There's nothing manlier than
taking care of your health
Erectile dysfunction is common but there are plenty of treatment options
Problems with erections are common. They can be due to issues with nerves, blood vessels, medications, and life stress. There are plenty of ways to manage these problems.
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Why do I have erectile dysfunction?
Erectile dysfunction can be caused by a number of things. Sometimes it is due to your habits, such as smoking, too little exercise, or an unhealthy diet. Sometimes it is due to the medications you take. Sometimes it is due to stress or medical conditions, such as high blood pressure, diabetes, or strokes.
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What changes can I make to help my erections?
Healthy habits, such as exercise and a balanced diet, can help prevent erectile dysfunction. Make sure your other health conditions are well managed, such as high blood pressure, diabetes, and heart issues. Using tobacco, alcohol, and drugs can cause problems with erections.
What medications can treat erectile dysfunction?
Erectile dysfunction can be treated with a type of medication known as PDE5 inhibitors. You may have heard of both sildenafil (also called Viagra) and tadalafil (also called Cialis). Sildenafil and tadalafil are both used before intercourse. Sildenafil should be taken 30-60 minutes before intercourse on an empty stomach. Tadalafil should be taken 2-3 hours before intercourse, but you can take it with food.
Another option is to take a lower dose of tadalafil every day, instead of just before intercourse. This can be helpful for people who don't want to worry about planning ahead.
Common side effects of both these medications include headache, stuffy nose, flushing, and upset stomach. Rarely, people can develop back and leg pain, but it goes away when you stop the medication.
Do not take these medications if you take nitrates or nitroglycerin for a heart condition.
If you develop chest pain while taking the medication, stop what you’re doing and call 911.
What other options are available?
Intracavernosal injections: You use a small needle to inject medication directly into the side of your penis. You are taught how to do your own injections.
MUSE: You put a pill inside your urethra (the hole at end of penis) to cause an erection.
Vacuum device: You use a medical suction device to create an erection, then put a band around the base of the penis to maintain the erection.
Penile prosthesis: A device is surgically implanted in the penis. You inflate the device to create an erection.
What about my heart?
Studies have shown that issues with erections can occur 5-10 years before heart problems. This is because the same blood vessel issues in the penis can happen in the heart. Let your primary doctor know that you are having erection problems so they make sure your heart is healthy. If you have a history of certain heart issues, Dr. Chertack may need approval from your heart doctor before starting you on treatments for erectile dysfunction.
Vasectomies are a safe, easy, and effective form of birth control
What is a vasectomy?
A vasectomy is an office procedure that blocks off both your vas deferens. The vas deferens are the tubes in your scrotum that transport sperm from each testicle. The purpose of this procedure is to prevent future pregnancies.
What happens at my pre-vasectomy visit?
Dr. Chertack discusses your medical history with you. He also performs an exam to confirm the vas deferens is present on both sides, as some people have only one or none.
How does Dr. Chertack perform the vasectomy?
Dr. Chertack will make two small holes in the scrotum, one on either side. He will find the vas deferens and cut out a portion. He will then burn the inner lining of the tube ends to make a scar and separate the ends with a small stitch. Once this is completed on both sides, he will put one small stitch in the skin.
What about pain?
Dr. Chertack will inject some numbing medication under the skin at the start of the vasectomy. This is similar to what is used during dental procedures. The injection may sting for a moment. Most people require only a small amount of numbing medication, but more can be given as needed during the procedure. It is normal to feel a pulling sensation or pressure during a vasectomy, but you should not feel pain.
Some people have a lot of anxiety about their vasectomy. This is completely normal! Dr. Chertack can prescribe a one-time anti-anxiety medication to take 30-60 minutes before your vasectomy. Sometimes people prefer to have their vasectomy in the operating room with sedation.
What do I need to do before my vasectomy?
You can eat the day of your vasectomy - in fact this helps prevent fainting during or after the procedure. Please trim the hair on your scrotum; do not shave, because shaving can cause little cuts in the skin that sometimes get infected. You should shower the morning of your procedure. Bring a pair of tight-fitting underwear or a jock strap to your appointment. Someone should come with you to drive you home after your appointment. Do NOT drive yourself home.
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Will I be sore?
It is normal to be sore! Dr. Chertack recommends taking tylenol (500-650mg) and ibuprofen/advil/motrin (400mg) every 6 hours. It works best if you alternate - take tylenol at noon, ibuprofen at 3pm, tylenol at 6pm, ibuprofen at 9pm… Usually taking the medications on a schedule like this will minimize your pain and you will not need to take anything after 3-5 days. You can also put ice packs (or frozen peas!) on the scrotum for 20 minutes on, 20 minutes off. You may notice some mild swelling of your scrotum, wear tight-fitting underwear for 1-2 weeks to prevent this. You can usually restart most normal activities, but avoid physical activity for 2-3 weeks.
How do I know if the vasectomy worked?
Do not ejaculate or have intercourse for one week while you are healing. After waiting one week, please ejaculate 20-30 times over the next three months. This helps clear out any remaining sperm that are in the vas deferens. During this time you need to continue using protection - you can still get someone pregnant! In three months you will give a semen sample to the lab. If this shows no sperm, then the vasectomy was a success and you no longer need to use protection!
What are the chances of a pregnancy after vasectomy?
Many studies have been performed to answer this question. The chances of a pregnancy are one in two thousand, which is a lower rate than all other contraceptive options (except abstinence).
What are the risks of vasectomy?
Although having some pain after vasectomy is common, the risk of having long-term pain is less than 1%. Having concerning bleeding or infection is uncommon, and injury to the testicle is very rare. Please call the office if you develop fever, severe pain, rapid scrotal swelling or swelling larger than a grapefruit, or severe bruising.
Will this cause any concerning side effects?
Vasectomy only prevents pregnancy. It will not affect your body’s ability to make testosterone. It will also not affect your ability to have erections or ejaculate. There is no evidence that vasectomy will lead to cancer, heart disease, or any other medical conditions.
How permanent is a vasectomy?
Having a vasectomy should be considered a PERMANENT form of birth control. There are certain surgeries to undo vasectomies. However, these can be expensive, require long times in the operating room, and they are not always successful. You should try to be as certain as possible before undergoing vasectomy.
Hydroceles occur without a specific cause but can be fixed with an outpatient surgery.
What is a hydrocele?
The testicle normally has a pocket with a small amount of fluid in it, this allows it to move within the scrotum. As some men get older, more fluid is made than the body absorbs, so the fluid increases and the scrotum grows in size - this is an adult hydrocele. Some babies can have hydroceles, this is through a slightly different process.
What needs to be done before treatment?
Dr. Chertack discusses your medical history with you, he also performs an exam to confirm the hydrocele size and location, and to rule out any other conditions. Often he obtains an ultrasound of the scrotum to rule out other causes of swelling including hernias or fatty tissue.
Do I need treatment?
Hydroceles are not dangerous or life-threatening, but as they grow they can become bothersome and sometimes painful from the weight they put on the scrotum. Hydrocelectomy is the best way to permanently treat a hydrocele. Some men decide to live with their hydrocele, every patient is different!
Are there any other options besides surgery?
Hydroceles can be drained in clinic. This requires a local anesthetic and can be done quickly. However the hydrocele usually grows back over months so this is not a permanent fix. It is not recommended prior to surgery as it can make the surgery more difficult. Chemicals can be injected into the hydrocele sac to help it seal shut, but this can be painful and is not commonly performed.
How does Dr. Chertack usually perform the surgery?
Dr. Chertack will make an incision on your scrotum (in the middle if you have hydroceles on both sides), he will find the sac and drain the fluid. He will then remove the extra tissue and place dissolvable stitches so that the hydrocele does not come back. He will then stitch up your incision with dissolvable stitches. For very large hydroceles, Dr. Chertack may place a rubber tube to drain any fluid that builds up immediately after surgery. Usually you will need to come to clinic to have this removed within one week of surgery.
What do I need to do before my hydrocelectomy?
Normally very little is required prior to hydrocelectomy. Depending on your medical conditions, Dr. Chertack may have you see your primary care doctor, or your heart/lung doctor if you have heart or lung conditions. Hydrocelectomy is a low risk procedure, but Dr. Chertack wants to make sure you are safe to undergo the anesthesia. Usually you do not need any labs prior to surgery. You will need to be “NPO” which means nothing to eat or drink starting at midnight the day of surgery - usually sips of water with necessary medications is okay. If you take blood-thinning medications, Dr. Chertack will discuss stopping this with your primary care doctor to confirm it is safe to do so.
What should I expect after my hydrocelectomy?
The most important thing to remove is that you will have some swelling after surgery, this can be normal for 6 weeks! Swelling and inflammation is how your body heals after an injury (or surgery), so this is normal. Do not be surprised when your scrotum swells up to the same size or slightly larger, the scrotum may also feel firmer than your hydrocele. As long as it is sore but not painful, this is normal. This is why Dr. Chertack wants to see you at 6 weeks after surgery, not sooner!
Immediately after surgery, you will want to do three things - ice, scrotal support, and pain medications. Dr. Chertack recommends using ice packs at least 3 times daily for 20 minutes on, 20 minutes off (do not apply directly to skin). Use a jockstrap or tight underwear to prevent your scrotum from dangling. Dr. Chertack recommends taking tylenol (500-650mg) and ibuprofen/advil/motrin (400mg) every 6 hours. It works best if you alternate - take tylenol at noon, ibuprofen at 3pm, tylenol at 6pm, ibuprofen at 9pm… Usually taking the medications on a schedule like this will minimize your pain and you will not need to take anything after 3-5 days. Most patients do not require any narcotic medications.
Dr. Chertack does want you to be active, you should be walking around and getting back to normal activity relatively quickly after surgery. Avoid physical activity (heavy lifting >20lbs) for 3 weeks after surgery.
Take the prescribed stool softeners to prevent straining with bowel movements - straining can put you at risk for a small bleed which can worsen the swelling.
Avoid physical and sexual activity for at least 3 weeks. Once your swelling is improving and you are feeling more comfortable, you can SLOWLY increase the level of physical activity.
You can drive when you are able to sit in your car in your driveway and slam on the gas and brake pedals without pain. If you cannot do so, do not drive!
You can shower starting on the second day after your surgery.
What are the risks of hydrocelectomy?
It is normal to be sore after surgery, but long-term pain is uncommon.
A small amount of bleeding can occur but life-threatening bleeding is rare.
Infection is uncommon.
Injury to the testicle is rare.
The chances the hydrocele comes back after surgery is less than 5%
Please call the office if you develop fever, severe pain, rapid scrotal swelling or swelling larger than a grapefruit, or severe bruising.
Hydrocelectomy will not affect your ability to urinate, have erections, ejaculate, or your sex drive.
Peyronie disease is also common and can be very bothersome
What is Peyronie disease?
This is a condition caused by scar tissue (plaque) that forms in the cavities that create an erection. Normally the penis has two chambers that fill with blood equally to provide an erection. If scar tissue forms on one of these chambers, it cannot fill completely and it causes the penis to curve in that direction.
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Why does this happen?
Often there is no clear reason why this occurs, it does not seem to be related to prior penile trauma or sexual history. Some patients with a condition called Dupuytren's contracture also develop Peyronie disease, and there is a higher occurrence in patients with diabetes.
How do I know if I have Peyronie disease?
You may notice development of a painful curvature that was not present before. This is called the "active phase." The curvature may worsen over time but usually stops and the pain resolves. This curvature does not usually get worse again, this is referred to as the "stable phase."
You may also notice that the penis does not become as erect past the point of curvature. Some patients also develop a "waisting" or tapering of the penis at one portion, this is often referred to as an "hourglass deformity."
During your clinic visit, Dr. Chertack will review your medical history and do an exam. If you are able, please bring pictures of your erection curvature to clinic, this allows Dr. Chertack to evaluate the severity of the curvature.
What is Xiaflex?
This is the only medical option shown to have benefit for treatment of Peyronie disease. A small needle is used to inject this medication (a collagenase) into the plaque. The penis is then gently stretched and bent to soften and flex the plaque. You may need to do stretching exercises at home to maximize the benefits. This treatment works well for more mild to moderate curves.
What are the surgery options?
These surgeries are all outpatient procedures, Dr. Chertack can discuss whether these would be right for you during your clinic visit.
Plication: Stitches are placed on the opposite side of the penis to bend it in the opposite direction, bringing it back to a straight appearance.
Incision/Grafting: The scar tissue is cut to release the curve, and the hole is patched with a piece of tissue.
Penile prosthesis: This option is best for patients with both curvature and poor erectile function. An artificial device is implanted within the penis and can be inflated to create an erect penis.