Men’s Sexual Health &

Erectile Dysfunction

A COMPREHENSIVE APPROACH TO Sexual Health and ERECTILE DYSFUNCTION

Sexual dysfunction represents a prevalent and clinically significant condition affecting a large portion of the male population. Current epidemiological data suggests that approximately 52% of men experience some degree of sexual dysfunction during their lifetime, with prevalence rates demonstrating a clear age-related progression.

Erectile Dysfunction Epidemiology and Risk Factors

The Massachusetts Male Aging Study and subsequent research have established that erectile dysfunction (ED) affects approximately:

26% of men under age 40
40% of men at age 40
52% of men between ages 40-70
Up to 70% of men over age 70

These prevalence rates increase significantly in the presence of comorbid conditions, including:

Cardiovascular Disease (Heart Disease)
Diabetes Mellitus (Type I and Type II DM)
Hypertension (High blood pressure)
Polypharmacy (Taking multiple medications)
General Aging (ED rates increase with age)

Clinical Presentation and Underlying Mechanisms of ED

Sexual dysfunction for men most commonly presents as erectile dysfunction, or the inability to initiate and maintain an erection substantial enough for sex. ED can also present as a general decline in the fullness and firmness of erections. Male sexual dysfunction can also encompass other challenges such as orgasmic disorders, decreased libido, premature ejaculation, and structural abnormalities such as Peyronie’s Disease.

The etiology of ED is often multifactorial:

Vascular Health and Endothelial Function (i.e. the health of blood vessels)
Hormone Health and Regulation (particularly testosterone)
Psychological Components (including stress, anxiety, and relationship dynamics)
Pharmacologic Factors (i.e., medication side effects)
Neurological Issues (can affect arousal, nerve function, and erectile response)

Understanding this interplay is essential for targeting effective treatment strategies, and is the reason why a comprehensive approach often leads to more successful outcomes.

Treatment Philosophy

Kass Precision Medicine’s Sexual Health Clinic emphasizes a treatment approach that acknowledges the sometimes multifactorial nature of sexual dysfunction. We have developed a multimodal treatment framework:

1 Advanced Diagnostics and Screening

Evaluating Low Testosterone’s Impact on ED

2 Medication Interventions

3 Innovative ED Therapeutics

Our clinical philosophy recognizes sexual wellness is important in the broader context of men’s overall wellness and relationship satisfaction. Our protocols are designed not just for symptom relief but for the sustainable restoration of sexual function and confidence.

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Treating Erectile Dysfunction - A Multimodal Approach:

Advanced Diagnostics and Screening

Our broad lab panel and thorough medical intake are targeted at identifying early indicators and risk factors that may contribute to ED.

Cardiovascular Health Status - Cardiovascular biomarkers reflect a relationship between vascular health and erectile function and serve as a crucial early indicator for ED. Research demonstrates that ED frequently precedes coronary heart disease by 3-5 years, functioning as a harbinger of systemic cardiovascular decline. Our lab panel includes the following:

Inflammatory Markers - i.e., CRP and IL-6, homocysteine that can reflect endothelial damage and impair nitric oxide synthesis, the chemical responsible for dilation of vessels in the penis and the heart.
Lipid Biomarkers - total cholesterol, LDL, HDL, LP(a), and Apolipoprotein B are lipid biomarkers that participate in plaque build up (i.e., atherosclerosis).
Blood Pressure Indicators - high blood pressure, even subclinical high blood pressure, can promote damage to blood vessels

Weight and Metabolic Health - Your risk of ED is nearly double if you are overweight or obese. Excess weight contributes to inflammatory cytokines, reduced testosterone, insulin resistance, and vascular compromise. Our clinic specializes in helping patients manage weight through medication weight loss and in-office body composition analysis. View our Medical Weight Loss page for more information.

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. We include the following markers to assess diabetes, pre-diabetes, and insulin resistance tendencies:

HbA1C
Fasting Glucose
Fasting Insulin
HOMO-IR.

Medication Burden - common prescriptions such as antidepressants and even some blood pressure medications can contribute to ED. We evaluate medications and help reduce or exchange them when possible.

Assess Exercise Regiment - Implementing 160 minutes of moderate to intense cardiovascular exercise per week has been shown to improve erectile function. We coach patients on target heart rates and assist with exercise goals.

Dietary Evaluation - while not exactly glamorous, dietary choices are incredibly impactful. Good nutrition can help you lose weight, reverse diabetes, improve testosterone levels, reduce inflammation, and improve cardiovascular health. We discuss your diet, making recommendations and referrals to nutritionists when necessary.

Hypothyroidism - this is commonly missed in men and can be a contributing factor to erectile dysfunction. Our thyroid biomarkers include:

TSH
Free T3
Free T4
TPO Antibodies
Thyroglobulin antibodies
Reverse T3

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Evaluating Low Testosterone’s Impact on ED

Testosterone plays a complex but important role in erectile dysfunction. Not all men with ED have low testosterone, but testosterone deficiency can and often does contribute to erectile dysfunction. Testosterone affects erectile function in the following ways:

Libido or sexual desire
Nitric oxide production
Penile tissue health
Arousal and orgasm

Testosterone naturally declines with age, and other health conditions such as diabetes, being overweight, and stress can participate in lower testosterone levels. 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. Visit our Testosterone Replacement Therapy to learn more.

Visit our Personalized Diagnostics page to learn more about our precision lab programs.

2 Medication Interventions

PDE5 Inhibitor Medications

PDE5 inhibitors are the standard initial intervention for erectile dysfunction. 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. The most common PDE5 inhibitors include:

Viagra
Cialis
Levitra
Stendra

They are typically taken by oral route 1-2 hours before sexual activity and can last between 12-36 hours depending on medication. We work with specialty pharmacies to make combinations of PDE5’s and alternative forms such as sublingual and rapid dissolve tablets for faster absorption.

Intracavernosal Injections Medications

For patients not responding to oral medication or experiencing significant side effects, intracavernosal injectables such as Alprostadil, Trimix, and Bimix are an option. These are administered via an insulin needle at the base of the penis 15 minutes prior to sex. These medications can be quite effective, but pose some risks including scar tissue at the injection site.

Emerging/Alternative ED Treatments

Bremalanotide (PT 141) - This is also an injectable medication, although it’s injected subcutaneously into the lower abdomen or thigh. This is a first in class mediation and is not FDA-approved for men. It has been approved for women with low sexual desire. PT 141 works on the central nervous system, targeting melanocortin receptors in the brain that are involved in sexual arousal and desire pathways. This makes it unique in that it is not targeting blood flow in the penis, but rather libido and sexual motivation. This is considered an experimental or alternative treatment for men, but has been studied in men and is used off-label fairly frequently.

Urethral Suppositories - a medication called Muse is a small pellet that is inserted into the urethra. It includes some of the same medications or active ingredient (alprostadil) as the injectable class. This medication has become difficult to get and is only available at specialty pharmacies.

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Innovative Erectile Dysfunction Therapeutics

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)

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 to 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 has performed thousands of shockwave therapy procedures since initiating the GAINSWave program and is one of the longest standing providers of shockwave therapy for ED in the US.

Shockwave therapy has 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 (i.e., improved sensitivity)
Plaque disintegration - breaks up debris called plaque that can collect in small blood vessels, decreasing blood flow.

CLICK HERE TO LEARN MORE ABOUT GAINSWAVE THERAPY IN SEATTLE.

Platelet Rich Plasma for Erectile Dysfunction (AKA The Priapus-Shot / 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.

Therapeutic Botox for Erectile Dysfunction

Medical research suggests that Botox is a safe and potentially highly effective treatment for ED. A one-time injection of Botox can treat erectile dysfunction by improving the vascular health and function in the penis. Additionally, Botox has also been shown to enhance performance and improve sexual confidence. We consult with men to determine if they are a good candidate for therapeutic Botox treatments.

Visit our Therapeutic Botox page to learn more.

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.

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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.

There are a number of causes that may contribute to premature ejaculation and other ejaculation problems, including: