R. Brian Denton Receives 2024 SMSNA Sexual Health Tipping Point Award
January 09, 2025
Innovations in Urology | Winter 2025
Every year, the Sexual Medicine Society of North America (SMSNA) recognizes a mental health professional who demonstrates exemplary work in the field of sexual medicine.

In 2024, University Hospital R. Brian Denton, PsyD, received the award for his work — in collaboration with his colleague, Nannan Thirumavalavan, MD — helping men adjust to a new normal of sexual arousal and functioning following the implant of a penile prosthetic. Dr. Denton is a clinical psychologist at University Hospitals Urology Institute and UH Cutler Center for Men. Dr. Thirumavalavan is a board-certified urologist at UH who performs penile prosthetic implants.
Dr. Denton says that although membership in SMSNA is primarily physician dominated, it includes mental health experts like him, and Michael Perlman, PhD, a sex therapist and elected Fellow of SMSNA. Dr. Perlman developed the Sexual Tipping Point Model and determines the award winner. Dr. Denton’s abstract about sexual challenges following penile implants earned him this year’s award.
“After a penile implant, patients have to navigate the changes that go along with that procedure,” Dr. Denton says. “I help men — alone or with their partner — address the psychological impacts and offer some pragmatic ways of navigating new ways of experiencing arousal and sexual functioning.”
Penile prosthetics are an option for some men who are experiencing erectile dysfunction (ED) as a result of conditions such as prostate cancer, heart disease or diabetes, and who have side effects or a lack of satisfactory results with other treatment modalities. According to the National Institute of Diabetes and Digestive and Kidney Disease, ED affects about 30 million men in the U.S., although it is not considered a normal part of aging.
Patient Satisfaction
Men who opt for a penile implant report generally high rates of satisfaction.
“When patients are dissatisfied, it’s more about not having realistic expectations about what the sexual experience will look like after the implant,” Dr. Denton says. “These men also fear that their partners will not be satisfied. We have to address the relational part as well as the physiological aspects of this change.”
Sexual Coaching and Therapy
“I often use the Sexual Tipping Point Model with patients,” Dr. Denton says. “It offers a nice balance of recognizing that even though the intervention affects a man’s physiology, it’s also important to address the psychological factors that go into a rewarding sexual experience following a prosthesis. It helps men see themselves as a more rounded individual rather than just a mechanical part that’s supposed to work.”
Dr. Denton also employs an extended version of the PLISSIT Model for sexual functioning. PLISSIT is a permission-based model that helps clinicians introduce sexual functioning into patient care.
“Each letter in PLISSIT is a part of the work,” Dr. Denton says. “P stands for permission giving. It recognizes that each individual has their own unique experience and views sexuality as different from what it used to be prior to the prosthetic. We ask patients to give themselves permission to let it be different.”
LI stands for limited information. It helps clinicians collect information regarding patients’ sexual functioning and the myths and messaging they have received that told them how sex was “supposed” to be. “This part of the model is a coaching process,’ Dr. Denton says. “I provide more sex-positive or medically accurate information.”
SS stands for specific suggestions: What’s interfering in sexual satisfaction, and what specific things can a couple do to try to mitigate the interference? Dr. Denton says that for some patients, this can be as simple as changing positions, adding lubrication or incorporating toys, for example.
Finally, IT represents intensive therapy. This part of the model is helpful for patients with internal struggles as a result of trauma or past experiences and may include more psychological interventions, such as anxiety management. “For some individuals, a few tips and suggestions do the trick,” Dr. Denton says. “Others need more extensive therapy. I treat patients on a case-by-case basis.”
Improving Men’s Sexual Health
Dr. Denton encourages all physicians to include routine questions about sexual health when making assessments. He says clinicians generally assume that if there’s a problem, patients will bring it up, but often this doesn’t happen when it comes to sex.
It’s important to keep in mind that sexual health also includes an important mental health component, and addressing these concerns and referring patients to the appropriate providers could help men deal with issues they may not otherwise bring up with their health care providers.
For more information about the psychological aspects of men's sexual health, contact Dr. Denton at 440-446-8627.
Contributing Expert:
R. Brian Denton, PsyD
Clinical psychologist
University Hospitals Urology Institute
University Hospitals Cutler Center for Men