Sexual Wellness: A Closer Look at Sexual Health in Men and Women
February 11, 2019
I am constantly surprised by my patients. It seems there is no age limit on having a healthy sexual relationship. Many patients, well into their 70s 80s and even 90s, are still enjoying the benefits of a healthy sex life. And yet, so many others have given up on their sexual health either because their partner cannot help them, or because they are unsure of where to seek help, or what help is available.
I hear the common complaint from men, “I would like to have sex, but my wife doesn’t enjoy it, so we have just given it up.“ For some couples, this is the best solution. But for most people, it is very sad to lose a part of your life that you enjoyed immensely. Conversely, I hear from some wives that they are very anxious to have intercourse, but their husband is unable to perform, and unwilling to get help. Probe a little deeper, and I usually find out that the husband is interested in help, but just didn’t know what was available or how to ask for it. A visit to your doctor is a safe place to speak frankly and honestly about your needs, wishes and desires. When it comes to sexual health, no subject is taboo.
For women, diminished interest in sex can be the result of menopause, a change in your hormonal status leading to vaginal dryness, itching or pain, decreasing sensitivity, and a decrease in ability to achieve orgasm. The number one complaint I hear is a loss of vaginal lubrication. Vaginal health can now be restored through the gentle application of Vaginal radiofrequency treatment by Votiva and ThermiVa. No hormone supplements are necessary. An office visit, with a treatment for 15 to 30 minutes, once a month for three months for a total of three treatments induces the best overall changes in the vagina. Multiple studies have shown, through biopsy and pathology that there is ingrowth of blood vessels, collagen, nerve endings and a whole lot of normal tissue induced by this treatment. The solution works especially well for women who have been advised against hormonal therapy, or who are afraid of it. That is the subject for another discussion. Bioidentical Hormone Replacement can be extremely helpful in this situation.
For men, it is usually about achieving and sustaining a solid erection. Once hormonal issues have been ruled out, by getting a normal testosterone level, care should be directed to the vascular structure and support of the erectile chambers. I like to think of the erectile chambers as a sort of reservoir which as it fills up with blood, reaches capacity against a rigid wall, shutting down the outflow of blood. The tributaries feeding the reservoir come from the cavernosal arteries, originating from pudendal arteries deep in the pelvis, these are fairly small vessels which are carrying an important amount of blood to create an erection. Any restriction of this bloodflow, and there will be difficulty achieving the erection. Things like smoking, high cholesterol, and anything that promotes atherosclerosis will affect these arteries. Smoking also directly affects the erectile chambers by constricting muscles instead of letting them relax. You see, erectile chambers are made up of many many smaller spaces, sort of like the structure of a sponge, and each smaller chamber is lined by smooth muscle which must relax in order to allow that chamber to expand and to fill up with blood. Nicotine causes an immediate constriction of these muscles. So does anxiety, by releasing adrenaline (Epinephrine) into the tissues.
As men age, these tissues become more inelastic, sometimes calcified, and less able to function normally. These changes can be treated by using two “regenerative” treatments for erectile dysfunction.
PRP, or platelet rich plasma, refers to the component of blood containing the important growth factors which induce tissue repair. This is the same stuff that the body unleashes naturally after an injury to heal wounds. PRP can be easily obtained with a simple blood draw in the office. When it is applied to the erectile chambers (corpora cavernosa) and the glans penis (corpus spongiosum), the blood platelets are activated to release their growth factors, and to repair the tissue. Scientific studies have even shown regeneration of cavernous nerves (the erectile nerves) after a PRP Injection. A large percentage of men report one or more of the following: an increased ability to maintain a rigid erection, better sensation, better girth, and longer orgasms. This approach works well for almost any man. There is no real risk to the procedure, as it uses your own blood. If a man is taking oral medications for ED (sildenafil, tadalafil, vardenafil, or avanafil) these medications become more effective, or may not be needed at all after PRP Injection.
LISWT, or Low Intensity Shock Wave Therapy, has been studied for about 10 years in its application for treating erectile dysfunction. Numerous studies report the benefits of the therapy, which is delivered through a hand held device. 5000 pulses are delivered to the penis in approximately 20 minutes, twice weekly for 3 weeks. No anesthetic is necessary. There are no serious side effects or contraindications. Research shows that LISWT creates a significant increase in the velocity of the blood flowing through the cavernosal (erectile) arteries. There is local recruitment of stem cells to the area. Release of substances like VEGF (vascular endothelial growth factor) enhance vascularity, and open more channels for blood flow.
I will always tailor a treatment plan to match the needs and goals of each man. In some cases, multimodal therapy is necessary. PRP, LISWT and oral therapies complement each other quite effectively. The huge benefit of this approach is the maintenance and restoration of normal sexual health, without the need for painful surgery or self injection. The duration of effectiveness can vary depending on the individual, most can expect improvement for 1-2 years after the treatment. The treatments can be repeated as often as necessary.
Several of our patients have kindly given testimonials on the effectiveness of our Sexual Wellness treatments. If you are interested in hearing their experiences, please visit our testimonial page here.
If you are having difficulties with your sexual health, please contact the Wellness Center day. We are here to support and treat you!
Additionally, I have made informational videos on Vaginal Rejuvenation and Sexual Health for Women, PRP Injection and Sexual Health for Men, and Bioidentical Hormone Replacement Therapy. Please watch below for addition information on how we treat Sexual Wellness at Dr. Gluck’s Wellness Center.
Wishing you the best in health,
Clifford Gluck M.D. FACS