What You Need to Know About Medical Treatment for Erectile Issues

Episode Overview

In this episode, Tim speaks with Dr. Max McCullen, a men’s sexual health consultant with decades of experience across pharmaceuticals, urology, surgical treatment, and sexual medicine. They explore the biological foundations of erections, the full range of medical treatment options, and how integrated care can remove shame and restore confidence.

Key Themes

• How PDE-5 inhibitors (Viagra, Cialis, Levitra) actually work

• The role of hormones, nerves, arousal signals, and blood flow

• What happens during penile injection therapy

• Penile implants, who they help, what surgery involves

• Penis pumps and vacuum erection devices when and why they help

• The psychological components of “medical” erectile dysfunction

• Why integrated sexual healthcare matters

• Reducing shame around medical ED treatment

• The complexity of erections and why no single solution fits everyone

Listen to the Episode

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Dr. Max McCullen

Dr. Max McCullen is a sexologist and men’s sexual health consultant with a doctorate in Human Sexuality and Gender Studies. His career spans clinical education, pharmaceutical science, urology consultation, hormone therapy, penile implant surgical assistance, and patient-focused sexual health coaching. He has worked with GlaxoSmithKline, Boston Medical Group, American Medical Systems, and Boston Scientific, and continues to advise urologists on cutting-edge treatments for erectile and urinary dysfunction.

Episode Transcript

Tim Norton: This is Max McCullen, who has worked in the sexual health field for 18 years. He worked for Boston medical group, Glaxo Smith, Kline, and a host of urologists all over California. He completed undergraduate studies at the university of the Pacific and the university of London. And then his research led him to the Institute for advanced study of human sexuality in San Francisco.

He has his doctorate degree in gender studies and human sexuality from the Institute and currently works for Boston scientific. 

 Dr. Max McCullen Welcome max. Thank you, Tim. Great to be here. 

Tim Norton: Yeah, I'm so excited. [00:01:00] So how did you find your career path? How did you get into sexual health?

 Dr. Max McCullen That's a great question and I'm not really sure.

I can't pinpoint one exact thing that happened. I've always been very interested in human sexuality. I think. The first time human sexuality hit me and this hole, this will date me a little bit, but I was watching the movie grease in the theater. And when I saw,  Olivia Newton, John come out in the black tights, I realized what all these, the men and women were talking about and fighting about and why my parents didn't get along.

And I realized the power of sexuality from Olivia Newton. John probably started right there. So after that, I just was always interested in it. And then. Did some undergraduate work in it and realize that it's when I started, I actually researched graduate degrees in human sexuality in the state of California.

And couldn't find one UC school or one state school that offered a graduate program in human sexuality. And I thought that was so. Funny, because what field [00:02:00] of study affects us more impactfully than our own sexuality, right. It kind of almost imprints everything we do. Definitely.  so I found the Institute,  in San Francisco, which obviously wasn't a UC or a state school, but they were doing some of the best work at that time.

And so,  I started to study there and then got involved, as you already mentioned with the medical side of things. Yeah. And that kind of brought me to where I am today. I'm still, I'm still treating men for,  sexual dysfunctions medically. 

Tim Norton: Right. And that's actually why I was really excited when we met, because in my.

Current social circles. I mean more of the mental health practitioners, sex therapists, I mean a lot of sex educators.  so I don't have a lot of access to that information regarding things like surgeries and Viagra and, and all the different medications outside of books and outside of just, you know, lectures that I go to and things like that.

So,  I'd like to talk [00:03:00] a lot about that today and, you know, and what you've done and the kinds of things that,  the, the options for, for guys struggling with,  erectile 

 Dr. Max McCullen issues. No, absolutely. And when you approached me, I'm the complete opposite, right? I'm always around the medical. Personnel. So I don't get to interact with the great work that,  your side is doing on how to help men out, you know, psychogenic only, so yeah, I think this could be an ongoing discussion for a long, long time.

Yeah. It could be fruitful for both of us to learn exactly. You know, what we do. And, and I guess the goal, and this is kind of what you mentioned is if you can bring those two worlds into a synergistic. Treatment paradigm, then that would be really impactful for men because they're both, they're both a huge part of it.

Tim Norton: Absolutely. Absolutely. And I think,  We need more of it throughout medicine, throughout mental health. However you want to distinguish it, but especially with sex, [00:04:00] you know, I've, I've looked at a lot of websites, have a lot of urologists and I don't see them mention anxiety reduction or, or therapy a lot of the time.

And, and it's unfortunate is because even if there is a real obvious,  biological cause, which oftentimes there is, or,  It 

 Dr. Max McCullen helps. And even if there is, you know, biological causes, which we're going to talk about, but of course that's gonna affect you. It emotionally as well. Absolutely. It's going to affect you.

Tim Norton: So, so all right, well, let's get into it. So one of the first typical medical treatments that you mentioned is PDE five inhibitors, right? What is that? 

 Dr. Max McCullen So, right. So basically what generally happens. And I think this is a pretty,  normal course for most men is they will bring up to their primary care physician.

That they're having an issue and, and the primary care physician will generally give him a prescription for Viagra. [00:05:00]  many times they will,  refer him to a urologist, but generally what's going to happen is that primary care guy is going to give him the Viagara. Unfortunately, a lot of those primary care guys don't follow up.

So, so hopefully they are, if it's a good primary care and let's say six months, Hey, how did that Viagra workout? Because a lot of guys just give up, but it doesn't work.  and then they'll go to urologist and then, you know, go down the, the whole,  treatment paradigm,  that we'll go into later. But,  to answer your question, a PD five inhibitor is essentially a medication that causes nitric oxide to be put into your system, which,   Has a kind of dual action.

It it's a, it's a muscle relaxer and then it's also a vassal dilator. Okay. 

Tim Norton: And yeah, so dilator. So basically it sounds to me like it, it makes your, your veins 

 Dr. Max McCullen wider. That's exactly what it is. You nailed it. Yeah. Where'd you go to medical school. [00:06:00] Yeah. You nailed it. So, yeah.  opens up the, the, the two corporal cavernosum and your penis and allows the blood to go in there.

 so first it relaxes the muscle and then it. And ends up once the blood goes in there, it's able to cinch up the, the, the,  Bobo cavernosa muscle. So the blood doesn't leak out. So it kind of traps it in there for a little while. And what's interesting is Viagra was a complete mistake. As a lot of things are in science.

 Pfizer was doing a study on pulmonary hypertension and the people. Once they started to interview people about the study, everyone started to say that they were, yeah, I hate doc. I can breathe better, but guess what else is happening? So Pfizer went, ding, ding, ding, you know, multi-billion dollars later.

They, they got the indication for ed. So it was a complete, complete,   mistake that they came up with Viagra. But,  so Cialis Levitra, you don't really hear about it anymore. I used to sell that to GlaxoSmithKline, but they're all the same medication. They're all called PD five inhibitors.

[00:07:00] Phosphodiesterase five inhibitors and they have the same basically mechanism of action. It's just like a delayed.  onset. So you would be like,  you know, Tylenol,  delayed 

Tim Norton: reaction. Yeah. And I I've read about this phenomenon before of a vassal dilation and. At a glance. I think it's counterintuitive because we're talking about relaxing a penis.

When guys in that moment kind of want the opposite. Right. They want an intensification of they because they didn't want it hard. So can you shed any light on, on how that works or why the paradox 

 Dr. Max McCullen with that? Well, I mean, I think that's a great, that's a great question. And yeah, I mean maybe some of the anxiety that men do go through could cause.

Could cause that to be, to be an issue because they're not able to relax because, and yeah, so that's kind of counterintuitive, but your muscles have to relax for the blood to flow into [00:08:00] the penis. Okay. And that's an important component of how Viagra works is it relaxes the muscle and then the muscle, once the blood goes in there and the penis becomes gorged.

There'll be th there's it, it wants to stop venous leakage. There's a term that urologist we use called venous leak is that means the blood can get in there. And we've most men have experienced that. Right? You get hard in the beginning. And then all of a sudden down the, throughout the course of you having sex things kind of start to slow down a little bit.

Well, that basically means that you're not keeping the blood in there. That's what, that's why people use penis rings by the way, because as we get older,  the P the venous leakage can start to happen more often.  so. I'm not sure if I answered 

Tim Norton: your question, answer my question perfectly. Okay. And so different PD, five inhibitors, they'll either,  slowly make the VESO dilation occur or all, all at 

 Dr. Max McCullen once kind of.

Right. Exactly. So Viagra has a little bit of a. Quicker [00:09:00] onset of action. And then Cialis is delayed over time. So see out that, you know, the whole way that the Cialis, the way they market their medication and the way they've designed it is that it's a, it's a delayed release, extended release. So for instance, you're able to,  Have sex, like over the course of a couple of days and it stays in your system like pharmacologically.

It means it has a larger half-life. I mean, we don't have to get into all that, but it just means it stays in your system a little bit longer. Viagra gives you that instant boom, and you're going to have probably a bigger reaction quicker, but then it's going to die over time. So in, you know, let's say eight hours that Viagra probably isn't going to kick in as much, whereas the Cialis will stay in your system a little bit less longer, but it won't give you the initial, the initial,  Erection that I, in terms of my experience of biography gives you.

Tim Norton: Okay. So we could almost say like one night sex, Viagra weekend sex. [00:10:00] Exactly. 

 Dr. Max McCullen Yeah. I think that's a great, that's a great way of looking at it. Okay. 

Tim Norton: And so you worked with those medications for a long time, or worked with guys who had varying degrees of success with those medications. What did you notice.

Would it w were there some guys that could just take it forever and it was fine. And maybe other guys that couldn't like, what, 

 Dr. Max McCullen what, what happened? That's a great question. And I don't think people realize that in. And, and is that 50% of men cannot tolerate PD five inhibitors. So 50% of men either,  I should say 50% of men.

I, I S I misspoke 50% of men can't get to goal. On PD five inhibitors. Now what that means is they may be on,  nitrates. So it's, you know,  it's a health concern, so they can't take it. Right. Cause it lowers your blood pressure so much. Or they have an adverse reaction. A lot of guys have flushing. Like my dad for instance, has really bad headaches.

He can't take Viagra.  or simply there's a, there's an issue over time because. [00:11:00] Viagra works, like I said, with your vasculature, right? So increasing blood flow to the penis. Well, if you're having other comorbidities like diabetes or atherosclerosis, which you know, or hypertension, which causes issues in your vasculature, the effect of Viagra will diminish over time.

So 50% of men that try Viagra, it's not there. They're not going to get to where they want to go. 

Tim Norton: I see. Okay. They, they don't exactly say that on the commercials do not. Okay.  and, and this goes, without saying this, this podcast is in no way, a medically sponsored podcast where we're not, we're not saying go out and take.

 Dr. Max McCullen Great. Are you saying Pfizer is not going to write me a check for this 

Tim Norton: interview? There is not paying max nor myself for this interview. And,  you, you do always want to consult your medical doctor when taking any of these medications. Although in London, they've started selling,  sildenafil. They started selling generic Viagra over the counter.

[00:12:00]  Dr. Max McCullen See that to me, I have heard rumblings about that. And to me that seems. I think there's gotta be some sort of a thing where a doctor's riding off on it somewhere because if a guy walks in that has heart failure or is on nitrates and he gets, and he hasn't consulted a physician, that guy could die. So there's, I got, I feel like there's gotta be a discussion or some sort of a prescription.

Or something like a prescription or at least a consultation. I don't think the, well, you know, the United States is so more, it's more litigious than Europe over here. I don't think it would fly because you'd have to have that consultation because it can be dangerous for a certain type of patient. But I have heard that I need to look into that and see exactly what's happening.

So tell me, tell me what you. Well, 

Tim Norton: I I've just seen the,  the headline brief articles, tweets and things like that, but I got the sense that they were going in and seeing essentially a pharmacist. 

 Dr. Max McCullen So maybe be that's maybe that's the consultation and [00:13:00] the pharmacist saying, Hey, you realize that if you're this patient, it's not to your benefit.

So maybe that's what's happening. Yeah. I don't, I feel like that wouldn't fly in the United States. Yeah. What do you think. I 

Tim Norton: think we'd be a long way away from that. Yeah. Although now there are these startups where you can get your generic or regular pills online, correct. Seeing a, a virtual, 

 Dr. Max McCullen virtual urologist or telemedicine and the stuff that's happening now, it's growing.

More and more rapidly. And so that's happening. Yeah. And the good news is for the other problem with Viagra, this is really exciting. You know, I mean, as we all know with drugs, branded drugs are they have the best efficacy, but they're also expensive. So there are generic options for people. I do work with a company that distributes generic sildenafil, which is actually indicated.

Remember earlier, when I talked about that, it was originally for pulmonary hypertension. So this medication is indicated for pulmonary hypertension, not erectile dysfunction. So they can get it a lot cheaper. So if [00:14:00] any of your listeners, you know, want to, you know, just go into their urologist or primary care and ask them for the generic form of, of sildenafil, which is the chemical name of Viagra, their physician should know that they at this date at this time, people should not be paying.

 retail for Viagra. That was other options out there. Okay. 

Tim Norton: And it's, it's literally the same product. 

 Dr. Max McCullen I mean, I would say it's probably the efficacy is going to be a little bit better with the branded, but you're going to pay three to four times. Right. So why not take two pills of the generic? That's going to save you 50 to a hundred bucks as opposed to taking one pill branded.

Tim Norton: Okay. Okay. Well, good tip. So. So you, you work with guys in various capacities and so, and you see them in, and at some point pills aren't working, they go to urologist and there are other options. There are other medical options. Correct. So next on [00:15:00] the list that you mentioned was injection therapy. Yes. So that sounds right.

I don't want an injection 

 Dr. Max McCullen there. What I heard when I heard about that option before I, you know, went into it and really saw it done. And, and, and I haven't had it done, but I've obviously been in the room many times.  I was, I was pretty much freaked out about it. I said, why wouldn't anybody want to do that?

But believe it or not, they do it in a part of the penis that has little to no nerve endings in it. So there are, as we, as we all know, there's certain parts of the penis that are more sensitive than others. And they do it at the nine and six o'clock sides of the penis where, and they use a very, very thin diabetic needle.

So what you would inject insulin into your stomach with, and the guys from what the patients that I've talked to, it feels like somebody slaps a rubber band,  medium strength onto the penis. So it's a, it's a little bit of a prick. Let's say no pun intended, but that it's not very painful at all. And,  it's.

The [00:16:00] efficacy it meaning how good it works is off the charts. I mean, gun to get an erection. Oh, 

Tim Norton: okay.  what are they injecting into your penis? 

 Dr. Max McCullen So there's a bunch of medications. Again, these are Vasso dilating medications they're used for other things, but,  I mean the names of them are prostate gland in the, the branded name would be Caverject.

That might be some of your listeners will remember having a doctor talk about Caverject.  there's.   fentanyl amine and they use these just for, you know, different medical reasons, but they just basically increased blood flow to those certain areas. So,  it's called,  the, the doctors refer to it as Trimix.

So a lot of times, if you go to urologists, that's the term that they will use, because it will be prostate landed,  attributes and phentolamine, which they will put together in a mixture and then inject that into the penis. 

Tim Norton: Okay. Yup. And so they. How long does the,  how [00:17:00] long does it last? How long does the injection?

 Dr. Max McCullen Yeah. And so, so,  part of the reason why injection therapy became,  well, First of all it was around before Viagra. So they were, they were using it and perfecting it even before Viagra came onto the scene, which is like right in the eighties and early nineties.  and then obviously it kind of fell out of fashion because Viagra started working so well.

But as we talked about a lot of men, aren't going to get to go on Viagra and,  you have immediate erection and it doesn't have to go through, you know, your. First pass metabolism. So you're going to have less side effects, you know, Viagra can have side effects and depends on what you've eaten. So if you're putting the medication right there, boom, you're going to get an erection and it's going to last for about 45 minutes to an hour.

 the, there are drawbacks of course, right? Some guys don't like needles.  [00:18:00] you're. You have higher risk of priapism, meaning an erection that won't go away. That can be very dangerous to the tissue. We've all probably heard the commercial, the Viagra commercials. If you've had an erection for longer than four hours, go to the emergency room, it can cause,  Tissue death.

It's very, very dangerous to have that, to have an erection that won't go down that can happen way more likely with injection therapy. So you have to kind of know what you're doing. That's why a lot of times when you go into a urologist, they'll do it in the office, kind of show you how it's done and you'll get a partial or three fourths of erection.

And then they'll discuss how you can do it at home. Okay. 

Tim Norton: Okay. All right. So that's, and then how much of those costs, 

 Dr. Max McCullen so the cost is, is generally going to be higher than Viagra, or of course the, the generic,  I would say generally, they're going to sell you up a six months supply and it could be anywhere from 500 to a thousand 

Tim Norton: dollars.

Okay. Six months supply figuring you're having sex like three to [00:19:00] five 

 Dr. Max McCullen times a week. Okay. 

Tim Norton: Okay. So yeah, 

 Dr. Max McCullen I don't know how you'd break that down. Cost-wise but that's generally they, they sell them in like lump packages.  cause it's just not. Profitable for them, I guess, to do it any other way. The other problem with, with the injection therapy is they have to take cut because they're pulling different medications from different pharmacies or compound pharmacies, the supplies, an issue.

So I've had that be a problem where. Urologists have asked me if I know pharmacies that do this, I would set them up with a pharmacy and this has happened more times than I want to deal with. As they said, Hey, they're having, they're having supply issues with one of the medications that I combined. So then the patient basically was out of luck.

So he had to wait until they got enough of the medication there to combine it. So then they had the medication already. There's also sterility issues. It has to be refrigerated. Right. You can't like, leave it in your car on a hot summer day and then use it. It has to be [00:20:00] kept at a certain temperature.

Whereas if you have a pill, you can leave it in your car. You can take it whenever you want. So traveling is an issue, right. Because you have to have a needle in a sword. Okay. 

Tim Norton: Okay. Interesting. And then, okay, so. For the guy who doesn't want the pill guy doesn't want the injection. What's next. Usually you've mentioned a vacuum.

So yeah, 

 Dr. Max McCullen the vacuum and the injection, I would say are kind of like the second, a and second B sometimes urologists are going to go for the vacuum device before the injection, because it can work at times synergistically with. Viagra. So remember when we talked about venous leakage earlier, so the guys can get hard and maybe it doesn't stay hard or maybe the Viagra is just kind of working halfway, but you're getting a little bit of extra blood flow.

So now what you can do is you can put a suction device on the penis, basically. That's just literally physically pulls the, the blood into there because you're co you're forcing [00:21:00] it. And then there's a ring at the end. So basically you put a cylinder over your penis. You want to create an airtight seal?

Some of them are hand held back in the day, like 50 years ago that it would be, it would actually be a PO a pump that you would do manually with your fingers. But now they have battery powers and you basically turn it on. It does make a noise. So it's not very sexy. Right? You wouldn't want to do it. In the S it's not discrete if you're going to do it next to your partner.

So you'd basically have to get up, probably go in the bathroom. It kind of makes a little bit of a humming noise as the battery kicks in. There's a button that you push. It kind of goes, mm. Literally physically sucks the,  blood into there. And then you, before you put the cylinder over your penis, you put a rubber ring around the tip of it.

And then you just slide that ring off the cylinder onto the base of your penis. And that keeps the blood in there and maintains the erection and then you can have sex. Okay. It's not very comfortable. I [00:22:00] did try one of these because I, obviously, when I was talking to patients, I wanted to be able to,  know what it felt like.

I didn't want to inject myself to know what it felt like, so I didn't go that far, but,  it's not w it was comfortable cause it feels like this cinching feeling. So even though it does work, it's just, it's not sexy. It's kind of embarrassing. It's not very discreet.  but there's no side effects, right?

You don't have to worry about any of the side effects with Viagra. You don't have to inject herself.  and you see it's pretty benign. If people, if someone does not want to use any medication at all, that could be. And 

Tim Norton: I imagine from like a sex positive viewpoint, you could. Play with your partner, get comfortable with the 

 Dr. Max McCullen machine fun experience to play around with it.

Absolutely. You could try it on. If you're with a female, you could try it on her. If you know, two males, obviously they could have fun with it. I mean, so [00:23:00] that's a great point, you know, and it could be something that you can incorporate into your 

Tim Norton: right. I think I heard people talking about that at like,  a talk on sexual disabilities, like people who have sexual disability, that's going to be something that, that 

 Dr. Max McCullen would be, that's a great, that's a great option, right?

Tim Norton: Okay. And well, a funny side note, I was at a, I was at a blow jobs class, as you know, we end up at classes in this field and the fruit around the class was his all kind. Yeah. Okay. 

 Dr. Max McCullen Was it like P prosthesis and dildos as though? Oh yeah. 

Tim Norton: All kinds of toys, but the instructor mentioned that. There's a blowjob technique that basically mimics a vacuum.

Interesting. That, of just sucking the blood. 

 Dr. Max McCullen And so you'd probably, you're probably creating an airtight seal cause that's, that's, you know, if you, if you don't do that, that's such an, the whole premise, right. So you'd have to be probably pretty far down on the yeah. 

Tim Norton: Well, and, but while the penis is [00:24:00] flacid, that wouldn't be as hard or difficult and then true.

So I was, I haven't actually. Seen it, but he swore by the technique and it was certainly compelling. Interesting. Yeah. So for all you a blow job givers out there that might, you might have a new, a new calling.  so next along the list, you mentioned something I haven't heard of 

 Dr. Max McCullen therapy. Yeah. Pellet therapy.

Let me back up for one second. The one thing I wanted to, to throw out there is. When I mentioned that you can use a vacuum erection device synergistically with Viagra or Cialis. One thing you would never want to do is use it if you're doing injection therapy. Okay. Yeah, because it's gonna, it's going to increase your chances for the priapism.

Okay. So if you're, if you're injecting, try mix into your penis and you're not getting an erection, there's something wrong with the medication. And I would not. Jump [00:25:00] into a vacuum erection device. Also, it could be maybe you didn't, maybe it's taking a second to kick in. Next thing, you know, you start using the vacuum erection device.

You get too much blood in there. So just to throw that out there as a caveat to listeners who. Would want to try that with injection therapy only used the vacuum was with Viagra. 

Tim Norton: Okay. Okay, good. Thank you.  that helps. So pellets, 

 Dr. Max McCullen so pellets. Yeah. So this is called, this is a brand name called muse. That's maybe what people would remember it by if a doctor ever brought it up, essentially what it is, it's a trocar, which would be a delivery device, basically.

 Has a small opening. It's kind of like a Turkey Beyster, but very small. And it's basically the same medication as prostate gland in it, which is the same main medication that you would put into the injection therapy. But for people who don't like needles, you would actually put a pellet into your wreath really into your penis.

[00:26:00] So Paul, like through the whole of you, 

Tim Norton: you're doing it yourself, 

 Dr. Max McCullen correct. Just put, put the end of the delivery device or the very small Turkey Beyster into your urethra deposit, the pellet and the pellet dissolves into the tissue. And you get the vassal dilation by having the immediate topical application of the, of that medication.

 I haven't. Had it done or seen it done. And I've heard that it's painful. I heard it's actually more painful than the injection that's okay. Yeah. So, okay. So then it's not as popular anymore, 

Tim Norton: right? Okay. Not as popular anymore. 

 Dr. Max McCullen  well, you know, there's always a patient that's like deathly afraid of needles, right?

Sure. Viagra doesn't work. Doesn't want to do the vacuum device cause he thinks it's embarrassing. Right? That's the guidance. And so there's that going to be that guy out there? That's like, Hey, that's for me. And maybe he's not as sensitive. 

Tim Norton: Maybe he's into your wreath [00:27:00] replay right there. There's a whole section at that, a lot of sex stores for your replay.

And,  they might stay like the pain in there and they might not mind it. It might not even bother them at all. Okay. So then hormone replacement, 

 Dr. Max McCullen right? Okay. So, you know, we've all kind of heard of this. I'm sure there's commercials ad nauseum about it, essentially, as we get older, We lose after 40, we lose 10% of our testosterone production a year testosterone.

So important for,  well, definitely women have testosterone as well.  but for men, you know, our mental acuity is tied into our PR you know, testosterone, our,   muscle.  formation muscle retention is all tied into testosterone. And of course your sexual functioning is tied into testosterone energy levels.

 you definitely want to go get your levels [00:28:00] tested before you do this, because if you and there's, there's, you know, I'm trying to think of one of the medications, but maybe you remember too well, they say,  Take this pill and you'll it creases your testosterone. I see commercials about all the time.

It's kind of dangerous because what happens is you, you run the risk of your body, basically what your body is going to say, Oh, well, I have all this now, free testosterone running around that you've put in artificially and then your body will stop producing natural testosterone and you run the risk of your body.

Totally shutting down and not producing any more testosterone. Which is worse, so, Oh no. Yeah, you don't, you don't want that to happen. So what you want to do is if you, as I would recommend any guy over the age of 40 to go get your testosterone levels checked, you can go to your primary care. You can go to like any sort of,  nephrologist or endocrinologist, probably do it more so than anybody, but any primary care will know how to do it and he'll come back and he say, yeah, you know, it's a little low [00:29:00] or Hey, guess what?

You're not, you're really low. And then you're like, boom, well, that's the problem. That's my problem right there. You know, it's not.  that I'm not turned on by my girl. It's not that I have Vasso dilating problems. It's that I'm producing. Absolutely no testosterone. So that's an option, but you're not going to know that until you get your level.

Tim Norton: Okay. And then, so that would, is there a connection between testosterone and blood fell? Blood flow? 

 Dr. Max McCullen So that's, it's funny because,  as far as my, my research,  Has like, basically shown me is that it's still, there's still some question marks about,  erectile dysfunction. What we do know is there's like five key components to getting an erection.

Okay. You have to be visually stimulated, right? If you take a Viagra pill, for instance, that w that has to work with the rest of your body, right. Not the injection, but if you take a Viagra and you go to like an insurance [00:30:00] seminar, you know, and there's nobody that you're tracking the two in the room and you don't have 

Tim Norton: insurance seminar kinks, that's not 

 Dr. Max McCullen your paraphilia is isn't.

Sure. All right. You're not going to get an erection. So men, I have to be, it has to start here. I'm pointing to my head for the viewers at home. For anything to work. So that's number one, number two. Your, your brain kicks in your endocrine system or your hormonal system. So the testosterone picks up your dopamine, your serotonin levels start picking up.

You know, you, you know, as we all know when we're, when we're turned on,  you feel good, right? Like, cause if I look at a picture of a beautiful woman, I feel, I feel good. I feel kind of like, Hey, that's that's because your serotonin levels is jumped up. Right. So, so your testosterone levels jump up. And what that does is that kicks in the rest of the.

Mechanisms, which now start your, your nerve innervation. So you have to have the nerve impulses, have to go down and, and talk about the, those muscles relaxing and [00:31:00] opening up, and then the blood flow. So all these things have to happen right at once you have to be turned on, you have to have hormonal output.

You have to have nerve innervation and you have to have a vessel dilation. So. To think about that. Yeah. It's pretty amazing what our bodies go through. And I don't know if, but like women really appreciate what's going on physiologically. It's complicated. It's complicated. So I think men need to give, give, we need to give ourselves a break, right?

Because that's a lot to go. And as you get older, right? None of us run as fast as we did when we were 16, we can't lift as many weights. So. Okay, listen, give yourself a break that, Hey, I don't get as hard as I used to, but there's a lot of things going on in my body and there's options out there to get me to the point where I can maybe not be like I was when I was 15, but I can still have sex and have a great time and have a great sex life.

Right. So,  yeah, there's a lot of things going on. And to answer your question, we don't know [00:32:00] exactly which one's going to carry the load more, but we do know testosterone is a key component. We just don't know. If it does more innovation than vessel dilation or more this or that or whatever, so, okay.

There's still some question works. 

Tim Norton: Okay. And then finally, and this is this, this last. Technique, this last process is what you do a lot of lately are these, are they implants surgical implants, right. And for the viewers at home, you can't see him. He is in scrubs because sexy scrolls right here and well, because as a part of your job, and you mentioned this earlier, you had, you attend these surgeries, correct?

You are present to these surgeries. Why? 

 Dr. Max McCullen  Two reasons really,  the devices are very, very expensive, so they want a representative of the company to be in the room. In case let's say you didn't have a representative there. And the scrub nurse opens up the device and drops it on the [00:33:00] floor. Well, now it's now it's not sterile anymore.

Well, that's a $708,000 piece of equipment. So the D the hospital might be in a. Discussion with the manufacturer saying, Oh no. Yeah, we didn't use that. If the reps in there now it's, it's our responsibility. If it gets dropped it's on us. So we're responsible for all of that. The other thing is, is that surgeons, you know, doctors know a lot about a lot.

Right.  and they're dealing with prostate cancer. They're dealing with urinary issues, bladder issues. They're dealing with. A whole, whole erectile dysfunction. They're dealing with female urology, you got all this stuff. And so they might not do this surgery more than once a month or once every two months.

So we're supposed to kind of just be in there in case. That doctor has any questions. Hey, by the way, how much am I supposed to fill up the rest? Well, you know, it's, you know, you want to fill it up to at least 60. [00:34:00] And so just kind of to be there in case. And also the scrub nurses do a lot of the prepping of the devices.

So you need to be there to walk through them with that process, if the doctor's doing his surgical,  Techniques to get ready to implant the device. So basically you're just kind of there to make sure everything's kosher. 

Tim Norton: Okay. And so these, these implants,  tell us more about them. I think everybody to get an idea should probably Google,  pictures of penile implants and you know what they look 

 Dr. Max McCullen like.

I'll leave. Well, I have one with you today. We can take some pictures and,  you know, I can actually give you one right now. Let's say you can kind of,  maybe.

This is basically, I just I'm handing Tim one right now. So you have that in your hand and that's a penile. That's a penile implant and we'll take a picture of that and you can put that on your, on your website so people can see, and of course they can Google it. If you Google [00:35:00] Boston scientific,   penile prosthesis, or American medical systems, penile prosthesis, there'll be pictures and videos that you can, that you can pull up and take a look at,  essentially the main device.

That is the best-selling device.  now is,  called a three-piece,  penile prosthesis. And it there's a reservoir or a balloon. That you put in your abdomen as a pump that goes into your scrotum. And then there's two balloons that go into your corporate cavernosum. So the penis is made up of three basic cavities.

Your, your corporate spongiosum is your urethra. So that's where you urinate and ejaculate out of. And then there's two cavities below that, which is your, your cavernosum. And that that's what fills up with blood. Okay. So that's how you get an erection. What the doctors do is they go in and it's kind of brutal to, to watch actually they take dilators and just.

[00:36:00] Work, all that tissue out of there. And they just kind of basically just slough it all aside and, 

Tim Norton: and max is making kind of a punching grinding motion. Like they're, they're literally clearing out 

 Dr. Max McCullen the tissue, the tissue out of the, yeah. And they actually don't bring any tissue out, which is interesting, but they're really aggressively just opening up these cavities.

Where's the incision. So the incision is mid. Mid glands under the penis. So let's say the scrotum it's in between the scrotum and mid penis. So, yeah. So let's say, let's say that the top of your glands, which is where your head, your helmet is two centimeters below that on the underbelly of your penis and about a centimeter and a half above your.

Well, your scrotum starts. They make two incisions right here, a gauge again, they're putting two balloons in there. Right? Right. So these two balloons are going in there [00:37:00] and they, they do, they shot them because they want to make sure that this is there's no bubbles through there because basically what runs on saline.

So to get the erection, they're moving saline in between these three.  parts of the, the device. So the, again, the pump, the balloons and the reservoir. So when you, the pump, it transfers the saline from the balloon or the reservoir, which is in your abdomen into the cylinders, which are in your penis. You get an erection when you're done having sex.

There's a deactivation button. That's in your scrotum. You push the deactivation button and you, with your hand, gently squeeze the penis. Downward and that transfers the S the saline back into the reservoir, into your stomach, and then it sits there until you're ready to have sex again. 

Tim Norton: Okay. And you, you described this to me before and also described it pretty, flatteringly like [00:38:00] pretty with guys saying they.

Had wonderful results 

 Dr. Max McCullen with them. I was literally shocked. So when I sold Viagra and when I worked with other urologists and we would do a lot of clinics where I would show people how to use the vacuum devices, I would mention this and I didn't. Realize how high the patient satisfaction was until I actually started interviewing urologists that were doing a lot of them, you know, urology surgeons, and then talking to patients afterwards, it's got about a 90% patient satisfaction rate.

Wow. And then they interviewed their partners and the partners had a real, like over an 80, 90% satisfaction rate mom. I mean, I take all these numbers in, in,  You know, lightly because it's coming from probably research that the company did, but the point is, and the reason I believe that it is really high is these guys have exhausted all of the other treatment options that we've previously talked about.

Once they go here, Dave, Most likely, I would say 99% of these guys have tried [00:39:00] one of the options that we've been talking about. So they've probably, haven't been able to have adequate sex in a really long time. And this is,  this is, this is what you would call a cure. I mean, you are definitely going to get an erection for as long as you want.

It's not going to go down. You don't have to take a medication. There's really no side effects other than the fact of what can happen when you have surgery, which is a huge thing you want to consider. Once you're out of surgery and you had no complications, it's a cure. You're going to get an erection.

Hmm. So I think that's why you have a high patient satisfaction rate. 

Tim Norton: And is the Jackie elation the same? Yeah, it's 

 Dr. Max McCullen exactly the same because you're not going into the Corpus spongiosum that houses the urethra. So you're not damaging the urethra whatsoever and the sensitivity. Now I haven't had this done and I've talked to some patients, they tell me the sensitivity is the same.

Huh?  I would think that there's, there has to be a little bit of a diminishment simply because you're, there's going to be some nerve damage. Anytime you take a knife to anywhere on the body, there's going to be some nerve damage. [00:40:00]  However they're doing it at, at that area that I discussed earlier where there's not as much.

Right. And,  so 

Tim Norton: yeah, it's not the most sensitive part of the penis at all. Correct.  okay. So, and then you could obviously still have your, your penis pumped up for a blow job as well for receiving oral sex. 

 Dr. Max McCullen Anytime you want to get a hard-on, you can have it all day. You can pump it up. You can have it all day.

And you don't have to worry about what we talked about earlier. So you're not going to have any tissue damage because you have no tissue in there. Right. So when people say this is a cure for ed, I mean, I guess in a way you could say that now,  side it's expensive, it's expensive. It's expensive. A okay.

Also surgery's a big deal. It really is. There's lots of things that can go wrong. You're under anesthesia in an Orr, right. There can be infection. You know, there's infection issues. I've, I've, I've done one of these where there was an infection. They had to go back in, take it out, right. Put a bunch of antibiotic.

[00:41:00] So surgery is no joke. So that's something that, you know, that's why I think that these guys have tried other options before they go down this road, because I don't think any of us take surgery lightly. Right. Right. None of us are going to just. Jump into that without seriously considering what the issues are.

 there are a lot of insurances that are covering this now, and I even did a transgendered prosthesis surgery,  three weeks ago and it was paid for by an independent organization. Awesome. And then also some of the,  you know, government agencies are covering it for some transgender patients.  Obviously veterans have really good coverage, so.

Okay. 

Tim Norton: Yeah. Okay. Well that all, so those are really the options that you're seeing. 

 Dr. Max McCullen Medically. That's pretty much what we're talking about.  there's other people who have talked about,   PRP treatment, which would be platelet rich plasma. Essentially what they're doing is they're [00:42:00] taking healthy cells from other areas, putting that into the penis.

 and then what I guess pretty much what my understanding is of that is that the healthy cells kind of teach the, the unhealthy cells or start to replicate more healthy cells. Now, I guess what that could do is improve. I guess, if you have epithelial damage, meaning that the lining of your arteries, maybe it could help heal that, which would help you.

Like, if you had some sort of atherosclerotic plaque, it would maybe diminish that. So then you could get, I don't know. I mean, I'm just saying what would be the applications. I know they're using it for like knees and elbows and stuff like that. So maybe there's an application in the penis again, like when we're talking about there's all these different ways of.

Getting to ed. And so you would have to, it would have to work on a certain, certain patient type that it would help. Like for instance, if he has low testosterone, that's not going to help. Right. [00:43:00] It would have to be one of these, the other 

Tim Norton: things. Okay. And then you would actually, I think. I think it was you.

And we talked about this once before,  those over the counter, the other ones that like seven 

 Dr. Max McCullen 11. So yeah, I've done a little bit of research on that and these are,  medical, I'm sorry. They're herbal options. So, so again, let's go back to what we talked about. 50% of men are getting to go on Viagra. Well, that's an option for these guys and one of the most powerful components of, of these,  pills that.

Are sold over the counter is yohimbe B route and it has a really amazing reaction. I've tried it. I had a strong erection for a couple of days. It went down, but like any of the wind would blow it. I think got up again. It was much stronger than PD five inhibitors. Huh? You can buy them at seven 11 now.  And I think they're like couple more called rhino.

There's one called black Mamba. They're very, they're small [00:44:00] pills. There's one. And they have really colorful,  packaging. They're behind the counter. If he asked the guy,  you know, what do you have for, to get men going? Or if I kind of make my arm go up, like on erection and they using it, if the guy speaks Spanish or whatever, he'll know what I'm talking about.

Now, there are about 12 to 15 bucks a piece. So that's probably around that. The cost, maybe a little bit less of what you'd pay for Viagra, definitely more than what you would pay for the generic sildenafil, but they work. And I remember you and I talked about that. So that's an option for people. And I think,  some men are like a little bit afraid to take something over the counter.

Obviously we know when we take medications like Viagra, it's FDA approved. So we know it's gone through that process. Now, these haven't because they're verbal, so they don't have to.  but you know, yeah. You don't know what you're getting.  but,  there's a reason that every one of these liquor stores and everyone has seven Eleven's has these things because they [00:45:00] work.

Okay. 

Tim Norton: So that's an option as well. Absolutely. Okay. Well, that's really interesting. And we started to touch on this earlier regarding all of the different things that have to be working on the same page in order for erections to occur. Right. And that speaks a lot to just general male sexuality, right? And, and performance anxiety.

And, and you said something to me when we were talking about this over lunch and how in our society, we really equate erections with intimacy. Yes. And maybe that's not the best path to travel down, but can you just speak a little bit more about 

 Dr. Max McCullen that? I think that men, and I don't know if it's, you know, strictly.

Adhered to, to this country or whatever, but we are socialized to equate our sexual prowess with erection. And not only that, but, [00:46:00] you know,  maybe porno style, vaginal penetration. I think that's kind of a lot of how we, a lot of us get our first. Sexual education from watching pornography. And that is not sexual intimacy to me.

I think that that's the wrong message to send. I think that you can have a wonderful sex life without that type of, you know, let's say aggressive vaginal penetration, you know, in and out, in and out aggressively. I think that a partial erection is. Great. You can still have sex. You can have amazing intimacy.

And that's just as important as, as any other type of sexual expression. Right. There's not one better than the other. So I think again,  yeah, I'm glad you brought that up because I think we need to give ourselves a break. We need to realize that we don't have to have these certain types of erections to have a great sex life.

There are things to help us now. And as long as we feel that we're [00:47:00] having intimacy with our partner,  that's really the goal. It's not, Y I see vaginal penetration, obviously there's other types of penetration for other partners, other partners. Right. So I don't, I don't, I don't want to strictly say that, you know, confined it to that, but yeah, it's not, it's not about penetrating.

Any anything and having, you know, an erection to do so we can express ourselves sexually.  without that norm that we've been socialized to, to feel is, is,  what it means to be a man sexually. 

Tim Norton: Okay. Well set. And I'm found myself curious, have you ever heard of urologists say something like that to somebody 

 Dr. Max McCullen or, or, and, and I, and I think the follow-up is, is an issue.

And I think that.  there's a huge psychogenic component to, to all this what we're talking about. And maybe that's something that we can talk about, you know, in another, [00:48:00] another discussion, but 100%, if you are anxiety ridden, okay. That changes your, your Vasso.  constriction your vassal dilation, your all the way, the blood flows through your body and that's gonna affect how you perform.

So there's a huge part of it. That's psychological.  and as you mentioned earlier, you know, there's so many different moving parts that we don't know which one actually causes what, right. So that should always be an adjunct part of therapy and urologists don't bring that up.   one of the things that I try and.

Talk to endocrinologists about is the fact that diabetes affects like three components out of that five tiered system that I talked about. Diabetes affects your hormonal output. It affects your, your nerve innervation and it affects your vasculature. Andrew cardiologists who generally treat [00:49:00] diabetes, don't even bring up erectile dysfunction to these guys.

Studies have shown that,  as you improve erectile dysfunction, those men are more likely to make lifestyle changes, which saves their lives improve. Right? Cause so once they're having sex, their sugars go down as a corollary system, they're now endocrinologist should mention erectile dysfunction to diabetics and they should mention the fact that they should have a psychogenic.

Therapy therapeutic part of that. Right. So I think they should, that should be a part of that because study after study has shown that those particular men, when their ed becomes better, Their life expectancy goes up, their sugars go down. Their depressive symptoms are reduced because they're getting laid.

So like, you know, if, if you're, if you can't have sex, it's like maybe why would I give up cigarettes? Why would I not eat what I want to eat? But, Oh, wait, I can have, I can start [00:50:00] having sex again. Yeah. Maybe I will lose that extra 10 pounds. Maybe I will start working out. And so I think a hundred percent that doctors should, should.

To,  refer them to somebody like you and also say, Hey, let's, let's also treat your ed while we're at it. 

Tim Norton: Absolutely. Huh? I it's again, shocking to learn when yet another field of doctors isn't, isn't talking about sex. Anytime I've ever gone on to Google scholar and looked at, okay, what's the latest on erectile dysfunction literature.

It's never more than three or four down before. There's a mention of diabetes. Like it's always, you know, that's where a lot of the research is going. So somewhere in there that they're, they're not reading their Gemma or they're just. Not the taboo. They're not bringing it up in there, but it's, it's a really common side 

 Dr. Max McCullen effect.

Th th that they're busy, right? These doctors are seeing a lot of patients. Ed is a long conversation. That's why a lot of the doctors bring in somebody like me, because they'll go, Hey, I'm going to bring in Maxis and erectile dysfunction. He's he's, he's an [00:51:00] ed specialist. And I can sit there with the guy for a half an hour, because there's so many different questions.

The doctors, a lot of times they don't have time. A, these endos, they're not paid to treat ed. They're paid to give the gut to get the guy's sugars down. Cause that's going to save his life right after that. He's like I got 25 people in my waiting room. I can't sit here for 20 minutes and discuss your sex life.

Is it that they don't care? Is it that they're too busy? Is it that they're not paid for it? Those are all things we can discuss, but the fact is is that you just nailed it. They're not, they're not having that car. Okay. For whatever reason, regardless of the reason. 

Tim Norton: Yeah. Okay. Okay. Well, gosh, this has been such a fun conversation.

Yes. 

 Dr. Max McCullen And I think we just barely hit the tip. Yeah. Iceberg. Yeah. So, 

Tim Norton: so we'll,  thank you so much for your time. I loved it. Yeah, and I hope to run into you out in the field soon and absolutely having hard 

 Dr. Max McCullen conversations. All right, Tim, I'll talk to you.

Shout outs to the sex, positive community, colluding sex educators, sex therapists, sex coaches, other fellow sex, podcasters, [00:53:00] sex, surrogates academics, sexual health, medical community, sex workers. The tantric community and everybody else involved with having hard conversation. .

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.

Mindfulness, Sexuality, and Erectile Function with Giselle Jones, LCSW

About the Episode

In this episode, Tim speaks with Giselle Jones, LCSW, a sex therapist, mindfulness facilitator, and yoga instructor about how mindful awareness transforms desire, arousal, and erectile functioning. They discuss the physiology of presence, the cost of sexual shame, and how couples can rebuild connection by slowing down and learning to feel again.

Key Themes

• How mindfulness shifts desire and arousal during sex

• Why many sexual struggles are relational, not mechanical

• The role of sexual shame in erectile difficulties

• How mindfulness disrupts self-criticism and performance anxiety

• The upside and limits of medications like Viagra

• Why couples therapy can be essential for long-term erotic change

• How mindfulness helps men reconnect to sensation, presence, and pleasure

Listen to the Episode

Listen Now

Giselle Jones

Giselle Jones, LCSW is a sex therapist, Certified Mindfulness Facilitator (UCLA MARC), and yoga instructor. A former actor and educator, she blends clinical skill, embodiment, and meditation-based approaches to help clients understand their sexual patterns with compassion and clarity. Her work centers emotional regulation, sexual agency, and relational healing.

Website: https://www.gisellejones.com

Psychology Today:https://www.psychologytoday.com/us/therapists/giselle-l-jones-los-angeles-ca/280916

Episode Transcript

Tim Norton: Hello, and welcome to hard conversations. Very excited today for my first guest. Jazelle Jones, Canadian born of Jamaican immigrants. Did her undergrad work at the university of Western Ontario. She's a former actor and educator first director of education for get lit words, ignite youth literacy program.

She's an LCSW certified yoga instructor, certified sex addiction therapist, candidate, and certified [00:01:00] mindfulness facilitator.  through the Marc awareness research center outside via UCLA inside of UCLA. Did I get all of that? Yeah, that's pretty good. Thank you so much for joining me today.

Giselle Jones: Hi, nice to be here. 

Tim Norton: Yeah. So erectile disorder or erectile issues, erectile dysfunction. How do you feel about the name of erectile dysfunction? 

Giselle Jones:  It's it's the, the biggest umbrella. I think we have for, but it is a little shaming. I would, I would think for most people experiencing it.  but that's, that's what we use.

That's why I like just saying ed, once we get around what it means, but yes. Yeah. Erectile issues, I think is a much more pleasant and inclusive. 

Tim Norton: Right. I th I think it changes. Cause we used to say impotence. Yeah, back in the day. That sounds awful. So I'm [00:02:00] sure it'll be something different in a few years. So client calls, you sets up an appointment comes in.

What are the first steps? What what's, what happens in the beginning of the 

Giselle Jones: session? Well, one of the first things I would do is actually just find out what's going on because. There may not be as much of a problem as they think there is.  and there might have be in the range of normal functioning and not even know it,  because they may be, they're just exposed to porn or maybe they're exposed to other media and it's, they don't realize that they're actually fine, but I would, I would have them, if there seems to be an actual issue, I would have them check in with their doctor or their urologist first to rule out. And maybe even before coming in, but certainly after the first session to just rule out any medical, any physiological issues first, because then we know what we're dealing with and I can help them.

And I don't know if we mentioned, I work in private practice here in Los Angeles [00:03:00] as a psychotherapist. And I F I do all sorts of issues, but I do focus on sexual issues for both men, women, and couples. And so that's. One of the, one of the things I come across frequently is someone coming in for this, or even coming in as a couple, they often come in for a couple, if there's an erectile dysfunction issue.

Good. Yeah. Yeah. Some of the things I just wanted to say that they might want to rule out, going to a doctor could be. Anything from hypertension.  the hypertension itself can lead to arterial hardening or,  the blood pressure medication, any beta blocker medication, which would be usually something that would be given for blood pressure.

They can, that can impede performance as well.  what else? Any artery hardening at all, a theory or sclerosis that can decrease the blood supply, going to the penis. And that's, you know, an obviously a functional issue that you need to deal with first, before coming in for therapy [00:04:00] on it.  also what's really important to note and not a lot of people know is,  diabetics can often have this as one of the early signs of diabetes and,  because of hardening veins and.

 nerve,  neuropathy, when extremities start to kind of go numb that can include things like penile functioning. So it's often times that people will go in to get this checked out and you can go to your MD or even better urologist. And this is the first diagnosis they might have for something like.

Like hypertension or diabetes. So it's important to, to check it out first with a doctor for many, many reasons. And,  one of the other things that it could be that could be a medical issue is his physical trauma to the penis, which is not actually as, as common as people think it's, and it's not usually [00:05:00] sex related or from, you know, Getting hit in the groin.

It's actually from, it can be, it can be, I shouldn't say that, but it's more likely even though nerve trauma to the penis is, is, is rare for,  to be the reason for, for erectile dysfunction. But it could be something like cyclists, like that would be more likely than, than another kind of physical trauma, like cycling and perinatal damage from, from just riding a bike.

Okay. Yeah. 

Tim Norton: Okay. So rule all that out. Okay. I'm filling all that out, rule all that out. And if they say, Oh, I haven't done that yet. You'll get through the first session, but say, okay, you still should go see your doctor.  and, and I think,  I guess I'll put this in the beginning, but,  I should have said like how we know each other, like, so she works at the marks center.

[00:06:00] UCLA. What is the actual name of 

Giselle Jones: it? The Mark. Oh, that's where I was certified for my mindfulness,  teaching mindfulness, facilitation, Mark 

Tim Norton: MIRC. Yeah. And Jazelle. And I know each other, cause we're both sex therapists and I think we met at a training. Yeah, right at the center for healthy sex. 

Giselle Jones: And that's where I was working at the time as well for about two 

Tim Norton: years.

Yeah. We both have private practices.  in Los Angeles, you, you have an office in silver Lake. Yeah. As do I. And so, okay. So they rule everything out and then they actually have been to their urologist. And they're saying, look, you've got erections in the morning. And you sometimes get them throughout the day.

You're just not getting them during sex. So go back to your sex therapist and work on this. So, so where do you start after that? I know you're a big fan of mindfulness. So do you, do you introduce that really early on in the 

Giselle Jones: work? I will not introduce it right [00:07:00] away. I just want to start by saying for anyone that, that doesn't know, which could be a great deal of people, even though there's a lot of buzz around mindfulness right now.

 just what it is, mindfulness is. Yeah. It's a simple concept, but more difficult to implement sometimes then than you think it's a deliberate paying attention to the present moment or deliberate immersion in the present moment with non-judgment, which I think is kind of a tall order. So let's just say with as little judgment as possible,  and.

I like to add with, with self-compassion. So just what you just took a sip of water, for example. So be having a really mindful moment would be feeling the glass in your hand, the coolness of it, the weight of it. As you lifted up to your lips, the anticipation in your mouth, what happens? Do you salivate as you're ready to put it on your, on your mouth and then what is it like when it first hits your mouth, your throat, your belly?

 what's it like to put it back down? All of those [00:08:00] are kind of. Radically putting ourselves in the present moment. And what mindfulness is is good for is, you know, it's, it's, there's a lot of correlated. Yeah. Studies right now that say the more that we pay attention to the present moment, the less we're kind of perseverating about the past, even though we need to pay attention to the past to learn things.

But when we get stuck in the past, we can tend towards some more. Depressive symptoms sometimes or feelings. And if we kind of get future tripping too much, we can come to get a little more anxious. So there, we're just saying that when you spend as much time as possible in the present moment, it can actually just enhance your wellbeing as well as deal with much larger issues like depression, anxiety,  stress trauma.

And I think in my opinion, that. Erectile dysfunction, ed erectile issues [00:09:00] can be largely, largely linked to anxiety, particularly,  but certainly trauma as well, a lot of things. So to, to heighten that strength to get your body and your mind in the present moment can be a great thing.  But to answer your question.

No, I do not introduce it immediately. I might let them know what it is and that it's something that I'd like us to explore depending on how they might have a practice already. I mean, these are ancient practices that go, go back centuries, at least as far as the far East. And so they may have a practice already and be keen and open to it.

And maybe I will launch in and just do. Sitting breathing meditation or something like that, but more than, than not the first session, I'll be looking into what their concept of, of the problem is. And again, maybe there's a level of functioning that, that the person might. I think it's a problem when it might not be as big a problem as they, as they think it is, but it's [00:10:00] how they view it.

And 

Tim Norton: you might be saying, so by level of functioning, you mean that they get erections nine times out of 10 and then they're really harping on the 10th time or? Yes, exactly. Exactly. Yeah. 

Giselle Jones: Yeah. But, you know, it's still a problem for them, so there's always chance to enhance performance, but it might not be as devastatingly out of the norm as they think.

I think it is right. 

Tim Norton: It can be really nice to hear, Hey, you're fine. Penises. Aren't supposed to. Work 100% of the times written not even work is the wrong word, but it's not like I was just reading this chapter in a book and they were talking about how it has to be a hard erection on demand as if males are designed to just being like at the drop of a hat and.

They have to be turned on. They have to be in the mood. They can't be, like you said, mindful, they can't be [00:11:00] stressed about the past, about their Workday, about their career. 

Giselle Jones: So exactly. And we spend a lot of time.  I still not enough, but a lot of time focusing on the issues around the psychological issues around and emotional issues around female,  desire and performance, if you want to call it that, but.

Not as much on the male performance, there is that cultural assumption that men do perform on demand. And we have to have a lot of compassion for that. That's a lot of pressure. And like you said, if there's other things going on that are affecting stress levels or even self-esteem, that can play a huge part.

And,  of course there are things as we get older as well,  But before you're running for, for the meds, I think it's a good thing to explore. Like just reevaluating your relationship with your body and mind.  so first session to get back to that, I would probably be [00:12:00] evaluated then one with their, their view of the issue is, but also what their history is there, their sexual history, but also their family, family history,  their experiential history.

So. What just emotionally, even, and what the role was in the family. And sometimes people,  men are not expecting such a traditional approach to the therapy. They just want like, okay, what are the exercises I need to do? And you know, or the pill I need to take or what what's, how can I just. Get rid of this or fix this, and they're not as willing to look into these things.

And so sometimes I have to normalize that part of the process as well, and talk about how that can be related because that can be often confusing.  cause they're like I came to a sex therapist. I would have just come to a regular therapist as like, well, surprise and we're still therapists, therapists, or just [00:13:00] therapists that are willing and able to talk.

About and explore and focus at least partially on, on sexuality, because not everyone is comfortable with that, but it is, you know, we still endorse the psychological process because that's. It's it's critical to some of this. So going through, you know, what the family was like, how I guess affection was expressed in the family.

 praise, success.  what was your role? Like? Are you the favored one? Were you the acting out child? Were you the silent one?  but certainly what were the conversations around sex and sexuality if they existed or didn't in the household? What was it like when you, if you were discovered masturbating by a parent, how was it treated?

 or were they the ones that encouraged you to do it?  yeah, first, first experiences dating and sexually and. Even presets sexual [00:14:00] activity and romantic activity, and just looking for anything that seems to be charged for them and to bring, or maybe they, they downplay it, but you're, you're like really, that seems like a pretty shaming experience.

It was no big deal for you. And just to see where they might have been, you know, caught up. 

Tim Norton: Yeah. But so when a guy is concerned about. Okay. Is there something wrong with me, right. I, why can't I adjust? Take Viagra and sail off into the sunset. Like why it's hard to talk about those things. Like why, why do I want to go and talk about,  what happened to me when I was 16 or six?

 why? 

Giselle Jones: Yeah, exactly. And, and why do I want to talk about these things and why do I want to talk about these things with a woman? Sometimes they'll come in and just say, okay, this person's going to give me a, B and C, but why am I getting this exposed?  it, it. It can be uncomfortable. I've definitely had clients [00:15:00] not be able to handle it,  especially early on in the process and just feel uncomfortable.

I completely honor that and can, you know, refer them to people such as yourself that that might be it. That might be,  it might be more aligned with,  or feel like they could be so, but why talk about it?  silence, as you know, can be. Just a great predator of so many dysfunctions in our life. And,  the unspoken can, it lives in us.

It lives in our body and the body. The body knows like the book, the body keeps the score or the body remembers,  something that perhaps. Seems insignificant, just say you're with a lover and they, they say something a certain way that brings you back. You might not even know, remember why consciously, why you're having such a strong reaction or a trigger.

As we say to, to that particular, you know, that [00:16:00] particular constellation of events or words or, or touch or whatever it is, and it can trigger something that you don't even. Consciously know about, and sometimes going back there. In, in therapy, the therapist, our job is to notice as you're recounting these things and just to say, Oh, wow.

It seems like you kind of just shut down there, or it seems like you got a little agitated or is there a reason that you really don't want to talk about this as it seem. Why do you think it seems uncomfortable and to maybe go into it, to lean into it gently. Now this is not something I would do in a first session.

So you're like, I don't wanna go to her. That sounds like torture because you know, the first couple of sessions are also about making the client comfortable with us and building that Alliance and building that trust and to move too quickly or to tell the person what their process should be, or is. When they are the expert on themselves, I never want to come across, like I'm the expert on the person.

[00:17:00] So I'm just there to notice and to guide and maybe to bring some curiosity to certain things at the beginning and. I think it does help and make people's anxiety go down when you give them something tangible. So I might give them something to read some bibliotherapy,  like you have this book, male sexual health hair, but I might give them something like,  coping with erectile dysfunction by,  that's a McCarthy.

Yeah.  or. Earlier than not maybe start them on after the first one or two sessions, start them on some, some exercises, mindfulness exercises.  now mindfulness as it, as a practice. Cause they were like, okay. Being paying attention to the present moment. How do you do that? I kind of briefly mentioned a sitting meditation or a breathing meditation.

 things, there are lots of apps out there now that can help with this, but I might start someone with, [00:18:00] cause I don't know what kind of trauma they have. So to bring someone deeply into their body, even into their breath for too long, might be like their feeling of their breath. When I say breath, it's the feeling of the breath near body at your belly or your chest, or even at the opening of it, your nostrils.

I tend not to dive too deeply or certainly give them. And out to say, you know, let me know if you want to end or it's uncomfortable, or just use this word because I don't know what it's like to be in their body. And they may be having these issues because they, they. Don't want to be in touch with their body that deeply, because it's not safe, it doesn't feel safe or it doesn't feel comfortable.

So I want to make sure that maybe it's a sound meditation to start or just feeling yeah. And their feet on the floor.  but if it doesn't feel like a, a major problem, it might be, I might start with a simple breath meditation. And what that does is it brings your mind into something. So when I say meditation and [00:19:00] mindfulness, We don't mean clear your mind, sitting on a mountain top, you know, levitating it's it's.

That would be cool. But,  with the limitations of our society and having to live in it, it's about putting something, focusing on something specific that's real and happening right now. Yeah. Well, 

Tim Norton: when you pointed out me taking that drink of water, it's like, she's a great mindfulness instructor because you.

Honed right into the sensations of the glass and tasting it and everything. And 

Giselle Jones: I, yeah. Yeah. And if you're paying attention to that, you're not really paying attention to all of the thoughts in that moment or you're giving it competition. Certainly the thoughts that can really dominate,  And, and, you know, I'm not good enough or I don't, haven't done enough today or the boss is out to get me, or I owe people money or, you know, my girlfriend boyfriend, you know, or is, is, [00:20:00] you know, mad at me are going to find me out, are going to leave me because of that.

All of that can kind of be backburnered for a little bit. When you, when you're focused on something that's actually happening, it's a lot easier to do that.  and to focus on something physical or. Or something you can sense with your senses, any of your five senses in the moment, rather than using your mind to combat your mind, to be like, get out of there, thought that's a lot harder than to say, Ooh, cool glass in my hand for a moment that is.

Commanded all of your attention. 

Tim Norton: And then you're, I'm assuming you're generalizing. Okay. So see what we just did with the glass. Now we want you to do that with your partner's body. I want you to do that with the present moment and the things that you like about the tactile. Aspects of sex? 

Giselle Jones: Absolutely. So what I would do probably first, unless it's couples coming in together, which they might,  I would have person do an individual,  practice at first, [00:21:00] just like a body scan, which I'll do a brief one with us in a bit, if you don't mind.

Sure.  a body scan,  a couple times a week or whenever they can get to it, it's a really hard thing for people to. Get to the coming and just feel ashamed or dismissive of it because they didn't get to it. But,  just having a practice of their own body and breath awareness, and then kind of bringing that awareness to a partner.

So mindfulness, as you said with a partner is,  we call it sensate focus. There are a lot of,  Ways you could describe it, but sensate focus therapy pretty much encompasses this. And what that is is basically interpersonal physical mindfulness activity, where one person radically receives and the other person radically explorers, you can say gifts, but that puts a little bit of a, an agenda on it.

And, and basically you are reclaiming intimacy in that [00:22:00] exercise without. Without agenda that I really want to stress without agenda. So normally when we have sex,  a lot of us tend to. Think about the reciprocity, like either, how am I performing right now or when someone's doing something to you? Okay, well, how am I going to do this back to them?

Or you're not really just focusing on the sensation that you're, you're feeling. Some people are better at this than others. You know, I definitely struggled with this. Myself is one of the reasons I'm in this. One of the many reasons I'm in this work, but that, that can be,  something that's really challenging and get people in their heads.

Performance-related anxiety. So to just know that right now, I'm just receiving and giving feedback to the other person and, or I'm just exploring right now. And there is no expectation. So to just broad, broadly to say what sensate focus is. It is an [00:23:00] exercise. I like to describe it as. Being like an alien, you're like an alien that's dropped to earth.

And this is the first time you've seen and into this body. First of all, for the first time, you're like transported into this really cool body with all of these senses in front of a human being, your first time, seeing another human being, this beautiful creature, how would you in a benevolent way,  explore that.

Explore that creature in front of you. Like how would you explore this person with touch with your fingertips, with the back of your hand, with smell, with taste.  and again, you're getting a,  a clearance from your partner about what's safe ahead of time, but what's, what's interesting about sensate focus as you take.

Sexual agenda off the table. And in fact, maybe in genital play is off the table for at least several sessions.  and you can clarify what genitals mean, but take that off the table so that, you know, [00:24:00] the, the, the temptation or the pressure to slide into that,  performance mode, even like a massage, you know, that, that.

That gets a little more formulaic. That's taken off the table and it's just exploring this person as if you're seeing them or a human being for the first time ever. And you don't say a lot and the person who's receiving,  gives feedback. They can use words, but they can also just use non-verbal feedback.

Like sounds moans. Like if something tickles, they can. You know, like they can, they can, you can say no with your body or with your voice or with your words, if something doesn't feel good,  or you don't want to be touched there or in that particular way. And let someone know if it feels good or neutral or whatever it is through your words and your, and your non-verbal activity.

And I also like to stress and not everyone does this, you do it on different nights. So the receiving person or days, or whenever you do it,  the receiving person is. [00:25:00] Receiving on Tuesday and the, and the next time you do it on a Thursday, you switch roles. So there still isn't that temptation to be like, okay, when I do it to them next, I'm going to do this.

It, it lessens that. 

Tim Norton: Okay, great. I ever heard sensate focus. Described so many times,  and trainings, and I love that so much that the alien metaphor and I love it. I love it. No, that's really good.  I'm going to back up to something you said a minute ago. We're I think, I dunno what it was, maybe just the way that you said it, but you were talking about how we.

Put a lot of pressures on males for, for performance anxiety. And it just the way that you've said it and your voice, I felt so validated and I'm not actually seeking treatment right now, but I, but it dawned on me in that moment, how nice that must be for men to [00:26:00] hear that from a woman, from a female therapist and the moment of, Hey, this is.

This is tough work. Sometimes we, we,  sometimes there's a lot of expectations.  do you, do you find that two guys respond well 

Giselle Jones: to that? I think a lot of them are, are greatly relieved by it. After the first, usually a couple minutes of them feeling kind of like, can we talk about this? Can I like, why not?

Because I'm so candid and sometimes overly. So like, it might be like, Oh, what kind of porn do you watch him? And then was like, what, what w what do you mean? I don't want to, you know what, and I'm like, Oh, I'm, you know what I might. So, you know what, we can ease into that as much as you are, as slowly as you'd like to.

Okay. I just want to let you know that I, I feel comfortable talking about it, so I will use, you know, and I'll use proper words for things, but I'm not, unless something's really offensive or I might have some curiosity about why they used a certain word for something.  I might. You know, I'm pretty open.

And like [00:27:00] people come to me for all sorts of things. People come to me too, open up their, their relationships or their marriages, or to explore polyamory or to, because I don't. Nothing really shocks me, you know? And the only thing I don't like is, you know, non-consensual activity pretty much. Yeah. 

Tim Norton: Okay. So, so it sounds like that could be a validating thing to explore and, and to hear,  from someone, Hey, that's I get it.

Is that that must be challenging for you. So 

Giselle Jones: yeah, a lot of men don't feel like they can talk of their space to talk about their issues because you know, for the same reason women have felt there wasn't space talk about their issues for a long time because there's, you know, people assume that, you know, men are men, male privilege, male men don't have as many problems or they have, you know, Their problems are not to be it's, it's a weak thing for men to share their problems, I guess, is another way of putting it that, [00:28:00]  you should be able to handle it.

And there it's a lot. It's a lot to handle the pressure of, of. Carrying the burden of initiating. And let's talk about like in a heteronormative,  situation,  it's initiating, dating or initiating. It's still out there it's much less than, than before, but the onus is on the male for that a lot. And,  I'd say in like the, the gay or the queer community, there's a different kind of pressure to always be, you know, And there's nothing wrong with wanting sex all the time with multiple partners, but there are a lot of men who are gay or who are in the queer community that do not necessarily want that.

And that's non that's. That's not the norm. So that's really difficult to talk about as well. So there are so many different pressures for men that you can have compassion on them, or you have compassion. The less people act in ways that that harm each other. So that's another way of looking at it. If people struggle [00:29:00] with saying, well, you know, They don't have the brand.

They have a lot of problems. There are so many men who, who struggle silently with sexual,  abuse or histories of sexual abuse as children, or even as adults for the first time. And don't feel like they have a space to report. They under report even even more than, than female fake temps. Yeah. Yeah. 

Tim Norton: Yeah.

Okay. So let's,  one of the reasons. I like working with erectile issues is there's it, it's a really easy,  easy thing to measure success. Like you're gonna be working with somebody with chronic depression and you never really know for sure. Like, Hey. Got a better job and, you know, did I do anything, but with erectile issues, it's, it's clear, you know, they come in next session.

 yay. And then something went really well. [00:30:00] So I, I want to ask if you, you know, you disguise the identity of your client, everything, but if you could re recall a success story or, or even just generally.  when therapy goes well for an erectile dysfunction client, like what, what does it look like? What are, what is the therapy or, you know, 

Giselle Jones: let me speak.

I really want to protect people that, you know, don't have,  having given clearance for me to share anything. So I'll just speak generally or making, maybe make an amalgam of a couple of clients. Okay.  so one of the things that's really helpful,  can be helpful is.  I mentioned really, really briefly porn is just checking in with like your consumption of porn.

And sometimes that along with some sort of mindfulness activity can really help, can help and they'll come back and they'll be like, you know what? After a couple of weeks, this, this, this worked and the w the, the relief and the [00:31:00] happiness and the, the sense of power that comes back to someone when they.

They and hope when they realize that they have, they can have control over this to some degree they can, they can shape this and they can do something that can help. And it doesn't have to be surgical or necessarily even,  medical, although it could be,  the relief and the empowerment I would say is the biggest thing that you see.

 what is one of the things I wanted to just,  Touch on because there can be so much resistance at the beginning to saying, how is this going to help me? But, Oh yes, this is one of the things I wanted to say is a practice. Like the practice of like, we might just start with the way that you're masturbating and I've had clients that.

Kind of avoid it because there's been such an issue. They actually will avoid engaging,  with even themselves. And there [00:32:00] can be a momentum that can happen. Like the more that they do it, the more they perform. And it's kind of counter-intuitive because you think you'd be building up all of this, you know, To be, to be crude juice, like building, building up, you know, your fire.

 but sometimes it's actually the use it or lose it. Like the more, the more you practice,  anything, but the more you practice masturbation, the more you practice,  intimacy with your partner, the, the, the more you. Bless you avoid, I guess there is a momentum that can happen. And that is one of the trends.

I think that I see more than anything that when you really dig in and you do you do it regularly, do the practice regularly. They're like, okay, they'll be like, okay, this came up this week, this came up this week. I couldn't practice because of this. I couldn't meditate because of this. I didn't, you know, engage with my partner because of this just life.

Right. Gets in the way. You'll see the functioning can go down. And then [00:33:00] when they're like, They get a little more time and space that they can give to it. It's the actual momentum of the practicing will, will help immensely. I mean, like it's almost scientific the way that the reports have come back. I haven't done a study, but it's, it's really consistent.

So yeah. Just know that if you do it once or twice, you're not expecting anything to happen, but that once or twice is, is part of a practice that over, you know, just say. A month or six weeks can actually make a difference that soon, or it could be longer. But,  and also maybe another thing that I've seen that gets people out of people's way is suppressed anger.

And that's where we talk about all of the stuff that's came before and that's going on now, when someone can actually express anger, maybe become less of a, a people pleaser and more of a leading more into there. Genuine yeses and nos with the people in their [00:34:00] lives that can actually open up the space because suppressed resentment and anger can actually be something that, that adds like a weight, like a weight on your penis.

Think of it that way. And then that might motivate you to, to explore it a little further. 

Tim Norton: And yeah, and it's, it's a it's fun homework, right? To assign,  masturbation as a homework assignment. I, you know, I always think of at the end of the day, like, Oh, I just signed two people to go home and masturbate and explore and, and get a new toy, get something like a Fleshlight or,  be like, you're saying, be mindful of.

Of their masturbation style and,  

Giselle Jones: the sensation in their whole body and not just focusing on the penis, it's a lot of pressure to just. You know, have that laser focus. Yeah. 

Tim Norton: You mentioned porn addiction earlier and porn, obviously there's a lot of [00:35:00] porn out there.  I think if you go onto the porn addiction websites, they'll say you got to stop altogether and, or you'll never have an erection again.

I mean, in so many words. So where do you, where do you stand on the whole porn as relating to the male sexuality? 

Giselle Jones: Yeah, that's a tricky, that's a tricky, tricky thing. And people get very defended. Sometimes, sometimes they don't care at all.  but sometimes they get very defended about,  just touching into their, their porn use at all.

And it's not, I think it's, it can be very normal and healthy for a lot of people. And for other people that are, have highly addictive personalities, it can really just be. And as an,  an escape from reality and in a deeper and more threatening way to their, to their healthy functioning as a sexual being.

So as I think maybe with all porn, but especially with heterosexual porn, it's just not realistic. So if you're, if you're really like. Attaching your [00:36:00] erotic template to something that can't happen and that can't happen in real life. And that's all you're watching and you're watching it a lot.  I don't know all of the neurological data on it, but you are changing your, your neurological makeup.

And the good news is it can change back, but,  you are changing it and you may find a real life situation, just not. No, you're not able to find arousal from it. So when I say assign,  masturbation homework, even if someone doesn't have, I think, a, an addictive problem with porn, which is, you know, it actually very common now and people who weren't didn't tend to other addictions can become addicted to porn because of all of those little,  bait clicks and things like that.

It's set up to deepen and deepen and deepen your. You're use and, and heightened what the intensity of what you need to see they to get off. But I [00:37:00] will say, can you use a picture and tell a story with like, you know, from a magazine, like a, it can be regular picture or it can be a porno, like a porn magazine.

That's fine, but it's still because your mind will slow down and allow the imagination to too. To move in and then maybe you don't even need the picture. Maybe just use your imagination. And then you're really in touch with what's going on in your body with, with anything like with TV, with most of screen stuff we check out like with kids and the speed at which they watch,   cartoons and things like that.

Now animation the real life can't compete with that. Even the, just, just the speed alone. So it's, it's a similar thing that I might ask them to just. You know, maybe tone it down. Like, I feel like I watch, you know, like two hours a day and I'm like, can you do like one hour, every three days, every two days.

 And give them other things to substitute. Like I said, like using a still picture or using toys [00:38:00] or using something that brings them into their body in a way,  that the mindfulness practice becomes part of their masturbation or part of their play. So they're, they're really in their bodies and less, less either checked out or in their heads.

Right? 

Tim Norton: No, that's,  two hours a day of masturbating to porn. And especially that can be a lot, especially if,  If you're going from screen to screen, to screen and from college gang bang to something kinkier and kinkier that isn't happening. I mean, Hey, if you're having college gang bangs all the time and your regular life, then, okay.

Yeah, you are, you're fine. And I mean, that's, that's, that's gonna be your erotic template, but a lot of people don't have access to that and that's not their sexual reality. So,  it, it. Stands to reason that it might be get hard. It might be difficult to get turned on by the one partner you've been seeing for the last five years,  that has a 

Giselle Jones: normal [00:39:00] body, their whole body, that 

Tim Norton: isn't right.

And, and, and she is not a sorority and she is not more like a changing person all the time.  and there's a, there's a big debate, you know, at some point, and we'll probably have an episode all about sex addiction or porn addiction, but just generally speaking. You know, for everybody who debates, whether or not it exists.

The one thing that we're all struck by is that there seems to be this development of tolerance. Yes. That that's what reminds us of addiction is Hey two beers. Isn't doing it for me anymore. I need three. And then eventually certain kind of drinker is drinking six, seven, eight, just, just going out. And we've seen that happen with porn.

Giselle Jones: Absolutely people lose time. People lose valuable time with,  people they'd rather be spending time with in real life, whether it's families or lovers or friends,  work. Yeah. They can actually get in trouble, major trouble at work if it's found on their computer, but just losing time [00:40:00] doing the things they should be doing at work and,  or just checking out more and more out of the real world and.

 there are, you know, you can develop like depression from that obesity. Different things can just, you can spiral into other different problems from that. But. The porn itself, just be conscious, be mindful during your use of porn because it's, it's often designed. I mean, they, that's how they made their money is to get you unconscious and to get your tolerance increasing to something that wasn't even on the radar for you, for your, for your template.

And there's nothing wrong with exploring, but then. Then, you know, like, boy, next door, girl, next door stuff. Isn't going to work for you anymore. Or, you know,  vanilla as we call it.  situations might not work for you. And as you said, if you have like a pretty intense community that you're in and you know, you, you have that, you know, safe access to BDSM practices and things like [00:41:00] that, then.

Yeah. Okay. But you probably don't need to watch that much more anyway, but yeah, just to make sure that you weren't checking out into something that's not. That's not attainable or accessible for you. There are people who will, you know, masturbate to porn or get hard with porn and then pull their partner in.

And that can, if that's something that you're doing together, but if something that you have, that's cool, I guess, for if that's cool for both of you, but if it's something that you, you have to do and you're your limit, you're limiting yourself and it will get harder and harder and harder for you to get hard.

 so. I think that something, that some people are very open and non defendant about checking in them. And some people are like, well, step off my porn lady, like, what are you doing? You know, they don't like it. Yeah. 

Tim Norton: There is that episode of South park where they lose the internet and they can't watch porn.

You see that and they [00:42:00] all go crazy 

Giselle Jones: the whole town. Great. It's really 

Tim Norton: fascinating.  Okay. Yeah. And then don't get me wrong where we're, I'm at least pro porn. And I know there's plenty of ways that it's going to enhance a relationship.  just like with anything, if you can't eat chocolate cake morning, noon, and night every day and not expect there not to be a ramification for that because you know, it's all about balance, man.

Yeah, exactly.  okay, good. So. What percentage of your case load, would you say at any given moment is guys who are struggling with erection issues? 

Giselle Jones:  I'd say because people are often daunted to go to a woman, it's pretty, you know, I'd say it's about maybe. 20% or maybe even 10%. Yeah. It's pretty, it's, it's not that high.

 but then people come in, you realize that it [00:43:00] might be part of it, but whether they knew it and they were couching it in something else to begin with, or it's part of a complex thing that a couple is going through and it's part of the whole constellation of what they're going through. And that's like, okay, now let's, let's touch on this.

 but I will say that some, there, there occasionally men. That will feel more comfortable coming to me. And yeah, I think part of it is there is not that, you know, that, that thing growing that whole Oedipal thing, that whole like male, male, male threat thing, like there's no competition here. I'm not performing in the same way that they are in any way.

So. They might feel less is, and this is not a sexual relationship, sexualized relationship.  well, it might be sexualized in, in their mind, but it's not in a sexual relationship, so there's a boundary there. So there is their safety,  That they will not be judging them in a certain way or they, they don't have to be [00:44:00] holding up themselves up to me is, you know,  as, as a comparative,  source.

Yeah. Or maybe they just felt a lot of compassion and from their mother and they didn't from their father, it might be that simple. And they might not even know why they prefer to talk to a woman about this, but some people do I'm here for you if you do. But if, if you do come in and you try and it just doesn't, it just.

Don't feel like you can open up or don't feel like you can talk about these things. I would not take offense at all. You know, I would definitely find I would process it and see if there's something there that we can work with. But if it's something that they just want to be, you know, facilitate just like someone's going to want to go to,  they, they want to know that the therapist is, is gay or queer or are.

Of a certain race or, you know, oftentimes it doesn't make a difference to people, but sometimes it does. So yeah. Yeah. 

Tim Norton: Hear you say that to remind me that sometimes that, that male, male tendency toward [00:45:00] competition can certainly be present in the room and that, you know, I have to make adjustments to language or just, you know, bring it up, just say, Hey, I know guys tend to compete.

 Do you know, do you, do you think about anything like that, is that interfering with your progress with being able to open up about stuff?  

Giselle Jones: it's really interesting. Yeah. Cause I always think about saying, are you comfortable talking to me as a woman, but I think that's awesome that you would say, are you comfortable talking to me as another man?

Sure. 

Tim Norton: And I would assume, I mean, I don't know your whole approach, but you're talking about that dynamic of why pick a female, you know, Are you processing some kind of mom thing, some kind of sister thing, is that getting worked out in these sessions? Could you speak a little bit more about that? Like how does that come up or play out or what does that even mean?

Giselle Jones:  yeah, that's a complex thing because you [00:46:00] know, some people are like, what do you mean? And I wouldn't necessarily say that to a client that that's. But I might say, do I remind you of anybody,  in, in your life and or how did you come across? You know, my,  how did you come to my doorstep? Like what brought you here?

And, you know, I've had people say, you know, you're you just remind me of. You know, they are white male who had a really, you know, hard upbringing and difficult family life and the black women in their community and black, by the way, the black women in their community,  you know, were really like nurturing to them or something like there or their friends or, you know, it could be that, or it could be,  I'm like a maternal or a sister kind of sisterly or auntie or whatever type of, type of a role for them.

And that might be someone from whom they felt very validated and also might be someone from whom they [00:47:00] are with whom they felt very, very invalidated so that they, they were shamed by. And,  it's what, you know, we call a corrective experience to be with. A woman or a woman of a certain demographic or age, or just, it might remind you of someone for just the non-obvious reason,  to have a good experience, to have a good kind, compassionate experience with someone that may even remind you of someone that you didn't have, that a core person in your life that you didn't have that with.

So sometimes you can see that there's something more going on then. Then the situation might obviously warrant. And you might say, you know, is there something more going on here or did I just remind you of someone or are I often will ask or not even that often I'll ask someone, how old do you feel right now?

And I try to say it in the least shaming way possible. Like how old are you right now? But they just know, I really mean like how [00:48:00] old do you feel right now? And it can sometimes shock people and be like, why, w w I don't know what you mean by that. And I might get a little more specific, like, but language seemed a little young that you use just then, did you feel like your age, or did you feel like in your body, do you feel like you might, it'd be like 14 or 20 or eight or two?

 and that's kind of a conversation that we can have too. And if you felt that way,  You know, is there anyone that I reminded you of in that moment or a situation that you were reminded of in that moment? And it might be something that might needs to unlock for them,  consciously or unconsciously to just talk about in a safe place or express an emotion more importantly, or a physical feeling emotions live in the body and express through the body first, in my opinion.

So if you have a tightness in your chest,  that could be. Anything, let's just say fear.  and we'll process that feeling first and then maybe we'll call it [00:49:00] identified as fear, or they'll identify it as fear of eventually, but to lean into it, first feelings that we avoid. 

Tim Norton: And I think that answer right there, you spoke earlier about how this is therapy.

Like, yes, I'm a sex therapist, but first and foremost, you're a therapist, we're therapists and talking about things like, you know, dynamics and who we represent as objects, as different roles and, and someone's lives and, and,  you know, different ages and regressions and things like that. We're, we're doing therapy and.

What's different, I think is we are more trained and more comfortable talking about sex. And, you know, technically all therapists should be talking about sex more often.  but, but you know, there's, that's been a gap in society, so there's jobs for people like you and me. And,  and that's. But, but we're therapists, but therapy is going to come up or, you know, some [00:50:00] sessions there, there are some periods of treatment where I'm not talking about sex much at all.

 and because we've got so much to work with around,  diff anxiety and indifferent issues and trauma and all of that, and, and. Try to remind someone that sex is a part of why they're there and let's get back to it and make sure we're not avoiding it.  but yeah, that's, that's that's 

Giselle Jones: therapy. Yeah.

Yeah, no, absolutely. Absolutely. That's that's why we do it. It's a little more complex than, than you might feel when you seek us out, but it's, it is therapy and, and. Hopefully this will open people's eyes a little bit more to what the process is like in the can have a little more patience and,  less trepidation going,  a little deeper with this kind of 

Tim Norton: work.

Yeah. And it's, I bet it was pretty good news that you said a few minutes ago. Sometimes it doesn't take very many sessions. Sometimes it really does. Yeah. Especially, you know, [00:51:00] If you've had success in the past, I think is, is a good sign. If it's just particular to this partner.  if you're younger sometimes too, you just, you need some, some training, some skills under your belt, and you need to be able to flush some things out with a professional and ask some hard questions.

 Yeah, it's certainly it's disappointing because you're like, Hey, we had just had success and Oh, by the way, 

Giselle Jones: I got what I need. And then there are other people that it's a little more convoluted. Like you said, maybe they haven't had any experience at all.  and or they haven't had any successes at all.

 but yeah, it can be pretty. Pretty speedy. Yeah. 

Tim Norton: So what are some things, or one thing, for example, that you find yourself explaining over and over again, that you sh you feel should be more common knowledge. You feel like more guys should know more guys should be taken [00:52:00] aside when they're going through puberty and said, this is how things work and just some basics.

That's 

Giselle Jones: okay. That's yeah, there's so many. I would think something like, well, one of the things I just that comes to mind is that pretty much, now everyone gets sex ed in school, but they don't get like sex ed on a relational level. And what it might feel like to,  explore for the first time and the, and the feelings that come up afterwards and what is normal and what isn't, and, you know, evacuating more quickly at first that might change all of these things.

Just what it's like to talk to somebody, talk to a potential partner about sex or talk to,  how you might feel afterwards. What is it like to,  achieve radical consent,  between partners,  even in the middle of an act?  I [00:53:00] think things like that need to be taught very, very young and. Because otherwise people are just getting their education from porn.

And that also is the relational part of that. That's, that's probably the most fake part of it is the relational part of what's happening in a lot of porn. And,  I think that's just really missing. I know,  sometimes my clients are like, yeah, I had sex ed, but if we just talked about STDs until it was like pretty.

Pretty gnarly. And then there's not even any, like, just like pleasure. Like people don't even talk about like how to seek and, and give yourself and ask for pleasure. Like, how do you talk about what you want? Like, no, not no one cause it's happening, but very few people are talking to their kids about, or their older children about,  teenagers about what.

What sex can be as far as a positive, beautiful thing. It's either just like here's some condoms be safe, whatever that means. And, [00:54:00]  you know, or just don't do it, or, you know, just a lot of deep conversations about the actual joy of sex, the pleasure of it. So those would be the two things that I would say are really missing early on.

Is how to, how to ask for the things that you want and also how to deal with relational issues, including,  the shifting nuance and, and nuanced animal that is consent.  that's a huge, huge thing. Hmm. Okay. I like that. Yeah. Boys and girls, men and women, and yeah. Good. 

Tim Norton: And. And you feel, I mean, that stuff's pretty obtainable out in the internets and books.

Any, any favorites that you have, or I don't know, films or anything that you go to that really like, I really like how they portrayed that. Or I have a trick question that I'm [00:55:00] hoping you have something, because what I find there's not enough example of like healthy or.  popular male sex role models out there that were like, Hey, you know, I really liked that intimate talk that they 

Giselle Jones: had.

Tim Norton: Right, right, right. Like, I, I can, I'm trying to think if I ever seen a movie where the guy really just asked for his sexual needs to get met in a really nice way that was. Blended into the plot and then didn't, you know, it wasn't just obviously, or an erotic 

Giselle Jones: movie. No, I'm struggling to think of one myself right now as well.

Tim Norton: so Hollywood, we need more of that guys. 

Giselle Jones: It's a really,  beautiful,  dual virginity last moment that I think of, and it might've even be horrible. It's from my childhood where I think of this one movie,  It was the first time I saw,  Helena, Bonham, Carter, [00:56:00] and Carrie always there in this movie called lady Jane.

It's like this nerdy, like,  English aristocracy movie. But,  it's about this, this young girl who was on the throne for nine days and then beheaded in real life and, you know, forced into a marriage, but how they actually find love in this, in this marriage. And it's one of the most like, Quirky awkward and tender love scenes.

There, there it's, that's both of their first times, I think,  to my knowledge and, but let me think of something contemporary. I'm not even sure. There's probably more fiction and books out there then. Right. Films. I've been 

Tim Norton: watching Atlanta and Oh, one thing I like awesome show. I don't know the. The couple talks necessarily about sex, but I really love their just intimacy while they're in bed.

I feel is really real. A very honest, yeah. It's it's like, Hey, I've had that conversation.  and I wish they would [00:57:00] delve into something along the lines of what we're talking about at some point. Yeah. That's a great job.  But, okay. So 

Giselle Jones: I want on that line, I would also like to see more,  healthy sexual representation among,  people of color as well.

 particularly with black males and black women and, and their partners.  that's under underrepresented and yeah. Hmm. Absolutely. 

Tim Norton: Absolutely. Okay. So you said you were going to lead us through a body scan? Yeah. 

Giselle Jones: Sure. Okay. Let's do it. So,  I just want you to sit. They don't have to change the way you're sitting, if you're lying down.

Cool. If you're sitting, if you're driving, just keep your eyes open and just, just feel the body parts as we go along, but don't get too lost in it. So. One thing I would like if you are sitting just to [00:58:00] really,  have your feet planted on the floor as opposed to dangling. So there's a grounded-ness with the earth and we might actually start there.

If you feel comfortable, you can, I'm not driving and you can lower your gaze or close your eyes entirely

and feed on the floor or maybe the whole back body or side body along a floor surface.  just start with taking,  just wait for it, but we're going to take three deep, more intentional breaths. If you can breathe in and out through your nostrils, if your nose isn't obscured, then I'm obstructed rather than you can,  use your nose.

Otherwise you breathe through your mouth. That's fine. So just deeply inhale and exhale. Just think the word soften in your head as you exhale. Again, deeply inhale, [00:59:00] exhale. Soften could be a jaw, your chin nose, deeply inhale, exhale, soften, shoulders, fingers, toes, and just allowing your breath to return to whatever its natural state is right now.

Just be aware that you have feet and you know, you have feed right now that your eyes are closed by the pressure of your feet on the ground, feeling the difference between the base of your feet and the tops of your feet. So the souls, the tops of your feet, and almost like drawing your attention up your body, like, like a spiral spiraling in and out.

Your inner ankle, outer ankle spiraling, upwards along your shins and calves to your knees. And we're just noticing right now, I'm moving kind of [01:00:00] quickly more quickly than I might, but just noticing areas of tension without needing to change anything. That's part of mindfulness, acceptance for things as they are.

And. Just noticing what feels tight, warm cold in the noticing things may change. Things may be release. Things could actually get more uncomfortable first, but just noticing even colors might come up for you or associations. If your mind drifts, just bring yourself gently back, gently, gently, gently, like letting go of a balloon and then bringing yourself back.

Your knee caps, the backs of your knees, spiraling up your inner outer thighs, strong muscle groups of your thighs. If you feel comfortable and safe, you might just rest your awareness for a moment. And the bowl of your pelvis, almost like your pelvis is a bowl and your awareness is just like milk pouring into [01:01:00] a bowl, filling it up.

And I'm not going to linger there too much right now and not knowing what your experience is, but you're bringing your attention to your lower abdomen. This might be an area where we might pause for a second and do one of more of those more deep, intentional breath. Steeply inhale with me. Exhale,

just noticing. What's able and willing to soften might do so, but just noticing for now your middle upper abdomen, solar plexus, just drawing your attention to your rib cage, your mighty rib cage, and just imagining you can, you can notice or sense the skin, the muscle, the bone, the delicate tissue underneath.

[01:02:00] Housing your heart, the powerful muscular organ of your heart. Also very, very tender and vulnerable at the same time. And with your intention, with your attention on your heart, perhaps bringing one of those more intentional breaths in again, deeply inhale, exhale, soften. Your shoulders and back down your shoulder blades, almost deaf as if too gentle, warm, benevolent hands are resting on your upper back on your shoulder blades.

See if anything softens there or just, just drops down and micro millimeter, even down your middle, back, lower back, noticing what feels tight, what feels tense, what feels positive? Negative. Neutral your fingertips, palms of your [01:03:00] hands, backs of your hands. Spiraling your attention up your wrists, forearms inner outer elbow, your biceps triceps, armpits, back up to your shoulders.

And just drawing your attention. This is just like shining a little light. Like someone's just shining a little flashlight inside your body. Again, there's a temptation to, to judge where you are sometimes just noticing as it is without needing to change it. Something changes. Cool. If it doesn't absolutely cool.

The back of your neck, sometimes our back body seemed a little more vulnerable. The area that we can't see. The back of your head, almost like combing your attention, like fingers up the back of your head. If you have hair like combing all the way up to the top of your head, dropping down your attention, dropping your attention down to your temples [01:04:00] across your forehead.

And again, imagine if somebody had a nice warm hand on your forehead, would it be all tense and scrunched up? Would it be soft and pliable? Drawing your attention down to your eye sockets. Are your eyes straining to see even with your eyes closed or lowered or they resting a little more softened back, back in their sockets, just noticing down the bridge of your nose, almost like skiing down a slope, drawing your attention down the bridge of your nose to your lips.

Tongue jaw. All of that can be connected. Lips, tongue, jaw, nose can even be connected down to your neck and shoulders, but kind of resting for a moment at your throat, a very vulnerable, powerful seat of the body where the voice manifests, but also a very vulnerable part, right by your windpipe [01:05:00] and drawing your attention back down.

And maybe we will just stop. Again, in our chest heart center, deep breath in and out.

And when you feel comfortable, you can just gently, gently blink your eyes open. And again, if you hear any sounds, we've got some sounds here in the background. That's all part of the experience. Just noticing. Okay. Noticing sound hearing, and then bringing yourself back when that's less compelling. To the feeling in your body and what it's like to have just given yourself a little attention, given yourself a little time in.

Yeah. Thank you for joining me for that. Thank you. 

Tim Norton: You're welcome. And I I'm really glad that we had a chance to do that because I [01:06:00] feel like that could be a really powerful tool.  when you. If, if a listener you were sitting there and you notice tension in every inch of your body,  Might not be the best,  circumstances by which to obtain an erection.

There's it doesn't sound like you're ready to have sex. It sounds like you're, you're ready to fight or you're ready to run away somewhere.  so.  thanks for leading us through that. 

Giselle Jones: Absolutely. As I would get more and more working with someone, I might, you know, we bring compassion to the parts that are, as opposed to like let's, let's muscle, our way out of this.

Let's bring compassion to those parts that are struggling inside of us. And,  Get more honed in, on, on the meditation, but that was a really general body scan. And I'm glad that we had a distraction as well, because sometimes people are like, I can't practice these things cause I've got kids in the house [01:07:00] or I've got this or I've got that, or I don't have it.

It's all part of it. We can't escape the chaos of our lives. So when you have chaotic things happening around you,  it's a great thing to just include it in the practice. I noticed this, I noticed that kid on what sounded like a skateboard or something out there. And as opposed to like, Oh no, now we've ruined this part of the podcast.

It's like, no, it's just included it's reality. Then that's what it is. That's what we're doing. Right. Paying attention to real things that are happening right now. Right? 

Tim Norton: Right. And that's, that's so different than,  a mindfulness meditation that asks you to clear your head, to imagine being on top of a mountain.

 that's why I really loved your example of me reaching for the water. Again, you're, you're paying attention to everything that's happening right here right now. Everything 

Giselle Jones: is an opportunity. Right. 

Tim Norton: Right.  and I don't know if the microphones would have picked up the, the noisy kids that were just outside the studio, but maybe they did.

 but yeah, there was a, there was a bang,  and,  but  [01:08:00] let us ride through that. Yeah. But you'll have your distract, so yeah. Well, anything else for the guys out there or anything else you wanted to say about.  Jazelle jones.com. That's with two L's. 

Giselle Jones: Yes. If you like, look me up my practice, both my therapy practice and my mindfulness offerings are on,  Jazelle jones.com, G I S E L L E J O N E s.com.

And I'll be happy to answer questions if you have, and you want to contact me through there, but it's just, it's really been a pleasure. I love that you've created this because this is an amazing opportunity to. Have dialogue already sex is a dialogue we don't necessarily have and in healthy ways and realistic ways.

And, and this is. A sub, you know, a sub, a sub subject of that that's even more in the shadows. So, yeah. Thanks for shining a little light on it. 

Tim Norton: Absolutely. Yeah. Thank you so much for, for coming and I, I hope [01:09:00] that,   hope to see you out in the field. Hope to do more stuff like this. This is great.  yeah.

Thanks for being on the show. 

Giselle Jones: My pleasure. Have a good one. Thank you. 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.