Let's talk about erectile dysfunction...

Let’s talk about erectile dysfunction.....

Yes, it happens and it is a much more common problem than anyone cares to admit. Its implications are deep and complex because once you feel something is wrong, you perpetuate the cycle by feeding into the performance anxiety. For a great number of patients, an occasional issue of erectile dysfunction can lead to a crippling issue of fear and anxiety that will become the real problem.  But there is help. 

There is currently an abundance of great options to treat erectile dysfunction and lead to male function enhancement.

Living through the “stay at home mandate” has given me a chance to listen to Radio and news media much more often than I usually do. I have heard numerous ads for organizations and businesses that promise to rejuvenate your sexual function and return to better erections. These are all businesses and only businesses. 
None of them are led by a board-certified urologist or an expert in the field.  Most of them are trying to sell you products on a cash basis.

There are safer, easier ways to get help and it should be through your local urologist.
Here is a summary of what you really need to know:

Failing to have adequate erections can be devastating in a short, and in a long-term way. It is at the core of your self-image and sense of masculinity. The sooner you attend to the problem the better off you will be. The more aggressive you are in your management the better your results. There is help out there for everybody, and 95% of the cases will be treated successfully one way or another.

Your initial evaluation should include a conscientious interview with your urologist. This interview should be detailed and it may be uncomfortable at times.  We are dealing with information that is very intimate and that you rarely discuss, but very important for your urologist.

A basic physical examination and a laboratory panel are important. We must rule out underlying diseases like low testosterone levels, hormonal imbalance, cardiac disease, diabetes hypertension, and other metabolic disorders.  A history of injuries will also be very pertinent.

The many alternatives to therapy can be used in any order. The order in which we use these approaches depends on the particular patient's situation. The options for therapy are as follows:

Oral therapies with medications known as phosphodiesterases. These are now a large family that includes Viagra, Cialis, Levitra, Stendra, Staxyn, and the different generic options. 

There are compounding pharmacies that can also create pills that combine different dosages of these medications. This approach has been proven to be very successful. The compounding pharmacies also prepare sublingual tablets or wafers made of these drugs and combinations thereof.  Once placed under the tongue, they dissolve speedily for a quicker onset of the effectiveness of the drug.

Currently there are studies being conducted with topical ointment and creams that include different drugs. The results are yet to be seen.

Another option is the use of intra-urethral suppositories. This is a small pellet that is applied directly into the urethra with a special device.  This suppository, which is smaller than a grain of rice, then is absorbed from the urethra causing an erection in a good number of patients reaching 60%.  The pellet is applied some 30 minutes before the anticipated sexual activity.

Remember that we are continuing down this list in no particular order. 

Another possibility is the use of intra-cavernosal therapy otherwise known as self-injection therapy.  There is a large family of solutions that are customized for each patient.  These include anywhere between one and four drugs that can be prepared in a number of different combinations as the patient’s history dictates. The agents used in these mixes have different purposes and include prostaglandin, papaverine and phentolamine in different concentrations. These drugs must also be prepared by a compounding pharmacy and are not commercially available other than through these pharmacies.  The thought of self-injection is initially daunting and uninviting but the truth is that 95% of patients learn to complete the penile injection quickly and find it very easy and tolerable.  The onset to erection is about 20 minutes.  Self-injection therapy will require a teaching session on the do's and don’ts of the therapy, as well as all necessary precautions.  If you search this topic, you are likely to find products or names like EDEX, CAVERJECT, and TRIMIX.

The newest approach to non-invasive erection enhancement is penile ultrasound therapy.  The market has been variable in naming this therapy.  A common name is penile shockwave therapy or penile ultrasound therapy. Gainswave, one such patented therapy, has the biggest pool of data and widespread coverage throughout the nation. Penile shockwave therapy has been used extensively in other countries and Gainswave became popular in the United States some eight years ago. The ultrasound therapy improves the arterial flow into the penis by opening your own chambers and also releasing growth factors to enhance the growth of new arteries. 

Penile shockwave therapy is an extremely easy and well-tolerated therapy provided in short sessions on a weekly visit.  Approximately 70% of patients report significant improvements in the quality of their erections. Parameters like rigidity, sensitivity and ease of erections all improve in the majority of patients. The therapy has absolutely no known side effects. It is also being used for Peyronie’s disease.

The Gainswave protocol of penile shockwave therapy is enhanced by a number of daily exercises and sublingual preparations of drugs that are similar to those described above.  Our office is an experienced GAINSWAVE therapy provider.

At the end of our list of options is the penile implant surgery. This should only be used in patients who have failed every other approach. This therapy is considered a point of no return. After you place the surgical penile implant, you will not have the option of removing it and going back to other therapies. 

When necessary and in the right patient, penile implants are a very good option and the patient will have the choice between an inflatable or semi rigid prosthesis 

The inflatable form has a pump that the patient activates at the time of sexual activity. This is surgically more complex but with more natural results.

At fog city urology we are extremely aware of how difficult it is to have less than optimal sexual function or erectile dysfunction. We have been helping patients in excess of 25 years with a great success record. Our office offers all of the options available today and will customize a solution based on the factors that are particular to your case. We offer our service in a private, respectful, and comfortable environment.  In the last 25 years we have accrued a wealth of experience in the management of this private and distressing issue. 

If we can help you with any information do not hesitate to call our offices at:


Thank you and be well.

Raul Hernandez, MD Raul A. Hernandez, MD President, Fog City Urology - President, Golden Gate Urology

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