These case studies demonstrate the manner in which we work with clients who have specific or common problems. The cases are real, but names are changed to protect the patient's privacy; our first priority.

Erectile Dysfunction

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Erectile dysfunction (ED) is the sustained or recurrent inability to achieve and/or maintain an erection to permit satisfactory sexual activity with penetration.
Under normal circumstances, when a man is sexually aroused, his brain sends a message down the spinal cord to the nerves of the penis. The nerve endings in the penis release chemical messengers called neurotransmitters, which signal the arteries that supply blood to the corpora cavernosa (the two spongy rods of tissue that span the length of the penis) to relax and fill with blood. As they expand, the pressure of the corpora cavernosa close off other veins that would normally drain blood from the penis. As the penis becomes engorged with blood, it enlarges and stiffens, creating an erection. Problems with blood vessels, nerves, or tissues of the penis can interfere with an erection.

Premature Ejaculation

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Premature ejaculation (PE) is a condition in which a man ejaculates (comes) earlier than he or his partner would like to achieve sexual satisfaction. The benchmark characteristic of premature ejaculation is the inability to prevent ejaculation for one minute (or less) after sexual penetration. A range of factors can lead to PE, including stress and anxiety. In many cases it is a genetically inherited imbalance of neurotransmitters in the brain. Fortunately, medications can be used to correct this imbalance and significantly extend the time to ejaculation.

Penile Rehabilitation

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Penile rehabilitation for erectile dysfunction following surgery, radiation for prostate or surgery for rectal cancer.

The nerves to the penis are intertwined within the capsule of the prostate gland. Following surgery, even with full nerve sparing, bruising of the fragile nerves is inevitable and results in the absence of spontaneous or stimulated erections until regeneration occurs. The chance of nerve regeneration is difficult to predict but your odds are improved if nerve sparing was possible, you are under 60 years old, you are in good health and have full erectile function prior to surgery. 

Peyronie's Disease

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Peyronie’s disease is caused by progressive fibrosis (plaque) of the normally elastic tunica albuginea (the lining of the erectile tubes within the penis) resulting in curvature or other deformities of the erect penis. There may be pain initially, or it may be the curvature or scar tissue that is first noticed. There is a genetic predisposition. The incidence of PD has been found to be as high as 9%.

PD is thought to be an over-response to minor trauma of the penis which usually goes unnoticed. If the curvature is excessive, vaginal penetration can be difficult, partners may suffer pain resulting in significant emotional distress to both.

For diagnosis, normally a history and examination is sufficient but at times a penile ultrasound or penile Doppler ultrasound may be indicated.