PRL), etc., at least one serum testosterone should be measured in patients with impotence. If there is no need to further examine other hormones in the normal range, the testosterone value decreases in the case of gonadal function. If serum is measured for the first time The testosterone level is low, it is best to repeat it again, and measure LSH, LH, PRL, etc. If the second testosterone value is still low, the patient may have hypogonadism. If the serum LSH and LH are normal or increased, the gonadal function is low. Is a primary testicular abnormality, physical examination should pay attention to whether testicular or testicular atrophy, and testicular texture changes, gonadal function secondary to pituitary disease, testicular size can be normal or slightly smaller, which is related to pituitary disease The length of time is related to the increase in serum PRL, which indicates that there is a problem with the pituitary gland, often accompanied by hypogonadism. In patients with impotence, serum testosterone is not necessarily low, and there is suspected pituitary tumor. A brain X-ray or CT tomography scan is needed to confirm the diagnosis.

4. Special examinations are carried out in conditional hospitals or specialties when necessary, mainly including quantitative measurement of penile vibration, somatosensory excitation potential test of penile dorsal nerve, nervous system examination of night penile erection test, penile erection hardness, penile systolic pressure , penile blood flow measurement, penile internal angiography and other vascular system examinations, to further make a more clear diagnosis of the degree of diseased lesions of impotence.

The main points of diagnosis of impotence are as follows:

(1) A married man's penis can't be erect or erect, so it can't be done, which is the main clinical manifestation of this disease.

(2) Impotence has two kinds of primary and secondary, and there are organic and functional points. The primary impotence is that the penis has not entered the vagina for sexual intercourse, and the secondary impotence has After sexual intercourse, but after the obstacles.

Organic impotence shows that the penis can not move at any time, neither erect during sexual excitement (such as when sleeping and filling the bladder), nor spontaneous erection; functional impotence has spontaneous erection, but The house erection failed.

(3) The vast majority of the disease is caused by mental and psychological factors. Therefore, patients are in varying degrees of mental state such as stress, fear, depression, anxiety and distress.

(4) Some patients with this disease are lack of normal sexual knowledge, so it is necessary to ask the patient about their sexual intercourse and other issues to find out the cause.

(5) Excluding functional impotence, should be combined with other signs to track the primary disease.

If you are secondary to diabetes, you should do blood and urine sugar test.

Differential diagnosis

1. Premature ejaculation: Impotence often coexists with premature ejaculation, but the two are fundamentally different in concept. When the premature ejaculation is sexual intercourse, the penis can be erected and can reach enough hardness to insert into the vagina, but the erection time is short, even just touching the vagina That is, ejaculation, the penis then quickly weak, so that sexual intercourse ends prematurely, the fundamental feature of premature ejaculation is to be able to have sexual intercourse, but can not make the woman reach orgasm; while the thin is the penis can not erect or erection, the intensity is very poor, can not be sexual intercourse, The clinical manifestations of the two are the same, and attention should be paid to the identification.

2. Sexual apathy Indifferent libido is a decrease in men's sexual desire, and can also indirectly affect the frequency of erection and sexual intercourse of the penis, but the penis can be normally erected during sexual intercourse.

3. Yang contraction: sudden onset of yang contraction, with penile contraction pain, accompanied by less abdominal arrest, severe pain, cold and cold limbs, can also affect sexual intercourse, but impotence is characterized by weak penis, can not erect, There is no penile retraction, pain and other symptoms.

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