Menopausal changes in sexual function and differential diagnosis between traditional Chinese and Western medicine: Pathogenesis analysis and severity assessment of impotence and erectile dysfunction

19. Is there a connection between male menopause and erectile dysfunction? Men often experience decreased libido and sexual function after entering menopause, which is often related to a decline in androgen levels. This is a common problem among middle-aged men, but male menopause does not equate to erectile dysfunction. Nearly 50% of men around 50 years old experience sexual dysfunction, while more than half have completely normal sexual function. Therefore, erectile dysfunction is not necessarily a direct result of aging. Middle-aged men may experience slower penile erection speed, smaller erection angle, shorter erection duration, longer intervals between erections, and fewer and less firm morning erections. However, for those with normal sexual function, sexual intercourse should not be a problem. Therefore, if erectile failure does occur, it is indeed a medical condition and should be promptly examined and treated appropriately.

20. How to correctly understand penile retraction and impotence? Penile retraction, also known as scrotal retraction, is a disease characterized by sudden onset, with the penis, testicles, and scrotum retracting, and lower abdominal cramping and pain as the main clinical manifestations. It is a disease unique to traditional Chinese medicine. In mild cases, patients only experience penile retraction, lower abdominal pain, aversion to cold, cold limbs, and weakness in the lower back and knees, but it does not affect sexual life. In severe cases, patients experience cold limbs, curled-up body, severe lower abdominal pain, rolling and howling, urinary retention, and sometimes paroxysmal attacks, which occur after exposure to wind and cold, 1-2 times a day or every other day. It may be accompanied by symptoms such as aversion to cold, cold limbs, sallow complexion, and decreased appetite. Other symptoms include a short and flaccid penis, a tightly retracted scrotum, and even inability to palpate the testicles, with a deep and wiry or weak pulse. Traditional Chinese medicine (TCM) classifies this disease into cold and heat patterns, but cold patterns are more common. These are often caused by prolonged lying in cold places, exposure to cold water, excessive consumption of cold drinks, or exposure to cold during sexual activity. Cold congeals in the liver meridian, leading to a lack of warmth and nourishment for the genitals, resulting in the onset of the disease. Western medicine considers this disease related to exposure to cold before onset or after sexual activity, as well as various psychological factors, classifying it as a functional disorder. Erectile dysfunction (ED) refers to the inability to achieve or maintain an erection sufficient for satisfactory sexual intercourse, often with a slow onset. TCM attributes ED to many factors, primarily the heart, liver, and kidneys, focusing on "deficiency" as the primary pathogenesis, with kidney deficiency being the main location of the disease. Modern medicine classifies ED into organic and functional types, with its onset closely related to physical, mental, and psychological factors. From a pathogenesis perspective, impotence is mainly due to kidney yang deficiency and decline of the fire of the gate of life, while stunted ejaculation is caused by cold congealing the liver meridian and stagnation of qi and blood. In terms of treatment, the main principles for impotence are to tonify the kidney and strengthen yang, consolidate essence and cure impotence, while the main principles for stunted ejaculation are to warm the liver and dispel cold, warm the meridians and relieve pain.

21. How to determine the severity of erectile dysfunction? Erectile dysfunction is a disease name shared by both traditional Chinese medicine and Western medicine. It refers to the inability of the penis to achieve an erection, or to achieve an erection but not a firm one, or to achieve an erection but not a long one (including the penis becoming flaccid after penetration), thus making sexual intercourse impossible. Complete erectile dysfunction refers to the inability of the penis to achieve an erection for intercourse when sexually aroused; incomplete erectile dysfunction refers to the inability to maintain a sufficient hardness for intercourse when the penis can achieve an erection. The degree of erectile dysfunction can be divided into the following four levels: (1) 0 degree (normal): Normal sexual desire; good erectile response, normal duration of erection, disappearing after ejaculation or interruption of intercourse; relatively firm erection, able to penetrate the vagina normally; good sexual pleasure; no significant change in the frequency of intercourse, able to complete intercourse normally; normal erectile response during masturbation. (2) Grade I (mild): Sexual desire is basically normal; erectile response is normal, but the duration of erection is unstable and sometimes cannot be sustained; the erection hardness is sometimes insufficient for vaginal penetration; sexual pleasure is generally normal; the frequency of intercourse is less than before, but intercourse can be basically completed; the erectile response during masturbation is basically normal. (3) Grade II (moderate): Sexual desire is weakened; erectile response is slow, the duration of erection is short or basically impossible; the erection hardness is often insufficient for vaginal penetration; sexual pleasure is significantly reduced; the frequency of intercourse is significantly reduced; the erectile response during masturbation is poor; intercourse cannot be completed normally. (4) Grade III (severe): Sexual desire is lost; intercourse is completely impossible; there is no erectile response during masturbation.

22. Is occasional erectile dysfunction in middle-aged men considered impotence? Men experience many illnesses throughout their lives, and impotence is a sexual dysfunction that some men are ashamed to discuss, significantly impacting their families and the patient's physical and psychological well-being. Occasionally, middle-aged men experiencing difficulty achieving or maintaining an erection sufficient for penetration are experiencing a very natural and common phenomenon; it is not pathological and should not be termed impotence. Occasional erectile dysfunction is closely related to the environment, mood, psychological state, tension, fatigue, and physical condition. Factors such as inability to have intercourse after a change in environment, inability to achieve an erection after fatigue, suppression of sexual arousal after using a condom, failure to have intercourse after marital arguments, concerns about penile size, extramarital affairs, and high levels of stress can all affect sexual intercourse. By strengthening understanding of sexual knowledge, correctly assessing one's sexual abilities, enhancing self-confidence, creating a positive atmosphere, and avoiding unhealthy behaviors, it is possible to ensure that every sexual activity achieves a level of physical and mental pleasure. Don't take occasional failures too seriously and let them become a mental burden. Don't prematurely or incorrectly diagnose yourself with "impotence." Instead, you should free yourself from mental pressure and avoid becoming a patient with psychogenic or psychological erectile dysfunction.

23. What are the manifestations of Peyronie's disease in middle-aged men? Peyronie's disease is a fibrous induration of the penis of unknown cause, also known as penile nodular cavernositis, chronic cavernositis, or nodular penile formation. The clinical manifestations are characterized by single or multiple cord-like indurations on the dorsal side of the penis, accompanied by penile pain, erectile pain, and penile curvature towards the indurated side. This disease is more common in middle-aged and elderly men. The onset is slow and is often discovered accidentally, or it may be noticed when there is severe pain or difficulty in intercourse. This disease can cause sexual dysfunction, such as pain during erection, weak erection or impotence, which affects sexual life. Generally, there are no other adverse consequences. The specific manifestations are as follows: (1) Local induration: The indurations are mostly located on the dorsal side of the penis. The small ones are the size of a grain of rice, and the large ones can involve the entire dorsal side of the penis. The shape is round, cord-like or patchy. The texture is hard and immobile. The subcutaneous tissue of the penis is not involved. (2) Erectile pain: caused by the traction of fibrous tissue during erection. About 50% of patients have this symptom. (3) Erectile curvature: Most patients experience erectile curvature due to the location of the nodule on the dorsal side of the penis and the influence of fibrous tissue hyperplasia, which affects sexual life. (4) Dyspareunia: Dyspareunia occurs due to erectile pain and erectile curvature. Locally, if the nodule is too large, it will affect the blood supply to the corpora cavernosa, resulting in weak penile erection, which in severe cases can lead to impotence.