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By David M. Odom, MD

Erectile Dysfunction

Erectile Dysfunction, commonly known as E/D is a debilitating issue for many men past age 40.This may include either the inability to obtain and maintain an erection, or simply a soft erection or one softer than acceptable.
I have used a variety of procedures to treat erectile dysfunction, including Extra-Corporeal Shockwave Therapy (ECSWT) using staccato-like sound wave pulses along the shaft of the penis 3 , Platelet Rich Plasma (PRP) injected into the corpus cavernosae 4 , or stem cells injected the same way 5,6 . Some men have found benefit from these procedures, but many have not found a reversal of their loss of erectile ability. 7
Although I am a physician who follows the current medical scientific literature, for medical procedures that are on the edge of current development, I am highly interested in the experience and opinions of patients who have undergone these procedures. Because of what I am hearing from these patients, I am continuing to look for E/D therapies that work better.
Older men, usually past age 70, who cannot benefit from use of phosphodiesterase type 5 (PDE5) inhibitors, like Viagra® or Cialis®, end up injecting “TriMix” into a corpus cavernosum of the penis to produce a hard erection. TriMix, as the name suggests, is a mixture of 3 drugs (Papaverine, Alprostadil, and Phentolamine) that together dilate the blood vessels in the penis, causing the inflow of blood into the penis, but temporarily preventing it from escaping, thus producing an erect penis. TriMix always works. The problem is that having to interrupt one’s romantic interlude to inject one’s penis is not the best answer.
I was so impressed when a relatively young patient of mine with profound erectile dysfunction, who could not obtain an erection without use of TriMix regained the ability to spontaneously produce an erection after getting his own stem cells injected into his penis. This man had suffered trauma to his groin at a young age and suffered E/D for over 20 years. He tried ECSWT multiple times and a variety of stem cell treatments, 6 of them, without success. But, after injection of his own fresh bone marrow, his E/D problem was resolved!
Everyone has stem cells, and powerful ones, sequestered in the bone marrow. The largest cache by far of such stem cells are in the pelvis bone 8 . When trauma occurs, the body is programed to activate stem cells in the matrix of the pelvic bone and send them to the damaged tissue to promote repair 9 .
But, the penis never gets the benefit of 20 million such stem cells via naturally occurring trauma. However, if a high-tech trocar or needle-like device is inserted into the center part of the pelvic bone and marrow is extracted as the needle is retracted, 20 ml of quality bone marrow, replete with millions of stem cells are obtained. Of course before any such procedures are done, local anesthetic is injected with a skinny needle into the skin and outer layer of bone where the trocar is to be inserted. As well a small amount of local anesthetic is injected into the dorsum of the base of the penis to numb it. Thus, the patient feels only pressure, not pain.
Immediately after the bone marrow is obtained, the marrow is injected into the corpus cavernosae, or blood reservoirs in the penis. With 10 ml of marrow injected into each corpus cavernosum, every part of this anatomical structure is bathed in stem cells.
The patient then dresses and goes home with a small gauze bandage on his penis and a little round band-aid over the marrow extraction site. He is told to refrain from sex for 4 days, and not to go into a hot tub for 48 hours.
Is there any benefit of this type of procedure for women?
Extraction of bone marrow and injection into areas of the vagina reverse post-menopausal vaginal atrophy. This procedure reverses painful lichen sclerosus. 12

Bibliography:
1. Prevalence of Erectile Dysfunction-https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/409619
2. Definition of erectile dysfunction-https://www.lexico.com/en/definition/erectile_dysfunction
3. Shockwave Therapy for Erectile Dysfunction-https://www.practiceupdate.com/content/shockwave-therapy-for-erectile-dysfunction/75461
4. platelet rich fibrin matrix injections for treatment of E/D-https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5754585/
5. Potential of Adipose-Derived Stem Cells for Treatment of Erectile Dysfunction-https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2895916/
6. Erectile function restored with cell therapy-https://stemcellsportal.com/news/erectile-function-restored-cell-therapy-preclinical-model
7. American Urological Association, Erectile Dysfunction: AUA Guideline, Guideline Statement 24-https://www.auanet.org/guidelines/erectile-dysfunction-(ed)-guideline
8. Canadian Cancer Society, How a stem cell transplant works-https://www.cancer.ca/en/cancer-information/diagnosis-and-treatment/stem-cell-transplant/?region=on
9. Revolutionary stem cell therapy boosts body's ability to heal itself. The Guardian.https://www.theguardian.com/science/2009/jan/08/stem-cells-bone-marrow-heart-attack
12. Vulvar Regenerative Medicine, Cynthia Rasmussen MD, FACOG, Director, Vulvovaginal Specialty Clinic, Harvard Vanguard Medical Associates Burlington, MA Vulvar Regenerative Medicine - ASCCP/