Differential Diagnosis of Vascular Erectile Dysfunction and Erectile Dysfunction: Pathological Mechanisms, Classification Criteria, and Early Clinical Warning

12. Why are middle-aged men prone to arterial erectile dysfunction? Arterial erectile dysfunction is a common secondary erectile dysfunction in men over 40 years of age, caused by vascular occlusive disease. If the pudendal artery and its branches are blocked or abnormally developed, blood flow to the penis will be hindered, leading to arterial erectile dysfunction. Generally, vascular occlusive diseases occur in the abdominal aorta, iliac artery, pudendal artery, and their branches to the penis. In addition to causing erectile dysfunction, it often causes intermittent claudication, short walking distance or speed, and soreness in the calves or lower limbs. The incidence of erectile dysfunction in these patients with vascular lesions can reach 70% to 80%, and erectile dysfunction can be the first symptom of vascular occlusion. After improving lower limb ischemia, erectile dysfunction will also be corrected accordingly. Vascular occlusive lesions can be diagnosed by bilateral iliac artery angiography or lower limb blood flow Doppler ultrasound. Some men experience symptoms of vascular occlusive disease along with erectile dysfunction. This manifests as a fully erect penis during foreplay, but rapid flaccidity after a few thrusts in the vagina. In the supine or lateral positions, the erection may last longer. This is because normally there is sufficient collateral circulation within the pelvis to compensate for any blockage in a branch of the penile artery. However, once active penile thrusting begins, the body's increased need for blood supply due to pelvic movement reduces or interrupts blood flow to the penis, leading to rapid loss of erection. In the supine or lateral positions, reduced pelvic movement decreases blood supply to the muscles, ensuring adequate blood supply to the penis. Treatment with vasodilators, thrombolysis, or surgery (such as artificial artery implantation) can restore the ability to maintain an erection during intercourse.

13. Which middle-aged men are prone to erectile dysfunction? It is generally believed that erectile dysfunction is related to one's physical condition, medication, lifestyle, and psychological factors, but this understanding is obviously superficial. Common characteristics of patients with erectile dysfunction: (1) Poor lifestyle habits: long history of smoking and large amount of smoking, alcoholism, drug abuse, work stress, high life pressure, long-distance cycling. (2) Poor general health: such as heart disease, high blood pressure, diabetes, hyperlipidemia, renal failure, history of prostate surgery, history of pelvic surgery, spinal cord injury, multiple sclerosis, endocrine diseases, mental illness (such as schizophrenia, depression, etc.), and long-term use of antihypertensive drugs, hypoglycemic drugs, antidepressants, antipsychotic drugs, sedatives and stimulants. (3) Men over 40 years old: As the body gradually declines, there will be mild or severe decline or abnormality in sexual function. This is a common problem, and these problems can be solved with the help and guidance of a doctor.

14. Is all white fluid from the urethra semen? Not all white fluid discharged from the urethra is semen. There are many other situations where white fluid can be discharged from the urethra, such as urethral discharge and pyuria, which are common symptoms in urology and andrology clinics. Due to a lack of understanding, these conditions are often mistaken for nocturnal emission. Some people also mistake pyuria for urethral discharge and underestimate its severity, thus delaying treatment.

15. How to correctly diagnose erectile dysfunction (ED)? Modern medicine defines ED as a penile erectile dysfunction, typically referring to the inability to achieve or maintain an erection sufficient for satisfactory sexual intercourse, even with sexual stimulation and desire. The erection is short-lived and quickly becomes flaccid, making sexual intercourse impossible. The criteria for diagnosing ED primarily consider the following aspects: the strength of libido is generally proportional to sexual function; the erectile response, the duration and rigidity of the erection, and the ability to penetrate the vagina for normal intercourse are important indicators and standards for diagnosing the severity of ED.

16. What is "New Erectile Dysfunction"? The concept of "new erectile dysfunction" emerged in the early 1970s. "New erectile dysfunction" differs from traditional erectile dysfunction. It doesn't emphasize penile erectile dysfunction itself, but rather refers to the quality of sexual intercourse and the expectations of both partners. This is due, on the one hand, to advancements in medical science that changed the understanding of erectile dysfunction; and on the other hand, to women's growing demand for equal sexual rights and their increasing initiative in sexual activity. While they may not be as eager for frequency, they place higher demands on the quality of intercourse. Men, who have traditionally perceived themselves as having a dominant role in sexual activity, are less receptive to women's demands regarding quality, and their reaction is what is known as "new erectile dysfunction."

17. How to Treat Psychogenic Erectile Dysfunction? Clinically, erectile dysfunction is divided into two main categories: psychogenic or psychological erectile dysfunction and organic erectile dysfunction. For middle-aged men, the first category accounts for a larger proportion. Psychogenic erectile dysfunction refers to difficulty in achieving an erection primarily due to psychological factors. Clinical surveys have found that nearly 50% of erectile dysfunction patients are directly caused by psychological reasons. Psychological factors related to erectile dysfunction are complex, such as a lack of proper sexual knowledge; marital discord or one partner having other sexual partners; lack of self-confidence in men, fear of not being able to satisfy their wives' sexual needs; and some men experiencing sexual dysfunction due to other illnesses or sexually transmitted diseases, or concerns about long-term effects after treatment. Many cases of erectile dysfunction are caused by psychological factors in life, and each case should be treated differently.

18. What is the difference between functional erectile dysfunction and organic erectile dysfunction? Erectile dysfunction is divided into functional erectile dysfunction and organic erectile dysfunction. (1) Functional erectile dysfunction: ① The onset is relatively rapid. ② It is often related to a certain psychological trauma, such as the death of a loved one, emotional setbacks, or childhood psychological trauma. ③ The attacks are mostly intermittent and temporary. ④ Sexual function still exists, and orgasm and ejaculation can be achieved by other means; spontaneous erection will occur when waking up at night with erotic thoughts and sexual stimulation; there is sexual desire and desire for intercourse. (2) Organic erectile dysfunction: ① The onset is slow and insidious. ② It is often related to congenital malformations, chronic diseases, long-term use of certain drugs, etc. ③ It is generally a continuous and gradually worsening condition. ④ Sexual function is generally progressively reduced to the point of disappearance, and there will be no orgasm or ejaculation by any means, and no erection can be achieved by any method. There is very little sexual desire and desire for intercourse.