Ask Dr. Drew - What Causes Sexual Dysfunction? Urologist Dr. Ashley Tapscott Has Answers – Ask Dr. Drew – Episode 88

Episode Date: May 13, 2022

Dr. Ashley Tapscott is an established expert in the field of sexual dysfunction. She is a board-certified urologist and fellowship-trained in male and female sexual dysfunction. Along with her work in general urology, Dr. Tapscott’s subspecialty interests have been nationally recognized at many urologic and sexual medicine society meetings. She frequently hosts patient education seminars and lectures to urologists and primary care physicians concerning the treatment of erectile dysfunction, Peyronie’s disease, and other sexual and urologic conditions. [This podcast was originally broadcast on April 7, 2022] Ask Dr. Drew is produced by Kaleb Nation ( https://kalebnation.com) and Susan Pinsky (https://twitter.com/FirstLadyOfLove). GEAR PROVIDED BY • BLUE MICS – After more than 30 years in broadcasting, Dr. Drew’s iconic voice has reached pristine clarity through Blue Microphones. But you don’t need a fancy studio to sound great with Blue’s lineup: ranging from high-quality USB mics like the Yeti, to studio-grade XLR mics like Dr. Drew’s Blueberry. Find your best sound at https://drdrew.com/blue  • ELGATO – Every week, Dr. Drew broadcasts live shows from his home studio under soft, clean lighting from Elgato’s Key Lights. From the control room, the producers manage Dr. Drew’s streams with a Stream Deck XL, and ingest HD video with a Camlink 4K. Add a professional touch to your streams or Zoom calls with Elgato. See how Elgato’s lights transformed Dr. Drew’s set: https://drdrew.com/sponsors/elgato/  THE SHOW: For over 30 years, Dr. Drew Pinsky has taken calls from all corners of the globe, answering thousands of questions from teens and young adults. To millions, he is a beacon of truth, integrity, fairness, and common sense. Now, after decades of hosting Loveline and multiple hit TV shows – including Celebrity Rehab, Teen Mom OG, Lifechangers, and more – Dr. Drew is opening his phone lines to the world by streaming LIVE from his home studio in California. On Ask Dr. Drew, no question is too extreme or embarrassing because the Dr. has heard it all. Don’t hold in your deepest, darkest questions any longer. Ask Dr. Drew and get real answers today. This show is not a substitute for medical advice, diagnosis, or treatment. All information exchanged during participation in this program, including interactions with DrDrew.com and any affiliated websites, are intended for educational and/or entertainment purposes only. Learn more about your ad choices. Visit megaphone.fm/adchoices

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please contact Connex Ontario at 1-866-531-2600 to speak to an advisor free of charge. BetMGM operates pursuant to an operating agreement with iGaming Ontario. Dr. Hapscott, I will give you, she is a urologist, and she and I actually are both paid spokespersons for Petros Pharmaceutical, and we share a common passion for men's health, also treatment of sexual dysfunction and associated therapies. And we'll be talking about all things men and urological today, something that often comes up on your mom's house.

I'm not so in control of the content of that show, but I am with this one. So I thought, given all the questions we've had over there, I'm going to get them responded to and answered by a real expert. Our laws as it pertains to substances are draconian and bizarre. A psychopath started this. He was an alcoholic because of social media and pornography, PTSD, love addiction, fentanyl and heroin. Ridiculous. I'm a doctor for f***ing sake.

Where the hell do you think I learned that? I'm just saying, you go to treatment before you kill people. I am a clinician. I observe things about these chemicals. Let's just deal with what's real. We used to get these calls on Loveline all the time. Educate adolescents and to prevent and to treat. You have trouble, you can't stop,

and you want help stopping, I can help. I got a lot to say. I got a lot more to say. Let's bring in Dr. Ashley Tapscott. Hey there, everyone. Good evening. Good evening. Thank you for being with us from near Charlotte, North Carolina, right?

You got it. Right outside of Charlotte, Huntersville, North Carolina. So tell us a little bit about how you got into this field. It's interesting. People always ask me, you know, how people get into their various specialties and subspecialties. What attracted you to urology? So I grew up the granddaughter of a pediatrician and really was involved in medicine early on, even in high school one of my mentors dr mitchell goldman i worked in high school at university of tennessee medical center between trauma and then you may have heard of the body farm which has spurned a lot of kind of fiction and non-fiction novels uh in terms of looking at forensic anthropology so i thought i

wanted to be kind of forensic anthropologist which is really all the crime scene shows we see now. I thought maybe, you know, growing up 2 and 4 a.m. getting called out for murders and things maybe wasn't the best dinner conversation. So then I looked into the world of surgery and urologists were kind of the funniest and the happiest surgeons that I knew. I worked with one for a short period of time during my medical school rotations and then really just fell in love with the intimacy and the long-term relationships that I could have with patients. Ended up training in Philadelphia, thought I wanted to be a real bad mama-jama prostate cancer surgeon. But once I started doing that, I looked at the impact of loss of erectile function, incontinence on the patient and their partners, and really felt a move towards that and a passion towards that expertise because there really weren't that many people. And that's how I ended up kind of where I am today. Very interesting. You'd be amazed how many times

when I ask our peers why they selected their discipline, they will say something on the order of, those guys were just nice. I liked hanging out with those guys. And especially, I would tell you, especially urology, almost every urologist, when I asked, they go, you know, they were the coolest group. They were joking. They seemed to be the happiest. The anatomy was kind of interesting and they were really helping people. Isn't that funny? It's funny. I think it's a unique personality. And I usually say I've never met a urologist that I didn't like. So I think that we have good jokes about it at dinner parties. And what's weird is people will say, like, I really didn't want to talk about that, but you brought it up, so I'll talk about it. They're saving it up for you. And then you sort of rushed past the forensic anthropological body farms.

People don't know what that is. I actually talked to the guy that you must have worked for, the founder. I did an interview with him. Susan, maybe we could figure out where that podcast is. It was one with Bruce. Dr. Bill Bass. Bob. Yeah.

And that is where they essentially bury bodies in the ground and study their rates of decay. That was Weekly Infusion. Yeah, it was with Bruce. Bruce. If you find out, is that still on the website? Caleb, is Weekly Infusion still up on the website? Yes, they're all still there, definitely.

Yeah, you can find it on Apple. iTunes. Apple iTunes. All right. It was wild talking to him about how he started his career and how deeply involved it all got. I mean, based on the insects and the soil and the decay and the bacteria they're growing, there's so many different criteria.

What funguses. Yeah. Yeah. Oh, my God. It's wild what they do there. So that was interesting. You vaporize superglue and you find out a lot of things. That's right.

That's interesting. Jesus. All right. And then so you now i'm by the way grateful for my prostate surgeon it's funny i sat down with him he did the robot he does the robotic uh you know the radical prostatectomies and i said you know all right we got to do this what's the complication rate he goes well i've done about 1100 and so far zero complications have that okay thought, okay, I'm in.

No significant complications. Let's go. And I found it to be so. It was a pretty slick operation, a big operation. And you're five hours on the table. And you're not the same afterwards, but it's fine. Everything's fine, which is amazing. But for those that do get into various kinds of trouble, you and I, I don't know where to start this conversation. In other words, you really take men all the way through the therapeutics if they do have erectile dysfunction after something like prostate surgery or just aging or diabetes or vascular disease.

Let's review again how erections happen and what that biology is. Absolutely. So basically, when we talk about erectile dysfunction, and again, you and I will separate psychogenic erectile dysfunction. So we talk about things that involve the brain or brain chemistry or perhaps side effects of medications or substance abuse. So substance abuse and medications can affect the brain, which is part of the trigger for men's erectile health. We're just going to talk about men here. When you talk about erections, really it's a filling or a storage problem. So you either can't get blood into the arteries, which dilate. And by the way, as we discussed on our discussion the other day, Tuesday, you know, really, you know,

these arteries are about four to six times smaller than the big ones in your heart. So if you've had any heart surgery, stents, cardiac disease, elevated coronary calcium score, these things are going to affect the smaller blood vessels in the penis. So these vessels may not be able to dilate. As an addition, aside from those vessels dilating, which we know nitrous oxide, okay, some people call it laughing gas, maybe in the dental office, nitrous oxide okay some people caught laughing gas maybe in the dental office nitrous oxide pushes blood flow into the penis once it gets in there you have valves okay or veins that have to shut like trap doors that secure the blood in the penis so the erectile function is a stimulation okay which occurs from the outside a partner yourself you, pornographic material, et cetera,

stimulates arteries dilating, pushing blood into the penis, and then the valves or the doors have to close and trap blood in the penis for a successful response. In the nitric oxide pathway, these are arteries that dilate and uncoil. They're very specialized arteries to put a bunch of fluid into the cavernous body in the middle there. That's actually what swells up, right? And when you guys put implants, where do you put those implants? Yeah, so there's a couple. So we put them directly in the two kind

of rocket boosters or the erectile chambers of the penis. So there are really three chambers. Yeah, the spongiosum. So there are the corpora cavernosa. There are two erectile chambers of the penis. So there are really three chambers. Yeah, the spongiosum. So there are the corpora cavernosum. There are two erectile chambers. So you have the corpora cavernosum, which are the two erectile chambers, what I call rocket boosters. Below that is what we call the urethra, which is the urinary tube, carries urine from the bladder out to the tip of the penis. That's got a little bit of spongiosum or erectile tissue around it as well. And so the implant basically goes inside the erectile tissues, the two rocket boosters of the penis, from the pelvic bone out towards hopefully the mid-tip or the head of the penis, the glands we call it.

And that is what basically allows us kind of two ballast tanks, if you will, on a ship or two water balloons that inflate that mimic the natural erectile tissue i'm going to bring susan in on this susan do you have any discomfort as a as a female partner do you feel any would you be any weirded out if i suddenly had to get an implant prepare she's taking water before she answers that well me me me me would i i mean would i i wouldn't have a choice right well i mean what i'm what i'm what i'm gonna give dr taps got a chance to do is one of the things she has to do is prepare the female partner as well as the male patient yeah for these things and so

i'm wondering how since you're here always ask me these tough questions? I mean. You can ask me tough questions. It's all right. Oh, God. So what questions would you have for Dr. Tapscott? What would I have? Yeah, what questions would you have for her? Because I'm not the female partner. If you couldn't be, if you had to use a penile implant.

Yeah. And we were going for the surgical consult. And we were going to go get these things put in. Well, first thing I would say, Dr. Tapscott, how happier than- I mean, you know I'm not a medical person, so I would just have to do whatever you said to do. Well, the fact that you get the willies from this- No, I don't have the willies. It's just, I mean, how do you answer that without sounding like a jerk? Like, whatever. I don't know.

I mean, I would say, Dr. Tapscott, how do, on average, how do the male patients and the female partners feel once someone has put one of these things in? Right. So again, I'll have a two-prong answer to that question. Number one is clinical. Number two is real life. So clinically, 98% of men have clinical satisfaction with their penile implants and 96% of their female partners. Again, you know, a lot of the literature and the examination

and clinical studies on partners is heterosexual. So if there are any of our, you know, homosexual, trans or lesbian partners listening, please understand the scientific data is not slided towards you. That's just historically how it's been. And so certainly I have lots of homosexual males in my practice and there is data directed towards them as well when we talk about penile implants. So really it's a 98% patient and 96% partner satisfaction. And I think one of the things that I talk about is really, it's really a couple's disease. And I think there's a lot of psychogenic, a lot of intimacy, anxiety, and angst around this. Look, scheduled sex is not sexy. You want to take a pill, you want to time it, maybe you've had a glass of wine. Most of these things happen on date night. A lot of the medications are faulted by the

metabolism of food and alcohol. And so I think we really have to have an honest discussion about patients with what is your schedule so my patients have their partners out of town and so they maybe have a 36 hour window some of my patients have partners that are maybe on cancer chemotherapy treatments and they have pain as well so I really involved the partner I think uniquely heterosexual or other couples me as a woman providing that expertise, you know, I welcome partners in my office because you know what? You're 50% of the equation.

And if you're sitting out in the lobby reading- I would definitely want to meet with her in the doctor's office if it was- Of course. I had the same situation when you had prostate cancer. I had to meet with the urologist. As you should. And thank you for being there. Because that is enormous.

Yeah, the first one. The first one. But I didn't like the guy because he giggled when I asked him questions about sex. So I was like, what's wrong with this guy? But I had, I mean, they had given me a book that said, you know, you had to start having sexual relationships with your husband, like in the operating, like right after the operation, I was just a horrible book that I had to read. And I was like, how soon do I have to like start doing this? And, and we ended up changing doctors, but I, and I, and I asked the second doctor the same question. I go, do I have to like get right

on top of it, like right away to get things working again? And, and he said, give it about a month. But the book said I had to like show up in the, in the, in the recovery room. And I got time for you to turn over all the cards. I wrote that book. I'm sorry. I wrote it. I made it look like it was an official document. I'm sorry. I'm sorry. It was you. I read the whole thing, though. I was very concerned. That's where she got this thing in her head that tomatoes were bad or something. Wasn't that something?

You know what? It was such a weird book. But I think Drew was more concerned with whether or not he would be able to perform for me after the fact if it went wrong how that would affect me and what you know i had to wait a month to have sex too so we had to like try other things you know use toys and stuff but i but i was like gung-ho to like be on a schedule and make sure that you know we got things moving again. And it worked, thank God. But if it hadn't, I wouldn't, I would try, if you could still have pleasure even without it,

I would try to, I would make sure that you did. But Dr. Tapscott has these devices that they can put in. Right, no, I get it. But you asked me before, you kind of threw me because I'm always the person that has to ask the answer to the sex questions. And I always get myself in trouble because the men out there are like, oh, God, she can't be talking about this. Ashley's got you covered. She's got you covered. So I'm going to let you take it from here.

No, no, no, no. No, no, we are not done with you. Oh, no. So my question, so we come in. I really want to sort of recreate this. So we come in and Dr. I don't know if you heard what she said. She said, well, that Mrs.

Pinsky, the men are 98% satisfied. The women are 96% satisfied. So it really is something everyone's happy with. What would your next question be, Mrs. Pinsky? How does it work? Okay. Show us the device.

You have any devices on hand? Well, I mean, I might just. Just so happens. Just so happens, yes. Listen, I'm a prepared girl, all right? I wasn't accepted into Girl Scouts, but I got you here. So here's how we go.

So the, the penile implant, well, you should know, has been around since 1973. Okay, and there have been several iterations of the device, several companies. But as we have it now in the United States, FDA approved, there are two main companies. Okay.

And I kind of loosely describe them as Coke and Pepsi because I think that we're lucky to have two devices, et cetera. When we talk about the penile implant chambers, okay, and I'm going to show, and sometimes I'll be honest, I don't show this device all the time in the office because some people aren't quite ready for it okay so i want to be respectful about fear and materials if susan are you ready for it you're ready miss susan i i would probably be that person but she's ready now yeah i'm good because you're good what a peacemaker looks like before it goes in but it saves your your heart. Okay. So, so, you know, I think you really have to be honest about this. So these are your two erectile chambers. Okay. And again, this is a custom link in the operating room. I know everybody

wants to measure themselves. You know, nobody's out there measuring the inside of vaginas. We talk about heterosexual sex and I love that everybody thinks that they're eight or nine inches and that is fantastic. But when you've had surgery, diabetes, non-use of your penis, it is a muscle and it will atrophy. If you don't use it, you will lose it. So if you come to see me in the office, what I tell you is I can appreciate where you are and I'm not going to take out a ruler today, which by the way, a lot of people's home rulers are different than my medical rulers, which I find is interesting because i thought it's a metric that exists everywhere but for some reason everybody has different rulers right so someone's seven inches at home

and i'm being very honest and and what i but my job is to preserve the penis i am the national penis preservation society that's what i do um but basically these are two inflatable cylinders that go inside the penis now what i will show you this end goes back against the pelvic bone which is where the penis ends okay and this these ends okay which are all ergonomically designed okay go to the tip of the penis now every tip of the penis is not the same. So I always describe it as a gumdrop on a pretzel rod. Okay. So the head of the penis is stensate erectile tissue. It is actually embryonically, okay, or in development, guys and girls, embryonically, similar to the clitoris. So the clitoris of the woman is similar in embryonic development to the glands of the penis.

So these go somewhere in the erectile tissue, wherever that glands in. Some people it's at the very tip. Some people it's in the middle. Okay. That's anatomy. I don't make the rules. It's signed. Okay. So these are two inflatable cylinders that go in your penis. This is your remote control. Now, yes, I get asked, do we have an app can i time it to music bluetooth lights we don't want your garage door opening thinking the neighbors can come home when you want to use your peanut oil implant okay so we're not there yet all right but this is a pump okay and this is how you operate i don't hear your mic susie mic's off no i can't yeah she's like i'm picturing your mic is right now lot. I like her.

Oh, good. I like you too. So this is the reservoir that holds the fluid. Now, the fluid that is in these implants is IV saline. So what do we know about implants? We think about breast implants, okay? There are a bazillion more breast implants performed a year as opposed to maybe 30 or 40,000 in the United States, penile implants per year, okay? This is IV saline.

It's the same thing we put in your veins if you were sick, if you were in the United States, penile implants per year. Okay. This is IV saline. It's the same thing we put in your veins if you were sick, if you were in the hospital. So if this system were to ever disconnect, the fluid is just absorbed by your body. It is not dangerous. This goes in a little place where you never see or feel usually next to your bladder over your pelvic bone. And that's magic that we perform. So you don't need to worry about that. The only thing you need to worry about is this little pump. Okay. And when you want to have an erection all you do is a like a third testicle in the scrotum and actually oh please i have a model here okay this would be a gentleman with an implant so where i make my incision is usually right here in a natural skin line in the middle of

the scrotum this takes me 45 minutes or less, maybe half an hour, just depends. Okay. And when I make this incision here, it's a natural skin line. So if you want to be a naked model, after you have your penile implant, you can certainly do that. Okay. And then the pump is sits in the scrotum, like a third testicle. Whenever you want to have an erection, all you do is simply squeeze the internal pump. And this may squeak because I tried to fill it today it's got a little bit of air in it you will not squeak i promise if you do then we gotta work on time but once it inflates it's fully hard okay and by the way you like the squeaking

you like this well listen i'll tell you one of my patients the other day i have some funny funny she took the i joked about the squeaking. She took the squeaker out of a dog toy and brought it to the office and hit it in her first time I activated her husband's implant. That's funny. That's going in my book. So anyway, the penile implant device is fully inflated. By the way, it does not go down until you hit this little button on the side.

So if there's a climax gap between you and your partner, if they have an orgasm, come. I don't like the word come. I like the word orgasm. If they have an orgasm, climax of sensation, your penis does not go down until you tell it to. So there's a little button on the side here. You hit that.

Penis goes nice and soft. The pizza guy comes to the door. Your delivery service, they interrupt your coitus. You go to the door. You answer. You come right back, you can pump it right back up. There is no limit on how long or how much you can use it. And the male has the same orgasmic function. This is all just erectile dysfunction. Absolutely.

It does not change orgasm, sensation, urination, ejaculation now if you've had your prostate removed or perhaps procedures for your prostate your ejaculation may be changed but overall the implant itself is just a new hydraulic system for the penis so it reminded of after dark they're always getting confused where semen comes from and that is from the prostate not from the testicles Susan any more questions you feel more comfortable about this now yeah remember. Remember this story about, yeah, I was just thinking about when she was saying saline and how women, when they get their boobs done, they always have to show them. And then the reason why we switched doctor was that somebody was, one of my friends was a nutritionist and the guy was a lawyer and he came in and he was all mad because he had

a bad prosectomy and he had a penile pump and he said, look, and he opened up his pants and he came in and he was all mad because he had a bad prosectomy and he had to, he had a penile pump and he said, look, and he opened up his pants and he showed her and she was like, dude, I'm your nutritionist. I don't need to see that right now. But I wonder if men are kind of like,

I have a lot of patients that like, I don't really want to tell anybody about this. Then all of a sudden it says, Dr. T can I, can I talk to other patients about this? So what I think one thing that may have been helpful, thankful that you all have not had to go down this route as a couple and as cancer survivors together. But basically, you know, I have patients from any age range of 40s, 50s, 60s, 70s, 80s that have had the implant due to various conditions that they and their partner are willing to talk to my patients about it.

And I think that duplicates an experience that I could never offer. And so, you know, whether, and I said, look, even if you don't want the implant, that's okay, but listen to this couple's journey and maybe it will direct you in some fashion. And so I'm, I'm very fortunate to have those patients. Uh, I'm just looking at some of the comments here. Review very quickly before I get into these other topics I want to address. We're talking about erectile dysfunction. Susan, first of all, any more questions? Are you satisfied with the procedure?

I go to surgery now. No more questions for Dr. Tuck? You don't need it. I know. I'm lucky. We're pretending. But if you did, I would be supportive. Okay.

We're just playing patient. I know how much it means to you. It does. Men are all about the penis. We talked the other day. I've never seen a woman wake up from surgery grabbing her genitalia or her chest. And men all the time. And of course, I've been in cancer.

I tortured them a little bit, unfortunately. But they always are very concerned about down there. And that's a native thing that goes way back to evolution that we can't change. And you need to explain something about like people who have cancer, I guess, like say you have prostate cancer and you have to have chemo and radiation. They have to take all your testosterone out, right? Yeah, we'll talk about that in a second. So, yeah, it's a big deal and and um i can see how that would you know really affect a man's you need to find something like this literally some men with

on androgen deprivation taking out the testosterone as you say i've seen them develop dementia all of a sudden like rapidly progressive dementias i mean men need testosterone it's an important part well you can yeah but you if you have a choice you want to live or you want to, you know. Well, there, I, all right, we're getting into complicated territory. There isn't choice because there's all kinds of treatment options now. Thank God, thanks to the Prostate Cancer Foundation, which I'm a part of, pcf.org, if you want to know more about that. Lots of treatment options for prostate cancer and more coming rapidly. I mean, very, very quickly evolving field. Prostate cancer, which used to be the sleepy field,

has now become one of the leading research sort of disease-specific entities out there. So it's kind of extraordinary. But you guys screwed me up. Okay, so let's just walk through. Sorry. No, no, no. It's all good. I went dark on you.

It's all good. So the point is, I wanted us to pretend what it was like to have a couple come in and deal with this thing. Cause I've never seen that anywhere. I've never seen anybody address that. And I've seen, I figured Dr. Tapscott was exactly the right person to play doctor in this particular situation. Yeah. Sorry. Sorry. I was a dud at the beginning. No, no, you were good. Um, but any last questions? That's how you start. That's how everyone is very afraid. They don't want, they say, you know what? My husband has already been through so much. I don't want him to do something just for me.

We have so many things going in our life. I don't want him to enter into a surgery or another procedure, you know, where he could hurt himself and not be around for our families. That doesn't sound like my wife. That doesn't sound like Susan. Susan would be like, yeah, for me, you can do this. So what is, how long, how long is the surgery and what's the recovery time? Is it pretty simple? Like, you know, breast implants are pretty straightforward. I'd say breast implants are probably a lesser procedure, a more, more intense procedure rather. Go ahead. It depends. I mean, breast implants, I think,

are a little more, and again, I'm not a plastic surgeon, but, you know, breast implants are a little more superficial. So I think, you know, we're really kind of going into vascular tissue here. So I think it depends on your surgeon. My procedures in general, I always talk to my patients, usually less than an hour, usually less than 45 minutes. In outpatient procedure, I see them in the office the next day and take a drain out. But there are always different nuances to everyone. So I think the bottom line is, I think if you want to talk about prosthetic surgeons, okay, so let's talk about not every

plastic surgeon does a lot of breast augmentation. Not every urologist, in fact, very few urologists do a lot of penile implants. It is a very specific prosthetic field. So you need to find someone that does a lot. And I don't mean I do 10 a year. You want someone that does several per year. This year, I'm hoping to do certainly well over 100. That is very unique. And I think that certainly the training that I've pursued and the colleagues and my mentorship that I've had echoes that. And I think, look, you're only as good as your best last outcome.

And I care about all my patients individually. So you really want to go to a high volume prosthetic surgeon. And so let's just walk through treatment of rectal dysfunction. Again, like something like 60 plus percent of men will experience this or experiencing it right now, I think, if you take in all ages. So very, very common. And we have lots of good medication for this now. As you mentioned, diet and, you know, timing and all these are really the issues of those medications, whether you're on empty stomach, full stomach, how long before, how long it lasts, the pharmacology

of these things. And after the medication, then it's the pump devices, correct? Correct. Well, there's four certain devices. So again, I think if we want to educate anyone about anything, look at the percentages of age, 40% of men, 40 and over have ED, erectile dysfunction, 50 over 50, 60 over 60. So that is the number with the decade. It's not because you're getting older. It's because whatever disease state you had at the beginning is progressing. And those arteries and veins are not able to recover. I can't do a penile transplant.

Now we have those in the country for certain very specific conditions, usually very, very young. It's microvascular surgery. I cannot stent your penile arteries. If you've had a heart stent, those vessels are four to six times bigger than the ones in your penis. And I can't change the ones in your penis. So the four treatment options are number one. And again, the American Neurologic Association has actually put all of these on a level playing field. So one thing which, you know, your wife Susan, you know, alluded to is like, well, we'll consider that if we need it, which is totally understandable in terms of penile implant. But the American Neurologic Association now says all of these should be put on a level playing field. It doesn't mean one comes before the other, but certainly the most conservative measures first. So number one, a vacuum erection device. So I have an example here. Okay. And there

are different kinds that you can have. You can get them on the internet. You can get them at his and her stores. I prefer a medical grade device because I do believe that they are scientifically studied. A lot of them are covered by insurance from your urologist or your primary care office. Unfortunately, Medicare does not cover these anymore, but I do have an affordable source, which maybe I can speak with Dr. Drew later on how to help patients get a quality device at a low price. Okay. I don't want you to spend more for a date night than you're spending on your erections when you get home. Then it's just a lose-lose situation. So the vacuum erection device is a suction cup for the penis you

put your penis inside here a veno-occlusive band or ring i hate the term cock ring but that's what we have in our society today it has to maintain the device because it is um second of all that might violate youtube stuff caleb i'm not sure but uh worries me me. But keep going. I'll let Kayla be the monitor of all that. No problem. Vano-occlusive band. And then we have the oral medications. There are four separate brands of oral medications. Some of them are generic at this time.

And I would encourage patients, the most cost-effective measure is a good RX card at this time. Certainly, that helps bring down the price generic, certainly. And they all work differently as we discuss food alcohol absorption time of onset time of length and we can go through those individually at some time if people want to the third option is an intra capillosal injection which is an injection into the penile tissue so through your skin directly into the penile tissue it dilates the arteries. However, if you have those leaky valves that we talked about, the injections may not be successful for

you. And we have to use a combination of a band and the injections together. And then again, the fourth option is the penile implant, which I call a permanent solution, which is a consistent and reliable for your erectile dysfunction. I heard about those injections. Remember? Yeah. I was like, oh, God. You didn't like that.

Yeah, but you could do it. Yeah. Yeah, but Drew's great with needles. He's the best with needles, and he was doing it to himself. The thought of it would just make me cringe a little bit. But you wouldn't be aware. I mean, I agree. No, I know. If I knew you, you'd do a great job.

Hey, well, one of the things I wondered about, I've often wondered about. I always thought that would eventually, because if guys are doing that a few times a week, you're going to get, aren't you going to get some scarring at the base of the penis? That's correct. So usually you can get some scar tissues, but much like, let's talk about another very common injectile therapy that Americans are familiar with, which is maybe diabetes therapy. So under the skin, injections of insulin or an insulin-like product. So certainly into the penis, that tissue is not just under the skin, it's a vascular tissue. So sometimes it can be

unforgiving. So a lot of Americans can develop something called, or patients, not non-Americans, can develop something called Peyronie's disease, which is scar tissue that's around the lining of the penis, either due to trauma from intercourse, you know, low dose, you know, very infrequent erections, or maybe non-robust erections in a partner who may have some estrogen atrophy or tissue atrophy where their tissues aren't as expansive. We're talking about heterosexual couples. And then just scar tissue from the injection itself. Let's flip over to the female.

You're mentioning the receptive capacity. I think about all the things women go through, like physically. And I now actually feel sorry for men for something. Like, you know, they have to go through this before the age of 50 you don't want a males after 50 that's essentially the an episiotomy unless it's like all the things we go through if if it was if the this happened to them each male it wouldn't feel so bad.

We'd feel sorry for you guys. Thank you. Thank you, Susan. That's very important. I don't wish it on anybody, okay? Let's flip over. I don't wish childbirth on anybody. I was telling Dr. Chapscott, we talked the other day, and I was telling her about your experience with home replacement therapy.

Why don't you just tell it from your perspective, what that was like? For me? Yeah, because she works with a guy named dr goldstein at ish wish which is really some of the the highest level scientific and clinical uh sort of uh issue research on these issues and clinical guidelines so what was your experience like i mean i i was i always was very sexual in my 30s or until I was in my 30s. We got married and I had triplets and my hormones were just whacked out. But I had menopause early and I didn't know. Okay, so two clues that were missed.

One, she had ovarian hyperstimulation. They didn't- She had a high voice too. And so I found out from a friend who had a hysterectomy that there was this thing called bioidentical pellets that you have after you have your uterus removed and your ovaries. And I went in and they found out that my testosterone estrogen levels were really, really low. And I was miserable for 20 years, like just, or yeah, well, 10 years from 30 to mid forties, 45. But well, I was 50, I guess when I first started and 20 years. Anyway, so I went in and I got it, I got it taken care of. And I swear, I was so angry that I was miserable

for so long. I had to go on antidepressants. I had to go to a therapist. I had to go to a psychiatrist. I had all these mental health problems because I had hormonal imbalance and I didn't know it, you know, and they didn't, my doctor told me that I told him that Drew liked to have sex a lot and I really had no interest. And he said, well, maybe you could get him a bin. So yeah, so we, they gave me this handful of pills and I would take them. And if I forgot to take them, I'd have hot sweats all night. So for like 10 years, I was like in and out of menopausal symptoms. I was miserable. I was crazy. I was sweaty and I'd sweat all night. I wouldn't sleep. I'd wake up, you know, the next day cranky and I'd have to take my kids to school. You know, it was just, it was awful being female problems are the worst you know and it but it was left untaken care of

for 10 years and and i begged my doctors they didn't know anything about it until i met this new person that came into town who was in the same office coincidentally which surprised me but i've been going to her ever since and um i am so happy having testosterone and estrogen in my system because now i can i wake up every day happy i i function i'm you know if if my hormones are a little bit off i get a little achy and i know it like i'm really attuned to my body and you get fatigue really i know when i'm depressed when i'm having know, when I need my next ones or whatever I have, but the symptoms are nothing compared to what I went through. I mean, I, and then I was the poster child in Pasadena of the identicals and the entire sex because I told everybody my story and every woman in town is calling and going, I got my pellets for free for a while because so many people were coming in by my recommendation.

And now she's no longer an obstetrician. She just does the hormone therapy. And I, you know, it's kind of cool. I like to see this and it's not covered by insurance, which is wrong. Yeah. Because it's only like $400 or $500 every 12 weeks. It's a lot for people. Yeah, it is a lot for people. Well, I'd like to say something about that. I might regret it later. Yeah. No, it's just not right because men get Viagra, but women can't get their hormones.

In my practice, women have parity. So one thing that I learned from one of my great, you know, women and men should have parity when it comes to sexual dysfunction. So, you know, I don't have women pay any more for testosterone pellets than my male patients do. And I am committed to that because like I said before, it's no good to put a Ferrari in a driveway if you can't put it in a driveway. It's incredibly important to have that period. I am willing to pay for the Ferrari. I've got

two Ferraris in my butt. She's talking about the pellets. The pellets, yeah. She means what that tepidum is. Unfortunately, it's a dynamic that's been created. And that's unfortunate. No, I love it. And I don't want it to stop anytime soon. I want to take it to my grave because literally I feel so good.

And I don't, even if there's side effects, like I'm losing some hair because my dad had pattern baldness. So I have very, very short hair on the top of my head, but it's not, you know, I can live with it. You know, I I'm happy with it. They say also you can have, I guess that's pretty much the worst symptom that you can really get. There's some women that don't respond as well as you do. And when I've heard of those sort of, I wouldn't say non-responders, but not as wonderful response as you, they're usually complaining about aggression.

Rather than feeling more energy and feeling good, they just feel more aggressive. Well, when I had way too much at the beginning because they were like, you know, they gave me a lot at the beginning, I found that I lost empathy for others. Yeah, I was more male. Like I was just like, I didn't give a shit if somebody was crying. Testosterone-induced.

Oh, they're just crying. Shut up. Just stop crying. Jesus. And then I realized that I needed to lower my testosterone. Oh my God, that's funny. No, I remember that. But I mean, if that's the worst thing, I guess. Yeah, yeah. Well, that's interesting. So thank you, Susan, for sharing that story. I tried to relate it to Dr. Tapscott, but I can't do quite as colorful a job.

I think I had perimenopause for like 10 years. I swear to God. I think you had it for 15 years. That's very awful. Yeah, and I think our peers grossly not only disregard, don't even consider the effects of perimenopause, and when they see somebody with depression or anxiety or sleep disturbances, hormonal disturbances, they don't even think about it. And it's very likely to be the issue. It's terribly common. And you know what? I don't have cellulite. I have

great legs. I don't, my butt looks good, right? Drew? Yep. Like I'm strong, you know, I'm what I was in my thirties, you know, I'm not, you know, people go, really? You're 60? Like, wow, you look pretty good. Like, I'm like, I don't want to tell you why, but, um, yeah, it helped. Yeah. So here's the deal. We're going to take a quick little break and more with Dr. Tapscott. I want to get into Peyronie's. I want to get into some effects of testosterone deficiencies in men. I got a bunch of stuff I want to get into.

So we'll be right back after this. And we're back with Dr. Tashley Tapscott. Dr. Tapscott, where should people go if they want to talk to you or get more information or see you, whatever the case may be? Absolutely. So I'm located with Carolina Urology Partners as my parent company in Huntersville, North Carolina. We're a large urology group organization, but I have created a subset in the division of our practice, which is SHEIK, the Sexual Health Institute of the Carolinas at at shicarolina.com i also have a youtube channel dr ashley taps before i talk a lot about penile implants and bronies disease and answer great questions that patients may have outstanding thank you and thank you for spending a little time with us today as i said at the outset dr tapscott and i are uh paid representatives of the petrus pharmaceutical organization we'll be back at a later time to talk, later podcast somewhere or streaming show

to talk about specifics of the PDE5 inhibitors, the things that increase the nitric oxide that allow erection to occur that has been revolutionary, frankly, in the field of erectile dysfunction. And I was saying, as it pertains to the female partners, when the first PDE5 inhibitors came on board, I have an internal medicine practice, so I had a lot of elderly men,

and they were lined up at the door the day they read about it in the paper. And then five days later, the women were lined up at the door mad at me because you have to prepare the female partners if they have not been active in a while. It's a thing. As you said, therari may be functioning but there's a lot of there's a lot of stuff in the garage still we got to clear out before before i put it in there as you say um so i'm sorry say that again yeah we're freezing up a little bit caleb is that uh server problems today yeah it's so it's not on

actually either of your ends there. There's some sort of a server issue to the streaming websites right now. So just repeat yourself if you have to. I'm trying to figure it out, but it's something on somebody else's end. Just wait. Just wait until it comes back. Don't worry about it. Yeah.

Let's get Elon Musk to buy YouTube or something. Maybe we can get this thing fixed. Rockets are shaped like penises, so we'll do something. Yeah, he's thinking of you when he sends those things off to orbit. So Peyronie's disease, speaking of things that don't look like those rockets, a pretty common problem. Talk a little bit about what causes that and what we can do about it today. Absolutely.

So Peyronie's disease, and we're talking about American men, right? So, this is a podcast worldwide, but it's only American men. We know it's present in about 13% of American men. Peyronie's disease is actually a scar tissue issue that really is a defect of wound healing. So, we think it's a combination of genetics as well as a wound healing disorder. So basically, you have some microscopic trauma, wearing tear on the penis, unless you've had a specific sex oops incident. And there's some scar tissue that forms in an area aligning of the penis of the erectile tissue called the tunica albigenia. And basically, more collagen gets laid down there that gets taken away. So that produces a scar. That scar is a hard scar to make, and it's a hard scar to break. and basically more collagen gets laid down there that gets taken away so that produces a scar that scar is a hard scar to make and it's a hard scar to break

and until 2013 we did not have any FDA approved treatments for Peyronie's disease we tried some vitamin E we tried some arginine which is you know amino acids we tried some injection of steroids etc nothing cetera. Nothing really worked. It's just a really hard scar. And if you think about it, if you have a heart attack and you have a scar on your heart, right, from that heart attack, that deoxygenated blood tissue, that heart tissue doesn't really come back. So we think about Peyronie's in the same. It's just that tissue is just very, very noncompliant and inelastic. In 2013, we had an approved treatment called Clostridium collagenase histolyticum. And basically it's a collagen bond breaker that breaks up the scar tissue in the

penis that we can inject into the penile tissue in the office to break up that scar tissue. There's also surgery. Yeah, surgery. Yeah, go ahead. There's something called plication. So I'm going to use my finger as an example. If you have a penile curvature, so we consider 30 degrees. The FDA indication is 30 degrees of curvature all the way up. I've treated men with 115 degrees. Plication is basically putting fingers on the other side to straighten out the penis. But you can imagine when you kind of shorten the long side, you may have a shorter phallus or shorter penis. And then if men have erectile dysfunction concomitantly or coexisting with their erectile dysfunction, we do talk to them about a penile implant, which is why I perform

ultrasounds in my office to look at the blood flow and the curvature. And recently, there must have been some articles out, because I had several patients obsessing about this, about penis scarring and shortening when it's not used effectively or not used frequently. Talk a little bit about that. I want to try to put that in context. In other words, how common is that? Does the penile length or size really change with circulating testosterone levels? Does it change with scarring from lack of use? What's the reality of all that?

Yeah, the reality is that we don't talk about clinical studies. So I'm going to talk about anecdotal and clinical outcomes experience. So circulating testosterone, I think, is super important. I think it's a piece of the pie. I don't think it's the entire pie. Now, unless you're very young and you have low testosterone, it's not the only driving factor. It's not the magic bullet. So I think testosterone is important for orgasm, vitality, sensation, et cetera. It's not the only driving factor for erectile dysfunction. So if you're waking up, let's say with less frequent morning erections, that's not necessarily just a straight up sign of erectile dysfunction. Now the penis is a muscle and if you don't use it, you lose it. So if we put a cast on my arm for six weeks and we take it off, that muscle is going to

look kind of debilitated and puny and scrawny. The same thing is with the penis. So if you're not having full robust erections, perhaps post prostatectomy or other surgeries or just in general, certainly I do use vacuum erection devices as a form of what I call penile rehabilitation in my office for various conditions for length and birth restoration and preservation. So with, let's say, just hypertension and routine vascular, you know, endothelial disease associated with aging and hypercholesterolemia and metabolic syndrome, that kind of stuff, there can be some shortening and scarring. Yes, that does happen and you can

rehabilitate it. And is there any change in penile size in some males associated with testosterone levels? Yes and no. So I think that there haven't been any succinctly just you know distinct studies with that scientifically but there there was some data in terms of men before a penile implant done by some by some of my colleagues down in florida that use of a vacuum erection device six to eight weeks before a penile implant it was able to actually procure a longer penis size before we place the implant inside because people should understand the implant goes on the inside of the penis not the outside so your stretch penile length may be different or your vacuum penile length than the internal length of which we measure to place an implant and i want to switch over to to female physiology for a second and anatomy the periurethral gland i i've heard various made of that made of that gland i my understanding is the the

cells them the cells themselves and and when we see when people say periurethral glands let me ask you this question first or do they mean bartholin's glands do they mean skein's glands do they mean something else no they actually mean it and when you say they so dr goldstein has has a lot of scientific literature around this out of the, you know, this is sexual medicine practice in San Diego. He's kind of our godfather of female sexual dysfunction. So, you know, he has some mappings and some scientific literature around the periurethral glands kind of simultaneously equating them to the prostate gland in the female. And certainly those are glands that run along the urethra. There are some discussions about whether these urethral slings, when we talk about for stress incontinence, kind of the cough, laugh, sneeze incontinence, if placing those disturbs those glands from a sexual dysfunction perspective as well. So a lot of people think, a lot of scientists and urologists, researchers think that that tissue or those gland secretions are synonymous to the

prostate gland in general, which I think is what you're alluding to. That's actually what Goldstein told me. And the first time I had heard that was from him years ago. And I've had thoughts, questions since, like, why don't women, particularly in the day of testosterone replacement, why don't they ever develop prostate cancer if those are really prostate cells, the way he implies. And he suggests that that may be the source of orgasmic discharge in women. Correct. Which makes sense to me. I think they measured some PSA. So PSA is a blood test that we do to assess the health of the prostate, whether it's enlargement,

infection, inflammation, and or cancer. It's a marker of what we call it in the medical field so psa supposedly was was elucidated from some of those fluids from female secretions of the periurethral gland why women don't get quote prostate cancer well obviously i don't think we have the organ density that men have uh and i just feel like the physiology you know we're still trying to understand genetically just is not there, but certainly, you know, there is some thought to that scientifically. It's interesting. Yeah. I was wondering about that. Those are most of my questions. Have we missed some topic? What are the sort of the urological hits these days? What are, I mean, obviously urinary function men are very concerned about as they aged, and that's, you know, as much as anything, pelvic. Oh, we didn't talk about pelvic floor and pelvic

floor rehabilitation. Why don't you talk about that a little bit? Sure. Well, I think if we talk about a lot of different pelvic and perineal, so perineum, just for some people listening that may not be aware when we use the term medically, basically means the term between the bottom of the scrotum and the rectum or the anus. So it's kind of that sensitive area, the perineum. A lot of people are actually sexually stimulated by this area. It's also an area that's very rich in nerve fibers and muscles that can generate lactic acid. So I always talk about, you know, I see a lot of men come to my office for pelvic pain, perineal pain that may radiate to their testicles, which everything's kind of connected there. And I think when we talk about the world of pelvic and perineal pain, it's very individual. Sometimes we find very little on imaging. I have men that

have seen four and five urologists. They've had MRIs. They've had CT scans. They've been doing all kinds of different things to try and help themselves. The male core muscles are very difficult to get to because basically we can only get to them through the rectum. So women have childbirth, they have intercourse in the vagina, they use tampons. There are a lot of things that stretch those muscles naturally. Men, not so much. So if a man's having pelvic or perineal pain, certainly you should see a qualified pelvic specialist like a urologist. But certainly there are magicians in my field in terms of physical therapists that are dedicated to the world of

pelvic floor health, pelvic floor musculature, that assessment, evaluation, and treatment. They're just, you know, quite frankly, again, magicians in my field in terms of helping these patients. Because a lot of times I think it's you seeing maybe dr drew these patients will be put on different neurologic medications they'll be put on opioids which really is not the right answer chronically for them and we know men on chronic steroids and opioids then start to have low testosterone right so so i i really i am not an opioid centric practice whatsoever i do not prescribe chronic opioids or am i looking to my practice. And so there have to be a lot of functional musculature and neurologic methods for these pathologic physiology. 100% behind that. It does remind me of a topic we sort of slid past the

very beginning, which was we were telling Susan how the male nervous system is very tied into their genitalia. And the point that we slipped by when what dr tap cuts said is that men are touching themselves when they come out of anesthesia it's literally the first thing that happens when people wait men wake up from coma is their hands go right there not because they're stimulated it's just part they're neurologically so tied to that area that there's just a natural tendency for hands to go there or whatever. It's just a circuit of some type that men have. And it comes out coming out of anesthesia, coming out of coma.

You see these things all the time. The other thing is in obsessive compulsive disorders is, again, more of this energy, neurological energy that men had towards the pelvis. I've seen men all the time that are preoccupied with shininess of the skin or size or all kinds of things with anxiety disorders, obsessive compulsive disorders. Most of them lose those preoccupations with a little bit of Zoloft or a little bit of Prozac, which are the medications for OCD. Or a wife. No, no, no. It's a weird preoccupation. I don't want to fault men for this. I mean, let's think about it. You know, cavemen or wherever we believe we came from,

the infatuation and the necessity was fertility and survival. Yeah, yeah, yeah. Absolutely. Reproduction. That's where we are. We had to procreate, reproduce to establish civilization. So it is what it is. I'm glad you said that because i i've been noticing lately i've been trying to get people not to think pejoratively about any features of the human being it all has a as advantages and and liabilities but there's a evolutionary adaptation to all of it what were you saying susan i was i remember when you were on love line and i would be home like listening i can't remember if we were on Loveline and I would be home listening.

I can't remember if we were married and had kids yet or whatever, but there was a period of time where every call was a guy calling about their penis. Yeah, is it normal? We should just call it penis line. These guys have questions all day long, and they were all different, but they all had a question about it. They were like teenagers or whatever, but I was just like, wow, can we get some female callers on here for Christ's sake? And listen, and that now they have, they have the solution or the

answers at the fingertips with the internet. And they're just as confused as that's how women look at it. Like I was just typical, like, Oh my God, you know, but now I get it because I'm on testosterone. And unfortunately, to your point, Dr. Drew, you know, I have seen so many young men, I'm talking late teens. I don't, you know, I'm an adult practice, but I do see some late adolescent males because they're basically developed like an 18 year old male, you know, with the permission and the accompaniment long time with their parents. But, you know, everyone is so internet addicted and camera and FaceTime and these social media apps. And I think that when people lose sight that everybody's Facebook and whatever, you know, only fans reel is supposed to be your normal reel. And I would tell you, no one, almost no one in my practice, whatever you see on social media, nobody's having

sex that much. It's just not what it is. It's not realistic. People have jobs. People have responsibilities. I'm not advocating that we can't all swing from the chandelier and have rodeo great sex. I just think that the reality that's out there has morphed into something that is not humanly sustainable. And I just try. So I spend a lot of time with reassurance in my practice and other avenues. And I have great sex therapists on hand too, which I think is very important. Yeah, that's important. Very important. Leopold, unmute yourself there, buddy. Hey, how you doing, Dr. Drew? Good. You have a question for us. I do. And actually it has everything to do with what you guys have been talking about.

But has the doctor, Dr. Tapscott, have you come across any folks who post-COVID infection have had a huge reduction in their ejaculate? Great question. Great question. That's a fantastic question. So that's one question. And then there's one fantastic question. So that's one question. And then there's one other question, and that is, I've been with some women who have copious amounts of female ejaculate. And can you explain that? Okay, so let's start with what's going on.

Let's talk about post-COVID and specifically ask Leopold's question. But post-COVID is sort of a protean topic. So go ahead. It totally is. So first of all, the one thing that I would say about science that everyone needs to realize when we're talking about COVID is, unfortunately, sometimes we can only accumulate the data as every day folds forward, right? So this is a really hot topic. I think it's very important.

Look, COVID is an inflammatory source. It is a virus. And I think the one thing that I've seen in my practice, most affected by COVID is actually fertility. Anytime a man has a fever or an inflammatory response in his system, his sperm counts may be down for 90 plus days, et cetera, even from a common cold. So when we talk about coronavirus, which is really a common cold and other things, certainly that can affect things. I think, unfortunately, scientifically, until we get some more research dollars, NIH or et cetera, behind this thing, we're not going to be able to have the answers. So I think COVID can certainly impact multiple layers of men's sexual health in terms of testosterone, psyche, erectile dysfunction.

A lot of those things are interconnected. So I don't have a lot of great answers, but I can tell you, I do believe that some part of that concern is real. And I think it has to be teased out on an individual basis. Yeah. I'll pile on and just say the neurological effects are protein that affects circulating testosterone and drive, and that affects production of fluid. It just all kind of goes together. And, and Leopold, I don't have to tell you you know how sick that thing makes you for how long you know oh my god yes so well and and what i noticed post-covid dr drew was i mean it went my the volume went down like 90 percent wow and so it's interesting get that hydrolite in you get the the hydrolite in you. Yes. Do they make a special hydrolite just for that area?

You're giving me ideas. Give me ideas. I'm glad I'm coming soon. I love it. It's really funny. And then the flip question, Dr. Tapscott, is, yeah, the female copious amounts of female What's all the difference there? Well, men are very variable too.

So let's talk about that variability in women. Yeah, I think 1,000%. So I think it's dangerous to compare partners to partners, right? I think that everybody wants to have that scale. And again, some people have very few partners. Some people have multiple partners. Some people have multiple partners at the same time. So I think sometimes the discussions have to be really open in terms of different

parameters and variabilities and things like that. I have women who have copious amounts of ejaculatory fluid, orgasm fluid, and some women just are not in that manner. So I think a lot of that, you know, again, Dr. Drew and I have talked about hormonal status, hydration, you know, relaxation, comfortability. I have a lot of women who are very excitable, but their pelvic floor is very tight and almost produces like that. Is that an RN2? One second. Her lips are moving. We lost your sound. I don't know if you can hear us, but we lost your sound. Can anybody hear us? Yeah, she can hear us. She hears us. I don't hear you yet. Caleb, are anybody hear us? Yeah, she can hear us, but she hears us.

I don't hear you yet. Hmm. Caleb, are you with us? I'm fixing it. It's something over on your end. I can't hear Caleb either. I didn't touch anything. I swear. We have done something. No, I didn't touch anything. I was on my phone texting a Twitcher. Oh really? No, it was on even because he said hey you guys i'm here we go come on now we're just basic urology uh let me just look at people's questions on restream see if anything pops up there all right let me see if there's anything maybe you can get the uh get the see if somebody's not leopold let's see if you're on there all right let's see if they can hear her we just can't

oh really yeah the restream people said uh did did i push the right button did i push the right buttons on the roadcaster yes hello we Hello. We can hear Caleb too. Normally not like this, Dr. Tapscott. Is she frozen again? No, you're there. Good. I'm here. So hold on.

Uh-oh, we've lost a whole bunch of stuff here. Well, I think what I will... Hold on one second. All right, let me go to the uh let me go to the restream since it's the only thing i can communicate with right now uh let's see you can still hear us yes i know and i'm sorry about that case as you hear me um you know we can do most sex therapists are cognitive behavioral therapists are they i'll let you answer dr ashley can you talk for a second can you uh can you hear me okay we got your back we got your back awesome what did we what have we done wrong i don't know there's some weird internet issues

happening but it's across the whole network so So it's not actually on anyone's end here. And I lost my remote control. So it turned off your sound on your end. But everybody can still hear everything. So you're good. But I'm here and I fixed it. Everybody. Giant cyber attack.

That's why I sit here. All right. We're going to keep moving. All right. So let's see if Josh wants to come up here. Another call for you, Dr. Teng. Hey, Dr. Drew. Josh, what's going on?

Not much. I have a question. Hi, how are you? I'm great. How are you? Really interesting conversation. My father is a urologic surgeon in Sarasota, Florida. And, but that's not why, that's not had anything to do with my question. It's just, it's, I've heard it, you know, I've heard the, I've sort of heard the dialogue before. It doesn't weird me out because I've, I grew up with it. Exactly. And I think it's really good to talk about. My question is, I'm a meditator, I'm sort

of on the spiritual side of things, and the Eastern philosophical scriptures, I'll tie it in in a second, but the Eastern ancient scriptures talk about semen and they talk about the value of retaining semen the value of celibacy say so this is the the holding the chi is the as some some yes exactly and let's talk about well i just want to can i just finish my yeah so so the reason they they they say this is because their their point is that there's an extremely large expenditure of energy to create semen. And I think that's the rationale, scientific or whatever, that's behind that.

That it's not so much that if you lose it, you become dull. But that could be the case. And also the case of trying to rebuild that reservoir in the seminal vesicles. Let's talk about it. So my understanding is if you hold your qi too long, your testosterone starts to plummet. So why don't you talk about that? Yeah, so there's lots of different studies and data. And I think we talk about Eastern

Western medicine. I think things get into different cultural and dialects and religious concerns, etc. So I think that there's some of the cross hatching of that research really hasn't happened as we need it to. Now of course what you may be alluding to too with some of the reward of drawing back is some of what people call tantric sex. I think there have been some celebrities that have been very big proponents of that in terms of increasing intimacy and fire, et cetera. And I do have men in my practice that maybe aren't having a lot of either masturbatory or partner-based, self-partnered or partner-based masturbatory ejaculations that do have some prostatitis

inflammation of the prostate as a result of that but i don't have i can't quote a lot of you know seminal vestibule imaging or etc that talks about buildup or whatever again that's a very specific individualized anatomic function um and i think in this day and age you know if it makes you feel well if it heightens your sexual experience i'm here here to tell you, you know, as long as you're not hurting anybody or yourself, you know, I'm here to give you the green flag to go forward and do what you need to do. Except at the extreme levels, you know, my understanding was testosterone goes up with sexual activity. If it's too much, it goes back down. If it's too little, it goes down. And so you're trying to optimize your, also, as you said, prostatitis, it goes back down. If it's too little, it goes down. And so you're trying to optimize.

Also, as you said, prostatitis, it irritates the prostate. Some data, prostatitis may be associated with other problems down the line. And then you had mentioned to me that sort of the – you were talking about the damage done by excessive sort of inflation. And this sort of goes with that kind of behavior, doesn't it? Are you talking about in terms of priapism or not priapism per se but you know sort of um excessive it you know excessive it sort of uh i guess i guess it would be sheer forces on the corpus cavernosum something like that yeah talk about that a little bit sheer forces i mean you know we could look at an arm and talk about it.

So, the penile tissue is really like a set of inner tubes or like a set of tires. And it really has a lot of pressure with a very thin yet robust lining of that tunica albigenia. By the way, that's the same tissue that covers the testicles. So, all of these sports that you men may be engaged in, all of the trauma or pleasure that testicles may have, they're aligned by the same tough lining, shell lining, tissue lining that the penis is. It is not totally amenable to injury and trauma. So we have testicular rupture from sports and trauma. You have penis rupture, what we call penile fracture. And everyone can look at the images of that. We call it, you have penis rupture, what we call penile fracture. And everyone

can look at the images of that. We call it, you know, the eggplant penis is the classic clinical scenario. But if that layer ruptures, all of the internal blood supply just leaks right out of the penis. And then again, that can cause scar tissue, Peyronie's disease and permanent erectile dysfunction. So again, I want my patients to have a robust, intimate encounter, but certainly, you know, there are limitations to the human body as in any sport such as sex or size, et cetera. Yeah. You mentioned that back to your tire analogy that that causes some of the micro scarring that we worry about, correct? Correct. Yeah. And I think, look, I think, you know, when we talk

about wear and tear on the penis, it is an organ. It's an organ that's used almost unlike any other, right? When you think about what the penis goes through, there's a lot of trauma with positions such as partner superior. That is one of the most common pathologies for penile fracture is partner on top because they're kind of in control. They're governing that suspensory ligament attachment to the pelvic bone that the penis has. But also I think that in general, you may have a partner, you know, who may be atrophic or maybe their tissues are inelastic, or maybe it could even be a young partner that's fully estrogenized if we're talking about female intercourse. And their tissues just may be very tight and that may cause some jamming or scarring

phenomenon, as well as a man who may have not quite full erections trying to kind of like make sure he gets in the garage all the way, if you know what I'm saying. I know what you're saying. Well, Dr. Tapscott, thank you so much for joining us. I think you have been Susan's favorite guest thus far, judging by her delight in your answers. I have a question. I wanted to give her the last chance. I figured she'd have some questions. Did you see my question?

No, I didn't see it. What is it? Okay, I want to know how to help Drew not wake up at night to pee post-prosectomy. Oh. Besides no coffee, but other suggestions? Okay. You know, like how to just sit it out

and then, because I hate waking up at 4 a.m. Also, how do I teach him how to shut the door when he goes let me let me let me clarify hang on hang on she's being funny okay let me clarify some let me clarify some of this i do shut the door but it's four in the morning so i'm sure it seems loud anytime when you pee i think you're talking about at the beach anytime when you pee shut the door okay i will but i think she'll tell me how to i think you're talking about the beach where anytime when you pay shut the door okay i will but i think she'll tell me how to i think you're talking about the beach is the one thing uh i have no i can hear you i've had a strange uh little bit of weird neurology with the bladder um in that uh stretch you know i used

to have the usual prostate related urgency that men get in my age group but i now it's now it's like a now it's it has a totally different feel to it it's like a stretch pain it's like it's painful and it feels like bladder stretch rather than the rather than the urgency of the of the prostate and it's very hard to predict you know if i have coffee at night for sure that it's going to be a 4 a.m wake up if i have a glass of wine with dinner it's going to be a 4 a.m. wake up. If I have a glass of wine with dinner, it's going to be a 4 a.m. wake up. So is there anything else that Susan should be aware of that she has to look after here? No more drinking. Well, no.

So listen, I'm not going to take anybody's caffeine or indulgences away from them because that's not real life. Right. And I think anything in excess, obviously, we can talk about, which, of course, is your expertise. But let's not forget one thing. And I, as a urologist, am guilty of of this. Men have bladders too. Okay. And you may not have prostate, but certainly you may have some overactivity to your bladder. And there are lots of fantastic agents that we can do. One thing I always say, your bladder does not care about your brain. It will boss the heck out of you. And women can tell me this all day long, but men after age

50 and 60 are actually more responsible for the overactive bladder population compared to the women. Okay. There's a, there's a really an inverse thing that happens just because their prostates blow their bladders out. It's like losing the elastic in your sock. Okay. This muscle works for so hard, so long to push against the prostate. So certainly I think you could talk about some overactive bladder measures. I'm not going to take away your caffeine or wine, but that's something that you all enjoy together. I can talk about some late night bed removes. You know, we can put a little light on the toilet so you can walk in there and not disturb her. I love that you guys apparently sleep so close together that you notice that about each other.

But certainly there are certain things we can do about the bladder to modify those risks and to increase your sleep and to increase her pleasure with sleeping as well yeah you're talking about medication absolutely yeah or hey really what do you think why don't you see a pelvic floor physical therapist as well have you done that no but i mean i got a lot of that rehab stuff after prostate do your kegels and i did a lot of that rehab stuff after prostate. Do your kegels. And I did a lot of that stuff. And I didn't really notice a difference. Yeah. I discussed. So kegels are for strengthening.

You actually might need some down training. Or maybe you need to expand your bladder capacity with the kind of bladder assailants that you're giving in terms of the caffeine and the alcohol. We need to really increase. We want to be nerdy about it. For physics, we want to increase the volume caffeine and the alcohol. We need to really increase, we want to be nerdy about it, your physics. We want to increase the volume without increasing the pressure. So we want to increase the compliance of your bladder.

Oh. So she said, listen carefully, she said assailants like alcohol and caffeine, both in coffee, both irritate the bladder. I'm sorry. Yeah.

All the fun, taking all the fun Yeah. Yeah. All the fun, taking all the fun away. Yeah. What's that? Figure out what? I said people are poisoned. You know, I have a lot of people that say,

Hey, look, I have a lot of patients that are very honest with me. You know, I'm from the land of like biscuit poisoning. You know, they want to have their whiskey and their a million beer, light beers,

et cetera. Like there's a little bit of a trade off. So if you're drinking fluids after 7 p.m., depending upon your bedtime, based on your age and your, get real nerdy about it, your glomerular filtration rate, your kidney function rate,

you're going to have to get up to pee based on the volume. So again, there could be medications that can increase your compliance rate. It just depends on whether you want to do that or not. Or look, you're a fit guy, you work out. You know, I can tell just from the waist up, you know, maybe you need a little bit of pelvic floor physical therapy adjustment to your core, and maybe that'll solve that solution. Interesting. And for his medication, which

medicine are you thinking of? Like an alpha 2? Well, I mean, I don't want to use brand names here, but there is a class of medications that have been, you know, in the past 10 years introduced that are most, I think the most superior efficacy and the safest medications on the planet. And those are the beta-3 adrenergic agonists, which are Mirbegron and Virbegron in terms of those medications. You know what? As an internist, I get to see those cause high blood pressure. They make me nervous. You know what?

That's awesome that you said that. So the previous Mirbegron does. Mirbegron is the only agent proven by the FDA to not cause an increase in blood pressure. It was released approximately one year ago, April 9th. Okay. All right. Excellent. Because I've been a little bit nervous about that class since I saw a lot of hypertension or people, it's usually with hypertension, suddenly becoming uncontrolled is really what it was. Correct. But there's been a new development of that class of medications that does not include a warning on hypertension. Excellent. Well, maybe that'll be the one I take to try to get my bladder compliance up. Listen, thank you so much.

If he's up at 4 a.m., Susan, bug him for something else that you need, you know, whether it's taking out the trash or helping the bride. You know what I mean? Somebody on the restream asked if you put the toilet seat down. Do you want to tell that story? Yeah, later. Okay. Yeah, I do. I do put it down. Well, sometimes you don't. If I don't, it's a, it's a, it's a really like I, I beat myself up. I fell in the toilet once when I was pregnant with triplets and that was the end of the toilet seat. I was like a turtle. I I was pregnant with triplets. And that was the worst. That was the end of the toilet seat. I was like a turtle. I couldn't get out. That was the end of the toilet seat sort of.

Who owned the toilet seat? She did. So that's it. Well, now we have two bathrooms. So he can do whatever he wants in his. And by the way, I didn't get up last night, if you notice. I know. I know.

But you haven't had any alcohol the last few days. You know, I've been doing something a little weird lately is I've been drinking water just before bed, and I know it's going to be a problem. And I don't know what that is or why I suddenly have a dry mouth at night. I should pay attention to that too. All right, Dr. Tapscott, the website again is thi shi carolina.com check her out there uh whenever i spoke the previous interview i had with dr taps got i said she and i could talk all

day about everything and i we've now proven that there's there's no limit to what we could get into and we will continue to do so we'll bring her back yeah our fans are very happy with this conversation i've always i've always said that you know people uh you know they're all this also bothered me too there's all kinds of people out there doing radio shows and podcasts about sexual health you are an expert in this area you are and they right and you rarely see people that know what they're talking about and it drives me a little nutty um you know it's just they just don't have the training to talk about this in the way you do. So thank you for bringing it. And, uh, we'll be back soon to talk more about these issues and we appreciate your time. Thank you. And thanks to miss Susan. And I'll always

be a fan of yours as well. So I can't wait to talk to you all those soon. All right. Fantastic. So nice to meet you, Dr. Ashley Tapscott, Susan Pinsky's favorite guest. I'm sorry people. Well, I'm sorry people. I'm being facetious. I just think it's funny because just watching the comments is really good. It is fun on the restream. We should have had Annie over here. Oh, my God.

Well, I'm going to bring her. I may bring her over to FJARC if I can. But you were cracking up, and I wish people could have heard you laughing because it was pleasant. It was nice to hear you reacting to her so positively. I love penis jokes. They were good, right? She's all over them, as they say. Thank you, Kenneth, for producing.

Thank you, Dr. Tapscott. We are back. Everybody want to check me on the schedule? I know we have Dr. David Swanson coming in on Tuesday. Is that right, anybody? How do I know him? You know David from the old days of Life Changers. Oh, yeah, that's right. That's how I know him? You know, David from the old days of life changers. Oh yeah,

that's right. That's how I know. Oh no, it was coming Monday, coming Monday. And that's going to be a little later, like at four o'clock. So Monday,

it'll be at four and a Tuesday. I don't think we have anybody. And Wednesday is when we're out. We will be from New York the week of the 18th. And who was I talking to today? Oh, what's that Susan? I can't hear you. Your mic's off. Oh who was I talking to today? Oh, what's that, Susan? I can't hear you. Your mic's off. Oh, if I can get everything to work. Well, you know what's interesting? I did this podcast today called Trash Tuesday,

and they were like, oh, how exciting. It's like when your streaming show goes on the road. It's like when the Wheel of Fortune goes to Hawaii. That's really, we should make something out of that. It's like, this is the Ask Dr. Drew on the road in New York. I know, we should get Kat to come over and do a show. Let's do it. Let's do it. She was just texting me today saying it's been way too long since we got together. We're going to be kind of busy in New York.

And so let's bring her over and do that. So that, all right, that's a plan. All right. So we will see you on Monday with Dr. Swanson. And then we will do something on Tuesdayay with dr swanson uh and uh and then we will do something on tuesday maybe just questions because the last question we're not doing anything tomorrow well you want to caleb you up for tomorrow ask it uh it depends on the time questions depends on the time he has a he has appointments so yeah What time works for you? What time is good?

What do you want? Any time after 3 o'clock Pacific I can do. Susan, do you want to be out of here by then? Or just Caleb and I could do it. Yeah, that's true. You can do an Ask Dr. Drew. I don't have to be here. What time? 4 o'clock?

We've got to load it up because we're going to take a couple weeks off this month. Yeah, at 3 o'clock. If you guys have any questions, we'll be just taking questions. What's that Tuesday? That worked really well this week. We had a good callers show. That was last week, right?

Yeah. No, it was this week or Monday. Oh, yeah, Monday. Yeah, because you guys have great things to talk about that are what's on your mind. It's kind of a nice change. All right, I agree. You don't have to listen to the same person talk for an hour. No, right.

We can just get into people's calls and questions and things like that. People have been asking me a lot about, I think I talked about a little bit on Monday, but I'm getting constant questions about narcissism all of a sudden and childhood trauma. Now that we're of in the aftermath of cove and I think people are looking at why they've been so crazy crazy world leaders yeah yeah think about all the narcissism and the problems that are going to come out of all these poor Ukrainians getting pushed out of their countries I mean the ones that got out let me tell you something it's really interesting. War and earthquakes and things like that don't necessarily, they don't create the same kind of problem that we see today, which is caused by caretakers and important figures violating the trust of the children. Yeah, I guess. This is different. being protected by their parents. Really? You think they're going to? It's scary. It challenges their nervous system. It may exceed their ability to regulate and thereby cause a trauma. But for the most part, I was watching that kind of carefully.

I feel like they're doing a good job of protecting the kids from adverse consequence. We, on the other hand, perpetrated this. That's what I'll talk about tomorrow. People don't understand how bad this all is. Okay. We will see you tomorrow then. Let's talk about your narcissistic mothers tomorrow.

Well, yeah. Perpetrating abuse by important relationships and how that's different. Yeah, but you don't always know they're doing it. I'm not blaming anybody. I'm not blaming anybody. Like I said, I'm at ease with it to the extent that it was part of my life. But you still don't do that. You don't do that.

People don't understand what that is and what the consequences have been. That's all I'm saying. Yeah. But you turned out pretty well, Dr. Drew, considering your mom was so bad. But, but it's a high stakes game with kids that you either go, the child suffers and becomes perfectionistic and tries to solve the problems by being high functioning or the child starts rejecting everything and becoming antisocial and ends up in real trouble. I it it's a high stakes game how would is there a chance you could have become antisocial you know it's an interesting question because theoretically that are you that would depend i'm attracted to it uh it uh a bigger part it it it depends on my it some of it is dependent on my genetic makeup right and so you could argue the reason some kids go one direction other kids go the other is their

genetic resiliency or whatever other factors are important so the answer is i don't know answer it sort of can't be answered um if if genetics were strong enough, it would have just gone the right way. Yeah, you also had money behind you, too. And I suffered a lot, too. You've got to remember, I was miserable a lot. And so that's the part that is inevitable. But then I came along. And everything was better ever since.

All right, we'll see you tomorrow at 3 o'clock. Ask Dr. Drew is produced by Caleb Nation and Susan Pinsky. As a reminder, the discussions here are not a substitute for medical care, diagnosis, or treatment. This show is intended for educational and informational purposes only. I am a licensed physician, but I am not a replacement for your personal doctor

and I am not practicing medicine here. Always remember that our understanding of medicine and science is constantly evolving. Though my opinion is based on the information that is available to me today, some of the contents of this show could be outdated in the future. Be sure to check with trusted resources in case any of the information has been updated since this was published. If you or someone you know is in immediate danger, don't call me. Call 911. If you're feeling hopeless or suicidal, call the National Suicide Prevention Lifeline at 800-273-8255. You can find more of my recommended organizations and helpful resources at drdrew.com slash help.