Erectile Dysfunction

The Penis Podcast Episode 5  |  Follow on Spotify | Follow on Apple iTunes

DR GAV: Hi everybody, I’m Dr Gavin Scriven, people call me Dr Gav, and with me is the founder of the non-surgical penis augmentation procedure we call CALIBRE, Dr Jayson Oates.

DR JAYSON: Thanks Dr Gav, and together we are the dick doctors and we are going to be talking about all things penis, our area of expertise is injectable penis augmentation. There’s a lot to talk about penises and together myself and Dr Gavin will be doing that.

DR GAV: Welcome, everybody, I’m Dr Gavin and I’m here with Dr Jayson from Perth. We are the CALIBRE Clinic and we’re here to talk about penises today, thanks for joining me today Dr Jayson.

DR JAYSON: Thanks, Dr Gav, and just to remind everybody, confidence changes everything. So, Dr Gav, today we’re talking about erectile dysfunction.

DR GAV: Yes, we are! It’s something that we talk a lot about with our patients, being the dicks doctors, and it’s unfortunately a very common problem people out there suffering with and not knowing where to turn or who to talk to. I guess my advice is always the first point of call would be your GP, don’t know if you agree with that, Doctor Jayson?

DR JAYSON: Yeah, well, the numbers seem to indicate that 50 percent of the men over the age of 50, in fact, even starting from the age of 40, have some erectile dysfunction. So the first thing would be to see your GP because it’s not just the function of your penis that you’re worried about with the erection, obviously it’s the flow of blood into the penis (fyi, the blood vessels in your heart are about the same size as the blood vessels in your penis). So if you’re not getting enough blood into the penis, one of the things that your GP may want to check out is the blood flow to your heart. So I guess as a GP, that’s something you’d be wanting to ask questions about.

DR GAV: Definitely, and that’s really interesting. You said it’s 50 percent of men over the age of 50!

DR JAYSON: Well, the study that I read was suggesting over the age of 40, and I couldn’t believe that. I’m over the age of 50 and that would be a concern if that many guys are having it. I don’t think it means that none of them can get an erection, it just means that they aren’t getting the erections and maintaining them.

DR GAV: Not like they used to when they were 18.

DR JAYSON: Yeah and the function that they wish to achieve with their erection.

DR GAV: Sure, well that makes more sense then. I’m sure if there was a survey put out asking if your erection quality, hardness and the duration of it was the same as when you’re 18, I’m sure a lot of people would put their hands up and say it wasn’t.

DR JAYSON: Yeah, that’s the other big one. I guess the two major functional things that can happen in a penis is a change to the blood flow or change to the nervous supply. So one, if you have cholesterol and therefore, the build-up of Atherosclerosis, decreases that blood flow into the penis, and if the nerves aren’t working as well and you’re not giving that nervous impulse that comes with the generation of an erection and nerve problems being very common in diabetes, becomes much more common with obesity and type two diabetes.

DR GAV: Yep. And in general practice, without screening, not only for diabetes but everyone over the age of 30 these days, even ladies who’s been through pregnancy, get screened for gestational diabetes, not that this is a problem with women, it’s very prevalent unfortunately, in our society today. Most guys wouldn’t realise this could affect the quality of their erections. Most understand it affects things like their eyes and feet. We conduct foot checks for diabetics but part of the common practice, I feel, should be doing an erectile dysfunctional check for people who are pre-diabetic or diabetic.

DR JAYSON: Yeah. Maybe if we spoke to younger people telling them they’re going to lose their ability to get an erection and that one of the major causes behind erectile dysfunction, (quarter of all erectile dysfunction cases) is put down to diabetes, would it have them getting out there exercising, watching their diets and losing weight.

DR GAV: Sugar would be off the shelves in their homes.

DR JAYSON: That’s right. So I guess the other thing that guys often think about is a change in their testosterone levels especially getting into their 50s. Do you check guy’s testosterone levels?

DR GAV: Yeah, as a GP, we do routinely check testosterone levels if someone’s come in to talk about erectile dysfunction, but I do let everyone know that it’s not a common cause of erectile dysfunction, rather one of the rarer causes, it’s probably one of the first things people think about. And especially with guys, I think it has something to do with the manly input, the testosterone levels. So of course, it’s a possibility and if you have low testosterone, that does affect erectile function, but it’s not a common cause.

DR JAYSON: So you may have erectile dysfunction and you may have a low testosterone level, but it doesn’t necessarily mean that’s causative.

DR GAV: Exactly.

DR JAYSON: And yes, if you go on testosterone, you get the increase in muscle mass and a possible loss in weight. Maybe you’ll have an improvement in your erectile performance, but once you start on testosterone, my understanding is that it’s hard to get off of it, because once you do, your natural production of testosterone is being suppressed and you can’t even get to the point where the testicles shrink, it doesn’t sound great. And if you stop your testosterone supplements, you end up feeling bad because it takes time for your natural testosterone level to come back up.

DR GAV: Yes, so I think it’s important to understand that there are many other causes other than low testosterone. Probably
the most common ones we’ve talked about already are the high cholesterol, diabetes, blood pressure, anything that affects the cardiovascular system in a negative way. That’s why I said at the very beginning, it’s important to start with your health checks, go to your GP, check your cardiovascular health and to look at the blood flow in your whole body at it’s important with regards to erectile dysfunction. And of course, the other major component we have mentioned is the psychological component, which is the other major cause of erectile dysfunction and I guess is part of the clinical history that we take as doctors, if we suspect is the case, then it’s a little bit more tricky to deal with. We still have to go through all the other checks and balances before we can say it is psychogenic in nature. It’s very important one to understand.

DR JAYSON: Absolutely. There was a time 30 years ago where the majority of erectile dysfunction cases were put down to psychological issues such as work related stress/exhaustion, etc. So we started to move more into the physiological side of things, the blood vessels and the nerves, etc., and that’s when we started getting the little blue tablets. And that’s when everything again was pushed back to being a physical cause.

DR GAV: Yeah, there’s multiple contributing factors.

DR JAYSON: Yeah, part of the problem is if a guy’s suffering from depression, stress, etc., he might get put onto antidepressant medications. And what’s one of the most common complications of some of them?

DR GAV: Erectile dysfunction.

DR JAYSON: That’s right. So then you’re in that sticky situation where if somebody’s got both depression and erectile dysfunction, does he continue with the medication or does he stop. It’s not an easy situation to be in. Also, blood pressure medications, in some cases maybe complicating things further. I guess part of the history is just checking what clients are on and whether it’s what we call iatrogenic that’s been caused by something that the doctor’s giving to them.

DR GAV: Yeah. So there’s many things that could affect a man’s erection, certain diseases, certain medications, psychological conditions, so it’s multifactorial and, as you said, one accompanied by the other, if you have a slight decrease in erectile function because your cardiovascular health is not as good, that can make you feel down which becomes a psychological issue then making you feel performance anxious and all this becoming one big vicious circle.

DR JAYSON: One of the things I tell all of my guys is exercise more, it improves your cardiovascular health. It’s a great natural way of improving your testosterone level. It’s actually shown to be almost as good for depression as antidepressants. If you look better, especially if you lose some of that tummy, it makes your penis look bigger as well, it makes you look more attractive all round. You’re more likely to get an erection if you exercise more. So there’s no downside to exercising.

DR GAV: Excellent. Well, if we can take one thing away, I think we’re both running home today.

DR JAYSON: I only live about five minutes away, so that’s not so bad.

DR GAV: Yes, so we touched on a lot of the causes, but you did mention one of the solutions previously?

DR JAYSON: Yes, so Viagra, as everybody knows, is that magic blue pill that can restore erections and it’s a “use as you need it” sort of thing. I isn’t something you take every day, it also has versions, like Cialis being perhaps the common one that has an effect for several days, which means you aren’t popping one as you need it. Whereas with Viagra its “oh you’re going to need an erection? Right. Time to take the blue pill.”

DR GAV: “The show is happening in the next hour”.

DR JAYSON: Yes. And so what was the idea behind the medications?

DR GAV: It’s to increase the blood flow, right?

DR JAYSON: Yeah, that’s where they came from. They were an offshoot of when they were looking for another blood pressure treatment medication and its side effect was dilating blood vessels into the penis and getting an increased blood flow and creating an erection. And then that leads to some of the complications of Viagra, which is that pounding vascular headache, because the blood vessels sort of dilated in your brain, lowering your blood pressure and then having to be really careful about mixing Viagra and some other blood pressure lowering medication or famously the Nitroglycerin paste or a heart attack. And so if you’ve had a Viagra, they can’t use the GT, in fact it drops your blood pressure so much that-

DR GAV: You might hit the floor.

DR JAYSON: Yeah, so that’s great. Unfortunately, Viagra doesn’t suit everybody, it comes in I think three separate strengths. So some guys have to higher and higher, but you can get to the maximum dose and still not have a benefit. Or the side effects can be too much.

DR GAV: And it’s obviously the other medication we mentioned before, some of them can be quite costly, ongoing if they’re using it on a regular basis. And some people don’t like the idea of medications and side effects. So I guess that sort of brings us to what other options are out there for erectile dysfunction.

DR JAYSON: So the next thing after the after the tablets is, is the injections, so more definite is to do the injections into the penis, which then dilate the blood vessels there and it can almost definitely create an erection in most guys. It means it’s a bit more intrusive, obviously, into the whole sexual adventure, if you’ve got to say “excuse me, I’ve just got to put a needle into my penis so I can get an erection”.

DR GAV: Kills the mood a little bit.

DR JAYSON: Yeah, it’d kill my mood.

DR GAV: But they can be highly effective, obviously and bypass some of the side effects that we get from the oral medications.

DR JAYSON: Yeah, the downside potentially of it is then having an erection that lasts too long, Priapism, and that can be a serious issue. It can be extremely painful for guys if it lasts longer than four hours. I had a patient come and see me and this was unrelated to medications, it was actually a blood clotting problem. He had an erection for four days and some guys might be thinking, hey, that sounds great, but no. It’s not great. Incredibly painful, incredibly embarrassing and unfortunately, that was his last erection, it damages the nerves in the blood vessels in there. And so, again, he was looking for a solution for now. Truly serious erectile dysfunction.

DR GAV: So injectables may not be for everyone either for a number of reasons. So then what next? Really after that, I guess there are more novel treatments out there that have some evidence.

DR JAYSON: Yeah. So there’s a few things, the next real medical treatment obviously is the surgical one where they can either do a flexi rod or probably more commonly nowadays is the pumps which can be either in the scrotum or in your groin and you’ve actually got to pump that fluid into a bag that’s inside the penis that creates the erection. Now, this is obviously sort of a no going back type thing. And if nothing else has worked, then that’s the way of getting an erection, that’s the way. So then we’re starting to get into perhaps some more novel and at this stage, still experimental treatments. There is a urologist in Egypt who’s published a couple of papers on injecting Botox into the penis. So this was an interesting thing.

DR GAV: Counterintuitive I imagine.

DR JAYSON: It was like trying to get the wrinkles out maybe.

DR GAV: Relaxing the penis, people would ask, would that relax the penis?

DR JAYSON: Yeah, well, maybe relaxed is good. In fact, it relaxes the muscles around the blood vessels that are restricting the blood flow in there. And so I took a urologist who really understood the physiology of an erection. And of course, we use Botox to relax muscles in the face and get rid of wrinkles, but we also use it in places like the armpit to reduce sweating. It’s a particular nerve and a neurotransmitter that releases that chemical message from the nerve to the muscle or the armpit (the sweat plane). In the penis, it’s the same neurotransmitter going to that muscle that keeps the blood vessels closed down and restricts the arterial blood flow in. So we came up with this idea of injecting Botox, with moderate success. But the idea of success was perhaps to be able to lower your dose of Viagra or shift from doing an injectable treatment to go down to something like a tablet to be able to gain an erection. I’ve used it on a few guys but with limited benefit. For some guys, it perhaps reduced shrinkage and maybe we’ll talk about shrinkage as a separate topic. Perhaps it increases the blood flow into the penis, that’s still very experimental at this stage.

DR GAV: And then, of course, we both offer something in our clinics, which has a lot of scientific evidence behind it in certain areas of medicine, maybe not so much in this area, which is platelet rich plasma (PRP) that some people know as the p-shot, penile rejuvenation, many different names out there that its recognised by. But essentially we’re taking people’s own blood, spinning it off down into its components and separating the platelets out of the blood into platelet rich plasma, so a higher concentration of platelets than you would find in your normal blood. We’re then injecting these back into the penis to stimulate some rejuvenation. Talk us through that a little bit more Dr Jayson.

DR JAYSON: So, platelets have a couple of main functions, the clotting process, which helps stop bleeding. So that’s great, bleeding to death’s not a not a great outcome, but then you’ve got the injury there, So the platelets being already stuffed full of growth factors and there’s so many of them, like skin growth factors, blood vessel nerve, (there’s about 40 or 50 of them), and they continue to find more. A clever orthopaedic surgeon in Germany 30 or 40 years ago thought about doing this, spinning the blood down, getting the platelets, injecting into bad knees, elbows and shoulders. He wasn’t so great on doing the science and publications, but did enough good reports about it that many American basketball and footballers were going to him to have their PRP injected into their busted up joints. So when I had my knee meniscus injury and asked my orthopaedic surgeon about it, he said there’s not enough evidence and so I had the arthroscopy and where I had my cartilage shaved. Three months later, a review comes out saying that maybe PRP into the knee is just as good as having surgery. That was three months late for me. So it’s been around for a long time. Oral surgeons have also been injecting it into jaws. Dr Charles Grinnells in the US came up with this idea of wanting PRP to be injected into penises, which I thought was really brave because anything going into the penis, clots. My thoughts were “Is it going to then sort of dry up and drop off”? My understanding is that he tested it on himself first.

DR GAV: As every good adventurous kind of doctor will do.

DR JAYSON: Turned out that after thousands and thousands of treatments none have dropped off. PRP has that allure of it being your own platelets, there’s nothing foreign injected into you and no medication. It’s just encouraging the body to heal itself. We’ve both got the same PRP machine (I think) that generates about 10 times the concentration of platelets that’s naturally in your plasma, which is almost as high as any machine can get (a million platelets per mil). It is still experimental, there’s really no good scientific evidence that it does what it’s meant to and cure erectile dysfunction.

DR GAV: Anecdotally, what have you found with your clients?

DR JAYSON: Clients have liked it, but it’s subjective, so it’s really hard to know. Of course, I never get to see the benefit of it, but guys seem to be happy with it. There’s a few other indications that people use it for. Perhaps we’ll discuss that in another podcast. So it doesn’t seem to cause any problems, it involves needles, uses your own growth factor to stimulate increased blood flow and improved nerve function in your penis. Guys seem to be happy with it, so we do it.

DR GAV: And one of the things I notice for guys who do respond positively, which has been quite a high percentage, they notice morning and night erections more frequently. These were things they didn’t have before they came in.

DR JAYSON: Yeah I don’t really want to say it’s like this magical injection making you 18 again, but there’s certainly something about it. I really hope we get some more publications. Maybe we should be doing one ourselves? but you can’t do every publication in the area.

DR GAV: But it’s worth opening the conversation and encouraging others.

DR JAYSON: When you’re looking at the range of treatments that are available to you and if you’re looking at what can improve the function of your penis, the PRP injection is something that you should be considering or at least something you should know about.

DR GAV: Yeah, definitely. I think there’s not too many other things we haven’t talked about, apart from simply the low intensity shock wave therapy that some have mentioned?

DR JAYSON: So low intensity shock therapy, I think is definitely going to be something big in the future, certainly in Europe and now starting in the US, it’s becoming more and more popular. I’ve got about 30 or so studies that talk about it. So it isn’t electric shock, guys. Don’t worry, it’s not low level so don’t go and get a nine volt battery and start wiring yourself up to anything. It’s related to the machines that crack kidney stones for lithotripsy. The smaller handheld versions have been used in physiotherapy for quite a while. I always call it “the thumper” and if you experienced it, you understand exactly why, because it has this little hydraulic jack in it that thumps backwards and forwards and it can be done between five and 20 times a second, really. There’s something about low intensity shock waves going into the penis that release nitric oxide, stimulate stem cells and blood vessel growth. This was found elsewhere in the body and then some bright spots said “if it’s growing, new blood vessels opening up blood vessels, let’s use it in erectile dysfunction”. So in the last five or so years, lots of studies coming out, saying guys seem to be getting benefits going out to 12 and 18 months. We have it here in the clinic in Perth and are using it for other treatments as well. But yes, we find the guys are very keen but it’s not something that they want to rush into. We often combine it with the PRP shot so they’ll have the platelet rich plasma and a series of these low intensity shockwave therapies, but I’ve seen some remarkable transformations in erectile function with that. So they’ve gone from needing the injections to waking up in the morning with erections. So they certainly do work.

DR GAV: And makes sense to be combining therapies that are both stimulating blood flow into the penis.

DR JAYSON: Yeah, it does. And there’s really no downside to them. Its 0 medications and their potential side effects. For these, apart from the inconvenience of having to come in and have the treatment. That’s really it.

DR GAV: An interesting thing I learned from a sexual health physician that actually helped us train with our PRP device we use for the penis, was that you don’t have to stop any of your other standard treatments, for example, medications, they also increase blood flow into the penis. He believes if you continue to use those medications, exercise, be healthy, it create as much blood flow into the penis as possible. It’s like a muscle in any other part of your body. If you increase the blood flow and use it more often, it will it will be healthier and stronger as a result. So I guess the moral of the story is to try everything, keep exercising and using it.

DR JAYSON: Yeah. Not that you’re saying that the penis is a muscle. We all know it’s not a muscle, there are little muscles in there, but the penis is not a muscle.

DR GAV: But yes, it’s about getting that blood flow into the base and combining multiple therapies to try and get that solution you want.

DR JAYSON: Yeah. Thanks a lot Dr Gav. That was great being able to talk about erectile dysfunction with you, I’m Dr Jayson, together we are the dick doctors. Remember, confidence changes everything, if you’ve got any comments that you’d like to make about what we’ve been talking about questions, feel free to post those below! we’ve also got some more interesting topics coming up soon.

DR GAV: Thank you very much for having me Dr Jayson, speak again soon.

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