Male Sexual Dysfunction

Low T or Testosterone Deficiency
Low T or testosterone deficiency is a drop in the hormone called testosterone. The condition may be associated with ED and is a common occurrence among men as they age. 

Erectile Dysfunction (ED)
Erectile dysfunction is defined as being unable to get or keep an erection that is firm enough to have sex.

Peyronie’s Disease
Peyronie’s Disease is a form of erectile dysfunction and refers to a build-up of collagen, plaque or scar tissue that causes the penis to bend, curve or form an hourglass deformity, which makes erection painful.

Ejaculation Disorders

• Premature ejaculation refers to ejaculation that occurs before or soon after penetration.
• Inhibited or delayed ejaculation means ejaculation is slow to occur.
• Retrograde ejaculation refers to semen being forced back into the bladder at orgasm, instead of leaving the body through the urethra and out the penis. 

Behavioral Techniques

Your doctor may instruct you in several behavioral changes that can help you learn to delay ejaculation during sex.

Psychological Counseling

May be recommended to help reduce performance anxiety and help you find better ways to cope with stress.

Topical Anesthetics

May be recommended to reduce sensation and help delay ejaculation during sex.

Medication

Medications that keep the bladder neck muscle closed during ejaculation may be prescribed if retrograde ejaculation results in male infertility. Other medications may be prescribed to delay ejaculation.

Lifestyle Changes

If you do not have an underlying health problem or physical abnormality, your doctor may suggest an exercise regimen, dietary changes and relaxation techniques that can increase your interest or sexual desire. Smoking cessation is encouraged and current medications are evaluated to look for pharmacological causes of ED. 

Psychological Counseling

May be recommended as the first line of treatment for people with depression or anxiety.

Medication

Several ED medications increase blood flow to the penis. While most are pill form, some are injected directly into the penis or administrated through a suppository placed in your urethra. Medications may also be prescribed to slow the progression of Peyronie's Disease, improve erections, and decrease pain.

Penis Pump

The vacuum erection device is a hollow tube with a hand- or battery-powered pump that promotes erection by increasing blood flow to the penis. It may be recommended if medication is not effective.

Penile Implant

A safe, reliable and effective treatment for erectile dysfunction (ED) and Peyronie’s Disease. An inflatable prosthetic device inserted directly into the penis to provide an erection suitable for intercourse. This minimally invasive procedure is performed through small incisions which minimizes blood loss and recovery time. We use a minimally invasive technique through a small incision which allows quicker return to normal activity.

Testosterone Replacement Therapy

Topical gels, creams, patches and injection therapy can restore testosterone to near normal levels and minimize symptoms. Testosterone implants or pellets are a relatively new delivery method. They are placed under the skin of the buttocks and release testosterone over several months. Pellet therapy offers the convenience of extended interval dosing without exposing your spouse or children to hormone therapy. 

Injections and Traction Therapy

A medication is injected into the Peyronie’s scar to straighten the penis without invasive surgery. Traction devices apply upward tension on the penis to stretch it. Over time, this reduces the curvature caused by Peyronie’s Disease.

Penile Plication

Straightens a penis bent by Peyronie’s Disease. Stitches gather tissue along the longer side of the penis so that it matches the short side.

Penile Grafting

Lengthens the shorter side of the penis by removing the scar tissue and adding healthy tissue (graft). Occasionally, grafting may be combined with a penile implant.

Personalized Treatment
We develop personalized treatment plans that take into account your age and lifestyle. Together we choose the best option for you.

Access to a Large Network of Specialists
If your sexual problem is related to a medical condition, we arrange timely referrals to our network of specialists in cardiology, sleep medicine, neurology, and endocrinology. This is important as low T symptoms -- decreased sex drive, fatigue, falling asleep after dinner, memory and concentration difficulties, bone density loss and diminished work performance -- can be a sign of an underlying medical condition such as depression, sleep apnea, heart disease and diabetes. Erectile dysfunction, ejaculation disorders, and a loss of sex drive may also be symptoms of these conditions. 

Guidance and Counseling Regarding Sex after Cancer

We work closely with cancer specialists at Duke because male sexual disorders are a common side effect of cancer treatment. Our cancer survivorship program encourages a proactive approach to managing the sexual side effects of cancer treatment. We offer counsel and guidance on the available treatment options before your treatment begins.