1. Erectile Dysfunction (ED) What Men Should Know Paul Gittens, MD, FACS Medical Director Philadelphia Center of Sexual Medicine

2. P  Dr. Paul Gittens is the medical director of PCSM  Expert in the field of Sexual Medicine  Dr. Gittens is a board certified urologist that underwent specialty training in Sexual Dysfunction, Hormone Replacement and Male Infertility  PCSM is a concierge modeled practice treating only problems dedicated to the sexual health of men and women  More time dedicated to patient and education  Excellent outcomes

3. Male Sexual Dysfunction & Infertility Hypogonadism (Low testosterone) Erectile Dysfunction Penile Prosthesis Peyronie’s Disease Premature Ejaculation Ejaculatory Dysfunction Male Infertility Orgasmic Dysfunction Vasectomy Reversal No Scalpel No needle vasectomy Libido

4. What is ED?  ED is the persistent inability to achieve and maintain erection significant for sexual intercourse  The reality is that ED comes in many different forms  Difficulty initiating an erection  Difficulty sustaining an erection  Stuttering erections, etc

5. Is it in my head? Mostly No, but Yes Anxiety ED

6. What causes ED ?  Vascular disease- heart disease, high cholesterol, hypertension  Neurologic disease- Parkinson disease, spinal cord injury, MS  Iatrogenic- prostate cancer treatment, radiation, pelvic surgery  Environmental- smoking, alcoholism, drugs  Hormonal- low testosterone, steroid abuse, excess estrogen  Medication- beta blockers, anti-depressants, water pills, SSRI  Psychological- anxiety, depression, anger, stress

7. Shared risk factors with cardiovascular disease  Diabetes  High blood pressure  High cholesterol  Cigarette smoking  Lack of exercise  Obesity  Metabolic Syndrome

8. Does the size matter?  Having ED proceeds the onset of heart attacks – Smaller vessels are affected first. 3.0- 4.0 mm1-2mm

9. What not to do:

10. Speak to a sexual medicine physiciansexual medicine physician  Focuses only on men’s health  Expert in the treatment of all sexual dysfunction and hormone disregulation  Time to explain your problem  Education on how to treat  Provides effective treatment for your sexual dysfunction, male infertility or hormonal needs

11. Is there treatment? Yes!  Life style changes Calorie restriction Weight reduction Stop smoking, decrease alcohol intake Exercise Stress reduction Sleep Will also decrease rates of cardiac disease, diabetes, high blood pressure, and stroke If you help your body you will help your penis

12. Medical Treatment  Oral Therapy  Viagra  Cialis  Stendra  Levitra Not just giving you a pill and kicking you out of the office Better education leads to better results with oral medication

13. Direct Penile therapy ?  Penile injection therapy  FDA approved medication  Trimix  Muse- Medicated urethral system for erections Your Sexual Medicine Physician (SMP) needs to be be able to dose medication to obtain a penetration hard erections, appropriately provide thorough teaching on how to use medication, and be able to manipulate dose. PCSM has a variety of penile injection doses which are tailored for each individual patient. It is important that the SMP knows how to manage any side effects, i.e. priapism, burning

14. External Devices Vacuum erection devices Provide negative pressure suction to the penis causing erections. Different techniques can be used to obtain an erection and stretch the tissues of a damaged penis.

15. Penile recovery Penile recovery after prostate cancer treatment Philadelphia Center for Sexual Medicine- Penile Rehabilitation Program Dedicated program To preserve erectile function and prevent negative structural changes in the penis after prostate cancer or pelvic surgery and radiation Therapy begins before or after therapy  Uses a mixture of medication and treatments depending on individual needs If you don’t use it…..?

16. Penile Implant  Surgical treatment for severe ED  Short surgery  Effective  Highest satisfaction rate amongst therapies  Ready when you are Dr. Gittens is an experienced prosthetic surgeon and has placed hundreds of penile prosthesis

17. Summary  Erectile dysfunction is common  ED and cardiovascular disease share common risk factors  Treatment should be provided by a physician dedicated to sexual medicine and men’s healthphysician dedicated to sexual medicine and men’s health  Treatments should be multi modal and individualized Life style Effective Treatment PCSM

18. Take control of your penis? Thank you PhiladelphiaSexualMedicine.com