Erections in the Age of Porn, Social Media, and Performance Pressure with Dr Chris Donaghue PhD, LCSW, CST, ACS

A thoughtful exploration of erectile function, arousal, intimacy, and the deeper patterns that shape sexual wellbeing.

About the Episode

In this episode, Tim speaks with Dr Chris Donaghue, therapist, educator, author, and host of Loveline, in a wide ranging conversation about erections, body image, sexual honesty, and the pressures shaping modern intimate life. Together, they explore how porn, social media, hookup culture, shame, and performance anxiety can affect arousal, pleasure, and connection. The original episode summary also notes their discussion of alternatives to an erect penis during sex, body positivity, and the importance of prioritising pleasure over rigid sexual scripts.

Key Themes

Body positivity and sexuality

Sexual honesty in online hookups

Alternatives to an erect penis during sex

Shame, pleasure, and performance pressure

How porn and social media shape sexual expectations

The ways culture enters the bedroom

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The Guest

Dr Chris Donaghue is a therapist, educator, author, and media host whose work focuses on sex, relationships, authenticity, and sexual culture. He is the author of Rebel Love and Sex Outside the Lines, and he hosted Loveline with Dr. Chris. Apple Podcasts describes him as a sex and body positive psychotherapist and author, and lists Loveline with Dr. Chris as an Audacy podcast active from 2016 to 2022.

Website: Dr Chris Donaghue 

Books:

Rebel Love on Bookshop.org

Sex Outside the Lines on Bookshop.org

Podcast:

Loveline with Dr. Chris on Apple Podcasts

If This Episode Resonated

If this episode spoke to you, there is a path forward.

Tim Norton provides a discreet, evidence-based therapeutic space where men and couples can understand the deeper systems behind desire, arousal, and connection. His work combines rigorous neuroscience with a grounded, relational approach to help clients rebuild aliveness in their bodies, strengthen partnership, and create lasting change.

How to Improve Erections with a Sex Expert and Erotic Bodyworker |

About the Episode

Erectile difficulties are not just about blood flow. In this conversation, sex therapist Tim Norton speaks with somatic sexologist and erotic bodyworker Dr Joseph Kramer about how erotic embodiment, conscious masturbation, and healthy porn use can improve erections and deepen pleasure. They discuss practical ways to work with breath, movement, and attention so that arousal feels more alive, less mechanical, and more connected to your whole body.

Key Themes

• How to masturbate in ways that reconnect you with your body, penis, and breath

• What somatic sex education and sexological bodywork actually are

• How Sacred Intimacy and The Body Electric approach erotic touch and healing

• Why state-dependent learning matters for erections and arousal

• How porn can shape arousal patterns, and what “healthy porn watching” looks like

• Why so many of us feel disembodied and how to come back into your body

• New masturbation practices and erotic meditation ideas to explore on your own

• How erotic bodywork can support men with erectile difficulties and performance anxiety

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Dr Joseph Kramer, PhD

Dr Joseph Kramer, PhD (Emeritus) is a pioneering somatic sexologist, erotic educator, and filmmaker who has taught erotic embodiment and pleasure activism for more than forty years. He founded The Body Electric School in 1984, where he created influential courses such as Celebrating the Body Erotic and The Dear Love of Comrades. Joseph went on to establish two erotic somatic professions, Sexological Bodywork and Sacred Intimacy, and developed trainings worldwide. His work has helped thousands of people use touch, breath, and movement to heal sexual wounds and reclaim pleasure.

Websites

Erotic Massage: EroticMassage.com

Porn Yoga: PornYoga.com

Sexological Bodywork: SexologicalBodywork.com

Episode Transcript

[00:00:00] Tim Norton: Hello, and welcome to hard conversations. We're really excited for my next guest. Joseph Kramer PhD is an American somatic sexologist, erotic educator and filmmaker. He has been teaching about erotic embodiment, somatic sex, education, and pleasure activism for over 40 years. In 1984, he founded the body electric school where he choreographed many of the schools courses such as celebrating the body erotic and the dear love of comrades over the course of his career.

Joseph has also invited individuals committed to erotic liberation into communities of service. He is the founder of two erotic somatic professions. Sexological bodywork and sacred intimacy. And he's developed worldwide trainings for these professions. He is a true pioneer in the field of erotic touch and hailing.

Welcome to hard conversations, Joseph. 

Joseph Kramer: Hello. Thank you. Glad to be here. 

[00:01:00] Tim Norton: Likewise. So as I had mentioned in your bio that I had read just before this, you've been training professional massage therapists, erotic Bodyworkers and somatic educators since 1984. 

Joseph Kramer: Yes. Yes. I didn't start out with that in mind. I, uh, I ran a massage school.

And I was very happy teaching the stodge totally separate from sex and erotic massage. So a California certified massage therapist and in Oakland, right across from San Francisco and AIDS yet in the early eighties, there was huge amounts of fear and there was, um, Especially in the area of sex. And one thing that I knew right away was touch was not a way this was communicated, unlike the epidemic we're now dealing with right now in the world.

And [00:02:00] so I saw, I thought, I know massage. I think I should start teaching erotic massage as a safe sex type. Behavior for men and bisexual men, especially in gay men. And I started that and it ballooned, it became a huge thing in the middle of this, uh, constriction. Uh, erotic constriction of AIDS. And I was invited to teach classes in erotic massage around the United States and around the world.

And, um, very soon I'd saw that something more than safe sex was happening that are robotic massage was a place where men were learning about their bodies and their router system in a different way, being on a table and being quiet. And then being aroused where they didn't have to do anything, someone else was kind of [00:03:00] offering this arousal.

And I, the word I didn't have at the time, but since have, is they're learning erotic self regulation, learning how to be with arrows in their body and to play with it. So that was, that came out of a massage in the early eighties, chess. And then I wanted to train other people to do this. I didn't want to be the only one doing it.

So my school started upper body electric was the name of the school and body electric, uh, doing these trainings around the world. I saw we did it people to be of service in offering classes like I was. And so I try to find a profession. And I named it sacred intimacy. I saw, I pulled out the name sacred, intimate, and I even saw on your list, Tim, you you've interviewed a sacred, intimate, um, and what's sacred intimates [00:04:00] for me where we're somebody who was there for someone's highest good that included touch and arousal, something psychotherapist and other folks.

Can't. Uh, and so I trained sacred intimates and sacred intimates turned into, but there's still illegal. Touching. Genitals was still illegal in the United States, no matter how high the intention was. And so I really worked on this in 2003. I got the state department of. Of a host post-secondary education too.

Okay. A training called sexological bodywork. That was that involved touching genitals as an education that people were learning. Again, erotic self-regulation they're learning about their body. So in California, this became legal, or it became legal for people who are trained by a [00:05:00] school that they approved.

Right. 

Tim Norton: And that, that sounds, I feel like we could spend an hour talking about that lobbying effort. Sounds amazing. Yeah. Even, especially back then. And we're, you know, we're in a slightly more sex positive times these days, but I can't even imagine trying to get something like that approved. 

Joseph Kramer: The head of the school in San Francisco, the graduate school said this will never be approved.

What kinds of people? And I sat with another writer and we wrote this, not for the public, not for, we wrote it for a bureaucrat sitting in an office who approves your not approves. And we wrote this up at word for word. And, you know, I'll, I'll tell you one of the thing that I think tipped it. This is the end I wrote, because this was 2003.

I said, 20 million people worldwide have died of HIV. 30 [00:06:00] million people, according to a world health organization are now infected with this disease. This is mostly sexually transmitted. We need new ways to educate people. We need to try everything to stop this. This is w this is part of the intention of this profession, and I hope if nothing else got through that, yes, let's do this.

Tim Norton: Hmm. Okay, well, good for you. Um, that's, that's really awesome work that you've you've started doing and that you've been doing now for a very long time. So let's, let's touch on that a little. Um, again, we could spend a whole hour saying, you know, what does a sexological body worker do? Um, but I do want to get into the content of being, working with erections.

Um, But I think the average person doesn't know what a sexological bodywork. Right. And is that how you would refer to the, the crux of what you do or is it, 

Joseph Kramer: um, [00:07:00] so I'm not sure if it's, I don't know how limiting, um, how it riff, how I refer to myself or. I would say I'm a sex educator through the body that I worked through the body of somatic sex educator.

And by that, I mean that my intention is that the body, uh, learn and function at its highest possibility. Um, and the, you know, recently, not very long ago, maybe 10 years ago, I first heard of state dependent learning and this idea that when you learn something, the state that your body's in is the optimum state for that learning.

And it's, it was on college campuses, kids joked about this. Cause they thought I was, when I studied for the test, I was stoned. [00:08:00] So I had to get, I had to get stoned for the actual test. Right. But I think it's operative here and that is if sex education, sex addicts. At the core is about erections and certainly many other things, but our erection is central.

So the learning has to be in the state of erection. So I think, so I find this is the, the real importance of erections is just, it's a learning state. And how do people get to this learning state? Well, probably the major place is not sex with a partner. Now the major place is watching porn for a minute.

This is the major behavior where men are in where men have erections for. Considerable amounts of time. Ah, what an ideal situation to learn something about or [00:09:00] reactions this is and to play with it, use that state. So that's, um, that's kind of how I got involved with this and I teach this in sexological bodywork.

There's 200 seconds. 2006, logical Bodyworkers worldwide have been educated and there's six schools. Um, and not everyone does the work that I do. There's women who work only with women. There's a trans there's all kinds of different folks who have specialties, just like psychotherapy. Um, but, uh, and some of them look at, uh, porn.

Yeah, in a very negative, scary way and stay away from it. People who have taught, they just don't want to even deal with it. If people come in and talk to them about porn, they stay away from it. Uh, but I think for the most part, they have an approach where there's something that can be learned here. [00:10:00] Let's see what let's, let's explore this with their classes or individuals.

So, uh, I dunno if. So that's how I would define. That's the work I do is to go where the arousal is. And that's what I like. I'm glad to be interviewed by. Yeah, no. 

Tim Norton: Great, great. And, um, that's what you're definitely doing these days and, and I, it sounds like that's evolved over time. Um, Uh, of course as a, as every career does.

Um, but just in general, before we get into, uh, you know, obviously we're going to talk about porn and erections and all of that, but in a typical sexological bodywork session, what happens? Um, everybody, I think that the first question is, are you having sex with your, with your patients? 

Joseph Kramer: Um, so sexological body workers.

Again, this is. And approved profession. And one of the people who helped me craft this and get it [00:11:00] through was Jack. And I don't know if you've ever met him, knew him, 

Tim Norton: never met him, but he was, 

Joseph Kramer: he was, he was my supervisor also in my doctoral studies. Um, but anyway, what sexological body workers. Do is, it's the idea that the body is an important place and, and that there is actually an epidemic of disembodiment in the world.

And what I mean by that is our attention is pulled everywhere, but right here on our own body. So we have in fact, People talk openly about being an attention merchant. They pay money to grab your attention. Not only that we give it away freely on the internet to television, to a million sources. And so we're forgetting our own body.

Um, for me, this [00:12:00] is an entirely horrible situation. Our body is the place where our health is our bodies, where pleasure. When we feel pleasure. If our attention is somewhere else, we're feeling less pleasure. We make decisions on information in our body health decisions. Our body tells us what's good. First of all, it doesn't.

So if our attention is elsewhere missing out on all this, so sexological bodywork. Is a profession. Number one, to help people to bring awareness to their body. I'd say that's the foundation. And secondly, when there's some of that bringing awareness is through practices and there's myriad practices, but we are a profession based on practice, meaning.

Um, depending upon what somebody's the situation, it might be. Let's do some breathing together and pay attention to your breathing, or it might be movement, or it might be, um, uh, running it might who knows what the practice is. There's 10,000 depends, but it's decided [00:13:00] with the client what's, what's, what's going to be the best benefit for you to be in your body and feel your body.

And. Um, and often when people do a practice, there's an opening, something happens. And I like this, I like this. Um, some people call it an epiphany, but regularly when people practice things happen and as you know, then things close have to the practice it closes down. So the idea is how can we keep this.

Opening this new thing going. So it's continuing practice and coaching and working with the sucks logical bodyworker so far nothing I said need even involve touch. People can work, uh, through, uh, through the internet with this. And, but people practice in order. Too, unlike Buddhism or other spiritual practices, [00:14:00] as they say, the, the reason for practices, the practice it's theirs.

You're not doing it for health or for, well, we are doing it for that opening for learning, for growth, for whatever we're we're sex educators. We want to help people to feel their body more. And so. We and we shift the practice and add more practices and help people with resistance to practices. Um, And the practices can be in a variety of areas.

If they're with a partner, we can have a partner come in and we do exercises with partners. I personally like a type of work where people videotape themselves solo sex. I don't work much with, I don't work much with couples. I have to say, but people videotape themselves doing masturbating. And sent it to me.

They put it into my Dropbox. I can look at it. And that right before when we have a coaching session, I've just seen how much they move, [00:15:00] how much they're enjoying it, how much they're breathing, where their intention attention is. And we can talk about this and they say, okay, I'm going to try this and go off.

And they could send me another session or two sessions. So that's the type of work. One way of sexological bodywork works and not what I used to do though. And what a lot of sexological body workers do is to use erotic and such. So someone comes in and they really don't have a sense of their arousal.

They don't, um, They have a sense of looking for someone to turn them on or some situation that turns them on, but here's a situation that people don't normally fantasize where they're on a massage table. Someone who's a professional does give them a massage because getting rid of stress is key in all forms of sex.

I find. We have sex in stress, out of [00:16:00] stress. This is horrible. So in these situations, maybe there might be a 45 minutes of relaxing massage, and then there's a touching of the generals to arouse and guiding that person. And that person guides the touch, but that arousal, the goal of the arousal is a prolonged arousal, a sustained arousal, and we call it active receiving where the person receives this arousal and they're encouraged to play with their breath a little bit, and we might guide them in breathing.

They're encouraged to shape their laying on a massage table and they're aroused. And by the way, we're talking about men here, but it can be male and female. It is males, men, and women. Um, we, we encourage them to move to shake. There are certain movements, especially the work, the spine or the pelvic floor, um, that bring.

The fielding South to the extremities, to the toes and fingers. [00:17:00] So I call it a erotic massage dancing because the person's on the table and they're aroused, but they're playing with that arousal. And the idea is that we get them to a place where they're dancing that arousal they're on the table, lying there, but they're actually comfortable not going towards chasing.

Orgasm ejaculation. And then they're comfortable just bead and playing with that arousal. So that's erotic massage dancing. And that evolved from the early AIDS days and 84. And then right away, right from the beginning, I had people breathing patterns that were not their normal breath because when they're breathing a pattern.

With me or on themselves, they have to be present. As soon as they stop breathing, I can see the moments they go away and that's a big deal in sex. People go away wherever and to a million different places. So [00:18:00] breathing is very important in this. It energizes the body, of course. And it makes you feel better, but it keeps people present, you know?

So, uh, so anyway, that's what sexological body workers who touch, may touch in that circumstance, but this is a learning environment. And if I can bring up one more, one more big thing. That's sick. Um, and this, this is, we use Jack ma in our trainings for sexological body workers. We use the erotic mind check mine's book and his book starts out.

With this idea. He said, people come to me and like you, he was a psychotherapist who focused on sex. He was a sexologist psychotherapist, but he said, people come in and list their sexual problems and I'm empathetic. But then I asked, tell me about. Tell me about some great times when you've had sex [00:19:00] and, uh, people aren't as comfortably.

So doing this, but the point is, if you can analyze the best time somebody had sex, what are those elements that we could do practices to get to that very seldom. Do we, when we're working with problems, do we ever get up to that those high points of best sex? It's a long erupt. And so I like that. So sexological body workers, aren't fixing people's problems.

And in fact, a big part of our training is how to refer people to, to psychotherapists to others. Um, Who have a variety of problems and that's not what we're about. We're educators who say, let's try this. How does this work? What about this practice? Let's feel this. Um, so it's working with the body 

Tim Norton: wonderful, wonderful profession, wonderful things [00:20:00] that sexual logical Bodyworkers do.

And as you speak, um, Like you, you, you made a point a minute ago about how people go away. People lose their attention during sex. And I think about the differences between our professions, you know, the differences between, uh, a typical therapist who is either trained in one school of thought to. Learn about a client's childhood and their parents and their upbringing, their family of origin and their attachment.

And then another school of thought that's going to really have you focus on your thoughts and your feelings and your behaviors and those kinds of things. And, and I can sit there and I can talk to them about the negative thoughts that they have about their interactions. And you know, where they learned that in that early traumatic experience you had, when I heard on an interview learning early on from their religion, that masturbation is bad or wherever it came from.

[00:21:00] And. And we can resolve that and teach them. Okay, well, here's a sex positive way of looking at that and you can do the Jack Morin exercise and you can learn about your sexuality, but then I'm not going to see them masturbate. I'm not going to see them in the bedroom. I'm going to tell them about mindfulness.

I'm gonna teach them about mindfulness, but there's going to be that limit where. They, they, they could be in the room with their partner and be completely distracted, be completely out of their mind out of their body. And, and then I have to trust that they're going to report that back to me accurately.

And so I idealize. Uh, Bodyworkers and people who are sematically oriented and then sex workers and surrogates and sexological body workers is having that advantage of being able to see a person in their sexual state and really be able to, to guide them in staying in their body. [00:22:00] So that's what you do, right?

Joseph Kramer: Yes. And in fact, in the past psychotherapist, in that environment where they can't really touch. Have used the quasi legal surrogacy and, and ideally that was a three-way environment where the surrogate would report back and you'd work with surrogate and. Then you would talk to the client. And I think a lot of, not a lot, but there are psychotherapists today.

And Jack Morton was certainly one of them who made use of sexological body workers in this way, because he could use the information that he got from the sessions and it wasn't sex with clients like surrogacy, our six logical wider workers wear clothes. We don't have sex with our clients. We just offer them experiences to help them learn.

Um, but anyway, I think so my, my hope is [00:23:00] that. Um, there's a corrective going on in psychotherapy right now. And it's a major correct of like the dial is moving more towards the somatic and mindfulness, et cetera. And I remember when people said I'm a somatic psychologist, that was a far out thing, but more and more people, they don't say that they just use those.

And I would hope in the future, that's that a lot of the things that are being tried out in sexological bodywork that don't involve touch. Can be used by psychotherapists because there's millions of psychotherapists and there's a lot of need. 

Tim Norton: Yeah, definitely. And, and just to clarify for the listener out there, there, there was.

A time when therapy first came out where it was kind of the wild West and there were therapists who had sex with their clients and, and it was a big shit show. And we had to establish boundaries around things like touch and consent and, and relationships. [00:24:00] And that was for good reason because there were people who were taking advantage of that.

Um, so w we're we're still trying to navigate that through the taboo of sex and through ethics and consent and things and, and, you know, People who sit in a therapy office or in a position of power. So they have to take that very seriously. And so I'm not advocating a bunch of therapists to go and have sex with their clients and touch them, but we have to find a way to.

Bring a consciousness of the body into the room because it's, it's really important. Um, so, so let's, let's get into it. So my, the typical client that that comes into my office is a man in his thirties or forties, a penis having person in his thirties or forties, where. They've, you know, might've had some issues with erections at one point and then they were fine.

At another point when they masturbate in the morning, they're perfectly fine. If they're alone, they're massing masturbating to porn or their erections are [00:25:00] fine. Um, but then a recent partner. That they're just really struggling with. And then maybe they tried Viagra for a little while and it worked at first and then it stopped on that really scares them.

And they're coming in panicked. Don't want to lose this relationship. Um, what w and they say, w w what can I, what can I do fix me, fix my Dick. So how would you conceptualize that kind of a case and, and fix that Dick, what would you do? 

Joseph Kramer: Well, as you know, there's 25 different directions to go there. But, um, I start with the premise.

I start with the premise that most people being members of the world as Western world, as it is, are somewhat disembodied. That their attention is pulled away from their [00:26:00] body. And even if in the morning when they masturbate and they're watching porn, they can get hard. I want to know about that. How, how what's that getting hardest?

And it often is just as into somebody as anything else it's a for watching porn can be a forgetfulness of the body. Um, they totally, their body is not involved. Their attention is in the porn so I can get a card. Can 

Tim Norton: you unpack that a little? Like what, what would a guy saying, well, what do you mean I'm disembodied?

What, what would that look like? 

Joseph Kramer: Um, so a few examples are, so I have people videotape themselves. And so here's some things I learned from watching video that I never would have fought. Here's some, first of all, I have people masturbate or watch porn standing up that's the beginning. And that is [00:27:00] because when people are lying down or sitting, there's almost no movement in their body, there's nothing, uh, demanded of them.

And so their body can be full of tension. It can be, they don't have to pay attention when they stand up. They at least have to slightly move a little bit. And what happens, what I find over time, they learned to really move with what's happening in their body and in the port. So that's the first thing I would say is what, how, what position are you in when you're watching porn?

That's part of it. Um,

So when I've watched people stand, one of the first things I noticed is how many people, men, especially men and women masturbating lose their balance and fall over. They're watching porn and standing and [00:28:00] they, they, they fall against the wall or against something that shows how far away they are from their body.

This is so regular. Um, I'm, I'm it, it shocked me at first, but that's the degree of disembodiment that people can't stand without balance. And now when I watch porn, I see this especially kind of amateur porn, not real slick. So a guy starting to get a blow job. And he'll want to sit down or lie down or lean against something because when his attention goes to wherever it goes, he can't stand that it loses his balance.

We actually talk about not paying attention to our body. Um, so that's just an example, but the forgetting of one's own body. Means that there's almost nothing of that experience that that guy in the morning had his orgasm is arousal that can [00:29:00] carry over to his afternoon with this partner because he was, he didn't pick his body was forgotten.

And if his body's forgotten in the afternoon, nothing happens. That's, that's one thing. So that's why I worked with the, how one of the ways I work is with how they watch porn. And the pain attention to one somebody. So there's a whole series of things that I do. And I started tongue in cheek, calling this porn, yoga things for you to do while you're watching porn.

And this grew and people liked it. So I kind of call it porn, yoga now, but it's things that people can do. So that they're more embodied. And if they wish that behavior that embodied orgasm could carry over more to their relationship with their partner, their attention is more on their own body. And I can go through a whole series of those, [00:30:00] um, different behaviors.

Tim Norton: But yeah. Could you, could you give us a little flavor of the kinds of things? 

Joseph Kramer: Sure, sure. Well, the first thing is standing and I say, Uh, stand with your knees, slightly bent. If you're bending your knees, it's this martial arts thing. It allows you to move and, and people naturally start to move with their arousal and what's going on in the screen.

And if they're having sex with a partner, even beginning play with a partner, this is a dance. This is some kind of. To gather and he's going to have to learn to move and play into that. So it's, so it's beginning to see arousal is a dance, it's a movement of the body. And I think that's the key. One of the key things is porn is about motionless sex for the most part, except the hand.

So it's not about movement and I fixed sex is about movement. So that's one [00:31:00] thing I'm working with and I have videos of them. And I'll say, uh, I noticed that repetitive of movement is good. So if people are swaying back and forth, just that one leg to the other, they're masturbating, watching the porn, but they're doing some movement.

This gets, I think it moves the blood. It moves to our bodies in a certain way. So that even if their attention is in the porns or getting something something's happening, then I have a suggestion. This is the, probably the biggest one is that at some point, I'm going to ask you, I ask that you turn away from the porn for five breaths and for those five breaths pay attention to what's going on in your body.

You've been masturbating. You've been, what kind of pleasure, what kind of feelings are going on? Just five breaths. And when I first started doing this, I [00:32:00] make I've made this up over the last 15 years. But when I first started doing this, I didn't realize, but a lot of feedback was I can't turn away from the porn for five breaths.

I might miss something. And luckily we have the civil bar here that we can hit and it stops the corn. So that solves that problem. And I was, it was a big problem for many people. So the turn away from five breaths, and this is a skill because they're in a. The visual part of the brain watching torn, and now they're going to feel their body in a Somat a more somatic sensing and five breaths.

Isn't a long time. So this is a skill that is learned of pulling in and paying attention to the body, which is something very important steps that you're aware of your body, a body scan, so to speak you're scanning through, but I'm not telling them start at your feet and do something I'm saying. You're masturbating.

What's the [00:33:00] result of that masturbating. Do you feel pleasure? What feels good? Um, and if I can skip ahead often what happens is not at the beginning, but as people get into this, they start with the five breaths and it's true. It's true, enjoyable paying attention to their body and masturbating to go back to the porn, to pull their attention into the story or whatever's happening on the screen is less fun than feeling their own body.

And this isn't my intention. My intention is to feel your body, but they go, what's going on in their bodies. More fun. Great. You've just learned something, but then they go back to the porn where it starts to the arousal might start to wane and you get a little more arousal. So it's some people I work with too.

I call it sipping wine. Uh, some people guzzle that guzzled their alcohol, but some people are watching the tour and like [00:34:00] a sip of wine. And then they're played with their arousal and they come back and get a little more arousal and then go off and play with their body in this way. And I think. This is more like a regular sex.

You focus in on different parts of the, of the encounter that arouses you, but then you're in other realms that aren't intense arousal, which you're still functioning. So I liked this Sydney wine approach to the guzzling approach, but this is quite often than people watching porn and it, in all of this, my, my statement to people is.

You never want to lose your watching porn for a reason that porn activates an arousal in you. So you don't want to block that. Uh, if you, if you need it to do porn yoga, I remember some man sent me his first tape and he had seen my website [00:35:00] to teach us and he did twenty-five behaviors in a row. And he barely looked at the porn.

So he was performing all of these activities, but he wasn't enjoying the porn if that's his choice. But I think I'm, I'm not making porn to be something bad. It's something that people are enjoying. It's how to continue to enjoy it, but how to enjoy your own body also. Um, let me go, let me skip to a big thing.

Orgasm ejaculation. I call it, uh, thank you. Uh, rock bass, but I call it D here, now orgasm. And so my recommendation, I say this is a big deal ejaculation and the time leading up to it. What if you tried not watching the porn for the evacuation, so you can be fully present to what's going on in your body to that attack elation.

I thought I would have a lot of pushback from some [00:36:00] people, not one person ever after they've done it as complaint. It's like, wow. This is, yeah, I feel it even more. I'm not a jacket sledding with her or him on the screen. I'm a jacket relating was me. I'm here right now. So that's another that's um, again, be here now.

Uh, I have. One other realm is I believe people walk around with stress in their bodies. Emma started out as some sore. I look at bodies and so they bring stress to sex, but when you're lying in bed, watching something or are sitting that stress can be there. But when you're standing the stress. A lot of people feel stress right away cause they have to balance themselves.

And um, so I recommend shaking and I recommend the beginning of session, watch your porn, [00:37:00] but get that stress out of your body shake and jump and move. So because the less stress, the more pleasure there's going to be, the more fun you're going to have. So those are just some I've. Um, I certainly teach a lot of different strokes for the, for the cock.

Is it okay if I use the word 

Tim Norton: cock? I use it as often as you'd like cock, 

Joseph Kramer: um, and, and, um, the end I men have this bad rap or this rap that right after they come, they. Rollover and go to sleep or roll over in her loss because in that the bliss is not something that I pay attention to. So there's savoring is a big deal in this.

And for me, that it's part of pleasure. The pleasure is excitement. It's the pleasure is also this bliss part. And can you save for all of that? So those are some of the, some of the [00:38:00] realms that I, that I address when people are, uh, You know when I'm coaching people and I coach men and women both. 

Tim Norton: Yeah. Good.

Now, as you were talking about. Standing and, and the differences between masturbating and, and regular sex. And, and let me for the listener, um, Joseph is standing during this interview and, and he, he, he rocks back and forth a little bit. And you can tell he's got his knees bent in and he's very, he's, he's a very embodied speaker, if you will.

Um, and it's, it's too bad. You, you can't see it cause he, he walks the walk. But as you're talking about it, I I'm thinking about. The difference between yeah, just between masturbating and sex. And especially if you're masturbating to porn, I can imagine. People holding tension in a lot of different places while sitting in front of a computer, especially if they're there for a half an hour, I can just can [00:39:00] imagine wrists tensing up and shoulders in jaws and necks and backs and legs and, and all those things that just flew the motions of, of a physical sex wouldn't be happening nearly as much.

Is that kind of the, the breakthrough there is, is that what you see? 

Joseph Kramer: Yeah. So what's interesting to me is Fitbit watches and Apple watches and other exercise watches have a function where every hour they beep and say, you should get up and move. If you've been sitting, this is speaking to that. And the phrase that really gets to muse sitting is the new smoking.

So it is, it is actually saying this isn't just sitting. This is really bad for you to continuously sit and what Fitbit, and, uh, says even a minute of standing and moving has beneficial. And I [00:40:00] think. A minute is hardly enough for if so. I, I, I try in my office with people, I work 10 minutes in an hour, we set the alarm and we might do some things for 10 minutes, but the idea is to get into more movement.

And I D and I, if I can go one step further here, I find as a, as a somatic, a body-based. Person who really likes masturbation and watches people masturbate what I've found. Is that when men and women masturbate, whether you're working on your clit or holding a vibrator are masturbating with your hand. It involves a tension that comes up to the upper chest and the shoulder and the, usually the whole shoulder, but sometimes the upper part of the body, especially as people go get to into more arousal, but even from the beginning, Just the [00:41:00] movement is not, there's always a tension in the upper chest.

This is the area of breath. And often there's a holding of breath that people have learned very early on habits that people learned when they were 12 learning to masturbate. Um, anyway, I find this really horrible for sex alone and sex with partners. And what I mean by that is. If, if someone's masturbated 3000 times before they're 20 or 5,000 times before they're 20 and they've masturbated with attention in their chest and holding these muscles, this is a habit that's curious with them that orgasm involves tension in the upper chest.

And I'm not very big on tantra, but. But, uh, up here is also the heart chakra, but for me, it's the lungs that the lungs are constricted in. This, the breathing is constricted. So I [00:42:00] consider masturbation normal masturbation where they're standing or sitting or whatever the way people do it, there's this tension in the upper part of the body.

And so I certainly noticing this, watching the videos of my clients. So then I said, can we do. I call it hands-free arousal. Can we get aroused? Can we masturbate without using our hands? So this tension doesn't happen. And certainly, um, the toy manufacturers I find Fleshlight is the ideal. A vehicle to anchor this, for example, on a table at the height of one's penis and you have your hands free and you can thrust.

And the thrusting here is not a fantasizing necessarily of you're thrusting into someone. This is your way of masturbating, that is using your hips and your thrusting muscles, but not your hands, not your upper part of your body. [00:43:00] I have videos. Many of the first time people have done this the first time they've ever done it.

It's like this physical liberation. A lot of people raise their hands almost in the air. It's like, Oh my God. And the, the normal constriction, the habitual muscle constructions that they've had. Aren't I aren't active. It's breaking a habit right there by doing this. Not only that, but the backup is I think most men thrust really poorly.

And so this thrusting exercise and I think people need to learn to thrust. And I would hope men would learn to thrust, not in somebody, but learn to thrust bef that, to do their practice in their fumbling in somebody. Work on it and then bring it to love making. But anyway, I find 'em. So I call by the way, I have the big category for this as orgasmic [00:44:00] yoga, all kinds of practices that involve orgasm are going toward orgasm.

But I think, um, I I'm, I've really looked into. Fleshlight and their online forums and all this, and really only a small percentage of people. I think use this. Um, thrusting and they've gotten better vehicles. They have holders for their flashlights now, uh, et cetera. And on my websites, I have all different ways to anchor for women.

It would be a vibrator, so large vibrator that they can push into as they wish and play with. But they're, you're getting you're masturbating. You here, you are a mess when you're stimulating yourself, but your hands are free. And this goes back to my original professionism sewer. I think this is the time when you're aroused to give yourself a massage.

You have, I have people start right in the belly and start in [00:45:00] the front of the body and their face in their head. And so people are masturbating and they're giving themselves a massage. How great is this? And there's. And they can, they can up the speed or down the speed based upon their hips. 

Tim Norton: Wonderful.

As you're talking about that, I'm thinking about how typically when people masturbate, especially men, they're probably not thrusting at all. They're not doing one of the most basic aspects of intercourse. 

Joseph Kramer: It's well, I don't think they're doing a lot. They're they're going up and down. And I, um, so I live near UC Berkeley, university of California at Berkeley, and it's quite a big campus and not recently, but 10 years ago, I was involved with educating peer counselors.

So students who would go out and do pure sex education [00:46:00] in the dorms and different places. And what I stories I heard over and over. Where of boys or students there who wanted their girlfriends to suck them while they watch porn or to check them off while they watch porn. And what this said to me is they've learned to behavior on their, the, the nerve endings on their penis.

Once something, this is the way they've learned to have sex. So they could, they could have other, they could do other things with her, but it's more effort. Can you just suck me while I watch porn? I go, wow. So this is, uh, that was, um, and I think, so I think that's where habits come in. Your, your porn watching habits can be limiting.

What I'm hoping is that people can use porn to let go of habits and create. Uh, behaviors that carry [00:47:00] over to their, to their play with their partners. 

Tim Norton: Hmm. Definitely, you know, and while you're mentioning that, I, I do have an avid listener out there who is a bit of a public service announcement opportunity.

There I've put an article out on PornHub at Bay, been interviewed in their, their sex education series. Porn porn hub is. Bringing a lot of sex and ideas into the world and, and there's, there's good sides to PornHub, but sometimes they do a terrible job of not screening nonconsensual videos that end up on their sites and underage sex that's going on on their site.

And yeah. They've got to do a much better job of that. People, people are having videos put up there, but that they didn't want there in the first place. And so by us talking about the upside of porn, where no way could doning that they could do a better job and still function as an organization now. But to the extent that we're talking about, um, ethically consensual, [00:48:00] Porn and, um, and all that good stuff.

That's, that's what you're saying. And that, that's what you're seeing. And then people are watching just, just wanted to put that right there, um, for the 

Joseph Kramer: listeners. So I hope this is true. What I have decided, I, I think early on, I realized that most people are embarrassed about what turns them on. They don't like to talk about the specifics of what turns them on.

So you could have a hundred men who identify as gay in the same room, and they're all turned on by different things and some so particular that they would rather not speak about it. But one of the things that I realized is I'm not into I'm interested. In helping people with the state of arousal. So what they're watching, I never know.

I, my videos, I want them to turn their screen away. Cause I do not want to know what they're watching. I don't want to know whether they're gay or straight or are anything that [00:49:00] they're watching a big come up in the coaching about their partner, but I don't ever ask them about the porn. They're watching you become accepted.

When I'm noticed they're having trouble with arousal. I say, you know, it looks like you're not finding arousing porn. And what happens with some people is free porn and searching for it. Isn't enough. And I suggest you, if you really have some realm that turns you on, and this is, this is fun for you. Why not try purchasing?

Of on a website and people do, and their arousal goes up because they're watching something. They like, it's like watching regular TV, you know, the regular stations or Netflix, or, you know, get, get to premium here. So I find it important that people watch things that turn them on. I, [00:50:00] um, as you know, Some psychotherapy could go into a couple of years about what people have of therapy, about why people are watching a certain thing.

And I'm, I certainly, um, it has never come up. Anything about bondage are unconsensual, not just bondage, unconsensual stuff, or ch child pornography, all this. And certainly that's I'm. I, uh, I hope they're not doing this, but I'm not policing what people are watching and I'm glad that I'm not, I'm here to help them with the arousal that comes from that.

Tim Norton: Okay. Um, so there's, there's a specific question of do guys come in to you saying they struggle with their erections? 

Joseph Kramer: Um,

[00:51:00] So, this is interesting. I feel there's millions and millions. There's hundreds of millions of people, men, even in the West. I deal with, I teach and I'm in Europe, Australia, um, lots of North America. Um, When we say, come in a lot of times it's virtual. So if someone says I'm a sex addict, I really have a problem.

Let me let's start there, which is rather than just my erection. I say, you know, I'm not a therapist. And if someone's self identifying this problem, they really want to work on this problem. I go, I can. Give you some practices you can try. And I've only worked with two people who really wanted to go into this from a place of saying I'm a sex addict and, um,

they both [00:52:00] have, well, one, both of them wanted to work on that. That was their focal point. And that's that thing of sex addiction is, is. A thing in the culture and this thing about moving while you're masturbating, this isn't a thing. They didn't value this at all. They valued how I deal with my compulsiveness.

Um, and so what I often, how I advertise is I would like to work with people who love porn and want to enjoy it even more. So, uh, I just know a population that this really works for. So. People who say I'm no fat, I've been 88 days. I haven't had, I haven't touched myself for 88 days in my mind. I do think this, that, what if for 88 days you were practicing alternative eroticism, not just know about arousal, but practicing other ways.

You'd [00:53:00] be learning skills. Now you're really quiet in the neurological pathways. Of course, through this. Uh, uh, abstinence, but you still have to learn at some time, uh, new ways. So I, and I do think breaks you important for some people, but I'm not a therapist, as I say, and I'm not a, uh, I don't deal with problems.

Eye problems can be helped by. Be hit by these, by exercises that I do, but I don't have to deal with the same thing you do with someone coming in saying, I have trouble with erection, but where I, where I would go right away is, uh, are there any times you are fine with reduction is, and usually it's with porn and masturbation.

So it's a really enclosed place. I mean, a really a contained place. And the way I would approach it is to start with that. Arousal is start making that place bigger stand and be aroused [00:54:00] move would be aroused, a wreath and exercise all of this so that that arousal can carry over. And what all that is is bringing them into their body more.

There's a supposition that they're just not in their body in my way of approaching it. Um, but I don't have people since I don't advertise for, since I don't advertise that I fix people, I don't say erection problems and all this isn't listed is mine. It does. I do say I can help with habits, bad habits.

That's masturbation is almost 99% happened for most people. I know. 

Tim Norton: Yeah. I bet you can offer some pretty keen insights, like one of the ways that this shows up and, and just this morning, I was listening to this interview that you gave on. Um, [00:55:00] uh, what was the show called? Uh, it was a podcast, um, the pleasure mechanics and.

And you, you, you know, if anybody out there wants to hear more of, of, uh, Joseph's, uh, origin story of, of his early sexual development and how that led to this work, it's, it's a, it's a fantastic interview. Um, but one of the things that you talked about was. Having those religious messages early on, uh, about impure touch and, and I, that was the way that it was put, you know, that there's a lot of sex negativity and in all the religions, you know, it was, we were talking about Catholicism, but I don't know of any major religion out there.

That's super sex positive and giving regular messages of, of, um, sexual openness. So when I'm working with clients who had that. Early on in their sexual development. They, [00:56:00] it's one thing to just say, okay, well, we're going to stop feeling guilty about your sexual thoughts. We're going to stop having sexual shame because that's, you know, and they can logically grasp that.

They, they can get, okay, it's wrong to think of sex as dirty or whatever, but it's, it's a whole different process to actually embody. That now absence of guilt or embody lust and joy and bliss and, and all the things that you want to embody when in a sexual place, rather than, you know, now we're naked. Now you feel shame.

Now you feel guilt. Now it's reminding you of, of some early Christian message. So you had to go through that process of undoing. Those negative sexual messages. Um, what do you think helps people the most along the way of, of shedding sex, negativity and early, um, sexual messages that are counter to, [00:57:00] to less than neurotic joy?

Joseph Kramer: Thank you for asking that question, by the way, the interview with sex mechanics, weight pleasure. Mechanics was quite extensive. I, and I liked it. Um, so as a kid, I was very strongly. I Irish Catholic and I grew up with, went to Catholic schools and I believed everything. And sex was a sin outside of marriage.

And masturbation was a mortal sin. Meaning that if you died after masturbating, before going to confession, you went to help. So I believe this. So after masturbating, I was in terror, sometimes here's a 15 year old or 14 year old in bed. At night thinking if I die, it's all I, I go to hell it was terror. And I I've, I have a quote I'd like to read from Kinsey because [00:58:00] I think that this upbringing has not been named.

And I think we're big on trauma today. I think this is actual trauma and traumatizing of the system that is. Yeah, it's so ubiquitous. We just call it normal. We call it sex negative, but, but even Kinsey and his day, and this is from his 1948 book. He said, millions of boys have lived in continual mental conflict over this for that matter.

Many of boys still does many boys pass through a period. Periodic succession of attempts to stop the habit. Inevitable failures in those attempts, consequent periods of remorse, the making of new resolutions and a new start on a whole cycle. It's difficult to imagine anything better, calculated to do permanent damage to the personnel.

[00:59:00] It's hard to, I think. So we're talking about hard cock. I think how society treats this with young people is, um,

We just call it , but it is horrible. It is traumatic and it has lifelong consequences in. And if I might say it keeps half of psychotherapists busy for the rest of their life with these people. So how do you deal with this? For me, it was like this closed system and I have to say. My own masturbation, which was a mortal sin cracked open that egg.

It was the crack in that egg. Finally, there was aye. Aye. Aye. Aye. It was the only way I got out of that system and it was the [01:00:00] pleasure and the understanding. Um, I think the values in a lot of religion are, are, um, Utility and connection and union. So for many people it's not masturbation, but it's whether they're gay or straight, um, behaviors that are not approved of by religion, but they know they're wonderful.

They love this person they're connected to this person. I think that is one area, but for me, it was the celebration of my body. And it didn't really resonate with my whole upbringing. And right now I don't go there a lot, but I have one person right now who's I'm working with with this. And there are Christian approaches, meaning focusing on this is a gift of God.

And it's a repeating of it over, this is, this is, uh, [01:01:00] this, this pleasure, this body, this is, this is God's creation. He grateful for its capacity. And yes, this is a different message, but it's at least parallel, but it's not quick. It's not a quick process. It's changing a whole belief system. Um, And I don't do therapy, but this comes up you're right.

This, and one of the things I liked about Kinsey reports in the middle of the 20th century is he said the single most negative factor. In sexual functioning and sexual pleasure, et cetera, is how religious someone else. And he said, uh, Hasidic Jews and very fundamentalist Christians in fundamentalist Catholics have the poorest sexual lives and relationships.

And that was across the board. What he, what he found. And that was 80 here of 70 years ago. [01:02:00] Um, And I think religion has softened a bit, but. Um, when I was in grad school, one of the other people studying for a PhD in human sexuality was a Mormon Bishop. Uh, and he was a liberated Mormon. He grew up in Hawaii and, and if you grew up in Hawaii, it's hard to have the same view of the body as if you grew up in Utah, you can imagine.

And so he was working on his PhD, but he works on, on masturbation and his. Studies at the university at, uh, of college aged kids in Utah was how many had thought of suicide as teenagers because they masturbated. And he said the difference between Catholicism Mormonism, should you go to confession in Catholicism and Mormonism?

You're impure, you're impure and, and [01:03:00] the same compulsion. And so there's a huge, it's still a problem, uh, suicides among young people because of heterosexuality and homosexuality and masturbation. And I go, people do not religion. Does it even change? When they see some of their best killing themselves over this religion is so it's what we value.

It's, it's closest to our core and to change those behaviors is often a communal environment is important. As you know, it's not just therapy one-on-one is hardly the best vehicle that, but I think relationships, but what I've come to is. I tell people who are anywhere in that struggle, that when they're in a high erotic state, if they're watching porn and they turn away from these five breasts, just to say, I'm [01:04:00] so thankful for this body, God, thank you that I can feel this.

Or when they orgasm, they say, thank you. This was amazing. Bless it. Be God, I'm not kidding. This is it's crucial. It's life giving. They have to say that because otherwise it's the devil, it's the negative what's happening. They have to say that. And that is awkward conditioning. That's a really good thing to say when you're orgasming blessed, be God I'm grateful for this.

So, um, but, but I F I. Recommend people. There's one in Berkeley spiritual guide that I sent people to there's I, this isn't my realm, but if somebody is really into that, I check more Warren used to be pretty good with this, but, um, anyway, I usually refer people it's not, but it's always there. [01:05:00] It's with everybody.

And it's still with me. It's still with me. I've I'm 73 years old and I still ha it's there's these imprints that are within me and, uh, this habits, habitual ways of thinking that come up. Um, not, not a lot. Cause you could tell it's great. I'm very grateful. It's an arrows. 

Tim Norton: Okay. But you mentioned too. Uh, yeah, very, um, Psychologically proven techniques, but just that idea, I really liked how you mentioned community, how maybe it'd be a good idea to be around sex positive Christians or whoever is going to be able to communicate to you.

Yes, yes. The body is good for joy. So just how therapeutic that can be. That's like a, you know, a group, a community and, uh, at the micro level, that's more of a Metso macro level, but at the micro level, Uh, when you, [01:06:00] when you orgasm adopting a new narrative adopting, uh, something positive, something that you say instead of I'm going to burn in hell great after you ejaculate.

Um, but something, uh, more sex positive it, and it can be found in, in the Bible or in a religious text that there the, you are made in the image of God. I've had other clients talk about that. Being a way of getting them out of, um, Thoughts of low self worth. Like you, you can't be all that bad if you're and made in the image of God.

Um, it'd been finding those unintentional sex, positive messages, um, yet they, there they are. And, and then it is definitely, um, we'll talk very, very, um, spiritually about orgasm itself. Um, As being a way to connect to the great divine, um, and so plenty of room in there to retrain your brain, rewire [01:07:00] your brain, we wire your physiology to have a, a positive spiritual expense, one being sexual, uh, masturbating.

Hmm. And it sounds like you had to do that. It sounds like you had to do you sounds like you had a lot of undoing and I imagine there was a period in your teens and twenties or whenever where there, there had to be a major transition. 

Joseph Kramer: And I think, um, I go so far as to encourage is to, for some people to put the idea of masturbating into the category of spiritual practice.

Okay. This is a spiritual practice that you do. And this really became big for me. About 10 years ago, when I was, this came through Daniel Siegel. At UCLA, a neuroscientist child psychiatry, child psychiatrist, but he was in one of his books. He was talking of. Buddhist monks meditating and how it benefits the [01:08:00] prefrontal cortex, the front of the brain through which we are, it's our executive function and how we function in the world and how, how beneficial over times.

And it was bigger in these monks and then the studies and he went on with that. This was that other types of practice, not just in the Buddhist monastery, but physical practices. Yoga. And he, he defined mindful practices, mindfulness practices. And this was for this benefit of the brain as having being clear on one's intention and being clear that you're placing your attention.

And that was the, that was kind of simple. And I realized that in my erotic Dave's in the eighties and nineties, I did thousands of erotic massages. And I in medicine, when I would sit and [01:09:00] try to do something like the pasta, now I get all kinds of distractions. When I was doing those sessions, I had an intention was so amazing to touch findings from the, and uh, almost all of those erotic insertions.

I did. The first half was a deep massage to relax the body. Before I went into the erotic, I did thousands of sessions. I should have a really big prefrontal cortex or something. And in a sense, I think that's, there is, there is a result here. I was a B student in high school and in college, I wasn't, I didn't see myself as exceptional, but I think through practice somehow I got to a place where.

Practice that also pulled me into my body and I could make better decisions. I think that's the key. I've made very good decisions in my adult life and I think it's because of practice. So I now encourage people to [01:10:00] practice orotic practice and. Uh, those people who carry a strong religious upbringing, et cetera, or trauma.

And I call that traumatic, strong religious or other trauma have trouble even getting to it. There's all kinds of resistance and I can't do it. And so that's where I think psychotherapy or something comes in because, um, Uh, the profession of sexological bodywork, we give people practice, but helping them get to the practice is another realm.

And some people are better at that helping people than others. So there's communal ways of doing it right now. For example, one of my favorite ways of guiding people. And this is within our profession, we have meetings and outside the profession, I'm teaching a class in the UK right now. And. I have it's a two hour class zoom class.

They'll come [01:11:00] and we'll talk, but I've sent them an email about a practice and erotic practice we're going to do so this week it was, uh, that there would stand for the practice and. The goal would be stimulation of the genitals with the idea of bringing the feeling up to the heart. So a conduction of the heart and genitals and being aware of those people and things that they're connected to.

So it's heart genital connection. That's the practice. And in this, what I would do is we talk about it, talk about intentions, all of this. Then we turn off zoom, go and do it for a half hour. And come back and then we talk about the practice. This really helps people. Uh, some people have to go away and still can't do it, but this is I found is the best.

There's a communal support and it's all set up and they hear people beforehand and they hear people afterwards [01:12:00] of what happened during this practice. By the way I've just did the first UK. I did my first UK, a couple of weeks ago, half of the class, half of these people who are 30, 40, 50 studying. These are people studying to be sexological body workers had extraordinary experiences because they never stood up.

Before there was just amaze standing up. So they'd had a thousand thousands of sessions sitting down. So there's habit when they stand up, habits are broken. I call it a leverage practice because if you stand up watching porn or just masturbating. For that very little effort of steadying up. There's huge benefits, the leverage.

So I recommend people if parents asked me, so how should we give permission to our children to [01:13:00] masturbate? And I, I have my, my rap, but I say and tell them half the time to masturbate standing half the time. And that will benefit their whole life. I think we need to give that message right from the beginning to kids so that they move and don't get into this motion.

The sex sex should not be motions. Sex 

Tim Norton: should not be motionless. No, I had one last little question because I can, we've been talking for a while and I feel like actually I have about 25 more questions, but you just mentioned they're setting an intention. And as a therapist, I'm a kind of a goal oriented therapist.

I like people to, to set intentions and establish goals and to pursue them. What could be an intention when you're masturbating? They, what, what would you have a person say as an intention? 

Joseph Kramer: Um, so somebody might say, I want more movement in my session period. And [01:14:00] at the end, there's an evaluation of that intention.

Another might say I'd like to be more aware of my breath or another. I like to bring as much awareness possible to my ballot, or I'd like to shake summer behaviors. Like I'm just saying others are, I would like to. Be aware of any wisdom that comes to the surface that's in my body. I want to pay attention to my own body wisdom.

I want to, um, a big thing is that I push in similar to intention. I want to remember what's important for me that just that I think that's the grounding. Uh, it's usually very physical and. Uh, attainable, meaning that afterwards they look at it and see, how did that influence that? Um, uh, the other thing I do at the end of sessions and [01:15:00] all sessions, even in sexological bodywork is we look at distractions, what distractions and people are taught to, to check out distractions, because these are interruptions of.

Of, uh, of your experience. And in fact, I come from a tradition, Sylvan Tompkins, where distractions are, um, shame. This is a shame episode, distractions take you out of the present moment into somewhere else. And so this is the beginning of a shame episode, so to speak. So we're. Constantly or if distractions here's, by the way, here's what I found.

Here's the important thing in masturbation and a lot of things that distractions recur in a general category and cry again and again, and again, people have the same distractions. They may meet the new boss. Same as the old boss. [01:16:00] Don't get fools again. Here it is another distraction. So without paying attention, it seems like.

Oh, it just, this told me this morning, but really there's a couple of categories. And usually I call it the core or erotic distraction. I got this from Jack moron, cause he has core erotic theme that people have the core of their arousal or the core of their, uh, sexuality. I think people have core erotic distractions and if they become aware of that, they can manage 

Tim Norton: wonderful.

Yeah. You alluded earlier to the attention merchants out there. It's I picture like a cartoon of there being the, you know, hidden, uh, uh, troops with guns, like. Ready to assassinate your attention and really to, to enslave it. And, and we've gotta be aware of the ones that are out there and, and that's, that's [01:17:00] your own.

Self-reflection, it's different for everybody. And then to start to change those. Relationships change that relationship to eliminate them or, or to, you know, sometimes we just can't and you know, and you just have to notice them, but be able to refocus on your sexual experience. 

Joseph Kramer: You know, this time of Corona virus right now that we're in, people are all over the world are in their homes.

This seems like a time when they're less could be less. Bombarded if they wish from attention merchants, but also I think it's a time of pain, attention to one's own self one's own body. And we all have lists of things. I should exercise more. I should meditate or I should eat this way or that way. Wow.

What a perfect time. Or I should connect with my family or fuck. Friends. You've got, [01:18:00] you know, these are times when we can. Make choices and make decisions. And I think we're right at the beginning, but I think this is months. Maybe we're right now, when we're talking in California, we're two weeks into this, but I think this is an ideal time and I have this background religious background, but I, I liked the idea of monasteries and I wished there were sex monasteries and, and Ostrom's where people go just to masturbate.

For the whole world, you know, are, have sex for the whole world. And, uh, we don't have that. We we've had a few attempts in the history of the world, but, uh, they were all killed as heretics and whatever, but I, but I, um, but I do think this is an important time and some amazing things can come out of these permitted churches that people are in.

We're in Hermitage right now. 

Tim Norton: Hmm, [01:19:00] I'm saying we could talk about this for days. Um, you mentioned that you would like to, to mention to the world, to, to our audience, like some of the online resources that are available to them, that, that you've been working on and putting out there, can you tell us, like, get more 

Joseph Kramer: information?

So I have a website called orgasmic yoga.com. And this is a website of erotic practices that you can watch and do some solo and there's men's women's and couples. So you can do touch as a practice and, uh, and it's there's 80 or a hundred, I would say practice sessions that one can do. And they're created just for that orgasmic yoga.com in terms of watching porn.

Um, porn, yoga.com. And these are [01:20:00] all practices that it shows men and women doing the very various practices. Uh, and so that's, I think that's very helpful. And, uh, for a Radic massage, which I find is a place of great learning, erotic massage.com, and there's all kinds of techniques and approaches and strokes.

That one can use. And certainly we didn't talk about this, but different. Places on the penis and different places on the vulva have different feelings States. Then we get used to just one place or two places or one way of doing it. So there's a lot of variety that one can learn from. And I learned half of what I learned from very early on watching videos on massage sports and such Swedish.

I did the eighties and nineties when they were first coming out. I got some of the videos from great from. The great teachers and there's so much [01:21:00] available now, and it can be quite expensive to go to a class, but right now online, you can get there's a lot. But anyway, our guests book, yoga.com erotic massage.com, porn, yoga.com.

Tim Norton: Okay, wonderful. And do you, do you tweet, do you, are you an Instagram kind of person? Are you a social media person at all? 

Joseph Kramer: I. Seldom tweet. And I do I a little bit on Facebook, but I don't think it's a place to really make connections. Um, No, so, 

Tim Norton: okay. So mainly those videos website it's that we mentioned and great.

Yeah. And you know, you just started to talk about, one of my questions was going to be that the genital mapping, but that sounds like something they can learn about the different parts of their penis on, on the site that you mentioned. And that could be a very eye [01:22:00] opening for some of the things that were, that the listeners of this show.

Are trying to learn about. So, um, any, any last thoughts before we go, you've said so much, and this has been such a wonderful 

Joseph Kramer: interview. I, I, I would just like to say that the core of all this for me is how a basing our bodies are. And. We forget ourselves. We forget our bodies so often and it's set up.

Society is set up and even porn is set up to grab our attention. This is why people make porn to grab our attention, to make us aroused. But that arousal is often our attention is in the porn. So I think. I would just to, as often as possible, bring your awareness back to right here. What's the pleasure of being alive, a liveliness, feel your own a liveliness.

Hmm. 

Tim Norton: Okay. And [01:23:00] let's end it right there. Feel your own alumnus. Thank you so much, Joseph. 

Joseph Kramer: Thank you, Tim.

If This Episode Resonated

If this episode spoke to you, there is a path forward.

Tim Norton provides a discreet, evidence-based therapeutic space where men and couples can understand the deeper systems behind desire, arousal, and connection. His work combines rigorous neuroscience with a grounded, relational approach to help clients rebuild aliveness in their bodies, strengthen partnership, and create lasting change.

How to Have Better Erections with Dr Ashley Winter

A sexual health urologist on ED, Viagra, and why it is not about your partner.

About the Episode

This episode looks at erectile dysfunction through both a medical and relational lens. Tim speaks with urologist and sexual medicine specialist Dr Ashley Winter about how stress, health, medication, and shame interact with erections. They discuss practical ways PDE-5 inhibitors like Viagra and Cialis can help, how to find a urologist who truly focuses on sexual health, and what partners need to know when ED shows up in a relationship.

Key Themes

• Erections in the time of COVID and how stress impacts sexual function

• The difference between “general” urology and sexual health–focused urology

• How PDE-5 inhibitors (Viagra, Cialis, Levitra) actually work and how to use them well

• The role of anxiety, performance pressure, and shame in erectile difficulties

• Why ED is rarely about a partner’s attractiveness or desirability

• Practical support for partners and couples navigating erectile dysfunction

Listen to the Episode

Listen Now

About the Guest

Dr Ashley Winter is a urologist and sexual medicine physician based in the Pacific Northwest. Trained at Weill Cornell Medical Center / NewYork–Presbyterian and further specialised in male and female sexual health in San Diego, she treats conditions such as erectile dysfunction, Peyronie’s disease, low libido, orgasmic and ejaculatory disorders, and sexual pain. She performs procedures including penile prosthesis surgery, Peyronie’s treatments, vasectomy, and other urologic surgeries, and is passionate about making sexual health care accessible, sex-positive, and free of shame.

Full 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.

Man with erectile dysfunction holding pill and needing online sex therapy

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.

If This Episode Resonated

If this episode spoke to you, there is a path forward.

Tim Norton provides a discreet, evidence-based therapeutic space where men and couples can understand the deeper systems behind desire, arousal, and connection. His work combines rigorous neuroscience with a grounded, relational approach to help clients rebuild aliveness in their bodies, strengthen partnership, and create lasting change.

Understanding Sex Addiction and Erectile Dysfunction

Episode Overview

In this episode, Tim speaks with Douglas Braun-Harvey, LMFT, CST-S, the leading voice behind the Out-of-Control Sexual Behavior (OCSB) model, the framework now used by certified sex therapists worldwide instead of the outdated concept of “sex addiction.”

They explore how anxiety, shame, relational distress, and coping-driven sexual behaviour shape erection patterns and why understanding OCSB can transform sexual wellbeing for individuals and couples.

Key Themes

• Sex addiction vs Out-of-Control Sexual Behavior (OCSB)

• How compulsive or impulsive sexual behaviour impacts erections

• The role of sexual shame in desire, arousal, and avoidance

• The trauma of betrayal and how it affects intimacy

• How porn, fantasy, and sexual imagery influence arousal regulation

• The impact of anxiety on sexual performance and emotional safety

• How a sexual-health framework can support healing

• The benefits of online sex therapy

Listen to the Episode

Listen Now

Doug Braun-Harvey

Doug Braun-Harvey is a Licensed Marriage and Family Therapist, Certified Sex Therapist, Certified Sex Therapy Supervisor, author, international trainer, and co-founder of The Harvey Institute. For over 30 years, he has developed sexual health–based treatment approaches for men experiencing out-of-control sexual behaviour.

He is the author of Treating Out of Control Sexual Behavior: Rethinking Sex Addiction and has trained clinicians globally in sexual health principles across addiction treatment, psychotherapy, HIV care, and trauma-focused work.

Website: theharveyinstitute.com

Book: Treating Out of Control Sexual Behavior, Rethinking Sex Addiction

https://bookshop.org

Episode Transcript

Tim Norton: Hello and welcome to Hard Conversations. Really excited for my next guest Douglas Braun-Harvey, a licensed marriage and family therapist, certified sex therapy supervisor certified sex therapist, sexual health author, and trainer. He teaches and trains nationally and internationally on sexual health principles within drug and alcohol treatment groups, psychotherapy, HIV prevention and treatment and child maltreatment. Since 1993, he has been developing and implementing a sexual health based treatment approach for men with out of control [00:01:00] sexual behavior. His book treating out of control sexual behavior, rethinking sex addiction was written with co-author Michael Vigorito and published in 2015, a couple of years before that Doug Braun-Harvey Co-founded the Harvey Institute and international education training, consulting, and supervision service for improving healthcarethrough integration of sexual health. He is an adjunct assistant professor in the center for human sexuality studies at Weidener university and faculty for the university of Michigan certificate program in human sexuality.

He also wrote sexual health and recovery, professional counselors, manual, and sexual health and drug and alcohol treatment group facilitators manual. Welcome to the show, Doug. 

Doug Braun-Harvey: Thank you. It's going to be here. 

Tim Norton: Yes. So excited for this interview.  You know, I, I worked in,  [00:02:00] well, we'll, we'll, we'll just jump right into it.

I worked at a clinic that, that branded itself as a sex addiction clinic for a few years. And, you know, I spent so much time in that world. And then, then when I got into ASAP, I was, you know, learning your model, honestly, learning the out of control, sexual behavior model and, and, and working with that population for so long that I kinda got.

Burned out on it, but I've, I've had a bunch of requests from people who want to hear, you know, how does, how does this impact erections and sexuality? And it's such a germane issue to, to male sex in 2019. So I'm just really excited for this interview. And thank you so much for 

Doug Braun-Harvey: appearing, Tim. It's great to hear about your background.

I don't often. Do podcasts or interviews of this kind of nature with people who've had their own professional direct work in, in providing sex addiction treatment and then, you know, moving into the sexual health model. So this is a rare opportunity. Thank you for letting me know that. I didn't know that.

[00:03:00] Tim Norton: Okay. Yeah, no. Fantastic. So let's, let's jump right into it. You developed a model for the treatment of out of control sexual behavior. He wrote a book,  

Doug Braun-Harvey: Michael Figueiredo and I co-wrote a book. Yes, 

Tim Norton: yes. The two of you. Yeah, a really important book in, in my world and in the world of, of sex therapy and sex therapy treatment.

So can you just tell us,  tell us a bit about 

Doug Braun-Harvey: that? Well, I think I would start with. Why there needed to be a book written like this,  and that, that th this, this human behavior. Which I'm going to call from a general perspective for this interview, sexual dysregulation, for whatever reason, somebody is not feeling like they're regulating their sexual behavior very well.

And there has been a significant controversy since the eighties about what exactly we call this. And for the most part. Everybody has been trying to figure out what to call this. And I'm going to emphasize this word [00:04:00] disease. The idea is, is that this human behavior is some sort of a disease, a psychiatric disorder, addictive disorder.

This has been the story since the eighties, that, that that's how people have been wanting to understand it. So is it compulsive sexual behavior? Is it a sexual addiction? Is it a hypersexual disorder? Is that,  impulsive compulsive sexual behavior disorder. I mean, these, these have all been sort of bandied about, but the, the, the, the one thing they have in common, As they've all viewed this behavior as a form of mental illness, a kind of disorder.

 and, and what people have been, you know, really kind of debating is what, what kind of disorder it is, but they've all believed it's a disorder. The one thing that stands out. In the sexual health model that Michael and I have developed without a control sexual behavior is that we do not believe this human behavior is a mental illness or a psychiatric disorder or an addictive disorder.

That is the most significant kind of [00:05:00] cleave here that we're going to be talking about today.  is that everything we're talking about in our model is we're not saying that somebody has a disorder.  and that's, that's really why this book was written. And that's why Michael and I spent so much time elucidating, a model that I eventually, you know, grew out of my work.

I started my first group for men and how to control sexual behavior. I didn't even use that term. Then the term out of control sexual behavior, didn't come come about until a journal article for John Bancroft and.    in 2004, where they recommended that until we have a better idea of this behavior, we call it out of control sexual behavior.

Before that I called it a variety of things, but I never believed in a sex addiction model. So since 93 I've been providing outpatient group and individual therapy without a disease model. Hmm. And, and having to kind of figure out, well, what is this? And so eventually, Michael and I really, really put together this model and built this book.

So [00:06:00] I think that's the most important thing. We're not talking about somebody who has a disease, and that's why the book is written. It's a sexual health model rather than a disease model. 

Tim Norton: Right. Absolutely. And, and I, I remember when I was first learning about the, the sex addiction model was one thing that I really didn't like about it was, it, it kind of felt like we threw the baby out with the bath water.

We threw out. Everything, you know, if we had a client who came in, nobody was asking, well, is this client depressed, bipolar and anxiety disorder, like that suddenly became secondary. And a lot of personality disorders, a lot of narcissism,  and borderline, and, and, and, and that was such a distant thing to talk about, but.

It's really different to work with bipolar than it is, you know,  just depression without mania or, or just anxiety and, and, and the clients would present much differently. And there was just [00:07:00] so many things that were getting lost. And, and I like not thinking of this as a disorder. It's, it's really. It's an aspect of something else that's going on.

Wouldn't you say? Or it's, 

Doug Braun-Harvey: it's a coping, it's a, it's a problem out of control. Sexual behavior is a problem, but many people can have problems and also have disorders. But that, that co-worker th th th th th that are happening at the same time, or ha or inter it affect each other interact together. What you're seem to be commenting on is that at least in your experience in a sex addiction treatment program, the, the, the psychiatric conditions that might be present,  we're, we're, we're not given as much prominence in the overall case conceptualization, but it sounds like you thought they needed to have.

And it, it seemed like a kind of an omission of priorities that, that,   that, that this wasn't somehow really looked at [00:08:00] in a more critically thought out way,  that the sex addiction model was really the model in which their behavior was viewed.  and,  that this is what can happen with disease conceptualizations or disorder conceptualizations.

It all has to kind of, every patient is supposed to fit within that sort of. You know, kind of narrative that's been designed around the particular disease.  and it sounds like you saw all that in your experience. 

Tim Norton: I did. And if somebody, I remember a couple of times where somebody might,   present.

With suicidality and I'd have to chime in and say, look, we're not that kind of clinic. We don't, we don't treat highly suicidal people here. We're not that that's a whole system that there's a whole way of handling that. And we, you know, we, we're dealing more with,  Long-term married people in an affluent neighborhood.

And the guy had acted out four years at a time. And there was a sudden,  a [00:09:00] fare that was revealed and which is tough work in its own. Right. But it's very different than somebody who is actively suicidal. And I'm just saying like, we have to work with this first and we probably are going to have to refer this person out to somebody who's accustomed to dealing with suicidality on a regular basis.

And those kinds of things.  yeah, it's, it's tricky in those settings. And I've seen that in a couple of different,  sex addiction, focused centers. Yeah. 

Doug Braun-Harvey: You also used a word of a phrase that I really like to highlight. You use the phrase acting out. In your sentence. And I wondered about that. 

Tim Norton: Yeah, you 

Doug Braun-Harvey: may have, you may have read my work enough and Michael's, and I work at it to know that he emphasized language and we think language is very important.

And I think the language of acting out that phrase is really also comes from,  you know, disease models and mental illness models that this sort of idea that a behavior. Is representational of, you [00:10:00] know, some more deeply,  you know,  kind of underlying psychological or psychiatric conditions. And so that's just sort of acting out of an unaddressed mental illness.

And I really, I really take umbrage at the use of the word acting out when we're dealing with out of control sexual behavior.  it, I find it a kind of.  when I train therapists,  I talk about how that, that you're really avoiding detailed and specific language about a person's sexual life. So whenever I'm working with a therapist or in a case, conceptualization with somebody, and they say, well, so-and-so acted out.

I didn't want to interrupt you with your podcast, but I would normally, I would normally say, wait, wait, let's want to stop you there. What do you mean by acting out? I don't know what that word means. And oftentimes a clinician or a therapist or somebody who's talking about it, or even a client, a client's is acting out well.

What do you mean? What do you, what do you want me to know about you? That you're telling me when you say acting out and let me get an idea of what are some of the common stories. Some people say when they say acting now, one of the most common is I'm not keeping my [00:11:00] relationship agreements. I've agreed to a certain kind of boundaries or certain agreements of how we're going to conduct our sexual life in this relationship.

And I'm not doing that. I'm not keeping those agreements. And I have unilaterally changed the agreement and I've not told the person I have the agreement with that. I've unilaterally changed the agreement. Now that's a lot to say. So what people will just say, they'll say they're acting out because who wants to say all that that's painful.

That's taking a lot of responsibility for decisions that are injured and hurt people and exploit people. You know, these are hard things to say, so. Acting out is often a shortcut way for people to avoid saying detailed and specific descriptions of their behaviors that are painful and difficult to acknowledge and be accountable for.

Yeah, 

Tim Norton: that that is a painful sentence. I've I like how you said that too. I unilaterally have changed our relationship agreement [00:12:00] and not 

Doug Braun-Harvey: told you. Yeah. And I told you here's the exploitive part. I'm going to keep acting like I have kept the agreement. Yeah. Now I've called that, you know, failure to keep our sexual health relationship agreements is one of the most common,  you know, behaviors as, as to why somebody says their behavior sexually on our control.

Hmm. 

Tim Norton: What would you say is the most. Typical or what your, your, did you just stop doing private practice work? 

Doug Braun-Harvey: I'm I'm PR Tim I'm actually in December. I will be ending all of my work as a psychotherapist after 40 years of mental health work.  I ended my individual psychotherapy work a year ago, and I've been doing my groups now for 27 years, but I'll be Andy and my outpatient group leader work.

The end of December. And my work now [00:13:00] is it's about generativity training and teaching other people,  sort of returning all the knowledge I've been given and passing it on and letting other people do more with the knowledge we have and writing books. So I'm going to be teaching training, writing books,  training other therapists in how to work with sexual health and those CSP, but I'm not going to be providing direct client services anymore.

 and they actually have five weeks. Oh,  five weeks. Wow. Okay. Well,  December 17th is my last day. 

Tim Norton: Alright. And I'd want to save this for the end of the interview, but in case we get so mired in this conversation, but thank you for the work that you've done.  and that's you, you've made an incredible and really important contribution to the field.

Thank you.  yeah. So in the, in the, in the individual work and group work that you have done in these last 40 years, and once you. Kind of, I don't know, developed a reputation as the CSP guy.  what would be the more, a typical two or three [00:14:00] different case presentations that would come through your door?

Yeah, I think 

Doug Braun-Harvey: we've already covered one of them there. Somebody in a,   a coupled relationship. They have agreements as to how their, what their boundaries are within their relationship agreement. And, and I've, I've only worked with man. This is the CSB model is really specifically developed for men of all sexual orientations.

  and I'm going to say cis-gendered men, we've not had a trans,  male client who's presented for therapy. So a cisgendered men of all sexual orientations is really what we're speaking of here.  And, and, and adults 18 or older, the youngest client I ever had was 23. The oldest was 78. So, you know, quite a wide age range.

 and what we're really speaking of here is some people will just not keep their relationship agreement. That's very common.  another common one is their relationship with sexual imagery.  you know,  oftentimes,  [00:15:00] couples or individuals themselves,  have not figured out what is a relationship with sexual imagery that they can feel good about.

That they feel,  pleased with,  that is pleasurable,  and is aligned with their values,  and is something that they can speak openly about to new partners or to their current partner.  the, the, you know, masturbation and the solo sex life using imagery for arousal or desire. Orgasm or increased excitement or,  access to an unconventional turn on that you may not be experiencing in person, but is very rousing and pleasurable to look at.

 these are all reasons. People look at sexual imagery,  for their solo sex life or their partner in sex life. And th this is a very common conflict is, is the whole relationship with, with masturbation solo sex and use of sexual imagery.  and the last one. I would say, I'm going to put under the con the category, the [00:16:00] Michael Figaredo and I speak about in our book, and that's an erotic conflict that somebody has a, a turn on a sexual interest, a fetish unconventional kind of turn on something that might be stigmatized or judged.

If it were to be known that this really turns me on, or I need this particular thing in order to have an orgasm,  People have a lot of conflicts about these,  unconventional turn-ons. They may have hidden them, keep them a secret.  and I'll mention here. One other aspect of the LCSP model is,  we only work with consensual sexual behavior.

So it if I'm talking about an erotic conflict in somebody,  has minor attractions,  or somebody is exhibitionistic, a voyeuristic or fraud or derision is in other words, they. In order to gauge and have this turn on, they have to non consensually engage with another person. And that person hasn't agreed to be part of this.

Uh that's non-consent [00:17:00] and this model is not a nonconsensual model. So, so those are the three would be not keeping agreements,  one's relationship with sexual imagery and solo sex,  and having,  an unconventional or unresolved conflict about how one gets aroused erotically in a very kind of unusual way.

Tim Norton: Okay. Wonderful. So let's unpack those with not keeping the relationship agreement.  what would the, the, the spectrum look like? So the guy who had,  one long-term affair, one short term affair, and what would be on the other end of that 

Doug Braun-Harvey: split? Well, you know, I tend not to use the word affair, so here's what I would say.

A guy. Maybe had a sexual relationship with somebody else. And it was not in the agreement of the relationship. The key factor there is. Did they fall in love with that person or not?  and you know, we, I think we have to reserve a fairs for the line, which a falling in love. Then somebody actually [00:18:00] not only broke the monogamy agreement of the relationship.

They had sex with somebody other than their partner, but they also broke the emotional. Monogamy relationship agreement, which is you're not going to fall in love with somebody else. Other than me, those are two different agreements and relationships that often get merged as if they're one in the same thing.

 so,  you know, I th so I think the bigger issue. Is,  you know, if they're having sex outside of their relational agreement, are they falling in love or not? That's a big, big issue right there.   how frequently her, how often are they having,  sex with other partners that are not within the agreement?

 you know, how frequency, how frequently it is and more importantly, what are the consequences?  you know, are people losing their job? Are they going to lose the ability to raise their children? Are they going to have a divorce?  you know, are they going to,   you know, have a high [00:19:00] conflict divorce?

Are they going to pass a B, maybe have to no longer be part of their religious community?  there, there are just so many consequences that people get concerned about,  and the amount of shame and embarrassment and humiliation that might bring to them.  So I think what, what, what really separates the, the, the spectrum of that first one, the relationship agreements is not so much the behavior they're engaged in it's.

What are the consequences? How severe are the consequences?  that's usually what gets people to come in for help is they've experienced a terrible consequence, or they are really scared, a terrible consequences going to happen. And, and. It's so interesting for one person, the terrible consequence might be my partner will find out for the other person, the terrible consequences isn't that the partner will find out it's that I might not get to raise my children in an intact family.

And they're really not concerned about injuring their partner. I mean, It's hard for therapists to hear this, but they may not really care that their partners that injured, [00:20:00] they think they're going to get away with it. They just don't want to be raising their kids in a divorced family. And that's why they that's what they're worried about.

So sometimes we have to be prepared to hear a consequence from a client that in our moral system, we're going, Oh man, those are crummy morals.  but you know, that's their conflict, right? No, 

Tim Norton: that's a really good point. What I was thinking about. With regard to the other end of that spectrum is in, in the media.

When we think of this idea of a sex addict, there is, there are stories of, you know, somebody who's gone to multiple sex workers and on dating apps,  while married and, and, and, and, you know, and the other partner has an agreed to that. And just going to strip clubs all the time and, and. Clinic or your treatment facilities, would you see that kind of presentation 

Doug Braun-Harvey: as well?

Absolutely. Any of these, you know, any of these sexual activities might be part of what's happening? I think what's different in some of the particularly sex addiction [00:21:00] models. Notice how, as you described the more severity of the behavior, your focus was on the sex acts. That they were engaged in, you know, and I think in particular, many people will see the severity be about how judged those sex behaviors are, how much they're stigmatized, how much they might be morally disapproved of,  how much they might be seen, you know, in a.

In a negative light. So I think in some models, the focus of severity is actually more on how judged the behavior is. The section behavior, our model focuses on consequences, not the sexual behavior itself. Any of these sexual behaviors could have these consequences. And some may not. For example, we have men in our, in our treatment program who it's on their sexual health plan.

 that,  they're single.  and they like to have erotic feelings in their body and they might go to a,  let's [00:22:00] say,   a place where people undress and are nude for entertainment and that that's part of their pleasure in their life.  and that in they're sitting in a group with another person with that exact same activity is what's torn their life apart and destroyed it.

So it's the consequences rather than the, the, the judgment of the sex act itself, that it really differentiates the sexual health model from some of the other models. Okay. 

Tim Norton: And that, that puts it in a really good perspective for someone like me and, you know, in terms of how to approach a case. But I'm also thinking about the partner, you know, who just might get really overwhelmed by, Oh my God, you did all of those things.

And you're saying at the end of the day, really the, the consequences are going to stand out, but I've, I've met those partners who. Want to just make this who want to pathologize, who want to make it a mental condition and who want to [00:23:00] send this person somewhere and say, you know, fix this and there, nobody could do all of those things if they were quote unquote normal.

Doug Braun-Harvey:  but yeah. Yeah, I think I, you know, one of the things I've, I've, I've learned over the years, it's a crisis for somebody to. To kind of question, who am I, what does this mean about me? If I love somebody like, like you, and now I know things about you that I can't unknown and what am I doing with this? How do I understand how I feel about you?

What, what does this mean about how our relationship has been over all these years? These are enormously, and I don't mean to overdramatize this, but these are existential crises in a relationship. And these are crises that happen over the, over the course of many relationships that may not be about not keeping a sexual agreement and exploiting a partner.

But I think what you're describing most important it is hurtful is how do I [00:24:00] reconcile somebody saying they may have loved me or do love me. And they've also exploited me. Hmm. This is, this is a very difficult thing for people to understand. And it's very painful. And so. That sentence is so difficult to understand, but it's, it's, it's, it's,  appealing to see it as a disease.

There's, there's something soothing about, there's something hopeful about seeing it as a disease rather than we have to talk about the fact, but you have explained it to me and I have been exploited by you. Where do we have conversations like that?

And it, 

Tim Norton: would you use the word traumatizing 

Doug Braun-Harvey: if the client needs to use that word? We have to assess it. I think we move a little fast. If we put that narrative on that experience [00:25:00] as a generalized story for clients. You know, we know from the child sexual abuse field, we know people who've engaged in non-con.

Who've been the target of non-consensual sex as minors. That some people that's an enormously, terribly traumatizing experience. And for other people, it is not a traumatizing experience. But they've had the same human experience and I'm very concerned about models that impose those narratives of trauma,  without a good assessment of trauma, you know, w what I, what I think is the word that I hear missing too often is hurt.

Hmm, this is what some people look like when they've been terribly hurt or in shock, or are,  you know, again, existentially they're completely disoriented, right. You know, [00:26:00] you know, you know, those are real time experiences for some people. Those experiences may activate historical trauma. And it may, and this experience may actually maybe be a trauma for them.

It may be the most traumatic thing that's ever happened to them in their lives. But we w I think the dilemma is we, we place this narrative in a general way to describe the experience of two people in a relationship where exploitation has been a solution to a problem, and it's injured somebody deeply.

Yeah, 

Tim Norton: I really appreciate you saying that,  regarding the assessment of trauma. And so maybe for the listeners who don't know how to assess for trauma, could you, could you highlight a couple of trauma symptoms that you'd like to see before actually, you know, using that word? Well, you 

Doug Braun-Harvey: know, you know, I can speak to this for many years of working with men with those CSB who have their own trauma histories, right.

I'm not going to [00:27:00] speak to the partners because I'm not treated the partners, but you know, trauma is when you have. Intrusive thoughts about past experiences in your current everyday life, that something something has happened in, in your environment something's happened in your own emotional state something's happening in your relational experience, where all of a sudden your body biophysiological is having an experience that is in some way, a component of some historical event that was highly traumatic.

You know, somebody might have a body memory that was, that had to do when they were, you know, physically assaulted and beaten on a street, you know, and, and, and, and they're sitting in a group talking about something and all of a sudden, they're, they're flooded with a memory of that. And their body's actually having sensations that are similar to that expense.

And it's terrifying for them because they don't, they don't know how to understand this. How can I be feeling this way? City here. And if they don't know that that's a trauma recall experience, they're going to think something in the room is [00:28:00] highly dangerous and this attribute what's going on and get terrified that somehow they're in danger.

Yeah. 

Tim Norton: Okay. Perfect. And that's, that's such an important point. I mean, not that you know, I don't want to get into semantics when, you know, people use words differently than clinicians do, but it, it, it can be hyper pathologizing if somebody is not dissociating or having flashbacks or nightmares and things like that, like they, like you said, there was a ton of it.

Doug Braun-Harvey: Yes. Yes. Pain. They're having pain. They're remembering something painful. When we remember something painful, that's not trauma. That's remembering pain. Yeah. Yeah. And I don't mean to minimize people who experienced trauma, but I also don't want to dilute the intensity of people who do experience trauma by, by overgeneralizing that word to people who are in a different spectrum of pain than trauma.

Yeah. Yeah. 

Tim Norton: And so [00:29:00] just to clarify before, I want to, I want to get into the, the imagery stuff, but I also just want this to be clear to the listeners that you know, everything that you talked about with the, the, the man who's not keeping.  his relationship agreement. It's w regardless of the details of that, regardless, even of the consequences of that, there's not, I don't want to think that there's somebody out here you're saying, well, that doesn't really apply to me.

No, I'm just an addict. Like you're talking about this and an all encompassing way that this is, there's not somebody, there's not some level of pathology that somebody gets to where, where you're calling them a sex addict ever 

Doug Braun-Harvey: me. Yeah, well, we don't have any science yet that establishes a kind of clear, agreed upon consensus, among many different people who understand this behavior.

We have no [00:30:00] agreement as to when this might be actually a disease or a disorder. I mean, there are people who believe it is. There are people who treat it as it's a disorder, but we still have no agreement,  as a mental health field to say, here's this here's the standards. Here's where you cross a threshold.

Here's where you've now really in the arrange of having a disease. Each attempt to do that,  in the psychiatric manual,  has been now eventually completely rejected. It's just been rejected because the science isn't there. Now we have the international diagnostic manual, which is called the ICD it's the international classification of diseases.

It's actually what every other country in the world uses to classify their diseases except the United States for their psychiatric diseases.  and that has just now come out with an actual disease idea. Of compulsive sexual behavior is what they call it, compulsive sexual behavior. And they [00:31:00] think it's a part of people who have impulse control problems.

There's a psychiatric disorder classification called impulse control disorders.  and,  they think some people might have compulsive sexual behavior who have difficulty controlling their impulses,  in, in, and the difficulty is reflected in their sexual behavior parents. Now, this is an idea it's in the classification.

We don't have it. Studies, we don't have anything. They actually say, yep, we've now studied this. And we've determined. There is a condition called compulsive sexual behavior, but the reason they included it in the classification was let's check it out. Let's, let's call it what it is. Describe what we think it is.

And now let's do some research to see if there's anything to support it. So that that's the closest thing we have. 

Tim Norton: Okay. And the distinctions, I suppose, have to do with, you know, when we're talking about,  drug addiction, when we're talking about withdrawal and we're talking about [00:32:00] tolerance and we're talking about consequences and all that good stuff.

So, and when you say the research hasn't been. Great on that, that it's, it's really hard for them to establish an actual physical withdrawal like you would get from a hair. Well, the, the 

Doug Braun-Harvey: sex addiction field has moved away from tolerance and withdrawal as their defining characteristic for the disease.

They've really put much more emphasis as well as many other, you know, addictive disorders have on the brain.  component of a deduct disorder and looking at changes in brain functioning and neuro-biological changes in the brain. We've looked at this with drugs, of course, and the changes in brain with different drugs, you put in your body how to fix the brain.

But this is a very important area of study.  and those brain studies, neurobiology and key neuro-biological studies,  neuropsychiatric and psychological studies around how the brain functions in the state. Of different aspects of sexual arousal and changes in the way the [00:33:00] brain functions in sexual arousal based on a kind of addictive process developing is really what the sex addiction field is invested a great deal in.

Now the dilemma with as most of the studies that I, and this is a perspective, I find credible as a critique. Is most of the studies that have been done, the FMR eye and the brain imaging studies on how the brain functions in States of sexual arousal,    have been done primarily by people looking at sexual imagery on a computer, you know, these sorts of situations, and then measuring the brains of people who.

Identify as sex addicts and measuring the brains of people who don't identify as sex addicts and see if their brains are wired differently. Based on the fact that they've now entered into an addictive process, that's the idea. And they have seen some differences and based on where the brains light up, however,  none of these studies have been done while people are having sex.

Right. So [00:34:00] the dilemma with all of these studies is it's based on how the brain functions while having sexual imagery or sexual activity being activated by viewing. But we know the brain functions enormously differently while we're having sex. We don't have any measurements of what somebody who's been diagnosed with sex addiction, what their brain looks like while they're having sex.

Yeah, 

Tim Norton: no. I had a Dr. Nicole Prouse on this show,  some months ago and she was very eloquent about that point and speaking from experience cause she actually does do research with people. It's it? 

Doug Braun-Harvey: It's Dr. Process research that I really rely on to make that statement. And I was going to say her name in a minute.

So thank you for saying that because it is Dr. Price who has taught me,  through her studies that, you know, we have to really look at the science. Yeah. And I'll just say one more thing about FMI studies. FMRI studies are where you look at the brain and where it lights up in these, in these [00:35:00] kinds of the technology, Rory Reed, who's a brain neuro-psych researcher as well told me this story, where they were doing some FMRI studies on fish.

And they were seeing if fish's brains lit up differently under these FMR machines, if they showed the fish different colors, so they would show Brad or Baloo and see if the brains lit up differently. And they did. But here's the most important thing about that study? All of the fish in the study were dead.

Oh my God. Now think about that. All of the fish were dead, but they did get some dip. Maybe get reactions on the machine. Huh? What this teaches us is the machines are not infallible. We think when we do research with machines, that the machine is so infallible, the only reason for any data to be a significance is the human subject that's being measured.

We have to remind ourselves these machines have their own fallibility. And so it's an interaction of the [00:36:00] technology limitation and the limitations of the scientific design that I think leads to some of these conclusions that I think are inaccurate. 

Tim Norton: Yeah, then I don't know if I've ever soap boxed about this on this podcast. I could probably fill an hour with the very large conclusions that a lot of people draw from those, those FMRI studies and, and. They're they're very compelling and you know, and I, I love, I would love it if the sex addiction camp would speak in those terms, like there's some compelling information that we've found where there's some similarities between these two brains, we're still going to research it.

We still I'd like to see a thousand subjects in just one of these studies. I'd like to see, like you're saying people while they're having sex, they that's really hard research to get funded. By the way, Dr. 

Doug Braun-Harvey: He probably told you on her program that she had to leave the campus. Have you sail to conductor studies because the university was uncomfortable with people in research labs, on campus, having [00:37:00] sexual activity and orgasm.

Totally. 

Tim Norton: Totally. So there are only a handful of places around the world that are doing that kind of research on a regular basis and incredible basis. So we're a long way from speaking definitively about that. Right. And while there. At the same time you speak, you spoke earlier about the hope that people receive when, when they, they, they have this medical diagnosis or a disease disease diagnosis.

And then there are places that will charge you $30,000 a month, based on that hope that you have telling you they're going to cure this. Yeah. Well, that's another 

Doug Braun-Harvey: thing they're going to cure, but they certainly saying they can help you and they can give you hope. But I, you know, I. I think we have to bring this to a human level.

All of us go to the doctor when we're, when something's wrong. And we want them to tell us what's wrong, right? I mean, that's human, right? This is, this is just something we want. And so to [00:38:00] have the kind of. Pain and, and, and, and fear and shame and,  threat of all sorts of consequences in front of you. And you walk into an office with somebody who's going to help you understand this sexual behavior.

It's enormously relieving to be told you have a disease. And here's exactly what we're going to do. Whether it's, whether it's a useful or accurate or pertinent to that client, clients feel relieved when a medical practitioner is sitting across from them, says, this is the story. And we've got an answer.

Damn. But 

Tim Norton: I've, I've seen this process on you. You have to, I'm sure at still there's two things happening there. There's one, there's the doctor. Who'd probably get sick of saying, I really don't know what to do with this. And once he starts saying, and you're a sex addict, you're a sex addict, sex addict. He gets [00:39:00] rewarder.

She gets rewarded for. For saying that and gets a thriving practice as a result. But two, I've seen that couple experience that relief and no, thank God. It's just this he's, he's got the sex addiction thing and we're going to go, we're going to, and you've got the answers 

Doug Braun-Harvey: for us. You've got tasks to do.

You've got a sequence of things to do. You've got people we're going to meet. Who've done the same thing. This is enormously hopeful for people who are scared and have no idea what's going to happen. Right. 

Tim Norton: And then. 30 days later, 45 days later, he gets out. And what he really has is narcissistic personality disorder.

And he has, you know, he's, he's using maybe he's just doing all kinds of things and 

Doug Braun-Harvey: that could take years, you know, 

Tim Norton: but not a lot of people will say, there's nothing you can do about that. And he's just spent a month and a half meditating and going to groups and doing all these things and in a really lovely place, but he could be years from being even slightly different.

And [00:40:00] if ever, and there's such a, almost like another level of hurt for the partner in that situation, he was like, what did we just do? You know, what did we just pay all of this money for? He's the same guy. He's actually a little worse now he's the same guy, but he has a narrative explaining. All of the things that, you know, the reasons why he's doing things and he's blaming me for stuff.

 yeah. And that that's been, that was, that was eventually what chased me away from that was just watching that several 

Doug Braun-Harvey: times in our model for treating out of control sexual behavior. We see the out of control sexual behavior as a problem, not a disorder, but that doesn't mean we're not assessing and looking at real diagnosable conditions that might contribute or actually explain why they're feeling sexually out of control.

For some of the people we look at, are they in a situation of fit they're not safe, there's violence or lack of safety in their home, or you mentioned earlier another, another aspect of physical safety. That [00:41:00] makes,  sexual behavior possibly feel less regulated or not a control is somebody who might be suicidal.

That's another form of violence, you know?  you know, I, I, I, I approach life that I could eventually just end my life as a, as a treatment plan for the distress in my life. You know, that that's, that may impact or impair somebody's motivation to change, or it may regulate their sexual behavior more effectively because they hold out the idea.

I can just end my life as things get too bad. But for some people that have medical conditions, I mean, we, there's lots of research out there that shows real medical illnesses and conditions that you are medications can cause hypersexual behavior or certain psychiatric,  medical conditions, Parkinson's disease, other things.

These actually have hypersexual disorder things. So you have to look for. Are there medical conditions that could explain this,   and then, and then we also have to look at,  medical conditions related to sexual functioning. Might somebody have an unaddressed erectile dysfunction or orgasm difficulties or, you know, or maybe they're, again, maybe you have a conflict about who they are sexually [00:42:00] and they don't, they're alone with this.

Men, oftentimes they're isolated alone with these problems. They come up with these treatment plans all on their own. And so what looks like out of control sexual behavior actually is some sort of an attempt to address a medical or physical condition related to their sexual lives.  and, and,  it's not a great treatment plan, but if they're trying to do something about it, Many people as you've alluded to have mental mental illnesses,  they may, you know, have you mentioned bipolar disorder, they might have personality disorders that might have depression, anxiety disorders, ADHD.

They might have PTSD.  there's there's so many range of the kinds of mental health issues that could be in the office when they're walking in. But yes, there are sexual behaviors out of control, but they might have an,  not significantly a well-treated enough anxiety disorder conditions. It's just not being treated well enough.

Or they've never been diagnosed for depression and they've been living with kind of, you know, depression their whole life, and it's never really been identified. And the last area we look at is their relationship [00:43:00] with drugs and alcohol, a significant number of people who have sexual dysregulation feel out of control sexually in their wives.

There. Using substances in a dependent and out of control manner, they might, they may have alcoholism that's so out of control,  you know, that there's really no hope for regulating the sexual behavior until they treat their alcoholism. A subset of men who have sex with men.  is a, is a it's called chem-sex.

This is really term. We came out of the United Kingdom, but there's a certain series of drugs on GBA, GHB, and, and other kinds of club drugs that people use. Men who have sex with men will gather together in large group settings, either in homes or in sexual venues and use these drugs have prolonged sexual experiences sometimes for days at a time.

And that's called cam sex. And so some men might who have chem sex patterns. I think that, you know, they have out of control sexual behavior or sex addiction and, and it's really this interesting Kim sex issue. So, you know, [00:44:00] all have to be looked at before you even begin to think, Oh gosh, maybe they have out of control sexual behavior.

We gotta, we gotta figure this out first to make sure we're not jumping to conclusions. Or as I like to say that our field suffers from premature evaluation. And there's help for them. 

Tim Norton: Yeah, that's really well put it is a premature evaluation and when you're kind of looking for. Yeah. The, the thing that we've been talking about this whole time, then a lot of that gets missed.

Doug Braun-Harvey: I think the idea you're talking about, and there's research for this, this is where this is a real human behavior. You're talking about confirmation bias. Confirmation bias is when somebody has a particular idea of something and how they understand things to be, or they need to see or want to see a particular way.

But. They, the human brain will do this. They'll filter out information, then it contradicts,  the, the idea they, they, they think explains the situation.  this is true for, this is just a [00:45:00] human behavior. Yeah. And so the LCSP model as Michael and I, but when you have a sexual behavior, that is so little understood.

There's no consensus about exactly what exactly the nature of this is, how to best treat it. It's something we know very little about. You know, the mental health field has a terrible track record of doing well in those situations. They've they've they thought they understood something only to 20 years later have to say, no, that's not the case.

We were wrong. So.  the LCSP model is based on the ethical principle of protecting the client as best we can from us. That we need to be trying to not, you know, prematurely place ideas or narratives on,  within a client's situation of having out of control sexual behavior,   in a way that,  doesn't really, really slowly and carefully help the client understand their situation and their [00:46:00] individual situation without applying a broad brush generalization to their situation that may.

Actually be inaccurate and could actually be even harmful. And that's 

Tim Norton: so important when we're dealing with 

Doug Braun-Harvey: sex. 

Tim Norton: Yes. There's such a tendency to stigmatize, as you've mentioned earlier as stigmatized sex and so many different aspects of culture and life and society, and to down to governmental policy,  that if you tell somebody they have a thing, their sexuality may never recover.

Or may, maybe really detrimentally effective for decades. Yes. 

Doug Braun-Harvey: Yes. The, these, these ideas of a, of a diagnostic, you know, kind of label for one sexual behavior sexual activity,  is, it needs to be thought of very carefully. And so if, if at some point [00:47:00] the science actually does come through and we have a consensus yet there is a disorder, there is a disease of some factor of how to control or, you know, set.

We're going to call it dysregulate sexual behavior. There actually comes into great, but there's still going to be many people. Who do not meet that diagnostic threshold who are going to have problems with feeling out of control, not everybody who has that is going to have the disease. So our model can still help the people who don't cross that diagnostic threshold.

And they, and we are this, this sexual health model can be quite useful for them. Even if a disease gets established. 

Tim Norton: Let's shift over to the second kind of client that you said would,  come into the practice a lot at the one who's really struggling with his relationship. Yes. Sexual imagery. Yes. Sexual imagery in, and some people might.

Call that a porn addiction, 

Doug Braun-Harvey: actually 99% of the people at 0.9% of the people in the world call that porn. [00:48:00] You know, you know, I th my, our sexual health languages, we use the word sexual imagery. We describe what the media is without trying to use a pejorative or judgemental language pornography is, is not,  it really has a pejorative history to it, a judgment.

Yeah. 

Tim Norton: So tell me about working with this population. So these, when they're coming into for treatment, is it more often that it's somebody who's just worried about. His relationship to it while he's not in a relationship or is it was most of your clients actually, their partner was taking issue with what they were doing or is it a little bit 

Doug Braun-Harvey: of both?

You know, I think there's three circumstances that come to mind. One is somebody who has recently lost a relationship that they hold held. Dear. There's been a real loss,  as a re  in, in their, in their understanding of that [00:49:00] relationship ended, they lost that relationship, having something to do with their masturbation life and sexual imagery, whatever it may be.

Again, some people are single, not in a current relationship, and they're concerned that their relationship with sexual imagery is, is so out of control or is so worrisome to them. That they believe it's actually interfering with finding loss and that they believe that that they're actually going to not find a love in their lives.

They're not going to find a part or there they're, there they're dooming themselves because of their relationship with sexual imagery. Some people are very concerned about that.  and then other people are very concerned,  about,  the secretive sexual life they have with imagery,  within their partner relationship.

It's either been discovered or it's been discovered many times and they've made promises and there's, you know, to change. And those changes haven't happened.  you know, th th th those are the three most common [00:50:00] relationships with sexual imagery. Some people come in, you know, and they're, they're conflict with sexual imagery.

They could be in any of those situations, single partner, whatever.  and they're very disturbed about the images they're looking at. Hmm. You know, th th th it's like, I can't believe this turns me on, Oh my God. I, you know, they're, they're, they're just like, they're just mortified or they're thrilled that it turns them on.

They love it. And somebody else hates them because it turns them off. Or is disgusted by them because it turns them off or, you know, thinks they're perverted. I hate to use that word, but that's an allegation that'll be used.  you know, so you know that those are big deals and they, and they all come in and say, I have a sex addiction.

Right. They all say 

Tim Norton: that. Yeah. Which is,  do you have just [00:51:00] recordings that you refer that you must, must've gotten sick of having to explain that? 

Doug Braun-Harvey: No, I don't get sick of explaining it because I don't want to take this away from people for their use of the word sex addiction. First of all, that's what the culture has given them.

That is the language they know.  and then quite frankly, that phrase might be what gives them hope. You know, so I, you know, I, it doesn't bother me that a client uses that language as, you know, as part of their early relationship formation with me.  they're just not going to hear me say it.  you know, so, you know, I, I, it's really important.

You don't want to take hope away from people and, and, and certain words and certain times, so,  you know, I think there's an interesting. You know, kind of responsibility of, even if you, you know, don't think that language is accurate because this is a human behavior. We know so little about, I can't just say absolutely that that's not true.

That doesn't exist.  you [00:52:00] know, there are, cause there are heat. They could walk right down the street and meet another professional who says right on that's exactly what you have. So, you know, I can't like just hold it like with other diseases, we have agreement to what they are. And so somebody uses the word and it's inaccurate.

They could probably go to 10 other people. And they'd all say the same thing. It's not an accurate word. So we, we have to be careful with this languaging of this in our offices.  letting people come at their own pace and coming to terms with. You know, when they're exposed and learn about the sexual health model, how they eventually might possibly begin to think about different language.

Hmm. I don't think it's an emergency because somebody uses that word in my office. Yeah, no, definitely 

Tim Norton: not.  W we've kind of started to, to wander into this area to a couple of different points. This is a podcast about erectile issues. So let's just segue from what you were just talking about there, of those three typical kinds of [00:53:00] presentations.

You didn't mention the guy who comes in because all the sexual imagery that he was taking in had led to an erectile malfunctioning. 

Doug Braun-Harvey: It happens.  in other words, what I mean by it happens is people say, this is their story. That's what happens.  you know,  again, this is premature evaluation. Somebody is having difficulty with their erectile functioning and they have come to the conclusion that it's correlated or completely linked with the fact of their relationship with sexual imagery and their masturbation practices.

 the science is beginning to reveal. There's many explanations for this.   one of the least likely explanations is that they have a biophysiological erectile dysfunction that can be measured.  I did have a couple of clients that however, who came in and said I was a porn addict.  and what the situation was is they actually [00:54:00] had low blood flow.

To their penis, which was a biological condition from birth.  and they had adapted to looking at sexual imagery as a way to kind of as their own kind of erectile therapy, thinking that if they masturbated,  they could. You know, gauge their penile tumescence, or they could gain confidence in how they could have orgasms while masturbating.

So they might have more confidence during partnered sex,  you know, all of this, but they, but they began to somehow think that their erectile difficulty was because of watching sexual imagery when actually their use of sexual imagery. What's that such high frequency, because they had an existing erectile dysfunction that was biophysiological caused, right?

Yeah. So it was, the imagery had nothing to do with it. Yeah. So there's a lot of thinking anger's here. Another,   porn addiction,   kind of narrative will be that somebody has a very [00:55:00] unconventional turnout.  and the only way they see it as can turn on is through going to,  imagery online. Let's say they,  you know, they like,   they, they like,  somebody being tied up and being restrained and they imagine they're the person being restrained when we're watching this.

And that fantasy state is very highly arousing for them. And they learned that this is actually their most preferred way to have. You know,  highly pleasurable, you know,  you know, sexual fantasy and arousal and body sensations that gives them the most pleasurable orgasms. And then they're in the middle of partner and sex and they th this fantasy isn't accessible to them.

They can't have the body experience of restraint because they're in the middle of having a partner in sexual activity. And so they've been, they've learned, this is such an important arousal, and it's a secret to their partner by the way.  and all of these things are inhibitors that get in the way of sexual excitement.

And so th these inhibitors are now [00:56:00] interfering with their ability to be excited.  and so they're not sexually functioning as well, and the client will make the connection. Oh, this is because I'm looking at imagery. When actually they have a conflict about what turns them on, where do men learn? How to say I have an erotic conflict, what a men learn to say?

There's something that turns me on that I feel so ashamed of. And I, if I think about it while I'm in the middle of the partner and sex, I feel ashamed of it because I'm not present with my partner. And then I lose my erection.  and then my partner knows I just masturbated two days ago. And so it was all of us to be because you're masturbating too much.

And that's the story in the couple. Because the erotic interest can't be discussed. It's too shameful. It's too painful. So the porn addiction is the better story because then you don't have to disclose your erotic conflict. 

Tim Norton: Right? No. I love that. Where do men learn that they have an erotic conflict? What are they learning?

Doug Braun-Harvey: That's right. Where do they learn to say it? And I can tell you in, in, this is one of the criticisms I have of many of the [00:57:00] treatment approaches, notch, the sex addiction, many of the treatment approaches for this behavior.  don't have really thorough and really slow methodical ways of helping men begin to  identify an erotic conflict that they have.  without that orotic interest being seen as something wrong with them. As I like to say to the men, we work with no erotic ectomies here. We're not going to remove what erotically arouses you. That is not the point of this therapy. We're going to try to help you enjoy that erotic arousal as much as it's designed for pleasure for you.

And. Keep your relationship agreements and not violate basic fundamental ideas of sexual health. There's a way to do that. Okay. 

Tim Norton: So. What about, I think the, one of the more common tropes though is [00:58:00] so that the competition, right? So guys, and 15 year marriage, two kids, and now he's watching a couple hours of porn a night after his wife goes to sleep and he's, you know, watching college gang bangs and, and you know, his wife is not 30.

College students every night, right in that comparison. And I think our, our culture says, well, like she can't compete with that. He's desensitizing himself. To, you know, being able to be turned on and then she'll never be able to turn them on again, 

Doug Braun-Harvey: there's about five different sexual narratives in that one situation that could all be part of it.

Right, right, right. But the easiest story is all of the problems this couple is having in their sexual life is because he looks at this imagery. That's the dilemma with that story. There's so many possibilities there. The biggest word that comes to my mind [00:59:00] in that story is avoidance. This is a couple who, you know, and, you know, for all sorts of reasons, they're, they, they they're busy raising kids.

I mean, who knows? There's so many things going on. I don't know what all those circumstances are, but I know that one of the most common approaches to sexual concerns in couples is they avoid them. They don't who teaches couples, how to talk about their sexual lives with each other. I mean, I ask people when they come in, what's your masturbation agreement in your relationship?

And it's like, what is that know? They don't even know what that is. He's like, what do you mean? We don't even, they wouldn't even know each other, man. They don't even know if each other masturbates no less than what their agreement is. Right? So the dilemma with all of these avoided problems in couples around their sexual lives is they get avoided until somebody hurt.

 And that's the dilemma, the injury carries too much weight [01:00:00] for understanding the big problem. You know, that there's a couple of you described that that's a 10 year arc 2015 year. I don't know what it is, but there's a whole lot of things that could have contributed to the situation they find themselves in the sexual imagery is the easiest target.

well in her book,    the state of affairs,  and mating in captivity, both,  talks about when couples lose desire,  for each other. And they've got a Arctic vitality of couples.  it, it, you know, there's a lot of reasons why, if I were erotic, vitality can be lost in couples. And then sometimes the masturbation monies is the way a person is.

Keeping alive their erotic cell, because there's no other place for it to be on life support. Now, are we going to call that a disease or are we going to call that [01:01:00] lifesaving techniques? It's all about perspective. Yeah, no, it really is. Really is, but notice how, what I'm saying is this is hard work. This is difficult work to explore and figure out why this couple is in this situation.

Whereas the porn addiction story creates a ready-made narrative that doesn't require the kind of in-depth individualized, painful exploration of two people looking at each other and trying to figure out how we got here.

And that's, 

Tim Norton: that's very daunting. It 

Doug Braun-Harvey: is. So, you know, gimme porn addiction. All right, here we go. Yeah. Go 

Tim Norton: and stop watching this for 30 days. Join, join the no-fat movement. How do you feel about those guys? The a no fat burners and the, this is your brain on porn and all these 

Doug Braun-Harvey: things. So you've got to remember, there are [01:02:00] these sorts of ideas about sex thrive in every culture.

Hmm. You know, where eliminating certain sexual behavior is the solution to complicated conditions and situations. You know, what draws somebody to those particular interventions? What draws somebody to go to a site where you learn how to stop masturbating the motives for that can be very many and very wide.

You know, I, I wanna, I want to remind viewers that there was a time in our country. When people who had same-sex attractions,  the mental health field provided a therapy that said we could make that go away. And people came to those therapy services in droves. We live in a culture that as long as somebody offers a viable solution to sever.

An erotic interest. They'll always be a commodity of people who find that very appealing. So I have no, I don't begrudge [01:03:00] those resources. They've always been there. The mental health field for crying out loud, licensed mental health professionals in this country 40 years ago were pretty much offering the same thing.

So I w who are we to cast stones? It's, it's just that they'll always be a group of people who want this solution. Yeah, 

Tim Norton: who, who, the first thing they want to point to is it's, it's the sex 

Doug Braun-Harvey: in a, in a, in a Puritan culture, which we are, it comes from our very origins,  that, you know, in our culture,  being uncomfortable with sex,  is,  a very powerful position to be in.

You know, when you're comfortable with sex, you don't have, you don't have power in our culture. The people of the power who are walking the room and say, that makes me uncomfortable. Stop it. They have the power, the people adjust to the people who are uncomfortable about sex

[01:04:00] yeah. And this happens in families and couples. If, if one person or a couple says that's disgusting, that makes me uncomfortable. I don't want that. They assume the rest of the system will adjust to them because their discomfort should be the power. They're discussed should hold forth. Right. And 

Tim Norton: were pushing back on that a little bit.

Doug Braun-Harvey: That that is that's the ebb and flow, right? That's the ebb and flow. And it's always been in all cultures and over history. We can go back through history and see, there were times this tension always exists and it ebbs and flows. It ebbs and flows in couples and ebbs and flows and cultures and ebbs and flows and families and it, and flows over time.

And so we just have to kind of put this into perspective. I 

Tim Norton: don't know if it's just because of the world that I'm in and being around sex therapists in, on, you know, seeing your emails in a, a list serve and things like that. But [01:05:00] I do feel like we're in a, a bit of a sexual explosion right 

Doug Braun-Harvey: now.  I think for me, the number one impact on the sexual lives of everybody on the planet is the internet available by a cell phone.

Hmm, these are sexual toys that we get walk around within our pocket, 24 seven, the, the access to talking about sex in privacy with other people, the access to seeing sexual imagery and sexual activity is, is. Is is literally never been unprecedented in history of the hue of humankind.  and so, you know, I like to remind people that the, when the automobile was invented, we didn't realize we had to teach people how to drive automobiles and give them licenses until the automobile had been around 30 [01:06:00] years and people were dying in car accidents everywhere.

It's so many figured out, well, maybe we better issue driver's licenses. So we have to respect that the internet and the access to these kinds of sexual imagery is very new, very new for people to understand. And so we don't have cultural norms. We don't have you, you know, established ways of relating to this as far as sexual imagery.

And so we, we, we gotta be careful to call people who don't know how to use this as well. As the ones with the problem, you know, there's a time of an adjustment. It takes a huge amount of adjustment for these kinds of changes that only happen every now and then. And then of course the history and we're in one of them right now, right now.

Tim Norton: Yeah. Now that I love that analogy. We have to teach people to drive. I actually recently did some work with PornHub and I feel very strongly about that. Like, because [01:07:00] they have such a presence that at some level we're going to have to take a real strong look at. You know, putting out sex positive instructional porn that might be seen by a lot of people that, you know, are, are watching porn and accessing porn otherwise.

Doug Braun-Harvey: Well, there's a, there's a, there's a movement that's just beginning,  to, to even be able to be spoken just even to be said and it's, and it's called porn literacy and, and that's the phrase that is being used in the, in the, in the sex ed field.   because it's a way for people to understand they're talking about, so you have to say the word porn, just like you have to say the word sex addiction.

So people know what we're talking about. So porn literacy, you know, that, you know, just like driver's license,  you know,  you know, it, it takes a while for people to understand that this is actually not a restriction on Liberty. This is not a restraint of, of [01:08:00] expression.  th this is actually a responsible thing to do with something that has major consequences when you don't have literacy on how to use it.

Right. If 

Tim Norton: we don't offer. Porn literacy courses, it would be like, well, let's put somebody in a car without taking drivers. 

Doug Braun-Harvey: Yeah. And we did that for 30 years, by the way. So it's not like we haven't really, we did not have driver's licenses for 30 years after the car was invented. The first driver's license was issued in Pennsylvania in the late 1920s.

God. Right. So cars were around for almost 30 years.

Human to, Hey, this is what human behaviors like we have to, we have to go back to history and, and get comforted by looking at history that this is just another re you know, another cycle of the same human response to significant change. Hmm. We [01:09:00] didn't, we did like people who got into car accidents, diseased.

You've got a mental illness. You got into three car accidents in the last five years. This was 1920. Hmm. Hmm. Well, that's, 

Tim Norton: that's a hopeful point. That, that was one of the last things I wanted to talk about was I didn't mean for me or us to, you know, by challenging. The sex addiction model to say that this is hopeless.

And I was hoping that you could close with, because you've worked with also with addiction, you've worked with and alcohol treatment and drugs, where there would be sexual acting out in conjunction. Can you say that differently? 

Doug Braun-Harvey: Then sexually, I want, I'm going to channel, you can tell me what, tell me what you're saying.

Tim Norton: I would be saying there would be the sexual breaking of agreements and there would be,  erotic conflicts that happened,  while in conjunction with. Taking more [01:10:00] drugs and alcohol than they had wanted to, to your point on. And I am a big fan of looking at language and I appreciate the correction. What was your question?

I 

Doug Braun-Harvey: interrupted you. Could you say so, so 

Tim Norton: the hope for the OCS B client who actually does reach that diagnosis, who might be in, you know, and also,  struggling with just impulsivity or out of control,  Behavior in life. Like what is, what 

Doug Braun-Harvey: is the, I think, I think the first thing is is you, you need to figure out who you want to talk to about it.

If there's something you've heard me say here on this podcast that sort of excites you and interests. You see, if you can find a therapist who works with,  sexual dysregulation, that's the general term I use,  from an OCM,  you know, from a sexual health perspectives. Sees it as a problem might consider it as an out of control sexual behavior, not a disease or disorder, [01:11:00] if that's important to you, if that seems like a source of hope for you, there are people that you can find in perhaps in your region.

 there not as many of them, but you might find some people who are at least willing to work or learn or have been trained in this method. If you've listened to this podcast, And I sound like a quack,  and that this is dangerous talk and that, you know, you're gonna, you're gonna, you're gonna endanger people's lives by not calling them a sex addict.

 the, you know, that you're a fool,  then you need to call a sex addiction therapist because that's where you're going to find help.  and, and as you, as you said, sometimes you'll find people who started at the sex addiction. Stage and found themselves in your office because for whatever reason, the hope wasn't there for them anymore in the sex addiction model, but who knows, maybe they need to just start there to get where they are now.

I don't know, but I'm, I'm more interested in [01:12:00] empowering clients, empowering people to, to walk in a door where they think they're going to find hope. And the problem was there was only a one door. Primarily, and that was sex addiction. And I'm just interested in offering more doors and ours is a sexual health floor.

Tim Norton: And you could say with confidence to that person who comes in and says, I'm worried, I'm never going to have a, you know, they'll say healthy, I'm never going to have a healthy or a normal sex life ever again. And you could say what to them, 

Doug Braun-Harvey: why did you come up with that idea? This is what I'd say to them.

How did you decide this? W where did, where did you come up with that idea? This is their idea, and I'd help them figure out where it came from. Hmm. I'm not going to give them some glib answer that Sue's their fear. I don't even, I don't know enough about them. Maybe that's an accurate assessment. I don't know.

I have no idea. [01:13:00] I got to get curious. 

Tim Norton: Yeah. Okay. Very well said. All right, Doug. Well, do you feel like there was anything else that you wanted to cover in 

Doug Braun-Harvey: this? Well, I, I guess I just want to say to you, Tim, the conversation we've had today is a little different than the conversations I've had with other people in some of the media work I've done because of your experience.

I really, I just want to applaud you for having, you had your feet in several pools. Of sexual behavior concerns and that that's, you know, I just want to applaud you for that journey because that's not an easy journey for clinicians to do.  and I'm just heartening to talk to you. And the questions you've asked, show me that you have a lot of experience in this area, this, that you really, I talked to other media people and they conceptually understand these ideas.

But it's real, it, it shows in your questions that you sat in the rooms with, with these various ways of working with this population and [01:14:00] it made for a richer conversation. So thank you for that. 

Tim Norton: Oh, absolutely. I really appreciate that. You know, that, that, that this, this is what we love. This is what we do. And this is what you have loved and done. You're you're at a, you know, this is a big changing year for you, so you are going to, you're still going to work, but you're just going to focus on training, training, teaching, and writing. Okay. Training teaching 

Doug Braun-Harvey: writing. And my clients know about this decision.

My clients know my motivation for this decision. And so I can, I can say this to you on this program and it's not anything I haven't also said to the people who I'm saying goodbye to. 

Well, I can tell from your eloquence and insight and experience that you're a wonderful trainer and I I'm really glad that you're going to continue to do this work.

Tim Norton:  where can people find you?  the website for the company?

Doug Braun-Harvey: My husband and I co founded in 2013 called the Harvey [01:15:00] Institute. It starts with the, the Harvey institute.com and then you'll find all the information about. The services of education, training consulting,  and all of the books, the three books that I've written, journal articles,  media,    interviews,  a variety of resources,  and then full information about the sexual health model here that we've spoken about today.

Tim Norton: Okay, well, fantastic. Well, thanks so much for this, Doug. This was a wonderful, I, you know, when we spoke originally, I, I think we could tell, like this would be a good conversation and I'm glad that we're offering that perspective out for, for other people. And thank you so much for your work 

Doug Braun-Harvey: and your work.

Thanks Tim. It was great to be here and, and you were a good sport. Thank you. 

Tim Norton: Thanks to all my friends and family for brainstorming this show with me. Shout outs to the sex positive community, including sex educators, sex therapists, sex coaches, and other fellow sex, podcasters, sex surrogates, academics, sexual health, medical community, sex workers, the tantric community, and everybody else involved with having hard [01:17:00] conversations. Bye-bye.

If This Episode Resonated

If this episode spoke to you, there is a path forward.

Tim Norton provides a discreet, evidence-based therapeutic space where men and couples can understand the deeper systems behind desire, arousal, and connection. His work combines rigorous neuroscience with a grounded, relational approach to help clients rebuild aliveness in their bodies, strengthen partnership, and create lasting change.

How to Get Better Erections with Self-Compassion with Dr Christopher Germer

About this Episode

In this episode, Tim speaks with Dr Christopher Germer, clinical psychologist, Harvard lecturer, and co-creator of Mindful Self-Compassion. They discuss how self-compassion directly impacts erections, anxiety, and emotional regulation. Dr Germer explains the science behind rumination, shame, and the nervous system, and offers practical tools for cultivating erotic presence, ease, and confidence.

Key Themes

• How self-compassion improves erectile function and sexual confidence

• Reducing anxiety and rumination through MSC practices

• The impact of shame on arousal and pleasure

• Transforming self-criticism into nervous-system regulation

• Practical exercises you can use during sex (or in daily life)

• How self-compassion strengthens emotional and relational intimacy

Listen to the Episode

Listen Now

Christopher Germer, PhD

Christopher Germer, PhD is a clinical psychologist, lecturer at Harvard Medical School, and co-developer (with Kristin Neff) of the global Mindful Self-Compassion (MSC) program, taught to over 100,000 people worldwide.

He is the author of The Mindful Path to Self-Compassion, co-author of The Mindful Self-Compassion Workbook, and a leading international teacher in mindfulness-based psychology.

Website:

chrisgermer.com

self-compassion.org

Episode Transcript

Tim Norton: Hello, and welcome to hard conversation. Christopher Germer,. PhD is a clinical psychologist and lecturer on psychiatry at Harvard medical school. He is a co-developer of the mindful self-compassion program, which has been taught to over 100,000 people around the globe and author of the mindful path to self-compassion and coauthor of teaching, the mindful self-compassion program and the mindful self-compassion workbook.

He is also a co-editor of the books, mindfulness and psychotherapy and wisdom and compassion in psychotherapy. Dr. Grimmer is a founding [00:01:00] faculty member of the Institute for meditation and psychotherapy, as well as the center for mindfulness and compassion, Cambridge health Alliance, Harvard medical school.

Hey teaches and leads workshops internationally on mindfulness and compassion and has a private practice in Arlington, Massachusetts, specializing in mindfulness and compassion based psychotherapy. Hello, Chris, and welcome to hard conversations. Thank you, 

Chris Germer: Tim. I'm really happy to be here. 

Tim Norton: Okay, great. I'm really excited to have you on the show.

 you know, in, in, in the therapy land, we, we nerd out to certain people and, you know, I don't know in the industry or whatever you want to call it. And,  You know, you're, you're really popular and self-compassion at least among my colleagues, at least along loss among Los Angeles therapists self-compassion is something that I feel like I'm talking about on a daily basis and trying to teach to a lot of people.

And it's a really valuable tool I'd say. And it's really counter-intuitive [00:02:00] to a lot of American or Western ideals, or maybe 

Chris Germer: you. Well said. 

Tim Norton: So a lot of clients I don't take to it immediately and I'm especially some of my more perfectionistic high achieving and go get them clients. And so I, I was hoping to just hear it directly from the expert himself.

And, and how do you feel that, or what's the. Best way for a person to just take that message in that this is a valuable tool. When they grew up in a culture, that's more of a, you know, work as hard as you can for 90 hours a week and get ahead and drive yourself until you collapse. And you can sleep when you're dead is, you know, there's a common effort.

Chris Germer: Yeah. So,  a lot of people actually throughout the whole world have a kind of a cringe reaction to the term. Self-compassion. But just about [00:03:00] nobody.   doesn't like the experience of self-compassion in the same way when somebody is being genuinely kind to us and just the right way, we don't usually be resistant.

We're just grateful, you know? And so a general,  informal definition of self-compassion is,  Giving yourself the same kindness and understanding as you would give to a dear friend. So when we're struggling, when we're stressed, when we fail, if we feel inadequate, which we often have little, you know, little pings up throughout the day,  to have a general self compassionate attitude,  really allows us to,  But it allows us to recover and be more resilient.

 but there are a few main myths about self-compassion,  [00:04:00] as people understand it,  the first myth is that it is like self pity and self pity kind of means, you know, that you're just kind of wrapped up in yourself. You can see beyond yourself. But the research shows actually that,  people who are highly self-compassionate or even just kind of self-compassionate,  are actually, they ruminate less, they're less self-absorbed they ruminate less and they are more able to see their struggles from a healthy perspective than people who are low in self-compassion.

So there's a very clear difference between self pity and self-compassion, what's interesting is there are actually five myths, main myths about self-compassion and we call them myths because the research shows, you know, precisely the opposite. Another big one [00:05:00] for men is a motivation. You know, you were talking about perfectionism that it'll kind of,  make a person feel like they'll lose their edge or something.

And. What's interesting about self-compassion is that actually people who are high in self-compassion are,  their, their standards are just as high. Like they have high standards just like anyone else.  but,  they, they're more motivated to achieve those standards. They're actually more able to,  see and admit when things go wrong and they're more motivated to correct what might've gone wrong.

And. To work hard toward achieving their goals. So self-compassionate, people are not less motivated. They're actually more motivated, but what's interesting is why they're motivated and that's because we can motivate ourselves with criticism or we can motivate ourselves with,  [00:06:00] encouragement. So most people on this call might've at some point had somebody.

Who is, who is kind of who they might've had a coach or somebody who feels like a coach or a wellwisher. And, you know, that's a person who motivates us to,  achieve our best.  but they do it with kindness. They don't understanding, they don't do it by saying, you know, what's the matter with you, you, you know, You're an idiot.

You know, what made you even think that you could do this kind of thing? Basically, they don't talk to us the way we talk to ourselves difficulty when things go wrong. So self-compassion is actually a new voice, a new motivating voice, a voice based on cars. 

Tim Norton: Okay. Yeah, I really liked how you started that.

Talking about rumination.  as we've discussed in it, as you're aware, this is a show that generally talks about erectile [00:07:00] issues and there's a tendency for guys to ruminate when they are not getting cooperation from an erection is, is how we say it.  and they'll really get in their heads. And, you know, what did I do wrong?

And what does this say about me? And I'm a failure. I'm a bad husband. I'm not a good man. And so what you're saying is that someone who is going to show more self compassion toward themselves is going to do that less. 

Chris Germer: Yes, definitely. And, and,  and there are other aspects to self-compassion that would surely help when somebody is having erectile difficulties.

Another core component of self-compassion is that people feel less isolated and alone. They feel more connected with the rest of humanity. So in other words, a guy might self-compassion that guy might be more likely to say, you know, Hey, I'm a guy, you know, this is [00:08:00] what happens for men when we're distracted or when we're anxious or whatever it may be, you know, or if it's organic difficulty like bros, post prostate, or something, to be able to say, you know, this, unfortunately it goes with the territory sometimes.

So the idea is,   when we feel,  alone,  then our suffering increases when we ruminate our suffering increases. And when we criticize ourselves, our suffering increases. And what's interesting to him is that those three points that I just made are precisely the opposite of the scientific definition of self-compassion.

So another, instead of rumination, we have mindfulness or kind of a spacious awareness instead of a sense of isolation. We have a sense of common humanity or I'm not alone. And instead of self criticism, we have [00:09:00] self-kindness and the other thing, and I think this goes right to the heart of,  people struggling with erections is,  those three experiences of self criticism, isolation and rumination are precisely what happens when people feel the emotion of shame.

Hmm. Shame and, and if nothing else, self-compassion, isn't antidote to shame. And there are many interesting ways that that works. I could, we could have that conversation as well, but,  you know, maybe there's something else which we should be discussing beforehand. 

Tim Norton: Hmm. Oh, let's, let's go with that.  because shame does come up so much, like this is, I was reading, this is what you do. When you have podcasts about erectile issues. I was reading the history of,  we call that impotence until not very long ago. [00:10:00] And there were records of, Greeks and Egyptians in their texts, worrying about this and writing about this and coming up with, with,  herbal remedies for ED.

This is something that the men have struggled with for a very long time. So, yeah, to say that it's a source of shame is, is historical 

Chris Germer: and humans have been dealing with shame since a long time. It's a, you know, part of the whole,  garden of story, right. As soon as. As soon as we have a sense of a separate self.

In other words, there's like me and you, and I'm no longer at one with everything in the garden. As soon as we have a sense of separate self, then we start to worry. Am I okay? But what's, but to get to the, to shame in particular, it's, it's really interesting to look at shame through the eyes of self compassion through the eyes of compassion.

Because when we do that, we. We learn a few things. So just let me say, first of all, that shame [00:11:00] is a really interesting emotion. It's a, it's a social emotion. It means I am imagining what you are imagining about me and it's not good. That's, that's what shame is. And it also,   boils down to the. It's an attack on the self, you know, get the difference between guilt and shame is guilt means I did something wrong.

Shame means something's wrong with me, you know? And that's what happens when people have erectile dysfunction. You know, I personally, yeah, I have this, you know, a number of times in my life and each time it kind of. Attack myself, you know, like what's the matter with be like, when I, at the last time it happened, I might've been 55 years old and it meant to be all my God, I'm getting old.

I can't perform anymore and so forth. But what it was was a doubt about myself, but, but not just doubt about myself, the thought [00:12:00] that there is something, this is the cool thing from a compassion point of view.  shame is the, is the fear that there is something about me that will render me unlovable. And every one of us is born with a wish to be loved when a child is born, the child has to, has to basically basic requirements.

One is to breathe and the second is to get somebody to love the child because otherwise the child cancer and we go through our whole lives. Wishing to be loved, you know, and, but, and also afraid that there's something wrong with us. That's going to render us on level. And when, when, when,  when a man, you know, particularly would like somebody to love them, you know, in the sexual area and so forth, and it doesn't work, then they think, Oh my God, I'm now on lovable.

You know? And because sexuality and intimacy and love is so co-mingled,  [00:13:00] generally speaking in our culture, So what self-compassion does, if it's really quite amazing is that,  self-compassion gives us a sense of self-worth first of all, not,  necessarily from what other people think about us, but rather from our capacity to be kind to ourselves, when things go wrong, self-compassion takes us out of that social approval cycle, which is so.

  pernicious in life because we can't get everybody to like us and we're definitely gonna, you know, fail, but when things go wrong in our lives, do we have an inner voice that can support us and lift us up? As we hope our lover would do or friend would do when we find that things aren't working the way we'd want it to.

So,  self-compassion takes us out of that spectator ring thing. And puts [00:14:00] and makes us feel good about ourselves through sheer inner kindness. Hmm. So that's the, that's the foundation of it. This is, this is why self-compassion is a wonderful antidote to shame. And one last thing is that,  when people have erectile issues,  it, it, it is also,  you know, in the general category of social anxiety, but more specifically performance, anxiety and performance anxiety has this kind of vicious cycle.

Like you worry about it. And then you worry about worrying and go tonight. So how do you break that cycle? How do you get out of, you might say a cycle of fear and the way to do that is to change your physiology from a fear state to a care state. And that's precisely what self-compassion to self-compassion moves us out of fear into care by, by doing the thing, [00:15:00] which ultimately we need the most, which is to care for it.

Tim Norton: All right. I think. If people could just take in that last of five minutes segment, that that would really, that really sums it up. That really, I feel, I, I really do appreciate your words there. So let's, let's delve into a little bit of it. Let's start with this inner voice.  So guy comes in,  third session and Annie hears your podcasts.

And he says something along the lines of, of course I've been rendered unlovable. My penis doesn't work. You know, I have so much shame. Can you, can you respond to that or teach some of the phrases or the, the lexicon of that inner voice and what he could start saying to himself? 

Chris Germer: Yes. Yes. Thank you. That's excellent.

So, as I mentioned, the three [00:16:00] components of self-compassion, particularly as articulated by Kristin Neff, who started all the research on this in 2003 are number one, mindfulness. And that means to know what we're feeling when we're feeling it, especially to be able to say,  this is painful. Rather than ruminating and getting into how I'm going to fix this and how I suck as a human being or as a man or whatever, to be able to simply say out, this is painful.

You know, I was really looking forward to this night and it didn't work hard. That's part one, part two is, and it's part of being a man. It doesn't always work when you're a guy, you know, women can kind of fake it. You know, guys have a harder time. They could just say, and this is part of being a man. You know, sometimes it just doesn't work and [00:17:00] I'm not alone.

You know, this is part of the experience, you know, and in particular, when I'm anxious or whatever, you know, it's even less likely to work. So that's part two, which is common humanity. So number one, Oh, this is a bummer. Number two, you know what. I'm not the only person that has happened to. And when we really internalize that, we can even say to our lover, you know, it, you know, it didn't work this time, but you know, let's give it a go again a little bit later, you know, let's see, maybe it'll work next time.

And even if it doesn't work next time, you're still a man, this is still normal. And eventually it'll probably fins on your situation, you know, but this is, this is, this is tough.  It's it's part of being a man. And then part three is actually to have an inner voice,  that we can talk to ourselves. And this is, this is the cool thing too, to ask ourselves, what would I say to a deer, a friend [00:18:00] right now who just called me up or said, I'd like to have a cup of coffee with you because I couldn't tell you what happened to me last night.

I feel so ashamed. If, if a friend. Called us up or asked to see us. And we had just like a minute or two to spend with that person. And, and heart-to-heart say something to that person. What would we say to a dear friend who just experienced the same frustration and whatever those words are. And they could be words like,  dude, you know, You're you're a good man.

You know, this kind of thing happens to us, you know? And, and besides, you know, you know, you think that so-and-so is not going to love you because it is, well, you know what, if you look at the history, you know, you're the best thing that's ever happened to her, you know, [00:19:00] or you know, any, any kind of conversation, but mostly to connect.

With a wounded heart of a friend, and then to turn to oneself. And, you know, just to say, you know, as you might say to a friend, I love you, man. I know you're going to get through this. This is temporary. I've been through this to say that to yourself. Imagine you can say to yourself, you know, it didn't work this time.

Part of being man. I love you. Anyway. You're you're a great guy. This isn't the end of the world. You know, your body knows what to do. It's done this before. Just give it a chance we can do this, but for now, let's just let it rest, you know, some kind of internal conversation that is fundamentally compassionate and supportive rather than the usual.

Hm. 

Tim Norton: Hm. Very well said. It's when that process, though, that [00:20:00] switching from. Being there for a friend to then turning it back towards yourself. I find so many people struggle with that. Like they can go in and I liked how you, in the beginning, you said, this is how you would behave with a dear friend. I hear a lot of people say, this is how they would treat a stranger or they'd be so much kinder to a, a waiter or someone, a bus driver.

And. How. Okay. So why is it so hard for people to be kind to 

Chris Germer: themselves? So I, you know, you're making a really great point, Tim,  because we also find we're not particularly kind to our family or to our children. So the key is actually perspective. In other words, actually the Dalai Lama once said, it's, it's really easy to be compassionate toward others.

Because they're not you.

[00:21:00] What it, what it means is that we're really close to ourselves and we're really close to her, you know, family or our children or something. And when we're really close, we just react. We don't have the space to remain calm and to be kind. Hmm, so that's perspective, but we can also make perspective. And this is why mindfulness is the foundation of self-compassion practice because mindfulness is, is spacious awareness.

Mindfulness is, you know, like I said before, knowing when you're experiencing, while you're experiencing it, if we can step back and to sit and say, you know, this really hurts, you know, and actually feel in our body, you know, that maybe our heart's beating or maybe we feel. Heartbroken in that moment, if we can actually feel that in the moment, our, we actually our sense of self separates a little bit from it, and we get perspective.

And in [00:22:00] that space, we can, we can say to ourselves, and I'm not alone. This is part of being a man. And we can be kind to where we have the possibility of new non-automatic language. When we have a mindful space when we are mindfully aware of what what's been going. Hmm. 

Tim Norton: So for the listeners, what might that moment look like?

So the guy let's say it's the next day, he's on the way to work. He's sitting in traffic, listening to this podcast and. He had a rough night and then the erectile issues wasn't working and he's beating himself up. And so now he's like, all right, what were the things I had to do again? I had to be mindful.

And so [00:23:00] what does, what does that actually mean? 

Chris Germer:  well, it usually means what I had described, which means that just the, kind of,  the courage to. Feel,  sad about it. And, and w when we do that, we're actually not caving. We're actually not going to, it's not going to increase the likelihood that the same thing happens again.

It's going to decrease the likelihood it happens when we can say that I, you know, I feel. Really frustrated and sad about this. This kind of breaks my heart. This was a hot day. You know, it was like such an odd date that I was like all turned inside out around it. Four.

This is, this is really disappointing to me. So that's actually to, you know, kind of the main thing, but let me say something else. There, there is a quintessential [00:24:00] self-compassion question. And the question is, what do I eat? What do I need? And when our heart is broken, because you know, we've suffered, we failed, we feel inadequate in some way, but our heart is broken.

Then we can ask ourselves, what do I need? And there are a few, you know, usually we're not able to answer that precisely so we can ask sort of more specific questions like right now, what do I need to feel safe again? What do I need to feel safe? So maybe I need to hear from my lover that. You know, I'm still loved or maybe I need, can you think of some other things that a guy might need to feel safe, Tim, 

Tim Norton: he might need to feel like, yeah, like she's not gonna leave him.

 that there's not something physiologically wrong with him.  that,  Yeah. Like [00:25:00] what you're talking about earlier. Feelings of self-worth. 

Chris Germer: So those things, you know, maybe someone needs to remind it, mind you. You're a good person. Maybe you need to go to the doctor if you're, if that'll keep you from obsessing, maybe you need to check with your.

Partner a, you know, this is not a big deal for me. Maybe you need to hear that, you know? Okay. So that's safety, but there are other things, what do I need? What do I need to comfort myself? Okay. So I'm like, Oh, maybe I need, maybe I need to hang out with a friend and share it with a friend. You know, what do I need to soothe myself physically?

You know, say if I'm, you know, we'll kind of. Tense about this. Maybe I need to go for a run. Maybe I need to swim. Maybe I need to lift weights, maybe, you know, whatever it may be, what do I need to do? Comfort myself, sued myself also, what do I need to validate myself? That means what do I really need to [00:26:00] know that maybe I don't know now that you know, Is true for me.

And one of those things might be, you know, dude, this has actually happened to you before. It wasn't a deal breaker in that relationship. Why would it be in this? And besides if it is, do you really want to be with this person, you know, kind of thing. So comforting, certainly validating, but then there also,  so that's what we call the inside of things.

The being with part, but compassion also has a young side or an action side, and that is what do I need to protect myself. Okay. So for example, it's possible that this person,  that a person where the rectangle issues actually trying to be intimate with stuff, buddy, who scared him, maybe it was actually a bad relationship or maybe, you know, he's.

[00:27:00] Interrelationship. And this other thing will like really wreck his life. And there's a part of him. That's just freaked out about it and it doesn't work. So then to protect myself would be not to do this. Maybe, maybe your body is smarter than my head. And it's just saying, I'm not going to go there. So that's protecting or providing, providing for ourselves means, you know, Maybe I was trying to make love in the morning and I'm really sleepy in the morning and, you know, Henry just didn't wake up, you know, or, or maybe in the evening, you know, or maybe I drank too much or something, you know, so provide for ourselves means to,   attend to what it is that we need in order to be relaxed and happy in a sexual context, you know, that's providing, and then motivating, motivating, as [00:28:00] I said, is motivating with encouragement rather than criticism.

And so,  surely after it doesn't work out, I know this personally because, you know, as I said, it's happened to me, I'm also a guy,   most of the thoughts in my head are like, Compulsive, you know, like, Oh, what'd, you need to do as quickly as possible. Try it again, you know, before it gets in your head and, and, you know, but that, that's kind of a tense voice, you know, it's kind of,  Chris, you know, get back on the horse and ride fast as possible or you're screwed, you know?

 what would it be to have a,  kind compassionate voice that says, Whoa, dude, you know, Like, let's just settle down a minute. Let's just ask ourselves, you know,  you know, a few, you know, fundamental questions. Like, do you really believe that for all band all the time it works, you [00:29:00] know, you know what.

Why don't you just like, make sure the next time that you're in the right place. And frankly, that you trust this person a little more, that you're feeling happier in your own skin. And so quick. In other words, you can do this, you have done this before. It will happen again. I know, but let's just take a look at it, figure out how to make it work for you.

So this is motivating ourselves with encouragement rather than. You know, compulsive and real and self-critical, so these are answering the question. What do I need? This is really important question to ask after a moment of, you know, quote unquote, you know, failure. And frankly, I think often when people have erectile issues, it's, it's not failure, it's body wisdom, and it's giving us an opportunity to learn 

Tim Norton: something.

Yeah, no, that's again, very, really excellent points. I want to go back to the, you named a couple of [00:30:00] emotions and you talked about,  you talked about fear and, and you talked about, you said this hurts, right? And I find that. A lot of guys, as simple as those sound,  really struggled to identify that in themselves.

And, and that point about mindfulness. I, I always try to guide people mindfully toward recognizing those emotions. Cause a lot of guys out there want to. Have this idea of themselves that nothing can hurt them. And, and they, they don't really need to be afraid of anything and vulnerable. Right. And so, again, he's driving to work and had a bad night, that mindful moment of fear and, and, and hurt.

I think gets skipped over a lot. So, and, and, you know, like straight [00:31:00] to the action straight to the like, okay, now how do I fix this? 

Chris Germer: Fix it. Right. That's that's, that's like the traditional male imperative, you know, six stuff. But so we can fix everything. No, we can't. Especially when it comes to the body, the body has a wisdom of it, so right.

It will not take orders. Barked out well, will not take orders that are being barked out to us. We'll take orders from the inside when there's a sense of safety and comfort. And.  happiness. 

Tim Norton: Totally. So I'm wondering if you, if you have come across this or just ever broken it down to its nuts and bolts of how do I even recognize fear in myself?

Like I've never been afraid of anything. Yeah, 

Chris Germer: yeah. Yeah. So how do I recognize for you? I think this is, this is really [00:32:00] key. The area of, you know, a rectanglish is because,  it's not helpful to be. Afraid, but also it's especially not helpful to be afraid of being afraid. So what we want to do is to just be able to will to hold one, number one, that I'm afraid, number two, that I'm afraid of being afraid, but then actually change the channel and change the channel by being kind to ourselves, you know, but an answer to the question, like how do I know when I'm afraid?

I think this is really close to a lot of the.  kind of traditional ways of working with erectile issues, which is to help people to get in tune with their bodies, you know, to know when they're afraid. And so we can feel fear in various ways. We can feel, for example, if our finger tips are invoiced or cool, we can,  sense [00:33:00] when our thoughts are racing when we're kind of spectators rather than in our bodies in.

You know, the engaged in the actions that we're doing.  and,  you know, our, our hearts could raise our blood pressure, go up, we'd get headaches. You know, I was once really, really nervous on a date. Then I got like a splitting headache and I almost vomited it dinner. And needless to say that particular evening didn't go well.

And from a erectile point of view, because I was in a state of. You know, extreme stress. Yeah. Anyhow. So I think it's just really helpful to know that fear in general,  we need to know fear when it's happening, but we also don't want to get like afraid of fear because that's called panic. And that is also part of.

You know, the, the [00:34:00] cycle that can occur, but the cycle is not a problem in and of itself. What it is, is an opportunity. It is an invitation to change the channel. It's an invitation. And this is, I think if, if anything, if I can share any message about self-compassion,  on your podcast, in the most essential message, I think is that,  What we're, what we're doing with self-compassion is being kind to ourselves simply because it's not working.

In other words, I'm afraid. So assuming I'm afraid of being afraid. So assuming this is called human physiology. And can we in this whole conundrum in this, in this, you know, kind of. A whole fixed, can we be kind to ourselves simply because this [00:35:00] is so and what people usually do at least initially to him when they learn self-compassion is they think, Oh, cool.

You know, I have a new strategy. I'm going to, you know, I'm going to knock this problem out.  with the slick new strategy called the self-compassion. And so then they throw, they, they think they can throw self-compassion at the anxiety or at the fear of fear or,  you know, their penis or something. And it just doesn't work.

So we have a saying, and this is, this is the most essential thing. And that is when we suffer. We practice self-compassion. Not to make things better, but simply because we feel bad simply because we feel bad. So can I love myself? Can I be kind to myself? Can I be supportive of myself? Because my penis isn't working, [00:36:00] can I just be kind to myself because this situation really sucks.

And I feel miserable and I have so much self doubt and I have so much worry and my heart is broken and I can't imagine how this is ever going to work. Can we love ourselves because of that? Can we be kind to ourselves and supportive of ourselves, be a good coach to as well because of that, rather than using self-compassion to manipulate ourselves into some other new physiological condition that we think is going to make it all built better.

This is absolutely essential. Hm 

Tim Norton: Hmm. Thank you so much. There's a real advocacy. Coming from you there that's,  you know, you're obviously very passionate about your work, but it, it sounds like you're helping people stand up for themselves. 

Chris Germer: Yes, indeed. And, and, and, and for their humanity, you know, [00:37:00] we're not standing up for some crazy image of what it means to be a man.

We're standing up to the man that we're standing up for the man that I am. Hmm. Know, you know, in other words, masculinity is not something out there. It's the way I am. If you want to know what masculinity is, you get 12, 20 male identified people in the room and that's it. So, so we're not, we're not comparing ourselves to some crazy notion of what it means to be a man we're actually giving ourselves permission to be more fully human.

This is, this is ultimately what makes the mind work, makes the body work and brings our life satisfaction. And it's a, it's a good thing that the penis doesn't always work because often it shouldn't work. And so if [00:38:00] we kind of try to. Make things happen. You know, we, we got to trust the body. We got to trust our humanity.

We got to trust our minds and we got to love ourselves when things don't work and then we can live happily. And truly, 

Tim Norton: no, there's so much there. Let's start with. So when the guy, when you're helping somebody stand up for themselves, I'm thinking about the guy in this situation and who, or what. He's standing up too, and all the messages from, you know, both at the macro level and in the bedroom, you know, the messages from porn, the messages from the media,  and messages in movies.

 but then the message from the partner,  which sometimes isn't is also not compassionate. Maybe, maybe, you know, you alluded to that earlier. Sometimes it's really hard to be kind to the people closest to us. [00:39:00] And so how does that 

Chris Germer: go when we have a partner who had, who's not understanding. Yeah. Yeah. So first of all, it's important to kind of take a look at that.

One is,  one point is that often once partner feels the same shame. Like, like what's the matter with me. I'm not attractive enough. I'm not. You know, sexy enough. I'm I, I, don't my technique. Isn't right. You know, I have failed you, you know, what's the matter with me. So then we have two people in two corners of the bedroom, both like engulfed in shame.

So,  you know, some, if one person, if one person, when we're in shame, we actually can't see beyond ourselves. So one of those two people needs to get out of their shame and actually be able to be self-compassionate, which means to say, you [00:40:00] know, didn't work for us tonight, did it. And it's kind of disappointing, I guess that's part of all relationships and, you know, even starting relationships and, you know, maybe find a way of being kind to each other.

That's like fundamentally self-compassionate, but,  it is possible sometimes that,  That the other person just doesn't have it in them to be compassionate when things don't work for a guy. And that is a take-home message that you really want to get, because you don't want to be with somebody who's like that.

You don't want to be with somebody who's going to react to your frustration. Attacking. It is sort of, the message is, you know, like that's a message from God in your head, find somebody who's kinder. [00:41:00] You know, when you think about like, what is a really good partner or person we like to spend time with, it's a kind heart, you know, I mean, we like sexiness.

We like brains. We like, you know, hell we like. Money. We like, you know, you know, anything, we liked so many external things, but at the end of the day, when we lay our head down on a pillow, what does it feel like to be with somebody else? Does does your heart rest and can your heart rest? If you're with a person who is not kind.

And the answer is no. So if, if, if we have a partner who's, who's harsh and critical. If a man has a, in my view, as a partner who was harsh and critical, when things don't work for him, that is an important message to take home 

Tim Norton: because he's [00:42:00] presumably. Going to be in that, that fierce state or she's, there's always a criticism around the corner.

And then it, it taps into the fear you mentioned earlier that he won't be loved. 

Chris Germer: Yes. And if the woman or the man, whoever the partner is, doesn't allow us to be human, then it's not going to go well, Because we are human 

Tim Norton: very well said because, and so if you're, if this is happening on your fourth or fifth date, it's, it's one thing.

Yeah. Okay. Let's move on to the next person and, you know, find a compassionate person, but let's say these issues,  Start to happen 10, 15 years into a marriage.  you're not going to just leave.  but it is that when you [00:43:00] know, how do you deal with that? Like, you're teaching yourself this level of self-compassion.

Now what about teaching a partner? How to be compassionate toward 

Chris Germer: you?  that's not worth trying.

You don't want,  Jack Kornfeld used to say, it's better to be a Buddha than a Buddhist. You know, you don't really want to have any kind of missionary zeal about, you know, other people. If, if we find that self-compassion is really good for us, then the best way to teach somebody self compassion is to be compassionate toward them.

And maybe they will. So in other words, to embody self-compassion and to relate in a compassionate way, And that combination is pretty persuasive to just about anybody, but the idea of like, Oh, I think my partners should practice self-compassion meditation, or they should stop criticizing [00:44:00] themselves and they should start doing this.

And therefore they should listen to Chris girlfriends or, or Kristin Neff's website. And that's just really annoying, you know? So,  you know, if somebody, if you have buy-in that, you know, that. And people can see actually that self-compassion is not more work. It's actually less work self-compassion is not a struggle.

It's it's a relief. It's a relief. Any moment of self-compassion is a relief. And when our partners can see the transformation in us, because we are being more compassionate with ourselves, they're going to want something, you know, but if we think, Oh, this person is, you know, Hurting themselves or hurting me and they, they need a little more self-compassion, we're just adding insult to injury.

And I really recommend people don't do any, all the energy that we would invest in somebody else [00:45:00] changing to become more self compassionate. We should just do a little U-turn and invest that energy in ourselves so that we more fully, deeply,  Lou. So compassionately, which means little bit more mindful lives, more self-aware life, kinder life, and also a life that's less separate or lonely, a more, a sense of more connected, 

Tim Norton: really like how you, you state that it is lead by example.

Right. And, 

Chris Germer: and as a therapist, you know, it's a little different, you know, as a therapist, You, you might say, Whoa, you know, this, you know, self-compassion is a really core factor in emotional wellbeing. It is across the board consistently associated with psychological wellbeing and,  with reductions in anxiety, stress, depression, perfectionism, shame of all things like this.

It is, [00:46:00] it is a remarkable, powerful,  Human resource. And when we learned self-compassionate, it's very efficient because it affects so many aspects of our psychological and physical function, even even improved,   immune system function,  So it's a really good thing to learn. So as a therapist, you know, so, but he comes with it in with anxiety or depression or they're self-harming, or they are really defensive in relationship and you want them just to chill out a little bit and you think, wow, that person could use some self-compassion.

Usually when we say, okay, well, what do you really need to do a little self-compassion, you know, they walk, they come in and feeling anxious or depressed and they work out, walk out anxious, depressed, and deficient and so professional. So that's when we have this idea, like as a therapist, we really need to back up a little bit [00:47:00] and we need to say, okay, okay, what I'm going to do?

Is to really connect with this person. I'm going to feel this person in my own direct experience. I'm going to make sure that this person knows that I know how they feel. I'm going to offer this person kindness, and also my highest wisdom and explore the options. And inevitably the person will reveal that they actually do want to be more self-compassionate.

But my recommendation to counselors is. See, if you can teach self-compassion without ever mentioning the term, which means can you be mindful with the person? And this also goes for like in couples, you know, can you be mindful with your partner? Or with your client, can you feel your partner or your client as yourself?

In other words, a sense of common humanity and emotional resonance. And can you be tend to [00:48:00] speak compassionately? Can you be compassionate with this person as you might with a different, and when we do that, they get the message they'll want what you have. And, you know, and it's so much easier. It's not a struggle.

Tim Norton: Yeah. Really, really valuable advice. Thank you. Huh. You know, you were mentioning briefly at the beginning of that. You, you said that,  self-compassion is a great.  indicator across the board of, you know, lowered anxiety and a couple of different things. Is there research on this? Is that what you were alluding to have there been,  studies on, on self-compassion 

Chris Germer: yeah, sure thing.

So,  so Kristin Neff started the field really in 2003, when she published her,  scale, the,  self-compassion scale. [00:49:00] And now as the, at the end of 2019, there are about 2000 articles in the peer reviewed academic literature, which have the word self-compassion and the title, probably another thousand articles that are about self-compassion and, and,  yeah, I mean, across the board, we find that.

Self-compassion is this,   actually there's a, there's a psychologist at Duke university, Mark Leary, who says that the research is boring because self-compassion is associated with just about every minute measure of emotional wellbeing that we have. Hmm. So for example, life satisfaction, happiness, gratitude, self-confidence optimism, wisdom, curiosity, conscientiousness, [00:50:00] creativity, autonomy, relatedness hope, emotional intelligence perspective taking, and it's also a soda associated with.

 reductions, as I mentioned, bangs across the board,  Tim cross the board just about always when you increase self-compassion you have a decrease in anxiety, decrease in depression, decrease in stress, and also research decreases in perfectionism, self criticism, rumination, and so forth. And it's also good for the body enhanced immune system, fewer self-reported health,  symptoms.

And people be treat themselves better. You know, when they're self compassionate, they eat more balanced meals, they exercise more regularly, they drink less alcohol, they get enough sleep.  and,  yeah, so, and also in clinical conditions, we find that,  that,  [00:51:00] increases in self-compassion or kind of a common factor when, when psychotherapy works, for example, Hm.

 but one thing is important to know is that,  there are many ways to learn. Self-compassion for example, if you own a dog, you're more like if you get a dog you're more likely to become self compassionate people who practice yoga more likely to become self become. Self-compassionate going, as I said, just going to therapy.

If it's a successful therapy, you will probably become more self-compassionate if you're compassionate, too. If you increase your compassion to others, you're more likely to become self compassion. If you practice mindfulness, you're likely to become more self compassionate. So there are many pathways.

Anyways, the, the program that Kristin Neff and I developed is probably the most well-known one it's been taught to about a hundred thousand people around the world by over 2000 teachers.  [00:52:00] and it's sort of carefully scaffolded per eight weeks. Two and a half hour per session training program. And so that's one way of learning.

Self-compassion sort of a structured way, but you don't need to do it that way. There are always other ways that can be done. 

Tim Norton: Yeah. Wait. I liked, I always liked the non therapy options for people, dogs, and yoga and mindfulness practice and things like that. Because of course we can make and learn these skills from other places.

And I'm a lucky few of us grow up with it, but I'm not, not that many. Yeah. 

Chris Germer: And even, even when we have had, you know, really less than childhood with what we call secure attachment and so forth. It's still, we're still hardwired,  Tim to,  criticize ourselves when things go wrong. It's actually part of the physiology of the threat state.

When the threat is internal, we attack [00:53:00] ourselves, we ruminate and we isolate ourselves, you know, just as we would, when we're threatened from the outside, we might attack somebody else or try to get away, you know?  Or freeze. So I think it's part of human physiology, no matter how blessed that our childhood may have been.

So all of us really,  could stand a little. Self-compassion it's a practice where we'll never, we'll never be, as long as we have a human body, we will never be like really great at it. But every moment that we're practicing, self-compassion it w it's a released. 

Tim Norton: And that's a really good point to take in, I think because yeah, the perfectionist is going to be bummed that they're not great at self compassion, but we're saying you're, you're hard wired for it.

So it's going to happen. You are going to be hard on yourself. Yeah. 

Chris Germer: But [00:54:00] there's also the paradox, Tim, which is. When we beat up on ourselves for not being great at self-compassion, we then can be kind to ourselves because we're beating up on ourselves because we're not great at self-compassionate in that act of kindness.

We are in fact self-compassionate so the cool thing about this is you can be self-compassionate in the present moment with anything. And, and frankly, even just the wish to be kind to ourselves, for example, say somebody has frustrating experience with an erection. You know, they may not be like, you know, a 10 on one to 10 in terms of how self-compassionate they are, but they can have the wish to be compassionate with themselves when things don't work out.

And that itself is compassionate. It's very, it's actually very easy, especially in the beginning, [00:55:00] we just. We just formulate the wish. 

Tim Norton: Another excellent point. Well, it's, it's been, it's been close to an hour. Are there,  it, was there anything that,  you wanted to add to this. General conversation about, erectile issues and self-compassion, I mean, you've made some really amazing points and takeaways and bullet points and things that 

Chris Germer: we really covered it all actually way more than I expected, but this key point of when we're, when things don't go right for us, we practice not as a kind of a manipulation to fix it, but rather out of.

Simple kindness because things didn't go wrong there. The metaphor tip is if you have a child that has the flu and it's a five day flu, you're really nice to the child on day one and day two, not to drive the flu away, but because your heart goes out to the child. [00:56:00] And so similarly, if things don't.  work in one, having sex or something is, is not,  this is, this is not ultimately a problem which needs to be fixed.

It is a disappointment which requires compassion. We can just be kind to ourselves because it didn't work. And the amazing thing is, is that when we do that, our nervous system shifts from a threat state. So when carrier, state, and lo and behold things are very likely to just take a normal evolution for the better, but again, We're not doing this to make it happen normal and leading the better with just loving ourselves when things go wrong.

And we know how to do this out of principle, just out of principle, just like, just like you would love a child who is struggling. We can love ourselves. And when we do it, The body says, thank you. And we'll follow. We'll start to [00:57:00] cooperate. 

Tim Norton: All right, Chris. Well, thank you so much. What's  what do you have on, on tap for you?

You you're very busy guy. You've got a lot going on. What? What's what's the future of Chris grimmer these days? 

Chris Germer: Oh, thanks for asking. Yeah, so,  I spend most of my time supporting teachers of the mindful self-compassion training program and so forth.  but.  I'm currently writing a book,  for Guilford press on shame through the eyes of compassion.

It's a whole new,  you might say approach to shame, a positive approach to shame. And,   so I'm doing that. And,  I spent a lot of my time kind of supporting people who are making adaptations of. Self,  self self-compassion training. And so for example,   I think it would be really amazing if somebody would,  [00:58:00] adapt, you know, the mindful self-compassion program, even a shorter version for everyone, Tyler shoes.

Oh, 

Tim Norton: I mean, this is, that's a 

Chris Germer: great idea. I knew this will go, we'd go right to the heart of the matter, because it's a,  it's a performance.  issue when there, when there aren't,  you know, organic causes, but even if there are organic causes for goodness sakes, that's when we need a lot of compassion as well.

This is totally no, but my sense is is that,  it would really get to the heart of the matter with direct dealerships. And this is why Tim, I was so delighted that you invited me to do this because it seems to me that,  when shame is involved, When erectile issues are either functional or organic, it is the, and a sense of self.

Is that under assault? This is precisely. The [00:59:00] ground that self-compassion gets a lot of traction, but, 

Tim Norton: Hmm. Well then you will be hearing from me about that. Let's, let's talk more about how to make that happen. Absolutely. That's a great idea. And I can't wait for your book on shame of all the people out there.

I want it to be writing about shame. That's that's going to be a very welcome addition to literature and,  And, and very needed. So thanks again, Chris.  this was a great talk and,  keep, keep doing what you're doing or your work is really important. 

Chris Germer: I'm so honored to be able to speak. And I I'm delighted that you're doing this work.

I wish when I had some of these difficulties. I could have, there was the internet and I could have listened to you. That would have been such a relief. 

Tim Norton: Yeah. Well, thanks for saying that. Okay. Well, thank you.

Chris Germer: Thanks 

Shout outs to the sex positive community, including sex educators, sex therapists, sex coaches, and other fellow sex, podcasters, sex surrogates, academics, sexual health, medical community, sex [01:01:00] workers, the tantric community, and everybody else involved. With having hard conversations. Bye-bye .

If This Episode Resonated

If this episode spoke to you, there is a path forward.

Tim Norton provides a discreet, evidence-based therapeutic space where men and couples can understand the deeper systems behind desire, arousal, and connection. His work combines rigorous neuroscience with a grounded, relational approach to help clients rebuild aliveness in their bodies, strengthen partnership, and create lasting change.

Why Somatic Sex Coaching Helps Erectile Function with Dr. Charlie Glickman

About the Episode

In this episode, Tim talks with Dr. Charlie Glickman Phd, a leading somatic sexuality educator, sex & relationship coach, and internationally recognised speaker. They explore how the nervous system shapes arousal, why traditional cognitive strategies rarely resolve erectile difficulties, and how somatic practices can restore confidence, regulation, and erotic presence.

Key Themes

• How to reconnect with your body when anxiety interrupts arousal

• Why erections depend on nervous-system regulation, not performance effort

• Breathwork and somatic exercises for better erections

• Adrenaline vs. arousal, understanding the difference

• Mind–body techniques for reducing anxiety during sex

• How somatic sex coaching supports erotic confidence and self-awareness

Listen to the Episode

Listen Now

Dr. Charlie Glickman

Dr. Charlie Glickman, PhD, is a sex & relationship coach, somatic sexuality educator, sexological bodyworker, and internationally acclaimed speaker. With over 25 years of experience, his work centres on sex-positivity, shame reduction, embodiment, and mindful erotic development. He is also the co-author of The Ultimate Guide to Prostate Pleasure.

Website:‍ ‍makesexeasy.com

Instagram: @cjglickman

Book: The Ultimate Guide to Prostate Pleasure at https://bookshop.org

Episode Transcript

Tim Norton: Hello, and welcome to Hard Conversations. My next guest, Charlie Glickman PhD is a sex and relationship coach of somatic sexuality educator, a sexological body worker and an internationally acclaimed speaker. He's been working in this field for over 25 years. And some of his areas of focus include sex and shame, sex positivity, queer issues, masculinity, and gender communities of erotic affiliation, and many sexual and relationship practices.

Charlie is also the coauthor of the ultimate guide to prostate pleasure, erotic [00:01:00] exploration for men and their partners. Find out more about him at make sex, easy.com or on Facebook. Welcome Charlie, and thank you for being on hard conversations. 

Charlie Glickman: Yeah. Hi Tim. It's great to be here today. Great to be here.

Third. Time's a charm. Yeah, we'll get it this time. We'll get it. 

Tim Norton: Yeah. All right. So I described you based on your bio as a somatic sexuality educator, as one of your titles.  

Charlie Glickman: what is that?  so somatic sex education is,  an umbrella term that covers a pretty wide range of approaches and modalities. But what they all have in common is that,  it focuses on,  experiential body-based explorations of sexuality boundaries, consent touch.

 so for example, rather than. Talking about,  you know, how [00:02:00] to boundaries feel for you and when do you know whether you want to say yes or no?  somatic sex educators can use interactive exercises and then help people figure out what yes or no feels like in their body. So it's experiential and in the moment.

Okay. 

Tim Norton: Yeah. You know, I saw. You on sex with sunny Megatron on Showtime.  and that was you. You were, you were introducing a couple to prostate play.  and that was, that was pretty hands-on. Yeah. Is that a typical for the kind of stuff 

Charlie Glickman: you do? Sometimes it depends on what somebody is coming to me for. So for that show, right, we wanted to work with a couple that wanted to explore,  anal play.

And so,  I. Demond. I wear gloves for hygiene. I always use gloves with my clients. [00:03:00]  I'm staying fully close to and touch is one way. So those are sort of the boundaries that keep the focus on what my clients are coming to me for.  and yeah, some times I, I help people figure out what kinds of physical stimulation feel good to them.

 I had a client once who had gotten out of a. 15 year long, emotionally abusive marriage, and she was ready to start dating again. And,  didn't know what to tell the people she was dating that she liked because she hadn't been having good sex for so long. And so we did a series of,  of, of,  massage sessions.

And when we found things that she liked, I was able to name them for her and tell her, yeah, this is, this is how to tell this to somebody else. Hmm.  so that's one kind of session that I might do, but another one might just be around, [00:04:00]  how to tell someone that you don't want them to touch you. Right.

And so I might sit with somebody on the couch, in my office, and this is all prenegotiated, but, you know, put my hand on their leg and then they get to practice. Right. What they would do in a dating context, if somebody did that and they felt uncomfortable by that. And that way, you know, it's a safe opportunity to figure things out so that,  when it comes time for the real life application, you have some more confidence.

So yes, sematic sex education covers a pretty wide range of,  explorations. Yeah. 

Tim Norton: I got the sense from seeing one of your recent lectures though, that you're really up to date on the literature. You, you know, you were, you were naming the books and authors that, you know, I had to read in therapy school and then continue to read.

And so you're, you're [00:05:00] really well versed in, in that, in like trauma literature and, and general like psychology 

Charlie Glickman: literature. Well, thank you. I I'm glad that it came across that way.  it's amazing.  just in the last decade or so,  since polyvagal theory and our understanding of developmental trauma became more widely available or, you know, the work on attachment theory, that's been around for 40 or 50 years, but.

Our understanding of how childhood attachment plays out in adult relationships is relatively new. So I feel like we're at this really exciting time where the science is finally available to talk about these things. And,  yeah, I've spent the last few years really digging into a lot of these topics because,  unfortunately they got left out of my education.

Personally [00:06:00] and professionally, because we didn't have that information, you know, 30 years ago when I became a sex educator. So it's really good to be able to go back and, and,  fill some of those gaps in. Hm, definitely. 

Tim Norton: And I suppose I have. An idealistic idea of, of the sematic contribution to the field.

And maybe it maybe it's accurate. Maybe it's not so idealistic, but let me, let me explain it. Like I think of, okay, so a person comes in with a sexual problem and we could just talk about an erectile issue and the ability for the practitioner to even just. Touch somebody's forearm and draw attention to the stress that they might be holding in their body and point out their breathing by putting your hand on their Chester or any of the things that you could tell us more about what you do.

 sounds so beneficial to a client, gaining [00:07:00] insight. 

Charlie Glickman: Well, it is, and it's beneficial for a few different things for a few different reasons. One is that,  you know, in traditional psychotherapy and to be clear, I've gained huge learning and healing from therapy. So this is not a,  Slam on that modality.

I think it offers different things.  but one of the challenges that,  therapists face, and I know that you experienced this, Tim, is that people in order for a client to share with you,  something they need to be able to notice when it happens, they need to be able to talk about it and they need to feel comfortable sharing that with you.

No, of course you, as a practitioner can do a lot to help with their comfort level. But,  as an example,  No. So in the exercise I mentioned when I was helping a client, [00:08:00]  explore their, their yeses in their nose with like touching their leg with my hand.  I was able to reflect to them that,  you know, Hey, every time you tell me to take my hand away, you have a big smile on your face.

And it makes me think that you're worried about how I'm going to react. And then it turned out that they. Had a history of partners who would yell at them if they said no. And so the smile was an attempt to soften the boundary and protect themselves from my emotional reactions that they predicted right now, that's a really common experience, but it's not something that would necessarily come up.

 between a therapist and a client, you might see it in a couple sessions.  but I was able to catch it in the moment and say, Hey, you know, you're doing that smiling thing again.  and we were able [00:09:00] to work with that. And so it gives me different information than you get, and you get different information than I get, and they really,  compliment each other.

Yeah, definitely. 

Tim Norton: And so, What well let's, let's get into it. Let's talk about,  some of the typical things that happen in a session and, you know, how do you, how do you teach a person and teach a person about their penises teach shippers and about the, the arousal process? 

Charlie Glickman: Ooh, that's a great question.  well the, the first couple of sessions are always about building the container because you know, you can only lean into your edge is when you feel safe.

 as one of my colleagues put it, you need to be safe enough to feel brave on. And when we're talking about erection challenges, you know, and, and specifically talking about cis-gender men, right? There's all kinds of fears and [00:10:00] worries and stories that men carry about sexual response. Penises erection ejaculation.

And so,  we need to have a lot of safety for that first, just to be able to, to make that happen,  because you know, Assuming that there isn't a medical issue at end of course, we know that erections are affected by cardiovascular health and diabetes and blood flow and like all of those medical things.

But assuming that those have been ruled out and we ex we know that it's going to be an emotional piece,  you know, anxiety is probably the biggest cause of. Erection challenges and,  early ejaculation. And you'll notice that I don't talk about erectile dysfunction or premature ejaculation.  I don't talk about erectile dysfunction when it's not a medical thing, [00:11:00] because an emotional situation isn't necessarily a dysfunction.

Here's an example.  I was talking with this guy who was really upset that he wasn't getting erections. And we started talking about what was going on in his life. And it turned out that,  he'd lost his job. His home was in foreclosure. He and his wife were so stressed out. They were talking about getting a divorce.

Of course his penis, wasn't doing what he wanted it to do.  when we're. Flooded with adrenaline,  erections don't happen because the body is going into fight flight, right? It's, it's run away from the bear. That's chasing you, not have an erection and have sex. And so for him, there was actually not an erectile dysfunction.

It was a functional response to a dysfunctional situation. So I do a lot of work around [00:12:00] that because,  if you think that it's an erection problem, when it's really that you're stressed out about your job or you and your partner are fighting all the time,  having an erection, isn't going to fix the problem.

You know, your body, your body will find other ways to keep you from having sex. Well, 

Tim Norton: the thing that I hear most guys talk about in that situation is. I should be able to handle those things. Everybody fights with their partner. Everybody has issues with work. Why, what, what do you mean? I have anxiety. I don't have anxiety.

Charlie Glickman: And you hear the anxiety in your voice even as role-playing. Yeah. Right.  so some, some, yes, it's true that everybody has stresses in their life.  but different things will stress people out to a different. Degree, depending on where they are in their life.  as an example, you know,  some people like [00:13:00] to exercise a lot and they could go for a five mile run and bounce back the next day and be just fine.

Somebody else who doesn't go running, even if they're athletic and other ways. Is going to be really sore after a five mile run. So it's not a question of comparing how I respond to a situation compared to how you did in something similar. All that matters is how I'm doing in that moment.  and for the record, you can be super athletic and like, you know, you could lift weights and be really strong and you're still going to be sore from running.

 so to, to not overuse the comparison, but you can be super capable and confident in your work life, but then when you get into arguments with your partner, that becomes a much more challenging situation or the other way around. And one last thing I want to mention there is, is you [00:14:00] said that the line that a lot of these guys say, and I hear this too, is I should just be able to handle this,  two pieces there.

One is any time I hear somebody use the word should I'm looking for shame, right? I should be able to handle this means I'm failing. Some sort of shame of feeling embarrassment, guilt humiliation, because I can't do it. So anytime there's a should, there's a shame. And in this case, the shame is probably coming from the messages that men get about how we're supposed to be strong and confident and capable and have all the answers.

 you know, back before we had GPS, it was the equivalent of the guy who wouldn't stop to ask for directions when he was driving somewhere. These days we have GPS, but the equivalent is, I [00:15:00] should just know how to handle this situation. I don't need any help. It's the same thing. Right. And that shame.

Tim Norton: Literally from what you're saying. And then what I've I gather from others is it's basically just a shame that your body is doing something in response to this situation. That's actually something 

Charlie Glickman: called for yeah. Yeah. If you're, like I said, if you're being chased by a bear, that's not the time for an erection.

The problem is that our bodies can't tell the difference between,  the adrenaline that comes from being chased by a wild animal and genuinely being threatened versus the adrenaline that comes from. Your manager dropping a project on your desk at like four o'clock on a Friday or the worry about whether you're going to have an erection.

There's a reason why performance, anxiety causes erection [00:16:00] problems because your body's producing adrenaline. And that sends the signal of, Oh right. Not the time for sex. This is the time for fight flight freeze right 

Tim Norton: now. Before I started learning. I've been exposed to brief amounts of, of the somatic literature and a little Peter Levine.

And, and I've got a friend who's a as a somatic experience practitioner.  my concept of anxiety was, had a lot more to do with thoughts. And in the psychological literature and anxious thoughts and thoughts keeping you up all night. And I started to get the sense that sematic informed people, somatically informed practitioners,  paid a lot more attention to the body and, and how we carry anxiety in our bodies.

 could you share for the listeners some ways that they can tell just from physical symptoms, what anxiety even is? 

[00:17:00] Charlie Glickman: Yeah, totally.  well, first off w an easy way you can tell us somebody is flooded with anxiety,  is that they will frequently use all or nothing language. You always say that I never get what I need.

This is what always happens. That's a sign that they have moved up the, the escalation scale to a pretty high degree, but, you know, there's also more subtle variations.  Some things that I look for,  is,  changes in eye contact or if somebody makes eye contact with me generally. But when we talk about whatever the topic is, they keep looking away that might be a sign of anxiety.

 I'm also looking for,  their breathing. No. Are they able to breathe down in their belly or is their breathing fast and high [00:18:00] up in their chest?  when people are talking, I'm going to demonstrate this a little bit. So now I'm using my, my belly breathing, talking, and you can hear my voice and it's calm and there's ups and downs of my vocal tone.

And when I get stressed out, I might talk more like this and I'm going nonstop. And my throat is, and that's making my voice higher and I'm not stopping to take a breath. And I'm just going to talk and talk and talk and talk. That's another sign of anxiety.  depending on somebody's skin tone, their face might.

Change colors. Some people will get very pale. Some people will get very flushed.  that's more visible on people with lighter skin tone, but the, the mechanism is still there.  and I think the, the last one that I would suggest looking for is,  if you notice that there's sort of like a,  [00:19:00] a frantic weakness.

To the way that somebody is talking, if it's like, here's this thing and I'm presenting it as an emergency, we have to deal with it right now. If we don't something bad is going to happen and you can objectively see that it's not really an emergency, right? Like the car. Yes. The car needs to be moved from one place to another.

But if you wait 10 minutes, it's not going to be a disaster, right. That might be a sign that someone's in anxiety.  part of what makes all of this a little challenging is everybody's anxious responses can manifest differently with different people, different situations, different topics.  some people will, especially men, some guys will jump to problem solving.

Right. That's that's, that's a behavior that's basically saying, let me fix the problem so that I [00:20:00] don't have to feel anxious about it anymore.  yeah. So lots of ways it shows up, which 

Tim Norton: is pretty adaptive, which is a nice thing to be able to do, but. My understanding. And from talking to a bunch of different guests about this is when we are in that state.

It's not, it's often not sexy. People can be a little,  in a little bit in high alert and instill, or are really like that, or like fear and their sex and things like that. But for a lot of people,  it's going to interfere with arousal. 

Charlie Glickman: Yeah. And 

Tim Norton: can you. So, so you have all this wisdom on when people are carrying that in and how it shows up in their body.

 how do they get rid of it and their penises get hard for a second? 

Charlie Glickman: Okay. That's always the question. Right? Of course he jumped to that. Well, as, as far as,   the, the [00:21:00] challenges with jumping to problem solving. I'm, I'm definitely a problem solver, whether that's my personality, my gender training, whatever it is, but the thing that's important here is take care of the emotions first and then get to the problem solving.

And that's for two reasons.  first is that if you're coming from that emotionally reactive place, You're not thinking as clearly. So your problem solving isn't going to be as efficient.  the second piece is that,  there's often really good data in the emotions. And so by taking a look at them, we actually get better information for coming up with effective problems.

So, so the, the balance here is taking care of the feelings first. And then get into the problem, solving, jumping to problem solving too soon can feel very controlling and [00:22:00] invalidating, but if you never get to problem solving, you're going to be stuck in the same situation for the rest of your life. Hmm.

So is both. Okay.  so, so for example, with, with,  this sky, you know, who this hypothetical guy we're talking about,  I might approach it in a couple of different ways. I might approach it from the perspective of, so, you know, what's going through your mind. What are the thoughts and what are the feelings you're having right before all of this?

Are you feeling worried about not getting an erection? Do you think that your partner is going to be upset with you?  Are you telling yourself stories about, well, I should just be able to do that. What are the thoughts and feelings that are there?  and let's take a look at those.  you know, maybe the story for you is if I don't have an erection, I'm not a real [00:23:00] man, or I'm not a good lover, what what's going on there.

And then I think the important piece is to slow way down. And do this in small steps.  I do a lot of work with people,  around,  breathwork practices.  and in fact, I'm going to demonstrate one right now. I'll talk you through it. And I invite the people listening to join us and see how this feels for you.

So it turns out that when we exhale longer than we inhale, it slows the nervous system down. It's the same thing that,  you know, my parents used to do when I was a kid, when I would break something and they would have that long side, they go. That. Yeah. Right. We do that because we instinctively know that it's calming our bodies down.

So all we're going to do is [00:24:00] repeat that five or six times.  and so,  I'm going to do this. You can follow along. I'm going to do a two count inhale and a four count exhale as you exhale. Imagine that you're gently blowing bubbles through a straw, into a glass of water, right? Gentle bubbles. Okay.  and so,  this is what it looks like.

It goes in and out,

in and out

and do two or three more of those with us.

Just one more time

[00:25:00] and now just go back to your regular breathing. And,  Tim, what did you notice doing that? 

Tim Norton: Well, I noticed that. I was starting to relax and I was having this thought of, but I want to stay a little on point. I want to be in interview mode. I want to be sharp. I was like, I don't want to relax right now.

Charlie Glickman: Right. You, you could feel it. You could feel the relaxation. Yeah.  some people will find that,  they start to get sleepy. If you Yon doing this, that's a great sign. It means your body is slowing down.  You might notice that your hands and feet feel a little bit light.  if that happens, that's totally fine.

But if you start getting pins and needles, it means that you're actually hyperventilating. And so just go back to your normal breathing patterns.  but this is something that you can do. We, we spent what, [00:26:00] 20, 30 seconds just now doing it. You can do this in the car. You can do this at home.  you can do this sitting up.

You can do it lying down. I actually do this literally every night when I get into bed and I've trained myself to fall asleep in about 30 seconds because my body now knows. That when I do this breathing pattern, it's time to relax. So this is something that you'll get more benefit from the more often and more regularly you do it one or two minutes maximum is all you need.

 and so I'll, I'll teach my clients this. And when we're talking about the situation and they start to talk faster and higher like this, and they're going, going in that direction, I'll jump in and I'll say, okay, wait, let's slow down for a moment and take a breath together. And by doing it together, I'm [00:27:00] joining them in it.

And I'm also calming my nervous system down, which they'll be able to pick up on and calm down themselves. So this is something that you can do if you notice you're getting anxious.  if you notice your partner is getting anxious,  if you're in the middle of having sex and you start having racing thoughts, and you realize that your penis has gotten soft, No stop what you're doing.

Pull out if this is the penetrative sex moment,  do some breathing, do some connecting with your partner and then come back to the erotic energy and see if that changes anything. Hmm. So 

Tim Norton: that would be a nice couples exercise in 

Charlie Glickman: a sense. Yeah. It's really helpful for the partner,  to also do it. Partly because again, we're doing it together.

I get more [00:28:00] relaxation when you're joining me, but also it puts us both on the same team here with me. You're not against me. And that, that will help for most people. Hmm. 

Tim Norton: No. How could a guy, what would you ever assign or incorporate breathing into an assigned masturbation homework exercise, or even something you might do in a session?

Charlie Glickman: Oh yeah, absolutely.  Joseph Kramer who founded the sexological bodywork,  modality, which has now,  Overlap somatic sex education. He makes this really interesting observation that most boys,  learn to masturbate as quickly and quietly as possible because you don't want to get caught. Right. Like whether you're 10 years old, 15 years old, whatever it is.

 we also learn to [00:29:00] hold our breath to be as quiet as possible. And so there's a lot of men who,  don't make any sound during sex or masturbation. They kind of hold their breath and hold their breath. And then at the end, we'll go,  the more you breathe, the more erotic energy can move through your body.

So I might suggest to somebody, you know, set a timer for 10 minutes and pleasure yourself whether you have an erection or not pleasure yourself for 10 minutes and focus on. Long deep breaths for as long as you can, as you get more turned on your breathing will naturally get shorter and faster.  but the more you can hold on to that long, slow breathing, the more benefit you'll get out of it.

It works the same way with exercise, by [00:30:00] the way that like, you know, for the first, if you go, if I'm a runner, okay. So if you go for a run or a bike ride or whatever, for the first quarter or half mile, try to keep your breathing as relaxed as possible. And then as you get more.  more up to speed. Your body will just naturally shift.

 it goes, it goes a long way and, and,  related to it. I'm just realizing one other piece I want to mention is a lot of men masturbate that like the death grip on their cock and is fast and furious and hard as they can.  there are. Probably a couple of dozen different erotic massage techniques that you can do with a partner or by yourself, different sensation, different pressure, different Mo different moves.

And,  you know, [00:31:00] if you're only doing the hard furious, you know, jacking off as, as quickly as possible, that's like eating one food your entire life. Every time you eat every meal, you eat,  learning lots of different ways of touching yourself.  you you'll be amazed at how much it improves your masturbation and,  by extension, how much it improves your sex with a partner.

Tim Norton: So let's, let's flesh out all the aspects of that. If, if you would,   so guys going to do 10 minutes of breathing and pleasuring himself. So what do you mean pleasuring himself? If he isn't direct? Like what are ways he could be doing that? 

Charlie Glickman: Sure. There are actually some erotic massage and masturbation techniques that work better when you're not fully hard.

 so,  for example, No, [00:32:00] where if, if your penis is partially erector or actually fairly soft,  you can do a move called rock around the clock walk, which is basically like, you know, you're pulling the stroke towards your head. That would be 12 o'clock and then one o'clock and then two o'clock. And you're basically it's, it's almost like a slow motion helicopter kind of motion.

 You know, you can hold the shaft of your penis in one hand and massage the head with your other hand,  when your penis is softer, the skin is stretched here. So you can play with that. You can tug on the skin of the scrotum more easily.  you know, there's a lot of different techniques that you either don't need an erection for, or they work better when you're soft.

And might 

Tim Norton: you have them pay attention to their favorite parts of that exercise? 

Charlie Glickman: Yeah, exactly.  I like to have people,  rate on a scale of [00:33:00] one to 10, you know, how good does this particular move feel to you?  in this moment, because it can change from one situation to the next,  you know, Some guys discovered that like, Oh, I really like soft, gentle touch around the Corona or on the head of my penis.

I never knew that because I've always been then doing the hard, fast overstimulating techniques. Hmm. And then what should they be thinking about? That's a really good question.  I don't know that there's really a, should I do recommend doing these explorations,  without porn and not that I think porn is inherently bad.

I think that, you know, there's a lot of reasons why people. Enjoy it, but,  when we're focusing on the images on the screen, it's a lot harder to feel what's happening in the [00:34:00] body. So rather than worrying about what to think about, try to focus. On the physical sensations,  kind of like if you were doing a wine tasting, right.

When you're tasting something, you're focusing on what you're tasting. You're not like looking around the room or having a deep political conversation. You can have those other times, but it takes your attention away from what you're doing. So,  Focus on the sensations. Okay. Yeah. If you're doing this with a partner, you can also give them feedback, like,  a little firmer, a little softer try using your fingernails.

Right. And really explore things like that with,  with someone else and all the, while 

Tim Norton: breathing. Yeah. Breathing in the, in the way you, you guided us through 

Charlie Glickman: a few minutes ago. Yeah. As much as you can. And like I said, when you get more turned on. Then let that happen. [00:35:00] It will change to get 

Tim Norton: faster. Yeah.

Okay. And then is this. 10 minutes. Would, would you generally find that guys do this until they evacuate late? Or just, is that 

Charlie Glickman: not recommended? I think it depends on where somebody is in their trajectory. So if on a scale of one to 10 of arousal, 10 is the point of no return, right. Or in sex therapy speak,  Jackie Latori inevitability,  Point of no return is a better name for it, I think.

But so maybe when you're new to this,  do it until you hit a six and then go to what is already familiar and then maybe another time do it until you hit a seven or a seven and a half. Like see how. Much arousal you can feel while still breathing and focusing on the sensations.  [00:36:00] the, the more you do that, the easier it's going to be to do that with a partner.

So it builds up over time.  but I have no problem with like doing this exploration for, you know, a few minutes. And then, you know, jerking off until you come. Right. And then like wrapping up that way. There's nothing wrong with that. I'm, I'm not somebody who argues that like a jacket slating should be delayed or you shouldn't do it more than, you know, some people will tell you, you shouldn't do it too often.

 I say, do it as often as it feels good to do. 

Tim Norton: Okay. So let's go back to this hypothetical guy and it could even be the guy who's having a hard time with wife and job and everything. And he goes home two weeks straight, 10 minutes a day, breathing and masturbating comes into your office and still not working.

I'm trying to have sex with my wife. I don't know. 

Charlie Glickman: So I would ask him, Hey, you know, when you masturbate, do you happen to erection? And if the answer is, yes, [00:37:00] that's when I might start looking into what's going on in the relationship here, you know, what happens? Do you feel like your, your wife genuinely wants to have sex with you?

Do you feel her desire for you?  do you feel criticized? Do you feel blamed?  you know, that's when we start looking for some of those. Relational pieces. And then the question I have is what do you notice in your body that, Oh, like every time you think you're being criticized, you get flushed with adrenaline and you start getting really defensive.

Where do you feel that in your body? Oh, it's a pit in my stomach. Okay. So then what I would say to him is start to pay attention to that feeling in your stomach. Because,  there's a really good chance that you're not noticing it when it's only at a [00:38:00] three, by the time you notice it, it's at a seven and it's too late then.

So the earlier you can notice those feelings, the easier it is to intervene. But 

Tim Norton: it's always at a 

Charlie Glickman: three. It's been, 

Tim Norton: it's been like that since, since I was, you know, I that's what I hear a lot. Right. I've I've had that little pit in there since I was 15 years old. 

Charlie Glickman: Yeah. And so, and you're right. That's such a common response and that's a place where,  you know, we start to.

Look at some of those earlier patterns.  you know, what's the story behind that. And you know, if, if what does that 15 year old who's still inside you?  you know, what does he need? Around this, you know, did it happen because you were in the high school, gym locker room and you saw boys who were older than you, or further along in puberty, and you suddenly developed anxiety [00:39:00] about the fact that like they had bigger penises than you, or they had more pubic hair than you.

 that's going to be a different situation than somebody who grew up in say a very religious, conservative household who got lots of messages that like, you know, your parents walked in the room when you were in your bedroom while you were masturbating and you got shamed for that for months, right.

That's going to be a very different. Reason for that same pit in the stomach. And so,  that's something that I can help some people with. It's also something that I might refer someone to a therapist around it, depending on the limits of my 

Tim Norton: okay. And other than. Breathing. Do you know any somatic techniques for getting rid of something like a pit like that that might, might help a 

Charlie Glickman: little?

Well, I think it's more that we get better at not letting those feelings takeover. [00:40:00]  I'll, I'll use myself as an example.  my nervous system leans towards anxiety. I get activated and revved up pretty easily. Right. If I'm having a bad day, that's going to happen, but I've gotten more practiced at noticing when the car is speeding up to like a four and a five and intervening then, and saying, Hey Tim, this conversation is really getting to me.

Let me take a break and get a glass of water, and then we can continue. Right? So to a certain degree, we never really get rid of some of these things. We just get better at. At not letting them take charge.  yeah, I wish I had a better answer than that. Cause I would love to not be as easily anxious as I am.

 but that's not how my body works. Right. And so 

Tim Norton: just noticing [00:41:00] in, in life, what, what gets that pit down from a three to a two and two to a one and doing 

Charlie Glickman: more of those things. And I do have some other tools that I'll use,  Things that came from,  tension and trauma release exercises, which is a sematic modality that's that's,  works with the nervous system.

 you know, Somatica, which is another modality that I'm trained in, has some tools for that.  there's a wonderful book by Stanley Rosenbaum Rosenberg. It's called,  accessing the healing power of the Vegas nerve.  He is,  a body worker and a close friend of,  Stephen Porges. And they've developed some, some,  practices that work with the nervous system when we're all spun up.

 so I do a lot of the body-based stuff. And then [00:42:00] when it comes time to do some of the more talk oriented work, that's where a therapist is hugely helpful. So 

Tim Norton: if one were to pick up a copy of accessing the healing power of the vagus nerve, what, what might be a typical exercise or practice as you say it in a book like 

Charlie Glickman: that?

So,  Let's see. So first off, if for people who were familiar with polyvagal theory, you don't need to right. Read the first section of the book.  I actually think there are some other books that are a little more clear in explaining how polyvagal theory works.  but one of the exercises that he has in there.

Is,  because when we go into anxiety, the, the fight flight response makes the muscles in the back of the head and the neck get really tight.  those muscles are super important for orienting the head to look for danger and for danger. It's [00:43:00] why, when we're stressed out, we get tension headaches because the muscles in the neck get rigid and that cuts off blood flow.

And then we get tension headaches.  It's not the only reason for tension headaches, but it's a common one. So, so he has these exercises for specific stretches,  to help release that tension. And I have found it to be really effective.  he's also got a diagram in his book showing four of the most common.

Pain patterns are when we get tension headaches, and then he shows different places on the neck to massage. So like, if you've got a, if you've got a,  a headache that's above your eyes, here's the spot to massage. If it's in your jaw, in the back of your head, here's the spots.  and,  I've been surprised at how useful it is.

Hm. Yeah. It's made a big difference for me. Awesome. And my, and [00:44:00] my clients. Yeah, no, that 

Tim Norton: sounds good. Sounds great. So, and the book kind of walks you through that. Have you seen good videos of people doing like really helpful grounding stretch or, or 

Charlie Glickman: I've seen a lot of videos,  The challenge with doing it over video is that you can think that you're doing it correctly and you're a little bit off, so that can, that can be a little challenging.

 but,  Yeah, I should look for some more of those and see what's out there. Okay. 

Tim Norton: Yeah. Maybe we'll, we'll post them in the, in the podcast notes.  so, but just in general, there, there are different areas of your body that you can, you can stretch and relax that will kind of chip away at your, at your general anxiety, especially if you do it on 

Charlie Glickman: a regular basis.

Yeah, exactly. And, and because life is anxiety producing,  You know, there's always [00:45:00] going to be reasons to do these practices, right? If this is not a one and done kind of deal, this is something that,  you know, you need to keep doing because life is going to stress you out. 

Tim Norton: Hmm. Yeah. So I imagine there are probably some listeners who are hoping to learn the stretch or the, or the breathing technique.

And then they might not practice it. And they're just going to try to use it the day of, of the sex. 

Charlie Glickman: Yeah. And it doesn't work as well.  you know, this really is something it's like playing a musical instrument or learning to cook or getting into shape or whatever it is.  you need to rehearse so that you have the tools when you need them.

A,  a friend of mine, who's an EMT. Likes to say that the time to learn first aid is before you break your leg. 

Tim Norton: Okay. But then, and then I'm going to hear the comment of, but it's sex. I should just know how to do it. And other people don't [00:46:00] have to rehearse. They just, they just do it 

Charlie Glickman: well. So there's two things in that one is that we've got this cultural myth of sex just naturally happens.

Let nature take its course. And you can do that if you want to have so-so sex. Right. But every single person's body is different, their nervous system is different. The things that they enjoy, you know, there's all of these different pieces.  nothing in sex works the same for everybody.  and so this idea that we should just magically know how to do it.

 a lot of that comes from the fact that we don't talk to young people about sex. It would be the equivalent of,  never talking with a child or a teenager about money, pretending money doesn't exist. You're not allowed to talk about it. And now you're 18 years old. Here's a credit card. Good luck with that.

[00:47:00] Yeah. So,  this isn't,  this isn't a should thing. I mean, honestly,  for, you know, other people who aren't doing these things would probably have better sex if they did, but also related to that. How do you know they're not doing these things exactly. Right. Unless you watch people have sex, I'm not talking about porn cause that's performed for the camera.

 but even if you've had group sex experiences, you're still not seeing what those people are doing at home. Right. I, I suppose, unless you're a nonconsensual Voyager and you've hidden webcams in somebody's home, which is super creepy. You don't know what people do behind closed doors. Yeah.  I definitely, I promise you, and I know, you know, this 10, that, like I talked to lots of people about their sex lives.

They do not look like what other people imagine them to [00:48:00] be. Yeah, 

Tim Norton: exactly. Nope. As you talk, it strikes me that you, you probably gained your expertise on, on prostate and an anal play before the somatic,  education that you have. And I'm wondering, is there, is there overlap? Is there, is there a crossover, a and B  what can.

A good strong familiarity with prostate pleasure and an anal pleasure do for erections or, or can it, is there, can it help? 

Charlie Glickman: Yes. Well, it depends. It depends because one of the reasons why erection difficulties happen is from a too tight pelvic floor. Hmm.  a lot of men have tight pelvic floors,  in part, I think it's because culturally, [00:49:00] you know, men in, at least in, in American culture tend to not to move their hips.

Like if you go, if you watch guys walking down the street or you're at a club and you're watching guys dance, a lot of men don't move their hips. Now of course there are cultural variations around that.  But men, you know, part of why men tend to have lower back problems is from tight pelvic floors.

Right? And so,  massaging the perineal, which is the area between the scrotum and the anus,  or receiving anal massage can help the pelvic floor relax, which makes erections easier. Hmm. I think,  prostate play. Also has benefits because it teaches guys that we have more erotic zones on our body than just the penis.

 the, the prostate really is the male G-spot. So if you think about, [00:50:00]  if you've ever been on the giving side of G-spot play and you know, how much your partner enjoys that, you know, imagine that you get to receive that just as much.  and so. Just recognizing that there are more options.  it does two things.

One is it creates more ways to feel turned on. And two, if you don't have an erection one evening, that doesn't mean you can't find something else. That's going to feel really good. Hmm. So,  and, and yes, I, I discovered prostate play and learned all about it before I got into the somatic work. In some ways,  I got into this work, I started exploring, you know, this part of the body that gets ignored a lot at the time.

Hmm. 

Tim Norton: And what would be a good way for somebody to get started on exploring their [00:51:00] prostate? 

Charlie Glickman:  I wrote a book about prostate plan play generally, is that you do wants to know how to do it safely. There's some technical pieces that make a big difference. And,  so my biggest recommendation is don't copy what you see in porn.

 and that's for two reasons. One, is it the people in porn. Do this a lot. And so it's easier for them to just dive right in as it were, but also porn doesn't show you all the warmup that happens before the camera gets turned on.  so it looks like you should just be able to stick a toy besides your or somebody else's anus.

In the same way that a cooking show will say, you know, have half a cup of chopped onion and it's just magically there on the counter and you don't see any of the prep.  porn gives it us unrealistic ideas about anal play. [00:52:00]  I would. I would definitely say to somebody before trying it for the first time, do a little reading about it.

 you know, obviously I'm going to mention my book, the ultimate guide to prostate pleasure, but also the book's website.  prostate pleasure.net,  has a lot of solid info.  and there are more and more companies out there offering information on Anil play.  one of them is B vibe, the letter B B V I B e.com.

 they have excellent resources on anal play and how to make it pleasurable. Hm. 

Tim Norton: Okay. Well, thanks for that. You know, We're actually somehow this hours flown by it. I feel like you could, you could share wisdom with us for four hours on this topic.  I, I talked to most of my guests, guests at least briefly about 

Charlie Glickman: Viagra.

Tim Norton: do you, do you have any thoughts [00:53:00] on, on Viagra and Jen? 

Charlie Glickman: Well, I think in a lot of ways, Viagara is a mixed blessing.  it's. You know, it can definitely help somebody feel more confident if they take it.  something like 40% of the effectiveness of Viagra is due to the placebo effect. But because if you think you have the support of the medication, you feel more confident.

Red. So, so it definitely has benefits around that. Having said that,  if the reason why you're not getting erect is because of emotional challenges,  those aren't going to go away and Viagra doesn't fix those.  and I've talked with a lot of guys who said, yeah, Viagra worked for a couple of months and then we stopped having sex for these other reasons.

And it turned out that they were actually all connected. [00:54:00]  so,  Viagra can be really helpful and it's not gonna fix everything. Okay. 

Tim Norton: And I guess in in, I also wanted to talk about it from the, I don't know if you'd call it the polyvagal perspective or the somatic perspective.  but also how well does the polyvagal camp.

Charlie Glickman: have a stance 

Tim Norton: or, or speak much on BDSM and then on that kind of touch and that kind of,  violence and, and, and, you know, those States is there, 

Charlie Glickman: do you deal with that? You know, I haven't seen anything from. Like the folks who specialize in polyvagal theory talking about kink specifically.  but my personal take on it is that the difference between consensual pleasurable, kink and abuse is the [00:55:00] difference between being on a roller coaster versus, you know, going down a steep Hill and the brakes in your car go out.

Hmm. Right. What, what makes it safe within the context of kink is that there's the, the agreements, the relationship, the container, all the things that create safety. So that there's just enough of that feeling of like the roller coaster to make it fun. It's when we don't have those pieces, that things can, can become real.

 real challenges for folks or, or shift into abuse.  but you know, ultimately for me, it's about what works for your body and your heart and your mind and good for you. That includes being tied up in spanked or whatever else it is.  as long as everyone has a smile on their face at the end of it, go for it.

[00:56:00] Hmm. Now, 

Tim Norton: would you just go ahead and could you write that book?

Charlie Glickman: I'll add it to my list of things I need to write. Cause I, I have like three others. 

Tim Norton: Yeah. Well, and that's the thing is that one reason I was really excited to, to see at the ACA conference that you were presenting on this, I hadn't known that you had, you had evolved into,  the somatic world is that every time I learned about a new kind of therapy.

I feel like they don't really get into sex, you know, whether it was CBT. I haven't seen the CBT of sex book. I haven't seen the DVT version. I haven't seen, you know, the sematic therapy and sex. And then I don't even see chapters. And in books, you know, and really popular ones, really, you know, really, really well,  published, like I haven't seen,  Bernay Brown talk a ton about, you know, graphically about [00:57:00] sex and, and the ins and outs and, and really dealing with it.

 so I, I'm just, I'm excited. You exist 

Charlie Glickman: and I'm happy.

Yeah, no, no, you go, I wasn't really question. You're right though. You know, there are all of these different modalities, but as a profession, outside of people who specialize in sexuality, most therapists are really afraid to talk about sex. Yeah.  you know, you don't get much training in it, even though it's something that affects everybody, whether they're partnered or not, whether they're sexually active or not.

 but therapists don't get much training around it. If any. Minimal training.  and,  and so it's really left this, this gap in the field, you know, I would love to hear about like, what are ways that somatic [00:58:00] experiencing or cognitive behavioral therapy can help specifically around sex. And that's why I go to the ACEP conferences.

 but yeah, we, we really need it. 

Tim Norton: Now we really do.  well, and you know, and so to the listeners out there, we've, we've attempted this interview three times and in the, the first and we've had technical difficulties,  but the first two times you made a point to make a distinction between,  You know, between talk therapy and somatic sex education and,  and the importance of the boundaries and talk therapy around,  not touching and keeping those.

And, and,  so I wanted to, you might, you might feel like now that you've said it twice, that you've ever feeding yourself, but it is a really 

Charlie Glickman: important point. Yeah. Well, and I think,  Yeah, let me see if I can, I [00:59:00] can pull that back out now. I understand why the boundaries around touch exists for therapist.

I think that they have their own problems. I talked to therapists who, you know, won't even shake their client's hands or give them a hug at the end of a session.  and, and the reason for that is partly because the profession hasn't really developed,  Good understanding of sex and the, or boundaries, but also because there are many, many examples of therapists who violate their client's trust and safety by engaging in sexual behavior with them.

And so the profession has said, Hey, we'll play it safe. Note to touch.  I think that another reason for that is that,  the issue isn't about whether there's touch or not, the issue is about,  the purpose behind it [01:00:00] and the boundaries around it. But it's really hard to know what somebody's intention is.

 it's easy to ask. Did they touch you? It's harder to determine what was their intention when they touched you.  and so from a legal perspective therapists, as well as, as professionals in other realms have just decided it's easier to say no touch. Yeah. But. Yeah. Yeah. The downside is that you miss out on all of this information and it creates a really artificial dynamic,  you know, especially for people who take it to the extreme of like, not even shaking hands.

Yeah. Yeah. 

Tim Norton: And I, and I love the, the rise of the, of the somatic stuff.  in response to even a couple of the exercises that you showed at the lecture that I attended, I've [01:01:00] already tried with clients. I've already had couples do some of those basic touching exercises and they're so powerful, they're they, they give me so much information,  in the room and it's really cool.

Charlie Glickman: Cool. Well, yeah, we covered a lot today. We 

Tim Norton: did.  do you have any final thoughts for the listeners out there? 

Charlie Glickman: Yeah. Whatever you do,  sexually, you know, by yourself or with a partner, follow your breath and follow your pleasure because those will be the, the tools that help you figure out how to create the sex life you want.

Hmm, 

Tim Norton: follow your breath and follow your pleasure. I think my social media person is going to tweak that as your quote,  what's what's on the horizon 

Charlie Glickman: for Charlie Glickman. Well, these days I've stepped back a little bit from teaching workshops and just, you know, I was traveling a lot.  so I have [01:02:00] been.

 you know, staying mostly here in Seattle and working with clients over video, as well as in person.  I, but I'm also,  going to be taking two more trainings over the next year or so.  one of them is like a pro with Betty Martin. She's the one who developed those exercises you were describing.  now that I've been doing this work for a few years, I want to see what it's like.

To take that workshop again.  and,  I'm signed up for a training next year on,  trauma and how to support people who are healing from it. That's those, those are my next things. And then hopefully someday that will turn into my next book. 

Tim Norton: Oh, okay. Awesome. I can't wait for that next book.  yeah, like I was saying, we, we need it.

 we need more, we need more sex books out there, so, so, okay. Well, thank you again, Charlie Glickman, and I hope to run out and [01:03:00] run into 

Charlie Glickman: you out in the field. I look forward to it. Have a good one.

Shout outs, the sex positive community, including sex [01:04:00] educators, sex therapists, sex coaches, and other fellow sex, podcasters, sex surrogates, academics, sexual health, medical community, sex workers, the tantric community, and everybody else involved with having hard conversations. Bye-bye. [01:05:00]

If This Episode Resonated

If this episode spoke to you, there is a path forward.

Tim Norton provides a discreet, evidence-based therapeutic space where men and couples can understand the deeper systems behind desire, arousal, and connection. His work combines rigorous neuroscience with a grounded, relational approach to help clients rebuild aliveness in their bodies, strengthen partnership, and create lasting change.

What You Need to Know About Sexual Pleasure and Social Justice

Episode Overview

In this episode, Tim speaks with sexuality educator, writer, and Afrosexology co-founder Dalychia Saah about how systemic oppression, cultural narratives, and body-based shame shape erotic expression — particularly for people of color. They explore pleasure as a form of liberation, the impact of racialized sexual messaging on erectile functioning, and why expanding our definition of sex opens deeper pathways to connection and fulfillment.

Key Themes

• How racial constructs influence sexuality, desire, and erectile confidence

• Pleasure as liberation, reclaiming body agency and self-determination

• The impact of shame and body policing on arousal and connection

• How to redefine sex beyond performance-based scripts

• Talking openly about pleasure, desire, and authentic erotic expression

• Expanding relational intimacy outside the bedroom

• Why faking orgasms harms connection and nervous-system trust

• Positive sexual messages that support freedom and confidence

Listen to the Episode

Listen Now

Dalychia Saah

Dalychia Saah is a sexuality educator, writer, award-winning speaker, and co-founder of Afrosexology, a pleasure-based sex education platform centering the empowerment and liberation of Black communities. Her teaching spans pleasure, body agency, masturbation, communication, racialized sexual oppression, and identity.

She is also a lecturer at the Brown School of Social Work at Washington University and a sought-after facilitator whose work has appeared in HuffPost, Teen Vogue, Allure, Harper’s Bazaar, and more.

Website: dalychiasaah.com

Afrosexology: afrosexology.com

Episode Transcript

Tim Norton: Hello, and welcome to Hard Conversations. My next guest, and I'm really excited about it, Dalychia Saah, using the pronouns She and her is a sexuality educator, professor writer, speaker, and the co-founder of Afrosexology, a pleasure based sex education platform that creates educational content and workshops to center the pleasure, empowerment and liberation of black people. Dalychia is also a lecture professor at the Brown school of social work at Washington university in St. Louis, where she teaches courses. In graduate level, social [00:01:00] theory, social justice and sexuality education. She is also a sought after facilitator and keynote speaker for conferences and events related to social justice and or sexuality.

Dalycia’s work and words have been featured in Huff post teen Vogue allure magazine, vibe, magazine, glamour magazine, Harper's bizarre Playboy broadly, and others. She has received the phenomenal woman award. Spirit of social work award, Reverend Robert Gilbert advocacy award and Academy for leadership and civic engagement leadership award.

Thank you so much for joining us today on hard conversations, Dalycia.

Dalychia Saah: Thank you for having me. I'm really excited for this

Tim Norton: conversation. So I just read your bio to everybody. And I just wanted to, to ask, like what got you into all of this? Yeah.

Dalychia Saah: it's, it's like one of those things. But like now I'm able to look back and be like, Oh my [00:02:00] gosh, it totally makes sense that this is what I'm doing in my life, but like fought it the entire path.

so growing up in a family that was pretty. I mean, I had like traditional, like conservative values around sex and relationships and dating a lot of it rooted in religion. but my parents are both like scientists. Like my dad's a doctor, my mom's a scientist. And so there, they taught us to be really inquisitive.

Man with erectile dysfunction needing online sex therapy

They're like, if we had a question, we are, their response is usually just to like send us somewhere to find the answer before they would give us the response, except for when it came to like religion question about religion and questions about sex. That was like, no. Conversations shut down, do not talk about it.

But unfortunately for them, they had already given us all these features, research skills. So like being the nerdy person, I was, I just feel like spend so much time, like looking up, like how do you know someone likes you? How do you hold someone's hand? What do you do? Like all this all from that all the way to like, looking up, how do you give a blow job?

Like just all [00:03:00] of it. Like just not really knowing. And so I was always the person in my. High school who was like, let me tell you all the fun facts about sex stuff. And like, it was very inquisitive prior to me even having many sexual experiences. but still, I always like really denied it as like a career path.

Cause like, this is not a thing that people do. Like no one really tells you about like, Oh, you can be a doctor, a lawyer, or a sexologist like that does not come up in many family conversations. So. Through lots of winding ways. I just like finally sat down and was like, this is the thing that's been drawing at me since like elementary school, middle school, high school college.

And I've been like, I can't do it. It's not a path sort a thing. And so when we finally sat down and I was like, let's just create something me and my friend Raphael created Afro sexology and that. The feeling we get when we do that work is so affirming that I was like, yeah, Oh, this is the thing I was supposed to be doing.

And I reflect back on all the people along the way, who were like, you're supposed to do this. And I'm like, I can't do this. It's not a, is that a job? It's not a thing that. Makes sense. And I really just [00:04:00] struggled because it was something that I was like in the black community with everything we have going on.

Like I do not know of talking about sex as a thing that's going to like heal us. so I was really resistant and honestly, it was just like, this is something that like white people have the time to do. And I would tell my mentors, like I don't have, I don't have the privilege to do this. And it really took like me reading Audre Lorde's uses of the erotic.

That really helped me to be like, okay, a part of our wellness, a part of our healing. It's also our relationship to our body or to our sexuality. And that there is. Space for this conversation and the work we've been able to do with Afros ecology, I should say affirm more and more that this is needed.

It's important.

Tim Norton: And when was that moment? Like how long ago?

Dalychia Saah: so that was like right after grad school. So five years

Tim Norton: ago, five years ago, and five years ago where you read Audrey Lorde and you were like, okay, now this, I see this as important work.

Dalychia Saah: Yeah. Yeah. So part that denying it.

Tim Norton: Okay. [00:05:00] Yeah. Five years of, of Afro sexology, where you were also, I don't know, you could almost call it spiritually invested in it and politically saying this is the right word.

Yeah.

Dalychia Saah: Yes. Yeah. It took. It was like, it was just a lot of different things. It was that it was like, we're based in St. Louis. So this is where Mike Brown was murdered and the police brutality and all the rights. And just seeing the way that black bodies are still constantly, we, in danger and just like the toll that like all of that was taking on our, on our bodies and on our health, I was like, Oh, okay.

Masturbation is something that feels good, but it also leaves it like gives you. Endorphins that you need to like, feel like a high again in a, in a positive feelings to keep you going when you're going outside and marching against police officers all the time. So it was a lot of things coming together to where I was really seeing that like, the work we're talking about is not just theoretic, but it also lives in our body.

And our body carries the [00:06:00] trauma and that like reclaiming our body and having agency over our body is like a way to survive, resists, thrive, and this like. World that we have set up. Hmm. Yeah.

Tim Norton: And when you have Afro sexology workshops and seminars, does it, does it get just as political as it is sexual?

Does it, does all that stuff also

Dalychia Saah: come up? It does. It does. I think it's, I think that's something that's really beautiful about. So many of the identities that a lot of people hold, especially people who are marginalized in many ways is that there's, it's really hard to separate. How politically are our identities have been constructed and used against us from us talking about our liberation and our joy and our pleasure.

So it comes up and it gets woven in these really beautiful ways. Or at one minute, we're just having this very like, Very intentional intro focused conversation around like orgasm and not knowing if I [00:07:00] know how to ask for it, feeling like we need a fake or you got to it's all this stuff to like going back to macro and thinking about all the other things that we fake in society to survive as women, as people of color as whoever in this world.

And so it, it, it oftentimes really just like balances in a really beautiful way, but we try to create our spaces. I first started in particular. To where we are talking more about pleasure, because there are so many spaces where, where, like we are talking about politics and how to resist all the time. And so we want to create spaces where it could just be like sheer joy.

Tim Norton: Yeah, well, that's, that's wonderful. And I heard you, so for the listeners out there, I saw delicious speak at a, at a conference, which is a as a conference of sex education S sex counselors, sex therapists, sex educators, In a room full of hundreds of people. It might've been a thousand people on there and she killed it.

It was just an awesome talk that she gave. And I already, I already knew about Afro sexology and I was really excited when I found out that you [00:08:00] were the speaker. but in your talk, you talked about like this two year break that you took, that was pleasure based. And I want to just hear a little bit more about what that was like and what you learned during that time.

Dalychia Saah: Yeah, yeah. That. Has been such like such a life altering experience. So what ended up happening was that, like I had all these internalize shame based messages around masturbation that it was like something that like people who are raised as women don't do all of these like messages that like it's, it's not what you do once you're partnered.

It's not whatever. And so I have like, over by that time, I had like worked through. A lot of that shame to come to the place where I was like masturbating. I was like, this is my favorite thing ever. I love this. It's great. But it also was really affirming to be like that. I don't have to wait for a partner or wait for somebody else to make me feel this.

I can do this for myself, by myself, with myself. And that, that, that understanding really inspired me to like, think about other [00:09:00] aspects of my life. But what happened at the two year point? It was like, I was, we were really like deep into Afro sexology. It was like this amazing work that we were doing. I was working a full-time job.

So I'm waking up at 4:00 AM working an Afro sexology, going to my 9:00 AM job coming home, working after sexology. And I was like the feeling that I have while doing an Afro sexology was like, Such a pleasure. It felt so orgasmic. It was, I mean, I would hop out of bed at 4:00 AM, like ready to go. And it was becoming once I had that positive, like really pleasurable feeling, it became harder and harder and harder to go to my job.

And it wasn't that my job was like, awful. It just like did not compare. Like I just was like, I don't feel challenged. I don't feel energized. I don't feel excited. I don't feel like the way that I feel when I'm working on Afro sexology. And I just started really questioning like. Is that okay. Or do I want to take the risk of like, feeling like I can do something that feels better?

Right. from that, that led me know, like quitting my job, which was a really [00:10:00] hard decision because everyone was like, like from the time I was young, I was told that like working a nine to five is supposed to kind of suck that like you're supposed to hate your job. That's a good thing in our culture as Americans that like.

You know, we have whole TV shows around people who hate their work life. And so it was like something that I had normal life that I think by creating our soldier was the first time where I really questioned, like, does this have to be my normal, like, can I have a job that I feel excited to be a part of that I still fully seen and I can be my full self and I get to be creative.

and so I just started like making moves towards that when it came to like, My job. And then my friends and then the food that I ate and the clothes that I wear. And I was just like, what does it mean to like actively move towards the thing that bring me pleasure? The things that are so good instead of just settling for.

These mediocre experiences. Cause I was at a place where I was like, I don't want to settle for mediocre sex. So why do I settle for mediocre work life, mediocre friendships, mediocre like X activities that things that I didn't want to [00:11:00] do. And I recognized that a lot of it was my conditioning, this since a really young age, you're like raised to kind of just like.

Settle and just like go for what is given to you. and to not ask for more, like, there were so many times when I was told, like my dreams are too big, I'm asking for too much. I like want to, I'm demanding too much of my country. I'm demanding too much of the da. And like at a certain point, I was like, actually I think that like, it's okay to like dream big and to ask for what you want and to move towards that.

So that journey has been super transformative for me. And like, Now I'm like a lecture at a university and I absolutely love, love, love my job. Like I am, I like teach it til eight 30 at night and I leave feeling so energized. Like it's like the best feeling in the world. I, my students are amazing. I love the, the intellectual discourse we have in the classroom, the work that we're producing.

And it's just been so rewarding to, like, for me to question, what I would say is like capitalistic and what I think some feminists would say is, is, [00:12:00] Paternalistic is that we are so focused. So what are we doing? What are you doing? Like, what are you producing? And I think this way of life really helped me to think about the process more than the product and the feeling more than the doing.

So it was like, how do I feel when I'm doing this job? I feel as I'm having this meal, I don't feel as I'm having this conversation, like what topics I want to really start talking. Like I had to tell my friends, like, I don't want to gossip anymore. Like, I feel like shit after this, I feel like really like, self-conscious, I don't want to keep doing this.

Like, why keep doing these activities? That don't feel good. So that intentionality for those two years has gotten me into a place where I feel like I trust myself so much more. I trust my decisions. I trust my know, like I know how to honor my, no, my gut reaction of like, actually don't want to do this, or I don't want to.

Put up with this and I've learned to like, pursue the things that I really want to say yes, to like the traveling more and like honoring more of my dreams and just say the things that I'm like, that I've told myself that I can't do because I'm too young or I'm, whatever, whatever. [00:13:00] And I'm just going after it.

And it feels really good. It feels really, it's been a really amazing journey

Tim Norton: and what a wonderful parallel for just pursuing pleasure in the bedroom. Just, just. Prioritizing the things that you want, the people that you want to be with, the way you want to spend that time. And it's, it's almost like a meta version of that.

And because maybe a lot of the time. You know, people bring in this directive of, okay, we've got to figure out how to have a spontaneous or, or simultaneous orgasm, through these very one or two or three different ways and within a certain timeframe and without any regard for right. How are the sheets right now?

And am I a little hungry or thirsty and all of those things. So I bet. When you're doing that 24 seven, I bet it really shines through when you're, you're talking about work [00:14:00] and you're talking about pleasure and sexuality with, with students and, and people taking your courses and seminars. Yeah.

Dalychia Saah: I think the one word that people use to describe me a lot, there was the comment of you're so passionate and I'm like, well, I think it's because I've, I've like in our society, we limit passion to the bedroom instead of like lending it, be through our entire lives.

And so. I wish everyone that we came in contact with who were seeing them and doing the thing that they feel most passionate about because our interactions with them will be so different. And that would, that would definitely influence our friendships, our relationships, our sexual experiences. If we're interacting with people who like steal that passion throughout their entire life, instead of feeling they'd have to dim their light everywhere else.

And then they have this one space where they're allowed to like light up. So I love it. I also had a student who like, had this amazing activity one day where she brought in a list of like feeling words. And she was like, like, she was like, how do you want to feel when you're having [00:15:00] sex? Like, do you want to feel aggressive today?

Do you want to feel naughty? Do you want to sow romance? Do you want to feel, like a T like, how do you want to feel and then to build actions off of that? And I really love that because I do think so often we're like, well, we're going to do this, this and this. But the idea of like tapping into the feeling, which can be totally different.

Like if I want to feel a animalistic, maybe we're going to set up for like play fighting or like wrestling, which is different than if I want to feel romance. If you're going to start off with like some music, you know? And so just thinking about how I want to feel when I'm doing things, as I definitely impacted so many aspects of my life.

And are you able to

Tim Norton: impart that to your. Did the students like, do they, do you feel like, how do they, how do they take this information in?

Dalychia Saah: I think they're pretty receptive. I think a lot of, I think a lot of us are realizing that like, we don't like the things that we have been taught are normal. Don't have to be our normal and that.

[00:16:00] Well, that might be like really unnerving to like rip the rug under somebody and be like, everything you thought was true is no longer true. But I think a lot of people who see it as that, like as an opportunity for them to expand. Their way of thinking and to select what their truth is going to be until like, explore like that space.

That, that possibility where we did not know possibility existed feels really energizing, but it can also feel really scary. And I tell my students all the time that like, there is sometimes resistance that comes up when people are talking about liberation or these new possibilities, because they could feel, they can really feel like someone's just like ripping the rug from under you.

so it's a lot of mix of feelings. I would say that like, by the end of the semester, my students have like gone along with the ride and they're they're onboard. and not that they're on board by meaning, like they believe what I consider to be true as they're true, but that they're open to this idea of like, we can question, we can critique, we can hold things, in a way that we haven't been able [00:17:00] to do in the past.

And there's beauty with that. And also having responsibility about what do you do with that new understanding? And what does that mean for like old ways of being that we have internalized and normalized. And so it's a lot, but that's what I love about my class more than mine, like a workshop. Cause it works for him.

I have you for three hours and it's a lot to drop that on you. That's a good, okay bye. But I work a class, I have them for 15 weeks. And so we're able to go through that journey in a very, yeah. More in a way that you could hold the transitions that people go through.

Tim Norton: Sure so that I think that's a great place to kind of segue into whatever hard conversations is typically about.

So, so let's start with normal and your regularly deconstructing normal and one really. Typical facet of normality. Normalcy is an erect penis in sex, right? Normal, normal sex. Usually the narrative will include something regarding [00:18:00] an erect penis penetration. So I imagine you've, you've deconstructed that once or twice.

Dalychia Saah: Yeah. I mean, it's. it's, it's, it's something that I think about a lot. And it's actually, I've been thinking more recently about like the, about creating new erotic language and like that. Can we create words for experiences that are prejudicial, that don't involve penetration or that are not limited to only penetration?

I think we've limited sex too. Penetration and orgasm and it could be other things. And I think, again, when you like become expensive with possibilities, you start questioning like, okay, so me and this person just mutually masturbated, is that sex. If there was a penetration or if you and this person had this like really hot make out session and wrestling around and we're closer OD it never came off as that, not as sexual experience.

Right. And so I think when we start thinking about the things that we. The experience is that when I start thinking about the experiences that are [00:19:00] pleasurable to me, it kind of makes me sad that I can't and our traditional standard, those, some of those experiences don't kind of sucks, but some experiences that I'm like that actually was pretty shitty sides, but that counts as like that counts at sites.

Right? And so I love the conversations that people are having about like all the different ways that our bodies can experience pleasure. And I think this conversation is becoming more expansive to include queer sex. People with disabilities, people who don't want to have penetration in sex for so many different reasons.

People who like what we consider foreplay and see that as like the main activity. And why is that the thing that we're calling, like, we're just doing this prior to getting into penetration instead of being like, no, like maybe we just want to have like a sexy massage and like Russell and roll around on each other and like kiss and lick all over each other.

And that doesn't have to include meditation. And so. yeah, and I think the way that we've limited. So being our penetration hurts a lot of us. It hurts people who cannot get a [00:20:00] rector who don't want to have penetration during sex. It hurts people who are having sex that has nothing to do with penises or penetration.

so I think this new creation that we're doing around, like expanding what sexism, and hopefully like create a new language to call it is going to be helpful for a lot of us.

Tim Norton: Yeah, the new language is I always love when language evolves and you start looking at the linguistics cause there's. There's so much power in language and just flippant words, like you just mentioned foreplay.

And I never thought about how oppressive. Yeah, because you're like, wait, what do you mean? This is for, this is before the plant. This, this could be the main course. I love

Dalychia Saah: this part. Yeah. A lot of people do love that part. Seen as like, just as like really let's just get this over with so that we can get to the main thing when it's like, I actually don't need that.

I just want more of this. Let's just slow down here, but it's not [00:21:00] seen as important or as valid as when penetration happens.

Tim Norton: I was talking on the show with Barry McCarthy and he, He was talking about one of his favorite things to do was with something that he made every client do. Every couple was the man had to achieve an erection or, and let it go like three times during the course of, of, of an encounter.

And, and he said like, Every single one of them hate, you know, a hated to just like, let that release. But, but the way you're, you're talking about it, but what you're talking about right now kind of reminded me of that, of just accepting the play of it and whatever happens, happens. And there's so many more enjoyable things there's so

Dalychia Saah: much, and it, it really sucks that we downplay so many things that we find part instead of, instead of having it all on the table, I think a beautiful challenge is for people to have sex [00:22:00] without penetration, because then you can like explore totally different things.

You might not have even known that like that spot behind your ear feels really great because you've never, you just kind of skip over and it gets a penetration. You might not realize you actually don't need penetration to orgasm. You don't need penetration to have a pleasurable experience. So yeah, I think it's great that people are getting challenged to do more things like that.

Even if it's hard.

Tim Norton: Yeah. Even if it's, it's challenging you, you mentioned a minute ago that people don't want to have penetration for so many reasons. could, could you go into a little bit of that as to why people might not want

Dalychia Saah: penetration? People may not want penetration because they don't need it to orgasm or to have a good time.

And so they don't want that people might not want penetration because they've experienced some type of sexual assault and that's not the kind of sex that they want to have right now. People might not want to have penetration because they don't [00:23:00] feel ready for that. And that that's just like, not where they're like, I hate that.

Like, when people say like, Oh, I want to have a sexual experience with you. That it just means to the, up to somebody that involves administration, which it might not, someone might just want to like have oral or just like do something else. So there's a lot of different things. And then some people might have, different feelings around things that are penis shaped or around penetration that like.

They don't want to do that. Some people might have body dysmorphia and so they don't want to, they want to get to sexual experiences without bringing in body like genitals in a particular way. And then some people might have a right tile. What is, what is the word that

Tim Norton: I was saying? Issues,

Dalychia Saah: issues, to where they feel like, because they can't that they're having those issues that. Their, their sex is limited now, [00:24:00] instead of like thinking there's so many other things that we can be doing, I love talking about getting people to think about, Oh, go ahead. No, no, you go, they're their own wheel of pleasure.

Like, what are all of the things that make you feel good? Right. And so on my will include like booty rubs because I love getting like, like fuck massages. And like, I love naked cuddling. And there's like other things like nipple plan there's things that like, feel good that like all of those things can be explored instead of saying that like Cyrex has to go in this formula every time.

Tim Norton: So. I'm imagining one of the biggest challenges to this idea is going to be the guy or just the person with a penis who, I don't know, maybe there's some self righteousness in there and just is like, you know, forget all that. Like, this is, this is crap. Like I gotta, I gotta go in there. I got to penetrate, I gotta calm.

I gotta nut. [00:25:00] And, and that's, that's what sex is like in, and I imagine a lot of people. Resist, you know, thinking of challenging, that might be kind of like a difficult conversation to bring up with somebody and trying to work with a partner who's so like such a bulldozer or so like narrow minded or just traditional.

Dalychia Saah: yeah. And I would say that like, if that works for you, if that works for you and the people you're having sex with them, like, go ahead. No, one's saying that you have to try. Whatever, you know, if you find something that's working for you, I guess you could continue doing it. But I do. But I think if it's not working for one partner, I think of one partner or whoever one person in the situation is like, actually this isn't working.

I want to have. Sexual experiences outside of this, which is really hard because a lot of people who are socialized to be women are not raised that to think that sex is for us, like sex is for our pursued hetero male partner. And so this whole conversation of like advocating for like, actually I don't want that [00:26:00] or that doesn't feel good or you go into early and I'm not aroused enough and it kind of hurts and it's dry it up, but I'm not in the moon.

And did it like all of that stuff. We don't get the space to say that out loud. But if you do have someone who was saying that, I do think it is a part of the responsibility of people who are in the partnership to say like, Oh, I actually want an experience as pleasurable for everyone involved and not just me.

But, yeah, I don't typically work with people who don't want to work with my work is like, usually have like your hair cuts, you want to do something different. So, but I, I, again, I think like what consent, I don't want to coerce to force anyone into do with something that they don't want to do. Cause then it's not going to be a pleasurable experience.

But I do think that like knowing how our bodies change and knowing how at any moment. our ability size could change if we're lucky our age will change. And with that comes different body functions that like learning [00:27:00] to experience, pleasure and eroticism outside of penetration and orgasm can be really liberating for you for the rest of your life and not just say what works for you right now.

But thinking about holistically about what's going to work for you in 50 years, what's going to happen. If something changes what's going to happen, if your partner no longer wants to do this and like, how do you create space that is pleasurable for you all lifetime and not just like what works right now, because this is what feels good.

Yeah.

Tim Norton: Hmm. I re I really like that. So I'm also, I guess I'm wondering, do. Do do men do males, do people with penises as well? Take your classes and seminars. Did you get both?

Dalychia Saah: Yeah, we do. We've actually done one that was particularly for men, which was more so of us being like, we want to know what y'all want to talk about.

And we were just really, I actually thought, like, I, to be [00:28:00] honest, I actually thought the conversations would be a lot more about sex. And it was a lot more about relationships and intimacy. I think it was a lot more like, I don't know how to, like someone in our workshops said, I dunno how to, what did he, what did he say?

He was like, I don't know how to penetrate a woman with anything other than my penis. Like, I don't know how to like, let my heart be open. I don't know how to like, tell to like, just. Be seen and like to see her until like, make her feel heard. And he's like, I struggled with pillow talk. I struggled with the intimacy.

I've struggled with breakups, like, and I don't know where to. And so it was a lot of conversations around that. And then it was like a surprising moment when, We like read numbers though, about how many people take orgasms. Like they all like were mind blown that people were not enjoying having, or that there was a possibility that someone to have sex with them and that faked it until that made them more open to like, Because I think there was a level of confidence of like, Oh, my game is good.

Like, I [00:29:00] know what I'm doing when it comes to sex. And then some of those numbers, they were like, wait, what do you mean? Like people evolve as don't mean penetration to orgasm. What do you mean? People fake orgasms. And so that opened them up way more to having conversations about like, Oh, okay, we need to have conversations about what kind of sex people want to have.

And then people also have to talk about like performance anxiety and like the pressure, especially as black men who have been. Hyper-sexualized in our culture, this idea that like, I always have to perform and I always have to like, be ready to go at all times. Then I can't say no that I can't say actually I disposed disputed shelter and I orange, or I want to cut off.

I want a booty Rob, like, you know, like not being able to say those things and feel like they have to always have penetrative sex.

Tim Norton: What would you say to them?

Dalychia Saah: I think, I mean, acknowledging how sexualized the culture is, particularly around blackness and particularly around black run and that they are oftentimes seen these stereotypes.

It's like you have the bigger penis and that year, [00:30:00] like the sexual proudness and so giving space for that, but then also like a, for me, As much as everyone else that like consent goes both ways, but all the way, then you have the right to say, no, you have the right to say, I don't want to do this. You don't have to feel.

And that like, if somebody is shaming you for it, that's probably not somebody you want to be hanging out with. Anyways. I know a lot of times like, People will like even women will shame men for like, not wanting to have sex with them. Right. They're right, right now. so I think training a conversation for people to see that like your experience is as common, which I think a lot of people do a lot of ways that shame manifested like, feeling like you're the only one.

So creating space for people to say like, Oh my gosh, I also feel that too. And then affirming that you don't have to get tenue going down that path because everyone else has treats you that treats you like you're supposed to. That

Tim Norton: must be a really nice thing to hear. I hope so. Yeah. Like taking away that pressure and I, I, it's a kind of [00:31:00] message that people probably need to hear dozens and dozens of times.

but yeah, that, that permission. To, isn't it all about permission at the end of the day? I feel like so much of this work is just permission.

Dalychia Saah: I agree. I was like telling someone, I was like, I feel like I have like the easiest job, because I don't actually have to like, especially in someone who's at a therapist, I don't actually have to like tell somebody, like, I feel like with calculus, the only way to teach someone is like giving them step by step instruction.

And like, this is the right way to do this, but. When it comes to people's sexual journeys. So many times like people already know what they want to do, and it's just about giving them permission. So I feel like I'm just like lighting flames and then watching it run free. Like, but I'm not. So it feels like a really easy job to just be like, yeah, you can fantasize about that.

Yeah. You can try that. Yeah. You should do that. Yes. Like you're not weird for thinking that. And then seeing people like. Like that one permission gives them permission to explore so many other things that they've been denying themselves or [00:32:00] shaming themselves about. So it's a beautiful

Tim Norton: word. Yeah. Yeah.

It's really nice. And so now I'm picturing the seminar and you're having a man, a black men. Giving them permission to, to not have, to have sex, to not have, to have an erect penis when you're naked with the person to not have to perform quote unquote, perform whatever that even means and, and what a nice normalizing message to hear it.

But then on the other end, like kind of schooling. they're partners on how to not shame them for not going along and doing the thing that everybody in porn or the media is telling them that should be happening in the bedroom. and then that's an important message too.

Dalychia Saah: Yeah. Yeah. I've been doing, I mean, even like, so I do this one talk called the oppressor within talking about the ways that we [00:33:00] like normalize.

A lot of different forms of oppression and having this practice, particularly with a lot of my students around the ways that we have been hurt by the system and the ways that we've helped the system. So the ways that we've been hurt by patriarchy and naming those, but we don't get to name that a lot of time in the system and then ways that we have perpetuated patriarchy, because it's a normalized, it's something that's been around us and it oftentimes happens without us even knowing it.

And so becoming more aware of. The way that we've been hurt by something and giving it space and holding space for it, whether that's like losing our relationship with our father. Once we had 13, because I could've sat on his lap, I knew more or. Being catcalled when I walked out of the street or being sexually assaulted or feeling like I can't walk at home by myself at night, all the different ways that we have to like survive within the system, but also the ways that we perpetuate it, whether that's say judging other women and slushing other women or shaming men for having small peanut or people with penises for having small [00:34:00] penises or.

Being, transphobic or being homophobic tour and telling a person who doesn't wanna have sex with us, that they're queer, like all of these other things that we have normalized in our culture that we also end up sometimes doing and taking ownership for that so that we can become more aware of the ways that we're perpetuating the things that we say, where her fire that we want to see God.

so yeah, it's a lot of. Deep introspective work, but I think it's the work that's needed. And as to move towards a more liberatory society and healthier relationships in general.

Tim Norton: So I love all of those points and I kind of want for the audience to just let's spell one of those out. So this is again under the topic of the oppressor within.

So how, how. What's so bad about penis shaming or penis size shaming. Like how, how is that perpetuating oppression?

Dalychia Saah: Yeah. I, so for me, I think that like [00:35:00] body, all body shame is perpetuating. Sizeism and like the ways that we feel like other things bodies are not seen as fully human or as like healthy or as worthy of other bodies, whether we're shaming, someone's body, because, the color of their skin, like you're not as worthy because you're not white or their gender.

You're not as worthy because you're not CIS or whatever. I think like, Or because they're five, we're like, you're not as worthy cause you're a fat body. So all of that is the same. And so if we're going to talk about getting rid of the shaming of bodies, we're talking about all bodies, which also needs critiquey the systems that are told us is that like bodies, male.

Well, these are supposed to have giant penises, which ends up being not. Well, it ends up being shaming towards a lot of people who don't have giant penises and also ends up being like pretty transphobic to people who, don't have, like, we're not given a penis up at birth. Right. so there's this for me, [00:36:00] it's like, I can't, I can't see the value of like saying, well, we're going to take down this and this one form, but it's okay over here because these people have these identities, And I think we have to do better at that because I, for me, liberation does not look like taking my oppressors place.

Man with erectile dysfunction holding pill and needing online sex therapy

And so it's not me getting to the position of power where I can say, well, now I can shame men and white people all day because like, that's, that is, that is fundamentally against a value that I have, which is like, I believe that you cannot, you can not dehumanize other people without dehumanizing yourself.

And so the moment that I am. Seeing somebody as less worthy by the human. To me, that is the humanization. I am also dehumanizing myself and there's no way for me, shouldn't for me and my practice to truly be at peace and love with my body. At the same time of shaming, somebody else's body, it feels like a very connected practice.

Tim Norton: Absolutely. And [00:37:00] so then from a practical standpoint of just of just language. You know, a person is going to see this small penis or this flacid penis, and have these norms in their head from all the porn that they've seen. And they're going to ask you a discrepancy and they're going to have this reaction and they don't know what to say.

And maybe it's that moment of nervousness or, or some other kind of force that's acting in the bedroom in that moment. So what can they say?

Dalychia Saah:

That is a really good question. I feel like I'm like, I don't think I would necessarily react to the penis. I think it would be a conversation of like, what are we, what do we want to do tonight or right now, as far as, because it could be that like penis is, or yeah, penis and penetration is now the table for what we're doing.

And so we need to have a larger conversation about like, [00:38:00] What turns you on what turns me on, what do we want to do? Like, what are you into, what are you not into? What are your, your, your boundaries like that, which is a conversation that I don't think a lot of us have over having sexual experiences. And so it's, it's hard for me to.

I don't know. That's a really good question. I don't, I don't think I would react to the penis. I'd make making a comment on it. Right. They want someone to make a comment about my breasts,

Tim Norton: right. Even what they'd say out loud, but maybe what they'd kind of have to say to themselves, like in a coaching way or.

In a normalizing way or like, what did, what did I learn in class that semester? Like, this is one of those situations where I'm trying not to perpetuate any, any shameful situations. What did, what did Dr saw teach me about body positivity in this moment? Yeah.

Dalychia Saah: I think, I, I think in my head, I would just affirm like what a beautiful person [00:39:00] and then keep it going.

I think, like stay focused on the reasons that you're like. And to this person, the reason that you're here and not looking for deficits, which I think we're really good at looking for or what we consider deficits in our culture,

Tim Norton: focus on the reasons that you're here and those might not come up. And then that's just a bigger message of what the heck are you doing here at all right.

Right now I'm just kind of reframing that moment where two people in this room or wherever we are in this car and this park.

Dalychia Saah: Yeah. Yeah. I think folks, like for me, those moments of connection are so much more powerful than like looking for. Cause the, the moment that for me, the moment that I'm scanning somebody looking for something.

Wrong in air quotes. I also have [00:40:00] to believe that they're scanning me looking for something wrong in air quotes and that. Takes me out of this moment of connection, because there's enough things for me to be self-conscious about, about my body. You know, like all of us have been giving all these things that we're supposed to be self-conscious about.

So the moment that I go, let my head, my head space, go there on someone else's body. It comes like it becomes my inner dialogue around me. And I go, I wonder what they're thinking about me. And then I, then I'm just like, Suck it in and position over here, turn the lights off. So it's like, it goes into this very chaotic space.

And so my practice of like, Oh, what a beautiful person? Or like, Oh, like, I'm excited about this is also a practice for me to be like, Oh, I'm a beautiful person. And I'm excited to be here. Hmm.

Tim Norton: I'm thinking about an analogy to some of the other ways that you've pursued pleasure or that people pursue pleasure in the last couple of years.

And I guess if you've cause cause people like let's say you're going to eat like your favorite meal [00:41:00] ever. So people will still have those doubts, like, Oh, this is gonna make you show up in my stomach or whatever. But once you've kind of made the decision it's it's time to enjoy, enjoy right. And then the last thing you want to be doing is, I don't know, analyzing your fork or what you're going to feel in the morning.

You just want to enjoy the cake or the steak or whatever the heck it is. like you want to enjoy the person and your moment and your time

Dalychia Saah: and yeah. Which is hard. I mean, it's, it's hard. Like getting out of our head into our bodies is not something we do well in this culture. It's not. And so it is very.

Hard to not have all those thoughts, judging that self judging voice, going through your head. That's telling you, Oh my gosh, if you eat this, you're going to regret it and did it as you're sitting in there taking everybody before, you know, the dishes over and you don't even remember taking a moment to just enjoy it.

And I think we go through a lot of activities like that, where we're just like in our heads, critiquing and judging ourselves and other people. [00:42:00] and not just like, like you said, once we make the decision, like accepting and enjoying what you're, what you're there to do.

Tim Norton: And we are two experts giving listeners permission to do that coming from different parts of the country.

And, and, and we're just saying, Hey, like it's okay. And the research backs it up. When you get out of your head, you're going to like your time in the bedroom more and it's okay. And people, actually, some people are actually able to do it and they have wonderful things to say about it. Yeah.

Dalychia Saah: Yeah. And I think like, if that voice is, is, is like, I don't know, for me, it's like learned, like I've learned to distinguish between my different inner voices.

Like the voice of me that is like, I don't want to do this and I'm forcing myself to do this. which I've. I mean, there's so many times when I'm just like, I don't want to be on this panel, but I've been asking me on this, but like just all these like different things. I don't want to eat this meal, but it's already in front of me.

[00:43:00] I don't want to read the finishes book, but a very started, I actually don't want to be at this event right now with colleagues, but there's so many times where I've like, ignore that voice. So it's like, I've had to learn how to say, like, this is that one voice that like, doesn't want to do this thing. And I need to honor that voice and like knowledge of the thing.

And this is the voice that. Wants to do the thing, but it's scared to do the thing. And so there's like fear there and like I've learned to push through my fear towards the things that I want to do. Then there's a voice that's like, Oh my gosh, I really do want to do this. And I'm, I'm learning to actively move towards that.

But like, so I would say don't push do don't push. Have a voice that is telling you, this is something that you do not want to do, or you, and, and like, to not go along with that, because we've been taught to like go along with so many things that we don't want to do, but to like, just like understand the voice that for me, the hardest thing has been, understand the voice that like is a voice of, of like a, I guess a positive fear.

Like my, the voice that's like trying to protect me, but like, from. This, I don't know how to distinguish it. It's [00:44:00] something that I want to do, but it's like self doubt that comes up because it doesn't want me to, like, with my writing, there's like a lot of voices. That's like, Oh, you're not good enough.

Right. You know, again, I've I know writing something I want to do. So I have to learn to like, hear that voice would be like, I hear you. I'm safe. I loved, you know, I could do this. I could take those like risk and trust on myself, which is totally different than the voice. You mean? That's like, you don't want to do this.

There's nothing in you that wants to do this

Tim Norton: right. Right. There's, it's almost like you have to ground it in a, in a value or like a, a real, a specific goal. Like, I like this person. I have been attracted to this person before we had a good time. I can sit and enjoy this state. if you don't have that stuff, like, I, I'm not sure.

I like this person he made he, or she made some weird comments earlier and, Okay then. Yeah. Your body seems to have heard it and maybe it's time to listen to the part of your brain. That's saying, yeah. We're not

Dalychia Saah: really into it. [00:45:00] Yeah. Yeah. And I am neuro-typical and so I don't know what that looks like for people whose bodies and brains are not telling them something that they can trust.

Right. so that, those distinguishing between those three voices have been like very much my, a couple for me. But I do want to say that. I don't know if it's like typical for every body and brain.

Tim Norton: Yeah, no, definitely not. So some of the things that you mentioned regarding, you know, all the different reasons that we might hear, one of these voices inside the bedroom, some of them are very political and I'm wondering if it comes up in your work, that there is.

Micro level political activism to be done in the bedroom.

Dalychia Saah: I think the, I think it does come up. I think the beautiful place where it's been coming up is around pegging [00:46:00] for everyone who doesn't know. I mean, hiking is when somebody, particularly somebody with a vulva puts on a strap on and then like penetrate somebody with a penis that there has been like a lot of.

work and research around like people with penises, enjoying posh, prostate pleasure, and like how that has like toppled. A lot of the things that they thought would make somebody like that would, that was like eMASS escalating. And like the, the people who have become more comfortable with pegging, like also have like seen their gender challenged in a really beautiful way.

And like this comfort in. Their own definition of masculinity, because I do think that like, a part of so many structures that are oppressive is they define themselves by what is not. And so to be man is to not be feminine to be man is to be, is to not be weak too. The man is whatever. And so when people are like, Oh my [00:47:00] gosh, I've started my whole life thinking that my masculinity also meant that I had to be home phobic.

And that means that I have to avoid all of these particular sex acts. And then I'm able to enjoy these sex acts and also understand my gender and my orientation and all this stuff in this very different way. I've seen some people do work there. Then there's also people who were just talking about like the way that we house typically have sex with like people, what was on the bottom.

When people with penises on top mirrors like patriarchy and sexism in our society. And so something as simple as like person with the Volvo on top can also challenge, power dynamics. And then I think people in the kink world have also been talking about power dynamics of ways. That ways that you can hold power in a way that is also really loving for the people that you have power over, which is not what we typically see.

And like an oppressive hierarchy where like the people with power are usually like exploiting and abusing the people that they have power over. And then I think he gives us this really beautiful example of like, [00:48:00] What it means to hold power with so much love and care for your people. So, yeah. So those are some of the things that I think come up pretty

Tim Norton: often.

Yeah. Those, those are great examples. pegging. So it's, it's good feminism to go out there and, and peg and, and, and teach, teach someone not only a way to. I don't stretch their ideas about their own gender, but also a really hot new level of vulnerability.

Dalychia Saah: Yeah. Which is what comes out for so many people, penises who do it, is that like, they, that, like, they didn't know what it meant to be like a receptive to like, receive, to like have the level of vulnerability that it requires to like give someone this much care.

Over it like to open up this much to this and they were talking physically and then also emotionally, right? Like there's a level of care and trust and it is extremely, extremely vulnerable. [00:49:00] It's really, it's a very portable practice. And I think as people are getting more comfortable with it, they're also seeing that like it challenged the challenges them.

And I've also heard, like people say, like, I didn't understand the importance of lube until didn't understand. It could be painful that like they have become way, much more caring penetrators after being penetrated and like knowing what it means to like. Be aroused and the vulnerability that it takes for someone to like a lot to open themselves up to you.

so yeah, I definitely think it's a practice that I think a lot of people are learning a lot things that challenge them sexually, but also like just things that they normalize as part of their masculinity.

Tim Norton: Yeah. And, and the way you're talking about love. and, and kink where, you know, I assume you met someone being loving while tying them up and, and you'd, you'd want a person who's getting penetrated by a, by a strap on would want the [00:50:00] penetrator to show some love in that moment.

That's a consideration. And is there enough lube there?

Dalychia Saah: Yeah. Or not things that I think. People are people who are raised to me, men are taught as a part of masculinity to like, hold that power and that responsibility in a way that is caring intentional. and that comes with a lot of communication, a lot of check-ins and a lot of just like vulnerability.

Tim Norton: Yeah. It would be something like I'm imagining like the, the sex education utopia, if that, you know, when you. Start having sex you're 18 or whatever someone took you aside and said, okay, you're going to get penetrated now to see you. What it's like to know, Hey, everything better be ready. You better be lubricated.

You better, you know, this person and, and listen, you know, what if, what if I don't [00:51:00] listen when you start just say, Hey, we're not ready. Hey, like, this is, it's not, not there yet. And all the different, yeah. Combinations of, of conversations that come up in that or should come up in that moment.

Dalychia Saah: Yeah. Yeah. I think if a lot more people with penises had experienced penetration, the way that they penetrate would be so different.

Yeah. Yeah. And not that I'm like advocating for us to like all eight only penetrate, but I'm just that level of like consideration that is required. I don't know. I would like to think that it would change the way that people currently penetrate.

Tim Norton: Absolutely. So let's, if we we've almost covered a full hour here, I kind of wanted to get a sense for the future of, Afro sexology or just Aleisha in general or where, what you have in the works.

Dalychia Saah: [00:52:00] yeah, so the future of Afro sexology, I mean, we're constantly growing, where in the works of writing a book. And so we are trying to slow down on our workshops and we can give more time so that we have a video series. We recorded like 10 black people sharing their sexual journeys. It was the most beautiful thing ever.

And we have a video series like edited, and we need to put them out. And so we're just waiting for the right time to do that. We are. I mean, we're constantly moving around for workshops. So we're going to be in Atlanta for sex down South. We're going to be in Cuba for the association of black psychologists and clinicians.

and then we always have like some private things at like universities. And then for me, I'm just like, I'm just good. Like people, like I remember after the talk, people were like, Oh my God, what's next? What's next? I'm like, I feel pretty good feeling right now. I mean, I'm moving fully into my [00:53:00] university.

And so I really want to dedicate more time to thinking about my practice as a professor. And I'm thinking more about my practice as a writer. Because I, I spend a lot of time in my head and I want to figure out how to like, display this and share this in a way that makes people not only think, but feel as I'm still working to find my, my bright language outside of academia, which is very think heavy and not feel heavy.

so I'm doing that and I'm also just trying to like, hold my own. Work right now. It's like, how do I, like, I quit my job, right. To do this two year thing of like, learning about my own pleasure. And now I'm moving more fully into my university. And it's like something that I love doing, but I'm also like, how do I maintain it?

W what I've discovered about myself in this journey and the middle point. So, like, I remember after my, the first day of like new faculty orientation, I like came home and I had to like, write down my definition of success, because I was like, I'm [00:54:00] not going to get. Brought into the system of like what they define as success and like, so trying to be really intentional with how, what it means to be in back in academia fully, and then constantly working to make sure that our work is way more inclusive.

Like we have to do way more work to make sure that we're, trans-affirming that we're thinking about ability status, that we're thinking about size or we're thinking about queerness. I just think we. We can always improve. And so just being more intentional, thinking about class way more and like how that intersects with sex and our work.

Tim Norton: And did you come up when you set up your own personal definition of success? could you give us a little highlight of

Dalychia Saah: sounded beautiful? It was like me jotting down. Like if I look over my life in the next 10 years, like one of the things that I want to say I've accomplished or that I've done. [00:55:00] and so writing that down and I was able to like, look at.

Most of them. And I was just like, okay, I'm on, I'm on the right track. Like I'm doing what I need to do. And it's just, I had to do that because my university is a research based school. And so they, like, they care about the million dollar grants that you're getting all of that stuff. And that's how they define success.

And I'm not interested in researching by people in HIV. And so I, I don't go after a lot of those million dollar grants and that's like, not even my work really. And so I just have to be clear what, what I what's important to me. And that's just, it's like, what am I values? What, what aligns with my values and not getting caught up or trying to seek external validation for something that I internally.

Can validate myself for which has been so much of my work these past two years. It's like learning to trust myself, learning, to validate myself, learning, to support myself and not seeking that externally. And I don't want going back into this environment to put me back in a space of [00:56:00] feeling. Like, I need to perform in a way that's different from my genuine self in order to seek external validation.

So I just said like, I have to stay on my own on my track, my track.

Tim Norton: Yeah, definitely. Well, it sounds like that's really been working for you anyways, so I hope it's easy to listen to that. yeah. I usually like to ask guests, like any, any final words for listeners and I'm thinking, you know, I don't really know the demographics of the people who listen to my show.

I don't get very good analytic data, but I'm wondering like, if, if it is like people that look like me and male and white, like, and. This is going to be a different kind of episode for them. I'm just wondering, like, if there are some, some things that you would, you might like to speak to that, that audience who thought they were going to come here today and get some tips on how to stay hard in the bedroom and, you know, and then they're getting like some [00:57:00] different perspective on things.

Like if you had any like final words of wisdom for them. Oh, well

Dalychia Saah: never with words. It wasn't, but words are reality. I think that. I think that like, if, if this is like, you know, mostly why am I listening to this? I think that the way that we have talked about oppression is that we have limited into only thinking about how it harms the people that are oppressed and not also thinking about how it harms the oppressor.

And so now we're getting words like white fragility, where we understand, like, this is something that comes from like a construct related to white privilege, or we're understanding toxic masculinity, which comes from patriarchy. And I think like, as we're getting this language, we're also seeing the way that these systems of oppression, we have set up also harm the people who set them up.

And so I think like when we're having these conversations that are asking people to expand or to think about things that they have normalized and kind of bought into, it could feel very hard to like ask someone to stretch in that way. But to [00:58:00] all in all understanding that like what people are asking you to do is.

Is to understand that by liberating others, you're, you're liberating yourself by like us are moving the definition of like Sykes to being centered on penis penetration. You're creating the space for everyone to have an expensive amount of sex. Right. That includes all kinds of different things. and that again can be scary, but in the end of the day, it will be so better for so many of us, because then we won't have to say here.

And be fighting and feeling so much shame and like negativity when we no longer fit inside of the box that was constructed for us. Because if we can all just like live outside of these boxes, then so many of the issues that we so many things that we think have issues or not issues because we didn't have, we didn't have center identity on these things to begin with.

So I hope that makes sense. To people who are not in these conversations every day.

Tim Norton: Yeah. It does. It makes it all make sense [00:59:00] to me. Does it like that? I think that first point of, you know, it, it hurts the oppressor to like, in a lot of different ways, setting up these rules. Like, could you give us like a couple of examples of just like how it might

Dalychia Saah: yes.

No, this is great. I rarely talk directly to white men. So I was like, okay. Yeah. You know, so I think, I mean, just like, as we're talking about toxic masculinity, And we're talking about like how, like even the workshop I did with, with mostly men, I was able to see that people are struggling with vulnerability.

Like what they're struggling with when they're talking about they're struggling with breakups or struggling with like the pillow talk that intimacy people are struggling with intimacy and vulnerability. And that's because we've made so much about masculinity around not being vulnerable. Right. And around being strong and about us following and stuffing down these feelings.

and so [01:00:00] something that I tell. I tell people like women who are like, they want their partner to be more vulnerable. I'm just like, well, that also means creating space for him to cry. Right? Like if you're partnering with a man, like you can't say you don't want somebody to cry because that's weak, but then you also want them to like sit up there and share with you around.

Their personal issues. And so I think the way that we've constructed masculinity, it's created a lot of people who are not in tune and know how to communicate their emotions, and are not as comfortable with vulnerability. Having said that, like, I think we're in a space where a lot of people are.

Question or like are now questioning and deconstructing masculinity and like saying like, actually I do want, like to talk to somebody about like mental health issues. I do want to talk to somebody around, relationship stuff and intimacy and sex. And so I think we're creating space for that, but I think what we saw with how uncomfortable that people raised as men were with emotion, that vulnerability is a by-product [01:01:00] of the patriarchal system that we set up to be oppressive in that way.

Tim Norton: And it's lonely. Yeah. Not being able to be vulnerable, to say things and then have pillow talk and all of those things and then cry or whatever. Like, like while you feel like you're doing what Brad Pitt did in the movie. You still it's, it's, it's a pretty isolated place. So kind of changing, deconstructing the Patriot here by breaking it down by, by making new rules, you get to not be the highest rate of suicide group.

And one with the least number of friends and people that you rely on and highest levels of heart disease and all of that you can connect.

Dalychia Saah: Right. Right. And I, and just for me to like, My area. I mean, like we all have areas of privilege. And so even me, like, I know that I learned so much about [01:02:00] my gender from queer theory.

Like when people were able to like ask people, have deconstructed gender norms, I was like, Oh my gosh. I don't have to wear heels everywhere, actually hate wearing heels. And like that doesn't make me any less of a woman. And so which sounds so trivial, but there's just ways that, like I was boxed illimited into what I was raised to think of as femininity and the people who are outside of the box who were redefining gender and gender expression have created a space for me to say that like, Oh, I also don't have to fit inside this box that I've.

Thought I had to. And so I, I get, I do think like as we liberate people or we create societies that are liberated for all of us, we're creating space for like us to expand and to be fully human and weights that we've had to cut off to like go along with what these oppressive norms are.

Tim Norton: Hmm really well said.

Thank you so much. I'm so this has been a great talk. If people need more than an hour and then they just want more Delecia where can they find you on the internet and in the world?

Dalychia Saah: Yeah, [01:03:00] so delicious sau.com is my website. I'm sure you'll have that spelled sober, not easy to spell. and then Afro sexology we're on Facebook, Instagram, Twitter, our website, and we have lots of really great content on there.

Tim Norton: Okay. Awesome. And they can go into classes at the university of Washington and St. Louis.

Dalychia Saah: Yeah. So bad school of social work at the university of Washington. Sigma was all right. Social

Tim Norton: worker. Yeah. All right. Well, thank you so much and I'll see you. Hopefully I want to go to sex down South. Yeah. I hope I'll hope to run into it at a conference

Dalychia Saah: soon.

Thank you for having me. This was a good conversation.

Shout outs to the sex positive community, including sex educators, sex therapists, sex coaches, other fellow sex, podcasters, sex, surrogates, academics, sexual health, medical community, sex workers, the tantric community, and everybody else involved with having hard conversations. Bye-bye. [01:06:00] [01:05:00]

If This Episode Resonated

If this episode spoke to you, there is a path forward.

Tim Norton provides a discreet, evidence-based therapeutic space where men and couples can understand the deeper systems behind desire, arousal, and connection. His work combines rigorous neuroscience with a grounded, relational approach to help clients rebuild aliveness in their bodies, strengthen partnership, and create lasting change.

What You Need to Know About Transgender Women and Erections

About this Episode

In this thoughtful and clinically informed conversation, Tim and Dr. Natalia Zhikhareva explore the diverse erectile experiences of transgender women and trans feminine people. They discuss hormonal changes, surgical considerations, gender dysphoria, relational challenges, and how to cultivate a new, self-directed relationship to sexuality and intimacy after transition.

Key Themes

• Erectile dysfunction and sexual response patterns among trans women

• Hormonal, anatomical, and surgical influences on genital function

• Gender incongruence, dysphoria, and their impact on arousal

• Rebuilding intimacy and erotic identity during and after transition

• The role of sexual shame and cultural narratives

• Developing a personalised, sex-positive relationship with the body

• Expanding definitions of pleasure, sexuality, and connection

Listen to the Episode

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Dr. Natalia Zhikhareva

Dr. Natalia Zhikhareva (“Dr. Z”) is a licensed clinical psychologist in Beverly Hills and a nationally recognised expert in transgender psychology. With advanced training from Lewis & Clark College and Pacifica Graduate Institute, she has spent her career supporting transgender youth and adults through identity development, body integration, sexual health, and relational wellbeing. Her clinical and academic work includes research on genital perception in pre-operative trans women and the development of transgender-focused sexuality education curricula for Loveology University®.

Website: https://drzphd.com

Instagram: https://www.instagram.com/dr.lbc

Episode Transcript

Tim Norton: Hello, and welcome to hard conversations. My next guest,Dr. Natalia Zhikhareva, also known as Dr. Z PhD, is a clinical psychologist specializing in gender issues and transgender care, and has worked with gender diverse individuals for over a decade. Her passion, working in the transgender community, fostered an interest in clinical research, leading to the publication of an article entitled preoperative trans women's perceptions of their genitalia.  Dr. Z's most recent work includes speaking on the effects of gender transition on sexuality.  the Los [00:01:00] Angeles County psychological association and at the center for healthy sex, she has been featured as a speaker on current transgender issues at the empowered trans women's summit has developed the comprehensive overview of transgender experience course offered by the online training program.

Love ology university and writes monthly on issues related to gender on the transformed blog. She is the founder and facilitator of two free monthly support groups for trans women and trans men. Thank you so much for joining us today Natalia -  or Dr. Z. 

Dr. Natalia Zhikhareva: Thank you. Thank you for having me here. 

Tim Norton: Yeah. And so can you give the listeners an introduction to male, to female transgender 

Dr. Natalia Zhikhareva: basics?

Sure, absolutely. I think for stars, it would be important too. Talk about what it entails to be a transgender individual. And I think transgender today generally encompasses pretty broad umbrella term under which a lot of gender diverse [00:02:00] individuals tend to cluster for the sake of today's conversation.

What I would mean by transgender and specifically male to female transgender. Is an individual's that was assigned to a male sex at bursts who does not feel comfortable or congruent with their assigned sex and desires to transition to a female gender. 

Tim Norton: Okay. And yeah, we had talked about this before the podcast.

We were. W we could probably do an hour on each situation. So maybe we'll come back and talk about this, but for today we are going to be really focusing on a male to female. 

Dr. Natalia Zhikhareva: Correct. And to clarify, even further to David who would be focusing on is not just only male to female, what, and I think it's a better terminology perhaps to use is a transforming.

Okay. Or a trans feminine person.  but we're also talking about a pre-operative individual. So in other [00:03:00] words, we're talking about trans women that are transitioning or have transitioned and ex present,  as women, but for whatever reasons, either personal or financial or otherwise have chosen not to undergo gender confirmation surgery also known as the bottom surgery.

Tim Norton: Okay. And that. To my understanding is the norm correct? Or the majority of,  transgender women don't get bottom surgery, don't get 

Dr. Natalia Zhikhareva: bottoms. 

Tim Norton: Yeah. Or they do. Are there numbers on that? I 

Dr. Natalia Zhikhareva: think it depends. I think generally the way we look at transition and what I mean by transition is transition as usual as a process that individuals undergone in order to get closer to the gender.

They are entered addition may usually Intel social transition, which is coming out to family and France legal transition, where you change your legal paperwork. And then there's the medical and surgical [00:04:00] transition, which what we'll be talking today about. And that can be anywhere from taking hormone regimen to kind of,  undergoing very surgical procedures in order to get your body aligned as close as possible to desire gender.

And I think one of the misconceptions is that transition tends to be a linear process. And is that the end goal for transwomen that we're talking about today is to,  fully align their body, with the desire, gender. Yeah. And I think what we're finding out today is that that's really not. The case is a tradition is non-linear process.

And there's a lot more individual trans women today that desired not to get a bottom surgery or not to get other surgical procedures, perhaps, maybe they'll just undergo hormone regiment, and that's pretty much it or a mixture of all above.  I think that's becoming much more common. 

Tim Norton: Okay. And, and, and it goes without saying like, this is [00:05:00] not a familiar territory for me.

And that, that was one of the reasons I wanted to have you on. And it gets talked about a lot in the therapy community that,  people who don't specialize in working with this population really probably shouldn't try to fake it. I think this is a very, Dr. Z has a lot of experience in this area. And as I said in the introduction has a,  free drop-in group a couple of times a month.

And this is your field, and this is something that like I've heard from multiple practitioners that you, you want him do your homework. 

Dr. Natalia Zhikhareva: Absolutely. In a, a stronger stand by that. I think that.  unfortunately today we have a lot of clinicians at,  do every single, I think it's impossible to design. I think it's important to focus, have specialists, you know, Tim it's completely okay.

Not to have much knowledge in this, again, your field sexuality.  and I think it's great that you are open enough,  to have somebody like myself to [00:06:00] be interviewed, to kind of expand not only your understanding, but the audience is understanding as well. 

Tim Norton: So you started to talk about hormone therapy and for trans women, is, are we just talking about adjusting levels of testosterone, lowering, testosterone levels, raising estrogen levels or, or, or what all is involved?

Dr. Natalia Zhikhareva:  for transwomen, the hormone therapy regimen usually entails for starters, but what we want to do. So we want to kind of suppress or bring the Starstone levels down. Right? So would those add by introducing antiandrogens and that's usually is a spider or by glutamine and Zen. What we want to do is we want to introduce estrogen, so that way we can enhance secondary sex, characteristics of desire, gender in this case, female.

And sometimes we'll introduce progesterone to further enhance secondary sex characteristics. And the hormone is really usually the initial step and tradition and a very important one because not only does [00:07:00] it give a physiological,  alignment or closer alignment of the desired gender, but also it has a psychological effect on,  bringing you even closer to congruency because you desire gender.

Okay. 

Tim Norton: And is it, is estrogen more common than progesterone or is it about the same or. 

Dr. Natalia Zhikhareva: Sort of estrogen is E is not only common, but it's a very vital part of, of hormone regimen. Progesterone is, is an add on hormone and progesterone can do really wanders to some people. And for some people it doesn't really work, but progesterone really firs helps enhance secondary sex structures.

For example, primarily really helps maybe,  expedites,  breast crows in San transwomen. 

Tim Norton: Okay. So, but if estrogen is going up and testosterone is going down, erections are going to go down. Correct. And that's [00:08:00] why we're here today. 

Dr. Natalia Zhikhareva: Exactly. And we're, we're really talking, I think, for transforming the origin of diverse people, listening to this conversation.

 what I would like to talk today about,  is trans women preoperative who have not had surgery. So in other words, transwomen that still have penis who really do want to engage in sexual activity, but,  cannot because their sexual organ is no longer functional. And so we're talking about really two subsets of transwomen.

Want that feel comfortable with our penis? And want that feel incredibly dysphoric about her. Okay. 

Tim Norton: Good word. Dysphoric with their penis. How might a lay person,  describe dysphoria? Hmm. 

Dr. Natalia Zhikhareva:  if I were, what comes to the top of my hat, when I think about just four is an incredible [00:09:00] feeling of an incredible discomfort.

Okay. Kind of a cheap sheet of discomfort. Zara is persistent and consistent and does not go away. 

Tim Norton: And as you say that the audience can't tell, but you're really looking inward. You're really thinking about it. And I get the sense that you've heard a lot of stories. You've heard a lot of people really open up about this.

Dr. Natalia Zhikhareva: Yes, I think, well, just worry is incredibly predominant in gender community.  that's really the origin of, of, of this issues, right?  to feel completely in-congruent in your body. It feels incredibly just for it to this individuals. So imagine yourself to him,  for yourself and myself who take our gender for granted.

We almost never really think about our gender per se. We wake up, we put on our closes whenever we really have to question our gender. Right? So imagine [00:10:00] yourself, it can up one day and having this feeling of incredible discomfort about your body.

Tim Norton: It is really hard to imagine just, and would it be like feeling like my penis doesn't belong, like attached to me? 

Dr. Natalia Zhikhareva: So it would depend. So just who I am is different for everybody. And everybody has a different sense of dysphoria, a society. When we think about dysphoria, we think about a classic trans narrative.

Fitch goes something like I am, let's say I'm a man stuck in a woman's body. Well, the truth is that narrative no longer applies. Most individuals don't really feel like that. So they feel a range of feelings and dysphoria tends to range from really severe to less a shift here to I'm being dysphoric about my penis too.

I'm not just worried about my penis, but I am just worried about my. Facial hair [00:11:00] or about my bone structure or my Adam's Apple or my voice. So it really depends.  and that's why it's important to remember that transition is non-linear because there's some people that feel comfortable with their penis.

For example, samp SOPs set of transwomen were taken aback today who don't want to have surgery completely comfortable and are sexually functional and have zero just worried about their genitals. 

Tim Norton: Okay. And would you, would, you know, off the top of your head, like the rate of dysphoria and people who identify as transgender women, where is it in a sense 

Dr. Natalia Zhikhareva: of 

Tim Norton: like what the happened to quarter?

Yeah. Like 

Dr. Natalia Zhikhareva: percentages of individuals who have gender issues who suffer VCs. Faria. Yeah. I would say the percentage is pretty high.  whether it's dysphoria by their genitals, that would be hard to pinpoint. Okay. But. So it will be just for an to laugh. Yeah. 

Tim Norton: And is that something [00:12:00] in treatment that well, what are you doing with that?

Are you trying to like help someone become more congruent or are you helping someone transition both. 

Dr. Natalia Zhikhareva: Right. So tradition is. A pathway to congruency. Okay. So really essentially what I'm doing is I'm helping an individual. First of all, I'm helping them identify what their gender identity is. And once we identify that I help educate individuals.

What entails transition, because again, it's not one size fits all. There's some people that, you know, we're very comfortable with starting hormones and having a few surgeries. And there's some people that really want to go from one binary strictly into another binary. And to be asked congruent as possible.

So it really depends. Okay. 

Tim Norton: So, so let's talk about it then. So with,  congruent individuals who suddenly are taking a much higher levels of estrogen [00:13:00] and, and presumably that leading to two struggles with erections,  what, what happens? What's that like? 

Dr. Natalia Zhikhareva:  well, I think what happens for us individuals is,  struggles in relationship and intimacy because here we have a group of trans women.

That are fully comfortable. Is there a penis hor sexually active or want to be sexual active, whether it is through penetrative intercourse or oral sex or any other forms of sexual intercourse? Really. And what we're seeing is that because of the introduction of estrogen and antiandrogens that bring down the testosterone levels we're seeing struggle of is being able to obtain a reaction, being able to maintain erection and thus can really interfere with the sex.

Tim Norton: Okay. Now, is it off, is it often that trans women need a hard penis? Is that typical for trans sex? 

Dr. Natalia Zhikhareva: Depends. [00:14:00]  I think it depends what your sexual preferences and what's your sexualities for transwomen that are attracted. Two male sexual partners and who sexually interested in penetrating us male partners.

Right.  that would be pretty important for trans women that are interested in is, are male or female sexual partners and are interested in oral sex. That would be pretty big deal. So I think it really depends on sexual preference. I don't think there's such a thing as transects. I think there's just sex.

And then I think there's just us and how we see ourselves in a context of the text. Okay. 

Tim Norton: Well, that's really well said. And so that, but that is kind of, I mean, it sounds like this whole process would be pretty overwhelming just in general. And now to add on. Sexual complications on top 

Dr. Natalia Zhikhareva: of that. Right.

Right. And you're absolutely right about that, because imagine, imagine even, even if [00:15:00] this trans woman per se doesn't feel, and you just worry about her penis, right. But she feels a very strong, let's say dysphoria about her breasts or her, her shoulders or her botics. Right. So she's already feeling some of them out of discomfort is her body.

And then on top of that, she realizes that her penis is now non-functional, that can add an Ozzie and other and as a mixed into that. Sure. 

Tim Norton: And that's the last thing you want to do is be in your head during sex about all these different parts of your body, whether it's your penis or your shoulders, right.

And to really be in your head about that. So, What does this kind of thing come up in,  the groups that you run or are people usually pretty talking a lot about sex and what goes on and 

Dr. Natalia Zhikhareva: in the groups that are run, I tend to get a mix of,  transwomen that for majority [00:16:00] part don't really feel comfortable with their Chantels and we have to keep in mind that for a lot of transwomen that cannot get the surgery, but once surgery.

A lot of them do feel very dysphoric. And so to have erectile issues is actually a relief. So that's another split of the client. Right, right, 

Tim Norton: right. Like, thank goodness this doesn't work. I don't want this thing anyway. 

Dr. Natalia Zhikhareva: Exactly. Right. But for those who really don't want to be sexually functional, this becomes a conundrum.

So what I do here, so in a way we really want to work with this individuals and helping them redefine their sexual roadmap. And they're kind of, recontextualize the ways that she's themselves and the ways that she's her body and the ways they she's her sexuality. 

Tim Norton: Okay. And so give us some of that.

Recontextualization like, what, what, what are some of the things you're trying to help these women understand about themselves? 

Dr. Natalia Zhikhareva:  I think one of the things that I try [00:17:00] to do is shift some away from this. Focal point off my PNS is a primary functional sex organ too. How can you still get sexual pleasure and sexual Oregon?

So what are the parts of your body are sexual? So for example, with brass gross nipples can become very sensitive and very, you know, very sensate for a lot of individuals. What about some areas of your neck? What about other types of sexual intercourse that does not include penetration? So you really try to, in a sense, broaden out their understanding of sexuality and shifts them away from this kind of fixation of, well, as the way I relate to my sexuality is through.

Being able to use my penis. And now that I no longer can use my penis, I can no longer have sex. So in other words, sex doesn't have to stop when the penis longer malfunctions, right. Sex continues. And in same thing for Duvass is for example, [00:18:00] males who have Eric Delicias right. We teach them that while sex doesn't.

Have to stop it, you know, you penis not getting hard, it can continue and just different types of 

Tim Norton: different types of sex. Right. And where I think that's what the current sexual education movement really is redefining what sex is and that's happening.  and, and the groups that you run on and the people that you work with so one other thing. Well, I was gonna, I was wondering about the partners and. Are you, are you often helping individuals help re-educate their sex partners as to how to. have sex with them and be sensitive. And, 

Dr. Natalia Zhikhareva: yeah, that's a great question, Tim. Absolutely. I think that if there's a partner involved, that become huge. Usually in those cases, to be honest, I'd refer them out to people [00:19:00] like yourself specialists and secretary P because I no longer really focused on sex therapy. And I just primarily deal with this kind of a gender issue of individuals. But absolutely. I think it's, it's really important when I talk to  sexologists and I educate them about how to work with this population that's becomes very significant point to bring in the partner to educate the partner also about,  erectile difficulties that the couple will face with the introduction of estrogen and antiandrogens. And to kind of help them also reshapes their sex life. So if the partners, for example, is a female, right?

So we're talking about trans woman and a woman partner, and they have always penetrative vaginal intercourse, right? Well, what can they do now? If your partner can no longer penetrate you with a penis, can you park and penetrate you with a strap-on or with a dildo? And what does that mean to you? So helping them also navigate [00:20:00] and reformulates their sex life is really important.

Hmm. 

Tim Norton: And, and would you say that a lot of the people that you're working with even in longer-term relationships are experiencing. Comments from their partners,  microaggressions and that kind of thing. That just insensitive comments. 

Dr. Natalia Zhikhareva: Oh, that's a good question. I think. Yes and no, I think it depends on the partners and I think it depends on a lot of factors. So it depends how long has it been together? How much? What I call emotional traction they have as a couple, right.  how, you know, how soon after being together, the partner came out. How receptive was the partner?  but it is common to sometimes I do see partners being what you describe, what kind of microaggression, right?

 I do she specialists out in a lot of female partners where,  you know, is there's this, [00:21:00] this feeling of I have lost,  not only my husband, but I, or my partner, but I have also lost my sexual partner. And now not only do I have to transition with that, but also have transition my sex life is,  Hmm. 

Tim Norton: And so how do you, how do you deal with that?

Dr. Natalia Zhikhareva: Well, I think the trick is how to tread the water very lightly and gently because we want to essentially what we want to do. So want this couples to thrive, right? We want them to have less friction and more cohesion. And,  I think was a way to achieve with this. What, and you really good couples therapist, again, I don't see couples really, but, and you could couples, therapist stasis, straightening the water lightly and being knowledgeable and educated about gender issues and also how tradition, not only facts, the primary person who is transitioning, but a partner as well.

Yeah. 

Tim Norton: And so that [00:22:00] question of like, how do we have sex now? And when somebody transitions in the middle of a relationship, is that usually the question or is it more often that they'd already been having sex? That was the kind of sex that the, the eventually transitioning partner would want it to be having?

Or does it, does it usually change significantly that the sex and that kind of relationship. 

Dr. Natalia Zhikhareva: You ask him he's a sex change, this relationship. Yeah.  I think it can, I think it depends on a couple and a couple base on how couples are sexually open or receptive. So if, for example, and we're using now again, re kind of using a stereotypical, you know, transforming in a woman partner.

Right.  but. For example, if for that female partner, if she has been Euston she's her orientation about sex is only penetrative intercourse. Does that bring in [00:23:00] something else? Even sexual twice in the bedroom can be very uncomfortable. So changing the sexual map of this couple can also change sexual interviews and values and maybe even morals.

Around this individual sexuality. So it's, it's really can shift and rugs the boss, so to speak, but what doesn't in our lives, 

Tim Norton: right? Well, yeah, no, I'm just thinking about how so if, if a trans woman was using her penis to penetrate for a long time, I mean, is she often doing that and not wanting to do that and maybe can't tell, well, 

Dr. Natalia Zhikhareva: sometimes that happens, right?

So sometimes we have people who are just worried about their genitals. And so here we have a couple and suddenly the partner is very dysphoric and suddenly does not want to engage in sexual intercourse at all, or any kind of sex. And suddenly the party can feel very [00:24:00] alienated and very alone. And I think what happens is unfortunately I think a lot of this couples forget to, to really communicate and ask questions during this times.

 and I can understand why, because transition can be often confusing and a difficult process for both of them and an immune. So everything else I think. People are less likely to be flexible and receptive and say, well, let's talk about our sexuality, but haven't had sex in a month. What's going on? I know that, you know, because of estrogen year erections, you know, will diminish,  also know you feel just worried about your penis or you don't feel it just for eco penis, you know, how do you feel about that?

And I think that's where people like yourself and sex therapists really come in.  and I refer couples a lot of times to sex therapists for those reasons. To open up the conversation, right? 

Tim Norton: Yeah. Cause that's, those are hard conversations for everybody. Absolutely.  [00:25:00] And, and even, even that question that you pose right there is, is pretty blunt.

 but, but crucial. So sweetheart, you know, what do you want me to do with your penis, right? Yes. And, and, you know, have you been not feeling great about putting your penis in me,  for a while, would you rather we waited something different, 

Dr. Natalia Zhikhareva: right. And vice versa. Right, 

Tim Norton: right. And vice versa.  and just getting to a level of comfort and sensitivity to those kinds of questions and answers because you have to be able to say it out loud.

Dr. Natalia Zhikhareva: You do, and you'd be surprised how many couples stoned and I think 

Tim Norton: not surprisingly, are you hearing that a lot? 

Dr. Natalia Zhikhareva: I think what happens for, for the partnership transwomen with, as a partner, sir, male or female,  or by gender or any other gender? I think [00:26:00] what happens is people, people feel terrified. Two asks equations that they feel is a very sensitive topic for that person.

And what they do is which you probably know is pretty quick to assume, say shrooms that, Oh, because you're transitioning, you must be very uncomfortable with your penis, right? You just want a bottom. And that's not the case for everybody. Right? Right. Or because you transitioned to your soldiers fork. I can't even touch your genitals again, not always the case.

Right. So suddenly communication goes out the window and the couples tend to really suffer. Right. 

Tim Norton: Hmm. And, and now I'm, I'm thinking with. My, my sex therapist cap on that. Okay. Well, when we're talking about sex, we're talking about touch and joy and intimacy, and these are the things that people want out of intimate experiences.

And so those, we get to make sure that people are doing all [00:27:00] that all, all the foreplay, all the cuddling, all the caressing. 

Dr. Natalia Zhikhareva: Right. We want to bring, play back in the bedroom, right? We want to bring experimentation and fun into our sex life.  you know, w we want to move away from stagnation into movement. And so I think it's important to look at the transition as everything is going to transition - your body's going to transition your mind is going to transition, your partner's going to transition with you. Guess what your sex life is going to transition with you as well. For sure. Right? So it's important to put that cap on and helps the client see it from that perspective.

Tim Norton: Everything's going to transition. Yes, I like that. That's really good.  so what are some of the struggles that transgender women face? What are some of the awards? Typical struggles. 

Dr. Natalia Zhikhareva: I think one of the, one of the bigger things that probably would be struggling, which is, you know, I think became [00:28:00] quite apparent now is a sense of dysphoria.

Right? And I think one of the things we don't understand is how, how do you work? It can be even somebody gets mis-gendered. I think mis-gendering is crucial. I think, especially for transfer men, when they start transitioning. For a lot of transwomen, there's going to be a part in between when they're not going to be possible or it's going to struggle to pass as women.

Right. And I think the biggest thing to understand for the public is when you come across somebody, anybody, whether they're transitioning or even not, whose gender is ambiguous to you, remind yourself that even though we live in society of binary and we still think in a very binary realms, There are a lot of expressions to gender.

And just to be careful not to gender individual, you'd be surprised how easy it is. Sexual to have a conversation of is out gendering. Anybody. All you have to do is just use a person's first name, 

[00:29:00] Tim Norton: pretty easy. That is easy. Dr. Z, huh? One thing that I often think about though, when thinking about this topic is hormones, are it can, it can be nasty, can be really tense and affecting a person's personality.

 we see this most often in society when,  when a woman goes on the pill,  for whatever reason,  there can be major changes to how somebody feels. And I always like to cite the study where they tried to do, they were trying to find,  hormone therapy for guys to,  as a form of birth control and they can't get through the studies because the guys would wouldn't finish taking the damn hormones.

Cause it was just messing them up too much. And it gives us some insight on what women have had to deal with for years. [00:30:00]  but. That's gotta be kind of intense to suddenly be throwing like all this estrogen and sometimes progesterone and other supplements in your body. And then, so what happens to a person's personality and sense of themselves and all that.

Dr. Natalia Zhikhareva: And I think it's be, I think intensity really will vary. I think we have to be careful.  To stay away from kind of gender stereotypes that estrogen will make, you know, a transwoman, Morse, emotional or sensitive for she's going to cry all the time. And the SaaStr is going to make a transmasculine person aggressive suddenly, or have angry outbursts.

And I don't really think the hormones necessarily to do that.  there will be changes for sure. For starters, you'll feel much more congruent because,  I see gender dysphoria. My understanding of gender dysphoria is that it's a medical condition, not a psychological one, meaning it's not a psychiatric disorder.

[00:31:00] It's it's medical, genetic people are born this brains that are more in alignment. This is a gender said they really want to be versus there assigned sex at birth. And so as the result of that, there's to speak in congruency, that happens. Right. And so. If we introducing estrogen, for example, to transforming and reducing their testosterone saddle is our brainstorm more in alignment, right?

Fizzer their gender. And suddenly the turbulence that they may have experienced having to Stastrom going through their bodies no longer there, and that can give tremendous relief. Right. And that can be intense for some people, but I think. It's often not. I think if anything, it's a sense of really a peace and relief is in yourself.

Having, you know, as a hormone that was meant to be there to floor Sue body. It's a big deal. Pretty powerful, actually 

Tim Norton: I bet. [00:32:00] And I'm thinking,  one of my favorite words in psychology is congruence. And in just thinking about,  That, that, that sensation of the inside being the same as the outside and that alignment and feeling at peace with yourself and,  that does wonders for anxiety reduction.

Dr. Natalia Zhikhareva: Right. And also, when you think about the word congruent, it's such a subjective word, right? So with congruent to you may not be what congruent to me. And I think that's one of the things to keep in mind when working with this population is art. Just because a person identifies as a trans woman and you automatically think, Oh, congruency for this person, me and S you know, a full transition, including a bottom surgery that may not be what congruent for this person.

So congruency also varies, and it's a very kind of subjective sense of who we are, 

Tim Norton: but [00:33:00] once they've gotten there, once they feel that authenticity and in the like themselves,  probably easier, easier to do life, but also easier to have sex. Also easier to obtain erections 

Dr. Natalia Zhikhareva: if, if Losada and the oldest pressure is lifted off, right?

Imagine if you will, your brain right now and imagine struggling is dysphoria. Now, does this worry will occupy a enormously big part of your brain capacity to the extent where you will really struggle. This maintaining attention with trying to do your job with trying to deal with this day to day things,  and on and on, including your sex life.

Right? If dysphoria is occupying such a big part of your brain, and you're not out here through, you're not, you know, comfortable with your gender yet. That's a pretty big deal. That's pretty difficult to do. And once we introducing hormone or [00:34:00] introducing you kind of transition, that is starting to get person to whoever they see congruency, all of that space is cleared up and suddenly the person can suddenly focus.

People can on the, go off living their lives and finish, you know, does it decrease? I always wanted to, to complain and so forth and so on. So it's really. It is a really big deal,  sense of congruency and sense of self. 

Tim Norton: I bet. You know, as you're talking about that, I'm kind of putting myself in that position and just thinking God, and to, to have such a constant source of anxiety, really how I wouldn't be surprised if the erectile issues were.

Really really common.  we're just with, with all of that in a dysphoric 

Dr. Natalia Zhikhareva: person, right. So yes, you bring it out a great point. Right? How often do our anxieties interferes our [00:35:00] sexual response period dissolve in congruency? Right? Let's look at just cisgendered, man. If you're anxious about your work or you finance or whatnot, chances are.

You're going to have a hard time getting an erection. And now imagine you're feeling really uncomfortable about your body, right? 

Tim Norton: Which happens at work at home everywhere. Yeah. 

Dr. Natalia Zhikhareva: And where some of those things are kind of where's your anxieties about your work or finances is something that is not seen to everybody else.

It's kind of invisible. Your gender is pretty visible handicap because everywhere you go, people are relate to you based on how the sheer. And if you are not transitioning, get some people see you, how you do not want to be seen. And that's pretty painful existence from day to day. That is, but 

Tim Norton: is there like with regular anxiety,  It fluctuates, you know, even a person with generalized anxiety disorder is going to have good days and [00:36:00] bad days.

And would that apply to dysphoria as well? Would there be days where you're just not as preoccupied by it and might be able to just kind of be okay with who you are and 

Dr. Natalia Zhikhareva: sure is that will also vary from individuals, right? And yes, you're right. And there will be some days for some people where. They have accepted to deliver in a binary world and Wilder transitionings.

That will be mis-gendered and that is okay. That will happen. Right. And then there's going to be som days where every angry little sign, a little machine during Q gap. Can just really spiral you into a sense of depression or alienation or anxiety. So yes, it's absolutely will vary. And I think the more you have support and then we have people around you as that are, you know, kind of there for you, the better off you're going to be.

Tim Norton: And I, I bet like with most psychological issues, it's a two way street where if you just [00:37:00] are anxious because you have a really intense job and because you haven't been sleeping and because you're having relationship problems, That that might ramp up some of your dysphoric feelings or your,  experienced sensitivity to microaggressions out in the world.

Dr. Natalia Zhikhareva: Yeah, 

absolutely. 

Tim Norton: Okay. So, so what do we do? Right. So,  You're, you're not a medical doctor, but I'm sure you've at least heard anecdotally about taking Viagra on top of hormones and Sheridan and people running into any issues around 

Dr. Natalia Zhikhareva: that. Not that I know of. And, you know, to put the anecdote aside, I actually did inquire,  vis medical professionals who worked with this population.

So if I do have a transwoman patient that you know, would like to be sexually functional, Can I introduce,  erectile medication into the mix and the answer is yes, absolutely. You can. There's doesn't [00:38:00] seem to be any country in educating points from a medical standpoint, those that work for everybody. I think that depends.

 it may, may not. And another thing to think about is there will be a group of individuals who just don't want to add another medication to their mix period. But that is a very kind of simple streamlined solution. If it works for XOs transfeminine that comfortable with our penis and want to be sexually functional.

Okay. 

Tim Norton: And.  doctors, he's going to put this podcast,  on, on her website and blog and it's gonna get,  promoted through various channels. And if anybody out there is listening, you know, I've done already like 16 or 17 episodes on different ways to approach. And,  a lot, you know, I've talked to some, some pretty big psychologists about it and in a lot of those.

 tips around mindfulness and [00:39:00] relaxation and,  having good conversations with your partner are also going to apply. 

Dr. Natalia Zhikhareva: Absolutely. I think that's great point to bring out and I'm glad you do that. And I hope that if anybody snatches this off my blog, which is called transformed blog, I hope that they also go and listen to the other podcasts because it is absolutely relevant because we're talking about.

And Eric tile issues out, whether it is for transwomen or, or SIS, man, it's still an Erik tile issue. Right. And I think the tools that we can apply can be very usable across the board and very important. And again, I'm not affect surface. So,  my toolbox is very limited when it comes to that. So it's important to go to people like yourself and gets us a tool.

Tim Norton: Yeah. And so what about.  I was thinking when we were talking about, you know, a doctor and then recommending Viagra and things [00:40:00] like that, I'm wondering how that experience is like we're, we're in Los Angeles.  Dr. Z is based in Beverly Hills and I'm in silver Lake. And I feel like here in the community that we know each other from we, we know of trans friendly doctors.

Dr. Natalia Zhikhareva: right, right. Well, We're doing the daunt.  so there's definitely clinics that have become much more trans opened. For example, UCLA has a great trans program. Sheeter Sienna has a great trans program, right? State John stars.  all of this clearly listed on my website under gender resources for people who are interested.

 but yes, there are going to be medical providers that may be not going to be as knowledgeable and that's okay. That's why you get an education by token, to, to your sex therapist about you, Eric Talley shows any sex therapists can save a heavy considered an Eric drug. And that's when you go to a medical provider and, you know, [00:41:00] find out if that's kind of a medically viable option.

Right? Because my understanding is that this also may not be for everybody based on their medical conditions. 

Tim Norton: Right. And it, for various reasons, you know, it,  Viagra or sildenafil and the PD five inhibitors are,  were originally intentioned as heart medications. And,  and they still,  there, you know, Cialis, some people just take daily Cialis, honestly, more as a heart medication.

And then there's the added benefit of, of erections. And so, yeah, that's a whole other topic and field.  but. I bet LA is probably like a decent place to go and see doctors, but it's probably not like that around the country and certainly not around the world. 

Dr. Natalia Zhikhareva: Yeah. I think LA is definitely much more accessible.

And I think that's a very easy kind of fix. I think it's a bigger challenge. Tim really is transwomen that want [00:42:00] to be sexually functional. And for some reason cannot get the surgery. Usually is the reasons for financial or you have some medical conditions that preclude you from getting surgery and yet have incredible dysphoria.

Right? I think it's a little bit easier to work with. Trans women that don't have this worry about their genitals to the shifts, that paradigm, but what are the Duvass transfeminine that are incredibly dysphoric, want to be sexual function? 

Tim Norton: Right. Wow. That sounds really complicated. Right? So, and dysphoric in the sense.

All right. And would you mean specifically dysphoric about their 

Dr. Natalia Zhikhareva: genitals? Correct. Okay. You still want to be sexually functional, right? So you have a transwoman country office that says I transitioned and I can't get a surgery. I want to get a surgery, but I can't, they just can't afford it. Or I have medical conditions that prevent me from getting it.

And I'm here with a penis that are not functional. And I don't feel good about it. I hate it. I [00:43:00] want to be sexually functional. So how do I do that?

Tim Norton: Yeah, 

Dr. Natalia Zhikhareva: million dollar question, right? I think one of the things that I try to, to help sex therapists understand is aparts from just shifting the paradigm of sex life. Right. Also having an anatomical understanding of, of male genitalia and anatomical understanding of what happens during vaginoplasty. vaginoplasty is a procedure where a new vagina is created, right?

And that the surgery is that this individual in this case cannot afford or cannot get. And why is it understanding of the construction and I, me so important. Well, you can really help a person understand that. Although you have this word toward the penis, perhaps because you have all this masculine associations to it.

It's, it's a penis so it's a sign of masculinity and Manliness. And I hate it. Every time I get an erection reminds [00:44:00] me of a man. I once was right too. Let's talk about if you were to get vaginoplasty, right? This part of your penile. penile skin or scrotum skin is going to be your, your internal depths of your vagina.

And this part is going to be your labia and this part is going to be your clitoris. So just kind of reorienting the understanding and the ways of user genitals even, I think in hops, tremendous 

Tim Norton: teaching them to love their penis. 

Dr. Natalia Zhikhareva: And also reframing it, reframing it truly. That's what us happens during surgery.

For example, drink penile inversion. That's what happens. I mean, the surgery is, is really not performed in a way where the penis is just gets traded and then a new, new vagina is plastered on all of this parts of your penis are used to construct new vagina. 

Tim Norton: What is going to be the clitoris? 

Dr. Natalia Zhikhareva: So the penile gland.

Okay. becomes clitoris. Okay. And [00:45:00] then the skin of the penile shaft and sometimes part of the scrotum depending on what doctor likes to use her, how's it like to, to, to do the procedure? Really? It becomes you adapt becomes you canal imaginal canal. So you can see how talking about that and shifting the narrative from does a subpoenas and does this my shaft and does this my.

Scrotum too. This is actually what makes labia, and this is actually what makes well, it makes the labia, well, again, it depends on what surgeon would like to use, right? And sometimes people will go for a second procedure is called labioplasty, which is actually a construction of labia to make it look much more like female vagina.

So depends how much skin people have, because shrinkage is again, very common on estrogen and testosterone suppression. But I think the important thing here is to remember how to shifts that narrative from seeing a justice penis to 

Tim Norton: my eventual [00:46:00] vagina. 

Dr. Natalia Zhikhareva: Absolutely. Yeah. That's one way to put it. Yeah. 

Tim Norton: Hm.

And that's really empowering. 

Dr. Natalia Zhikhareva: Very much so. And I think people who do, especially people who do and you kind of bodywork, right. Is this population or any kind of,  sexual body work and having that understanding in work and visit the segment of population is really important. Like you said, incredibly powerful.

Yeah. 

Tim Norton: Yeah. That, that, that congruence and that, that just self-love  cause you've got to love your body and love yourself in order to be. And I, and a loving sexual relationship. 

Dr. Natalia Zhikhareva: Yeah, absolutely. Very 

Tim Norton: important. Yeah.  you know, it's one thing if it's casual sex or a one night stand, but you know, we're talking about it over the long term, you know, I'm sure people can drag themselves out of gender dysphoria, just like any anxiety and you know, over the course of a night.

 but in the long-term you have to come to a grounded [00:47:00] self-acceptance in order to have regular. Yes. 

Dr. Natalia Zhikhareva: Yeah. And sometimes, you know, I, I tell people, look,  it sounds like surgery is for, for all of the reasons is not viable option here. It sounds like you're human being and you shall going to leave and you're going to be intimate and you're going to engage in lovemaking.

And I think it's pretty painful to continue to hate yourself and hate your penis every single time you have to engage in lovemaking. And I think it's really unnecessary because all this association real is that we have to, to what constitutes and what penis represents or just social construct. That's really all.

It is just our social narrative doesn't mean it has to be that way. And it doesn't mean that your narrative has to be that way 

Tim Norton: now. So if we. Take that social construction. How of your relationship to your body? [00:48:00] It's, it's really nice. And that you get to determine what you want your genitals to mean. 

Dr. Natalia Zhikhareva: Yes.

I think the knowledge is to,  one of the, kind of a simplified analogy that comes to mind is a women.  and penis envy, right? Whether Freud was right on it or not. I doubt it. He was, I don't think many women, if any role have been a sandwich, but let's hypothetically for the sake of the, Synology say that people do,  understandings that your clutter says essentially.

Penis is, can be very powerful. And thus, now, if we're stuck about thinking about the reverse, right. Taken about the trans man that have not had bottom surgery, having Zad understanding that they're clutters is a penis is very, Hmm. 

Tim Norton: I bet. Yeah. Hmm. Okay. I'm really liking this. [00:49:00] I feel like I'm starting to get some 

Dr. Natalia Zhikhareva: fans, so broaden your understanding and that's, that's why we're here, right?

That's why we're having this. Heart's conversation 

Tim Norton: that's correct. Huh. So, so do you feel like we've, we've done a good job of, of covering the things that you were hoping to communicate at least in this hour? 

Dr. Natalia Zhikhareva: I think we have, I, I think my biggest,  point in this conversation was to, to help people understand that they are trans feminism.

 feel very comfortable with their penis and want to be sexual. And there's transformers that have a lot of dysphoria, but still, also want to be sexually functional. Now, of course,  we, you know, we've kind of eliminated transwomen that,  do not want to be sexually functional, not want to, and that's okay because that's, that's not what we're addressing here.

Right. Again, it's important to remember that. [00:50:00]  once I see does not fit all. Everybody's Shandra and their transition and how this is our sexuality and relationship to transition is going to be drastically different. Right. 

Tim Norton: And, and as we said, at the beginning of the podcast, we, we haven't really spent much time talking about transgender men today.

And so. Can you summarize one hour and like a minute and like, what would we talking about if, if we had a conversation about that? Like what, what would be some of the basics? Oh, well, 

Dr. Natalia Zhikhareva: I think in a lot of ways, maybe it would be somewhat similar, right? We'd be talking about transplant that have not had phalloplasty rheumatoid reapply, CV, which the bottom procedures for the trans man,  who, some of them want to be.

Sexually functional. Right. Although, you know, for those who feel very comfortable with their vaginas and have no interest in getting bottom surgery, right. That would not necessarily be a problem. I mean, the only problem that they would struggle with is on [00:51:00] testosterone is, is that they will have dryness.

So did the vagina would not be lubricating as it once was an estrogen. And so just to remind yourself, to bring.  lubricant in the bedroom.  I think the problems are going to be slightly different. I think the understanding is going to be different.  so hard to summarize Tim. I don't know what to tell you.

Maybe another conversation. 

Tim Norton: Well, no. And I'd want to talk about like the functionality of, of that penis, like my, after an operation and if. I think that's probably a pretty common question, but also, yeah, normalizing,  people who are going to just keep their vaginas and that they'll still have to have those conversations about okay.

You know, even though there's a strap on, on, or whatever toy we're using, I would still like you to play with my vagina and still stimulate me in those ways. And when that person would probably still have to learn about loving their vagina, even if there was dysphoria or, and reframing. Yeah, 

[00:52:00] Dr. Natalia Zhikhareva: right.

Absolutely. 

Tim Norton: Okay. Well, we'll see if there's a huge demand for this.  and so, yeah, like I was saying in the, in your intro, you run a free drop-in group, which after this podcast airs, there's probably going to be a really long waiting list. 

Dr. Natalia Zhikhareva: Well, I don't know. My, my trans women groups that I started about, I would say about four, maybe even five years ago now.

Already has a wait list every single time.  and that's a pretty, pretty popular group and it's, it's a free monthly group and,  it has kind of a solid group of, of women. And that's a really great group. I have started a trans man group just in the recently this year that I'm still working on building up.

 So that's another free muscle support group. That was that one might get a weightlifter after this conversation. 

Tim Norton: Yeah. And I suppose I should have asked you this at the beginning. [00:53:00]  no, ma'am maybe I can just edit it, but why did you take an interest in working with this population? 

Dr. Natalia Zhikhareva: You know, it's him.

I have always been the type of person that likes to fight for underdog. Hmm. And I think in many ways we'll live in a society where we're so ignorant about gender and understanding of gender fluidity. And as a result, we tend to really marginalize people that express gender other than binary and as somebody that likes to fight for underdog.

Okay. They just kind of tick off my father's. Yeah. And I think that's why it's important to mention for this, for people who are listening for new genders, people is in my way of supporting community. What I do is I do all the trans surgical evaluations for new trans surgical procedures completely for free.

[00:54:00] So if anybody listening to this and NITSA ladders, they're welcome to just. Email me or call me and I'll do it for free.  again, that's a underdog in me. Yeah. Yeah. 

Tim Norton: For free. I don't know how I feel about the fed now. I was just from like a work-life balance.  that's. Do you work like really long hours?

And, 

Dr. Natalia Zhikhareva:  I do, I, I, I work five days a week, probably like yourself. I have Mondays and Fridays are my days off and I'm,  I'm very, I'm fortunate to have a good private practice. And,  I noticed that this is something that.  a lot of people need, and there's not a lot of clinicians that are skilled in how to properly evaluate and do a lot of write-up.

And a parts for me is there's really just only another clinician in LA, as far as I know, Aiden Kennedy said does the also for free, and I think it's really important service to the community. And I [00:55:00] think S S clinician says, psychologists, we should, we should be able to also give something back to the community.

Tim Norton: Well, that's. Awesome and admirable. Thank you. And, and thank you for doing that work. That's, that's really crucial. That's really, really important work. And so, yeah, like she's saying, if you need that letter,  reach out to her, how, how can people find you? 

Dr. Natalia Zhikhareva:  the easiest way to get ahold of me is you can just drop me an email at Natalia Dr.

Z phd.com com Natalia, 

Tim Norton: Dr. Z phd.com. 

Dr. Natalia Zhikhareva: Okay. Or you can just drop me a text at my number. Okay. (310) 946-6361. And all you have to say is, Hey, I heard your podcast and I need a ladder. And you said it's free. So let's get together. 

Tim Norton: Right. Okay. Well, and do [00:56:00] you, do you do social media stuff? 

Dr. Natalia Zhikhareva:  I do in a sense that,  I do have an Instagram page.

It's Dr. Z PhD, Dr. Z PhD. Right. And then it's a Facebook page is under the same name and that's pretty much, that's pretty much it. I do try to write regularly on my blog transforms and gender issues. And the last, last week I wrote about progesterone and why trans women should consider progesterone.  so I do try to write pretty regularly.

Okay. 

Tim Norton: Well, awesome. Thank you so much for coming out today. Thank you 

Dr. Natalia Zhikhareva: so much for having me here. This was 

Tim Norton: fun. Okay, good. And then, yeah, maybe we will, we'll have another conversation about this. Okay. Great. All right, well, thank you.

Shout outs to the sex positive community, including sex educators, sex therapists, sex coaches, other fellow sex, podcasters, sex, surrogates academics, sexual health, medical community, sex workers. The tantric community and everybody else involved with having hard conversations. [00:58:00] .

If This Episode Resonated

If this episode spoke to you, there is a path forward.

Tim Norton provides a discreet, evidence-based therapeutic space where men and couples can understand the deeper systems behind desire, arousal, and connection. His work combines rigorous neuroscience with a grounded, relational approach to help clients rebuild aliveness in their bodies, strengthen partnership, and create lasting change.

How Anxiety Disrupts Erections with Alan Gordon, PRT Founder

About the Episode

In this episode, Tim talks with Alan Gordon, the creator of Pain Reprocessing Therapy (PRT) and a leading expert in mind-body disorders. Together, they explore how the brain interprets arousal as “danger,” why this shuts down erections, and how to retrain the nervous system toward safety, pleasure, and confidence. Alan also demonstrates a practical technique through a short role-play that listeners can try at home.

Key Themes

• How the brain misinterprets sexual arousal as a threat

• Chronic pain and erectile anxiety as parallel “danger signal” patterns

• Fight-or-flight states and their impact on erections

• Noticing the early signs of fear in the body

• Techniques for lowering stakes and rebuilding ease, presence, and play

• How past negative experiences create future shutdown

• Using mind-body tools to reinterpret physical sensations

• The importance of bringing fun and lightness back into sex

Listen to the Episode

Listen Now

Alan Gordon

Alan Gordon is a psychophysiologic psychotherapist in Los Angeles and the founder of Pain Reprocessing Therapy (PRT). His work integrates neuroscience, mind-body psychology, and emotional regulation to resolve chronic pain and tension-driven physical symptoms. Alan has been featured on CBS’s The Doctors, collaborated with University of Colorado Boulder on groundbreaking fMRI research, and teaches at USC. His work illuminates the same nervous-system mechanisms that underlie many forms of erectile anxiety.

Website: painpsychologycenter.com

Podcast: Tell Me About Your Pain.

Book: https://bookshop.org

Episode Transcript

Tim Norton: Hello, and welcome to hard conversations. Really excited about my next guest today, Alan Gordon, who is a psychotherapist in Los Angeles, California, specializing in treatment of chronic pain. Alan is an assistant adjunct professor at the university of Southern California. You know what? I 

just, 

Alan Gordon: I don't believe it.   You're not selling it. I'm not - A little more enthusiasm.

Tim Norton: okay. All right. As a, as an adjunct professor at the university of Southern California has authored patients on the treatment of chronic pain and is presented on the topic of pain treatment at conferences and trainings. [00:01:00] Throughout the country. He served as the chair for the 2013 mind body conference at USC.

And co-created the treatment outline and trading protocol for the psycho. Wow. Look at that word for the psychophysiologic disorders association. Hi, Allen, and welcome to hard conversations, Tim. It doesn't say you were on the doctors in your, 

Alan Gordon: in your,  it's a,  an old bio. We haven't changed the website maybe like four years.

Tim Norton: Okay. Any other things you wanted to just brag about while, while talking about your, your intro and your bio? 

Alan Gordon:  we just did a really big, well, it's all pain related stuff, which isn't, it isn't necessarily. Linked to what we're going to be talking about. So lots of, lots of good pain stuff. That's a good pain step.

Yeah. 

Tim Norton: Well, and we are going to talk a little bit about pain because pain is your, your paradigm, but I feel like your paradigm gives you a really cool insight. Into treating erectile issues. When I, when I [00:02:00] texted you about this, you had a great, you had a great answer. You said the treatment for ed is similar to the treatment for TMS for, for psychogenic pain.

It's the fear and preoccupation around the symptom that perpetuates it. Outcome independence reduces the level of preoccupation. 

Alan Gordon: It's true. It's like a text. It's 

Tim Norton: a good text. And that could be the whole interview, right. That kind of sums it up, but why don't we break some of that down? Well, why don't we give a little bit more background for that?

So you, that this place, the pain psychologist center, where I work,  could you, how do you answer the question? What is it that you guys do there? 

Alan Gordon: We treat. Chronic pain.  studies have shown that the majority of chronic pain is actually caused by neural pathways in the brain, not structural problems in the body.

 and so, you know, people have chronic pain, you have chronic back pain, chronic neck pain, chronic pelvic [00:03:00] pain, and obviously the. Initial belief is like, Oh, there's something wrong with my body. And that could be reinforced by doctors or physical therapists, but more often than not, they find that many forms of chronic pain are actually caused by the brain misinterpreting safe messages from the body as if they're dangerous.

So what we do is we essentially help to rewire the brain to accurately interpret those messages, which deactivates the pain signal. Okay. 

Tim Norton: And I think the way that I started to think about you as a guest for this show is it's more than just back pain that ends up getting treated at your center. Right.  can you give us an idea of the array of symptoms that.

That get treated 

Alan Gordon: there. It's if it exists, we've treated it. I mean, mouth pain, tongue pain, eye pain,  stomach [00:04:00] pain, back pain, neck pain, foot pain.  you know, the brain is capable of generating any physical sensation in any part of the body. So there isn't something that can exist that the brain cannot create that isn't to say that all pains or even all chronic pains.

Are created by the brain, but they can be. 

Tim Norton: Okay. And obviously you've seen these symptoms reduce or get eliminated, right. And all of these parts of the body.  and at some point I am one of your, I attend Allen's case consultations and lectures, and it, at some point you did talk about erectile dysfunction as the kind of symptom that is along the lines of other things that you treat and you've, and you've treated it.

You are, you it's come up in sessions. And so tell me more about 

Alan Gordon: that. Well, I think that first off like pain is a dangerous signal, right? If you think about pain, it's a danger signal. If you put your hand on a hot [00:05:00] stove, the pain is letting you know, you got to move your hands. So you don't cause additional damage, but sometimes these dangerous signals can get activated.

And even in the absence of like an injury or structural damage or something. So the brain is actually interpreting danger where there is none. And I think. It's really similar with erectile dysfunction.  You, you actually asked me before the,  interview if I had any metaphors. And so I was, I was brainstorming.

And,  you grew up in Los Angeles. So you may remember this,  back in 1983, do you remember Steve sax on the Dodgers? Of course. So Steve sax was like this rookie phenom in 1983, he won rookie of the year. You know, he had this like amazing promising future and it was in his second year, he played second base and there was a ground ball hit to him and he threw it like 10 feet over the first baseman's head.

It's kind [00:06:00] of like a silly error people in the crowd, like, you know, or laughing or whatever, but it got in his head a little bit. So then. The next game, someone hit a ground ball and it was like a two hopper to first base. And it got even more in his head and it became this thing where every time there was a ground ball hit to him, you know, sometimes it would, you know, be in the dirt.

Sometimes he would literally throw it like 20 feet over the first baseman's head and it would fly into the stands and it became this whole thing. Like. At away games, people in the stands, it would like start wearing helmets is like a way to just like mock him, you know? And he made like 50 errors or something before the all-star break.

And so that's how it happens. Where at one point playing second base was fun. You know, he was confident, there was a ground ball hit to him and it was great. But then one time it didn't go well. And he started feeling all of this anxiety around it, and he started putting all of his pressure on himself around it.

[00:07:00] And obviously, you know, fielding a ground ball and throwing it to first base. It's like, you need to be loose. You need to be relaxed. And so when he was so tight, when he was feeling so much pressure, it injected him into a fight or flight state. He wasn't able to. Performs so to speak and he kept messing up.

And that's exactly what it is with erectile dysfunction, where, you know, for a lot of people, it was like, it didn't, it wasn't always like that, but they have, they have one incident where.  it doesn't go as they had hoped or as they planned, they felt really bad about it. They started feeling nervous about the future.

They started putting pressure on themselves. And now it's this thing where they're in this fight or flight state, right? Like you need to be in kind of like an easy, relaxed state,  to get an erection or maintain an erection. But because they were in this fight or flight state, There are sympathetic nervous system was activated.

They're putting so much pressure on themselves and they're [00:08:00] not able to do it. Well now it's like twice that that's happened now, is this going to become a thing I've read about it? Oh my God. I'm I have to spend the rest of my life on Viagra. Am I going to have to like start telling partners about this and advance they get in their head and it really becomes an issue.

And so it's this kind of like positive feedback loop where it happens. You feel terrible, nervous, freaked out that. You know,  compromises your ability to, to,  successfully perform in the future. So that a good metaphor. Yeah. That's a great metaphor. 

Tim Norton: And I wish the end of that story was Steve Sachs came to the pain psychology center and the problem went away and he, he won the world series with the Dodgers, but 

Alan Gordon: well, you know what, actually what happened is it was one of the first times this has ever happened.

Cause it's happened since then for baseball players, but. If they named it Steve sack syndrome, because it was like such a big deal. And it's happened, [00:09:00] you know,  with people in sports, at different levels. And almost no one is able to overcome it. Like it's the end of their career because it's just this downward spiral.

But Steve sacks. Was able to overcome it. And he went on to be a great player and like won the world series in 1988. He actually went to visit his dad and he was telling his dad all this stuff that was going on and his dad just kind of gave him a talk and it was like, Oh, you're putting so much pressure on yourself.

Like, what's the big deal. And it was like his ability to just kind of. Take the pressure off and relax into it. And you're just kind of like, ah, the worst case scenario was like, you know, I do something else or I, I N I try, I learned how to play first base or something. He took the pressure off, it took him out of a state of fight or flight, and he was able to do it again.

I think it's the same lesson, you know, if you could lower the stakes, if you could just start having fun with it again, that's the thing that could actually [00:10:00] pull you out of a fight or flight state. And allow you to overcome the issue. I 

Tim Norton: love the end of that story. Cause he's, you know, that's so psychodynamic, he's channeling his, his inner paternal object.

Right? His inner dad. Who's telling him everything's going to be okay, son. Yeah. And that that comes out in some of your methods. 

Alan Gordon: Doesn't it a little bit. Yeah. I'm actually thinking back now on what his dad, he kind of looked at his dad, he like pedestals, I, him so much, he's like this was, you know, a guy who had like a mind of steel and was so internally and externally strong.

And I think what his dad actually said to him is, Oh, I went through something like that when I played ball also. And he was like, Oh, like, This isn't the worst thing. And that if my dad could go through it, like this is fine, you know? So I think it allowed him to put less pressure on himself.  

Tim Norton: and, and that's really the name of the game, isn't it?

[00:11:00] Alan Gordon: And you know, it's, it's very similar with someone who has pain is there's so much fear around it. There's so much anxiety. There's so much pressure to get out of the pain and it just, it reinforces to your brain that that pain is dangerous. So it's a really about. You know, taking yourself out of this place of interpreting things as dangerous and into a place where you're able to interpret things as safe because,  You know, like we were talking about earlier, there's the sympathetic nervous system and the parasympathetic nervous system, right?

The sympathetic nervous system is, you know, when you're in a state of high alert, if you think of like a zebra and a jungle, surrounded by lions, like you're in a state of high alert because you need to be able to like run like first notice parasympathetic nervous system is when you're safe, when you're relaxed.

When you're out of danger, it's I feel like whenever I'm talking about that, there's like a siren or motorcycle in the background, just sub communicating the opposite of what [00:12:00] I'm saying, but, you know, and that's when you're able to like go to sleep and relax and you need to be in a parasympathetic state to like, get an erection to maintain an erection.

So the irony is the anxiety and the fear and the preoccupation and the pressure. Around getting an erection and maintaining an erection is the very thing that brings you out of that sympathetic state. I'm sorry, out of that parasympathetic state that you need to get it in the first place. It's like a catch 22.

So what do we do?

What do you think? 

Tim Norton: So. You know, I I've, I've worked with you guys for, for some time now and the approach lately and the approach for, for a significant period of time, that's been really effective that you guys are applying and your study and everything has to do with,  [00:13:00] tracking with approaching this pain and, and tracking pains, various paints.

And I'm wondering if. You know, giving that attention to a non-interactive panus and, and tracking it and, and trying to eliminate the fear of the symptom would also probably be okay. 

Alan Gordon: Effective. I don't think it would work. You don't think so? No. I think that it would just lead to even more pressure and hypervigilance around it for something like that.

Okay. Can we role play? Yeah. Okay. Absolutely. You be someone who. It is like, has ed okay. Is freaked out about it and,  you know how, however it manifests, maybe you're not able to get an erection. Maybe it's premature ejaculation. Okay. No, so, 

Tim Norton: yeah. So,  for the last,  three months, Like three months ago, I was on vacation with my [00:14:00] girlfriend.

We were in,  we were in San Francisco and we got a really nice hotel. It was a Friday night and everything was, was great. And it came to time to, to have sex and nothing, nothing just, and ever since then, like at best, I'll have an erection, I'll run into the bedroom and try to have sex with then I'll lose it.

And. And it, I just can't. I can masturbate fine. Yeah. 

Alan Gordon:  you're all, you're able to get an erection when you masturbated master. 

Tim Norton: Yeah. And you're I went to a urologist. He said my everything's okay. Testosterone levels are fine.  I even got an erection during the exam that was kind of embarrassing and every, literally 

Alan Gordon: owning this role, 

Tim Norton: I've never actually heard somebody say that.

 yeah. It's so soon. So what do I 

do? 

Alan Gordon: Something funny? Steve Sachs was able to make the throw to first base every time during practice. Right? So [00:15:00] you're able to get the erection when you master Bay, right? Because there's no pressure because the stakes are low, but as soon as you're in the game, there's so much pressure.

And it sounds like having sex is a really fun anymore. It's like, you're trying to do it successfully to overcome this problem, to beat this thing. It's like a job. It's like a chore. You know, when I was in high school, I read the book catch 22. Cause I had to, for school, you need to read three chapters a week.

You know, you need to like write a paragraph on character development. And I hated it because of the situation that I was at, like forced to read it, you know, needed to kind of gather all of this data. And then I read it when I was like 25. And I said, this is the best book I've ever read. Yeah. And the reason why is because the first time it was a chore, it was a job.

It was a responsibility, but the second time it was fun. I could [00:16:00] do it at my own pace. It was enjoyable. And I think that, you know, what you're telling me is that, you know, sex a thing that used to be fun. I'm assuming is no longer fun. Now it's like a test. You're taking a test and if you pass, you're going to feel okay about yourself.

And if you fail, you're going to feel awful about yourself. And the irony is that makes it almost impossible to pass because of the pressure around taking a test is literally going to pull you out of the state that you need to be in when you have sex, you know, no one, I don't care. You know who you are.

No one would be able to get an erection under gunpoint. Literally, you know, like it would be impossible if someone's holding a gun to your head to get an erection because you're not in the right. Your nervous system is not capable of it. So if you think about the [00:17:00] pressure that you feel. To need to get an erection and those moments it's like, you're holding yourself at gunpoint.

So we just need to lower the stakes. What was going on?  you know, do you have any ideas or theories why you didn't get the erection the first time? I feel like people are going to be joining at this point in the, in the podcast. And they're not going to realize this is a role-play they're like, wow.

Tim's are really making themselves vulnerable. 

Tim Norton: Yeah. Yeah.  so the question again is, do I, do I remember what was going 

Alan Gordon: on? Yeah. You may have not gotten an erection that first night in San Francisco on vacation in the really nice hotel. You know, 

Tim Norton: I have no idea.  we, we decided to drive. It was, it was a long drive.

 they had the wrong room for us and we had to wait and we actually had to kind of yell the manager and then like,  we were hungry. We went out to eat and then like, I ended up at this restaurant [00:18:00] that was really expensive and like the food was kinda kind of shit and got home. And it just had been an awful day, but she had gotten new lingerie for the night and, and we even had like,  just some sex toys and it was, it was, it was, this was a big night cause we hadn't been having much sex.

 and it was like this vacation. It was all like, okay, this is going to be our weekend. 

Alan Gordon: You bet you guys really planned for it. We did. But it sounds like the day was so heavy and stressful and frustrating that it's like, Ah, you weren't really in that parasympathetic state that we were talking about, you weren't really in that relaxed state where you were able to, which is fine, that happens.

And so it makes sense that under, you know, I understand why you weren't able to have sex that first night, but the next time you tried having sex. You know, it probably wasn't as awful of a day, but the new fear, the new preoccupation was, am I going to be able to have [00:19:00] sex? So it started because you were in this state of anxiety and preoccupation about other stuff, but then after it happened one time, it was like, The sex itself became the new stressor.

So you didn't even need to be stressed out about anything else. So this is kind of like the cycle, you know, for pain, we call it the pain fear cycle. I think that, you know, for the sake of this condition, it would be like the erection fear cycle,  where it's like, you know, you weren't able to get an erection the first time because you were in a state of anxiety about something else, but then it was the fear of not being able to get an erection.

Itself that prevented you from being able to get an erection. Then the second time you weren't able to have sex, I'm sure. Now you're like, Oh my God, once it was a fluke, now this is like a thing. Yeah. Tell me about that. 

Tim Norton: Yeah, no, you're right. You're right. And now, now I think about it at work. [00:20:00] I think about it, you know, all day long when she's nowhere near me, where there's no, no sign of sex anywhere and get.

Totally worked up about it,  to the point where yeah, I feel like I need to drink more or I've looked at like getting gone anxiety medication just it's. Yeah. It's, it's kind of 

Alan Gordon: maddening desperation. Yeah. And is she feeling a sense of powerlessness over it? Is she feeling bad about it? You know, does she, not really.

Is she like. Well, we're going to work this out together. How she feeling about it? The first 

Tim Norton: couple of times she was like that. She was like, okay. Yeah. You know, it's, it's no, it's fine. Don't worry about it. Yeah. But I think sometimes when I get really anxious about it, like she just, she's starting to get impatient.

Like she just wants me to. To 

Alan Gordon: handle it. It almost doesn't even sound like she's like mad at you for not satisfying her. It's almost like now there's just so much [00:21:00] anxiety you're out about having sex. She's like, let's just, let's figure this out. You know, like it's time to get past this. It sounds like sex.

Isn't fun for either of you guys anymore. That's true. Hm. Well, you know, we talked about how. Being in the state of anxiety, having this fear, having this preoccupation is the thing that can bring you out of that parasympathetic state that you need to be. And, you know, because you're in a state of anxiety, she's in a state of anxiety and has it become like a central thing in your guys's relationship?

Has it hurt your relationship chip? Yeah. Yeah. I 

Tim Norton: feel I'm scared. She wants to leave 

Alan Gordon: me. 

Tim Norton: We fight, we bicker. Yeah. 

Alan Gordon: Mm. And it kind of seems like, you know, the anxiety around this or the stress around this is like spilling over into like different areas of your relationship. Yeah. [00:22:00] Do you feel like she's on your team?

Like, do you feel like if you had a solution or a new approach that she would be like in to try it with you or do you feel like she's just so frustrated with you at this point? She's like, you just figure it out. You know, or do you feel like there's like some support from her. 

Tim Norton: I feel like if I handled it better and I presented it to her that, yeah, she would be a 

Alan Gordon: team player.

You do? I do. So if we had her here and I explained to her the whole erection fear cycle, it happened that first time it got in his head, the more pressure he puts on himself. You know, the harder it is for him to get an erection, the harder it is for him to get an erection, the more pressure he puts on himself.

And now, you know, it's this thing where he's not able to be in the right state. And she understood that. Then you think that, you know, if we put together like a plan or something like that, that she would be on board, she'd be like, okay, we're a team we're going to address this. Yes. Okay. That's that's important [00:23:00] because if she was like, Putting extra pressure on you and not willing to work with you through it.

Well, how are you not supposed to feel pressure if someone else is putting pressure on you? You know,  but if we had her here and we were able to kind of talk about it together, okay, this is what's going on with the primitive part of, you know, Tim's brain is blah, blah, blah. This is happening to his autonomic nervous system.

I have a plan. Here's what I want you guys to do. She would be like, all right, let's try this thing. Great. So here's the plan. Okay. All right. I'm taking notes. All right. So what we want you to do is just make sex fun. Again, it doesn't even matter if you get an erection, you know, you're there, you have so much outcome dependence around whether or not you get interaction.

 outcome independence is one of the most important components of overcoming. [00:24:00] Erectile dysfunction. My favorite example of outcome independence is have you ever seen the movie dead poet society? I have. So there's this scene where there's this kid and he has this huge crush on a girl from a school across town, but he's always too scared to ask her out.

So one time he just like goes to a party across town to ask her out and he comes back and his friends see him walking back and he has. A big smile on his face and he has a black eye and they're like, what happened? And he's like, I asked her out. And they're like, and she said, yes. And he's like, no, she said no.

And her boyfriend punched me in the face and they said, well, why are you so happy? And he said, because I asked that's outcome independence where you know, where you no longer defend, defined success as whether or not you're able to achieve the outcome. But you define it as your attitude around independent outcome independence.

Right? Right. [00:25:00] So that's where that term comes from.  So I think that for you, you're very outcome dependent right now. If you're able to get an erection, you pass the test, you get an a, if you don't get an erection, you fail the test, you get an F right. We want you to really work on outcome independence and start looking at the definition of success as.

Was I able to enjoy myself, was I able to enjoy the experience independent of the outcome? So the goal is for you and your girlfriend to engage in sexual activity and really just enjoy it. Be light about it, you know, reconnect with each other, reconnect with each other's bodies, you know, and, and if you're able to be in that state of joy, it doesn't matter if you're able to get an erection or not.

That's a win, right. You've developed an association where sex is now [00:26:00] dangerous. We want to create a new association or sex is fun. Is safe, is exciting. Does that make sense? It does. 

Tim Norton: It does. What I'm worried about though, is that I'll just be too nervous going into the bedroom. Like, is there anything I can do to just settle my nerves?

Like I, all I'm thinking about is my penis. Isn't hard and it's never going to get hard. And then she's going to. Be obsessed. She's going to give me a look. I'm going to get scared. Like it's just a lot. 

Alan Gordon: Well, it's sounds like you've really kind of developed in association with even any kind of sexual activity is just like, I mean, the first thing we want to do is just kind of like, take it off the table.

The first time you guys do this, you're not going to get an erection. That's not even an option. That's not something that's going to be on the table. You know, that's not the goal. The [00:27:00] goal is for you guys to have fun and you know what. If the bedroom has, if you've developed this association where you're like super nervous to even go in the bedroom, take it somewhere else, get a hotel, go to her place, you know, hang out in the living room.

We want to kind of create an environment where we're not adding more obstacles or barriers than there needs to be. And I could give you techniques for anxiety regulation and things like that. But, you know, the point is. You need to get back to just, you know, lowering the stakes and enjoying being with her in a sexual way, knowing that that's off the table right now in the early stages, if we're able to get back to just enjoying ourselves eventually, you know, Your body will be able to be in a parasympathetic situation while engaging with her in the sexual way [00:28:00] and it will follow.

Okay. Yeah. Any questions about that? 

Tim Norton: Nope. No, I think that was,  I think that was really helpful. 

Alan Gordon: I'll let you know how that goes. There was,  I think that this is really a great analogy. I had a friend who got a rescue dog, right? This dog that was treated really poorly the first couple of years of its life, Rocky, the rescue dog.

And so my friend got this rescue dog and, you know, because it was treated so poorly by its previous owners, it had developed a specific association people. Equals dangerous. Right? So every time anyone of us would come over, we ring the doorbell. We knock on the door dog, Sprint's behind the couch. It's terrified.

But of course, every time we came over, we would treat the dog really nicely. So after a week or two knock on the door, dog is still behind the couch, but he's like poking his head out. A couple weeks after [00:29:00] that, dog's like halfway between the couch and the door a couple weeks after that you knock on the door, the dog is like pieing at the door.

He can't wait to get to you. After enough corrective experiences, the dog developed a new association. People equals safe. That's what we want to do. With you in that situation is we want to create a new association where sex your girlfriend in general sexual activity is safe, and we want to help you get some corrective experiences by just enjoying the experience of being with her in a sexual way.

And just taking sex off the table, reconnecting with the joy, getting some of those corrective experiences. So we could teach that rescue dog in your brain, a new associate. 

Tim Norton: I like that. And kind of where I'm at right now is 

Alan Gordon: I don't. Are we still in the role-play still in the role-play [00:30:00] overall 

Tim Norton: or are we sometimes like my, my girlfriend, my real life, non role-play girlfriend listens every episode.

Alan Gordon: Hi. 

Tim Norton: And so, yeah, that would be, that'd be kind of fun. Yeah.  so no, no, no. In my role play with this, like in the dog situation, I don't even want to call my girlfriend. I I'm, I'm avoiding, hanging out with her. 

Alan Gordon: Lately the association has grown, you know, it started with,  And this happens for a lot of people who have pain also, right?

Like maybe you have back pain, it starts to have back pain every time you walk, but then it spreads and you have a back pain every time you stand and then you have back pain. Every time you sit and now you even have back pain when you're lying down. So a lot of times these associations spread. So I think at first the association was sex equals dangerous, but then it's [00:31:00] spread.

It's like a contagious. And then it was like, My girlfriend equals dangerous and now it's spread. Even beyond that, or even thoughts about your girlfriend are dangerous and it's like, there's probably a part of you that one sort of break up with you just so you can be free. Of all that danger, but so that's what we want to do.

We want to start creating new associations, right? So when you find your mind going to a fear about it, right, just kind of like check in, bring your attention to the physical sensation of anxiety that comes up, let your brain know it's okay. You're safe right now. We're going to take care of this. What would 

Tim Norton: a physical sensation of anxiety be?

Alan Gordon: Good question. I'm taking too much for granted these listeners.  so, right, so let's say you're in the middle of work. And, you know, you know, you're hanging out with her girlfriend that night, you guys are going to dinner and you're like, Oh, we're probably going to have to have sex later. Right. And all of a sudden you feel this like, feeling of tightness in your chest or your stomach or your throat or something [00:32:00] like that.

And your mind goes to, okay, let's see, dinner is going to end at this time. You know, maybe if we order enough alcohol she's, he'll pass out. And she won't, you know, you start kind of going through all of these things to kind of. Regulate your anxiety. So that's a moment where it's like, this is an opportunity to start promoting messages of safety instead of danger to your own brain.

Right? So, you know, you have that thought of great, we're going to dinner. I'm probably gonna, you know, are going to have to have sex afterwards. I'm going to feel bad about myself. She's going to be disappointed in me. Right then as an opportunity, that is a moment. Check in. See if you could identify where you're feeling anxiety in your body.

Is it in your chest as in your stomach? Is it in your throat? And let's say that, you know, for instance, there's a feeling of tightness in your chest. All you need to do is just bring your attention to that physical sensation of anxiety. This is that tracking thing [00:33:00] that you were talking about earlier, right?

Yes. So just lean into the anxiety. Bring your attention to it and just breathe into it for a second. Right? So now instead of, you know, running away from the sensation to all of these terrifying thoughts, you're leaning into it. Right. So that's a way of, of, you know, kind of trying to create a new association with the fear thoughts around it.

But that's what we want to do. We want to start creating new associations first with, you know, the fear thoughts around it, then just with your girlfriend in general, and then with like sex with your girlfriend. Okay. 

Tim Norton: So I'm visualizing all these things or having all these thoughts and noticing the sensations in my body.

Right. And then am I literally trying to make the chest pain 

Alan Gordon: go away? Good question. Remember, you know, this chest pain, this anxiety is just another [00:34:00] thing that, you know, it's a physical sensation in your body and. We want to teach your brain that all of these physical sensations are safe as opposed to dangerous.

Like that's the paradigm with everything. Our goal is to teach our brain that something that is learned to interpret as dangerous is actually safe. Right. Whether it's the prospect of getting an erection, whether you're a rescue dog, living with a new family, or whether you're sitting at work and a feeling of anxiety comes up, we want to promote messages of safety.

So if there's a feeling in your chest of anxiety, if you want to get rid of it, if you try to get away from it, You're just reinforcing to your brain, that it's dangerous. Why would you want to get rid of something that's safe? So instead, instead of trying to get rid of it or change it in any way, all you need to do is lean into it, explore it.

So even right now, see if you could just bring your attention to the physical sensations in your body. Okay. All right. And what are you aware of feeling right [00:35:00] now in this moment in your stomach or your chest or your throat? Is there any tightness? Is there any warmth? Is there any tingling or burning feelings?

Yeah, 

Tim Norton: there's in the front of my chest, like in the middle of my chest plate. There's like a, 

Alan Gordon: like a, an ache. Good. That's great. So even just the fact that you're able to identify it as fantastic, because oftentimes people are feeling anxiety and they're so distracted that it's beneath the radar. They're not even connected with it.

So just the fact that we're even aware of it and. This is a real nut role, right? I do have a little bit. Okay. That's good. Cause we all have physical sensations at different times.  so I want you to see if you could just bring your attention to that achy feeling. And sometimes it can be like a little challenging to attend to something that is kind of unpleasant or, you know, a little sharp, but that's okay.

As long as you can tolerate it. See if you could just bring your attention to that physical [00:36:00] sensation. We don't even need to label it. Right. Maybe it's pain, maybe anxiety, maybe it's an emotion, but let's just call it a physical sensation. That's a little achy. Kay. So the first thing that I want you to do is just describe it for me, right?

Like. Is it widespread or is it localized? It's localized. Good. And is it pleasant? Is it unpleasant? Is it neutral? Is it slightly unpleasant? How would you describe it? Slightly unpleasant. Great. So again, even just the fact that you're able to identify that you're really paying attention to it. So how would you describe the quality of activity tightness?

Is it a stabby feeling? Is it a sharp sensation? Is it Tingley? Fluttery? What do you think? 

Tim Norton: It's vague. It's. It's mild. It's like a, it's a dull pain. 

Alan Gordon: Okay. So it's a dull, it's dull. Is it tight? Is it pick about it? [00:37:00] Just bring your attention to it for even like five or 10 seconds and just kind of explore it.

You don't need to jump to any assessments, really. Just kind of like give yourself the time to attend to it and assess like why, what is the sensation? What's the quality of this sensation? Well, it's, it's kind 

Tim Norton: of disappearing, 

Alan Gordon: right? So, so bring 

Tim Norton: your attention to it. 

Alan Gordon: Okay. But let's just call it a delay.

Okay. All right. So it's this localized, slightly unpleasant delay, and I want you to lean into it and you don't need to get rid of it. You don't need to change it in any way. All you're doing is attending to this sensation. And just watching, you know, if you've ever been like scuba diving or snorkeling and you see a really interesting looking fish, you're not doing anything to it.

You're not chasing after it. You're just watching it, noticing it. Exploring how the patterns on his body in the way that it swim. That's the same thing. You're just paying attention to the [00:38:00] slightly unpleasant, localized, dull, achy sensation. We know it isn't dangerous. It's just a sensation. And see if you could just watch what happens to it really kind of like Explorer.

Does it expand? Does it contract, does it intensify? Does it subside? Does it. Change in quality. How would you describe it? What's what do you notice happening that 

Tim Norton: sometimes on an exhale it's like it sinks down and disappears. And then it's gone for like two breaths and then on an inhale, it kind of 

Alan Gordon: comes back.

So this is an awesome opportunity to practice outcome independence. We don't want, we don't want to be excited when it's gone and bummed when it's back, we just want you, we want you to be okay either way and really just kind of like a Marvel at the fact that your brain is powerful enough to like actually [00:39:00] cause these.

You know, ebbing and flowing sensations in your body and see if you could just watch it and you don't need to change it. And again, you're not necessarily watching it with any intensity or scrutiny, almost kind of like if you're like lying back in the field, watching clouds pass by over a hat or a beautiful sunset, you're just kind of watching.

And then this like easy, effortless kind of way, knowing that whatever happens to it is okay. And again, it's just ebbing and flowing. It's like a few of her, I don't know, been to a symphony or something like that. And it's like, sometimes the violins come in and the tempo increases and then the tubas come along and like it slows down.

Are there tubas in a symphony? Yeah. Okay. I need to research my analogies more. So see if you can just like lean into it and enjoy it. Just enjoy the show. We know it's safe and if it intensifies that's okay. If it flutters, that's fine. And what do you [00:40:00] notice happening?

Tim Norton: It was, you know, was really absent for the majority of when you were talking to them. Right. When you started to finish it kind of flared up again. Cool. 

Alan Gordon: And is it still there? Is it still unpleasant? Yeah. Good. Barely. But yeah. Great. So yeah, just the fact that you're able to pay attention to it, this physical sensation that came up in your chest without trying to run away from it without trying to get rid of it.

You were literally communicating to your brain, this physical sensation that my brain has been interpreting as dangerous as actually safe. That's what we want to do. We want to teach your brain to reinterpret something that is looking at as dangerous as if it's safe. That makes sense. It does. Do you know about that?

Lorimer Moseley study with sadomasochist?  remind me, so Lorimer Moseley did a study with [00:41:00] like sadomasochist, like people who, you know, go to dominatrixes dominatrices dominate dominator seas dominate as soon as you knew that a little bit quickly.  and,  this is a show that's all about 

Tim Norton: sexuality. We actually almost had a dominatrix.

We've had a couple porn stars. Oh wow. Sex surrogate. So yeah. BDSM comes up. Oh, 

Alan Gordon: okay. Well, there was an explanation for that.  okay. So anyway, he did this study with, you know, sadomasochists and it was this really fascinating thing where they put like a hot, a really hot probe on their leg. And they were taking an FMRI of their brain kind of scanning the activity of their brain.

And,  they were all listening to a recording. And the scientist was talking and he was just narrating. What was happening? There's a hot probe on your leg. It's this many degrees. This is the chemical reaction that's happening on your skin. And the person [00:42:00] was processing it as pain, which is what you would expect.

Now. Everything stays exactly the same, except the recording changes. And it's no longer the scientists talking anymore. It's a dominatrix. She's actually following the exact same script. This is what's happening on your leg. This is how it feels. This is what's happening on your skin. And the subject went from processing it as painful to processing it as pleasure.

Pleasure. Exactly. Wow. So nothing changes except the interpretation, right? So when there's a physical sensation of anxiety in your body, You don't need to get rid of it. Cause there's nothing to get rid of. It's just your brain brain interpreting this, these little bits of sensory input as dangerous and as being processed as unpleasant, but by leaning into it, by tracking it, by exploring it in that kind of like objective mindful, curious way by reminding your brain that it's safe by enjoying the [00:43:00] experience, you're developing new neural pathways to interpret that sensation as safe.

Okay. 

Tim Norton: So. Now I'm doing that just when I'm trying to lower my anxiety. Would I also do that with my non erect penis? 

Alan Gordon: I don't know why that was such a funny question at that moment. You know, what's so funny is I've been, I've talked about. This so many times somatic tracking, reinforcing to the brain that it's safe.

And for a sec, I forgot that I was on a podcast about erectile dysfunction. So all of a sudden take what I do know with a nonresident felt totally out of the blue though. It isn't. That was amazing. Never gotten that question before, not at that point in the explanation. Okay.  you know, I think that. Your guts telling, you know, my gut is telling me no.

And the reason [00:44:00] why is because I don't think you're going to feel the anxiety in your penis. I think you're going to feel either your anxiety in different parts of your body, you know, and I think it would be hard to pay attention to your penis and be outcome independent. I think it would be hard to be like, Oh, that's interesting.

You know what I mean? You'd be like annoyed or frustrated that it was in that state. Yeah. 

Tim Norton: But that task of otherwise lowering the anxiety symptoms in every other part of your body is 

Alan Gordon: pretty important. Well, it sets the stage for being in a parasympathetic state, you know, like when you're able to regulate your anxiety.

Then your body, you know, this is, this is what insomnia is. It's people being on able to get into a parasympathetic state because they're in such a state of anxiety throughout the day. So it's, it's kind of globally important, but generally speaking, that was a really big statement. 

Tim Norton: Oh, what's that? That's what 

Alan Gordon: insomnia is.

That's what [00:45:00] insomnia is. Okay. I like that. Yeah. Okay. When you start your insomnia podcast, we'll have the same conversation with a different application, right? 

Tim Norton: No, I've, I've broken it down as such before, too. Like, it's hard to imagine someone getting out of that sympathetic state,  when it's just been so long, your body doesn't, doesn't quite shut down that quick.

Yeah. Zebras bodies do. 

Alan Gordon: Yes, we don't. Yeah, it's complicated.  But just to kind of give some context to the different things. We've talked about, the anxiety that you carry all throughout the day, you know, is it going to just like prime you to be in that state of, you know, your sympathetic nervous system being activated, you being in that kind of like high alert state.

And so being able to kind of practice regulating your anxiety throughout the day is. Can I is it's going to help you lower the stakes. It's going to make it [00:46:00] easier for your body to be in that parasympathetic state necessary in order to get the erection. So I know we've been talking about different parts of this, and I don't want any of the listeners to be confused as like.

Ah, do I do the somatic tracking thing? Do I like enjoy the sex? Like these are all different parts of it. You know, you want to lower the stakes in general. You want to promote messages of safety to your brain. You want to kind of teach your brain that these anxious sensations that it's interpreting as dangerous are actually safe.

You want to, you know, reconnect with your girlfriend or boyfriend and, and get them on board and try to create some new associations where it's enjoyable and light and easy and effortless again. Hmm. That's, that's 

Tim Norton: really eloquent and succinct. I like that. And it actually corroborates. Did I say that word right?

That was perfect.  an earlier guest who, who we weren't role-playing who was telling an actual story that had happened to him. And he was talking about his issues [00:47:00] with erectile issues. 

Alan Gordon: When you said an earlier guest, you said that like they do on shows when someone's about to come out and like join. And here he is like, wait, but we're in my place.

Tim Norton: He's not, he's not here.  and his solution was he developed an intense meditation practice, like over an hour to two hours a day. Yeah. And just really, I mean, obviously kicked up that parasympathetic state 

Alan Gordon: tremendously that it's a little intense to me. Yeah. Because you know, I've actually, you know, worked with like meditation experts and gurus before,  Who meditated way more than me, but, you know, they still had pain and it was almost kind of like they were meditating with a sense of intensity, you know, because meditation is all about just being easy and effortless and enjoying the moment.

And [00:48:00] sometimes even like, You know, you could take up something like meditation, but do it with an energy that's intense and not to kind of, you know, whoever that previous guest was. It sounds like it worked for them. But I think a lot of people, they feel like they need to work so hard to overcome this problem.

And the irony is. All that extra work is just more pressure, you know, and more intensity and more tension, which contributes to the very problem in the first place. Was that, was that earlier to no, no, 

Tim Norton: no, no, no, no. You, the way you described that story, I actually have been talking to somebody recently who heard another story that you had told and another.

 place, I don't know where, where you talked about your dedication to symptom reduction and how you, you kind of took it,  where you were doing, like all the things. So you have a little 

Alan Gordon: experience. I remember, cause I [00:49:00] kind of have that personality where it's like, I have a tendency to put a lot of pressure on myself.

And I remember when I was in grad school, I used to. Highlight like three fourths of every page. And I remember one of my friends was like, you know, it actually be more efficient to highlight the stuff you thought wasn't important. Right.  and I remember when I had really bad pain, you know, I, I, at one point I had really bad head pain and I.

Knew all the things I was supposed to do. I was attending to my internal state. I was doing the somatic tracking. I was paying attention to my emotions. I was, you know, meditating, and this is on a Sunday and I spent a lot seven straight hours doing all these things that you're supposed to do. And at the end of that 11 hour stretch, I was in even more pain.

And instantly I was just like, I'm never going to beat this. I don't care. I'm done trying, I'm going to have this for the rest of my life. I'm just like surrendering and the weirdest thing. Within [00:50:00] five minutes, it was 50% better. And I was like, Oh, on the surface, I was doing all of the right things. But when you're doing anything with an energy of pressure and intensity, it can turn a tool into a weapon.

So that's why I'm kind of hesitant to be like, yes, an hour of meditation a day will solve this problem two hours. Well, it's less about the behavior and more about the energy. Beneath that behavior. Hmm. No, that's really good. All right. 

Tim Norton: Well, I think we covered a lot. 

Alan Gordon: Is it, has that been 

Tim Norton: an hour? It's it's been 50 

Alan Gordon: minutes.

Wow. It was relief, like flu. That was really fun. Yeah. 

Tim Norton: Good.  so any, any other tips that you'd like to give to all the guys out there about 

Alan Gordon: their,  

Tim Norton: They're non erect penises in there. They're eggs about it.  how does it usually show up? I was [00:51:00] wondering, do you, do you work with somebody on back pain?

And then they're like, okay, there's something else that's going on? Like, 

Alan Gordon: it could just be related a lot of patients that I've seen. Don't even know that I do the pain thing. Cause they're like referred from like one of my friends or a friend of a patient. And so, yeah.  I, it's probably the only like 50, 50 now.

I mean, I'm only saying like four patients right now, so that doesn't say anything, but historically I've seen a lot of like non-paying patients, but yeah, generally speaking people who have pain are more likely to have anxiety also because it's just a different way of the brain interpreting danger. And people who have pain or anxiety might be more likely to have EDD because likewise it's like brain just interpreting danger.

So I think, you know, the most important thing I can say is you want to just kind of like lower the stakes. I know it's hard because you're like, this is so important. How could I lower the stakes? But the irony is like when the stakes [00:52:00] are really high, It just, it makes it hard to be successful. And when you're, when you're able to get back to that joy, that lightness, that ease, that effortlessness that you used to have, you know, that's when your body and your brain are able to be in that state, that primes you for success.

And then once you start getting those corrective experiences, Oh, I actually enjoyed this experience, you know, and. At a certain point. It like, there's less fear. There's less preoccupation. There's less hopelessness. You see the light at the end of the tunnel. And from there, it's just kind of like an upward spiral.

Okay. Yeah. Well, 

Tim Norton: thank you so much. You're welcome. What's going on for Alan Gordon and the pain psychologist 

Alan Gordon: center.  well, we just finished this huge pain study out in Boulder,  chronic back pain where, you know, we did this treatment versus a control group and everyone got FMRIs rise of their brains before and [00:53:00] after.

And that should be coming out sometime in the next year. And we're going to be writing a book, talking about all of this treatment and everything. That's going to be specific on pain. We're still trying to come up with a title for the book and,  One of our,  one of my coauthors friends wrote a book on depression called the upward spiral, and I was like, ah, that's the best name for a Vogue ever.

So where, if you have any ideas for the name of a book about. Ouch. We, we want to focus on the solution of the problem. Okay. That's good though. I like that, right. That is definitely like,  attention grabbing. Right.  so we're writing that book and you know, all of this stuff should be coming out at the early part of 2020, and we're really excited about it.

Yeah, 

Tim Norton: it's really exciting. And we find you at pain, psychology center.com 

Alan Gordon: pain, psychology 

Tim Norton: center.com. Yeah. Okay. And any, any other social media plugs or anything [00:54:00] like that, or 

Alan Gordon: that's pretty much the website. Yes. There are other social media things, but I never check them. So I don't even know what their handles are.

Yeah. Okay. 

Tim Norton: And there's a big presence on,  this, this bland called TMS Wiki. 

Alan Gordon: Yes, we have a pain recovery program,  on TMS T like Tom M like Mary S like Samantha Wiki,  that is like a 21 day program on how to overcome pain. And I bet a lot of that stuff 

Tim Norton: I haven't looked at in a minute, but a lot of that 

Alan Gordon: stuff would apply to this.

It really does. I mean, the Steve sack story is on there. The Rocky, the rescue dog story on there. I really borrowed a lot. All right. All right. I'm gonna recover it for him, but it's all the same application it's like lowering the stakes. Regulating your anxiety, getting corrective experiences, things like that.

Okay. 

Tim Norton: Sounds 

Alan Gordon: good. Well, thank you so much, Alan. Yeah, that was fun.

Tim Norton: Shout outs to the sex positive community, including sex educators, sex therapists, sex coaches, and other fellow sex, podcasters, sex surrogates, academics, sexual health, medical community, sex workers. The [00:56:00] tantric community and everybody else involved with having hard conversations.

If This Episode Resonated

If this episode spoke to you, there is a path forward.

Tim Norton provides a discreet, evidence-based therapeutic space where men and couples can understand the deeper systems behind desire, arousal, and connection. His work combines rigorous neuroscience with a grounded, relational approach to help clients rebuild aliveness in their bodies, strengthen partnership, and create lasting change.

What You Need to Know About Erectile Issues, with Dr Barry McCarthy

Insights from one of the world’s leading authorities on male sexuality.

About This Episode

In this conversation, Tim speaks with Dr Barry McCarthy, a legendary sex therapist, researcher, and author whose work has shaped modern understanding of erectile dysfunction. They discuss why sexual difficulties are rarely “just physical,” how performance anxiety distorts erotic presence, and why couples benefit most when intimacy becomes collaborative instead of evaluative. The episode also explores aging, desire, relational repair, and the myths we must unlearn to build satisfying sexual lives.

Key Themes

• Why erectile issues are best treated in couples therapy

• Desire, arousal, and the “good-enough sex” model

• Why porn and media distort expectations of eroticism

• The psychological roots of performance pressure

• How aging affects sexual function and why this is not failure

• The role of sexual shame in shutdown or avoidance

• Practical strategies for rebuilding intimacy and arousal

• The benefits and limits of Viagra and PDE-5 medications

• How ED impacts men and women differently

• Why integrated, relational therapy leads to sustainable change

Listen to the Episode

Listen Now

Dr. Barry McCarthy

Barry W. McCarthy, PhD, ABPP, is a board-certified clinical psychologist, certified marital and sex therapist, and tenured professor of psychology at American University. He is one of the most prolific authors in the field, with more than 120 professional articles, 32 book chapters, and 16 books on sexuality, including Coping with Erectile Dysfunction, Men’s Sexual Health, and Enduring Desire. Winner of the Masters and Johnson Award for lifetime contribution to sexuality, Dr McCarthy is internationally recognised for his clear, practical, research-backed approach to sexual wellbeing.

Website: psychotherapynetworker.org

Books: https://bookshop.org

Episode Transcript

Tim Norton: Hello, and welcome to hard conversations. Could not be more excited for my next guest. Barry McCarthy, is a board certified clinical psychologist. Certified marital and sex therapist and a tenured professor of psychology at American university, his clinical expertise focused on integrating sex therapy, strategies and techniques into individual and couples therapy, assessment and treatment of the most common male and female sexual problems and a special expertise in the treatment of sexual desire [00:01:00] disorders.

Dr. McCarthy earned his BA from Loyola university, his MA and PhD from Southern Illinois. His professional memberships include the American psychological association, American association of marriage and family therapy, society for sex therapy and research, and the association for behavioral and cognitive therapies.

He's a diplomat in sex therapy, earning this from the American association of sex educators, counselors, and therapists. As a leading expert in this field, Dr. McCarthy has presented over 450 workshops around the world. And his extensive list of publications includes over 120 professional articles, 32 book chapters, and co-authorship of 16 books, including finding your sexual voice, celebrating female sexuality.

Cognitive behavioral therapy for sexual dysfunction [00:02:00] sex made simple. And during desire discovering your couple sexual style, men's sexual health coping with erectile dysfunction, getting it right the first time and coping with premature ejaculation in 2016. Barry received the masters and Johnson award for lifetime contribution to the sexuality field.

Wow. Hello and welcome to hard conversations, Barry. 

Dr. Barry McCarthy: Well, I'm very glad to be here. Great, great.

Tim Norton: right, perfect. Let's let's just get into it.  the reason I know your name is cause one of the first books that I'm I was handed when learning how to be a sex therapist was coping with erectile dysfunction, which you wrote with Metz, rest in peace, and the other one was coping with premature ejaculation. And I gotta say, I mean, I haven't been doing this nearly as long as you, but I've given those books to a lot of people. [00:03:00]  have you gotten a lot of, thanks for writing those. 

Dr. Barry McCarthy: But, you know,  those books were more Michael's books.

And my books, Michael, is the one who developed the concept of good enough sex, which I think is the core issue in understanding male, sexuality and male erectile problems. But yes, it's, it's still cells that are kind of amazes us. 

Tim Norton: Yeah. And so if, if that was,  Something, you know, I'm giving away this book that you guys wrote.

What, what would you consider your number one resource to hand out to two guys for, for this kind of thing, 

Dr. Barry McCarthy: in terms of problems? It is the coping with erectile dysfunction book in terms of healthy sexuality. It's a book that I wrote with Mike Metz called men sexual health. About preventing problems about a new approach to male sexuality.

 and I think that's really important that,  the way I learned about sex [00:04:00] and I think the way most men learn about sex works fine as an adolescent, it works fine as a young adult, it works terrible as an adult, especially in adult and an ongoing relationship. So this notion of totally predictable autonomous sexual performance, that's the theme of what real male sexuality is.

It's reinforced still in the environment. It's very much reinforced in porn videos that a man always has an erection is ready to have any sex with any woman, any time in any place. And that. It's crazy-making. Yeah, it really is. You know, one of the things that most people don't know, including sex educators and sex therapists, is that when couples stopping sexual, especially after age 40, it's almost always the man's decision.

Who's in a joint decision and he's made it because he's lost his comfort and confidence with erections, intercourse, and orgasm. [00:05:00] And he says to himself, I don't want to start something I can't finish. And that's very self-defeating 

Tim Norton: and is it's very sad. 

Dr. Barry McCarthy: It is very sad. Again, let me give you both a positive statistic and a sad statistic.

The positive statistic is there's good science now. That it's clear that you can be sexual, not just in your twenties and thirties, when you're 60 seventies and eighties, the bad news is about one out of three. Men stopped being sexual in her sixties, two out of three in their seventies. And the major cause of that is the field that they're a failure sexual that they can't have sex.

The way quotes real men are supposed to have sex. 

Tim Norton: Hmm. And so that book that you're talking about, it gives a lot of information about how to, how to think differently about male sexuality, 

Dr. Barry McCarthy: right. And at the [00:06:00] key to male sexuality, as it is to the key to female sexuality is that the essence of sexuality is not performance, always in favor of intercourse, orgasm, ructions.

Totally. In favor. No. Hidden agendas, but that's not the essence. The essence of sexuality, the new mantra sexually is desire, pleasure, eroticism, and satisfaction. And the most important thing is desire. There you look forward to being sexual. You feel that you deserve for sex to work in your life, even if it is not perfect sex.

And that is a message. That the culture doesn't say to men, it's a message that the drug companies don't say to a man, but it is the key to staying sexual throughout your life 

Tim Norton: desire. Desires the first pleasure eroticism 

Dr. Barry McCarthy: measures. The second neuroticism, big, big fan of a Raddison it's [00:07:00] integral to sexuality.

And then the last one is feeling satisfied and feeling satisfied means you feel good about yourself as a person, you feel more energized and bonded as a sexual couple, and that is not contingent on perfect performance. 

Tim Norton: Yeah, you and you write, I think pretty extensively. And you presented extensively on this topic as well of, of inhibited inhibited sexual desire.

Dr. Barry McCarthy: Right? The new term is a low desire, but I'd like 

Tim Norton: inherited low desire, low libido. 

Dr. Barry McCarthy:  but you know what happens with so many men is that they attached desire to a spontaneous erection. Any idea in the learning as you go to intercourse, an orgasm on your first direction. Again, there's nothing wrong with that, except when it becomes a mandate.

If you look at the typical man [00:08:00] who's been in a relationship and has been, and is over, let's say over age 30 or 40, that often his desire comes not from spontaneous erections. It comes from giving and receiving pleasure oriented, touch it. And then the major reason that men fail at Viagra, if you want, we can talk about the Cialis versus Viagra.

I have very strong opinions about that, definitely, but the reason he fails is as soon as he gets an erection, in other words, his subjective arousal on a 10 point scale is like a four or five that's when you get an erection. He immediately rushes to intercourse. Cause he's afraid he's going to lose the erection.

And it becomes a self-fulfilling prophecy that the drug companies basically lied to me. What the drug company say to the man is you'll get [00:09:00] erections like you did in your twenties. It's not true. You'll get when you're aroused, your erection would last longer. But you're not going to get those totally predictable spontaneous directions.

And you know, it's funny cause the good enough sex model really sells with female clients and female clinicians. It doesn't sell very well with the drug companies, with male physicians or even male therapists. But certainly not male friends. 

Tim Norton: Hmm. The good enough sex model, a 

Dr. Barry McCarthy: good enough sex model. Then what that talks about is it's a couple oriented model and that for 85% of encounters, sex flows from comfort to pleasure to arousal, to erotic flow, to intercourse, to, or guests.

But when it doesn't flow, Rather than panicking or apologizing, which is incredibly anti erotic for both the men and the woman. What the man [00:10:00] does is he turns toward his partner. And this is also true of gay men, not just straight man. He turns toward his partner and says the guy isn't going to be an intercourse night, but let's make it either essential sexual night or let's make it an erotic non intercourse, but I'm not going to apologize and we can still have a good time.

Tim Norton: Hmm. I love that. And I love how that starts with comfort. Right. And the cause one of the things that is so challenging is if we're expecting this spontaneous erection to occur just anywhere in the world,  they w people learn quickly that, that doesn't, it doesn't always happen. It often doesn't happen.

Well, especially 

Dr. Barry McCarthy: after age 40, it does one of the things, again, it is not talked about at all among either therapist or male clients or couples. Is that the great majority of men by the time they reach 40 or [00:11:00] 45 have had at least one sensitizing experience do what that means is he doesn't get an erection sufficient for intercourse, and that can happen in your teens or twenties, but as much more likely to happen in your thirties and forties, the key element after sensitizing experiences, you don't go back to our time with sex.

You can't what the drug companies promise is not going to happen. You're not going to go back to the totally predictable auto sector. What you can do is you can be a much better lover, much better sexual partner, but then you've got to accept this concept of variable, flexible male and couple sexuality.

Yeah. And I say to my man, you can be a traditional man. And you'll stop being sexual in your fifties and sixties, or you can be a wise man and you can be sexual in your 60 seventies and eighties and men embrace good enough [00:12:00] sex. And when they turn toward their partner, as their intimate neurotic friend, not as somebody to perform for.

Tim Norton: There, there are so many golden tidbits here that you're offering. It's hard for me to,  to remember all the questions cause,  I mean, I'm taking notes here on things I want to say in sessions. No, this is, this is really, this is really wonderful. 

Dr. Barry McCarthy: One of the things that is very important, I want your listeners to hear loud and clear is that when you're talking about penile stimulation, I'm a big fan of peanuts, but it's only orotic when your subjective arousal is four or five on that 10 point scale.

If you are not turned on and your partner says, I'm going to turn you on, I'm going to give you the best oral sex in the history of California. It's probably going to be counterproductive. You're probably not only not going to get turned down, but you're going to feel more. [00:13:00] Self-conscious. And there's nothing more in diarrhetic and stuff consciousness.

So, so what I think of as basic facts about male sexuality and couple of sexuality, so many people, including physicians and therapists, I'm not that aware of or comfortable with. And so 

Tim Norton: what should the partner be doing in that situation? 

Dr. Barry McCarthy: I think that it isn't her job or her partner's job to turn him on and give him an erection.

What the partner's role is, is to be both an intimate and erotic ally that says let's enjoy each other. Let's enjoy touching again. The hope is it's going to flow into intercourse and orgasm, and if it doesn't flow, I still want you to stay with me. I don't want you to turn away for it. And I want to have either essential experience or playful experience or erotic non, and of course it can be [00:14:00] neutral or it can be asynchronous, but I want to have fun with you sexually, and I want you to have fun with me sexually.

Hmm. And what 

Tim Norton: kinds of things tend to slow that process down or make that process more challenging? 

Dr. Barry McCarthy: The most, the major distraction, the major turnoff. Is where you're always monitoring your penis. Is your penis responding the way it's supposed to respond or not. And that just takes you out of the pleasure eroticism process, and it puts you into a performance orientation, performance anxiety in both anticipatory and performance.

Anxiety is the major. Reason that males develop and maintain rectal problems and erectile problems lead to inhibitor desire, and then a major cause of inhibited desire for adult men is a rectangle. Mm. 

Tim Norton: And then it's, then it's a vicious loop. 

[00:15:00] Dr. Barry McCarthy: It's a terribly vicious loop and think about it positively first, but then let's talk about it negatively.

Okay. So positively what you want the man to be doing is you want him to anticipate he's going to have fun. It's going to be a pleasure oriented experience. And he really does get into not just turning on the partner one way Singlish, but he's open to giving and receiving stimulation. And then Anne's arousal bills in advance.

When you talk about eroticism, an erotic flow, and if, if you. If your listeners want to take one specific technique from today's podcast, it is, do not transition to intercourse until your subjective arousal is about a seven or eight. So many men, as soon as he gets an erection rush intercourse and they lose their erection.

And then especially for men and they're [00:16:00] over 40. A key element in enjoying intercourse is giving and receiving multiple stimulation during intercourse. So it isn't like it you're in your 18 or 22 where you're worried about premature ejaculation. When you don't want additional stimulation as an adult, man, you want to give and receive additional stimulation.

Those common stimulation that demand receives his testicle simulation. The most common he gives is. Clitoral stimulation to his partner, but actually the most common stimulant model simulation for both men and women is using erotic fantasies during couple sex. That's normal and healthy. It serves as a bridge to keep you more involved in a couple of sexuality 

Tim Norton: using erotic fantasy, like verbally and talking about it, or just kind of thinking 

Dr. Barry McCarthy: for most people, most of the time.

Again, one of my favorite lines is sexually one size, never [00:17:00] fits all, but for most people, most of the time, one of the best ways of losing the erotic charge from fantasy is verbalizing and playing it out for most people would makes the fantasy erotic is that it's totally different than who you really are and what you really want to be doing, but it's very charged.

So enjoy your erotic fans. Don't feel shameful. Don't feel guilty about people. Most of the time you want to keep them private. It works so much better. 

Tim Norton: Right. But, and keeping them private, a lot of people feel that's kind of disconnecting. 

Dr. Barry McCarthy: Well, the best way of thinking about that is in a healthy relationship, a healthy sexual interchange.

It's a bridge to increase pleasure, increased eroticism. In an unhealthy use of fantasy. It is surfaces a wall to keep you walled off from your part. But that in fact, that reading allows you emotionally and physically to feel more [00:18:00] present with your partner. That's the positive role of erotic friends. I know it's very controversial, right.

But I know it can be really misused, but in general, that is true for the great majority of men and couples. Hmm. 

Tim Norton: And so the couple would have to get on the same page about that, that they're trying to build that bridge. 

Dr. Barry McCarthy: They don't have to be on the same page. One of the better thing for them to say is I want you to have a good time.

Centrally playfully, erotically, intercourse wise, or gasoline. And I don't care what you use internally to have a good time. That's okay. As long as it doesn't negate me or negate us, 

Tim Norton: as long as it doesn't negate me, but it's another woman or it's another man. 

Dr. Barry McCarthy: No, it is another person, nobody fan. And again, let me be blunt.

Okay. Nobody fantasizes about having [00:19:00] intercourse in their bedroom, in the missionary position with their park. No, by its nature or erotic fantasies or non socially acceptable sexual behaviors and feelings.  but it has a positive role in people's lives. If they let it have a positive role. Hmm. Now, let me say one other myth that I want to make sure we talk about please.

And that is that, you know, the best sex is mutual synchronous sex. And what you mean by that is both new and your partner feel desire. You both enjoy pleasure. You're both erotically turned on and you're satisfied with the sexual experience. You feel good about yourself? That's the best sex. But it's really important to understand that among Hambling married personally, sexually functional couples, less than 50% of their encounters [00:20:00] are mutual and synchronous, that the majority of sex is better for one partner Mia.

And for folks under 40, it's usually better for the man woman. The thing that's so interesting to me is I've gotten older and studied this more. Is that for folks over 60 asynchronous sex is typically better for the woman than the man and that men who can accept that and feel good about it. That's my emotion of the wise man.

He learns the piggyback, his arousal on his partners. And so it makes it for much better sex. 

Tim Norton: I really like the bluntness of that. There there's a lot of pressure, I think, in the narrative about this to strive for totally quality. 

Dr. Barry McCarthy: And that really kills sexual function and sexual desire. Sex is not a politically correct experience.

The more you [00:21:00] understand it has different roles and different meanings and different outcomes, the better off you're gonna be. Hmm. 

Tim Norton: Okay. But then, so some, there might be some female listeners out there saying, well, he has more orgasms than I do. That's not unfair. 

Dr. Barry McCarthy: He does have more orgasms than you do. And again, one of the myths about female sexuality cause females about 15, 18% of women are multi-orgasmic.

And the myth is that multi-orgasmic women are more satisfied in singly, orgasmic women. It's not true scientifically. There's no evidence for that at all. Let me tell you a different approach. And again, I want us to focus on male sexualities, but just the tooling. You know, our newest book that came out last two weeks ago, I guess it was, is called.

Finding your sexual voice, celebrating female sexuality. And then one of the things that we say in there and read very much, believe we're not hypocrites is a [00:22:00] females. There are many more similarities sexually between men and women. When there are differences, it's not true in socialization. It's not true going up.

It's not true in adolescent, but it is true in adulthood. And males do have more orgasms that's correct. Their sexual functioning tends to be more predictable and reliable, but it doesn't mean that they have more desire or more satisfaction. And then the big issue with adult women, but one out of three women, adult women reports, inhibited desire.

And what we used to believe as the answer to inhibited desire is more orgasms. And it turns out that there's no, there's no truth to that at all. That the, the, the key element in female sexuality is her feeling like a first-class sexual woman and accepting the variability and flexibility of female sexuality.

So that's what we'll do too. Great. 

Tim Norton: Great. And so [00:23:00] if we equate satisfaction with orgasm, Then we were going down the wrong road. 

Dr. Barry McCarthy: You're going to, you're going down a performance road, which is the wrong road. I love orgasm. I love male orgasm. I love female orgasm, but sexual satisfaction is so much more nor yes.

And this idea of. Coming to the performance model. It says the way you hand sanctioned your teens in your twenties is the right way to have sex in your forties. 50, 60, 70 is absolutely destructive. Hmm. 

Tim Norton: Okay. And this is at the beginning of. One of your books. I was glancing through it, re rekindling desire, said that you've worked with over 3000 couples and that, that came out a while ago.

So that numbers presumably gone up since then. So would you say that a lot of what you're saying you're drawing on from that experience, but you also seem like you [00:24:00] read the studies? 

Dr. Barry McCarthy: Yeah, I do read the studies. I go to the meetings. I still do. I actually go to more meetings, do more workshops and do more writing.

Since I retired from clinical practice in 2012. So I practiced for 42 years and sexuality and a couple of sexualities, my specialty. So I've seen all kinds of different folks, both mainstream, traditional value folks and gay folks in non traditional value folks. In one of the things that I really do believe is that everybody deserves a first-class sexual life.

 being self-accepting and developing a couple of sexual style with your partner, whether your partner is straight or gay, whether your partner is traditional or non-traditional you. One sex sex is very paradoxical folks, but when it works well, it's not a major factor. It [00:25:00] plays this 15 to 20% role.

Feeling good about yourself as a person and energizing your boss. The paradox is that when sex is dysfunctional conflictual, or you're fighting about it like affairs or you're fighting about it with a painful sexual secret, it plays an enormously powerful negative. It really breaks. So six can save a relationship, but it can break up a relationship.

Tim Norton: Oh, that's 

Dr. Barry McCarthy: too bad. It is to wrap and sometimes it's actually the right decision. But most of the time, if people would actually disclose who their authentic sexual self is with their strengths and their vulnerabilities, their partner is usually, and this is especially true when the woman is usually much, much more accepting of the man than he is accepting of himself, you know?

 sexual trauma [00:26:00] occurs much more with women than it occurs with men, but it's also much, much more impactful and destructive for men than it is for women in that it becomes his shameful secret. He basically never tells anybody, including his part about his trauma history. And that's a terrible mistake that you need to need to honor your history.

But don't give it control over you. You are much more sexually than your trauma. What is your trauma is part of your authentic sexual self, but don't give a control. And I know this all sounds too easy way too easy, but I rethink it's true. 

Tim Norton: Yeah, no, it doesn't sound easy to me.  you, I think as a, as a couples sex therapist, you probably.

Heard about a lot of sexual trauma or a lot of non-sexual trauma. How do you [00:27:00] generally, I guess that's a really difficult question, but how do you work with trauma? 

Dr. Barry McCarthy: Well, I work with it in two ways, and again, this is way too simplistic and it's much more challenging that for people, but the one is a clear message to them.

That you want to be a proud survivor. You don't want to be an angry, anxious, or depressed victim. And the cognition is that living well is the best revenge, but that the best way of dealing with your history is actually processing it with somebody who you trust, whether that's your best friend. It is your partner.

Elrod is a therapist. Or you can tell all of the whole story about who you are psychologically relation and sexually and feel you're accepted. That makes it so much easier to then take the step of [00:28:00] saying, I want to be a proud survivor and that feeling that you can not get a do over, you cannot change the past.

You can learn from the past. You can honor it. But you can't change your power for changes in the present or future and in a healthy relationship. When you experience again, desire, pleasure, rotten system satisfaction. You've taken back control of your sexuality. It doesn't reside back in a trial. 

Tim Norton: I'll get that question a lot.

When I'm seeing an individual and they're processing their own trauma and they wonder how much to share with their partner about what happens to them.

Dr. Barry McCarthy: The easy answer is share all of the themes, do not share the details. What happens when people. Share the details was it [00:29:00] usually re sensitizes them and they feel more and more controlled by the past when they share all the themes, it really does free them to be the authentic sexual person that they want to be in the present.

You know, one of the things that is a, again, easy to say, hard to implement, is it the challenge for folks whether they're married or they're partnered, whether they're straight or they're gay? Is how you integrate intimacy and eroticism into the same relationship. And then part of the issue with intimacy is it's about feeling warm, close, and secure, totally different experience than eroticism.

Eroticism is all about taking risks, breaking boundaries, it's mystery, it's creativity. It's not socially acceptable. It's an interesting issue in terms of the past sharing. Feelings about yourself. [00:30:00] The intimate feelings are, I think are really, really helpful. Sharon, the erotic details, including the sexual abuse and trauma is really destructive for most people most of the time.

Hmm. 

Tim Norton: Okay. That's that's really helpful. And we keep talking a lot about couples. Going through these experiences. Do you prefer when there is a, an issue like erectile malfunctioning, do you prefer to work with the couple 

Dr. Barry McCarthy: yes. Far and away? I think you not only get better results when you see intimacy and sexuality as a complication, rather than a man's, it's a convolution, but you get much less relapsed.

And it's partly because in doing couples therapy, You Rayanne, trying to build a bridge and a couple that says we're both intimate and erotic friends, so many men. And I know I [00:31:00] don't want to overstate this, but it is true. So many men feel intimately connected to their partner, but they have de eroticized their partner that they see her as a good person, a good spouse, a good mother, somebody to share feelings with.

But not somebody to share. Right. And then in healthy relationships, you value both intimacy and pleasuring and eroticism. Hmm. One bike that scored so much better as a couple. 

Tim Norton: Yeah. Oh, that's, that's another great piece of advice. And I, you know, I guess a lot of the times. I'll be on the phone with the guy.

He said he wants to come in for individual and I'll, I'll, I'll not nudge him toward bringing in his partner, but a lot of time the guy just wants to sort this out on his own. And then, yeah, I guess it's kind of a compartmentalization and then take it home and show his partner. Hey, my Dick is fixed.

[00:32:00] Dr. Barry McCarthy: He's performing for his partner. He sees his partner. There's somebody who's judging him and he's going to win her over or him over. It's not a good way of doing it. Let me make a specific suggestion for clinicians watching this. And that is in that first phone call to say to them, you know, I've done this awhile.

And, well, my experience has been is that if we do a four session assessment, I can make a good recommendation of whether you should come alone or as a cup in the four session assessment. The first session has done as a couple, and then you do individual psychological, relational sexual histories. If you do the history with the partner in the room, you're not going to get the genuine near, you're not going to get the truth.

They're going to get a sanitized version again. I've done a lot of these. I've done a little over. Probably 4,000 of them,  [00:33:00] 85% of people have sensitive skin sensitive or secret materially haven't shared with their partner. Hmm. And,  so I want to know what it is. And then we, the fourth session is we talk about them as individuals, but what are their strengths?

Where are their vulnerabilities as a couple? What other strengths and vulnerabilities and make a recommendation? Usually the recommendation is to work as a couple, but not always, sometimes it is much better to work with the man alone. 

Tim Norton: Okay. And I want to go back to eroticizing a partner. We were just talking about that.

And I feel like when I was first starting out, I was on the lookout for a seminar on how do you. Teach someone how to reroute assize their partner. Once they've become the family member or, you know, the mother or the sister, like, like when you, you know, for the listener that when you've been with somebody a [00:34:00] long time, you stopped seeing them as a sexual object in you, because they've done so many things for you.

They've raised your children and they've, you know, you guys go to the library together and you do lots of nonsexual things. Yes. Right. Which is a good thing to do, which is great, which is the hallmark of a long lasting relationship. But, so how do 

Dr. Barry McCarthy: you. Unnamed vital resilient, sexual desire. Eroticism is an integral part of it.

And again, we've got to be blunt here in that. The way eroticism is portrayed in movies in porn in novels is not in fact healthy, integrated eroticism. What integrate eroticism is about is that you own your sexual voice and you are inviting your partner to share in that sexual voice. And then,  you don't split it.

You don't compartmentalize, you know, one of the things that I hear over and over again, [00:35:00] and this is probably more true, cause you're in Los Angeles, right? I am. Yeah, so you're close to Las Vegas. So we are in North Carolina or Washington DC where I practiced there's. So many men will go to Las Vegas and they'll pay somebody $250 and they'll get an erection.

And the reason that they do that is that they see it's the woman's role. I gave you 250 hours. You owe me an erection. So it reduces the performance anxiety.

You can do that with your intimate partner, whether it's just married or a sexual friend where you say to your intimate partner, you don't own me interaction, but what we always, each other is a, have a good time in terms of pleasuring in terms of playfulness and in terms of eroticism. And then one of the things that becomes important is rather than our assuming of what is really a turn-on.

Is it we'll do psychosexual skill exercises, which I'm a big fan of [00:36:00] to try to identify what are Roddick turn-ons for each of us, as in the big key element is it can't be at the expense of the partner or the expense of the relationship. And for most people, the thing that feeds eroticism is cost. Partner interaction, arousal, more aroused.

You are the more grouser partners, but for some it's also self and arousal of taking turns. One of you turns on the other one, but the key thing that I'd really like you to hear is that everybody has their own erotic voice. So for example, in the media, the assumption is no, all men 99.9% of women. Really liked being filled-in you've heard that, sir.

I that's what people believe. And again, there's not great science, but probably somewhere around one out of five men is [00:37:00] uncomfortable receiving oral sex. He would never tell that to his partner, but it's the truth. Part of eroticism is you're being honest with yourself and you're. About what really does work for you.

But what I think the key, the key is element with eroticism is you, is that you've got a solid base of feeling comfortable in pleasure. And then the eroticism is integrated. 

Tim Norton: So I can hear a guy sitting there saying, okay, well, what turns me on is, you know, porn, you know, Watching somebody else have sex. So how am I going to share that with my boss?

Dr. Barry McCarthy:  well, let me give you the overview with porn. The way of understanding porn is it's an erotic fantasy gear. So we talk and I writing about five gears of [00:38:00] touching. Affectionate touch sensual, touch, playful, touch, erotic touch, and intercourse stuff. Think about porn is like a supercharged six gear. It's an erotic fantasy gear.

And what works in porn is totally different than works in real life sexuality. The reason that people do well with porn is it's often attached to masturbation, but it's also attached to you letting yourself let go, and really go with the erotic fantasy.  what makes porn problematic for people is where they make this differentiation between fantasy and reality in that what works in fantasy often.

And in fact, usually does not work in reality, or what happens with porn is you get this combination of about the 15% of men who misuse boy is that it's high degrees of secrecy. High degrees of eroticism and high degrees of shame. [00:39:00] You put that together. It's like taking a cancer pillar poison pill. Now there are couples who will use porn together as a way of having an erotic turnout, but it usually works better if they've played before and they're already open and receptive.

And then the porn is like a supercharge gear. 

Tim Norton: They. Watch it individually before, or they want 

Dr. Barry McCarthy: to know, okay. They play with each other and then together, they turn on the porn scene that they find erotic. Now, the problem with traditional porn is it gives a really crazy message about women that the crazier, the woman or more orotic, she is in the craziest situation.

Little robotic shit. If you can understand it's about fantasy and not think it's about reality, you're not going to get in trouble. When you blur those lines, you get. And especially when you add shame, no, of all the emotions, shame is the most [00:40:00] destructive for men and women, but especially 

Tim Norton: the, the biggest libido killer.

Dr. Barry McCarthy: It is a Beto killer, but it also, this combination of secrecy, eroticism and shame is very powerful and very destructive. 

Tim Norton: Yeah, really 

Dr. Barry McCarthy: isolating it is isolating and it doesn't serve as a bridge to anywhere it serves as a bridge to you feeling more isolated and shameful. Yeah. Hmm. 

Tim Norton: Okay. Wow. There's so much good stuff in here.

We, we spoke earlier about Viagra. And if you were, you said you were in private practice for 42 years. So there was a good couple of decades before Viagra came out. That's 

Dr. Barry McCarthy: correct. And I've also almost 15 years when very Agra was out. Yeah. So. [00:41:00] Here's what let's say it positively first. Okay. Yes. The advantage.

Let me tell you why. Let me actually let's start positively with YCL is for most men is a better medication. Okay. And that is, it fits better into your couple sexual style of intimacy, pleasuring and eroticism. The problem with Viagra is that you have this narrow window of opportunity for desire.

Basically an hour to four hour opportunity window. It works well for procrastinators and people who like structured, but it works less well for most couples where Cialis gives you much more degrees of freedom in terms of, of windows of opportunity. And,  the other is the notion with reactor is that a gives you an erection.

It doesn't give the man in erection. What it does is that when he is subjectively aroused, it makes it easier to [00:42:00] become objectively aroused and to maintain his erection. That's the advantage of Viagra and Cialis.  and then using it as a anti-anxiety medication, which has half of its function. The other hand is an increased.

The efficacy of your vascular system is fine. No, here's where it's really problematic. And that is where the nobody gets the results that you see in the ads. Nobody period, exclamation point, even among the best Viagra and Cialis users, they don't get a hundred percent predictable erections. They usually get between 65 and 85% erections, which is good.

Not bad. But they, the dropout rate is high because they feel they're the only one in LA who's failed a pre-algebra based on the ads everybody's failed. If you think about [00:43:00] Viagra as an additional resource, both anti-anxiety and firmness of erection. That's it's good. Use the thing that's interesting about medical interventions is that the more invasive the intervention.

The more effective it is, but it's more difficult to integrate it in a couple sexual style. So for instance, penile injections are much more efficient for getting erections than Viagra Cialis, but for penile injections to work, the partner's got to feel that they haven't,  rolled in there. The man who goes into the bathroom, injections himself comes out with an erection meeting, wants to go to intercourse.

That is not going to, you're going to have that high dropout rate because the partner says, I don't understand what's going on. It's not. And often he has a hard time reaching orgasm as he isn't. He's not turned on the reason he's not [00:44:00] reaching orgasm. He's not turned on. Even though he's got objectively from direction, he doesn't have subjective arousal.

That's the other thing in treatment, that a message that is very hard for people to accept, but I think is really a true message. Is it subjective? Arousal is more important than object, or it really is true. Feeling turned on is more important than having an erection, you know? The reason, you know, a Janka Tori inhibition, which we don't talk about enough with men, especially men over 50, because I think it's as many as 15% of men have trouble with the janitorial inhibition, is it the reason he doesn't reach orgasm is that his penis is lying.

His penis says I'm turned on, but he's not really subjectively aroused. And he's trying to have sex. Like he had sex when he was in his twenties, just doing trusting the key element, re in overcoming a jacket terrain [00:45:00] division. Is don't transition to intercourse until you're an a seven, eight or even a nine in terms of subjective arousal.

And then do some multiple stimulation during intercourse. Don't to just throw stuff. Is that too much or is 

Tim Norton: that that's wonderful. I'm kind of processing that and, and just wondering. You know, you, you saw the transition from guys who are having much more sex when they really weren't, that turned on because of, you know, now they can with, with Fiat GRA would you say it's been genuinely, generally beneficial to couples and class 

Dr. Barry McCarthy: if they use it the way it's supposed to be used, which is the integrated in their couple sexual style, it's been helpful.

It's caused more non-sexual relationships than anything else in history now, because it's not a good drug, but nobody tells man about these two [00:46:00] guidelines about transitioning intercourse when you're highly turned on and doing multiple stimulation and adopt the good enough sex model. You know, let me say one last thing and to make sure we get it in.

You know what, I'm a big behavioral person in terms of the psychosexual skill exercises, the psychosexual skill exercise, and I think has the most value. And Michael did it probably with 2000 men before he died. And I probably done it probably not 2000, maybe 15, 1800, when, and that is the exercise of waxing and waning of erections, neither Michael or I ever did it with a man who enjoyed it.

It's just not an enjoyable exercise, but it's a crucial exercise. It's kind of an anti panic exercise. And that is when man is turned on you stop stimulation. So his erection wanes, if he stays relaxed, mindful, and open to central and playful touch, [00:47:00] his erection will wax again. Let him lose it again. Let him let it wait a second time.

Don't go to intercourse until your third direction. All men that I've met personally and professionally prefer to go to intercourse on their first direction, which I think is a great preference. It's a terrible mandate. You got to understand your penis and don't be the enemy of your penis. Be the friend of your penis.

Understand that it's okay for penises to be variable and flexible. 

Tim Norton: Yeah. One of the things that. I will talk about what guys sometimes is. If, if lubrication in, in, in a female waxes and wanes, we don't know. Yeah, of course.  but, but it's, it's obviously not as visible.  yes. And so to, to clarify that, that waxing and waning technique, you're [00:48:00] letting the situation and then all of the erotic charge of it create the erection.

You're not trying to.  jerk him off to get the erection. It just letting it 

Dr. Barry McCarthy: happen again. You're it's about pleasure, not a month,  orgasm and performance. So you're trying to play and your body responds with interaction. If you stop your Wrexham away, if you become obsessed with your penis and panic and apologize, your retro will never wax again.

But if you're mindful, relaxed, and open to sensual and playful touch, your erection will wax again. Let it wait a second time and then go to intercourse and orgasm the third direction and in any, because I'm in favor of third directions, I really want him to understand, be nicer to himself and to his penis to understand it's normal.

One other point, whether you're using Cialis or Viagra or not, or even if you're using injections, [00:49:00] the likelihood is the weather happens once a month. Once every 10 times a once a year, you will not have an erection sufficient for, you know, the man is cured when he doesn't have an erection sufficient for intercourse and he can accept it without panicking or pods.

That's the cure for erectile dysfunction. Hmm. 

Tim Norton: Oh, I love it. It's so good. Thank you so much.  so what's,  You know, you've, you've done a lot of work and it, over the years you've been at this for multiple decades. What are you most proud of? 

Dr. Barry McCarthy: Well, the thing that I think about, about my legacy, you know, when Michael died about six years ago, when I gave a presentation at a conference about his legacy and his legacy was the good enough sex model.

I [00:50:00] think Michael would still roll in his grave if he, if he would be so frustrated, the good enough sex model has not been adopted, especially by physicians. I rethink that. That's key. When I think about my legacy, I think about my legacy being about a couple approach to desire, especially this idea of valuing both intimacy and eroticism and positive, realistic expectations.

No, I'm always in favor of positive experiences, but the real test of a couple is when they have a lousy experience, can they turn toward each other and shrug it off or laugh it off and say, let's be sexual again in a day or two we're more awake alert and really receptive and responsive. So the legacy I would like to have people think about me is about desire issues.

And about relapse prevention about how you [00:51:00] maintain healthy sexuality and ongoing relationship. 

Tim Norton: Hmm, I'm wonderful. And I like even thinking about it with the waxing and waning exercise, we talk about what the male was learning, but also what his partner is learning about penises and waxing and waiting, and both of them being on the same page of, of achieving that good enough sex.

Dr. Barry McCarthy: So I did that. There's so many more similarities and differences between men and women. Remember that book that's so, so many copies back in the eighties, when are from Mars, women are from Venus. There is no science to that at all. He's a very nice man, but there's no science to that. That's just the opposite is true.

Yeah. And,  I do think the reason good enough sex so much more, much better with women is it fits their sexual socialization about variable, flexible sex and fantasy.  when I teach my undergraduates, I still teach an [00:52:00] undergraduate psych sex class in American university. And there's always more women than men take the class.

 but that one of the themes for men is you want to be a wise man and wise men think of women as intimate, neurotic preps. Hmm. 

Tim Norton: Hmm, love it. And gosh, those kids are so lucky over at American university. Getting that class as a part 

Dr. Barry McCarthy: of it. You think about it as primary prevention. We think about as a clinician, you're always doing tertiary intervention.

Would we so much better? And again, one of the things with books though, I think books work much better when you're in therapy. It's self help books, but sometimes when they work well, the self-help book really helps somebody do secondary prevention. That's does. Huh? I didn't know that. Now I know it. I feel so much better about myself as a sexual person.

Yeah. 

Tim Norton: Great. [00:53:00] Okay. And all this work that you're doing, it seems like at some point you and your wife started working as a team. 

Dr. Barry McCarthy: Right. Emily, Emily and I have been married for a long time since we've been married 52 years from we come from nine middle-class backgrounds. We were the first ones in our family ever graduated college.

We have a lot of pride in what we've created as individuals as a couple.  but it's been fun. Working writing together. Her background is not mental health, it's speech communication. And I think her approach really does put a, a humanness and a,  nitty gritty newness to it. I mean, I talked more as a scientist and she talks more as a human being.

Tim Norton: Okay. And you guys, do you also present together or it's mainly the writing together? No. 

Dr. Barry McCarthy: It's the writing together that we do many years ago.  I [00:54:00] tried to talk her into switching careers and getting into the field and she says, you know, I love what I do now. Sex therapy is a weird profession. 

Tim Norton: It's pretty weird.

Isn't it? Okay. Well, you know, thank you so much for, for agreeing to this.  Well, you know, you've made such incredible contributions to the field with, with your writing. And, you know, I can tell from just his dozen or so questions, what a depth of knowledge you have on this subject and you were offering really good advice to our listeners.

I really appreciate 

Dr. Barry McCarthy: that. Well, it's been fun. I hope it is. 

Tim Norton: Yeah. Yes. I know it will be. All right. Well, thank you again. And any, any w what are you working on now? 

Dr. Barry McCarthy: I love to work and I love presenting. I present. I actually, I would love to present the lay public, but I present the professions, the book, the second book that we're now working on, which [00:55:00] supposedly is going to come out in the summer is called enhancing Cabo sexuality, creating an Intuit neurotic bound.

And then the book that'll come out in 2020 is the third edition of rekindling desire. 

Tim Norton: Okay. And 

Dr. Barry McCarthy: you know, the book that I'd love to write, if I can get a contract for it is about what women need to understand about male sexuality. That would be good for her, for him and for the couple. That's a book that's the back 

Tim Norton: of my head.

Okay. So for all the agents out there listening,  where, where can they find you if they need to get ahold of you for that? 

Dr. Barry McCarthy:  probably the best places by email. So it's Barry McCarthy, forty3@gmail.com. 

Tim Norton: Okay. Then do you, do you tweet, do you get out in the social media sphere? 

Dr. Barry McCarthy: I don't, I probably don't. I probably should, but,  you know, everybody, one of the things that has been helpful to clients and talking to me, I have this [00:56:00] notion that everybody has their strengths and everybody has their vulnerabilities for somebody who writes as much as I do.

I have a perceptual motor learning disorder so that I cannot do computers and I cannot type. So it's really, as a board becomes more online, as you said, the social media, I am totally overwhelmed. I mean, for, you know, to write an email for me, like an email to you, I think I would imagine it takes you. Yeah, 30 seconds for me, it takes me about seven minutes.

Oh, 

Tim Norton: wow. Okay. Well then thank you more times over for all the work that you've done. Right? Cause that sounds like it was quite a feat. 

Dr. Barry McCarthy: I'd love to do it.  and I also, it's not my line that you need to own your vulnerabilities, but don't give them control. So like what we say about trauma, you want to own it.

You want to learn from it. You don't want to give her control. 

Tim Norton: Okay, well, I'm, I'm going to tweet probably 10 different cores from you [00:57:00] following this over the next couple of weeks. Cause there are some, yeah, absolute gems in here. Thank you again, Dr. Barry McCarthy: and  hope to run into you out in the field.

Dr. Barry McCarthy: Thank you. 

Tim Norton: Shout outs to the sex positive community, including sex educators, sex therapists, sex coaches, and other fellow sex, podcasters, sex, surrogates, academics, sexual health, medical community, sex workers, the tantric community, and everybody else involved with having hard copies.

If This Episode Resonated

If this episode spoke to you, there is a path forward.

Tim Norton provides a discreet, evidence-based therapeutic space where men and couples can understand the deeper systems behind desire, arousal, and connection. His work combines rigorous neuroscience with a grounded, relational approach to help clients rebuild aliveness in their bodies, strengthen partnership, and create lasting change.

How to Relieve Pelvic Pain and Erectile Problems

Episode Overview

In this episode, Tim speaks with Dr. Howard Schubiner, one of the world’s foremost experts on psychogenic pain and mind–body disorders. Together, they explore how neural circuits can generate real pelvic pain, erectile issues, and bodily symptoms even when there is no physical injury. They discuss why symptoms become chronic, how fear amplifies pain and arousal shutdown, and how retraining the brain can restore ease, pleasure, and confidence during sex.

Key Themes

• How the brain can create pain without physical injury

• Neural circuits that influence erections and pelvic tension

• Why some symptoms become chronic due to fear activation

• How to retrain the brain to reduce danger signals

• The overlap between psychogenic pelvic pain and erectile dysfunction

• How calm, curiosity, and safety change the body’s sexual response

• The profound reassurance of understanding mind–body pathways

Listen to the Episode

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Dr. Howard Schubiner

Dr. Howard Schubiner is a physician, researcher, and international leader in the treatment of psychogenic pain, pelvic pain, somatic symptom disorder, and TMS (Tension Myositis Syndrome). He directs the Mind Body Medicine Center at Providence Hospital and serves as a Clinical Professor at Wayne State University and Michigan State University School of Medicine.

His 60+ scientific publications and groundbreaking clinical program have shaped modern mind–body treatment. He is the author of Unlearn Your Pain and has been listed in Best Doctors in America since 1996.

Website:

https://www.unlearnyourpain.com/

https://www.tmswiki.org/ppd/Howard_Schubiner,_MD

Book:

Unlearn Your Pain. https://bookshop.org

Episode Transcript

Tim Norton: Hello, and welcome to hard conversations. Really excited about my next guest, Dr. Howard Schubiner, who is an internist and the director of the mind body medicine center at Providence park hospital in Southfield, Michigan. He has a clinical well professor at the Michigan state university college of human medicine.

And as a fellow in the American college of physicians and the American Academy of pediatrics, he has authored more than 100 publications in scientific journals and books. And lectures regionally, nationally and internationally. Dr. [00:01:00] Schubiner has consulted for the American medical association, the national Institute on drug abuse and the national Institute on mental health.

Dr. Schubiner is the author of three books on learn your pain on learn your anxiety and depression and hidden from view written with Dr. Allen ABIs. He lives in the Detroit area with his wife of 34 years and has two children. We're going to be talking about two things today. Psychogenic pelvic pain and penises that don't get erect for psychological reasons.

There's a lot of crossover between these two topics. And even though Dr. Schubiner primarily deals with chronic pain, his approach to treating these conditions is perfect for working with psychological erectile issues. Note to the listener, the beginning of this recording, where we say hello, and thanks for being on the show got cut off. So just know that I did say the things that one says when they first meet someone. And I don't just start off conversations with people asking about [00:02:00] erections before saying, hi,  how can a guy have pelvic pain? And it not be something structurally or biologically wrong with 

Dr. Howard Schubiner: him. Right. And that's a great question.

In fact, most people would think if your arm hurts, there's something wrong with your arm. If your penis hurts or something wrong with your penis, that only makes perfect sense. But when you dive deeper into what pain is, and if we have time, I can explain that a little more deeply.  it turns out that statistically speaking.

Most pain is not due to a structural tissue damage problem in the body, which is pretty surprising, but take headaches probably 15 to 20 million Americans have, have headaches, chronic headaches. And if you ask any neurologist. The vast majority of those 95 to 98% do [00:03:00] not have a structural cause for their pain.

In other words, when you scan their brain and do x-ray their sinuses, you don't find sinus disease. You don't find tumors, infections, inflammatory conditions, you just have headache, it's pain. And so that pain is not due to a structural problem in the head. Well, it turns out if you look at abdominal pain, it's virtually the same thing.

And if you look at pelvic pain, the vast majority of people with chronic pelvic pain do not have a structural problem where they're feeling the source of the pain. It's, it's shocking. Really? That's true. And 

Tim Norton: could that apply to not just pain, but. Burning urination burning, burning after your jacket plate, numbness, tingling all the, like the golf ball and the butt feeling, right.

[00:04:00] Dr. Howard Schubiner: Is that I've seen it. You've seen it all. Some of them, myself. Oh man. Yeah. It's pretty common. In fact, the majority of people have had some sort of pains, tingling, numbness, burning.  at some point that was not due to a structural problem and I have so the, any, and any, and all symptoms can be caused purely by the brain.

And certainly most symptoms can also be caused by a structural problem in the body. If you have. No gonorrhea infection or a chlamydia infection you're burning after urination. Well, okay. That's an, that's a infection. That's an inflammatory condition. That's triggering the brain to activate pain, but you know what happens sometimes is somebody might have a structure, a cause for pain, say a chlamydia infection and their brain learns that pain.

The [00:05:00] infection gets treated. Infection is cleared. Cultures are negative, but the pain can continue. And that's because the neurocircuits that are actually activating the pain are still going. So when you touch a hot stove, it's not your finger that's causing pain. It's actually a neurocircuit in their brain that gets triggered by the injury that causes the pain.

Tim Norton: Interesting. So yeah, why don't, why don't we get more into what pain is? You said that you could, you could give an explanation of that. So how does that neurocircuitry plan to 

Dr. Howard Schubiner: this? Well, if you think of it from an evolutionary point of view or intelligent design, if you prefer the brain has to be able to do two things with pain.

Number one has to turn on pain when there's an injury and.  at times. And certainly [00:06:00] if you imagine,  one of our forebears running across the Savannah, trying to chase down a deer long time ago and they break their ankle. Now, if you don't get severe pain, you're going to keep running, destroy the ankle, never hunt again, and never reproduced.

So, but it's not the ankle that's causing the pain. It's the brain that's activating severe pain. It turns out that stress and emotional,   insults or assaults activate the exact same parts of the brain that cause pain. So the brain can turn on pain as if it were a physical injury in the absence of a physical injury.

Because the brain knows that's how it's designed. That's what it does. And so research shows that people who have, for example, the famous story we always tell is there was a guy who jumped off the scaffolding in Britain few years ago onto a nail. The nail [00:07:00] went clear through his boot screaming, yelling, rush to the hop in medication.

They take his boot off when the eldest precisely between his toes, no injury at all. But that pain that he had was severe and real. Hm. 

Tim Norton: And so, so Y 

Dr. Howard Schubiner: well, it's a protective measure. If we, children who were born without the ability to feel pain, often die at an early age. So pain is a signal. It's like a smoke alarm and it's warning us.

There's something wrong when you break your arm, your pain is warning. You telling you there's something wrong and that you need to go to the hospital and get a cast or whatever. When you're in a situation in your life where your partner's cheating on you or your bosses. Criticizing you and micromanaging you or your kids [00:08:00] are acting up or using drugs or whatever your brain can produce a warning signal and that signal can be pain.

It can also be anxiety or depression or can't sleep. Pain is a common alarm mechanism that the brain knows how to do and it, and that pain can be burning, tingling, numbness, shooting, pain, sharp pain, throbbing pain, pain that comes and goes it's up to the brain to whatever it wants to do. 

Tim Norton: And so why does it stay chronic?

Dr. Howard Schubiner: Well, what happens is, is the alarm signal goes off,  to tell us there's something wrong. And if someone's talking to you and you don't listen, someone will typically talk louder. Okay. So that's kind of what the brain is doing because it's trying to get your attention so it can talk louder. Can [00:09:00] talk longer.

And then what happens, and this is the critical point. Most chronic pain is due to the fact. That the pain itself causes fear and worry and attention to it and monitoring of it. And that fear and attention and monitoring puts more focus on the pain. And the more you worry about the pain, the more the pain itself is driving the danger alarm mechanism in the brain to create more pain.

And that's the vicious cycle of chronic pain. Okay. 

Tim Norton: And that that's something that I do hear a lot with guys who are struggling with, with maintaining erections or achieving erections, is that they're afraid they're not going to get another one. And you know, they'll probably get one when they masturbate, but they're afraid that they're not going to get one when it comes, when there's another person in the room.

Dr. Howard Schubiner: Exactly. The more fear, the more worried about it, [00:10:00] the more pressure to perform. The worst it gets. And that's why,  when there's less pressure, if they're masturbating for example, or,  there was another, not a person in the room, but a computer,  then the pressure's off and then the system works fine.

Hmm. 

Tim Norton: So is it, how do we get better? Do we get it? Do we just face our fears? Is that 

Dr. Howard Schubiner: well, yeah. It's first of all, from my point of view is making an accurate diagnosis. Knowing what the problem is. If one thinks they have a structural problem or hormonal problem or whatever, it's going to be pretty hard to turn off the fear of it to turn off the dangerous signal.

So the first step is recognizing what the problem is, and that's usually done through getting normal medical testing.  making sure there's nothing structurally [00:11:00] wrong, which is usually pretty easy. Hormones are normal.  cat scan is normal,  physical exam by doctor's normal. And that's usually the case.

As I mentioned before, 90 some percent of people with chronic pelvic pain don't have anything structurally wrong with them.  so that's the first step. The second step is. Become is freeing yourself from the fear and the worry. So once you have the diagnosis that, you know, there's nothing wrong, it doesn't mean the pain is real.

It's very real, not imaginary. Anybody who says it's all in your head is either ignorant or cruel or both. But once you get, if you can get past that, When you can realize it's not your fault, there's nothing wrong with you. And this is just part of being human. Then every time you get a discomfort or you're in a situation where you need to perform [00:12:00] sexually, you just need to stop worrying about it.

Stop focusing on it and train yourself to calm in the face of. Pressure or stress or pain, calm your brain. And when you do that, then you're turning off the dangerous thing and then this, and then you get better. 

Tim Norton: So you, there's a couple of things that I want, I want to address with that. So one of the things you said was that,  and this is what we run into when dealing with mind, body medicine all the time is people, people don't want to think or hear, Hey, it's all in your head.

And, and you describe that statement as, as ignorant and cruel. Could you elaborate on that? Because on the one hand, you're saying, you know, the brain is causing the pain,  the brains in the head. And so, you know, that's why, why are we not saying that it's all in your head? 

Dr. Howard Schubiner: Well, that's an important distinction because all in your head has pejorative terms.

It [00:13:00] implies that the pain isn't real, you're imagining it. Well, that's not true. It's real pain because all pain is caused by the brain. It's implying that it's your fault, that there's something wrong with you. That you're nuts. You're wacko. You're mental. That's not true. As I pointed out earlier, I've had many instances of pain in my stomach, back neck,  rectum.

Scrot you name it over the years. It comes and goes when I'm crazy. For mental or deficient, it's part of being human. So that's the key is taking the guilt away, taking the shame away and recognizing that these symptoms are very real, not, not someone's fault. So that's why we say it's not in your head, right brain.

It's the brain that's doing it. You can't control your brain. The brain has, you know, has. It's way [00:14:00] of doing things and you can't go in there and just turn off the pain in your brain. You have to work with the brain and train it and rewire it and reprogram these neurocircuits that have become learned over time.

Tim Norton: Yeah. And how, how do we retrain those? Neurocircuits. 

Dr. Howard Schubiner: Exactly. Well, that's, that's what we do. And that's, that's why I've written books on this. And that's why people at the pain psychology center in Los Angeles, as you do teach people how to do this. And the key is recognizing that the pain is not dangerous.

When we recognize that it's not dangerous, then you start training your brain. That is not dangerous. So when it occurs, you train yourself to separate from it rather than to react to it. So the reaction is fear, frustration, worry, monitor, constant monitoring, stopping what you're doing, acting like you can't do [00:15:00] anything.

This, so the opposite is, is, is recovery. It's acting like it doesn't matter. It's treating yourself like the pain doesn't matter. It's kind of like a bullet, you know, bullies feed on fear of their victim. The more fear, the more the bully is emboldened. And they keep tormenting their victim. But when the victim either fights stands up to the bully and fights back and says, you know, you can't do this to me anymore.

Punches him in the nose. Or the victim says to the bully. Oh, you're saying I'm stupid. That's a good one. Ha I don't care. You're in essence, laughing at the pain now, is that easy to do? No, not always. It's simple, but it's not always easy to do and it can take several weeks or months for people to retrain their brain.

Tim Norton: Yeah. And especially if it's been happening for a long time, 

[00:16:00] Dr. Howard Schubiner: you'd be surprised though. Yes, that's true. But it's amazing how sometimes quickly these neurocircuits can turn on and off because they are in essence. Neurocircuits. It's not a hardware problem. It's a software problem.

Tim Norton: Interesting. So emotion. So you, you were, you were talking about fear and I recently watched one of your talks. I think he gave a talk at Google,  sometime ago. And there was a lot, there was a, there was mentioned in that, and there's a lot of talk in the psychogenic pain world about pain being. Connected to emotions.

 could you speculate on what emotions might be coming up for someone with erectile issues? 

Dr. Howard Schubiner: Well,  yeah, their research shows that emotions activate the exact same areas of [00:17:00] the body as an injury. Does. So the brain is wired to produce pain or other symptoms when emotions occur, because,  we feel like we're in a situation which is dangerous.

If someone, if we feel like someone's judging us, that would, that would qualify as feeling endangered. Maybe not physically endanger, but emotionally endangered, but it's the same thing. The brain responds the same way. So if you're performing in. Work gymnastics, golf or sexually, you're still performing.

And it's a question of how do you feel judged here now? Do you feel embarrassed? Do you feel guilty? Those are powerful, powerful emotions. Am I good enough powerful feelings. That can produce,  significant,  and real symptoms, like real [00:18:00] psychogenic symptoms. Right. 

Tim Norton: And then I, yeah, I've, I've looked at unlearn your pain.

I've looked at that book. I quite extensively. And there are, there are a lot of passages in there where you're really you're writing about your emotions. 

Dr. Howard Schubiner: Yeah, exactly.  there's several ways. To deal with the emotions that come up in our daily lives. And if we don't deal with them, don't don't can either not recognize them or not express them.

We can suppress them. Pretend they don't exist. Anger is a common one. Many people are taught. Anger is bad. You shouldn't be angry. You shouldn't be an angry person. Bad people are angry. Violence needs to horrible things. And violence does lead to horrible things, but anger is a healthy and normally emotion that oftentimes we need to help.

Our patients recognize that it's [00:19:00] there,  allow themselves to feel that allow themselves to express it in a safe and healthy way. For example, in writing or when they're alone, verbally, not necessarily to the person.  guilt is a very powerful emotion that people commonly feel that can trigger pain or other,  psychogenic disorders.

 unexpressed sadness and grief, same thing.

Tim Norton: And as you say that, I think about how different anger is,  to fear. And I wonder sometimes when people are, you know, when working with people on this, if I can see that when they're angry about it, there, it almost seems like they're. They're less afraid that they're, they're kind of moving past that they're, they're 

Dr. Howard Schubiner: empowered.

[00:20:00] Yeah. I've seen it many, many times,  because this, the life stress and the life situations,  that where someone feels powerless, for example, at work or in a relationship.  creates a tremendous amount of fear if you're powerless to do anything.  and that fear activates the dangerous signal, which can cause pain or other psychogenic disorders.

But when you're trapped and feeling powerless, oftentimes you're angry about them. And anger leads to action. Anger is a powerful and positive emotion that leads one to express oneself. And as long as you're not expressing anger in a way that creates violence or creates harm or creates defensiveness, or, you know, you can ruin a relationship easily by expressing anger.

[00:21:00]  so what we've learned to do is help people express anger and private ways that.  don't ruin relationships and then go back to the relationship to express,  to be assertive, but civil, but that makes sense. It 

Tim Norton: does. And, and I'm, I'm, you know, I deal with this stuff a lot. So I'm trying to put myself in the shoes of a client and we, we kind of glossed over some of the stuff.

And I, and I'm wondering, you know, guys are told they have. CPPs, they have chronic pelvic pain syndrome and they have prostititus and they have a host of other things. And are you saying that this process and these mechanisms that they'll apply to those conditions or are any of those separate from, from the psychotic pain?

Dr. Howard Schubiner: Well, what I'm saying is those conditions are labels, which we [00:22:00] often mean nothing, chronic pelvic pain syndrome as a label, which means virtually nothing other than you have pain chronically. And the reason it sounds horrible. And if you look it up online, you can read about people who suffer for it for years and keep going from doctor to doctor without any care, because when you treat.

A psychogenic pain syndrome as if it were a medical syndrome with drugs or injections or surgery. Oftentimes it'll just get worse because you're not addressing the underlying cause. And the reason they give a diagnosis of chronic pain syndrome or chronic prostititus is usually because there's, they haven't found anything.

So they're just giving it a label which describes in a sense where the pain is or. No.  you know, pudendal neuralgia is another one of those is saying, well it's though, which just means pelvic neurologists means pain. That's like a nerve pain [00:23:00] is completely meaningless. So those are three diagnoses that we commonly see that are in fact a psychophysiologic or a psychogenic pain disorder period.

There's nothing wrong physically, but 

Tim Norton: with a nerve. Can't they get in there and see that the nerve is 

Dr. Howard Schubiner: no, not at all. When you're given a diagnosis of moralgia it just means you have nerve like pain nerve, like pain. Yeah. And so, like you said, remember, you were saying earlier, well, you cannot be tingling.

Can it be burning? Can it be scratchy? Can it be itchy? Can it be sharp? And lancinating, it can be any of those things. And so the brain chooses a pain that is like a nerve like pain, then they'll call it. On their answer, but it's really meaningless though, that that term is given. Like I say, when the tests are normal, when the cat scan or MRI of the area is normal.

So what does that [00:24:00] mean? It means there is no tumor. There's no infection, there's no inflammation. There's, there's nothing structurally wrong and it's just hard. Sometimes to explain that to people because we, as a society are so steeped in the knowledge that pain equals physical damage and shockingly, most of the time, that is an incorrect statement.

And it 

Tim Norton: does just get worse with medical treatments that, that kind of reminds me of with the erectile issues. A lot of guys, especially if they start taking.  one of the PDE five inhibitors, Viagra early on that eventually they don't work very well. And if you've been taking that for 10, 15, 20 years, I mean, it's only been out 20 years.

 D you might need a higher dose, so you might have to start having way more side effects. And it might've been something that it could have [00:25:00] been treated, you know, with, with dealing with emotions and things that we're talking about and, and retraining the brain.  had you just not had a medical treatment to begin with, 

Dr. Howard Schubiner: right.

And most, you know, when you, when you look carefully at the studies,  there's a high likelihood in many medications, including opiates, including Viagara, et cetera, that the, the effect of the medication is a placebo one, rather than the actual effect of the medication. And so over time, The kind of placebo effect wears off, you know, because we haven't, as you point out you haven't addressed the underlying, you haven't addressed the underlying issue, the underlying issues ongoing and may get worse.

Over time. I saw a guy who had testicular pain,  so bad that he ended up having his testicle removed. [00:26:00] Oh, man. Not the reason I saw him of course, is that the removal of the testicle didn't stop the testicle from hurting because the pain wasn't due to an abnormal testicle. And in fact, they knew it was not an abnormal test to go before they removed it, but they were at their wit's ends and he was in such severe pain.

It turned out that,  in this case, he. He had found out that his wife had, had had a quote emotional affair with one of his friends and that precipitated the onset of the testicular pain, kind of like getting kicked in the nuts, so to speak. Sure. And,  smooth things over and things we're going to find for awhile.

And then he found out that no, she wasn't having an emotional affair with these guys. She was actually having a. Full-blown sexual affair with this guy and then the pain [00:27:00] skyrocketed to the roof and wouldn't go away. I saw, I saw a guy who had,   you got hit in the, in the, in the scrot  on a basketball court by a ball.

You know how, when someone's going out of bounds, they throw the ball real hard back into the court and get them square in the nuts. Annie. You know, doubled over how many guys have that happen to them, millions doubled over and walked it off. He can finish the rest of the game and the pain never went away.

So we had an injury and the injury healed there wasn't like anything was wrong. He went to numerous doctors, but the brain took that pain and just kept it going, kept going, kept it going. And the more he worried about it in theory, Hmm. 

Tim Norton: Fear that there was something wrong. 

Dr. Howard Schubiner: Fear that there was something wrong and just fear of the pain itself and frustration at the pain and [00:28:00] frustration at the doctors for not finding anything or frustration at the doctors for not doing anything, we're doing things that don't work and then getting invasive procedures that were even more scary like injections or, or,   you know, there's a diagnosis.

Another similar diagnosis is pelvic floor dysfunction, pelvic muscle tension, which again, in my mind, points to a psychophysiologic disorder and some of those people get internal pelvic therapy. That's not pleasant. Man, it's embarrassing and it's comfortable and they're pushing on the muscles and they're trying to make the muscles relax and maybe the muscles relaxed for a while.

And then they get tight again, because it's not the muscles. Aren't the problem. The muscles aren't damaged or disease. They're just reacting to tension in the brain.

[00:29:00] Tim Norton: What role does a person's. And environment play. I was watching your talk and you were talking about repetitive strain injury.  I don't know what that is, but that you, you commented that the work environment. And then I was just wondering work environment, pressure of marriage.  does, does that impact these, these 

Dr. Howard Schubiner: symptoms?

Well, oftentimes the brain will choose so to speak a symptom that makes sense. In some way, it makes medical sense. For example, RSI is pain with typing, basically being with writing or typing for the most part. And so, I mean, it can occur in the elbow or other joints, but usually refers to wrist pain and hand pain, finger pain with typing and,  [00:30:00] So you're typing and then you get this pain and maybe you're getting this pain because your work is you're overloaded at work or deadlines are coming out of here.

Your colleagues are obnoxious or your bosses ruthless or micromanaging, or you're not getting promoted. And all those things can come out in the hands. And what is the brain saying? Get out of there. Don't work. You shouldn't be, you shouldn't be typing as too much for you. So the message is there's something wrong with your job, but the interpretation of the message is often there's something wrong with my hand or my wrist or the ergonomics of the situation is really bad.

So you get a new chair and you get an economic gutter. Better keyboard or whatever, all those things. And maybe it helps for a while. But the point is, is that you got to treat the underlying cause, which is in the [00:31:00] brain.

Tim Norton: One thing that I've noticed working with these clients is that in those situations,  sometimes they do respond quite well to.  physical therapy and I have a theory about why that might be an, and I was wondering your 

Dr. Howard Schubiner: thoughts on that. What's your theory. 

Tim Norton: My theory is that there are, there are some, some pelvic floor specialists out there, some, some, some physical therapists in any profession.

And in fact doctors, all doctors before penicillin, I feel probably had really great bedside manner. And I'm really psychologically sound.  Ways of communicating with people so that they were able to do all these things that you're talking about face their fears, [00:32:00] feel, hope, you know, believe that they're going to be okay.

You know, all the things that doctors today are telling them that, that they're, they shouldn't feel right. That they're, they're going to have a condition for the rest of their lives. And there's really not much they can do other than manage of it. That, that a really good practitioner instills that sense of.

You're going to be, you're going to be good. You're you're going to be this. We're going to work on this and you're gonna get bad. 

Dr. Howard Schubiner: It's that? And more,  first of all, so there's three major components of a very powerful,  clinician, client relationship. And this has powerful effects.  one is giving an explanation that makes sense.

Hmm. So if the provider and the patient agree on the explanation, that's a powerful force, binding them together, and the explanation can be your pelvic muscles are, or that, you know, you need to change your ergonomic thing or whatever. It doesn't matter what the ex the next nation might be, or she is [00:33:00] off, or your shockers need adjusting.

Any of those are perfectly valid explanations, as long as both, both parties agree on it. The second thing is then you need a technique, something to do. So the technique of the physical therapy or the acupuncture, or the,  adjusting the shock Rose or, you know, whatever that is, is powerful again, because you believe it.

And the third part. Is the hope and the optimism and the relationship of a caring provider. And so when you put those together, you get a very powerful effect that the psychophysiological disorder, that's all you need. And the research has shown that,  for example, in acupuncture,  studies showed that are kind and caring.

Acupuncture said much better results than a brusque. And non-caring an acupuncturist sorta makes sense, obviously. Yeah. 

Tim Norton: So explanation, technique, 

Dr. Howard Schubiner: hope and 

[00:34:00] Tim Norton: relationship, relationship. Okay. I love that cause that that's so inclusive. I hate ruling out all the other disciplines and, and, and everybody, you know, but that, that's really saying as long as you and your client are on the same page and you have hope and you have a, and you have a path that, that that's what really counts.

Dr. Howard Schubiner: When people are coming to me because,  you know, my explanation is what I consider to be the truth. That there's not the instruction when that's the case, when there's nothing structurally wrong and that's the brand doing it to me, that's from my point of view, it's the best, best path because it doesn't require somebody else to treat you and you treat yourself number one.

Number two it's it's cheap and inexpensive. You're not getting long treatments and expensive treatments for the most part.  and still self-efficacy in the person that they can take care of it. And then over time as. [00:35:00] When which is often the case new psychophysiologic or psychogenic problems occurred because they're still human.

They have the tools to deal with them. So when I see somebody who had an acupuncture treatment, then their symptoms completely resolve. They say, Oh good. Now we know what your brain is. Acupuncture actually works on the brain. When you get,   nerve symptoms completely go away. When you get a shocker adjustment symptoms completely go away from my point of view, as, as a medical scientist, I'm saying, instead of saying, Oh wow, that's a good thing.

You got your cheek corrected. I'm saying, no, that was a great mind body therapy or a great placebo therapy. However you want to think of it because all those four characteristics were in place. And. Symptoms went away. Cause we're looking for helping people eliminate their symptoms rather than simply cope with them.

Tim Norton: And, and I have a feeling that a few hundred years ago, the, the way that,  a [00:36:00] doctor or a witch doctor or the way somebody stayed in practice was being really good at that, you know, and saying, okay, this is what you've got to do to get in alignment with the gods that. Are, you know, bestowing these injuries upon you in this pain upon you and because of their status in their community.

It had a really profound effect 

Dr. Howard Schubiner: on people. Oh yeah. Completely. They, if you look at a healing in the native native communities and healing,  you know, across centuries, you find that the,  That the explanations make sense within the context of the community.  it's often delivered by a powerful and respected,  shaman or doctor or whatever.

 there's this famous story of a native American young man in the Pacific [00:37:00] Northwest true story.  and he would see all these. Native healings, shamanistic healings. And he thought it was all a bunch of crap. You know, he thought, Oh, they're just, you know, it's just all Hocus Pocus and for show. So he decided to, to join the training, become an apprentice to be a shaman himself.

So he could expose this. No, this whole thing. So they taught them all the things and the different incantations and the rules and the tricks. And one of the tricks was they used to have this thing where they would. If someone had say abdominal pain, they would put their mouth to this, to the person's stomach and they would suck out the bad humors and they would spit them out and they would spit out all this blood and guts and stuff.

Well, it turned out what they had done prior to putting their mouth on the person's abdomen was put a bunch of junk in their mouth, bite their tongue. So it got bloody. So their own blood was [00:38:00] there. And when they spit it out, you know, there were. Whatever feathers and guts, whatever it was, they put in their mouth was there with blood.

And so it was very, you know, she had a great show. It had a really powerful effect on people. I mean, the bigger, the effect, we know the greater than placebo shots work better than pills. Casinos surgery works better than shots. So, so anyway, so he was ready to do his own healing. And this young Indian princess came with a domino pain.

And she was suffering so much and she was so beautiful and he did the treatment just like he was taught and she, and she got better and he's like, Hey, this is pretty good stuff.

So he never, he didn't expose it. He became, you know, he, he used it because it works. 

Tim Norton: I like that point that you say [00:39:00] surgeries work better than shots. And, and I think about the context of these surgeries, first of all, you know, our, our shamans are these, a lot of men and women and white lab coats and tall, clean, sterile buildings that have.

People admitting you and, you know, upheld by structures and insurance policies and, and waiting rooms. And then you go in there and that's, that's quite a show. And then, and then there's a surgery, there's these instruments, there's,  anesthesia and all of the various things that are going on and other people standing around and assistance.

And, and, and that's that, that, that's, that's a pretty big 

Dr. Howard Schubiner: deal. Yeah, the higher tech, the,  the more elaborate and the higher tech, the intervention, the stronger the placebo effect, the more it costs, the stronger that placebo effect that's been shown pills that are more expensive, have better [00:40:00] effect on pain pills that are less expensive.

 you can get very elaborate treatments,  for back pain where people take your blood and. No, mix it up and centrifuge it, or your bone marrow and injected and people are claiming, you know, you can cure almost anything with that. You can go to Germany for back pain and spend $30,000 on these elaborate treatments.

And you know, the farther you go. And I had a patient who,  Young woman who had horrible pain, horrible fear. And I worked with her and she didn't get better. And I worked with her and she didn't get better. And then the year or so later, she traveled to Brazil. She went into the countryside. She went to the sacred compound of this healer named John of God.

Well, no, [00:41:00] he does workshops in the States here as well. And,  and she,  he had her lie in her back and put her hand over her heart and, and pray and think and meditate or whatever. And miraculously, you know, she got better. So more power to him. 

Tim Norton: Yeah. I think the longer I do this, I try to suss that out in the beginning of treatment, like.

What, what, what treatment they believe in the most generally speaking. So in grad school, I remember reading this study where one of the best indicators as to whether a psychotropic medicine was going to work, like, like an antidepressant or something, was that a person believed he was going to work. And oftentimes, you know, someone will say, do you think I need medication?

And I'll say, look, I'm not a psychiatrist. I can't prescribe you any medication, but I'll just ask you point blank. Do you think it's going to help you? Because that's, that's going to make a really big [00:42:00] difference. And I had somebody 

Dr. Howard Schubiner: just go ahead. I write a prescription for something. I, I tell people how it's going to work and why it's going to work.

And,  you know, how beneficial this will be. And if they ask about the side effects, I'll say, yeah, there can be, there can be these side effects, but they don't occur in, you know, most people don't get them and, but most people do get the benefit. So,  I'm using the placebo effect of the medication to my advantage as must as much as possible.

Yeah. 

Tim Norton: But then we run into, so even when there's the explanation, the technique relationship and hope. If they have some intense underlying stressor or source of anxiety, the symptoms are going to return. 

Dr. Howard Schubiner: Right. That's one of the part of our treatment is to look at their life. Let's see what's going on. Are they in a dangerous situation, a [00:43:00] physically dangerous, emotionally dangerous situation?

Is there some boundaries that you need to set? Is there something they need to do? The other thing is that people who have adverse childhood events who have had abandonment, emotional abuse, physical abuse, sexual abuse, and assault are much more likely to get. These kinds of psychophysiologic disorders.

And sometimes it's necessary to take steps to deal with the traumatic events that are currently going on in their life or have gone in there, on, in their life, in the past. Yeah, 

Tim Norton: definitely. And one of the reasons I wanted you as a guest was I feel like.  a penis not getting hard. And having that having to do with emotions is not even, it is not, not even nearly [00:44:00] as big of a leap as thinking of, you know, like a burning or, or,  an ache that lasts for months and years at a time,  that could be caused by emotions and an avoidance of emotions and compounding fears.

Dr. Howard Schubiner: Or, or simply by this vicious cycle of pain, leading to fear, leading to more pain. Yeah.  it is,  it's from my point of view, it's sad that we've gone on a path where that possibility is rarely recognized in most people with chronic pain. When in fact it's the most common. Cause of chronic pain. And so our medical profession has veered in a direction which is highly technological and I'm not against technology and medicine.

I'm a physician. I value the advances that have been [00:45:00] made in the last 70,  80 years. But we've thrown out our understanding ending of the effects of the mind and the brain on the body. 

Tim Norton: What's what's up with that path. Why, why do we throw out so much when, when we started to get a handle on, on just basically on penicillin and on some of these drugs and 

Dr. Howard Schubiner: surgeries?

Yeah. Well,  So I'm not,  an expert in history of science, but several things have happened. One of course is the rapid rise of technology. So technology becomes so effective for certain things that we feel that it will be effective for all things.  30 40 years ago with the rise of all these antibiotics that we had,  we thought we would cure all infectious diseases and it turned out [00:46:00] that wasn't the case.

 and so there's the tendency to think that technology will solve problems. On the other hand, there's also been a degrading of psychology.  a backlash against Freud and Freudian analysis because some of his theories were a little bit wacko and off the rails. And so people threw out all of his theories, but he was a giant and he had really important things to tell us about the effect of,  the mind on the body.

And so,  so that kind of got thrown out at the same time in psychiatry itself when in a direction of biological psychiatry, thinking that we could solve our psychiatric problems by looking at neurotransmitters and by psychiatric medications. So those three factors, I think, are the ones that I would point to.

[00:47:00] Tim Norton: So what is the shift going to look like? 

Dr. Howard Schubiner: Yeah. I think the shift is, is profound, but in some ways it's extremely simple. I mean, what is, how hard is it to recognize that? For example,  I have,  a friend who, when she was,  a little girl in elementary school, she got,  one day she came in from recess.

And had a note on her desk and it said she looked, she read it and said, we don't like you. You're not like a, something like that just mean girls stuff. She looked at. If she looked around, wasn't clear who sent it. And day after day, she kept getting those kinds of notes. And within a week or two, her mother took her to her pediatrician because she was having stomach pain.

So the pediatrician felt her belly. He didn't order any tests. [00:48:00] He just felt her belly.  realized that I was fine. And he looked at her and he said, honey, is there something bothering

simple and so profound? And she looked at him and said, no, no, not at all. But she knew exactly what it was. So he made the connection for the next day. She go away, have to recess. She took the note. She didn't read it. She dropped it in the trash. And it, she got a couple more notes and she didn't read any of them.

She dropped them in the trash. They stopped coming and her stomach was a profound example of wisdom now, because the wisdom is, is that when you have people who have common syndromes in the absence of. Any,  you know, bleeding or tumors or infections and simple tests don't show anything most commonly it's a psychophysiologic disorder.

And so if we were [00:49:00] recognized those, if people would recognize them in their own lives, families would recognize them. If that was part of our culture, if it was part of our medical culture and our medical diagnosis, it's really not that hard. The big shift would have to occur in. In doing less invasive procedures for chronic pain.

Tim Norton: And that's really gotten out of hand. 

Dr. Howard Schubiner: The cost of chronic pain to our society is more than the cost of cancer, diabetes, and heart disease. Combined currently

is huge. No we're spending billions and billions less estimated $60 billion a year on chronic pain. 

Tim Norton: And is the majority of that like back surgeries or is it a lot of costly meds or, 

Dr. Howard Schubiner:  it's around 10 to $20 billion in back surgeries. [00:50:00] And. And roughly $10 billion in injections. I figured these out, roughly these are rough estimates.

Don't hold me to the number.  you know, there's less money in opiates, but more deaths. Right. And those are more suffering and more addiction. Yeah. 

Tim Norton: Yeah. It's, it's, it's staggering. And I find it sometimes pretty frustrating when you. See advertisements or people talking about those kinds of things. When we've seen so many people recover from, from, from mind, body techniques, from, from facing fears and processing emotions and reducing anxiety 

Dr. Howard Schubiner: and the effects of our mind body techniques will only get better over time.

As more people recognize these disorders. [00:51:00] Recognizing how common they are recognizing them earlier and people having support for, or using these types of therapies from their friends and family, as opposed to now, oftentimes someone will say, Hey, I read this book about this kind of mind, body connection.

And I think that's the cause of my pelvic pain in my back pain, my headache. And then there. Their siblings or their parents or their children say, are you kidding? You know, that's ridiculous. You know, go see a real doctor. 

Tim Norton: Right, right. And there's no support, but even that step, have you learned a trick along the way where when somebody's talking about something that sounds like psychogenic pain to offer.

Your ideas. I, I've kind of learned the hard way that unless they come to me because they've heard about what I do or [00:52:00] what I'm talking about or what I know that they don't, people don't respond really very well to it. 

Dr. Howard Schubiner: Yeah. People can be very defensive because of the same problem of feeling. It's majority of peoples.

Assuming that their pain is not real. They're not validated. So yeah, the first thing that you always want to do is to validate their pain is to empathize with them, is to see, make them know that you know, that their pain is real and that they are truly suffering. So you have to do that right up front and then.

 you can ask what they've all done and what path they've been on, because oftentimes they've been to doctors and they've tried a whole variety of things that haven't worked. And then you can begin to ask about what it's like. And so I've got a whole method and that I've written about in my books about how to accurately more accurately [00:53:00] diagnose this condition.

 so the medical testing is negative. First of all, second of all, that the characteristics of the pain or the symptoms fit into a psychophysiologic pattern. For example, they may turn on and turn up. That's typical of a neurocircuit problem. You mean better in the morning and worse in the afternoon, or are they're triggered by Somner they're lighter.

Something that suggests that it's triggering the brain. There's a whole variety of those things that we look for. And so that gives us more clues that it is a psychophysiologic or a psychogenic disorder.  and then we're looking at kind of the circumstantial evidence. Did it start at a time of great stress?

Do they have adverse childhood events?  is it worse with stressful situations? Have they had other psychophysiologic disorders at different points in their life when you put all that together. [00:54:00] And then at some point you have to say, well know, I know how much suffering you've had, and I know that you're not crazy.

I know this isn't all like in your head, but it turns out that many people, including myself have had symptoms like this that are caused by a neurocircuit. And you might be interested in reading about them. We're looking into that. 

Tim Norton: Hmm. I like the neural circuit term, as opposed to saying, you know, this might be caused by a by repressed emotion, 

Dr. Howard Schubiner: right.

It takes the psychology part out of it. Right. Neurological type. Of disorder. We've talked in our community of doctors and psychologists and social workers and physical therapists work in this vein. We've talked a lot about that and, and we are coming and be like the sobriety of terms from you is [00:55:00] neuropathway disorder and neurocircuits disorder, physiologic disorder, psychophysiologic disorder,  neuroplastic disorder, neuroplastic pain disorder, et cetera.

Tim Norton: Yeah, those are good, because like we were saying at the beginning, literally everything happens in your head, in your brain. Do you? Can't see, you can't hear you. You can't breathe. If, if there's something wrong with your brain and your brain processes, why you don't even know you're in reality without. The use of your brain and we, we might not, we might not be in reality, right.

We might all be a part of a computer that's just tapped into our brains. But that, that is, it's a moot. It's a, it's a meaningless statement. You're it's all in your head. Yes. So our ability to have this conversation is taking place 

Dr. Howard Schubiner: somewhere in our head. We there's been a tremendous amount of advances in neuroscience and neuroscience of consciousness.

 And also the neuroscience of how our brain [00:56:00] controls our body. It turns out that we don't see with our eyes, we see with our visual cortex in the brain, and basically we see what our brain expects to see. We hear what our brain expects to hear. We feel what our brain expects to feel. So these are all neural circuits and the neuro and the neuroscience term that people are using for this is predictive coding.

The brain codes for what it predicts will happen. If you expect to have pain every time you bend over. And this is not a conscious expectation, it can be of course, but it's really a subconscious, that's a brain expectation and a coding and neural circuit of having pain. When you bend over every time you bend over your brain is actually turning on pain and it's up to us to recognize what's going on and change that pathway.

Tim Norton: And we might be expecting to not get an erection or expecting to lose an erection. 

[00:57:00] Dr. Howard Schubiner: Exactly. It's a very powerful thing. And research has shown that,  you know, that expectation effect has powerful physiologic effects on the body.  people who were told that they, if you take people who are given a, a smoothie to drink, And you'd tell half of them, it's a high calorie smoothie and the other half, it's a low calorie smoothie, even though the smoothies are all the same.

The people who got the high calorie smoothie have,  their brain turns on secretion of the hormone Greenland, which is produced when you're, , when you've had enough to eat. So you think you're eating, you think you've had enough to eat your brain response by turning on the hormone, which says, yeah, you've had enough to eat.

That's pretty amazing study. 

Tim Norton: That is amazing. And, and you mentioned sight and hearing, I've heard some amazing studies with, with that as well [00:58:00] with, with seeing things that we are expecting to see or not seeing things that we're not expecting 

Dr. Howard Schubiner: to see exactly. There's the famous one with the gorilla where 

Tim Norton: the, where everybody sees an intro to psych where they're passing the basketball to one another and a gorilla walks right through.

This group of people passing. I remember I watched that in a, probably 300 person auditorium at USC in intro to psych. And then they asked us to, you know, everybody had to raise their hand and say, did you guys see a gorilla? You know, 

Dr. Howard Schubiner: maybe 

Tim Norton: 30 or 40 people raise their hand. And, and I was not one of them. I was like, there was no gorilla.

Then they show the video again. And there's, 

Dr. Howard Schubiner: there's a gorilla. What am I, the story I like to tell about that. My wife every morning has the exact same breakfast, sliced Apple, granola, yogurt. And,  so that's what she has. And one morning,  she was up early and I was still in bed and [00:59:00] our room was dark and she had an extra slice of Apple and she came up to the bedroom.

It was all dark. She took the Apple and she, she just fed it to me. Basically. I opened my mouth and I bit down on it. And my immediate and powerful reaction was disgust. This tasted horrible. It turned out it was a peach,  and, but it was a good peach. It was not a rotten peach and it turns out my favorite fruit is peach.

Wow. What my brain was expecting a crunchy Apple, and I got a soft. Sweet pea sweet sensation, but I didn't taste it as sweet at all. I tasted it as disgusting as rotten. My brain turned on the sensation for discussed and, and,  and,  you know, rotten sensation in the mouth purely because of expectation.

And that's, that's amazing that that could have is so powerful. 

[01:00:00] Tim Norton: That is amazing. Did you read the,  Lisa Feldman Barrett book about emotions? And she talks about her. Twelve-year-old having a sleepover party and they, they put lemonade in a catheter or something like that. And everybody was just so grossed out thinking that they were drinking pee and yeah, it's our brains.

Do those things in so many ways. 

Dr. Howard Schubiner: I mean, I, you know, I mean, you're a police officer. No, you get called to a park, you get called to a scene of something you're on a chase and you know, you get there and what do you see? Well, you see what your program to see what you expect to see what you're afraid of seeing.

And, you know, sometimes police officer in the situation where they shoot innocent people or kids even,  because their brain is registering something that is not really, they're really scary. 

[01:01:00] Tim Norton: That is really scary. So what are you, what, what,  what are you working on at the moment? What are what's what's in the works for Dr.

Schubert? 

Dr. Howard Schubiner: Well,  you know, we've written,  written a couple books for patients. We have a new book for professionals called hidden from view by,  with the Dr. Allen. They have this fantastic and wonderful psychiatrist from Halifax.  we. We recently last year we published a, the first study to show that,  one psycholog, psychological intervention for pain is actually superior to another.

And that was the case where we compared in emotional expression intervention that we devised to the standard cognitive behavioral therapy intervention for people with fibromyalgia pain were. We're working on a back pain study,  at the university of Colorado in Boulder. [01:02:00] And we've randomized people to getting the mind body intervention versus a placebo injection or a treatment as usual.

And all those patients are getting functional MRI of the brain pre and post the intervention. And those results will be coming up this year. Hopefully. So,  we're doing research, we're teaching a lot of people. We were teaching seminars for physicians, nurses, psychologists, social workers, physical therapists, health coaches,  all over the country.

So, you know, trying to make this. Paradigm shifts,  happen sooner or later. Yeah. 

Tim Norton: And you're, you're doing really great work and really inspirational work.  I'm realizing that I haven't done the best job of, of, of making the analogies between a lot of what you're saying to the erectile issues. And even as [01:03:00] you were talking about,  that last process of assessment.

 it, it sounded like all of that stuff could, could really apply, you know, like you, you get erections when you're alone, when you don't get them when you're with other people. And,  there was an experience that, that,  where this started happening and it's been happening ever since. And I was just wondering if, you know, with that in mind, if you had one piece of advice to tell clients out there with erectile issues and one, one, one nugget that you could leave them with, what would that be?

Dr. Howard Schubiner:  for the most part,  assuming that again, there's no major vascular and neurologic issue,  which is the vast majority of people with erectile dysfunction situation.  the best advice is to recognize that you're not damaged, that you're perfectly normal and try to be in the moment [01:04:00] and,  Try to enjoy what you're doing sexually, as opposed to worrying about what you can't do, what, what might happen, what could happen.

And those thoughts will come up, but you have to just keep going back to the back to the moment where you can hopefully be as,  As engaged as possible and, and what's important and what you're doing and then yourself and then the other person, not so much out of your head. And then the other person is probably the best piece of advice, really?

Because if you're all in your own head, so to speak, your brain is going to get in the way, right. 

Tim Norton: It really is going to get in 

Dr. Howard Schubiner: the way. All right, 

Tim Norton: Dr. Schubert. Well, thank you so much for your time and for this interview. I, I think if there was, there's been a lot of really helpful information and, and thank you so much for the work that you do.

You're really a pioneer out there, and then you're doing good [01:05:00] stuff. 

Dr. Howard Schubiner: It's a pleasure, Tim. I really appreciate being here. 

Tim Norton: One thing I wanted to ask you is how can people find you on the internet and out in the world? 

Dr. Howard Schubiner: My website is unlearn your pain.com. Unlearn your pain.com. So that's really the best way to find me.

 people can friend me on Facebook or, or,  on Twitter. But,  through my website and my email's available there. 

Tim Norton: Okay. Good. All right. Well, have a, have a wonderful rest of your day and weekend 

Dr. Howard Schubiner: then I'll, I'll see you around take care. Bye-bye

Tim Norton: Shout outs to the sex positive community, including sex educators, sex therapists, sex coaches, and other fellow sexual podcasters, sex surrogates, academics, sexual health, medical community, sex workers, the tantric community, and everybody else involved with having hard conversations. Bye-bye.

If This Episode Resonated

If this episode spoke to you, there is a path forward.

Tim Norton provides a discreet, evidence-based therapeutic space where men and couples can understand the deeper systems behind desire, arousal, and connection. His work combines rigorous neuroscience with a grounded, relational approach to help clients rebuild aliveness in their bodies, strengthen partnership, and create lasting change.

Pelvic Pain and No Hope? What You Actually Need to Know

Episode Overview

Pelvic pain is one of the most misunderstood and misdiagnosed contributors to erectile difficulties. In this episode, Tim speaks with internationally renowned pelvic floor physical therapist Stephanie Prendergast, cofounder of the Pelvic Health and Rehabilitation Center, whose work has transformed how clinicians understand male pelvic pain.

Key Themes

• How pelvic pain can directly disrupt erectile function

• The differences between performance issues and pain-driven dysfunction

• Why the pelvic floor becomes tight, guarded, or overactive

• Practical at-home strategies to reduce pelvic tension

• How pelvic floor PT actually works (and what good care looks like)

• The role of breathing, awareness, and interoception

• Why sexual shame worsens pelvic pain

• When to seek an interdisciplinary team

• Hope for men with chronic pelvic pain and ED

Listen to the Episode

Listen Now

Stephanie Prendergast, MPT

Stephanie Prendergast, MPT, is a globally recognised pelvic floor physical therapist and cofounder of the Pelvic Health and Rehabilitation Center, with nine locations across the United States. She specialises in complex pelvic pain disorders — including pudendal neuralgia, chronic pelvic pain syndrome, vulvodynia, interstitial cystitis, and male pelvic pain.

Stephanie was the first physical therapist to serve as President of the International Pelvic Pain Society, is coauthor of Pelvic Pain Explained, and teaches internationally. Her clinical work is known for its interdisciplinary precision, patient advocacy, and world-leading expertise in pelvic floor rehabilitation.

Website: https://pelvicpainrehab.com/

Book: Pelvic Pain Explained. https://bookshop.org

Episode Transcript

Tim Norton: Welcome to Hard Conversations. My next guest I'm very excited about - Stephanie Prendergast is a pelvic floor, physical therapist and the co-founder and co-owner of the pelvic health and rehabilitate patient center. The largest multicenter clinic in the United States dedicated solely to the management of pelvic floor disorders, helping women, men, children, transgender, and gender non-conforming persons optimize their pelvic health.

Stephanie was elected to the international pelvic pain society's board of directors in [00:01:00] 2002. And in 2013, she was the first physical therapist to be president of the society. In 2013 and 2015, she served on the program committee of the world, Congress of abdominal and pelvic pain, and 2017 served as the scientific program chair, bringing the world Congress to the United States.

She's authored numerous publications in peer reviewed journals and textbooks and regularly lectures at medical conferences and in the community on pelvic health related topics. She is an advocate for people with pelvic pain, pelvic floor, physical therapists, and the field of pelvic health. She is a coauthor of the popular book.

Pelvic pain explained in 2016. PHRC publishes an award-winning blog as the pelvis turns every Thursday. Thank you, Stephanie, for joining me. Thank you very much.  what is CPPs? What does that even [00:02:00] stand for? And what's the difference between CPPs prostatitis about pelvic floor disorder. 

Stephanie Prendergast: Coming out hard.

Let's get into it. CPPs stands for chronic pelvic pain syndrome,  which is a term that I don't necessarily enjoy because it implies that this is a problem. That's chronic meaning it's going to be with a person for the long haul.  what it refers to is a musculoskeletal condition where the pelvic floor muscles become hypertonic.

Okay. And can cause symptoms of urinary urgency, frequency, penile pain, Squirtle pain, perinatal, or anal pain posted dilatory symptoms and erectile dysfunction in men. Okay. So it is different than prostatitis in that those terms were overlapping only used interchangeably and incorrectly for a period of time.

The term prostatitis implies that there's inflammation and [00:03:00] infection of the prostate, and while the symptoms of an actual prostate infection mimic. The ones I just described. It actually happens in the absence of infection. So commonly men with these symptoms are often misdiagnosed with prostatitis and being prescribed antibiotics.

When in fact it's actually a musculoskel disorder. 

Tim Norton: Okay. And that's, prostatitis now. What's pelvic floor 

Stephanie Prendergast: disorder. So the pelvic your muscles run from the pubic bone to the tailbone. Most people think of them in terms of childbirth and in women and have do your kegels, but obviously men have pelvic floors too.

So it's responsible for helping with urinary function, sexual function and bowel function. And once things become dysfunctional, as we just mentioned with CPPs, then you can have a whole host of symptoms in any of those areas. The muscles are very important to support our organs and to help keep our body functioning normally.

Okay. 

[00:04:00] Tim Norton: So let's, let's talk about those symptoms because I suppose I should mention that in therapy I'll occasionally see somebody who's been diagnosed with any of these things and the symptoms that I hear. Are burning numbness, dripping, leaking, painful urination, painful ejaculation, tingling, aches, and, and then the state of being hard flacid.

So which, which symptoms correspond to which, or how do, can we even delineate 

Stephanie Prendergast: that way? So CPPs encompasses all of what you just said. So it's this really broad umbrella term that is. F it's defining a syndrome more than a specific disease. And that's important to make a note of that. This is a cluster of symptoms that can manifest with some of the symptoms you just mentioned, or unfortunately, in some cases, all of them.

And so the symptoms can range from dollar achy to severe stabbing shooting, debilitating [00:05:00] pain. 

Tim Norton: Wow. And there's a difference between something that is a functional problem versus a pain 

Stephanie Prendergast: problem. Correct. So functional problems often precede the pain issues. So men may start to notice all of a sudden.

There urinary stream is a little bit different, or if they try to start their stream, they may have hesitancy where they didn't before they may notice their stream diverts to one side or the other, they could have terrible evacuating stool.  and then sometimes as that goes on long enough on checked, then it can proceed into a pain issue where then they start to develop pain again in the penis, paranoia marinas as well.

Okay. 

Tim Norton: And yeah, I love 'em. The formality of the language evacuating,

so pooping trouble pooping.  but, but I [00:06:00] suppose that in that situation where we're talking about these very intimate areas, that it helps to stay very formal and, and clinical. And unmedical about all of these things. Cause it's it, not many people get to see guys in that state. 

Stephanie Prendergast: We have different language, for sure.

Tim Norton: Yeah. And so tell, tell me about that state. Tell me,  when somebody comes in and they they're. They're trying to figure out what what's wrong. Why, you know, why do I have this burning? Or why w what's wrong with my poop?  what do they actually go through? So 

Stephanie Prendergast: it's unfortunate because most men have been through at least five to seven providers before they typically get into our office and actually understand what's wrong, which can come with a fair amount of trauma, because people are saying, you just need to take this antibiotic, or there's actually nothing wrong with you.

When in fact they don't feel like anything is normal. So by the time sometimes they get to our office, they are extremely distressed. And at least the first day, [00:07:00] hopefully we can do is normalize their symptoms and they are not alone. These symptoms affect one in 10 men.  symptoms start as early as the twenties and thirties, they can progress into the forties and fifties and sixties as well.

But there's a whole host of issues that can affect men from the time they're 20 til the time they're 70. And it just isn't. As talked about in the mainstream as female pelvic health issues, 

Tim Norton: one in 

Stephanie Prendergast: 10 men, one in 10 men studies have shown have the symptoms of CPPs. Wow. 

Tim Norton: You know, if you think of something like schizophrenia effects about.

1% of the population, maybe two, maybe, maybe, you know, depending on how you count it. This is five to 10 times more common than that yet until I started to get into this work, I never had heard of that. And I still, I think I told you one of the times where I was talking to you about this, that I met a nurse who dealt with female [00:08:00] pelvic pain.

I think she worked in a, in a urologist office and didn't know men had this. So it's really just really not talked about much. 

Stephanie Prendergast: It, it hasn't been in the past. So it's great that you're doing podcasts like this to help get them information out there because men may be listening to this and thinking, Oh, I I've noticed that I have these symptoms.

And in a lot of people, it can be a very insidious onset. So as I mentioned, you may start to notice it's hard to start the urinary stream, or you notice you have a little bit of post-void dribble. There's another word, another medical term, like you're still dribbling a little after you urinate.  and then all of a sudden, you start to notice, you may have tingling at the tip of your penis after you ejaculate or something, more significant.

And men, a lot of times, some of these things can be triggered and exacerbated by things like exercise such as cycling or certain workouts. So they may notice that after they go to the gym, they have trouble with urination, but if they don't go to the gym, they. They don't have those issues. So [00:09:00] it's starting to show that there is a functional problem.

That's tied to their musculoskeletal health. That's creating these symptoms. So 

Tim Norton: another word that I've heard thrown around or no, let me back up. So what I was asking. What's it like when they get to your 

Stephanie Prendergast: clinic. So Wednesday arrive at our clinic. We will go through a comprehensive history to understand how the symptoms started.

And a lot of times we may be asking questions that they may not even realize are tied to their symptoms.  a lot of times people do think it's an infection or an STD. So once they've been cleared for that, It usually is left in the musculoskeletal department. After we go through the history and answer any questions that they may have is the physical examination.

At that point in time, we will examine the muscles connective tissue and joints, basically between the ribs and the knees. Depending on the etiology and also do an internal pelvic floor exam, which has done transiently. At that point, we are checking for motor control. Can people can track [00:10:00] their muscles.

Can they relax their muscles? We're looking for pain, tenderness, nerve sensitivity. Yeah. As well as just overall function of the pelvic floor. That's the passive part. If there is a biomechanical cause for people's symptoms, which is often the case with male pelvic pain, then we also need to see how they're moving.

What happens during various movements, during various exercises, things that will normally provoke their symptoms. Okay. 

Tim Norton: And let's, let's get into some of that. There's a limitation for this being a podcast and we can't. Show people a diagram of that area, but can you describe, like, let's say a listener at home is going to try to figure out their pelvic floor and where everything is.

Can you give us the geography of, of, of these areas? 

Stephanie Prendergast: So a simple thing that people can do is when you cough, [00:11:00] reflexively your pelvic floor muscles contract, otherwise you would leak urine you. And if you think about trying to pay attention to the area between the scrotum and the anus, when you cough, you may feel that.

 so those are the muscles that do compromise. I heard that our pelvic floor, 

Tim Norton: okay. Right there that, that. It should be, what should it do when you cough? 

Stephanie Prendergast: When you cough, you should feel a small contraction. Okay. And when you orgasm, that's a rapid muscle contraction, which is also a pelvic floor muscle function in the, in the 

Tim Norton: same 

Stephanie Prendergast: area, same area.

Okay, great bowel movement. You're relaxing your pelvic floor muscles. So that's the opposite of the cough. Everything has to relax to be able to evacuate stool. Okay. You never think about it. Cause I never do. 

Tim Norton: And the other day somebody told me, you know, We were talking about relating their anxiety to these issues.

And so, and she said the moment she had some breakthrough about one of the major sources [00:12:00] of her anxiety, that the moment that she had that realization, her pelvic floor relaxed. And I thought, how do you know, how do you tell? But, but, okay. So it's kind of like having just avoided stool. 

Stephanie Prendergast: Right? Okay. But if you just, like you mentioned, if you don't think about it, These muscles are going to function on their own, right?

And that is what makes them different than other parts of the body. You couldn't make a fist without voluntarily thinking to do so, but your pelvic floor always maintained some tone, cause it's a little bit different than every other skeletal muscle in your body, because it has some autonomic function.

It's the same thing. As your diaphragm, you can choose to breathe and you can choose to breathe faster or to hold your breath. Just like you can choose to squeeze your pelvic floor. Or relax it, or if you don't think about it, it's going to do what it normally needs to do without your consciousness. 

Tim Norton: Hmm.

Okay. And so. You're examining somebody from the knees to the ribs, [00:13:00]  where, and, and who are these people 

Stephanie Prendergast: and what are we doing exactly what you're doing? Yeah. Passive part of the exam is palpation and we are literally touching each of the muscles that attach to the pelvic girdle, the connective tissue, as well as.

Peripheral nerves looking for tenderness pain. If the muscles can contract, if people can control them. And the same thing happens internally. So the first part of the exam, people are laying on the table. And that may be the first few appointments, especially if they have pelvic pain until we can do the manual therapy, which kind of mirrors the evaluation to help the muscles get back down to normal tone.

Okay. 

Tim Norton: And then as you said, manual evaluation, you gestured. So can you describe the manual evaluation? 

Stephanie Prendergast:  I guess you could think, I mean, it's hard, it's not as general as a massage, but it looks somewhat similar to that in terms of evaluation and [00:14:00] treatment. Okay. Okay. 

Tim Norton: And so how invasive is it? 

Stephanie Prendergast: In my world.

I don't think it's invasive as all, but in other people who may not be used to a physical therapist using a gloved finger to examine the muscles of the pelvic floor through the anus that may be considered invasive.  but that's what's, but that's how we have to get their 

Tim Norton: finger lubricant 

Stephanie Prendergast: lubricant one finger, right.

While people are lying down. So it's different than a prostate exam where. Men envisioned bending over the table, turn your head and cough. That's not what we do. Right, 

Tim Norton: right. Cause you're not even necessarily getting to the prostate. 

Stephanie Prendergast: We can access the prostate, but it's not necessary for the evaluation that we're doing.

 we were examining the muscles, which actually surround the prostate. 

Tim Norton: Okay. And I have heard of this thing called a wand used and. Treatment. Do you use a wand? 

Stephanie Prendergast: Not really. [00:15:00] Okay. So a wand is a therapeutic tool that people can use at home for therapy to try to mirror what may go on in pelvic floor, physical therapy.

I have very mixed feelings about them. I find it's difficult for patients to actually use them on their selves in a way that's effective. I would rather have them spend their time at home, doing something that we know is going to help there. Problems such as meditation or things like that. Whereas using a wand is I think rather difficult to access some muscles and successfully treat them.

Tim Norton: I feel like I've heard of, of a wand gone wrong story or two that you can hurt 

Stephanie Prendergast: yourself. The anus is a vacuum too. People need to know that. So if they're using something that isn't long enough in length, yes, we've had. It bet stories where people have. Accidentally sucked up the wand and has needed surgery to get it back out.

 and also [00:16:00] people can press on structures that are sensitive, that you shouldn't be pressing on with a wand. And I feel like the lay person really has a hard time telling the difference even with instruction. 

Tim Norton: Okay. So you use at your own discretion using 

Stephanie Prendergast: your own discretion or maybe just don't use.

Okay. 

Tim Norton:  I've heard of well. Okay. And the other question that I had was pelvic floor therapists. What kind of training do they have? And, and, you know, what's their background, pelvic 

Stephanie Prendergast: floor, physical therapists have their physical therapy degrees. They are state and. Federal certifications,  beyond that it gets a little dicey.

So there's a varied amount of educational experience between pelvic floor PTs, typically, because this is not yet taught in graduate schools. It's all post-graduate education. Which means that the person people may be going to see for pelvic floor PT has really sought out additional advanced [00:17:00] training on their own to be able to treat this patient population.

And that can come. There's really no standard of care at this point in time, because it's a fairly new field. So there can be a range of experience among providers. 

Tim Norton: Okay. And you guys train. 

Stephanie Prendergast: Yes. So we, I mean, as a company, all we do is pelvic health. So we obviously train our employees and we teach classes to other pelvic floor, physical therapist to be able to do the same thing.

Tim Norton: Okay. And I. Do you feel like the, so we didn't say this. This is mine and seventies. Second, take this interview. I had my first hard conversations and possible conversation. I had a major technical malfunction, but the last time that we talked about this, we, we somehow stumbled upon the fact that it's difficult to train this.

Cause there aren't that many men in the field and they're practicing on each other.  

[00:18:00] Stephanie Prendergast: so the training that pelvic floor PTs undergo is in, as I mentioned, postgraduate classes. So what that consists of is a two to three-day course where they usually have to travel and learn the didactic information, but also there's a lab portion where.

People practice on one another. And there's very few men as providers that are in this field, which means often women are trained by practicing on other women, which is clearly not the same thing, which is why I'm glad this podcast is happening because a lot of men may not have access to people who can help them.

And it really does requires specific training to be able to do so. Right. And 

Tim Norton: so. In those classes, weren't you saying that they'll actually hire not actors, but people to come in to be subjects for that 

Stephanie Prendergast: training? They actually do not in most cases. And I think they need to, because as a female physical therapist, who's about to treat this patient population.

It's very [00:19:00] difficult to take. Book knowledge and then translated into the clinic and know what you're doing with manual therapy and treatment plan progressions and those types of things. 

Tim Norton: Yeah, definitely. Yeah. You would, you would want to know. I mean, you're asking the question. So how many, how many men's butts have your fingers actually been 

Stephanie Prendergast: in mine?

A lot, 18 years of a lie, 10 years out, I actually was trained by a urologist on. Actual male patients. So my experience was quite different than, 

Tim Norton: okay. So. Another word that I've heard thrown in the gamut is pudendal neuralgia. Where does that fit into all of this 

Stephanie Prendergast: carpal tunnel of the button? Penis. Okay. So that basically means tingling, shooting, stabbing pains, just like you think of in carpal tunnel of the wrist, but that can occur again in all the territory of the pudendal nerve, which is.

The penis, the parent IOM and the anus, the majority of the pelvic floor muscles, part of [00:20:00] the urethra and part of the rect 

Tim Norton: I guess you just have to go to you to keep all of these things straight. 

Stephanie Prendergast: Well, if you notice that you have those symptoms, I think men primarily go to the urologist first. If they're not familiar with the diagnosis, I would seek a second opinion.

I can provide resources for medical providers across the country who are, are trained.  but I don't. Want patients to feel discouraged if their doctor doesn't actually understand what's wrong with them at first, because it is. Physical therapists need specialized training in this. So do physicians, right?

And unless they're seeking this information out on their own, they're probably not exposed to these syndromes or the fact that they can even happen. So it's pretty easy to diagnose the clinical symptoms are what we just said.  there's no further diagnostic testing that can confirm or refute that that's a problem it's completely based on symptoms.

Yeah. And that 

Tim Norton: that's a challenging factor as well. And I got to imagine there are other. Diagnoses that [00:21:00] trickle into this, this diagnosing process. 

Stephanie Prendergast: So CPPs technically encompasses pudendal neuralgia and pudendal neuralgia. Encompasses CPPs, which again is chronic pelvic pain syndrome. It overlaps with what's called prostatitis and basically they'll umbrella male, pelvic pain.

Okay. But 

Tim Norton: are there other disorders that are thrown out there? Other names of other disorders that you're hearing that other urologists have? 

Stephanie Prendergast: Sometimes they will say interstitial cystitis, which is technically a. What was originally thought to be a bladder syndrome, but we now know that bladder is the victim, not the cause in overlapping musculoskeletal condition.

Tim Norton: Okay. And interstitial cystitis for all of those of you Googling all these things out there or just, I see I'm among friends.  so. Let's let's segue into sex here. So how does C [00:22:00] PPS affect sex? 

Stephanie Prendergast: So it's, it's unfortunate. Cause one of the primary symptoms of, of CPPs can be posted Jackie dilatory pain, erectile dysfunction, just genital pain in general.

And when people have pain, it can affect desire obviously, but also if. What it's supposed to be pleasurable is associated with pain. It's very difficult for our male patients and they're just uncomfortable and they're upset and they're stressed about it. Understandably. 

Tim Norton: Yeah. And then they come in and they talk to you about their sex 

Stephanie Prendergast: lives, right.

And often relieved that their partner isn't having an affair as unfortunately, men may think because it feels like an STD and it's not. Yeah, 

Tim Norton: as I suppose we should say that there's a, there's a good chance that it's not an STD guys or not an STI. So,  get this checked out or you get tested for the STI first and then when that's ruled out, you're, you're really in this territory.

So. You mentioned erectile [00:23:00] dysfunction. And for those of you who listened to every single episode and, and memorize my words,  I'm, I'm pretty careful about when I say erectile dysfunction. And when I'm talking about erectile issues, because we don't want to call. Like anxiety, a dysfunction, because if you essentially, if your body's in a state of fear, it's not as functioning.

It shouldn't be hard. Your peanut shouldn't be hard, but we're actually talking about something that's physically wrong. And so I would put that under the umbrella of dysfunction. So what exactly is happening to your pelvic floor? That, that makes it so that the penis isn't retaining blood? 

Stephanie Prendergast: And I think you did bring up a good point too, about the words and the language.

Like, it's easy for me to say erectile dysfunction, but I think it'd be better to say transient erectile changes. Just like I don't like chronic pelvic pain. It should be persisting right now because I don't want people to feel limited that this is stuck with them for a long time. But what transient 

Tim Norton: erectile 

Stephanie Prendergast: change?

[00:24:00] Changes and 

Tim Norton: erectile issues or issues.  what's the best,  acronym, T a S T 

Stephanie Prendergast: a Thai. I just want people to know it's a, it's a transient thing like this, just as quickly as it showed up, it can also be treated. And that's where I think people are. They're just not informed enough with what you read online.

This looks like a pretty. Dim situation. But as we mentioned, the pelvic floor muscles are responsible for orgasm function. And as we discussed last time, they're also responsible for maintaining interaction. So they help to close the blood vessels to keep blood in the penis during erectile function. And if the muscles are too tight to effectively do that, which happens in pain syndromes.

Or if they're weak, which can happen in older gentlemen after things like prostatectomy surgeries, thinking of the whole gamut here,  it's going to be a challenge to maintain the erection that isn't just the vasodilation factor and things that people think of when they take Viagra [00:25:00] and Cialis. Right.

Tim Norton: So if they're they're too tight, Then blood's not going to get there and then get in there in the first place 

Stephanie Prendergast: where it's harder for the muscles to effectively contract to keep those vessels closed. It's like trying to clench your fist when you're already in a tight fisted position, you can't go any further.

So they're just not functioning efficiently as they 

Tim Norton: could. Okay. Yeah. And you can help with that. 

Stephanie Prendergast: And we can help with that. So we we'll examine if the muscles are too tight, which again is usually the case in pelvic pain, syndromes manually lengthened the muscles through weekly physical therapy sessions.

Typically eight to 12 visits is standard for shorter term duration problems, and then teaching the patients how to actually regain control of the muscles themselves to maintain what we did in the clinic. Okay on the latter end of the spectrum. If they have weakness or issues [00:26:00] following prostatectomy procedures, and it's the opposite, we're actually teaching them how to strengthen and again, teaching them control.

But the treatment is exactly the opposite. We're trying to up train everything. 

Tim Norton: Okay. And that's, that's a huge 

Stephanie Prendergast: difference. Huge difference. It's important to know the difference as well. Yeah. 

Tim Norton: Is there another. Version of a cough test that they could do at home right now to have an idea. If it's, if it's strengthening or relaxing, 

Stephanie Prendergast: if, if men try to squeeze their muscles or hold back gas, if you will, and you feel like you actually can't do that, you might be weak.

Tim Norton: Okay. Oh, okay. So if you can't hold it in your fart, then you've got, you might have,  some,  condition that. Could improve 

Stephanie Prendergast: treatment and in the later decades of life, and especially after prostatectomy, pelvic floor dysfunction affects about 80 to 90% of men. Okay. Okay. 

Tim Norton: Did you work on those with older gentlemen as well?

And can they [00:27:00] see improvement? 

Stephanie Prendergast: Yeah. So research has actually shown that if you are undergoing a prostatectomy surgery, men have less chance of stress incontinence and erectile dysfunction. If you go through pelvic floor physical therapy before and after. So I think a lot of people aren't prepared for.

Exactly what I just said, stress incontinence, leaking urine and erectile dysfunction. And as people live longer and the age where these surgeries are happening remains the same, people want to preserve their sexual function. So it is an easy, low risk thing that should be part of every man's treatment plan.

And it isn't always, which still surprises me now. Right. 

Tim Norton: And then as you mentioned earlier, Viagra, isn't going to fix this situation. Even an older man. If the blood has no way of holding itself in, or being held in, then the bagger can't help. Correct. Okay. So yeah, that is surprising. What 

Stephanie Prendergast: about you surgeries, knee [00:28:00] surgeries.

You have to do physical therapy afterwards. Think of how much more complicated that pelvis is. Like the fact this isn't integrated into some of these things really does surprise me at this point in time. 

Tim Norton: Did I hear. At one of your lectures on all these issues and women that there are countries that mandate physical therapy before and after pregnancy.

Yes. 

Stephanie Prendergast: Yes, absolutely. And I prostatectomy as well, but our insurance system runs a little bit differently here in America and 

Tim Norton: as well. Yes. Do 

Stephanie Prendergast: you remember which countries?  mostly all of them that have socialized medicine because the rate, the cost of people continuing to go to the doctor and continuing to need another surgery or another procedure.

Far exceeds the amount of pelvic floor physical therapy. So if you think about it that way, it actually lowers costs in these other countries where medicine is socialized. Whereas in the United States, it's almost viewed by insurance companies as one more [00:29:00] thing they don't want to pay for. So it's a little bit of a political situation 

Tim Norton: there.

Then yeah, that could be a whole other conversation about the medical. Yeah, don't get me started. Okay. That physical therapy has actually taken place. What are, what are guys telling you about how their sex lives have changed? They're 

Stephanie Prendergast: actually quite happy with a few visits and learning how to control their muscles and regained function.

There can be quite a dramatic change, especially for example, if you're leaking urine, you may not want to leave the house. You may feel socially isolated. And again, these aren't. And these people are in their fifties and sixties. This is a problem that this is happening at this point in their life. And that they can also maintain intimacy with their wives.

So there can be things like Viagra and Cialis. There can be injections that they have to administer themselves into the penis, but if the pelvic floor muscle function makes up at least 50 to 60% of that, it makes sense to maximize that, [00:30:00] to reduce these other interventions. 

Tim Norton: Right. And what, what about the other symptoms?

 When somebody had a burning for a while or, or the one I've heard a few times is the sensation of a golf ball on your butt. 

Stephanie Prendergast: So switching back to the more younger end of the spectr right?  obviously if those sensations are there, it's unpleasant. And so over the course of time, we're able to help reduce them.

Doesn't feel like there's a golf ball in the butt anymore, which can be a sign of pudendal nerve issues or pelvic floor, muscle dysfunction. 

Tim Norton: Okay. And then they come in and they say, gosh, I'm feeling a lot better. 

Stephanie Prendergast: They can. And it's often if the symptoms are very severe, cause we're talking about a whole range of things.

So on the pelvic pain end of the spectr it is an interdisciplinary approach. That's the most helpful for our patients with severe pelvic pain. So that involves medical management, which may include some pharmaceuticals that are not antibiotics. Okay. More [00:31:00] neuropathic drugs.  there could be various procedures such as Botox or nerve blocks.

It can be therapeutic in conjunction with physical therapy. 

Tim Norton: Okay. And once you said interdisciplinary, 

Stephanie Prendergast: that means doctors and physical therapists, psychologists are all involved to help people function better in the face of their issues. 

Tim Norton: And so when would you involve a psychologist or a mental health therapist 

Stephanie Prendergast: at this point?

I mean for me in my career, I feel like we can kind of assess how distressed people are about their symptoms. I mean, obviously this is unpleasant for everybody, but you can kind of gauge how people are coping or not coping. And at the point that we. Obviously suggest people like you, we want to have them establish a relationship with us.

So we're not offensive, which some people can take this as I'm only upset because I have a physical issue, but that's okay. You're just not coping well while you have [00:32:00] it. And maybe we can help you make this. Less sufferable as you're going through the process. So I think in an ideal world, mental health specialists would be involved from the beginning.

Our society doesn't totally work that way. And some people definitely need it more than others. Right. 

Tim Norton: And then what I find is that,  The anxiety, the stress, the lack of coping exacerbates the 

Stephanie Prendergast: symptoms. So they, of course it does. So people think they're doing this to themselves because stress makes all musculoskeletal pain worse.

 and that's just not the case, especially if you've been told by five, six, seven doctors that there's nothing wrong with you or the medications that are prescribing it, working, you Google your symptoms. You read online that you're going to have this chronic condition that affects. Your sex life for the rest of your life.

You're not going to be happy and that's okay. We have to sometimes undo all of that misinformation because treatment is available. It is effective. It's just not readily available to every provider across the country. 

[00:33:00] Tim Norton: Right. And I bet some of your interventions are actually pretty similar to some of mine.

I'm like stop Googling. Yes. And,  sometimes stop. The examining your penis once an hour. And,    Dr. Gonzalez actually was, was saying some of those things, like he, we would get continual calls from people,  about just put the same questions over and over again, and clearly. Way too in their heads about it and read thus increasing their stress and thus leading to probably be more tension and the area more attention throughout their body and worse symptoms.

Hmm. 

Stephanie Prendergast: It sounds like you're in this situation and you're going to be here for the next 40 years and people often think, Oh my gosh, if I feel this bad now, how bad is it going to be then? And we do want to stop that thinking because that's just not how it has to go. 

Tim Norton: Right. And you're sitting there and telling them, okay, stop thinking like that.

Yeah. That's where we see a lot of results. We [00:34:00] see a lot of progress in this area and I know you've gotten mixed messages, bots. This is something that we're really good at treating. And I bet that you have to have a pretty good bedside manner as you talk to these guys. 

Stephanie Prendergast: Yes. I mean, I mean, I understand if I Googled the same symptoms and I thought I had this, I would be probably in the same boat.

So I understand, 

Tim Norton: but you could also read your book 

Stephanie Prendergast: began and they also it's so funny how often men see so many men coming in and out. Of our office. And one thing they say is everyone here looks so normal. I'm not sure what they thought, but of course they looked normal and there's so many men in here which is true.

I mean, this is not a women's issue. Yeah. Yeah. 

Tim Norton: Should they buy your book? What's in your book is everything that we just talked about in your book. 

Stephanie Prendergast: Yes. The book contains,  a more detailed explanation about the specific musculoskeletal issues that happen, but more importantly, my book isn't [00:35:00] do this stretch, do that stretch cause everybody's symptoms are totally different.

And so are the reasons for it. It's more teaching people how to understand how they develop the symptoms and how to navigate the treatment process because some people may need physical therapy and pudendal nerve. Blocks. And some people may not even need physical therapy. They may be, they need psychology.

So it's really important to understand where the person is and how to troubleshoot things if they plateau or if they can't tolerate certain treatments or medications. It's really about teaching people how to think through this issue versus just go stretch your hamstring. Cause that's very rarely effective.

Tim Norton: Is there a. Do this stretch, do that stretch book. 

Stephanie Prendergast: Well books. Yes. No, there's a ton of books saying stretch, this, do that. And I don't find them very effective. I went for strata. 

Tim Norton: Right, right, right. Okay. Cause yeah, I, there, there are a lot of pelvic pain books out there, but you don't have one that you love.

No. [00:36:00] Okay. All right. You heard it here first. Now we have talked a little bit about medications and that's another thing that I've, I've heard. Well, here's the typical story is, you know, somebody told me I had prostatitis and they, it was a urologist, gave me an antibiotic. Everything was working well for a few days and everything came back and now they want to give me another antibiotic.

And then I've found you. 

Stephanie Prendergast: So, I'm glad you brought up the antibiotics situation. This is important, and everyone needs to know this, that there are analgesics in a number of animal Biotics. Analgesic. Analgesic is a it's Tylenol. Yeah. Pain numbing medication, because oftentimes people with infections have pain associated with infections.

Infections are unpleasant. They usually hurt. And so people can erroneously think that the antibiotic is killing the bacteria because they feel better on it. When in fact they're taking a pretty high dose of Tylenol [00:37:00] with the Cipro, for example. And so they may feel better. And then they think their infection came back when they go off of it.

When in fact they're just not taking that much. Of the Tylenol anymore. So many people don't realize that. And that's important to know, especially if they're given antibiotics without proper testing to diagnose prostatitis you have to undergo a full semen analysis, not a urine culture, but a full semen analysis and many people who are diagnosed with that have not been through that process.

Tim Norton: You're right. I'm telling you you're right. That the few times I have worked with somebody who said. They have prostatitis I asked that question and then a semen analysis. Isn't that common, 

Stephanie Prendergast: right? And that's because it's, it's difficult to do. And there are issues with the labs. It's just not always a clear cut in a straightforward test is we want it to be, there can be false positives.

There can be false negatives. It can get contaminated quite easily. So. People don't bother. They [00:38:00] just give the antibiotics, but that's actually not right. Especially time and time. Again, it can cause gastrointestinal distress and a whole host of other problems for men, 

Tim Norton: antibiotics are not the only medications I've heard prescribed in this arena.

What else is being given to these patients? So, 

Stephanie Prendergast: because this is a. Pain syndrome. They're often given the same medications that are used for any type of pain, whether it be a migraine or back pain or things like that. And there's three classes of drugs that could possibly be effective. Those are either tricyclic, antidepressants that are used at a dose lower than treating depression to treat pain.

 there's SNRI such as Cymbalta. Have been shown to have musculoskeletal pain reduction effects. And the third class of drugs are the neuromodulators, which are Lyrica and Gabapentin.  so those drugs may be prescribed for this just as they are for any other pain syndrome. And depending on how involved the nervous [00:39:00] system is, or isn't in somebody issues, they can be effective or not effective.

Tim Norton: That's interesting because when I took my licensing exam, I learned about all three of those medications and yeah. So those must be secondary benefits to those medications. Does SNRI wasn't designed for pain? 

Stephanie Prendergast: No, but it has been FDA approved for pain. Whereas the tricyclic antidepressants and the neuromodulators are off-label uses.

Those are off-label use actually the tricyclics may be on label at this point, but Lyrica and Gabapentin are off label for pain, but really commonly prescribed commonly prescribed. 

Tim Norton: Okay. And how do you feel about all three of those drugs? 

Stephanie Prendergast: I think for certain patients, some of them have been quite effective.

I think. The side effects can sometimes outweigh the benefits. The most important thing with the medications is that patients often don't understand why they're taking them and they have unrealistic expectations as to what they should do. So if [00:40:00] you take these medications and you have. Daily unprovoked pain.

It's not going to take it away, but it may take it down a few notches. So if you can't sit for more than 10 minutes without getting severe parallel burning, maybe instead you get perinatal aching at 15 minutes instead of 10, and that actually is considered effective for what it's intended to do, but people think it's just going to completely take away their symptoms.

And that's just not how it works. 

Tim Norton: Right. Cause I'm thinking about the way that that study would be designed is study the efficacy of that medication and that isn't right. Improvement. 

Stephanie Prendergast: That is an improvement, but this may be why it's not FDA approved for pain. It's very difficult to quantify. Right, 

Tim Norton: right.

Okay. Yeah. Cause I would imagine. I'm prescribed a tricyclic and I go home and I Google that. I'm like, wait a second. I'm not depressed. I'm not bulb. Am I depressed? Because I'm certainly very distressed about this, or are they saying that if my depression goes [00:41:00] away, that this pain is going to go away?

Stephanie Prendergast: Right. So I think, again, people think that they're given it because they're being told it's all in their head or things like that because often physicians may not have time to explain why we're giving, why they're giving patients these drugs. So they are meant. To treat pain at different doses. And for depression, it's important to know for the tricyclics.

 Cymbalta is the same for anxiety, pain and depression, and that can be an effective medication to help people go through the treatment process. 

Tim Norton: Okay. So I'm trying to imagine the guy who has some of these symptoms, who's kind of a long way from deciding, okay. I'm going to come in. Okay. What can you say to him, or is there a video where he could look online and say, okay, I just want to see what this is like, or is there something that might kind of make it hasn't been in a [00:42:00] movie?

Not yet. 

Stephanie Prendergast: It's creeping into movies for female, pelvic pain and TV shows and all kinds of IX right now. Now it hasn't been in a movie.  I think doing some Google searches, the lecture that you attended at USC is amazing online,  where people talk about the whole spectrum of things. And I think for men, not sure if this is.

What they need or not. I think an evaluation is warranted and at least get a little bit more information. If you have these symptoms, I think you should rule in or out the pelvic floor as a source of them. So, you know, 

Tim Norton: and they could come in and get a decent evaluation without getting a finger on the button.

Nope. Nope. Okay. So that's going to be a part of it. So it's just going to be part of it. I don't, I don't want us, I don't want to say man up, but I guess I'm 

Stephanie Prendergast: kind of saying that well, and as the symptoms get. Severe enough. They rarely, once you get to a symptomatic point, they may not resolve on their own.

And I think that motivates people to seek appropriate attention because they can see that things [00:43:00] are changing and progressing and often not in the right direction. Okay. 

Tim Norton: Is there anything that. People could be doing in the meantime that they're mulling over this decision of whether or not to come to your center.

Are there stretches, you already mentioned, maybe ease back on the cycling. 

Stephanie Prendergast: Well, and again, it's all about someone's anatomy, plenty of people cycle and have absolutely no problems. And certain people may ride their bike a mile. And all of a sudden have penile numbness for two days. It really depends on your anatomy.

And if your body can do the activity in question and so listen to your body, if you do feel symptoms after certain exercises you do at the gym or riding your bike or sitting for 18 hours, you know, listen to your body, get up, move. And if the symptoms repetitively, keep coming back, that activity may not be okay for you, but you also may have a treatable.

Condition 

Tim Norton: are [00:44:00] there yoga poses guys could do to help this condition? 

Stephanie Prendergast: If. The in general, the child's pose will help relax the pelvic floor muscles.  however, if you have symptoms of pudendal neuralgia or there is nerve symptoms, burning shooting, stabbing, tingling, things that stretch muscles. Will also stretch the nerve and provoke the symptoms nerves do not like to be stretched.

So it's really important to distinguish patients with nerve issues from muscle, because what you think could be therapeutic could actually be less useful. Same thing with a lot of people with low back pain, they want to strengthen their core. That's actually going to provoke your pelvic floor muscles to tighten.

If your muscles are tight enough that they can't relax things that are well-intended to help your back are actually going to cause pelvic pain or exacerbate your pelvic pain. So strengthening is not always the answer in these cases until the muscles are in a [00:45:00] position that they can do. So. Okay. 

Tim Norton: I think that's a really good rule to live by.

You say things that stretch the muscles, stretch the nerves. Yeah. Yeah. 

Stephanie Prendergast: So it can be provocative instead of therapeutic and you'll know, it may not happen right away. It may be a delayed onset, like two to three hours, but people usually can start to tie provoking activities to their symptoms. Once we start asking them more specific questions.

Hmm. 

Tim Norton: Yeah. And that would happen over the course of treatment. They'd start to piece things together. I bet a lot of guys will say things like. But I've been cycling my whole life or something like that though, or all of the exercises.  

Stephanie Prendergast: what's your response. Maybe they'd been cycling their whole life, but recently they had a bad sciatica.

And so now things are different, the sciatica resolved, but maybe their hip muscles are still tight or there's still some sort of tissue change that is now. [00:46:00] Causing symptoms during the same activities they've always done. And I also say your body changes over time. Like we can not do the same things in our thirties necessarily that we did in our twenties, as much as we all want to, things are different as you age.

And it doesn't mean it's not correctable, but you may need to focus your attention on addressing impairments. Hmm. 

Tim Norton: You keep mentioning. Studies is there, is there, has there been a really good meta analysis or maybe your book would just be a collection of those? Or what, where should a guy start reading? So he's just not Googling blindly about this stuff.

Stephanie Prendergast: That's a good question. I think our blog is a good patient friendly resource and we referenced that to go to other places. Most people don't want to read medical journal articles. However, I would say. Yes. I would say that this year,  just in August,  Rodney Anderson published in the journal of urology,  a [00:47:00] huge meta analysis on CPPs.

And instead of calling it a prostate dysfunction, they're finally acknowledging it as a psycho neuromuscular disorder. So effecting the mine, the body. And the nervous system. And they went through all of the literature on this. And again, showing that the majority of men never have an infection, they don't respond to any Biotics.

They don't respond to a lot of medications cause it's not that type of a problem. And I think that's a big step forward because most urologists get the journal of urology. So even if they're not seeking out additional knowledge for these patients, this came to their doorstep. So hopefully they read it.

Tim Norton: Awesome. So yeah, if, if guys, if your urologist doesn't seem to know what's going on, get the August journal of urology, find the article by Anderson. And this is Google-able,  obviously, and you probably have to pay the 40 bucks for the article, or there are ways around that we won't go into on this podcast.

[00:48:00]  but yeah, and. Forward it to your I'll just hopefully he or she will read it. And this is why these studies,  take place in a big meta analysis. And that, so that was just a couple months 

Stephanie Prendergast: ago. That was recent. Yeah. Big step forward. I'd 

Tim Norton: say that's great. And you're reading your journal of urology 

Stephanie Prendergast: must stay on top of it.

Yes, you 

Tim Norton: do. Okay. So. What just in general, what, what would you like to say to the guys out there who have some of these symptoms? Like what words of hope can 

Stephanie Prendergast: you give to them? Canon will get better. There's usually room for improvement.  if you have these symptoms and people are telling you there isn't anything wrong or.

Certain treatments that they're prescribing are not working. I always recommend getting a second opinion.  I can direct you to resources where they can find providers that are skilled in treating this. And I think that they [00:49:00] should. Move forward and try to get the issues taken care of. Don't ignore them.

Great. 

Tim Norton: And their sex lives can improve. 

Stephanie Prendergast: Sex lives can improve. Erections can improve. Anxiety can go down. You can return to the exercises that normally provoked your symptoms. All of this can get 

Tim Norton: better. Okay, good. And what about for, for you? What's going on in your world? You have how many centers. Nine. 

Stephanie Prendergast: Wow.

Now we just opened one more. Yeah, just open 

Tim Norton: one more. And those are not all in 

Stephanie Prendergast: California. So we're in new England, Northern California and Southern California. Okay. 

Tim Norton: What kinds of things do you have on the horizon? 

Stephanie Prendergast: What's on the horizon.  that's a good question right now. We're trying to hold down the Fort right now.

We're pretty busy in the clinic and it looks like in 2019, we're going to start teaching again and locally.  I have a larger space now, so things will [00:50:00] be changing a little bit on that front. Basically just keeping the clinics running at this point. Yeah. 

Tim Norton: Yeah. That's a lot to oversee and it was,  You, you are very busy.

Absolutely. We, it took us a while to get this rescheduled after I blew it on the first episode, but you you're at the top of your field and you're doing really great work. And every time somebody named drops you, they're saying really wonderful things. So I know I said it at the beginning of this episode that I was excited, but I am,  you know, I think that you're doing really.

Really important work. And I'm so grateful to have you on here and helping us have these hard conversations.  where can we find you on the 

Stephanie Prendergast: internet?  our website is pelvic pain, rehab.com. A book is on Amazon. It's called pelvic pain explained, and that's where we are. I practice in our Los Angeles location.

Right. You're on Twitter. I'm on Twitter at pelvic health. I'm also [00:51:00] on Instagram. The same at pelvic health and Facebook is pelvic pain, physical therapy 

Tim Norton: kinds of pictures. Do you put on Instagram? Yeah, that's a good question. 

Stephanie Prendergast: Yeah. Check us out. It's a challenge. All right, Stephanie. 

Tim Norton: Well, thank you so much.

Thank 

Stephanie Prendergast: you. Bye-bye.

Shout outs to the sex positive community, including sex educators, sex therapists, sex coaches, other fellow sex, podcasters, sex, surrogates, academics, sexual health, medical community, sex workers, the tantric community, and everybody else involved with having hard conversations. Bye-bye.

If This Episode Resonated

If this episode spoke to you, there is a path forward.

Tim Norton provides a discreet, evidence-based therapeutic space where men and couples can understand the deeper systems behind desire, arousal, and connection. His work combines rigorous neuroscience with a grounded, relational approach to help clients rebuild aliveness in their bodies, strengthen partnership, and create lasting change.

Obsessive Thoughts and Erectile Dysfunction| ACT Founder Dr Steven Hayes on Restoring Sexual Confidence

Episode Overview

In this episode, Tim speaks with Dr Steven Hayes , founder of Acceptance and Commitment Therapy (ACT) and one of the most influential psychologists of our time. Together they explore how obsessive, looping, or fear-based thoughts can interrupt arousal, create performance anxiety, and trigger erectile shutdown.

Dr Hayes offers a powerful reframing: the goal is not to eliminate unwanted thoughts, but to change your relationship to them so they lose their grip on the body. When men stop fighting their internal experience, erections become more stable, presence returns, and pleasure becomes accessible again.

Key Themes

• How intrusive thoughts trigger sympathetic arousal and shut down erections

• Why “trying to stop the thoughts” makes them stronger

• ACT principles, willingness, acceptance, defusion, values

• The role of psychological flexibility in sexual confidence

• How avoidance patterns shape erectile anxiety

• Practical strategies for staying present, embodied, and regulated during sex

Listen to the Episode

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Dr. Steven C. Hayes , Founder of Acceptance and Commitment Therapy (ACT)

Dr. Steven C. Hayes, PhD, is a clinical psychologist, researcher, and Professor of Psychology at the University of Nevada, Reno. He is best known as the originator of Acceptance and Commitment Therapy (ACT), a pioneering evolution of Cognitive Behavioral Therapy that integrates mindfulness, behavioral science, and values-based living.

Across his career, Dr. Hayes has published over 600 scientific articles and 47 books, including the seminal text Acceptance and Commitment Therapy, which helped establish ACT as one of the most empirically supported modern therapeutic frameworks. His work has been cited more than 200,000 times, placing him among the most influential psychologists in the world.

Dr. Hayes’ research focuses on psychological flexibility, the ability to be present, regulate thoughts and emotions, and act in alignment with personal values even under stress. His work has shaped treatment approaches for anxiety, trauma, chronic pain, obsessive thinking, and relational challenges.

He is the recipient of numerous awards, including the Lifetime Achievement Award from the Association for Behavioral and Cognitive Therapies, and he is the co-developer of Relational Frame Theory, a groundbreaking model of language and cognition.

Dr. Hayes’ mission is to help people build lives of meaning, connection, and psychological strength — not by eliminating difficult thoughts, but by transforming their relationship to them.

Website: https://stevenchayes.com

Book: https://bookshop.org

If This Episode Resonated

If this episode spoke to you, there is a path forward.

Tim Norton provides a discreet, evidence-based therapeutic space where men and couples can understand the deeper systems behind desire, arousal, and connection. His work combines rigorous neuroscience with a grounded, relational approach to help clients rebuild aliveness in their bodies, strengthen partnership, and create lasting change.

What You Need to Know About Blood Flow and Penis FunctionWith Dr. Johanna Hannan, PhD

Episode Overview

In this episode, Tim speaks with Dr. Johanna Hannan, an award-winning physiologist whose research explores the pudendal arteries, pelvic nerves, and the mechanisms behind erectile function. They discuss how aging, diabetes, obesity, and prostate cancer treatment affect blood flow, the limits of medications like Viagra, and the extraordinary role lifestyle plays in restoring vascular health.

Key Themes

• How laboratory research actually studies erectile function

• Pudendal artery physiology and why it matters

• How aging, diabetes, and cardiovascular disease impact erections

• What Viagra does and does not do

• The role of pelvic nerves in erection and sensation

• Why diet, movement, and metabolic health make a profound difference

• Insights from rat, rabbit, and mouse models of erectile physiology

• What “normal” testosterone truly means

• Understanding nerve injury after prostate cancer treatment

Listen to the Episode

Listen Now

Dr. Johanna Hannan

Dr. Johanna Hannan is an assistant professor of physiology at East Carolina University’s Brody School of Medicine. Her research investigates the vascular and neurological systems that support genital function, including pudendal artery health, endothelial function, and pelvic nerve integrity. She studies the mechanisms behind aging-related, metabolic, and post-surgical erectile dysfunction to support the development of more targeted treatments.

Website: https://physiology.ecu.edu/research/johanna-hannan/

Xr: @hannan_lab

Episode Transcript

Tim: Hello, and welcome to hard conversations. My next guest is Johanna Hannan, an assistant professor at the Brody school of medicine at East Carolina university. She did her postdoctoral fellowship at the James Buchanan Brady neurological Institute and department of urology. And studied medicine at Johns Hopkins.

Her research focuses on the internal pudendal arteries. Those are the arteries that supply our genitals and their impact on aging, cardiovascular disease, diabetes, and obesity. She and her fellow researchers are searching for treatments that will [00:01:00] improve both sexual dysfunction and lower rates of cardiovascular disease.

She's received multiple honors and awards for her research and urology and sexual medicine. And I'm interviewing her today at East Carolina university. Hi Joanna. Hi Tim. Hi. Was, did, did that intro and capsulate? Yes. 

Dr. Johanna Hannan: Yeah, so we do both,  vascular dysfunction and renal dysfunction. 

Tim: Okay. Okay. And we're, we're going to get into that.

So what,  what got you into this? You're a lot of your, a lot of your research ends up covering erectile issues. 

Dr. Johanna Hannan: So when I was an undergraduate student at Queens university, I, we did research projects in our senior year and I was looking for a project and I got involved with a researcher who I. Who mainly did cardiovascular research.

And,  I thought I'd be getting involved in one of those projects. And when I came to the lab to start [00:02:00] learning techniques, I found out I was going to be doing behavioral responses and rats and counting erections. And it did involve cardiovascular disease, but it just wasn't the type of study I was looking for or thought I'd be involved in initially.

But it was,  the first paper that I published and he was a big part of the reason why I ended up doing research, but we pretensive animals and the impact of different antihypertensives to remodel the vasculature and not only lower blood pressure, but also improve rectal function. 

Tim: Okay. So that was the first time that that happened.

And it sounds like you liked it. 

Dr. Johanna Hannan: I liked it. I was hooked. It was, to me, it was a very interesting field to get involved in because we can apply a lot of the things that people were studying in cardiovascular disease. To a widely understudied problem, like [00:03:00] erectile dysfunction, so that in urology,  there's fewer researchers, there's less competition.

And so you can really make big contributions to the field. I think.

Tim: Why is that? 

Dr. Johanna Hannan:  I think there's fewer basic scientists who are purely PhDs that are researching it and I'm not sure. Y exactly.  I think since there's been a boom in basic science research since Viagara yeah. And overall everybody's more comfortable talking about erectile dysfunction. There was more research funding available for it.

 but still primarily the, a lot of the research is being done by primarily urologists to dabble more so in the basic science. And so,  I really enjoy this field because I feel like I can really [00:04:00] dive in deep and contribute. 

Tim: Okay. Now, My next question. I feel like I knew the answer to at when I took my high school biology final, but why, how can we study rats and learn about human erections or human cardiovascular systems?

Dr. Johanna Hannan: Well, there's. Benefits and disadvantages to working with Rodin models. So there's always pros and cons. We find it beneficial to work with rats because when we're looking at erectile dysfunction, they do have very similar anatomy when it comes to the vascular supply and the neuronal supply. It's very similar to humans.

 the nice thing about rats is that they're fairly inexpensive to work with.  they are. There's a variety of different disease States. [00:05:00] Again, some of them actually will mimic human conditions. So we try and take what we can from the rat and then try and make it relevant to what's happening clinically and what we see clinically.

Tim: Okay. So how is their vascular system similar to humans? 

Dr. Johanna Hannan: So when we're talking about the internal pudendal artery, which you referenced earlier,  it has the same branching and,  it takes the same pathway as it does in the human. And so we've actually done some studies where we've characterized this vasculature in rats and then compared it to human cadavers.

And we see similar paths vagical remodeling in these vessels in both. Clinical situation and in the animals as they age. 

Tim: Okay. That is really fascinating. Isn't it? Okay. Cause, and you would have to study a cadaver to do that. So have you gotten to [00:06:00] study human cadavers or was that already done? And you can just read the study.

Dr. Johanna Hannan: So we, when I was at Hopkins, during my postdoc, we collaborated with,  West Virginia university medical school and they had some students over the summer who were prospecting cadavers and they would send us,  coronary arteries and pudendal arteries. What does 

Tim: prospecting mean? 

Dr. Johanna Hannan:  it's a fancy word for dissecting cadavers 

Tim: damn hazy Prosek thing.

Okay. So you were 

Dr. Johanna Hannan: pro sexy for medical students who were dissecting cadavers and removing coronary arteries and internal pudendal arteries. And they would ship them to us so that we could look at the histology and the vascular remodeling in these 

Tim: vessels. Okay, fascinating. And you're sitting there looking at them under microscopes and saying, wow, these are just like rat arterial systems.

Dr. Johanna Hannan: Right? So the big thing that we believe is important [00:07:00] with this vascular bed, a lot of people focus their research on the penile tissue itself, which of course is very important for erectile function. But we believe that if you can't get blood into the penis, The function of the P and L tissue becomes a little bit less critical.

 if we can't deliver blood and so. What we found is that these vessels are actually quite susceptible to vascular damage. And we'll often find damage to these vessels prior to other vessels in the body. Such as we've looked at aorta, we've looked at renal arteries, we've looked at mesenteric arteries, and these are in different disease States like hypertension, or, and we believe that the.

The Pew dental artery, because the only time it really sees high changes in blood flow is during an erectile response, but it can be susceptible to damage. And that's where you'll see [00:08:00] cases where. And prior to cardiovascular disease, and we believe it's comes down to these, this vasculature, that seems to be more sensitive to damage.

Tim: How many of them, those, how many rat penises do you see in a week? Is it, or is it just like during the. Portion of the study where that's that's happening. It 

Dr. Johanna Hannan: depends. It depends. Cause sometimes the castration studies we're doing now, they go on for they're castrated for over eight weeks. So at the end, when we're doing a whole bunch of experiments is when we will well, and luckily now I have students that do this for me.

So. But yeah, towards the end, we'll have some crazy days. Cause we'll do we also measure sexual function in vivo in the animals. So we'll do a surgery that we stimulate the cavernous nerve and measure the pressure in the penis. And so then we'll when we're done that surgery, it's a terminal surgery. Then we take everything out and [00:09:00] then it's an eight to 10 hour experiment afterwards where we put everything into tissue baths and run all the curves.

So. Tends to be a long day. That's a long day, 

Tim: right? That's a 

Dr. Johanna Hannan: lot of fun. I,  we don't have a urology,  department here at the medical school. So any of the students that want to go into urology usually come to see me to try and get on some papers and things like that. So it's fun working with them.

That's really 

Tim: cool. Interesting. So, There was a, I had a urology just on recently and he did explain that system of,  of tissue in the penis and gorging with blood. And can you distinguish the difference between in case everybody hasn't listened to every single episode?  what, what that process is?

Cause I think maybe the, the layman just thinks, well, [00:10:00] there's arteries in my penis and when there's blood in my penis, I'm hard. It's not quite that is it. 

Dr. Johanna Hannan: Right. And I did listen to Dr. Gonzalez, his podcast. He was saying that there's, there's two different aspects of erectile function that clinicians are interested in.

And one of them is whether or not blood can get into the penis. And the penile tissue can relax to allow that blood to expand. And then the other type of dysfunction that can occur is a result of being weak. So the veins that are on the perimeter of the penal,  erectile tissue, when the penis fills with blood and expands, The tissue will actually pinch those veins and close them off and prevent the blood from escaping the penis.

And so this is a different type of dysfunction that can happen as a result of the changes of the penile tissue itself. So if it [00:11:00] becomes. Too fibrotic with age or diseases, then it will not be able to expand enough to pinch off those veins and completely occlude the blood and cause of rigid direction.

So I'm not so much interested in that aspect of erectile dysfunction, but more so getting the blood into the penis. 

Tim: Okay. And then once it's in the penis, what does it do? 

Dr. Johanna Hannan: So then it, the PNL, so she will relax and expand. And then as long as we can get that, what we call it, you know, occlusion or the complete blockage of those veins, then it will maintain, interact rigid.

Tim: Okay. And does it do the same thing in rats? 

Dr. Johanna Hannan: It does the same thing in rats. 

Tim: And what is rat sex like? It's very quick. Is it quick? It's very like how quick is quick. 

Dr. Johanna Hannan: It's about three to five seconds. So one of the [00:12:00] ways that we can assess erectile function behaviorally is we administer April morphine, two rats, and then watch them over a half hour observation period.

And,  One of the unfortunate side effects that they were morphine. Wait, what is 

Tim: April morphine? It just is. It's like morphine. 

Dr. Johanna Hannan: So it's a dopamine agonist. So it's going to act essentially in the hypothalamus and the areas of your brain to act on dopamine receptors and trigger a erectile response neurally.

Okay. For us, it's an interesting tool because. You're initiating erections in the brain. And if there's any vascular defects in these animals, then there'll be a parent because they will not be able to have interaction. Now it's also,  causes vomiting. And the nice thing about working with rats is rest don't have a gag reflex or a vomit reflex.

And so it's a little bit less messy than if we were to decide to [00:13:00] do these with let's say with dogs. Okay. 

Tim: So, so the rats. Now does that mean that they'll be able to have more sex in that time? Or it's just, it's more controlled. You can just induce the erection when you want it. 

Dr. Johanna Hannan: So we use it as a tool to measure the amount of erections they can have in that happen.

And so if they're potent and they have good erectile function, they'll typically have three to four erections. And if they have dysfunction, they'll usually have less than two. 

Tim: Okay. And then, and, but these are pretty small erections, right? Are you looking with a microscope or can you spot one net with the naked eye?

No, 

Dr. Johanna Hannan: we can spot it with the naked eyes. So we typically have them sitting on plexiglass platforms with cameras underneath and when the rats have an erection, they have a very specific behavioral response in which the public thrusts. There penises [00:14:00] at emerges and then they'll groom. And so we can, we have a very specific response that we're looking for.

So this will allow,  to, to monitor the animals. And because it's, it's a non-invasive procedure. If we want to look long-term at the effects of a treatment or effects of diet or exercise, then we can monitor them weekly to see if things improve. 

Tim: Okay. Yeah. And when I was going through your. Body of research.

You had looked at a lot of those things,  at diet and exercise and,  yeah. Okay.  now you, you said I learned so many words going through. These, these papers neuronal  you? So the brain, the brain is similar in structure to in rats. So,  and I imagine you're probably focusing on specific aspects of the brain, [00:15:00] especially ones that are linking to.

 sexual processes and that kind of thing. So what, what, what's similar about rat brain and people brain when we're, when we're sexual? 

Dr. Johanna Hannan: So I'm not sure if I can answer that we're much more interested in the peripheral nervous system. And so we look at changes that can happen to the nerves that are supplying the penile tissue.

So we'll use different models,  that can mimic nerve injury. And then that is similar to the nerve injury that would happen for patients who are undergoing,  prostate removal for prostate cancer or radiation therapy. 

Tim: Okay. Okay. Yeah. You're more focused on. The penis itself on, on the 

Dr. Johanna Hannan: public areas, everything in the pelvic 

Tim: area.

Right. And we'll, we'll leave the brain stuff up to the other doctor. So. Let's dive into it. What can you tell us about what have you found with diet? 

Dr. Johanna Hannan: In our case, we've [00:16:00] done mainly things in the lab where we've either manipulated what the rats are eating,  in terms of giving them a more higher fat diet to see how that impacts on erectile function.

And then we've also taken animals that are overweight and sedentary and given them a restricted diet where we've restricted. 40% of their caloric intake daily to see how that improves function. Now there's a lot of parallel studies that others have done clinically. So a lot of the data that we're seeing, we're seeing improved vascular function.

We're seeing weight loss as well as improved erectile function. A lot of these correlate to what we see clinically as well. 

Tim: Okay. What does a rat get fat eating? Is it ice cream or what 

Dr. Johanna Hannan: is it? I mean, they would love to eat ice cream. Unfortunately, the, the rat diet's pretty boring. So a high fat diet that,  [00:17:00] Is more high in cholesterol and that will cause them to get fat, but we have animals.

The rats are very,  social animals since they're typically their house together. When I was in graduate school, we had a bunch of brats that. Had been housed separately in aged. And I don't know if there was rat depression going on with them, but they ate just a lot of the regular bland food that they had access to and they become, they became quite overweight.

Tim: Hmm. Just eating more of the boring stuff that they 

Dr. Johanna Hannan: eat, like any more of the boring stuff and just sitting in their cage and not really doing a whole lot. 

Tim: Okay. So, so you do. Get them fat. And you, you see like fewer erections in these studies where you've put the, the dopamine agonist inside of their brain, and they've got a [00:18:00] half hour to have as many erections as they can, and they have fewer correct.

And we're able to pretty confidently generalize that to what might happen in a human. 

Dr. Johanna Hannan: Right. So we, in addition to just looking at the behavioral response at the end of the study, we can also look at the actual vascular function of both the penis and the, the vessels that supply the penis. And so we can see that they don't relax as easily to, to things like nitric oxide.

 and they typically have an increase in. Basal constriction. So if they constrict more than the blood is going to have more trouble getting to the penis. And so we see these vascular changes that correlate with a lower number of erections and these animals. 

Tim: Okay. And that's, that's something you're not going to be able to see with the naked eye.

So you, but you're able to [00:19:00] obviously then get right in there with the rat and. Go is it wouldn't be like a camera study where you're going inside and looking at it. If they're flowing, how do you test to see vasoconstriction in an IRAT? So in this 

Dr. Johanna Hannan: case, these are all experiments that are done at the end of the study.

So we'll actually collect the tissue and then take small little,  rings of the vessels. So we'll section the vessels into two millimeter rings, and then we can take these rings and put them in a tissue bath and administer different drugs. To determine how the physiology has changed. 

Tim: Okay. At the end of this study and they've, they've died at that point.

Dr. Johanna Hannan: Right. They're done. 

Tim: Okay.  which 

Dr. Johanna Hannan: is another benefit of using animals because unfortunately we can't get these same types of studies to understand the actual mechanistic things that are happening with humans, because not [00:20:00] many humans are willing to donate their vasculature or their penis. So it's a challenge.

Tim: Right? Right. That, that wasn't even a,  Box that I could check on the organ donation list. Was it,  huh. Maybe that would be something for us to lobby for.  okay, so that's that's diet and then I guess an exercise study would be pretty similar they're they're running on wheels or, or how does a racket exercise?

Dr. Johanna Hannan: So they actually make small. Size rat treadmills. So the rats can run on these treadmills and there's different things that will encourage them to run because it's, unfortunately we can't do this with humans sometimes, but they'll have a little thing that can shock them. If they slide back on the treadmill or a little burst of air to encourage them.

Cause the rats. Need that extra motivation. They're not, they're not very enthusiastic to run, especially if they're overweight and sedentary. 

[00:21:00] Tim: Okay. So a little, a little boost of air, even my just kinda, yeah, no, they'll 

Dr. Johanna Hannan: start to get them going. 

Tim: And so then they run and they run and then they, they eventually lose weight and, and then they die and then you look at their arteries and they're there.

They're wider or they're presumably that 

Dr. Johanna Hannan: are they relaxed better. So we try and look at different,  molecular pathways to try and see what other type of drugs would potentially work clinically in humans to improve vascular function. Or if we can understand how exercise is benefiting humans, then it'll help us try and come up with more cures for.

That's disease. 

Tim: Okay. So you can say then with a fair amount of confidence, that exercise would help erectile function. 

[00:22:00] Dr. Johanna Hannan: Exercise definitely helps erectile function.  there's a study that came out this past week saying that not exercising is just as bad as smoking, having high blood pressure or being diabetic.

And it was a study where they looked at over a hundred thousand patients and found going through their stress tests and then their eventual,  mortality that patients who exercised independent of other things were better off. And so it was quite remarkable to hear that that, that no exercise there were equating to.

Worse than being sedentary or worse, you know, worse than smoking and having high blood pressure. So I thought that was quite interesting, just a small amount of exercise and essentially not being sedentary. It had such a benefit 

Tim: how small and amount of exercise. So 

Dr. Johanna Hannan: that's something where I think there's, there's a [00:23:00] variety of studies that looked at it,  or that I've looked at the amount of exercise and how critical it is.

I think it depends on how sedentary you are, but in general, a very small amount of exercise, whether it's you start walking 30 minutes a day,  it will have benefits. So there's definitely more exercises better, of course. But even that small amount might really help. 

Tim: Hmm. I don't know if I'm, I'm repeating an anecdote.

But I heard this the other day and that,  a friend was talking to a friend who is a cardiologist and he was telling her that. The only way he gets men to exercise is telling them that it will help their penises that yeah. That when he puts it in those terms, that, you know, cause if you just say, you know, it'll lower your chance for heart disease, that, that, that, that does nothing.

 but [00:24:00] yeah, if you can say you're going to be much better in the SAC,  you might, you might get them. I'm out walking. And so I guess that would be a difficult thing to generalize from the rat study. Like how much do they have to exercise to see an improvement in? 

Dr. Johanna Hannan: Yeah, so we were giving them, they were, they probably doing a moderate amount of exercise, so it wasn't just walking is a little bit faster than walking and it was half an hour, a couple of times a week.

I think the big thing it depends on is. In rats, it always gets to the point where the disease has progressed so far that we can't come back from it. So a lot of the treatments that we're doing, we're trying to either improve blood flow. We're trying to,  make sure that nerves are. Regenerated, but frequently in these conditions, the penis becomes hypoxic.

It's not getting adequate blood flow, hypoxic, hypoxic, so not enough [00:25:00] oxygen. Okay. And so it's,  as a result of that, it will start to remodel and it can become very fibrotic. So there's a lot more colleges. It becomes stiffer, which you might think would be a good thing for the penis, but when it's stiff like that, it can't relax and expand to allow the blood to come in.

So it seems with a lot of these as the disease progresses,  there comes to a point where. We can't really reverse this. So you really want to get patients in to see their doctors early, when they're first getting signs of erectile dysfunction, because at that point, exercise and diet can probably fix.

Everything that they've got going on. Whereas if they wait too long and it progresses, then it could be that their penises become more fibrotic and things like PD five inhibitors won't work for them anymore. And they might be on the track to then eventually having to get a penile implant or [00:26:00] something more serious to have erections again.

So we're really looking at that initial window. I'm trying to determine. What the mechanisms are and where can we target that to be able to revert, to reverse the disease before it gets to that late stage where there's really not a whole lot we can do about it. 

Tim: Hmm. Yeah. So take away from that is get into your doctor as soon as possible.

Especially if, if you have a sedentary lifestyle or, or, or poor diet. Yes. Yeah. Okay.  and you are not basing that on just the, the studies that you've completed because when you do research, you know, I don't know the last time any, any of my listeners have used Google scholar and actually read a study, but the whole first page of a study or more talks about all the research that's been done beforehand.

[00:27:00] And so, and you've, and you've got to know that then you, you don't want to repeat. Repeat stuff or are you sometimes you repeating it, but you don't want to be redundant and you want to grow the literature suit. So you're familiar with it. And you know, the research that's out there that,  is in contrast to what you're saying.

So, and if you've been doing this for a while, so you've, you've got a pretty good handle on, on,  what we know. 

Dr. Johanna Hannan: Yeah. So everything we're doing, we're aware of what other basic science studies have been done. But I think more importantly, we have to be aware of. What's been done clinically are where the holes are clinically.

Cause that's where basic science really fits in is to try and answer a lot of those questions that we can't address clinically in patients. And so we work really closely with urologists and other clinicians to try to really understand what's happening clinically and then take those holes that are.

That we can't understand because we can't [00:28:00] dive into it as deep with human patients and go to our rodents and try and understand what's going on in that and understand the mechanism behind the disease state. 

Tim: Right. Okay. And have we ever. Done those kinds of studies where we would actually go in and, and study,  a live person and cut open their penis or anything like that, like it, or that's just maybe before, back in the day when we did shady or things or no.

Dr. Johanna Hannan:  I think, I mean, back in the day today, they would definitely dissect cadavers to try and understand how blood came into the penis and things like that. One of the tools that we, that we can do is when men are getting implants done,  there's a lot of tissue that's removed from the penis. Right. And so we can use that tissue in the lab to look at it and put it in [00:29:00] the tissue baths and look at contractility to different drugs or relaxation, or we can look at it histologically to see how things have changed.

The big issue with that tissue is it's starting to reach that end stage disease that I was talking about where at that point. It's not normal. It's very, very diseased. You start to see strange responses with it. And then the other side of that is that we don't frequently get normal tissue from young, healthy men, but we get a lot of tissue from these very, very diseased men with erectile dysfunction, but then we have nothing to compare it to.

Tim: Right. And so it would be nice if there were a bunch of guys out there with great erections who would just donate their tissue, but that's pretty unlikely. 

Dr. Johanna Hannan: It's a challenge. I think it's, it's much more challenging here in the U S to, to have it done. There's one researcher in Spain, who's [00:30:00] done a. Really nice series of studies where they've, they have quite a bit of young control tissue, and I'm not sure if they get it from organ donors or,  younger patients who've donated their bodies who died in a motorcycle accident or something like that, but they have a.

With their system there, they have more access to,  control normal tissue from patients that we just don't have here. 

Tim: Okay. So this is a call out there for, to donate your penises to science so we can learn more about this. Okay. And so another. Big part of the research that comes up. And then I see in headlines and on, Oh, what's the one that I'm thinking of.

Well, it'll come to me, but I keep seeing headlines about testosterone and I noticed,  a couple of your studies had gotten into [00:31:00] testosterone and, and I think the general lay person thinks that, okay, well, If your testosterone's high, then you're gonna have more erections. And,  when I talked to Gonzalez, he, he kind of broke that down in a certain way.

And then I also had a neuroscientist guest on, and then she had other things to say about that. So, so what have you seen and what have you studied? Whereas with regards to SaaS throne, 

Dr. Johanna Hannan: So in where our interests in testosterone are more so focused on,  the lack of testosterone. So when. One of the most common treatments for men with prostate cancer is the first thing that their doctors will do is often put them on some sort of anti testosterone producing or binding drug.

And so they want to deplete them of testosterone to starve their prostate cancer of testosterone. And that helps the cancer shrink because quite [00:32:00] often, prostate cancer is very dependent on. The testosterone that these patients produce in their bodies. And so unfortunately there are adverse effects from these men who have a testosterone inhibition things such as,  they have a higher risk of cardiovascular disease.

 recently there's a study that just came out that showed there are high risk of fracture and. Erectile dysfunction is a huge problem for them and testosterone.  For the vasculature to relax and respond to nitric oxide, it needs to be present. And so what happens is you'll get a lot of vascular dysfunction.

So your blood vessels will become more. Contractile and will constrict more and impair blood flow. And then you'll also have a lot of fibrosis and atrophying happening. So the [00:33:00] penis will become more stiff and it won't relax as well. And so these men at times will be on this,  anti testosterone therapy for months and years.

I mean after their prostate cancer has been in remission. And, and there's this fear that if the testosterone comes back, that it's going to feed the prostate cancer and they're going to have recurrence. And unfortunately there was one study that was published.  I can't remember if it was in the fifties or the sixties, but it showed that if you gave it.

Testosterone back to prostate cancer cells that were growing in a Petri dish, it caused it to grow rapidly. And so now we have this fear that is men who are deprived of testosterone. If we get them back any testosterone, then it will be bad. And so. There's we're trying to [00:34:00] do more studies now to see if giving back very small amounts of testosterone is enough to improve their erectile function, improve their cardiovascular health without having a big impact on prostate cancer recurrence.

So we're doing this in the lab by castrating animals, and then we're examining what that castration does to their sexual function, so that their vasculature to the nerves that supply the penis. And then we're also trying to get back testosterone to see if we can improve function in those animals faster.

Tim: And you said animals, is this other animals other than rats? 

Dr. Johanna Hannan: No, we, I mean, we were mainly using rats, I'm just using it. 

Tim: Okay. Okay. Are there other animals that also have similar 

Dr. Johanna Hannan: vasculature structure or is it people will also use,  rabbits and mice as well? I try to [00:35:00] shy away from mice because a lot of our peripheral nerve experiments that we do.

 the ganglia is very, very tiny in a rat. So if you go all the way down to a mess becomes even smaller. So we use rats for the ease of collecting tissue and having enough tissue to do our studies.  but a lot of people have used rabbits as well. Again, we're even bigger. So,  It's a lot easier to do some of the experiments, but again, with the bigger animal comes a bigger price tag.

So it depends what your budget is like. 

Tim: Ah, right. And that would probably explain why there's not more primate research and that kind of thing. Okay. Well, I guess as you were describing what you're studying with testosterone, one thing that both of the other guests definitely agreed upon was when it's really, really low.

It's absolutely bad. It's absolutely. There's nobody disagreeing about that. What we run [00:36:00] into is there are,  varying opinions on what normal level of testosterone is and what high testosterone is. And if like, I suppose if the difference between normal and high would actually see an increase in erectile function.

And would that be something that you'd. Run into, 

Dr. Johanna Hannan: I mean, how high testosterone are we talking? People who are trying to become like Arnold Schwartzenegger using steroids to increase muscle mass? Is that the type of high testosterone you're referring to? Yeah. Yeah. So in that case,  I don't think. It's going to benefit erectile function.

We know that those men end up with a lot of testicular atrophy.  and as a result, they become infertile and actually may begin to develop erectile dysfunction. So too much testosterone, it's [00:37:00] not a good thing.  but yeah, if it's just indogenous levels of testosterone, I don't know if they have, I don't think that they would have a greater sexual function per se.

Necessarily.  

Tim: okay. And then how does it interact with the blood flow? Like how, why, why does it affect it? 

Dr. Johanna Hannan:  so on our blood vessels, we have receptors. That testosterone will bind to. And so when testosterone binds these receptors, it's actually going to trigger a cascade of molecules being activated and the release of nitric oxide and the vessels will relax.

So it can act directly on the vessels to cause them to relax. But then it's also important for general vascular health. So it's believed that,  [00:38:00] it will prevent without it you'll have more inflammation that can lead to damage to your blood vessels.  so in general, it's, it's going to promote vascular health, improve relaxation without getting into really, really boring.

Nitpicky cascades of signaling molecules.  that's, that's in general what it's going to do. 

Tim: Okay. Okay then. And that, that obviously, that makes sense. Hmm. And, and so is that pretty much the spectrum? What else are you studying besides diet exercise testosterone? Pew dental arteries. 

Dr. Johanna Hannan: And so, so I'm interested in a nerve injury.

And so, as I mentioned, these men who have prostatectomies their prostates removed or radiation to their prostates, [00:39:00] it frequently results in a neuronal injury leading to erectile dysfunction. And so one of the things that we do is that we're trying to understand. That progression of neuronal injury from the time of injury.

So we will mimic,  the prostatectomy injury by taking rats and we'll actually crush the nerve, their pelvic nerve or their cavernous nerve that supplies the penis. And so we'll do this bilaterally. And so this crushed mimics the same type of nerve entry that can happen when,  clinicians are performing a radical prostatectomy and.

So when clinicians are performing prostatectomies, they will use the retractors and they'll push the nerves out of the way in attempt to preserve them. But even this manipulation of the nerves can lead to crush or a stretch injury and resulting in erectile dysfunction. And so [00:40:00] by mimicking this and the rats, we can do a time course and we try and understand what's happening at that early stage, because if we can distinguish.

 certain pathways or drug targets that are up or down, then this is something that we could potentially turn into a treatment that you could apply to the nerves directly. When the patients are having their prostate removed in the hopes that you would prevent that whole damaging cascade of events from here and preserve erectile function.

Tim: That's really interesting. Well, first I'm sitting here wondering, so how do you crush that tiny little. Thing without what are you 

Dr. Johanna Hannan: use? Use microscope and very small, fine forceps. And so we'll just take our forceps, we'll find the nerve and then we'll close the forceps as hard as we can on the nerve for 15 seconds at a time, three different times.

And so we're in, we're done. You'll [00:41:00] actually, the nerve is typically. This little white line, but when we're finished crushing it, there'll be this little clear part within the nerve. Almost like a little dent with no white, but it'll still be attached. So then we can look and see how the nerves can regenerate back across this little gap that we've created 

Tim: and is anybody getting them to do that?

Dr. Johanna Hannan:  the basic science experiments have actually been very successful. I think. The problem is they haven't translated into clinical success as well. So commonly when we're using rats, we, because it's more cost-effective we tend to use very young animals. And so one of the issues is in these young animals, when we do these very specific nerve injuries, If we were to leave them long enough, they will regenerate their narrows on their own.

So a [00:42:00] lot of these studies where they're doing different types of,  neuro regenerative therapies that are trying to. They get to the clinic like injecting STEM cells or using shockwave or,  amniotic fluid or whatever. Your favorite type of regenerative medicine is hemp.  they're very successful in that, but the rats are young.

They it's an ideal. Controlled environment. The frequently we are seeing that we're able to recover function. And I think the issue is we're not doing these in older animals or animals that have underlying disease like diabetes or hypertension though. The experiments in the lab are working really well, but they really haven't translated clinically.

Tim: So I meet a bunch of guys who. Say [00:43:00] that they have,  pudendal nerve injuries and something. When I, when I read about that, I have noticed that there is a disagreement on how to test for that on how to see that. Is it something that we can. Definitely see with some kind of an ultrasound. 

Dr. Johanna Hannan: So when you say pure dental or nerve injury, do you mean more from a like hip fracture or bicycling or?

Tim: Yeah. Bicycling is one of the common ones where it sounds like sometimes that conclusion is. Inferred versus actually seen. Is there something that when there's that kind of nerve damage that would show up and we can say, Hey, that's a damaged nerve. 

Dr. Johanna Hannan: Mm I'm not sure. I don't know what the tools are for that.

Tim: Okay. Okay. But, but in a rat. You could see it. And it's just, it's really clear. [00:44:00] Okay. That forcep 

Dr. Johanna Hannan: worked. Right. So it's, I mean, it's different. Have you actually done the injury? If it's, if it was a stretch injury or if it was something that we weren't opening the animal and doing to the animal and seeing where we were doing it?

I don't know that we would actually recognize.  that there's an injury there. And so this is a little different because we're actually opening them up. We know exactly where we're doing the entry. 

Tim: Right. And so if, if they had that kind of an injury coming into the experiment, you might not even be able to spot it like, right.

Yeah. It'd be unlikely. Cause you've had them since birth presumably and you would've known if they would have fallen or something like that. 

Dr. Johanna Hannan: Okay. Yeah. I mean, I think the rats are pretty resilient, so we don't have any of them cycling yet. So.

Tim: All right. So do you have any. Any, any,  [00:45:00] insight as to the future of this kind of research and what we can expect to see 

Dr. Johanna Hannan: that there's a lot of potential in the regenerative therapies. So there are clinical trials going on for,  STEM cell therapies. That are happening across the country. I think we're, we're still in the early stages for a lot of them.

The nice thing about them is that you can take, you can isolate STEM cells from those, from those patients, whether they're bone marrow derived, or from there. Fat tissue and give them back to the patients. So you don't have to worry about immune responses and they're their own donor. And I think that there's a lot of potential there for these therapies too, to,  give him more of a curative treatment to erectile dysfunction, because a lot of the treatments that we have currently, like the Viagra's there.

More of a band-aid than a [00:46:00] cure for erectile dysfunction. So I think that STEM cells are something that could really benefit these patients, give them a cure, uh long-term  improvement in erectile function. The other one that I think is very interesting and don't think that we have enough data on to really know.

How well it's going to work yet is shockwave therapy. And so the low end energy shockwave therapy, it's similar to the therapy that a urologist would use to break up a kidney stone. And so it just gets, it sends these little shock waves. Through the penis. And what they believe is happening is that these shockwaves are causing a little tiny bit of damage to the inside of,  the smooth muscle within the penis.

And this is going to cause an inflammatory response and then initiate all of these [00:47:00] growth factors that are responsible for going in and repairing the penis. It will also activate what we believe are these. STEM cell populations that are within the penis. And so they think that by giving these shockwave treatments, which are very noninvasive, the patient will come in and they'll just apply some ultrasound jelly to the penis.

And they'll barely feel anything as the shockwave is growing over their penis.  this is something that we hope has the potential to. Repair the damage that is present in the penis leading to better erectile function. 

Tim: Okay. And I've actually seen the video or videos for that, where. I guess a urologist would have been selling that service and giving a demonstration of, of what the process is actually like.

So this is being done and there, there are human volunteers for this 

Dr. Johanna Hannan: research, right? So [00:48:00] it is being done.  but I would caution patients that it is not yet FDA approved. So until we have clinical trials where patients are not paying for the service. Where they're either receiving placebo or they're, you know, a well-controlled double-blind appropriately run trial that can say without a doubt that this treatment is efficacious, it works that it,  that it's not something that people are just selling as a hoax.

Until we have that data. I would caution patients to be careful because there are a lot that are trying to take advantage of patients by trying to sell STEM cells or perform shockwave. And if you're not sure if it's not a re if, if it's something that's not FDA approved, there's no saying what it is that they're injecting into these patients penises, but they just need to be very careful.

[00:49:00] Tim: Okay. And that's a really good thing to know.  because I know what happens with a lot of guys is they get pretty desperate and willing to try anything. And,  You know, when you watch the video, it looks like no big deal. Like, Hey, there, that's certainly a lot less scary than a penile implant. And it's certainly a lot,  smoother than an injection.

And it's nice to not have to take a pill. That's gonna make you see your red and give you a headache. And,  it's, it's compelling, but let's be clear. There haven't, there has not yet been enough research. It's not yet FDA approved and we don't know, hopefully that's as promising as the science would imply, but it might turn out to not be an actually good treatment.

Dr. Johanna Hannan: Right. And we still don't know how, what the effects are going to be long-term. Is that something that [00:50:00] you're going to have to get done every six weeks? This is something that's going to last for six months. So there's still a lot, a lot of clinical research being done that hopefully we'll get the answer to that soon.

Tim: Okay, well, thank you so much. That's a, this is all very interesting. And I think, you know, I think there's a certain kind of guy out there who just wants to know that there is hard science behind some of these things that, that we report and share. And, and then I wanted to get into the nitty gritty of what it's like to, to study a rat and it's sex.

And, and so. People could have a little bit more confidence that know the science behind this is taken very seriously and it's, it's replicated and, and there are dedicated academics out there who are, who are doing this research and doing it well. So it it's,  you know, it's cause you, yeah. I mean, anybody ever, everybody's going to tell you, Hey, you should have exercise more.

 yeah, [00:51:00] but, but no, you really should. 

Dr. Johanna Hannan: Yeah, it's the same thing with the smoking campaign. When you told men that smoking gives you erectile dysfunction and they put all the nasty impotent like pitchers on the cigarette cartons, I think that has more of an effect than telling them you're going to die of lung cancer, or you're going to get.

High blood pressure. 

Tim: Right? Right. Absolutely. Okay. So,  thank you very much for this. This has been really interesting. And,  thank you for contributing to this hard conversation. 

Dr. Johanna Hannan: Thank you very much, Tim.

Shout outs to the sex positive community, including sex educators, sex therapists, sex coaches, other fellow sex, podcasters, sex, surrogates, academics, sexual health, medical community, sex workers, the tantric community, and everybody else with having hard conversations. Bye-bye.

If This Episode Resonated

If this episode spoke to you, there is a path forward.

Tim Norton provides a discreet, evidence-based therapeutic space where men and couples can understand the deeper systems behind desire, arousal, and connection. His work combines rigorous neuroscience with a grounded, relational approach to help clients rebuild aliveness in their bodies, strengthen partnership, and create lasting change.

How Meditation Can Improve Erections

Episode Overview

In this episode, Tim speaks with Irish author and meditation teacher Conor Creighton, who openly shares how anxiety, shame, and performance pressure disrupted his erections in his twenties and how intensive meditation practice helped him restore presence, confidence, and erotic ease. Conor’s story blends vulnerability, insight, and practical techniques for cultivating a calmer, more embodied sexual experience.

Listen to the Episode

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The Guest

Conor Creighton is an author, journalist, meditation teacher, and internationally published writer. His work has appeared in The Guardian, The Irish Times, and VICE. After travelling the world as a journalist and speaker, Conor trained in mindfulness and Vipassana meditation with the Dalai Lama and The Redwood Institute. His teaching integrates ancient contemplative practice with contemporary psychological insight.

Based between Berlin and Dublin, Conor is known for his grounded, humorous, deeply human approach to healing.

Website: https://www.meditatingwithconor.com/

Episode Transcript

Tim: Hello, and welcome to Hard Conversations. My next guest is Conor Creighton, who is a writer for Vice magazine. You write for all kinds of publications. 

Conor Creighton: Yeah, I do. I'm a, I'm a, I'm a gun for hire. 

Tim: And from his website, he also says that his work concerns the limits of story psychedelic States and buried intuition Sometimes it concerns other things. He is living in Germany. He's living in Neukolln 

Conor Creighton: Neukolln

Tim: Neukolln all right. I was kind of close [00:01:00] now or is going to share from his own personal experience with erectile issues. He's actually the first guest to do this on this podcast. And it's something I would like to do more often.

So if there's anybody out there listening, who would also like to share their own personal experience with erectile issues, then it could also be a partner of someone who's gone through this. We'd love to hear from you. Okay. Now back to Connor. Tell us a little bit more about yourself. 

Conor Creighton:  I'm 38, 10.  thank you first off for having me on your podcast.

And,  yeah, I'm 38. I'm from Ireland. I grew up in a small village in the middle of Ireland. It was very,  kind of classic. Fairy tale, Irish upbringing raining all the time. There was a local priest who lived at the corner from us, the, this,  a tiny little village with ghosts and goblins and, and way too many bars.

And [00:02:00] I quickly left that place when I was about 17 and, and started to started to travel a lot. And. And kind of like, like anyone I suppose, is who's grown up in a very small village where they felt like an outsider and I couldn't get enough of being at, in the world. And, and the more I traveled in, the more I realized that, you know, Bennet been a skinny ginger kid with Francos.

Was considered attractive in other parts of the world. So,  that, that obviously like spurred a lot of the travel on. And then I got into, I got into writing at a year. Right. And, and understood pretty quickly that being a freelance writer suited very much. So this whole,  nomadic lifestyle and that's, that's kind of what I've continued to do since then writing books and, and journalism.

Tim: That sounds I can see why you're a writer. I really liked the way that you [00:03:00] described that. And you know, I'm actually dating somebody from Ireland and as I, I don't necessarily think you would know her not going to give her name on air or anything. Like maybe we can talk afterwards and see if you guys know 

Conor Creighton: we have, we all do know each other, funnily enough.

It's at some point. Yeah. 

Tim: Yeah. Okay. So somewhere in that very storybook upbringing, you started to learn about sex. 

Conor Creighton: Yeah.  well, and it very much, it was an odd autodidactic experience because,  the only sex education that I received growing up was actually from a non. And,  the school that I went to, we had, we had nuns who told us a lot of the time.

And we had a nun who took us for,  a class instead of sexual education, which was very abstract. Do you know it, there [00:04:00] was nothing that they never really actually talked about sex. I remember it was one session and we came out from we, we, we watched this strange compilation video. And we walked out of the classroom afterwards and looked to each other and say, did we just get sex education?

And none of us really knew. And I know for myself it was, it was very confusing.  I, I became very, very sexual at, I guess, of at the age of eight, you know, or. And even younger, my, my father used to buy these,  tabloid newspapers, which had page three girls in them. And I don't know if in the U S you have that, but it's a very, it's a very English thing on page three, there was always a picture of a topless woman.

And,  it's kind of like an English cultural staple, you know, these, these tablet papers. And I used to, when my parents weren't at home, Because they, they keep these newspapers to like the fireplace [00:05:00] with, and I would just rummage through these papers, looking for what I used to call booby girls. And,  I re I remember just, just getting erections and not really knowing what erections were,  up until I think about what would have been, I think maybe nine or 10 when.

I spontaneously. 

Tim: Wow. Without masturbating yourself. 

Conor Creighton: Yeah. And then w was it w I felt like I, you know, hemorrhaged or something, I remember being a little scared by thing. 

Tim: And was this before or after the talk with the 

Conor Creighton: nun? This was probably before to know this. I think this was maybe before this preempted, the nun and yeah, there was.

And then, and then after that, you know,  realized that, Oh, I could also do this with my hand. And,  that sort of came to me [00:06:00] very instinctively bizarrely enough. And,  yeah, but it was, I, that was more or less,  how, how sexuality,  how I grew into my sexuality, but, but it was also,  we, we were told, you know, my mother was very, my mother was a fundamentalist Christian and still is, and,  When I go to these Sunday school meetings and we, you know, we re, we were told a lot about this idea of impure thoughts and the dangers of playing with yourself and how it was,  you know, a carnal sin to, to spit your seed and these things.

So I just remember that first. It took me the best part of a decade and a half to learn, to be able to masturbate and not feel guilty afterwards. Wow. Yeah. 

[00:07:00] Tim: And th that guilt, was there any description of what happens to people who masturbate. 

Conor Creighton: Well, well, I guess there's always, you know, within the Christian faith, there is always that great big,  there is always hell, you know, looming in the distance.

 so, and, and even though kind of at a, at a, at a young T as a teenager, I already started to move. I stopped going to church and, you know, rebel that it against these things. I was very, very much conditioned.  from the get-go to this idea of, well, death is a judgment. And if you haven't followed these rules, especially the rules regarding like your, your thoughts.

And you can imagine Tim, like a therapist, he knows that as a teenager or just as a young male, I mean, all of your thoughts are in pure Jim, do you know what I mean? Like, like,  [00:08:00] Some curved fruit gave me a record. You know what I mean? It was, it was, yeah, it was nonstop. So,  it was very confusing anyway, this idea and this thought that I was somehow making Jesus who I didn't particularly have a relationship with, but had a kind of an historical respect for,  that I was making him upset.

Tim: Hm. And, and, and think this is the common story that we hear of, of growing up Christian or Catholic and, and, or really any religion and just it being shut down and sexual thoughts being impure. And it's interesting that. The nun even tried. Hey, have you ever made sense of what she might've even had aspired to be saying, 

Conor Creighton: but I, it was,  I, I feel it I'm I'm I can't [00:09:00] remember, but I'm sure it was very uncomfortable for her too.

Yeah. Yeah. When you consider it,  she like, she was very much the wrong person for that job and, 

Tim:  Yeah. Yeah, but I mean, she probably was working within some pretty strict parameters of what she even could say. Like, I doubt somebody, anybody in the other class got great sex education. 

Conor Creighton: Yeah. Completely. I mean, and it sort of, it,  you could see how it played out.

I remember when I was,  in the Irish school system, we have a kind of,  at the age of 15, you go from one level up to the next level. And then you go into say like, I suppose you become like a senior high school student is what you'd call it in the U S and I remember after summer break at the age of 15 coming back, and it was maybe half a dozen girls were no longer in school.

I knew you'd ask around and you go, where did such and such go? And where did such and such go? And they don't become pregnant moms. [00:10:00] And so they dropped out of school and,  It was very strange. We'd we'd refer, we talk about pregnancy as like catching a cold, you know, like where you can't, you don't know when it's going to come to you.

You know what I mean? And this was the sort of,  the limits of our understanding of how you could plan a pregnancy and so on and so forth. 

Tim: Hmm. And this wasn't like that this wasn't like the fifties, 

Conor Creighton: it sounds like , this is the nineties like this, this is the nineties in rural Ireland. And Ron. Yeah. 

Tim: Okay.

Well, so presumably at some point you decided to involve other people in your sexuality. Yeah. And so what was there like a first kiss or a first encounter? There 

Conor Creighton: was, yeah, there was a couple of first cases and a lot of say this,  kind of dry [00:11:00] humping and so on and so forth, but,  How old, like 14, 15, 13, that, those sort of ages.

And then I, so I left home when I was seven a team. And,  I, I ended up, I took a job in the, in the Swiss Alps where I was just running a little,  hostel up there, you know, and making beds and washing dishes and so on and so forth. And,  I, I lost my virginity there. On the top of a 9,000 foot mountain, which is beautiful, which is, which is pretty Epic.

But that was when, like coming back to the subject of the show. That was when I realized that sex was one of the scariest things imaginable and, and,  I lost my virginity to a much older woman and. [00:12:00]  bizarre kind of traumatically enough. Like it was, it was someone who I really, really cared about. And that was when I realized for the first time that Whoa, getting erections, isn't the easiest thing in the world to do.

Tim: So let's, let's back up just a little bit until that point.  even in the dry humping, had you ever noticed any issues with erections or 

Conor Creighton: no, no, no, not really, but I mean, no one had ever,  no one had ever like touched my Dick before then. You know what I mean? I've never had a hand job or a blow job or anything like that.

So it's a little bit like I kind of.  I skipped a lot of the intermediary stuff and went straight for. The super bowl. I'm sorry. 

Tim: Yeah. And I'm, I'm asking so many questions in part for the listener to get an [00:13:00] idea of how I might start talking about sex in, in a, in a regular sex therapy session. Like just, you know, making sure not to,  Skip over any of the details?

I, yeah, I would also have asked you earlier on, in, in,  in a talk, like, had you ever experienced any sexual trauma as a little kid or anything like that along the way? No. Nothing. Nothing. Nothing. Okay. Yeah. And, and then you saw the, what were they called? The, the page three. The magazines. Okay. And was there any,  Video porn around guy house that you had access to.

Conor Creighton: I didn't have a TV until I was about 11 or 12. We were, we were, we were quite, we were quite poor. So, and then, and then I remember,  I think I got a computer when I was about 16 and, but then, I mean, there wasn't, we weren't online on that computer. So there wasn't really. There [00:14:00] wasn't any sort of visual. I remember at school, there was some guys that had a collection of pornos that they would distribute and stuff like that, but I never, I never got my hands.

Tim: Okay, so, well, I'm just thinking about your eventual journey to writing for vice. Like there's a very pure, very innocent,  17 year old who ends up on this 9,000 foot mountain. And,  the very first time you tried to have intercourse, you had erectile issues. 

Conor Creighton: Yeah, totally.  I was,  I mean, I've, I feel in some way,  Blessed when, and that I lost my virginity to someone who I had a huge crush on you.

You know that though, and someone who,  is still is still a friend and,  and someone who kind of really [00:15:00] inspired me, this was just an incredible woman who,  traveled around the world was a vegetarian was very,  Was, it was a huge adventure read Jack Kerouac and all these sort of people. And she, she really kind of influenced so many decisions I made.

And then I think when it came to us actually kissing, I was so blown away that this person was actually kissing me. And then when it came to us having sex, I was guessed. I was so caught up in my head. And the,  performance anxiety that it was, I didn't know, there was all sorts of weird things with condoms and, and it, it wasn't, it didn't seem to work out.

And then it worked out for a second. And,  I remember having a moment where I kind of a little out of body experience in the middle of it, where I was thinking Connor you're having sex. You're finally having sex. And [00:16:00] then instead of replying to myself going, but. Why is it not fun?

Tim: Huh. And so you're struggling with the condom and penis is it's hard and then it's not. Yeah. And then it just doesn't happen. And how does she react? 

Conor Creighton: Well, I, I think again, and this is perhaps the beauty of,  Having lost my virginity with an older woman is that I, she, we didn't talk about it.  but she just sort of, I think she then just kind of finished me off with her hand.

I think that's how it, how it ended up happening. Okay. And then that was kind of the end of that, you know, we didn't, we didn't do that again. 

Tim: And so what was your. Feeling afterward. I [00:17:00] mean, you still, like, it was still your first hand job. That's really nice. But was there embarrassment? Was there? 

Conor Creighton: Yeah, I mean, it was,  it was really tough to him because I remember I had, I was completely infatuated with this person.

And,  understood that this was, Hmm. It's something that I wasn't really sure. I wanted to try and do again with her. You know what, I'm not sure I want to bring it to that level again, because what if that happens again? And so probably. I guess at that stage, that's when I would have started to,  act a little aloof, you know, in, in my defense.

And,  yeah, I guess I [00:18:00] was, I guess that was pretty devastated by, you know, Cause it was, it felt like a moment of victory. You know, I, I lost my virginity, you know, there was even if, even if I didn't do it in style, I'd still done it, you know? And, but at the same time, wasn't so sure that I, you know, I'd lost my virginity, but certainly it hadn't been this,  Epic occasion, you know, it had been more scary than it.

Tim: And then did you guys continue to see each other out there? Not really. Cause 

Conor Creighton: she, it, it all happened on a last night. You know what I mean? It was a classic,  I'm leaving because she, she was leaving the mountains that day. And, and then that was the end of it. Hmm. 

Tim: And did you get the sense? I mean, did she know you were a Virgin?

Conor Creighton: I bullshitted her and told her that I wasn't. [00:19:00]  but I don't know. I mean, maybe she got the idea, maybe she understood. I'm not sure. 

Tim: And so by that point, though, you. You had seen some porn somewhere. You, you did have an idea of what you were supposed to do. 

Conor Creighton: Yeah. Yeah. I have. I've watched some, you know, we used to, I remember when I was 16 or so actually this, this is kind of, I used to,  friends, we'd kind of at weekends, we we'd watch, we'd sort of have sleepovers and we wouldn't watch porn, but some would have.

 some would be able to pick up German TV stations on their cable packages and you'd sometimes see like soft core movies. And so I, I mean, I knew the rudimentary fees, if not really. I, I not, I was, I wasn't deft or [00:20:00] anything, but I, I knew that I knew the basic biology. Yeah. 

Tim: Okay. And so it was very clear to you that what happened between you and her was not what you saw in the movies and, yeah, exactly.

Yeah. Okay. So then when was the next time you tried to have sex with somebody? 

Conor Creighton:  I think there was, there was a bit of a gap then I think because,  And I actually, I remember I, the next girl I went out with,  was a Virgin and didn't want to have sex. And in some ways I think that's sort of suited me because I could, I could put it on her, you know, and I can see that guy I wanted, but, you know, she was, she won't.

And,  and so we just, like, we made out a lot and then,  Yeah. And then I [00:21:00] guess a lot of the next set of sex occasions that I had were when I was really drunk. A lot of, I guess, from the age of say 18 to 26 or so, just had a shit ton of, of drunk sex. And,  I worked, I worked as a bartender and I used to work in nightclubs.

And there was just a,  there was just a lot of, and I, there was just a lot of, of that sort of this very, what can I say, not loving sex, you know, and very sort of casual,  casual hookups. And I think the, the, the thing that I noticed at that stage was that. Sometimes,  you know, sometimes I, I could have sex and it was fine.

And [00:22:00] then sometimes I couldn't, but because, because we were always drunk and we used to take, there was also like a period in Dublin where there was a lot of,   everyone was taking ecstasy. And MTMA, and there was just a lot of drugs around, and it was a big party scene in Dublin at the time. So there was lots of,  it was kind of a common cliche that if you say, if you took ecstasy, sometimes you'd get an erection for a very long time, or sometimes you wouldn't get one.

And so it was a great,  for me, I find that period was a great,  I always had a great excuse. If I brought somebody home and I couldn't have sex with them, that I would just say, Oh, I'm too high or I'm too drunk. And I, it was a good way,  of set of not confronting, not confronting these issues. 

Tim: Yeah.

And so then [00:23:00] behind the scenes, are you thinking, are you worried. From 17 to 26, that, that you have a problem. 

Conor Creighton: You know, I was pretty much worried, nonstop,  but not just about sexuality. I mean, I was an extremely anxious person. I actually, I suffered a lot from anxiety in my whole, my childhood, and just had a very,  Overactive,  worrying muscle.

And that, that was so all of these things seem to kind of,  unite into a kind of a. A a force for fucking open my life for want of a better word. And so,  yeah, I, I worried, I worried a hell of a lot about us and, but what, what [00:24:00] really, the hardest part was that there was a couple of occasions where I really met very special people and wanted to have relationships with them.

And how had similar feelings for these people that I had with the, with the woman who I lost my virginity with, but was just kind of, it was a combination of being like too intimidated by what might happen sexually. If we were to have loving sex, you know, if we were to have a real sexual connection, a second, a sober sexual connection.

And, and so I feel that in my early twenties, there was a couple of amazing people who I met, who could have been super powerful, who mentioned on my life. And I had to, I had to kind of pass them by or avoid them. And even on one occasion, there was, there was an amazing woman. I met who, and we, we did finally end up [00:25:00] together and I was just.

The occasion was just way too much for me. And I couldn't get an erection. 

Tim: This is a really devastating story.

Okay. Don't don't don't give up yet guys. Alright, so, okay. So in the meantime, and do you suppose that you were all along drinking to the point. Of like the drink was actually even to quell your anxiety as much as have that excuse, was 

Conor Creighton: it? Yeah, I mean, I definitely had a lot of alcoholic tendencies and my dad's, my dad's a recovering alcoholic and they just, as, as, as the classic Irish family, you know, there's, there's a lot of alcoholism coming down through my genes and I being sort of very socially anxious to [00:26:00] alcohol.

Alcohol was great, you know, I couldn't, and it allowed me to talk to women in a way that I couldn't really before and allowed me to kind of come out of my little anxious shell. And yes. So, and then kind of, you know, you can imagine sort of, you know, in these formative years dealing with a couple of hundred hangovers a year, And, and trying, and sort of, you know, stumbling through the dark lines of depression and long winters and, and the many sort of just, you know, being, being poor and living in these sort of squat homes and this sort of existence, it was, it was no,  it wasn't the most conducive place for, for becoming mature and reflective and dealing with your shit, I guess.

Hmm. 

Tim: So it, at [00:27:00] some point there's a transition. 

Conor Creighton: Yeah. Well,  I guess,  there was whether it was another day of a thing that happened in the middle of all of that, where I started to, I S I started to fix myself. Okay.  not at an emotional level or not at a psychological level, but at a, at a purely technical level.

So I, I went to a doctor to talk about erection problems, but,  and was prescribed by Agra. Okay. And,  how 

Tim: old were you when this happened? 

Conor Creighton: Maybe 1920. 

Tim: And so until that point, had you spoken to anybody else about this, about erections, nobody, guy friends or no. 

Conor Creighton: Well, I didn't, I mean, there was some,  in bars that I worked at, there was some banter, you know, and every, so often some guy [00:28:00] would.

Would admit something like, Oh, I brought certain search home. I mean, we were horrible the way we tell we were, we were brutes, but someone said, Oh, I brought some at home, but I was floppy. And yeah, a little part of me would look and go, I, can we admit this? Are we allowed to say this? And I wasn't admitting it myself, but I was like, wow, that's all right.

We can other people, this happens too. But it only, you could only,  it seems like sort of only the most.  only the guys who are so entirely comfortable with their, with their sexual performance could admit to not being able to perform. Hmm. And,  but, but for me, like it was, there was no way I could talk about, and yeah.

So, so instead I went to a doctor and the doctor didn't really, I remember the doctor didn't really talk to me so much. I think he was just very quick to prescribe me Viagra. 

Tim: So if [00:29:00] you're 38 and that was 17 years ago, so Viagra hadn't been out very well. No, 

Conor Creighton: I don't think so. No. 

Tim: And so how did that work out for you?

Conor Creighton:  well, this was, this was all tied into this.  it, it had just come on the back of,  that, that story that I told you, that this, this amazing woman who I met and then I blew it with, because we spent.  two nights together and both nights I couldn't get erections and just, just wanted to die. You know, really was, there was, it was probably one of the lowest points in my life.

Just lying in bed and feeding. So,  just feeling so inadequate and. Then trying to, I think it's always the funniest thing that when you kind of with maybe some of your listeners know about this, that, [00:30:00] that awkward transition from when you've been trying to have sex with them and encounter sex at summit, and then you want to change the subject.

And so you, the, you, you try to switch to lighthearted conversation or you suggest food or let's watch a movie or these things, and it's, it's. I didn't know, there's nothing can really compensate for sex in that moment. There's nothing you can offer. At least from my experience. There's nothing that you can offer a woman when you haven't been able to like fulfill her sexual needs.

That will make up for that. You know what I mean? Maybe it could be like, Hey, how about I let's go on a holiday for a week to the Caribbean and she'd still might be add, I don't know. No. 

Tim: Yeah, it's,  that's, that's always going to be an awkward situation. 

Conor Creighton: So that, that kind of, that was very much a catalyst for me.

And that's what made me go to the doctor, even though I was, I was terrified to go to a doctor and talk about this. And so I went to adopt her and I got play [00:31:00] Agra. And then rather than do the, kind of the, the collaborative thing, I guess, and, and go back to this woman and talk to her about these things. I instead ended up using it on someone else.

Who I didn't care so much about, but there was less anxiety involved. And, and that was, I remember that situation that we were in a bar together. And I, I knew that this person liked me and I knew that I could have sex with them. And we were all sitting around this boat together. So I, and I took it the Viagra.

And I remember within like already within the first 10 minutes, I could feel like blood, like just. Flushing throughout my whole body. And I could feel myself heating up and,  my cheeks became very red and even my tongue felt big in my mouth and I had an erection. And it was a [00:32:00] real like school boy erection you the kind of your, your side of your desk and you're going shit, please don't pick me.

Please don't pick me. It was that kind of erection where I just thought, Oh, I can't control this. This is too big. And I remember just sitting at the table and,  Realizing that, that this interaction would not have. And I, I think, I think I ended up doing some little gymnastic maneuver where I kind of, without being noticed, reached into my jeans and pushed my penis up so I could took it onto my path to something.

Cause it was just, I was, there was no way I was going to be able to stand up without everyone seeing that I had a big erection and,  Yeah, w we ended up then w w I, I quickly convinced her to come home with me and we, I remember like I [00:33:00] just having sex for hours and hours and hours and never coming. And at one stage, like going to the bathroom and putting cold water on my penis.

And I remember being very worried. Because I've never, I actually, I actually had visions that this thing was going to burst because it was so full of blood, which again was just my overactive imagination.  and, and, and my runaway anxiety, but it, it,  it was, yeah, I guess I wish that someone had told me, you know, that you can take Viagra in quarters or halves.

Instead of like taking the full, I don't know, 20 milligrams or something. I think it was in the tablet, which was, which was enough to, you know, to make, to, to launch a battleship here. It was, it was a huge dosage. 

Tim: Yeah. And [00:34:00] was this the thing that you talked about in your article where it actually did last for nine hours and it was painful at a certain point?

Yeah. 

Conor Creighton: Well, I just, I remember waking up in the morning and I was still a wreck. And, you know what I mean? And I'm going to the bathroom to pee. And I was that ho how am I supposed to piss with this thing? And I had to pee into the bathtub. Do you know what I mean? Cause it was just, it was flying in here and  yeah, but at the same time I was, I had lots of, lots of sex with this person.

So it w it felt like it was very good value for money that, that biography, and,  so in a way I was like, okay, what I've kind of I've it, it felt it's, it's some sense of that, that I now solve the problem, at least temporarily, at least technically. 

Tim: Okay. [00:35:00] And then did you continue to have sex with other partners with the Viagra?

Conor Creighton: Yeah, so yeah, I found the, kind of, what would happen is that maybe the first couple of times that we had sex together, I'd be very nervous and anxious with a partner. And then I would maybe take a half of an Agra or,  but then once I got to know them, I didn't need it anymore. So once I became, I mean, it was totally about me and it was totally about my levels of anxiety.

And so maybe after we'd had sex once or twice, I wouldn't need it anymore. And,  what, what that, so I wouldn't, I wouldn't take it anymore. And so what, what that would, what that then kind of did, is it sort of established a pattern in my life of real, like a serial of being a serial monogamous. Monogamous.

And so when I, basically, when I would find someone and the sex would [00:36:00] work, I would date them. And even, even sometimes when I wasn't really, you know, it didn't really feel that much love for the person, I would say, well, no, the sex is working and you need to get over whatever sexual hangups you have. And perhaps the best way to do that is to be in a monogamous relationship with someone where the sex works.

And my hope was always, then that I would,  by getting lots and lots of practice of functioning sex, that it would, it would, it would kind of cure me. But what actually happened is that when the relationships would break down, I then go into another relationship or I would just. Be hooking up with people and all of the erectile dysfunction would come back again.

Tim: Hmm. Okay. And then at some point you discover meditation. 

Conor Creighton: Yeah.  it, it was, [00:37:00]  I guess in my, in my early thirties,  I was engaged. And to, to an amazing woman. And we, then when we start,  we had our sex life was very healthy. It was very functional, very loving, but,  we started to break down, our relationship started to break down and it was,  I just remember being hit with this idea,  this huge.

 wave of disappointment. I just disenchantment with love because I've been very, very much in love with this person. And now was no longer in love. And I, I guess I, since, since walking away from Christianity and all of these sort of faith based my faith based youth, I put an awful lot of,  [00:38:00] expectation on the thought that like love was the one important thing on the planet.

And that when I find love that will complete me at some stage. And this was a person who I thought had completed me. And when I love started to fall apart, I just remember being so depressed. And, and in the last few weeks, while we were breaking up and while it was obvious that we were breaking up, she started to use it.

She started to meditate and,  I'd watch her in the house meditating and I would in a very child is resentful way would be that. This is, this is exactly, exactly why we're breaking up. Cause you can't do with the real world. Look at you just off there with your eyes closed. And, and then when she, when we did finally break up, I was, I then went and looked into meditation myself and,   started with the Headspace app.

[00:39:00] And, and then, and then from there, you know, at, even the first say just the first five minutes session I did, I felt peace and I thought, Oh wow, this is a way to,  this is a way to stop the thoughts and this, this is a way to deal with that onslaught of anxiety and worry. You can actually control them if only for 10 seconds or 20 seconds, I can still control these thoughts.

And that was the first time that that ever happened in my life. Before that I could control the thoughts. And just, just as an aside, the thoughts were the thing that would torment me. What I was trying to have sex. I'd be trying to have sex with a person and I will be. All of my, like my favorite worries would, would gather together and just scream at me.

Tim: Can you give some examples? 

Conor Creighton: I've [00:40:00] been worried about money since the age of four. Yeah. Like huge security fears, or then worried that,  I was a sham. I couldn't actually Bryant and I'm like, what am I doing? You're faking it. Or I didn't know. I spent a lot of, in my younger years, I. I spent a lot of time working in factories and working on building sites and so on and so forth.

And I was, and the worry would come back and be like, well, maybe that's your level. And you have to go back to that. Brutal, you know,  maybe you're sort of, you, you, you you've, you've gone too close to the sun. Do you know what I mean? You're, you're, you're a working class kid. And what are you doing?

Hanging out in this art world with journalists and traveling and so on and so forth. This isn't your place. 

Tim: And with these kinds of thoughts, pop in your head during sex too. 

Conor Creighton: Oh, I think pop into my head when I was getting a blow job too. You know what I mean? It's sort of some of the most pleasurable physical things that I could be doing or receiving, and I'd still get [00:41:00] tormented by this idea of, or, or even things that say, I mean, I had a very, very strong ego at that stage.

So if it was very. Had lots of rivals. So there was different men who I would,  compete with. Do you know, and I would see their online profile and they did something like this and I would go, Oh, dominant. It would put me in a bad mood. And so little things like that. And you know, I've been there with the woman I love and she's miraculously has her mouth on my penis.

And I'm thinking about some guy who's published an article somewhere.  He made some analogy and I'm going, damn, that analogy was so good. And it would torment me, you know, and, and there I'd be like, it would take me, I don't know, a quarter of an hour to ejaculate from a blow job or something, because I was so caught up in these petty [00:42:00] rivalries and ego gangs.

Tim: Right. And just to clarify, you don't have a fetish for other men publishing articles that, that wasn't something that 

Conor Creighton: turns you on at all. I don't think so. Maybe, maybe we should cover that in the next podcast. 

Tim: Yeah. But lots and lots of very. Unsexy thoughts,  intruding, maybe we call them intrusive thoughts.

Conor Creighton: Yeah, totally on uninvited thoughts, 

Tim: uninvited thoughts. And so you go, you sit down with Headspace and you get your first 20 seconds of peace from 

Conor Creighton: these thoughts. Yeah. Yeah. And then you, you know what that did, to me, that was a gateway drug for me. It really was in that, after that,   that was that all it coincided at the time when I sold my first novel.

 and so for the first time in my life I had, I had a little bit of cash, you know, I [00:43:00] got an advance for this book. 

Tim: Can you plug your novel? What w what was the name 

Conor Creighton: called? St. Frank. Okay. And,  so. But what I had money and I said, okay, what I'm going to do for the next six months is I'm going to use all this money to heal myself.

So, and I decided to be just open-minded to everything. So,  I went to meditation retreats. I went on say, psychedelic drug retreats. I started to do yoga classes. I went to sound therapy and I went to lectures from different spiritual advisors and so on. And I just, I, I traveled a lot in this time and basically my, the emphasis on everything that I was doing was,  I'm going to get myself healthy and I'm going to explore [00:44:00] the, the, the inner mechanisms of my mind.

And,  I, I became, I became vegetarian. I tried to limit my alcohol intake. And then, and then I finally, I stumbled upon this, this,  ancient meditation technique, which was originally taught by butter and it's called personal. And this is,  it's it, it's a 10 day silent meditation retreat.  which, which basically teaches you.

Through this very,  simple, but, but intensive meditation technique, it teaches you kind of how to rewire your brain and, and see things as they really are. And,  ma it's, it's become quite popular recently because maybe, you know,  Yuval Noah Harari from homosapiens. This book and yeah, it was he's, he's a teacher in this, in this field of your past and he teaches [00:45:00] it.

And so he's popularized it a lot recently. And so I started, I did my first, one of those and now,  and since then I sit maybe two 10 day silent retreats a year and I meditate between an hour and two hours a day. And.  what,  what what's happened since I started with this meditation is that it's become very, very good, easy for me too.

Drop the things that are no longer serving me in my life. So for example, I, I, I quit smoking after my first good pass then I, I just didn't want a cigarette anymore. After the second to last minute, I quit alcohol. I mean, I never imagined that I would. Ever have a life without alcohol. And then, and then other things like my, I quit these ego games as well.

Of course they come [00:46:00] back, you know what I mean? The ego still wants to be fed, but the idea of comparing myself to other people all the time, that kind of drifted away. And even my style of writing changed when I, when I first started to write for advice, I was very obsessed with being clever and being funny.

And quite often, you know, had no problem in taking the piss out of other people or undervaluing other people for the sake of a joke. And that'll change. I mean, I kind of, I kind of ride that anymore. And, and so I started, my style of writing started to change and the things I wrote about started to change.

And that's when articles like the one that I wrote about meditation and erectile dysfunction came about. Like, I think without, without all the experiences that I had in that period, I would never have had the balls. To open up about a problem like that and certainly would never have [00:47:00] published it. Wow.

Tim: That's really powerful. 

Conor Creighton: Yeah. Yeah. It's, I'm, I'm so grateful to, for I'm so grateful to everything that happened in my youth, that kind of, I was, you know, it had such a struggle that would bring me to such extreme, to such an extreme solution, which then,  paid off. So, well, I needed the benefits and, 

Tim: and now how's your anxiety in 

Conor Creighton: general?

 I don't really have anxiety anymore. 

Tim: Yeah. I, when you first described it at the beginning of this interview, and then how you, you grew up anxious. I was thinking. So some people just hide it really well because this guy seems really, really chill. And I know it's, it's seven 30 in the morning in Berlin, or by now it's almost eight [00:48:00] 30.

And so I was like, maybe he's just kind of groggy in the mornings, but this is not an anxious person. 

Conor Creighton: No. So, but, but, you know, I mean, my,  my dad used to always describe me as a duck. And he would say, there you are on the surface of the water. You know, you're still in your calm, but beneath the water, your feet are going a million miles an hour.

And,  yeah, I, I think I've always just been the baby of the family. You, you, I mean, the baby of the family as I was the actor. Right. And they're always the comedian and that's the only way they ever get attention. And I think I learnt.  I mean, I grew up in a house with big, big personalities who sucked up all the attention.

So I, when I cried out for help, I didn't get it. So I quickly learned that the best thing for me to do was to, to fake being okay. And, and that sort of, that carried me throughout most of my life. So I, most people would [00:49:00] have never been, I got the impression that I was an anxious wreck. Okay. 

Tim: Yeah. And now you're not faking it though.

You're you're pretty 

Conor Creighton: calm. No, I like,  I would say on my piece, you know, very much at peace. I'm the, not the, not that I don't have issues every so often or that there's it, I'd still sometimes hard for me to make decisions, but,  But I'm I'm. I used to have anxiety that would attack me and all I could do is just lie on the floor.

You know, we get to the, or I would have moments where I would leave the house to go somewhere and halfway there would just be gripped by tight sensations throughout my body. I'd have to turn around and come home again. And really, it felt like the anxiety that I had at that time, it felt like it was a kind of a hand.

Wrapped around [00:50:00] my body that could pull and push me for whatever it wanted beyond my control.  and I was extremely nervous socially and so drank all the time. And,  now and now it's kind of, for me, what I just noticed as a med, like I, I still have an awful lot of,  older friends from my drinking days.

And I still go to bars with them all the time, but I drink alcohol free beers and, and I I'm, I'm always amazed by that. There's sometimes I'm sitting there and I'm drinking an alcohol free beer or I'm drinking a sparkling water or something. And I go, this is good. Yes. I could never have imagined myself this position feeding.

Okay. Amongst my peers who are all drinking beer and I'm not. And I can, I'm not quiet. I'm still like the loudest person [00:51:00] at the table. Do you know what I mean? I'm still in there, you know? Yeah. 

Tim: And so how has your relationship to sex changed and directions in your penis and all of that? 

Conor Creighton:  well, one of the big things,  that also that the meditation helped me with too, was it, it really allowed me to, to love a lot more.

You know, and,  it, it, it allowed me to first off love myself and I don't understand myself and accept myself and then, and then forgive myself. Cause you know, I was, I was a jerk for a long time in my twenties and. It wasn't always the best of boyfriends to the, to the partners that I went out with and was pretty selfish and used to use to castigate myself a lot about that.

But since I started to meditate, I understand. Well, okay. Of course you, of course you were a [00:52:00] gr like you were, you were in so much pain all the time. And so I, I guess I sort of, I mean, it's easy to forgive yourself for that, but the important thing is to not do it again. So it was a matter of, kind of forgiving myself, but then saying, okay, and that behavior is done with, you know what I mean?

There's no, you, you can't manipulate people anymore and you can't just go around,  treating people unkindly. And, and so I suppose since then,  I've,  the relationships that I've had have been much more kind of loving relationships rather than hookups. You know, and the idea of casual sex is I,  I'm single at the moment, but,  more or less, I've been meditating about four years now.

And the only relationships that I've had, I've been very, very much in love with the people [00:53:00] and it's and sexually it's been extremely helpful. 

Tim: Extremely. Healthy, sorry. 

Conor Creighton: Healthy. Okay. Not extremely healthy, just healthy, 

Tim: just healthy. I think you're my first guest to say that self love and acceptance and forgiveness might help an erection.

Conor Creighton: Yeah, I get totally, totally. Well, it just,  this there's so much as, as men.  our penises are often symbolic for, for the who we are as people. And if our penis isn't functioning, we start to think, well, as a mom, I'm not functioning. And, but when you learn to sort of let go of this,  penile emphasis and you let go of your attachment to the erection and, and even let go a little bit of the, the sort of, I mean, the diction always be [00:54:00] in the spotlight when it comes to sex.

You know what I mean? It's, it's a, it, it shouldn't always have a leading role, you know, it can also be a support actor. And so I guess what meditation and, and sort of maturity did for me is it sort of,  taught me that it's not all about this, and it's not such a big deal. And it just allowed me to be much slower in sex.

Like I remember when,  And the time of my life when, when erections were, did a bit random that if, when I was hard, my first thought was okay, we've got it. I got to get in there, got to get in there and do something with this now. And I think now as I'm way more comfortable and sort of, it's not that,  I know that I'd always get an erection cause there's still some times when I'm just, Oh, you know, I'm just not that into it right now.

But I think I have the, the [00:55:00] acceptance and the, just the presence of mind to be able to go, Oh, I guess I'm just not that horny right now, pipe, you know? And, and that's a, that's a wonderful way of kind of just dis releasing tension from the air. And,  and again, it's this idea of just deemphasizing, the penis.

Tim: Yeah, letting I loved how you said, let go of the attachment to the 

Conor Creighton: erection. Yeah, totally. Yeah. Or even Jackie lighting, you know what I mean? Instead of it's, there's this idea that, you know, we always have to come, I think is, is maybe a little bit of a it's inhibiting. 

Tim: Absolutely. And I think what a number of guests have talked about is you can still have fun.

You're, you know, you're presumably [00:56:00] now naked with somebody you care about, or if it's casual someone who you want to have fun with, and there's still tons of things you can do without 

Conor Creighton: an erection. Yeah, exactly. Yeah. Yeah. And I think it's, you got to come back to the fact that, you know, you're human and you're having a human experience here on this planet.

And if you can't manage to make that fun, then you're missing it. And the way to make it fun is to be a little bit easier on yourself and take away the emphasis and meditation has definitely allowed me to do that. Hmm. 

Tim: Very well said, Connor, thank you so much.  I think that's a really nice place to kind of wrap that up with that thought.

Very, very Buddhist. I can tell the influence. Yeah. You know, in Los Angeles, I've, I've met quite a few people who have done a [00:57:00] 10 day thing at some point. I still haven't still haven't gone and done it.  maybe, maybe that's on the horizon. So any what's what's next for Connor? Any we're working on a book or what do you, where can people find you on the internet?

Yeah, I mean, 

Conor Creighton: at the moment, the best place to find me, or just a Twitter or Instagram and at the moment I'm working on a book. So I, I, I ran a boys club for a couple of years in Berlin. So it was, it was, it was basically,  I realized that I was like, hold on. I want to, amongst my male friends, I wanted to have a more real talk with them and it wasn't happening.

And you know, when we we'd go play football together and stuff, and we didn't have this real talk or we'd go to the bar and we wouldn't have this real talk. So I set up the Berlin boys club. And we'd meet once a month in a friend, a friend of mine has a flower shop and we'd meet once a month in this flower shop after hours.

And I [00:58:00] said, the rules were very simple. There's no, there's no alcohol. And there's no banter. We have to talk at an emotional level about issues affecting us and our masculinity. And, and so I ran this group for about a year and a half. And,  now I'm trying to turn it into a book. 

Tim: Okay. Wow. Sounds awesome.

Conor Creighton: Yeah, it was, it was amazing. I'd really I'd recommend anyone to do it. It's very, it's very,  it's just a very healthy thing to do. 

Tim: Yeah. And when that book comes out, let me know.  is there going to be like a chapter on how to set it up? I mean, it seems pretty straight forward. Yeah. 

Conor Creighton: Yeah, exactly. What I'd love the book to do is I'd love the book to be a kind of a.

A guideline for other people to set up their own boys clubs. 

Tim: To, to spawn a revolution of new masculinity out there. 

Conor Creighton: Yeah. I mean, I was thought it was like, it's like fight club, but instead of knocking each other out, we, we poke each other, you know? 

[00:59:00] Tim: Yeah. All right. Well, again, thank you so much. Well, you said Twitter, what's your Twitter handle by name?

So Connor crikey. 

Conor Creighton: And 

Tim: then Connor Crighton and that's one N 

Conor Creighton: yes, C O O C R D I G H T O N. You can get me a Twitter or an Instagram, I guess are the two things. All right. 

Tim: Well, thanks again, Connor. 

Shout outs to the sex positive community, including sex educators, sex therapists, sex coaches, other fellow sex, podcasters, sex surrogates, academics, sexual health, medical community, sex workers, the tantric community, and everybody else involved with having hard conversations. Bye-bye.

If This Episode Resonated

If this episode spoke to you, there is a path forward.

Tim Norton provides a discreet, evidence-based therapeutic space where men and couples can understand the deeper systems behind desire, arousal, and connection. His work combines rigorous neuroscience with a grounded, relational approach to help clients rebuild aliveness in their bodies, strengthen partnership, and create lasting change.

Insights from a Sex Researcher and Neuroscientist

Episode Overview

Tim Norton speaks with neuroscientist Dr. Nicole Prause about what the brain actually does during sexual arousal. They explore penile salience networks, the impact of anxiety on erectile function, how pornography and partnered intimacy activate different brain pathways, and how modern neuroscience supports sensate-focus techniques. This episode brings clarity to one of the most misunderstood areas of sexual wellbeing.

Key Themes

• How testosterone really relates to erectile variation

• Why the body drives testosterone as much as testosterone drives the body

• The effect of anxiety on erections and why mild stress can be beneficial

• What neuroscience shows about porn versus real-life intimacy

• How sensate focus aligns with neural activation patterns

• Penile salience networks and brain-based arousal mapping

• What neuroimaging reveals about desire, attention, and erection strength

• How researchers study sexual response in controlled lab settings

Listen to the Episode

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Dr Nicole Prause

Dr Nicole Prause, PhD is a neuroscientist specializing in human sexual behaviour, addiction, and the physiology of arousal. She is the founder of Liberos LLC, an independent research institute conducting government-funded studies on sexual neuroscience. Her career spans multiple research appointments including UCLA’s David Geffen School of Medicine, the Mind Research Network, Idaho State University, and the Kinsey Institute. She is widely regarded as one of the most rigorous scientific voices in contemporary sex research.

Website: liberoscenter.com

X: @NicoleRPrause

Episode Transcript

Tim Norton: Hello, and welcome to Hard Conversations. My guest today, Dr. Nicole Prause is a neuroscientist researching human sexual behavior addiction and the physiology of sexual response in Los Angeles, California. Her resume mentions among other things, a doctorate degree from Indiana university Bloomington research at the Kinsey Institute, a clinical internship at the VA Boston healthcare system, psychology internship training program, tenure track faculty member at Idaho state university research scientist at the mind research network, full member of the international [00:01:00] Academy of sex research and research scientist on faculty at the UCLA school of medicine.

She is also the founder of Liberos, LLC. Did I pronounce that correctly? Sure. Okay. And independent research Institute where she currently oversees ongoing sex research. Hi, and welcome to Hard Conversations

Dr. Nicole Prause: Well done. Thank you. 

Tim Norton: So today we're going to basically talk about. The neuroscience of erections.

I was speaking with a urologist the other day on the podcast, and he was talking about how, you know, there's usually three areas of,  of the body that affect erections has going to be hormonal blood flow and neurological. And so if you could sum up everything we need to know about the brain. And how it affects erections, 30 seconds, 30 seconds or less, our guests would really appreciate it.

So,  can you just speak [00:02:00] broadly about how the brain determines erections or is that just a ridiculous question? 

Dr. Nicole Prause: No, we can kind of dive in and see what happens. So, so the first thing the brain has to do is recognize,  stimulus,  or a cue, something that it encounters as being sexual. And that turns out to be a little more complicated than you might think.

So,  one of my favorite studies, they,  put some vibrators on guys' penises,  in the Netherlands of course, This is decades ago and they turned the vibrators on them and they watched their erections and they really weren't getting erect. And they said, wow, this stimulus is directly on their penis and they're not getting an erection.

That's bizarre. So they turned on some porn and then turned on the vibrator. Full erections. No problem. So what that suggested was that the vibrator itself, even though it's direct, tactile stimulation to the penis, does not necessarily do anything. Your brain has to recognize that it's being presented with something [00:03:00] that it needs to respond to, that it needs to activate that sexual system for.

And,  it doesn't have to be porn per se. Of course. It's just something that you recognize and the, you know, your penis vibrating alone is not a common form for most guys. So,  basically you have to, you know, see this kind of competent queue and then have,  networks of the brain activated that. Caused you to become motivated to act.

So,  with one exception, there's really no sex center in the brain. There's no area of the brain that becomes active and says, okay, you know, we're getting a wreck now.  we need to activate that, but. The centers that are most relevant,  are probably the salience network. So nowadays we don't really talk about areas of the brain as much as networks, because it's a recognition that these things don't operate independently.

They're all interconnected and salients,  links. Some of the areas that are really responsible for motivation. So just as,  like someone who's depressed, [00:04:00] these areas tend to be really under reactive.  someone who's manic, they tend to be very overreactive. And so the sexual response then kind of activates these networks that are associated with motivating us to go do something, to get off our butts, which is important for sex.

Then the only part that's really kind of specific to the erection is in somatosensory cortex. So just across the brain, you know, the you've maybe seen these body maps. Before where it says, Oh, your lips are here and your arms are here, you know, across the,  top on the outside. And there's an area for the penis too.

And it also becomes active when you watch the,  things being done to a penis on a screen. So there's some mirroring that occurs there, although we don't know a lot about those. So,  that's broadly kind of how things work that is, you certainly can sense things from the genitals going up to the central nervous system to the brain.

 but. You really have to have that central activation or you're not going to get anything downstream. 

Tim Norton: Okay. And that sounds like kind of a lot to stay on top [00:05:00] of, in terms of you've mentioned one area that we don't know a lot about. And it just seems like what's something as complicated as brain that there's really a lot of things that are operating at the same time.

Dr. Nicole Prause: There's a lot going on. Yes. 

Tim Norton: So one thing that I've always kind of struggled with is. I do get really excited about neuroimaging studies, but I, I sit and think about it and I say, well, that's just. One picture of one second of the brain at one point in time, isn't it kind of hard to make a huge generalization about that?

How do 

Dr. Nicole Prause: we, yeah, it really depends what you're trying to comment on. So there are some things I wouldn't want to step as far as like. I don't know if this stuff we're measuring in the lab really applies to partnered sex in a lot of cases. And there's some reason to think now that I have data on 250 people having sex in my lab, that I do,  I don't think that it does apply.

And I think we're about to change a lot of that literature. [00:06:00]  and so, you know, trying to,  Step and think like how generalizable is this, you know, as a laboratory. And so on the other hand, if you're trying to study something, like, I always say a vagina is a vagina is a vagina at some point, you know, if you're just trying to study,  blood flow dynamics in the vulva,  you basically just need someone who has a functioning full VA and.

Then you can comment broadly on when blood does go in this area. However, I got it there.  this is what that looks like in terms of temperature change, for example. So,  the things that are more kind of physiological, I think are very reasonable to look at in the lab and kind of the further and further we get from that, then we have to worry about like, eh, you know, is this really going to generalize to a partner setting, which is usually what people care the most about.

Right. And 

Tim Norton: usually how we hear the data reported. Like, it'll be a study that. Did some FRM FMR I technology. And then they'll say this means you want to have sex every 30 seconds. 

[00:07:00] Dr. Nicole Prause: Please, please. Your partner by doing this new XYZ move. 

Tim Norton: According to neuroscientists around the world. 

Dr. Nicole Prause: Yeah, we didn't say that.

Tim Norton: Right. And I bet a lot of times when you see anecdotal presentations of neurological neuro neuroscience research, you're saying she didn't actually, he didn't actually say that 

Dr. Nicole Prause: it does vary. I think,  like I've had to learn that I have to be comfortable sometimes telling media the brain responds more.

And what I mean is there was enhanced late positive potential at the time. Yo positive 500 millisecond Mark for the stimulus, comparing the neutral and this to that substance. I'm like, okay, the brain responds more. And so there has to be compromises made and it's like, the more you do that kind of work, you recognize hopefully when your colleagues are doing that, you know, that they're really more careful than that, but you have to be able to communicate.

Tim Norton: Okay. And so one of the areas that,  Gets a lot of publicity. These days is [00:08:00] porn.  porn is, you know, obviously being watched by hundreds of millions of people every day. And,  porn hub puts out as statistics every year of just how many people are. And it's, it's massive. And so I do see these headlines every now and then about neuroception scientific findings about porn, but when I.

Really thumb through the research. I'm not really finding a ton of it outside of you, not a ton of it, where they actually got the approval for the funding for the study, where they actually in a laboratory at ways actually masturbating. They were actually looking at their brain. Like I see generalized,  video games studies and, and internet studies and other things, but not is there you tell me, you tell us about how much data there actually is on good data.

Dr. Nicole Prause: Yeah, I think it does depend kind of how you're slicing it. So I sometimes see people say, Oh, you know, there's so little known about porn in the brain. And I say, you've [00:09:00] gotta be kidding me. They're 40 years old. So there's a, one of the most widely used emotions. Stimulus sets in all of neuroscience is something called the international effective picture system.

Or I apps. And this stimulus set contains pornography. It's been used all over the world.  there are thousands of studies with it. So if you say, do we know how porn affects the brain? I was like, yes. I'm like, we have a lot of data looking at erotic cues.  they're visual.  Now films of course have been more recent, but even in that respect, you know, this is,  most commonly how psychophysiology is provoke a response to the lab?

 I would say 95% of sex labs use porn to provoke sexual response. So really, really common stimulus.  what's maybe atypical is usually that stimulus doesn't last, like max five minutes. You know, we might hit three minutes,  most commonly. And so you can ask again, like, well, how generalizable is that?

And so what I am trying to do in my work is [00:10:00] exactly to take the next step and say, we need to be looking at the full response to really understand.  how people are interacting with and viewing porn to understand what is sitting down and viewing a film versus what most people are doing through it, which is masturbating versus then transferring that to something with a partner there.

Tim Norton: So a lot of that old. I app's research people probably wouldn't have been masturbating in a lot of those studies. Well, getting the visual acuity 

Dr. Nicole Prause: masturbation is almost always prohibited in our lab studies. We explicitly tell people don't do that. Okay. 

Tim Norton: Right. And so, which is, is that part of the reason why you have your own research thing?

Now? It 

Dr. Nicole Prause: is. So we had two things happen while I was at UCLA. I'd applied to do a study, looking at orgasm response in the lab. And they were okay with me vibrating genitals, but I had to promise that I would never have anyone have an orgasm. And usually an ethics board is required to give [00:11:00] you a safety or privacy concern that you can respond to, to, you know, get your study adjusted and approved.

So it's something you can do. And they refused to give us any, they just said, you have to remove the orgasm component. And I said, I'm not going to do that. It's about orgasm and. So, you know, we had like a letter writing campaign, a bunch of my colleagues wrote in and said like, this is real science. I don't know, like, what's going on.

 the chair personally said, like, he was really uncomfortable with the topic. Well, then we need another chair on this board, but we couldn't get it through. And so that's just dead in the water. If you can't get your stuff through ethics board, you can't do the study. And then we got a grant that was supposed to be two years to fund my work.

And typically if you're on a.  position like the one I had, you get grant funding, the school accepts the money. Like no question, you know, they, they always take money. Universities don't turn down cash, but this was to have partners come into the lab and interact sexually. The school refused the money.

So at that point I kind of realized this is not going to be able to happen here. And it [00:12:00] really is,  I, the nature of the work. And when I was initially at Kinsey as a student, I always said, I thought if the work was good enough, it wouldn't matter. I said, you know, we're going to get over this. This is a puritanical thing that the us is like moving through.

And I don't say that anymore because I ran into it myself. 

Tim Norton: Would you say that that was particular? So I went to USC and there's a huge green and I want to bash UCLA any chance I get, let me help you. But was that, would you say that was. Particular to UCLA, like, are there other institutions that are more liberal with the kinds of research that they allow?

Dr. Nicole Prause: Definitely European universities are. So for example, with the pornography research that I've done, I've been prohibited from recruiting patients in the U S because they say,  if these people are porn addicts and you show them porn, you're going to cause them to relapse. For some reason, the Europeans don't think that way.

So they don't,  they allow them to test patients there. So that's been a challenge and trying to generalize some of my [00:13:00] work,  And the labs of course vary some from place to place. But I will also say, I don't think I had any protocols that were that challenging when I was at those other institutions.

I was doing stuff that was a little more standard. I mean, I had a, at the mind research network, you mentioned I had a pneumatic vibrator in the FMRI,  that the, they tolerated. So what kind of vibrator?  pneumatics. So when you take things into that Fri they can't have anything Ferris. Metal in them.

Cause you'll hurt people. It's a large magnet. And so pneumatic is just air driven. So we had a giant compressed air tank in the control room that we just ran tubes through,  to the genital. So somebody else had done this work,  making a vibrator for the forearm. And I said, well, we're just gonna move it down.

We're just gonna move it. Fan blades and put it on the genitals. So,  we were doing some of that kind of work, but it wasn't partnered, it wasn't to orgasm. It was really just kind of swapping films for vibrators at that 

Tim Norton: time. Okay. So [00:14:00] you're mentioning all kinds of research that I guess I don't see very often.

It sounds like it always seems like it's hard to get this kind of research funded, as we're saying. And, but you also mentioned other research sex labs. Are there a lot of. What you have a lot of these kinds of places, 

Dr. Nicole Prause: not in the U S so most of them have moved to Canada. So,  the Canadian federal government actually has money set aside at, for sexuality like female sexuality studies.

 here we have been advised by program officers at our funding agencies, not to use the word sexual in our grant applications.  that makes it impossible to dream about,  seeking some of these larger grants.  that are federally sponsored. So,  sometimes they can kind of repackage them, you know, and try and put them,  as something that might be useful for depression.

Something might be useful for,  sleep disorders, for example, but it just, the funding climate is already so tight. You know, about 8% of [00:15:00] grants are funded, depending what agency you look at.  so you already have a very, very high bar. And now you're going to say, if you climb that bar, there's a very good chance.

Just the content,  will prohibit it from being funded. 

Tim Norton: Okay. Man. All right, well, so I'm back to erections. So when we talk about,  regardless of where the research stands, why, what did you find? So you w when I Googled porn addiction and erectile dysfunction and Google scholar,  you come up, you come up pretty much near the top.

So what did you find? 

Dr. Nicole Prause: So we,  There were kind of two studies, I think that are relevant for that. And one was a study I did with Jim Fouse, where I scraped together. My 10 years of testing people doing random sexual things in my lab and said, who in these studies do I have measures ever tell functioning with a partner?

And do I have some indication of their,  [00:16:00] sexual response? And so I.  tried to link those two things in, I forgot exactly what the sample slides ended up being, but a couple of hundred guys and found kind of two pieces. That is one that,  to the sexual films that we showed them in the lab, which are very,  very vanilla.

So we have one man, one woman consensual vaginal intercourse. That's the definition of a sex film that 99% of is use in the lab.  and so you could argue if someone, you know, has been viewing a lot and you're making the argument that someone should escalate their use, that the nature of porn is such that,  you have to continue to see things that are more extreme or it doesn't work.

Then you would expect that someone who thinks they're struggling in this area, Or has a lot of porn exposure is then not going to be responsive to these kinds of lower levels stimulating. And we didn't find that. In fact, we found the opposite that was guys who'd had kind of more exposure to the films actually, [00:17:00]  reported feeling more sexually aroused.

And for guys, this is not the case for women, but for guys,  their self-reported sexual arousal in their erectile responses,  are highly correlated. Most commonly.  so it could be that, that wasn't the case in this study. We didn't record erectile responses, but there's good reason to think that they should be.

And there was another,  lab that did that work,  with PNL measurements.  but the other piece of ours before I get to that is,  then we looked at just the porn viewing with their erectile functioning, using the international index work, tell functioning questionnaire. And there was no relationship there.

And when you see no relationship, the main thing you have to be worried about is,  is it possible that there was a small relationship and I just didn't have enough people to see it. That is, was this statistical power sufficient to see an effect, had it been there. And,  it was sufficient to have seen a small effect size, and we still saw no evidence for it.

So that was my paper. That was probably the [00:18:00] closest to that topic. 

Tim Norton: Okay, let's whittle that down a little bit. So being the first one, you know, in addiction terms is tolerance. Really what we find with people who are technically addicted is that more and more, they need more and more stimulation in order to get the same desired effect.

And that's what a lot of. The anti-porn advocates were talking about. And then you didn't find that you found the opposite of that. Yes. Yeah. Okay. And then with the other one, how would you tell it to the media? Like in when like one sentence 

Dr. Nicole Prause: we've found no relationship between the amount of porn viewing and erectile difficulties with a real partner.

Tim Norton: Has there been a lot of studies like that 

Dr. Nicole Prause: there've been a number of them. It hit around that. So kind of,  different pieces of that. So just by chance, when our study came out, literally a week later,  Alex Sanders,  still Hoffer's laboratory in Croatia. I had a study that did this. Same kind of thing.

Almost like he used the same freaking questionnaire. I was like, Sasha, where you been? [00:19:00] So we just,  we easily could have been his replication and it turned out in his study as well. Like they just didn't find relationships between porn viewing and this international index, worst health function.  so that was probably the closest, but,  Jason winter's work.

Is,  someone that also had guys trying to like self-regulate,  looking at whether or not they felt like they had problems in the laboratory to films and found very similar to what we found that is,  people who thought they had problems actually were more responsive. They don't seem to have done down-regulated or not be responsive to these kinds of vanilla milk toast.

Similarly,  And another one is like the Kinsey tested a group that had some reasonable criteria for,  what was, what would have been sexual compulsion at the time. And,  we're measuring erectile response and found no relationship,  with the erectile response in the laboratory. And there, [00:20:00]  felt.

Difficulty in the real world. So there are a few streams like that. Then there's some broader ones. Like there's a study out of Netherlands just last year. That was the first that had a nationally representative sample. So part of what we always work with with laboratory is we have to be aware, you know, who is it?

This walking in our door. Yeah, who's willing to come to these studies. And the most common bias by far is they tend to have higher sex drive on average. And they actually don't differ that much in terms of like religiosity or things you might guess, but the nationally representative studies kind of make sure that that didn't happen.

That is they make sure they got a good kind of cut of society. And so at the Dutch study found was there was no relationship between sexual dysfunction defined very, very broadly. So their measure was not as detailed.  And,  port and belief that you were addicted to porn. So,  that was nice to see just because we had some confidence that it wasn't just the weirdos.

We got to come do our stuff. Right. 

Tim Norton: Okay. And [00:21:00] there's so many different dimensions, but one thing that you keep touching on is, you know, how we define addiction or a sexual compulsion, I think varies. Throughout the literature. And so I think that's, that's one part of this. And then the other part,  that I see people debate a lot is, is the idea of withdrawal.

And when we're talking about, you know, heroin addiction or alcohol addiction people, when they stop drinking alcohol, they literally shake. Like, I never really want to define alcohol addiction when I'm working on that with somebody, right. But if they say they're shaking us. Okay. We've we've got problems.

So I need a medical detox where he'd read me something. Yeah.  there no shakes and porn addiction. And in that, I think, you know, if you go on to like different websites where guys are talking about the things that they're going through while quote unquote, withdrawing from porn, they re report all kinds of things for [00:22:00] sure.

But has that, has any of that been shown in a lab? 

Dr. Nicole Prause: Not that I know of. So,  I was curious about this as well, at one point, cause I said, well, what, what are they saying? Withdrawal is because as soon as I know what the claims are, then I can test them. And it turns out of the published literature, at least, I don't know, website wise.

 the most of the effects seem to be claimed to be physical. That is, they are saying, you know, sleepiness changes,  alertness, concentration. And I was like, those are all things I can measure. So we, we have some data around some of those now, certainly not all of them.  and so I don't know. I don't think the claims are as narrow as,  you know, just, I feel sad and that's going to make it hard, harder to quantify.

We can measure sad, but, but it's a little harder to quantify. So,  I think there are clear enough claims there that withdraw claims can be easily tested, but I have not seen them [00:23:00] tested well, certainly by questionnaires. Totally people report them. But as we've seen people often report things that aren't really 

Tim Norton: there.

Right. Yeah. And that's, you know, that's why we want the neuroscientific data is, is we're, we're tired of just the questionnaires. And so, and you're, so you're saying neuroscientific evidence of withdrawal as it has to do with porn. Doesn't it just yet? 

Dr. Nicole Prause: I haven't seen anything convincing. No. Okay. 

Tim Norton: Yeah. And then the other aspects of addiction that we normally talk about, I can't imagine how.

 you would study, like I also say, I don't want to want to even use the word unless you've had some ramifications. If you're drinking two bottles of wine every night and your partner's not upset and your physical looks fine and you're not missing work, then why did you even call me? I don't want to, it sounds like a lie, but you know, if you're fine, then my I'm not going to slap you and tell you to go to an AA meeting.

And so I don't know how. You know, neuroscientists could quantify or [00:24:00] look at something like that.  and all the behaviorals have an isolating. And,  

Dr. Nicole Prause: yeah, so,  we're trying there's  so one of the criteria I would say of most addictions is negative consequences and there is a questionnaire that was made a long time ago that I like to use because it kind of divides the concept into where one is kind of.

Feel bad feelings. And the other one is negative behavioral consequences. And that's part of why I like it is it's like, okay, but really have you been fired? You know, like what is something really happened to you? You know, not to, it's terrible that you feel bad and I I'll try and help you with that too, but there's anything really happened behaviourally that I can document.

 and so erection problems have been a good one because that is something that's so easy to quantify. Like if you're saying the negative effect for me is I can no longer have sex with my partner. That's a good one. We can test that.  another potential negative effect is just feelings of disconnection from the partner that is,  [00:25:00] you know, maybe I have some.

 type of,  avoidance or anxiety connection rather than a secure connection. If we didn't want to go all attachment theory,  with folks and maybe the pornography viewing is either a symptom of me for having those feelings or it's driving me having those feelings. And so I'm no longer able to kind of relate and feel intimate,  in some sense.

And that is what we currently have under review at a journal. So I can't tell you the results. Okay. But we're trying,  So that was part of our, a couple of studies. We had folks where we assessed their kind of attachment status and looked at its relationship with pornography and felt compulsivity okay.

Tim Norton: Oh, fascinating, please.  let me know how that whole I'm sure. I'll see it. Hopefully maimed and blogged everywhere. And then yeah, 

Dr. Nicole Prause: I see. Yeah. Fingers crossed. He's always takes so long, but yeah. Okay. 

Tim Norton: When I'm in, in psychological communities and therapy communities, we use a lot of [00:26:00] neuroscience language in our, you know, mental health write-ups even at some times.

And there's a handful of parts of the brain that I hear a lot of therapists talk about.  And in it, I think it's really makes them sound more convincing to clients. And it's good too, to know those areas, but it's another thing that I also worry that gets oversimplified sometimes. So one thing that I always see with porn and erections and then sex and everything is dopamine.

Hmm. And so there's listeners out there couldn't see her face. And I said that, but it looked a little exasperated at it. Never 

Dr. Nicole Prause: too old to roll your eyes. 

Tim Norton: So if someone's understanding, if they just looked at the headlines was, you know, look at porn, get dopamine, get addicted to dopamine, and eventually you don't get any dopamine.

From porn and you're depressed and you don't get erections. So I get this terrible. I get the sense that this problem will be a [00:27:00] thousand times bigger than what we're talking about. Because when I look at the numbers on PornHub,  a but B I I've also have seen some headlines around how we do oversimplify dopamine, and that it's, it's actually a little more nuanced than just this.

Pleasure chemicals, so to speak. 

Dr. Nicole Prause: So there, yeah, there are a few things with dopamine that I would love to never see again, in that what you just mentioned is probably the biggest one that is,  there was some really Seminole important work done by Schultz years ago, showing that dopamine is not responsible for pleasure.

That is not a pleasure chemical period, do not call it pleasure. Dopamine is not pleasure, dopamine,  surrounds it's around pleasure. It happens also when pleasure happens often, but not all the time. And so what I'm trying to get at as the main function, well, okay. WWII has multiple functions, but in this context,  its main purpose is to help us learn.

And so. When you see something that's novel,  your brain tags it by saying dopamine [00:28:00] salience network come online. We need to remember what just happened. We didn't know that this was a thing. So pay attention brain, and it helps us learn in that way. And then again, you know, some people,  will say yes, and these, these neuroplasticity changes as like, you mean learning.

That's learning. So neuroplasticity is like this big word people like to throw in with dopamine.  and there's really,  there's nothing super stimulus about porn. That is, it does not.  So one of the challenges like with cocaine is it is driving the system, using its natural,  centers harder than it can drive itself.

So the exoticness substance comes into the body and can occupy more of the dopamine receptors than,  we would be able to by doing anything,  running or masturbating,  porn can't do that. Masturbation can't do that.  it can't occupy more of the dopamine receptors than our. Naturally able to be [00:29:00] occupied.

 they are an indogenous function. And so they use indogenous systems to generate their feelings of pleasure. 

Tim Norton: I'm going to go out on a limb with endo and XO, the Dodgers as an exemption is so exogenous, being external stimulus, stimuli 

Dr. Nicole Prause: coming in and stuff. Yeah. 

Tim Norton: And endogenous being things that happen inside of your body.

Dr. Nicole Prause: Yep. Exactly. Okay. And so it's,  to some extent like the, your body self limits, you know, it's like, you can only drive the system so hard. And so sometimes I see people describe porn as having like some incredible, like it's driving the system. I said, Porn isn't gonna do anything that you were not doing with it.

So by paying attention to it, by engaging in a fantasy with the material that you're encountering in the same way that I can,  turn a vibrator on, on your penis and not have you have an RXL response, I can show you a porn film and ask you, watch this film as a director. [00:30:00] Critique the appearance of the actresses,  pay attention to the lighting.

 think about how awful the dialogue is. If there is any dialogue and blammo, you still got all the content of the sexual stimulus, but you don't,  have a sexual response to it. And that's a particular type of emotion regulation.  That,  we often refer to as reframing. So it's,  an alternative strategy is like distraction.

So just, you know, taking your brain somewhere else while you're watching the thing. And so that's kind of another piece is that, you know, it's just by having this. Thing presented to you that is these images coming in.  you can only drive the system so hard and it's not done automatically. And that is, you know, this dopamine is not, I see bathing the brain, it's not bathing the brain.

So there was no bath.  there's nothing super stimulus about it. That is it's not driving the receptors harder [00:31:00] than they're able to endogenously drive themselves. So I would say it's the. Maybe two key things with dopamine are it's not responsible for pleasure.  and that it's,  not flooding the system in any sense.

You know, there's really not,  a pouring in of the closest thing I would say to like, if you what's the highest dopamine change you could possibly get might be an orgasm and it doesn't modulate with orgasm. Okay. Okay. So increases with sexual arousal, but not an orgasm. Which is weird 

Tim Norton: dopamine doesn't ModuLite with 

Dr. Nicole Prause: sarcasm.

Yeah. So we,  there's increases up until that point. And there's a little bit of debate about like how well we can capture that exact moment because it's so fleeting and only happens one time. And that's the science is about, there's a, yeah, some of that,  So, yeah, there's still some questions there, but in general, the data we have so far, it looks like it doesn't especially spike with orgasm per se.

It's like [00:32:00] dopamine increases an earlier section. So 

Tim Norton: then, then what's the pleasure chemical during orgasm. 

Dr. Nicole Prause: So we think,  opioid based, but I don't know. Because other challenges, we don't have good orgasm models and a lot of animals where we could do some of that basic work. And so like, Jim Bause has done some work recently trying to argue that female rodents have vocalizations that are consistent with orgasmic response in his rats.

 there's some arguments to be made there.  I'm not sure I'm convinced because there aren't kind of other physical.  correlates there that I would expect to see with guys, we can make a little bit more of an argument for animal models cause they have ejaculation and usually that's accompanied by orgasmic sensations in humans, but there again, like how do you decide an animal had an organism?

Tim Norton: So how would we even study that? Provably in humans. Like if we were the, some shady fascist, underground rogue [00:33:00] lab, like what would you literally have to do to see what chemical was happening during an orgasm? 

Dr. Nicole Prause:  so probably the closest way. Is to do something to speed up a positron emission tomography.

So pet,  or positron emission tomography. He is,  you can use radio ligans to tag stuff in the brain, which just means I inject you with something that will,  get on a particular chemical that I'm interested in. And there are some really good ones for,  dopamine.  There aren't any for oxytocin.

And then they vary for other things oxytocin. So we've never seen oxytocin active in the brain. So if you ever heard oxytocins, they'll love chemical in the brain for bondings. They'll say it's in the periphery, but it's not, we don't know what's happening in the brain. We can make some guesses based on animal work, but yeah, 

Tim Norton: we haven't even seen it.

Dr. Nicole Prause: We can't working on that tag right now, but,  I. I haven't seen it published yet. [00:34:00] So just 

Tim Norton: ruining everybody's understanding 

Dr. Nicole Prause: of my science. I know for, and,  yeah. Helen Fisher is a little aggressive in her interpretation of oxytocin. Yeah.  because there, there are changes in the periphery with sex.  and there are reasons to think it might be the case, but there's no direct evidence.

So I would love to see as a pet. Sampling continues to kind of speed up. And some of the things we can tag are going to continue to advance. I think that's the most likely place we would see evidence with dopamine is, you know, once we're able to get it kind of quick enough that we can be confident that what we just got was actual orgasm and there are other issues with that with women, especially.

So I'm trying to, what do you define as the onset? You know, what's the offset,  we're doing work on that right now and. So I think that's probably where it's going to come from. Our best information is just as that technology continues to develop. 

Tim Norton: And so how do we [00:35:00] transition this into erections? So I think one might guess he, if, if,  my dopamine levels are low, then I won't be able to get erections.

Dr. Nicole Prause:  They would have to be damn low in a sense. So,  We get this with testosterone a lot too. Like guys, if they have some erectile Fe failures, I shouldn't even call them failure. Rochelle variants, they have a new name for it.  you know, they often will make, you know, I think I need to go on T my team must be low and,  there is not a good documented relationship between testosterone as long as it's in physiological range.

 that is, if you happen to be a quote unquote high testosterone,  versus on the lower end of normal,  your erections are probably fine. It's once you end up getting on the very low end to where, you know, you actually have a hypogonadal problem in the [00:36:00] case of testosterone, that you start to see an impact in that area.

So,  I don't see. And if you need to increase your dopamine one way to do it is to masturbate because,  you know, maybe this is a good bar trick. I don't know, but.  often when guys seem to want to brag about their testosterone level. Oh, I got tested the other day and my range is high. I was like, yeah, it means you're masturbating a lot.

Cause you're single. So they don't realize what they're saying,  because you should never do that to a sex researcher.  cause we know, but it's  so you know, the body is not just being driven by testosterone. It's also driving testosterone. So if you're very sexually active, even by yourself, You can increase your own testosterone, dopamine levels by doing that.

And,  we think that may be therapeutic and helpful in some, with some difficulties. So,  still trying to understand some of it.  but the, the system is a lot [00:37:00] more kind of cyclical. I would say. It's not like, Oh, you know, my dopamine is low. And so if I go take cocaine, no, my erections will be good. Don't do that.

Tim Norton: Okay. So masturbate more. Is the lesson taking away from there, but we still, we just don't know. Cause people talk about, there was actually not a, a great link between testosterone and erectile dysfunction or erectile issues.  but I only see that about 10% of the time, I'd say 90% of the time. I see, you know, that's the first thing you should look at.

Dr. Nicole Prause: If it's, hypogonadal sure like in that maybe, and they never say that I've never, never, yeah. Like an MD might reasonably suggest that because if that's the case, that's an easy solution.  we have very straightforward and if it's not that. Now, what are we going to do? So we used to,  give you a device to take home, to wear on your leg, that you would then loop around your penis and it [00:38:00] would measure your erections during sleep.

For two nights, nephew got erections at night, we said, then your erection problem is psychogenic. And if you didn't get them, we said it was organic. We now know that's not true. So we stopped doing those tests.  well, Most of us and 

Tim Norton: she's gone some people out today. 

Dr. Nicole Prause: So,  yeah, there,  and because I think Viagra is now so available and so cheap in most cases, I think there's very little interest in looking at etiology.

If you're a physician and somebody comes in and says, my is bothering me, you just give them a prescription for a PD, five inhibitor,  whatever that class is. And so. I don't know that people are doing that work anymore, you know, to really think through like, where is this coming from? Why? And the doctors don't really need to, in the sense that,  you know, unless it's, hypogonadal like really kind of severe problem that has clear medications to address, [00:39:00]  then they're not going to go through testing anymore because it really doesn't differentiate.

And here we have this pill that's super effective. 

Tim Norton: Yeah. Okay. So it's not just dopamine and oxytocin and testosterone. I also hear about serotonin and endorphins or any of these other things, something where I can eat like a nice brain food for, and then I'll get better erections. 

Dr. Nicole Prause: Yeah. A lot of those things are really hard to disentangle in humans.

So one of the ones that we. Maybe know more about is if you are taking an antidepressant and you were taking a SSRI, selective serotonin re-uptake inhibitor, chances are very good. You no longer have orgasms. And that may later affect your erections as well, just because why do I bother? I'm never going to have an orgasm and then it's just going to know me,  which you shouldn't think that, but whatever.

So I, you know, there.  [00:40:00] like in the case of serotonin. So if you're taking something like that, to be helpful, we have kind of a natural experiment and I'm like, okay, well, if we put a bunch of serotonin in the system, you know, that alone is not enough. You need an intact sympathetic, nervous system functioning to support interaction and orgasm and you know, all of those things.

So,  it's not enough, certainly just to have those things intact or to have them high or, or working in general. But I would say that one of the best,  well-documented causes of erectile problems is anxiety. So to the extent that these chemicals are associated with you having better mood and being less anxious with your partner,  whether that's for,  we'd say threat of performance, failure, theater, performance consequences.

So kind of two classes of anxiety are very common. That is,  I'm not going to get hard. And my partner's going to laugh at me or think I'm less of a. Dude or,  leave me whatever,  or,  you know, I'm going [00:41:00] to have this sex and this person is going to get pregnant by me. I don't want to deal with this person being around, you know, this is supposed to be a short term, whatever the kind of,  wherever the anxiety comes from it, that is it.

Dang good inhibitor for erection. And so, you know, to the extent those we can modulate those systems, kind of whether it's search synergic,  or dopaminergic to kind of support people, having less anxiety, that's probably what's going to be most helpful. So rather than worrying about being happy, I worry more about reducing anxiety per se.

Tim Norton: And so how does that work? So let's say I'm worried that I'm going to get her pregnant. How do I get from that thought to,  flacid penis? That won't 

Dr. Nicole Prause: right. So Mike is, so I work more and the functional space, and so I don't want to step on molecular toes. This is a little more Jim's world, but a fast world, but,  [00:42:00] So from my perspective, kind of what happens is there when you're having a full arousal response, there's an early stage when you're trying to get sexually aroused.

So you have high evidence of high effort and cognitive engagement in the brain. And you're saying, come on, buddy, let's go. Let's do this. Let's go. And then later on in the response you say, okay, I'm sufficiently aroused, whatever that is. We're still working on that. Now I'm going to have an orgasm at some point and let myself go there.

So I'm going to reduce cognitive control. And now we see hypofrontality like decreased activity,  less engagement, more,  cortical idling, you might say,  in the brain. So. To me, the main problem with erections then is most likely to happen in that early phase. That is when like I'm supposed to be expending efforts and really engaging.

And so if I get a little bit of anxiety, it can actually help me. Yeah. That is that's the rollercoaster study. You know, you come off a roller coaster, your [00:43:00] heart's beating a little faster and you attribute it to that cute person. You know, you see the rollercoaster and so you respond a little bit more than you might otherwise, but then you tip over that scale and now.

 you're no longer able to engage that sexual excitatory system because you're just looking for danger everywhere and,  worried about the pregnancy. And so to me, it's that kind of delicate balance of like, you need. In the early stage to develop an erection, to be able to,  focus on and expend effort to get your brain and a sexual set.

So that is,  I am now in a sexual situation. And that's what I'm thinking about. I'm not thinking about pregnancy situation, 

Tim Norton:  but you are a little. Riled up. You're a little, 

Dr. Nicole Prause: there's some, yeah, there's some Yerkes Dodson curve there. So that's the optimal arousal idea that is,  and this exists in many systems, of course, that it's, you need a little bit of activation, but I would say in [00:44:00] this case, like the activation has to be of a type, you know, that's,  those motivational systems.

That's not a strong frontal inhibitory activity. That's going to shut that down. 

Tim Norton: Okay. So would it, would it be like a little bit of cortisol? In the beginning that, 

Dr. Nicole Prause: yes, that's fair. I feel okay with 

Tim Norton: that. And then, but we, and I doubt we could study this live. But then we'd want us to it, but then we'd want it to drop.

 so we could, it sounded like you were saying, so we could be more present in the sex. So, so the, some of the frontal lobe activity would slow it down. 

Dr. Nicole Prause: Yeah. Part of what I love is this stuff feeds, I think right into sensate focus. It's like maybe they didn't think of it as doing that, but I do,  I think,  maybe part of what the mechanism is for that.

Exercise working is partially like I'm just going to be touched and I'm just going to feel it. And I'm not going to, you know, like I'm just going to concentrate on getting my head in this thing and feeling everything as much as I can [00:45:00] feel it. And I'm not worrying about where it's going or you're having these other inhibitory things come on.

And I'm not worried about trying to have an orgasm that's, you know, Week eight or whatever, sensate focus. So,  I think it might be getting at some of those things,  which always love when you find like afterwards. Oh, that's probably the mechanism. 

Tim Norton: Yeah. And then thousands of old time sex therapists would be saying, yeah, yeah.

You can tell me anything new, but so neurologically. You, you say sensate focus and maybe I should talk about how, what that basically is, is,  hallmark that your sex therapist gives you where you very gradually touch each other in a very mindful way. And initially in a non-sexual way, like a non penetrative sexual way.

And then you gradually increase that touch and mindfulness over time until your, your back.  Firing on all cylinders. And so from your understanding of the brain and what happens to the [00:46:00] brain during sexual sexual arousal?  that seems like a good model. 

Dr. Nicole Prause:  yeah, I like it a lot for that. Okay. 

Tim Norton: And name drop some of the chemicals that would be happening at the same time as those sensate focus exercises or regions or 

Dr. Nicole Prause: so, yeah, I've never seen.

Anyone trying to sensei focus and record anything at the same time.   there has been some work done by Yana coach Jedis,  who is in Europe with guys being masturbated by their female partners with their head in the scanner and their case.  Yeah, they, he again is focused on some of these motivational salience networks.

And so you, you don't see,  the strong engagement of, again, like frontal systems that are going to be monitoring and doing what I associate with them. Spectator ring. So that other kind of concept that is I'm not [00:47:00] engaged in the sexual act itself. I'm kind of looking in from the outside, evaluating how fat I look or how much my partner is going to leave me rather than just feeling the sensations.

And so his people are all functional, you know, they're screened to not have issues,  significant sexual issues. And so that's largely what he's documented with the partners is just this increase in,  kind of motivational.  stance and salience network. So kind of nucleus, nucleus, accumbens, ventral striatum are classic.

In this respect. He's also looked at women,  tagging dopamine while they masturbate to orgasm. Awesome. So without a partner,  there is evidence, he was specifically, so with pet, you have to pick what you're looking at and who specifically picked a dopamine. So there were increases during sexual arousal, orgasm.

Maybe, maybe not,  some debate, so those kinds of changes are happening.  [00:48:00] but we don't have great evidence for them with partnered acts are really, really thin.  and then this stuff that we do have that's partnered is mainly like FSRI kinds of work and sometimes it's not well characterized exactly what the partners were doing.

So that's part of what, again, like with our.  the 250 people we had through,  we're trying to get away from porn models and really use partnered stimulation to see if this is really the same thing. So,  if I can go a little aside, if I haven't been going aside the whole time,  there is, there are big distinctions between porn in the brain and partner touch and the brain.

And this is part of why I don't expect there to be erectile problems due to porn use is because. They really seem to be completely different processes. So if you're just watching a film,  we'd say that's a secondary reinforcer because you're watching it and saying, [00:49:00]  wow. Normally I would be masturbating right now.

This is kind of weird to sit in a lab and watch porn, or, you know, I would be getting my partner in here because I'm like ready to go.  and I would like to start having sex now, please.  whereas the, the partner situation is the primary reward. So this is actual, you know, touch. And social touches really cool.

There's a lot of really neat work done on social touch that we're now expanding with.  Jim Cohen, who has done a lot of work in this area with handholding. I say, we've got to move, move the hands down, Jim. And so these look very different. Another way you could think of it as like,  when somebody followed people after we show them porn in the lab.

 a lab in the Netherlands and it turns out people are much more likely to have sex with their partner when they get home from one of our studies. So clearly the porn was not satisfying.  that is,  porn is not a primary reward,  and primary [00:50:00] and secondary rewards are represented very differently in the brain.

So it's really important that we don't try and make generalizations about how sex works. Based on porn studies, because I think we're studying very different things. And,  I really want to see a lot of work done in with couples and if not with couples, at least with vibrators, so that we're doing direct genital stimulation and can really talk about how that might generalize,  to situations people care more about.

Hmm. 

Tim Norton: Yeah, it does sound like that's work. That's really necessary.  But unfortunately probably, probably not going to take place in an American university. 

Dr. Nicole Prause: That's why I am where I am. 

Tim Norton: Yeah. And how long have you had this setup and 

Dr. Nicole Prause: five years?  three years now. Three years. So pretty young? 

Tim Norton: Yeah. Okay. Okay.

And right now you do have data from 250 people who had sex somewhere and not in this room that I'm in right now. [00:51:00] No, that's down the hall, somewhere down the hall. And I just wonder, do you, do you get, is there a lot of,  like a lot of people who.  think of themselves as exhibitionists who come for these studies.

Is that 

Dr. Nicole Prause: something? Yeah. People ask a lot of course, about who volunteers for these things. Oh my God. And there is some of that. I think that people,  You know, once you to know as the experimenter, just how open they are and like, you don't really need to tell me it was like, I get it.  so there is some aspect of that with some people I think who come in, but a lot of folks, especially like the orgasm setting I'm working on now, the woman are like, We need to know this about women's bodies.

You know, this is a very much a feminist agendas they're being paid to be here. And they're like the money's great. And that is helping me with parking, but I'm here because we need to know this stuff. So I think some of the motivation is altruistic as well.  [00:52:00] and we get by coming into the community, I've gotten a lot more diverse sample now.

So like the study that I was doing, I was shocked. Like we have a majority African-American women, it's like. We've never had, you know, normally we have a really young white sample usually and,  mostly queer women,  which I don't know how that happened, but that's great. And they don't need to be straight anymore because I don't show them porn.

So, you know, as long as you can masturbate in my lab,  so we're making, I think a lot of strides and figuring out.  you how to do this in a different settings, I'm going to try and make more people do it. And. And it's,  some of the benefits are there. I think in terms of like the diversity of folks that we get in.

And,  and it's not all folks who are just,  extreme and again, it really depends what we're studying. So if I just need to see the brain at orgasm, all I need is an orgasm. I don't really care how you got [00:53:00] there.  that is they should look very similar.  the contractions that are associated with orgasm are highly stereotyped.

They're very easy to see. So,  physiologically speaking. So that's,  I really love that kind of about having a different lab experience where folks can come in, who are not necessarily the frankly, mostly sorority girls in psychology, one Oh one classes getting credit. 

Tim Norton: Yeah. I think I participated in like 50 of those as an undergrad.

I really

okay. So, wow. This is all. Well, some of it's kind of a bummer because, you know, I think as clinicians, we feel like we know something about oxytocin and dope domain and how those things interact with the brain and affect behavior. And you're kind of, I don't know if you're saying that it's all wrong, but I feel like you're saying, dang, maybe [00:54:00] we're over-generalizing  with, with some of our, our.

Broad statements. 

Dr. Nicole Prause:  I mean, I think it's, there are of course elements of truth to all of this. It's like, none of that would be sticky if it was just off the wall. So the dopamine modulates with sex, it does, we're working on exactly how and under what circumstances and at what time exactly that's happening.

And,  we know it's not pleasure. So what is generating the pleasure and,  for example, When people have an orgasm, they have all kinds of different reports about it. And I was like, dude, it is the same physical thing, you know, from a physiologist perspective, I was like, it happened, it didn't happen. It was like, so why are you saying that when sucked?

And I was like, you had 14 contractions and you're telling me, you know, that was amazing. And this person was,  not satisfied with 20.  and so, yeah. Like that variance, I think [00:55:00] is really important to keep capturing for us as well, because the that's, the psychophysiology list is psychology and physiology.

And if you just get the physiology without kind of being able to translate into what the patient says, when they walk in the door, then we're not helping you very much.  and so I guess maybe that's part of,   what I would love to see is. You know, we use a lot of skepticism when people come in and report something,  which is not to say we're,  saying they're lying to us or being jerks, but it's like, we want to understand how that report got generated.

And if there was more curiosity around like, okay, this person is reporting, having this experience,  Do we want to just take their word for it?  or can we help them more by understanding etiology of what might be going on? So like in the case of pornography,  Marty Klein has a book that talks to him about his clinical cases that I [00:56:00] really like.

Cause he talks about, you know, a lot of the kind of back and forth. And the couple is being an insecurity of one that. You know, why does usually he, sorry, pick on the guys, but you know, why does he need that stuff? And he was thinking. I just like it. So if I can find, you know, some of these things in the brain that said he, he does just like it.

Like, it's just a thing he does. And is there some compromise we can have here so that he can do the thing that he likes? And it has nothing to do with the fact that he occasionally has erectile problems with you. You know, that he's not finding you unattractive, but this is kind of how they're managing,  their sexual life together.

 so that's why I really liked the psychophysiology approach is I think. You know, hopefully what we're finding in the lab can map on Maura to,  help a clinician say, you know, this, person's having this report. I know that when tested, you know, that they're not. Actually likely to be having erectile problems due to the pornography [00:57:00] viewing,  itself.

So it could be right. I,  a bellwether of something else, you know, I'm, if I'm dissatisfied with sex for my partner, maybe I am an attracted to them, a weight gain being the classic here. I used to be a couples therapist and Oh my God, that was a terrible want to have to deal with. Right.  So, you know, he's not watching the porn potentially because,  you know, he's addicted to it, but it's like, I just don't know how to have that conversation with my partner.

Maybe I shouldn't have that conversation because how do you tell your life partner that I don't want to have sex with you anymore? That's a horrible conversation to have to have,  And maybe you shouldn't, I don't know.  so those conversations are really more complex than hard, I think as a clinician to have than just saying, yeah, you need to stop watching porn.

Porn is bad for your brain. They probably just have a higher sex drive and you know, and they're using this to manage whatever relationship [00:58:00] conflict they're having. So,  you know, if something that we're doing can help kind of inform that that would be ideal is to have the.  communication to say, like in the brain stimulation study I did, I was like, okay.

 you know, we have some sense now that people who have a lot of sex partners, we can do brain stimulation with them and it helps them gain control of their sexual response in the lab. Well that stuff's already available through FDA. You know, you could potentially get your brain stimulator. I'm not advocating that you immediately send your sex addiction clients to,  get their brain stimulated.

But it is an option. And I don't see discussion about that because I think that is viewing it as more of a sexual desire or urge problem.  you know, where there's not that evidence, what can people do?  so we did a trial with transcranial magnetic stimulation or TMS,  with people who specifically had had a lot of sexual partners and,  were reporting some distress [00:59:00] around there.

 Sexual activities. So they'd say yes, I had fun. Yes, it was consensual. But you know, I didn't plan to do that when I went out that night, that was a bit much. And so we looked at if the, so these folks tend to be very reactive to sexual accused. So if you show there, show them,  one of these sexual images, their brain is a very reactive to even like the hint of sex.

So something romantic that's shadowing, doesn't show penetration. They're still brain very responsive to it. And,  whereas people who have lower drive and don't get as much trouble,  aren't D their brain doesn't respond to those cues until the cues are pretty explicit. Like you have to have. Oh, wait, that's definitely sex.

No doubt about it. This, these are not just,  hugging kissing people. And so we kind of took that principle and said, so we know these people are likely responding very strongly to the sexual cues. So can I stimulate their brain using this TMS [01:00:00] device in a way that decreases their brains responsiveness to these cues?

Because we know that their responsiveness predicts their sexual behavior in the near future. So,  we were able to modulate their brains, reactive newness responsiveness in the lab. And so that's the reason to think, you know, the next step could be trying that,  to help you kind of manage the sexual urge, but no one ever talks about these, which drives me nuts.

I was like, it's a very, you know, it's already FDA approved for all these other applications. And,  yeah, that means it could potentially be talked about,  off-label use if an MD were to agree to that, you know, and think it was a useful thing to try. So, you know, we do that work, but sometimes I think it's so mechanistic and really,  testing thing that I don't write it in the way that necessarily translates as,  Easily.

Cause I, I don't want to make claims that are too strong, you know? Cause I don't want to go and say, Oh, here's the next [01:01:00] treatment? You know, don't give them Naloxone, send them to TMS treatment. And I was like, I actually don't. I would say don't go send people all to TMS treatment right away, but it could be an option.

You know, there's already some data suggesting that that could help people manage their sexual urges. Hmm. 

Tim Norton: Okay. And is it stuff that, I mean, would. Would the TMS provider have to know the kind of work that you guys did or is it actually pretty easy for them to, is there like a patches or an app? 

Dr. Nicole Prause: Yeah. TMS is funny because of the,  depression and approval.

There are now a ton of centers, especially in LA. I get calls all the time to do this stuff. And so the centers usually have a tech and an MD. And the MD is present because,  there is a risk of seizures. If you have a personal history or family history,  we do a really good job of screening out now. So it's very, very rare for someone to have a seizure, but [01:02:00] you still need someone nearby just in case that were to happen.

 and sometimes the centers will require that the MD also meet with the patient.  sometimes they're okay. Taking referrals. I've just seen it vary the tech themself. It doesn't necessarily know. They may just see, okay. Stimulate dorsolateral, prefrontal cortex at this frequency with this device, you know, using data burst stimulation.

You know, the stimulation itself is five minutes.  and for depression treatments, it's done, you know, somewhere around like 12 to 16 times.  and the response to it is logarithmic in the sense that the biggest effects occur earliest in treatment. And then the,  it kind of Peters off towards the end in terms of effect size.

So, and this is not direct current stimulation. So there are lots of different types of brain stimulation and. Direct current is one that's,  there's a lot of debate as to whether it's even getting through the cranium. And,  is it really having the effects we think TMS [01:03:00] is getting in? It's definitely getting it.

 but there's more debate about,  how targeted we are. Exactly. You know, and when we'd stimulate this area, what network is it propagating through primarily?  but it is not your mama's.  electroconvulsive therapy. We are not doing any CT anymore,  with the TMS. And I think it's a really fascinating option.

 if it's something that makes sense for that patient and that the MD agrees is safe. 

Tim Norton: Maybe give it a shot. Okay. And I actually had a, it's actually gone over an hour. I just wanted to see if there was anything you were excited about for the future of like, Neuroscience research and,  

Dr. Nicole Prause: yeah, as you might imagine, it's all partners for me.

So,  there is so little work being done kind of on the high end of stimulation. So we have people doing their first, like five minutes of sexual arousal [01:04:00] alone without touching anything. And that's fine.  and there's a lot of that. So, you know, I wouldn't say porn studies are in their infancy. I'd say they're mature.

 and now we need to stop doing that and go to some better models that better resemble actual sexual behaviors to see if porn actually has anything to do,  with how the brain is responding under conditions of erotic touch. 

Tim Norton: Right. So there's probably never been. The study of what we think of as the quote unquote porn addict, who's sitting there masturbating for five hours,  going from thing to thing that too much.

So nobody's done that. Yeah. 

Dr. Nicole Prause: That's another good,  Like, I've always been curious when I hear someone, like I looked at porn for five hours and I want to sit them down and say, okay, like, so when you start, tell me about starting and tell me, so were you masturbating the whole time or you wreck the whole time?

Did that change? How many [01:05:00] orgasms did you have? Were they all ejaculatory? I've never seen a study that asked those simple, like questions in detail and it really matters. Stuff, I'm testing. I need to know, you know, is it that you're having three orgasms in that time because that's a very different model of what the porn effects are.

Then just, I watched a movie and it wasn't touching myself and I just find porn movies more interesting than Hollywood movies. I doubt that's the case, but we don't know why don't we know. And 

Tim Norton: it does hap well, according to self-report anyways, and I had to learn this. And doing sex therapy. Intakes is, do you watch porn?

And that's a different question then, do you masturbate to the porn men? Some, some people every once in a while, they'll say no. And I'm always caught off guard. Why? But sometimes yeah. And 

Dr. Nicole Prause: even more that, yeah, like when you master it, w how, how are you masturbating? Like what does that pattern look like?  Because I just exactly like, that's what I'm always confused about is like, [01:06:00] what are you, what are you doing for five hours?

You know, I need to,  somewhat tongue in cheek, but I also need to understand that process. So am I talking about multiple orgasms to where I need to think about.  really quantifying refractory periods in a more sophisticated way than they have been before, because those are almost all self-report too.

 or is that not possible because they're generally only having the one orgasm at the end. And that's the big,  event when you find the perfect film? I don't know. I don't know if anybody knows. 

Tim Norton: But you want to find out and you are putting a lot of time and effort and energy into this work. And I want to thank you for doing that.

 because I know it is hard to come by this kind of data. And then I know, you know, As a sex therapist, I want to have it. I want to be able to share it with clients and, you know, let them know that I'm not just making this stuff up. So your work is really important and I hope all whoever's funding all [01:07:00] of this that they, they triple and quadruple that you'd see thousands of couples in here.

Cause it's, it's really 

Dr. Nicole Prause: important. I appreciate it. Yeah. I hope,  that I keep having nice people who are willing to come in and do the studies as well. I think,  as a scientist, we sometimes. Forget how lucky we are, that people are willing to trust us and that we're going to protect their privacy and safety and all that good stuff.

So thank goodness for the research subjects. 

Tim Norton: Yeah. Okay. So yeah, that's a call for people to sign up for sex studies and I'll say it,  cause we, we need to know this stuff. Well, thank you so much for your time. And,  Like any last thing or how can people find you out on the internet and everything?

Dr. Nicole Prause: Libero center.com, L I B E R O S center. All one word.com and I tweet sometimes about motorcycles.  Nicole R Prause. 

Tim Norton: Thank you so much. Thanks.

Shout outs to the sex positive community, including sex educators, sex therapists, sex coaches, other fellow sexual podcasters, sex [01:09:00] surrogates, academics, sexual health, medical community, sex workers, the tantric community, and everybody else involved with having hard conversations. Bye-bye.

If This Episode Resonated

If this episode spoke to you, there is a path forward.

Tim Norton provides a discreet, evidence-based therapeutic space where men and couples can understand the deeper systems behind desire, arousal, and connection. His work combines rigorous neuroscience with a grounded, relational approach to help clients rebuild aliveness in their bodies, strengthen partnership, and create lasting change.

Learning About Your Penis From a Sex-Positive Therapist

Episode Overview

In this conversation, Tim Norton speaks with Dr. Hernando Chaves, sexologist, professor, and renowned sex-positive therapist about how erections reflect emotional life, relational dynamics, and cultural conditioning They explore delayed ejaculation, premature ejaculation, porn, performance anxiety, the myth of long-lasting sex, and why your penis is often more accurate than your thoughts when it comes to understanding desire and safety.

Key Themes

• The penis as an emotional barometer what erectile changes actually signal

• Why Dr. Chaves avoids the term “ED” in favour of “uncooperative penis”

• How shame, guilt, and fear undermine arousal

• Biopsychosocial influences on erections: body, mind, and culture

• How porn enhances and complicates sexual functioning

• Premature ejaculation, delayed ejaculation, and nervous-system patterns

• Creating a safe bedroom environment that supports arousal

• How PDE-5 inhibitors work and their limitations

• Building a sex-positive internal narrative

Listen to the Episode

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Dr. Hernando Chaves

Dr. Hernando Chaves is a licensed marriage and family therapist, sexologist, and professor of psychology and sexuality at Orange Coast College and Pepperdine University. His clinical expertise spans sexual minorities, kink, nonmonogamy, intimacy difficulties, and male sexual dysfunction.

He has consulted for major sex-education projects, appeared in publications including Rolling Stone, Marie Claire, Vice, and The Guardian, and maintains a private practice in Beverly Hills.

Website:

https://www.psychologytoday.com/us/therapists/hernando-chaves-beverly-hills-ca/129341

Episode Transcript

Tim Norton: Hello, and welcome to hard conversations. My next guest, Dr. Hernando Chaves holds a BA in psychology from the University of California, Santa Barbara, an ma in marital and family therapy from the university of San Diego and a D H S doctorate in human sexuality from the Institute for the advanced study of human sexuality.

He is a licensed marriage and family therapist, specializing with working with sexual minorities, kink fetish, sex work non-monogamy intimacy, relational difficulties and sexual concerns and dysfunctions. [00:01:00] Dr. Chaves as a psychology and sexuality professor at orange coast college and Pepperdine university.

He's presented at various academic institutions, including Alliant, Cal Lutheran, Cal state, long beach, NYU Pepperdine, USC, and the university of San Diego and conferences and shows such as AVN a E. ASAP catalyst con S S S S. And she, I saw him present she not the sexual health expo. And he was awesome.

And a Western region past president for the society, for the scientific study of sexuality, which was S S S S he has written and or consulted for 14 instructional sex education projects. Co-hosts for penthouses sex Academy instructional series consultant for Badoink VR, virtual reality sex therapy instructional video.

And Dr. Chaves has written for sexpert.com. askmen.com. He is a contributing author to the international encyclopedia of human [00:02:00] sexuality and been featured in publications, such as rolling stone, the guardian Marie, Claire bustle, vise Maxim, the daily star Esquire and alternate. Welcome Dr. Chaves. 

Dr. Hernando Chaves: Thanks for having me on.

Tim Norton: So did I leave anything out there? 

Dr. Hernando Chaves: I'm excited to be here. Gosh, you know what, biosphere, I always try to whittle them down and,  there's always things we miss. I mean, I, I sometimes tell people, I, I like watching family guy and Rick and Morty, and I also used to be a football, so, 

Tim Norton:wow.  let's, let's get right into it.

So why sex therapy? Why, why work on non. Sexual problems with individuals 

Dr. Hernando Chaves: and couples and yeah. You know, years ago when I first,  got into therapy,  I started working with children and it was. Emotional. It was challenging. It was difficult for me,  because I brought my work home with me and,  and it was too difficult to see change with the kids because of the parents also had a lot of,  issues and contributing factors to their, their, their difficulties.

So,  I had to look for something that was [00:03:00] more in line with who I was and,  You know, people always tell you, follow your heart. You should follow your passions, make passion a part of your life. And so I realized that by transitioning the sex therapy and human sexuality studies,  it was really a part of me.

It was, it was something that I've always been passionate about, always been a sexual, being a sexual person, and it just fit. And it was the best decision I've ever made. The people I work with, you know, there's a lot of,  You know, when we discipline, we discuss sexual issues. It's, it's really wonderful to see people's growth and you can see it very tangibly in front of you.

And there's a lot of,  opportunity to seek,  that,  those changes that I think really make the work fulfilling. That's 

Tim Norton:really cool. I think the community that, that we're in is it really,  You can do it without having passion for the work. I think you're going to raise eyebrows, you know, just by saying, yeah, I am, I'm a sex therapist.

I'm a sex coach. I'm not even a human sexuality professor. And so, [00:04:00] I mean, so many people that just love what they're doing and they're. They're involved in all kinds of things. And it's really 

Dr. Hernando Chaves: cool. Absolutely. And, and if your heart's not behind it, then I think people should,  consider other options in their life.

If that's not what their passion is driving. 

Tim Norton:Yeah. Yeah. Now, one of the first things I remember hearing from you, we were at a luncheon and you were the first person I ever heard say,  uncooperative penises. And every time I, I repeat that everybody loves it.  did you trademark that you should. And 

Dr. Hernando Chaves: that's really what I think the world should 

Tim Norton:have it.

Okay. He's, he's giving it away.  uncooperative penises is, is, is perfect. Right? Why were, well, you tell us you, why did you come up with that phrase? Why, why not just say ed? Like, like all the 

Dr. Hernando Chaves: commercials, I'll tell you what, you know,  society has sanctioned certain terms that I think can also be problematic for the individual, for people.

 sometimes the, the words that we use and the language that we express doesn't always have empathy or [00:05:00] compassion,  at its core, you know, when you mentioned something like erectile dysfunction, you know, some people will hear that and immediately associated with pain or heartache or,  you know, just a sadness and.

The term dysfunction also really implies that you're not functional. It's kind of this by like bi-modal sort of term that that's suggest that you're broken or that you're not good enough. And I think people are already experiencing enough of that within their own,  self-criticism and their own sort of psyche that we don't need to perpetuate that.

So I've always been encouraging people to use terms like,  erection concerns or sexual difficulties and, and they. Although they have a little more of a neutrality to it, and people can still apply some of their projections of their own sort of insecurities and their own sort of pain.  it still is, is a gentle introduction into, you know, discussing some difficult topics.

And I usually ask people, what are some of the terms that you use, and maybe we can find one together and create our own language with each client.  I'll give you an example, and this is a little off the topic of sexuality, but,  I had a [00:06:00] client who was experiencing,  some, some sexual and relational concerns.

Associated with his difficulty in relationships. He was narcissistic and he had a lot of narcissistic qualities, but he didn't like that term narcissism because it reminded him of his father whom he uses that term.  he directs that term towards, so we developed quirks. So he would talk about his,  his personality.

Quirks is a relationship. Quirks. And we knew what that meant, but in the moment in our sessions, it sort of allowed us to not dwell on some of these,   psychological sort of,  symptoms, if you will, but we can now sort of address maybe the impact or the feelings associated with these quirks. And so that was really helpful to come up with our own language.

Okay. 

Tim Norton:So let's talk about some of these corks. Okay. Maybe not with that client in particular, but just the kinds of quirks that lead to sexual issues, that to uncooperative penises, for example, why does it happen? What are these quarks? 

Dr. Hernando Chaves: Well with uncooperative penises, I think we have to start asking the question.

[00:07:00] Why are we focused and fixated so much on the penis? And I think even if we aren't penis owners, if we're Volvo owners or we have other sort of genitalia,  why are we fixating and felt so focused on that? You know, when I look at my life, I think to myself, the majority of people that I know. Don't ever get to see my penis.

They get to see my heart. They get to see how I express myself, how I interact with them. So there's so much more than meets the eye than just what's underneath the belt or inside of our pants. And I encourage clients to begin to sort of deconstruct this idea that we're putting so much focus. We're putting so much weight and pressure on one piece of the pie in our life.

And there's so much more to the individual or to the relationship than our sexual functioning. So I think we have to deconstruct a bit of that,  that,  Overemphasis, which I think can also create a lot of anxiety and pressure for individuals because they have the bullseye on what is not working.

They put the microscope on their,  on an area of their body or their, of their,  relationship that maybe they're creating more of a monster or catastrophizing [00:08:00] than really what's what's meets the eye. 

Tim Norton: Okay. I like that. And so, but I, I get the feeling that if somebody comes in for treatment, they're going to appreciate that validation then, but then they're going to say.

But I really do want to talk about my penis. 

Dr. Hernando Chaves: Absolutely. So most people will still want to work on that deconstruction and that sort of deemphasis, but still want to work on the, the functioning itself as well.  generally you'll find that,  people will come in if they're having the concerns about their penis and their sexual functioning, it's usually associated with three or four areas that I'm seeing.

 the most common, of course there are other.  areas as well too, that people will, will, will, will present with,  in therapy. But you typically see erection concerns. You typically see early ejaculation, or what's also known as premature ejaculation concerns.  you'll see, delayed ejaculation concerns,  which used to be called retarded ejaculation, which we definitely don't want to use in therapy or even in, in writings and literature.

 and I also see a lot of,  Sexual or performance anxiety. So I feel like the ed, the PE, the D E [00:09:00] and the, I call it PA the performance anxiety, or the essay,  are, are really prevalent. And I, I find those to be sort of like the four pillars of what a lot of men, a lot of penis owners come in for. 

Tim Norton: Okay.

So. Oh, erectile issues.  generally speaking and we're, we're talking about nonmedical, they've already been in the urologist. Urologist is gone over the hormonal and gone over the neurological and gone over the blood flow and everything's good. And they sit and they get a sense from the client in the room.

Hey, you're, you're, you've got some stuff that I'm not really suited to handle. I want you to talk to the sex therapist. And so then they come to you and, and what do they generally present with when it comes to ? 

Dr. Hernando Chaves: Shannon. The first thing I would do would be to congratulate them that they saw a urologist or a medical professional to rule out some of the medical concerns that really as therapist we aren't able to address.

And, and that's, that's a good start.  psychologically speaking, what I find is that for many people,  there are influences and influencers to their anxiety [00:10:00] that typically will perpetuate a lot of these concerns. For example, a family upbringing. Trauma,  their relationship concerns,  mental health concerns, depression, anxiety,  You know,  PTSD, there are so many factors that can be associated with the psychological origins of individuals,  sexual difficulties.

You'll also find too that,  we can characterize difficulties what as if they're lifelong or if they're acquired, meaning some people experience these difficulties throughout the entire course of their life that they experienced from,  either early adolescents or even puberty.  and then you'll find people that will experience these sort of situationally or at certain times of their life.

And so with a number of, of. Clients. I like to do timelines to get a better understanding of when these occur and when they don't occur. Cause what I find is that things like outside work or relationship stress or life stress typically have a very profound impact on our bodies.  what I tell a lot of my penis owner clients,  is [00:11:00] your penis is a thermometer that takes the temperature of your life.

Hmm. And maybe in your life there are stressors or there are problems in your relationship or there's a death in the family, or there's just things going on. And oftentimes our psyche is very much influenced by the outside world, the external factors, the,  the social component. So if we look at sort of the bio-psycho-social model and sort of see our clients through that, if we're addressing the biological with those medical referrals, if we are looking at some of the psychological anxious,  mental health and some of those factors.

 and we're also looking at the social factors. Let's say their environments who they're being exposed to their relationships, their work life. We're going to get a pretty good sense about what are some of the struggles. And sometimes you find with timelines that you can pinpoint when these difficulties started and line them up with certain stressors that they experienced.

And sometimes there's a light bulb that goes off in session like, Oh, it was when I changed jobs that all of a sudden my sexual functioning changed. Oh, my gosh. It was when my father passed away and I realized that maybe there's this underlying [00:12:00] depression. And I didn't realize that that was affecting my sex life.

So it's important for us to just sort of dig. I always find that as therapists, we're like psychological detectives trying to help our clients really discover maybe an unearth, a baby, some unknown or unconscious areas that they're struggling with with anxiety. Hmm. Okay. That's really interesting. 

Tim Norton:So, What about when it does have to do w when we were talking about lifelong or persistent or things that they've been dealing with for a long time.

And what about when it does have to do with something that happened like a, as to them as a, as a kid, and it's particularly hard for the guy to talk about difficult for the guy to talk about,  do they have to talk about it forever? Like how, how do you get through that trauma when it's so influential?

Dr. Hernando Chaves: You know, trauma is something that, especially when we're dealing with it for the first time and facing it,  sometimes you notice that,  it increases the anxiety, it increases sort of the fears and the insecurities and the worries and the pain. So we have to, [00:13:00]  let our clients know that it's going to be a challenging road, but there is going to be, you know, change and improvements down the road.

But it's going to be hard to get to that. Place, there's going to be a difficult journey. I find that if there's a trauma present, I think it's a very valuable and, and ethical for us to look at referrals that might be able to help work with that trauma. So for myself, I don't consider myself a trauma expert, so I will refer to a brainspotting expert or a certified EMDR specialist.

And maybe they're not sexuality. Train necessarily, but they can work with those traumas. And then when they're feeling more sort of,   at ease or equipped with dealing with that traumatic sort of experience and coming to a place of acceptance, or at least working through it and may of management, then I encourage them to seek out the sexual piece because I do find that we can,  the work that we can do sexually can sometimes be very valuable.

Once we start first start working on the trauma piece or the PTSD piece that's present. Okay. Sorry. 

Tim Norton:And I there's, there's shame. There's, there's a lot of shame whether or not there's [00:14:00] trauma or, or not. And sometimes I, I feel like guys are really hesitant to come in. So how do you, how do you make them comfortable talking about something that's particularly uncomfortable?

Dr. Hernando Chaves: Because shame. And because guilt are things that are embedded within us, they're experiences that oftentimes are secretive and we hide from the world and we, we have to develop a safe space in a, in a, in a room that can bridge the gap between fear and trust.  I do find that things like humor self-disclosure, I'm trying to formulate sort of bonds within a relationship that, that are based in empathy or compassion or non-judgemental perspectives can really begin to open the door for that relationship to thrive.

 we do find with research that the most change that happens in therapy for clients, isn't so much about the theoretical orientation or the,  specific sort of a,  A [00:15:00] modality that is being used. It's it's about the relationship you have with that therapist. It typically opens people up to feeling more vulnerable, more honest, more transparent,  that trust.

And I think we can emulate some of the relationships that we're hoping clients will be able to recreate outside of session. For example, a lot of clients will come to me and share some of these. Fears, these insecurities, these concerns, and they have a hard time sharing that with their partner. So sometimes I look at it as I'm your practice, when it comes to expressing sort of deeper, intimate communication, that can be really valuable because you know, communication is lubrication.

It, it will allow your relationship to thrive in ways that you had no idea. You know, when you take a risk and your partner can embrace it and can,  hear you and can offer some empathy and compassion back to you and validate or acknowledged sort of your experience. It feels really good people. Deep end people get closer.

You know, we talk oftentimes in couples therapy about how much people in relationships, how distant people are. You can live in the same house under the same roof. You can be married, you can have all this, [00:16:00]  sort of what, what society perceives in our resume as being very connected, right? But you can feel totally alone or totally isolated.

And so I think that's part of our job is to helping them get that relational comfort to them, begin to bring that into their own life. And, you know, generally when I have an individual client,  I will, at some point want them to either bring in their, their partner or,  maybe even refer them to a couples clinician that can help work sort of in conjunction.

Tim Norton:You, you said communication is lubrication. I love that quote for two reasons. One, that's an amazing quote. And two, I think I can actually put that on Facebook. I don't think they'll sensor that one. I mean, when I, when I boost the post for this interview, so it doesn't have sex in the title, I've been running into it.

Dr. Hernando Chaves: If I could give some credit to that one, a sex educator named Emily Morris uses that line often, and she's a great friend and has a really upbeat and positive,  attitude when it comes to sex and, and intimacy. And. To piggyback that I really believe it how important it is for people to become sexually [00:17:00] educated and challenge our sexual discomfort so that they can really immerse themselves into sex therapy processes,  to become more educated, knowledgeable, and comfortable.

You're going to find that that's going to open the door up to sexual pleasure, sexual sort of connectivity and intimacy to communication and relational intimacy and growth.  so really the more you learn, the better you can apply those learnings to and teachings to your life. Yeah. 

Tim Norton: Communication is lubrication.

So. And you don't get to communicate when you just take a pill.  you know, a lot of the time out in the world I'll meet people and I'll tell them what I do. And they say, well, people just take Viagra for erectile issues.  what do you, what's your stance on that? 

Dr. Hernando Chaves: You know, there's a place for everything.

And I think that, that,  PD five inhibitors and, and,  pills that help enhance sort of, sort of PNL performance,  there is a place for them, me personally, in my practice. I think they're a last resort. I think that people, especially if it's a psychological concern, [00:18:00] we owe it to our clients to help them look at the origins of their problem and not sort of apply only quick fixes and short term solutions that don't necessarily address the issues they're struggling with.

And sometimes even mask the problems if you're having a relationship. Difficulty or if you're struggling with trauma or bereavement or a work stress appeals, not going to remedy that stuff. It's just going to be sort of a way for us to help, you know, cope with it in a, in a way that's not addressing specifically what we're struggling with.

 I do find that people sometimes get reliant on the pills. I do find also too that,  people like their short-term quick fixes.  I also find too that people's anxiety can be so powerful that you can actually overcome the effects of a PD five inhibitor. So you can actually it's like mind over matter.

You can be so anxious or so worried or so sort of depressed or,  struggling that the pill is not going to have an effect and, and what people sometimes miss.  misunderstand what these pills is that they're not intended to create desire. They don't make you horny. They simply open up blood flow. You [00:19:00] know, they, they help with the sort of the nitric oxide sort of a process within the brain to help with the relaxation of the muscles,  so that we can allow blood flow to that region.

But if you're experiencing depression and have low desire taking that pill is not going to make much of a difference for you. Just sort of allowing more blood flow to, to come to that region. But if there's little desire or little interest, It's not going to do very much. So we have to look at a much more than simply popping a pill.

Yeah, 

Tim Norton:definitely. Okay. So you. We talked about it in your bio, you work in the kink community and alternative sex community and so forth. Are there differences in the kinds of clients or the other kinds of erectile issues that in the different populations, are there, 

Dr. Hernando Chaves: you know, with, with all the erotic minorities or sort of the all community clients that I have,  they're going to experience very similar difficulties.

Like,  the rest of the population sometimes they'll call them the vanilla or the non-monogamous folks.  essentially, you know, yeah. We, we all experience as humans, anxiety, or depression at certain times, [00:20:00] or, you know, different sort of challenges with stress and with, with,  our environments and our relationships, what a lot of these erotic minority clients really value is having somebody who understands their lifestyle or their,  sexual expression and somebody who's not going to demonize it or, or going to sort of.

Pull the, put the bullseye on that to say that, well, that's the reason why you're experiencing sadness or depression or relational difficulties. It's because you're kinky or it's because you like to go to Dungeons or you have that fetish.  so generally you'll find that many of the concerns are very similar.

They're just looking for someone who understands their life and their interests. That being said, you'll also find insects therapy.  let's say people who are coming out or people who have their internalized shame that are having difficulty with coming to terms with who they are sexually, maybe their sexual identity has unique orientation aspects.

Maybe their sexual identity has a certain unique gender nonconforming or gender identity aspect. And, and maybe there's a, you know, fantasies that they've never really incorporated into their,   sexual experiences. And so part of their low [00:21:00] arousal or low desire is that okay? I can enjoy my sex life in private or by myself, but I'm afraid to share that with my partner and without that sort of introduction of bringing in our interest into our real life, you're going to find that people might,  you know, their fantasies may,  may be better than the reality.

Hm. When we're 

Tim Norton:talking about anxiety sometimes. People just wanting that validation from a sex therapist and that alone can really reduce some of their anxiety. Do you, do you see like a lot of, it's almost like an identity? 

Dr. Hernando Chaves:  you know, there was, there was a researcher,  an, an academic named Vivian Cass who in the 1970s came up with this identity formation,  stages.

And she had different stages that essentially went from being very unaccepting of the self. Too accepting of the self and sort of that process between identity, formation, identity sort of integration. And I see that a lot in people. And I don't think it's just with people that are gay or people that are kinky or people that are non-monogamous or [00:22:00] queer.

I think that's what a lot of things, I mean, I think there's even an identity formation when it comes to. Being an individual,  going through puberty, being a relational individual, I've noticed an identity sort of formation occur within myself with my own sense of advocacy or a sense of feminism that has really evolved since my earlier days of teenage and young adult years.

So I think there's a lot of that.  That people are going through that growth, that change that realization, that there are things about ourselves that we never really allowed to surface, or we felt shame about anger, about maybe anxiety about,  I do find that some people have internalized anxiety about who they are, especially with their sexual self.

So the internalized homophobic person who might hate themselves, that they're experiencing feelings towards it, the same sex, because maybe their history,  It didn't allow for that. Maybe they had sort of social constructs, like religion or a conservative family,  that created self judgment criticism towards it's the people who are attracted to the same.

And you'll see that internalized transphobia, internalized kink phobia, [00:23:00] internalized non-monogamy phobia. I mean, we sort of apply this to different areas and many people when they can come to terms with who they are. And embrace that, find community, find partners or love,  and find sort of that, that,  strength within who they truly, and really are that authenticity that we often talk about.

You see people thrive, you see people just spread their wings. It's like they've lived their life in a cocoon. And all of a sudden they now are a butterfly. And it's really beautiful when they discover that parts of themselves. But it's a journey and it's not always easy for each person to have that,  to arrive at that destination, with that journey.

Tim Norton:Hm. And you, you lit up, nobody could see this. You lit up, as you were saying that, that sounds like maybe that's one of your favorite parts of this 

Dr. Hernando Chaves: work. Some of my favorite parts are when people are overcoming the obstacles and the,  the, what I call the, the restraints, because I like these bonds terms,  the restraints of, of society and, and social constructs.

And when they can break free from those shackles, you just see them really light up, but I'm just emulating and mirroring what their experiences. [00:24:00] The first time a client visited a sex worker and experienced a,   of sexual behavior they fantasized about and all of a sudden their, their lighting, but they're trying to work through this shame of seeing a sex worker, but, you know, if we can work through that, now they have this leftover sort of residual of that was a really plus full, wonderful experience for me.

And it made me grow and understand myself more,  on a sexual identity,  level. And you'll see this all the time with. Person's first trip to a sex toy,  shop where they're buying their first sex toy, because they're an orgasmic and never experienced an orgasm where you'll see this with that first masturbation or that first time that person,  visits a dungeon and, and has like this,  their first sort of pro Dom session.

It's really amazing to see people have to go through that internal conflict of, yes, I feel some stress and anxiety and shame and, and difficulty with it, but I'm also feeling a lot of this. An incredible release of this pressure and,   you know, restraint that, that I've been experiencing for maybe a lifetime.

Yeah. 

Tim Norton:I think the [00:25:00] sex therapists are her best data or why can't, you know, if it's essentially an anxiety problem, why, you know, most therapists work with anxiety and trauma to some level. So, so why can't we just go to,  a regular old non-sex 

Dr. Hernando Chaves: therapist? I had a new client,  two weeks ago who came in for their first session and they were skeptical.

They were a little bit,  concerned about me and who I am and my perspectives. And so we talked over the phone and, and the things I said, I guess, resonated with them. So they decided to make that first session.  I, I guess I calm some of their fears in that, that first a phone consult. And when they came in, they said, you know, the last therapist I went to.

Because this person identifies as monogamous, but their partner,  was non-monogamous and had other partners and share that, that they do like to have an open relationship, the therapist they said in that first session stated, well, that means that they're cheating on you and, and really sort of placed a judgment on this person who is [00:26:00] trying to be honest, trying to express that they're non-monogamous and.

The, the client didn't like that. I mean, they felt judged. They felt sort of like, how do you make these distinctions about my relationship? You've known me for 15 minutes know for 20 minutes.  and so when she shared that with me, I thought that was really important to note that not all therapists are the same, that,  I'm going to use sort of a, it's going to be a little bit of a.

Controversial way to describe it, but I think there are some wolves in sheep's clothing and people can talk about being open-minded and nonjudgmental, but they may have a lot of judgments and they may have a lot of,  opinions. And even as myself, I, I teach,  MFT students in graduate school. You know, I see that there are a lot of judgments and part of, I think the,  the, the importance of our training and our, just our, our constant sort of growth as therapists, we've got to work on what we have opinions about what we have judgments about and what we have,  discomforts about.

And we have to know sort of our kryptonite, if you will.  I know some of the crypto kryptonite and that's w in my work, so I [00:27:00] oftentimes will refer when there's, you know, challenging cases or things that may be, I F. Realize that I may have some difficulty working with a one for example, is bereavement.

You know, I, I, in my own personal life, you know, death has been something that has been really difficult for me. So I've found that it's really helpful for me to refer to an expert or a specialist in those areas for other people, because I don't want my stuff to ooze into our therapy sessions. That's going to affect the way I help somebody.

 and the same goes with sexuality. You have people who have judgments about homosexuality judgments, about being queer judgments about,  You know,  who's monogamous and who's non-monogamous, I mean, even some of our great sort of therapy leaders like John Gottman, you know, in recent years,  has discussed sort of their positions on porn or their positions on,  uh non-monogamy and there, and it appears Common's very anti those and very sort of judgemental about those, even though a lot of us really value and appreciate his work on communication, for example.

 so we have to, I think be mindful of just how people's perceptions [00:28:00] and their own,   Perspectives and biases come into the room 

Tim Norton:and Dr. Chaves has an AVN shirt on. So I'm going to guess that you're not anti-porn 

Dr. Hernando Chaves: well, if you notice what I'm wearing today, I've got a pride hat. So it's got a rainbow,  sort of supported the LGBT community.

 and I've also got an AVN shirt, which is,  adult video news.  I'm a big proponent of. Gay rights, trans rights, and also sex worker rights. I'm, I'm a advocate of the porn industry, and there's an area where you see a lot of judgment with therapists and just the society in general, with stigma and discrimination and a judgment placed on people who are essentially,  creating sort of a.

Labor practice that we sort of demonize, you know, sex work is work and porn is a way that people make a living and pay for educations and pay for families and pay for their own livelihoods. Yet we love to masturbate to it in private. And then in public, we will either not support it or demonize it. Yeah.

Tim Norton:Tons of hypocrisy, billions of hours of porn [00:29:00] consumed every year.  yet somehow they're all bad. The 

Dr. Hernando Chaves: last week, couple of research studies I read on, on porn consumption,  anywhere from 80 to 90% of men watch porn. And yet how many actually stand up for porn rights or sex worker rights? Well, 

Tim Norton:yeah know the, the heart.

Part about doing porn research is they can never have a control group. There's never any guy. Absolutely. Haven't seen any porn to compare the, the non Watchers 

Dr. Hernando Chaves: to, yeah. You have to keep them in a bubble since, since birth. 

Tim Norton:Yes. So,  you,  you're a sex nerd. You ever, every time I'm talking to you, you, you have some study at hand, you've read your Kenzie.

You, you, you. You get to 

Dr. Hernando Chaves: love this stuff. You know, I love this stuff, but I also,  I enjoy learning about it. And for some reason, this stuff clicks, like when someone talks to me about a PE you know, perform a premature ejaculation I'll bite. Talk about, I dunno, there's eight. There's about a 20%,  likelihood that people experienced that [00:30:00] in the, in the twenties and thirties.

And I'll talk about in their fifties and sixties, it's about 31%. And for some reason, these studies just click and that's from Laumann from 1999.  And I like to have a little bit of backing behind the words that I say or the perspectives I have. It's not always the case. Like for example, there's conflicting, you know, research and values in certain areas, but it really helps.

I think for people to know that there's studies being done and there's a. People that sort of are behind, you know, really understanding and on a deeper,  sort of,  level when it comes to a lot of these sexual concerns.  you know, even when we look at something like in California, we have the prop eight,   court case, which was essentially the California voters initially had voted.

That,  we were not going to legalize gay marriage, and then they went to court and then the California Supreme court,  deemed that unconstitutional and actually reverse that. And a lot of the information that was provided in that propagate court case was research. It was research that said, you know, if you are gay, it doesn't mean that you're going to [00:31:00] pass along being gay to children.

So you can be a teacher. And, and there was all these different evidence. And in research studies are showing about,  you know, two gay parents when they have children let's say adopted or, or,  in creating sort of the families where there.  the, the, the patriarchs and matriarchs,  that are gay,  that they actually had notes changes in the child's mental health,   challenges or difficulties.

And they actually found that they had more egalitarian and more accepting attitudes. So it was actually kind of healthy for them. So all of these different studies were really valuable in, in that court case and really overturning and allowing gay marriage to be something in California that we can all celebrate.

Hmm. I 

Tim Norton:think I'm starting to get a feel for what some of your classes might be like. You're, you're a professor and you're just w what are, what are the college kids like these days learning about sex? Are they, do you feel like they come to the table with a decent amount of information, because there's so much information out there, or do you still get lots of pretty basic questions?

Dr. Hernando Chaves: You know, you still, you still will get the whole spectrum.  so. [00:32:00] A lot of the research. If you look at a website like  dot org,  or you can go to planned Parenthood as well. There's a lot of different,  websites that are promoting information regarding comprehensive sex education. And if you look at what is being taught, there is abstinence only sex education.

There's comprehensive sex education. And then there's no sex education. And typically you find in America about a third of each being practiced in different schools. A lot of it has to do with the, the subculture. So in the Bible belt, and then in the South, you have a lot less,  sex education, or if there is sex ed, it's an abstinence focused, which is faith-based.

And typically utilizing, just say no and fear based tactics in order to educate and teach.  they'll do things like,  showcase, you know, big pictures of STI and say, if you have sex, you're gonna, this is what's gonna happen. Get, and, or,  using religiosity, like if you have premarital sex, you're going to go to hell and creating sort of dog line.

And, and in that sense, but we know that that doesn't educate people. We know that that [00:33:00] doesn't stick or linger. It just creates fear and they're still going to be sexual. So you can be afraid and knowledgeable being, having sex. What I see in my classes is that,  you're seeing a little bit more. Comfort when it comes to gender identity and orientation in the younger generation.

So they're a little more, you know, with social media and with some of the progressive movements, I think they're getting a little more comfortable with that notion and that flexibility and fluidity with sexuality.  you're still seeing things like,   a lack of understanding about anatomy, about contraception, about how to get pregnant,  or how to prevent pregnancy.

Most people at that age are not looking to, to, to have babies are looking to try to protect themselves from it. But,  without that knowledge, they're still escalating STI rates. I mean, I think in the last year we had some of the highest rates we've ever had here in America, and that is associated with decreased funding with comprehensive sex ed and decreased funding with a lot of these harm reduction,  STI and contraception services that are out there.

And, you know, your votes really matter. The politicians that you vote [00:34:00] for. Whether you realize it or not are picking Supreme court judges, they are,  putting forth,  legislation that removes money for sex education. That room was money from mental health services. It can remove money from,  you know, supporting our troops and, and, you know,  offering sort of money to the VA.

So it's really important for us to know what we're voting for and know the people, what they stand for and represent. Okay. Right on. 

Tim Norton:So. Let's let's get back to penises a minute ago. You talked about PE and you, you said by over a quarter of man, did you say in their twenties at 

Dr. Hernando Chaves: some point it's usually around 30%.

I mean, that's kind of a number that I'll just generally express and it's consistent across time, like in your twenties and in your fifties. Typically men will, will consistently have a similar experience. Whereas ed will oftentimes increase over time because of there's a physiological component as well.

So with ed, you might find at age 40, about 40% of men are experiencing ed at age 50, about 50%. So it's kind of lined [00:35:00] up,  with our ages. Okay. 

Tim Norton:So specifically with PE I think what is the DSM say? Like under a minute? Are you you, what do you, how do, well, how do you talk about it with a client? Like, 

Dr. Hernando Chaves: how do you.

I do my best to keep the DSM out of it.  just because it can be a little bit technical and sometimes if they're high, high, anxious, highly anxious clients,  they're going to be really fixated on like, what are the terms? What are the diagnoses? Do I fit the criteria? So I like to kind of create a little bit of a definition together.

 but you're right. The DSM will say within one minute,  but some people experience, you know,  what they perceive is. PE and they, and when I asked them, how long do you have sex? They'll typically report like three minutes, five minutes, seven minutes, or, or they didn't incorporate the foreplay. And, and so they have this sometimes an assumption that,  the way that their beat their functioning is actually inadequate.

And you know, that part of my job is to offer some sex ed, but also to validate that, you know, Research shows that,  for heterosexual couples, the [00:36:00] average intercourse time is about two to seven minutes. And you just reported that your intercourse was about three to four minutes. So you're actually right in the middle of like what most people experience.

And sometimes that's like a light bulb moment to say, give yourself a break. Yeah.  there are people now let's be realistic that. Baby ejaculate before they even have their pants off or before they even get their underwear off. So there are some people that have incredibly sensitive, tactile responses to arousal, to sensation to their own sort of fantasies and thoughts.

 and then in those instances, we oftentimes find,  a strong, anxious,  Predisposition. So anxiety across the board in life with work with themselves internally, but also with relationships and being sexual. So I find it very important for us to do a lot of anxiety reduction mechanisms, do a lot of cognitive behavioral work,   addressing things like cognitive distortions thought, stopping,  automatic thought records.

 Incorporating postmodern techniques, like beditation deep breathing, slowing things down. Maybe we'll incorporate some behavioral methods like [00:37:00] Kegel exercises or masturbation peaking exercises to help sort of stretch out and elongate sort of the time between arousal and orgasm.  you know, everybody's gonna have sort of a different.

A treatment plan, if you will.  and I'm not even addressing yet the relational stressors, the work stressors, the life stressors, the anxiety in the world around us.  so each person I think, is going to have their own sort of origins, but also their own sort of ways that they can begin to work on this and try to create a little bit of satisfaction and, and empowerment and agency in their sex life.

Hmm. So 

Tim Norton:you, in a very brief 10, second period, you mentioned a lot of really helpful things. Yeah. What do you suppose helps the most between the CBT stuff, the thought stopping the cognitive distortions or the, the modern stuff, the breathing and the meditation and that kind of stuff. Where, where, where do you really see guys responding?

Dr. Hernando Chaves: Well, you know, there's a mind, body experience, and I think we have to look at it from both perspectives.  What I just did, right. There [00:38:00] was sort of throwing everything in the kitchen sink.  and in a session I would never express all of that, but,  you know, Gradually, if, if, if there's a course of treatment, that's going to be for a few months or hopefully more of if they, they, if they,  dedicate themselves to this, this change in this improvement that you interrogate this and you build upon each sort of successive week of homework assignments, I find that it's very valuable.

The behavioral exercises.  so I really encouraged the Kegel work and I also encourage the, the peaking masturbation exercises and incorporating things like the classic start-stop method in the classic,   squeeze method. Those have shown to have some, some very solid results, you know, from traditional search studies, from masters and Johnson's to more recent research, anywhere from 90 to 61%, I've seen with different research,  for those behavioral methods.

But that doesn't always mean that, you know, we still aren't anxious or worried.  I think it's very important for us to. Sort of help the person with the cognitive,   fears and insecurities and, and, and the way that our mind starts to race and the [00:39:00] thoughts that we have that could be rational or irrational.

So I love to do a lot of,  empowerment with,  with learning about cognitive distortions, learning about negative feedback cycles, where your thoughts and your catastrophization actually magnify the intensity of this, the, of the problem, the situation.  so I do believe that it's really important for us to highlight our patterns and our, and our dynamics when it comes to our thoughts and how they work against us.

 and of course,  I really believe that the future of sex therapy is incorporating mindfulness and breathing exercises that the people that are doing like calm and the Headspace or imagery exercises, or doing their own deep breathing work, you are finding such a powerful change in the brain. That is sort of going to the core of where a lot of our anxiety and depression and mental health struggles lie,  the affect regulation, the relaxation of the amygdala, the changes in the brain that we see with breathing,  is something that, you know, talk therapy doesn't always address or at least target.

Okay. 

Tim Norton:So [00:40:00] you said cognitive distortions, and so we're talking about. PE right now. And so what might a,   an example of a cognitive distortion and be in a, in a typical, highly anxious PE client, what the heck is a cognitive distortion? 

Dr. Hernando Chaves: Sure. It's, it's sort of our mind playing tricks on us and the way that we think can sometimes affect the lenses that we see the world.

Through and our experience through. And so we have to adjust the filters in our life in order for us to see things a lot more realistically and clearly,  let's say for a person who's experiencing, let's say early ejaculation, it's very possible. They may have like an anticipatory sort of anxiety that any situation that may become sexual, or they may become close to somebody, they may have a predisposition to do something called.

Catastrophization where they're going to magnify the moment and believe in their hearts, that things are going to go wrong because the previous experiences in the past, they felt haven't gone the way that they'd like it. So we are creating this self fulfilling prophecy in our minds of saying, I feel [00:41:00] like I failed before, so I will fail again right now.

And therefore I will fail. And so we have to try to break some of those cycles of creating catastrophes. When in fact we can learn skills, you know,  sexual skills,  to. Slow down to incorporate foreplay to,  again, stretch out the plateaus,   in our sexual response cycle. So we can elongate the time, you know, that we Jacqueline have orgasm.

 for a lot of people it's really about,  quieting sort of the irrational thoughts in the mind. And that's what cognitive distortions really do is they create a lot of irrationality within the self. 

Tim Norton:And you also mentioned Peking. Exercises 

Dr. Hernando Chaves: what's that a peaking exercise or our classic masters and Johnson's technique.

 An individual can do this by themselves and they can do this with a partner. And it's a part of what we called it. It's part of the protocol that we call sensei focus. So I'm going to briefly talk about that first and then I'll get into Peking sensei. Focus is essentially an anxiety reduction,  protocol.

Call [00:42:00] that creates kind of a baby step,  experience for individuals to,  gently experience more and more anxiety in a reasonable and manageable way. And they stay in this place of, of anxiety until they sort of overcome or master that anxiety and they move forward. And, and I'll give you a quick little example of a systematic desensitization process.

A person may have difficulty with. Touch. And that may come before being sexual. So we may work with a hand massage exercise until they get comfortable with that. And then they move towards maybe a full,  of massage with their clothes on and that exercise,  until they can master that anxiety. And then they may want to maybe a massage with, with maybe their underwear on.

And when they master that, they might move towards a partner exercise where they might have a, take a shower together and be new together. And so we start working. These baby steps to sort of more and more levels of,  physical and sexual intimacy and people will make a hierarchy of fears in order to address what are the things that create most anxiety for them.

And then you work with their hierarchy now. [00:43:00] Peaking exercises can be part of that process. It's an exercise where an individual can touch themselves and masturbate,  to where they get to the point of no return to right when they're about to ejaculate and they're going to stop,  typically people will do a squeeze with the Kegel exercise.

 some people will actually even do the squeeze method, which is,  taking your two fingers and applying pressure on the frenulum. And the top of the head of the penis and just applying this a short squeeze and what we're doing is trying to teach the body to manage high levels of sensory experience and sensation in the body and in the penis.

 and so when you do that three or four times, you sort of,  go to, let's say if we use the zero to 10 method and 10 is orgasm trying to get to about an eight or a nine, right before orgasm, then stopping, allowing yourself to return back to maybe a six or a five.  not to lose the full erection, but to then sort of,  diminish the sensory experience.

And then you masturbate and touch yourself all the way back up to that. Eight or nine, close to a 10, that point of no return. And then we do this [00:44:00] about three, four or five times, and then the person can ejaculate over the course of weeks and weeks and months, you'll find that people will have better management and better at what we call ejaculate, Tory control.

So these peeking exercises are very classic. They're very effective and they're fun. You get to masturbate while you're doing your, so what a fun homework 

Tim Norton:assignment. So, yeah. We,  also earlier in the interview, we talked about delayed ejaculation.  this, that just the opposite. It sounds like obviously there there'd be much different homework assignments for 

Dr. Hernando Chaves: something like that.

Culation what I've experienced. And what I've also read about,  with the experiences of the clients is that it's also still a very.  it's a, it's a sexual concern. That's still tied to anxiety. And for a lot of people, it's about difficulty letting loose. It's about,  sort of,  allowing anxiety to,  reduce our sensation or to, you know, some people will try to divert away from pleasure in order to last longer.

So sometimes they start to learn to last longer,  uncontrollably.  generally what you'll find too is that there could be [00:45:00] associated mental health concerns. There could be.  like a depression or a low desire concern that may not be addressed. So being sexual might not be that enjoyable or pleasurable or exciting.

And so it creates a long lasting experience that can be,   challenging now with the anxiety piece.  many times it's about the performance as well or sexual anxiety. So we have to look at what is the, the anxious origins,  what I have found too, as well as that there are certain things that can be very beneficial for delayed ejaculation.

For example, I'm using this, let's say,   certain products that can actually enhance the sexual experience. Some people that have delayed ejaculation,  could enjoy their sexual experiences more if they had some more of that sensory stimulation.  I've seen both with erection difficulty and also delayed ejaculation,  prostate play in the insertion of a prostate toy, actually having wonderful effects on people's erections and also people's sort of pleasure.

And so that can oftentimes facilitate a. Quicker orgasm and also a stronger erection.  I've also found too [00:46:00] that,  incorporating more of their fantasies as well, too. Cause a lot of times with delayed ejaculation, the, the anxiety of sharing, who they really are sexually their authentic sort of sexual.

Desires is scary. And many times you'll see things like,  desire to wanna incorporate kink or incorporate fetish or incorporate something that maybe they masturbate to a, with porn, but they don't necessarily bring it to the bedroom. And so there is going to be a need for us to address why they're afraid to share that.

And also. If you were able to, to address it and, and, and share with a partner, could you then sort of begin to enjoy the process more? Now, there are going to be some medical concerns as well, too. So it's important for us to have a medical,  clinician as well associated with, you know, seeing if there are any,  brain issues, any,  neurological components, any sensory components.

 they do have tests that can actually,  With heat and with cold, they can test the sensory experience of a, of a penis. But,  it's important for us to get inside of people's heads as to why they're,  they're not really fully immersing themselves. Why are you [00:47:00] holding back? Is it a trauma? Is it a fear?

Is it an insecurity? So there's a lot to explore as well with delayed ejaculation. And 

Tim Norton:so, you know, I think sometimes people. I really don't understand why that would be a problem. Like, Hey, this guy, this guy can fuck forever.  so what do they tell you? Like, what's the,  why do they come in? If, if that's their, their only 

Dr. Hernando Chaves: issue, you know, In society, we have sort of a put on a pedestal, this idea of long-lasting, maybe we see it in porn.

We see somebody lasting 20, 30, 40 minutes in a video. And we think that that's the way that we're supposed to behave or, or, or be sexual. When in fact, when you look at a research,  most partners don't want to have sex that long that you find that,  although that.  the orgasm gap may be a little bit,   longer with women versus men.

If we're talking about sort of the, the, the, the binary gendered model,  you still will find that if a person lasts too long that,  female [00:48:00] partners, for example, for talking heterosexually will complain about dyspareunia, painful sex, maybe,  lubrication sort of diminishes, and that can also be abrasive.

 you may find that if they have an orgasm,  That that may,   you know, after that sort of can be very sensitive and almost painful as well.  you'll find too that it can create, you know, when people stop,  it can create sort of our own self-criticism and self-doubt with ourselves because we're not able to, you know, we we've attached a lot of, of expectation to sex with orgasm means.

Good sex. And for a lot of people, they want to orgasm. So they're putting more and more pressure on themselves to have that orgasm. So this comes back to that,  deconstructing sort of the expectations we have, but also getting to know our bodies. You know, a lot of people don't talk about your body and my body and how we can work together to,  work through, you know, through a concern.

For example, if.  let's say we're having a hetero couple and a male takes 20 minutes of intercourse to ejaculate and their female partner may be orgasms in, [00:49:00] you know, eight minutes.  that means there's like a 12 minutes sort of difference. And I know I'm being very systematic here, but it's sort of an example.

Could they engage in other behaviors that can help. Maybe a,  move his sexual response along so that he might be more in line with her sort of experience, you know, could it be that he masturbates, you know, to start off their sexual sessions, maybe there's an incorporation of oral sex.  maybe it's the transition from,  him touching himself and, and stroking his penis and then going to oral sex on her, on her vulva.

And that sort of pushes him back closer to that 20 minutes. Maybe it's about reconfiguring. Their sexual script, maybe it's about the different positions they're in certain positions can facilitate more,  orgasm or,  or delay the orgasm. You know, some positions, like for example, the premature ejaculating who's in missionary will create more,  muscular tension in their body.

Because they're going to be holding up their bodies.  so it might facilitate a faster orgasm. Typically you find that the, with orgasm, it's the release of muscular tension in rhythmic contractions.  [00:50:00] so if you're building up tension, it might make you come quicker. So if you are more relaxed in a side to side or in a laying down bottom position that might facilitate you to,  lasting longer.

So we have to sort of be mindful of our bodies and, and the communication of how we can work together and sort of mesh our bodies together. Hmm. Hm. 

Tim Norton:Yeah. I love all of those points. That's really invaluable information for everybody out there.  we keep mentioning partners. Could you speak to partners?

Any of them have a person with delayed ejaculation or early ejaculation Mo how can they help or how can they not make it worse or what should they not say or say? 

Dr. Hernando Chaves: I think that's a great question. Cause sometimes,  the people that are. Around some of these concerns, the relationship itself isn't always brought into the room.

 just like we've talked about those who let's say are caretaking for someone who may have cancer. And we sometimes forget that the part, those partners are also experiencing their own challenges. So are those that are experiencing,  partners with their own sexual concerns? I do think it's important for us to not.

[00:51:00] Put the bullseye on one individual and say that this is your problem. And it's not, it's, it's a relational component because we work together in relationships to help each other. It's a mutually sort of beneficial, supportive environment that a true sort of healthy relationship,  evokes. So I think important if we can, if they have a partner to incorporate them into that,  the, the treatment process,  to do a couple of things, one encouraged them to be,  Compassionate, you know, sometimes people, if they're not getting what they want sexually can be a little bit harsh.

They can criticize, they can make,  contemptuous comments or snide remarks or, you know, nonverbal gestures. And, and it may be just our natural reaction of emoting our frustration. But we have to be mindful that to be supportive means that we have to sometimes acknowledge that there are times that we,  maybe contribute to the, to the challenges.

So. A partner that can listen a partner that can communicate a partner that can be supportive, a partner that can maybe participate in some of these exercises, [00:52:00] a partner who may be able to lighten the load, maybe using things like,  You know, helping their partner to challenge maybe some of the cognitive distortions or to sort of create a less anxious environment can be really valuable.

And those partners also need to take care of themselves. You know, we talk about self care with just about all of our clients, but especially those that are in a supportive role, they need to have their self-care and their time for themselves too. And for example,  if there is a sexual concern, let's say there's an erection difficulty, or an early ejaculation difficulty with a partner, you know, It's important for us to also acknowledge that that other partner may have their own sexual frustrations and we should encourage them to masturbate, to be, you know, to, to offer,  pleasure whether it's through oral or it's through sir touch or sex toys.

 we have to also remember that they're also struggling too, and that's not always,  we're not always sort of on that radar.  

Tim Norton:you keep talking about. The,  the different things that guys can do and different things, things that partners can do, people with penises [00:53:00] can do.  where does porn fit into all of this?

Do you ever tell guys not to watch porn while working on an issue or any of the above mentioned or, or to watch more porn? Or how does that work into your day? Typical treatment, 

Dr. Hernando Chaves: depending on the issue. Yeah. That comes into the office. I may have a different perspective of how I want to utilize porn in their treatment.

Most people, you know, if we know that about 80 to 99% of men are watching porn,  let's just be real. Most people are, and, and very few are actually having difficulties or problems with it. One thing I may see is that,  there is a comparison effect that some people will engage in where their, their masturbatory porn sort of experience is different than are there.

 the realism of their, let's say sexual relationships in real life. And so sometimes we're attaching a lot of our heightened arousal and our true sort of authentic sexuality to that more secretive porn,  masturbation expression. [00:54:00] So I think it's important to incorporate more of that into the couples,  experience,  there's research that suggest that when couples.

Viewpoint together and also are supportive of each other's master Victorian porn use that they actually have typically more communicative and more intimate relationships and more,  openness when it comes to their sexual behaviors. Whereas if there's a hidden nature of porn, that in itself can be sort of problematic because I think that can pull people away from coming together and sort of sharing intimacy rather than experiencing it separately in a way from our partners.

 there are sometimes people that I encourage to, you know, if you're.  trying to explore different things that might be arousing. Sometimes it's helpful to find different arenas of porn to explore if that's something that you're interested in. So I think also if people are working on body images, some people,  don't see themselves as, as attractive or rousing or sexual.

And sometimes seeing people with, with similar body types and similar sort of looks can be really empowering and that can be done through watching porn. [00:55:00]  you know, Occasionally you'll have people where they're watching so much porn that it becomes problematic. And I think it's important for us to maybe set some boundaries around that and yeah.

And create,  a little bit more of a, an awareness of how it's impacting their life. If they're, if they're having legal trouble with a relational difficulties work challenges with, because of their porn use, you know, we definitely want to,  be mindful of how we can sort of in a harm reduction method, not remove it completely, but do it in a way that it's more of a reward.

Or celebrating pleasure rather than detracting from us, you know, taking care of a lot of our activities, activities of daily living. 

Tim Norton:Okay. Very well said.  I think that's, that's about all I have for today. Were there, was there anything else, I mean, you you've done so much, you get involved in so many different things.

 Anything else you want to talk about? Or where do you see yourself in 10 years? Like we're we're what are your, what do you want to see happen with sexuality and in the world? And with this 

Dr. Hernando Chaves: country? [00:56:00] My hope is that in 10 years, people will be more open to sexuality in a less stigmatized and more sort of open framework within the world.

You know, we're in a time right now where our president is,  you know, We're talking about our president having sex with a porn star. We're talking about people in the, in the military,  transgender individuals, having a space and a place, you know, to, to fight for our country. You know, we're looking at the need for us to create.

D data backed evidence-based researched programs for sexual education with our children and having that incorporated. I think that we can look to other countries as models as well. You know, there's some great,  sex education in places like Sweden and the Netherlands and Germany. And I would love to see some of that sort of coming our way.

I know there's a lot of. Pushback. And there's a lot of fear around sexuality. So with our conservative sort of perspectives and also the [00:57:00] religiosity that's tied to it. And, and some of the,  the fears around sex, I think it will be challenging, but I'm up for the fight. I love advocacy work and, you know, little by little, we'll see some positive changes and, and it's a pendulum.

It swings back and forth. You'll see. Progressive liberal openness and some, some positive changes. And then you'll see things sort of swing back because of the backlash and vice versa. So I'm just hoping that we become more and more,  open with our discussions, especially within relationships and with individuals.

I mean, here we are,  talking about couples and relationships and we're seeing,  more books coming out. We're seeing more TV shows around sexuality, more movies that are covering this,  these topics. I'm just hoping people will. Stop being so uncomfortable and judgmental around something that is so natural.

Yeah, me 

Tim Norton:too. And then,  we'll have to find other jobs that would that be a nice problem to have? Okay. Well, thank you so much for, for this. This is great.  and,  keep having hard conversations out there, guys. 

[00:58:00] Dr. Hernando Chaves: Thank you so much for having me.

Tim Norton:Thanks to the show's executive producer, Robin Morrison. Thanks to Kat Murphy, director of social media. Thanks to Tim scrub for the music. Thanks to the sound editor there. Robbie Carmen, thanks to Brian. We for naming the show. Thanks to Alex PIDs for the intro. Thanks to Arlina sushi on Logan, you can find this podcast at hard conversations, podcast.com or wherever you get your podcasts.

You can locate me on Twitter at Tim Norton LCSW or on my website for my private practice, Tim Norton therapy.com. You can also email us@hardconversationspodcastatgmail.com. Or calling to our hotline at (662) 626-4276 that's six six two, man. Hard, thanks to all my friends and family for brainstorming this show with me.

Shout outs to the sex positive community, including sex educators, sex [00:59:00] therapists, sex coaches, and other fellow sexual podcasters, sex, surrogates, academics, sexual health, medical community, sex workers, the tantric community, and everybody else involved with having hard conversations.

If This Episode Resonated

If this episode spoke to you, there is a path forward.

Tim Norton provides a discreet, evidence-based therapeutic space where men and couples can understand the deeper systems behind desire, arousal, and connection. His work combines rigorous neuroscience with a grounded, relational approach to help clients rebuild aliveness in their bodies, strengthen partnership, and create lasting change.

A Urologist Talks About Medical Erectile Dysfunction

Episode Overview

Tim speaks with Dr. Josh Gonzalez, a board-certified urologist and fellowship-trained sexual medicine specialist, about the biological causes of erectile dysfunction and why treatment requires more than a prescription. They explore hormone pathways, blood flow, nerve integrity, prostheses, injections, and the psychological factors that often accompany medical ED.

Key Themes

• The three medical pathways of ED: hormonal, vascular, neurological

• What actually happens during a urology consultation

• The limits of pills and when they work best

• Testosterone, endocrine health, and sexual function

• Penile injections, shockwave, and implant surgery

• Pelvic pain, prostatitis, and chronic tension patterns

• How psychological and biological factors intertwine

• Why integrated sexual healthcare leads to better outcomes

Listen to the Episode

Listen Now

Dr. Josh Gonzalez, MD

Dr. Josh Gonzalez, MD is a board-certified urologist and sexual medicine specialist whose work focuses on male and female sexual dysfunction, hormone health, arousal disorders, orgasmic difficulties, pelvic pain, penile curvature, and erectile issues. He is a recognized advocate for sexual health and inclusive care for the LGBTQ community.

Website:https://joshuagonzalezmd.com/

Episode Transcript

Tim Norton: Hello, and welcome to hard conversations. Today's guest Joshua Gonzalez MD is fellowship trained in sexual medicine and specializes in the management of male and female sexual dysfunctions. These include issues surrounding hormone deficiency, menopause, sexual arousal, orgasm ejaculation, the Beto desire, sexual pain, penile curvature, and erectile function.

Dr. Gonzalez also treats a variety of common neurological conditions, including benign prosthetic disease, voiding dysfunction, and male infertility throughout his career. [00:01:00] Dr. Gonzalez has focused on advocating for sexual health and providing improved healthcare to the LGBTQ community. Thank you, Dr.

Gonzalez for this today. I really appreciate it. Yeah. Thanks for having 

me. 

Tim Norton: Yes. Does your, does your bio.  leave anything out. You said you were born in Los Angeles. You're from Los Angeles originally. 

Dr. Gonzalez: Yup. Yeah, I was born and raised here. Didn't leave here until I got into medical school than I did my medical school training and residency in New York.

So I lived there for 10 years in New York. Yes. 

Tim Norton: Columbia medical school, Columbia 

Dr. Gonzalez: medical school. Yeah. 

Tim Norton: And were you able to learn about sexual medicine over there? 

Dr. Gonzalez: No. So I think that's a disservice,  in the medical education, the way that we do medical education in this country, it's, it's really not an emphasis.

And I think people who are drawn to sexual health as a career, kind of have to seek it out themselves. And so, you know, medical education is very much about exposing students to just the basics of [00:02:00] physiology and pathophysiology and kind of introducing them to the different fields of medicine and then allowing them to choose their career path based on that.

 but sexual health can be sort of approached from,  several different sort of traditional areas of medicine,  if you're interested, but you kind of have to,  be motivated to do that on your own. And you were initially,  not, I didn't really know what that it was a F fields really. I mean,  I, so I, initially, the way I got into this was basically I in medical school was drawn to sort of surgical subspecialties, which we were made to rotate through during our third year of medical school.

So we got to kind of be exposed to all the different surgical subspecialties. And I just really liked urology. I thought that the,  people that go into the field of urology just tended to be. Which is kinda cool.  a lot of surgeons, you know, don't have the best reputations of being personable or humble.

 but a urologists didn't seem to [00:03:00] really fit that mold and kind of did seem more genuine to me. And I don't know if that has to do with the fact that we kind of deal with. Private parts,  and therefore have to have a certain sense of humor and kind of not take ourselves too seriously, but I just was really drawn to the people.

So I decided to go into urology. And then once I got into urology, just kind of looked at the different potential subspecialties within that field. And really liked the men's health space.  and so I, when I was getting towards the end of my residency, kind of looked at fellowships that I could focus on mental health and kind of stumbled upon,  sexual medicine as a field, which involved not just male sexual health, but female sexual health, and,  ended up doing fellowship in San Diego.

Doing just that. I mean, focusing on,  treating male and female sexual dysfunctions, so. Okay, great. 

Tim Norton: And so, I'm curious about this program and San Diego, [00:04:00] this fellowship, how many fellowships are there like that in the country? 

Dr. Gonzalez: So that one in particular is pretty unique. Meaning I don't think that there's any other fellowships like that in the country, in the country.

 primarily because it does focus on both men and women. Okay. So the other fellowships that I applied to. You know, simultaneously we're more focused traditionally on male sexual health. So they kind of were a combination of men's health issues and,  male and fertility. So,  the, the fellowship I did in San Diego is pretty 

Tim Norton: unique.

So are there a lot of those around, I'm just 

Dr. Gonzalez: trying to get a lay of the land there. I mean, there's less than. 15. I think when I applied, I applied to 10 different programs.  they're kind of spread out all over the country and you know, it's a fairly small community. I mean, when we have sexual medicine, national meetings, it's the same core group of like 200 to 300 people globally that comes so globally.

[00:05:00]  who, yeah. Who are considered specialists in sexual medicine. So, and 

then 

Tim Norton: globally, do you get the sense that. Like which countries are more cutting edge or kind of on top of it or is it, can you really say that's 

Dr. Gonzalez: no, the T it's hard to say.  I mean, I think that in terms of publications in the sexual medicine space, a majority of those are probably coming out of the U S but there's, you know,  a large interest in sexual medicine in Asia, China, Japan,  Europe, certainly.

 we have some colleagues in,  in South America.  there's a lot of people,  that come out of Brazil,  who attend the meeting. So there, there there's, there is really a global interest.  but I would say, you know, in terms of publications in sexual medicine, my guess would be most of them come at it, the U S okay.

Tim Norton: All right, outstanding. So I'm a sex therapist and [00:06:00] if I'm. Doing my job, every guy that comes in and wants to talk about erectile issues. My first question is, have you talked to a doctor? Have you talked to a medical doctor? Yeah, most of the time they say, Oh, I've talked to for the last thing I wanted to do is talk to you.

Talk to me, talk to talk about the, you know, what's going on in the bedroom and everything like that, that this could be some form of anxiety. So I, and I actually. Heard of your name a while ago, and you've got a good reputation in this town. Oh yeah. I am a bit genuinely. I always say that about my guests, but it's always true.

I am excited about this interview. I appreciate,  what happens when they come here? 

Dr. Gonzalez: So, I mean, I think that one of the,  strengths that I have in terms of treating patients with these issues is that,  a lot of them come to see me and I am the fifth or six doctor that they've seen because I think men, especially, you know, if they happen to.

Be on the younger side, [00:07:00] get,  dismissed. And that's after, you know, months to years of shame that they have had about this issue.  if we're talking about erection specifically where they haven't sought help, so then they finally get the courage to seek help and,  You know, if you get a,  unqualified provider who doesn't really understand the nuances of how to sort of formally work up erectile dysfunction, then they just either throw pills at these patients, which may or may not be appropriate depending on their problem.

Or they tell them that it's, they. You know, are unhappy in their relationship or it's all in their head. And,  that's not helpful for patients,  because they still are. They walk away, not fully understanding why they have this problem. And so I spend a good amount of time in their first visit.  just educating them on the various causes of erectile dysfunction and basically tell them.

You know, as their physician, I'm going to focus on primarily the physical causes or potential physical factors that are [00:08:00] contributing to their issue.  give them solutions to address those problems and,  just educate them on, on,  all of the factors that come into play when you're talking about,  erectile dysfunction and, you know, I'm, I'm, I'm pretty upfront with them in that first visit.

I tell them that,  That anxiety and certain psychological factors can definitely play a role. And, you know, I try to make them feel better and say that, you know, in my experience, a majority of men have some psychological component and, and it makes sense because if you're a man who is in a relationship and you enjoy having sex and you want to have sex and you can't, then it's going to cause anxiety and,  Then you're going to carry that anxiety onto future encounters.

And it's always going to be something that you're thinking about and,  could potentially contribute or,   make worse any physical issues that are going on. So, right. Yeah. Yeah. I 

Tim Norton: think the unfortunate thing is when the doctor who says whatever, it's all in your head, [00:09:00] or this might be stress there, it would be great if they had a.

A psychologist next door. Right. You can say, well, go talk to this person today. And I don't, we still haven't really bridged that. Yeah, sure.  maybe I'll get an office in this suite, but I think we're really, we always talk about mind, body. And are you getting the sense that there's, we're gonna be able to reach across the 

Dr. Gonzalez: aisle?

Well, so the, where I did my fellowship,   in San Diego, the, my mentor, who's sort of like the guru of sexual medicine. I mean, he's been in the field for 40 years.  really,  his practice is integrated, so he has onsite,  himself. He has,  Physician extenders. He has like a nurse practitioner and a physician assistant,  who help him,  with the medical side of stuff.

And then,  in the same office, he also has a sex therapist and the pelvic floor, physical therapist. So [00:10:00] each new patient who comes to see him,  his men has to see all three. Clinicians. So,  they are all seeing him as the physician. They're seeing the sex therapist and they're seeing the public for physical therapist,  for at least an initial evaluation.

Now, not all those patients need to see, continue to see those providers, but,  because it is often such an integrated problem. Yeah.  it's a really great model. I think the problem is, is that it's,  he is a fee for service practice, so he can, he has the sort of freedom to do that. I think when you're talking about,  Integrating providers,  and trying to work in the sort of Western medicine model, it becomes a little challenging, but I do think it's a, it's a very valuable way of sort of treating these patients because they don't even have a choice like that first visit.

They're seeing all three providers, even if they think like, no, I don't have anxiety about this. It's all a physical problem.  they're still getting sort of screened to make sure [00:11:00] that there's not, you know, See significant non-physical issues. It 

Tim Norton: sounds like utopia. Yeah. No, no, that sounds great. Yeah. Have you heard among, you know, if you went to a conference, like when you're talking about anybody else talking about doing things 

Dr. Gonzalez: like that, I think people are, they see value in sort of an integrated approach.

I mean, yeah. People talk all the time about like a bio-psycho-social model. And so I think there are centers that are. Being created.  it's interesting. Cause I think a lot of it is happening in the female sexual health space where you're seeing pelvic floor, physical therapists working alongside kind of colleges who are interested in sexual health,  and maybe psychologist or sex therapist or what,  I don't see it a ton in the male sexual health space.

So yeah, I mean, I definitely think there's a need for it. Okay. 

Tim Norton: So maybe briefly, I don't know if there are a lot of different reasons, but there maybe hundreds [00:12:00] maybe, but when it's physical and then it's very clear like that you wouldn't have to have any kind of an anxious response or in any elevated cortisol levels.

What are the most typical 100% physical erectile dysfunction? 

Dr. Gonzalez:  so if you're just talking about physical, I mean, you can break it down. Into like three basic causes. So you can have a hormonal issue,  in which, you know, your testosterone, as an example may be low. And,  we know that, you know, men's erections tend to function better when.

They have healthier levels of testosterone. So that's something that's pretty easy to screen for it. Just do some blood work,  on their initial visit. I also pause,  when I am talking to patients about this particular,  type of, of ed, because a lot of them have had testosterone levels checked and they might fall into the normal range.

And so that's a point at which they are often dismissed because their doctor's like, listen, we checked her testosterone. It's normal. This is not [00:13:00] our physical problem.  the truth is, is that, you know, they could be in the normal range, but that normal range is pretty wide.  because it's meant to encompass men from adolescents until death.

So, you know, if you're a 35 year old guy and you're on the very low end of normal, that's probably not going to be an optimal level for you being a 35 year old guy who is having issues with his erections or. You know,  symptom of, of having low testosterone. So I think a little bit more liberally about that.

And I explained to patients like I'm not looking for normal or abnormal, I'm looking for are your levels optimal for what we're trying to accomplish. So,  that's why,  you know, one physical area that we investigate,  blood flow is obviously huge. I mean, for our erections to work,  the blood flow to the erection has to, has to function normally.

 but what, what I think some people don't appreciate regarding. Blood flow is it's not enough to just deliver enough blood into your penis for an erection. You also, we have the, the ability, [00:14:00]  to trap the blood in the penis. And so that's a unique thing to the penis,  because most of the time blood.

Enters tissue drops off. Oxygen picks up waste and immediately circulates out. But when you have an erection, blood does not leave the system. At least it shouldn't in a normally functioning erection.  and so a lot of guys think like, Oh, well I can get an erection. I just have trouble keeping it so that doesn't qualify as erectile dysfunction, but that's actually not true so that we have a way of investigating that.

By doing an ultrasound to actually look at their blood flow in real time, when they have interaction and figure out which potential vascular issue they may have, are they not delivering enough blood there or are they not trapping the blood there? And those two things are really important because it's going to sort of predict how they respond to certain medical treatments.

If you're trying to give them a solution for the,  blood flow issue.  lastly, you can have a neurological issue. So a problem of the nerves, we see that in people who have had long standing diabetes, people who have. [00:15:00] Spinal cord injury, people who have,  certain neurological diseases.  so those are the, the sort of broad categories of physical causes.

Tim Norton: So I want to ask about neuro neurological issues and the trapping. So what is the basic mechanism that traps the blood in 

Dr. Gonzalez: there? So,  It would be nice if I could,  illustrate this. But 

Tim Norton: the first thing I thought of was a cock ring, 

Dr. Gonzalez: right? So Cochran does basically what you should be able to do on your own by physically constricting the blood and not letting it leave there.

But basically,  we have veins that take blood. Out of the penis that exists on the periphery or on the edge of the chamber, the erection chamber that has the spongy tissue that gets that expands. When you get blood into your penis during arousal, in an ideal situation, the erection chamber rapidly expands as it fills with blood, your penis gets bigger and it gets harder.

And as that erection chamber expands, it compresses the [00:16:00] veins that exist at the periphery.  but there are certain conditions,  where men can develop scarring in the, in their erection tissue. And so those areas of scarring don't allow for rapid expansion or sometimes incomplete expansion of that particular area.

And so at that. Periphery,  you have veins that remain partially open. So,  you're kind of leaking blood,  back into your systemic circulation,  when you don't want it to, I mean, you want the blood to, to stay there. So,  that's primarily how it's called venous leak, erectile dysfunction,  how that happens.

And then, you know, you try to overcome that using a ring by,  externally compressing,  the blood in the penis, 

Tim Norton:  thumbs up, thumbs down. Cock ranks. What, what is,  I always wanted to ask for 

Dr. Gonzalez: a urologist function, both.  I mean, I think that they're fine,  [00:17:00] for,  play, which certainly,  I think you need, I counsel patients that they just need to be careful of what kind of conquering they use.

 because obviously when your penis becomes gorgeous, it's bigger than.  it was when you put the cock ring on.  so I have in residency had to cut cock rings off. So I usually,  tell patients to steer clear of metal cock rings because those,  are difficult to remove. And the last thing you want is an electric saw down there trying to cut through to do that.

Yeah. Oh my God. Yeah.  the fire department was involved, but yes, I was there.  but you know, rubber, a rubber cock rings, I think are fine.  and then in terms of function, it just really depends on the problem. So I mean, if, if a man has really mild venous leak, I'm using Cochran's in combination with pills or sometimes even injections,  can be helpful.

 some guys will use vacuum erection devices, also in conjunction with those. But, you know, I mean, I've had patients who [00:18:00] have more moderate or severe venous leak who asks. If the, if I think it'll be helpful and in, in those guys, it really isn't.  it just,  it's not strong enough to sort of overcome them their issue.

Tim Norton: And so what 

Dr. Gonzalez: do you do for them? So, so for guys who have pretty serious venous leak,  the gold standard of treatment is really a penile implant. So surgery. Yeah. 

Tim Norton: And do you, you don't do those, are you? Yeah. Oh, you do. Okay. 

Dr. Gonzalez:  It's like my favorite surgery. It's your favorite 

Tim Norton: surgery? Yeah. What do you like about doing penile implant surgery?

Dr. Gonzalez: you know what, I think it's the most satisfying. No. Well, first of all, it's the most satisfying for patients. I mean, the satisfaction rate with penile implants like 90, 95%,  it's higher than any medical treatment we have for ed.  and I think, I think for a physician it's very satisfying because you take guys who have probably been.

Impotent for the lack of a better word. I don't really like that word, but,  [00:19:00] non-functional sexually for years. A lot of the times,  sometimes decades. I mean, it's it's and, and, and then you give them the ability to be.  as functional as they want to be. And so the peanut and plant, it takes a guy who probably couldn't get an erection or at the very least couldn't maintain his erection.

Now he has the ability to activate the device, have sex and basically stay hard until he chooses to not be hard anymore. And so it's really satisfying.  and can be life-changing. I mean, I've had patients tell me that. You know, saved their marriage and it completely changed their life. I've had patients who were depressed for years because they couldn't have satisfying sex who, you know, got off medications.

I mean, because they were the source of their depression was no longer there, so. Wow. Yeah. 

Tim Norton:  On the off chance that the listener out there isn't binge listening all my episodes and doesn't know exactly what a penile implant surgery is. Could you kind [00:20:00] of tell us what happens? We did talk about it in another episode, but 

Dr. Gonzalez: yeah, so basically what we do is,  implant a device that,  how do you get it in there?

 well, there's different types of incisions you can make. I mean,  we typically choose to do like a scrotal incision. Because,  you can sort of approach all of the things that you need to get access to through that incision. But some men will, or some physicians will make like a called an Infor pubic incision, which is basically just at the base of the penis.

Okay.  either one,  Works.  but basically through one incision, we kind of implant a multi-component device. That's composed of two cylinders that are placed where your erection tissue is currently,  a pump that goes into the scrotum and a reservoir that holds fluid that gets circulated over and over again.

And so,  what you do. You know, what, what a man does basically when he wants to have sex is reaches down [00:21:00] into his scrot pumps up the device and it draws fluid out of the reservoir, into the erection,  sorry into the,  the cylinders,  until you get fully hard. So it provides the rigidity that you, you can't, you can no longer do naturally.

Tim Norton: And it literally stays hard until they. Yeah. 

Dr. Gonzalez: So at least hard, I mean, you basically become like the world's greatest lover because you stay hard until you deactivate the device. And so on the, on the top of the pump, there's a button that you press that basically reverses the whole process. So it's a hydraulic system that basically just reuses, salient fluid over and over again.

 but yeah, I mean, it it's,  I remember when I was a fellow, one of the,  male patients that we had said that he,  His comment was, he felt like he could have sex, like a woman after the surgery. And my, my,  mentor said, well, what do you mean by that? And he said, well, w I can literally lay there. And [00:22:00] my wife can, you know, go to town basically.

And I'm just, you know, until she's done, I'm just, you know, I can just. Read a book. If I, you know, basically was saying he doesn't have to be present if he doesn't want it.  you know, and for years that he was probably really concentrating, trying to like maintain his erection. But,  so yeah, he was actually really happy about that.

So the partner satisfaction rate is also really great too, because especially for people who are in couples,  because it's such a big part of, you know, Being in a couple, and if you can't have sex, now you have the ability to, so it can be really sort of life-changing for both people. 

Tim Norton: And do, does anybody say that after a certain amount of time it's uncomfortable to leave?

Was 

Dr. Gonzalez: it hard or, yeah, I mean, you definitely don't want to leave it hard for like hours and hours and hours, but,  cause you, you know, you can have complications from that, certainly.  but you know, most people are. Not leaving it hard for, for longer than a couple of hours [00:23:00] I would imagine. Yeah. Yeah. 

Tim Norton: And so what, what can go wrong with it?

What, what do people come back 

Dr. Gonzalez: for? Well, it's a mechanical device, so I, you know, everybody gets counseled on at some point, this is going to fail. So it just really depends on the patient's age.  the average, you know, life expectancy for one of these devices is 10 to 15 years. Okay.  so if you have an older gentleman, you know, he may just need one surgery and then,  That's it, that's it.

If you have a younger patient,  you know, if they have, if they have a device failure, at some point they would have to have surgery to have it explanted planted and have a new one put in.  so that's just something that all patients get counseled on prior to surgery.  but you know, th th that life expectancy's pretty good.

Okay. Yeah. And 

Tim Norton: then they just come in and get it replaced, correct? Yeah, that's fine. Yeah. All right. So you also said neurological issues. Yes. Can you test for those? 

Dr. Gonzalez: So there are ways of testing,  [00:24:00] someone's   sensitivity. It's usually done through . So basically what you would do is use different modalities to test how sensitive they are.

 and we usually use the finger as sort of a comparative point. So,  when I was a fellow, we would often do vibratory testing.  we would test,  hot and cold and basically put it on, you know, put the, the,  T test their finger first and then,  test the head of their penis and then both sides of the shaft to, to assess both of the different erection chambers and see if there was a discrepancy between how sensitive their finger was versus how sensitive their penis was.

 should they be the same, roughly? Yeah. Yeah.  the. The only problem with that is [00:25:00] that we don't have,  traditionally there have not been ways to. Change that. So if you find that,  someone is not as sensitive as they should be, there's not really a way to fix that. Now, my mentor is doing a lot of investigating of neurological causes of erectile dysfunction.

It's been primarily focusing on the spine. So, I, I don't know how many patients,  they have in their series, but, you know, he's reported on a few instances of patients with, you know, various sexual dysfunctions that are, you know, genital specific,  where they've found spinal pathology, they do spine surgery to fix whatever spine issue there is.

And some of those patients have gotten better, but that's sort of. Avant-garde kind of stuff. And he's really the only one that's doing it at this point. So, but he, as I mentioned is sort of the guru in this field. And I think if anyone is gonna push us,  to the next frontier in sexual medicine, it's going to be him.

[00:26:00] And what's his name?  Erwin golden Ali. 

Tim Norton: Yeah. Okay. So you've narrowed down to one of those three broad categories. Yeah. And. Let's say, let's say it's blood flow.  and let's say, it's not that bad. Yeah.  what are, what are their options or what do you, what, what, what are you sending them home saying?

Okay, this is what you need to do more of. 

Dr. Gonzalez: So, I mean, you can talk to people about,  you know, lifestyle, behavioral things that they can do to help improve their, their issue. I mean, certainly if they're a smoker, you know, you wouldn't want to counsel them on quitting smoking, that's going to not only affect their erectile health, but their general cardiovascular, you know, if they're obese maybe, maybe yeah.

Have like some hormonal issue you can talk to them about, well, if you lost some weight, your hormones. Parameters would likely improve.  so those are the two big things, you know, regular cardiovascular exercise,  healthy diet. I mean, there's the, [00:27:00] there's a sort of saying in sexual medicine than what's like good for your heart's good for your penis.

So, you know, people were always asking me, well, what can I do in terms of diet or whatever,  to improve things. And I tell them just that, you know, what your doctor tells you, that the diet that your doctor tells you. To,  you know, help your heart or help your cardiovascular health is exactly what you need to do to help your erectile health too.

And that's again, because it's all about blood flow, right? So if you're, if you are in the beginning stages of developing atherosclerosis, then you know, the things that your doctor would talk to you about in terms of trying to reverse that or prevent it from getting worse, it's exactly what you would need to do to help.

With your erections and help the blood flow to your erections. Are there 

Tim Norton: any magical foods out there that you endorse these days? 

Dr. Gonzalez: Not really. I mean, unfortunately none of it's like, there's, there's not a ton of science driven data out there looking at,  at that kind of stuff.  but patients like, you know, a lot of patients like to feel like they're doing something other than just taking medicine for these issues.

So I think giving them [00:28:00] advice on, on how to eat healthier,  heart healthier is something that they. They can use as motivation to try to help with this issue. 

Tim Norton: I've been wondering, how do I know when to go to a urologist versus a cardiologist? Or do you sometimes send 

Dr. Gonzalez: guys to cardiologist? Yeah, so there's actually a,  a fair amount of data that's been published in the last like decade or so, that has shown,  correlations between erectile dysfunction and cardiovascular health.

 primarily that men. We'll often present with ed before they would present with other symptoms of underlying cardiovascular disease. So it's, it's been called the soul sort of Canary in the coal mine in terms of predicting underlying cardiovascular disease. That wasn't. Yeah. Previously detected. So there are, and I have sent,  patients to,  cardiologists to be screened for, you know,  other effects of [00:29:00] cardiovascular disease.

 if their initial complaint is ed and we find that they actually have a vascular problem. Okay. Yeah. 

Tim Norton: Now you said to me before off camera, you said to me that you only see on a, on a busy day, 10 to 12, 13 patients in a day. And I think, you know, there's a larger narrative in our culture right now about how all these doctors are seeing 40 people in a day.

And,  w what's the difference between you and them and, and why? 

Dr. Gonzalez:  well, I think. To work in this space and to try to help address these issues. Like it just, it's impossible to see many patients. There's a lot of education that I have to do. So, you know, my initial consultations tend to be longer than, than a doctor who's, you know, Treating primary care health issues.

There's a lot of, you know, like I said, these patients have been sort of circulating [00:30:00] through the healthcare system for years a lot of times. And so they, if we got, if they didn't already have neurotic tendencies, they've developed those because they've been dealing with this issue for a while and it's not been addressed.

 and no one believes them and they feel dismissed. And so I'm sort of, I have to then unpack a lot of that. So for me, it just doesn't, it, it would not. Be possible to see that number of patients. And I think that's where patients and even providers who refer to me find my practice, especially helpful is that, you know, patients walk out of here understanding exactly why they have their problem and how we're going to sort of fix it or address it as best we can.

Not everything is reversible, but I can usually offer some sort of strategy to at least address whatever problems we find. 

Tim Norton: Okay. So do those initial consults get pretty Frank and graphic about the sex that they're having? 

Dr. Gonzalez:  not necessarily in the specifics, but [00:31:00] I just basically try to assess from them what their goals are.

I mean, if you're talking about a gay man, for instance, like I will ask them, you know, on their first visit, do they have a preference in terms of topping or bottoming? What is their goal?  because. To top someone and to have eight, you know, anal sex, you have to be pretty rigid. And so if that's not a priority to them, then, you know, that's, that's important for me to know, or if that's an absolute priority to them, I definitely need to know that because we have to figure out a way to get them the rigidity that's necessary to top.

So I ask those kinds of questions more from a, how can we get you? Do your functional goal. I don't get into the specifics about what kind of, sort of day-to-day sex they're having or what their sort of sexual preferences are outside of that kind of stuff. Okay. Yeah. I mean, 

Tim Norton: do they ever start to just really open up about that stuff?

Dr. Gonzalez: Sometimes people I get both. Spectr some people walk in here and blush and say, they can't believe they're talking to me about this.  I've had other patients who [00:32:00] are very Frank about what kinds of sex they're having, and they're going to, you know, a sex party this weekend and they need to figure out how they're going to be able to stay hard the whole time.

And,  So, yeah, I mean, I, I just, I tell them, you know, at the end of the day I need, I want them to be as honest and open as possible because that's just going to help me be a better doctor to them and provide them the best care, because then I know where they're coming from and what their goals are.

Okay. 

Tim Norton: So how does somebody stay hard for an entire weekend? 

Dr. Gonzalez: Well, I don't, I wouldn't advise doing that attempting.  that's something called priapism and it can be a major, major problem.  but you know, I have patients who use injection therapy. A lot of times they need it. They actually have real vascular issues.

 but they enjoy using it for sometimes, you know, group sex situations. And,  I think I am. I don't want to say unique. And I learned, definitely learned this from my mentor, but a lot of my patients who use injection therapy, who, you know, potentially could be at risk for [00:33:00] developing priapism, like getting an erection that lasts longer than four hours that you hear about on the commercials all the time.

 which actually is a V is, you know, a medical emergency.  but you know, when guys use injections, they are at real risk of developing that. So I. Again, spend a little extra time trying to prescribe an upper, you know, the appropriate strength of injections that they're using.  try to counsel them on what I think is inappropriate dose, and then also teach them how to administer the anecdote.

So it's the same stuff we administer in the ER, if someone comes in,  with this problem,  and, and essentially reverses the erection,  and just tell them, listen, if you have an erection that doesn't go away after three hours. I would advise you to use this reversal. And then the next time you inject, you know, that that dose that you use the last time, it's probably too much.

 so, you know, I tell them they have to do a little bit of dose adjustment at home on their own, the goal being that they get an erection that lasts however [00:34:00] long they need it to last. But if you're getting to that three hour, Mark, you know, you want to, you want the erection to resolve spontaneously on its own and not have to use the reversal, but they have, they have the tools with them.

Should they need to use it? 

Tim Norton: And I did talk about injections on, on the same prior episode. Remind everybody what's in these injections. Is it just a fluid of Viagra of sildenafil or what's what's in 

Dr. Gonzalez: there? They're vasodilating,  medications. I mean, I do kind of describe them to patients as sort of like a supervi Agra that you're going to inject directly into your penis.

 so they work much more powerfully than Viagra and Cialis and the other pills,  because they're not absorbed systemically. I mean, they're literally. Being injected right where you want it to work. So, but they, the injections come as a single, a single medication. They come as compounds of either two or three medications, sometimes four, but they all basically function to maximally dilate the,  [00:35:00] cavernosal artery so that you sort of bring as much blood into the penis as possible.

Tim Norton: Was that what they were designed for. I know how Viagra was originally intended to be just a heart 

Dr. Gonzalez: medication. Right. You know, I don't know the history specifically of injections, but interestingly, the injections have been around longer than Viagra and Cialis. So part of the reason that those medications have become so prevalent and successful is that.

For years, like through, through the eighties and most of the nineties, the only medication that was available was an injection. And it's, you know, not the easiest thing in the world to get a guy to be excited about injecting himself when he wants to have sex.  so I, yeah, I don't know how they were initially studied.

 but,  they'd been around for a while since you know, the seventies 

Tim Norton: and do people when I get them also. Typically get the antidote or 

Dr. Gonzalez: no. So most patients don't. So, [00:36:00] you know, we see, see patients all the time coming into the emergency room saying that they used injections and they've had an erection for 24 hours and it's a, it's a big problem.

And it, depending on what needs to be done to make the erection go away, I mean, it can, it can lead to worsening ed or sometimes. Medication refractory erectile dysfunction. So it's a big issue.  so, you know, I teach all my patients how to safely inject themselves with the reversal medication.  so that, that doesn't happen because there's a lot of shame, you know, depending on what kind of sex they were having at the time of their priapism.

There's, it's not uncommon for men to just not seek help and to wait. You know, the whole weekend. And then they come in on a Sunday night or they come in Monday morning to their doctor and they've had an erection for 48 hours.  that's a major, major problem, and they're probably going to end up having to be operated on to, to fix this issue.

And then they sometimes are, you know, end up with permanent ed. Oh man. Yeah. 

Tim Norton: But then they get a penal implant, then they could get a penile implant. Okay. Good. So, one thing I was going to ask [00:37:00] is,  when I met you, I introduced myself to you. It was at a pelvic pain talk. So is this a significant part of your practice as well?

Working with male pelvic 

Dr. Gonzalez: pain? It is. Yeah. So I,  am pretty,  pretty close relationship with several sort of pelvic floor. Physical therapists in LA. And so they refer a lot of patients to me,  to,  act as sort of like the medical adjunct to whatever,  you know, myofascial or muscle issues that these patients have.

 so I do, I'm sort of becoming, you know, without even really trying sort of,  the. Prostititus pelvic pain specialists in this area.  so yeah, it is, it's a pretty significant,  number of patients that I see, 

Tim Norton: what I noticed out in, in, in life is that a lot of people don't know that. Men get pelvic pain, right?

What are some [00:38:00] of the more common forms of male pelvic pain you're seeing? 

Dr. Gonzalez: So it can present. I mean, that's where it becomes.  it can become challenging. And again, this is a space in which men are often dismissed and told that they're crazy or which is really unfortunate because a lot of these patients get.

Better with sort of minimal medical treatment and physical therapy, but it can present in a myriad of ways. So men will often report,  pain with erection pain, with a jacket, elation, lower abdominal pain, testicular pain, pain in their parents, Niamh.  sometimes, you know, burning when they pee, they think they have a UTI or some sort of STD,  So it can present in lots of different ways.

And sometimes it's even been not, you know, benign symptoms, like just I'm going to the bathroom more frequently than I used to, or my stream is weaker than it used to be. And so they often will, you know, see urologists or know sometimes just their primary care doctor and would be given just sort of [00:39:00] thrown medication at them or just, you know, told that it's.

It's nothing, you know, they get checked for a urinary tract infection and it's not a UTI so that they get dismissed as, you know, you're just straight or, you know, whatever it is. But yeah, it can present in lots of different ways, which I think is why it's challenging for a lot of providers who don't treat it a lot because, because they don't believe the symptoms or they don't see how pain in the testicle can be, you know, a pelvic floor issue or, you know, sort of, it's sort of a.

One symptom of a pelvic pain disorder basically. 

Tim Norton: Right. And so when I meet those guys too, I find that a lot of them have gotten an automatic prescription of some kind of,  either a steroid or, or some kind of,  like a penicillin, like an antibiotic. Yeah. Yeah.  And it does nothing. 

Dr. Gonzalez: Right, right. Right.

Well, because I mean, most of these patients don't have an infection, so, but, you know, [00:40:00] historically I think that providers, you know, want to feel like they are doing something. And so they just put people in sort of blindly on, you know, broad spectrum antibiotics. And some, some of those patients do get better symptomatically.

The reason that, that, that is usually the case is not because there's an actual bacteria that's being killed and that they're getting better.  and.  in that regard, but you know, a lot of antibiotics are really strong anti-inflammatories and a lot of this issue is more inflammatory related. And so often, you know, the patients that do get better with antibiotics,  that is the mechanism by which they're getting better.

Not because there's some, you know, bacteria that's causing their problem and it's being treated by the antibiotic. 

Tim Norton: You said historically in your studies, in, in, in your fellowship and everything. What is the history of male pelvic pain? It doesn't go back very far. Do you remember? 

Dr. Gonzalez: Or, I mean, it's basically just taught us prostititus yeah.

In medical [00:41:00] education, which is like a horrible name, because it implies that there's some sort of, again, infection in the prostate and sometimes there is, but most of these patients have. You know, these chronic forms of pelvic pain, it's not like an acute bacterial prostititus where they're getting fevers.

And, you know, sometimes I have to be hospitalized and that's, that is a real infection, but most of these patients have been dealing with this for six months, three years, you know?  and it's a chronic condition, but it all kind of gets lumped in at least in medical education and the prostititus category.

And so the treatment has been the same. Everyone gets, like you said, antibiotics,  And there's a big gap in terms of understanding the importance of the pelvic floor and incorporating that into their treatment plan. So I tell patients all the time, who I see, you know, that they have a condition called chronic prostititus chronic pelvic pain syndrome.

And the first thing I say to them, I'm like, it's a horrible name and I don't want you to freak out. Number one, chronic sounds scary to patients and you know, prostititus is a bit of a misnomer. And I basically [00:42:00] say your problem is primarily a function of. Your muscles and connective tissue in your pelvis, and maybe some inflammation on top of that.

And so medically we'll all help treat the inflammation.  but you know, if, if they didn't, if they didn't already come to me from a physical therapist, they're getting a referral at the end of their first visit for sure. 

Tim Norton: Okay. It's just, it's weird when so many people haven't heard of it, you know, 

Dr. Gonzalez: so, and I, you know, especially like what I tell patients is, you know, some things that can cause flaring of symptoms is like prolonged sitting,  stress, anxiety, right?

Those, those all cause us to sort of tense. Tents are pelvic floors. And like, we live in Los Angeles, so everyone is always sitting in their car or then they go to work and they sit at their desk all day. We're all constantly stressed out and anxious. And so it's like a perf you know, of course here, and I'm sure it's true in most, you know, large urban centers.

 yeah, a lot of people miss problem. [00:43:00] Yeah. So that's 

Tim Norton: very common. Yeah. You, you you'll always have plenty of business or for awhile, right.  porn. Yeah. Guys, ask you about that. Yeah. Trying to cover everything.  guys, come in then do they say is my EDD because I watch too 

Dr. Gonzalez: much porn?  yeah. Yeah. I think it depends on how they got to me.

Some people have like read online themselves and they've convinced themselves that they have like a porn addiction. Other people have, have already been seeing a therapist and maybe they've had that conversation with their therapist.  So it just depends, you know, but, but the truth is, is that I've had patients who have believed that about themselves and have sort of cut back on porn and it doesn't always help.

So, you know, I, I try to discourage patients from thinking black and white regarding porn and that it's not, it shouldn't necessarily be thought of as a bad thing in terms of how it relates to their sexual function. Certainly it can, you know, Be a helpful thing and in some situations, but [00:44:00] like with anything, if all you're doing all day is watching porn and you're masturbating five times a day and then you have opportunity to have sex with another person and you can't be physically or mentally stimulated in the same way as you can with plans.

And then yeah, maybe it's probably causing an issue and yeah. That's where I think sex therapists and therapists in general can be helpful.  sort of retraining that sort of behavior. Mm. 

Tim Norton: Any other times we can help all the time. No, I'm just kidding. But yeah. When do you typically refer or say, what do you see that you're just like, you 

Dr. Gonzalez: need a Dakota?

Well, I mean, certainly if we do the sort of physical workup and there's no problem,  which is pretty rare,  honestly, so that's obviously where I would refer to,  a therapist. Anytime. I feel like there's like a significant relationship problem.  not like the PR the relationship itself is problematic, but this larger sexual issue has caused [00:45:00] distance or, you know,  the partner now, you know, doesn't want to have sex because for years, you know, my patient couldn't.

Perform. And now I've given him the ability to perform. And now the partners sort of, you know, like, well for, I was, I had to deal with this for years, and now I'm not interested in having sex with you. So there's, there's lots of sort of relationship issues that can come up. Patients who have, who are younger.

I think it can be really helpful for, because if they've never had normal. Or satisfying sex.  then they have a lot of anxiety about how to, how the, how is that going to look going forward now that you've, you know, we've addressed these issues and you've given me the tools. I think that the therapy can be really helpful in those situations too.

 and I think just, you know, if you have a generally anxious person who is, you know, Fluctuating, you know, they have a good day and they're doing great, but if they have one, you know, they wake up one morning and there are penises and erect and they, they call freaking out like, well, for the last [00:46:00] five days I had morning would, but now I don't, what does this mean?

And they start spinning out those patients. I think, you know,   definitely are, can be helped with therapy for sure, because, you know, I can only do so much in terms of giving them solutions for their physical issues.  but if their anxiety is going to keep creeping in and, and, and. It's sort of counteract what I'm doing then I think it's really helpful.

Tim Norton: And I think that's probably a good thing for guys to hear that the occasional, non mourning 

Dr. Gonzalez: wood. I mean, I don't get morning. You never get morning with no, I know I do. I just don't get it every day. Not every morning. Right. No man gets it. Right.  or necessarily wakes up with it. I'd have it in your sleep.

A lot of guys get it, get it in their sleep and they just don't know. And then they wake up.  but yeah, I mean, I have a lot of patients who like perse Everett on that, you know? Well, I had like a. You know, two weeks and it was great every day and then they have one bad day. It's just like life, right? So it's just about keeping perspective.

And, and sometimes that's easier for the [00:47:00] therapist to do, because I can't see a patient in the office every week to reassure them. But I think that's where therapy can be helpful, you know, while we're treating whatever physical issues that are, 

Tim Norton: I have developed kind of a saying that I. I mentioned in sessions and I haven't even actually run this by anybody, but you deal with women too.

So sometimes I say something along the lines of, we don't freak out when a woman isn't as lubricated one night as she was the prior night. Right. And is that a good analogy? Like, is it, do men sometimes just focus way too much on it and then there's less that we can do about it, whereas it's a lot easier to just use some lubricant.

Dr. Gonzalez: Right, right, exactly. I think it just depends on the guy, you know,  I think if you have a baseline anxious person,  and, and they have,  sort of a fixation with their penis then, I mean, I, I get guys in here all the time that are asking me about this little [00:48:00] spot and that little spot and what I think yesterday, my erection was harder than it was the day before.

And, you know, at the end of the day, it,  I try to keep it.  give them perspective and say, well, you had sex both of those nights and you were able to complete intercourse. So you're just because your assessment of how hard you were happens to fluctuate from one night to another. It doesn't at the end of the day, really mean anything or try to reassure them that your penis looks completely normal.

And I've had to tell patients, like, stop looking at your penis, right. You're not allowed to look at it anymore. Yeah. Or don't go online and read about, you know, all the things that it could be on web MD or on Reddit or whatever, because you know, people can really go down like dark wormholes about this kind of stuff.

My 

Tim Norton: social media, person's been asking me to,  Get get sound bites. I think that's the one stop looking at your piece. Yeah, right there. 

Dr. Gonzalez: Yeah. Sometimes I use the more,  [00:49:00] colloquial terms. I don't always say penis, but yeah. Okay. 

Tim Norton: That, that,  I can only imagine. So what are, what are some things that are just super normal?

Nothing to worry about. A little spots here and there a little, what, what,  what are the things that just guys 

Dr. Gonzalez: can. Oh, penis sizes. Huge. Yeah, no, I mean, no pun intended. Yeah. So,  people there, there's also,  a huge discrepancy in how men perceive how big their men perceive their penis to be. Especially if you're talking about a guy who's had ed for years, like he will imagine that he used to be like eight and a half, nine inches, and then we'll do a penile implant surgery for instance, or whatever in his penis is now.

Seven inches. And he's swears that from the surgery, he lost two and a half inches. And the truth is, is that there probably is some shrinkage, but the reason behind that is that for 10 years, he hasn't been getting great erections. So the blood flow to that [00:50:00] tissue is not been great. And you get atrophy just like you would, you know, your bicep would get smaller if you're not working out, your biceps is going to shrink.

So does your penis, so,  People always imagine how they were when they were 18. And now that they're 65, they think that they're going to be there once they get it, you know, give them a treatment for their ed.  but you know, again, that's sort of playing with,  expectations and, and helping people have realistic expectations about what qualifies as normal and, you 

Tim Norton: know, Yeah, and I I'm sure guys will come in worried that their penises 

Dr. Gonzalez: are too right.

Yeah. What do you tell them?  it's pretty rare that you see somebody who has a penis that's so small that it would, you know, make them make it difficult for them to function at the end of the day. Like, you know, I try to reiterate to patients like most partners don't care how big your penis is Pat, you know, above a certain [00:51:00] size, which.

99% of men are.  they just care that it gets hard, like at the end of the day, right. If you can't get hard, that's going to be a problem for your partner.  and so if you can get, if your penis is on the smaller side, but you can get rock hard and you're going to please somebody. 

Tim Norton: Yeah. Yeah. Okay. Because my understanding of anatomy is that everything that they're trying to reach is within reach, 

Dr. Gonzalez: right.

Exactly. G-spot 

Tim Norton: yup. Prostate. You're going to hit it. Yeah.  yeah, with,  something on the smaller end of the spectrum and that's, that's what everybody wants. Exactly.  okay, well, that's good. So this has been 

Dr. Gonzalez: great. 

Tim Norton: Yeah.  what, you know, I haven't been asking anybody this, but I was wondering why you said yes to this interview.

Like what, what is it that, what do, what do you think.  the world needs to know. And, and, and why, why should we be having conversations about erectile issues? 

Dr. Gonzalez: And,  I just think it's time that like we stopped having [00:52:00] shame and about these issues. I mean, as men in general, but you know, women as well. I mean, there's, there's a lot of shame that, that women experience too, in seeking out help,  for their own sexual issues.

But, you know, I think,  it's my goal to kind of help. The larger community, even beyond my own practice, understand that, that it's okay to talk about these things. Oftentimes it is not strictly a psychological problem. It's not all in your head.  and F whatever physical things are going on that could potentially be causing problems.

There are solutions for, so, I mean, every guy that comes into my office for ed, I tell them at the, like, on their first visit, like one way or another, we're going to get you. And erection, like whether that be a pill that we prescribe, whether we put you on a hormone program, whether we give you injections or you end up having surgery, I tell them if you are willing to listen to my American recommendations, once we kind of do the whole workup, we'll get you an erection one way or another.

So, [00:53:00]  you know, there are solutions for, for all of the stuff that we find out, find out there. I 

Tim Norton: felt that when you said what a nice message that must be to hear. Yeah.  Looking someone in the eye got your and your doctor's office and everything. I bet. That's really powerful. 

Dr. Gonzalez: Yeah, I think so. Because a lot of patients think that they're, they feel hopeless a lot of times.

Yeah. Yeah. 

Shout outs to the sex positive community, including sex educators, sex therapists, sex coaches, and other fellow sex podcasters, sex surrogates, academics, sexual health, medical community, sex workers, the tantric community, and everybody else involved with having hard conversations. Bye-bye.

If This Episode Resonated

If this episode spoke to you, there is a path forward.

Tim Norton provides a discreet, evidence-based therapeutic space where men and couples can understand the deeper systems behind desire, arousal, and connection. His work combines rigorous neuroscience with a grounded, relational approach to help clients rebuild aliveness in their bodies, strengthen partnership, and create lasting change.

A Sex-Positive, Tech-Nerd Porn Star Talks About Erections

Episode Overview

Tim speaks with VR-porn innovator and adult-film performer Ela Darling about what actually happens behind the scenes when performers experience erectile difficulties and why even highly experienced professionals lose erections under pressure. They discuss the realities of porn sets, the biology of erections, the effects of alcohol and PDE-5 medications, and how men can shift from performance mode back into embodied erotic presence. Ela also shares candid insights on how VR technology is reshaping sexual experience, intimacy, and shame.

Key Themes

• Why porn performers experience erectile difficulties and the real causes

• How stress, pressure, and performance expectations shut down erections

• Why alcohol reliably inhibits sexual functioning

• How porn actors use Viagra, Cialis, and penile injections

• How to return attention to the body instead of the “script”

• The psychological gap between real intimacy and porn performance

• What partners wish men would express more openly

• The rise of VR porn, teledildonics, and immersive erotic technology

• Why porn shouldn’t set expectations for real-world sex

Listen to the Episode

Listen Now

Ela Darling

Ela Darling is an award-winning adult-film performer and co-founder of VRTube.xxx, the first VR webcam platform. A Master of Library Science–trained former librarian, she has become one of the most influential innovators in virtual-reality erotics, shaping the intersection of technology, embodiment, and sexual expression. Her work has been featured in Rolling Stone, The Guardian, Vice, and more.

Website: www.eladarling.com

Instagram: @eladarling

Episode Transcript

Tim Norton: Hello, and welcome to hard conversations. I'm really excited about my next guest. Ela darling is an adult film actress and co-founder of virtual reality company VR two.xxx. She grew up in Texas has a bachelor's degree in forensic psychology from the university of Texas in Dallas and a master's in library and information science from the university of Illinois.

Which she earned by the age of 21. She starred in over 100 films and won the 2018 ex biz award for crossover star of the year. You can see her 2017 Ted talk dare to [00:01:00] start over where she talks about the intersectionality between porn and virtual reality technology. Hello, Ela. Hello. Thank you so 

Ela Darling: much for having me.

Tim Norton:  Thank you so much for coming. This is really exciting. You are. We had one porn performer on my second to last episode, a gay male performer who had some great insight. His name is Allen silver. Okay, cool. Kind of like,   dad is his, his, his John rhe type. And so my first female porn actress, really excited about your insight into male erectile issues on and off porn sets.Awesome. So what do you know that will cure erectile issues for all men? Tell me 

Ela Darling: in two minutes. Thanks.  I've got this magical potion I make from snake oil. I charge a very, very reasonable fee for it. And it'll cure all of your ails, frankly. Yes. Your website. Knock it out, living my cons.  I see, I don't really have a website so much as a, a spot in this alley.

[00:02:00] It's it's very nice one though. And,  

Tim Norton: all right, good. So we'll, we'll put that alley location on the website after this interview.  so seriously though. Has that ever come up,  on a porn set? 

Ela Darling: Oh, yeah, absolutely.  it's a porn set is,  is a pretty rough environment,  to perform in. And especially for men, you know,  as a female performer, there's a lot that I can fake.

Right.  if my, if I'm not aroused, there are ways that I can accommodate whatever's going on to, to make it work. But,  if you're someone with a penis it's really hard to pretend you have an erection, you know?  so it's certainly come up,  There are different ways that people handle it. Sometimes they take pills.

Sometimes they use injections.  sometimes it just doesn't work out and you have to call it.  I've had instances where it just, you know, it was a tough day. It's very hot. You're surrounded by people on [00:03:00] important set. So. You've got people behind the camera. There are people everywhere.  most of them don't really care.

Like it's not exciting for them. They're just working. They want to go home. So you've got this added pressure of, you know, everybody's sort of depending on you right now,  and that can get into someone's head pretty easily.  if you're not attracted to your scene mate, or if your teammate isn't attracted to you and it's hard to foster chemistry that can, you know, cause,  that can lead to.

Some erectile dysfunction issues.  there's, there's a lot of things that, that would put someone in that position.  and it happens sometimes. Yeah, most performers that I know have a plan in place or have, you know, something in their back pocket to, to deal with it when it comes up so that they can make it through the scene.

Because at the end of the day, we all want to just work and get paid and go home.  I've had really only one instance where it turned out to be a really, really,  sort of. Challenge, like really challenging.  but it was because the [00:04:00] person was drinking, they brought a bottle of vodka and just started drinking onset, which is something that almost never happens.

 and this was sort of a,  not your typical porn set. And so when we finally got to the sex part, he just could not perform. And,  I did my best to sort of get him to a place where he could. And I think eventually we managed, but it was a very challenging day.  it added, you know, extra time to the day and not made it even more stressful for him to get into the right head space.

He shouldn't have been drinking on set. It's a job. That's just not what you're really supposed to do, but we, we dealt with it. 

Tim Norton: Even even people and adult film can't drink on the job. 

Ela Darling: Yeah.  this guy was new and I think he just thought that porn was a party and it was not a good day. Well, this is kind 

of 

Tim Norton: disappointing to hear though that it's not just a party, but it's work.

There's sets there's people. There's, there's a sound man [00:05:00] and yeah. And they're not that interested in it. And that, that is a lot of pressure to perform. You called it a rough environment. 

Ela Darling: Yeah. It can be pretty rough. It can be a stressful environment.  yeah. It's not rough in that it's unsafe. It's just rough in that the nature of the work you're doing is very physical and,  the, the pressure to perform and to deliver a good scene and deliver a good performance,  and create something that you're proud of, that your fans are going to enjoy.

That will take you a little bit farther in your career. I mean, that's yeah. 

Tim Norton: And salon Atlanta to be thinking about,  And was that you said you sometimes call it was, was that kind of like the only time that that happened or, yeah, 

Ela Darling: it's not something that happens very often in my experience. And I'm not, I'm not a director, so I couldn't tell you how common that is because I'm not the one who has to call their shots.

Yeah. I really, haven't seen many instances where, where that's been the case again, most guys who, who anticipate that, that might happen, bring [00:06:00] a pill or a surrender or whatever, and they handle it themselves and their penises, their business. And they're 

Tim Norton: good to go. Yeah. And their penis is their business.

Yeah, it's not like they're going to come to you and say, can you help me? 

Ela Darling: They do. And we do, and I'll do the best I can, but I'm saying however, they choose to handle it. Whether they want to take a pill or they want to use an injection or whatever, that's, I don't feel like it's really my place to have an opinion on.

 people do have opinions on whether that's something that people should be doing.  whether that's healthy, whether that's, you know, a good practice to put into place or a good expectation. But,  I just don't think I'm. Really the right person to, to comment on that since it's not mine. 

Tim Norton: Right. It's now yours do with your penis, what you will.

Yeah. Yeah. Do you get a sense of what emotionally is going on for the guy in those situations? 

Ela Darling:  it's not really a scenario where there's a lot of. [00:07:00] Disclosure,  especially in a situation like that, the instances where I've come across that we didn't know each other. We met that day,  frequently, we didn't really click.

And so we don't really have the relationship dynamic where they're going to, you know, emotionally disclose their state to me. But I can tell that they are feeling very distressed. They're very anxious. They're embarrassed.  They're feeling concerned on a professional level, because they're worried that failure to perform onset means that they might not get hired again by that company.

 they don't want people, you know, they don't want another performer in the room to talk about it. They don't want to get a reputation for not being able to do the job that they're hired to do. So I think there's a lot of distress. There's a little bit of humiliation. There's some embarrassment and,  You know,  the best thing I could think to do is just sit with them help, whatever way I can physically.

I mean, some people are opposed to that there are some performers who really do not want to engage sexually [00:08:00] off-camera because that's just not the job that they're there to do.  personally, it doesn't usually bother me as long as they're respectful, as long as we foster, you know,  good communication together.

 And sold to the bus. They can both physically and sort of just in a emotionally supportive capacity to help bring them back to a place where they can sort of move past it. 

Tim Norton: Yeah. And in that, that supportive capacity, do you, do you feel like you're soothing, like this performance, anxiety, like you said, they've got a lot at stake here or are you more trying to turn them on 

Ela Darling: for me?

 It really, I have to read the situation.  if they're, if they're, if they appear to be very distressed and very upset and very, you know, up in their head about something, then I'll try to sort of Sue them and tell them, you know, it's okay to just, we, we can take our time. This is what we're here to do [00:09:00] today.

Take, we can all take, felt like everybody is going to be happy to, to go have a smoke break, go have a bottle of water or whatever, just, you know, focus on you. It's okay. That's sort of the approach that I take with them. If that's the kind of talk that we're going to have,  if it's a sex thing I'll maybe sexy.

I don't know. It's again, I don't necessarily know them that well, so I don't know what it is that is going to turn them on. And having that conversation in that moment is something that. Just doesn't really happen. It's I kind of have to guess, so physically stimulate them. However, they usually I'll just go down on them and just see if I can get through them.

Tim Norton: Yeah. And that that'll help. I like your point about smoke break. And,  maybe, maybe get a bottle of water,  cause that could apply to the listeners out there, who aren't on porn sets and trying to have sex and bedrooms. And a lot of the times I think what happens [00:10:00] is, is guys will really just call it right there without that smoke break option.

And then let's go have a bottle of water.  so that that's really nice advice. That's really like a nice way of looking at it. Like. Take it easy for a minute. 

Ela Darling: Yeah.  in a porn scenario, I think obviously it's very, very different from an experience you would have personally at home with your partner.

And,  I've experienced that in a few cases too, which we'll get to.  but when we're on set, it's just, you know, There is a little bit more pressure because the sex is something that we're being paid to do and have right now.  you don't have the same flexibility as you would if you were at home with a partner,  just, you know, we can have sex right now, or we could go and have a snack or we could, you know, watch some dorky YouTube videos and see if we can sort of revisit this place in a few minutes or an hour.

 it's. Much more pressing in terms [00:11:00] of time onset.  whereas, you know, in my personal life I've had experiences like that with guys, and it's just, I think taking a step back and taking the focus off of having sex right now and, you know, redirecting our energies to something else so that the pressure is off,  as something that can really help,  frequently just deciding, okay, we're just not going to do this right now.

We'll. Maybe do it another on another day, maybe we'll see how we're feeling later. And in those cases, I found that when we make that choice and when we mentally disengage from that, that experience, then a pressure is lifted off of them. And then like there's one case. I remember one experience I had where as soon as it was, as soon as the, the script changed to, okay, let's just go.

Hang out. We'll hang out another time. Then the boner came and then it was just like, there it is. Hello. There, there, [00:12:00] there we are.  because there was a lot of mental pressure and we just needed to relieve that pressure. So he could get back into a space where,  an erection was going. 

Tim Norton: Right. And I hear that.

Time and time again, in my practice, you know, the way we explain it is until that moment, your body was basically in a fight or flight state, and it was, it was probably ready to flee. And your words you sang, Hey, we don't even have to do it today. Take it completely off of the table. No body can leave flight state.

Now body can relax. Blood can start flowing wherever it needs to flow. And they're relaxed and Hey, when we're not in a fight or flight state, there was blood for the penis. Yeah. Great. 

Ela Darling:  the instances where I recall being with a partner who is experiencing erectile dysfunction were almost always situations that were especially high pressure.

[00:13:00] So they were very intimidated because it was our first time together and there,  They're intimidated by the fact that I'm a porn star and that I have seen a lot of penises. And so they sort of get hung up on that, or they're afraid that they won't perform to the standards that I'm used to, or they're put off because I'm.

Someone who they consider to be out of their lead in some way, which is I think silly. But,  

Tim Norton: it sounds like you go in there and, and you engage them. You're you're, you're finding out what's 

Ela Darling: going. Yeah. I mean, if I'm here and I'm ready to have sex with you, like you Pat, like you're through the door, like you're good.

You got it. You got in,  or,  Having like a threesome with someone where there's this other person who isn't present in your day-to-day life. So it's sort of a, I kind of now or never thing or now, or if we don't do it now, then we might lose the opportunity altogether. And then,  the whole situation is incredibly arousing.

It's something that he was [00:14:00] very, very enthusiastic about, but because there was so much else on, you know, on deck at that point,  It happened. And then again, we just deescalated, we said, Hey, you know what? This is this third person that we're interested in having sex with is also just really cool person.

So we could just hang, we just, you know, chill out a little bit. And then again, it happened. You're good at this, I think, yeah. 

Tim Norton: You might have to open this little shop in the alley at all. You might not really. Sell anything. You'll just have to give an elaborate description of what to say as you take the snake oil.

And so, yeah. Speak to some of the partners of people out there. Like, did you notice maybe as you matured in relationships, I think we all learn how to talk to our partners better with time, or maybe you were just good at it. Maybe you just had that kind of style of communication, but do you notice. Like, it's a, it's a part of your delivery in the [00:15:00] way that you communicate that message to the guy.

Like, no, really we can chill for a minute. 

Ela Darling: So. Speaking to two partners who, who experienced this?  it's, it's definitely something that I've grown into and matured into because when I was younger, I was not good at handling situation like that because I completely internalized it. And especially when I was younger immediately, I thought, Oh, this is about me.

Am I not pretty enough? Am I not sexy enough? Do you not? Are you not attracted to me? Is it something that like, what am I doing wrong? What do you like about me? And it, I realized as I got older and I had more sex that I met more people. It's not about me at all. It's entirely about them and directing the conversation to something it, to, to that to, well, is it, what am I doing wrong?

What am I not pretty enough? Do you not like me? Do you not think of attractive? That is all, that's such a boner killer in the first place. Like competence is important. Competence is key [00:16:00] understanding that this is about your partners. Body. This is about them. This is about their Headspace. And it's not about you at all.

You are not, you're not the one causing this, but you can help get them through it if you, if you try and if you choose to.  but I think first and foremost, you have to understand that this, it just happens. It happens sometimes, and it's not a reflection on you. So coming to terms with that and realizing that,  is something that was.

That took some time to learn similarly,  if I would be with a partner and they just wouldn't ejaculate, we would have sex and then they just wouldn't come for a while. When I was younger, I took that so personally,  and then, I don't know, maybe I maybe being a sex worker made me jaded or maybe I just stopped giving a shit about men that much.

It's like, it's not a destination. It's not. It's not a sprint, it's a marathon. It's an experience. It's a journey. [00:17:00]  at the end of that journey, maybe you, you reach a finish line where there's a climax. Maybe you don't what's important is that you enjoyed yourselves along the way. So if I had a good time and I didn't come, I'm still cool with that.

And when I realized that about myself, that I can. Have fun, engaging sexually.  if we don't have penetrative sex, but we have fun in other ways and we have sexy time and we feel sexy and we enjoy each other's company and we feel good. Even if we don't feel orgasmic, that's still a really great experience to share with, with a partner.

And it's okay if that's where it ends. Like that can be enough also. And so finding. Finding ways for me to enjoy an experience and walk away satisfied, regardless of the outcome was something that I found very helpful. 

Tim Norton: Hmm. I feel like this could be your next Ted talk. You're very eloquent about this. I actually find it [00:18:00] kind of moving how much I I'm imagining guys listening to this.

And it's one thing to hear from me in that see, you know, paying for me to say it. And it's another thing with your experience and, and, and being able to speak so. Confidently matter of faculty about this. I think that it's a really good message to try to just help sink in.  and so as you got older and, and it was less about you then, did you notice you were just other things were occurring to you that you could say in those situations?

Yeah. I mean, once 

Ela Darling: I stopped making it. And once I stopped interpreting it as a personal reflection and I switched to just understanding that this is just their, their body, their experience, a thing that they're dealing with right now.  and I identified that a very strong component that was contributing to the experience was emotional.

That they were feeling emotional in some way, whether they were [00:19:00] scared or intimidated or nervous,  And that when I reacted emotionally, by being upset by, you know, blaming myself by being hurt by being,  you know, performatively upset about it, that was always something that led to further failure. So removing the emotional component or at least,  neutralizing it and finding.

The highs or the lows in myself and finding ways to sort of like to, to center myself and not, not internalize it, not, not interpreted as something that is about my personal value or my value as a sex partner and not interpret their experience as a personal failure to them or a personal failure on their part or.

They're just lack of desire when I took that away, then all I was left with was okay, well, these are the things that are standing in the way of the erection. Let's address those. If it's emotional, which for, in [00:20:00] my experience, it usually was, let's just calm those emotions. Let's redirect our energies and then we can come back to it or we don't.

And that's also okay. 

Tim Norton: Calming the emotions. How do you calm a guy's emotions? 

Ela Darling:  so. Frequently. No, no, no, no.  frequently men are,  not forthcoming about their feelings and especially in a situation like that, they're feeling very vulnerable. And so to discuss their emotions in the moment just brings them to an even more vulnerable place.

So it can be very hard to get them to open up about those things. So. I sort of anticipate what they might be feeling. And I try to find the words to,  to soothe those ideas without planting those ideas in their heads. So I don't want to say,  something like, Oh,  you know, I, it's not that, like, I don't think you're any less of a man because you don't have an erection right now, because then what I'm saying is, you know, [00:21:00] That might be a thing that you should think about that this for some people would make you less of a man in their eyes, you know?

 I try very hard not to,  not just state what I think they might be thinking and just to sort of accommodate them where they are. So,  I am being very vague and I'm trying to, no, that's 

Tim Norton: perfect. Cause you're, you're not making them sit there and say, Like I'm scared. You're not trying to pull that out of them, you know, which I'm trying to do honestly,  whose we're not obviously not having sex in the moment and everything, but just trying to get them to engage with that.

But in that moment, you you're guessing or you're intuiting. Okay. What's going on? And maybe what do I like to hear? What most men like to hear when they're having those kinds of a fear and since, so you just kind of give them that. Yeah. Is that what you're saying? Yeah, 

Ela Darling: basically.  if I think that they're feeling like they,  They're not going to satisfy me in any way.

I can just say, you know what, let's just not do sex. Let's do other things. Let's do. Let's make out. Let's [00:22:00] do hand stuff. Let's do other stuff like finger bang or something. Like we can still have fun. I'm still gonna have fun. You're going to have fun doing it because we're going to enjoy each other's company.

And there's, you know,  an inclination that you want to make the other person come. And if. You're not going to do it with your penis, then how do you do it? Well, here, here's how you can do it.  if, if you're, if that's the thing, then we can still reach that desired end,  without an erection in the picture.

And once we just decide, you know what, we're just not going to do that thing. Then it, in my experience has been much more likely that an erection ends up, ends up coming because again, the pressure is off. 

Tim Norton: Okay. And you, and you said that before, but now you're saying that. With full recognition that they're having this emotional experience going on.

And then you're, you're, you're kind of juggling those two things. So you, you know, he's having this emotion, you know, commenting on it directly, we'll just [00:23:00] kind of make it more intense. Right. So you're still dealing with it, but just 

Ela Darling: indirect. Yeah, exactly. If I think that they're feeling a sense of failure in some way, I might compliment other things that they do.

Like you're an amazing kisser, or I love it when you do this thing, like that's really hot. That's so sexy, I think. But I think you're really awesome and really sexy person. And the fact that you don't have an erection right now, doesn't change that. And I might say that explicitly, I might not, but conveying to them that you still find them acceptable, attractive, worthy of your affection worthy of your time.

You still consider them to be a worthy partner. I think can, can help them move past it. Mm 

Tim Norton: Hmm. That's great. As you were saying that I started to feel guilty. You know, this is, this is,  this is a podcast. For men, for people with penises and erectile issues. And you had commented earlier that if you're on [00:24:00] a porn set and you're having essentially lubrication issues or issues being turned on, it's more subtle.

And there are things that you can do. I assume you can add lubricant.  but, but we're not talking about that there, you know, I haven't had an episode for the women out there who are struggling with this, or we could have a whole podcast just dedicated to that, obviously. 

Ela Darling:  yeah, I mean, from my perspective, if I'm not aroused and I'm not really into it, I'll take some time to myself, all masturbate, I'll use some lube.

 I find that certain breathing exercises can help sort of loosen things up a little bit. So it's not like painful, especially in porn, you tend to work with fairly big penises. So if you're not aroused and you, I mean, It can hurt sometimes. So just finding ways to sort of get into a place where I don't have to like have an orgasm, I can fake my orgasms, but at least physically where,  it's a comfortable experience.

 [00:25:00] that's sort of what I, what I go for. And usually I can find something either in my brain or in my memory or, or, or just physical simulation to at least bring me to a point where I'm having an okay time, you know, What's your breathing exercise. See, I don't really know how to describe it. It's just when,  when I feel like it's just the person I'm having sex with is too much or a little too big, or they're maybe going a little deeper than,  than I find comfortable.

I just sort of,  relax and I'll take deep breaths and sort of just rhythmically. I don't know, I, again, I breathing, it's just breathe it's inhalation and the next relation, but I don't really know how to describe it. It's not something I really studied. It's just something that, that I found helps for me is just taking some deep breaths in and relaxing my vaginal muscles and just kind of breathing through it.

And,  also just asking them to sort of pick, [00:26:00] like go slowly and sort of pace themselves. And that also helps. 

Tim Norton: And you can do that on a porn 

Ela Darling: site, on a porn set. I had it described to me as the Heisman where you use your hand, that's sort of not facing the camera and you kind of like tap them and that sort of the signal that, you know, slow down or pull back or, you know, ease into it a little bit more.

 so you've got kind of this, this backhand sort of it's tap. Yeah. And I guess it's supposed to look like the Heisman trophy. It was one porn director who said it. So I don't know that that's necessarily a common parlance, but,  But I thought it was funny and it, and it helps like, I'll talk to them ahead of time or we'll, we'll kind of, we'll take a break or something and I'll just be like, Hey, you know, yo just give me a little, a little time to sort of work up to the full, the full thing.

Tim Norton: Okay. Interesting. So you,  you doing other things besides porn?  tell me more about.  the [00:27:00] Oculus rift, or what do you have going on with, with your, your app? Is it a channel? Is it a website? A 

Ela Darling: couple of things. So I was just hired as the chief marketing officer of a new adult VR headset company called PVR pvr.fun and Avenue, a new headset called the Iris.

And it's this really beautiful, lightweight headset.  it connects to their site. So you,  when you buy it, you have a free subscription for. A certain period of time and you can buy VR videos through the website and you pair your device with your account. So you can just send them to the site or send them to your headset.

And if the headset is connected to wifi, it'll just automatically download. So you can watch it very easily. It's very streamlined.  And it's, it's just a really cool product.  I met the people who run the company a couple of months ago and I tried it out and I was actually really impressed by it. And so they were interested in having me on their team and I, I liked it.

So, so now I work with them and it's really cool. I'm really excited about it. So [00:28:00] if you're someone who enjoys VR porn, it's a really great headset to have a sort of your own personal. Private adult VR experience.  I use VR a lot. I have several VR headsets and a lot of the time, a lot of the time I have people over and I want to show them stuff in my rift or my vibe or whatever.

And the last thing I want is. To have like lube on the headset or hand,  you know, a mobile headset to a family member that, you know, and I've used this headset when I was jerking off. And who knows what kind of humor is might be left out? There's there's just a lot that runs through your head where it's like, you know, Maybe having a private headset for your private moments is a good choice.

And,  and also if I'm watching VR porn on my computer and then someone sees it and they're like, Oh,  an Oculus rift, let's try this out. And they put it on. Then they're immersed in a porn experience that can be very jarring for them. And it can lead to a very uncomfortable situation, a very uncomfortable conversation.

So,  So I, yeah, I think it's really [00:29:00] great headset. It's really great product. It's really nice if you are interested in VR porn, but you're not very tech savvy. It's a very simple process. So that is one of the things I'm doing now. I'm representing this company.  we also make a VR camera for VR production, which is simple and cool and really high quality.

 and then I'm also starting a new non adult VR app. That will be a live broadcasting. That I sort of, I sort of like to think of it as,  a live VR podcast on us where you can be present in the room with the broadcaster.  it's 3d three 60. You can look all the way around you and you see the studio that they're in.

 there are markers on the wall there AR markers. So when you look at these markers, they're overlaid with a video or an image or a link,  they also control. Little Arduino robots that I build that are placed around the different rooms that you can engage in. So there's like an up phone leader. So if there's two people in a broadcast having a debate, you can sort of thumbs up or thumbs down or, or [00:30:00] vote for one who you think is winning the debate,  over the other.

 and then another style of broadcast is,  Basically, I built a car. I built, I built a little, a little Arduino car that you can drive around my living room and you can give my dogs, my dog treats in virtual reality from a dog treat dispenser I made and there are markers all over the walls. So we're gonna, once we launch, we're going to put in a different, like maybe weekly new content that you can sort of drive around and see maybe an ongoing narrative, maybe something that gives you like a badge for, you know, checking in, checking out the markers every week.

 And it's kind of a proof of concept. Eventually. I'd love to have, have it set up so that there's a cool VR card that you can drive around,  the creative office of your favorite cartoonist or artist or something like that. I think there's a lot of applications.  And yeah, that's kind of what I'm working on.

So I don't have a launch date yet, but,  I'm really psyched about it.  and yeah, those are the [00:31:00] cool things I'm doing. I'm hosting the red carpet at the porn hub awards in September and a couple of weeks. So that'll be, 

Tim Norton: yeah. Yeah. I mean the reason or how I found you was I had no idea how to pick someone was you come up when you Google,  Porn stars who were smarty pants and like a few different searches.

And,  you know, your master's degree in library information science did. And you did work at a library for a while, or where was it? I watch it 

Ela Darling: a few. I was the associate director of a library just outside of Boston,  right after grad school. And that was around the time that I started dipping my toes in the adult industry.

And so once I had a few like fetish shoots under my belt, I realized that if I moved to Los Angeles, I can pursue this and make this a full-time job. And if I want to do that, it's kind of, I need to do it sooner rather than later.  and it was. A situation where I do [00:32:00] my degree, I wasn't going anywhere and librarians tend to be pretty cool about a lot of things.

 so I felt like if it didn't work out, I could probably still find work in a library afterwards.  and so I just, I just did that. I, I finished up my year at the library and then I said, goodbye. And I moved to LA and I started doing lesbian porn and that was almost nine years ago. 

Tim Norton:  And would you say you're pulling away from porn or because you are.

Mixing, right. You're getting involved in other things. Right.  but 

Ela Darling: yeah, I am, I wouldn't say that I'm retired yet because I think that it's very unlucky to, to say that.  but it's, I, I don't really focus on performing anymore. I'm really more focused on behind the scenes corporate stuff.  yeah.

Technological innovation and sex tech.  and also, you know, our new company, the new company that I'm starting with, my business partner [00:33:00] is completely outside of the adult realm. And eventually as I move forward with that, I'll probably eventually leave the adult space behind,  And so it's sort of a slow transition.

So I worked for two years, a little over two years as a content manager at a webcam company, the VR content manager. And I worked in training models on VR and empowering other performers to, to differentiate themselves with virtual reality. And,  and yeah, it's, I love performing when I did it, but I just am not really in the Headspace anymore.

And,  and yeah. And you love the VR. I love VR. You do? Yeah. 

Tim Norton: It's so much fun. You have a few sets around so 

Ela Darling: many headsets. It's it's a lot. Yeah.  I couldn't even count how many headsets are in my house right now. Awesome. But, but yeah, it's, I mean, I we're developers, so, 

Tim Norton: and so before you completely leave, I want to [00:34:00] collaborate on something.

So I think, or whoever would do it, but. What you said in like the first 20 minutes of this interview combined with like someone I don't know where I would even want them to be, but could combine with some kind of Oculus rift or VR technology.  I think that could be really cool. I think that could be really helpful just to like, get those soothing messages from an actress, from somebody who really was, had like a nice tone and delivery and just like kind of a therapy.

Ela Darling: Yeah.  that would be very, very achievable. It would really just be a matter of shooting a VR video that is like VR porn, except without the sex aspect necessarily. I mean, that's yeah. 

Tim Norton: Anyone else there listening, take the idea. I'm probably not ever going to follow through on it. I relinquish all rights to, I just, I like seeing their posts.

Aren't very good about [00:35:00] utilizing the latest technology and being on top of the game, especially when compared to porn, right. Porn is always at the cutting edge of that kind of thing.  but I haven't seen, you know, there's explicit educational videos, but I haven't really seen anything that touched on, on the psychology of it.

 which is pretty cool.  cause it's, this is a problem affecting a lot 

Ela Darling: of people. I think. Something like that would be best done as a collaboration with a professional like yourself who can be present to sort of guide the discussion in the right direction and to make sure that it's being delivered in a way that is still therapeutically effective and safe and helpful.

You surely don't 

Tim Norton: yeah. Yeah. Added to the list.  Cool. Cool. So where are you headed next and with all of 

Ela Darling: this?  so right now I'm with PVR. I am finding I'm seeking a VR content creators in the adult space who are interested in doing a [00:36:00] partnership with us to license their content and, and do a rev share on, on getting their videos out to our consumer base.

Because again, it's a really cool headset and I want to get as many producers and creators,  Involved and, and on our site so that people can access their content. So that's something I'm really focused on. I'm going to Prague in a few weeks to make some more connections with people and just really build up that platform,  because I really love it.

And then,  with, you know, my own kind of interests, just really, really, really excited about this new live broadcast thing that I'm making.  I've been building little dorky, Arduino robots that you can play with in the VR experience. So building what, like,  do you know what an Arduino is? I do not.

It's a microcontroller, so it's,  it's a little board that you can,  you can write code and upload it to this little board and it will like, it controls whatever kind of robotic thing that you're making with it. So for example, the [00:37:00] doctorate dispensary made has an Arduino in it and a stepper motor. So.

I wrote code that would tell the stepper motor to move this, this much, this many steps,  whenever a certain command was received. And so it'll basically move it over. Rotate. And then a doctorate will fall out the bottom of the little dispenser because it's rotated in such a way that it's now available.

So an Arduino is just something that you can connect other things too. You can connect LEDs to it. You can connect Servo's or motors or any number of things, and it will control those things. So,  I've been learning C plus plus for, do we know. Okay. And I've been doing that. I also in Python to, to network with our VR application.

And so I'm going to go home and I'm going to work on optimizing some code for a drawing mechanism that 

Tim Norton: I'm making. Okay. But that is in computer programming languages. It's not like you can, at this point, say, walk [00:38:00] five meters and drop the tree. You have to really program that. Okay. Okay.  Technology, one thing I, when I was looking you up and your bio teledildonics, your, you had a quote,  somewhere saying that something about patents slowing that industry down.

 do you, do you have much experience with telltale dynamics at this point? Like it, it seems kind of in its infancy and kind of. Stuck there 

Ela Darling: right now. I've no some companies that are doing some really great stuff. Key Ru is one that's,  that's really ahead of the game on that one.  it's so strange on my Wikipedia page.

I have nothing to do with it. I've never touched it. I don't even know how it came to be, but that's one of the things that is mentioned there and it's, I, I I'm sure Ray said that. I just don't really know. Talk that much about that specific field. It's certainly not a Hill I would die on, but,  but regardless that patent that I referenced actually just expired in [00:39:00] past maybe the past week or two.

Good. So,  so yeah, that's been a pretty big thing in, in some of the tech spaces that there's now a lot of opportunity to, to innovate in that space. And I think that there's a lot of good that can be done for people.  so teledildonics is basically,  I devise that that offers sexual stimulation across space.

So you have, let's say you have a stroker that you put on your penis.  it could be connected to a porn video you're watching. So the movement on that stroker,  replicates the movement on video or,  another application could be, let's say I have a dildo device and you have a stroker device. Whatever I do to that dildo would be,  Reciprocated in your stroker device.

So it's just it's stimulation across space using a device. Basically. I think that's a good way to describe,  so if you don't know what it is now, you know,  [00:40:00] but yeah, I think it's, I think it's really cool. I think there's a lot of room for growth and I think there's a lot of potential for,  for devices that could give people a sense of sexual engagement and satisfaction when they wouldn't otherwise have it.

Tim Norton: And have you seen anybody pull off that marriage between a VR porn and Attila a teledildonic? 

Ela Darling: Yeah, that's something that Cuba does a lot of.  I haven't been working in,  and pre producer pre recorded VR porn for a very long time, but. I switched to working in live streaming VR about three years ago.

So there has been a lot of growth there that I just haven't necessarily kept up with because it wasn't relevant to what I was working on. But that is definitely something that has been done that is being done, that people are exploring. There are a couple of other companies, I think Levin's is one of them that,  when I met them a couple of years ago, that was something they were working on.

 and so it's definitely available. 

Tim Norton: Is that going to be all sex at some point? [00:41:00] What do you mean VR teledildonics across space. 

Ela Darling: Oh, is that going to be all of the sex or 

Tim Norton: is that going to be really going in that direction 

Ela Darling: now? People, Oh my gosh. People love to clutch their pearls about this, about how nobody's going to have sex anymore.

And that's not true. People are going to have this as one of the things that they enjoy, but, and maybe some people will decide, wow, I don't need to try to date. I don't need to try to court anyone. I don't need to do that. And that's cool. Like that's their choice if they. Don't want to go and find someone to have sex with, like, why is that anyone else's business?

 but now I think people are still going to want to have sex and, and want to procreate and want to have an experience with someone who could reject them because that risk being present is arousing by itself. Okay. 

Tim Norton: So no, no Armageddon here. No, 

Ela Darling: probably 

Tim Norton: not. Darn it.  well, okay. Any, any other messages for the guys out there having hard conversations or not having hard conversations or you're basically saying don't have the [00:42:00] hard conversation to have the light conversation,  and then, and keep it, just keep it playful and keep it mellow and take all the pressure out of the room.

Ela Darling: Yeah.  the, the things that I covered, the experiences that I'm covering, obviously that's not. That doesn't address every situation. There are plenty of reasons why you might have erectile dysfunction. It's not because you're nervous or in your head about it. It could be medication. It could be, it could be any number of things, but whatever it is, it's okay.

It happens to everyone. You don't owe anybody sex. You don't owe anybody, your body or an intimate experience if you're not ready for it, or if it's just not. So if you, even if you really want to have sex, you're just not. There that's okay. You're allowed to not have sex just as anyone else's. This is part of your, your agency over your body and you deserve that just as much as anyone else.

So,  just. Remember that and your, your personal value, isn't [00:43:00] tied to what your penis is doing.  in any case, whether that's not a lot or whether that's a whole lot, like whether you're not having sex or whether you're having all of the sex, that doesn't really change how valuable you are. So it kind of goes in both directions, 

Tim Norton: right?

Well, you heard it from Ela, your personal value is not tied to what your penis is doing. And I love that. Thank you. I think we'll end it right there. Thank you very much for coming. 

Ela Darling: Thank you for having me.

Shout outs to the sex positive community, including sex educators, sex therapists, sex coaches, other fellow sex, podcasters, sex surrogates, academics, sexual health, medical community, sex workers, the tantric community, and everybody else involved with having hard conversations. Bye-bye.

If This Episode Resonated

If this episode spoke to you, there is a path forward.

Tim Norton provides a discreet, evidence-based therapeutic space where men and couples can understand the deeper systems behind desire, arousal, and connection. His work combines rigorous neuroscience with a grounded, relational approach to help clients rebuild aliveness in their bodies, strengthen partnership, and create lasting change.

Sex Tips From a Gay Porn Star & Sacred Intimate

Episode Overview

In this episode, Tim speaks with Allen Silver, prolific porn performer, certified massage therapist, and trained sacred intimate. Together, they explore how play, breath, and nervous-system awareness can support stronger erections, deeper pleasure, and a more connected erotic life. They discuss common challenges such as delayed ejaculation, performance pressure, and the trap of “doing porn moves” rather than engaging with a partner. Allen offers grounded, compassionate guidance for men looking to rediscover pleasure and presence.

Key Themes

• Why many porn performers use penile injections

• What “sacred intimacy” really is and why it helps erections

• You don’t need a fully hard penis to have great sex

• How to stop doing “porn moves” and start connecting

• Breath as a pathway into pleasure and regulation

• How erotic play transforms anxiety and performance pressure

• Three ingredients that consistently create good sex

• Why ejaculation may be delayed and how to work with it

• Finding joy and authenticity in your erotic life

Listen to the Episode

Listen Now

Allen Silver

Allen Silver is a sacred intimate, certified massage therapist, and adult film performer based in San Francisco. Trained at the Body Electric School, he blends somatic touch, erotic education, and healing practices to help individuals reconnect with pleasure, embodiment, and erotic authenticity. His work centers on sensitivity, liberation, and joy.

Website:https://allensi.com

Adult Film Profile (explicit): https://www.pornhub.com/pornstar/allen-silver

Episode Transcript

Tim Norton: hello and welcome to hard conversations. I'm really excited about my next guest, Allen Silver, who resides in San Francisco. He's a sacred, intimate, certified massage therapist, adult film, performer. And,  anything else that I left out there? 

Allen Silver: Oh, I'd like to say conscious sex worker, 

Tim Norton: conscious sex work. Okay. So I think there are a few things there that not, I mean, everybody knows what a massage therapist is.

 but I don't know if we know what a conscious sexual worker is in a, in a sacred, intimate is 

Allen Silver: sure. Well,  my approach,  my [00:01:00] reason for getting into this was because it was a calling for me. So a lot of people get into some version of sex work because,  they want to make money or,  they think, you know, it'll validate them in some way or some other reason maybe they're coerced into it.

But for me, it came from a deep place of needing to be useful. Okay.  so the modality that fits me most in that is a sacred, intimate. 

Tim Norton: Okay. And can you tell me a little bit more about what a, what a sacred intimate actually is? Sure. 

Allen Silver: So th th that's a term that was coined by the body electric school.  Joe Kramer came up with that and,  different people have different definitions for sacred, intimate, but I will tell you what mine is.

It's a,   a conscious sex worker, someone who does erotic healing work with an intentionality connected to it. So sometimes I like to say,  Sacred into the SIS is also a specific intention. So that means someone comes to you with an [00:02:00] intention around,  something. They want to explore something, they need healing around something maybe they're afraid of.

 and you're,  being allowed to trust from that person when you go into that session, as opposed to trading sex for money, which is what we traditionally think of when we think of sex workers. 

Tim Norton: Okay. And I get the sense. So you, you started that later in life, or how long have you been doing sacred intimate work?

Allen Silver:  almost 18 years now.  yeah.  I came into it,  via some workshops I did through the body electric school.  and it just so resonated with me that it ended up being my life's calling. 

Tim Norton: Oh, that's really cool. And so. You know the name of the show or the theme of the show has a lot to do with erectile issues.

So why don't we just go ahead and dive right into that? Because I, when I was reading about you, I was thinking along the lines of, well, you might be working with erectile issues [00:03:00] as someone on an adult film sets,  someone who has sexual partners and someone who's a sacred intimate. So. Of those avenues or any other ones that we haven't covered here.

Where do you think you've learned most about how to deal with,  either your own erectile issues, if they've ever been an issue or with others of other clients or other, other actors? 

Allen Silver: Well,  so completely different worlds,  in terms of dealing with,  sexual and what are we saying? Sorry. Erectile issues, right.

Thank you for saying erectile issues. I just hate erectile dysfunction is the worst, because I mean, I think the penis has wisdom, you know, if we listen, so, you know, it's not. Dysfunctional something's happened.  but,  I'm digressing, you asked about those barriers, various places and how,   regular issues come into play.

So completely different worlds. The porn world,  adult video, that's all [00:04:00] about putting on a show and,  hopefully sneaking in some genuine connection and passion and, and all the good stuff we really want to have important as opposed to working one-on-one with somebody.  In which case we're, it's a different approach.

 should I keep going about that? 

Tim Norton: Okay. So does it ever happen? Well, how long have you been doing it? Yeah, 

Allen Silver: they actually started that later.  so,  but a long time,  probably 15, 17 years ago as well.   I'm 57 now I started,  I think I, one of was 40 and,  What was the 

Tim Norton: question? Okay. Ha that's. So you've been doing porn.

I always ask about,  people's relationship to porn with respect to Viagra. So Viagra was only a couple of years old when you just got started. Was it all, was it already ubiquitous on sets or did it take awhile or is it [00:05:00] even ubiquitous on sets? I don't even know. Is it something that guys are just always taking.

Allen Silver: Oh, sure. Well,  most guys are,   not everybody,  you know, and there's, there's,  other,  erectile medications apart from that.  so, you know, it's in on a porn site, it's about,  you know,  performing and looking a certain way and, and turning to the camera at times. And,  so. Yeah, that's a different,  place,  held an erection in,  other porn situation very differently than I would in a sacred intimate session.

Tim Norton: Okay. Do you guys have erectile issues on porn sets? 

Allen Silver:  yes. Yes.  but as you probably know, there are,  even stronger things than Viagra people can use on porn set. So that generally takes care of most,   hard-on issues. [00:06:00]  wait, 

Tim Norton: what's actually stronger than Viagra. 

Allen Silver: Well, like,    Caverject, say that again?

Tim Norton: Caverject with, Oh, like an injection, right? Yeah. Yes. An 

Allen Silver: injection. So, okay. So sometimes we'll use that.   but what I have seen them include in the contract sometimes is,   That you, they won't pay you if you can't,  come. And so, and I asked about that, cause it was like, I don't, I don't quite get that because that's not really always necessary for every shoot.

And,  the director told me that it was because they'd have guys who had been out partying the night before, you know, came in high or something. And you know, so when you have a mitigating mess like that going on in a set, it's gonna, it's gonna mess up your ability to get an 

Tim Norton: erection. No, definitely. Okay.

So wow. Even in the contract, huh? They were pretty strict. Yeah. I thought that was 

Allen Silver: hilarious there. I was just was like, wow. Okay. 

Tim Norton: And do you have to initial that paragraph?

[00:07:00] Okay. So, so guys are usually, but, but when you first got started in, it was there already the injections and the pills are, were guys trying other 

Allen Silver: things.  I didn't know about all that at the beginning.   I think, I think we did have IRA at that point. So,  and as you know,  fire only,  supports,  you getting erection has nothing to do with if you're actually turned on or interested.

Right. So you still have to be 

Tim Norton: aroused. Yeah. And I don't even know that we mentioned that you're doing gay porn here that we're talking about. So when you are with other actors, are you also helping them sometimes? Do you guys help each other? If there's.  if somebody is not quite getting as hard as they want to.

Allen Silver: Yeah.  Oh God. Trying to think of the names. Charlie Daniels and Leo forte. We're off camera doing things to turn me on once [00:08:00] for a solid shoot at tight-knit. So yeah, absolutely. It's like we absolutely support each other in that situation. Okay. Yeah. And that's something we're so off to watch it got me going and it's like, okay, this stood behind the camera man.

While they were taking stills. All right. And what kind of the worst? I hate doing stills, but yeah. Oh, I bet. So interactions when you're interacting with somebody, there's something going on, you know, there's, there's something to work off of, or to react to, or to help them help you with.  but when you're just by yourself and put you cameras, that's the most challenging.

Tim Norton: Right. And so what kinds of things would they do to, to help get you turned on? Was it just like kinky? Oh, these guys, I just like watching them. They were, they have back 

Allen Silver: there. Okay. Oh, okay. Yeah, but you know, I want to say that people always ask me about, you know, Oh, well, can I be a fluffer around the set?

And you know, I have yet to see an actual flipper on a point. So

it's not 

Tim Norton: you, you just dispelled the [00:09:00] myth. Okay. Well, I'm 

Allen Silver: not saying they don't exist, but in my experience, I haven't seen it. 

Tim Norton: Right. Okay. So on a set, you, you might be with. Other actors, you might have an injection, you might use pills, but I get the sense that you wouldn't bring pills to a sacred intimacy session and say, here, take this and then we'll get started.

Allen Silver: No, no. So,  I, I have no problem with people using Viagra as a support. I just don't have any negative connotations around it. However, it's not something that,  is going to correct.  the underlying issue or help you with, you know, the reason you came in there for, or they wouldn't be coming in.  but most of my clients don't come in specifically for erectile issues.

  however,  it is something I work with them a lot around,  to get them comfortable with getting playful, to get them into a space where it's not.  as big an issue [00:10:00] and even also to help them understand that there's a hell of a lot of fun you can have without having an erection. So that's,   new information for some men.

Tim Norton: Yeah, I will. What do most of them come in for? 

Allen Silver: If people want to try something, something specific that they've, haven't had a chance to try it.  a lot of role-play,  I am very turned on with the dad boy type role play.  so I get a lot of people who come in for that kind of thing. 

Tim Norton: Okay. And then can you see them in movies too?

So clarify for the listeners, what dad, boy role-play is in your shoes. 

Allen Silver: So in this context, it's a, it's a fantasy play,  around the archetype of dad and boy, we're not talking literal dead end boy. So,  most gay men have. Things going on in their history, around how they dealt with their father. And they have a,  probably a wound around it.

[00:11:00]  they had wishes that their father had supported them as a little gay boy in ways that he probably didn't once in a while, I run across somebody who that's not the case for it, but it's extremely rare. So it can be a fun. Yeah. Can also be healing to explore that, to be the dad that wished that had that's one 

Tim Norton: option.

Okay. And I bet that's really very moving work, 

Allen Silver: but yes, I, I it's the most fulfilling thing I can imagine doing well. It really is. Yeah. That's really cool. 

Tim Norton: So back to backed off hard penises.  so does,  would you say that any, if there's any crossover, like, have you learned things from doing porn? That you actually bring into your sacred intimate work?

Allen Silver: yes.  and before we go on, I just want to say that,  [00:12:00] you don't have to have a hard penis to have fun right. All the time. But,  that I brought in from the porn. Yes. Because, 

I would say in terms of,  Because I've had that actual experience.  I can help some of these guys with their fantasies and, and guys get hung up on porn and they study the way things are done in porn,  that are maybe done more for the camera that are then for actual disengaging each other. So can you give an example?

Yeah, well, there's the whole,   turning to the camera and doing the twisty,  cock sucking thing. Like, you know, I've said guys to do this thing to me and I'm like, What are you doing? And that their favorite porn star does that. And,  I will say,  you know, that's great, but that I don't actually enjoy that.

So let's talk about what does feel good. Let's find out what feels good to you. And they might not enjoy that particular thing same [00:13:00] either.  yeah, but it just that idea. And in terms of erections,  you know, they just think you're supposed to be able to pull it out of your pants and just go.  you know, because from watching porn and I explained to him and say, no, this, if you could see how it shot, it's,  you know, it's all done very cleverly and very technically.

And,  you know, it looks like that the guy was just pulled over by the police. And one minute later they're having sex, but,  you know, it showbiz. Right. 

Tim Norton: And so, and behind the scenes, there are a lot of other things happening. Well, it's just, 

Allen Silver: it's actually very boring and in many ways, I mean, there's lots of sitting around and waiting.

And then when you get around to doing like the actual action scene,  you know, you get a chance to get ready to do that and build up to it. And then, you know, the shoot it, then it all fits into a story. Right.  but in terms of bringing anything, it's funny, I feel like I bring things to the other direction.

But bringing something from porn into the sacred, [00:14:00] intimate work, it's just that I can actually help them to understand what really goes on.  so they don't have to hold on to unrealistic fantasy so much. 

Tim Norton: Okay. And we'll then talk about,  bringing it in the other direction. So you bring sacred, intimate work into, on the porn sites.

Allen Silver: Well, in terms of,  I have,  I have a secret agenda to foster hot sex between men. It's not a secret, I suppose, but,  One of the things is just a basic thing that a sacred, intimate body electric things around connecting, and you'd be surprised how many men won't look you in the eye. So if you can coax them into looking into in the eye,  yeah, on screen,  something happens.

Something always happens and,  the connection gets a lot bigger and it gets more powerful and hotter in my opinion.  so that's one thing I do.  I also make,  an effort to,  connect with a man ahead of [00:15:00] time,  in terms of supporting him and allow him to get the chance to support me because, you know, we bet we may both be nervous and to have like a genuine human connection ahead of time,  is a 

Tim Norton: good idea.

And what might that look like? Are you talking about on the set or, or in advance of the shoot that would 

Allen Silver: say before the shoot, just, you know, Clearing the air, making sure that there's nothing,  we need to Claire there's anything that, you know,  may have inadvertently done something he's pissed off about, or,  I may accidentally have done something or maybe my breath is bad.

So,  it's,  it's  you get to drop a certain wall with that around having to be Mr. ReadyMan,  and showing your vulnerability. And then I give him a chance to,  be vulnerable too.  I don't necessarily get a big response from that, but I think it does set a nice tone, but that's an example of something that comes from the sacred into my [00:16:00] world into,  into the kicking it in to, in front of the 

Tim Norton: camera.

Okay. Okay. That's that's  that's really interesting. And then, so in your, actually your secret mission, as you say is you want to ha you want, you want the viewers to see some of these elements from sacred intimate work and to. Hopefully apply some of that when they start having the kind of sex that they're seeing on your porn.

Yeah. 

Allen Silver: That's mixed in there, man. You know, honestly, I'm a, an exhibitionist to a certain degree, so little pre-Madonna going in there. So, you know, I love to be told I'm pretty good front of the camera and, you know, get positive feedback. It feels good.  you know, just being honest.  and then you also have to just trust the director.

You know, I've had wonderful directors cause they try to create amazing stuff out of the water. Footage of that I would have thought had been terrible.  but I also think another place in which maybe some of my,  segregated [00:17:00] background comes in is in some of the times where it is,  akin to role-play,    dad in a joke, age movies.

And,  you know, I can really get down to that energy that,  that place of being the loving dad, he's there to support son. Okay. 

Tim Norton: So. Earlier, you said you were,  a conscious sex worker. Is that kind of the same as a sacred, intimate, or is that, are those two different 

Allen Silver: things? Just throw that in there because people don't necessarily would know what a,  a sacred intimate is.

And that one's a little more like you can kind of figure that, that label out by yourself to the most degree. But I also like to say it because,  there are an awful lot of guys who just do,  some form of sex work because they need to pay the bills.  or, you know, cause, Oh, well everyone tells me I should and et cetera.

And that's absolutely not the place I'm coming from. I have this agenda and desire to be useful. And I found the way for me [00:18:00] to be useful is to use my whole body. And that includes my cock and my brain. 

Tim Norton: Okay.  so you, you said you were taking classes at the body electric? 

Allen Silver: Yeah. The bunny electric school is a school that,  started in Berkeley in the eighties.

It came out in response to.  the AIDS crisis and they created this amazing set of classes.  Joe Kramer created this thing and,  they were helping men who were basically traumatized and terrified at the time,  sex equals death for awhile. And so,  they helped them to connect in a,  safe, sexual and spiritual way,  using things like Reiki and breathing techniques.

And. Dallas erotic massage and a bunch of other really cool stuff. Hmm. Yeah. I had a, I took a win a workshop with them while I was on vacation in Hawaii. And,  it was a pivotal point in my life,  because [00:19:00] I'd never been exposed to that. And all of a sudden there was this big, big world, big erotic world.

I didn't have an inkling of as a boy from West Texas. So that sent me on a new trajectory. 

Tim Norton: Hmm, that sounds like a good trip to take. 

Allen Silver: It depends on your point of view. My ex was not thrilled about it. One party electric did to me. 

Tim Norton: Yeah. So you, you mentioned something like, so Reiki in breath techniques. So I would imagine that could really affect,  sexuality and intercourse and penises and everything like that.

Could you tell us a little bit more about how you incorporate that into sex? 

Allen Silver: I don't use a whole lot of that. Probably electric does mainly just because I'm lazy, but it's a kind of a,  a way of doing a,  Putting your body in a, in a very, as a short term, altered state through a breathing technique.  and it's [00:20:00] one of those ways that you can have like a, almost like a mini shamonic experience.

Like every, every, each amount of type experience is about knocking yourself out of your room, normal bubble, getting a different point of view and then coming back. And this is like a really minimal way to do that.  So yeah. In terms of erections it's it's in fact in that situation, erections are irrelevant.

Yeah. Because that's one of the beauty, beautiful things that body electric did is they taught me to have these awesome erotic experiences that weren't about having a boner. 

Tim Norton: Okay. So then when you're in this altered state, Is this something that you're doing with a partner or is it like a solo sex situation?

I need to go do one of these. I do.

Yeah. 

Allen Silver: It's very, very well-described,   plan it's it's in a group and,  I don't want to give you too many details about it because, [00:21:00] you know, go do it and experience it, but it's done an absolutely safe, respectful,  Beautiful container,  in such a way that you were allowed to just have your experience, whatever it is, and not,  feeling like there's any sheds attached to it about how you should be feeling or what you should be doing.

Tim Norton: Okay. That sounds really nice. Yeah. So, so what are some of the other things that you you do with clients that you find that are, is really helpful for them to learn about their sexuality? 

Allen Silver: Well,  I, I really want to get people connected with what really turns them on and what's what is real for them and not what they think they should be doing.

 that that can be challenging.  I'll tell you the way that I approach that is,  wiggling around again, is that I,  in a way I almost kind of trick them into,  [00:22:00] finding their playful self. Like that's, what I love to do is going to a playful place with guys. And,  because I have this belief that there's,  an unspoiled inner core in there, no matter what screwed up stuff has happened to you, it's in there.

And,  if we can just tap into that a little bit, we're going to get some insight. And,  an example of that is too.  I've had guys come to me who,  for example, couldn't,  ejaculate in front of another person, or they may have been concerned about interaction, but in either case the same kind of approach that we take in which I find a way to,  play with them,  get them to,  drop their guard and be in a safe place with me.

 it's very important that I can take, create a container of trust with the person. So it's a confidential space.  they get permission to be as messy or as weird or stupid as they want to be inside that space. And no one else is ever going to know what happens inside there. I don't tell them, but, [00:23:00]  working with somebody who has an issue around ejaculating in front of another person, or,  having a boner, I,  get them to a playful space hopefully, and they forget about that part.

And then lo and behold, it happens if that's what's appropriate to happen. And sometimes it isn't appropriate what to happen, but they've let go of that. Need to have,  

Tim Norton: an erection. Okay. The need to have an erection. Cause they're, it's like they're controlling the erection or they're really kind of clenching.

And does the play relax them or what's your take on it? 

Allen Silver: Ticket is such a direct physical thing is more,   their, their intellectual self and their,  uptight adult self is getting in the way. Of what is really play for them. Right. So that's, my job is to get that crap out of the way and we'll see what happens.

Yeah. And they're, 

Tim Norton: they're just letting go of yeah. That uptight [00:24:00] adult self. Yeah. 

Allen Silver: It's funny. I, I avoid using words like uptight, because I think when you say things like it's, for example, telling someone to relax actually makes them more tense because now they're efforting to relax. Right. But yeah, you're right.

Uptight would be a way to say it.  Yeah, I would say, I want to get them into a free-flowing loose playful space,  try to evoke,  what they were when they first started exploring their sexuality to that kind of Headspace. That's a, that's a fun place to visit. 

Tim Norton: Yeah. And you know what the w w in, in sex therapy terms, you know, we'll call that it's something like delayed ejaculation.

And, and they, there are no big studies on, on some, on that. There's, there's no pharmaceutical company who cares, who wants to research that. And so the, the old psych literature does just kind of depict it as this [00:25:00] inability to let go of, of literally of the semen, but also let go of, you know, of the 

Allen Silver: psychological mood.

Yeah. Oh my God. So what comes to mind when you talk about that is that this is a,  kind of people. A lot of guys have a script when they come in to spend time with me and,  felt you can S you can end the place very clear that they're very close to,  coming and it's,  it's totally appropriate if they choose to do so.

And then suddenly how much time do we have left? No, no, no, don't go there. It's like, if you feel like it, do it, if you don't feel like it, do it, that's the role don't, you know, It's sticks. Cause then lo and behold, if you try and hold back and do it, then you're performing, then you're, you know, making it about something other than what your inner desire is.

Tim Norton: Yeah. And I bet you could almost see something shift in their body. Right. When they say that the, how much time do we have left, right? Yes. Yes. And there, 

Allen Silver: I don't there's little part inside of me. It's like, damn it. Oh, I do. In that play [00:26:00] space and you popped out of it. Right. But then I bring them to it because now they're back in their head and I, you know, that's, that's a conscious learning that can be useful,  in the future for them to realize that they're doing that.

I think it's giving the permission to just go ahead and enjoy it when they felt like enjoying it. You know, I give him permission to do that. It's 

Tim Norton: a teachable moment 

Allen Silver: to change.

Tim Norton:  I,  I read, I read a couple of the things on your website and I like to quote, I think it was, I think it was maybe Robin found it. I have learned that expanding my own joy and pleasure is not selfish. It creates more of it for the whole world. Hmm. Can you talk a little bit more about that? Are you quoting somebody or is that, is that Allen silver.

All right. That does 

Allen Silver: sound good. Yeah. Yeah. Well, you know, I, I think people have a kind of a [00:27:00] scarcity approach to a lot of things in life and they, by default somehow use that kind of approach when it's about, you know,  enjoying themselves and,  I'm all in supportive. Being a shameless enjoyer of lots and lots of sex,  have guys who feel guilty about,  their sex drive, being so high.

 and,  I just know for me, I kept myself so repressed for a long time. And then when I wasn't,  it seemed almost too big to handle and I just wanted to go out and have sex with the world. So,  I'd never want to shame somebody if they're in that space and,  Do you know, there's more,  we'll make more, remember the, you know, the Doritos ads, like, you know, go out there and have enjoyment.

It's not like it's a limited resource we're going to run out of,  by making it, you make more. 

Tim Norton: Hmm. And so do you feel like you were, [00:28:00] sometimes I try and teach people how to embody joy, you know, like I think about where they hold joy in their bodies and, and what it actually looks like. 

Allen Silver: Oh, good for you.

That's 

Tim Norton: so cool. Yeah. I love that. You know, we all kind of know what we feel. I feel like somatically with shame and with fear, you know, we spent so much time talking about, okay, where do you hold your fear? And it's in your gut, but it's also important to think about where you hold love and joy. And I think,  I'm wondering, you know, when I read the quote, I was wondering like, if, if you being more joyful in your erotic space or spaces is, is,  contagious.

Allen Silver: Absolutely. Yes. I'm sure you've experienced that being around somebody who's well, who's alive and lit up and is enjoying their life. It's contagious, you know, to say the same around being somebody who's a downer and depressed and looking at everything in a crappy way.  I call it the,  I call it the bug light.

So, if you can [00:29:00] find the thing that lights you up, it's kind of a bad metaphor, but I'm stuck with it because I've been saying it so long, but you know, when you find the thing that brings you joy, when you're lit up and what makes you feel most alive,  you dislike this light that is attractive, you know,  doubt.

And I just love helping people,  find that it's also,  it elicits trust in people when you're that way.  I've I, in an odd way, I'm think I'm more vulnerable when I'm in that joy space, because I will just say things are blurred out things that are unfeeling,  from an honest place when people can sense that and it allows them to do that as well.

Tim Norton: Yeah. Well, it reminds me of dancing, you know, I, I know I never liked the people who make fun of you for dancing because you're in that joyous state where you don't want to care what everybody's thinking about. And then to tie that into sex, like it. Sometimes it's really hard to [00:30:00] embody the joy of the experience if you're just so preoccupied by the performance or by the other person's pleasure.

Allen Silver: I love it. Yeah. 

Tim Norton: And just trying to let go of that.  Do you, do you find the same to be true? 

Allen Silver: I do. I just want to say, you know, in terms of that, like,  my previous statement about the guy doing the cock sucking as if he had the same way, seen it on porn, it's like, you know, w what is it dance as if no one is watching and talk as if psychotic is, if no one is watching, you know, just get into it and don't care about how stupid it was.

Yeah. That your partner is gonna have a great time. Yeah. So are we we're allowed to say that on this show, 

Tim Norton: right? Yeah, I think so. I, I put them up on iTunes and then so far they haven't taken them down. I don't know if I'm supposed to put a disclaimer at the beginning of it. It will. We'll find out [00:31:00] one day I may have a lot of editing to do.

 but for now it's fine. So, you know, BV, I know. You're you're saying you don't need a hard cock to have a good time.  but what about those times when you, do you know, what, what do you, what do you tell guys? 

Allen Silver: Well, it depends on the guy in the situation, but,  I try to circumnavigate their heads, so getting them into a place of play and also,  There are still some shirts around, cause sometimes there's guys who just really, they think they should be wanting to be a top and they just really honestly don't care about it that much.

 but okay. To answer your question,  I finesse him into it is the best I can say. And I haven't been a hundred percent successful with that.  I try to shy away from it being,  like a, a technical thing. [00:32:00]  you know, Oh, maybe see the, you know, of course, I assume they've already dealt with this in terms of medical issues and stuff.

 but what will often happen to him? And we'll get into a space where they go ahead and get an erection and don't even know it because we've gone to another place and are too,  we're two kids on a camp out, you know, having fun and, and it, it happens. And then,  if they have a specific agenda around what they want to do with their Dick, I will just do it,   jump on it, so to speak and,  give them a chance to experience what that's like until they suddenly realize what's happening.

And then it becomes a conscious thing again, but it made a little tiny,  connection in a neuron somewhere. And so I'm always looking for little pieces of progress, you know, not giant breakthroughs. And so I can,  Say at the end of the session now let's review. And do you remember what happened? Do you remember how that happened?

Because they'll go back into there, like on the failure space and I'll remind them of, but you remember that moment, you remember what happened? You weren't thinking about [00:33:00] it. Right. And then you did get a boner and then we did do this thing and. Just remember that happened. Remind yourself about that. And then sit on that.

Like what, what made that possible so that sometimes can help them get to a better place. You know, there's a lot of old programming in their brain, you know, about how crappy a lover they are. I'm a failure because my Dick isn't get hard enough. And,  you're looking for ways to build new neural pathways around that good experiences.

I'm always trying to get put good experiences in there to give them another point of view. 

Tim Norton: Okay. It sounds like they're, they're coming to the room, almost playing a role that they play every single time and kind of telling themselves the same thing. And you're, you're breaking them out of that. You say you're, you're finessing the situation.

So it's like you're distracting them, but also by them not so being so preoccupied by the situation they're relaxing. 

Allen Silver: Yeah. As a matter of fact, you say roles it's actually [00:34:00] beneficial because we are enrolls when someone's coming to me in a session, it's a form of role play, even if I'm just there as their sex educator.

So,  they're off the hook to some degree in the same way that they would be if they had picked somebody up in a bar and,  therefore they're willing to take orders a little more and,  listen to me.  But, you know, you have, you have like three things that make a good sex. So you have three possible avenues.

And if you can get all three of them go on at once, it's really hot, but there's a role-play, which could be where lovers could be, you know,    your sacred, intimate, and your client could be a lot, could be, you know, gladiator and slave boy.  and you have,   the erotic trance. Which is a type of connection that is not requiring eyesight.

It's about the touch. It's about the feeling. And then you have the , which is like, you're looking in each other's eyes and you're having [00:35:00] a kind of connection that way. And if you can get all three of those going at once,  it'll usually send you to a really good place. And most men are not able or willing to do all three at once.

So that's one of my. My middle secrets. I'm letting you in on there. That's a 

Tim Norton: great secret.  can you talk more like when,  for listeners we're, we're on a Skype call and when he said I vow, he kind of pointed at his eyes and then at my eyes,  what's, what's going on in, in Idaho. 

Allen Silver: So,  as both an icebreaker, a connector and it can be challenging.

 well you usually start a session. By standing across from a man, especially if he's nervous putting our hands on each other's hearts and just breathing together. And then I will, I will look in his eyes and try to get him to look in mine. If he is hesitant to all try to gently coax him into doing that.

And if you look in another person's eyes [00:36:00] and breathe for 30 seconds, or even a minute, something always happens. And then I take,  then I asked them to check in with their body and I check them with mine and I am always seeking to be completely honest with them. Whatever's going on with me.  and now you're inside a really beautiful container when you've done all that.

So that's the out part in terms of opening the session. 

Tim Norton: Okay. Then that sounds really wonderful. You know, I, what I hear from a lot of people is. A lack of eye contact during sex. And a lot of people are blaming porn on that, but I, you know, I think it's been happening for just maybe just more, a lack of sex education and not being so good at being intimate and vulnerable.

So your icebreaker is, is diving right into it. A vulnerability or an intimacy that a lot of people don't get to experience. 

Allen Silver: Okay. Which part is conscious and which part is not conscious. So you [00:37:00] could consciously not be doing eye contact in order to have a deeper experience. Maybe you want to go deeper into this sensation.

Maybe you want to go deeper into the role play. And that involves being blindfolded. So that's a different, that's like choosing not to do it for that reason. So I don't wanna get anybody hung up on. You should always maintain eye contact all the time. You're having sex, but don't avoid it. If it's keeping you from being connected.

Tim Norton: Oh, that's a great distinction. Okay. And, and,  so there was role-play and I though, what was the middle one?  

Allen Silver: erotic trance. That's where your friends, that's just, that's just about being in sensation. So,  you know, when I think of it, I think of being in a, in a, in a sex club with a really dark lighting and just, you know, someone is touching you and you can't see them and you just didn't join the touch.

And,  it's, it's that kind of feeling. 

Tim Norton: Okay. And I, and not feeling you're not preoccupied with. [00:38:00] Is the other person enjoying this. 

Allen Silver: That's an interest I'd never thought of it that way.  you could be it, but you're talking about being in a give and taking situation.  yeah. Yeah. I honestly have not thought about it that way.

 you know, in order to enjoy sex, you need to be a little selfish, you know, you can get what you want and ask for what you want and just enjoy it. When you get it. So if you're always trying to, you know, what drives me crazy is when you're with somebody and you ask them what they want and they said, I want to please you now, unless it's, you know, that's a role-play and that's a specific purpose around, that's a different server, but otherwise it's like now, now you're just throwing it back at me, you know?

So,  that's really curious when someone says it like, Oh, so you can't name anything in this moment that would make this feel better for you. And just bringing their attention to that. Yeah. Oh, okay. Maybe I [00:39:00] can't. Okay. 

Tim Norton: That's a great reply. You can't think of anything in this moment, 

Allen Silver: right. And also the power of, no, you got to give people permission to say no, you know, that's a lot that goes on a lot too.

Cause it's just tolerating stuff that they don't like. And you know, that's keeping them from being turned on. It's like, you know, I really don't care for that. Stop that. I have a lot of rules around how people can touch my nipples. And I tell them that up front. 

Tim Norton: So my, my last guest and this interview isn't up yet, but she was a tantric practitioner and she felt like she could tell a lot of guys were masturbating to porn a lot, and it was spilling over into our work.

It was making sessions longer, people being desensitized, people behaving differently. Do you, do you pick up on any of that and your client 

Allen Silver: work? You do? I do. And I have, I have some,  homework around masturbation, which is, I believe in masturbating as much as you [00:40:00] care to.  but I required that 50% of it be,  without any form of porn and just whatever you create in your head.

Okay. Cause that's actually, if you can get by yourself and just do something, you can come up with stuff, you know, It's it's just pot, Reno. You could make up a story in your head. You can touch yourself, but all of that is coming from whatever's going on inside of you instead of the external bombardment.

Because I mean, as you probably know that the it's one thing to flip through a magazine and in the old days, like we did, but now you can just like have a continuous fast feed of one thing after another, and it's totally desensitizing it's too much. 

Tim Norton: And how do you see that play out in a session or what.

What evidence do you see of, of guys just watching way too much porn? Why does it affect them?

Allen Silver: I would say just to kind of,  like a weak muscle, like how, you know, when you do an exercise and you have a weak muscle, so [00:41:00] you just are not very good at being able to connect the genuine playful way with another guy.  I don't know that I've ever found somebody where it's totally lost,   Well would say something about that in a second, but in terms of watching too much porn, it's still possible to get, it's just, you know, it's just a matter of getting back in the habit of doing that exercise of, you know, getting masturbating to what turns you on without any external stimulation, something will show up for you when you do that.

Guys may find that it goes into a romantic space. Like, you know, they're just dreaming of the perfect lover or some, you know, fantasy rape scene or whatever thing goes on in their head. But,  you know, It's back there. You just gotta give it a chance to emerge. I did want to say that one time. I do have a hard time.

I can't say I've had a lot of success with is with guys who are,  have become,  disconnected from their own pleasure due to a drug use. And that's another area I'm not an expert in, so yeah. Okay. 

[00:42:00] Tim Norton: And mainly like, like math or just, yeah, that's what I'm thinking of. Yeah. Like over too much math in sex and.

And sex is very different without 

Allen Silver: math. Yes. Yeah. So getting back down to the, you know, mundane world after doing it that way, I think it's really challenging for them. Uh it's it's that's always, that's a hard 

Tim Norton: one. Yeah. Yeah. There was actually a seminar on that recently at the center for healthy sex on, on sex aftermath.

It was,  I still haven't watched it. I mentioned, yeah, 

Allen Silver: I'll say I'll send them to you if I get people. Okay. Okay, 

Tim Norton: great. Yeah, I'm the expert.  So I also, do you have regulars? Do you, do you have clients that you have long-term,  treatment with or connections with that you work with multiple times? 

Allen Silver: Yes.

Tim Norton: You know, I, I know that in therapy, when, in those situations and even in short-term situations, sometimes I learn from them [00:43:00] and, you know, we're, we're constantly learning about sexuality and, and, and I mean, that's such a broad. Thing on itself. We're, we're learning a lot about sexuality.  do you, are you learning from your clients too sometimes?

Like, what are the, some of the things, what have you learned about 

Allen Silver: for college

patients?   allowing,  trusting the moment and,  you know, I've had somebody come in for something. And I thought we'd be done lickety split and half them out the door. And it was clear that it was going to take a very long time.  and I've had the opposite where,  somebody just had this idea in their head that this was going to be this huge, challenging thing.

 but what you got to remember sometimes is by the point somebody comes in to see someone like me, they've already gone through a big process. So. Their session, so to speak has been going on for [00:44:00] awhile. And sometimes I'm just the final step in that the actual showing up and being in front of this person and gathering the courage to do the thing they wanted to do.

So they may have thought that was going to take them six months to do in terms of two took suit one day or two sessions. Hmm. Hmm. 

Tim Norton: That's really interesting. And you've worked with,  sometimes you'll work with people who are actually physically disabled. 

Allen Silver: Yes. I've had a lot of it, you know, it's, it's, it's I, I was thinking about this the other day.

They seem to have come in,  waves of things. So for a while, there are ahead to see a lot of guys who were,  had,  various prostate situations. And there's, you know, there's a lot of guys who have to relearn how to have sex after having prostate surgery.  and I've had a while there, I had several guys in a row that were different types of amputees.

 as a wheelchair bound clients,  I've never had a [00:45:00] blind client, which I think is interesting. I've had deaf clients.  yeah, it's an honor to work with people like that, you know, just like you can bring,   some level of hypersexuality to their lives. It just like what, how wonderful. 

Tim Norton: Yeah. And I know that,  the, with prostate.

Cancer and prostate surgery. That's, it's always,  it's always tricky because the guys are dealing with doctors and, you know, urologists and so forth, who I find to be fairly often pretty sex negative. And I always, you know, they're often told, Hey, you're never going to have sex again, or you're always going to struggle.

 so I'm really happy to hear that you're, you're seeing those guys come through and, and, and you've had some success. 

Allen Silver: Yes. And, [00:46:00]  a number of things. It's just, there's a lot of stuff that can happen when you've had a prostate surgery.  and one of them is that it changes the way your acceleration happens.

And then they can also like be more leaky in this kind of prosthetic fluid and urine. And they can, they have shame around that. So I can work with them to shift that,  And just accept that that's the way it is. And it actually can actually be kind of hot, you know, and I'm sure there's a lot of people that are turned on by that.

 so,  it, it physically changes you and there's also the mental aspect. You're talking about doctors just telling them yep. It's over. You know, and it's just beyond what I hear that it's like, it's not totally over. There's something, even if you're caucus and capable of ever getting hard, again, there's some kind of erotic enjoyment you're going to be able to have, and let's find out what that is, how fun it would be to find out what that is.

You know, look at it that way and mourn the loss of what [00:47:00] was, I can't pretend everything's hunky Dory. And so 

Tim Norton: what are some of the pleasures of a non-hard. Cock, whether it's medical or just so much damn stress the last few months of their 

Allen Silver: lives, like, well, obviously it's still fun to have your cock sock when it's soft.

 you also can move it in certain ways. You can't, it's hard for vibrations and wiggling, things like that.  and then, you know, of course I work with gay men, so there's a whole world of enjoyment to be had,  with your asshole.  As a matter of fact, I even have a hard time having erection if they're bottoming and that's normal.

So then he's let go of thinking. They're supposed to be hard all the time. Then they can have,  an internal orgasm, you know, she's not required hard cock. You can have whole lot of bodywork essence by, you know, spreading that or riding energy around it. It's like your whole body is a penis when you're [00:48:00] like that.

So,  Yeah. There's some examples. Yeah. 

Tim Norton: And, you know,  anecdotal evidence out there that,  prostate massage can help with erectile issues. Or if you found any of that along the way, or know anybody who's, who's good at that or any, 

Allen Silver: I haven't approached it for that reason.  yeah. Let me think if I can think of.

I think, I can't think of it being connected to someone coming in, being concerned about direction. And then, you know, I have admin be surprised that they get an erection during prostatic prostrate and slash, and actually ejaculating the traditional sense during the prostate massage, which they were surprised by.

 and that happened like a 

Tim Norton: gum. Yeah. That happens fairly regularly or, or more often than I think a lot of people might think, 

Allen Silver: right.  [00:49:00] no,  I don't have a basis of comparison for that.  so for it to happen in a, in a way, because there's, I've been with a number of guys that are like that, but they already know they're like that.

It's just like, Oh, this is how I am.  but I'd say over the past 12, 18 years, like maybe half a dozen times it's happened by surprise. Okay. So from whatever numbers that were sent to. 

Tim Norton: Okay. Yeah. But even for the guys who know about it yeah.  I just think,  especially in the straight world, don't know that from anal play alone, you can evacuate.

Allen Silver: It's that's a beautiful thing. I don't know. It's all it's always happened for me just as a circuit. Is this as a by-product of the pleasure?  never set out, trying to do that, like to train someone to do that. I don't know if there's a way to do that. Okay. Sophia, a fun thing to take out though. 

Tim Norton: Life goal.

Yeah. All right. So are there at [00:50:00] that hour, just kind of flew by. Wow. I feel like we could talk about all kinds of stuff.  was there any other things that you felt like you want the world to know? And,  my, my mom to know and listening to this podcast, though, the guys on my football team. 

Allen Silver:  yeah, there's a little thing around it kind of touched on, which is, I think your cock has wisdom.

And a few years back,  I was at a ceremony and we were making intentions that I decided that I wanted to have an intention of letting go of my own concerns around having an erection. And,  then I had to learn to trust that my Dick had,  some wisdom to itself. And if I'm,  in a situation and I am, I'm having trouble getting an erection.

The first thing I do is like, well, what's going on here? That's not working for me. And sometimes I have to be honest with like, [00:51:00] there's nothing in this situation that's turning me on. So that's the word is,  yeah, but other times it's like, you don't really tolerate. And so me, I don't want to be tolerating.

I'm just going to go and tell this guy that his bad breath is killing me. I wouldn't say killing me. It'd be book life in that, but that's an example. And, and in trusting your Dick rather than demanding it to do things my early,  I remember it in the James Bond movies when I was a kid that James Bond was just walking into a room with a sexy girl and BAMMIES screener, you know, it's like, I, I felt like such a loser as a kid.

Like I can never do that. It was such a terrible role model to get as a kid.  And now I've learned the joys of the, all of the many shades of erections that Cox can have

Tim Norton: with that. That would almost be a runner up title for the podcast.  the Dick has wisdom that's so, so [00:52:00] profound and simple, but so true. 

Allen Silver: Well, you know, you gotta make your Dick, your friend, you know, if it's, how are you going to learn wisdom? If you're on not a speaking terms. And if you're mad at your Dick all the time, then you know, there will, there we go.

We've got to start there. Yeah. Yeah. 

Tim Norton: It'd be nice. Your Dick give it what it wants, 

Allen Silver: but I mean, do you have a nickname for your Dick? 

Tim Norton: No. No, I don't. That's time. 

Allen Silver: Is this a question? I it's, this is,   Avenue to playfulness. I will do it as I'll talk, ask us if they have a nickname for their day. Which one you, they come up or they can come up with it, but you can't help, but get you in a silly space.

And now are you stepped away from the seriousness, right? We're a little bit closer to being kids playing together. 

Tim Norton: And yeah. And then you talked about,  forming new neural pathways, you know, you're accessing the creative part of your brain and you know, as long as you're not now worried about not coming up with a clever.

Pet name. So yeah, you might do that. I don't know. I don't want to 

Allen Silver: see the wheels spinning too much. I'd I'd [00:53:00] have them back off. Yeah. Right. Okay. 

Tim Norton: And that's, what's nice about working with someone like yourself in a hands-on situation is you're going to very quickly be able to read that and say, okay, that wasn't a good idea.

That's not working. Let's, let's move over here and let's try 

Allen Silver: it. Yeah. I don't want to be too arrogant about that because I don't assume I always read things right.  I've had situations where,  somebody will be behaving in a way that it looks to me, like they're shutting down. And so I gotta remind myself not to assume I know what's going on.

And so hopefully we'll see. I don't always do this perfectly. Hopefully I'll stop in and say,  you know, I noticed you kind of got quiet and look like you're looking away and. And then give them a chance to be wherever they're at and respond because it may be yes, they had checkout or maybe it's happened quite a few times.

Wow. Something just came up for me. We need to go a different direction. Here's this [00:54:00] blah, blah, blah. And you're like, you're off to the races. So,  gotta trust the moment and not assume, you know, what's going on. Oh, 

Tim Norton: that's great. And then what a nice thing for. For, for a couple to model, you know, one partner doing that and just kind of checking in and then, you know, obviously they're the partner doing that too.

 but not making assumptions, having hard conversations. Wow. That 

Allen Silver: would be awesome. And,  yeah. Would be 

Tim Norton: great. Right. Especially over the course of a long-term relationship. You, you have those kinds of conversations. I love it. I noticed you kind of checked out right there and yeah. Cause I wanted to leave me alone and other times.

Yeah, no, I didn't even realize doing that. 

Allen Silver: Thanks for pointing out now. I would just caution you to say Nazi. I checked out. I didn't, that I would say that something happened and I, I don't understand, you know, give them a chance to paint their own words, but yeah. Yeah. Okay. Say 

Tim Norton: Monday. Yeah, [00:55:00] that is all right.

Well, this has been a blast. Thank you so much for your time. Thank you, 

Allen Silver: Tim. You're a cool guy. Such a pleasure to talk to you. 

Tim Norton: Yeah, absolutely. Is there any, anything we can plug for you?  where, where can people find you on the interwebs and social media and all that? 

Allen Silver: Sure.   my secret intimate side is Allen SSI.

That's Allen spelled a pretty way. A L L E N S I.com and,  my site it's more about my,  adult film work is Allen silver. And I am working on a book, but I am not ready to,  plump that yet. But,  you know, I think we have got a chance to plug that later on your show. 

Tim Norton: Oh, absolutely. Be sure. To put me on the list of people interested in when that book comes out.

Really cool. Yeah. Thank you. Yeah. All right, Allen. Well, thank you so much for your time. Thank 

Allen Silver: you. [00:57:00] [00:56:00] .

If This Episode Resonated

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Tim Norton provides a discreet, evidence-based therapeutic space where men and couples can understand the deeper systems behind desire, arousal, and connection. His work combines rigorous neuroscience with a grounded, relational approach to help clients rebuild aliveness in their bodies, strengthen partnership, and create lasting change.