Patient's question:
What factors or causes can lead to male sexual dysfunction? What symptoms are easily confused with male sexual dysfunction?Doctor's answer:
How to prevent male sexual dysfunction? Suggestions: Classification of Etiology The etiology of this disease is very complex. At the current stage, there is still a lack of sufficient understanding of the pathophysiological processes that cause sexual dysfunction. However, sexual dysfunction is not solely caused by functional disorders, as there are indeed many organic diseases that can lead to sexual dysfunction. It is classified by etiology as follows:1. Sexual psychology and sexual response physiological dysfunction
1.1. Sexual desire arousal disorder
Abnormal cerebral cortex sexual excitement or inhibition,、，、.
1.2. Penile erection disorder
Erection dysfunction or abnormal persistent erection.
1.3. Ejaculation disorder
Premature ejaculation, retrograde ejaculation, anejaculation, or retrograde ejaculation.
1.4. Sensory disorder
Painful erection, painful ejaculation, reduced or absent sexual climax, or improperly delayed climax.
2. Organic diseases related to sexual dysfunction
2.1. Systemic diseases
Some systemic, chronic wasting diseases can cause reduced sexual desire. Examples include heart disease, tuberculosis, severe malnutrition, chronic kidney failure, hypertension, and malignancies.
2.2. Neurological diseases
Tumors, injuries, or inflammation of the nervous system can disrupt sensory, motor, and ejaculation functions, thereby affecting sexual function.
2.3. Endocrine system diseases
Diabetes, hypogonadism, hypothalamic-pituitary disorders, adrenal cortex disorders, and thyroid disorders.
2.4. Reproductive system diseases
Abnormal genital development, hypospadias, corpora cavernosa plaques, penile-scrotal elephantiasis, as well as chronic inflammation such as prostatitis, seminal vesiculitis, and prostaticitis.
2.5. Other
Long-term excessive alcohol consumption, smoking, drug addiction, excessive use of antihypertensive drugs, anticholinergic drugs, estrogen, and other anti-androgen drugs, as well as lead or pesticide poisoning.
Mechanism
Normal male sexual function includes processes such as sexual desire impulses, sexual intercourse actions, sexual climax, and ejaculation. To perform normal sexual activity, one must have a healthy sexual function center, nerve conduction, and sexual hormone regulation, as well as reproductive organs. Any dysfunction or absence in any organ or link can lead to male sexual dysfunction.
The male sexual function center includes the cerebral cortex, limbic system, and erection and ejaculation centers in the spinal cord. Stimuli related to sexual arousal are transmitted to the cerebral cortex and other sexual function centers via visual, auditory, gustatory, olfactory, and tactile nerve endings, inducing sexual arousal. Direct stimulation of the genitalia and other erogenous zones can unconditionally excite the sexual center.
The hypothalamus-pituitary-gonad (testis) axis regulates the secretion of sexual hormones. Male androgens promote and maintain the development and maturation of reproductive organs. In adult males, androgens keep the sexual center and organs in a state of readiness, and when appropriately stimulated, they produce the expected response.
The spinal cord controls erection and ejaculation primarily through the following structural components:
First, the afferent nerves, which transmit various stimuli from the genitalia to the spinal cord.
Second, the spinal cord's erection and ejaculation centers. The parasympathetic erection center is located in the S2-S4 segments of the spinal cord and receives external stimuli and directs the corresponding genital organs to respond. The sympathetic erection center is located in the T11-L2 segments of the spinal cord and is considered to transmit central information stimuli from the brain.
The spinal cord's ejaculation center also has dual localization: one is the sympathetic segment in the T11-L2 segments of the spinal cord, which controls the first stage of sexual climax and the expulsion of semen; the other is the S2-S4 segments of the spinal cord, but this is under the control of the autonomic or somatic nervous system.
The third part of the reflex arc consists of the effector, i.e., the efferent nerves. The efferent nerves can be sympathetic or somatic.
When sexual impulses are transmitted, the parasympathetic erection center in the spinal cord sends nerve impulses through the parasympathetic nerves to the cavernous arteries of the penis, causing the penile tissue to become highly, leading to erection. Conversely, if the erection occurs, it will subside.
If sexual stimulation is sufficient to induce sexual climax, another reflex mechanism begins to function. The sympathetic center in the T11-L2 segments transmits signals through the sympathetic nerves in the lower abdomen, causing the seminal vesicles, vas deferens, and prostate to contract and expel their contents, mixing them into semen. At the same time, nerve impulses cause the internal urethral sphincter to contract, preventing semen from entering the bladder or urine from entering the urethra. Additionally, the bulbocavernosus muscles, ischiocavernosus muscles, urethra, and perineal muscles contract rhythmically and forcefully to expel semen.
If certain functional or organic factors or etiologies inhibit cerebral sexual arousal, disrupt the transmission of sexual afferent or efferent nerves, cause spinal cord pathological damage, or lead to endocrine dysfunction resulting in insufficient androgen secretion, clinical manifestations may include reduced sexual desire, severe cases of impotence; if the cerebral cortex's sexual excitement or inhibition of the ejaculation center is, it may manifest as premature ejaculation or anejaculation. If the neural regulation function of the ejaculation center is disrupted, and the urethra is obstructed, it may result in retrograde ejaculation.