Etiology and Psychological Factors of Erectile Dysfunction
**Erectile dysfunction-a condition with broad social psychological implications**
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> **and its medical significance**
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> Impotence is a traditional Chinese medicine term. Erectile dysfunction is its specific term. It generally refers to the inability of the penis (called yangju in Chinese medicine) to effectively enlarge and erect, so as to be unable to penetrate the vagina for sexual intercourse.
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Humans have been aware of impotence for a long time. In the Book of Genesis in the Bible, God punished the Abimelechites for impotence, causing them to lose their sexual ability and become like the living dead. This shows the harm that impotence can cause to men.
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Erectile dysfunction (impotence), premature ejaculation, and low libido are the three major fatal flaws in men's sexual behavior. Many men value their sexual ability and believe that losing sexual ability is equivalent to losing masculinity, self-confidence, and self-esteem. They may seek relief by avoiding social interaction or numbing themselves with alcohol or drugs.
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There are currently no statistics on the prevalence of erectile dysfunction in my country. In Shanghai, the prevalence of erectile dysfunction is 32.8% for those aged 40-49, 36.4% for those aged 50-59, 74.2% for those aged 60-69, and 86.3% for those over 70. The number of cases gradually increases with age.
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The pathological basis of erectile dysfunction is that, under sufficiently strong sexual stimulation, blood cannot be adequately perfused into the penis or penile blood pressure cannot maintain adequate perfusion, resulting in the penis being unable to maintain an erection and remaining in a flaccid state. The causes are multifaceted, including psychological, vascular, and neurological factors, ultimately leading to the inability of the penis to maintain an erection or achieve a full erection for sexual intercourse.
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It can be secondary to a physiological disorder or caused by a psychological illness.
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**3.1//What causes erectile dysfunction?**
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① Psychological reasons.
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The psychological characteristics of patients with erectile dysfunction often include depression, anxiety, and suspicion.
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① Disharmony in the marital relationship is a common contributing factor.
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The husband has too many social engagements outside of work hours, stays out all night, and has too little time for emotional communication with his wife.
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Issues such as child custody, financial matters, and parental care within the family cannot be properly resolved, leading to frequent arguments that damage the marital relationship. This can result in suspicions of infidelity and hostility towards the wife, ultimately undermining the emotional foundation of the marital relationship.
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From a work perspective, being too busy at work and experiencing excessive work pressure can lead to a lack of interest in sex. Furthermore, unexpected life events, such as the death of a loved one or a major mistake at work that significantly impacts one's future, are all socio-psychological factors contributing to erectile dysfunction.
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> ② Negative sexual experiences.
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For example, the guilt associated with repeated failed sexual encounters and frequent unsafe extramarital sexual behavior before marriage.
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Loss of confidence in sexual function can lead to anxiety and fear about sex, affecting penile erection.
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③ The failure of sex education.
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Currently, sex education is almost non-existent, and many people always feel confused about sex. During their growth and development, they are influenced by religion, family, traditional culture and moral ethics, and believe that sex is vulgar and dirty. These factors leave a shadow on their sex life in adulthood.
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> ④ Inappropriate or insufficient methods of sexual stimulation.
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Some people enjoy direct stimulation of the external genitalia to obtain visual, tactile, conscious, and emotional pleasure, while others may require stimulation methods related to masturbation habits or their own sexual experiences. Most people need to rely on thinking or fantasy to enhance the effect of sexual intercourse.
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If a man does not receive proper and sufficient stimulation during intercourse, it is difficult for him to achieve sufficient sexual arousal to achieve an erection.
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> ⑤ Mental and psychological illnesses.
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For example, schizophrenia and depression can cause impotence. 50% to 90% of patients with depression have reduced interest in sexual activity. At the same time, sexual dysfunction often causes depression and anxiety.
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The renowned Massachusetts Center for Research on Male Aging found that among those with severe depression, irritability, and a strong desire for dominance, the prevalence of moderate erectile dysfunction was 35%, 35%, and 15%, respectively, while the prevalence of complete erectile dysfunction was 16%, 19%, and 7.9%, respectively.
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> ⑥ Age.
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It is a well-known fact that the prevalence of erectile dysfunction increases with age. Statistics in the United States show that the prevalence of erectile dysfunction is 7% in people aged 20-30 and 57% in people aged 70-79.
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However, age is not a direct cause of erectile dysfunction. In other words, erectile dysfunction is not an inevitable event in the aging process. In fact, many elderly people still have sexual ability in their 90s. Age only plays a role in promoting the onset of erectile dysfunction.
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As people age, their psychological response to sexual stimulation weakens, their libido declines, and the sensitivity of the penis to sexual stimulation decreases. In addition, after the age of 45, male sex hormone levels also decline. These are all adverse effects of age on penile erectile function.
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> ⑦ The relationship between smoking and impotence.
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Smoking is a direct cause of high blood pressure and heart disease. It can also cause erectile dysfunction by affecting blood flow to the penis. Whether smoking can directly cause erectile dysfunction is not yet fully confirmed, but the incidence of erectile dysfunction is significantly higher among smokers than non-smokers. Condra's survey showed that 81% of patients with erectile dysfunction were smokers, while 19% were non-smokers.
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Smoking can cause many diseases such as high blood pressure, heart disease, and high cholesterol, all of which can directly lead to erectile dysfunction. Therefore, we cannot ignore the relationship between smoking and erectile dysfunction, and quitting smoking can definitely reduce the risk of erectile dysfunction.
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> ⑧ Can excessive alcohol consumption cause impotence?
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There is an ancient Chinese proverb: "Do not enter the room after drinking alcohol." It is undeniable that excessive drinking can cause decreased sexual function.
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Small amounts of alcohol can increase libido, but excessive drinking can indeed reduce sexual function. Long-term alcohol abusers have a significantly higher incidence of erectile dysfunction than non-alcoholics.
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Lemert's report on 17,000 drinkers with more than 37 years of drinking history found that 80% suffered from erectile dysfunction, and even after years of abstinence, half of them still failed to regain erectile function, indicating that heavy drinking is a direct cause of erectile dysfunction.
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Long-term alcohol abuse will lead to two harms: one is changes in the body's biochemistry, such as a decrease in androgen levels.
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The above changes can be reversed in the short term after quitting drinking, but long-term alcohol abuse will cause irreversible changes.
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Secondly, alcohol can directly damage testicular and liver cells. Liver damage can lead to a decrease in estrogen metabolism, resulting in elevated estrogen levels.
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Testicular damage reduces androgen production, further causing hormonal imbalance, which makes erectile dysfunction easier to understand.
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> 9. The relationship between drug use and impotence.
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Many people believe that drugs such as marijuana, opium, and heroin can enhance sexual performance.
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Occasionally taking small amounts of drugs such as marijuana, cocaine, and amphetamines may increase sexual pleasure and prolong intercourse in the short term. However, large and long-term use of drugs, like alcohol, will inevitably affect male erection and cause impotence. According to a report by Yang Min, a domestic scholar, the incidence of impotence among heroin users is 32.2%.
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