Male erectile dysfunction

　　(1) Urological and reproductive system anomalies: Congenital penile curvature, biphallia, small penis, penoscrotal displacement, posterior bladder inversion, urethral cleft, congenital absence or maldevelopment of the testes, formation of fibrous scars in the corpus cavernosum, varicocele, etc., may not be erect due to anomalies, curvature, and dysfunction of the cavernous bodies.

　　(2) Urological and reproductive system diseases: Chronic inflammation of the urological and reproductive system, secondary to erectile dysfunction, is relatively common, such as orchitis, epididymitis, urethritis, cystitis, prostatitis, etc., among which chronic prostatitis is the most common to present with erectile dysfunction. Urological and reproductive system surgery and certain injuries, such as benign prostatic hyperplasia, transurethral resection of the prostate, urethral rupture, penile, and testicular injuries, can all cause erectile dysfunction. Patients with chronic renal failure often experience erectile dysfunction due to testicular atrophy and decreased testosterone levels.

　　(3) Vascular causes: The etiology of this erectile dysfunction includes any disease that can cause a decrease in penile cavernosal arterial blood flow, such as atherosclerosis, arterial injury, arterial stenosis, pudendal artery shunting, and sexual dysfunction, or any factors that hinder the venous return closure mechanism, such as the white membrane of the penis, or a decrease in smooth muscle in the cavernous sinus of the penis, leading to penile venous leakage.

　　(4) Mental and neurological factors: Such as sexual psychological trauma in childhood, or lack of sexual knowledge in newlyweds, psychological tension and anxiety, or disharmony in marital feelings and family relationships; or bad habits, such as excessive masturbation, which can lead to reduced sensitivity of the penis, mental tension, and heavy psychological burden, and can cause male erectile dysfunction; overwork of the mind or body, or adverse mental stimulation, such as excessive depression, sadness, fear, or indulgence in sexual activities, etc., can all cause dysregulation of the function of the cerebral cortex and the appearance of male erectile dysfunction.

　　(5) Drug effects: Many drugs have a suppressive effect on sexual function, such as reserpine, guanethidine, digoxin, diazepam, furosemide, metoclopramide, etc., which can cause male erectile dysfunction.

　　(6) Chronic fatigue: Fatigue can cause male erectile dysfunction because of over-fatigue of muscles or overuse of the brain, depression, anxiety, and other psychological fatigue that interferes with the arousal of libido, including the reduction of brain function inhibiting sexual interest, the reduction of excitability of the limbic system emotional center, and the reduction of sexual excitement due to the decrease in the secretion of gonadotropin-releasing hormone from the pituitary gland and androgen from the testes.

　　The pathogenic factors of male erectile dysfunction are often seen in some patients' adverse psychological reactions, but at present, some adverse living habits and lifestyles are also the main triggers of the disease, affecting patients' physical health and leading to some diseases. Most patients with erectile dysfunction also have chronic diseases. The etiology of male erectile dysfunction is complex, generally without organic lesions, and is most prone to impotence, making normal sexual life impossible. Some patients may affect their fertility.

　　1. The penis cannot become fully erect or the erection is not firm, which prevents normal sexual life from being completed.

　　2. Young people may experience anxiety and impatience along with male erectile dysfunction due to insufficient emotional communication with sexual partners or inconsistent sexual behavior habits.

　　3. Occasionally, male erectile dysfunction occurs, but it is completely normal in the next sexual life, which may be due to temporary tension or fatigue and does not belong to a pathological state.

　　4. Although male erectile dysfunction occurs frequently, the penis can become erect and maintain for a period of time in the morning or during masturbation, which is mostly caused by psychological factors.

　　5. Male erectile dysfunction persists and progresses continuously, mostly caused by organic lesions.

　　I. Strengthen the study and mastery of sexual knowledge

　　Only by understanding more about normal sexual physiology and psychology can one ensure that unnecessary anxiety and psychological burden caused by sexual ignorance will not occur, and can further prevent the possibility of spiritual erectile dysfunction.

　　II. Reduce life stress

　　To prevent male erectile dysfunction, it is important to maintain a pleasant mood and try to reduce psychological and physical stress. Studies have shown that many young and middle-aged men with ED are related to their mental factors. Therefore, in daily life and work, try not to be troubled by trivial matters around and maintain a cheerful mood.

　　III. Adjust diet

　　To avoid the occurrence of this disease, men should also pay attention to avoiding smoking and drinking, and eating should be moderate, not to overeat or undereat. Developing good living habits and maintaining normal daily and nightly routines play a very important role in the prevention of ED.

　　IV. Maintain the regularity of sexual life

　　Experts introduce that to prevent the occurrence of erectile dysfunction, everyone must pay attention not to overindulge, because excessive sexual activity can reduce sexual ability. Do not indulge in sexual desires without limit and overindulge in sexual pleasures.

　　Keep the mood cheerful, keep the mind clear and desires few, pay attention to the adjustment of life, strengthen physical exercise to enhance physical fitness, and improve the ability to resist diseases. Once male erectile dysfunction occurs, both partners should treat it correctly, carefully find out the cause, and actively treat it.

　　Blood routine, urine routine, liver function test, kidney function test, blood electrolyte test, blood glucose, thyroid-stimulating hormone, luteinizing hormone

　　Laboratory Examination

　　In addition to blood and urine analysis, routine examination of prostatic fluid and seminal fluid, liver and kidney function, blood electrolytes, blood glucose, blood lipids, and thyroid function, it is also necessary to determine serum testosterone (TE), thyroid-stimulating hormone (LSH), luteinizing hormone (LH), prolactin (PRL), and other hormones. Male erectile dysfunction patients should at least undergo one serum testosterone test. If the level is within the normal range, further examination of other hormones is not necessary. For those with hypogonadism, the testosterone level decreases. If the first serum testosterone level is low, it is best to repeat the test, and simultaneously measure LSH, LH, PRL, etc. If the second testosterone level is still low, the patient may have hypogonadism. If the serum LSH and LH levels are normal or increased, hypogonadism is attributed to primary testicular abnormalities. During physical examination, attention should be paid to whether there is testicular atrophy or change in the texture of the testicles. Hypogonadism secondary to pituitary disease may have normal or slightly smaller testicles, which is related to the duration of the pituitary disease. Increased serum PRL also indicates a problem with the pituitary gland, often accompanied by hypogonadism. For patients with male erectile dysfunction, serum testosterone levels are not necessarily low. For those suspected of having a pituitary adenoma, a cranial X-ray film or CT scan is required for an accurate diagnosis.

　　Special Examination

　　When necessary, it should be carried out in hospitals or specialized clinics with conditions, mainly including penile vibration quantification, penile dorsal nerve somatosensory evoked potential test, nocturnal penile erection test, and other neurological examinations, as well as penile rigidity, penile systolic pressure, penile blood flow measurement, penile internal artery angiography, and other vascular system examinations, to make a more accurate diagnosis of the location, nature, and degree of the disease in male erectile dysfunction.

　　The dietary care for male erectile dysfunction patients should pay attention to the following:

　　1. Tonify the kidneys without damaging the Yin. In terms of food properties, it is necessary to eat some kidney-tonifying foods that are not dry and hot. Patients can eat some seafood such as shrimp and crab, which have the effect of tonifying the kidneys and strengthening Yang, and can enhance the libido of ED patients.

　　2. Use blood-activating foods. Some blood-activating foods that can be eaten as food or medicine, such as hawthorn, can be consumed.

　　3. Not what you eat is what you supplement. Traditionally, it is believed that what you eat is what you supplement, such as 'eating animal testicles and penises can tonify the kidneys and enhance sexual function'. In fact, this is a misconception. Animal testicles and penises are some high-quality proteins and have a certain effect on increasing libido, but have little effect on erectile function.

　　　1) Erectile nerve repair surgery

　　Erectile nerve repair surgery is a minimally invasive surgery with good controllability and no side effects from traditional therapies. For the complex etiology of erectile dysfunction, it can flexibly target individual differences, differentiate and treat, and help patients relieve psychological and physical pain. Since the surgery only targets the sensitive dorsal nerve on the lateral side of the corpus cavernosum muscle, the damaged nerves and a few blood vessels, the treatment of erectile nerve repair surgery will not cause postoperative complications and will not affect the male reproductive function; the treatment of erectile dysfunction by erectile nerve repair surgery is carried out in a laminar flow purification sterile operating room, completely avoiding the possibility of cross-infection.

　　2) Drug treatment

　　1. Sex hormones: Suitable for male erectile dysfunction with hypogonadism, intramuscular injection of testosterone propionate 25 mg once every other day for 2 weeks; thyroid-stimulating hormone 500-1000 units intramuscular injection once or twice a week for 4 weeks (hypothalamic and pituitary diseases);

　　2. Psychological: Psychological counseling and sex education as the main treatment, supplemented with medication;

　　3. Decreased libido: Thyroid-stimulating hormone treatment;

　　4. Hyperprolactinemia: Dopamine enhancer (bromocriptine);

　　5. Vitamin E 100 mg three times a day, and 20 mg of ferulic acid three times a day;

　　6. Inject 30 mg of opium alkaloid into the corpus cavernosum of the penis using a 1 ml syringe and a skin test needle. Insert the syringe and skin test needle from the side front of the root of the penis vertically into the corpus cavernosum and inject the medication into the cavernous body. Compress the root of the penis for 1 minute and gently massage the penis for 3-5 minutes, and the penis can become erect.