Dr. Gapin defines ED as the inability to achieve an erection satisfactory for sexual intercourse. However, he points out the subjectivity of erection and reduces the definition to “inability to have satisfactory intercourse”. He distinguished ED from performance anxiety by looking at the psychological component of a person’s psyche that acts when one worries and develops anxiety about poor performance.
Various causes of ED
He distinguished various causes of Erectile Dysfunction into four categories and briefly talked about the disorders that could cause these malfunctions. Impaired normal nerve function Impaired penile blood flow Hypogonadism, thyroid, hyperlysinemia from poorly controlled diabetes and hypercortisolemia from chronic stress. The cognitive component plays an important role in erectile function. According to Dr. Gapin, stress can act as an inhibitory component in a person’s life that takes them away from the thought of sex.
Evaluation of ED
Dr. Gapin is involved in the systems-based approach to health care practice. She cautions people to recognize the multiple ingredients that could be causing ED before trying to fix it with a pill. He promotes a human systems approach with his patients, where he understands and addresses sleep patterns, stress, vascular health, hormones, and all other factors that could affect erectile function. It advocates adaptation to healthy diet and lifestyle change to reverse the effects of DM by improving glycemic control, weight loss, all of which have an effect on energy, hormones and cortisol, ultimately resulting in sexual health.
Improve erectile function by improving six areas of health
Dr. Tracy emphasizes improving six areas of health – Nutrition, sleep, mindset and stress, hormones, detoxification and fitness to ultimately improve erectile function. While quantity is an important factor in sleep, the focus is on sleep quality. Poor sleep is said to increase cortisol and blood sugar levels, cause you to store fat, and decrease testosterone levels, ultimately affecting sexual function. She advises eating a healthy diet by following an individualized plan of what foods to eat and avoid, as genetics play a big role in diet. As stress is a major component that men occupy in various aspects of their lives, he emphasizes practicing gratitude and mindfulness with the following meditation and nose breathing. In terms of fitness, Dr. Tracy recommends strength training, cardio, low-intensity activities, and stretching. For more than 50% of men, improving their health in all of the above areas will profoundly improve their sexual function.
Treatment options
Dr. Tracy talks about “band-aid therapy,” including oral medications and injectables. Oral medications commonly used are Viagra and Cialis and they last from 24-48 hours depending on the medication. Injectables such as trimix, bimix or quad mix are taught to be injected directly into the penis and give an erection for up to two hours. These treatments are short-term fixes and will not correct the underlying cause.
Correcting the underlying cause will help improve blood flow to the penis in the long run. He recommends a vacuum pump that works as a real vacuum by sucking blood into the penis to create an erection. A penis ring can be used to maintain an erection and help compress the penis. It is a non-invasive procedure and it is recommended to use it 10-15 minutes every day to have a profound effect.
Two of the regenerative treatments are gain wave and PRP. Gainswave is a low-intensity shockwave therapy that is used to focus shockwaves on a specific point under the skin to induce neovascularization and angiogenesis to create new blood vessels in the penis. It is done by stimulating stem cells and growth factors to produce new blood vessels and can be done in 8 to 10 sessions. Platelet-rich plasma (PRP) is when you draw a patient’s blood to separate the platelet layer and growth factor and inject it into five different places on the penis to stimulate the stem cells and growth factors to make new blood vessels. It is done in a single session.
Dr. Tracy talks about penile implants as a last resort. It is a surgical procedure performed by placing an inflatable cylinder-like device on the penis, which can be manually pumped to stimulate saline solution to flow from a reservoir located in the abdomen into the cylinder to produce an erection. It explains many disadvantages of the procedure, including a slight shortening of the penis, loss of sensitivity, loss of the sensation of a natural erection, and ruining the chances of ever having a natural erection.
Testosterone pandemic
Dr. Tracy opens up to us about some shocking numbers of falling testosterone levels and fertility levels over the last 30 years. He talks about the chemicals and endocrine disruptors in the environment that deplete hormones, causing immune diseases, obesity, infertility, hormone problems and cancers. He points out the difficulty in avoiding these as they are everywhere in our food, plastic water bottles, packaging containers, household cleaning products, personal care products – shampoo, deodorant, cologne, sunscreen, soap, etc. he says we need to teach and learn how to minimize exposure to these chemicals.
