Don't talk about male Sexual dysfunction

        Father's Day is coming, and many hard working dads have finally paid off the bills at home. They are trying to enjoy their happy moments, but they may suddenly become "soft today" because of their hard work! This issue of "Health Column" introduces the most common Sexual dysfunction of men and the latest treatment methods.

        1、 Erectile dysfunction

                Commonly known as "Erectile dysfunction (ED)" for impotence or impotence, it means that after sexual stimulation, the Corpus cavernosum penis is poorly congested, unable to achieve sufficient hardness, or difficult to maintain hardness until ejaculation is completed. The prevalence of Erectile dysfunction in men over 40 years old is about 25%, and it increases with age. If there are diabetes, hypertension, smoking, obesity, low testosterone and other risk factors, the probability of occurrence is higher.

        1. Cause of occurrence

        The causes of Erectile dysfunction can be mainly divided into two categories: "psychological factors" and "physiological diseases", but most patients are not caused by a single factor, which may be caused by combining different reasons.

        There are some characteristics of Erectile dysfunction caused by psychological factors, such as: erectile status is sometimes good or bad, and erection is normal in the morning. Most young people (under 40 years old) belong to this category, usually caused by insufficient sleep, high work pressure, fatigue, or pressure from their partners; Some people will also suffer from bad conditions once or twice, which will lead to Psychological stress from fear of failure in the future, forming a vicious circle. In addition to improving life, reducing sources of stress, increasing sleep, and communicating with partners, treatment methods can also try to use drugs to increase the comfort and success rate of sexual behavior, breaking the vicious cycle.

        Erectile dysfunction caused by physiological diseases refers to the male's congestion of Cavernous tissue due to some physiological mechanism problems, including vascular disease, neuropathy, low testosterone and other factors, which usually degenerate over time and reduce the frequency of morning erections. Physicians can distinguish by the patient's age and chronic medical history, or by drawing blood to determine whether it is low testosterone. Only in a few cases may other invasive examinations be recommended, such as penile Doppler ultrasound (to evaluate penile arterial blood flow).

        2. Medication and treatment methods

        A. PDE5 inhibitor drugs

                In addition to training exercise habits, quitting smoking, and controlling the original chronic diseases (such as diabetes, hypertension, etc.), Erectile dysfunction can also be treated with PDE5 inhibitor drugs (such as Weiergang, Sharps) to increase the efficiency of Cavernous tissue congestion and achieve satisfactory erectile function, and more than 70% of patients can be improved.

        Among them, "Weiergang" is best consumed on an empty stomach 1-2 hours before sexual activity; Xilishi "is a longer acting drug that can be taken earlier, and can also be given a fixed low dose dosage form of 5mg Xilishi daily to enhance the effect. However, if you have cardiovascular disease and must take nitrates, you must not use them together with PDE5 inhibitors. In addition, some antihypertensive drugs may also cause hypotension when used together. You should consult your doctor first.

        B. Low energy penis Extracorporeal shockwave therapy

        Low energy Extracorporeal shockwave therapy can be applied to Corpus cavernosum penis and perineum to promote vascular proliferation and improve Erectile dysfunction caused by vascular diseases. The process is safe and does not require anesthesia, even if the patient is using anticoagulants. The complete course of treatment should be 6-8 times, with an interval of one week between each session. However, due to the time required for vascular proliferation, the therapeutic effect is not as fast and obvious as taking PDE5 inhibitors, and it belongs to maintenance therapy. It is recommended to use drugs in combination for better results.

        C. Testosterone supplementation therapy

        Testosterone is produced by the testes and can affect male sexual function, libido, muscle growth, and hematopoietic function. If patients with Erectile dysfunction have low testosterone, they can also receive testosterone supplement treatment. At present, there are injections, skin gel, and the latest intranasal gel preparations.

        D. PRP Cavernous tissue injection

        PRP (Platelet-rich plasma) has been widely used in the injection treatment of tendon, fascia, joint and other soft tissues, with the effect of tissue repair; According to the latest small study, injection in the Cavernous tissue can improve erectile function. Therefore, if the therapeutic effect of drugs or low energy shock waves is not ideal, it is advisable to consider this treatment method.

        2、 Premature ejaculation

        Premature ejaculation (PE) generally refers to sexual intercourse lasting less than three minutes from entering the vagina to ejaculation, which cannot be prolonged with willpower and causes psychological distress for oneself or a partner. The prevalence rate is approximately 15-30%. Generally, it can be divided into two categories: primary premature ejaculation (Lifelong PE) and secondary premature ejaculation (Acquired PE). The former starts from the first sexual act, which means that the ejaculation time cannot be extended for more than one minute, and belongs to the more serious type; The latter was originally able to maintain sufficient sexual intercourse time, but gradually unable to extend it for more than three minutes from a certain day.

        1. Cause of occurrence

        The causes of premature ejaculation are usually multiple factors, including psychological factors (anxiety, lack of experience, etc.), neurological factors (glans hypersensitivity, abnormal 5-HT receptor), genetic factors, endocrine factors (hyperthyroidism), etc. In addition, up to 50% of premature ejaculation patients also have Erectile dysfunction, and the two Sexual dysfunction affect each other, resulting in more difficult problems that need to be treated at the same time.

        2. Drug treatment methods

                At present, the treatment method is mainly medication, and there are currently FDA approved drugs such as Priligy and the latest Fortacin topical spray.

        A. Bi Li Jin

        Bilijin (Dapoxetine) is a selective Serotonin Reuptake inhibitor (SSRI). There are many types of SSRI drugs, which belong to the category of antidepressants and have the effect of prolonging ejaculation time. Among them, Bilijin has a short action time, fast metabolism, and less common side effects of other antidepressants. Therefore, it is approved as a specialized drug for treating premature ejaculation. It is recommended to take it one hour before sexual intercourse.

        B. Empower for a long time

        Fujiujin is a local anesthetic drug spray formulated with special ingredients to attach the drug to the glans and form a thin film, reducing the sensitivity of the glans. It can continue to work within an hour and prolong ejaculation time. Before engaging in sexual activity, spray three times on the glans and wait for five minutes before wiping off the medication. There is no need to use a condom specifically to keep the medication in place.

        According to the research results, patients with primary premature ejaculation (a more severe type of premature ejaculation) can have an average ejaculation time extended from "less than one minute" to "more than three minutes" after 3 months of treatment with Fu Jiujin. If treatment is continued for 5-9 months, the average ejaculation time can also be extended to six minutes. The treatment effect is significant and easy to use, with very few side effects.

        epilogue

        Due to cultural factors, the problem of Sexual dysfunction is often difficult to talk about, but it is a very important part of the relationship. In view of the fact that Sexual dysfunction is often caused by different factors, it is suggested to consult a professional doctor to suit the medicine to the case, help yourself and regain intimate life.

        *About Doctor Tan Chun Seang: https://www.femh.org.tw/section/sectionDetail2?CID=0285&&DoctorID=88545

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