Dr. Duzyurek helps his patients overcome the following difficulties in a confidential, affirmative, comfortable, unrushed and low-pressure atmosphere of a private practice setting through a comprehensive, integrated, noninvasive and pain-free evaluation and treatment approach as a professional ally for what is best for your sexual health:
- Erectile Dysfunction (mild to severe; persistent or intermittent; situational or generalized)
- Penetrative performance failure or inconsistency in partnered sex despite having a full and sustained erectile potency in other settings, such as foreplay, oral sex or self stimulation.
- All forms of Delayed Ejaculation (a difficulty in reaching ejaculatory release/orgasm)
lifelong or later acquired (due to surgery or cancer treatments; neurological problems; aging; etc.) continuous or intermittent intercourse-specific or other situation-specific, or generalized OCD or OCPD related; paruresis related; other psychogenic drug induced; due to masturbatory over-training or conditioning toward ejaculatory over-control
- Sexual Rehabilitation, Remediation, or Prevention of erectile, ejaculatory, orgasmic or sensation problems, or penis size loss (associated with atrophy, fibrosis, or hypersympathetic activity) due to (1) aging, (2) certain conditions such as neurological disorders (e.g., MS or spinal cord problems) or hormonal problems, (3) effects of surgery, radiotherapy, or drug therapy (e.g., finasteride) for male pelvic conditions, (4) trauma such as compression injury due to bike riding, (5) a delayed correct treatment for ED, or (6) following penile implant (prosthesis) placement.
- Sexual Dysfunctions associated with Shy Bladder (A Psychogenic Inhibition of Micturition)
- Premature Emission (a dissociation between the emission and ejection components of ejaculation), or Absent or Retarded Emission
- Poor Orgasmic Intensity or Quality; Ejaculatory Dysphoria (instead of orgasmic pleasure)
- Ejaculatory Anhedonia, also known as Pleasure Dissociative Orgasmic Disorder
- An impairment in experiencing a pleasurable feeling in the penis despite having adequate erectile arousal, usually along with a poor orgasm quality or with a difficulty reaching ejaculatory threshold
- Male Persistent Genital Arousal Disorder (a.k.a. Restless Genital Syndrome)
- Local Pain or Other Physical Discomfort During or Following Ejaculation
- Partial or Complete Loss of Libido (absent or low sex drive); Sexual Anorexia
- Excessively Increased Libido (sexual overdrive)
- Sexual Performance Anxieties, Sexual Confidence Issues, or a Susceptibility to Sexual Shame
- Postorgasmic Malaise (a.k.a. Postorgasmic Illness Syndrome), including Post-coital Tristesse
- Certain Fetishes or Paraphilias that interfere with functioning in non-paraphilic (conventional) sex, when the latter is also desired by the person.
- Chronic or Recurrent Male Pelvic Pain Syndrome (or Male Pelvic Myoneuralgia)
- Dissatisfaction or concerns about the size or form of penis or testicles
- Receptive Sexual Dysfunctions in gay/bi men including anodyspareunia (painful intercourse)
MEDICAL EVALUATION and COUNSELING related to Sexual Health and Functioning
SEXOLOGICAL and SEXOPHYSIOLOGICAL ASSESSMENT and ADVICE for Sexual Health and Penis Fitness Improvement, Remediation, Restoration, or Proactive Size and Function Maintenance
SEXUAL PHARMACOTHERAPY for libidinal, erectile, ejaculatory or orgasmic problems
- Oral Rx Medications, including personalized medication combinations for enhanced efficacy
- Oral OTC Drugs (Evidence Based Options)
- Topical or Transdermal Medication Options
SEXUAL PHYSIOTHERAPY utilizing MEDICAL DEVICES for Erectile or Ejaculatory Dysfunctions
PHARMACO-GENETIC TESTING for optimizing and refining drug treatment, as needed.
BEHAVIORAL and PSYCHOLOGICAL THERAPIES for SEXUAL PERFORMANCE PROBLEMS
Many patients can achieve satisfactory results with a biomedical approach alone (e.g., an optimized use of medications and/or sexual physiotherapy plus professional advice and tips). In some others, where factors involving the mind-body connection are significant, a full accomplishment of treatment goals also calls for a form of mind-and-behavior-based (psycho-behavioral) therapy tailored for particular sexual functioning issues of the patient. An effective such therapy for sexual dysfunctions requires an integration of various elements in a way that is tailored for a particular individual, the nature of the problem and the phase of treatment. These elements may lie within cognitive, psychodynamic, relational, and behavioral therapy domains, such as simulative corrective experiencing and training.
Dr. Duzyurek offers Self-Imagery-Guided Therapeutic Simulation as part of an integrated and sex-positive treatment program for ejaculatory dysfunctions and certain forms of libidinal or erectile performance problems when a psychosomatic component is involved. Imagery and device assisted simulation therapy is related to medical hypnosis, cognitive-behavioral therapy, biofeedback, and 'positive psychology' approaches. This form of behavioral therapy may be valuable for men without a participating partner, either by choice or by necessity. A typical therapy program takes advantage of certain intercourse simulators used by the patient at home in order to obtain a realistic sensorimotor effect to help create a corrective or therapeutic 'virtual reality' experience that is central in treatment. For erectile performance issues, delayed ejaculation, or anorgasmia, the aim is to cultivate a skill for attaining and maintaining a mental and bodily flow of a focused, passionate, and autotelic arousal immersed and engaged in the present moment with an openness to the multiple (and sometimes seemingly conflicting) dimensions of the immediate sensual and sexual experience, free of inhibiting or defocusing concerns, or other distracting mental processes or psychological entanglements. For premature ejaculation, the aim is to cultivate an improved capacity for self-control of ejaculatory timing and a neural reconditioning of the ejaculatory response. Masturbatory retraining via therauetic homeworks or vibrotherapy options may also be employed for ejaculatory or orgasmic dysfunctions.
INTEGRATED TREATMENT of psycosocial or psychiatric aspects of sexual function difficulties.
CONSULTATION or COORDINATION with OTHER MEDICAL or SURGICAL SPECIALISTS (such as an endocrinologist, neurologist, or urologist), when indicated, such as when Dr. Duzyurek's evaluation points to an endocrine disorder or certain types of severe problems involving nerves, blood vessels, or other structures of the penis.
COORDINATION with, or REFERRAL to, OTHER ALLIED CLINICIANS (such as physical therapists specializing in pelvic floor issues, psychotherapists, couple therapists, marriage counselors, or sex therapists), when indicated or preferred.
A SEXUAL HEALTH MESSAGE FOR MEN
Some men with sexual functioning issues are unaware of, or they act complacently about, the importance of obtaining an effective, personalized and optimized professional treatment without an undue delay. No man should settle with less than fully hard erections that develop briskly, or with poor orgasms, ongoing premature or excessively delayed ejaculations. Like many other medical conditions, various progressive biological disease processes underlie most sexual dysfunctions, leading to an entrenchment of the problem, and potentially additional complications, over time. For example, an untreated erectile dysfunction (ED), regardless of its initial cause or severity, will likely lead, over time, to a gradual degeneration in the fine architecture of erectile tissues, as well as in the overall structural integrity of the penis, simply by the virtue of a reduction in the frequency, duration or quality of erections. Untreated ED begets more ED over time. Its incorrect or delayed treatment may also lead to an insidious loss in penis length and girth.
The adage "erections are supported by erections" is backed by evidence. The main reason for this is that regular, fully rigid erections with an adequate duration are necessary for the penis to maintain its optimal structural and functional integrity. When this penis-maintaining and penis-nourishing function of full erections with adequate frequency and duration is compromised, a progressive atrophy in key anatomical elements of the penile tissues takes place, along with diffuse fibrotic changes within the erectile bodies of the penis, causing a decrease in erectile tissue stretchiness, expandability and fillability, also leading to an insufficient (leaky) blockage of the blood flow in veins that drain the erectile tissue. This appears to be the underlying reason for the veno-occlusive dysfunction, which probably is the most common cause of organic ED. (Also, various causes of ED themselves are known to be directly and progressively degenerative towards neural, vascular and/or connective tissue elements involved in penile functioning and structural integrity.) It is crucial to prevent this course and outcome, and to reverse any early degenerative changes. The importance of regular, frequent, and fully rigid erections that last 15 minutes or longer can also be inferred from the widely-accepted function of the REM-sleep-induced erections that the males of mammals evolved to have. These sleep-erections are especially frequent, prolonged, and fully rigid in every male mammal that lost through evolution its baculum (a.k.a. os penis, or penis bone), including men, as they have to rely on the structural and functional integrity and coordination of numerous components which need to work like a team, instead of a push-button raising of the penis bone. These inherently softer body elements need to perform a complexly coordinated and modulated choreography in order to achieve a bone-like rigidity based on hydrolic principles. In human males these erections occur in 3-6 episodes every night, each lasting 15-50 minutes, including the longest lasting terminal ones experienced as morning erections or "morning wood". They also occur during the REM part of naps during the day. These automatic penis-maintenance erections, which require adequate testosterone levels and REM periods during sleep, increase the blood and oxygen supply of the erectile tissues (the two corpora cavernosa and the corpus spongiosum), activate anti-apoptotic (anti-autodestructive), cell-protective and pro-growth genes in the epithelial, smooth muscle and neural cells, including their stem cells, activate mechanisms to remove cellular debris, and induce the synthesis and release of certain biochemical factors (such as nitric oxide) that are necessary for the maintenance of the structural and functional integrity and health of the erectile tissues. In addition, regular, fully rigid erections activate anti-fibrotic mechanisms and exercise the spongy elastic tissue components, thus helping to maintain their elasticity. Otherwise, the normally stretchy (elastic) tissue components gradually die off ("atrophy") and become insidiously and diffusely replaced by nonstretchy (inelastic) and shrinkage-causing fiber-like tissue components ("fibrosis"). Sleep-induced ("nocturnal") erections function as a safety net mechanism for the functional and structural maintenance of penis. However, in almost all forms of ED (including most common forms of psychosomatic ED, such as depression-related ED), nocturnal erections are also impaired, either in terms of quantity (frequency and duration) or quality (degree of rigidity), or both. In addition, for the maintenance of optimal penis structure and function, erections during sleep must be supplemented by regular awake erections triggered by commands from the erotic arousal centers of the brain, as well. These awake erections have certain additional features that are different from REM-sleep erections physiologically and a lack of their contribution to penis health and fitness may not be fully compensated by sleep-induced erections. Starting to have less robust erections in masturbation is often the earliest sign that an ED process is under way in young men. An initially mild or intermittent ED, when not acknowledged and effectively treated, can become a driver of its own persistence and worsening in time by creating a vicious cycle, which not only causes a progressive entrenchment and down-spiraling of the problem, but may also be associated with an insidious size loss in erection, as reported by a significant group of patients. This shrinkage may become particularly pronounced in the presence of certain co-factors, such as a prolonged testosterone deficiency or anti-testosterone medication use, hypertension, diabetes, abdominal obesity, cholesterol problems, certain neurological conditions, advancing age, certain sleep disorders (such as sleep apnea), smoking, alcohol and certain other substance abuse, chronic inflammation, or the treatment of male pelvic conditions (e.g., cancers or BPH) with surgery, drugs, or ablative techniques (e.g., radiation, microwave heat, laser evaporation or enucleation, or needle ablation). Certain forms of treatment for ED have emerged in recent years as more successful than other alternatives in preventing, and even reversing, the degenerative changes (atrophy and fibrosis) involved, whereas some others, such as penis injections, carry a sizable risk of harm, especially in the long-term. Therefore, it is crucial for a man with any type or degree of ED to initiate an optimized treatment regimen expeditiously even when he may not be having partnered sex currently, or may not even be planning to be sexually active with a partner in the foreseeable future. A male with any degree of ED at any age should not regard this only as a practical performance issue to be symptomatically managed today, but also as a progressively degenerative condition that should be preempted by treating it effectively, correctly, organ-protectively, and without complacency for as long as he values improving his odds for carrying on his full sexual function and penis fitness into his future. Similarly, the importance of avoiding a prolonged delay in correct neuroprotective treatments appears to apply to other forms of problems in sexual functioning, such as libido or orgasm problems, and ejaculatory dysfunctions. In addition, sexual function health and overall health can not be isolated from one another. Sexual function problems can be an indicator or harbinger of other physical, mental, behavioral, or relational health problems, and, conversely, they can trigger various other complications.
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