Male Sexual Dysfunction
Virtually every male can regain sexual function if he so chooses. The silent suffering experienced by over 50% of males can come to an end with a wide spectrum of treatment forms from well-known means like Viagra to not so commonly known ones like penile implants.
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Forms of male sexual dysfunction
Evaluation and Treatment
Treatment Options
Forms of male sexual dysfunction
- Loss of adequate erection (erectile dysfunction or impotence)
- Early climax (premature ejaculation)
- Penile bend (Peyronie's disease)
- Other such as delayed or absent orgasm
Evaluation and Treatment
A directed history and physical exam can identify causative factors for sexual dysfunction as well as other health risks.
- Initial Testing
- Biothesiometry
- Blood studies
- Assessment of penile blood flow
Advanced studies are sometimes required for specific initial findings such as blocked blood vessels into the penis. Dr Bastuba offers the regions most complete evaluation of sexual dysfunction and all currently available treatment options. Take also our online male sexual dysfunction test.
Penile duplex Doppler ultrasound
Often used as a screening tool, gives important information about what's going on inside the penis. This information is often invaluable in helping couples to understand the cause of ED and in accepting that it is indeed a physical problem. The acceptance often begins an important aspect of the healing process allowing the couple to work past psychological second-guessing.
Treatment Options
Oral Agents (e.g. Viagra, Levitra, Cialis)
The choice between the various available treatment options involves interaction between the physician and patient and is optimized when the patient's partner is also included. Patients are often given an oral agent to try during evaluation. Response to an oral agent such as Viagra does not work for everyone and that incomplete training on proper use of this drug is often a cause of perceived failure. Up to 50% of Viagra failures will actually be successful with full training in its correct use. When a treatment doesn't work it does not mean the patient is a failure but rather that the treatment is. Keep trying. The most important component of success in the treatment of ED is interest. With interest virtually every patient can attain success.
Topical Agents
Topical agents are substances applied to the surface of the penis with the aim of entering it and creating an erection. Past attempts produced only modest results. New agents utilizing improved delivery systems are undergoing testing to gain FDA approval. These medication delivery systems are not currently FDA approved and are therefore not commercially available.
MUSE
The Medicated Urethral System for Erection (MUSE) is FDA approved. With this therapy a soft pellet of a substance is placed into the tip of the penis with a plastic applicator. The substance causes the channels that bring blood into the penis to open up, initiating an erection. The combination of MUSE and a tourniquet applied to the base of the penis results in an erection adequate for intercourse in a number of patients.
Penile Devices
Penile devices are safe, effective and FDA approved. Many motivated couples successfully use them and they function regardless of the cause of the ED. The process involves a clear plastic cylinder being placed snugly over the penis. A vacuum is then created which draws blood into the penis. A tourniquet placed at the base of the penis traps blood within it and the cylinder is then removed. It is strongly recommended that patients take advantage of the free "hands-on" training to optimize function and minimize frustration.
Penile Implants
An inflatable penile implant remains the gold standard form of therapy for erectile dysfunction when other options don't meet a couple's needs. These devices are completely concealed within the body and recapture a natural erection by allowing full hardness and softness at any time desire for as long as desired. Following healing couples can begin to experience the return of natural function and intimacy. Various studies have shown inflatable penile implants to have the highest long-term satisfaction rate of any form of therapy (~95%). The devices are not subject to rejection and look and feel quite natural. The device is placed through a small opening at the base of the penis and can be done in an outpatient setting. Penile implants are completely concealed within the body and there is no external sign one is present.
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Penile Microvascular Arterial Bypass Surgery (PMABS)
There is a select group of young patients in which initial testing suggests blocked arteries. Heart bypass surgery can save lives by redirecting the flow of blood around blocked heart arteries. PMABS can save love lives by redirecting blood-flow around blocked penile arteries. A typical patient may have had a direct trauma to the groin or penis. Sometimes these injuries involve avid bicyclists. Definitive testing for blood flow issues is required in these patients and creates a roadmap for care. Dynamic Infusion Cavernosometry and Cavernosography (DICC) is the study of choice. Dr. Bastuba heads up the only team in this region that can direct and interpret the sophisticated studies required and render the microsurgical repair (PMABS), which can lead to the return of spontaneous erections.
Male Fertility Specialists
6699 Alvarado Road, Suite 2207
San Diego, CA 92120
(619) 286-3520
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