Sexual dysfunction in elderly males

　　The main cause of sexual dysfunction in elderly males is the increase in age, the decline in the function of various tissues and organs, and at the same time, the following factors also affect male sexual function.
　　1. Somatogenic diseases:Such as diabetes, renal dysfunction, spinal cord lesions, pelvic inflammation, consumptive diseases, etc.
　　2. Mental disorders:Such as mania, depression, anxiety neurosis, etc.
　　3. Psychological factors:Anxiety, tension, and overthinking, etc.
　　4. Medications affecting sexual function:Such as alcohol, hormones, antipsychotic drugs, etc.
　

　　Sexual dysfunction in elderly males mainly affects normal sexual life, which can, therefore, affect normal spousal relationships. However, reducing sexual activity in elderly males is more beneficial for physical health, so this condition usually does not involve complications. Apart from having some impact on family relationships, there are no other physical complications, but there may be some psychological effects.

　　The sexual dysfunction in elderly men mainly manifests in two aspects:

　　1. Decreased libido

　　In the past, it was believed that due to the decline in physical strength and sex hormones, the decline and disappearance of libido were inevitable phenomena, so the elderly would not have sexual emotions, desires, or behaviors. The natural physiological sexual desires of the elderly cannot be understood by society, and even considered vulgar. The elderly themselves are also influenced by traditional concepts, considering their sexual desires as indecent, and believing that sexual activity can affect health. Especially for the elderly with coronary heart disease or hypertension, they adopt the form of self-restraint and self-elimination, forcing abstinence or separation. Under the influence of these social and psychological factors, it leads to abnormal manifestations such as sexual apathy and sexual aversion.

　　In addition, the decrease in testosterone levels and the imbalance of estrogen to testosterone ratio in the elderly can also lead to decreased libido and reduced sexual activity. Therefore, those with decreased libido should understand whether it is caused by psychological or endocrine factors. The former should undergo psychological counseling to resolve the various causes of psychological disorders; the latter should use related hormone supplements for adjustment, and it should be noted that androgen supplementation should first exclude prostate cancer.

　　2. Erectile dysfunction

　　Erectile dysfunction in elderly men is mainly caused by organic and mixed factors, including neurological, vascular, endocrine, and structural lesions of the reproductive organs themselves. In the diagnosis, it should be checked step by step, and attention should be paid to exploring the causes of various organic lesions.

　　Erectile dysfunction in elderly men is a functional disease, usually related to frequent sexual life in youth, so the focus of prevention should be on the cause, avoiding excessive indulgence that can lead to kidney Qi deficiency and trigger sexual dysfunction in old age. For patients with impotence and premature ejaculation in their youth, active treatment should be sought to avoid affecting their sexual life in old age. It is advisable to eat more high-zinc foods to reduce the incidence of this disease.

　　Elderly men should undergo liver and kidney function tests, blood sugar, blood lipid tests, and hormone level determination to help explore the causes of erectile dysfunction.
　　1. Nocturnal penile tumescence (NPT) test
　　It is one of the important and objective indicators for distinguishing between psychological and organic erectile dysfunction. Under 8 hours of normal sleep, the penis of a normal male can have 3 to 5 erections, lasting 15 to 25 minutes each time, and the hardness of the erection should reach 65%. With the increase of age, the strength and duration of erections will slightly decrease. If an abnormality is detected in 8 hours, it is usually considered to be caused by organic factors and usually requires repetition of 2 to 3 times.
　　2. Intracavernosal injection of vasoactive drugs
　　Vasodilator drugs include papaverine, phentolamine, and prostaglandin E1, which can be used singly, in combination of two, or in combination of three. The drug injection leads to normal erection within 5 to 10 minutes, and can maintain it for more than 20 minutes under sexual stimulation, indicating that the penile blood circulation function is still good. Delayed onset of erection, early disappearance of erection, or absence of rigid erection may预示penile arterial blood supply disorder or inability to close venous blood flow.
　　3. Detection of penile vascular system
　　Using Doppler ultrasound blood flow imaging technology, it can accurately observe the changes in penile artery diameter, maximum blood flow, and resistance index before and after injection of vasoactive drugs, and can directly differentiate whether there is arterial or venous erectile dysfunction. Before surgery is suspected for arterial lesions or venous return lesions, intravaginal artery angiography should be performed to observe the dynamic perfusion test and angiography of both penile arteries or corpora cavernosa, which can help in the diagnosis of penile venous return obstruction.
　　4. Detection of the penile erection nervous system
　　By measuring intravesical pressure, electromyography, latency time of the bulbocavernosus and ischiocavernosus muscle reflexes, and somatosensory evoked potentials, the functional state of the autonomic and somatic nerves that control penile erection is assessed, and it is differentiated whether there are neurological lesions causing erectile dysfunction.
　　5. Biopsy of the corpus cavernosum
　　Patients with erectile dysfunction often have abnormal structure of the corpus cavernosum itself, a decrease in smooth muscle volume, and even if surgical correction of arterial blood supply and venous return lesions is performed, the efficacy is not ideal.

　　Patients with sexual dysfunction in elderly males should choose foods that provide high-quality protein, abundant vitamins, and trace elements. The following are several recommended food therapy recipes.
　　1. 150 grams of chives, 240 grams of fish and shrimp, appropriate amounts of vegetable oil, monosodium glutamate, and salt. Cut the chives into 3 cm long pieces, wash the fresh shrimp clean, heat the pot, put in the vegetable oil, wait until the oil bubbles are gone, then add the chives and fresh shrimp, sprinkle salt and monosodium glutamate, and stir-fry and remove from heat. Accompany with meals.
　　2. 250 grams of large loach washed with salt water, 200 grams of tofu, two heads of garlic, one bunch of scallion, appropriate amounts of ginger juice, and various seasonings. Heat the soybean oil, stir-fry the tofu, then add the loach and various seasonings. Eat it after it is cooked.
　　3. 20 grams of Cistanche deserticola, 100 grams of fine mutton and glutinous rice, a little fine salt, two scallions, and two slices of ginger. Clean and finely cut the Cistanche deserticola and mutton first, then decoct the Cistanche deserticola juice in a pot, remove the dregs, add the mutton and glutinous rice, and cook until done. Add salt and ginger and cook again. Take it after it is cooked.
　　4. Wash 15-20 grams of yam meat with clean water, cook it with 100 grams of glutinous rice in a pot, and add a moderate amount of rock sugar when the congee is about to be cooked. Take one dose in the morning on an empty stomach every day.
　　5. Take 20 grams of Chinese wolfberry, 9 grams of bitter melon seeds, 1 sheep kidney, 100 grams of mutton, appropriate amounts of scallion, salt, and 50 grams of rice. Cut the sheep kidney clean and wash, remove the tendons, and cut into strips; chop the mutton. Boil the Chinese wolfberry and bitter melon seeds into a decoction and remove the dregs, then cook with rice, sheep kidney, and mutton until cooked. After cooking, add scallion, salt, and monosodium glutamate for seasoning. It can be eaten as breakfast or dinner.

　　Recognizing that there is a great individual difference in sexual concepts, sexual ability, and sexual interest among the elderly, it is necessary to guide, adjust, and treat according to age differences, health conditions, sexual psychology, and the degree of sexual physiological damage.
　　1. Psychological treatment
　　Sexual dysfunction caused by psychological factors in the elderly accounts for about 1/2, and there are also psychological factors in organic erectile dysfunction, therefore, it is crucial to remove their psychological barriers, which requires the cooperation of both husband and wife.
　　The elderly need to correctly understand that physical aging does not necessarily mean a decrease or disappearance in libido and the ability to achieve an orgasm. Regular sexual life in the elderly can stimulate androgen secretion, delay the aging of sexual organs, and enhance metabolism. Active cessation of sexual life makes it difficult for sexual organs to release energy, and the psychological trauma caused can interfere with normal body function, leading to the decline of the body. Loss of hormone regulation in internal organs is also prone to trigger various diseases, and sexual function and sexual organs may also undergo atrophic changes. Therefore, maintaining regular and healthy sexual life is an effective way to maintain sexual psychology and mental health. However, excessive sexual life can lead to excessive physical fatigue, central nervous system fatigue, and the gradual emergence of potential pathogenic factors such as coronary heart disease, diabetes, hypertension, and tumors, leading to the decline and disappearance of sexual function, which will promote aging. Therefore, advocating moderate sexual life is recommended. The standard of moderate sexual life is that one feels relaxed and happy after sexual intercourse, and if one feels tired, it is possible to have been excessive.
　　Elderly people with diseases should also eliminate the psychological overconcern about their diseases, as some scientists said, 'No matter how ugly and helpless the disease makes a person, a person will never stop being a sexual creature.' Like the rest of us, they also have desires, expectations, and needs. Therefore, objective examinations such as tolerance tests (cycling test) should be used to guide them in rebuilding their sex lives, and measures to prevent disease outbreaks such as having nitroglycerin on hand should also be included. In summary, disease should not be an insurmountable obstacle to the sexual life of the elderly, and one of the goals of sex therapy is to help the elderly achieve satisfaction in sexual aspects.
　　2. Endocrine therapy
　　Sexual dysfunction in the elderly may be related to a decrease in testosterone levels. Appropriate testosterone supplementation can increase libido and promote the recovery of sexual function, but attention should be paid to the fact that excessive testosterone intake can affect liver and kidney function and blood lipid levels, and can also worsen atherosclerosis and increase the risk of vascular thrombosis; patients with prostate cancer should be prohibited from using it. It is usually recommended to stop taking testosterone after 3 to 4 weeks if there is no effect, and it is not advisable to take it for a long time.
　　3. Drug therapy
　　Oral medication: The currently preferred drug is sildenafil (Sildenafil), which is a type of phosphodiesterase type 5 inhibitor. Under the condition of sexual stimulation, non-cholinergic and non-adrenergic nerves and vascular endothelial cells release the mediator NO, which can activate guanylate cyclase, increase the level of cyclic guanosine monophosphate, promote smooth muscle relaxation, and achieve penile erection. However, phosphodiesterase type 5 can degrade cyclic guanosine monophosphate, thus weakening the relaxing effect of smooth muscle and preventing it from achieving the effect of erection. Sildenafil inhibits phosphodiesterase activity, enhances the relaxing effect of NO on smooth muscle, and produces penile erection. Clinical evidence has confirmed that the drug has a certain therapeutic effect on various types of erectile dysfunction, but the drug has side effects such as facial flushing, headache, dizziness, vision impairment, and nasal congestion, which are all transient reactions. Since sildenafil can increase the effect of NO, it cannot be used with NO preparations such as nitroglycerin to avoid excessive blood pressure drop and life-threatening situations.
　　Other oral medications such as alpha-blockers phentolamine, yohimbine, dopamine agonists apomorphine, and others all have certain efficacy.
　　Intravesical Injection of Medications: Currently, most commonly uses intravesical injection of alprostadil (prostaglandin E1) suppositories, which enter the urethral cavernosa and the corpora cavernosa of the penis through the urethral mucosa to treat erectile dysfunction. The drug is relatively easy to use, but the efficacy is not as good as sildenafil, and due to the side effects of urethral administration, such as urethral penile discomfort, the incidence is relatively high, reaching 4.9%, but the severity is mild. The drug may enter the female vagina in a very small amount, so it is not suitable for women who are pregnant or planning to become pregnant.
　　Intracavernosal Injection of Medications: Usually using papaverine, phentolamine, and alprostadil (prostaglandin E1), the incidence of abnormal penile erection with the first two drugs is relatively high, reaching 3% to 5%, and they are less commonly used; the incidence of pain side effects with alprostadil (prostaglandin E1) is relatively high, reaching 3.5%; therefore, currently, the combination of three drugs can reduce the incidence of side effects. However, the route of administration is relatively complex, and it is difficult for patients to accept. The frequency of use should not be too high, otherwise it may cause complications such as penile cavernosal sclerosis.
　　Vacuum Constriction Device: Using negative pressure attraction to physically make the penis engorge and swell, and placing a rubber ring at the base of the penis to prevent venous return, maintaining penile erection. This method is suitable for the elderly, and the blood flow should not be blocked for more than 30 minutes each time, which may sometimes affect ejaculation.
　　Surgical Treatment: Chosen according to different etiology. Penile artery reconstruction surgery often uses the subcutaneous artery under the abdominal wall and the dorsal artery of the penis for end-to-side anastomosis or the dorsal deep vein of the penis for arterialization, suitable for arterial injuries caused by trauma, not suitable for elderly patients with arteriosclerosis.
　　Penile Implant Surgery: There are mainly two types, semi-rigid rod-shaped implants and inflatable penile implants, which are suitable for organic erectile dysfunction and are used when other treatment measures are ineffective. The efficacy of implantation is definite, but the incidence of various complications is high, such as infection, perforation, and mechanical failure.
　　Traditional Chinese Medicine Treatment: According to different etiology and pathogenesis, traditional Chinese medicine carries out dialectical treatment, using Chinese herbal medicine, acupuncture, and acupoint injection methods for treatment.