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Erectile Dysfunction:
Common, but NOT a normal part of aging! 

Erectile Dysfunction (ED) is the most commonly reported sexually related problem by men.

It affects more than 30 million men in the United States. Symptoms vary from mild performance lapses to a complete inability to achieve an erection.

 

Erectile Dysfunction increases as men age. It is estimated 40% of men in their 40s experience ED, 50% of men in their 50s, 60% of men in their 60s, etc.  Surprisingly, ED doesn't only affect older men, as men in their 20s and 30s can experience erectile dysfunction

Erectile Dysfunction is defined as difficulty getting an erection firm enough or keeping an erection long enough for sexual intercourse.

Though it's not rare for a man to have some problems with erections from time to time, ED that is progressive or happens routinely with sex is not normal, and it should be treated.

There is NO reason why men cannot remain sexually active well into their 70s and beyond. 

Many men accept ED because they are embarrassed to speak with their health care provider about it. 

We make the process to get help easy, simple, and discrete.

Causes of Erectile Dysfunction

Many Different things can lead to Erectile Dysfunction:

  • Medical Causes: 

    • Low Testosterone/Increased Age

    • High Blood Pressure

    • Type 2 Diabetes

    • Cardiovascular Disease

    • Prescription Medications:

      • antidepressants, blood pressure medications, antacids 

    • Not Enough Blood Flow to the Penis​

    • Nerve Signals from Brain/Spinal Cord do not reach the penis

    • Benign Prostatic Hyperplasia (BPH)

  • Physical/Lifestyle Causes

    • Smoking

    • Alcohol Use

    • Obesity

    • Sedentary Lifestyle 

  • Emotional Causes​

    • Stress at home, work, socially

    • Anxiety

    • Depression​

    • Relationship Conflicts

    • Worry / Anxiety about Sexual Performance 

concerned man

Finding the cause(s) of your erectile dysfunction will help treat the problem and

help with your overall well-being.

Hormonal:  An optimal testosterone level is necessary for good erections. Testosterone stimulates the central nervous system to release neurotransmitters that help with erections, like dopamine, nitric oxide, and oxytocin. Testosterone stimulates penile tissues to produce nitric oxide, which starts a series of reactions that lead to an erection.  Low testosterone causes a decreased interest in sex which can secondarily impact erection quality, as well.  

 

Vasculogenic: This type of Erectile Dysfunction is caused by impaired blood flow into the corpora cavernosa of the penis. This can happen with age, high blood pressure, diabetes, or by taking certain medications.  

Neurogenic: This type of Erectile Dysfunction is caused by damage to the nerves that initiate blood flow to the penis. This can happen with diabetes, physical injuries, as well as with treatment for prostate cancer.

Psychogenic: This Erectile Dysfunction happens when arousal is impaired due to psychological factors. This is commonly due to performance anxiety or general depression.  Psychological factors can contribute to ED in any man, especially if you have experienced some failures in the past. Worrying about whether or not your erection is going to work "this time" can create a stressful situation impacting your ability to achieve an erection.

Lifestyle Causes: Erectile Dysfunction can be related to smoking, a sedentary lifestyle, stress, fatigue, alcohol use, or being overweight. These causes are addressed by lifestyle changes, such as increased exercise, employing methods to better cope with stress, losing weight, or eliminating alcohol consumption. 

The Male Erection Process is a Marvel of Divine Engineering:

Did you know the penis is capable of increasing its blood flow by a factor of

40-50 times over baseline within seconds?!

The male erection process is complex and involves the coordination of nerves, blood vessels, muscles, and the brain. All of these processes must work together for an erection to occur.

A breakdown in any area will result in erectile dysfunction.

Mechanism/Physiology of an Erection

How Erections Work 

During sexual arousal, nerves release chemicals that increase blood flow into the penis. Blood flows into two erection chambers in the penis, made of spongy muscle tissue (the corpus cavernosum). 

Flaccid vs Erect Penis

During an erection, the spongy tissues relax and trap blood. The blood pressure increases within the chambers which makes the penis firm, causing an erection.

 

When a man has an orgasm, a second set of nerve signals reach the penis and cause the muscular tissues in the penis to contract and blood is released back into a man's circulation and the erection comes down.

When you are not sexually aroused, the penis is soft and flaccid (limp). Men may notice that the size of the penis varies with warmth, cold or even with worry. This is normal and reflects the balance of blood coming into and leaving the penis.

Erectile Dysfunction Therapy
Oral Medication

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One of the available treatment options is an oral ED medication that works by preventing/inhibiting the action of the chemical phosphodiesterase type 5. Tadalafil is our primary 'go to" for this type of medication, primarily because it has multiple functions outside of simply addressing ED. It is protective of the prostate, treats symptoms of Benign Prostatic Hyperplasia (BPH) and Lower Urinary Tract Symptoms (LUTS), improves ejaculatory latency times, it increases blood flow to muscles delivering more oxygen and giving more of a "pump" in the gym, it also offers some improvement on blood pressure. 

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We recommend daily, low-dose tadalafil to avoid the awkward and unnecessary period of planning that prevents sexual spontaneityNo need to get ready, if you stay ready. 

Erectile Dysfunction Therapy
Penile Injectable Therapy

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Penile Injection 2 oclock

Trimix, Quad-mix, and similar penile injection products are the most powerful therapies for Erectile Dysfunction (ED) available. Many men with severe ED have found success with penile injections when other oral pharmaceutical tablets (such as, tadalafil) fail or when patients are unable to take the oral medications. 

These penile injections most commonly include a mixture of medications: phentolamine, papaverine, alprostadil (prostaglandin), and possibly atropine. These medications work together to dilate blood vessels and improve blood flow to the penis, creating a powerful erection within 5-20 minutes.  
 

Penile Injection close up

The medication is injected directly into the penis using a small needle usually in the middle third of the penis shaft, avoiding all veins, around 20-30 minutes before the sexual activity. Most men start to see the result in as little as five minutes and increases in rigidity over the course of 20 minutes. The erection will typically last for one to two hours, and will typically last after orgasm or ejaculation.

Since 1983, these ED penile injections have been utilized with great success for men. Although the thought of injecting a needle into your penis may sound intimidating and evokes thoughts of discomfort in many men, once trialed most men are very satisfied with this therapy. Also, you have the option of using a semi-auto-injector to make the process easier and a less intimidating. We can perform the first injection in the clinic and walk you through the process so you feel comfortable performing these injections at home.

 

These penile injections have proven to be a complete game changer for many men. Although the process looks intimidating, men are very happy with the process and the renewed confidence they have with knowing they have a therapy which works - every time.

Erectile Dysfunction Therapy
ESWT - Extracorporeal Shock Wave Therapy

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Before shockwave

Extracorporeal Shock Wave Therapy (ESWT) is a effective and non-invasive treatment option. 

 

ESWT stimulates increased blood flow in the penis and the formation of new blood vessels, which leads to an improvement in erectile function.

 

ESWT increases stem cell production, causes an increased release of growth factors, healing cytokines, nitric oxide, and substance P in the penile tissues.  

What are the shock waves used in ESWT?

 

Shock waves are sound waves. They occur in the atmosphere during explosive events, such as lightning strikes or when airplanes break through the sound barrier. Shock waves are acoustic pulses characterized by high positive pressure amplitudes and a steep pressure increase compared to the ambient pressure. They are capable of temporarily transmitting energy from the point of generation to remote regions. 

Focused shock waves are generated in the device hand piece by electromagnetic induction - electricity sent into a copper rod surrounded by copper coils, which creates a magnetic field. The magnetic field causes a copper membrane to move abruptly, which in turn produces a shockwave. The shock wave is reflected and focused into the tissues from the hand piece.

These shock waves are generated extracorporeally, i.e. outside the body, in a hand piece, and introduced into the target tissue with the help of a medium, usually gel, hence the name extracorporeal shock wave. 

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​In the tissues, these shock waves cause cavitations in cellular tissues. This process is called mechanotransduction, which is where cells sense the mechanical force exerted on them and convert it into a biochemical responses.

This stimulates intracellular and extracellular responses, ultimately causing the release of healing growth factors, stem cells, increased blood flow through angiogenesis (creation of new blood vessels) and improving rigidity of erections. 

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Does Focused Shock Wave Therapy hurt?

No. With a name like "Shock Wave" it seems like something that would hurt, but most people only feel a mild sensation that is described as a mild vibration or a "zing," but not pain. This is because the energy penetrates far beneath the surface of the skin where most skin sensation is felt. 


This is in contrast with treatments such as radial pressure wave therapy which do not penetrate deeply. Those radial pressure waves originate at the surface and are dissipated inward and, therefore, generally require medication to numb the skin prior to therapy. Focus Shock Wave Therapy produces better results without the need to apply external force (pressure waves) to the skin surface. 

Does Focus Shock Wave help with Peyronie's Disease (curvature of the penis)?

Yes. Focused Shock Wave Therapy is used to treat Peyronie's Disease, as their higher energy dense waves can be precisely delivered to an exact area up to 12cm under the skin. These precise, focused shock waves can be used to accurately target and break down the fatty plaques that cause Peyronie's Disease. 

What will I experience in an ESWT with a focus device?

The process begins with meeting with the health care provider to discuss the procedure. You will have warmed ultrasound gel applied to the penis and perineum areas. The focus shockwave device will be applied for a series of "pulses" to each of the areas indicated in the above diagram. You will feel the pressure of the device and potentially an internal vibration (also described as a non-painful, "zinging sensation").  The process takes about 30 minutes total.  

How many treatments are required?
Not surprisingly, there is a relationship between efficacy of shockwave therapy and number of treatments. Typically, research has shown 6 treatments to be the standard for most men; however, men with more severe ED will typically need 12-18 treatments.

Are there risks?

As with any procedure, there may be risks. However, complications would be very rare. Regarding potential side effects or adverse events of ESWT, only few studies have reported low grade complications, such as headache, dizziness, or heartburn. This suggests the safety of the procedure and side effects/adverse events may be more related to personal stress/anxiety related to the treatment instead of being caused by any physiological impact. You can read more about this in this article from the Journal of Investigative and Clinical Urology: Low-intensity extracorporeal shock wave therapy for erectile dysfunction: Myths and realities.

Do all types of shockwave therapy work to treat ED?
No. The only wave therapy proven to work for treatment of ED is called FOCUSED SHOCKWAVE THERAPY. Focused shockwave therapy has been shown to significantly improve erectile function in men with vasculogenic ED (the most common type) in randomized, double-blinded, placebo controlled clinical trials. There is NO strong evidence of efficacy for other therapies including radial pressure or acoustic wave therapy. Focused shockwave therapy addresses the root cause of ED. Radial Pressure Wave Therapy is better utilized for musculoskeletal conditions, not ED. 

Unlike radial pressure waves, focused shock waves promote the release of nitric oxide (NO), a vasodilator, meaning improvement in circulation by dilation of blood vessels. Research has shown that nitric oxide plays an essential role in erections, and nitric oxide deficiency can be a factor in ED itself. 

Are at home shock wave devices the same or produce similar results? 

While these at home devices may not hurt you; they are unlikely to produce results. The research showing the results of shock wave therapy for ED are all utilizing professional, medical grade devices, such as the Storz Duolith SD1 used by Precision Health Alaska. This matters because only a medical grade device can produce the frequency, intensity, and depth needed to achieve the results you need. At home devices are only radial pressure wave devices which are the equivalent of using a Theragun percussive massager on your penis. They do not emit true shockwaves. 

What Shock Wave device is utlized by Precision Health Alaska?
Precision Health Alaska is the only Alaskan clinic to offer Focused Shock Wave Therapy to date. Precision Health Alaska utilizes the Storz Duolith SD1, this is the same shock wave device used in most of the Erectile Dysfunction clinical trials demonstrating efficacy of this therapy. It is considered the best medical grade Focus Shock Wave devices available. 

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Sepia Handpiece

Erectile Dysfunction Therapy

Vacuum Erection Devices

​​
Vacuum Erection Devices are used to maximize blood flow to the penis. The penis is placed into the cylinder and the pump is used to draw air from inside the cylinder out so a vacuum is created. This vacuum draws blood into the shaft of the penis and causes it to swell and become erect.

Vacuum Penis Pump

Vacuum Erection Devices are recommended following ESWT, Shock Wave Therapy, to increase blood flow and encourage healing and angiogenesis. 
 
Men may utilize these in conjunction with a constriction band to maintain the erection prior to intercourse.
 
Medical-Grade Product Quality

Erectile Dysfunction Therapy

Lifestyle, Diet, and Exercise Support
And
Over-the-Counter Supplements

Lifestyle, Diet, and Exercise
​Sometimes it may seem easier to simply take a medication or have a medical procedure performed to get the desired effect - in this case, better erections. While different medical causes contribute to erectile dysfunction, such as diabetes, high blood pressure, etc., many people overlook the most basic things which significantly contribute to erection quality; things which are completely within their control to change. Specifically, lifestyle, diet and exercise choices. 
 

  • Lifestyle

  • Diet

    • Eat real, whole foods. Not processed boxed foods. A diet with high amounts of processed foods does not do you any favors when it comes to weight management, cardiovascular health or generalized health overall.
       

    • Focus on increasing your protein intake and reducing carbohydrate intake.
       

    • If you are overweight, change that. If you need help - ask. < Weight Loss Therapy >

  • Exercise

    • A sedentary lifestyle is directly connected to a decrease in blood flow which leads to the development of erectile dysfunction. 
       

    • Get Moving. If you aren't exercising, start - even if it is simply with walking every day.

Over-the-Counter Supplements Recommendations

Having optimal levels of certain nutrients have been shown to increase erection quality. There are many different supplements which have shown benefit, below are just a few along with supporting research.  

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Get Started with Erectile Dysfunction Therapy
The process of getting started is simple.
After submitti
ng your information, you will receive an email containing
intake forms and complete details of the process. 

There are never any HIDDEN FEES or COSTS. You know all costs up front. 

Step 1

Initial Consultation










$199 Lab Panel (one time fee)
$200 Consultation (one time fee)

A blood draw laboratory work-up will be performed, followed
by a 60-min consultation with the provider to discuss your symptoms, medical history, available therapies, along with a physical examination.  

Consult photo

Step 2
Therapy Selection
and Delivery










The diversity of Erectile Dysfunction Therapy options are quite broad. Each available option appropriate for your condition will be discussed with you in the initial consultation. 

If medications are needed, these are all delivered directly and descretely to you. 

 

TRT Delivered to Home

Step 3
Monitoring
and
Optimization











Follow-up appointments are determined by your therapy option, but you will know all the details up-front. 

  

Happy Couple Fixed ED
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