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Care Path

Erectile health, discussed plainly.

Erectile changes can involve circulation, medications, hormones, stress, sleep, relationship factors or other health conditions. The visit is private and direct, and it starts with figuring out what is actually going on.
Request a Call314-394-1660
Independent, physician-owned St. Louis men’s health practicePersonal care from a consistent physician-led teamServing St. Louis and the Metro East1062 Old Des Peres Road, St. Louis, MO 63131314-394-1660

Overview

Is this worth evaluating?

Erectile changes are common and they are worth raising. Men most often describe:

  • Difficulty getting or keeping an erection, consistently or in certain situations
  • A change in sexual desire alongside the erectile change
  • Fewer morning or spontaneous erections than before
  • Concern that something else — blood pressure, blood sugar, a medication — may be behind it

Erectile dysfunction can be a marker of cardiovascular or other health concerns. That is one of the clearest reasons to have it evaluated rather than treated blindly.

Evaluation

A careful evaluation comes first.

The evaluation is a conversation first. Depending on what you describe, it may cover:

  • When the changes began, and whether they are consistent or situational
  • Sexual desire, and whether morning or spontaneous erections still occur
  • A review of your medications and substance use, including alcohol
  • Diabetes, cardiovascular, blood pressure and neurologic history
  • Testosterone or other laboratory testing, when clinically relevant
  • Your goals, and how comfortable you are with each treatment route

Options

How the options differ

Treatment routes differ in how they are taken, how they are timed and what instruction they require.

Tadalafil

Oral PDE5 inhibitor

An oral PDE5 inhibitor with a longer duration of action. Depending on the clinical plan, it may be prescribed as needed or on a regular schedule.

Sildenafil

Oral PDE5 inhibitor

An oral PDE5 inhibitor generally taken ahead of anticipated sexual activity. Timing, food and individual health factors can affect how it is used.

TriMix

Compounded intracavernosal injection

A compounded injection containing more than one medicine. It requires a prescription, hands-on instruction in the office, storage guidance and a clear plan for what to do in an emergency.

Compounded and not FDA approved as a combination product.

Safety

Safety, limits and monitoring

A few points here are not negotiable. Read them before any treatment conversation.

  • Sildenafil and tadalafil must not be combined with nitrate medications. The combination can drop blood pressure dangerously.
  • Other cardiovascular medicines, and alpha blockers in particular, require review before a PDE5 inhibitor is prescribed.
  • TriMix is a compounded preparation and is not FDA approved as a combination product. Compounded medications are not FDA approved. The FDA does not review compounded drugs for safety, effectiveness or quality before they are marketed, and a compounded preparation is not a generic version of, or equivalent to, an FDA-approved product.
  • Erectile dysfunction can be a marker of cardiovascular or other health concerns, which is why evaluation comes before treatment.

Seek care immediately

  • Sudden changes in vision or hearing require urgent medical attention.
  • An erection lasting four hours or longer is a medical emergency. Seek emergency care.

What to expect

What to expect at MMI

Dr. Mimlitz personally conducts every initial evaluation and follow-up visit.

MMI is independent and physician-owned, so the MMI care team coordinating your care knows your plan, communicates clearly and supports consistent follow-through without corporate layers in between. Decisions are individual rather than a standard protocol passed between rotating providers.

  1. 01

    Schedule an evaluation

    Tell us what you are noticing. We schedule a focused visit rather than a rushed one.

  2. 02

    Review symptoms and labs

    Dr. Mimlitz reviews your history, symptoms and lab work with you and explains what they mean.

  3. 03

    Agree on a plan

    If treatment is appropriate, you leave understanding the options, the tradeoffs and the next step.

  4. 04

    Follow through

    Care is adjusted over time based on how you feel and what your follow-up labs show.

Questions to bring to your visit

  • Could one of my current medications be contributing to this?
  • Does anything in my evaluation suggest a broader health issue worth pursuing?
  • How do the oral options differ for someone with my history?
  • What would need to be true before an injectable option is considered?

Related care

  • Testosterone therapy

    Hormone findings are one of several things reviewed when erectile changes appear.

  • How care works

    What a first visit at MMI involves, and what happens after it.

  • Answers Center

    A developing, physician-reviewed library. Articles are published as Dr. Mimlitz reviews them.

Start with an evaluation, not a package.

Call the office to schedule a focused visit with Dr. Mimlitz.

Request a Call314-394-1660

Clinical references

This page is general education, not medical advice, and it is not a substitute for an evaluation. The information here draws on the primary sources below.