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Urologic Care for Sexual Health

Although sometimes difficult to acknowledge or discuss, sexual complaints such as erectile dysfunction and premature ejaculation are common and increasingly easy to address through consultation or medical or surgical care. Among specialists, urologists serve as the source of evaluation and intervention for men experiencing problems with sexual function, just as gynecologists serve as the primary point of such care for women. (Some urologic conditions can impair desire or cause discomfort in women, though, thus compromise sexual function.  Virtua urologists can treat these physiologic causes of sexual problems.)

Men should and often do see their primary doctor first to explore such problems.  Today, these primary-care physicians can provide more than advice and counseling, with medications that are effective for many men, particularly those experiencing erectile dysfunction. But for patients who need additional care, the family physician may refer to an experienced urologic service such as that at Virtua.

Finding the Cause of the Problem

Virtua urologists are extensively trained in care for problems in male sexual function. These specialists can further diagnose and identify the emotional or physical issues that may be the cause of these challenges.  Most cases have a physical basis; however, stress, anxiety and depression can also play a role in sexual dysfunction.  By far the most common complaint in sexual function among men is compromised ability to achieve an erection, and the experienced urologist can help to determine the factors contributing, which can include sometimes overlapping emotional, hormonal, vascular, cardiovascular, neurological or drug side-effect variables.  Conditions of the genitals can also cause pain and dysfunction that diminish sexual performance and satisfaction.

Testing may include completion of questionnaires, nocturnal penile tumescence testing neurologic testing, ultrasound penile Doppler flow studies, vasoactive medication stimulation test (injection of prostaglandin into the penis), or blood tests or endoscopy.

Therapy an Option

Virtua urologists have an understanding of the psychological factors that may contribute to erectile or ejaculatory problems. They have referral and collaborative relationships with certified sex therapists, to whom they send patients when they cannot find an organic cause of sexual dysfunction. Assessment of the sexual function of the patient’s partner may also be part of sex therapy.

A Surgical Solution If Other Steps Fail

As a result of physical circumstances, some men do not respond to any measures involving counseling or medication (including including prescription erectile-function aids or androgen therapy).  Sometimes the blood vessels or nerves that supply the penis may be deficient in function or injured.

For men for whom other measures have failed –– sometimes because they suffer from diabetes or have undergone cancer surgery or other operations –– the advanced urologic team at Virtua can provide penile prosthetics to restore erectile function.  The urologic surgeon conducts an operating-room procedure to place this implanted aid in the penis. The prosthesis consists of one or more inflatable cylinders in the penis, a pump in the scrotum, and fluid-filled reservoir behind the pubic bone.  The urologist puts the entire system in place through a small incision.  Men with such devices, activate the prosthesis with a pump that forces sterile solution from the reservoir into the cylinders, creating an erection that can be maintained as long as desired and easily stopped by pressing the release valve.

Help For All Patients

Other issues of male sexual health that experienced Virtua urologists can help address include low sex drive and difficulty in ejaculating.  In these cases, the cause is sometimes psychological, sometimes neurological and sometimes a side effect of a prescription medication.  Premature ejaculation is also a common sexual problem that is usually behavioral and can be addressed through change in habits or therapy. Some men are helped by the use of condoms or creams that can reduce sensation. Penile curvature and priapism (an erection that lasts too long) also affect sexual health. The Virtua urologist can offer testing, counseling, and treatment for these conditions

Problems with sexual function affect many millions of men in the U.S.  But treatment can be very effective.  Patients should choose a caring, experienced urologic group, such as that at Virtua, to manage this evaluation and intervention in sexual health.

NPT Test

Men with normal sexual function have several sustained erections per night (during each cycle of REM sleep).   Testing that reveals the presence and quality of these nocturnal erections (the nocturnal penile tumescence test or NT test) can indicate that the physical aspects of erectile function are normal and that erectile dysfunction may therefore be psychological.   Conversely, the testing can confirm that physical ability to gain erections is compromised, if nighttime erections are insufficient.

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