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 * Homepage
 * Our Team
 * What We Treat
   * Erectile Dysfunction
   * Premature Ejaculation
   * Penile Rehabilitation
   * Low Libido
   * Ejaculation Problems
   * Peyronie’s Disease
   * Men’s Health Check
   * Sexually Transmitted Illness
 * Scenarios
 * Fees and Rebates
 * Contact
 * Appointments
 * Resources

 * Homepage
 * Our Team
 * What We Treat
   * Erectile Dysfunction
   * Premature Ejaculation
   * Penile Rehabilitation
   * Low Libido
   * Ejaculation Problems
   * Peyronie’s Disease
   * Men’s Health Check
   * Sexually Transmitted Illness
 * Scenarios
 * Fees and Rebates
 * Contact
 * Appointments
 * Resources

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OUR SEXUAL HEALTH PHYSICIAN, UROLOGY NURSE AND DEDICATED RECEPTIONISTS




DR YIN MIN HEW

MBBCh, MRCP(UK), Dip GUM, Dip HIV, FAChSHM (Fellow of the Australasian Chapter
of Sexual Health Medicine)

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NICK FONCECA

Urology Nurse

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PATRIZIA AND WILMA

Front Desk

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PMH HAS A CLOSE RELATIONSHIP WITH UROLOGISTS, A CLINICAL PSYCHOLOGIST AND
PHYSIOTHERAPISTS TO OFFER A FULL SERVICE FOR ALL SEXUAL HEALTH PROBLEMS.




MAKE A BOOKING

 * Homepage
 * Our Team
 * Premature Ejaculation
 * Erectile Dysfunction
 * Low Libido
 * Sexually Transmitted Illness
 * Ejaculation Problems
 * Penile Rehabilitation


 * Men’s Health Check
 * Peyronie’s Disease
 * Case Studies
 * Fees and Rebates
 * Contact Us
 * Appointments
 * Privacy Policy
 * My Health Record Policy




ABOUT US

Perth Men’s Health (formally WA Sexual Health Centre) was founded by
internationally respected sexual medicine physician, Dr Denis Cherry in 1992.
Sexual medicine aims to improve both sexual health and overall health through
the prevention, early diagnosis, treatment and rehabilitation of conditions or
diseases that involve sexual function.




HOLLYWOOD SPECIALIST CENTRE

Suite 27, 95 Monash Avenue
Nedlands WA 6009

Telephone: (08) 9389 1400
Fax:  (08) 9389 1411
Email:  info@perthmenshealth.com.au




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Copyright © 2023 Perth Men's Health



48-year old Keith was pushed by his wife Natalia to seek help for low sexual
desire. For the past 9 months he had not instigated sex with her and she was
beginning to believe that he had met another partner. She is 10 years younger
than him, retains a very healthy libido and was considering leaving him.

Keith shared that despite loving his wife and still finding her very attractive,
he no longer felt the urge for sex. There was no difficulty with attaining or
maintaining full erections. He reported having very low energy levels with
fatigue in the afternoon, absent morning erections, difficulty to concentrate at
work, marked mood swings and poor motivation. The grumpiness and reduced help
around the house was causing major friction. He used to attend a gym on a
regular basis but ceased because he no longer felt benefits from exercise and
had muscle pains for several days after.

There was no significant medical history and he was not taking any medication.
He was not overweight. Testicular volume was lower than normal with no history
of previous trauma or infection to the testicles recalled.

Subsequent early-morning blood tests revealed that Keith had low testosterone
levels. Elevated pituitary hormone levels revealed that despite increased
stimulation from the pituitary gland, the testes were no longer able to produce
adequate testosterone (primary hypogonadism).

Testosterone has a profound effect on sexual function, brain function, muscle
mass, bone density and other parts of the body. While no cause for Keith’s low
testosterone levels were evident (as occurs in 50% of cases), his quality of
life was clearly suffering because of the low levels.

He was commenced on testosterone replacement with a preparation applied to the
skin each day and within 3 weeks described feeling like a new man with
resolution of all symptoms. Natalia was absolutely delighted saying “I have my
man back”.

Note: There is controversy even amongst the medical profession as to whether or
not testosterone replacement therapy is indicated and/or safe. Around the world
the consensus is that indeed testosterone replacement is indicated in men with a
clinical picture of low testosterone and associated low testosterone levels.
Full assessment is therefore required along with education before commencing men
on replacement as this is a lifetime decision and requiring continued
monitoring.



21-year-old furniture maker, Mark, presented with a history of premature
ejaculation beginning with his first sexual partners. Mark confided that he
always ejaculated less than 60 seconds after penetrating a partner, had no
control over this and the problem was causing him major distress. A number of
relationships had ended because he was unable to satisfy his partners and he
described feeling like a total failure. Techniques such as the stop – start
technique and getting drunk before sex had very little benefit.

Mark was congratulated for having the courage to address his problem, and was
informed that up to 30% of men have PE in their lives and that effective
treatments exist. He was transformed.

We discussed that the cause of lifetime premature ejaculation is primarily an
imbalance between two neurotransmitters (chemicals within the brain) and that
this runs in families. Dopamine pushes us towards ejaculation and serotonin
blocks ejaculation. In PE the serotonin level is low making it impossible to
prevent ejaculation even with various physical exercises.

After hearing the treatment options, Mark elected to commence a daily SSRI which
after three weeks allowed him to last over five minutes before ejaculation. On
review he was ecstatic.

We went through various relaxation techniques such as breathing meditation and
mindfulness as means to take further control over the time to ejaculation with a
view to tapering him off medication, if possible, in the future.



Andrew’s wife Emanuella encouraged him to make an appointment with us for
erectile dysfunction.

18 months ago he found it increasingly difficult to attain an erection
sufficiently hard for satisfactory sex which he and Emanuella last had three
months ago. Initially he had a full response to Viagra 100 mg and Cialis 20 mg,
but these gradually became ineffective over 12 months. Andrew was becoming
increasingly distressed at being unable to satisfy Emmanuella and was avoiding
physical intimacy.

Andrew is a 62-year-old Construction Engineer working long hours in a stressful
environment. He quit smoking 15 years ago after 25 years of 20 cigarettes per
day. With a relatively sedentary job he was 15 kg overweight and had been on
medication for diabetes for the past five years which he confided was poorly
controlled. He was also on medication to treat elevated cholesterol levels.

Approximately 50% of men Andrew’s age have erectile dysfunction, he was greatly
relieved to hear that he was not the only one. Causes of ED include blockage of
the small arteries to the penis, nerve damage, low testosterone, medications,
dysfunction of the mechanism that normally seals blood within the penis and
performance anxiety. Any stress such as fear of failure results in the release
of adrenaline which rapidly causes deflation.

It was explained to Andrew that the cause is very likely to be a mix of arterial
blockage and secondary performance anxiety. As blockages can occur in arteries
to other organs such as the heart, vascular ED is referred to as the “canary in
the pants”. Andrew was asked to have a CT coronary artery calcium score to
exclude signs of blockage to the coronary arteries.

We discussed the severe toxic nature of fat within the belly and the urgency to
reduce his weight with a supervised diet and regular aerobic exercise such as
walking at a moderate pace for 45 minutes, 3 – 4 times per week. He agreed to
see his GP to discuss better control of diabetes. We also discussed relaxation
techniques such as mindfulness and for Andrew to re-prioritise time for work and
play.

He was interested to know that Renova low intensity shockwave therapy can
stimulate the body to produce new healthy arteries and wished to research this
further. In the meantime he was taught self-injection of the penis which
produced fully satisfactory erections. Emanuella had no problem for the need for
penile injection to restore sexual intimacy. In fact he arrived home one
evening, opened the fridge for a beer and found an injection syringe drawn up
ready to go with a little bow placed around it.



Dr Yin Min Hew is the Medical Director of Perth Men’s Health. As a UK trained
specialist in Sexual Health Medicine, Yin Min has been involved in managing STD
and HIV. He strongly feels that sexual health is an important aspect in life and
that providing a safe and comfortable zone to discuss the issues is crucial to
the overall wellbeing of a person.


AREAS OF SPECIALTY INCLUDE:

SEXUALLY TRANSMITTED DISEASES (STD)

 * Chlamydia
 * Gonorrhoea
 * Syphilis
 * HIV Medicine
 * Genital warts and genital herpes
 * Hepatitis B and C
 * Mycoplasma genitalium

    

 HIV PREVENTATIVE MEDICINE

 * Pre-exposure Prophylaxis for HIV (PrEP)

    

 MALE SEXUAL DYSFUNCTION

 * Erectile dysfunction (inability to achieve and/or maintain an erection)
 * Premature ejaculation (coming too quickly)
 * Delayed ejaculation
 * Loss of libido (lack of desire for sex)
 * Peyronie’s Disease
 * Sexual rehabilitation following prostate surgery

    

   RELATIONSHIP COUNSELLING



Nick has worked as a nurse on surgical wards since 2009. His role involves the
pre and post-operative care of patients who have undergone urological and
gynaecological procedures. Nick has a keen interest in urology, in particular
procedures relating to the prostate. Nick joins the practice to manage the
sexual recovery aspects of patients that have undergone prostate surgery. Not
only will he assist with the teaching/educating components of rehabilitation, he
will also assist with other treatments that relate to men’s sexual health. Nick
is available to speak with you on a Monday, Wednesday and Friday.

TEACHING/EDUCATION

 * Penile rehabilitation post prostate surgery
 * Testosterone replacement therapy (TRT)
 * Intracavernosal injection (ICI)

TREATMENTS

 * Renova shock wave treatment



Patrizia and Wilma are our dedicated receptionists.



John came in with his wife Belinda at the recommendation of his Urologist, two
weeks prior to robotic assisted laparoscopic prostatectomy. They had largely
come to grips with the diagnosis, the decision to proceed with surgery and John
was undergoing a Physiotherapist supervised pelvic floor exercise program. They
were unsure as to why they had come in prior to surgery to discuss erectile
function as they had resigned themselves to the possibility that sexual
intercourse would no longer be a component of their close and loving
relationship.

Both were in their late 50s and prior to diagnosis they enjoyed sex on a regular
basis. John shared that he had no erectile dysfunction and retained a healthy
libido . The only significant medical history was of abdominal obesity and
borderline diabetes. Lifestyle was healthy in all aspects. Examination of the
penis and testes was completely normal.

They had been told by their surgeon that nerves would have to be sacrificed on
one side of the prostate because of their closeness to the cancer but that nerve
sparing on the other side was likely. We discussed the fact that, while these
nerves would not be cut, they are incredibly fragile and almost always become
bruised in the process of being kept out of harm’s way. This nerve damage
results in severe erectile dysfunction until the nerves regenerate, which if it
occurs, takes from 12 to 18 months.

They were informed that John was having approximately 6 erections every night to
preserve erectile tissue health and elasticity and that these would cease after
surgery because of the nerve damage. We then went over a program to maintain
erectile tissue health and elasticity while we wait to see what degree of nerve
regeneration occurs.

Because medications like Viagra and Cialis require significant nerve function we
discussed why these would not be effective in achieving a full erection in the
medium-term following surgery. Upon hearing that penile injection (virtually
painless, simple to learn and safe) would allow a return to full erectile
function within several months after surgery, they became quite exuberant. John
admitted to being depressed at the thought of impotence following surgery
because he enjoyed sexual intimacy with Belinda and distraught at being unable
to satisfy her sexual needs.

He was apprehensive at the thought of self-injection but Belinda offered to
inject him calling it a “new form of foreplay”.

We discussed the effect of his visceral obesity and borderline diabetes in
causing blockage to the arteries of the penis over the next 12 – 18 months. I
urged him therefore to undergo a supervised weight loss program to prevent this.

In the end they were delighted that they had come along to discuss penile
rehabilitation prior to surgery and that options exist for them.




CHLAMYDIA

 * the commonest STI that is easily passed in during sex.
 * causes pain on urinating or discharge
 * pain in the lower abdomen or testicles
 * abnormal vaginal discharge and pain during sex in females




GONORRHOEA

 * white or yellow discharge from penis and pain on urination
 * pain and tenderness on testis
 * vaginal discharge and abnormal bleeding in females




SYPHILIS

 * early stages cause painless or painful ulcers on genitals or mouth
 * sore can disappear after 5-6 weeks
 * secondary stages can give symptoms like rash on body, patchy hair loss,
   disturbed vision
 * late stages occur after many years and can cause serious conditions such as
   heart problems and paralysis




HIV

 * can be passed through unprotected sex, infected blood (i.e. sharing needles)
 * affects immune system making it less able to fight infections and disease
 * nonspecific symptoms – rash, flu like illness, sore throat, swollen glands on
   neck (seroconversion illness) initially
 * no cure for HIV but highly effective treatment to control the infection




TRICHOMONIASIS

 * caused by parasite called Trichomonas vaginalis (TV)
 * In men, rarely causes symptoms – may experience pain or burning after passing
   urine or have an inflamed foreskin
 * in females, a frothy white watery discharge, itching or soreness of the
   vagina can be noticed




GENITAL WARTS

 * fleshy growths, bumps or skin changes on genital area
 * caused by Human Papilloma virus (HPV)
 * occasional itching, soreness
 * spread via skin to skin contact




GENITAL HERPES

 * common virus caused by Herpes Simplex virus (HSV)
 * can develop painful small shallow ulcers on genital area
 * can also cause itching and tingling sensation and difficulty urinating
 * no cure but can be controlled with antiviral medication




PRE-EXPOSURE PROPHYLAXIS FOR HIV (PREP)

The risk of HIV infection can be minimised by taking an oral tablet called
Truvada (or equivalent) Based on multi international trials, this has proven to
be efficient in reducing the acquisition of HIV in high risk situation if taken
consistently before sex.
For more information, please arrange an appointment to discuss further.



Sam awoke one morning to find that his morning erection was bent upwards and
slightly to the left side. He was understandably horrified. There had been no
trauma to the penis with he and his partner, Mary, last having sex two days ago.
On examining his penis, he could feel a small tender lump on the top of the
penis. Sam did not alert Mary hoping the problem would go away.

The next time he and Mary attempted sexual intercourse he found it difficult to
achieve vaginal penetration. They managed to have sexual intercourse, but she
commented on the difficulty to penetrate and was shocked to see his bent penis.
He was mortified.

“Dr Google” revealed that he most likely had Peyronie’s disease. A massive
number of treatments were recommended on-line including surgery. Confusion and a
heavy work schedule led to Sam avoiding no to see his GP until Mary urged him to
do so, 8 months after the onset. His GP confirmed the diagnosis of Peyronie’s
Disease? link to PD in conditions we treat and referred Sam to PMH.

Sam had the foresight to bring in 2-demensional photos of his erect penis,
which, using a protractor revealed a 40-degree upwards curve commencing at the
middle of the shaft and a 20 degrees curvature to the left side. He reported
some difficulty to maintain a fully firm erection. Examination revealed a 1 x
2mm area of fibrosis (plaque) in the middle of the top of the shaft extending
slightly to the left side.

We recommended that Sam begin a conservative course of treatment consisting of
once daily Cialis 5mg, use of a vacuum erection device (VED) in a structured
program and a 5-week course low intensity shockwave therapy. In his case, over a
period of 3 months, the treatment resulted in removing the curve to the left
side, reduction of the upward curvature to 20 degrees (measured by repeat
photos) and a return to full erectile function. Sam was very satisfied with the
outcome. As the problem was initially causing significant distress between, he
and Mary, we referred him to a Psychologist with Sexology training at the
beginning of the physical treatment for counselling and guidance. They reported
major benefit from this.

Disclaimer: Not all patients will have the same degree of success with
conservative treatment. Beginning a holistic, scientifically based treatment
program is however a major psychological boost to patients such as Sam,
especially with his wife’s support.