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Sexual Dysfunction/Peyronie's Disease

Male sexual dysfunction is defined as any problem that prevents a man from being able to have normal sexual relations. This can be due to an anatomic abnormality causing curvature to the penis or a functional abnormality with the penis or the process of ejaculation. Sexual dysfunction problems oftentimes are not reported by patients to their physicians because of embarrassment or misinformation regarding the problem. Many effective treatment options are available.

Peyronie's Disease

Peyronie’s disease (PD) is a fibrotic tissue disorder of the penis that is characterized by the presence of excess collagen formations (often called plaque) that affects the erectile bodies of the penis. The fibrotic lesions reduce penile tissue elasticity and can result in penile curvature, painful erections, constrictions (hour-glass deformity), loss of length or girth and erectile dysfunction. The prevalence of PD is reported as approximately 6% of the male population with a slightly increasing incidence with older age.

Trauma to the penis is one of the most common causes of PD and can result during regular sexual intercourse when the penis bends or is struck severely, leading to scar tissue formation or plaques. These plaques can decrease normal tissue elasticity with the resultant changes in penile appearance. Genetics can predispose patients to PD. The presence of a family member with PD or other fibrotic tissue disorders such as Dupuytren’s contracture or plantar fibromatosis is associated with this condition. Medications belonging to certain drug classes have been reported to cause PD. Beta-blockers, anti-seizure medication (phenytoin) and certain supplements such as glucosamine / chondroitin or large doses of vitamin C are associated with PD.

Treatment options for patients with PD are various and depend on the degree of curvature and sexual disability in the individual patient. Many proven and unproven treatments exist. Your physician will determine which treatment option is appropriate for you. Treatment options found to be beneficial include:

  • Oral Medications (Vitamin E, Colchicine, Pentoxyfilline)
  • Topical Medications (Verapamil Cream)
  • Plaque Injections (Verapamil, Collagenases, Interferon)
  • Surgery (Penile Plication, Penile Grafting, Penile Prosthesis and Modeling)

Premature Ejaculation

Premature Ejaculation (PE) is one of the most common forms of male sexual dysfunction affecting approximately 30% of sexually active men. PE is found at the same consistency across all age groups, unlike erectile dysfunction which increases with age. Many men refuse to discuss the problem of PE with their physicians owing to embarrassment or misinformation regarding the problem.

The definition and diagnosis of PE can be made by several different classifications. Some physicians prefer to use an intra-vaginal ejaculatory latency time of less than 1.8 minutes to make the diagnosis of PE. However, we believe that a patient’s sense of control over ejaculation and patient/partner emotional distress is of equal importance. We prefer the broader definition of PE published by the American Urological Association as “ejaculation that occurs sooner than desired, either before or shortly after penetration, causing distress to one or both partners.”

There exist several effective treatment options for PE. Your physician can discuss with you behavioral modification, oral medication or topical therapy.

Erectile Dysfunction

Erectile Dysfunction (ED) is the inability to attain or maintain an erection of adequate rigidity and duration to complete sexual intercourse. Please click on the link to learn more about the diagnosis and treatment of ED at El Camino Urology.

Ejaculatory Dysfunction

A decrease in ejaculate volume can be due to several factors. Your ejaculate is composed primarily of fluid produced by your prostate and seminal vesicles which is under the control of hormones (testosterone). Sperm from the testicles contributes only a small fraction to the ejaculate volume (5%). This is why most men who undergo vasectomy do not notice a difference in their ejaculate volume.

The process of ejaculation first involves deposition of fluid in your posterior urethra (emission). This fluid is then forcefully expelled out the end of the penis during climax by contraction of the pelvic muscles (ejaculation). In order for the fluid to be expelled in a forward direction (antegrade), the bladder neck needs to close preventing the fluid from being expelled backwards into the bladder (retrograde ejaculation). Abnormalities in the production of seminal fluid or obstruction of the ejaculatory duct can cause problems with ejaculation as well.

There are several well known causes of decreased ejaculate volume. Enlargement of the prostate, prostate cancer, ejaculatory duct cysts, neurologic diseases, hypogonadism (low testosterone), surgery and certain medications can causes ejaculatory dysfunction. Contrary to popular belief, vasectomy does not cause any significant change in the ejaculate volume. Your physician can determine which treatment option is appropriate.

Decreased Sex Drive (Low Libido)

Decreased sex drive (low libido) is one of the most commonly reported symptoms in men with hypogonadism (low testosterone). Please click on the link to learn more about the diagnosis and treatment of hypogonadism at El Camino Urology.

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