Bonus Episode: When the Going Gets Tough, We Get You Going -Dr. Mistry and Donna Lee on Difficulty Ejaculating, Retrograde Ejaculation, and Anorgasmia

In this episode, Dr. Mistry and Donna Lee answer listener questions on erectile dysfunction and orgasmic dysfunction. Whether you have difficulty getting an erection, maintaining an erection, or achieving orgasm, this episode is for you! Dr. Mistry explains the different factors that contribute to these and other conditions, including retrograde ejaculation--a condition when semen makes its way into the bladder rather  than coming out of the head of the penis during ejaculation. While this is pretty harmless to the male body, it can impact sexual performance and even point to underlying conditions such as nerve damage or high blood sugar levels. Fortunately, NAU Urology Specialists offers an holistic approach to urology, utilizing medication, surgery, pelvic floor physical therapy, sex therapy, and more to get you back in action! If you or a loved one are experiencing any of these conditions or other forms of sexual dysfunction, call or visit us online to schedule an appointment today.

Voted top Men's Health Podcast, Sex Therapy Podcast, and Prostate Cancer Podcast by FeedSpot

Dr. Mistry is a board-certified urologist and has been treating patients in the Austin and Greater Williamson County area since he started his private practice in 2007.

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Transcript

Speaker 1: 0:09

Welcome back to the Armor Men's Health Show with Dr. Mystery and Donna Lee.

Speaker 2: 0:15

Hello

Speaker 3: 0:16

And welcome back to The Armor Men's Health. I'm Dr . Mystery , your host here with my co-host Donnel Lee . That's

Speaker 4: 0:22

Right. I'm a board certified co-host in case the listener didn't know

Speaker 3: 0:25

Certifiable. Mm-hmm. <affirmative> , uh, for our award-winning self award perhaps , uh, given , uh, uh,

Speaker 4: 0:30

Show . The award is on my desk. I don't know why you have to gimme grief . It's an actual award, and I've got a little sticky note and said The Armor Men's Health Hour award-winning . And it's a little man too, by the way, on my desk. You've seen him.

Speaker 3: 0:40

That's right. It's like the Snowflake award that you give to , uh, to everybody.

Speaker 4: 0:44

That everybody wins

Speaker 3: 0:45

The U YMCA's.

Speaker 4: 0:46

Everybody on the show gets an award.

Speaker 3: 0:48

I'm a board certified urologist. This is a men's health show. We love getting questions from you. Mm-hmm . <affirmative> on a variety of men's health topics. You know, interestingly enough, a lot of our topics are about erections,

Speaker 4: 0:58

<laugh> , uh, most of them.

Speaker 3: 1:00

I , I would love a question every so often about how to manage my cholesterol better. <laugh>,

Speaker 4: 1:04

<laugh> .

Speaker 3: 1:06

Well , or I'm having an atypical arrhythmia, or I have gerd, or I have sleep . I have any one of 'em . But No, no, every , it's pretty much, it's pretty much about the erections.

Speaker 4: 1:14

Erections or the flp , which is a funny looking penis.

Speaker 3: 1:18

I will say that that focus we have on kind of the function of our main man down there really, really seems to ruin , uh, I'm sorry, run, run, run. Not ruin, but run our lives , um,

Speaker 4: 1:30

And ruin some from ,

Speaker 3: 1:31

From , from 12 years old all the way until death. I , I'm always amazed, even those men who are in their seventies and eighties when, you know, they haven't been able to have an erection for a decade and you bring up the possibility of maybe getting an erection back and

Speaker 4: 1:45

They get all excited.

Speaker 3: 1:45

He's like, yeah, yeah . Maybe, you know ,

Speaker 4: 1:48

<laugh> ,

Speaker 3: 1:50

It's like having a hammer and no nail. But , uh, oh, no. But we love, we love patients that are having problems that they've had a difficult time addressing with other doctors to come in and feel a sense of that they're being listened to and they're being given the very best of what we have to offer. We had a great topic on this issue that comes up is the topic of anorgasmia hypo orgasm. And this week , uh, I had a fertility patient with that same problem. He was a , a man in his fifties and is having trouble getting pregnant cause

Speaker 4: 2:22

He is a man

Speaker 3: 2:23

<laugh> and That's correct. He said , having trouble getting his spouse pregnant. He's

Speaker 4: 2:27

Like, when I had the prostate at the last segment, <laugh> ,

Speaker 3: 2:31

Oh man, you are the funny one. This, this group , you

Speaker 4: 2:33

Know , I really am ,

Speaker 3: 2:34

Uh , he , he has, he's 50 years old, he's a diabetic and reports difficulty with. His problem is a combination of two problems. One is that his diabetes has caused a condition called retrograde. Mm-hmm. <affirmative>, where when he the semen goes into his bladder, that's a consequence of nerve damage caused by the diabetes.

Speaker 4: 2:56

Oh, I didn't know that. But then

Speaker 3: 2:57

There's this other problem, people having tru trouble getting an orgasm. Right. When it happens with women, we usually classify it as primary or secondary. Crazy . Oh , sorry, <laugh> . No , I dunno . <laugh> either. It's always been the case or just started being the case. Right. And unfortunately, a lot of women were just kind of told to, you know, I it up , don't know , drink some wine or whatever because

Speaker 4: 3:17

Maybe relax a little, maybe

Speaker 3: 3:18

Relax a

Speaker 4: 3:18

Little stop being so crazy or whatever . Obsessive,

Speaker 3: 3:20

Whatever , whatever it is that Michael is , is , is unfortunately told to women, which is completely unscientific way of dealing with

Speaker 4: 3:28

It. <laugh> ,

Speaker 3: 3:28

You think . And so and so, the same kind of internal processes that result in an orgasm in a man are the same ones that activate in a woman's, although I'm not gonna speak about angas and women. Uh , but if you do have that problem, it's certainly something that we have a lot of experience and success with dealing with a man ,

Speaker 4: 3:45

A sex therapist.

Speaker 3: 3:46

That's right. If, if , if that's the problem. Right . But oftentimes there's a biological underpinning. Right? Right. So in a man, especially one that was getting orgasms before and now no longer mm-hmm. <affirmative>, we really have to figure out what is that neurologic or hormonal piece that got dislodged. Low testosterone can contribute to that. Then you have , uh, a variety of nervous system conditions. Diabetes would be the classic one that diminishes penile sensitivity, makes it harder to orgasm. But there also can be other things. People can have pelvic fractures. We had one , uh, patient this week that had a , um, a motorcycle accident mm-hmm. <affirmative>, and ever since his motorcycle accident, he's been able to , uh, unable to orgasm. Oh. And that's, and we did some testing called vibratory and temperature stimulation testing of the penis. Mm-hmm. <affirmative>. And what we realized was that his penile vibratory stimulation , uh, is much diminished. So he requires a lot more stimulation Oh, wow. Than you would otherwise. We got him Aix with a , um, this , this wonderful ring that , uh, gets applied to the base of the penis that vibrates during intercourse. Really? And that thing fixed him up. He won't, he won't stop it , he won't leave home without it. He loves that thing. <laugh>,

Speaker 4: 4:51

He's walking around with it on all the time. <laugh> smiling. So ,

Speaker 3: 4:54

So it's just an example of how, you know, really trying to find what is the underlying, and maybe we can't fix nerves that are broken. Right . But we can find , uh, tools that can help you overcome them.

Speaker 4: 5:05

This is a dumb question, but it's , I can't stop thinking about it. What's the correlation with diabetes and the retrograde? How does that sync up?

Speaker 3: 5:12

That's a great question. So , um, the way that semen is emitted from our penis mm-hmm. <affirmative> , is that first when the orgasm happens, the semen is, is is placed from the prostate into the urethra, the two b p from mm-hmm. <affirmative>, now that, that whole up from has two openings. One that goes up into the bladder mm-hmm . <affirmative> , and one that goes out the head of the penis mm-hmm. <affirmative> so that the bladder opening has to close. It's called the bladder neck has to close so that the everything can only goes out , goes out one end mm-hmm. <affirmative>, but in diabetes, that bladder neck closure doesn't occur. And so why It , because the , the nerve damage that excess blood sugar causes mm-hmm. <affirmative> causes that nerve to not , not regulate properly. And so it's similar to the nerve damage that's gonna cause pain in the feet. It can cause a diminished sensation in hands and feet. Oh. This neuropathy can also affect the bladder neck. Oh . And so when that happens , um, the semen preferentially travels the one centimeter into the bladder as opposed to making the six centimeter. In some men , uh, <laugh> , <laugh> travel down the urethra. H how , at the end of that wishful thinking that's right out the end of the penis. And so , um, those men cannot get pregnant, which may not affect a 65 year old guy who doesn't care about getting pregnant. Does

Speaker 4: 6:25

It feel the same?

Speaker 3: 6:26

The orgasm feels the same. Okay. But there's no show and that that bothers a lot of people . It doesn't bother a lot of guys. It's the same side effect that you'll see with Flomax or Tamsulosin that people take for bph mm-hmm. <affirmative>. So , uh, even though, and I, I I'll tell you , I'm not a diabetic and I, I don't take Flomax, so I'm , I can only say what is reported in the literature, which is that it should not change or orgasmic strength, but, but undeniably there are gonna be people who it does. Right. So a classic example of a medicine that it caused this problem in is rapa flow or SIL doin . Mm-hmm. <affirmative>. So that's a medicine that we were using very frequently for , um, for bph. And I was later just completely convinced that it, that it led to a diminished or orgasm to the point that I was prescribing it to men with premature with success. Really? That's right. And then it , it later went into study, I think I , I think I kicked that off. Oh , <laugh>. Um, so , uh, anorgasmia is maybe something that would benefit from nerve testing. Mm-hmm. <affirmative>, we also use a medication called Yohimbine . Mm-hmm. <affirmative> . And we use a medicine called Carboline , uh, bless , bless you . Or Dossin X

Speaker 4: 7:31

Is he Yo , him being a supplement or It's an actual

Speaker 3: 7:33

Prescription? Yohi being's an actual prescription. Oh, okay. Uh , and sounds like a supplement from , and the Cabergoline is also a medication, it is a , a African free route . In fact , <laugh> , uh, and so smarter

Speaker 4: 7:43

Than a look,

Speaker 3: 7:43

But we use something that's highly refined. We can get it at multiple different compounding pharmacies. Mm-hmm. <affirmative> . And if you want to come in and describe or, or , um, kind of get treated for an anorgasmia or hypo orgasm condition if it just takes a long time mm-hmm . <affirmative> to get there. I mean, you know, it wouldn't be a , you wouldn't complain about it if it wasn't a problem. <laugh> . I mean, you know . Right. Nobody wants this to be work or the

Speaker 4: 8:07

Wife is

Speaker 3: 8:07

Complaining. Yeah . Nobody wants it to , could you just be done already?

Speaker 4: 8:10

<laugh> , I have dishes,

Speaker 3: 8:11

I got dishes in , I got some laundry, hands of laundry or something. Uh , so, but , um, but especially for the couple trying to get pregnant, for example, or , um, the couple where there's lots of vaginal dryness issues. I mean, it , it can make sex a real chore and not fun. And the guys that come to us, they are generally very satisfied with , uh, our treatment approach. Mm-hmm. <affirmative> , um, we do in patients with severe nerve injuries, use a lot of , um, uh, vibrator therapy. Mm-hmm. <affirmative>, and, you know, you know what? The vibrator of choices,

Speaker 4: 8:40

The fleshlight? No.

Speaker 3: 8:41

Oh,

Speaker 4: 8:42

It used to be .

Speaker 3: 8:42

No, no, that's the peanut, that's the vaginal

Speaker 4: 8:44

Prosthetic. Oh , that's , oh, that's right. Sorry. Vibrator of choice. The , the rabbit,

Speaker 3: 8:48

The Hitachi magic wand. Oh,

Speaker 4: 8:51

I've not heard of that. Hitachi makes me think of an oven.

Speaker 3: 8:53

That's correct. <laugh> . It shouldn't blend . I don't think they make blender of those things.

Speaker 4: 8:58

A caner

Speaker 3: 8:59

Maybe.

Speaker 4: 9:00

Or a tv.

Speaker 3: 9:01

Whenever I think of Hitachi, I think about vibrators. And so I never, the Hitachi magic wand is the quintessential a people Google it. Uh , one size fits all . Uh , it has, it has hundreds of attachments you can attach to the head . Right ? Yes. It's amazing.

Speaker 4: 9:14

Oh my

Speaker 3: 9:15

Goodness. It's amazing. From the , from , from the mild to the surreal. Well, reach out to

Speaker 4: 9:18

Us. Maybe the person who emails us first is the winner of a new Hitachi can opener .

Speaker 3: 9:24

It's , it's one of the few things I can't keep here on the shelves, because I think our staff keeps stealing the Hitachi magic wand. The biggest problem is not wireless. So you gotta be near an outlet. Stop it. But you're gonna find that this , uh, oh

Speaker 4: 9:36

Look , I in Hitachi,

Speaker 3: 9:37

Please don't do that

Speaker 4: 9:38

Before I finished it . The magic wand, the show right off on

Speaker 3: 9:40

Google Show . Not, not right now. Oh ,

Speaker 4: 9:42

I got to look at it now.

Speaker 3: 9:43

Well, if you're having any problems with orgasm and wanna learn more about , um, you know , kind of our approach to therapeutically introducing , um, these types of tools into your sex life to enhance it, please let us know. It's a wonderful , um, opportunity for you to get advice from people who know Donna, how do people get ahold of us?

Speaker 4: 10:02

People who know things like Dr . Mystery knows about this Hitachi thing. Yes. And just Googled it. Google it. Um, you can call us during the week at 5 1 2 2 3 8 0 7 6 2. Our email address is armour mens health gmail.com and our website is <laugh> armour mens health.com . So please send us your emails, we'll answer them all anonymously. Um, I promise they're really good questions. So , armor mens health gmail.com.

Speaker 1: 10:27

The Armor Men's Health Show is brought to you by N AAU Urology Specialist. For questions or to schedule an appointment, please call 5 1 2 2 3 8 0 7 6 2 or online@armormenshealth.com.