Men's Sexual Health with Valerie Padd

 In this episode  of the Functional Medicine Podcast we present to you a detailed discussion of men's sexual health  with our special guest  Nurse Valerie Padd,  certified  sexual educator and coach.  Sexual well-being is a part of the fabric of overall  health.  A vibrant sex life is your birthright, and yet it is very common for men to struggle with various sexual health concerns.  These concerns may be devastating to the affected individuals. Yet, men's sexual issues are stigmatized and swept under the rug.  Men are often embarrassed and even ashamed to discuss these issues and seek help.   They are left to feel frustrated and inadequate,  and are  often forced to suffer in silence, not knowing where to turn for help. 

In this episode of the Functional Medicine Podcast we  unabashedly address these issues head on.  We offer a range of practical solutions for our listeners, so that they can better understand men's sexual health concerns,  and move forward toward a more fulfilling  sex life. 

Valerie Padd applies the "bio-psycho-social" model to  a man's relationship with his own body,  his mind, his partner, and the world around him.  She then utilizes a functional and integrative approach to address these concerns.  Men's sexual health is not just a personal matter; it's intertwined with societal expectations, spiritual beliefs, cultural norms, and the ever-evolving landscape of human relationships.

 Societal pressures have historically placed unrealistic expectations on men.  These expectations have only been exacerbated by the  omnipresence of pornography in our society.  By opening up a dialogue on men's sexual health, we aim to  identify and dismantle the stereotypes that perpetuate shame, fear, and ignorance.  Ms Padd exposes and confronts the myths surrounding men's sexual health, and she delves into a wide array of  specific topics ranging from  low desire, to erectile dysfunction. 

 In this podcast  we hope to empower men with information to help them  foster healthier connections with themselves and their partners.

We hope that you enjoy the show and learn something that is helpful to you or someone that you care about. 

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Episode Transcript

Speaker 1 (00:00):
Welcome to the Functional Medicine Podcast with
Dr McMinn and Coach Lindsey.
We're coming to you from McMinnClinic in Birmingham, alabama,
where Dr McMinn is anintegrative in functional MD and
Lindsey Matthews is aregistered nurse and IIN
certified health coach.
In this podcast, we'll bediscussing the latest
information on a wide range oftopics in the field of

(00:21):
functional medicine, which looksfor the root cause of disease,
and integrative medicine, whichincorporates both conventional
and alternative therapies.
Our overall goal is to help yoube the best that you can be in
mind, body and spirit.
The following discussion is foreducational purposes only and
is not intended to diagnose ortreat any disease.
Please do not apply any of thisinformation without approval

(00:42):
from your personal doctor.
And now on to the show with DrMcMinn and Coach Lindsey.

Speaker 3 (00:51):
Hello and welcome to the Functional Medicine Podcast,
where we share with youevidence-based and up-to-date
information on integrative andfunctional medicine, along with
the practical take-homesolutions so you can live a
healthier and more vibrant,optimized life in mind, body and
spirit.
We thank you for joining ustoday.
I'm Dr Jim McMinn, and ourco-host, coach Lindsey, is off
for the day again, but don'tworry, she'll be back next time.

(01:12):
However, we do have a veryspecial guest with us on the
show today.
Ms Valerie Padd is with usagain.
I'll tell you more about MsValerie in just a moment.
She was with us on a show lasttime where we talked about
sexual health for women, andtoday we'll round out the
discussion by discussing sexualhealth for men.
So just a heads-up.
This show may not be appropriatefor the kitties to be listening

(01:34):
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(01:56):
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(02:17):
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And now on to the show.

(02:38):
As a functional medicine doctor,I pride myself in being an
excellent listener.
One of the major concerns Iheard from my men folks had to
do with sexual health,especially things like low
desire and erectile concerns.
No doubt that sexual health ispart of the fabric of overall
health and well-being, but we inthe medical community and, as a
society, often sweep thesetopics under the rug and expect

(02:59):
people to just go figure it outon their own.
And yet these issues tend toseverely affect the lives of our
patients, their partners andtheir families.
So we did our best to addressthese concerns at our clinic
with an up-to-date,comprehensive, integrative and
functional approach.
As I mentioned last time, weeven went so far as to put
together a sexual health supportgroup that met after hours once
a month.
Everyone in the community wasinvited.

(03:21):
You didn't even have to be apatient at the clinic.
Men and women would meet anddiscuss all sorts of topics
having to do with sexual healthfreely, openly and without
judgment.
It was great.
We developed a core communityof wonderful folks who were
dedicated to improving theirrelationships, their marriages
and their intimate lives.
During this time, I was superblessed to meet and work with
Valerie Pad, a nurse andcertified health counselor.

(03:42):
Valerie has dedicated her lifeand career to helping women and
men in this important aspect oftheir lives.
Let me tell you just a bitabout my friend and esteemed
colleague, valerie Pad.
She's a registered nurse with abachelor's degree in nursing.
She developed a wide range ofexperience and skills in nursing
and once she got the calling topursue specialized sexual
health training, she completed apostgraduate certification

(04:02):
program in sexual health at theUniversity of Michigan.
Valerie is a member of theAmerican Association of
Sexuality Educators, counselorsand Therapists, and she is the
founder of the Center for SexualHealth and Wellness in Hudson,
ohio.
She has applied an integrativeand functional health model to
sexual health and she partnerswith clients to discover the why
behind the problems, allowingher to put together an effective

(04:25):
and personalized plan toresolve their issues.
Having worked with Valerie formany years, I can testify she's
a kind, caring, smart,compassionate and thoughtful
healthcare professional who ispassionate about her work.
She also enjoys life to thefullest and works to serve
others outside the workplace.
She treasures time with familyand friends and enthusiastically
holds volunteer roles, withcompassion, international and

(04:46):
youth for Christ.
And so, without further ado,welcome to the show, valerie,
and thank you so much forjoining us today.
I'm really excited to pick yourbrain concerning this important
topic called men's sexualhealth.

Speaker 2 (04:57):
Well, thank you, dr McMinn, for having me back.
I'm so happy to be here to giveequal time to men's sexual
health.
You know it's not uncommon forus to think of men's sexual
health, you know, as pretty muchstraightforward, simple, right.
You know, after all, theanatomy of men's genitals are
front and center.
There's certainly no hiddenagenda there.

(05:18):
There are parts involved insexual health are not as complex
as the female body and really,thanks to mainstream media,
we're told that they have onething, and only one thing, on
their minds, and that is sex.
And of course that isn't true.
Men's sexual health is morecomplex and involving many

(05:40):
systems of the body, right, thenervous system, glands and
organs and all the vessels thatcarry blood throughout the body.
So it is a little bit morecomplicated than we sometimes
think.

Speaker 3 (05:53):
This is your specialty.
You see a lot of guys, and sowhat are some of the common
problems that come up in yourpractice as far as your
interactions with men and theirsexual dysfunctions?

Speaker 2 (06:02):
Yeah.
So again, it may seem prettystraightforward, and what
probably most of your listenersare thinking of are erection
issues.
For sure, I think that is topof mind, but it's true that male
sexual dysfunction can includea wide variety of complex issues
Low libido, low sexual desire,premature ejaculation, delayed

(06:28):
ejaculation, performance anxiety.
Men also struggle with bodyimage issues especially of the
genitals.
Is my penis too small?
Is it too big, Wide narrow?

Speaker 3 (06:41):
Especially in the state of Nage of porn right.

Speaker 2 (06:43):
Yeah, oh for sure, orgasmic problems.
We don't think of men havingproblems with orgasm, but they
do.
Horn addiction can become areal problem, and desire
discrepancy, and these are justa few.
So you know, while men andwomen both suffer from sexual
health issues, men seem to be abit more at a disadvantage,

(07:09):
since for them, I think, sexualdysfunction can be difficult to
talk about.
Now, that doesn't mean it's notdifficult for women, but we
women, we have our friends right.
We talk about things like this.

Speaker 3 (07:21):
Men might talk about their success stories, but they
don't talk about theirdysfunction, right?

Speaker 2 (07:25):
Yes, Right, Right yeah.
So, unlike women, theytypically don't turn to their
buddies about their issues right.
They're more interested, likeyou said, the success stories.
So in turn I've seen it playout that they wait men in
particular wait several months,if not several years, to seek
any type of help, and that makesit even more difficult to

(07:48):
restore right.
So that is almost prolongingthe problem and then their
problem becomes an issue in therelationship right.
So, that length of time fromhaving a problem to seeking
advice about it for men inparticular, I think is very long
.

Speaker 3 (08:08):
My beloved father-in-law Gordon, who was a
true cowboy.
He had this wonderful saying tocowboy up or suffer in silence.
I think that it can apply to alot of men, you know.

Speaker 1 (08:19):
Definitely Right.

Speaker 3 (08:20):
You know you're just going to suffer in silence,
especially with this issue, andjust don't bring it up to people
and go on for a long time.
But how common is it for guysto struggle with some sort of
sexual dysfunction?

Speaker 2 (08:31):
Well, the research is pretty consistent here, and
it's about 31% of men experiencesome form of sexual dysfunction
in their lifetime.
Now, just to give that a littlecontext, that's compared to 43%
of women.
So experts widely agree thaterectile dysfunction is the most

(08:52):
common by a long shot, and itdoes increase with age.
So ED, as we call erectiledysfunction, affects more than
30 million people in thiscountry between the ages of 40
and 70.

Speaker 3 (09:06):
Isn't that amazing?
It is yeah.

Speaker 2 (09:08):
So before though, Dr McMinn, we go any further, I'd
like to define ED for yourlisteners, in case there's any
misconceptions out there.
So, according to the NationalInstitutes of Health, the NIH,
ED is a consistent orreoccurrent inability to attain
and or maintain penile erectionsufficient for sexual

(09:32):
satisfaction.
Okay so we're all on the samepage, right, okay, so one of the
largest studies on men's sexualhealth was the Massachusetts
male Aging study.
Now, this was completed back in1994, but rings true today.
This study found thatapproximately 52% of men
experienced some form of ED intheir lifetime.

(09:54):
Studies show that ED thatnumber increases about 10% per
decade of life.
So that means at age 50 there's50% of men that experience ED,
at age 60, at 60%, at age 70, at70%, and so on.
So ED I like to call iterectile Unpredictability.

(10:17):
Okay, so I'm going to use thoseterms interchangeable.
It doesn't just happen to menwho are older.
Another study published in theJournal of Sexual Medicine found
that ED selected about 26% ofmen under the age of 40.
And so, just as a side note,over the last few years In

(10:37):
practice I've seen a pattern ofyounger and younger men seeking
help with sexual function, evenas young as 18 years old.
Wow and you know that's like myson's 22, so it's like looking
at my son across across thetable.
So that's that's.
That's a little strange.
So think about that though.

(10:59):
Age 80, 18 to 40 young men arealready experiencing some form
of ED, or, as I like to say,unpredictable erections.

Speaker 3 (11:10):
Any ideas why?
Why we might be seeing thatwith these younger and younger
men having ED issues?

Speaker 2 (11:16):
Yeah, it's certainly not just me, it's a national
problem and I think,unfortunately, primary care
physicians aren't picking up onthis.
They see a young, fit guy infront of them and erection
issues just never cross theirmind, so they don't even go down
that path at all, you know, andthen if a guy is brave enough

(11:40):
as to inquire about hisunpredictable erections, studies
report that healthcarepractitioners just quickly
dismiss these individuals, likewe Allude alluded to before our
docs really listening to theirpatients.
So there was this NIH study of27,000 men in eight countries,

(12:01):
all under the age of 40, andwhat they found and reported was
that in the age group of 20 to29, ed was prevalent at 8%.
In the age group of 30 to 39,it jumped up to 11%.
And actually there is evidencefrom these studies that young
men may experience ED due toseveral different factors,

(12:28):
individually as well ascollectively.
Okay, so in other words, theycan have just one of these
problems or they can haveseveral of these problems, and
they can be organic reasons likevascular impairment or
metabolic syndrome or lowhormones.
They can be psychologicalreasons like depression, anxiety
, worry about body image, penissize, self image and, of course,

(12:53):
relational problems, rightproblems in couples relationship
due to stress and mostly poorcommunication.

Speaker 3 (13:00):
It's so interesting that these young guys can have
ED secondary to vascularimpairment at that age, isn't it
?
I think we typically think ofus older guys having vascular
issues, but I think the studiesare showing that the people are
getting it younger and younger.
I don't know if it's related tothe poor diets and the
processed food we have, the lackof exercise as we have more
screen time and Video games,whatever, but yeah, it's

(13:24):
interesting that these youngpeople have vascular issues.
You mentioned the connectionbetween ED and cardiovascular
health, so please tell us moreabout that, sure sure.

Speaker 2 (13:32):
One of the most common causes of ED is
atherosclerosis, sclerosis whichis just hardening of the
arteries right, right, so basic.
Basically, a buildup ofcholesterol in the blood vessel
walls, causing the blood to slowdown.
Right and it slowed downThroughout the entire body
including the penis so, as weall know, in order to have an

(13:53):
erection there must be bloodflow to the penis.
So now in our minds, thisbuildup of black is usually
associated with heart attacks.
But the condition is not justabout the arteries that supply
the heart with blood.
It affects the blood vesselsthroughout the entire body.
So there was a study done inAustralia where they looked at

(14:14):
95,000 men with ED, and theywere shown to have more
cardiovascular problems,including heart failure, stroke
and Peripheral vascular disease,than those without ED.
So we might conclude there thatErections are kind of or the
lack of erections are kind of abarometer for overall health,

(14:37):
and so the take-home messagethere is your erection problems
may have a lot more to say aboutyour overall health as well.

Speaker 3 (14:46):
Mm-hmm.
Yeah, I've heard that ED iskind of like a canary of the
coal mine for heart issues.
So if a guy has ED he mightneed more than just phyagory,
might need to see hiscardiologist and get a good
workout.

Speaker 2 (14:56):
Yeah, there's actually many diseases besides
heart disease that areassociated with male sexual
dysfunction.
That could be cancer, yourlogic infections, diabetes, high
blood pressure, highcholesterol, hormonal issues,
alcoholism and drug abuse.

Speaker 3 (15:13):
Yeah, you mentioned the hormonal issues.
We recently I did a podcast ontestosterone and men.
I'm sure there are otherhormones that can affect it as
well, but I think that's, ofcourse, the most important and
that would podcast, by the way,was podcast number 29 and we
invite you to go back and checkthat out if you're interested in
the subject.
So we'll go back through thisin great detail, but just to
please give us a few of the sortof take-home points, if you

(15:34):
will, about men, testosteroneand sexuality.

Speaker 2 (15:37):
Okay, I'd be glad to.
So testosterone can have amajor impact on male sexual
function, most dramatically interms of desire.
We think of testosterone as thehormone of desire, right, but
it also can help with erectilefunction.
It can be a major game changerfor some men and of course, this

(15:57):
has to be done by a providerwho is knowledgeable and
experienced in the management oftestosterone therapy.
But if done properly, it isconsidered safe and can be very
helpful for some guys, not onlyin terms of sexual function, but
also in terms of energy, moodand other benefits for the body.

Speaker 3 (16:18):
Yeah, there's a wonderful book about it I highly
recommend, called testosteronefor life, by a guy named Abraham
Mordenthaler who's a Harvardprofessor in urology, so that'd
be a good reference for you.
I think he's a academic,evidence-based straight shooter.
Might want to check him out.
We'll have that book in thenotes for you down below.
You can find that at themenmdcom for slash references,

(16:41):
okay.

Speaker 2 (16:42):
Okay.

Speaker 3 (16:42):
And so, valerie, let's move on to lifestyle
changes.
You know, I I call lifestyle tobe the most powerful medicine
on earth, and so how couldlifestyle changes help improve
ed?

Speaker 2 (16:53):
Yeah, and I I highly agree with that too.
I believe if doctors wouldstart writing scripts for
lifestyle changes, we'd solve alot of our health problems, not
just ed.
So you know we throw aroundthat term lifestyle behaviors
and I think it's become somewhatof a buzzword for your
listeners.
Though let's explain whatlifestyle behaviors are.

(17:15):
So I'll start.
According to the NIH, lifestylebehaviors are everyday
activities that affect bodyweight as well as overall health
, and that would includeexercise, diet, nutrition, sleep
, stress, social interaction,time in nature and Meditation or

(17:37):
relaxation.
So every company, organizationor group seem to have their own
list, but what I foundconsistent on the list was
always in the top three, forsure, and that's exercise Moving
your body.
So, to answer answer yourquestion with one word moving
your body is also known asexercise Is at the top of the

(18:01):
list you know, valerie, I'mreading a great book right now
by Peter Atia called Outlive.

Speaker 3 (18:06):
It's really interesting.
And he said and this I was kindof surprised at this he said
the number one thing you do toimprove what I call health span
not lifespan, but health span isExercise.
I would have thought it wasdiet, but he said it's exercise.
It's kind of interesting.
But anyway, yeah, check out ourpodcast number 34 If you want
to get more detailed informationon how you can use the amazing

(18:28):
power of lifestyle medicine themost powerful medicine on earth
to help you with things, butbasically anything but including
things like ED.
When ED does strike, valerie,how does that impact a guy's
overall sense of well-being andquality of life?

Speaker 2 (18:43):
Well, of the variety of sexual disfunctions we spoke
about, the most studied issuewhen it comes to quality of life
is ED.
So, starting with the obvious,there is a significant
embarrassment with men when itcomes to any sexual health issue
, but perhaps in more, anythingthat affects their ability to

(19:05):
have an erection.
So you know better than I dodoctor men to a degree.
For some men His erection isclosely linked to his manhood.
You take that away and whatcomes next is poor self-esteem,
depression and often anxiety.
So again, since men are notrunning to their doctors or
friends, and in many cases noteven their partners, their

(19:28):
mental health can worsen.
They can quickly suffer fromdecreased work productivity,
withdrawal from sexual intimacy.
They can build up anger, guiltand a lack of confidence.
So you can see how quickly theSituation can spiral out of
control.

Speaker 3 (19:45):
Yeah, so tell us about the other different
factors that influence malesexuality.

Speaker 2 (19:50):
I'm so glad you asked that question, dr Mines McMins,
since it's often overlookedwhen we talk about sexuality.
I can best explain this with animage, but since we're not on
camera, I'm going to try todescribe this image.
So, if your listeners canpicture three circles when a
small portion of each of thosecircles intersect with the

(20:12):
others, the intersection of thethree circles represents our
sexuality, both male sexualityand female sexuality.
Now, each circle represents thefactors that influence our
sexuality and in simple termsthey are circle number one,
what's going on in the body, sothink physical and biological

(20:36):
factors.
Circle number two is what'sgoing on in the mind.

Speaker 3 (20:41):
And circle number three, social mind, for instance
, what stress?
Or right, right?

Speaker 2 (20:46):
Uh, maybe depression, maybe anxiety, things of that
nature.
And then circle three is what'sgoing on in the relationship,
right?
So in practice this is referredto as the biopsychosocial model
of sexuality and it representsthat every sexual expression
consists of an interaction among, among biological, the body,

(21:09):
psychological, the mind and thesocial factors, like
relationship factors.

Speaker 3 (21:15):
So if Mr John Doe I say of 45 year old guys having
some ED issues, for an instance,what's the significance of I
have trouble with the wordbiopsychosocial, so I'll say the
BPS model when it comes to hissexual health issues?

Speaker 2 (21:29):
Right, right.
So okay, john Doe, let's talkabout him for a minute Okay.
Okay.
So the significance ofunderstanding the intersection
of these factors is reallyrealizing that it's often not
just one factor causing a sexualhealth issue.
So, for example, if John isexperiencing Unpredictable

(21:50):
erections and he finds his wayfinally to seek help, he's
thinking okay, doc, just fix myerections, I'll go on my way and
everything will be okay.

Speaker 3 (22:01):
Just write a little blue pill for me Exactly.

Speaker 2 (22:03):
Well, not so fast.
Understanding the model I justexplained.
Although he may be experiencinga lack of blood flow in the
genitals Remember the physical,the biological circle he also
may be, at the same time, havingperformance anxiety due to the
lack of confidence, and evengetting an erection and keeping

(22:25):
it so.
At this point, john's brainsand genitals are Disconnecting
due to the psychological factors, the other circle.
So now we have what's going onin the body, what's going on in
the mind.
So, additionally, for allintentional purposes of our
story, let's say that John andhis partner have been in

(22:45):
constant disagreement on, the,say, the next step to take with
his aging mother.
Okay, they're struggling withthese ongoing relationship
issues.
And there's where that thirdcircle comes into play the
stress of the relationship, theresentment John is feeling
towards his partner.
All of this could very well beinterfering with his ability to

(23:08):
stay focused and keep hiserections.

Speaker 3 (23:11):
You know, valerie, you mentioned the brain genital
connection.
I sometimes call it the brainpenis connection.
It's really kind of interestingand as much as our brain would
like to control our genitals, itjust doesn't work that way.
I think if I was the designerof the human body, I would just
put in like a valve with astopcock you can just flick the

(23:32):
valve when you want an erection,turn it off and you don't but
but yeah, I mean, sometimes youknow you might be in a situation
where the guy he's turned on,he, you know, wants to have sex
and please his partner orwhatever, but it just doesn't
happen.
And then once it doesn't happena few times and he kind of gets
in this negative Cycle where hehas less and less confidence and

(23:52):
then that kind of builds onitself and it's less likely to
happen.
So I don't know, just seemslike that brain penis connection
could be hard wired a littlebit more efficiently.

Speaker 2 (24:02):
Right for right for our satisfaction, exactly.

Speaker 3 (24:05):
But anyway, you know, I think, when it comes to men's
and women's sexuality, we havea lot of Misconceptions, myths
and stereotypes, and so so tellus some about those with men.

Speaker 2 (24:16):
Hmm, I love debunking myths about men's sexuality.
In fact, one of the first timeson stage for me as a sexual
health educator was a guestspeaker at At the Great Lake
Science Center in Cleveland, andthis was actually the title of
my presentation themisconceptions and debunking

(24:36):
myths about male sexuality.
And, oh gosh, a document McMinn.
I can't tell you howintimidated I was by this large
crowd standing there, and now,seven years later, I'd stop
anybody on the street and I wantto talk about this issue so
it's come.
I've come full circle with that.
So where do we start?

(24:56):
Let's say a common myth is thatmen are always interested in
sex 24, 7 right, that's one myth.
Another is that they're alwaysfocused on physical Connection
and not emotional connection,and that men's preference is
always to be the pursuer.
Wow, that's a lot of pressureright Sure is and the

(25:19):
stereotypes go on.

Speaker 3 (25:22):
And of course you know you might have some men who
are interested 24, 7 but theimportant point here is that not
all men fall into that categoryand and but there's still.
You know we can take the EmilyNogoski's book about, come as
you are and apply that to men.
Yes and just because maybeyou're a little bit lower on the
curve as far as your desire.
That doesn't mean that you'rebroken and you're still normal.

(25:42):
You're still on the curve, it'sa little bit lower down.
So, um, it's important to debunkthese stereotypes so that when
John Doe does come to see you,you can let him know, reassure
him.
This is all normal, but that,and don't worry about if you
don't fit the stereotypes thatyou see, for instance, in porn
or that you hear from yourfriends or whatever, chances are
that your friends are lyinganyway.
Exactly right right.

Speaker 2 (26:05):
Well, that tees up something I really want to talk
about today, and that's themisconception that society holds
is that men are only interestedin the physical connection, not
the emotional connection.
And the reason I want to talkabout this so much is I see a
lot of it in my office.
I see men coming in thinkingtheir wives think they're only

(26:30):
interested in In physicallyconnecting, when indeed what
they want is the emotionalconnection.
So it is true that men's sexualdesire is triggered by visual
and physical cues.
We, you know, can't blame themfor that.
Mini skirt, sexy lingerie andteasing does help to Heighten

(26:52):
men's desire, but what we missis that the emotional connection
matters more to them.
Can I repeat that again?
Please the emotional connectionmatters more hands down
connection matters.
So men feel just as vulnerableas women do.
They're naked, they're exposed,they're letting somebody really

(27:15):
see them.
They're letting somebodycompletely love them.
They're wanting to be wanted.
So if the emotional connectionis missing, men's sexual desire
can actually decrease.
He withdraws and disconnectsfrom his partner.
This can be from an unresolvedfight, it could be trouble

(27:35):
outside the bedroom or just ahistory of declining
disconnection with therelationship.

Speaker 3 (27:43):
You know your phrase that men want to be wanted.
I, I think everybody wants tobe wanted, you know, and and I
think that's one problem, whenwe we're going to talk in a
minute about Initiation, but youknow, when your partner say,
let's say she expects the man toinitiate all the time and she
never initiates, well then Ithink that kind of gets in a
man's head sometimes like shenever comes on to me so
therefore she's uninterested ofme, I don't feel wanted and I

(28:06):
think that that kind of can eathis Eagle, if you will right
right.

Speaker 2 (28:11):
Yeah, you know there's a great book that came
out about five years ago thataddresses these issues about
men's sexuality.
It's by dr Sarah Murray.
She's a sex researcher andrelationship Therapist.
The books called not always inthe mood the new science of
men's sex and relationships.
So in her 10 years of researchshe reports that, despite the

(28:35):
myth that men are sexuallyselfish, most men love to please
their partners.
They actually see it as theirrole to do so, and so, according
to her, it seems that thatpartner's pleasure, or his
partner's pleasure, reflects theshared connection they have.
There we go again with thatemotional connection.

(28:57):
They're on the same page,they're close or enjoying sex
together.
Men like that.

Speaker 3 (29:03):
That does make sense to me and I appreciate Dr
Murray's work on that, becauseyou know I'm into evidence-based
stuff.
However, I think, just off thetop of my head, it seems like
you know men, yeah, okay, theywant to excuse my French Get the
rocks off.
Is it okay to say that?

Speaker 2 (29:17):
I think it's your podcast.

Speaker 3 (29:18):
But?
But having said that, they alsowant to be and this, I guess,
is a selfish thing too, in a waybut they want to be good lovers
, right, and if you're a goodlover, then you need to be able
to please your partner, right,right.
And so I think that kind ofgoes hand in hand with the men's
psyche here pleasing theirpartner is part of them

(29:40):
considering themselves to be agood lover right.
So we learned in our lastpodcast about women's sexual
health how importantcommunication is for healthy
sexual relationships.
What is the role of acommunication play in fostering
a satisfying and fulfillingrelationship for the men folk?

Speaker 2 (29:56):
Communication again is so very important for a
healthy sexual relationship andthat emotional connection that
we're talking about.
I'll share a Complaint aboutcommunication that I hear from
about 90% of my male clients,and that is we are not mind
readers and I'm wondering if anyof your male listeners can

(30:19):
relate to that.

Speaker 3 (30:20):
Yeah, I bet most can yeah.

Speaker 2 (30:22):
This is often where there's a huge Communication gap
between partners when it comesto sexual wants, and this gap
gets wider and wider when womendon't openly share what their
needs are or what their wantsare or sexual preferences.
By not saying anything, theyare unknowingly leaving their
partners in the dark or, worse,forcing their partners to guess

(30:46):
what they want.
So men want to know what theirpartner wants.
They are not mind readers,right.

Speaker 3 (30:54):
Yeah, and when women leave it up to us men to read
between the lines, then moreoften than not we're gonna get
it wrong.
We're gonna sort of skew it inthe direction that we want it.
So why is it, valerie, thatwomen are not clearly sharing
their needs with men?
Why do they keep us guessing?

Speaker 2 (31:09):
Yeah, yeah.
There's a few reasons that Ican think of off the top of my
head.
First, I think women are afraidto ask men for what they want,
and this has a lot of historybehind it, right.

Speaker 3 (31:22):
Why.

Speaker 2 (31:23):
Well, historically, if they were asking for what
they want, they were nasty.

Speaker 3 (31:29):
Right, and we all want to be good girls, right?
Yes, exactly.

Speaker 2 (31:32):
Yeah, we learned that in last month's podcast.

Speaker 3 (31:34):
Right, right right.

Speaker 2 (31:35):
Okay.
So this does come from decadesand decades of living in a
patriarchal world where women'svoices weren't heard, even if
they did voice it, so theyweren't heard back then in the
boardroom nor the bedroom.
So today, thankfully, thingsare shifting away from that
total patriarchal type ofsociety.
But for some women the fearstill is real, and it really

(32:01):
depends a lot, too, on theirpartner's attitudes towards open
communication.
This fear may be especiallyrelevant to women in the age
group of, say, 65-ish and older.
So that's one reason that I canthink of.
The other is there seems to bea trend where women believe that

(32:22):
their partner loves them moreif they can figure out what they
are thinking, isn't thatamazing?
Yeah yeah, A woman may thinkwell, you love me, you know me,
you must be able to figure meout.
And that is very dangerous.

Speaker 3 (32:40):
Is there a component here and you may be getting to
this is there a component thatshe hasn't really figured it out
?
Yeah definitely, and so she'strying to get him to figure it
out for her Right yep, or withher.
I'm just guessing, I don't know.

Speaker 2 (32:52):
Again, it goes back to the patriarchy and the years
of thinking, or society thinking, that women are bad if they
express what they want.
So she may need a little helpand really kind of putting the
pressure on him.
So it's certainly not a spiritof healthy communication.

(33:14):
Nonetheless, it is true forsome women.
So if this is the case withsome of your male listeners, I
would really recommend them totake the first step to open up
the line of communication with apartner instead of feeling
frustrated.
Make sure she feels safe forall those reasons we just talked
about.
Make sure she feels cared forand heard, and that might make

(33:37):
it easier for her to talk aboutit.
If she's still reluctant totell her partner what she wants
sexually, then start askingpoint blank do you like it when
I do this, do you not like itwhen I do that?
Men can take the lead in thisdepartment and I think they'll
be glad that they did.

Speaker 3 (33:58):
Yeah, in our last podcast you labeled this as what
I call courageous conversations.
I think that's a wonderful term, but how would a couple get
started with this communication?
Is it sort of a one-off typething you have the conversation
and then you're done or is itongoing as needed?
What do you recommend here,Valerie?

Speaker 2 (34:15):
First of all, let's face it, talking about sexual
desires and your wants and yourneeds and preferences, that can
be pretty scary, right?
It can be awkward, it'svulnerable, even for couples
that have been together for along time.
So I think sexual communicationis definitely a skill and it's
not something we certainlylearned in school or church or

(34:37):
and certainly our parentsprobably didn't talk to us about
it either.
So for a couple it's brand newterritory.

Speaker 3 (34:46):
Seems like.
I frequently hear from womenthat they claim that the men
just sort of clam up and they gointo their shells or they glue
or whatever and they won't talkabout feelings.
And it's kind of a guy thing, Iguess, but for some of us it's
just not in our nature.
But, however, I think that inthis case everyone would benefit
if the guy sort of stretcheshis comfort zone a bit and opens
up to his partner, and we'llall be happier for that.

(35:08):
So what are some of thecommunication pearls that you
can share with us as far asgetting this going?

Speaker 2 (35:13):
Yes, I have a few.
At first off, I'd like to saythat choosing the right time to
talk is probably a good firststep.
It's easiest to talk when thereisn't an ongoing conflict right
.
It's easier to talk when timeis less stressful, maybe on the
weekend, maybe during a long carride.

(35:34):
Make sure that neither one ofyou is tired or rushed and has
the energy for this discussion.
It's certainly going to takesome time and, as you reminded
everyone, dr McMinn, in ourpodcast last month, make sure
it's not during an Alabamafootball game right, there we go

(35:55):
.

Speaker 3 (35:55):
That's right, especially if there's two
minutes left and we're threepoints behind on the two-yard
line.
Yeah, exactly.

Speaker 2 (36:02):
Okay, so that is choosing the right time.
I also think using the righttone is important.
Okay, never a blaming tone orcriticizing tone, especially
about a previous sex act.
Right, the tone of compassionand kindness will always get you
further.
And make sure you have somepositive feedback to share

(36:25):
what's going well, what youenjoy about your sexual
relationship or each other, andtry to use a kind of a softer
tone.
Sometimes touching some of yourpartner's hands will help.
So, granted, no two people willhave the exact same sexual
interests, desires orpreferences, so finding common

(36:46):
ground will make everybody thatmuch happier.
Now some tools for that.
You could use sexual quizzes.
They're available online.
We talked in our last podcastabout yes, no, maybe lists.

Speaker 3 (37:00):
That's a good communication tool to use and I
think sex with only has one, andyou have one right yes, and
we're going to post both ofthose in the show notes, having
kind of a sexual expectationlist, right?

Speaker 2 (37:12):
Not making sure that your goals together are
attainable and they're notthreatening to either parties
important, and then again have apriority list in mind.
What are the top one or twoissues that you want to talk
about?
Don't try to throw everythingout on the table.
Your first discussion.
So you're a guy.

(37:33):
Dr McMint, can you add anythinghere?

Speaker 3 (37:36):
Well, valerie, I'm working progress.
You know I'm working on it butI'm still not there.
But I'm trying to get it.
But I think to make the most ofmost relationships, both
parties really need to open upand share their wants, their
needs, their desires, theirturn-ons and turn-offs.
They need to learn to be goodlisteners and to act on what
they've heard.
If she has to tell you ahundred times to do what she

(37:57):
likes and you still never do it,then eventually she'll stop
asking and she'll be rightfullyresentful.
So open up, guys, and talk andlisten and act and you'll reap
the rewards.
So also use some tools thatValerie just talked about, like
the questionnaires.
That can be very helpful.
That wonderful book I'vementioned before our previous
podcast called Supermerital Sexby Paul Piersall.
He has a lot of great quizzesin that book, which I think that

(38:20):
can be helpful.
I find if you kind of both dothe quiz together, right Blindly
together, and then kind ofcompare answers, that can really
open a lot of wonderful fodderfor some good discussion and
movement forward.

Speaker 2 (38:32):
Right, right yeah.

Speaker 3 (38:34):
So, valerie, as our conversation on the women's
sexual health, there's sometimesan interest, but there's an
awkwardness when it comes toinitiation.
Do you have any recommendationsfor getting things started?

Speaker 2 (38:45):
Yes, I do.
That part of initiation isawkward, right, and so you
really have to have a goodintention here and maybe even do
some practicing.
I think it's a skill, butcertainly having a warm and
loving and honoring tonethroughout the day, not just 30
minutes before one has sex iscan go miles and miles.

(39:08):
It can really prime the pump,if you will, for a connection
and then the next can lead on tosomething else.
So I think again, having a warm, loving and honoring tone
throughout the day I think too,not rushing into anything,
having some shared experiences,either even a few days before or
the day of going for a walk,watching a movie, sitting on the

(39:32):
couch together talking, this isa perfect time to just really
connect, leave the outside worldbehind and do it well, in
advance of any other sexualadvances, if you will.

Speaker 3 (39:49):
And it seems like, once again, this is a great
example of the need forcommunication.
It seems like there are somewomen who and this is from my
reading and whatever who want aman who's gonna quote, take
charge, right, and yet there areother women who might want a
more, say, subtle approach.
So I think that this canrequire some communication, and

(40:10):
that can be verbal, nonverbal,whatever as far as his likes and
dislikes and her dislikes asfar as getting this initiation
going.

Speaker 2 (40:20):
Right, right.
And I think for the guy, hedefinitely has to read the room.
If you will, okay, check to seehow his wife is feeling or,
excuse me, partner is feeling.
What are her words like thatshe's talking about?
Is she stressed out?
What's her body language saying?
So, reading the room beforejust diving in and wanting sex

(40:42):
is a good thing to do.

Speaker 3 (40:44):
Right.
So on the podcast we did aboutwomen's sexuality, we talked
about the triad of desire,arousal and orgasm.
So let's start with desire.
Please comment on the role ofdesire as it applies to male
sexuality.
And again, the myth out thereis that men always want sex 24
seven.
So if there is a desirediscrepancy, then women are

(41:05):
often assumed to be the deniers.
So comment on that force please.

Speaker 2 (41:08):
Right, we're going to talk more about desire
discrepancy in a little bit, sothe answer to this question,
though, is interesting.
There have not been a lot ofstudies that exclusively relate
to men's sexual health.
Most of the existing researchhas focused on men's low sexual
desire, especially in thecontext of men and women as a

(41:30):
couple.
So what we do know, though,from the research, is that men
spend considerably more timethinking about sex.
They spend more timefantasizing about sex and
feeling sexual desire andmasturbating, and this isn't
compared to women.
So there was one Ohio StateUniversity study that recently

(41:51):
debunked the popular myth thatmen think about sex every seven
seconds.
I'm sure you've heard of that,which is pretty impossible,
right, since if you do the math,that would be 8,000 thoughts in
a 16 hour period.
So what the OSU study did showis that men typically think of

(42:11):
sex about 19 times a day onaverage, which may sound like a
lot.
However, the same study showedthat women think about sex about
10 times a day, so that's nottoo far behind, right?
So other studies, though,showed that men typically have a
higher sex drive than women onaverage, and that may be due to

(42:32):
men having an abundance oftestosterone right.
The hormone of desire.

Speaker 3 (42:38):
Right.
I'll never forget a lady whocame in one time and she had a
low T and we don't givetestosterone to people who have
normal, but if they have lowtestosterone sometimes we bump
it up.
And she came back to me.
She said doctor, now I knowwhat an 18 year old boy feels
like.

Speaker 2 (42:53):
So, oh, good for her so anyway.

Speaker 3 (42:56):
So what kind of factors can influence that male
sexual desire?

Speaker 2 (43:00):
Okay.
So low sexual desire.
So that is a real thing andmore common that you might, then
you might think.
And studies show that about 15%of men experience low sexual
desire and that would becompared to 30% in women.
So sex drive does naturallydecrease with age, but often

(43:22):
loss of libido is tied to anunderlying condition like stress
or depression, low testosterone, certain medications we know
antidepressants, antihistamine,blood pressure medications so
not just medications but thosehealth conditions that are there
Because people are takingmedications, right, like high

(43:45):
blood pressure itself, diabetes,you know both of those can
damage a men's vascular systemand affect his ability to
maintain an erection.
So oftentimes the anxietyassociated with not being able
to maintain an erection cancause men to avoid sexual
intercourse and even intimacy.
So what we do know about men'sdesire is that although it can

(44:10):
wane, just like women's desire,it doesn't ever completely
disappear.
But it will change over timeand it may change in the way you
make love, it may change inwhat type of sex you enjoy or
the frequency of sex.
But rest assured, sex andintimacy can be a pleasure area

(44:31):
or part of the aging process.

Speaker 3 (44:35):
In the classic scenario when there's a desired
discrepancy.
Please give us some pearls ofwisdom on how to sort of bridge
that gap and come up with sortof a happy compromise,
especially in a situation wherethe man is the avoider.

Speaker 2 (44:47):
So just to clarify for our listeners, desired
discrepancy is when one memberof a couple experiences more or
less sexual desire relative totheir partner.
Okay, so knowing thatdefinition is important.
So, interestingly enough, thisis among the main reasons that
couples seek counseling ortherapy.

(45:07):
Is this desire difference?
Right so, but another mythrelated to desire discrepancy,
if I may, is that in aheterosexual relationship, the
discrepancy is always the malepartner wanting more sex.
That is a misconception, whenin reality it's many times the

(45:29):
male partner is the one with alow desire and the female
partner is the one with higherdesire.
I just want to share that.
So in most long-term couplesthey often have worked out their
differences with desire okay,by not having the expectation
that they will always be in sync.
Okay, when it comes to theirdesire for sex, they've adopted

(45:50):
this ebb and flow mentally,which is very healthy right.
For others who haven't beenable to get into that sync,
though, there's a few strategiesthat they could use.
They could realize that it's anormal part of the relationship
for starters, that no one isbroken, that it doesn't even
have to be consideredproblematic.

(46:10):
They can be physical withouthaving intercourse.
There's cuddling, there'skissing, there's caressing,
there's talking.
There's much more to sex thanjust penis and vagina.
That we've talked about.
Scheduling sex is one of myfavorite ways in which to help
with desire discrepancy.
It's on the calendar, we knowwe're going to do it, everybody

(46:34):
can get ready for it andeveryone's on the same page.

Speaker 3 (46:38):
You know I used to have a couple of sometimes and I
would ask them so how oftenwould you like to get together?
And one would say maybe threetimes a week and the other would
say once a month.
So I try to press them on.
How can we find a compromisethere and can we agree on maybe
once every two weeks, right?
You start with that, and thenultimately you see if you can
sort of keep moving the needlein the right direction so they

(47:00):
find a good, happy compromise.

Speaker 2 (47:01):
Right, right.
Yeah, I'm a big fan ofscheduling sex and it works.

Speaker 1 (47:06):
That's the thing it works right.

Speaker 2 (47:08):
You can also consider engaging in an activity without
the partner, okay.
So again, if your partner's notready, and so you can engage
yourself, we call this solo sexor a masturbation.
And then, dr McMinn, there's aphilosophy of yes that I've
learned from you.
Do you want to talk about thata little bit?

(47:30):
Sure.

Speaker 3 (47:30):
I'll do Really help.
Please, oh me talk about that.
Yes, you.

Speaker 2 (47:34):
Yeah, yeah.

Speaker 3 (47:36):
It's something I learned back in my ER days and I
think it applies to life andapplies to all sorts of things
with the relationships.
But basically, when somebodyasks you for something, the
first word out of your mouthideally is yes, but now we can
have a qualified.
Yes, yes, but let me finishthis project I'm working on.
Or yes, but whatever.
But the more times you canapproach their request with an

(48:03):
affirmative yes, then I thinkthat goes a long way towards a
healthy relationship.
Like, for instance, if yourpartner approaches you and the
answer is usually no, then he orshe's going to stop approaching
you, and because that'srejection, right?
Nobody likes rejection, and sowhen somebody's sticking their

(48:26):
neck out and being vulnerable byasking, the last thing they
want is had their head choppedoff right, and especially over
and over and over again.
And so I think, as much as youcan sort of say yes, but again,
maybe yes, but I've got a bigproject tomorrow, let's get
together tomorrow night.
But the first thing out of yourmouth should be yes.

Speaker 2 (48:44):
Right, right, and I like that for all the reasons
you stated, but also, as I'mthinking about it myself, if I'm
expecting myself no pressure.
But if I'm expecting myself tosay yes, I'm going to
automatically be thinking of allthe reasons to say yes Instead
of without the philosophy of yes, I can think of way too many

(49:06):
reasons to say no right.
So it's a mindset.

Speaker 3 (49:10):
Sure, sure, it sure is, and, as I said, I think it
could apply to the workplace orto lots of aspects of
relationships.

Speaker 2 (49:17):
So anyway, and all of these strategies that we've
just listed to help with desirediscrepancy, they only work
through communication, right?
I think your listeners are sotired of us talking about
communication.
We've said it again and again,but it's a must in this area of
desire discrepancy.

(49:38):
So desire discrepancy doesn'tbecome a serious problem and
instead goes back into that ebband flow of the relationship.

Speaker 3 (49:46):
So let's move on to the arousal phase.
It takes a guy about five toseven minutes to have an orgasm
or a jack late, whereas it takesa woman, on the average, about
15 to 20 minutes and sometimeseven much longer.
So this sounds like a recipefor failure and frustration and
disaster.
So what to do in this situation?

Speaker 2 (50:03):
It certainly can be a recipe for disaster and it
often leads to dissatisfactionfor the partner, which may
result in them pulling away fromsex altogether.
So remember, we talked in ourlast podcast about having sex
worth having.
Well, if a partner iscontinuously disappointed in the
sex they're having, well,they're going to stop wanting it

(50:25):
.
Now we have a situation of lowdesire the wanting and desire,
discrepancy, less frequency.
You are right, it does spelldisaster.
So basically, what we'retalking about here is the orgasm
gap and, just as a reminder,the orgasm gap was a term coined
to describe the disparity inorgasms between couples.

(50:50):
So men love to think thatthey're great in bed, right, of
course.
They quickly move through thekissing and the cuddling, they
skip past the foreplay andinsert penis into sometimes a
semi-moist or dry vagina.
They thrust for a bit and thenthey finish and roll over on
their back.
Now I apologize for beinggraphic here, but I think your

(51:13):
listeners can get the picturenow.
So a few pointers here.
If it sounds like, this is yourguy.
So one sex is not a one-sidedact, right, it needs to be both
partners needs to be honored andprovided for.
And two oftentimes it's notmost of the time women don't

(51:35):
orgasm through penetration,especially if the position
doesn't come near the clitoris.
So keep in mind, about 70% ofwomen orgasm through clitoral
stimulation, with only about 30%with vaginal penetration.
What I would say to guys, drMcMinn, is two words.
Well, that keeps it simple.
Slow down, let's repeat thatfor us please Slow down.

Speaker 3 (52:00):
There we go, there we go.

Speaker 2 (52:02):
And I feel the vibes of a virtual amen from the
ladies out there.
Seriously, though, I say thisfor two reasons the orgasm gap
and women's arousal.
So let me explain.
So, technically speaking, theorgasm gap refers to the
disparities and inequalities inorgasms between heterosexual
couples.
In simple terms, it meanswomen's orgasm during sex is far

(52:27):
less than men do, hence the gapright.

Speaker 3 (52:32):
The noting far less is less often Right, less often.

Speaker 2 (52:36):
Yes, right, thank you .
Given that penetrative vaginalsex is a common form of sexual
activity with heterosexualcouples and reaching orgasm
tends to be the goal for most,guys just tend to get uber
focused, maybe even selfishly,on reaching orgasm Self and
without considering if thepartner has or will reach orgasm

(53:01):
too.
So if guys would just slow downduring the arousal phase,
making sure their partner isbeing pleased, enjoying the
encounter and ready to move onto orgasm, ah, that would
definitely begin to bridge theorgasm gap and, may I say, bring
the whole sexual encounter up anotch.

Speaker 3 (53:24):
Well, it sounds like a great solution.
And there again back to thecommunication issue, isn't it?
So it's like a wonderfulstrategy.

Speaker 2 (53:31):
Yeah, and I'd have to say too that the orgasm gap is
getting worse, since a lot ofmen take their cues from porn,
and I think that repeatedthrusting that they see in porn
is they think it's what theirpartners want.
Yet she typically does anorgasm through thrusting alone,

(53:52):
right, there's no clitoralstimulation there.
So before I realize it, he hashad his orgasm and he checks out
of the sexual encounter,leaving her to feel unfulfilled
and, may I say, unsatisfied too.

Speaker 3 (54:08):
All right, val.
We've previously talked abouthow the number one concern of
men when it comes to sexualdysfunction is erectile issues,
that is, erectile dysfunction.
So any thoughts on that?
What could a guy could do?

Speaker 2 (54:22):
Yes, I have a list of common treatments for erectile
dysfunction.
But one thing I wanna saybefore we go through that list
is to keep in mind, as we gothrough the list, that the best
treatment for ED is going to bewhat is best for the individual.
Okay, so it's got to work forthat individual person.

(54:42):
But starting out, oralmedications.
For sure, most commonlyprescribed medications for ED
are Sildenafil, known as Viagra,the little blue pill, and
Tidalafil, which is known asCialis.
Now, oral medications have thelongest track record, for sure.
However, treating ED doesn'thave to begin and end with oral

(55:05):
medications, which they can comewith some unwanted side effects
.
In addition, oral medicationscan be unsafe for some men to
take at all, including those whohave had, let's say, severe
heart disease, heart failure,have low blood pressure, or
those who take nitrate drugs totreat chest pain, not to mention

(55:27):
, too, these oral medicationsoften fail to work in some men
altogether.
So there are some options otherthan oral medications.
The first one is the vacuumerection device, often called
the VED, or it's often calledthe penis pump as well.
This works by pulling bloodinto the penis using suction.

(55:48):
Once the erection is formed, atension ring can be slipped on
the base of the penis, whichhelps maintain an erection for
about 30 minutes or so.
Now, dr McMinn, I like to usethis too in something I call
penile rehab as well.
So let's just say that it's moreabout unpredictable erections,

(56:10):
perhaps with performance anxietyor something of that nature.
Where it's not full blown ED isthat I'll have guys use this
about once every week just toget blood flow into their penis,
just for them to see the bloodflow that comes in the penis
right.
So vacuum erection device canbe used for a couple of

(56:31):
different reasons.
So the next one on the list istestosterone replacement therapy
, and we've already talked aboutthat, so I'll leave it at that.
There's also an option ofintraurethral therapy.
Now.
This involves inserting a smalldrug pellet into the tip of the
penis.
It takes about 10 minutes foran erection to form, and

(56:54):
typically that erection willlast 30 to 60 minutes.
Now I will say that I've heardthe complaint from some men that
there's a burning sensation andsometimes bleeding at the end
of the penis.
Penile injections are anothercommon use in that I know sounds
a little scary and I don't havea penis, but it still sounds

(57:18):
scary.
Now, this medicine is injectedinto the base of the penis using
a very, very small needle, andit's self-injected, so you can
do this yourself.
And, lastly, there is alwaysthe option of a penile implant.
It is about a 30 to 45 minutesurgical procedure that places a
water-based device into theerection chambers of the penis.

(57:41):
Now this enables a person toreliably control exactly when
and how long that they wanttheir erection to last, and,
according to many urologists,this is really the closest
option to a cure that exists forerectile dysfunction.

Speaker 3 (58:00):
Yeah, it seemed like in the last few years there's
been also this penile ultrasoundthat they've been using.
Right, You've met with that.

Speaker 2 (58:06):
No no.

Speaker 3 (58:08):
Yeah, I think one particular brand is called
Gaines Wave.

Speaker 2 (58:11):
Oh yeah, acoustic wave there.

Speaker 3 (58:13):
Right acoustic wave, which is a type of ultrasound,
and I think there's some prettygood evidence on that.
I don't think it's curative.
For a lot of guys it can be abit expensive.
I don't think there are muchdownside effects other than it
makes your wallet a little bitthinner.

Speaker 2 (58:26):
Yes.

Speaker 3 (58:28):
But yeah, I think it's another potential solution.
I think for most guys not all,but for most guys where there's
a will, there's a way.
Right this can usually beovercome.
Okay, now that we've got theguy a good erection, let's talk
about ejaculation.
Some men are able to get it upand keep it up, but they have
issues with orgasm andejaculation.
The two most common issueswould be premature ejaculation

(58:49):
and then, on the opposite end ofthe spectrum, you have delayed
orgasm or delayed ejaculation.
So let's start with thepremature situation.
Tell us the actual definitionfor this situation, please.

Speaker 2 (58:59):
Okay, so premature ejaculation is also referred to
as PE.
Okay, this occurs when the manejaculates sooner than wanted
during sex.
So, as you can see, there's noparticular stated time here.
It's not like they have PE ifthey come in less than a minute
or two minutes or five minutes?
It really is all about does itlast as long as you want it to

(59:24):
last?

Speaker 3 (59:25):
Right.
Do you have any recommendationsfor this?

Speaker 2 (59:27):
as far as therapeutic options, oh sure, yes, I think
our listeners are probablyfamiliar with the stop-start
method, the edging method, thesqueezing technique, the scrotum
pull technique.
These are all really wellexplained if you do a Google
search.
I'm in lieu of time today I'mnot going to go into those, but

(59:50):
as you practice these techniqueswith your partner, you'll learn
how to control your ejaculationand over time you'll gain
confidence and ultimately you'llbe in complete control.
You can also masturbate beforeyour date or when you were going
to have a sexual encounter.

(01:00:11):
Now you'll have to figure outwhat works best for you.
Sometimes, if you masturbatethe night before, it can be
helpful.
Other men may find that it onlyneeds to be an hour or so
before the date for it to bebetter, so that's another option
there.
There's also local anestheticsthat men can use on their penis,

(01:00:33):
such as a topical lidocaine.
There's some commercialproducts available too, and
they've really done well withthose.
They're not transmitted ontothe partner.
So there's the older ones.
They used to have sometransmission and everybody would
feel a little numb after it wasall over, but now they've
perfected those to where there'snot this transfer.

(01:00:55):
So that's really about it.
For tips on that, I will saythis one thing and this goes
back to what we were talkingabout earlier and supportive
partner is key.

Speaker 3 (01:01:07):
Oh my gosh, that's huge.

Speaker 2 (01:01:08):
Right, it really is so.
Communication first right.
And then a supportive partner.
It's important with all ofthese issues that there's
conversation going on and thatthe partner is being supported
and included.
So you might even want to.
If a guy's going in to see hisurologist or his primary care

(01:01:29):
physician, you might want yourpartner to come along.
This affects them just as muchas it affects you.

Speaker 3 (01:01:36):
All right, then, on the other end of the spectrum,
tell us more about the delayedejaculation.

Speaker 2 (01:01:40):
Sure.
So delayed ejaculation,sometimes called DE.
So we've got ED.

Speaker 3 (01:01:47):
Everything has initials, doesn't it?
Tisey?

Speaker 2 (01:01:48):
We've got ED, PE and now DE.
So delayed ejaculation is whenthe ejaculation takes much
longer than desired, orsometimes it doesn't happen at
all.
Some men find that they canonly reach orgasm and ejaculate
after long periods ofstimulation, even though they
have normal desire and normalerections.

(01:02:09):
Oftentimes too, with delayedejaculation, it doesn't happen
during masturbation, but ithappens with partner sex.
So, we go back to that wholebiopsychosocial.

Speaker 3 (01:02:21):
What's going?

Speaker 2 (01:02:21):
on in the body, what's going in the mind?
What's going on in therelationship?

Speaker 3 (01:02:25):
And is there anything a guy can do for this?

Speaker 2 (01:02:28):
Oh sure, yes, there are.
First of all, though and Ithink you would agree with this
is to visit your primary carephysician, or urologist in this
case, and talk to them.
Make sure that there's noanatomical problems or any
medical problems that arecausing this delayed ejaculation
.
So that would be first andforemost, and, like I said

(01:02:51):
before, make sure you're takingyour partner along with you, for
that support, theirunderstanding and the grace that
you're going to need duringthis time.
When you visit, make sureyou're taking a list of all the
medications that you're on.
That will be helpful to yourphysician, also writing down

(01:03:11):
when this happens.
Does it happen with a partner?
Does it happen withmasturbation?
Be very clear, almost likehaving a diary for this, so you
can really be an advocate foryourself with your physician.
There's some other tips, too,like not drinking alcohol and
not using any recreational drugs, or making sure that, if you do

(01:03:34):
partake in those, that it's adifferent timing than when
you're having a sexual encounter.
There's also some anti-anxietymedications that your doctor can
prescribe for you, kind of tolower, slow things down in your
mind as well as your body.
So those are a few of the mostcommon recommendations I can

(01:03:54):
think of.

Speaker 3 (01:03:55):
Well, thank you.
So how does mental health,including factors like stress,
anxiety and depression, affectmale sexual function, starting
with desire, but also with aright-out function?

Speaker 2 (01:04:04):
Yeah, so we go right back to that biopsychosocial
model that we talked about, andI think you're putting that in
the show notes too.
So we know from knowing thatmodel, talking about that model,
that it's not just what's goingon in your body.
So we have delayed ejaculationgoing on, or even premature
ejaculation or ED.
That's what's going on in yourphysical body, but there's other

(01:04:27):
factors, like you mentioned.
There's stress, there's anxiety.
Those are all going to affectthe male sexual function.
Relationship issues.
What's going on?
And, too, sex and context,right what's going on in your
environment around you?
as well as what's going on inyour mind, so the mental piece
plays a huge role when it comesto sexual function.

Speaker 3 (01:04:51):
Yeah, and, by the way , Valerie, in the show notes
they only give you extemberwords and so it's really limited
, so I'm gonna have it on thewebsite Okay great, okay good.
And so, speaking of mentalissues, how do you deal with men
who have issues withperformance anxiety?
I hear this pretty common.

Speaker 2 (01:05:06):
Right.
You know, performance anxietyis a psychological issue that
affects your sexual function and, just as the name says, it's
anxiety in regards to yourperformance.
What I see in a lot of men thatcome in with performance
anxiety and there are quite afew is that they're worried

(01:05:30):
about a number of things.
It typically is not are thekids sick or is the laundry need
to be done?
It is about body image, believeit or not.
Okay, am I satisfying mypartner?
Is my penis too big?
Is my penis too small?
Is it too narrow?
Is it too wide?
Those kind of things it'salways.
It's also and women may be alittle surprised to hear this

(01:05:53):
it's about making sure, or it'sthe worry behind making sure,
that they're pleasing theirpartner.

Speaker 1 (01:05:59):
Right.

Speaker 2 (01:06:00):
And so not only are they performing up to their own
standards, but am I alsopleasing my partner so that
performance anxiety can get in aperson's head and if they have
issues, perhaps once or twice,with not performing as they
really intended to, then thatcan be a cycle.

(01:06:23):
It can affect the brain,genital connection and if
they've had it once, they'regoing to go into the next sexual
encounter thinking it mayhappen again.
And the whole thinking andworrying about it makes it
happen again and it becomes thisvicious cycle.
So it's a matter of reallysitting down and this is I

(01:06:43):
recommend highly that someonewith performance anxiety not
continue this vicious cycle,that they talk to someone about
it.

Speaker 3 (01:06:52):
Okay, good, and so, looking at now the big picture
as we're wanting things down,how can we create a more sex
positive culture that helps tofoster healthy sexuality in men
in our society and healthyrelationships?

Speaker 2 (01:07:05):
That's a really good question and just really to take
that 30,000 foot kind of view,it's about communication.
I really really go back tocommunication, supportive
partners, communication, talkingabout these issues.
Realizing too, I think, drMcMinn, is that sex doesn't go

(01:07:29):
perfectly all the time.
Their bodies just don't workthat way.
Just because we want it doesn'tmean it's going to happen
perfectly.
So I think that speaks toexpectations, right.
Okay, it's realizing there isan ebb and flow, there's a
sexual energy in each of ourbodies, and so it's just again,

(01:07:50):
it's not going to happenperfectly every time and that's
okay, that's normal, andespecially if you're
communicating and your partneris supportive, then you can work
through all of those.

Speaker 3 (01:08:00):
Now and as you go through life, you might have a
great chemistry with one person,but maybe not another person.
Years ago I played in a bluesband.
We played this wonderful songcalled I Got my Mojo Workin' and
it said I got my Mojo Workin',but it just doesn't work on you.
So I think that throughout alifetime we'll find that one

(01:08:22):
partner once again we can'tcommunicate, just not on the
same page, whereas anotherpartner it works out fine.
So if a guy's kind of workingon it and he's doing his best
and it's just not happening forhim or his partner, when is it
time to seek third-partyprofessional help?
And what would that look like?
A counselor, a pastor, a friend, a therapist, a doctor, et
cetera.

Speaker 2 (01:08:39):
Right?
Again, a great question, and Iwanted to bring this up earlier,
but I'm glad that we can talkabout it now.
I do think that the sooner thebetter.
Again, as we pointed outearlier, typically people aren't
responding immediately.
They have a problem the nextweek they call their physician,

(01:08:59):
or call a sexual health educatoror a sex therapist.
They're usually waiting monthsand months.
So it is.
If the problem brings distressin their life, then definitely
to seek out help.
I wanted to talk about thedifference between a sexual
health specialist like myselfand many others out there, and a

(01:09:20):
sex therapist.
Can we do that?

Speaker 1 (01:09:22):
for just a minute.

Speaker 2 (01:09:23):
So a sexual health counselor or coach is
well-versed on the intersectionof sexual function, intimacy and
optimal health and is able toexplore the root cause of issues
and concerns that a guy mayhave.
So everything fromunpredictable erections to
performance anxiety.
So often times this onlyrequires a few visits, maybe two

(01:09:48):
or four, depending on theindividual's motivation to make
changes and to do the homework.
So, in other words, it happensin real time.
What is the problem?
Let's work on the solution,whereas a sex therapist works a
little differently.
So the amazing work that theydo.
However, they tend to dig deepinto the psychological issues

(01:10:10):
surrounding whatever issue orconcern one might have.

Speaker 3 (01:10:14):
They put a 40-inch pin on it.

Speaker 2 (01:10:16):
They certainly do.
They look at things like wewere just mentioning.

Speaker 3 (01:10:21):
What does your mother mean to you?

Speaker 2 (01:10:23):
Exactly, it goes back to utero.
I typically go back a littlebit and not into utero, so they
do.
The look, though, at attachmenttheories and family of origin
connections to the problemyou're having.

Speaker 3 (01:10:36):
And there's a time and a place for that, but not
everybody needs that.

Speaker 2 (01:10:40):
And they often deal with some pretty heavy work in
sexual abuse, sexualcompulsivity, which is like an
addiction, or pornographicaddictions as well, infidelity,
betrayal, all those things.
But if you're having problemwith sexual function again back
to that circle if it's going on,what's going on in your body,

(01:11:00):
what's going on in your mind, inyour relationship then I would
highly suggest someone as asexual health counselor to see.
So.
This work takes time, though,so typically one can expect with
a sexual health counselor tomaybe again two to four visits a
sexual therapist, maybe alonger period of time, months,

(01:11:21):
if not years in some cases.
So I did want to make that clear, because we've talked a couple
of times about reaching out to athird party.
It doesn't have to be.
I mean, guys don't tend to liketo go to counseling, right?
I consider myself a coach a lotof times with guys and I can
get a lot further coaching andeducating and then going deep

(01:11:45):
into their psyche.

Speaker 3 (01:11:47):
Right, and the average doctor, I think, is
going to know how to prescribethe little blue pill, but he or
she's not going to really knowmuch about otherwise human
sexuality.
So you only get so far withthem.
But yeah, I think thatsometimes we have to be humble
and wise enough to know that weneed help, and sometimes when
you're trying to work it outwith your partner, it can become

(01:12:08):
kind of an us versus them thing.
We have to all realize we're onthe same page, on the same team
, trying to move forward.
So we have this mutuallywonderful sexual relationship
and so sometimes that requires athird party in there helping us
out.

Speaker 2 (01:12:23):
I do tell my couples that sexual issues is an us
issue.
It's not a me or you issue.
It's an us issue to your point.

Speaker 3 (01:12:32):
When you mention the word homework, it's not like the
therapist is going to fix itfor you.
You have to fix it yourself.
But they can just guide you inthe right direction.
But you do have to go home anddo your homework there with your
partner.
So now I know that you do seemen and couples locally in your
practice up in Ohio, but I alsounderstand that you deal with
them remotely.
Is that correct?

Speaker 2 (01:12:50):
That is correct, yes, and how would that happen?

Speaker 3 (01:12:52):
How would they get in touch with you?

Speaker 2 (01:12:54):
Sure, so we can put my website on the show notes or
on your website for a link.
In the meantime, though, ifanyone anyone of your listeners
have questions, they can simplygo to my website.
It's intimacyhealthcom.
So that's intimacyhealthcom,and there's actually a chat box

(01:13:16):
there that they can click on andsimply ask a question.
Isn't that nice.
Just reach out anonymously, ifyou want to.
And just reach out and let'sget the conversation started.
Wonderful.

Speaker 3 (01:13:27):
Yeah, so I'll be sure to put your name and contact
information on our list of linksin the website.
You can find it at the bottomof McMinnMDcom, on the homepage
at the bottom, and so it'll beright there for you.
Well, all right.
Well, valerie, before we wrapthis up, is there anything else
you'd like to tell us about malesexuality that we have not
already discussed?

Speaker 2 (01:13:44):
No, dr McMinn, I think we've covered it all,
we've covered it all and more.

Speaker 3 (01:13:49):
Well, once again, we hang our hat on being
evidence-based and thorough, sowe appreciate you bearing with
us.
So I think that's about all thequestions we have for you,
valerie, and once again, thankyou so much for sharing your
wealth of knowledge andexperience with us on this
important subject.

Speaker 2 (01:14:05):
Well, thank you, it's been a pleasure, dr McMinn.

Speaker 3 (01:14:08):
Well, that will about do it for this episode of the
Functional Medicine Podcast.
Thank you so much for listening.
Please take a moment to give usa five-star rating on iTunes.
These reviews really do make abig difference for us and I
thank you in advance.
By the way, they do make it abit difficult to do, so.
I have written out thedirections for you on how to do
this.
On your iPhone, you can findthis information at mcminnmdcom.

(01:14:29):
It walks you through theprocess step by step and once
you get the hang of it, it justtakes a few seconds to do it.
If you have an Android, sorry Ican't help you.
I'm not in that world, butanyway, also help us grow by
telling your friends and familyabout us.
Word of mouth really helps usget the word out, and if you'd
like to reach out to me with anycomments or suggestions for

(01:14:50):
future topics, you can reach meat drmcminndoctormcminnyahoocom.
We'd love to hear from you, andthanks again for listening.
I certainly appreciate it.
This is Dr McMinn signing out.
Until next time, take care andbe well.