請不要稱它們為「私密部位」

與雷切爾·魯賓博士一起談性相關事務

Rachel S. Rubin，醫學博士 / 2023 年 9 月 13 日 / Medscape

我是雷切爾·魯賓 (Rachel Rubin) 醫生，一位接受過性醫學專科培訓的泌尿科醫生。今天，我想談談私密部位。你知道：生殖器就在那裡。

我實在很討厭這一切，我真的希望我們能夠像談論高血壓和糖尿病一樣談論生殖器和性健康。事實上，當一位新患者進來並被診斷出患有糖尿病時，您會花時間向他們解釋胰腺的工作原理。我不記得所有細節，因為我是泌尿科醫生。但你會解釋糖​​尿病的細節、它是如何運作的、為什麼治療很重要，以及它如何對生活品質非常重要。

我希望我們能對解剖學和生理學有同樣的理解，並且用它來向患者解釋他們的性健康是如何地運作，因為當他們理解它時，他們就擁有了改善性健康的工具。我對病人說：「你必須先知道自己有哪些部位，才能弄清楚它們是如何駕馭的，對嗎？」，我們希望他們能駕馭得更好。

讓我舉一個例子。許多男性來找我抱怨勃起功能障礙。他們拒絕服用西地那非 (sildenafil) 和他達拉非 (tadalafil)（亦即是威而鋼和犀利士），並說：「天哪，這些都是神奇的藥丸。如果服用它們，我就不再是一個男人了。」，我們都知道這並沒有任何意義。我向他們解釋陰莖的工作原理：「你的陰莖是一塊肌肉。肌肉有兩個作用。它收縮和放鬆，就像你的二頭肌一樣。只是你的陰莖肌肉是平滑肌，這意味著它會對戰鬥或逃跑做出反應……它是關於自主神經系統的」。

我解釋說，如果陰莖的肌肉放鬆，它就會充滿血液並擴張。它變得又大又硬，並且會滯留血液。但當陰莖的肌肉收縮、繃緊時，就會把所有的血液都擠出來，就像擠出海綿一樣。因此，如果您想要良好的勃起，最重要的是讓肌肉放鬆。放鬆的肌肉會增加勃起。我讓他們了解西地那非和他達拉非是磷酸二酯酶 5 抑制劑 (phosphodiesterase 5 inhibitors)：平滑肌鬆弛劑。與其說「我需要服用威而鋼或犀利士，因為我已經崩潰了」，不如說，「哦嘿，親愛的，我需要服用肌肉鬆弛劑，因為我的肌肉不再像以前那樣工作了」。

在以後的影片中，我將探討勃起功能障礙的情況。我們將探討勃起功能障礙可能發生的情況及其發生的多種原因。這會讓他們明白，如果我們讓肌肉放鬆，你就會有更好的勃起。這就是陰莖的工作原理，這就是藥物起作用的原因。患者實際上會去嘗試這種療法，他們會感覺好得多了。他們會說：「天哪，這太有道理了。他們透過鍛鍊精神肌肉，來讓陰莖肌肉放鬆。於了解解剖學和生理學後有助於他們了解治療方法，從而獲得更好的結果。

女性方面又如何呢？如果一個女人來找我報告她無法達到高潮，這部分便是要教育和了解解剖學和生理學。陰蒂和陰莖是完全相同的東西，陰蒂頭和陰莖頭是相同的。陰蒂的腿一直延伸到臀骨。所以現在每個人都坐在自己的生殖器上。臀骨連接到陰蒂底部或陰莖底部。他們每個人都有腿，稱為陰莖腳（陰蒂腳）。當您讓患者了解他們的解剖結構及其功能時，他們就能夠了解如何最大限度地提高其生活品質。

陰蒂和陰莖一樣有平滑肌。當平滑肌放鬆時，它就會充滿血液。當你刺激它時，大多數人都會達到高潮。但是，等一下。陰蒂不在陰道內。是在外面。它位於大陰唇後面。如果沿著小陰唇向上，就會到達陰蒂頭部。如果患者明白這一點，他們就會明白插入並不是大多數人達到高潮的方式。

我喜歡圖片。我給大家看我辦公室的照片。它們幫助患者了解為什麼外陰振動或外部刺激會讓性高潮發生。因此，患者不要進來說：「我崩潰了，我無法透過插入達到高潮」，或者「魯賓博士，我崩潰了，因為我無法勃起」，讓他們了解解剖結構並了解生理學可幫助他們了解治療方法。

隨著我們的進展，我將更多地談論解剖學和生理學以及如何提高患者的性健康。但現在，請不要再稱它們為私密部分。請利用您對解剖學和生理學的理解來教育您的患者擁有更好的性健康和更高的生活品質。您可能是唯一一位這樣做的臨床醫生，這將使他們的生活變得更加美好。

以上觀點均為作者本人觀點。

Don’t Call Them ‘Private Parts’

Sex Matters, With Dr Rachel Rubin

Rachel S. Rubin, MD / September 13, 2023 / Medscape

I’m Dr Rachel Rubin, a urologist with fellowship training in sexual medicine. Today, I’d like to talk about private parts. You know: the genitals, down there.

I hate all of that. I really wish that we can get to a place where we can talk about genitals and sexual health the same way we do about high blood pressure and diabetes. In fact, when a new patient comes in and they get a new diagnosis of diabetes, you spend time explaining to them how their pancreas works. I don’t remember all the details because I’m a urologist. But you explain the details of diabetes, how it works, why therapy is important, and how it’s very important for quality of life.

I would like us to take that same understanding of anatomy and physiology and use it to explain to patients how their sexual health works because when they understand it, they then have the tools to make it better. I say to patients, “You have to know what parts you have in order to figure out how they drive, right?” We want them to drive better.

Let me give you an example. Many men come to see me with complaints of erectile dysfunction. They refuse to take sildenafil and tadalafil (Viagra and Cialis), saying, “Oh my gosh, those are magic pills. I won’t be a man if take them.” We all know that doesn’t make any sense. I explain to them how their penis works: “Your penis is a muscle. The muscle does two things. It contracts and it relaxes just like your bicep. It’s just that your penis muscle is smooth muscle, which means it responds to fight or flight. It’s on the autonomic nervous system.”

I explain that if the muscle of the penis is relaxed, it fills with blood and expands. It gets big and hard, and it traps the blood. But when the muscles of the penis are contracted, when they are tight, it squeezes out all the blood, like squeezing out a sponge. So the important thing to do if you want to have good erections is to get the muscles to relax. Relaxed muscle increases erections. I get them to understand that sildenafil and tadalafil are phosphodiesterase 5 inhibitors: smooth-muscle relaxants. Instead of saying, “I need to take Viagra or Cialis because I’m broken,” it’s, “Oh hey honey, I need to take my muscle relaxants because my muscles aren’t working the way that they used to.”

In future videos, I’ll go into what happens in erectile dysfunction. We’ll go into what can happen with erectile dysfunction and the many reasons why it happens. It’s getting them to understand that if we get the muscles to relax, you will have better erections. This is how the penis works. It’s why the medicine works. The patients will actually try the therapy and they’ll feel so much better about it. They’ll say, “Oh my gosh, this makes so much sense. They work on their mental muscles to get the muscles of the penis to relax. Understanding anatomy and physiology helps them understand the treatments, which leads to better outcomes.

How about the female side? If a woman comes to see me reporting that she can’t have an orgasm, part of it is education and understanding the anatomy and physiology. The clitoris and the penis are exactly the same thing. The head of the clitoris and the head of the penis are the same. The clitoris has legs that go all the way down to the butt bone. So everyone is sitting on their genitals right now. The butt bones connect to the bottom of the clitoris or the bottom of the penis. They each have legs called crura. When you get patients to understand where their anatomy is and how it functions, they will then understand how to maximize their quality of life.

The clitoris has smooth muscle just like the penis. When that smooth muscle relaxes, it gorges with blood. When you stimulate it, it can lead to orgasm for most people. But, wait a minute. The clitoris is not inside the vagina. It’s outside. It’s behind the labia majora. If you follow the labia minora up, you get to the head of the clitoris. If patients understand that, they then will understand that penetration is not the way the majority of people orgasm.

I love pictures. I show everyone pictures in my office. They help patients to understand why vibration or outside stimulation on the vulva will allow orgasm to happen. And so instead of patients coming in saying, “I’m broken, I can’t orgasm from penetration,” or, “Dr Rubin, I’m broken because I can’t get erections,” getting them to understand the anatomy and physiology helps them understand the treatment.

As we go forward, I’ll talk more about anatomy and physiology and how to increase the sexual health of our patients. For now though, please stop calling them private parts. Please use your understanding of anatomy and physiology to educate your patients to have better sexual health and higher quality of life. You may be the only clinician to ever do so, and it will make their life so much better.

Any views expressed above are the author’s own and do not necessarily reflect the views of WebMD or Medscape.

Cite this: Don’t Call Them ‘Private Parts’ – Medscape – Sep 13, 2023.