Dr. Paul Gittens: ED affects 50% of men over 50 - The Breakthrough Treatments Your Urologist Isn't Telling You | #138 - The Sex Reimagined Podcast

Episode Transcript
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Leah (00:06):
Hello, welcome to the Sex Reimagined Podcast.
My name is Leah Piper.
I am your tantra expert here onthe show, and I am with.

Willow (00:14):
Dr.
Willa Brown, your Daoist expert.

Leah (00:16):
And I wanna thank so many of you who have commented on the
hidden truth about male intimacythat no one talks about Episode
#124.
Uh, you guys have just lovedthat conversation, and it's a
really important conversationfor Willow and I in particular
because male intimacy and thatability for men to connect on

(00:38):
such a deep, profound level issuch an important conversation.
And please, if you haven'tlistened to it yet, go check it
out.
We'll have it in the show notesfor this episode.
But we've got something reallyspecial up for you today.

Willow (00:49):
That's right.
We interviewed Dr.
Paul Gittens, who is a leadingsexual medicine and male
fertility specialist, boardcertified urologist.
He's got three practices in NewYork and Philadelphia and Leigh
Valley.
Um.

Leah (01:05):
Allen Town.

Willow (01:06):
Allentown.
There you go.
And he is treat.
He treats men and women.
He helps so many people withsexual function in so many
different ways.
I mean, this man is a wealth ofinformation.
You are going to love thisinterview.
It's gonna open your mind in somany ways, and you'll be
reimagining what's possible withyour sexuality.

Leah (01:27):
it might just be an answer to a prayer folks, so please
tune in a turn on and fall inlove with Dr.
Paul.

Announcer (01:34):
Welcome to the Sex Reimagined Podcast, where sex is
shame-free and pleasure forward.
Let's get into the show.

Willow (01:43):
All right, so today we are here with Dr.
Paul Giddens and we, we werejust chatting with him for
pressing record, and this isgonna be a great interview,
everybody, because Paul is justa wealth of information around
sexual health, everything to dowith it.
I mean, we could take thisconversation about 20 different

(02:04):
directions it sounds like.
but why don't you tell us.
Dr.
Paul, you are a medical doctor.
How did you get interested in,um, sexuality as a sort of more
niched part of your medicalpractice?

Dr. Paul (02:18):
Yeah, so I am a board certified urologist.
and then I did a, fellowship insexual medicine and male
infertility.
I treat men that are having someissues with fertility where I.
Their sperm counts might belower.
The other part of my practice iswe treat men and women for
sexual dysfunction, and that canrange from anything from men

(02:41):
having problems with erections,hormonal issues, so low
testosterone, prematureejaculation, not ejaculating,
uh, pelvic pain, you name it.
Anything that goes wrong in thebedroom we take care of.
And then for women, the samething.
So women that are going throughmenopause, we have a whole
hormonal program for that.

(03:02):
Um, women that are having painwith sex or pelvic floor
dysfunction, we take care ofthat for them.
Issues with arousal, libido.
And another part of my practiceI'm really proud of is that we,
um, also help men and women thatare going through cancer
treatments, like women that aregoing through breast cancer
treatments, or women or guysthat have prostate cancer and
helping them to enhance theirsexual function.

(03:25):
Um, in that respect.
So really happy about that.
I mean, my origin story reallyis when I was a urologist, um,
at the time, you know, I'mdating myself, it's a long time
ago, but nobody cared aboutsexual function at all, right?
Nobody cared about it.
Um, women that were undergoingbreast cancer therapy, nobody
talked to them about sexualhealth.
Nobody talked to them about whathappens after you've gone

(03:48):
through chemotherapy or you'reon Lupron and you're on
Tamoxifen for breast cancer, um,or for women that just have low
libido, just out of the blue.
Right?
And then for men as well, youknow, nobody talked to men
about, um, what happens afterprostate cancer or radiation to
the pelvis, or what is thisnatural thing of aging?

(04:08):
Why, why are guys gettingerectile dysfunction?
Like what's happening in theirtwenties, thirties and forties?
That's leading up to erectilefunction.
So.
And then hormones as well onboth ends.
Um, what happens to yourhormones over time and
everything declines.
I've been in practice since, um,well, I've been doing this since
2009.
I.
But I've opened up my ownpractice since 2014, so we're at

(04:31):
10 years and I have threepractices, one practice in
Philadelphia, in Allentown,which is upstate Pennsylvania
and um, in Manhattan, New York.
So I go between those threelocations to help, um, men and
women from all over the worldreally.
We have patients flying from,you know, Dubai, from Europe,
from California, or just they'relocal.

Willow (04:53):
Wow, I love this.
So you've created like an empireof sexual function, health and
wellness.

Dr. Paul (04:59):
There you go.
Yeah.
I never thought of it as anempire.

Willow (05:02):
You are an emperor of sexual health and wellness,

Dr. Paul (05:06):
I'll take that.

Willow (05:07):
Anyway.

Dr. Paul (05:08):
I'll take it, I'll take a compliment when I can get
one, you know.

Willow (05:11):
That's pretty remarkable.
I mean, really what a service tothe world.
And yeah, when you started doingit, just the, the, you know, low
levels of conversation that werehappening and, and now there's
so much more conversation

Dr. Paul (05:24):
so much more there.
But you know, we need showslike, you know, podcasts like
you, like you guys have, becausethere's so much more information
that needs to be out there aboutthese things.
You know, just as simple assomething as simple as
menopause.
You know, like women don't, havean idea of what happens to the
body after menopause or guys asthey get older, what happens to

(05:45):
their erectile function and someof the things that we can do to
kind of abate those, um, thesymptoms that they're having.
So, yeah.
So

Willow (05:51):
much you can do.
I mean, God, I was just talkingto someone last night.
He's like, my girlfriend'shaving the worst time in
perimenopause.
I'm like, well, she doesn't haveto.
She could be having a great timein perimenopause.

Dr. Paul (06:03):
She can.

Willow (06:03):
Yeah.
Give her my number.
You know, like it is really justabout educating people and, and
showing them what is possible.
we were also chatting before wepressed record.
Um, Dr.
Paul, not only do you help priwell fertility, I'm sure on both
male and female side, but lotson the on male side.

Dr. Paul (06:21):
Yeah, fertility is all the male side.
The um, yeah, so in medicine,the urologists kind of take care
of, that's fellowship training.
They'll take care of the malefertility end.
And the OB-GYNs that arefertility trained, they take
care of the,

Willow (06:35):
female.

Dr. Paul (06:35):
the female patients.
Yeah.

Willow (06:37):
But you also do vasectomies, so you're creating
a nice balance around, um, the,the humans who are making more
humans in the world.

Dr. Paul (06:45):
the ying and the yang, right?
I mean, so we do vasectomies,but then we also do vasectomy
reversals.
So we do both.
So for guys that it, um,

Willow (06:54):
Which are very successful, the reversals.

Dr. Paul (06:57):
Well, yeah, I mean, I like to say that, I mean for
sure, like in our hands, we havea very high success rate.
Um.
Yeah.
So for men that, um, that havehad their vasectomy and they
have a change of mind, they havea different partner or, you
know, in, interestingly enoughand sad enough, you know, obvi
obviously everybody's dealingwith kind of the opioid epidemic
and everything.

(07:17):
So we've had a, a couple ofpatients where there's daughter
or son might have passed awayand they're still young and they
had a vasectomy and they wannahave another child.
And so we do, um, a reversal forthem.
I'm always a little bitemotional when I, when that
happens, you know, when, youknow.
And everybody's emotional andeverything and um, and
oftentimes we get a good result.
So it's great.

Leah (07:38):
Wow.
You know, one of the things yousaid that, um, sparked my
interest with your long list ofwonderful things that you are
helping people with.
I'd love for you to comment onmen who have a hard time
ejaculating.
I have a couple students rightnow, and I have over the years,
it's more, it's more uncommon.

(07:58):
I see more people who arestruggling with erectile
dysfunction and prematureejaculation, but on occasion the
struggle to reach climax, um, isreally prevalent.
And I'm curious what you do totreat that.
I.

Willow (08:12):
And piggyback on that before you answer, also to add
in like those who are having ahard time ejaculating with a
partner versus just at all.

Dr. Paul (08:24):
Oh yeah.
So, um, as you mentioned, youmentioned three things, right?
So you mentioned prematureejaculation, you mentioned
erectile dysfunction, and thenthe delayed ejaculation.
So premature ejaculation is themost common sexual function that
guys have, right?
I mean, you know, when you'reyounger it's more prevalent.
It's usually a guy that, isejaculating within about two

(08:45):
minutes or so and there iscausing some distress.
And then you have ed, which isalso really common, right?
Ed, affects about 50% of 50 yearolds, right?
Really common.
And you can have issues with,initiating and maintaining the
erection, right?
And then delayed ejaculation.
You know, we try to give adefinition of like two standard
deviations around 20 minutes orso, right?

(09:07):
So about 20 minutes unless theywant to go for 20 minutes.
But 20 minutes is kind of thedefinition of delayed
ejaculation.
Um, but it has to cause somedisturbance to that person.
So if the person is happy with20 minutes.
and they, some guys wanna go 30or 40 minutes, you know, then
it's not a problem.
Right?
But delayed ejaculation issomething that is more common as

(09:29):
guys get older, to be honest.
So, premature ejaculation, yousee this subset of guys that are
younger, but delayed ejaculationIt becomes more and more common
as you get older.
And there's a number of reasonsfor that.
Some of it is'cause of hormones,some of it because of the
receptors in the penis justbecome less sensitive.
Every time we have an orgasm,it's usually like the symphony

(09:50):
of events that have to happen.
It's not just like one thing,like you move your arm and or
you move your finger.
It's like you have to have theright serotonin levels,
prolactin levels, dopaminelevels, all these things that we
take advantage of when you'reyounger because orgasms just
happen, right?
But when you're older, it'sthing when you're older, um, a
lot of things happen.
So there's a lot of theories.
There's some psychologicaltheories why guys got delayed

(10:12):
ejaculation, like how they feelabout sex as they get older.
Also, masturbatory habits.
Some guys that when they wereyounger, they might have
masturbated, kind of lying flaton their bed and they're kind of
humping the bed a little bit.
Those guys are more likely tohave it as they get older,
possibly because of just the,the friction of the penis and
kind of the underside of thepenis.

(10:33):
So there's a number of thingsthat can lead to it.
Um.
Unfortunately, there's no directtherapy for delayed ejaculation.
There's just not, there's nomedication that you can put
someone on, that strictly dealswith, delayed ejaculation.
But in sexual medicine, there'sa number of things that we do
that we may regulate dopamine,we may regulate, um, prolactin.

(10:56):
To try to decrease the thresholdto get that orgasm for men.
sometimes if it's just asensitization issue.
We'll bring in like vibratorsand things like that.
Sometimes it's a hormonal issue,so we may have to increase their
testosterone or do somethingwith their thyroid.
So, you know, delayedejaculation, it's complex and
it's really the art of, ofsexual medicine is, is really

(11:18):
treating that personspecifically to get them over
whatever their problem is.

Leah (11:22):
Hmm.

Willow (11:23):
And then sometimes it, it happens for younger men too.
Like it's not

Dr. Paul (11:27):
It does.
It does, but it's much morecommon in older men, but it can
happen in younger guys, but it'sjust much more common, I would
say.
If you look at a guy that's like20 or 30, the likelihood of
having him having delayedejaculation is pretty low, but
the premature ejaculation ispretty high.
When you get in the fifties andsixties, we start seeing more
and more delayed ejaculation.

(11:49):
Also the penis isn't as hard,right?
So if you're not having a hardpenis, then you're not gonna
have the sensitization.
You're not gonna have like thepleasure.
You're gonna be thinking aboutother things.
My penis gonna go down rightnow.
Am I gonna be able to make thissession?
You know?
And so that can also cause someissues and, and the delayed
ejaculation.
So it's so many things that Ialways tell guys that when they

(12:09):
come to my practice, you'regonna have the highest rate of
me fixing your delayedejaculation then if you go
probably in most to most places.
But it's still not gonna besuper high.
You're not gonna get to be ahundred percent.
You know, I would say mostpractices, if you go to a
urologist or primary caredoctor, the success rate's
probably about 5%.
I always tell guys who are about40%, um, when you come here and.

(12:31):
And that 40% means that everytime you get into, every time
you have sex doesn't mean you'regonna ejaculate.
But if I can increase you by 50%of where you are, or 30% where
you're, then we have a win.
So I always have to set up myexpectations for delayed
ejaculation just because of thetherapies that we do and the
medications that we use.
Nothing's gonna ever get tosomebody a hundred percent.

(12:51):
But, um, but what always happensis a guy's not ejaculating at
all, right?
He's like, doc, whatever, 50%you can, let me do like 30%.
I'm happy.
Right?
And then you get him to thatrate and then you get into 40%
and they're like, oh, I wantmore, and I always want more.
You know, it never fails.
And so.

Willow (13:07):
well, isn't it true that their bodies would then like ha,
have a greater capacity for, formore to be possible?

Dr. Paul (13:15):
Well, we would hope so, but we do see a point of
diminishing return.
We do see a point where we can'tget them past a certain amount
because we can only do so muchto kind of enhance what's going
on with the medications that, orwith the therapies or whatever
that we have.
it's.

Willow (13:31):
to go down that rabbit hole a little bit.
Like what, what, what do youattribute that 40% in your
practice to like, are obviouslyyou're, you know, looking at
hormones, you're looking atpotential medications.
Are you also doing, um,psychological therapy, hands-on
therapy, anything of

Dr. Paul (13:49):
So I don't do any psychological therapy.
I'm a medical physician.
So when?
When a person, yeah.
Yeah.
So when a person comes in.
They get a full exam.
Right.
And, and most of the time whenthey, um, they're talking about
delayed ejaculations.
They, they've had this for along time and they've been to
multiple people most of the timethat's when they're seeing me.
And like during the exam, we'lldo nerve testing, to make sure

(14:11):
it's not a nerve issue.
So we'll do some nerve testingto the penis in the office.
We'll check reflexes as well tosee if that's a problem.
And then we'll check hormones.
and we do a gambit of hormones,which range from a lot of
hormones.
And then, we're checking theirerectile function.
We talk about what's going on intheir life.
Like, is it situational?
Is it with your wife?
Is it not with your girlfriend?

(14:33):
Or what have you.
Right?
And is it just occurring like,during stressful situations?
So we go through all of that.
And then we kind of bringeverything together.
And to be honest, there's nodirect pathway for everyone.
Usually It's something that'sdeveloped for that individual.
And so, yeah, so we have sextherapists that we refer to.
And then if we feel like theyneed sex therapy, then we'll,

(14:55):
send them to a sex therapist orwe'll treat'em in the office
depending on what we find in,their labs or what we found on
the exam.
So we do incorporate, I mean,sometimes it's pelvic floor
physical therapy that we'llbring in as well.
It just depends on thatindividual.
Like when I check their pelvicfloor, if I feel their, their
pelvic floor is really tight,then all right, so we have to do

(15:15):
this.
I wish, you know, like everyonecomes in and everybody asks me
like, what do you do for this?
And um,

Willow (15:22):
It is different for every person.
It

Dr. Paul (15:24):
different, but it doesn't really give me like, you
know, it's nice to say like, youknow, the Eagles are gonna win
the Super Bowl and that's it.
You know, like it's just so mucheasier and people grab

Willow (15:34):
wants to know the future.

Dr. Paul (15:35):
People gravitate towards that.
They want to know.
Right.
But in reality, and I, you know,I was having this discussion
with my friend, in reality it's,I wish it was like that, then it
would be a lot simpler.
And then, you know, I, I'd getall the, like, the clicks and
everything, but it's never likethat.
You know, it's, it's, it's, it'snever, it's, it's just the way
humans are.
It's, it always depends andnobody likes sending

Willow (15:56):
always depends.

Leah (15:57):
It's

Dr. Paul (15:57):
it, it always

Leah (15:57):
a combination.
I mean, we have to also rememberthat we are these complex
organisms.
You know, like when in life it'spretty rare that we get just a
simple question, a simple answerto a complex question.
But at the same time, when we'rereally taking a look at a, a
holistic approach of how,because when I look at

(16:18):
sexuality, it's never just onething.
If, if there's, you feel likeyour sexuality is problematic,
it's affecting a lot of othersectors in your life too, not
just what's happening in thebedroom.
So we have to kind of take alook at all these various
combinations to try to find theright treatment, and that really
requires someone to be verypatient.
And a willingness to beinfluenced and to try different

(16:41):
things and to stay the course.
How often are you getting peoplein your office who are dedicated
and committed to staying thecourse, or do they just get
frustrated because our attentionspans are so

Willow (16:54):
limited

Leah (16:54):
days.

Dr. Paul (16:55):
No, I'll tell you, like I'm, I've, I've been
fortunate.
I think it's, it's hard ifyou're like a primary care
doctor and you're treating likehigh blood pressure and it's a
chronic disease that's beengoing on forever.
It's, it's sort of a silentdisease.
It's, it's one of those things,you take medications all the
time and I feel like people can,sometimes they stop taking their
meds.
They go back on their meds.

(17:16):
I've been pretty fortunate andbecause I've been very specific
in terms of what we do in theoffice.
So most of my patients, um, havealready seen, uh, like two or
three people, you know, onaverage before they get to me,
for some reason, and I

Willow (17:33):
And when you say

Dr. Paul (17:34):
I'm.

Willow (17:35):
two or three people, are you talking about other medical
doctors?

Dr. Paul (17:38):
Sexual medicine.
Yeah, yeah, yeah.
I mean, I'm a self-payphysician, so I don't take any
insurance and because of that,like everybody tries to exhaust
like everything they can.
Right.
So they've seen everyone.
It's funny, when I'm in NewYork, like all my guys, they've
already been to Columbia,they've been to Cornell, they've
been to all these high, and thenthey find their way over to me.
And so they're ready.
They're really, they're, they'reengaged.

(18:00):
So, um.
And I've had people that have,like I said, we talked before,
that people will fly over andthey'll come to see me.
So they're engaged and, and theywant to get better.
So I feel like I'm fortunate,uh, in that respect.
Um, so I have their undividedattention and they're listening
to what we have to say.
But it starts with our interviewwith our patients.
Like my first uni was about anhour.

(18:22):
So within that hour, like we'regoing through a number of
different things as well asgoing through a battery of tests
to just try to figure out what'sgoing on with that particular
person.
Uh, be it male or female.

Willow (18:33):
Is there anything that you give people that you have to
give people like, you know,right away, let's say maybe
they've had a prostatectomy,they now have ed, it's been
years, they, uh, want toreawaken their sexual energy and
feel their virility again and,and have, have a heart on again,

(18:54):
and they're maybe leaning towarda penis pump or a surgery of
some kind.
Is there anything that you wouldgive a person that they could,
like start doing on their ownright away?

Dr. Paul (19:06):
Oh, I love how you said like they want to just have
sex.
I love how you.

Willow (19:10):
Yeah.
They wanna fuck, I

Leah (19:12):
Yeah.

Willow (19:12):
don't we all.

Leah (19:15):
Yeah.
Confident.

Willow (19:19):
Yeah.
Yes.

Dr. Paul (19:24):
But yeah.
So yeah, they wanna do that.
Um, and as you were sayingbefore, there's so much more
that goes into having sex withsomeone.
It's that emotional attachment.
It's like having thattogetherness.
It's just, it's a sense of powerfor some individuals and it's so
many things that go into sex andfor somebody that had, a
prostatectomy, you know, there'sa number of things we can do
before they get to the pointwhere they need a penis pump.

(19:46):
Many patients that have hadprostatectomy, especially if
it's bilateral nerve sparing,that means they spare the
nerves, for some of the guys, weget them to use pills.
We can get them to useinjections, prior to getting a
penile implant.
Not to say a penile implant ishorrible.
I don't place them anymore.
I used to do tons of penileimplant, but my job really is to
try to get guys to functionagain that we can function.
So, yeah.

(20:06):
what do we do?
I mean, once again, it dependson that person.
So for some people they may havemore of a vascular issue, then
we would do one thing.
If they have more of a nerveissue, we would do another
thing.
Are they responding a little bitto Viagra and cls?
Are they not responding at all?
You know, what are theirhormones?
If their testosterone's reallylow, we used to think it was
this horrible thing to givetestosterone.

(20:27):
But we know if their PSA's beendown for a number of years, we
can still give testosteroneunder the right consent, under
the right person.
You know?
So if a person has been, hasPSA's been, you know, extremely
low for five years?
No evidence of cancer.
You know, when they did the, um,when they did the surgery,
there's no other extensionanywhere else.

(20:48):
I mean, you know, it shows in anumber of studies that you can
give that guy testosterone.
But you still have to say, allright, your testo, your, your
prostate cancer may come backand all these other things.
But we usually don't see that,you know, but we have to consent
and say.
You know, the old thinking wasthat if you gave testosterone it
would come back.
But in general we don't reallysee that.

(21:08):
You know, in studies it showsthat.
In studies that guys on thathave prostate cancer that are
watchful waiting, so there's asubcategory of guys that um,
have a low grade prostate cancerand you're just kind of
watching.
'Cause you know, they don't wantit to go surgery, it's not the
great isn't high enough.
So even in studies with that,when, when you give those guys
testosterone, if they need it,if it's symptomatic.

(21:31):
We don't see an overwhelmingincrease in the progression of
prostate cancer.
So it's a number of things thatI think the general public kind
of, I think there's a lot of oldinformation that's still out
there.
Um, whereas like, you know,physicians in that are in the
field and sexual medicine thatdo this on a daily basis, we
know there's nuances to how wetreat these guys.

Willow (21:54):
That's great.
Uh, I was also, sorry, Leah, Iwas also curious, um, if there
was something that you wouldmaybe give them to do, like at
home right away, that they couldjust start doing, like increase
their, you know, electrolytes ortheir salt intake

Dr. Paul (22:07):
Oh, oh yeah.

Willow (22:09):
or something that they can really just like really
start empowering themselves to

Dr. Paul (22:15):
Yeah.
I like penis pumps.
Does that count?

Willow (22:17):
Okay.
Yeah, that counts.
Penis pumps are great.
That's something they could doat home.
Yeah.

Dr. Paul (22:21):
I'm a fan of penis pumps.
I really, I think they reallyhelp.
I think when you look atstudies, it shows that there's a
benefit.
It might be a psychologicalbenefit, but it's also a, a
blood flow of benefit.
There's a number of differenttheories of why penis pumps
work.
So I think doing that forexercise is, is key.
so I have that, in most of myprograms that I do for eds, we

(22:44):
add a penis pump and we havethem use it during certain times
and, you know, different,certain situations.
So we'll do that.
But yeah, I think that, youknow, we always talk about kinda
the men's or women's health.
In terms of really trying to getin tune with, you know, your,
your spiritual side, if yourspiritual, you know, yoga, like
all these things that youmentioned I think are so

(23:05):
important.
Eating the right foods, tryingto stop smoking and, you know,
all those things that, um, weknow that are, uh, detrimental
to our sexual health.
We promote all of those things.

Leah (23:16):
Are you doing anything with stem cells?

Dr. Paul (23:18):
Ooh, stem cells.
Oh man.
You talking

Willow (23:21):
Ooh, stem cells.
Here we go down the rabbit hole.

Dr. Paul (23:24):
Everyone know.
So stem cells, we can't callthem stem cells anymore.
So if anybody says they'regetting stem cellS.

Willow (23:30):
PRP?

Dr. Paul (23:31):
Well, PRP is different from stem cells.
We do PRP, I can say that.
stem cells, you can't really saystem cells anymore.
You can say like biologicalproduct.
You can say all these otherthings.
But I think that the, what mostpeople are, most people are not
informed.
They have a theory of why stemcells work, but they don't
really know how it works.
It's pretty interesting.

(23:52):
Most people think that you put,you get stem cells from like the
placenta, your bone marrow, yourfat, and you can do all that.
And, those stem cells thenbecome your penis cells.
Wouldn't that be great?
Or it becomes like your bloodvessels.
That's not how it works

Willow (24:08):
That's not how it works

Dr. Paul (24:09):
No.
So what happens is they, thestem cells actually die in
culture.
When you look at it in culture,it actually dies.
But what, what that stem cellsare doing, it's really the, it's
really all the surrounding,stimulatory cells that are
supporting those stem cells thatare really doing the work.
Right?
And that is called a milieu orlike it, the, all the stuff

(24:31):
that, that stem cells, it'sbathing in, that's really the
signaling pathway that's causingyou to have the result that
you're having.
It's not the stem cells.
Right?
And so some of the cell cellsyou can get from placenta, um,
or bone marrow, what have you.
Like I said, the stem cells die.
But all those stimulatory cellsare there, which are kind of

(24:52):
like this orchestra that'shelping to remodel and restore,

Willow (24:56):
I am not totally gra grasping.
So is it like the, the cellsaround the stem cell, like
almost like the

Dr. Paul (25:05):
the soup that it's in.
It's like if you have chicken,if you have like chicken soup,
right?
And chicken, the chicken is thestem cells and you have all that
other soup that's around thattastes really good.
And then what happens is youremove that chicken, but you
still got the soup right,

Willow (25:19):
got really good broth.

Dr. Paul (25:21):
the broth, and that broth

Willow (25:22):
the nutrients.

Dr. Paul (25:23):
all the nutrients.
You got it.

Willow (25:25):
that.
By the way, y'all, if you'remaking bone broth, be sure to
put some kobu in there, somekelp so that you get good iodine
for your breast health, yourthyroid health in your womb
health if

Dr. Paul (25:36):
I love that.

Willow (25:37):
and probably your penis if you're a man.
I'm not sure, but

Dr. Paul (25:40):
too.
I'm sure your,

Willow (25:41):
yeah.
Yeah.

Dr. Paul (25:42):
will benefit from a little bit of broth.

Leah (25:44):
Okay,

Willow (25:45):
you go.

Leah (25:46):
I, I, I have a prostate question.
What is your stance on prostatemassage for health and wellness
and for possibly, um,diminishing the potential for
things like high PSA scores?

Dr. Paul (26:01):
um.

Leah (26:02):
Regular

Dr. Paul (26:03):
so prostate massage.
I think, um, for some people Ithink it's fine.
You know, I think that you gottafeel comfortable with somebody
feeling your prostate andmassaging your

Leah (26:14):
Going up your butt.

Dr. Paul (26:15):
yeah, some guys, cause a little

Willow (26:18):
see, we'll say it

Dr. Paul (26:19):
you know?

Willow (26:19):
Dr.
Paul.
Don't worry.

Leah (26:23):
Some people love a little bit of a, um,

Dr. Paul (26:26):
Some people, you

Willow (26:26):
love a lot.

Dr. Paul (26:27):
some people love it a lot.
Prostate stimulation is, um, forsome people it's their, it's
their erogenous zone.
I don't really go either way onprostate massage, to be honest
with you.
I think that if you'reejaculating, I think it's
probably doing somewhat of thesimilar thing.
I don't really have a comment onthat to be honest with you.
I don't really, we don't reallydeal with prostate massage as
much.

(26:47):
obviously we want guys to beable to ejaculate and, you know,
and we want, if they'remasturbating, that's fine.

Willow (26:54):
in, in all of the, the vast modalities and therapies
that you offer your clients, ifyou do ever kind of refer, I
know that you would refer tolike a sex therapist, but if you
ever refer to people who just dohands-on like tantric healing
work as well.
Do you

Dr. Paul (27:11):
You know, it depends on it.
It really depends on what the,uh, patient's comfortable with,
to be honest with you.
And, you know, if somebody saysthat, you know, that they would
like to try that, I'm like, I'mall in.
You know, if it's acupuncture,if it's, um, any of the other
therapies like I am, um, 100% inon that.
so I am open to almosteverything, that's beneficial

(27:35):
for that person because Irealize you're not just healing
the person's like by likemedicine or anything.
You also have to heal theirbrain too.
And, um, I find that, you know,if somebody brings it up, it's
something that they probablywant to try anyway.
unless it's something that Ithink is de detrimental,
detrimental, then I, I'm all forit.
Like, we've had patients thathave undergone, like acupuncture

(27:56):
for a number of, of things likepelvic floor, acupuncture, um,
you know, Pilates, yoga, any ofthese things can help.
I will support my patients ifthey're, um, if they're
interested in that for sure.

Leah (28:09):
What?
What are some of theinterventions that you recommend
that Have a higher success ratewhen it comes to premature
ejaculation.
And are you finding anycorrelation between a tight
public floor, which could bepossibly cau idle to premature
ejaculation?

Dr. Paul (28:29):
Yeah.
So we do.
For some of our patients I do apelvic floor exam on my,
patients, um, male or female.
And, if they have a hypertonic,so a tight pelvic floor, then we
would refer'em to a pelvic floorphysical therapist.
Not all patients, but we do forsome patients.
If they have that, then we willrefer them for sure.
Um, and then also like with.

(28:50):
Premature ejaculation.
There's like, um, there's anumber of reasons why men will
have premature ejaculations.
You know, is sometimes It'sepisodic.
Sometimes it's if they're in theback of the car and they're
having sex, they'll have it, butnot in the bedroom where they're
more comfortable.
Sometimes if, you know they havea multiple partner, sometimes
it's with one partner and notanother partner.
So it varies in terms of thetreatment for that.

(29:11):
But oftentimes, you know,medications can help, you know,
obviously you start with somenumbing sprays and things like
that.
That's usually the first thing,along with sex therapy or pelvic
floor physical therapy, um, tohelp with that.
And then there's othermedications that we use the side
effects of to help with, um, thepremature ejaculation.

Leah (29:29):
Okay, so the, the majority of the treatment is like those
sprays, pelvic floor releasework and um, medication.
What kind of medication?

Dr. Paul (29:39):
So you can use some of the side effects of, like,
antidepressants, um, low doseantidepressants you can use for
it.
And, um, amazingly, like forsome of the men, most of the
men, they don't have the sideeffects that you get with some
of the other medic when they'reon a medication that, and they
have like depression or anxiety.
The, the, um, the side effectsare very, very low.

(29:59):
You just have to choose theright one for that patient.
Um, and then there's otherthings.
Sometimes we'll use like 10units.
Sometimes we'll use Botox.
There's a number of other thingsthat we can use for the, the
penis.
Sometimes we'll use filler toplace in the, uh, in the penis.
So there's a little decreasedsensitivity of it.
Um, we do a lot of girthenhancement procedures

Leah (30:21):
was gonna follow up with that.
Yeah.
So what is that?
Fat injections

Dr. Paul (30:25):
No, we use filler.
We use filler like, uh, people,like men or women use for the
face for volume.
So we'll use that into the penisand we get really good results
with that.
My patients are extremely happy,um, with.

Leah (30:38):
but that's not permanent, right?
So they come in a couple times ayear to

Dr. Paul (30:42):
No, no, no, no, no, no.
Usually like, you know,depending on how much filler we
place, um, sometimes, eventhough I always tell them, all
right, the filler's gonna lastabout a year.
So I have guys that are stillthree years out and their filler
looks great.
So I always tell guys it's not,you're not using it as much as
you use and, and like you'reusing your muscles in the face
all the time.
I mean, even though guys wouldlove to use their penis probably

(31:03):
as much as they're using their

Leah (31:04):
Yeah.

Dr. Paul (31:05):
muscles, but, um.

Willow (31:07):
They'd never get anything done.

Dr. Paul (31:11):
I know.
Tell me about it.
So we just find that it last, wefind that it lasts a little
longer, you know?
Um, but I do tell them, becausethe product says it's a year.
I always say it's about a year,but we, we squeeze a lot more
out of it.

Leah (31:25):
do you also cut the tendon?
I don't know the name of thetendon

Dr. Paul (31:28):
Oh, for penile longer.
No, I don't do any, um, that'sfor making the penis longer.
I just don't, I don't, I mean,at this point I don't do that.
Um, sometimes you get somescarring and some other issues
with that.
So I just, um, I, I like the waylike the, the filler really
looks, I think it looks naturaland guys are, are really happy
with it.

(31:49):
It's funny'cause the guy's like,I want a penis, this big doc.
I want a penis this big.
And I'm like, all right, let'sjust make it look natural.
Let's like make it look good.
And then, you know, and I'mlike,

Willow (31:59):
been watching too much porn.
They're like, I wanna look like

Leah (32:01):
I know

Dr. Paul (32:03):
oh my God.
You know how like, uh, likewomen, when they get some women,
when they get their hair done,they'll bring in a picture of
like a famous person.
All this is like, I want, I wantthis hair done.

Willow (32:12):
I wanna look like this person.
Can you just change everything?

Dr. Paul (32:17):
So funny.

Willow (32:18):
That's an inside job, most likely.

Dr. Paul (32:21):
I had a guy that came in the other day and he brought
like a clip from a porn and heis like, I want my penis to look
like this.

Willow (32:26):
Hilarious.
I'm surprised that doesn'thappen all the time actually.
Um, I, you know, I loving,loving this conversation and I
also wanna make time and spaceto talk about the, you know, the
work that you're doing withcancer.
Um, people who currently have itand people who are survivors

Dr. Paul (32:45):
Yeah, so I, I'm really proud of that.
We have a, a sexual health afterbreast cancer program here for
women that, have had either someof them are on Lupron or
Tamoxifen, or a number of thesemedications that, or
chemotherapy that sped up theirmenopause.
and it's hard and obviously withhormones, you have to be very
careful with hormones in, um, inthose patients.

(33:08):
we have a program that helpsthem with their vaginal health,
they're libido.
And just some of the issues thatthey're having after they've
gone through breast cancertherapy.
And then on the, on the otherside for men, men that have had
like pelvic floor surgery, Imean pelvic surgery like
prostate cancer or even someradiation to the pelvis for, for
colon cancer and some surgerieswith colon cancer where you can

(33:30):
get some ed.
We have special programs forthem as well where we, we take
all that into consideration and,um, we can really focus on their
eed and try to get, try tomaximize, um, everything we can
out of their, their sexual, fortheir sexual function.

Willow (33:45):
What does a program look like?
Like is it

Leah (33:48):
What are some of the

Willow (33:48):
of time?
What's going on in the program?
Who do they see?
I.

Dr. Paul (33:51):
um.
Yeah.
So for the, for women, it'sreally, we, we always discuss
their cancer.
Um, some cancers are estrogenpositive, progesterone positive.
We get into that.
We get into their particularside effects that you, they've
gotten from their therapy.
Not, not all women have lowlibido, or not all women have
issues with, um, vaginal healthor, um, vaginal atrophy.

(34:13):
A lot of them do.
So we kind of target in on termsof whatever they're in need of.
And then we kind of focus onthose problems.
But you know, obviously whenwe're focusing on the problems I
mentioned before, you know, wehave to be very careful in terms
of what we give them for theirtherapy, right?
So sometimes we're using lasertherapy for their vagina, or
sometimes we're usingmedications to increase their,

(34:35):
um, libido, that that's notgonna affect their hormonal, you
know, their, their hormones.
Oftentimes we, we send them tosex therapists.
We work with a bunch of sextherapists or if it's pelvic
floor physical therapy.
So we really tailor our programsparticularly for that person.

Willow (34:51):
Got it.
So it's not like a one size fitsall.

Dr. Paul (34:54):
No, like I am saying, I wish it

Willow (34:55):
pick and choose.
Yeah.
Depending on the

Dr. Paul (34:58):
And then even for some breast cancers, depending on
what you have, you could stilluse a little bit of topical
estrogen.
In terms of the data, we knowthat most of the estrogen is not
getting into the system.
It's staying very topically, butthat's a conversation that we
have with the patient, but alsotheir oncologist.

Willow (35:15):
That is such an interesting phenomenon.
I've always wondered about that.
'cause I mean, you put estro,you know, estriol or estradiol
on your belly, your breasts,your arms, your legs, and it
goes into the bloodstream.
I wonder why, I've alwayswondered why, maybe you can
enlighten me.
Why when you put it in the vadgeor on the vulva, it doesn't
quite hit the bloodstream thesame way.

Dr. Paul (35:36):
Yeah.
I mean, we know that it gets, itdoes get in a little bit.

Willow (35:40):
A little bit.
It's like drinking a decaf.
You

Dr. Paul (35:42):
Yeah, but you got Exactly, but like that, that
tissue is very estrogensensitive and it wants to
really, I mean, the easiest wayof putting it, it really wants
to soak it up,

Willow (35:50):
it just wants to soak it out.
It's like a

Dr. Paul (35:52):
yeah, it's, it just really wants to.

Willow (35:54):
Lot of receptors there.

Dr. Paul (35:56):
Yeah, it really wants to, proliferate in terms of like
the vaginal health, it increaseslike the collagen, lubrication,
everything.
So we just don't find that itgets into the levels.
And, and, and it's also theamount that we're giving, you
know, when you're putting it onthe skin, it's usually a higher
amount, higher concentration ofestradiol or estro l whatever
you're using, as opposed to whatwe're placing in.

(36:18):
For estrogen, it's usually forthe vagina, it's a lot less and
the concentrations aredecreased, um, than if you would
place on the skin.

Willow (36:26):
Okay.
Okay.
And do you guys use Bioidentical

Dr. Paul (36:30):
We do, yeah, we do bioidentical hormones.
I stay away from like progestinsand the, and anything with the
ends on the end of it, justbecause of some of the studies.

Willow (36:40):
And then what kind of testing do you guys run?
Yeah.

Dr. Paul (36:43):
Oh, we do blood testing.
it's just it, to be honest,there's like saliva testing,
urine testing, all thesetesting.
Um, I just find that, you know,when patients come in they all
have insurance.
They want to use theirinsurance.
And so we'll, we'll send them toone of the major lab companies
and then we'll go from there.
And I don't find there's adifference between, you know, we
used to do all this othertesting, but you know, the

(37:05):
outcomes for me are the same interms of what I'm looking for.
And what I'm looking for is Ijust look for highs and lows,
right?
So it's not, you know, when it'snot a particular number, it's
highs and lows.
We don't want to be too high.
We don't wanna be too low,right?
But it's really about how thatperson's feeling.
I just had a conversation.
I, I'm, I'm in the middle of myoffice hours and we were talking

(37:26):
about this, I was talking, I wastalking to a physician, he is a
physician and he is like, what'sthe best number for me?
I'm like, it's not a bestnumber, right?
It's.
It's really about how you feel.
It's really about how you feel.
And, and so those lows, we don'twant you to be below a low
number because then it might notbe beneficial for your bones and
all these other things, but wealso don't need you to be super
high.
Um, and then you're gonna havesome side effects.

(37:47):
And this guy I was talking to ison testosterone.
And you know, with testosterone,I always say like, this is kind
of my analogy with testosterone,is that when you.
if testosterone is like waterand you're like a plant, right?
And you put that water in,you're withered plant, you put
that water on the withered plantand you're gonna make flowers,
right?
It's gonna blossom.
But what happens if you keepputting that water on that

(38:08):
plant?
You're just gonna get water allover the floor, and that's all
the side effects that you get.
And people don't reallyunderstand that, that, you know,
there's side effects withestrogen or your hemoglobin goes
up too much, you have a higherrate of having a stroke and, and
DBTs and all these other things.
All these little subtle thingsthat.
I think people miss over time,um, when they're dealing with
hormones.

(38:28):
You know, so there's all theseonline hormone centers and I, I
see these guys that are, theselevels are like in the 15
hundreds and they're like, ohyeah.
But then you look at, um,they're like, oh doc, this is
great.
This is great.
But then I look at yourmetabolic stuff and you're,
their panel and their estrogenlevels are 90 or a hundred.
Um, we had a guy that was wasusing one of these, online, uh,

(38:49):
pharmacies and he had a strokeand all these other things.
And so, you know, there's somesubtleties to hormonal therapy
that, you know, we all should bepaying attention to.

Willow (38:58):
Absolutely.
Yeah, that's really important.
It's so important to havesomebody who's, um, if you are
doing bioidentical or notbioidentical hormones, any
hormone replacement therapy tohave, um, somebody who's really
guiding and watching and testingand making sure that things are
not too high and not too low.

Leah (39:18):
I'm surprised there's even hormone products out there that
just aren't bioidentical.
I mean, with all the informationout there about Bioidentical,
why wouldn't everyone just be onbioidentical?
Why would choose?
Why would you choose anythingother than that?
Since that appears to be thesafest option?

Dr. Paul (39:36):
Well, I mean, I don't think it's the safest option for
everyone.
There's a thought that, hormonesthat are made by manufacturers
that aren't bioidentical arejust as effective.
So, you know, I think it dependson the audience that you're
talking to and the literaturethat you're reading.
If you're, I mean, to give anobjective answer, um, I think
that's, that's why.

(39:56):
Because we do what we do and weunderstand some of the
literature and this is what webelieve, then that's the reason
why I, um, I, I, I'll deliverwhatever medication it is, if
it's bioidentical, if it's, ifit's something that's, I'm using
off label for something, butthere's other people on the
other end, right?
And they say, oh, it doesn'treally matter as long as our
estrogen or testosterone orwhatever is getting to the right

(40:17):
level.
And it doesn't matter how we getthere.
I think that's it.
I mean, for me, like if I'mgiving testosterone to women or
estrogen to women or anything towomen, I like, I personally like
bioidentical.
That's my first choice.
Um, but it's not everybody'sfirst choice.
And it's just, and that's thebeauty of medicine, I think.
I think that there is a choice,but I think you just have to

(40:39):
educate your, I think you shouldknow both sides and I think you
just have to educate your, your,um, your patient.

Willow (40:45):
you're patient inside your programs, are you also
addressing, um, nutrition.
Do you talk about herbs at allwith your client.

Dr. Paul (40:54):
I wish I did.
I really wish I did, because Ithink there's a whole, um, other
side of it in terms ofnutrition, in terms of the
microbiome of the gut and howthat reflects to like your brain
health, your heart health, howit reflects, um, on sexual
health.
So I wish I did, to be honestwith you, I just don't, I just,

(41:15):
um, you know, I've kind offocused on this.
Um, once again, you know, wehave people that if they're
interested in, then I woulddefinitely refer'em to, so I'm
open to all that stuff and Iknow that all helps.
It's just, I just can't doeverything at

Willow (41:28):
can't do everything.
You already are doing so

Dr. Paul (41:32):
wish, you know, but I just can't.
And so, you know, that isprobably an element of my
practice that I wish that we cankind of build up.
In terms of the nutrition and,and like nutrition and sex.
I think that's a whole like,topic of conversation.

Willow (41:47):
to God, we could change the whole world if we just got
microbiome and posture, right?
I

Dr. Paul (41:52):
Oh, I know.

Willow (41:53):
would feel so

Dr. Paul (41:53):
see my posture right now.
It's horrible.
I should sit up right now.

Willow (41:56):
Sit up, open the

Dr. Paul (41:58):
that, is that what you're telling me right now is
you gotta sit up?
I, I get it.

Willow (42:02):
I'm talking directly to you and everyone else out there
who's

Dr. Paul (42:05):
I.

Willow (42:05):
as they listen.

Leah (42:08):
So.

Dr. Paul (42:09):
It's good for your vagina.
Sit

Leah (42:10):
That's right.
That's right.
Um, alright.
I have, you know, a finalquestion and that is, what
advice do you have for women whoare headed into perimenopause,
who are in perimenopause, ormight be even as much as five
years from perimenopause?
When should we start taking alook at our menopausal plan as

(42:32):
women?

Dr. Paul (42:34):
So first thing I think is that women should understand
what it means to be in meperimenopause and what signs
they have, like if they'rehaving hot flashes, if they're
having more anxiety, if they'renot sleeping well at night.
Those are some kind of keylittle things.
Obviously you start gettingirregular periods and things
like that.
So I think understanding likethe symptoms that you're having

(42:54):
and understanding what is thepossibility, of the, what are
the sexual or other symptomsthat you can have with
menopause?
So I think having a good idea ofthat is like the first step,
right?
Um, I think that as women startto have those symptoms, then
they should reach out to someonethat, understands how to treat
them.

(43:14):
Right and understands, and thisis key where nutrition comes in.
I think nutrition is key forperimenopause patients and
menopausal patients.
that's the first step.
And exercising more exercise isgreat, right?
You're increasing dopamine.
you're helping with your bonestrength, you're, it does so
much for wellbeing.
it's great.
You know, those are the thingsthat we should be doing all the
time, but especially in thatperiod.

(43:36):
Also understanding like what'sgonna happen to your bone mass
over time.
So, you know, I can see, um,Leah, I can't really see all of
you, but you look fairly thin,right?
And so do you, Dr.
Willow, um, but alsounderstanding what's going on
with your bone health, right?
Because as you get older, what'sgonna happen is it's gonna
deteriorate, right?
Because of the lack of estrogenon the bone, you get

(43:57):
osteoporosis.
So starting to exercise,starting to use resistance
training early is key.
Right.
Um, also eating the right foods,vitamin D, calcium, also really
important.
So really having a game plan ofwhat is perimenopause, what is
menopause?
What does it look like, whatdoes it look like for me as a
person that might be thinner, ora person that might be heavy,

(44:18):
right?
Because as you get older, it'sharder to lose weight too,
right?
So for those patients, like youreally want to get ahead of the
game, before you get in thatmenopause stage, this is the
time to lose weight.
Because it's so much harder tolose weight as you get through
menopause because of the changesin hormones and everything.
So get ahead of it.
Right?
And that prevents like osteoarthritis as you get older

(44:39):
because of the, because of theweight and all these other
things that weight bringsinflammation and all these other
things.
So that's the time for thatperson to, to maybe look ahead
and say, all right, I gotta dothis now'cause I don't have much
time.
You know?
And then, you know, depending onwhat we find, if it's hormones
or what have you, then we cansupport with that, if you're
having some issues with hotflashes or, or some women start

(45:00):
to have some decreased inlubrication, so we'll help with
that.
You know, I'm a big fan of likehyaluronic acid, vitamin E and
all these other things to thevagina, but also helping to, um,
help with, um, the lubricationor arousal or whatever issues
that they may have.
I know it's a, it's all over theplace, but perimenopause and
menopause is all over the placefor a lot of people.

Willow (45:18):
Yes.

Leah (45:19):
I know I said that was the final question, but I have
another final question.
Um, because I know you do workwith the Venus, right?
The um.
Some laser work working

Dr. Paul (45:29):
use the Mona Lisa,

Leah (45:31):
the Mona Lisa.

Dr. Paul (45:32):
Yeah, the

Leah (45:32):
Yeah, yeah, yeah.
You wanna say anything about theMona Lisa?
For those people in our

Dr. Paul (45:36):
Oh yeah.
I love them.
I mean, it's, it's one of myfavorite tools in my office.
And full disclosure, I was oneof the investigators on the
animal studies for the MonaLisa.
So we, um, we had to do a bunchof animal studies to try to get
it approved by the FDA.
It's not a, it's not FDAapproved.
They, the FDA actually came backand they said they needed
several more million dollars andmore animal trials and all these

(45:57):
other things.
So it is always used off-label.
Um, so I have to say thatthere's, um, but I'll tell you,
I, I am such a fan.
I actually wrote a paper on theMona Lisa laser and what it
does, so it really helps, youhave to think of the Mona Lisa
laser as something likemicroneedling or laser to the
face or, and all thosetreatments, what they're doing

(46:19):
is they're just stimulating yourown body to kind of heal itself,
right?
And so we use core wave therapyin our office for erectile
dysfunction.
Same thing, right?
And so what the Mona Lisa doesis stimulates the tissue and it
promotes collagen.
Um.

Leah (46:33):
Okay.
That's what I

Dr. Paul (46:34):
And then it also promotes hyaluronic acid and all
these other, um, proteoglycansand things that come in and they
start to, um, help withproliferation of the, of, of the
thickness of the vagina.
It helps with lubrication,moisture.
I'm a huge fan of the modal,Lisa, I've been using it and,
you know, I always have people,you know, other companies come
to my office and they want me touse their laser, but I get such

(46:56):
good results with the way I useit.
You know, in most people'shands, I think it works well
just because I've, I've done somuch research on it that we kind
of tinker with a couple thingsto get the maximum results out
of it.

Willow (47:07):
Can you send us a link for your paper?
I wanna read it.

Dr. Paul (47:10):
Oh yeah.
It's on my website, I think.
Um.
Yeah, I can send you a link.
It's, it's old, but what we didis we looked at, women that
were, it was breast cancer.
We looked at our breast cancerpatients and then we compare
them to our menopausal patients.
And then we looked at, you know,using the laser and we looked at
a, a bunch of different factors.
There's like thesequestionnaires that we use that

(47:32):
looked at like sexual functioninterest, all these things.
And at the end of the Mona Lisa,we were able to get them, even
if they were on.
Um, even if there were breastcancer patients on hormonal
therapy, we were able to, um,really have a good satisfying,
you know, se sexual experience,libido, everything went up.
So, there were the same formenopause and, women that, had

(47:52):
breast cancer.
So it works really well.

Leah (47:55):
Just for clarification, the Mona Lisa is good for
treating vaginal pain?
Um, vaginal dryness...

Dr. Paul (48:03):
so vaginal pain, vaginal, um, vaginal pain is a
long, is a big category.
We can't say vaginal painbecause vaginal pain could be
due to the pelvic floor and allthese other things.
So, so, um, vaginal atrophy,right?
And, and, and so GSM is anotherword for vaginal atrophy and,
um, it's.
General syndrome of menopause.
So that's where you have thevaginal atrophy, some pain with

(48:26):
intercourse because of thatatrophy.
Right?
Um, and so.
It's great for that.
I'm, I am such a big fan of itfor that.
Vaginal pain is hard becausethat could be coming from a
number of different places,right?
It could be coming fromendometriosis and all these
other things and pelvic floordysfunction.
So it doesn't help with that.
But it helps to help with theproliferation of the vaginal

(48:49):
lining.
It helps to increaselubrication.
We'll see changes in pH in thecorrect direction when we're
using the Mona Lisa.
The good thing is not hormonal.
So, you know, for women thatdon't like, taking any, um, type
of, hormonal therapy or theycan't take any hormonal therapy,
then it's perfect for them.

Leah (49:06):
Great.

Dr. Paul (49:07):
But like I said, it is not FDA approved.
It's off label for that.
But, um, I mean, that's

Willow (49:12):
it.

Dr. Paul (49:12):
way,

Willow (49:13):
Does it have to be administered by a doctor

Dr. Paul (49:15):
um, in my office I mostly do it.
Sometimes my nurse practitionerdoes it, but I don't know if.

Willow (49:21):
It's not a home use thing.

Dr. Paul (49:23):
No, definitely not.
No.
No, definitely not.
Definitely not a home use.
It's very expensive.
It'll be pretty

Willow (49:29):
$10,000 thing or something?

Dr. Paul (49:31):
no,

Leah (49:31):
I think it's more like a hundred.

Dr. Paul (49:33):
It's probably more than

Leah (49:34):
yeah.
Yeah.

Dr. Paul (49:34):
You gotta go up.
You gotta go up.
But it's okay.
Um, it's very expensive, but,um, it works well.

Leah (49:41):
to,

Dr. Paul (49:41):
No, it's not.
I mean, if you, it shouldn't bepainful.
I mean, the first time, um, youcan have a little discomfort
depending on the, the thinningof the, um, the atrophy of the
vagina.
You know, for some of ourpatients, they're pretty severe.
And so then we modify thetechnique a little bit.
We modify how we use the laserdepending on like the thickness
of the, um, the vagina and howmuch atrophy

Leah (50:03):
It's using sound, right?
It's not

Dr. Paul (50:05):
No, it uses CO2 laser.

Leah (50:07):
okay?

Dr. Paul (50:08):
That's CO2 laser.
When you're talking about sound,you're talking about like core
wave therapy for like erectiledysfunction when you're talking
about, and those are focusedshockwave therapy, and that
could be used.
We use that for pelvic floordysfunction.
We use it for erectiledysfunction.
It's a number that's a wholenother,

Leah (50:23):
used for men and women or just men?

Dr. Paul (50:25):
so we use it for men and women.
We have a, we have somethingcalled fem tensity for women,
where we use low intensityshockwave to help with orgasms
and and, and you can also use itfor pelvic floor dysfunction.
We use it for that too.
It just depends on the, theamount of frequency and the
energy that you're using andwhere you're putting it.

Leah (50:41):
When it's used for orgasms with women, is it to help with
clitoral orgasms, vaginalorgasms, both.

Dr. Paul (50:47):
So we see that it helps with both, but it's mostly
for, uh, clitoral orgasms.
but, uh.

Leah (50:53):
with blood flow?
What, what is it?

Dr. Paul (50:54):
Exactly.
So it helps with blood flow, ithelps increase nitric oxide
levels in the, in the clitoris.
I mean, the clitoris is, isessentially the same thing as
the penis, right?
I mean, it's just, so as, aswe're in utero, what happens is,
like the, for instance, the headof the penis is the same thing
as the head of the clitoris.
And then the bodies of the penisor the shaft of the penis, women

(51:16):
have these corporal bodies, butyou can't see them.
They're on the inside, so theystill have those corporal
bodies.
They're just split.
Um, so it helps with both.
It helps to increase blood flowin men and in women.
It helps to increase nitricoxide levels in rat studies.
Um, for men in the penis, itactually showed some more, uh,
stem cell formation in.

Willow (51:34):
I wanna try it.
What

Leah (51:35):
know I.

Willow (51:36):
if somebody doesn't really need it?
And they try and they try it?

Dr. Paul (51:40):
Orgasms all the time.

Willow (51:42):
Oh, my God.
Let's fly out there.
Leah.
Let's take a

Dr. Paul (51:45):
like, oh, everywhere you go.
Everywhere you go.

Willow (51:48):
every step we take.

Leah (51:52):
well thank you so much, Dr.
Paul.
This has been reallyenlightening

Willow (51:56):
Yeah,

Dr. Paul (51:57):
no problem.

Leah (51:57):
on the show.

Dr. Paul (51:59):
Yeah.
Thanks for having me on thisshow.
It's been, uh, it's, it's beenfun.

Leah (52:02):
Cool.
Well everybody stay tuned thedishes up next and we will catch
you on the flip side.
Love, love, love.

Announcer (52:09):
Now our favorite part, the dish.

Leah (52:14):
Dr.
Paul,

Willow (52:15):
I love Dr.
Paul.
That was so much fun.
Yes.

Leah (52:20):
I know you.
I could tell your little medicalmind was just geeking the fuck

Willow (52:23):
It was so good.
I was just telling Leah I didn'tlook at the time.
One time I was just a riveted.
I mean, there were so manythings to talk about, so many
directions to go.
And you know, he's got such avast well of information that,
um we could have dug so deep onany one of those topics, but I'm
glad we got like a really niceoverview of everything he does.

(52:46):
'Cause now our audience knowsabout him.
You can use him yourself, referpeople to him who you know are
having a struggle.
I mean, I think that he justoffers quite a, quite an array
of support for sexual health andwellness.
Totally different than what wedo also.

Leah (53:04):
Very, very different.
I can see how, um, a greatapproach is by combining the
two.
I think there's definitelyplaces from the holistic
standpoint that he's lacking interms of, um, kind of just
having that whole holisticapproach.
I mean, he can't do

Willow (53:21):
But he is open to it.
Yeah.

Leah (53:23):
enough, you know, and I, and he seems really like
open-minded about, you know, allthe things.
So that's great.
I wasn't surprised by his answeraround the men who have delayed
ejaculation.
I wish there was something thatwe knew that could have a
greater success rate, that couldpinpoint, you know, things for
people to try.
Out of all the people that Ihelp, um, people who suffer from

(53:46):
delayed ejaculation forinstance, like the satisfaction
of having someone overcomeejaculatory control and having
more ejaculatory choice due topremature ejaculation, that is
such a big win for me.
Like I can help people sodramatically with that.
With delayed ejaculation, it isjust a real process and it's
often, uh, really frustrating.

(54:08):
You know, a lot of times it is adesensitization.
That's been my experience.
The other direction I've beentrying to bring people towards
exploring is some of thesehidden corners of desire.
Where are the places that areuninvestigated that might turn
your desire onto greaterheights?
But we've been ex, we've beenafraid to look at it because of

(54:30):
our judgments about what it

Willow (54:32):
Too

Leah (54:32):
turned on in a more taboo direction.
And I'm finding that's even adifficult process to guide
someone too.
There's still so much resistancethere, even though that could
really unlock some things.
Um, interesting to hear uh, I'mtrying to remember now what some
of his interventions were.

Willow (54:50):
He was talking about hormonal replacement and

Leah (54:54):
Yeah.
Looking at the

Willow (54:55):
and

Leah (54:56):
hormonal stuff?
Yeah.

Willow (54:57):
Yeah.
Yeah.
And, and I think, um, one thinghe kind of alluded to and
mentioned around that, which I'mreally big on right now is, you
know, if somebody's been layingon their back on the bed
masturbating for years,

Leah (55:12):
When you're, when you're rubbing your penis up against
the sheets,

Willow (55:15):
humping on your

Leah (55:16):
of stimulation.

Willow (55:18):
he said on your back.
But yeah.
either, either way.
I

Leah (55:20):
make sense on the back.
It's

Willow (55:22):
Yeah, either way, we, we, um, you know, start to work
our bodies in a certain way.
You know, we all maybe alwayshula to the right or always hula
to the left, and like, it, itkind of,

Leah (55:34):
I like

Willow (55:35):
it, it kind, um, you know, it creates this, uh, this
one groove in your, in yourbrain to heart to gut and penis,
you know, pathway of like what'spossible.
And so you gotta get out of thatgroove and try something
different.

Leah (55:50):
Well, and I think just a reminder of like, look, you,
you're never, you're probablynever gonna get to the point
where you just ejaculate whenyou want to, whenever you want
to.
It's gonna be your increase inbeing able to reach ejaculation
will go up.
You know, 20 to 40% and that's asuccess, you know, and that's an
increase then maybe what you'reexperiencing now.

(56:13):
Um, yeah, so that was, I wasreally eager to get his answer
on that.
And, and I it

Willow (56:21):
you did.
Yeah.
Um, I, I was happy to learnabout the Mona Lisa.
I didn't know about that.
How did you know about that?
Already

Leah (56:29):
Oh, because, um, Nalini Prassad it

Willow (56:33):
Okay.

Leah (56:33):
and does it, and I've had a couple of students in the
seminars promote it because theyhave had it and have had
dramatic results as a, as aresult of diminished pain, um,
due to intercourse.
Um, a more tightening of thevaginal opening so that sex is
more pleasurable, uh, betterlubrication.

(56:54):
Um, all the things that he

Willow (56:55):
mentioned.
I had a client who got some kindof something to her vulva.
I think it was laser.
I wonder if that's what she got.
Now her clitoris is like sohypersensitive.

Leah (57:06):
Well, this isn't done to the clitoris.
This is done to the vaginalopening to produce more
collagen.
Um, the other treatment that hementioned was a laser that
treats the pelvic floor.
Um, and that is what's helpingorgasms and, uh, the name of it
he mentioned in the interview,I, it was one of those medical.

(57:27):
Things that I, I would've tohear it like eight times before
I could recall it.
'cause it's not the Mona Lisa,it's something else.

Willow (57:34):
Right.

Leah (57:35):
But that has to do with more pelvic floor stimulation.
And I think that has to do withthe shockwaves

Willow (57:39):
Hmm.

Leah (57:41):
um, the other kinda lasers that produce collagen.

Willow (57:43):
Mm-hmm.
Interesting.

Leah (57:46):
Yeah.
Interesting.
Um, and it sounds like he, yeah,I, I couldn't, I'm not sure we
got a straight answer about the,um.
I wanna say blood platelets, butit's stem cells of whether or
not he actually provides that asan intervention or not.
To me, it was like, it doesn'tmatter to me whether the stem
cells are doing the job or thebroth is doing the job.

(58:09):
As long as something's doing thejob, win-win,

Willow (58:11):
right.
Exactly.
Yeah.
Yeah,

Leah (58:15):
anyways, tell us what you think about Dr.
Paul and if you felt like yougot some answers to some prayers
because you've been dealing withsome difficulties and some of
the things that he said, uh, areinspiring you,

Willow (58:30):
yeah.

Leah (58:30):
get some extra support from the medical industry.

Willow (58:34):
Yes.

Leah (58:36):
All right.
Please subscribe, comment andshare this episode with someone
who you know could benefit fromit.

Willow (58:45):
Much love.

Announcer (58:46):
Thanks for tuning in.
This episode was hosted byTantric Sex Master Coach and
positive psychology facilitator,Leah Piper, as well as by
Chinese and Functional Medicinedoctor and Taoist Techology
teacher, Dr.
Willow Brown.
Don't forget your comments,likes subscribes, and
suggestions matter.
Let's realize this new worldtogether.

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Dr. Paul Gittens: ED affects 50% of men over 50 - The Breakthrough Treatments Your Urologist Isn't Telling You | #138

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.css-14f5ked{margin:0;word-break:break-word;display:-webkit-box;-webkit-box-orient:vertical;box-orient:vertical;-webkit-line-clamp:2;overflow:hidden;}Dr. Paul Gittens: ED affects 50% of men over 50 - The Breakthrough Treatments Your Urologist Isn't Telling You | #138