Patient's question:
Ejaculation occurs spontaneously Scrotal itching Short duration of intercourseDoctor's answer:
Erectile function is divided into reflexive erection, psychogenic erection, and nocturnal erection. Reflexive erection refers to the erection produced by sensory stimulation through the pudendal nerve and sacral central nervous system. Reflexive erection is achieved through neural reflexes, with the afferent nerves being the dorsal penile nerve and the pudendal nerve, and the efferent nerves being the sacral parasympathetic nerves. Damage to the spinal cord, spinal nerve roots, pelvic nerves, pudendal nerves, and cavernous nerves can lead to the loss of reflexive erection; the impact of spinal cord injury on erectile function is closely related to the severity of the injury, with injuries above the thoracic segment having minimal effects, while injuries below can cause severe effects, even leading to the loss of reflexive erection. Psychogenic erection is the penile erection caused by sexual awareness generated in the brain. Psychogenic erection works synergistically with reflexive erection, and it is more common in young people, gradually decreasing with age. Nocturnal erection, also known as nocturnal penile tumescence (NPT), refers to penile erection that occurs during rapid eye movement (REM) sleep. All healthy men, including infants and the elderly, experience NPT, although the mechanism behind it has not yet been fully understood. Most researchers believe it is related to the transmission of information from the central nervous system to the sacral parasympathetic plexus during sleep. A normal man experiences three or more NPT episodes per night, totaling approximately 100 minutes. The presence or absence of NPT is a clinically important factor in distinguishing between psychological erectile dysfunction and organic erectile dysfunction. Tang Wenhao, Department of Male Diseases, Peking University Third Hospital.Generally, penile erection function declines with age. As one ages, the penis may require stronger stimulation to achieve erection, and the intensity of sexual climax, frequency of sexual activity, and intervals between erections tend to weaken. However, with age, the incidence of various diseases and the use of medications tend to increase, making it sometimes difficult to distinguish whether changes in erectile dysfunction are due to aging, diseases, or medications.
Erectile dysfunction may primarily stem from two issues: 1) The organ itself is not problematic, but its performance is poor, often due to psychological factors; 2) The organ itself has organic lesions, such as those caused by aging, diabetes, or hypertension, leading to neural and vascular damage in the erectile organ. Medications used to treat hypertension, particularly beta-blockers and thiazide drugs, can easily cause erectile dysfunction. In such cases, consulting a cardiologist for a detailed evaluation and switching to other types of medications may be advisable. Sexual activity is a complex physiological and psychological process, so treatment should first involve sexual counseling, additional information, and coordination between partners, combined with medication. If the organ itself does not have organic lesions, it should be curable; if there are organic lesions, the treatment effect may be less effective.
The main medications are PDE5 inhibitors, such as Viagra (Sildenafil) and Cialis (Tadalafil). The first-generation PDE-5 inhibitor Sildenafil (Sildenafil), marketed as Viagra, was approved by the FDA in March 1998, marking a revolutionary milestone in the history of ED treatment. Currently, second-generation PDE-5 inhibitors with higher selectivity are either in clinical use or under development. Notably, Vardenafil (Levitra), developed by Bayer, and Tadalafil (Cialis), developed by Lilly, are representative examples. Other new drugs with codes such as T-1032 and DA-8159 are also under development.
At therapeutic doses, these three drugs exhibit high selectivity for PDE-5, mild inhibition of PDE-1, PDE-6, and PDE-11, and negligible inhibition of other PDE isoenzymes. PDE-1 is primarily found in the cardiovascular system, and the higher its selectivity, the higher the risk of side effects such as flushing and fever. PDE-6 is mainly present in the retinal cone and rod cells, and higher selectivity increases the risk of visual disturbances. PDE-11 is found in skeletal muscle, testes, liver, and kidneys, and higher selectivity increases the risk of back pain and muscle pain. Sildenafil and Vardenafil have higher selectivity for PDE-1 and PDE-6 compared to Tadalafil, while Tadalafil has higher selectivity for PDE-11 than Sildenafil and Vardenafil, making back pain and muscle pain more likely with its use. Therefore, in clinical practice, the following recommendations can be given to patients: If sexual activity is planned once a week, Sildenafil or Vardenafil should be used; if planned 2–3 times a week, Tadalafil can be chosen. Since all three drugs are metabolized by the liver enzyme CYP3A4, they should not be used concurrently with CYP3A4 inhibitors. CYP3A4 inducers can reduce drug efficacy. Sildenafil should not be taken after consuming heavy, fatty meals to avoid reduced drug effectiveness, whereas Vardenafil and Tadalafil are largely unaffected by diet.
Emerson once said, "Self-confidence is the first secret of success." Yuan Yang Mengqiu also said, "A person is a tree, and confidence is its root." Therefore, when treating a disease, one must have confidence, as this will surely overcome the of the illness.