Dr. Mohit Khera, a distinguished Urology and Andrology specialist and Professor at Baylor College of Medicine, delves into the intricate landscape of men’s sexual health in an engaging discourse on Dr. Peter Attia’s YouTube platform, offering profound insights into this crucial aspect of sexual health.
Unraveling the Root Cause of Erectile Dysfunction
A predominant theme in Dr. Khera’s dialogue is the intricate relationship between aging and erectile dysfunction. He unveils the core physiological issue underlying this condition, known as veno-occlusive dysfunction or venous leak, which serves as the main culprit behind erectile dysfunction in aging males.
Dr. Khera delves into the anatomical complexities, explaining, “Inside those two tubes are muscle and sinusoids, down the center of the tube is an artery… right under the Tunica albuginea are veins we call subtunical veins… As we age, atrophy and fibrosis of the muscle impede the ability to maintain enough pressure on the venous wall.” This breakdown of muscle and fibrotic changes hinders the proper maintenance of blood pressure within the penis, resulting in erectile dysfunction.
Therapeutic Strategies: Overcoming the Challenge
To surmount this physiological barricade, Dr. Khera delineates two strategies for treating erectile dysfunction. The first approach involves enhancing the inflow of blood into the penis using medications like Viagra to counteract the venous leak. By increasing blood flow, these medications help offset the impairment caused by the leak.
“In the aging process, we experience muscle atrophy and fibrosis…we can get the blood in, but we can’t keep the blood in,” Dr. Khera notes, elaborating on the physiological changes associated with aging and their implications for erectile function.
He further explains the mechanism behind erectile dysfunction and the solutions to counter it. “It’s a simple outflow-inflow game… if you give someone Viagra and you make the inflow 25, you can overcome the venous leak by increasing the inflow.”
Dr. Khera then introduces another method – the use of a penile band or a tourniquet. “Some people use something called a penile band…you can actually compress the veins and still allow the inflow…you’ll get a better erection because you’re blocking the outflow.”
For those hesitant about using a penile band, there are pharmacological solutions. “Most people say, ‘I don’t want to use a tourniquet.’ I say, it’s fine, just increase the inflow…we use intracavernosal injections, we use Viagra…we can significantly increase the inflow to overcome the outflow.”
He concludes by reaffirming the link between aging and erectile dysfunction, highlighting the role of lower testosterone levels in muscle atrophy. “Aging does cause a venous leak…lower testosterone levels have been implicated for causing penile muscle atrophy.”
The Interplay between Aging, Testosterone, and Atrophy
Dr. Khera’s research has revealed a profusion of androgen receptors within penile tissues obtained from procedures like penile prostheses.
As testosterone levels decline with age, the loss of androgen receptor activation contributes to muscle atrophy in the penis. Understanding this interplay between testosterone, aging, and penile muscle health is crucial in developing effective treatment approaches.
Advocating for Preventative Measures: The Role of Cialis
Dr. Khera strongly advocates for preventative measures to combat penile muscle atrophy and maintain overall penile health. He emphasizes the importance of regular erections in preserving penile muscle integrity and suggests using daily Cialis as a preventive tactic.
“Daily Cialis has been shown to cause hypertrophy of the cavernosa smooth muscle, keep the tissue healthy. I look at daily Cialis as a preventative measure to keep the tissue healthy.” This approach not only addresses erectile dysfunction but also provides long-term benefits in maintaining overall penile health.
Shattering the Silence on Sexual Dysfunction
Beyond the scope of erectile dysfunction, Dr. Khera draws attention to the extensive prevalence of sexual dysfunction in both genders. He emphasizes that over 52% of men over 40 and 43% of women in the United States experience some form of sexual dysfunction.
Despite this prevalence, a deafening silence surrounds these issues, causing individuals to “suffer in silence.” Dr. Khera seeks to break this silence and promote more openness and understanding surrounding sexual dysfunction, encouraging individuals to seek help and support.
Expanding the Treatment Horizon for Erectile Dysfunction
As the conversation progresses, Dr. Khera presents a panoramic view of treatment alternatives for erectile dysfunction. Alongside traditional medications like Cialis and Viagra, he highlights innovative modalities such as shock wave therapy, stem cells, and PRP. These cutting-edge interventions offer new possibilities and hold promise in treating erectile dysfunction, broadening the horizons for individuals seeking effective and proven solutions.
Dr. Khera further explores the connection between Peyronie’s Disease and testosterone levels, highlighting that 74% of men also have low testosterone levels. This correlation exacerbates the situation, as low testosterone levels contribute to decreased penile rigidity and hinder wound healing, promoting plaque formation.
To address Peyronie’s Disease, Dr. Khera outlines several therapeutic approaches. One option involves using an FDA-approved medication, Xiaflex or collagenase, injected directly into the plaque to break it down and improve the curvature. Surgical procedures can also be employed, such as cutting out the plaque and applying a graft or straightening the penis using stitches on the opposite side.
Penile fractures, which occur during sexual activity and manifest as a sudden pop or injury, necessitate immediate medical attention. Dr. Khera emphasizes the importance of recognizing the symptoms associated with penile fractures to ensure timely diagnosis and treatment, often involving surgical intervention to repair the fracture.
In addition to approved treatments, off-label methods and traction devices are also being explored for Peyronie’s Disease. These devices apply constant tension to the penis, resulting in a longer, wider, and straighter penis. For instance, the RestoreX device from Mayo Clinic bends the penis in the opposite direction of the curvature and shows promise in treating Peyronie’s Disease. Consistent and diligent use of these devices is crucial for optimal results.
Erectile Dysfunction Treatment Options: Injections and Penile Prosthesis
When oral medications like Viagra, Levitra, Cialis, or Stendra fail to deliver the desired results, penile injections can be employed.
These injections involve a cocktail of medications, such as trimix (phentolamine and prostaglandin), which dilate the arteries and effectively induce an erection. It’s important to note that the duration of the effect is dose-dependent, and these injections should always be administered under expert supervision to avoid complications such as priapism.
For individuals with more severe cases of erectile dysfunction where injections and other treatments prove ineffective, penile prosthesis implants offer a viable solution. This surgical procedure involves the placement of two cylinders or balloons inside the corpora cavernosa, a small pump in the scrotum, and a reservoir that holds normal saline. The user can control the erection by pressing the pump to bring saline into the cylinders, and deflation occurs when they wish to end the erection.
Considerations for Penile Prosthesis Surgery
Dr. Khera emphasizes the relative safety of penile prosthesis surgery, although all surgical procedures carry some risk. The critical factor lies in the experience and expertise of the surgeon performing the procedure. The infection rate associated with penile implant surgery is typically less than two percent, thanks to prophylactic antibiotics and strict operating room protocols. In the unfortunate event of an infection, the implant must be removed, and a waiting period of three months is necessary before a new one can be inserted.
In conclusion, Dr. Khera’s exploration of erectile dysfunction, Peyronie’s Disease, penile fracture, and treatment options provides a comprehensive guide to understanding and addressing these complex issues in men’s sexual health. His insights underscore the importance of early diagnosis, tailored treatment approaches, and patient education for optimal therapeutic outcomes. His wealth of knowledge offers invaluable guidance to individuals grappling with these conditions and healthcare providers seeking to enhance their treatment strategies.
