Sexual wellness continues to be a hot topic in the field of aesthetic medicine. One big reason for this is that many of the non-invasive treatment options available are not typically carried by other specialties since oftentimes they are not covered by insurance.
Within our practice, the area of sexual medicine is growing at a rapid rate as patients suffering from sexual dysfunctions desire alternatives to surgical procedures. Many times, oral medications are not tolerated, or appropriate, due to side effects and/or lack of effectiveness.
Specifically, erectile dysfunction (ED) affects over 50% of men in their 50s, and this number increases by 10% by every decade.
Erectile dysfunction is a physiological lack of adequate blood flow, along with venous and arterial insufficiency from either a disease, medication or psychological cause. History of hypertension, specific blood pressure medications and underlying hormonal malfunction are often associated with ED. Anxiety, depression and medications to is treat psychological disorders can also be associated with sexual dysfunction. Therefore, during the patient’s visit, a thorough health history and assessment must be completed in order to help determine the root cause of the issue.
This health history and assessment is completed by one of our highly qualified nurse practitioners who then creates a plan of care for the patient, which is physician reviewed and approved.
We have now entered an era where there are energy-based treatments that use soundwaves to improve and sometimes cure ED.
Low-intensity extracorporeal shockwave lithotripsy (LI-ESWL) uses soundwaves to break up damaged arteries and veins causing microvascular injuries and ultimately angiogenesis. While this technology has been around for over 20 years, recent studies have shown an approximate 80% success rate in improvement of erectile function1. Once a practitioner obtains specific training they can properly perform the treatment to maximize results.
There are number of trademarked names for these types of devices, but for our ED cases we use the Big D Wave™ from Zimmer Medizinsystems. While this has been a more recent addition to our practice’s treatment offerings, the patient request for this procedure is growing at an accelerating pace. Treatments are quick, taking only about 15 minutes to perform, and pain free.
The most successful course of our ED rehab therapy involves ten sessions of Big D Wave treatment, with a recommended frequency of twice a week for five weeks. Each visit takes approximately 15-30 minutes and consists of applying a specific protocol of energy via the soundwave transmitting wand. We also recommend that patients use a penile pump for at least ten minutes every day, as well as a low dose of a PDE5 inhibitor daily, in order to increase circulation in the penile tissue, which allows for increased blood flow to promote angiogenesis.
We also recommend a platelet-rich plasma injection into the penile tissue, otherwise known as the P-shot®, and medication review with hormone optimization. Adding the P-shot allows for further regeneration of the penile tissue as the cytokines and growth factors create a sort of ‘healing bath’ for the arteries and veins.
The P-shot procedure consists of drawing a patient’s blood and centrifuging the platelets away from the red blood cells. The resultant PRP is then injected into specific locations of the penile tissue, per protocol. Patients are prepped with topical numbing anesthetic prior to the procedure with minimal discomfort or bruising.
With this fine-tuned, patient-centered protocol, our practice has successfully helped multiple men with severe erectile dysfunction. Prior to therapy, these patients were not able to maintain an erection with the maximum dosage of PDE5 inhibitors. They had to use intercavernosal injections with an insulin syringe, which are painful and often ‘mood killing’, in order to maintain erection.
Typically, a patient can expect at least a step-down in treatment therapy. For example, if a patient requires a maximum dose of Viagra prior to ED rehab, after therapy that patient should have a realistic outcome of only needing to take a low dose of a PDE5 inhibitor on an as-needed basis, which is a promising result. PDE5 inhibitors are less likely to cause unwanted side effects at a lower dosage.
Some of our severe erectile dysfunction patients are now completely medication free. In addition, patients with moderate and mild dysfunction have experienced consistently positive results, with restored ability to obtain and maintain firmer, longer lasting erections.
Our office keeps future and existing patients informed of the services we offer via an e-mail list, as well as through social media outlets, radio talk shows and television appearances. We find that patients often hear about our services through a media outlet, and we have been extremely successful in helping both men and women enhance their sexual wellness, which has positive physical and psychological outcomes. We look forward to helping improve the quality of life for many more patients.
1. Kalyvianakis, Dimitrios et al. Low-Intensity Shockwave Therapy for Erectile Dysfunction: A Randomized Clinical Trial Comparing 2 Treatment Protocols and the Impact of Repeating Treatment. The Journal of Sexual Medicine, Volume 15 , Issue 3 , 334 - 345
About the authors
Jennifer Walden, M.D.
Dr. Walden is a board certified plastic surgeon by the American Board of Plastic Surgery and is fellowship-trained in cosmetic surgery. She has a full-scale cosmetic surgery practice and two medical spas in Austin, Texas, as well as a medical spa in New York City, N.Y. Dr. Walden is an active member of the prestigious American Society for Aesthetic Plastic Surgery, where she also serves on the Board of Directors and serves as the commissioner of communications. She is a member of the American Society of Plastic Surgeons and a Fellow of the American College of Surgeons. Dr. Walden is a clinical assistant professor in plastic surgery at The University of Texas Southwestern, and continues to be a leader in the cosmetic medicine industry.
Samantha Thiry, A.P.R.N.
Ms. Thiry is a board certified family nurse practitioner by the American Academy of Nurse Practitioners, and has had extensive training in the field of Urology. She graduated from Ohio State University, University of Miami and Barry University. She has been a clinical professor of psychiatric nursing for Miami-Dade College, as well as a nurse care coordinator for the Florida Dept. of Health. She is known by her colleagues and instructors for her academic and clinical excellence throughout her career.