Ologies with Alie Ward - Urology (CROTCH PARTS) with Fenwa Milhouse

Episode Date: May 12, 2022

We’ve done Nephrology, Gynecology, and Phallology — but nothing prepared us for this. Penis implants. Road trip pees. Kegels. Bidets. Squirting. UTIs. Clitoral flim-flam. Elephant bladders. Everyone’s favorite Urologist, Dr. Fenwa Milhouse, makes chatting about the uh, juicy stuff effortless and easy. Like peeing should be. She humbly describes herself as a crotch plumber, but she’s so much more: a surgeon, a mentor and an inspiration. Dr. Fenwa Milhouse on TikTok @yourfavoriteurologist or Instagram @DrMilhouseMore links at Alieward.com/ologies/urologyYou may also enjoy our episodes on Nephrology (KIDNEYS), Gynecology (VULVAS AND SUCH), and Phallology (PENISES)A donation went to UrologyUnbound.orgSponsors of OlogiesTranscripts and bleeped episodesSmologies (short, classroom-safe) episodesBecome a patron of Ologies for as little as a buck a monthOlogiesMerch.com has hats, shirts, masks, totes!Follow @Ologies on Twitter and InstagramFollow @AlieWard on Twitter and InstagramSound editing by Jarrett Sleeper of MindJam MediaTranscripts by Emily White of The WordaryWebsite by Kelly R. DwyerTheme song by Nick Thorburn

Up top, mom, dad, don't listen to this one. Thank you. Okay. Okay. It's the bandaid on the sidewalk. You really should pick up, but you don't want to at all. Allie Ward, I'm back with an absolute banger. An instant classic, wow, urology, I never suspected, but I should have. So let's not waste a drop of this. So urology comes from the Greek for the study of P, and I will be honest, I had no idea at all what this involved. It's more sexy and weird. You will not be pissed that you listened. So this guest is your favorite urologist, literally. That's her handle on social media. She earns it. She got her MD at the University of Texas at Houston. She did her residency at the University of Chicago and is currently a urologist in Oakland, Illinois, just south of Chicago,

but also all over the world as she addresses your down there parts on TikTok for hundreds of thousands of strangers. She loves her job. We love her. So I also love you patrons for, oh, you send in some great questions. Join at patreon.com slash allergies for a dollar a month. You can send in your questions. Thanks also to everyone who keeps us up in the charts by actually subscribing and with your ratings and reviews. I read them all, and then I prove it by reading one. Thanks AWIX who left the review. This is great, but can there be otters? They continue. I dreamed that there was an episode on otters and not realizing it was a dream, was absolutely crushed when I couldn't find it. Any chance of an otter?

Neutrology episode? AWIX, we ought to get that up ASAP for you. It's a great suggestion. Okay, onto your crutches. And reminder, this is a podcast. This is not a doctor's appointment, so if you need medical advice or treatment, please see a doctor in three dimensions. But right now, take a seat for penis implants, sex, head resources, elephant bladders, road trip peas, split streams, trampoline anxiety, the magic of pelvic floor workouts and what they are, prostate stimulation, refractory period statistics, clit worship, squirting, cranberry research, anatomical flim flam, and why every family should have a urogenital specialist in it with physician and urologist, Dr. Fenwa Milhouse.

Dr. Fenwa Milhouse, my pronouns are she, her, and hers. And now, you're not just a urologist, you're our favorite urologist, correct? That is correct. That is correct, Allie. How did you land at that handle? I mean, other than the fact that it's just true. Exactly, right? What else needs to be said? No, I, gosh, I started my Instagram, Dr. Milhouse's Instagram, I think in 2000, might have been 2018 or early 2019. And there's very few, there are still very few urologists kind of using social media to educate, more and more cropping up. And I was like, I'm just going to be your favorite urologist.

And so, I use that hashtag and it's stuck and I'm working to trade market actually. So, are you? Yes. Oh, yes. Some amazing lawyers reach out, right? Yes. Yes. That's the best. Okay, you mentioned that there aren't a lot of urologists, but you are one. How did you decide like, beep, bop, beep, bop, okay, I'm in the right spot? Yeah, so that's what medical school is about. Very few doctors, I think, know from the jump, this is what I want to do type of doctoring. For me, it was, I was like, I'm just happy to be here. Thank you for letting me get in. I'm going to be somebody's doctor someday. And it was like,

okay, process of elimination. I love my own kids and some others, a few other people's kids, but I knew I didn't want to do kids for, you know, doctor kids. So, I crossed that off. And urology really, I didn't even know, I didn't know what it was when I was in medical, when I got to medical school. I remember a friend saying, I want to be a urologist and I had to like play it off. Like I knew what he was talking about. And I had to like Google it on my desktop computer back then because we didn't have smartphones. And so, I Googled and I was like, oh, this doesn't sound like anything that I would want to do. Really? Yes, really, yes. Urologist is primarily male, very male dominated. Hello, boys. And people think of urologists like the male

gynecologist, like the male version of what gynecology is for humans with vulvas. Urologist are that version for humans with penises, which is true. We do a lot of other things though. And so, I just thought this is a four men by men type of specialty. Like what's a little black girl like me gonna like offer or do or be able to like make a way in this field. That all changed when I met a female black urologist who gave a lecture, I think it was second year of medical school. And I was about to leave the lecture and then I see that the speaker looks like me. And I was like, oh my God, like, wow. So, I just think this woman is a badass. You know, and I just want to be like her. And I then I followed her and I was like,

this is my niche. This is home. You know, it just felt right. My gut feeling was like, this is it. You found it. Yeah. Do you want to shout her out? Yes, Dr. Lanane Westney absolutely changed the course of my life, my career. So, I think she knows this. I've seen this story like a million times over, but it really truly, it was life changing, life opening, maybe I should say. So, thank you, Dr. Westney. Your 15 minute talk absolutely changed her life and in turn helped all of our junk. I guess what is the scope of it? You know, where does nephrology end and urology begin? That's awesome, awesome question. Thank you for asking because we get people confusing that all the time and I understand. So, I'll talk about what urology

is. So, urology is the study of the urinary tract and also we deal with male reproductive system. So, the year. Oh, okay. I didn't know that. Yes. I didn't know that there was any any Nards involved. No one ever told me that. Oh, yes. We deal with the Nards. Yes, yes, yes. So, male reproductive system, I think that's self-explanatory. The urinary tract begins with the kidneys and goes down these tubes called the ureter and empties into our bladder and then goes out the tube that we pee out of called the urethra. So, any of that is fair game. I like to tell patients and people think of us urologists like the plumbers. We're like really fancy plumbers. If there is a blockage, if there is a structural abnormality, like something anatomically out of whack,

we're your girl or guy. Well, there's your problem right there. But if the engineering itself, like the actual pump itself is broken functionally, then that's the nephrologist. So, the kidney function is more nephrology where kidney structure and anatomy is more urology. Urologists are surgeons. That's the big thing. So, urologists are surgeons that just deal with a certain part of the body. I didn't know that at all. I know. So, when you were in medical school and you were trying different things out and you saw a mentor, did you anticipate being a surgeon ever or is that like a completely different type of medical field? At all, Ali. I mean, literally thought the opposite. Okay, like there's no... I was very klutz-y and probably still a

little bit now, much less so. But klutz-y as a child, I was intimidated completely by the thought of being in the operating room and surgeons just seemed like intimidating people. I didn't... I don't have... I didn't have any like medical doctors in my family. So, what I perceive surgeons is what I saw on TV or kind of what the little bit of interactions I had as a student. It's an intimidating aura about surgeons. I'm a surgeon. And I just thought, no way. I don't have what it takes. Bottom line, I did not think I had what it takes. Which were lies? Which were lies, honey. Lies. Yes, yes, yes, yes. On her way up, Dr. Milhouse says that she really battled imposter syndrome and had to keep telling herself, I got this. I got this, which she does. But seeing

representation like you really matters, she says. And she would think back on Dr. Wesley, who at the time was the interim dean of urology and it helped Dr. Milhouse get fired up about being a surgeon too. But okay, what kinds of surgery are we talking? Woo, woo. Boy, howdy. Everything from shockwaves that blast kidney stones into little sand grains to fixing birthing organs that can fall out of your body. Tumor removals. There's a penis tip procedure that is written as metoplasty, but thankfully it's pronounced as miatoplasty. And tons more problems that I hope I never have. When it comes to urology, why do people ring you up to be like, Dr. Milhouse, fix my pee? Yeah, yeah, yeah. Well, first of all, urology is for everybody. That's a huge,

like the whole we're just male gynecologist or whatever. Urology is for everybody. In fact, majority of my patients are humans with vulvas. So anybody who pisses is liable to need a urologist. And it's so funny when I decided to become a urologist. I'm going to answer your question, by the way, but when I decided to choose urology, like all my friends and family were like, what are we going to do with that? Like, we're like, how are we going to use you? You were supposed to be our doctor. Like, what are we going to use with that? And wouldn't you know, I probably could name, think of like 20 people who have like, oh my God, I have this urologic problem. Can you help me with this? Can you help me with that? So, you know, in urinary issues, if you can't pee,

if you pee too much, if you pee on yourself, if you have a kidney stone, kidney stones are very common, you would need a urologist. If you have anything wrong sexually, particularly if you are a human with a penis, you're that's a urologist. Okay, so can't get it up. It come you come too fast. You I say things bluntly. So I mean, people are premature ejaculation is not people are going to be like, what the heck is that? Okay, yeah, you come too fast. You can't get it up. You have low libido. We also do help humans with vulvas in these areas too. Okay. So some of a few of us urologists are experienced to to do that. If you are born with an undescended testicles, that means your testicles were weren't they didn't drop in your sack, you're going to need a urologist. If

your testicles twisted, you'll need a urologist. If you break your penis, there's something called penile fracture, you'll need a urologist. Okay, if you're sitting there thinking, but unlike a walrus or a raccoon, I don't have a penis bone called abaculum, only highly vascularized tissues that form blood and gorge cylinders called the corpore carvenosa. You're correct. And if a boner gets bent suddenly and with a lot of force, you can rupture the tunica albugini or the lining of those cylinders, which is a big fucking ouch. Also, if you're uncircumcised and you still have a little connective thread from your Johnson top to your foreskin that serves as kind of like an elegant cape sleeve, that's called a frenulum and that can snap. But hey, there's more than just

pickle problems. If you have something called prolapse, that's where this is in humans with bulbous where things are falling out of your vagina. No thank you. Yes, I know, no thank you. You might need a urologist there. The list goes on. If you have recurrent UTIs, you're going to see a urologist. I see a ton of people with that. If you have blood in your urine, you're going to see a urologist probably. I have a question. How many people do you feel like you see don't know that you don't pee out of your vagina? I think way more than would admit because I see their faces. Especially before we used to wear, before we didn't wear masks and I'd be like, they'd be talking like, oh, you're in and I could tell like they're saying it's from their

vagina and I'm like, oh, yeah, no, you mean your urethra and they're like, oh, yeah, yeah, yeah. And I could tell they're like, oh, so I had a patient who was very sweet and came in and was like, this is going to be weird. Please don't laugh at me. And I never laugh at my patients. We might have a laugh together, but never laugh at my patient. And she was like, I've been peeing out of a new hole. Like now I'm peeing out of a new hole. I promise you, I've always been peeing out of my vagina, but now there's a new hole there that was not there before. Oh no, that's so scary. I was like, really? There's a new hole? I was like, I don't think that's how it works though. Okay, but all right, let me examine you. And so examine and it's a perfectly normal anatomy,

you know, you see the urethra, the vulva, and then the anus obviously down below. And I'm like, it looks pretty good. And so I like convince her that it's normal. I pass a catheter in the urethra. I pass one in her vagina. I was like, yeah, look, this doesn't go anywhere. The urine's not coming out here. So, you know, we aren't taught our bodies like a vulva. It's like a mystery to us. I imagine that it's such a delicate subject that doesn't get addressed enough that a lot of people kind of come in just being like, I need some basics before we get into the mechanics of it. Yes. What about a mount that we pee? How much do most people pee? Does it really last 22 seconds for all mammals? I've never measured my pee. Is it a pint? What's going on?

Yeah, yeah. So the amount per 24 hours is typically like a good amount that we like is two liters or 2000 milliliters. Okay. Wow. We do things in metrics. I would say probably a lot of us don't get there because we don't drink enough. So we're probably somewhere between 1.2 to 1.5 liters per day, 24 hours. You tend to pee more in the waking hours when you're awake than when you are asleep. Okay. About two thirds or more of your urine volume is in the waking hours. And like a third or less is typically in the nine time hours. Now this can be abnormal and then cause some problems for patients, but this is in a normal state. And 22 seconds is like absolutely not a thing. I mean, I mean, you could like, yeah, sure, I could pee in like 10 seconds,

but if you don't, if you pee in 30 seconds, there's not something inherently wrong with you. Two liters. That's so much Mentos and Diet Coke blasting out of your crotch every day. And okay, where did the 22 seconds figure come from? So the Georgia Institute of Technology, that's where, and Dr. Patricia Yang and her team watched a bunch of zoo animals taking leaks, male and female cows and dogs and elephants, goats, even rats. And they crunched all the numbers because human curiosity knows no bounds. And they found that despite bladder capacities that range from 100 milliliters to 100 liters, which I'm guessing were the elephants, every piss took an average of 21 seconds. And if you need more data on this, just peruse their 2014 paper,

duration of urination does not change with body size, which includes the hope quote, this study may help in inspiring the design of scalable hydrodynamic systems based on those in nature, but humans weren't included. So you can do your own research and maybe set a stopwatch to time your pee quantitative biology. It's happening right over your toilet. And do some people have smaller urethra's than others? Like, you know, how if you're in a public bathroom and there's sometimes there's just like an orchestra, like a symphonic effect, because different people's pee sounds different. I know that some, you know, people with vulvas are worried that they pee too loud. And some people with penises are like, my pee sounds too tinkly.

What's affecting that? Oh, this is great questions, Allie. So the male urethra is longer. Than the female urethra. Okay. The like almost about three times as long. And so male urethra's, and I'm saying male, but we understand that we're talking about humans with penises and not all humans with penises are men and so forth. But for the sake of just anatomy, the male urethra is more prone to potential blockage issues. Okay. And so men urethra can be blocked more easily than female urethra. And that can create a slower stream that is like more of a trickle or, you know, less loud. So if you are vulva, your urethra is about an inch and a half long. And penises, you've got eight inches of the tubing, at least. And kind of like the muzzle velocity of a shotgun

versus a derringer, one's just going to have more force. But what if it's changing over time for you, fellows? One big cause is a male prostate, which is an organ that sits around towards the back of the urethra, that sits around it, and it can grow. And part of the growth can intrude inside the urethra and cause it the urine to be slow to come out or blocked. Okay, come on. The female urethras don't have to deal with the prostate. The other thing is there's something called urethral stricture. And that's where you have the, again, a tighter urethra. It's tighter. And it's not a good thing. You don't want this to be tight like that. And so it can cause problems with not being able to pee. And that is much more likely in men than women. It's really rare in women. It's not super common

in men, but it's rare in women. And then sometimes it's not even about the urethra. It's the force of the bladder. So you think about the bladder as the pump. And when you have to go, it squeezes, okay, and trying to push urine out. So we think about like urine problems as outlet or is it the bladder, the outlet being like the tube that goes out of i.e. the urethra. If you have a slow stream, for instance, well, I don't know if it's the outlet that's an issue or is it the bladder, the pump that's an issue. And you mentioned prostates. I don't know what they do, why are they? What do they do? Yeah. So prostates are important for fertility, very important for fertility. Prostates, they basically fortify the sperm and make them able to

penetrate the egg to initiate conception. And so they release these acidic proteins and enzymes that gets mixed in with the semen. And so the sperm are there, these acidic enzymes that the prostate secretes is there. And then there's another organ that's important to male fertility called seminal vesicles. They give these the food source. So they secrete a lot of fructose, which is a sugar. And so it's like, okay, sperm, we're on a mission, we're getting to the egg. You know, so here's food for the journey. And here's how you're going to break through because you have to penetrate the egg. And so the prostate is the important organ for the breaking through. Okay, so you got your danglers, themnards, and those are in a pouch outside. And then inside,

you have your peepers, your bladder. And under that is the prostate. And in between the two, there are some squiggly glands called seminal vesicles. And the prostate supplies the weaponry, like here is a battering ram to get you in there. And seminal vesicles are your honey makers. And they give your sperm fructose and good tidings. They're like, okay, good luck. Take a snack. And yeah, about 5% of love juice is sperm. What's the other 95% 70% or so is from the seminal vesicles. And 25% is the milky stuff courtesy of the prostate. But if it's enlarged, that's not good. Yes. And it's the only organ in humans with penises that can continue to grow until they die. You know, usually like you stop growing, right? Like stuff is growing. In fact,

they start, stuff starts shrinking, you know, but no, the prostate doesn't do that. It just will continue to grow and grow. You can. And that does not happen with a penis? The penis does not continue to grow. No, I didn't think so. Yeah. What about how many of your patients are like prostate milking? Tell me everything. Like they want to prostate? Yeah. Like is prostate milking, is that a thing? What is it kind of like a G spot for penis havers? Sure. Yeah, it is. I think there's, you know, we, the G spot is ever elusive. I've looked everywhere. In men and in women, but it is thought to be an erogenous zone. Okay. And the way to get to it is through the anus,

you know, and just like an upward, you know, putting your finger in the anus and, you know, aiming sort of upwards because the prostate sits in front of the rectum. Okay. And so that is thought to be an erogenous zone or just even, you can even like put what we call perineal pressure where you kind of press that, the taint. I was so uncool. I didn't know what that was until like six months ago. One of my, one of my, yeah, one of my, one of my patients like, it's my, my taint. I got, you know, he was talking about like his symptoms. I was like, it's in the taint. I'm like, you know, the area between your anus and your balls, your balls and your anus like, oh, okay, the perineum, that's a medical term. Yeah. I was

like, oh, the taint, I'm going to start using that. I've also heard it called a grundle, which sounds like a great space that you would have in between the eaves and the attic, you know, maybe like the grundle. Like I store winter clothes in my grundle. It sounds too fancy for that area. That's a new one. I haven't heard grundle. Yeah. Other words for this, gooch, twirt and bifkin, which will forever change my relationship to the Birkenbag. It is now known as a bifkin bag in my head, unfortunately. And by the way, I just found out today that a Birkenbag, I knew it was expensive, but I found out that number one is made by Hermes. I never knew that. And it can cost like $300,000 for a purse.

And people who own them say that you should never carry a pen or a bottle of water or hand sanitizer because it might spill, which is like, what a purse is for? I don't understand. But anyway, yes, Birkenbags, they're very expensive. Bifkins, that's your taint. Anyway, back to my comfort zone, which is your buttholes. You don't have to call it a grundle or a twirt or a bifkin or even a gooch. No pressure, but also maybe a little bit of pressure. So pressure in the taint can also like stimulate the prostate. In terms of erectile function or even clitoral dysfunction, do they tend to have the same etiology? So this is like going to be like a light bulb moment for probably a ton of your listeners. The clitoris is the same as the penis. Yes. Okay. So penetrators,

if you're penetrating a vulva, think about what you would like. Okay. The penis is highly innervated or has high sensory nerves. And so, you know, you don't want somebody to like give you a blowjob on your thigh. It's like not going to do anything, you know? So the clitoris is the key to the orgasm, okay? Because that's where our nerves are concentrated. I love that there's a period between every, there's a period between every word in that sentence. You can see it. You can see it, right? What's a clap too, you know? There's something called the black girl clap. The clitoris is the key. I'm clapping as I'm talking to orgasm. Okay. And in case you did not hear that in the back, the clitoris is the key to orgasm because that's

where the nerves are concentrated. So anyway, humans with vulvas get erect because our clitoris gets erect. It has erectile tissue, which is similar to the erectile tissue that are in men. The badass thing about humans with vulvas though that's different than humans with penises is we can come and come again and come again and come again and come again. Like we can go back to back to back to back to back. Okay. Come again. Where there's usually a refractory period in humans with penises, you know, where they D2, what we call D2 mess or basically get laced or go down after ejaculation and then coming back to erect enough to penetrate takes time. Hey, I look this up for us an 18 year olds about a 15 minute refractory period. Typical adult males twice that 30 minutes.

But if you are still knocking them boots in your seventies, you might need to schedule ejaculations about 20 hours apart, which don't be sad. It's still more frequent than a wordal. And also you're 70 and you're getting off. So can't complain. What can people complain about? Most common dysfunction complaints in men are premature ejaculation coming too fast. Difficulties getting an erection, not getting hard enough. Most common complaints in humans with vulvas are low libido, low desire, and then painful intercourse or lack of like orgasm. So we got to do better for the women. Like the women are being like, we've been kind of suffering. The men suffer too, right? But they have like more concrete answers where the women are like, where do I go for this?

And there you can go and get help for these things. One thing that it can similarly affect is something called phymosis. And again, because the penis and the clitoris are the same. And when I mean they're the same, they literally start off the same way when you're an embryo. Bonkers. And then it differentiates based on if you're X or Y chromosome, right? It'll differentiate any elongate to be a penis. It'll not elongate as much, nearly as much if you X or XXX. Okay. So but it starts from the same embryologic line. But both can get phymosis. So you have something called the clitoral hood, which looks like a little hoodie over your clitoris. Again, the other thing that's mind blowing is the clitoris is actually quite large. It's deep inside.

Like most of the clitoris is deep inside you. And as we have covered in the 2018 sexology episode and the gynecology episode, a clitoris isn't just that one spot at the top of the labia. It's bigger. It's almost as long as a dick and it's shaped kind of like a wishbone and it runs underground. And I have said this before, you may have visualized the clitoris as just one of Jackie Kennedy's pillbox hats, but it's really more the whole Chanel suit. You just see the little bit ahead, you know, at the tip, but it has a hood over it and the hood can get stuck completely over the clitoris. And then you can either lack sensation or it can be painful. There should be a whole other ology for this topic, right?

I have to shout out Dr. Rachel Rubin because she is the self-proclaimed clitorologist. And she is like, people don't examine the clitoris and she's 100% right. No one examines their clitoris. Patients don't do it. Doctors don't do it. Okay. Yeah. But if a man came in with their foreskin completely stuck over their penis, which this is something that happens very common called Phymosis and they can't retract it back and everybody's going to know it right away. Like it's right there. Both can cause problems and we can treat both. And what about circumcision? Where is the medical community on that? Because I know it's social. It can be spiritual. What do doctors, if you have a patient who's expecting a baby with

XY chromosome that is expecting a... Yeah. This is a somewhat controversial circumcision or not. Well, I should say neonatal circumcision is what is controversial. Okay. Not like an adult who decides I want to do circumcision. I don't think anybody has any issues with that because the adult can understand the pros and cons. But is like the neonatal circumcision, is it beneficial? There's a whole thought that maybe we're doing something where in this person, you know, there's obviously a baby has, you know, it doesn't have autonomy over that decision. So I won't get into that because that's like more political. Yeah. For sure. The medical community in the United States,

United States is a heavy circumcised population in the world. And there are potential benefits to neonatal circumcision. And I will talk about that. Having said that, I want to be clear. I don't think any institution, whether it's American Urologic Association or the Pediatric Association, are advocating for universal circumcision or saying that we recommend that you should get it. It is very, very, very much a personal decision. Okay. Very much a personal decision. But there are potential advantages that include a decreased risk of urinary tract infections. Again, the risk of urinary tract infection and penises are so low to begin with. So it's like something is already so low. Like you're lowering

the risk of something that's super low anyway. Potential decrease risk of penile cancer. Again, a penile cancer is super rare. So you're decreasing something that's pretty rare already. And maybe just decrease risk of like, you know, infections around the head of the penis, which are less concerning, or just decrease what I call foreskin fiascos. Bless you. Okay. Gird the loins because she's going to run through some cautionary tales. Foreskin fiasco. So like my foreskin is stuck up, which is Phymosis. I can't get it down. Or my foreskin, what's worse is the foreskin is retracted down and it's, and I left it down too long and now it's stuck and I can't pull it up. And that is a medical emergency because that's

like, it's like putting a rubber band around your penis. And so if you leave it down too long, you can cut the blood supply up to the, to the head of the penis. Okay. That's it though, right? Nope. It's not. Or foreskin stuck in like something. I had a patient who had a foreskin stuck in a zipper. These are the foreskin fiascos that I thought about that. I hate. Yeah. Any difference in terms of STI contraction at all? Yes. Yes. Yes. Thank you. Yeah. So there have been studies performed primarily in Africa where there's a high HIV transmission rate that it can redet circumcision, reduces the transmission of

HIV considerably. And so there is that potential decrease HIV, but it shouldn't, but again, we aren't advocating it as a way to say this should be a universal like recommendation still. Yeah. Okay. And do you have any advice for people who in general come to you and say they are having trouble with orgasms? Like is there a first line of questioning that you have to kind of go down to figure out if it's biological or psychological? Sure. Absolutely. I want to know, have they ever gotten orgasms? You see, it's like huge starting like, okay, is this new? Or is this like, well, I've never had this. Okay. Do you get orgasms in other scenarios? Like, do you orgasm when it's you, yourself and I? Do you orgasm with other partners? And it's this partner. Okay. Do you feel, is it

pleasurable, sex pleasurable to you? Or is it painful? Like, why would you orgasm? It's sex painful. Like, you know, is there obviously ask about relationship issues, the context, especially, you know, for women, it's more complex. And so, you know, as, how is the, the nature of the relationship with the sexual partner that you're engaging with? Are there feelings of guilt or shame? Or, you know, is there a disconnect and trust and intimacy in that relationship? Do you know your own body? This is something again that goes back to like, we don't, the Volvo is a mystery. I was just talking to a patient recently, and I was like, do you know what feels good to you? And she, I had to think about it and like, well, it feels good

when we have missionary sex. And, and I was getting a sense she was what, what happens a lot is we are like, well, I'm happy it feels good because my partner is being pleasure and that feels good to me. And that absolutely is like, great. Like, that's best kind of sex, you know, when you feel good because the partner's feeling good. But I told her, I was like, well, I don't care about your partner right now. You my patient, I want you to feel good. What about you feeling like getting off? You know, when she just changed that mindset of me, like, okay, let me just be objective, like me getting off. She's like, yeah, I don't know. I don't think so. It's like, if you have to think about it hard, it's probably a no. And that's okay. You're not alone. You're not alone.

But you can get there. And I think we need to talk about female masturbation. You know, we need to, I mean, no one talks about it. And it's kind of like, oh, it's kind of gross or that's kind of icky or it's kind of shameful. It's so different. Men don't care. They talk about it. Yeah. Like, quite freely. Like, I want us to get there. What's wrong with learning our bodies and figuring out what makes us go? You know, and like, again, most of us don't even realize how important the clitoris is in all of this. Yeah, I was going to ask, do you have patients that come to you thinking, I think there's something wrong with me. I'm not coming during penetrative sex. Fix it. Is that a common anxiety? Well, I think it's not, unfortunately, because

society has done a great job of like making sex more about the penetrator and not really about the receiver. Like there are millions and billions of women that are completely content with like never having an orgasm. Like it's so it's not like a priority. I mean, I guarantee you if the men couldn't orgasm, they would be like droves in our office. Okay. Oh, for sure. I thought that you worked for like a service or a company that helped that guys that are so horny that their stomach hurt because that's where I am. It's a problem. It is a problem. So it's very different, um, the mentality. But when they do, I love it. I love when patients do that. It makes it's like, I'm seeing more of that. I think we are moving towards a way of like, hey, recognizing the power

of our Volvo, recognizing our own pleasure, you know, sex is supposed to be pleasurable. The clitoris is designed for pleasure. Yeah, why else would it be there? Right? Seriously, it's designed for pleasure. Come on. You're like, don't be drama. But I did look this up. And yes, there's been a study 2016, the evolutionary origin of the female orgasm, which reads that the evolutionary explanation of female orgasm has been difficult to come by. And the orgasm in women does not obviously contribute to the reproductive success and surprisingly, unreliably accompanies heterosexual intercourse. So this scientific study starts with a pun, difficult to come by, and then it just reads us heteros for filth. And I love it. So essentially, the researchers now believe that our ancestors'

orgasms, at one time, released an egg, and then we evolved to just not do that, quote, potentially freeing female orgasm for other roles. So if you have a clit, is there like an owner's manual stimulation? I'm like, get a sex toy. Like just try to get a vibrator, okay. Utilized by so many different vibrators and just try to try it on yourselves. You can try and your partner can try it on you. You know, I haven't sent them to resources on like how to masturbate. I mean, I'm going to find some. That's a good question. I'll be honest. I haven't like been like, go to this platform or this website and you'll learn. I mean, this is probably going to get me in trouble. I have told a couple of patients, you're like, maybe watch a porn or two.

And I want to say this porn can distort normal expectations from sex. If that's like your primary like, how do I say this? If it's done in excessiveness, I think it can in some individuals detach them from the real world and then they can't really get excited or even enjoy real sex. Because porn is like sex on steroids. It's like, you know, like just overdone. So I don't want patients to compare themselves to what's happening to porn, but to like be like, oh, they're so free with their body as far as like the way they touch themselves and that sort of stuff. Like, okay, yeah, let's try stuff like that. Oh, you know what the side I was trying to think of is, and they were sponsors of the show for a bit called OMG Yes. Have you ever heard of them?

Yes, I have. So I had to, you know, before deciding if I would approve them as sponsors, I went and looked it up and I was like, oh, shit, this is like a university of like, how to use a vulva, etc. You know, so there's that. Well, there we go. There you go. That's gonna be my new thing. Technique, look, I'm going on the website on my phone now. Techniques with toys now available. I love this. Yes. Now I have questions from listeners. Can I just lightening around you? Sure. Okay, but first each week, you know, we shower a good cause with some money and Dr. Millhouse chose the nonprofit Urology Unbound, which offers mentorship, networking opportunities, and support for minority urologists at all levels of their career to help the urology workforce

mirror the diversity of the communities it serves, and to reduce urologic health disparities. Awesome. So you can find out more at urologyunbound.org. And that donation was made possible by sponsors of the show. Okay, you had many, many burning questions, but none as inflammatory as the ones about UTIs. So patrons Courtney Peterson, Annika Alliomayers, Leslie, Aubrey Alice, Garvey's, Amy Naramatsu, Annika's Kat Arya, Lucas O'Neill, Nicole Kleinman, Kaitlet Oaks, Levna, Lucien Vadego, Kate Waters, Maria Gilmore, Anna Glassbetter, Don Mateo, and first-time question-askers Laura, Samantha Raffo, Kristen Serresi, and Rachel Gardner all asked, essentially, why, why, why, UTIs, why, how to stop? And then on the other end of it,

patron Aaron Ryan wrote in and said, my friends shout profanities at me when I tell them I've never had a UTI. Are they really so common? Wow, Aaron. You know, it could be for you. It must be nice. Tons of people asked, how to avoid UTIs? Oh, yes. Also, why do they hurt so bad? Why do some people get them and some people will never get them? Yes. And should you pee right after sex? Should you pee during sex? These are great. These are great. This is what I do all day long. UTIs are more common in vulvas because our urethra is short. I just said, our urethra is like third or fourth of the male urethra. Urethra is short, so it's easier for bacteria to get in. The other thing, risk factor is sexual activity, the act of being the

receiver of penetration puts us at higher risk. It's not because sex is dirty. The royal penis is clean, your highness. FYI, it's just the mechanics, okay? Bugs hitch a ride on the penetrative whatever, you know, if it's penis. The other thing is menopause is a risk factor. So the declining estrogen after menopause puts postmenopausal women at higher risk, okay? So these are things I get patients like, well, can we figure out what's causing this? And I'm like, it's factors that you cannot change, okay? It doesn't mean we can't do anything to reduce your risk. It's just like, I kind of change the mindset, like, don't get fixated on finding like, aha, it is this and we can undo it because it's almost never that simple, okay? Or that just, you know,

easy. So most women who get your current UTIs do not have a serious problem with them. Why do some women get it? And some don't. We don't know all the answers. We think there might be some genetic predispositions, but we haven't elucidated directly what is. So Patron Mary and Thomas tell your relative to ask about estrogen cream, perhaps. Also, recently when I brought my dad to the hospital to get an MRI, the one that found his brain tumor, they tested him for a UTI first. And I was like, those seem like real different problems, doc. But Patron Heather Dykes asked, why do UTIs sometimes cause psychosis or dementia type symptoms in older people? And so I looked into this relevant. And UTIs can also cause sleeping

issues and anxiety and depression, confusion, aggression, delusions, hallucinations, and paranoia because of an immune system protein called Interleukin 6, IL-6, that can increase inflammation. So get cozy with your urologist because you may need them later in life. And yes, Patron Anne Kavanagh who asked, I've heard that UTIs might be genetic. Is this true? Indeed. And for more on that, you can leisurely enjoy the 2007 study titled, inherited susceptibility to acute pylonephritis, a family study of urinary tract infection, which found that some people just got the shit out of the stick and their P-tubes are velcro for bacteria. We think that has to do with maybe the attach that's more easy for bacteria to attach to the

bladder lining of certain women than other. But again, the biggest risk factors are anatomic and like just age and the ways to help yourself. Okay. All right. So yeah. Cranberry or no cranberry? Okay. Cranberry ditch the juice. Okay. Ditch the damn juice. Don't do the actual berries. Please stop drinking the cranberry juice unless you love it. Fine. But it ain't doing a diddly for your UTIs. Okay. Do high, if you're going to do cranberry, we recommend a high dose cranberry supplement. How do you know if it's high dose? Cause it certainly doesn't say it on the bottle. This is high dose. This is low dose. It's not going to say that. You want to look for 36 milligrams of proanthocyanidins. Proanthocyanidins are the active ingredient that has been shown in some

studies at 36 milligrams to potentially be effective in reducing UTI risk. Okay. It was not effective below that. I checked this out and yes, 36 milligrams is the magic number of pyroanthocyanidins as outlined in the 2018 study, standardized high dose versus low dose, cranberry pyroanthocyanidin extracts for the prevention of recurrent urinary tract infection in healthy women, a double blind randomized controlled trial protocol, which found that tannins known as type A proanthocyanidin, which we're just going to call them PACs from now on. That's what doctors do. The PACs step in to say, excuse me, E. Coli, you're about to not adhere to these Euro epithelial cells. Keep a moving butt germs. So first time question asker, Arvind

Bhusnirmath, who wrote in, I'd never heard of cranberry juice being some kind of UTI wonder drug until I came to this country, assuming that this is not some urban legend. What are the alternatives for those in tropical countries? I'm not sure about tropical remedies, but a 2021 study did find that pine tree extracts can outperform cranberries in terms of PAC content. So patrons Anna, Chris, Konchata Gibson, Lynn Roweke, Erica Stairs, and Mercedes, and first time question asker, Alyssa Gregory, noted juice, yes, to 36 milligrams of PACs proanthrocyanidins. Not a fun word to say. I had to do a lot of takes of this society. Some cranberry supplements will just show milligrams of cranberry, and I'm like,

as a urologist, I laugh at that information. I'm like, this is not information we want. So yes, this is going to change a lot of people's lives. Just that right there. The other thing is, if you're postmenopausal, get you some estrogen nation in your vulva or vagina. Vaginal or vulva estrogen, which is usually prescribed, is a great way to reduce UTIs in women that are peri. That means I'm kind of sort of getting to menopause. It's like I'm almost there or postmenopausal. And in fact, this is a guideline that the American Urologic Association put into play in 2019 as a recommendation. If you have women who are getting UTI, recurrent UTIs that are postmenopausal,

you should offer them vaginal estrogen. And estrogen has been demonized. They have successfully demonized estrogen. I say estrogen and patients like, oh no, I don't want it. I don't want it. I don't want it. It's not natural. I'm like, what is not natural about it? It's your body's hormone. And let me tell you, they're trying to push testosterone on these men like it's fountain of youth. So I say that to say vaginal estrogen is safe. There is literally almost no patient that can't safely get it. If you've had breast cancer even, you can safely get vaginal estrogen. Shocker. If you've had blood cuts, you can safely get vaginal estrogen. If you are a smoker, you should stop smoking, but you can get vaginal estrogen.

So it's not the same as systemic patches or pills, which I think have been successfully over demonized anyway, but that's another talk. But those are my two biggest recommendations. There are other things that are in the works. There is a supplement called D-manos, which is a natural occurring sugar that can help block attachment of bacteria to the wall, particularly E. coli. Oh gosh, don't even make me try to say the whole name, but. Escherichia coli. Okay. E. coli. Everybody knows E. coli, recognized E. coli, but E. coli is the most common bacteria that causes UTIs and D-manos potentially can block that attachment. D-manos in early studies has been shown to be beneficial. There's actually a larger study happening now

that hopefully will wrap up soon with the results to substantiate the claims, but I generally will recommend D-manos to patients and that's over the counter, just like the cranberry supplements over the counter. And then there is actually a vaccine trial undergoing. They're like trying to come up with a vaccine, if you will, for UTIs. Whoa. Also life changing. Yes. A peen. Peen after sex. Yeah. So here's the reality. We talk about it all the time, like I'll tell patients, yeah, P after sex, but guess what? We actually don't have evidence that it does anything. It does like, yeah, yeah, yeah. But it's like, it's not, there's no harm to doing it, right? So why not? You know, but I tell patients, yeah, P after sex, like, I mean, get up and go,

what's the harm? But don't, I don't want to create people who are like anxious and anal, that they lose the fun of sex because they're just like paranoid about, oh my God, I got a shower, I got a pee, I got a, no, that's not really actually probably going to help. So first time question askers, Morgan and Gertle Bob and also to you too, Allie Vessels, Joy Cothimer, Sarah Holloway and Aubrey Ellis, take the pee, but don't freak out if you don't. And for more, you can please enjoy the very straightforwardly titled study. Does urinating after intercourse reduce the risk of urinary tract infections among women? Which concludes, overall, urinating after intercourse does not reduce the risk of symptomatic

urinary tract infections among sexually active young healthy women. However, there may be some protection in voiding within 15 minutes for women without any history of past UTIs. And I don't understand that pair of sentences, but they seem to reinforce the can't hurt advice. But let's address Anna's inquiry, which I'm so thankful for. She wrote, I've had this experience and I've had other hetero ladies confirm you get UTIs with some guys, but are totally fine with others. Why is that? And patron Phoebe Ridgian was like, yes, why? Well, don't blame the guy, you're just horny. According to the 1981 research, relationship between frequency of sexual intercourse and urinary tract infections in young women,

no group differences were found from manner of hygiene, frequency of urination and frequency of urinating after coitus. We conclude, picture like a little drum roll here, that an increase in sexual intercourse may be one of the factors involved in the development of a symptomatic UTI in young women. Increase in sexual intercourse, which is why this condition was archaically dubbed honeymoon cystitis. It happens because you're just boning more. So you can pee or not pee afterwards or I guess in between rounds. Get it. Well, you know, this kind of dovetails with a question. A few listeners, Maria Joralveva and first time question asker Silas Gullion, or Guion, I think, asked, is making yourself pee when you don't really have to really bad for your pelvic floor?

Is that bad for your bladder? Like, should you try to take like squeeze out a road trip pee as my husband calls it before he goes to bed? He's like, do I do a road trip pee? Okay. So there's levels to this. Okay. If you pee too often just because, like, I'm gonna go pee every time I see a bathroom regardless. And it's like getting too excessive, like more frequently than I'd say every two hours, like every hour I just pee, I just pee. Or the slightest urge I might pee just because, just because. And you're over peeing. Then you can actually create a bladder that doesn't hold as much as it can. And that can be a problem. It can basically become too frequent because it doesn't, it's not allowed to fill

to capacity. And so then your bladder and your brain gets used to you going at like half capacity or a fourth capacity. Okay. And we'll give you stronger and stronger urges at lower and lower volumes potentially. Okay. So a common thing is like, Oh yeah, if you hold it, that's bad. It's bad. It's not bad to hold it. If you can hold it, hold it. Like it's not inherently bad to hold it. The holding isn't the problem is if you can't empty your bladder, that could be a problem. But holding it an extra hour, two, three actually is not a problem. So all the people that are like been telling everybody don't, don't hold it. You'll get a UTI or your bladder will stop working. That's not, that's not actually the case. Okay.

Dr. Milhouse says that some people have a condition called overactive bladder though. And when it's coming, it's here. So she says peeing on a schedule every two or three hours is good for them. But for the rest of us, including those who put the pee and patron at night, Jason Hoffman, Yoko Mel, Amelia Hines, Bruce and first time question asker, Abigail Whirly, call a urologist if it's a problem, but otherwise let nature do the calling, even if you sleep in a bed with me and have to get up in the middle of the night, share it. And then squeezing out that road trip pee, like, we don't want you to squeeze any, any, like we don't want you to strain to urinate. Okay. That's not what's supposed to happen. You're supposed to relax your pelvic floor.

And this is supposed to be a subconscious thing, not like you say, okay, now I'm relaxed. Naturally, you're supposed to pelvic floor is supposed to relax. So one thing that y'all need to stop doing immediately is trying to do a Kegel while you pee. Please don't do that. Please don't contract and stop your piss. Okay. You're, you're, you're teaching your pelvic floor to do something that it's not supposed to do at that time. It's supposed to be relaxed, not tight when you're peeing. So practice your Kegels when you're not peeing. Let pee happen when you're peeing. Let pee happen. Let the pee happen. That's great. Let pee happen. Yes. Yep. So we don't like you straining because that can also put strain on your pelvic floor. We had a lot of

questions about pelvic floor. Star, Amanda Ramirez, Juliana, Zambat, Lydia Lamby, Lydia asked, so what's the deal with the public floor? Like, do you, you need to strengthen it? And if so, how do you do that? And is a pelvic floor contraction the same as a Kegel? Okay. Great question. So your pelvic floor is vitally important. Thank you for noticing. It is important for peeing. It is important for pooping. It is important for sexual function. Okay. So it's not three P's though. P poop. I wish there was a three P's. I could say the P-U-S-S-Y word, but then it's also important for pussy and penises. Pleasure. Pleasure. Yes. Piss, poop, pleasure. Yes. Thank you. It's important for those three. And this goes in all humans. Okay. This is not just for humans with volvas.

And so it is supposed to contract and relax at specific times. It's not all about pelvic floor contraction. We do not want you walking around with your pelvic floor like you're like tight up. Okay. That's not comfortable. That's painful. That makes you feel like you have to go all the time. That makes it hard to pee or to poop. It makes it hard for sex to feel good. That's why I don't want people kegling all day long. But obviously we do like the pelvic floor to be tighter in certain circumstances. It can help control certain types of leakage of urine, I should say. And so that's when you would utilize it. Pelvic floor contraction is important for male ejaculation. That's how semen gets expelled or expulsed out, which is critical to your natural

conception. Hi, it's me. I'm just here to let you know that the word ejaculate comes from the Latin for ex out, ejaculare throw. So to throw out, it has the same root as javelin. And the muscle behind that tossing power is the bulbo cavernosis muscle, the BC, which you can kegel up, penis people. So there is importance for both. That's why the pelvic floor is a coordinated, complex set of muscles. When you have to go, your brain perceives your bladder to be full. And you get an urge to pee. And then you get to a bathroom. And when you sit down, you don't think and say pelvic floor time to relax. No, what happens? You just sit down and urine starts coming out. Well, the first thing that actually happens is your pelvic floor relaxes before your bladder

even contracts and lets urine out. The first thing that happens is your pelvic floor relaxes, bladder contracts and lets urine out. Now, in some people, their pelvic floor is dysfunctional and doesn't relax. It contracts actually when they pee. And so it's like trying to pee through a closed door because it's not relaxed. Your bladder is like, I cannot stand this. Oh, speaking of standing. Well, we had a couple of people ask what you thought of female urinals. Zambot wanted to know what you thought of the Shiwi. Any thoughts? Let me look up the Shiwi. I've seen some female urinals. I think that's actually great. I'm going to embarrass my husband. My husband can pull over anywhere and literally will piss indiscreetly anywhere. And you'll be like, are you taking

a piss? We're about to go inside the movie theater. I'm like, well, that's not fair. We can't do that. So these kind of portable things allow us to stand up and pee, taking away the need for the toilet seat. And so I'm a fan. I'm all for it. Yes, I'm all for it. We have a very open-minded household. My husband is very proudly a sitter to pee on. So is mine. I think more men are than admit. More people with penises are sitting to pee. As my husband says, Jared, he says, kings take their throne while gestures stand before. I love it. And I also feel like bathroom cleanups so much easier. Take a load off, man. I feel like I don't have Jackson Pollock of ultraviolet pee all over our house. Which actually, we had a few people ask, and I thought this was

a great question. Ryan Kennedy and Elizabeth Edwards wanted to know. Ryan asked, what's up with random rogue streams? One just shooting off somewhere. And Elizabeth Edwards wanted to know, why do my kids have such terrible aim? I'm so tired of cleaning up pee. Because they're kids. I mean, they're just learning. But if you've just got like an absurd going the wrong direction, what's going on? Well, I think a large part of it is just the force of the stream behind it. So your urine, when you first start urinating, the stream in the early part of urination is really strong because your bladder is full. So you have like the tank is full and it's ready to go. And so then as that tank empties, then you'll notice that stream kind of then draws out. And now it's

more directed. Basically, when the force of the stream is really strong, that stream can just just boom, boom, like spray. I think that's what he's calling rogue stream. I'm thinking he's thinking spraying stream. It's like a spray. I'm thinking so. Yes. Why am I peeing like I was up all night having sex? If you ask this, Michael Swords, Avron, Dante Bruno, Ryan Kelly, and first time question asker Nish, if you're seeing double from your dong, it could also be a little negative dried spunk in there or a prostate issue. So if it keeps happening, holler at a urologist and maybe invest in some cleaning wipes for your bathroom. And then it causes the seats to get all messy. I have a younger brother and he and I shared the same bathroom all throughout.

And I was like, I will never share a toilet with a man when I get married, his and her toilets, because this is disgusting. Oh my God. It was the worst, the worst walking in. It's like all over the place. Yeah. Yeah. And you can smell as soon as you walk in. I'm telling you, kings take the throne. Sit down. Sit down. Have a seat. Yes. But a few people, Emma Meadar and Leschatz Gormons, wanted to know what you thought about the days. Is the bidet the best for everyone? I love the day. You do? Okay. Yes. We need to normalize it. Okay. So they're sanitary. Yes. They're great. That's amazing. Yes. And one other question that we got a ton was about the oopsies. So many people, I will list them in an aside. I got you, Katie Courtwright, Nicole Austin,

Cassie Kenton, Missy Briggs, Molly Johnson, Heaven Klinger, Elena Horne, Rosalyn Hesby, Sadani Shimer, Krista Jones, McKinnell Lawson, Ruby Bray, Katch S, Gwen Kelly, and first-time question asker is Natalie Parsons, Meg W, Casey Ryan, and Charlie Gray J. In Elijah's words, said, is it possible to ever jump on the trampoline with my kids again without peeing myself? Yeah. Yeah. And sneeze peas, little escapies. Some people have had children. Some people haven't, but that like oopsie. Yeah. Yeah. So that is called stress incontinence. And it's not mental stress, but it's physical stress from the abdomen and pelvis that isn't supported by the almighty pelvic floor or underneath the urethra. So you jump on a trampoline, that causes rise in

pressure in your abdomen and pelvis, but your pelvic floor can't support it as well under the urethra and you urinate or your urethra moves. Okay. And it urinates because of that pressure. You can cough this same thing, laugh, pick up something heavy, go for a run, all of these maneuvers. And this is definitely more common in women than men, more common in women who've had babies than not, but not universal. It's not exclusive to like only women who've had babies. For instance, one population that is not talked about, that can suffer higher risk is like athletes, young athletes. So you're athletic, you're in cross country, you're running all the time. That constant wear and tear on your pelvic floor can predispose you to incontinence. And in fact,

my young patients with stress incontinence are almost always athletics, athletic. Almost always. Yep. There are certainly things you can do about that. That's the good news. You can work on pelvic for strengthening with Kegel exercises. You can work with a physical therapist, which are, which physical therapists are great. They're like the gurus of the pelvic floor and they are like personal trainers for your pelvic floor. So you can do that. Here are like incontinence devices. So like things you can put inside the vulva. This is for women put inside the vulva or humans with vulvas put inside to try to like support the urethra like a speed bump. There's a tampon called impressa that makes something like that. And then there's devices we use in the clinic

called pesteries. And then there's surgeries. So there are surgeries that we can do to help create and support the urethra to do leakage. And it's one of the most common surgeries that I do in my practice. And I got to say, it's like, I love these surgeries because these patients are like, Oh my God, you gave me my life back. Now I can go running. Now I can jump on that trampoline. Now I don't have to, you know, wear a pad. I can wear my panties. And it's like, I love it. I love it. I love it. So kegels, glute bridges, squats, a physical therapist, and maybe a call to the urologist for a procedure that can change your life. Now we were running quickly at a time. So many questions. So many things I wanted to ask, but given that things like

scrotox are happening, which is scrotum botox, it helps them hang lower. I had to just toss off one question that no one had had the pendulous balls to ask. I completely forgot to ask. I know listener did, but people with penises, are they getting injections for enlargement? Is that a thing? Well, they are, but I wouldn't recommend it. They're putting all sorts of stuff in the penises, like silicone. It's bad. It can be bad. Like, don't do it. Like, don't do it. Don't do it. Don't do it. Like, that's a part of your body. You just cannot afford to lose. I bet. I bet there's more risk. The risks are not worth the game. No, that's like the butt injections. You know what I'm saying? Like, yeah, sure, people do them, but are the, you know what I'm

saying? Yes, there's out there. They're out there. These are not, this is not at all recommended by American Urologist Association by urologists. So yeah, but there is a new device, speaking on penon enlargement, there is a new device that is not widely done. It's super early still. It's not for every man with a penis. So I don't want all these men, all these people jumping out as going like, I need to find you're all just now. We get that now. But there's a device, an implant called penuma that can be inserted to give, basically the way I just, it was described to me, which I love, is like, it makes you into a shower. Interesting. So it doesn't change like erect penis, whatever, but it gets the, it can increase length and girth

in the flaccid state. I mean, it's an implant that's done. It's like a little, like a implanted device thing. You know what else can do that is just a sock in your pants. If you're out to impress strangers. That works. Yeah, that also works. He knows how many. We don't know what John Hamm's really doing. Yeah, exactly. John Hamm, if you're out there, I'm sorry that people sell magazines with pictures of your pants area. It's a weird thing. But for everyone else who's not John Hamm, let's talk about your hogs. So I want you to know that I looked into this penuma implant and it costs about $15,000. Also, you are not allowed to bone with it for six weeks post-op. Also, there are three sizes of penuma implant to choose from.

There's large, extra large, and extra, extra large, which is just a sizing system that puts the Starbucks small, tall to shame. But you know, if you cannot afford a $15,000 implant and some pain, what can also increase your flaccid length by an inch or two is just trim in your pubes. The best pep talk I could give anyone is that you have so much dick under that muff. Don't hide your lightsaber under a bush. Now, if you're feeling bad about feeling bad about it, one Urology website, I saw said that quote, nearly half of all men think that their packages are smaller than average. At first, I was like, that's so sad. And I was like, wait, half of all men think that their packages are smaller than average. And then I was like, well, that's also

just math. But so many studies have shown that the vagina are fine with size and that it really does not matter. Confidence does. And when it comes to vulva havers, turning your focus to the clitter is going to get you more points. And by points, I mean orgasms straight up. Final listener question. Alia Myers put it well for all of us. Once and for all, is squirting just peeing? Is it pee? Yeah, I know they all might. This is like the most common question. It has urea in it. It's probably diluted urine. Yes. Yes. It is. Yes. Where is it coming from? Which hole? It's coming from the urethra, most likely, and around the urethra. So there are peri urethral glands. There's squirting and there's female ejaculation,

which is different. Female ejaculation is just really the peri urethral gland. So these are glands next to the urethra. They're really tiny. You can't see them with the mirror. They're just located on either side of the urethra and they like ooze out ejaculate type of fluid. They're kind of, we call them similar to like the prostate in a man. But squirting is probably coming from the urethra. There's some probably increased vaginal like expelling of lubrication and fluid, but I think that it's probably coming out of the urethra as diluted urine. I mean men, many ejaculate out of there urethra. So, I mean, it's not pee. We know definitively like it's not, semen is different than pee, but in women, it's probably diluted urine.

We don't have organs that make like seminal type fluid like the men do. So embrace it. Embrace the wetness. Embrace the spot. Yes. Embrace it. Embrace the wet spot. Get a towel. Have fun. Yes. You know, just get weird. Enjoy yourself because one day we're all going to die and it's okay. Your molecules might become a frog or a bagel. What about things that suck about urology? What is this part of your job that is the hardest or the most frustrating? Like what's the downside of your job? Well, complications as a surgeon, those really freaking suck. And the patient, you know, I have had like sleepless nights over certain complications and you know, I am thankful to say that I've gotten through it. And in most cases, it has made my relationship

with the patient closer because I'm very like transparent and I also become very available. If there's a complication, I'm like, most likely you're getting my cell phone number and I'm like, listen, I just want you to know I'm not going to abandon you. And I think really patients respect like they just don't want to be abandoned, you know, in suffering through this, you know, alone. There are certain things that we, you know, kind of like are difficult to treat. And so I don't want to say suck, but they just are frustrating. So just chronic pain conditions in urology are our bummer, just because it can be difficult to treat, because we don't understand it. There's something called interstitial cystitis, which is a chronic pain bladder condition that

can be frustrating for both very like frustrating for patients. I will need to emphasize that. But also for the provider, there's painful like chronic ball, we call it ball pain in urology, but testicular pain or scrotal pain. And it's totally normal, you know, everything looks normal, feels normal, but it hurts. Just a side note, if you don't know what interstitial cystitis is, congratulations. I don't either. It sounds terrible. It's also called painful bladder syndrome. And it's often mistaken for a UTI. And if you have it, get yourself a favorite urologist who may recommend pain medications or physical therapy. You can also check out the dolerology episode with Dr. Rachel Zoffness. We did November about chronic pain. I just asked and she said, yep,

some cognitive behavioral therapists can help with stabbing bladder pain management. Speaking of stabby bladder things. Oh, I know what we hate. I just thought the difficult catheter call. The difficult catheter, especially in the middle of the night. Doc, we need to, we can't place this catheter, this tube in, and can you come in? And I'm like, oh my God, please. And so I have to drive like 45 minutes to the hospital because this is where I just live to do like what is usually a five minute like insertion. Like, okay. And when I come in, the patient's like, they've tried a million times. I was like, but they ain't me. I love her. She's my favorite urologist. But I have actually taught some nurses like how to get a

difficult catheter in. And I, again, I think about my TikTok. I'm like, this, I did a TikTok about this. So I told the nurse, I was like, this is the catheter you want to use. Put it, lube it up. The thing is people don't use enough lube to lube it up, do this, go gently, blah, blah. And she called me. She was like, I got it. I got it and saved me a 45 minute trip. And I was like, go best friend. Yes, best friend. You're like, watch my TikTok before you call me and then let me know. And then let me know. Yeah. Have you had a catheter? Is part of urology is like, you have to have a catheter done to you so you understand what it's like. Because I've never had one and they terrify me. No, you don't have to, but I have. So I'm an open

book. So this is like, oh, gotta be classic. So I have catheterized myself. And why do you ask? Why did I catheterize myself? Because I used a cream. I won't say the brand. I used a cream to, to, to, for hair removal in, uh, down there, right? And I guess it was an expired thing. I don't know. I've been using this cream for years, no problems. I put that cream on me and it burned like hell. It was like my crotch was on fire. Washed it off. It was still on fire. But when I pissed, it was like fire, like fire. I've never, so I was like, Oh, forget this. I can't pee. I'm just going to catheterize myself every time. And I can do this. I tell my, teach my patients how to do this. I can do this. Man, I had a newfound respect. Found respect. Yes. Urologists heal

myself. Yes. I was struggling for like 10 to 15 minutes. I was like, really? Wow. And I know exactly what I'm supposed to do. Yeah. And it, yeah, yeah, yeah. So yeah, sometimes we become the patient and it's humbling. It's definitely humbling. Now what about, what about your favorite part about your job? Oh, I really love, I love people. So there's a couple of different favorites. Number one is I love surgery. I really do. It's my happy pace. The operating room is my happy place. I'm like, yes, I get to do my thing. And a lot of what I do is quality of life. So it's fun. Like, it's fun because it's not as stressful as like brain cancer, but it is life changing nonetheless. Okay. And so a lot of the times I walk into the operating room and then walk out and I'm like,

ah, yes, I see my work. That, I love the operating room. I love being able to relate to patients and talk about like intimate intimate things that they don't talk about. And I just use plain language to do it. I tell patients, this is a no judgment zone. Don't be ashamed about anything you say to me. Use just the words you want. You like just say like, you don't have to be like, my male member. No, just say dick if you want to say dick. Okay. Don't, you know what I'm saying? I'm going to be, and I think I do that and I curse a little and I tell you every time I curse, patients are like, wow, I like you more. Like literally you see the like, the loveliness on their face and like, oh yeah. Like it breaks the walls down and I just love getting to get

that information from patients and them feeling like they can have somebody they can talk about and hopefully get answers from. You do such an amazing job of making us all more curious about urology and also stigmatizing so many issues that we might not realize we had someone to ask, you know? Oh yes. Yes. That's great. I love that you said that about me because that is absolutely 100% like what I want to do. Educate, destigmatize. Yeah, you're doing it. Well, you are my favorite urologist, I have to say. Thank you. You live up to the hype 100%. I appreciate it. It's been a pleasure. I can't wait for all of us to listen to this when it comes out. So ask brilliant surgeons, shame free questions and use whatever language you like. Also,

hello to the folks in Dr. Milhouse's office who listen to oligies. Thank you for helping her fix p-holes and telling her to come on the show. Now, Dr. Milhouse also adds that the Urology Care Foundation is a great resource for a lot of conditions. You can also learn more about her work by following her at your favorite urologist on TikTok. She is a hoot and Dr. Milhouse won Elle and Milhouse on Instagram. And just look up the hashtag your favorite urologist. You will find her very quickly. We are oligies on Twitter and Instagram. I'm Ali Ward, also 1L on Instagram and Twitter, do say hi. You can tag photos of you in oligies merch with hashtag oligies merch so we can show you off and repost you. oligiesmerch.com has items you can put on your body to help you

find other oligites in the wild. Thank you, Susan Hale, for managing that and so much more. Thanks, Erin Talbert, for admitting the oligies podcast Facebook group with Assis from Bonnie Dutch and Shannon Feltis of the podcast You Are That. Noel Dillworth helps with scheduling and so much more. Emily White of the Wordery makes professional transcripts, Caleb Patton bleeps episodes. Those are all up for free at alleyward.com slash oligies-extras. There's a link in the show note to all of this. There's also a link to alleyward.com slash oligies slash urology for tons more links. Kelly R. Dwyer maintains our website. She can make yours. Every few weeks we put out small oligies episodes that are scrubbed of anything adult, including language and talk of

dongs and Zeke Rodriguez-Thomas of Mindjam Media helps us make those with Assis from Stephen Ray Morris, Nick Thorburn made the music, and the king of this throne who puts all these pieces together. Each week is Jared Sleeper of Mindjam Media. Thank you, Jared. Stay golden. If you stick around to the end each week, I tell you a secret and this week in the Acoustic Ecology episode from last week, we had so many issues recording it that I forgot to even mention the part where the afternoon sun was hitting my laptop and heating it up in such a way that the fan was worrying really loudly and I had to put Dr. Game on hold while I ran across the house to get a frozen pizza. I do have a frozen pizza. Does that work? Is that a cutie? I don't know,

but I have a frozen pizza and I might as well just put it right under there, right? And put it under my computer. So my computer the whole time we recorded that was sitting on top of a frozen pizza to try to cool it off because life finds a way. Everything matters and yet nothing does. Thank you also just to everyone being such sweetie-pedies to me and being so patient with these episodes. Coming out as we handle some family stuff. Mom, Dad, if you listen to this, that's your problem. So, okay, bye-bye. I'm gonna say something nice about my penis. Oh Ramon, your penis is so powerful. I'm coming. Okay, thanks. Get off me now.