Impotence and premature ejaculation are two common male sexual dysfunctions. Impotence, or erectile dysfunction, refers to the inability of the penis to achieve or maintain an erection hard enough for satisfactory sexual intercourse. Premature ejaculation occurs before intercourse or immediately after vaginal penetration, with a significantly shortened ejaculation latency period. Impotence and premature ejaculation are often associated with psychological and physiological factors, severely impacting the patient’s sexual life and fertility. It is recommended to seek medical attention promptly, identify problems early, and initiate appropriate treatment.
Clinical classification
Impotence can be divided into three categories according to the cause: psychological, organic and mixed. Premature ejaculation can be divided into primary premature ejaculation and secondary premature ejaculation according to the symptoms.
1. Classification of impotence
(1) Psychological impotence: This type of impotence is mainly caused by psychological factors, such as anxiety, depression, stress, tension, fear, etc. Psychological impotence usually does not have organic lesions, but is due to psychological factors interfering with the normal erection mechanism.
(2) Organic impotence: Erectile dysfunction caused by physical illness or injury. These diseases or injuries may include vascular disease (such as atherosclerosis, arterial stenosis), nerve damage (such as spinal cord injury, diabetic neuropathy), endocrine abnormalities (such as low testosterone levels), and drug side effects.
(3) Mixed impotence: Both psychological and organic factors exist. This type of patient is affected by both psychological factors and organic lesions, and treatment requires comprehensive consideration of both factors.
2. Classification of Premature Ejaculation
(1) Primary premature ejaculation: Premature ejaculation occurs during the first sexual intercourse, with the patient ejaculating before or shortly after the penis enters the vagina. Primary premature ejaculation is often related to factors such as the patient’s lack of sexual experience and lack of sexual skills.
(2) Secondary premature ejaculation: The patient once had a normal sexual life, but later developed symptoms of premature ejaculation due to primary disease or psychological factors.
Epidemiology
Contagious
Impotence and premature ejaculation are not contagious.
Incidence
1. Impotence, or erectile dysfunction, is a common condition among adult men. It’s estimated that approximately 150 million men worldwide suffer from impotence. Literature indicates that the prevalence of impotence among men over 40 in my country is 40.6%, with the incidence increasing significantly with age.
2. Premature ejaculation is also a common male sexual dysfunction. The prevalence of primary premature ejaculation and secondary premature ejaculation is approximately 2% to 5% and 20% to 30%, respectively.
High-risk population
1. Impotence is more common in middle-aged and older men, but it can also occur in younger men. Certain factors, such as cardiovascular disease, diabetes, and chronic prostatitis, may increase the risk of impotence.
2. Premature ejaculation is common among adult men, but the specific groups most susceptible to it may vary due to different research methods and definitions. It is generally believed that premature ejaculation may be more common in men who excessively masturbate before marriage, have frequent sexual impulses, or have psychological problems.
Causes
Overview
The causes of impotence and premature ejaculation are complex and can generally be categorized as psychological and organic, directly impacting a man’s erectile function and ability to control ejaculation. A range of risk factors, such as aging, chronic illnesses, unhealthy lifestyle habits, and medications, further increase the risk of impotence and premature ejaculation. Furthermore, triggering factors such as mental stress, excessive fatigue, and adverse sexual stimulation can directly trigger or exacerbate symptoms of impotence and premature ejaculation in certain situations.
Basic cause
1. Psychological factors
(1) Emotional problems: Stress in life, work, and interpersonal relationships can lead to anxiety, which in turn affects the normal functioning of sexual function. Depressive emotions such as low mood, low self-esteem, and loss of self-confidence can also lead to decreased libido and sexual dysfunction, resulting in impotence and premature ejaculation.
(2) Sexual psychological disorders: If men lack sexual knowledge or are influenced by bad sex education, they will form negative ideas about sexual behavior, which will lead to fear and anxiety about sexual behavior, thus affecting erection and ejaculation control.
(3) Relationship problems: Poor communication, emotional distance, or conflict between couples may lead to decreased libido and sexual dysfunction such as impotence and premature ejaculation.
2. Organic factors
(1) Vascular factors: Penile arteriosclerosis, arteriovenous fistula and other vascular diseases can affect the blood supply to the corpus cavernosum of the penis, leading to impotence.
(2) Neurological factors: Nerve damage caused by spinal cord injury, pelvic surgery or trauma may affect the nerve conduction of the penis, leading to impotence and premature ejaculation.
(3) Endocrine factors: Endocrine diseases such as low testosterone levels and hypothyroidism may affect male sexual function, including erection and ejaculation.
(4) Urogenital system diseases: Prostatitis and benign prostatic hyperplasia may cause the prostate to compress the urethra and sexual nerves, leading to dysuria and sexual dysfunction. Varicocele may lead to obstruction of testicular blood return, affecting testicular function and sex hormone secretion, and further affecting sexual function, causing impotence and premature ejaculation.
Risk factors
1. Age
As men age, their sexual function typically declines. Impotence and premature ejaculation are more common in older men because aging is associated with a variety of physiological changes, such as declining hormone levels and decreased vascular function.
2. Chronic diseases
Chronic diseases such as diabetes, hypertension, hyperlipidemia, as well as cardiovascular disease and arteriosclerosis are all risk factors for impotence and premature ejaculation.
3. Bad living habits
Smoking and excessive drinking can damage the body’s nerves and blood vessels, thereby increasing the risk of impotence and premature ejaculation.
4. Drug effects
If you need to take antihypertensive drugs, antidepressants, antipsychotics and other drugs for a long time due to medical conditions, the side effects of these drugs may affect your sexual function and lead to impotence and premature ejaculation.
Predisposing factors
1. Mental stress
Sudden mental stress events, such as increased work pressure and family conflicts, may lead to acute attacks of sexual dysfunction.
2. Overwork
After long periods of physical or mental labor, physical fatigue may lead to decreased sexual function and induce impotence and premature ejaculation.
3. Adverse sexual stimulation
Frequent sexual stimulation or an unfavorable sexual environment, such as excessive indulgence in pornographic content or a poor sexual environment, may cause men to experience premature ejaculation during their sexual life.
symptom
Overview
Impotence is primarily characterized by a man’s inability to achieve or maintain an erection sufficient for satisfactory sexual activity. Premature ejaculation, on the other hand, is characterized by premature ejaculation, typically occurring shortly after intercourse begins, shortening intercourse and affecting its quality.
Typical symptoms
1. Typical symptoms of impotence
(1) Difficulty in achieving an erection: The penis cannot achieve sufficient hardness for sexual intercourse under sexual stimulation.
(2) The penis cannot maintain an erection: Even if the penis begins to erect, it quickly becomes flaccid during sexual intercourse and cannot maintain sufficient hardness.
(3) Abnormal morning erections: Morning erections are a natural erection that occurs in men during sleep. Patients with impotence may experience a decrease or disappearance of morning erections.
2. Typical symptoms of premature ejaculation
(1) Early ejaculation: Ejaculation occurs shortly after sexual intercourse begins, usually less than 3 minutes.
(2) Unable to control the time of ejaculation: The patient is unable to control the time of ejaculation, resulting in a shortened sexual life.
Associated symptoms
complication
1. Psychological barriers
Long-term impotence and premature ejaculation can lead to a loss of interest in sexual activity and a significant decrease in libido. This can lead to feelings of frustration, anxiety, and even low self-esteem due to the inability to satisfy one’s own or one’s partner’s sexual needs. These psychological barriers not only impact a patient’s mental health but can also negatively impact their social and work lives.
2. Broken family relationships
Due to the disharmony of sexual life and the tension in the relationship between husband and wife, impotence and premature ejaculation may lead to the breakdown of family relationships and even cause serious consequences such as divorce.
3. Increased risk of cardiovascular disease
Impotence may be one of the early signs of cardiovascular diseases (such as hypertension and coronary heart disease). If these diseases are not treated in time, they may pose a more serious threat to the patient’s health.
examine
Scheduled inspection
Patients experiencing symptoms of impotence and premature ejaculation should seek medical attention promptly. Doctors typically perform a physical examination to gain a preliminary understanding of the condition. They may then recommend routine blood tests, blood biochemistry, serum hormones, penile ultrasound, cavernosal angiography, assessment scales, erectile function testing, and penile neuroelectrophysiological testing.
Physical examination
The physical examination includes a routine physical examination and specialized examinations of the secondary sexual characteristics, reproductive system, and nervous system.
1. Routine physical examination
The main focus is on checking general vital signs such as body temperature, blood pressure, respiration, heart rate, and mental state, to comprehensively assess the patient’s health status.
2. Secondary sexual characteristics
Special attention should be paid to the patient’s skin, body shape, fat distribution, bone and muscle development, the presence of Adam’s apple, the distribution and density of beard and body hair, and the presence of male breast development.
3. Reproductive system examination
Pay attention to the shape and development of the penis, including any deformities such as hypospadias, penile curvature, or penile induration. Also, check for normal testicular number, size, position, and texture. Men over 50 are recommended to undergo a digital rectal examination to determine if there is prostate hyperplasia or nodules.
4. Local neurological examination
Pay attention to the patient’s pain, touch, and temperature sensation in the lower abdomen, perineum, penis, and lower limbs. Check the bulbocavernosus reflex and cremasteric reflex if necessary.
Laboratory tests
1. Blood routine test
Including indicators such as red blood cells, hemoglobin, white blood cells, platelets, etc., as a routine examination, it is mainly used to understand the patient’s overall health status and help detect or rule out infectious diseases and blood system diseases.
2. Blood biochemistry
It mainly includes blood sugar and blood lipids, which are used to check whether the patient has underlying diseases such as diabetes or cardiovascular disease.
3. Serum hormones
Serum testosterone levels are significantly correlated with the severity of sexual dysfunction, particularly free testosterone, which can be elevated in patients with premature ejaculation. Other hormone levels, such as luteinizing hormone, prolactin, and thyrotropin, also play a role. Testing can be performed based on diagnostic needs.
Imaging examinations
1. Penile ultrasound
Typically, prostaglandins or papaverine are injected into the corpus cavernosum of the penis. Within 10 minutes after injection, penile length, circumference, and erection firmness are measured. Ultrasound examinations are also performed to observe parameters such as peak systolic velocity (PSV) and end-diastolic velocity (EDV) of the penile blood vessels. Penile ultrasound can reveal vascular lesions such as arterial insufficiency and venous occlusive insufficiency, helping to identify the specific causes of impotence and premature ejaculation.
2. Cavernous body angiography
Cavernous body angiography is primarily used to diagnose penile arteriovenous fistulas. Generally, prostaglandins or papaverine are injected into the corpus cavernosum to induce an erection. Then, a contrast agent is perfused, and continuous X-rays are taken. Reconstructed images clearly visualize penile blood flow, allowing for the timely detection and assessment of the severity of vascular lesions.
Other tests
1. Assessment Scale
Doctors can have patients fill out standardized questionnaires based on their condition to quickly understand their condition and medical history. For impotence, the International Index of Erectile Function questionnaire and the Erection Hardness Score can be used, while for premature ejaculation, the Premature Ejaculation Short Form, the Premature Ejaculation Index, or the Premature Ejaculation Diagnostic Tool Scale can be used.
2. Penile erectile function test
Penile erectile function testing primarily involves real-time monitoring of the hardness and duration of penile erections using a hardness tester. It is typically divided into nocturnal penile erection hardness testing and visual and auditory stimulation testing. The former monitors the penis for involuntary nocturnal erections over two consecutive nights, while the latter measures the patient’s penile erection after visual and auditory stimulation while the patient is awake.
3. Penile nerve electrophysiological examination
Using penile nerve electrophysiological examination can measure various sensory thresholds, evoked potentials, and penile sympathetic nerve skin reactions in the perineum, which can assist in determining the excitability of the glans penis, dorsal penile nerve, and sympathetic nerve, and help diagnose the cause of premature ejaculation.
diagnosis
Diagnostic principles
Impotence and premature ejaculation require a comprehensive assessment of the patient’s sexual function through detailed medical history, combined with physical examination, laboratory tests (such as sex hormones, blood sugar, blood lipids, etc.), sexual function tests (such as erection tests) and imaging tests (such as penile ultrasound).
Diagnostic basis
1. Diagnostic basis of impotence
(1) Medical history and sexual history (can be assessed using valid scales, such as IIEF and EHS).
(2) Key physical examination results, including penile deformity, prostate disease, signs of hypogonadism, and neurological and cardiovascular conditions.
(3) Laboratory test results, including glucose and lipid metabolism indicators, serum total testosterone or free testosterone, and bioactive testosterone.
(4) Other special examinations and assessment results, such as penile erectile function test, cavernous vascular function test, penile cavernous angiography and angiography, early vascular function assessment, neurological examination, etc.
2. Diagnostic basis of premature ejaculation
(1) Medical history and sexual history provided by the patient or partner, including short latency period of intravaginal ejaculation and poor control over ejaculation.
(2) Results of physical examination, neuroelectrophysiological examination, and laboratory tests (reproductive hormones and serum 5-HT).
(3) Other special examination results, including penile biosensory threshold measurement, transrectal ultrasound examination of the seminal vesicles, and functional magnetic resonance imaging of the brain.
treat
Treatment principles
The goal of treating impotence and premature ejaculation is to improve erectile function and prolong ejaculation time, thereby enhancing sexual satisfaction for the patient and the quality of life for both partners. Treatment focuses on controlling the cause and preventing complications. Treatment options include medication, surgery, treatment of the underlying condition, and psychotherapy.
Treatment of the cause
Impotence and premature ejaculation may be caused by underlying diseases. For patients with clear underlying diseases, etiology treatment is needed to control the underlying disease. For example, diabetic patients need to follow the doctor’s advice to use hypoglycemic drugs to control blood sugar and reduce the damage of high blood sugar to nerve endings, thereby improving the symptoms of impotence and premature ejaculation.
Drug treatment
1. Drug treatment of impotence
Treatment primarily involves phosphodiesterase type 5 inhibitors (PDE5i), which work by increasing penile arterial blood flow, causing congestion and dilation of the cavernous sinus, and promoting erections. Currently, my country has approved four selective PDESi or their generic equivalents for the treatment of erectile dysfunction: sildenafil, tadalafil, vardenafil, and avanafil.
2. Drug treatment of premature ejaculation
The mainstay of treatment for premature ejaculation is dapoxetine, a selective serotonin reuptake inhibitor (SSRI) that suppresses the urge to ejaculate, thereby treating premature ejaculation. Other SSRIs, such as paroxetine, sertraline, and fluoxetine, also have some therapeutic effects. Topical anesthetics can also be used to reduce sensitivity in the glans penis, thereby prolonging orgasm and treating premature ejaculation. Currently, these medications are available in a variety of formulations, including gels, creams, and sprays, containing ingredients such as lidocaine, prilocaine, or combinations of other medications.
Related drugs
Sildenafil, tadalafil, vardenafil, avanafil, dapoxetine, paroxetine, sertraline, fluoxetine, lidocaine, prilocaine
Surgical treatment
Surgery is not the preferred treatment for impotence and premature ejaculation and is only used when other treatments are ineffective. Penile prosthesis implantation can be used for impotence, while selective dorsal penile nerve resection can be used for premature ejaculation.
1. Penile prosthesis implantation
Penile prosthesis implantation is a treatment method that restores the patient’s erectile function by implanting an artificial assistive device. With the improvement of surgical techniques, prosthetic materials and mechanical stability, it has gradually become an effective treatment for patients with impotence.
2. Selective dorsal penile nerve resection
By selectively severing a portion of the dorsal penile nerve, the procedure targets the sensory input during ejaculation, reducing sensory input and raising the patient’s sensory threshold, thereby delaying ejaculation. This procedure is only suitable for patients with primary premature ejaculation and is an irreversible, nerve-destructive procedure. It should be carefully considered after careful analysis of the patient’s condition and objective examination.
Psychotherapy
Patients with impotence and premature ejaculation are prone to psychological problems, so sexual psychology guidance, psychological counseling, and behavioral therapy can all help restore patients’ sexual function.
1. Sexual psychology guidance
Patients should understand that sex is an important component of quality of life and should work with their partners to address this issue. Appropriately stimulate interest in sex and encourage them to increase the frequency of sex through psychological or pharmacological treatments, gradually learning sexual skills. Furthermore, care should be taken to avoid unfavorable times. Avoiding sex during illness, fatigue, high stress levels, relationship problems, or adverse circumstances can minimize the embarrassment of failure and the resulting physical and mental impact on both partners.
2. Psychological counseling
Psychological counseling should enable patients to correctly understand the condition of impotence and premature ejaculation, actively help patients find possible inducements and risk factors, improve or eliminate mental factors such as anxiety and depression, avoid excessive attention to the disease, and divert attention.
3. Behavioral therapy
Behavioral therapy can help alleviate symptoms of premature ejaculation. Classic behavioral therapies include the stop-go method and the glans squeeze method. The stop-go method involves stopping sexual stimulation when the man feels ejaculation is imminent. The squeeze method involves the partner manually squeezing the glans penis just before ejaculation.
Treatment cycle
The treatment cycle is affected by factors such as the severity of the disease, treatment plan, treatment timing, age and physical condition, and may vary from person to person.
Treatment costs
There may be significant individual differences in treatment costs, and the specific costs are related to the selected hospital, treatment plan, medical insurance policy, etc.
Prognosis
General prognosis
Some cases of impotence and premature ejaculation may resolve naturally after the causative factors are removed, but most require treatment. With active treatment, impotence and premature ejaculation can generally be cured or significantly improved. The key to a good prognosis lies in timely detection and standardized treatment.
Hazards
1. Impotence and premature ejaculation can prevent patients from enjoying a normal sex life, affecting marital relationships and family harmony. Patients may bear a heavy psychological burden, experiencing low self-esteem, anxiety, depression, and other psychological problems, which may even affect their work and personal life.
2. Impotence and premature ejaculation may be secondary manifestations of certain diseases. If not treated in time, the condition may worsen. For example, worsening prostatitis may lead to infection in other parts of the reproductive system and even affect fertility.
3. Although impotence and premature ejaculation usually do not directly lead to death, long-term psychological stress and emotional problems may have a negative impact on the patient’s overall health.
Curative
If the symptoms of erectile dysfunction and premature ejaculation are mild and not accompanied by serious organic diseases, they can usually be cured through active treatment and lifestyle adjustments. If the patient’s condition is more serious or is accompanied by organic diseases such as diabetes or prostatitis, treatment can significantly improve symptoms, but some chronic underlying diseases can only be controlled to a certain extent and are difficult to completely cure.
daily
Overview
Impotence and premature ejaculation are common sexual dysfunctions in men, seriously affecting their quality of life. Good daily routine management can help patients restore normal sexual function and improve the effectiveness of professional treatment.
Life Management
1. Regular work and rest schedule
Maintaining adequate sleep time and avoiding staying up late can help relieve physical fatigue and improve sexual function.
2. Moderate exercise
Appropriate physical exercise, such as jogging, swimming, and playing badminton, can help strengthen your physical fitness, improve local blood circulation, and promote the recovery of sexual function.
3. Psychological adjustment
Maintain a positive and optimistic attitude and avoid excessive anxiety, tension and other negative emotions. You can relax mentally through meditation, yoga and other methods.
4. Avoid bad habits
Quit smoking and limit alcohol consumption, avoid excessive masturbation and frequent sexual intercourse to reduce damage to the reproductive system.
diet
Dietary adjustment
A proper diet plays an important role in improving symptoms of impotence and premature ejaculation. Patients should focus on a balanced diet and consume more foods rich in protein, vitamins, and minerals to improve their physical fitness and sexual function.
Dietary recommendations
1. Protein-rich foods
Such as beef, fish, eggs, etc., protein is the main component of semen and sperm, which helps to improve sperm quality and sexual function.
2. Foods rich in vitamins
Fresh vegetables and fruits, such as vitamins C and E, are rich in antioxidants, which help protect the reproductive system from free radical damage.
3. Foods rich in zinc
Such as oysters, walnuts, peanuts, etc. Zinc is an important trace element in the male reproductive system, which helps maintain the normal function of sperm and the health of gonads.
Dietary taboos
1. Spicy and irritating foods
Foods such as chili peppers and garlic may irritate the prostate and urethra and aggravate symptoms.
2. Greasy food
Such as fried chicken, hamburgers, etc. These foods may cause increased blood lipids, affect blood circulation, and are not conducive to the recovery of sexual function.
3. Caffeine and alcohol
Excessive intake of caffeine and alcohol may depress the central nervous system and affect sexual function.
prevention
Preventive measures
Impotence and premature ejaculation are preventable. By adopting a series of scientific and reasonable lifestyles and healthy habits, the risk of their occurrence can be significantly reduced.
1. Psychological adjustment
Have a correct understanding of sexual behavior, avoid fear and anxiety, enhance emotional communication with your partner, and reduce stress.
2. Lifestyle adjustments
Control the frequency of sexual intercourse and avoid excessive sexual activity. Correct bad habits such as staying up late, smoking, and drinking alcohol, and keep exercising to improve your physical fitness.
3. Maintain personal hygiene
Keep your genitals clean to prevent infection. Get regular physical examinations to detect and treat potential diseases promptly.
Medical Guide
Outpatient indications
1. Symptoms of impotence and premature ejaculation persist or gradually worsen;
2. Impotence and premature ejaculation are accompanied by other discomfort symptoms, such as local symptoms such as frequent urination, urgency, pain during urination, increased urethral secretions, or systemic symptoms such as fatigue, lack of energy, and soreness of waist and knees;
3. Impotence and premature ejaculation place a serious psychological burden on patients;
4. Other severe, persistent or progressive symptoms and signs occur.
If the above situation occurs, you should go to the hospital for treatment in time.
Treatment department
Patients who suffer from impotence and premature ejaculation can go to the andrology department for treatment.
Medical preparation
1. Make an appointment in advance and bring your ID card, medical insurance card, medical card, etc.
2. A comprehensive physical examination may be performed, including examination of the external genitalia and local nerves. It is recommended that you wear clothing that is easy to put on and take off.
3. A blood test may be performed, and it is best to have the visit in the morning on an empty stomach.
4. If you have had medical treatment recently, please bring relevant medical records, examination reports, laboratory test results, etc.
5. If you have taken some medicine to relieve symptoms recently, you can bring the medicine box with you.
6. It is recommended that your partner accompany you to seek medical treatment.
7. Patients can prepare a list of questions they want to ask in advance.
Questions your doctor may ask
1. When did impotence and premature ejaculation begin to appear?
2. How often and how long do the symptoms last?
3. Is it more severe in certain situations (e.g., with certain sexual partners, in certain environments)?
4. Do you have a history of acute or chronic illness, especially diseases related to the reproductive system, cardiovascular system, and endocrine system?
5. Is there a history of surgery or trauma, especially related to the reproductive organs?
6. Do you have a history of using psychotropic drugs or abusing alcohol or drugs?
7. What is the frequency and satisfaction of your current sex life? How is your relationship with your sexual partner? Are there any communication problems or emotional stress?
8. What are your living habits like? Do you often stay up late or overwork?
9. Have you faced significant psychological pressure recently, such as troubles with work, family, or finances?
10. Have you ever received treatment? How effective was the treatment? Were there any adverse reactions?
What questions can patients ask?
1. Why do I suffer from impotence and premature ejaculation?
2. What treatment is needed? Medication, surgery, or psychotherapy?
3. How effective is the treatment? Can it be cured?
4. How do I need to adjust my lifestyle and eating habits during treatment?
5. How to deal with the psychological pressure and emotional problems caused by the illness?
6. Does my partner need treatment?
7. What is the prognosis after treatment? Will the disease relapse?
8. How to prevent recurrence or aggravation?