The effects of circumcision, hernia repair, and spinal cord injury on sexual function
186.
Correct understanding of circumcision
Circumcision is a circular excision of the foreskin that is too long. It is also known as circumcision and is indicated for phimosis and paraphimosis.
Some men are worried about this, fearing that the surgery will affect their sex life and reduce their own sexual desire.
Others are afraid of leaving scars that will cause discomfort.
Now, we can tell men who have already had a circumcision or are about to have one that such worries are unnecessary.
Circumcision is performed in an operating room where the area and surgical instruments undergo strict sterilization, minimizing the chance of postoperative infection. The procedure does not leave large wounds or scars.
In Western countries, especially among Jews and Muslims, this is considered a sacred religious ceremony, and every boy must undergo circumcision, known as "circumcision."
Some people believe that circumcision, which exposes the glans penis and causes the epithelium to keratinize, will reduce sexual sensitivity.
However, according to experimental research on sexual response by modern American obstetrics and gynecology expert Dr. Masters and psychologist Dr. Johnson, there is no difference in the tactile sensation of the penis between people who have undergone circumcision and those who have not.
In recent years, some male health experts in China have believed that circumcision has no impact on sexual life.
If the foreskin opening is very small and the foreskin cannot be retracted at all, it is called "phimosis". The harm it may cause is that it restricts the development of the glans penis. After a large amount of smegma accumulates, it is not only unhygienic, but also becomes one of the causes of penile cancer and cervical cancer. Sometimes it may cause pulling pain in the penis during intercourse. Some young men have their penis growth restricted due to severe phimosis, and their penis is still the size of a child's after adulthood, causing lifelong regret.
Therefore, men with phimosis should have a circumcision before marriage.
Of course, if parents have a lot of sex education, they should help their children resolve this issue before puberty.
187.
The impact of hernia repair surgery on male sexual function
Some patients who have undergone hernia repair surgery have told their doctors that their orgasmic experience has been greatly reduced after the surgery. Is the reduction really caused by the hernia repair surgery? First, let's look at the relationship between hernia repair surgery and the nerve innervation that controls erection and orgasm, and analyze whether the surgery may damage the relevant nerves and induce the above situation.
In fact, hernia repair surgery only involves the groin area, while the nerves that are related to erection and orgasm run behind the bladder and prostate. Therefore, anatomically speaking, the two are very different and unrelated. The patient's decreased sexual pleasure after surgery is not caused by the surgery itself.
So why does the feeling of diminished orgasm occur? One reason is that in the early postoperative period, the pain in the wound area during the healing process can radiate to the external genital area, which can also affect the sensation to some extent, leading to discomfort during sexual activity. However, this unpleasant feeling will gradually subside over time.
The second reason is that as people age, the frequency of sexual intercourse decreases, and the reduced force of ejaculation during orgasm can also diminish sexual pleasure.
The psychological effects of surgery can reinforce these negative feelings.
It can be said that the impact of surgery can significantly aggravate the age-related changes in bodily sensations, and the various concerns of patients before and after surgery often further complicate the problem.
Sometimes, simply hearing rumors or misinformation from others is enough to produce obvious physical symptoms.
Doctors should make it clear that this surgery will not damage the nerves that control orgasm, so the surgery will never cause this problem. After understanding the surgical procedure, the situation is often greatly alleviated.
188.
The impact of spinal cord injury on sexual function
Spinal cord injury is a relatively common type of disability, mostly caused by trauma or traffic accidents, and the vast majority of patients are young adults.
The process of penile erection is essentially a series of neurovascular activities. The nerves that control erection and relaxation include the sympathetic and parasympathetic nerves, as well as endocrine factors.
Erections can be classified into reflex erections, psychogenic erections, and nocturnal erections.
A reflex erection is an erection caused by direct stimulation of the penis or surrounding tissues, and is controlled by the sacral autonomic nerves.
Reflex erections can disappear due to damage to the nerves in the sacral segment and below of the spinal cord.
Patients with spinal cord injuries may have no penile erection at all, or they may have psychogenic erection, reflex erection, or a combination of both. However, this is related to the degree of injury. Generally, the thoracic segment of the spinal cord is the boundary. The above-mentioned injuries have little effect on reflex erection, while the following injuries can cause serious effects or even complete disappearance.
Psychogenic erection refers to an erection primarily caused by stimuli received by or generated within the brain, including conscious stimuli such as visual, auditory, olfactory, memory, and imagination, and is controlled by the thoracic autonomic nervous system.
Therefore, it can be seen that paraplegic patients commonly seen in clinical practice may still have the possibility of reflexive erections if the sacral segment is not involved. The higher the level of damage, the more obvious the reflexive erection.
Psychogenic erectile function can persist even at a lower level of injury, as long as there is no complete paraplegia.
At the same time, psychogenic erection and reflexive erection are synergistic, and psychogenic erection can enhance reflexive erection function.
Therefore, many patients with spinal cord injuries still have relatively normal sexual function.
In women with spinal cord injuries, sexual function is relatively less affected. Generally speaking, female patients do not have much difficulty having sex with their partners. Although a few patients may experience sensory disturbances in the reproductive organs, lack of local response and orgasm, they can still have sex.
189.
The impact of myocardial infarction on sexual life
Acute myocardial infarction is a type of coronary heart disease, which refers to an acute blockage of any branch of the coronary artery, causing ischemia, damage, and even necrosis of the myocardium it supplies.
After a myocardial infarction, patients can gradually increase their physical activity and exercise over a few months, and can gradually resume some or light work.
It should be noted that energy expenditure varies greatly during sexual activity. If only one normal sexual activity is performed, it should not be a problem for a patient who has recovered from a myocardial infarction for six months.
Therefore, doctors currently believe that there is no need to be overly cautious about avoiding sexual activity after being diagnosed with heart disease; coronary heart disease is not a no-go zone for sexual activity.
When can one resume sexual activity after an acute myocardial infarction? It is generally believed that sexual activity can only be resumed 6 months after recovery from an acute myocardial infarction. Before resuming sexual activity, some tests should be performed, such as a pedal and cycling exercise electrocardiogram test to observe changes in electrocardiogram and blood pressure.
Sexual intercourse should be conducted slowly and gradually. If you have many concerns, you can first observe your reaction after orgasm through masturbation before deciding.
You can start with stroking and hugging. Sexual intercourse can only begin if the patient shows no symptoms. During sexual intercourse, pay attention to the following: avoid overexertion, overeating, emotional fluctuations, alcohol, and spicy foods before intercourse, and keep emergency medications by the bedside in case of emergency; choose the most comfortable position for intercourse, such as lying on your side; do not engage in intercourse for too long, use excessive force, or too frequently; if chest tightness, chest pain, or difficulty breathing occurs during intercourse, stop immediately and take medications such as isosorbide dinitrate or nitroglycerin sublingually.
190.
Hypertension and Male Sexual Dysfunction
If a man suffers from high blood pressure for a long time, it will definitely affect his sexual function.
What is hypertension? Hypertension can be diagnosed if the systolic blood pressure is greater than or equal to 21.3 kPa (160 mmHg) and the diastolic blood pressure is higher than 12.7 kPa (95 mmHg).
Among the male sexual dysfunctions caused by hypertension, the main manifestations are low libido, erectile dysfunction, and ejaculation disorders.
The reasons are as follows:
(1) Arterial factors: Atherosclerosis can occur in any blood vessel, from the aorta to the penile artery, and is the main cause of secondary erectile dysfunction in men over 40 years of age.
Risk factors for atherosclerosis include hypertension. Long-term elevated systolic and diastolic blood pressure can cause proliferation, calcification, and fibrosis of the penile arterial intima, leading to insufficient blood supply and thus affecting the blood flow to the penis.
According to data from the Massachusetts Male Aging Study (MMAS), hypertension is significantly associated with erectile dysfunction. Among men receiving treatment for hypertension, 15% suffer from complete impotence. The penile blood flow velocity of hypertensive patients who are capable of sexual intercourse is lower than that of the normal control group, while the velocity is lowest in hypertensive patients with impotence.
(2) Antihypertensive drugs: including diuretics, β-adrenergic receptor blockers, central antihypertensive drugs, ganglion blockers and others, such as clonidine, methyldopa, compound antihypertensive tablets, etc., are the most common causes of erectile dysfunction (theoretically, diuretics and vasodilators do not cause erectile dysfunction, but can cause incomplete erection through other mechanisms).
After treatment for hypertension, side effects can cause sexual dysfunction such as decreased libido, erectile dysfunction, and anejaculation.
(3) Psychological factors: Long-term high blood pressure can cause organic damage to important organs such as the heart, brain and kidneys, making patients feel anxious and worried, leading to mental depression, which in turn affects sexual function.
191.
Precautions for sexual activity in patients with hypertension
Hypertension is a very common chronic disease, generally divided into two types: slow-onset and rapid-onset. In my country, it can be divided into three stages according to the degree of target organ damage: Stage 1: hypertension, but no clinical manifestations of heart, brain, or kidney; Stage 2: hypertension, with ventricular hypertrophy or changes in fundus arteries or kidney function; Stage 3: hypertension, complicated by heart failure, hypertensive encephalopathy, kidney failure, or fundus hemorrhage, etc.
Therefore, the requirements for sexual activity are different at different stages of the illness.
This is because during sexual activity, the body undergoes a series of sexual response changes, and changes in blood pressure are one of these responses.
Studies have shown that during the excitement phase of sexual activity, leading up to orgasm, men's systolic blood pressure can increase by at least 2.67 kPa (20 mmHg), and their diastolic blood pressure can increase by at least 1.33 kPa (10 mmHg).
People with hypertension have higher blood pressure than normal people, and their blood pressure fluctuates more. During sexual activity, their blood pressure may rise further, which could be dangerous.
So what should patients with hypertension pay attention to regarding their sex life? Here are some points to summarize:
① Arrange sexual activity according to the patient's condition.
People with stage I hypertension can have sex like normal people.
Individuals with stage II hypertension, who may also have mild complications affecting the heart, brain, and kidneys, must engage in sexual activity in a controlled manner under the protection of medication.
Individuals with stage III hypertension, characterized by significantly elevated blood pressure and associated with obvious complications affecting the heart, brain, and kidneys, should abstain from sexual activity.
② According to the above principles, for those who are permitted to have sexual intercourse, it is appropriate to do so once or twice a week, or once every 1 to 2 weeks. Intercourse should not be too exciting, the movements should not be violent, and the duration should not be too long.
Choosing a suitable body position is important to conserve energy and help stabilize the condition.
③ Emergency medications should be available by the bedside, and close attention should be paid to symptoms such as chest pain, headache, dizziness, and shortness of breath that occur during sexual activity. If any of these symptoms occur, the activity should be stopped immediately and treatment should be sought immediately.
④ Psychological preparation: Antihypertensive drugs may induce erectile dysfunction, such as methyldopa, guanethidine, hydralazine, reserpine, etc. Therefore, if erectile dysfunction occurs during medication, do not have unnecessary mental burden. It is best to suspend sexual activity for a period of time and resume sexual activity after changing the medication under the guidance of a doctor.
To avoid worsening of high blood pressure.