Latest / The Sexology Lab / Beyond Erections - Hormones and Sexual Function with Dr. Amy Pearlman | Episode 10

Transcript

Beyond Erections - Hormones and Sexual Function with Dr. Amy Pearlman | Episode 10 · The Sexology Lab

0:00
There is no evidence to support people not masturbating, right?
0:04
So big trend on social media about holding off and not
0:07
masturbating for months or years at a time.
0:10
And yeah, I'm sure that works for some people, but for a lot
0:13
of people it doesn't. And we don't know of any health
0:15
benefits to doing that. OK.
0:16
So that's not something that I would typically recommend.
0:19
What were you never taught about your body?
0:21
That you probably should have been.
0:23
Today in the lab, we're joined by Doctor Amy Pearlman, a board
0:26
certified urologist who is redefining how we think about
0:30
men's sexual health from what's normal to what really deserves
0:33
attention. With a background in hormone
0:36
optimization, sexual function, and gender affirming care,
0:40
Doctor Pearlman brings a refreshingly honest and deeply
0:43
educational perspective to topics most people are too
0:47
afraid to ask about. In this conversation, we
0:50
discussed everything from penile health and testosterone to
0:54
orgasm quality, prostate pleasure, and the gaps in sex
0:58
education that leaves so many people confused.
1:01
If you ever had a question you were too embarrassed to ask your
1:05
doctor or didn't even know, you should be asking.
1:08
Your Doctor, this episode is for you.
1:12
Welcome to Sexology Lab. Each week we speak with the most
1:15
compelling minds in modern sexology to ask the questions
1:19
shaping the future of desire, connection, and human Wellness.
1:23
Let's dive in. Doctor Amy Pearlman, you're a
1:27
board certified urologist, so I have to ask you how crooked is
1:32
too crooked when it comes to penises?
1:34
And when does curve go from totally normal to OK, let's
1:39
actually talk to a doctor. Oh my goodness, Michelle, that's
1:42
like the age-old question. You know, crooked isn't a
1:45
problem unless it's a problem. So a lot of people are born and
1:49
they have some sort of curvature to their penis.
1:52
It could be left, right, up, down, somewhere in between those
1:56
and that is very normal. OK, A lot of people don't have
2:00
perfectly straight penises. Now as people go through their
2:04
life, think about what the penis goes through.
2:07
It is essentially in a boxing ring, all right.
2:10
And so there are things that happen to the penis even if
2:12
someone doesn't remember a specific circumstance that was
2:16
traumatic. Microtraumatic events happen to
2:19
the penis all the time by just run-of-the-mill, even vanilla
2:23
intercourse. And so some people can develop
2:26
scar tissue in the penis. Scar tissue doesn't stretch as
2:30
well as normal, healthy penile tissue, and so that can cause a
2:34
curvature of the penis. Typically, if guys have less
2:37
than 20° of curvature, it typically doesn't cause issues
2:41
when it comes to sexual activity.
2:43
They might not like the way their penis looks, or they might
2:46
want to know, is this OK? When do I worry about it?
2:49
But if it doesn't cause issues with intercourse or sexual
2:52
activity, it's not a problem. Problem.
2:54
Once the curvature starts getting above 30°, sometimes it
2:58
becomes problematic. Most of the curvature we see is
3:02
dorsal curvature, which means the penis curves up towards 1's
3:06
face. Now for some people, that's kind
3:08
of like their secret sauce. We can give them like a better
3:12
angle to get more of that G spot stimulation.
3:16
So I have some guys that have curvature and they say, Amy, I
3:18
don't want you to do anything about it because this gives me
3:21
an edge. So when those guys it's not a
3:23
problem, but if it causes the man pain during intercourse, if
3:28
it hits his partner in a spot where it's just very
3:31
uncomfortable because of the curvature or if it causes a lot
3:34
of hourglass or cinching in of the penis or shortening of the
3:38
penis, that's when it becomes problematic.
3:40
Yeah, and when you said that, my first thought was like, curving
3:42
up, isn't that an issue when you're trying to pee and go to
3:45
the bathroom? Would that be a struggle for
3:48
some men? Yeah, it absolutely can be.
3:50
Oftentimes when guys wake up in the morning and they have
3:53
morning, it can get quite messy if they have curvature.
3:56
So yeah, like, let's say someone has some curvature and it
3:59
doesn't cause them any issues during sex, but it makes a huge
4:02
mess when they're peeing. I mean, in my practice that
4:05
would be a reason to fix the curvature if it bothered them.
4:08
Totally, totally. All right, so now I want to know
4:11
what do men panic about when they look at their penises?
4:15
That's almost always completely normal.
4:18
I've never seen such high anxiety when men come in and
4:22
they're worried they have a sexually transmitted illness,
4:26
they notice a bump on their penis.
4:27
Oftentimes in my practice is a little bit different because I
4:30
have a concierge practice. I don't run an urgent care.
4:33
So most of the time when these guys come in, it's like an
4:36
ingrown hair, right? But when a guy notices like a
4:40
lump or bump on his penis, especially if he's had a recent
4:43
like high risk interaction with a partner or unprotected sex, he
4:48
is very nervous that he has an STI now.
4:51
I think that's totally legit reason to see a healthcare
4:54
provider because sometimes it is an STI, right?
4:56
It's not always an ingrown hair. You know, I wish it were always
4:59
an ingrown hair. You know, if you see something
5:01
that looks abnormal, go see a doctor.
5:04
The problem is we don't have great access for guys to come in
5:07
to go see a doctor. And so oftentimes they're
5:10
waiting a little bit longer than they know they should because
5:13
it's hard to get in for a visit. And oftentimes whoever is
5:16
examining them is just like, oh, it's normal, don't worry about
5:18
it. But we should always encourage
5:20
people to come in to see a health care provider if they
5:23
notice something that looks different.
5:25
Right. Oh for sure.
5:26
I would say always play it safe. So besides an ingrown hair, like
5:30
what else could it be? It's skin irritation, skin tag.
5:33
Are those common things you see? Yeah, I mean, it could be a skin
5:36
tag. It could be some guys when
5:38
they're circumcised, they get like these skin bridges of the
5:41
tissue that just kind of heals in a different way.
5:44
It could be irritation from different soaps that people are
5:47
using. It could be a dermatitis.
5:49
But most of the time I would say it's like an ingrown hair
5:52
because they're kind of shaving that part of their penis.
5:55
Yeah, that totally makes sense. All right, I want to talk to you
5:58
about testosterone. All right?
6:01
What does healthy testosterone support when it comes to sexual
6:05
confidence, energy, and pleasure?
6:08
So testosterone is really important for foundational
6:12
well-being, including sexual health.
6:14
And we often times think about testosterone.
6:16
I mean it is called a sex hormone.
6:18
So often times it gets lumped into if you don't have erectile
6:22
dysfunction where you don't have low libido, then your
6:23
testosterone level must be normal.
6:26
And that's not true, right? Someone could have a completely
6:28
normal sex drive and completely normal erections and still have
6:31
low testosterone. People can also have normal
6:34
testosterone and still have erectile dysfunction, right?
6:37
So not everyone who has Ed has low T.
6:40
However, I will say this, if a guys are coming in and they're
6:42
not having as robust erections as they used to have, they
6:46
should get their testosterone level checks.
6:48
In fact, it's in our American Neurological Association
6:50
guidelines because if we optimize someone's hormones, we
6:54
will help them become better responders to therapies that
6:57
specifically treat Ed medications like tadalafil and
7:01
sildenafil, which are the generics for Viagra and Cialis.
7:04
So you don't want to skip foundational hormone support.
7:07
Do I necessarily give men who have Ed testosterone therapy to
7:11
help with their Ed? No, it wouldn't be a primary
7:13
treatment, but it can help them better respond to Ed treatments.
7:16
Yeah, absolutely. So if somebody says I just don't
7:20
feel like myself anymore, how often is testosterone part of
7:24
the picture? What else do you look at
7:26
alongside that? It's hard to answer that
7:28
question because much of my practice is hormone
7:30
optimization, right? So usually the patients who come
7:33
to see me, they've already had some of their other labs
7:36
checked. They don't have a thyroid issue,
7:38
so someone else has already screened them for a lot of other
7:40
different things. The reality is when men or women
7:44
don't feel like themselves, it can be due to a hormone issue we
7:47
should acknowledge. So anyone who comes in with that
7:50
concern, I'm checking a full hormone panel on them.
7:53
Now I see guys, they hope they're praying that it's a low
7:56
testosterone issue because then if I put them on testosterone, I
7:59
can fix the problem. And that's not always the case,
8:02
right? There are some guys that I see
8:04
that have very normal testosterone levels and so there
8:08
I don't feel like myself or they might have more fatigue, they've
8:10
lost some pep in their step. They aren't quite getting muscle
8:13
like they used to. Sometimes it is due to other
8:16
reasons. It could be due to 30 different
8:18
things that I can name and probably 100 others that we
8:21
haven't identified. Anything that impacts sleep, it
8:24
could be nutrition, it could be exercise, it could be stress
8:27
levels, it could be a thyroid issue.
8:29
Any sort of other comorbid or health issue can show up as
8:33
someone not feeling like themselves.
8:34
All right, I want to know. We all know that sex Ed is not
8:37
the greatest, especially in the US.
8:39
OK, So what is the most misunderstood thing about penile
8:43
tissue that men were never taught in sex Ed?
8:48
Taught that the penis can change throughout one's lifetime and it
8:52
can change in a variety of different ways.
8:54
We previously spoke about how someone can develop curvature,
8:58
right? And I don't think any man in who
9:01
goes to any sex education class is ever taught that he could
9:06
injure his penis. And contrary to popular belief,
9:09
even though we call it a boner, there is no bone in the penis,
9:13
but there is muscle and there is tissue that surrounds that,
9:17
spongy erectile tissue to that if it tears, we call it a penile
9:21
fracture. So what I tell men, or you have
9:24
to have sex safely, I don't just limit that to having safe sex.
9:28
When we think about using condoms and using protection, I
9:30
mean, have to be careful with your penis.
9:33
And their partners need to know that as well.
9:36
And a lot of partners don't. They'll just go to town on the
9:40
penis and not worry about how the penis angle is with
9:45
different positioning. And that can injure the penis
9:48
and 'cause that that's actually major issue.
9:49
So men and partners out there, when you're having sex, you have
9:54
to be careful. You don't want the penis to like
9:56
come out and then go back in and hit the pubic bone.
9:58
I've had this happen like sometimes in my own personal
10:01
life, No, like if I break it, I, I don't want to have to fix
10:05
this. So let's, we got it.
10:07
You got to be careful. Sometimes you got to slow it
10:09
down. I know when you said that, I was
10:11
like, oh, like I that's definitely happened.
10:13
Are you OK like? It like hits deep in my soul
10:16
because I'm like, Oh no, like, we just protect the penis.
10:19
So you got to be careful. The other thing that a lot of
10:22
men are not taught in sex education that can also change
10:25
the penis is when someone is not getting regular erections, like
10:28
daily erections, the penis can shrink in both length and girth.
10:33
And so when I tell guys, if you don't use it, you lose it.
10:37
I'm not necessarily telling them you have to have sex with your
10:39
penis every day to maintain its size, right?
10:42
But you do need your penis to become erect on a regular basis
10:46
to maintain its size. So I have a lot, a lot of
10:48
patients that I'll put on a daily medication like tadalafil,
10:51
even if they're not sexually active, just to maintain their
10:55
erection so we can maintain their PNL health and preserve
10:58
their length and girth as they get older.
11:00
It sounds like you do a lot of sex education in your practice
11:03
like as well as medical treatment.
11:06
Would you say that's accurate? I would say that's accurate.
11:08
I would say, Michelle, that my biggest therapeutic benefit is
11:12
talking to patients and actually more so than doing any procedure
11:17
or surgery. Thought of something that I'm
11:19
curious about. How often should men be
11:22
masturbating to completion? How often should men be
11:26
ejaculating? I'm going to give an answer
11:28
that's supported by research and then also a very unsexy answer,
11:32
and I'll suffer the unsexy answer first, if you don't mind.
11:34
So the unsexy answer is it depends.
11:37
Shocker. Shocked.
11:39
It depends on what works for the guy.
11:42
There are some guys that don't really care to masturbate, they
11:46
just want to engage with their partner whenever they're
11:48
sexually active and it's just not something that's important
11:51
to them. I totally get it.
11:52
And if I were to try to force them to self stimulate or
11:55
masturbate more often, it just wouldn't feel natural to them.
11:59
So I don't think I'm really helping them in that
12:01
circumstance. There are other guys that just
12:03
feel better. I actually, I was seeing a
12:05
patient earlier today, He's in his 50s.
12:07
He travels internationally all, all the time.
12:09
And he said, Amy, when I'm traveling, my just like go to is
12:13
I go to the hotel and I masturbate and that is how I go
12:17
to sleep. It is how I calm down.
12:19
It's how I take the edge off. And I feel like that's really
12:21
healthy for me because I'm not going to the bar and drinking
12:24
when I'm traveling. I think that's the best way of
12:26
coping and of putting yourself to sleep is by masturbation,
12:29
right? And so for him, he does that
12:32
very regularly and that's very healthy for him.
12:34
So it really depends on the person.
12:36
There is no evidence to support people not masturbating, right?
12:40
So big trend on social media about holding off and not
12:44
masturbating for months or years at a time.
12:47
And yeah, I'm sure that works for some people, but for a lot
12:49
of people it doesn't. And we don't know of any health
12:51
benefits to doing that. OK.
12:53
So that's not something that I would typically recommend.
12:55
And then the research answer, you know, there is some research
12:58
to suggest that getting off 21 times or more a month is
13:02
actually good for prostate health.
13:04
When I say that to people, I'm not telling them.
13:06
So I'm giving you permission so that you're part partner should
13:09
have sex with you at least 21 * a month to keep your prostate
13:12
healthy. So I have to be careful with how
13:14
I say that because their partner may not want to engage in sexual
13:17
activity that often. But it does mean that maybe the
13:20
other days of the month, if they want to, they can masturbate.
13:22
So you know it's going to be a combination of masturbation and
13:25
any partnered activity that suits their life.
13:27
Yeah. If somebody comes in as I
13:29
haven't ejaculated in three months, like, is that something
13:32
concerning to you? If they're fine with it and it's
13:35
not part of their daily routine, then I'm I'm OK with it.
13:39
You know? I'm not going to make them
13:40
ejaculate more. With that being said,
13:42
ejaculating and masturbating and being with loved ones and
13:45
partners is one of the best ways for us to cope.
13:48
Yeah, I love that answer. But I'm also very sex positive.
13:52
Right. Which I think is why people love
13:55
you for real. So, you know, I do have some
13:58
patients that practice celibacy and those are more challenging
14:02
conversations for me to have. And then and that's where I
14:05
actually, there's one patient that I have, we have every other
14:08
week sessions where I meet with him and a sex therapist on a
14:10
call. And the two of us, me and the
14:13
sex therapist, we're both very sex positive.
14:15
And so talking to someone who wants to be celibate is kind of
14:18
a bit of a dance. Now we're exploring different
14:20
ways for him to experience celibacy but still engage in
14:25
masturbatory exercises, but just not with a partner.
14:29
So I think even the sea has a lot of different layers.
14:32
Oh definitely, I love that you brought that up about
14:34
collaborating with the sex therapist.
14:36
How important do you think cross collaboration is among
14:39
professionals? Oh, my gosh, It's everything.
14:42
I used to work in a big academic center, and a lot of my
14:45
colleagues do. And I think a lot of patients
14:48
assume that if we work under a single roof, that we all talk to
14:52
each other. And reality is oftentimes the
14:54
more providers there are, the less we communicate.
14:57
Yeah, more so communicating through our notes, which some
15:00
providers, their notes are better or worse than others.
15:03
So I've actually found it easier being in my own practice now
15:06
that I have all these different collaborations with people and I
15:09
have their cell phone numbers in my phone.
15:12
So if we have a mutual patient, I can easily communicate with
15:16
that provider to talk through something.
15:18
But I love with this complicated patient.
15:20
I have the patient who practices celibacy.
15:22
I love that most of the times that we meet, I'm meeting with
15:25
the sex therapist because she meets with him way more
15:27
frequently. She has much more context than I
15:31
will ever have, right? So she can sort of get me up to
15:33
speed and then we can all talk through this.
15:36
But I think it's especially important for more complex
15:38
patients. Yeah, I love that you said that
15:40
and I think that's incredible. I don't think I have ever had
15:43
providers collaborate with each other.
15:45
Well, I think, and especially if things aren't going well, like
15:47
if I'm struggling to help a patient, I think it's really
15:50
important that I can communicate back to let's say the referring
15:53
provider and just be like, hey, I think I've exhausted
15:56
everything that I can do. Because oftentimes when we refer
15:59
a patient to someone, we're assuming that provider is going
16:03
to take care of it, right? So if a patient has, let's say
16:05
urinary tract infections and we send them to, let's say a
16:08
gynecologist, that primary care doctor can check off their list,
16:11
OK, UTI's are taken care of because I made the referral to a
16:14
gynecologist or a urologist. The question becomes, is that
16:18
person taking care of that issue?
16:20
Or was that person even the appropriate person to send my
16:22
patients who just because you send them to the appropriate
16:25
specialty doesn't mean you're sending them to the appropriate
16:27
specialist. And so that communication,
16:30
especially if that person is still struggling, the patient,
16:33
is even more important. Oh, absolutely.
16:36
All right. Now I want to know when should
16:38
someone stop waiting it out and realize that their body is
16:42
asking for support? Especially with men, sometimes
16:45
this can happen. They're like, oh, it's fine, no
16:48
big deal. I'm just going to wait.
16:49
What are like some signs that they need to be seeking support?
16:52
That really hits on the topic, like when to worry and when to
16:55
wait. As a healthcare provider, they
16:57
have learned this, but it took me like 15 years to learn.
17:02
I will tell you, Michelle, that one of the most challenging
17:05
lessons I learned throughout my training was understanding and
17:10
picking up sick versus not sick. Because there's some people that
17:14
come in and they look totally fine and an hour later they are
17:18
sick and you're calling a rapid response, right?
17:21
But that takes a lot of clinical experience to understand when to
17:26
worry and when to wait. But I have a lot of patience and
17:29
I can sort of tease that out, right?
17:30
And I can see them a week later and say, how are you doing,
17:32
right? And then that adds to my
17:34
knowledge Bank of like, who does well and who doesn't.
17:37
It's much more challenging as a patient because they're an end
17:41
of one. They don't have anything to
17:42
compare to. So what I always think is a good
17:45
idea is to build your pit crew, build your A-Team before you
17:50
need their help. Because if you have a skin issue
17:54
or if you have a urologic issue, it's much more challenging to
17:58
get an appointment as a new patient than it is as a return
18:01
patient. So if you think about sort of
18:03
like all these different specialists that you may need
18:06
established care before you need them, so you're in their system.
18:10
That would be my first piece of advice.
18:12
And my second one is if you're worried and you need Peace of
18:16
Mind, that is reason enough to schedule a visit.
18:19
If you are completely healthy and you just want to learn more
18:22
about your body, how it works, and how it might not work at
18:26
some point in the future, I think that is reason enough to
18:29
schedule a visit. The problem, however, is that
18:32
our system is not set up that way, right?
18:35
Our system doesn't have well man's visits like it does well
18:38
woman's visits, you know. So now in my practice, I saw a
18:42
guy earlier today who scheduled a well man's visit.
18:45
He doesn't have any problems. He just wanted to come in, get
18:47
part of his executive physical, and we spoke about sex toys for
18:51
an hour, right? But Michelle, what's his
18:53
diagnosis? He has diagnosis.
18:55
You have nothing to type in. There's no.
18:57
ICD 10 code for him, right? He wants to live his best life
19:02
if he wants to continue being successful.
19:05
He wants to continue traveling and he wants to continue having
19:07
great sex and maybe even better sex.
19:09
That's his diagnosis. So I have a little bit of a
19:13
different perspective, I think because I like the well men's
19:16
visits. I like those wells.
19:18
I like the education visits, but oftentimes in healthcare, we
19:21
don't have time for those visits.
19:23
So I think as much as I want to encourage people to like build
19:27
their team, get the access, call up the doctor's office whenever
19:30
you have a question, the access is going to be the problem,
19:34
right? So I think my biggest piece of
19:35
advice is build your team ahead of time so at least you have a
19:38
number to call if you're concerned.
19:41
Absolutely. Are you curious about sexology?
19:44
Do you want to? Further integrate sexology into
19:47
your work or your life. Well, friends, then we've got
19:50
something just for you. It's called the sexology
19:53
practice. Guide and it walks.
19:55
You through the ways this shows up in your work in your life and
19:58
guides you through working within your scope, incorporating
20:02
intimacy and sexual health into your.
20:04
Work without starting over. Download this short practical
20:09
guide at sexologylab.com/guide. That's Sexology lab.com/guide,
20:16
and while you're here, make sure to subscribe and share.
20:19
And now back to the show. All right, now I want to talk
20:23
about something fun. Let's talk about sex toys.
20:26
So from a urologist perspective, how can sex toys actively
20:31
support sexual health, pleasure and orgasm quality for men?
20:35
I don't think we talk enough about men's sex toys.
20:38
We don't, as one of your recent conferences, you had Doctor Evan
20:43
Goldstein on and that guy is just so freaking awesome.
20:46
And he talks about the use of different sexual Wellness
20:49
products and dilators to optimize anal health as well as
20:53
anal penetration. Right.
20:54
And to do that comfortably, as part of his discussion, he was
20:57
talking about prostate play and prostate pleasure.
21:00
And I was thinking about this from a urologist perspective.
21:03
And I had this epiphany. Michelle, I want to share it
21:06
with you. Yes.
21:07
OK. This is my epiphany As
21:09
urologist, we are trained in prostate pathology.
21:13
We are trained that the prostate can get bigger and can cause
21:17
urinary symptoms. We're trained the prostate can
21:19
become inflamed and cause infection or different types of
21:23
pelvic pain syndromes. And we're talked that the
21:25
prostate can develop prostate cancer, right, which ends up
21:28
being one of the most commonly diagnosed cancers in adult men.
21:31
We are not taught about prostate pleasure.
21:34
How unfair is that? We are only specialist in bad
21:38
things that happen to the prostate.
21:39
The prostate always gets a bad reputation.
21:43
But we have not understood how do we counsel people on the
21:47
blessing that is the prostate, on the pleasure that prostate
21:51
stimulation can add to people's lives.
21:54
And I think that's a problem in our education.
21:56
I want to tell you the year of 2026, I am delving deep into
22:00
this. I've made it my mission to be a
22:03
master of prostate pleasure because we as urologists should
22:08
be experts in that. Like who's the expert in
22:11
prostate pleasure? I don't mean, I mean Doctor
22:14
Goldstein is essentially because he's a specialist in like the
22:18
rectum and he's really delved into that.
22:20
But like otherwise, I don't really know too many other
22:22
specialists that have really taken that on.
22:24
One of the most challenging conditions that I treat in my
22:28
male patients is when they have difficulty reaching climax or
22:32
they're unable to climax at all. And you know, the patient that I
22:36
saw earlier today was funny him, he was there with his wife and
22:39
they had this assumption that any man will just get off any
22:42
time that they're having sex. And I said that's actually not
22:45
true. Not every man can get off every
22:48
time. And again, the most challenging
22:50
patients I see are guys that can't.
22:52
And what research suggests is that prostate play can help men
22:57
who were unable to ejaculate, ejaculate.
22:59
But my biggest challenge is getting heterosexual men to play
23:04
with their prostate. That's where I think some of
23:06
that research has actually been helpful because instead of me
23:09
just telling a guy to put some toy up his butt, I can say
23:12
research which actually suggests that if you use something to
23:16
stimulate the prostate, it can help you reach climax.
23:19
So we're so focused on the penis in female sexual health.
23:22
We've expanded, right? We have Twitter nipple play,
23:26
clitoral, G spot anal. Like we've really expanded the
23:31
female space and the female toolbox.
23:33
And I think we need to do that for men.
23:35
This is a challenge too for toys for men.
23:37
There are a lot of fancy gadgets and I have yet to hear from
23:41
patients about what one that really helps them.
23:44
I have heard some amazing things about anal play and prostate
23:47
massagers though, so that's why I want to delve into it.
23:49
Oh, yeah, I love this. Yeah.
23:51
I mean, even for me, like finding experts to come share
23:55
knowledge, finding a Doctor Who specializes in a prostate play.
23:58
Now it's going to be Doctor Amy Pearlman, because 2026 is the
24:03
year of the prostate. I always try to stay relevant in
24:07
my field. And so like each year as I come
24:10
upon January, I legit ask myself, what can I contribute to
24:14
my field this year? What is something that I can
24:16
learn so that I can legitimately teach my colleagues something
24:20
new? So when I kind of thought more
24:23
about this prostate play, I think that's something that I
24:25
could learn more about so I can teach some of my colleagues.
24:28
All right. So this kind of goes with what
24:30
you were saying where a lot of men think that orgasms are
24:34
automatic. OK, So what actually determines
24:38
orgasm quality? That's a really great question.
24:42
I'm still trying to figure out whether or not this is the case,
24:45
that every orgasm is the same. And what I try to explain to
24:48
people is every orgasm feels a little bit different.
24:52
Someone is using, or if I'm using like a clitoral suction
24:54
device, like that feels different than if I use a magic
24:57
wand or if there's penetrative intercourse or anal intercourse.
25:00
You can orgasm in all these different settings and they all
25:04
feel slightly different in terms of intensity, but also in
25:07
quality. And sometimes it's like,
25:09
difficult to explain. And for men, when I ask them,
25:13
they tend to say that it's all the same.
25:16
But sometimes the intensities can vary.
25:19
But that's also why I'm trying to bring in more of this
25:22
prostate play because I want men to feel all the feels.
25:27
You know, I feel like there are different qualities and
25:31
intensities of orgasms that I just don't think a lot of men
25:34
have explored because I think they're so used to.
25:37
This is how I masturbate and this is how I have sex.
25:40
And so go to the two different ways that I orgasm.
25:44
Yeah. And I think if we expand this
25:45
more, I do think quality and intensity could be just as
25:49
variable potentially as women. Yeah.
25:51
Oh, for sure. It's like you mentioned with
25:53
women, there's so many different ways I think you can orgasm with
25:57
men. If we expand that, besides
25:59
penetration or masturbation, what are some other feelings
26:02
that you could feel and how great could that be?
26:05
Yeah. Now I will tell you this,
26:06
Michelle, as a urologist, we don't really learn about this
26:09
either either. A lot of guys that will come in
26:12
and say my orgasms are not quite what they used to be.
26:16
We don't have any treatments for them.
26:18
There are no treatments. We're so focused on purpose and
26:22
we're less focused on pleasure in the healthcare system.
26:26
And I think that's a problem. And I asked my patients, you
26:30
know, even if they're coming in for what seems to be a
26:32
completely unrelated issue, could be like a urinary symptom,
26:35
maybe they're coming in for a vasectomy is I'll ask them, do
26:38
you have any reduced sensation or reduced pleasure with orgasm?
26:41
Do you feel like you have muted orgasms?
26:44
Cause a lot of guys, they're not necessarily going to bring it
26:46
up. It just doesn't come to mind.
26:48
But they've noticed some of this difference.
26:49
It goes back to your question when to worry and when to worry.
26:52
And I think a lot of guys, when they do bring it up, a lot of
26:54
healthcare providers say, well, I mean, Sam, you're getting
26:57
older. But if there's something I can
26:58
do about it, then we might as well try.
27:01
Sometimes I'll use medications off label.
27:04
I'll use medications that are actually approved in
27:06
premenopausal women who have low libido, one of which was just
27:10
approved in postmenopausal women.
27:12
And I'll use them off label in men.
27:14
And they're generally well tolerated.
27:16
And sometimes they can help with orgasm.
27:18
We'll talk about prostate massagers, different vibrational
27:21
products. Right now I'm learning about the
27:24
orgasm quality because I think we've all assumed that either
27:27
it's just all or nothing, or we haven't actually asked our
27:31
patients. And I think like with many
27:33
things and sexual health, we need more research.
27:35
We need a whole study done on men's orgasm quality, you know?
27:40
And I think there's just so much room to explore things.
27:43
Well, the other piece too that I don't think a lot of people
27:46
realize, and certainly a lot of patients don't realize this is
27:49
that erection is different from orgasm, which is different from
27:53
ejaculation. So that's what, when I'm talking
27:56
to someone, sometimes they can have a great erection but not
27:59
have an orgasm or ejaculation. There are other guys that will
28:02
orgasm and not ejaculate, and there are other guys that will
28:05
ejaculate but not feel that pleasure of orgasm.
28:09
So often times in those conversations we use the term
28:11
ejaculation to also resemble orgasm, but they're actually two
28:15
different processes. That is so important for people
28:19
to know because I think it's very common just to lump it all
28:22
together. Now the other thing that I think
28:24
is really important to know too is we think about orgasm and
28:27
ejaculation. It is common as men get older
28:31
that the volume of ejaculate will go down OK.
28:34
And it is common when we put people on different medications
28:37
for urinary issues or to treat their prostate that that can
28:40
cause a reduction in their ejaculate volume.
28:43
What I never really considered until I actually interviewed 2
28:46
people that you've had on a lot of your digital platforms, Dr.
28:51
Josh Gonzalez and Doctor Brian Sykeser.
28:53
There were the company Pop Star Labs, and they've noticed that
28:56
when they can increase the ejaculate volume with one of the
28:59
supplements that they have, they've actually had people say
29:02
their orgasm quality is better, right?
29:04
Because in order to get more of that volume out, your body needs
29:08
to have more pressure to actually expel that volume out.
29:11
I think it's a very interesting concept, one that I'm also going
29:14
to delve into in 2026. I've heard that for women there
29:18
was also a study published that edging can increase orgasm
29:22
quality. Do you think that's the same for
29:23
men? I haven't really delved into
29:25
this much. I will say I see a lot of guys
29:28
that have delayed ejaculation, as I mentioned before, right?
29:31
And so I think a lot of guys, what I'm seeing is when they
29:35
train their body to last a long period of time, let's say
29:38
they're training their body not to orgasm for let's say 45
29:41
minutes, then it can become challenging to orgasm within 10
29:46
minutes when they don't want to have sex for 45 minutes.
29:49
So I see a lot of guys that are used to lasting so long and then
29:53
five years later, let's say they don't want to last as long
29:56
anymore. They just, they want to have sex
29:57
for 20 minutes and they can't. It can become problematic
30:00
because they've trained their body to last longer.
30:03
Oh. That is so interesting, yeah.
30:05
Because you want that flexibility.
30:07
Like sometimes you don't have 45 minutes, you know?
30:10
I think it's helpful to train one's body to orgasm in a lot of
30:15
different circumstances, right? So you can train your body to
30:18
last maybe 45 minutes. But then also I think it's good
30:22
to train your body either with masturbation or when you're with
30:24
a partner, to orgasm within 10 minutes, right?
30:27
I think all the possibilities are great.
30:29
Now I have some patients that say, well, I want to be able to
30:33
climax with my partner without a toy.
30:36
Yeah. Which means when they're
30:38
masturbating, they need to train their body to climax in
30:41
different situations. It's all kind of building on
30:43
different ways that our brain is wired.
30:46
Yeah. And so is this something that
30:47
you've learned just by talking to people in your practice?
30:51
Has there ever been research done on like, neurologically,
30:55
like what goes on in your brain with their neural pathways when
30:58
you're masturbating, having intercourse and all that?
31:01
Oh. That's a good question.
31:02
You know, there are functional MRI studies that have been done
31:05
in women as they're masturbating, which is always
31:08
like your six study to read about.
31:10
I don't know that they've done those studies in men, quite
31:13
honestly. The Sexual Medicine Society of
31:15
North America or the SMS and a currently has a research
31:18
registry where we're trying to enroll patients who are coming
31:22
in with ejaculatory dysfunction because currently our guidelines
31:26
by the American Neurological Association for men with
31:29
ejaculatory issues are pretty bare bones.
31:33
We have different treatment options for premature
31:35
ejaculation, so we have options that can help men last longer,
31:39
although admittedly none of them are FDA approved.
31:41
To date, we really don't have great options for men who have
31:44
delayed ejaculation. So there are a lot of things
31:47
that people have tried, but that's where we definitely need
31:50
more research is in the delayed ejaculation space.
31:52
Yeah, definitely. Yeah.
31:54
So much work to be done. That's my theme.
31:56
So much work to be done in this space.
31:58
All right, I want to wrap things up with some rapid fire
32:01
questions. All right.
32:02
Are you ready? What's one thing men need to
32:05
stop blaming themselves for sexually?
32:07
Erectile dysfunction. Yep, one habit quietly killing
32:12
sexual pleasure. Our egos.
32:14
One question everyone should ask the urologist but doesn't.
32:19
I don't have an answer to this one because I think it's not the
32:22
fault of like the patient but the fault of urologist not being
32:24
able to answer the question. All right, the most underrated
32:27
factor in great sex. Being able to fantasize.
32:30
I think curiosity and creativity are so important.
32:33
All right. So you recently presented with
32:35
Sexual Health Alliance and I was wondering if you could tell us a
32:37
little bit about your experience.
32:39
What did you think about presenting with Shaw?
32:41
Oh, I loved it. I would say that it was one of
32:45
the most engaged audiences I've ever presented to in my life,
32:52
and there were so many great questions.
32:55
I got a patient out of it that I saw last week.
32:58
I loved people, were very curious, and I felt like I was
33:04
able to give people tangible information and advice that they
33:08
can start implementing right away.
33:10
Yeah, well, I love that. I'm so glad you had a good
33:12
experience. We loved having you for sure.
33:14
Awesome. All right, I want to close it
33:17
out with a couple questions for you.
33:18
So if someone's listening to this and thinks, oh, this
33:21
episode is about me, there's lots of things that I need to
33:24
ask the urologist and I'm too embarrassed to ask.
33:27
What's the very first step you want them to take?
33:30
I would say to doctor shop, and I know a lot of my colleagues
33:34
are like, you know, we always say if a patient's seeing a
33:37
bunch of different providers, oh, that patient is doctor
33:39
shopping, doctor shop, right? Because if today's episode
33:43
resonates with you, the problem is a lot of urologists don't
33:48
necessarily have the time and or the interest or expertise in
33:52
having these nuanced conversations.
33:54
All right, A lot of urologists see 60 patients in a day.
33:57
You think they can talk about the nuances of toys and delayed
34:01
ejaculation and prostate pleasure.
34:04
So if you're seeing a urologist and you're not getting what you
34:08
need from that urologist, I would encourage you to see
34:11
another urologist urologist. I also would encourage you to go
34:15
down some online rabbit hole. So this is the second thing a
34:18
lot of people tell patients not to do, and I'm telling you to do
34:21
it right now. You want to come in prepared.
34:23
And in order to be prepared, you have to have some foundational
34:26
knowledge. So learn about some of the
34:28
basics online. There's a lot of good material
34:31
online, but don't be afraid that if you ask your urologist a
34:35
question and they say, oh, that's not true and This is why
34:38
that's OK, Not all the information you gather is going
34:40
to be true. That's one of our jobs, right?
34:42
My job is to tell you what's true and what's not based on the
34:45
research and my clinical experience, right?
34:47
That's part of the office visit #3 again, something that a lot
34:50
of people are told not to do. Have some conversations with
34:52
ChatGPT, right? I think ChatGPT has a really
34:56
good way of emphasizing some of the basic lifestyle factors that
35:01
can be really helpful, right? So if a patient says, what are
35:04
the five different ways that I can improve my erectile
35:06
function? ChatGPT in a very empathetic
35:09
way, way more than I could ever be empathetic.
35:12
He's going to educate that person on the importance of
35:14
nutrition and exercise and sleep management and stress
35:17
management, right? As well as some other medical
35:20
therapy. So it has a great way of having
35:23
some conversations again, to build some of that foundational
35:25
knowledge. So there are some people that
35:28
they're always going to want to use their insurance because hey,
35:30
we're paying a hell of a lot for it anyway.
35:32
We might as well go to providers that accept our insurance.
35:34
I totally get it. With that being said, sometimes
35:37
it's challenging to find the right experts when you're just
35:40
looking through an insurance model.
35:42
Absolutely. I could not agree more.
35:44
What is your boldest hope for the future of men's sexual
35:48
health? Care.
35:48
My boldest hope is delving into prostate pleasure, that the
35:53
prostate should not just get a bad reputation.
35:56
Urologist. We need to be experts not just
35:58
in prostate pathology, but experts in prostate pleasure.
36:02
Yes. Oh, I love it.
36:03
It's all about the pleasure. All right.
36:07
Well, thank you so much for being with us today, Doctor Amy
36:11
Pearlman. It was a joy.
36:13
Always a pleasure, good to see you.
36:15
You too. All right.
36:16
Bye everyone. Don't forget to subscribe on
36:20
YouTube, Spotify, Apple or wherever you listen.
36:25
Links are in the. Description below.