In Your Pants with Dr. Susie G - Dr. Ralph Esposito - Go See the Doctor, Guys!

Episode Date: September 7, 2017

Today Susie welcomes Dr. Ralph Esposito. They talk about guys getting over being uncomfortable going to see the doctor and finally taking care of what is in THEIR pants.   Dr. Esposito is a naturopathic physician, licensed acupuncturist, and functional medicine practitioner. His precise and personalized style embodies a progressive approach to medicine. He has been published and is a peer reviewer in well-respected medical journals. Furthermore, Dr. Esposito has authored several medical textbook chapters and has designed education modules for health professionals specifically on urological conditions, fertility, male and female hormone dysfunction, Low Testosterone, exercise, fitness, men's health and sexual dysfunction. He has trained and collaborates in research at NYU Integrative and Functional Urology Center.  Dr. Esposito also holds a position as adjunct professor at New York University and at the University of Bridgeport College of Naturopathic Medicine where he lectures on integrative medicine.

You're listening to In Your Pants with Dr. Susie G, the physiotherapist for your private, helping you get in the know down below. Today, Susie welcomes Dr. Ralph Esposito. Dr. Esposito is a naturopathic physician, licensed acupuncturist, and functional medicine practitioner. His precise and personalized style embodies a progressive approach to medicine. Join us as they discuss how guys can get over being uncomfortable and going to see the doctor, and finally take care of what's in their pants. All right, guys, thank you so much for being on the show.

This is In Your Pants with Dr. Susie G. And I have a very, very special and important guest on today's show, Dr. Ralph Esposito. Thank you so much for being with me on today's show. It's a very important topic. Oh, yeah, I'm super excited for this. This is going to be great. You know, it's hard to find people who are willing and openly able to talk about this stuff from an expert point of view. and having us both on here is just going to be life-changing for me and also you know the people

listen to the podcast it's going to be great oh absolutely and our listeners honestly our guy listeners for sure are going to be forever grateful for this conversation that we're having together and on that topic um goes to my very first question you're a guy right you're a dude i am uh tell me you know guys just don't like going to the doctor for for for things in general right but we're talking about private parts and their penis right so so talk to me a little bit about the hesitation and how you know sometimes when things aren't working well down there you know how mental is it and what are guys to do right so men are macho and that's just part of a societal norm that we've been ingrained with it's you're a man you have to be tough you have to be strong

and for some reason that has translated to if you're ill or if you're hurt suck it up and deal with it. But we are in the 21st century, 2017, and now when men are not feeling well, they still have this macho type of thing where they are reluctant to go to the doctor. And I don't get it, especially when you have pelvic pain or your penis hurts or your prostate hurts or basically anything below the belly button hurts. I don't understand why men are reluctant to go to the doctor. But it's not so much as I don't understand why men don't want to go to the doctor. I know why they may feel reluctant to go because it's, you have to take off work and you have to make a day out of it. And sometimes, you know, you get there and the doctor has no answer for you. So I

get it. But men need to realize that this is a serious issue and it can lead to more problematic issues down the line and it could lead to things worse than just having pelvic pain so you know a lot of men are not really paying attention to this and they and especially it's your pelvic area i mean come on every time you say the word penis people giggle right exactly i just did it exactly exactly so you know men don't want to go to the doctor and tell them that their penis hurts and especially, and especially, I mean, I'm not with you, but especially a medical doctor who's a female, they have this, there's a stigma that you don't talk about that, that that's, you know, that makes you feel less manly. And I think that's what's translated is the men just really

avoid going to the doctor because they're scared to talk about the problem, even though they actually aren't unable to function on a daily basis, like at work and also in the bedroom. so it's it's a conundrum for me and i really can't figure out exactly why but i think it has a lot to do with our societal norms as having that macho type of approach to to uh to masculinity and such right so so on that topic what would you recommend or what would be the first piece of advice that you would give to these guys to get over some of that mental fear of being macho right what how how can you advise them to just you know get the help that they need sooner than later right so pelvic pain or prostatitis often occurs as a first time event where it might be a an infection right

might be an std or it could just be that the male just had sexual intercourse and wasn't able to have or just had an infection that occurred spontaneously after it doesn't have to be an std but it could just be similar to like a UTI, right? How women are more prone to UTIs than men. Well, it does happen in men. Now, if they have a UTI for the first time, or they have some pelvic pain for the first time, what do they do? They're in pain and like, okay, I'm going to go to the either urgent care emergency room or call my doctor and tell him, look, this really, really hurts. I can't deal with this. And they give him an antibiotic, right? Then after they get this antibiotic the pain might go away and then it returns a month later two months later and then

they go to the doctor again it's like look gave me the antibiotics last time it really hurts again and then they get antibiotics one more time they have already set themselves up for chronic prostatitis and how is that well the thing is is that when you first get a bacterial infection or a UTI in a man, and you take an antibiotic, you are destroying a lot of the bacteria that are supposed to be supporting or protective in the urogenital tract. Now, when men go to the doctor and they get this UTI, or even if they go to the doctor and get like a stomach bug, or they get a cold and they get an antibiotic, that can set off a reaction in the pelvic area. Because if the antibiotic doesn't completely kill this bug or this bacteria, whatever it is,

whether it's E. coli or chlamydia or gonorrhea, it can set off something called molecular mimicry. So I'm sure you're familiar with that term, but for your listeners who are not, really it's a bacteria or a bug infects a certain area. A lot of the times in these type of conditions, it's the prostate or the seminal vesicles or an area around the prostate. And the bacteria kind of hide. And when the antibiotic gets to it, they kill it off and the bacteria still remains or some part of the protein from that bacteria still remains in the prostate or pelvic area. Now, there's technically no bug there, right? But the immune system identifies it as something that is not self so it sees this protein it says oh man there's

this bug here there's this bacteria here we have to kill it and the body tries to go after it and it elicits an inflammatory response and that's the pain that a lot of these men are feeling but there's no bug there right there's no bug so when you give an antibiotic you're trying to kill something that is not even there right so now you're continuing to kill the good bacteria that are supposed to be protective. And that creates this whole idea of molecular mimicry, where this bacteria is mimicking the molecule of, or the protein on the bacteria is mimicking a molecule on the prostate or the pelvic area that the body identifies as non-self. And then it continues to attack it, attack it. And that's how we create chronic inflammation, chronic pelvic pain.

Now, these bacteria can range from anything from gonorrhea, E. coli, but I've seen a lot of Lyme disease tends to migrate or be focused in the pelvic area. And Lyme disease, oh yeah, certainly. And especially here, I'm here in Connecticut in the Northeast, Lyme disease is all over. so that's that's a something very common that i see where lyme disease and it's also oftentimes missed because what do you think of lyme disease you think of bullseye rash fever joint pain chronic fatigue but when you have a guy who's just experiencing chronic pelvic pain and this is this ties into the other issue right when men are they don't want to go to the doctor it's like all right i'm coming to you for my pelvic pain i don't care about my blood pressure

I don't care about my headaches. I don't care about my joints. I don't care about that stuff. I don't care about my penis. Fix my penis. My penis hurts. What now? Right.

Right. Exactly. Exactly. Do something for my penis. Exactly right. So tell me about the Lyme disease. So how does one have underlying chronic Lyme disease? Is it from just having a tick bike?

Is it transmitted otherwise? and what are some signs and symptoms other than, you know, pelvic pain that a guy can look out for to rule this out? Right. So, you know, when I have somebody with pelvic pain or prostatitis, chronic prostatitis, acute prostatitis, oftentimes I don't see as Lyme. Lyme, if it's acute, you know, they have to pay attention to the bullseye rash. That's usually pathognomonic, But most people don't show that bullseye rash. They have to pay attention to chronic fatigue. They have to pay attention to joint pain.

They have to pay attention to chronic headaches or migraines. But the issue with Lyme is that it's actually nonspecific, right? Because that could be, I mean, you name five other things. It could be, yeah, well, I have that. You could even talk to people who don't have Lyme disease, and they might say, oh, yeah, I have those symptoms. So when I have somebody who has chronic pelvic pain that is resistant to typically a lot of the things that I'm approaching them with, I have to say, okay, let's think about Lyme here and what might be going on. And now oftentimes, and I see this a lot more, is that it's not even the Lyme, but it's the co-infections that go along with Lyme.

so you know there's other tick-borne infections that are transmitted along with Lyme and but the hardest part is that these tests are very hard to interpret and depends who's looking at them because you ask one person they say yeah you don't have Lyme and then you ask another person like oh yeah this is Lyme absolutely so you really need to take it on a case-by-case basis but my question is if, and one of my instructors in med school mentioned this to me, he said, okay, I'm taking a hundred people. I put a hundred people in a room and then I take strep, like strep throat, the bacteria, and I throw strep in the room where it touches every single person. Does every single person get strep? I would say no. No. Right. Good answer. Okay, great. Yes.

that was not a leading question but i'm glad you got it or else i would have looked really dumb not my intention whatsoever i felt like i was back in grad school okay it was just like quick thinking yeah take your chance right right all right so not everybody gets strep and that's the same thing with lime is that a lot of people come back with positive lime but is it really the Lyme or is it their body's inability to handle and suppress the infection or the Lyme or the virus? And that's really the underlying question is because you can continue to go after the Lyme, you go after it, I mean, attack it, but your body at some point is going to need to fight it on its own. So what are you going to do? Are you going to give somebody doxycycline for their whole life?

no and and a lot of times that a lot of men are doing better when they're on doxycycline but it's not because the doxycycline is killing the bacteria it's because doxycycline is partially anti-inflammatory right so we're we need to focus on why that inflammation is actually occurring and then you know if it actually is a Lyme infection that's never been addressed then we go after the Lyme and I use a lot of herbs I use herbal medicine to go after the Lyme infection and then I try to strengthen the body from the ground up. But one thing that I've seen and a lot more recently is that Lyme is a underlying cause for chronic pelvic pain and also interstitial cystitis, which, you know, let's not forget about that. That's also considered part of

pelvic pain, which I'm sure you see a lot of. Right. Could you just, for the listeners, you know, some might not know what interstitial cystitis is. Could you kind of talk a little bit about interstititis? Sure. So I see is, so there's cystitis, which is inflammation of the bladder, right? And interstitial cystitis is, well, we won't really exactly know exactly why it's happening, but it is an inflammation of the bladder and it can be due to the interstitial cells that the bladder makes up. And some people say it's an autoimmune condition. Some say it's an allergy type of condition. Some say it's a hypersensitivity. The consensus is a little bit mixed. But the bottom line is that the body is overreacting and creating an inflammatory response

in the bladder that is not caused by a pathogen or a known substance. So it's kind of like fibromyalgia where you know it's these people have chronic pain all over their body and we're not really sure exactly why is it neurological is it immune related is it endocrine related and i believe ic is all of the above and you really need to get down and address every single aspect and hit it from a variety of aspects so you can actually get to the underlying cause so basically it's it's bladder pain uh and and this happens a lot in men too but it's misdiagnosed because it's usually a condition of women have you ever seen men with ic i have actually i've i'm actually treating a few and i think they're calling it um painful bladder syndrome now or

yeah um bladder pain syndrome i think the common terms are now but yeah i i have and and honestly to be honest with you i think they've been misdiagnosed you know they're they're giving them um you know interstitial cystitis sort of like fibromyalgia where it's like well we don't really know what's happening so we're just going to label it as interstitial cystitis and in my opinion it was just it wasn't you know no and sometimes it could just be i call a trash can diagnosis it's like well it's not an infection and it's not your kidneys and it's not your uterus or it's not your prostate so we're going to just call it ic and that's what it is but i see a lot of studies and you know um i've seen this go both ways where it's accurate and not accurate but

i've seen ic been related to someone's like leaky gut yeah where it could be like a leaky bladder and these cells start becoming um permeable and they start overreacting and becoming similarly to uh you know ibs where they're just reacting to every single thing but you know Interestingly enough, Lyme disease, one of my colleagues for her thesis in med school found that Lyme disease tends to hide in areas with minimal or low blood flow or vascularization. The bladder, actually, because of its type of tissue, its blood flow is less than what it is in other parts of the body, similar to the prostate, and the joints as well. Those are areas of the body that have indirect blood flow where it's through a diffusion type of method.

So I've seen some people also have IC from Lyme, and it could be just because the immune system is unable to get to that area and attack the pathogen. So I've seen that as well. wow that's fascinating so you just blew my mind right there so how does how does one so like let's say a guy has these symptoms first of all who should who should he see and what should he be requesting or what should he be looking for in a practitioner um very much so like yourself obviously you do a really good job of thoroughly assessing from the ground up and making sure you're ruling out any underlying causes and you're getting to the root of the issue. So to help these guys out, is there anything specific that you would directly recommend

that they ask or seek before taking any treatment? Yeah, absolutely. I think before a man takes an antibiotic for a prostatitis or a pelvic pain, he should try to identify the actual pathogen and try to ask their doctor to do a culture they might do a urine culture they might do a semen culture to see if they can identify what the specific pathogen is just to make sure that you're actually going after a bug and if they are reluctant to do that because a lot of doctors are just going to trigger symptomatically and just say all right well i don't care if it's strep or E. coli or staph or chlamydia, you know, I'm going to go after it with a specific antibiotic and see if that helps. Now, if your doctor is being stubborn and is just going to say,

no, I'm giving you this antibiotic, don't fire him because he's, I mean, he's not, he's technically not doing the wrong thing, but he's not supporting you in the long run. because what happens when that antibiotic stops working or it doesn't work and it leads to chronic prostatitis. So what I would say is if you're going to see a medical doctor for chronic prostatitis or chronic pelvic pain, you want to make sure that this is a condition that he sees often. I can tell you right now, most of my chronic prostatitis patients are referred to me from the urologist who can't figure it out. And they're just like, all right, go see Dr. Esposito because I can't give you any more antibiotics. There's really not much more I

can do. So you need to make sure that the doctor that you're seeing actually has seen this quite a bit and understands that a treatment can lead to chronic pelvic pain or chronic prostatitis if they don't support the body in the first place at the first time around and actually abolishing this bacteria. So unfortunately, and you know this as well, that a lot of medical doctors are not very well versed in herbal medicine and functional medicine. So you want to find somebody who is at least open to it and say, you know what, it might be helpful. Or they are a medical doctor who does specialize in this. I'm in this field, and I don't know anybody personally who specializes in both the conventional and the functional aspect of urology and chronic pelvic pain.

So then if he is only going to give you the antibiotic, then you say, okay, who do I have to see in order to help me allow this antibiotic to work better to try to get to the underlying cause and make sure that this doesn't come back? And I think a functional medicine practitioner or a naturopathic physician or holistic practitioner should be competent enough to say, all right, you're on these antibiotics. We need to make sure you have enough probiotics. We need to make sure that we give you some herbal antibiotics and herbal, well, I call them herbal antibacterial substances that will potentiate and allow this antibiotic to work better. And that's really what you want to do because if you don't, you're going to go down this rabbit hole of still chasing a pelvic pain that has no absolute cause or really a bacteria is not the actual cause.

so you want to make sure that you have somebody who's going to support you on on both ends so what i do with most of my patients is i tell them okay you want to get the antibiotic that's fine i don't think it's going to help you but i i hear you like what other options are there um from your medical doctor so you could take it that's fine but we're gonna also add um certain herbals i like to use artemisia which is a great herb um i like to use green tea actually a lot of studies have shown that green tea can potentiate and enhance the efficacy of certain antibacterials antibiotics in the pelvic area so i've read that that's it's awesome yeah do you like to do just like an herbal like is it tea enough or do you prefer um the herb itself in terms of potency

so i like to do um if you're going to do the tea it has to be about eight cups a day that's a lot yeah so yeah so a lot of bathroom trips exactly and it's caffeine too right so caffeine is also a trigger for it can be a trigger for pelvic pain right so because it's stimulating to the prostate stimulating to the to the bladder stimulating to the urethra and it causes irritation so um i like to do a capsule or an extract where they could just do like a few drop or fold a day or just take a few capsules a day and it'll potentiate the antibiotic. And then artemisia, which is a phenomenal herb, is one of the strongest antibacterial herbs that we have. And that works phenomenally well. And the great thing about these herbs is that

they evolved with these bacteria. So the risk of bacterial resistance is pretty low. And I actually have not seen many uh people tell me that you know these these herbs stopped working i mean they've been around for millennia so yeah yeah exactly so that's the that's the approach that i like to tell people when they are going to their medical doctor and they it takes it takes a village to help somebody there if if your doctor says i have all the answers run really exactly you're right on right yeah I tell people myself I said if I ever tell you if you ever hear the words from me that I have all the answers fire me because that's just naive there's no way that I could have all the answers I'll try to figure them out and I'll do whatever I can but if anybody

ever tells you that they know exactly what's going on now granted I see a lot of pelvic pain I see a lot of prostatitis. I see a lot of, um, uh, penis pain. So, uh, yes, I could probably figure it out, but I can't figure out everybody. Right. And I'm sure you, you're in a similar situation. Yeah, absolutely. There isn't a one size fits all protocol. So it has to be very individualized and customized to the person that's sitting in front of you telling their story. and bringing in their story and their experiences and their beliefs and what's happened in their life. I mean, it can be very complex but yet simple at the same time

if you just listen, you know, and give space. The patient will tell you. Men, I'm speaking to the men right now. Like, guys, please speak up. Tell us what's going on. Don't hide it. It's okay to tell somebody that you're in pain. It's fine.

You're not going out and you're not posting it on Facebook or Instagram. You're telling your physician who's there to actually help you. So don't be ashamed. It's really nothing to be ashamed about. And you and I both know, how can I help you if you don't tell me? Right. That's one of the biggest obstacles. And that's when we get back to, you know, the men don't want to go to the doctor.

Well, why don't they want to go to the doctor? Well, because they're ashamed. Right, right. And they just don't, they feel like they're the only ones dealing with this. And it's not true with over, I think the last statistic I read was over 2 million outpatient visits alone for men are with pelvic pain. And that's in the U.S. alone. I know. And that's a problem.

Yeah, it is a problem. It's a big problem and nothing to be shy about, for sure. You know, you don't have to suffer in silence. Right. Probably life is important, you know. And younger guys especially. Yes. People have these symptoms earlier on, like in their 20s.

And by the time they see someone like you or I, it's several years later. And then we have to reverse years of damage. Right, exactly. There was a study out, I believe it was from the Cleveland Clinic, that 40, I believe it's like 40, I did a post on this, I did a blog on this, 48% or men, the first person that they go to regarding a health issue is who? Guess. Oh.

who do they go to who they go to first oh their spouse yes yes trick question again okay well i'm yeah i'm married to one of those men that don't go to the doctor you know like he just does not no way he'd rather take care of everything himself and and he does confide in me yeah a lot it'll come to me like what do you think about this should i go to the doctor yeah like okay i'm a guy right and if i and one of my guy friends came to me and was like my penis hurts i was like okay well you need to go to the doctor like it's just like and if i went to him and i said hey my penis hurts he would say okay you need to go to the doctor like they know they know they know what to do but they're just the

testosterone gets in the way and it just frustrates me so much but you know 12 go to the doctor yeah 12 of men go to the doctor first regarding a health issue isn't that like staggering yeah yeah that's like if you get sued who do you go to first a lawyer yeah right right that's that's how i approach it but men it's a mental game the mental game is a real struggle it really is it really is it is real and men when it comes to their their pain it's a lot of the time it's a mental aspect now i do not want to sound like the doctor who's like oh it's all in your head i hate that that really irks me because okay it's all in my head now what what do i do do i just go ahead and get an antidepressant do i go take you know an ssri do i take i don't smoke

weed like what am i supposed to do if it's all in my head but this is actually how men work and i think we spoke about this on the set at a separate time um if a man comes to me and he has a pelvic pain of a eight out of ten i could probably pretty confidently get that pain down to two or three pretty quickly i would say within a few yeah that's pretty good right nice work yeah i know thank you i should applaud for myself no but you could do the same thing too and and and that's the beauty of our specialty is that we know how to do it and we could do it pretty quickly right now instead of them spending years going to the medical doctor or another physician and they're just like throwing antibiotics or

here's a Tylenol or here's a anti-inflammatory. Um, but if that guy is constantly having this pain and he felt that pain once in his left testicle, okay. And I told him, let's say his pain is down to a one. And I said, John or Joe or whoever, think about pain in your left testicle. They'll recreate it right yeah and they will recreate it very quickly so ben can mentally create this pain because they there's a mental pelvic or mind pelvis connection and i'm sure you talk a lot about that as well i do a lot a ton and pain is 100 constructed in the brain structurally not you know not just the mind psyche mental thing but um in order to for it to be a threat it is a it's remembered and then the rolodex in the brain and then the whole neural tag and the and the

motor cortexes they all kind of talk to each other and then spit out a response right like is this something we need to be worried about or is this something that we need to be chill about it's kind of like um like a bruise right we've all gotten a bruise before and we oftentimes wake up with it we're like how the heck did that happen right like you know you have tissue damage a bruise that's black and blue but you have no idea how that happened because it wasn't on your radar and it's not painful right exactly right and men are the same exact way with their pelvic area so i i often tell my male patients you know we got this pain down to a one out of ten and if you want to recreate it it it can be a five if you wanted to but as much as you can

make a one out of ten pain and by the way a one is like no pain right if you can make it a five out of ten just by thinking about it you can also make it a zero out of ten right and that's the hardest part is trying to get men to commit to mindfulness and that is huge that is huge in my practice. Um, and I'm sure you do a lot of mindfulness. Uh, you know, I was looking through your book, uh, briefly, and I saw a few aspects where you talk about the connection, you know, the stretching and, and a lot of those, those stretches are really just being aware of releasing that pelvic floor and that pelvic area. Absolutely. So, so, you know, getting men and, oh, and you tell a man a macho man who's a construction worker or uh you know a top-notch ceo

i need you to do yoga i need i need you to do meditation i know do you know what kind of looks i get like deer in the headlights are you crazy oh i get i'm not doing that crazy stuff I'm not I'm not doing chakras and and humming and and all the spiritual stuff I'm like yeah yeah nobody's telling you to do any of that I just want you to stretch your pelvis dude and breathe how about we just start with breathing because oftentimes they're just so the the patterns of breath holding they're they're significant breath holding under stress with physical activity emotional I mean we I'll do it too I'm notorious you know for for you know under stress i'm on the go and you know you'll kind of just take a deep sigh and you're like

wait a second that felt really good i don't think i've been doing that at all and then you become a shallow breather and then that just kind of hypes up the nervous system and so forth and so on so absolutely right so teaching people how to breathe it's something that we do subconsciously all the time but you need to actually they need to know what breathing is like and um this is why i love acupuncture have you ever had acupuncture done i have i love acupuncture and that's i was just going to ask you a follow-up question about your approach because um i'll tell you this much you know when we get these guys coming to our office i don't know if you've had this experience but they've by now by the time they see me or you they've spent astronomical amounts of money

on other treatments and they'll look at me and say how can you what's what's so different about yours right right and what's you know when they ask you what's different you have you have your own unique approach and my unique modality is acupuncture and acupuncture in and of its own is well i call it meditation on autopilot right so if you get somebody so acupuncture works it's traditional chinese medicine been around for thousands of years um but it was actually standardized um after you know in the cold war post-world war ii era where we standardized it to a point where it can be repeated and tested over and over to follow a pattern right and a lot of the times i'll notice in my men with uh prostatitis pelvic pain is that acupuncture

whatever you think it does on a physiological level if it does anything at all it just forces the brain to breathe deeply comfortably and that of its own will reduce stress levels not even discussing releasing pelvic floor muscles releasing you know the adductor muscles and in the leg or your groin muscles not even talking about that just having people breathe acupuncture lets people leave the office feeling better automatically right but it also so a lot of men who are having pelvic pain they get they have a lot of congested energy in that area right and they'll um when they hold their stress that's where they tend to hold their stress like you have people who have Crohn's or colitis they hold their stress in their you know their abdomen area or

their uh you know their colon area yeah they're always butt gripping yes exactly like please just relax relax your anus don't be so anal yeah don't be so anal retentive right but that's the that's the case with acupuncture excuse me with pelvic pain as well is that these men are holding it in their pelvis area and then they experience other issues like rectal dysfunction and then they start becoming more conscious of themselves. You know, I was reading a study recently that said that one of the biggest causes or the most common causes of erectile dysfunction in younger men is pelvic pain or chronic pelvic pain. Now, this means testicular pain, this could be prostate pain, it could be bladder pain, or just generalized pain in the area. But that's a common cause for

erectile dysfunction, and nobody's talking about it. I see so many people, 16 years old, 18 years old 20 years old and they'll come to me and you know it's like yeah i have pelvic pain or i'm sorry i have this pain or that pain and then all of a sudden it's like oh yeah and i also have issues with erections when i want to have sex and they're embarrassed at 20 years old at 18 years old they're like because i remember when i was younger all my older guy cousins they were like oh man you know i saw this girl and she was so hot and you know we went into the room and we did this and that i'm like oh man like wow that's what being a man is like and now you have an 18 year old guy who's around all these people even his buddies or if he's in college and he's like wow

my my pelvic area my penis hurts like i don't like i don't know if i could actually do this and then it becomes a mind game but acupuncture can reset that and it works on the brain pelvis this connection to allow the mind to relax, allow those pelvic muscles to relax and increase blood flow, increases the neurological response in that area. So it'll allow the body to calm down. And I've seen acupuncture work very, very quickly. And that's, that's one of the benefits that I see the acupuncture that it works much quicker because it allows the body to heal from the inside out. That's awesome. I mean, I, I'm a huge believer of acupuncture has helped me in so many ways um with illnesses and anxiety and all that sort of thing so acupuncture is awesome but uh

i have to ask you are is everyone created equal and what should we look out for in an acupuncturist if you're going to go see someone for pelvic issues in particular okay so this is a little bit of a beef i have with acupuncture the technical term for acupuncture means you put a needle in somebody or you put an acupuncture needle in somebody, right? You penetrate the skin to insert acupuncture needle at a specific point. Now, that doesn't mean that they're practicing traditional Chinese medicine because you can actually stick an acupuncture point in a trigger point area and that pain might go away. But traditional Chinese medicine, there's a root and a branch. Now, when we put a needle in an area that's painful, we call that

the branch treatment. We're treating the symptom, we're treating the outside. But now with traditional Chinese medicine, it looks deeper and it creates, and you try to identify the pattern that that person is creating. So your pelvic pain, it may be different than my pelvic pain, may be different than John's pelvic pain, right? So when you go to a Western physician, they say okay it's pelvic pain i'm going to approach it this way but when they see people like you and i we understand that every person's pelvic pain manifests differently and that's where acupuncture becomes a big factor because there can be just you know just for pelvic pain there might be three or four different patterns that i identify and i say you know what your pelvic pain

is because uh your pelvic pain in this area is caused by this type of pattern because you also have intestinal issues. You'll also have insomnia. You also have acid reflux. And your pelvic pain is located more in the perineum area, so between the anus and the scrotum. So I think your pelvic pain is more of a damp heat presentation. Whereas other people, it might be like a tight feeling that they feel and like tension and pulling that they feel in their pelvic area. And they might be really high strung and they get very angry very easily. And they might be very irritated, which is different than the other guy who's just like really like mellow and laid back but kind of like has given up really like low motivation those are two different presentations they're both pelvic

pain but you know putting a needle in the location that will help with the pelvic pain might help but it may not hold so when you see somebody who does just acupuncture who puts needles where it hurts we call that dry needling so you want to make sure that the acupuncturist that you see has a um has a license so they it would be lac so licensed acupuncturist comparatively because there are a lot of other medical doctors and even some physical therapists and chiropractors and even naturopaths who um who just you know insert acupuncture you know they did like a weekend course or something and now they're doing acupuncture so you really want to make sure that that person is a licensed acupuncturist but you also want to make sure that that person has

seen this condition before because just as much as people as men don't want to talk about this issue you know you also have to assume that not everybody's going to go these men are not going to go to the doctor to see somebody for this problem but they may go to the doctor if they know that that person specializes in that area like if like if you have um let's see like if you have like alzheimer's or dementia right i certainly do treat a lot of alzheimer's of dementia. But if I know somebody who specializes in just that and sees that all the time, I'm going to tell you, you know what, you might want to see this person because they have a lot more experience with this and vice versa. That person might say, you know what, I see a lot of Alzheimer's. I don't

see a lot of pelvic pain. You might want to go see Dr. Esposito. So you want to make sure that somebody actually has some experience with it. And you could just call their office and say, hey, you know, do you deal a lot with pelvic pain? You don't have to say my penis hurts. you could say you said you deal a lot with pelvic pain and they'll tell you yes or no if they kind of beat around the bush like oh yeah you know we see all conditions i would probably pass i want to see somebody who does this that's that's really important because you don't want to waste your time waste your money and leave there feeling you know helpless and then you create another cycle of like oh man nobody can help me nobody can help me and that in itself

is more difficult. It is, it is. And that's, I don't know if that's who you see, but that's certainly lots of people who reach out to me. They've already, they're just so desperate and they've spent so much money on other treatments and they've, you know, quote unquote, tried to acupuncture and herbs and so forth and so on. And, and at that point, like you said, yeah, it is very, it's a, it's a construct that is, is becoming to be more like sandstone versus sand, you know it's nice analogy yeah thanks can't use that yeah of course you can absolutely anyone can um but yeah we it's it's difficult it's difficult to chip away at that at that point but it's not impossible because you've seen it i've seen it it's it's not impossible at all it just takes a

little longer and it takes a little persistence and patience and determination and and really i think for me and for the message that i sent to guys is patient acceptance in some way or form is don't resist so much of what's happening it'll be easier to let it go absolutely right that is it's half the battle and again that speaks back to the to the mental pelvic connection where people are not they want to ignore it why why do you want to ignore that condition it's it certainly is bothering you so don't pretend it's not there because pretending it's not there is not going to get rid of it and i often tell people you know set up reasonable expectations now with acupuncture we usually say for every year that you've been unwell it'll usually take a month

to see some progress now that is not you know always accurate sometimes it's longer sometimes it's sooner but if you've been unwell for two years three years i'm not going to cure you overnight i'm a physician not a magician yeah you're a physician not a magician exactly there's no magic cure magic pill if there were it we wouldn't be in our profession but i want to give i want to give your listeners and i want to give the general public whether the person that's listening is having pelvic pain themselves or their partner i'm going to assume that a lot of men are going to be listening to this but it's also could be women who are like yeah my man or my uncle or my brother is well i don't know if a brother would tell his sister that he's having

pelvic pain but wait a second i gotta interrupt you my brother sorry bro so this was before i even went to to um i was in grad school and he comes to my room so why i address this to my bro he's probably gonna be listening to this but you are my bro as well but um he comes into my room he goes can I ask you a question and I said yeah what's going on he's like well it's somewhere private and I said okay well what's going on and he's like what's on my balls and I said yeah yeah okay I mean get this he's like he's like 20 years old right and I'm like all right well he's like well I'm gonna have to show you though and I said fine you know show me what's going on he's like well I'm gonna move everything out of the way but he had varicoseal and he was so he yeah it's like

the torturer's vein and the testicle and and he's like well it feels like a bag of worms exactly what they describe it as right a varicose which yeah technically and it's harmless for the most part right my understanding is it's harmless but he was so freaked out and he was living with this for over a year oh my god what are you doing seriously doc like he was for a whole year struggling to just come up to his sister to ask hey now that you're in medical school can you tell me what this is and you know that is a common cause of low testosterone really yes it is certainly because if the uh the venous system there and the arterial system there is not getting enough blood flow right testosterone is mainly most made mostly in the testicles

where's it gonna go right it's not it's not gonna it's not gonna diffuse by asposis from the testicles to your you know whole body it that is a common cause of low testosterone and then you add stress to it because now you're freaked out and he's freaked out and he's like why the hell is there a bag of worms and then now imagine he's gonna be in if he was with another woman or a guy or you know i don't know where he is in that aspect right but if he's with somebody else a partner okay and they're like oh man like that feels unlike what i'm used to then if that person responds he that scars him forever right and that can lead to more pelvic pain in the long run and it creates it creates a cycle where this whole idea of like oh man if i be if i'm with

somebody are they going to notice this again but what do i do if they do if they notice it and to be honest if you are with somebody who's your partner right and they're with you because of that emotional spiritual aspect they're not going to dump you just because you have pelvic pain and it's causing an issue in your um your relationship certainly it does cause problems and it is frustrating on both ends but they're not going to just be like oh well he has pelvic pain i'm out and that's where a lot of men really get into their own head where they kind of convince themselves of issues that do not even exist most of the times i'll tell men they come in like yeah i have this pelvic pain and what if i transmit it to my to my girlfriend or to my wife and i'm like

transmit what right what are you transmitting oh but you know like if we have sex and what if this is a bacterial and like what's it what if this is lime and then this whole thing like now they're saying that lime or i've had a few people come up to me saying you know there's research showing that lime is transmitted of you know via sexual intercourse and and there is some possibility of that but there really have been no proven cases of it right so let's not make up a disease let's not make up a condition let's treat what is actually here and then we'll deal with that if that comes across so it certainly is a mind a mind thing as well but you know that's similar with ibs right and ibs i've seen go hand in hand with uh with pelvic pain and usually if you treat

the gut and you know it's a it's a uh a common saying in naturopathic medicine is treat the gut when in doubt when in doubt treat the gut well that's not i mean that's not wrong it certainly does work but the gut oftentimes the colon is very close to the prostate i mean in order for me to fill your prostate i need to guys don't cringe i need to do a digital rectal exam i stick my finger in where's that finger going um up the anus and i palpate and feel the prostate through the colon and there is so there are and this is really interesting um it's in one of the textbook chapters that i i uh published that when uh there are nerves that innervate the colon but they also can innervate the uh the prostate and they can communicate and it can there are bacteria that

can actually activate that part they activate that colon the part of the colon that's very close to the prostate and and irritate those nerves then it actually can irritate the prostate so it may not even be the prostate it's the colon exactly right isn't it fascinating yes yes can you tell everyone what books that you that you wrote a chapter in oh um well yes healing and neurology So you'll find a lot of this information in that textbook, Healing and Neurology, with the publishers are Bilal, Dr. Gio Espinoza, who I worked with, and Amy Stein. Dr. Gio Espinoza is at NYU. I trained with him for about five to six years. And so you'll find a lot of this information in that book as well.

And then I have a few other chapters and other sexual health books as well, which are not out yet, but keep an eye out for them. they should be coming out in the next few months or so but you know i when i was reading and doing the research on this i'm like oh my god this makes complete sense because i knew like if you have to fix the prostate you really have to treat the gut as well and you'll see this a lot in chronic pelvic pain is that you treat if you do if you dose them high with probiotics they actually their prostate pain gets better so a lot of the times i'm not sure if it's the actual prostate or the colon but i'm sure there's a certain i'm sure there's a communication thing that's going on there and i wanted to bring this up um have you ever heard of people injecting the prostate

wow the first i heard was from you actually from a previous conversation about the antibiotics directly injected into the prostate that is not i don't have a prostate but oh my gosh i am like clenching down there because that just sounds not so fun. It sounds like what you do for fun on a Friday night, right? Right. Let's inject her prostate. No, tell us about it. Okay. So this is a pretty new procedure that I have seen and not many people are doing it. And I'm not quite sure what to think of it yet, but I have had a few patients who went through it. And one particular patient, he started off with a pelvic pain. Um, and by the way, this patient had Lyme. Um, he started off with pelvic pain. He got his Lyme under control, but the pelvic pain wasn't completely

gone. And after treating the pelvic pain with acupuncture and herbs, we got his pelvic pain literally to like a two, two or three. And then he was like, you know what? I don't, I want to try this this thing where he saw a physician who injected his prostate with several antibiotics amoxicillin doxycycline um ciprofloxacin wow and you know i was like why okay i i experienced a lot of men who go for prostate biopsies and they tell me i would never do that again ever right Because it's painful, you start urinating blood, or you start having blood in your stools. It's not fun. Risk of infection can happen.

But now you're injecting the prostate with these antibiotics because the issue could be a bacterial infection, and the prostate might be a hard area to get to. But for me, for myself, you're injecting the prostate 20 times with an antibiotic without even knowing if there's an actual infection there. and a lot of the times men might notice relief but is it because that antibiotic is anti-inflammatory or is it because it's anti uh it's an antibiotic it's killing the bacteria so you know and there's one patient who's telling me that he was urinating out um for lack of better terms like white debris like i was like are you are you urinating out like like kidney stones like what are you urinating

out and it was very it was very fascinating and i haven't really bought into it yet and i don't know if I would advise a lot of my patients to go ahead and get injected 20 times with an antibiotic but it certainly does exist you know like I know I mean and that inducing I mean that's not pleasant I'm sure I mean are they anesthetized I don't yeah well it was painful he did mention that it was painful um it was very uncomfortable uh and it didn't resolve his issue his issue went the pain was still at a two or a three out of 10. He had some relief for a few days or actually it was like about two weeks. He's like, yeah, my pain is down to like a one, but again, it was still not a zero. And that's where the difference happens where, you know, you can get the pain

down all the way to a one, but you really need to like knock it home in order to get that away. And that's where the mental approach comes in. But to have injections in your prostate, i mean geez i know men who avoid that at all costs and now men are going after it so it's certainly and that's something that i want to tell a lot of your listeners to pay attention to is if somebody does tell you to do that um just make sure you clear it with your urologist make sure you clear it with your um you know the physician who's handling your problem because you don't want to open up another bag of worms especially for something that's so new yeah and but it's it's people, you know, these guys are desperate and they've been frustrated. And I, I totally

understand where, you know, I understand. I can only imagine the frustration and the scarcity of, um, getting quality help out there. And, um, but this is why we're doing it. This is why we're having the conversation. This is why I thought it was so important to have you on the show to talk about these things. And you really hit some really major points throughout this entire conversation and um hopefully that will help spread the message to to guys sooner so they don't have to wait or suffer in silence anymore and honestly how could um because i appreciate your time so much and i could go for hours don't worry don't worry guys we're gonna have more shows with dr esposito on the show he's fantastic how i encourage all of you guys if you have issues to

connect with dr esposito how can they connect with you doc okay so um there's several ways you can find me on my website doctor spelled out d-o-c-t-o-r-e-s-p-o um growing up everybody used to call me uh espo so it's dr espo.com e-s-p-o uh you can check me on instagram at the same tagline dr espo uh facebook i'm on facebook as well and then i practice in uh connecticut in um in in bridgeport connecticut i also practice in danbury connecticut and um you know i teach in bridgeport but a lot of my patients uh do virtual consults as well so if you can't come in for the acupuncture or come in for the actual approach a visit a lot of my patients do reach out to me via you know skype or things like that because to be honest as you know uh not a lot of

people are doing this. Not a lot of people specialize in this area. No guys, Dr. Esposito is wonderful. He's so integrative and, and really just specific for male, male health in general, I think. Um, and, and I think what you're doing is fantastic and fabulous. And yeah, thank you. I'm so grateful to number one, be on the show with you, but just somebody who I can speak to who's like, yeah, no, I feel that, that I see that all the time. And then, you know, rather than speaking with somebody who's like, oh yeah, you know, pelvic pain, we just give them an antibiotic and it goes away. It's like, like you, you are so in tune and I love it. It's great. Oh, thank you so much. I mean, you know, great, great minds think alike and we gravitate to each

other. So I see a lot of great things in our future together and collaborating. So all you guys out there, um, there's hope, you know, keep it alive. Um, don't let pain bring you down and And any links and Dr. Esposito's bio and all that, his books, they'll all be linked to this show. So you can connect with him later and check those links out for sure. But Dr. Esposito, thank you so much for being on the show. I really look forward to having you again very soon. Oh, it's my pleasure. This was a blast.

I could talk about this for days. And I tell this to my patients every day. This is not work. This is fun. i i and i can see i can hear it in your voice as well as that this is not like a job for you and i don't think i'll ever work a day in my life so i it's a pleasure to connect with like minds and this is going to be great i'm sure your listeners are gonna eat this up thank you so much dr esposito you're wonderful oh my gosh likewise same here such a great passion energy i'm looking forward

to it so thank you guys thank you to all the listeners out there if you have any questions feel free to email me drtizzyg.com. We'd love to connect. Thanks so much. Thank you.