Article 69: Environmental Factors Affecting Sperm Production and Psychological Factors in Chronic Prostatitis

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Treatment and recuperation of common diseases

Environmental factors affecting sperm production

1. Excessively high temperature: Temperature can also damage sperm production. For example, in men with cryptorchidism, if the testicles are in an environment 2-3°C warmer than the scrotum for a prolonged period, the spermatogenic cells can suffer irreversible damage and cease to divide and develop into sperm. Other factors such as high fever due to internal medical conditions, wearing tight pants that prevent the scrotum from dissipating heat, frequent hot baths, long-distance truck drivers, and workers in high-temperature environments can all lead to infertility due to excessively high scrotal temperature.

2. Radiation exposure: Spermatogenic cells are very sensitive to radiation. Direct exposure to radiation can gradually reduce the number of spermatogenic cells. However, this damage is related to the intensity of the radiation and the duration of exposure. Mild, temporary damage may allow fertility to recover, while excessively strong or prolonged exposure can cause irreversible infertility.

3. Medications: Some medications can affect fertility. For example, anticancer drugs like cyclophosphamide and vincristine can inhibit sperm production. Tripterygium wilfordii, used to treat rheumatoid arthritis, and colchicine, used to treat gout, have similar effects. The antiepileptic drug phenytoin sodium inhibits the pituitary gland's secretion of gonadotropins, indirectly affecting sperm production. Antihypertensive drugs like reserpine can interfere with normal erectile and ejaculatory activity. Testosterone can inhibit hypothalamic function, thus suppressing spermatogenesis.

4. Alcohol and Smoking: Excessive alcohol consumption can damage the liver, affecting its metabolism of estrogen and leading to excessive estrogen levels, which in turn reduces the secretion of pituitary gonadotropins. Excessive smoking can increase the thiocyanate content in semen, thereby inhibiting sperm motility. In particular, patients with varicocele have a sperm count that is 10 times lower after smoking compared to non-smokers with the same condition. Furthermore, environmental pollution should also be given serious attention.

The Influence of Mental and Psychological Factors on Male Reproductive Function

Psychological factors can affect male reproductive function. Male infertility caused by psychological factors is mainly due to abnormal mental and psychological states, which lead to neuroendocrine disorders, affecting testicular function and interfering with sperm production.

External stimuli can cause mental and psychological abnormalities, thereby affecting testosterone secretion and inhibiting sperm production. This is commonly seen in prisoners, athletes in training, introverted men after major surgery, and in cases of sudden stress.

Infertility caused by psychological factors mainly manifests as anejaculation and impotence.

Anejaculation caused by psychological factors is often related to premarital psychological trauma, inappropriate parenting, setbacks in first romantic relationships, marital discord, relationship disharmony, lack of mutual understanding and comprehension, and the resulting sexual aversion. In some cases, it is due to a lack of knowledge about reproductive physiology and sexual experience, fear of pregnancy, and aversion to sexual activity.

Psychogenic erectile dysfunction is often related to initial sexual failure, the influence of religious precepts, incorrect understanding of sex life, marital disharmony or dissatisfaction, mental depression, and long-term smoking and alcohol abuse.

Chronic prostatitis can affect male fertility.

Chronic prostatitis can cause severe erectile dysfunction, premature ejaculation, and other neurasthenia symptoms at certain stages of its course, and it also significantly reduces semen quality. One-third of semen comes from prostatic fluid, and inflammatory changes in the prostate alter the composition and physicochemical properties of seminal plasma. The semen of prostatitis patients may contain bacteria and their toxins, which can inhibit sperm motility, cause sperm poisoning, sperm agglutination, sperm decomposition, or shorten sperm lifespan. All of these factors can reduce male fertility to varying degrees.

Endocrine disorders and male infertility

The main endocrine disorders associated with male infertility include:

1. Pituitary disorders: Hyperpituitarism may initially present with increased libido and changes in body shape, followed by decreased libido, abnormal semen, impotence, and infertility. Hypopituitarism leads to decreased libido and sexual function, testicular atrophy, resulting in insufficient testicular endocrine function, impaired development of the seminiferous epithelium, reduced sperm count, or dead sperm, thus causing infertility.

2. Hypothyroidism: Seen in myxedema, cretinism, etc.

3. Hyperthyroidism: Seen in Graves' goiter, etc.

All three of the above conditions can lead to spermatogenesis dysfunction, resulting in a decrease in sperm count, an increase in dead sperm, and a decline in sperm motility. At the same time, patients may experience decreased libido, impotence, and other symptoms that can lead to infertility.

4. Diabetes: In patients with type 1 diabetes, degenerative changes occur in the seminiferous epithelium, resulting in a decreased sperm count, an increased number of dead sperm, and potentially significant erectile dysfunction. Type 2 diabetes has milder symptoms and less impact on fertility. Furthermore, type 2 diabetes typically occurs in older individuals, therefore its relationship with fertility is not close.

5. Cushing's syndrome: caused by excessive secretion of adrenocortical hormones, often seen in adrenal tumors. Patients experience decreased libido, impotence, low plasma testosterone levels, testicular atrophy, interstitial cell degeneration, and impaired spermatogenesis.

6. Feminizing adrenocortical tumors: These tumors can secrete large amounts of estrogen, causing feminization in male patients, atrophy of testicular tissue, impaired sperm production, and suppression of testosterone secretion, leading to infertility.

7. Addison's disease.