Sex With Emily - It’s Just a Phallus, See? with Dr. Edward Karpman

Episode Date: April 21, 2020

On today’s show, Dr. Emily is joined by certified urologist Dr. Edward Karpman and we are pertaining to all your penile needs – taking calls and giving you the hard facts – because most of us could use some penile focus.They discuss what may be causing your ED and what you can do about it, what the heck is a cock shocker, and how does it improve your sexual functioning, and a little insight on the foreskin debate. Plus, some of the most interesting things that have been requested in a urologist’s office.Follow Emily on all social @sexwithemilyFor more on Dr. Karpman, visit https://healthy-male.com/ For even more sex advice, tips & tricks, visit http://sexwithemily.com/  Hosted on Acast. See acast.com/privacy for more information.

It wrecks how this function does can occur in a 47-year-old, but it doesn't happen that rapidly. I mean, it can, but it's not common. Usually, it's more of an insidious process that kind of sneaks up on you over time. I would ask you to look at your life, your stress levels. Something we don't talk a lot about is the effect that stress has on our erection. So, we have this thing called a fight or flight response. And this is something you learn in like basic physiology. It's like we were designed so when this saber tooth tiger is chasing you, what you do is, it's not a good time to have an erection or have babies or do unnecessary things like

that or digest food, you want to shut all your blood to your muscles to your heart, your heart starts racing, your blood pressure goes up, your objectives are just to get away from the saber-toothed tiger. That's how we were designed. And, you know, fortunately in 2020, we don't have saber-toothed tigers anymore, but we still have stress. And stress does the same thing to you. And we kind of divert our blood flow from where we'd like it to be, to where the body

thinks it needs to be because it's under stress. Thanks for listening to Sex with Emily. I'm Dr. Emily and on today's show, I'm joined by Certified Urologist, Dr. Edward Cartman, and we are pertaining to all of your PNL needs. Taking calls and giving you the hard facts. Hey, because most of us could use some PNL focus. Topics include, what may be causing your ED and what you can do about it? Okay, what the hell is a cock shocker and how does it improve your sexual functioning? A little insight on the foreskin debate

and some of the most interesting things that have been requested in your Royal Justice Office. All this and more, thanks for listening. Music Look into his eyes They're the eyes of a man obsessed by sex Eyes that mock our sacred institutions Betrubized they call them in a bag on day Hey Evelyn, you got a boyfriend? Cause my man E here, he just got his heart broken, he thinks you're kind of cute

The girls got every standard, oh my The women know about shrinkage Isn't it common, though? What do you mean, like laundry? It shrinks. Can we not talk about sex so much? Are you kidding me? Oh my god, I'm so dumb.

Being bad feels pretty good. But you know, Emily's not the kind of girl you just play with. You're listening to Sex with Emily. We're talking about sex, relationships, and everything in between. For more information, please talking about sex relationships and everything in between. For more information, please check out sexwithemily.com. We are updating that daily to give you guys blogs and posts and things are going to help you with your sex and relationships.

A lot of the questions you might be asking, maybe we've answered it there. And find us on all social media, it is sex with Emily across the board and intentions with Emily. So each show, it helps us set an intention, I'm gonna do the same and we're, think about this. Like while you're listening, what would you like to learn? What would you like to glean from this episode?

How could it help you? It could be, oh, Dr. Emily, I've been having some performance issues and I'd like to know tips to get back into peak performance. Or maybe it's, my partner's penis isn't always in full mast. What do I do? Help me. My intention is to give you all the penis knowledge that may just save you and help you in your bedroom activities. All right, enjoy the show.

I'm so excited to welcome my guest. He's the man Dr. Edward Cartman came in just to be here with us tonight. Board certified urologist and he's also one of the few urologists who's a fellowship trained in male reproductive medicine and surgery. You were you're up in the Bay area. You're very well versed in all things penis penis health. They can find you at eCartmanMD Instagram and healthy dashmail.com. This will all be in our show notes as well at sexathamely.com. So welcome, Dr. Carpman. I just want you all to say that they call in right now.

We've got to get back to our friend Jake and Ellen Nori about his open relationship. But then we're turning it over to your penises, either your penis or penis in your life, anything going on, erectile dysfunction, challenges, erection, too hard, too soft. You wanna last longer, you don't last long enough, you're worried about your penis size. Am I missing any major penis things? Penis, oh, you can talk.

He's pointing to his friend. He just threw his friend on the bus so Dr. Cartman brought in a friend. I'm like, bring him in. He's like, his friend apparently is worried about his penis size. How do he can't even talk? He's like, thanks buddy. You guys like friends? Good friends? We're good buddies. We met through the industry we work together for many years and we've developed a relationship. Okay. You can make fun of each other's penises. He helped me with a penis

reduction. It was something that was plaguing me for a very long time and now I can function normally in society. Good, it's a good man. Like these two though large penises came, one of the biggest problems that we hear from, it's actually not just not a small penis, but you don't know anything about that. It's a curse.

I hear you, man. Okay, let's just talk to Jake in Illinois, 23 in this open relationship, having some challenges. So Jake, I'm just feeling it's a curse. I hear you, ma'am. Okay. Let's just talk to Jake in Illinois, 23, in this open relationship, having some challenges. So Jake, I'm just feeling it's not working for you guys right now. Yeah, that's kind of how I'm feeling, too, and kind of what I wanted to ask you. Yeah. Because we're on the apps. You've recommended fields and stuff.

And we've tried that out. But it just seems like every time an opportunity presents itself, she kind recommended fields and stuff. We've tried that out. But it just seems like every time an opportunity presents itself, she kind of avoids it. She avoids conversation about sex and general mental field in relationship. Oh, okay. Well, it sounds like she's got work to do too, Jake. She's 23 years old. Maybe she hasn't really explored her body yet and figured out what feels good. And it's probably confusing for her to be with you and then go out and have sex with someone else. You know, I 23, I probably would have canceled that plan as well. So she just might not be where you're at.

And that's okay. You can still love her and take a break, you know, from each other and just break up because you're not in the same place. I think that's really brave. Okay, Jake, let me know. Go, I'm here for you, buddy. Every night. I got you.

Dr. Cartman. Hi. Hi. Welcome I got you. Dr. Cartman, hi. Hi. Hi. Welcome. Thank you. So, is there anything I need to know since we've talked last? Because otherwise, we could jump into some penis questions, but you're going to stay and hang out for a bit.

Yeah, I'll be here. What's new in the world of sexual medicine? Well, one of the hottest things is shockwave therapy for the penis. Tell me everything. I call it the cockshocker. Just make it sound. Of Tell me everything. I call it the cock shocker. Just make it sound. Of course, you're right, I love it. So there's this interesting thing we found out

about 10 years ago that if you do very low energy shock waves to a body part, you could actually stimulate stem cells to help it recover and to heal. And this is a therapy that they've used for many years in different parts of the body. A lot of athletes do this to recover from sports injuries. And it's been very useful. And they finally said, well, let's try it out.

You know, let's try it out on the penis, see if it works. Yeah. So about 10 years ago, the first paper came out. And what they did was they did this low intensity shockwave therapy on the penis. We're on the penis, do you shock it? We shock it all over. So we focus on the external, so probably some of your listeners don't know this, but only two-thirds of your penis is outside your body.

One-third of your penis is inside your body. One-third of your penis is inside your body and it's deep down in the pelvis. And so, guys don't understand that. And so, when we, I think we talked about, penile size and how guys say their penises are small and they get smaller. I tell them, the best thing you could do to get a bigger penis is lose some weight. Yeah, that's incentive. That's the best incentive I've ever heard. To lose some. For many a man. Yes.

To be like, oh, now I'm going to lose weight. Absolutely. My penis looks bigger. Okay. So they found out that if you put these low energy waves around the penis onto the penis, and these treatments are really short. They only take us about 10 minutes to perform. They're pain-free.

It's not invasive. It's really, there's no side effects. It's almost as, I mean, it's the closest thing that I could say that it's non-invasive, there's no side effects. It's almost the closest thing that I could say that it's sprinkling magic fairy dust on your penis to make a better. Because everyone's looking for that holy grail. Because usually they're taking biographs, they have this problem or some pill. Right. Which has side effects.

Yeah, absolutely. Or it's an invasive procedure which requires surgery. And finally, something came along that it's not invasive, really no side effects. And over time, it could actually improve your penile health. So, you know, the big thing now in medicine is regenerative medicine. We're trying to like have our bodies just heal themselves because we have these amazing abilities to heal ourselves. Like, you cut yourself.

Why do you heal in two months? Well, it's because you activate those stem cells locally, which then start repairing the injury. Right. Well, we don't want to go in and cutting guys, penis is just so they could try to grow new blood vessels or get better. So this is a nonvase of way to kind of stimulate

those stem cells that live in the penis. It makes so much sense. Okay, so I want to hear more about this, but Amy's been holding for like an hour, and she only has six more minutes. And she winds a question for you. So we're going to go to Amy. Amy, 40 in Orange County.

You have a question. Hi, thanks for calling. I'm here with Dr. Cartman, and I just got the message from them that you only have. Hi. So what's going on with your boyfriend? We want to help you. And then we're going to get back to the shock cock.

What's a cock? Cuck shocker. Okay, yeah. Tell me everything. So he has trouble reaching orgasm when we have sex. And sometimes it just takes a really long time and sometimes it just gets up and we can't at all. We just stop and then sometimes we stop and then he'll just like finish himself up masturbating

and then he can. Okay. And so I just wanted to know what you can do. It's because of it and if I can do anything. Yeah. Great question. So it's a delayed ejaculation is what it sounds to me. What do you say about delayed ejaculation when typically a man lasts longer than what

it 30, 45 minutes? So some guys with premature ejaculation, which is the most common problem, say, are saying, why are you complaining? Right. But it is a problem. And my first question to you, Amy, is your boyfriend on any medications for depression? No, he's not.

Okay. He doesn't take any medications. None at all. Okay. Because the reason is, is that a lot of people take anti-depressants like Prozac, paxil, lexapro, all these medications. And they have a known side effect of delaying ejaculation. We actually use them off label to treat men who have premature ejaculation, which is the

most common sexual problem that men have. But if that's not the case for your boyfriend and he doesn't do any drugs, okay. No, he drinks alcohol, but this happens if he drinks or if he doesn't. Right, and he's probably, oh, as he said, this has been a thing that's always been an issue or a challenge for him. I have been really gone there to probe that. I don't know how long it's been going on, but he, we're both divorced and he told me the reason he think that happens is because with his ex-wife, the whole relationship they never use birth control. And so he always have to pull out and he thinks they just like develop like a nervous thing

from that and that part. Okay. So I don't know if that's the case or not, that's what he attributes to. Huh. I mean, could be. Could he watching porn too? Like, if he has a good tight grip around his penis when he's watching porn, that could be it too. Well, that's that that was going to be my next question. Does he watch porn? Do you guys watch porn together or does he watch porn alone? We've been watching it together and not that I know of that he does, but from what you're saying of the type of like when he does do it, he seems to have like a really

loose grip when he does it. What do we do here? Can we shock that? No, we can't. So first of all, we have to explain where our orgasm really comes from. Everyone thinks it comes from the penis. It really comes from your brain. So it's when you reach a certain threshold, when a man reaches a certain threshold in his brain, he releases all these neurotransmitters. That's a big word, I'm sorry. But things like dopamine, which give us that shiver down our spine.

And I always try to explain this to guys. That's where an orgasm is, it's in the brain, it's not in the penis. And so there's a lot of things when we think of any kind of a jack-tory problem like that, we're always thinking what's going on in the brain. And so one of the things, and I would explore this a little bit more with him

is how much porn he does watch, because there's this thing called porn-induced ED, but there's also a desensitization that happens with watching too much porn he does watch because there's this thing called porn-induced ED but there's also a desensitization that happens with watching too much porn. So you can imagine if you're a guy and you watch porn and you watch your favorite genre, you could pick any genre but it's like, you know, three women with big breasts

and taking turns on you. And so that becomes your new threshold for reaching climax. And then you come back to your relationship where it's kind of normal sex. I'm sure you guys experiment, but it's nothing like that what you see in the movies. Yeah. So I would just have more.

I think we just give you a few ideas of what it could be, but I think in talking to him and kind of getting more history and saying, hey, I'm just curious, is this always happened? Can you tell me the history of this? I mean, if it is a learned response from his marriage, that's also possible, but what Dr. Karpon was also saying about this ability to think your way to orgasm and kind of like learn to orgasm without ejaculation. Is that where, which is a practice?

Yes. No, which is a practice. Yes. No, and it's true. It could be also a form of depression that's manifesting as delayed ejaculation, which is very possible. So depression and the treatment for depression both can cause delayed ejaculation, but then it goes back to the point that I was making. It's in the brain.

Yeah. Yeah. Amy, I would just get clear with it. I've been start to talk to him. And there is some more information we've information on our site about learning how to orgasm without ejaculation. We can get into that. But let's get some more history from this and then

call me back. Call me back with him. Okay. Thanks, Amy. Let me help. The previous calls are lining up for you, Dr. Cartman. I'm here with Dr. Edward Cartman, healthy-mail.com, eCartmanMD, triple-8, 9478277. Okay, let's talk to Ken 55 in New York.

Hi Ken, what's going on? How can we help you? Hi, Dylan. Having trouble maintaining and getting an erection and even after taking CLS. Okay, 55 in New York. All right. Ken, okay. So even after taking CLS, how long were you taking CLS for?

I needed. I mean, just doesn't seem to work. Did it ever work? Not really, no. Well, how are you taking it, first of all? Up till. Well, no. Are you taking it 20 minutes before sex

and then you sit there watching sports center until something happens? Or do you take it on an empty stomach an hour and a half before intercourse and then you go stimulate yourself? How do you take it on an empty stomach and hour and a half before intercourse and then you go stimulate yourself? How do you take it? I've been tracking exactly what I've done, I've waited, but not seeing results. It's very important. So, so, Silas is the one different one out of all the drugs that we use, like Viagra,

LaVitra, Stendra. Those are all quick acting 30 minutes after you take it. If you take it on an empty stomach, they kick in. They only last for four hours, though. Silas or the generic name is Tadalafil. It works a little differently. And it's been dubbed the weekender because a guy could take a pill on Friday and potentially it can work all through Friday night, Saturday,

morning, Saturday, night and even maybe into Sunday morning because it has a 24-hour, 24 to 36-hour duration of action. But you have to take that one an hour and a half before intercourse and if you take it with food in your stomach, it'll take longer to absorb. So the most common, you know, consultation I get for failed, you know, the viagra, I'll just use the viagra as a name, but any one of these drugs, they don't work on me anymore. The most common reason I find is that people just aren't using them correctly. And they're prescribed by their primary care doctor nowadays. You can even get them online without even a real consultation.

A doctor explains how to use them. And people just take them the wrong way. And so the first thing to do is make sure you're taking the right way. You re-challenged yourself. And then you're in the right situation. So with psialis, it's an hour and a half before sex, empty stomach, sexual stimulation after an hour and a half.

All right. Can you want to try it that way? Yeah, I tried crushing it too with that help. It can, but it will make that big an effect. Again, if you have a stake sitting in your stomach from dinner, and no matter whether you crush it, you take a hole, it's not going to get absorbed adequately. Yeah, okay, so it, you take a hole. It's not going to get absorbed adequately. Yeah. OK. So Ken, I would take a... Yeah.

One more. If there, what could be the problem physically, if there wasn't, if I was taking it correctly? OK, so let's talk about that. So first of all, real quickly, do you have any medical conditions like high blood pressure, diabetes, heart disease? No.

OK, so you're otherwise completely healthy. Yeah, for, heart disease? No. Okay. So you're otherwise completely healthy. Yeah, for the most part. Yeah. Okay. And is it more of a problem getting it up or is it more of a problem keeping it up? I'd say getting it. Getting it up. Okay. So when we, when guys say getting it up is a problem to me, that sounds more of like an arterial problem means you can't get enough blood flow into your penis, okay? And that could be due to the most common reasons would be a disease in your blood vessels that things like heart disease. And erectile dysfunction is really now considered like a form

of a manifestation of cardiovascular disease. And so I would recommend if you haven't, get checked out by a cardiologist. In fact, I'll tell you an interesting anecdotal story. When Viagra came out in the late 90s, we started giving it out like candy as urologists. And we were rock stars. We had the first FDA-approved oral medication that actually worked. And people loved us. And we were giving it out.

And guys were having great sex finally with a pill and what we found out is that these same guys were coming back about five years later and telling us they had their first heart attack and it wasn't that the Viagra was causing the heart attack is that we weren't recognizing back then that these guys are really are suffering from cardiovascular disease and we were treating it as though, like if a guy came in and said, hey, Doc, my chest hurts when I exercise. And I said, okay, here's a viagrapil. That's not the right thing to do.

You should go get checked out, get a cardiologist, check your blood vessels to see if there's anything wrong with them. And the ultimate thing to do is to get a penile ultrasound by somebody who knows how to do those and interpret them. All right, Ken. Okay, thank you. Thanks for coming, Ken. Okay, thank you. Thanks for calling Ken, have a good night. Wow, that's a lot.

It is, right? So it could be from your heart, we don't get checked out. Right? Often we're not getting the right kind of tests. Correct? Absolutely. And so in fact, you know, the guidelines have changed now that we're almost obligated to ask these guys,

these questions about their heart when they come in and say, hey, Doc, I just have ED just write me a prescription for the pill out of your office in no time. I'll let you go see the next patient. And I say, sure, I'll write you the prescription, but you got to do this for me. You got to go get your heart checked out. And so I work very closely with a lot of cardiologists because it's very important if you're dealing with sex, especially if you're dealing with erectile dysfunction, is to understand this relationship and make

sure that these guys aren't coming in and you're just giving them a pill or a treatment and not recognizing the underlying problem that's going on. Yeah, that sounds like makes so much more sense. Holistic approach, just giving a pill to solve it. Okay, we've got Rick, 46 in Ohio. Hey Rick, you're on with Emily and Dr. Cartman. How can we help you? Hi Emily and Dr. Cartman.

Hi. Hey, so I have a question about, I got to dissect me about almost 10 years ago now. Okay. And ever since I got to dissect me, my ejaculation is so different. I mean, it feels the same, but I used to be able to spray everywhere now, it just a little bit drizzles out.

I was wondering why is that, and is there anything I could do to get that back? Love it, Rick. Thanks for the question. Hold, please. We got, what do you think, Dr. Cartman? Well, let me ask him, what was the interval between the vasectomy and you noticing this problem starting? I'm sorry, I'm sorry. Can you repeat that? I can hear you. How long was the time from when you had your vasectomy? How long of time went by after you had your vasectomy before you noticed this problem that your will call the money shots? Right away. Right away. Right away. Right away. Okay.

problem that you're called the money shot. Right away. Right away. Right away. Okay. So, so this requires a little physiology to bear with me here. Okay. So, your ejaculation, most of it actually comes from your, no pun intended, but it comes from your prostate and your semolvesicles which are way downstream from where we do

have a septomy. And the, the only thing that the testes contribute to your money shot is the sperm, and that makes up about by volume, only about by 5%. So most guys don't notice a change in their volume of ejaculate after they get a vasectomy, nor do they praise me when I reverse their vasectomy and say, oh my god, I got this huge load now that's coming out. We just don't hear that. Now whenever you have a procedure done on your body, okay, you become more in tune to what's going on.

And so sometimes it's just a question of like observation and being alerted to it. And I've had guys come in and tell me that in my office after I've done a vasectomy and they said, well, as far as anything comes out, and I said, well, let's check it out. And I have them do a seamen analysis right there in my office, and I show them like the volume is really unchanged. You can't really perceive a change.

So the vasectomy doesn't, like I said, doesn't take away more than 5% of your ejaculate volume if you get one done. So if you do notice a decrease of your ejaculate volume if you get one done. So if you do notice a decrease in your ejaculate volume you should be looking downstream at the prostate and are the seminal vesicles. It could be a hormonal problem. Maybe your testosterone's low and you're just not producing as much fluid anymore because your testosterone's low and that's what drives your prostate and your seminalvesicles. Yeah, I wasn't, that makes sense. I wasn't my mid-30s when I did that. So I guess

that'd be the time when, you know, you might start losing testosterone. I guess you'd start losing it. Yeah. And that time. And then I had one more follow-up question if I may. Sure. I have a younger wife who's about 15 years younger than me, likes to have sex a lot. And I find that I usually take about a half of Viagra, like 80 milligram. Just so it's nice and erect, and I don't have any issues, because when I don't take that, I don't have any issues because when I don't take that, I can get an erection. It just isn't as firm and hard. It doesn't stay and last as long.

I mean, I exercise. I would tell you to stay on a little overweight, but I'm certainly not, you know, I mean, it's not out of control or anything. And so you're wondering. Yeah, Rick, good question. What do you think, Dr. Cartman? Well, so first of all, 80 milligrams of Niagara, it's almost the max dose.

That's a pretty big dose. But, you know, you cut an 80 net. Okay. Okay. It works. And listen, I talk guys, as you get older, you're gonna have some decrease in your rigidity. Now, it's not anywhere close to being classified

and say ED that you can't complete the sexual act and satisfy yourself and your partner, but you notice a little change as you get older. This is part of the aging process. You know, I talk guys, like, these drugs are like performance enhancing drugs. And it's kind of like, you of like the steroids that people use. Barry Bond was a great baseball player before he took steroids and he became an exceptional

baseball player when he started taking them. It's kind of like the way these drugs work. Yes, in a guy who's getting older, you're not old, okay? I'm older, I'm older, we older than you, okay? But it can happen. You can start noticing some decrease in function. And so these drugs do help park you up a little bit. And we also don't know Rick,

if she's, she might be fine with your penis, where however it is, but you are thinking, like it's gotta be harder, it's gotta be bigger, it's gotta be all these things. And I'm gonna bet that your wife is pretty satisfied as it is right now. That's true, that's true, that's true. It's an ego thing. Yeah, okay, well, you know, so, all right. Okay. Our work here is done with you, Rick. As it is right now. That's true. That's true.

It's an ego thing. Yeah. Okay. Well, you know, so all right. Okay. Our work here is done with you, Rick. Thank you very much. All right.

Dr. Cartman, you're going to hang out. We're going to take a quick break and we come back. We're going to get into your questions. I have a note. Anything new penis issues that I haven't, I don't know about? You want to hear the weirdest requests I've ever got. Yes, please. So I had a guy call me and ask me if I could split his penis into two. Okay, you've got me.

What? So the penis actually has two chambers, the two corporal bodies, and there's just one of these fetishes or paraphernalias that people have. And this is, I think we talked about this last time, and I said this to you, there's no way to train and prepare for this kind of stuff because I could not find that in textbook anywhere.

And I had to, actually I heard from one of my colleagues who does a lot of this stuff also. And he told me once a long time ago that he had a patient that actually asked him to do that and he did it. And when this guy called me, I said, oh my God, I wouldn't even know what a turn to but thank God I remember my buddies told me this story. And we were, I think it was like, just one of those conversations you have at a bar and you never believe what I did.

And I had to call him and ask him, how do you do this? Where do you put the other agon confuse? Like split it in half so it's like, is it staying on him or is he like, so it's two penises? So you could have like two horns coming out. And like double penetration?

I kind of thought maybe that's what it was about, but I think it would be, it's weird. It's not gonna say weird, but it's one of those. Oh, it's, we've got it up on the, yeah. Okay. There we go. Yeah, he's good with music and sound

and graphics, thanks Brian. Right, so you could, there's actually two chambers and theoretically you can split them in half and then you have two erectile bodies. And whether it's like a forked penis, you wanna call it or like a forked tongue, something like that, I don't know what you do with it. But, people do things to their bodies

and it's not a question of asking, why? It's really a question of, you know, is it doable and is it safe? You know, you obviously don't wanna do something that's gonna hurt the guy. And you wanna make sure that he really knows what he's getting himself into when you do this. And I'm a big believer in, you know, your body,

your choice. You know, so. So did you do the surgery on him? You did it. He never followed through with it. But it was like, one of those weird, super weird requests that I was like, oh my God, I was racking my brain. Like, what am I gonna do?

I wouldn't wanna do it. I wouldn't wanna do it. What if you regret it? I don't know. Yes, that's the big thing. So, take a look back, Kenny. Well, so my friend who did it, when I was talking to him, he told me that the person he did it on

actually changed his mind and then he put them back together. Oh God. But it's not going to be the same. Right. No, right, exactly. Wow, man, he talks about penises as much as I do. It's so good to have you here, Dr. Cartman. You guys can call us with anything, any questions.

Jim, 47 in Texas. Hi, Jim. What's going on? How can we help you? Yeah, I'm just curious in regards to then experiencing in regards to fullness of erection. And curious if it's just typical with my age or

something that's lacking with the partnership between myself and my wife. Okay. So you mean like you are 47 years old and you're wondering, you're not able to get a full erection right now and you're wondering maybe it's, are you, is it because you're not into your wife anymore, you're not attracted to your wife or is it because of your age? Is that your question? So

47 I've been you know super super sexual masturbate, you know every day We have sex probably you know two to three times a week amazing over the past month I haven't been able to get fully erect, which I went to a doctor and he prescribed me the lowest dose of Viagra, which I've used a couple of times and incredible. But wondering if it's because of the repetit, the repetitiveness of, you know, the sexual act, the fact that, you know, my wife only does missionary because of some, you know, problems that she has, you know, with, you know, vaginally. And the fact that, you know, she's not into the chatter, or it's just, hey, I'm getting old and maybe I need probably

all those things. Jim, I think it's a little bit of everything, likely. Yeah, so, so, Jim, this kind of happened in the last month. You went from hero, like, to not to zero, but hero to lot less in the last month. Yeah, it's like 50, 50 that, you know, I'll be, you know, running out of skin or, you know, just kind of like 75% heart. Okay. So, when there's like an acute drop in your erection function or hardness, and you didn't

just undergo a surgery, which would cause that or star on some new drug that can cause that. Whenever I have a patient who just comes in and says, I could just happen last month, the first questions I start asking them are about what's going on in your life because, you know, erectile dysfunction does can occur in a 47 year old, but it doesn't happen that rapidly. I mean, it can, but it's not common. Usually it's more of an insidious process that kind of sneaks up on you over time. And so, like, I would really ask you to look at your life, your stress levels. Something we don't talk a lot about is the effect that stress has on our erection.

So, we have this thing called a fight or flight response. And this is something you learn in like basic physiology. Like, we were designed, so when this saber tooth tiger is chasing you, what you do is, it's not a good time to have an erection or to have babies or do unnecessary things like that or digest food. You want to shut all your blood to your muscles, to your heart, your heart starts racing, your blood pressure goes up. You shunt all your blood to your muscles because your objects are just to get away from the saber-toothed tiger. That's how we were designed. And, you know, fortunately in 2020, we don't have saber-toothed tigers anymore, but we still have stress. Stress does the same thing to you.

It releases these same kind of chemicals in our body that cause our heart to race and our blood pressure to go up. We kind of divert our blood flow from where we'd like it to be to where the body thinks it needs to be because it's under stress. So I would really look at what's going on overall in your life right now and work stress Even something like commuting stress financial stress Maybe the stress of your relationship with your wife is finally getting to you where like you just said It's like I'm tired of just doing mission now. Yeah, I get that. Yeah, missionary like can't talk to your wife about

You know, maybe try something what else she's into? Could she try other things, you know, a lot of times, it's just, we get bored, that's okay, but we gotta like mix it up, have that conversation with your wife as well. K, Jen. Got it. What one other question is, if I continue to, you know, supplement with the Viagra,

is there any long-term effects using the lowest dose? We don't know of any long-term effects of taking these medications. I mean, we've taken them for many, many years. Like I said, Viagra came on the market in 1999. So it's been around for over 20 years, so I could tell you in 20 year experience that we haven't

really seen any long-term effects of it. But who knows, maybe after we take it for 40 years, we might notice something, but there's nothing that we know of currently that a viagra can cause if you take it for a long period time. And by the way, you haven't been taking it for a long period of time. Right, thanks Jim. I'd say I have a talk with your wife and work on the stress That stress is the biggest killer of our sex drive truly. We don't really relate. We don't really think about it from that am for women

Stress style it's hard to orgasm. We're like in our heads. We're you know thinking about everything else Well, you know, I I practice in Silicon Valley, which is probably like one of the most stressful areas to live in. Yeah. All those penises must be just, yeah, I'm sure. Okay. And yeah, now we've stressed out penises. I see, I see young guys in their 20s coming in complaining of this stuff. Wow. In their 20s. And it's, it's a real problem. It's a real problem. And they don't understand. And imagine if this is doing this to your penis, what's it doing to your blood pressure? How? What's it doing to your heart? You know, and again, think of your penis

as a barometer of your health, okay? It's like the canary and the coal mine, okay? When that thing starts going bad, you gotta think, okay, what changed? Especially if something abrupt happens, like what Jim's describing, you know? There's something that's changing his life. And if he called up and said,

well, the last 20 years, I've been noticing it's slowly getting worse, worse, worse. Like, well, you've got Garden Variety ED. Right, okay. But this drastic change in the last month makes me really suspicious that he has something like that. And this is a very common problem. We see a lot of, and again, in Silicon Valley,

young engineers. Wow. He was too busy. Yes. Yeah. That's, I mean, so it's, what do you tell a guy who's in his late 20s or 30s, you just go to yoga, go meditate?

How do you get him to come off that distress, anxiety? So that's the hard thing. So it's like telling An obese person to lose weight or telling a smoke or to quit smoking. It's very easy easier said than done And so these people usually are so happy because they finally achieve that that dream job at that one of these big tech companies They've been wanting to have the one impressed their bosses. They're living in suck on value. It's super expensive It's crowd is traffic. It's all this stuff. They're away from their families. It's new environment and You know, what do you tell them you tell them you have to find a way to disconnect? No, you know, we could also talk about something that I think is really well, you know technology

Yes, it's ruining our sex lives. Yes, and our lives. I agree. Yes, because remember when you and I were I'm not dating us here But but when we were growing up, your parents came home and they didn't get emails or phone calls or text messages about work, they disconnected and they relaxed in the evenings. They actually enjoyed whatever they did. It watched the news, read the paper, spend time with the family,

but now it seems like people don't disconnect. We just don't disconnect. We keep going and going and going. And even if you don't answer that email from your boss, because he decides to send it to you at 10 o'clock, because he has a whim. And you happen to be like flipping through your phone. Oh, let me look at this. It's not like, you know, he sends this thing for you that to do tomorrow. Oh, you don't have to worry about it tonight. Just do this tomorrow. You start thinking about it. Exactly. So then you have a hard time focusing on your partner.

You're going to have sex with your partner. But now you're thinking about, oh my god, this guy just made me do this. What am I going to do is project. And so I try to tell patients that they really have to try hard to disconnect. So tech, we're going to have in 20 years. We're going to have like, we have now, you know, smoke zones, like, you know, like restaurants without smoking and all that kind of stuff. We're going to have like tech free zones where there's going to be no Wi-Fi, no cell signal. People are going to go for retreats.

You're throwing it home. Yeah, I do that now. It's September, I went away for a week. I like looked at my phone just like once or twice. It was the, it was such a great thing. I think we need it now. Yeah. But you're right in 20. I mean, hopefully we'll just start leaving the phones at home like we used to. Yeah. We couldn't bring them everywhere. Absolutely. You know, one of the other things we can talk about this in California, because it's legal here. And one of the things that, you know, people could consider doing is using, you know, marijuana. And, you know, the way marijuana works is it works by binding to your pleasure receptors in your brain. These things called, we have these natural pleasure

hormones are called endocannabinoids. And that's how we feel pleasure. And that's part of the orgasms. We get that feeling of euphoria. And some people, if they can't disconnect themselves, you know, they can't break that cycle, you know, it's not a bad thing to try. And it's very hard as a physician, as a professional, to recommend, it's like saying, yeah, have some wine, but then they get a DUI and then you get in trouble, because they're like, oh, well, my doctor told me to start

drinking. But it's one of those things to consider. You know, it's like, if you can't de-stress, you know, if you can't disconnect. One, like, maybe like, it doesn't have to be, I think you will picture like, you're gonna let me smoke this bong, but like, honestly, it does. We're all fans here. You take like one hit or one, like, you just,

it really is a game changer for sex. For masturbation, to get you in the mood, you don't care about that work email as much. Your way more in sex and your orgasms can feel amazing. There, I just recommended it. We should have recommended that to the previous caller who said that our boyfriend couldn't get an orgasm. So you think if he was stoned,

if he was a little high, little high, he wouldn't, that great one. I wanted to cover a few things. Lah-li, this has been coming up a lot and that's fimosis, having to do with foreskin. Can you kind of walk us through wide now more than ever where the foreskin can't be retracted? Sure. Okay. So that's exactly what it is. Fimosis is a medical condition when a man can't retract his foreskin or he can retract it but it's tight, it's painful. And we have to remember that the penis is larger, uh, uh, girthier when it's erect. So even though he might be able to retract in the

flaccid state, if he can't retract it in the erect state, it's a problem. So you have to be very aware of that. And, you know, the primary treatment for that, you know, you could talk about using steroid creams and all that kind of stuff, which I've found to be not so effective, is surgery, which is called circumcision, which, you know, a lot of men are routinely circumcised in this country of birth. And, but you go to other countries, and they don't do it. And yet, we're this melting pot here in America now, we're seeing so many people coming here from other countries and they're uncircumcised and they have these problems.

And, you know, I have guys coming into my office, young guys, complaining of a rectal dysfunction. And I ask them all these questions. And, you know, one of the questions I used to forget to ask, and I started asking this all the time now, is, do you have any pain when you have sex? And, you know, you never think of asking about pain. and I start asking this all the time now, is do you have any pain when you have sex? And you know, you never think of asking about pain, but obviously if you have pain, you can't maintain an erection.

And I tell these guys, like, you think if you had a full erection and I punch in your kidney, you can maintain that erection? No, you couldn't. So pain makes your erection go down. But when you have a phymodic foreskin, and the car can come out of the garage, as I say, it causes pain

because when you're thrusting forward, the head is supposed to come out in a normal penis if it's uncircumcised. Right. And a lot of these guys, they convince themselves because during masturbation, it doesn't hurt, it's not a problem. Why doesn't it hurt when they masturbate? They masturbate in the forward direction. Not the way you have sex.

When you penetrate, you don't have control or your foreskin. The foreskin has to retract. And if it doesn't, it causes pain at the tip. And then come in and complain of a rectal dysfunction. And I only picked, I started picking it up on the physical exam.

And I'm like, oh, doesn't this hurt? And sometimes guys would still argue with me, say, no, it's fine. It's fine, it's not a problem. I go, come on, it's got a hurt, man. Yeah, right, you're like, yeah. So why is it happening? It's when, as many are at a certain age, just for all the years of the foreskin being there,

and then it just sort of over time it starts to age the way they are touching themselves. Like why does it happen to some foreskin, and not all foreskin? So that part of the body requires a lot of hygiene and I tell you say these guys it's not a problem if you can maintain hygiene. So whenever you have skin on skin and what are the areas of the body that have skin on skin we have armpits.

Okay we have your groin creases or if you're like overweight you have a panace with folds. You know now imagine that so you could imagine how dirty it gets. But imagine like you also pee through your armpit and you ejaculate through your armpit. And then if you didn't pull that thing back and clean it thoroughly multiple times throughout the day, it gets infected. And then when it gets infected, it develops scar tissue.

And then scar tissue is not elastic and then stops accommodating the when you pull it back. Right. It's just you got to teach guys like to wash their sheets and do all these other things and then it's like another thing You got to wash your penis. Yes, or use wipes like these freshie wipes, which we love. Those would be great for cleaning the penis Right. Just keep them in your bag something Interesting. I feel like we're hearing about that. You're helping so many penises right now. Are people who are friends of penises or are of a penis in their life?

What about, let's see, what about the circumcision? I feel like adult circumcision, people wanted to put the foreskin back on. Yeah. Do you forget people coming to you for that? Yes, I do. So we have this, and this is again, thanks to the internet, we have this Forsken Restoration Movement that's going on in this country. I don't want to make it sound like it's a huge movement or anything like that. And it was kind of interesting. So when we went to our last national meeting in Chicago, we had these protesters. So the AUA, which is our biggest national meeting, a 10,000-,000 neurologists show up to this, to international meeting, actually, 10,000

neurologists there. So they decided to protest circumcision in front of the convention hall. And I took a picture of these guys, there's three guys standing there with big signs in the middle of the day during the week. And I'm like, okay, is this the movement here? This is the movement here. So they were, they were, they were having signs up that said how horrible circumcision is on the baby and it's like general mutilation and you know, let the child choose themselves.

And so obviously they're not happy with their circumcision or whatever, but this is a very, very small percentage of people who want to restore their foreskin. So how do they do it? Yeah. Okay. Well, this is it you could actually take the shaft skin of your penis and stretch it out over the head and actually use like a device, like a clamping device that will keep it over the head of the penis and over time, it will stretch out. In fact, this is this is historical. So during World War II, this

is how the Nazis would identify the Jews by, they were circumcised. And so there's, I forget the movie that it was, but there was a movie about this. It was either the diary of Anne Frank or something like that. They talked about this, where these kids would literally do this is that the young Jewish kids would do this, stretch out their foreskin. That's how they would know, wow. So this has been practiced, but that was done for life-saving measures.

Right. Because you would be put in a concentration camp if you were identified. But nowadays it's done for more for pleasure, for people are saying that an uncircconcised penis is more sensitive. That is a true statement, but it's not true that if you're circumcised, you don't enjoy sex. Exactly.

It's like this FOMO for missing your foreskin, I guess. You want to put it back on, but how sex right now? It could be what you have, right? Cause it seems like it could be dangerous or it could just, to attach it again, not dangerous, but like, what could you fuck something up that way too? Like, couldn't that, I don't know, you, if you were doing it, but I don't know.

You could, yes, yes, you can. People can mess things up, definitely. But it's just one of those things that, you know, I guess the people who are doing this are people who are circumcised at birth So they've never experienced you know sex both ways and I guess the best thing to do and I don't I don't know of any study that exists of taking men Who were uncircumcised and had a sexual life and then got circumcised and doing like a study on them to say like What do you feel what is the difference in in you know sexual pleasure?

And in this country because we circumcise so many men, boys at birth, we definitely are not an asexual country. We're not suffering from sexual dysfunction more than- Because of our circumc- Right. More than any other country that, you know, routinely doesn't circumcise. Right.

No. Okay. Good point. It just keeps coming up. People are like, save the foreskin, do all the things, and I just feel like we've got so many other things to work on. We're kind of your stress levels, good part. It just keeps coming up. People are like, save the foreskin, do all the things, and I just feel like we've got so many other things to work on. Work on your stress levels, your anxiety. I don't think you need to obsess about your foreskin.

No. Whether you have it or not, but clean it. Clean your foreskin. Hygiene is important. Hygiene is important. It's so important. Yeah. Oh my God.

Yeah, especially, yeah, if you're with someone with the pain, like make sure it's clean, because that's how we can get infections and stuff. Yes. All right, we just have a few more minutes. So what else, Dr. Kermann, I mean, we have calls, but we just, I mean, Jeff has been at a hold for a while. He's 58. Jeff, we only have like a minute though. I know if you're question about ED, but I guess we haven't answered it. Jeff 58 in Washington. Yeah, well, I got MF, and I've taken pillow the Don't See Alice and Vagra. guess we haven't answered it just fifty and washington yeah i i do i got ms

done i've taken pillow the don't see allis and vega kind of the way you said that none of those are really working it's kind of started up the last probably five years or so so it's been going on a lot and i'll just ask quick is

is the electric shock that you are talking about, that's the same as a Gaines wave or is it something, and wouldn't my urologist know about it up here in Washington? Great, okay. Thanks, Jeff. So, Gaines wave is just one brand of shock wave therapy, and in fact, what you want to ask your doctor is the type of energy they use. So you want to make sure it is unfocused pulse therapy and not radial frequency. Okay, so that's the question you want to ask your doctor

if you're going to do some kind of shockwave therapy for your penis, because that's where most of the research is on, but these radial frequency machines and devices and companies are kind of trying to piggyback on the data that's coming out from the unfocused pulse therapy. So that's really what you want to ask your dog. All right.

Thanks, Jeff. Thank you all for supporting the show, and thank you to my incredible team. I appreciate you and all your hard work. Ken, Kristen, Alisa, Brian, producer, Jamie, and Michael. Was it good for you? Email me. Feedback at sexwithemily.com. [♪ OUTRO MUSIC PLAYING [♪