Sexual health is a crucial aspect of overall wellness, but sometimes, even the fittest among us can experience difficulties in this area. If you’re facing problems in the bedroom, don’t worry, you’re not alone!
As an award-winning urologist trained at UCLA, Harvard, and Vanderbilt, I constantly push the envelope of what is possible. Twenty years ago, I helped to pioneer robotics for prostate cancer surgery. Five years ago, I began focusing my clinic and research efforts on assisting men to regain and optimize their sexual health. I learned that strong blood circulation is the key to male and female sexual health, but this article will go way beyond the basics of cardio exercise, a clean diet, healthy habits, and adequate hydration.
What follows are the best treatments I use in my sexual medicine and urology office in Northern California.
Oral Medications:
1: Boosting Nerve Signals with Nitric Oxide Supplements: Erections start as electrical impulses transmitted by the spinal cord into the pelvic nerves. These nerves release Nitric Oxide, a vital molecule that dilates blood vessels allowing blood to flow into the penis or clitoris. As you age, your natural Nitric Oxide levels decline, leading to reduced circulation, less rigidity, and difficulty with penetration. Boosting Nitric Oxide with a supplement such as AFFIRM will help restore blood flow to the genitalia resulting in harder erections. Nitric Oxide supplementation is also a natural way to decrease systolic blood pressure by 5-10 mmHg, increase brain function, boost workouts, and improve immune function.
2: PDE-5 Inhibitors like Viagra and Cialis: When I was a surgical resident at UCLA in the 90s, my professors discovered the mechanism of action of PDE-5 inhibitors like Viagra and Cialis. Since then, hundreds of millions of men have tried these wonder drugs, which have proven very safe. In fact, beyond helping erectile function, studies show that Cialis improves urinary function, Viagra reduces the risk of dementia, and Cialis decreases the incidence of heart attacks.
The minor side effects of these medications include:
- Headache – so have some Tylenol available.
- Stuffy nose – I suggest Patanase (don’t use Afrin or Sudafed because they can make erections worse).
- Reflux – you can use TUMS if you experience heartburn.
Other tips on using PDE-5 inhibitors include:
- The low-cost generic versions of these drugs are Sildenafil (Viagra), Tadalafil (Cialis), and Vardenafil (Levitra).
- Cialis starts working in 30 minutes and lasts up to 36 hours and has a 5mg daily dose and a 20 mg maximum dose.
- Viagra and Levitra start working in 30 minutes but only last 8 hours.
- The maximum dose of Viagra is 100mg, and the maximum dose of Levitra is 20 mg.
- It is better to take Viagra on an empty stomach, but you can take Cialis and Levitra with or without food.
- Viagra and Cialis work better when combined with a Nitric Oxide Booster like AFFIRM.
3: Bremelanotide or PT-141: PT-141 is a peptide initially tested to darken skin naturally, but researchers discovered that it increased libido as a side effect. Injected under the skin or used as a nasal spray, men experience a temporary increase in sex drive and spontaneous erections. In women, PT-141 was FDA-approved as Vyleesi, a prescription medicine used to treat hypoactive (low) sexual desire disorder (HSDD) in women who have not gone through menopause. PT-141 is a safe and effective drug for both men and women, although about a quarter of users experience nausea.
4: Apomorphine: Apomorphine is a drug that has been used to treat Parkinson’s Disease for more than 20 years that has a beneficial side effect. Apomorphine works in the brain to stimulate nerves that trigger the relaxation of the smooth muscle of the erectile body, enhancing blood flow to the penis and resulting in an erection within 20 minutes. The effects typically last for hours, and there are reports that Apomorphine decreases the time before a second and third ejaculation. Studies investigating Apomorphine for treating low arousal and sexual dysfunction in women show increased sexual satisfaction scores. Uncommon side effects include nausea, vomiting, headache, and dizziness. To increase potency, Apomorphine is often combined with Cialis and Viagra as a sublingual troche (under your tongue), available on Rugiet.com, eliminating the wait time that traditionally comes with pills.
5: Oxytocin: Oxytocin is a peptide hormone produced in the body. In women, it plays a crucial role in childbirth and nursing. In men and women, taking Oxytocin before or during sex has been shown to increase overall sexual satisfaction with growing feelings of connection with a partner and enhancing the sensation of orgasm. Numerous studies have shown Oxytocin to be safe. The most common and quickest application route is an intranasal spray with plasma oxytocin levels rising within 20 minutes and lasting for about an hour. Another form is oral drops applied beneath the tongue about ten minutes before intercourse.
Building New Blood Vessels: 90% of erectile dysfunction is related to reduced blood flow to the penis due to clogged arteries. Two technologies stimulate new blood vessels’ growth – low-intensity shockwave therapy and platelet-rich plasma (PRP).
6. Low-intensity Shockwave Therapy is applied directly to the penis by a medical provider. The waves stimulate an acute inflammatory response that activates local stem cells and releases growth factors that result in the growth of new blood vessels. Some practitioners claim that the waves knock plaque off blood vessels, but this has not been demonstrated by medical research.
What you should know about Low-intensity shockwaves:
- This technology is effective in roughly three of every four men.
- Usually, it takes 4 to 6 weeks for men to feel the benefits, and they typically need 6 to 12 treatments.
- There is a similar device for use at home called the Phoenix, but despite marketing claims, there has never been a published study showing that the Phoenix improves erectile function.
7. Platelet Rich Plasma (PRP): Platelets have two functions. The first is to form a blood clot to stop bleeding. The second is to initiate healing and regrowth by releasing various growth factors. Many specialties, notably orthopedics and dermatology, use Platelet Rich Plasma (PRP) to stimulate the growth of localized tissue. If a qualified sexual medicine physician injects PRP into your penis once a month for at least 2-3 months, you will likely experience improved erectile function. Women receive the injection in the clitoris, which enhances sensation and orgasms. Believe it or not, the injection is not nearly as painful as you might think, but don’t try this at home!
Injections:
8: Botox Injections in the Penis: In a flaccid penis, the vascular smooth muscle is contracted so that blood does not enter the penis. During an erection, nerve impulses signal blood vessels to relax and open to increase penis size. If a qualified physician injects Botox into the penis with a tiny needle, within a week, a man will notice a larger flaccid penis and better erections. Depending on the dose, the effects of Botox for ED will last three to six months.
9: Penile Injection Therapy: For men with damage to the nerves that supply the penis, creating an erection through sexual stimulation is not possible. However, injecting medication (Trimix) directly into the penis can artificially dilate the arteries leading to a rigid erection. The duration and firmness of the erection depend on the medication dose and the quality of a man’s blood circulation. Typically, erections can last between 30 minutes and four hours. If an erection lasts more than four hours, injecting the penis with an antidote is necessary to reverse the initial therapy’s effects. Some men with normal erectile function inject Trimix for recreational purposes to prolong their erection, but I would not recommend this. Sometimes the enemy of good is perfect.
Other Miscellaneous Technologies:
10: The Emsella Chair: High Intensity Focused Electromagnetic Waves from the Emsella Chair provide noninvasive electromagnetic stimulation of the pelvic floor musculature, strengthening weak pelvic muscles in men and women. Studies in women show a dramatic improvement in sexual function. My soon-to-be-published studies in men demonstrate improvement in ejaculation, erections, and urination after ten sessions lasting 30 minutes each. Absolutely no work is required by the patient – he/she sits on a firm surface on top of a 2 Tesla magnet while the magnetic field contracts the pelvic floor musculature. The muscle stimulation is not painful, and the treatment has no risks or side effects.
11: Lubricants: Vaginal dryness due to inadequate lubrication is an issue for women of all ages and their partners and is a relatively easy fix. More than a quarter of all women reported experiencing pain during intercourse, and a lack of lubrication is a major cause. In addition, research shows that lubricant use is associated with higher sexual pleasure and satisfaction. Water-based lubricants can dry out quickly; oil-based products should not be used with condoms and altered vaginal bacteria. My favorite is silicone-based lubricants like UberLube , a high-end lubricant designed to enhance sensation and reduce friction. When not in use, it dissipates, leaving the skin soft and moisturized without any wet or sticky residue.
12: Testosterone Replacement (TRT): Erections are a circulation function. Testosterone replacement does not directly increase blood flow. However, testosterone supplementation does boost sexual desire in both men and women. A third article in this series will focus on Testosterone.
Treatments to avoid!
Truckstop supplements such as Yohimbine, Tribulus, Fenugreek, and Ginkgo biloba have not been found to be effective. Maca and Horny Goat Weed have limited data and avoid Rhino pills (manufactured by a man sentenced to 46 months in federal prison). Many clinics offer stem cells for ED, but their benefit has not been adequately researched, and the cost and standardization have not been established. Finally, despite claims to the contrary, the Phoenix home device has never been adequately tested for the treatment of ED.
What does the development of ED mean? Important! Read This!
It is essential to understand that ED represents a decline in penile circulation and is an early warning sign for other blood vessel blockages that can occur in the future. Therefore, if you develop ED in your 30s, 40s, or 50s, strongly consider alterations in diet, exercise, sleep, stress management, and habits to prevent more severe changes to your health in the future.