Sex With Emily - Does Size Matter? w/ Dr. Karpman

Episode Date: February 17, 2023

Insecurities around our bodies can make sex and pleasure more difficult to enjoy, especially when it comes to our more intimate parts. And one body part I always get asked about is the penis, from people with penises and those sleeping with them. That’s why I’m bringing in board-certified urologist, Sex With Emily regular, and my friend, Dr. Edward Karpman to answer all your questions about the penis. We’ll answer questions from delayed ejaculation and erectile dysfunction, to yes, penis size. All this and more in today’s episode.Show Notes:Sex Toys for Penis Owners: A GuidePRE-ORDER MY NEW BOOK! Smart Sex: How to Boost Your Sex IQ and Own Your PleasurePenuma.com/PodcastMore Dr. Karpman: Healthy-Male.comThis episode is brought to you by BetterHelp. Give online therapy a try at betterhelp.com/sexwithemily and get 10% off your first month. Hosted on Acast. See acast.com/privacy for more information.

And also, I always remind people that if you're with a vulva owner in particular, we're going to have orgasms with probably nothing that has to do with your penis. Usually it's a fingers, or it's a mouth, or it's a toy, but we're not as obsessed with your penis size as you are. 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. Insecurities around our bodies can make sex and pleasure more difficult to enjoy, especially when it comes to our more intimate parts. And one body part I always get asked about is the penis.

From people with penises and those sleeping with them. That's why I'm bringing in bored certified urologist and sex with the Emily regular and my friend Dr. Edward Cartman to answer all your questions about the penis. We'll answer questions from delayed ejaculation and a rock doll dysfunction to yes penis size. All this and more covered in today's episode. Intentions with Ebley for each episode. I want to start off by setting an intention for the show and I encourage covered in today's episode. Intentions with Ebley for each episode? I want to start off by setting in Intention for the show, and I encourage you to do the same. My intention is to offer a safe space to talk about some of the top penis challenges

that may be holding some of you back from your pleasure potential in the bedroom. Please rate and review Sex with Emily wherever you listen to the show. It really helps us. We read all of your reviews reviews and I love to get your feedback on the show. Also, check out my article, Sex Toys for Penisoters, a guide. Up at sexwithemily.com. Also, please check out my YouTube channel, social media and TikTok. It's all at sexwithemily for more sex tips and advice. If you want to ask me questions, leave me your questions or message me at sexwithemily.com

slash askemily or comment outline 559 talk sex or 559 825 5739. Always include your name, your age, where you live and how you listen to the show and as always it's totally fine to change your name or choose to remain anonymous. Before we get into today's show, I want to tell you all something very, very exciting. If you haven't heard yet, I am coming out with a book. You can actually pre-order it now. And this has been my baby. I've been working on it for almost two years, and we just did the cover reveal.

So check out my Instagram. It's also sex with Emily. The book is called Smart Sex. How to boost your sex IQ and own your pleasure It's being released on June 13th and you can pre-order it like I said I'll put that in the show notes and I'm learning all the stuff about pre-orders now and Apparently if you pre-order it that will also help make sure that more and more people will get to know about the book We'll get to read the book and we'll have smarter sex

You can also request that your libraries, and yes, preorder at Amazon, all the major booksellers. If you want to preorder at your local indie store, that really helps the book as well, helps for me, but also helps support your indie booksellers like Skylate books. You could order from their website and check out your stores. And you can totally preorder the book now at sexwithmla.com. You just go to the drop down menu and select new book. And it's easy from there. Or you can just go to the show notes. We'll put a link there. So when I first sat down to the right of the book, I was like, okay, I've been doing this show for 20 years. I've got a lot to tell you all. It's going to be all my years of sex information into a book. But then in the middle of the book,

in the middle of the writing process, I realized, wait a minute, wait a minute, there's a whole new way that I can talk to y'all about sex, and it's all being focused around sex, IQ. How to up your sexual intelligence. It's a whole new way if you think you might have sex, there's five pillars of sexual intelligence. I can't wait to share it all with you. And meet you. I'm going on a book tour, and maybe I'll be in your city. Do you want me to come speak? Do you want me? I'd love to meet you. Here's the other thing that hasn't happened over 20 years. I've never taken this show on the road. I've been sitting in my house

or a studio talking to you and I'm just more excited, even more excited than the book. To me, to all of you, so hopefully you're going to join me on this journey the next few months. The book again is smart sex, pre-ordered, support me coming to meet you on the road, and thank you all for making this possible. I'm super excited for this year and to talk to you all soon. All right, I want to enjoy this episode. Dr. Edward Cartman is a board-certified urologist specializing in male reproductive medicine and surgery, microsurgery, and male sexual dysfunction. He is the medical director of the Men's Health Center at El Camino Hospital Los Gatos and the California Vasectomy and Reversal Center.

Dr. Cartman attended medical school at the University of Vermont where he was awarded the James Demulus surgical research award before completing his derelict surgery trading at the University of California Davis Medical Center. Dr. Cartman is authored numerous articles on the subject of urology, sexual dysfunction, penal implant surgery, and male infertility. Before we get into the interview, I just want to preface a couple things. So we had a really great interview, but I want to tell you this. Dr. Carmen talks about penuma. It's a new penis enhancement surgery. And I want you all to know

that we get into it because I was fasting to learn more about it. It is FDA-cleared for cosmetic enhancement of the penis. And it's been successfully implanted in thousands of penis owners since 2004. So we're hearing about it now. As we talk about in the episode is because the owner was so excited about it. He was doing all the surgeries and then he decided, I've had all this success now for almost 20 years. I'm going to train other doctors as well. So we actually trained Dr. Cartman in this groundbreaking procedure. So that being said, I want to just reiterate this because this is very, very important to me. You know that I believe that penis size does not equal sexual satisfaction. It doesn't make you a better person.

It doesn't make you a better lover. It doesn't make you more of a man, more penis owner. I know that for many men, they're like, if I could have a larger penis, I could rule the world or it'd be a better lover, but we can just some really interesting angles to this. And I think for a lot of men, understandably you were grown up in an environment where maybe penis size was hailed as a big deal.

Or maybe something did happen in a locker room where you were comparing yourself to others. Maybe you just have a hangups around penis size. And I do not want the fact that this surgery is now available for you to think like I'm in any way saying you should get it. But as a sex educator, I do feel responsible for sharing all of the available resources on my platform. This field has grown and changed so much over the years and whenever I hear about anything new, cutting edge, I try to bring you the latest and greatest in a unbiased information so you can make decisions for yourself.

Alright everyone, let's get into the interview. So Dr. Cartman, welcome back to the show. Whenever you're on, we get so many people who are so excited that we actually are focusing an entire show on penises, penis challenges. Obviously when we have penises, then people who love penises. So it's really for everybody. You have so much knowledge and experience in the area. And what I also love about the work you do is that you're constantly innovating and learning and bringing new information that I've never been heard of

and new technologies and procedures to me and to my listeners. So I appreciate you. How have you been? I've been doing great. We've been busy and COVID kind of made business even better, because I think one of the things that people realize during COVID how important sex is,

because you're stuck with your partner in some quarantine area, and then these sexual problems kind of came to the surface for a lot of couples. So ever since COVID, we've been busy and just kept on moving along afterwards. That would make sense. So that's the piece of the pie that I haven't really heard. I haven't talked to any doctors in your position, but people were home. They were thinking like,

perhaps I've had this challenger on my penis or my sex life for so long. Let me see what I can actually do about it. So did you notice a change in the requests that you were getting or did it switch? What people were focusing on? No, just the volume of requests went up because people were now at home and they were focusing on these problems. And the other thing is, our society is so, was so busy and so bogged down with so many things to do.

And the sexual function is not a life or death thing for many people. So it was always a second or third order issue for couples that they wanna get to at some point, but they're their careers, they have jobs, they have families, they have other things going on, and so they were always put it on hold, and say, I'll do it next summer,

I'll do it next time I have some time down, but this really allowed people to focus on themselves. And I think a lot of self care was taking place during the pandemic, where people were like, oh, hey, you know, I'm at home here. Let's use that home gym. Let's use that penis. Let's use that vagina.

You know, let's have some fun. Oh my god, that's so true. Let's bring out that. I was going to see the thigh master. That's so data. Let's bring out our, like, yeah, let's use the bike. Let's use our penis. Let's use the Louvre.

Let's just make it happen because, yeah, when I first heard about the pandemic and we are locked down and like, everyone's going to be home masturbating. That's just make it happen because yeah, when I first heard about the pandemic and we are locked out I'm like, oh everyone's gonna be home masturbating That's literally what's gonna happen. I was gonna like take to Instagram live every day and just start talking to people about like what to do But things got busy, but I'm so glad to hear that though I'm glad to hear that people have found their way to you Last time you were on I mean we talked about so many things But I was thinking just even defining maybe we we could start with this erectile dysfunction. If someone calls into your officer, come to see you, how would you define a

erectile dysfunction? Because it can mean so many things. So it's essentially the inability not just to get an erection, but to maintain erection, satisfactory for penetrating intercourse, to satisfy yourself and your partner. And that's a really broad definition. Some guys think that if I could get it up, I don't have a problem. I'm fine, but there's a condition called a venous leak, which is a form of rectal dysfunction

that causes guys to not be able to hold it up or keep it up. And it's devastating because these are the young guys that get ED. And if a 70-year-old guy gets ED, well, he's 70 years old, you know, he had a good life. But Venus Leaks affect young guys. And you know, the youngest man that I ever had to treat with surgery with a penile implant was actually 18 years old. And he had such a horrible Venus leak that even when I gave him a shot of that medicine that the porn star's used and they keep their penises up for hours, his penis came up and then came right back down right in front of my eyes. So it was really amazing how significant his condition was. But once we completed surgery and he was having

a fulfilling sexual life, he was extremely satisfied. So what causes the venous leak? Well, it's just bad luck in most cases, especially with these young kids. Why do some women have varicose veins in their legs and others don't? We're all just built a little differently. And venous leak could be, it's kind of the analogy that I give people, if you had a problem with filling up your sink and you call the plumber and you think, well, I have a water pressure problem, he's going to have to fix the sink or the faucet.

And then he comes over there and he says, no, no, no, no, your water pressure is fine. The problem is your drain isn't stopping the drainage. So that's why you can't fill up your sink. And that's essentially what a venous leak is, as these guys have totally normal arterial inflow into their penis. And that's a good thing also in the sense, because, you know, ED is erectile dysfunction is associated with heart disease. So once those arteries are clogged up,

your heart arteries are clogged up, your brain arteries are clogged up. And you know, you could have more serious things happen to you like a heart attack or a stroke. Oh, okay, that makes sense. So that is part of erectile dysfunction could also be like blood flow. People aren't exercising, eating, well,

taking care of themselves. I could also cause erectile dysfunction, right? Yeah, that's your garden variety ED. That's the one that we know about. That everyone is aware that Viagra works for that. You know, most of these treatments are designed for. And, you know, if you have a venous leak, these pills don't work. The shots don't work. So there's very few things that we could do. We can't offer these guys some constriction rings like coccrings. And that's why they're so popular. There's a lot of guys have venous leaks, they don't understand it, but they just know they put that coccring on their penis.

It stays up. So it's really genetic. Some of them are born with it. And then some of them also develop it over time. So things like Peroni's disease will kind of develop a venous leak. Some guys get treatments for prostate cancer as they get older and that can cause a venous leak to form. And it could be just an aging problem where guys as they get older, and that can cause a venous leak to form. And it could be just an aging problem

where guys as they get older, the tissues don't work as well. So, a mechanism that we have built into our penises that really helps trap blood in there, it just doesn't work anymore. It spans the whole spectrum of age, but again, this affects the younger population as well as the older population.

That's why it's really devastating. And I've seen people who started in college and they were collegiate athletes, division one schools, and you can imagine how much fun you could have sexually as a division one collegiate athlete. And they go on to professional sports, and then they still didn't understand what the problem was. And it's only after their marriages were failing

that they come to me and they say, hey, help me out, Doc, What's going on here? We diagnosed some of it. So it's really tragic and devastating because it happens to younger people. Is it more common now? I don't know if it's more common, but we do know what to do. We're more aware of it, let's just say. And you have to know what you're looking for in order to find it. And if you're not looking for, these guys have for the longest time been put into this bucket of, oh, it's in his head. He's young, there's nothing wrong with them.

There's no way a 20-year-old, 30-year-old guy should have a problem with his erection. There must be in his head. He's thinking about sex too much. He's obsessed with it. Go get a hobby. He'll get better by itself, but it doesn't. Are there other causes like, what about like hormones

or the guy who maybe has less testosterone is any of that based in anything that you're seeing that it's not the venous lake? Hormones are a normal part of sexual function and hormone deficiencies are related to erectile dysfunction. So they essentially, if you have no libido, okay, you're not gonna wanna have sex. And that's a big trigger for

Initiating erectile function and sexual intercourse guys who have low testosterone for example now to stochrons had this Horrible stigma in our society because There's athletes who abuse it his bodybuilders who abuse it what they do is they get to such high levels that it's it's almost Dangerous for them and they develop these. And then people kind of associate that with giving testosterone replacement to a man who has low testosterone. So it's like giving estrogen to a woman who's gone through menopause,

just getting her back in their normal range versus giving some woman some super physiologic ranges of estrogen that makes weird things happen to her body. So that's the difference. And so testosterone plays a big role in sexual function. And man, it's very important to be optimized. We always check it when guys come to see us to make sure that's not part of the equation. And the good news is that testosterone nowadays has become much more well known in the medical community. The primary care doctors are checking for low testosterone. I'm very impressed how, at least in the community

that I've practiced in, the primary care doctor looking for. Well, I wanted to get into this first question. This is from Randall, he's 49 in Utah, and he actually listened to an episode we did. He says, hey, Dr. Emily, I recently listened to the penis promise podcast and I have a question of a mayor for 27 years. My wife and I have always had an amazing sex life and no issues.

This year, I've noticed that during sex, I'm losing my erection. I'm a healthy man, no medication. So you don't drink or smoke, no medical problems. I've been doing TRT for the past five years. So he's doing a hormone replacement. We will initiate sex. Everything's going well and I'll start to lose my erection. I have a feeling it's all in my head and I'm struggling.

It's making sex no fun, I'm starting lose interest. You used to take me 2-5 minutes to climax, and now it's taking 10-20 minutes. I feel at times I'm trying to force the orgasm, or I'm more focused in trying to get there as opposed to letting it happen and enjoying the feeling. I understand I'm getting older, not that 49 is old, but I wonder if that plays a role in the mental gymnastics I'm feeling any direction or advice to be greatly appreciated. Anytime a guy says that he can get an erection but can't keep it up, we're obviously thinking about a Venus leak. And that's really easy to sort out if he goes to a urologist who can do a P-Nile,

a Doppler ultrasound. They can figure that out in a second. I have guys who come to me with these classic scenarios like this guy. It sounds like he has a venous lake and we do the ultrasound. There's nothing there. I mean, it's fine. And those scenarios, then what I start talking about is more of the psychological aspect of it.

I've started telling guys, or talking about this to my patients is what I call sexual ADD. And it's essentially lack of focus or losing focus. And we have guys who are working, they've got things on their minds. And especially if you've been with a partner for 29 years, sometimes you take that for granted. And that's another big problem. We could talk about a little bit more.

But maybe this listener of yours is focused on something else. What else is going on in his life? Are there stressors or are there kids influencing this? Are you worried about? Are there financial worries? Are there things that are causing him not to focus on the naked woman that's laying in his bed? Now, the other part of it is,

and this is probably something that you deal a lot with as a therapist, is reorienting couples to appreciate each other. And I think that a lot of people take each other for granted, becomes like even like I tell people if you ate your favorite food every day for the last 29 years, you didn't spice it up. You put a little Tabasco on it one day,

a little holiday sauce the other day, you know, dress it up with some side dishes or something, it gets boring. People need to understand that if you continue to have sex on Friday night at 10 p.m. missionary style for 29 years, no matter how beautiful and great your partner is, you're going to get bored with it. And so, you know, we talk about things. I'm sure you do this too with your clients is, you know, role-playing, you know, tell some time to

tell them, go have hotel sex. That just changes things up and makes it more interesting. Byerson lingerie put on some horn in the background, but make it different because you can't have the same kind of sex for 29 years and expect to still be as excited. That's where I think some of these guys will fall into that category. They just lose it because they're either losing focus or it's the same sex for 29 years. Okay, that's really good advice. Did you cover what you do for the Venus League exactly? They're either losing focus or it's the same sex for 29 years. Okay, that's really good advice.

Did you cover what you do for the venus leg exactly? You mentioned there was a shot, because I think a lot of people are going to be curious about this to close the venus leg loop. They should always try a cock ring or what's called a venus constriction band on their penis. And they come in different forms. Usually they're some form of elastic rubber things and I first of all let me just warn

everybody don't ever put anything on your penis that you can't cut off with the pair of scissors. So you know I've seen guys in the emergency room that put metal ball bearings on their penis and you know we have to get the fire department in there with these fancy saws and like saw this thing off of their penis is because it's really hard to get because what they'll get is they'll get edema in their shaft after keeping that on for too long and then you can't slide it off it's almost impossible you have to cut it off so if it's metal wood is better obviously but I tell them always use something that you can cut off so something like elastic a rubber so most

summer rings but they also have these type that are it look like little loops I tell them always use something that you can cut off. So something like elastic rubber. So most of them are rings, but they also have these type that are, it look like little loops, so that like a bulletize, which are, you know, the Texas ties you cinch them up. So it's like a little cinch, it's an elastic loop with a little cinching mechanism. And so they put at the base of their penis

once they get in direction, they cinch it up. And the other reason I like those, those cinching types of venous occlusive devices is that if you want to see your money shot, if you're trying to get somebody pregnant, remember, if you use one of these rings and you don't take it off when you ejaculate, the semen's going to hit this wall and then it might be impainful. Oh, because it would go back down, because you're sinching it. Exactly, because you're sinching your rethth, or your reth was on the underside.

So I'm going to, I'm going to bring out my ivory penis here. Okay. So we put them, we put them at the base. The prostate is deep down here. So guys will put it at the base of their penis, the penis grow junction, or they'll incorporate their scrotum into it, like, like this. But remember, the prostate is over here and the the jack-tory duck is right here. So that sinching mechanism is going to run into a wall, and it's going to cause some discomfort, or if they're trying to conceive, or if they want that money shot, you know, whoever desires it, you won't get it, because there's a rubber band in the way. So that's the first line of treatment. I'll always tell guys, you know, just go ahead and try that. But I

think that guys wants to get to that point to have been on the internet. They've tried just about everything before they come to see me. But then ultimately a lot of these guys end up getting what's called a Pinole implant. And a Pinole implant, it's not the Pinole implant that your grandpa had.

Those Pinole implants were these malleable rods that you bend up and bend down. The new ones are, I tell people they're analogous to breast implants, but imagine like women could pump up their breasts like when they went out to get cleavage and then deflate them in the morning when they wanted to put on their lulu lemons and do yoga. So that's the way P-Nile implants work. They're made out of the simmers, a material, surgical grade, either silicone or polyurethane, filled with saline, they pump them up,

and they could have sex essentially whenever they want to. It takes about 30 seconds to get an erection. The fastest way to get an erection is faster than any medication shot that you can use. The erection will last after orgasm. So if the patient, it takes some five minutes to ejaculate, but his partner needs a good 20, 30 minutes. And I remind guys about this if the patient, it takes some five minutes to ejaculate, but his partner needs a good 20 to 30 minutes. And I remind guys about this all the time is don't be selfish.

Because if you want your partner to come back and want more, you got to satisfy her also. And a lot of guys, you know, when they have a natural direction after they ejaculate, there's a refractory period. And so they're down for the count for at least, and the young guys could probably get it back up in a half an hour, the older guys that could be hours to maybe even, you know, a day before they could get it back up. But these PNL implants are really cool because they allow couples to really have satisfactory

intercourse, and not only does the guy enjoy it, but the woman can actually enjoy it. And we put them in in 30 minutes nowadays, full recovery in three weeks, back to full sexual function in three weeks. And the part that a lot of people don't know, which is really exciting, is these peanut oil implants are covered by health insurance. So it's not an out of pocket cost for them. That's amazing. I think people don't know about this. We first talked about this.

See, whenever we were on the show, we talked about so many interesting things. I actually had no much about them, and they were safe. And so people leave them in, and you just set it and forget it, or you have to go back and get it updated every few months, or you just have it in. No, you could have for lifetime without any problems, but I tell people they're

like a mechanical object. And so just like, you know, breast implants can leak, they can rupture, they can be damaged, whatever. And you have to replace them. And that can happen also with peanut and lymph plants. And it happens though at a very, very low rate. We're talking about something like 2 to 4 percent, you know, mechanical failure rates. And one to two percent infection rates. So those rates of, you know, failure are so low. And that's why I think they've been around for so long. And people like them. This is not a new invention that Pinoleum plans been around for 50 years. They're inflatable. So they're flaccid, like a normal penis when they're not in use. They are rigid, more rigid. I tell you guys, they get harder than your a normal penis when they're not in use. They are rigid, more rigid.

I tell guys, they get harder than your erection was when you're 20 years old. Where do people go if they can't come to see you in California? There's a lot of great surgeons around the country and I think a good place to start would be the sexual medicines decided in North America website because most of the people who are like myself who are high volume implanters and who focus on sexual medicine and their practices are part of that organization. So I think that would be a great place to start. Amazing. We're going to link to that in the show notes along with Dr. Cartman too,

so you can find them. Let's get into another thing. This is, I know you're going to have a lot to say about this as well. We were saving all these for you, Dr. Cartman. We couldn't wait to have you on. This is from John 32 in San Antonio. Hey Dr. Emily, I have to say your say about this as well. We were saving all these for you, Dr. Cartman. We couldn't wait to have you on. This is from John 32 in San Antonio. Hey, Dr. Emily, I have to say your show is the best. How could I be more confident in my penis size? I feel like every time I get sexual with a girl, I'm not the stud I want to be. I've never been told anything about my size,

but I'm not as hung as blessed as I'd like to be. I feel like this insecurity has hauled me back from being out there more. Thanks Emily. Let me know what you think. I want to talk about penis size because I think for years, I always comes up and I'm off talking to penis owners saying, you know, it's fine. Like your penis size, it's not just about size. Of course, so people might think that size matters and maybe that they want a huge penis. Let's say maybe you're not their person. I'm not gonna be with guys who want a large breasted woman.

Let's just say that. I won't be for everybody. And also, I always remind people that if you're with a vulva owner in particular, we're gonna have orgasms with probably nothing that has to do with your penis. Usually it's a fingers or it's a mouth or it's a toy, but we're not as obsessed with your penis size as you are. I don't know where he's getting his information here that he doesn't love his size, but

I can just tell you from personal experience and my show that a lot of guys feel like everything is contingent upon their penis size and it means so much about who they are sexually. And there's so many other tools here at Toolkit and I don't think it's just about that. And I want to say what I've recently heard it, when I heard that you knew more about this, I didn't think that men could really enhance the size of their penis in a safe way, and I would just brush this off. But then I heard about an area of medicine and that you're working in that I found fascinating, and since you were a part of this,

I want to talk to you more about cosmetic enhancements for the penis. Sure. First of all, I want to tell you, you are 100% right when you say it's more about satisfying them than their partners because we know that it only takes a certain amount of length and girth to satisfy a woman. And when you talk to some of these guys, you sometimes wonder, are you trying to impress your girlfriend or the guys at the gym when you're changing, you know?

One thing that a lot of people don't realize is that all men are growers and not showers. And so people think that certain guys are blessed to be showers and it's just that there might be ginormous, there might be eight, nine inches erect and so flasso there are five to six inches. The average penis is 13 centimeters in length and about 11 centimeters in circumference. And so I know we're not metric here in the United States, so 13 centimeters will equate to about five and a quarter

inches. So five and a quarter inches is an erect penis, average size in this country, although every guy who comes into my office tells me he's six inches. So I select out the hung guys only. But so when your penis is erect and it's five and a quarter, that means when it's flasset it's probably like two and a half inches. So two and a half inches is a little bit, you know, people think that they're going to assume that they're probably two and a half inches

erect as well. Or the other way they think about it is like, well, we all know that we grow to like we double our size when we get erect. So if I was walking around with 5.4 inches at the gym, then they would just assume that when I'm erect, I'm probably 8.9 inches and they would just assume I'm a stud because, know you're starting off with five and a quarter okay and so this is where you know a lot of people have decided that they want to have that augmentation procedure because it has a psychological impact on some guys. I'm careful with saying that because people then start you know saying well that's that's called body dysmorphism or a penile dysmorphism you know personally I think we all have body dysmorphism or a penile dysmorphism. You know, personally, I think we all have body dysmorphism

because is there any part of your body that you wouldn't mind changing if you had a magic wand? You know, I'll admit there's parts of my body I wouldn't mind seeing improved, but we all technically have some body dysmorphism to some degree and if you think about all the plastic surgery that's done in the society, you know, gosh, I mean, there's there's a lot of body dysmorphism. But so I don't want to get into that arena and even say that guys who are obsessed with their penis have any form of body dysmorphism. And that's what some people are trying to label it. And that'll be like saying that a woman who has perfectly normal breasts that are C or D cups, but she wants to have double Ds that she has body dysmorphism.

And imagine that, imagine that medical doctor is telling women that you need to check your head out if you want to get bigger breasts. Well, that's why I want to talk to you about this because I feel like I would tell women yes, if you want to augment your breasts, I would say with safety of course, because now there's been some recalls and it's not always out there. Let's say it's the healthiest thing in the world and it's gonna make someone feel comfortable. I'm all for it. I'm all for augmenting wherever you Think it's gonna make you feel better. So yes, I'm with you on that. I just want to kind of set the stage here And we start talking about this because I think people's minds start to wander and people start to kind of

They have this double standard when it comes to a woman choosing something like that You know, that's fine, but if a guy wanted to choose and identified as having a bigger penis, then, you know, there must be something wrong with his head and we need to check him out. After the break, we'll be answering some of your penis-related questions. So don't go anywhere. So a lot of guys have historically done a lot of dumb things to their penises because of this quest for a bigger penis. Now let's give another little piece of background information.

You know about this just as much as I do and we probably even more is about the woman's in-toy-tale anatomy where the clitoris is and all that good stuff and what a lot of guys don't understand is I always do this. This is my vagina diagram, okay? Okay. And I always tell them that clitoris is at the top and guys have a if they have a very long skinny penis What they're gonna do is they're just gonna poke the back of their partners the vagina and cause pain and not do much in terms of stimulating Now there is a certain minimal threshold So I don't want to tell a guy who's got two inches of penis that he can satisfy a woman so long as he has a girth Because that's not true either, but there's a certain minimum. And that's somewhere probably around three, maybe four inches that a guy needs. But after that, it's really girth that women are looking for because what I tell guys is the fat

penis will change the anatomy of the vulva or the enjoytus of a woman exposing that clitoris to more penile stimulation. So when that penis is going in here, okay, if instead of being the clitoris up at the top here, we can distort or bring the clitoris down and expose it more, then when the penis is going in and out, it's going to stimulate that clitoris more, and that's what gives a woman or a orgasm. And so, growth is important. A length is important to a certain extent, but growth is probably even more important because a girthy penis will give a woman more satisfaction. So there's, like I said, the average circumference of a man's penis is 11 centimeters, so that's under five inches around.

And so guys have historically tried to do all kinds of weird things to make their penises fatter. Historically, we really didn't have anything that we offered in the Western or kind of mainstream medical community that we could safely offer to guys to augment their penises. So what they would do is they would either go down to Tijuana or to other countries and have these things injected into their penis, fillers like PMMMA, which is an epoxy filler, fat injections, all kinds of stuff, silicone, and if I could show you some of these pictures that

I've seen and things that I've had to deal with in my career, guys who come back and then show me these horrendous penises and distortion that happens. So a lot of these are permanent fillers. So permanent fillers don't dissolve and so you're stuck with them. What happens with these fillers? So normally a guy's penis is in this position, right? It's hanging. So you put the fillers uniformly through the shaft, but because they walk around all day long, and there's this thing called gravity that pulls it down. So they end up getting no growth enhancement here and then the bulges out like here and it ends up looking like Popeye's forearm. I know that the younger generation never watched Popeye cartoons but I think you and I did grow up on Popeye cartoons and so we know

what Popeye's forearm's like like. Yeah and it's not what we want here in our penis because what we are talking about too is that like the long skin of your penises are also fabulous. However, what we're saying is that when there's a girth at the tip of the penis, even if your penis is three inches, if it's a girth of your penis, the way the vagina and the clitoris is constructed is that it's really, if you talk about the G-spot or the G-area, it's really just about two inches inside. So if you have a girth of your penis, you're more likely to stimulate those internal nerve endings. So people are doing these distorted thing and you're probably seeing the afters. Yes, they don't go back to their Tijuana doctor to get that fixed. Then they come running

to our offices. And I have a lot of colleagues around the country who dealt with the devastating complications of some of these filler injections and the reconstructions that we have to do are their penises to kind of make them somewhat look back normal. Some of the other things they've done, they've wrapped sheets of dermal fascia, cataviric dermis around their penises underneath the skin also. And they've done all these various things. And it wasn't until recently that we've come up with some really exciting new ways to augment the growth of a man's penis. And I'm going to share with you two different modalities that I think are promising to be a surefire way, the safe way that guys can have increased growth or penal augmentation

done here in the United States by board certified urologists who know what they're doing. And the first one is a, well I'm talking about it's called the penuma implant, okay? Why, I just happen to have one right here next to me. A penuma implant is a silicone implant and it's made out of the same material that breast implants are made out of. So there's different types of breast implants,

there's the saline fill ones and there's the gummy ones. Well, this is made out of that same gummy material that breast implants are made out of. So this is a material that we implant into people's bodies in various different locations, chins, calves, peck, butt, breast. These are all, it's the same material. So this was FDA cleared for a growth enhancement, and what we do with the penuma implant is we slide it underneath the skin of the man's penis, and we secure it underneath right behind the head here, okay? It has somewhat of a taper here, and we can size it to the man's penis. So this implant stays underneath the skin

just like a breast implant. And what it does, it gives them an absolute girth enhancement. This girth enhancement is anywhere from one to two inches depending on the size of the implant they use. And so if we go back to our metric centimeter markings, two and a half centimeters is one inch. So anywhere from two and a half to five centimeter

increases in growth with an implant. They come in different sizes. So not every guy is the same size. So there's large, there's extra large, and there's double XL sizes. Now every guy comes in and says, Doc, I want the double XL. Of course, that's what I was going to say,

but you make it work with their body type because they're probably like as long as I'm coming in here I might as well be the girthiest I can be, but I'm picturing the penis and I'm actually putting on my lens of so many people I know and obviously listers who get breast implants and I can see it now and looking at it and we can also post this video You guys you can see what it is showing here. So you're basically cutting open a guy's penis, feels like that could be very painful and there'll be a lot of downtime. Right, so this surgery has evolved over the last several years

and now we don't even have to cut the penis to put it in. We actually make a little opening in the scrotal sack. And so when it heals up, it just looks like another wrinkle on their scrotum. And so it's very discreet and people can't even tell that they've had something put in there. During the surgery, there's no pain because we do it under anesthesia. So it's a pain-free operation. The recovery is variable, but I tell guys the reason they have this comfort. So we put it in there.

I'm going to go back to my ivory penis and my penuma. We secure it only over here right underneath the head of the penis. But what happens with every guy when he sleeps is he gets those nocturnal erections. And so when they get those nocturnal erections, they pull on these sutures. So for the first two weeks, I tell guys, they'll have a little discomfort when they

get that nighttime erection. And we give them some medicine to help prevent those nighttime erections for the first two weeks, but ultimately they get used to it and that discomfort goes away. So I reassure them that they're not going to live without pain for the rest of their life, but there is that discomfort because if I put sutures here to keep it in place, then when your penis becomes erect, it stretches, it's going to pull on those sutures. And the cool thing about the pen stretches, it's gonna pull on those sutures. And the cool thing about the penuma is it's hinged.

So, you know, a man, we put it in in the flasset state, but we wanted to expand when the man gets erect. So these penuma will expand with the guy's penis in girth so they get even fatter. And I'm talking about the guys that are really impressed with the girth enhancements. And even the guys that I put in the large one, which is the smallest size, they go, wow, I can't put a magnum condom on my penis anymore. So then you're saying the first few weeks, obviously, like any surgery, there's going to be discomfort. But then after that,

because you probably, you probably say don't have sex for two weeks, but you can't say, don't get a direction because when you're sleeping, you get a direction. But then after that, because you probably, you probably say, don't have sex for two weeks, but you can't say, don't get a direction because when you're sleeping, you get a direction. But then after that two weeks to three weeks, they're able to go about their business usual. And so this is mostly a girth enhancing experience, not length. It's girth, but it's also flaccid length expanding. And so, and this is a distinction

that I always want to make for guys because the thing is that, again, we're, now we go back to that guy who feels Self-conscious of the gym or when he pulls down his pants wherever he goes, you know He feels self-conscious because his penis is shrunk up and as I say we're all Growers not showers and so we all shrink up when we're not in use not excited And if you're blessed to have nine inches, then when you shrink up, you're still five or six. So you don't suffer. You don't feel the embarrassment. But the guy who's the average guy, five and a quarter inches, he shrinks up to two and

a half inches, and he's embarrassed. So this penuma, as you can see, it has a certain amount of axial rigidity also. So what we put them in there, we size them for their stretch length. So I'll stretch out their penises, and there we size them for at their stretch length So I'll stretch out their penises and then I'll size it for their stretch length so that their penises will always stay Extended so they will become showers and not growers And this is something also that guys look for and again, I don't I don't make this stuff up You know, I don't put these IDs into guys' heads. This is what they want. They are concerned about it.

And I guess they identify as men with fatter penises that are more extended when they are not excited. So this is a very exciting development that we've had in the medical field for our guys who have concerns about their peanut and length or growth. How long has it been around, then? So the new implant was developed by Dr. James Ellis in Beverly Hills, and he's been doing them since 2004.

In the last about three to four years, he started recruiting some of the top peanut surgeons around the country because his demand for doing these has been getting so high that he's like I can't keep up with this So I'm one of the guys that started doing it with him and so Dr. Allison myself were the only guys in California currently do it But we have a network of about ten top Peno implant surgeons

We have them in Washington DC Dr. Tash Karemi. We have Dr. Valenzuela, New York City. We've got Dr. Geiler, Miami, Dr. Henry and Treyport. We've got Dr. Kansas. In Austin, we've got Dr. Levine and Chicago. So who makes the ideal candidate for this? Is this any guy can do it or who's ideal? Well, so the guy with ideal candidate is a guy

who has a penis that works. So we don't want to do this on guys who have erectile dysfunction. So this is not to improve your erection. Okay, so we want guys who have normal erections. So this is purely cosmetic for girth enhancement and flaccid length enhancement. And we prefer guys that don't have any kind of

significant curvature to their penis. They must be circumcised. So if they're not circumcised, we have to perform a circumcision or ask them to get a circumcision perform and it will do the surgery three months later. And unfortunately, any guy who's had one of these injections or fillers done previously or no longer candidates for this because it makes it difficult to put this penuma in. The nice thing is the penuma is removable and so if you don't like it you can always take it out. Now I wish we can have guys try these on like a pair of shoes for like a week and then tell me if you like it and then you know if you do

great if you don't we take it out out, okay? But we can't. So there's a little bit of a leap of faith that I tell guys that they need to take with us. But this is not uncommon in this implant world, like so for breast implants, for example. Did you know that about 10 to 12% of women voluntarily just remove their breast implants because they just don't like them?

In fact, we had a Danica Patrick, you know, the Indy 500 Formula One racer. She went public with that. She had breast implants and she said, they're just not for me and she took them out. It shouldn't be a knock on breast implants if a woman chooses to remove the breast implants because she's like, they're just not for me.

And like I said, you can't take a pair of breast implants for a test drive and then, you know, then commit to the surgery, just like you can't take a penuma for a test drive and commit to the surgery. And so we do have a certain percentage of guys that, you know, and believe it or not, it's actually less guys who want their penuma's removed and women want their breast implant. I can imagine. Can anyone tell that you've had an implant? You know, you touch a breast and you're like, oh, I can tell. Yeah, so the thing is that most women or men will be touching penises when they're erect,

not when they're flaccid. So it becomes hard to tell. And the interesting thing, if you go on the Panyuma website, they do have a bunch of before and after pictures there. So people could see what it looks like just to kind of get a sense of what the before and after pictures are like. But again, I said these are gummy silicone implants,

just like the breast implants. Most of the times, you can tell that when a woman has breast implants by feeling them, okay, and that's not a knock, you know, people are like, wow, well, they look great. I mean, yeah, that you can feel them, but they look great. And, you know, it's stimulating. And likewise, if a woman felt this and knew those in there,

you know, the end result is, you know, it's not that it's fake, so therefore I don't like it. It's like, well, if you can have more girth and stimulate my clitoris better, then I don't care how it works. I mean, women use dildos and vibrators all the time to stimulate themselves and that's less real than a penuma wrapped around a guy's penis, right?

So it's not necessarily the reality of it, that's important, it's the functionality of it, it's important. And so that's why I think that they're really good. There's one more treatment that I do think is encouraging and we should all keep our eyes out on it and in the future. And there's an injectable called Eurofill and it was developed by a urologist in Miami named Dr. Perrito, and that too is gaining a lot of traction. So I might be coming on your show in the future and talking about that as well. But Europhil, it's a hyaluronic acid that you can inject into the penis. And the cool thing about it is that it doesn't leave that kind of scarring that these other, these permanent injections have been causing the penis.

It is dissolvable, so it's kind of like more like fillers that women get in their faces. So women don't mind going back every six months and getting fillers here or here or whatever. And so it's kind of like a filler for the penis. And it's gaining a lot of traction as well. And for the same reason is that guys want to have a safe procedure for

girth enhancement that is done here in the United States by board certified biologist. Okay, got it. That's really great to know that these are some, but then again, going back to our question, let me loop this and I'm not saying that anyone has to go do this. A lot of times you can please your partner in so many ways. So I think it's important to check a story. Is this just about your ego? Is it to impress guys in the locker room or has your penis size caused you a lot of distress in your life where you think that maybe this would be something for you?

Amazing. But a lot of times it's just what we think someone's going to perceive of us. But I would just say if you've been out there having sex, it's been successful. You feel good. Your partner feels good. There is probably not a problem when you're not there wrong. You should check the story, listen to all the other time and I talk about this. I want everyone to have the options on this show.

Like these are the toys you can get. These are the procedures that are available to you. These are positions. It's all just part of what we talk about sexually. That's what I want for all of you. Well, thank you for that. I was dying to talk about that. Okay, so that's penuma, everything's in the show notes. That's what I want for all of you. Thank you for that. I was dying to talk about that.

Okay, so that's Panuma, everything's in the show notes. Okay, let's get into one more question here. This is Brody 26th of Florida. Hey, Dr. Emily, my fiancee is a female, and we listen to your show. We both listen to a recent episode, in which a woman collar noted her male partner has difficulties with ejaculating during sex,

while she's able to orgasm most of the time. My fiancee and I have been together for approximately four years and whenever we have sex it is difficult for me to ejaculate. With there being a 30 minute to one and a half hour delay and then we get tired of my fiancee orgasm and be too sensitive for us to continue. Can you please help us with giving ideas and how to help with delayed ejaculation? We always want to talk about this because it is the one penis challenge that can be confusing for people. A lot of times we just say it's like psychological, it's happened a lot,

so therefore it continues to happen. Is there a trauma? There's a lot of ways to empath with this. It's not a simple answer. What would you say to a delayed ejaculation? I always define delayed ejaculation as someone taking 30 minutes or longer to tell they diagnose it as 30 minutes or longer to ejaculate. Either during partner sex or masturbation. I always say, well, good for her and she has a partner like you. So she's never deprived. But yeah it can be a challenge because sometimes too much of a good thing is also not a good thing. And you know women I'm sure lose lubrication after you know their fourth orgasm they get tired and so they they might start getting dry down there and then it becomes painful for them to continue on with sex.

So, I jokingly said that it's good for her, but it can also be a problem for women. And for the guy, it's really it's a hard to treat problem. And I usually try to first assess, you know, the medical aspects of this hormones again are very important. So, a lot of it has to do with testosterone libido. If a man has a normal healthy testosterone, then we're okay. But some men, even young men, you know, and it's interesting how the connection that we were understanding between certain things and low testosterone like bad sleeping habits sleep apnea.

So, just because you're young and skinny doesn't mean you're immune from getting a sleep apnea. In sleep apnea is essentially a condition where people either stop breathing or they don't get enough oxygen to their brain during their sleep. And so when that happens is that they actually disrupt that cycle of production of testosterone, which starts in the brain. It's called a hypothalamus and pituitory, which signal your testicles to make testosterone, but oxygen deprivation is not a good thing for any part of the body. And when you have sleep apnea, it can cause these problems. So it's interesting, and it could be something from like,

I see patients come into my office and their noses are off to the side like this. And I ask them, how do you sleep? And they go, oh, that's a normal lot. I go, have you ever gotten checked out for do you sleep? And I go, I snore a lot. I go, have you ever gotten checked out for sleep apnea? And they're like, no. But they're in there to talk to me about their sexual dysfunction and their young healthy.

And sleep medicine is a relatively new field. And in fact, I tell it to my patients that when I was in training, which was like 20 years ago, and 20 years is not a long time in the field of medicine, but I did not ask a single question about sleep. We didn't even have a sleep department at the university that I trained at and we never evaluated sleep problems, but nowadays we're realizing how important and how intimately

related sleep disturbances are with sexual function and a lot of other different functions in our body and overall health. And so we become strong advocates for people to get good, healthy sleep. I wear one of these straps now even because I'm concerned about my sleep because I wanna make sure that I'm getting my eight hours of sleep with 35% of REM and deep sleep in there.

And it's something that we've neglected for so many years, but sleep is so important. It's regenerative. It's important. Sexual function. There's a lot of research coming out showing that guys who have sleep apnea suffer from ED, ejactoid problems and all kinds of things like that. So those are things that I would be looking for.

It's like, what is your lifestyle and what is really going on with you? Other things we look for is you know are like neurologic problems and so how do we reach orgasm? So the penis and the glands which is the head of the penis is just a very strong sensory part or organ of our body which gives us that signal to release that dopamine in our brain which gives us an orgasm. And that's what I tell people is or why we like orgasms because when you get an orgasm. That's what I tell people is, or why we like orgasms? Because when you get an orgasm,

you release dopamine. Dopamine's that pleasure hormone, and that's what happens when, like, you know, you eat a chocolate cake, you just get this flood of dopamine, just feels good, or, you know, you do something decadent or fun, and you know, you just get that dopamine rush,

you feel good, and that's what drives us to feel good. And that's what orgasms are. It's dopamine being released in our brain, but it's that tip of the penis that needs to be stimulated adequately. I look at this problem as we're in this circuitry, from the tip of the penis to the brain, do we have a breakdown? That's what I can do as a surgeon, as a doctor, try to figure out, is there a nerve problem? Is it a hormone deficiency? Is it a vitamin deficiency, vitamin B12?

Some of the B vitamins are important for nerve conduction. Is it somebody who's an undiagnosed diabetic or a portal control diabetic that's not allowed those nerve signals to function properly? Those are the kinds of things that I look for. I think you as a sex therapist would probably look at it from a slightly different perspective. And this is why we work together so well, therapists and surgeons, is that, you know, I stop here and you take over there. But, you know, to look at the relationship, what's going on in the relationship there? Why are you not

getting off on your partner who's a naked woman laying in front of you who wants to have sex with you is on orgasm number four and you still can't reach climax. What is going on in your head? Are you not focused? Do you have that sexual ADD that I'm talking about that you can't stay focused on your partner at the moment? That's where you or the therapist would take up and kind of look into this world to say like what is going on here? But for my standpoint, it's really just from the tip of the penis to the circuitry all the way to the brain to try to figure out, where is that circuit broken if it is broken? It's fascinating because it's all connected is the truth. I mean, if you have a pattern of delayed ejaculation, which you actually just said something that I've never thought about before

that, like, if somebody has problems with breathing, with breathing or they've like when you said their nose is turned like maybe they have a deviated septum right? No one would ever make that connection and that would be that their whole life that if they broke their nose in high school let's say or something and they never realize that that could be part of the delayed ejaculation. But yes, it could also be psychological or trauma or all the other things we talk about. But the delayed ejaculation in particular I often find that it's something it's something else and this could be the other things we talk about, but with delayed ejaculating in particular, I often find that it's something else, and this could be the other, something else.

And I often also wanna say that when you talk about the tip, a lot of times, yeah, the partner might be used to in that grip, they're always used to masturbating themselves in a certain way, maybe there's a certain porn, you know, when you're a brody, watch this porn, and he always says, we just call it the death grip by his penis, and no matter how he has sex with his partner nor how does she touches him, she can't replicate that.

And he's got this circuitry of neural pathways that are used to orgasm only in that way. So maybe there's an unlearning and a relearning and a new way of touch or a new kind of stimulation or maybe there's a toy, like a cop grain or something that would really stimulate you in a way that would feel amazing along with your partner. So using like a wearable vibrator or maybe even prostate play. I've found for many penis owners who can't have a problem with delayed ejaculation, like you play with their prostate and their penis. There they go, right?

Joculation might no longer be a problem. So it's really just kind of listening to this information that we're providing and and being able to kind of help diagnose yourself and we're always here to help you with it. So I want to emphasize one thing porn, okay? And you're right. You're absolutely right. When we grew up, porn was those two playboys that I had in a new mattress, okay? You didn't get a lot of variety, you know, and just to get those two magazines was a chore, but nowadays porn is so readily available to people. I mean there's so You can get a lot of variety, and just to get those two magazines was a chore. Nowadays porn is so readily available to people.

There's so many websites that I heard a statistic that half of internet landing sites or porn sites and the other half are the sites that you flip to and someone walks into the room. How men have porn? And porn is good and bad. And porn in small-d dose of moderation can be helpful. And I don't know if you've ever recommended it to your clients to have it watch a little porn, and that's not bad,

but it's when it becomes excessive. And it's just like drinking is. You know, yes, you can have a drinker to a night, but if you start drinking a whole bottle or two every night, that's a problem. And so we need to understand what moderation means. And so I think sometimes people like Brodie And I don't know Brodie's history and I don't want to throw him under the bus here

But maybe he's just watching too much porn and he's desensitize himself You know, and I tell his to my patients like when you watch porn You don't pick that genre that is that girl that looks kind of like your partner Having just missionary sex the kind of sex that you have. You pick the girl, like, you know, the threesome with the flame throw or the donkey because that's like crazy. So and so you start watching that kind of stuff. So your threshold for orgasm starts going up, up, up and your partners, you know, which she can provide you.

It only gets you to this threshold of orgasm. And so you never get to that threshold. And that's why in certain things like put the finger in the butt and give a prostate massage, it might be what takes, takes them over the top. No, that's a great point. It's like we tend to escalate all these things that are good for us. Like a glass or wine or two is fine. Pouring every now and then is fine. But if it's the only way you've been ejaculating, only people can be their own best advocate and kind of take a look at themselves

and see where they might be able to modify and moderate. So yeah, I don't bash any, I'm like, you know what, porn's great. It's all good for until it's not right. It all works until it doesn't. This is amazing. Dr. Cartman, thank you so much for being here. We've got to have you back on because we didn't even get to everything today, but you've been so helpful, so knowledgeable. I love our conversations. Is there anything else we're putting all this stuff in the show notes, but where people can find you now, anything, any parting words, anything we didn't cover that you're excited to share? Yeah, go to my website, www.healthy-mail.com. There's a lot of information, there are videos, pictures, things that I take care of, if you

want more information. And thank you for having me on the show again. Emily, I have to tell you that so many patients that come to me and they say, they tell me that they watch your show and they learn so much from you. So you're a great asset to our society of sexual medicine because people really listen to you. Thank you, Dr. Cartman. I appreciate you so much.

That's it for today's episode. See you on Tuesday. Thanks for listening to Sex with Emily. Be sure to like, subscribe, and give us a review where every listen to the podcast and share this with a friend or partner. You can find me on YouTube, Instagram, Facebook, and Twitter at Sex with Emily. Oh, I've been told I give really good email. So sign up at sexwithemily.com

and while you're there, check out my free guides and articles for more ways to prioritize your pleasure. If you'd like to ask me about your sex life, dating, or relationships, call my hotline 559 Talk Sex. That's 559-825-5739. Go to sexwithemily.com slash askemily. Special thanks to A-Cast for powering the Sex with Emily podcast.

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