Hi, it’s Noah, Williams, director of optimal health associates in Oklahoma, City I have a practice of gynecology and wellness and all kinds of crazy internal medicine stuff. So I’m going to talk about a very important subject today, it’s penis’s, that’s right! We’re gonna talk about penises. Now it’s always a little funny to think hey. The gynecologist is going to talk about penises, but who would you rather talk about penises that I got ecologist because we actually talk about sexual medicine with our patients, unlike neurologists and primary care and internist, which is in which in no way shape or form? I am I, criticizing, there’s, not comfort with talking about sexual function, and so I have to talk about sexual function every day, all day long and have for more than 20-some years, I’ve been in practice. Twenty five of my focus has been menopausal medicine for about 22 or 23 of those years and along the way, as I was treating women with their menopausal symptoms or vaginal problems or problems with or difficulties with sexual relations. I started getting requests from a lot of my patients if I would treat their husbands so for many years, I would refer them out really through 2002 about 2005, because there was an older doctor in the south side of Oklahoma. City I could depend on, but eventually I had a guy come in with his wife and say one day, you’re taking care of me I know you I’m comfortable with you. You talk about it much more straightforwardly so take care of me. So I took care of him and from there now, 15 years later, I have several thousand men in the practice, and some of them very interestingly call me their guy Nacala gist, which is pretty humorous, but they they like being taken care of by a gynecologist, because we can talk about things that very comfortably, usually that other people don’t feel comfortable talking about. So let’s talk about erectile dysfunction for a second or actually a few minutes. Erectile dysfunction is really common. It starts the incidence starts to go up really in the 30s and kind of flattens out per se by the 50 60 70s, where it is the highest. So the classic cause for erectile dysfunction is there’s a decrease in blood flow from the pineal artery into the penis, and so the penis doesn’t get engorged, and so the erection doesn’t happen. Now it’s multifactorial. You can have a whole bunch of different issues with our causes, for it I mean we always think about testosterone levels first, but there’s also just vascular changes that happen where, even if you have really good testosterone, your erectile function can change, and that can be just bad luck. It could be because you have diabetes, you have heart disease, so there’s a lot of causes and one thing I would want. Every single man to know is if you’re having erectile dysfunction, you do have a risk for coronary artery disease, and so talking to your doctor about it is important and your doctor should want to make sure you get some cardiovascular testing. If your doctor doesn’t do that, dump that doctor okay, it is a mandatory thing that they investigate at some level either through questioning or testing to make sure you don’t so then what do you do about erectile dysfunction? What what does anyone do? Well, the thing they do. Is you get a phosphodiesterase inhibitor? That’s a class of drugs like viagra or cialis that increases blood flow within the penis, and those can be extremely helpful for people. But what happens if you get a severe migraine from taking one or it doesn’t work, or you have blurred vision or a variety of the different risks or side effects to it, plus not working? Well, you can do shots in your penis and everyone gets really excited about doing a shot in the penis before trying to have sex and so the shot and the penis is basically it has to do with something called prostaglandins that can be helpful to good, but again its side effects. It’s not super exciting and overtime. It causes scarring within the penis, which then inhibits blood flow, to which maybe perhaps is counterproductive for long-term treatment and then, after that, most physicians, if they’ve even gotten to the second thing, have no idea what to do next. Well, that’s what we want to talk about today. There are some amazing, newer treatments for erectile dysfunction that no no one talks about which is crazy, so the first one is doing something called shock wave therapy, so we’re gonna take a step back and imagine I’m talking about sexual challenges for women or the vaginas aging. What we’ve done for years is something called the Mona Lisa touch where we take a little laser device and we put it in the vagina and we rotate it through and that laser just puts energy into the tissue to agitate it, and it starts the second half of inflammation, which is the healing half, and so we could take vaginas that looked 80 years old and get them back to twenty five. We could restore sexual function, lubrication stretchability internal orgasm, and then it did all kinds of wonderful things for bladder and in comments. But I had many patients I treated go well. What can you do for my husband and I didn’t have I didn’t have anything that could d.edge the penis well with shockwave therapy, where you take an ultrasound device and you put energy kind of like if you were breaking up a kidney stone but way less and you put that energy into the penis and then the groins. That starts a healing cascade that gets blood flow back into the penis, so for the average patient or man, it’s going to fix a wreck tile dysfunction, 85% the time and or make a something like viagra that which hadn’t worked. Work and part of that too, is there’s a second cause for erectile dysfunction that people don’t know it, which is the venous drainage of the penis, has gone awry. So, if you think about an erection, what happens blood comes in, but we don’t want it to just come out, so the veins have to time their collapsing down and not letting the blood leave appropriately. Well, if you start to have veins that have gotten old or worn out, you can get blood flow in, but then it just goes back out so well, that’s one of the other issues with the wrecked-tile dysfunction that a lot of people have no earthly idea about who treat treat it. Drugs do not treat that there is not a drug to make the venous system work. So that’s where once again, with the shock wave therapy, for example, if you’re getting an erection, but it seems to fade during intercourse. That may be a sign of that, and so the shock wave therapy not only stimulates healing and blood flow and angiogenesis or formation of new blood vessels in the penis. It also reefs team, you late a healing process in the venous drainage, so it’s normal again, so it knows how to clamp down when you get an erection. So that’s the really unique thing about the shock wave therapy plus the fact a lot of times, if you’re, using a drug for a reptile dysfunction, you’re not going to need it anymore, which is pretty awesome since they cost money and have side effects. So that’s one way of treating erectile dysfunction, that’s newer, but I, think novel and truly amazing. The other thing they available in two different mechanisms is the concept of platelet-rich plasma, so platelet-rich plasma just means we’ve drawn a couple ounces of your blood spun it down extracted the plasma which has all these healing proteins and mediators in it. You then concentrate that and then you just do erection or if you do injections into the penis, which will again stimulate angiogenesis and healing and correct erectile dysfunction. So that’s a really cool tool, and if you combine both both of those together, you can you get some outstanding results, meaning the shock wave therapy and the PRP. But then you can do a third thing, which is probably the more optimal thing to do. If you’re going to go into the PRP, is you can supercharge the PRP and by supercharging it I mean put something else in there that will make it work better and the thing that’s, the extra touch is including exosomes and exosomes are little bubbles that come from placental cells, also known as stem cells, and those little bubbles contain healing proteins and mediators that can heal tissues. So when you combine exosomes into the PRP with the shock wave therapy, you can fix a myriad number of men. Who’ve had a wreck tile dysfunction because you get healing through both the PRP, the shockwave therapy, which is a janitorial axes, ohms, which will go to where the shock wave therapy agitated the tissue and turn on the healing process much in a much greater way. So the summary, then, is: we have all these really cool tools to help someone just get back to normal, so when they’re feeling amorous with their significant other, they just get an erection and they don’t have to take a medicine. And so it’s really cool shockwave therapy. Also does some prostate stuff too, because you also shockwave the prostate, so it also is very, very effective for urgency frequency for men too, just like the Mona Lisa, the laser was for girls for bladder stuff. The shockwave, since we also do the prostate, is incredibly helpful for bladder related issues for men or urgency frequency stuff. Now, one of the things that people often are gonna think when I’m talking about this is oh, my god. How would I get through that? Well, thankfully, is someone who’s done all of it. The I can tell you that we have the most amazing numbing creams ever made that you really it. You really don’t notice that much with the shots in the penis. You don’t know notice anything at all. Now the shockwave, you’re gonna notice a little, but it’s very, very tolerable, the hardest part about the shockwave. To be honest, it’s a little. It feels a little embarrassing I mean you’re. Getting a ultrasound to your penis I mean it’s just a concept you have to adjust to, but the payoff is amazing and, of course, the situation you would be doing it in and if it happened to be at our offices we’re at least cognizant of the what it means to go through stuff like this. So that’s a lot on erectile dysfunction and penises, but I want people to understand, there’s really great choices for you and you don’t have to just be restricted to meds and there’s ways of healing the penis and helping it just be normal and also collaterally, helping the prostate be better without doing surgeries. So thats penises from a gynecologists perspective, have a nice afternoon bye.