Expert Series with Dr. Peter Stahl: Erectile Dysfunction, Premature Ejaculation, and Sex Rx + Climax Control

Continuous innovation and consumer insights were key in developing our newest personalized offering, Sex Rx + Climax Control. The launch of Sex Rx + Climax Control enables providers to prescribe a compounded 2-in-1 medication designed to help men address multiple aspects of sexual satisfaction without the need to take multiple pills.

“While our providers have had great success treating erectile dysfunction and premature ejaculation with currently available prescription medications, we believe there is opportunity to continue to improve quality of care and treatment outcomes by offering providers and consumers the ability to access new innovative, personalized treatments,” said Dr. Peter J. Stahl, MD, SVP Men’s Reproductive & Sexual Health, Hims. “Sex Rx + Climax Control will further empower providers on our platform to provide best in class care for men with premature ejaculation, both with and without erectile dysfunction.“

In a deep dive conversation with Dr. Peter Stahl, he gives an overview of erectile dysfunction (ED) and premature ejaculation (PE), answers common questions on the conditions, and shares more on why Sex Rx + Climax Control can be an option for individuals experiencing multiple aspects of sexual dysfunction. 

Erectile dysfunction (ED) and premature ejaculation (PE) are very common and can affect a large population of men. According to large national and multinational studies, ED affects up to 30% of young men and more than 50% of men aged 40–70, and PE affects approximately 30% of all men. With so many men experiencing these conditions, we know it’s an important subject to discuss, but not always easy to talk about. 

What are the symptoms of ED and PE?

ED very specifically refers to the condition when a man sometimes or often experiences difficulty achieving or maintaining an erection. Other sexual dysfunctions like PE or loss of sexual desire often coexist with ED, but they are distinct and separate conditions. PE is a different clinical condition that can vary in how it is described, but generally refers to men having short ejaculatory latency times (less than a few minutes), a sense that they lack control over ejaculation, and personal or relationship distress related to fast ejaculation.  

What age groups deal with ED and PE?

All age groups of men are affected by ED and PE. For ED specifically, there are definite differences in prevalence and pathophysiology when you break up the population by age. In general, ED is less prevalent in younger men than in older men. That’s because vascular, hormonal, and nerve problems that impair penile function usually develop over time as men age and accumulate other medical problems. PE, on the other hand, is more common and bothersome in younger men. 

Is PE related to ED?

PE is a different, distinct clinical condition that is also very common. It often gets confused with ED, especially when affected men ejaculate quickly and then experience the totally normal and natural difficulty in achieving a second erection immediately after an orgasm (during the refractory period). However, one of the most common forms of PE is acquired PE that develops in men with ED as a compensatory mechanism. You can think of it as the brain and body subconsciously realizing that ejaculation needs to happen quickly before they inevitably lose their erection because of ED.  

At what point should someone see a physician about issues they are having that may be related to ED or PE?

Everyone can have a bad day. Single or rare isolated instances of failing to get or maintain an erection, or of losing control and ejaculating very quickly, are totally normal and can occur for a variety of reasons (stress, lack of sleep, a new partner, etc.). A good rule of thumb is that a person should seek professional help if they find they are worrying a lot about sexual performance or avoiding partnered sexual activity due to fear that they won’t be able to meet their partner’s expectations. This is very common and again, nothing to be embarrassed about. 

Is it important for someone who is, for the first time, seeking treatment for ED or PE to visit a medical professional in-person? Why or why not?

We are learning every day about what conditions can appropriately be managed with virtual care outside of conventional in-person visits. As a fellowship-trained and experienced expert in male sexual health that has treated a lot of men, I’ve come to strongly believe that ED and PE can be safely and effectively treated without an in-person visit in most cases. In fact, I think virtual care has many advantages over in-person care for the initial treatment and evaluation of ED and PE. 

‍Barriers to care like embarrassment or needing to take time off from work are alleviated — that makes care for sensitive issues like sexual dysfunction much more accessible and approachable. I believe that technology can also enhance quality and safety by standardizing intake and ensuring that the right information is gathered from a patient so that the treating provider has the information that they need to make evidence-based, personalized treatment decisions. Overall, virtual care is a great way to initiate evaluation and treatment for ED and PE. 

Can any non-Rx treatment help those struggling ED and PE?

There are some non-prescription interventions that can help with ED and PE. Sleeping enough, eating well, and avoiding behaviors like smoking cigarettes that impair sexual function are great first steps. Weight loss in overweight or obese men can improve sexual performance. Sex therapy can be important for men in whom ED and PE results from psychological factors like anxiety about sexual performance. Certain dietary supplements may help with erectile function, though improvement in sexual function is much smaller than improvement seen with prescription ED and PE medication. There are also some effective OTC treatments for both ED and PE like vacuum erection devices for ED, and topical numbing agents for PE.

At what point, or for what reasons, do healthcare providers feel it’s recommended to prescribe ED or PE medication?

The decision to start ED or PE medication is a highly personalized, shared decision between a patient and their healthcare provider. Since the available ED or PE medications are effective and generally low risk, my personal opinion is that they should be strongly considered for any man of any age who is consistently or episodically struggling with sexual performance. It is important to note that treatment with oral medication is an appropriate option for sexual dysfunction irrespective of the cause of that sexual dysfunction. For example, oral medications can be a great treatment for ED or PE even when it has a non-physical, psychogenic cause. Sometimes, that’s exactly what men need to get their confidence back and eventually regain their normal sexual function without the need for medication. 

What types of ED or PE treatments can someone obtain from visiting with a healthcare provider through Hims? Are these treatments safe?

Hims provides access to licensed healthcare providers who can evaluate and treat men who have ED by itself, ED and PE at the same time, or PE by itself. Our partnered healthcare providers are trained to provide evidence-based prescription treatments personalized to the unique needs, situations and preferences of each individual patient. For ED, they can prescribe commercially available medications like Viagra® or Cialis®, or their generic versions sildenafil or tadalafil, or more personalized compounded medications that might be better suited to an individual person. For example, a provider might prescribe a medication that contains both fast acting and long-lasting active ingredients for a patient with an unpredictable sex life, or a provider might prescribe a chewable tablet for a person who wants to be able to discreetly take their medication at the right moment without needing a glass of water. Just like for ED, providers on the Hims platform can prescribe commercially available medications for patients with PE alone or PE and ED at the same time. Depending on the clinical scenario, this might include medications that improve penile blood flow like Cialis or Viagra (or their generic versions), or medications that delay ejaculation like sertraline or paroxetine. They can also prescribe more personalized compounded medications to serve an individual patient’s unique needs, including through the Sex Rx + Climax Control offering, which enables providers to use a 2-in-1 approach to the medication.

What can someone expect from a virtual visit about ED or PE via Hims?

Hims provides a secure platform through which consumers can access licensed healthcare providers who conduct telehealth evaluations. The initial portion of the visit consists of answering questions about their general health and their condition, in this case ED or PE, and providing additional information that may be necessary to complete the process. The intake process is designed to collect all of the clinical information needed to inform high-quality medical decision-making in an efficient way, and to provide consumers with additional information about some of the potential medications that their provider has the ability to prescribe through the platform, including the cost of potential treatments. Once an individual completes the intake process and submits their information, the patient’s clinical information is evaluated by a healthcare provider to determine whether they are a good candidate for treatment through the platform, and if so, which prescription treatment is appropriate. The consumer and healthcare provider have the opportunity to communicate back and forth to provide any necessary clarifications and to answer any questions. If treatment is recommended, the provider can write a prescription and treatment will be delivered directly to the consumer within a few days. After an initial prescription is written, each patient’s care subscription includes ongoing 24/7 ability to message our partnered providers and their care team, as well as regular online check-ins and follow up appointments to ensure that continued care is safe and effective.  

Why should people trust medical professionals providing care through the Hims platform to safely diagnose and treat ED?

The healthcare providers that the Hims platform connects to patients are carefully vetted and fully credentialed US licensed healthcare providers. Each provider undergoes additional training in any condition that they are treating through our platform. In addition, Hims has leveraged expert physicians (like me!) to help develop platform features, clinical guideline statements and reference documents that are readily accessible to guide clinical care. We also have a highly structured quality and audit program that is very similar to quality programs found in large brick and mortar healthcare organizations. In fact, we’ve reviewed and audited over 1 million clinical interactions so far. All of these factors allow us to monitor and maintain high standards of care for all of the conditions that are treated through our platform.

To find out more about Sex Rx + Climax Control, go to https://www.hims.com.