Author: Akash Kapadia, MD

Online Pharmacies vs. Brick-and-Mortar Urologists: What’s Really the Better Route for Men’s Health?

Posted on August 20, 2025September 11, 2025 by Akash Kapadia, MD in Men's Health, Supplements

In recent years, online pharmacies and telehealth platforms have become an increasingly common way for patients to access medications and medical advice. With just a few clicks, you can order prescriptions, connect with a provider virtually, and have medications shipped directly to your door. For busy patients or those living in rural areas, the convenience is undeniable.

At the same time, the question naturally surfaces: Are online medical platforms as safe and effective as visiting my doctor and picking up a prescription from the local pharmacy?

Both approaches have their place. Online pharmacies offer discretion, privacy, and quick access to treatment, especially when it comes to sensitive issues like erectile dysfunction or urinary problems. And yet, as appealing as online platforms are, they can never fully replace the depth of care that comes from an in-person visit.

Let’s explore the pros and cons of both approaches and where each may (or may not) fit into your healthcare decisions.

The Appeal of Online Pharmacies

It’s easy to see why online pharmacies have carved out such a strong niche – there’s no denying the convenience factor. Online platforms allow you to:

Access care from anywhere: Whether you live hours from the nearest clinic or simply prefer the comfort of your home, telehealth and online prescribing can make treatment more accessible.
Save time: No waiting rooms, no pharmacy lines, and medications can often be discreetly shipped within days.
Avoid face-to-face interactions: For sensitive conditions like erectile dysfunction or urinary issues, many patients appreciate the discretion of talking to a healthcare provider over the phone or online chat, along with the ability to order through a website.
Potentially lower cost: Some platforms offer competitive pricing, bulk discounts, or subscription models that can sometimes be easier on the wallet.
For straightforward, low-risk prescriptions, online pharmacies can be a safe and practical option. For example, medication refills for patients who are already stable on a regimen may be well-suited to online ordering.

The Risks of Skipping In-Person Care

While the advantages are real, there are equally important drawbacks to relying solely on online pharmacies or telehealth platforms for sexual and urologic health.

An online questionnaire is not as thorough as an in-person exam, and can result in missed diagnoses. Urologic symptoms like urinary frequency, blood in the urine, or erectile dysfunction may seem straightforward, but can sometimes point to more serious conditions.

Even though a provider may review them, online intakes can’t pick up on the subtleties of your health or replace a physical exam, lab testing, and imaging when needed. On that note, many online pharmacies are often run by mid-level providers with minimal to no supervision. To make things worse, the supervising physician might not even be a urologist.

A strong, ongoing relationship with a physician allows for nuanced care – your physician keeps track of your health history, test results, and past treatments, weaving them together into a bigger picture. Online encounters, by contrast, can feel transactional and limit the patient-provider relationship, with different providers, different systems, less opportunity to ask questions, and no one connecting the dots. Online platforms like Hims or Ro are more like one-trick ponies and aren’t capable of offering the comprehensive treatments a specialized provider like a urologist can.

When you encounter different providers online or switch platforms, important aspects of your medical history may be lost, which can disrupt the continuity of care necessary for long-term outcomes.

There are also medication safety concerns. While some online platforms are reputable, others operate in a gray zone. The U.S. Food and Drug Administration (FDA) has repeatedly warned about unlicensed or foreign-based sites selling counterfeit drugs, contaminated pills, or incorrect doses.¹ Even when the medication is legitimate, the oversight and follow-up are often limited compared to what you’d get with your doctor and a trusted local pharmacist.

Reputable online pharmacies do exist, but distinguishing them from fraudulent ones can be difficult for patients.

The Value of In-Person Care

In-person care is still the cornerstone of good medical practice. A doctor who sees you face-to-face can perform a comprehensive evaluation, catch early warning signs that can be easily missed in a telehealth setting, provide a nuanced interpretation of symptoms, and coordinate with specialists or labs when needed. There’s also reassurance in knowing that your medications are being dispensed by a licensed pharmacy, staffed by pharmacists trained to double-check prescriptions for safety, side effects, and interactions.

Because of the live interaction, in-person doctors and pharmacies can help safeguard your health – you get a team that knows you, your history, and your goals.

When Online Pharmacies Can Work Well

It’s not a question of “all good” or “all bad.” Online pharmacies have their place, and they can work well in the right situations. A reputable online platform can be effective when:

You need a refill for a stable, ongoing prescription.
You live far from medical care and need interim access to medication.
Common conditions are managed under the supervision of an established and qualified healthcare provider.

Patients who choose online platforms should verify legitimacy, ensure the site requires a valid prescription, and avoid offers that sound too good to be true (like extremely low prices or “no prescription needed”). Use platforms that are U.S.-based, licensed, and verifiable through the FDA or the National Association of Boards of Pharmacy (NABP).

A good online pharmacy should always require a valid prescription, provide a physical U.S. address and phone number, and have licensed pharmacists available to answer your questions. If a site skips those steps or promises miracle deals, it’s a sign to steer clear.

A Balanced Approach

The future of medicine is not either/or. You don’t have to choose between technology and tradition. The wiser move is to explore your pathways to better health based on your medical history and the specific condition for which you’re seeking help.

Online pharmacies and telehealth services will continue to expand access to care, and for certain scenarios, that’s a positive thing. But they should complement, not replace, the personalized care of an in-person physician. Better treatment outcomes often happen when patients utilize technology as a tool, while relying on brick-and-mortar doctors and pharmacies as the foundation of their healthcare.

If you’re considering online options, do so thoughtfully. Research licensed, verifiable platforms and use them for convenience, not comprehensive care.

Keep your doctor in the loop, and never ignore new or concerning symptoms. Online convenience should never delay a needed diagnosis or exam. And whether you order online or locally, make sure your provider is aware of all the prescriptions you’re taking.

There are no shortcuts in healthcare – a trusted doctor and pharmacist know you, your history, and your health goals in ways an online questionnaire never can. Only a physical exam, lab work, or imaging can rule out serious underlying conditions. In these cases, online convenience isn’t just inadequate – it can be unsafe.

As a fellowship-trained urologist specializing in male fertility & men’s health, Dr. Kapadia’s greatest passion is helping men restore confidence in their sexual and urologic health. If you are unsure where to turn, reach out to our office to schedule a confidential consultation. Symptoms such as blood in your urine, new or worsening pain, sudden changes in urination, new-onset erectile dysfunction, or anything out of the norm demand an in-person evaluation.

Reference:

U.S. Food and Drug Administration. (2025, June 20). Internet Pharmacy Warning Letters. FDA. https://www.fda.gov/drugs/drug-supply-chain-integrity/internet-pharmacy-warning-letters.

A Reboot in the Bedroom: Penile Implants for Gay Men

Posted on August 6, 2025September 9, 2025 by Akash Kapadia, MD in Penile Implants

If you’ve experienced erectile dysfunction (ED), you’ve probably already tried the usual suspects – pills, pumps, injections. When those stop working or never quite do the job, a penile implant (also called a penile prosthesis) moves from “someday” to “maybe.”

Penile implants are researched and time-tested with high satisfaction rates for the right candidates. What the current medical literature doesn’t do brilliantly – at least not yet – is speak directly to the experiences and outcomes of gay men. Most studies lump everybody together, so specific data by sexual orientation are sparse. Still, we can combine what the evidence shows about implants overall with the practical realities of gay men’s sexual practices to help you make a confident, informed decision.

(A quick note on language: we’ll say “gay men” for readability throughout this article, but we mean that to include any men who have sex with men.)

Penile Implant Basics (The 60-Second Version)

A penile implant is a device placed inside the penis to create a dependable erection on demand. There are two main types:

Inflatable implants (most popular): Two cylinders are placed in the penis, a fluid reservoir sits internally (usually in the lower abdomen), and a small pump hides in the scrotum. Squeeze the pump for an erection; press the release to deflate. These offer the most natural aesthetic and rigidity or flaccidity when you want it.
Malleable (semi-rigid) implants: Bendable rods keep the penis firm at baseline; you position it up or down manually. They’re simpler, but less discreet under clothing and less “natural” in appearance.

Across studies, patient satisfaction is typically high – often in the 80 to 90% range for inflatable devices, with partners also reporting improved quality of life. The risk of infection for first-time inflatable implants is low (approximately 1–3%), thanks to antibiotic coatings and modern surgical techniques. Device reliability is strong, with eventual wear-and-tear addressed via revision surgery if needed.¹

There is a small but growing body of work looking specifically at men who have sex with men and penile prostheses, suggesting overall satisfaction as well, though the samples are small and not yet definitive.²

Why Talk About Orientation at All?

Because sexual goals, positions, and expectations can vary – and those details matter when you’re choosing a device, sizing cylinders, and planning recovery. For example, anal intercourse can place higher axial (straight-line) forces on the penis than vaginal intercourse, so rigidity and stability are central to comfort and performance.³ That doesn’t mean you need a different kind of implant; it means your surgeon should customize device choice and sizing with these realities in mind. ⁴

Who’s a Good Candidate?

You’re typically a candidate if:

ED has been persistent (often 6–12+ months) and medical therapies (pills/injections/vacuum) aren’t working or are not tolerated.
You’re medically optimized for surgery (e.g., diabetes reasonably controlled, smoking addressed, any active infections treated).
You want a dependable erection, value spontaneity, and understand that the implant replaces natural erectile function.

Men with scarring (as in conditions like Peyronie’s disease), post-prostatectomy ED, or long-standing diabetes-related ED routinely do well with implants, though the surgical plan may be slightly altered from a straightforward surgery.

Choosing Your Implant: What Matters for Gay Men?

Rigidity and angle control. Anal intercourse, especially in positions that create higher leverage, requires strong axial rigidity from an implant to prevent “buckling.” Three-piece inflatable devices generally provide the best blend of firmness for penetration and a natural, comfortable flaccid state for daily life and concealment. Device design and cylinder materials differ slightly across brands; some offer greater maximal girth or perceived rigidity at a given length. Your surgeon will match device characteristics to your goals and anatomy. ⁵

Girth vs. length expectations. Implants don’t increase natural penile length; in fact, men can sometimes perceive a slight decrease in size due to long-standing ED and tissue remodeling. The priority is functional length and reliable rigidity. Sizing is individualized during surgery to maximize usable length safely and effectively. Over-lengthening risks erosion; under-lengthening compromises performance.

Glans support and curvature. If you have Peyronie’s disease, your surgeon may correct the curvature at the same time. Some men benefit from techniques that improve glans (head of the penis) support when indicated.

Concealment and day-to-day comfort. Inflatable devices are designed to deflate completely when not in use, allowing the penis to hang naturally and remain discreet under clothing. When you want an erection, the pump in the scrotum allows you to inflate the cylinders on demand, providing rigidity only when needed.

The Operation and Recovery

Surgery is typically performed on an outpatient basis, and the procedure usually takes approximately one hour. You’ll go home the same day with pain control instructions, antibiotics as indicated, and a scrotal support.

Pain and swelling peak in the first few days, then steadily improve. Most men are back to light desk work in about a week, and more physical jobs in two to three weeks (per your surgeon’s guidance).

There may be a bit of a learning curve when it comes to activation. With an inflatable implant, you’ll be taught to cycle the device (inflate/deflate) to get comfortable using it and to keep tissues supple. Many surgeons start gentle cycling around two to four weeks after surgery.

Sexual activity will have to be put on hold for a while as the anatomy heals. Penetrative sex is usually cleared at around six weeks, once tenderness subsides and you’ve mastered cycling, though your exact timeline may vary.

Sex After an Implant

Positions and comfort. Early on, choose positions that let you control depth and angle. High-leverage positions (where the partner’s body weight or angles create greater force) may be more comfortable after you’ve had a few weeks of practice with the device. Remember, anal intercourse can require higher axial forces; that’s normal, and your implant is built for function, but your body and soft tissues are still recovering.

Lubrication and condoms. Use plenty of lube to reduce friction and pressure on soft tissue. Condoms are still a viable recommendation for STI prevention; implants don’t change STI risk. Choose higher-quality condoms that fit your girth comfortably.

Communication. If you’re the insertive partner, communicate about pace and angle. Let your partner know you’re getting used to a new device and may need a gentler start the first few times of resuming sexual activity.

Ejaculation and orgasm. An implant restores erection, not sensation, libido, or the ability to orgasm – those depend on nerves, hormones, and overall health. Many men report stable or improved sexual satisfaction once the anxiety about ED is gone.

Risks, Complications, and How Surgeons Reduce Them

All surgery carries risk. For implants, the big three are infection, erosion, and mechanical failure over time.

Infection: Modern infection rates for first-time, three-piece inflatable implants are approximately 1–3%, which is reduced by meticulous sterile technique and the use of antibiotic-coated devices. Risk is higher with poorly controlled diabetes and other underlying health conditions. If an infection occurs, the device may need to be removed and later replaced. ⁶
Erosion or tissue injury: This is rare, but the risk increases if a device is oversized or if tissues are too fragile. This is why careful sizing and experienced surgical technique are imperative.
Mechanical issues: All devices can eventually wear out, and revision rates naturally increase after many years of use. Your erection is dependable for as long as the device works, and devices can be replaced when needed.

Your surgeon will screen for modifiable risk factors (optimizing blood sugar, encouraging smoking cessation, treating skin infections), choose the right device for your anatomy and goals, and use infection-prevention protocols to reduce complications. ⁷

What About Satisfaction, Specifically in Gay Men?

Research is limited but encouraging. In a study of MSM undergoing inflatable penile prosthesis, men reported a renewed sense of vitality and overall greater satisfaction in daily life. We need larger studies that correspond with sexual orientation, but the available signal aligns with what many patients report in the clinic: once healed and comfortable with the device, sexual function becomes consistent, and confidence returns. ⁸

A penile implant is a durable, on-demand solution for ED with high satisfaction and low infection risk in well-selected patients. For gay men, the key is personalization: choose a surgeon who will talk candidly about your sexual goals, optimize device selection and sizing for strong axial rigidity and comfort, and guide you through recovery so you can return to the sex life you want, safely and confidently.

As a fellowship-trained urologist in men’s sexual health, Dr. Kapadia prioritizes respectful, individualized care. He has been designated as a Coloplast Titan and Boston Scientific AMS 700 Center of Excellence surgeon for penile implants. If you’re considering an implant or just want to understand your options, schedule a confidential consultation. Bring your questions, your goals, and your partner if you’d like. We’ll talk through candidacy, device choices, recovery, and what sex can look like afterward so you can make an informed decision that truly fits you.

Notes on evidence: Research specifically focused on gay men with penile implants is limited but growing; early studies suggest high satisfaction, consistent with broader implant literature. Anal intercourse can involve higher axial forces, which is relevant for device selection/sizing and return-to-sex recommendations.

References:

Levine, L. A. (2024, April 25). AUA2024 PREVIEW Prevention and Treatment of Inflatable Penile Prosthesis Infection, and Placement Following Explant – American Urological Association. American Urological Association News. https://auanews.net/issues/articles/2024/april-2024/aua2024-preview-prevention-and-treatment-of-inflatable-penile-prosthesis-infection-and-placement-following-explant.
La, J., Loeb, C. A., Barham, D. W., Miller, J., Chung, E., Gross, M. S., Hatzichristodoulou, G., Park, S. H., Perito, P. E., Suarez-Sarmiento, A., Van Renterghem, K., & Yafi, F. A. (2023). Satisfaction rates of inflatable penile prosthesis in men who have sex with men are high. International journal of impotence research, 35(6), 564–568. https://doi.org/10.1038/s41443-022-00603-2.
Miller, J. A., Loeb, C. A., La, J., El Khatib, F., & Yafi, F. A. (2023). Penetrative anal intercourse may require high axial loading forces. The journal of sexual medicine, 21(1), 40–43. https://doi.org/10.1093/jsxmed/qdad156.
Thirumavalavan, N., Cordon, B. H., Gross, M. S., Taylor, J., & Eid, J.-F. (2018). Rear Tip Extenders and Penile Prosthesis Rigidity: A Laboratory Study of Coloplast Prostheses. The Journal of Sexual Medicine, 15(7), 1030–1033. https://doi.org/10.1016/j.jsxm.2018.05.001.
Chung, E., Bettocchi, C., Egydio, P. H., Love, C., Osmonov, D., Park, S. S., Ralph, D., Xin, Z. C., & Brock, G. (2022). The International Penile Prosthesis Implant Consensus Forum: clinical recommendations and surgical principles on the inflatable 3-piece penile prosthesis implant. Nature Reviews Urology, 19, 534–546. https://doi.org/10.1038/s41585-022-00607-z.
Baird, B. A., Parikh, K., & Broderick, G. (2021). Penile implant infection factors: a contemporary narrative review of literature. Translational andrology and urology, 10(10), 3873–3884. https://doi.org/10.21037/tau-21-568.
Moukhtar Hammad, M. A., Barham, D. W., Sanford, D. I., Amini, E., Jenkins, L., & Yafi, F. A. (2023). Maximizing outcomes in penile prosthetic surgery: exploring strategies to prevent and manage infectious and non-infectious complications. International Journal of Impotence Research, 35, 613–619. https://doi.org/10.1038/s41443-023-00773-7.
La, J., Loeb, C. A., Barham, D. W., Miller, J., Chung, E., Gross, M. S., Hatzichristodoulou, G., Park, S. H., Perito, P. E., Suarez-Sarmiento, A., Van Renterghem, K., & Yafi, F. A. (2023). Satisfaction rates of inflatable penile prosthesis in men who have sex with men are high. International journal of impotence research, 35(6), 564–568. https://doi.org/10.1038/s41443-022-00603-2.

Low T: Patch, Pellet, Pill, or Shot

Posted on July 21, 2025August 7, 2025 by Akash Kapadia, MD in Low Testosterone

Testosterone replacement therapy (TRT) is having a moment. Scroll through social media, tune into late-night radio, or walk past a strip mall, and odds are you’ll spot an ad or clinic offering to “boost your T.” But behind the hype is a decades-deep history of clinical use and an evolving toolkit designed to restore balance for men dealing with low testosterone.

Just how many decades back did the research start? In 1889, physician Charles-Édouard Brown-Séquard injected himself with a concoction made from animal testicles, believing it rejuvenated his vitality. While his experiment was probably more alchemy than science, it sparked over a century-long exploration into testosterone’s potential. By the 1930s, testosterone had been isolated and synthesized in a lab; by the 1950s, longer-acting injections became the gold standard of therapy.¹

Since then, TRT has expanded to include intramuscular injections, transdermal gels, subdermal pellets, buccal tablets, nasal sprays, and, more recently, oral capsules, each with unique pharmacokinetics and benefits.

We’ve come a long way, with options that are more ethical, advanced, accessible, and personalized – but they also require thoughtful guidance. In the following sections, we’ll dip into modes of testosterone delivery, how they work, and what patients can expect from each one.

Modern Options

Testosterone, the primary male sex hormone, plays a central role in sexual development, reproductive function, muscle mass, bone density, and mood regulation. When levels dip too low – a condition known as hypogonadism – men may experience symptoms ranging from fatigue and depression to erectile dysfunction, infertility, and reduced lean body mass. In cases where testosterone is measurably low (typically under 250 nanograms per deciliter), clinicians may recommend therapy to bring levels back into a normal physiological range.

While testosterone levels naturally decline with age, dropping about 1% per year starting around age 30, not all men develop symptoms. That’s why treatment isn’t based solely on numbers, but on the presence of real, disruptive symptoms supported by lab work and a legitimate medical evaluation.

The FDA-approved options on the market today offer flexibility in how testosterone is delivered, how often it’s dosed, and how steadily it’s absorbed. Each route comes with its rhythm, risks, and appeal depending on your lifestyle, goals, and medical profile.

Subdermal Pellets

Testosterone pellets are tiny cylinders placed just under the skin (usually in the upper buttock or hip area) during a quick in-office procedure. Once implanted, they slowly release testosterone over several months by diffusing steadily into the surrounding tissue and bloodstream.

Why people like them: They’re hands-off after insertion. No daily doses, no weekly shots, and most people get them reinserted every 3 to 6 months. Pellets are popular for their consistency, eliminating the need for self-administration or adhering to a strict daily schedule.

What to consider: The timing of symptom relief and when levels start to taper can vary. Some men feel great right away, while others may experience a lag as hormone levels build. Toward the end of the dosing cycle, it’s common for symptoms to return as the pellets lose potency.

There’s also a small risk that the pellet may work its way out or cause skin irritation or infection at the insertion site. It doesn’t happen often, but it’s worth being informed when making a decision.

Intramuscular Injections

Testosterone injections have been around longer than any of the other methods of delivery. They’re typically administered into a large muscle (like the glute or thigh) every 1 to 2 weeks, depending on the formulation or brand.

Why people like them: Injections deliver a full dose of testosterone directly into the bloodstream, which can bring fast symptom relief. Many men appreciate the simplicity and cost-effectiveness, especially when self-administering becomes routine.

What to consider: Levels can spike and crash between injections, leading to mood swings or fluctuations in energy. Some men find the needle aspect intimidating at first, but with a little practice (or help from a provider), it usually becomes second nature.

Transdermal Gels and Patches

Transdermal testosterone is delivered through the skin in two forms: gels and patches. Gels are applied once daily to clean, dry skin – typically on the shoulders, upper arms, or abdomen – while patches are worn continuously, usually on the back, thigh, or upper arm, and replaced every 24 hours.

Why people like them: Both gels and patches offer a consistent, daily dose of testosterone that closely mimics the body’s natural hormone cycle, offering steady absorption and bypassing the peaks and valleys commonly associated with intramuscular injections. Gels absorb quickly with minimal mess, and patches are easy to use once you get into a routine – no needles or office visits required for administration.

What to consider: Transdermal methods require careful hand-washing and drying time before dressing to avoid skin transfer to others, especially children or partners. Patches can sometimes cause mild skin irritation or redness at the application site, and may not stick as well in hot or humid climates. Still, many men find these options easy to integrate into daily life with a bit of trial and error, and rotating where the patch is applied helps to reduce skin irritation.

Oral Capsules

Several oral testosterone options have been FDA-approved in the last five years. In the past, oral testosterone was discontinued due to concerns about liver toxicity. But newer formulations have solved that issue by bypassing the liver entirely – they’re absorbed through the lymphatic system instead, making them a safer option for long-term use.

Why people like them: Oral testosterone is straightforward and needle-free. It’s in a form most of us are familiar with, and dosing is usually twice a day with food. There’s no need for patches, gels, or procedures, and it avoids the skin-to-skin transfer risks associated with topical products.

What to consider: Despite the convenience, hormone levels can sometimes fluctuate compared to other delivery methods until you get a rhythm going. Some men also experience gastrointestinal side effects, and for those with cardiovascular concerns, you’ll need to work more closely with your provider.

Buccal Tablets

These are small, sticky tablets that you press against your upper gum twice a day, where they slowly dissolve and deliver testosterone through the tissues in your mouth.

Why people like them: They’re discreet, they don’t require needles or gels, and they don’t come with the peaks and valleys of some other methods. Once they’re in place, you can go about your day with a steady release of testosterone.

What to consider: They can take a little getting used to. Some men notice a strange taste and potential gum irritation. The need to apply it twice a day like clockwork creates a steady influx of the medication, so missing a dose can throw off the constant flow your body gets used to.

Nasal Spray

Nasal delivery is a fast-absorbing option for men seeking more frequent microdoses – one spray in each nostril, three times a day. It might seem odd to take a hormone through your nose, but the nasal lining gives testosterone a direct and efficient path to your bloodstream.

Why people like it: It’s a good option if you’re looking for something less invasive that keeps hormone levels from swinging too much, and it has the advantage of minimal systemic buildup, meaning there’s less chance of having to dial back the dose to avoid off-target effects from elevated testosterone levels.

What to consider: Because it requires multiple applications a day, it might not suit everyone’s schedule. Nasal irritation or a stuffy nose are potential side effects, and the delivery can be impacted by congestion, especially in allergy season.

The Next Move

Research shows that most delivery methods are equally effective in raising testosterone to therapeutic levels and improving body composition, mood, and sexual function.² What differs most is the side effect profile and how well each method fits into your daily life. Other medications you take will also be a deciding factor.

With so many options on the market, it can be tricky to navigate legitimate therapy and fly-by-night online distributors. That’s why it’s essential to work with a knowledgeable and experienced provider who understands the nuances of hormone therapy and can tailor treatment based on your full medical picture.

If you’re feeling a drop in energy, a dip in sex drive, or noticing changes in mood or muscle tone, Dr. Kapadia specializes in personalized hormone therapy that prioritizes safety, efficacy, and your preferences. Reach out to schedule a consultation and start feeling like yourself again.

References:

Figueiredo, M. G., Gagliano-Jucá, T., & Basaria, S. (2022). Testosterone Therapy With Subcutaneous Injections: A Safe, Practical, and Reasonable Option. The Journal of clinical endocrinology and metabolism, 107(3), 614–626. https://doi.org/10.1210/clinem/dgab772.
Ahmad, S. W., Molfetto, G., Montoya, D., & Camero, A. (2022). Is Oral Testosterone the New Frontier of Testosterone Replacement Therapy?. Cureus, 14(8), e27796. https://doi.org/10.7759/cureus.27796.

Dyspareunia in Men: When Sex Hurts

Posted on July 7, 2025August 7, 2025 by Akash Kapadia, MD in Peyronie’s Disease, Sexual Health

Many people, for a multitude of reasons, don’t talk about experiencing pain during sex. When the infrequent conversation does come up, it’s usually in the context of women’s health. In men’s health, it comes up even less often.

Do a quick search online, and you’ll find that most articles and studies about dyspareunia focus on women. Very few address men. That knowledge gap reflects just how little attention it gets, even though men can also experience pain during or after intercourse. Pain during sex in men remains under-recognized, under-reported, and under-studied.

That doesn’t mean it’s uncommon. Studies estimate that about 5% of men worldwide experience painful intercourse at some point in their lives – that’s roughly 190 million men across the globe.¹

Intimacy is natural, and a healthy sex life is part of overall well-being. When things in the bedroom become uncomfortable, it’s not something to ignore. In this article, we’ll spotlight common causes, what you can do about them, and when it’s time to speak with a healthcare provider.

What’s Triggering the Pain?

Sex isn’t supposed to hurt. When it does, it’s likely a signal that something deeper could be going on, so don’t just power through it. Do some medical detective work with your urologist and men’s health provider to figure out what’s going on. Although not exhaustive, here are some of the most common causes.

Infections and Inflammation

Pain during sex can be the body’s way of sounding the alarm for an underlying infection. Urinary tract infections (UTIs), sexually transmitted infections (STIs), and prostatitis (inflammation of the prostate) can all cause discomfort or burning during ejaculation, urination, or penetration. Balanitis (inflammation of the head of the penis or foreskin) is another common source of pain. Any inflammation in the genital region can make even mild friction feel unbearable.

We can’t avoid every germ we encounter or the disruption microbes can cause. Still, safer sex practices and good hygiene can create a physiological environment that is inhospitable to them. When the culprit isn’t bacterial, proactive health strategies (like regular checkups, stress management, and an anti-inflammatory lifestyle) can support immune function and lower the risk of chronic inflammation.

Treatment depends on the source: antibiotics for bacterial infections, antivirals for STIs, and pelvic floor therapy or medication for chronic prostatitis. All of the above respond well to additional dietary or lifestyle adjustments in conjunction with medical attention.

Pelvic Floor Dysfunction

When the pelvic floor muscles are overly tense, imbalanced, or irritated, they can compress or entrap nearby nerves like the pudendal nerve, which runs through the pelvis and into the genitals. This can lead to pain that radiates into the groin area, thighs, lower back, and toward the penis or scrotum that’s sharp, burning, tingling, or aching. Some people also describe a pressure or “foreign body” sensation in the rectum or urethra.

The pelvic muscles also support the bladder, bowel, and reproductive organs. Because of the neighboring structures, issues with pelvic floor dysfunction (PFD) can create a cascade of symptoms that feel worse with sitting, sex, bowel movements, or stress.

Referred or radiating pain is one reason PFD can be misdiagnosed or overlooked. It often mimics other issues like prostatitis, sciatica, or hernias, but doesn’t respond to antibiotics or typical treatments for those conditions.

Pelvic floor dysfunction can stem from physical strain, injury, prolonged sitting, poor posture, or stress-related muscle clenching. It’s especially common among cyclists, weightlifters, and people with chronic tension patterns. Unlike infections or injuries, this type of pain often doesn’t show up on imaging or lab work, making it frustrating to diagnose.

Once it can be identified, it’s highly treatable. Pelvic floor physical therapy, biofeedback, breathing exercises, and bodywork can all help retrain muscles to relax and coordinate properly. In some cases, muscle relaxants or targeted injections may be helpful, and many men find lasting relief through conservative, movement-based approaches or a combination of therapies.

Skin Conditions

The skin on the penis is delicate, and like skin anywhere else, it can be affected by dermatological conditions. Eczema, psoriasis, lichen sclerosus, and contact dermatitis can all show up in the genital area, sometimes without warning. These conditions may cause redness, dryness, flaking, or cracking of the skin. Add the friction of sexual activity to already irritated skin, and discomfort is almost inevitable.

Flare-ups can be mitigated by identifying triggers – harsh soaps, fragranced body products, latex, certain fabrics, or even excessive moisture can all contribute to skin irritation. When it comes to our more sensitive parts, switching to gentle, non-irritating products can go a long way.

Treatment often includes topical steroids or barrier creams, but a dermatologist’s insight is warranted, especially if the condition is chronic. Avoiding allergens, keeping the area clean and dry (but not overly so), and using lubricants during sex can help prevent skin irritation.

Phimosis

Phimosis is a condition in which the foreskin is too tight to be pulled back over the head of the penis. In some cases, it’s present from birth and resolves naturally. But when it persists or develops later in life, often due to repeated infections or inflammation, it can make erections and intercourse painful. Even minor retraction can cause tearing or micro-injuries, making future encounters more stressful and uncomfortable.

Maintaining good hygiene and avoiding irritants can help prevent inflammation that exacerbates tightness. In recurrent or more severe cases, topical steroid creams can reduce tightness and inflammation, sometimes eliminating the need for surgery. Gentle stretching exercises may also help at times when inflammation isn’t present. When conservative options don’t work, surgical approaches like circumcision or preputioplasty might be considered.

Peyronie’s Disease

Peyronie’s disease occurs when scar tissue develops under the skin of the penis, causing it to bend or curve, sometimes too sharply, making erections quite painful. The curvature can make sex painful or even impossible. The condition can develop gradually or occur after an injury, and some men may not recall a specific event that triggered it.

There’s no surefire way to prevent Peyronie’s disease, but reducing the risk of injury during sex by using adequate lubrication and avoiding rough thrusting can help. Early diagnosis and treatment in the initial inflammatory stage can help prevent progression.

Treatment depends on the severity of the symptoms. For mild cases, watchful waiting may be enough. In more bothersome cases, options include injections into the scar tissue, traction therapy, or surgery for unresponsive cases.

Past Trauma or Surgery

Past injuries to the penis, pelvis, or perineum, usually from accidents, sports, or surgical procedures, can leave behind more than just scar tissue. Nerve damage, altered anatomy, or chronic pelvic floor tension may develop long after the original injury has healed. Even surgeries like hernia repair, prostate procedures, or circumcision can lead to lingering pain or changes in sensation that show up most clearly during sex.

Prevention isn’t always possible, but seeking early treatment for injuries and being proactive with post-surgical care can reduce incidences of long-term pain.
Treatment depends on the nature of the trauma. Pelvic floor therapy, nerve pain medications, scar tissue mobilization, or even reconstructive surgery might be needed. It’s also helpful to work with a provider familiar with post-surgical complications, particularly if pain develops months or even years after the event.

Pain Echoes

Sexual pain is often made worse by the stress it causes – our perception of pain, and the anticipation of it, can intensify how we experience it. Anxiety, fear of pain returning, and a sense of embarrassment can create a feedback loop, where worry tightens muscles, dulls arousal, and heightens the body’s pain response.

Even when the root cause is physical, the nervous system’s pain signals can become amplified, and the body may stay on high alert. Addressing pain with awareness of both the source and the surrounding stress is part of a holistic approach to care and leads to better outcomes.
Therapists who specialize in sexual health can be a real asset in this department. They’re trained to help people reconnect with their bodies through guided support that calms the stress response, reduces discomfort, and rebuilds confidence in intimacy.

Get In Touch

Painful sex doesn’t need to be your norm, and it’s not something to tough out alone. If you’ve been experiencing discomfort that doesn’t go away, seems to be getting worse, or is interfering with your ability to enjoy intercourse, it’s time to talk to someone.

Start with a provider who listens, takes your symptoms seriously, and is willing to explore beyond surface-level explanations. You deserve honest answers and relief.

Dr. Kapadia is a board-certified urologist with fellowship training in male sexual and reproductive health. Schedule a visit to dissolve pain, restore intimacy, and start enjoying your sex life again.

Reference:

DelCea, C. (2019). Dyspareunia in Men. International Journal of Advanced Studies in Sexology, 1(1), 48–52. https://doi.org/10.46388/ijass.2019.12.11.120.

Rebuilding Connection: Penile Implants & Quality of Life for Patients and Their Partners

Posted on June 23, 2025July 28, 2025 by Akash Kapadia, MD in Erectile Dysfunction, Penile Implants

Sex isn’t just about sex. It’s about closeness, confidence, desire, and feeling like yourself. When erectile dysfunction (ED) enters the picture, it can take a toll far beyond the bedroom. Patients often describe a quiet erosion of connection, marked by less eye contact, increased distance, and fewer shared moments. Partners feel it too – frustrated, concerned, or unsure how to help.

For couples dealing with ED, the strain is both physical and emotional. Research shows ED can significantly impact mental and emotional well-being, not just for the individual, but for their partner, too. Many patients experience a dip in self-esteem, confidence, and even depression. Partners often report feeling unwanted, rejected, or isolated in response.¹ And when pills or pumps don’t work (or stop working), it’s easy to feel like hope is off the table.

But it’s not.

Inflatable penile prostheses (IPPs), also known as penile implants, are a highly effective, discreet, and long-lasting solution that’s helping men restore their sexual function and reclaim their quality of life. And research shows that both patients and their partners are overwhelmingly satisfied with the results.

Information about the mechanics of penile implants is widely available. But let’s focus on what really matters: how people feel afterward.

What the Numbers Say

Psychological factors such as stress, negative self-talk, or fear of failure in the moment are almost the worst part about ED – what researchers call “cognitive interference.” A penile implant eliminates the need to mentally manage the timing and success of medication, removing a significant source of anxiety.¹

In one study, more than 83% of patients were satisfied with their implant a year or more after surgery and said that they’d recommend it to a friend.² Another review noted satisfaction rates as high as 90%, putting penile implants on par with other life-enhancing surgeries like knee replacements and breast augmentation.³

Why so high? There’s the obvious reason, of course – regaining an erection. But it also brought people back to a place of comfort, connection, and spontaneity. For many couples, the implant removes the performance anxiety and pressure that often comes with ED. Intimacy becomes possible again, without the clock ticking on medication or external devices.

Men, as well as women, just want to be close to their partner again, and 85% of partners reported satisfaction with the results, alongside the men themselves.⁴ The better the partner feels, the more satisfied the patient is, and vice versa. Restoring erectile function helps restore emotional equilibrium for both partners.

Partners play a huge role in recovery, communication, and emotional healing. That’s why more urologists now encourage couples to come to consultations together to ask questions, express concerns, and start rebuilding trust as a team.

More Than an Erection

Sure, regaining sexual function is important. But the benefits of a penile implant often reach well beyond the bedroom. Patients frequently report improved confidence, reduced stress and anxiety, increased relationship satisfaction, and a return to physical closeness that had been absent for months or even years.

And while not every couple discusses these feelings out loud, many describe a quiet shift in their relationship – hand-holding comes back, affectionate jokes return, and emotional intimacy starts to feel easier again.

Some men worry the implant will “feel fake” or that their partner won’t accept it. In reality, most partners are grateful to regain intimacy and connection. Many couples report that once they adjust, the experience feels natural and emotionally freeing. And while the idea of surgery can seem daunting, the procedure itself is straightforward. Most patients return to light activity within a few days, and sexual activity within 4 to 6 weeks – just a brief recovery when you consider the months or even years of frustration that came before. Even better? Most implants last 10 to 15 years or more, making them a long-lasting solution to a long-standing challenge.

Most implants today are inflatable, discreet, and completely concealed within the body. Once healed, there’s no visible sign, and the function is entirely under your control. That means no waiting for pills to kick in or worrying about timing. It’s there when you want it, and completely undetectable when you don’t.

And with satisfaction rates this high, you’re investing in so much more than a medical device – you’re investing in quality of life, for yourself, and your partner.

Penile implants offer men and their partners a chance to reclaim something deeper. Whether ED has been a lingering issue or a recent frustration, you deserve to know your options and to have a partner in that conversation.

If you’re ready to talk about what life after ED could look like, Dr. Kapadia is here to help. He is a Coloplast Titan and Boston Scientific AMS 700 Center of Excellence for penile implants, and one of the few centers in the nation to achieve this dual designation.

He can offer expert guidance to patients and couples exploring treatment options, and has helped many people find their way back to a satisfying, connected life.

The earlier the ED is addressed, the less emotional distance builds between partners. Don’t wait until things feel unmanageable – many couples say they wish they’d explored treatment sooner.

References:

Allen, M. S., Wood, A. M., & Sheffield, D. (2023). The Psychology of Erectile Dysfunction. Current Directions in Psychological Science, 32(6), 487–493. https://doi.org/10.1177/09637214231192269.
Jorissen, C., De Bruyna, H., Baten, E., & Van Renterghem, K. (2019). Clinical Outcome: Patient and Partner Satisfaction after Penile Implant Surgery. Current Urology, 13(2), 94–100. https://doi.org/10.1159/000499286.
Barton, G. J., Carlos, E. C., & Lentz, A. C. (2019). Sexual Quality of Life and Satisfaction With Penile Prostheses. Sexual Medicine Reviews, 7(1), 178–188. https://doi.org/10.1016/j.sxmr.2018.10.003.
Jorissen, C., De Bruyna, H., Baten, E., & Van Renterghem, K. (2019). Clinical Outcome: Patient and Partner Satisfaction after Penile Implant Surgery. Current Urology, 13(2), 94–100. https://doi.org/10.1159/000499286.

What Causes BPH, and Can It Become a Medical Emergency?

Posted on June 9, 2025July 28, 2025 by Akash Kapadia, MD in BPH

Benign prostatic hypertrophy, or BPH for short, is a non-malignant condition in which the prostate enlarges. This is quite common, especially as men get older. Although it isn’t fully understood, scientists do know that an excess of certain male hormones encourages parts of the prostate to grow more than usual. Causes of BPH have garnered significant interest in the research community, and we’ll go over some of the theories shortly.

Symptoms

BPH typically presents with changes in urinary habits. Common symptoms are often referred to as “voiding symptoms” because they involve the process of urination or emptying the bladder. This includes a weak or slow urine stream, an uptick in frequency, difficulty urinating or starting to urinate, and waking up at night to urinate more than usual. Another set, called “storage symptoms,” includes sudden urges to go and occasional leakage. Sometimes they can be part of the BPH pattern, but they can also indicate other urinary-related conditions.

Globally, studies have shown that about one in four men will experience these symptoms at some point in their lives, and this rate has remained relatively stable over the past two decades. Though BPH is common, it can still interfere with quality of life, disrupting sleep, increasing bathroom trips, hampering social and work activities, and sometimes affecting sexual and emotional health.

Causative Theories

Forewarning: this part gets super scientific, but don’t worry, it’ll be over soon.

As researchers continue to uncover the mechanisms behind BPH, one recurring theme is the role of chronic inflammation. Other theories include age-related hormonal changes, altered signaling between various cells, and imbalances in growth factor activity. Together, these factors may create an environment that supports abnormal, yet noncancerous, tissue growth.

Another area of growing interest is the idea that BPH may represent a kind of “reawakening” of embryonic growth patterns in the prostate. This theory, first proposed in the 1970s, suggests that aging-related factors can trigger stem cells (cells that develop into other cell types) to become active again. These cells may originate in the prostate itself or be recruited from the bone marrow. Once they arrive, they respond to inflammatory signals and growth factors, leading to abnormal but benign growth of prostate tissue. In particular, mesenchymal stem cells (which can form connective and smooth muscle tissue) seem to play a key role by altering the local environment and encouraging further proliferation of prostate cells.

Untreated BPH

If BPH isn’t treated, the problems can get worse than just annoying bathroom trips. The complications go from uncomfortable to serious. These include impaired bladder emptying, where the bladder fails to fully drain, which increases the risk of urinary tract infections and bladder stones. Sometimes, gross hematuria (visible blood in the urine) can occur, signaling the need for medical attention.

More severe complications include acute urinary retention, a sudden and painful inability to urinate that requires emergency care. In the worst cases, urine can back up into the kidneys, leading to kidney failure, which can cause permanent damage.

Beyond the urinary system, untreated BPH can lead to chronic sleep loss that affects energy, mood, and concentration. In older adults, sleep disruption increases the risk of falls, which can lead to fractures or head injuries.

When Is It an Emergency?

BPH becomes an emergency mainly when it causes acute urinary retention (AUR) – a sudden inability to urinate that’s painful and needs immediate medical attention. If you can’t urinate at all, it’s important to get help right away to avoid serious complications.

When urine builds up suddenly and can’t be released, it puts extreme pressure on the bladder, potentially damaging the bladder muscle and reducing its ability to function correctly over time. Urine trapped in the bladder can also become a breeding ground for bacteria, increasing the risk of urinary tract infections (UTIs). If these infections spread into the bloodstream, they can cause sepsis, a serious medical emergency.

Because the kidneys filter waste from the blood, any blockage that causes urine to flow backward can impact kidney function. The effects on other body systems further afield are often related to the complications that arise from infections or the body’s response to severe pain and stress.

Treatment Options

Treatment for BPH depends on the extent to which the symptoms are impacting daily life. For men with mild or stable symptoms, active monitoring with regular check-ins with a healthcare provider may be sufficient. However, if the symptoms are more severe, many treatment options become available.

In situations where procedures or surgery aren’t possible due to other health conditions, catheter-based management may be used. This involves placing a tube (catheter) into the bladder to allow urine to drain, either as a temporary solution or for longer-term management. The goal of each of these treatments is the same: to relieve obstruction, improve bladder emptying, and alleviate symptoms. However, they differ in terms of their invasiveness, speed of action, and alignment with a person’s overall health and preferences.

The Bottom Line

Importantly, there’s no reason to suffer and just put up with urinary symptoms. If your urinary function is at all bothersome or if something feels off, talk to a urologist. At the very least, you deserve less stress and better sleep. And who knows? A simple conversation could spare you a lot of trouble down the road.

Dr. Kapadia Achieves Center of Excellence Status for AMS 700 Penile Implant

Posted on September 26, 2024October 20, 2024 by Akash Kapadia, MD in Penile Implants

One of Dr. Kapadia’s most gratifying treatments for erectile dysfunction is known as a penile implant or inflatable penile prosthesis. These implants offer qualifying patients with severe erectile dysfunction an option for achieving an erection and enjoying a normal sex life with their partners when other options like medications and injections have failed. For some, this can even restore fertility and the ability to conceive without external procedural intervention.

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Prostate Cancer Screening – Should You Do It?

Posted on September 11, 2024September 18, 2024 by Akash Kapadia, MD in Prostate Cancer

Prostate cancer screening has been a mixed bag over the past several decades. In the late 1970s and early 1980s, we were excited to find a marker in the blood specific to the prostate known as PSA – prostate-specific antigen. This was a watershed moment in the diagnosis and, ultimately, treatment of prostate cancer, but not in the way we all thought back then. Without the benefit of hindsight, the initial reaction to PSA was to set a cutoff (of about 4), at which point a prostate biopsy would be ordered.

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Comparing Coloplast Titan and Boston Scientific AMS 700 Penile Implants

Posted on August 28, 2024September 18, 2024 by Akash Kapadia, MD in News, Penile Implants

With his recent designation as an AMS 700 Penile Implant Center of Excellence surgeon, Dr. Kapadia is now a COE-designated doctor for both major inflatable implantable penile prostheses on the market. As such, there might be no better time to compare the two devices to see which is better for any given patient.

Hint: Each penile implant device has pros and cons and may suit different anatomies. Both devices have size and rigidity options depending on the patient’s needs. As such, Dr. Kapadia chooses the best device for his patients without regard to loyalty to one device maker or the other.

That said, let’s dig deeper into the differences between the two.

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The Decision to Treat Peyronie’s Disease

Posted on August 14, 2024September 9, 2024 by Akash Kapadia, MD in Peyronie’s Disease

It’s essential to shed light on a condition that affects about 5% of men both psychologically and physically, known as Peyronie’s Disease or PD – a condition that involves the abnormal presentation, often curvature, of the penis. Peyronie’s can manifest in several ways, and while the most common curvature is upward, the penis can also curve to the side or downward. How the penis curves and the degree of curvature is related to plaque accumulation. This plaque pulls on the penile structures, causing the penis to curve during erection. The most common cause of Peyronie’s Disease involves micro tears in the penis that, over time, create an exaggerated inflammatory reaction with resultant penile plaque accumulation.

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