Erectile dysfunction, penis size and the p-shot

Fiona Clark

From Erectile Dysfunction to increasing penis size, Dr Shirin Lakhani discusses treatment options

Most men don’t like talking about problems with their genitalia – but erectile dysfunction is a common concern. It’s estimated that it will affect every second man at some stage in their life and the incidence increases with age.

Dr Shirin Lakhani is the first woman in the UK to have been trained in performing the P-Shot  and here she runs through a series of men’s health concerns that it could help with including erectile dysfunction, lichen sclerosus, Peyronie’s Disease and issues with size.

You can see the original video interview here.

What is Erectile Dysfunction (ED)?

“It is the inability to get and maintain an erection that’s suitable for satisfactory intercourse. It’s is extremely common and it becomes increasingly more common as you age. But it’s not just old men – if you think of a 50 year old and that’s not that old – at least 50% of them have issues with ED and that percentage increases as they get older.

“I am seeing men in their 20’s and 30’s as well – so the first think that’s important to realise is that you’re not alone.”

Once you realise you aren’t alone it can make it easier to talk about with your partner and/or your doctor and that’s important because there could be underlying health conditions that are causing it that need to be treated, Dr Lakhani says.

“For example, it could be neurological, it could be vascular and it could be hormone related as well. I advice my patients to have a hormone test as well. And with the cardiovascular cause – ED is often the first sign, and is in fact a sensitive earlier indicator that you may go on to develop heart disease later. So it’s important to get all all your heart disease risk factors checked, and diabetics are more likely get ED as well because of the changes in the blood vessels and the nerves.

“Another reason is psychological. In most a cases stress and things like that are not the cause of long standing ED unless the person gets themselves into such as state that they’re their own worst enemy, and in that instance counselling can help.”


When Should You Seek Help?

“From my point of view, when it’s a problem for you. Obviously everyone suffers when their tired or stressed but if it’s an ongoing issue and you’ve tried things to alleviate the stress and nothing helps, then it’s time to seek help. And you’d be surprised how many people I’ve tested that come back with a lower than average testosterone as well. So it’s important to find out the causes for your individual case.”


Can Lifestyle Changes Help?

“Absolutely. Obviously cutting down on alcohol, quitting smoking because that’s going to affect you blood vessels and cause atheroma formation. If you’re a diabetic make sure your blood sugars are controlled as well as your cardiovascular risk factors. Take plenty of exercise and reduce your stress levels. Taking a supplement like arginine can help too. It’s an amino acid that helps with blood vessels and blood flow.”


What is the P-Shot and how can it help?

“The P-shot uses platelet rich plasma or PRP for short. What that is, is using your body’s own systems to heal itself. So how I explain this to patients is that when you cut yourself you get that yellow goo forming a the site of the injury and then the blood clots as well. That yellow goo is PRP effectively – they release their growth factors and attract stem cells to the site and this causes the wound to heal. That’s the mechanism. So your tricking the body into thinking there’s been an acute injury and it starts off the repair process.

“Effectively the stem cells with differentiate into whatever cells are needed, so they can repair blood vessels, nerve endings or get new tissue growth as well and the P-Shot is capable of producing all of those things which is why it works so well for so many conditions.

“It can help with sensitivity, erectile firmness by improving blood flow, and because it encourages new tissue it can lead to an increase girth and length.”


What About Size-What Can Men Expect And How Long Will It Last?

“It’s a tricky one because everyone is individual but I can talk about averages.

“In terms of response to treatment you can expect to see a 10-20% increase in length and a slightly bigger increase in the girth and you’ll see the girth first. as a caveat, I do encourage my patients to use a penis pump alongside the treatment and the reason why I say this is that if you use a penis pump alone it’s like going to the gym and doing weights, but if you have the treatment as well it’s like doing that on steroids. You will let an increase in size using a penis pump on its own but this will give you a quicker and an enhanced response.”

Results may be seen as soon as six weeks but maintenance will be required. How often will depend on age, health, lifestyle and background testosterone levels.

“As you get older you’re going to lose tissue and it will go down again, so if you embark on this you may find that you need to come back every 12 to 18 months to maintain it.”


How many treatments are required?

“The initial treatment depends on the condition. For ED I often say let’s start with one treatment and see where we are in three months. If they’ve had a full resolution I usually say come back and see me when it starts to wear off and that’s usually around 12 – 18 months.

“If they only have a partial response then we usually do a second treatment but that will on what they want to achieve and their finances.

“For size men tend to have 2 to 3 treatments over 6 to 9 months.”


What About Peyronie’s Disease?

“A lot of men have Peyronie’s disease and don’t realise it. Effectively all it is, is a bent penis. It can be minor or it can be severe – even 90 degree bends. It can interfere with intercourse and sex can be painful.

“My advice is that if it’s minor and its’ not interfering with intercourse, leave it. But, if it interferes with your quality of life then there are treatments you can try. It is usually caused by trauma and a plaque forms at the site of the trauma which causes a bend.

“So, here you’re treating scar tissue and this will, from experience, usually need 2-3 treatments, a couple of months apart.”

What’s Involved In The Procedure?

“It’s really simple. After the consultation, they come and visit me in the clinic. I take blood – between 60-120mls and that gets spun in the centrifuge and is concentrated down to 10 mls of PRP. While it’s being processed in the centrifuge I apply a numbing cream and once that’s kicked in I give a nerve block as well – then they don’t feel anything at all. Once that’s done I activate the PRP with some calcium and it’s injected along the penis and that’s pretty much it. Everyone gets the standard P Shot but patients Peyronie’s Disease or Lichen Sclerosus get extra PRP in those areas where it’s required.”


The P-Shot And Lichen Sclerosus

“Lichen Sclerosus is a really poorly understood condition. It’s thought to be autoimmune and that’s because it occurs with other autoimmune diseases. It’s more common in women like all autoimmune diseases but it can affect men as well. In men it particularly affects the foreskin and the glans [the head of the penis.] It can cause the foreskin to rip apart or have little fissures in it and it can be painful during intercourse and it can, as it does in women, develop into cancer. It can cause tightening of the foreskin over the glans as well.  So it’s a horrible condition to live with and the mainstay of traditional treatment is steroids which most people don’t get on with. They find it messy, it doesn’t work all the time and they stop using it and they get a flare up.

“So PRP is a really good option as it tends to reverse some of the autoimmune process and it can histologically reverse some of the changes occur with lichen – so usually they respond quite quickly. Within a few days they say that the itching has calmed down and they they feel more comfortable. And over a few weeks you can see an improvement in the tissue quality too so that it doesn’t tear so often and isn’t so uncomfortable for them.”

“A few years ago I did a little case study in the clinic as I wanted to see if it was doing what it said it did and in the vast majority of men and women there was significant improvement. Some haven’t had to come back for a treatment as they’ve remained in remission, and some have come back for a top up.”

This doesn’t mean they can ditch the steroids but some will be able to cut back and others may not need it at all. Often men are told that they need to be circumcised but afterwards they may still be symptomatic.



Viagra helps the symptoms but it doesn’t treat the cause. Many men find that over time they need to use more to get the same results.

Talking about ED And Viagra With Your Partner

“One thing partners need to remember is that men may be embarrassed. It’s not because they don’t find you attractive. Try to put yourself in their position  and think what if you were the one who was having the issue with the aging and sexual dysfunction and try and broach it like that. Try not to punish yourself over it as its probably got nothing to do with whether he finds you attractive or not. The fact that he’s even taking the viagra shows he’s making an effort.”

“Find a sympathetic doctor – remember we talk about these all the times. You’re not alone and there are treatments available.”

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