Drugs that cause ejaculatory dysfunction, identification of functional ejaculatory dysfunction, and causes of retrograde ejaculation.

61.

Drugs that can cause ejaculation failure

In the autonomic nervous system that regulates ejaculation, the excitability of the sympathetic nervous system plays a major role. Therefore, drugs that can cause ejaculatory dysfunction-the side effect of anejaculation-are mainly anti-sympathetic drugs used to treat hypertension, neurosis (such as depression), psychosis, and hormones.

(1) Antihypertensive drugs: Adrenergic nerve blocker - benzophenone ethinyl can cause 75% of users to experience anejaculation; half of the patients taking thioridazine complained of reduced semen volume or no semen ejaculation during orgasm; ganglion blocker - methyldopa can cause 14% of people to experience anejaculation. These antihypertensive drugs are now rarely used.

Reserpine, phentolamine, and chlorpheniramine hydrochloride can also cause ejaculatory dysfunction.

(2) Antipsychotic drugs: Amitriptyline, clomipramine, fentanyl, perphenazine, trifluridine hydrochloride, thioridazine, thiamethoxam, doxepin, and benzodiazepines can all cause ejaculatory disorders.

(3) Antispasmodics: such as atropine and propantheline can delay or prevent ejaculation.

The above situations can be collectively referred to as iatrogenic anejaculation.

62.

Differential diagnosis of functional anejaculation

Functional anejaculation is the most common type of ejaculatory disorder, accounting for over 90% of cases, but it is easily confused with the following diseases:

(1) Retrograde ejaculation: This is caused by incomplete closure of the bladder sphincter or excessive resistance of the membranous urethra. During intercourse, the semen enters the bladder retrogradely. These patients have ejaculation movements and sexual climax, but no semen is discharged. After intercourse, urine collection examination can reveal a large amount of sperm and fructose substances, which can confirm the diagnosis.

(2) Atonic ejaculation: Due to the insufficiency of the external sphincter of the bladder, the "pressure chamber" of the posterior urethra is not formed properly during ejaculation, and the ejaculation ability is reduced, so the semen is not ejaculated, but slowly dripped out. It is often caused by lesions of the sympathetic nervous system in the thoracic and lumbar region, so it is also called weak ejaculation.

(3) Other diseases such as semen production disorders, obstruction or absence of semen ejaculation tract, ejaculation disorders without sexual orgasm, etc.

63.

Common causes of retrograde ejaculation

There are many reasons for retrograde ejaculation, mainly including the following:

(1) Nerve damage: Trauma or surgical damage to the sympathetic nerves can cause retrograde ejaculation.

Retrograde ejaculation can be caused by procedures such as rectal resection, bladder and prostate surgery that damage nerves.

(2) Damage to the urogenital system: Due to pelvic fractures, urethral tears, surgical damage to the bladder neck sphincter, or transurethral resection of the prostate, the bladder neck sphincter loses its function, resulting in the inability of the internal urethral orifice to close during ejaculation, causing semen to flow back into the bladder. In particular, the frequency of retrograde ejaculation caused by transurethral resection of the prostate is as high as 89%.

(3) Endocrine diseases, mainly diabetes, especially in young patients, can cause diabetic bladder neck ataxia, which weakens the function of closing the internal urethral orifice and causes semen reflux during ejaculation.

(4) Drug effects: drugs such as guanethidine, reserpine and others can block adrenergic nerves, which can disrupt the contraction of various parts of the reproductive tract during ejaculation and cause semen to flow back into the bladder.

(5) Some young people use the method of pressing the urethra to ejaculate during intercourse in order to prevent pregnancy, which artificially causes retrograde ejaculation. Over time, when they want to get pregnant, they still cannot return to normal ejaculation through the urethra.

64.

Common causes of painful ejaculation

(1) Genital infections, such as seminal vesiculitis, prostatitis, penile fibrosis and cavernous body inflammation, cause congestion and edema of these organs. When ejaculating, the rhythmic contraction of the muscles of these organs causes pain during ejaculation.

(2) Sexually transmitted diseases such as gonococcal urethritis, genital stones, and tumors can also cause painful ejaculation;

(3) Psychological factors, such as anxiety caused by poor ejaculation, can induce spasmodic contraction of the perineal muscles, leading to painful ejaculation.

(4) Excessive sexual activity, excessively dry sexual activity, prolonged abstinence from sexual activity or frequent sexual activity can cause excessive work of the genitals and lead to painful ejaculation. Generally, it can be restored to normal after a few days of rest. Phimosis can also be a cause of painful ejaculation. Diseases of the anus, rectum and perineum can also cause neurogenic painful ejaculation.

65.

Types of premature ejaculation

There are several ways to classify premature ejaculation, the most common of which are as follows:

(1) In 1943, Shapiro classified premature ejaculation into type A, which is more common in the elderly and is often accompanied by erectile dysfunction, and occurs after they have good control; and type B, which is common in young people with normal libido and erectile function, who have never had good control over the ejaculation process.

(2) Cooper classified premature ejaculation into three types in 1969: Type I, which refers to primary premature ejaculation that occurs after puberty, without erectile dysfunction, but with premature ejaculation related to psychological anxiety; Type II, which refers to premature ejaculation that occurs suddenly and is related to erectile dysfunction and psychological anxiety; and Type III, which refers to premature ejaculation that occurs gradually, although psychological anxiety is not obvious, but is accompanied by decreased libido and erectile dysfunction.

(3) In 1989, Godpodinoff divided premature ejaculation into two main categories: primary premature ejaculation and secondary premature ejaculation. Primary premature ejaculation refers to premature ejaculation that has been present since the first sexual intercourse; secondary premature ejaculation refers to premature ejaculation that has gradually developed in men who previously had normal ejaculation function.

Premature ejaculation can also be divided into two main categories: ① Partner-related premature ejaculation, i.e. situational premature ejaculation, which improves when the partner changes, indicating that interpersonal conflicts that lead to antagonism play a role in maintaining sexual dysfunction.

② True premature ejaculation refers to ejaculation occurring within 15 thrusts or less than 1 minute when having intercourse with different partners or in different situations. It is also known as complete premature ejaculation. These patients tend to respond well to drug treatment.

66.

Western medicine's understanding of premature ejaculation

Premature ejaculation can be caused not only by psychological abnormalities, but also by neuropathological and organic lesions.

The summary is as follows:

(1) Psychological reasons: such as the psychological trauma caused by improper sexual awareness or behavior in childhood, resulting in feelings of guilt, anxiety, and lack of confidence in sexual life.

In 1997, Lee conducted a psychopsychological personality analysis of patients with primary premature ejaculation and normal controls using the Symptom Checklist 90 Revision (SCL-90-R). The results showed that there was no significant difference between patients with premature ejaculation and normal controls in terms of psychopsychological abnormalities, except for some abnormalities in depression, anxiety, psychosis, and hostility.

(2) Organic causes: such as penile hypersensitivity or increased excitability of sensory nerves, and dysfunction of the ejaculation center in distinguishing penile sensations.

Evidence suggests that in 1996, some scholars conducted a neuropathological study on patients with primary premature ejaculation and normal controls using penile vibration sensation measurement. The results showed that the penile sensation of patients with premature ejaculation was significantly lower than that of normal people. In normal people, the sensation increases with age, but this is not the case for patients with premature ejaculation. In particular, the sensation of the glans penis is too sensitive than that of normal people. During intercourse, the sexual impulses perceived by stimulation are too high, which leads to the brain's dysfunction in controlling the ejaculation reflex and thus causes premature ejaculation.

Other scholars have used penile dorsal nerve sensory evoked potential measurement and penile sensory evoked potential methods to study patients with primary premature ejaculation and normal control groups. The results showed that the latency of penile glans sensory evoked potentials in patients with premature ejaculation was significantly shorter than that in normal people, while the amplitude of penile glans sensory evoked potentials was significantly higher than that in normal people.

This indicates that the excitability of the dorsal nerve of the penis, especially the sensory nerve of the glans penis, is too high in patients with premature ejaculation, making the ejaculation reflex more likely to occur during intercourse and thus inducing premature ejaculation.

(3) Endocrine system: When the level of testosterone in the blood increases, the excitability of the ejaculation center increases and the threshold decreases, the ejaculation center is easily excited and ejaculation occurs prematurely.

(4) Other: Organic brain damage such as arteriosclerosis, spinal cord tumors, epilepsy, or vascular accidents can all manifest as premature ejaculation; various inflammations of the urinary system (such as balanitis, prostatitis, epididymitis, etc.), benign prostatic hyperplasia, seminal colliculus hyperplasia or seminal colliculus inflammation, drug withdrawal syndrome and morphine poisoning, alcohol poisoning, diabetes, taking drugs such as Despranmin, overwork, lack of close cooperation between partners, and other irritating injuries can also cause premature ejaculation due to the burden that local stimulation places on the ejaculation center.