Patient's question:
Why can't I stay hard during sex? It gets hard just as I'm about to enter, but then it softens, making it impossible to penetrate. It's really frustrating. However, when using a sex toy, it remains firm and strong. At that moment, even when my wife's vagina isn't wet, I can still insert it and complete the act, which lasts about eight minutes. It feels okay. Could you tell me what might be wrong? I'm really worried because this keeps happening. It feels like I'm dreaming. I'm desperate for a response. Please help me understand.Doctor's answer:
It is possible that you have erectile dysfunction.Erectile dysfunction refers to the inability of a man to achieve or maintain an erection sufficient for satisfactory sexual intercourse, or the inability to insert the penis into the vagina for sexual intercourse. It is also known as "impotence" and is one of the most common male sexual dysfunction disorders. Occasional 1-2 instances of sexual failure should not be considered erectile dysfunction. Only when the failure rate of sexual intercourse exceeds 25% can it be diagnosed as erectile dysfunction.
According to statistics from foreign sources, erectile dysfunction accounts for approximately 37% to 42% of all male sexual dysfunctions. Domestic surveys indicate that about 10% of adult men experience erectile dysfunction. The incidence of erectile dysfunction increases with age. Many men experience erectile dysfunction after the age of 50, and the incidence reaches its peak between the ages of 65 and 70. However, it varies from person to person and is not absolute.
【Etiology】
Most cases of erectile dysfunction are functional, while a few are organic. The common factors or causes include the following:
1. Psychological and neurological factors: such as trauma to sexual psychology during childhood, lack of sexual knowledge after marriage, tension and anxiety, marital discord, harmonious family relationships; or bad habits, such as excessive masturbation, which can lead to decreased sensitivity of the penis, mental tension, and heavy mental burden, all of which can cause erectile dysfunction; excessive mental or physical exertion, or adverse mental stimulation, such as excessive depression, sadness, fear, or indulgence in sexual activity, can all lead to dysfunction of the cerebral cortex and result in erectile dysfunction.
2. Neurological disorders: hypothalamic-pituitary tumors or tumors in other parts, focal brain damage, such as focal epilepsy, encephalitis, cerebral hemorrhage, spinal cord injury, spinal cord tumors, chronic alcoholism, multiple sclerosis, or pelvic surgery that damages the autonomic nerves can all cause erectile dysfunction.
3. Endocrine disorders: diabetes, hypopituitarism, testicular damage or dysfunction, or hypothyroidism and hyperthyroidism, or insufficient adrenal function can all lead to erectile dysfunction.
4. Urogenital organ disorders: such as prostatitis, benign prostatic hyperplasia, epididymitis, varicocele, etc., can often lead to erectile dysfunction. Some middle-aged and elderly patients develop erectile dysfunction due to prostatitis and benign prostatic hyperplasia.
5. Drug effects: many drugs have an inhibitory effect on sexual function, such as reserpine, guanethidine, digoxin, diazepam, furosemide, and metoclopramide, etc., can all cause erectile dysfunction.
【Pathology】
The etiology of erectile dysfunction is complex, and the study of its pathological mechanisms is gradually being refined. The exact pathogenesis is still not fully understood. According to the factors or causes of erectile dysfunction, it can be divided into three categories: psychological, organic, and iatrogenic.
1. Psychological (psychogenic, spiritual): psychological erectile dysfunction accounts for about 85-90% of all cases of erectile dysfunction and is the most common sexual dysfunction disorder. After examination, there are no organic diseases that cause sexual dysfunction, but the penis cannot become erect during sexual intercourse. However, under non-sexual activity conditions, such as in dreams or when reading or watching sexually stimulating books or movies, as well as when the bladder is full or during masturbation, the penis can become erect. The mechanism of psychological erectile dysfunction may be due to the interference of various psychological and psychological factors on the cerebral sexual center, resulting in insufficient excitation of the cerebral sexual nerve center. There are many psychological factors that can cause erectile dysfunction, which will be discussed in detail in the following content.
2. Organic: although organic erectile dysfunction accounts for only about 10-15% of all cases of erectile dysfunction, its causes are numerous and the pathology is complex. In general, it is not outside of congenital abnormalities, diseases, drug effects, and iatrogenic factors.
(1) Urogenital malformations: congenital penile curvature, bifid penis, micropenis, penile-scrotal transposition, retroverted bladder, urethral fissure, congenital absence or underdevelopment of testicles, fibrosis of the corpora cavernosa, varicocele, etc., can fail to become erect due to malformations, curvature, or dysfunction of the corpora cavernosa.
(2) Urogenital diseases: chronic inflammation of the urogenital organs leading to erectile dysfunction is relatively common, such as orchitis, epididymitis, urethritis, cystitis, prostatitis, etc. Among them, chronic prostatitis is the most common cause of erectile dysfunction. Urogenital system surgery and certain injuries, such as benign prostatic hyperplasia, prostatectomy, urethral rupture, penile or testicular injury, etc., can also cause erectile dysfunction. Patients with chronic kidney failure often experience erectile dysfunction due to testicular atrophy and decreased testosterone levels.
(3) Endocrine diseases: many cases of erectile dysfunction are caused by endocrine diseases, mainly seen in diabetes, hypothalamic-pituitary abnormalities, and primary gonadal dysfunction. According to foreign reports, about 23% to 60% of diabetic men develop varying degrees of erectile dysfunction. The mechanism is mainly related to the pathological changes of autonomic nerve fibers on the corpora cavernosa, narrowing of penile blood vessels, endocrine abnormalities, and psychological factors.
(4) Neurological and psychiatric diseases: post-stroke sequelae, cranial brain injury, cerebral palsy, myasthenia gravis, late syphilis, spinal cord injury, paraplegia, multiple sclerosis, lumbar disc herniation, and chronic alcoholism can all lead to erectile dysfunction. Intellectual disability, schizophrenia, neurosis, depression, and epilepsy can also cause erectile dysfunction.
(5) Cardiovascular diseases and drug effects can also lead to the occurrence of erectile dysfunction. Antihypertensive drugs such as methyldopa, reserpine, phenothiazine, cimetidine, domperidone, and 3-ring antidepressants and hormone preparations (estrogen, progesterone) can all cause erectile dysfunction.
3. Iatrogenic: erectile dysfunction caused by doctors or other factors in patients also occurs clinically from time to time. This may be due to the doctor's careless words or overly detailed explanations to patients with erectile dysfunction, or it may be due to the patient's misunderstanding of the doctor's explanation or guidance. In some cases, erectile dysfunction occurs during the treatment of other diseases. In addition, patients' incorrect understanding of sexual knowledge introduced in books and magazines, as well as certain misleading information, can also cause erectile dysfunction.
【Symptoms】
1. The penis cannot become fully erect or the erection is not firm enough to engage in normal sexual intercourse.
2. Young men may experience anxiety and irritability with erectile dysfunction due to insufficient emotional communication with sexual partners or inconsistent sexual behavior habits.
3. Occasional erectile dysfunction, where full erection occurs during subsequent sexual activity, may be due to temporary tension or fatigue and is not considered pathological.
4. Although erectile dysfunction occurs frequently, the penis can become erect and maintain it during morning erections or masturbation, which is mostly caused by psychological factors.
5. Persistent and progressively worsening erectile dysfunction is mostly caused by organic lesions.
【Diagnosis】
It is important to emphasize that normal male sexual function also has physiological fluctuations. When sexual function is affected by factors such as unstable mental and emotional states, fatigue, poor health, or a cold or negative attitude towards sexual life from the female partner, temporary "erectile dysfunction" may occur. This occasional phenomenon should not be considered pathological. Only when the factors mentioned above are excluded and repeated sexual failures occur under normal sexual stimulation can it be considered erectile dysfunction. If a person suffers from erectile dysfunction or suspects that they have the condition, they should seek medical attention from a specialized doctor in a regular hospital in a timely manner and should not hide the condition, as this may delay treatment.
The diagnosis of erectile dysfunction includes medical history, physical examination, laboratory tests, and special tests. Due to the complexity of the etiology of erectile dysfunction, the diagnosis should be cautious. The general steps are to first determine whether erectile dysfunction exists and to preliminarily evaluate whether it is functional or organic. If necessary, special tests can be performed to identify the cause of organic erectile dysfunction. In individual cases, multidisciplinary expert consultation may be required.
1. Understanding the medical history is an important part of the doctor's diagnosis of erectile dysfunction. Patients often only know that they are "not up to it," but they are not very clear about the reason why. When the doctor is inquiring about the medical history, due to personal privacy, the patient can request a quiet single room. The doctor should be caring and gain the trust and cooperation of the patient and their family. Some patients may be unable to describe the condition actively and may need the doctor to explain and guide them. As a patient, one should treat the disease correctly, overcome shyness, and frankly tell the doctor the process of the occurrence and development of erectile dysfunction and related problems, so that the doctor can obtain more comprehensive and detailed information to make a correct diagnosis and treatment. The doctor should abide by medical ethics, strictly keep the patient's privacy, and protect the patient's right to privacy.
During the medical history interview, it is important to understand the patient's marital history, sexual history, frequency and ability of sexual intercourse, erectile dysfunction status, whether it is sudden or gradual, and whether there is nocturnal penile tumescence. The factors or causes of sexual intercourse failure, concerns, and the wife's reaction. Cultural, educational, and economic status, living conditions, etc. What diseases, what medications, past history of mental trauma, trauma, diabetes, or other chronic diseases, such as atherosclerosis, hypertension, renal insufficiency, hypothyroidism, etc. Whether there are habits of masturbation, whether there are smoking, alcoholism, and other hobbies, whether there is a history of prostatectomy, sterilization, or other surgeries, whether there is a history of chronic prostatitis or epididymitis, seminal vesiculitis, varicocele, and whether there is a history of taking drugs that affect sexual function. Through the analysis of the medical history, it can basically be distinguished between psychological erectile dysfunction and organic erectile dysfunction.
2. The patient should cooperate with the doctor during the physical examination. The physical examination should include the patient's overall condition, such as blood pressure, nutrition, and health status, as well as the development of secondary sexual characteristics and whether there is gynecomastia or nipple discharge. It is also necessary to focus on checking whether there are testicles, the size and texture changes of the testicles; whether there are any abnormalities in the scrotum and within the scrotum; whether the penis is deformed, phimosis,,, etc., and whether a circumcision has been performed; whether the penis has nodules or curvature, and its hardness. Digital rectal examination will carefully examine the size, texture, and nodules of the prostate to determine whether there is benign hyperplasia, cancer, or prostatitis. Normal seminal vesicles are generally not palpable, but they can be palpated in chronic infection and cancer, and the wall of the seminal vesicles becomes thick and the texture becomes hard. Gonococcal, tuberculous, or non-specific infections of the seminal vesicles can form abscesses. The examination of the lower limbs can provide information on the blood supply of the genitalia, such as erectile dysfunction caused by obstruction of penile blood flow due to vascular blockage. Palpation of the femoral artery, popliteal artery, and dorsalis pedis artery can basically understand the blood supply of the penis. In addition, the sides of the penis should be palpated when the penis is not erect to directly understand the pulse of the penile arteries.
3. Laboratory tests include blood and urine analysis, routine examination of prostatic fluid and semen, liver and kidney function, blood electrolytes, blood sugar, blood lipids, and thyroid function. At least one determination of serum testosterone should be performed in patients with erectile dysfunction. If the level of serum testosterone is within the normal range, no further hormone tests are needed. In cases of hypogonadism, the level of testosterone decreases. If the first determination of serum testosterone level is low, it is best to repeat it and measure LSH, LH, and PRL at the same time. If the second level of testosterone is still low, the patient may have hypogonadism. If the serum LSH and LH are normal or increased, then the hypogonadism is due to primary testicular abnormalities. During the physical examination, attention should be paid to whether there are testicles or testicular atrophy, and whether the texture of the testicles has changed. Hypogonadism caused by hypothalamic-pituitary disease may have normal or slightly smaller testicles, which is related to the duration of the hypothalamic-pituitary disease. An elevated serum PRL also indicates hypothalamic-pituitary problems and is often accompanied by hypogonadism. The serum testosterone level of patients with erectile dysfunction is not necessarily low. Suspected pituitary tumors require cranial X-ray or CT scans to confirm the diagnosis.
4. Special tests are performed when necessary in hospitals or specialized clinics, mainly including neurological examinations such as penile vibratory sensory threshold testing, penile somatosensory evoked potential tests, and nocturnal penile tumescence tests, as well as vascular system examinations such as penile erection hardness, penile contraction pressure, penile blood flow measurement, and penile internal artery angiography, to further make a more definite diagnosis of the location, nature, and severity of the lesion in erectile dysfunction.
【Treatment】
1. Sexual hormones: suitable for hypogonadal erectile dysfunction, testosterone propionate 25 mg, intramuscular injection, every other day for 2 weeks; gonadotropin 500~1000 units, intramuscular injection, once a week for 2 weeks. (Hypothalamic-pituitary disease)
2. Psychological: psychological counseling and sex education are the mainstays, supplemented by medication.
3. Sexual function decline: treatment with gonadotropin and thyroid hormone.
4. Hyperprolactinemia: dopamine agonists (bromocriptine);
5. Intracavernous injection of papaverine 30 mg, use a 1 mL syringe and a skin test needle, vertically insert from the root of the penis into the corpora cavernosa, inject 30 mg of papaverine into the corpora cavernosa, compress the root of the penis for 1 minute, gently massage the penis for 3~5 minutes, and the penis will become erect.
6. Vitamin E 100 mg, three times a day, gamma-oryzanol 20 mg, three times a day.
7. Endocrine surgery: hypothalamic-pituitary tumors, feminizing tumors, hypercorticism, hyperthyroidism, can be surgically treated.
8. Penile prosthesis.
The of erectile dysfunction
Kidney qi deficiency type 【Symptoms】Erectile dysfunction or weak erection. Dizziness, forgetfulness, tinnitus, deafness, sore waist and knees, fatigue, shortness of breath, sweating. Pale red tongue, weak pulse.
【Treatment】Fill the kidney essence, benefit the kidney qi.
【Formulas】
1. Main formula: Lu Rong Yi Jing Pill (Shen Jin Jiao, "Shen Shi Zun Sheng Shu")
Prescription: Lu Rong 3 g (boiled separately), prepared dodder seed 15 g, mountain dog 12 g, mulberry mantis 12 g, prelate 15 g, poria 18 g, ginseng 30 g, goji berry 20 g, morinda 20 g. Decoction or decoction with residue, once a day.
If there is soreness in the waist and knees, add Eucommia ulmoides 12 g and dogwood 12 g. If there is sweating, add Job's tears root 30 g, floating millet 30 g, and astragalus 30 g. If there is dizziness, forgetfulness, and insomnia with frequent dreams, add roasted sour jujube 12 g, night climbing 15 g, or take Gui Pi Pill, 2 pills a day.
2. Chinese patent medicine
(1), oral, 1 pill each time, 2 times a day, take with light salted water.
(2)Jin Gui Shen Qi Pill, oral, 1 pill each time, 2 times a2. Chinese patent medicine
(1), oral, 1 pill each time, 2 times a day, take with light salted water.
(2)Jin Gui Shen Qi Pill, oral, 1 pill each time, 2 times a day, take with light salted water.
(3)Strong Spring Pill, oral, 9 g each time, 2 times a day, take with boiling water.
(4)Tortoise and Deer Kidney Tonifying Oral Liquid, oral, 1 piece each time, 2 times a day.
3. Single formulas and effective formulas
(1)Yang Yang Qi Wei Decoction (Li De Ming effective formula)
Prescription: Astragalus 20 g, ginseng 20 g, aconite 5 g, epimedium 10 g, morinda 10 g, polygonum multiflorum 10 g, eucommia ulmoides 5 g, goji berry 10 g, prepared dodder seed 10 g, curculigo 10 g, mountain dog 10 g, prepared rehmannia 10 g, Polygonum multiflorum 10 g. Decoction twice, take twice a day, take Zhi Bao San 3 1 grain at the same time.
(2)Zhen Wei Decoction (Zheng Wen Hua et al. effective formula)
Prescription: epimedium 30 g, chives seed 20 g, Yang Qi stone 20 g, goji berry 12 g, prepared rehmannia 15 g, ginseng 6 g, Chinese giant salamander 2 g. Decoction once a day. 15 days is one course of treatment, generally 1-3 courses of treatment.
(3)Xing Yang Dan (Qiao Zhen Gang et al. effective formula)
Prescription: raw ginseng 30 g, angelica 15 g, yam 15 g, poria 15 g, chives seed 15 g, epimedium 15 g, morinda 15 g, prepared rehmannia 15 g, polygonum multiflorum 15 g, bupleurum 15 g, white peony 20 g, centipede 4 pieces, deer antler 10 g, placenta powder 10 g, sea dog kidney 1 piece, sulfur 3 g, prepared Strychnine 1 g. The above drugs are ground into fine powder, mixed evenly, and put into capsules. 7~10 pills each time, 2 times a day, take with warm water or a small amount of yellow wine, half a month is one course of treatment. During medication, drink more water and abstain from sexual activity.
Life gate fire decline type 【Symptoms】Severe erectile dysfunction, the penis is limp and cannot stand up. Sore waist and knees, dizziness, tinnitus, limb cold, aversion to cold, frequent urination at night. Pale red tongue, deep, slow, weak pulse.
【Treatment】Warm the life gate fire.
【Formulas】
1. Main formula: You Gui Pill (Zhang Jie Bin, "Jing Yue Quan Shu")
Prescription: prepared rehmannia 240 g, yam 120 g, goji berry 120 g, prepared dodder seed 120 g, Eucommia ulmoides 120 g, prepared rehmannia 120 g, polygonum multiflorum 90 g, prepared rehmannia 90 g, aconite 60 g, cinnamon 60 g. Honey-coated pills, 10 g each time, 3 times a day. It can also be decocted with 1/10 of the above drugs, once a day.
If there is premature ejaculation, add long bone 20 g (boiled first), oyster shell 20 g (boiled first). If the waist and knees are very sore and there is frequent nighttime urination, add goldthorn 20 g, intelligence 10 g. If there is spleen deficiency, poor appetite, loose stools, add astragalus 30 g, ginseng 20 g, yam 30 g.
2. Chinese patent medicine
(1)You Gui Pill, oral, 9 g each time, 3 times a day, take with light salted water.
(2)Fu Gui 8 Flavor Pill, oral, 9 g each time, 3 times a, take with light salted water.
(3)Kidney Treasure, oral, 9 g each time, 3 times a day, take with boiling water.
3. Single formulas and effective formulas
(1)Bu Tian Ling (Lai Tian Song et al. "Clinical Effective New Formulas")
Prescription: epimedium 62.5 g, cinnamon 7.5 g, sea horse 12.5 g, curculigo 7.5 g, goji berry 12.5 g, astragalus 5 g, prepared dodder seed 5 g, polygonum multiflorum 10 g, prepared rehmannia 10 g, mountain dog 0.2 g, dog kidney 0.5 g, deer penis 0.7 g, ox kidney 5 g, sheep kidney 0.7 g. Made into sugar-coated tablets 50 tablets, 8 tablets a day, take twice a day, take for 10 weeks.
(2)She Qu (Liu Ju Fang et al. "Male and Female Reproductive Diseases")
Prescription: nutmeg 10 g, epimedium 10 g, Yang Qi stone 10 g, farndale 5 g, eucommia 5 g. Decoction twice, take twice a day.
Add cinnamon 3 g, prepared aconite 10 g if cold. Add goldthorn 15 g, prepared dodder seed 10 g if there is premature ejaculation and premature ejaculation.
(3)3 Seed Yang Yang Decoction (Qi Hao "Good Formulas Collection")
Prescription: goldthorn 30 g, epimedium 10 g, prepared dodder seed 30 g, goji berry 12 g, prepared rehmannia 10 g, polygonum multiflorum 10 g, prepared rehmannia 20 g, prepared rehmannia 20 g, polygonum multiflorum 15 g, prepared rehmannia 15 g, polygonum multiflorum 15 g, polygonum multiflorum 15 g, polygonum multiflorum 15 g. Decoction twice, take twice a day, take in the morning and evening.
Stomach qi deficiency type 【Symptoms】Erectile dysfunction or weak erection, pale yellow face, thin body, stomach discomfort, poor digestion, little food,.Pale tongue, white or little fur, thin and weak pulse.
【Treatment】Benefit the stomach qi, assist in reviving yang.
【Formulas】
1. Main formula: Shen Ling Bai Zhu Decoction (Chen Shi Wen et al. "Taiping Huimin Hejiu Fang")
Prescription: ginseng 30 g, white 10 g, poria 15 g, prepared licorice 6 g, yam 12 g, broad bean 12 g, lotus seeds 15 g, jujube 6 pieces, cardamom 6 g (added after decoction), tangerine peel 6 g, fennel 9 g, asparagus 9 g, epimedium 12 g, prepared rehmannia 12 g. Decoction once a day.
2. Chinese patent medicine
(1)Shen Ling Bai Zhu Decoction, oral, 9 g each time, 3 times a day, take with warm water.
(2)Qing Gong 8 Immortal Cakes, oral, 9 g each time, 3 times a day, take with warm water.
3. Single formulas and effective formulas
(1)Jian Wei Yi Qi Decoction (Lai Tian Song et al. "Clinical Formula Handbook")
Prescription: yam 15 g, ginseng 20 g, white 9 g, poria 9 g, prepared licorice 9 g, cardamom 5 g, yam 12 g, prepared rehmannia 12 g, broad bean 12 g, lotus seeds 12 g, jujube 12 g, tangerine peel 6 g. Decoction or decoction with residue, once a day.
(2)Astragalus Jian Zhong Decoction (Li Zhen Qiong modified formula)
Prescription: astragalus 30 g, white peony 20 g, 6 g, cinnamon 12 g, asparagus 30 g, bupleurum 30 g, 15 g, 6 g, 30 g, 20 g. Decoction or decoction with residue, once a day.
Psychological deficiency type 【Symptoms】Lack of sexual desire, weak erection, palpitations, anxiety, poor appetite, abdominal distension, easy startle, shortness of breath and fatigue, loose stools, poor appetite.Pale white tongue, weak or intermittent pulse.
【Treatment】Benefit the heart and spleen, assist in reviving yang.
【Formulas】
1. Main formula: Gui Pi Pill (Chen Zi Ming "Women's Good Formulas")
Prescription: ginseng 30 g, white 10 g, poria 15 g, prepared licorice 6 g, angelica 10 g, longan fruit 10 g, acid jujube 10 g, farndale 9 g, wood 6 g, epimedium 10 g, honeycomb 10 g, ginger 3 slices, jujube 6 pieces. Decoction once a day.
2. Chinese patent medicine
(1)Gui Pi Pill, oral, 1 pill each time, take twice a2.
(2)Bai Zi Yang Xin Pill, oral, 9 g each time, take twice a day25(《》).
Liver channel dampness and heat type 【Symptoms】Erectile dysfunction, scrotal dampness or itching, yellow urine, penile pain, restlessness, irritability, dry mouth, bitter taste, costal and hypogastric regions, lower abdomen, testicular pain and swelling. Yellow greasy tongue, wiry pulse.
【Treatment】Clear the liver and benefit the.
【Formulas】
1. Main formula: Long Dan Xie Gan Tang (Wu Qian et al.