The Uncomfortable Truth About Common ED Treatments

This podcast is for you. The Modern Man I'm Dr. Anne Truong, your host. I'm an intimate health medical doctor and best selling author of the book Erectile Dysfunction Fix. I'll do a deep dive into sexual health and performance and how it affects men of all ages and backgrounds. So let's get started and be sure to visit my website@sexualhealthfulmenpodcast.com for more information and resources from the show. See you on the inside. Well, hello there. Welcome to episode 66 erectile dysfunction treatment now, before we start, let's review how an erection happened. I talked about this in the last episode. Now, in order for an erection to occur, they need to have an increase of blood flowing into the penis versus going out of the penis. And so, in order to have a net increase in blood flow, four crucial steps must take place. Number one, the nerve in the pelvis region must send neurotransmitter or chemical to the arteries of the penis directing increasing blood flow. Second, the arteries must respond to the command of these nerves by opening up and widening the diameter of the artery to allow for increasing blood flow. And third, the erectile penis muscles must be able to stretch and to expand to accommodate the increasing blood flow. 4 the veins of the penis must allow for a net increase in blood flow by closing the drainage valve to keep the blood in the penis. On top of this, an erection requires the coordination of 6 system in the body to work synchronously to produce an erection. Those systems are the brain which involve emotion and nerve, the peripheral nerve, the heart, the blood vessel which include the arteries and the veins, hormones and the penis muscle, the corpus cavernosum. Mainstream medicine and the media are not treating men with ed. With just ED is a serious problem that could lead to life threatening heart disease. When a man has ed, he either finds solutions by himself online or go to a doctor who then gives him ED medication. ED is regarded as shameful. You're inadequate. It's uncomfortable to discuss and the discussion is shoved under the carpet or is frankly ignored. Taking ED medication is like taking pain medication for minor pain, like low back pain. The truth is that ED medication covers up the symptom of ED, but worsens the ED over time. The drug creates a dependency on your bedroom performance, the same as opioid dependency. There is very little education that ED is reversible and can be treated with other modalities beside medication. I believe patients deserve the best care. Thus I manage and evaluate my patient from the beginning and in every procedure. When I evaluate A patient for an evaluation, I look at the whole person. I use objective data like questionnaires and assessment to evaluate for sexual function. At the first visit, a thorough history of your lifestyle, medical condition, work history and family history is done. In addition to blood work, look at the hormones from your brain all the way down to the genital area. Your organs function and also your inflammation level. I also do a penile Doppler ultrasound to evaluate for the blood flow integrity of the penis. I do this because I want to know why you have ed. And if I understand why you have ed, I can help you solve it by treating the root cause. This is the best and the right thing to do. So for those of you that seek ED treatment, make sure that this is done. Make sure that you are seeing a doctor that can evaluate you thoroughly from head to toe and and that is looking at the root cause of why you have ED and not just say hey, you have ed. Here's a medication to take. And don't go to a place that has the doctor of the day or the nurse of the day and you don't see the same person. If they are not evaluating why you have ED and not doing a Doppler ultrasound, you're not getting a full evaluation that you deserve. On top of that, for me, I evaluate my patient progress by measuring the blood flow with the Doppler ultrasound and also follow your progress by the questionnaires and objective data on the Doppler ultrasound. In addition to the medical intervention, it's important to address lifestyle factors that play a big role in ed. Some common factors that can lead to conditions affecting blood circulation include lack of activity, smoking, stress. We'll talk more about stress later and how stress can really be a big harbinger. Affects sexual function and a lot of conditions. Alcohol, excessive alcohol or not even have sex frequently. Lack of sleep and certain common medications such as anti inflammatory ulcer medication can affect your erectile capacity. I reviewed that in episode five. Other small changes to improve your erection include just things like just getting at least seven hours of sleep every night. Sleep is essential for physical and mental repair and healing. For the body, try sleeping between 7pm and 6am From 10pm to 2am your body undergoes physical repair. From 2am to 6am your body undergoes mental repair. Sleep is so critical I can't say that enough. Eat a healthy diet. I recommend a Mediterranean diet. Exercise at least 30 minutes five times a week. Exercise to a level where it's difficult to carry on a conversation or moderate level exercise improves circulation and also Help control your weight. Sexual activity is equivalent to walking a mile on a flat surface for 20 minutes or briskly climbing two flights of stairs in 10 seconds. Also, try to decrease your stress because stress increases cortisol. But if you decrease it, the cortisol is less. And then it stimulates the parasympathetic nervous system, which then create better erection. Stop smoking. Smoking causes blood vessel constriction, resulting in less oxygen to the penis tissue. Do yoga. Yoga help with joint pain. Men with ED tend to have less joint pain. Actually, men without ED tend to have less joint pain, less headache and help you relax. And it gives you more flexibility, which can be advantageous in the bedroom. In a study of 25,000 men in seven countries, it was found that those men without ED exercise more and do yoga more. Also meditate. Meditating can help you relax, reduce anxiety and also headache. Minimize watching tv. Why? Because when you're watching tv, you don't have time to be active. You shouldn't spend more than two hours a day watching TV and limit to one hour a day because it takes time away from your family, your friends and your exercise. And time that you can spend being productive. And also watch on the porn. You shouldn't watch porn more than eight hours a day. The more you watch porn, the less likely you may be stimulated by your partner. And I'm talking about like more than eight hours a day. And have sex at least once a week, optimally three times a week. Weekly intercourse has been shown to decrease ED. And remember, you burn about 100, 200 calories during intercourse. And think of it as going to the gym. The more you go, the stronger you get. And for the penis, you use it or you lose it, because the muscle do undergo atrophy and scar. And those with obstructive sleep apnea, make sure you get treated with cpap. The CPAP machine offer positive oxygen pressure to the lungs. As a result, you get better sleep, you get more oxygenation, you enter into REM sleep would help with nighttime and spontaneous erection. And it's like exercise to your penis while you're sleeping. And it also reduces exhaustion. And if you have restless leg, make sure you treat it well. Because if you treat it well and you take magnesium, it actually help you rest, actually help you sleep better. So that's all good for erectile capacity. And also when you sleep better, your hormone will also improve as well, particularly testosterone. And make sure you get your testosterone hormone measured, because if it's low, you can supplement it with either injection or pellet. Also Avoid prolonged bicycling, which can affect the nerve around the penis, decreasing arousal from physical stimulation and eventually limiting your ability to have erection. Now, prolonged biking, I'm talking about like eight, more than eight hours a day, every day. And just monitor that as much as you can. Also, make sure you get your thyroid hormone measured because hypo or hyperthyroid can affect erectile capacity as well. And also Kegel exercise is important because it strengthens the muscle that help with ejaculation and orgasm. So treatment of ED are derived from restoring function to the 6 system I mentioned before. So the brain psychological. It makes up about 10% of ED. It involves primary guilt, depression, anxiety and fear of intimacy and secondary psychological causes. In most cases, mean erection have been normal but become problematic performance due to anxiety. So the treatment is usually counseling and therapy. But we'll definitely go over it more in detail in the future episode where we'll talk about strategies for psychological issues that are affecting your erection. The next system is nerve. It's a connection from your brain to your neck, to the nerve in your spinal cord and to the nerve to the penis. The neurotransmitters are the chemicals, messenger or group of chemical agent released by the nerve cell to stimulate the neighboring nerve, muscle or the gland, allowing impulses to be passed from one cell to the next. Particularly in the nervous system. Treatment involves such as PT141, which is a peptide that stimulates the nerve of the penis, the pudendal nerve, to help with an erection. The next system is the heart. Atherosclerosis occurs when the blood vessels that carry oxygen and nutrients from your heart to the rest of your body, like the arteries, become thick, very thick and stiff, sometimes restricting the blood flow to your organs and tissue. Healthy arteries are flexible and elastic. But the walls in your arteries can harden over time. A condition commonly called hardening of the arteries or atherosclerosis. So atherosclerosis is the buildup of fat, cholesterol and other substances in and on the arteries wall. The buildup is called plaque. A plaque can cause your arteries to narrow, blocking blood flow. The plaque can also burst, leading to a blood clot. Although atherosclerosis is often considered a heart problem, it can affect arteries anywhere in the body. Atherosclerosis can be treated, however, with healthy lifestyle habits like a good diet, exercise, stress reduction. All of these can prevent and stop the progression of atherosclerosis. The penis arteries are only one to two millimeter in diameter. The the smallest in the body. They are the first one to get plaque buildup, the sign of arterial blood flow restriction is difficulty getting an erection or unable to get one at all. On the other hand, if there is a vein leakage or venous leakage, it presents as an inability to maintain an erection. The next system is the blood vessel, which means the arteries and the veins and the blood flowing in the arteries and the veins. A lot of modalities that exist today is geared in this category that treat ED to increase blood flow. Let's discuss one thing called low intensity shockwave therapy. It's the novelty treatment. It's an innovation, non pharmacological therapy. And it treats ED by uses energy from sound wave and it transfer the energy of the sound wave to restoring blood flow in the penis tissue and increasing more blood vessels and also rejuvenating tissue. And therefore if you build more blood vessels and and rejuvenating the tissue, you're restoring more blood flow. So this treatment involves a handheld probe device that held in the hand and then you deliver the energy to the penis. It's non invasive, it's painless and the treatment can be done in about 15 minutes. And so I also include the picture of the the shockwave machine in the show notes as well too. And then you can also go to my website@trunkrehab.com to look at a video. The next modality to increase blood flow is the penis pump. It can come in an electric or a manual. It's a device that consists of an acrylic tube and a negative pumping mechanism. The resulting vacuum increases blood flow to the erectile tissue and you pump the air out and by this you are creating an erection. It's like going to the gym and doing biceps curl. You're bringing blood flow to the muscle and by doing this you're increasing the expansion of the muscle, which is what you want. So that way it can be flexible and it can bring in more blood flow to keep it healthy. The next and the best thing is called the priapism shot or the P shot, which is an injection of the platelets which is in your blood into the penis. This innovative technique uses the blood to restore blood flow to your penis. It is by far the best treatment for long term treatment of ED and rejuvenating the penis. And we're definitely going to dive more into this in the next episode. ED treatment medications such as Viagra Cialis increase nitric oxide release in the blood vessel to increase blood flow to the penis tissue. And then you also have another treatment called Trimix which Is an injection of three substances. Alprostatil, which is called PGE1, which open up blood vessel. Pentolamine, which also help with increasing blood flow and papaverine. Papaverine, these chemicals all work together to increase blood flow. And you only use this when you have severe ED that nothing else seem to help to because the patient actually self inject with these medications prior to sexual activity. So one of the systems I talk about that need to work is the hormone. Low testosterone, high prolactin and low or high thyroid hormones can cause ed. Hormones are released from the brain and pituitary gland where prophylactin is released and then send messengers called send messengers down to the testicles where in the testicles testosterone is released. And the thyroid gland is here around the neck area and produces the thyroid hormone. Now I mentioned before, low testosterone, high prolactin and high or low thyroid affect erection. So testosterone when it's low can be supplemented through injection, pellet implant, skin patches, gel or by a tablet that is placed between the cheek or the gums or underneath the tongue. The pellet implant is an insertion of bioidentical testosterone hormone made into a little small tic tac size. The tiny pellets are inserted under the skin on the buttock. And this allow testosterone release in a consistent concentration with the least side effect. This is my favorite and preferred method for testosterone supplementation. Now you can also get thyroid treatment by taking a pill. And when prolactin is high, you have to find out whether it's because you know dysfunction in the brain or other stressors causing prolactin to be high. So the next system is the penis muscle, the corpus cavernosum. Remember the corpus cavernosum are actually smooth muscles. They're not skeletal muscle like the biceps or the triceps. The smooth muscles is actually controlled by your autonomic nervous system called the parasympathetic and sympathetic nervous system. And these muscles have to expand and contract. And if the corpus cavernosa muscle do not expand for an erection, over time the muscle begins to atrophy and they become scarred down and then it becomes less compliant and it become has more increased deposition of collagen and decreased elastic fibers. And in people that had diabetes, high cholesterol vascular disease like atherosclerosis, like I mentioned, penile fracture or sometimes it getting older have decondition that affect the corpus cavernosum. So by doing low intensity shockwave therapy that I talked about earlier, actually reduces the scar tissue and actually can rejuvenate the corpus cavernosum tissue. This is in conjunction with doing pumping as well. Kegel exercises can contract the muscles of the bulbocavenosus and the ischiocavenosus muscles. These muscles are near the scrotum and between the rectum and they are involved in helping maintaining an erection and also help with ejaculation. And they can be improved by doing Kegel exercises. And we'll go over more about what Kegel exercise all about in future episodes. So lastly, if all those treatment does not help and you have ED over time, that is severe, there are surgery that's called vascular surgery that can move that that replaces the arteries in the penis or a penile implant where the implant is placed into the corpus cavernosum tissue. But again, this is the last resort and has many complications. The bottom line is I want to stress that it is very important to understand the organic causes of ed, which will allow the doctor to discover the therapies and for correction and provide reassurance to the patient facing a very personal and devastating problem. So I hope that you're able to absorb the overall treatment. We went over it very fast and it's a lot of them, but we'll dive into more important ones in the future episode. And thank you for listening and I'll see you in the next show. Sam.