The treatment of erectile dysfunction (ED), premature ejaculation (PE), and anorgasmia (AO) is not simple and requires someone with expertise in medications and methods beyond giving you samples of the “little blue pill”. This is a more complex issue. In this blog we will learn a little more about what these terms are, and the medications used to treat them.
Erectile Dysfunction (ED) Any aspect of sexual function involving the penis. There are a multitude of causes. Remember, no men over 50 have “normal” erections if your point of reference is how you performed at age 25 or 30. So, welcome to the club. It could be as simple as occasionally losing your erection during sex, having more difficulty getting an erection, or not being able to achieve an adequate erection for penetration.
Testosterone (TRT) The penis requires testosterone to work properly. Patients with low testosterone levels will have much better success in treating ED when their testosterone levels are optimized. Some ED is “cured” just by optimizing T levels. This is more common in younger patients. This is managed through our clinic.
Troche ("trosh") A sublingual/lozenge form of medication. It dissolves under the tongue and is absorbed directly into the bloodstream. More medication gets into the bloodstream directly compared to swallowing a pill. Troches generally need to be refrigerated.
Tadalafil(tad) = Cialis This works like Viagra, but lasts up to 48 hrs. I prefer it as it gives you more bang for your buck, generally less side effects, and because it lasts so long, you can take hours in advance of anticipated sexual activity. And if you don’t get lucky, it will still be working tomorrow! We offer this in a troche form.
Sildenafil(sil) = Viagra The original PDE5 medication for ED. Lasts 4-8 hrs. Similar effect as Tadalafil, just shorter acting. Higher incidence of some side effects. Take about 30-60 minutes before sex. We offer this in a troche form.
IT MAY BE LOW TESTOSTERONELow testosterone may make getting or keeping an erection more difficult. Some men may notice a drop in libido while others may lose interest in sex completely. If your initial physical exam and blood test results show you have low testosterone, you may be a candidate for Testosterone Replacement Therapy.LEARN MORE
There are other PDE5 medications for ED such as Levitra. We do not carry this as our cost (and therefore your cost) is double compared to sildenafil/tadalafil. I do not feel there is a significant difference unless a patient does not tolerate sildenafil/tadalafil.
Apomorphine(APO) "Viagra of Europe". Apo and tad/sil are like ibuprofen/Motrin and acetaminophen/Tylenol. They accomplish the same thing, but in slightly different ways. The combination of both gives a better effect than just increasing individual dosage. The only patient who would not benefit from adding APO to the tad/sil is someone who has issues with premature orgasms.
DO YOU HAVE PREMATURE EJACULATION?Learn more
Apo improves sensitivity and improves the ability to get to orgasm. We offer this in a troche form by itself but also in combination with tadalafil and sildenafil. Unless a client has issues with PE, I prefer the combination to plain sildenafil or tadalafil.
Oxytocin Oxytocin is naturally produced by the body. In fact, when a woman has an orgasm, especially if semen is deposited in the vagina (no condom), the oxytocin level jumps rapidly. It naturally suppresses cortisol, which leads to reducing anxiety, promotes restful sleep, and can help men and women more easily reach orgasm in many cases. It is often referred to as the “cuddle drug” due to the sense of contentment it can bring. We offer this in a troche form.
TriMix Generic term for all our injection treatments for ED. The painless injection is accomplished easily with an “autoinjector” similar to an insulin pen. It results in a reliable erection within minutes of injection and can be formulated to give as much hardness and duration as desired. TriMix may contain one or all the following components:
Most patients receive either a prostaglandin-only TriMix or a combination of all three ingredients. Some patients do not tolerate prostaglandin(pain). For these patients, we use a TriMix that only has papaverine and phentolamine. I then add tadalafil or sildenafil, with or without apomorphine, to replace the prostaglandin effect (better firmness).
“Cock Ring” Oldest ED remedy in history. Hard rubber ring that is placed over the penis before it gets completely hard. Prevents some blood flow out of the penis, thereby promoting a longer lasting erection. It has variable success. Often used with PDE5 drugs. These can be purchased at most sex stores.
Achieving orgasm “too soon”. This can be very subjective, but most would consider reaching orgasm with less than a few minutes of penetration as “too soon”.
(The treatment of PE is too complex to discuss here.)
TriMix Generic term for all our injection treatments for ED. The painless injection is accomplished easily with an “autoinjector” similar to an insulin pen. It results in a reliable erection within minutes of injection and can be formulated to give as much hardness and duration as desired.
PDE5 Medications See above. Some clients may notice delayed orgasms with these medications. It is more prominent when too much is taken. Can be effective for PE.
Dextromethorphan Works at the brain level to reduce the overall excitement that can lead to premature ejaculation. Comes as a sublingual troche and is taken about an hour before sex. We offer this in a troche form.
PE CAN SOMETIMES BE A PROBLEM FOR MEN WITH ERECTILE DYSFUNCTIONLearn more
Tramadol Prescription non-opiate pain reliever that works in a similar way as Dextromethorphan. It is a pill that is taken about an hour before sex. A prescription is called into your pharmacy.
Paroxetine (Paxil) Originally designed as an antidepressant like Prozac. These drugs work on the serotonin centers in the brain. Serotonin is an inhibitor of desire and sexual function. The effect is to reduce excitement and prolong the time to orgasm. Many women and men have noticed difficulty in reaching orgasm when put on antidepressant doses of Prozac and others. When taken as needed for PE, the effect can be remarkable. It may not work immediately but over time,can be very effective. A prescription is called into your pharmacy.
Anorgasmia(AO) Inability to have an orgasm despite having an erection. This can happen for many reasons. The PDE5 medications for ED (tadalafil, sildenafil, etc.) can cause this in some patients. TriMix injections can also be a cause.
The treatment of anorgasmia is difficult but not impossible. Trial and error is the rule.
Apomorphine. See above
Oxytocin. See above
Cabergoline (Dostinex) Increases the levels of dopamine. Cabergoline is from the dopaminergic family of drugs that increase the level of dopamine and decreases the levels of prolactin. Prolactin reduces libido and dopamine increases libido.
Cabergoline has been described as being able to do everything that Viagra can’t. This is because rather than induce an erection (as Viagra can), cabergoline has been shown to improve libido, orgasm and ejaculation (which Viagra has not). There have been reports of enhanced and multiple orgasms as well as stronger ejaculations. It is considered to have a very low side-effect profile. A prescription is called into your pharmacy. Unfortunately, it is not inexpensive but is only taken twice-a-week.
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It could be said that testosterone is what makes men, men. It gives them their characteristic deep voices, large muscles, and facial and body hair. It plays a role in sperm production, fuels libido, and contributes to normal erections. It also fosters the production of red blood cells, boosts mood, and aids cognition.
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