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July 22, 2021

Better Boners: Erection Facts, Fiction & Advice

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Urologist, Dr. Denise Asafu-Ajei, joins us to answer your questions about erections:

• How can you prevent erectile dysfunction?
• How do you treat erectile issues?
• How do you know if erectile issues are psychological or physiological in nature?
• What can you do if you lose your erection?
• How do you manage anxiety to reduce negative feedback loops?

Dr. Denise Asafu-Adjei is a urologist with subspecialty training in sexual dysfunction and male infertility. She completed a Fellowship in Andrology at University of California Los Angeles (UCLA). She will be joining the Urology Department at Loyola University in Chicago as the Medical Director of Male Reproductive Medicine.

She completed her Urology residency at Columbia University Irving Medical Center and received her M.D. from the University of Michigan Medical School. She obtained an MPH in Health Policy and Management from the Harvard School of Public Health and a Bachelor of Science from Carnegie Mellon University.

In the future, she aims to utilize clinical research and physician leadership to help healthcare systems achieve access to equitable and high quality healthcare for sexual dysfunction and male reproductive services. Follow Dr. Denise’s Instagram and Twitter.

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Rough Transcript:

This is a computer-generated rough transcript, so please excuse any typos. This podcast is an informational conversation and is not a substitute for medical, health or other professional advice, diagnosis or treatment. Always seek the services of an appropriate professional should you have individual questions or concerns.

Better Boners: Erection Facts, Fiction & Advice

00:00:05 – 00:05:01

You’re listening to the sax with dr jess podcast. Sex and relationship advice you can use tonight Welcome to the sex with dr jazz. Podcast i’m your co host brandon. Wear here with my always. Lovely other half doctor jess how you doing. I’m great today. we are. we’re talking boehner’s love me again boehner. Sometimes i love a good. Sometimes i can live without it. Yeah we’re talking directions and we’re going to be answering a listener question. That is a little bit similar to last week’s but from this side of the person with the penis and of course there’s no one better to weigh in on erections than our guest today. Urologist dr denise software agyei the incoming director of male reproductive medicine at loyola university in chicago Her resumes too impressive. She went from carnegie mellon to the university of michigan to harvard. To columbia to ucla. And she’s going to help us. Better understand erections erectile dysfunction and discuss some preventative measures since erections tend to subside with age. And of course. You don’t need a raging like joke about taking it or leaving it but the reality is there are so many ways to enjoy pleasure insects without a boehner as well i agree and i. I couldn’t agree more that that c. I mean there’s no one better to talk about this. Dr tennessee absolutely. I mean we won’t say boehner doctor because it’s much much more than that. Her specialties are run. Quite deep including male fertility so really looking forward to that conversation and before she joins us. I have a couple of notes for you including a giveaway. So i got a couple of notes this week from folks who have been writing reviews on the podcast because of an old promo. We were running. So i wanted to offer something in return and kind of just i guess run another contest. So i’m going to mention the we’ve i’ve touch has long been my personal favorite toy. So actually there’s one sitting in front of me. And that’s a total coincidence of course actually to it actually isn’t convinced that this Toy’s sitting here so we touch fits in the palm of your hand. It looks like a computer mouse. But skinnier curves beautifully along. The lips and had has a gorgeous rounded tip. You know that’s perfect for more pinpointed. Pleasure down at the bottom of lathrop shed or up at the top near the head of the taurus. So i think everybody here knows where the head of the clitorises but an off neglected region of the vulva is low for sheds solo. Shutdown francia in french for for shut means fork. So it’s the fork in the road where the lips meet at the bottom. And i call it the lower clitoris torres. Although it’s not a part of the clitoris it can be really sensitive. And the vibe touches definitely perfect for not only pinpointing suffer shed but also wrapping around the vulva so beautifully and i just. I love this toy. I’ve had mine for what feels like a decade. I don’t think it’s been a decade because the brand has only been around eleven years but it’s and this wasn’t there. I tweet anyhow. I am giving away the original we vibe tach and the way you can enter is write a review on the podcast on any platform. I think i tunes is a is oftentimes easiest. But it’s up to you and if you don’t want to write a review you can also share on social and tag and just leave a link and once you’ve entered the way you’re going to officially enter is just send a quick email to info at sex with dr jasser dot com or go to the website and submit via contact form so info at sex with dr just dot com. And we’ll enter you in a random drop we’re going to pick the winner on august third announce and we’ll let you know in august but will formally announce to y’all on august six on the podcast so i’m learning to do this properly because last time i was like here’s a contest and i didn’t have an end date or anything like that. So writer review or do a social media showed out endorsing. Or i mean say anything you want about the podcastone wanna force you to endorse it and you will be entered to win the we’ve vibe touch which is a really cool toy and i should mention that all the we’ve i’ve toys and many many more toys every brand under the sun pretty much are available at love honey one of our sponsors and they are having really a deep deep sale right now like i was checking out some of their toys and many of them are fifty percent off some of their g-spot vibe. Some of their butt plugs some of their prostate toys. So if you had to love honey dot com love-hate dot ca. I’ll take you to the same place. You can check out their sale this week. Really really really deep discounts and you can save a little bit extra with code dr jess ten so an extra ten percents off so i was looking at this one vibe and it was already fifty percent off and i double check the code doctor. Just ten gives you another ten percent. So deep deep discounts from our friends at luv. Honey all right. Let’s dive into the topic at hand with our esteemed guest joining us. Now is dr denise. Asaf ajay who is starting as the director of male reproductive medicine at loyola university in chicago just in a in a couple of months. You’re making a move across the country.

00:05:01 – 00:10:00

How long have you been on the west coast just about a year. Actually i was on completing my fellowship here. Ucla so as year long. So i’m not too long here on the beaches of the west coast. Now i’m back to the mid four. Yeah well thank you so so much for joining us from way. Way across the continent appreciate it. How did you get into your work as a male reproductive medical specialists during residency. I am really quickly knew that. I was interested in something that really focused on preserving quality of life. There’s lots of different sub specialties. Within urology and i think for me was just like you know so many people so many areas of medicine kind of focused on you know you’re sick. What are we gonna do. But so many people are actually really concerned about their quality of life. And your sex. Life is a big quality of life issue and so the sub specialty of andrology which actually encompasses male fertility and mail kind of sexual function. That is the area that i want to focus in on because you’re helping people to have better sex lives and to make babies and that’s probably the best things that you can do for people in indian. So that’s what really attracted me to that sub specialty and so after residency. I decided to do even more focus sub specialty training within that area. And so i am more specially trained within the medical surgical management of issues pertaining to sexual function male infertility. But it was really the quality of life that i’m really attracted me to this particular field. I really appreciate your saying that because it really sex is not just about pleasure. It’s not just about connection. It is so key to overall life satisfaction and again that doesn’t mean everyone has to be having all the sex whether you’re a sexual whether you are in a partnership whether you’re having sex with yourself multiple people just being comfortable in your own skin is so important and to have medical. Professionals doctors surgeons like you who actually value that. Sadly is a little bit rare so we’re lucky to have you We have some questions from some of our listeners. And you’re here to help. I wanna start with somebody. Who says i’m just gonna read you their question. In their own words. I’ve been having difficulty maintaining and erection especially during penis in vagina intercourse. I love the language my listeners use when my girlfriend gives me oral i’m usually okay but with pi. In v eight goes down and what sometimes happens is that i will be so turned on while not fully hard that sometimes i will ejaculate either prematurely or jack late when not fully hard. Is it in my head. Is it something physical. The thing is that. I know i can have a full erection as it happens when i masturbate and when i wake up sometimes in the morning. I have an erection. I’m really lost and anxious. Please help and then they add. It happens in my head all the time and my girlfriend keeps telling me to stop thinking. What can i do. Well sounds like you know you. Listen i really appreciate the question. It sounds like a little bit of insight into what is causing that. I’m you know when. I’m looking at my patients in saying okay on. Where does the issue lie. It’s actually really encouraging that he’s saying that. Hey i can get a full erection when i’m masturbating or in different settings but this particular setting my wreck shit going down gives me some confidence that you know. The pipes are working. We just have to get them to work at the right time you know anxiety and nervousness pretending to sex is totally normal right especially if you have someone you are super attracted to you know maybe even a new partner but your body is doing is seeing. I’m so nervous. I’m so anxious. Edit actually activate that part of your nervous system that actually is terrible for erection so you think about your fight or flight response when you are trying to run from something or again some emergency situation. That is not the time that your body wants to have sex and so when you are anxious it’s activating that same system and so what that’s doing is actually completely eradicating erection. So i think to their point part of it is i. Don’t say in your hat but malaysia can just be psychological in that. I’m when you are activating that system. That response you’re sympathetic. Speak but thank nervous system it saying we don’t want an erection right now so we have to try to maximize our setting so that we are not feeling anxious. Totally easier said than done. I would certainly say. I like to be a minimalist in. I don’t think necessarily starting off. All the time is helpful but certainly if you have a supportive partner and i’m someone who can kind of go through this journey with you. That’s always really helpful rates so if you have a partners okay i get it. I love you. Let’s just you know work on this. But i think i’m really trying to figure out. What are the optimal ways to enhance that pleasure where you don’t feel nervous you know. Do we need to concentrate more than four place that you ease anxiety before things start there are also physical and like you know real causes. I’m you know that can cause wanna lose erection as well. So i think after optimizing kind of behavioral modifications around figuring out what worked for you and your partner we do think about the physical causes premature ejaculation are use it or losing.

00:10:00 – 00:15:02

The erection in certain settings are also early signs of erectile dysfunction. And that we really explore with thinking about artist. Ostro levels normal. Do you have good vessels you know. Do you have bad. Hypertension diabetes all things that affect your blood. Vessels can cause directions to also be sub optimal so in summary for our viewer. I would say. I would really focused on thinking about. What is it in those other settings that make you not so anxious. At how can we bring that to the penetrative intercourse setting. And then if you’ve gone through that i would really encourage you to seek out a local urologist. Think about okay. Let’s make sure we can rule out any organic causes so that you’re not chasing your tail. And the event that there is something that we could actually like treat and address the fact that he can get a full erection either while masturbating or when they wake up in the morning. Does that rule out those vascular issues or no. He should still see a physician physician because it could be early. Signs of as opposed to him not having it in any setting. If it just certain settings at it’s happening these could be kind of early signs that coming on and you know perhaps we can prevent that from worsening lifestyle issues outside of just you know your dynamics with your partner. Exercising eating right healthy life. Those are all classically. Really really helpful for your erectile quality so think i would still definitely explore it early on so that we don’t get to the point of no return to speak. Yeah so what. At bausch on somebody who isn’t getting erections when they wake up who is always having trouble getting an erection and is finding that they’re ejaculate eating before they get hard before they get fully hard. What would you look at them. So i would definitely be more inclined to look at physical causes because if you’re not getting it across settings that to me is saying that you know this is more of an issue. This is not just you know in your head. This is likely an organic cause. So that is when i’d be looking to see a mortar other kind of corollary signs at your bat you know. Blood vessels are not so great prediabetes hypertension looking at your lifestyle issues. Even looking at your sleep patterns right on you know actually really sleep patterns also have an impact on your hormone production and you know you need good levels of for normal levels so also get a maintain good direction so i think definitely unique that something else is going on. So i would definitely explore that further and further vascular issues or issues that have to do with circulation. Do you work with things. Like penis rings. Can that help for some patients. Not that they should not see their doctor and also check for other issues. But is that something that you work with. Yes so you know peanuts. Rings are really great. Actually and i think that you know of course on the internet. There’s many things that you could find on a google search by penis rings actually really really good especially for men who find that they are having issues. Maintaining that erection to some guys can get the erection. They can’t looking to prolong get what those physical rings do is at. It helps to keep blood within the penis. And so if you are able to actually achieve an erection you can help prolong by basically physically trapping. You know blood within a year Penis if you have other kind of more troublesome issues around erectile dysfunction. It doesn’t directly help. Let’s say premature ejaculation. Can certainly help. But i think that all of these can kind of work together. So your behavioral changes. The penis rings work really well in prolong game theoretic. Shen may not be as helpful if you can’t achieve it but once it’s there you can keep it going so that’s certainly something that i’ve regularly recommend but it’s particularly helpful in guys who find that. Hey i can get it. But i can’t really maintain it and for those who are struggling with that negative feedback loop and that enacting of the fight or flight response. Cognitive behavioral therapy can help with that anxiety. Also maybe with mindfulness and mindfulness meditation. And what we used to call it sense eight focus but it’s basically just like slowing down tuning into your body not touching your penis not focusing on just getting it hard. Is that something you see in your practice. Yes very much. So and i think that’s probably really underutilized. Where talking about sexual dysfunction. I would certainly say. I’m you know during my fellowship training. I really really appreciate the fact that we were really big on having a freddie low threshold to recommend sexual therapy. Because you know again if we’re thinking about having all these adjuncts to help when issue it’s certainly not going to hurt anything but people wanna move and more of a step wise fashion like lemonade. Find out what’s happening but it’s just like with therapy across all settings right. It’s just it can only really helped if anything but it’s really not going to hurt or make things worse so i think that that is certainly something. Should really be more emphasized than i’ve seen it used currently okay. So let’s talk about erectile dysfunction because there’s a difference between just losing your erection sometimes and clinically diagnosed dysfunction. So what is erectile dysfunction.

00:15:02 – 00:20:01

How common is it. Oh so erectile dysfunction actually one of the most common medical conditions so like over fifty percent of men over fifty have erectile dysfunction and it’s also very common among young men as well. I’ve seen guys coming in their twenties. You know they’re thirty that it’s not just a disease men and i think people are starting to appreciate that a lot more especially younger guys. Think feel like they have a lot of lead time before that happens. It’s just like it can happen sometimes. Transient or temporary in the case of being anxious new partner new setting but sometimes it can actually be early signs of other physical issues that are causing you to have that. Erectile dysfunction is just the inability to either achieve or maintain direction that bothersome to the patient to the percent at hand so that’s kind of the clinical definition but under so many different causes of it. But it’s really really comment. And i think you know we kind of talked previously about quality of life. I think people are a lot more inclined to be concerned about your hypertension than they are about your erectile dysfunction but it actually is a mobile gateway disease meaning with erectile dysfunction. You need all these things to be working right. Your blood vessels your good healthy and all this when things are not working. It’s actually a sign that there’s something else awry and there’s lots of guys who you may not see them for anything else. But they’ll come in for erectile dysfunction and we actually end up really finding a lot of other important medical issues in addition to the erectile dysfunction. So it’s kind of like a a red herring for us sue. Can you tell us a little bit about that. What are some of the causes of erectile dysfunction and what are the commodities that you might be able to see as you said. It’s a red herring. So what might be a sign. The most common cause of erectile dysfunction are going to be your vascular issues. Meaning i’m you know to have a good erection. You make good blood vessels to get. What’s your peanuts unique appl- to keep it there. You’re kind of classic. Most common causes of askar issues. Today are going to be your diabetes hypertension pretty anything that messes with your circulation. He no peripheral vascular. Disease is anything that can compromise. The quality of your vessels are going to hurt your erections but diabetes and hypertension are really kind of the most common ones and in a small subset of those patients. The inability to kind of maintain your erection. That means that your blood vessels are not doing a good job of kind of trapping. The blood there. That’s kind of another subset of the big group of vascular issues. Your vessels can commander be like the arteries meaning the blood coming to your penis. Your veins are what’s actually helping to prolong direction and keep blood within the penis and so they’re kind of two subsets within vascular issues but then the most common causes are gonna be like diabetes and hypertension other big causes of erectile dysfunction or neurological issues. Diabetes also comes into play because diabetes also can affect that but other people that have maybe a prior history of some kind of accidentally no stroke or spinal cord injury. Those are kind of the same. Neurological causes of erectile dysfunction because he also have nerves at play. That are helping you to feel that sensation get that erection and kind of complete that loop. What’s happening when you get an erection and then when you go on to ejaculate there’s lots of medications that can also as issues with erectile dysfunction. Several classes of anti-depressants actually can cause erectile dysfunction and so your mental wellbeing is really important. And you know that’s something that again we also worked around. So that’s one thing when i’m seeing somebody or taking a really thorough history as to what they’re taking just to make sure that you know again we’re not chasing our tails with something that we know is actually causing this and then another big category the psychological. That’s actually also really common. But i would say most people that are working erectile dysfunction. That really is kind of a diagnosis of exclusion. So i would say even for someone who had seems pretty obvious. potentially that could be it. You still really want to make sure that you are ruling out other causes of erectile dysfunction but those are the the big buckets would say so. I’d i’d like to talk a little bit about vascular health and hypertension so hypertension is something that runs in my family. It’s has to do with my background. i don’t have it. i think. I’m like the only one but all of my mother and her sisters is hypertension. A mix of physical and psychological. So like if part of it is genetic if part of it is your diet if part of it is your sleep. If part of it is your lifestyle is a part of it. Also what’s going on in your head when we talk about just classic hypertension. You know that is truly elevated blood pressure that i’m you know just kind of above what it should be. You know. we’ll say that we really also i think as a society underestimate the impact of stress on that and so i think psychological endorsed kind of other external factors on top of genetics and the physical or measuring really does contribute to that.

00:20:01 – 00:25:00

If you are having a panic attack your blood pressure is going up under sweating more. That will cause your blood pressure to go up. So i think on top of other kind of lifestyle issues really thinking about minimizing stressors which is easier said than done in most cases might oil stressors can really really impact your ability to control some of these other things so i think it is a combination of the behavior changes but then also seeking a medical professional that can really help keep it at bay and then what about vascular health so that came up right from the beginning lawlessly. Easley it’s absolutely essential to blood flow to the penis the clitoris for erections which i’d like to talk about as well. What can we do to improve our vascular health weather. We’re having erections that we’re really happy with or perhaps were not so happy with and whether folks are in their twenties thirties. Forty fifty sixty seventies and beyond so exercise and diet are really are the most important things that you can do for your body to. I mean help. Prevent either the onset of astor issues or the worsening of it when you exercise and you are actually kind of testing your blood vessels improving blood flow. And i’m a good diet. You know so. I would say in terms of a good diet. I’m not really believer in extremes. You need to like a vegetarian. Not losing the wrong with that but actually a good client base diet where you are diversifying your intake a little bit so you know having a good portion of your fruits and vegetables. Not just twenty. Four hours stake diet. That’s certainly gonna do volumes for your record and your health long term and the reason is it’s not that every time you’re eating a steak it’s directly affecting erections it’s the cascade affective everything else. And so you have a poor diet. That’s gonna worse in your cardiovascular health your cardiovascular health is directly linked to the vessels that are feeding. Your pena said so. Everything is really interconnected. And so i’d say for the ambassador issues. Best thing you can do for yourself is actually just take care of yourself. Weight loss exercise good diet and that actually helps Tremendously even on top of any medical therapy. You know we could be doing if you’re really dedicated and focused. A lot of people will see improvements in that just from their own kind of active lifestyle. Changes are there any foods that are good for circulation are vascular health so plant. This diet is something that has been studied in terms of something that really does help with erections are increasing. The amount of fruit and vegetables in the diet really aren’t any great foods out there that i’m like. Hey this is really going to you know. Help make sure you’re having a good water and take on my just say plant based either something that has really been studied as something that helps with just healthy lifestyles in general but particularly around erectile dysfunction that has at least slightly good data around that but no lake foods. I can say that. Hey this will certainly like help to keep you in good shape but i would try to minimize rudd needs junk foods and things like that all right now. We also have to talk about meds. So you know you’re you’re talking about lifestyle. You’re talking about cognitive behavioral therapy. You’re talking about minimizing anxieties. And all of these things are very important. Also talk about penis rings and overall health. What about medications. When is medication indicated. And what you prescribing. For erectile dysfunction and of course. I know you’re not giving anybody listening or prescription. But what is out there. And how do we know they got the question. I get on instagram all the time. How do i know if it’s psychological or medical and you sort of answered that you know if psychological. It’s a bit of a diagnosis of exclusion. You wanna rule out these other possibilities by to- what are you doing in office to figure that out or in clinic and one thing. I kind of slightly mentioned de even kind of another category. And i didn’t include one of the big things. We have to rule out our low testosterone issues. And so i mean drone is a really has a huge impact on the quality of your erections and so when we’re thinking about organic causes it’s actually even in our kind of society guidelines. You have to rule out that las strong you know isn’t app play. Starting medications are really kind of doctor. Patient discussion my do have some patients who don’t wanna take any medications right which is okay. I think our job here is not necessarily bro prescription at them. Which good evidence. And i’ll talk a little bit about the medication reused but the information is there. We know that works. I think i have some people that are a little bit more motivated to start with the behavioral modifications to see if there’s an effect before they start taking a medication. There really isn’t a right or wrong. Answer i will say probably for the seventy year old person that has diabetes hypertension heart failure in a multitude of issues. Lifestyle alone is probably not going to be the thing that puts them over the edge but for my younger guys who really have no other major identifiable medical issues where we can kind of cash this before it gets worse. They’re probably going to seek more benefit but at any point along the spectrum of where you are lifestyle. Changes have been a help medication. I think if it’s bothersome enough to somebody where they’re saying.

00:25:00 – 00:30:00

Hey i’ve tried. Everything is impacting my quality of life. I think that’s usually when that button is turned by. Hey i need something more. I think a lot of guys are really resistant to it. A record a really associated with this some sense of manliness and whether or not partners or society contributed to it but it can be troublesome even started medication. because then you’re admitting. I have a problem or i have something that’s defunct that wasn’t always the case. And so it’s really sensitive discussions around it but i do think that if one we’ve identified organic causes you had your diabetic or your blood. Pressure is through the roof. We know that there’s some underlying issue at play. And i think it has to be addressed really. The oscar. category of medications for erectile dysfunction are what we call on. pd five inhibitors. Phosphor diastrous inhibitors. And that basically plays on a part of the cascade of molecules that are played when you have direction and so it helps to prolong that. Everyone has seen a biogra- commercial. I think in twenty twenty one at this point. Biographer is part of that class of medications as cialis. You know avi trez inaugura medication. That’s also falls into that category and these are things that we commonly on start our guidelines actually changed within the last year or two. And i’d say most people will start off with medications and then there’s some other things that we can do that increasingly more invasive to address erectile dysfunction but certainly to start off with medications with a pill that you take cialis that particular medication is something that you can actually take on a low dose daily to help with erections by across a little bit more short acting. And you have to take that right before sex with some caveats again effect. Something that you have to do. Certainly your urologist should be guiding you into like the proper administration of these medications but everything works differently for people you know some guys may try one works great or even though they’re all within the same drug class some work better than others i would say most urologist would at least try at least to drugs within that medication class before we think about anything more invasive but they work they were pretty. Well i’d say in most guys that took the general class of medication so it’s Something that we certainly discussed early on. Do you find that those meds work for people who are highly anxious like who have you know a really really stressed out. They’ve created that negative feedback loop where they’re afraid they’re gonna lose their reaction and so that causes them to lose. Their erection can meds help in that case yet. Great question can actually. Because i think you find that if you at least can you know get a few settings or you know a few wins where you build your confidence back up. I think if you have something that’s kind of working in the background that can really help. So yeah that’s an excellent question. I think that’s a pretty common technique that we discuss with our with. Our patients is a hey. This can be really distressing but if we can just have you to have a few good runs where you’re just like i got this then. I think they’ll find that they may not even need it right. You know and i would say really for the super healthy person at otherwise. There is really no obvious reason. I think that’s a great way on top of kind of behavioral and you know adjusting relationship dynamics. That’s a great way to really kind of get people back in the saddle so to speak and builder confidence backup. You know something you brought up by. A couple of times is distress. And whether or not a patient finds something bothersome. And that takes me kind of right. Back to the beginning with the question around while i ejaculate really quickly and i’m not quite hard something i always want to start with. Is you know how do you feel about that right. I mean if they’re writing me i’m in. This person. provide some context. It’s problematic for them. But it’s not inherently problematic right so with all of these things like for example and this is what brings me to the clitoris. Clitoris also gets directions. But nobody really knows if my clitoris is erect internally. I don’t even know. I might feel some pressure. You might feel that the shaft feels a little bit more ball g through the forest skin. A partner is never going to know and so it’s just not associated with the same distress but we’ve created a culture in which sex means one specific thing and i’m not saying that that’s the case in with regard xin who wrote in because even the language they used was so specific like they counted oral sex they called. Pnv sex something else. But i think that’s another piece that you know a big part of our work is reframing sex to know that it’s not dependent upon your erection right like if it feels really good to get a little bit hard and a jackie quickly as opposed to prematurely like if you jackie late quickly and feels good for you and then there’s something else you can do with a partner that feels really really good using your hands or your mouth or a toy or a tongue or an album or whatever you’ve got Or strap on that may work for some people. I think that’s a harder thing to overcome right. I think that it’s sometimes it feels easier to take a pill. I think it’s very interesting that you’re saying that your patients sort of see medication as a last resort. Because i think i would have assumed that so many people just want pill like they wanna fix it. They don’t wanna do mindfulness. They don’t wanna just their diet.

00:30:00 – 00:35:01

They don’t wanna just their lifestyle so that’s interesting. I didn’t understand that perspective. It’s tied to variety. Right if i take this pill am i as much of a man and i’m wondering brandon like because you’ve got you’ve got a penis and you get erections. Poke me with them. Sometimes what your associations are in terms of like versatility and manliness and erections. I think that the idea of not being able to have an erection would definitely challenge my my sense of kind of amusing. Air quotes your. I think we have to work on reframing that but it would certainly the times where i have had moments where i get in my head. I’m notorious for getting my own head for any reason under the sun. So i have this loop where if something does feel off. I start questioning. Something wrong is something wrong. Is there a bigger issue bigger. And like going through that loop when you’re having sex or being intimate with your partner is really and then it’s you talked about this cascading effect. I’ve just been sitting here listening. And absorbing yup yup yup and i hear everything so i’m kind of getting away for your question. Yeah not getting an erection would certainly make me feel less of a again. I know that this is incorrect. But less of a man. I would have assumed that most people would just want to take a pill because it’s really quick fix. I love the idea of really analyzing what are the underlying issues. And can you work through this without some of those other medications or procedures. Because i think for me. I love the idea of being able to fix the problem on my own and then i think if i can fix the problem my own and i loved your comment about. You just need a few wins. Because i liked that. I think that that you get a couple of wins under belt and then for me i could think confidence up feeling good. I got this and then boom onto the next so yeah no but it’s there’s a lot to unpack here. I’ve just been listening and learning and absorbing and nodding my head the whole time. Because you know dr denise So much to take over this. There’s just so much you know it’s interesting because the last few weeks doctors we’ve been talking about swinging and some answering some other questions not swinging. Sorry the lifestyle. And threesomes and i also talk a lot about consensual non monogamy. And when i did more work with swingers would go down south and do workshops. That was something that came up with. A lot of folks with penises that they’re so excited for their first racism or they’re so excited for their first group experience and they think it is going to be you know the most mind blowing euphoric experience of ecstasy and then their body doesn’t respond in the way that their body usually response right. I thought you were going to say something else that i received their body responses that are being attacked by a bear and doctors and he said the blood flow does not exactly. That’s exactly eh. The body they’re nervous. They’re anxious they’re excited. And so finding that line between how much anxiety you can handle and it’s different for everybody because a lot of us you know. We need anxiety to be excited to perform at our optimal but like the degree of anxiety. That i need is different than say what brandon needs like. I need a lot of challenge to be excited. Brennan doesn’t need as much challenge. Said say it’s not that. I don’t need as much challenge in an intimate environment. I need to be relaxed. I need i need to be totally in that mindset of just being relaxed whereas just like you said i can take an early but yet you figure that out brandon like you know you’ve reflected upon it and you’re like well how do i just my breath. How do i ask for what i need from my partner. How do i touch myself. What kinds of touch do i like. Where do i like to be touched. Where do i like my mind to go. What fantasies can i access. All of these things like those are just five strategies that relax you and we haven’t even started talking about lifestyle so you might find that you’re more relaxed when you turn your phone off earlier in the evening and you’re not on the line with clients you might find you’re more relaxed when you set boundaries with family. You might find that you’re more relaxed when you do things to facilitate a good night’s sleep you might find that you’re more relaxed when you eat a home cooked meal versus take all of these different things go hand in hand and you figure that out for yourself so those must be explorations. You have with your patients to help them understand that like those things. Were relaxed brandon. That might stress. Someone else at bray and i just wanted to say i love the fact that you mentioned reframing how we think about sex how we think about iraq shows because i do think that everyone has in their mind again these blowing settings at i think everyone is adding and one of the first things i say is that you know ninety. Five percent of people are not what you’re gonna see in their porno right. It’s just like you are not going to have a forty five minute rush in. You are not going to be fleeing from the chandeliers. Potentially i mean. I think really reframing that is so important and i think it’s very individualized you know. I mean no some couples. What are seen as being pleasurable or something.

00:35:01 – 00:39:57

That really relaxes enhances. Things are so different. And so i think for guys that partners or in some kind of partnership is just like a team effort right where your first analyzing how am i most relaxed. What are really good What’s really going to optimize. What i seek as pleasure and the senate and that’s different for everyone and i think it’s also okay. If you’re not having sex five times a day you know and i just think that. What people’s expectations are i think. Resetting that is so important. What works for one couple is not gonna work for another. We’re just trying to optimize. What does work for. You know a particular couple and optimizing that. But i’m so many thinking about these benchmarks that we feel that we have to hit to her pleasure and that’s just not the case. Yeah absolutely and you know the fact that you started with the statistic that fifty percent of folks over fifty experience erectile dysfunction. I think that’s just such an important normalizing peace right. And sometimes i forget the language use. Sometimes it’s just situational and sometimes it’s chronic but it’s normal and it’s not the end of the world You know last week. We were answering questions from a partner who was dealing with the way their partner responded in terms of erection so this time it’s from the perspective of somebody who gets her doesn’t get erections that we can personalize that and so the more we have these conversations. The better i think were the medical community is so lucky to have folks like you. I just reading your resume. I think the fact that you also have that public health background really helps to take a holistic approach and not just write a prescription and say here take to you. Call me in the morning or don’t call me because you won’t need me anymore. So really really appreciate it any last thoughts on ed or reassuring folks who are struggling with erections either at times or more regularly. I encourage people to talk about it. I think you know now that i think people are appreciating that this is not just you know a disease of an old man or something that talk about it a really encourage more people to have these discussions. You know the only way you can address a problem. One admitting you have one potentially and i think so many people suffering silence so i actually really excited when people come in and it’s just like i’ve been struggling with this for five years. I finally basically reached my breaking point. And i wanted to see you and it’s like better late than never you know correspond years ago. It started great time to come in. And i think our goal now is to have people thinking about. Let’s address a sooner rather than later rather than suffering in silence for years or using other modalities of addressing and on their own without just having someone actually say. Hey we could start off with x. y. z. So something for the listeners. Please if you are going to vary commonly you know. There’s lots of things at gas stations and other random places that traumas that they will give you a good erection. These things often contain usually coffee or caffeine of some kind. But just these weird cocktails right and it’s just like that’s not what we should be doing like this is just like you would address. Your hypertension erectile dysfunction deserves that same and that same level of importance from providers. I think of someone who focuses on this. I recognize that a lot of providers. Don’t ask about it. It’s awkward for them to even talk about it so it doesn’t come up but i’m really encouraged guys out there. If you think that there’s an issue talked doctor about it. If doctor thinks it’s an awkward conversation find a urologist to of specialize in it. Some don’t but any urologist i think can at least do a basic workup addressing erectile dysfunction but please please suffering silence. It’s too important everyone You know this big quality of life. Issue and i’m really determined to be not just some kind of get the word out so that people do realize that it’s normal and under something you can do about it. Thank you so much for that. Absolutely folks get checked folks can follow along with. Dr denise will make sure we link her handle in in the show notes but it’s denise underscore dock like double d but we’ll make sure we link it there and folks can perhaps see you in chicago starting a couple of months but do follow along because there’s a lot of info on your instagram as well. Thank you so much for joining us. Thank you for sharing those insights. I hope you inspire people to go get their checkup and also just start talking about it and thank you for joining us for this conversation. All about boehner’s more. Don’t forget to enter to win. The we touched by writing review or sharing on social. And make sure you email info at sex with dr jeff dot com so we can make sure you get entered and of course if. You’re looking for some vibrating or non vibrating goodies. We’ve got some really great sales going on over at love. Honey dot com so do check them out and use code. Dr jess ten to save a little extra before that sale is over. Thanks folks will see and hear from you next week. You’re listening to the sex with dr jazz podcast. Improve your sex life improve your life.