WEBVTT - How Long Should Sex Last? Understanding Ejaculatory Disorders

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<v Speaker 1>Let's talk about it.

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<v Speaker 2>Let's talk about the marrow. Let's talk about it. Let's

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<v Speaker 2>talk about the man. Hero. Welcome to the man. Welcome

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<v Speaker 2>back to the mailroom. Jordan Runta in the house. How

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<v Speaker 2>you doing, man, You sound a little stuffy. Maybe talk

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<v Speaker 2>to me about what's going on in your life right now?

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<v Speaker 3>Man, Man, I went up to Uh, visiting my folks

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<v Speaker 3>for a Memorial Day. I grew up on a on

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<v Speaker 3>a lake in central Massachusetts. Seems like the perfect place

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<v Speaker 3>to do some grilling, hanging out by the dock. But

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<v Speaker 3>I got here and the place was yellow, just palling everywhere.

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<v Speaker 3>And I've got nuclear grade allergies.

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<v Speaker 2>Right now, sorry, everybody, spring is sprung. No, man, I

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<v Speaker 2>think you know you're like half a register from Berry White.

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<v Speaker 2>We should we should lay down some tracks. No, it's

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<v Speaker 2>all good. You wear it well, But allergies suck. I

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<v Speaker 2>have been blessed to not have those. But yeah, bummer, yeah,

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<v Speaker 2>do you do a lager and all that stuff?

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<v Speaker 3>Everything right now?

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<v Speaker 2>Yeah, just the whole cocktail. See what works? Yeah? God

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<v Speaker 2>bless you. How's your home? It was good? Ye know?

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<v Speaker 2>Just did my run, got in the sunshine, worked on

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<v Speaker 2>my citrus grove. I mean, all kinds of just fun

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<v Speaker 2>California things to do. Citrus grove, what is sits grove?

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<v Speaker 2>So I, you know, we moved back to California. I

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<v Speaker 2>grew up here, as you know pretty much, and uh

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<v Speaker 2>and I was gone for almost twenty years, and I said,

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<v Speaker 2>if we're moving back, I really I gotta have an

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<v Speaker 2>orange tree. I gotta have a lemon tree. We actually

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<v Speaker 2>grew a lemontree in Colorado that I would take out

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<v Speaker 2>every winter. I would bring in rather than in the summer.

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<v Speaker 2>I would take it out and it would grow it

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<v Speaker 2>on the deck. I mean, I was so citrus fixated

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<v Speaker 2>because to me, that's like the sign of just you know,

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<v Speaker 2>it's live and it's so good and fresh fortress. And

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<v Speaker 2>I remember the first summer. It took two to three

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<v Speaker 2>years of growing this lemitary about four or five feet.

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<v Speaker 2>You know. It was a big ass planter and we

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<v Speaker 2>had it on rollers so I could roll it in

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<v Speaker 2>and out in the Colorado sun, which is amazing and

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<v Speaker 2>it's incredible. But obviously the winter is we had to

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<v Speaker 2>bring it inside into our little solarium. And I was

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<v Speaker 2>growing this lemon and I was so excited. I had

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<v Speaker 2>this beautiful lemon. It was green, it was just starting

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<v Speaker 2>to get a little bit yellow, and then a squirrel

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<v Speaker 2>ate it. And it was the worst. The thing that

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<v Speaker 2>was so bad about it because I love my nature

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<v Speaker 2>and our wildlife, but it just it hated it. It

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<v Speaker 2>cut it, it bit it out, and it tried to

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<v Speaker 2>eat it. It was like, this sucks. And so this lemon

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<v Speaker 2>that I'd been nurturing for months to have my first

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<v Speaker 2>lemon off my Colorado lemon tree, this goddamn squirrel ate it.

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<v Speaker 2>So I was so pissed didn't get to enjoy it.

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<v Speaker 2>And then finally, you know, got the call to come

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<v Speaker 2>back to the UCLA, and I said, we're having trees.

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<v Speaker 2>And so it started off with like one lime tree,

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<v Speaker 2>and then I got a couple mire lemon trees. And

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<v Speaker 2>now I've got navels and pomegranates, which I know is

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<v Speaker 2>not citrus. But during my little grove, I've got grayfruit trees.

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<v Speaker 2>I've got a couple of Eureka lemons, a couple of tangerines,

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<v Speaker 2>cumquats kalmandan, you know those little delicious cum quite like

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<v Speaker 2>varieties are fantastic. Yeah, So I have about thirteen or

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<v Speaker 2>fourteen trees that I love to tend to is sort

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<v Speaker 2>of my my outdoor therapy and getting a little bit

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<v Speaker 2>of the sunshine. So yeah, and I'm not allergic to

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<v Speaker 2>any of those things. So sucks to be you. Man.

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<v Speaker 3>I was gonna say, my hometown is the birthplace of

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<v Speaker 3>Johnny appleseeds.

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<v Speaker 2>We're an apple no way there? Yea, all right, what's

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<v Speaker 2>your favorite apple variety? Is it? Is it cosmic crisp?

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<v Speaker 2>Gotta go? Oh really? Okay? Yeah, I got turned on

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<v Speaker 2>to the cosmic crisp, which are absolutely fantastic. But yeah,

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<v Speaker 2>Fuji's are great. Yeah, they're kind of a West Coast thing.

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<v Speaker 2>I think they're grown in Washington, but they're they're pretty delicious.

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<v Speaker 2>So that's what I got going on.

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<v Speaker 3>You were a man of many talents.

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<v Speaker 2>I don't know about that.

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<v Speaker 3>Musicians, surgeon major and grove master.

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<v Speaker 2>Grove master. Yes, I did spend time when I was

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<v Speaker 2>a kid. I had a really good friend whose dad

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<v Speaker 2>had a citrus farm in Alvocado Farm, so I did

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<v Speaker 2>learn a few things when I was growing up, and

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<v Speaker 2>we spent the weekends down there in San Diego, so

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<v Speaker 2>I had that. But bottom line is just great to

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<v Speaker 2>have your own fresh citrus so cool. So that's my deal. Hey,

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<v Speaker 2>should we do something like medical or do you want

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<v Speaker 2>to just let's talk about citrus And well, we did

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<v Speaker 2>start out with allergies for example C vitamin C scurvy

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<v Speaker 2>where you get limeys. From no offense to my British listeners,

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<v Speaker 2>by the way, I won't call you limeies anymore. I promise.

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<v Speaker 2>That's sort of a seventeenth or eighteenth century insult. But

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<v Speaker 2>it's a supplement that works. Vitamin C is a supplement

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<v Speaker 2>that works, so you heard it here. Not all supplements

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<v Speaker 2>are bad. Yeah. I I was thinking about talking about

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<v Speaker 2>ejaculatory disorders because when we started this gig a while back,

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<v Speaker 2>one of our first guests was Natalie Finnger Goldberg, who's

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<v Speaker 2>a sex therapist, and we brought up premature ejaculation, brought

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<v Speaker 2>up delayed ejaculation, touched on a little bit. But it's

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<v Speaker 2>something that's so common in my practice that I thought

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<v Speaker 2>maybe we actually do a little Q and A with

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<v Speaker 2>what's on your mind, as well as a little physiology

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<v Speaker 2>for our an anatomy I guess for that matter, for

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<v Speaker 2>our listeners out there, just because I think it is

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<v Speaker 2>something that you can't talk about it enough, and it

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<v Speaker 2>just always comes up and it can be vexing for

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<v Speaker 2>my guys as well as the partners there with. So

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<v Speaker 2>let's talk about it. Welcome to the mailroom. Let's talk

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<v Speaker 2>about it. Yeah, so talk to me about Well, you

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<v Speaker 2>tell me what you know about premature ejaculation, delayed ejaculation.

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<v Speaker 2>What's the difference between ejaculation and orgasm?

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<v Speaker 3>For example, Okay, ejaculation actually is the release.

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<v Speaker 2>Of boom sperm, the money shot.

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<v Speaker 3>And orgasm is something more internal.

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<v Speaker 2>Orgasm is the euphoric feeling of when one expels a

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<v Speaker 2>load of semen. Yeah, so that's the difference between jaculation orgasm.

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<v Speaker 2>So there are guys the most common are men after

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<v Speaker 2>prostate cancer surgery where we take out their ejaculation organs,

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<v Speaker 2>which are the seminal vescals in the prostate where the

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<v Speaker 2>fluid is made, but they still have orgasms. Sometimes they

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<v Speaker 2>have more intense orgasms afterwards because they don't have that

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<v Speaker 2>fluid to expel. So the same muscles are just squeezing

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<v Speaker 2>joy and euphoric feelings up in the brain, and so

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<v Speaker 2>orgasm is that sensation and ejaculation is the fluid. So actually,

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<v Speaker 2>I think that's a reasonable place to start. So I

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<v Speaker 2>think about ejaculation an orgasm in physiologic anatomic term. So

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<v Speaker 2>there is a nerve that is on the tip of

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<v Speaker 2>the penis in the area we call the frenulum, which

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<v Speaker 2>if if you're standing up looking down at your penis

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<v Speaker 2>and you see the head right on the opposite side

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<v Speaker 2>of that head, so at the six o'clock position, that's

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<v Speaker 2>an incredibly sensitive part of the penis. And it's also

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<v Speaker 2>we call an ejaculatory reflex arc, which comes about midway

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<v Speaker 2>into your spinal corrid around T ten to T twelve

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<v Speaker 2>somewhere in there, and it is what causes us to

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<v Speaker 2>have a orgasm through stimulation, which would be you know,

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<v Speaker 2>either hand, mouth, vibrator, orifice, anus, vagina, however, whatever you know,

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<v Speaker 2>there's a lot of different ways that guys can can

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<v Speaker 2>generate an orgasm and an ejaculation, and it does stimulate

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<v Speaker 2>that T twelve reflex arc. And so even in guys

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<v Speaker 2>with spinal cord injuries, interestingly enough, if their injury is

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<v Speaker 2>above that area, they can actually still have an ejaculation

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<v Speaker 2>and potentially an orgasm because that arc is intact. So

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<v Speaker 2>that's the beginning of this. The deeper center for orgasm

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<v Speaker 2>actually is in the tiny sympathetic nerve fibers that surround

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<v Speaker 2>the prostate. And so there are guys that talk about

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<v Speaker 2>having prostate orgasms, and that's a real thing too, because

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<v Speaker 2>you can stimulate the nerve fibers right at the level

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<v Speaker 2>of the prostate, usually through rectal massage. Rarely can guys

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<v Speaker 2>do it through the perineum because it's a little bit

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<v Speaker 2>too much skin in the way. But essentially that's the

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<v Speaker 2>other way to have an orgasm is through prostatic massage.

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<v Speaker 2>And now we go up to the brain and there's

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<v Speaker 2>about five different hormones that are necessary for a guy

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<v Speaker 2>to be able to have an orgasm in av Just

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<v Speaker 2>guess one. You have five different ones, So just give

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<v Speaker 2>me one. I feel like you're one of my medical students. Now.

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<v Speaker 2>Dopamine Yeah, okay, that's yeah, damn dope mean good. Yeah,

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<v Speaker 2>I mean, that's that's number one. Don't mean, is that

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<v Speaker 2>feel good hormone? So that's one. Yeah, Number two. You

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<v Speaker 2>googling this colo yep, dopamine, serotonin, oxytocin. Wow, there's two more.

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<v Speaker 2>I mean the big one that like you know everybody

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<v Speaker 2>and everybody and everybody's on it, the big T man testosterone. Oh,

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<v Speaker 2>du and then the last one is prolactin. So you

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<v Speaker 2>got the three hard ones. Yeah, yeah, So any disorder

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<v Speaker 2>in any of those or any drugs that we take,

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<v Speaker 2>can cause disorders and ejaculation based on how they perturb

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<v Speaker 2>any of those levels from testosterone to dopamint to everything

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<v Speaker 2>in between. So in order to have a good intact

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<v Speaker 2>orgasmic response, and by the way, those are pretty much

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<v Speaker 2>the same in women as men. All those hormones are

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<v Speaker 2>conserved across across gender, and so even testosterone. So women

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<v Speaker 2>that have hypo arousal disorder, it was very difficult for

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<v Speaker 2>them to get aroused or have orgasms often have low testosterone.

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<v Speaker 2>So you got to have hormones and you got to

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<v Speaker 2>have nerves. And those are really the two different ways

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<v Speaker 2>that we think about orgasm. And so when we think

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<v Speaker 2>about disorders of orgasm and ejaculation, we think about him

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<v Speaker 2>as a spectrum of timing. And what I mean by

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<v Speaker 2>that is there are men that have incredibly shortened ejaculatory

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<v Speaker 2>responses where they what we often refer to as premature

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<v Speaker 2>ejaculation or rapid ejaculation, where briefly after stimulation, sometimes even

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<v Speaker 2>prior to penetrative intercourse, a man will ejaculate and that

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<v Speaker 2>is almost always a reflex issue. And when I try

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<v Speaker 2>to unshame this and a guy comes into me, because

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<v Speaker 2>again this is something guys get judged with, they get

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<v Speaker 2>compared to other partners. It's an incredibly shameful thing for

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<v Speaker 2>guys to go through, and it doesn't have to be

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<v Speaker 2>the reason for that is that that when I went

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<v Speaker 2>to medical school and I did my rotations, one of

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<v Speaker 2>the rotations that we did is a neurology where we

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<v Speaker 2>all walked around with their reflex hammers. Maxwell's silver hammer

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<v Speaker 2>for Beatles fans out there, which I think he used

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<v Speaker 2>for very different purposes, but it probably started off as

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<v Speaker 2>a reflex hammer, and there's this little rubber mallet that

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<v Speaker 2>you would hit right under the knee cap, and that

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<v Speaker 2>that was a great way to test our reflexes. I'm

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<v Speaker 2>sure at Viera, any high school physical everybody remembers sitting

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<v Speaker 2>down in the doctor's office with their knees hanging over

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<v Speaker 2>the bed and she or he hit your reflex and

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<v Speaker 2>you kicked your knee out, and we graded that from

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<v Speaker 2>zero to two, I believe, or two plus where a

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<v Speaker 2>guy could be hyper reflexic. So those knees. That knee

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<v Speaker 2>reflex and the same thing we can do in the

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<v Speaker 2>elbow is very important for our ability to know how

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<v Speaker 2>well we're doing neurologically. And if a guy has diminished

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<v Speaker 2>reflex or hyper reflects here, there could be a neurologic condition. Well,

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<v Speaker 2>I kind of look at ejaculation the same way, because

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<v Speaker 2>I just said that reflex arc at the tip of

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<v Speaker 2>the penis is very important for determining how much stimulation

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<v Speaker 2>you need to form an ejaculation. Some guys the wind

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<v Speaker 2>blows funny boom, you know, they ejaculate. Some guys they

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<v Speaker 2>can have penetrated sex for minutes upon hours and not

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<v Speaker 2>be able to ejaculate, and a lot of that is

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<v Speaker 2>delayed reflex. So that's the way I look at this.

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<v Speaker 2>I talk about physiology, and you know, I'm good friends

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<v Speaker 2>and colleagues with Natalie find Get Goldberg, who we had

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<v Speaker 2>on a few episodes ago twenty odd and we talk

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<v Speaker 2>about that a lot of my sex therapists, you know,

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<v Speaker 2>they want me to correct the physiology so that they

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<v Speaker 2>can deal with the psychological manifestations of the physiologic or

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<v Speaker 2>anatomic abnormality. So whether it's about the size of a

0:11:50.760 --> 0:11:54.240
<v Speaker 2>guy's penis or whether it's about how quickly they ejaculate,

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<v Speaker 2>there are things I can do anatomically and physiologic to

0:11:57.240 --> 0:11:59.560
<v Speaker 2>improve those. So then my therapists job is a little

0:11:59.600 --> 0:12:02.240
<v Speaker 2>bit more I don't know, synergistic. We work together better

0:12:02.280 --> 0:12:06.640
<v Speaker 2>that way. So that's the anatomy the physiology of an

0:12:06.679 --> 0:12:11.320
<v Speaker 2>ejaculation in six short minutes. I'm just guessing on the time.

0:12:12.320 --> 0:12:14.000
<v Speaker 2>So what can go wrong? So a guy can either

0:12:14.080 --> 0:12:16.240
<v Speaker 2>come too fast or he can not come at all,

0:12:16.520 --> 0:12:18.920
<v Speaker 2>And what can we do to treat all of those?

0:12:19.000 --> 0:12:21.839
<v Speaker 2>And so I think what I would love for you

0:12:21.920 --> 0:12:23.880
<v Speaker 2>to do, because I just feel like I talk all

0:12:23.920 --> 0:12:25.600
<v Speaker 2>the time, Jordan, I want you to put on your

0:12:25.760 --> 0:12:30.000
<v Speaker 2>journalist hat and pretend like I'm not Ringo star, but

0:12:30.360 --> 0:12:33.760
<v Speaker 2>you know, as a Rolling Stone journalist extraordinary, you know

0:12:33.800 --> 0:12:36.200
<v Speaker 2>in your former life interview me. Tell me what you

0:12:36.200 --> 0:12:39.280
<v Speaker 2>want to know about ejaculation, the good, the bad, and

0:12:39.320 --> 0:12:39.880
<v Speaker 2>the ugly.

0:12:40.640 --> 0:12:42.480
<v Speaker 3>Well, what are the most common issues that you see

0:12:42.520 --> 0:12:43.400
<v Speaker 3>in your practice.

0:12:43.559 --> 0:12:45.640
<v Speaker 2>I think the majority of guys, and I think this

0:12:45.720 --> 0:12:47.959
<v Speaker 2>bears out in the literature and surveys, is that most

0:12:48.000 --> 0:12:52.240
<v Speaker 2>men are more concerned with premature ejaculation. It is something

0:12:52.240 --> 0:12:55.240
<v Speaker 2>that especially happens, we think in younger people, and often

0:12:55.280 --> 0:13:00.400
<v Speaker 2>it starts off with less experienced men because all of

0:13:00.400 --> 0:13:02.840
<v Speaker 2>this is new to them and their nerves, and so

0:13:03.200 --> 0:13:06.000
<v Speaker 2>it's something that is prevalent, and there are all kinds

0:13:06.000 --> 0:13:09.720
<v Speaker 2>of treatments out there, including a lot of off label

0:13:09.800 --> 0:13:12.160
<v Speaker 2>things that we use. In fact, there's actually no FDA

0:13:12.200 --> 0:13:16.640
<v Speaker 2>approved drug for premature ejaculation, So whatever I write for,

0:13:16.720 --> 0:13:18.480
<v Speaker 2>if I'm writing a prescription, it's not going to be

0:13:18.559 --> 0:13:21.679
<v Speaker 2>FDA approved. But yeah, I would say premature ejaculation is

0:13:21.679 --> 0:13:23.559
<v Speaker 2>the most common one. So the first thing I want

0:13:23.559 --> 0:13:25.679
<v Speaker 2>to do is rule out any other things going on.

0:13:25.800 --> 0:13:28.240
<v Speaker 2>You know, I do a full evaluation. Often I will

0:13:28.400 --> 0:13:32.319
<v Speaker 2>even check hormones because a you know, I just don't

0:13:32.320 --> 0:13:34.839
<v Speaker 2>want to miss anything. But most of the time the

0:13:34.960 --> 0:13:38.120
<v Speaker 2>guy with premature ejaculation is perfectly healthy. Otherwise it doesn't

0:13:38.120 --> 0:13:43.640
<v Speaker 2>really indicate any other underlying hormonal pathology or any neurologic dysfunction,

0:13:44.000 --> 0:13:46.680
<v Speaker 2>And it's just a matter of how do we diminish

0:13:47.040 --> 0:13:49.960
<v Speaker 2>that trigger, how do we diminish that T twelve reflex

0:13:50.120 --> 0:13:53.200
<v Speaker 2>arc or that pathway at the frenulum. And so for me,

0:13:53.320 --> 0:13:56.560
<v Speaker 2>the common treatment for this is is to do something

0:13:56.600 --> 0:13:58.880
<v Speaker 2>to diminish the sensitivity, not to the point where the

0:13:58.880 --> 0:14:01.160
<v Speaker 2>guy is numb, or not to the point where he

0:14:01.160 --> 0:14:03.880
<v Speaker 2>could spread any treatment I give to him to his partner,

0:14:03.960 --> 0:14:08.000
<v Speaker 2>especially having penis and vagina sex or P and V sex.

0:14:08.640 --> 0:14:11.720
<v Speaker 2>But there are really good over the counter topical creams

0:14:11.720 --> 0:14:13.559
<v Speaker 2>and sprays. You can get them online. You can get

0:14:13.559 --> 0:14:17.160
<v Speaker 2>them at CVS target, I think, anywhere that and I

0:14:17.200 --> 0:14:19.360
<v Speaker 2>don't endorse any of these, but they're pretty easy to

0:14:19.360 --> 0:14:23.880
<v Speaker 2>find and Google is to help decrease that sensitivity so

0:14:23.920 --> 0:14:28.240
<v Speaker 2>that when a man's having direct stimulation of that area,

0:14:28.760 --> 0:14:30.960
<v Speaker 2>they don't have that quick trigger. And so I think

0:14:30.960 --> 0:14:34.200
<v Speaker 2>that's first line anybody. It's safe, it's effective, and most

0:14:34.240 --> 0:14:36.240
<v Speaker 2>of the time guys don't complain that it gets to

0:14:36.240 --> 0:14:38.360
<v Speaker 2>the point where they can't have any sensitivity at all.

0:14:38.400 --> 0:14:41.720
<v Speaker 2>It's just enough so they can have incredibly meaningful sex

0:14:41.760 --> 0:14:44.040
<v Speaker 2>and last longer than they would without it at all.

0:14:44.320 --> 0:14:46.360
<v Speaker 2>So that's my first line therapy.

0:14:46.520 --> 0:14:49.160
<v Speaker 3>Now do you see have you noticed in your practice

0:14:49.200 --> 0:14:51.640
<v Speaker 3>that younger men these days are having more issues with

0:14:51.840 --> 0:14:54.240
<v Speaker 3>ejaculation than men previously.

0:14:54.920 --> 0:14:56.640
<v Speaker 2>You know, I think it's what it is is just

0:14:56.680 --> 0:15:00.080
<v Speaker 2>becoming much more prevalent and much more talked about. And

0:15:00.240 --> 0:15:01.960
<v Speaker 2>you know, one thing we also didn't talk about, which

0:15:02.040 --> 0:15:05.920
<v Speaker 2>is huge in the zeitgeist is ejaculate volume and this

0:15:06.040 --> 0:15:09.720
<v Speaker 2>idea of loadmaxing and shooting ropes. And again that goes

0:15:09.760 --> 0:15:12.280
<v Speaker 2>back to what it all goes back to. It seems

0:15:12.320 --> 0:15:14.560
<v Speaker 2>like on when we talk about sex on this podcast,

0:15:14.640 --> 0:15:16.600
<v Speaker 2>is what are your expectations based on what you see

0:15:16.600 --> 0:15:19.480
<v Speaker 2>on the internet or in pornography, And so it goes

0:15:19.520 --> 0:15:22.120
<v Speaker 2>back to the athleticism of some of our adult entertainers

0:15:22.160 --> 0:15:25.800
<v Speaker 2>that are able to ejaculate volumes of semen and be

0:15:25.840 --> 0:15:30.080
<v Speaker 2>able to hold their ejaculation through what seems like interminable

0:15:30.400 --> 0:15:34.200
<v Speaker 2>sexual relations, and that to the average guy, especially some

0:15:34.320 --> 0:15:37.480
<v Speaker 2>that it's not so sexually experienced, thinks that that is

0:15:37.760 --> 0:15:40.480
<v Speaker 2>what they aspire for. And again, as we talk about

0:15:40.480 --> 0:15:44.480
<v Speaker 2>so often in the show, most people, especially well I

0:15:44.480 --> 0:15:48.160
<v Speaker 2>should say most people that have vaginas are not orgasming

0:15:48.200 --> 0:15:50.880
<v Speaker 2>through penetrative intercourse, and so sometimes too much can actually

0:15:50.920 --> 0:15:54.480
<v Speaker 2>be too much, and so this is not the goal

0:15:54.560 --> 0:15:56.520
<v Speaker 2>as to how long they are you able to hold

0:15:56.560 --> 0:15:59.240
<v Speaker 2>out before you orgasm. But if you do have a

0:15:59.280 --> 0:16:02.760
<v Speaker 2>partner that does orgasm through vaginal intercourse and you can

0:16:02.840 --> 0:16:05.800
<v Speaker 2>time it, then this idea of simultaneous climax is a

0:16:05.840 --> 0:16:08.920
<v Speaker 2>pretty great aspirational thing, but functionally it doesn't really happen

0:16:08.960 --> 0:16:12.680
<v Speaker 2>that often and is something more in romance novels uh

0:16:12.840 --> 0:16:16.360
<v Speaker 2>and fireworks on scene. So again, don't aspire for something

0:16:16.360 --> 0:16:18.640
<v Speaker 2>that probably doesn't exist that often in nature.

0:16:46.360 --> 0:16:48.560
<v Speaker 3>Back it up a little bit and talked about too soon,

0:16:49.040 --> 0:16:52.120
<v Speaker 3>too late for lack of that in real numbers, what

0:16:52.280 --> 0:16:55.160
<v Speaker 3>is a realistic what is the normal amount of time?

0:16:55.200 --> 0:16:58.040
<v Speaker 2>And I hate you we're normal, but yeah, I love it. No, Actually,

0:16:58.040 --> 0:17:03.680
<v Speaker 2>there are there are clinical definitions of what we consider

0:17:04.119 --> 0:17:07.919
<v Speaker 2>premature ejaculation, and really the best definition I have is

0:17:07.960 --> 0:17:10.240
<v Speaker 2>that anytime that a patient or his partner is not

0:17:10.359 --> 0:17:14.360
<v Speaker 2>satisfied with the length of time prior to ejaculation and orgasm,

0:17:14.960 --> 0:17:17.720
<v Speaker 2>that is what I would consider not long enough. Because

0:17:17.720 --> 0:17:22.960
<v Speaker 2>there are some guys that that again have such severe

0:17:23.080 --> 0:17:27.520
<v Speaker 2>I think is reasonable to say premature ejaculation, rapid ejaculation,

0:17:27.640 --> 0:17:31.040
<v Speaker 2>that they're having an orgasm prior to even having penetrative sex.

0:17:31.520 --> 0:17:34.600
<v Speaker 2>And so that's on one end of the spectrum. The

0:17:35.000 --> 0:17:39.159
<v Speaker 2>typically greed upon term is you know, somewhere under a

0:17:39.200 --> 0:17:42.440
<v Speaker 2>couple minutes, you know, the average sexual exponse from insertion. Again,

0:17:42.480 --> 0:17:44.840
<v Speaker 2>this is based on penis and vagina sex for the

0:17:44.880 --> 0:17:48.480
<v Speaker 2>most part, because that's what we have standardized questionnaires for. Unfortunately,

0:17:48.520 --> 0:17:51.200
<v Speaker 2>we don't have great other alternative methods of having sex

0:17:51.240 --> 0:17:54.880
<v Speaker 2>for anal and oral intercourse, but it is this two

0:17:54.920 --> 0:17:57.920
<v Speaker 2>minute to five minutes is kind of a normal time

0:17:58.000 --> 0:18:01.960
<v Speaker 2>from insertion to orgasm, and so that means anything greater

0:18:02.000 --> 0:18:05.000
<v Speaker 2>than that. If, again, it's causing discomfort to either the

0:18:05.000 --> 0:18:08.240
<v Speaker 2>patient or the partner, then that could be delayed ejaculation.

0:18:08.640 --> 0:18:10.959
<v Speaker 2>And so really the sweet spot depends on the couple.

0:18:11.240 --> 0:18:15.280
<v Speaker 2>You know, for some it's the partner comes first, and

0:18:15.320 --> 0:18:18.760
<v Speaker 2>then it's just a matter of the man or the

0:18:18.800 --> 0:18:21.119
<v Speaker 2>person with the penis that is able to finish whenever

0:18:21.320 --> 0:18:24.520
<v Speaker 2>at their leisure. Because the other person has already achieved orgasm,

0:18:25.000 --> 0:18:29.480
<v Speaker 2>then premature ejaculation delayed ejaculation becomes less of an issue.

0:18:29.720 --> 0:18:33.200
<v Speaker 3>And there are some men who struggle to orgasm during

0:18:33.240 --> 0:18:36.920
<v Speaker 3>partnered sex even though when they're alone. That is not

0:18:37.040 --> 0:18:40.520
<v Speaker 3>a problem of performance anxiety or any kind of other

0:18:40.520 --> 0:18:43.679
<v Speaker 3>psychological issues. Are there some physiological reasons for that?

0:18:44.000 --> 0:18:45.560
<v Speaker 2>Yeah, I mean there are. I mean I think that

0:18:46.080 --> 0:18:47.920
<v Speaker 2>I kind of not joke about it, but I do

0:18:47.960 --> 0:18:50.320
<v Speaker 2>want people to kind of think about the fact that

0:18:50.359 --> 0:18:54.520
<v Speaker 2>if a man has been used to the feeling of

0:18:54.560 --> 0:18:57.119
<v Speaker 2>his own hand and grip strength for a long period

0:18:57.160 --> 0:18:59.760
<v Speaker 2>of time and spends a lot of time in masturbation,

0:19:00.560 --> 0:19:03.560
<v Speaker 2>then that's a feeling and that's a neurologic conditioned response

0:19:03.640 --> 0:19:06.240
<v Speaker 2>that when he goes to have penetrative intercourse with the partner,

0:19:06.840 --> 0:19:09.000
<v Speaker 2>it may not feel the same way to those nerves,

0:19:09.040 --> 0:19:12.120
<v Speaker 2>and so there can be a desensitization to that. I'm

0:19:12.160 --> 0:19:14.800
<v Speaker 2>not here to judge on what the appropriate amount or

0:19:14.840 --> 0:19:18.119
<v Speaker 2>the ratio of a single versus partnered sex should be, because

0:19:18.080 --> 0:19:20.479
<v Speaker 2>I don't think amy has an answer that, except for

0:19:20.520 --> 0:19:23.200
<v Speaker 2>if it becomes a problem where it's pathologic and somebody

0:19:23.240 --> 0:19:26.160
<v Speaker 2>is having more partnered or more solo sex than partnered sex,

0:19:26.160 --> 0:19:28.439
<v Speaker 2>and the partner's like, hey, what's going on, then that

0:19:28.520 --> 0:19:31.919
<v Speaker 2>becomes a problem. But for sure, it's not as simple

0:19:32.400 --> 0:19:35.080
<v Speaker 2>as just a psychological issue of saying I can orgasm

0:19:35.359 --> 0:19:38.040
<v Speaker 2>with my partner, but I can by myself. But it

0:19:38.040 --> 0:19:41.280
<v Speaker 2>can be definitely a relationship issue that needs to be explored,

0:19:41.520 --> 0:19:44.080
<v Speaker 2>and really the therapy for that depends. Sometimes it is

0:19:44.080 --> 0:19:48.280
<v Speaker 2>sex therapy, sometimes it is not having solo sex and

0:19:48.400 --> 0:19:52.320
<v Speaker 2>manual sex for a period of time and then engaging

0:19:52.320 --> 0:19:56.360
<v Speaker 2>in normal penetrative intercourse with a partner. That can help

0:19:56.400 --> 0:19:59.000
<v Speaker 2>some guys through this. But yes, a conditioned response is

0:19:59.359 --> 0:20:02.119
<v Speaker 2>for sure, and it's a neurologic issue. And if you

0:20:02.200 --> 0:20:04.880
<v Speaker 2>desensitize the penis or you get used to only one

0:20:04.920 --> 0:20:08.199
<v Speaker 2>sensation to orgasm, it's the same thing with positions. I mean,

0:20:08.240 --> 0:20:10.720
<v Speaker 2>there's some men that can only orgasm in one position

0:20:10.960 --> 0:20:14.560
<v Speaker 2>versus another position, and it's that same condition response. Some

0:20:14.600 --> 0:20:16.840
<v Speaker 2>of that isn't pathologic as long as you're okay with it.

0:20:16.880 --> 0:20:18.800
<v Speaker 2>In other words, as long as as you and your

0:20:18.800 --> 0:20:22.240
<v Speaker 2>partner are okay and you're both sexually satisfied, then everything

0:20:22.280 --> 0:20:25.000
<v Speaker 2>else is just judgment. And we don't judge here, man.

0:20:26.640 --> 0:20:27.800
<v Speaker 2>I guess dovetail with that.

0:20:27.960 --> 0:20:30.720
<v Speaker 3>There's a phrase it's become very buzzy of seeing on

0:20:30.840 --> 0:20:33.840
<v Speaker 3>the internet lately. I was curious, if it's crossed your

0:20:33.880 --> 0:20:36.960
<v Speaker 3>path and your practice death grip syndrome, does that mean

0:20:37.000 --> 0:20:37.600
<v Speaker 3>anything to you?

0:20:38.280 --> 0:20:42.560
<v Speaker 2>Well, I can only imagine. But obviously we have different feeds,

0:20:42.640 --> 0:20:46.920
<v Speaker 2>you know, mostly I mostly get updates on my sabermetrics,

0:20:46.920 --> 0:20:51.000
<v Speaker 2>on my Dodgers and my in basket, but Okay, Jordan. Again,

0:20:51.000 --> 0:20:54.080
<v Speaker 2>I'm not judging that I've not had any death grip

0:20:54.119 --> 0:20:58.080
<v Speaker 2>syndrome feet, but it sounds like, yeah, guys are probably

0:20:58.480 --> 0:21:01.880
<v Speaker 2>using way too much man old grip strength in order

0:21:01.880 --> 0:21:04.240
<v Speaker 2>to induce an orgasm, so they're used to that incredible

0:21:04.320 --> 0:21:07.920
<v Speaker 2>level of grip strength or just the right amount of stimulation,

0:21:07.960 --> 0:21:09.679
<v Speaker 2>which again goes back to the whole deal is if

0:21:09.720 --> 0:21:12.600
<v Speaker 2>you're only doing it one way, then that can condition

0:21:12.680 --> 0:21:14.399
<v Speaker 2>that response so that that's the only way you're ever

0:21:14.440 --> 0:21:17.399
<v Speaker 2>going to orgasm and your partners don't stand a chance.

0:21:17.680 --> 0:21:19.800
<v Speaker 2>And I think that is much more common than we think,

0:21:20.200 --> 0:21:22.960
<v Speaker 2>and one that probably does take a lot of retraining

0:21:23.000 --> 0:21:24.919
<v Speaker 2>and maybe a little bit of sex therapy, but mostly

0:21:24.960 --> 0:21:28.760
<v Speaker 2>probably neurologic reconditioning so that they can have a better

0:21:29.119 --> 0:21:32.440
<v Speaker 2>sex life and not induce death grip syndrome in order

0:21:32.480 --> 0:21:37.200
<v Speaker 2>to have that same ejaculatory response. That's sad. Yeah, I

0:21:37.200 --> 0:21:40.000
<v Speaker 2>haven't heard of death grip syndrome, but boy, but now

0:21:40.000 --> 0:21:42.440
<v Speaker 2>I can't unthink it or unsee it. Probably, and I'll

0:21:42.520 --> 0:21:44.120
<v Speaker 2>go back to my office today and have three guys

0:21:44.200 --> 0:21:46.240
<v Speaker 2>that have death grip syndrome in my clinic because of you.

0:21:46.320 --> 0:21:48.800
<v Speaker 3>Now, death grip weren't they one of the big four

0:21:48.840 --> 0:21:50.200
<v Speaker 3>in the post punk.

0:21:50.440 --> 0:21:55.560
<v Speaker 2>Yes, that's right exactly. They were. They open for Circle Jerks.

0:21:56.320 --> 0:21:58.800
<v Speaker 2>So there you have it, death Grip syndrome. If not,

0:21:58.880 --> 0:22:01.240
<v Speaker 2>we're doing it. We're starting our own band right now.

0:22:02.400 --> 0:22:07.199
<v Speaker 2>DGS Baby catch DGS at CBGB's Oh yeah, seventy eight

0:22:07.280 --> 0:22:09.359
<v Speaker 2>that show. I was there, man, I was in the

0:22:09.359 --> 0:22:12.040
<v Speaker 2>front row with the Red Hot Chili Peppers wearing socks

0:22:12.040 --> 0:22:14.880
<v Speaker 2>on their dick. Yeah, I think you're thinking of Death

0:22:14.920 --> 0:22:18.000
<v Speaker 2>Grip for cuty I mean, they really launched this entire

0:22:18.960 --> 0:22:23.239
<v Speaker 2>choking vocals kind of indie punk sort of thing. It was.

0:22:23.920 --> 0:22:26.840
<v Speaker 2>It's really big in the late nineties, early two thousand's

0:22:27.080 --> 0:22:29.520
<v Speaker 2>Death Grip for Cutie. I think they're probably Hall of

0:22:29.560 --> 0:22:32.800
<v Speaker 2>famers by this point. Oh man, we could go on.

0:22:33.000 --> 0:22:34.359
<v Speaker 1>So yeah, we're keeping all of this.

0:22:35.480 --> 0:22:38.359
<v Speaker 2>Of course we are. Yeah, because again, I mean the

0:22:38.600 --> 0:22:41.600
<v Speaker 2>theme of this is also you're probably gonna be okay

0:22:41.359 --> 0:22:44.080
<v Speaker 2>that there are so many treatments, so we you know,

0:22:44.119 --> 0:22:46.800
<v Speaker 2>getting past past what we were talking about with the premature.

0:22:46.800 --> 0:22:48.639
<v Speaker 2>And I'm by the way, not trying to reroute you

0:22:48.680 --> 0:22:51.399
<v Speaker 2>at all, because I could talk punk rock forever, but

0:22:51.680 --> 0:22:54.000
<v Speaker 2>you know, somewhat a medical show. I think we're still

0:22:54.040 --> 0:22:57.440
<v Speaker 2>in that category, haven't quite got to the entertainment level yet.

0:22:57.720 --> 0:23:02.679
<v Speaker 2>But rerouting to thinking about premature ejaculation, So topical spraise,

0:23:02.960 --> 0:23:06.720
<v Speaker 2>topical creams first line. But there is a whole branch

0:23:06.800 --> 0:23:11.800
<v Speaker 2>of relatively good data on looking at starting guys on SSRIs,

0:23:11.800 --> 0:23:14.359
<v Speaker 2>which you talked about as one of the hormones in

0:23:14.440 --> 0:23:17.720
<v Speaker 2>that ejaculatory pathway serotonin. So if you can modulate serotonin

0:23:17.800 --> 0:23:21.440
<v Speaker 2>levels through taking the drugs that we usually prescribe for antidepression,

0:23:21.840 --> 0:23:24.159
<v Speaker 2>that could be a game changer for some guys. And

0:23:24.200 --> 0:23:27.080
<v Speaker 2>I think that's really really interesting, and I've certainly used

0:23:27.080 --> 0:23:29.920
<v Speaker 2>those over the twenty odd years I've been treating guys

0:23:29.920 --> 0:23:33.399
<v Speaker 2>with premature ejaculation to a good effect, and you often do.

0:23:34.359 --> 0:23:37.080
<v Speaker 2>I always started a lower dose, and again this by

0:23:37.119 --> 0:23:39.399
<v Speaker 2>no means as medical advice, just so we know this,

0:23:39.600 --> 0:23:41.919
<v Speaker 2>but if you were in my office and you were

0:23:41.920 --> 0:23:44.720
<v Speaker 2>actually my patient, I do often start at a lower

0:23:44.760 --> 0:23:47.840
<v Speaker 2>dose then I would when a guy would be treating

0:23:48.200 --> 0:23:51.399
<v Speaker 2>depression with antidepressants, and sometimes that can be effective at

0:23:51.520 --> 0:23:55.000
<v Speaker 2>just taking that serotonin level to the point where where

0:23:55.000 --> 0:23:57.920
<v Speaker 2>a guy's ejaculatory threshold gets up a little bit takes

0:23:57.920 --> 0:24:00.480
<v Speaker 2>a little more stimulation to make that release and to

0:24:00.520 --> 0:24:03.600
<v Speaker 2>cause that orgasmic cascade which then leads to ejaculation. So

0:24:04.000 --> 0:24:07.560
<v Speaker 2>SSRIs are I would say first to second line therapy

0:24:07.600 --> 0:24:10.879
<v Speaker 2>for this and the other therapy that some people have

0:24:10.960 --> 0:24:14.359
<v Speaker 2>tried is more of a dopamine modulator, and that's something

0:24:14.480 --> 0:24:18.639
<v Speaker 2>called ultram tramadol Is is a generic name. Now, problem

0:24:18.680 --> 0:24:21.639
<v Speaker 2>with tramadoll is it's also considered a little bit along

0:24:21.720 --> 0:24:25.199
<v Speaker 2>the controlled substance narcotic pathway, and so it never I

0:24:25.280 --> 0:24:27.439
<v Speaker 2>was years ago part of a clinical trial or an

0:24:27.440 --> 0:24:31.760
<v Speaker 2>advisory board looking at bringing tramadol on at a slightly

0:24:31.800 --> 0:24:35.680
<v Speaker 2>different dose than what we use for postoperative pain as

0:24:35.760 --> 0:24:40.439
<v Speaker 2>a as an premature ejaculation FDA approved drug, and it

0:24:40.520 --> 0:24:42.440
<v Speaker 2>ran into a couple of problems. One is, it was

0:24:42.480 --> 0:24:44.880
<v Speaker 2>already generic, so there was no market for this because

0:24:44.920 --> 0:24:46.719
<v Speaker 2>you could write for it anyway, and it was pennies

0:24:46.720 --> 0:24:49.679
<v Speaker 2>on the pennies on the dollar. But two is because

0:24:49.720 --> 0:24:51.919
<v Speaker 2>the concern is that it could be habit forming, and

0:24:51.960 --> 0:24:54.399
<v Speaker 2>it was never really panned out very much as being

0:24:54.440 --> 0:24:57.320
<v Speaker 2>habit for me, especially at the dosing and the on

0:24:57.440 --> 0:24:59.879
<v Speaker 2>demand way that we would prescribe it. For a pre

0:25:00.080 --> 0:25:03.639
<v Speaker 2>mature ejaculation because you just took it ahead of sexual accounter,

0:25:03.800 --> 0:25:06.000
<v Speaker 2>just like you would take a drug like sildentiphil or

0:25:06.000 --> 0:25:08.639
<v Speaker 2>to dalaphil for rectile dysfunction. But again it never got

0:25:08.680 --> 0:25:11.200
<v Speaker 2>AFTY approved. Only thing made to a clinical trial may

0:25:11.359 --> 0:25:13.639
<v Speaker 2>not have even made it past that advisory board because

0:25:13.800 --> 0:25:16.320
<v Speaker 2>you know, I think from a financial standpoint, it's really

0:25:16.400 --> 0:25:18.480
<v Speaker 2>tough to go to the FDA and getting a drug

0:25:18.520 --> 0:25:22.600
<v Speaker 2>approved that already as an indication and as generic there's

0:25:22.640 --> 0:25:25.600
<v Speaker 2>just no notion, just no money in it. But Tramadah

0:25:25.600 --> 0:25:28.520
<v Speaker 2>will be another one that some people use. There also

0:25:28.800 --> 0:25:31.280
<v Speaker 2>are medical devices out and there are a couple of

0:25:31.320 --> 0:25:33.600
<v Speaker 2>these that do have that I think are pending FDA

0:25:33.680 --> 0:25:37.240
<v Speaker 2>clearics that are available overseas that essentially are like nerve

0:25:37.280 --> 0:25:40.280
<v Speaker 2>stimulators that you wear behind the testicles in that area

0:25:40.640 --> 0:25:43.800
<v Speaker 2>that we lovingly referred to as the taint or the perineum,

0:25:43.840 --> 0:25:45.920
<v Speaker 2>where you place a little patch that's the size of

0:25:45.960 --> 0:25:49.800
<v Speaker 2>a poster stamp, and it actually hyper polarizes or causes

0:25:49.840 --> 0:25:54.640
<v Speaker 2>the nerves to fire a little bit less aggressively and

0:25:54.640 --> 0:25:57.119
<v Speaker 2>it can delay the ejaculatory response. And the clinical trials

0:25:57.119 --> 0:25:59.879
<v Speaker 2>and that are actually pretty good, and so that's a

0:26:00.080 --> 0:26:03.080
<v Speaker 2>device that will be a disposable that again somebody wire

0:26:03.200 --> 0:26:05.520
<v Speaker 2>just prior to intercourse, and it can be so discreete

0:26:05.280 --> 0:26:08.320
<v Speaker 2>that your partner may not even know that you have

0:26:08.400 --> 0:26:10.280
<v Speaker 2>it because it's so small. It's just a couple of

0:26:10.280 --> 0:26:13.440
<v Speaker 2>little electrodes, and it's safe. It's not going to shock

0:26:13.480 --> 0:26:15.440
<v Speaker 2>you or anything. But it is something that can cause

0:26:15.480 --> 0:26:19.560
<v Speaker 2>a little neurostimulation to delay ejaculation. So I'm kind of

0:26:19.560 --> 0:26:21.960
<v Speaker 2>interested in that. Again, don't have right now, have no

0:26:22.119 --> 0:26:24.520
<v Speaker 2>financial interest in any of the companies or no consulting

0:26:25.000 --> 0:26:27.840
<v Speaker 2>for any of those companies, but certainly as an observer

0:26:28.119 --> 0:26:30.040
<v Speaker 2>and an intellectual, I think that could be a new

0:26:30.119 --> 0:26:32.080
<v Speaker 2>future for guys with premature ejaculation.

0:26:33.280 --> 0:26:35.359
<v Speaker 3>That's interesting that you prescribe BSSRIS for us. So I

0:26:35.440 --> 0:26:37.439
<v Speaker 3>was going to ask you about what happens because you

0:26:37.520 --> 0:26:40.440
<v Speaker 3>hear all these stories about people being put on anidepressants

0:26:40.480 --> 0:26:44.080
<v Speaker 3>and then the libida goes down right in extreme cases

0:26:44.440 --> 0:26:48.080
<v Speaker 3>or yeah, extreme cases, perhaps I should ask you how

0:26:48.119 --> 0:26:50.159
<v Speaker 3>do you deal with kind of the inverse of that?

0:26:50.480 --> 0:26:52.320
<v Speaker 2>Yeah, yeah, I mean I think that's a big problem.

0:26:52.400 --> 0:26:55.200
<v Speaker 2>So that goes back to why we discovered this would

0:26:55.200 --> 0:26:57.879
<v Speaker 2>be an interesting therapy for guys with premature ejaculations. The

0:26:57.880 --> 0:27:00.560
<v Speaker 2>guys are on full depressant doses. So you know what,

0:27:00.600 --> 0:27:02.480
<v Speaker 2>I have not been able to have an orgasm since

0:27:02.520 --> 0:27:05.280
<v Speaker 2>I've been on these medications, and my depressions better, but

0:27:05.359 --> 0:27:09.160
<v Speaker 2>now I'm kind of upset about this untoward side effect.

0:27:09.160 --> 0:27:10.800
<v Speaker 2>And so there is a balance, and there are a

0:27:10.800 --> 0:27:14.919
<v Speaker 2>couple of medications that do better for treating depression that

0:27:14.960 --> 0:27:20.000
<v Speaker 2>have less orgasmic effects, and those you can certainly talk

0:27:20.040 --> 0:27:22.719
<v Speaker 2>to your primary or psychiatrists prescribing and they'll know what

0:27:22.760 --> 0:27:26.399
<v Speaker 2>they are that that you can try those instead, because

0:27:26.400 --> 0:27:29.679
<v Speaker 2>they have some of them have dopamine pathways and some

0:27:29.760 --> 0:27:32.080
<v Speaker 2>of them have nor epinephrin pathways, and so they do

0:27:32.359 --> 0:27:37.360
<v Speaker 2>modulate different than just pure serotonin reuptake inhibitors, and so

0:27:37.359 --> 0:27:39.439
<v Speaker 2>so that's definitely where that having a conversation on. And

0:27:39.480 --> 0:27:42.240
<v Speaker 2>when I see a guy that's on more traditional pure SSRI,

0:27:42.760 --> 0:27:44.639
<v Speaker 2>that might be my first thing is check back in

0:27:44.680 --> 0:27:47.919
<v Speaker 2>with your psychiatrists, because there maybe something out there that

0:27:48.040 --> 0:27:50.280
<v Speaker 2>is a little bit better for sexual function that still

0:27:50.280 --> 0:27:54.399
<v Speaker 2>gives you the benefit of not having the depressive sentence

0:27:54.400 --> 0:27:56.760
<v Speaker 2>I got you on that medication in the first place.

0:27:57.320 --> 0:28:00.520
<v Speaker 2>So yeah, there are better alternatives out there than the

0:28:00.000 --> 0:28:02.800
<v Speaker 2>classic SSRIs that have been out for thirty five years

0:28:02.880 --> 0:28:04.040
<v Speaker 2>now at least.

0:28:27.400 --> 0:28:29.760
<v Speaker 3>Are there any ways that you could think of offhand

0:28:29.840 --> 0:28:34.000
<v Speaker 3>that men well meaning who are maybe too shy to

0:28:34.040 --> 0:28:36.040
<v Speaker 3>go speak to a doctor about this, will try to

0:28:36.240 --> 0:28:38.880
<v Speaker 3>help their own treat their own what they may be

0:28:38.960 --> 0:28:44.160
<v Speaker 3>used performance anxiety or rectile dysfunction or ejaculatory disorders and

0:28:44.200 --> 0:28:46.200
<v Speaker 3>actually accident and make it worse. There things that guys

0:28:46.240 --> 0:28:49.320
<v Speaker 3>should absolutely not do. That maybe are myths out there

0:28:49.400 --> 0:28:52.920
<v Speaker 3>that are our old wives tales that people should steer

0:28:52.960 --> 0:28:53.320
<v Speaker 3>clear of.

0:28:53.720 --> 0:28:58.320
<v Speaker 2>Yeah, I mean, I guess for ejaculatory dysfunction or erecti dysfunction,

0:28:58.400 --> 0:29:02.040
<v Speaker 2>there really are very few and no reasonable supplements that

0:29:02.040 --> 0:29:04.920
<v Speaker 2>I would recommend. So I'm sure it's just it's a scary,

0:29:04.920 --> 0:29:07.760
<v Speaker 2>scary world out there. And again a lot of the

0:29:08.240 --> 0:29:11.520
<v Speaker 2>supplements that are on the erectodysfunction pathway, especially ones that

0:29:11.560 --> 0:29:15.320
<v Speaker 2>may have any effect at all, have contraband still dentifiled

0:29:15.320 --> 0:29:18.040
<v Speaker 2>to dala fill in them. So the ED the pharmacologic

0:29:18.320 --> 0:29:22.120
<v Speaker 2>ED drugs are in there, and I would hasten and

0:29:22.280 --> 0:29:26.200
<v Speaker 2>hazard to guess that that maybe some of the vitamins

0:29:26.280 --> 0:29:29.080
<v Speaker 2>or supplements that people would be marketing for premature ejaculation

0:29:29.160 --> 0:29:31.960
<v Speaker 2>may have ssriyes in them and in the same level,

0:29:32.080 --> 0:29:34.280
<v Speaker 2>don't know that at all. But Sirch stands to reason

0:29:34.280 --> 0:29:36.320
<v Speaker 2>that if you can go to a truck stop and

0:29:36.320 --> 0:29:39.239
<v Speaker 2>buy a truck stop viagra that actually has viagrant is

0:29:39.240 --> 0:29:42.760
<v Speaker 2>not just horny goat weed and gin sing and el

0:29:42.840 --> 0:29:45.840
<v Speaker 2>citraline or something, it does actually have an active FDA

0:29:45.880 --> 0:29:47.840
<v Speaker 2>approved ingredient. And I bet they're doing the same thing

0:29:47.840 --> 0:29:50.360
<v Speaker 2>on premature ejaculation. So the answer is, yeah, don't just

0:29:50.400 --> 0:29:52.560
<v Speaker 2>don't know, go talk to your physician about it and

0:29:53.520 --> 0:29:56.240
<v Speaker 2>get on a real pathway that even if it's off

0:29:56.320 --> 0:30:01.440
<v Speaker 2>label like the SSRIs are for premature ejaculation, it's still possible.

0:30:01.800 --> 0:30:04.560
<v Speaker 2>And that really the same with delayed ejaculation. And I

0:30:04.560 --> 0:30:06.960
<v Speaker 2>think the other thing that we talked about with Natalie

0:30:06.960 --> 0:30:09.200
<v Speaker 2>finding a goldberg that I think is really interesting is

0:30:09.240 --> 0:30:11.240
<v Speaker 2>that there may be a role for pelic floor physical

0:30:11.280 --> 0:30:16.960
<v Speaker 2>therapy and both improving ejaculatory response from a premature or

0:30:17.000 --> 0:30:20.600
<v Speaker 2>a delayed ejaculation standpoint. And there are pelvic floor exercises

0:30:20.600 --> 0:30:22.880
<v Speaker 2>that can make us have a little better control of

0:30:22.920 --> 0:30:25.440
<v Speaker 2>our ejaculatory response. So again I would go to pelvic

0:30:25.520 --> 0:30:28.920
<v Speaker 2>therapy before I think about buying any supplements that would

0:30:28.920 --> 0:30:31.840
<v Speaker 2>report that or any medical devices that don't have any

0:30:31.840 --> 0:30:35.760
<v Speaker 2>good data behind them. So yeah, be careful what you

0:30:35.840 --> 0:30:39.680
<v Speaker 2>come across because it's an incredible market out there of

0:30:39.720 --> 0:30:42.160
<v Speaker 2>things that you can try that really don't have efficacy,

0:30:42.480 --> 0:30:45.920
<v Speaker 2>and potentially some of them have dangers, like hidden prescription

0:30:46.000 --> 0:30:48.480
<v Speaker 2>drugs that you may have a response to. For example,

0:30:48.480 --> 0:30:51.600
<v Speaker 2>if you're already on an antidepressent, you still have premature ejaculation,

0:30:51.680 --> 0:30:53.880
<v Speaker 2>then you take a drug that may have or a

0:30:53.920 --> 0:30:56.200
<v Speaker 2>supplement that may have snuck in some you know, that

0:30:56.240 --> 0:30:58.680
<v Speaker 2>could not be great to be overdosing on that same thing.

0:30:58.720 --> 0:31:01.800
<v Speaker 2>As if you're taking any drug and then you take

0:31:01.840 --> 0:31:03.600
<v Speaker 2>another one at a truck stop, or if you have

0:31:03.640 --> 0:31:07.000
<v Speaker 2>heart conditions that you need to take medications where those

0:31:07.080 --> 0:31:11.040
<v Speaker 2>drugs are absolutely contraindicated. Yeah, he could end up really

0:31:11.040 --> 0:31:14.240
<v Speaker 2>harming yourself. So yeah, really be careful of anything that

0:31:14.920 --> 0:31:17.600
<v Speaker 2>you see over the counter and anything in the supplement world,

0:31:17.640 --> 0:31:18.840
<v Speaker 2>anything you can buy online.

0:31:19.000 --> 0:31:21.200
<v Speaker 3>It was a broad question, but I'm interested in your

0:31:21.200 --> 0:31:24.240
<v Speaker 3>take on it. What is the healthiest way to think

0:31:24.280 --> 0:31:27.200
<v Speaker 3>about ejaculation and performance because I feel like so much

0:31:27.200 --> 0:31:29.160
<v Speaker 3>of it is people getting in their own heads.

0:31:29.520 --> 0:31:31.960
<v Speaker 2>Yeah, you know. I think it goes back to if

0:31:31.960 --> 0:31:35.040
<v Speaker 2>it's with a partner, it's having that communication, you know,

0:31:35.080 --> 0:31:37.479
<v Speaker 2>and what feels good to both you and the partner,

0:31:37.480 --> 0:31:40.240
<v Speaker 2>and then having that discussion, especially if you have a

0:31:40.320 --> 0:31:46.040
<v Speaker 2>history of having either difficulty achieving orgasm or premature orgasm.

0:31:46.320 --> 0:31:48.480
<v Speaker 2>Those are two things that your partner should know because

0:31:48.800 --> 0:31:52.040
<v Speaker 2>a lot of people will take it personally if a

0:31:52.080 --> 0:31:56.000
<v Speaker 2>guy has delayed orgasm and they're with a new partner

0:31:56.400 --> 0:31:58.960
<v Speaker 2>and he has a physiologic or neurologic reason, or he

0:31:59.040 --> 0:32:01.640
<v Speaker 2>is on medication that he has to be on, and

0:32:01.680 --> 0:32:04.800
<v Speaker 2>you don't communicate that upfront, and you're ten minutes, fifteen minutes,

0:32:04.840 --> 0:32:08.520
<v Speaker 2>thirty minutes, sixty minutes into an in session of intercourse

0:32:08.800 --> 0:32:11.280
<v Speaker 2>and it hasn't happened. That person may take it personally

0:32:11.280 --> 0:32:12.520
<v Speaker 2>if you didn't say, hey, look, I just got to

0:32:12.560 --> 0:32:14.600
<v Speaker 2>let you know ahead of time. This is kind of

0:32:14.640 --> 0:32:16.680
<v Speaker 2>an issue for me. So again, it goes back to

0:32:17.200 --> 0:32:20.800
<v Speaker 2>communication being the most important thing to any sexual encounter,

0:32:21.440 --> 0:32:25.800
<v Speaker 2>either pre game, intro game, or postgame, and especially postgame.

0:32:25.840 --> 0:32:28.120
<v Speaker 2>If you find something that really did work, then you

0:32:28.160 --> 0:32:29.960
<v Speaker 2>want to be able to talk about that and say, hey,

0:32:29.960 --> 0:32:32.520
<v Speaker 2>this was really effective for me. This was great. You

0:32:32.600 --> 0:32:34.560
<v Speaker 2>got to let that partner know, so you got to

0:32:34.560 --> 0:32:36.600
<v Speaker 2>know what to look forward to next time.

0:32:36.760 --> 0:32:38.920
<v Speaker 3>The main takeaway from a lot of these episodes lately

0:32:38.960 --> 0:32:40.479
<v Speaker 3>has been talk about it.

0:32:41.200 --> 0:32:43.800
<v Speaker 2>Yeah, man, let's talk about it. These are things that

0:32:43.840 --> 0:32:46.720
<v Speaker 2>also that it's so hard to talk about. And I again,

0:32:46.760 --> 0:32:48.680
<v Speaker 2>I always go back to how grateful I am for

0:32:48.720 --> 0:32:50.560
<v Speaker 2>the career I have where men are able to come

0:32:50.560 --> 0:32:53.800
<v Speaker 2>to me and speak with me and talk with me

0:32:53.880 --> 0:32:56.680
<v Speaker 2>about these conditions that they may not have had that

0:32:56.720 --> 0:33:00.920
<v Speaker 2>conversation with their partners yet. And some times I hear

0:33:00.960 --> 0:33:02.840
<v Speaker 2>back from them and say, you know what, that was

0:33:02.840 --> 0:33:05.040
<v Speaker 2>actually the best thing we ever did is we sat down,

0:33:05.120 --> 0:33:08.320
<v Speaker 2>we talk about it. And my advice I always hear

0:33:08.320 --> 0:33:11.560
<v Speaker 2>from my sex therapy colleagues is that you want to

0:33:11.560 --> 0:33:14.040
<v Speaker 2>talk about sex not in the bedroom. You want to

0:33:14.080 --> 0:33:16.520
<v Speaker 2>talk about it somewhere else and then bring it to

0:33:16.600 --> 0:33:18.760
<v Speaker 2>the bedroom. So you know, if you're going through your

0:33:19.240 --> 0:33:21.360
<v Speaker 2>x's and o's and your chalk talk, you do that

0:33:21.400 --> 0:33:22.680
<v Speaker 2>in the locker room, and then you get on the

0:33:22.680 --> 0:33:25.480
<v Speaker 2>field and you play your game. So don't start doing

0:33:25.520 --> 0:33:28.800
<v Speaker 2>a game plan mid game. Don't call audibles, and sex.

0:33:29.320 --> 0:33:31.680
<v Speaker 2>That seems very restrictive. Maybe I don't want to say that,

0:33:31.720 --> 0:33:33.600
<v Speaker 2>maybe you should call audibles and sex, but I think

0:33:33.640 --> 0:33:36.040
<v Speaker 2>only when you're to the point where you communicate and

0:33:36.080 --> 0:33:39.680
<v Speaker 2>you're such a field marshal that you have commanded the situation,

0:33:40.480 --> 0:33:43.040
<v Speaker 2>that you can do that. But for the most part,

0:33:43.200 --> 0:33:45.400
<v Speaker 2>it's really good to talk about this so that everybody's

0:33:45.440 --> 0:33:49.800
<v Speaker 2>expectations are on the same playing field, the same level,

0:33:49.840 --> 0:33:53.680
<v Speaker 2>to know what we're all getting ourselves into this with

0:33:53.800 --> 0:33:57.200
<v Speaker 2>this beast with two backs. Damn we got Shakespeare today,

0:33:57.280 --> 0:34:02.880
<v Speaker 2>Jordan Wow right to flow host punk and Shakespeare host

0:34:02.880 --> 0:34:05.400
<v Speaker 2>Punk and Shakespeare, same episode. You heard it on the mail,

0:34:06.680 --> 0:34:09.080
<v Speaker 2>So yeah, I think right. For all of these things,

0:34:09.120 --> 0:34:13.279
<v Speaker 2>it's it is just knowing that there are therapies out there,

0:34:13.440 --> 0:34:18.400
<v Speaker 2>also knowing that, especially for delayed orgasm, the medical therapies

0:34:18.440 --> 0:34:20.799
<v Speaker 2>are very very limited. You know, we really just we

0:34:20.840 --> 0:34:24.719
<v Speaker 2>have zero FDA proved. But there are some things at work,

0:34:24.840 --> 0:34:26.880
<v Speaker 2>you know. One of the things we talked about is

0:34:27.360 --> 0:34:30.440
<v Speaker 2>prolactin is one of the hormones that has to be

0:34:30.440 --> 0:34:32.319
<v Speaker 2>at a good level for an orgasm, and if you

0:34:32.360 --> 0:34:35.759
<v Speaker 2>have your prolactin levels too high, it can actually inhibit orgasm.

0:34:36.200 --> 0:34:39.240
<v Speaker 2>So there are medications off label used for other reasons

0:34:39.760 --> 0:34:43.200
<v Speaker 2>that you may have some success with. The classic one

0:34:43.239 --> 0:34:47.000
<v Speaker 2>is something called kabergoline, which lowers the prolactin levels. We

0:34:47.120 --> 0:34:49.440
<v Speaker 2>use it for guys that have or women too, that

0:34:49.520 --> 0:34:52.920
<v Speaker 2>have pituitary tumors where they're secreting too much prolactin, and

0:34:52.920 --> 0:34:55.680
<v Speaker 2>we knew that again, that's another cause of delayed ejaculation

0:34:55.760 --> 0:34:58.200
<v Speaker 2>that you should see your doctor about, because if you

0:34:58.200 --> 0:35:00.959
<v Speaker 2>had normal orgasm, normal orgasm. Let me tell you a story.

0:35:00.960 --> 0:35:02.920
<v Speaker 2>Actually I remember this when I was in fellowships this

0:35:03.360 --> 0:35:06.320
<v Speaker 2>twenty plus years ago, and I saw a very nice

0:35:06.640 --> 0:35:10.399
<v Speaker 2>he was a PhD student and very smart, obviously, and

0:35:10.560 --> 0:35:12.759
<v Speaker 2>he was in his thirties and they were coming to

0:35:12.840 --> 0:35:17.160
<v Speaker 2>us for fertility issues and the main problem was that

0:35:17.480 --> 0:35:20.200
<v Speaker 2>he couldn't provide a sperm sample, nor could he orgasm

0:35:20.239 --> 0:35:23.120
<v Speaker 2>with his partner. And the partner was taking it very personally,

0:35:23.160 --> 0:35:25.480
<v Speaker 2>as would happen, and he said, look at this has

0:35:25.480 --> 0:35:28.160
<v Speaker 2>never been a problem before, but all of a sudden,

0:35:28.200 --> 0:35:30.759
<v Speaker 2>I've not been able to orgasm. And I said, well,

0:35:30.760 --> 0:35:33.879
<v Speaker 2>that's interesting. I mean, no saddle traumas, you're not riding

0:35:33.920 --> 0:35:35.799
<v Speaker 2>your bike six hundred miles a day. You're not doing

0:35:35.840 --> 0:35:38.480
<v Speaker 2>any don't have any numbness, No, no numbness. Everything's fine,

0:35:38.520 --> 0:35:42.600
<v Speaker 2>no pelvic trauma. And we test all his blood work

0:35:42.640 --> 0:35:45.160
<v Speaker 2>is to stostern levels, all of his hormones, and then

0:35:45.160 --> 0:35:47.959
<v Speaker 2>we also tested his prolactin, and his prolactin came back

0:35:48.440 --> 0:35:51.359
<v Speaker 2>in the five hundred range, which normal is anything less

0:35:51.360 --> 0:35:55.920
<v Speaker 2>than sixteen. And so this guy had a pathologically highest

0:35:55.920 --> 0:35:59.400
<v Speaker 2>secretion of prolactin, which prompted us to do an MRI

0:35:59.680 --> 0:36:02.160
<v Speaker 2>of his pituitarylant because that's what you gotta do. And

0:36:02.200 --> 0:36:04.600
<v Speaker 2>he had a big, fat tumor on his pituitary plant

0:36:04.680 --> 0:36:08.759
<v Speaker 2>called a prolactinoma. That's the most common reversible cause other

0:36:08.800 --> 0:36:13.360
<v Speaker 2>than medications of delayed ejaculation or change in orgasm is prolactinoma.

0:36:13.440 --> 0:36:17.759
<v Speaker 2>And it's not cancer. It's treatable often with medication. And

0:36:17.760 --> 0:36:20.560
<v Speaker 2>guess what the medication is, Kerbergline. And so we actually

0:36:20.560 --> 0:36:23.160
<v Speaker 2>can take a guy with a brain tumor, which sounds horrific,

0:36:23.719 --> 0:36:26.080
<v Speaker 2>and then reduce it by putting them on a drug

0:36:26.480 --> 0:36:29.319
<v Speaker 2>that makes the tumor shrink, makes the prolactin levels go down.

0:36:29.680 --> 0:36:32.120
<v Speaker 2>And this couple was not only able to he was

0:36:32.160 --> 0:36:33.759
<v Speaker 2>able to have an orgasm, but they really able to

0:36:33.760 --> 0:36:36.799
<v Speaker 2>ejaculate and make babies a good old fashioned way just

0:36:36.840 --> 0:36:39.640
<v Speaker 2>because he had this this strange tumor. And I actually,

0:36:40.000 --> 0:36:42.160
<v Speaker 2>you know, in my practice where certainly I take care

0:36:42.200 --> 0:36:44.880
<v Speaker 2>of thousands of guys every year, but every you know,

0:36:44.880 --> 0:36:47.319
<v Speaker 2>I would say two to three times a year, I

0:36:47.360 --> 0:36:50.080
<v Speaker 2>will pick up a prolactinoma. So it's not the rarest

0:36:50.120 --> 0:36:53.240
<v Speaker 2>thing in the world by any means, and so so kerbergline,

0:36:53.280 --> 0:36:57.480
<v Speaker 2>we use off label to treat guys with an orgasm

0:36:57.640 --> 0:37:00.319
<v Speaker 2>or difficulty achieving orgasm, even if they're proactin level are

0:37:00.360 --> 0:37:03.319
<v Speaker 2>just a little bit high or even high normal. And

0:37:03.360 --> 0:37:05.640
<v Speaker 2>there's studies out there on this, again not FDA approved,

0:37:05.760 --> 0:37:10.520
<v Speaker 2>very off label, but relatively safe side effects. And so

0:37:10.680 --> 0:37:14.359
<v Speaker 2>with proper patient counseling and selection, that is probably one

0:37:14.360 --> 0:37:16.080
<v Speaker 2>of the more common things we see to help guys

0:37:16.080 --> 0:37:17.879
<v Speaker 2>that delate ejaculation. But you got to make sure they're

0:37:17.880 --> 0:37:21.240
<v Speaker 2>not anything more serious going on. First, the other crazy one,

0:37:21.280 --> 0:37:24.560
<v Speaker 2>which isn't so crazy, but also because you either did

0:37:24.600 --> 0:37:28.240
<v Speaker 2>your homework or just new you talked about something called oxytocin,

0:37:28.320 --> 0:37:31.360
<v Speaker 2>which is part of those hormones, and there are guys

0:37:31.360 --> 0:37:37.280
<v Speaker 2>that have low oxytocin that they may benefit from oxytocin supplementation,

0:37:37.840 --> 0:37:40.640
<v Speaker 2>usually through a nasal spray, which also has There's a

0:37:40.719 --> 0:37:43.600
<v Speaker 2>British Medical Journal article from like two thousand and six,

0:37:43.640 --> 0:37:46.040
<v Speaker 2>so this is again not cutting edge by any means,

0:37:46.760 --> 0:37:49.760
<v Speaker 2>but showing that guys that have delayed ejaculation by taking

0:37:49.840 --> 0:37:53.239
<v Speaker 2>an intra nasal spray of oxytocin mid coitus. So it's

0:37:53.239 --> 0:37:54.840
<v Speaker 2>almost kind of like, hang on, babe, I got to

0:37:54.840 --> 0:37:57.200
<v Speaker 2>switch over here and just take a little puff, and

0:37:57.560 --> 0:38:00.400
<v Speaker 2>that actually, because oxytocin is such a short half life,

0:38:00.520 --> 0:38:03.400
<v Speaker 2>like on the order of about eight minutes, that it

0:38:03.560 --> 0:38:06.799
<v Speaker 2>actually can improve that ejaculatory threshold and cause orgasm. I've

0:38:06.800 --> 0:38:09.040
<v Speaker 2>had very limited success with that, but the guys that

0:38:09.080 --> 0:38:11.839
<v Speaker 2>it worked for, they're super happy because it's safe. There's

0:38:11.840 --> 0:38:15.080
<v Speaker 2>really no downside to it. And this is a compounded drug,

0:38:15.200 --> 0:38:17.560
<v Speaker 2>is not there is no pharmaceutical form of oxytosin, so

0:38:17.600 --> 0:38:19.960
<v Speaker 2>you have to get it from a specialized compounding pharmacy.

0:38:20.000 --> 0:38:22.640
<v Speaker 2>But you can certainly talk to your local doc or

0:38:22.680 --> 0:38:26.640
<v Speaker 2>your local sex med specialist probably to at least try

0:38:27.040 --> 0:38:30.920
<v Speaker 2>a trial of oxytocin nasal spray or they have trophies

0:38:30.960 --> 0:38:32.919
<v Speaker 2>under the tongue as well, but I think the nasal

0:38:32.920 --> 0:38:34.720
<v Speaker 2>spray is the only one that's actually been really studied.

0:38:34.760 --> 0:38:36.319
<v Speaker 2>So you got to make sure you're getting it from

0:38:36.320 --> 0:38:39.080
<v Speaker 2>a great pharmacy that has a good track record, and

0:38:39.200 --> 0:38:44.040
<v Speaker 2>another thing to potentially try to help improve that anargasmy

0:38:44.080 --> 0:38:47.600
<v Speaker 2>or difficulty achieving ejaculation. I had heard of.

0:38:47.640 --> 0:38:50.280
<v Speaker 3>Oxytosins supplements, I did not know that it was administered

0:38:50.360 --> 0:38:50.640
<v Speaker 3>that way.

0:38:50.719 --> 0:38:54.440
<v Speaker 2>Wow. Yeah, yeah, so again you're probably gonna be okay.

0:38:55.280 --> 0:38:57.480
<v Speaker 2>Rule out the bad stuff. Number one. All we do

0:38:57.560 --> 0:39:00.160
<v Speaker 2>in medicine, and the reason the only thing I have

0:39:00.239 --> 0:39:04.760
<v Speaker 2>against telehealth or direct to consumer medical or supplement sales

0:39:05.480 --> 0:39:08.040
<v Speaker 2>is you have to do the evaluation because no matter

0:39:08.080 --> 0:39:10.680
<v Speaker 2>what condition we're going to talk about on the show,

0:39:11.160 --> 0:39:14.160
<v Speaker 2>you need a good high level medical exam, most likely

0:39:14.160 --> 0:39:17.000
<v Speaker 2>a physical exam, very most likely blood work before you

0:39:17.000 --> 0:39:19.040
<v Speaker 2>can just treat this stuff and not worry about it.

0:39:19.080 --> 0:39:22.840
<v Speaker 2>Because what if you did have something that needed medical

0:39:23.160 --> 0:39:25.600
<v Speaker 2>treatment that could be reversible, could be serious if you

0:39:25.680 --> 0:39:28.640
<v Speaker 2>didn't reverse it, and you just started getting brown paper

0:39:28.640 --> 0:39:32.960
<v Speaker 2>bags in your mailbox every month, So not cool. You

0:39:32.960 --> 0:39:34.319
<v Speaker 2>don't want to do that. You want to make sure

0:39:34.320 --> 0:39:36.640
<v Speaker 2>you get the evaluation and you have a good doc

0:39:36.719 --> 0:39:39.919
<v Speaker 2>that's in your corner, well, said my friend. Yeah, man,

0:39:40.239 --> 0:39:42.239
<v Speaker 2>So we started with orange trees, ended up with some

0:39:42.239 --> 0:39:44.839
<v Speaker 2>punk rock, and I was basically able to solve the

0:39:44.960 --> 0:39:48.919
<v Speaker 2>entire problem of too much too soon or not enough

0:39:48.920 --> 0:39:51.000
<v Speaker 2>too late. And we did it again on the mail room.

0:39:51.160 --> 0:39:53.120
<v Speaker 2>That's what we do here, my friend, Joran, this is

0:39:53.160 --> 0:39:55.640
<v Speaker 2>too much fun. I mean, I love our guests. I

0:39:55.680 --> 0:39:58.240
<v Speaker 2>also just love hanging with you and talking through this stuff.

0:39:58.320 --> 0:40:01.520
<v Speaker 2>So we should probably it again sometime. I'll let you

0:40:01.560 --> 0:40:04.319
<v Speaker 2>get back to fighting your allergies and breathing in that

0:40:04.440 --> 0:40:07.560
<v Speaker 2>beautiful Massachusetts lake air go, we're you gonna go fishing?

0:40:07.560 --> 0:40:10.120
<v Speaker 2>Do you fish up there at all? I do fish? Actually, yeah,

0:40:10.120 --> 0:40:12.800
<v Speaker 2>I got some bass up here. No, it's nice up here.

0:40:13.080 --> 0:40:15.120
<v Speaker 2>Oh yeah, well that's right because you yeah, you were

0:40:15.160 --> 0:40:18.120
<v Speaker 2>deep sea fishing in the Keys and now you're bass fishing.

0:40:18.920 --> 0:40:20.319
<v Speaker 2>That's not bad, all right.

0:40:20.440 --> 0:40:21.920
<v Speaker 3>Next career is a sushi chef.

0:40:22.239 --> 0:40:25.840
<v Speaker 2>There you go. I love that. I love that. Well, everybody,

0:40:25.840 --> 0:40:28.640
<v Speaker 2>thanks again for hanging out with us on the mail route.

0:40:29.000 --> 0:40:31.239
<v Speaker 2>Thanks to iHeart Radio for making this all possible, and

0:40:31.280 --> 0:40:34.600
<v Speaker 2>our sponsors and Jordan Runt above all thanks for making

0:40:34.600 --> 0:40:37.400
<v Speaker 2>it all sounds slick man. Have a good one, Doctor Mills,

0:40:37.440 --> 0:40:47.359
<v Speaker 2>thanks for doing it with us. We love you. Let's

0:40:47.400 --> 0:40:55.839
<v Speaker 2>talk about it. Let's talk about the man. Let's talk

0:40:55.880 --> 0:40:59.960
<v Speaker 2>about it. Let's talk about him. The Man.

0:41:04.080 --> 0:41:13.160
<v Speaker 1>About the Mailroom with Doctor Jesse Mills was a production

0:41:13.239 --> 0:41:16.960
<v Speaker 1>of iHeart Radio. It was executive produced by Jordan Runtog.

0:41:17.480 --> 0:41:20.880
<v Speaker 1>It was edited, mixed, and mastered by Beheid Fraser, and

0:41:20.960 --> 0:41:24.040
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0:41:24.160 --> 0:41:27.040
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0:41:35.640 --> 0:41:39.600
<v Speaker 1>This program is intended for educational and informational purposes only.

0:41:40.120 --> 0:41:44.000
<v Speaker 1>It is not a substitute for professional medical advice, diagnosis,

0:41:44.120 --> 0:41:47.840
<v Speaker 1>or treatment. Consult your healthcare provider for any medical or

0:41:47.880 --> 0:41:51.520
<v Speaker 1>other related questions or concerns. The views and discussions aired

0:41:51.560 --> 0:41:54.080
<v Speaker 1>on this podcast are those of doctor Mills and do

0:41:54.200 --> 0:41:58.240
<v Speaker 1>not represent the official positions of UCLA or UCLA Health