Men's Health: Understanding Anejaculation, Hematospermia, and Priapism

What is Ejaculatory Anejaculation?

Ejaculation refers to the inability to ejaculate during sexual intercourse despite sexual desire and penile erection, without the expulsion of semen from the urethra or the presence of orgasm. This abnormal phenomenon is called ejaculatory anejaculation.

Ejaculatory anejaculation can be divided into two types based on its nature: functional anejaculation and organic anejaculation. Functional anejaculation refers to the inability to ejaculate during intercourse, although nocturnal emission is common during sleep; this type accounts for 90% of cases. Organic anejaculation refers to the complete absence of ejaculation under any circumstances, whether awake or asleep, accounting for 10% of cases.

Ejaculation is a very complex reflex process, a coordinated behavior involving the central nervous system, peripheral nervous system, sympathetic and parasympathetic nervous systems, gonadal endocrine system, and reproductive organs. It can be divided into three processes: semen entering the posterior urethra, bladder neck closure, and the forward expulsion of semen from the posterior urethra. Each process is controlled by different nerves. If any part of the process is not sufficiently aroused or coordinated, it can lead to anejaculation.

How to treat hematospermia

After discovering hematospermia, the cause should be identified as soon as possible, and then treatment should be targeted at the cause. For example, for prostatitis and seminal vesiculitis, treatment should focus on the inflammation; for hematospermia caused by tuberculosis, anti-tuberculosis treatment should be the main focus; and for hematospermia caused by tumors, surgical treatment should be performed. For hematospermia of unknown cause, antibiotics and sulfonamides or quinolones can be used for anti-infection treatment. Sometimes, seminal vesicle and prostate massage is used to empty the fluid containing bacteria from the seminal vesicles as soon as possible to facilitate recovery. For persistent hematospermia, electrocautery can be performed under urethral endoscopy to stop the bleeding. During the acute phase, the blood is bright red. First, sexual activity should be stopped and rested for 1-2 weeks. Afterward, as the amount of hematospermia begins to decrease and the color becomes dark brown, indicating old bleeding, sexual intercourse can be resumed 1-2 times. The frequency should not be too high, and the movements should not be too vigorous. The reason for not advocating abstinence from sexual intercourse is that the stagnant blood and semen in the seminal vesicles or prostate should be drained promptly to prevent worsening of infection or spread. At the same time, each sexual encounter should not be too long, aiming only to expel old semen and prevent further congestion of the prostate, which could worsen bleeding or cause a recurrence. During intercourse, one should maintain a calm mood, avoid excitement, and use gentle movements, avoiding haste. Simultaneously, reduce the intake of stimulating foods, such as alcohol and spicy foods, to prevent aggravating congestion in the affected area.

How to Treat Ejaculatory Pain

Don't panic about ejaculatory pain. Try to reduce the frequency of sexual intercourse, and avoid excessive excitement and vigorous movements during intercourse. Seek medical attention as soon as possible for a clear diagnosis.

Treatment of ejaculatory pain mainly targets the underlying cause. For example, prostatitis, epididymitis, seminal vesiculitis, and urethritis require appropriate anti-infective treatment. For urinary tract stones, small and few stones can be expelled by drinking plenty of water, combined with diuretics, antispasmodics, and stone-dissolving and expelling drugs. Larger and more numerous stones may require surgical treatment. Tumors of the reproductive organs and accessory glands should be treated with surgery, radiotherapy, or chemotherapy depending on their nature. Painful ejaculation caused by phimosis or redundant foreskin should be treated with circumcision promptly. Painful erection caused by urethral stricture or Peyronie's disease should be treated surgically accordingly.

Traditional Chinese medicine treatment of painful ejaculation focuses on identifying the underlying cause and treating accordingly, and may also incorporate acupuncture and external therapies.

How to manage penile priapism in an emergency

Generally speaking, persistent painful erection lasting more than 6 hours without sexual arousal, or an erection that persists for a long time after intercourse, with significant swelling and pain in the corpora cavernosa that is unbearable, can be diagnosed as priapism. If an erection lasts longer than two days, a blood clot will form in the corpora cavernosa. If the erection continues and cannot be relieved, the neuroreflexive (functional) erection will be replaced by a thrombotic or sclerotic erection. If it lasts longer than 10 days, fibrosis of the corpora cavernosa will occur, causing serious organic damage and leaving permanent erectile dysfunction. Therefore, priapism should be considered an emergency and must be treated as soon as possible.

In case of priapism, first aid at the scene can include applying ice packs to the penis or inhaling amyl nitrate to dilate the small arteries, and immediate transport to the hospital for treatment. Generally, based on the duration of the priapism, non-surgical conservative treatment should be performed for 12 hours. If the swelling does not subside, a shunt surgery should be performed.

Non-surgical treatment methods are numerous, including pain relief, sedation, cold compresses, large-volume intravenous fluids, epidural anesthesia with corpora cavernosa aspiration, low-pressure anesthesia with nitroprusside, local injection of metaraminol, and prostate massage. Priapism induced by papaverine injection into the corpora cavernosa can be treated with rapid cycling exercise therapy. This involves the patient performing rapid, vigorous cycling motions, causing the engorged penis to disappear within minutes. It is essentially a simple, non-invasive lower limb "shunt." There are also reports of intracavernosal injection of 3-5 mg of Aramine, followed by manual kneading to promote blood reflux. Urokinase 10,000 units dissolved in 5-10 ml of normal saline and injected intracavernosal has been used, resulting in complete resolution of the erection within 5-30 minutes.

If the above treatments are ineffective, surgical treatment should be performed as soon as possible. The success of the surgery depends on timing; it should be performed before a thrombus forms in the corpora cavernosa. The purpose of the surgery is to remove the blood clot, reduce penile arterial blood supply, and restore sexual function. Commonly used surgical procedures include: corpus cavernosum-urethral spongiosum shunt, glans penis-corpus cavernosum shunt, great saphenous vein-corpus cavernosum shunt, and dorsal penile vein-corpus cavernosum shunt.