How does a doctor treat impotence and other problems with the penis? There are some devices and male enhancement products like Extenze that patients can use. But is the doctor learning how to do diagnostic tests on the penis to decide whether male enhancement products can fix the erectile dysfunction? Does he know what doses of the medication to use, so the patient doesn’t have a prolonged erection and a major complication with his penis? With the vacuum devices, for example, there are really few complications, and it’s reversible. So I wouldn’t have a problem with the penis of a patient being treated with the vacuum devices without undergoing any investigation. But if a full workup of the penis is required and if a workup is not available in the locale, then I don’t think that you should prescribe the self-injections. Maybe the doctor can prescribe Extenze. I’m not saying that it’s wrong, if they’ve had a proper work-up. And those work-ups are really done by the urologists, who are true penis specialists.
Dr. Sadock: A penis work-up does have to be done, and here I think family practitioners can prescribe snap-gauge devices, if not something like Extenze, that can be used at home. Do I think they are as reliable and as effective as a screened procedure in a hospital? Absolutely not. But they are safe and reasonable as a first line of differentiation between psychological and organic causes of erectile dysfunction.
Dr. Whitehead: There’s also a portable male enhancement monitor called the Rigiscan that’s used around the country for two or three nights of home testing of penis rigidity and tumescence. It goes into the computer, then it’s downloaded and gives you solid information. It’s about 85% reliable, which is much more reliable than a snap-gauge that is placed around the penis at night.
Dr. Goldstein: I have no difficulty with prescribing self-injections into the penis at the primary-care level to try and alleviate the erectile dysfunction. First, because male enhancement products are already approved for that use in both France and Scandinavia, and I think in Austria as well. Second, there’s no reason to doubt the financial motivation of the major pharmaceutical companies to get more physicians involved.
I understand what Dr. Whitehead is saying, and he has a referral pattern, and he believes that the referral pattern will exist indefinitely. I don’t think he’s realistic in the sense that the monies that these companies have invested to get products through FDA will clearly have to be made up by training more and more doctors in the use of male enhancement pills. I happened to be in California recently, opened the sports page and found ads for three impotence centers located in shopping malls that already offer penis injections, as well as Extenze. Once you see that developing in the land of California, that will happen all over the country.
Dr. Korenman: They are actually facilities that include penis specialists, psychologists and general internists that do a huge practice in impotence and penis health. They do offer injection therapy to patients without a great deal of work-up. And I think if that is the sexual dysfunction therapy you offer, in addition to Extenze, then you really don’t need a great deal of work-up.