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Virtual premature ejaculation consult
Dr. Ricardo Dunner, MD5.0(16)Internal medicine
"He was incredibly helpful and educational as far as why I had reoccurrences and even made me revisit my options that I had previously ruled out. He was kind, patient, and very relatable! So happy I chose him! I'll absolutely see him again !"The following inclusions and exclusions apply:
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Virtual ED consult
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What health conditions are more common in men in their 60s & up?
What about men in their 40s & 50s?
What about men in their 20s & 30s?
What types of doctor appointments are recommended for men in their 20s & 30s?
If you have any of the conditions we just mentioned - acne, anxiety, hypertension, or ED - you should see a doctor to get care. If you're sexually active, you should get tested for STIs regularly.
But the most important type of visit in your 20s and 30s is with a primary care doctor. Now is the perfect time to establish a relationship with a primary care doctor who can get to know you and your health over time - starting with a routine check-up.
What types of doctor appointments are recommended for men in their 60s & up?
If you have any of the conditions listed above - anxiety, hypertension, hair loss, high cholesterol, or ED - you should see a doctor to get care. In addition, doctors recommend a shingles vaccination at 50 and a pneumococcal vaccination at 65.
Doctors also recommend 4 important screenings:
- Colonoscopy at 45 - or earlier if you have a family history of colon cancer.
- Prostate cancer screening at 50 - or earlier if you have a family history of prostate cancer.
- Lung cancer screening at 55 if you have a history of smoking.
- Abdominal aortic aneurysm screening at 65 if you have a history of smoking.
How can I stay healthy as I get older?
What kind of specialties does Sesame offer?
Can doctors fix erectile dysfunction?
If ED is affecting your sex life? Causing you relationship problems? The best treatment for ED is to not stress about it. Most cases of ED are easily treatable with some ED medication and a few lifestyle changes. Erectile dysfunction is one of the most common men's health conditions, with nearly 1 in 3 men experiencing some form of ED during their lifetime. Men often experience ED as a result of aging or stress, or as a side effect of health problems such as cardiovascular disease, high blood pressure, and heart disease. If you book an ED consult visit with a primary care provider or men's health specialist (such as a Doctor of Urology), they can provide medical advice and treatment options such as:
Physical activity: Moderate to vigorous exercise can help increase blood flow and lower cholesterol. Blocked blood vessels and poor cardiovascular health are some of the most common causes of ED. Because of this, physical activity is one of the most effective and commonly prescribed erectile dysfunction treatments offered by doctors. Adopting a regular exercise routine can help fix ED, and improve mental health at the same time.
Counseling/ Sex therapy: ED can be caused by mental health conditions such as depression, anxiety, and stress. Talking to a licensed mental health professional, such as a psychologist or sex therapist, can help address stress management, performance anxiety, and other factors affecting your sex drive.
Prescription medication: Oral medication that relaxes blood vessels and increases blood flow to the penis can be used to treat persistent ED. Drugs such as sildenafil (Viagra), tadalafil (Cialis), vardenafil (Levitra) are approved by the FDA to treat erectile dysfunction and premature ejaculation. When diagnosing and treating sexual dysfunction, doctors prescribe these drugs to patients of all ages, not just older men.
Injections: For persistent cases of ED, doctors may recommend a penile injection of alprostadil to relax muscles and increase blood flow to the penis during sexual activity. Alprostadil can also be released into the body by a tiny suppository inserted into the urethra before sex. If ED is being caused by hormone conditions such as changing testosterone levels, an endocrinologist may recommend a hormone injection to boost low testosterone.
Mechanical aids: Devices such as penile implants, or vacuum erection devices (penis pumps) can help stimulate blood flow during sex. Penile implant surgery is usually reserved for patients who have severe conditions that prevent erections (such as Peyronie's disease). Penile implant surgeries are usually performed at health care centers such as hospitals or urology clinics.
There is no one cause of ED, just like there are many treatment options. Talk to a primary care doctor or urologist if you experience persistent erectile dysfunction, as ED can often signify other health conditions. Don't wait to get control of your sexual health. Book a virtual erectile dysfunction consult on Sesame to discuss your symptoms and treatment options that might be right for you- all at affordable cash prices up to 60% less than what you'll find through insurance networks.
What kind of doctor should a man see for erectile dysfunction?
Primary care providers (sometimes known as family doctors), as well as Doctors of Urology, are capable of diagnosing and treating erectile dysfunction. It's generally recommended that you speak to a primary care provider (PCP) first to help determine if any underlying conditions or health problems are causing your erectile dysfunction. From there, your PCP might refer you to a urologist or endocrinologist, based on your medical history and symptoms.
Urologists specialize in the urinary tract and reproductive systems of both men and women. A urologist can conduct urine tests, as well as penile ultrasounds to check for conditions such as kidney disease, STIs, or blood flow issues that might be causing erectile dysfunction.
Endocrinologists specialize in the diagnosis and treatment of conditions related to hormones and the glands that create them. You may be referred to an endocrinologist for ED if your primary care provider thinks that your sexual health is being caused by low testosterone or other hormonal issues.
Is ED a symptom of other medical conditions?
Erectile dysfunction can certainly be a physical side effect of several medical conditions and psychological issues.
Erectile dysfunction is one of the most common forms of male sexual dysfunction. In fact, ED affects nearly 30 million men worldwide. The prevalence of ED cases can be attributed to aging. However, men of all ages experience sexual dysfunction caused by a wide range of health conditions.
Aside from age, common causes of ED include:
- Poor vascular health (heart disease, high blood pressure, lack of blood flow)
- Substance abuse
- Multiple sclerosis (MS)
- Psychological problems (such as depression or anxiety)
- Peyronie's disease (scar tissue inside the penis)
- Spinal cord injuries
Erectile dysfunction can be a touchy subject for a lot of guys. If you have difficulty getting or keeping an erection once in a while, you are not alone. Millions of men worldwide experience some form of ED at some point in time. If your ED is persistent, or if you're worried that it's a side effect of other health conditions, speak to a men's health care provider or Doctor of Urology as soon as you can. ED is extremely common but can signify underlying health risks such as heart disease, diabetes, or obesity. The good news? Most cases of ED are easily treatable with a prescription.
How do I know if I need a prescription for erectile dysfunction?
Is erectile dysfunction curable?
There are several treatment options doctors may recommend to reverse or treat erectile dysfunction and prevent it from occurring persistently. Some methods to help ED on your own may include:
Exercise: Moderate to vigorous physical activity done several times a week can increase blood flow by lowering blood pressure. This can help blood move through blood vessels in the body easily during sexual stimulation. Obesity, high blood pressure, and poor vascular health are all underlying causes of erectile dysfunction. Adopting a regular exercise routine can help reverse these effects.
Counseling/ Therapy: Erectile dysfunction can be caused by stress, anxiety, or depression. These mental health risk factors affect sexual stimulation and can make sexual performance/ arousal difficult. Speaking to a licensed counselor or therapist can help you with stress management, relationship issues, depression, and anxiety. Sesame offers Video Mental Health Visits with licensed therapists in Columbia, SC.
Routine Physical Exams: Some cases of ED can be caused by underlying medical conditions. Routine physical examinations are recommended for all adults, as they can help catch serious health problems and conditions early. ED might signify problems such as high blood pressure, diabetes, low testosterone, and more. If you are experiencing persistent ED, talk to your physician about any symptoms or concerns you may have. A primary care physician can screen for diseases, and discuss treatment options with you.
Quitting Smoking: Smoking causes blood vessels to narrow, limiting blood flow to different parts of your body. This can seriously affect your ability to get and maintain an erection. Additionally, chemical addiction can lead to psychological side effects, further complicating your ability to respond to sexual stimulation. Quitting smoking is a major lifestyle change that can positively impact your sexual health, your vascular/ cardiovascular health, and your mental health.
If lifestyle changes and mental health counseling doesn't improve your ability to get and keep an erection, you may want to speak to your primary care physician about your persistent erectile dysfunction. A primary care physician can discuss ED treatment options for you, including:
Prescription medication: Your doctor may prescribe oral medication (known as PDE5 inhibitors) to treat persistent ED. The Food and Drug Administration (FDA) requires a prescription to obtain these drugs, but they have been proven effective by clinical trials. Oral erectile dysfunction medication relaxes muscles in the penis by increasing the effects of nitric oxide in the body. Nitric oxide widens blood vessels, resulting in improved blood flow throughout the body. This can help you get an erection in response to sexual stimulation. These drugs do not cause erections but allow the blood flow needed for function during sexual intercourse. These prescription drugs include:
These oral medications have been known to cause mild, short-term side effects such as headaches, congestion, muscle aches, and indigestion. Because of this, it is recommended that you talk to your doctor before taking any PDE5 inhibitors to be sure that oral medication is the right treatment plan for you.
Alprostadil injection/ urethral suppository: Alprostadil is a drug used to treat ED that opens blood vessels and increases blood flow, improving erectile function. Alprostadil is most commonly administered in 1 of 2 ways: through injecting a tiny needle into the base or side of the penis, or through an intraurethral suppository (placing a small suppository of the drug in the penis through the urethra). Alprostadil will usually begin to work in about 5-20 minutes. Alprostadil therapy is generally considered effective and safe. Side effects are minor but may include some discomfort, mild bleeding, and a prolonged erection after ejaculation.
Penis pump (vacuum device): A vacuum erection device is a hollow tube with a pump attached that is operated either by hand or with a battery. The pump pulls air out of the tube, creating a vacuum around the penis. This pulls blood into the penis, causing an erection. After the penis is erect, you slip a tension ring around the base of the penis to keep blood in that area. This should help you keep an erection long enough for sex.
Testosterone therapy: If erectile dysfunction is being caused by low testosterone levels, your doctor may prescribe testosterone replacement therapy (TRT) to help improve libido and erectile function. TRT can be done through patches, gels, and injections. Side effects of TRT are minor, but you should speak with your doctor before starting TRT, to discuss any health risks.
What are some physical causes of sexual dysfunction in men and women?
There are a number of physical factors and health concerns that may cause sexual dysfunction in both men and women. Sexual function can often be a sign of health and well-being, while dysfunction may be caused by physical conditions such as:
- Vascular problems (heart disease, high blood pressure)
- Thyroid disease (hyper/hypothyroidism)
- Hormone imbalances
- Substance abuse
There are many causes of sexual dysfunction, but there are also many ways to treat it. If you are struggling with sexual performance or experiencing anxiety about sex, book a video visit with health care providers on Sesame to discuss your symptoms and talk about treatment options.
What are the most common treatments for premature ejaculation?
Premature ejaculation can cause stress and anxiety for men and may lead to sexual intimacy problems between couples. There is a wide range of psychological and behavioral factors that may cause early ejaculation, just as there is a wide range of treatment options to help with the treatment of premature ejaculation.
During a premature ejaculation consultation, doctors will discuss your symptoms and health history to help determine factors that may be causing you to ejaculate prematurely. Unless you are experiencing male sexual dysfunction due to a medical condition, doctors can help control ejaculation with behavioral therapy and sexual medicine. During a consultation, your doctor may perform a physical exam to check for underlying health conditions, blood pressure, and hormone levels, as these can all affect sexual performance.
Some common treatment options include:
Behavioral therapy: Doctors can recommend several behavior techniques to help delay ejaculation. Techniques such as the squeeze technique and the stop-start technique help you control sexual satisfaction and learn to control the ejaculatory impulse. Doctors may also recommend masturbating an hour or two before sexual intercourse to delay ejaculation during sex.
Psychological therapy: Some men experience premature ejaculation as a side effect of psychological conditions such as performance anxiety around sexual intercourse. Psychological therapy can help patients talk about their relationship and sex life in a safe space. This can help with self-confidence, anxiety, and depression related to sexual relationships.
Exercises: Exercises to help strengthen the pelvic floor muscles can help delay ejaculation. To locate pelvic floor muscles, stop yourself from urinating midstream and hold the stream. The muscles that you use to perform that action can also help control ejaculation during sexual intercourse. Constrict those muscles for several seconds every day to strengthen the pelvic floor.
In addition to behavioral and therapeutic techniques to prevent premature ejaculation, doctors may recommend or prescribe oral medication to help. Do not self-diagnose and self-treat premature ejaculation with oral medication. Talk to a health care provider (such as a primary care provider or men's health specialist) to help create a treatment plan that's right for you.
What is male pattern hair loss?
Male pattern hair loss (or male pattern baldness) is the most common type of hair loss in men. Androgenetic alopecia/ androgenic alopecia (the interchangeable medical term for male pattern hair loss) is hereditary and occurs gradually as men grow older. If you have a family history of receding hairlines or baldness, you will likely experience male pattern hair loss at some point in time. By the age of 35, roughly two-thirds of men will experience male pattern hair loss. By the age of fifty, roughly 85% of men will experience noticeable hair loss due to androgenic alopecia.
Male pattern hair loss is caused by the male sex hormones androgens. The most prevalent androgen is testosterone, which is converted to DHT, or dihydrotestosterone. Androgens regulate hair growth, which explains why men grow facial hair and pubic hair. As men age, these hormones can affect the growth cycle of hair and shorten hair follicles, leading to thinner and weaker strands of hair. Eventually, hair begins to fall out and balding begins to occur.
There is no known cure for androgenic alopecia. However, with hair loss treatments such as minoxidil (Rogaine) and healthy lifestyle choices, you can slow and reduce the effects of male pattern hair loss.
If you have thinning hair or a receding hairline, you may be experiencing the early signs of male pattern hair loss. Want help? Get in touch with a primary care provider or doctor of dermatology on Sesame for medical advice and treatment options. With both in-person and telehealth options, it's never been easier to take control of your hair loss. Book a visit today to connect with a real, quality doctor in Columbia, SC.
How do you know if you're experiencing male pattern baldness?
Male pattern baldness, or male pattern hair loss, can usually be diagnosed by observing the pattern of hair loss on the head. The Norwood scale, a classification system that measures the extent of hair loss, helps determine whether or not you are experiencing male pattern baldness or hair loss caused by another factor. Male pattern baldness usually begins with thinning hair at the crown of the head and a receding hairline. This eventually can create a "horseshoe" shape at the top of the head.
Hair loss can be caused by a number of factors, including stress, medical conditions (such as alopecia areata, high blood pressure, and thyroid problems), and medication. One of the best ways to tell if you are experiencing male pattern baldness is by tracking where hair is being lost or thinning. Use the Norwood scale as a guide to help determine if the hair loss you are experiencing is due to male pattern balding, or another condition.
Still not sure if you're experiencing male pattern hair loss? Want to save those locks? Connect with real, quality health care providers on Sesame to discuss your symptoms and talk about treatment options to prevent further hair loss. With both in-person and telehealth visits available, Sesame makes it easy to take control of your hair loss. Providers on Sesame can prescribe medication and offer medical advice, all at a fraction of the price you'd pay through insurance companies. Save up to 60% when you book a hair loss consultation with a dermatologist certified by the American Academy of Dermatology and get the care you need right away- no insurance needed.
What are the common causes of hair loss?
Hair loss (alopecia) is a common condition that affects 300+ million people every single year. Nearly 85% of men over the age of 50 will experience hair loss, as will nearly 50% of women. By the age of 35, two-thirds of men will experience symptoms of male pattern hair loss, with balding occurring as early as 21. There are several types of hair loss, just as there is a wide range of causes. Some common causes of hair loss include:
Hereditary hair loss: Hereditary hair loss as a result of aging is a medical condition called androgenetic alopecia (or androgenic alopecia), and is the most common cause of hair loss among adults. Androgenetic alopecia, also known as male pattern baldness or female pattern baldness, occurs gradually as hair follicles shrink and eventually stop growing. In men, this is usually displayed by a receding hairline and bald spots. Women may experience thinning hair at the top of the head, and some patchy hair loss.
Hormone changes: Women may experience hair shedding and hair loss during pregnancy and after childbirth as a result of hormone changes in the body. Additionally, medical conditions such as thyroid problems can result in hair loss.
Medical conditions: Medical conditions such as alopecia areata can cause hair loss and scalp infections. Alopecia areata is an autoimmune disorder in which the immune system attacks hair follicles, which hold the hair shaft in place. This results in patchy hair loss, or total hair loss across the body (including eyelashes and eyebrows).
Stress: Stress can lead to temporary hair shedding. This may occur after the death of a loved one or a traumatic event. Hair loss due to stress is usually not permanent, and hair growth often resumes after some time.
Cancer treatment: Hair loss is a common side effect of radiation to the head (chemotherapy). Hair loss usually begins within the first few weeks of treatment, and may not grow back the same. Dermatologists will prescribe hair restoration treatment options (such as hair regrowth medication) to help restore healthy hair.
Hairstyles and hair care products: Hairstyles that pull hair such as ponytails, cornrows, and pigtails can cause permanent hair loss. Additionally, hair styling products such as dyes and perms can cause hair to fall out, sometimes permanently.
Can male pattern hair loss be prevented?
There is no known cure for male pattern hair loss. However, the FDA has approved several drugs that can slow hair loss by blocking DHT production in the body. Both finasteride (found in Propecia) and minoxidil (Rogaine) can prevent hair loss by stopping DHT from binding to hair follicles, which is the underlying cause of male pattern hair loss. While these drugs can not totally stop or cure male pattern hair loss, they can prevent most hair loss, especially when used as soon as symptoms are detected.
Other factors can increase the rate of hair loss, including high blood pressure, excess stress, and lifestyle habits such as cigarette smoking. These health conditions can weaken hair follicles, which leads to thinning hair and hair shedding. A healthy, active lifestyle, along with DHT blocking medication can help reduce hair loss in men.
What is a prostate condition?
All men are at risk of prostate problems. If you have a family history of prostate conditions, you may be at a greater risk of developing one yourself. Some common conditions that affect the prostate include:
- Benign prostate hyperplasia (BPH): BPH is an enlargement of the prostate. A man’s risk of developing BPH increases with age. BPH only causes symptoms in about half of diagnosed cases and does not lead to prostate cancer.
- Prostate cancer: One of the most common forms of cancer diagnosed in men, the risk of prostate cancer increases with age. Nearly 1 in 6 men are diagnosed with prostate cancer in their lifetime. Although this form of cancer is rarely fatal, and generally treatable, it must be diagnosed early in its development.
- Prostatitis: An infection of the prostate, prostatitis occurs when bacteria in urine leaks into the prostate. This can cause pain, flu symptoms, and difficulty with urination.
Common symptoms of a prostate condition include:
- Difficulty with urination
- Pain in the groin or lower abdomen
- Flu-like symptoms
- Blood in the urine
- Cloudy urine
It is important to note that even though ultrasounds can help doctors detect suspicious masses or growths in the prostate, an ultrasound is rarely used to definitively diagnose cancer. For this, your doctor will require a biopsy (a tissue sample) from the prostate to screen it for cancer cells. To retrieve a sample of the prostate, your doctor will use a transrectal ultrasound as a guide through the rectum and to the prostate.
When should someone consider getting a prostate or testicular cancer screening?
For prostate cancer, it's recommended that men of average risk be screened at 50; men with a family history of prostate cancer should begin screening between 40 and 45. Men should continue these routine screenings until 75.
For testicular cancer, routine screenings are not recommended for asymptomatic patients. That means only patients with symptoms like a testicular mass or pain should be screened as needed.
Risk should always be assessed with your primary are doctor.
Who should get a PSA test?
The American Urological Association suggests the following guidelines regarding PSA testing.
Men with an average risk of prostate cancer are those who do not have a first-degree relative who has been diagnosed with prostate cancer. Higher risk populations include African-American men and men who do have a first-degree relative who has been diagnosed with prostate cancer.
The AUA’s suggestion is detailed below:
Under 40: Screening is not recommended
40-54 (Average risk): Screening is not recommended
40-54 (High risk): Talk to your doctor about whether or not PSA screening is right for you
55-69 (All): Yearly screening if recommended by your doctor.
Over 70: Screening is not recommended
The American Cancer Association recommends yearly screening based on these guidelines:
40-45: Recommended for those at high risk
50 and over: Recommended for those with average risk
Talk to your doctor about your risk factors, and whether or not regular PSA screening tests are right for you.