A recent NYT article about the association between COVID-19 and sexual dysfunction is at least highly questionable in context. There are many statements that are clearly untruth and easily verifiable like a number of manuscripts published etc. In short, I have been a part of the COVID-19 clinical expert’s group for Northwell Health for close to 3 years: I have not seen one case of orchitis after covid-19 or vaccine, no sudden sterility etc. The few men who I saw with ED who somehow connected it to the COVID-19 infection have a normal evaluation and clearly, their ED is psychogenic. Please take the media and internet with a grain of salt. Docs spend a lot of time getting their education and are your best resource of medical advice. NYT is not.
Normal sexual function require correct processing of sexual cues (memories, recollection of positive experience, visual cues, auditory, olfactory, tactile sexual cues) in different part of brain. Integratrion of sexual cues is affected by normal brain function, hormones, overall health, stress levels among others. The nerve siganls from brain are then send to spinal cord motor generator which receive and control signals from genital areas. Once treshhold for activation of ejaculation and orgasm are reached, the rhythmic contractions of pelvic floor muscles result in expulsion of semen (ejaculation) and positive sensation of pleasure (orgasm).
To achieve erection more blood flow has to go inside the penis (arterial inflow) than leave penis (venous leak). The more blood stays inside penis the better erection man has.
Ability to enjoy sex is based on our internal past experiences, religious and social restrictions of recognizing importance of happiness in one’s life: hence aheadonia often seen in depression will often decrease one’s ability to experience orgasm despite of normal ejaculation.
Relatively simple issues like vision problems or decreased sensitivity in penis from diabetes may result in sexual dysfunction. Hence during initial visit doctors start with full physical examination of patients from head to feet: sexual health specialists often are first doctor man sees since high school.
Physical exam focuses on identifying disorders of thyroid, heart function, lung auscultation, checking grip of hands, performing full neurological examination, and of course detailed examination of penis, scrotum, and prostate. The penis is examined both in flaccid state and when erected.
The history taking will identify history or risk factors for diabetes mellitus, high blood pressure, peripheral vascular disease, heart disorders: again we are trying to identify if vascular issues may be culprint of sexual dysfunction.
Social habits like excessive alcohol abuse, anabolic steroids abuse, illicit and prescribed drug abuse, lack of exercise are important risk factors for sexual dysfunction.
Psycho sexual development during childhood and adolescents and early sexual experiences have powerful effect on ability to connect, bound, and trust one’s partners. Lifetime prevalence of physical and emotional abuse are relatively similar between men and women (30% and 22%) but few recognize that 23 % of men report lifetime experience with sexual abuse. Military, all-boys boarding institutions, men-only jobs, low socioeconomic status are important risk factors for sexual abuse. Most of men do not reveal such traumatic experiences to their doctors or see therapy. The patients present with often difficult to objectively confirm complaints of low sex drive, pelvic pain, prostate infections, loss of sensation in the penis. Considering high prevalence of sexual, emotional, and physical abuse among US young men our physicians are sensitive to help men to bring such painful experiences with their doctors so we can connect the patient with appropriately trained mental health expert to work with us on rehabilitating men back into developing trustful and loving relationships.
Sex brings intimacy to couple’s life and intimacy brings more sex; hence our physicians often incorporate partners in some of visits to identify how best to help the couple to achieve sexual satisfaction.
LGBT patients often present with specific sexual medicine needs and our physicians pride themselves in providing state of the art and compassion care to all of our patients regardless of their sexual identify and gender.
Dr. Paduch’s office as one of first in nation and first in NYC area will soon be offering unique new treatment for chronic pelvic pain in men using regenerative wave therapy.
Using well established in urology, rheumatology, and orthopedics method bursts of sound energy are applied to prostate through the skin to stimulate improve blood flow and help with chronic pelvic pain.
This therapy has been used to treat erectile dysfunction and Peyronie’s disease and is painless.
“Hey there Dr. Paduch,
I recently read a quote from you in GQ about the use of pumps and the ability to increase the size of a man’s penis. I was curious if you’ve ever found pumps to add permanent enlargement? Or are there any studies on this available? I’m looking for girth specifically and I would like to do anything I can to avoid surgery.
I truly appreciate your time.
Dr. Paduch’s answer: There aren’t many studies published on “penile pump use for girth expansion,” but from my experience, girth depends on levels of two hormones. These two hormones are testosterone, and a growth hormone derivative called IGF-1 during the adolescence period. Interestingly girth can continue to increase slightly with age. My advice is to use a pump without a cock ring and only 10-15 min a day. Best to pump it up for a minute then release the pressure, then pump again for a minute and repeat the cycle 10-15x. Don’t over pump the device, and if you feel pain, stop. The increase in girth is mostly temporary but with persistent use for 3 months, we can see a 1/2 inch-full inch increase in some men.
Most of the cases of pain in scrotum, penis, and pelvis are simple: kick to the groin, sexually transmitted diseases, acute and chronic prostatitis, urinary tract infection, and penile trauma. Reasons for chronic pain may be more difficult to diagnose especially in younger men: voiding dysfunction and Peyronie’s disease can also be seen in younger men. The most difficult reason to uncover for genital pain is physical, emotional, and sexual abuse experienced by the patient as a child or young man. Unfortunately by some estimates 8% of the general population of men in USA report history of sexual abuse. Among college students with drinking history, 1/3 to 1/2 of male students report a history of sexual abuse or coercion over last 5 years, however because of social stigma men are less likely to report the history of sexual and physical abuse. In these men, the pain in the genital area may be a sign of psychological trauma they experienced at the vulnerable age of psychosexual stage of development. In my practice 1/3 of my young men (18-29) who suffer from difficult to define genital pain or sexual dysfunction eventually report a history of emotional, physical or sexual abuse as children and young adults.
These are difficult patients to help but they are very appreciative patients when they start to rebuild their sense of trust in other human beings and sense of self-worth. With the help of psychologists and psychotherapy focused on rebuilding the patient’s trust and sense of self-worth, along with the medical therapy we offer, we can impact the lives of our young patients to a huge extent. Yes, we have to first exclude medical reasons for genital pain but as physicians, we have to consider non-organic reasons for somatic symptoms.
Then try harder, find the way, there is always a way, most of the time, it is not an easy way, but nothing significant in life comes easy.
Training new doctors and researchers is an important part of my professional life. Over the past decades I have trained brightest of the students, among them:
- Ryan Flannigan, MD
Finally after many trials and learning linux I installed my own server and website.
Aim to share exciting work in my lab and practice.