Chronic Pelvic Pain Syndrome in Men: Why Antibiotics So Often Fail, and What Actually Helps

chronic pelvic pain syndrome

Most men told they have “chronic prostatitis” do not have an infection, which is why round after round of antibiotics so often achieves nothing. Here is what chronic pelvic pain syndrome actually is, why the pelvic floor and nervous system matter more than the prostate in many cases, and where focused shockwave therapy fits.

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Low Testosterone vs. Erectile Dysfunction: How to Tell Them Apart

low testosterone vs erectile dysfunction

Low testosterone and erectile dysfunction get treated as the same problem, but they are usually not. One is a hormone issue that blunts desire; the other is a blood flow issue that affects the mechanics of an erection. Here is how to tell which one you are dealing with — and why testosterone therapy often disappoints men who expected it to fix their erections.

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HARD FLACCID SYNDROME (HFS)

Two young men talking about discomfort linked to hard flaccid syndrome

What Is Hard Flaccid Syndrome?

HFS is characterized by a persistently semi-rigid or “rubbery” penis in the flaccid state, even without sexual arousal. 
It is distinct from classic erectile dysfunction and typically appears in younger men (often in their 20s and 30s).
 
Core features:
  • Penile changes: Semi-rigid flaccid state, retracted or shortened appearance, reduced elasticity, numbness of the glans/shaft.
  • Erectile difficulties: Reduced rigidity, difficulty achieving or maintaining erections (frequently worse when standing), softer glans during erection, diminished morning or nocturnal erections.
  • Pain and sensory issues: Perineal, penile, or pelvic discomfort that often worsens with standing, sitting, or arousal; altered sensation (tingling, burning, or reduced erogenous feeling).
  • Associated symptoms: Urinary changes (weak stream, discomfort), ejaculatory pain or reduced pleasure, and psychological distress (anxiety, reduced confidence, sleep disruption).
Symptoms are frequently positional—better lying down, more pronounced upright—and can create a self-reinforcing cycle of tension and worry.

Why Does Hard Flaccid Syndrome Occur?

The exact cause is not fully established. Current understanding points to a cascade that may begin with trauma (aggressive masturbation or penile stretching, sexual activity, or pelvic injury) and lead to:
  • Excess sympathetic nervous system activity in penile smooth muscle.
  • Pelvic floor muscle hypertonicity or spasm.
  • Possible neurovascular irritation (pudendal nerve pathways).
  • Local inflammation, reduced microcirculation, and tissue hypoxia.
These elements are interrelated but distinct: neurological dysregulation, muscular overactivity, and vascular changes each contribute without fully overlapping.

How Focused Shockwave Therapy Works

Focused extracorporeal shockwave therapy (focused ESWT / Li-ESWT) delivers precise, low-intensity electromagnetic shockwaves to targeted tissues. Unlike radial acoustic waves, focused shockwaves (TRUE SHOCKWAVE) concentrate energy at a specific depth to promote neovascularization, neuromodulation, and healing processes. 
 
In the context of HFS, treatment typically targets the penile shaft, perineum, and sometimes adjacent pelvic floor areas. 
Focused shockwaves can trigger biological responses that address the vascular, inflammatory, and tissue-level components of the condition. 
Sessions are non-invasive, usually last 15–20 minutes, and require no downtime.

Potential Benefits of Focused Shockwave for Hard Flaccid Syndrome

Evidence remains limited to small case series and pilot reports rather than large randomized trials. 
Reported benefits fall into these mutually exclusive categories:
  • Vascular improvement: Stimulates angiogenesis (new micro-vessel formation) and enhances endothelial function, potentially improving blood inflow and reducing the semi-rigid flaccid state.
  • Anti-inflammatory and tissue-healing effects: Reduces local inflammation and promotes regenerative processes in penile and perineal tissues, which may ease the chronic “tense” feeling and support recovery of normal tissue elasticity.
  • Neuromodulation and pain reduction: May desensitize irritated pelvic/pudendal nerve pathways and interrupt the pain–tension cycle, addressing the stabbing or aching discomfort that often worsens with standing.
  • Support for pelvic floor and erectile quality: By improving local blood flow and reducing muscle-related restriction, some patients experience better erection rigidity and less positional loss of firmness (e.g., when moving from lying to standing).
In published early reports, a common protocol involved six sessions delivering approximately 3,600 focused shocks per session at low energy flux density (around 0.13 mJ/mm²) distributed across the shaft and crura. 
Some individuals noted partial or substantial symptom relief, particularly when shockwave was combined with pelvic floor physical therapy and, in certain cases, daily low-dose PDE5 inhibitors. 
Benefits, when they occur, may appear after several sessions and continue to develop over weeks.

Practical Considerations and Next Steps

Focused shockwave is one element of a multimodal approach. Best results in available reports occurred alongside pelvic floor physiotherapy, stress-management strategies, and medical evaluation to rule out other causes. 
Candidacy requires professional assessment – certain conditions (active cancer, recent steroid injections near the treatment area, infection, or pacemakers) are typically absolute contraindications.
 
A typical pathway includes:
  • Comprehensive history and examination by a clinician experienced in sexual medicine or pelvic health.
  • Discussion of realistic expectations given the limited evidence base.
  • Individualized treatment planning if shockwave is deemed appropriate.
Important Limitations and Disclaimer
Focused shockwave is not a proven cure for hard flaccid syndrome. 
Outcomes vary, evidence is preliminary, and many patients benefit most from combined therapies. 
This content is for educational purposes only and does not constitute medical advice, diagnosis, or a treatment recommendation. 
Always consult a qualified healthcare professional for personalized evaluation and care decisions.
If you are experiencing symptoms consistent with hard flaccid syndrome, reach out to a specialist to explore evidence-based options tailored to your situation. 
Early, informed assessment offers the clearest path forward.

Questions asked by every Peyronie’s Disease patient?

Peyronie's disease treatment options including traction device and shockwave therapy

Here’s how the Mayo Clinic defines Peyronie’s Disease (PD):
“Peyronie’s Disease (PD) involves formation of fibrous scar tissue (plaque) in the tunica albuginea of the penis, leading to curvature, pain, shortening, or other deformities during erection. The exact trigger is often unclear, but the process centers on injury followed by abnormal wound healing.”
https://www.mayoclinic.org/diseases-conditions/peyronies-disease/symptoms-causes/syc-20353468

In my experience in dealing with thousands of PD patients, here’s 4 key questions and discussions about this very challenging condition.

WHY THE F&%# DID THIS HAPPEN?

Let’s just get a bit of science out of the way: The core mechanism of PD is improper healing and susceptibility to scar formation. PD is fundamentally a disorder of disordered wound healing rather than simple injury. After trauma or microtrauma causes bleeding and inflammation in the tunica, genetically or biologically susceptible individuals (sometimes linked to conditions like Dupuytren’s contracture) produce excess collagen, persistent myofibroblast activity, and inelastic plaque instead of normal remodeling. In short, PD most often begins with penile trauma in a susceptible person, followed by faulty scar-tissue formation. Symptoms of PD are painful erections, curved erections, difficulty in penetration, indentations or hourglass shaping, palpable fibrotic anomalies, loss of length and girth, erectile dysfunction, anxiety & depression.  Patients will experience one or more of these symptoms, and the disease progresses from an acute phase (< 12 months) to a chronic phase (> 12 months).  

HOW THE F&%# DID THIS HAPPEN?

Most cases have no clear recalled trigger; 75% of my guys don’t know why or how their PD started. 25%, however, are certain; they injured it during sex or masturbation, they got a puck or a foot in the groin, or they snapped a branch off on the head of their cock when they were clearing some brush, or post unrelated surgery (catheter insertion or removal?). 

IT HAPPENS. S&%# HAPPENS.

Don’t worry bro – you aren’t alone.

In fact it happens a lot, to a lot of guys over the course of their lives – PD prevalence is estimated as high as 9%.
For comparison sake – Diabetes has a similar prevalence – and everyone knows what diabetes is. 

Most people don’t know what the F&%# PD is. And it’s very likely to be underreported. 

So 25% for sure know HOW it happened, but for the remaining 3/4 of men, who just WAKE UP one morning – and it’s curved, or in pain – they have no idea what caused their condition.

I have my own theory.

I estimate that most of these men, specifically those who, prior to their injury, had normal erectile function, simply turned over on their boners during sleep, and boom, there’s your trauma. If you are a guy with healthy erectile function, you may be having 3-5 nighttime erections (nocturnal penile tumescence) every night! Accidents happen when you have a boner!

Simple preventative solution?  Sleep on your back as much as you can!!!  DICK UP!

Ultimately, being the detective in this scenario isn’t really relevant to you. 
The question becomes – HOW DO I FIX THIS?

HOW THE F&%# DO I FIX THIS?

I’ve heard from several patients that when presenting to a urologists with PD, often later during the acute phase (because how long does it take to get a urologist appointment?), the advice for the patient was to ‘just wait it out’. 
Whoa – yeah, don’t do that.

“See ya in a year!” said one urologist, without even completing a physical exam.  Patient complained to me: “I just waited 10 months to be told there’s nothing that can be done?” Brutal. BS.

PD is a disease – meaning it progresses and usually worsens without intervention – and you should do what you can to halt it in its tracks early. 

I’m not saying you need to have surgery or start injections – but you should be considering non-pharmaceutical, natural, non-invasive solutions now. I understand why most doctors opt to do nothing. In about 10% of PD patients, they will see a return to relative normalcy WITHOUT any intervention. 

Following the Voltaire logic (“the art of medicine consists of amusing the patient while nature cures the disease”)
It just heals. And I’m sure, for a very small number of people – it does. 
But for most, it won’t.  And so being proactive is really important.

My advice is to throw the kitchen sink at the problem.

Here’s your list – Do all of them if you can:

  1. Focused Shockwave Therapy.  It’s powerful and painless for most people.  It is expensive and there is no guarantee for success.  But the data is very promising. 

  2. Traction Device and/or a vacuum pump. I recommend the RestoreX, the Penimaster, and the Active 3 Medintim Electric Pump. But don’t just buy it to let it sit under your bathroom sink.  USE IT.

  3. Nightly massages and jelquing.  5 minutes in a warm shower is all you need.  These are somewhat controversial but I believe they can be done safely. Be careful!  You CAN hurt yourself.

  4. Apply Castor Oil to fibrotic plaque area.  Purchase the very highest quality organic castor oil for topical use you can find. There’s none that I can specifically recommend.  Go to a local Health Food Store. The data on castor oil is generally poor, but the side effects are so low that it’s generally worth a shot.

  5. Bang & Masturbate (Carefully).  Don’t let the blood flow to the area stop.  USE IT.

Don’t do one, and ‘see what happens’.  If you CAN – do them all.  Do you think when Aaron Rodgers’ achilles exploded, he did the surgery and then was like ‘ahhh, I’m not gonna use the walking boot?’

Of course not – Throw the Kitchen Sink at the Problem.

WHAT HAPPENS IF I DON’T FIX THIS BS?

Unfortunately, PD is like the achilles heel injury of the cock. PD, like an achilles rupture, is very difficult to fix, even with the best of care. How can such a small injury cause such a giant, and difficult to fix problem? 

Often times you will never fully heal exactly, and If you do, prepare for a long recovery. The healing process takes time. 

But if you DO NOTHING – I think you set yourself up for long term failure. 

It’s important to note that there is a strong association of PD with mental health disorders. Many men develop significant emotional distress, clinical depression (rates often cited around 48% or higher in clinic samples), anxiety, relationship strain, and reduced quality of life.  This is totally understandable given the impact PD can have on sexual function and body image.

https://pubmed.ncbi.nlm.nih.gov/40684259/

PD can often result in erectile dysfunction. While many guys who come to see me report no issues with ‘getting’ the erection, over time, it’s well defined that PD can result in early onset ED.  In a retrospective analysis of 309 men with active-phase PD, ED was present in 37.5% of cases; in ALL of these, ED occurred during the course of PD. https://pmc.ncbi.nlm.nih.gov/articles/PMC4958366/

Again – it’s a disease.  

Do what you can to halt its progression.

ADDITIONAL REFERENCES

Clinical Presentation of Peyronie’s Disease: A Retrospective Study of 564 Cases (2024) — Found ED in 39.8% of PD patients.
https://www.mdpi.com/2075-4418/14/11/1125

Peyronie’s disease in the United States: A real-world, 13-year nationwide analysis of demographics, clinical characteristics, and treatment trends (2025) — ED present at diagnosis in 28.2% of patients; additional de novo ED developed in 14.8% within one year of PD diagnosis.
https://onlinelibrary.wiley.com/doi/10.1111/andr.70029

 

Why Viagra/Cialis don’t work for you

Man skeptically examining ED pill, illustrating pill fatigue with erectile dysfunction medication

If you’ve tried Viagra, Cialis, or similar ED medications (PDE5i) and felt disappointed with the results, you’re not alone.

Many men discover that pills only provide temporary relief – or stop working altogether – because they don’t fix the underlying problem.
It’s called ‘pill fatigue.’

PDE5i medications simply increase blood flow for a short time, but they cannot repair damaged blood vessels, improve natural nitric oxide production, or restore healthy penile tissue.

The Real Reason Many Men Struggle with ED

Over time, blood vessels in the penis can become narrowed or damaged due to age, diabetes, high blood pressure, heart disease, or prostate issues.

When blood flow is impaired at the root level, pills often lose effectiveness.

Focused Shockwave Therapy Does What Pills Can’t

At FocusWave Clinic, we use clinically proven focused shockwave therapy to:

  • Stimulate the growth of new blood vessels (angiogenesis)
  • Break down micro-plaque in existing vessels
  • Improve natural blood flow and tissue regeneration
  • Help your body heal from the inside out – with no pills, no surgery, and no downtime

Many of our patients who previously had poor or inconsistent results with ED medications now report stronger, more reliable erections and better spontaneity in their intimate life.

In like manner, patients who are struggling with inconsistent results from their PDE5i medications tend to see much stronger erections after shockwave therapy treatments begin and medication levels remain constant.

Real Results Without the Side Effects

  • Treatment takes just 15–20 minutes per session
  • 6–12 sessions is typical for lasting improvement
  • Results often continue improving for weeks after treatment ends

If you’re tired of relying on pills that don’t deliver consistent results, we’d love to help you explore a long-term solution.

→ Book a complimentary In-Clinic Consultation [Booking Link]

During this no obligation assessment with our team of compassionate clinicians, we’ll discuss your specific situation in confidence and let you know if you’re a good candidate for this amazing medical technology.

You deserve to feel confident again – without depending on medication.

Looking forward to speaking with you!

Regaining Intimacy After Prostate Surgery – A Natural Option Many Men Are Choosing

man regaining intimacy and confidence after prostate surgery

If you’ve had a prostatectomy, you already know how common it is to experience changes in erectile function afterward — even with nerve-sparing surgery. Many men find that pills or injections help only partially or come with side effects they’d rather avoid.

You’re not alone, and there is hope for meaningful recovery.

Book your complimentary, in-clinic assessment HERE

At FocusWave Clinic, we specialize in focused shockwave therapy specifically for men recovering sexual function after prostate cancer treatment. Unlike medications that offer only temporary effects, shockwave therapy works by:

  • Stimulating the growth of new blood vessels
  • Supporting nerve regeneration and tissue repair
  • Improving natural blood flow to the penis
  • Helping restore spontaneous, reliable erections over time
     

Treatment is non-invasive, takes about 15–20 minutes per session, requires no downtime, and has no systemic side effects. 

Many men begin noticing improvements within a few weeks, with results continuing to build for months afterward.

We’ve helped numerous prostate cancer survivors in the Ottawa and Waterloo regions regain confidence and intimacy without relying on ongoing medication.

Next Step – Completely Confidential
We offer a free 15-minute discovery call where we can discuss your specific situation, timeline since surgery, and whether you’re a good candidate for shockwave therapy.→ Call us at 888-558-9283.

There is no obligation — just clear, compassionate answers from a team that understands what you’ve been through.

If you’ve already done your homework, and understand that we are your BEST choice in Ottawa or Kitchener-Waterloo (with the best technology, with the most capable and compassionate team to help you along the way) then you can simply book your free, no-obligation in-clinic consultation anytime HERE

You’ve already overcome a lot. 

Taking this step can help you reclaim an important part of your life.

Kitchen sink model: Shockwave + Pelvic floor physio + Training for reversing premature ejaculation

reverse premature ejaculation

Premature ejaculation (PE) is often linked to physiological factors like pelvic floor dysfunction, poor penile blood flow, hypersensitivity of the penis, or chronic pelvic pain syndrome (CPPS). The combination of Focused Shockwave Therapy (FST), Pelvic Floor Physiotherapy (PFP), and pelvic floor muscle training addresses these root causes, offering a synergistic approach to improve intravaginal ejaculation latency time (IELT) and reverse PE symptoms.

Focused Shockwave Therapy (FST)

How It Works:

  • FST delivers Focused Shockwave Therapy to targeted areas (e.g., penile tissue or perineum), stimulating neovascularization (new blood vessel formation), reducing inflammation, and promoting tissue regeneration.
  • For PE, shockwaves are applied to the perineal area or penile shaft to enhance blood flow, improve nerve sensitivity, and reduce pelvic floor hypersensitivity often associated with CPPS or prostatitis.

Scientific Evidence:

  • A 2020 study in Therapeutic Advances in Urology found FST significantly improved IELT in men with PE and CPPS, with mean IELT increasing from 37.98 seconds to 74.81 seconds after 12 sessions.
  • Shockwaves reduce smooth muscle hyperplasia and inflammation in the pelvic region, addressing CPPS-related PE. A 2023 review in Sexual Medicine noted improved pelvic floor function post-FST, enhancing ejaculation control.
  • Mechanism: Shockwaves trigger the release of vascular endothelial growth factor (VEGF) and nitric oxide, improving penile blood flow and nerve function, which supports stronger erections and delayed ejaculation.


Why It Helps
: By targeting physiological causes like poor blood flow or pelvic inflammation, and in the neuromodulation of the penile nerves, FST creates a foundation for longer-lasting sexual performance, particularly in younger men with acquired PE.

Pelvic Floor Physiotherapy (PFP) Examination

How It Works:

  • A pelvic health physiotherapist assesses pelvic floor muscle (PFM) function using manual techniques, biofeedback, or surface electromyography to identify dysfunction (e.g., hypertonic/overactive or hypotonic/weak PFMs).
  • Hypertonic PFMs can cause rapid ejaculation due to excessive tension, while weak PFMs reduce ejaculation control. The exam provides a baseline to tailor subsequent training.

Scientific Evidence:

  • A 2014 study in European Urology showed pelvic floor muscle rehabilitation increased IELT almost 500% (from 31.7 seconds to 146.2 seconds) in men with lifelong PE after 12 weeks of therapy.
  • Hypertonic PFMs are common in PE, contributing to hypersensitivity. Relaxation techniques identified during the exam can reduce this tension, per a 2021 study in International Journal of Impotence Research.
  • The exam also rules out other conditions (e.g., prostatitis) and ensures shockwave therapy is applied correctly to complement PFM health.

Why It Helps: The PFP exam pinpoints the exact pelvic floor issues contributing to PE, enabling targeted training and ensuring shockwave therapy is optimized for the patient’s physiology.

Pelvic Floor Muscle Training (Post-Examination)

How It Works:

  • Based on the PFP exam, patients receive guidance on pelvic floor exercises (e.g., Kegels for strengthening or reverse Kegels for relaxation) to perform at home. These exercises improve PFM coordination, strength, or relaxation, enhancing ejaculation control.
  • Training may involve biofeedback tools or simple protocols (e.g., 10-second holds, 10 repetitions, 3 times daily) tailored to the patient’s needs.

Scientific Evidence:

  • A 2019 meta-analysis in Physiotherapy confirmed that PFM training significantly improves IELT and sexual satisfaction in men with PE, with effects lasting up to 6 months post-treatment.
  • Strengthening weak PFMs enhances the bulbocavernosus muscle’s ability to delay ejaculation, while relaxing hypertonic muscles reduces involuntary contractions that trigger early ejaculation.
  • Combining PFM training with other therapies (e.g., FST) amplifies outcomes, as noted in a 2022 study in Andrology, which reported synergistic benefits when PFM exercises followed shockwave therapy.

Why It Helps: Pelvic floor training empowers patients to actively improve ejaculation control, building on the physiological improvements from shockwave therapy and the diagnostic insights from the PFP exam.

Synergistic Effect of the Combination

  • Complementary Mechanisms:
    • FST improves blood flow, reduces pelvic inflammation, and enhances nerve function, addressing vascular and neurological contributors to PE.
    • PFP exam identifies specific pelvic floor dysfunctions, ensuring treatments are personalized.
    • PFM training builds long-term muscle control, reinforcing the physiological gains from shockwave therapy.
  • Evidence of Combined Efficacy: A 2023 study in Journal of Sexual Medicine highlighted that multimodal therapies (e.g., shockwave + PFM training) yield better IELT improvements than single modalities, with 70–85% of patients reporting significant symptom relief.
  • Why It’s Effective for Young Men: Men under 30 often have acquired PE due to CPPS, stress, or pelvic floor dysfunction rather than lifelong neurological issues. This makes them ideal candidates for non-invasive treatments targeting these reversible causes.

Expected Outcomes

  • IELT Improvement: Based on studies, patients may see IELT double (e.g., from 40 seconds to 80+ seconds) after 4 shockwave sessions and PFM training, with greater gains possible with extended treatment.
  • Sustained Benefits: PFM training ensures long-term control, while shockwave therapy’s regenerative effects can last months.
  • Patient Satisfaction: Non-invasive, drug-free nature and discreet delivery (private clinic setting) align with younger patients’ preferences, with testimonials indicating high satisfaction (85% improved sexual function).

Limitations and Considerations

  • Response Variability: Some patients may need more than 4 shockwave sessions for optimal results. The package is a starter, with follow-up options available.
  • Compliance: PFM training requires patient commitment. FocusWave can provide digital guides or apps to support adherence.
  • Off-Label Use: FST for PE is not FDA-approved but is supported by growing research and safely used off-label, as per FocusWave’s protocols.

How Shockwave Therapy Works for Peyronie’s Disease

shockwave therapy for peyronie’s

How Shockwave Therapy Works for Peyronie’s Disease in Ottawa & Waterloo

Men over 40 in Ottawa, Waterloo, Kitchener, and Gatineau searching for a non-surgical Peyronie’s disease treatment now have a proven solution: shockwave therapy. At FocusWave Clinic, low-intensity extracorporeal shockwave therapy (LI-ESWT) safely breaks down penile plaque, reduces painful curvature, and often improves erectile function—without surgery or injections.

Understanding Peyronie’s Disease

Peyronie’s disease affects many men over 40, causing penile curvature, pain, and sometimes erectile dysfunction due to scar tissue (plaque) in the penis. For men in Ottawa and Waterloo seeking non-surgical solutions, FocusWave Clinic offers shockwave therapy—a safe, effective treatment to reduce symptoms and improve quality of life.

What Is Shockwave Therapy and How Does It Help?

Shockwave therapy, or low-intensity extracorporeal shockwave therapy (LI-ESWT), uses focused or linear shockwaves (true shockwave!) to break down scar tissue, improve blood flow, and promote tissue regeneration. For Peyronie’s disease, it targets the fibrous plaque causing curvature, reducing pain and improving penile function. Clinical studies show that shockwave therapy can reduce curvature by 20-40% in many cases, often within 6-12 sessions.

The Process at FocusWave Clinic

At our Ottawa and Waterloo clinics, shockwave therapy for Peyronie’s disease is simple and discreet:

  1. Consultation: Our specialists assess your condition and medical history.
  2. Treatment: Each 20 minute session delivers targeted true shockwaves to the affected area, with no downtime.
  3. Results: Most patients notice reduced pain and improved curvature after a few weeks, with optimal results after completing the treatment plan.

Why Choose Shockwave for Peyronie’s?

  • Non-Invasive: Avoids surgery or injections, appealing to men seeking low-risk options.
  • Complementary Benefits: Often improves associated ED, a common issue for Peyronie’s patients.
  • Tailored for You: Our team, including pelvic floor physiotherapists, customizes treatment for men over 40 in Ottawa, Waterloo, and nearby areas like Kitchener and Gatineau.

Who Can Benefit?

Men over 40 with Peyronie’s disease, especially those with painful erections or curvature affecting intimacy, are ideal candidates. If you’re in Ottawa or Waterloo and seeking a discreet, effective solution, shockwave therapy could be the answer.

Start Your Journey to Relief

Peyronie’s disease doesn’t have to define your life. FocusWave Clinic in Ottawa and Waterloo offers advanced shockwave therapy to reduce curvature and restore confidence. Schedule your private consultation today to learn how we can help.

Visit www.focuswaveclinic.com or call 888-558-9283 to book your appointment at our Ottawa or Waterloo clinic.
Take control of your men’s health now.