MEN’S YOUROLOGY

Can erectile dysfunction actually be reversed—not just treated?

This review critically examined emerging regenerative therapies for erectile dysfunction (ED), focusing on whether these approaches can restore erectile function rather than temporarily bypass it. The authors reviewed preclinical and early human studies on low-intensity shockwave therapy (LiSWT), platelet-rich plasma (PRP), and stem cell–based therapies, primarily in men with vasculogenic ED (trouble getting or keeping an erection due to poor blood flow).

Among these options, low-intensity shockwave therapy had the strongest and most consistent clinical evidence. Across multiple randomized and prospective studies, LiSWT improved erectile function scores, particularly in men with mild to moderate ED, with benefits persisting months after treatment. Protocols using multiple sessions over several weeks appeared more effective than single or short courses. Importantly, LiSWT worked best alone or as an adjunct to PDE5 inhibitors, helping some people respond to pills again. PRP and stem cell therapies showed promising biological signals, but evidence was limited to small trials with variable preparation methods, dosing, and follow-up. Meaning it's too early to tell.

Clinically, this review suggests regenerative ED treatments are not equal. Shockwave therapy currently stands apart, while injectables remain experimental. The message is hopeful—but cautious—and underscores why patients should ask which regenerative therapy is being offered, and what evidence actually supports it.

WOMEN’S YOUROLOGY

Are Kegels really just about muscle strength, or are we missing the bigger picture?

In this review, authors take a deeper look at how pelvic floor muscle training (PFMT) actually improves urinary incontinence in women, not just whether it works. Drawing on clinical trials, imaging studies, and neurophysiological data, they examine PFMT’s effects across stress (leakage when you cough, sneeze lift heavy things), urgency (leakage when you can't make it to the bathroom in time), and mixed (both stress adn urge) urinary incontinence, primarily in adult women studied across Europe and Australia.

The key finding is that PFMT works through multiple mechanisms, not a single one. Stronger pelvic floor muscles improve urethral support and closure pressure, which is especially important for stress urinary incontinence. But the review highlights that it also helps with coordination and reflex control of the muscles helping urgency incontinence as well by preventing of involuntary bladder contractions (which make you feel like you gotta go!). These neuromuscular changes help explain why PFMT can also reduce urgency and leakage—not just leaks with activity. The most effective approach was supervised, correctly performed PFMT, often combined with bladder training and making sure to "squeeze before you sneeze" or do the muscle contraction when you're most likely to leak. Simply “doing Kegels” without instruction was far less reliable.

This shows that PFMT isn’t just exercise—it’s retraining a system. When done properly, it addresses both the muscles and the bladder-brain connection.

This week, someone asked me, “Why is there penile over sensitivity and premature ejaculation? Reasons and treatments please!!!”. Penile oversensitivity and premature ejaculation often happen together and can be driven by nerve sensitivity, anxiety, frequent rushing during sex, relationship issues, inflammation, or hormonal and neurotransmitter factors like serotonin. The good news is that this is very treatable. Treatments range from simple techniques like the stop-start method and pelvic floor exercises, to topical numbing sprays or prescribed medications—all proven to help you regain control and confidence. Check out my podcast on premature ejaculation for an in-depth discussion on YouTube here or your favorite podcast platform here.

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!

WHAT I’VE BEEN UP TO LATELY

I recently joined The Health Exchange Podcast for an honest, no-fluff conversation about men’s private health struggles that don’t get talked about enough.

We unpack what actually drives erections, desire, and performance, why issues like ED or early climax can be early warning signs of bigger health problems, and how prostate health, hormones, mental health, and relationships are all deeply connected. This episode is about moving past shame, understanding your body, and taking control of your health. Watch it now here!

HIGHLIGHTS FROM MY CHANNEL

I broke down some of the most common sex tips we all hear—and ranked them based on what really works (and what doesn’t). "To have really excellent sex, you need to put some effort into it. Anything worth having requires work. And it's okay to work on your sex life because the end goal is amazing."

Here are your quick takeaways:

• Talking openly with your partner about sex is absolutely essential for great intimacy.

• Foreplay and using lube are simple, evidence-backed ways to make sex better for everyone.

• Skip the pressure for things like simultaneous orgasms or what you see in porn—they’re just not realistic for most people.

At the end of the day, it’s all about communicating and finding what feels good for both of you. Want more advice scored and simplified? Let me know what you want me to cover next!

HIGHLIGHTS FROM MY PODCAST

I break down what’s actually “normal” when it comes to sex, and honestly, it’s a super refreshing take! I tackle the myths we all see in movies and share easy-to-digest info about the sexual response cycle, timing in the bedroom, and why communication matters most.

Here are some quick takeaways:

• Good sex is about learning and talking—not just anatomy.

• Arousal and desire work differently for everyone, and that’s okay!

• Satisfaction comes from connection, not comparing yourself to others.

Give it a listen if you need a confidence boost or want science-backed advice you’ll actually remember. Sexual health education should be for everyone! So listen on Apple Podcasts, Spotify, or here and see why people are commenting, “If I took this recording, time travelled 35 years back and showed it to my younger self, I would have had a much better life. Happy to have it now though, great education as always doc. You’re amazing.”

NEW MEDIA

Think you’re doing your Kegels correctly? You might be sabotaging your results. Check out my new Substack: Are You Doing Your Kegels Wrong? Here’s How to Get Them Right—From an Expert Pelvic Surgeon

In this article, I break down the biggest Kegel mistakes I see as a urologist, explain why technique matters for bladder control and sexual health, and share the exact approach I teach my own patients to get real results.