In Your Pants with Dr. Susie G - America's Favorite Penis 🍆 Doctor

Episode Date: March 7, 2019

So, what's the weirdest thing you've ever wanted to know about your penis but were too afraid to ask? Fear no more because I've got a special episode today to quench your curiosity. Dr. Aaron Spitz is a leading expert in male sexual health and fertility. He's served as an assistant clinical professor at UC Irvine's Department of Urology for 15yrs. He's the director of male reproductive and sexual medicine at Orange County Urology Associates. He serves as the leader delegate representing all of America's urologists to the American Medical Association and he has served as the president of the California Urological Association. Dr. Spitz has appeared on Dr. Phil and the Real Housewives of Orange County and is regularly featured expert on The Doctors.

You're listening to In Your Pants with Dr. Susie G, the physiotherapist for your private, helping you get in the know down below. Hey guys, it's Dr. Susie G here and welcome to the In Your Pants podcast, a show where we talk about the issues in your undercarriage so that you can keep embarrassing search histories off your browser. So what's the weirdest thing you've ever wanted to know about your penis, but were too afraid to ask? Fear no more, because I've got a special guest on today's show to quench your curiosity.

Dr. Aaron Spitz is a leading expert in male sexual health and fertility. He served as an assistant clinical professor at UC Irvin's Department of Urology for 15 years. He's a director of male reproductive and sexual medicine at Orange County Urology Associates. He serves as a leader delegate representing all of America's urologists to the American Medical Association. and he served as a president of the California Urologic Association. Dr. Spitz has appeared on Dr. Phil and the Real Housewives of Orange County and is a regularly featured expert on the doctors. Dr. Spitz, thank you so much for being on the show today. We've got a lot of curious listeners who are ready to dive right in, pun intended. Well, it's great to be here with

you, Susie. And I'm looking forward to uncovering some myths about the undercarriage. Absolutely. So let's get this party started. And my first question is, how did you become America's favorite penis doctor? Oh, it's by overwhelming popular vote. Yeah. But that does bring a good point is, you know, hopefully everybody does get out the vote tomorrow. Well, I have been on television numerous times over the past 11 season of The Doctors, and as you mentioned, also on Dr. Phil and Real Housewives. And as a urologist, I've always been called upon to talk about urological topics, and more often than not, the penis. And I've really been able to convey a lot of helpful information, demystify things, empower guys. And over those years of having

that public presence and being able to deliver that kind of information without too much wonkish medical terminology, easy to understand language, a spoonful of sugar to help that medicine go down, I've sort of emerged as America's favorite penis doctor. Well, that's awesome. And I love your book, The Penis Book. I've been recommending it to patients. I love your tone of voice. It's right up my alley. So without the medical jargon and you're just laying it out there literally well thank you so much i really appreciate that yeah no problem no problem i hope that people would find it entertaining but also learn a little something along the way or a lot really along the way oh yes totally and speaking of your book

you you definitely explained very well the physiological mechanisms behind a boner but for our listeners who are really curious can you briefly explain the ins and outs of getting an erection and perhaps shed some light on how it involves the most important organ involved which is the one between your ears as you say the brain yes yes well i i appreciate you uh uh starting off with that uh right up front because it it is crucial to understand how an erection works if we're going to understand all the realities and the mythologies around male sexual functioning so an erection is a combination of a lot of systems having to work in a coordinated way, kind of perfectly. It's almost miraculous that it actually even happens. The penis itself is a hydraulic

system. There are two cylinders that are side by side that make up the shaft of the penis, and they fill up with blood, kind of like a tire fills up with air. And as those cylinders fill up with blood, they expand somewhat, but then they stop expanding and they just get harder and harder as more pressure builds up as the blood flows in, but is trapped in there and can't get out. And when they can't hold any more blood and can't expand any more, you've got a fully erect penis. Now, what triggers that blood to go in there in the first place? A nerve signal, a nerve signal that comes from the brain. And that's why the brain is actually a guy's biggest sex organ, because without that trigger from the brain, there's no signal telling the blood to rush into

the penis and make the penis erect. Now, a person's got to have healthy blood vessels and healthy nerves and a healthy brain for all of this to, so to speak, come together. And there are a lot of things that can get in the way, and a lot of things can cause physical problems with getting an erection, but there also can be psychological problems with getting an erection as well, starting at the level of the brain. And those are usually tied to anxiety because anxiety causes us to release adrenaline and adrenaline shuts off the flow of blood into the penis. Understanding this kind of helps us understand why performance anxiety does what it does. That's awesome. And And you mentioned this in your book, too, and I've seen this with a lot of my patients where all it takes is one episode of erectile dysfunction or something not going right the way you intended, and it just kind of sticks with a guy.

It sticks with a guy, and the next time it's, you know, fight or flight, right? Exactly. The fight or flight reflex has saved our species, as it will. I mean, it's what allows us to survive life-threatening attacks. And the way that reflex works is life-threatening attack, body releases adrenaline. What does adrenaline do?

Well, it makes all the blood rush to our vital organs, our heart, our lungs, our brain, our liver, our central organs are getting all the blood because why? Well, we might be being attacked. We might actually be losing blood. And if we're losing blood, we got to shunt it all to where it's the most important. And that means shunting it away from less vital structures like, oh, fingers, toes, the penis. Now here's the problem, that fight or fight

reflex occurs when we perceive danger. And these days in our modern society, the danger we're perceiving is typically more intellectual, psychological, situational. It's really not very often that we are dealing with life and death danger, but our body doesn't know the difference. And so when we feel anxious, not about a bear that's about to attack us, but about will I be able to get an erection because I couldn't the last time? And am I going to have trouble this time like I did the last time? That degree of fear and anxiety releases adrenaline, just as if we're about to be attacked by a bear and all the blood gets shunted away from the less vital structures to our heart, our lungs, our brain. And so we can't get that erection or if

we're getting the erection, we lose it. And that is how performance anxiety works. Something so subtle, so mild can turn into such a big problem. And then guess what happens the next time after that? You go, huh, am I going to have trouble having an erection like I did the last two times, like I did the last three times? And then it really creates this vicious circle that really triggers your brain to be on high alert. And so when you're in that sexual context, you can't help yourself, but have that adrenaline release. And there's nothing harder than telling yourself to not think something. Don't think I'm anxious. Don't think I'm worried. Well, then that's all you'll think about. Right. It never works. It never works. I've tried it.

It never works. You can't talk your way out of it. Don't think about the color red. What's the first thing you did, you thought, well, exactly. Well, and on that topic, how common in your opinion is performance anxiety and should guys really be worried about that? If it, if it happens once or twice, I mean, relationships are very different. You know, maybe the time in somebody's life is very different. You know, what, what can you speak to that account? Yeah, no, you're absolutely right. A situation will arise that throws somebody off, but that person doesn't understand unless they have access to a book like the penis book or, or great podcasts like this one or other good source of information. If they don't understand what causes an erection and what kills

an erection, their thought is, oh my gosh, now there's something wrong with my erections. Like it's starting now. This is it. This is what I've always been afraid of. This is what I've heard about, or this is what I've, you know, heard other guys talk about. Uh, and now it's happened to me. And if they're ignorant as to why an erection might not work in a particular situation, they assume the worst and their mind goes to the darkest place. And now the next time they're up to bat, they are very anxious and they are very scared. And it's a self-fulfilling prophecy. And this is something that causes erectile dysfunction, typically in younger guys. Older guys can have just as much anxiety, but the underlying cause of their erections is usually

more built-in physical. The blood vessels are older. They're sicker. They have diabetes. They have high blood pressure. They're on medications with side effects, et cetera. But in the younger guys, 20s, 30s, 40s, you start to get borderline where you can start to get physical overlapping with psychological. But in those younger guys, it's that psychological, it's that performance anxiety that is the true actual cause of the erectile dysfunction. But in older guys, it's a shared contributor, but not the major contributor. And I'm so glad you brought up the younger guys, because that was my next question, actually. So perfect segue. In your book, you talk about a very important topic, which is pornography and its impacts on men's sexual function and

relationships. And I've been seeing and hearing of more younger men with erectile issues, you know, sort of like performance anxiety or erectile dysfunction or premature ejaculation. Can we talk a little bit about this and your the trends that you're seeing in regards to all this it is it is a a really a striking and alarming problem and it's really a problem that's new on the scene in human history related to technology because of streaming porn and our access to streaming porn on all of our cell smartphones and our our computers tablets etc because there is immediate access to pornography, there has become this incredible change in individuals who allow themselves unfettered access to it. And pornography can be very enticing and very addicting.

There are centers in our brain that respond to sex the way we respond to drugs, okay? We have certain basic needs that we need to fulfill to survive as a species. We need to live, and so we respond to thirst and hunger. But we also need to reproduce, so we respond to sexual cues. And the parts of our brain that respond to the sexual cues are actually the same parts of our brain that respond to drugs, to narcotics, different than the parts of our brain that respond to just hunger or thirst. So it's a very powerful stimulation. And just like with drugs, the more you do, the more you need and the less satisfaction you get.

And so with unfettered access to pornography and guys that are viewing it frequently and what's frequently daily or many times a week, MRI studies of the brain show an actual shrinking in the centers of the brain that are important for experiencing desire and pleasure from sex. And so there's this physical decrease in the actual brain's ability to even enjoy sex with the more the individual is exposed to sex. And it is causing erectile dysfunction in young guys. We're seeing erectile dysfunction in high school and college-aged men. Up to 25% of these guys, it's unheard of. Prior to the advent of streaming pornography, the incidence of erectile dysfunction in a young population of guys was three or 4% at most. Not only does it interfere

with her ability to have an erection, it is also interfering with her ability to reach a sexual climax. I mean, remember the day when young guys, you know, had a hard time lasting a long time because, you know, hey, they're young, they're very sensitive and experienced. Now young guys are having trouble even reaching climax. This is typically a condition of an older guy with nerve damage. So this is a very profound effect, not to mention the sociological effects, the perceptions of women in the depictions of pornography and the expectations that men who view this pornography have of how women should behave with them sexually or what women should be responding to sexually. you know that's that's a whole nother issue but i'm just talking at a biological level it's harmful

right right and how much of that even leads to body dysmorphia too i mean i treat a lot of men with pelvic pain and other issues and sexual function as well but just you know knowing what's normal and not norming and and really like where are they getting their education from that was what i was going to follow up with like where should guys get educated on sex and education i think that's really lacking no you're that's a great point about body dysmorphism many guys well most guys at some point or another question if their penis is you know properly uh if they're properly endowed and many guys are are here that they are too small to satisfy a woman and pornography depicts porno stars these are selected for their physical attributes just like a uh

NBA basketball player has to have certain physical attributes to be an NBA basketball player. A porno star has certain physical attributes to be a porno star. This is at the end of the bell curve. These guys are not normally sized. They're much larger than normal in most of these pornographic videos. And most guys don't get a chance to look at hundreds and hundreds and hundreds of penises to compare themselves like I get to. So I know where I stack up in the real world and I'm fine.

I'm average, but most guys don't realize how they truly stack up because the only other penises they typically see is going to be depicted in pornography. They're not really going to have the opportunity nor go out of their way to look at other guys' real penises. I mean, I'm not talking about all men and all sexual preferences, but in general, a lot of the fear comes from ignorance and also a very skewed representation of reality. And even though we get sex ed in high school. We don't get this kind of sex ed. Nobody's talking about average penis size. Nobody's talking about climax and the real nitty gritty stuff that most of us learn on the streets, as it were. But as a urologist, I, of course, learn it in a much more comprehensive

and scientifically sound way. I'm able to impart that information through platforms like us talking right now. And if individuals were to seek out good information and use that same technology that's distorting reality for them to find some good reality, because they can find plenty of good information online from reputable sources like the American Urological Association or books like mine, then they can kind of take it down a notch. Most of the people who come into urology offices desiring sexual enhancement surgery to make their penis bigger leave not wanting that surgery once they are simply educated as to the fact that their penis is in fact normal and i see the same thing happening with women and labiaplasties and

vulvar surgeries just to make things look a certain way yeah no it's um you know we're really very susceptible to these media images. We respond so strongly to images on the screen, and we're seeing that take its toll in a variety of ways, young and old, and it is taking its toll sexually. Yeah, I totally agree. Where would, where do you, or what do you recommend to the younger guys to learn the rope, so to speak? Do you have any good resources other than your book or anything else you can add? Yeah, well, I mean, there is going to be an increasing amount

of information available free as a result of my book because I have been able to speak in different forums and on blogs. But I think that if a person wanted to go right to the sources, they could go online, they could go to a source like PubMed.

PubMed is a search engine of medical journals and they could type in questions and actual journal articles would pop up and tell them what the studies are. Now, it might be in very scientific language, it might be Wankish, but they'd be able to get the gist and they could start from there.

It's hard to say what a good layperson's source of information is. I would trust WebMD. I think that they're very well vetted and they speak in language that's very clear. And I would also look at the American Urological Association section for patients, the American Society of Reproductive Medicine, ASRM.org. They have a lot of information for

couples that are seeking fertility treatments. And because there's also questions about fertility and sperm and these kinds of things. But there is a lot of good information that's at no charge on the internet, but it's important to know your source and try and stay with a respected source. Mayo Clinic, UCLA, major medical institutions often have webpages about different conditions for their patients. But there's certainly nothing wrong with seeing your doctor and asking him questions as well. And your doctor can give you that information. Don't be embarrassed to ask questions if you're concerned about how something looks or how something's feeling or behaving. um you know ask your doctor don't be afraid right and that's a big point don't be afraid to ask and

a lot of many of us i mean i would say men and women are just afraid because we think well we're the only ones that are not normal dealing with something or maybe this is weird and and there you get there you have it then you're kind of like suffering with this question and wonder without just asking so absolutely um you know when it comes to these these sexual issues you often get your uh your fear from some incorrect information you're getting online and then you go back to those same incorrect sources try to get answers and then you only find yourself digging yourself into a deeper and deeper hole yes very very true very true and i and as far as like uh you know sex education because you mentioned you know sex ed in grammar school

I mean, that's like nothing, nothing. And there are, I don't know if you know about these sites, but Cindy Gallop, her site, Make Love Not Porn. Yes, I've heard of that. I think, is she the same woman that did a TED Talk? Because there was an excellent TED Talk. Yes, yes, that's her. Yeah, and there's also been a TED Talk by another individual who was a recovered porn addict, if you will. And he had, you know, kind of descended to the depths of erectile dysfunction, inability to reach sexual climax, all of that, and then come back out of it by becoming abstinent to pornography. And this is what you see actually in the medical journals is cases of men who suffer severe effects of chronic pornography is being able to recover

by being abstinent to it. It can take a few months, but the good news is that these things are reversible uh problems that people experience in the sexual realm are very often treatable very often reversible and so uh the first thing to do is to just come in and ask the question ask for help yeah absolutely absolutely bioplasticity neuroplasticity right yeah it's wonderful that's great and one more uh little uh tidbit for our listeners sexplanations dr doe d-o-e is a youtube channel i don't know if you've heard of that one either but that's another great source i've kind of scoured her stuff and she's pretty even keel um and not biased and gives out good information so excellent or whatever that is worth those are great no it's great that you're providing these

resources absolutely absolutely the more the better yeah because honestly uh you know specialists in sexual medicine that are urologists like myself are few and far between. There's not a lot of us in the country. There are many people in the country who don't have access to somebody like myself. So it's great to be able to find a resource like what you're providing, giving people this kind of information right in their own home, right in their own car, because, you know, I take it for granted that I know and can provide this to my patients. But I know there's a lot of people around the country that don't have access to that level of expertise. So it's really great that you're doing this.

Right. Oh, well, thank you so much. And it's great that you can help me pass on this message. So we're going to switch gears a little bit because I'm not sure if you've ever heard of these symptoms of hard flaccid. And, you know, this is something that's been not so mainstream, but I've been I've been seeing a lot of my PT colleagues have been learning about it. and discussing it with their patients. But what are you, I mean, do you know anything about it? And if so, what are your thoughts on this? Well, I'm not familiar with that phrase. So can you describe what the syndrome is?

So it could be in the absence of pain. The gentleman will feel a sense of feeling weird, weirdness in his penis. It'll be hard when it's supposed to be soft, hence the hard flaccid. Sometimes exercise can induce these symptoms. um they start to see maybe perhaps skin color changes sort of along the lines of you know again i'm not sure how much of this is body dysmorphism but um these are things that are quite alarming to them um again it doesn't always have to be with pain so it's sort of like changes in the penis you know how much of this is actually normal again we don't know there's no research on it

whatsoever. Let me break it down into a couple of different subsyndromes that may or may not be part of what you're talking about. Because, you know, I certainly have seen patients over the years who have odd discomforts in their penis or feel that their penis lacks sensation as opposed to having an abnormal sensation or they have an abnormal sensation or there's these color changes or texture changes and in some of these cases i do think that it is uh more of a behavioral component with with a sort of an an overly surveilling mindset kind of you start to notice something on the penis and then you really start to notice things you haven't seen before but it's just because you weren't looking and now you think oh this is this wasn't there before what

is this. You know, I've had patients come in to me because they were sure they had some kind of a STD, but they were just noticing the little sebaceous glands around their hair follicles that have always been there. But now that they're noticing it and they're scared, they think it's warts, for example. Now, on the other hand, there is a under-recognized syndrome, a neurological syndrome that can cause pain in the penis and unusual sensations of discomfort with arousal, with erections that hurt and that are not wanted, that are not sexually triggered. And this is a real but very minimally recognized syndrome. My colleague, Dr. Erwin Goldstein, who is in Alvarado Hospital in San Diego, has pioneered research in this. And what's going on

in these cases, and maybe going on in some of the cases you're encountering too, is that there can be a small injury in the lower spine, like a bulging disc or a narrowing, that is irritating the nerves that are on their way to the penis. But it's irritating them at a part of the nerve that's not supposed to be irritated. It's supposed to be just conducting the signal. And it's as if you're creating a short circuit in in the wiring and so this this point of irritation on the nerve before it gets to the penis from a bulging disc say or from a narrowing in the spine is causing a false sensation in the brain that's making the brain perceive that there is pain from some kind of an injury in the penis that's not there and it can also release that signal to make an erection

inappropriately. And you can have pain with the erection. And so these people have a real nerve cause, and that nerve is in their lower spine. And when it is recognized and then surgically treated by a spinal surgeon, say with minimally invasive disc reduction, for example, there can be a relief. And women can get this as well. Women can get chronic, painful arousal feelings in their vagina and their clitoris that's intrusive and disruptive and unpleasant. And it can be due to an injury or a problem with the nerve in the lower spine. So that may be some of what you're seeing. And then how does one, what diagnostic measures?

I mean, is this really easy to pick up on scans or is this something? I would say it's easy if you know what you're looking for. So the way these patients have been successfully evaluated has been with MRI, MRI of the lower spine. And then they've been treated with neurosurgery, often with minimally invasive techniques like little needle scopic procedures, because the lesions, the things that are pressing on the nerves tend to be small and tend to be able to be treated with minimally invasive procedure. But that's how it's been evaluated with MRI and treated with a skilled neurosurgeon who understands how to look for these and how to treat them but it is very very early in the

understanding of this and in the and in the dissemination of knowledge about this so right now you know your top center of excellence for this kind of a problem is going to be dr erwin goldstein yeah i'm really curious because i'm curious if they're studying those that show these anomalies in the spine because those are fairly normal i think to see in any spine some some sort of degeneration or disc issue, you know, compared to those that experience the pain or the symptoms versus those that don't. Are they doing that research as well? Yeah, they are actually studying this in a formalized way. They do nerve conduction studies as well. And so it's not just a diagnosis made on an image alone. It's a pretty sophisticated workup leading up to the

surgery up to the surgery itself awesome great i'll have to look up is any of that has been published yet or i believe you should find some uh either abstracts or articles on it i would i would look uh you know in your search for erwin goldstein and um painful arousal syndrome okay thank you that's that's awesome definitely shed some light i know i know it's like good this is when technology can really help it's true we do make advances every now and then we actually get better what we're doing right right that's awesome great well the follow um the follow-up two questions i have come from listeners and followers this question comes from a follower who asks are there any ways to regenerate penile sensitivity after extensive keratinization of the

glands as a result of neonatal circumcision? So this is an interesting question because the assumption is that there has been an abnormal amount of keratinization of the glands of the penis that is then causing an abnormal suppression of sensitivity. And that is because of a neonatal circumcision. So this is really a question about does neonatal circumcision impair a normal sexual experience. And that's been studied, and studies were done comparing the sensitivity of the penis, the head of the penis, the shaft of the penis, between men who are circumcised and men who are not. So men who are circumcised as babies versus men who are not, and also their ability to have erections, to reach orgasm,

the full spectrum of sexual function, as well as specifically sensitivity. And the findings were that, in fact, there was actually no difference when this was scientifically studied. Now, there will be plenty of forums online that describe an alarming deficiency in sensitivity and impairment in sexual response. But these are going to be, by and large, anecdotal accounts And when it's really studied on a population basis in a controlled way, we see that there in fact is not a difference. I myself have performed many circumcisions on adults who had diseases of their foreskin. They had phimosis where the foreskin was too tight and it wouldn't allow the erection or

it was trapping the urine and it was causing pain. Or it was chronically becoming infected and would crack and bleed and it was a source of a lot of pain and misery. And so these were adult men that required circumcision for a disease of their foreskin, not for cosmetic reasons. And after I perform their circumcisions, I'm able to ask them how they're functioning sexually and how their sensation is. And they do not report to me decreased sensitivity or decreased enjoyment of their partner or

of their sexual experience. If circumcision caused a significant and dramatic decrease in sensitivity and sexual pleasure, I would expect it to be pretty dramatic in adults that suddenly lost their foreskin. And I don't see that clinically, plus the scientific literature doesn't show that either. Right, right. So if you wanted to enhance penile sensitivity, how would one go about that? what would be some like would you use different textures perhaps vibrators well yes i mean there are definitely men who have decreased penile sensitivity uh we lose our nerve endings as we get older and so older men have less sensitive penises than younger men diabetes will affect penile sensitivity and so can certain neurological conditions multiple sclerosis or nerve injuries

And an individual who's concerned about their penile sensitivity because they had a neonatal circumcision, they have to be careful not to be reacting to something that may be more of a behavioral, psychological reaction than a physical. Because if in the end, they actually do have normal penile sensation, but they don't recognize it or they don't believe it, and then they pursue medical means to improve their sensitivity, they may just be reinforcing a condition that's not actually physically happening and drive themselves into a deeper and deeper sense of loss of normalcy. And there won't really be a fix for something that's not broken, but they can take a situation that they perceive as being broken

and make it even more broken. So I don't really want to encourage this particular caller to seek a medical remedy for something that is unlikely to actually be a medical problem. But having said that, for men that do have decreased sensitivity to their penis due to decreased nerve density and decreased nerve health, there are lubricants that they can use that can increase sensitivity. Some of them have a little bit of a stimulant in them, like capsaicin, that gives a little bit of a tingle or like a menthol. And this can increase the sensitivity. Now, some people might find that unpleasant. Some people might find it more sexually stimulating. Also, some of these lubricants create a sense of heat. You can also use an actual vibrator designed for the head of

the penis that cups it both on the top and on the underside called Viberect, V-I-B-E-R-E-C-T. and this is sold in medical supply stores particularly that are urologically based such as the urology store for example and this is a vibrator that goes and sort of sandwiches the penis and increases the stimulation of the penis and helps that person have an easier time reaching climax or staying aroused after they take it off and then pursue penetrative sex you could also just get a garden variety vibrator and hold it to the very underside of the penis below the urethra called the frenulum, which is one of the more sensitive areas of the penis or on the head of the penis or on the undersurface of the head of the penis. These are all the more sensitive areas

and using a vibrator or using some stimulating lubricant can, yes, enhance the sexual pleasure in somebody who has decreased sensitivity. But in a person with normal sensitivity, they may or may not find that uh unpleasant right right and thank you so much for bringing that up again about the behavioral psychological reaction perhaps you know working with a sexologist or sex therapist or counselor and to help someone through through something like that instead of just looking at you know just the pure physical uh bio biological mechanisms it's more of you know which is psychological as well it's using the brain and the nervous system but approaching it in a different way. Awesome. Awesome. Great. This is really good stuff. This is the last question

from another follower or a listener. It might be short, but what are the chances of fertility after a vasectomy? So it is very possible to have a child after a vasectomy, but it will require technology, either surgical technology, which is a vasectomy reversal, and this is performed with a microsurgical approach using an operating microscope and microsurgical instruments. And this is something that I myself actually specialize in. And with vasectomy reversal, couples can have children again. However, it's not 100%. The chance of having a baby after vasectomy reversal will decline the longer it's been since the vasectomy, but it doesn't go to absolute zero by any means. It just declines. So it's not the case that there's a certain period

time after which it will not work. But for example, if you have the vasectomy reversed within a year or two of the vasectomy, you've got about an 80%, maybe even higher chance of having a baby, particularly if it's with the same partner and it's even higher. But if you wait, say 10 years, your chances are down to about say 50%, maybe 60%. And so there's this sort of a decline over time the longer it goes, but it's not zero. Now, the other way you can have a baby after a vasectomy using technology is using in vitro fertility technology. And that's the technology where an egg is removed from the woman's ovary with a little needle through the vagina, and then sperm is removed from the man's testicle or epididymis. Again, it may be with a

needle through the scrotum or a little cut. And the sperm is always being created even after vasectomy. So it doesn't matter how many years it's been since a vasectomy, as long as nothing else has happened to injure that testicle, there will be new sperm being made, formed, and then broken down. And so you can get the sperm out of the testicle behind the blockage of the vasectomy, and you can take that sperm and inject it, one sperm per egg, into the egg that you take out of the woman and create an embryo. And then that embryo can be put back into the woman's uterus to make her pregnant

and then she can have a baby. And the success rates there do not depend on how long it's been since the vasectomy. Instead, they depend on how healthy the woman's eggs are. And for most women in their 20s and 30s, they can expect success rates of 65, 70, 75% baby born per try. And if they don't have success on one try, they can try it again a second or third time. So it is quite possible to have a baby after a vasectomy with one or another of

these techniques. That's great technology again at its finest. That's wonderful. This is a follow up to that is on average, how often do you see men who get vasectomies and I treat a lot of them that have pain afterwards or chronic pain after having a vasectomy? Can you speak a little to that sense? Yes. So I also do a lot of vasectomies. I also subspecialize in that as well. And fortunately, the incidence of chronic pain following vasectomy is very low. It's under 1%, but it's a real thing. And I have had a small number of patients over the years, either my own or other people's patients, because I do specialize in this area and I get patients from other people as well, for whom when I do a vasectomy reversal, the pain in fact goes away. Now, there are other

maneuvers that have been successful with treating pain after a vasectomy. And one of the first things I do with these gentlemen is I ask them to see somebody like you, a pelvic physical therapist, because in many of these cases, the chronic pain is not actually due to the vasectomy, it's due to some other trigger, but it feels like it's coming from the vasectomy. It's pain that's radiating down into that area. And I've seen many people have great success with pelvic physical therapy for pain in their testicle, but there are others for whom this is really due to the vasectomy and the pelvic physical therapy may be helpful to some degree, but it's not going to relieve it. And for those people, vasectomy reversal or another kind of a procedure called

the nerve denervation, where we just go in and strip all the nerves from that area, will be successful. But even so, I do have an interesting subset of patients for whom I'm able to relieve their pain with electrical stimulation. I have a device called TMR, which provides an electrical current to the tissues, kind of like a TENS unit does, but the physics of it is a little different. And it's very effective at relieving chronic vesticular pain, and in some cases, post vasectomy pain interesting and i've had a patient that had the reversal because of fast post vasectomy pain but turned out to be worse which is probably very rare as well but well i go into surgery very judiciously because if somebody is already having pain in their scrotum

and their testicle um and it in fact is not due to the thing that you're going to go in there and cut out you may just be giving them an additional source of pain by cutting in there and creating new disruptions of nerves and new scar tissues so i'm very cautious about proceeding to vasectomy reversal surgery or any surgery for testicular pain and i'll tell you i have a very healthy referral uh conduit going to my pelvic physical therapy because i really use that as a very important screen. Thanks for the shout out, Doc. I got to tell your audience, it is remarkable how many men's testicle pain gets cured by pelvic physical therapy. I see so many men who have gone through other doctors, other neurologists have gone through rounds and rounds of antibiotics

and ibuprofen and have been told that they have epididymitis over and over and over again. And that's not what it was. It was something in the pelvic nerve and muscle alignment or some spasm, something that you as a pelvic physical therapist understand and treat. And when I finally get those guys into the pelvic physical therapist's hands, the pain finally ends. And it almost seems like it's impossible that it could work because the pain seems so certainly in the testicle. How could it possibly be coming from the pelvis? But I get my patients to just take a leap of faith. And so often they're amazed. And I'm always amazed, too, because, you know, it wasn't a regular part of my education years ago. But I really come to respect how powerful therapy that really is.

Well, thank you. Thank you so much. I mean, we're honored. And yes, we are here to help all testicles and penises that may come our way. Come one, come all. Come one, come all. That's right. I love the puns.

Oh, Lord. Oh, great. Awesome. Well, thank you. This has been so informative and really just a pleasure to have you on the show. How can listeners connect with you? Well, they could go to my website, AaronSpitz.com. and uh through there they can get some interesting information and uh communicate with me as well

um they can also uh follow me on twitter and uh facebook but um probably erinsquitz.com is going to be uh the best way and also i would encourage them invite them to take a look at the penis book oh yes and i've been i've been your number one fan so i've been giving it to all my male patients Yeah. Nope. You have to read this. This is your home play. Not homework, but home play. Thank you so much. I actually made all three of my sons read it because I think it's going to keep them from going off into the world half-cocked, you know? Yes, I love it. Great. I love it, Doc. Thank you so much. And to all our listeners out there, thanks for listening. As always, and loving wellness for your pelvis. This is Dr. Susie G.

until next time my friends thanks for listening to today's episode be sure to head on over to drsuzyg.com where you can get more information show notes and related articles on today's topic also if you like what you're hearing head on over to itunes subscribe to the podcast and leave us a rating and review we'd love to hear feedback thanks again and there you get there you have it