Penile health is foundational to physical intimacy, urinary function, self-esteem, and overall quality of life. Whether due to trauma, inflammation, vascular changes, or hormonal imbalances, penile dysfunction and discomfort can significantly impact mental and physical well-being. At the Performance Medicine Institute, we offer expert, confidential care for a wide range of penile conditions. Our approach integrates detailed clinical assessment, hormonal analysis, Doppler ultrasound, pelvic floor evaluation, and pain-free treatments including regenerative medicine, laser therapy, and pelvic rehabilitation.
We care for the following penile conditions:
Erectile Dysfunction (ED)
Erectile dysfunction is a common condition, impacting up to half of men, some as young as their early 20's. Something that surprises most men is that erectile dysfunction is often caused by a combination of poor blood flow along with overly tight or inactive muscles. Hormone deficiencies such as low testosterone can also negatively impact erectile function.
Our ED treatment program is truly unique because we get to the root cause of poor erectile quality and treat all of the factors that contribute to ED. We see most patients once or twice a week for 8-12 weeks, and most men that complete our program are restored to total or near total erectile function. Because our program is based on the latest in clinical research and scientific advancements, we have tremendous success treating men with all forms and severity of ED. This includes men with other conditions such as diabetes, prostate cancer, pelvic injuries, and neuromuscular disorders.
Blood flow
Optimizing blood flow is key to establishing and maintaining an erection. In many men with ED, the blood supply to the penis is restricted due to a combination of poor quality or clogged blood vessels, and overly tight muscles that prevent proper blood flow. We enhance blood flow by using pain-free shockwave and thermal ultrasound techniques, as well as manual therapy and muscle exercise techniques. This helps to both loosen and tone tight, restrictive pelvic muscles which then restores proper function.
Weak and tight muscles
It takes the coordinated action of over 20 muscles to cause an erection, and if even one of those muscles aren't functioning properly, it can disrupt the ability to become erect. We carefully assess muscle function to determine if there are any tight or inactive muscles, and use a combination of gentle stretching, myofascial release, neuromuscular electrical stimulation and therapeutic exercise to restore muscle function and optimize erectile quality.
Hormones
Disruptions in testosterone, thyroid hormones, human growth hormone, as well as other hormones can prevent proper erectile function. These hormones are responsible for the optimal function of the muscles, nerves, blood vessels and glands in the penis that cause erections. We test for these hormones, and treat any deficiencies to optimize erection quality and restore full function.
Advanced Medications
Medications like Viagra, Cialis, Levitra and Trimix can help promote erectile quality. We also use medications like apomorphine, bremelanotide (also known at PT-141), and oxytocin to improve erectile quality and libido. While our goal is for our patients to not rely on medications, they can be useful for a limited period as patients progress in our innovative treatment program.
Hard Flaccid Syndrome
Hard Flaccid Syndrome (HFS) is a complex and often misunderstood condition affecting the male pelvic region. Characterized by a semi-rigid yet non-erect state of the penis, HFS can cause a range of symptoms, including discomfort, penile numbness, reduced sensation, pelvic pain, and erectile dysfunction. These symptoms can be physically distressing and emotionally challenging, often impacting confidence, relationships, and overall quality of life. While the exact cause of HFS can vary between patients, it is often a combination of pelvic floor muscle dysfunction, nerve irritation, dysautonomia, and circulatory issues. Stress, trauma, or repetitive strain to the pelvic area may trigger or exacerbate the condition. We take a highly comprehensive approach in diagnosis the root cause of HFS, including extensive labs, imaging studies, physiological assessments, and vascular studies.
Our highly effective treatment program is truly comprehensive, addressing the hormonal, neuromuscular, circulatory, connective tissue, libido, nutritional, and lifestyle components that cause HFS. We take a personalized approach to HFS, addressing the root causes and empowering patients to reclaim their sexual health and well-being through evidence-based treatments tailored to their unique needs. We combine physiotherapy with neurovascular modulation, targeted laser therapy, thermal ultrasound, shockwave, advanced medication therapy as needed, and behavioral strategies to reverse symptoms and restore normal penile function.
Peyronie’s Disease
Peyronie’s disease is a condition characterized by the development of fibrous scar tissue (plaques) within the penile shaft, leading to curvature, pain, and, in some cases, erectile dysfunction. At the Performance Medicine Institute, we provide a comprehensive, evidence-based approach to managing Peyronie’s disease, focusing on reducing discomfort, restoring function, and improving our patients’ overall quality of life.
Our treatment strategies prioritize non-invasive methods to restore normal curvature and enhance penile health in a pain-free way. We use specialized equipment to comfortably deliver high energy mechanical remodeling signals to the penis, avoiding painful injections. This therapy is complemented by specialized therapy targeting the pelvic region, which helps optimize circulation, alleviate discomfort, and strengthen the muscles at the base of the pelvis. By leveraging advanced, evidence-based treatments in a supportive environment, we help patients reduce curvature, restore function, and enhance quality of life with non-surgical solutions.
Penile Fracture
A penile fracture is a rupture of the connective tissue and vascular structures of the penis. After acute management, our team improves recovery with manual therapy, scar mobilization, and strategies to restore sexual function and reduce anxiety. Our treatment approach helps patients who have suffered a penile fractures to reduce pain and return to healthy erectile function without the use of implantable devices.
Priapism
Priapism is a prolonged, often painful erection not related to sexual stimulation. It may be ischemic (low flow), non-ischemic (high flow), or medication-induced. In some cases, a priapism may arise due to compression of nerves in the lumbar spine, or a lesion in the central nervous system. We assist with long-term erectile rehabilitation and evaluate underlying hematologic, pharmacologic, or neurologic contributors to prevent recurrence.
Phimosis and Balanitis
Phimosis is the inability to retract the foreskin fully, which may lead to inflammation (balanitis), infection, or hygiene issues. Our treatment approach is able to comfortably mobilize the foreskin to allow for safe retraction over the head of the penis, while maintaining sensation. We use a combination of laser therapy, thermal ultrasound, and myofascial release to very gently and painlessly increase foreskin flexibility and improve cosmetic appearance. This also reduces the risk of a paraphimosis, which is where the foreskin gets stuck behind the head of the penis, requiring emergency surgery to treat.
Nerve Injuries and Pudendal Neuralgia
Nerve injuries can have a significant impact on penile function by causing pain, numbness, burning, or other unpleasant sensations. Evaluation includes sensory mapping, pelvic and lumbar assessment, and neurovascular testing. Our team focuses on restoring sensory input through nerve mobilization, pelvic floor retraining, and circulation-enhancing therapies like high-intensity laser to effectively restore nerve function and improve overall penile health.
Anorgasmia and Delayed Orgasm
The inability to achieve orgasm may be linked to pelvic floor dysfunction, neurological impairment, medication side effects, or psychosexual factors. Evaluation includes a comprehensive hormonal and neurophysiological workup. We integrate physical, hormonal, and behavioral therapies to target the underlying cause and help patients restore pleasurable and reliable climax.
Ejaculatory Disorders (Premature, Delayed, Anejaculation)
Ejaculatory dysfunction can impair satisfaction and intimacy. Premature ejaculation may be due to hypersensitivity or anxiety; delayed or absent ejaculation may be linked to medication, neurologic impairment, or pelvic floor overactivity. Our treatment plans address both physiology and arousal patterns, using desensitization techniques, medication adjustments, and pelvic muscle retraining.
Decreased Libido / Hyposexuality Disorder
Low sexual desire can be caused by testosterone deficiency, stress, poor sleep, depression, or relationship factors. We provide full endocrine evaluation, sleep and lifestyle optimization, and testosterone replacement therapy (TRT) when clinically indicated. We utilize specialized esters of testosterone to improve libido. We also use medications like apomorphine, PT-141 / bremelanotide, and oxytocin to restore libido. We work to identify and reverse the biological and psychological contributors to low desire, restoring sexual vitality and motivation through tailored care.
Sexually Transmitted Infections (STIs)
We provide confidential evaluation, testing, and treatment for a full spectrum of STIs including chlamydia, gonorrhea, syphilis, HPV, HSV, and HIV. Patients may present with discharge, lesions, or penile irritation. Our care includes same-day treatment when indicated, education on prevention strategies, and PrEP or PEP access for high-risk individuals.