It’s Just a Phallus, See? with Dr. Edward Karpman

Okay, so let's talk about one of my favorite ways to upgrade your solo or partner play. It is the Hera by Jiu. It's a sleek, powerful rabbit vibrator that's basically the best of both worlds. It's incredible for internal stimulation and those rumbly, mind blowing clitor vibes Jaejoo is known for. Here's what I love. The external ears are powered by the same motor as the Mimi which you've heard me rave about before. I love the Mimi. And the internal arm delivers deep, satisfying vibrations right to your G spot. It's super so soft, ultra quiet and it moves with your body. So whether you're using it solo or with a partner, it has this feel like it's made just for you. And honestly, it's kind of a no brainer. Everyone loves the hera and right now you can get 20 off the hera using code emily20@sexwithemily.com hera that's emily20 for 20 off at sexwithemily.com h e r A so if you've been looking for a toy that delivers powerful blended orgasm with thoughtful design and serious quality, this is it. So go treat yourself. You deserve it.

Erectile dysfunction does can occur in a 47 year old, but it doesn't happen that rapidly. I mean, it can, but it's not common. Usually it's more of an insidious process that kind of sneaks up on you over time. I would ask you to look at your life, your stress levels. Something we don't talk a lot about is the effect that stress has on our erection. So we have this thing called a fight or flight response. And this is something you learn in like basic physiology is like we were designed so when the saber toothed tiger is chasing you, what you do is it's not a good time to have an erection or have babies or do unnecessary things like that or digest food. You want to shunt all your blood to your muscles, to your heart. Your heart starts racing, your blood pressure goes up. Your objective is just to get away from the saber tooth tiger. That's how we were designed. And you know, fortunately in 2020 we don't have saber toothed tigers anymore, but we still have stress and stress does the same thing to you. And we kind of divert our blood flow from where we'd like it to be to where the body thinks it needs to be because it's under stress.

Thanks for listening to Sex with Emily. I'm Dr. Emily and on today's show, I'm Joined by certified urologist Dr. Edward Cartman. And we are pertaining to all of your penile needs, taking calls and giving you the hard facts. Hey. Because most of us could use some penile. Focus topics include what may be causing your ED and what you can do about it. Okay, what the hell is a cock shocker and how does it improve your sexual functioning? A little insight on the foreskin debate and some of the most interesting things that have been requested in your urologist's office. All this and more. Thanks for listening.

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 bygone days.

Hey Emily, you got a boyfriend? Cuz my man E here, he just.

Got his heart broken. He thinks you're kind of cute.

A girl's gotta have her standard.

Oh my.

Do women know about shrinkage?

Isn't it common knowledge?

What do you mean? Like laundry? It shrinks.

Can we not talk about sex so much? Are you kidding me?

Oh my God, that feels so good.

Being bad feels pretty good.

But you know, Emily's not the kind of girl you just play with.

You're listening to Sex with Emily. We're talking about sex with relationships and everything in between. For more information Please check out sexwithemily.com we are updating that daily to give you guys blogs and posts and things are going to help you with your sex and relationships. A lot of the questions you might be asking, maybe we've answered it there and find us on all social media. It is Sex with Emily across the board and intentions with Emily. So each show it helps us set an intention. I'm going to do the same. And think about this like while you're listening, what would you like to learn? What would you like to glean from this episode? How could it help you? It could be, oh, Dr. Emily, I've been having some performance issues and I'd like to know tips to get back into peak performance. Or maybe it's my partner's penis isn't always in full mast. What do I do? Help me. My intention is to give you all the penis knowledge that may just save you and help you in your bedroom activities. All right, enjoy the show. I'm so excited to welcome my guest. He's the man. Dr. Edward Cartman came in just to be here with us tonight. Board certified urologist and he's also one of the few urologists who's a fellowship trained in male reproductive medicine and surgery. You are. You're up in the Bay Area, you're very well versed in all things penis, penis health. They can find you at ecartmanmd, Instagram and healthy-mail.com. this will all be in our show notes as well at sex with emily.com. so welcome Dr. Cartman. I just want you all to say that. Call in right now. We've got to get back to our friend Jake and Illinois about his open relationship. But then we're turning it over to your penises. Either your penis or penis in your life. Anything going on. Erectile dysfunction.

Challenges erection. Too hard, too soft. You want to last longer. You don't last long enough. You're worried about your penis size. Am I missing any major penis things? Penis size. Oh, you can talk. He's pointing to his friend. He just threw his friend on the bus. Or Dr. Cartman brought in a friend. I'm like, bring him in. He's like. His friend apparently is worried about his penis size. How he can't even talk. He's like, thanks, buddy. You guys like friends? Good friends.

We're good buddies. We met through the industry. We worked together for many years, and we've developed a relationship.

Okay, you can make fun of each other's penises.

He helped me with a penis reduction. It was something that was plaguing me for a very long time, and now I can function normally in society.

Good. It's a good man. It is true, though. Large penises, one of the biggest, biggest problems that we hear from sexually. Not just not a small penis, but you don't know anything about that.

It's a curse.

I hear you, ma'. Am. Okay, let's just talk to Jake in Illinois. 23, in his open relationship, having some challenges. So, Jake, I'm just feeling it's not working for you guys right now.

Yeah, that's kind of how I'm feeling too. Kind of what I wanted to ask you. Yeah, because we're on the apps you've recommended field and stuff, and we've tried that out, but it just seems like every time an opportunity presents itself, she. She kind of avoids it. And she avoids conversation about sex in general, not just the open relationship.

Oh, okay. Well, sounds like she's got work to do too. Jake, she's 23 years old. Maybe she hasn't really explored her body yet and figured out what feels good. And it's probably confusing for her to be with you and then go out and have sex with someone else. You know, at 23, I probably would have canceled that plan as well. So she just might not Be where you're at. And that's okay. You can still love her and take a break, you know, from each other and just. Or break up because you're not in the same place. I think that's really brave. Okay, Jake, let me know. It goes. I'm here for you, buddy, every night. I got you. Dr. Cartman. Hi.

Hi.

Welcome.

Thank you.

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

Yeah, I'll be here. What's new in the world of sexual medicine? Well, one of the hottest things is shockwave therapy for the penis.

Tell me everything.

I call it the cock shocker. Just make it simple.

Of course. Right. I love it.

So there's this interesting thing we found out about 10 years ago that if you do very low energy shockwaves to a body part, you could actually stimulate stem cells to help it recover and to heal. And this is a therapy they've used for many years in different parts of the body. A lot of athletes do this to recover from sports injuries.

And it's been very useful. And they finally said, well, let's try it out. You know, let's try it out on the penis, see if it works.

Yeah.

So about 10 years ago, the first paper came out and what they did was they did this low intensity shockwave therapy on the penis.

Where on the penis do you shock it?

We shock it all over. So.

We focus on the external. So probably some of your listeners don't know this, but only two thirds of your penis is outside your body. One third of your penis is inside your body and it's deep down in the pelvis. And so guys don't understand that. And so I think we talked about penile size and how guys say their penises are small and they get smaller. And I tell them the best thing you could do to get a bigger penis is lose some weight.

Yeah, that's an incentive. That's the best incentive I've ever heard. For many a man to be like, oh, now I'm gonna lose weight.

Absolutely.

Looks bigger. Okay.

So they found out that if you put these low energy waves around the penis onto the penis, and these treatments are really short, they only take us about 10 minutes to perform. They're pain free, it's non invasive. It's really. There's no side effects. It's almost as. I mean, it's the closest thing that I could say. It's like sprinkling magic fairy dust on your penis to make it better. Because everyone's looking for that holy grail.

Because usually they're taking Viagra if they have this problem or some pill.

Correct, Right. Which has side effects.

Yeah, absolutely.

Or it's an invasive procedure which requires surgery. And finally something came along that it's non. Invasive. Really? No side effects. And over time, it could actually improve your penile health. So the big thing now in medicine is regenerative medicine. We're trying to have our bodies just heal themselves because we have these amazing abilities to heal ourselves. Yourself. Why do you heal in two months? Well, it's because you activate those stem cells locally, which then start repairing the injury.

Right.

Well, we don't want to go in and cutting guys penises just so they could try to grow new blood vessels or get better. So this is a non invasive way to kind of stimulate those stem cells that live in the penis.

It makes so much sense. Okay, so I want to hear more about this, but Amy's been holding for like an hour and she only has six more minutes. She wants a question for you. So we're gonna go to. We're gonna go to Amy. Amy, 40 in Orange County. You have a question. Hi, thanks for calling. I'm here with Dr. Cartman, and I just got the message from them that you only.

Hi.

So what's going on with your boyfriend? We want to help you. And then we're gonna get back to the shot cock. What's it?

Cockshocker?

Okay, yeah, tell me everything.

So he has trouble reaching orgasm when we have sex. And.

Sometimes it just takes a really long time, and sometimes he just gives up. And we can't at all. We just stop. And then sometimes he can. We stop and then he'll just like, finish himself up masturbating, and then he can.

Okay.

And.

So I just wanted to know.

What you can do, what could be.

Causing it, and if I can do anything.

Okay, great question. So it's just a delayed ejaculation is what it sounds to me. What do you say about delayed ejaculation? When typically a man lasts longer than what, 30, 45 minutes?

So some guys with premature ejaculation, which is the most common problem, are saying, why are you complaining?

Right.

But it is a problem. And my first question to you, Amy, is, is your boyfriend on any medications for depression?

No, he's not.

Okay.

He doesn't take any medications.

None at all.

Okay. Because the reason is that a lot of people take antidepressants like Prozac. Paxil, Lexapro, all these medications, and they have a known side effect of delaying ejaculation. We actually use them off label to treat men who have premature ejaculation, which is the most common sexual problem that men have. But if that's not the case for your boyfriend and he doesn't do any drugs.

Okay.

No, he drinks alcohol. But this happens if he's drinkers, he doesn't.

Right. And he's probably, as he said, this has been a thing that's always been an issue or a challenge for him.

I haven't really gone there to probe that. I don't know how long it's been going on, but he. We're both divorced, and he told me the reason he thinks that happens is because with his ex wife, the whole time, their whole relationship, they never used birth control, and so he always had to pull out. And he thinks that he just, like, developed like a nervous thing from that. And that's hard to get there because that. So I don't know if that's the case or not, but that's what he attributes it to.

Huh. I mean, could be. Could be watching porn too. Like, if he has, like, a tight grip around his penis when he's watching porn, that could be it too.

Well, that's. I was gonna be my next question. Does he watch porn? Do you guys watch porn together or does he watch porn alone?

We don't watch it together. And not that I know of that he does, but from what you're saying of the tight grip, like, when I. When he does do it, he seems to, like, have a really loose grip when he does it. I don't think that's it.

What do we do here? Ejaculation is a little more of a. Can we shock that?

No, we can't. Yeah. So first of all, we have to explain where our orgasm really comes from. Everyone thinks it comes from the penis. It really comes from your brain.

Yeah.

So it's when you reach a certain threshold. When a man reaches a certain threshold in his brain, he releases all these neurotransmitters. That's a big word. I'm sorry. But things like dopamine, which give us that shiver down our spine, and I always try to explain this to guys, that's where an orgasm is. It's in the brain. It's not in the penis. And so there's. There's a lot of things. When we think of any kind of ejaculatory problems like that, we're always thinking, what's going on in the brain. And so one of the things, and I would explore this a little bit more with him is, is how much porn he does watch. Because there's this thing called porn induced ed, but there's also a desensitization that happens with watching too much porn. So you can imagine if you. If you're a guy and you watch porn and you watch your favorite genre, you could pick any genre, but it's like, you know, three women with big breasts and taking turns on you. And so that's your. That becomes your new threshold for reaching climax. And then you come back to your relationship where, you know, it's kind of normal sex. You know, I'm sure you guys experiment, but it's nothing like that what you see in the movies.

Yeah. So, Amy, I would just have more like, I think we just gave you a few ideas of what it could be. But I think in talking to him and kind of getting more history and saying, hey, like, I'm just curious, has this always happened? Can you tell me the history of this? I mean, if it is a learned response from his marriage, that's also possible. But what Dr. Cartman was also saying about this ability to think your way to orgasm and to kind of like learn to orgasm without ejaculation, is that weird? Which is a practice.

Yes, and it's true. It could be also a form of depression that's manifesting as delayed ejaculation, which is very possible. So depression and the treatment for depression both can cause delayed ejaculation. But then it goes back to the point that I was making. It's in the brain.

Yeah. Okay.

Yeah, Amy, I would just get clearer with him and start to talk to him. And there is some more information. We have information on our site about learning how to orgasm without ejaculation. We can get into that. But let's get some more history from this and then call me back. Call me back with him. Okay. Okay, thanks. Av. Let me how it goes. The penis calls are lining up for you, Dr. Cartman. I'm here with Dr. Edward Cartman. Healthy-mail.com ecartmanmd888 9478277.

Okay, let's talk to Ken, 55, in New York. Hi, Ken. What's going on? How can we help you?

How you doing? Having trouble maintaining and getting an erection. And even after taking Cialis.

Okay, 55 in New York. All right, Ken. What? Okay, so even after taking Cialis, how long were you taking Cialis for?

As needed. I mean, just. It doesn't seem to work.

Did it ever work?

Not really, no.

Well, how are you taking it, first of all.

Until.

Well, no. Are you taking it 20 minutes before sex and then you sit there watching SportsCenter until something happens? Or do you take it on an empty stomach an hour and a half before intercourse and then you go stimulate yourself? How do you take it?

It's, you know, like an hour before and, you know, I mean, I don't, you know, I haven't tracked exactly what I've done. You know, waiting, but not. I'm not seeing results.

Well, it's very important. So. So Cialis is the one different one out of all the drugs that we use, like Viagra, Levitra, Stendra, those are all quick acting 30 minutes after you take it. If you take it on an empty stomach, they kick in. They only last for four hours, though. Cialis, or the generic name Tadalafil, works a little differently and it's been dubbed the Weekender because a guy could take a pill on Friday and potentially it can work all through like, you know, Friday night, Saturday morning, Saturday night, and even maybe into Sunday morning because it has a 24 hour, 24 to 36 hour duration of action. But you have to take that one an hour and a half before intercourse. And if you take it with food in your stomach, it'll take longer to absorb. So the most common consultation I get for failed the Viagra, I'll just use Viagra as a name. But any one of these drugs, they don't work on me anymore. The most common reason I find is that people just aren't using them correctly and they're prescribed by their primary care doctor. Nowadays you could even get them online without even a real consultation from a doctor explains how to use them. People just take them the wrong way. And so the first thing to do is make sure you're taking it the right way. You rechallenge yourself and then you're in the right situation. So with Cialis, it's an hour and a half before sex, empty stomach, sexual stimulation after an hour and a half.

All right, Ken, you want to try it that way?

Yeah, I tried crushing it too. Would that help?

It can, but it won't make that big of an effect Again, if you have a steak sitting in your stomach from dinner and no matter whether you crush it, you take it whole, it's not going to get absorbed adequately.

Yeah. Okay, so, Ken, I would take.

What could be the problem physically if I was taking it correctly.

Okay, so let's talk about that. So first of all, real quickly, do you have any medical conditions like high blood pressure, diabetes, heart disease?

No.

Okay, so you're otherwise completely healthy?

Yeah, for the most part, yeah.

Okay. And is it more of a problem getting it up, or is it more of a problem keeping it up?

I'd say getting it.

Getting it up. Okay. So when guys say getting it up is a problem, to me that sounds more of like an arterial problem. It means you can't get enough blood flow into your penis. Okay. And that could be due to. The most common reasons would be disease in your blood vessels, that things like heart disease and erectile dysfunction is really now considered like a form of. A manifestation of cardiovascular disease. And so I would recommend if you haven't get checked out by a cardiologist. In fact, I'll tell you an interesting anecdotal story. When Viagra came out in the. In the late 90s, we started giving it out like candy as urologists, and we were rock stars. We had the first FDA approved oral medication that actually worked, and people loved us. And we were giving it out, and guys were having great sex, finally with a pill. And. And what we found out is that these same guys were coming back about five years later and telling us they had their first heart attack. And it wasn't that the Viagra was causing the heart attack. It's that we weren't recognizing back then that these guys are really are suffering from cardiovascular disease. And we were treating it as though, like if a guy came in and said, hey, doc, my chest hurts when I exercise. And I say, okay, here's a Viagra pill. That's not the right thing to do. You should go get checked out. Get a cardiologist to check your blood vessels to see if there's anything wrong with them. And the ultimate thing to do is to get a penile ultrasound by somebody who knows how to do those and interpret them.

All right, Ken.

Okay.

Thanks for calling, Ken. Have a good night. Wow, that's a lot. It is, right? It could be from your heart. We don't get checked out right often. We're not getting the right kind of tests, correct?

Absolutely. And so, in fact, the guidelines have changed now that we're almost obligated to ask these guys these questions about their heart when they come in and say, hey, doc, I just have Ed just. Just write me a prescription for the pill. I'll be out of your office in no time. I'll let you go see the next patient. And I say, sure, I'll write you the Prescription. But you got to do this for me. You got to go get your heart checked out. And so I work very closely with a lot of cardiologists because it's very important if you're dealing with sex, especially if you're dealing with erectile dysfunction, is to understand this relationship and make sure that these guys aren't coming in and you're just giving them a pill or a treatment and not recognizing the underlying problem that's going on.

Yeah, that sounds like such a. That makes so much more sense. Holistic approach, not just giving a pill to solve it. Okay, we've got Rick, 46, in Ohio. Hey, Rick, you're on with Emily and Dr. Cartman. How can we help you?

Hi, Emily.

Hi.

Hey, so I have a question about.

I got a vasectomy about almost 10 years ago now.

Okay.

And ever since I got that vasectomy, my ejaculation is so different. I mean, it feels the same, but, you know, I used to be able to spray everywhere. Now it's just a little bit, drizzles out. I was wondering why is that? And is there anything I could do to get that back?

Love it, Rick. Thanks for the question. Okay, hold please. We got. Okay. What do you think, Dr. Cartman?

Well, let me ask him. How many. What was the interval between the vasectomy and you noticing this problem starting.

I'm sorry, I'm sorry, can you repeat that? I couldn't hear you.

How long was the time from when you had your vasectomy? How long of time went by after you had your vasectomy before you noticed this problem that you're. We'll call it the money shot.

Right away.

Right away. Right away. Okay, so. So this requires a little physiology, so bear with me here. Okay? So your ejaculation, most of it actually comes from your. No pun intended, but it comes from your prostate and your seminal vesicles, which are way downstream from where we do a vasectomy. And the thing that the testes contribute to your money shot is the sperm. And that makes up about. By volume, only about by 5%. So most guys don't notice a change in their volume of ejaculate after they get a vasectomy. Nor do they praise me when I reverse their vasectomy and say, oh, my God, I got this huge load now that's coming out. We just don't hear that now. Whenever you have a procedure done on your body, okay. You become more in tune to what's going on. So sometimes it's just a question. Of like observation and being alerted to it. And I've had guys come in and tell me that in my office after I've done a vasectomy. And they said, well, barely anything comes out. And I said, well, let's check it out. And I have them do a semen analysis right there in my office. And I show them like the volume is really unchanged. You can't really perceive a change. So the vasectomy doesn't, like I said, doesn't take away More than 5% of your ejaculate volume if you get one done. So if you do notice a decrease in your jacklet volume, you should be looking downstream at the prostate or the seminal vesicles. Could be a hormonal problem. Maybe your testosterone's low and you're just not producing as much fluid anymore because your testosterone's low and that's what drives your prostate and your seminal vesicles.

Yeah, I wasn't. That makes sense. It makes sense. I was in my mid-30s when I did that. So I guess that'd be the time when, you know, you might start losing testosterone. I guess you'd start losing it.

Yeah.

In that time. And then I had one more follow up question, if I may.

I have a younger wife who's about, you know, 15 years older than me, likes to have sex a lot. And I find, and I find that I have to take. I usually take about a half of viag or like 80 milligrams just, just so it's nice and erect and I don't have any issues because when I don't take that.

I can get an erection. It just isn't as firm and hard and it doesn't stay and last as long. I mean, I exercise. I, you know, I'm not, I would probably say I'm a little overweight, but I'm certainly not, you know, I mean, it's not out of control or anything. And so I was just wondering.

Yeah, Rick, good question. What do you think, Dr. Cartman?

Well, so first of all, 80 milligrams of Viagra, that's almost the max dose. That's a pretty big dose.

But you know, I cut it in half.

Cuts in 80 and a half. Okay.

Okay, it works. And listen, I tell guys, as you get older, you're gonna have some decrease in your rigidity. Now, it's not anywhere close to being classified as, say, ed, that you can't complete the sexual act and satisfy yourself and your partner, but you notice a little change as you get older. This is part of the Aging process. You know, I tell guys like, these drugs are like performance enhancing drugs, and it's kind of like, you know, the steroids that people use. Like, Barry Bonds was a great baseball player before he took steroids, and he became an exceptional baseball player when he started taking them.

Right.

So it's kind of like the way these drugs work. And yes, in a guy who's old, getting older. You're not old. Okay? I don't want to. I'm older, way older than you. Okay. But it can happen. You can start noticing some decrease in function. And so these. These drugs do help perk you up a little bit.

And we also don't know, Rick, if she's. She might be fine with your penis where. However it is. But you're thinking, like, it's got to be harder, it's got to be bigger. It's got to be all these things. And I'm gonna bet that your wife is pretty satisfied as it is right now.

That's. That's true. That's true. That's very true.

Ego thing. Yeah. Okay, well, you know, so. All right, our work here is done with you, Rick. Thank you very much. All right, Dr. Cartman, you're going to hang out. We're going to take a quick break, and we come back. We're going to get into your questions.

Anything new? Penis issues that I haven't. I don't know about?

You want to hear the weirdest requests I ever got?

Yes, please.

So I had a guy call me and ask me if I could split his penis into two.

Okay, you've got me. What?

So the penis actually has two chambers, two corporal bodies, and there's just one of these fetishes or paraphilias that people have. And this is. I think we talked about this last time, and I said this to you. There's no way to train and prepare for this kind of stuff because I could not find that in the textbook anywhere. And I had to. Actually, I heard from one of my colleagues who does a lot of this stuff also. And he told me once a long time ago that he had a patient that actually asked him to do that, and he did it. And when this guy called me, I said, oh, my God, I wouldn't even know where to turn to. But thank God. I remember my buddies told me this story and we were like. I think it was like just one of those conversations you have at a bar and you say, you'll never believe what I did, and had to call him and ask him, how do you do this?

Where do you put the other? Like, I'm confused. Like, split it in half. So it's like a. Is it staying on him or is he like. So it's two penises.

So you could have like two horns.

Coming out, like double penetration.

I kind of thought maybe that's what it was about, but Interesting thing would be it's weird. And I don't want to say weird, but it's one of those.

Oh, we've got it up on the. Yeah. Okay.

There we go.

Yeah. Yeah, he's good with music and sound and graphics. Thanks, Brian.

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

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

So did you do the surgery on him? You did it?

He never followed through with it, but it was one of those weird, super weird requests that I was like, oh, my God. I was racking my brain. What am I going to do for this?

I wouldn't want to do it. What if you regret it? I don't know. I, I.

Yes, that's. That's the big thing. So back, Ken. Well, so my friend who did it, when I was talking to him, he told me that the person he did it on actually changed his mind. And then he put them back together.

Oh, God.

But it's not going to be the same, right? It's not going to be the same.

Oh, right. Exactly. Wow. Manny talks about penises as much as I do. It's so good to have you here, Dr. Cartman. You guys can call us with anything. Any questions? Jim, 47 in Texas. Hi, Jim. What's going on? How can we help you?

Yeah, I'm just curious in regards to.

Then experiencing in regards to fullness of erection. And curious if it's just typical with my age or something that's lacking with the partnership between myself and my wife.

Okay, so you mean like, you are, you're 47. Years old and you're wondering, you're not able to get a full erection right now and you're wondering maybe it's. Is it because you're not into your wife anymore, you're not attracted to your wife, or is it because of your age? Is that your question?

Yeah. So 47, I've been, you know, super, super sexual, masturbate, you know, every day.

We have sex probably, you know, two to three times a week. Over the past month.

I haven't been able to, you know, get fully erect, which I went to a doctor that he prescribed me the lowest dose of, you know, Viagra, which I've used a couple of times. And, you know, incredible, right? But, you know, wondering if it's because of, you know, the repetitiveness of, you know, the sexual act. The fact that, you know, my wife only does missionary because of, you know, problems that she has, you know, with, you know, vaginally and the fact that, you know, she's not into the chatter or it's just, hey, I'm getting old.

And maybe I need probably all those things. Jim. I think it's a little bit of everything likely.

Yeah. So. So, Jim, this kind of happened in the last month. You went from hero, like to not to zero, but hero to a lot less.

And in the last month.

Yeah, it's like 50, 50 that, you know, I'll be, you know, running out of skin or, you know, just kinda like 75% hard.

Okay. So when there's like an acute drop in your erection function or hardness, and you didn't just undergo a surgery which would cause that or start on some new drug that can cause that. Whenever I have a patient who just comes in and says, like, it just happened last month, the first questions I start asking them are about what's going on in your life. Because, you know, erectile dysfunction does can occur in a 47 year old, but it doesn't happen that rapidly. I mean, it can, but it's not common. Usually it's more of an insidious process that kind of sneaks up on you over time. And so, like, I would really ask, and I would ask you to look at your life, your stress levels. Something we don't talk a lot about is the effect that stress has on our erection. So, so we have this thing called a fight or flight response. And this is something you learn in basic physiology. We were designed so when the saber toothed tiger is chasing you, what you do is it's not a good time to have an erection or have babies or do Unnecessary things like that, or digest food. You want to shunt all your blood to your muscles, to your heart. Your heart starts racing, your blood pressure goes up, you shunt all your blood to your muscles. Because your objective is just to get away from the saber toothed tiger.

Tiger.

That's how we were designed. And you know, fortunately in 2020 we don't have saber toothed tigers anymore, but we still have stress. And stress does the same thing to you. It releases these same kind of chemicals in our body that cause our heart to race and our blood pressure to go up. And we kind of, we kind of divert our blood flow from where we'd like it to be to where the body thinks it needs to be because it's under stress. So I would really look at yourwhat's going on overall in your life right now and work stress, even something like commuting stress, financial stress. Maybe the stress of your relationship with your wife is finally getting to you where like you just said, it's like I'm tired of just doing missionary.

Yeah, I get that, yeah, missionary. Like talk to your wife about, you know, maybe trying what else she's into, could she try other things? You know, a lot of times it's just we get bored. That's okay, but we gotta like mix it up, have that conversation with your wife as well. Okay, Jen.

One other question is, if I continue to, you know, supplement with the Viagra, is there any long term effects using the lowest dose? Dose?

We don't know of any long term effects of taking these medications. I mean, we've taken them for many, many years. Like I said, Viagra came on the market in 1999, so it's been around for over 20 years. So I could tell you in 20 year experience that we haven't really seen any long term effects of it. But who knows, maybe after we take it for 40 years we might notice something. But no, there's nothing that we know of currently that Viagra can cause if you take it for a long period of time. And by the way, you haven't been taking it for a long period of time.

All right, thanks Jim. I'd say have a talk with your wife and work on the stress.

Stress is the biggest killer of our sex drive. Truly. We don't really relate, we don't really think about it for men and for women, stressed out, it's hard to orgasm. We're like in our heads, we're, you know, thinking about everything else.

Well, you know, I practice in Silicon Valley, which is probably like One of the most stressful areas to live in.

Yeah. All those penises must be just. Yeah, I'm sure. Okay.

And, yeah, no, we stressed out penises. I see young guys in their 20s coming in complaining of this stuff.

Stuff.

Wow. In their 20s, and it's a real problem. It's a real problem. And they don't understand. And imagine if this is doing this to your penis, what's it doing to your blood pressure? What's it doing to your heart? And again, think of your penis as a barometer of your health. It's like the canary in the coal mine. When that thing starts going bad, you gotta think, okay, what changed? Especially if something abrupt happens like what Jim's describing, there's something that's changed in his life. If he up and said, well, the last 20 years, I've been noticing it's slowly getting worse, worse, worse. I go, well, you've got garden variety, Ed.

Okay.

But this, this drastic change in the last month makes me really suspicious that, you know, he has something like that going on. And this is, though. This is a very common problem we see a lot of. And again, in Silicon Valley, young engineers, busy. Yes.

Yeah, that's. I mean, so, so it's. What do you tell a guy who's in his, like, late 20s, early 30s, you just like, like go to yoga, go meditate. How do you get them to come off that? Distress anxiety.

So that's the hard thing. So it's like telling an obese person to lose weight or telling a smoker to quit smoking. It's very easier said than done. And so these people usually are so happy because they finally achieved that dream job at one of these big tech companies they've been wanting to have. They want to impress their bosses. They're living in Silicon Valley, it's super expensive, it's crowded, it's trafficky, it's all this stuff. They're away from their families. It's new environment. And what do you tell them? You tell them you have to find a way to disconnect. We could also talk about something that I think is, well, technology.

Yes. It's ruining our sex lives and our lives. I agree.

Yes. Because you remember when you and I were. I'm not dating us here, but when we were growing up, your parents came home and they didn't get emails or phone calls or text messages about work. They disconnected.

It's done.

And they relaxed in the evenings. They actually enjoyed whatever they did. Watch the news, read the paper, spend time with the family. But now it seems like people don't disconnect. We just don't disconnect. We keep going and going and going. And even if you don't answer that email from your boss because he decides to send it to you at 10 o' clock because he has a whim and you happen to be flipping through your phone, you're like, oh, let me look at this.

It's not like he sends this thing for you to do tomorrow. Oh, you don't have to worry about it tonight. Just do this tomorrow. Tomorrow you start thinking about it.

Exactly.

So then you have a hard time focusing on your partner. You're gonna have sex with your partner, but now you're thinking about, oh my God, this guy just made me do this, what am I gonna do? This project. And so we, I try to tell patients that they really have to try hard to disconnect. So tech is, we're gonna have, in 20 years, we're gonna have like, we have now, you know, smoke free zones, like, you know, restaurants with, without smoking and all that kind of stuff. We're gonna have like tech free zones where there's gonna be no WI fi, no cell signal. People are gonna go for retreats.

Yeah, I do that now. In September, I went away for a week. I like looked at my phone just like once or twice. It was such a great thing. I think we need it now. But you're right. In 20 years, hopefully we'll just start leaving the phones at home like we used to. Yeah, we couldn't bring them everywhere.

Absolutely. One of the other things we could talk about this in California because it's legal here.

One of the things that people could consider doing is using marijuana. And the way marijuana works is it works by binding to your pleasure receptors in your brain. These things called, we have these natural pleasure hormones, they're called endocannabinoids. And that's how we feel pleasure. And that's part of an orgasm, is we get that feeling of euphoria. And some people, if they can't disconnect themselves, they can't break that cycle.

It's not a bad thing to try. And it's very hard as a physician, as a professional to recommend. It's like saying, have some wine. But then they get a DUI and you get in trouble because they're like, oh, well, my doctor told me to start drinking. But it's one of those things to consider. It's like if you can't de stress.

If you can't disconnect, maybe like. And it doesn't have to be. I think people picture like, you're gonna have me smoke this bong. But, like, honestly, it does. We're all fans here. You take like one hit or one vape, like, you just. It really is a game changer for sex, for masturbation to get you in the mood. You don't care about that work email as much. You're way more into sex, and your orgasms can feel amazing. There. I just recommended it.

We should have recommended that to the previous caller who said that her boyfriend couldn't get an orgasm.

So you think if he was stoned, if he was a little high.

Try it.

Little high. He wouldn't. Great one. I wanted to cover a few things. Lately, this has been coming up a lot. And that's phimosis having to do with foreskin. Can you kind of walk us through why now more than ever where the foreskin can't be retracted?

Sure.

Okay.

So that's exactly what it is. Phimosis is a medical condition when a man can't retract his foreskin, or he can retract it, but it's tight, it's painful, and we have to remember that the penis is larger, girthier when it's erect. So even though he might be able to retract in a flaccid state, if he can't retract it in the erect state, it's a problem. So you have to be very aware of that. And, you know, the primary treatment for that, you know, you could talk about using steroid creams and all that kind of stuff, which I found to be not so effective, is surgery, which is called circumcision, which, you know, a lot of men are routinely circumcised in this country at birth. But you go to other countries and they don't do it. And yet we're this melting pot here in America now. We're seeing so many people coming here from other countries, and they're uncircumcised and they have these problems. And, you know, I have guys coming into me, into my office, young guys complaining of erectile dysfunction. And I ask them all these questions. And, you know, one of the questions I used to forget to ask, and I start asking this all the time now, is, do you have any pain when you have sex? And you never think of asking about pain, but obviously, if you have pain, you can't maintain an erection. And I tell these guys, you think if you had a full erection and I punched in your kidney, you could maintain that erection? No, you couldn't. So pain makes your erection go down. But when you have a phymotic foreskin and the car can't come out of the garage, as I say, it causes pain because when you're thrusting forward, the head is supposed to come out in a normal penis if it's uncircumcised. And a lot of these guys, they convince themselves, because during masturbation, it doesn't hurt. It's not a problem. And why doesn't it hurt when they masturbate? They masturbate in the forward direction, not the way you have sex. When you penetrate, you don't have control over your foreskin. The foreskin has to retract. And if it doesn't, it causes pain at the tip. And they come in complaining of erectile dysfunction. And I only picked. I started picking it up on the physical exam, and I'm like, like, oh, doesn't this hurt? And some of these guys would still argue with me and say, no, it's fine. It's fine. It's not a problem. I go, come on, it's got to hurt, man.

Right, right. You're like, yeah. So why does it happen? As men are at a certain age, just for all the years of the foreskin being there, and then it just sort of, over time, it starts to age, is the way they are touching themselves. Like, why does it happen with some foreskins and not all foreskins?

So that part of the body requires a lot of hygiene. And I tell this to these guys. It's not a problem if you can maintain hygiene. So whenever you have skin on skin and what other areas of the body. We have skin on skin. We have armpits. Okay. We have your groin creases. Or if you're, like, overweight, you have a panis with folds. Now imagine that. So you could imagine how dirty it gets in there. But imagine you also peed through your armpit and you ejaculated through your armpit. And then if you didn't pull that thing back and clean it thoroughly multiple times throughout the day, it gets infected. And then when it gets infected, it develops scar tissue. And then that scar tissue's not elastic, and then it stops accommodating when you pull it back.

Right. Sometimes you gotta teach guys to wash their sheets and do all these other things. And then it's like another thing. You gotta wash your penis.

Yes.

Or use wipes, like these freshy wipes, which we love. Those would be great for cleaning the penis. Right. Just keep them in your bag. Something interesting. I feel like we're hearing that you're helping so many penises right now, or people who are friends with penises or have a penis in their life. What about.

Let'S see, what about the circumcision? I feel like adult circumcision, people wanting to put the foreskin back on.

Yeah.

Do you forget people coming to you for that?

Yes, I do. What do you do? So we have this, and this is again thanks to the Internet, we have this foreskin restoration movement that's going on in this country now. I don't want to make it sound like it's a huge movement or anything, anything like that. And it was kind of interesting. So when we went to our last national meeting in Chicago, we had these protesters. So the AUA, which is our biggest national meeting, 10,000 urologists show up to this. It's an international meeting, actually, 10,000 urologists there. So they decided to protest circumcision in front of the convention hall. And I took a picture of these guys. There's three guys standing there with big signs in the middle of the day during the week. And I'm like, okay, it's. Is this the movement here?

This is the movement here. So they had these signs up that said how horrible circumcision is on the baby and it's like general mutilation and let the child choose themselves. So obviously they're not happy with their circumcision or whatever. But this is a very, very small percentage of people who want to restore their foreskin. So how do they do it? Okay, well, you could actually take the shaft skin of your penis and stretch it out over the head and actually use like a device, like a clamping device that will keep it over the head of the penis and over time it'll stretch out. In fact, this is, this is historical. So During World War II, this is how the Nazis would identify the Jews is by they were circumcised. And so there's. I forget the movie that it was, but there was a movie about this. It was like either the Diary of Anne Frank or something like that. They talked about this. Where these kids would literally do this, is that the young Jewish kids would do this, stretch out their foreskins.

That's how they would know. Wow.

So this has been practiced, but that was done for life saving measures because you would be put in a concentration camp if you were identified. But nowadays it's done more for pleasure. For.

People are saying that an uncircumcised penis is more sensitive. And that is a True statement, but it's not true that if you're circumcised, you don't enjoy sex the opposite, you know, so.

Exactly. And how would you know? Like, it's like this FOMO fear of missing your foreskin. I guess you want to put it back on. But how's sex right now? Like, it live with what you have? Right? Because it seems like it could be dangerous or it could just to attach it. Again, not dangerous, but, like, couldn't you fuck something up that way too? Like, couldn't that. Not you if you were doing it? But. But I don't know.

Yes. Yes, you can. People can mess things up, definitely. But it's just one of those things that I guess the people who are doing this are people who are circumcised at birth, so they've never experienced sex both ways. And I guess the best thing to do, and I don't know of any study that exists of taking men who were uncircumcised and had a sexual life and then got circumcised and doing a study on them to say, would have you feel, what is the difference in sexual pleasure? And in this country, because we circumcise so many men, boys at birth, we definitely are not an asexual country. We're not suffering from sexual dysfunction because of our circumstances. More than any other country that routinely doesn't circumcise. Right. No.

Okay, good point. It just keeps coming up. People are like, save the foreskin. Do all the things. And I just feel like we've got so many other things to work on. Work on your stress levels, your anxiety. I don't think you need to obsess about your foreskin.

No.

Whether you have it or not. But clean it. Clean your foreskin.

Hygiene is important.

Hygiene is important. So important. Yeah. Oh, my God. Yeah. Especially. Yeah. If you're with someone with pain, like, make sure it's clean, because that's how we can get infections and stuff.

Yes.

All right, we just have a few more minutes. So what else, Dr. Cartman? I mean, I. We have calls, but we just.

I mean, Jeff has been at hold for a while. He's 58. Jeff. We only have like a minute, though. I know. If you question about Ed, but I guess we haven't answered it. Jeff, 58 in Washington.

Yeah, I. Well, I got Ms. And I've done. I've taken pills. I've done Cialis and Viagra. Kind of the way you said. None of those are really working. It's kind of started up in the last probably five years or so. So it's been going on lot. And I'll just ask quick, is the electroshock that you were talking about, is that the same as a Gainswave or is it something and wouldn't my urologist know about it up here in Washington?

Great. Okay, thanks, Jeff.

So Gainswave is just one brand of shockwave therapy. And in fact, what you want to ask your doctor is the type of energy they use. So you want to make sure it is unfocused pulse therapy and not radial frequency. Okay, so that's the question you want to ask your doctor if you're going to do some kind of shockwave therapy for your penis, because that's where most of the research is on. But these radial frequency machines and devices and companies are kind of trying to piggyback on the data that's coming out from the unfocused pulse therapy. So that's really what you want to ask your doctor.

All right, thanks, Jeff. Thank you all for supporting the show and thank you to my incredible team. I appreciate you and all your hard work. Ken, Kristen, Elisa, Brian, producer, Jamie and Michael. Was it good for you? Email me feedbackexwithemily.com.

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