191: What Really Matters in Men’s Sexual Health

Scot: If you had to base what you think you know about sex and sexual health and performance based on what you've learned from society, media, spam, or your buddies, what would you say the most important thing to your partner is when it comes to sex? Mitch?

Mitch: Oh, the ads always tell me that I need to have a larger member. That's one of them, for sure, right?

Scot: There are a lot of those emails in your spam folder. I mean, for most of us. Some of us might have them in our main inbox, but you definitely will find them there.

How about you, Dr. Smith? I mean, putting the doctor coat aside for a second. You're just wearing the man coat right now.

Dr. Smith: I mean, the years of experience I have say maybe you should talk to your partner and find out what's important to them. But I don't know, I'm just throwing it out there.

Scot: Here comes John with a serious answer.

Dr. Smith: I mean, if people are coming here for . . . Let's give them what the real deal is. But yeah, if you check the algorithm, the algorithm is going to tell you that you need to go for two hours, and you need to be bigger and better, man.

Scot: And you better be able to do it and be ready any time. Doesn't matter what's going on. It's like that appetite is always there, right?

Dr. Smith: Yeah. Exactly.

Scot: And if not, there's something is wrong with you or there's something wrong with your partner, because certainly you would never have a time where that's not the case.

Well, when it comes to men's sexual health and performance, are those really the most important aspects, or are there other aspects that we should actually be paying attention to because they're the ones that matter to our partners and really ultimately matter to our own health? Not only sexual health, but emotional health.

Welcome to "Who Cares About Men's Health," with information, inspiration, and a different interpretation of men's health. I bring the BS. My name is Scot. The MD to my BS, Dr. John Smith, who's a urologist. So this is the kind of stuff you talk to guys all the time about.

Dr. Smith: Absolutely.

Scot: And joined by "I care about my health now" convert, Producer Mitch.

Mitch: Hello there.

Scot: All right. So, John, I'm sure as a urologist you do hear all sorts of concerns when it comes to sexual health or what guys think is important to their partners. Can you give us some of the ideas of the things that you hear from guys?

Dr. Smith: I mean, I hear a lot of different things, but a lot of stuff . . . I deal in the men's health space for probably a little over half of my practice, and so people are always coming in with questions about erectile function, premature ejaculation, or anejaculation, the inability to ejaculate, difficulty with climax, things like that, that people deal with on a day-to-day basis. Those are the main things.

And then people come in with low libido, with low testosterone. Some of them don't have low testosterone but still have a decrease in their libido or their desire. Some people call it your sex drive. So those are a smattering of the men's health things that I hear about quite frequently.

Scot: Yeah, but what are the things you hear about that if that person's partner is sitting there, it's really important to the guy, but the partner's shaking their head, "No, that's not that big of a deal"? Is there anything like that?

Dr. Smith: I mean, all of it, pretty much. I'm joking, but a lot of times, the perceptions that are out there, like you said earlier, all those things that are in your inbox, a lot of those things their partner doesn't care that much about it.

I have guys that come in, and they'll talk about different things. People always want to know if there's a way to be bigger and better and last longer and things like that. In reality . . .

Scot: Push out more cargo, so to speak. That's a big thing I've heard about, right?

Dr. Smith: Yeah, there are a lot of things out there that people will come in. They'll ask me specifically about, "Hey, what about this herb?" or, "What about this thing or this trick I saw on the internet?" or whatever. And we're not hiding anything, by the way. We don't have this special thing where if you pay extra, we take you to the speakeasy in the back, and that's where we keep all the good stuff, right?

Scot: All the things you're promised in your email.

Dr. Smith: I'm like, "What's the password?" They're like, "Swordfish." I'm like, "All right. Come on in."

Scot: Well, that's actually a little disappointing to hear.

Dr. Smith: I know, it really is, man. I thought it was going to be that way when I got into this, and now I'm disappointed too.

Scot: You spent a lot of time and money in med school just to find out that was all a lie.

Dr. Smith: Yeah, I got a mortgage on my brain and then found out it was a hustle.

Scot: All right. So what does really matter when it comes to sexual health? Let's talk about some of these things that the guys think matter, and let's break it down, whether or not they do matter. And then from your experience, Dr. Smith, later in the show, would like to talk about some other things that you think matter.

So the first one is size. Does size matter? I mean, is that a big deal to most partners of men?

Dr. Smith: I mean, I think most gentlemen who come in think it's something that they need, and then when their partners are there, oftentimes most partners don't . . . that's not something that's high on their list of things that's important to them.

Very rarely you'll find a partner that'll say that. But I would say over 90% of the folks that come in with their partner that mention that, their partner is like, "Well, why do you want to do that?" And they actually question that logic of their partner. So I don't know that that's as big of a factor as it's purported to be out there.

I usually tell gentlemen average is average for a reason, because the majority of people are going to be average. And so, in reality, what you think that is going on is really not necessarily what's happening on those fronts, if that makes sense.

Scot: And Mitch, from the research you've done, what did you find about as far as size is concerned? Does that jive with what Dr. Smith is saying?

Mitch: Yeah. There was actually this interesting article I came across. It was a 2006 journal "Psychology of Men & Masculinities," and the title was "Does Size Matter?" And what was interesting is it was more looking at partners' satisfaction with size.

Not necessarily the literal size. They're not pulling out a measuring tape. They're just asking, "How do you feel about it?" And 85% of women said that they were satisfied with their partner's size. But when that same group was asked, only 55% of the men in those partnerships said they were satisfied, with 45% of those men saying that they wanted it to be bigger.

Scot: That's kind of a disconnect there, isn't it? Eighty-five percent of women say they're satisfied, 55% of men are satisfied. That leaves 45% not. And that can cause some mental and emotional stress and strain. Have you seen that sort of thing, Dr. Smith?

Dr. Smith: Oh, absolutely. I see guys come in all the time, and there are some avenues of trying to add size or do other things, and a lot of them are not the best things you can do. Most of them are cash pay. And a lot of times people come in after they've had stuff done, and they're disappointed in the results, and they regret it.

And so I think it is a disconnect. I think it's more of a mental thing for guys is, everybody wants the biggest and the baddest things that they can get ahold of. And so I think that that is a line that's portrayed out there, and sometimes people try to capitalize on that little bit of insecurity that we have as men.

Scot: I mean, when you talk about average. What about guys that are not in that average? Should that be something concerning? I mean, you did say there are some things that can be done. Do you run into situations where that's the case and something needs to be done? What about for those gentlemen?

Dr. Smith: Ten out of 10 times, I would not recommend doing anything.

Scot: Really? Okay.

Dr. Smith: Yeah. I mean, most of the time, the things that are out there cause a lot of problems. They're not great solutions, despite what's being sold.

Scot: Yeah. So much of sex is about intimacy for our partners, right? It's not about the physical aspect. And there are a lot of routes you could go to get that intimacy.

Dr. Smith: Sure. And I think most partners would say, "I want to be connected with my partner." It's not necessarily that, but they want to feel that connection and feel that closeness with their partner.

Having sexual relations is an intimate thing that most people aren't doing with just everybody. And so it's something that you're sharing with your partner that makes the relationship special and is something that you can share with your partner.

A lot of the partners that come into my office, when these folks come in with these concerns, they're just like, "I'm not interested in all of these other things. I just want to be with my partner and have them be there without reservation," if that makes sense.

Scot: All right. The second one that we hear a lot of, and that was brought up in the beginning, is good sexual intercourse should last hours. If I'm a man, I should be able to just . . . I mean, Lionel Richie, all night long, all night, all night. You know what I'm saying? What do you have to say about that, Dr. Smith? Is that a concern that you get from men? And what's the reality there?

Dr. Smith: I mean, I do have a lot of folks come in with that concern. It's very prevalent. And the reality of it is . . . I'll have guys come in quite a bit and I'll start the conversation with, and I'll ask you two, "How long do you think the average sexual encounter is, just on average? What do you think the number is?"

Scot: I'm going to go four minutes.

Mitch: I'd say 15.

Dr. Smith: Scot's my guy, dude. And then Mitch goes . . . So the average sexual encounter of penetrative intercourse lasts five to seven minutes. And so a lot of guys come in with similar to what Mitch said. "I'm only lasting 15 to 20 minutes." And I'm like, "Well, great. You're double the average, bro. This is not a problem, right?"

But I think that a lot of people have in their minds, either through media or other things that they've seen, they think that that's the norm, right? And in reality, Scot, you were much closer to the norm of four or five minutes. That's the average sexual encounter that the literature shows. Most of these couples that they surveyed and got these things back said five to seven minutes is the average sexual encounter.

So I think that's a big misnomer, because a lot of guys come in and they're like, "How do I . . ." And I'm like, "You're already above the average. I don't know how much better I can get you there. You're already getting an A. What do you want?"

Scot: I think we've all heard the joke. I don't know. Maybe you have had women say this, but I think a lot of women are like, "No, I don't want a half hour of that activity."

Dr. Smith: Said no woman ever, right?

Scot: Exactly. I mean, it's not comfortable. It's not fun after that point. So that's really, truly one of those things that we think defines us as more of a manly man if we can go and go for a long, long period of time. But really, that's not what women, in my experience, necessarily want.

On the other hand, they don't want something that's super short. So if a guy comes in and he's like, "You know what? This just isn't lasting as long as I'd like it to," and maybe it is just really quick, or you mentioned premature ejaculation, what are some things that men could do?

Dr. Smith: Yeah, that's an awesome question, because that's one of the things I talk to gentlemen about. There is something called premature ejaculation. I mean, I have people who come in, and they have difficulty lasting a minute or two minutes. And so that can be a really difficult thing in making a connection sometimes with your partner. Sometimes partners are very understanding and that's not what it's about for them.

I think to start, I would say having a conversation with your partner. I think that's the number one thing, if I can be serious for one minute on this podcast. Have that conversation with your partner, because it's not a taboo thing. This is someone who you are sharing these intimate moments with. And so you should have those conversations of what are things that are important to you.

And then on the flip side now, if that's still something that is occurring that's a problem where you're unable to maintain for a period of time that's sufficient, there are some physical maneuvers, and then there are some topical medications that you can get over the counter.

Then anything beyond that, you'd want to go and sit down with a men's health specialist about possible other medications that are out there. But I'll talk about the stuff that you can just do on your own.

So there are some physical maneuvers. They call them physical maneuvers. During intercourse when you are approaching climax and you're getting close to climax, you can kind of discontinue the sexual experience, either maintaining penetration in your partner or even pulling out and waiting for that sensation to subside before continuing the sexual encounter to try to help prolongate the encounter.

Other things you can do are you can pull out and hold on to the glans, or the tip of the head of the penis, with some pressure until you feel that sensation go away. Those are some of those physical maneuvers that you can do.

I can tell you how many guys in my clinic go, "Oh, yeah, that sounds good. I'm probably going to try that." It's very few people that are like, "Oh, yeah, that sounds great."

Scot: Because none of that seems particularly manly, right? That still doesn't solve the mental disconnect that I should be lasting a long time. So these little exercises or maneuvers, does it eventually build and you can build a little bit more endurance by doing them, or is it something you would have to do every single time?

Dr. Smith: Usually it's a training process, where you get better at it. When you start doing push-ups, you can only do a couple, and then you get to where you can do 40 or 50. And so, yeah, there is this process where things should improve, right?

Scot: Forty or 50? We need to look up the average number of push-ups a guy can do because I think you're a little exaggerating on that one.

Dr. Smith: I might be, man. I'm not going to say I'll do 50 right now because I've got an earpiece in, but if I didn't, I'd give it a go.

So those are the things you can try, physical maneuvers. And then over-the-counter stuff, there are a few companies out there that make delay sprays and things like that.

The thing I tell folks is when you get those, make sure to read the label because some of them can also desensitize your partner if you don't wash them off. And so some of them say that they're safe to not desensitize your partner. But if you can imagine you're trying to last longer to help your partner to reach climax and then you're making them decrease their sensation, you're going to be sad because your partner is going to be numb as well.

Some of them are as simple as lidocaine gels that you can get over the counter. You'll see some of these companies online that will sell benzocaine, which is another anesthetic that'll kind of numb things. Wipes. One that I have a few patients use . . . Can I say name brand stuff on the podcast?

Scot: I think so. I mean, if as a doctor that's what you recommend, yeah.

Dr. Smith: I mean, I don't recommend any of these things per se because I don't . . . None of them are better than another. But I have patients who've used . . . it's called Promescent spray. I've had plenty of patients come back and say they thought it was helpful.

But again, all these are over-the-counter things that you can just pick up over the counter. You don't need a prescription for them. And so you can look around. KY Jelly makes a delaying gel. A lot of these different companies will make these things, and if it is a true concern, you can try those first before you go and talk to somebody.

Scot: I had read somewhere that a lot of it can be mental as well. And I'm going to share a little something. At one point I had this issue, and you know what I did to solve it? It was the very first thing you recommended. I talked to my partner about it. And it was crazy because after I did that and I got that stress off my brain, it went away. It was amazing.

I don't know if I was telling myself these myths that translated into what I needed to be, so then I was psyching myself out a little bit. I'm not a clutch player, guys. Just to warn you when you're picking teams next time, I'm not a clutch player.

But when I had that conversation, it was like this whole load was taken off my mind. No pun intended, but I couldn't come up with another way to put it.

So, anyway, it could be mental, it could be emotional, and just having that conversation could be the cure. And it might not, but it worked for me.

Dr. Smith: Yeah, I think that's a big one. And the other thing is there are some sex therapists out there. You have talk therapy, and it seems to be helpful. Some people, if they have sexual trauma in their past or difficulties or things like that, having a conversation with a psychologist, psychiatrist, or meeting with a sex therapist can also just do worlds of benefit for those folks as well.

Scot: Yeah. Just thinking about playing basketball helps. I think I've heard that.

Dr. Smith: I thought it was Margaret Thatcher naked on a cold day.

Mitch: That's what I've heard.

Dr. Smith: The classic Austin Powers. That helped him.

Scot: I'm sorry, I wanted to quickly go back to our first one, "Does size matter?" Those things that I get in my email, do any of those work, by the way? Any exercises, pills, any of that kind of stuff?

Dr. Smith: No. I mean, there's no literature out there that shows that it works. Again, I have not seen any of those be effective. There are no surgeries. There are a lot of people out there that'll try to sell you on it. Anything that costs $20,000 out of pocket and promises results is . . . I would just say please be careful.

Scot: All right. Sorry to circle back around there, but I wanted to make sure.

Dr. Smith: No, it's fine. We've come full circle, and it's only halfway through the show.

Scot: I mean, you get those and you're like, "Well, maybe it'll work." I don't know. It'll take people . . .

Dr. Smith: Man, I've got $80. Let's go.

Scot: It'll take the most pessimistic man and turn him into just the eternal optimist. "Well, it could work."

All right. Number three, the importance of male ejaculation for female sexual satisfaction and function. What exactly are we talking about here when we talk about that? Is this quantity? Is this the fact that a male has an ejaculation?

Mitch: It's quantity. It is in response to those ads you see online about increasing the size of your loads because that is important for something. I don't know. But apparently it is a major industry of supplements. And this was a research article in 2018 that was looking at how much female partners in particular actually care.

Dr. Smith: And what was the consensus? I can tell you what I think that paper says, but I want to hear what they said first.

Mitch: What they said was . . . So they interviewed a whole bunch of women. I think it was something like 1,000 surveys done online. Thirteen percent of women regarded ejaculate quantity as an expression of their attractiveness. But 61% said that the quality of their orgasm and the quality of sex overall has very little, if anything, to do with quantity.

Dr. Smith: I would have said that nobody cares.

Scot: That 61% means 39% do. But that kind of goes against what you've told us before.

Dr. Smith: I have not found that to be true anecdotally in my practice of people who come in and we have that discussion with their partner there. I can tell you a lot of the folks I have that come in who've had prostate procedures and now have what's called retrograde ejaculation, where they no longer have . . . it's a dry ejaculate. They still are able to climax and have an orgasm, but little or nothing comes out. I can tell you that majority of those partners go, "It's great. The easy-cleanup sex is great." So I would probably push back a little bit.

But again, 61%, two-thirds of people, say they don't care. My question to those people who say they care is, "In that moment, are you able to identify the quantity during the moment?" I don't know that that's something . . . I mean, I would like to have somebody tell me, "Yeah, I can identify the amount of milliliters immediately."

Mitch: Just eyeball it?

Dr. Smith: Yeah. Well, are you eyeballing it? I'm pretty sure you can't see it in the moment, but I don't know.

Scot: This is interesting. So for the 13% of women who think that it's an expression of their attractiveness, again, it's just what culture and society and media tells us. And actually, from a medical standpoint, it has nothing to do with that, right? If you had a not-attractive and attractive woman and you had this single guy, it's going to be the same, right, Dr. Smith?

Dr. Smith: I mean, a lot of it has to do with hydration status and things like that that are going on as far as quantity goes. I'm pretty sure . . .

Scot: Not how hot she is. It's "Are you hydrated?" and how hydrated you are.

Dr. Smith: And also, the quantity can also increase with the frequency in which you have intercourse. So, a few days in between, there's going to be . . . Generally, when people are looking for the best chance for fertility, they say every couple of days to allow for ejaculate build-up to increase your chances. And so I think some of that obviously plays into it, too, from a scientific perspective, what we know about how the system works.

Scot: And we also got a little bonus tip there. If you're having trouble with fertility, a couple or three days in between sessions could help you with that.

All right. So we've talked about some of these myths and whether they matter or not. Dr. Smith, can you take a few minutes to explain what are the things we should focus on?

So much of life and what we talk about on this health podcast is there's a lot of stuff out there that we're told is important and that we should focus on, but really doesn't make that much of a difference in our life.

And then there are all these things that we should be focusing on that we're distracted from because we're focusing on all this other crap that would make a big difference, but we don't.

So from sexual health and relationships, what are the things we should be focusing on?

Dr. Smith: I gave the punchline up front. It's having that conversation with your partner and being there with your partner. And I think your goals of intercourse with your partner . . . If your goal is, "I need to just have this physical effect," and that's it . . . I think majority of the relationships I've had in my life where intimacy has been involved, it's been where I care about the person, and I'm more interested in making sure that the experience is mutually beneficial. And I think having those conversations . . . Just like you said, you struggled with some things, and then you had a conversation with your partner.

I think a lot of times, even when we're in a relationship where that person, we're okay to be vulnerable to them in so many other aspects of our life, but we're still maybe not super comfortable being vulnerable from that aspect or from the angle of sexuality or sexual prowess.

And so I would say take the moments to have those conversations and really just say, "Hey, these are the things that I feel are important or that I sense are important to you. Am I reading the room right?" Get their opinion and talk and have those moments of conversation, because that's going to go a long, long way in helping to create a long-term satisfying sexual relationship for both parties.

Mitch: It seems almost too obvious that it's, "Just have a conversation with your partner." But I do wonder if in the particular society that at least I grew up in and culture that I'm a part of, it seems like men are often advertised to in an aspirational way, right? "You need to work out like the bodybuilders do. You need to be as athletic as the sports stars are." And here in my research of men's sexual health, it's, "You want to be like the people you see on adult entertainment."

And it just seems like that's not what we . . . If that is your job, if you are a professional, that's one conversation, right? But if you are just a regular person just trying to have a good time with your partner, why are we shooting for what those top-tier athletes are doing?

Dr. Smith: So you're saying we should have intermural intercourse and semi-professional.

Mitch: Yes, I like that. I like that a lot.

Dr. Smith: Yeah, that's fair.

Scot: Yeah. I think it is in so much of our guys' heads and just as much, or probably more, of a mental issue. So I get the feeling, Dr. Smith, that sometimes when these gentlemen come in your office, it's really undoing the programming that we've gotten. And maybe that does mean some professional counseling where you can talk through these things and maybe get some skills and some tools to talk to your partner.

I'm going to tell you, that was one of the hardest conversations I ever had. Once I got into it, it was easy, but getting into it was really tough. I thought I was lesser than because I had to speak of these things that I should normally just be able to do as a man. This should not even be a problem, and I shouldn't have to burden my partner with it, right?

But once I got over that and was just like, "You know what? I want to be sure that we have an intimate relationship and everybody's happy," I had to put that aside. And when I did, it made all the difference in the world. And that can be hard. It can be really hard.

Dr. Smith: Yeah, I agree. I think it's interesting in Mitch's research, I think men are advertised that way, just like I think women are advertised to in a different way to look a certain way and to have certain things that appeal, that, "These are the things that you need to do. You need to look a certain way and wear this and do that." And I think it's the same way for men. But we're advertised to with more of our libido and our sexuality from a standpoint of performance than women are.

When you say that conversation was very difficult, I find that a lot of my patients say it is a hard conversation to have. And I'm like, "Yeah, but you guys have been married for 25 years." It's interesting to think that you've gone that long, you've got three kids, and you've still never had that conversation with your partner because you feel lesser than or you feel whatever it is.

It kind of boggles the mind to think that we are kind of programmed that, "Hey, you probably shouldn't talk about that," or, "You're probably not very good at it."

You get to the pros, and they give you a playbook. You've got to study the playbook, you've got to learn it, you've got to go and watch film, and do all those things. But then in our life, when you talk about these things where we could go in and we could learn those things about our partner very early and have those conversations, I think I would always advise younger couples that come for whatever reason, I always tell them, "Hey, you guys have to talk about this."

Talk about these things, because it makes a huge difference when you're both on the same page and you know that your partner is on the same page.

Scot: Can you just give me a pill instead? I'd rather not talk about.

Dr. Smith: Exactly. "Yeah, I'm not interested in that. So you got those pills still? Can you send them to the pharmacy for me?"

Scot: "I would do anything to have a more intimate relationship with my partner." "Well, why don't you talk to them?" "No. I mean I'd take any pill, any exercise."

Dr. Smith: Right. Well, it's like anything else, all the other stuff. "How can I just . . ."

Scot: "How can I get more sleep?" Well, maybe put your phone down a half hour before you go to bed. "No. I mean is there a pill I can take? Is there something I can drink?"

Dr. Smith: Right. Weight loss, all these different things that we have in our life. I mean, there are keys that we can use, and we're just like, "Nah, what else you got?"

Scot: Right. And those are the things that don't work, and those are the things we don't want to focus on.

So if you enjoyed this conversation or if this conversation sparked any questions or ideas, thoughts, or anything you would like to share to help out fellow guys, please feel free to reach out to us at any time.

It also sounds like, Dr. Smith, that maybe if somebody's experiencing some of these issues, a urologist would be a good place to go. Or maybe even some counseling or mental health might be a good place to go.

Dr. Smith: Yeah. I mean, look for a men's health specialist, a urologist. Some urologists don't do men's health stuff. So I would just kind of look for somebody who does this stuff. But it's run-of-the-mill. I mean, we see it all the time.

Mitch: But not the alpha bro Reddit?

Dr. Smith: Right.

Mitch: Just making sure.

Scot: That's not going to help you? Okay. Good.

So, yeah, you can reach out to us if you have anything you would like to say, if you have any questions. And it could be anonymous if you want. We won't say who you are on the air. We won't say, "Yeah, Mitch Sears said this is something he's struggling with." It's [email protected].

Dr. Smith, thank you so much for helping us get rid of some of these misconceptions in men's sexual health and having this conversation with us.

Dr. Smith: Thanks for having me.