Avoiding common self-diagnosis misconceptions about erectile dysfunction and conducting systematic examinations for functional and organic lesions.

Modern medicine gives a concise definition of erectile dysfunction: it usually refers to the inability of the penis to achieve or maintain an erection sufficient for satisfactory sexual intercourse when there is sexual stimulation and desire. In fact, any subjective conjecture or guess is unscientific. Whether or not one has erectile dysfunction should be determined through a detailed understanding of the patient's condition and rigorous testing. Many people easily fall into the trap of self-diagnosing erectile dysfunction, thus becoming mentally burdened and unable to recover. The main misconceptions are: (1) regarding the inability to induce female orgasm and pleasure as erectile dysfunction: as long as the man's penis can achieve an erection and penetration, and as long as the man can successfully ejaculate and reach orgasm through intercourse, it is not erectile dysfunction, even if there is no sexual pleasure. One of the characteristics of male and female sexual function is that "men are faster and women are slower", so if the man has ejaculated but the woman has not yet reached orgasm, this is a physiological phenomenon, at most a problem of disharmonious sexual life, and should never be considered as erectile dysfunction. (2) The belief that masturbation inevitably causes impotence: This is a common misconception among unmarried young people. Undeniably, masturbation is a common behavior among teenagers, and many people worry that it will induce impotence. However, modern medicine has clarified that this type of impotence is not essentially caused by masturbation itself, but rather by long-term masturbation leading to psychological and emotional problems. The psychological state of masturbators is very complex, often characterized by anxiety, guilt, depression, and unease. This unhealthy thinking can hinder normal sexual function. However, even a long-term masturbator may not develop impotence if they resolve these psychological issues. (3) Treating weak penile erection response as impotence: Some men used to experience spontaneous penile erection when viewing pornographic films, books, or pictures, but now this response is not obvious. Does this mean they have impotence? The answer is simple: due to the lack of complete sexual stimulation from their partner, including visual, auditory, tactile, and olfactory stimulation, and due to the lack of actual sexual intercourse, impotence cannot be diagnosed solely based on whether or not the penis is erect. In fact, male penile erection is divided into reactive erection (such as erection after sleeping at night, which does not require any sexual stimulation and is spontaneous through nerve reflexes) and psychogenic erection (such as erection that requires some kind of sexual stimulation, including subtle sexual fantasies from the mind). It often varies with a person's physique, thoughts, and emotions, sometimes better and sometimes worse. This is not an indicator for judging impotence at all. (4) Treating several failed sexual intercourses in the early stages of marriage as impotence: This situation is quite common, but it actually violates the principle that couples must have a 2-3 month adjustment period before starting sexual activity. At the beginning of marriage, especially on the wedding night, excessive excitement, fatigue, or even intoxication may cause temporary erectile dysfunction due to a lack of coordination between the couple during the early stages of marriage. Some newlywed couples also experience poor sexual performance due to premarital sexual activity, which is caused by a high failure rate due to the complex emotions of exploration, experimentation, tension, and fear. This leaves a shadow of poor sexual ability in their minds. In such cases, there should be an adjustment period in sexual activity after marriage. (5) Frequent nocturnal emission leads to impotence: This is a common misconception among teenagers. The misconception is that frequent nocturnal emission greatly damages "vital energy" and sexual function will be lost. In fact, this concern is completely unnecessary. It is normal for a healthy unmarried man to have 1 to 2 nocturnal emissions per month, and more than 4 to 5 times is a bit excessive. This may be related to inflammation of the reproductive and urinary organs or certain lifestyle factors, such as wearing tight pants, excessive heat in the local area during sleep at night, and excessive fatigue during the day. However, modern medicine has clearly stated that there is no necessary connection between nocturnal emission and impotence. (6) Premature ejaculation inevitably develops into erectile dysfunction: These patients initially experience premature ejaculation, ejaculating shortly after or without sexual intercourse with their partner, and later even lose their erectile function. From a medical perspective, this situation is often due to psychological factors. Because of premature ejaculation, the patient feels dissatisfied and guilty towards their wife. Some wives express dissatisfaction, mocking and complaining, which puts immense pressure on the husband, and sexual function can indeed be overwhelmed under this complex psychological state and mental stress. If premature ejaculation is effectively treated at its onset, and the patient maintains a strong will and an indifferent attitude, or if the wife doesn't mind at all, erectile dysfunction will not develop.

In daily life, some men, after experiencing occasional or temporary dissatisfaction with their sex life, often suspect they have erectile dysfunction (ED) and readily label themselves as such. Little do they know that this often increases their mental burden, hindering improvement and potentially worsening the condition. In fact, organic erectile dysfunction is relatively rare. Most temporary instances of "erectile dysfunction" encountered are psychological or due to fatigue, and not true erectile dysfunction. In a narrow sense, judging the degree of erectile dysfunction only considers whether the penis achieves an erection and the degree of erection; however, in a broader sense, erectile dysfunction is a reflection of sexual function, and a true assessment of its degree should also include libido, sexual response, and sexual pleasure, among other factors. Patients can be analyzed based on the following specific indicators: (1) Mild erectile dysfunction: The libido is basically normal, and the penile erection response to stimulation of the erogenous zones is acceptable. The penis can still make an erection response relatively quickly when receiving sexual stimulation from the opposite sex. When stimulated by masturbation, the penile erection sometimes cannot be sustained, and sometimes it cannot be successfully placed in the vagina. The erection angle can still reach 90°, but the hardness is not ideal. The frequency of intercourse is reduced compared to before, and the sexual pleasure is still acceptable. (2) Moderate erectile dysfunction: The libido is weakened, and the penile erection response to stimulation of the erogenous zones is slowed down. When stimulated by the opposite sex, the penis cannot make an erection response immediately, or can only make an erection response with difficulty. When stimulated by masturbation, the penile erection response is very difficult. During intercourse, the penis often cannot make an erection or often cannot sustain an erection. During intercourse, the penis often cannot be placed in the vagina, the erection angle is not in place, and the hardness is extremely poor. The frequency of intercourse is significantly reduced, and the sexual pleasure is significantly reduced. (3) Severe erectile dysfunction: Loss of libido; regardless of stimulation of erogenous zones, sexual stimulation from the opposite sex, or stimulation through masturbation, the penis does not respond to erection; there is no erection during intercourse, and penetration is completely impossible. There is no erection angle or hardness; sexual activity is essentially stopped, and there is no sexual pleasure. The diagnosis of erectile dysfunction requires a specialist doctor. Hastily labeling oneself as "impotent" will only increase psychological burden and may actually induce psychogenic erectile dysfunction. As a wife, one should not label one's husband as "impotent" or "useless" due to temporary dissatisfaction with sex or failed intercourse; this will only make him more pessimistic. If the wife provides care, consideration, and sympathy, the "cloudy days" will often pass quickly, and the "sunshine" will soon return.

Methods for examining erectile dysfunction: (1) Psychological counseling tests can identify whether there are mental and psychological problems. Abnormal test results indicate functional erectile dysfunction, while normal results indicate organic erectile dysfunction. (2) Penile nocturnal penile erection test: Healthy adult men experience 3-5 spontaneous penile erections during sleep each night. Those with functional erectile dysfunction still experience spontaneous erections. Conversely, those with organic erectile dysfunction also experience nocturnal penile erections. (3) Judgment of clinical symptoms: Those with normal libido, intermittent erectile dysfunction, and basically normal erectile response during masturbation tend to have functional erectile dysfunction. Those with significantly weakened or absent libido and very weak or completely ineffective erectile response during masturbation tend to have organic erectile dysfunction. (4) Sex hormone tests: Measuring blood testosterone, follicle-stimulating hormone, luteinizing hormone, prolactin, and estradiol, etc., to determine whether there is endocrine erectile dysfunction. (5) Special examinations, such as measuring bulbocavernosus reflex, bulbocavernosus reflex latency, perineal somatic sensory excitation potential, and penile skin bio-vibration threshold, can help determine whether neurogenic erectile dysfunction exists. (6) Measurements of penile arterial blood flow, penile cavernous body pressure, penile cavernosography, and penile blood flow Doppler ultrasound can help determine whether vascular erectile dysfunction exists. There is also a simpler method, namely, injecting prostaglandin E₁ into the penile cavernous body. If the penis, which should be erect after injection, cannot achieve an erection, vascular erectile dysfunction is highly suspected. (7) Consult a specialist to determine whether there are any malformations or local lesions of the reproductive organs. (8) Review the medication history in detail to determine whether certain drugs have induced erectile dysfunction. (9) Measure blood glucose levels to see if erectile dysfunction is caused by diabetes.