Best Of: Power to the Penis w/ Dr. Edward Karpman

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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. Totally different.

Totally different.

Orgasm in your head. Ejaculation is in your penis.

Look into his eyes. They're the eyes of a man obsessed by sex. Eyes that mock our sacred institutions. Bedroom eyes, they call them in a bygone day.

You're listening to Sex with Emily. I'm Dr. Emily and I'm here to help you prioritize your pleasure and liberate the conversation around sex. I'm joined by board certified urologist Dr. Edward Cartman to talk about the penis and how to be your healthiest self so you can have the sex life you deserve. We 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 how a penis implant actually works. Dr. Cartman also breaks down the pivotal role testosterone plays in your sex life, how his patients think about their penis size, and the benefits and drawbacks of pills that treat erectile dysfunction. All right. Intentions with Emily, join me in setting an intention for the show. What I mean by this is when you're listening, what do you want to get out of this episode? How could it help you when you state it more likely to make it happen? My intention is to give you a comprehensive look at all things penis related so you or the special penis in your life can have the great sex you want and enjoy. Oh, and Mother's Day, Please meet the sexiest Mother's Day gift guide you'll ever read. We've got cbd, bath salts, so many sex toys, and some really great discounts. So whether you're shopping for your mom or you're a mom shopping for herself, which I highly encourage, check out our website@sexwithemily.com for our list of curated gifts designed to delight and deliver pleasure. What are you going to get your mom? Have you thought about it? All right, if you want to ask me questions, call my brand new hotline. It's 559-TALK SEX. That's 559-825-5739. Just leave me your questions or message me sexwithemily.com askemily. As always, always include your name, your gender identity, location, age, and how you listen to the show. And one more thing, remember when you're listening to this episode, if there's something in here that resonates with you, I'll bet there's someone in your life that could also benefit from this knowledge. So start the conversation, share the episode with them. I've just heard from a lot of you who are listening together in a relationship or as friends. So I just want to encourage you to do that. All right, everybody, enjoy the show.

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 seem amazing.

Dr. Cartman. Now you'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 penises. 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, a renaissance for us, and we finally had a drug that could effectively treat erectile dysfunction. And we started talking about it. Remember, there were commercials for Viagra. Famous senators like Bob Dole 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 just talk about erectile dysfunction real quickly, because I think people sometimes get confused with what it might mean. So what is it? And how. Like, how would you define it? And how does it affect a person psychologically?

Well, it affects a person psychologically tremendously. Okay, let's just 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, well, if 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.

Involved a minute.

And in fact, that's a form of. 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. And this is a very devastating form of erectile dysfunction because it affects young men.

And how does it affect young men? What is it? Is it something that's genetic? Is it something else?

Well, it's just. It might be something that they acquired from, say, 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 give my patients is that imagine you had a faucet and you had a bucket, and someone said, hey, you gotta carry a bucket of water from the faucet over to that point B. Faucet 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 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, like, it's this umbrella of penis challenges. Like, it's just.

You can't get hard or you get hard, you can't stay hard, and it's a problem. And then sometimes there's pain involved.

It's a form of pain. I mean, 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. You know, those will contribute to erectile dysfunction. Expectations being inappropriate, you know, 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 it and fix it.

Just to make the distinction here that people with premature ejaculation, which is you come too quickly, you're hard, and then you're not hard very long. That could be more mental in many ways.

It can be. Exactly. And a perfect example is a guy who has a venous leak realizes he only 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. But there's other things that happen.

You're right. I don't want to miss. Minimize the whole process. Foreplay is important. The process.

Foreplay starts after last orgasm. I saw you notice my sign when you came in. Love it.

Love it.

So, yeah.

So I think that 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 and they develop another problem because they don't address their underlying problem.

Okay, so this venous leak thing is a new, 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, he might not know about the venous leak.

Well, no, urologists will know about it, but a lot of people.

Regular doctor. Regular doctor. Your general physician.

Yeah, you go into your doctor and if you're 20 or 30 years old and you say you 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 they're like, oh, yeah, maybe I'm just crazy, maybe it's all in my head. And they don't want to go anywhere else because they don't want to be embarrassed a second, third, fourth time by another doctor telling them 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 leak when they were young, but then when they turned 40, 50, and they already went through a ruined 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.

Well, 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, people 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 100% erection, like hard firmness.

Right.

Let's knock on the table. What does hard sound like? And then. 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. And then, and then out of nowhere, this thing just started 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 organic problem that out of the control of the guy. It has nothing to do with his head. He's into it. He's in the game. He wants to have sex without woman or man.

But that describes this sounds like most erectile dysfunction then is that you get hard and then you don't.

So the traditional garden variety. Garden variety eating is an arterial problem where a guy can't get a full erection.

So because of blood flow and yeah.

You don't need a full. You don't need 100% rigid erection to have sex, to have penetration.

Right.

You could have penetration with about 50% rigidity. So. And it doesn't go from 100 to 50% overnight. It goes from 100 to 95 to 90 to 85. So there's.

But the venous link is like hard and then soft.

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, walk me through A patient comes in, like a typical patient comes in. If you have a typical patient.

We don't. No, everyone's different. But I think that 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.

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 ejaculations going backwards into their bladder.

Right.

Or you have, you know, the guy, you know, who cannot. Can't understand why he can't get an erection or maintain an erection. The guy who has the crooked penis, I mean, there's no typical patient, so.

So a crooked penis. I get 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 psyched.

It all depends on your partner.

Depends on your partner. It depends on the things. But like, but Peyronie's is another. That's when it could start to get more painful for men.

Well, so any curve, most curves in the penis, I should say, are due to Peyronie's. 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 know, you're having sex doggy style, you hit that G spot. But what about the 90 degree left curve? And you're, you're hitting the woman's ovary every time you're having sex or just.

Has to kind of flip over on.

A side or something. Yeah. Could you imagine the position there?

Right, so that sort of problem. So, okay, so what about people who come in to see you, then they come into 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 a relationship and are preparing to be in a relationship, and they want this stuff all fixed before they get into a relationship, because this is what's holding them back.

Okay.

And they're, they're having some concerns that they meet the, 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 like, say a penile implant is around mid-60s, late-60s.

Okay.

You could use that as metric. But then you have young guys who are as early in their 20s who are having sexual dysfunction. My oldest man I ever put a penile implant in is 92 years old. Why do all these studies stop looking at sexual dysfunction after the age of 60 or 70? I don't know.

It's upsetting to me because I feel like people like, oh, our life. I've met a couple other day, they're like in their late 60s, and they asked what you. What do I do? Like oh, we don't need to have to talk about that anymore. I'm like, yes, you do. You can still have sex. I'm like, at 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. 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, you're like, oh, is my penis going to get bigger? Like, let's talk about implants. What that means your specialty.

So your specialty. So penal implants, first of all, 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 were putting in. They're not your grandfather's implants, 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 in a pen implant. So.

Okay, what is it? Okay, let's back up, though. What does that. Why. Who. Who was that patient? Why were they there? And then we need to understand.

So he was your garden variety guy.

Garden variety. How old was he?

Maybe pushing 70, 68. 70. Erectile dysfunction 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 erectile dysfunction. And he got to the point where other things just didn't work for him anymore and he needed a penile implant.

Okay, so then. Because then you put the penile implant in 17 minutes, and now what happens when he goes home?

So how does his life change? So it doesn't change immediately because we don't. We don't let them use it.

Quick fix.

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 imp. Like, let's explain it. So he's got the pump. He's got the. He's got the.

So let's back up.

He recovers. 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.

I'm so excited.

The malleable type.

All I've ever wanted.

Which are the bendable type. And this, what we're showing you here today is an inflatable 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 scrotum.

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 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 in 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.

They're in charge. So explain to me. So they're getting there 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 blowing. What does this remind me of? Like blowing up a ball or something.

Like a. Yeah, it's like a pump.

Like a bicycle pump or an air pump.

That's exactly what it is. It's like a bicycle pump.

Oh, this. Okay, this is it.

Okay, try this one. Try the real thing.

So this is the Right.

And again, it's not filled with water. So it works differently when it's filled with water, that's the reservoir and that goes into behind his 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 in 17 minutes you put this contraption into their penis.

Yes.

That's amazing.

Through a 1 inch incision. And, and then they have full recovery, full sexual function in three weeks. And this is covered by medicare. And in California, 95% of insurance plans cover penile impl sense.

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 and that's the beauty of it. So you know, the biggest concerns with a penile implant are infection rates. And if you look at national statistics, the implants now come coated with antibiotics. 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.

Right.

But I mean if you take, you know, if you look at high volume surgeons around the country, you know, 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% that people report. That's one of the biggest problems with a penile implant. You can have a mechanical breakdown like, you know, you might buy a brand new car but the transmission goes down in six months.

That happens. I'm not saying you're perfect, but you know, you've won the awards and stuff, you're the man in 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's working, right.

So first of all, Viagra doesn't work on everybody or it's equivalent.

I hate the pills that I don't know, I'm sort of 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 gotta take em 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. That's not the way we roll. So there's a lot of limitations of 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 flushing, they got muscle ache, all kinds of things. And if you don't get any of those things and, 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 have. It doesn't help everybody.

Right.

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, because no one talks about anything. Women don't understand about perimenopause 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, how's your diet? And a lot of people are on medication, so I'm like, well, if you're taking blood pressure or you have diabetes or there's all these factors, all these risks. Obviously, if your 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 understand what it might be?

I think it's to acknowledge you have a problem. That's the main thing.

It's acknowledging it. Yes.

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 compliant, she's fully lubricated and everything. All, you know, 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, you know, we say that's like shooting pool with rope, you know, yeah, you can do it, but it's not. You're not going to be very effective.

Right?

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 erectile 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. Where do you tell them to go? Like, Google it, find you? Obviously, we'll give them all your information.

You could you get a specialist? So there's 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 website.

Yep.

Edcure.org that has.

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, go find somebody.

It's kind of worth it, right? Men are obsessed with their penises and networking. I think if you got to travel a little bit, you got to do some research.

You do not go down the street to the first guy for surgery on your penis.

I believe this too. We're going to take a quick break, and when we come back, Dr. Cartman and I break down what testosterone does for your sex life.

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, 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, it's every biochemical step in an erection is testosterone dependent. And testosterone is extremely important for. For a man's libido. So libido is your drive. If you don't have an interest for sex, you're not gonna care about your erection.

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 your testosterone is low. So you need to have a healthy, normal testosterone level. And we know that men go through a manopause or andropause, whatever you want to call it. Yeah. And it starts as early as the age of 30. So women get to about 50, and their hormones, like, 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 goes through menopause, it's impressive.

I have another word, but, yeah, whatever.

Word you want to use. That's okay.

Interesting.

But for men. For men, we start losing testosterone as early as the age of 30. 30, and it goes down by about 1 to 2% per year, such that it kind of. 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. 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. Or I had a rough week, which is true, though. Kids are annoying me, you know, Like, 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 1 to 2% a year, that's 20, 30, or 40 to 60% of your testosterone is decline. And then 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, we made those up, right? Like, do you think, like, our bodies really believe that three hundred 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 the doctor says, oh, it's normal. See, 300 to a thousand is normal. So you're normal.

But I keep hearing people that all the time. I'm like, well, get another opinion.

Right? But I mean, maybe you lived 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 they'll look for any reason to deny you coverage for something like that. They'll say, ah, it's not under 300, we're not going to 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, and that's why I'm so glad that I, I love the service that my show provides because I realize that my listenership, well, it's 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. Like they could even go to their doctor and be like, yeah, things are fine. Like, right. What is this with men? Like, they're obsessed with their penises. I know, like the size and how they're performing. And it's a bit. And I understand it like evolutionarily speaking, like if your penis doesn't work or if men are going through depression, like, it's like, you know, they feel emasculated. They feel like they definitely don't want sex 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 to go to sex and I 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? 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 hate penis challenges is what I say.

I asked them how their wood is. I love it. I said, can you get it up.

That'S how I would do it.

Can you make her scream? Yeah. Is it. Is it satisfying? You know, I ask them simple questions like that. I always, I always advocate this to other urologists and they say, well, how do you talk to a patient about this? 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 or some other environment, we shut down, we don't talk. So I think you have to initiate that. And there's this thing called this interpersonal dilemma that we see in medicine that 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 hop, but when it comes to sex, we're like so puritanical and we don't talk about it.

I'm trying 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, is talk to them in a way that they can almost disarm them so they feel comfortable in the law.

I love it that you're like, how's the wood? Like, 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 flowing? And you'd turn down if you'd have. Do you masturbate? That's what I say to women. Have you masturbated? Touch yourself? Have you had an orgasm? Do you fantasize? But that's what you gotta do with men. I love that. Dr. Cartman, you're bringing it. You're just getting him to open up to you. You're doing important work. How did you decide in all of your. 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 happened?

It's interesting how we choose our specialties. And for me, I was gonna 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 that 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. Then I said, well, maybe I want to be a plastic surgeon, because I like the art part of it, the reconstructive 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 field. We don't have people dying. We're not like cancer doctors or heart doctors. People come to us for a quality of life condition that we can improve and we can make them happier. We change their quality of life. And it's not about a cancer doctor. Everyone in your practice ultimately dies. Right. But when in my practice, it's, you know, it's a lot of happiness.

You've given them more life.

So I get.

I get more joy.

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. It said A plus and she signed her name.

I love it. I was gonna ask him. That's amazing. What are 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.

Yeah. So some, it's. Some have to bring their partners in. Some are self motivated. Some spouses are very happy for what I did for their partners. Some spouses hate me for what I did to their part because, you know, there's always that discrepancy.

I was happy with the no sex. I get it.

Yeah. So she's a little older. Problem here, she's not on hormones, she's dry. It hurts a little bit when they're having penetrative intercourse. And. And she was kind of happy that he had erectile dysfunction. Now he's bionic and a superhero and she's still at the status quo.

And then what do you tell her to do? Where do you send her off to get her balance check?

Well, yeah, fortunately, like, we have a lot of people and resources in our community. And I talked to them about, you know, that the women's health initiative study, you know the one came out 18 years ago, it scared all women from taking hormones. And now 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, I get it.

And a lot of doctors, 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 new enhancements.

That's why I keep telling people, get another opinion. Look for bioidentical 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. Yeah, 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 lasers. Yep.

Yes. 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 then it makes even to say, like, I want to get my vag rejuvenated.

It's like, what do you like to do?

I don't know. Just like. Because I haven't. 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. It just. I don't know. I'd rather have it be like. I was gonna say like spring cleaning.

Well, that's better.

Like a little zhuzh. The vase jush.

I think if you have one partner who's fixed and the other one's not, it's gonna be a problem.

It is a problem. We kind of have to be on the journey together.

Yeah. There's a discrepancy in what level they're at. And I think 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.

Be right back after this quick word from our sponsors. When we come back, Dr. Cartman tells you how to find the right doctor for you.

Why would someone Go to a prosthetic urologist instead of a regular urologist. How do they get to you and.

How do they come. Now a prosthetic urologist is a board certified urologist who either has fellowship training in doing penile prosthesis or it's become a big part of their practice. It's something 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 gonna be good. And again, this is your penis, okay. This is not your thumb.

You don't mess around.

Yes.

Get your penis, like take, do some research, spend some time.

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 wanna 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 prosthetics. So it's not just any board certified.

It's like worth a plane ticket to.

Because it's your penis or a plane ticket.

Yeah, 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 penises. Like, why do you think that is?

The number one reason is embarrassment. And you know, guys just get embarrassed about it. The penis is, it's, it's. We're a phallocentric gender, okay. And you know, sex was, is very important. And I always tell people the most important system in the human body is the reproductive system, which the penis is part of. Right. The heart's 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, as a species. And so every living thing, its 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. And our society kind of humiliates men who are impotent because, like, you know, that word is it means more than just the medical term impotent. Okay. You're impotent. You just can't get it done, right?

Can't get anything done.

You can't get anything done. So when someone calls you impotent, it's like, I'm just a total loser.

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 its 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. That's why they have these problems. And men are internalized things. They. They hope things just float away and go away, and. And they don't. They heal themselves. The statistics are that 70% of health care decisions in a family are made by the woman.

Yeah, I was gonna say. That's why I pictured women dragging their partners into your office.

Yes, that happens. And we've. We've.

The men, they're like, I'll get better. I don't want to deal. I don't know. It's a weak sign of weakness.

Perhaps it is. But remember, like, so we. 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, go out, put his life on the 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 be. They have to be providers for their family in every which way possible. And I think it's just gonna 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. No money, one or 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?

You know, exactly what do you do? Right. Exactly.

You want to meet at the Pink's hot dog stand and.

Right.

I'll let you get it. Yeah, I'll let you get any topping you want.

Exactly right. That's what you do. But it's true. Men are like, I'm not ready to provide yet because there's all these, 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 want to talk about it, but they're embarrassed to talk about it. So they kind of mumble under their breath as they're 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.

Like, you out the door already. I was getting 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 talk about your penis. Right, Right. So that's what happens. But we, that's why I just want men to get curious. I think this is going to be very inspiring for men to know they could get an implant. There's other treatments, but with 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's put in and we teach them how to use it, it's operational, they're good to go. And you know, 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 almost.

Yeah, yeah.

Okay.

They're there to stay. And. And so unlike breast implants, you know, we had that scare with the liquid silicone breast implants that came off the market.

Yeah, that's what I'm saying. Like that.

So. So all penile implants are filled with saline. So there's a difference between formed silicone. So the breast implants are still made out of formed silicone. The shell is formed silicone. They stop using that liquid silicone inside as a filler.

Okay.

Penile implants are also made out of formed silicone and they're filled with saline. Saline is 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 or consequences for having a penile implant. That's another thing that people oftentimes ask me because they equate the two, because they've heard all the bad things about breast 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. You know, the studies that have been published quote a 92 to 95% patient satisfaction rate and a 90% partner satisfaction rate. And again, that's all comers, no pun intended. In my practice, you know, 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.

Yeah.

Yes. 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 a penile implant's there to give them a 12 inch penis.

Right. Well, this is, I'm so glad we're talking about this now because I know that so many men are like, yes, finally.

Yes.

Sorry, guys.

Penile 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 want to have triple Ds. You know, like, you know, porn star boobs. You can't, you can't do that. You can't say, I want a porn star penis. It doesn't work that way.

And we don't want that either from you men.

I, I think, I think men are.

More obsessed with that.

Yes, absolutely. Men would rather have a long, skinny penis than have a short, fat penis. But most, 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. 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 saying, whoa, look at John, he's hung and. But we're not. We're never looking. We're never looking. We're never looking.

Right? You're never looking. Yes.

We don't know. We don't look. We're not looking.

You know what's going on with John. Yeah.

So there. So guys are obsessed with size, although most women will. We should talk about size. That's a great, 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.

Results are, like I said, 99%. 99% happy once you get them over that teaching phase. Because no one's born with a pump in 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 and there's an off. Okay. 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, 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.

Which. Have you seen that video?

I've seen the video, but we should link to the video too. But yeah, we could watch it now that you're here. Like, I understand, 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 a 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, five to six inches.

Actually 5.55 and a quarter five and a quarter inches. So. And when you go every inch, you go up, you go up to 6 inches. You're around already in the 90th percentile of penile length. So you go up to 7 inches, you're like in the 98th percentile of penile length. You go up then any. Every inch increment above that you're down to like a fraction of a percent of. So like, when you get above 6 inch. And by the way, every guy comes into my office and I say, how big is your penis? And they're all six inches, which is not true.

Right. It's like men with their height, when they're really 5 10, they're like, I'm 5' 11.

I'll tell you what they do. So 2/3 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. 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, 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. We're talking about visible external penis. And the more weight you put on the. The more penis you lose. Because your abdominal wall starts growing away from. As your fat pad 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, three inches underneath that fat paddle. No one can see it.

Yeah, that's a good reason for men to get sleep. In these words, their penis will grow. Okay. So most of them think they're six inches, but you're like, sorry, 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 discrepancy in what they really have and what they think they have. And I'll give you an example. I had a guy once, came to see me. He had prostate cancer, operation, lost his erections, but he was able to get an erection by sticking a needle into his penis every time he wanted to have sex. That's what all the adult film stars do.

I know.

Yeah. And so guys out there. Yeah, well, that's. That's how they perform so well. Yeah, A lot of people think it's natural.

It's not natural. Porn is not real.

Yes.

Okay.

Anyway, so he. That's. But we use that as a treatment, as a medical treatment for some men who are willing to do that, who to stick a penis or a needle into their penis every time they have sex. So this Guy was arguing with me that he has a 6 inch penis. And there's this thing called a stretch test. So if you take a man's penis when it's flaccid, he grabbed 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. 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 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, it's 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 in the clinic. Let's see what you get. So I gave him a shot in the clinic, 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 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 2 inches.

Yep.

And so I know he only has 4 inches. In his mind, he's stuck that he has 6 inches somehow, and he's never gonna have 6 inches. And if I did his surgery, he would be a very unhappy patient and tell me that I stole two inches from his penis.

Yeah, that's so. So 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 dysmorphism.

It is. Body penis dysmorphia.

Penile dysmorphia.

Yes. Yeah. It's a thing so. For men coming in so obsessed with their penis, though. I just want to say, as 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, know how to pay attention to women.

It's not the size of the waves it's the motion in the ocean.

It's true, though. It is true. But you. Yeah, I mean, you see the other side of it, though. Can't you just say to that guy, doesn't matter, four or five, you're fine? No, I'm glad you got rid of that guy.

Yeah. I could spend a whole month telling him that. He still won't believe me. Yeah, 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.

You're not gonna change.

He's like this in all over his life, like at work and with his partner. He probably just thinks he's always right anyway. Dr. Edward Cartman with a K, K, a R, P, M A N. And they can find you@healthy-mail.com and then your Instagram wardcartmand.

We will put this all in the show. Notes facebook.com edwardcarpmanmdfacs we'll make it 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, you know, the importance of, you know, the quality of the relationship and the intimacy. Its 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. That's all that matters. And women are obsessed with the penis. And a guy with a big penis is everything.

That's all you want.

I was there too. I was fine.

Okay.

Most men start there, but it took a lot of training, a lot of years experience to realize that that's not the case exactly.

Good. Glad you've learned. Okay, what's your biggest turn on?

My biggest turn on is a person who lets me be who I want to be and doesn't try to change me, who's easy to get along with. To me, that is so hot and sexy. That is so hot and sexy.

Biggest turn off.

Somebody who's bossy, demanding. Number one sex tip, careful with woman on top. Why?

From like, a medical perspective?

Penile fracture, baby.

How much are penile fractures a problem? Do you hear a lot of it?

They're not a big problem, but it's devastating when it happened. So when.

What do we avoid with a woman on top then?

Well, you can still have sex with a woman on top, but you don't. 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. She hits her pubic bone against a fully rigid penis, a buckle will blow out and you'll get a penile fracture. Yeah, it's like taking like an. A water balloon that's fully full and then like trying to bend it. You know it's gonna happen, it's gonna rupture.

Oh, okay. Good to know. Warning. Warning. What is the most important personality trait in another person?

Kindness.

Kindness. All right, you did well there. Now I have so many 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.

That's it for today's episode. Thanks for listening to Sex with Emily. Be sure to, like, subscribe and give us a review. Wherever you listen to podcasts and share this with a friend or a partner, believe me, if you got something out of this episode, they will too. We release two to three episodes a week. Find me at Instagram, YouTube, Facebook, and Twitter. It's all.

If you'd like to ask me a question about sex or dating relationships, email me feedbackexwithemily.com or sexwithemily.com askemily and check out my website. We have so many great articles diving deep into topics like how do I have multiple orgasms? How do I last longer in bed? How do I stop thinking about my ex? What sex toy should I try? And so much more. Sign up for weekly email. I've been told I give really good emails. I do. Was it good for you? Email me feedbackexwithemily.com there's one overlooked mineral behind better sleep, sharper focus, stronger muscles, and a healthier heart. And at least half of us aren't getting enough. Most people don't realize they're running low on one of the most vital minerals for human health. Magnesium. And here's the thing. No single form of magnesium can deliver all of its benefits. That's exactly why Qualia Magnesium plus was created with 10 highly bioavailable forms of magnesium plus over 70 essential minerals. It provides total magnesium support, helping you sleep better, think clearer, move stronger, and feel your best every day. And honestly, when you're less stressed and more energized, your intimacy and desire naturally benefit too. Sure, magnesium can help you sleep, but Qualia Magnesium plus goes beyond that. It's a whole body nourishment for how you think, move, connect and feel. More than just a sleep supplement, it's a foundation for daily well being which absolutely supports a healthier sex life. Getting enough magnesium from food alone is harder than ever due to depleted soils and chronic stress and our body's reduced ability to absorb it as we age. Well, Qualia's Magnesium plus formula is non gmo, vegan, gluten free and designed so all the ingredients work together for comprehensive magnesium support. And personally, I've been taking Qualia Magnesium plus in the evenings and I really notice calmer nights and clear mornings and just just feeling more grounded in my body, which always makes intimacy feel more accessible and enjoyable. It's become such an easy part of my nightly routine. Experience the most trusted magnesium for your purity, potency and performance. Go to qualia life.comsexwithemily for 50% off. And here's a bonus use the code Sex with Emily for an additional 15 off your order. That's Q U A L I A life.com sexwithemily thanks for Qualia for sponsoring this episode.