Diabetes and sexual dysfunction, including erectile dysfunction and occasional premature ejaculation, are not necessarily diseases.

What impact does diabetes have on male sexual dysfunction?

**Dr. Cao:**

I am a diabetic patient. In recent years, I have felt that my sexual dysfunction has become increasingly severe. What impact does diabetes have on male sexual function?

Yu XX

Mr. Yu:

Sexual dysfunction in male diabetic patients is often progressive and not easily detected in the early stages. Most cases only develop noticeable symptoms several years after the onset of diabetes. Early signs of sexual dysfunction include prolonged time to achieve an erection after stimulation, mild to moderate decrease in erectile strength, and shortened erection time. However, libido, intercourse, ejaculation, and orgasm are often unaffected, making it difficult for patients to notice. As the condition progresses, penile erectile strength gradually decreases, and erection time further shortens until intercourse becomes impossible.

The causes of sexual dysfunction in male diabetic patients are still unclear, but may be related to the following factors: ① Diabetic patients often experience depression and anxiety, which can induce or aggravate sexual dysfunction. ② Diabetic patients often have co-existing conditions such as hypertension, coronary heart disease, and cerebrovascular disease, and the use of certain antihypertensive drugs, diuretics, and antidepressants can all cause erectile dysfunction. ③ Diabetes can cause systemic large and small blood vessel damage; when diabetic vascular lesions affect the small blood vessels of the penile corpora cavernosa, it can also cause erectile dysfunction. ④ It is generally believed that penile erection is controlled by the pelvic visceral nerves and pudendal nerves; when diabetic patients experience neuropathological changes affecting the pelvic autonomic nervous system, erectile dysfunction can occur.

Treating diabetic sexual dysfunction is quite difficult. This is because the onset of sexual dysfunction is gradual and often goes unnoticed by patients, by which time it is often irreversible. Some patients also have psychological or other contributing factors, further complicating treatment.

Male diabetic patients need to maintain stable blood sugar control over the long term. Early treatment is crucial if changes in sexual function are observed. For individuals with normal genital development, well-controlled blood sugar, and no obvious neuropathy, vascular disease, or medication-related factors, sexual dysfunction may be related to psychological factors. They should receive sex education to understand the impact of psychological factors on sexual function and reduce their psychological burden.

**Cao Kaiyong**

**Erectile dysfunction may have underlying medical causes.**

**Dr. Cao:**

My penis has been experiencing prolonged erections that don't shrink back, causing inconvenience in my daily life and affecting my work. I'm in great distress. What illness do I have? How should it be treated?

Jiang XX

Mr. Jiang:

You have a common urological condition called erectile dysfunction (ED). In traditional Chinese medicine, ED is the opposite of impotence. It manifests as a persistent, hard erection that lasts for hours or even days, and cannot be relieved through sexual intercourse. This strong and prolonged erection can cause excessive blood flow to the penis, leading to swelling, pain, and discoloration.

The main causes of priapism are: ① Yin deficiency, excessive sexual activity, and depletion of kidney yin. Yin deficiency leads to yang hyperactivity, causing excessive activity of the ministerial fire, which can result in priapism, seminal emission, and premature ejaculation. ② Emotional distress or anger damaging the liver, leading to stagnation of liver qi. Prolonged stagnation can transform into fire, which travels down the meridians and causes easy erection, or even priapism. ③ Excessive sexual activity, holding back ejaculation, retention of semen, or bad habits such as masturbation and lustful thoughts can also cause stagnation of the ministerial fire, leading to the decay and stagnation of semen, obstruction of the orifices, and disharmony of the penile meridians, which is also one of the causes of priapism.

Patients with erectile dysfunction should practice moderation in sexual activity and abstain from masturbation to avoid damaging their essence and kidneys; they should pay attention to mental regulation and avoid anger, which can harm the liver; they should eat less fatty, sweet, and rich foods to avoid damaging the spleen and stomach and promoting dampness and phlegm; they should avoid mental stress and patiently follow the doctor's treatment.

**Cao Kaiyong**

Occasional premature ejaculation is not a disease.

**Dr. Cao:**

I've noticed that my sexual function fluctuates. For example, on the first night after a long separation, I often experience premature ejaculation, while on the second and third nights, the ejaculation time is longer. Does this mean my sexual function is normal, or do I have premature ejaculation?

Yue××

Mr. Yue:

Premature ejaculation (PE) refers to the condition where a man ejaculates immediately upon penetration of the woman's vagina, and the penis becomes flaccid. Some also define PE as ejaculation occurring within a minute of penetration or after fewer than 15 thrusts within the vagina.

The speed of ejaculation varies greatly from person to person, and the time taken for each ejaculation is different. It generally lasts from 1 to 3 minutes, but some people can last up to 20 minutes or even more than half an hour. Sometimes, the same person might ejaculate quickly due to fatigue, but the time will be longer next time. However, it cannot be said that ejaculating within 1 minute is premature ejaculation; it depends on whether both partners are satisfied. If both partners are well-coordinated, and intercourse occurs when the woman is fully aroused, and both feel satisfied after ejaculation, it should not be considered premature ejaculation. In the case of newlyweds or the first intercourse after a long separation, the man's excitement often leads to faster ejaculation or premature ejaculation, which is not unusual. Some couples who have been separated may experience premature ejaculation on their first night together, but it is normal on the second and third nights. This proves that the man does not have premature ejaculation disease, but is simply experiencing a temporary premature ejaculation, and there is no need to worry.

Some people are prone to premature ejaculation when they have sex before falling asleep, while having sex after waking up in the middle of the night can delay ejaculation. The timing of sex can be determined by the individual and the time.

If premature ejaculation is caused by excessive excitement, you can wait a moment after penetration or shift your focus to calm down before resuming intercourse, which can delay ejaculation. Some men prone to premature ejaculation can use condoms or even double condoms to reduce friction and stimulation of the penis and prolong intercourse. If all of these methods are effective, it indicates that the premature ejaculation is psychogenic and reversible.

To delay ejaculation, measures can be taken, such as changing positions and activities. Between couples, some positions stimulate men more than women, while others stimulate women more. Therefore, one can choose a position where the man is least likely to be stimulated, from those where the woman experiences the most stimulation and excitement. If premature ejaculation is caused by excessively frequent intercourse, the frequency of intercourse should be adjusted accordingly.

**Cao Kaiyong**