Conditions

Erectile dysfunction (ED):
  • Erectile dysfunction is the inability to obtain or maintain an erection. This can occur at any age.
  • There are many causes of ED and finding a precise diagnosis allows us to tailor treatment to the individual’s or couple’s specific needs.
  • Diagnostic workup may include:
    • Comprehensive medical history including current and previous medications
    • Detailed physical exam
    • Blood tests to evaluate hormone profiles and lipid panels
    • Penile ultrasound with doppler technology to look for structural abnormalities, abnormal blood flow, scar tissue, or penile curvature.
Testosterone deficiency / low T / hypogonadism
  • Testosterone is an important hormone for both men and women. Symptoms of testosterone deficiency (low T) can include:
    • Low libido
    • Erectile dysfunction (ED)
    • Fatigue / low energy
    • Mood / cognition changes
    • Decrease muscle mass
  • Testosterone declines with age; however, symptoms of low testosterone can affect men at any age, and treatment can drastically improve symptoms.

We don’t treat patients based solely on abnormal lab values, but rather individualize and tailor care based on severity of symptoms, lab tests and patient goals

Peyronie’s Disease / Penile curvature

Penile curvature can occur at any age. The curvature is only seen during an erection and happens when a hard collagen plaque builds up around the erectile tissue.

While it is not a dangerous condition, it can cause disfigurement of the penis, pain during intercourse, and significant distress for men and their partners. The curvature can be so severe that penetration is impossible.

Ejaculatory Dysfunction
  • Premature ejaculation
  • Delayed ejaculation
  • No ejaculation / anejaculation

These problems are treatable and require a comprehensive workup to tailor specific treatment plan.

Pelvic Pain

Pelvic Pain / Chronic Prostatitis / Orchalgia / Penis Pain / Testicular Pain / Scrotal Pain / Pain with Erection, Orgasm or Ejaculation / Pudendal neuralgia

Pain is never normal and requires a full diagnostic workup. Many treatment options are available. Dr. Rubin believes in multidisciplinary care when treating pain and will build a team or work with other providers to adequately understand and treat the underlying problem.

Cancer

No matter the type, a diagnosis of cancer can affect sexual function drastically. This has significant consequences for your partner and relationship as well. It’s important to talk to your oncology team and understand how your cancer treatment may affect sexual function.

Quality of life after cancer treatment is one of Dr. Rubin’s main interests.

Sexual Dysfunction can occur with nearly all Cancer treatments including

  • Chemotherapy
  • Radiation
  • Surgery
Male Stress Incontinence / Post prostatectomy incontinence

Men can leak urine for a variety of reasons. After prostate removal surgery for cancer, men can leak urine when they cough, laugh, sneeze termed “stress incontinence.” Often men will leak urine during orgasm “climacturia.”

  • Treatment may include
    • Specialized pelvic floor physical therapy
    • Surgery:
      • Male Sling
      • Artificial Urinary Sphincter
Enlarged Prostate / Benign Prostatic Hyperplasia (BPH) / Sex friendly treatments to maintain your ejaculation
  • Prostate enlargement can lead to distressing urinary symptoms which may include:
    • urinary frequency
    • urinary urgency
    • waking up at night to urinate “nocturia”
    • difficulty emptying your bladder
    • weak stream
    • difficulty initiating urination
  • BPH is typically treated with lifestyle modifications, medication and surgery.
  • Unfortunately, the medication and surgeries for BPH can have devastating sexual side effects causing low libido, erectile dysfunction and potentially irreversible changes to ejaculatory function.
  • New minimally invasive treatment options exist to avoid these unwanted side effects.
Medication induced Sexual Dysfunction
  • Post-SSRI Sexual Dysfunction (PSSD)- Medication for depression, anxiety and other mental health disorders called selective serotonin reuptake inhibitors or “SSRIs” can have severe sexual side effects.
    • Symptoms may include:
      • Erectile dysfunction
      • Reduced sensation in genitals
      • Delayed or inability to orgasm (anorgasmia)
      • Muted orgasms or lack of pleasure with orgasm
      • Decreased libido (sex drive)
      • Decreased or absence of nocturnal erections
      • Premature ejaculation
  • Post Finasteride Syndrom (PFS)- Men who have taken finasteride or other 5 alpha reductase inhibitors for enlarged prostate or androgenic alopecia (male pattern baldness) may develop distressing sexual and non-sexual complaints.
    • Symptoms may include:
      • Decreased libido
      • Erectile dysfunction
      • Penile shrinkage
      • Orgasmic anhedonia (loss of pleasure with orgasm)
      • Fatigue
      • Muscle atrophy
      • Depression
      • Brain fog
      • Difficulty sleeping
Erectile dysfunction (ED):
  • Depending on the underlying cause, we discuss several treatment options with the patient. These may include:
    • behavioral and lifestyle changes
    • couples and sex therapy
    • specialized physical therapy
    • medications
    • surgery
  • Penile Implant: When conservative treatment strategies fail, a penile prosthetic implant is a successful method to achieve reliable and rigid erections. Dr. Rubin has special expertise in penile prosthetic surgery. She offers a variety of different implant options tailored to each patient’s specific needs.
Testosterone deficiency / low T / hypogonadism
  • Treatments may include:
    • Lifestyle modifications
    • Medications that preserve fertility and sperm concentration
      • Men who want to conceive children should never use testosterone replacement therapy because it decreases sperm count. Alternative methods are available.
    • Monitored testosterone replacement therapy
      • Gels
      • Injections
      • Pellets
Peyronie’s Disease / Penile curvature

Treatments include medications injected directly into the plaque to dissolve the collagen or surgery.

  • Unfortunately, research shows that oral medications once thought to treat this condition are not effective.