Middle-aged section: Coping with erectile dysfunction and premature ejaculation during menopause, causes of weight gain and decreased semen volume

**103. How to cope with erectile dysfunction and premature ejaculation during menopause?**

As everyone knows, many organs in a man's body begin to show signs of aging after he enters menopause, one important manifestation of which is erectile dysfunction (ED). ED, medically known as erectile dysfunction, refers to a man's inability to achieve or maintain an erection sufficient for satisfactory sexual intercourse. ED has significant negative impacts, not only affecting the quality of sexual life but also potentially affecting marital relationships and family harmony. The likelihood of experiencing ED increases during menopause, therefore, it requires both partners to work together to address it.

Strengthen communication and emotional exchange between husband and wife, eliminate misunderstandings and barriers. If premature ejaculation occurs occasionally, the woman should comfort, understand, and care for the man, and gently and considerately help him overcome fear, tension, and guilt. She should avoid blaming or scolding the man.

Both partners should learn about sex, understand the physiological differences in sexual response between men and women, and appropriately master necessary techniques for sexual intercourse. Sufficient foreplay, including caressing and kissing, should help the woman reach arousal first and more easily achieve orgasm.

Actively treat any organic diseases that may cause premature ejaculation, and at the same time avoid masturbation and moderate sexual activity to fundamentally prevent the occurrence of premature ejaculation.

Reduce the amplitude and speed of penile thrusting to decrease sexual stimulation of the penis, while the woman actively responds to the thrusts to reach orgasm as quickly as possible, aiming for mutual satisfaction. To further reduce penile sensitivity, condoms can be used during intercourse.

Distracting the man from intercourse can help delay ejaculation. Maintaining a relaxed mood and striving to create a warm, positive family atmosphere and a quiet environment for sexual activity are also important.

After receiving behavioral therapy, the female-superior position was used for a period of time to alleviate the husband's tension and increase his adaptability to vaginal stimulation. A second sexual intercourse within one hour of ejaculation can significantly delay ejaculation time.

Eating more fruits and vegetables, especially those high in vitamin B₁, can help maintain the balance between excitation and inhibition in the nervous system. Abstain from alcohol and avoid spicy and stimulating foods. Eat more seafood, soy products, fish, shrimp, and other foods that nourish yang and replenish essence to strengthen the body.

Prevention is better than cure. Early detection of symptoms and signs of premature ejaculation can prevent the condition from worsening.

**104. Why do middle-aged people often appear "well-off"?**

When men reach 40, their bellies will grow larger and they will start to gain weight. Some people call this a "lucky state," but this "lucky state" may not necessarily bring you good fortune, because you may have already suffered from male menopause syndrome.

Male menopause syndrome refers to a clinical syndrome that occurs in middle-aged and elderly men during a specific period. The main symptoms include:

(1) The main mental symptoms are changes in temperament, such as depression, sadness, melancholy and wanting to cry, or mental tension, nervousness, mood swings, or wild thoughts, making unfounded accusations, lack of trust, etc.

(2) Autonomic nervous system dysfunction mainly manifests as cardiovascular symptoms, such as palpitations, discomfort in the precordial region, or fluctuations in blood pressure, dizziness, tinnitus, hot flashes and sweating; gastrointestinal symptoms, such as loss of appetite, abdominal distension, and alternating constipation and diarrhea; and neurasthenia symptoms, such as insomnia, difficulty sleeping and dreaming, easy to wake up, memory loss, forgetfulness, and slow reaction.

(3) Common sexual dysfunctions include decreased libido, impotence, premature ejaculation, and low semen volume.

(4) The main changes in body shape are that the muscles of the whole body begin to relax, the subcutaneous fat is more abundant than before, and the body becomes fatter, which is what we call "blessed state".

The pathogenesis of male menopause syndrome remains unclear, but most scholars believe that the mechanisms of menopause are similar in men and women. In men, it is mainly due to testicular atrophy, decreased testosterone secretion, increased pituitary secretion in response to feedback stimulation, and reduced responsiveness of the atrophied testes to gonadotropins, leading to an imbalance in the body's sex hormone regulation.

Faced with male menopause syndrome, we should actively respond and make changes: In terms of lifestyle, strengthen physical exercise to improve physical fitness and enhance the body's adaptability; maintain regular daily routines and moderate sexual activity to preserve kidney essence; eat a light diet, protect the spleen and stomach, abstain from smoking and alcohol, regulate emotions, reduce worries, and promote the smooth flow of qi and blood; in terms of diet, while treating the syndrome, dietary regulation should not be neglected, since the pathogenesis of male menopause syndrome is fundamentally kidney essence deficiency, so the diet should include foods that nourish kidney essence, and should be light, easily digestible, with less fried, fatty, and sweet foods, and avoid spicy and stimulating foods; in terms of mental state, strengthen ideological cultivation, maintain an optimistic mood, overcome psychological stress factors, establish a firm belief in life, and cultivate perseverance.

**105. What causes decreased semen volume and inability to ejaculate?**

Men's sexual function gradually declines after middle age, mainly manifested as decreased libido, erectile dysfunction, and premature ejaculation. Some men may also experience reduced semen volume or inability to ejaculate. Therefore, when men experience reduced semen volume or inability to ejaculate, they often assume it is due to menopause, when in fact it may be due to other diseases, thus delaying treatment.

There are many main reasons for decreased semen volume: ① Decreased testicular function and endocrine disorders, leading to poor development of the epididymis, prostate, and seminal vesicles, resulting in insufficient semen secretion. ② Urogenital system infections, such as prostatitis, seminal vesiculitis, and epididymal tuberculosis. ③ Tumors or cysts of the seminal vesicles, urethral stricture, urethral diverticulum, or damage to the vas deferens caused by reproductive tract surgery. ④ Excessively frequent ejaculation.

Non-ejaculation refers to a condition where the penis is erect during intercourse, but no semen is ejaculated after intercourse.

There are many factors that can lead to anejaculation. Of these, 70% are not caused by disease, but mainly by poor psychological and emotional states, unhealthy lifestyle habits, and insufficient sexual stimulation, such as frequent masturbation, which can cause the ejaculation center to only be excited under strong stimulation. However, 30% are caused by certain diseases, such as inflammation or injury leading to obstruction of the reproductive tract, including the vas deferens, seminal vesicles, and epididymis. Anejaculation can have serious consequences, including impotence, abnormal ejaculation, nonbacterial prostatitis, hematospermia, and frequent nocturnal emissions.

Clinically, inflammation of the reproductive system, such as prostatitis, is a major cause of reduced semen volume and ejaculation failure. If the inflammation is not controlled, the condition can worsen and lead to complete loss of sexual function. Therefore, men with reduced semen volume or ejaculation should seek medical attention promptly to find the cause and prevent the condition from worsening.