COVID-19 and men’s health

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. 

Primer on Sexual Dysfunction by Dr. Paduch

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.

Exciting new treatment for chronic pelvic pain in men.

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.  

Masturbation, it’s what’s good for you

Well, let me get something clear. I do it. You do it. Your neighbors do it. Every guy does it. We all masturbate. It’s normal bodily function and actually is healthy. Let me ask a question, what is the normal number (minimum) you should be masturbating a week? 1-2? Nope. You need at least 3 to ensure you’re staying functional down there. It’s important to remember that your penis is a muscle and if you don’t use your muscles, then what’s the point of having them?

Here’s another way to put it, ever say you’re gonna go to the gym, and you do it once or twice a week, and then the next week maybe once. And then none at all. You start to lose the urgency to really go and work out. Well, the same goes for ejaculations. Your body responds to ejaculations in the sense that it’s a pleasuring thing to do, and the more you do it, the more you want to do it, and this will raise your sex drive and get you back into the healthy flow. So, more masturbation means more sex, simple math right?

Now a question pops up, is it healthy to be masturbating several times a week, for say, 7 or 8?

Here’s your answer: Is the masturbating getting in the way of your job? Is it making you antisocial? Are you trying to have a kid with the specimen you ejaculate from that very instance? If you answered no to those three questions, then masturbating 7 or 8 times a week, or more is not a health concern. The only thing masturbation is affecting is your sperm count, which rebounds after a day or two, and you’ll only need to worry about the sperm count when you want to have a kid, otherwise, there is no reason to stop you. The more you masturbate, the more your sex drive increases, and your sex drive is very necessary for many reasons. You want to be able to have sex with your partner and to do so you need to get erections hard enough to penetrate and in order to do so, you need to masturbate. As I’ve said before, masturbation raises your libido through muscle memory and a real chemical response in your brain that will be asking for more. So it’s ok to set aside alone time and get the job done, no matter how many times you do it a week (at least 3), as long as it isn’t hurting you as a character. That simple, keep going the way you’re going and keep producing dopamine with every stroke. It feels good to know what you’re doing is safe, doesn’t it?

By  Eli Conlin and Darius A Paduch, MD, PhD

Students and trainees

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:

  1. Ryan Flannigan, MD

LAMP and wordpress

Finally after many trials and learning linux I installed my own server and website.

Aim to share exciting work in my lab and practice.