Male Infertility & Erectile Dysfunction

Foreword-
For many years, men have thought, and in many cases still think, that sexual impotence is an unavoidable and expected consequence of the aging process. Prior to the scientific understanding of how an erection occurs, the common belief was that 90 percent of all cases of impotence were due to psychological or mental factors.

Thankfully, today we have a much better understanding of the physiology of an erection. Consequently, we can determine the underlying causes of impotence and in virtually all case, offer successful treatment.

At the Center for Sexual Health, we are committed to finding the cause of our patients' individual difficulty with the most appropriate and up to date methods. This is accomplished as expeditiously and as cost effectively as possible, while maintaining patient confidentiality and dignity.

- Rafael S. Wurzel, M.D.
Medical Director, Center of Sexual Health
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What is impotence?
Impotence is the consistent inability to obtain or maintain an erection that is rigid enough to achieve penetration. In spite of the penis being flaccid, male orgasm may still occur.

How does a normal erection occur?
Erections occur as a result of the normal interactions of nerves, blood vessels and hormones. Sexual thoughts or sensations cause the brain to transmit a signal, through the nerves, to the blood vessels of the pelvis and penis. Consequently, two cylindrical chambers which run along each side of the length of the penis become engorged with blood. When this occurs, the penile shaft becomes rigid, elongated and erect.

An erection will not develop if the nerve impulse transmitted is interrupted, if adequate blood flow does not reach the chambers or if the blood is not satisfactorily stored within the chambers.

Testosterone, the male hormone, has a "priming" effect on both the brain and ultimately the penis in initiating the process of an erection. Diminished levels of testosterone, frequently identified with the aging process, caused diminished sexual desire, general fatigue and ejaculatory difficulty.

What is Impotence?
In the great majority of cased, impotence is caused by physical reasons.

Medication - Sedatives, blood pressure medications, antidepressants, Weight control medications Peptic ulcer medications, Hormonal abnormalities, Alcohol and tobacco use

Medical conditions - High blood pressure, arterioscleroses, heart disease, diabetes, Peyronics disease (scar tissue in the penis).

Common conditions that can cause psychological impotence are - "Performance anxiety" - (a man's fear that he will not be able to perform sexually), depression, stress, fatigue

What happens during your initial consultation?
At the Center for Sexual Health, we will diagnose the cause of your impotence and make a treatment plan especially for you.
During your initial visit the physician will interview you to obtain a detailed medical and sexual history. This will be followed by a physical examination.

What are the medical treatments for Impotence?
Please Note:If you are taking medications, the side effects of some of these medications may be causing your problem. Do not stop taking your present medication(s). Please bring a record of your current medications so that the physician can make an evaluation.

Hormone deficiency can easily be treated with hormone replacement therapy, if necessary.
In cases of mild to moderate degree of impotence, oral medications may help restore adequate erections.
In instances where psychological issues are the reason for erectile failure, referrals to certified sex therapists will be offered.
If oral medications do not produce desired results, the following alternative therapies will be offered:

Penile self injection - When a single drug (Prostaglandin) or a combination of three drugs (Prostaglandin, Papaverine and Phentolamine) are injected into the chambers of the penis, adequate erection will result within minutes, in about 75% of patients. These drugs are effective only when used in injection form. The injections are given at the base of the penis, with a extremely fine needle. The procedure causes minimal discomfort. In our Pharmacologic Erection Program (P.E.P.) we will find the smallest dose necessary to produce a satisfactory erection, and instruct our patients, and/or their partners, in how to properly self inject.

Penile self injection is the most prevalent form of treatment because of its relative simplicity, effectiveness, and patient satisfaction. The complications are rare and usually preventable.

Vacuum Erection Device (V.E.D.) - This External Device Pools blood into the penis by means of negative pressure (suction). The blood is then trapped in the penis by a rubber compression ring at the base of the penile shaft. If not properly used complications can arise. Some patients use the V.E.D. satisfactorily. Many, however discontinue its use due to diminished sensation along the penile shaft difficulty with ejaculation or due to "flopping" of the penis at is base.

Penile Implant - If the above treatment options do not meet with patient satisfaction, or if the patient wishes another alternative, a penile prosthesis (implant) is an excellent alternative. The implant allows patients the flexibility to have an erection at any time and for any length of time. The penile implant is inserted completely within the body. The inflatable (hydraulic) device is most frequently recommended because of its simplicity of use and superior cosmetic appearance. This device is F.D.A. approved.

Because of the many refinements in design and engineering over the last 20 years, the mechanics of these devices are now extremely reliable. On patients satisfaction surveys, the satisfaction rate of patients in terns of sensation and partner satisfaction if about 90%. This is the highest satisfaction rating of any form of available treatment.

The surgical procedure takes from one to two hours. Most of the time it can be done on an outpatient bases or at most require an overnight stay in the hospital. Depending on the physical demands at work patients many return to their routines as early as ten days following the procedure. Sexual intercourse many be resumed after four weeks.

Arterial "Bypass" procedure - Unlike the coronary arteries located around the heart, the penile arteries can not be routinely bypassed if a blockage is found. The only time this procedure is effective is when the blockage affects the blood vessels within the pelvis due to traumatic injury.

Insurance Coverage
Medicare and the majority of insurance plans will usually cover the cost associated with the diagnostic testing and treatment.
Our experienced staff will gladly assist you in reviewing the insurance benefits of your health plan.

If you have any further questions regarding this material or if you wish to be evaluated at the Center for Sexual Health, please contact our office. Utmost discretion will be assured.