The Bottom Line
You may be saying to yourself, “Wait a second, I thought Botox was used to relax things, that’s the complete opposite of what I want going on down there!” Well, you’re right…and wrong. Okay guys, think about the last time you jumped into cold water, what happened down there? Well, that happened because of muscle contraction. Now without getting too much into the physiology of an erection – the first stage of an erection is muscle relaxation (read below if you really want the details). So what we’re talking about here is the muscle relaxation properties of botulinum toxin as part of a treatment for a longer, harder erections. And there’s a prospective placebo controlled, double blind study proving this. This same study showed that the effects last longer than the normal time frame of Botox® about 6 months.
The Nuts and Bolts – really just the bolt
Here is the really boring part of the blog post (Skip down to “Stacking the Deck” if you don’t care how you get an erection). Penile erection involves the relaxation of arterial blood supply to the erectile tissue and the trabecular mesh work of smooth muscle in the corpora cavernosa. The main mediator of penile erection is Nitric Oxide (NO). Sexual stimulation leads to the release of NO by cavernosal nerve endings and endothelial cells lining the sinusoidal spaces of the corpora cavernosa. NO diffuses into cavernosal smooth muscle cells to stimulate guanylate cyclase and generate cyclic GMP (cGMP) which ultimately results in reduced intracellular calcium levels and a consequent relaxation of arterial and trabecular smooth muscle, leading to arterial dilation, venous constriction, and the rigidity of penile erection. Medications like Viagra® and Cialis® are phosphodiesterase type 5 inhibitors (PDE5-Is) that block the breakdown of cGMP allowing for normal erections. (You thought this was boring? I left out a bunch of steps).
Then how does Botox help? First, erections are a parasympathetic response (trust me on this). And there is a permanent sympathetic tone applied to penile vessels and cavernosal smooth muscle fibers responsible for flaccidity. There are multiple studies showing how Botox® blocks the release of norepinephrine thereby blocking sympathetic tone (this is how botox stops underarm sweating) and it also increases the expression of vascular endothelial growth factor and CD31. The expression of these factors and the activation of its down-stream signaling cascades enhance vasodilation and endothelial cell proliferation (it helps grow a better penis). In the penis, Botox® shifts the balance between contractile and relaxant factors that governs flaccidity and rigidity. For penile erection to occur, activation of relaxing and inhibition of contractile mechanisms are mandatory.
Sympathetic over activity that increases in vascular and corporal smooth muscle tone is probably what causes ED in many people. We see sympathetic over activity in many diseases that cause ED including hypertension, ischemic heart disease, chronic heart failure, type 2 diabetes mellitus, a metabolic syndrome, sleep apnea, post-radical prostatectomy, and depression.
Stacking the Deck
If erections are caused by a balance of parasympathetic and sympathetic tone, you may be asking yourself if you can boost your parasympathetic response with Viagra® or Cialis® while blocking your sympathetic response with Botox®. And the answer is a resounding, YES! In fact there is a study showing just that, so stack away.
Do you want a longer, harder erection?
If you do, give Rejeuene MD a call at (262) 373-0169 to schedule your appointment. Don’t forget to read up on our other procedures that can help you have better erections (speaking of stacking the deck): The P-Shot®, testosterone replacement by the BioTE® method, or Pulsewave therapy. Remember, Botox does, unfortunately, wear off and the procedure will need to be repeated in about 6 months or so.
