Sexual complaints are among the most common reasons adults see a physician and among the least likely to be raised. Patients wait, on average, years. Physicians frequently do not ask. The result is that a category of problems which are treatable, and which often signal something else worth catching, goes undiscussed.
We treat this as ordinary clinical work. It is confidential, it can be done by video where an examination is not required, and it is handled by the same physicians who manage the vascular, hormonal and urologic conditions that sit underneath most of it.
For men
Erectile dysfunction is the one that matters most to catch, and not only for the obvious reason. The penile arteries are small; the coronary arteries are larger. When endothelial function begins to fail, the small vessels declare it first, which means erectile dysfunction frequently precedes a cardiac event by several years. A man who arrives asking for a prescription is, from our side of the desk, a man who should have his blood pressure, lipids, glucose and smoking status addressed while he is here. Writing the prescription and skipping that is a missed opportunity we are not willing to take.
Treatment then proceeds from least to most invasive: correcting what is correctable, oral medication, shockwave therapy for appropriate vascular cases, PRP, injection therapy which remains highly effective when tablets fail, vacuum devices, and implants where nothing else restores function. Hormones are checked, but testosterone is a treatment for desire more than for mechanism and we say so.
Premature ejaculation is more common than erectile dysfunction in younger men and much less often treated; behavioural technique, topical agents and off-label SSRIs all work. Peyronie's disease — curvature from scar tissue in the penis — is evaluated by stage, because treatment during the active inflammatory phase differs from treatment once the plaque has stabilised. Low desire in men is worked up rather than assumed hormonal; medication, depression, relationship factors and sleep all feature.
For women
Painful sex is a symptom with a specific differential rather than a diagnosis, and it is one where women are too often told that nothing is wrong. Genitourinary syndrome of menopause — thinning and dryness from estrogen loss — is common, under-treated, and responds well to local estrogen or non-hormonal alternatives. Pelvic floor overactivity produces pain that no amount of lubricant fixes and that responds to pelvic floor physical therapy. Endometriosis, vulvodynia, vaginismus, infection and skin conditions such as lichen sclerosus each have their own treatment and their own examination findings.
Low desire is evaluated in context rather than pathologised: medications — particularly SSRIs and hormonal contraception — thyroid disease, depression, sleep deprivation, pain with sex, and the state of the relationship all matter, and hormone levels are frequently the least informative part. Where hormonal treatment is appropriate it is discussed properly, including what is and is not licensed. Our gynecology service handles this alongside menopause care.
Testing and prevention
STI testing is available with or without symptoms, including for patients who simply want to know. Our virtual UTI and STI clinic handles straightforward cases quickly. HPV vaccination is offered and is worth discussing well past the ages people assume it stops being useful. HPV screening and colposcopy are provided for women, and contraception including IUD placement is available in both offices.
What a first visit looks like
A conversation, a medication review, an examination where it is needed, and usually blood work. Nothing is done at a first visit that you have not agreed to. If you would prefer to start by video, that is available and is how a good proportion of these consultations now begin.
A note on what we do not do
There is a large market in sexual wellness treatments sold with medical vocabulary and very little evidence, and some of it is offered by clinics that look much like ours. We will tell you when something is elective, when a device has no clearance for the indication it is being marketed for, and when the honest answer is that a treatment has not been shown to beat placebo. That occasionally costs us a sale, and it is the correct trade.
Conditions & services
Understanding Erectile Dysfunction
Erectile dysfunction (ED) is more common than most people think and far more treatable than many realize. If you’re ex
Premature Ejaculation
Peyronie's Disease Treatment in NYC
Peyronie's disease treatment in Manhattan and Forest Hills with Xiaflex collagenase injections, traction and mode
Shockwave Therapy for Erectile Dysfunction in NYC
Low-intensity shockwave therapy for mild-to-moderate vascular erectile dysfunction in Manhattan and Forest Hills, with
STDs & STIs
STDs and STIs can be a common occurrence for those who are sexually active. To keep yourself and future partners prote
Menopause Treatment in NYC
Menopause treatment in Manhattan, Forest Hills and Rego Park: individualized hormone therapy, non-hormonal options, vaginal and b
Questions patients ask
Is this confidential?
Yes, in the ordinary way that all medical care is. Records are part of your chart and are not shared without your authorisation. If you are concerned about what appears on an insurance statement, say so at the visit and we will explain what will and will not be itemised.
Can I be seen by video?
For most first conversations, follow-ups, results and medication management, yes. An examination is needed for Peyronie’s disease, for painful sex in women, for any lump or skin change, and before some treatments — we will tell you when a visit has to be in person.
My partner and I both need to be seen. Can that happen together?
Yes, and for several of these problems it is the better way to do it. Sexual difficulties are frequently shared between partners even when only one has the symptom.
Why does my erectile dysfunction need blood tests?
Because erections are a vascular event, and difficulty with them is often the earliest visible sign of vascular disease elsewhere. Checking glucose, lipids, blood pressure and testosterone finds things worth treating in their own right and sometimes explains the problem entirely.
Are these visits covered by insurance?
Evaluation of an underlying medical problem generally is. Some specific treatments — shockwave therapy and PRP among them — are usually not covered, and we tell you the cost before anything is scheduled.
Make an appointment
Manhattan (212) 991-9991 · Forest Hills (718) 360-9550 · same-week visits and all insurance accepted, including Medicaid and Medicare.