Diagnosis and treatment of seminal vesiculitis and male ejaculatory disorders: causes of dysfunction and painful ejaculation.
The seminal vesicles and prostate both open into the posterior urethra and are closely related. Therefore, when the seminal vesicles are infected, prostatitis or posterior urethritis often occurs at the same time. Staphylococcus, streptococcus, Escherichia coli, etc., spread upward from the urethra and infect the seminal vesicles. Seminal vesiculitis can be divided into acute and chronic types. (1) Acute seminal vesiculitis: Patients often have systemic septicemia symptoms such as fever and chills. Local symptoms include lower abdominal pain, which can extend to the groin and perineum. The posterior urethra is also often involved at the same time, so there are symptoms such as urinary urgency, urinary frequency, dysuria, difficulty urinating, hematuria, and urethral discharge. Hematospermia is a characteristic of seminal vesiculitis and is sometimes the first symptom in clinical practice. Treatment of acute seminal vesiculitis can be based on the choice of antibacterial drugs according to the infecting bacteria. Local massage is contraindicated, and sexual stimulation and sexual activity should be avoided. When an abscess forms and drainage is poor, incision and drainage are required. (2) Chronic seminal vesiculitis: Due to poor drainage, seminal vesiculitis is prone to become chronic. Its symptoms are not easily distinguishable from those of chronic prostatitis, but chronic seminal vesiculitis is characterized by hematospermia. The semen is dark red and may contain fragmented old blood clots. Treatment for chronic seminal vesiculitis often involves comprehensive measures, including hot sitz baths, physical therapy, the use of effective antibacterial drugs, and prostate and seminal vesicle massage to expel inflammatory secretions from the seminal vesicles.
Common male ejaculatory disorders include: (1) Anejaculation: This refers to the inability to achieve a firm erection during intercourse, the duration of intercourse being long enough, but the inability to reach orgasm, ejaculate, or experience pleasure, and the inability to ejaculate into the vagina. It is divided into primary and secondary types. (2) Retrograde ejaculation: This refers to the condition where the duration of intercourse is normal, there is sexual climax and ejaculatory pleasure, but no semen is ejaculated from the urethra and instead ejaculates into the bladder. (3) Painful ejaculation: This refers to the condition where pain occurs in the penis, urethra, perineum, lower abdomen, scrotum, etc. during ejaculation. It is mostly caused by inflammation of the reproductive system. (4) Nocturnal emission: This refers to the ejaculation of semen without sexual intercourse. Nocturnal emission in unmarried young adults is not more than twice a week and is a physiological phenomenon. If nocturnal emission is frequent or occurs only when there is sexual desire, and is accompanied by symptoms such as lethargy, dizziness, weakness, and soreness in the lower back and knees, it is a pathological condition.
Causes of ejaculatory dysfunction: ① Myopathy: Damage to the elastic and muscle fibers of the bladder neck during prostatectomy. ② Neurological causes: Damage to the output nerves of the thoracolumbar region, or surgical damage to the sympathetic nerves. ③ Metabolic causes: Autonomic neuropathy caused by diabetes. ④ Drug-related causes: Medications used to treat hypertension and depression, such as guanethidine and reserpine. ⑤ Congenital causes: Absence of vas deferens or seminal vesicles on one or both sides. ⑥ Functional ejaculatory dysfunction: Similar to erectile dysfunction. Additionally, prolonged and intense masturbation can increase the sexual stimulation threshold required by the ejaculation center; or excessive sexual activity can lead to exhaustion of the ejaculation center.
Treatment of ejaculatory dysfunction should target the underlying cause. The treatment of functional anejaculation is, in principle, the same as that for erectile dysfunction. Sexual health education is crucial. Patients should eliminate negative psychological factors. Those who masturbate excessively or have frequent sexual activity should abstain from masturbation and, in some cases, separate from their partners for a period of time. Levodopa can be used to increase the excitability of the higher ejaculation center. Some advocate taking ephedrine orally before bedtime to enhance the contraction of the smooth muscle of the seminal ducts. For peripheral nerve damage, vitamin B₁, vitamin E, vitamin K, and traditional Chinese medicine can be tried to promote the recovery of nerve function.
Causes of painful ejaculation: ① Sexual factors: Overly vigorous movements during intercourse, excessive dryness of the sexual organs, or prolonged abstinence from sexual activity leading to excessively intense or frequent sexual arousal upon recurrence. ② Psychological factors: Commonly seen in individuals with nervousness, emotional agitation, or emotional instability. ③ Disease factors: ● Inflammation: The most common cause, including seminal vesiculitis and orchitis, where strong contractions of the sexual organs during ejaculation cause pain. ● Stones: Such as bladder stones or seminal vesicle stones. ● Tumors: Located in the epididymis, seminal vesicles, prostate, vas deferens, or posterior urethra. ● Others: Such as urethral stricture or Peyronie's disease. Treatment: Depending on the cause, those with pain due to sexual factors should abstain from intercourse for several days; those with pain due to psychological factors should try to eliminate anxiety; those with pain due to disease should receive symptomatic treatment under the guidance of a doctor.