Human Sexuality * Erectile Dysfunction * Impotence

• V. Gary Price, M.D.

True or false? Everyone around us enjoys a completely carefree sex life. If you guessed "false," you're correct. In fact, experts estimate that one in three adults suffer some form of sexual dysfunction that can cause either temporary problems or develop into a chronic problem with serious emotional and physical results.

Urology Associates of North Texas has brought together, under the leadership of V. Gary Price, M.D., Director of the Center for Human Sexuality, specialists from several different areas with experience in human sexuality. These physicians in this Center of Excellence are specially trained in both the latest technology and procedures in order to effectively address human sexuality conditions.

Select from the following conditions to learn more about that condition and preparation information.

	Male Erectile Dysfunction (Impotency)		Vasectomy
	Male Infertility		Vasectomy Reversal
	Premature Ejaculation		Counseling (Individuals and Couples)
	Female Sexual Dysfunction		Peyronie's Disease
	Penile and Vaginal Reconstruction
	Sexual Problems due to Neurological Disease and Spinal Cord Injury

Male Erectile Dysfunction

Erectile dysfunction, or ED, can be a total inability to achieve erection, an inconsistent ability to do so, or a tendency to sustain only brief erections. The number of men in the United States who suffer from ED to some extent is estimated at one in ten, nearly 50% of men over 40 years of age.

Says V. Gary Price, M.D., Director of the Center for Human Sexuality at UANT, "Because of the complexity and subtlety of diagnosing and treating ED, a referral to a urologist trained in this specialty is often indicated. Current widespread consumer advertising for pharmacological ED 'cures' notwithstanding, a specialist can pinpoint the cause and optimum treatment for each patient's ED."

Since an erection requires a complex sequence of events, ED can occur when any of the events in this sequence - such as nerve impulses in the brain, spinal column and area around the penis, along with responses from muscles, arteries and tissues - is disrupted. Factors that can lead to a disruption include:

• Damage to nerves or tissues
  
• Diseases such as diabetes, Parkinson and alcoholism
  
• Surgery involving the prostate or bladder
  
• Psychological factors such as stress and anxiety
  
• Some medications commonly prescribed for high blood pressure, antidepressants and tranquilizers
  
• Lifestyle choices such as smoking

The most prevalent of causes is disease. In fact, diseases such as diabetes, kidney disease, chronic alcoholism, multiple sclerosis, atherosclerosis, vascular disease, and neurologic disease account for about 70% of ED.

Only a thorough diagnostic procedure can pinpoint the exact cause of the problem. This begins with a detailed medical and sexual history, followed by a physical exam. Due to the tremendous technological advances made in this area, there are now several treatment options available, from medication to improve blood flow to surgical implants. Counseling for psychological problems relating to ED is also available.

Treatments include:

• Oral medications such as Viagra, Levitra and Cialis. All increase blood flow into the penis. Studies have shown that up to 70% of impotent men experienced some improvement in erections when taking these drugs.
• Intaurethral pellets can be inserted into the urethra at the tip of the penis, causing blood vessels to relax and increasing the blood flow.
• Penile implants, an irreversible procedure. The primary surgical treatment for ED, inflatable devices or semi-rigid rods of silicone or polyurethane are inserted into the penis.
• Vacuum device. A hand pump is used to create a vacuum inside a cylinder placed over the penis. The vacuum draws blood into organ, making it erect.
• Hormone therapy is a less common treatment as less than 5% of men with ED have a testosterone deficiency. With this treatment, testosterone is administered by patch, topical gel or injection.
• Counseling, provided by specialists who treat diseases of the genitals and urinary tract, can help patients overcome the psychological factors associated with ED such as low self esteem and depression.

Premature (rapid) ejaculation

Premature or rapid ejaculation occurs when a man reaches climax before he and his partner are ready, which can have an adverse effect on their relationship. This condition can present itself at any time in a man's life and can be either learned behavior or a response to an unhealthy lifestyle. The good news is that the condition can be successfully treated by the human sexuality specialists at UANT with medications, counseling or a combination of the two.

Female Sexual Dysfunction

Sexual dysfunction effects approximately 4 out of every 10 women. This dysfunction can take several forms; the inability to achieve orgasm, a lack of desire or pain during intercourse. The causes can physical/medical, psychological, a symptom of stress or a combination of all of these.

The Human Sexuality Center of Excellence at UANT is currently expanding its offering of services in order to better diagnose and treat women's sexual problems. Following a complete physical assessment, your physician may recommend treatment ranging from pelvic muscle relaxation techniques to a surgical procedure that could correct a physical problem that is interfering your ability to have/enjoyment of sexual intercourse.

Penile and Vaginal Reconstruction

This type of surgery is one of the more difficult types of surgery for men and women to handle emotionally and physically. While extremely rare, cancer of the penis or vagina can lead to partial (glansectomy, partial vaginectomy) or complete (penectomy, radical vaginectomy) removal of these parts of the body. Reconstructive surgery is performed to restore these parts - most often using tissue from other parts of the body - and return their functionality as best as possible.

Peyronie's disease

Peyronie's disease is an abnormal curvature of the penis caused by scar tissue that prevents straightening of the penis during an erection. . Peyronie's disease is seen most frequently in middle-aged and older men, and the curvature may be so severe that it prevents penetration during intercourse.

Counseling (Individuals and Couples)

Consider this: No one's sexual problem is their own. Whenever an individual suffers with some physical or emotional sexual dysfunction, it has a profound effect on their partner as well. Sex therapy is a focused form of counseling that helps people overcome emotional, physical and medical concerns that may be prohibiting them from having satisfying sex. This therapy, which we encourage you to participate in as a couple, can enhance self-esteem, add warmth and intimacy to your relationship and finally, enrich your life.

The first step is recognizing the problem.

Says V. Gary Price, M.D., Director of the Center for Human Sexuality at UANT, "Problems with sexual dysfunction are more common than you think. The first step in any treatment is recognizing the problem. Once you've taken that first step, the specialists here at the Center for Human Sexuality are well trained to provide you with the treatment you need in order to have a more fulfilling sexual relationship."

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