Ep #60: Erectile Dysfunction, Peyronie’s Disease and Premature Ejaculation with Kelly Casperson

The Midlife Sex Coach for Women Podcast with Dr. Sonia Wright | Erectile Dysfunction, Peyronie’s Disease and Premature Ejaculation with Kelly CaspersonThe majority of my episodes focus on my vulva-owning Diamonds but this week I’m here for you – my penis-owning Diamonds. I am super excited about introducing you to my guest today because she’s joining me to talk about issues that penis-owners may be dealing with.

Dr. Kelly Casperson is a life coach and board-certified urologist and she joins me this week to share her experience of why people might visit a urologist, and everything you need to know about the issues that penis-owners may face.

Join us this week to hear Kelly’s invaluable insight into issues that penis-owners face such as erectile dysfunction, Peyronie’s Disease, and premature ejaculation. We’re discussing what these are, treatments for them, and the thoughts that penis-owners and partners might have as well as how to address them.

How is your sex life? If you rated it on a scale from 1 to 10, is it less than an 8? If so, we need to talk. I’m inviting you to check out my new 30-day program Your Empowered Sexuality (YES!). We’ll give you the sexual tune-up you need to kickstart your intimacy and create the sex life that you deserve, whether you have a partner or not. Click here for more information!

 

What You’ll Learn from this Episode:
  • How lifestyle can affect erectile dysfunction.
  • Some options available to you if you are experiencing erectile dysfunction.
  • Why you get to define what your sexual intimacy looks like.
  • Some of the treatments available for issues faced by penis-owners.
  • What Peyronie’s Disease is and how it is treated.
  • Some of the reasons men come to urologists.
  • Why facing these issues is nothing to be ashamed of.
Listen to the Full Episode:

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Full Episode Transcript:

Welcome to The Midlife Sex Coach for Women™ Podcast, the only show that combines a fun personality, medical knowledge, sexual counseling, and life coaching together. To create unique sex coaching that helps busy women awaken their libidos, address intimacy issues, and learn how to express their sexuality for the rest of their days. Here is your host, certified life coach and sexual counselor, Dr. Sonia Wright.

Hello hello hello, Diamonds, this is Dr. Sonia. I am so happy to have you with me this week. This week we have a special guest and I was thinking about my male Diamonds. I think I couple months back I mentioned how my brother listens to my podcast and he said that he tells a lot of his male friends about my podcast so they can get a better understanding of women and sexuality just in general and how it has helped him. And that made me start thinking about my male Diamonds and my Diamonds just in general, and their partners, my male Diamonds,

I started thinking, what could I do to help? And of course, I have this amazing friend and she’s also a doctor, Dr. Kelly Casperson, and she’s a urologist which is a doctor that deals with male issues around the penis and urology. So I thought, I’m going to reach out to her and talk to her about the most common issues that men experience and just be able to talk about it and get it out there. I wanted to make sure that my Diamonds and my male Diamonds knew about what treatments are available, what are the most common conditions, and how urologists in generally trat these conditioned.

Specifically, I am not your doctor and Dr. Casperson is not your doctor, but we wanted to make sure that this general information got out and also, we just love talking. She is so amazing so I asked her to come on the podcast and talk to us further about issues so here we go.

Here is our conversation, enjoy Diamonds, and enjoy my male Diamonds too. Take care talk to you next week.

Sonia: Hello, hello, hello everybody. I am super excited about my next guest. I just think she is fabulous. We could talk all day about so many different subjects but she’s agreed to come on and talk to us about issues that penis owners may be dealing with. And so I’m going to let her introduce herself. I want to surprise you because I’m so excited about this. I think that this is going to be such a great interview. So Dr. Kelly Casperson, tell us everything about you and then let’s start talking about penis owners.

Kelly: Awesome. Well, thanks for having me. I am a board certified urologist. I just got certified literally today by the North American Menopause Society. I know we’re not talking about menopause owners, we’re talking about penis owners but they sometimes can be the same people. So it’s a broad spectrum of interest because urology really is dedicated to male sexual function.

And a couple of years ago I realized nobody was taking care of the vulva owners or the women who were sleeping with the people with the penises. So I kind of just decided to become more comprehensive and be able to help everybody in their relationship, so I’m glad to be here. I feel like we could talk all day. We just giggle in between serious conversations.

Sonia: Yeah, I agree. I agree. This is going to be so much fun. And so let’s just start talking about penis owners and what they have to deal with. So myself, I’m the midlife sex coach for women and I do focus more on the vulva owners out there. And some of them may be engaged with penis owners and some of them are not.

For the ones that are partnered with penis owners and have been dealing with some of the issues that penis owners may have to deal with like erectile dysfunction, and premature ejaculation, and other things that are out there that you know much more than I know about. But I come to you because one thing that I hear quite a bit about women in midlife is that they’re dealing with their partners – some of their partners, if the partner is male and a penis owner that is dealing with erectile dysfunction.

So I just wanted to start right there in terms of if you can explain what it is and then maybe we’ll talk a little bit more about treatments. And then because I know you’re a life coach as well I really want to look at thoughts that penis owners may have when they’re having erection difficulties and how we could address those thoughts. So I guess the first thing is, tell me all about erectile dysfunction.

Kelly: Yeah. So erectile dysfunction actually before Viagra, so we’ll do a little history in medicine class. Viagra came out in the late 1980s ballpark. So before Viagra came out, we thought all erection problems were psychological. We thought it was all in your head, that’s the only reason that your penis wouldn’t work. And that’s really how everybody was treated. Then we developed a medication which we call Viagra and all of its cousins’ work by increasing blood flow into the penis, that’s what brings the erection in.

So we realized this is actually more of a vascular problem or a blood flow problem. We know that erectile dysfunction now is kind of a harbinger or the canary in the coalmine for heart disease and vascular disease. I think if we put on cigarette packages that smoking cigarettes causes your penis not to work that would be fantastic antismoking marketing.

But what we’ve done in kind of moving it to a more biologic reasoning behind it is we’ve kind of ignored or neglected that the penis is still controlled by the brain is the biggest sex organ and there is still psychological erectile dysfunction. Whether that’s anxiety, or feelings of shame, or inadequacy, or just nervousness and anxiety, there are other reasons that the penis just might not want to perform when the owner wants it to perform.

Sonia: Great, okay. So the kind of a baseline concept that it can be psychological in nature but also a big component of it is cardiovascular or vascular in nature in terms of blood flow getting into the penis. So as a urologist, what are different treatments? And the reason I’m asking you this and I know you’re not specifically anybody out that’s listening to this call or watching this, you’re not specifically their doctor. I’m not their doctor, you’re not their doctor. But I feel like it’s hard for some of my Diamonds’ partners to go and see a urologist.

They don’t know what would happen when they go to see urologists. They don’t necessarily know what treatments are available. And so if we could at least give some general knowledge that’s out there to people in terms of what might possibly be different options or what happens. What would happen if they go into a urologist office? That’s kind of the first thing. Okay, they have to take their clothes off. Well, let’s break it down in some basic things and then also just some general knowledge about what type of treatments are available.

Kelly: Yeah. So first people should know is that urologists, this is our bread and butter. It’s like going to a neurologist for headaches, is you go to a urologist for erectile problems. I would say universally most urologist are comfortable talking about this. They all know what the treatment options are. So it’s almost normalizing it, that that’s the place to go to do with erections. Primary care doctors are also, I think, pretty good in the basics, erections 101 and can kind of get you started.

The first thing I’m going to do is go over your health history, see what medications you’re on. Medications can cause erection problems and then see what your cardiovascular risk factors are. Do you have high cholesterol? Do you have an elevated, what we call central adiposity or a lot of extra weight in the midsection? Which is an increased risk for metabolic syndrome, cardiovascular disease, smoking, diabetes, poor sleep. We might check your testosterone to see if any hormones are an issue.

We might do a prostate exam, do a prostate specific allergen screen for prostate cancer, kind of go over the comprehensive male panel. So it’s not a lot of bloodwork. It’s usually a penis exam just to make sure nothing is in the way, or there’s scar tissue, or any sort of abnormality. So it’s really history, physical, maybe a little bit of bloodwork. And then we talk about optimizing any of your risk factors. So stop smoking, manage your diabetes well, blood pressure control. Sadly, blood pressure control meds can cause sexual problems.

But really optimizing and educating guys that their health really does matter in preserving the longevity of the function of their penis. And a lot of guys do not know that.

Sonia: Okay. So when you come in, you’re going to be talking to them for a period of time, going over some history, and then there’s going to be a physical examination as well?

Kelly: Yeah. And sometimes some bloodwork to check either a testosterone or a PSA which is prostate cancer screening.

Sonia: Okay. And then with this testosterone, if you’re talking to a man in their 40s, 50s, 60s, what should we know about testosterone levels?

Kelly: Well, there’s a lot, so testosterone levels will naturally decline with age, that’s pretty common. But what a lot of guys don’t know is the life that they’re living can influence their hormones. Again, bad sleep cycles, drinking alcohol, smoking marijuana or cigarettes, lack of physical exercise, especially muscle building exercise. All of that can really affect a man’s testosterone. So we’ll talk about lifestyle changes and we’ll recheck the testosterone in three months, see if he brought it up a little bit, without putting anybody on supplemental testosterone.

The other thing on that is erections and testosterone aren’t a one-to-one correlation. So you could have low testosterone with a great sex life, great erections. You can have erectile dysfunction, low libido and have a normal testosterone. So it’s not as easy as a black and white picture on this. There’s all different variations.

Sonia: So when you think about testosterone is there something that jumps out at you in terms of, I’d better check this person’s testosterone? And if somebody comes with low libido, what is it that makes you think I’d better check the testosterone?

Kelly: For me it’s more just kind of a screening test. To be like, is your hormonal access working well? That’s really about it.

Sonia: So once you diagnose ED, what do you do then at that point in time? What options are available?

Kelly: So the first options are just lifestyle, increasing your physical activity if that’s reasonable for you, decreasing smoking, losing extra adipose tissue weight. Just to kind of get the body, the penis is kind of like, again, canary in the coalmine. It’s kind of the bellwether of how the body’s functioning. And so it’s to get the body functioning as best we can if it’s possible to do that. So lifestyle choices, number one, modifying risk factors. And then number two would be to try the Viagra or the Viagra cousins out there. They really work to increase blood flow to the penis.

Sonia: Okay, great. So what is this about adipose tissue and weight?

Kelly: So central adiposity. So adipose tissue actually has something called aromatase, it produces aromatase. So it will convert your testosterone to estrogen. So it can affect again that hormonal, we think adipose tissue is a hormonally active organ and it does affect hormones.

Sonia: Okay, so that’s great to know and to understand that the more weight we have, and it tends to be weight around our abdomen, or for penis owners it’s weight around the abdomen that can affect them?

Kelly: Yes, the central adiposity. And then conversely, people don’t know also that muscles are metabolically active. And the more we do weightlifting activities and increase our muscle mass we can raise our testosterone that way.

Sonia: Okay. So we would look at lifestyle first?

Kelly: Lifestyle first.

Sonia: Alright. So once we get the lifestyle stuff in order, then and maybe things haven’t specifically changed, then what other options are there?

Kelly: Yeah. So it’s PD5 inhibitors is the class of drugs, the Viagra, Cialis, Levitra. There’s a couple of other ones now that are on the market. And what they do is you usually take them about an hour before sexual activity. They don’t act like light switches, you still need sexual stimulation. But they do work to allow more blood flow into the penis.

Sonia: And so what about the ones that are like the slow release that are over an extended period of time versus the ones that you would take an hour before or would you take both? I mean what’s that about?

Kelly: Yeah. So you really don’t take both. We usually don’t pile them up on each other. They’re kind of all just cousins, they kind of act similarly. There’s the weekender, they just have a longer duration of action versus short acting. There’s a sublingual one that works pretty quick. So it’s kind of different. I usually go with what’s generic and cheap which is Viagra’s generic now, it’s called Sildenafil. So I tend to just go with the cheapest option.

Sonia: But it’s interesting that they have the weekender, you have plans.

Kelly: Yeah. I’d say it allows more spontaneity. You don’t have to be like, “Are we going to do it in an hour so I can take my pill?”

Sonia: Right, okay. So we’ve got lifestyle. We have pills. And then what other options are available?

Kelly: So the next step up and saying that didn’t work, that didn’t work, what’s the next step is penile injection therapy. And so you can either get a compounded combo of meds or there are some prescription brand name ones. And it’s an injector, kind of like a diabetic needle. And you inject it in the base of the penis on the sides, at 3 o’clock or 9 o’clock. And it works immediately, again, bringing blood flow into the penis.

Pretty effective, I’d say studies say it works better than the pills. But your barrier is being comfortable or your partner being comfortable with doing an injection in your penis.

Sonia: Right. And so how well have men received that? You’re talking to the penis owners and you’re just saying, “Okay, I’m going to – you have an option of an injection.” What percentage of people are like, “Oh, this sounds like a decent idea?” And what percentage would be like, “Yeah, no, never?”

Kelly: I’d say in my practice about 50/50. Some guys are like, “Whatever.” “No, it’s not – a needle’s not worth an erection.” And some guys are like, “Yeah, an erection at any price, let’s do this.” So it’s been around for a long time, it’s not new. But I think just the comfort of that for some guys, they’re not willing to go there, which I understand. I’m not sure I’d put a needle in my clitoris but it’s an option.

Sonia: It is an option and then it would just depend, right?

Kelly: Yeah. So I mean certainly I acknowledge that some guys don’t want to do that and that’s perfectly fine. The other, before we get to the surgery, the other option, you can do a penis pump which is basically a cylinder that goes on top of the penis. It’s basically like a vacuum erection device is what they call it, a VED. And you pump it, basically we pull, it pulls the blood into the penis and then you put a band around the base of the penis to hold that blood flow in.

A lot of guys feel like that it kind of feels unnatural or the penis kind of feels cool to the touch. They don’t like the kind of artificialness of it. But it’s cheap, it’s around – you can usually find them in a sex store. There are some prescriptions for it. But that’s been around for a while. I can’t tell you I have a lot of enthusiastic guys with that but maybe some other people do.

Sonia: Because I’ve worked in a sex toy store, I mean we did have that available in the sex toy store. And some people were interested. They would come in and ask us about the pumps and we would discuss it and show the different options that are available. So being on the other side of things, people would come in and they would ask about it. But I’m not sure what percentage in terms of the urologist talking about it versus people coming in and actually wanting to utilize it.

Since I have you here captive, can you talk a little bit about a cock ring because this is something else, we would end up selling in the store? And I’m always like, “Be aware, if it feels uncomfortable or what things.” But what things would people need to be aware of if they’re going to be considering using a cock ring?

Kelly: Well, my first rule is never metal. They do sell, I think that you should not ever sell a metal cock ring but they do sell them. The problem being you get an engorged penis, you can’t get it off and then number one, you have to go to the hospital to get it cut off. It’s happened to me. I’ve been in that scenario in the hospital, you can’t get it off. So to me I’m like silicone, rubber, plastic, whatever, just not metal, just for your safety and to not meet your local urologist in the ER at 2:00am. That’s my only real warning about cock rings.

A lot of people who don’t have erectile dysfunction will use it just because they think it gives them a little more stiffness or they like the feeling of the – it almost keeps more blood flow in there. So they like the sensation of it. They think it really kind of enhances an erection. So certainly you don’t need to have erectile dysfunction to like to use a cock ring.

Sonia: Is there any things they need to be concerned about in terms of – obviously make sure they can come back off. But is there – do you normally have rules like don’t use it longer than an hour or two or anything like that or is it just look at your penis and see what it’s doing?

Kelly: Yeah. If there’s any discoloration, certainly lack of sensation, you worry about a nerve injury. So I would say, use it as little as you need to and don’t fall asleep with it on.

Sonia: That sounds like very good advice.

Kelly: A good code of conduct. I would say the other thing is actually buy something that’s meant for that because in the urology department we see all the things that people use as makeshift cock rings and that tends to go poorly. So I’ve seen the – if you unscrew a soda – plastic soda top, there’s the bottom plastic band that you unscrew. I’ve seen that used as a cock ring, that went poorly. I have seen high grade motorcycle, automotive steel rings used, that goes poorly. So I’d buy something that’s manufactured for it. That would be my other advice.

Sonia: Yeah, you’re blowing my mind, as a person that works in a sex toy store, I’m just like, you just go into the sex toy store and there’s so many of them. But it’s the perspective that people may choose to – maybe they don’t have something at hand or they don’t have access to it, or they’re not sure what to do. And so they are – they don’t feel comfortable going into the store so they choose to come up with another plan, which sounds good at the time but then yeah, it may not be the safest option.

So everybody that’s listening to this, there are cock rings available, you can get them online, in stores as well. So yes, use something that is meant for this purpose, I think that’s some excellent ideas.

Kelly: I feel like in my future I should just be some sort of consultant for the product industry of you’ve got to make these safe, people.

Sonia: Exactly. So if you’re past the not using cock rings, then what level do you get to next in terms of erectile dysfunction?

Kelly: So the next step is surgical. Surgical tends to be the end of the line, meaning once you get to the point of an implant, if you had to take it out for any reason, you’re not going to have any remaining natural erectile function left. So we tend to save that for people who really have a lack of erection status because if you were to ever take out an implant because of how you have to put it in. So it goes in actually, it sits in the erection bodies, the corpora cavernosa of the penis. And so in doing that, if you were to ever have to take it out you don’t have any natural erection left.

So we usually save it, you don’t get it unless you’re already kind of at that point, if that makes sense. Outpatient surgery, people do very well, it’s been around for at least a decade, probably two decades at least. And most people are very satisfied with it. I think people who aren’t satisfied with their surgery they either haven’t communicated with their partner about what their partner actually wants. And is their partner going to be engaging?

I think they just think it’s going to solve all the relationship problems. So I’ll see people unhappy there. Or unhappy in the sense that it doesn’t quite feel as natural as your erections did when you were 20. Because it is, it’s a fake erection but it actually looks pretty darned realistic these days. They have them so that it’s only erect when you use a pump. So it’s a very natural appearance. Unless you were with a urologist as your life partner, people really don’t notice you have a pump implanted.

Sonia: Okay, that’s great to know. Now if for some reason it fails or it needs to be replaced, can you replace it? Can you put another?

Kelly: Yeah, you can replace it. Because like anything we implant into our body to try to make our bodies improved in some way, there is a risk of it wearing out, or getting an infection, or it having a malfunction. So certainly it’s been around long enough now that there’s newer models and you can usually just get the newer model.

Sonia: Great. And how long do they normally last for?

Kelly: I have seen them last for 20 years. I think they give you – I don’t know accurate but I think they give you a 10 to 15 year lifespan on the newer ones.

Sonia: Okay, well, 10 to 15 years of fun and activity, that sounds like a good plan definitely.

Kelly: Pretty good.

Sonia: Okay. Anything else that you’d like to say about ED before we talk about another topic?

Kelly: Well, I think the thing I would want people to think about with ED is in all stereotype heterosexual sex here is we’ve narrowed it so narrow to penis and vagina sex that when something goes wrong the whole relationship of sex goes out the window. Because we’ve just made sex about putting an erect penis in the vagina. And so I always say with people is, “You know that’s not the only way to be intimate and to have sex.” And it kind of blows people’s minds because it was so narrow to begin with and then it doesn’t exist so it all fell apart.

And so I always think there’s a lot to unpack there when people think that’s the only way it has to happen and now we have nothing.

Sonia: Exactly, yeah. And I talk about the same thing as well in terms of you get to decide what your sexual intimacy needs to look like. It doesn’t have to be in one way. Penis and vagina or penetrative sex can be a lot of fun. But sexual intimacy is so much more than that. And if you have a limited definition, when something doesn’t go exactly the way you want it to then you’re kind of left with that’s all there is. But if you have a larger definition and you get to be creative with all this so I definitely love that as well.

Kelly: I think one last thing is we really define penis owners or manly-hood by their ability to have an erection. And how devastating that is for people when their definition includes the ability of their penis to have an erection. And it’s really something I want to acknowledge and respect, that it’s a really heavy weight on a lot of people. But then when we say, “Why are we defining somebody by the blood flow of an appendage?” You can actually be like, “Maybe that’s not the definition of what makes me a man or how I identify as a man or a human”, for that matter. So that’s always something kind of nice to talk about.

Sonia: Yeah, definitely, I love that. And I talk about that as well in terms of we are human beings, we’re people. And this I think is what stops a number of penis owners from going to see the doctor is this fear that they’re going to be told that there’s nothing that can be done. And really it’s an identity crisis that’s happening as well. It’s not just that there’s a part of the body that’s not functioning the way they would like it to.

It’s really about who am I if this is not working because society has decided that they’re going to define a man specifically as a person that has an erection. And if you don’t have an erection then are you manly? Who are you and what is your identity? So there’s a lot going on here and I definitely talk to my Diamonds about the fact that they have partners that are having erectile dysfunction, that they need to recognize that it’s not just a piece of equipment that’s not working. It’s their whole identity that can be involved here.

And this is why it become such a hot topic is there’s a matter of it really it’s about this person’s identity and the core of who they are and for some people. And so it may be something that you’d be like, “Well, why won’t you go to the doctor?” And not recognizing that there is this concern that if they go and they discuss this topic and there’s not necessarily a solution that this might be the end of who they are as a person. And so it’s definitely, yeah, something that people avoid, punish themselves for something that there can be a lot of help.

And that’s why I want to discuss this topic with you specifically because people will recognize the different options that are available.

Kelly: Absolutely.

Sonia: Okay. So what, besides erectile dysfunction, what do you think are some of the other reasons that men come to urologists?

Kelly: Well, I think two other conditions of the penis to know about, the first one would be Peyronie’s disease which is actually a curvature of the penis. And it can cause pain and it can actually cause difficulty with penetration so therefore your sex life. Most people don’t know what’s going on.

They haven’t heard of Peyronie’s disease, certainly it’s kind of a bit player compared to the amount of erectile dysfunction out there. But there are treatments. Some of them consist of just little injections and then straightening therapy at home that you can get at the urologist, to the point of actually excising the scar tissue that causes the bend. And then again, penile implant, again to straighten out the penis. So a lot of people don’t know about what Peyronie’s is. But if it’s painful, if it’s preventing penetration or difficulties with sex, it’s worth seeing a doctor for.

Sonia: And how does the scar tissue develop?

Kelly: We don’t really know. The theorists think it might be some microtrauma or kind of if there’s a little microtrauma from either repeated use or an injury. But most guys can’t remember back to a specific injury. I think some people actually they take offence at that. I had one guy and he’s like, “My doctor told me that my penis is bent because I had vigorous sex.” And he was actually quite upset that somebody had told him that because most people can’t remember what it was.

So we just think it’s maybe some microtrauma or in the way that some people’s collagen works, actually you can get contractures in your palm, called Dupuytren’s contractures and that’s associated with Peyronie’s disease of the penis. We think it’s kind of a related condition.

Sonia: That’s really interesting to get this information and to make sure that people are aware of this. And so is it 100% of the time, is it something acquired, you’re not necessarily born with this? This happens at some point?

Kelly: Just something that’s acquired.

Sonia: Yeah, okay. And then the treatment for that is usually surgery or injections?

Kelly: Yeah. So it comes in two phases. In the beginning it might be called – it’s a stage, it’s an unstable stage. So it might be getting better, it might be getting worse. So really people don’t treat it at that point because it might just resolve on its own and you don’t want to jump in too soon. So really to qualify for the injections or the surgery you have to have what they call stable disease for at least six months with a significant, you have to basically document the angle of the curvature. So you have to document it for insurance to say, “Yeah, you can get these treatments.”

Sonia: And so what does the shot do specifically, somehow it breaks up the scar tissue?

Kelly: Yeah, it’s collagenase, I’m not saying it perfectly right now. But basically you inject it into the adhesion or the scar and it kind of breaks it up.

Sonia: Is there anything else we need to know about Peyronie’s disease?

Kelly: Well, I don’t think so. I think it’s – a lot of guys don’t know what it is and just kind of having a name to it to understand what’s happening is part of the stress relief. And then no, some of it just gets better on its own but if it doesn’t, there’s treatments available.

Sonia: I think that’s really good for people to realize that there are treatments available for this. And then what’s the last one? You said that there’s another one that people tend to come to you for.

Kelly: Yeah, so the third one would be premature ejaculation. You can either be born with it and have premature ejaculation your whole life or you can have acquired premature ejaculation. So things were going well for a while but now all of a sudden you’re not able to control the length of time it takes you to have an orgasm or ejaculation. They have to define that timeline for research purposes, they usually say less than two minutes after vaginal penetration is the definition of that.

Other people will just say it’s before you want it to be, but I’d say within reason. If somebody’s like, “I used to last two hours and now I last 45 minutes.” People would be like, “I don’t know if that’s actually a dysfunction or not”, even though it causes you stress. But certainly for couples it’s very distressing, especially we know in heterosexual couples, stereotypically the woman takes longer to have her orgasm than the man does. So if he’s really taking a short time, I think the dynamics in the relationship can be a little stressful.

Sonia: Yeah. And then also we can add to that as well in terms of this has to do with penetration but we also know with women that it’s more than just penetration. So we also have to put the focus on the vulva region and some pleasure in there too so that people are not just thinking that okay, I’m going to extend this out and then she’d better have an orgasm now. Well, you have to understand that, yes, the penetration can be fun, but we also want to add in the stimulation to the vulva region, no matter how long you’re taking, dudes.

Kelly: I agree. I think it’s just like erectile dysfunction is like we have to expand our definition of sex. Because if we say, “Well, this is a problem.” It’s like, but she can actually have tons of pleasure without the penis ever being in the vagina. So really expanding the definition for people so that maybe you don’t need treatment. Maybe you just need to communicate about what she wants and what you want. And if you’re not distressed you don’t need to do anything about it.

Sonia: And but what if you do choose to have treatment, what types of options are available?

Kelly: So there’s no FDA approved medication for premature ejaculation. Basically what they do is they use the side-effect of antidepressant medications because the side-effect of antidepressant medications is delayed ejaculation. So you’re basically giving them an antidepressant to hope for the side-effect of delayed ejaculation. Also you can use numbing creams and jellies to kind of decrease your sensation and hoping that will last longer.

Also sex therapy, couples of therapies to say, “What’s going on? Is there an anxiety component involved? Is he feeling stressed, or pressured, or rushed? What’s going on?” And they’ve realized that combining medication with the cognitive behavioral therapy together is more effective than either one alone.

Sonia: so if you had numbing creams and jellies, how do you prevent the partner from feeling numb as well?

Kelly: Yeah. Well, either number one, you can’t, or number two, you can wear it underneath a condom, sometimes you just wear a condom so that can be a numbing component for the penis owner too. But it’s hard to only numb half the situation.

Sonia: Yeah, exactly. Okay. Anything else that you want to tell us about that penis owners may be encountering that we should be aware of?

Kelly: I think that’s the majority of the health problems would be those three.

Sonia: Okay. And how can people reach out to you if they want to check in with you, and talk to you, and get some help?

Kelly: The best way to find me is on Instagram @kellycaspersonmd, that’s also my website, kellycaspersonmd.com. And then my podcast is called You Are Not Broken.

Sonia: And that’s a fabulous podcast. I want to thank you so much for coming on today and talking to us about this subject, it’s so important. And it’s just an honor having you, so thank you.

Kelly: A pleasure to be here.

Diamonds, how is your sex life? No, really, how is your sex life? On a scale of one to ten how would you rate it? You know I’m all about the intimacy for women in midlife. If you rated the passion in your life as less than an eight then we need to talk, sister. I’m personally inviting you to check out my new program, Your Empowered Sexuality 30 day kick starter. I am so excited about this program. Most of you know that I have an impossible goal to positively impact the sex lives of over a million women. And I am just getting started.

Come work with me for 30 days to kick start that intimacy in your life. Let’s create that amazing, satisfying, intimacy that you deserve. Let’s face it, if you’re in your 40s, 50s or 60s, you could have 30 to 50 more years of intimacy ahead of you. What do you want that intimacy to look like? Let’s get real and talk about what’s going on with your body, your libido, let’s see what we can do to kickstart this intimacy. This program is for you whether or not you have a partner.

If you are a woman who wants to enjoy all aspects of her life then this is the program for you. It finally gets to be your time. So, click on the link in the show notes or on my website at soniawrightmd.com and come join me for Your Empowered Sexuality aka YES, Your Empowered Sexuality 30 day kick starter. I cannot wait to see you Diamond, talk to you soon. Take care.

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About

Sonia Wright MD

Hi, I’m Dr. Sonia Wright and I’m YOUR SEX COACH! I’m on a mission to end the pain and isolation associated with sexual difficulties and to help women create satisfying sex lives.

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