TODAY'S GUEST: Dr. Ashley Winter, sexual health Urologist

I'm extremely happy to welcome Dr. Ashley Winter to Hard Conversations!

Ashley Winter, MD grew up in New Jersey and undertook most of her training there, until hopping state lines to New York City for residency at Weill Cornell Medical Center/New York Presbyterian Hospital. Growing up, she never thought she would become a doctor. She comes from a long line of engineers (father and grandfather) and thought she would go into that field as well. While she was completing her engineering degree, however, someone close to her had significant urologic concerns. She felt it was her calling to champion their urologic health. So, she went to medical school with a mission: to become a urologist! It has been a wonderful and unexpected journey to her current practice, surrounded by the beauty of the Pacific Northwest.

She enjoys all of urology; however, her passion is sexual health. After finishing her residency, she spent an additional year studying male and female sexual medicine in San Diego, California. During that time, she devoted herself to researching and treating conditions such as erectile dysfunction, Peyronie's disease, low libido, orgasmic and ejaculatory disorders, and sexual pain. She loves taking care of all genders, all ages, individuals and couples. She believes that the capacity for intimacy is fundamental towards helping people thrive. Common surgeries/procedures include: injection treatment for Peyronie's disease, Peyronie's surgeries, penile prosthesis (penile implant), vasectomy, scrotal surgery, and male incontinence, as well as kidney stone surgery and other general urology. She is thrilled to work at Kaiser Permanente. She believes integrated health systems (such as KP) deliver high-quality, accessible care, and is excited to see how sexual health initiatives can help their members lead better, longer lives.

• Social Media:

• Twitter and Instagram - @AshleyGWinter

• WEBSITE:

  https://healthy.kaiserpermanente.org/oregon-washington/clinicians/ashley-winter-0679025

YOU'LL LEARN

• Erections in the time of COVID-19

• Sexual health and urology

• Tips on PDE-5 Inhibitors like Viagra, Cialis, and Levitra

• The detriments of sexual shame

• The importance of liking your doctor

• Practical tips for partners of guys struggling with erectile dysfunction

• Insights on sexuality

• The benefits of online sex therapy

• And more!

THANK YOU FOR LISTENING to my male sexuality and sex therapy podcast!

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And lastly, if you have any questions (or would like answers to previously submitted voicemail questions!), head on over to Tim’s website.

About the Show

Introducing Hard Conversations, a podcast about male sexuality, and all things erectile, from the latest natural erectile dysfunction treatment to the best ed medical treatment. Therapist Tim Norton expands the conversation about male sexuality, adds context to why we struggle as a society to have hard conversations and breaks down how in a sex-positive environment there really is no room for taboos, judgment, or shame when it comes to penises.

YOUR online sex therapy and couple’s therapy HOST:

Tim Norton is a sex positive sex therapist working in private practice. He offers online therapy, online sex therapy, online sex coaching, and therapy and coaching for somatic symptom disorder.

Tim obtained his bachelor’s and master’s degrees from the University of Southern California. Tim is a proud member of American Association of Sex Counselors, Educators, and Therapists (AASECT), the Los Angeles Sexological Association, and works part-time with the Pain Psychology Center in Beverly Hills.

Hard Conversations Podcast Transcript

[00:00:00] Tim Norton: Hello, and welcome to hard conversations, really excited for my next guest, Dr. Ashley Winter, a urologist and sexual medicine physician currently based in Portland, Oregon. She is a former fellow of urology and sexual medicine. And Kaiser Permanente was a research fellow in the urology department at Memorial Sloan Kettering cancer center in New York, and did her urology residency at Cornell university. Dr. Winter has an undergraduate degree in engineering from Rutgers has received various honors and awards in her field and has authored several publications. She's appeared on TV shows like health busters as a featured physician on several terrific podcasts about sexuality, including Dr. Drew’s podcast and the Savage love cast. And is the co-host of the podcast The full Release with her fiance comedian Mo Mandel. Welcome to the show Dr. Ashley winter, you know, we set this up or we started talking about recording [00:01:00] this when the world was a much different place. 

Dr. Ashley Winter: Yes, I know it is funny cause I remember we decided to do it remotely as a kind of like, Oh, well, you know, we couldn't get together and make our schedules work, so we'll have to do it remotely. And now I was just thinking about this and said to myself, Oh, this is the way everything is being done right now. You know, re doing this remotely and. Like, thank God we kind of set it up this way because we were almost, you know, pre adapted to the situation.

I don't know. It's just crazy. It's, you know,  the Corona virus is changing everything essentially.  you know, that we know of. I, yeah, 

Tim Norton: yeah. It, it really is. And where you were. Briefly in LA and then your back up, where are you 

Dr. Ashley Winter: now? I'm in Portland. So I, yeah, so I live in Portland, Oregon, and my [00:02:00] fiance is a comedian and he lives in LA.

Although currently with all this,  quarantining and he has come up here.  to stay because, you know, I would like to say for, for the, you know, to be around me in these dark times and for his deep love of me, but, but really, I think it's because I have a washer dryer in my apartment. Let's just be honest, man.

It's like, you know, because I work in healthcare, I am high risk of getting it exposure, but he's kind of like, you know, do I weigh, you know, Increased risk of death and coronavirus versus, you know, laundry. And, you know, that was a really important one. 

Tim Norton: Okay. Well it's probably will laundromats. I didn't even think of that.

Well, laundromats even be open. 

Dr. Ashley Winter: I don't know. I have no idea. Yeah. But anyway, so, you know, I, I traveled between LA and Portland, like all the time, essentially, although yeah. With, with everything [00:03:00] that's going on on airplanes right now, it might not be for a little while. So, so 

Tim Norton: yeah, sure. Sure. So you're,  as, as I presumably said in your bio that I will later recorded and put at the beginning of this, no, it's fine.

I, I should have asked you for it earlier. The world has been a big mess for, for the last couple of weeks and, you know, we weren't even sure. We were going to do this, but I wanted to just talk about sex in the age of Corona virus and pandemic. And so briefly your, your sexual health urologists, sexually sexual health trained urologist.

 and so for the listeners, what exactly is that how's that different than our regular garden variety 

Dr. Ashley Winter: urologist? I do many of the things that a regular urologist does,  you know, like I take call, I take care of kidney stones. When people have them, I do surgery. I, you know, whatever, if somebody has a tumor and their test to go, I take their [00:04:00] test to go out.

But I also, after my six years of residency, which was the urology training I had after. Four years of med school. I then did an additional one year,  specifically focused on sexual health for men and women.  that was a fellowship program with this guy or when Goldstein, who is, you know,  a. Crazy genius and an incredible human and,  you know, the focus there was just, you know, kind of to take a more in-depth exploration on disorders of,  of course, you know, erections,  but also, you know, orgasmic disorders, sexual pain disorders,  libido desire disorders,  and, you know, delving into kind of more sophisticated ways of approaching.

You know, any of those conditions and,  you know, the average, it doesn't know what it's like to be in a urology residency. Cause that's a very narrow and small. Life to have, [00:05:00] you know, experience.  but you know, a lot of what we do in those six years, even though it seems like forever,  is learning to do surgery and take care of patients in hospitals.

And a lot of sexual medicine is not that. So it was really great to have that additional experience and, you know, going out into the rest of my career, I just feel, you know, Uniquely S you know, uniquely trained to,  kind of approach some of those conditions,  you know, in a more robust manner.  so, so that's that's.

Yeah. And, you know, in terms of more concrete things, I do a lot of penile implant surgeries,  you know, prescribed hormones, talk to people about their libido and.  you know, do,  examine people kind of in a way targeted towards determining of the source of their pain. Should they come in with sexual pain?

Things like that. So, yeah. 

Tim Norton: Wonderful. It's wonderful work, but it does strike me. So six years of urology and sex doesn't really [00:06:00] come up that much in those six years, or how does that. 

Dr. Ashley Winter: It doesn't come up there. That's a great question. It doesn't come up very much. And one of the reasons why I did the fellowship was because I felt like I knew so much about prostate cancer.

I mean, urologists love talking about prostate cancer. It's like 90% of what they want to think about all the time. And,  and you know, But, but really one of the core things that we kind of, that one of the core roles that we play is, is being the, you know, I would say kind of the, the, the. Champion of, of men sexual health from the medical standpoint, you know, I mean, or that's the role we are assumed to take.

And yet we don't spend a lot of time in our training, really focused on sexual health.  most of it really is on, you know, like kidney stones, cancers of the bladder, kidney, prostate, you know,  things like [00:07:00] that. So it w it felt like there was going to be a need. When I went out into the world for somebody to address these things with the care and consideration that people want, when they have.

Issues related to their sexual health. And you know, that, that even that just that one year of training was really going to make a big difference to the ability for me, for me to do that.  

Tim Norton: definitely. Yeah. And it's Irwin's, or Dr. Goldstein has been mentioned by other people on this podcast and he does have a pretty amazing reputation down in San Diego.

And, and thank you for getting that additional training. I, you know, I have. Talk to some urologists along the way. And you know, I'm always looking for,  People to send clients to when we've either, either they haven't gone in and we're talking about the psychogenic aspects of erectile issues. And, and obviously, you know, they, they do need to check in with [00:08:00] doctor with a urologist, if, if, if possible.

And sometimes,  yeah, I have a concern about bedside manner and the ability to have a sex positive conversation and talk very openly. And so when, when I meet. Post,  Dr. Goldstein people, and then they, they're clearly comfortable talking about sex. It's such a breath of fresh air and it didn't really helps to know that I can send someone there.

Yeah. 

Dr. Ashley Winter: Yeah, no, definitely. And I think it is a really key point that not everybody and I love the community of urologists and, you know, urologists are my homeys and whatever.  I have tons of, Oh, I don't want to talk you out on our community. Right. But there are tons of people that go into urology who are not interested in, in taking care of sexual health issues.

Right. 

Tim Norton: Want to take out blows me away. Like they you're you're so, right. 

Dr. Ashley Winter: Yeah. Yeah. I mean, there are people who want to go into urology because they [00:09:00] want to take out massive kidney tumor and that's all they want to do. And there are people that go into urology because they want to.  take care of massive kidney stones and that's all they want to do.

And, you know, people who just want to take care of pee in her pants and that's all they want to do. And so if you come to that person, they're like, Hey, it hurts me after I Dracula it. They're going to say like, ah, don't worry about it. And that's not true, but you know, it can, it can potentially go. And so it is really important if you.

Are, you know, going to a urologist specifically with a sexual concern.  no matter what it is that, you know, I would say in this day and age, you can find something on the internet about almost any doctor and just look and not necessarily what other people have to say about them, but what they have to say about.

Themselves and their interests and somebody who is interested in taking care of sexual health. We'll let you know that that's going to be front and center in their bio, you [00:10:00] know, and you know, like I work,  At Kaiser Permanente up in Oregon. And you know, my bio basically says that front and center, like I did this extra training, this is what I care about, you know?

So that's, that's important to me. And you can, you can definitely find that. Yeah. So 

Tim Norton: awesome. And they, that's a really good thing to mention to listeners. If, if someone has taken that extra training, they're very likely going to put that right out front.  because it is, it is unique. So what's, what's your job like lately?

Is it different in, yeah. Does it change at all or are you still implanting penises and taken out testicles and. 

Dr. Ashley Winter: Yeah. Great question. So, and this is, you know, for anybody's reference it's, it's March 17th to contextualize this. Cause I know everything is changing day to day and you know, even if you put this up in three days, I don't even know what's going to be going on.

It's it's just, just mind blowing,  the rapid [00:11:00] progression and evolution of, of, you know, the, the situation on the ground. But as it stands,  My practice and our hospital system has suspended all elective surgeries. So yes, any, I mean, fundamentally that means anything. That's not an immediate life-threatening emergency, or let's say a very aggressive cancer that if you delayed the procedure, For more than two weeks, it would lead to a negative impact on their life expectancy.

Right. So everything else is being canceled. So even if you have a cancer, but it's not a very aggressive cancer, it's being postponed. So this is, yeah. So actually I've had several, a penile implant surgeries this month that had to be canceled. And I don't know when they're going to get back on the schedule.

 everybody who's scheduled for a vasectomy that's that's done.  We don't know when they're going to get rescheduled and not even so much to, to leave. [00:12:00] I mean, for a number of reasons, right? One, because everybody's running out of masks, gloves, gowns, all this stuff. And if people are sick and we need protective equipment for healthcare providers, it can't, we can't be like, Oh, a bunch of dudes got the sec dummies last week.

We don't have any more gloves, you know, like, like that, that could mean life or death. Right. So we just can't do it. So it has radically radically changed,  in a matter of days, the practice. And then the other thing we're doing is, is just keeping people out of the office. So for two reasons, again, when you get back to the gloves,  You know, they were saying initially, Oh, you know, you could bring people into the office.

 as long as examining them does not require use of gloves. Right. So what does that work for? Like doing listening to somebody's heart. Right? You don't have to wear gloves to that, but basically. Almost anything or urologist does your, your red gloves, right? Like I'm not going to give you a [00:13:00] rectal exam without it.

It's not going to happen. And if somebody is, you know, touching your scrotum with, in a professional environment without a glove on, that's just, you should fight it. That's not. So, so that was number one,  you know, utilization of resources and number two,  just about exposure, right? So if for some reason, somebody walked into our office who had it.

We do share space. For example, with an urgent care, people with respiratory complaints are coming in and if they got exposure, God forbid, even though they were coming in for a non-urgent reason, you know, then they're going to go out and they're going to spread it. And you know, we're talking all about this social distancing and flattening the curve and you know, one of the best ways to flatten the curve high yield way to flatten the curve.

Physically keep people out of the doctor's office. So whatever we can do remotely, we are doing it right when somebody, there was a, I'm just ranting about this now, but it's all really [00:14:00] critical stuff right now. So, you know, I was listening to the white house, like press conference this morning, and usually I would never.

Do that,  for a number of reasons, but the, one of the very first things they said was that Medicare was going to start paying. 

Tim Norton: Yeah. You tweeted that. Yeah. I saw that. Yeah. That's that's really a 

Dr. Ashley Winter: big deal. Huge right, because that will allow people to keep their door that will allow medical practices to keep their doors open while providing care.

Right. And if I have a half-hour conversation with you about your, you know, erectile dysfunction goals, or, and we review our testosterone and we talk about the treatments you've had before, and we'd come up with a plan, you know, that's valuable too. Right. And, and maybe we're going to have to execute on that plan later on, but you've received medical care.

At no risk to you, if we do that over the phone or zoom or whatever it is. Right? So, so this is like really important right now. And, and that's, you know, [00:15:00] what we're focusing on,  in addition to supporting the people who are on the front lines, you know, in terms of critical care,  although you don't want a urologists doing most of your yeah.

Tim Norton: Well, have you been asked to do that kind of stuff or are you still just seeing like, I'm like. Prostate cancer that's really advanced or has your day-to-day changed? 

Dr. Ashley Winter: So the types of diagnosises IC have, have not yet changed. I mean, we still are bringing people into the office for emergent things. Like somebody's peeing blood, you know, and profusely, then we're getting them in the office.

But,  we have not yet. Had to roll over into providing non-Euro illogic care. But I have received emails from our institution specifically saying, you know, you have admitting privileges to the hospital, meaning like, you know, I'm allowed to have somebody in the hospital under my name, [00:16:00]  and potentially you may be needed in the future to help with,  you know, care of, of, of patients outside your specialty.

And so, you know, there has been no discrete request yet to do that, but it's something that I think we all have to keep on the horizon. Should we come to a catastrophic situation? And I 

Tim Norton: got that sense that that's. What's been happening in Italy. Like there they're an all hands on deck kind of situation out there.

So we'll, we'll see. Yeah. And like you say, today's St Patrick's day happy St. Patrick's day.  right. March 17th. So yeah. If you're listening to this episode a week or two, it might sound,  very dated.  but yeah, when you were talking about having to, to postpone something like a penile implant surgery, you know, I've had a couple of guests come on and talk about that and, and did spend some [00:17:00] time talking about PNL, implants, and I've, I would think that that would be a really.

Big decision that somebody would make and have to spend a lot of time to finally come to that. And now to have something like that put off and the same with like a low level prostate cancer, low risk prostate cancer, and all of those things, you're, you're nervous enough about going into surgery. And now the poor guys, like having to put that off and.

Dr. Ashley Winter: Oh, without a doubt. I mean, people, when you think about it, you know, people have taken the time off of work. They've got it in the FMLA,  you know, approved if that's what they needed.  you know, they made arrangements, they postponed their vacations. They yeah. Mentally prepared themselves. They did all the blood work and the urine tests and the preop appointments and, and yeah, and they did everything.

And, you know, we had one guy, you know, while this was so rapidly evolving, The we had a coronavirus. The first coronavirus case in Oregon was, you know, admitted to one of our hospitals the [00:18:00] night before or two nights before he was supposed to have a surgery. And, you know, they called everybody who was scheduled for surgery that Monday and said, Hey, we're canceling you the day before.

You know? So he found out the day before that he wasn't going to have that surgery. And that is a big deal. But I'd say by and large, everybody has been extraordinarily understanding.  You know that, that it's not about just them. It's about the public health, but also canceling their surgery in the moment is about there.

Right? Right. I mean, there's no point in having a. A penile implant if you're dead. So, you know, so don't put yourself at risk, stay alive and, you know, try to stay alive. And then when this blows over, get your PNL and you'll have a lot more sex that way. Yes. You 

Tim Norton: feel like you do see a fair number of guys who come in and you could tell that stress might be impacting their erections.

[00:19:00] Dr. Ashley Winter: Yeah, without a doubt. 

Tim Norton: Yeah. So if they can't come in and see you and they want to quarantine and chill, like what, what are some of the broad things that we can talk about that, that might help them during this, this time of quarantine and chill? 

Dr. Ashley Winter: Okay. So,  I'm going to sound very medically cause I, you know, I am more on the medical side and less on the sex therapy side and I love sex therapist and I think it's super important.

It's just not my, like, I'm the, you know, like, you know yes. Do do do like, like let's check these boxes and this is the plan sort of thing, you know? And, and, but, but anyway, so, so one thing, and I, I hate saying that. I hate sounding like I just throw this at everything, but if you're not on a PD five inhibitor, right?

So Viagra, Cialis, Levitra, Stendra,  you know, I, I strongly recommend you consider one, [00:20:00] even if you are,  Having stress induced erectile dysfunction or psychogenic erectile dysfunction. It will still treat that right. So there have been, actually there was a study I really loved, it was pretty simple in concept, but I think this is a really important thing for a lot of men to know,  that took.

Looked at men with presumptive psychogenic ed, meaning guys who don't have erectile dysfunction because their prostate was removed. They don't have severe diabetes. They don't know they didn't have an injury to their penis. Right. But they're having oftentimes like young, otherwise healthy. Right. And they took a bunch of those guys and they gave them sildenafil.

 and then told them, you know, when you feel ready, try tapering this off. Okay.  with the idea being that even if you don't have,  you know, an innate biological,   you know, cause in your, in your penis tissue to [00:21:00] have a diminished erection that this still can make it easier and therefore habituate you to positive sexual practices.

Right. Because nervousness, right. Literally just send stress hormones down to your penis. Right. So you've get that fight or flight. Hormone the fight or flight neurotransmitters, right. And th that signaling from your brain, and that literally turns erections on, okay, it's that fight or flight transmission.

And it goes through a penis and it turns erections off. So this just says, you know what the PD five inhibitors do is make that signal,  you know, harder to kill your erection. Right? So anyway, so they took those young, healthy guys. They gave them Viagra, told them to stop when they felt like they were ready to.

And I think after a year time,  most of the men not only were not taking it any more, but also had functionally sure. Direct how this function. So what it did was actually just broke the cycle of,  [00:22:00] nervousness and self fulfilling prophecies and negative thoughts surrounding sexual activity, because it just like, you know, allow them to get over that hump.

 and I think that's like so key and I'm not like, you know, I don't want to, I don't want to be. Pill pusher, whatever.  but it's just such an easy tool, you know, it's not addictive. It doesn't change,  your penis forever. You're not going to require it for long-term it doesn't. You know, it, it doesn't give you a spontaneous or erection such that if you weren't, you know, wanting to have sex, you're just gonna walk around with a boner.

So I, I'm just a huge fan should talk to your doctor, get a prescription for it.  you know, get it mailed to your house. I don't care. And then quarantine yourself and take that stuff. So that's what I think. Yeah, 

Tim Norton: that, that sounds like an awesome study. If, if you. To think of the year, the authors,  totally would love to check that out.

And I have heard that from other,  clients who've come in, especially [00:23:00] younger clients whose doctors literally told them, like, I want you to get a few wins here. I, you know, I want you to have some positive sexual experiences and these are guys who could masturbate fine. Who were, who were good. Like you described it, you know, have no sign of any physical injury or diabetes or anything like that.

 but the, the philosophy, I have a few good positive sexual experiences, but also with that. That,  message that, you know, we don't, if you're 23 and you're trying this, we're not saying take Viagra until you're 73.  yeah. And D can you speak, can you speak as to why, like, why we can't just do you know, or is there, is there a good information about, I mean, it's only been out 20 years, but do you know what happens?

Long-term with PD five inhibitors. 

Dr. Ashley Winter:  you know, there's been data on that and, [00:24:00]  you know, there's nothing convincingly detrimental. So, you know, there have been some reports where they've talked about a potential increased risk of melanoma.  you know, and I don't remember the exact methodologic issues with that, but it's not,  you know, there was.

That was not conclusive. And it's certainly,  there is no expectation,  that, that somebody who takes Viagra or Cialis has a high risk of skin cancer. So,  you know, that is not something to worry about.  Yeah. I mean, I mean, most of us, most of the consequences are associated, you know, sort of short-term side effects that are reversible,  once you stopped taking them, right?

Like headache, runny nose,  acid reflux,  and some people don't have those side effects.  so yeah. No, I, I [00:25:00] personally have not ever seen a patient with a long-term health adverse health effect from, from using those medications. Yes. Okay.  and you know, the thing also to remember is like this, these class of drugs are given to people at all ages.

So if you look, they were initially studied for,  Cardiovascular use. Right. And in young children, even babies who have,   what we call pulmonary hypertension, which means like high blood pressure and the blood vessels of their lungs, they'll give,  Viagra, you know, the generic version and at a modified dose, but they'll give that to.

Young children. So it's not like an adult drug, you know, it's a drug that leads to relaxation of the muscles in blood vessels. That's basically it. So if it's in your long, because you have high blood pressure in your lungs and that's lifesaving. That's what you use it for. And if it's [00:26:00] because you're nervous and that led your penis to tense up and your erection to go away, it helps you with that, you know?

And, and, and, you know, that's the fundamental takeaway. It's not a penis drug, it's not a sex drug. It's a muscle relaxation drug.  and. It works great for a lot of things. So, you know, I'm just a huge proponent. I mean, I've given it to teenagers to be quite Frank and I have no, absolutely no reservation about that whatsoever.

 you know, I mean, and it's not for everybody, but, but you know, if somebody, and this is with a lot of areas, you know, that kind of span the.  you know, kind of bio soap, psychosocial sphere, right? I mean, there are ways that cognitive processes and interpersonal processes and also medications can all, you know, lead towards an improvement.

Yeah. And you know, this is just one option, but you know, for some people it's a good option. Yeah. 

Tim Norton: So [00:27:00] I've heard. A bunch of different things about men's relationship to the drug. Like sometimes,  just knowing it's on the shelf or some guys will just carry it in their wallet or something like that. And just kind of having that reassurance sometimes can give them, you know, cause the anxiety starts.

Long before the sex, you know, guys will cancel dates if, you know, they're, they're too afraid that they're not going to be able to have penetrative sex. So there's a pretty elaborate relationship that can develop. And sometimes, you know, really just benefit just to have that, that safety option that then when things don't go the way they want them to.

Dr. Ashley Winter: No, I think that is huge. And. Like you're saying you don't even necessarily have to use it. It's just to [00:28:00] know that you have that option available if you want it. And I think that's a great thing for people and there you're right. There may even be a therapeutic value in having that thing sitting on your shelf.

Now, one of I also it's really great.  To know about a lot more flexibility than people realize they can have with these medications. So what do I mean by that?  you know, if you actually read a Viagra bottle would probably say, you know, take one hour before sexual activity. Right. And so the important thing to know is that it, it does take probably around an hour to reach,  you know, around its maximum efficacy, but it does stay in your body about eight hours.

So. So it doesn't have to be that you decide you're going to be sexually active and now you have to take that pill and wait an hour. Right? There's so many ways to do this. So I say to people, for example, if you're a morning sex guy, take it right before you go to bed. Okay. Because when you wake up in the morning, it's still [00:29:00] going to be in your system.

And I've had people that, that was. Life-changing for them. Right. So they were using it before and it wasn't working for them because they were a morning sex person and waking up in the morning and taking it and waiting an hour was not the right model for them. Right. And then they started just taking it every night before they went to bed.

And who knows, maybe they won't have sex in the morning, not a big deal. Right. Whatever. But at least then they have that as part of their routine and they know that they're ready.  and it's kind of in the system, right? So that's one option.  if you are, you know, the evening sex guy, right.  instead of taking it.

Like after dinner right before you plan to have sex, technically also for that, you supposed to have it on an empty stomach. Just take it like on your way home from work, right. It's active for eight hours. Okay. So,  you know, set an alarm on your phone, say like 5:00 PM, take your pill, right. Or whatever you want to put a coded message on your phone.

[00:30:00] And in case somebody sees your alarm, I don't know, but you know, that's going to last you the rest of the night. So you go to bed. So whatever, if you don't have sex, not worry, right. Or. If you have date night, you know, take it before you go on her date. It's going to be there all night. If you don't have sex, no big deal.

Right? So there are so many ways to play around with these things to make it work for you. And I think the problem is that people aren't really counseled on the fact that they can do that. Right. They just get a bottle with a label and it says, do it this way. And then there internal constructs around using it are, are.

Just what that label says. Right. And that's, that doesn't have to be that way. There's just so much more flexibility with this, you know, like think of it as your penis breath mint. I don't know, you know, take it when it works, you know, obviously there are certain limitations, right? Like you need to make sure that you don't take more than the limit that somebody should have in a day, because that can lead to an unsafe drop in their blood pressure.

If they take certain medications, they can't take it right. Nitrates,  you know, [00:31:00] and if they've had a. Bad reaction in the past, they should talk to their doctors, things like that, but there, but there is definitely flexibility.  so, you know, that's one thing.  and you know, then there are other variants, right?

Like the Cialis, which you can take every day.  and then it just reaches a steady state in her system all the time. And then you don't even worry about when you're planning around it at all. It's just there. And you know, I, for a lot of guys, you know, that's a. Really awesome. One just because their anxiety over deciding when to use it also contributes to everything.

So this just eliminates that entirely, you know? So, so there are, there are good options. And I think if you tried it once and you didn't have a good, you know, experience, then, you know, kind of circle back with your doctor or maybe ask, ask them some of these questions or ask for a different dosing or type or, you know, whatever.

Tim Norton: Yeah. Okay. Now, so wonderful advice for,  This, [00:32:00] this quarantine and chill. If you can get your hands on some Viagra, there's, there's plenty of,  online, generic sildenafil distributors there. W how do you feel about that whole business of get Roman and HIMS? And those are those, what do you think of that?

Dr. Ashley Winter: Yeah. I would say my initial gut reaction is not very positive, but I also have to acknowledge to myself that this is in part probably the way of the future and, you know, not,

yeah. Fighting. It is probably not necessarily the answer, but rather,  you know, understanding it and trying to kind of contextualize that with the regular,  No healthcare infrastructure,  you know, is probably how I should feel now. I, I haven't personally tried any of those programs, so I don't really know what it's like to be a patient on the inside.

[00:33:00]  you know, I think. It's a failing to some extent that anybody who has a regular doctor,  feels that they can't just ask their doctor for Viagra prescription. Right? I mean, 90% of the primary care doctors in America, I am sure have multiple patients on Viagra. Okay. Like I do not have any doubt in my mind, this stuff is so pervasive and probably the area where something like a hymns is going to be.

Really beneficial is maybe somebody who's younger who does have that anxiety induced, erectile dysfunction. Maybe doesn't have a primary care doctor. You know, they're 25. They don't really need to go in otherwise. And they feel nervous about making an appointment and sitting in the office anyway. Right.

 or recording team, for example, now, If you have a regular internist or a regular urologist that you're seeing for any reason, you know, now it would be a time to say, call their office and say, Hey, can you call in a Viagra [00:34:00] prescription for me? Right. Because that does not require an office appointment, right?

Like, I mean, your Dr. May decide that they want to see you before giving you that. But technically it does not require an office appointment. For the most part, right? I mean, if you had some problem with your blood pressure in the past and they wanted to recheck it fine, but most of my patients who like send me an email and say, Hey, can you give me Viagra?

I'm like, yes, of course. I'm happy to do that. Don't come in. So and so, so you know, the unfortunate thing that I see with something like a hymns is like, you know, That person has now linked you probably to some subscription program to get this medication that you probably could be able to get without being in like a subscription model, you know, where you have your insurance cover it.

And not [00:35:00] now most Viagra is not covered by insurance, but your doctor's appointment would be right. Or if you don't need to go to the doctor and they can just prescribe it for you, then that encounter. Doesn't cost you anything, right. You're just paying for the medication. Whereas something like a hymns probably is kind of putting you on a pathway.

I mean, I mean, they're making money off of it, right? Why, so why does that exist? Right. So anyway, I don't think it's bad. I think it serves as a role.  you know, it's just, you know, don't, don't be scared to talk to your regular healthcare provider about, about something simple, like.  Viagra prescription or a Cialis prescription, right?

Yeah. I mean, and the other thing I'll say is doctors when they have a hard time it's because they, with something generally it's because they don't know what to do. It's not because they don't care it's because they don't know what to do. So if a patient comes to them, like if a patient comes in my office and like tells me what their goals are or what they want, it's oftentimes very easy to satisfy them.

Right. [00:36:00] Like, if you tell me, if you just send me a message and say, I have erectile dysfunction, then I'm going to say you have to come into the office. Right. If you send me a message and say, I want Viagra, I'm like, okay. So, 

Tim Norton: yeah. Okay.  again, very. Very good messages. If you, you want to make a COVID baby, right?

That that's the theory is that nine months from now a lot of, a lot of, a lot of we're going to see a spike in birth because everybody's quarantined everybody's at home having. 

Dr. Ashley Winter: I think that's BS. I mean, I think right now with all the economic uncertainty, I think the last thing people want to do is have a kid.

And let's be honest that most adults in America know how to use birth control these days. So,  just because there's COVID-19 quarantine and people are going to have a lot more sex doesn't mean they're going to have a kid, right. And if you're like, Oh shit, I just got fired. And my 401k tanked, like, do you really want to have another kid?

If you weren't planning on it, 

Tim Norton: you didn't want to have sex at all. [00:37:00] You're 

Dr. Ashley Winter: right. Or you might be stressed out and just say, I want to eat this gallon of ice cream and watch curb your enthusiasm and face plant. Afterwards. So like, I don't know. So, but yeah, I'm not, I'm not buying the COVID baby thing. I'm not buying it.

Okay. 

Tim Norton: Well, makes me think about, you know, we, we talk about the real typical guy with erectile issues comes in once Viagra, but do you also see any other kind of. In situations where you, it, you have to utilize your sexual health doctor skills when, when erectile issues aren't necessarily at the, at the heart of it.

Dr. Ashley Winter: So in a sense, you're kind of asking me what are the most common sexual function concerns that men come to the doctor? Yeah.  so other than ed, I'd say the majority of complaints are pain complaints. So after I. [00:38:00] Ejaculate it hurts, right. Or when I have an erection, it hurts.  that is,  or, or when I, you know, have sex, my testicles hurt.

 or I feel a pain in my,  paraniem, which is, you know, colloquially is like your taint or your Grundle.  but, but you know, those are really common. And then. Obviously Peyronie's is a huge one. Although, you know, I I'd say maybe that could be on the spectrum of erection category, but of course, erectile dysfunction, classically is erectile rigidity.

Whereas, you know, Peyronie's would technically be the erection shape.  right. So the, and so that's where guys are coming in saying, Hey, you know, The classic story is, Hey, I woke up one day, six months ago and my penis was bent or my erection was bent and it has stayed that way. And now sex is hard and some guys have erectile [00:39:00] dysfunction because of that.

And other guys, you know,  had erectile dysfunction before and some guys have a very rigid erection, but it's like bent at a 45 degree angle. And because of that, they can't penetrate. Right. So those probably pain complaints,  And, and, and Peyronie's are probably the main, the main complaints and then,   low libido.

Yes.  although yeah, libido is PR is in that mix. And then I'd say with a much less frequency as people who say that, like they can't orgasm or they don't have pleasure with orgasm. Something like orgasmic anhedonia, which is like, I climax ejaculated, but it doesn't feel like what it's supposed to. And that's a much lower frequency.

And I would say those are kind of the main. Categories coming in. Okay. 

Tim Norton: Well, that's great because that's great. [00:40:00] That is great because,  there, there's going to be some libido killers going around right now. There's, there's a lot of, there's nothing like stress and uncertainty and anxiety about the future to, to make people it make it difficult for people to, to connect and to feel sexually vigorous.

So. Well, first of all, why is that? Why, wait, why, why does stress mess up our sex drive or does it always, sometimes people have sex because they're stressed and 

Dr. Ashley Winter: that is true. So there are a few different ways to think about this. I mean, there's one, if you are chronically stressed, then you, you increase,  basically your, your cortisone production and that's like a, a stress hormone in your body.

 and, and that can lead to changes,  that may affect, you know, negatively impacted or testosterone levels. It may make you fatigued. [00:41:00]  You know, it can lead to imbalances in your metabolism of sugar in your body.  you know, so, you know, there's a problem in that regard.  and then of course there's the,  you know, psychologic component in the sense that, you know, if you're having good sex requires focus, right.

So if you're thinking about the world imploding because of COVID-19,  That's not going to be a good sexual experience, right. Or not focused more like presence. Right. You have to be present, right. Like sex is something that requires presence. And,  a lot of us do not have our head in the game right now.

And, you know, again, you know, I'm certainly not a,  you know, therapist, but I would definitely say if you feel like. You are falling out of your ability to be interested in sex right now. [00:42:00] You know, see what activities you can do to focus, focus on. You know your presence, right? Like, like even some apps for meditation, for example, and see if that can give you opportunities to distance yourself from this broader picture, right?

Not that it's not important, but in your, you know, upfront cognitive space to, to separate that and allow you to live in the moment, you know, and, and when you go off and, and, you know, enjoy time with your partner or. You know, whoever it may be, that, that you can have that presence, you know? And I think that might be an interesting thing to explore and see how that affects your ability to, to engage in sex.

Sure. 

Tim Norton: And I bet you have a unique insight into the kinds of things that guys are struggling with. You know, like I'll meet. [00:43:00] Men outside of, of my work and just, you know, casually tell people what I do. And there's certainly a kind of guy who's never going to go to a therapist and who would only go to a doctor and, and vice versa, you know, book guys who I have to kind of force to, to see,  a doctor at least once over the course of our treatment, but who really don't like that experience.

And I'm kind of wondering, like, what are some of the things that, that guys tell you that, that you. I would probably guess that they wouldn't tell their girlfriends or their boyfriends in gay relationships that, that, or what are they struggled to talk about or what's, what are the difficult things for them to just, you know, even open up to you about that, that bring them in that, that all the girlfriends and boyfriends out there should just know that is kind of, that they can listen.

They can hear it on this podcast, even though their partners are just never going to say it to them. 

Dr. Ashley Winter: Well, there is the notorious. Thing [00:44:00] of the partner's thinking that it's them or the partner thinking that, that the guy with EDD is not interested, basically thinking of that, it's a, it's a desire thing or that it's a fundamental dysfunction with the relationship.

Right. And in the people with the psychogenic one, right. Sometimes that is literally just like Palm sweating type, basic body reaction, even though it's, you know, Related to a cognitive process. It's like a reflex that that guy doesn't want. Right. He's like stop sweating. I am nervous. Right? It's like, you don't want to have the sweaty palms.

You don't want your erection to go away. It's just happening. Right. It's not, you probably you're actually my diet more because you like the girl that much. Right? Like you're so into them that your erection that goes away. So it's not a problem with them even though it's psychogenic right. And then on the other end of the spectr you have the people [00:45:00] who like have had really severe type one diabetes or.

Whatever direct biological problem. Right. And those people it's, it's just not about that. Their partner, it's not about their relationship. It's about nothing other than the, the cellular level. Right. And, or, or I've had guys, I mean, I had a guy, you know, I hear this so often had a prostatectomy erectile dysfunction.

After that wife thought it was. Something wrong with the relationship left them. I mean, it's like, it's heartbreaking. It was so heartbreaking. And it's like, you know, this is a challenge in the relationship. It does not define the relationship. Right. And I think,  time and time again, I see men terrified that it is defining the relationship instead of being something that they work with their partner on.

 [00:46:00] And so that is probably number one. And obviously there are people with erectile dysfunction because they are having a relationship problem. But, but usually when they're coming to me, it's not like I hate my wife. It's like I have ed. My wife thinks it's her. And I'm like, no, I'm like, no, no, no, that's bad.

And, and it's crazy with all the information we have out there today that that still is such a pervasive, pervasive feeling. And I think it's that even when people know better, even if his wife knew that erectile dysfunction was a co a very common side effect of. Of prostate surgery. There's still the insecurity we all have.

And seeing that physical reality in a moment of intimacy of the erectile dysfunction is something that people just in their gut interpret on this personal level. And I wish, you know, that, that there were concrete ways for people to not, I have that happen, you know?  and that's why [00:47:00] I think, you know, upfront treatment of ed is just, can be so helpful for so many reasons.

If. To just not create that wedge, you know?  so that's a huge one. I mean, people were just like, their lives were destroyed by it, you know? And it's, it's terrible. 

Tim Norton: It will be a really good distinction too, is if I find it tricky when there are guys who, that they're a court. Really want out of the relationship or they don't, you know, they they've had something, not out of the relationship, but they've had something that's been bothering them about the relationship for a really long time.

And yet they still get erections and that's that's who comes in to see me is that there'll be in that situation. They still got erections. And then the erections gradually go away. Once they've upped their doses too many times. And eventually they, they grow up,  tolerance or whatever to the Viagra.  those are, those are really tough.

 Right. Cause they're, they're acting they're, their penises are not acting in accordance with their hearts, [00:48:00]  with, with their deeper heart. But the sweaty pump thing is different. Like if you breathe it out, well, you tell us like the sweaty pump thing doesn't last for days, right? It's it's a pretty quick,  autonomic nervous system response.

Yeah. Like killing erection. Like that's a great analogy. 

Dr. Ashley Winter: Yeah. Yeah. Yeah. Yeah. It's like, it's, I mean, it's performance anxiety. It's just penis performance, anxiety. That's what, you know, that type of psychogenic ed, which is very common in very young, healthy men is, is sexual performance anxiety. That's basically it, you know, it's not, I don't like you, you know, it's like, I remember when I was in high school, you know, I really wanted, I really wanted to be in the school play.

I really wanted to. And when I would get up there, I like would freak out and like, I have to run off the stage, you know, like I was terrified of public speaking and I wanted it so much. Right. And I know that there are all these people, you know, who are in that age group. Right. They like wanna have sex so [00:49:00] much.

And it's like, They're just scared and their brains as I want it. And their body's like, no, and that's all, you know, it is that. And, and I've had these guys, young men come in and they are devastated and they think they have a fundamental flaw and I like explained to them what's going on. And they were like, just relieved to understand, you know, and this is especially, I mean, when you think of, you know, there's discussions about sex ed and.

 you know, how that's changing in modern times. And I think, you know, there's been really revolutionary discussions regarding, you know, sexual orientation and sexual partner preference and sexual gender identity. But I wonder, and I don't know, but I wonder to what extent, you know, curriculums for younger people.

Deal with sexual dysfunctions, right? Like is the teenage, you know, is the new California high school, public sex ed curriculum saying, you know, [00:50:00] Explaining gender non-con gruel, but are they also saying, Hey, you know, young women, if you have pain with sex, that's not normal, you can ask for help, right. Or to young men, Hey, you may have difficulty with your erection that happens.

Sometimes you can ask for help. You know, like, I don't know if that's incorporated into that, you know? And, and so we're really re. Thinking broadly about redefining sex education, but I don't think sexual dysfunction is included in that. And maybe I'm wrong. I don't know if you know more than I do, but I don't remember learning about any of that when 

Tim Norton: I was no, definitely not when I was younger either.

 but I, I still generally hear negative stuff on the, on the sex education front. I think it, I don't know if it'll change in time. But like, it might, as kids might, are you going to find their way to podcasts? Because if you're going to find their way to fault masterclasses and things like that. And,  it would probably take, you know what, I think I'm a part or I'm in the neighborhood where they would be a Los [00:51:00] Angeles unified school district.

And it's massive. And to change. Yeah. Things like a sex education curricul I feel like would take them years. And so I don't know. I I'm, I'm pretty skeptical that, that we see that.  but who knows?   I'm certainly,  not, not up to date on that and maybe that'd be good person to have on the podcast, but I really do like hearing you talk about like the validating that partner, you know, and.

Them hearing like, okay. It's, it's just like a performance society. It's it's like Palm sweating. It's not them.  these guys who feel like they are fundamentally flawed, it's, it's good for, for the partner to hear, Hey, he feels deeply inside that he's fundamentally flawed. Like this is terrifying him. He doesn't bring it up with you.

He might have a, a secret Viagara prescription that, you know, You know, w w what do you tell those guys, like, [00:52:00] do you, do you say, you know, you might want to talk to them about it, or you try to normalize it, or does that not usually come up? Like, 

Dr. Ashley Winter: I definitely normalize it. I mean, and I will say, you know, definitely the amount of time I have with patients is, is somewhat limited.

You know, oftentimes this is an appointment where we're going to be like in the room for 10 minutes,  and you know, 15 minutes, whatever, but,  You know, one of the things that I incorporate as part of my strategy, and I know this sounds like a non strategy, but just to be so matter of fact with people.

Okay. So instead of saying like,  No guy comes in for ed, you know, instead of starting off, like, how do you feel about that? You know, and I see that oftentimes there's this initial barrier, cause they're like, you're a young woman like you, how do you understand my problem? You know, and this is going to be awkward.

And instead I'm just like, okay, Yeah. How long has this been going on for what have you tried? How often are you able to penetrate? Does it hurt? Are you [00:53:00] able to orgasm and like, you know, just the things like then when I understand that you can orgasm and ejaculate, even if you don't have an erection, if you stimulate yourself, right?

Like, like just going through that and suddenly their mouth has opened and they're talking about their body with someone. For those guys who are not the therapist, guys who don't want to talk about their feelings and somebody is getting it, what they're, what's happening to their body, because they're asking those questions that feel like I understand the process, right.

And that opens up the dialogue and then suddenly they're talking and it doesn't have to be about, you know, like, Deeper sayings or judgements. And those deeper things are critical for some people, but some people have to like leave that off the table, you know, and time and time again, you know, we kind of delve into these things, go over, you know, the basics.

 of what's been happening to their body and I've had guys like that [00:54:00] say to me at the end of you know, 15 minutes, Oh my God, it was so much easier to talk to you than I thought it was going to be. You know, and we talked about their body, what they've been going through, what they've tried and a care plan.

And they're just happy that it got out in the open, you know? And, and so that seems like a non strategy, but that's actually one of my strategies. And for certain guys, you could tell who they are. That is. Really great. Like they don't want to have to explain themselves in a, in a way, you know, from an emotional standpoint, you know, and, and, and so some people, that's what you have to do.

 and that's okay.  and, and even people who are very emotionally intelligent, you know,  or not that people like that aren't emotionally intelligent, but you know, people who are, let's say emotionally,  more emotionally sharing,  you know, express sometimes that's the right thing. Yeah, yeah, yeah.  and then, you know, another thing I'll say another tool I employ is that for followup [00:55:00] appointments, I can't always control if somebody comes with their partner to their first appointment, but for follow-up appointments,  I strongly, strongly, strongly, strongly encourage their partner to call I'm like you.

Like, like for certain people, I tell them they have like, this is a not starter.  and that's not, and I don't do therapy, but it's again, because me sitting in that room, having a matter of fact conversation with them about this problem is just normal. Right. And that has to happen.  and so even if they sit in the room and say, Oh, I catch all those, you know, like, They need to be in the room, you know, and that's huge and they have to cop.

So,  the times that I really, really stress it are when guys come back in the office and they're learning to do the self-injections right? So some people use,  you know, [00:56:00] inter Coverdale cell injections medication that they stick in the side of their penis with a small needle, like insulin,  to produce an erection, usually done.

When, you know, pills are no longer enough. And I go over all the teaching about that. And I really, really, really want the partner to be there for a few reasons. One,  you know, some people are squeamish and even though they do okay with the needle and the doctor's office, when they go home, they're like, Oh, I don't know why.

So if you have two people, then you guys can conquer that technical challenge together. Right. Number two, again, if you're scared to come home from the office and be like, Hey honey, I got these Dick shots. Like. That seems crazy. You're not going to use it. Right. But if both of you are like super excited that you're gonna have this rock hard erection now, and you can do it together.

It's like this sexy home project and you both understand what it's about. Right. So that's gonna mean a critical difference. In the success of that treatment. Right. I know if you take enough of that shot, [00:57:00] you'll have a boner fine. Right. But if you're afraid to use it, you know that you're not gonna, it's not gonna mean anything.

  and then, and then, you know, on a more technical standpoint, there are some people because of their waistline who cannot see their own penis and then their partner has to do it. I just mandate that because you know, it's technically an intravenous drug.  and if you can't see your own penis and you're just like poking around.

 then you can end up injecting yourself in a non-hygienic and dangerous fashion. And I have seen people do this.  so. You know, that's, that's just,  something that I'd like, could you see your own penis? And if you can't, you gotta bring your partner to the office to stick a needle in your penis. 

Tim Norton: I'm so, so happy to hear you say all of that, you know, that you're trying to incorporate the, the partner and, and get everybody on the same page and normalize it and do it in a really great and sex positive way.

It got me. Kind of [00:58:00] fantasizing. Hopefully there, there are some really huge Hollywood producers listening to this right now. I'd love to see it on a TV show where a couple on like,  easy. Do you ever watch that show or something? Really? A show with a ton of sex. We're a couple just sat down and did that and then made it fun.

And, you know, I don't see this issue really addressed very much considering how you Pequot as it is.  I I've actually recently started,  watching sex in the city just for like, Cultural curiosity. I doubt you skipped it at the time. And it comes up throughout like the whole fourth season or something like that.

And it's handled in this really very sex, negative shaming way and all that jokes and all the things. And, and that's usually all we hear is some impotence joke or, you know, some analogy to some thing that's, that's not working. So that would be great. 

[00:59:00] Dr. Ashley Winter: No, that is a great point. So I remember recently,  you know, I was, I was at the sexual medicine society of North America conference last fall, and they were talking, you know, in one of the meetings about policy and the fact that Medicare might stop covering penile prosthesis.

And if it does,  the manufacturers won't have enough people to make it worthwhile to produce the device. And it will. Cease to be available even in a caspase circumstance. Right. Which is just a devastating thought. Now, I don't know that this is going to happen. We were just saying that without the advocacy of urologists, we Teeter on the brink of them taking away that benefit.

Right. It happened that we're on the brink of that happening and they, they pull back from it. But not too far. Now I stand up and said, No, everybody, probably everybody knows. [01:00:00]  I don't know what percentage of America, but probably a huge percentage of America knows that, you know, Angelina Jolie had a prophylactic mastectomy,  because of her BRCA gene and that she's had breast implants.

Right. And she is not afraid of that and she's not ashamed of it. And she is advocating for it. And since the. 1990s, I think for breast reconstruction purposes, breast implants are not allowed to not be covered by insurances, right. Medicare and also commercial insurances. Right? This is a right. That is encoded in our federal law for people surviving breast cancer, right.

And for prostate cancer survivors,  Penile prosthesis, which sometimes is, you know, in rare circumstances, but sometimes it's the only way to achieve potency after prostatectomy. There is no protection whatsoever. Right. [01:01:00] And, and the difference is,  advocacy, not from, from urologists. Like nobody really cares about your apologists, you know, but from people, people who have,  Sway, right?

Like the Angelina Jolie's of men. Like there are people out there who are that,  popular and well-known and formidable who have. Been given treatments for ed and they don't talk about it because it's so stigmatized still. Right? Yeah. And people want to say, Oh, well, it's so different. It's like your breast.

And it, you know, it's a penis. And it's like, why is it that difference? Especially if you're a prostate cancer survivor. If this is about your cancer survivorship, you should be an advocate for men going through the same thing. And, you know, This is a right for you to survive your cancer and have restoration from that.

And, and the advocacy at the level that you [01:02:00] see it for other healthcare conditions is not there. And until you start seeing it right on television, until you start on television, until we start seeing celebrities talking about surviving it, you know, Until we de-stigmatize it we're we're not going to catch up and it's, it's incredible.

The disparity.  

Tim Norton: are you okay if, if I put applause over on overdub, like over, I'm really happy that you're saying these things. Yeah, no, that's really good points.  let's, let's make sure. The next time, there's a lobbying effort for that. We'll just we'll get in there and move. We gotta make that happen.

Cause that, that that's,  that's mind blowing that, that, that was said at that conference, because what I've heard from, I don't know, I've talked to a handful of different doctors about it is it's like they can't think of a surgery with a higher satisfaction rate. Like it's, it's a major [01:03:00] game changer.

Yeah. 

Dr. Ashley Winter: Right. And it's not cosmetic, it's, it's functional and it's restorative. And,  you know, it's just, it's just, you know, I mean, it's just incredible to me that, that there's still so much like shame and,  you know, silence and lack of advocacy and lack of. You know, protection for, for these treatments in our laws,  as well.

And you know, somebody also brought up after me.  and I don't know the specific one, but, but if you look in, you know, parts of the country with a much higher,  you know,  Hispanic population,  like Miami, there's a much higher rate of penile prostheses. And there was this very famous,  like,  and I, I forgot what country is from Latin America, but, but very famous, like actor there or something who basically went on the record.

It was like, I have a penile implant and it's great. And I'm like sexier because I have it. And I have [01:04:00] lots of grid sacks and I'm sexy. And I have this peanut and plant and it kind of changed the cultural narrative around that. Right. And so that specific population. Far less stigma, far higher rate of people getting treatments that they need.

Right. And that's the watershed moment that needs to happen, you know, in like North American English speaking populations that has not happened yet. And yeah. So, yeah. 

Tim Norton: Okay. So we've, we've got to get that actor on both of our podcasts. We've got gotta, we've got to make this happen. You get that. That's huge that,  I'm going to find out who that is.

That's, that's really cool.  and, and not 

Dr. Ashley Winter: to look at it and not, and again, not to look at it like, Oh, I'm less of a man because I have this penile prosthesis in. But to say, like, I survived prostate cancer and I'm having so much great sex right now because I have this penile implant in and that is fucking sexy, right?

Like, yeah. That's that's [01:05:00] what you say, not the other 

Tim Norton: thing. Absolutely.  that swagger, that confidence and he's proud of it. I'm sure that will clearly made a very big difference.  at least in that community, you know, we've been talking for a little over an hour and I feel like we barely scratched the surface.

I feel like I could ask you a thousand more questions.  but I want to be respectful of your time and, and your. You know, and, and just, you know, that you're taking care of yourself during this, like, because you still have to report to the office every day. Is that, or how has that 

Dr. Ashley Winter: yeah. Yeah, no, I have to go in tomorrow.

 cause I have to do some emergency procedures, so, okay. 

Tim Norton: We're not, I heard a political correction that it's not social distancing. It's physical distancing, because we want to stay social. We want to. Talk on, on Skype and zoom and on FaceTime. And we [01:06:00] want, you know, it's really important to connect to people while you're isolated in your homes.

And to feel like you're not going through this arm, I get in alone. And, and, and to do that, but, but it is important to keep physical distancing. And it sounds like you're. You're even able to do that by minimizing the kinds of client patients that come through the doors and you guys are probably being as careful as possible and in the hospital setting to keep physical distance and cleanliness and all that.

Any, any tips that I don't know, I, I feel like we've heard of a thousand times, 

Dr. Ashley Winter: but no. I mean, I think the things that people, people have been saying, you know, wash your hands, 20 seconds, soap and water.  you know, you don't. If you have his hand in his hand sanitizer, that's great. If you don't wash your hands and you know, if you're outside touching things before you wash your hands, you know, don't touch your face.

 You know, I, and this is something I, I proposed on Twitter.  but I would say if you, you know, you don't have access [01:07:00] to a mask which most people don't, and you probably shouldn't start tracking down and buying up masks because we need them in hospitals. But,  if you have difficulty not touching your face, consider even, you know, making some sort of mask that won't necessarily be protective from viruses or droplets, but something that reminds you to not touch your face.

Right. So like I, when I wear a mask in the hospital, I don't touch my face. Right. And so I have very, I have a lot of difficulty, normally not touching my face though. So, you know, there are different strategies, like just think of the things that you, the tools that you can do to, to create the habits you need to have right now, if you're fine not touching your face anyway, then, then that's great.

But,  you know, Or, I don't know if you're somewhere where it's colder and you want to, I don't know where some club and right on your glove touch your face. So when you look down at your hand, it's so much, I don't know, but you know, just make it easier on yourself because this idea just don't touch your face.

Like yeah. [01:08:00] We keep hearing this messaging, Oh, humans touch their face three times every second or something. And then everyone's like, don't touch your face. And it's like, okay, well you just told me that all humans touch their face all the time and then not to touch my face. So what, what are you telling me to do to make that actually happen?

Like, yeah, like that's ridiculous. So, so think of creative ways to, to make those. Things happen of, obviously this is when you need to go outside. If you're at home, Hey, you 

Tim Norton: just, she just scratched her nose for the record. I saw it, but you're at home. And so it's okay. 

Dr. Ashley Winter: Yeah, but it's at home. Why do I hope it's okay.

Touch her face.  you know, and,  yeah, and, and then I think exercise,  is important because that's, you know, something that we're all probably doing less,  I wouldn't recommend going to the gym because. You're going to be touching a lot of things that other people touched and sweating and that's bad.

Hopefully.  you know, I do think though, going outside, [01:09:00] going for a run or walk, you know, is, is a good thing. If your, where you're living is allowing that. I mean, it sounds like the like San Francisco Bay area is so shut down now. You're not really supposed to go outside. Like at all, which is really intense.

But if your jurisdiction is allowing it, I would definitely tell you to go outside, take a walk, take a run, just don't get close to anybody. Right. Right. Yeah. I mean, it's not floating around in the general atmosphere. Right. You have to be near somebody else to get it. So,  I, I guess those are my main points.

Okay. 

Tim Norton: No, those are, those are very good points, much appreciated. Thank you. Thank you so much for the work you do. Thank you for your time. 

Dr. Ashley Winter: Yeah. And th thank you for the work you do, and for having this important topic on a podcast, because like you said, people need resources to get the help they need. So 

Tim Norton: absolutely.

Where can people find you on the internet? 

Dr. Ashley Winter: Oh, yeah. Thank you.  my Twitter is at Ashley G winter. [01:10:00] So A S H L E Y G as in grape and then winter, like the season.  that's also my Instagram, although my Instagram is not very content oriented. It's more like, hi, I got new glasses. Here's a photo of me of that.

And  I also have a podcast with my fiance who is a. Comedian, and that is called the full release. And you can find that, you know, wherever you get your podcasts, Stitcher, iTunes, Google podcasts,  our Instagram is at, Oh, what is it? The full release pod. And on Twitter, it. At full release pod because we can't have as long of a name, but yeah.

Check us out. And we would love to, for people to listen and participate and give us feedback. And also it's a call in podcast. So if you have questions about anything at all, leave us a voicemail.  we have a number [01:11:00] it's,  (213) 631-3460.  or we have an email,  which is the full release pod@gmail.com.

I'm sorry. That's way more info that you want. 

Tim Norton: Yeah. And I'll,  I'll also type it in the,  the show notes in case,  we left anything out. You can just send me all that and I'll put it up and thank you again. 

Dr. Ashley Winter: All right. That's great. Thank you.