What Actually Works for Erectile Dysfunction — And What Doesn't

Most men with erectile dysfunction (ED) are just handed a pill and sent home. But a major review says that's not enough. ED affects up to 71% of men and is often an early warning sign of heart disease, diabetes, or obesity — not just a bedroom problem.

The go-to ED pills like sildenafil (Viagra) and tadalafil (Cialis) remain the best first step, and they work well for most men. But there's a bonus many don't know about: men who took daily low-dose tadalafil (5 mg) had a 25% lower death rate and fewer heart attacks compared to men who didn’t take ED medications.. That said, these pills work less well in men with diabetes or after prostate cancer surgery — and up to 76% of men quietly stop taking them.

For men who don't respond to pills alone, combining treatments works far better. Adding a vacuum erection device, testosterone therapy (for men with low levels), or supplements like L-arginine to daily ED medication produced real improvements — with no extra side effects. Most strikingly, prostate cancer survivors who started exercise, daily ED medication, and vacuum device use before or shortly after surgery recovered sexual function at much higher rates than those who waited.

Newer options like platelet-rich plasma (PRP) and stem cell therapy show early promise but still lack strong enough evidence to recommend. The bottom line: ED is a whole-body issue, and treating it early, with the right combination of lifestyle changes, medication, and support, gives men the best chance at recovery.

Only 1 in 11 Women With a Common Menopause Condition Is Getting the Treatment That Actually Works

Many women after menopause deal with vaginal dryness, pain during sex, burning, and frequent urinary tract infections (UTIs). These symptoms come from a condition called Genitourinary Syndrome of Menopause (GSM), and there's a safe, effective treatment for it — low-dose vaginal estrogen (VE). So how many women are actually getting it?

In this study, researchers looked at over 1.8 million older women who had a GSM diagnosis, following them for up to 12 years. Shockingly, only 9% — roughly 1 in 11 women — ever filled a vaginal estrogen prescription. Even more concerning, the average wait time from diagnosis to getting a prescription was 15 months. Women with the most complex symptoms (multiple GSM problems at once) were far more likely to get treated, while women with recurrent UTIs — a condition VE is proven to help — were the least likely to receive it.

The gap in treatment wasn't the same for everyone. Younger and healthier women were more likely to be prescribed VE, while older women and those with more health conditions were often left untreated. Black and Native American women were also significantly less likely to receive a prescription compared to white women. Vaginal cream was the most commonly prescribed form, making up over 90% of all VE prescriptions — even though studies suggest many patients actually prefer tablets or rings.

This study is a wake-up call. A safe, well-studied treatment exists, yet the vast majority of women who need it are not getting it — often due to fear, misinformation, or simply not being offered it by their doctor. The findings point to a serious need for better education for both patients and healthcare providers, and a stronger push to close the gap in who gets treated and who doesn't.

This week, someone asked me, “What is cause of leaking semen without feeling it during foreplay and resulting in no or weak orgasm? What may improve the situation? @ age 83.” What you’re describing can happen as men age, and it’s often related to changes in pelvic floor muscle strength, prostate function, nerve sensitivity, or the muscles involved in ejaculation. Sometimes semen can leak during arousal or foreplay because the body is less able to control the ejaculatory reflex, and that can lead to a weaker orgasm afterward. Medications, prostate enlargement, low testosterone, and prior prostate procedures can also contribute. Pelvic floor exercises (you can watch my video about that here), reviewing medications, improving overall vascular health, and seeing a urologist for a hormone and prostate evaluation may help improve both control and orgasm quality.

I love hearing from you, so if there’s a question you’ve been wanting to ask, just let me know. Who knows? Your question might be the one I dive into next!

Last week I went to the American Urological Association meeting. While I was there I recorded 6 podcasts with some of the leading experts in urology on conditions including erectile dysfunction, low testosterone, anabolic steroids, peptides, kidney stones, and more! Can’t wait for you to hear them!

I dove into a topic that so many people wonder about but rarely discuss openly—why most women need more than just penetration to reach orgasm and how simple changes can make a huge difference. "80% of women can't reliably orgasm from intercourse alone and that is completely normal. The research would support that."

Here are the quick takeaways:

Remember, you’re not broken if penetration alone isn’t enough. Small adjustments make a big impact! Check out the full episode for all the details and practical tips.

I just had an awesome conversation with Dr. Tami Rowen about women’s sexual health, hormones, and how complicated desire really is. Dr. Rowen gave some super relatable advice, like: “Just because we can't explain it physiologically doesn't mean it's not real.”

She breaks down myths and really gets what we’re dealing with! A few takeaways that stood out for me:

Honestly, this episode will make you feel understood and empowered to ask for what you need. So listen on Apple Podcasts, Spotify, or here and see why people are commenting, “Thank you for doing your videos. I really don’t know anyone else discussing the topics you cover in such a comprehensive, mature, professional, nonjudgmental, and reliable manner”.

Why are so many women still left without answers about their sexual health, anatomy, and hormones? Check out my new Substack: Why Sexual Health Is Vital: Urology, Hormones, and the Truth About Menopause.

In this article, I break down the critical gaps in women’s sexual medicine—from misunderstood anatomy and menopause-related hormone loss to how language, stigma, and medical training shape (and often limit) the care patients receive.