Erectile Dysfunction (ED

)
What Men Should Know

Paul Gittens, MD, FACS
Medical Director
Philadelphia Center of Sexual
Medicine

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

Hypogonadism
Orgasmic Dysfunction

Male Sexual

Erectile Dysfunction
Penile

Dysfunction
&
Infertility

Prosthesis

Ejaculatory Male
Dysfunction

Infertility

Vasectomy
Reversal

Libido

(Low testosterone)

Peyronie’s Disease
Premature Ejaculation
No Scalpel No
needle
vasectomy

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

Is it in my head?
Mostly No, but Yes

ED
Anxiet
y

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

Shared risk factors with cardiovascular disease






Diabetes
High blood pressure
High cholesterol
Cigarette smoking
Lack of exercise
Obesity
Metabolic Syndrome

Does the size matter?

Having ED proceeds the onset
of heart attacks – Smaller
vessels are affected first.

12mm

3.0- 4.0 mm

What not to do:

Speak to a sexual 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

Is there treatment? Yes!

f you help your body you will help your penis

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

Medical Treatment

ot just giving you a pill and kicking you out of the offi

Oral Therapy



Viagra
Cialis
Stendra
Levitra

er education leads to better results with oral medication

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

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.

Penile recovery after prostate cancer treatment
Philadelphia Center for Sexual MedicinePenile 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…..?

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

Summary

Life
styl
e

PCSM

Effective
Treatme
nt

Erectile dysfunction is
common
ED and cardiovascular
disease share common risk
factors
Treatment should be
provided by a
physician dedicated to sexu
al medicine and men’s healt
h
Treatments should be multi
modal and individualized

Take control of your penis?

Thank you

PhiladelphiaSexualMedicine.com