Erectile Dysfunction (ED)

What is the definition of erectile dysfunction?

Erectile dysfunction is defined as a consistent inability to achieve or maintain an erection suitable for completion of sexual activity.

What is the cause of erectile dysfunction?

Erectile dysfunction can be caused by a hormonal imbalance, a blood flow issue, a neurological problem, and even result from psychological stressors. These four primary causes are not mutually exclusive and ED is often the sum of one or more of these issues.

What are the symptoms of ED?

Men can present with a number of symptoms with regard to erectile dysfunction. Men will sometimes report that their erections do not last as long or that their erections are not firm as they were previously. Men with ED may also report that it takes longer for them to achieve a full erection or reach orgasm.

How can I prevent ED?

ED is common as men age and is caused by many factors that can negatively affect your overall health. As a general rule, we say that what’s good for your heart is good for your penis. That means eating healthy, sleeping well, and exercising regularly are all important factors in maintaining your erectile function.

What is the prognosis if I have ED?

The prognosis for erectile dysfunction is excellent if the kind of ED can be determined. Not all erections or erectile dysfunction is created equal. Treatments therefore should be tailored to your specific diagnosis. My promise to every man with ED is that one way or another we can get you a reliably hard erection.

What kind of doctor treats ED?

Many men seek help for ED first with their primary physicians. However, primary docs are not trained to diagnose the underlying cause of your issue. For that you need a specialist. You can seek the guidance of a urologist, but your best bet is to find a doctor who specializes specifically in male sexual health.

What tests are required to diagnose ED?

Most new patients with ED require blood tests to evaluate their hormones, which are typically done on the first visit. Depending on a patient’s individual history and the severity of their condition, we may recommend an ultrasound evaluation of their erection to assess penile blood flow. Any additional testing would be based on the outcomes of these initial tests.

How do I know if my ED is “all in my head”?

In more than 80% of cases, there is some underlying physical issue that is contributing to ED. That means in most cases it’s not all in your head. It’s worth a formal medical evaluation to figure out what’s really causing your erection difficulties.

What medications are there for ED?

There are several medical therapies available for erectile dysfunction. The most commonly used and well-known are the oral medications known as PDE5 inhibitors. These include Viagra, Cialis, Levitra, and others. These are taken at the time of sex to induce an erection. When men stop responding to pills or become frustrated because they are no longer reliable, they can use injections that are administered directly into the penis prior to sex.

What other types of treatments are there for ED?

For men who do no respond reliably to medications, surgery can be a great option. The gold standard surgical treatment for ED involves the placement of an inflatable penile prosthesis. This device replaces the no longer functioning erectile tissue and can easily be activated at the time of sex. These prosthetics are implanted through a single incision and are completely hidden within the body so that your penis will look the same as it always has.

Hypogonadism (low T)

How do I know if I have low testosterone?

Testosterone naturally lowers with age. If you have experienced low energy or chronic fatigue, decreased sex drive, increased anxiety or worsened mood, erectile dysfunction, or decreased muscle strength, it’s worth investigating if these problems

may be due to low testosterone.

What are the causes of low T?

Low T can occur for a number of reasons. It happens naturally with age. Men with common comorbities such as high blood pressure, diabetes, obesity, liver problems, chronic opioid use, and HIV/AIDS are all at risk for developing low testosterone.

How can I prevent low T?

Maintaining a generally healthy lifestyle is your best bet at preventing low T. That means eating well, getting good sleep, exercising frequently, and seeing your doctor on a regular basis.

What are the treatment options if I have low T?

Depending on your age, there are a number of ways to increase your testosterone. Lifestyle or behavioral modifications are a place to start. But beyond that there are a variety of testosterone replacement options including topical gels, injections, and even subcutaneous pellets.


How do I know if I’m in menopause?

The average age of onset of menopause is 51, but the process can start much earlier or later depending on the woman. The first indication is usually persistently irregular periods.

What are some common symptoms of menopause?

Common symptoms of menopause include hot flashes, chills or night sweats, trouble sleeping, irritability, chronic fatigue, vaginal dryness, pain with intercourse, weight gain, and even depression or anxiety.

What are the available treatments for menopausal symptoms?

Menopausal symptoms can be alleviated through a number of different methods including certain medications. We believe that many if not all menopausal symptoms can be effectively treated with a carefully tailored, closely monitored hormone replacement program.

Is hormone replacement therapy safe?

There are a lot of misconceptions about hormone replacement therapy (HRT). When monitored closely it is absolutely safe. HRT should be treated as any other hormonal condition, like diabetes or thyroid disease, is with regular checkups and careful observation.

Low Libido

Is low libido just part of getting older or being married?

Libido can certainly fluctuate during a person’s life and throughout the course of a relationship. However, if your lack of sexual interest is distressing and/or is something that is negatively affecting your relationship, then you should certainly discuss it with your doctor. Low libido can also be the first sign of a hormonal problem.

Are there treatments to improve sexual desire?

There are many different ways to improve sexual desire including hormonal treatments, non-hormonal medications, and even sex therapy.

Painful Sex

Is it normal to have pain during intercourse?

Painful sex is never normal. If you experience pain, then something is wrong.

What are the risk factors for having pain?

Pain with intercourse can occur from several causes including vaginismus, pelvic floor muscle problems, exposure to certain birth control pills, and menopause.

What are the treatments if I have pain?

The treatment for your pain depends on the cause. Treatment options include physical therapy, acupuncture, hormones, pain medications, and many others.

Will sex always be painful?

Painful sex is treatable. So no, sex will not always be painful.

Peyronie’s Disease

What is the definition of Peyronie’s disease?

Peyronie’s disease is a condition in which scar tissue forms within the penis that causes shortening, indentation, or curvature of the penis. These scars can sometimes be associated with pain.

How did this happen?

Peyronie’s is usually the result of trauma to the erect penis. Sometimes these traumas are recognized, but not always. Peyronie’s can result from an accumulation of micro-traumas sustained over many years.

Why is it painful when I have an erection?

Pain is a common complaint during the early, acute stage of Peyronie’s. It is almost always transient but can sometimes take weeks to months to resolve.

What can I do to prevent it from getting worse?

If you are concerned you may have Peyronie’s, see your doctor soon. In up to 30% of cases, the condition resolves completely. But certain medications may help your condition from getting worse.

How do I stop my penis from getting smaller?

Maintaining good blood flow to your penis is key to preventing shrinkage. Talk to your doctor about how you can maximize your penile blood flow.

What treatments are available to help with this issue?

There are several treatment options including oral medications, scar tissue injections, and even surgery.


What is prostatitis?

Prostatitis is a condition characterized by inflammation or infection within the prostate. It almost always occurs along with tightness in the pelvic floor muscles, which can cause persistent pain even after the inflammation or infection has been


What are the most common symptoms of prostatitis?

Prostatitis can present with a myriad of symptoms including pain in the lower abdomen, penis, testicles and scrotum, and perineum. If prostatitis is caused by a bacterial infection, it can sometimes present with fever, burning with urination, and even blood in the semen.

What is the prognosis if I have prostatitis?

The prognosis for prostatitis is excellent if the underlying cause is identified. If the cause is a bacterial infection, several weeks of antibiotics may be needed to eradicate the infection. However, most cases of prostatitis are non-bacterial and require a combination of medical and physical therapy.

What are some of the treatments used for prostatitis?

Treatment options include antibiotics, anti-inflammatory medications, and pelvic floor physical therapy.

How do I prevent prostatitis from coming back?

The patients who are most successful at preventing recurrent prostatitis are those that are compliant with prescribed medications and most importantly pelvic floor physical therapy.

Premature Ejaculation

How is premature ejaculation defined?

Premature ejaculation is defined as ejaculation that always or nearly always occurs prior to or within one minute of penetration. It can be lifelong or acquired, meaning it can occur later in life.

How common is premature ejaculation?

Premature ejaculation is actually the most common sexual dysfunction. Some studies have estimated the prevalence of premature ejaculation to be as high as 30%.

Are there medications to treat premature ejaculation?

There are no FDA-approved treatments for premature ejaculation. However, several medications have been used off label to lengthen time to ejaculation.

Are there other non-medical treatments?

Pelvic floor physical therapy and sex therapy can often be helpful in strengthening ejaculatory control. The use of intramuscular Botox is also a promising treatment for premature ejaculation currently under investigation.