Sensitivity Treatment Procedures

Foreskin restoration:

This will restore a significant amount of sensitivity, by protecting the glans and remnants of the inner foreskin, and allowing these areas to revert to mucosal tissues.

The fine-touch sensitivity will increase beneath the new foreskin, and the remaining sensitive areas will be protected from external abrasion. The process requires wearing weights or an elastic strap attached to the foreskin with surgical tape or a device to grip the foreskin.

Such an arrangement applies continuous pressure to stretch and eventually to grow new skin cells to form a lengthening foreskin tube. There are numerous websites and internet support groups relating to this process, and its specific techniques.

Cost: very low
Effectiveness: Significantly improves the sensitivity of the glans and foreskin-protected areas.
Time to provide results: Typically 2-6 years of tugging

Additional information: Read about foreskin restoration on this site. For support information go to the National Organization of Restoring Men (NORM) website:
www.norm.org.

Testosterone Hormone Replacement Therapy (HRT):

This is artificial replacement of the male hormone testosterone, which typically declines with age or from certain diseases or hormone abnormalities. This hormone effects male sexuality, libido, energy, muscle development and many other functions in men.

Low testosterone alone can contribute considerably to perceived low penile sensitivity. In some cases, “normal” age-appropriate testosterone levels for older men are in fact too low for optimum functioning, and HRT can improve a man’s life both sexually and in general well-being.

HRT programs are provided by male andrology clinics and specialized urologists.

Testosterone treatment can be achieved by injections, dermal creams, gels or patches, or by imbedded time-release pellets. The most favored and least expensive treatment is with dermally-absorbed (through the skin) bio-identical testosterone cream, which has fewer side-effects such as prostate enlargement.

Sometimes long-term HRT is combined with Human Chorionic Gonadotropin (HCG) injections, to offset HRT effects of shutting down the body’s production of testosterone. Testosterone HRT therapy should always be closely followed by a physician, since side effects could include increased Prostate-Specific Antigen (PSA) level, aggravated existing prostate cancer condition, or disrupted body chemistry.

Cost: Clinic or urologist programs from about $300 to $2000 per year
Testosterone – cream from a formulary pharmacy, from about $80-$160 for 6 months; injectable testosterone about $200-$600 for 6 months.
HCG injectable only, about $250 – $500 for 6 months, alternately used about 30% of the time.
Effectiveness: Usually very effective for low testosterone effects, including erectile ability and some boost in sensitivity. Most effective in combination with other medications, discussed below.
Time to provide results: 7-14 days for dermal creams, 2-6 days for injections.
Additional information: There are numerous male enhancement clinics with websites, and specialized urologists are often available around metropolitan areas.

Treatment medications and supplements

Alcoholic beverages: may provide some relaxation and reduction in anxieties, but they do not provide any improvement in penile sensitivity. In fact, the effects of alcohol are to degrade neural response, and are likely to further reduce perceived penile sensitivity. If you have RPS, it is better to avoid alcoholic beverages entirely before attempting sex.

Cost: various
Effectiveness: Negative

Arginine: is a conditionally nonessential amino acid, so that generally it can be manufactured by the human body, and usually does not need to come from diet or supplementation.

It is a precursor of nitric oxide, which is needed for body muscles to function properly and in getting an erection. Arginine has been used with in combination with Yohimbine to treat erectile dysfunction, but newer medications are much more effective for ED. In most cases, there is no need to supplement arginine, but if taken it may add to the perceived energy level and possibly marginally help erections.

Dosage should be on the order of 4 grams/day, best accomplished by the use of arginine powder, which is bitter by nature and needs a buffer or mix to improve the taste. Arginine seems to be helpful in combination with Yohimbine for improving RPS and delayed ejaculation. (See section on Yohimbine.)

Cost: About $20 for a 2-month supply of arginine powder
Effectiveness: Minimal when used alone, but helpful with Yohimbine.

Caffeine: does improve mental and neural performance, but does not appear to be at all helpful in improving RPS or delayed ejaculation.

Cialis (Tadalafil): is one of the three big erectile dysfunction drugs, and is the only one which is helpful in treating RPS. All of the big three drugs are PDE-5 inhibitors, that is, a drug which activates enzymes which lead to smooth muscle relaxation of blood vessels to the penis, increasing blood flow and enhancing the ability to get an erection.

Unlike Viagra, Cilais requires stimulation to start this process (Viagra may actually cause spontaneous erections). When using Cialis , you will find penile sensitivity is enhanced, leading to an erection, and helpful in maintaining the sensitivity to an ejaculation. My experience is that it benefits all stages of having sex. Cialis also has the longest “half life” of the PDE-5 drugs, about 18 hours, verses about 4 hours for the others.

Cost: About $15 for a single Cialis 20mg tablet. Generic tadalafil tablets made mostly in India are widely available for $3-4 per 20mg. tablet from on-line pharmacies, and seem to be almost as effective as the branded Cialis.
Effectiveness: Positive effect on RPS, delayed ejaculation and ED.
Time to provide results: Cialis takes at least an hour to become effective even when taken on an empty stomach. My experience is that it typically takes 4-6 hours to peak in effectiveness, but the effect can last 36 or more hours. Sublingual “Softgel” tablets act in about half the time as regular Cialis (tadalafil).

Additional Information: Note: many online pharmacies sell diluted or bogus versions of the drug.
Finding a reliable pharmacy for generic tadalafil may take some searching. Any reputable pharmacy requires a doctor’s prescription. I have had good results with an online pharmacy called BestNationalPharmacy.com, under their “Weekly Specials”.

DHEA (5-Dehydroepiandrosterone): is a natural steroid hormone, produced in the body of humans and other mammals secreted mainly from the adrenal glands, and to a lesser extent, the sexual organs and the brain in both males and females. It plays a part in the production of testosterone and estrogens. Regular exercise appears to naturally increase DHEA in the human body. As humans age the DHEA plasma (blood) levels frequently decrease, as do a host of other hormones. However, the marketing claims of DHEA as a performance enhancer or longevity supplement are unproven.

Studies have indicated an increase in testosterone in older males with DHEA supplementation, but the extent would probably depend on the DHEA and testosterone levels existing before taking the supplement.

It is also possible over-consuming DHEA can excessively increase estrogen, with a negative overall effect on male hormone balance. It is available in tablet form from 25 to 50 mg, or as a trans-dermal cream. I found no improvement in RPS while taking DHEA.

Cost: Approximately $5-20 for 100 tablets.
Effectiveness: Not generally effective for RPS, but might be helpful in the case of subnormal DHEA levels.
Time response: Unknown.

Dostinex (Cabergoline): is a so-called dopamine receptor agonist on dopamine D2 receptors, primarily used to treat Parkinson’s Disease, high prolactin and other endocrinological disorders. The drug has also been reported to shorten the refractory (recovery) period in males after sex. I have tried this medication at the minimum dosage of 0.5mg for several months, and found no benefit for either RPS or delayed ejaculation.

Once the point of ejaculation is reached, it may have marginally increased the intensity of the climax, but otherwise had no definable effect. I was hesitant to increase the dosage to the 2-6mg. used by Parkinson’s patients because of unknown effects on a normal brain at that dosage, and because the increased side-effects of mostly nausea, constipation and psychiatric disturbances.

Cost: Approximately $13 per 0.5mg tablet generic cabergoline
Effectiveness: Not effective for RPS at 0.5mg level
Time response: Effects begin 0.5-4 hours after ingestion, and the half life is estimated from 60-80 hours.

Horny Goat Weed (Epimedium): is extracted from the plant, located originally in China and Asia. Icariin is the “active ingredient” in Horny Goat Weed, and the supplement is typically found in capsules with standardized extracts from 10% to 20% potency.

Icariin is a PDE-5 inhibitor as the popular ED drugs on the market, but also seems to increase the sensitivity in the genital area as Yohimbine. In fact, the overall positive effects of this supplement seem mirror those of Yohimbine, but for the most part it doesn’t have the array of Yohimbine side-effects.

I have only noticed some bowel upset when taken on an empty stomach. It does seem to help RPS, but not to the extent of Yohimbine. Horny Goat weed is not a stimulant such as Viagra, and is most effective as a supplement taken every day. Usually the effects will not be noticed for 1-2 weeks, and after that it does not require increasing amounts to maintain the effects.

Cost: $25 – $100 for a two-month supply
Effectiveness: This supplement is effective in improving RPS, and additionally helps erectile response and libido.
Time to results: 1-2 weeks at normal dosage
Additional information: When purchasing this supplement, ensure that the percentage of the Icariin extract is shown – the higher the Icariin, the more potent the capsule.

High-potency Niacin (Vitamin B-3): is a vitamin supplement available typically in 500mg-1000mg time release tablets. Niacin improves blood circulation and increases HDL cholesterol.

When combined with Yohimbine, it can improve ED. However, when used alone for RPS and delayed ejaculation, it has no noticeable effect. It typically causes a face-flush 15-30 minutes after ingesting a tablet, and at levels above 2g per day, could cause serious side-effects, including liver toxicity.

Cost: Typically about $20 for a two-month supply of time release tablets.
Effectiveness: Not effective for RPS.

Human Chorionic Gonadotropin (HCG): is a natural protein hormone which mimics the natural male Luteinizing Hormone (LH) nearly identically.

LH is a precursor to testosterone production, and HGC will stimulate the testes in the same way to enhance the production of testosterone and sperm.

HCG may be used alone, but is more often combined with testosterone HRT (See the Treatment Procedures section above on this page)

Cost: injectable only, about $250 – $500 for 6 months, alternately used about 30% of the time.
Effectiveness: Very effective at maximizing natural testosterone production.

Levitra (Vardinafil): is one of the popular PDE-5 drugs sold for ED. This medication seems to be marketed particularly for men with diabetes and the circulatory problems typical of the disease.

I found no effect from the drug for RPS, but also found no significant effect on erectile function. My circulatory system is in good condition from years of exercise, and I am able to obtain an erection without drugs, albeit somewhat slower than in my prime years. This medication has a half-life of about 4-5 hours.

Cost: About $20 per tablet, available in sizes from 2.5mg to 20mg, generic about $3.50 and up.
Effectiveness: Not effective for RPS.

Marijuana (Cannabis): is a slightly legal / illegal drug with psychoactive properties used for medical and recreational purposes, typically taken by inhaling the smoke. I must admit that I have not personally tested this drug, although I could have obtained a prescription for medical marijuana here in California.

From testimony by others, having sex after marijuana adds the feeling of being high and an added sexual euphoria, but it also delays ejaculation. Unfortunately, this is the reverse of what’s needed to improve RPS and delayed ejaculation …the euphoria does not help if you never get there!

Cost: Market cost
Effectiveness: The reverse or the desired effect for with RPS and delayed ejaculation (check out details of this male sexual dysfunction here).

P-Boost: is a supplement of natural ingredients designed to enhance erections. (A partial list of ingredients is provided on their website at p-boost.com.) At first, this product sounds like so many others guaranteed to enhance sexuality in some way, but never work.

However, this product does work. I found it when I was seeking information on a competing product which sounded encouraging. I found a website which tests non-prescription “male sexual health” products with a reliable panel of men (SexHealthReview.com).

The product I was seeking tested at near a “0”, but I found this product P-Boost which had the highest score of any product they ever tested. My personal testing rated it almost as effective as Viagra – it, too, will even cause spontaneous erections.

Unfortunately, like Viagra, it does not seem to help penile sensitivity, but it can serve as a help to maintain an erection better during a delayed ejaculation session when penile sensations begin to fade. Unlike Viagra, it has few side effects, but it will still cause flushing in the face.

Cost: less than $3.00 per capsule, depending on quantity purchased.
Effectiveness: Definitely increases erectile response.
Time to results: Effective within 60 minutes on an empty stomach, with an estimated half-life of about 8 hours.
Additional information: Available only from the website P-Boost.com.

Testosterone: is the primary male hormone, and plays a major role in sexuality, libido, fertility, and development of male characteristics.

As a supplement, it is very powerful, and should only be used under a physician or a clinic as described under the Treatment Procedures on this page, with frequent blood tests to evaluate its effect on your metabolism.

If you have a lower than ideal testosterone level, testosterone hormone replacement therapy can improve libido, erectile function and penile sensitivity.

Testosterone can be administered by oral tablets, injections, imbedded pellets, or trans-dermal creams, gels or patches. Oral testosterone works poorly, since most of the hormone ingested is captured and processed by the liver. It is also dangerous, since excessive oral testosterone can become toxic to the liver.

Testosterone injections are uncomfortable with a rather large needle, and must use an artificial testosterone formula to assure gradual absorption. Shots are required about every 2-3 weeks, so that the absorption rate and effectiveness cycle vary over that time period, causing uneven results.

Trans-dermal patches require frequent changing, and commonly cause skin irritation problems. Gels and creams are the easiest to administer, and are generally the preferable bio-identical testosterone. Gels are manufactured by pharmaceutical companies, and creams are typically made by formulary pharmacies.

Cost and Effectiveness: See Testosterone Hormone Replacement Therapy (HRT) in the Treatment Procedures section above.

Tongkat Ali (Eurycoma longifolia): is an extract from a flowering Eurycoma longifolia tree, originally found in Indonesia, Malaysia, and Southeast Asia. The Tongkat Ali extract has been used for centuries to treat fertility, strength and libido, as well as other maladies in folk medicine.

This medication is a hormonal modulator, and needs to be taken consistently in sufficient quantity to effect natural hormone production (including testosterone). It works most effectively with scheduled breaks, for example five days on and two days off, to ensure that the body does not develop a resistance pattern to the supplement. Like other effective supplements, it must be at a certain strength to be effective.

Assurance of this strength should be on the label: the Indonesian plant is considered most potent, and the label must also state the “production ratio”.

A ratio of 1:50 indicates that 50 grams of the plant root were used to make 1 gram of extract, so the higher the number, the stronger the extract. Detailed information about the effects of this extract verses other medications, and ordering advice, is available at the website AsiaTour.com, and other Tongkat Ali informational websites.

Cost: Approximately $200-300 for a 100 day supply, at the level of supplement recommended in “Effectiveness” below.
Effectiveness: The results with respect to RPS seem to be similar to those of Horny Goat Weed, but the medication must be taken a level of medication well in excess of Horny Goat Weed. To be effective, the daily dose should be the equivalent about two 300 gm. Capsules with a 1:200 ratio (200 gm. of plant root for 1 gram of the capsule extract).
Time to results: Typically 2-4 weeks with a buildup to higher dosages. Effective dosage level varies significantly with the individual.
Additional information: Ensure that the extract ratio is given on the label.

Uprima (Apomorphine): is a new type of ED medication which works directly through the brain, rather than with the use of PDE-5 inhibitors found in the other major ED drugs.

Uprima works by targeting an area of the brain known as the hypothalamus, which stimulates the production of a brain chemical called dopamine, in part responsible for sexual response and initiating erections.

Having en ED drug which works through the nervous system is an exciting possibility for those with RPS which has resulted from nerve damage.

The drug was approved by the European Union (EU), but refused by the US FDA, so it is not legal in the USA. While it is legal in the EU, it does not seem to be available at this time. Unfortunately, an evaluation will have to wait for availability of the drug.
Cost: Last listed price EUR80.00 for 4-3mg tablets

Viagra (Sildenafil): is the first and best known of the three popular ED medications. It is also a PDE-5 inhibitor, that is, a drug which acts to activate enzymes which lead to smooth muscle relaxation of blood vessels to the penis, increasing blood flow and enhancing the ability to get an erection. Unlike Cialis,

Viagra requires no stimulation to initiate an erection, and so spontaneous erections are likely to occur once the drug takes effect. While it is highly effective in enhancing erections for most men, it does not seem to help penile sensitivity.

However, it can serve as a help to maintain an erection better during a delayed ejaculation session when penile sensations begin to fade, and so it may be beneficial when used in combination with other medications..

Cost: About $21 for a single Viagra 100mg tablet. Generic sildenafil tablets made mostly in India are widely available for $3-4 per 100mg. tablet from on-line pharmacies, and seem to be almost as effective as the branded Viagra.
Effectiveness: Very effective in enhancing the ability to get an erection, but ineffective in treating RPS.
Time to results: Viagra normally becomes effective in less than 60 minutes., and has a half-life of about 4 hours.
Additional Information: Note: many online pharmacies sell diluted or bogus versions of the drug.
Finding a reliable pharmacy for generic sildenafil may take some searching. Any reputable pharmacy requires a doctor’s prescription. I have had good results with an online pharmacy called BestNationalPharmacy.com, under their “Weekly Specials”.

Yohimbine: an alkaloid with stimulant and aphrodisiac effects derived from the bark of the Pausinystalia yohimbe tree. It is used both as an ingredient in non-prescription male supplements and as a prescription medication. The prescription drug was one of the first drugs to treat ED, particularly with the combined use of high potency niacin, but was effective with only about one-third of men with ED.

However, Yohimbine also acts as an aphrodisiac, improves penile sensitivity, and has been shown to be effective in the treatment of orgasmic dysfunction (delayed ejaculation) in men.

My personal experience verifies all these qualities of Yohimbine, when used as a supplement taken every day. It seems like the perfect drug for RPS!

Unfortunately, Yohimbine has numerous side-effects. These include headaches, insomnia, rapid heart beat, anxiety reactions, skin flushing, increased urgency for urine and bowel elimination, shivering, loose bowels and sometimes diarrhea, and dizziness.

Usually the headaches, dizziness and insomnia will fade out after taking the drug for a few weeks. Moreover, if the daily dosage is low and spaced out, the side effects will be mild.

As the body becomes accustomed to the medication, you will have to gradually increase the dosage to maintain the benefits, and as the dosage increases the side effects tend to increase as well. I originally started with two 5.4mg tablets per day and after about 8 years I was up to six per day. Six per day is about the maximum: greater than about 30mg. per day can cause liver damage.

The final problem with Yohimbine is the cost. As late as 2004, Yohimbine tablets cost about $0.10 for a 5.4mg tablet. By 2008, the price was more than $0.50 per tablet. At 6 tablets per day, the annual bill for Yohimbine was over $1000! The supplement Horny Goat Weed, discussed earlier, has many of the benefits of Yohimbine albeit a milder form, without the many side effects and without the liver toxicity issues.

Cost: About $0.50 per tablet, or about $1000 per year at 6 tablets per day
Effectiveness: The most effective single medication I have experienced for RPS, but with many side effects
Time to results: About 3 weeks from the start of daily medication.
Additional information: If you wish to try Yohimbine, do use the prescription pills. Supplements using Yohimbine bark extract do not have a controlled amount of the extract and are unreliable for establishing the effectiveness of the medication.

Other medications: are available which are untested by me, but according to the literature have been prescribed at some time to treat delayed ejaculation. This group of drugs is normally prescribed to treat Parkinson’s Disease or other brain dysfunctions, such as depression or anxiety attacks.

There is little or no information on their effectiveness in treating RPS or delayed ejaculation. For additional information, I recommend consulting Wikipedia.org.

• Amantadine (Symmetrel) There have been anecdotal reports that low-dose amantadine has been successfully used to treat ADHD. Limited data has shown that amantadine may help to relieve SSRI-induced sexual dysfunction.
• Bupropion (Wellbutrin, others) Bupropion is one of few antidepressants that does not cause sexual dysfunction. According to a survey of psychiatrists, it is the drug of choice for the treatment of SSRI-induced sexual dysfunction, although this is not an FDA-approved indication.
• Buspirone (BuSpar, Vanspar) Buspirone (brand name BuSpar) is a psychoactive drug and pharmaceutical medication of the piperazine and azapirone chemical classes. It is used primarily as an anxiolytic, specifically for generalized anxiety disorder.
• Cyproheptadine (Periactin) Cyproheptadine has been used in the management of moderate to severe cases of serotonin syndrome. Cyproheptadine can also be used as a preventive measure against migraine in children and adolescents. Cyproheptadine can relieve SSRI-induced sexual dysfunction and drug-induced hyperhydrosis (excessive sweating).

Future Treatments for Reduced Penile Sensitivity

The future will certainly bring better medications and more effective treatments for RPS. As these become available, this Web page will be updated to include them.