Article 20: The Relationship Between Obesity and Erectile Dysfunction and the Diagnosis and Classification of Erectile Dysfunction

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Treatment and recuperation of common diseases

Obesity and Erectile Dysfunction

Many obese patients also experience sexual dysfunction. Hormone tests in some patients with simple obesity show low levels of testosterone and high levels of estrogen, along with decreased libido. Studies have found that overweight patients have significantly lower plasma free and bound testosterone levels than men of normal weight. If an individual is more than twice their normal weight, their average plasma testosterone level is even lower. Obese individuals are prone to diabetes, hypertension, coronary heart disease, and other illnesses. Being overweight can also cause degenerative changes in joints, especially the knees, making certain sexual positions difficult. Furthermore, the weight of an obese person can be unsatisfying for their partner, or require them to spread their legs for intercourse, causing psychological distress. Some severely obese individuals are unable to engage in vaginal intercourse due to excessive abdominal fat accumulation. In addition, obesity can cause psychological problems such as body image issues, social difficulties, lack of self-confidence, and significant depressive reactions, thus affecting their sex life and even leading to avoidance of sexual contact.

1. Under no circumstances can the penis achieve an erection.

2. Spontaneous erections occur during sleep and upon waking, but erections are not achieved during sexual arousal.

3. The penis has a good erection at the onset of sexual arousal, but becomes flaccid when attempting intercourse or before ejaculation.

4. Within 3 months, the success rate of sexual intercourse is below 25%.

Can failure during a newlywed's first sexual encounter or the first time indicate erectile dysfunction?

Failure on the wedding night or the first sexual encounter does not necessarily indicate erectile dysfunction. There are many reasons for failure during the first sexual encounter: Firstly, both partners experience anticipation and longing. The first sexual experience, the first exploration of sexual secrets, the first time turning hesitant and vague sexual desire into reality, often involves a mix of emotions: excitement, agitation, mystery, desire, tension, anxiety, and uncertainty. The man, in particular, may lack sufficient sexual knowledge or have a masturbation habit, leading to a greater fear of failure and excessive pre-coital tension. Secondly, both partners may lack proper understanding of their reproductive organs, have insufficient sexual knowledge, or use incorrect sexual positions, all of which can contribute to failure. Therefore, failure during the first sexual encounter does not necessarily indicate erectile dysfunction.

Differentiation between functional erectile dysfunction and organic erectile dysfunction

Functional erectile dysfunction is mostly caused by emotional, psychological, and social factors, as well as loss of sexual control and lack of sexual knowledge. It was previously believed that functional erectile dysfunction accounted for 90% of erectile dysfunction cases, but with the continuous improvement of diagnostic technology, it has been found that many of these cases involve organic lesions. Therefore, a comprehensive and meticulous examination is still necessary for functional erectile dysfunction to avoid misdiagnosis.

The psychological characteristics of patients with functional erectile dysfunction can be summarized in five points:

(1) They have an inhibitory constitution, are not very eager for sex, and find sex life boring.

(2) Passive attitude, calm personality, docile and rarely angry, lacking initiative to seek stimulation.

(3) He demands a passionate sexual response from the woman, and his penis becomes weak when the woman cannot satisfy him.

(4) People who have had abnormal sexual lives (such as homosexuality, excessive masturbation).

(5) Having excessive admiration and respect for the woman.

Organic erectile dysfunction (ED) is a concept proposed in contrast to functional erectile dysfunction (ED), referring to erectile dysfunction caused by organic diseases. Clinically, it manifests as the inability to achieve or maintain an erection at any time, and the erectile dysfunction may persist even after the organic cause has been successfully eliminated. Relatively speaking, the treatment outcomes for organic erectile dysfunction are worse than those for functional erectile dysfunction.

Organic erectile dysfunction shares the following characteristics:

(1) Regardless of time or place, and regardless of sexual intercourse or masturbation, the penis cannot achieve an erection.

(2) There is no penile erection during sleep, and even if there is, the erection is not firm.

(3) Although unable to achieve an erection, sexual desire remains intact and strong, but the desire is not strong enough.

(4) Because it is caused by disease, most cases start and worsen gradually.

(5) It is often accompanied by changes in mental and behavioral states.

Classification of erectile dysfunction

Erectile dysfunction can be divided into three levels:

Level 0: Cannot achieve an erection at any time.

Level 1: Sometimes erections are possible, but erections disappear during intercourse.

Grade 2: Erectile dysfunction, unable to satisfy sexual intercourse.