Encyclopedia of Family Medicine

Chapter 32 Sexual knowledge and eugenics (4)
[Behavior Therapy]
Aversion conditioned reflex therapy is generally used: let homosexuals watch some sexy homosexual photos or homosexual videos, and after arousing sexual arousal, give them an aversive stimulus.Aversive stimulation involves stimulating the genitals or other parts of the body with a moderate amount of electrical current.There were also injections of apomorphine, an emetic, or snapping of wrists with rubber bands.After several conditioned reflex treatments, the homosexual psychological impulse can be weakened or disappeared. 8 times is a course of treatment (once every other day), most of them need 1-1 courses of treatment.

[medical treatement]
Some homosexuals have strong sexual impulses, and they can take chlorpromazine 100-200 mg per day or 2-4 mg of diazepam per day to suppress sexual impulses.When severe cases have obvious anxiety or mental depression, doxepin, amitriptyline, etc. can be used for symptomatic treatment.

② heterosexual cross-dressing
Also known as transvestism, it is more common in men.

Patients desire to dress up as the opposite sex, such as men dressing up as women and women dressing up as men.Often dresses up as the opposite sex when alone and feels euphoric in cross-dressing.

[treat]
It is the same as the treatment principle of "homosexuality", except that when implementing aversion conditioning therapy, the opposite sex can be dressed up and then given aversion conditioning stimulation.

③Exhibitionism
Also known as exhibitionism, it is more common in men and extremely rare in women.

The patient often hides in hidden places and waits for young and middle-aged women to approach, that is, exposes the erect penis for the other party to see. When he sees the emotional reactions of women being aroused, such as anger, shyness, fear and screaming, he obtains a lot of psychological benefits from it. or sexual desire and immediately flee without further obscenity or sexual assault.Serious exhibitionists can also occur in crowded public places, such as buses, large gatherings, on the road, and even individual may masturbate in front of women.

Female patients may appear to go out naked.

[treat]
Basically the same as "gay" treatment.

④ Voyeurism
Also known as obscenity.Mainly male.

The patient obtains the maximum satisfaction of psychological or sexual desire by peeping at the female genitals, but the normal sexual life cannot achieve such a high degree of pleasure.It is manifested as peeking at women taking a bath, or even hiding in the toilets of men and women, and so on.

[treat]
Psychological treatment is the main treatment, which is basically the same as "homosexual" treatment.

⑤ Fetish
Predominantly male.

It is often used to occupy a part of the female body to achieve physical and psychological sexual desire satisfaction, but such a high degree of euphoria cannot be obtained for normal sexual life.For this reason, patients often steal women's clothing, such as lingerie, bras, panties, stockings, menstrual belts, and so on.Or cut women's hair (braids) secretly, often treat the obtained women's items as treasures, and cherish them carefully, touching and admiring them from time to time to obtain sexual pleasure and psychological satisfaction.

[treat]
Mainly psychotherapy, the treatment principle is the same as that of "homosexuality" treatment. During aversive conditioned reflex therapy, the patient can be made to hold a sexual fetish and then perform aversive stimulation.

⑥Sadomania

Sexual sadism is to abuse the sexual object, so that when the sexual object produces pain, cry and other struggle responses, one's own sexual excitement will increase, and in severe cases, the sexual object will die before sexual satisfaction can be obtained.This kind of person is normal in other respects except that they have sexual intercourse in a way different from ordinary people and cause different degrees of mental and physical pain to the other party.It is more common in men, and its etiology is extremely complex.Because of the sexual sadism, the other party has great mental and physical pain, and the marriage and family are often broken because the other party can't bear it.

Opposite to masochism, there is also a "sexual masochism", which refers to a behavioral abnormality that vents sexual desire and obtains sexual satisfaction by receiving pain from the opposite sex.

[treat]
Mainly psychotherapy.Prevention and treatment of sexual dysfunction
Sexual dysfunction refers to a group of diseases in which abnormal psychophysiological reactions occur during sexual intercourse, so that sexual intercourse cannot be completed satisfactorily.

People with sexual dysfunction are psychologically depressed, distressed, and inferior, which seriously affects their physical and mental health, as well as their relationship and family stability.Therefore, it is very important to strengthen the prevention and treatment of such diseases.

1. Impotence
Impotence refers to the fact that although a man has sexual desire, the penis cannot be erected, or the erection is not firm, and the erection cannot be maintained, so that the vagina cannot be inserted for sexual intercourse.

Impotence is divided into two categories, one is primary, which means that the penis cannot be erected under any circumstances, cannot be inserted into the vagina for sexual intercourse, cannot have normal sexual life, and is infertile.The other type is secondary, which refers to having had successful sexual intercourse before, and then having erectile dysfunction; or usually (such as pornographic images, etc.) can cause spontaneous erection, but when trying to have sexual intercourse, the erection disappears.

[Cause]
(1) Disease factors: seen in multiple sclerosis, diabetes, alcoholism, peripheral neuropathy, spinal cord injury, after pelvic surgery, etc.

(2) Endocrine factors: such as hypogonadism, hyperprolactinemia, hyperthyroidism or hypothyroidism.

(3) Psychological factors: For example, if the first sexual intercourse fails, the wife blames the husband for being incompetent. From then on, she bears the burden of thinking. Every time she has sexual intercourse, she is worried about failing again, mental stress, anxiety, and fear, forming a vicious circle. Severe mental depression leads to erectile dysfunction .

(4) Vascular factors: divided into arterial and venous: arterial is seen in hypertension, atherosclerosis, hyperlipidemia, diabetes, perineal or pelvic trauma, pelvic radiotherapy, etc.; venous is seen in the elderly, high cholesterol Hyperemia, penile trauma, etc.

(5) Drug factors: Many drugs can cause impotence.Such as antihypertensive drugs; cardiotonic drugs such as digoxin; diuretics such as double grams; sedative hypnotics and so on.

[diagnosis]
The main thing is to distinguish between mental impotence and organic impotence. You can show the patient pictures with sexual stimulation. If there is penile erection, it can be diagnosed as psychosocial impotence.Otherwise, it may be organic impotence, and further examinations such as angiography can be performed to confirm the diagnosis.

[treat]
(1) Psychotherapy

Help the patient analyze the cause of the disease, ask his wife to cooperate, understand together, and relieve the burden of thinking.Explain to the patient about sexual anatomy, sexual physiology and other knowledge.Carry out psychological counseling to eliminate the patient's fear, tension and depression.Guide married life, introduce "sexy concentration training method".

Sensual concentration training has a very good effect on impotence. It is divided into four stages. The specific methods are as follows:

①Non-genital sexy concentration training: The patient couple touches certain parts of each other, such as: hands, waist, thighs.Do not touch breasts and genitals.Focusing on skin sensations, body lines and temperature, non-verbal communication triggers sensory perception.By touching each other, you can achieve sexy concentration, improve body sensation, and evoke a natural sexual response.

②Concentrated genital sexy training: On the basis of non-genital sexy intensive training, both husband and wife touch each other's body at the same time, including breasts and genitals, and the movements should be gentle.Sexual fantasies can be used when necessary to enhance sexuality and prevent distraction.Through this stage of training, anxiety can be eliminated, and the feeling of genital sensual concentration can be directly appreciated.Through mutual caressing, the sexual excitement of both parties is gradually increased, but sexual intercourse is not allowed.If the man has a strong erection, stop stroking, let the penis soften, and then repeat the operation 2 to 3 times.

③Vaginal accommodation training: adopt the female-on-top posture, and the woman should take the initiative to guide the penis into the vagina with her hands, and stand still to experience its comfort.When the penis becomes soft, the man can twitch the penis slightly or the woman’s vaginal muscles contract, moving up and down to rub the penis, so that the man can feel the sexual stimulation and maintain the penis erection.

④Vaginal accommodation and movement: On the basis of vaginal accommodation training, the man can change his position naturally, from the lower position to the upper position, and the woman moves first to make the man feel pleasure.Then the man moves, first slowly and then quickly, with normal pelvic movements, and finally develops into full sexual intercourse.

(2) Qigong treatment

The relaxation exercise in Qigong is the most suitable, and it has a better effect on the treatment of impotence (see the exercise health care of family health care for details).

(3) Traditional Chinese Medicine Treatment

Traditional Chinese medicine has long been researched on impotence. Traditional Chinese medicine believes that:

① Liver qi stagnation, the treatment is suitable to soothe the liver and relieve stagnation, clear the collaterals and invigorate the atrophy.

Bupleurum, Paeonia lactiflora, Citrus Citrus, Licorice, Centipede.

②Damp-heat in the liver and gallbladder: It is suitable for purging the liver and invigorating the gallbladder, clearing away heat and removing dampness.Recipe with Longdan Xiegan Decoction plus centipede.

Gentian, Scutellaria, Shanzhi, Bupleurum, Mutong, Plantain, Alisma, Angelica, habitat, centipede.

③Fear hurts the kidney: treat Yi Ningshen and invigorate the kidney, promote Qingzhen atrophy, and use Xuanzhi Decoction.

Rehmannia, Baji, Ginseng, Atractylodes, Angelica, Yam, Poria, Zao Ren, Polygala, Keel, Oyster, Bupleurum, Cimicifuga.

④Mingmen fire decline: treat and warm up the lower yuan, and stimulate the yang to atrophy.Fang with Zanyudan addition and subtraction.

Rehmannia glutinosa, wolfberry, cornus, angelica, cistanche, Morinda officinalis, antler gum, fried eucommia, fried leek, curculigo, celestial spleen, cnidium, cinnamon.

Traditional Chinese medicine is also commonly used some folk prescriptions and proven prescriptions for treatment, which also have certain effects.like:

①Schisandra chinensis, Cnidium chinensis, and Cuscuta 10g each are decocted in water.

② Stir-fry leeks and fairy spleen 100g each, decoct in water and take.

③ Turtle gum, medlar, cistanche, celestial spirit spleen each 10g, actinolite 15g, one dose per day, decoct in water.

④4 dragonflies, 15g each of Cynomorium and Cistanche.Stir-fry the dragonfly wings and feet, add Cynomorium cynomolgus and cinnamon glutinosa to make soup together, once a day for 10 days.

⑤ centipede 18g, angelica, white peony root, licorice 60g each.Dried Angelica, Radix Paeoniae Alba, and Glycyrrhizae, and then sieved, then grind the centipede finely, then mix and divide into 40 packs, take one pack each morning and evening, take it with white wine or rice wine on an empty stomach, 15 days as a dose course of treatment.

⑥ Cistanche 9g, make tea and drink every day, and chew food residue after drinking.

Traditional Chinese Medicine Diet Therapy:

①"Braised Dog Meat" 500g of dog meat, 5g of cumin, 5g of dried tangerine peel, appropriate amount of ginger, garlic, pepper water, cooking wine, salt, monosodium glutamate, vegetable oil, sauce, and starch.First wash the dog meat and cut it into pieces, prepare all the seasonings, put the vegetable oil on the fire, put the dog meat and onion ginger in the pot after cooking, fry for a while, then add pepper water, salt, cooking wine, and add some water. Then put the fennel and dried tangerine peel into the pot, simmer and simmer on the fire until the meat is cooked, move it to the fire, add the starch juice, and sprinkle with monosodium glutamate.This medicinal diet warms the spleen and kidney and is suitable for impotence patients with kidney yang deficiency.

② "Steamed chicken with red berries" 15g red wolfberry, one hen, cooking wine, pepper, ginger, green onion, monosodium glutamate, salt, etc.First cut the onion into sections, slice the ginger for later use, put the whole chicken into the pot, boil it thoroughly with boiling water, remove it and drip all the water, then put the wolfberry into the chicken belly, then put the chicken belly down into the pot, put the onion, Put ginger, add clear soup, salt, cooking wine, pepper, cover the pot, steam for 2 hours, add monosodium glutamate after cooking and eat.

③ "Fried Lamb Liver with Leek" 200g leek, 150g lamb liver, a little salt and monosodium glutamate.Clean leeks, remove impurities, cut into sections, slice lamb liver, fry in peanut oil, fry over open fire, add salt and monosodium glutamate, and then eat. This medicinal diet warms and nourishes kidney yang, and is suitable for impotence due to deficiency of kidney yang.

④ "Pig Kidney Soup": one pig kidney, 15g plantain, 30g Eucommia ulmoides, 30g wolfberry.Wash the pig kidneys and remove the tendons, and put them into the casserole together with the herbs to make soup.After removing the dregs, take it with seasoning and take it every other day for several days.This medicinal diet can nourish the kidney and remove dampness, and is suitable for impotence caused by kidney deficiency and water retention.

⑤ "Cordyceps Placenta Soup": 15g of Cordyceps sinensis, 20g of raw land, and half a fresh placenta.Wash the placenta, cut it into pieces, put it in a steamer, stew it with the herbs and take it, once every other day, 7-8 times in a row.

(4) Western medicine treatment (according to the doctor's advice)
① Hormone therapy: testosterone propionate 500mg, intramuscular injection, once a day, for a week, or chorionic hormone 800~1000 units, intramuscular injection 1~2 times a week, for 2 weeks.

②Exciting and strengthening agent: strychnine tablet, 1mg each time, orally 1-2 times a day, or 1mg each hour three hours before sexual intercourse.It is not advisable to take more than one dose or take it for a long time.

③ Vasodilators: Papaverine 60~80mg or papaverine 30mg, phentolamine 0~5mg in combination, the effect is better.If the effect of papaverine is not good, you can also choose phenoxybenzamine, imipramine and naftofiram, which can also produce erection.

(5) Surgical treatment

① Penile prosthesis implantation: Silicone rubber and other materials are used as supports and implanted into the corpus cavernosum of the penis to restore sexual intercourse.

② Vascular reconstruction: Connect an artery in the abdomen to the artery leading to the genitals to improve blood supply to the penis.

[prevention]
(1) Learn about sexual health care knowledge, understand physical and psychological conditions, strengthen psychological self-adjustment, enhance self-confidence, do a good job with your wife patiently, and strive for your wife's cooperation in adjustment.

(2) Pay attention to strengthening nutrition, maintain a balanced diet, and pay attention to supplementing vitamin C, A, E and trace elements such as zinc.

(3) Avoid using drugs that affect sexual function.

(4) Strengthen physical exercise and enhance physical fitness.

2.premature ejaculation

Premature ejaculation refers to when a man and a woman have intercourse, the man's erect penis has not yet touched the woman, or ejaculation occurs immediately after the penis is inserted into the vagina, and then the penis softens and shrinks, which is called premature ejaculation.In the first sexual intercourse after a newly married or reunited after a long absence, it is normal for the man to ejaculate faster due to his high excitement.Premature ejaculation that occurs occasionally cannot be regarded as an abnormal phenomenon, and it should be paid attention to if it occurs frequently.

[Cause]
Most are functional.Premature ejaculation can be caused by excessive mental stress, excessive emotional excitement, fear of unsuccessful sexual intercourse or fear of ejaculation too fast.Retrospective medical history, most first sexual intercourse is carried out in a hurry.Other factors include: excessive physical fatigue, excessive sexual intercourse, long-term masturbation, inflammation of the external genitalia and lower urinary tract, and short foreskin frenulum.

[treat]
(1) Psychotherapy

Help the patient to build confidence, enhance the control of the mind, make the patient's mental state stable and good mood, and ask the woman to understand, never insult the man as "incompetent", "wool", etc., so as not to increase the psychological burden, the woman should kindly help the man overcome his fears , nervousness and guilt.Consciously distracting yourself during intercourse to avoid getting too excited can help overcome premature ejaculation.

(2) Functional training

The patient's wife uses non-coital stimulation to stimulate the penis. When it reaches the level of ejaculation, the stimulation is stopped. After the excitement level is reduced, the penis is stimulated again. When it is about to ejaculate, the penis is stopped.Intermittent stimulation is repeated in this way, and the stimulation time is gradually extended, and the intermittent time is shortened, and finally it is possible to receive a considerable degree of stimulation without interruption without ejaculation.Thereby improving premature ejaculation.

(3) Adjustment of the sex life of husband and wife

Carry out appropriate sports and recreational activities, adjust the taste of life, ensure enough sleep, and achieve a balance between work and rest; pay attention to abstinence in sexual intercourse, avoid excessive sex life; eliminate the bad habit of masturbation; After the sexual function is gradually adjusted, you can have sex again; you can also adjust the sexual intercourse position to reduce sexual sensitivity. Some people are sensitive in the upper position, but not sensitive in the lower position. If you are too excited and cause premature ejaculation, you can rest for a while after the penis is inserted into the vagina to stabilize your mood, and then twitch after calming down; if premature ejaculation is caused by chronic inflammation, you should stop having sex and have sex after it is completely cured.

(4) Medication

Oral drugs: methaphen, tranquillium, chlordiazepoxide and the like, mainly to adjust the neural activity of the cerebral cortex.

外用药物：性交前5~10分钟在阴茎头部涂抹1％~2％可卡因溶液，或1％达克罗宁油膏，以降低阴茎头部的敏感性。

(5) Chinese medicine therapy

①Damp-heat type of liver meridian: characterized by premature ejaculation, hypersexuality, bitter mouth and dry throat, yellow and red urine.Main symptoms: hypersexuality, premature ejaculation, dizziness, bitter mouth and dry throat, upset, yellowish red urine or stranguria, itchy vulva, red tongue, yellow or greasy fur, stringy pulse.It is suitable for clearing liver meridian and damp-heat.Addition and subtraction of Longdan Xiegan Decoction:

Gentian, Rehmannia, Angelica, Bupleurum, Alisma, Plantain, Mutong, Huangling, Gardenia.

②Yin deficiency and yang hyperactivity type: characterized by Zaoxie slippery essence and five upset heat.Main symptoms: restlessness and insomnia, impotence, premature ejaculation, slippery sperm, soreness of the waist and knees, five upset fever, hot flashes and night sweats, red tongue with little coating, thready and rapid pulse.Treatment should nourish yin and subdue yang.Addition and subtraction of Zhibai Dihuang Wan:

Rehmannia glutinosa, dogwood, yam, peony bark, Poria, Alisma, Anemarrhena, Treats.

③ Kidney qi deficiency type: characterized by loss of libido, premature ejaculation, nocturnal emission, soreness of waist and knees, clear and long urination, and frequent urination at night. Multiple, pale tongue with white coating, deep and weak pulse.It is suitable for nourishing the kidney and strengthening the essence.Addition and subtraction of Jin Kui Shen Qi Wan:

Dried Rehmannia glutinosa, Chinese yam, Cornus officinalis, Alisma, Poria cocos, Moutan bark, Guizhi, aconite, honey.

④ Deficiency of heart and spleen type: characterized by premature ejaculation accompanied by insufficiency of heart, spleen, spleen and blood.Main symptoms: premature ejaculation, limb fatigue, dull complexion, emaciation, palpitations, shortness of breath, forgetful dreams, or spontaneous sweating, anorexia, loose stools, pale tongue, thready pulse.The treatment should benefit the heart and spleen.Recipe with Ginseng Guipi Decoction:

Ginseng, Atractylodes macrocephala, Astragalus, Poria cocos, longan meat, angelica, polygala, jujube seed, woody fragrance, roasted licorice.

Chinese herbal medicine diet therapy:

"Walnut and Chestnut Candy Soup" 50g of walnut kernels, 50g of chestnuts, and appropriate amount of sugar.Stir-fry the chestnuts first, peel them, mash them with walnut kernels, add sugar and mix well, bottle them for later use, and eat them at any time.This diet nourishes the liver and kidney, and is suitable for premature ejaculation and spermatorrhea caused by insufficient kidney qi.

"Tongshayuan Carp" 500g male carp, 25g Tongshayuan, 25g Cistanche, 15g Morinda officinalis, 10g medlar, 25g ginger.First cut the belly of the male carp to remove the viscera, pay attention to keep the carp scorpion (that is, the male sperm, which is a cystic white slurry) and wash it, then add medicine and two bowls of water, stew it until cooked, discard the medicine residue, eat the meat and drink the soup.This medicated diet strengthens yang and improves essence, and is suitable for premature ejaculation and impotence.

3.nocturnal emission

After a man reaches puberty, ejaculation without sexual intercourse or masturbation is called nocturnal emission.The occurrence of nocturnal emission in sleep is called nocturnal emission, which is a sign of the growth and development and functional maturity of the male reproductive system, and is a normal physiological phenomenon.After the first nocturnal emission, nocturnal emission often occurs, and the interval is irregular, 1-2 times a week, or there may be nocturnal emission for several consecutive days.There are also a small number of healthy young men who seldom have nocturnal emission.

Spontaneous ejaculation under the influence of language and pictures during the day is called synovial sperm.

Young men with nocturnal emission no longer occur after marriage and have a normal sex life.Excessive nocturnal emission (several times a week or several times a night), or still nocturnal emission or slippage after marriage are all abnormal.Excessive frequency of nocturnal emission can cause dizziness, lack of energy, memory loss, weakness of limbs, soreness of waist and knees, heavy mental burden, which is not good for health.

[Treatment and Prevention]

(1) Strengthen the education of sexual physiology and hygiene knowledge among adolescents, weaken sexual curiosity, disperse sexual excitement in the brain, correct masturbation habits, avoid reading obscene books and paintings, and reduce sexual stimulation.

(2) Actively treat phimosis, prepuce, urethritis, prostatitis and other diseases.

(3) Chinese medicine treatment:
(End of this chapter)