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Men's Health

What is Men's Health?

We diagnose and treat every aspect of men’s health offering expert care for conditions ranging from prostate and urinary concerns to sexual health and wellness.

Uropartners provides the highest quality of care to Men's Health issues such as enlarged prostate (BPH), male infertility, erectile dysfunction (ED), peyronies disease, ejaculatory dysfunction, prostate cancer, testicular cancer, and low-testosterone. Our physicians help men feel young, confident, and energetic again.

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Men's Health Conditions and Services

Bladder Cancer

Diagnosis of BPH

Epididymititis and Orchitis

Erectile Dysfunction

Hematuria (Blood in the urine)

Interstitial Cystitis (Bladder Pain Syndrome)

Localized Prostate Cancer Treatment Options

Low Testosterone (low T)

Male Infertility

Medical & Minimally Invasive Treatment of BPH

Overactive Bladder (OAB)

Pelvic Floor Muscle Exercises

Penile Prosthesis for Erectile Dysfunction

Peyronie's Disease

Premature Ejaculation

Prostate Cancer

Prostatectomy

Prostatitis

PSA & Prostate Cancer Screening

Spermatoceles

Testicular Cancer

Urinary Incontinence

Varicoceles

Vasectomy

Vasectomy Reversal




What is Erectile Dysfunction?

Erectile dysfunction, or ED, is the most common sex problem that men report to their doctor. It affects as many as 30 million men.

ED is defined as trouble getting or keeping an erection that's firm enough for sex.

Though it's not rare for a man to have some problems with erections from time to time, ED that is progressive or happens routinely with sex is not normal, and it should be treated.

ED can happen:

  • Most often when blood flow in the penis is limited or nerves are harmed 
  • With stress or emotional reasons
  • As an early warning of a more serious illness, like: atherosclerosis (hardening or blocked arteries), heart disease, high blood pressure or high blood sugar from Diabetes 

Finding the cause(s) of your ED will help treat the problem and help with your overall well-being. As a rule, what's good for your heart health is good for your sex health.

 

How Erections Work

During sexual arousal, nerves release chemicals that increase blood flow into the penis. Blood flows into two erection chambers in the penis, made of spongy muscle tissue (the corpus cavernosum). The corpus cavernosum chambers are not hollow.

During erection, the spongy tissues relax and trap blood. The blood pressure in the chambers makes the penis firm, causing an erection. When a man has an orgasm, a second set of nerve signals reach the penis and cause the muscular tissues in the penis to contract and blood is released back into a man's circulation and the erection comes down.

When you are not sexually aroused, the penis is soft and limp. Men may notice that the size of the penis varies with warmth, cold or worry; this is normal and reflects the balance of blood coming into and leaving the penis.

Causes

ED can result from health problems, emotional issues, or from both. Some known risk factors are:

  • Being over age 50 
  • Having high blood sugar (Diabetes)
  • Having high blood pressure 
  • Having cardiovascular disease
  • Having high cholesterol
  • Smoking
  • Using drugs or drinking too much alcohol
  • Being obese
  • Lacking exercise

Even though ED becomes more common as men age, growing old is not always going to cause ED. Some men stay sexually functional into their 80s. ED can be an early sign of a more serious health problem. Finding and treating the reason for ED is a vital first step.

Physical Causes of ED

ED happens when:

  • There is not enough blood flows into the penis
    Many health issues can reduce blood flow into the penis, such as hardened arteries, heart disease, high blood sugar (Diabetes) and smoking.
  • The penis cannot trap blood during an erection
    If blood does not stay in the penis, a man cannot keep an erection. This issue can happen at any age.
  • Nerve signals from the brain or spinal cord do not reach the penis
    Certain diseases, injury or surgery in the pelvic area can harm nerves to the penis.
  • Diabetes can cause small vessel disease or nerve damage to the penis
  • Cancer treatments near the pelvis can affect the penis' functionality
    Surgery and or radiation for cancers in the lower abdomen or pelvis can cause ED. Treating prostate, colon-rectal or bladder cancer often leaves men with ED. Cancer survivors should see a Urologist for sexual health concerns.
  • Drugs used to treat other health problems can negatively impact erections 
    Patients should talk about drug side effects with their primary care doctors.

Emotional Causes of ED

Normal sex needs the mind and body working together. Emotional or relationship problems can cause or worsen ED.

Some emotional issues that can cause ED are:

  • Depression                                                                                                      
  • Anxiety
  • Relationship conflicts
  • Stress at home or work
  • Stress from social, cultural or religious conflicts
  • Worry about sex performa

Symptoms

With Erectile Dysfunction (ED), it is hard to get or keep an erection that is firm enough for sex. When ED becomes a routine and bothersome problem, your primary care provider or a Urologist can help.

ED may be a major warning sign of cardiovascular disease indicating blockages are building in a man's vascular system. Some studies have shown men with ED are at significant risk of getting a heart attack, stroke or circulatory problems in the legs. ED also causes:

  • Low self-esteem
  • Depression
  • Distress for the man and his partner 

If ED is affecting a man's well-being or his relationships, it should be treated. Treatment aims to fix or enhance erectile function, help circulatory health and help the quality of a man's life.

Diagnosis

Finding the cause of your ED will help direct your treatment options.

Diagnosing ED starts with your health care provider asking questions about your heart and vascular health and your erection problem. Your provider may also give you a physical exam, order lab tests or refer you to a Urologist.

Health and ED History

Your doctor will ask you questions about your health history and lifestyle. It is of great value to share facts about drugs you take, or if you smoke or how much alcohol you drink. He/she will ask about recent stressors in your life. Speak openly with your doctor, so he/she can help you find the best choices for treatment

What Questions Will the Health Care Provider Ask?

Questions about your health:

  • What prescription drugs, over-the-counter drugs or supplements do you take?
  • Do you use recreational drugs?
  • Do you smoke?
  • How much alcohol do you drink?
  • Have you had surgery or radiation therapy in the pelvic area?
  • Do you have any urinary problems?
  • Do you have other health problems (treated or untreated)?

Questions About ED

Knowing about your history of ED will help your health provider learn if your problems are because of your desire for sex, erection function, ejaculation, or orgasm (climax). Some of these questions may seem private or even embarrassing. However, be assured that your doctor is a professional and your honest answers will help find the cause and best treatment for you.

Questions about your ED symptoms:

  • How long have you had these symptoms? Did they start slowly or all at once?
  • Do you wake up in the morning or during the night with an erection?
  • If you do have erections, how firm are they? Is penetration difficult?
  • Do your erections change at different times, like when going in a partner, during stimulation by mouth, or with masturbation?
  • Do you have problems with sex drive or arousal?
  • Do you have problems with ejaculation or orgasm (climax)?
  • How is this problem changing the way you enjoy sex?
  • Do you have painful with erections, feel a lump or bump in the penis or have penile curvature? These are signs of Peyronie's Disease which can be treated but calls for an expert in urology to assess and manage.

Questions About Stress and Emotional Health

Your health care provider may ask you questions about depression or anxiety. He or she may ask about problems in your relationship with a partner. Some health care providers may also ask if they may talk to your sex partner.

  • Are you often under a lot of stress, or has something recently upset you?
  • Do you have any anxiety, depression or other mental health issues? 
  • Are you taking any drugs for your mental health?
  • How satisfied are you with your sex life? Has there been any changes lately?
  • How is your relationship with your partner? Has there been any changes lately?

Physical Exam

A physical exam checks your total health. Examination focusing on your genitals (penis and testicles) is often done to check for ED. Based on your age and risk factors, the exam may also focus on your heart and blood system: heart, peripheral pulses and blood pressure. Based on your age and family history your doctor may do a rectal exam to check the prostate. These tests are not painful. Most patients do not need a lot of testing before starting treatment.

Lab Tests

Your health care provider may order blood tests and collect a urine sample to look for health problems that cause ED.

Other Tests

Questionnaires are often used by health experts to rate your ability to initiate and keep erections, gauge your satisfaction with sex and help identify any problems with orgasm.

Advanced Erectile Function Tests

For some men with ED, specialized testing may be needed to guide treatment or re-assess you after a treatment fails.

  • Blood work to check Testosterone and other male hormones
  • Blood work to measure blood sugar (Diabetes)
  • Ultrasonography (penile Doppler) to check blood flow
  • A shot into the penis with a vascular stimulant to cause an erection
  • Pelvic x-rays like arteriography, MRI or CT scanning are rarely needed to check ED unless there is history of trauma or cancer
  • Nocturnal penile tumescence (NPT), an overnight test to check for sleep erection

Treatment

The treatment for ED starts with taking care of your heart and vascular health. Your doctor may point out ‘risk factors' that can be changed or improved.

You may be asked to change certain food habits, stop smoking, increase workouts or stop using drugs or alcohol. You may be offered alternatives to the drugs you take. (Never stop or change prescription drugs without first talking to your health care provider.)

Your health care provider may also suggest treating emotional problems. These could stem from relationship conflicts, life's stressors, depression or anxiety from past problems with ED (performance anxiety). 
The treatments below are available to treat ED directly.

ED Treatments

Non-invasive treatments are often tried first. Most of the best-known treatments for ED work well and are safe. Still, it helps to ask your health care provider about side effects that could result from each option:

  • Oral drugs or pills known as phosphodiesterase type-5 inhibitors are most often prescribed in the U.S. for ED (Viagra, Cialis, Levitra, Stendra)
  • Testosterone Therapy (when low testosterone is detected in blood testing)
  • Penile Injections (ICI, intracavernosal Alprostadil)
  • Intraurethral medication (IU, Alprostadil)
  • Vacuum Erection Devices
  • Penile Implants
  • Surgery to bypass penile artery damage for some younger men with a history of severe pelvic trauma. Penile vascular surgery is not recommended for older men with hardened arteries.

Oral Drugs (PDE5 inhibitors)

Drugs known as PDE type-5 inhibitors increase penile blood flow. These are the only oral agents approved in the U.S. by the Food and Drug Administration for the treatment of ED.

  • Viagra® (sildenafil citrate)
  • Levitra® (vardenafil HCl)
  • Cialis® (tadalafil)
  • Stendra® (avanafil)

For best results, men with ED take these pills about an hour or two before having sex. The drugs require normal nerve function to the penis. PDE5 inhibitors improve on normal erectile responses helping blood flow into the penis. Use these drugs as directed. About 7 out of 10 men do well and have better erections. Response rates are lower for Diabetics and cancer patients.

If you are taking nitrates for your heart, you SHOULD NOT take any PDE5 inhibitors. Always speak with your health care provider before using a PDE5 inhibitor to learn how it might affect your health.

Most often, the side effects of PDE5 inhibitors are mild and often last just a short time. The most common side effects are:

  • Headache
  • Stuffy nose
  • Facial flushing
  • Muscle aches
  • Indigestion

In rare cases, the drug Viagra ® can cause blue-green shading to vision that lasts for a short time. In rare cases, the drug Cialis® can cause or increase back pain or aching muscles in the back. In most cases, the side effects are linked to PDE5 inhibitor effects on other tissues in the body, meaning they are working to increase blood flow to your penis and at the same time impacting other vascular tissues in your body. These are not ‘allergic reactions'.

Testosterone Therapy

In those rare cases where a low sex drive and low blood levels of Testosterone are at fault for ED, Testosterone Therapy may fix normal erections or help when combined with ED drugs (PDE type 5 inhibitors).


Vacuum Erection Device

A vacuum erection device is a plastic tube that slips over the penis, making a seal with the skin of the body. A pump at the other end of the tube makes a low-pressure vacuum around the erectile tissue, which results in an erection. An elastic ring is then slipped onto the base of the penis. This holds the blood in the penis (and keeps it hard) for up to 30 minutes. With proper training, 75 out of 100 men can get a working erection using a vacuum erection device.

Intracavernosal (ICI) and Urethra (IU) Therapies

If oral drugs don't work, the drug Alprostadil is approved for use in men with ED. This drug comes in two forms, based on how it is to be used: intracavernosal injection (called "ICI") or through the urethra (called "IU therapy").

Self-Injection Therapy

Alprostadil is injected into the side of penis with a very fine needle. It's of great value to have the first shot in the doctor's office before doing this on your own. Self-injection lessons should be given in your doctor's office by an experienced professional. The success rate for getting an erection firm enough to have sex is as high as 85% with this treatment. Many men who do not respond to oral PDE5 inhibitors can be ‘rescued' with ICI.

ICI Alprostadil may be used as a mixture with two other drugs to treat ED. This combination therapy called "bimix or trimix" is stronger than alprostadil alone and has become standard treatment for ED. Only the Alprostadil ingredient is FDA approved for ED. The amount of each drug used can be changed based on the severity of your ED, by an experienced health professional. You will be trained by your health professional on how to inject, how much to inject and how to safely raise the drug's dosage if necessary.

ICI therapy often produces a reliable erection, which comes down after 20-30 minutes or with climax. Since the ICI erection is not regulated by your penile nerves, you should not be surprised if the erection lasts after orgasm. The most common side effect of ICI therapy is a prolonged erection. Prolonged erections (>1 hour) can be reversed by a second injection (antidote) in the office.

Men who have penile erections lasting longer than two to four hours should seek Emergency Room care. Priapism is a prolonged erection, lasting longer than four hours. It is very painful. Failure to undo priapism will lead to permanent penile damage and untreatable ED.

Intraurethral (IU) Therapy

For IU therapy, a tiny medicated pellet of the drug, Alprostadil, is placed in the urethra (the tube that carries urine out of your body). Using the drug this way means you don't have to give yourself a shot, unfortunately it may not work as well as ICI. Like ICI therapy, IU Alprostadil should be tested in the office, before home usage.

The most common side effects of IU alprostadil are a burning feeling in the penis. If an erection lasts for over four hours, it will need medical attention to make it go down.

Surgical Treatment

The main surgical treatment of ED involves insertion of a penile implant (also called penile prostheses). Because penile vascular surgery is not recommended for aging males who have failed oral PDE5 inhibitors, ICI or IU therapies, implants are the next step for these patients. Although placement of a penile implant is a surgery which carries risks, they have the highest rates of success and satisfaction among ED treatment options.

Penile implants are devices that are placed fully inside your body. They make a stiff penis that lets you have normal sex. This is an excellent choice to improve uninterupted intimacy and makes relations more spontaneous.

There are two types of penile implants.

Semi rigid Implant (Bendable)

The simplest kind of implant is made from two easy-to-bend rods that are most often made of silicone. These silicone rods give the man's penis the firmness needed for sexual penetration. The implant can be bent downward for peeing or upward for sex.

Inflatable Implant

With an inflatable implant, fluid-filled cylinders are placed lengthwise in the penis. Tubing joins these cylinders to a pump placed inside the scrotum (between the testicles). When the pump is engaged, pressure in the cylinders inflate the penis and makes it stiff. Inflatable implants make a normal looking erection and are natural feeling for your partner. Your surgeon may suggest a lubricant for your partner. With the implant, men can control firmness and, sometimes, the size of the erection. Implants allows a couple to be spontaneously intimate. There is generally no change to a man's feeling or orgasm.

What is the Surgery Like?

Penile implants are most often placed under anesthesia. If a patient has a systemic, skin, or urinary tract infection, this surgery should be postponed until all infections are treated. If a man is on blood thinners, then he may need to talk with a medical expert about stopping the medications for elective surgery and healing.

Most often, one small surgical cut is made. The cut is either above the penis where it joins the belly, or under the penis where it joins the scrotum. No tissue is removed. Blood loss is typically small. A patient will either go home on the same day or spend one night in the hospital.

Recovery Time after Penile Implants:

  • Most men will feel pain and will feel better with a narcotic pain-relief drug for one to two weeks. After the first week, over- the-counter pain drugs (such as acetaminophen or ibuprofen) may be substituted for narcotic pain drugs.
  • Discomfort, bruising and swelling after the surgery will last for a few weeks. 
  • For the first month, men should limit their physical activity. The surgeon will explain when and how much exercise to do during the healing period.
  • Men most often start having sex with their penile implants by eight weeks after surgery. If there is persisting swelling or pain, the use of the implant may be delayed. The surgeon or health care expert in the surgeon's office will talk about how to inflate and deflate the implant.

There are risks to prosthetic surgery and patients are counselled before the procedure. If there is a post-operative infection, the implant will likely be removed. The devices are reliable, but in the case of mechanical malfunction, the device or a part of the device will need to be replaced surgically. If a penile prosthesis is removed, other non-surgical treatments may no longer work.

Most men with penile implants and their partners say that they're satisfied with the results, and they return to more spontaneous intimacy.

Clinical Trials

Several restorative or regenerative treatments are under investigation for the future treatment of ED:

  • Extracorporeal shock wave therapy (ESWT) - low-intensity shock waves that aim to fix the erectile tissues and help restore natural erections.
  • Intracavernosal injection of stem cells - to help cavernous tissue regrowth
  • Intracavernosal injection autologous platelet rich plasma (APRP) - to help cavernous tissue regrowth 

These are not currently approved by the FDA for ED management, but they may be offered through research studies (clinical trials). Patients who are interested should discuss the risks and benefits (informed consent) of each, as well as costs before starting any clinical trials. Most therapies not approved by the FDA are not covered by government or private insurance benefits.

Supplements

Supplements are popular and often cheaper than prescription drugs for ED. However, supplements have not been tested to see how well they work or if they are a safe treatment for ED. Patients should know that many over-the-counter drugs have been found on drug testing to have ‘bootlegged' PDE 5 Inhibitors as their main ingredient. The amounts of Viagra, Cialis, Levitra or Stendra that may be in these supplements is not under quality control and may differ from pill to pill. The FDA has issued consumer warnings and alerts.

After Treatment

All of the treatments for ED (except for implant surgery) are used as needed for sex and then wear off. The treatments help the symptoms, but do not fix the underlying problem in the penis.

If medical treatments don't work as well as hoped:

  • Changing the dosage (for PDE5i, IU or ICI alprostadil) as prescribed by the doctor may help
  • Reviewing the instructions again may reveal a missing step in a treatment plan
  • Considering a different path may be necessary: emotional/relationship counselling, a vacuum erection device or penile implant are all good alternatives when others methods fail. Don't give up!

 

Frequently Asked Questions:

 

How do I know my ED is physical and not mental?

It's hard to know. Health providers now realize that most men have an underlying physical cause of ED. For most patients, there are both physical and emotional factors that lead to ED. It is impossible to prove that there is no psychological part to a man's ED.

If I worry about being able to get an erection, can I make a bad condition worse?

Nothing happens in the body without the brain. Worrying about your ability to get an erection can make it difficult to get one. This is called performance anxiety and can be overcome with education and treatment.

Can I combine treatment options?

This is often done. However, only combine treatments after talking with your health care provider about this. Erections can last too long with drug therapy, which is dangerous. Ask your doctor for proper instructions.

I was fine until I began taking this new drug, what should I do?

Never stop or change a prescription medication without first talking with your health care provider.

Many drugs can cause ED, but some cannot be changed because the drug's benefits are too important for you. If you feel sure that a specific drug has caused the ED problem, ask your health care provider if you can change drugs. If you must stay on the drug that is causing the problem, there are ED treatments that can help.

What Questions Should I Ask My Health Care Provider?

  • What is ED?
  • What causes ED? Can it be prevented?
  • Can you help me with ED, or do I need to see a specialist? If I need a specialist (Urologist), do you have a referral for me? 
  • What tests do you suggest to find the cause of my ED, and why? 
  • Can you check my heart and blood health?
  • Are there any lifestyle changes that could help my symptoms? 
  • What types of treatments are available?
  • What treatment do you suggest for me and why?
  • What are the pros and cons of each type of treatment you suggest?
  • What are the side effects?
  • What happens if the first treatment doesn't help?

 

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Hypogonadism

Male hypogonadism is a clinical syndrome caused by a failure of the testes to produce adequate levels of testosterone that are needed for the normal growth and development of a male. The condition may be congenital or may develop later in life.

 

Causes

Hypogonadism can be classified into primary and secondary hypogonadism. Primary hypogonadism may be due to testicular failure that refers to any dysfunction of the testicles which interrupts the normal hormone production. The common causes of primary hypogonadism include Klinefelter syndrome, which is a congenital abnormality of the sex chromosomes (an extra X chromosome) causing abnormal development of the testicles. Other causes of primary hypogonadism include undescended testicles, mumps orchitis, hemochromatosis, testicular injury, chemotherapy and radiotherapy.

Secondary hypogonadism may result from a dysfunctioning of the hypothalamus or pituitary gland that interrupts their normal functions. Certain conditions such as Kallmann syndrome (abnormal development of the hypothalamus), pituitary disorders, inflammatory diseases, HIV, certain medications, obesity and normal aging may also result in hypogonadism.

 

Symptoms

The symptoms of hypogonadism generally depend on the age of the affected individual. During fetal development it may result in impaired growth or underdevelopment of external male or ambiguous genitals. The symptoms during pre-puberty include impaired growth of external male genitals, improper distribution of body hair, decreased muscle mass, gynecomastia or development of breast tissues, lack of deepening of the voice and disproportional growth of arms and legs in relation to the trunk of the body. Certain symptoms such as erectile dysfunction, infertility, lack of facial or body hair, reduced muscle mass and gynecomastia may be seen in adult patients. Sometimes affected individuals may experience emotional and mental disturbances, fatigue, and loss of libido, hot flushes and lack of concentration.

 

Diagnosis

The diagnosis of male hypogonadism includes medical history, physical examination and laboratory investigations. Other tests such as estimation of hormonal levels, semen analysis, pituitary imaging, testicular biopsy and other genetic studies may be used to diagnose the underlying causes of the disorder.

 

Treatment

Hormone replacement therapy is the most common approach for the management of male hypogonadism. Testosterone replacement therapy can be used in young as well as adult patients. Testosterone replacement therapy is useful for restoring sexual function, muscle and bone strength as well as to provide a sense of wellbeing in adult patients. In young patients it stimulates puberty and the development of secondary sexual characteristics.

What is Peyronie's Disease?

Peyronie's disease is where plaques (segments of flat scar tissue) form under the skin of the penis. These plaques can cause the penis to bend or become indented during erections. The plaques can often be felt through the skin, and can also be painful.

 

How Does the Penis Normally Work?

 The main roles of the penis are to carry urine out of the body and sperm into the woman's vagina. There are 3 tubes inside the penis. One is called the urethra. It's hollow and carries urine from the bladder through the penis to the outside. The other 2 tubes are called the corpora cavernosa. These are soft, spongy tubes that fill with blood to make the penis stiff during an erection. The 3 tubes are wrapped together by a very tough fibrous sheath called the tunica albuginea. During sex, the stiffness of the penis makes it hard enough to push into the woman's vagina. Then the urethra acts as a channel to carry semen into the vagina.
 
 
 
 

Causes

Peyronie's disease is likely caused by minor injury to the penis. (See penile trauma.) This type of damage is most often caused by vigorous sex (such as bending the penis during penetration or pressure from a partner's pubic bone), though it can also be caused by sports or other accidents. Injury to the tunica albuginea may result in scar tissue forming in the cells (fibrosis). This scar tissue then forms the plaque of Peyronie's disease. Peyronie's disease is the result of a problem in the way the body heals wounds.
 

Other Factors

Not all men who suffer mild trauma to the penis get Peyronie's disease. For this reason, most researchers believe there must be genetic or environmental reasons Peyronie's disease plaques form. Men with certain connective tissue disorders (such as Dupuytren's contractures or tympanosclerosis) and men who have a close family member with Peyronie's disease have a greater risk of getting it. Certain health issues, such as high blood sugar, tobacco use, or past pelvic trauma, may also lead to wound healing problems, and may help cause Peyronie's disease.
 

Stages of Peyronie's Disease

Peyronie's disease is often split into 2 stages: the acute phase and the chronic phase. During both phases, the bent/curved penis may cause problems with sex. You also may have ED.
 
Acute Phase: The acute phase lasts for 6 to 18 months. During this time, the plaques form in the penis, the bending/curving of the penis gets worse, and you may feel pain when your penis gets hard.
 
Chronic Phase: The chronic phase is when the plaque stops growing and the penis doesn't bend any further. If there was pain with erection during the acute phase, it often will have ended by this time.
 
 
 
 

Symptoms

Peyronie’s disease plaques mostly (70% of the time) form on the top (or dorsal side) of the penis. The plaques make the tunica albuginea less flexible and may cause the penis to bend upwards when it stiffens. When plaques form on the bottom or side of the penis, the bend will be downward or sideways. Some men have more than- plaque, which may cause complex curves.
 
Sometimes plaques form that go all the way around the penis. These plaques most often don’t cause curving but may cause the shaft of the penis to narrow like the neck of a bottle (sometimes called “bottle-necking” or “waisting”). In bad cases, the plaque may collect calcium and become very hard, almost like a bone. Men may also notice that their penis has shrunk or gotten shorter.
 
Other signs that you may have Peyronie's disease are:
  • bent/curved penis
  • lumps in the penis
  • painful erections
  • soft erections
  • having trouble with sex because of a bent/curved penis
Peyronie’s disease can make your quality of life worse. Over 75 out of 100 men with Peyronie’s disease are stressed and depressed because of it. Unfortunately, many men with Peyronie’s disease are embarrassed and choose to suffer in silence rather than get help.

How Common is Peyronie's Disease?

Peyronie’s disease is thought to happen in about 6 out of 100 men between the ages of 40 and 70. It’s rare in young men, but has been seen in men in their 30s. The number of cases may be higher than the estimates because many men may be embarrassed and choose not to see their health care provider.
 
Interestingly, more Peyronie’s disease cases have been noted in recent years. This may be because new meds for erectile dysfunction (ED) have come to market, and health care providers may notice Peyronie’s disease in men seeking help for ED. For this reason, the number of Peyronie’s disease cases reported will likely keep growing.

 

 

 

 

Diagnosis

Your health care provider may be able to tell if you have Peyronie's disease with only a physical exam. The hard plaques can most often be felt whether the penis is stiff or not. To check how the penis curves, your health care provider may inject a drug into your penis to make it stiff, and may take pictures for study. In some cases dynamic ultrasound, which uses sound waves to get a picture of what's in your body, is used to see where the plaque is, check for calcium buildup, and show how the blood flows in your penis.

 

 

 

 

Treatment

In a very few number of cases (about 13 out of 100), Peyronie's disease goes away without being treated. Many health care experts suggest treating the disease without surgery for the first 12 months after the disease is first noticed.
 
Men with small plaques, not much curving of the penis, no pain, and no problems with sex may not need to be treated. If you need to be treated, there are many choices.
 

Oral Drugs

Drug therapy may help men who are badly affected by the disease during the acute phase. There haven't been enough studies to tell exactly how well these drugs work, though.
 

Oral vitamin E

Vitamin E is an antioxidant that's popular because of its mild side effects and low cost. Studies as far back as 1948 show that taking vitamin E may make plaques smaller and help straighten the penis. But most of these studies did not compare a group of people using vitamin E to a group of people who did not (a control group). A few studies of vitamin E that used a control group suggest that vitamin E doesn't work better than placebo. (A placebo is a pill with no drugs in it - a "sugar pill.")
 

Potassium amino-benzoate ("Potaba")

Small studies with placebo controls show that this vitamin B-complex helps reduce plaque size, but not the curve. Unfortunately, it is costly and patients need to take 24 pills per day for 3 to 6 months. It also can upset your stomach, so many men stop taking it.
 

Tamoxifen

This non-steroidal, anti-estrogen drug has been used to treat desmoid tumors, which are like the plaques in Peyronie's disease. There are only a few controlled studies of this drug and they haven't shown that tamoxifen works better than placebo.
 

Colchicine

Colchicine is an anti-swelling agent that has been shown to be slightly helpful in a few small studies without controls. Many patients taking colchicine get stomach problems and stop taking the drug. It hasn't been proven to work better than placebo.
 

Carnitine

Carnitine is an antioxidant drug that lowers swelling to help wounds heal. Studies without controls show some benefit. But a recent controlled study didn't show it to work better than placebo.
 

Penile Injections

Injecting a drug right into the plaque brings higher doses of the drug to the problem than when a drug is taken by mouth. Plaque injection is often used for men with acute phase disease who aren't sure they want to have surgery. The skin is often numbed before the shot to reduce pain.
 

Verapamil injections

Verapamil is mostly used to treat high blood pressure. Some studies suggest that verapamil injection also works for penile pain and curving. Verapamil appears to be a good, low-cost option for Peyronie's disease. More controlled studies are needed to prove how well it works.
 

Interferon injections

Interferon is a protein made in the body that helps control swelling. It has been shown to help control scarring, perhaps by slowing down the rate that scar tissue builds and by making an enzyme that breaks down the scar tissue.
A large-scale test of interferon injection for Peyronie's disease showed that this treatment can help. But more studies are needed.
 

Collagenase injections

Collagenase is made in the body and breaks down certain tissues. Studies have shown that injecting collagenase into plaques helped fix Peyronie's disease. This drug (Xiaflex®) is now approved in the U.S. for treatment of men with penises curving more than 30 degrees.
 

Other Treatments

Other ways to treat Peyronie's disease are being studied. But there isn't enough data on them yet to prove they work.
 
Some small studies have shown that stretching the penis for 2 to 8 hours a day for at least 6 months may help restore length and curving.
 
Treating the penis with ultrasound, radiation, shock-waves, heat, and verapamil on the skin are also being studied. These, for the most part, are not proven and are not recommended by experts in the field.
 

Surgery for Peyronie's Disease

Surgery is reserved for men with severe, disabling penile deformities that make it hard to have sex. Most health care providers suggest putting off surgery until the plaque and curving have stopped getting worse, and the patient has been pain-free for at least 9 to 12 months. 
 
Before surgery, your health care provider may check the blood flow in the penis by injecting a drug that will make it stiff, and may also look inside the penis using ultrasound. These tests help show what is going on inside your penis (such as whether there is also ED) so your health care provider can decide which type of surgery is best for you.
 
There are 3 basic ways to fix Peyronie's disease with surgery:
  • making the side of the penis opposite the plaque shorter
  • making the side of the penis that curves longer
  • placing a prosthetic device inside the penis

Surgery to Shorten the Side of the Penis Opposite the Plaque/Curve

This type of surgery can be done either by cutting out small pieces of tissue on the outside of the curve and sewing it closed or by folding the tissue and pulling it together with surgical thread. The surgery is most often safe, easy for the surgeon to do, and has a low risk of problems (such as bleeding or making ED worse). A drawback is that this type of surgery can make the penis shorter. This surgery is better for men with mild or no ED, mild-to-moderate penile curving, and a long penis.
 

Surgery to Make the Side of the Penis that is Curved Longer

This type of surgery is used when the penile curve is severe or the shaft has become very narrow. The surgeon cuts the plaque to ease tension, and may remove some of the plaque. The space that's left is then filled with a graft. 
In most cases, this surgery won't make the penis much shorter. But it's harder for the surgeon to do and there is a risk it could make ED worse. This surgery is often only recommended for cases of severe deformity in men who are able to get erections hard enough for sex.
 

Types of Grafts

Grafting surgery moves tissue from one place on the body to another. It can also replace missing tissue on your body with donor tissue or a laboratory-made replacement. Your surgeon will help you decide which type of graft should be used to fill the space left by taking out the plaque.
 
There are 2 types of grafts that are most often used:
 
Autologous tissue grafts: These are grafts made of tissue taken from another part of your body during surgery. Some sources of grafts used for Peyronie's disease are a vein from your leg (saphenous vein) or skin from behind your ear (temporalis fascia). Since autologous grafts are living tissue, they often grow into the surgical site much better than some other materials. A drawback to using an autologous graft is that the surgeon must make a second cut to harvest the graft.
 
Non-autologous allografts: These are sheets of tissue that are commercially made from human or animal sources. Before use, they are sterilized and treated to remove anything that could cause infection. These grafts act as supports for your body to grow fresh, healthy tissue on while they are slowly absorbed by your body. Allografts are strong, easy to work with, and well tolerated by most patients. Man-made materials such as Dacron® mesh or GORE-TEX® aren't often used for Peyronie's surgeries now. These materials can cause fibrosis that can make the deformity worse.
 

Penile Prosthetic Devices

An inflatable pump or moldable silicone rods placed inside the penis are good options for men with Peyronie's disease and moderate-to-severe ED. In most cases, this will straighten the penis and allow it to get stiff enough for sex. If the device doesn't straighten the penis enough, the surgeon may straighten it more by modeling the plaque against the stiff prosthesis or by cutting the plaque and using a graft to cover the opening.
 
 
 
 

After Treatment

A light pressure dressing is often left on the penis for 24 to 48 hours after surgery to stop bleeding and hold the repair in place. During surgery, a tube (catheter) will have been placed through the end of the penis into the bladder, and this may still be in place when you wake up. The tube is often removed in the recovery room.
 
Most patients leave the hospital the same day after surgery or the next morning. You may be given antibiotics to take for a few days to lower the risk of infection and help keep swelling down, as well as pain meds. You shouldn't have sex for at least 6 weeks after surgery, or longer in cases of complex repairs.
 
 
 
 

Frequently Asked Questions

Are Men with Peyronie's Disease More Likely to Get any Other Illnesses?

Some men with Peyronie's disease (about 13 out of 100) get fibrosis in other parts of the body. The most common sites are the hands and feet. Dupuytren's contracture, in which fibrosis occurs in the tissue of the palm, is one health problem linked to Peyronie's disease. Dupuytren's contracture may lead to permanent bending of the outer fingers. It isn't clear what causes plaque to form in either disease, or why men with Peyronie's disease are more likely to get Dupuytren's contracture.
 

Does Peyronie's Disease Turn into Cancer?

Cells taken from Peyronie's plaques act like cancer cells in some ways, such as not dying normally and forming tumors when put into mice with no immune systems. But there has never been a case of Peyronie's disease that has turned into a cancer in a human.
 
If you have other symptoms that aren't often seen with Peyronie's disease, such as external bleeding, trouble peeing, or penile pain that lasts for a long time, your health care provider may take a sample of the tissue (biopsy) for further study.
 

Ejaculatory Dysfunction

Ejaculatory dysfunction is a type of sexual dysfunction in which the male ejaculates too early, too late or not at all during the sexual act. There are three types of ejaculatory dysfunction: premature, delayed or retrograde ejaculation.

On average, once the penis enters the vagina, there is a delay of 5 to 6 minutes before ejaculation. Premature ejaculation occurs when the male partner ejaculates too quickly over 50% of the time. Delayed ejaculation occurs when you have difficulty reaching climax after prolonged sexual activity (>30 minutes) even if your erection is adequate. Most cases of premature or delayed ejaculation develop over time, but some cases may be life-long. Retrograde ejaculation is rare type of ejaculatory dysfunction resulting in the backward ejaculation of sperm into the bladder.

Ejaculatory dysfunction may be caused by medical conditions such as high blood pressure, diabetes, neurological disorders, or prostate and thyroid problems. Psychological causes for dysfunction may include stress, anxiety about your problem, causing you to hasten the sexual act, marital problems, depression or the negative effects of past sexual experiences. Certain medications as well as substance abuse can also contribute to ejaculatory dysfunction.

If you or your partner experience dissatisfaction as a result of ejaculatory dysfunction, you must not hesitate to contact your physician as these problems are common and often treatable. Your doctor will review your symptoms as well as your medical and family history and may perform certain tests to rule out physical problems that could be causing ejaculatory dysfunction. You will be asked questions to gauge your mental state, attitude towards sex, and find out if you have any psychological issues contributing to the problem.

Your doctor may prescribe medication to treat ejaculatory dysfunction. Couples therapy or sex therapy may be recommended to resolve marital issues, improve intimacy, remove psychological blocks, and teach you sexual techniques that either delay or enhance ejaculation. Topical anesthetics or thick condoms may be recommended in cases of premature ejaculation to decrease sensation thereby delaying ejaculation. Medications contributing to ejaculatory dysfunction are either stopped or altered. Retrograde ejaculation does not usually affect sexual life, but may affect childbearing for which medication or artificial fertility methods are suggested.

What is Testosterone?

Testosterone is the male sex hormone that is made in the testicles. Testosterone hormone levels are important to normal male sexual development and functions.

During puberty (in the teen years), testosterone helps boys develop male features like body and facial hair, deeper voice, and muscle strength. Men need testosterone to make sperm. Testosterone levels generally decrease with age, so older men tend to have low blood testosterone levels.

What is Low Testosterone?

Some men have low testosterone levels. This is called Testosterone Deficiency Syndrome (TD) or Low Testosterone (Low-T). Deficiency means that the body does not have enough of a needed substance. Syndrome is a group of symptoms that, together, suggest a disease or health condition.

The American Urology Association (AUA) identifies low blood testosterone (Low-T) as less than 300 nanograms per deciliter (ng/dL). These symptoms or conditions may accompany Low-T:

  • Low sex drive 
  • Fatigue
  • Reduced lean muscle mass
  • Irritability
  • Erectile dysfunction
  • Depression
  • There are many other possible reasons for these symptoms, such as: opioid use, some congenital conditions (medical conditions you are born with), loss of or harm to the testicles, diabetes, and obesity (being overweight). See your doctor if you have any of these symptoms.

Why Testosterone Therapy (TT)?

You may need testosterone therapy (TT) if you have Low-T. Both the FDA and the AUA suggest that TT be used to treat conditions you are born with, such as Klinefelter syndrome.

You also may need TT if you harm or lose your testicles. If your testicles are removed because of a sickness such as cancer, you may need TT. Most men with Low-T (no matter what the cause) will be treated if they have both symptoms of Low-T and blood tests showing Low-T levels. Talk with your doctor if you feel that you may need TT.

TT may help you but it may have adverse (harmful) results. (See discussion of these side effects below.) The Federal Drug Administration (FDA) has said that testosterone drug labels should state that there is a risk for heart disease and stroke for some men using testosterone products. All men should be checked for heart disease and stroke before, and periodically while on, TT. The AUA however, on careful review of evidence-based peer review literature, has stated that there is no strong evidence that TT either increases or decreases the risk of cardiovascular events.

The FDA also was concerned when they found that men were being treated for Low-T due only to aging. There is ongoing research to determine more about TT in aging men. Your doctor will talk with you about the benefits and risks of TT and carefully consider how to treat your symptoms.

How Common is Low Testosterone in Men?

It is hard to know how many men among us have TD, although data suggest that overall about 2.1% (about 2 men in every 100) may have TD. As few as 1% of younger men may have TD, while as many as 50% of men over 80 years old may have TD. People who study the condition often use different cut-off points for the numbers, so you may hear different numbers being stated.

TD is more common in men who have diabetes or who are overweight. In one research study, 30% of overweight men had Low-T, compared to only 6.4% of those with normal weight. The same study found diabetes to be a risk factor for TD. In another study, 24.5% of men with diabetes had Low-T, compared to 12.6% of those without diabetes.

 
 
 
 

Causes

Some persons are born with conditions that cause Testosterone Deficiency (TD) such as:

  • Klinefelter syndrome 
  • Noonan syndrome
  • Ambiguous genitalia (when the sex organs develop in ways that are not typical looking)

Some men may develop Low-T because of conditions like these:

  • Damage to testicles by accident
  • Removal of testicles because of cancer
  • Chemotherapy or radiation
  • Pituitary gland disease leading to hormone deficiency
  • Infection
  • Autoimmune disease (when the body makes antibodies that attack its own cells)

Basically, if your testicles keep making less testosterone than normal, your blood levels of testosterone will fall. Many men who develop TD have Low-T levels linked to:

  • Aging
  • Obesity
  • Metabolic syndrome (high blood pressure, high blood sugar, unhealthy cholesterol levels, and belly fat)
  • Use of medications such as antidepressants and narcotic pain medications

Men with certain health problems also tend to have low testosterone. Some of these are:

  • HIV (about 30 out of 100 also have low testosterone)
  • AIDS (about 50 out of 100 also have low testosterone)
 
 
 
 

Symptoms

There are many signs and symptoms of Low Testosterone. Some are more closely related to Low-T levels (specific signs and symptoms). Others may not necessarily be linked (non-specific signs and symptoms). Your doctor will help you make sense of your own situation.

Specific Signs/Symptoms of Testosterone Deficiency (TD)

Specific symptoms are those more likely or directly linked to TD such as:

  • Reduced sex drive 
  • Reduced erectile function
  • Loss of body hair 
  • Less beard growth 
  • Loss of lean muscle mass
  • Feeling very tired all the time (fatigue)
  • Obesity (being overweight)
  • Symptoms of depression

Non-specific Signs/Symptoms of Testosterone Deficiency (TD)

Non-specific symptoms are those that may or may not be linked to TD such as:

  • Lower energy level, endurance and physical strength
  • Poor memory 
  • Difficulty with finding words to say
  • Poor focus
  • Not doing well at work

Having any one of the specific or non-specific symptoms may not mean that you have TD. But if you have a mix of symptoms, for instance, if you start to feel very tired and sad over a period of time and this is a change for you, you may want to check for TD.

Low sexual desire alone may not mean that you have TD. But if you have a combination of low sexual desire, reduced erectile function, and feelings of sadness and tiredness, you should talk to your doctor.

 
 
 
 

Diagnosis

Although many symptoms may be tied to Low Testosterone (Low-T), total blood testosterone level is the most important measure of testosterone deficiency. To make a diagnosis, your doctor will use other specific signs and symptoms in addition to your testosterone blood level.

At your medical visit, your health history will be taken, and the doctor will do an exam and look for some of the signs and symptoms mentioned in this article.

Health History 

Your doctor may ask you about:

  • Headache, visual field change (possible symptoms of brain mass such as a pituitary tumor) 
  • How you developed at puberty 
  • History of head trauma 
  • Cranial (head) surgery/brain tumor or cranial irradiation 
  • Anosmia (loss of ability to smell) 
  • History of infection in your testicles 
  • Injury to your testicles
  • Mumps after puberty
  • Past or present use of anabolic steroids 
  • Use of opiates 
  • Use of glucocorticoids (medicines, such as cortisone, used to treat inflammation) 
  • History of chemotherapy or irradiation 
  • Family history of diseases linked to Low-T
  • History of stroke or heart attack
  • History of unexplained anemia 

Physical Examination

Your doctor will check for the following:

  • BMI or waist circumference for obesity 
  • Metabolic syndrome. These are symptoms (seen together) of increased blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol or triglyceride levels 
  • Hair pattern, amount, and location 
  • Gynecomastia (enlarged breasts) 
  • Whether testicles are present and their size 
  • Prostate size and any abnormalities 

Testing

Your doctor may order these blood tests:

  • Total testosterone level. This test should be done at two different times on samples taken before noon. Testosterone levels are lower later in the day. If you are ill, the doctor will wait until you are not sick because your illness may cause a false result.
  • Luteinizing hormone (LH). This test is done to help find the cause of a Low-T level. This hormone controls how you make testosterone. Abnormal levels may mean a pituitary gland problem.
  • Blood prolactin level. If your prolactin level is high, your doctor may repeat the blood test to make sure there is no error. High prolactin levels also may be a sign of pituitary problems or tumors.
  • Blood hemoglobin or Hgb. Before doing this test, your doctor will look for other reasons for low Hgb such as climate level (like climate altitude), sleep apnea, or tobacco smoking.

The following also may be done to help with further diagnosis:

  • Follicle stimulating hormone (FSH). This test is to check for sperm-making function if you want to have children. You may also need to have semen tests. These tests will be done before any hormone therapy.
  • Estradiol hormone test is done if there are breast symptoms.
  • HbA1C blood test may be done for diabetes.
  • MRI (magnetic resonance imaging) of the pituitary gland 
  • Bone density tests.
  • Karyotype (Chromosome tests).

You may hear about free testosterone or bioavailable tests for testosterone. These are not the same as total testosterone level tests. Ask your doctor about the differences and if you need these tests.

 
 
 
 

Treatment

In recent years, the media has reported more about Testosterone Therpy (TT), and more men between the ages of 40 and 64 have been tested and given TT. Some men with certain symptoms may even want TT without being tested. This action may not be safe or helpful for them. Total testosterone level should always be tested before any TT.

The AUA recommends that TT be prescribed only to men who meet the clinical and laboratory definition of testosterone deficiency (Testosterone level of less than 300 ng/dL). Here are some of the things you will need to know about TT:

Your doctor will likely measure your testosterone level if you have these conditions:

  • Unexplained anemia 
  • Diabetes 
  • Bone density loss 
  • Low-trauma bone fracture
  • Radiation to your testicles 
  • HIV/AIDS positive test results
  • Chronic narcotic use
  • History of infertility 
  • Pituitary gland disorders

Even if you do not have specific signs and symptoms, your doctor may test your total testosterone level for these conditions:

  • Insulin resistance
  • History of chemotherapy
  • History of using corticosteroid medicines
  • Health changes such as losing weight and getting more physical activity will likely raise your testosterone levels. 

Your doctor will want to check your hemoglobin/hematocrit (Hgb/Hct) levels while you are on TT. This blood test will help check for thickening of the blood. 

Blood thickening may cause blood clots. Your doctor may do Hgb/Hct levels two to six weeks after you start TT and every six to twelve months after that test. 

If you are at risk for heart disease, your doctor will follow you more closely when you are on TT. It also is important to make health changes to decrease the chances for heart and blood vessel disease. 

Your doctor will treat your Low-T level to raise it above 300ng/dl but the exact level may vary.

Your doctor will watch you for signs and symptoms of improvement. Any changes will likely appear within three to six months of treatment.

If your total testosterone blood level returns to normal and you still have symptoms, it is likely that there are other reasons for your symptoms. Your doctor may stop TT and try to find out what else might be the problem.

How Do I Take Testosterone?

There are generally five different ways to take testosterone. They are: transdermal (through the skin), injection, oral/buccal (by mouth), intranasal (through the nose), and by pellets under the skin. No method is better than another. While you are taking TT, your doctor will test your blood to determine testosterone levels.

Here are some details about the five different methods:

Transdermal (Topical). There are topical gels, creams, liquids and patches. Topical medicines most often last for about four days. They absorb better if covered with an air- or water- tight dressing. 

  • Apply liquids and gels, creams or patches to skin that is dry and without cuts or scratches. 
  • Do not wash the area until it is time for the next dose. 
  • Wash your hands after you apply liquids, gels or creams. 
  • Make sure that other people, especially women and children, do not touch the medicines. 

A topical patch is like a band-aid with medicine on it. You put it on and leave it until the next dose is due. The medicine on the patch is less likely than liquids, gels and creams to transfer to others.

  • Injection. There are short-acting and long-acting forms of testosterone injection. The short-acting medicine may be given under the skin or in the muscle. The long-acting one is usually given in the muscle. Injections are usually given either weekly, every two weeks, or monthly.
  • Oral/buccal (by mouth). The buccal dose comes in a patch that you place above your incisor (canine or "eyetooth"). The medication looks like a tablet but you should not chew or swallow it. The drug is released over 12 hours. This method has fewer harmful side effects on the liver than if the drug is swallowed, but it may cause headaches or cause irritation where you place it.
  • Intranasal. This form of testosterone comes in a gel. You pump the dose into each nostril, as directed. It is usually taken three times daily.
  • Pellets. Your doctor will place the testosterone pellets under the skin of your upper hip or buttocks. Your doctor will give a shot of local anesthesia to numb your skin, then make a small cut and place the pellets inside the fatty tissues underneath your skin. This medication dissolves slowly and is released over about 3-6 months, depending on the number of pellets. 

You may want to choose how you take your testosterone based on what is best or most useful for you. In some cases, your insurance provider may decide the order in which testosterone therapies are provided. Talk about the choices with your doctor.

Are There Side Effects of TT?

There are some side effects of TT. Some side effects are mild while others are more serious. You should ask your doctor or pharmacist about these side effects and watch for them while you are taking TT. Some of the side effects are as follows:

  • For gels and liquids, there may be some redness at the skin site. With patches, you may have itching and a rash around the area. A very small number of patients report back pain.
  • For short-acting injections, you may have some reaction at the injection site. Some persons have had serious allergic reactions to the long-acting injection. Because of this, when you get the long-acting injection they will watch you closely for a while afterwards in the medical office.
  • For testosterone pellets, possible adverse effects include swelling, pain, bruising and, rarely, hematoma (clotted blood under the skin).
  • During TT, there is increased risk of erythrocytosis (abnormal raising of blood hemoglobin and hematocrit).
  • TT may interrupt normal sperm production. You should not have TT if you plan on having children soon. If you are being treated for Low-T your doctor may suggest added treatment for sperm production.
  • Topical testosterone, specifically gels, creams and liquids, may transfer to others. Women and children are most at risk of harmful effects from contact with them. You should take care to cover the area and wash your hands well after putting on the medication. Be careful not to let the site with the topical TT touch others because that could transfer the drug.
  • The FDA suggests watching for signs and symptoms of early puberty in a child you live with or have contact with if you use topical testosterone. Do not let children touch the unwashed or unclothed area where you put the drug.

Here are some things you should know:

  • There is no evidence linking TT to prostate cancer.
  • There is no strong evidence linking TT to increase in vein clots.
  • At this time, there is no strong evidence that TT either increases or decreases the risk of cardiovascular events. However, while you are on TT, you should call your doctor right away if you have signs or symptoms of stroke or heart attack.
 
 
 
 

After Treatment

Remember that each person is unique, and each body responds differently to treatment. TT may help erectile function, low sex drive, bone marrow density, anemia, lean body mass, and/or symptoms of depression. However, there is no strong evidence that TT will help memory recall, measures of diabetes, energy, tiredness, lipid profiles, or quality of life.

You will need routine checkups to see that your testosterone level stays normal. In patients who are stable on TT, total testosterone and certain other lab tests should be checked every 6-12 months.

If you are overweight, try to work on keeping your weight within recommended ranges. Increasing physical activity may help you lose weight and also may help increase testosterone levels.

 
 
 
 

Some Questions You Might Ask Your Health Care Provider about Low Testosterone

When you go to see your doctor, you may be a bit nervous. It will help if you make a list of the most important things on your mind. Here are some ideas:

  1. What tests will I need to find out if I need Testosterone Therapy (TT)?
  2. Will I have to repeat these tests? If so, how often?
  3. Does a Low-T level make it hard for me to make sperm? 
  4. Will TT help me to be more fertile? 
  5. What methods of TT are there? Which one would you suggest for me? Why? 
  6. I have diabetes. Does this mean I will need TT?
  7. I have trouble getting an erection. Will TT help with sexual function?
  8. During or after treatment, are there any changes I can make to my life and routine to help keep my testosterone level normal?
  9. My son was born with low testosterone. Will he need TT all his life?
  10. Are there support groups to help my son cope with his TD?
  11. Heart disease is in my family. Is it safe for me to have TT?

 

Make an Appointment

 
 
 
 

Men's Health

What is Men's Health?

We diagnose and treat every aspect of men’s health offering expert care for conditions ranging from prostate and urinary concerns to sexual health and wellness.

Uropartners provides the highest quality of care to Men's Health issues such as enlarged prostate (BPH), male infertility, erectile dysfunction (ED), peyronies disease, ejaculatory dysfunction, prostate cancer, testicular cancer, and low-testosterone. Our physicians help men feel young, confident, and energetic again.

Male basketball 500.jpg

Men's Health Conditions and Services

Bladder Cancer

Diagnosis of BPH

Epididymititis and Orchitis

Erectile Dysfunction

Hematuria (Blood in the urine)

Interstitial Cystitis (Bladder Pain Syndrome)

Localized Prostate Cancer Treatment Options

Low Testosterone (low T)

Male Infertility

Medical & Minimally Invasive Treatment of BPH

Overactive Bladder (OAB)

Pelvic Floor Muscle Exercises

Penile Prosthesis for Erectile Dysfunction

Peyronie's Disease

Premature Ejaculation

Prostate Cancer

Prostatectomy

Prostatitis

PSA & Prostate Cancer Screening

Spermatoceles

Testicular Cancer

Urinary Incontinence

Varicoceles

Vasectomy

Vasectomy Reversal




What is Erectile Dysfunction?

Erectile dysfunction, or ED, is the most common sex problem that men report to their doctor. It affects as many as 30 million men.

ED is defined as trouble getting or keeping an erection that's firm enough for sex.

Though it's not rare for a man to have some problems with erections from time to time, ED that is progressive or happens routinely with sex is not normal, and it should be treated.

ED can happen:

  • Most often when blood flow in the penis is limited or nerves are harmed 
  • With stress or emotional reasons
  • As an early warning of a more serious illness, like: atherosclerosis (hardening or blocked arteries), heart disease, high blood pressure or high blood sugar from Diabetes 

Finding the cause(s) of your ED will help treat the problem and help with your overall well-being. As a rule, what's good for your heart health is good for your sex health.

 

How Erections Work

During sexual arousal, nerves release chemicals that increase blood flow into the penis. Blood flows into two erection chambers in the penis, made of spongy muscle tissue (the corpus cavernosum). The corpus cavernosum chambers are not hollow.

During erection, the spongy tissues relax and trap blood. The blood pressure in the chambers makes the penis firm, causing an erection. When a man has an orgasm, a second set of nerve signals reach the penis and cause the muscular tissues in the penis to contract and blood is released back into a man's circulation and the erection comes down.

When you are not sexually aroused, the penis is soft and limp. Men may notice that the size of the penis varies with warmth, cold or worry; this is normal and reflects the balance of blood coming into and leaving the penis.

Causes

ED can result from health problems, emotional issues, or from both. Some known risk factors are:

  • Being over age 50 
  • Having high blood sugar (Diabetes)
  • Having high blood pressure 
  • Having cardiovascular disease
  • Having high cholesterol
  • Smoking
  • Using drugs or drinking too much alcohol
  • Being obese
  • Lacking exercise

Even though ED becomes more common as men age, growing old is not always going to cause ED. Some men stay sexually functional into their 80s. ED can be an early sign of a more serious health problem. Finding and treating the reason for ED is a vital first step.

Physical Causes of ED

ED happens when:

  • There is not enough blood flows into the penis
    Many health issues can reduce blood flow into the penis, such as hardened arteries, heart disease, high blood sugar (Diabetes) and smoking.
  • The penis cannot trap blood during an erection
    If blood does not stay in the penis, a man cannot keep an erection. This issue can happen at any age.
  • Nerve signals from the brain or spinal cord do not reach the penis
    Certain diseases, injury or surgery in the pelvic area can harm nerves to the penis.
  • Diabetes can cause small vessel disease or nerve damage to the penis
  • Cancer treatments near the pelvis can affect the penis' functionality
    Surgery and or radiation for cancers in the lower abdomen or pelvis can cause ED. Treating prostate, colon-rectal or bladder cancer often leaves men with ED. Cancer survivors should see a Urologist for sexual health concerns.
  • Drugs used to treat other health problems can negatively impact erections 
    Patients should talk about drug side effects with their primary care doctors.

Emotional Causes of ED

Normal sex needs the mind and body working together. Emotional or relationship problems can cause or worsen ED.

Some emotional issues that can cause ED are:

  • Depression                                                                                                      
  • Anxiety
  • Relationship conflicts
  • Stress at home or work
  • Stress from social, cultural or religious conflicts
  • Worry about sex performa

Symptoms

With Erectile Dysfunction (ED), it is hard to get or keep an erection that is firm enough for sex. When ED becomes a routine and bothersome problem, your primary care provider or a Urologist can help.

ED may be a major warning sign of cardiovascular disease indicating blockages are building in a man's vascular system. Some studies have shown men with ED are at significant risk of getting a heart attack, stroke or circulatory problems in the legs. ED also causes:

  • Low self-esteem
  • Depression
  • Distress for the man and his partner 

If ED is affecting a man's well-being or his relationships, it should be treated. Treatment aims to fix or enhance erectile function, help circulatory health and help the quality of a man's life.

Diagnosis

Finding the cause of your ED will help direct your treatment options.

Diagnosing ED starts with your health care provider asking questions about your heart and vascular health and your erection problem. Your provider may also give you a physical exam, order lab tests or refer you to a Urologist.

Health and ED History

Your doctor will ask you questions about your health history and lifestyle. It is of great value to share facts about drugs you take, or if you smoke or how much alcohol you drink. He/she will ask about recent stressors in your life. Speak openly with your doctor, so he/she can help you find the best choices for treatment

What Questions Will the Health Care Provider Ask?

Questions about your health:

  • What prescription drugs, over-the-counter drugs or supplements do you take?
  • Do you use recreational drugs?
  • Do you smoke?
  • How much alcohol do you drink?
  • Have you had surgery or radiation therapy in the pelvic area?
  • Do you have any urinary problems?
  • Do you have other health problems (treated or untreated)?

Questions About ED

Knowing about your history of ED will help your health provider learn if your problems are because of your desire for sex, erection function, ejaculation, or orgasm (climax). Some of these questions may seem private or even embarrassing. However, be assured that your doctor is a professional and your honest answers will help find the cause and best treatment for you.

Questions about your ED symptoms:

  • How long have you had these symptoms? Did they start slowly or all at once?
  • Do you wake up in the morning or during the night with an erection?
  • If you do have erections, how firm are they? Is penetration difficult?
  • Do your erections change at different times, like when going in a partner, during stimulation by mouth, or with masturbation?
  • Do you have problems with sex drive or arousal?
  • Do you have problems with ejaculation or orgasm (climax)?
  • How is this problem changing the way you enjoy sex?
  • Do you have painful with erections, feel a lump or bump in the penis or have penile curvature? These are signs of Peyronie's Disease which can be treated but calls for an expert in urology to assess and manage.

Questions About Stress and Emotional Health

Your health care provider may ask you questions about depression or anxiety. He or she may ask about problems in your relationship with a partner. Some health care providers may also ask if they may talk to your sex partner.

  • Are you often under a lot of stress, or has something recently upset you?
  • Do you have any anxiety, depression or other mental health issues? 
  • Are you taking any drugs for your mental health?
  • How satisfied are you with your sex life? Has there been any changes lately?
  • How is your relationship with your partner? Has there been any changes lately?

Physical Exam

A physical exam checks your total health. Examination focusing on your genitals (penis and testicles) is often done to check for ED. Based on your age and risk factors, the exam may also focus on your heart and blood system: heart, peripheral pulses and blood pressure. Based on your age and family history your doctor may do a rectal exam to check the prostate. These tests are not painful. Most patients do not need a lot of testing before starting treatment.

Lab Tests

Your health care provider may order blood tests and collect a urine sample to look for health problems that cause ED.

Other Tests

Questionnaires are often used by health experts to rate your ability to initiate and keep erections, gauge your satisfaction with sex and help identify any problems with orgasm.

Advanced Erectile Function Tests

For some men with ED, specialized testing may be needed to guide treatment or re-assess you after a treatment fails.

  • Blood work to check Testosterone and other male hormones
  • Blood work to measure blood sugar (Diabetes)
  • Ultrasonography (penile Doppler) to check blood flow
  • A shot into the penis with a vascular stimulant to cause an erection
  • Pelvic x-rays like arteriography, MRI or CT scanning are rarely needed to check ED unless there is history of trauma or cancer
  • Nocturnal penile tumescence (NPT), an overnight test to check for sleep erection

Treatment

The treatment for ED starts with taking care of your heart and vascular health. Your doctor may point out ‘risk factors' that can be changed or improved.

You may be asked to change certain food habits, stop smoking, increase workouts or stop using drugs or alcohol. You may be offered alternatives to the drugs you take. (Never stop or change prescription drugs without first talking to your health care provider.)

Your health care provider may also suggest treating emotional problems. These could stem from relationship conflicts, life's stressors, depression or anxiety from past problems with ED (performance anxiety). 
The treatments below are available to treat ED directly.

ED Treatments

Non-invasive treatments are often tried first. Most of the best-known treatments for ED work well and are safe. Still, it helps to ask your health care provider about side effects that could result from each option:

  • Oral drugs or pills known as phosphodiesterase type-5 inhibitors are most often prescribed in the U.S. for ED (Viagra, Cialis, Levitra, Stendra)
  • Testosterone Therapy (when low testosterone is detected in blood testing)
  • Penile Injections (ICI, intracavernosal Alprostadil)
  • Intraurethral medication (IU, Alprostadil)
  • Vacuum Erection Devices
  • Penile Implants
  • Surgery to bypass penile artery damage for some younger men with a history of severe pelvic trauma. Penile vascular surgery is not recommended for older men with hardened arteries.

Oral Drugs (PDE5 inhibitors)

Drugs known as PDE type-5 inhibitors increase penile blood flow. These are the only oral agents approved in the U.S. by the Food and Drug Administration for the treatment of ED.

  • Viagra® (sildenafil citrate)
  • Levitra® (vardenafil HCl)
  • Cialis® (tadalafil)
  • Stendra® (avanafil)

For best results, men with ED take these pills about an hour or two before having sex. The drugs require normal nerve function to the penis. PDE5 inhibitors improve on normal erectile responses helping blood flow into the penis. Use these drugs as directed. About 7 out of 10 men do well and have better erections. Response rates are lower for Diabetics and cancer patients.

If you are taking nitrates for your heart, you SHOULD NOT take any PDE5 inhibitors. Always speak with your health care provider before using a PDE5 inhibitor to learn how it might affect your health.

Most often, the side effects of PDE5 inhibitors are mild and often last just a short time. The most common side effects are:

  • Headache
  • Stuffy nose
  • Facial flushing
  • Muscle aches
  • Indigestion

In rare cases, the drug Viagra ® can cause blue-green shading to vision that lasts for a short time. In rare cases, the drug Cialis® can cause or increase back pain or aching muscles in the back. In most cases, the side effects are linked to PDE5 inhibitor effects on other tissues in the body, meaning they are working to increase blood flow to your penis and at the same time impacting other vascular tissues in your body. These are not ‘allergic reactions'.

Testosterone Therapy

In those rare cases where a low sex drive and low blood levels of Testosterone are at fault for ED, Testosterone Therapy may fix normal erections or help when combined with ED drugs (PDE type 5 inhibitors).


Vacuum Erection Device

A vacuum erection device is a plastic tube that slips over the penis, making a seal with the skin of the body. A pump at the other end of the tube makes a low-pressure vacuum around the erectile tissue, which results in an erection. An elastic ring is then slipped onto the base of the penis. This holds the blood in the penis (and keeps it hard) for up to 30 minutes. With proper training, 75 out of 100 men can get a working erection using a vacuum erection device.

Intracavernosal (ICI) and Urethra (IU) Therapies

If oral drugs don't work, the drug Alprostadil is approved for use in men with ED. This drug comes in two forms, based on how it is to be used: intracavernosal injection (called "ICI") or through the urethra (called "IU therapy").

Self-Injection Therapy

Alprostadil is injected into the side of penis with a very fine needle. It's of great value to have the first shot in the doctor's office before doing this on your own. Self-injection lessons should be given in your doctor's office by an experienced professional. The success rate for getting an erection firm enough to have sex is as high as 85% with this treatment. Many men who do not respond to oral PDE5 inhibitors can be ‘rescued' with ICI.

ICI Alprostadil may be used as a mixture with two other drugs to treat ED. This combination therapy called "bimix or trimix" is stronger than alprostadil alone and has become standard treatment for ED. Only the Alprostadil ingredient is FDA approved for ED. The amount of each drug used can be changed based on the severity of your ED, by an experienced health professional. You will be trained by your health professional on how to inject, how much to inject and how to safely raise the drug's dosage if necessary.

ICI therapy often produces a reliable erection, which comes down after 20-30 minutes or with climax. Since the ICI erection is not regulated by your penile nerves, you should not be surprised if the erection lasts after orgasm. The most common side effect of ICI therapy is a prolonged erection. Prolonged erections (>1 hour) can be reversed by a second injection (antidote) in the office.

Men who have penile erections lasting longer than two to four hours should seek Emergency Room care. Priapism is a prolonged erection, lasting longer than four hours. It is very painful. Failure to undo priapism will lead to permanent penile damage and untreatable ED.

Intraurethral (IU) Therapy

For IU therapy, a tiny medicated pellet of the drug, Alprostadil, is placed in the urethra (the tube that carries urine out of your body). Using the drug this way means you don't have to give yourself a shot, unfortunately it may not work as well as ICI. Like ICI therapy, IU Alprostadil should be tested in the office, before home usage.

The most common side effects of IU alprostadil are a burning feeling in the penis. If an erection lasts for over four hours, it will need medical attention to make it go down.

Surgical Treatment

The main surgical treatment of ED involves insertion of a penile implant (also called penile prostheses). Because penile vascular surgery is not recommended for aging males who have failed oral PDE5 inhibitors, ICI or IU therapies, implants are the next step for these patients. Although placement of a penile implant is a surgery which carries risks, they have the highest rates of success and satisfaction among ED treatment options.

Penile implants are devices that are placed fully inside your body. They make a stiff penis that lets you have normal sex. This is an excellent choice to improve uninterupted intimacy and makes relations more spontaneous.

There are two types of penile implants.

Semi rigid Implant (Bendable)

The simplest kind of implant is made from two easy-to-bend rods that are most often made of silicone. These silicone rods give the man's penis the firmness needed for sexual penetration. The implant can be bent downward for peeing or upward for sex.

Inflatable Implant

With an inflatable implant, fluid-filled cylinders are placed lengthwise in the penis. Tubing joins these cylinders to a pump placed inside the scrotum (between the testicles). When the pump is engaged, pressure in the cylinders inflate the penis and makes it stiff. Inflatable implants make a normal looking erection and are natural feeling for your partner. Your surgeon may suggest a lubricant for your partner. With the implant, men can control firmness and, sometimes, the size of the erection. Implants allows a couple to be spontaneously intimate. There is generally no change to a man's feeling or orgasm.

What is the Surgery Like?

Penile implants are most often placed under anesthesia. If a patient has a systemic, skin, or urinary tract infection, this surgery should be postponed until all infections are treated. If a man is on blood thinners, then he may need to talk with a medical expert about stopping the medications for elective surgery and healing.

Most often, one small surgical cut is made. The cut is either above the penis where it joins the belly, or under the penis where it joins the scrotum. No tissue is removed. Blood loss is typically small. A patient will either go home on the same day or spend one night in the hospital.

Recovery Time after Penile Implants:

  • Most men will feel pain and will feel better with a narcotic pain-relief drug for one to two weeks. After the first week, over- the-counter pain drugs (such as acetaminophen or ibuprofen) may be substituted for narcotic pain drugs.
  • Discomfort, bruising and swelling after the surgery will last for a few weeks. 
  • For the first month, men should limit their physical activity. The surgeon will explain when and how much exercise to do during the healing period.
  • Men most often start having sex with their penile implants by eight weeks after surgery. If there is persisting swelling or pain, the use of the implant may be delayed. The surgeon or health care expert in the surgeon's office will talk about how to inflate and deflate the implant.

There are risks to prosthetic surgery and patients are counselled before the procedure. If there is a post-operative infection, the implant will likely be removed. The devices are reliable, but in the case of mechanical malfunction, the device or a part of the device will need to be replaced surgically. If a penile prosthesis is removed, other non-surgical treatments may no longer work.

Most men with penile implants and their partners say that they're satisfied with the results, and they return to more spontaneous intimacy.

Clinical Trials

Several restorative or regenerative treatments are under investigation for the future treatment of ED:

  • Extracorporeal shock wave therapy (ESWT) - low-intensity shock waves that aim to fix the erectile tissues and help restore natural erections.
  • Intracavernosal injection of stem cells - to help cavernous tissue regrowth
  • Intracavernosal injection autologous platelet rich plasma (APRP) - to help cavernous tissue regrowth 

These are not currently approved by the FDA for ED management, but they may be offered through research studies (clinical trials). Patients who are interested should discuss the risks and benefits (informed consent) of each, as well as costs before starting any clinical trials. Most therapies not approved by the FDA are not covered by government or private insurance benefits.

Supplements

Supplements are popular and often cheaper than prescription drugs for ED. However, supplements have not been tested to see how well they work or if they are a safe treatment for ED. Patients should know that many over-the-counter drugs have been found on drug testing to have ‘bootlegged' PDE 5 Inhibitors as their main ingredient. The amounts of Viagra, Cialis, Levitra or Stendra that may be in these supplements is not under quality control and may differ from pill to pill. The FDA has issued consumer warnings and alerts.

After Treatment

All of the treatments for ED (except for implant surgery) are used as needed for sex and then wear off. The treatments help the symptoms, but do not fix the underlying problem in the penis.

If medical treatments don't work as well as hoped:

  • Changing the dosage (for PDE5i, IU or ICI alprostadil) as prescribed by the doctor may help
  • Reviewing the instructions again may reveal a missing step in a treatment plan
  • Considering a different path may be necessary: emotional/relationship counselling, a vacuum erection device or penile implant are all good alternatives when others methods fail. Don't give up!

 

Frequently Asked Questions:

 

How do I know my ED is physical and not mental?

It's hard to know. Health providers now realize that most men have an underlying physical cause of ED. For most patients, there are both physical and emotional factors that lead to ED. It is impossible to prove that there is no psychological part to a man's ED.

If I worry about being able to get an erection, can I make a bad condition worse?

Nothing happens in the body without the brain. Worrying about your ability to get an erection can make it difficult to get one. This is called performance anxiety and can be overcome with education and treatment.

Can I combine treatment options?

This is often done. However, only combine treatments after talking with your health care provider about this. Erections can last too long with drug therapy, which is dangerous. Ask your doctor for proper instructions.

I was fine until I began taking this new drug, what should I do?

Never stop or change a prescription medication without first talking with your health care provider.

Many drugs can cause ED, but some cannot be changed because the drug's benefits are too important for you. If you feel sure that a specific drug has caused the ED problem, ask your health care provider if you can change drugs. If you must stay on the drug that is causing the problem, there are ED treatments that can help.

What Questions Should I Ask My Health Care Provider?

  • What is ED?
  • What causes ED? Can it be prevented?
  • Can you help me with ED, or do I need to see a specialist? If I need a specialist (Urologist), do you have a referral for me? 
  • What tests do you suggest to find the cause of my ED, and why? 
  • Can you check my heart and blood health?
  • Are there any lifestyle changes that could help my symptoms? 
  • What types of treatments are available?
  • What treatment do you suggest for me and why?
  • What are the pros and cons of each type of treatment you suggest?
  • What are the side effects?
  • What happens if the first treatment doesn't help?

 

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