Sex With Emily - Power to the Penis! With Dr. Edward Karpman

Episode Date: June 25, 2019

On today’s show, Emily is joined by board certified urologist Dr. Edward Karpman to talk about the penis & how to be your healthiest self to have the sex life you deserve.  They discuss the most common penis challenges and ways to work through them, how to get your brain on board when you’re dealing with performance anxiety, and what a penis implant actually is & how it works – because your sex life does not have to end! Thank you for supporting our sponsors who help keep the show FREE: We-Vibe, pjur, Apex, SiriusXM, Veritas Farms  Follow Emily on all social: @sexwithemily For even more sex talk, tips, & tricks visit sexwithemily.com For more information on Dr. Edward Karpman, click HERE Hosted on Acast. See acast.com/privacy for more information.

Thanks for listening to Sex with Emily. On today's show, I'm joined by board certified urologist Dr. Edward Cartman to talk about the penis and how to be as healthy as ever to have the sex life you deserve. Topics include penis challenges. So they're more common than you think, but there are so many ways to work past them. Performance anxiety. Although your brain is the biggest sex organ, it can sometimes work against you, so here's how to deal. What is a penis implant?

And how does it work? Power to the penis because hey, age is a number and don't let it keep you from pounding away into the golden years. here, he just got his heart broken. He thinks you're kind of cute. The girls got a hair standard. Oh my! The women know about shrinkage. Isn't it common, Evelyn? What do you mean, like laundry? It's shrink?

Can we not talk about sex so much? Are you kidding me? Oh my god, I want to feel so drunk. Being bad feels pretty good. So you know what? I'm not going to be a bad boy. I'm not going to be a bad boy. I'm not going to be a bad boy.

I'm not going to be a bad boy. I'm not going to be a bad boy. I'm not going to be a bad boy. I'm not going to be a bad boy. I'm not going to be a bad boy. I'm not going to be a bad boy. I'm not going to be a bad boy. I'm not going to be a bad boy. I'm not going to? It's drink. 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 check out sexwithemily.com. You're going to love our site. You know all the information on there to help you have the sex life and relationship you want. You can also catch me Monday through Friday, 5 to 7 pm Pacific on SiriusXM stars. It's channel 109. There's awesome sex stock. You can even call in if you don't have SiriusXM at AAA947 8277 and I can give you some advice. You can also get a 30-day trial at sexblemly.com slash SXM for free. Alright guys, you can find me on social media. It's at sex with Emily across the board. And I hope you enjoyed this interview with Dr. Edward Cartman. I am really excited to welcome my guest today.

If you've ever had a question about a penis, either yours or one that you know, anything at all, this is the man. Dr. Edward Carpman is a board certified urologist and one of the few urologists who is also fellowship trained in male reproductive medicine and surgery, microsurgery, and male sexual dysfunction. He's the medical director of the Men's Health Center at El Camino Hospital, Los Gatos, and the California Vasectomy and Reversal Center. You're amazing.

Welcome to the show. I think you're amazing. You're seeing me as a doctor. Dr. Carman. Now we've established you know all things penis. Penis challenges I feel have been on the rise lately. I mean, no pun intended, but they have been, or not on the rise. They're not rising as much as they'd like to.

The penis is. But what's going on? Like, I know that it affects 50% of men over the age of 40. Some kind of penis challenge, but why do you think it's becoming more of a problem now? Or is it just that we talk about it more? I think it's a little bit of both. I think that I always tell people that in 1999 when Viagra came out, it was a sexual revolution and renaissance for us and we finally had a drug that could effectively treat erectotid's function and we started talking about it. Remember there were commercials for Viagra famous

senators like Bob Dull were going on TV saying that I'm using this. And it became socially acceptable in our Puritanical Society to talk about sex. And I think it's only been 20 years since Viagra came out and we've seen this evolution. And we're seeing new products come to market. Things to treat crooked penises, more hormone replacement products and we're seeing a lot more attention to it. So that's one of the things.

I think we're just bringing more attention to the issue of sexual dysfunction. And our society is not getting healthier, so we're getting more problems at the same time. Let's talk about erectile dysfunction real quickly, because I think people sometimes get confused with what it might mean. So what is it, and how would you define it, and how does it affect a person psychologically? Well, affects a person's psychological tremendously. Okay, I was just to get that out of the way.

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

Evolved. A minute. And in fact, that's a form of erectile dysfunction is called a venous leak, where guys can get a good erection, but they just can't maintain that erection. And this is a very devastating form of erectile dysfunction because it affects young men. And how does it affect young men? Where is it? Is it something that's genetic? Is it something that's...

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

from the faucet or to that point B. Fosset works great, water flows in great, but someone drilled a hole in that bucket. So by the time you get over to point B, half the water's leaked out already. So obviously, you're not gonna have much hole in that bucket. So by the time you get over to point B, half the water's leaked out already. So obviously, you're not gonna have much water in that bucket. So that's the kind of ED that younger men get, and a lot of older men get as well.

Okay, so that's one kind of, but essentially we're just talking about, I always say that it's the umbrella of penis challenges. Like it's just, you can't get hard, or they can, you get hard, you can't stay hard, and it's a problem. And then say, there's pain involved. It's a form of pain. I mean, it's painful. It's a painful relationship. Well, it's painful. So let's talk about it. How much of these penis challenges are

mental and not necessarily physical? Small percentage. We're talking about 10% of erectile dysfunction is due to some psychological causes. And there's things like stress, anxiety, those will contribute to erectile dysfunction, expectations being inappropriate. Those will contribute to erectile dysfunction, but it's really a small percentage, about 10% is due to what we call psychogenic erectile dysfunction. The vast majority is truly an organic problem that there's something wrong with the guy and we can usually identify and fix it. Just to make the distinction here that people with premature ejaculation, which has

you come too quickly, you're hard and then you're not hard very long, that could be mental more mental in many ways. It can be exactly. And a perfect example is a guy who has a venous leak, realizes healing has about a minute or two of hardness before it goes soft. So just like Pavlov's salivating dog, he trains himself to come quickly in order to reach climax because orgasm is why we have sex, right? Emily?

No, not the only reason. Well, that's the... It's a drive, it's the carrot, I guess. Exactly. But there's other things that happen. You're right. Okay. I don't want to minimize the whole reason. Well, that's that's that's the it's a drive it's the carrot, I guess, but there's other things that happen. You're right. And I don't want to minimize the whole process. Four plays important. The process starts after last orgasm. Exactly. I saw you notice my sign. Love it. Love it. Love it. So yeah. So I think that what we strive for orgasm, because if we don't achieve orgasm, then we feel like we didn't complete our sexual act. And so these men who have these momentary erections then almost train themselves to have premature

ejaculation, they develop another problem because they don't address their underlying problem. Okay, so this venous link thing is a new information for me, to be honest. So is this something, are you telling me then that there's a lot of younger men that could have this venous leak and not know it at all because not many doctors know about this as Western, you go into your regular urologist, you might not know it at all because not many doctors know about this is Western you go into your regular Eurologist he might not know what the Venus leak well no urologist will know about it, but a lot of people Doctor, yeah, your general physician. Yeah, you go into your doctor and if you're 20 to 30 years old

You say have a problem with your erections they automatically assume it's in your head and they neglect you They say you're having stress. you don't need to see anybody, and then the patient becomes embarrassed because you're like, oh yeah, maybe I'm just crazy, maybe it's on my head, and they don't wanna go anywhere else because they don't wanna be embarrassed the second, third, fourth time by another doctor

telling the same thing. So they just leave it at that. But it is a big problem in our society, and it's under-addressed. And I've seen some devastating life experiences and patients who didn't know they had venous leek when they were young, but then when they turned 40, 50 and they already went through a rune marriage

and they're having depression, all these problems, they finally come to somebody who can address that issue and explain it to them and treat it effectively. Is there any way, what are the symptoms of, I know you explained to me with the bucket and there's a leak, but how could you, is there any way you could know? Like when I do my call show, we go call in, is there any way I could say like,

that sounds like a venous leak? Or do they actually have to go see you? No, I mean, essentially if a guy could get a 100% erection, like hard firmness. Right. It's not gonna table it. Hard, hard, hard, hard. It does not sound like.

And then, but it doesn't last. So you're having sex with your partner, you're into it. I don't know. But it doesn't last. So you're having sex with your partner. You're into it. It's hot and sweaty and you want to be there. You don't want to be anywhere else. Right. And then out of nowhere, this thing's just going soft.

You're like, what's going on? I'm not thinking about anything else. I'm thinking about you. You're naked in front of me. You're beautiful. I'm turned on. But why is he getting soft? So that is a physiologic or organic problem

that out of the control of the guy has nothing to do with his head. He's into it, he's in the game. He wants to have sex with that woman or man. But that describes, this sounds like most erectile dysfunction then. You get hard and then you don't. So the traditional garden variety,

as called garden, right? and then you don't. Well, so the traditional garden variety, as called garden variety, yeah. Is an arterial problem where a guy can't get a full erection. So, because of blood flow and that. Yeah, you don't need a full, you don't need a hundred percent rigid erection that have sex to have penetration. Right.

You get a penetration with about 50% rigidity. So, and it doesn't go from a hundred to 50% overnight, it goes from a hundred to 95 to 90 to 85 So there's but the Venus link is like hard and then soft got hard and then soft It goes soft so they'll get they'll get up to 100 and I'll be there for a minute and then it starts getting soft in the midst of it Okay, got it. So what are the top penis challenges that you see that come to you the top penis challenges? Yeah, well my practice What does it look like if you could like me through a patient comes in, like a typical

patient comes in? Well, if you have a typical- We don't. No. Everyone's different. But I think the main thing is understanding the terminology and what the patient is saying. And so a lot of people just don't know the difference between the different terms that we use. Like, the difference between orgasm and ejaculation.

Yeah. Totally different. Totally different. Totally different. Orgasm in your head, ejaculation is in your penis. And guys will come in and say, I don't have an orgasm. And when you start talking to them and you find out that they're on medications for their prostate or they had a prostate operation, so they're still really having an orgasm, they just have retrograde ejaculation, going backwards into their bladder.

Or you have, you know, the guy you have the guy who can't understand why he can't get an erection or maintain erection. The guy who has the crooked penis, I mean, there's no typical patient. So a crooked, I give a lot of things about the crooked penis. I don't think it's not always a problem, right? No, sometimes it's a good thing.

It's a benefit. I mean, I think we've got toys shaped like crooked penises. We're like, we're like, we're psyched. But then, it depends on your partner. It depends a benefit. I mean, I think we've got toys shaped like crooked penises. We're like worse like, but then depends on your partner. Depends on your partner, depends on the things, but like, but Paronis is another. That's when it's good start to get more painful for men. Well, so any curve, most curves in the penis, I should say, are due to peronis.

And so, and that's an acquired condition. So if the curve is mild and it's in the right direction, like a little bit up curve, you know, you hit that G spot or even a little down curve, but you're having sex doggy style, you hit that G spot. But what about the 90 degree left curve? And you're hitting the woman's over every time you're having sex or...

It just has to kind of flip over in a slider spot. Yeah, could you imagine the position there? Right, so that's sort of the problem. So, okay, so what about people who come in to see you then? They come in to your office, are they typically in relationships? They're not in relationships. Most of them are in relationships, but there are people who are not in relationship and are preparing to be in a relationship. And they wanted to

stuff all fixed before they get into relationship. Because this was holding them back. And they're having some concerns that they meet the woman or man of their dreams. And they want to make sure that when the question of sex comes up, they're ready. Okay. So here's the thing. So if they come into you, whether they're in a relationship or not, would you say your typical client is of a certain age?

Because I know that men over 40 start to experience challenges with their penis. I have the whole spectrum. I have, like I said, you wouldn't even say the majority then. Well, if you look at the most, the average age of a man who gets, I say, a PNL implant is around mid 60s, late 60s. Okay. You could use that as one metric, but then you have young guys who are early in their 20s who are having sexual dysfunction.

My oldest man I ever put a PNL implant in is a 92 years old. Why do all these studies stop looking at sexual dysfunction after the age of 60 or 70? No, it's upsetting to me because I feel like people are like, oh, I've met a couple other day. They're like in their late 60s and they asked what do I do. They're like, oh, we don't need to have a talk about that.

And more I'm like, yes, you do. You can solve sex. I'm like, this political fundraiser yelling about sex to them, but I'm like, you look happy. Well, yeah, I don't know why. I don't know why we don't keep talking about sex because that's just because we don't have the information out there. It's really discouraging for people. Tell me about these implants because I think they could be your implant. You like think of

breasts usually like people like, oh, my pain is going to get bigger. Like, let's talk about implants. What that means, though, your specialty. So, the piano implants first have been around since 1972. Okay. They've been around for a very long time. It's not something new, and the implants that we're putting in today are very different than the ones we're putting in. They're not your grandfather's name. Exactly. They're very sophisticated. They've been refined. They're more reliable. They're less prone to problems. They're wonderful. And now the surgeries that we're doing to put them in, you know, when I do a penile implant, I could put one in, I did one yesterday,

took me 17 minutes to put in a penile implant. Average about 24 minutes, usually under 30 minutes to put an appeal implant. So. Okay, let's back up though. What does that, who was that patient? Why were they there? And then we need to understand.

So he was your garden variety guy. Guards variety. How old was he? Maybe pushing 70, 68, 70. Rectod is function from arterial disease, from having narrowing of his arteries, didn't have the cleanest lifestyle, which a lot of Americans do. You know, we all eat cheeseburgers,

we all skip exercising, we all put on a little extra weight. Right. All those things help contribute to a rectal dysfunction. And he got to the point where other things just didn't work for him anymore and he needed a PNL implant. Okay. So then because then you put the PNL implant in 17 minutes and that what happens when he goes home. So it doesn't change immediately. We don't let him use it. Perfect. Exactly. Well, they have to heal, okay? Just like, you know, when a woman gets breast implants,

they don't really want them to do all the things that they want to do with them right away. We want to let them heal a little bit. So we give them three weeks to heal. And after three weeks, that's when their life changes because now they're gonna have unbelievable sex, him and his partner. How does it work?

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

Which are the bendable type. And this, what we're showing you here today, is a new flable implant. And the reason we call it a three-piece implant Is because it has three even though it seems like there's four components. There's the reservoir There's the pump and then there's two cylinders because there's two chambers in the penis and so we put one cylinder in each chamber But we call this a three-piece implant. So this goes into their Scardom right so the pump is right here So this one is not filled with water,

it's just filled with air, so normally they're filled with saline, but when a guy wanted to have an erection, he would take this pump, which is in the scrotum, and he- That's in the scrotum, okay. I saw the video. I saw the video. It's not filled with water, so it's supposed to be filled

with water and then it works fine. And then it pumps up and the penis comes up like this, and then it stays hard. So both of those are in the penis. Yes. And so the cylinders then stay hard, and these cylinders, the pressure they generate, can generate, is greater than a man's natural erection

when he was 17 years old. So most guys don't go to 100% when they want to have sex because then it feels like you're, you know, it really feels like wood. But they're in charge, so it explains me. So they're getting, they're with the partner, he goes home, they're getting turned on, and then he's like, he reaches down to his scrotum,

and he starts to squeeze. Yes. So if you're, how do you explain it like a squeezy ball, like when you're, what does this remind me of, like blowing up a ball or something, like a pump? Yeah, it's like a bicycle pump or a air pump. Yeah, that's exactly what it is. It's like a bicycle pump.

Oh, this, okay, this is it. Try this one, try this one. Try the real thing. Right. And again, it's not filled with water, so it works differently when it's filled with water. So does this pump go? That's the reservoir, and that goes into behind is abdominal wall, which is never seen or felt. This is amazing.

Up in here. Yeah, okay, I've seen the video. Okay, right. Now I get it. Okay. So, and 17 minutes you put this contraption into their penis. Yes. That's amazing.

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

So we've got the infection rates down to 1.4% for non-diabetics and 2.5% for diabetics. That's the national average all-comers, no pun intended. But I mean, if you take, if you look at high volume surgeons around the country, our infection rates are even lower than that. I've I've had two infections in a 14 year career Which is much lower than the 1.4% the people who report That's one of the biggest problems with a penal implant

You can have a mechanical breakdown like you know you might buy a brand new car, but the transmission goes out in six months Nothing happens. I'm saying you're perfect But you know you've won the awards and stuff. You're the manager charge. Do you think that there's a lot of men who could benefit from this that wouldn't normally, like, they're taking a pill, they're taking viagra, like, what's the limitations to viagra?

If they're like, well, viagra or whatever pill is working, why should I get a penal template? Is there a certain candidate that you think is best for this? Right, so first of all, viagra doesn't work on everybody. Or it's a equivalent. I hate the pills, I don't know, I'm sorry. You just rely on it. Right, and you're dependent on it. So first of all, Vagra doesn't work on everybody or it's a quibble. I hate the pills. I don't know. I'm sorry. I'm just rely on it. Right. And you're dependent on it. So first of all, I tell everyone in order for those medicines to work,

you got to take them on an empty stomach and avoid alcohol. And I'm sure you're the same as me, but starving and sober is not the way we like to have sex, right? It's not the way we roll. So there's a lot of limitations to those medications. They take half an hour to 90 minutes to kick in. There's side effects. People get, you know, halos around lights. They get headaches. They get facial flushes. They get muscle ache. All kinds of things. And if you don't get any of those things and it still works and you manage to have sex, starving, and sober, it still only works in about 70, maybe 80% of people. So it doesn't help everybody. It's still a miracle drug because it helps 70, 80% of people, but it doesn't help everybody. Who are the guys that will come to you?

We talked about the Venus leak, but like who else? I'm just trying to think of like I get thousands of calls, emails. I mean, there's, I can't get it up anymore. I'm over the age of 50. What's happening, you know, occasionally younger men, but I mostly hear from men in their 40s and 50s, who never had any knowledge that their penis would change. Like no one ever took, because no one talks about anything,

women don't understand about paramedicons and menopause. And they're like, what do I do? Like what is the first step for people? Like what do you think, I always say like, well how'd you die? And a lot of people are on medication. So Michael, if you're taking blood pressure or you're diabetes or there's all these factors, all these risks, obviously if you're diet, if you're taking blood pressure or you're diabetes or there's all these factors,

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

And so many guys are in denial about their dysfunction. And like I said, a guy could have a 60% rigid erection, which is enough to penetrate a vagina, maybe not something else, but a vagina. If she lays still, if she's complying, she's fully lubricated and everything, all the stars and moons line up. And so they think, I don't have a problem

as long as I could get it in. And we say that's like shooting pool with rope, you know? You can do it, but it's not, you're not gonna be very effective. So acknowledging that you have a problem once you get down to anything under 100%, recognizing there's a problem and then seeking help. And then coming to a specialist who knows what they're doing so they could identify the different types of rectal dysfunction

and offer you the whole menu of options. Well, I feel like that's what I've been trying to open up to my listeners and say, you know what? Just because you went to your doctor, you've been seeing for years, your Western doctor, wherever you're at, there might be other solutions that he might not know about or she might not know about because there's been so many advancements now

in sexual health for men and for women. Would you tell him to go? Like, Google it, find you, obviously. We'll get a million from you. You could, you get a special. So there are societies that are like the sexual medicine society in North America. They have an extensive list of specialists like myself,

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

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

for surgery or penis. I believe this too. All right guys, we're gonna take a quick break and we come back. We believe this too. All right guys, we're gonna take a quick break and we come back We got more doctor-carpment Let's talk about hormones for a minute as well like how much of this is hormones for men who are a little bit older Or 40s 50s when things start to testosterone starts to dive I know there's been a lot with bioidentical hormones and different treatments.

What do you think about that? So, yeah, hormones are very important testosterone. I call it the lube for an erection. You know, every biochemical step in an erection is testosterone dependent. And testosterone is extremely important for a man's libido. So, libido is your drive. If you don't have an interest for sex, you're not going to care about your erection or retreat. I didn't even know it wasn't working because

I haven't wanted sex in five years. You're like, I'm more interested in my car and in my garage and in playing baseball and shooting pool with my friends and drinking beer. That's more fun for me now and that's because you're testosterone as well. So you need to have a healthy normal testosterone level. And we know that men go through a manopause or andropause wherever you want to call. Yeah. And it starts as early as the age of 30. So women get to about 50 and their hormones drop off the cliff and they feel it. They get hot flashes.

They get moody. Their vaginas get dry. And it's impressive. There's no doubt about it when a woman vaginas get dry, and it's impressive. There's no doubt about it when a woman goes through menopause. It's impressive. I have another word, but yeah. Well, whatever word you want to use, that's a good thing. Interesting.

But for men, we start losing testosterone as early as the age of 30, and it goes down by about one to 2% per year, such that it's a very insidious process. So it's kind of like looking at yourself in the mirror every day and saying, do I have more gray hair? Do I have another wrinkle? You don't really know, because you're living with yourself 24-7.

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

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

And so our bodies don't read our textbooks or follow our textbooks. So some guys will be like 375 and they go see their doctor and their doctor says, oh, it's normal. See, 300 to 1000s normal. So you're normal. But keep hearing for people that all the time, I'm like, well, but get another opinion. Right. But I mean, maybe you live at 8 to 900, your entire life. And now you have a 60% decrease in your testosterone production and somebody's telling you you're normal. And the insurance companies are horrible like that

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

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

They're obsessed with their penises. I know the size and how they're performing and I understand it. Evolutionarily speaking, if your penis doesn't work or men are going through depression, it's like they become feel-amaskulated, they feel like they definitely don't want sex. So if they have money problems, so there's all these things around the penis, but yet they're still not comfortable talking about it. So I love what you're doing here, but like how hard is it when they get there, are they finally like, I got dragged in here with my partner?

Did they meet you at a party? I'm just trying to think about you at a party because me at a party is like everyone wants like what's X and they can imagine you with the penis. They all want to come after you. So what happens? How do they get in there? Why won't they talk about it? Say three questions.

Yeah, for my practice, you know, the guys are self-selective. So obviously these are people who recognize they have a problem, they want help with it. And so they come seek me out and they come in. And what I try to do, first thing I try to do with every guy that comes in is I try to put them at ease. And I try not to use big words like erectile dysfunction.

Yeah, I hate using that word too. I just say penis challenges is what I say. I ask them how they're what is. I said, as that can you get it up? That's how I would do it. Can you make a screen? Yeah, is it satisfying? You know, I ask some simple questions like that.

And I always advocate this to other urologists. And they say, well, how do you talk to a patient about this? And I say, just think of guys as like we're simple. We're like cavemen, you know, with a little sophistication. A little bit. And just locker room talk. I mean, just every guy talk, we talk about everything in the locker room.

And I'm sure just like women talk about everything in the bathroom. Yeah. You know, men talk about everything in locker rooms. And we're open, we open up to each other, We talk about these things. But then as soon as we get into a doctor's office, some other environment, we shut down. We don't talk. Right. So I think you have to initiate that. And there's this thing called as interpersonal dilemma that we see in medicine that, you know, for the longest time, people were embarrassed to bring up these

subjects with their healthcare providers. And this is again where I credit Viagra and these commercials that we're seeing for drugs to treat crooked penises and stuff like that is that it's making it more acceptable. And we live in a very puritanical society, although we try to sound all progressive and we're like really cool and hip. But when it comes to sex, we're like so puritanical and we don't talk about it. We'll try to change that. I'm glad you're doing it. I'm with you.

So I think that we're trying to do that is when we talk to them, it's talk to them in a way that they can almost disarm them so they could, they feel comfortable in the locker. I love it. You're like, how's the wood? That's exactly what you need to do. I love it. That's what I would do if I was there.

But I'd be like, how's it flow when I turned on? Have you had a de-master rate? That's what I say to women. Have you masturbated? Have you touched on? Have you had a de-master rate? That's how I say to women. Have you masturbate? Have you touched yourself? Have you had an orgasm? Do you fantasize? But that's what you got to do with men.

I love that doctor-carpment. You're bringing it, you're just getting them to open up to you. Well, I'm... You're doing important work. I feel so. How did you decide in all of your things that you've done that, like penis was important? Was there like a moment in your life where you're like, this is a good place to focus when you're in medical school? Young Dr. Cartman, what did you

so it's interesting how we choose our specialties. And for me, I was going to be a primary care doctor. I know you can't imagine that looking at all this right now. Yeah, so but I wanted to be a primary care doctor. Just like take care of patients, be the community doc, live somewhere on a coastal community, surf, and have fun, you know? And I was bit by the surgery bug and I realized I'm good at it. And I said, well, maybe I want to be a plastic surgeon because I like the art part of it, the reconstructed part.

And then I kind of bumped into urology and you meet people along the way that inspire you. You get excited by things, and it's a generally happy feel. We don't have people dying. We're not like cancer doctors or heart doctors. You know, people come to us for a quality of life condition that we can improve and we can make them happy.

We change your quality of life. And it's not about, you know, a cancer doctor, everyone in your practice ultimately dies, right? But in my practice, it's a lot of happy- Yeah, that's a given them more life. So I get cards from patients and their partners, even with, I got this one card from a woman of a guy that I did a penile implant on. And all she did was send me a card and said, A plus and she signed her name.

I love it. I was going to ask that that's amazing. What would what would the spouses they must be thrilled, right? I'm sure you must hear from a lot of them or they even had to bring their partners in. Yes. So some it's some have to bring their partners in some or self motivated. Some spouses are very happy for what I did for their partners. Some spouses hate me for what I did to their partners.

You know, there's always that discrepancies. I was happy with the no sex, yeah. So if she's a little older. There's no problem here. She's not on hormones, she's dry. It hurts a little bit when they're having penetrative intercourse, and she was kind of happy that he had erectile dysfunction.

Now he's a bionic and a superhero, and she's still at the status quo. And then when you tell her to do it, where do you send her off to get her last check? Well, yeah, fortunately, like we have a lot of people and resources in our community. And I talked to them about, you know, the women's health and issues study. You know, when I came out 18 years ago, scared all women from taking hormones. Yes, yes.

The follow-up study came out 18 years later and said, oh, well, actually, it's not that bad. It's not that bad, but people still think it's bad. Right. And a lot of the oxards, you oh, actually, it's not that bad. It's not that bad, but people still think it's bad. Right. And a lot of the oxards, you know, we're all busy in our practice, so we just don't have the time sometimes to sit down and go over in detail all these like all these data points. That's why I keep telling people, get another opinion, look for biodenical hormones, look Google it in your area who's specializing in women's health, men's health in a different

way that might not be your regular doctor. So we do, like we make sure they're estrogenized. My partners do the vaginal rejuvenation procedure now in the office. Yeah, which is the laser. Yes. Yeah. And so sometimes we have to send their partners

to get their tune up so that they can now be more receptive to this amazing penis that we gave them. I hate the word vaginal rejuvenation though because it makes it even to say like I want to get my vage, it's like even though it doesn't, I don't know, just like because I haven't, I want to rebrand everything sex. I want to rebrand the word vagina. I want to rebrand the way we talk about sex and just some of the words

aren't great. But what I'm saying is rejuvenation is like, I don't know. I'd rather have it be like spring cleaning. That's better. Like a little judge. The vages. I mean like because it's not just about cosmetics either, I guess, is a thing. For women? No, it's more about like, you have pain because you have low estrogen and the lining of your uterus has become more painful. And then there are these laser treatments that are non-invasive that you go in and they

can help stimulate collagen and it's really healthy. And I just think, I don't know, for some women, I think it can be a turn. I'm like, oh, I don't need that. What's wrong? I just think it's just my whole branding, marketing, different. But I think I'm glad you're doing that and telling about it. I think, you know, if you have one partner who's fixed and the other one's not, it's going to be a problem.

It is a problem. They kind of have to be on the journey together. Yeah. There's a discrepancy in what level they're at. You know, and I think they, if they're at the same level in terms of desire, comfort level and functionality, then it's a better relationship, it's a better fit, whereas one is good and the other one's not that good. Why would someone go to a prosthetic urologist instead of a regular urologist?

How do they get to you and how do they come to know? A prosthetic urologist is a board certified urologist who either has a fellowship training in doing penile prostheses or it's become a big part of their practice. They summon they specialize in. So you never want to go to anybody for anything important surgically that does one or two or three of these a year. You want to go to somebody who does this on a regular basis every week, every month at

the least so that you get a level of expertise that you know is going to be good. And again, this is your penis, okay? This is not your thumb. You know what the mess around? Yes. Your penis, like take do some research at the time. Right. You get your best shot at getting your optimum result is the first time you get a penile implant. And unfortunately, too many guys don't know how to find a specialist or they just get lazy and they say, like, well, I don't want to drive 30 minutes to go see that guy. There's a guy right down the street here who says he does them, so I'm just going to go

to him. And so it's overcoming that problem where guys need to know where to find the guy who specializes in prosthetic. So it's not just any board certified. Right. It's like worth of playing ticket too. Okay. Did your penis or a plane ticket?

Yeah. I get that. So that's when they come see you. So what is this? They don't actually want to talk about their penis. It's like, why do you think that is? Number one reason is embarrassment. And you know, guys just get embarrassed about it.

The penis is it's we're a phallocentric gender okay and you know sex was very important and I tell people the most important system in the human bodies, the reproductive system which the penis is part of right. The heart is there to pump blood for the penis right. The lungs are just there to give oxygen to the penis is part of, right? The heart is just there to pump blood for the penis, right? The lungs are just there to give oxygen to the penis. Because if we did not reproduce in one generation, we'd become extinct as a species.

And so every living thing, it's most important role on this planet is reproduction. And sex is what it is. And that's why we're programmed to want to have sex, to be virile, and to have a good sexual function sexual life. Our society kind of humiliates men who are impotent because like, you know, that word is, it means more than just a medical term impotent, okay? You're impotent. You just can't get it done. Right. Can't get anything done. And can't get anything done. So when someone calls you impotent, it'sent It's like I'm just a total loser. Yeah, I'm a total loser

But yeah with men anything with their penis. It's just like shut down right yeah, and so our society has has kind of Made men think that the that our lives do kind of revolve around our penis and the strength because when you're impotent It means a lot of bad things for a man and not just his penis can't get totally hard. It's psychologically damaging for a lot of men, I think. And so that's why they have these problems. And men are internalized things. They hope things just float away and go away. And they heal themselves.

The statistics are that 70% of health care decisions in a family are made by the woman. Yeah, I was going to say that's why pictured women drag in their partners into office. Yes, that happens. What's the men that are like, I'll get better, I don't want to deal, I don't know, it's a week to a weakness perhaps. It is, remember, you have to look back in history, okay? So we see today's society and we're all equal, right? But you think 100, 200 years ago where the man was supposed to protect the family was

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

which is another thing about them being the provider, when they're stressed about money or their job, or a penis challenge, it's like everything else shuts down. Like, I don't know how to be a man in society right now because this is not working and I have no money. One of the other is what just kills their sex drive and their confidence. Absolutely, I agree with you.

And I mean, also they feel that if they're single, you know, if you're single, you don't have a job, you don't have money, how are you supposed to take a girl out on a date? Yeah, exactly. And what do you do? Right, exactly. You want to meet at the pink hot dog stand

and I'll let you get, I'll let you, yeah, I'll let you get any topping you want. Exactly, no, that's what you do, but it's true. And I'm like, I'm not ready to provide yet because there's all these problems with my penis. But they come into you and then you were talking about the, well, it's kind of, it's kind of they wanna talk about it

but they're embarrassed to talk about it. So they kind of mumbled under their breath, those are walking out the door, they grab the door handle, oh yeah, my erection doesn't work. And then you know, you as a provider have to recognize and acknowledge every single problem that they have.

And then if you're not an ED specialist and you're in a busy practice, that's the last thing you want to do is start a conversation about- Like you've got the door on, I mean- Yeah, yeah, I've- I've just gotten my lunch. Exactly. Right. I was going on my break and here you go, you want to start a 20 minute conversation.

You want to start doing your Venus? Right. Right, so that's what happens. But we, that's why I just want to start a 20 minute conversation. You want to talk about your Venus? Right. Right. So that's what happens. That's why I just want to take it. Curious. I think this is going to be very inspiring for men to know that they could get an implant.

There's other treatments. But what the implant, is it a one-time thing? How often do they have to come back and see you? Well, they don't have to. After the implant is put in and we teach them how to use it. It's operational. They're good to go. And people can live an entire lifetime with their penile implant and never have to have any

kind of maintenance. There's no routine maintenance for it. You don't have to fill it up with water or saline every couple of years or anything like that. It's like breast implants at almost. Yeah. They're there to stay. And so unlike breast implants, you know, we have that scare with the liquid silicone

breast implants that came off the market because they- Yeah, that's what I'm saying. Like that. So, all PNL implants are filled with saline. So, there's a difference between form silicone. So the breast implants are still made out of form silicone. The shell is formed silicone. They stop using that liquid silicone inside as a filler.

Okay. PNL implants are also made out of formed silicone and they're filled with saline, saline, it's just physiologic water. So that thing explodes because who knows what happens, like a devastating accident, who cares, your body's just going to absorb that saline, you're going to pee it out. So there's no like long term risk for for consequences for having a penile implant. And that's another thing that people oftentimes ask me because they equate the two because they've heard about all the bad things about rest implants. So they try to attribute it to the penile implant as well. So what kind of results have you seen from people

having the implants done? I want to hear like the success stories or the happiness that comes with the feedback. It's amazing. Studies that have been published quote a 92 to 95 percent patient satisfaction rate and a 90 percent partner satisfaction rate. And again, that's all comers, no pun intended. In my practice, I do things a little differently. I tend to see more of a 99% patient satisfaction rate because once and one of the things we should talk about expectations also

because expectations are very important and I like to set their expectations going into this, what I'm capable of doing and what I'm not capable of doing. And so a lot of guys think of Pinole implants there to give them a 12 inch penis. Well, I'm so glad we're talking about this now because I know that so many men are like, yes, finally. Yes, that's that's that. So Pinole implants can make your penis a little bit larger and a little bit wider, girthier, okay?

But you can come in like with breast implants and say, I wanna have triple D's, you know, like, you know, porn star boobs. You can't do that. You can't say, I wanna porn star penis. It doesn't work that way. We don't want that either for you, men. I think-

I think men are more obsessed with that. Yes, yeah, absolutely. Men would rather have a long skinny penis than have a short fat penis, but most women will tell you that the girth is more important than the length. Yes And for guys it's like again, it's part of their virility They they want to be sure and it's not for the woman It's for their friends in the locker room so that when they're undressing in the locker room They want all their buddies to be envious of them and say whoa look at John

He's hung and but we're never looking, we're never looking, we're never looking, right? You're never looking. We know. We don't look at you. You know what's going on with John. So guys are obsessed with size, although most women will, we should talk about size.

That's a great conversation. I love the conversation. But first time we had the results though, that you're seeing, and then we'll talk about the size. Results are, like I said, 99% happy Once you get them over that teaching phase because no one's born with a pump and their scrotum and Some people are easier to teach how to use it other people are a little bit more difficult and I find it if you just keep it simple. It's the best way to learn

It's a two function remote control. I tell people there's an on and there's an off. Some people think of this as a 50 function remote control with all the, I'm like, it's not that hard, you know, it's real simple to operate. And once they get it down, they can pump these things up in less than 30 seconds. I can't believe that this is what goes in their penis. That's all it is. And then you said there's also saline in it? Yes.

And I have, actually, I have a video on my website. Yeah. Wait, have you seen that video? I've seen the video, but we should link to the video too, but yeah, we can watch it. Now that you're here, like I understand it, but this is just amazing and it doesn't hurt. And so that guy, he has an above average penis.

An average penis size is about little over five inches. And most guys think the average penis is seven to eight inches. I know, I tell them all the time. It's like six at five to six inches. It's five, actually five, five, five to four inches. Five and a quarter inches. So, and when you go every inch you go up, you go up to six inches.

You're already in the 90th percentile of penile length. You go up to seven inches. You're like in the 98th percentile of peanut length. So you go up to seven inches, you're like in the 98th percentile of peanut length. You go up then every inch increment above that, you're down to like a fraction of a percent of, so like when you get above six inches, and by the way, every guy comes into my office and I say how big your penis and they're all six inches,

which is not true. Right. They don't, they underestimate the size of their penis. Are they under rapport? They overestimate the size of their penis. Overestimate the size of their penis. They're not six inches. Well, that's what they do.

So is it like men with their height when they're like, when they're really five-ten, they're like on five-eleven? Or when they think they're six, would they say they're six feet, but they're five-ten? I'll tell you what they do. So, so, two-thirds of your penis is external, and one-third of your penis is internal. And so what they do is they push it all the way down to the pubic bone.

So we all have a fat pad, which is a couple inches, you know, even in skinny people, you have a little fat pad there. So they push it all the way down to the bone and then they stretch it and they go, ah, yeah, it's six inches. But then when you let go of that fat pad, you're going and then you're down to four inches. Okay. Right. So they measure down to the bone and we don't measure to the bone. So most of the studies, because we were talking about visible external penis. And the more weight you put on, the more penis you lose, because your abdominal wall starts

growing away from, as your fat pet grows away from your abdominal wall and it like swallows your penis. And so the visible penis is what you care about. It doesn't matter that you have another two or three inches underneath that fat pad, no one can see it. So that's- This is a good reason for men to get in these gross. Your penis will grow.

Okay, so they're most of them think they're six inches, but you're like star, you're actually five, or what happens, you measure them? Oh, I measure everybody. Because that is probably the number one problem we have with every guy is the the discrepancy in what they really have and and what they think they have. And I'll give you an example. I had a guy once. Came to see me. He had a prostate cancer operation, lost his erections, but he was able to get an erection by sticking a needle into his penis. Okay. Every time he wanted to have sex.

That's what all the adult film stars do. I know. And so guys out there, that's how they perform so well. A lot of people think it's natural. It's not natural porn is not real. Yes. Anyway, so what we use that as a treatment, as a medical treatment for some men who are willing to do that,

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

Wow, okay. Okay. Okay. We've corroborated this in our own studies. And so we know that. And so I don't need to have a guy get an erection, but I need to be him to be on board when I pull that penis out. This is how long your penis is when it's erect, right? Right? So this guy goes and I measure, I said four inches and he goes, no, it's six inches. I go, well, I'm measuring four inches.

I said, okay, well, since you respond to those shots, let's give you a shot here on the clinic. Let's see what you guys. I gave him a shot on the clinic. I got a full erection and I measured I go it's four inches and he still was arguing with me that last week he gave himself a shot. He measured it was six inches and I you know what I said to this guy? I'm not gonna do your surgery because after he won't be happy. Yes, after surgery, he's gonna tell me that I cheated him out of two inches. Yep. And so I know he only has four inches. In his mind, he stuck that he has six inches somehow

and he's never gonna have six inches. And if I did his surgery, he would be a very unhappy patient and tell me that I stole two inches from the penis. Yeah, that's an ego thing with men like he just or he really. Anyway, I'm glad you didn't it's like a body this morphism. It is body to penis this more. Peanile this morph.

Yeah, it's a thing. So for men coming in to obsess with their penis though, I just want to say is a public service announcement. Women are not as obsessed about your penis size as you are. And so I think that there's just a lot of men who are worried about this unnecessarily, as long as you can just be a great lover, not just about orgasm, and if only 18% of women

orgasm through penetration, we're not obsessed with the size. Just know how to work everything else. Now I pay attention to women. It's not the size of the wave, it's the motion, the ocean. True though, it is true. But yeah, I mean, you see the other side of it though.

Can't you just say to the guy, it doesn't matter, four or five, you're fine. No, I'm glad you got rid and the ocean. That's true though, it is true. But yeah, I mean, you see the other side of it though. Can't you just say to the guy, it doesn't matter, four or five, you're fine. No, I'm glad you got rid of that guy. Well, yeah, I could spend a whole month telling him that he still won't believe me. Yeah, so it's fixed in his head, and I just realized from all these years of experience that when people believe something, it's like gospel.

It's like telling them something's not true about the Bible, you know? Exactly. And he's like this in all of our areas of life. I can work with his partner. He probably just thinks he's always right. Anyway, after Edward Cartman, K-A-R-P-M-A-N, and they can find you at healthy-mail.com. And then your Instagram at Edward underscore Cartman underscore M-D underscore F-A-C-S. We will put this all in the show notes.

Facebook.com slash, Edwork Cartman MD, F-A-C-S. Let me get easier on our notes. You got it. All right, here we go. Five questions. We ask our guests. Something you would tell your younger self about sex and relationships. Kind of one of the things that you mentioned about the importance of the quality of the relationship and the intimacy, it's intimacy is more important than the actual mechanics of it. And I'm no different than any other guy out there when I was young and stupid and naive.

I used to think it's how big and fat and hard it gets as it's all matters. And women are obsessed with the penis and like you know a guy with a big penis is everything that I want now. As I was there too I was one. Check if most ones start there. But it took a lot of training a lot of years experience to realize that you know that's not the case. Exactly.

God I'm glad you've learned. Okay what's your biggest turn on? Oh, I just asked to be physical or- To be anything. I think honestly, you haven't been in relationships. I'm dating now, and I've been in a lot of relationships. But my biggest turn on is a person who lets me be who I want to be and doesn't try to change me,'s easy to get along with to me that is so hot and sexy. That is so hot and sexy

biggest turn off Somebody's bossy demanding Number one sex tip Careful with woman on top why from like a medical perspective Penal fracture, baby. How much are Penal fractures a problem? Do you get rid of a lot of them?

They're not a big problem, but it's devastating when it happened. So, what do we avoid with woman on top then? Well, you can still have sex with woman on top, but you got to be careful. So, you're a petite lady, and I'd say, even like a 90-pound soaking wet partner could come down on a

fully rigid penis and if she comes down the wrong way she hits her pubic bone against a fully rigid penis, a buckle will blow out and you'll get a pin-off fracture. Yeah it's like taking like a water balloon that's fully full and then like trying to bend it you know it's gonna happen to erupt her. Oh okay good to know. Morning, morning. What is the most important, personally, trait in another person? Kindness. Kindness.

All right, you did well there. Now, I have some other questions for you, but we have to end the show. Thank you, Dr. Cartman, for being here. This was great, so illuminating for my listeners. I'm really excited we got you here today. Thanks for your time. Thanks for having me, Emily. Alright guys, I hope you enjoyed this show. Let me know your thoughts on the interview

and all the other shows. What would you like to hear? What are you into? And also, I ask your questions. Thank you so much, Dr. Edward Cartman and shout out to Boss and Scientific. We love everything you're doing for the penis. And thanks to my amazing team, Ken, Michelle, Kristen, producer, Jamie, and Michael. Was it good for you? Email me. Feedback at sexwithemily.com.