Hi Toby call her back again from a men’s health moment today, I’d like to talk about erectile dysfunction, treatments, specifically ones that don’t work ones that you probably shouldn’t, spend your money on scam treatments, the ones you hear on the radio you see in the back of newspaper articles, etc. The more I work in clinic the more I get asked about these, so I thought it’d be important to kind of go over, which ones are experimental, which ones are worth trying and again review some of the real treatments that we know are tried and tested and will work for you, okay. Well, let’s begin by talking about a little history and the history of treatments for erectile dysfunction in 1600 BC in Egypt, people would do incantations to help take an old man and convert them back to a young man with good directions. In 320 BC in Greece, the herbs a Tyrian was harvested extension for consumption in ensuing centuries. People would rub their genitals with different stuff. Like ginger cloves asses milk in england, in 1,000 people would consume, love bread. What is love bread? Well, it’s a highly scientific process in which you take a group of naked maidens, have them frolic in a field in a specifically counterclockwise direction and then bake bread from the wheat in that field and then consume it and hopefully help your erections yeah. That’s a crazy one! In the Middle Ages back to putting stuff on the penis, men used fat from camel humps to lubricate their penis, and not so long ago. In the 1920s there was a gentleman using testicles from goats and transplanting them into human scrotums in order to help with fertility and fix erections, etc. If you don’t believe me, they actually made a movie about this guy. It’s called nuts, the documentary from June 2016, actually quite entertaining, and there you can see the inventor of this technique, riding a goat, all right. Well, it’s 2019 and there are still plenty of unproven treatments for sexual dysfunction out there, maybe not quite as crazy as the goat, testicle one, but pretty close. If you check your emails, that particular your spam folders you’re gonna find plenty of examples of drugs that make all these crazy claims. I just made a simple search on the WWF da gov website and if you search an erectile dysfunction, you come up with all these articles. You can see here the pictures tainted sexual enhancement, products, all natural alternatives for recto dysfunction or risky proposition, essentially every day or every month, the FDA’s shutting down more more products which have bogus materials. Yeah people are trying to sell these different drugs and they don’t actually work, and sometimes they have unsafe chemicals in them. So what does the FDA recommend? Beware of products that promise quick results are advertised. Alternatives to FDA approved prescription drugs are sold in single servings advertised via spam, have labels written primarily in a foreign language or of directions and warnings that mimic FDA approved products. So some of these companies will try to be slightly more intelligent about the stuff they’re peddling, but buyer. Beware: alright! Well, I think it’s important to have some context before we go any further. The more primary problems that I see in clinic is that men are often afraid that their abnormal and they often will compare themselves to television actors from adult films etc. Again, this is fantasy. These are, this is not reality. So it’s not a good thing to try to compare yourself to most often guy complaints about penis size about length of time. It takes men to ejaculate about problems, the directions just to set the record straight. There have been a number of studies done on what normal penis length is it’s 5 inches of erect length? If you want to look it up, you can look it up in the Journal of Sexual Medicine in 2013. You can see some of the other distances in centimeters in table 3, but yeah 5 inches, that’s average, so most guys who actually complain of thinking they have too small penis, actually have a normal penis size. That’s why average is average. In addition, most guys when they have sex will ejaculate in about 4 minutes the most common sexual complaint in men, less than age 50 is ejaculating to cool quickly and a lot of times it’s around that Foreman at work anyway. So truly a problem is something that bothers you that is typically less than a minute. In addition, men are often embarrassed about having problems with erections. It’s really really common. So if you take all the 50 year-old men in the United States, half of them will have significant problems directions as you get older, it becomes more and more common 70 percent of seven-year-olds 80% of eight-year-olds, etc. Because they’re embarrassed, they don’t want us visit a doctor and that’s a problem, because instead they want to believe in these magic bullets. These kind of wonder cures that you see on the late-night television but like you’ve heard before, if it seems too good to be true, it probably is here are some basic facts which you should remember. Despite radio messaging testosterone, it’s Asadullah testosterone levels are not the end-all be-all for sexual function. There are plenty of men which we intentionally take away, testosterone levels for various reasons, and they still have a good sex drive and have normal reactions, and if you have problems directions- and you just load somebody up with testosterone that doesn’t necessarily help them. For example, bodybuilders who have tea levels in the 3000 range normal being 300. Many of them have problems directions, so testosterone can help in some settings, but it’s not as important as it’s made out to be neck. Despite the emails, the erect penis cannot be lengthened with either pills or even surgery. Okay, so it’s a guy that operates on penises for a living, I’ve, seen horrible complications from surgeries in which so-called doctors try to change the size and shape of penises. It simply doesn’t work and if you want to look it up at the Internet, there are many many case, reports of even death from patients injecting stuff into their penis and getting what’s called a fat embolism. This happened in Sweden last year, all right. Finally, there are these IDI shot clinics, most often advertised in local newspapers, and they will guarantee your actions and most the time they’re, not legit organizations. They basically have non-sexual medicine specialists in charge and they make these guarantees and they give you a medication. This medication are penile injections. This is the same injection that I would prescribe for a patient if appropriate, and the average price of the medication would cost $100. How much did these shot clinics charge? Two thousand dollars, or more so essentially you’re getting the same medication but they’re, somehow labeling and is different and they’re charging a lot more for it. So don’t fall prey to these clinics, okay. So what are the three kind of hottest but unproven, edie treatments to know about? Well, there’s three things that I get asked about a lot these days, one the shockwave therapy, the penis. This is where you basically go in and there’s a machine, and it basically does what it sounds like at. A price apply sound waves to the penis several hundred times per session, and the idea is that you’re supposed to have new blood vessels grow in the area and help with erections. There is no great data that this is effective, yet it’s super early in the treatment and I’m very skeptical at this point, but we’ll see also stem cell therapy is used a lot. Basically, stem cells are cells that haven’t differentiated into a certain type of tissue, and so people hope that, if they inject stem cells into whatever part of the body that that those stem cells will will kind of fuse and become what you want them to be, that is not the case. It’s kind of like taking a tropical flower and that’s used to getting a lot of rain and putting it in the just because you put something in there doesn’t mean it’s gonna work or grow. Just because you put stem cells in the penis, doesn’t mean they’re gonna, do what you want them to so again, unproven, finally, platelet-rich plasma. This is where you take somebody’s blood. You spin it down, you separate the components of the blood, and then you inject the plasma portion of the blood back into the area in question again. I have no idea why people would think this would work the data on it is very questionable. So this is a position statement from the sexual medicine Society of North America. This is a a group of physicians dedicated to helping people with sexual health. There are no conflicts of interest, we’re not making money by making these statements etc. Basically, it says the following: if you were gonna, try one of these three treatments: you can try them because hey if you want to take a risk and see if it might work, that’s fine, but never pay money for it and know that it’s unproven, and so, if you’re gonna go to a place that does it go to a place, that’s doing a clinical trial to show whether or not it’s actually gonna work or not or be helpful. Okay, so again these three treatments they may work I have no idea. I, just don’t have any evidence to support the fact they do work. The evidence, in my opinion right now shows that they don’t work, but we need more studies if you want to participate in these studies more power to you, but just know that you’re being experimented upon and you shouldn’t pay money for that. Okay, so we’ve talked a lot about treatments that don’t work and what to watch out for what does work for improvement erections? Well, it’s good news and bad news. The good news is is that you have proper diet exercise. If you get slimmer and you quit smoking, your erections will be better. Anything, that’s healthy for the penis is also healthy for the heart, etc. So the more your cardiovascularly fit, the better. Your actions will work and a lot of these studies that look at lifestyle change show that lifestyle change is as powerful as some of the medications we prescribe for problems, interactions plus you’re, getting that added health benefit – for heart, health, etc. So that’s the first thing we tell all men with problems, directions to do what are there other things? We can offer well clearly pills introduced in the early 80s pills like sildenafil, it’s viagra they can help with erections. These pills were originally invented for heart disease for angina, chest pain, but the people in the trials testing them didn’t, send the samples back, which is really weird, and so they discovered yeah. It helps with our actions. So if all the men who try them they’ll work in about two-thirds men in one third of men, that won’t work because the penis is too sick in the first place for the pills to help in general, if the pills are helpful for you, they’ll work about five years and then over those five years you don’t become immune to them, but your penis gets sicker. So now you need more powerful agents to try to help with erections. So what else do we have well back erection devices? This is a external appliance men apply and then they hit a hand, pump or a button and actually gives you interaction. Once you take this vacu device off, you’ll lose the erection unless you put a ring at the base that penis to trap the blood there, so these used to be covered by insurance. They no longer are. They are a good treatment for some couples who aren’t safe enough for some of the other treatments or happy with them penile injections. So, just like we talked about the shot clinics offering these medications a few slides earlier. Indeed, urologists and sexual health specialists will write prescriptions for these medications. Now only a few of these medications are FDA approved, and these are they single agent injections. The vast majority of injections that are written for by doctors and neurologists are not FDA approved. That doesn’t mean they’re wrong just means we don’t have great evidence about their safety from trials. However, we’ve been using peel injections for 30 or 40 years and, if you use them properly, they’re, safe and effective in about 75 to 80 percent of men with problems of the erections who fail pills. Finally, if none of these other options work or if you don’t want to try injections or the back device- or you can’t take the pills, because they’re unsavory or they’re no longer work, implant surgery has a high satisfaction rate. Ninety ninety-five percent of men would say that they would do it again, etc, and so that’s an option that any man heart healthy enough to climb a flight of stairs is healthy enough to fix their erections so see my other videos for more details, but all these above treatments remember that insurance will pay for the initial medical consultation proposal directions most of the time and for many of the treatments listed above. Interestingly, the coverage for pills is not awesome and it really depends on your insurer. But there are generic forms of these pills know which are much more affordable. Vacu erection device is used to be covered no longer, are they cost somewhere in the range of two to three hundred bucks? The pills are something like five to thirty dollars per pill, depending on which kind you get pealed injections, an entire vial, with about twenty doses, should cost about a hundred dollars so about five dollars per erection and then the penile implant surgery it’s going to depend. Sometimes it’s completely covered by insurance. Sometimes you have your copay. If you don’t have insurance that I can get expensive so make sure you check into those things before you do any of the above. Well, I hope you found that information useful. If you have any questions again, you can email me at IPP at mayo, edu or if you want to schedule appointment, use the number to the side of the screen until next time, tobe caller signing off for Mayo mid-south moment.