Infertility and erectile dysfunction (ED) are two of the most common problems men face in regard to their sexual health. Dr. Christopher Adams, MD specializes in Urology at MercyOne North Iowa Urology and Mason City Clinic. Dr. Adams chose urology because it allows him many modalities for treating urological diseases, and it offers the perfect combination of surgical and medical disciplines. In this presentation Dr. Adams will be discussing common issues with Men’s Sexual Health, focusing on erectile dysfunction and male infertility.
ED, or impotence, is the inability to get and keep an erection hard enough for sex. Having occasional erection trouble isn’t necessarily a cause for worry. But when erectile dysfunction is an ongoing problem, it causes stress and relationship problems and hurts your self-confidence. Problems achieving or maintaining an erection can be signs of some underlying health condition that requires treatment. It is also a risk factor for heart disease. Infertility affects about 13 percent of couples who have unprotected sex for at least one year. Of these, about one-third are specifically male infertility problems.
The urology team at Mason City Clinic offers leading-edge treatments for men who are experiencing erectile dysfunction (ED) and infertility. ED affects men of all ages but most commonly after age 40. If you’re concerned about ED or male infertility, talk to your doctor – even if you’re embarrassed. Remember that many men experience this problem. Don’t let embarrassment keep you from a solution!
Schedule a consultation today at: 641-494-5280.
Hello, and welcome to the Men’s Sexual Health seminar. I am Carol Gifford, and I’ll be the facilitator this evening. Our featured speaker is Dr. Christopher Adams, who is a board-certified urologist at MercyOne North Iowa, urology specialty at the Mason City Clinic. Dr. Adams has successfully treated many men over many years that have faced erectile dysfunction and also male infertility.
And so, those are the two topics he will be talking about tonight, and so we look forward to his presentation and his recommendations for different types of treatments. Just a reminder, you probably just heard it, but this presentation will be recorded. And also, if there are any questions during the presentation, please just type them into the chat box and Dr. Adams will answer those at the end of this presentation. So, I am just going to pass it over to you, Dr. Adams, to start the presentation. Welcome.
Welcome. Thank you so much, Carol, for that wonderful introduction. It’s so good to see you. Very happy to be here. I’m Dr. Christopher Adams, one of the board-certified urologists here at the Mason City Clinic, MercyOne North Iowa. I’ve been asked to give a cursory talk today on just a couple of real important issues for men’s health, including erectile dysfunction as well as male infertility. So, we’ll go ahead and get the presentation started,
So, the two main topics that we will discuss today when it comes to men’s health are erectile dysfunction as well as primary male infertility. So, the definition of erectile dysfunction, you can see here, it’s basically the consistent or recurrent inability to attain or maintain penile erection for sexual satisfaction, including sexual performance. It’s a pretty standard definition that we use in the urological community.
So very common disease, this is something that I definitely want men to understand. Because there’s a lot of stigma and taboo that can come with erectile dysfunction, but it really is one of the most common disease processes that we see in our clinic. And so, 30 million men in the United States and 150 million worldwide essentially have some form of erectile dysfunction.
So, you know there’s not a day goes by, in my clinic, where I see somebody with some type of erectile dysfunction. Especially when you get to about the age of 50, it becomes really, really, really common. It’s really important for men to realize that it’s something that, you know, your neighbor has, your brother could potentially have, your best friend could have. And obviously this is a private matter but understanding that it’s common and that there are good treatments for erectile dysfunction. And making sure you see the appropriate physician, whether it’s a primary care physician or a urologist to address it, if it’s an issue for you.
Some of the different causes of erectile dysfunction, which I alluded to earlier – age is a big component of erectile dysfunction. You know we rarely see men in their teens or 20s who come in for erectile dysfunction. It’s usually men mostly 50 years of age and beyond. And the reason why that is, there’s a lot of different factors that can basically worsen erections over time and it is time dependent. Such as smoking history, if someone has been smoking for one year, it’s very different than someone who has been smoking for 30 years. So, you know there’s that cumulative effect that you get from smoking. It’s the same thing for diabetes.
You know, someone who’s newly diagnosed with diabetes tends not to have the type of severe erectile dysfunction as say for somebody who has had it for 20, 30, or 40 years. High blood pressure, high cholesterol, depression, obesity, and sedentary lifestyle. And the reason for this is for a man to achieve an erection it’s a very complicated physiological process, but to simplify it down, you basically need an intact nervous system and a vascular system, the venous and arterial supply. And, you know, smoking, diabetes, hypertension high cholesterol – all of these disease processes affects arteries, affects veins, and affects nerves. So as those get damaged, you could damage the nerves that control erections, and the arteries and veins that control erections.
So, when you come see a urologist for erectile dysfunction, we’re obviously going to do a clinical history. We’re going to figure out how long it’s been going on. We’re going to figure out whether it’s essentially, you know, something that’s continuous or something that’s intermittent. Whether it’s during the daytime, nighttime. There’s a lot of information that we can gather just from the clinical history alone. And then, obviously, you’ll get a physical examination. Sometimes there are some palpable diseases or visible diseases that we can see on a general urinary examination that can lead to erectile dysfunction. And then in some select cases, we can do some blood work. If there’s anything that we can gain in the clinical history that makes us think you could have low testosterone or have hyperthyroidism. Some of those things can cause erectile dysfunction and we may offer you additional labs. Because if you treat those conditions, it can make the erectile dysfunction get better if not go away.
So, you know, one of the biggest questions that we get asked when patients come see us in the clinic is what do we do to treat erectile dysfunction? So I’m going to go over the different modalities that a urologist can offer you to treat erectile dysfunction. Those include oral pills, there are medical-grade vacuum devices, there’s injectable therapy, there’s what’s called a urethral suppository, and then there’s actually corrective surgery, that we can do as well as really a last stop to try to treat erectile dysfunction.
And so the mainstay of treatment for erectile dysfunction is what we call the phosphodiesterase inhibitors. That’s what commonly patients know as Viagra, Cialis, Levitra. These medications have been around for 20 to 30 years now, and so they’re really sort of the first line therapy for treating erectile dysfunction. And so basically the way that these medications work is they block the enzyme or the protein that makes erections go away and that’s actually very important. So I think there’s a misnomer out there, that these medications give you an erection and that’s actually false. These medications have never given a man an erection. They basically prevent you from losing an erection. And the reason why that’s important is for some men with very severe erectile dysfunction, they are not able to amount an erectile response on their own whatsoever. So if you’re unable to amount any type of response, you actually don’t respond to the pills whatsoever.
So I think that’s something, if you’re going to take something away from this talk, it is just understanding these medications don’t actually give you erections. Now there are some medications we’re going to talk about in a few minutes here that do give you erections, but erectile phosphodiesterase oral pills do not. That’s something to keep in mind. But again, these medications now are generic, and so they’re much cheaper than they were in the late 90s and early 2000s.
So these medications were initially developed to treat high blood pressure, especially in a cardiopulmonary system, and so, because they use the nitric oxide pathway to help maintain erections they can’t be taken with nitroglycerin or other type of nitrates that people take for angina or cardiac pain. So that’s one of the contra indications. And so people always ask you know what’s the difference between Viagra or Cialis or Levitra? And it really has to do with the half-life, and so in medicine half-life is basically how long the drug stays in the system. And so the longer the half-life, the longer that the medication stays in the blood system. And so that determines what’s a better medication for you.
So Viagra has an easy, on easy off, so it’s a very short half-life. So Viagra is more of an on-demand type of erectile dysfunction treatment. So it’s something that you take an hour before sexual activity, and usually within a couple hours it’s completely out of your bloodstream. That is very different than Cialis or Tadalafil, which has a very long half-life. So it actually can stay in your bloodstream for several days. So if you take the maximum dosage of Tadalafil, it actually stays in the bloodstream for up to 72 hours or three days. So Cialis does allow for more spontaneity just because it stays in the bloodstream a little bit longer. Levitra is somewhere in between, and actually Levitra has a sublingual tablet which you can put on your tongue that dissolves very quickly, that actually hits the bloodstream pretty quickly.
And so common side effects that we hear about with these medications, and a lot of it has to do with fluctuations in blood pressure, as well as the fact that it does affect the vascular system, so people can complain of dizziness, headache. We do see guys who have a lot of facial flushing, can cause upset stomach. It can cause visual disturbances. So the same sort of nitric oxide pathway that deals with cardiac issues and erections, there’s another pathway that deals with vision, and so some guys can complain of seeing blue halos. You can get muscle cramps, especially with the Tadalafil or Cialis.
For people who don’t have really bad erectile dysfunction or use these medications really for abuse, they can get priapism, which is an erection lasting more than three to four hours. And I will say, if you look at the scientific literature for men who have true moderate to severe erectile dysfunction there’s never been a case of priapism for someone who is taking the medication. Correctly. And you can get low blood pressure as well as it is affecting that pathway.
So like I said, most physicians, both urologists and primary care physicians, start you on one of the pills first. Some people, just based on genetic variances, respond better to other pills than others, if you will. So sometimes if people don’t respond to Viagra, we will switch them to Cialis or vice versa.
But if the pills ultimately fail, or you truly are unable to generate an erection on your own, if people are looking for a noninvasive way to achieve an erection, there are medical grade vacuum erection devices. And so, this is actually a vacuum device that creates a negative pressure. So when it’s placed over the penis and creates a negative pressure it basically forces blood into the penis and so you get an erection. And then, what the device also includes is basically a rubber band type constriction ring that you put at the base of the penis, where the penis meets the scrotum. So that blood that has been drawn into the penis is now trapped when you snap the rubber band. And so the blood is trapped in the penis and you have an erection. And so, it’s cheap cost, medical-grade vacuum device but you do need a urologist prescription. Costs a couple hundred dollars.
So, I would avoid things that you find on Amazon or things that you find online or in certain adult shops, usually just see a urologist for a real medical prescription for a medical grade product. But they work very well and I’ve got a lot of patients that use this and really like it, because they’re not taking a pill. You know they’re not doing injections or invasive surgery and so if it works for you, you know, this is a good device. And so side effects, for this is, you can get bruising from the penis, from the vacuum device and from the rubber band. There can be decreased ejaculation or, if you do have a constriction device at the base of the penis some men will complain of some numbness and coolness and then some guys will complain of decreased sensation.
And so, some more invasive ways to achieve erections are there are injectable therapies. So, like I told you with the pills, the pills don’t actually give you an erection they just perpetuate an erection that you get on your own. That is different than the injectables. So the injectables usually consist of three or four substances, of which two of those actually give you an erection, so they’re much more powerful than the pills. One of the slurries, if you will, that is used here is called Trimix. And so two of the three substances give you an erection, and the third substance essentially is basically Viagra or Cialis in liquid form, so it actually helps within erections.
So you’re basically getting a double whammy, the medication that’s causing an erection and a medication that’s preventing the erection from going down. So it’s much, much more powerful. So a couple of things that I like about it, it’s self-administered, it’s on demand. The needle is a diabetic needle. I think a lot of guys get freaked out about a shot to the genitals. We usually give the first shot in the office, so that we can go over the proper anatomy and how to give yourself the shot and basically show patients, you know, what the shot feels like. I think a lot of patients are surprised when they see the size of the needle. I mean it’s smaller than like a little bee stinger.
And then the other thing I like about the injectables too is, you know, depending on insurance, the product can actually be cheaper than the pills. That was almost certainly the case before Viagra and Cialis and Levitra became generic. But even based on some insurance plans, the injectables can be cheaper. It’s usually about $3 to $5 a shot. So, it can be very cost-effective. Some side effects that we can have with the injectables obviously you get a little pain from the needle; you can get scarring in the tubes that fill with blood. You can get bruising, or you can get what’s called a hematoma or a pretty big bruise. You can get low blood pressure and you can get dizziness.
And so suppositories aren’t really something that a lot of men use, but it’s something that I will go over. And it’s really basically the same substance as the injectables but, as opposed to actually injecting it into the tubes that cause erections, you’re basically putting the dissolvable pellet directly into the urethra. And then basically it dissolves in the urethra and your penis absorbs it and then it causes the tubes to have the same effect as you would if you actually got the injectable. It’s called MUSE (m, u, s, e, all capital). Like I said a lot of men don’t tend to use this, they tend to use injectables but for being thorough with this discussion, I want to let people know that this is an option. This is something that a urologist can prescribe. So it has a lot of the same side effects as the injectables, you know, a certain amount of pain. Some different types of side effects you might see from using this is the urethra burning. As it’s dissolving in the urethra you can get some testicular pains and minimal bleeding. It can also cause low blood pressure and dizziness as well.
So really the last option for erectile dysfunction is what we call an inflatable penile prosthesis. This is a device that’s actually implanted into the penis, and you can actually pump up an erection. So there’s two tubes in the penis that basically fill with blood and cause an erection. So you can put these inflatable cylinders where those tubes are, on the inside of the tubes. And then there’s a pump that we put into the scrotum and it’s almost like a third testicle and there’s a reservoir of water that we put into your abdomen. Nothing’s exposed, everything’s internalized. And so the balloons are deflated and essentially once the device has been implanted and you recover from surgery, you can use the pump that’s in the scrotum to pump fluid from this reservoir in your abdomen into your cylinders, and then your cylinders get erect. And so you’re going to have you know, obviously, an erection that is satisfactory for sexual intercourse. And then obviously there’s a deactivation button. And when you hit the deactivation button the fluid goes back into the into the reservoir, that way you don’t have an erection all the time. So, actually, believe it or not, the penile prosthesis probably has the highest satisfaction rate of any erectile treatment. It actually works extremely well.
Most urologists, though, will only reserve this treatment for men with really severe erectile dysfunction, and the reason for that is once you put this device in place, you can never get a natural erection on your own again. And so, for men who are able to get erections, whether it’s via injectables or the vacuum device or with pills… I mean if you can get a natural erection on your own, I’ll be able to help you if you’d prefer that. There’s some men with very severe disease processes, especially if they’ve been going on for several decades that have essentially basically kind of cooked out their nerves and arteries and veins to the penis and really can’t get an erection whatsoever, so this becomes a good device for them.
So it does require surgery, but I would consider it more of a major surgery to put the device in place. I’d say our clinic probably puts about 10 to 15 of these devices in per year. Takes about an hour and a half to two hours to put this device in and you do stay in the hospital overnight. It takes about six weeks to recover from the surgery. The device itself last about 10 to 15 years, it’s very durable. This device has been around longer than I’ve been alive. I think the first one was implanted in like 1974, 1975, so it’s been around for a while. And what’s interesting is the actual design of it really hasn’t changed much. There’s not a lot of technologically advancement with this device, it works so well.
They do offer different type of antibiotic coatings to help prevent infection, which is one of the biggest risks of this procedure, but as for the actual engineering, the mechanics of how the device works, there really hasn’t been a lot of updates it works so well. This procedure is done exclusively by urologists who specialize in men’s health, so this is something that if you’re interested in definitely bring up with a urologist and they can decide whether you are a good candidate for it or not,
So I’ll open this up to any questions, if anyone has any questions regarding this portion of the talk.
So, there is one question, Dr. Adams, from Rick. He is wondering if, I’m sorry, let me find it, if sonic wave therapy is a thing.
Yep, so I would say sonic wave therapy is definitely on the experimental side right now and is most certainly not the standard of care. And we have something that’s called the American Urological Association guidelines, which is basically big conferences, where all the urologists who are experts in this field get together and decide what is first line, second line, third line therapy. And so right now it’s not recommended as really a durable therapy at this point in time. That being said, there are ongoing trials and studies to see if it’s viable or not.
And so the theory behind it, for people who are wondering what it is, is you can use shock waves to basically break up plaques and to breakup scar tissue that’s in our arteries and veins or within the tubes that carry, who basically filter blood. And so basically, it’s putting a device that’s delivering these shock waves to break up these plaques and scars and the thought is by doing that, you’re allowing natural blood flow to the penis and that way you can lessen the dosage that you need for oral therapy or naturally get erections on your own. So that’s a very good question. I’ll be interested to see where the scientific studies go, I’d say in the next five years or so. If we’ll see if they’re seeing any good durable response. Great question.
I think that’s it for questions right now.
Okay, all right. And so I’m going to move on to just primary male infertility. This is something that we do see in our clinic. So we’ll just talk about the definition, how common is it, and how is it evaluated, and just some cursory treatments. And so primary infertility is defined as inability or failure to conceive within 12 months of attempted contraception. It’s extremely common and actually if you look at some of the World Health Organization semen parameters, fertility is actually worsening, especially in men and we don’t know why. We don’t know if it’s due to stress, we don’t know if it’s due to cell phones. There is some data out there saying that covid-19 can decrease sperm counts. Obviously, you know, with covid-19 still being a relatively new disease, it takes years to really assimilate that data. So we don’t really have a good answer yet, but we’re seeing definitely a decrease in the quality and amount of sperm in men.
And so, about 15% of couples are unable to conceive after one year of unprotected intercourse. If you think about that, that’s pretty common. And for, you know, folks I would say 40 years and under, you probably know a friend or two that’s probably having trouble conceiving. And they’ve probably talked to you about or it’s come up in, you know, over a beer or you know out at a restaurant. So it’s something that happens very, very commonly. So the male factor is solely responsible in about 20% of infertile couples, meaning that it’s the male that basically has the issue. But at least partially responsible, 50% of cases,
So you know a lot of people, a lot of couples, when they have erectile dysfunction, I’m sorry, not erectile dysfunction but primary infertility, a lot of the focus goes to the female. But in reality, the male should be evaluated too because 50% of the time there’s a male component leading to the infertility. And so, when I evaluate somebody in the clinic for erectile, or excuse me, for male infertility, the clinical history is very important. So you know, we want to find out, you know, age of the patient, also includes the age of the female. It’s a bit less important in the male under age 50, I would say, but obviously for advanced maternal age, that can play a role in decreased fertility. We also want to know if there’s been any genital or urinary trauma. You know, it’s also nice to know whether you’ve actually you know gotten somebody pregnant before or that your partner has been pregnant before. If there’s been exposure to radiation or chemotherapy. We can also you know just from clinical history tell if there’s any evidence of any hypogonadism or low testosterone. So just a good clinical history alone can give us a lot of information.
And then a physical examination is very important too, especially a testicle examination. About 90% of testicular volume is actually due to sperm production. So if men have very small caliber testicles, that can be just on physical examination alone, a telltale sign that they’re having problems with sperm production. You can also test to see if you have what’s called vas deferens, these are these tubes that carry the sperm away from the testicles. I’ve actually diagnosed somebody with cystic fibrosis, believe it or not, as an adult, on this physical examination. He came in for infertility and men who are born with cystic fibrosis don’t have this tube, they basically have a natural vasectomy, and they don’t know it. And so I did a physical examination and they didn’t have this tube. They basically didn’t have this vas deferens and so I actually sent him to a geneticist, and he had a very mild form of cystic fibrosis. So you can have a lot of things you can catch on a physical examination.
And then potentially based on the clinical examination, get a test for thyroid and test for testosterone. And then probably the most important aspect of a male infertility evaluation is getting two high-quality semen analysis which can be ordered by an infertility specialist on the gynecological side or obviously by a urologist. And really if you look at our American Urological Association guidelines, you really want two semen analysis with about three days of abstinence.
And so how is infertility evaluated? It depends on several factors, you know, is it a female problem? Is it a male problem? Is it both? When we look at the semen analysis, we’re looking for the concentration of sperm. We’re looking for the quality of sperm, meaning how well those sperm swim forward. We’re looking at the volume of the ejaculate.
So there’s a lot of little parameters that we look at to see, basically, how good the sperm is, especially in the ejaculate. And so, if the two semen analysis are completely normal, then it’s probably more a female problem. But you know, sometimes we have men that have very low sperm counts. Sometimes we have men who have great sperm counts, but their motility is terrible, so you know they have sperm, they just don’t swim well. Sometimes there’s a lot of defects in the sperm, so they’re just not high-quality sperm, and that can lead us to get additional tests.
A lot of times, if the sperm count is really low, we’ll do a pretty extensive sexual hormone workup even beyond just testosterone to see if there’s a problem with sperm production. Sperm production, actually a lot of people don’t realize, starts in the brain – actually doesn’t start down in the testicles. So that signal that gets the process going starts in the brain, so we have to figure out, you know, if there’s a hormonal problem or is it actually the brain that’s the issue. Or is it the actual testicle that’s the issue, meaning the brain is sending the signal, but the testicles just aren’t responding to it. So obviously that’s beyond the scope of this talk, but your urologist knows how to evaluate that and then offer the proper treatment.
So how do we treat male infertility? So there are drugs that can be used to stimulate natural sperm production. There are some different antioxidants and things that can actually be used to help improve sperm quality, make them swim a little bit better. There are surgeries that can be done to increase both the concentration of sperm, as well as how well they swim and what their quality is. And then, you know, if you get sort of deep down the rabbit hole, we can actually harvest sperm directly from either the ejaculate or from the testicle itself, and that can be used for advanced reproductive techniques with combination with in vitro specialists and gynecology.
So I’ll open this up for any questions regarding this talk.
So, Dr. Adams, going back to the erectile dysfunction, there’s a question, do you have any recommendations on taking Viagra? Timing? Full versus empty stomach? Etc.
Yep. So I usually tell gentlemen to take it on an empty stomach, try to avoid alcohol, and usually an hour before sexual activity. And so, something else that’s really important too, and I forgot to mention this, I’m glad someone brought this question up, is going back to how these pills work. If you remember, I told you, they don’t give you an erection. They basically stop you from losing an erection. And the reason why that’s important is I think it’s a misnomer that men take these pills, and they think that they get an erection. So something that I’ll hear from patients is yeah, I wanted to have sexual relations with my wife so I took a couple of Viagra. But then the Twins game was on so then I sat on the couch. And then I got a tub of popcorn and then I was watching a Twins game, and then I never got an erection so Dr. Adams, the pills don’t work. Yeah, so that’s not the way it works, right, you’ve got to be sexually stimulated.
So you got to take the pills, you know if you’re taking Viagra it would be an hour before sexual activity and on empty stomach. I would try to avoid alcohol, but then you know, once you kind of hit that hour mark, you need to be stimulated or look at somebody pretty. Otherwise, if you’re sitting on the couch watching the Twins game, eating a tub of popcorn, you’re never going to get an erection. Tadalafil, like I said, it’s got a little bit longer half-life. So there’s a five milligram, that’s a daily dose, you take it in the morning and it covers you all day. If you take the 20 milligram, which is the three day dose, it doesn’t matter, it covers you for three days. So hopefully that answers the question.
And another question. This gentleman had the Urolift procedure, and he’s been on Flomax and he’s wondering … he said, ever since he’s been on Flomax, he’s had little or no ejaculate. Is this typical?
Yep, it sure is. So there’s three silos that accomplish proper sexual function. You know when you’re young, you don’t realize they’re different silos. It’s not until things start to go awry, if you will, that you realize that things are different. So there’s a silo for an erection. There’s a silo for ejaculation. And there’s a silo for orgasm. They are all actually different silos. So when you’re talking about ejaculation, essentially what happens is the ejaculatory ducts and the prostate ducts basically dump into the urethra where the prostate is, like that prostatic portion of the urethra. And so semen is deposited in the back of the urethra and then what’s supposed to happen is when you ejaculate, the bladder neck is supposed to slam shut. And so that way, the path of least resistance, and/or the only way semen can come out is at the tip of the penis. And that’s why ejaculate at the tip of your penis.
Flomax Tamsulosin paralyzes and relaxes the bladder neck, and so what happens is that bladder neck can’t come closed anymore, but that’s the point of the medication because that’s what helps you pee better.
And so what happens is when it’s time to ejaculate, because that bladder neck is wide open and not slammed shut, the path of least resistance is actually into the bladder. So in reality when guys are taking Tamsulosin, they have an erection, they have climax, and they feel like they’re ejaculating and nothing comes out. In reality, you did ejaculate. It just went back into your bladder, and you urinate out the semen later. And so that’s one of the side effects you can see with Tamsulosin. So with the Urolift you’re basically stapling open that prostate tissue and so you know the claim is with the Urolift that you can still get some bladder neck closure and so you don’t necessarily have the retrograde ejaculation that you get with Tamsulosin. And one of the benefits of the Urolift is theoretically you could stop medications if your provider deems it appropriate. So you know when men stop the Tamsulosin, magically the ejaculation appears again. Very good question.
So, are there any other questions? Let’s see, one question I have for you, Dr. Adams, if a male is experiencing erectile dysfunction or primary male infertility, do they have to go to their primary care physician to then be referred into you? Or to the Urology Department? Or can they come directly to you?
Our department accepts self-referrals. We’d be more than happy for you to just contact us for a self-referral. You do not, under any circumstances, need a primary care physician referral. Now, a lot of primary care physicians can deal with erectile dysfunction and, obviously, if it’s beyond their scope on practice of medicine, they’ll refer you to us. But no, we are more than happy to see any patient for any urological concern, regardless of a PCP referral.
Great and just maybe, oh, there’s the telephone number.
Yep. This is our department, there’s four urologists, all board-certified. We all deal with erectile dysfunction and male infertility. We’re available 24 hours a day, 365 a year, and it’s a full scope practice. We always have openings, so you can call in and get an appointment, even if it’s a self-referral.
Well, terrific. Thank you so much, Dr. Adams. That’s a wonderful presentation. And is there anything else you want to say?
Well, it’s a pleasure doing these talks and it’s a pleasure to do this on behalf of the Mason City Clinic and MercyOne North Iowa. It’s been a pleasure being here for the last eight years delivering urological care. And I just want guys to know, there’s a lot of good treatments out there. I know covid has really kind of scared a lot of folks away but there’s a lot of preventative measures for covid in the hospital and the clinic setting. If you need to get treated for any type of medical issue, get treated.
Great closing message. Well, thank you so much, Dr. Adams, and this has been very informative. And it’s good that we’ve got the contact information up on the screen right now, if people want to get in touch with you or your colleagues in the Urology Department, so thank you so much.
Absolutely, thank you for having me.
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