Men’s Sexual Health
A COMPREHENSIVE APPROACH TO ERECTILE DYSFUNCTION, PREMATURE EJACULATION, AND LOW LIBIDO
Sexual dysfunction happens. In fact, it’s pretty common. Research reveals 31 percent of men report some degree of sexual difficulty, and the likelihood of sexual dysfunction - including difficulty initiating or maintaining an erection, delayed or absent orgasms, decreased libido, and development of curvature of the penis (i.e. Peyronie’s Disease) - only increases as you age.
According to the Cleveland Clinic, 40 percent of 40-year-old men experience erectile dysfunction; that number increases to 70 percent for 70-year-old men who have heart disease, and diabetes and are taking certain medications have an even greater chance of erectile dysfunction.
The good news is that there are many tools that, when used in a comprehensive approach, enable most men to reclaim a healthy sex life. Sexual wellness is a major focus of our clinic, and over the years, Kass Precision Medicine has developed a four-pronged approach to thoroughly address erectile dysfunction - leveraging our specific training in many specialized treatments and protocols to enhance patients’ sexual experience. Sexual wellness is an integral component of overall wellness and healthy relationships, and we are committed to helping men achieve the benefits of sexual fulfillment at any age.
TREATING ERECTILE DYSFUNCTION:
A FOUR-PRONGED APPROACH
1. OBSTACLE REMOVAL
Pre-existing conditions, lifestyle choices, medication burden and weight burden can all be contributing factors to erectile dysfunction:
Improving cardiovascular health - the healthier the heart, the better the blood flow, the more reliable and consistent the erection. Cardiovascular health can be seen as the canary in the coal mine of ED. Addressing heart disease and high blood pressure is paramount.
Weight loss - being overweight or obese can increase the risk for ED by 30-90% compared to normal weight subjects.
Diabetes and Pre-diabetes - these are independent risk factors for erectile dysfunction. Diabetes contributes to disease of the blood vessels, nerves and endocrine system and ED occurs in 75% of men who have type 2 diabetes.
Reducing medications where possible - common prescriptions - such as antidepressants and blood pressure medications - can contribute to ED. Reducing or exchanging medications can be helpful when possible.
Implementing 160 minutes of exercise per week - this amount of moderate to intense cardiovascular exercise has been shown to improve erectile function. Sweat, elevate your heart rate, get out of breath. Walking around the block won’t cut it.
Low-glycemic, whole foods diet - while not exactly glamorous, this can be incredibly impactful. Good nutrition will help you lose weight, improve testosterone levels, reduce inflammation and improve cardiovascular health.
Hypothyroidism - this is commonly missed in men and can be a contributing factor to erectile dysfunction.
2. THE HORMONE AFFECT: TESTOSTERONE REPLACEMENT CONSIDERATIONS
For every patient complaining of erectile dysfunction, Kass Precision Medicine recommends comprehensive labs, which help to identify some of the aforementioned conditions and can also help evaluate testosterone levels. Testosterone can naturally decline with age, sometimes contributing to erectile dysfunction and loss of libido.
Patients experiencing ED may be simultaneously experiencing symptoms of the loss of testosterone including:
Loss of drive and motivation
Fatigue
Low desire or libido
Difficulty reaching orgasm or ejaculating
The feeling of having “passed your peak”
Loss of morning or nocturnal erections
Sleep challenges
Mood changes
Body composition changes
Low testosterone has been associated with ED and should be addressed in the appropriate patient. It’s important to note, however, that erectile dysfunction is a multi-variable condition, and testosterone replacement on its own is not always the cure-all. Dr. Kass and her team have extensive training and experience in evidence-based, safe, effective methods of testosterone replacement therapies. They will evaluate the possible effectiveness of this approach - including the possible risks and benefits - with each patient.
Visit this page to learn more about testosterone replacement therapy.
3. MEDICATION
PDE5 inhibitors are the standard initial intervention for erectile dysfunction. The most common medications of this class are Viagra, Cialis, Levitra and Stendra. These medications can often be helpful by perpetuating the effects of nitric oxide in the tissue - encouraging blood vessels and tissues in the penis to relax and engorge with blood longer. PDE5 inhibitors do not cause an erection alone - they still require physical and mental arousal. PDE5 inhibitors are typically taken by oral route 1-2 hours before sexual activity and, depending on the medication, can last between 12-36 hours.
Kass Precision Medicine works with patients to understand the strategies and nuances of taking these oral medications and, for more challenging cases, may discuss “super charged” ED meds such as sublingual deliveries or intracavernosal injectables such as Alprostadil and Trimex.
4. REGENERATIVE TREATMENTS
Because the majority of ED cases are caused by a decline in vascular function, starting treatments to help improve the number and function of blood vessels is highly effective. There are three regenerative options that consistently lead to improvement in erectile function.
Low-Intensity Shockwave (AKA GAINSWave™ Therapy)
The Priapus Shot, or P-Shot
Penis Pump (Vacuum Device)
Read on for more detailed information about each.
Regenerative Treatment Options
Low-Intensity Shockwave (AKA GAINSWave™ Therapy)
GAINSWave (AKA Shockwave) therapy is a breakthrough non-invasive treatment for erectile dysfunction. It uses high-frequency acoustic waves to open up old blood vessels and stimulate the formation of new vessels. The resulting improved blood flow helps any man, not just those with ED, to obtain stronger and more sustainable erections. Dr. Kass is a shockwave therapy pioneer, one of only two doctors in the US who initially saw the potential and piloted the GAINSWave program. She and her team have performed thousands of shockwave therapy procedures since initiating the GAINSWave program and are one of the longest-standing providers of shockwave therapy for ED in the US.
Shockwave therapy has been proven in over forty published studies to address the four key challenges associated with vasculogenic erectile dysfunction:
Angiogenesis or neovasculation - the stimulation of new blood vessels
Blood vessel dilation - the stimulation of existing blood vessels can address a decline in nitric oxide
Neurogenic - the stimulation of new nerve tissue. Think improved sensitivity.
Plaque disintegration - breaks up debris called plaque that can collect in small blood vessels, decreasing blood flow.
P-Shot
The Priapus Shot, or P-Shot, harnesses the power of platelet-rich plasma to give you improved erectile function; penile sensation, stamina, and health - as well as stronger, more frequent erections.
PRP was popularized in orthopedic medicine, specifically sports injuries, but can also be utilized for erectile dysfunction. The P-Shot involves separating out the growth factors in your own blood, and then re-injecting your super-charged plasma back into your body. The PRP mobilizes local stem cells, which accelerates tissue regeneration and the formation of new vascular networks. This results in increased blood flow to the penis and stronger, more reliable, and more frequent erections. This extremely safe procedure takes under an hour and patients feel little to no discomfort. Drugs or surgery aren’t required and results last up to a year or longer. It is commonly combined with shockwave therapy for synergistic treatment.
Penis Pump (Vacuum Device)
Our clinic coaches patients on incorporating a vacuum device as an exercise for improving ED. Vacuum devices, used properly, can improve vascularity and are an excellent follow-up exercise to treatments such as shockwave therapy and the P-Shot.
PREMATURE EJACULATION - OVERVIEW & TREATMENT OPTIONS
Premature ejaculation (PE), also referred to as rapid or early ejaculation, is defined according to three essential criteria: (1) brief ejaculatory latency (reaching ejaculation in two minutes or less according to one study); (2) loss of control; and (3) psychological distress in the patient and/or partner. PE is relatively common with the Mayo Clinic stating that as many as one-third of men say they experience this problem at some time in their lives.
If you are a man who struggles with premature ejaculation - or other ejaculatory issues including anejaculation or retrograde ejaculation - many of the interventions outlined earlier on this page can help. Kass Precision Medicine works to explore various treatments for premature ejaculation with patients. These treatments might include oral ED medications, SSRIs, topical desensitizing prescriptions, pelvic floor strengthening exercises, and/or behavior interventions. Dr. Kass will devise a treatment plan based on your specific needs that will likely involve several or all of these four approaches.
There are several causes that may contribute to premature ejaculation and other ejaculation problems, including:
Abnormal hormone or neurotransmitter levels
Lower urinary tract symptoms (generally in older men)
Commonly used medications (i.e. Flomax, antidepressants)
Surgery for BPH
Thyroid problems
Inherited traits
Unusual reflex activity
Depression and anxiety
Relationship problems
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