Breaking the Stigma: Erectile Dysfunction, Porn Culture & Sexual Health with Dr. Jeff Loh-Doyle | Anew Ep. 51

In this powerful episode of ANEW Body Insight, Board-Certified Urologist & ED Specialist Dr. Jeff Loh-Doyle joins Dr. Supatra Tovar, clinical psychologist, registered dietitian, and fitness expert, for a deep dive into male sexual health, erectile dysfunction (ED), and the role of lifestyle in sexual well-being.

🔍 What you’ll learn in this episode:
✔️ How porn culture and unrealistic media portrayals fuel body insecurities
✔️ Why erectile dysfunction affects men of all ages—not just older men
✔️ The connection between diet, exercise, and sexual health, including the benefits of the Mediterranean diet
✔️ How stress, anxiety, and depression play a major role in ED
✔️ The latest medical and surgical treatments for ED, including penile implants

💡 Key Insights from Dr. Loh-Doyle:

• Many men don’t realize the impact of diet and exercise on erectile function until they experience issues.
• Excessive pornography consumption and performance anxiety are common causes of ED, especially in younger men.
• Cultural pressures and misinformation lead to unrealistic expectations about sexual performance and body image.
• ED can be an early warning sign of cardiovascular disease—treating it holistically is key.
• There is no “one-size-fits-all” approach to treating ED, and modern solutions exist beyond medication.

🎧 Tune in now! Click the link in our bio to watch and listen.

For more information about Dr Jeff Loh here are his social media link: https://keck.usc.edu/faculty-search/jeffrey-loh-doyle/,  https://www.keckmedicine.org/provider/jeffrey-loh-doyle/,  https://www.rrh.org/find-a-provider/jeffrey-c-loh-doyle-md/,  https://profiles.sc-ctsi.org/jeffrey.loh-doyle,  https://x.com/drlohdoyle,  https://www.linkedin.com/in/jeffrey-loh-doyle-94b023114. 

👉 If you're ready to take control of your health, break free from diet culture, and transform your relationship with food and body image, join our online course, Deprogram Diet Culture, at anew-insight.com.

📢 Follow us for more expert conversations on health, wellness, and mindset at @my.anew.insight on Instagram, TikTok, Facebook, Threads, and YouTube.

Thank you for joining us on this journey to wellness. Remember, the insights and advice shared on the ANEW Body Insight Podcast are for educational and informational purposes only and do not constitute medical advice. Always consult with a healthcare professional before making any changes to your health routine. To learn more about the podcast and stay updated on new episodes, visit ANEW Body Insight Podcast at anew-insight.com. To watch this episode on YouTube, visit @my.anew.insight. Follow us on social media at @my.anew.insight on Facebook, Instagram, TikTok, and Threads for more updates and insights. Thank you for tuning in! Stay connected with us for more empowering stories and expert guidance. Until next time, stay well and keep evolving with ANEW Body Insight!

Transcript

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Welcome
to the ANEW Body Insight podcast,


00:00:04:03 - 00:00:07:05
empowering and inspiring your journey to optimal health.


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Hosted by Dr. Supatra Tovar, clinical psychologist,


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registered dietitian, fitness expert, and author of Deprogram Diet Culture:


00:00:16:02 - 00:00:19:23
Rethink Your Relationship with Food, Heal Your Mind, and Live a Diet-Free


00:00:19:23 - 00:00:24:15
Life, and Chantal Donnelly, physical therapist and author of Settled:


00:00:25:00 - 00:00:27:22
How to Find Calm in a Stress Inducing World.


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Here at City Club Los Angeles, we follow our guests journey to optimal


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health, providing you with the keys to unlock your own wellness path.


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Tune in and evolve with us.


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Hello and welcome to the ANEW Body
Insight podcast.


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I am Dr Supatra Tovar,
and I am thrilled to have board


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certified urologist Dr
Jeff Loh-Doyle with us today.


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Welcome, Doctor Jeff.


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So much for having me. Yay!


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Well, I am going to read a little bit
about Doctor Jeff,


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and then we will get right
into our questions.


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Doctor Jeff Loh-Doyle is a board certified urologist


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at Keck Medicine of USC
specializing in male sexual health,


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particularly erectile dysfunction


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or otherwise known as ED.


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With a passion for improving men's health.


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Doctor Loh-Doyle combines clinical
expertise with compassionate care,


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helping patients navigate the complexities
of urological disorders.


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He completed his medical education
at USC, followed by residency


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training that solidified his commitment
to urology.


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Doctor Loh-Doyle is dedicated
to advancing research in male


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sexual health, aiming to destigmatize
discussions around ED


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and provide effective, personalized
treatment options for his patients.


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Welcome, Doctor Jeff.


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Thank you so much.


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And it's really a pleasure being on here.


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And I commend you on this podcast
for really bringing in multiple different


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specialties, because as we'll discuss
today, ED is not just surgery.


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It's not just medications.


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It's about overall health. Yes.


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I'm really excited to talk about it.
Me too.


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So first question.


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Why penises?


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Just kidding, just kidding.


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No, what inspired you to specialize in
urology, especially men's sexual health?


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So I think as many urologists can attest,
they truly don't


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really set out being a urologist
as their lifelong dream from childhood.


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In reality, you only learn about urology,
probably through medical school.


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Yeah.


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But what's really interesting is that
when you're deciding what you want to be


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when you're practicing medicine,


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you have to rotate
with different specialties.


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And oftentimes
what we realize as urologists


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is that we will
somehow get exposed to urology,


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but then we get exposed to the
personalities not just of the urologists


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but also of the nurses, and all the other
staff helping, but also to the patients.


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And we also just then realize
are these the type of people


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that we want to work with
but also take care of.


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And oftentimes we find that urologists
are known as the happy surgeons.


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I mean they're known
as having a great sense of humor.


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They have a good quality of life


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because we take care of really complex,
sensitive issues.


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So you can't really take yourself too
seriously.


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So we identify with people
that we really feel


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that are have very like minded.


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And that's where we kind of decide,
all right,


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do we want to follow that specialty.


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And then you kind of come to find out
that urology is awesome.


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I mean it's just a great field.


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It has a huge breadth.


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You can do surgery.


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You can do a lot of procedures.


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You can really choose
what type of urology you want to practice.


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And also selfishly,
there's not many of us.


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So we're always busy.


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So we can really choose
what we want to do.


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So a lot of us have practices
that we really hone


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in on specific diagnoses
that we really are passionate about.


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Right.


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So for you, the passion lies where?


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So I take care of men
and they're and issues that arise


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either because of other comorbidities.


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Or specifically
because of cancer therapies.


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Right.


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So I take care of the after effects
of prostate cancer therapy.


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And we know that prostate cancer
is the number one solid organ in men.


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And so
there's a lot of patients out there.


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And there's a huge unmet
need of taking care of patients that have


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erectile dysfunction, incontinence.


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And I also take care of patients
that have really bad scar tissue


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that forms after radiation therapy,
as well as cancer therapies.


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So I'm very much
about treating quality of life.


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I'm not necessarily a cancer surgeon.


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But I take care of the after effects
and consequences of cancer therapies. Wow.


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And I would really love to know what


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actually inspired you
to become a doctor in the first place?


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So I always loved working with my hands.


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So when I was young,


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I would always help my dad in the yard
and helping him with the yard work.


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My dad was an engineer.


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But, I was always doing K'Nex.


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I was doing Legos
ever since I was really young.


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And I just felt that working with my hands
was really fun.


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And first, I wanted to be an orthodontist,
and then I transitioned,


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probably through my teenage years.


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And I wanted to be a surgeon, so I didn't
know what type of surgeon I wanted to be.


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Initially, I thought I wanted to be
a plastic surgeon.


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And then I kind of pivoted
towards urology.


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Turns out,
though, I married a plastic surgeon.


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So I really realized
that I made the absolute right choice,


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because plastic surgeons


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are a little bit different than urologists
in terms of their personality,


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and I identify way more with urologists.


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But very much what I do now in


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urology is very much
the plastic surgery combined with urology.


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So we do a lot of reconstructions as well.


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But from a really a young age


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I really wanted to be a doctor
and specifically a surgeon. Wow.


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Well you specialize in


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erectile dysfunction among other things.


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Can you explain to our audience,


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I think a lot of people


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actually have a lot of misconceptions
about erectile dysfunction.


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How is that its own condition


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as opposed to having maybe difficulties
in just achieving an erection?


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Well, how we define 


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erectile dysfunction is either the failure to attain
or maintain


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an erection that’s satisfactory
for sexual pleasure or performance.


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Okay.


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That's very much defined by the patient.


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So just because someone doesn't
have a strong erection doesn't mean


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that they're not happy.


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And vice versa.


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You can have a patient that has a quote
unquote strong erection that's unhappy.


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So that would be


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defined as having dysfunction
and specifically erectile dysfunction.


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So that's where it comes
into a conversation that we have to have


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with the patient.


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We have to break those barriers down
and we have to identify.


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All right.


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Specifically where
where can we make things better.


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Where do you feel like
things are not quite


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where they're where they want to be.


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What do you mean by they're not happy?


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So it's very much dependent on patients.


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I mean, in this day and age,
there's a lot of exposure to social media.


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There's a lot of pressure on patients
to perform in some way.


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And so even though we may feel


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that they're performing just fine,
they may not feel that way.


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So we really have to identify, alright,


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where can we do better
and where can we make you happier,


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whether yourself or in a relationship
or with your partner?


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Because all those things matter. Right.


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Would you say that
there's a lot of pressure because of porn?


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Huge.


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So one of the largest patient populations
that we see is younger patients. Wow.


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And the younger patient
that's very physically fit.


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They have no other comorbidities.


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And they when you really ask them.


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All right.


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So what what
how much pornography do you watch?


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And they say well doctor I you know,
I watch every day.


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I'm like, okay, how often do you watch?


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You know about an hour.


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And how often are you masturbating?


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Three or four times a day.


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So I don't know about many men out there
that can maintain a strong erection


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if they're masturbating four times a day.


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But then you actually have
to figure out, alright,


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how can we undo that obsession.


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Because when you actually ask a patient
you know, why do you do this?


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I mean they're actually not watching it
for pleasure.


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They're actually watching it
as a way of an outlet of stress.


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So it's actually stress relief.


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It's actually not for pleasure.


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So you've now now converted something
that should be pleasurable


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into something that it's done
to release anxiety or stress.


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You know, created a little bit
of a different paradoxical scenario


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where, you know,


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we all assume that an erection’s
for pleasure,


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but it's actually
someone's getting an erection


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and that masturbating
more to kind of satisfy


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something else or to at least get rid of
or at least block out something mentally.


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You mean now you've kind of created,
you've undone something. Yes.


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And I mean, certainly boys


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are becoming more and more inundated


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with porn, especially with having,
you know, access to devices.


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Yep.


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Would you say that erectile dysfunction


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has shifted to younger generations
because of that primarily?


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No, I think we've just seen more of it.


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I think that it's always been an issue.


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I think that, you know, performance
anxiety has always been an issue,


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no matter how old that patient is.


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No matter how old someone is.


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You can still have anxiety over that.


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But I think that what it has done
is that it's taken it


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and out of it's
this it's been destigmatize a bit.


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Right. Where now we know that, you know,


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younger patients are susceptible to this
and even older patients.


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But I think there's now
more and more patients knowing that,


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all right,


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I can't necessarily just ignore this.


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This is a problem
and it's affecting relationships.


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So we see more of it now


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because I think that as urologists
we're doing a better job of talking about it.


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Oh I would agree.


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But I also do wonder the medium
in which they're receiving porn


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is different, say, since the 70s
or the 80s, 


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Oh yeah, you had to go sneak into like a supermarket
or your dad's closet


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to go find it. Now you can just Google something
and get it on your phone.


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Right. And get it immediately.


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Do you think the phones have anything
to do with contributing to ED?


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Probably, yeah.


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I mean, I would say that,
you know, there's a lot of other outlets


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besides pornography.


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I mean, you know, there's ways in which
that people interact now with, you know,


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they have various things such as OnlyFans
and other subscriber options.


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I mean, it very much eliminates
the interpersonal connection


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that someone has with having
an in-person talk with someone.


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I mean.


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You know people pay to interact
with someone just over the phone.


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Yeah.


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And it's not necessarily
just about you know seeing a picture


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or seeing a video, but you actually like
find out what people are paying for.


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It's actually to talk.


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So it's it's very you know, that's
what's unique is


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that it's
not just about a visual stimulus.


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It's actually a conversation.


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And so it's really, really complex.


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But we know that pay that people
now have less social interactions.


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They're a little bit more lonely.


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And you know how's that going to kind of
and this is these are younger people.


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I mean we talked to I have you know


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my my wife has younger female friends.


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They're single.


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And they say that
the younger generation of men


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don't know how to interact with them
but know how to talk to them.


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They don't know how to flirt.


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They don't quote unquote have game.


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Wow. So I mean,
this is a problem for society.


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And so is this contributing to ED?


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Yeah, but it's contributing
to a bigger issue of just overall,


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you know, dysfunction and interaction
between people.


00:11:41:11 - 00:11:41:22
Right.


00:11:41:22 - 00:11:46:05
And I'm sure the pandemic didn't
help things at all. No it did not.


00:11:46:05 - 00:11:49:01
Did you see an uptick in
ED with the pandemic?


00:11:49:21 - 00:11:51:01
Not necessarily.


00:11:51:01 - 00:11:54:16
I mean I think that, you know,
the way that my practice is built


00:11:54:16 - 00:11:55:19
instead of cancer centers.


00:11:55:19 - 00:11:58:15
So I'd say a large
proportion of my patients


00:11:58:15 - 00:12:01:21
are post prostatectomy
or post cancer therapy.


00:12:02:09 - 00:12:06:00
But you know there's still
a very steady stream of young patients


00:12:06:00 - 00:12:10:06
that come see me from
you know, local colleges that have issues.


00:12:10:16 - 00:12:14:12
But it's been pretty consistent
because we know that accessibility


00:12:14:12 - 00:12:18:15
to pornography has been pretty stable
over the past decade or so.


00:12:18:19 - 00:12:19:10
Oh, yeah.


00:12:19:10 - 00:12:20:11
Definitely.


00:12:20:11 - 00:12:23:10
Well, I'm sure there was an uptick in it,
but maybe it's


00:12:23:10 - 00:12:26:17
not necessarily seen right away right now.


00:12:27:01 - 00:12:30:15
But can you tell us
what are some of the most common


00:12:30:15 - 00:12:34:00
misconceptions about erectile dysfunction?


00:12:34:14 - 00:12:38:00
Especially the kinds
that you encounter in your practice?


00:12:38:01 - 00:12:38:08
Yeah.


00:12:38:08 - 00:12:42:06
So, you know,
everyone thinks that ED is somehow,


00:12:42:15 - 00:12:45:15
you know, less represents
less of being a man


00:12:45:22 - 00:12:49:18
or that it's somehow just caused strictly
because the plumbing is bad.


00:12:50:06 - 00:12:53:02
But we know that having an erection


00:12:53:02 - 00:12:57:18
and being satisfied is very much
a combination of different things.


00:12:57:19 - 00:12:59:12
I mean, you have to be anatomically,


00:12:59:12 - 00:13:03:06
physiologically
and mentally able to have those things.


00:13:03:06 - 00:13:05:22
All three have to be clicking
simultaneously.


00:13:05:22 - 00:13:08:11
If one thing is not working,
you're going to have a problem.


00:13:08:11 - 00:13:12:16
And so you know it's
not just a fixable thing with medications.


00:13:12:16 - 00:13:16:22
We know that you know
it's a complex interaction


00:13:16:22 - 00:13:20:06
of things that creates a strong erection
or at least a meaningful erection.


00:13:20:17 - 00:13:23:19
And you have to treat
it in a multifaceted way.


00:13:25:08 - 00:13:27:10
So what do you think is


00:13:27:10 - 00:13:31:02
the most common misconception
that it's all in somebody's


00:13:31:02 - 00:13:35:14
head, that it's, you know,
just because of diet or lifestyle?


00:13:35:19 - 00:13:39:00
No, that erectile dysfunction
only affects older people.


00:13:39:00 - 00:13:43:20
I mean as we talked about earlier,
I mean it affects men of all ages.


00:13:45:19 - 00:13:47:04
And so very much it's


00:13:47:04 - 00:13:51:04
about destigmatizing and talking,
and being and telling patients, you know,


00:13:51:12 - 00:13:54:14
you got to talk to someone about this
because it can represent a lot of things.


00:13:56:07 - 00:13:59:06
So that's the biggest,
that's just confined to an older patient.


00:14:00:03 - 00:14:02:11
But there must be a lot of shame?


00:14:02:11 - 00:14:02:23
Absolutely.


00:14:02:23 - 00:14:05:23
And you know, just a, you know,


00:14:05:23 - 00:14:09:18
an inability to talk to,
you know, seek help.


00:14:09:19 - 00:14:13:09
How do you suggest people overcome that?


00:14:13:23 - 00:14:15:21
Well,
if you're a younger patient, you know,


00:14:15:21 - 00:14:18:05
where do you seek out
I mean, if you're going to go online?


00:14:18:05 - 00:14:19:19
You're going to talk
to your regular doctor?


00:14:19:19 - 00:14:23:18
Many patients today, many especially male
patients, don't have doctors.


00:14:24:10 - 00:14:26:07
So who's going to be that person?


00:14:26:07 - 00:14:29:07
And so oftentimes you know as a urologist


00:14:29:09 - 00:14:32:09
especially we're the first doctor


00:14:32:20 - 00:14:35:20
that a patient that a, that a guy has seen.


00:14:35:21 - 00:14:39:10
And so when we see a patient
especially let's say in their in their mid


00:14:39:10 - 00:14:43:21
30s or 40s, sometimes it's not just
attributable to performance anxiety.


00:14:43:21 - 00:14:47:07
I mean it could be because of a cardio
vascular issue.


00:14:47:10 - 00:14:51:04
So we have to be
we have to put our doctor hats on


00:14:51:04 - 00:14:54:16
and we have to say well let's look at
their labs, let's look at their cholesterol.


00:14:54:16 - 00:14:56:00
Let's look at their lipids.


00:14:56:00 - 00:14:57:09
Let's look at their blood pressure.


00:14:57:09 - 00:14:59:03
Let's look at their blood sugars.


00:14:59:03 - 00:15:03:01
And sometimes we diagnose all these issues
and then we say all right cool.


00:15:03:01 - 00:15:04:11
We can fix your erections.


00:15:04:11 - 00:15:06:08
But there's some other issues
going on here.


00:15:06:08 - 00:15:08:11
You need to see our established
care of the regular doctor.


00:15:09:13 - 00:15:10:10
Are you seeing


00:15:10:10 - 00:15:13:10
those kinds of issues in younger
patients today?


00:15:13:14 - 00:15:19:10
Well I think that with Covid, you know,
we know that patients are not exercising.


00:15:19:11 - 00:15:22:03
They're not eating
as well as they used to.


00:15:22:03 - 00:15:24:10
Foods themselves are more processed.


00:15:24:10 - 00:15:27:10
So just overall, you know,


00:15:27:10 - 00:15:30:13
we know that overall health correlates
with erections.


00:15:30:17 - 00:15:33:17
And poorer health means
erections are not going to be as good.


00:15:33:19 - 00:15:37:04
So we're seeing patients
now that just don't


00:15:37:18 - 00:15:40:16
you know they they come in
they never work out.


00:15:40:16 - 00:15:42:10
They don't exercise.


00:15:42:10 - 00:15:44:09
They're overweight and they wonder
why the erections aren't bad.


00:15:44:09 - 00:15:47:05
Well there's really no mystery behind
that. Right.


00:15:47:05 - 00:15:51:11
Do you, do you see that it's most common
with people who are overweight?


00:15:51:11 - 00:15:52:16
Or is it.


00:15:52:16 - 00:15:53:10
It's all over the place.


00:15:53:10 - 00:15:54:16
I mean, you be very surprised.


00:15:54:16 - 00:15:56:14
You may have a guy that's very fit.


00:15:56:14 - 00:16:00:15
That, you know, is in a very stable
relationship, has a meaningful


00:16:00:15 - 00:16:04:12
relationship and then you just has bad
luck, erections just aren't quite there.


00:16:04:17 - 00:16:09:00
And then you can have someone that you
know, you would think that


00:16:10:03 - 00:16:12:20
they have diabetes, they have poor blood
pressure, they get strong erections.


00:16:12:20 - 00:16:14:05
And you're like.


00:16:14:05 - 00:16:16:20
So it's not just those things, I mean,
that's for a it's


00:16:16:20 - 00:16:19:20
really a combination of things.


00:16:19:21 - 00:16:23:03
To create a strong erection
or at least one that someone's happy with.


00:16:23:08 - 00:16:24:01
Right.


00:16:24:01 - 00:16:26:20
Well being a psychologist myself
this is a very,


00:16:26:20 - 00:16:29:21
you know, a question
that's very close to my work.


00:16:30:03 - 00:16:33:19
What are some of the psychological factors
that contribute to ED?


00:16:34:04 - 00:16:36:14
Depression, anxiety.


00:16:37:18 - 00:16:39:14
Feeling like you're not quite,


00:16:40:06 - 00:16:43:10
you know, in
meeting the expectations of society.


00:16:44:05 - 00:16:46:19
There’s shame. There's some issues


00:16:46:19 - 00:16:49:18
with patients that have religious beliefs.


00:16:51:03 - 00:16:53:20
So as a urologist
or anyone kind of talking to a patient


00:16:53:20 - 00:16:57:01
that has ED, you have to kind of dive
deep into those issues.


00:16:57:16 - 00:17:00:23
And I commend you in your work
because us as urologists,


00:17:01:10 - 00:17:03:02
we're good at prescribing medication.


00:17:03:02 - 00:17:04:17
We're good at doing surgery.


00:17:04:17 - 00:17:09:03
We're not really good at diving deep
into someone's psychological experience.


00:17:09:21 - 00:17:12:12
But we know that it's
extremely important.


00:17:13:02 - 00:17:15:20
And there's been numerous studies to show


00:17:15:20 - 00:17:19:08
that if you were to compare patients
that just get medication


00:17:19:15 - 00:17:22:10
and you come, and you compare
those two patients, that medication


00:17:22:10 - 00:17:25:16
plus the role of a psychologist
or a sexologist.


00:17:26:07 - 00:17:27:19
Those patients do much better. Right.


00:17:27:19 - 00:17:30:08
If you're involved a couple it's
even better. Right.


00:17:30:08 - 00:17:33:15
So, it's you're really your field.


00:17:34:02 - 00:17:37:01
They're vital
in the treatment of erectile dysfunction.


00:17:37:12 - 00:17:39:17
Do you assess for that when you,


00:17:39:17 - 00:17:40:22
how do you do that?


00:17:40:22 - 00:17:43:07
So we ask a patient, we'll ask them, you know


00:17:44:18 - 00:17:46:22
you know do you feel or what,


00:17:46:22 - 00:17:49:22
it's very much dependent
on their description


00:17:50:03 - 00:17:53:03
of their erection
and where they're having dysfunction.


00:17:53:12 - 00:17:57:19
You may have someone say, well, doctor,
I have a good strong morning wood.


00:17:57:19 - 00:18:00:06
I get great morning erections,
nighttime erections.


00:18:00:20 - 00:18:04:00
But, you know, when I'm on my third
Tinder date,


00:18:04:18 - 00:18:07:01
I'm not having great erections.


00:18:07:01 - 00:18:07:13
Okay.


00:18:07:13 - 00:18:11:05
Well, is it because you're not necessarily
in a stable relationship


00:18:11:08 - 00:18:15:03
and you're kind of dating around? 
And you're always trying to be the best?


00:18:15:17 - 00:18:18:22
And maybe you're having it
with maybe a drink or two on that date.


00:18:19:13 - 00:18:24:17
So we have to kind of ask
the situational relationship of erections.


00:18:24:23 - 00:18:28:16
We have to understand where the erections are
good and where they're bad,


00:18:28:16 - 00:18:31:16
I mean if they have a great erection
when they're during masturbation.


00:18:31:20 - 00:18:33:00
That means the plumbing is good.


00:18:33:00 - 00:18:34:10
That means the mechanics are good.


00:18:34:10 - 00:18:38:11
They're having that night time erection that means the physiology


00:18:38:11 - 00:18:39:22
machinery is good.


00:18:39:22 - 00:18:42:22
But if they just don't get a good erection
when they're with a new partner,


00:18:43:19 - 00:18:46:19
there's a pretty obvious answer as to
what's going on, it’s situational.


00:18:46:19 - 00:18:49:06
So we have to dive deep into that. Right.


00:18:49:06 - 00:18:53:17
How much do you think
culture say things like diet culture or,


00:18:53:17 - 00:18:58:13
you know, exposure on social media plays
into those psychological factors?


00:18:58:14 - 00:19:03:02
Are they comparing themselves or are
they worried that they don't stack up?


00:19:03:07 - 00:19:07:01
Yeah. I mean, I think that there's a lot of guys
that feel like they have a small penis


00:19:07:11 - 00:19:10:04
and that they they just don't last
as long as they should.


00:19:10:04 - 00:19:13:04
And they're watching,
you know, pornography or they whatever


00:19:13:04 - 00:19:16:04
they perceive to be something
that's quote unquote normal.


00:19:16:09 - 00:19:20:07
I mean, it's not normal
what you see online.


00:19:20:08 - 00:19:23:18
I mean, for the most part
it's very abnormal.


00:19:24:11 - 00:19:27:11
And so our job and we do


00:19:27:11 - 00:19:31:05
sometimes counsel patients is to say
look this is like not normal.


00:19:31:05 - 00:19:33:11
What you're describing is normal.


00:19:33:11 - 00:19:35:12
And you know it's okay.


00:19:35:12 - 00:19:37:05
It's okay to be normal.


00:19:37:05 - 00:19:40:20
Because you know
there's a big spectrum of normal.


00:19:41:00 - 00:19:44:00
So we have a lot of patients that come in and say doc is my penis too small?


00:19:44:01 - 00:19:47:00
I’ll be like, Sir, I've seen ten penises


00:19:47:00 - 00:19:50:00
today and yours is just fine. Yes.


00:19:50:00 - 00:19:52:14
Your’s is absolutely fine. Yes.


00:19:52:14 - 00:19:57:00
Then we talk about average sizes and all those things,
but it's all about providing reassurance.


00:19:57:00 - 00:20:00:00
And I think that the patients do
get some relief from that. Yes.


00:20:00:05 - 00:20:01:04
And I do think that


00:20:01:04 - 00:20:05:20
what they're consuming as far as porn
has become more and more violent.


00:20:05:20 - 00:20:09:10
We had someone who specializes
in, helping people with,


00:20:09:10 - 00:20:14:04
you know, sexual issues
and said that there's so many,


00:20:14:04 - 00:20:18:04
porn sites that promote violence
against women and choking.


00:20:18:04 - 00:20:18:17
Yep.


00:20:18:17 - 00:20:21:16
Do you think that
that also plays a part in,


00:20:22:01 - 00:20:26:12
you know, men
when they're going to have regular sex?


00:20:26:20 - 00:20:29:20
Yeah, they're not going to they don't,
quote unquote, have that pleasure.


00:20:29:20 - 00:20:33:09
Maybe they require requiring a higher
and higher threshold.


00:20:33:14 - 00:20:38:03
Yes. Of things that that would quote unquote
make them,


00:20:38:11 - 00:20:42:00
you know, sexually, you know, excited.


00:20:42:05 - 00:20:44:15
And so that's not normal. Yeah.


00:20:44:15 - 00:20:49:01
And so then that you know then
at what point do they feel like all right


00:20:49:14 - 00:20:50:09
I'm satisfied.


00:20:50:09 - 00:20:51:22
And maybe they're just trying to achieve


00:20:51:22 - 00:20:54:02
or get something
that just is not realistic.


00:20:55:05 - 00:20:58:00
Well let's talk about some treatments.


00:20:58:00 - 00:21:01:22
We're going to get this into this
a little bit more into the next section.


00:21:02:05 - 00:21:06:23
But give us kind of an idea of how
you would treat erectile dysfunction.


00:21:07:07 - 00:21:09:05
All the different arrays.


00:21:09:05 - 00:21:12:10
So when we see a patient
that has erectile dysfunction


00:21:12:10 - 00:21:15:08
and then after we pinpoint
exactly what that cause may be.


00:21:16:11 - 00:21:19:04
So it's very much a shared decision
making model.


00:21:19:04 - 00:21:21:17
So we discuss all options.


00:21:21:17 - 00:21:26:03
And we give the patient
the best options that they could.


00:21:26:03 - 00:21:27:21
But then we'll put all options
on the table.


00:21:27:21 - 00:21:29:12
Everything’s acceptable.


00:21:29:12 - 00:21:32:17
And so you know for years
everyone thought you had to go through


00:21:32:17 - 00:21:35:20
a very stepwise
algorithmic type of treatment.


00:21:36:05 - 00:21:39:12
And for the most part,
I think that most people do follow that.


00:21:40:03 - 00:21:42:10
But we do have some patients
that come and say,


00:21:42:10 - 00:21:45:10
you know, I want the most invasive thing
because I want to be fixed immediately.


00:21:45:14 - 00:21:49:16
And that's okay because there are
some patients where that's acceptable.


00:21:49:17 - 00:21:53:03
You don't necessarily have to go through
things to prove that they won’t work


00:21:53:11 - 00:21:56:11
to get to know that inevitable
successful treatment option.


00:21:57:00 - 00:21:59:07
And so you know we our job


00:21:59:07 - 00:22:02:07
is to counsel
patients on risks benefits of everything.


00:22:02:08 - 00:22:05:21
And it's very much up to the patient
to decide where they want to go with that.


00:22:06:21 - 00:22:08:02
Well you


00:22:08:02 - 00:22:11:13
just said the most invasive option
and that got me curious.


00:22:11:23 - 00:22:13:01
What is that?


00:22:13:01 - 00:22:15:15
So it's the penile prostheses.


00:22:15:15 - 00:22:18:15
So it's been around for 40, 50 years now.


00:22:18:19 - 00:22:20:08
And there's different variations of it.


00:22:20:08 - 00:22:24:02
But you know what I specialize in
is the inflatable penile implant.


00:22:24:13 - 00:22:26:08
Just a great piece of engineering.


00:22:26:08 - 00:22:32:01
And now one of the companies,
one of the major companies of this device


00:22:32:11 - 00:22:36:06
is actually trying to de-stigmatize
what a what a penile implant is.


00:22:36:17 - 00:22:41:17
So last year, they actually produced
a direct to consumer marketing documentary


00:22:41:17 - 00:22:45:11
which documents patients, couples
and their journey


00:22:45:11 - 00:22:49:13
towards getting a penile implant. And it's a very it's,


00:22:49:13 - 00:22:52:23
a very tried and true tested
or tried and true treatment option.


00:22:54:03 - 00:22:56:07
But it’s now without risk,
but there are some patients


00:22:56:07 - 00:22:59:07
that really benefit from it
and it really changes for their lives.


00:22:59:16 - 00:23:04:01
Well, can you give us a little bit
more detail about what that might involve?


00:23:04:01 - 00:23:08:06
I can imagine there's a lot of people
cringing at home and thinking, oh my gosh,


00:23:08:19 - 00:23:10:11
you're going to cut into it. What?


00:23:10:11 - 00:23:10:17
Yeah.


00:23:10:17 - 00:23:13:17
So in general, the surgery itself
takes about 30 or 40 minutes.


00:23:13:23 - 00:23:19:08
Wow. It's outpatient surgery
and it's done through a very small cut,


00:23:19:08 - 00:23:23:03
either above the base of the penis
or at the junction between the scrotum


00:23:23:03 - 00:23:23:16
and the penis.


00:23:23:16 - 00:23:25:08
So just on the skin itself.


00:23:25:08 - 00:23:27:13
There's no visible cuts on the penis.


00:23:27:13 - 00:23:31:09
And through that incision,
you place two inflatable cylinders.


00:23:31:09 - 00:23:34:09
They get placed inside the actual penile
tissues.


00:23:35:00 - 00:23:38:21
Attached to those inflatable
cylinders is a pump and then a reservoir.


00:23:39:03 - 00:23:42:17
So that is the gold standard
three piece device.


00:23:42:17 - 00:23:46:16
And how you get an erection is
you will transfer water


00:23:46:16 - 00:23:48:09
which is in the reservoir


00:23:48:09 - 00:23:51:23
into the cylinder is by squeezing the pump
that we placed in your scrotal sack.


00:23:51:23 - 00:23:56:03
So the skin itself is very much like
in the skin on the back of our elbows.


00:23:56:12 - 00:23:59:14
Very loose in sensate. It’s just skin, it’s all it is.


00:23:59:14 - 00:24:02:16
So you can place pumps in there
that are really easy to access.


00:24:03:08 - 00:24:06:08
And then obviously the
you have to heal from this operation.


00:24:06:10 - 00:24:09:18
You come back in about two to four weeks
depending on who the surgeon is.


00:24:10:01 - 00:24:12:12
And they start teaching you how to use it.


00:24:12:12 - 00:24:13:10
And then after that,


00:24:13:10 - 00:24:16:05
once you feel comfortable
using it, you're off to the races.


00:24:16:05 - 00:24:20:00
So God bless insurance


00:24:20:00 - 00:24:23:00
for the most part
this is covered by insurance.


00:24:23:05 - 00:24:26:17
And this is very much a quality of life
restorative treatment option.


00:24:28:05 - 00:24:30:03
Is pleasure the same?


00:24:30:23 - 00:24:31:19
Absolutely.


00:24:31:19 - 00:24:34:19
So I don't have a penile implant myself, but I've been told


00:24:34:23 - 00:24:36:06
that patients themselves


00:24:36:06 - 00:24:40:23
feel like it's as close
to what a normal erection would be like.


00:24:40:23 - 00:24:43:06
It’s not the same. But you should still be


00:24:43:06 - 00:24:46:06
able to experience orgasm and sensation.


00:24:47:03 - 00:24:50:09
That is
I think a good question to add on to that.


00:24:50:09 - 00:24:54:04
What if they do have difficulty
with orgasm?


00:24:54:11 - 00:24:56:20
They get the penile implant.


00:24:56:20 - 00:25:02:01
Does that actually contribute
to a better orgasm or having an orgasm? It may.


00:25:02:01 - 00:25:04:05
Yeah. So we don't guarantee that.


00:25:04:05 - 00:25:08:06
But there are some patients out there
that have an orgasmia or dysorgasmia


00:25:08:09 - 00:25:12:08
because they just cannot,
you know, have a satisfactory erection.


00:25:12:16 - 00:25:16:02
They feel like,
you know, with a soft erection,


00:25:16:02 - 00:25:20:14
they just can't quite get to that
climax point because mostly they're


00:25:20:14 - 00:25:24:16
probably embarrassed or they're concerned
about how their partner feels about them.


00:25:25:21 - 00:25:28:20
But what's interesting
is that patients for that


00:25:28:20 - 00:25:32:06
have their prostates taken out, and
some of these folks don't have erections.


00:25:33:08 - 00:25:34:17
They can still get them to climax.


00:25:35:10 - 00:25:36:05
Easily.


00:25:36:05 - 00:25:39:05
Wow. So having an erection


00:25:39:09 - 00:25:42:09
doesn't necessarily guarantee you orgasm.


00:25:42:19 - 00:25:46:10
And you can have an orgasm without having
an erection which is really interesting.


00:25:46:10 - 00:25:48:04
That's a really interesting concept, right?


00:25:48:04 - 00:25:48:23
I didn't know that.


00:25:48:23 - 00:25:51:23
Lot of patients only realize that


00:25:52:13 - 00:25:55:15
after their erections are gone,
especially after cancer therapy.


00:25:55:15 - 00:26:00:03
And they're like, doc, you know,
my wife can still give me oral


00:26:00:03 - 00:26:05:03
pleasure and I can still orgasm,
but I have a soft erection, I’ve got nothing.


00:26:05:03 - 00:26:07:13
So that's what we try and counsel patients
to, is that you can


00:26:07:13 - 00:26:09:17
there's still other ways
of having pleasure,


00:26:09:17 - 00:26:12:17
you know,
that necessarily need a hard erection.


00:26:13:13 - 00:26:15:22
But the penile implant gives you that ability.


00:26:15:22 - 00:26:17:21
And the nice thing too for the partner


00:26:17:21 - 00:26:20:12
is that the erection lasts
as long as you want it to.


00:26:20:12 - 00:26:25:11
So one minute, five minutes, 30 minutes,
whatever you can decide.


00:26:25:11 - 00:26:28:16
You can already have your orgasm
but the erection will still keep going.


00:26:28:23 - 00:26:30:17
Wow. So the wife's got the timer.


00:26:30:17 - 00:26:32:22
She's like, yep, I've got five minutes.


00:26:32:22 - 00:26:35:02
Let's go, let's go. Wow.


00:26:35:02 - 00:26:39:07
Okay, well, we're out of time for this
half of this episode.


00:26:39:07 - 00:26:42:22
But this is fascinating to me
and I'm sure it's fascinating to you.


00:26:43:04 - 00:26:46:22
We will be coming back for the second half
of this amazing episode


00:26:47:01 - 00:26:50:19
with Doctor Jeff,
and we really hope you join us next time.


00:26:50:20 - 00:26:52:20
Thank you so much for joining us.


00:26:52:20 - 00:26:56:12
(clapping)


00:26:57:22 - 00:27:01:21
Thanks for tuning into the ANEW Body Insight podcast.


00:27:01:21 - 00:27:05:08
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00:27:05:08 - 00:27:08:09
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00:27:08:19 - 00:27:09:21
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00:27:14:03 - 00:27:18:09
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00:27:18:19 - 00:27:21:14
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00:27:21:14 - 00:27:25:11
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