Background

As men age, erectile function is compromised to varying degrees for one reason or another. Erectile Dysfunction (ED) is defined as the inability to get or keep an erection firm enough for sexual activity. Causes of ED are multifactorial and often come as a constellation of issues. Common causes include cardiovascular/atherosclerotic disease, hormonal imbalance, low testosterone, stress, psychological/emotional problems, chronic pain, and more.

Even mild ED can be a cause for concern. The fact that you are no longer achieving optimal firmness may be enough to cause self-esteem issues that impact your relationships and sense of worth.

Why Are Traditional Treatment Options So Frustrating?

Current treatment options include use of vacuum pumps, cock rings, prescription medication, and surgery.

Vacuum pumps can assist in achieving erections, however, they can be cumbersome and interfere with spontaneity. Vacuum pumps basically create negative pressure to engorge the penis with blood. When used on a regular basis vacuum pumps expand pre-existing blood vessels in hopes to improve blood flow, but they do not promote formation of new circulation. Although blood is drawn into the penis, often the erection is not sustained especially with underlying venous leakage. This is often remedied by use of a cock ring to trap blood within the penis. However, many complain that the ring interferes with intercourse or it may be uncomfortable to wear.

Prescription medications like Viagra and Cialis (PDE5 inhibitors) work well, but can be expensive and require planning as most would rather not waste an expensive pill unless they have a high certainty of having a sexual encounter. There may also be associated undesired side effects like flushing, congestion, visual changes, headache, and dizziness. Drug interactions with these medications are also a concern, particularly with nitrate drugs used to treat hypertension. The combination of PDE5 inhibitors and nitrates may result in a severe and potentially fatal drop in blood pressure.

Surgery is expensive, invasive and requires general anesthesia. The postoperative recovery period requires time off from work and physical activities. In addition, surgical procedures may result in unsightly scars. Surgery entails placement of a prosthetic that typically requires undermining the corpus carvenosa, the chambers that accepts blood to engorge the penis. This structure is basically compromised. If the body were to reject the implant immediately or years later, there is no way for the patient to be able to achieve an erection.

What Treatment Options Do We Offer?

To address ED caused by poor circulation, we offer injectable therapies and daily supplements.

Injectable therapies include the Priapus Shot® and Grotox® . They may be performed individually or in combination with each other.

To address ED caused by hormonal imbalance or low testosterone levels, bio-identical hormone replacement therapy is a great option.

Do We Still Offer EPAT/PAWT?

Extracorporeal Pulse Activation Technology (EPAT) or Pulse Acoustic Wave Therapy (PAWT) is a form of treatment which utilizes sound waves to mechanically breakdown atherosclerotic plaque within blood vessels. Although it may be effective in some patients, treatment failure is often a result of simply not having enough treatments. How many treatments are required? Sometimes 6, 10, 12, 18, 24, … Some protocols would require multiple office visits per week for 2-4 weeks then a repeat of the sequence a few months later. If 6 treatments failed to produce noticeable improvement, it is a challenge convincing patients to return for additional treatments. Despite 12 treatments, it may still be insufficient.

We have had great success with the Priapus Shot® and Grotox® in improving function with fewer office visits. The former may be as infrequent as every 12-18 months or a series of 3 treatments performed every 6-8 weeks. The latter may be performed every 3-6 months depending upon dosing and severity of ED.

For these reasons, we no longer perform EPAT/PAWT for the treatment of ED. You are more than welcomed to seek this treatment option elsewhere though.

What Is The Role Of Daily Supplements And/Or Medication?

As we age, we are unable to extract Nitric Oxide (NO) from our food sources as effectively as in our youth. NO is a small molecule that signals blood vessels to vasodilate i.e. open up to deliver more blood, oxygen, and nutrients.

There are several NO booster capsules/tablets on the market, however, their bioavailability is rather poor due to breakdown by the liver after ingestion by mouth. This is known as the 1st Pass Effect of the liver. N1O1 Lozenges, however, are dissolved within the mouth. NO is able to enter the blood stream through the mucosa thereby avoiding the 1st Pass Effect.

Supplementation with N1O1 lozenges helps on the front end of improving NO concentrations. PDE5 inhibitors like Viagra, Cialis, and Levitra help on the backend to reduce the breakdown of NO. The lozenges are to be taken every 12hrs ideally on an empty stomach. We are able to prescribe a compounded low dose generic form of Cialis, Tadalafil, which can be taken every night. This compounded form is much more affordable than paying brand name. These two therapies work best in conjunction with each other. When both are taken on a daily basis, there is a better chance of improved spontaneous function. Depending on the severity of ED, these options can be taken as monotherapy, in conjunction with each other, or in combination with our injectable therapies: the Priapus Shot® and Grotox® .

What If These Treatment Options Fail?

In severe cases despite our best efforts, there may not be any appreciable improvement. For these patients, we offer Trimix injection therapy. Trimix is a cocktail of 3 potent vasodilators: alprostadil, papaverine, and phentolamine. The injection is self-administered on demand. This option may seem like a cumbersome non-spontaneous treatment, however, when it works well one could benefit from a reliable erection lasting 20-60min depending on dosing.

A consultation is required to educate you regarding safe practices, dosing, technique, and managing complications.

Please Contact Our Office To Schedule Consultation