Going the Distance: Dr. Mistry and Donna Lee answer a listener question about premature ejaculation
Donna Lee:
The Armor Men’s Health Hour is brought to you by Urology Specialists. For questions during the week, call us at (512) 238-0762, or visit our website at armormenshealth.com. The Armor Men’s Health Hour is a show dedicated to providing information on a variety of medical topics, some of which may include sensitive subject material about penises. All cases discussed have been done with the permission of the people involved and their penises.
Speaker 2:
Welcome to the Armor Men’s Health Hour with Dr. Mistry and Donna Lee.
Dr. Mistry:
Hello and welcome to the Armor Men’s Health Hour. I’m Dr. Mistry, your host here with my cohost, Donna Lee.
Donna Lee:
Hello everybody! I am not a board certified cohost, but plan on being one someday.
Dr. Mistry:
Thank you guys for joining us. We love our listeners. I am a board certified urologist. My name is Dr. Mistry, M.I.S.T.R.Y. That is a real name.
Donna Lee:
That’s your real name, I hear.
Dr. Mistry:
That’s right. You know, my partners, Dr. Ong, Dr. Yang, and Dr. Jacomides are often not mistaken for having a psuedonym…
Donna Lee:
For having real names?
Dr. Mistry:
…having a fake name on the radio, but…
Donna Lee:
Well, you know, people did think that was your fake name, and that we didn’t think of that in the beginning.
Dr. Mistry:
That’s right.
Donna Lee:
It didn’t even cross our mind until we get that angry email that said “gimmicky.”
Dr. Mistry:
“Gimmicky.” If you like gimmicky you’re in for it!
Donna Lee:
You’re the right place.
Dr. Mistry:
This is a men’s health show. I’m a board certified urologist, which means that I’ve been specifically trained…what was that?
Donna Lee:
Around the block.
Dr. Mistry:
Around the, around the block. I’ve been specifically trained for the dealings of genitourinary issues. That’s kidneys, bladder, prostate, we talk a lot about erectile dysfunction. Over the years, I’ve developed a very large patient following when it comes to low testosterone, advanced erectile dysfunction is a specialty of our practice Peyroni’s disease is a specialty of our practice. And of course, the use of robotics and advanced technology for prostate cancer and other cancers are exactly what we do. We have been on the radio for about a year.
Donna Lee:
Isn’t that crazy?
Dr. Mistry:
And, you know, this is men’s health month in June.
Donna Lee:
That’s right, happy June.
Dr. Mistry:
…because I think father’s day fits in the middle there. This was actually the reason we started the show was really to celebrate men’s health month.
Donna Lee:
That’s right, one year ago. Didn’t even think about that.
Dr. Mistry:
That’s right. And although it would seem to some that maybe men’s health issues were kind of simple and just, you know, one dimensional, I think we’ve shown that it’s really deep.
Donna Lee:
I think that’s why we have so many downloads on the podcast.
Dr. Mistry:
That’s right.
Donna Lee:
Because the word is spreading that it’s not just ED issues or testosterone issues.
Dr. Mistry:
That’s right, there’s even more, there’s even more.
Donna Lee:
There’s more do you guys? What?
Dr. Mistry:
Well, you know, we men are a complex beast.
Donna Lee:
Haha, no. Food, sex…that’s all y’all need. That’s so complex.
Dr. Mistry:
All of a sudden our needs are pretty quick, I guess. Well, there you go. There you go. For those of you that don’t know what are some standard conditions that a urologist will treat, right now, kidney stones are making a real big show of force. We’re seeing a lot more stones than we have.
Donna Lee:
…because of the heat.
Dr. Mistry:
Because of the heat. And people are getting out more and getting more dehydrated and these stones are passing. We’re seeing a lot of patients getting back to the doctor’s office after being kind of self-quarantining for the stay at home orders for so long. And so we’re actually seeing a lot more advanced conditions than we would normally–cancers that are further along in the progress, lab results that are more out of whack than they would have been, patients suffering from low testosterone and all sorts of things. So if you have a urologic issue and you need to be seen, we are open for business. We can do it via telemedicine. We can do it in person. We will do it safely, and we will do it thoroughly.
Donna Lee:
That’s right. We’ve been, and we stayed open actually the whole time.
Dr. Mistry:
We’re essential.
Donna Lee:
We are essential. But some medical offices weren’t as essential, but we deemed ourselves super essential, extra central.
Dr. Mistry:
No, I think the governor did tell…
Donna Lee:
Okay, thank you, governor Abbott.
Dr. Mistry:
…it’s not just for us. Why don’t you tell people about our practice?
Donna Lee:
You can call us during the week at (512) 238-0762. Our email addresses armormenshealth@gmail.com. We’ll answer your questions anonymously. I think I’m doing a pretty good job, responding to all of them when we have a moment, and I let the person know we’ll send them the podcast directly. So if you miss your answer and you’re super excited about it, I will certainly get that podcast directly to you. Our website is armormenshealth.com. You know, we have some questions.
Dr. Mistry:
I love it. I love it. If you have your questions, send them to us. It is absolutely one of the most important drivers of the show and keeps us going.
Donna Lee:
Yeah. What would we do without questions?
Dr. Mistry:
You just hear me talking about the same seven things, over and over.
Donna Lee:
It’s not…let’s avoid that. We had a listener question the other day, Dr. Mystery. He said, his question is how to last longer in bed. He wants to know how to make love to his wife for longer periods of time without using the spray, the delay spray, if you will, the one with the lidocaine base. He said that he can only last a minute or so. What can he do to keep it lasting a long time?
Dr. Mistry:
That’s great.
Donna Lee:
A long time.
Dr. Mistry:
I thought you were going to not use any kind of weird accent.
Donna Lee:
I am going to. He wants to love her long time. I had to do it. He’s not an Asian man based on his name, but I had to say that.
Dr. Mistry:
Oh my lord. Premature ejaculation is one of those conditions that is not life threatening, of course, but can really kill a sexual relationship and can really ruin a man’s kind of, his confidence in himself when it comes to sexual performance. I think that if you don’t have the condition or you don’t suffer from it, you really can’t really appreciate how damaging severe premature ejaculation can be. Either you decide not to have sex because you can’t last long enough, and you have to come up with all these other ways of satisfying your partner, or you just feel like you’re going to be considered a failure, or you try to use all these additional aids like alcohol to delay your erection, which may work when you’re young. But then when you get older, you can’t get it up because the alcohol, you know, actually induces erectile dysfunction. So the treatment of premature ejaculation in our practice really starts with a fundamental understanding of trying to make the patient understand what’s happening. So an ejaculation is just like a reflex. I explain it just like how we reflectively we’ll take our hand off a hot plate or a patellar reflex will kind of make our leg jerk when hitting the right place. This is something hard wired right into our spinal cord in which ejaculation happens with the appropriate amount of stimulation. We have talked about in the past on this radio show delayed ejaculation, because I think a lot of people have never heard of that condition, or that even know that there are treatments for it. Premature ejaculation, I think is seen by many as condition that can be treated if you just kind of focus. You really can’t control this reflex, and if you think too much about it, sometimes it can make things, you know, go off, go off the rails. We start with knowing if there are things that heightened reflexes like certain medications, certain stimulants, those things can cause premature ejaculation. If you’re about to lose your erection, then sometimes the body quickly puts the ejaculatory response on so that it can finish its job.
Donna Lee:
Oh. What a thoughtful penis.
Dr. Mistry:
And so if you didn’t have premature ejaculation, if you didn’t have premature ejaculation before and now do, we call it secondary PE, then we start looking for ways to improve your erectile rigidity, and then we look at maybe even low testosterone can sometimes induce premature ejaculation. Then we look at medicines that we can then control to affect the stimulation. So that’s why the use of a lidocaine or prilocaine spray. In our office, we use something called Promescent, and that, and you can also find things like lidocaine in condoms, lidocaine sprays in the pharmacy. These kinds of premature ejaculation kind of resources are available at almost any pharmacy, but you lose some sensation.
Donna Lee:
Right. Which is why he probably said, is there another route.
Dr. Mistry:
He probably won’t [inaudible], and another problem is if you don’t do it right, she loses sensation.
Donna Lee:
Oh, that’s right!
Dr. Mistry:
There’s nothing worse than finishing early and making her go longer.
Donna Lee:
Oh, no, she’s busy! Let her do the dishes!
Dr. Mistry:
Let her go back to the laundry. So…
Donna Lee:
Sorry, Michael.
Dr. Mistry:
Sorry, Michael. Premature ejaculation, the use of these kinds of numbing creams are very popular. What’s nice about them is they can be applied to the flacid penis, so you don’t have to be hard already to get it, to use it. Also, what’s not good about premature ejaculation is any kind of medicine that you have to rub on…
Donna Lee:
…you want to avoid.
Dr. Mistry:
That’s right. You want to avoid that one. And so, the use of these numbing jellies or numbing condoms can have downsides to them. In our office, we use in an off label way, two medications. One of them is Tramadol. 30 minutes prior to intercourse can take people who ejaculate in less than three minutes to greater than seven to ten minutes. Unfortunately, Tramadol is a controlled substance. It’s one of those narcotics that can become habit forming. So it’s not something that’s…
Donna Lee:
Oh, oops. Side effect!
Dr. Mistry:
…and so now with a current kind of focus on reducing narcotic use in the community, it’s something that we’ve done less and less of, but in the appropriate patient, it is something that we could think about. The third medication that we use routinely is some type of SSRI. It’s a whole class of antidepressants. Paxil, Zoloft are going to be kind of examples of this. It’s a well known side effect of these medicines that they delay ejaculation. So if you have premature ejaculation, a low dose of these medicines taken daily, or even four hours prior to intercourse can really help prolong your ejaculatory time. And we can usually do it at a dose that’s not going to cause any kind of cognitive or psychological side effect. And then the most important thing that we do here is we really do try a biomechanical based approach. So we have Angela Treadway, our pelvic floor physical therapist who’s going to work with you on holding techniques, teach you which muscles are those that you’re actually trying to keep from firing in the orgasmic pathway. That’s kind of our premature ejaculation kind of workup, which will include hormones, identifying stimulants that you’re taking through medication or through your lifestyle, trying different medications, and that biomechanical approach. Donna Lee, that was a great segment. Why don’t you tell people how to get ahold of us?
Donna Lee:
You can call us at (512) 238-0762. Send us these questions. We’ll get them answered. I appreciate the time you take to send us a question. We will make sure they are anonymous. Our website is armormenshealth.com and again, email us to armormenshealth@gmail.com. We’ll be right back.
:
Dr. Mystery wants to hear from you. Email questions to armormenshealth@gmail.com. We’ll be right back with the Armor Men’s Health Hour.