erectile dysfunction

male sexual dysfunction

Sexual disorders are common in men and increase with age. It’s convenient to divide them into Erectile dysfunction (ED), decreased libido, and ejaculatory disorders. Normal sexual function starts as a stimulus in the central nervous system, which is then relayed down the spinal cord. From there, neural impulses cause dilation of the vascular bed in the corpora cavernosa of the penis and, Voila, erection! If it were only that easy, you probably wouldn’t be reading this.  Problems can occur at any level, from your big head all the way down to the other one. The really good news is the vast majority of time, male sexual disorders are easily treated. P

LIBIDO

Libido, is akin to desire.  It's what gets things cooking. If your partner doesn't arouse you wearing a sexy negligee or a sexy scene in a movie doesn't excite you, your libido is probably low.  Not to be confused with the Coolidge effect*.

 

Low libido may be caused by:

 

  •     Testosterone deficiency

  •     Medication

  •     Alcohol

  •     Recreational drugs

  •     Fatigue

  •     Relationship problems

  •     Depression

  •     Medical illness

 

Good news, most of these conditions are easily treated. The Hormone Testosterone, T, plays a pivotal role in normal male sexual function. Without it, impotence results. Once levels are restored, normal sexual functioning returns. Testosterone is produced in the Leydig cells in the testicles. They peak in teenage years and gradually decline with age. Remember when you where 18? You probably did not have any “desire” issues back then. Testosterone can be taken topically, intramuscularly, or in an injected pellet form. Recently, a new pill form has been FDA approved. In the past, oral T was known to cause liver toxicity. Until we see more studies we will continue with the traditional treatments. We have had amazing results with T replacement.

Some of the results include:

  • Increased libido 

  • Improved sex life

  • Increased energy

  • Increased muscle mass

  • Decreased body fat

  • Increased endurance

  • Increased confidence and self esteem 

 

ERECTILE DYSFUNCTION

Another common problem is Erectile Dysfunction (ED). This indicates a problem in blood flow. ED increases with age affecting nearly a third of men 40 and older. It may occur by itself or in combination with low libido. And again, there are multiple risk factors. 

 

ED may be caused by:

  •   Medications - 8 of the 12 most commonly prescribed medications list ED as side effects

  •   Alcohol, smoking and recreational drug use   

  •   Medical illness, Heart disease, Diabetes, high blood pressure and depression

  •   Obesity, sedentary lifestyle

 

With the advent of the “little blue pill” and all of his cousins, ED is easily treated. That being said, if a 50-year-old  healthy male suddenly develops ED, a cardiac work up should be considered, since they are both blood vessel disorders and have similar pathways. The medications known as Phoshodiesterase-5 inhibitors (PDE5 inhibitors), are easy to use, have excellent results and have minimal side effects.  PDE5 inhibitors should not be taken with long acting nitrates and should be used with caution with certain types of blood pressure medications known as Alpha blockers. If you’re not sure, review with your doctor. Since these pills are mostly generic, they are affordable, even if your insurance doesn’t cover them. Our personal preference from patient feedback, is Tadalafil, the generic of Cialis. It is the longest acting PDE5 inhibitor, with a half-life of about 36 hours, although, many of our patients say it lasts 5 -7 days. Patients can take the medication on a Friday and not have to be worried about ED symptoms throughout the entire weekend, which is good for those spontaneous moments.  As a comparison, Sildenafil, the generic of Viagra, has a half-life of about 4 hours. Newly used in the treatment of ED, Oxytocin, is a peptide secreted by the pituitary gland, studies show it increases sexual pleasure and intimacy, in both men and women. Bremelanotide (PT 141) and Melanotan ll, both peptides, have also been shown to be effective in treating ED, even in men who failed more conventional treatment options. If these medications are ineffective, penile injections or an intra-urethral suppository may be beneficial. We have had excellent results with Super Tri-Mix Injection Formula 1: Prostaglandin (E1)/Papaverine/Phentolamine. If none of the above have proved effective, then consideration for a vacuum pump or even penile implant are options.

EJACULATORY DISORDERS

Premature ejaculation (PE), is another common problem facing men. Other ejaculatory problems include retrograde ejaculation and anejaculation. Treatments PE,  include, SSRI’s,  which include medications like Prozac or Zoloft.  If these are ineffective the next line drug, Clomipramine, may be tried. Tramadol has been used as third line drug treatment for PE.  

 

 

Invigorate Med Spa Options to Overcome ED

Tadalafil

Tadalafil is a proven ED medication and its

effects are cumulative and improve with daily

use. It’s effective for both male and

females.Tadalafil orally can be effective to

increase sexual desire, sexual arousal, sexual

orgasm and sexual satisfaction. It not only

increases nitric oxide in the corpus

cavernosum of men, but in women it also

results in the relaxation of clitoral and vaginal

smooth muscle and increased blood flow in

these sites, a normal step in arousal and

necessary to achieve orgasm.

Available dosing:

- 5mg capsule $5

- 10mg capsule $7

- 25mg capsule $10

- 6mg gummy $6

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Sildenafil

Sildenafil, the little blue pill that started it all, is used to treat men who have erectile dysfunction (also called sexual impotence). Sildenafil belongs to a group of medicines calledphosphodiesterase 5 (PDE5) inhibitors. These medicines prevent an enzyme called

phosphodiesterase type-5 from working too quickly. The

penis is one of the areas where this enzyme works. By controlling the enzyme, sildenafil helps to maintain an erection after the penis is stroked.

Available dosing:

- 100mg tablet $10

- 150mg troche $10

Oxytocin

While Oxytocin certainly lives up to its reputation as the “Love

Hormone,” it also has broader applications like weight management

and a performance enhancer. Oxytocin levels reach extreme levels

during childbirth and breastfeeding, however they have also found to

be elevated during sexual arousal, skin to skin contact, and orgasm. Due

to this, research has been conducted and shown that exogenous

administration of Oxytocin can improve libido, orgasm

intensity/frequency and sexual pleasure.

Available dosing:

- 20 IU sublingual troche $3.00

- 50 IU sublingual troche $4.50

- 100 IU sublingual troche $7.00

- 20 IU nasal spray  $125

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Wanting something beyond Tadalafil? Have you tried Apomorphine?

Whether you’re a male or female looking for a more spontaneous and natural sexual experience our novel

approach may be exactly what you’ve been looking for.

Apomorphine is a dopaminergic agonist with affinity for dopamine receptor sites, mostly D(2), within the

brain known to be involved in sexual function. It enhances normal neurological signaling in sexual response.

It stimulates dopamine receptors in the hypothalamus, causing neural signals that relax smooth muscle and

allowing erections to happen more easily.

Like Apomorphine, Tadalafil is a proven ED medication and its effects are cumulative and improve with daily

use. For females, Tadalafil orally can be effective to increase sexual desire, sexual arousal, sexual orgasm and

sexual satisfaction. It not only increases nitric oxide in the corpus cavernosum of men, but in women it also

results in the relaxation of clitoral and vaginal smooth muscle and increased blood flow in these sites, a

normal step in arousal and necessary to achieve orgasm.

Apomorphine with Tadalafil is often the perfect combination for both men and women to experience a

spontaneous and natural sexual encounter. Apomorphine is effective in 43% of men who don't respond to

tadalafil alone. Daily use allows sexual activity to happen any time, without needing to wait for a pill to start.

Apomorphine - 2mg troche $4.00

Tadalafil / Apomorphine - 20mg/4mg troche $12.00

Tadalafil / Apomorphine - 40mg/4mg troche $12.50

Tadalafil / Apomorphine - 20mg/6mg troche $14.00

Trimix

Trimix NOW available in transdermal gel

Trimix is also used for sexual function. It is an intracavernosal three-drug

injectable prescribed medication used to treat erectile dysfunction. This

is most useful for men who cannot take oral medication or for those for

which oral medication has not been shown effective.

Transdermal Gel: Alprostadil/Papaverine/Phentolamine 10mcg/30mg/0.5mg - 5mL TopiClick applicator - $175.00

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Shop at our on-line store, without embarrassment, and no waiting for an appointment at you doctors office.  All orders will be mailed to your address. Call us at Invigorate Med Spa for any questions. 412-248-7777.  Note  all prescriptions drugs will need a Telemedicine evaluation.