Pathogenesis identification and targeted treatment recommendations for retrograde ejaculation and delayed ejaculation.

Causes of retrograde ejaculation: From a mechanical perspective, retrograde ejaculation can be caused by two factors: factors leading to bladder neck paralysis and weakness, and factors causing abnormal resistance in the membranous urethra. Specific factors include: ① Congenital factors: These mainly include congenital wide bladder neck, congenital urethral valves or urethral diverticula, and congenital spina bifida. ② Iatrogenic factors: These mainly include various bladder neck and prostate surgeries, extensive retroperitoneal lymph node dissection, etc., which can lead to nerve resection or damage, resulting in retrograde ejaculation. ③ Mechanical factors: Traumatic and inflammatory urethral strictures increase urethral resistance. Traumatic pelvic fractures often cause posterior urethral injury leading to stricture. Additionally, long-term difficulty in urination can also decrease bladder neck tension, resulting in weak closure. ④ Disease factors: The most common cause of retrograde ejaculation due to peripheral neuropathy is diabetes. Spinal cord injury can cause loss of ejaculation ability or retrograde ejaculation. ⑤ Drug-related factors. Taking alpha-adrenergic receptor blockers, such as reserpine, guanethidine, and bromide. ⑥ Idiopathic factors. Some causes are unknown.

Treatment for retrograde ejaculation should involve oral medications that effectively close the bladder neck, ideally taken just before intercourse. Commonly used medications include: ① Alpha-adrenergic receptor activators such as ephedrine, which increase the closing ability of the internal bladder sphincter. 25 mg three times daily, or 50 mg 1-2 hours before intercourse, orally. ② Brompheniramine, 8 mg twice daily, orally; or imipramine, 25 mg three times daily, orally, which are effective in treating retrograde ejaculation caused by retroperitoneal lymph node dissection and diabetic neuropathy. ③ Levodopa, which increases the excitability of the ejaculation center and stimulates the sympathetic nervous system. Dosage: 0.25-0.5 g three to four times daily.

Delayed ejaculation refers to the inability to reach orgasm or experience any sensation of ejaculation during intercourse, despite prolonged intercourse, until pain occurs, ultimately forcing cessation. Experts believe that if intercourse lasts 1 to 1.5 hours without orgasm, it is considered delayed ejaculation. The delay is generally caused by psychological factors such as stress or fear, but it can also be due to aging. Additionally, diabetes or abdominal surgery may also contribute.

For delayed ejaculation, the following suggestions are made: (1) Find the cause: Is the patient taking a new medication? Is the patient under too much psychological stress? Is the patient very sleepy or tired? Has the patient's feelings towards their sexual partner changed? (2) Limit alcohol consumption: A common cause of delayed ejaculation is excessive drinking. Alcohol has an inhibitory effect and can inhibit ejaculation. Experts suggest: Moderation is key – you can have a small drink each time to keep your spirits up. (3) Use fantasy to stimulate sexual desire: Some people cannot ejaculate because they feel guilty about everything in front of them, and this guilt buries their excitement and orgasm. Therefore, you can fully indulge in fantasy during intercourse. (4) Appropriate artificial adjustment: If the woman's vagina cannot provide enough friction to arouse the other person, and if vaginal intercourse cannot achieve extreme excitement and pleasure, you can appropriately adjust by using other sexual behaviors to touch the sensitive parts of the penis to stimulate and achieve orgasm.