Patient's question:
Hello, I recently feel that my stamina during sex is not up to par, and my hardness doesn't last long—it gets soft quite quickly.Doctor's answer:
(1), Incorrect sexual attitudes:Sexual anxiety arising from fear of sexual failure may be the most common cause of impotence, while inappropriate demands regarding sexual ability or excessive insistence on sexual activity are also fundamental causes of sexual dysfunction. Additionally, another significant reason for sexual dysfunction is acting as a spectator, where one partner becomes anxious and obsessively focused on the other's reaction during intercourse, thereby diverting attention and hindering the establishment of appropriate sexual responses and the attainment of orgasm.
(2), Influence and conflicts from past sexual experiences:
If a person has experienced strict control, harsh treatment, or harm during past sexual encounters, it may leave unresolved psychological trauma, easily leading to conditioned reflexes. Once such a person is confronted with sexual situations again, they may unconsciously recall past sexual traumas, resulting in impotence, lack of orgasm, and other sexual dysfunctions.
(3), Impact of interpersonal tension on sexual function:
This primarily refers to interpersonal conflicts between sexual partners, such as suspicion, jealousy, and distrust. Obviously, one partner's strong disappointment or hostility can provoke a similar response in the other, which is harmful to sexual desire. For example, women are highly sensitive to being used and may perceive their partner as merely interested in their body while ignoring their humanity. Intercourse may be seen as exploitation, domination, or degradation, leading to a lack of sexual response or even aversion to sexual activity.
(4), Psychological repression caused by various external factors:
These can also affect sexual function. The fast-paced modern life, busy work or household chores, harmonious interpersonal relationships, workplace competition and setbacks, as well as an individual's education level and social status, can all create psychological pressure. Sexual desire and sexual function are influenced by psychological factors.
The etiology of sexual dysfunction is very complex. Although the current understanding of the pathophysiological processes that cause sexual dysfunction is still insufficient, it is clear that sexual dysfunction is not solely a functional disorder but is also caused by numerous organic diseases. According to their etiology, they are classified as follows:
I. Sexual psychological and sexual response physiological dysfunction
1. Sexual desire arousal disorder: Abnormal cerebral cortex sexual excitement or inhibition,、、.
2. Penile erection disorder: Impotence or abnormal persistent erection.
3. Ejaculation disorder: Premature ejaculation, nocturnal emission, anejaculation, or retrograde ejaculation.
4. Sensory disorder: Painful erection, painful ejaculation, reduced sexual climax, absence, or inappropriate delay.
II. Organic diseases associated with sexual dysfunction
1. Systemic diseases: Some systemic, chronic, consumptive diseases cause reduced sexual desire, such as heart disease, tuberculosis, severe malnutrition, chronic kidney failure, hypertension, and malignant tumors.
2. Neurological diseases: Tumors, injuries, or inflammation of the nervous system can disrupt sensation, movement, and ejaculation, thereby affecting sexual function.
3. Endocrine diseases: Diabetes, hypogonadism, hypothalamic-pituitary disorders, adrenal cortex disorders, and thyroid disorders.
4. Reproductive system diseases: Abnormal development of reproductive organs, hypospadias, corpora cavernosa plaques, penile-scrotal elephantiasis, as well as chronic inflammation such as prostatitis, seminal vesiculitis, and seminal colliculus inflammation.
5. Others: Long-term excessive alcohol consumption, smoking, narcotic 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 sexual desire impulses, sexual intercourse actions, sexual climax, and ejaculation. To complete normal sexual activity, a healthy sexual function center, peripheral nerve conduction, and sexual hormone regulation, as well as reproductive organs, must be present. Dysfunction or absence in any organ or 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 through visual, auditory, gustatory, olfactory, and tactile nerve endings to the cerebral cortex and other sexual function centers, causing sexual arousal. Direct stimulation of the reproductive organs and other erogenous zones can non-conditionally excite the sexual center. The hypothalamus-pituitary-gonad (testis) axis regulates sexual hormone secretion. Male androgens promote and maintain the development and maturation of reproductive organs. In adult males, androgens keep the sexual center and sexual organs in a prepared state. When appropriately stimulated, the expected response occurs.
The spinal cord controls erection and ejaculation primarily through the following structural components:
First, the afferent nerve, which transmits various stimuli from the reproductive organs to the spinal cord. Second, the spinal cord's erection and ejaculation centers are located in the S2-S4 segments of the spinal cord, involving parasympathetic nerves for erection. The parasympathetic erection center receives external stimuli and directs the corresponding sexual 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 in the T11-L2 segments of the sympathetic nerves, which controls the first stage of sexual climax and the emission of semen; the other is in the S2-S4 segments of the spinal cord, where it is part of an autonomous or somatic nervous system reflex arc. The third part is composed of effectors, i.e., efferent nerves, which can be sympathetic postganglionic nerves or somatic nerves. When sexual impulses are transmitted, the spinal cord's parasympathetic erection center 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 sexual stimulus is insufficient to cause sexual climax, the reflex mechanism begins to function. The sympathetic center in T11-L2 transmits signals through the sympathetic nerves in the lower abdomen, causing the seminal vesicles, vas deferens, and prostate to contract, expelling their contents to form semen. Meanwhile, nerve impulses cause the bladder internal sphincter to contract, preventing semen from entering the bladder or urine from entering the urethra. Additionally, the ischiocavernosus, bulbocavernosus muscles, urethra, and perineal muscles contract rhythmically and forcefully to eject semen.
If certain functional or organic reasons cause the inhibition of cerebral sexual arousal, dysfunction in the afferent or efferent nerve transmission, spinal cord pathological damage, or endocrine dysfunction leading to insufficient androgen secretion, it may manifest clinically as reduced sexual desire, with severe cases resulting in impotence. If the cerebral sexual excitement or inhibition and ejaculation center is, it may result in premature ejaculation or anejaculation. If the nerve regulation function of the ejaculation center is disordered, or if the urethra is obstructed, retrograde ejaculation may occur.