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Sex with Dr. Jess


April 29, 2022

Sexual Health Qs Answered: Erections, Orgasms, Hormones & More!

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Board – certified urologist; Dr. Joshua Gonzalez joins us to answer your sexual health questions.

  • What can I do about ED? Are there natural treatment options for someone on blood pressure meds?
  • How can I deal with Interstitial Cystitis?
  • What can I do about vaginal atrophy, itchiness, and irritation?
  • Should I be worried that one testicle pulls up into my body at orgasm?
  • Can I speed up my orgasm? I have delayed ejaculation.
  • What can I do to improve the taste of my ejaculate?

Our guest, Dr. Josh Gonzalez is fellowship-trained in Sexual Medicine and specializes in the management of sexual dysfunctions. He completed his medical education at Columbia University and his urological residency at the Mount Sinai Medical Center. Throughout his career, Dr. Gonzalez has focused on advocating for sexual health and by; providing improved healthcare to the LGBTQ+ community. You can follow Dr. Gonzalez on his social media accounts from his Twitter to his Instagram.

He also; recently started a men’s health supplement focusing on enhancing ejaculatory volume and taste, POPSTAR – check it out!

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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.

Sexual Health Qs Answered: Erections, Orgasms, Hormones & More!

Participant #1:
You’re listening to the Sex with Dr. Jess podcast, sex and relationship advice you can use tonight. Welcome to the Sex with Dr. Jess Podcast. I’m your cohost, Brandon. We’re here with my always lovely other half, Dr. Jess feeling extra lovely because I’m thinking about penises and vaginas and balls and all of your sexual health questions. We are going to be answering them today with sexual medicine urologist doctor Josh Gonzalez. We’re going to find out where your balls go when you orgasm. If you’ve been wondering, that’s a great question. You know what? You should have led with that. Where do your balls go when you orgasm? Well, we’re going to find out because Dr. Josh is here. And before we invite him on, I just want to announce that I’ve got a new sponsor that I’m really excited about because this is a sponsor that I’ve worked with in other capacities. But now we’ve got an even better discount code for you because these premium toys don’t generally go on the deep sales. But is offering 15% off with code. Dr. Jess, Dr. J-E-S-S. They keep it simple. And if you don’t know about Womanizer, they are a sex toy brand that revolutionized the sex toy space. There was nothing like it on the market when they broke into it. And actually, it comes from Germany. They are based in Berlin. I was just there doing some work with them. What were you there for? Thanks, Charles. I was there for a female rap camp. So it was a bunch of female rappers with Warner Music creating music over the course of this week. It was so cool. The Soho House in Berlin, and Womanizer was one of the sponsors. So they do a lot of stuff supporting women in business. And I did a little talk for the rappers, and it was super fun because the energy in that room was just kind of on another level, like they were creating all week. They were young, obviously. There was a range of ages. The women came from all over the world. And I got to go to the Womanizer’s offices in Berlin and tour and see all the cool stuff that they are creating. Like they’ve got a lab with the prototypes. They’ve got the things that they’re building molds with. I don’t want to say too much because I’m sure it’s super proprietary, but Womanizer is pleasure air technology. Womanizer is an orgasm in the palm of your hand. Womanizer is the toy that I have long recommended since they broke onto the scene to clients who have never had an orgasm, who have difficulty orgasming, who haven’t had an orgasm since their postpartum, who are struggling with orgasm during perimenopause or postmenopause, or who just freaking like orgasms because it’s really cool technology. So it’s a little kind of opening that fits around the head of the clitoris. Tiny changes in air pressure create the most unique sensation of any sex toy. It is a cross between sucking, licking, flicking, pulsing. It is and vibing. It is like just the coolest sensation. They created the technology, they patented the technology. I know there are other brands doing similar things, but they are the ones that really pioneered it. And it was because this guy, an inventor in Berlin, heard that women are far more likely to orgasm from oral than from penetrative sex. Big light bulb went off. I mean, all of us with clitoris, as we already knew this. But he set off to create a toy that would sort of mimic or even improve on oral. And he started with a fish tank pump. And I can’t just imagine this guy with the pump and practicing on his partner. Hey, baby, tonight we’re going to try something new. Sorry, Goldfish, I mean, listen, clearly it worked out, but interesting backstory, right? Really cool. Anyhow, they’ve built all these different models so you can get 15% off, which is very, very with Code Doctor Jess. And there are many to choose from. Many of them are actually on sale already, so go check them out. If you don’t know where to start, I’m going to give you a couple of tips. If you like to travel and carry your toys with you, I recommend the Womanizer Liberty because it’s got a little case. Okay, so that’s what I carry. If you are brand new to the technology and you’re not really sure about it and you want to save a little bit, the starlet is on sale. Plus you can use the discount code if you know that you want to try the technology and you just want the best of the best. You’ve got the premium two, which is the brand new model that has smart silence technology, meaning you turn it on and it stays in standby by mode until it touches your skin. It’s got the autopilot mode so you don’t have to think about it so that you can check out the premium too. Also, the premium is also on sale, so you can check that out. And then finally, if you want it all, if you are greedy and you like internal stimulation, bulbus stimulation against the GZone. Plus you want this Pleasure air technology externally against the clip, you can check out the duo or actually the Inside out is also on sale. But I’m a personal fan of the duo. It does look a little bit like a spaceship, but it’s super cool, very overwhelming. Leads to quick orgasms, if that’s what you’re kind of into. And again, it’s Code Doctor Jess. I always had to laugh because you had a client once come to me and say after using one of their toys, said to me that they felt guilty because they orgasmed too quickly. It was too easy. I felt like it shouldn’t have happened that fast. They were like, I just felt like I should do it again. That’s what I go ahead. Go for it. Go ahead and have multiple so happy women’s reviews on board. So excited and had a great time in Berlin with them. All right. Now it is time to welcome our guest and get to your sexual health questions.

Dr. Joshua Gonzalez is a board certified urologist who is fellowship trained in sexual medicine. He specializes in the management of sexual dysfunctions, completed his medical education at Columbia and his urological residency at Mount Sinai Medical Center. Throughout his career, Dr. Gonzalez has focused on advocating for sexual health and providing improved health care to the LGBTQ plus community. He is also an Astroglide ambassador, as am I. And he recently started a Men’s health supplement focusing on enhancing ejaculatory, volume and taste that is called pop star. Super excited to have Dr. Gonzalez here with us to answer a bunch of your questions. Thanks so much for being here. Yeah. Thanks for having me back. I appreciate it. I am curious. So we spoke sort of near the beginning of the pandemic. And because you deal so much with sexual dysfunction, I’m curious if you’ve seen any shifts or trends or any changes throughout the course of this very difficult and transitionary period. Yeah. I mean, I think it’s interesting. I definitely saw a lot of people who had been treating for a while coming back and kind of complaining of their symptoms coming back. So I saw a lot of patients coming in reporting decreased libido, suddenly having problems with erections or increased performance anxiety, and a lot of times not understanding why. And so I really tried to ground it, what was happening in the world around that. I mean, obviously, 2020 was an incredibly stressful year, not just because of the pandemic, but sort of sociopolitically. There was a lot going on and helping patients understand that, of course, what’s going on around you is going to affect sort of how you see yourself as a sexual person, how you see yourself in a relationship with a sexual partner. And it’s going to kind of creep in there even if you think you’ve got everything under control. So trying to kind of help patients understand that it’s almost expected that that kind of stuff is going to carry over into the bedroom was a really important, I think, service that I provided patients during the really stressful time and would definitely make sure that there wasn’t anything new physically going on. But many of those patients just kind of needed some encouragement and years to essentially listen to what’s going on, what was going on with them. That makes sense. And I would think from just the psychological or emotional perspective, the reassurance that, hey, this is normal, this is happening to other people might be enough to kind of address those secondary emotions. Right. Like, you have the first emotion, which is like, oh, I’m upset that this is happening, but then you get upset, you upset. It yourself for being upset or you get hard on yourself for not functioning or performing in the way that you have become accustomed to. So I’m so glad you’re facilitating these conversations. We know that physicians who work with the genitals oftentimes still refuse to talk about sexual functioning. And I know that that’s shifting with kind of, I think, the next generation. But so glad you’re here because we have a bunch of questions related to sexual health and hoping you can help us out with those. Let’s start with one about the testicles, because I like to talk about the balls. Me, too. This person says sometimes when I orgasm and ejaculate, it feels like one of my balls is being pushed up into my groin, into my stomach, even though I’m not actually putting any physical pressure on it. Why might this happen? And is there a cause for concern or anything I can do about it? So it doesn’t sound like any kind of a serious problem. So I would say off the bat, it doesn’t sound like a concerning issue. I would definitely want to make sure or ask this person how long this has been going on. Right.

This is like a new phenomenon. His balls were stayed at one level during orgasm for most of his life, and now suddenly one or both are kind of retracting and becoming uncomfortable during orgasm. Or has this been going on his whole life? And both. We see both of these situations in which it’s either a lifelong problem or sort of a new acquired issue. Oftentimes men who have the lifelong version may have had testicles that had not fully descended when they were a baby. Sometimes they had to have surgeries to kind of bring them down so that the testicle could develop properly. And in those cases, they will sometimes develop scar tissue that kind of naturally pull the testicles closer to the body. And part of the sexual experience and the physiology as we approach orgasm is that the testicles kind of are retracted closer to the body. Right. That happens to everybody. So if you’re kind of starting from a hyper retracted state to begin with, when that process happens during sexual arousal and as we approach orgasm, it’s going to become uncomfortable for some people. There is the other version where they had a period of their life in which this did not occur. And suddenly it’s starting to happen. And sometimes it’s unilateral, meaning it’s on one side more than the other. And oftentimes what we see in those cases is patients have developed some sort of myofascial or muscle and connective tissue restriction on that particular site. And that can be from working out too much and really stressing their core, which then has effects on the pelvic floor and pelvic muscles. It can be from some sort of physical trauma related to a bike accident. I mean, there’s lots of different things that can cause strain on the muscles and connective tissue in that area. And when there is asymmetry in that tension, then you can get pulling on one side more than the other, and that can cause discomfort during the sexual experience. Okay. And so I would assume you would recommend they see a pelvic floor physiotherapist for those muscular issues. Yes. So I would definitely examine them, make sure that there’s nothing inherently wrong with the testicle itself, that there’s not any pain with palpation, and often their exam is totally normal. And in those cases, yes, I typically will work for them to have a pelvic floor physical therapist. Okay, great. Thank you for that. Yes. Okay. So switching gears, we have some general questions about interstitial cystitis, and you can correct my pronunciation. Oh, that was great. There we go. Can you tell us what it is, what the symptoms are and what is the treatment? So interstitial cystitis, often referred to as. I see, because it’s hard to say that word is what we call a diagnosis of exclusion. Right. So it’s in urology. It’s a diagnosis that is given to people with like a confluence of symptoms that we can’t explain with another medical condition. Right. So off the bat to me, I see it a little bit problematic for that reason because there’s not any well established criteria or even symptomatology that we use to give people this diagnosis. It’s just a bunch of different symptoms that can present in many different ways. And when we can’t explain it through another medical condition, people are given a diagnosis. So the symptoms are often UTI like symptoms. So frequency, urgency, burning with urination, urethral burning even outside of urination, bladder pressure, pelvic pain, cramping, spasming, pain with sex. And you can get any kind of combination of those symptoms. And the severity can be mild to debilitating. There is an overwhelming number of women that are given this diagnosis. It’s almost always women that are given this diagnosis. And to me, that’s also kind of a bit of a red flag because there’s not very many medical conditions in which it’s so skewed towards one sex. Right. And women are often given this diagnosis when they complain of these things. And people don’t know how to necessarily do proper exams or do lab tests to look at things like hormones or try to figure out why they may suddenly have this issue. And so in my experience, I’ve seen, I would say probably greater than 90% of women given this diagnosis are found to not actually have an inherent bladder problem, but have a combination of a hormonal issue and often a pelvic floor muscle problem. And it’s really unfortunate because a lot of these women will spend years getting bladder installations, going on medications that can be somewhat toxic to the body, really restricting what they eat and drink because they’re told that it’s going to aggravate their bladder symptoms and living this sort of like miserable life. And oftentimes they’ll end up in my office. They’ll be perimenopausal or menopausal or even younger women who are on birth control can kind of develop hormonal issues that can present like this. And so we’ll do blood tests, and I’ll do an exam and send them to a physical therapist and correct their hormonal issues. And a lot of times their bladder symptoms or their IC symptoms go away completely. So I’m sure there are a subset of patients that actually have true IC, which is an inherent bladder issue, but it’s a grossly overdiagnosed condition. And the majority of the patients that I have seen actually get better with treatments that don’t focus on the bladder at all. All right. So they need to be advocating for themselves if their doctors aren’t ordering those blood tests, if they’re not seeing a pelvic floor physiotherapist. And the reason I ask about IC so glad I can now call it that and not have to pronounce it is because obviously these bladder issues interfere with so many elements related to sex, whether it’s arousal or pain or tightness. I’ve seen it kind of comorbidities with vaginismus.

So feeling as though you can’t actually put anything into the vaginal canal, frustration, loss of libido, inability to orgasm, feeling as though you have to pee during sex, which can make it I know for some people that’s hot, but for other people, that can be very uncomfortable and burning sensations as well. So I’m glad that even though you can’t test for IC, you can test for related issues that could be misdiagnosed as IC. Is that correct? Yes, I would agree with that. And I think part of the advocacy that patients should do on their own part is if you’re not getting better, if you’ve been given this diagnosis and you’re not getting better with the treatments that are primarily used to treat IC, then it might be time to think of another diagnosis. And that’s something that I have to tell patients a lot of sense because for whatever reason, and I think it’s probably because many of these people spend so many years not knowing what’s wrong with them when they’re given the diagnosis. If I see they hold on to it. And so then they get in my office and I tell them, actually don’t think that you have this problem. And sometimes they’re relieved. Oh, thank God it’s not that because there’s a lot of things online about IC that can make people spin out and sort of lose hope. So some of them are really grateful, and others are actually have a really hard time letting go of the diagnosis because it’s become part of their identity. And so they’re like, well, that’s impossible. I have to have IC. And what I tell them is exactly what I just said is, well, in my mind, if you have this problem, shouldn’t you have gotten better with the treatments that we use to treat this issue? And you’re not because you’re sitting in my office. So let’s just imagine for 1 second that it could be something else. Why don’t we try something else and see if it helps you? Okay. Awesome. So we have another question here from somebody about Ed. Is there anything natural that can be done for Ed without medication? My partner has diabetes and cardiovascular disease, so he’s on meds for blood pressure. He’s not in the mood, has trouble getting an erection, and is upset about it. So, yes, there’s definitely things that can be done in this particular case. What I would say is if a person has those comorbidities, specifically cardiovascular risk factors, diabetes, those are all risk factors for having not only sexual dysfunction, but things like low testosterone and erectile dysfunction specifically. So he sounds kind of like a set up for someone who would have low T. I would probably start by investigating that. And there’s a lot of misinformation out there about the safety of testosterone replacement therapy and cardiovascular risk. So just because he has a cardiovascular history does not mean that he cannot be on testosterone replacement therapy. In fact, there’s like 70 plus years of data showing decreased cardiovascular risk in patients who are on testosterone replacement therapy. So he actually would be a very good candidate in my mind, knowing what little I know about him for a testosterone replacement therapy program, he could also consider using medications that specifically work on low, meaning that his cardiologist would be okay with that. Things like Viagra Cialis. Those can be taken either daily or on demand if the person or their doctor doesn’t feel comfortable using sort of prescribed medications. You could consider certain supplements. There’s not a robust medical literature out there showing improvements in sexual function with specific supplements. But things actually some of the stuff that we have in pop star, things like zinc arginine, have both been associated with improvements in male sexual function. So you could look into using those sort of more natural remedies to help with this issue. =

Should he be checking with his doctor if he’s on the blood pressure meds before he takes any supplements? Yes. So anytime. And that’s a blanket statement that we have not only pop star, but just basically any supplement. You should think of it as a medicine, even though people think of it as more natural and that you can get it over the counter. You want to make sure that none of the ingredients are going to interfere with medications that are already prescribed. So any time you take this opinion, you should definitely run it by your doctor to make sure there’s not a contraindication, because sometimes certain ingredients and supplements can interact with certain enzymes in the body that can either make your medications too high in your bloodstream or even sub therapeutic. So you want to double check with that? I have a question about testosterone and lifestyle. We always hear that if you exercise more, it can help with your T levels. Would that be relevant in a case like this, or would that be too minuscule of a potential increase in T levels? Yeah. For a person like this specifically, it’s tricky. And a lot of times it’s sort of a Catch 22 situation. Right. Because to build muscle, to decrease body fat, you need testosterone. Right. So patients will often get in this cycle where they have low T and they have these other comorbidities that kind of make it harder for them to exercise regularly. Right. He might have chest pain with exertion or something else that limits his ability to exercise. So you get into the cycle where if you have low C and you have these other things that prevent you from exercising so you can’t do the exercise but then increase your testosterone. So oftentimes what we will do is try to support patients with either testosterone replacement therapy or something else to help them boost their testosterone so that they can get going and get exercising. And then at some point in the future, they may be able to come off those treatments if they start to produce higher levels on their own. Okay. Interesting. And I just want to add into this conversation as well that you don’t always need to have an erection to enjoy sex. Of course, it’s totally fine to want to get an erection again and to want to work on erectile dysfunction. But also, I hope you are exploring other kind of pathways to pleasure, whether it’s with the hands, with toys, blue with your face, with anything you can get your body on because there are so many other ways to play, regardless of what your health status is. Okay. We have a few more questions here. The next one is about vaginal atrophy. So this person says they’re 67, they have vaginal atrophy. They are a type two diabetic and have vaginal dryness with bouts of itchiness and irritation. They have no yeast infection, no BV diagnosis. They haven’t had intercourse in two years and would like to. So it sounds like the person is a great candidate for some sort of hormonal treatment. Generally speaking, hormone replacement therapy is a program that involves replacement of systemic hormones that the body no longer makes once a woman enters menopause. Right. So I’m assuming this woman, being 67, she’s in the age range in which we can assume that she’s probably in menopause. How long she’s been in that state depends on when she started the menopause period. Generally, some physicians will refrain from putting women on HRT again because of some data that came out over 20 years ago that scared a lot of people about the safety of hormone replacement therapy. Most of that data has been reanalyzed and not really shown to be any less safe than people who are just not getting any hormone replacement therapy at all. But I think one thing that she’s a great candidate for that wouldn’t involve traditional HRT would just be something like vaginal estrogens, which involves putting estrogen in the vagina directly. And that’s a local acting therapy. So it doesn’t affect your blood levels. It’s not going to have systemic effects. But what it does is it sort of like give the genital tissues the hormone that it needs to continue to produce lubrication and not feel so dry and irritated all the time. And even women who have a history of breast cancer or family history of breast cancer can use these treatments safely and oftentimes can be life changing, can suddenly make things feel wetter, more pleasurable that can then have a positive impact on desire and increase initiation on the part of the person. Could you repeat the name of you said estradiol? Yes. So estradiol is essentially the primary estrogen in the female body. That’s what we replace in HRT. But you can get essentially like a vaginal cream that has estradiol in it, and you just place it intravaginally, usually daily for a couple of weeks. You just reduce it to like a couple of times a week. So it’s not even something that you necessarily have to do every day. And is that something you would go to your doctor for and get a prescription? Yes. So that is a prescribed medication, and you would want to talk to your doctor about sort of the risks and benefits of that treatment. But it’s a very safe treatment. Like I said, some doctors are a little hesitant to do anything hormonal because of some misguided information from two decades ago. But if it’s something that you really think that you would do well with, this is where the advocacy team can be really helpful, because if you look at the North American Menopause Society, it’s something that they do advocate for. So if your doctor seems unwilling to prescribe it, it may be worth getting a second opinion with somebody who kind of deals specifically in the management of menopause or sexual dysfunction. Okay, great. Yeah. So if this person says they haven’t had intercourse in two years, I’m hoping you’ve had other types of sex, perhaps playing externally. I talk about the womanizer toys all the time because they specifically focus on the head of the clitoris externally, which for many of us, that’s really all we need. Again, if you want to go back on the inside, that’s awesome, too. But don’t ignore all the fun external parts.

All right. So last question and I really want to talk about. Well, I have two questions. One relates to your product, but this person says unlike most guys who worry about premature ejaculation, I’m the opposite. I go on and on. I take over an hour to finish. Can I speed it up at all? Because my girlfriend says that longer isn’t always better. Yeah. So delayed ejaculation, that’s what we call that particular condition. It’s tricky because there are so many things that can be playing a part here. Right. So guys who may not have completely rigid directions will often have trouble ejaculating because they can’t stimulate the penis enough to cross that sort of threshold. So you’d want to make sure that the person’s erections are good. Sometimes it can be behavioral. I’m sure you deal with this more than I do, but I often will refer to sex therapists if I think that it’s something that they might be doing when they’re masturbating that they then cannot replicate with a partner. So it’s important to make sure that they’re working with someone on their masturbatory technique so that it more mimics what’s going on with their partner, because many times men who complain of delayed ejaculation will often report that it’s only an issue with their partner. And that’s kind of a clue that there may be some behavioral going on. It can be hormonal. So we’ll sometimes check people’s hormones, and then if their testosterone is low. Correcting. That can sometimes help with the issue. It can be neurochemical. So there are no FDA approved drugs for delayed ejaculation, but we use a lot of things off label that are known to sort of be proecidatory and result in increased dopamine or norepinephrine levels in the brain, which are sort of excitatory molecules. So we can sometimes use medications like that that kind of increase excitement to try to try to help with the late ejaculation. But it’s a bit of trial and error and kind of case dependent because, like I said, it could be a neurochemical problem, it could be a hormonal problem, or it could just be a behavioral issue. So kind of trying to distinguish between those is really important to figure out what the appropriate treatment for that particular person is. And do you run into folks who report this after starting on SSRIs? Because I see a lot of that when people start on antidepressants having difficulty ejaculating orgasming? Oh, yeah, absolutely. So it’s a big problem with those medications. There are some medications that we can use sometimes to offset that, or if the person and their provider are willing sometimes I’ll encourage them to discuss maybe going on a different antidepressant that may not have the same sexual side effects. Right. There are classes of antidepressants that specifically don’t have the same sexual side effects. Right. Like I remember. Exactly. Many clients have kind of done the switch and felt that the symptoms dissipate. Yeah. So SSRIs, which are the most prescribed, are kind of like the most notorious. It can happen with any of them. But sometimes switching from one SSRI to another will have less of an effect. For some people, medications like Wellbutrin, which is an SNRI, works differently, but it essentially works on the dopamine pathway. It’s a medication that we will often put people on in addition to their SSRI to kind of offset those effects. Or patients can consider switching to that as their primary antidepressant. And it should not have the same effects on Ejaculation. Yeah. And I was thinking about this person’s situation. There are ways to kind of speed it up. Sometimes you have to reach down and use your hands or you need to play with a vibrator. Some people are just not as sensitive. And there’s nothing wrong with that. Right. Like, for example, some people feel a lot when you touch their feet. Some people don’t feel anything at all. Some of us have very sensitive earlobes. Some of us feel almost nothing. And so it might be worth kind of exploring what else might also bring you to orgasm without pressure. Right. Whether it’s perhaps playing with the prostate or playing with the perineum or playing with your nipples or just exploring all these different options, I think can be helpful as well, just as a kind of holistic way of looking at it. Yeah. And it could be. Well, first, I want to correct something that I said. I said SNRI for Wellbutrin hidden. I think it’s an NDRI. So Norepinephrine and Dopamine. But yeah. So I think for someone like this, it’s going to be important to figure out whether or not this is something he’s always dealt with. Right. Or maybe it’s a partner thing. Right. Maybe he hasn’t communicated with his partner exactly what feels good and can’t get there with this particular person. And maybe it’s just as easy as having a conversation about, hey, this is the way you can touch me that’s really going to put me over the edge. So I see that a lot, too, where it’s like a new partner problem. And a lot of times that’s just talking it out is too. Yeah. Absolutely nothing like actually having a conversation. All right. Now, the reason I called you because I know we talked a little while ago, but the reason I called you is because I saw online that you have this relatively new supplement called Pop Star. And I got a question, a very kind of succinct question from someone who wants to know what can I do to make my ejaculate taste better? Because my wife complains about the taste. Now Pop Star affects both the taste and the volume. So tell us all about it. Yeah, I’m excited. So my partner, Brian Stechner, and I, more than two years ago, kind of were talking about this unmet need that people were coming in complaining of essentially low volume ejaculate initially. Right. And all of the studies that had done on ejaculate volume all are related to reproductive health. It’s a very important component of reproductive health. But there wasn’t really anything to address sort of the pleasurable aspect of sort of larger volume Ejaculates. Right. And we were getting a lot of patients initially, a lot of my patients who were gay were coming in saying that I’m getting a little bit older or I’ve noticed over the last few years that my ejaculate volume has decreases or anything, I can do it. There wasn’t really anything available. So as a side project, we kind of just started doing a ton of research and putting together a list of ingredients that we were pretty confident would increase volume. And at the same time, we thought, why not let’s just make a supplement that covers all aspects of ejaculatory health. So while we’re not really aiming at the reproductive market, we want to make sure that we’re including ingredients that have been shown to increase volume and help cement parameters.

And then, of course, there’s this taste issue, which initially we thought of as like, oh, wouldn’t it be fun if altered the taste? But then the more we ask people about it actually was kind of a concern or insecurity of theirs. And there’s all the jokes about, well, you can just eat pineapple, and that will affect the flavor. But the truth is you would have to eat, like, truckloads of pineapple for it to actually be concentrated enough to affect the flavor. So what we did, we actually included an extract from pineapple, which is called bromelain, and added that to the ingredient list with hopes that it would have a positive effect on flavor. And the feedback that we’re getting from patients, from customers who are purchasing the product has been really fantastic, far beyond what we expected. And people are reporting that they’re noticing within a few weeks, increased ejaculatory volume, a sweetening of the flavor. I mean, we haven’t gotten science down enough to specifically change the flavor to, say, cherry or green Apple or anything like that. But the goal here was to kind of sweeten the flavor because a lot of people who complain about the taste will report a sort of bitter taste. And we wanted to change that to something sweeter. So we’ve been really excited about it. We launched kind of early 2022, like December, January, and have been growing ever since. And we’re excited about the future of pop star, for sure. Love it so much. So just so people know the web address, it’s And of course, we’ll put that in the show notes. I’m curious about volume of ejaculate as it relates to pleasure. So is it that somebody might feel the orgasm differently if there’s more ejaculate load, or is it just that you like the idea of more ejaculate? I mean, just ask Brandon. Do you notice a difference in terms of ejaculate volume load? I do notice the difference. I mean, I notice that if we’re having sex more often, the volume is less. But I have to be honest, it’s not something that has ever I’ve really thought too much about other than perhaps the cleanup. Right. I’m wondering if straight versus buying gay men, if there’s, like, a different perception around this or concern. Is that something you’ve observed in your practice? As I mentioned, it definitely started as sort of a gay male centric complaint. But the more and because I’m gay, I see a lot of gay patients. Brian is Men’s Health Focus, but sees a much wider array of patients. And when he started asking his patients, he was seeing a lot of sort of older, straight identifying men. Also kind of reporting this as well. And to get to your question, yes, most men will report more intense orgasms with larger ejaculatory volume. So there’s that aspect of the pleasure. But there’s also just like the fun of having a bigger load that I think a lot of men and maybe this is somewhat influenced by our exposure to porn and seeing that all the time as these huge loads and us associating that with sort of more pleasurable sex. So I think it may be a bigger issue or a bigger concern in the gay or bisexual male group. But the more we’ve asked about it, the more interest we’ve actually gotten from patients who we wouldn’t necessarily think it would be an issue for. So I think it’s sort of an untapped problem. People have never really thought to talk to their doctor about it because they didn’t really think that there was much that they could do about it. You know what I’m curious about? I’m curious if a greater volume means that the contractions are themselves are more of a luminous like you have more contractions, or perhaps if you don’t have more contractions, they’re more intense. I doubt we have any data on that, but anything anecdotal. Yeah. So there’s definitely not any data that I’m aware of, but yes, to me it makes sense that you’re going to have more contractions if you have to expel larger volumes. Right. I mean, we’re talking about split seconds here, but any kind of extension of that sort of muscle contraction phase of orgasm, it’s going to heighten the intensity of that orgasm. Yeah. Sorry. For many of the women that I work with, they’ll keep the contractions going and going and going and going.

Like maybe you naturally without putting any effort into it. You have four or five contractions in an orgasm, but some of them kind of know how to contract their pelvic floor or touch in a certain way so that they can have contraction after contraction. Like they could have ten, they could have 20 if they keep going. They could have 30 or more if they want to. And it kind of prolongs the orgasmic experience. So I wonder if people with penises can do something similar. Yeah. I think in people with penises, the ejaculation and the orgasm are so they go hand in hand in most cases. Right. There are times or conditions in which they become uncoupled. But do I think generally folks with penises are not as aware of their pelvic muscles. But if you’re creating larger volumes and the body is inherently going to have to contract with either greater force or more frequency to expel a larger volume, but it would be a fun study to do. Just anecdotally I was going to say anecdotally from the porn that I’ve seen the people who have larger volumes that ejaculate certainly sound like they’re having a much better time, right? Oh, my God. I think anecdotally too. Like, if you have ever been in a situation in which you are abstaining from sex not for religious reasons or anything, but let’s say you just haven’t seen your partner in two weeks or you’ve been super busy and you haven’t masturbated like that first time you have sex again, your volume is usually a greater and it’s a much more intense experience than it would be if you were having sex every day. So that kind of validates kind of what we’re saying here. I would agree with that. I would. Absolutely. Very cool. All right. So,, Dr. Gonzalez, really appreciate you answering all of these questions because we need a lot of help with these medical questions and people can follow along with you. Again checking out and of course, we’ll put Dr. Josh Gonzalez’s links for his Instagram. His TikTok. You’ve got a big TikTok following now, don’t you? Yeah, we’re over 200,000. Oh, my goodness. It’s pretty exciting. Still dancing? Trying to yeah. I give the fans what they want. Thank you so much for being here. Yeah, of course. Thanks for having me. And thank you for hanging with us. Always appreciative that you decide to spend some time with us every week. And do not forget code doctor Jess 15% off all of those pleasure air toys doesn’t get better than that. Folks. Wherever you’re at have a great one. You’re listening to the sex with Dr. Jess podcast. Improve your sex life. Improve your life.