Sexual Health

Sexual Health is Important

Sexual health is a significant aspect of overall health. Sexual dysfunction can be an early warning sign of underlying health issues that in some cases can be life threatening. Age and chronic medical conditions are common causes of declining sexual function. Sometimes medications or surgeries can interfere with normal sexual function. Psychological stress can play a role as well. Poor lifestyle choices can undermine sexual health as well. Dr Aaron Spitz provides expert evaluation and treatment to restore and preserve sexual health for men. He is a recognized leader in the field of male sexual health. In fact, he wrote the book.

Types of Sexual Dysfunction

• Erectile dysfunction: difficulty initiating or to maintaining an erection that is satisfactory for sex. This is a common condition that can affect men of all ages. Although “performance anxiety” may be a cause, it is not typically just a psychological issue. It is most commonly associated with age related changes of the blood vessels, nerves and hormones of a man and affects at least 50 percent of men over age 50. Chronic medical conditions like diabetes and high blood pressure make it worse. The remedy for erectile dysfunction is not one size fits all, and for some pills are not enough, however, the vast majority of men can be helped with appropriate evaluation and treatment. Lifestyle modification including dietary modification can help prevent and reverse erectile dysfunction as well.
• Premature Ejaculation: reaching a sexual climax too soon for the enjoyment of both partners during sex. This is typically ejaculating within 2 minutes or less. This condition affects many men. The underlying cause for many men is that their tipping point for climax is simply neurologically set to happen quickly. For other men it may be a subconscious adaptation their body makes to try to achieve a climax before a weak erection gives out. Premature ejaculation can be effectively treated for the vast majority of men with behavioral therapy techniques which retrain the man's nervous system to prolong the tipping point for climax. Topical medications that lower the sensitivity of the penis can be effective as can oral medication.
• Delayed Ejaculation: difficulty reaching a sexual climax despite a normal erection and appropriate sexual stimulation. Like erectile dysfunction, this condition can be psychological in nature but it can also be due to physical causes. In some cases it may be due to hormonal imbalances. It is also a common age related change. As men get older they often experience more difficulty reaching sexual climax and they often notice a decrease in the volume of their ejaculation. Behavioral therapy can often be effective at restoring climax. In some cases hormonal therapy or medications can restore sexual pleasure. This is a challenging condition that can be improved in many men.
• Painful ejaculation: pain in the pelvis or testicles during or following ejaculation. This condition is common and is often a sign of pelvic floor dysfunction. Pelvic floor dysfunction is a condition where in muscles in floor of the pelvis that surround the base of the penis and prostate can spasm during ejaculation and cause an unpleasant sensation. Pelvic floor physical therapy often remedies the situation, but a careful examination to rule out a cancer or infection of the prostate or testicles as the cause is appropriate. Dr Spitz specializes in hormonal therapy for men as In such cases sexual desire may be improved with hormonal therapy. As with other aspects of sexual dysfunction low testosterone is often an age related change but it can.
• Lack of sexual desire: a decrease in interest in having sexual relations. This may occur even with normal erections, but often occurs in addition to erectile dysfunction. This can be a psychological condition but another common cause is low testosterone. For men with low testosterone, hormonal therapy can restore sexual desire and improve sexual function. For some men behavioral therapy is the solution.
• Peyronie's disease: a sudden or gradual onset of curvature of the erection, sometimes shortening and often with pain in the penis. Erections often become weaker. A lump may be noticeable as well. This is a common condition affecting about 12 percent of men typically in their 40s and 50s but can occur in younger and older men as well. The underlying cause is scar like tissue that occurs in the shaft of the penis which alters the way the erectile tissues are able to fill with blood.. Sometimes it is due to an injury of the penis, typically during sex, but in many cases it arises spontaneously without a recognizable injury. In a small percentage of cases it may resolve on its own but for most men it persists and in some cases worsens over time. Fortunately there is effective treatment. For most men a combination of mechanical stretching and injections which gradually eliminate the scar like plaque tissue will restore sexual function. For some men surgical correction provides the greatest improvement.

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Diagnosis

Diagnosis typically involves:

• Physical Examination: examination of the genitals and sometimes the prostate. Assessment of general physical condition.
• Laboratory studies: evaluation of blood hormone levels including testosterone and in some cases other related hormones that affect testosterone balance. Evaluation of blood sugar, cholesterol profile, and in some cases thyroid balance.
• Ultrasound: in select cases examination of the soft tissues and the circulation of the penis.

Treatment Options

Treatment varies by condition but may include

• Oral medications: Pills for erectile dysfunction are generally safe for long term use with little to no side effects for most men. They work by allowing and increase in blood flow to the penis. They are not effective in all men, however. Oral medication for both premature ejaculation and delayed ejaculation are typically well tolerated and work at the level of the brain centers that control ejaculation.
• Low intensity shock wave therapy: Sonic waves applied to the penis can stimulate stem cells and the release of growth factors to allow blood vessels to rejuvenate and allow new blood vessels to form in the penis. Age related changes and chronic disease related changes can be reversed to some degree allowing for stronger blood flow to the peins. This therapy is effective in about 65% of men and it has no harmful side effects.

• Injection therapy: for some men low intensity shock wave and pills are not enough to restore erections and for these men, injections of a more potent medication directly into the penis will be effective in most cases. Men are instructed how to perform the injections when desired about 10 to 20 minutes prior to sex. There is a risk of a prolonged erection requiring emergency intervention so proper dosing under medical supervision is important.

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• Vacuum erection device: For men for whom low intensity shock wave, pills are not effective or for whom injections are not desired or effective, a vacuum cylinder that is temporarily placed over the penis to induce an erection can be very effective. The device is used by the man on demand for sex and can be used to help condition the penis if he has poor blood flow.

• Surgical implant: form men for whom low intensity shock wave, pills, injections and vacuum erection devices are not effective or desireable, a surgical implant can restore sexual function. The chambers of the penis that fill with blood to make the penis erect are implanted with cylinders that fill with water and the erection can be “pumped up” by the man through a control switch that is implanted in the scrotum. Dr. Spitz specializes in non surgical management of erectile dysfuncton but refers patients who require surgical implants to an expert penile implant surgeon in his practice.

• Behavioral therapy: psychological strategies can be very effective for men suffering from sexual dysfunction. In some cases underlying anxiety may interfere with normal sexual function. In many cases although there may not be underlying anxiety, nonetheless, strategies for sexual engagement and enjoyment help restore pleasure and function. Dr Spitz often refers patients to a sexual behavioral health specialist for therapy related to performance anxiety, premature ejaculation, delayed ejaculation, and some cases of low sexual desire.

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Contact the office of Dr Aaron Spitz to restore your sexual function.