Latest / Sex Advice for Seniors Podcast / He Helped Invent Viagra What’s Next for Men’s Sexual Health? | FT. Dr. Arthur Burnett

Transcript

He Helped Invent Viagra What’s Next for Men’s Sexual Health? | FT. Dr. Arthur Burnett · Sex Advice for Seniors Podcast

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[music]
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SPEAKER_01: Intimacy doesn't have an age limit and Oh My Bod is redefining pleasure
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SPEAKER_01: with beautifully designed tech-savvy wellness products.
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SPEAKER_01: Rediscover connection and confidence at ohmybod.com.
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SPEAKER_01: That's O-H-M-I-B-O-D dot com.
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[music]
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SPEAKER_01: Hi, this is Suzanne and welcome back to Sex Advice for Seniors,
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SPEAKER_01: the podcast where we refuse to accept that great sex has an expiration date.
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SPEAKER_01: Now let's be honest,
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SPEAKER_01: erections can be unpredictable,
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SPEAKER_01: libido can take a dip,
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SPEAKER_01: and suddenly sex maybe isn't quite as effortless as it used to be.
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SPEAKER_01: But different, as I know, doesn't mean finished, and it definitely doesn't mean boring.
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SPEAKER_01: And today I'm joined by a man who has literally helped change what's possible in
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SPEAKER_01: the bedroom, Dr. Arthur Budd Burnett, as he's called.
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SPEAKER_01: Dr. Burnett, welcome to the show.
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SPEAKER_01: I'm here and delighted to join you.
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SPEAKER_01: Fantastic.
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SPEAKER_01: So I want to know,
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SPEAKER_01: when erections start becoming unreliable,
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SPEAKER_01: is that actually the end of your sex life or do you see it as the beginning
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SPEAKER_01: of something completely different about sex that men just don't ever learn?
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SPEAKER_00: Well, I would consider it more the latter.
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SPEAKER_00: I would hate to think that men have to just give up an important quality
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SPEAKER_00: of life function of their body.
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SPEAKER_00: But things do change as men get older or acquire the health conditions.
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SPEAKER_00: So we have to understand that these are factors that can impact sexual functioning
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SPEAKER_00: and relationships and intimacy and all of the above.
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SPEAKER_00: But let's not just throw everything out the door here and forget it all.
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SPEAKER_00: Let's look to achieve some positive action.
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SPEAKER_01: I know that one of your key achievements is in creating Viagra,
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SPEAKER_01: but do you think it's actually made men worse in bed by relying on that pill instead
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SPEAKER_01: of understanding their bodies?
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SPEAKER_01: What was the rationale for that?
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SPEAKER_00: Well, that's a very loaded question in so many ways.
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SPEAKER_00: Let me start with the first part of that,
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SPEAKER_00: which is,
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SPEAKER_00: do I think it's created some sort of dependency or maybe kind of inappropriate ways
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SPEAKER_00: to move forward with sexual activity,
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SPEAKER_00: thinking I just got the pill and I don't need to think about other aspects.
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SPEAKER_00: You know, I think it certainly does enable men to perform better with better erections, okay?
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SPEAKER_00: It may not help libido,
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SPEAKER_00: it may not necessarily help intimacy and relationships,
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SPEAKER_00: but hopefully it has some association with these other aspects of So whereby
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SPEAKER_00: with counseling, okay,
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SPEAKER_00: counseling that goes along with using these medications will enable
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SPEAKER_00: a more satisfying experience for a couple.
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SPEAKER_00: So I think it's, yes, it helps your function, but it shouldn't replace all aspects.
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SPEAKER_00: And I think we need to do our best job of informing our patients and helping
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SPEAKER_00: The patients themselves also having better expectations about what's going on there.
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SPEAKER_00: Now, how did this all come about?
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SPEAKER_00: It came about,
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SPEAKER_00: I think,
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SPEAKER_00: was just realizing that we did not have the best interventions
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SPEAKER_00: for treating erectile dysfunction.
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SPEAKER_00: This goes back to the late 1980s,
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SPEAKER_00: and I've been hearing And back when I trained as a urologic surgeon,
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SPEAKER_00: we did not have good answers for addressing erectile dysfunction other than writing
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SPEAKER_00: for a kind of an herbal supplement or planning ahead for a surgery with one
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SPEAKER_00: of these more primitive penile prosthetic devices.
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SPEAKER_00: And I think we move forward now to say, okay, what is the science of erections?
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SPEAKER_00: And I got involved with some of that in the late 1980s.
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SPEAKER_00: And we started to figure out that like any phenomena that occurs in our bodies,
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SPEAKER_00: there's got to be something on a scientific level that explains all this.
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SPEAKER_00: And we were able to make some discovery work, figure out the science of erections.
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SPEAKER_00: The nitric oxide,
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SPEAKER_00: this elusive gaseous molecule that really is an amazing chemical factor
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SPEAKER_00: in our bodies, actually operates in the penile tissue to make erections happen.
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SPEAKER_00: And once we were able to understand it,
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SPEAKER_00: harness it,
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SPEAKER_00: and develop drugs surrounding it,
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SPEAKER_00: which includes the Viagra and some of the other oral medications,
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SPEAKER_00: then we kind of started a revolution with sexual dysfunction.
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SPEAKER_01: But you know what I see as somebody who's had partners who have used Viagra?
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SPEAKER_01: My experience, sadly,
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SPEAKER_01: was that they didn't understand enough about what was going on
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SPEAKER_01: with their erectile function to look at the deeper root cause.
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SPEAKER_01: And sadly, both of those men are no longer alive.
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SPEAKER_01: Because by the time the Viagra stopped working, they were in a pretty bad way, frankly.
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SPEAKER_01: And of course...
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SPEAKER_01: Back when this one particular man that I was with started using it,
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SPEAKER_01: he bought it under the counter because at that point,
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SPEAKER_01: of course, it wasn't that easy to get.
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SPEAKER_01: Now it's almost,
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SPEAKER_01: I think,
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SPEAKER_01: on the opposite way where you can just dial it up and it can be delivered
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SPEAKER_01: to your door with virtually no oversight.
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SPEAKER_01: You can answer some questionnaires online and you can just like get the stuff.
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SPEAKER_01: So I I suspect that when all of this discovery was going on back in the 1980s,
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SPEAKER_01: you couldn't have fast forwarded in your brain to where we are now.
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SPEAKER_01: How do you feel about where we are now with Viagra versus where we used to be
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SPEAKER_01: with it,
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SPEAKER_01: where it was actually a lot more difficult to get and perhaps required
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SPEAKER_01: a bit more digging into the root cause versus now where I'm in the UK.
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SPEAKER_01: I can walk up to the top of my road and get Viagra.
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SPEAKER_00: Well, you know, you speak to something that, you know, is very true to my concerns as well.
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SPEAKER_00: The unfortunate sad truth is now we're going on more and more with online ordering,
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SPEAKER_00: deliveries,
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SPEAKER_00: doesn't require really a true physician or clinician, okay,
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SPEAKER_00: and not always just physician,
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SPEAKER_00: but even nurse practitioners and others who are healthcare professionals
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SPEAKER_00: that should be appreciated as well.
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SPEAKER_00: Having that conversation and reviewing your health history.
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SPEAKER_00: And I think that is a very unfortunate development in our field
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SPEAKER_00: because I think you're absolutely right.
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SPEAKER_00: Just like you have that personal experience with your male friend,
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SPEAKER_00: I think this happens perhaps all too often.
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SPEAKER_00: That men,
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SPEAKER_00: instead of getting a proper health workup,
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SPEAKER_00: identifying health-related factors that have to do with erectile dysfunction,
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SPEAKER_00: these things either are dismissed or just overlooked altogether.
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SPEAKER_00: And that's an unfortunate situation.
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SPEAKER_00: We should use the opportunity of having rectile dysfunction be a bit of a harbinger,
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SPEAKER_00: a bit of a signal to say,
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SPEAKER_00: go and get checked out and get a checkup and then go forward from there
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SPEAKER_00: with proper right So that's something that I'd like to carry forward as a message,
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SPEAKER_00: even as you and I are talking today.
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SPEAKER_00: And let that be a strong message to your audience,
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SPEAKER_00: because I preach that all the time, that get your proper health checkup.
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SPEAKER_00: And while we've had a sexual revolution,
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SPEAKER_00: that doesn't mean that we should not do the right health thing.
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SPEAKER_00: Hopefully it should guide more men to say,
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SPEAKER_00: yes, let's be honest about our health issues and go and get checked out.
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SPEAKER_00: That's the message I would share.
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SPEAKER_01: Unfortunately, though,
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SPEAKER_01: the statistics around men that actually go to healthcare professionals
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SPEAKER_01: when they have erectile dysfunction is really low.
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SPEAKER_01: It's something like 25% of guys won't see a healthcare professional ever about this.
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SPEAKER_01: So how do you think we remove the shame around it?
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SPEAKER_00: Well,
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SPEAKER_00: I think that the way to remove the shame is to address it in a more forthright way
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SPEAKER_00: for one thing.
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SPEAKER_00: You know,
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SPEAKER_00: I think if we continue to treat it like some sort of mysterious subject matter,
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SPEAKER_00: a taboo, or maybe something that is shameful or embarrassing, that's just not right.
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SPEAKER_00: And the conversation I have with my patients in the clinic and even with these kinds
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SPEAKER_00: of activities you and I are doing right now is to just go ahead and talk openly and
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SPEAKER_00: then just say,
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SPEAKER_00: you know what,
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SPEAKER_00: you know,
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SPEAKER_00: just like women talk about their health issues, men,
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SPEAKER_00: let's talk about our health issues and do it in such a way
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SPEAKER_00: that nobody's passing judgment.
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SPEAKER_00: But rather,
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SPEAKER_00: let's just say, OK,
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SPEAKER_00: these things are real and they're important to maintain your life and live
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SPEAKER_00: a long time.
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SPEAKER_00: So let's just remove the shame.
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SPEAKER_00: Let's just talk about it.
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SPEAKER_01: Yeah, and I think that a lot of men don't realize that erectile dysfunction is often
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SPEAKER_01: a signifier of,
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SPEAKER_01: you know,
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SPEAKER_01: vascular health issues or diabetes or prostate issues or stress
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SPEAKER_01: or hormone imbalances and all the things.
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SPEAKER_01: I think for me,
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SPEAKER_01: one of the reasons why I'm developed this program that I developed was because
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SPEAKER_01: of my own experience of two men who died, started with having erectile dysfunction.
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SPEAKER_01: And, and I didn't know enough at the time to understand what was going on back then.
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SPEAKER_01: I just thought, frankly, that it was a sign of aging.
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SPEAKER_01: I just thought, you know, men get older, erections get a bit more unreliable.
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SPEAKER_01: That seems, why wouldn't that happen?
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SPEAKER_01: Because, you know, with women, it becomes more difficult to get aroused.
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SPEAKER_01: But I didn't realize until I started digging into all of this
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SPEAKER_01: that actually erectile dysfunction is often one of the very first signs
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SPEAKER_01: that things are wrong, like significantly wrong with your body.
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SPEAKER_01: And that's why I'm passionate about it.
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SPEAKER_01: Sure.
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SPEAKER_00: Sure, sure.
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SPEAKER_00: Well, I couldn't agree more.
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SPEAKER_00: And there's actually some science behind that.
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SPEAKER_00: I mean, I don't want to sound like we're over-medicalizing a discussion here,
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SPEAKER_00: but, you know, think about erections.
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SPEAKER_00: An amazing thing that involves vascular tissue,
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SPEAKER_00: blood vessel tissue, nerves that regulate how that blood vessel tissue works.
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SPEAKER_00: And hormones that somehow have a role in sensitizing all that tissue in the penile area.
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SPEAKER_00: The penis is an amazing organ.
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SPEAKER_00: And it really is a signifier of our cardiovascular health.
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SPEAKER_00: I almost equate erectile dysfunction with penile vascular dysfunction,
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SPEAKER_00: much as we talk about cardiovascular dysfunction.
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SPEAKER_00: And why not?
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SPEAKER_00: We learn about cardiovascular health.
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SPEAKER_00: We should be understanding our penile vascular health.
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SPEAKER_00: It is in a structure in our body that works.
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SPEAKER_00: And it has all these components in it that relate to the cardiovascular system by all means.
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SPEAKER_01: Yeah, just a completely off-the-wall question because it's something
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SPEAKER_01: that I've been curious about for ages.
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SPEAKER_01: People have said that women can take Viagra and that it will have some sort
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SPEAKER_01: of similar effect that it does to men, but it's going to go into the critteral area.
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SPEAKER_01: Is that just an urban legend?
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SPEAKER_00: Well, I think the answer is that it is true, but it also has to be modified to some extent.
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SPEAKER_00: And my laboratory and lab colleagues did make some discovery work following kind of
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SPEAKER_00: the male mechanisms of erectile tissue responses
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SPEAKER_00: that indeed clitoral responses Are similar.
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SPEAKER_00: They're similar.
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SPEAKER_00: It's a homologous organ,
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SPEAKER_00: meaning it's similar, but in the female, that's a different body kind of organ.
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SPEAKER_00: But the basic biology of it is similar in terms of how the erectile tissue responds
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SPEAKER_00: with nerve stimulation.
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SPEAKER_00: And so we studied it and found out,
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SPEAKER_00: yeah, nitric oxide and the whole process occurs in the clitoral area as well.
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SPEAKER_00: But the issue here,
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SPEAKER_00: while it does create engorgement and sensations and so forth in women's bodies,
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SPEAKER_00: is to understand that there may be other factors that are also largely in play.
11:20
SPEAKER_00: Okay.
11:20
SPEAKER_00: In terms of hormones and other aspects of the sexual response cycle.
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SPEAKER_00: So it's again, not just what the clitoris does.
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SPEAKER_00: It may be a number of things that all interplay into
11:31
SPEAKER_00: the best satisfying sexual experience for women.
11:34
SPEAKER_00: And so...
11:34
SPEAKER_00: So, you know, men, you know, you judge it by how firm is the penis.
11:37
SPEAKER_00: But again,
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SPEAKER_00: I don't want to minimize the male side of it too,
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SPEAKER_00: because we don't want to just say men,
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SPEAKER_00: you know, it's all about just getting a hard erection.
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SPEAKER_00: No, it's a good erection,
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SPEAKER_00: but it's also a satisfying experience between two individuals and
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SPEAKER_00: a couple's experience.
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SPEAKER_00: And there is some interplay of intimacy,
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SPEAKER_00: interplay of hormones,
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SPEAKER_00: interplay of conversation and finding a satisfactory experience,
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SPEAKER_00: not just wham, bam, thank you, ma'am, and get on.
12:00
SPEAKER_00: I don't want to have that be kind of the message.
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SPEAKER_00: I want to help an erection,
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SPEAKER_00: but hopefully that helps to drive an overall better sexual experience
12:09
SPEAKER_00: for both partners.
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SPEAKER_01: So have you looked into developing a Viagra for Women program?
12:13
SPEAKER_00: Yes, it may have some benefit in some situations with women with sexual dysfunction,
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SPEAKER_00: but the answer is things may be a bit more complex on the female side,
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SPEAKER_00: and we need to certainly recognize all these other components that are in play,
12:26
SPEAKER_00: and it may not be just one simple drug that's going to solve all of that.
12:31
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12:34
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12:39
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12:42
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12:46
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12:52
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12:56
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13:01
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13:07
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13:12
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13:23
SPEAKER_01: Talking about what goes on around all of this,
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SPEAKER_01: which is,
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SPEAKER_01: you know,
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SPEAKER_01: people have also said,
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SPEAKER_01: and I've observed as well,
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SPEAKER_01: that Viagra is not like something where,
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SPEAKER_01: you know, you take it and suddenly the penis gets hard.
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SPEAKER_01: The brain has to operate as well.
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SPEAKER_01: So how much of all of this around erectile dysfunction is psychological versus physiological?
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SPEAKER_01: Yeah.
13:45
SPEAKER_00: Well, you know,
13:46
SPEAKER_00: the very interesting storyline that you're touching on is that, yes,
13:50
SPEAKER_00: sexual activity and perhaps the best sexual responses is kind of a combination of
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SPEAKER_00: the mind and the body experience.
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SPEAKER_00: You know, so having the best experience is also how we derive satisfaction.
14:02
SPEAKER_00: And even the orgasm sensation is what people say is a cerebral event.
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SPEAKER_00: It's a brain event of appreciating how You know,
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SPEAKER_00: you get sensations that your mind has a degree of satisfaction with.
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SPEAKER_00: So you can see all of this is in play.
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SPEAKER_00: But the truth about the science of these new drugs, okay,
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SPEAKER_00: the new,
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SPEAKER_00: and they've been around 25 years now,
14:21
SPEAKER_00: Sildenafil,
14:21
SPEAKER_00: which is Viagra,
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SPEAKER_00: and Tadalafil,
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SPEAKER_00: Which is Cialis,
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SPEAKER_00: is that they actually work on the mechanism of erections, okay,
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SPEAKER_00: in terms of erectile tissue responses,
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SPEAKER_00: even in the clitoris,
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SPEAKER_00: based on how well you have a proper nerve stimuli that drives a response.
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SPEAKER_00: And these drugs Work on interfering with the brakes that control those responses.
14:43
SPEAKER_00: So if the upstream activity of driving the response is not there,
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SPEAKER_00: the pills don't really make much of a difference
14:50
SPEAKER_00: because basically erections is something that drives it and something
14:53
SPEAKER_00: that controls it.
14:54
SPEAKER_00: So these drugs kind of lessen the control side, so it perpetuates or promotes the driver's side.
15:00
SPEAKER_00: So the driver's side has got to be in play.
15:01
SPEAKER_01: Yeah, yeah.
15:02
SPEAKER_01: And again,
15:03
SPEAKER_01: my personal experience is I had a partner who was very reluctant to take it
15:07
SPEAKER_01: because he had diabetes and he had other chronic health conditions
15:12
SPEAKER_01: and things just weren't working.
15:13
SPEAKER_01: And so, you know, my suggestion was he did that.
15:16
SPEAKER_01: He said, it's not working, you know, and I suspect he didn't want it to work.
15:21
SPEAKER_01: He didn't want to feel that that was what was causing it,
15:26
SPEAKER_01: that he wasn't in control, you know, and exactly as you've just said.
15:30
SPEAKER_01: So he was putting the brakes on it whilst it was trying to do its thing.
15:34
SPEAKER_01: He was like, yeah.
15:36
SPEAKER_00: Well, you know, that just shows you the complexity of sexual responses.
15:40
SPEAKER_00: And for patients who have diabetes or cardiovascular conditions or other sorts
15:43
SPEAKER_00: of things going on,
15:44
SPEAKER_00: they may require a little more stimuli to kind of drive the system forward.
15:48
SPEAKER_00: And if they're just not kind of engaged in that,
15:51
SPEAKER_00: These drugs, again, work on the backside to try and lessen the control elements.
15:57
SPEAKER_00: But if you're not really having things that are really driving it, then that's problematic.
16:01
SPEAKER_00: We also know that diabetes does have impact on nerve tissue,
16:04
SPEAKER_00: blood vessel tissue,
16:05
SPEAKER_00: and maybe almost a premature aging kind of phenomenon in bodies.
16:10
SPEAKER_00: And so these things are less revved up than, yes, the response rate.
16:19
SPEAKER_00: Yeah, and
16:23
SPEAKER_01: do you think that partly as a result of putting so much emphasis
16:27
SPEAKER_01: on penetrative sex,
16:28
SPEAKER_01: which is kind of what we're talking about here,
16:31
SPEAKER_01: and performance,
16:32
SPEAKER_01: that we're actually missing some of what makes sex better as we age?
16:37
SPEAKER_00: Yeah, and I think you're absolutely right.
16:40
SPEAKER_00: And maybe,
16:41
SPEAKER_00: you know,
16:41
SPEAKER_00: there's some preaching or at least some enlightenment that surrounds,
16:45
SPEAKER_00: you know,
16:45
SPEAKER_00: looking to make the sexual experience better,
16:48
SPEAKER_00: not just having just penetrative sex and then move on.
16:51
SPEAKER_00: I think we've been kind of speaking to that here
16:54
SPEAKER_00: and there throughout our conversation,
16:55
SPEAKER_00: that the really satisfying experience is perhaps more than just the physical act.
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SPEAKER_00: And maybe there should be more surrounding that experience that I think makes some sense to me.
17:06
SPEAKER_01: And when people see you,
17:08
SPEAKER_01: I mean, you're obviously dealing with a whole range of urological conditions.
17:12
SPEAKER_01: One of the biggest conversations that I have with men,
17:16
SPEAKER_01: especially around all of this,
17:18
SPEAKER_01: is that often when they see urologists,
17:20
SPEAKER_01: especially Especially when it's prostate related,
17:24
SPEAKER_01: that often sex and the consequences of some
17:27
SPEAKER_01: of these more significant operations like radical prosectomies,
17:32
SPEAKER_01: for example, that sex isn't really talked about.
17:36
SPEAKER_01: That sometimes you guys don't really talk about sex.
17:40
SPEAKER_01: You talk about erectile performance.
17:43
SPEAKER_01: You talk about penile health.
17:45
SPEAKER_01: You talk about this sort of stuff.
17:47
SPEAKER_01: We don't actually talk about what potentially could happen between two people
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SPEAKER_01: when something doesn't work with the penis.
17:57
SPEAKER_00: Your discussion here is spot on.
18:00
SPEAKER_00: Because I think,
18:00
SPEAKER_00: unfortunately,
18:01
SPEAKER_00: and I speak as somebody who's probably in that space as a urologic surgeon,
18:06
SPEAKER_00: that many times we just get too clinical with our patients and say,
18:08
SPEAKER_00: just we want to treat your prostate cancer.
18:10
SPEAKER_00: Because as I'm in that camp, I'll take some blame too.
18:14
SPEAKER_00: But we don't necessarily kind of put it in a more holistic way
18:18
SPEAKER_00: and understand all aspects of that man's experience and really try
18:23
SPEAKER_00: to address it more than just say, get your prostate out and you're going to be fine.
18:27
SPEAKER_00: We really need to be much more thorough and really understand the whole human experience here.
18:32
SPEAKER_01: Yeah.
18:33
SPEAKER_01: I know men who have been completely traumatized by that experience and
18:37
SPEAKER_01: the realization that actually they weren't going to have an erection for a while,
18:42
SPEAKER_01: if ever.
18:44
SPEAKER_01: And nobody really adequately explained that to them.
18:47
SPEAKER_01: And I find that really horrifying, frankly.
18:50
SPEAKER_00: It can be,
18:51
SPEAKER_00: but I think the good news is we need to put it in a proper frame of reference
18:55
SPEAKER_00: that we're saving your life.
18:57
SPEAKER_00: At the same time, we address how we can bring back your best sex life.
19:02
SPEAKER_00: Sometimes if the surgeon's not the key person, well, get some colleagues involved.
19:06
SPEAKER_00: Get your sex therapist involved, your nursing team and others.
19:10
SPEAKER_00: And fortunately,
19:10
SPEAKER_00: I think we are becoming more and more aware as practitioners
19:14
SPEAKER_00: of prostate cancer management that we need to provide therapies in a better way,
19:19
SPEAKER_00: where we better select people.
19:20
SPEAKER_00: Who should go forward and who shouldn't.
19:23
SPEAKER_00: When we execute treatments,
19:24
SPEAKER_00: do these in a way that are most preserving of functions,
19:27
SPEAKER_00: both on the radiation side as well as surgery side.
19:30
SPEAKER_00: I think we are making improvements in how we execute these procedures
19:33
SPEAKER_00: to maximize recovery amidst the intent for prostate cancer cure.
19:39
SPEAKER_01: Interesting.
19:40
SPEAKER_01: I mean, you're obviously on the leading edge of all of this.
19:43
SPEAKER_01: Is there new procedures out there now supporting men so that
19:47
SPEAKER_01: if they do have prostate cancer,
19:49
SPEAKER_01: they won't necessarily lose their erectile function?
19:53
SPEAKER_01: Is that one of the things that is actually being worked on?
19:56
SPEAKER_00: Well, absolutely.
19:57
SPEAKER_00: Prostate cancer surgery,
19:59
SPEAKER_00: which I'll speak to most directly since that's in my wheelhouse,
20:03
SPEAKER_00: historically was associated with never recovering functions,
20:06
SPEAKER_00: erections, sexual ability, blah, blah, blah.
20:09
SPEAKER_00: You know,
20:09
SPEAKER_00: we made innovations that date back to one of my mentors recognizing how we can do
20:14
SPEAKER_00: the surgery better with so-called nerve sparing approach,
20:17
SPEAKER_00: knowing the nerves that encase the prostate.
20:19
SPEAKER_00: If we can delicately preserve these nerves that regulate blood flow in the penis
20:22
SPEAKER_00: while still removing the prostate deep within the pelvis— We can have a higher rate
20:26
SPEAKER_00: of men recovering than zero.
20:28
SPEAKER_00: But the answer is, is we haven't achieved the kind of results we still want to get.
20:32
SPEAKER_00: So in the modern era now,
20:33
SPEAKER_00: we are doing more exciting new technologic things of identifying the courses of
20:39
SPEAKER_00: the nerves,
20:40
SPEAKER_00: bringing in New innovations such as pelvic stimulators to help the nerves recover
20:45
SPEAKER_00: from just having kind of a shocky mode that can go on for several months,
20:49
SPEAKER_00: sometimes after surgery.
20:50
SPEAKER_00: So yes, there are innovations that are coming along as we understand the mechanism
20:54
SPEAKER_00: of erection and develop new technologies we can bring this to the surgery.
20:58
SPEAKER_01: And are you still recommending things like pumping, for example, after surgery?
21:02
SPEAKER_01: Yes.
21:03
SPEAKER_00: Well, pumping,
21:04
SPEAKER_00: I guess you're talking about,
21:05
SPEAKER_00: you know,
21:05
SPEAKER_00: using various things that help rejuvenate the flesh of the penis and bring blood in
21:09
SPEAKER_00: and all these kinds of things.
21:10
SPEAKER_00: And certainly those things, I think, certainly are still promoted.
21:15
SPEAKER_00: I think we need to put them in some perspective that they keep nourishing the penis
21:19
SPEAKER_00: and,
21:19
SPEAKER_00: let's say,
21:20
SPEAKER_00: keeping the guy,
21:20
SPEAKER_00: let's say,
21:21
SPEAKER_00: in the game and trying to at least be aware of interventions that may help help.
21:26
SPEAKER_00: Are you going to let us know what those are?
21:53
SPEAKER_00: Well, they're in progress.
21:54
SPEAKER_00: I didn't want to be too detailed for the audience in me.
21:57
SPEAKER_00: I know people get glassy-eyed when some of us scientists start talking to
21:59
SPEAKER_00: with all these scientific terms.
22:01
SPEAKER_00: But basically,
22:02
SPEAKER_00: we are doing things like intraoperatively,
22:04
SPEAKER_00: seeing exactly the nerves that course around the prostate
22:07
SPEAKER_00: and figure out each individual man, man by man.
22:10
SPEAKER_00: Where those nerves are,
22:12
SPEAKER_00: how to make sure that we don't damage them,
22:14
SPEAKER_00: how we delicately remove the prostate cancer but not damage those nerves.
22:18
SPEAKER_00: So these kind of concepts are in production.
22:21
SPEAKER_00: I hope that they'll become really kind of standard fare with regard
22:25
SPEAKER_00: to how we offer interventions here in a few years to come.
22:29
SPEAKER_01: That's really exciting.
22:31
SPEAKER_01: And how do you talk about sexual decline with a new partner
22:34
SPEAKER_01: without instantly killing attraction?
22:37
SPEAKER_01: Have you got any advice on that?
22:39
SPEAKER_00: Do I have advice on that?
22:40
SPEAKER_00: And you're speaking to a surgeon and an old army officer and all that.
22:44
SPEAKER_00: Oh, you know,
22:45
SPEAKER_00: I remember I was training as an army officer was,
22:47
SPEAKER_00: you know,
22:48
SPEAKER_00: you know, you're,
22:48
SPEAKER_00: you're in,
22:49
SPEAKER_00: you're an officer basic camp and,
22:50
SPEAKER_00: you know, you do what you're told and that's how things go.
22:53
SPEAKER_00: But, um,
22:55
SPEAKER_00: But I think, again,
22:57
SPEAKER_00: you know,
22:58
SPEAKER_00: those who are really colleagues in the areas of sexual health,
23:03
SPEAKER_00: sex therapists,
23:05
SPEAKER_00: counselors,
23:05
SPEAKER_00: things of that sort of,
23:06
SPEAKER_00: you know, I want your audience to know that it doesn't really have to be us, sir.
23:10
SPEAKER_00: You know,
23:11
SPEAKER_00: there are many different experts out there who can help you get
23:14
SPEAKER_00: through these experiences.
23:16
SPEAKER_00: Surgeons like myself are very sympathetic,
23:18
SPEAKER_00: but I don't tell you, I can't tell you all my colleagues in surgery are like this.
23:22
SPEAKER_00: They just want to do the surgery and they can kick you out the door.
23:24
SPEAKER_00: And that's just unfortunate.
23:25
SPEAKER_00: So, so how do I do it?
23:27
SPEAKER_00: I just, again, talk very sympathetically, very honestly, very straightforwardly.
23:31
SPEAKER_00: And that's how I go about it.
23:33
SPEAKER_01: Just going back to the conversation about Viagra,
23:35
SPEAKER_01: if somebody doesn't want to take that,
23:38
SPEAKER_01: what actually can work in the real world to fix their sexual performance?
23:43
SPEAKER_01: What other things could they be doing aside from taking the blue pills?
23:48
SPEAKER_00: Well, first and foremost,
23:49
SPEAKER_00: even before the pills,
23:51
SPEAKER_00: is to recognize that maintaining your best health is fundamental.
23:58
SPEAKER_00: And then,
23:59
SPEAKER_00: you know,
23:59
SPEAKER_00: don't ask any physician,
24:01
SPEAKER_00: including surgeons,
24:01
SPEAKER_00: that just bring a miracle drug or a miracle cure into play
24:05
SPEAKER_00: if you're smoking three packs of cigarettes a day or you're way overweight
24:09
SPEAKER_00: and not trying to maintain your best health,
24:12
SPEAKER_00: not getting your right checkups and getting your cardiovascular health in order.
24:16
SPEAKER_00: You've got terrible sleep habits and not getting your best sleep hygiene.
24:22
SPEAKER_00: I mean, all these fundamental aspects of just maintaining your health
24:25
SPEAKER_00: and preserving your best health, that should be the first layer of action.
24:29
SPEAKER_00: Always, always.
24:30
SPEAKER_01: Yeah, and I've read that supplements,
24:32
SPEAKER_01: for instance,
24:33
SPEAKER_01: like getting that nitric oxide into the body, would you recommend taking those?
24:39
SPEAKER_00: Well, the short answer is I don't have a lot of faith in all of that.
24:43
SPEAKER_00: You know,
24:44
SPEAKER_00: I think that's unfortunate because there may be some out there who are trying
24:47
SPEAKER_00: to market something that sounds like, oh,
24:49
SPEAKER_00: it's based on Dr.
24:50
SPEAKER_00: Burnett's science at Johns Hopkins,
24:51
SPEAKER_00: he's the authority, and therefore this is a great product that we have for you.
24:55
SPEAKER_00: I've even seen my name on stuff that I had no idea was going on.
24:58
SPEAKER_00: But the truth of the matter is,
24:59
SPEAKER_00: is again,
25:00
SPEAKER_00: if you're doing the right physical fitness,
25:02
SPEAKER_00: health fitness things,
25:04
SPEAKER_00: you are probably achieving your maximal kind of chemical balance in the body,
25:09
SPEAKER_00: including nitric oxide.
25:10
SPEAKER_00: And these supplements questionably offer anything more than that if you're doing
25:14
SPEAKER_00: the right healthful things.
25:15
SPEAKER_01: All right, because there's some urologists I know that are promoting these supplements.
25:21
SPEAKER_00: Well, I hope that they're doing it in an above table kind of way.
25:25
SPEAKER_01: What you said about nitric oxide,
25:26
SPEAKER_01: from what I understand as a layman,
25:29
SPEAKER_01: is like the rocket fuel that gets the blood into the penis, right?
25:34
SPEAKER_01: That's the thing that's pushing it in there.
25:36
SPEAKER_01: And what I have read is that If you eat lots of nitric oxide-rich foods,
25:44
SPEAKER_01: for example,
25:45
SPEAKER_01: not necessarily take the supplements,
25:47
SPEAKER_01: you are going to support nitric oxide production,
25:50
SPEAKER_01: which is going to help get the blood flow in there.
25:52
SPEAKER_01: That's right,
25:53
SPEAKER_00: isn't it?
25:54
SPEAKER_00: Well, I think the concept makes sense.
25:57
SPEAKER_00: The question is whether if you're already kind of topping off your engine with
26:02
SPEAKER_00: the best tune-ups,
26:04
SPEAKER_00: if you're doing that, does trying to pour more into the tank make any difference?
26:10
SPEAKER_00: And to add to that,
26:13
SPEAKER_00: if the rest of the situation is not optimized,
26:16
SPEAKER_00: then I just don't see how that really adds anything.
26:19
SPEAKER_00: We're maybe kind of giving some Wrong expectations about the likelihood of benefit
26:24
SPEAKER_00: with these interventions.
26:26
SPEAKER_01: Okay.
26:27
SPEAKER_01: Interesting.
26:28
SPEAKER_01: Because like I said, I've spoken to lots of urologists.
26:32
SPEAKER_00: Yeah, I'm sure you
26:33
SPEAKER_01: have.
26:33
SPEAKER_01: Some say one thing, some say something else.
26:36
SPEAKER_01: Obviously, you've said what you've said, and so I take that on board.
26:40
SPEAKER_00: Yeah.
26:41
SPEAKER_00: Well, I'm not making this up.
26:42
SPEAKER_00: I'm speaking from guidelines.
26:44
SPEAKER_00: I'm speaking from real consensuses of individuals who really are experts.
26:49
SPEAKER_00: So the audience here is not just, you know, this is Dr. Burnett's opinion.
26:52
SPEAKER_00: No, I think I'm speaking really from What is really thought
26:54
SPEAKER_00: to be major society guidelines about what's really evidenced to be beneficial
27:00
SPEAKER_00: or what isn't?
27:01
SPEAKER_01: Yeah, fair enough.
27:02
SPEAKER_01: And I think what I've heard and what I know is that for every man out there
27:07
SPEAKER_01: with erectile dysfunction,
27:08
SPEAKER_01: the best thing you could do to get started is just get yourself in
27:12
SPEAKER_01: the best possible shape, right?
27:14
SPEAKER_01: Eat well, exercise, get good sleep, minimize your stress, just get yourself in good shape.
27:23
SPEAKER_01: And the chances are if you do that, Then hopefully you will have good erections.
27:29
SPEAKER_01: But if one thing goes, then other stuff may follow.
27:34
SPEAKER_00: Yeah.
27:34
SPEAKER_00: I mean, and again, that's fundamental.
27:37
SPEAKER_00: But if these things are done well and you regain some level of function
27:40
SPEAKER_00: or maintain your level of function, hallelujah.
27:43
SPEAKER_00: But then,
27:44
SPEAKER_00: you know,
27:44
SPEAKER_00: within that whole equation,
27:46
SPEAKER_00: if you have to next go to the next level forward with the clinician's help,
27:50
SPEAKER_00: whether it's a sexual medicine expert or even a therapist expert,
27:55
SPEAKER_00: depending if there's kind of a mental health aspect to things,
27:58
SPEAKER_00: well, then add on with those things.
28:01
SPEAKER_01: The basic thing is, guys, don't neglect your help.
28:04
SPEAKER_01: Go and see a doctor if something's not working.
28:07
SPEAKER_01: And I'm very much about removing the shame around all of this.
28:12
SPEAKER_01: And clearly, so are you.
28:13
SPEAKER_00: Well, absolutely.
28:14
SPEAKER_00: We're perfectly aligned.
28:16
SPEAKER_00: And there's a main message I would leave the audience with.
28:19
SPEAKER_00: I would just say, men, recognize that we're all human beings.
28:24
SPEAKER_00: Let's just be realistic about who we are.
28:27
SPEAKER_00: I mean, let's get past the Marlboro Man and the bravado and all this kind of stuff.
28:33
SPEAKER_00: I mean, that's just nonsensical and just not really smart.
28:38
SPEAKER_00: You know, if things are happening in your body, be attentive to that.
28:42
SPEAKER_00: But sometimes things are not even symptomatic,
28:44
SPEAKER_00: and that's why you should go still get a health checkup.
28:47
SPEAKER_00: And let's just be real.
28:48
SPEAKER_00: Let's be authentic.
28:50
SPEAKER_00: Go and get your health checkups.
28:51
SPEAKER_00: Certainly,
28:51
SPEAKER_00: as you get in older age ranges,
28:53
SPEAKER_00: but even younger men may want to get a checkup just to see where you are and say,
28:56
SPEAKER_00: okay, I'm fine.
28:57
SPEAKER_00: I don't need to be seen again for five years.
28:58
SPEAKER_00: Fine, if everything is stable.
29:00
SPEAKER_00: But there are some silent killers going on out there.
29:02
SPEAKER_00: You know, in terms of blood pressure issues and various other kinds of things.
29:06
SPEAKER_00: So just be authentic people.
29:08
SPEAKER_00: Just be real.
29:09
SPEAKER_00: Let's be real.
29:10
SPEAKER_00: Men, get your checkups and go forward.
29:15
SPEAKER_01: Yeah, thanks so much for taking the time to speak to me.
29:17
SPEAKER_01: I really appreciate it.
29:19
SPEAKER_00: Well, it's my delight.
29:20
SPEAKER_00: I really enjoyed it.
29:24
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