Digest

This podcast delves into the intricate aspects of sexual health, beginning with the surprising link between orgasms and brain health, suggesting increased orgasms may reduce dementia risk due to enhanced brain oxygenation. It then addresses the potential for irreversible neurological and sexual side effects from common medications like SSRIs and anabolic steroids, introducing conditions such as Post-SSRI Sexual Dysfunction (PSSD) and testosterone dysmorphia. The discussion features Dr. Irwin Goldstein, a pioneer in sexual medicine, who elaborates on the phases of orgasm, neurochemistry, and various sexual dysfunctions. Key topics include pathologies of the pre-orgasm phase (excitation and inhibition insufficiency) and their treatments, delayed orgasm, anhedonic orgasm, and the debilitating Post-Orgasm Illness Syndrome (POIS). The conversation critically examines the widespread use and severe consequences of SSRIs and 5-alpha reductase inhibitors (like finasteride), emphasizing their potential for permanent sexual dysfunction. Advanced diagnostic tools like high-resolution ultrasound and thermal imaging (FLIR) are discussed for evaluating erectile dysfunction (ED) and Hard Flaccid Syndrome (HFS), respectively. The podcast also covers the increasing prevalence of ED in young men, attributing it to factors like finasteride, PSSD, and anabolic steroid use. It explores venous leakage as a significant cause of ED and introduces regenerative therapies like shockwave therapy and PRP as promising treatments, contrasting them with traditional symptomatic approaches and cautioning against unproven supplements. The discussion then transitions to female sexual dysfunction, addressing low libido, the impact of hormonal contraceptives, and the complexities of testosterone therapy for women. Finally, the importance of region-based medicine, frequent sexual activity for overall health, and the role of ED as an indicator of cardiovascular health are emphasized, alongside a call for more sexual medicine providers.

Outlines

00:00:00

Brain Health, Orgasms, and Medication Risks

The podcast begins by highlighting the importance of brain oxygenation and the potential link between increased orgasms and reduced dementia risk. It then discusses the concerning side effects of medications like SSRIs and anabolic steroids, including potential irreversible neurological changes and severe consequences like testosterone dysmorphia.

00:01:09

Introduction to Guest Dr. Irwin Goldstein and Scope of Sexual Health

Dr. Rina Malik introduces guest Dr. Irwin Goldstein, a prominent figure in urology and sexual medicine. The podcast aims to cover a broad range of topics related to health, sex life, and relationships, including the surprising and permanent effects of common medications on brain neurons and sexual function.

00:03:12

The Physiology and Phases of Orgasm

Dr. Goldstein provides a detailed explanation of the phases of orgasm, emphasizing the complex interplay of the nervous system, neurotransmitters, and hormones. The discussion covers the pre-orgasm, orgasm, and post-orgasm phases, including satiety and the refractory period, and introduces Post-Orgasm Illness Syndrome (POIS).

00:12:42

Pathologies and Treatments for Pre-Orgasm Dysfunctions

The conversation details pathologies of the pre-orgasm phase, specifically excitation insufficiency (difficulty achieving arousal) and inhibition insufficiency (difficulty inhibiting pain during arousal). Various therapeutic strategies, including medication and physical therapy, are discussed for these conditions.

00:19:23

Delayed Orgasm, Anhedonia, and PSSD

This section addresses delayed orgasm, its potential link to spinal issues, and treatments. It also explores anhedonic orgasm, the inability to experience pleasure, often associated with Post-SSRI Sexual Dysfunction (PSSD), and the debilitating effects of POIS.

00:29:51

The Devastating Impact of SSRIs and Finasteride

The podcast critically examines the widespread use of SSRIs and 5-alpha reductase inhibitors like finasteride, highlighting their potential to cause irreversible sexual dysfunction (PSSD) and other severe side effects, significantly impacting quality of life.

00:38:52

Advanced Diagnostics for Erectile Dysfunction and HFS

New ultrasound techniques are presented for objectively assessing penile tissue health and diagnosing erectile dysfunction (ED). The discussion also introduces Hard Flaccid Syndrome (HFS) and its diagnosis using thermal imaging (FLIR) and pelvic floor dysfunction assessment.

00:44:05

The History of Viagra and Rise of ED in Young Men

Dr. Goldstein shares the story behind the publication of the Viagra paper and discusses the concerning rise in erectile dysfunction among young men, identifying finasteride, PSSD, anabolic steroid use, and "jelqing" as contributing factors.

00:52:38

Understanding Hard Flaccid Syndrome and Venous Leakage

Hard Flaccid Syndrome (HFS) is detailed as a novel sexual dysfunction linked to hypogastric nerve hyperactivity. Venous leakage is also identified as a prevalent cause of ED, explained as a failure of erectile tissue to trap blood effectively.

00:57:40

Treatments for HFS and ED: Regenerative Therapies

Treatments for HFS, including prolotherapy and physical therapy, are discussed. The conversation then focuses on ED treatments, emphasizing regenerative therapies like shockwave therapy and PRP, while cautioning against unproven supplements and highlighting the importance of differentiating true shockwave therapy.

01:13:17

Female Sexual Dysfunction and Hormonal Impacts

The discussion transitions to female sexual dysfunction, addressing the tendency to over-psychologize issues and the impact of hormonal contraceptives on testosterone levels and sexual function. Treatments for low sexual desire and the complexities of testosterone therapy for women are explored.

01:25:17

Evolution of ED Treatment and Future Outlook

The speaker reflects on the evolution of erectile dysfunction treatment, from initial disbelief in oral medications to the widespread acceptance of PDE5 inhibitors. The potential for long-term PDE5 inhibitor use, contraindications, and the importance of region-based medicine and frequent sexual activity for overall health are emphasized. The efficacy of Viagra in women and ED as a health indicator are also discussed.

Keywords

Q&A

• How can orgasms protect the brain and reduce the risk of dementia?

  Providing oxygen to the brain is beneficial, and there is evidence suggesting that more frequent orgasms increase brain oxygenation, which may, in turn, reduce the likelihood of developing dementia.

• What are the potential long-term risks associated with SSRI use?

  While SSRIs are effective antidepressants, in 1-3% of users, they can cause irreversible changes to neurons and neurotransmitters, leading to conditions like Post-SSRI Sexual Dysfunction (PSSD), characterized by anhedonia and other sexual impairments.

• What is Hard Flaccid Syndrome and what causes it?

  Hard Flaccid Syndrome (HFS) is a condition where the penis is shriveled and cold in a flaccid state, causing discomfort and functional issues. It is believed to be caused by hyperactivity of the hypogastric nerve, leading to smooth muscle contraction and reduced blood flow.

• Can medications like finasteride cause permanent sexual dysfunction?

  Yes, 5-alpha reductase inhibitors like finasteride can cause irreversible changes to the enzyme and DHT synthesis, leading to permanent sexual side effects, including erectile dysfunction and loss of libido, similar to PSSD.

• What is the significance of region-based medicine in treating sexual dysfunction?

  Region-based medicine allows for the precise identification of the trigger for sexual dysfunction, whether it's an issue with the end organ, pelvic floor, spine, or brain. This targeted approach leads to more effective and individualized treatments.

• How does venous leakage contribute to erectile dysfunction?

  Venous leakage occurs when blood cannot be adequately trapped within the erectile tissue during an erection due to scar tissue or other factors. This prevents the penis from maintaining rigidity, leading to erectile dysfunction.

• What are the main phases of orgasm and their physiological significance?

  Orgasm involves a build-up phase of intense arousal with simultaneous sympathetic and parasympathetic activity, followed by the orgasm phase with pleasurable muscle contractions and relaxation, and finally a resolution phase with satiety.

• What is anhedonic orgasm and what are its common causes?

  Anhedonic orgasm is the inability to experience pleasure during orgasm. It is often associated with Post-SSRI Sexual Dysfunction (PSSD) and can be linked to disruptions in the brain's reward pathways.

• How is shockwave therapy used to treat erectile dysfunction?

  Shockwave therapy uses acoustic waves to stimulate the growth of new muscle tissue and improve blood flow in the penis. This regenerative approach helps to counteract the effects of scar tissue and improve erectile function.

• What are the potential dangers of anabolic steroid use in young men?

  Anabolic steroid use in young men can lead to severe and potentially permanent consequences, including testicular shrinkage, scarring of tissue, and severe hypogonadism, impacting testosterone production and overall sexual health.

• How do hormonal contraceptives potentially impact female sexual function?

  Hormonal contraceptives can increase Sex Hormone-Binding Globulin (SHBG), which binds to testosterone, making less free testosterone available. This reduction in available testosterone can lead to decreased libido and other sexual dysfunctions in some women.

• What are the main contraindications for using PDE5 inhibitors like Viagra or Cialis?

  The most significant contraindication for PDE5 inhibitors is the concurrent use of nitrates, as this combination can cause a dangerous drop in blood pressure. Other cardiovascular conditions may require careful consideration and physician consultation.

• Why is it difficult to establish "normal" testosterone levels for women?

  Defining normal testosterone levels in women is challenging due to significant individual variations in SHBG levels and androgen receptor sensitivity. Free testosterone, rather than total testosterone, is considered a more accurate indicator, but even this can vary widely.

• Can Viagra be used effectively by women for sexual dysfunction?

  Oral Viagra has shown limited effectiveness in women. While topical formulations applied to the clitoris may offer some benefit with enhancers, arousal is not typically the primary complaint for women experiencing sexual dysfunction, unlike men where erection is the main issue.

Show Notes