Treatment Options for Sexual Dysfunction

Best therapy starts with accurate diagnosis. No other field in medicine requires an individualized approach to therapy as in sexual medicine. We pride ourselves in treating the whole patient and bringing joy of sex into individuals life. Sometimes reassurance and education is all that is needed.

Behavioral modification therapy is especially useful in treatment of  men with delayed ejaculation and painful ejaculation. The mainstay of therapy underscores the focus on pleasure during arousal, for men who have decreased sensitivity in penis we use different forms of tactile reintegration therapy with penile and pelvic vibratory stimulation patients first performs in office and then at home. For men with pelvic floor tension we introduce acupuncture and relaxation techniques combined with focus on sexual cues and identifying specific erotogenic areas for each patient. Men who are very forcefull in sexual activities because of fear of losing erection we utilize artificial vagina and learning to defocus from intravaginal ejaculation and rather focus on sense of pleasure and connection. The sex toys are often used together in couples to break the barriers of communication about one’s sexual needs and wants. Incorporating couples session when both men and women have ability to discuss their concern with treating physician is important part of treatment when communications barriers or sexual boredom leads to decreased frequency of sexual activities. We  utilize help of therapists and psychiatrists if needed.

Pelvic floor therapy: with pressure point release and pelvic floor biofeedback is helpful in men with chronic prostatitis / chronic post orgasmic pelvic pain.  I utilize TENS therapy and sometimes patients will use prostatic massages to help with resolution of pelvic pain.

Men with abnormal sexual cues processing on functional MRI are treated with sensory integration/refocus therapy whose main aim is to identify alternative pathways of arousal, for example men who are not aroused by visual cues are focusing on tactile, olfactory and auditory stimuli.

FDA approved medical oral therapies are only available to help with erections:

  • In the past 30 years, a number of medications have been developed that help improve sexual function by increasing blood flow to the penis. These include sildenafil (Viagra®), vardenafil (Levitra®), and tadalafil (Cialis®). They differ in timing of onset, effects of food on absorption and how long they last. Oral medications for erections have side effects and interactions with other medications hence never use someone’s else medications for erections.
  • Hormone therapy. We treat low levels of testosterone with hormone replacement therapies that include injections, patches, or gels however low testosterone is relatively rare cause of sexual dysfunction
  • Intracavernosal injection therapy for erectile dysfunction is a successful form of treatment in men with severe forms of erectile dysfunction
  • Vacuum devices and penile rings are designed to keep blood inside the penis but require understanding partner to accept that form of treatment
  • Dr. Paduch is an expert in penile implant placement— inflatable and malleable — for patients with erectile dysfunction. The implants make it possible to have penetrative sex on demand but once placed patient loses ability to achieve spontaneous erections

Alternative therapies for erections:

MRA guided microsurgical penile vascular reconstructions (Paduch’s penile shunt reconstruction)

Dr. Paduch pioneered MRA guided microscopic vascular reconstruction of penile vascular shunts and malformations. Based on work performed in Asia Dr. Paduch modified Hsu venous stripping to utilize microsurgical approach to offer alternative treatment for men with severe erectile dysfunction often life long. Vascular ligation of the arteriovenous shunt in well selected patients offers an attractive alternative to penile prosthesis in men with severe forms of erectile dysfunction who failed to respond to oral therapy like Viagra, Levitra or Cialis.

PRP injections

Erectile dysfunction is more common in older men, one of underlying mechanisms of loss of erections is degeneration of stem cells and blood vessels in the penis.

PRP is a unique and novel methods of therapy aimed at restoring normal endothelial functions and stem cells activation. Intracavernosal injection of autologous (derived from your own blood) platelets rich plasma (PRP-injection) preparations. Our initial study showed that we achieve 100x higher concentration of pro-angiogenesis factors that published in literature. 

Low intensity shock wave therapy (ESWT) 

 Low intensity shock wave therapy (ESWT) is recommended treatment modality prior to considering penile prosthesis.  This unique therapy which has been shown to improve angiogenesis in the penis (blood flow), some patients experienced improvements in erections just after 2 treatments. We typically perform 6 treatments using MTS equipment. The therapy is also used for Peyronie’s disease.