Sexual Health
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Erectile Dysfunction
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Premature Ejaculation
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Low Testosterone
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Erectile Dysfunction
Overview
Erectile dysfunction (also known as ED or impotence) is the inability to achieve or maintain an erection firm enough to have or complete sexual intercourse. Experiencing ED from time to time is normal. As many as 40% of men in their 40s, 50% in their 50s and 60% in their 60s experience ED occasionally. However, ongoing erectile dysfunction may indicate an ongoing (or chronic) or more serious health complication, including poor circulation to the heart. If you are concerned about erectile dysfunction, we can help you to achieve a healthier and happier sex life, as well as to assess your overall health risk.
Causes
The evaluation of erectile dysfunction can be complex, with any of a number of various underlying causes being responsible, and often a combination of these.
Erectile dysfunction can occur as a result of a number of physical and psychological factors, such as:
In many cases, erectile dysfunction has a physical cause:
In most cases, ED is a combination of psychological and physical factors. These can include depression, performance anxiety, and stress. Mental health factors are usually secondary to physical causes of ED, so it is important to speak with a doctor if your symptoms persist or become more frequent.
Treatment Options
We follow a step-wise approach to the treatment of ED, starting with oral medication. This is by far the most non-invasive, safest and cheapest option, and is universally considered the first-line therapy. We only advocate progression to second line therapies if there is an unsatisfactory result from the initial ones.
During your initial consultation and evaluation, we can determine the best treatment option for you. We will thoroughly explain your options so that you can make an informed decision.
Erectile dysfunction (also known as ED or impotence) is the inability to achieve or maintain an erection firm enough to have or complete sexual intercourse. Experiencing ED from time to time is normal. As many as 40% of men in their 40s, 50% in their 50s and 60% in their 60s experience ED occasionally. However, ongoing erectile dysfunction may indicate an ongoing (or chronic) or more serious health complication, including poor circulation to the heart. If you are concerned about erectile dysfunction, we can help you to achieve a healthier and happier sex life, as well as to assess your overall health risk.
Causes
The evaluation of erectile dysfunction can be complex, with any of a number of various underlying causes being responsible, and often a combination of these.
Erectile dysfunction can occur as a result of a number of physical and psychological factors, such as:
- Smoking cigarettes/ marijuana
- Excessive alcohol consumption
- Low testosterone
- Stress and anxiety
- Relationship problems
In many cases, erectile dysfunction has a physical cause:
- Vascular disease (arteriosclerosis)
- Diabetes Mellitus
- Peyronie’s disease (curved penis)
- Kidney failure
- Drugs (prescription and over-the-counter)
- Neurological conditions
- Pelvic trauma (injury, surgery, or radiation)
- Venous leak
In most cases, ED is a combination of psychological and physical factors. These can include depression, performance anxiety, and stress. Mental health factors are usually secondary to physical causes of ED, so it is important to speak with a doctor if your symptoms persist or become more frequent.
Treatment Options
We follow a step-wise approach to the treatment of ED, starting with oral medication. This is by far the most non-invasive, safest and cheapest option, and is universally considered the first-line therapy. We only advocate progression to second line therapies if there is an unsatisfactory result from the initial ones.
- Oral Medication: Prescription medications with selective enzyme inhibitors can be very successful in the majority of cases. They are more commonly known by their brand names – Viagra®, Levitra® and Cialis® . Although they are considered very safe to use, there is a small subset of patients who are at risk for adverse effects following taking these medications. We screen patients thoroughly to ensure their safety; if you have pre-existing severe heart disease such as heart failure or unstable angina, or had a recent heart attack, we will arrange a cardiology evaluation for clearance to take these drugs. Your safety and satisfaction are our primary concern.
- Other Therapies: Patients who cannot take oral medications or undergo surgery may be candidates for a vacuum erection device, medicated urethral pellet (MUSE®), intraurethral gels, or penile injection therapy.
- Surgical Procedures: Surgery can also help men who have failed other therapies overcome ED. Surgical treatment has a 95 percent satisfaction rate and can also effectively treat simultaneous conditions such as Peyronie’s Disease (penile curvature). A penile prosthesis can allow you to achieve an erection whenever you choose, for as long as you choose.
During your initial consultation and evaluation, we can determine the best treatment option for you. We will thoroughly explain your options so that you can make an informed decision.
Premature Ejaculation
About 30 percent of men suffer from this condition. Even men whose condition does not meet the medical definition of premature ejaculation – the inability to sustain sexual intercourse for more than 60 seconds prior to ejaculation – may wish to enhance their stamina. Premature ejaculation (PE) can affect your quality of life, but helpful therapies are available to you.
There are potential psychological causes for premature ejaculation. Relationship issues, depression, anxiety, or low self-esteem can interfere with your sexual performance. Unfortunately, suffering from premature ejaculation may also cause or exacerbate these conditions, resulting in a self-sustaining cycle. In addition, there are many physical or medical disorders that can contribute to PE which you should be evaluated for.
We provide three primary treatments for premature ejaculation:
We will help you determine which treatment or combination of treatments is best for your needs.
There are potential psychological causes for premature ejaculation. Relationship issues, depression, anxiety, or low self-esteem can interfere with your sexual performance. Unfortunately, suffering from premature ejaculation may also cause or exacerbate these conditions, resulting in a self-sustaining cycle. In addition, there are many physical or medical disorders that can contribute to PE which you should be evaluated for.
We provide three primary treatments for premature ejaculation:
- Topical Medications: Applied directly to your penis, these local anesthetic agents desensitize the tissue, allowing you to delay ejaculation longer. We often prescribe these substances first.
- Oral Medications: If the source of your premature ejaculation is neuro-biochemical, taking a low dose of antidepressants (which influence the level of serotonin in your brain) may help. However, these drugs can cause side effects, including insomnia, dry mouth, vision issues, insomnia, weight gain, or even erectile dysfunction.
- Behavioral Modifications: We can offer explanation of several maneuvers, such as the squeeze and start/stop techniques, which may help delay orgasm. However, these methods can interfere with sexual satisfaction and many men prefer alternative treatments.
We will help you determine which treatment or combination of treatments is best for your needs.
Low Testosterone
Hypogonadism, also known as low testosterone or “low T,” can lead to symptoms of decreased energy and libido, difficulty building lean muscle mass, moodiness, difficulty concentrating, and even loss of bone density. If you are suffering from low testosterone, you may be a candidate for testosterone replacement therapy (TRT). There are many options for TRT, each of which has its benefits and disadvantages.
Testosterone Replacement Therapy
Which option is right for you?
Patches
Injectables:
Advantages include efficacy and patient satisfaction, infrequent dosing ranging from weekly to every 10 weeks, and low cost. Disadvantages include in testosterone levels compared to daily dosing options, and the need for needles and self-injection.
Inhalable:
The advantages of this modality is that avoids needles, and implants. Additionally it cannot be passed from skin to skin contact between people.
Natesto (Inhalable Testosterone):
Administered by inhalation of the gel. It is recommended to apply one pump to each nostril three times daily.
Testosterone Replacement Therapy
Which option is right for you?
Patches
- Androderm: Transdermal patches, in two different strengths: 2mg testosterone per 24-hour patch and 4mg testosterone per 24-hour patch. The usual starting dose is one 4mg patch applied to skin daily. It is associated with skin irritation.
Injectables:
Advantages include efficacy and patient satisfaction, infrequent dosing ranging from weekly to every 10 weeks, and low cost. Disadvantages include in testosterone levels compared to daily dosing options, and the need for needles and self-injection.
- Testosterone Undecanoate (Nebidu®): 1000mg in 4cc is injected into the muscle. Injections are performed in the clinic upon initiation, at 4 weeks, and then every 10 weeks.
Inhalable:
The advantages of this modality is that avoids needles, and implants. Additionally it cannot be passed from skin to skin contact between people.
Natesto (Inhalable Testosterone):
Administered by inhalation of the gel. It is recommended to apply one pump to each nostril three times daily.