Ilan Gruenwald

• Ass. Professor
• Head of Department at Rambam Medical Center

Introduction The VERTICA® is a hand-held, home use device, designed to treat 'mild to moderate' and moderate erectile dysfunction (ED) using radiofrequency (RF) electrodes. These electrodes deliver sequential RF energy to the penile area, with additional electrodes on a pad applied to the perineal area to also cover the penile crus. We hypothesize...

Introduction The VERTICA® is a hand-held, home use device, designed to treat “mild to moderate” and moderate erectile dysfunction (ED) using radiofrequency (RF) electrodes. These electrodes deliver sequential RF energy to the penile area, with additional electrodes on a pad applied to the perineal area to also cover the penile crus. We hypothesize...

Premature ejaculation (PE), lifelong and acquired, is the most common male sexual disorder, with serious impacts on the patient and his partner’s quality of life, sexual well-being, and psychosocial health. The most popular treatment options are on-demand topical anesthetics and off-label daily or on-demand selective serotonin reuptake inhibitors (...

Introduction Collagen is an essential component of the structures involved in the erectile mechanism. Radiofrequency (RF) energy has been shown to renew and restore the spatial structural arrangement of collagen fibers and may improve erectile function of men suffering from erectile dysfunction (ED). Objective To assess the feasibility, safety, an...

Aim To provide a snapshot of the current use of oral nutritional supplements, its association with inpatient characteristics, and with a focus on the role of nursing monitoring of food intake and implementing nutritional interventions for patients with low intake. Design Retrospective cohort study. Methods The study collected data from a hospital...

This study retrospectively examined the effects of low-intensity extracorporeal shockwave therapy and tadalafil on erectile dysfunction patients. 116 patients got low-intensity extracorporeal shockwave therapy twice weekly for 3 weeks, 5 mg of tadalafil daily for 3 weeks, and adjuvant therapy for 6 months. Group A (1 year), Group B (2 years), Group...

The erectile mechanism depends, in part on the intactness of the collagen components in the penis. As such, impaired collagen may have a deleterious effect on erectile function. Radiofrequency energy has been shown to renew and restore spatial structural arrangement of collagen fibers; therefore, treatment of erectile dysfunction with radiofrequenc...

Objectives Recently, studies emphasized the importance of “embodiment knowledge” (EK) - the lifetime experience in relationships as internalized, in understanding women’s sexual function. While studies found a high prevalence of insecure attachment patterns among women with sexual dysfunctions (SD), and other studies revealed movement characteristi...

Objectives A recent study of a new radiofrequency-based device (RF Vertica®) in treating Erectile Dysfunction (ED) showed promising results, safety, and satisfaction. However, there are no data on long-term follow-up. We aim to assess 1,3, and 6-months follow-up efficacy based on IIEF-EF and EHS questionnaires. Methods Follow-up data assessment of...

Introduction While Premature Ejaculation (PE) is a common and disturbing sexual dysfunction in men, currently available treatment modalities have limited efficacy and low treatment adherence. In this study, we assessed perineal Transcutaneous Electrical Stimulation (TES) as a new possibility to treat (PE) Objective To assess the feasibility, safet...

Collagen is an essential component of the structures involved in the erectile mechanism and as such, impaired collagen may hinder it. Because Radiofrequency (RF) energy has been shown to renew and restore spatial structural arrangement of collagen fibers, treatment of ED with RF could lead to anatomical and physiological changes at the penile tissu...

Background While premature ejaculation (PE) is a common and disturbing sexual dysfunction in men, current available treatment modalities have limited efficacy and low treatment adherence. Aim To assess the feasibility, safety, and efficacy of the vPatch, a miniaturized on-demand perineal transcutaneous electrical stimulation device for treating PE...

Objectives To assess the feasibility, safety, and efficacy of low-intensity radiofrequency therapy in men with erectile dysfunction ED Methods We recruited men with moderate & mild to moderate ED. After basic guidance, each patient treated himself with the Vertica® device (Ohhmed, Israel), applying his selected individual radiofrequency (RF) inten...

Objectives It is recommended to test total testosterone in the blood (BT) in patients who are evaluated for erectile dysfunction Our aim was to assess the need for a BT test in patients referred for ICI treatment. Methods Medical records of men evaluated at the ED clinic and were referred for ICI training/ treatment were reviewed for BT levels. R...

Objectives To evaluate the feasibility, safety, and efficacy of low-intensity shockwave therapy (SW) in patients with provoked vestibulodynia. Methods This is a double-blinded, randomized, sham-controlled, prospective study of 32 women. The treatment included a series of treatments, performed twice a week for 6 weeks. Each treatment consisted of 5...

Objectives It is recommended to test total testosterone in the blood (BT) in patients who are evaluated for erectile dysfunction Our aim was to assess the need for a BT test in patients referred for ICI treatment. Methods Medical records of men evaluated at the ED clinic and were referred for ICI training/ treatment were reviewed for BT levels. R...

Objectives To assess the feasibility, safety, and efficacy of a miniaturized on-demand perineal Transcutaneous Electrical Stimulation (TES) Using the vPatch device, for the treatment of premature ejaculation (PE). Methods We designed a bi-center, international, prospective, randomized, double-blind, sham-controlled, clinical study. A total of 59 l...

Background Vaginal looseness and decreased sensation during intercourse is prevalent in up to 30%–55% of premenopausal women. The efficacy and safety of CO2 laser have been demonstrated for these indications; however, the effect is temporary, up to 6–12 months. No studies regarding the efficacy and safety of adjuvant laser treatments have been cond...

Erectile Dysfunction is a major health concern with a deleterious effect on both men and partner. In the past decade a new concept of treating Erectile Dysfunction by applying energy to the penile tissue has been introduced and the recurrent use of low intensity shockwave therapy is used as an optional treatment for Erectile Dysfunction. Such a tre...

Introduction and hypothesis: To evaluate the efficacy and safety of a single carbon dioxide (CO2) laser maintenance treatment in women previously treated successfully with laser for stress urinary incontinence (SUI), who have demonstrated a decline in treatment effect. Methods: Women aged 40-70 years who experienced temporary significant improve...

Introduction Post-SSRI sexual-dysfunction (PSSD) is an iatrogenicsyndrome, the underlying neurobiological mechanisms of which areunclear. Symptom onset follows cessation of serotonergicantidepressants i.e. Selective Serotonin and Norepinephrine ReuptakeInhibitors (SSRI's, SNRI's), and Tricyclic antidepressants (TCA's). PSSDsymptoms include genital...

Purpose: To evaluate the effect of in vitro fertilization (IVF) on sexual function in men, particularly erectile dysfunction. Materials and methods: A prospective case-control study at a tertiary medical center. The study group comprised men of infertile couples that required IVF to conceive. The control group comprised men of couples who concei...

Background and Objectives Vaginal fractional carbon dioxide (CO2) laser treatment has emerged in the past two decades as a non‐surgical option for vaginal tightening. Mounting evidence supports the effectiveness and safety of this treatment for female sexual dysfunction. A newly developed vaginal tactile imaging (VTI) technique accurately evaluates...

Background Provoked vestibulodynia (PVD) is an exhausting pain syndrome that immensely affects quality of sexual life and consequently negatively affects quality of life. Low-intensity shock wave therapy produces physical forces that lead to pain relief. Aim The aim of this study was to evaluate the feasibility, safety, and efficacy of low-intensi...

Objective Hysterectomy for benign indications has profound effects on both anatomical and physiological pelvic floor and vaginal properties. Vaginal tactile imaging (VTI) enables the quantification of pelvic floor and vaginal biomechanical properties; this enables objective evaluation of various pelvic floor functions. The purposes of this study we...

Premature Ejaculation (PE) is a very common and disturbing sexual dysfunction in men. Currently available treatment modalities are associated with limited efficacy and low treatment adherence. In this prospective, single-blinded, self-controlled study, we evaluated the efficacy and safety of transcutaneous electrical stimulation (TES) for the treat...

Background and Objectives Vaginal laxity lacks standardized diagnosis and severity criteria. It is considered as a subjective complaint that reflects decreased sexual satisfaction due to vaginal loosening. Treatment modalities have included physiotherapy and plastic surgery. Recently, laser treatments have also gained popularity as a means of relie...

Introduction and hypothesis Conservative treatment is recommended as first-line therapy for stress urinary incontinence (SUI). We hypothesized that CO2 laser treatment would demonstrate safety and efficacy for women with SUI. Methods A prospective, open-label, cohort study of 33 women (mean age 43 years) referred from a continence clinic after uro...

Introduction: Most studies on female sexual dysfunction (FSD), and female sexual orgasmic disorder (FSOD) in particular, have qualitatively examined cultural and educational factors; only few have quantitatively examined physiological factors. Aim: The aim of this study was to compare quantitative sensory testing (QST) between women for whom FSO...

Introduction: Low-intensity shockwave therapy (LISWT) has been investigated for the treatment of uroandrological disorders including erectile dysfunction (ED), Peyronie's disease (PD) and chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) with controversial findings. Aim: To review the evidence on LISWT for ED, PD, and CP/CPPS and provid...

This introductory manuscript aims to familiarize the concept of the ability of certain forces or energies applied on the penis. This concept is described and discussed in more detail for three optional applicative energies; shock wave energy via mechano-transduction, ultrasound energy via its theoretical unique effect on the cellular membrane, spec...

Introduction: A position paper presents the standpoint of the Israeli Urological Association on clean intermittent catheterization (CIC) for all physicians and nurses. The position paper is based on international guidelines and professional literature and is adapted to medical activities in Israel. CIC is indicated for the treatment of temporary/p...

Purpose: To study the long-term efficacy of penile low-intensity shockwave treatment (LIST) - two years after an initially successful outcome. Materials and methods: Men with a successful outcome of LIST according to minimal Clinical important difference in IIEF-EF questionnaire were followed-up at 6, 12, 18, and 24 months. Efficacy was assessed...

Functional sexual pain disorders in women are a particular challenge to the gynecologist, inasmuch as phobic avoidance and guarding on the part of the patient lead to difficulties in the gynecological examination and diagnosis. In some such cases examination may even be impossible. Vaginismus is the commonly diagnosed etiology of such cases. This a...

This series of articles, Standards for Clinical Trials in Male and Female Sexual Dysfunction, began with the discussion of a common expected standard for clinical trial design in male and female sexual dysfunction, a common rationale for the design of phase I to IV clinical trials, and common considerations for the selection of study population and...

The focus of this article, the fourth in the series, Standards for Clinical Trials in Male and Female Sexual Dysfunction, is on aspects of clinical trial design and measurement that are specific to clinical trials for treatments of female sexual dysfunction. Challenges in this area include the limited extent of treatment development and clinical tr...

The second article in this series, Standards for Clinical Trials in Male and Female Sexual Dysfunction, focuses on measurement of patient-reported outcomes (PROs). Together with the design of appropriate phase I to phase IV clinical trials, the development, validation, choice, and implementation of valid PRO measurements—the focus of the present ar...

This series of articles outlines standards for clinical trials of treatments for male and female sexual dysfunctions, with a focus on research design and patient-reported outcome assessment. These articles consist of revision, updating, and integration of articles on standards for clinical trials in male and female sexual dysfunction from the 2010...

Introduction Previous studies have reported changes in the sensory functioning of the vagina in women with pelvic floor disorder. Aim To evaluate vaginal and clitoral sensation before and after surgery with trans-obturator tape (TVT-O, Ethicon Johnson & Johnson). Methods Quantitative sensory thresholds for warm, cold, and vibratory sensations wer...

Introduction and hypothesis: The objective was to evaluate vaginal and clitoral sensation before and after robotic sacrocolpopexy for the repair of pelvic organ prolapse. Methods: Twenty-two women, mean age 63 years (range 41-77), were admitted for robotic sacrocolpopexy repair of pelvic organ prolapse; 4 were lost to follow-up. Quantitative sen...

Purpose: Sham-controlled evaluation of penile low-intensity shockwave treatment (LIST) effect on patients unable to have sexual intercourse with phosphodiesterase 5 inhibitors. Materials and methods: A prospective randomized double-blind sham-controlled study on vasculogenic ED patients who stopped using PDE5i due to no efficacy. All patients ha...

The objective was to compare vaginal and clitoral sensory thresholds in women with pelvic organ prolapse and women with normal pelvic anatomy. Quantitative sensory thresholds for warm, cold, and vibratory sensations were measured at the vagina and clitoral area of women with pelvic organ prolapse, pelvic organ prolapse quantification (POP-Q) stage...

Benign prostate enlargement causing lower urinary symptoms is a common progressive phenomenon in adult men. Lower urinary tract symptoms may emerge during the storage, voiding, and post micturition phases, harm quality of life and may be caused by a variety of factors. The purpose of evaluation is to identify benign prostate enlargement and factors...

Penile extracorporeal low-intensity shock wave therapy (LIST) to the penis has recently emerged as a novel and promising modality in the treatment of erectile dysfunction (ED). LIST has angiogenic properties and stimulates neovascularization. If applied to the corpora cavernosa, LIST can improve penile blood flow and endothelial function. In a seri...

Low-intensity extracorporeal shock wave therapy (LI-ESWT) to the penis has recently emerged as a new and promising modality in the treatment of erectile dysfunction (ED). To review the published literature on the mechanism of action of LI-ESWT; and to report our clinical data on its efficacy in men with vasculogenic ED. A Medline search using the r...

Low-intensity extracorporeal shock wave therapy (LI-ESWT) is a novel modality that has recently been developed for treating erectile dysfunction (ED). Unlike other current treatment options for ED, all of which are palliative in nature, LI-ESWT is unique in that it aims to restore the erectile mechanism in order to enable natural or spontaneous ere...

In 1950, Gräfenberg described a distinct erotogenic zone on the anterior wall of the vagina, which was referred to as the Gräfenberg spot (G-spot) by Addiego, Whipple (a nurse) et al. in 1981. As a result, the G-spot has become a central topic of popular speculation and a basis of a huge business surrounding it. In our opinion, these sexologists ha...

We investigated the clinical and physiological effect of low intensity extracorporeal shock wave therapy on men with organic erectile dysfunction who are phosphodiesterase type 5 inhibitor responders. After a 1-month phosphodiesterase type 5 inhibitor washout period, 67 men were randomized in a 2:1 ratio to receive 12 sessions of low intensity extr...

The existence of an anatomically distinct female G-spot is controversial. Reports in the public media would lead one to believe the G-spot is a well-characterized entity capable of providing extreme sexual stimulation, yet this is far from the truth. The aim of this article was to provide an overview of the evidence both supporting and refuting the...

Low-intensity shock wave therapy (LI-ESWT) has been reported as an effective treatment in men with mild and moderate erectile dysfunction (ED). The aim of this study is to determine the efficacy of LI-ESWT in severe ED patients who were poor responders to phosphodiesterase type 5 inhibitor (PDE5i) therapy. This was an open-label single-arm prospect...

To explore the relationship between urinary incontinence and genital sensory functioning in females with sexual dysfunction disorders. A retrospective consecutive chart review was conducted for all women who were referred to our tertiary female urology clinic with a primary complaint of sexual dysfunction between October 1999 and January 2009. Our...

This study aims to evaluate the association between pelvic floor muscle (PFM) strength and sexual functioning. Retrospective chart review of consecutive all women who were referred with a primary complaint of sexual dysfunction. Women underwent standardized clinical evaluation including pelvic muscle strength which was ranked from 0 (weak) to 2 (st...

Low-intensity extracorporeal shockwave therapy (LI-ESWT) is currently under investigation regarding its ability to promote neovascularization in different organs. To evaluate the effect of LI-ESWT on men with erectile dysfunction (ED) who have previously responded to oral phosphodiesterase type 5 inhibitors (PDE5-I). We screened 20 men with vasculo...

Although the effect of phosphodiesterase type 5 inhibitors on endothelial function in the systemic circulation has been extensively studied, its effect on penile endothelial function remains unexplored. Therefore, we evaluated the effect of daily sildenafil on penile endothelial function. A total of 60 patients with erectile dysfunction were random...

Purpose of review: Most men who request surgical penile enhancement have a normal-sized and fully functional penis but visualize their penises as small (psychological dysmorphism). This fact by itself leads to controversy regarding the true indications for penile enhancement procedures in men without micropenis. Recent literature: One of the typ...