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王彬 北京中医药大学东直门医院男科主治医师 \n目前,我们已开通了咨询热线,由中国人口宣传教育中心设立,相关专家针对青少年成长过程中出现的心理、生理、亲子关系和生殖健康方面的问题进行解答。欢迎青少年、家长来电咨询。\n电话号码:010-64412025\n咨询时间:每周一、三、五下午2:00-5:00(节假日除外)

王彬

王彬 北京中医药大学东直门医院男科主治医师 \n目前,我们已开通了咨询热线,由中国人口宣传教育中心设立,相关专家针对青少年成长过程中出现的心理、生理、亲子关系和生殖健康方面的问题进行解答。欢迎青少年、家长来电咨询。\n电话号码:010-64412025\n咨询时间:每周一、三、五下午2:00-5:00(节假日除外)

文字实录

  • 嘉宾:

    网民朋友们,大家晚上好,今天的嘉宾是北京中医药大学东直门医院男科主治医师王彬,话题是伟哥治疗无效的阳痿患者怎么办。

  • 嘉宾:

    阳萎的患者首先想到的药物就是伟哥,但是今天的题目是伟哥吃了以后没有效果怎么办?我们首先明确了,勃起功能障碍的首选药物是PDE5抑制剂,就是伟哥,那么无效的定义是什么?什么叫做无效?就是吃完这个药物之后没有应答,开始是这样的,吃完这个药物还是这样的,这叫无效,医学上对于伟哥治疗无效的定义是按照说明书所推荐的最大的剂量服用四次以上都没有效果,那么才是无效。一次吃了没效果,两次吃了没效果,五次吃了都没有效果才是无效。所以说有些患者吃了一次,这么贵的药物,100多块钱一片,没有效果,就找医生麻烦,说开的药没有效果,就不吃了,换了一个医生,还是处方这个药,就不治了。那么就提示我们医生在处方这个药物的时候,首先就要给患者做一个挫折教育,就是要讲明白,不是说吃一次,吃一片就100%有效了,可能有70%有效,那么就要尝试第二次、第三次,至少尝试四到五次,有效率就可能更高了,所以要明确一个无效的定义,吃了五次以上还是没有效果,那就放弃吗?肯定不是,我们今天就要强调一下,服用PDE5抑制剂正确的方法,有的人服完之后就等着,这也没有效果,什么才是一个正确的服用PDE5抑制剂的方法呢?首先就是要足量,PDE5抑制剂,有些医生说可以吃半片,吃四分之一片,但是第一次吃的时候一定要吃一整片,如果第一次吃完效果特别好的话,第二次、第三次,或者是往后可以吃半片,或者是四分之一片,这是首剂一定要足量。第二点就是要服用足够的次数,就是刚才讲到的吃一次两次没有应答,要接着吃,因为不同人的体质不一样,吃一段时间才会有应答,现在西艾力,最新的5毫克的上市,就是原来的四分之一,就明确的讲,5毫克是每天吃一片,前四天吃了血药浓度没有到一个峰值,前四天基本没有什么效果,到第四天、第五天慢慢的效果才会起来,所以一定要服用足够的次数,这些都需要医生跟患者解释清楚。第三点,就是服用PDE5抑制剂的时候,一定要有充分的而且是有效的性刺激,有患者吃了一粒药,上床就等着,结果等了一晚上也没有起来,就生气了,不行,吃完这个药物之后过半个小时左右,一定要有性刺激,它才有可能起来,但是也有患者说了,我吃完以后,还是起不来,因为这不是有效的刺激,因为你内心是处于焦灼的状态,想着要起来,医生说了,吃完这个药要足够,吃一片,今天晚上一定要成功,也有性刺激了,虽然有性刺激,但是内心非常的焦虑,等待的焦虑,操作的焦虑,所以刺激是无效的,压力很大,紧张和焦虑不良的情绪刺激也会抑制勃起,所以起不来。

  • 嘉宾:

    我有一个患者,他跟他太太,一开始非常的甜蜜,偶尔一次的失败,就开始有矛盾了,再不能解决的话,蜜月期都不能维系了,先生刚开始是勃起不错,挺好的,但是两个人都没有性经验,一开始找不着地,太太说我帮他呀,还是进不去,工作再紧张,慢慢就起不来了。最后吃了PDE5抑制剂,吃完以后非常棒,但是还是进不去,女性一说疼就完了,可能是缺乏一些技巧吧!这是第一次,他说再往后吃伟哥都不成,他都焦虑,起不来,一准备做这个事就紧张,但是有一个特点,就是他吃完伟哥以后,他的夜间勃起非常好,自发勃起非常好,睡着以后起来了,早上起来非常坚挺,我说这个时候你去做呀,他说我们尝试了,刚一配合就软了,这时候就发生了一个变化,吃完伟哥以后就起不来了,但是他的自发勃起有,就是非常焦虑。

  • 嘉宾:

    像这种的,我给他们的建议就是说,伟哥仍然要吃,以前是办事之前吃,吃完以后有充分的性刺激,但是有充分的性刺激对这位先生是无效的刺激,那么你就打破这个服药和性生活之间的关系,时间的依赖性,就是不再按需服用,就长期小剂量的服用,隔一天吃半片,不管过不过性生活,晚上的时候,你可以定在中午12点吃,或者是晚上5点吃,到了10点钟休息的时候,你的自发勃起非常好,欲望也还不错,这个时候再性刺激,相当于是一个比较自然的性生活了,这个时候再配合一些性技巧,这位先生按照我说的,因为他打破了服务要性生活之间的关系,没有说一定要成功,每天都吃,或者是隔一天吃半片,两周以后成功的,他们的关系一下就缓和了。所以说充分有效的性刺激,还要注意一点不要太焦虑,等待的过程中本来就焦虑。还有是预期太高,他就希望我一次就成功,我吃一次药就成功,而且硬度一定达到四级勃起,非常坚挺的硬度,这样的话往往容易失望,对于疗效的满意度等于实际的疗效减去期望值再除以实际的疗效,也就是说期望值越高,满意度越低的。这是第三种方法,期望值不要太高。

  • 嘉宾:

    另外还有一个注意事项,如果按需服用没有效果的话,可以改用长期的小剂量的服用。另外该是他不仅仅有勃起功能障碍,通过其他的检查发现体内雄激素水平是缺乏的,有研究者做的实验,对于一些PDE5抑制剂治疗无效的患者,也进行的指导,一部分患者是有效的,但是还有一部分患者仍然无效,发现他体内的雄激素水平是偏低的,为什么补充雄激素以后会有效呢,雄激素会提高男性的性欲,而且雄激素本身对于阴茎的海绵体、平滑肌的小梁,勃起的神经也好,都有营养和支持的作用,雄激素水平正常或偏高一些,他的功能就好,结构维持的就好,如果雄激素水平低下,组织结构就发生紊乱,甚至细胞发生凋亡,神经也会受到损伤。还有一点,雄激素对于阴茎局部动脉血管的扩张是有帮助的。

  • 嘉宾:

    另外血糖、血脂得控制达标,有这些原发病的,我要建议患者积极控制原发病,原发病控制好了以后,这些患者以前吃PDE5抑制剂的时候没有效果,控制好了以后有效果的,效果也不错。

  • 嘉宾:

    最后就是得基础病的时间太长了,血糖很多年都没管,有糖尿病足了,这类患者怎么办呢?虽然60、70岁了,能活一年就要有一年的生活质量,那么我们医生怎么办?吃伟哥没有效果,那还能想个什么招呢?我们医生说,那这一类的,吃药可能就不行了,那么就是负压吸引,还有的就做阴茎假体,这样也可以。所以我们总结一下,PDE5抑制剂是治疗勃起功能障碍的一线用药,如果无效的话,要询问患者是不是正确用药,包括要独剂量的用药,要使用足够的次数,起码四次以上,要有充分的性刺激,还要降低预期的心理期望值,如果雄激素缺乏要补充雄激素,有原发病的要积极控制原发病,如果实在保守治疗不好的,可以手术治疗。我们今天就先介绍这么多。

  • 嘉宾:

    53了 阳萎 腰酸背痛 射精难 少精 起不来

  • 嘉宾:

    勃起的硬度不够,我建议去当地大的医院,去男科综合性的查,通过补充雄激素以后,胰岛素受体的敏感性也会增加,对血糖的控制也是有好处的,所以要积极的治疗。

  • 嘉宾:

    前列腺肥大,有阳萎早泄,怎么办?

  • 嘉宾:

    对于前列腺肥大,我们要看肥大的程度,有轻中重度,如果前列腺肥大的程度比较轻,尿线也是比较粗的,没有尿中断的表现,也可以观察,如果耽误了,前列腺变得非常的大,有可能要电切。对于早泄,有一些阳萎的患者射精快的,开一些抗抑郁药,抗抑郁药有一些副作用就是射精延长。我在临床治疗早泄的时候,吃我的药物70%、80%都可以延长,吃到20天左右的时候效果会非常明确,这个时候会非常坦率地跟患者讲,我就说百度我的名字,有一篇文章,叫做早泄的行为疗法,你去看每一步,其中可能有三四种方法,选一种,你觉得你可以实施的,性不仅是一种本能,更是一种技能,如果性和谐的话,他们的爱会时间久一些。

  • 嘉宾:

    您好,请问阳萎早泄吃什么药好我已早泄四五年了老婆和我不过了。每次吃一点前列康能延长性生活但继续吃后面就没效果了。请问我应该从那方面治为什么刚开始有效果后面就没有了

  • 嘉宾:

    有的患者刚开始吃伟哥的时候效果好,后来吃就没有效果的,就是因为比较紧张,或者是心态比较敏感,前列康可能对勃起功能和早泄都没有特别明显的效果,他吃完之后觉得有效果,可能有安慰剂的作用。在临床上,同时有勃起功能障碍,又有早泄的患者非常多,其实他们二者之间是有矛盾的,我说的意思是在治疗的时候,他们是一对矛盾,治疗早泄的药物会抑制勃起,当勃起功能不太好的时候,不能维持,这一类患者当早泄和阳萎同时存在的,过早的使用的抗焦虑、抗抑郁药,那么他的勃起功能甚至更差,甚至过不了性生活了,那么患者回来就跟你打架,所以临床有一个原则,就是一定要先治疗勃起功能,再治疗早泄,对于勃起功能不是那么差的可以同时治疗,但是一定不能单独的治疗早泄。到底吃什么药好呢?勃起功能障碍首选的药物肯定是PDE5抑制剂,再配合点雄激素,当然就更好了。勃起功能好了以后,有一部分患者,他的射精时间是能相应的延长的,其机制一部分就是紧张焦虑的情绪消失了,更自信了。还有一部分的原因,就是性生活是三三条线,这是疲软状态,这是勃起状态,这是到射精的时候,那么勃起好了以后,我们需要造成勃起的刺激就能到第二条线,第二条线和第三条线之间的区域会增加,从勃起到神经需要的刺激量更大,也就是说勃起改善之后,轻微的刺激就改善了,需要运动更多的刺激才会射精,时间也会相应的延长。所以说一定要先治疗勃起,勃起好了以后再服用药物,有可能不用服用药物,射精时间还会延长,如果还是不满意,就可以用一些药物,所有的方案都是一个综合的方案,不是一片药,一种药就能解决所有的问题,还是要辨证论治,看具体原因,具体的事具体分析。

  • 嘉宾:

    你好我做包皮半个月后就阳萎了、换个女人在我面前也没以前那么博起了、请你帮帮我该怎么办、在中医院检查是海绵体冲血不足、医生给我开了10付中药喝了也没效果、您看我该怎么办、我是宜昌人、我该到那里治疗啊

  • 嘉宾:

    吃了10副中药也没有效果,不要着急,治疗这类疾病的时候不是在治感冒,起码得两个月,三个月,相对一个比较慢的过程,放松心态,如果没有严重的基础病,一般没有大的问题,通过治疗,通过调理,心情放松,一般都能恢复的。他是宜昌人,不好推荐具体哪个医院,但是有一个原则,就去正规的大的三甲医院,特别是高校的附属医院,相对还比较正规一点。

  • 嘉宾:

    前列腺炎一般怎么治,吃什么药效果好

  • 嘉宾:

    前列腺炎是生活方式疾病,久坐、喝酒,把这些不良的生活方式改掉,中药的方式还不错,特别是疼痛类的,尿频、尿急的用点消炎药,清热利湿的中药,效果还是不错的,现在随着正规男科的宣传,这个病是可以治好的,多长时间治愈,三个月甚至半年,不是说3天10天能治好的。

  • 嘉宾:

    半年前不洁感染病菌,治疗至今半年未愈,治疗效果不明显,期间在省军区医院(被骗做了介入),湘雅附一,省中医附一治疗,前列腺液培养及pcr检查都是阴,有培养出过葡萄球菌。症状:尿频尿量大,尿道口时常出现异常症状,小腹不适,腹股沟及大腿内侧灼通,久坐会阴及小腹不适感明显,右侧腰部疼痛,左耳耳鸣,大便时偶见滴白,晨勃少有。急需医生的帮助

  • 嘉宾:

    可能是有菌性的前列腺炎,可能吃药物的时候症状不明显,但是一过性生活,真正又反复,寄生在前列腺的菌,随着前列腺液的分泌造成尿道的感染,所以这类的患者一定要注意规范的足疗程的治疗,通过细菌培养来看到底是什么菌造成的炎症,然后规范地使用抗生素,用4周、6周,甚至8周,一定要避免不洁的性交史,如果有尿路感染,一定要治疗,避免这个菌向后尿路发展,造成后尿路炎症,造成有菌性炎症。

  • 嘉宾:

    支原体阳性引起前列腺炎,没有明显不适,尿次数稍微增多了一些。偏黄。做了尿液检查,还有前列腺液。

  • 嘉宾:

    三个月一般可以治好的。

  • 嘉宾:

    前列腺炎没好的时候可以性生活吗

  • 嘉宾:

    慢性非细菌性的没有问题,而且鼓励过性生活,过完性生活以后会舒适一些,那1%急性细菌性的是不鼓励过性生活的。慢性细菌性的前列腺炎患者可以过性生活。

  • 嘉宾:

    霉菌性前列腺炎怎么治疗,应该吃什么药比较好。

  • 嘉宾:

    针对性地用药,应该会比较好一些。

  • 嘉宾:

    精液中有果冻状物体是前列腺炎吗

  • 嘉宾:

    如果是果冻状,提示液化不好,可能是有前列腺炎,或者是长时间没有排精,造成偏黄,出现果冻,也有可能正常的,查一个精液常规。

  • 嘉宾:

    时间的关系,今天的直播就结束了,各位网民朋友再见。

网友互动

  • 游客:53了 阳萎 腰酸背痛 射精难 少精 起不来

  • 游客:前列腺肥大,有阳萎早泄,怎么办?

  • 游客:您好,请问阳萎早泄吃什么药好我已早泄四五年了老婆和我不过了。每次吃一点前列康能延长性生活但继续吃后面就没效果了。请问我应该从那方面治为什么刚开始有效果后面就没有了

  • 游客:我阳萎不举早泄应该吃什么药有好处能根治吗?

  • 游客:阳萎早泄,可能是长时间手淫引起的,每次欲望很强烈,自己一个人时勃起和硬度都很好,也有晨勃,可真做起来就不行了,我该咋办?

  • 游客:你好我做包皮半个月后就阳萎了、换个女人在我面前也没以前那么博起了、请你帮帮我该怎么办、在中医院检查是海绵体冲血不足、医生给我开了10付中药喝了也没效果、您看我该怎么办、我是宜昌人、我该到那里治疗啊

  • 游客:你好。我今年三十三,我现在是阳萎患者,还是早泄患者请问如何治疗谢谢

  • 游客:前列腺炎一般怎么治,吃什么药效果好

  • 游客:我今年得了前列腺炎,能治好吗?

  • 游客:你好!我得前列腺炎有4至5年了!中间也治疗了两次但后来都复发了?请问我这病还能完全根治吗?

  • 游客:尿后余沥是肾虚症状还是前列腺炎

  • 游客:我今年25,患有前列腺炎,现在每天遗精,遗精后难受请问喝金锁固精丸还是锁阳固精丸

  • 游客:失眠多梦口干腰膝无力前列腺炎增生用什么药?

  • 游客:手淫过度引起的慢性前列腺炎吃什么药比较好?有了10年的手淫习惯引起了前列腺炎手淫过度充血引起的非细菌性慢性前列腺炎吃什么药可以彻底根治啊?

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