TODAY'S GUEST: Robert Nicholson, founder of edtreatment.info

I'm extremely happy to welcome Robert Nicholson to Hard Conversations!

Robert Nicholson is a successful Silicon Valley entrepreneur with many years experience building Internet and technology companies. He developed erectile dysfunction following prostate removal surgery and has become very active in spreading awareness about how men can get help with their sexual functioning post-prostatectomy. He is the President and Senior Editor of EDtreatment.info

• WEBSITE:

  https://edtreatment.info/

YOU'LL LEARN

• All about the website edinfo.org

• Tips on various erectile dysfunction treatments for aging males

• Tips on various post-prostatectomy erectile dysfunction treatments

• The experience of going through prostate cancer

• The experience of having erectile dysfunction following prostatectomy

• The importance of letting go of sexual shame

• Misinformation from uninformed doctors is detrimental

• Dissatisfaction rates regarding helpfulness of medical professionals for post-surgical sexuality

• That there is hope

• Information about penile implants

• Information about penile injections

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

To get more hard conversations sent directly to your device as episodes become available, you can subscribe on iTunes or Stitcher!

Also, reviews on iTunes are extremely helpful and greatly appreciated! I read each and every one of them, and feel free to share your URL there so I can contact you later on and say thanks!

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

About the Show

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

YOUR online sex therapy and couple’s therapy HOST:

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

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

Hard Conversations Podcast Transcript

Tim Norton: Hello, and welcome to Hard Conversations. My next guest. Robert Nicholson is a Silicone Valley entrepreneur with many years experience building online companies and websites. He is the co-founder and president of the ed treatment information center. That's ed treatment.info, a website with a focus on posting authoritative and scientifically validated information on the causes, treatment and impact of erectile dysfunction.

His previous ventures in the online medical information space include drug [00:01:00] ratingz.com and therapistratingz.com. Those are both spelled with a Z. He was also an advisor for the website rate mds.com. He has a master's degree in computer engineering from Stanford university and a bachelor's degree in computer science from California state university Chico.

Robert is currently undergoing treatment for ed following a radical prostatectomy. Hello, Robert, and welcome to hard conversations. And thank you so much for coming on the show today. 

Robert Nicholson: Thank you for inviting me. 

Tim Norton: Yeah. So I just kind of read through your bio, but why don't you also just tell us a little bit about yourself and what inspired you to start,  ed treatment.info.

Robert Nicholson: Well, Tim, it's been kind of a long personal journey for me.  like a lot of men, I was first diagnosed with erectile dysfunction when I was in my mid forties and for a long time prescription [00:02:00] medications, like my agro or Cialis or effective, and allowed me to have a normal sex life.  but when I was 60, I was diagnosed with prostate cancer.

And I eventually had my prostate removed,  by an excellent surgeon,  Dr. Jonathan, he, Andy at the Sutter medical center in Sacramento, but after hovering from my surgery, I found that I had severe ed and medications no longer work. So my doctor, Dr. Andy was focused on, I have to say appropriately on curing my cancer and saving my life.

And I'm very thankful for that. But after my recovery,  to help me deal with the ed. He prescribed Trimix injections, which worked to some extent I'll touch on that more later.  but he really couldn't provide any more in terms of support. And I [00:03:00] felt like I was on my own and dealing with the ed. So,  I started attending prostate cancer survivors groups, and there was usually a guest speaker, a doctor who would talk about something like.

Healthy eating or watching for recurrence of cancer.  but 90% of the people in the room wanted to talk about ed and the speakers. Weren't prepared to deal with that. And that's when I started doing some research on my own,  reading books, searching websites, and what I found was confusing and contradictory often wrong and not very helpful.

So I joined some online discussion groups, found a lot of people in that same situation, looking for help and not finding it. And of course I saw a lot of bad information being passed around now from my bio. You know, that my background is in technology. [00:04:00] I'm a smart guy. I know how to research things and I know how to build a web business.

So I decided that. The first thing to do was help myself. And I did that by talking to experts, reading medical journals, reading clinical research, learning, everything that I could about erectile dysfunction. And then I wanted to use that information to build a website, to help other guys. So that was kind of the goal and that brings us to today.

Tim Norton: Okay. No, that's really cool. Yeah. And your, your, your bio doesn't mention, I mean, you have a long history in tech, there was, you started Stanford, you go to Oracle, Hewlett Packard. It wasn't, you know, they kind of just mentioned some of the more recent stuff, but yeah, you you've been,  Successful silicone Valley guy up there and, and, and a long career.

And then, so let's, let's go back to your [00:05:00] forties when you're, you're first dealing with erectile issues. And so at that time, can you tell us a little bit more about what that experience was like? 

Robert Nicholson: Well, back to my forties,  You know, I started having some problems. I was embarrassed to talk to my doctor about it, but I had a pretty good relationship with them.

So I did. And he said, you know, very typical,  for most men as you age, Your circulatory system deteriorates and you know, all that stuff I've been telling you about diet and exercise. Well, you really should have been paying attention.  but for now, we're going to give you some medications and you know, they're going to help you take them half an hour ahead of time and you'll be able to have an erection.

 so I think it was pretty much first-line treatment protocol. Tell the patient what the problem is, give him the pills and send them home. And,  [00:06:00] Oh, I didn't feel particularly good about that. It was kind of a sign of aging things going wrong in my body. Yeah.  but. It worked for a long time. 

Tim Norton: Okay. And, but even looking back now, you, it sounds like you probably know a lot more about this topic now than you did in your forties.

Even your forties, you probably took the pill, maybe Google it once or twice. And then that was just that, that was just what it was correct or, okay.  so looking back, do you feel like that was still probably the best treatment for you? 

Robert Nicholson: Yes. I think that the,  the oral medications, the PDE five inhibitors are the first-line treatment protocol and for a reason, for most men with mild to moderate ed, they work.

 and it's, it's, it's a bit of [00:07:00] a.  it kind of takes way spontaneity that you have to take the pill beforehand.  but it it's a viable solution for most men with mild to moderate ed. 

Tim Norton: Okay. And it worked for you and did it work every time? Did it, did you ever have any issues with it not working. 

Robert Nicholson: Yeah, there were issues.

There were times when it didn't work, mostly when I hadn't followed the protocols. So for example, if I Agra be taken with,  heavy meals were fatty foods. So if I went out and had a, you know, a hamburger and fries and then took a biography pill,  the results weren't very good. Oh man. As I got older, It was less effective and I had to increase the dosage.

And again, [00:08:00] that's, that's pretty normal for guys in their forties and fifties who are using the oral medications. 

Tim Norton: And when you increased your dosage, did you notice any side effects? 

Robert Nicholson: I would occasionally have a headache, not enough to where. It caused me to not use the medication for some, for some men, the side effects can be severe.

And in that case, the Dr. May switch them to a different medication. If you're having serious side effects with Viagra. Try Cialis or Levitra. And if they respond early to all of the oral medications, well, then you move on to another treatment protocol. 

Tim Norton: Right? Okay. And certainly your headache was never so bad that you didn't feel like having sex.

Robert Nicholson: Not in my case, but for some men it is. And, and for those men, obviously the oral medications, aren't the right solution. 

Tim Norton: Okay. So the PDE five [00:09:00] inhibitors were working throughout your forties and your fifties. And then,  what, what were your first symptoms of prostate cancer? 

Robert Nicholson:  actually I didn't have any symptoms and that's, that's pretty typical.

 my doctor, my primary care physician believes in PSA screenings. And so he had me take a PSA test part of a routine checkup. And he said, yes, you know, your PSA tests, numbers came up kind of high. I want to repeat the test and he did numbers came back high again. So we said, okay, we're going to get you in to see a,  an oncologist and see what the symptoms are, what what's the situation is at that point, I had a biopsy.

 and it came back,  came back positive for cancer.  so,  we're not for the routine screening. My prostate cancer [00:10:00] probably would not have been detected. 

Tim Norton: And how old were you when you started getting the routine screenings?

Robert Nicholson: I believe my doctor started that. When I turned 50, I'm not sure about that. 

Tim Norton: Yeah. I think that's pretty typical. This is 50. Okay. And then biopsy and, and, and pretty bad news. How did, or how did you take that? 

Robert Nicholson:  it was terrifying for me.  you know, prostate cancer has a very high survival rate, right. But the word cancer is still frightening.

You know, I, I think it goes back to when we're little kids and we hear those adult can conversations. You know, I just heard that Mary has cancer. Oh my God. No. How long does she have? And we remember that. So just hearing the word cancer, it really scared me.  I also personally [00:11:00] have a terrible fear of hospitals and surgery.

It's, it's almost a phobia. So for me, it was very hard to make the decision to have surgery. And it was very, it's hard to actually go through with it. Right. You know, it's the night before I contemplated getting in my car and running away. My girlfriend was just incredibly supportive. She was there every step of the way.

She, let me talk about my feelings, my fears, and,  encouraged me to think about the future and getting past this. I probably would not have gone through the surgery if it weren't for her.  I have to say that waking up from the surgery, finding her, waiting for me was one of the most amazing feelings in my life just being alive.

And when my doctor came in and told me that the surgery had gone very well and he'd cleanly removed all the cancer, I had this tremendous feeling of it. Hmm.  even the, the recovery went very well. I had a laparoscopic robotic [00:12:00] surgery, so the incisions were very small. I was up and around the next day.

And I just had to take it easy for a couple of months while everything healed. But at about the two month Mark, when I found that I was completely unable to have an erection, I took that very badly for a long time. I was very depressed and I mean, how weird is that I was cured of cancer, but I felt worse than ever.

Yeah. And that's when I started reaching out, looking for answers 

Tim Norton: because in that surgery, they literally remove your prostate. 

Robert Nicholson: Absolutely. But,  my doctor is the head of robotic surgery at, at, at Sutter medical center. So the incisions are incredibly small and it's all done with robotic instruments and.

And,  you know, they do a clean excision around the [00:13:00] boundaries of the prostate and they're able to withdraw it from a very small incision. I I'm just, I'm astounded by,  the technology involved in surgeries is stays. 

Tim Norton: Yeah, definitely. And now a couple of months later, no erections, and they probably had warned you about that.

Yeah, 

Robert Nicholson: they had warned me about it. They did,  you know, in, in fairness,  my doctor did tell me that that's a frequent occurrence, but when you're dealing with cancer, Everything else kind of just fades into the background noise. It's like, you know, am I going to survive this? And the warning, there was very clear, you know, prostate cancer has a very high survival rate, but if it metastasizes and spreads through your body, then the odd shift dramatically.

Right? So we need opinion of my surgeon. [00:14:00] The idea is get it out so that you never have to deal with that. Right. 

Tim Norton: And what's the timeline for all this. So, first of all, you had a girlfriend, how long had you guys been together, but at the point where you were diagnosed? 

Robert Nicholson:  we'd been together for about three years.

So we were living together. We had,  had a good relationship and,   And she is a person that, you know, she was just very supportive and really helped me through it. 

Tim Norton: Okay. And, and not to get too personal, but you know, sometimes in really long term relationships, If you've been together since your twenties, like sex starts to, for some couples fade to the background and be less significant.

 but three years into a relationship, it was probably a really important part of your relationship. Yeah. And then, and the prospect of not getting erections anymore,  was probably really daunting. 

Robert Nicholson:  [00:15:00] absolutely. And, you know, fortunately I think we're, we're both pretty open people sexually. And so we,  explored a lot of, a lot of other ways for, you know, having any intimate, satisfying sexual relationship.

You know, it's not all about the ability to have an 

Tim Norton: erection right now. What did they tell you with regard to how long it would be like that for? Did they say that it would come back or did they just kind of say you might not ever get erections again? 

Robert Nicholson: 

problems is that there's not a lot of good data out there. Surprisingly. So what my doctor said based on his experience, and he's done hundreds of prostatectomies, he said that recovery time for the ability to have an erection is generally one to two years. If you recover. And he said, in my case, [00:16:00] because I had ed beforehand and it was progressing, the odds that I would ever recover were pretty small.

So,  he was pretty clear after the surgery that I could not expect the ability to have a normal erection again. 

Tim Norton: And that's gotta be really horrible news. 

Robert Nicholson: Yeah. Yeah. 

Tim Norton: Was that at your appointment where you went in after a couple months, was, was that when he kind of said it to you or was it like right 

Robert Nicholson: now, I went in and asked him about it, you know, where things stand?

What, what are the next steps? What's the prognosis.  and,  you know,  again, my girlfriend was with me. She was very supportive Saturday on the meetings because oftentimes. I would be in a mental state where things just kind of went past me. And then she told me afterwards what he said, but,   [00:17:00] he said that he didn't think the prognosis was good.

 the oral medications just didn't work for me at all at that point. So he prescribed.  penile injections with a drug called Trimix, which is actually a mixture of three drugs. That's why it's called Trimix. I'm not sure how many of your listeners are familiar with this, but you have a tiny little needle and you inject the drug directly in your penis about half an hour or an hour ahead of time, just as if you were taking a pill.

 and then it lasts for a couple of hours.  This helps a lot of men who no longer respond to the oral medications. So it's kind of a second line treatment.  but in my case, It doesn't always work. It's pretty hit or miss, you know, my ed is at the point where even the objections are kind of borderline as to whether they're going to [00:18:00] be effective or not.

And so on, on my website, we talk about some of the newer treatments, like shockwave therapy and PRP injections, but frankly, the research results are mixed at this point. Yeah. And because these treatments have not gone through the FDA approval process, there's no established peer review treatment protocol.

So if you go that route, you have to really look into the doctor's track record because the way he is doing shockwave treatment may be entirely different from the way another doctor is doing the same treatment. The companies that, that are doing a lot of this work could run. Peer reviewed clinical studies and it somewhat concerns me that they're [00:19:00] not doing them.

Yeah.  so what we have is a lot of self reporting. Oh, we've helped 80% of our patients, but you have to take it with a grain of salt. And the other thing that, that concerns me about it not being an FDA approved clinical trial. Is when you do a clinical trial, you're establishing the treatment protocol.

Here's how you do it. If it's medication, here's the optimum dosage and here's how often you administer the treatment so forth without those clinical trials, you're not establishing that base methodology. And what that means is that two doctors may be administering the treatment. In an entirely different way and you just don't know what results you're going to get.

Right. So I have a lot of concerns. I think there's a lot of potential there, but I think to some extent, the people who are promoting this [00:20:00] have a very self-defeating attitude by not opening up their results. 

Tim Norton: Right. Right. And that that's always going to give you pause.  definitely 

Robert Nicholson: not to mention. These treatments can be very expensive and because they're not FDA approved, they're not covered by insurance.

So it's a significant out of pocket expense for something where,  you don't know what the results are going to be. Right. Personally, I've started looking into a surgical implant, which we also talk about on our site. And I think ultimately that's going to be the right treatment for me given the stage of my 

Tim Norton: ed.

Okay. And. For the listeners who haven't yet listened to my interview with,  with the urologist, with Dr. Gonzalez, we do talk about,  injections and penile implants. And,  we also [00:21:00] talk about it on episode with, with max on like the second or third one.  but so you've have you, you've done those, those injections.

Robert Nicholson: I have done the injections. Yes, for me. It's yes. Sometimes it works. Sometimes it doesn't.  but, but I will say that, that the injections as a second line treatment help a lot of men who are no longer responding to the oral medication. So it, it's not hopeless at that point. I would say that my cases is pretty extreme.

And so at this point, even the injections don't always work for me. 

Tim Norton: Okay. Is it painful to do the injection? 

Robert Nicholson: No, it was scary. You know, nobody, nobody wants to stick a needle in their penis. Right.  but, but the needle is very fine. It's, it's just, you know, a hairline type needle.  You go into the doctor's office for the [00:22:00] first time and he shows you how to do the injection.

Has you do it yourself in the office?  and once you've done it a few times, you know, it's like a pinprick it's very easy, becomes pretty much automatic. And so I would not let that be off putting at all.  it's just not a big deal. Okay. 

Tim Norton: And then how long does it last for. 

Robert Nicholson:  typically a couple of hours,  what you need to do with this is you need to find the right dosage.

 and what the doctor will typically do is have you start at a very low dose. Where you may hardly notice the effect. It certainly doesn't give you a serviceable erection. And then he'll say, you know, I want you to increase this by two units each time until you get a serviceable erection. [00:23:00] And at that point stop, you don't want to overdose with this.

You know, some guys are saying, Hey, you know, 15 milligrams are kind of working. I'm going to go for 25 and you don't want to do that because there's a serious risk of priapism, which is the condition where you have a painful, long lasting erection, and you need to go into a doctor and get it treated and get the blood drained out of your penis, which is not at all pleasant.

You don't want to go through that. So for guys to try this. Follow the doctor's directions increase the dosage in small amounts until it works for you. And then stop at that point. 

Tim Norton: And, and you haven't gone through priapism? 

Robert Nicholson:  actually, Oh, I on one occasion for whatever reason, just had a,  an erection that just didn't go down [00:24:00] just.

You know, and at about the, you know, three and a half hour, Mark guys started to say, well, this is something's wrong here. And the general recommendation is if you experienced this, the first thing to do is to take some,  over-the-counter decongestants, take a couple of Sudafed, apply some ice. And if it doesn't go down in half an hour to an hour, Then get yourself into an urgent care center.

 in my case, the Sudafed on the ice worked, but I was definitely on that one. Okay. 

Tim Norton: Wow. That must have been an interesting afternoon. And your, your girlfriend's there with you the whole time. 

Robert Nicholson: Yeah. And of course she was saying, you know, we should, we should go to a doctor. And of course being a guy it's like, no, no, no, what are they going to do?

[00:25:00]  and fortunately,  you know, the kind of prescribed first-line response worked, right? 

Tim Norton:  And in those cases, do you, you stay hard after you ejaculate with the shad injection. Okay. 

Robert Nicholson: Yes. So the mechanism that releases blood from the penis just doesn't work, the drugs are overriding it, and it's just not letting the blood flow out.

And so, yeah. What that does is you now have this blood trapped in your penis. It's not flowing out, but you're also not getting a fresh blood supply flowing in. So the tissues aren't being oxygenated and you can do serious and permanent damage by not getting the blood flow and the oxygenation through your penis.

And that's why it's a [00:26:00] serious issue. That's why you need to get that blood. To flow out fresh blood to flow in. And if it doesn't happen, you need to see a doctor right 

Tim Norton: away. Right. Okay. And now you're considering implant and then every time I've talked to. Someone in the, in the urological world about penile implants, they'd give me just very glowing responses and, and very high customer satisfaction.

So where are you in the process of making that decision and what are you hearing 

Robert Nicholson: in terms of patient satisfaction? I hear the same thing. One of the things that we found in some of the survey work that we've done, which I can touch on later is that satisfaction with treatments for ed is very low across the board.

Guys are just not satisfied with the treatment until you come to penile implants where the patient satisfaction rate is like [00:27:00] 90%. Yeah. I mean, you have guys. In their sixties saying, man, I wish I'd done this when I was 20. 

Tim Norton: Yeah, it sounds great. You just pump it up. 

Robert Nicholson: Yeah. So you can have an erection whenever you want, for as long as you want.

 pretty magical.  certainly there's a surgical procedure and that can be frightening. And there is a recovery period, which for some men lasts weeks and can be very painful. But once you get past that, you know, pretty much just works. Unlike a lot of the other treatments that we've talked about, where in my experience and the experience of other men, well, Connor him hit or miss it doesn't work every time.

It may not work at all. 

Tim Norton: Okay. And are you on the verge of pulling the trigger or are you still just kind of taking your time with it? 

Robert Nicholson: I am in the process of [00:28:00] considering a move.  and so what I want to do is figure out where I'm going to be living and then investigate, you know, local surgeons and local surgical centers.

So I haven't stepped up to the point of actually making the commitment yet, but it's definitely something that I'm planning on doing as soon as I'm at a point in my life where, where that makes sense. 

Tim Norton: Okay. You're really situated well, at least with your, your website and all this research that you've done into this condition, you know, a lot about it.

You know, I was going through your website after I reached out to you and us just like, this is, this is perfect. This is really succinct. And, and it's really well laid out and. I guess, is that just, I mean, there's, there's treatments, there's the herbal, the medical, the surgeries, the foods. You've got a section on finding doctors and coaches.

 you go through all of the causes and you even have a [00:29:00] section on book reviews in there.  it just everything. So what, what inspired you to be so thorough? 

Robert Nicholson:  well, when I started doing my own research. I just really wasn't happy with the quality of the information that I was finding. So I wanted to do a, a better job.

 so with my team of advisors, we decided a couple things. We wanted everything that we posted on the site to be backed up by strong research. We wanted to share the links to the research, to be credible and to let people do further reading on their own. We wanted the content to be driven by what users wanted to know.

So when we get a question or we see something come up in a discussion forum and we don't have an answer, then we go off and research that and add a page to the site. So it's very much user-driven. [00:30:00] Well-researched and authoritative, those were kind of our ground rules. I also have to say that I've gotten tremendous help from Dr.

Aaron Spitz.  he's on our advisory board. He's one of the foremost urologists in the United States. He's been incredibly generous with his time and advice and knowledge. And,  I have to say. I don't know if you've read his recent book, the penis book, which came out. 

Tim Norton: I just, when I saw it on your side, I just bought it.

I was like that. That looks great. 

Robert Nicholson: Well, Aaron is a really funny guy. He worked his way through college, doing standup comedy. I have read dozens of books on ed and sexual health. As you probably have yourself. And I can honestly say this is the only book where I was laughing out loud as I read it. 

Tim Norton: Okay.

That's good. Cause he's, 

Robert Nicholson: he's got a great way of taking serious material and making it lighthearted. And I think when people are concerned [00:31:00] about ed and feeling bad about themselves, that approach really helps. 

Tim Norton: Yeah, definitely that I'll, I'll, I'll look through that thoroughly because sometimes especially if you're dealing with.

Some of the traumatic effects of this a little lightheartedness is probably, you know, very welcome,  because it, and like you say, well, so you, you guys even ventured out into,  having. Intimate contact without erections. Right? So you, you guys were already on that wavelength as well, and that's, that's really good to hear.

 how did, where did you come up with that? Was that just from discussions or did you also read about that a little bit? 

Robert Nicholson: Well, this really came out of the survey research that we did and yeah. One of the things. One of the takeaway points that [00:32:00] we came away with is that, 

for a lot of couples, it isn't so much about not having an erection and not having penetration.  obviously that's a factor, but what really happens is the ed. Causes men to withdraw causes couples to separate to where they're not having any intimacy in their relationship anymore. And that's what they really miss.

 so one of the things that I think people need to think about is you can have a satisfying sexual relationship that doesn't evolve, involve an erection every time you can, you can still have that intimacy. Which is what's really lacking in a lot of relationships when the men are dealing with 

Tim Norton: ed. [00:33:00]  definitely my name, I really liked the way that you say that.

And it's also nice that this was this, this was an evidence informed decision on your part. So why don't we talk about this, this study that did you fund it personally? Did you get investors? Did you just, how did you do it? No, 

Robert Nicholson: we, we, we funded this,  you know, w we do have. The advisors have put a little bit of money into the site at this point.

 we're starting to make some, some revenue from advertising on the site.  but it wasn't terribly expensive to do this.  the biggest expense wasn't promoting it to find, to get people to the site, to take the survey. Okay. 

Tim Norton: And you ended up. Like getting over almost 700 people to fill it out. And then not everybody scored high enough on the, the assessment tool to determine whether or not you have [00:34:00] a, an erectile dysfunction and then, but, but by the people who did it, you had almost 600 guys.

Robert Nicholson: Yes. We ended up with about 597 or 98 valid responses from qualified 

Tim Norton: individuals and 70 questions. Right? 70 some odd questions that they're answering. 

Robert Nicholson: Yeah, well, not quite,  there were 70 questions in the survey, but a lot of them were qualified questions. So. Have you tried peanut injections? If no, we're going to skip the three questions about penile injections.

Okay. So the average person ended up taking about 45 questions still along survey. So,  we, we kind of went overboard there and we learned from that and in the future, we're going to be doing smaller surveys.  but we did get some really great information. We learned a lot from this,  Unfortunately, what we learned is pretty discouraging [00:35:00] by overwhelming numbers.

What the guys said is they're not satisfied with the support they've gotten. They're not satisfied with their doctors. They're not satisfied with their treatment result. So just for example, we asked about doctors 38% of the guys said they were very dissatisfied with their doctor. 32% said they were somewhat dissatisfied.

Only 24% said they were somewhat satisfied and only 6% said they were very satisfied. So if we were to graph this, the graph would be way over on the dissatisfied end of things.  as far as treatment options, we asked about a bunch of different treatments. And if you've tried this, how satisfied were you for every single treatment option?

There were more dissatisfied men than satisfied everyone.  [00:36:00] and at this point, you know, I do want to remind your listeners that the one thing that we didn't ask about or didn't get enough responses about were penile implants, and we didn't get enough responses to include penile implants in our results.

Just because it's a relatively small number of men, but again, other research shows that's a treatment where the men are overwhelmingly satisfied. Right? I want to put that in a separate category almost.  but I think what the research showed us is that the first line treatment protocols and second line treatment protocols really aren't doing the job.

Ed treatments haven't really changed in 20 years. And doctors are not providing the advice and help and support that men are looking for. And those are two of the big takeaways from our 

Tim Norton: survey, the advice, the help and support. So did you get a sense of what was [00:37:00] so dissatisfying about their experience with their doctors?

Robert Nicholson: Part of it is the men themselves have a hard time communicating, right?  there's still a lot of stigma around ed. And one of the things that they told us is that they're embarrassed talking about it. 40% of the men who responded to our survey said they're not comfortable talking to their doctor. And almost half 48% said they're not comfortable talking to their spouse or partner.

So this leads to the men being isolated. And feeling like they get no support, partly because of their own lack of communication. But the other thing that we've found is that, you know, doctors prescribed the medication, they do some tests, they say, here's the [00:38:00] prescription, go get these pills by. And that's sort of the end of it.

And what is lacking is support for the emotional needs of the man who are getting treatment for ed. So we found that the great majority of men have experience,  loss of confidence, lack of self-esteem.  And a negative impact on their relationship and more than 80% of the respondents had experienced each of those things.

So, so, so what we're saying here is that there's a big emotional impact that nobody is helping them to deal with.  we had some, we had an open comment section on the survey where men could just talk about their feelings and,  if I can, I'd like to share some of the. The quotes, just to really show what these guys are going through.

Tim Norton: Yeah. I'd love that. And [00:39:00] they consented to having quotes shared and everything. I 

Robert Nicholson: hope it in there, they consented to having the information shared and besides which it's anonymous, right. This is no way associated with an individual. Right. So a few of the quotes, I feel inadequate and demoralized. I can't share my feelings of physical love for her.

My desire is always there, but I can't realize it. It has cost me self-respect it has caused me to lose feelings of closeness and desire. My feeling of being inadequate has severely damaged. My relationship. I've been belittled and shamed. I just have to accept it. I don't feel like a good husband because I can't have a relationship with my wife.

It's been years with no sexual contact, bring on death. I have no life quality. And my only joy is my [00:40:00] children. So this is really painful stuff. And nobody's talking about it and nobody is helping guys get past that, partly because. They don't know how to ask for real. Yeah. 

Tim Norton: Yeah, definitely. We don't, we don't do the best job of training men.

How to talk about. Difficult things like this. And then even if they were kind of good at it with, with something as stigmatized as sex, that's, it's going to be difficult for doctors. 

Robert Nicholson: Yeah. And even the doctors aren't prepared to deal with it. 

Tim Norton: Right. Talked about it on this show before with a couple of different guests, there's all these statistics in the sex education community about the very small amount of training that doctors typically get in sexual health.

Robert Nicholson: Yeah, I'm actually glad you mentioned that because,  I've also had this conversation with my own primary care physician.   [00:41:00] back when I was going through the early stages of ed and what he told me at the time is that as he recalled, he probably got six to eight hours of instruction dealing with erectile dysfunction and his whole medical education.

He understood the physical causes and the psychological causes. But he'd never been trained on the emotional issue that comes from ed. And so it's not surprising that his approach is deal with a medical issue that he has been trained to deal with and provide no emotional support because nobody's taught him how to do that and think about how different it would be.

If the doctor said to you. I'm going to prescribe some medications that should help with your problem. But you know, a lot of men who have a D start feeling bad about themselves, maybe withdraw from their partners and even have depression. So I want you to know that these things are very normal and if you [00:42:00] feel that way, it can be really good to talk to your partner about it.

Maybe get some counseling.  I'm going to give you some referral information here with some people you can talk to. And if you have any questions about this, please give the office a call because we know how tough it can be to deal with. I mean, how much difference would it make if the doctor spent literally one or two minutes having that brief conversation that they're not trained to do 

Tim Norton: that?

No. Yeah, definitely not. And from my perspective, You know, even as a, as a sex therapist, I. I regularly will get clients because they've reached a point in therapy with their regular therapist who isn't comfortable talking about sex. And this is a person who's probably comfortable talking about really painful emotions about death and suicide and childhood trauma and all kinds of things.

But then when it gets to the sex there's [00:43:00] even for us, even for, okay, Bruce, supposed to be the people who are able to talk about anything. There's still this gap. So to, to imagine, you know, a doctor or anybody that there's just no way that they're going to be adequately competent in talking about this without training, without, you know, as a part of becoming a sex therapist, I had to look at my own sexuality.

You have to look at, you know, Benny taboos that you still have, and you may have to be able to really frankly, just say, okay, so how was your penis this week? And. Talking about butts and talking about like every possible thing and Jackie lighting and all that stuff. And it's, it's, it's not necessarily hard, but you have, you have to put in the work and you have to really get comfortable doing it.

So yeah, I can imagine that a lot of that work just isn't getting done now, have you come across,  the, the folks down in San Diego, Dr. Goldstein and, and, and some of his research and what they're doing down there. It's, it's [00:44:00] pretty interesting.  no, I have not.  yeah, they, they hit the place. I'll send you a link to it.

It's it's called something like the sexual health center, but. To, to address that component of, okay, when are we going to talk about the emotions they have a team, they have, you see him, you see a pelvic floor person and you see a therapist as a standard part of the treatment. You know, it's, it's not just, you're probably going to have emotional things you are, and, and we want you to, at least, I don't know what they mandate, but it's.

It's a treatment team.  and I think a nurse practitioner in there as well. So that, that, that should probably be the standard for,  not just for this, but for a lot of things where there's going to be trauma and anxiety about any medical condition. 

Robert Nicholson: Yes, absolutely recognize the emotional impact and, and the, the part that, that plays in the healing process as well.

Tim Norton: Yeah, definitely. So you run this study [00:45:00] and God, you know, reading through some of that stuff is,  it's pretty heartbreaking. Yeah, 

Robert Nicholson: it is. We're hoping that we can help make a difference at a minimum. We want guys to understand that they're not going through this alone. That other people have similar experiences and that there are people they can talk to.

 we also did a second survey where we targeted specifically partners who have been with ed C, what we learned from their perspective.  we found that the partners also go through a loss of self-esteem and confidence in about the same numbers as men.  they often feel undesirable or like they've done something wrong.

And they feel responsible for the man D  and guys need to realize that they need to realize what their partners are going through. And the survey that we did really made me rethink my relationship with my girlfriend,  [00:46:00] she's been tremendously supportive and I took that for granted and I never thought, or I hadn't thought about how my ed was affecting her emotionally.

And since that time, I've had some very good talks with her. It's, it's opened up some really wonderful conversations, but I needed to take that step. So,  know this was one of the things that we are hearing from the women is they feel a lot of pain,  women and men partners, partners event with ed.  they're feeling a lot of pain and.

The guy isn't willing to talk about it.  again, it's not so much about the sex, it's the lack of communication and the lack of intimacy and the withdrawal. And I'd like to kind of do what I did for men and, and, and share some of the comments that we got from partners. That'd be great. Yeah.  He's too focused [00:47:00] on his embarrassment and anger at the situation to hear how rejected I feel.

I feel guilty if I have a climax, because he can rarely sustain the activity to that point. It's exhausting to try to keep things going when he really isn't able, but he wants to keep trying. And then I feel guilty about not wanting to keep working at it when it just doesn't work. I love him dearly, but it's hard not to have intimacy.

He avoids contact because he thinks it might lead to something and he will fail. I miss the physical closeness we want shared, I feel bad for him that he can no longer satisfy his needs. And I understand his frustration, but. I miss physical closeness, even simply cuddling my needs. Aren't being addressed and I feel ignored and just very sad.

It's been difficult because he doesn't want to [00:48:00] talk about it. I feel very lonely and disconnected from my husband. I think he must feel the same way, but he avoids talking about it. He acts immature and defensive. When he loses his erection during sex, he withdraws in many ways. He shuts down when I try and discuss it and he won't try other forms of intimacy.

It's taken a major toll on my feelings of self-esteem and self-worth. So what we see here in comment after comment, as well as the formal questions on the survey. Is that the problems aren't directly caused by not having an erection is the lack of communication, the withdrawal from intimacy and the failure to get help.

 one more thing that we do see a difference between men and their partners, partners in general [00:49:00] are significantly more open to talking about the problem. And significantly more open to getting help or counseling than the men are themselves. And so that can often cause conflict in their relationships because the men feel pressure and they don't want to deal with it.

So what guys really need to hear and understand is that their partners are hurting just as much as they are and not getting help. Is damaging their relationships. 

Tim Norton: Yes, definitely. And I think one of the things that I learned early on that a lot of sex therapists feel, and a lot of sex educators is that regardless of the nature of the problem, if it's an erectile issue or pelvic pain or something like that, that sexual problems are couples problems.

And in a lot of the times, guys are. Getting the message, you know, either from their own filter because they hear things cynically or [00:50:00] because it's very literally the message, but they hear the message from their, their partner go in and fix your Dick. And it's, it's not. But that's not really the best way to approach it.

Like not all partners have to come in, but they should at least be open to the idea and at least be willing to come in for a couple of sessions because, you know, in the case where you're not even cuddling anymore and you're not talking about it, those are things that. You know, if I'm working with a guy alone, like he's got to go home and talk about those things, you know?

And I, I prefer to be able to talk to both of them and say, okay, you know, you guys got to cuddle, we got to talk about these things, or you got to, I mean, we gotta get, we gotta get somewhere with this. And, and that's, that's a, that's a big piece. Yeah. We're, you're you're sex. Isn't just happening in a vacuum.

 Kurt even got a partner who is the boot probably doesn't even care as much about the erection as just the loss of intimacy. 

Robert Nicholson: Yes. [00:51:00] So Tim, you get this, you understand how sexual issues affect couples,  in the erectile dysfunction community people, aren't having these conversations. It's all about what are the causes and how do I treat it?

And maybe there's a psychological cause. So, gosh, I guess I need to talk to a counselor or a therapist, but nobody is really talking about dealing with the impact on relationships. And that's part of what we're trying to do with our site is. Get people to start having those conversations. And 

Tim Norton: that was what inspired me to, to start the podcast.

Yeah, no, I, I get it.  because a lot of the time, you know, it's, it's one thing to have your prostate removed and you know, and that that's, that's a really severe form of, of erectile dysfunction that you are suffering from. But, but a lot of the time [00:52:00] the guys can really. Bounce back from this, especially in their, in their twenties, in their thirties with, with a fairly minimal amount of treatment and, and having good conversations in any relationship is a really good idea,  about sex and intimacy and, and unmet needs and those kinds of things.

A lot of times people have no idea of what their spouse or their partner. Is looking for needs. And, and a lot of times they're really easy needs to, to fulfill.  maybe just, Oh, I didn't know you want that where she would have told me 15 years ago.  cause I would have gladly done it.  so I'm glad you guys are, are doing this research and you're  well how, how was the traffic to the site where you guys were promoting it and everything.

Robert Nicholson:  we're doing a lot of what is called search engine optimization, which means putting the right keywords on the site,  and then getting other sites to [00:53:00] link to us and, and participating in forums and things where we get link backs. It's a lot of work and it's not an overnight project.  we've been working on the site for over a year now.

And just since. Probably the last month, probably since mid December, we've seen a pretty sharp uptick in the traffic. So we're feeling really good about where we are right now. The work that we've been doing is really starting to pay off, and we're also getting a lot of,  questions and comments and outreach people contacting us about the sites.

So that's all good. That's, that's what we wanted to see. And we're starting to get there. 

Tim Norton: That's really cool. And one thing that I remember reading on your site, as you have a little section on how to start a support group, has anybody actually taken you up on that? 

Robert Nicholson: No, honestly, this is one of our early ideas,  that, that [00:54:00] hasn't worked out.

 what we find is people are too busy. They feel, they lack the knowledge or the resources or the time, and it just doesn't happen. What we have heard from people is that there is interest in some online support groups. So we're working on figuring out how we could do that. But that's probably going to be a direction that, that we take the site in the future is adding some, some online resources for support, because the idea of having people go out and start local support groups in their community.

Tim Norton: Right.  well obviously the, the stigma, we, we always run into that, but you know, I've known therapists who working with people with,  major physical disabilities and, you know, couldn't get out of the house or maybe like major,  Social phobias who have started a, I think in like Google Hangouts kinds of support groups and, you know, [00:55:00] get, I think one guy I talked to actually had a group up to eight at one point that,  he was having,  a lot of success with, so it's, it's not unprecedented.

Robert Nicholson: And, and zoom and,   Skype, you know, offer facilities for group conferencing. So, you know, there are some tools out there it's a matter of putting in place the organization, getting the people to participate, you know, doing the scheduling and so forth, but definitely one of the things that we hope to do in the near future.

Tim Norton: Cool. And. You've you've done this research. You do. It sounds like you've done a lottery search. Have you noticed some other gaps in the research or are you looking at any future directions? 

Robert Nicholson: Well, I would say there's been this long period, essentially 20 years where treatment protocols haven't changed and there haven't been any real advances.

 hopefully some of the things that are starting to happen over the last couple of years will pan out with, with [00:56:00] new established treatments.  that's something that we can't do very much about, but I think it really points out the need for more investment in medical research.  obviously there's the knee, which we've discussed a lane for better emotional support.

So,  one of the things that,  we're doing on the site, as I mentioned, is providing more resources, more help on a,  emotional support side.  we are also trying to address that question that we talked about earlier. About doctors not being trained to treat these conditions. We're working on putting together some resources and content specifically targeted to doctors saying here's what you need to understand about the.

Psychological and emotional impact of ed on relationship. And here are some basic and simple things [00:57:00] that you can do to help address this. So that's something that we will probably be rolling out in about a month where we're working on some content specifically to target the, you know, the medical 

Tim Norton: community.

Interesting. And would you be doing that in like a webinar or like educational video format? 

Robert Nicholson:  material on the site, both text, material, and video,  probably setting up some webinars and even going to the point of putting together a small pamphlet that we can send out to doctors saying, here's what you need to understand about it.

The emotional impact of ed here's. Some of the research we've done here are some facts that you can incorporate into your practice and the advice that you're giving your patients. 

Tim Norton: Yeah. And it would even be nice to maybe at some point present at a medical conference or at some trainings or something along those lines.

[00:58:00] Robert Nicholson: Yes. That's, that's a really good idea.  we're taking a multi-pronged approach. One of the things we. I know about building a web business is you try a lot of different things and you measure the results and you see what works. So we will often roll out information in several different formats. We'll do a, a written page on our site.

We'll have a YouTube video,  we'll share through social media, we'll post in forums, and then we'll see what kind of response we get. And. Then we find out what's working and we do more of that. Hmm. 

Tim Norton: Well, great stuff, Robert, really, really glad to know that,  someone with your background is, is out there and an, a part of this cause and doing really good work.

And I'm, I'm, I'm glad that, you know, I guess I was probably a part of that uptick in the traffic to your website, how, whenever I, I came across,  your information and, and it's, that's, that's, that's really [00:59:00] good. And,  I'm just really glad to have met you and Dave had this interview. 

Robert Nicholson: Well, Tim, I thank you for the opportunity to, to,  appear on your podcast.

I really appreciate the work that you're doing. I've been listening to your podcasts and I think that's exactly the kind of conversation that people need to be having, and just being more open about sex and intimacy in general. So, all right. Thanks work 

Tim Norton: that you're doing. You're welcome. And thank you.

And,  thank everybody for listening and did, where can everybody find you on the internet and are you on Twitter or is it just the website? We 

Robert Nicholson: have the website, ed treatment.info. And at the bottom of the page, we have links to a Facebook page, a Twitter page and a LinkedIn page. So, Oh, and, and our YouTube page.

So,  again, we've got multiple communication channels and we welcome questions and feedback and,  request for help, you know, whatever, whatever we can do. [01:00:00] We like hearing from people and,  like hearing about. What they're looking for and. What has helped them. 

Tim Norton: All right. Sounds great. Okay. Everybody check out ed treatment.info and thank you so much, Robert.

Okay. 

Robert Nicholson: Thank you, Tim.

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