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. 

Transcript

Speaker 1: 0:00

Welcome to the Functional Medicine Podcast with Dr McMinn and Coach Lindsey. We're coming to you from McMinn Clinic in Birmingham, alabama, where Dr McMinn is an integrative in functional MD and Lindsey Matthews is a registered nurse and IIN certified health coach. In this podcast, we'll be discussing the latest information on a wide range of topics in the field of functional medicine, which looks for the root cause of disease, and integrative medicine, which incorporates both conventional and alternative therapies. Our overall goal is to help you be the best that you can be in mind, body and spirit. The following discussion is for educational purposes only and is not intended to diagnose or treat any disease. Please do not apply any of this information without approval from your personal doctor. And now on to the show with Dr McMinn and Coach Lindsey.

Speaker 3: 0:51

Hello and welcome to the Functional Medicine Podcast, where we share with you evidence-based and up-to-date information on integrative and functional medicine, along with the practical take-home solutions so you can live a healthier and more vibrant, optimized life in mind, body and spirit. We thank you for joining us today. I'm Dr Jim McMinn, and our co-host, coach Lindsey, is off for the day again, but don't worry, she'll be back next time. However, we do have a very special guest with us on the show today. Ms Valerie Padd is with us again. I'll tell you more about Ms Valerie in just a moment. She was with us on a show last time where we talked about sexual health for women, and today we'll round out the discussion by discussing sexual health for men. So just a heads-up.

Speaker 3: 1:32

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Speaker 3: 2:38

As a functional medicine doctor, I pride myself in being an excellent listener. One of the major concerns I heard from my men folks had to do with sexual health, especially things like low desire and erectile concerns. No doubt that sexual health is part of the fabric of overall health and well-being, but we in the medical community and, as a society, often sweep these topics under the rug and expect people to just go figure it out on their own. And yet these issues tend to severely affect the lives of our patients, their partners and their families. So we did our best to address these concerns at our clinic with an up-to-date, comprehensive, integrative and functional approach. As I mentioned last time, we even went so far as to put together a sexual health support group that met after hours once a month. Everyone in the community was invited. You didn't even have to be a patient at the clinic. Men and women would meet and discuss all sorts of topics having to do with sexual health freely, openly and without judgment. It was great. We developed a core community of wonderful folks who were dedicated to improving their relationships, their marriages and their intimate lives.

Speaker 3: 3:37

During this time, I was super blessed to meet and work with Valerie Pad, a nurse and certified health counselor. Valerie has dedicated her life and career to helping women and men in this important aspect of their lives. Let me tell you just a bit about my friend and esteemed colleague, valerie Pad. She's a registered nurse with a bachelor's degree in nursing. She developed a wide range of experience and skills in nursing and once she got the calling to pursue specialized sexual health training, she completed a postgraduate certification program in sexual health at the University of Michigan.

Speaker 3: 4:05

Valerie is a member of the American Association of Sexuality Educators, counselors and Therapists, and she is the founder of the Center for Sexual Health and Wellness in Hudson, ohio. She has applied an integrative and functional health model to sexual health and she partners with clients to discover the why behind the problems, allowing her to put together an effective and personalized plan to resolve their issues. Having worked with Valerie for many years, I can testify she's a kind, caring, smart, compassionate and thoughtful healthcare professional who is passionate about her work. She also enjoys life to the fullest and works to serve others outside the workplace. She treasures time with family and friends and enthusiastically holds volunteer roles, with compassion, international and youth for Christ. And so, without further ado, welcome to the show, valerie, and thank you so much for joining us today. I'm really excited to pick your brain concerning this important topic called men's sexual health.

Speaker 2: 4:57

Well, thank you, dr McMinn, for having me back. I'm so happy to be here to give equal time to men's sexual health. You know it's not uncommon for us to think of men's sexual health, you know, as pretty much straightforward, simple, right. You know, after all, the anatomy of men's genitals are front and center. There's certainly no hidden agenda there. There are parts involved in sexual health are not as complex as the female body and really, thanks to mainstream media, we're told that they have one thing, and only one thing, on their minds, and that is sex. And of course that isn't true. Men's sexual health is more complex and involving many systems of the body, right, the nervous system, glands and organs and all the vessels that carry blood throughout the body. So it is a little bit more complicated than we sometimes think.

Speaker 3: 5:53

This is your specialty. You see a lot of guys, and so what are some of the common problems that come up in your practice as far as your interactions with men and their sexual dysfunctions?

Speaker 2: 6:02

Yeah. So again, it may seem pretty straightforward, and what probably most of your listeners are thinking of are erection issues. For sure, I think that is top of mind, but it's true that male sexual dysfunction can include a wide variety of complex issues Low libido, low sexual desire, premature ejaculation, delayed ejaculation, performance anxiety. Men also struggle with body image issues especially of the genitals. Is my penis too small? Is it too big, Wide narrow?

Speaker 3: 6:41

Especially in the state of Nage of porn right.

Speaker 2: 6:43

Yeah, oh for sure, orgasmic problems. We don't think of men having problems with orgasm, but they do. Horn addiction can become a real problem, and desire discrepancy, and these are just a few. So you know, while men and women both suffer from sexual health issues, men seem to be a bit more at a disadvantage, since for them, I think, sexual dysfunction can be difficult to talk about. Now, that doesn't mean it's not difficult for women, but we women, we have our friends right. We talk about things like this.

Speaker 3: 7:21

Men might talk about their success stories, but they don't talk about their dysfunction, right?

Speaker 2: 7:25

Yes, Right, Right yeah. So, unlike women, they typically don't turn to their buddies about their issues right. They're more interested, like you said, the success stories. So in turn I've seen it play out that they wait men in particular wait several months, if not several years, to seek any type of help, and that makes it even more difficult to restore right. So that is almost prolonging the problem and then their problem becomes an issue in the relationship right.

Speaker 2: 8:00

So, that length of time from having a problem to seeking advice about it for men in particular, I think is very long.

Speaker 3: 8:08

My beloved father-in-law Gordon, who was a true cowboy. He had this wonderful saying to cowboy up or suffer in silence. I think that it can apply to a lot of men, you know.

Speaker 1: 8:19

Definitely Right.

Speaker 3: 8:20

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

Speaker 2: 8:31

Well, the research is pretty consistent here, and it's about 31% of men experience some form of sexual dysfunction in their lifetime. Now, just to give that a little context, that's compared to 43% of women. So experts widely agree that erectile dysfunction is the most common by a long shot, and it does increase with age. So ED, as we call erectile dysfunction, affects more than 30 million people in this country between the ages of 40 and 70.

Speaker 3: 9:06

Isn't that amazing? It is yeah.

Speaker 2: 9:08

So before though, Dr McMinn, we go any further, I'd like to define ED for your listeners, in case there's any misconceptions out there. So, according to the National Institutes of Health, the NIH, ED is a consistent or reoccurrent inability to attain and or maintain penile erection sufficient for sexual satisfaction.

Speaker 2: 9:34

Okay so we're all on the same page, right, okay, so one of the largest studies on men's sexual health was the Massachusetts male Aging study. Now, this was completed back in 1994, but rings true today. This study found that approximately 52% of men experienced some form of ED in their lifetime. Studies show that ED that number increases about 10% per decade of life. So that means at age 50 there's 50% of men that experience ED, at age 60, at 60%, at age 70, at 70%, and so on. So ED I like to call it erectile Unpredictability. Okay, so I'm going to use those terms interchangeable. It doesn't just happen to men who are older. Another study published in the Journal of Sexual Medicine found that ED selected about 26% of men under the age of 40. And so, just as a side note, over the last few years In practice I've seen a pattern of younger and younger men seeking help with sexual function, even as young as 18 years old.

Speaker 2: 10:47

Wow and you know that's like my son's 22, so it's like looking at my son across across the table. So that's that's. That's a little strange. So think about that though. Age 80, 18 to 40 young men are already 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 that with 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 on this.

Speaker 2: 11:26

They see a young, fit guy in front of them and erection issues just never cross their mind, so they don't even go down that path at all, you know, and then if a guy is brave enough as to inquire about his unpredictable erections, studies report that healthcare practitioners just quickly dismiss these individuals, like we Allude alluded to before our docs really listening to their patients.

Speaker 2: 11:56

So there was this NIH study of 27,000 men in eight countries, all under the age of 40, and what they found and reported was that in the age group of 20 to 29, ed was prevalent at 8%. In the age group of 30 to 39, it jumped up to 11%. And actually there is evidence from these studies that young men may experience ED due to several different factors, individually as well as collectively. Okay, so in other words, they can have just one of these problems or they can have several of these problems, and they can be organic reasons like vascular impairment or metabolic syndrome or low hormones. They can be psychological reasons like depression, anxiety, worry about body image, penis size, self image and, of course, relational problems, right problems in couples relationship due to stress and mostly poor communication.

Speaker 3: 13:00

It's so interesting that these young guys can have ED secondary to vascular impairment at that age, isn't it? I think we typically think of us older guys having vascular issues, but I think the studies are showing that the people are getting it younger and younger. I don't know if it's related to the poor diets and the processed food we have, the lack of exercise as we have more screen time and Video games, whatever, but yeah, it's interesting that these young people have vascular issues. You mentioned the connection between ED and cardiovascular health, so please tell us more about that, sure sure.

Speaker 2: 13:32

One of the most common causes of ED is atherosclerosis, sclerosis which is just hardening of the arteries right, right, so basic. Basically, a buildup of cholesterol in the blood vessel walls, causing the blood to slow down.

Speaker 2: 13:46

Right and it slowed down Throughout the entire body including the penis so, as we all know, in order to have an erection there must be blood flow to the penis. So now in our minds, this buildup of black is usually associated with heart attacks. But the condition is not just about the arteries that supply the heart with blood. It affects the blood vessels throughout the entire body. So there was a study done in Australia where they looked at 95,000 men with ED, and they were shown to have more cardiovascular problems, including heart failure, stroke and Peripheral vascular disease, than those without ED. So we might conclude there that Erections are kind of or the lack of erections are kind of a barometer for overall health, and so the take-home message there is your erection problems may have a lot more to say about your overall health as well.

Speaker 3: 14:46

Mm-hmm. Yeah, I've heard that ED is kind of like a canary of the coal mine for heart issues. So if a guy has ED he might need more than just phyagory, might need to see his cardiologist and get a good workout.

Speaker 2: 14:56

Yeah, there's actually many diseases besides heart disease that are associated with male sexual dysfunction. That could be cancer, your logic infections, diabetes, high blood pressure, high cholesterol, hormonal issues, alcoholism and drug abuse.

Speaker 3: 15:13

Yeah, you mentioned the hormonal issues. We recently I did a podcast on testosterone and men. I'm sure there are other hormones that can affect it as well, but I think that's, of course, the most important and that would podcast, by the way, was podcast number 29 and we invite you to go back and check that out if you're interested in the subject. So we'll go back through this in great detail, but just to please give us a few of the sort of take-home points, if you will, about men, testosterone and sexuality.

Speaker 2: 15:37

Okay, I'd be glad to. So testosterone can have a major impact on male sexual function, most dramatically in terms of desire. We think of testosterone as the hormone of desire, right, but it also can help with erectile function. It can be a major game changer for some men and of course, this has to be done by a provider who is knowledgeable and experienced in the management of testosterone therapy. But if done properly, it is considered safe and can be very helpful for some guys, not only in terms of sexual function, but also in terms of energy, mood and other benefits for the body.

Speaker 3: 16:18

Yeah, there's a wonderful book about it I highly recommend, called testosterone for life, by a guy named Abraham Mordenthaler who's a Harvard professor 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 the notes for you down below. You can find that at the menmdcom for slash references, 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 to be the most powerful medicine on earth, and so how could lifestyle changes help improve ed?

Speaker 2: 16:53

Yeah, and I I highly agree with that too. I believe if doctors would start writing scripts for lifestyle changes, we'd solve a lot of our health problems, not just ed. So you know we throw around that term lifestyle behaviors and I think it's become somewhat of a buzzword for your listeners. Though let's explain what lifestyle behaviors are. So I'll start. According to the NIH, lifestyle behaviors are everyday activities that affect body weight as well as overall health, and that would include exercise, diet, nutrition, sleep, stress, social interaction, time in nature and Meditation or relaxation. So every company, organization or group seem to have their own list, but what I found consistent on the list was always in the top three, for sure, and that's exercise Moving your body. So, to answer answer your question with one word moving your body is also known as exercise Is at the top of the list you know, valerie, I'm reading 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 kind of surprised at this he said the number one thing you do to improve what I call health span not lifespan, but health span is Exercise. I would have thought it was diet, but he said it's exercise. It's kind of interesting. But anyway, yeah, check out our podcast number 34 If you want to get more detailed information on how you can use the amazing power of lifestyle medicine the most powerful medicine on earth to help you with things, but basically anything but including things like ED. When ED does strike, valerie, how does that impact a guy's overall sense of well-being and quality of life?

Speaker 2: 18:43

Well, of the variety of sexual disfunctions we spoke about, the most studied issue when it comes to quality of life is ED. So, starting with the obvious, there is a significant embarrassment with men when it comes to any sexual health issue, but perhaps in more, anything that affects their ability to have an erection. So you know better than I do doctor men to a degree. For some men His erection is closely linked to his manhood. You take that away and what comes next is poor self-esteem, depression and often anxiety. So again, since men are not running to their doctors or friends, and in many cases not even their partners, their mental health can worsen. They can quickly suffer from decreased work productivity, withdrawal from sexual intimacy. They can build up anger, guilt and a lack of confidence. So you can see how quickly the Situation can spiral out of control.

Speaker 3: 19:45

Yeah, so tell us about the other different factors that influence male sexuality.

Speaker 2: 19:50

I'm so glad you asked that question, dr Mines McMins, since it's often overlooked when we talk about sexuality. I can best explain this with an image, but since we're not on camera, I'm going to try to describe this image. So, if your listeners can picture three circles when a small portion of each of those circles intersect with the others, the intersection of the three circles represents our sexuality, both male sexuality and female sexuality. Now, each circle represents the factors that influence our sexuality and in simple terms they are circle number one, what's going on in the body, so think physical and biological factors. Circle number two is what's going 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's going on in the relationship, right? So in practice this is referred to as the biopsychosocial model of sexuality and it represents that every sexual expression consists of an interaction among, among biological, the body, psychological, the mind and the social 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 word biopsychosocial, so I'll say the BPS model when it comes to his sexual health issues?

Speaker 2: 21:29

Right, right. So okay, john Doe, let's talk about him for a minute Okay. Okay. So the significance of understanding the intersection of these factors is really realizing that it's often not just one factor causing a sexual health issue. So, for example, if John is experiencing Unpredictable erections and he finds his way finally to seek help, he's thinking okay, doc, just fix my erections, 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 just explained. Although he may be experiencing a lack of blood flow in the genitals Remember the physical, the biological circle he also may be, at the same time, having performance anxiety due to the lack of confidence, and even getting an erection and keeping it so. At this point, john's brains and genitals are Disconnecting due to the psychological factors, the other circle. So now we have what's going on in the body, what's going on in the mind. So, additionally, for all intentional purposes of our story, let's say that John and his partner have been in constant disagreement on, the, say, the next step to take with his aging mother. Okay, they're struggling with these ongoing relationship issues. And there's where that third circle comes into play the stress of the relationship, the resentment John is feeling towards his partner. All of this could very well be interfering with his ability to stay focused and keep his erections.

Speaker 3: 23:11

You know, valerie, you mentioned the brain genital connection. I sometimes call it the brain penis connection. It's really kind of interesting and as much as our brain would like to control our genitals, it just doesn't work that way. I think if I was the designer of the human body, I would just put in like a valve with a stopcock you can just flick the valve when you want an erection, turn it off and you don't but but yeah, I mean, sometimes you know you might be in a situation where the guy he's turned on, he, you know, wants to have sex and please his partner or whatever, but it just doesn't happen.

Speaker 3: 23:46

And then once it doesn't happen a few times and he kind of gets in this negative Cycle where he has less and less confidence and then that kind of builds on itself and it's less likely to happen. So I don't know, just seems like that brain penis connection could be hard wired a little bit 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 have a lot of Misconceptions, myths and stereotypes, and so so tell us some about those with men.

Speaker 2: 24:16

Hmm, I love debunking myths about men's sexuality. In fact, one of the first times on stage for me as a sexual health educator was a guest speaker at At the Great Lake Science Center in Cleveland, and this was actually the title of my presentation the misconceptions and debunking myths about male sexuality. And, oh gosh, a document McMinn. I can't tell you how intimidated I was by this large crowd standing there, and now, seven years later, I'd stop anybody on the street and I want to talk about this issue so it's come.

Speaker 2: 24:53

I've come full circle with that. So where do we start? Let's say a common myth is that men are always interested in sex 24, 7 right, that's one myth. Another is that they're always focused on physical Connection and not emotional connection, and that men's preference is always to be the pursuer. Wow, that's a lot of pressure right Sure is and the stereotypes go on.

Speaker 3: 25:22

And of course you know you might have some men who are interested 24, 7 but the important point here is that not all men fall into that category and and but there's still. You know we can take the Emily Nogoski's book about, come as you are and apply that to men. Yes and just because maybe you're a little bit lower on the curve as far as your desire. That doesn't mean that you're broken and you're still normal. You're still on the curve, it's a little bit lower down.

Speaker 3: 25:44

So, um, it's important to debunk these 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 that you see, for instance, in porn or that you hear from your friends or whatever, chances are that your friends are lying anyway. Exactly right right.

Speaker 2: 26:05

Well, that tees up something I really want to talk about today, and that's the misconception that society holds is that men are only interested in the physical connection, not the emotional connection. And the reason I want to talk about this so much is I see a lot of it in my office. I see men coming in thinking their wives think they're only interested in In physically connecting, when indeed what they want is the emotional connection. So it is true that men's sexual desire is triggered by visual and physical cues. We, you know, can't blame them for that. Mini skirt, sexy lingerie and teasing does help to Heighten men's desire, but what we miss is that the emotional connection matters more to them. Can I repeat that again?

Speaker 2: 27:00

Please the emotional connection matters more hands down connection matters. So men feel just as vulnerable as women do. They're naked, they're exposed, they're letting somebody really see them. They're letting somebody completely love them. They're wanting to be wanted. So if the emotional connection is missing, men's sexual desire can actually decrease. He withdraws and disconnects from his partner. This can be from an unresolved fight, it could be trouble outside the bedroom or just a history of declining disconnection with the relationship.

Speaker 3: 27:43

You know your phrase that men want to be wanted. I, I think everybody wants to be wanted, you know, and and I think that's one problem, when we we're going to talk in a minute about Initiation, but you know, when your partner say, let's say she expects the man to initiate all the time and she never initiates, well then I think that kind of gets in a man's head sometimes like she never comes on to me so therefore she's uninterested of me, I don't feel wanted and I think that that kind of can eat his 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 that addresses these issues about men's sexuality. It's by dr Sarah Murray. She's a sex researcher and relationship Therapist. The books called not always in the mood the new science of men's sex and relationships. So in her 10 years of research she reports that, despite the myth that men are sexually selfish, most men love to please their partners. They actually see it as their role to do so, and so, according to her, it seems that that partner's pleasure, or his partner's pleasure, reflects the shared connection they have. There we go again with that emotional connection. 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, because you know I'm into evidence-based stuff. However, I think, just off the top of my head, it seems like you know men, yeah, okay, they want 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 also want to be and this, I guess, is a selfish thing too, in a way but they want to be good lovers, right, and if you're a good lover, then you need to be able to please your partner, right, right. And so I think that kind of goes hand in hand with the men's psyche here pleasing their partner is part of them considering themselves to be a good lover right.

Speaker 3: 29:43

So we learned in our last podcast about women's sexual health how important communication is for healthy sexual relationships. What is the role of a communication play in fostering a satisfying and fulfilling relationship for the men folk?

Speaker 2: 29:56

Communication again is so very important for a healthy sexual relationship and that emotional connection that we're talking about. I'll share a Complaint about communication that I hear from about 90% of my male clients, and that is we are not mind readers and I'm wondering if any of your male listeners can 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 comes to sexual wants, and this gap gets wider and wider when women don't openly share what their needs are or what their wants are or sexual preferences. By not saying anything, they are unknowingly leaving their partners in the dark or, worse, forcing their partners to guess what they want. So men want to know what their partner 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 more often than not we're gonna get it wrong. We're gonna sort of skew it in the direction that we want it. So why is it, valerie, that women 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 I can think of off the top of my head. First, I think women are afraid to ask men for what they want, and this has a lot of history behind 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 decades and decades of living in a patriarchal world where women's voices weren't heard, even if they did voice it, so they weren't heard back then in the boardroom nor the bedroom. So today, thankfully, things are shifting away from that total patriarchal type of society. But for some women the fear still is real, and it really depends a lot, too, on their partner's attitudes towards open communication. This fear may be especially relevant to women in the age group of, say, 65-ish and older. So that's one reason that I can think of. The other is there seems to be a trend where women believe that their partner loves them more if they can figure out what they are thinking, isn't that amazing?

Speaker 2: 32:29

Yeah yeah, A woman may think well, you love me, you know me, you must be able to figure me out. 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 that she hasn't really figured it out? Yeah definitely, and so she's trying to get him to figure it out for her Right yep, or with her. 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 help and really kind of putting the pressure on him. So it's certainly not a spirit of healthy communication. Nonetheless, it is true for some women. So if this is the case with some of your male listeners, I would really recommend them to take the first step to open up the line of communication with a partner instead of feeling frustrated. Make sure she feels safe for all those reasons we just talked about. Make sure she feels cared for and heard, and that might make it easier for her to talk about it. If she's still reluctant to tell her partner what she wants sexually, then start asking point blank do you like it when I do this, do you not like it when I do that? Men can take the lead in this department 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 type thing you have the conversation and then you're done or is it ongoing 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 your needs and preferences, that can be pretty scary, right? It can be awkward, it's vulnerable, even for couples that have been together for a long time. So I think sexual communication is definitely a skill and it's not something we certainly learned in school or church or and certainly our parents probably didn't talk to us about it either. So for a couple it's brand new territory.

Speaker 3: 34:46

Seems like. I frequently hear from women that they claim that the men just sort of clam up and they go into their shells or they glue or whatever and they won't talk about feelings. And it's kind of a guy thing, I guess, but for some of us it's just not in our nature. But, however, I think that in this case everyone would benefit if the guy sort of stretches his comfort zone a bit and opens up to his partner, and we'll all be happier for that. So what are some of the communication pearls that you can share with us as far as getting this going?

Speaker 2: 35:13

Yes, I have a few. At first off, I'd like to say that choosing the right time to talk is probably a good first step. It's easiest to talk when there isn't an ongoing conflict right. It's easier to talk when time is less stressful, maybe on the weekend, maybe during a long car ride. Make sure that neither one of you is tired or rushed and has the energy for this discussion. It's certainly going to take some time and, as you reminded everyone, dr McMinn, in our podcast last month, make sure it's not during an Alabama football game right, there we go.

Speaker 3: 35:55

That's right, especially if there's two minutes left and we're three points 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 right tone is important. Okay, never a blaming tone or criticizing tone, especially about a previous sex act. Right, the tone of compassion and kindness will always get you further. And make sure you have some positive feedback to share what's going well, what you enjoy about your sexual relationship or each other, and try to use a kind of a softer tone. Sometimes touching some of your partner's hands will help. So, granted, no two people will have the exact same sexual interests, desires or preferences, so finding common ground will make everybody that much happier. Now some tools for that. You could use sexual quizzes. They're available online. We talked in our last podcast about yes, no, maybe lists.

Speaker 3: 37:00

That's a good communication tool to use and I think sex with only has one, and you have one right yes, and we're going to post both of those in the show notes, having kind of a sexual expectation list, right?

Speaker 2: 37:12

Not making sure that your goals together are attainable and they're not threatening to either parties important, and then again have a priority list in mind. What are the top one or two issues that you want to talk about? Don't try to throw everything out on the table. Your first discussion. So you're a guy. Dr McMint, can you add anything here?

Speaker 3: 37:36

Well, valerie, I'm working progress. You know I'm working on it but I'm still not there. But I'm trying to get it. But I think to make the most of most relationships, both parties really need to open up and share their wants, their needs, their desires, their turn-ons and turn-offs. They need to learn to be good listeners and to act on what they've heard. If she has to tell you a hundred times to do what she likes and you still never do it, then eventually she'll stop asking and she'll be rightfully resentful. So open up, guys, and talk and listen and act and you'll reap the rewards. So also use some tools that Valerie just talked about, like the questionnaires. That can be very helpful. That wonderful book I've mentioned before our previous podcast called Supermerital Sex by Paul Piersall. He has a lot of great quizzes in that book, which I think that can be helpful. I find if you kind of both do the quiz together, right Blindly together, and then kind of compare answers, that can really open a lot of wonderful fodder for 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 sometimes an interest, but there's an awkwardness when it comes to initiation. Do you have any recommendations for getting things started?

Speaker 2: 38:45

Yes, I do. That part of initiation is awkward, right, and so you really have to have a good intention here and maybe even do some practicing. I think it's a skill, but certainly having a warm and loving and honoring tone throughout the day, not just 30 minutes before one has sex is can go miles and miles. It can really prime the pump, if you will, for a connection and then the next can lead on to something 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 couch together talking, this is a perfect time to just really connect, leave the outside world behind and do it well, in advance of any other sexual advances, if you will.

Speaker 3: 39:49

And it seems like, once again, this is a great example of the need for communication. It seems like there are some women who and this is from my reading and whatever who want a man who's gonna quote, take charge, right, and yet there are other women who might want a more, say, subtle approach. So I think that this can require some communication, and that can be verbal, nonverbal, whatever as far as his likes and dislikes and her dislikes as far as getting this initiation going.

Speaker 2: 40:20

Right, right. And I think for the guy, he definitely has to read the room. If you will, okay, check to see how his wife is feeling or, excuse me, partner is feeling. What are her words like that she's talking about? Is she stressed out? What's her body language saying? So, reading the room before just diving in and wanting sex is a good thing to do.

Speaker 3: 40:44

Right. So on the podcast we did about women's sexuality, we talked about the triad of desire, arousal and orgasm. So let's start with desire. Please comment on the role of desire as it applies to male sexuality. And again, the myth out there is that men always want sex 24 seven. So if there is a desire discrepancy, then women are 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, so the answer to this question, though, is interesting. There have not been a lot of studies that exclusively relate to men's sexual health. Most of the existing research has focused on men's low sexual desire, especially in the context of men and women as a couple. So what we do know, though, from the research, is that men spend considerably more time thinking about sex. They spend more time fantasizing about sex and feeling sexual desire and masturbating, and this isn't compared to women.

Speaker 2: 41:47

So there was one Ohio State University study that recently debunked the popular myth that men 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 show is that men typically think of sex about 19 times a day on average, which may sound like a lot. However, the same study showed that women think about sex about 10 times a day, so that's not too far behind, right? So other studies, though, showed that men typically have a higher sex drive than women on average, and that may be due to men having an abundance of testosterone right.

Speaker 2: 42:35

The hormone of desire.

Speaker 3: 42:38

Right. I'll never forget a lady who came in one time and she had a low T and we don't give testosterone to people who have normal, but if they have low testosterone sometimes we bump it up. And she came back to me. She said doctor, now I know what 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 and more common that you might, then you might think. And studies show that about 15% of men experience low sexual desire and that would be compared to 30% in women. So sex drive does naturally decrease with age, but often loss of libido is tied to an underlying condition like stress or depression, low testosterone, certain medications we know antidepressants, antihistamine, blood pressure medications so not just medications but those health conditions that are there Because people are taking medications, right, like high blood pressure itself, diabetes, you know both of those can damage a men's vascular system and affect his ability to maintain an erection.

Speaker 2: 43:55

So oftentimes the anxiety associated with not being able to maintain an erection can cause men to avoid sexual intercourse and even intimacy. So what we do know about men's desire is that although it can wane, just like women's desire, it doesn't ever completely disappear. But it will change over time and it may change in the way you make love, it may change in what type of sex you enjoy or the frequency of sex. But rest assured, sex and intimacy can be a pleasure area 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 of wisdom on how to sort of bridge that gap and come up with sort of a happy compromise, especially in a situation where the man is the avoider.

Speaker 2: 44:47

So just to clarify for our listeners, desired discrepancy is when one member of a couple experiences more or less sexual desire relative to their partner. Okay, so knowing that definition is important. So, interestingly enough, this is among the main reasons that couples seek counseling or therapy. Is this desire difference? Right so, but another myth related to desire discrepancy, if I may, is that in a heterosexual relationship, the discrepancy is always the male partner wanting more sex. That is a misconception, when in reality it's many times the male partner is the one with a low desire and the female partner is the one with higher desire.

Speaker 2: 45:34

I just want to share that. So in most long-term couples they 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 their desire for sex, they've adopted this ebb and flow mentally, which is very healthy right. For others who haven't been able to get into that sync, though, there's a few strategies that they could use. They could realize that it's a normal part of the relationship for starters, that no one is broken, that it doesn't even have to be considered problematic. They can be physical without having intercourse. There's cuddling, there's kissing, there's caressing, there's talking. There's much more to sex than just penis and vagina. That we've talked about.

Speaker 2: 46:24

Scheduling sex is one of my favorite ways in which to help with desire discrepancy. It's on the calendar, we know we're going to do it, everybody can get ready for it and everyone'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 often would you like to get together? And one would say maybe three times a week and the other would say once a month. So I try to press them on. How can we find a compromise there and can we agree on maybe once every two weeks, right? You start with that, and then ultimately you see if you can sort of keep moving the needle in the right direction so they find a good, happy compromise.

Speaker 2: 47:01

Right, right. Yeah, I'm a big fan of scheduling 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 not ready, and so you can engage yourself, we call this solo sex or a masturbation. And then, dr McMinn, there's a philosophy of yes that I've learned from you. Do you want to talk about that a little bit? 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 and applies to all sorts of things with the relationships. But basically, when somebody asks you for something, the first word out of your mouth ideally is yes, but now we can have a qualified. Yes, yes, but let me finish this project I'm working on. Or yes, but whatever. But the more times you can approach their request with an affirmative yes, then I think that goes a long way towards a healthy relationship. Like, for instance, if your partner approaches you and the answer is usually no, then he or she's going to stop approaching you, and because that's rejection, right? Nobody likes rejection, and so when somebody's sticking their neck out and being vulnerable by asking, the last thing they want is had their head chopped off right, and especially over and over and over again. And so I think, as much as you can sort of say yes, but again, maybe yes, but I've got a big project tomorrow, let's get together tomorrow night. But the first thing out of your mouth should be yes.

Speaker 2: 48:44

Right, right, and I like that for all the reasons you stated, but also, as I'm thinking about it myself, if I'm expecting myself no pressure. But if I'm expecting myself to say yes, I'm going to automatically be thinking of all the reasons to say yes Instead of without the philosophy of yes, I can think of way too many 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 or to lots of aspects of relationships.

Speaker 2: 49:17

So anyway, and all of these strategies that we've just listed to help with desire discrepancy, they only work through communication, right? I think your listeners are so tired of us talking about communication. We've said it again and again, but it's a must in this area of desire discrepancy. So desire discrepancy doesn't become a serious problem and instead goes back into that ebb and flow of the relationship.

Speaker 3: 49:46

So let's move on to the arousal phase. It takes a guy about five to seven minutes to have an orgasm or a jack late, whereas it takes a woman, on the average, about 15 to 20 minutes and sometimes even much longer. So this sounds like a recipe for 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 dissatisfaction for the partner, which may result in them pulling away from sex altogether. So remember, we talked in our last podcast about having sex worth having. Well, if a partner is continuously disappointed in the sex they're having, well, they're going to stop wanting it. Now we have a situation of low desire the wanting and desire, discrepancy, less frequency. You are right, it does spell disaster. So basically, what we're talking about here is the orgasm gap and, just as a reminder, the orgasm gap was a term coined to describe the disparity in orgasms between couples.

Speaker 2: 50:50

So men love to think that they're great in bed, right, of course. They quickly move through the kissing and the cuddling, they skip past the foreplay and insert penis into sometimes a semi-moist or dry vagina. They thrust for a bit and then they finish and roll over on their back. Now I apologize for being graphic here, but I think your listeners can get the picture now. So a few pointers here. If it sounds like, this is your guy. So one sex is not a one-sided act, right, it needs to be both partners needs to be honored and provided for. And two oftentimes it's not most of the time women don't orgasm through penetration, especially if the position doesn't come near the clitoris. So keep in mind, about 70% of women orgasm through clitoral stimulation, with only about 30% with vaginal penetration. What I would say to guys, dr McMinn, is two words. Well, that keeps it simple. Slow down, let's repeat that for 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 this for two reasons the orgasm gap and women's arousal. So let me explain. So, technically speaking, the orgasm gap refers to the disparities and inequalities in orgasms between heterosexual couples. In simple terms, it means women's orgasm during sex is far less than men do, hence the gap right.

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 vaginal sex is a common form of sexual activity with heterosexual couples 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 the partner has or will reach orgasm too. So if guys would just slow down during the arousal phase, making sure their partner is being pleased, enjoying the encounter and ready to move on to orgasm, ah, that would definitely begin to bridge the orgasm gap and, may I say, bring the whole sexual encounter up a notch.

Speaker 3: 53:24

Well, it sounds like a great solution. And there again back to the communication issue, isn't it? So it's like a wonderful strategy.

Speaker 2: 53:31

Yeah, and I'd have to say too that the orgasm gap is getting worse, since a lot of men take their cues from porn, and I think that repeated thrusting that they see in porn is they think it's what their partners want. Yet she typically does an orgasm through thrusting alone, right, there's no clitoral stimulation there. So before I realize it, he has had 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 about how the number one concern of men when it comes to sexual dysfunction 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 say before we go through that list is to keep in mind, as we go through the list, that the best treatment for ED is going to be what is best for the individual. Okay, so it's got to work for that individual person. But starting out, oral medications. For sure, most commonly prescribed medications for ED are Sildenafil, known as Viagra, the little blue pill, and Tidalafil, which is known as Cialis. Now, oral medications have the longest track record, for sure.

Speaker 2: 55:01

However, treating ED doesn't have to begin and end with oral medications, which they can come with some unwanted side effects. In addition, oral medications can be unsafe for some men to take at all, including those who have had, let's say, severe heart disease, heart failure, have low blood pressure, or those who take nitrate drugs to treat chest pain, not to mention, too, these oral medications often fail to work in some men altogether. So there are some options other than oral medications. The first one is the vacuum erection device, often called the VED, or it's often called the penis pump as well. This works by pulling blood into the penis using suction. Once the erection is formed, a tension ring can be slipped on the base of the penis, which helps maintain an erection for about 30 minutes or so. Now, dr McMinn, I like to use this too in something I call penile rehab as well.

Speaker 2: 56:05

So let's just say that it's more about unpredictable erections, perhaps with performance anxiety or something of that nature. Where it's not full blown ED is that I'll have guys use this about once every week just to get blood flow into their penis, just for them to see the blood flow that comes in the penis right. So vacuum erection device can be used for a couple of different reasons. So the next one on the list is testosterone replacement therapy, and we've already talked about that, so I'll leave it at that. There's also an option of intraurethral therapy. Now. This involves inserting a small drug pellet into the tip of the penis. It takes about 10 minutes for an erection to form, and typically that erection will last 30 to 60 minutes. Now I will say that I've heard the complaint from some men that there's a burning sensation and sometimes bleeding at the end of the penis. Penile injections are another common use in that I know sounds a little scary and I don't have a penis, but it still sounds scary.

Speaker 2: 57:19

Now, this medicine is injected into the base of the penis using a very, very small needle, and it's self-injected, so you can do this yourself. And, lastly, there is always the option of a penile implant. It is about a 30 to 45 minute surgical procedure that places a water-based device into the erection chambers of the penis. Now this enables a person to reliably control exactly when and how long that they want their erection to last, and, according to many urologists, this is really the closest option to a cure that exists for erectile dysfunction.

Speaker 3: 58:00

Yeah, it seemed like in the last few years there's been also this penile ultrasound that 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 pretty good evidence on that. I don't think it's curative. For a lot of guys it can be a bit expensive. I don't think there are much downside effects other than it makes your wallet a little bit thinner.

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.

Speaker 3: 58:35

Right this can usually be overcome. Okay, now that we've got the guy a good erection, let's talk about ejaculation. Some men are able to get it up and keep it up, but they have issues with orgasm and ejaculation. The two most common issues would be premature ejaculation and then, on the opposite end of the spectrum, you have delayed orgasm or delayed ejaculation. So let's start with the premature situation. Tell us the actual definition for this situation, please.

Speaker 2: 58:59

Okay, so premature ejaculation is also referred to as PE. Okay, this occurs when the man ejaculates sooner than wanted during sex. So, as you can see, there's no particular stated time here. It's not like they have PE if they come in less than a minute or two minutes or five minutes? It really is all about does it last as long as you want it to last?

Speaker 3: 59:25

Right. Do you have any recommendations for this?

Speaker 2: 59:27

as far as therapeutic options, oh sure, yes, I think our listeners are probably familiar with the stop-start method, the edging method, the squeezing technique, the scrotum pull technique. These are all really well explained if you do a Google search. I'm in lieu of time today I'm not going to go into those, but as you practice these techniques with your partner, you'll learn how to control your ejaculation and over time you'll gain confidence and ultimately you'll be in complete control. You can also masturbate before your date or when you were going to have a sexual encounter. Now you'll have to figure out what works best for you. Sometimes, if you masturbate the night before, it can be helpful. Other men may find that it only needs to be an hour or so before the date for it to be better, so that's another option there.

Speaker 2: 1:00:28

There's also local anesthetics that men can use on their penis, such as a topical lidocaine. There's some commercial products available too, and they've really done well with those. They're not transmitted onto the partner. So there's the older ones. They used to have some transmission and everybody would feel a little numb after it was all over, but now they've perfected those to where there's not this transfer. So that's really about it. For tips on that, I will say this one thing and this goes back to what we were talking about earlier and supportive partner is key.

Speaker 3: 1:01:07

Oh my gosh, that's huge.

Speaker 2: 1:01:08

Right, it really is so. Communication first right. And then a supportive partner. It's important with all of these issues that there's conversation going on and that the partner is being supported and included. So you might even want to. If a guy's going in to see his urologist or his primary care physician, you might want your partner to come along. This affects them just as much as it affects you.

Speaker 3: 1:01:36

All right, then, on the other end of the spectrum, tell us more about the delayed ejaculation.

Speaker 2: 1:01:40

Sure. So delayed ejaculation, sometimes called DE. So we've got ED.

Speaker 3: 1:01:47

Everything has initials, doesn't it? Tisey?

Speaker 2: 1:01:48

We've got ED, PE and now DE. So delayed ejaculation is when the ejaculation takes much longer than desired, or sometimes it doesn't happen at all. Some men find that they can only reach orgasm and ejaculate after long periods of stimulation, even though they have normal desire and normal erections. Oftentimes too, with delayed ejaculation, it doesn't happen during masturbation, but it happens with partner sex. So, we go back to that whole biopsychosocial.

Speaker 3: 1:02:21

What's going?

Speaker 2: 1:02:21

on in the body, what's going in the mind? What's going on in the relationship?

Speaker 3: 1:02:25

And is there anything a guy can do for this?

Speaker 2: 1:02:28

Oh sure, yes, there are. First of all, though and I think you would agree with this is to visit your primary care physician, or urologist in this case, and talk to them. Make sure that there's no anatomical problems or any medical problems that are causing this delayed ejaculation. So that would be first and foremost, and, like I said before, make sure you're taking your partner along with you, for that support, their understanding and the grace that you're going to need during this time. When you visit, make sure you're taking a list of all the medications that you're on. That will be helpful to your physician, also writing down when this happens.

Speaker 2: 1:03:12

Does it happen with a partner? Does it happen with masturbation? Be very clear, almost like having a diary for this, so you can really be an advocate for yourself 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 partake in those, that it's a different timing than when you're having a sexual encounter. There's also some anti-anxiety medications that your doctor can prescribe for you, kind of to lower, slow things down in your mind as well as your body. So those are a few of the most common recommendations I can think of.

Speaker 3: 1:03:55

Well, thank you. So how does mental health, including factors like stress, anxiety and depression, affect male sexual function, starting with desire, but also with a right-out function?

Speaker 2: 1:04:04

Yeah, so we go right back to that biopsychosocial model that we talked about, and I think you're putting that in the show notes too. So we know from knowing that model, talking about that model, that it's not just what's going on in your body. So we have delayed ejaculation going on, or even premature ejaculation or ED. That's what's going on in your physical body, but there's other factors, like you mentioned. There's stress, there's anxiety. Those are all going to affect the male sexual function. Relationship issues. What's going on? And, too, sex and context, right what's going on in your environment around you?

Speaker 2: 1:04:43

as well as what's going on in your mind, so the mental piece plays a huge role when it comes to sexual function.

Speaker 3: 1:04:51

Yeah, and, by the way, Valerie, in the show notes they only give you extember words and so it's really limited, so I'm gonna have it on the website Okay great, okay good. And so, speaking of mental issues, how do you deal with men who have issues with performance anxiety? I hear this pretty common.

Speaker 2: 1:05:06

Right. You know, performance anxiety is a psychological issue that affects your sexual function and, just as the name says, it's anxiety in regards to your performance. What I see in a lot of men that come in with performance anxiety and there are quite a few is that they're worried about a number of things. It typically is not are the kids sick or is the laundry need to be done? It is about body image, believe it or not. Okay, am I satisfying my partner? Is my penis too big? Is my penis too small? Is it too narrow? Is it too wide? Those kind of things it's always. It's also and women may be a little surprised to hear this it's about making sure, or it's the worry behind making sure, that they're pleasing their partner.

Speaker 1: 1:05:59

Right.

Speaker 2: 1:06:00

And so not only are they performing up to their own standards, but am I also pleasing my partner so that performance anxiety can get in a person's head and if they have issues, perhaps once or twice, with not performing as they really intended to, then that can be a cycle. It can affect the brain, genital connection and if they've had it once, they're going to go into the next sexual encounter thinking it may happen again. And the whole thinking and worrying about it makes it happen again and it becomes this vicious cycle. So it's a matter of really sitting down and this is I recommend highly that someone with performance anxiety not continue this vicious cycle, that they talk to someone about it.

Speaker 3: 1:06:52

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 to foster healthy sexuality in men in our society and healthy relationships?

Speaker 2: 1:07:05

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 to communication, supportive partners, communication, talking about these issues. Realizing too, I think, dr McMinn, is that sex doesn't go perfectly all the time. Their bodies just don't work that way. Just because we want it doesn't mean it's going to happen perfectly. So I think that speaks to expectations, right. Okay, it's realizing there is an ebb and flow, there's a sexual energy in each of our bodies, and so it's just again, it's not going to happen perfectly every time and that's okay, that's normal, and especially if you're communicating and your partner is supportive, then you can work through all of those.

Speaker 3: 1:08:00

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 blues band. We played this wonderful song called 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 a lifetime we'll find that one partner once again we can't communicate, just not on the same page, whereas another partner it works out fine. So if a guy's kind of working on it and he's doing his best and it's just not happening for him or his partner, when is it time to seek third-party professional help? And what would that look like? A counselor, a pastor, a friend, a therapist, a doctor, et cetera.

Speaker 2: 1:08:39

Right? Again, a great question, and I wanted to bring this up earlier, but I'm glad that we can talk about it now. I do think that the sooner the better. Again, as we pointed out earlier, typically people aren't responding immediately. They have a problem the next week they call their physician, or call a sexual health educator or a sex therapist. They're usually waiting months and months. So it is. If the problem brings distress in their life, then definitely to seek out help. I wanted to talk about the difference between a sexual health specialist like myself and many others out there, and a sex therapist. Can we do that?

Speaker 1: 1:09:22

for just a minute.

Speaker 2: 1:09:23

So a sexual health counselor or coach is well-versed on the intersection of sexual function, intimacy and optimal health and is able to explore the root cause of issues and concerns that a guy may have. So everything from unpredictable erections to performance anxiety. So often times this only requires a few visits, maybe two or four, depending on the individual's motivation to make changes and to do the homework. So, in other words, it happens in 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 they do. However, they tend to dig deep into the psychological issues surrounding whatever issue or concern one might have.

Speaker 3: 1:10:14

They put a 40-inch pin on it.

Speaker 2: 1:10:16

They certainly do. They look at things like we were just mentioning.

Speaker 3: 1:10:21

What does your mother mean to you?

Speaker 2: 1:10:23

Exactly, it goes back to utero. I typically go back a little bit and not into utero, so they do. The look, though, at attachment theories and family of origin connections to the problem you're having.

Speaker 3: 1:10:36

And there's a time and a place for that, but not everybody needs that.

Speaker 2: 1:10:40

And they often deal with some pretty heavy work in sexual abuse, sexual compulsivity, which is like an addiction, or pornographic addictions as well, infidelity, betrayal, all those things. But if you're having problem with sexual function again back to that circle if it's going on, what's going on in your body, what's going on in your mind, in your relationship then I would highly suggest someone as a sexual health counselor to see. So. This work takes time, though, so typically one can expect with a sexual health counselor to maybe again two to four visits a sexual therapist, maybe a longer period of time, months, if not years in some cases.

Speaker 2: 1:11:23

So I did want to make that clear, because we've talked a couple of times about reaching out to a third party. It doesn't have to be. I mean, guys don't tend to like to go to counseling, right? I consider myself a coach a lot of times with guys and I can get a lot further coaching and educating and then going deep into their psyche.

Speaker 3: 1:11:47

Right, and the average doctor, I think, is going to know how to prescribe the little blue pill, but he or she's not going to really know much about otherwise human sexuality. So you only get so far with them. But yeah, I think that sometimes we have to be humble and wise enough to know that we need help, and sometimes when you're trying to work it out with your partner, it can become kind of an us versus them thing. We have to all realize we're on the same page, on the same team, trying to move forward. So we have this mutually wonderful sexual relationship and so sometimes that requires a third party in there helping us out.

Speaker 2: 1:12:23

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: 1:12:32

When you mention the word homework, it's not like the therapist is going to fix it for you. You have to fix it yourself. But they can just guide you in the right direction. But you do have to go home and do your homework there with your partner. So now I know that you do see men and couples locally in your practice up in Ohio, but I also understand that you deal with them remotely. Is that correct?

Speaker 2: 1:12:50

That is correct, yes, and how would that happen?

Speaker 3: 1:12:52

How would they get in touch with you?

Speaker 2: 1:12:54

Sure, so we can put my website on the show notes or on your website for a link. In the meantime, though, if anyone anyone of your listeners have questions, they can simply go to my website. It's intimacyhealthcom. So that's intimacyhealthcom, and there's actually a chat box there that they can click on and simply ask a question. Isn't that nice. Just reach out anonymously, if you want to. And just reach out and let's get the conversation started. Wonderful.

Speaker 3: 1:13:27

Yeah, so I'll be sure to put your name and contact information on our list of links in the website. You can find it at the bottom of McMinnMDcom, on the homepage at the bottom, and so it'll be right there for you. Well, all right. Well, valerie, before we wrap this up, is there anything else you'd like to tell us about male sexuality that we have not already discussed?

Speaker 2: 1:13:44

No, dr McMinn, I think we've covered it all, we've covered it all and more.

Speaker 3: 1:13:49

Well, once again, we hang our hat on being evidence-based and thorough, so we appreciate you bearing with us. So I think that's about all the questions we have for you, valerie, and once again, thank you so much for sharing your wealth of knowledge and experience with us on this important subject.

Speaker 2: 1:14:05

Well, thank you, it's been a pleasure, dr McMinn.

Speaker 3: 1:14:08

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 us a five-star rating on iTunes. These reviews really do make a big difference for us and I thank you in advance. By the way, they do make it a bit difficult to do, so.

Speaker 3: 1:14:22

I have written out the directions for you on how to do this. On your iPhone, you can find this information at mcminnmdcom. It walks you through the process step by step and once you get the hang of it, it just takes a few seconds to do it. If you have an Android, sorry I can't help you. I'm not in that world, but anyway, also help us grow by telling your friends and family about us. Word of mouth really helps us get the word out, and if you'd like to reach out to me with any comments or suggestions for future topics, you can reach me at drmcminndoctormcminnyahoocom. We'd love to hear from you, and thanks again for listening. I certainly appreciate it. This is Dr McMinn signing out. Until next time, take care and be well.