Penile Prosthesis

Penile Prosthesis

When should a man consider a prosthesis?

Usually, a prosthesis is considered a last resort. Men with erectile dysfunction (ED) are encouraged to try all other possible treatments (such as pills, injections, and vacuum devices) before getting an implant. However, some treatments are not suitable for all men. For example, men who take nitrates cannot take certain ED medications.

What types of prostheses are available?

Generally, there are two different types:

Semi-rigid positionable rods have an inner core made of stainless steel or interlocking plastic joints. A man can bend the penis up when he wants an erection and bend it back down when he’s finished with sexual activity.

Inflatable implants use a pump system. When a man wants an erection, he activates a pump placed in the scrotum. This action sends fluid (usually a saline solution) into inflatable cylinders placed in the penis.

Inflatable implants can have 2 or 3 parts. With 2-part implants, the fluid is held in the back part of the inflatable cylinders. With 3-part versions, the fluid is contained in a separate reservoir.

Nowadays, 3-part inflatable implants are the most common.

Both semi-rigid rods and inflatable implants are completely concealed within the body. Nobody can see them.

What are some of the drawbacks of a penile prosthesis? Can the device malfunction?

Infection is one risk. If the implant becomes infected, it will need to be replaced. Sometimes the implant damages surrounding tissue.

It’s possible for an implant to malfunction. This is more common with inflatable devices, which can leak saline fluid into the body. The fluid itself shouldn’t cause problems, but the device should be replaced or repaired.

What is the implant procedure like?

For some men, an implant procedure is same-day surgery. Others need to spend one night in the hospital. Men receive general anesthesia and incisions are made in the penis, lower abdomen, or scrotum. Afterward, many men need to take oral medications for pain. Sexual activity should be avoided for about a month after surgery.

Can the prosthesis wear out?

Yes. Normally, the device will function for about 12 to 15 years. After that, it will probably need replacement, if the patient wishes.

What is the satisfaction rate for penile prostheses?

The satisfaction rate is very high. For men with implants, the rate can reach 85%.  For their partners, it can be as high as 90%.

Will sex still feel the same with a prosthesis?

Most men feel sensation, reach orgasm, and ejaculate just as they did before getting an implant.

What if I don’t like the implant? Can the operation be reversed?

No. The implant replaces the corpora cavernosum, the spongy tissue that typically fills with blood during an erection. So, it’s important that men discuss the pros and cons with their physician before getting an implant. Usually, other treatments for erectile dysfunction (such as oral medications or vacuum devices) are tried before an implant is considered.

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Are certain foods helpful in addressing erectile dysfunction (ED)?

Are certain foods helpful in addressing erectile dysfunction (ED)?

It’s possible. Research published in January 2016 found that men who ate foods high in antioxidants called flavonoids had a lower risk of erectile dysfunction (ED) than those who didn’t eat a flavonoid-rich diet.

Flavonoids can be found in certain plant-based foods like citrus fruits, blueberries, strawberries, apples, pears, cherries, blackberries, radishes, and blackcurrant. Some teas, herbs, and wines also have flavonoids in them.

Past studies have shown that consuming flavonoids could reduce a person’s risk for diabetes and heart disease, both of which can lead to ED.

Eating a healthy diet overall, particularly a Mediterranean diet, can go a long way in preserving erectile function, however.

This type of diet includes fruits, vegetables, whole grains, and olive oil. Nuts and fish are good additions.

What does diet have to do with erections?

When a man is sexually-aroused, his penis fills with blood, giving it the firmness it needs for sex. Many men with ED have poor blood flow to the penis. Some medical conditions, like diabetes and heart disease, can damage blood vessels and nerves that are critical for this process.

Eating a healthy diet keeps the body in good working order. It can help men maintain a healthy weight, keep their blood sugar under control, and reduce the risk of blood vessel damage, which can impair blood flow.

Diet isn’t the only path to good erections, however. Other lifestyle habits, like regular exercise, quitting smoking, and managing depression are important too.

A man’s doctor can help him decide which dietary changes to make. However, men who are having trouble with erections should be sure to mention it. Many factors can contribute to ED and it’s best to have a complete medical checkup.

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What is penile ultrasound?

What is penile ultrasound?

An ultrasound is an imaging test that uses sound waves to produce pictures of internal organs, giving doctors a more detailed view.

Penile ultrasound can be used to evaluate many conditions affecting the penis, including erectile dysfunction (ED), plaques (such as those caused by Peyronie’s disease), fibrosis, lumps, and even cancer.

Doppler Ultrasound

Men with erection problems often have a Doppler ultrasound, which can show the way blood flows in and out of organs. In a Doppler ultrasound, the sound waves bounce off circulating red blood cells. A change in pitch signals the movement of blood.

Blood flow is critical for a man’s erections. When a man is sexually stimulated, the arteries in his penis widen and the penis fills with blood. This blood is what gives the penis the firmness it needs for sex. Veins in the penis constrict, holding the blood in. When the stimulation stops, or when the man ejaculates, the veins widen again and allow blood to flow back into the body.

Many men with erectile function have problems with this blood flow. The arteries might not widen enough for sufficient blood to flow in. Or, the veins might not constrict enough to keep the blood from flowing out. Both situations can lead to weak erections.

The test begins with an injection of medicine, which causes an erection by widening arteries and increasing blood flow. From there, a doctor moves a small device called a transducer over against the skin of the penis. The transducer sends data to a computer so that the doctor can tell how fast blood is flowing in and out.

A Doppler ultrasound is noninvasive and the test itself shouldn’t hurt. Some men have pain or bruising at the injection site. Men might also feel dizzy for a few minutes. If the induced erection lasts longer than the test, the doctor might give another injection so the penis will become flaccid again.

Men are usually advised not to take any erectile dysfunction medications (such as Viagra, Levitra, or Cialis) for a day or two before the test. They might also be instructed not to have sex or masturbate the day of the ultrasound.

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Congenital Penile Curvature

Congenital Penile Curvature

Patients with congenital penile curvature will have noticed this problem during their entire post puberty adult life. Erections will have always shown the abnormal curvature, which most often is downward. There will not be any history of penile injury. No scar or "plaque" can be felt in the penis during examination.

In terms of treatment, if this curvature is significant and very disturbing to the patient and/or his sexual partner, it may be corrected by relatively simple outpatient surgery. Slowly absorbing stitches are placed in the opposite side of the penis to cause the curve to be neutralized. Recovery is rapid and the results most often quite gratifying and long lasting. The stitches do not change penile feeling or interfere with one's ability to have erections. Penile length is not significantly changed.

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Why should men talk to their doctor about ED?

Why should men talk to their doctor about ED?

There are several good reasons:
  • ED can be a sign of a larger medical issue. ED is common in men with heart disease and diabetes. It can also happen to men with high blood pressure or kidney disease. Often, it’s the first sign that something else is wrong. The good news is that treating these conditions can usually alleviate the ED. Plus, taking care of yourself now can improve your overall health for years to come.
  • ED can affect a man’s mental health. As we saw with Gordon, ED can damage a man’s self-esteem. For many men, part of their identity is connected with their ability to perform sexually. Being unable to do so can lead to a lack of confidence and anxiety in new sexual situations. Depression – and sadness over the loss of intimacy – are common, too.
  • ED can be treated. Most men with ED have lots of options. Medications like Viagra, Levitra, and Cialis have been popular for many years now. But not all men can take this class of drugs, particularly men who take nitrates for heart conditions. If you can’t take pills for ED (or if they don’t work for you), there are other treatments to consider. Some men try self-injections, suppositories, and vacuum devices. More serious cases might be treated with surgery or penile implants. Sex therapy may also be helpful.
Keep in mind that medications for ED are available only by prescription and are not appropriate for every man. You should always be checked out by a doctor before starting them. It may be tempting to order them online and avoid seeing the doctor, but this is a dangerous practice.
It’s possible that you won’t need formal treatment at all. Sometimes, ED can be managed through lifestyle changes. For example, if your ED is caused by diabetes, changing your diet to keep your blood sugar under control may do the trick. Some men’s erections improve when they get more exercise.
Talking to the Doctor
Once you’ve decided to see your doctor about ED, how do you start the conversation? Here are some steps to consider.
  • Think over your questions beforehand. It may help to write them down and take them with you, so you don’t forget anything. Partners may think of questions that haven’t occurred to you. Remember that no question is foolish. If it matters to you, be sure to ask.
  • Try not to feel anxious. While you may feel awkward, remember that ED is common and chances are, your doctor has treated it before. If not, he or she can refer you to a specialist. You might say, “You know, I feel a little embarrassed about this, but lately I’ve been having trouble with erections.” Most likely, your doctor will try to put you at ease and ask questions to guide the discussion.
  • Consider bringing your partner. If you are in a relationship, you might bring your partner to the appointment with you. He or she can be a second set of ears if there is a lot of information to process. And since ED affects partners, too, he or she can provide some perspective.
  • Follow up. Don’t hesitate to call the doctor if you have questions or concerns later on.
When you leave the appointment, pat yourself on the back. You’ve taken a huge step forward for your overall health, for your sex life, and for your relationship.

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A Man’s Penis Changes with Age

A Man’s Penis Changes with Age

As we get older, it’s inevitable that our bodies change. Our hair might turn gray, our skin may become wrinkled, and we might put on a little weight. These are changes we can usually expect.
Some men might be surprised to learn that their penis and testicles change with age, too. Why does this happen? And should men be concerned? We’ll look at these questions today.
Men might be surprised to learn that their penis and testicles change with age
Testosterone Levels Gradually Fall
Testosterone is an important hormone for men’s health, as it gives them their masculine traits and contributes to sex drive.
As men get older, their testosterone levels naturally decline. Some experts call this process “andropause” or “male menopause” to compare it to female menopause, when estrogen levels drop. However, it is not the same. Once men are in their 40s, their testosterone levels decrease about 1% each year. For women, the hormonal drop is much more dramatic.
Still, it helps to understand this decline in testosterone and the role it plays in the aging man.

Changes in Penis Appearance

Men might notice that their penis starts to look different:

  • It might change color. Good blood flow to the penis is important for genital health. But with age, atherosclerosis – hardening of the arteries – becomes more common. When this happens, the blood supply decreases and the tip of the penis becomes lighter in color.
  • It might look smaller. Some older men worry that their penis is shrinking, but this can be an optical illusion. If a man has gained abdominal weight, the extra fat can hide part of the shaft, making the penis look shorter than it actually is.
  • It might actually become smaller. Sometimes, the penis does actually shorten, due to reduced blood flow and testosterone levels. A buildup of scar tissue can also contribute to the problem. This “shrinkage” could be as much as an inch over time. Keep in mind that the change is gradual and that for many partners, penis size is not important.
  • It might start to curve. Peyronie’s disease, a condition marked by a distinct bend in the penis, becomes more likely with age. In some cases, the curve becomes so great that intercourse is impossible. Men in this situation should see their urologist for treatment.
  • Testicles may become smaller. Over time, the size of a man’s testicles may decrease by as much as a third.
  • Pubic hair may diminish. As testosterone levels decrease, so might the amount of a man’s pubic hair.


Functional Changes in the Penis

Aging can affect the way a man’s penis performs, too:

  • Men may need more time. With their testosterone levels falling, older men often need more stimulation to become sexually aroused, get an erection, and reach orgasm. They may also need more time before they can have sex again. It can be frustrating, but it’s normal. Keep in mind that female partners may need more time, too.
  • Erectile dysfunction (ED) may develop. ED – being unable to get or keep an erection firm enough for sex – is quite common in aging men, especially if they have developed atherosclerosis in penile blood vessels. Fortunately, there are a variety of treatments for ED, including pills and vacuum devices. If you are having trouble with erections, be sure to see your doctor. ED can be a sign of other medical conditions, like heart disease or diabetes, so it’s important to have it checked out.
  • Urinary problems may occur. Older men are likely to have an enlarged prostate, also called benign prostatic hyperplasia (BPH). When this occurs, the prostate gland grows inward. The urethra – the tube that carries semen and urine out of the body – runs right through this gland. When prostate tissue enlarges, it can squeeze the urethra, making it more difficult for men to urinate. Men with urinary problems are encouraged to see their doctors as well.


What Can Men Do?

While none of us can turn back the clock, there are a number of ways men can keep the penis healthy as they get older.

  • See a doctor when you have concerns. It might be awkward to discuss your private parts and even more awkward to acknowledge that you’re having a problem. But talking to your doctor is the first step toward better penis health, better sexual health, and better overall health.
  • Develop healthy habits. Ask your doctor about dietary changes and fitness plans that are right for you. You might consider having fruit for dessert instead of cake, going to the gym, or taking a walk around the block after dinner. Maintaining a healthy lifestyle can reduce your risk of heart disease and diabetes, which can contribute to erection problems. And losing some weight might bring back some of that penis length you “lost.”
  • Communicate with your partner. If you’re worried about changes in your penis, be open with your partner. Most likely, he or she will be glad you brought it up, supportive in your search for answers, and understanding if your performance isn’t what it used to be. Your partner may also have ideas for adjustments the two of you can make in the bedroom.

By accepting the course of aging and maintaining healthy habits, you and your partner can still enjoy an active sex life for many more years.

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Discolored semen

Discolored semen

Should I be concerned about discolored semen?
Semen is normally a whitish-gray color. It's usually quite thick after ejaculation, but liquefies within 30 minutes.
Changes in the appearance of semen might be temporary and not a health concern. However, sometimes these changes can be a sign of an underlying medical condition that requires further evaluation.
If changes persist for longer than a week or two or if the color change is associated with other symptoms such as pain, fever, sexual dysfunction or blood in the urine, see your doctor for an evaluation.

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Premature Ejaculation

Premature Ejaculation

What is premature ejaculation (PE)?
Premature ejaculation is repeated ejaculation in response to minimal stimulation before, at the time of, or shortly after penetration, but before the man wishes it, and over which the man feels he has little or no control. It is important to recognize that premature ejaculation is a subjective diagnosis and totally depends on the satisfaction of the partners.
How common is PE?
PE is the most common sexual dysfunction reported by men but is still under-diagnosed and under-treated. Estimating the prevalence of PE is difficult since many men do not want to talk about it, while others may not even perceive that they have PE.
However, recent research indicates that 25-30% of men struggle with PE.
PE can happen at any age and its prevalence is consistent across all ages.
Is there variation in incidence between countries?
Global studies consistently report that 20-30% of men experience PE worldwide. This means that PE is experienced at similar rates across the globe.
What is the difference between life-long and acquired PE?
Primary PE refers to men who have experienced this sexual problem since first having sex.
Secondary PE refers to men who had ejaculatory control at some point but began experiencing PE later in life, sometimes even after years of satisfying sex, without explanation.

How does PE affect a man's psychology?

PE can have a broad impact on many aspects of a man's life. Men experiencing PE can suffer anxiety, embarrassment, inadequacy, depression, anger and guilt.

PE can cause both personal stress, and stress to a relationship. In one study, men with PE were less satisfied with sexual intercourse and their sexual relationship, and suffered more problems with sexual anxiety and arousal compared to non-sufferers.

Some men with PE have trouble staying in relationships or may be scared to begin new ones.

Does PE affect the partner of the man with PE?

PE is a problem for the couple as a whole. Partners sometimes experience frustration and anger. Also, many couples do not discuss the problem with each other or with friends and family and there can be a breakdown of intimacy between them.

Causes - Premature Ejaculation

Unfortunately, the cause of PE is generally unknown. Historically PE was seen as a psychological disorder, but researchers now suggest that most cases are multi-factorial with a contribution from both psychological and physical factors.

PE is categorized as either primary or secondary as mentioned above.

Many researchers believe that premature ejaculation, at least in some men, may be due to a chemical imbalance or changes in receptor sensitivity in the brain or spinal cord.

What are the key factors in diagnosing PE?

Although there are no specific diagnosis or treatment guidelines for PE, the diagnosis of PE is based mainly on a detailed sexual history that establishes:

  1. The patients' perception of his control over ejaculation. Is it poor, fair or good?
  2. The time frame within which he ejaculates. Less than a minute? More than 2 minutes?
    1. The majority of men who self-identify themselves as having PE will ejaculate in less than 2 minutes.
    2. The majority of men who self-identify as NOT having PE will ejaculate in longer than 2 minutes.
    3. PE is considered to be the occurrence of ejaculation prior to the wishes of both sexual partners, (which can vary widely from couple to couple); no clear time cut-offs have been set as to the appropriate duration for sexual contact before reaching orgasm, although the FDA in its assessment of drugs for PE uses 2 minutes as the guideline. Patient self-report time to ejaculation (known as ejaculatory latency time) has been shown to be surprisingly accurate.
  3. That the short ejaculatory latency time is a source of distress for him or for his partner.
  4. That the short ejaculatory latency time is interfering with the satisfaction of sexual relations for him or the couple.
  5. If this condition has been life-long or if it has occurred more recently. Life-long PE is known as primary PE and recently acquired PE is known as secondary PE. If the onset of the problem is more recent, are there precipitating factors?
  6. Frequency of PE. An occasional instance of PE might not be cause for concern, but if the problem happens more than 50% of the time, a pattern usually exists for which treatment may be appropriate.

PE or ED ?

How do I know if I have ED or PE?

ED is a man's inability to attain or sustain an erection for the duration of sexual intercourse. Whereas PE is when a man and/or his partner perceives that he reaches orgasm and ejaculates too quickly and with little control.

In other words, PE is ejaculation before a man and his partner wants it to happen. There are men however who develop PE as a result of poor erection sustaining capability. In this situation, they condition themselves to reach orgasm/ejaculation quicker so they can do so before they lose their erection. The treatment of this begins by treating the erection problem first. With treatment many men can resolve the PE problem. Differentiating between the two conditions is a very important step for patients and physicians. An experienced physician should be able to define the real problem relatively easily.

Treating Premature Ejaculation

What types of treatment are available for PE?

  • Medications
  • Physical & Psychological Treatment

What medications are currently available for PE?

  1. Desensitization treatments:these are aimed at reducing the sensitivity of the penis immediately before sexual relations. It is noteworthy to mention that there is no evidence that men with PE have any difference in penis sensitivity than men without PE. Although these techniques work for some men with mild PE, they can cause a reduction in sensitivity so that sexual satisfaction during intimacy is also reduced. Little research has been done on these techniques and their true benefit. Techniques that are employed by some men include:
  2. Using condoms: the use of a single condom may reduce sensitivity enough to make a difference in ejaculatory control for some men. Using multiple condoms, however, reduces sensitivity, potentially to the point where the sensation during relations is less than satisfactory for men.
  3. Using desensitization ointments: local anesthetics like lidocaine/prilocaine creams can be applied to the undersurface of the head of the penis (the glans) 30 minutes before sex. Desensitization ointments are best applied and then washed off 5-10 minutes before sexual relations, otherwise they will cause a numbing effect for the partner also. Some men use these creams underneath a condom.
  4. Masturbating prior to intercourse: many men with PE, even those with primary (life-long) PE, have much better ejaculatory control if they have sexual relations a second time within a short period of time after the initial encounter. Some men use masturbation in the hours before anticipated intimacy as a means to improve ejaculatory control.
  5. Non-FDA approved treatment options: a number of over-the-counter and prescription 'medications' have been used for PE:
  6. Herbal therapies: there are currently no studies that show the effectiveness of herbal products (also known as nutriceuticals). Many of these products contain androgens (testosterone, DHEA and androstenedione) that may be inappropriate for some men to use. Furthermore, some herbal products used for male sexual health contain Viagra and Cialis, which is of concern to men taking nitroglycerin-containing medications, since taking these together can be deadly
  7. PDE-5 inhibitors: medications such as Viagra®, Levitra® and Cialis® have been used by some men for PE. Studies suggest that they may help some men suffering from PE. Scientists are not sure why these medications would work in men with PE. However, it is generally believed that these medications can help men with PE who also have ED.
  8. Antidepressant medications: Antidepressants have been used for the treatment of PE. Prozac®, Paxil® and Zoloft® have been used with some success for this condition. Although no antidepressants have been specifically used to treat PE, several weeks of treatment with some of these medications has been shown to help many men with PE. Several weeks of treatment is required for these medications to work. The drawbacks of these medications include the need for daily use (when men stop using them they return to having rapid ejaculation), the stigma that they are anti-depressant drugs (for example, airline pilots are not permitted to take these medications and fly) and side effects (drowsiness, nausea, dizziness, dry mouth and a range of sexual problems, such as decreased or increased sexual interest, ejaculation or orgasm problems, and impotence).


What types of psychological treatments are available?

Distraction techniques: distracting mental exercises during sex can be used to help PE (such as thinking of mundane things like baseball, work, etc.). These techniques are probably most useful for men with occasional PE or men who experience PE in the initial stages of a new sexual relationship. For men with long-standing PE, the consistent use of these techniques usually interferes with spontaneity and satisfaction.

Psychological Therapy: these treatments have been utilized for decades and are associated with success in many people. However, it is questionable for how long these treatments work. For example, for a man who has derived benefit from the techniques described, how long-lasting are the beneficial effects? It is estimated that 25% of men helped by such techniques retain the benefit for 2 years after starting the treatments.

PE can be both due to, and the cause of, psychological stress or other mental health and personal issues. Psychological treatments often involve counseling or sexual therapy that can include talking about relationships and experiences with a mental health professional and/or learning practical tools. By investigating relationships and individual issues that may be causing or compounding PE, mental health professionals can help find effective ways of coping with and solving problems that may be causing PE. For many couples affected by PE, working with a therapist together may produce the best results.

Some psychological therapies also focus on helping the individual find ways in which they can control ejaculation. Healthcare practitioners may provide instruction about distraction techniques, and "stop-start" and "squeeze" techniques that allow the patient to develop a sense of ejaculatory control.

The stop-start method works to help the individual identify ways of controlling their sexual stimulation and ejaculatory response. This method requires the man to engage in sexual stimulation, either with or without his partner, until he realizes that he is about to ejaculate. At this point he stops for about thirty seconds, reducing his urge to ejaculate, and then begins the sexual stimulation again. These steps are repeated until ejaculation is desired. In the final step of the sequence, stimulation is continued until a climax is achieved.

The squeeze method also involves sexual stimulation until just prior to the "point of no return". Once the man senses that he is about to ejaculate, his partner stops sexual stimulation and gently squeezes the tip or the base of the penis for several seconds. Further stimulation is withheld for 30 seconds and then resumed. The couple may choose to repeat the sequence as many times as they like, or continue stimulation until ejaculation is desired. These exercises have little benefit if conducted by the man himself and require the participation of partner.

The only treatment approved by FDA for PE

New medications are being developed to treat PE. The first is a quick acting drug taken one to four hours before sex, called Dapoxetine. In trials, Dapoxetine has been shown to effectively treat men with PE. The difference between this drug and SSRI medications is that it does not need to be taken every day and is not prescribed for depression. Dapoxetine is currently approved by the FDA.

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