A comprehensive overview of ejaculatory disorders: finding the root causes of persistent erectile dysfunction.

Finding the Causes of Ejaculation Problems

A certain level of stamina is a sign of strong male sexual function, which is something many men aspire to. However, if a man cannot reach orgasm and ejaculate for a long time, and his penis is already flaccid but he still has no desire to ejaculate, does he also feel worried?

Ejaculation is a highly complex physiological reflex, resulting from the coordinated actions of the nervous system, gonadal endocrine system, and internal and external genitalia. Male hormones circulating in the bloodstream are the driving force behind sexual arousal. Based on this, various external stimuli induce sexual intercourse. Normal ejaculation involves three physiological processes:

Ejaculation: The discharge of prostatic fluid, seminal vesicle fluid, and sperm into the posterior urethra.

Ejaculation: When a certain amount of semen is released from the posterior urethra, it is expelled from the body through the external urethral opening.

The internal urethral orifice closes: at the moment of ejaculation, the internal bladder sphincter closes and the external sphincter relaxes to prevent semen from flowing back into the bladder.

If one of these steps goes wrong, it can lead to an uncontrollable situation – ejaculation disorder.

Ejaculatory disorders manifest in various ways, generally categorized into three types: premature ejaculation, retrograde ejaculation, and anejaculation. Premature ejaculation is the most common ejaculatory disorder; retrograde ejaculation refers to the patient being able to achieve a normal erection and ejaculate, but the semen is not ejected forward through the urethra, but rather backward into the bladder, resulting in retrograde ejaculation; anejaculation refers to the patient being able to achieve a normal erection and engage in sexual intercourse, but without sexual arousal or climax or ejaculation, or having arousal or climax and ejaculation but without ejaculation.

The causes of ejaculatory dysfunction are complex, but can be summarized as follows:

1. Psychological reasons. This is the most common and important reason: such as lack of sexual knowledge and incorrect understanding of sex (believing that sexual behavior is sinful and that the reproductive organs are unclean); sexual anxiety and sexual phobia; hostility or rejection towards one's partner; fear of pregnancy and desire not to have children; severe mental illness or depression, with feelings of guilt; psychological disorders caused by masturbation; and a chaotic or unsafe environment for sexual intercourse.

2. Organic causes. Inflammation of the prostate and reproductive system; post-urethral and prostatectomy, bladder sphincter surgery or injury; spinal cord injury; syringomyelia; diabetes; psychosis; Parkinson's disease; traumatic urethral malformation.

3. Drug-related causes. Frequent use of drugs such as methyldopamine, reserpine, and phentolamine can all cause ejaculatory dysfunction.

4. Congenital causes. Congenital anatomical abnormalities of the urogenital system, such as urethral malformations, absence of bilateral seminal vesicles or vas deferens; congenital vas deferens cysts, etc.

Specifically, the reasons for retrograde ejaculation are as follows:

Congenital spina bifida affects the sympathetic nerve function of the lower urinary tract; congenital bladder diverticulum can also cause retrograde ejaculation; traumatic or inflammatory urethral stricture; surgical damage to the bladder neck. Other diseases can also have an impact, such as diabetes; large bladder stones; and adrenergic neuron blocking agents, such as reserpine and guanethidine.

During diagnosis and treatment, relevant examinations should be performed on patients suspected of retrograde ejaculation.

1. Preliminary urine examination: Perform a fructose qualitative test on a fresh urine sample.

2. Immediately after masturbation, examine the patient's semen for sperm and fructose. Some men who experience retrograde ejaculation accompanied by antegrade ejaculation often have very little semen volume, and the semen contains neither sperm nor fructose.

3. Post-masturbation urine analysis. Urinate immediately after masturbation and collect a urine sample to examine for sperm and fructose to determine if there are sperm present in the bladder urine due to retrograde ejaculation.

4. Examine prostatic secretions. Prostatic fluid obtained through prostate massage is examined for sperm and fructose to determine the presence of sperm secondary to the peristalsis of the vas deferens and the contraction of the seminal vesicles.

5. Urine analysis after prostate massage. Sperm and fructose are examined to determine if the fluid is from the seminal vesicles.

Drug treatment includes the following:

1. Adrenergic stimulants can excite the sympathetic nerves in the bladder neck, strengthening the contractile force of the bladder neck muscles, thus correcting retrograde ejaculation. Commonly used drugs include: para-phosphine, phenylephrine, ephedrine, imipramine, etc. They have good efficacy in treating retrograde ejaculation caused by retroperitoneal lymph node dissection and sympathectomy.

2. Anticholinergic drugs can reduce the excitability of the parasympathetic nervous system and relatively increase the tension of the bladder neck sphincter.

Surgical treatment: Restores antegrade ejaculation, suitable for patients who have undergone cystoscopy. Reconstructing the bladder neck and tightening the bladder neck opening with catgut has a good effect on preventing retrograde ejaculation into the bladder.

For the diagnosis of ejaculatory dysfunction, a detailed history should be taken during medical history collection, including the patient's growth and development history, sexual history, genetic history, and medical history and medication history of other systems, to rule out or identify possible causes of ejaculatory dysfunction. Physical examination should focus on secondary sexual characteristics, and check for abnormalities in the testes, epididymis, vas deferens, prostate, and seminal vesicles. For patients with primary absolute ejaculatory dysfunction, it is important to examine both vas deferens and seminal vesicles, performing excretory urography and vasography to determine if any congenital malformations are present. Sometimes, the patient does ejaculate semen, but it enters a urethral diverticulum or a Müllerian cyst in the ejaculatory duct. In such cases, surgically opening the vas deferens can resolve the problem.