How do I add sexual health services to my practice?

Start with structured clinical training so you can evaluate and treat the common presentations confidently, then build the practical infrastructure around it: a normalized intake that asks about sexual function, a defined menu of services, clear cash-pay pricing, and compliant marketing. Most clinicians begin with the highest-demand, lowest-overhead offerings — PDE5 management and a structured men's sexual health visit — and add injectable therapy, devices, hormones, and women's sexual medicine as their comfort grows. Empire's sexual dysfunction training is built to take a provider from no formal background to offering these services.

What training is required to offer sexual health services?

Sexual medicine is not a standalone board specialty, so there is no single mandated certification to offer most services. What matters is documented competency: understanding the sexual response cycle, the cardiovascular and hormonal workup, contraindications for PDE5 inhibitors, injection and device technique, and the honest evidence behind emerging treatments like shockwave and PRP. A focused CME course is the fastest, most defensible way to acquire that competency. Empire's CME-accredited sexual dysfunction training, developed by Dr. Betsy Greenleaf, DO, covers the clinical foundation for both men's and women's sexual health.

Who can treat erectile dysfunction?

Erectile dysfunction is managed by licensed prescribers — physicians (MD/DO), nurse practitioners, and physician assistants — working within their state scope of practice and collaborative or supervisory requirements. ED is a common primary-care-level complaint, and most prescribers can evaluate and treat it once trained. Because ED is frequently an early marker of cardiovascular disease, the clinician must also be prepared to screen for and refer underlying conditions, not just write a prescription.

Is a men's or sexual health practice profitable?

Sexual health is largely a cash-pay field with strong, recurring patient demand, which is why many practices add it. Studies estimate roughly 43% of women and 31% of men experience some form of sexual dysfunction, and the broader sexual wellness market has grown substantially. Profitability depends on the specific services, your local market, overhead, and how compliantly you market and price — Empire teaches honest, sustainable service and pricing models rather than promising specific revenue figures.

How do I get started?

The fastest path is to complete structured training, then launch with a small, well-understood menu of services and grow from there. Enroll in Empire Medical Training's sexual dysfunction training to learn the clinical evaluation, the full treatment toolkit, patient communication, and the business and compliance considerations, then build your intake, pricing, and marketing around what you are trained to deliver.

How to Add Sexual Health Services to Your Practice

Creator: Empire Medical Training Editorial Team
Published: 2026-06-05

Written by Empire Medical Training Editorial Team

Medically reviewed by Betsy Greenleaf, DO Board-Certified OB/GYN & Urogynecologist; Empire Director of Anti-Aging

Updated June 2026 ·11 min read

Few areas of medicine are as consistently in demand and as consistently neglected as sexual health. Patients raise these concerns reluctantly, and clinicians, often without training or time, frequently move past them. The result is a large population of men and women living with treatable conditions that meaningfully affect their relationships and quality of life. For a practice willing to address this field competently and respectfully, that gap is both a clinical service and a durable business opportunity.

This guide is written for providers who are considering adding men's and women's sexual health to their practice. It situates the opportunity within Empire's broader sexual health resource center and is intended as practical, business-and-clinical orientation — not medical advice, and not a substitute for structured training in the evaluation and treatment of sexual dysfunction.

The short version: Sexual dysfunction is common, under-reported, and largely cash-pay, with high patient loyalty. Most licensed prescribers can offer these services within their scope once properly trained. The single highest-leverage step is to get trained, because the clinical depth — patient selection, the cardiovascular and hormonal workup, injection and device technique, and honest handling of emerging therapies — is what separates a defensible service from a liability.

Why add sexual health to your practice

The case begins with prevalence. As Dr. Betsy Greenleaf frames it in Empire's training, sexual dysfunction is common across both sexes and all ages: studies estimate that roughly 43% of women and 31% of men experience some form of sexual dysfunction, and those figures are widely considered under-reported because of the embarrassment and stigma that keep patients from raising the subject. Prevalence rises with age and with comorbidities such as diabetes, cardiovascular disease, and metabolic syndrome — exactly the patients already in most practices. Erectile dysfunction alone affects more than half of men between 40 and 70.

The second part of the case is the market. The sexual wellness field has grown substantially over the past decade, driven by greater awareness, an aging population, and a steady stream of new products and treatments. Demand spans both men's sexual health — ED, premature ejaculation, low libido, cosmetic urology — and women's sexual health — low desire, arousal and orgasm concerns, and the genitourinary changes of menopause.

Three features make this field attractive to a practice specifically. First, it is largely cash-pay: many sexual health and cosmetic-urology services are not covered by insurance, which simplifies billing and removes the practice from much of the reimbursement squeeze. Second, it generates high patient loyalty — a patient you help with a sensitive, personal problem in a respectful setting tends to stay, return, and refer. Third, the conditions are frequently recurring rather than one-and-done, which supports an ongoing therapeutic relationship instead of a single transaction. We treat the financial picture honestly in the cost of ED treatment, and in the business section below.

Who can offer it

There is no single board specialty that owns sexual medicine, which is part of why it is so under-served — and part of why it is accessible to a range of clinicians. In practice, these services are offered by physicians (MD/DO), nurse practitioners, and physician assistants working within their state scope of practice and any applicable collaborative or supervisory requirements.

Most of the core services sit at a level that a trained prescriber can deliver: evaluating and managing ED, prescribing and titrating PDE5 inhibitors, teaching device use, performing in-office injection therapy, and managing the hormonal and genitourinary aspects of women's sexual health. What changes the equation is not licensure alone but competency — because so much of sexual dysfunction is the visible symptom of a deeper problem. Dr. Greenleaf's recurring metaphor is to "look at the roots under the leaves of the tree": ED can be the canary in the coal mine for cardiovascular disease, low libido often traces back to stress and the nervous system, and female sexual concerns are frequently rooted in hormones, relationship dynamics, or both. A provider offering these services must be prepared to recognize and route those underlying causes, not merely write a prescription.

Getting trained — the key step

If there is one decision that determines whether adding sexual health succeeds or stalls, it is getting properly trained first. Sexual medicine rewards a clinician who understands the why beneath each treatment: the sexual response cycle and the role of the brain and nervous system, the vascular and neuroendocrine physiology of erection and arousal, the cardiovascular workup that ED demands, the contraindications and drug interactions that make PDE5 prescribing safe, and the realistic, evidence-honest picture of newer modalities. Trying to assemble this piecemeal from product reps and scattered sources is how practices end up over-promising and under-delivering.

Empire Medical Training's sexual dysfunction training, developed and taught by Dr. Betsy Greenleaf, DO — the first board-certified female gynecologist in the United States, double board-certified in OB/GYN and urogynecology, and Empire's Director of Anti-Aging — is built to take a clinician from no formal background in sexual medicine to confidently offering these services. It covers evaluation and diagnosis, the full men's and women's treatment toolkit, patient communication, and the practical considerations of building the service into a real practice. This is the fastest, most defensible path to offering sexual health services, and the course is the product this guide ultimately points to.

Get trained to offer sexual health services

Empire Medical Training's Sexual Dysfunction Training is a CME-accredited program — developed by board-certified OB/GYN and urogynecologist Dr. Betsy Greenleaf, DO — covering the evaluation and treatment of men's and women's sexual dysfunction, the in-office procedural toolkit, patient communication, and how to build the service into your practice. Enroll and start offering sexual health services.

Enroll in the Sexual Dysfunction Training →

The clinical toolkit

Part of the appeal of sexual health is the breadth of treatments a trained provider can offer, from simple oral therapy to in-office procedures. The overview below is intentionally high level; the patient selection, dosing, technique, and protocols behind each one are taught in clinical depth in Empire's course rather than reproduced here.

Men's sexual health

PDE5 inhibitors — sildenafil, tadalafil, vardenafil, and avanafil are the FDA-approved first-line oral therapy for ED, working by preventing the breakdown of cyclic GMP so that nitric oxide–mediated vasodilation can produce and sustain an erection. They are the foundation of most men's sexual health offerings.
Injections and devices — intracavernosal therapy (for example, alprostadil and compounded combinations such as bi-mix, tri-mix, and quad-mix) is highly effective for men who do not respond to oral agents, and vacuum erection devices and constriction rings offer non-pharmacologic options. These are in-office, procedural skills that benefit most from hands-on training.
Shockwave therapy — low-intensity shockwave aims to improve penile blood flow through angiogenesis and tissue remodeling. It is emerging: the evidence is mixed and the optimal protocol is still being researched, and the Sexual Medicine Society of North America recommends it be used under research protocols. Provider claims must reflect that.
PRP for sexual health — platelet-rich plasma is offered for both men and women, but the clinical evidence remains limited and mixed, with at least one randomized trial showing no significant benefit over placebo. It should be discussed and marketed with appropriate caution.

Women's sexual health

Female sexual medicine — low desire, arousal and orgasm disorders, and the genitourinary syndrome of menopause (vaginal dryness, irritation, painful intercourse) are common and treatable. Options range from FDA-approved agents for premenopausal low desire to vaginal estrogen, DHEA, and testosterone for genitourinary symptoms, alongside lubricants, moisturizers, and energy-based devices.
Hormones and sexual function — testosterone in men and estrogen, DHEA, and testosterone in women all influence libido and tissue health, but, as Dr. Greenleaf emphasizes, hormones are "a tool, not the answer": if the underlying stress and nervous-system drivers go unaddressed, hormones alone will disappoint. This connects naturally to Empire's hormone replacement therapy cluster.

For libido and arousal specifically, the melanocortin peptide PT-141 (bremelanotide) acts centrally on desire in both men and women — a useful cross-reference for practices that also offer peptide therapy.

Creating the comfortable conversation

None of the toolkit matters if patients never raise the problem — and most will not, unprompted. Dr. Greenleaf identifies building rapport and a comfortable environment as the first step in evaluating sexual dysfunction: establish a trusting, non-judgmental atmosphere, assure confidentiality and privacy, and treat the topic as the legitimate medical issue it is. The practical move is to normalize the subject by asking routinely, rather than waiting for the patient to volunteer it.

That starts with intake. Adding a brief, matter-of-fact question about sexual function to your standard history signals that this is a normal part of care, and validated questionnaires — the International Index of Erectile Function for men and the Female Sexual Function Index for women — give you a structured, non-awkward way to assess severity and track response over time. A respectful, systematic intake does more to build a sexual health practice than any single procedure, because it surfaces the demand that is already sitting silently in your patient panel.

Service and pricing models

Because most sexual health services are cash-pay, you set the model — and a clear, transparent one builds trust in a sensitive field. Most practices structure offerings into a few recognizable tiers: an evaluation visit (history, exam, questionnaires, and labs where indicated); oral therapy management for PDE5 inhibitors; in-office procedures such as injection therapy, device training, or shockwave; and membership or program models that bundle follow-up and supplies for recurring needs.

On pricing, the honest guidance is to anchor to your local market, your true overhead, and the time and skill each service requires, then publish ranges plainly. Sexual wellness is a field where patients are wary of being upsold, so transparent pricing is itself a competitive advantage. We walk through the real-world ranges and the cash-pay economics in the cost of ED treatment; Empire's course covers how to assemble these into sustainable service and pricing models without over-promising.

Compliance and marketing

Sexual health marketing lives or dies on the accuracy of its claims. The treatments most likely to draw regulatory and reputational trouble are precisely the emerging ones — shockwave therapy and PRP among them — where the evidence is still limited or mixed. Marketing copy that promises guaranteed results, presents investigational treatments as proven, or implies FDA endorsement that does not exist is both an ethical and a compliance problem.

The discipline is straightforward: distinguish clearly between FDA-approved, off-label, and investigational treatments in everything you publish; describe emerging therapies in measured terms that match the literature; and let the strength of a respectful, competent service do the persuading rather than inflated promises. The same evidence-honesty that protects patients also protects the practice — and it is the standard Dr. Greenleaf models throughout the training.

The business case

Put the pieces together and the business logic is clear without resorting to invented numbers. Sexual health combines large, under-served, recurring demand with a cash-pay model that sidesteps insurance friction, and it earns unusually high patient loyalty because of the personal nature of the care. Many of the services layer onto infrastructure a practice already has — exam rooms, a prescriber, basic procedural capability — which keeps incremental overhead modest relative to the demand.

What this guide will not do is promise a specific dollar figure. Real outcomes depend on your services, your market, your overhead, and how compliantly you price and market. The reliable lever is competence: a provider who is genuinely trained to evaluate and treat the full range of presentations, who normalizes the conversation, and who markets honestly will convert the silent demand already in their patient population into a respected, sustainable line of service. The honest, defensible way to get there is to start with the training.

Training and getting started

Adding sexual health is best approached as a clinical capability you build, not a kit you buy. Get trained in the evaluation and the full treatment toolkit, then launch with a focused menu — typically a structured sexual health evaluation and PDE5 management — and expand into injections, devices, hormones, and women's sexual medicine as your confidence grows. Build your intake, pricing, and marketing around exactly what you are trained to deliver, and keep your claims tethered to the evidence.

Empire Medical Training's sexual dysfunction training is designed to give you all of that in one CME-accredited program, taught by a board-certified physician who has built this into real practice. It is the fastest, most credible path from "I'd like to offer this" to actually offering it.