MEN’S YOUROLOGY

When ED pills don’t work well enough, is “more” actually better?

This systematic review and meta-analysis looked closely at whether combining erectile dysfunction (ED) treatments truly outperforms using a single therapy alone. Researchers analyzed 44 clinical studies including almost 4,000 men, with an average age of 56, comparing standard PDE5 inhibitor monotherapy (like sildenafil or tadalafil) with combination approaches. Overall, combination therapy led to a statistically meaningful improvement in erectile function scores compared with pills alone, without increasing side effects. The benefit was especially notable in hard-to-treat groups, including men who previously did not respond to PDE5 inhibitors, those with low testosterone, and men with ED after prostate surgery.

What stood out most were certain combinations. Adding a vacuum erectile device to PDE5 inhibitors showed the largest improvement in erectile function scores, followed by low-intensity shockwave therapy, daily (low-dose) tadalafil, and specific add-ons like folic acid or metformin, though many of these were supported by only one study each. Importantly, not all add-ons helped: alpha-blockers and pentoxifylline showed no clear benefit. So for men who don’t respond well to pills alone, thoughtfully chosen combination therapy may offer a real advantage, without added risk. But the details matter, and the strongest options aren’t always the most obvious.

WOMEN’S YOUROLOGY

Can something as simple as cranberries really prevent urinary tract infections or have we oversold the hype?

This review takes a hard look at whether cranberries truly help prevent urinary tract infections, and for whom they actually work. The authors analyzed 50 randomized controlled trials involving over 8,800 participants, including women with recurrent UTIs, older adults, children, pregnant individuals, and people with bladder emptying problems. The key finding is more nuanced than “yes” or “no.” Cranberry products reduced the risk of symptomatic, culture-confirmed UTIs, with the clearest benefit seen in women with recurrent UTIs. In this group, cranberry use lowered UTI risk by roughly 26% compared to placebo or no treatment. The strongest evidence came from cranberry juice and capsules with 36mg proanthocyanidin (PAC) content, the active compounds thought to block bacteria from sticking to the bladder wall. Importantly, cranberry products did not meaningfully reduce UTIs in older adults in nursing facilities or in people with neurogenic bladder.

Clinically, this means cranberries aren’t a cure, but for the right patients, they may be a reasonable, low-risk preventive option alongside standard care. Adherence and formulation mattered, and not all cranberry products performed equally. For patients trying to avoid frequent antibiotics, these findings make cranberry prevention worth a closer look, while also showing exactly where it falls short.

This week, someone asked me, “I dont really know if I am suffering with ED but I was with a girl and each time i got hard before i got in my penis would go down again How can I last longer in bed too How do I know if my penis is a micro or average penis”. Losing firmness before penetration could be mild erectile dysfunction or just nerves. I recommend you see your primary care doctor to evaluate any risk factors that might be associated with getting erectile dysfunction and talk to them or a urologist about options to help you, and review this video. As for size, most penises are in the average 3.5-6.5 inch range, so unless yours is much outside that, you’re likely totally normal.

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

The Better Sex App is 20% off from December 17 through January 2 only! So if you’ve been thinking about improving your sexual health, this is the perfect time to start, for less than a dollar a day.

Inside the app, you’ll get personalized guidance for common sexual health concerns plus access to an AI coach trained directly by me, all designed to support you privately and judgment-free.

HIGHLIGHTS FROM MY CHANNEL

I dove into a fascinating conversation about hypersexuality versus just having a high sex drive, and how to tell the difference. “There’s nothing wrong with having a high sex drive, but generally it’s a great idea to find a partner who has a matching or similar sex drive.”

Here are some quick takeaways:

• Hypersexuality means urges you can’t control, not just liking sex a lot.

• It’s only a problem if it causes distress or negatively impacts your life.

• Most people who have more than 7 orgasms a week are totally normal—don’t stress the numbers!

Remember, if you ever feel your sexual urges are out of control or hurting your life, it’s important to reach out for help. Check out the full episode for more on when high sex drive is healthy and when to consider seeing a specialist!

HIGHLIGHTS FROM MY PODCAST

My conversation with Dr. Simone Dube is about something you probably never thought about: sex and intimacy in space! Honestly, this episode blew my mind. As Dr. Dube put it “Sexuality is a profoundly human experience. And we take it everywhere we go. We take it to technology, we take it to space.”

Some of the coolest points we covered were:

• Yes, sex is absolutely possible in zero gravity (with a few creative tweaks!).

• Managing intimacy in space is crucial for astronaut mental health and teamwork.

• AI companions and sex robots could change intimacy on Earth—and beyond.

Check out this episode to think about sexuality in a whole new way. So listen on Apple Podcasts, Spotify, or here and see why people are commenting, “Crazy but interesting chat”.

NEW MEDIA

Sharing a bed but waking up exhausted—or disconnected? Check out my new Substack: Can Sleeping Separately Save Your Sex Life?

In this article, I break down how snoring, mismatched sleep habits, and poor rest can quietly drain intimacy, and why “sleep divorce” may actually boost energy, desire, and relationship satisfaction.