Western medical understanding of priapism, its different types and adverse consequences

54.

Western medicine's understanding of priapism

We know that the process of penile erection is essentially a series of neurovascular activities, and the degree of erection depends on the balance between the amount of blood flowing in from the arteries and the amount of blood flowing in from the veins.

The penis is mainly supplied with blood from four branches of the internal pudendal artery: the dorsal penile artery, the deep penile artery, the bulbar penile artery, and the urethral artery.

There are communicating branches between the dorsal penile artery and the deep penile artery, and the penis also contains abundant cavernous sinus tissue. When these cavernous bodies become engorged with blood under the action of the erection regulation mechanism, the penis becomes hard and erect.

However, under the influence of certain pathogenic factors, the arteries in the corpora cavernosa of the penis become persistently dilated, while the veins become persistently constricted, resulting in a persistent state of congestion, which in turn leads to priapism.

The consequences include impaired blood circulation and oxygen supply to the penis. Over time, this can lead to pathological changes in penile tissue, such as hypoxia, thrombosis, and fibrosis of the corpora cavernosa, ultimately resulting in loss of erectile function.

55.

Types and differences of priapism

There are two types of this disease: high-flow (non-ischemic) priapism and low-flow (ischemic) priapism. High-flow type is characterized by bluish-gray penile tissue and milder pain, while low-flow type is characterized by a hard, inelastic penis and severe pain.

It is generally believed that the two types are essentially the same except for the number of veins affected.

High-flow priapism is caused by rupture of the cavernous artery. The mechanism is that the blood flow into the torn artery is out of control, and the sinusoids partially dilate. Because the trabecular smooth muscle is not relaxed, the blood in the sinusoids flows directly out through the unaffected subtunic venous plexus. Therefore, the venous outflow is not significantly obstructed, and there is no blood stasis or ischemia in the sinusoids. As a result, it is generally not accompanied by pain and the prognosis is good.

However, most cases are low-flow blood types, also known as venous priapism. It is a low-flow, low-output type, which is based on the obstruction of the cavernous veins. The obstruction of venous outflow hinders arterial inflow, reduces arterial blood supply, and causes rapid development of tissue hypoxia and acidosis. It is very easy to cause paralysis of the smooth muscle of the cavernous body and small arteries and the formation of intracavitary thrombosis.

It can easily lead to permanent erectile dysfunction and has a poor prognosis.

56.

Adverse consequences of priapism

Medical scientists have learned about the serious consequences of priapism through pathophysiological studies of the penis-permanent erectile dysfunction, and even penile necrosis.

Under normal circumstances, if various pathological factors stimulate the nerve-vasomotor mechanism of the corpus cavernosum for a long time or excessively, causing spasm of the outflowing blood vessels or relaxation of the inflowing blood vessels, the normal erection and de-eruption process will be disrupted, resulting in prolonged erection.

At this time, blood stasis occurs in the corpora cavernosa, blood viscosity increases, oxygen partial pressure and pH decrease, and carbon dioxide content increases. These changes can be seen as early as 6 hours after the onset of the disease. If not treated in time, it will further cause edema of the corpora cavernosa interstitium, eventually leading to thrombosis of the main efferent veins. Ischemia and hypoxia cause the patient to feel severe pain.

If this continues for a long time, it can lead to fibrosis of the corpora cavernosa and erectile dysfunction.

This is the serious consequence of priapism.

57.

Common causes of male ejaculation disorders

The causes of ejaculatory dysfunction include:

(1) Disorders of sperm production. Semen is composed of sperm produced by the testes and secretions from accessory glands. Sperm accounts for less than 0.1%, prostatic fluid accounts for 13% to 32%, and seminal vesicle fluid accounts for 45% to 80%. Semen production depends not only on the integrity of the anatomical and physiological functions of the internal reproductive organs, but also on the influence of androgens.

Therefore, whether it is congenital or acquired, abnormalities of the internal reproductive organs or factors affecting androgen production can cause ejaculation disorders, such as congenital absence of seminal vesicles, removal of pituitary tumors, and anorchia.

(2) Semen discharge obstruction can be caused by the following conditions, such as congenital absence of the vas deferens, vas deferens atresia, urethral abnormalities, etc., which prevent semen from being discharged from the body.

Abnormalities in the nervous system can also cause problems with semen expulsion, such as surgical damage to nerves, spinal cord injury, diabetes, and other neurological diseases.

(3) Psychological disorders, which mainly cause delayed ejaculation and premature ejaculation, without any organic lesions.

58.

Causes of primary male ejaculatory dysfunction

Patients who have never ejaculated while conscious have primary absolute ejaculatory dysfunction.

It is caused by sexual ignorance or sexual inhibition, but there is nocturnal emission in normal times.

The reasons are as follows:

(1) Sexual ignorance: Before marriage, neither party knew what sexual intercourse was, and they were completely lacking in sexual knowledge. They did not even know that sexual intercourse would result in ejaculation. The sexual position was incorrect. Some people did not even know the location of the vagina and had sexual intercourse in the anus or urethra for a long time.

The man felt the urge to urinate during intercourse and interrupted the act for fear of soiling the sheets. After urinating, his penis became flaccid, and intercourse could not continue.

(2) Mental and emotional factors: having some kind of "knot" in one's mind about sex, such as dissatisfaction with one's current spouse, not forgetting a former lover, or suspecting that one's wife is having an affair; the woman has been raped or has had sexual experience, and the husband is still bothered by this, etc., which form a vicious sexual stimulus, leading to non-ejaculation.

(3) Female factors: fear of painful intercourse, fear of tearing the vagina, poor physical condition of the woman and aversion to sexual activity, which frustrates the male's sexual impulse.

(4) Other objective factors, such as small housing, different jobs and different get off work hours, and lack of coordination in sexual activities.

59.

Causes of secondary anejaculation in men

If a person has previously been able to ejaculate after marriage, but loses the ability to ejaculate due to other factors, this is called secondary anejaculation.

Common causes include:

(1) During the first marriage, sexual impulses were unusually intense. Even without thrusting, ejaculation could occur during intercourse. However, after this peak period, due to improper methods, ejaculation could no longer occur.

(2) Being discovered and punished for masturbation or improper sexual activity, causing psychological trauma, frequent masturbation before marriage, lack of coordination between partners, etc.

In the past, one could ejaculate normally, but in order to intentionally prolong intercourse, one may use methods such as distraction to develop a habit of delaying ejaculation, which may lead to anejaculation.

It is worth mentioning that when sexual intercourse is too frequent, ejaculation may slow down, or even be prolonged or absent. For example, it is common for newlyweds to have sex multiple times in one night and then not ejaculate.

People over 50 years old do not always ejaculate during sexual intercourse.

60.

Traditional Chinese Medicine's understanding of the etiology and pathogenesis of anejaculation

Involuntary ejaculation falls under the categories of "sperm blockage," "inability to ejaculate," "non-ejaculation," and "non-ejaculation" in Traditional Chinese Medicine.

Its etiology and pathogenesis are as follows:

(1) Indulging in lust: Prolonged illness damages the kidneys, or excessive sexual activity or masturbation in adolescence can lead to kidney qi deficiency, making it unable to open the seminal gate; or kidney essence is depleted over time, resulting in no sperm to be released; or yin deficiency and fire excess cause internal heat to burn the sperm, resulting in little sperm that cannot be ejaculated; or for the sake of momentary pleasure, one suppresses the ejaculation, which over time leads to the depletion of sperm and blood stasis, obstructing the seminal duct, and making it difficult to ejaculate.

(2) Emotional injury: Excessive joy injures the heart, depletes the heart qi, and the heart fire cannot descend to the ministerial fire, so the seminal gate cannot open normally and the seminal essence is blocked; anger injures the liver, the liver loses its regulation, the qi mechanism is not smooth, the function of dispersing and draining is impaired, the seminal gate does not open and the seminal essence cannot be ejaculated; or sudden fright injures the kidney qi, which cannot stimulate the seminal gate and the seminal essence cannot be released; or excessive thinking injures the spleen, the spleen and stomach are weak, the production and transformation are weak, the essence and qi are not sufficient and cannot be released.

(3) Improper diet: Excessive consumption of rich and greasy foods damages the spleen and stomach, leading to the generation of phlegm and dampness, which flows down the meridians to the lower abdomen, obstructing the collaterals. When the seminal ducts are blocked, seminal fluid cannot be released.

(4) Excessive nourishment: Excessive nourishment will cause stagnation and obstruction, resulting in poor ejaculation and inability to ejaculate.

(5) External injury to the seminal duct: Damage to the seminal duct and its surroundings, as well as various pathological products, can block the seminal orifice, preventing the normal ejaculation of semen.