Can erectile function really be “rehabilitated” after prostate surgery—or is that wishful thinking?

This study set out to compare all major penile rehabilitation strategies used after prostate surgery, instead of looking at them one by one. Using a large body of randomized trials, the authors analyzed and ranked approaches such as PDE5 inhibitors (like sildenafil or tadalafil), vacuum erection devices (VEDs), injections, and combination programs to see which methods most improved erectile recovery.

The strongest and most consistent benefit came from combination therapy, especially daily or regular PDE5 inhibitors paired with a vacuum device. These approaches were more likely to restore erections firm enough for intercourse compared with no rehabilitation or single therapies alone. PDE5 inhibitors by themselves helped, but they worked best when started early and used regularly rather than “as needed.” Vacuum therapy alone showed modest benefit, mainly by preserving tissue health.

Why this matters: This study supports the idea that erectile recovery is not passive—you don’t just wait and hope. The most meaningful results came from early, structured, multi-tool rehabilitation, not one-off pills. It suggests that penile rehab works best when it’s proactive, consistent, and combined—shifting care from “treat later” to “protect function now.”

Is female sexual dysfunction actually rare—or just rarely diagnosed?

This paper pooled data from multiple international studies to answer a simple but uncomfortable question: How common is female sexual dysfunction (FSD) in primary care settings? up to 39% of women report ongoing sexual problems, including low desire, arousal difficulty, pain with sex, and orgasm problems. That's mroe than one in three!

The strongest and most consistent pattern was not age alone, but mental health, chronic illness, and relationship factors. Women with depression, anxiety, diabetes, cardiovascular disease, or hormonal changes were more likely to report symptoms. Pain-related conditions stood out as especially disruptive, often affecting desire and satisfaction at the same time.

Why this matters: In real life, this means sexual symptoms are not rare side issues—they are common health signals that often travel with other medical and emotional conditions. The study highlights a care gap: many women are never asked about these problems. Recognizing FSD earlier could shift treatment from silence to meaningful, whole-person care.

This week, someone asked me, “Hello Dr. Malik! Love your podcast! I am a 66-year-old male living with genital herpes since my 20's. I have found an amazing gal that I hope to marry someday. She knows about my STD. We have not had sexual intercourse. I haven't had an outbreak in decades. What are the risks involved with sexual intercourse? I still test positive. I don't want her to contract herpes as well. Thank you!”. Thank you for trusting me with this, and I really respect how thoughtful you’re being about protecting your partner. Even though you haven’t had a genital herpes outbreak in decades, it’s still possible to transmit the virus through skin-to-skin contact during sex, including when you have no symptoms—this is called asymptomatic shedding. The good news is, the risk of transmission is much lower when you have no active sores, and there are effective ways to further reduce the risk. Using condoms every time you have sex and considering daily antiviral medication (like acyclovir or valacyclovir) can significantly lower the chance of passing herpes to your partner. While no method is 100% foolproof, combining these approaches makes the risk very small, especially since you haven’t had outbreaks in so long. I encourage you both to talk with a healthcare provider about these options, so you can make an informed decision together and approach intimacy feeling as comfortable and secure as possible. Your openness and care for her really go a long way in building trust and safety in your relationship.

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!

This week, I attended an event to support my friend and colleague, Dr. Gabrielle Lyon, as she launched her new book, The Forever Strong PLAYBOOK. She’s still offering $400 in bonuses with your purchase, so it’s a great time to check it out here!

We’re also getting ready to release a brand-new course of our own very soon—and as a newsletter subscriber, you’ll be the first to hear about it and receive a special subscriber-only discount.

I tackled an important question about hormone therapy for women and why so many are told they’ve “missed their chance” even when that’s not always true. “Bottom line, guys, when is it too late to start hrt? The answer is it depends.”

Here are some quick takeaways:

I always tell women: if you don’t feel heard, get a second opinion. Your options might be wider than you think! Check out the full episode for more practical advice on hormone therapy and menopause.

Last week, I answer your burning health questions—everything from boosting erections to pelvic floor exercises! For anyone curious about what actually works: “When you look at data on sexual function medications, when I give you a placebo pill and I say, hey, here’s a sugar pill, it’s going to improve your erections 40% of the time… That’s called the placebo effect.”

Here are my top takeaways:

If you want more practical tips, this episode is worth a listen! So listen on Apple Podcasts, Spotify, or here!

Ever had to pull a medical tube out of your own body? Check out my new Substack: What It’s Really Like to Remove a Ureteral Stent at Home—A Urologist Explains.

In this article, I share what patients actually experience when removing a ureteral stent at home, how painful it really is, why doctors sometimes recommend DIY removal, and the key steps that can make the process safer and less stressful—based on both research and what I see in clinic as a urologist.