Sex With Emily - Best Of: Power to the Penis w/ Dr. Edward Karpman

Episode Date: May 7, 2021

I’m joined by board-certified urologist Dr. Edward Karpman to talk about virtually every penis topic there is and explore how overcoming your penis challenges can boost your sex life. He even shares some cautionary tales about penis fractures when your partner is on top.We discuss the most common penis challenges (low testosterone, premature ejaculation, erectile dysfunction) and ways to work through them, how to get your brain on board when you’re dealing with performance anxiety, and how a penis implant actually works. Dr. Karpman also breaks down the pivotal role testosterone plays in your sex life, how his patients think about their penis size and the benefits and drawbacks of pills that treat erectile dysfunction.For even more sex advice, tips, and tricks visit sexwithemily.com Hosted on Acast. See acast.com/privacy for more information.

And so a lot of people just don't know the difference between the different terms that we use, like the difference between orgasm and ejaculation. Totally different. Totally different. orgasm in your head, ejaculation is in your penis. Look into his eyes. They're the eyes of a man obsessed by sex. Eyes that mock our sacred institutions.

Betrubize they call them in a fight on day. You're listening to Sex with Emily. I'm Dr. Emily and I'm here to help you prioritize your pleasure and liberate the conversation around sex. I'm joined by board certified urologist, Dr. Edward Carpment, talk about the penis and how to be your healthiest self so you can have the sex life you deserve. We discuss the most common penis challenges

and ways to work through them. How to get your brain on board when you're dealing with performance anxiety and how a penis implant actually works. Dr. Carpment also breaks down the pivotal role testosterone plays in your sex life. How his patients think about their penis size and the benefits and drawbacks of pills

that treat a reptile dysfunction. All right, intentions with the Emily. Join me in setting an intention for the show. What I mean by this is when you're listening, when you want to get out of this episode, how could it help you? When you state it, more likely to make it happen. My intention is to give you a comprehensive look at all things penis related to you or the

special penis in your life can have the great sex you want and enjoy. Oh, and Mother's Day, please meet the sexiest Mother's Day gift guide you'll ever read. We've got CBD baths, so many sex toys, and some really great discounts. So whether you're shopping for your mom or your mom shopping for herself, which I highly encourage, check out our website at sexwithemily.com for our list of curated gifts designed to delight and deliver pleasure. What are you going to get your mom? Have you thought about it? All right, if you want to ask me questions, call my brand new hotline. It's 559 Talk Sex. That's 559 825 5739. Just leave me your questions or message me, sexwithemily.com slash ask

Emily. As always, always include your name, your gender identity, location, age, and how you listen to the show. And one more thing. Remember, when you're listening to this episode, if there's something in here that resonates with you, I'll bet there's someone in your life that could also benefit from this knowledge. So start the conversation, share the episode with them. I've just heard from a lot of you who are listening together in a relationship or as friends, so just want to encourage you to do that. Alright, everybody, enjoy the show.

I am really excited to welcome my guest today. If you've ever had a question about a penis, either yours or one that you know, anything at all, this is the man. Dr. Edward Carpind is a board certified urologist and one of the few urologists who is also fellowship trained in male reproductive medicine and surgery, microsurgery, and male sexual dysfunction. He's the medical director of the Men's Health Center

at El Camino Hospital, Los Gatos, and the California Vasectomy and Reversal Center. You're amazing. Welcome to the show. I think you're amazing. You see them? Thank you, I like you. Dr. Cartman.

Now we've established you know all things penis. Penis challenges I feel have been on the rise lately. We know pun intended, but they have been, or not on the rise. And not rising as much as they'd like to, the penis is. But what's going on? I know that it affects 50% of men over the age of 40, some kind of penis challenge, but why do you think it's becoming more of a problem now? Or is it just that we talk about it more?

I think it's a little bit of both. I think that I always saw people that in 1999 when Viagra came out, it was a sexual revolution and renaissance for us. We finally had a drug that could effectively treat erectile dysfunction. We started talking about it. Remember there were commercials for Viagra famous senators like Bob Dull were going on TV saying that I'm using this. It became socially acceptable in our Puritanical Society to talk about sex.

And I think it's only been 20 years since Viagra came out. And we've seen this evolution. And we're seeing new products come to market. Things to treat crooked penises, more hormone replacement products. And we're seeing a lot more attention to it. So that's one of the things. I think we're just bringing more attention to the issue of sexual dysfunction.

And our society is not getting healthier. So we're getting more problems at the same time. Let's talk about erectile dysfunction real quickly. Because I think people tend to get confused with what it might mean. So what is it, and how would you define it, and how does it affect a person psychologically? Well, affects a person's psychological tremendously.

Okay, I'll just get that out of the way. But erectile dysfunction is defined as the inability to obtain and very importantly, maintain an erection adequate to complete sexual intercourse. So many guys think that, well, I can get it up for a minute, 100%, I don't have a problem, but even though it goes down before I can reach climax a minute, 100%. I don't have a problem, but even though it goes down before I can reach climax or satisfy my partner,

I don't have a problem. That's a problem. That's a problem for everyone. Yes. Evolved. A minute. And in fact, that's a form of erectile dysfunction is called a venous leak, where guys can get a good erection,

but they just can't maintain that erection. And this is a very devastating form of erectile dysfunction because it affects young men. And... How does it affect young men? Where is it? Is it something that's genetic? Is it something... Yes.

Well, it's just, it might be something that they acquire from some trauma or some injury or something like that. But a lot of guys, it's a genetic problem. And it's the inability of them to just hold out blood and their penis. And the analogy that I always get my patients is that imagine you had a faucet and you had a bucket and someone said, hey, you got to carry a bucket of water from the faucet over to that point B. Fossil works great, water flows in great, but someone drilled a hole

in that bucket. So by the time you get over to point B, half the water is leaked out already. So obviously, you're not going to have much water in that bucket. So that's the kind of ED that younger men get. And a lot of older men get as well. Okay. So that's one kind of, but essentially we're just talking about, I always say that it's the umbrella of penis challenges. Like it's just you can't get hard, or they can get hard, you can't stay hard. And it's a problem. And then say there's pain involved. It's a form of pain. I mean, it's painful. It's a painful relationship. Well, it's painful. So let's talk about it. How much of these penis challenges are mental and not necessarily physical? Small percentage. We're talking about 10% of erectile dysfunction

is due to some psychological causes. And there's things like stress, anxiety, causes. And there's things like stress, anxiety, those will contribute to erectile dysfunction, expectations being inappropriate. Those will contribute to erectile dysfunction, but it's really a small percentage, about 10% is due to what we call psychogenic erectile dysfunction. The vast majority is truly inorganic problem that there's something wrong with the guy and we can usually identify and fix it. Just to make the distinction here that people with premature ejaculation, which has you come to quickly, your heart and then you're not hard very long, that could be mental, more mental in many ways. It can be exactly. And a perfect example of

a guy who has a venous leak, realizes healing has about a minute or two of hardness before it goes soft. So just like Pavlov's salivating dog, he trains himself to come quickly in order to reach climax. Because orgasm is why we have sex, right Emily? That's not the only reason. Well, that's the, that's the,

It's a drive, it's the carrot, I guess. But there's other things that happen. You're right. I don't want to minimize the whole process. Okay. The door plays important. The process starts after last orgasm. Exactly. I saw you notice my sign with things that happen. You're right. And I don't want to minimize the whole process. Okay. Four plays important. The process starts after last orgasm. I saw you notice my sign. Love it. Love it. So yeah. So I think that what we strive for orgasm because if we don't achieve orgasm then we feel like we didn't complete our sexual act. And so these men who have these momentary erections then almost train themselves to have premature ejaculation

that they develop another problem because they don't address their underlying problem. Okay, so this venous link thing is a new new information for me to be honest. So is this something, are you telling me then that there's a lot of younger men that could have this venous leak and not know it at all because not many doctors know about this, is Western, you go into your regular urologist, you might not know about the venus link. Well, no, urologist will know about it, but a lot of people, very regular doctor,

your general physician. Yeah, you go into your doctor, and if you're 20 to 30 years old, you can say, have a problem with your erections, they automatically assume it's in your head. And they neglect you, they say you're having stress, you don't need to see anybody.

And then the patient becomes embarrassed because you're like, oh, yeah, maybe I'm just crazy. Maybe it's on my head. And they don't want to go anywhere else because they don't want to be embarrassed to second-third-fourth time by another doctor telling them the same thing. So they just leave it at that.

But it is a big problem in our society and it's under-addressed. And I've seen some devastating life experiences and patients who didn't know they had Venus leak when they were young, but then when they turned 40, 50 and they already went through a ruined marriage and they're having depression and all these problems, they finally come to somebody who can address that issue and explain it to them and treat it effectively. Well, is there any way what are the symptoms of a...

I know you explained to me with the bucket and there's a leak, but how could you... Is there any way you could know? Like, when I do my call show, people call in, is there any way I could say, like, that sounds like a venous leak, or do they actually have to go see you? No, I mean, essentially, if a guy could get a hundred percent erection, like hard firmness. That's not gonna table it. It's not hard. But it does not sound like, and then, but it doesn't last. So you're, you're having sex with your partner. You're into it. You're, you're you're it's hot and sweaty and you want to be there You don't want to be anywhere else

And then and then out of nowhere this thing just started going soft You're like what's going on? I'm not thinking about anything else. I'm thinking about you You're naked in front of me. You're beautiful. I'm turned on but why is he getting soft? So that is a physiologic organic problem that out of the control of the guy has nothing to his head. He's into it, he's in the game. He wants to have sex without woman or man.

But that describes, this sounds like most erectile dysfunction then. You get hard and then you don't. So the traditional garden variety. Garden variety, that's called garden, right? Is an arterial problem where a guy can't get a full erection So because a blood flow and yeah, you don't need a full you don't need a hundred percent rigid erection that sex to have penetration right you get a penetration with about 50%

Regidity so and it doesn't go from a hundred to 50% overnight it goes from a hundred to 95 To 90 to 85 so there's but the Venus link is like hard and then soft. The hard and then soft. It goes soft. So they'll get up to 100 and I'll be there for a minute and then it starts getting soft in the midst of it. Okay, got it. So what are the top penis challenges that you see

that come to you? The top penis challenges. Yeah. Well, my practice. What does it look like if you could walk me through a patient comes in, like a typical patient comes in. If yeah, you have a typical we don't know everyone's different But I think the main thing is understanding that the terminology and what the patient is saying and so a lot of people Just don't know the difference between the different terms that we use like difference between orgasm and ejaculation

Yeah, totally different totally different orgasm in your head ejaculation is in your penis and guys will come in and say I don't have an orgasm And when you start talking to them and you find out that they're on medications for their prostate or they had a prostate operation So they're still really having an orgasm. They just have retro great ejaculations going backwards into their bladder Right, or you have you know the guy you know who can't or you have the guy who can't understand why he can't get an erection or maintain an erection, the guy who has the crooked penis. I mean, there's no typical patient. So a crooked, I get a lot of things about the crooked penis. It's not always a problem, right? No, sometimes it's a good thing.

It's a benefit. I mean, I think we've got toys shaped like crooked penis. It's like worse like, but then depends on your partner. Depends on your partner, depends on the things, but like, but peyronis is another. That's when it's good start to get more painful for men. Well, so any, any curve, most curves in the penis, I should say, are due to peronis. And so, and that's an acquired condition. So if the curve is mild and it's in the right direction, like a little bit up curve, you know, you hit that G spot or even a little down curve, but you, you know, you're having

sex doggy style, you hit that G spot or even a little down curve, but you're, you know, you're having sex doggy style, you hit that G spot. But what about the 90 degree left curve? And you're hitting the woman's over every time you're having sex. Or- It has to kind of flip over and it's like- Yeah, could you imagine the position there? That's right. So that's sort of the problem. So okay, so what about people who come in to see you then?

They come into your office, or they typically in relationships. They're not in relationships. Most of them are in relationships, but there are people who are not in relationship and are preparing to be in a relationship. They wanted to stuff all fixed before they get into a relationship, because this was holding them back. They're having some concerns that they meet the woman or man of their dreams, and they

want to make sure that when the question of sex comes up, they're ready. Okay. Here's the thing. If they come into you, whether they're in a relationship or not, would you say your typical client is of a certain age? Because I know that men over 40 start to experience challenges with their penis. I have the whole spectrum. I have, like I said, you wouldn't even say the majority then. Well, if you look at the most, the average age of a man who gets, like I say, a penile implant is around, mid-60s, late 60s.

You could use that as one metric, but then you have young guys who are early in their 20s who are having sexual dysfunction. My oldest man I ever put a PNL implant in is a 92 years old. Why do all these studies stop looking at sexual dysfunction after the age of 60 or 70? No, it's upsetting to me because I feel people are like, oh, our life, I've

met a couple other day. They're like in their late 60s and they asked what do I do? They're like, oh, we don't need to have a talk about that anymore. I'm like, yes, you do. You can solve sex. I'm like, this political fundraiser yelling about sex to them. But I'm like, you look happy. Well, yeah, I don't know why.

I don't know why we don't keep talking about sex because that just because we don't have the information out there. It's really discouraging for people. Tell me about these implants because I think they could be your implant. You like think of breasts usually like you're like, oh, my penis is going to get bigger. Like let's talk about implants. What that means though, your specialty. So, PNL implants first of all have been around since 1972. Okay. They've been around for a very long time. It's not something new. And the implants that we're putting in today are very different than the ones we were putting in. They're not your grandfather's name. Exactly. They're very sophisticated. They've been refined. They're more reliable. They're

less prone to problems. They're wonderful. And now the surgeries that we're doing to put them in, you know, when I do a PNL implant, I could put one in. I did one yesterday. It took me 17 minutes to put in a PNL implant. Average about 24 minutes, usually under 30 minutes to put an appeal on implant. Okay. What is it? Okay, let's back up though.

Why, who was that patient? Why were they there? And then we need to understand. So he was your garden variety guy. Garden variety. How old was he? Maybe pushing 70, 68, 70. Rectod is function from arterial disease,

from having narrowing of his arteries, didn't have the cleanest lifestyle, which a lot of Americans do. Right. You know, we all eat cheeseburgers, we all skip exercising, we all put on a little extra weight. Right.

All those things help contribute to a Rectod is function. And he got to the point where other things just didn't work for him anymore and he needed a penile implant. Okay. So then, because then you put the penile implant in 17 minutes and now what happens when he goes home? So, his life changed. So it doesn't change immediately.

We don't let him use it for the exact... It's not perfect. Well, they have to heal. Okay. Just like, you know, when a woman gets breast implants, they don't really want them to do all the things that they want to do with them right away. We want to let them heal a little bit. So we give them three weeks to heal. And after three weeks, that's when their life changes because now they're going to have unbelievable sex, him and his

partner. How does it work? So he's got the, like, let's explain it. So he's got the pump, he's got the, he's got the, so that's back up. He recovers, yeah, there's different kinds. Like, let's talk. So they need to go to you and you're like, this is what kind you need. Well, yeah, so the, there's the, oh, so excited. The malleable type. I really never wanted.

Which are the bendable type. And this, what we're showing you here today, is a new flabble implant. And the reason we call it a three piece implant is because it has three, even though it seems like there's four components There's the reservoir. There's the pump and then there's two cylinders because there's two chambers in the penis And so we put one cylinder in each chamber

But we call this a three-piece implant. So this goes into their Scrum. So this one is not filled with water. It's just filled with air So normally they're filled with saline But when a guy wanted to have an erection, he would take this pump, which is in the scrum, and then it pumps up and the penis comes up like this, and then it stays hard. So both of those are in the penis.

Yes, and so the cylinders then stay hard, and these cylinders, the pressure they generate, can generate, is greater than a man's natural erection when he was 17 years old. So most guys don't go to 100% when they want to have sex because then it feels like you're, you know, it's really feels like wood. But they're in charge, so it explains me.

So they're getting, they're with the partner, he goes home, they're getting turned on and then he's like, he reaches down to his scrotum and he starts to squeeze. Yes. So if you're, how do you explain it like a squeezy ball, like when you're, what does this remind me of, like blowing up a ball or something like that? Yeah, it's like a, like a bicycle pump or a airplane. Yeah, it do you explain it like a squeezy ball like when you're blo- what does this remind me of like blowing up a ball or something like?

Yeah, it's like a like a bicycle pump or a airplane. Yeah, it's exactly what it is. It's like a bicycle pump. Oh, this, okay. This is this is it. Okay. Try this one. Try the real thing. So this is the right. And and again, it's not it's not filled with water. So it works differently when it's filled with water. That's the reservoir. And that goes into behind is abdominal wall, which is never seen or felt. This is amazing. Up in here. Yeah, okay. I've seen the video. Okay.

Right. Now I get it. Okay. So in 17 minutes, you put this contraption into their penis. Yes. That's amazing. Through one inch incision. Wow.

And then they have full recovery, full sexual function in three weeks. And this is covered by Medicare and California 95% of insurance plans cover PNL implants. That's unbelievable to me, and that also makes me angry for all the things that aren't covered for women. But what about side effects? The side effects are minimal, and that's the beauty of it. So, you know, the biggest concerns with a PNL implant are infection rates. And if you look at national statistics, the implants now come coated with antibiotics. So we've got the infection rates down to 1.4% for non-diabetic and 2.5% for diabetics.

That's the national average, all-comers, no pun intended. But, I mean, if you take, you know, if you look at high volumes surgeons around the country, you know, our infection rates are even lower than that. I've had two infections in a 14 year career, which is much lower than the 1.4% the people will report. That's one of the biggest problems with a PINL implant. You can have a mechanical breakdown, like, you know,

you might buy a brand new car, but the transmission goes out in six months. Nothing. That happens. That's not saying you're perfect, but you know, you've won the awards and stuff. You're the man of charge. Do you think that there's a lot of men who could benefit from this that wouldn't normally like they're taking a pill, they're taking a viagra?

Like, what's the limitations to viagra? If they're like, well, viagra or whatever pill is working. Right. So first of all, viagra doesn't work on every way. Or it's a quibble. That's right. I think I hate the pills. I don't know. I'm sorry. You just rely on it. Right. So first of all, vagranism work on every way or it's equivalent. I hate to pills. I don't know. I'm sorry. Just rely on it. Right. And you're dependent on it.

So first of all, I tell everyone in order for those medicines to work, you got to take them on an empty stomach and avoid alcohol. And I'm sure you're the same as me, but starving and sober is not the way we like to have sucks, right? It's not the way we roll. So there's

a lot of limitations to those medications. They take half an hour to 90 minutes to kick in. There's side effects. People get, you know, healos around lights. They get headaches. They get facial flushing. They got muscle ache. All kinds of things. And if you don't get any of those things and it still works and you manage to have sex starving and sober, it still only works in about 70, maybe 80% of people. So it doesn't help everybody. It's still a miracle drug because it helps 70% of people,

but it doesn't help everybody. Who are the guys that will come to you? We talked about the Venus leak, but like who else? I'm just trying to think of like, I get thousands of calls, emails. I mean, there's, I can't get it up anymore. I'm over the age of 50, what's happening, you know, occasionally younger men, but I mostly hear from men in their

40s and 50s who never had any knowledge that their penis would change. Like no one ever, because no one talks about anything, women don't understand about paramanopause and menopause. And they're like, what do I do? Like, what is the first step for people? Like, what do you think, I always say like, well, how's your diet? And a lot of people are on medication. So Michael, if you're taking blood pressure or your diabetes or there's all these factors,

all these risks. Obviously, if you're diet, if you're not eating well and you're smoking and not exercising, those are all things. So what would be the first step, you think, for people to just go under, say what it might be? I think it's technology of a problem. Most of the main things. Yes.

And so many guys are in denial about their dysfunction and like I said a guy could have a 60% rigid erection which is enough to penetrate a vagina Maybe not something else, but a vagina If she lays still if she's complying she's fully lubricated and everything all you know the stars and moons line up And so they think I don't have a promise long as I could get it in and you know we say that's like like shooting pool with rope, you know, you can do it, but it's not, you're not going to be very effective. Right. So acknowledging that you have a problem, once you get down to anything under 100%, recognizing there's a problem and then seeking help.

And then coming to a specialist who knows what they're doing, so they could identify the different types of rectal dysfunction offer you the whole menu of options. Well, I feel like that's what I've been trying to open up to my listeners and say, you know what? Just because you went to your doctor, you've been seeing for years, your Western doctor, wherever you're at, there might be other solutions that he might not know about or she might not know about

because there's been so many advancements now in sexual health for men and for women. Would you tell him to go? Like, Google it, find you, obviously, we'll get a lot of information. You could get a special. So there are societies that are like the sexual medicine society in North America.

They have an extensive list of specialists like myself all over the country that can help treat their problems. You could go to a website, say like to Boston Scientific's website, edicure.org, that has a- We'll have all this in the show notes as well. That has all the information for people like myself around the country who specialize in this and they could identify the person in their area

if they want to travel somewhere, go find somebody in that way. Kind of worth it, right? Men are obsessed with their penises and not working on thinking if you got to travel a little bit. You got to do some research. You do not go down the street to the first guy

for surgery or your penis. I believe this too. We're gonna take a quick break and we come back. Dr. Cartman and I break down what testosterone does for your sex life. Let's talk about hormones for a minute as well. How much of this is hormones for men who are a little bit older, 40s, 50s when things start to testosterone, start to dive? I know there's been a lot with biodeonical hormones and different treatments.

What do you think about that? Yeah, hormones are very important to testosterone. I call it the lube for an erection. Every biochemical step in an erection is testosterone dependent. And testosterone is extremely important for a man's libido. So libido is your drive. If you don't have an interest for sex, you're not gonna care about your erection or retreat.

Yeah, but I didn't even know it wasn't working because I haven't wanted sex in five years. You're like, I'm more interested in my car, and in my garage, and in playing baseball, and shooting pool with my friends and drinking beer. That's more fun for me now, and that's because you're testosterone as low. So you need to have a healthy normal testosterone level.

And we know that men go through a manopause or andropause wherever you want to call. Yeah. And it starts as early as the age of 30. So women get to about 50 and their hormones drop off the cliff and they feel it. They get hot flashes. They get moody. Their vaginas get dry. And it's impressive. There cliff and they feel it. They get hot flashes. They get moody.

Their vaginas get dry. And it's impressive. There's no doubt about it when a woman goes through menopause. It's impressive. I have another word, but yeah. Oh, whatever word you want to use. That's a good one. Interesting.

But for men, for men, we start losing testosterone as early as the age of 30. And it goes down by about 1 one to two percent per year, such that it's a very insidious process. So it's kind of like looking at yourself in the mirror every day and saying, do I have more gray hair? Do I have another wrinkle? You don't really know, because you're living with yourself 24-7.

And, you know, well, I'm just a little bit less horny today than I was last month, but you're like, you chalk it up to something different. Right, like I'm not attracted to my partner anymore. Right, right, right, I had a rough week. Right, which is true though, in my neighborhood. Kids are annoying me, and I'm tired and sleep well last night. But you'll never know until you get your hormone levels checked. And so by the time you get to about 50 or 60, you could say that you've been losing

testosterone for 20 or 30 years, or you could say if we say one to 2% a year, that's 20 or 30 or 40 to 60 percent of your testosterone is declined. And the other problem I find is that, you know, people, we have these normal values. And I always tell people, what are normal values? Like, like, we made those up, right? Like, do you think, like, our bodies really believe that 300 to 1000, a nice round number like that, is the true normal testosterone. We made that stuff up, right?

And so our bodies don't read our textbooks or follow our textbooks. So some guys will be like 375, and they go see their doctor and their doctor says, oh, it's normal, see, 300 to 1000's normal. So you're normal. But- But keep hearing from people that all the time,

I'm like, well, but- But- But, I mean, maybe you live at eight to 900 your entire life, and now you have a 60% decrease in your testosterone production, and somebody's telling you you're normal. And the insurance companies are horrible like that,

because I look for any reason to deny you coverage for something like that, they'll say, ah, it's not under 300, we're not gonna pay for it. So these guys get frustrated, and then they literally have to live with these symptoms until it drops to some new low level that, again, your body has to read the textbook and say, it's got to be below 300, otherwise you're not symptomatic. Yeah.

And I guess what I've also found is, and that's why I'm so glad that I love the service that my show provides because I realize that my listeners, well, it's half-man-half women, but I would say that I'm probably for many, many, the only person they've ever talked to and it's anonymous. They call in about their penis ever. They could even go to their doctor and be like, yeah, things are fine. What is this with men? They're obsessed with their penises.

I know the size and how they're performing and I understand it. Evolutionarily speaking, if your penis doesn't work or men are going through depression, it's like, you know, they feel emasculated, they feel like they definitely don't want sex so if they have money problems, so there's all these things around the penis, but yet, they're still not comfortable talking about it.

So I love what you're doing here, but like how hard is it? When they get there, are they finally like, I got dragged in here, my partner, do they meet you at a party? I'm just trying to think about you at a party because me at a party is like everyone wants like what's that? And I can imagine you with the penis.

Yeah, I want to come after you. So what happens? How do they get in there? Well, why won't they talk about it? It's three questions. Yeah, for my practice, you know, the guys are self-selective. So obviously these are people who recognize they have a problem. They want help with it.

And so they come seek me out and they come in. And what I try to do, the first thing I try to do with every guy that comes in is I try to put them at ease. And I try not to use big words like erectile dysfunction. Yeah, I hate using that word too. I just say penis challenges is what I say. I ask them how they're what is. I said, I said, can you get it up?

That's how I would do it. Can you make a screen? Yeah, is it satisfying? You know, I ask some simple questions like that. And I always advocate this to other urologists. And they say, well, how do you talk to a patient about this? And I say, just think of guys as like, we're simple. We're like cavemen, you know, with a little sophistication.

A little bit. And just locker room talk. I mean, just every guy talk, we talk about everything in the locker room. And I'm sure it's just like women talk about everything in the bathroom. You know, men talk about everything in locker rooms. And we're open, we open up to each other, we talk about these things. But then as soon as we get into a doctor's office,

some other environment, we shut down, we don't talk. So I think you have to initiate that. And there's this thing called as interpersonal dilemma that we see in medicine that for the longest time, people were embarrassed to bring up these subjects with their healthcare providers. And this is, again, where I credit Viagra and these commercials that we're seeing

for drugs to treat crooked penises and stuff like that is that it's making it more acceptable. And we live in a very puritanical society. Although, we try to sound all progressive and we're like really cool and hip. But when it comes to sex, we're like so puritanical. And we don't talk about it. We'll try and change that.

I'm glad you're doing it. I'm with you. So I think that we're trying to do that is when we talk to them, is talk to them in a way that they can almost disarm them. So they could, they feel comfortable in the locker. I love it. You're like, how's the wood? Like that's exactly what you need to do.

Yeah. I love it. That's what I would do if I was there. But I'd be like, how's it flow when I turned on? Have you had a de-mastery? That's how I say to women. Have you masturbate? Have you touched yourself? Have you had an orgasm? Do you fantasize? But that's what you got to do with men. I love that doctor-carpment. You're bringing it, you're just getting them to open up to you. You're doing important

work. How did you decide in all of your things that you've done that like penis was important? Was there like a moment in your life where you're like, this is a good place to focus when you're in medical school, young doctor, Carpman, what did you happen to? So it's interesting how we choose our specialties. And for me, I was gonna be a primary care doctor. I know you can't imagine that looking at all this

right now, but I wanted to be a primary care doctor. Just like take care of patients, be the community doc, live somewhere on a coastal Yeah, so, but I wanted to be a primary care doctor. Just like take care of patients, be the community doc, live somewhere on a coastal community, surf, and have fun, you know. And I was bit by the surgery bug and I realized I'm good at it. And I said, well, maybe I want to be a plastic surgeon because I like the art part of it, the reconstructive part. And then I kind of bumped into urology and you meet people along the way that inspire you, you get excited by things. And it's a it's a it's a generally happy feel. We don't have people dying. We're not like cancer doctors or or heart doctors. You know, people come

to us for a quality of life condition that we can improve and we can make them happy. We change your quality of life. And it's not about, you know, a cancer doctor, everyone in your practice ultimately dies, right? But when, in my practice, it's, you know, it's a lot of happy- Yeah, that's a given them more life. So I get- I get- I get- I get- I get cards from patients and their partners even with-

I got this one card from a woman of a guy that I did a PNL implant on. And all she did was send me a card and said, eight plus and she signed her name. I love it. I was gonna ask if that's amazing. What are the spouses? They must be thrilled, right?

I'm sure you must hear from a lot of them or they even had to bring their partners in. Yes. So some have to bring their partners in, some are self-motivated. Some spouses are very happy for what I did for their partners. Some spouses hate me for what I did to their partners,

because you know, there's always that discrepacy. Because I was happy with the no sex, yeah. Yes, yeah, so she's a little older. There's no problem here. She's not on hormones, she's dry. It hurts a little bit when they're having penetrative intercourse. And she was kind of happy that he had erectile dysfunction. Now he's a bionic and a superhero,

and she's still at the status quo. And then what do you tell her to do? Where do you send her off to get her last check? Yeah, fortunately, we have a lot of people and resources in our community. And I talked to them about, the women's health and issues study. When I came out 18 years ago,

I scared all women from taking hormones. And now the follow-up study came out 18 years later and said, oh, well, actually, it's not that bad. It's not that bad, but people still think it's bad. Right. And a lot of the oxards, we're all busy in our practice, so we just don't have the time sometimes to sit down and go over in detail all these like all these data points. All the new advanced.

That's why I keep telling people, get another opinion, look for biodenical hormones, look Google it in your area who's specializing in women's health, men's health in a different way that might not be your regular doctor. So we do, like we make sure they're estrogenized. My partners do the vaginal rejuvenation procedure now in the office. Yeah, which is the laser. Yes. Yep.

And so sometimes we have to send their partners to get their tune up so that they can now be more receptive to this amazing penis that we gave them. I hate the word vaginal rejuvenation though because it makes even to say like I want to get my badge with juvenile. I don't know just like I have I haven't I want to rebrand everything sex I want to rebrand the word vagina I want to rebrand the word vagina. I want to rebrand the way we talk about sex and just some of the words aren't great. But what I'm saying is rejuvenation is like, I don't know, I'd rather have it be like, because they're like spring cleaning. That's better.

Well, that's better. Like a little judge, the vegish. You know, I think, you know, if you have one partner who's fixed and the other one's not, it's gonna be a problem. It is a problem. It's kind of to be on the journey together. There's a discrepancy in what level they're at, you know.

And I think they, if they're at the same level in terms of desire, comfort level, and functionality, then it's a better relationship, it's a better fit, whereas one is good and the other one's not that good. Be right back after this quick word from our sponsors. When we come back, Dr. Cartman tells you how to find the right doctor for you. Why would someone go to a prosthetic urologist instead of a regular urologist? How do they get to you?

How do you come to know? Yeah, a prosthetic urologist is a board-certified urologist who either has fellowship training in doing peanut prostheses or it's become a big part of their practice. They something they specialize in. So you never want to go to anybody for anything important surgically that does one or two or three of these a year. You wanna go to somebody who does this on a regular basis every week, every month at the least, so that you get a level of expertise that you know is gonna be good.

And again, this is your penis, okay? This is not your thumb. You don't wanna mess around. Yes. You got your penis, like take do some research that's the time. You get your penis, like take do some research at some time. Right. You get your best shot at getting your optimum result

is the first time you get a penile implant. And unfortunately, too many guys don't know how to find a specialist or they see a lazy and they say, like, well, I don't want to drive 30 minutes to go see that guy. There's a guy right down the street here who says he does them. So I'm just going to go to him. And so it's overcoming that problem where guys need to know where to find the guy who specializes in prosthetic.

So it's not just any board certified. It's like worth of playing ticket to because it's your penis or a plane ticket. Yeah. I get that. So that's when they come see you. So what is this? They don't actually want to talk about their penis. It's like, why do you think that is?

Number one reason is embarrassment and you know, guys just get embarrassed about it. The penis is, it's, we're a phallocentric gender, okay? And you know, sex was very important. And I will tell people the most important system in the human body is a reproductive system, which the penis is part of, right? The heart is there to pump blood for the penis, right? The lungs are just there to give oxygen to the penis, because if we did not reproduce in one generation,

we'd become extinct as a species. And so every living thing, it's most important role on this planet is reproduction. And sex is what it is. And that's why we're programmed to want to have sex, to be virile, and to have a good sexual function, sexual life. And our society kind of humiliates men who are impotent because like, you know, that word is, it means more than just a medical term impotent. Okay. You're impotent, okay? You're impotent, you just can't get it done.

Right, can't get it. You can't get anything done. And can't get anything done. So when someone calls you impotent, it's like, I'm just a teller, loser. So yeah. And so our society has kind of made men think that our lives do kind of revolve around our penis

and the strength because when you're impotent, it means a lot of bad things for a man and not just his penis can't get totally hard. It's psychologically damaging for a lot of men, I think. So that's why they have these problems and men are internalized things. They hope things just float away and go away and they heal themselves. The statistics are that 70% of healthcare decisions in a family are made by the woman. Yeah, I was gonna say that's why pictured women drag

in their partners into office. Yes, that happens. And we, what's the men that are like, I'll get better, I don't wanna deal, I don't know. It's a weak side of weakness perhaps. It is, remember, like, so we, you have to look back in history, okay? So we see today's society and we're all equal, right?

But you think 100 200 years ago where the man was supposed to protect the family was supposed to go out to war, go out, put his life on line, go hunt, go do all that stuff and to provide for the family. So you have to provide and so it's in our DNA, it's in our culture that men still feel that way. They have to be, they have to be providers for their family and in every which way possible. And I think it's, it's going to change over time as we kind of get away from that stigma, whatever you want to call it, that a man has to go kill himself on the battlefield in order to be a real man. But they're so wired that way that I see it when a man is can't perform sexually or when they're stressed about money, which is another thing about them being the provider when

they're stressed about money or their job or penis challenge. It's like everything else shuts down. Like, I don't know how to be a man in society right now because this is not working and I have no money. One of the other is what just kills their sex drive and their confidence. Absolutely, I agree with you. And I mean, also they feel that if they're single,

you know, if you're single, you don't have a job, you don't have money, how are you supposed to take a girl out on a date, you know? Exactly. What do you do? Right, exactly. You want to meet at the pink hot dog stand and that's fun every month in a while.

Yeah, unless you get any topping you want. Exactly, right, that's what you do, but it's true. And I'm not ready to provide yet because there's all these problems with my penis. But they come into you and then you were talking about the, um, well, it's kind of, it's kind of they want to talk about it, but they're embarrassed to talk about it. So they kind of mumbled under their breath as they're walking out the door. They grab the door handle. Oh yeah, my erection doesn't work.

And then, you know, you as a provider have to recognize and acknowledge every single problem that they have. And then if you're not an ED specialist and you're in a busy practice, that's the last thing you want to do is start a conversation about the door. Yeah, yeah. I was getting my lunch. Exactly. I was going on my break and you go, you want to start a 20 minute conversation.

You want to talk about your Venus? Right. Right. So that's what happens. But we, um, that's why it's about my day at Cures. I think this is going to be very inspiring for men to know that they could get an implant, there's other treatments. But with the implant, is it a one-time thing? How often do they have to come back and see you? Well, they don't have to. After after the implants put in and we teach them how to use it, it's operational, they're good to go. And people can live an entire lifetime with their penile implant and never have to have any kind of maintenance.

There's no routine maintenance for it. You don't have to fill it up with water or saline every couple of years or anything like that. It's like breast implants, I don't know. Yeah, they're there to stay. And uh, and so unlike breast implants, you know, we had that scare with the liquid silicone breast implants. They came off the market. Yeah, that's what saying. Like that. So, so all PNL implants are filled with saline. So there's a difference between form silicone. So the breast implants are still

made out of form silicone. The shell is is formed silicone. They stop using that liquid silicone inside as a filler. PNL implants are also made out of formed silicone and they're filled with saline. Saline is just physiologic water. So that thing explodes because who knows what happens, like a devastating accident. Who cares? Your body is just going to absorb that saline, you're going to pee it out. So there's no like long-term risk for consequences for having a penile implant. And that's another thing that people oftentimes ask me because they equate the two because they've heard about all the bad things about breast implants. So they try to attribute it to the penile implant as well.

So what kind of results have you seen from people having the implants done? I want to hear the success stories or the happiness that comes with the feedback. It's amazing. You know, studies that have been published quote a 92 to 95 percent patient satisfaction rate and a 90 percent partner satisfaction rate. And again, that's all comers, no pun intended. And in my practice, you know, I do things a little differently. I tend to see more of a 99% patient satisfaction rate because once, and one of the things we should talk about expectations also because expectations are very important and I like to set their expectations going into this, what I'm capable of doing and what I'm not capable of doing. And so a lot of guys think a PenoLin plants there to give them a 12 inch penis. Well, I'm so glad we're talking about this now

because I know that so many men are like, yes, finally. Yes, no, that's not that. So PenoLin plants can make your penis a little bit larger and a little bit wider, girthier, okay? But you can come in like with breast implants and say, I wanna have triple d's, you know, like, you know, porn star boobs. You can't do that.

You can't say, I wanna porn star penis. It doesn't work that way. We don't want that either from you, men. I think- I think men are more obsessed with that size. Yes, yeah, absolutely. Men would rather have a long skinny penis than have a short fat penis,

but most women will tell you that the girth is more important than the length. Yes. And for guys, it's like, again, it's part of their virility. They want to be sure, and it's not for the woman, it's for their friends in the locker room, so that when they're undressing in the locker room,

they want all their buddies to be envious of them and say, well, look at John, right? He's hung. But we're never looking. We're never looking. We're never looking, right? You're never looking. We don't know.

We're not looking. You know what's going on with John. So guys are obsessed with size, although most women will, we should talk about size. That's a great conversation. I love the conversation. But first time we had the results though that you're seeing, and then we'll talk about size. Results are, like I said, 99% happy. Once you get them over that teaching phase,

because no one's born with a pump and there's scrotum, and some people are easier to teach how to use it. Other people are a little bit more difficult, and I find it if you just keep it simple, it's the best way to learn. It's a two function remote control. I tell people there's an on and there's an off. Some people think of this as a 50 function remote control with all the, I'm like, it's

not that hard, you know, it's real simple to operate. And once they get it down, they can pump these things up in less than 30 seconds. I can't believe that this is what goes in their penis. That's all it is. And then you said there's also saline in it. Yes. And I have actually I have a video on my website. Yeah. I've seen that video. I've seen the video, but we should link to the video too, but yeah, we can watch it now that you're here. Like I understand it, but this is just amazing. And it doesn't hurt. And so that guy, he has an above average penis. An average penis size is about little over five inches.

And most guys think the average penis is seven to eight inches. I know, I tell them all the time, it's like six, it's five to six inches. Five, actually five point six, five to four inches. Five to four inches. Five and a quarter inches. So, and when you go every inch you go up, you go up to six inches, you're already in the 90th percentile of penile length.

You go up to seven inches, you're like in the 98th percentile of peanut length. You go up then every inch increment above that, you're down to like a fraction of a percent of, so like when you get above six inches, and by the way, every guy comes into my office and I say, how big is your penis? And they're all six inches, which is not true. Right. Is it like men with their height when they're really five times, they're like on five or 11? I'll tell you what they do.

So, so, two-thirds of your penis is external and one-third of your penis is internal. Right. And so, what they do is they push it all the way down to the pubic bone. So, we all have a fat pad, which is a couple inches, you know? Even in skinny people, you have a little fat pad there. So, they push it all the way down to the bone and then they stretch it and they go, ah, yeah, it's six inches.

But then when you let go of that fat pad of gwing and then you're down to four inches. Okay. Right. So they measure down to the bone and we don't measure to the bone. So most of the studies, because we were talking about visible external penis and the more weight you put on the more penis you lose, because your abdominal wall starts growing away from, as your fat pad grows away from your abdominal wall and it like swallows your penis. And so the visible penis is what you care about. It doesn't matter that you have another two or three inches underneath that fat pad, no one can see it. Yeah, this is a good reason for me to get into these.

This way, your penis will grow. Okay, so they're most of them think they're six inches, but you're like, sorry, you're actually five or what happens? You measure them. Oh, I measure everybody. Right. Because that is probably the number one problem we have with every guy is the discrepancy and what they really have and what they think they have. And I'll give you an example.

I had a guy once, came to see me. He had prostate cancer operation, lost his see me. He had a prostate cancer operation, lost his erections, but he was able to get an erection by sticking a needle into his penis every time he wanted to have sex. That's what all the adult film stars do. I know. Yeah, and so guys out there, yeah, that's how they perform so well. Yeah. A lot of people think it's natural. It's not natural porn is not real. Yes. Anyway, so we use that as a treatment, as a medical treatment for some men who are willing

to do that, to stick a penis or a needle into their penis every time they have sex. So, this guy was arguing with me that he had a six inch penis and there's this thing called a stretch test. So if you take a man's penis when it's flassey, grab by the head, you stretch it out, you measure it from the tip to his skin, that's almost within a half a centimeter his erect length. Okay. Studies have been done about this. Wow, okay.

We've corroborated this in our own studies. And so we know that. And so I don't need to have a guy get an erection, but I need to be him to be on board when I pull that penis out. This is how long your penis is when it's erect, right? Right? So this guy goes and I measure, I said it's four inches how long your penis is when it's erect, right? Right? So this guy goes and I measure, I said it's four inches

and he goes, no, it's six inches. I go, well, I'm measuring four inches. I said, okay, well, since you respond to those shots, let's give you a shot here on the clinic. Let's see what you got. So again, I'm a shot on the clinic. Got a full erection and I measure, I go, it's four inches. And he still was arguing with me

that last week he gave himself a shot, he measured it with six inches. And you know what I said to this guy? I'm not gonna do your surgery because after... He won't be happy. Yes, after surgery. I know you're not.

He's gonna tell me that I cheated him out of two inches. Yep. And so I know he only has four inches. In his mind, he stuck that he has six inches somehow and he's never gonna have six inches. And if I did a surgery, he would be a very unhappy patient and tell me that I stole two inches from the penis.

Yeah, that's an ego thing with man. Like he just, or he really, anyway, I'm glad you didn't, I can tell. I can tell. It is like a body dysmorphism thing. It is body dysmorphism. It's a penis dysmorphism. Yeah, it's a thing.

So for men coming in so obsessed with their penis, though I just wanna to say as a public service announcement, women are not as obsessed about your penis size as you are. And so I think that there's just a lot of men who are worried about this unnecessarily as long as you can just be a great lover, not just about orgasm. And if only 18% of women orgasm through penetration, we're not obsessed with the size. Just know how to work everything else. Now, I pay attention to women. Not the size of the wave,'re not obsessed with the size. Just know how to work everything else.

Now, our pay attention to women. It's not the size of the waves, it's the motion, the ocean. It's true though, it is true. But yeah, I mean, you see the other side of it though. Can't you just say to the guy, it doesn't matter, four or five, you're fine. No, I'm glad you got rid of the guy. Well, yeah, I could spend a whole month telling him that, he still won't believe me.

Yeah, so it's fixed in his head, and I just realized from all these years of experience that when people believe something, it's like Gospels, like telling them something's not true about the Bible. Yeah. Exactly. And he's like this and all of our area of his life. Yeah.

I can work and with his partner, he probably just thinks he's always right. Yeah. Anyway, after Edward Cartman. With a K. K-R-P-M-A-N, and they can find you at healthy-mail.com, and then your Instagram at Edward underscore Cartman underscore MD underscore F-A-C-S. We will put this all in the show notes. Facebook.com-sash Edward Cartman MD F-A-C-S. I'm going to get easier on our notes. You got it. All right, here we go. Five questions. We ask our guests. Something you would tell your younger self

about sex and relationships. Kind of one of the things that you mentioned about the importance of the quality of the relationship and the intimacy. It's intimacy is more important than the actual mechanics of it. And I'm no different than any other guy out there when I was young and stupid in naive. I used to think it's it's how big and fat and hard it gets is it's all it matters And you know women are obsessed with the penis and like you know a guy with a big penis is

Everything's all you want now as I was there too I was one of the most fun start there But it took a lot of training a lot of years experience to realize that you know that's not the case Exactly. God glad you the case. Exactly. Glad you've learned. Okay. What's your biggest turn on? My biggest turn on is a person who lets me be who I want to be and doesn't try to change

me, who's easy to get along with. To me, that is so hot and sexy. That is so hot and sexy. Yeah. Biggest turn off. Somebody is bossy, demanding. Number one sex tip. Uh, careful with woman on top.

Why, from like a medical perspective? Penal fracture, baby. How much are penal fractures a problem? Do you get a lot of them? They're not a big problem, but it's devastating when it happened. So when... What do we avoid with a woman on top then? Well, you can still have sex with a on top, but you got to be careful.

So you're a petite lady, and I'd say even like a 90-pound soaking wet partner could come down on a fully rigid penis. And as she comes down the wrong way, she hits her pubic bone against a fully rigid penis, a buckle of blowout, and you'll get a pin-out fracture. Yeah, it's like taking like a water balloon, it's fully full, and then like trying to bend it, you know, it's gonna happen to the rupture. Oh, okay, good to know, morning, morning.

What is the most important, personally trait in another person? Kindness. Kindness. All right, you did well there. Now, so we got other questions for you, but we have to end the show. Thank you, Dr. Cartman you did well there. Now I have some other questions for you, but we have to end the show. Thank you, Dr. Cartman, for being here. This was great, so illuminating for my listeners.

I'm really excited we got you here today. Thanks for your time. Thanks for having me, Emily. That's it for today's episode. Thanks for listening to Sex with Emily. Be sure to like, subscribe, and give us a review. Wherever you listen to podcasts, and share this with a friend or a partner. Believe me, if you got something out of this episode, they will too. We release two to three episodes a week, find me at Instagram, YouTube, Facebook, and Twitter. It's all at Sex with Emily. If you'd like to ask me a question about sex or dating relationships, email me.

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