Sexual dysfunction in older men

Introduction to sexual male dysfunction in older men After entering the old age, the sexual organs and their functions gradually decline like other organs in the body. However, although male fertility declines, there is no obvious limit of termination. Older people over 90 can still produce sperm. Although the sexual physiological response of the elderly is weakened, it does not mean that the sexual function of the human being will inevitably be lost after entering the old age. basic knowledge The proportion of sickness: 0.5% - 0.8% (the incidence rate of elderly men over 60 years old is about 0.5% - 0.8%) Susceptible population: elderly male Mode of infection: non-infectious complication:

Etiology of elderly male sexual dysfunction

Mental and psychological factors (20%):

Erectile dysfunction is divided into three categories: psychological, organic and mixed. Most of the elderly are organic and mixed, and their incidence is significantly higher than that of young adults. Affected by traditional customary prejudice, one-sided understanding of the human aging stage will inevitably lead to sexual dysfunction, and even forced to suppress normal sexual requirements, resulting in disuse atrophy, loss of sexual ability, some long-term interruption of sexual life due to widowhood, once remarried Erectile dysfunction.

Organic factor (20%):

Many geriatric diseases can affect erectile function, and can not ignore the weakening or loss of erectile function may be a local clinical manifestation of systemic diseases, such as cardiovascular disease, cerebrovascular disease, diabetes, benign prostatic hyperplasia.

(1) Cardiovascular disease: common cardiovascular diseases refer to coronary heart disease, myocardial infarction, arteriosclerosis, etc. Penile arteriosclerosis causes penile blood vessels to be narrowed or weakened, and blood entering the cavernous body under sexual stimulation is insufficient to achieve sufficient blood. Flow rate (the maximum blood flow rate of the penis usually needs more than 25ml/s), which causes erectile dysfunction. The fear of excitement in patients with coronary heart disease can lead to coronary heart disease, worsening or dying. It is believed that erectile dysfunction is a natural manifestation of aging and is irresistible. According to statistics, in 81 cases of myocardial infarction, 59.3% of libido decreased, 40% of patients with myocardial infarction had erectile dysfunction, Hellerstein and Friedman studied atherosclerotic heart disease and coronary heart disease tendency but no myocardial damage Middle-aged people, heart rate can be as high as 117.4 beats/min (90-144 beats/min) during orgasm, lower than the highest heart rate achieved during normal work, 120.1 beats/min, and patients with myocardial ischemia ST-T changes. Sexual life center electrogram changes are usually no more serious than daily life, so the physiological consumption of sexual life is not too large, physical exertion in the whole process of sexual behavior Generally, there is no great risk to coronary heart disease patients. According to the survey of 5559 cases of sudden death, only 34 cases (0.6%) were caused by sexual intercourse, and 27 cases (70%) died of extramarital sexual intercourse with strong emotional changes. Eliminate the patient's fear, accept the endurance test of the heart, such as the car test, when cycling at 5 ~ 6km / h speed, heart rate, ECG, blood pressure, no significant changes, it is considered to be able to withstand sexual activity, of course, before drinking, avoid drinking and eating, Sexual intercourse should relax the position, not excessive force, such as chest pain and other discomfort, should slow down or stop sexual intercourse, while taking medicine or see a doctor, coronary heart disease patients have a restrictive life, it is also necessary.

(2) cerebrovascular disease: In 105 cases of cerebrovascular accident patients under 60 years old, 60% of patients still have sexual desire, and the right side paralysis patients are more likely to have decreased sexual desire, but most of the stroke patients are over 60 years old, due to Many people have reduced their sexual function due to psychological factors, physical condition, other types of diseases or taking drugs before the onset of illness. Once a cerebrovascular accident occurs, the effect on sexual function will be greater, except for cerebrovascular accidents. In addition to erectile dysfunction, there are often non-ejaculation, asexual orgasm, and affecting sexual life due to inconvenience. Patients and spouses also worry that sex life will lead to worsening of the disease. In fact, it is less dangerous, but it varies from person to person.

(3) Diabetes: Among Chinese patients with diabetes, 65% are over 50 years old, and 30% are over 60 years old. Among people with diabetes over 50 years old, 50% to 70% have erectile dysfunction, and 308 erectile functions in China. Among the patients with diabetes, there were 36 cases (11.7%). The erectile function caused by diabetes was mixed. In addition to psychological factors, it also caused neurovascular disease. The metabolic disorder of diabetes itself caused degeneration of peripheral nerve vessels. Polyol deposition on nerve fibers causes segmental demyelination and myeloid lipid synthesis in nerve fibers. 60% of diabetic patients can have autonomic neuropathy, vasomotor dysfunction, and 45 cases of diabetic erectile dysfunction through intravesical pressure In the detection of autonomic nervous system function, there were 37 cases of abnormalities (82.22%), and the somatosensory evoked potentials were detected by the body nervous system and spinal cord conduction abnormalities by 30% to 85%. Peking University First Hospital performed ball sponges for this type of patients. 61.1% (11/18) of abnormalities in body muscle reflex and somatosensory evoked potentials, diabetes can reduce lipid clearance and reduce vascular wall lysosomal lipids due to low plasma insulin Enzyme activity, hyperinsulinemia may cause triglyceride and cholesterol synthesis, it is deposited in the arterial wall, smooth muscle and connective tissue vascular intimal hyperplasia, penile arteries leading to diastolic dysfunction, erectile dysfunction generated.

(4) Prostatic hyperplasia: Prostatic hyperplasia is a common disease in older men. The autopsy specimens found that the incidence of 55-60 years old is 20% to 40%, 61-70 years old is 50% to 76%, and 71-80 years old is 57%. ~68%, there is no large-scale investigation of the relationship between benign prostatic hyperplasia and sexual life, but according to statistics, 10% to 30% of males need surgery for prostate hyperplasia, and one of the main complications of surgical treatment is erectile dysfunction. At present, the most commonly used surgical methods are transurethral resection of the prostate and suprapubic prostatectomy. Surgery usually does not damage the erectile nerves and blood vessels. There are fewer postoperative erectile dysfunction. Finkle and Prian report erectile function through transurethral surgery. Only 5% of the obstacles, the incidence of suprapubic surgery is higher, up to 10% to 20%. Transurethral surgery may damage the nerve vessels during coagulation and hemostasis. High-pressure perfusate can destroy the white membrane into the corpus cavernosum and destroy its structure. Most patients have retrograde ejaculation due to intraoperative intravesical sphincter damage. On the contrary, there have been reports of significant improvement in sexual function after surgery. 84 cases of 55-85 years old prostate hyperplasia in China After pubic prostatectomy, 25 patients (30%) had sexual dysfunction, 14 (17%) had loss, and 5 (6%) had hyperactivity. In the past, the treatment of benign prostatic hyperplasia was a single surgical treatment, and now it is converted into most of the medical treatments. Among them, -blockers are the main ones, which can relax the smooth muscle. It is observed that these drugs may have the effect of improving erectile function; One drug is a 5 reductase inhibitor, which inhibits the conversion of serum testosterone to dihydrotestosterone, which can cause sexual dysfunction in 3% to 4% of patients.

(5) Other factors: the elderly often suffer from endocrine disorders, liver and kidney diseases, obesity, etc., taking various drugs such as antihypertensive drugs, antipsychotic drugs, etc., affect the erectile function to varying degrees.

Degenerative changes in the gonads (20%):

In humans between the ages of 50 and 60, due to hardening of the arteries, the male gonads - the testicles begin to shrink, the seminiferous epithelium of the seminiferous tubules becomes thinner, the lumen expands, the spermatogenic function decreases, the sperm count decreases, and the vitality decreases. Above 90 years old, still retain spermatogenic function, testicular interstitial cells decreased and degenerative changes, increased lipofuscin, production of androgen testosterone decreased, free testosterone in blood decreased, plasma steroid-binding globulin increased Pituitary gonadotropin is gradually increased, and the secretion of androgen from the adrenal gland is also gradually decreased. Adult male testosterone is 6-8 g/L (600-800 ng/100 ml), and after 60 years old, serum testosterone is lower than 3 g/L (325 ng/100 ml). There may be burnout, loss of appetite, weight loss, decreased sexual desire or inhibition, loss of sexual function, lack of concentration, irritability and similar performance of female climacteric syndrome. After treatment with testosterone, the symptoms can be significantly relieved.

Loss of libido (20%):

Human sexual desire is related to psychological factors and endocrine factors. Androgen can stimulate sexual desire. With the decrease of androgen, human sexual desire also declines. Studies have shown that sexual function gradually declines after age 50. According to statistics, 476 elderly people over 60 years old have sexual desire. Only 6.3% (30 cases) remained strong, including 26 people aged 60-70 years old, only 4 people aged 70-80 years old, 50% (238 people) who lost 60-year-old libido, of which 60-65 years old was 12.44. %, 17.89% from 65 to 70 years old, 30.34% from 70 to 75 years old, 30.77% from 75 to 80 years old, and 67.66% from 80 to 85 years old. Japanese gold Chongshou investigated 55 males aged 65 to 80 years old who completely lost sexual intercourse. Only 12.7%, but the decline in sexual desire is not entirely dependent on testosterone concentration, psychological factors also play an important role, such as adult patients, due to various diseases or trauma to remove testicular patients, due to sexual experience before resection of the testis, sexual stimulation There will also be physiological reactions under induction. For couples with strong sexual interests and sexual behavior coordination, their sexual interests and abilities can be maintained at 90 years old.

Changes in frequency of sexual intercourse (10%):

In addition to the intensity of sexual desire, sexual frequency is also affected by sexual psychology, physical strength, mental state, education level, religious belief, sexual life coordination, life and environment. Foreign survey data show that the frequency of sexual intercourse in healthy elderly is : 60 times/week for 60-64 years old, 0.4 times/week for 65-74 years old, 0.3 times/week for 75-79 years old, and 0.1 times/week for 80 years old and older.

Sexual response cycle change (10%):

Sexual excitement in the elderly slows down with age, requires strong stimulation, and can achieve effective penile erection for a long time; due to weakened muscle tension, the elasticity of the penis cavern is reduced, the erectile function is weakened, and the time for ejaculation is prolonged due to the urethral cavernous body. The muscle contractility is reduced, the sperm range is short or overflows from the urethral orifice, the amount of semen is reduced, some can be injected without semen, and the refractory period is relatively prolonged after ejaculation, often requiring 12 to 24 hours or more.

Prevention of sexual dysfunction in elderly men

Active etiology treatment: Diabetes, hyperlipidemia patients should control the development of primary disease, excessive smoking and alcoholics should be non-smoking, all contribute to the recovery of sexual function.

Complications of sexual dysfunction in elderly men Complication

Complications are rare, but the elderly have psychological barriers.

Symptoms of sexual dysfunction in older men, common symptoms, libido, hypertension

Mainly manifested in sexual desire and erectile dysfunction.

Loss of libido

In the past, it is inevitable that the elderly will decline due to physical strength and sex hormones, and the decline and disappearance of sexual desire. Therefore, the elderly will not have sexual emotions, sexual demands and sexual behaviors. The natural physiological requirements of the elderly cannot be understood, even It is considered vulgar, and the elderly themselves are also influenced by traditional concepts. They regard their sexual requirements as indecent and think that sexual activities will affect their health, especially those with coronary heart disease or high blood pressure, adopt self-discipline and self-elimination. In the form of forced abstinence or separation, under the influence of this social psychological factor, it leads to abnormal performance such as sexual apathy and sexual annoyance.

In addition, the testosterone level of the elderly declines, the ratio of estrogen to testosterone imbalance, can also lead to loss of libido, sexual activity is reduced, so people with libido should understand whether it is caused by psychological factors or endocrine factors, the former should be psychological counseling, solve the problem Various reasons for psychological disorders; the latter is adjusted with the use of related hormone supplements, it should be noted that androgen supplementation should first exclude prostate cancer.

2. Erectile dysfunction

In 1994, the Massachusetts epidemiological survey of men aged 40 to 70 years old experienced 52% of erectile dysfunction, including 48% in 50-59 years old, 57% in 60-69 years old, and 67% in 70-year-old.

The erectile dysfunction in the elderly is mainly caused by organic and mixed factors. The organic factors include neurological, vascular, endocrine and genital structural lesions. The diagnosis should be carried out gradually, and attention should be paid to the various devices. The cause of the qualitative lesion.

Examination of sexual dysfunction in elderly men

Liver and kidney function, blood sugar, blood lipids and hormone levels are measured to help find the cause of erectile dysfunction.

1. Night nocturnal penile tumescence (NPT)

It is one of the important and objective indicators to distinguish between psychological and organic erectile dysfunction. Under normal 8h sleep state, the penis may have erection 3 to 5 times, lasting 15 to 25 minutes per time, and the hardness of erection should be 65%. With the increase of age, the intensity and duration of erection will be slightly reduced. For example, the abnormality of 8h detection is caused by organic factors, and it usually needs to be repeated 2 or 3 times.

2. Intracranial injection of vasoactive drugs in the penis

Vasoactive drugs from papaverine, phentolamine and prostaglandin E1, can be used alone, in combination with two or three drugs, normal erection occurs 5 to 10 minutes after drug injection, and can be maintained for more than 20 minutes under sexual stimulation, indicating penis The blood circulation function is still good, and the erectile dysfunction is late. The early or no hard erection of the erection may indicate that the penile artery has blood supply disorder or that the venous blood flow cannot be blocked.

Doppler ultrasound flow imaging color imaging technology can accurately observe the changes of penile artery diameter, maximum blood flow and resistance index before and after injection of vasoactive drugs, and can directly identify the presence of arterial or venous erection. Dysfunction, before the surgical treatment of suspected arterial lesions or venous return lesions, vaginal internal angiography should be performed to observe the dynamic perfusion test and angiography of the penile artery or corpus cavernosum on both sides to help diagnose the penile venous return obstruction. obstacle.

4. Detection of penile erectile nervous system

Determination of intracranial pressure, electromyography, measurement of bulbar and ischial corpus cavernoum muscle latency and somatosensory evoked potentials, assessment of functional status of autonomic and somatic nerves that govern penile erection, and identification of neurological disorders Caused by erectile dysfunction.

5. Penile cavernous biopsy

In patients with erectile dysfunction, the structure of the corpus cavernosum itself is abnormal, and the volume of smooth muscle is reduced. Even if the surgical correction of arterial blood supply and venous return disease is not satisfactory, the Meuleman study found that the 30-year-old penile cavernous smooth muscle volume accounted for 65%, while the 80-year-old only 48%, such as biopsy cavernous smooth muscle volume accounted for less than 30%, any arterial or venous surgery is not effective.

Peking University First Hospital conducted a series of examinations and comprehensive analysis of 503 patients with erectile dysfunction, confirmed 255 cases (50.7%), 224 cases (44.6%), of which 6.2% were arterial and 38.4% were venous. 30 cases (5.9%) were endocrine, 48 cases (9.5%) were neurological, and mixed erectile dysfunction was more than 70% in patients with erectile dysfunction over 50 years old.

Diagnosis and diagnosis of sexual dysfunction in elderly men

1. Medical history inquiry

Should be based on the characteristics of the elderly, in addition to understanding the extent of erectile dysfunction, the course of the disease, should also be particularly aware of the husband and wife's awareness of the elderly's sexual life, what diseases, history of trauma surgery, taking drugs and possible psychological barriers.

2. Physical examination

Older people often have high blood pressure and cardiovascular disease, so cardiovascular and other series of examinations are very necessary.

Many geriatric diseases can affect erectile function, such as cardiovascular disease, cerebrovascular disease, diabetes, and benign prostatic hyperplasia.

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