A Deep Dive into the Pathological Mechanisms of Ejaculatory Abnormalities and Male Dyspareunia and Psychological Disorders

A couple came to the infertility clinic. During the medical history taking, the woman said the man didn't ejaculate because nothing came out of his vagina after intercourse. The man, however, insisted he felt nothing unusual, ejaculated every time, and experienced pleasure during ejaculation. This ruled out ejaculatory dysfunction, but where did the semen go?

The doctor instructed the man to urinate immediately after intercourse in the morning and bring the urine sample for testing. The next day, the patient brought his urine, and examination revealed a large number of sperm in the urine sediment. The doctor told the couple that the man had retrograde ejaculation. Retrograde ejaculation mainly occurs due to various reasons causing dysfunction of the bladder neck sphincter, preventing the urethral orifice from closing during ejaculation.

The common causes of retrograde ejaculation of semen into the bladder from the posterior urethra include: (1) damage to the muscles and elastic fibers of the bladder neck caused by prostate surgery or transurethral bladder neck obstruction incision, resulting in bladder neck relaxation and retrograde ejaculation. In addition, thoracolumbar sympathectomy, pelvic surgery, spinal cord injury, etc., can also cause loss of bladder neck function and lead to retrograde ejaculation.

(2) Sympathetic neuropathy, severe urethral stricture, bladder stones, cystitis, urethritis, etc. in diabetes can also cause retrograde ejaculation. (3) Long-term use of drugs that block sympathetic nerve function, such as guanethidine, reserpine, thioridazine hydrochloride, bromide, guanidine, etc., can lead to retrograde ejaculation. (4) A few congenital malformations, such as spina bifida, congenital urethral valves, bladder diverticulum, etc., can all cause retrograde ejaculation.

Western medicine has shown good efficacy in treating retrograde ejaculation caused by surgery with oral alpha-adrenergic receptor activators such as ephedrine. For retrograde ejaculation caused by diabetic neuropathy, oral imipramine is recommended. Surgical treatment is also an option. Traditional Chinese medicine is not ideally effective for retrograde ejaculation caused by surgical trauma, but it has some efficacy in treating retrograde ejaculation caused by other factors.

Reports indicate that the four key techniques of inhalation, licking, contracting, and holding (inhalation refers to inhaling, licking refers to the tongue licking the palate, contracting refers to contracting the anus, and holding the breath) have shown some effectiveness in treating retrograde ejaculation. Method: This can be performed in a sitting, lying, or standing position. Relax your entire body, tighten your buttocks and thighs, inhale as your abdomen expands, and exhale as your abdomen contracts. Repeat this inhalation and exhalation 15-20 times.

Lick your tongue against the roof of your mouth while simultaneously contracting your anus upwards. Hold your breath for 5-10 seconds after contracting your anus, then exhale and relax your whole body. Repeat this 20-30 times. Practice every night before bed, washing your perineum with water beforehand. It's not uncommon for men to visit the hospital due to hematospermia (blood in semen). Generally, hematospermia is not easily noticed immediately unless there is significant bleeding, and it's difficult to detect during intercourse.

Even if blood is found on the penis or clothing after intercourse, people often first assume it's the woman's fault. However, if a condom is used during intercourse or withdrawal is used, blood in the semen is less likely to be detected. People naturally become anxious when they suddenly notice a change in semen color. If semen changes from its normal milky white to blood red, reddish-brown, or contains streaks of blood, it means blood has entered the semen.

Blood in semen simply indicates a pathological change in some tissue along the sperm's pathway, such as bleeding, inflammation, or even a tumor. Don't take hematospermia lightly; it could be a sign of a serious illness, and it's best to consult a specialist for a thorough examination. Clinically, hematospermia is not uncommon, and the vast majority can be controlled or cured with treatment. Only a very small number of patients with tumors require further treatment.

If the hematospermia is only occasional and no specific abnormalities are found during examination, it may be caused by the rupture of tiny blood vessels in certain tissues due to rapid congestion and mechanical impact during intercourse. There's no need to panic about this transient hematospermia; it will fully resolve on its own after abstaining from sexual activity for one or two weeks. Bleeding caused by inflammation is mostly intermittent, but it doesn't last long.

If hematospermia persists and worsens, the possibility of a tumor cannot be ruled out. Some patients have a concurrent tendency to bleed extensively in other parts of the body, which is more likely a systemic hematologic disorder such as leukemia or thrombocytopenia, rather than a result of a local lesion. Other causes of hematospermia include tuberculosis, seminal vesicle cysts, seminal vesicle tumors, prostate cancer, and trauma.

So, can hematospermia cause infertility? First, we need to analyze the causes of hematospermia. If it is caused by severe seminal vesiculitis or prostatitis, these two diseases are prone to becoming chronic due to long-term neglect, leading to secondary obstruction of the vas deferens and edema obstruction of the ejaculatory duct orifice, resulting in dry ejaculation where there is only the action of ejaculation but no semen is discharged. This is the mechanism by which hematospermia causes infertility.

Other causes of infertility include changes in seminal plasma composition due to seminal vesiculitis. Bacteria in this condition consume nutrients, compete for oxygen, and excrete toxins and metabolic waste, creating an extremely unfavorable environment for sperm. However, in most clinical cases, seminal vesiculitis and prostatitis have a very mild impact on fertility. Most patients can still conceive normally.

Generally, it won't affect fertility. However, it can't be guaranteed that there are no problems. The way to dispel these concerns is to perform a simple analysis of the semen. Not only women experience pain during intercourse, but men can also experience it. If a man experiences pain during intercourse, it should be taken seriously, as it may indicate an underlying medical condition.

Pain should be considered as a pathological condition. In this case, the following situations should be considered: (1) If the man forcibly inserts his penis into the woman's vagina before the vagina is sufficiently lubricated, friction pain is likely to occur when the penis is moved, and even foreskin tearing may occur. (2) Painful penile erection is mostly caused by a short frenulum or a narrow foreskin opening when the foreskin is too long.

In men with phimosis, if the foreskin opening is narrow, the enlarged penile shaft or glans will be compressed due to the narrow foreskin opening after penile erection, causing pain. If it cannot be repositioned in time, severe cases may result in foreskin edema or even foreskin ischemia and necrosis, i.e., "paraphimosis". (3) Peyronie's disease is more common in middle-aged men. One or more cord-like or oval nodules can be felt on the dorsal side or base of the penis.

When these symptoms occur, it's important to actively investigate the cause and seek treatment. First, reduce the frequency of sexual activity. If the pain lessens or stops, it's likely due to excessive sexual activity. If diagnosed as being caused by phimosis or redundant foreskin, surgery is necessary. If caused by prostatitis, a prostate fluid examination can confirm the diagnosis. Seminal vesiculitis usually presents with hematospermia, while urethritis can be diagnosed through a urine test revealing white blood cells.

Some men, when faced with sexual intercourse with their wives, are unable to take the initiative, experiencing fear or anxiety about sex and unable to experience the pleasure of orgasm, resulting in obvious erectile dysfunction. This phenomenon is medically known as sexual copulation phobia. Sexual copulation phobia is simply a psychological disorder, and its causes are quite complex.

For example, some people do not receive proper education during their childhood psychosexual development, or are subjected to some kind of strong stimulation, so they cannot form normal sexual roles and find it difficult to perform corresponding sexual role behaviors as adults. There are two situations: one is that they lack parental love, are relatively lonely, and their psychosexual development remains at the "narcissistic" stage, finding comfort only in masturbation.

Another cause is intense stimulation. For example, a man who, as a minor, was responsible for caring for a bedridden female elder and had to handle her bodily functions might associate female genitalia with filth in his mind. As an adult, he might develop a fear of seeing female genitalia and a fear of sexual intercourse. Some young people also experience sexual dysfunction during their first sexual encounter due to excessive excitement, fear, and tension.

To prevent sexual phobia, the first step is to establish a strong psychological belief that human sexual behavior is a natural instinct. Before intercourse, one should only consider success, not failure. Having this mental preparation and psychological foundation is already half the battle won. Secondly, obtaining the wife's consent and understanding is also extremely important.

In treating male sexual anxiety, the wife plays a crucial role. She must give her husband more love to melt away this fear. The couple can also read relevant sex education materials together. Furthermore, she should encourage the husband to take the initiative during sexual activity, proceeding gradually to overcome his fear.