Classification and treatment of genital injuries caused by sexual intercourse and a multidimensional analysis of male hypoactive sexual desire disorder

The main causes of genital injury in men during intercourse are as follows: (1) Urethritis: Vigorous intercourse often causes urethritis in some men, especially when the patient has phimosis, poor personal hygiene, or the female has vaginitis. There will be tenderness in the urethra, and sometimes pain during urination. Diagnosis and identification of the cause can be made through microscopic examination and culture. Prevention: Sufficient foreplay should be done before intercourse, and the intercourse should be carried out gently. Attention should be paid to the hygiene of the reproductive organs of both men and women. (2) Urethral injury: Prolonged vigorous intercourse or excessive pressure on the urethra may cause urethral trauma and accompanying pain. Because the corpus spongiosum of the urethra becomes congested and hard during erection, it is easily damaged. Using sexual instruments such as negative pressure suction devices or physiotherapy rings at the base of the penis to enhance or prolong erection may damage the urethra. Pre-existing abnormalities such as urethritis, urethral stones, urethral diverticulum, and urethral stricture can increase the possibility of urethral injury. Treatment is the same as for urethritis. (3) Penile skin trauma: Commonly seen in bites, underlying foreskin abnormalities, and the use of instruments, which can cause distal edema, making it difficult or impossible to remove the instrument. Unless necrosis occurs due to prolonged delay, most cases can fully recover. Sometimes, severe urethral edema can cause difficulty in urination, which may require the use of a No. 2 catheter or suprapubic cystostomy. (4) Paraphimosis: Occurs in men with phimosis or a tight foreskin. When the foreskin is retracted to the coronal sulcus behind the glans, due to congestion of the glans and foreskin edema, the foreskin cannot return to its original position. In this case, blood supply to the glans should be restricted, so it is necessary to go to the hospital immediately to deal with this problem. (5) Testicular injury: Generally speaking, the tunica albuginea of ​​the testis can withstand a force of 50 kg without rupturing. In addition, its mobility and deep location make testicular injury during intercourse rare. If an injury does occur, it is likely that the testis is squeezed into the pubic or groin area. If testicular bleeding or tunica albuginea rupture is suspected, surgical exploration and repair should be performed at the hospital. Its spermatogenic and hormone secretion functions can usually be preserved. Diagnosis is not difficult based on medical history and testicular tenderness or the presence of surface rupture. If there is a history of epididymitis or hydrocele, the movement of the testicles during intercourse will cause discomfort during intercourse. (6) Priapism: It rarely occurs when the intercourse is prolonged or the movements are too vigorous. If this condition does occur, a complete blood count should be performed to rule out sickle cell anemia and leukemia, and a history of neurological disorders, trauma, or special medications should be inquired about. (7) Penile fracture: It is usually caused by a tear in the tunica albuginea of ​​one or two corpora cavernosa, and it only occurs during penile erection. During erection, the tunica albuginea is thinner, only 1/4 to 1/2 mm thick. Tearing mostly occurs in the middle and distal part of the penis. Patients will report hearing a cracking sound when the injury occurs, followed by severe pain and rapid swelling. Penile swelling, discoloration, and deformity are common clinical signs. Urethral injury may occur in 30% of cases. Urethral injury should be suspected if there is bleeding from the urethra, hematuria, or difficulty urinating. Sexual intercourse is neither the only nor the most common cause of penile injury. Most injuries occur when the penis is forcefully squeezed to reduce erection, or when the erect penis is rubbed against a bed or hard object; they can also occur when the erect penis is kicked, hit, or falls. Penile fractures during intercourse are more common than when the erect penis hits the woman's pubic bone or perineum, when it slips out during thrusting and hits a bed, or when the sexual position is changed abruptly. If a penile fracture occurs, seek immediate emergency medical attention.

Low libido refers to a patient's lack of subjective desire for sexual activity, including sexual dreams and fantasies; a lack of awareness of participating in sexual activity; and no feeling of frustration when deprived of sexual opportunities. The frequency of sexual activity is not a reliable standard for judging low libido, but generally speaking, less than twice a month can be used as a reference standard. The main factors leading to low libido are: (1) False beliefs and information: Many people have deep-rooted false beliefs and information, such as believing that nocturnal emission is a manifestation of kidney deficiency, that semen is a much more precious human essence than blood, that sexual activity will affect a person's lifespan, and that it will cause great damage to a person's vitality. (2) Marital conflict: Insufficient communication, especially regarding sexual needs and feelings; lack of common interests and mutual trust; bringing non-sexual conflicts into sexual life. Sexual and non-sexual problems can exist independently or be mutually causal, but once one of them appears, it will always aggravate or complicate the problem. For example, some women regard sex as a means of blackmail, saying things like, "If you don't buy me clothes, I won't let you have sex," or "If you don't do housework, I won't let you have sex," etc. Over time, the man must submit and obey the woman's every whim in order to maintain the marital relationship. Once the man realizes this or finds it difficult to comply with his wife's unreasonable demands, he has no choice but to give up on sex. As time goes by, the man will eventually lose interest in sex and experience low libido, or even impotence. (3) Lifestyle: A tense and stressful work environment, long hours of desk work, poor living conditions, lack of privacy and safety, conflicts in work hours between husband and wife, living apart, and the influence of seasons and temperature are also reasons for low libido that cannot be ignored. (4) Psychological barriers: The patient's own psychological conflicts can often be reflected in the couple's sex life, such as excessive anxiety about sexual ability or guilt for not being able to satisfy the wife's sexual demands. (5) Poor sexual skills: A monotonous and unexciting sex life makes it a dull routine, and even the schedule is arranged in advance. Sex is no longer the highest form of emotional communication. It lacks passion, motivation, and fun, which ultimately leads to low libido. (6) Age factor: Men’s libido begins to decline after age 40, and weakens significantly after age 50, but most can maintain it until age 70.