128. Erectile dysfunction part 2: The mind/body connection with sex therapist Justin Paulsen

This episode is Part 2 of a series on Erectile Dysfunction. 

In this episode I discuss with Vancouver based Conselor Justin Paulsen:

• How mental and emotional factors play a role in ED
• How stress and the nervous system affect erectile function
• Porn use and its relationship to ED
• Masculinity and identity tied to erections
• Performance anxiety
• Relationship factors 
• Pelvic floor patterns and physiotherapy
• Misconceptions about kegels
• How can therapy help? (sex therapy, couples therapy)
• Successful sex’ beyond penetration
• How can people rebuild confidence after repeated ED experiences?
• Medical red flags 

Justin Paulsen (he/him) is a virtual Psychotherapist, Couples Counsellor and Clinical Sexologist based in Vancouver. He works with individuals and couples on mental health concerns, relationship and communication concerns, and sexual concerns. His research background is in penis complications such as erectile dysfunction and premature or delayed ejaculation.

Justin works from a holistic solution-focused approach as he works together with clients to take a look at thoughts, feelings, and the nervous system to help you manage stressors and build stronger relationships and fulfilling sex lives - almost like a personal trainer for your emotional, relational, and sexual health! Along the way you may laugh, cry, and celebrate as you work towards your goals

Be sure to check out Episode 127 with Urologist Dr. Chris Bitcon first which addresses:

• What is erectile dysfunction (ED)? 
• At what point does it move from a temporary issue to a condition requiring a doctor's visit?
• Primary causes (prostate treatment, vascular, hormonal, neurological, psychological)
• What can you do before you go see a urologist?
• Treatment options 

THANK YOU TO THIS EPISODE SPONSOR

SRC Health:  Use the link below for a discount at checkout!

https://srchealth.com/?ref=PELVICFLOORPROJECT

Thanks for joining me!
Here is where you can find out how to work with me:  www.pelvicfloorprojectspace.com/

mel@pelvicfloorprojectspace.com

Transcript

SPEAKER_00 0:00

Welcome to episode 128. This is part two of a two-part series on erectile dysfunction or ED. If you haven't already listened to episode 127 with urologist Dr. Chris BitCon, this is where I would pause and listen to that one first. In there, you'll hear about medical considerations that are important to know, along with treatment options, including medication and injections. But you'll also hear Dr. BitCon talk about the importance of considering psychosocial factors. For example, life stressors, relationship factors, expectations. Just the other day, I had a young male client. Many years ago, he had an injury to his penis, which negatively affected his erectile function. He saw a urologist at the time whose only solution was a medication. Over ten years later, and that still isn't helping. So this young guy went to see a new urologist who happened to be Dr. BitCon, my guest from episode 127. And this time he was presented with more options. He was still provided the option of a medication, but was also referred to pelvic floor physiotherapy for a better understanding of the pelvic floor and acknowledgement of the mind-body connection. And here is where we get to part two today. Joining me is Justin Paulson, psychotherapist, couples counselor, and clinical sexologist to help explain the non-medical reasons for ED. Take a listen as we go into the importance of being able to relax or let go for an erection and all the factors that can get in the way, the influences of pornography, performance anxiety, relationship issues, a busy life or expectations. Listen, this is not an easy topic to discuss. I can just feel the nervousness and shame in the room when men disclose the symptoms of E. D. But if you understand how the body works in coordination with the mind, perhaps it will bring you some hope. I will be right back with Justin Paulson. And then, listeners, I will be taking a pause on the podcast until the fall. Enjoy your summer. Listeners, whether you're a busy mom, a fitness enthusiast, or just navigating everyday life, millions of women experience challenges like bladder leaks, prolapse, or pain. It can feel overwhelming. But it doesn't have to be. That's where SRC Restore shorts and leggings come in. These aren't your typical garments. They're revolutionary medically designed compression wear that can help your organs feel supported and minimize bladder leaks. Unlike products that just absorb leaks, SRC Restore helps the function of surrounding muscles, giving you support and confidence. This line of leggings not only provide the trusted compression, but also come with pockets, perfect for on-the-go lifestyle, whether you're working out, running errands, or just relaxing. Hundreds of women have reported real results like improved mobility, reduced discomfort, and enhanced quality of life. With a 100-wash durability guarantee, these garments are made to last. If you're looking to restore confidence, feel supported, and take control of your pelvic health, check out the SRC full range by using the QR code provided in the show notes, and this will automatically provide you with a 10% discount site-wide. All right, Justin Paulson, we've been talking about this um episode and trying to coordinate it for a while. So I really appreciate you taking the time to chat with me today. I'm gonna just share a little bit about how I know you because I've never met you in person. Um I um obviously as a physio, I work with a lot of um people that have different sexual health issues. And I one time had a client come in who was working with you and she had many good things to say. And I what really stood out to me is that you reached out to so that we could kind of, with her permission, obviously we could talk a little bit about her. So she felt that our sessions were intertwined and that she was working on a common goal. And I really appreciated that about you. And um, I also work with some of your colleagues that are based here in Kelowna and have heard heard really great things. And so I was interested in doing an episode on the topic of erectile dysfunction, and I heard that you would be a great resource for this episode. And so before you get going, would you tell everybody that's listening, Justin, a little bit about yourself?

SPEAKER_01 4:24

Yeah, for sure. Yeah. So my name's Justin. I am a registered clinical counselor who does, you know, specializes in couples therapy, and I'm also a registered clinical uh sexologist. So I basically work with individuals and groups on mental health challenges, but a lot of relationship dynamic challenges and a lot of sexual challenges. And my background history and that is doing research in what I call penis problems. So anything from uh erection concerns to ejaculation concerns to you know performance anxiety, those sorts of things, um, you know, all the things that people with penises kind of come up against in their sexual challenges. And so I did a lot of research there and then now really less research and more actively working with folks, which is much more my style.

SPEAKER_00 5:13

And I think like just to set the stage, like I would say that there's not that many people that would come in for a physio appointment with their primary concern being erectile dysfunction. I'm gonna say ED a lot just because it's easier to say. Yeah, but um that not many people would actually make that their primary symptom. They might come in, maybe referred by their urologist because of like bladder concerns. There's, you know, they're maybe kind of feeling frequency or incontinence. Maybe there's been some sort of prostate treatment, and then and then ED will come up in my questioning. Um, can you talk a little bit about for yourself? How does this usually um I'm trying to formulate my question? Do you find a lot of people come in with that primary concern? Yeah.

SPEAKER_01 6:05

Um, yes, yeah, for sure, because of it's kind of really what I specialize in. So they've found me. And often I'm might not be the first stage in their care journey, right? They might have seen a physio or they might have gone a lot of times gone to a medical doctor first, right? And assumed that there's something medically wrong with their situation in psychology and their and their mind frame or mindset hasn't really come into play. So they're getting referred to me. But there are the odd times when um I'll see a couple or I will see an individual and it'll it'll present as things like low desire or sexual avoidance. And then when we dig into where that's coming from, it is a fear or an experience of ED in the bedroom that is then causing them to withdraw from sex, right? So there are some times where it comes in and sneakily with uh with other things.

SPEAKER_00 6:53

I think so. I'm gonna picture that someone comes into you, whether they're by themselves or with their partner, and they come in and you kind of start explaining some of this stuff to them that um, you know, what what is ED? Can you just talk a little bit about how you might actually then explain that to the person in front of you?

SPEAKER_01 7:10

Yeah. So I like to talk a lot about the nervous system and bring the body, um, the body into the talk about the mind, right? Obviously, when we say like psychological ED, like what even does that mean? And so I like to kind of link how something in your mind can then shift your nervous system and therefore shift how you sexually function, right? And so um I talk about erections as kind of having two main ingredients. Really, the first one's the only necessary one with a supplemental one. So the first one is relaxation. Your body has to be in a state of relaxation in order to prioritize sex. That's just like evolutionarily important, right? If we were back in times where we didn't, you know, weren't civilized and didn't have homes and things and we were just in the wilderness, um, procreation mattered to our to our nervous system. We wanted to keep going with our with our genetics. However, if a bear pops out of the woods, you know, we're not going to be thinking about sex, and erection would get in the way, if anything. So we need to prioritize safety and you know, comfort in those moments before we would prioritize sex. We now don't live in the wilderness. So what our brain codes is that bear popping out of the woods might be various different things, right? But um, what can happen with folks experiencing performance anxiety or just ED issues that are non-medically related is something they're experiencing is being coded as a threat, right? So their body is no longer in a state of relaxation and it deprioritizes sex. And the way it does that is through the pelvic floor and through the nervous system, you know, moving blood to where it needs to go, right? By adding tension in certain places. And so I would go through, you know, how that works, where the pelvic floor tightens, how that restricts blood flow, and how that can hurt things. And so that's that first, you know, place of helping them understand that relaxation is really important. And if you're not feeling relaxed, your body's you're fighting an uphill battle around trying to get an erection. Secondarily is stimulation. So, like the information we're giving our body that an erection is meant to happen, that this is sexy time, right? And so sometimes anxiety can get in the way of that. You know, you've got a beautiful partner, whoever you're attracted to, and maybe they're naked and you're really excited, but then you're thinking about, oh, am I gonna get an erection or am I gonna perform well or am I gonna do well? My guess is that, you know, these these people with penises, like they're not turned on by thinking about their own erections and whether they're gonna get it or not. It's not a sexy thought. So now this beautiful person that's in front of them that's really sexy to them, they're not even able to focus and actually get that stimulation to their brain to tell them that it's sexual time, right? And so that's kind of how I formulate like, okay, are we dealing with a relaxation issue? Are we dealing with a stimulation issue? Are we dealing with both? Um, yeah.

SPEAKER_00 10:08

I I think it's so helpful because can you imagine if someone like this is such sensitive information that we never talk about at coffee or talk about it when we're walk with our friends? Like, this is not something that comes up. And so chances are good people coming to appointments with either myself or yourself are not necessarily super excited to come or the information's not flowing freely. And so I find that like there's no way when someone comes in, I'm gonna say things like um, almost like accusing, kind of kind of like, I think you have this, or I think you have this. And I I think I start the exact same way you do through either a series of models or images on my computer, just first just laying out how it all works. Yeah, like this is what the pelvis looks like, this is what the pelvic floor looks like. Um, if in this case, obviously I'm working with like um male genitalia, but like um this is the penis, these are how the pelvic floor muscles are, this is where the bladder and the prostate and the rectum are. And I usually start by explaining kind of like how the poop system works, how the P system works because it feels less sexual. And yeah, it's more clinical. Yeah. It's more clinical, and then and then talk more about kind of like how erection and everything works, and then usually use other examples. Like I've had people that have come in that will describe this or people that will describe this, and then quite often they like to identify, like, I think I'm that person. But the number of people then, once you just explain it, that they'll be able to say, That's me. Like, I think about some people that have come in recently. This one young man that said, Do you think this is related to like I'm going through a really I've I've got this new partner, but I'm going through this messy divorce, right? And do you think some of that is like tied up to this? I'm like, 100%, right? Or I find sometimes as soon as you explain it, it feels less um threatening to people that there's something wrong with them, but more like, well, yeah, that makes sense. That I'm not sure.

SPEAKER_01 12:02

Yeah, like your body's actually operating the way it's designed to. And that's really what I'm trying to like when you're not dealing with medical ED, when there's not a low testosterone or your pelvic floor hasn't like weakened over time and you actually can get an erection, it means that your body is not being put in an environment where it knows it's supposed to get an erection, right? And that means that there's an issue outside of your body, and that sometimes alone is just like a breath of fresh air for people.

SPEAKER_00 12:31

Yep. So, what are some of the things then? Because obviously there's a whole nother episode that I'm doing that talks a little bit more about the medical aspects here. So we won't spend our time talking about that. But are you um can you give some examples, like just some different examples? Like I said, I know that some people will bring up things like um, I had a gentleman recently that explained that he's like, I just have some attention issues. Like I'm always stressed. Um, I feel like I can never relax, right? Um can you talk a little bit about how sometimes maybe things like porn use come into this? Because this is something that I don't always know how to like this is something that people are usually working with someone like yourself with this and they don't share everything with me. But can you talk a little bit about how some of these things that we have quick access to are affecting how our nervous system works?

SPEAKER_01 13:27

Totally. And so I want to caveat and and and say right off the bat, I have nothing against pornography use. Clients can use that, clients have really healthy sex lives while using pornography. Um, where things can go um south for some folks is if it's it's kind of intention of use. So if people are in a habit of self-pleasure or masturbation where it is stress-induced, so it's I'm stressed, so I'm using this to relax, um, that can become really challenging when it comes to sex with a partner because do they feel relaxed when they have sex with a partner? And if not, then where they're used to the environment and the in the energy that they're used to having when they are experiencing sex with themselves and the body doesn't know the difference, the body still sees that as sexual engagement. Uh, if one is involving stress um, like uh to relieve the stress, but the other one is adding to stress, again, we're not gonna have an erection in one and we're gonna have one in the other. There's also the stimulation piece. So there's that, that's the relaxation component, the stimulation component. So if we are consistently being fed information to our body around pornography, specific pornography, maybe I'm always looking at, you know, women with big breasts or something, or very specific kink stuff, or whatever it might be. And that's like the only type of porn I'm watching. And I'm doing that on the regular, and that is so far removed from the type of sex I'm having with a loved one. We're sending kind of mixed messages to our brain that this is sexual over here, and it might find it really challenging to code what you're doing with that other person as sexual. And so, yeah, sometimes we make a shift to the type of pornography or the frequency of pornography, or just like the intention behind when we're uh masturbating, and can we slow down that process and kind of make the practice look like the play, make the masturbation look more like the partnered sex?

SPEAKER_00 15:26

Also, too, like I like a lot tied into expectations, expectations and masculinity. I would say this is a different, like I find it's interesting. I find when you when you compare, um, there's a certain, I would say a lot of like kind of like the female population will come in with a very different um expectation. It's almost like they don't expect it to be enjoyable, which is a whole nother episode. Versus versus this very kind of like hard on them um personality or per or or kind of feeling when like I should be able to enjoy this or I should be better at this, and this is challenging my masculinity.

SPEAKER_01 16:07

Yeah, yeah, and and the things that they see as their role during sex, right? A lot of men see their role as providing pleasure for them their partner and themselves. Like they're responsible to make sure their partner orgasms, but they're also responsible to make sure they themselves orgasm. And they see very little responsibility on their partner, right? Which, whether their partner actually agrees with that or not, they might be going through their own thing and have their own pressures, but to the individual I'm in front of, they're putting the entire sexual experience on themselves, which robs them of the ability to communicate during sex, to ask questions, right? Because they have this pressure that I should already know how to please a woman or a man or whoever they're with. And they almost have like a very um minimized view of sex as if there's one way to please a person, and every person is pleased the same way. Um, and so they rob themselves of just the experience of communicating what's working, what feels good. They put so much pressure on themselves. And it's yeah, that's usually one of the hardest narratives to kind of shift in the work.

SPEAKER_00 17:14

I just recorded an episode recently with a psychologist where we talked about um purity culture and um just some of the different nuances that come in there. And I'm sure like the same thing. We again I happen to be talking with a female and she was sharing her experience. But can you talk a little bit about some of the other thoughts you have around cultural differences, um, kind of purity culture messages that that that um people get that would influence this?

SPEAKER_01 17:41

Totally. Um it can totally impact, like I I would say the one I come up against a lot with this specific subsect is purity culture and around the the idea of being a good, good, nice man, right? And um this idea that uh taking what I want or um being assertive with what I want is not okay because in all these other aspects of my life, that's not okay, right? I'm supposed to, you know, be a feminist and uplift my partner. And so what happens in the bedroom if you're if if I'm with a woman who likes to be taken, likes to be maybe you know thrown against the bed, you've got these guys that are coming in and going, ooh, like that doesn't feel like I'm staying in this bubble of a nice guy, right? Or they all have their own desires, right? Maybe the porn that they're watching or what their fantasies are doing is something that doesn't fall within this bracket of nice guy or good pure culture, right? And so their fantasies in their brain and their sexual self is running away with these things, but then when it comes down to having sex with someone, they don't allow themselves, they don't give themselves permission to actually play with those realities and those fantasies. And again, then the body doesn't respond, right? Because the body's not really seeing that as sexy, it's not really true to what they find sexual. Uh, and so that's not the only culture. There's a lot of cultures, a lot of different things that can come in and say, like, you know, rob people of what can be consensual, amazing sexual experiences. Um, but for some reason they're being told, hey, this is wrong or this isn't allowed, or this isn't acceptable. And so unpacking that is really important too. Yeah.

SPEAKER_00 19:32

What do you find? Do you find most people will describe that this is something that comes on suddenly or gradually?

SPEAKER_01 19:40

A little bit of both. So you kind of get both stories. Um, you'll get the guy who the person with a penis who like has never had any issues with erections and it happened that one time, and then from that time it's just been so challenging. Um, usually, maybe not always, because sometimes it could be something medical going on, but usually it's because they had an idea, they had an idea in their head that um they always get erections and therefore they always will, and that's the norm. And they don't really understand that erections come and go, and that's normal and that's natural. There's a lot of things that impact it, how tired you are, if you've got any cramps in your body, pain, anything. And so for some reason, that one time something was going on, maybe they didn't need enough that day or whatever, but they saw that as there's something wrong with me. And then it creates this panic immediately and this like uncomfortable experience that they that are then afraid to re-experience, and the fear of re-experiencing it is then what keeps causing it for them, right? They're going into sex, feeling the threat of that experience happening again. You also get the guys on the other side who are gradual in the sense of it happens, but it doesn't bother them. Like they're like, oh, it was probably just a one-off. But then maybe they're ignoring the signals of the things in the relationship or the things that are happening that are causing it. So they almost like um, you know, don't look into what could have happened at all. And then slowly over time, whatever it is, maybe it's a habit they have or a relationship dynamic they have, that continues on and starts to impact their erections more and more. And um, it's not until it gets quote unquote bad enough that they come in to see someone, right?

SPEAKER_00 21:22

I find like if it's someone coming to see me, and and again, I it would probably be something along the lines of I explain how the system works, I'm talking to them about the symptoms that brought them in. And then as they feel more comfortable and start sharing some of the things that make them think, oh, this is related, that I might say, Have you ever worked with someone like someone like Justin, or have you ever worked with talked to a counselor about this? When do you find like what things would make you say, Have you ever seen a pelvic floor physio?

SPEAKER_01 21:54

Honestly, first couple up uh first couple sessions, regardless. Yeah. Um, because of the solution. To the problem might be both physical and mental, right? And so it's very early on because I'm getting guys doing Kegels, reverse Kegels, and I'm I'm suggesting these things from very early on because I like to come at the solution from both ends, right? If you're not relaxed, okay, what's causing that distress for you mentally? Let's talk it through, see if we can shift some perspectives, but also can you learn to relax your body manually? Right. And so in response to, oh, I noticed that I'm nervous, my pelvic floor is tightening up. Can I relax it? Right. And for a lot of people, connection to their body isn't always very high, right? So I'm getting them to do the exercises, but I'm I'm not physically there. I'm not doing the exercises with them in a more intimate setting like a pelvic floor physio. And so if they're starting to feel like, I don't know if I'm doing this right or it's not really clicking, I'm like, there are people out there that will help this click for you. And that's that's where I refer out to pelvic floor physios almost all the time. Most clients are getting that referral, whether they take it, receive it, and do it is another thing. But yeah.

SPEAKER_00 23:07

Yeah. Well, I think a lot of people, when you just either explain it to them or show them, like I have different um images on my computer that will show the pelvic floor tightening versus relaxing and how it's related to like the male anatomy so that they can see it. And a lot of times that's enough for people. But um, yeah, just to give people an idea when they come in here, that and this is obviously how I practice, I can't speak for everybody, but I would start first with just visuals and getting them to try things on their body and maybe sitting on a ball or something where they can get that feedback. And then I might, if if they're like, oh yes, and that you can just see that they're getting it, that might be all they need. For some people, I find I I usually would probably start kind of from external palpations. I might go through your underwear or through some sheets that are draping you to be able to touch kind of underneath the testicles or between kind of the anus and testicles where the way I have access to the pelvic floor or kind of between the sit bones, just to get people to feel that. But then obviously the only other way in through the male pelvic floors through the anus. And and so it just depends on the person. I think there's a lot of misconceptions around what has to happen in a pelvic floor physio appointment, which which are not true. Um, and and you can tell really quickly from someone's body language what they might may or may not be be comfortable with with comfortable with. Yeah. And so, yeah, no expectations of what has to be done in the physio.

SPEAKER_01 24:29

Yeah, that's really helpful for me too, to even be able to describe what what can a pelvic floor physio, you know, appointment look like. Yeah.

SPEAKER_00 24:36

Yeah. And I think I always tell people to do your homework because I think some physios do feel more comfortable with palpation or that not not that it's mandatory, but they may may be more likely to start there. But you know, I think people should just know that they can get what they want to out of it. They don't have to say yes to anything.

SPEAKER_01 24:51

Yeah, and there's there's some clients that I know who would prefer, you know, just get the expert into my body and tell me what's going on. Exactly. Whereas others might go, tell me how I can do it myself. Yes.

SPEAKER_00 25:01

Exactly. Yeah, exactly. Um, what about okay? So this is where sometimes I find I don't know who to send to for this. So let's say um, let's say um, like what do you suggest is let's talk with about therapy for a second. So we've talked about how to explain it and and to people and so that they understand, um, normalize it a bit. Where do we start with treatment? So we I talked a little bit about the pelvic floor specifically, but how would you explain to people? I often say there's like a menu of options. Here's some different things that we can do. Can you give an example of your menu of options?

SPEAKER_01 25:38

Yeah, there's a lot. So it really, you know, you try to gear it towards a specific client and what they're comfortable with and where they're at, right? In their own comfort level and stuff. But usually some general ones that show up on most people's docket of treatment is gonna be um working with their own self-pleasure practice and and making some shifts there. So that could be bringing the pelvic floor into it and having them actively relax the public floor while they're you know stimulating themselves. It can be getting comfortable with their own soft penis, soft penis play and noticing emotional response to just like no expectation of erection, no stimulation, right? Like no fantasies or pornography and just like light touch on you know, stimulating themselves. Uh, furthermore, from that, learning for them to notice pleasurable sensations regardless of high intensity, right? Just like what feels nice when you're not thinking sexually, just like as a you know, tissue, what feels like a good sensation. So, some sort of stuff with self-pleasure, shifting it and doing some work there. Um, obviously, there's the in-session stuff. So we will be figuring out, you know, where we want to talk about. So a lot of times with clients, we'll be doing things that we call like a sexual development survey, where we together go through their life through the lens of sexual development. So, what was it like for them growing up and what did they take in in that time about their body, about boys and girls or narratives around things? When did they start learning about sex? And did they have any touch experiences when they were younger of a curiosity and those sorts of things? And just look at, you know, I'm always as a therapist looking for where did their curiosities stop? Like when did things stop being about exploration? Because that's essentially what sex is, right? It's this feels good, let's see where this can go. And for kids, kids get it right. Like we don't really like to think of kids as sexual beings, but they're exploring their bodies and they're figuring out what feels good and they're following through with it. But at some point, a lot of times, as we get into adulthood, we have shoulds come in, right? And so we lose that curiosity and then we feel like there's demands of us. And so I'm always kind of looking of when did that shift kind of take place? And then we start talking through some of those things and allowing clients to go does this should or narrative or expectation I have of myself really serve me, or could I maybe loosen my grip of it a little bit and and think of the idea of maybe it doesn't matter and maybe I can get back to that curiosity piece. So that's another big one. But then there, you know, there's a plethora of like at-home exercises and partnered exercises that I do. Yeah.

SPEAKER_00 28:27

And I think about when you describe that and you describe it kind of like when in the when in the lifespan did did something happen. And I think too about things like a surgery, um, cancer. Like, do you know what I mean? It could not, you know, just like what what happened physically or emotionally? Um, and I it's funny how people people don't always connect those dots till you bring it up.

SPEAKER_01 28:48

Like, oh, having kids is a big one, right? Changing your gin, your roles, getting married, moving in together.

SPEAKER_02 28:55

Yes.

SPEAKER_01 28:56

Any major life um act that you disconnect from sex, it's like it's it's all holistic. You are a person taking in the world around you.

SPEAKER_00 29:05

Yeah.

SPEAKER_01 29:05

And so, yeah.

SPEAKER_00 29:06

Well, and you make a good you make such a good point that I think a lot of people wouldn't understand is that think about, and especially if if those stresses or if those changes start to to change the function, and then all of a sudden you have the expectation that, you know, oh, the next time it's not gonna be good, this is getting worse. Um, and I think when when talking with people, the number of people think that they need to try harder for things like arousal and ejaculation or at orgasm.

SPEAKER_01 29:35

Like when you really achieve exactly when you achieve an orgasm.

SPEAKER_00 29:39

Exactly, instead of allow. Yes, right. And so I think as soon as you start, um as soon as you start explaining that, people are like, oh my god, that makes sense, right?

SPEAKER_01 29:48

Yeah, you just have to get out of the way, right? You have to get out of the way. And it really is like, can we show up with curiosity and presence and just noticing, observing what our body is responding to, and and just sitting with that. If you stay with pleasure, an orgasm will come eventually. It might not come when you want it to, and maybe you don't have the time to get there. And so that day we don't reach orgasm, but you still focus on the pleasure, and then who cares?

SPEAKER_00 30:17

Listeners, I know many of you are physios that are perhaps new to the area of pelvic health and feeling like you could benefit from some guidance as the complexity of your caseload goes up. I offer mentorship and I'm here to help. Let's figure out a structure that works best for you. My contact details are in the show notes, so please do reach out. As you talk, it makes me think like we're in this this time now where we get like instant gratification. We can get things at our doorstep as soon as we want. And it makes me think like, do we do we all also have a bit of an issue of just not being patient enough? Like a hundred percent.

SPEAKER_01 30:52

I mean, quickies have been around since you know forever.

SPEAKER_02 30:54

Yes.

SPEAKER_01 30:55

But um, but there's this idea of like, well, we always say pleasure-focused sex versus orgasm-focused sex, right? Pleasure-focused sex is where we want people to be. We want you in the moment and not thinking about this thing in the future, right? Because a lot it robs a lot of people of in the moment sensations. But I think that instant gratification is it creates this like we're used to only looking for the big spike, right? The big, the big moment. And so when we grab our phones or when we go to the TV or when we want something now, it's not that the journey there wouldn't have been pleasurable, right? We're just so focused on the highest point of stimulation and and and and dopamine that we are robbing ourselves of enjoying like subtle dopamine or quiet dopamine along the way. And this, you know, shows up in every aspect of our life. So of course it shows up with sex, right? And so, um, and it happens both ways, right? One partner is really fixated on the other. Like when we're talking about erections, right? So we need you to get an erection because we want to start penetration right away, because we want to get to, you know, orgasm. And for some reason, people, you know, sometimes assume that like penetration orgasm is the ultimate one, and that's the one we need. Um, and so sometimes the pressure isn't even coming from the person themselves. Their partner's also like, hey, get that thing up so we can get going. And um, yeah, if we actually just like took a sigh, relaxed, go back to like when sex started to become new to us, right? Like, we didn't just like hop into bed with someone when we were younger. Typically, there was like hand holding, there was hugging, there was kissing, maybe there was even dry humping. There's a lot of stuff going on that allowed for arousal to take place. And I just don't think we give our bodies the benefit of the doubt that they can get there if we just give them the time and patience, you know?

SPEAKER_00 32:47

What do you? I wanted to ask you, and I was talking a little bit about with the urologist as well. Like, I think about something like a penis pump. Okay. So some um, and I'm gonna talk a little bit in that episode a little bit more about different options, like medical options. But when it comes to something like a pump, do you teach that? Like, I I find like urology appointments, for example, are very short. The chances of them teaching them in those appointments are very slim. And I think a lot of people don't feel comfortable like going to YouTube to find like, is that something that you'll actually walk people through?

SPEAKER_01 33:21

Yeah. So I typically will actually I shouldn't, I should have explained.

SPEAKER_00 33:26

Can you just before you go, will you explain a penis pump? Because it kind of brought that out of left hand.

SPEAKER_01 33:31

Yeah, yeah. So penis pump, I mean, it it there's a lot there's you know, a lot of history around people joking around penis pumps, around them trying to like make penises bigger or these sorts of things. In the purpose of erections, what it is meant to do, it is it's it's meant to promote blood flow in the penis. Like that's just the basic fundamentals of what it's doing, it's using that through suction. And um I don't often find clients wanting to use penis pumps, I would say. I but I have in the past worked alongside clients that were, but I don't typically do the walkthrough of how to use a penis pump. Um, typically, because uh it would be whether they're working with a medical professional or um, yeah, like a specific men's sexual health clinic. Um, but what I would do is if they had gotten the information and something feels like a gap, I will help fill in the gaps of what that is. So I don't do the initial walkthrough. Yeah, but what I will do is go, okay, how are you using it? How often are you using it? Okay, where are the challenges for you? How can we help clear that up for you?

SPEAKER_00 34:40

I'm thinking specifically of the like the prostate um treatment client. And I find that this is something that they're definitely hearing a lot about. And so um, yeah, some people more comfortable figuring it out themselves versus others, and so yeah, I'm personally I love human information.

SPEAKER_01 34:58

I want to sit in front of someone and them tell me that just makes me feel better. So some people are definitely the same.

SPEAKER_00 35:05

So yeah. Um what would you say? Okay, so let's say I think like you said, a lot of people would maybe go to the medical route first, they go to their doctor, and if they feel brave enough to share this is something that could be better in my life, they're quite often perhaps sent to perhaps a urologist or somebody else to make sure everything's okay. And let's say that you then are sent them, that would be you know that you, you know, medically what's been considered, right? What if that goes the other way? And you're someone just finds you on your website or Google, and what would you you'd obviously talk about all of this stuff with them? What would be some red flags that might make you say, I want you to go talk to your doctor?

SPEAKER_01 35:47

Yeah, well, first off, I would tell everyone to go see a doctor. I try to promote, I understand it can be an uncomfortable topic, but I always think that medically it's a lot easier to rule out than it is psychologically. Ours is much more nebulous, right? Like you're saying, like sometimes it takes a while for people to make the connections. Medically, why not get tested? Why not know that your testosterone's fine, right? So I always kind of market it as that is that it's an easy cross off the list. However, uh there are some signs that this goes beyond something mental. And so what we would look at is okay, what is your body doing normally? So are you getting nocturnal erections? Right? Do you do you basically do you wake up with morning wood ever, right? And if that's never happening, okay. Uh, does your erection problem exist in partnered sex and masturbation? Right? Okay, so that's interesting, is like there's never a place that my erection is coming up because now we're going, okay, even if we're in a safe environment, I'm struggling. There still could be some mental stuff around just like sex in general or hangups and or sticky points. But we're starting to wonder a little bit more if there could be some medical stuff. Whereas if someone's getting nocturnal erections or is able to get an erection on their own, or it's only with new sexual partners that they're not able to get an erection, we at least can feel like it's probably not something medical. Still helpful to go get checked and rule it off, but it's most likely not because it's more situational, right? So those are some of the red flags I would say. Um anytime there's pain, like severe pain with an erection, um, or I will always ask around, it's really important with people who if if someone is circumcised or uncircumcised, knowing if um there's any tugging. Like if someone has an erection, is there wet with their erection, is there like tightness in any skin or any discomfort or potential discomfort? Because that's obviously going to be something that their body is going to deprioritize because of something going on. So that those are the ones that come to my mind right now for red flags around medical stuff.

SPEAKER_00 37:56

And when you say that stuff, I think too, like I I actually talked about the pelvic floor, but I didn't talk about some of the other fascial considerations or tissue considerations. Like that's also something that we work on is I've had several people recently, there's definitely more of the male population just learning about this and seeking out, but several people that because of different injuries, maybe some people some one person said I got hit with on the left side of my groin as a child. And ever since then, my my penis is kind of drawn over to that side, and they definitely had some fascial tension to work on, but they were getting pain with erections. Um, sometimes just after surgeries, I find um recently I had someone that shared that after his vasectomy he did not rest. And I think he just created a lot of irritation and swelling, and now his tissues and muscles are really tense, but just giving them sometimes different fascial things to do with their testicles or their penis, like we don't just work on the pelvic floor. So yeah, and and a lot of these people have already been to a medical professional because that's who they think of first. Nobody thinks of a physio first, and so quite often they they go there first and they're very surprised. Like, I had no idea that I could kind of work on this.

SPEAKER_01 39:07

Yeah, there's exercises. Obviously, there's medical stuff. I know there's yeah, there's different treatments to help like break down calcified or anything like any tissue that's kind of causing major kinks or issues in the penis. But yeah, there's there's always the medical route, but then there is just the exercise physio route. And I think a lot of people unfortunately uh don't understand how helpful your your area can be. Like I always say, like, there's a reason that there's physiotherapists just for the pelvic floor. Like there's so much that that one field can do. Um, just how I say, like, there's so much just because you're a therapist doesn't mean you work with all these things. Like I work specifically with this because there's so much we can do, and there's so much that could be going on.

SPEAKER_00 39:49

Yeah. What do you think? Because obviously in this area that we work in, it's not that every not everybody shows up um ready to work on this. They might a lot of people, one of the reasons I started this podcast is I know a lot of people like to listen and just consume some information before they feel comfortable reaching out to somebody. What do you think? Um, something simple, someone could start with doing today if they don't feel comfortable seeking help? Like just any messages for someone listening that's like, oh, I need to go for help, but I'm just not there yet.

SPEAKER_01 40:18

I'm not there yet. Yeah, it would be okay. And they're not experiencing erections when they want. So I would probably go first. Step I'd go, okay, do you know, do you know how to check in with your body? And if not, look up YouTube videos or or different apps that are around like body scanning and mindfulness stuff, where it will have you kind of in a relaxed state, connect and notice tension or or relaxation in your body, and just do it throughout your whole body first and just get used to that process. And then when you feel ready, try to connect that to your pelvic floor, try to connect that to the areas around your penis and just notice is there anything that feels tight? Is there anything that feels tense? Um, and I would say that's a really good first place to start. Start knowing your body. And if your body doesn't feel safe to you at the moment, maybe looking at um your thoughts, right? Looking at the belief that you have around sex. You can simply maybe get a journal out and write down like, what is the expectation of men, what is the expectation of women or my partners in sex and and write, just write it all out. What's all the stuff that you think is is required or expected, all those shoulds that you might have, and just write it out. You don't have to do anything with it yet. Just simply kind of try to acknowledge where some of these beliefs might be. And if there's any that stand out to you as like, hmm, that one makes me a little uncomfortable, or that one maybe is really getting an emotional reaction out of me. Just kind of sit with that for a bit and just kind of reflect on if you do want to speak to someone about these things because you don't have to tackle these things alone. Therapy, you know, I don't know about physiotherapy, I'm assuming so, but therapy, like there's a lot of fun. It's not all uncomfortable and sitting in the discomfort and pushing you. There's a lot of jokes, a lot of dick jokes. Like, like there's a lot of fun that we get to have, and and to to to try and add levity to it. But um, yeah, those are the first two things that come to my mind.

SPEAKER_00 42:21

It's funny when you talk about when you say get in your body and just listen to you know what your body's telling you. The amount, the amount that someone's personality fits into this. And I I like I'll see people and you can take two different injuries or two different surgeries, and then you add a personality and and how much it shows up. Like, I have a lot of people that are like, I don't listen to anything in my body. I just learned to like suck it up, move forward, and just like get on with it. So I do not take time to listen to my body, whereas the next person that comes in might be so hyper-vigilant and they listen to everything in their body.

SPEAKER_01 42:54

Too much in their body, yeah.

SPEAKER_00 42:55

Yes, which I think is the fast most fascinating thing about our jobs is that you have to figure out the person in front of you because you're like, man, all the things that influence, like you said, you take not only this timeline and all the things that have happened in your life, but just also are your personality and your tendencies and your beliefs.

SPEAKER_01 43:13

Well, yeah, how you view how you view health in general makes such a big impact, right? And so, yeah, you do get those people who are a little hyper-vigilant and they have like a fear response to their body. And that's where it's like, can we actually just witness our body without trying to change it even? Yes, right. Yeah, um, yeah, it's so fascinating. And a lot of, you know, I won't lie, a lot of my clients would come in are more disconnected to their body in general with the demographic I work with. But it's really cool to see people learn their body or learn their body differently, or learn to relate to their body differently. It's really cool. The person that you see sitting in front of you changes just on the fact that they exist different in their body. That's one of the reasons I love doing what I do. Um, because you'd think that you're coming in for sex therapy. So, you know, I'm not really gonna see any of the results because that's happening when I'm not there. But it's like, no, I can tell when something is clicking for a client just by the way they show up to the room.

SPEAKER_00 44:12

Absolutely. Um, I can tell you're good at what you do, Justin. And is there anything that you feel like um I haven't asked you that is relevant for this conversation?

SPEAKER_01 44:26

Um, the only thing I can think of is the concept of trauma and trauma's impact. And so obviously, when I'm talking about relaxation and stimulation and stuff, like trauma almost feels like its own medical thing. It's not, but it is a more severe experience of what I'm talking about. And that's one of the things that I personally do not work directly with. So I refer out just like I would medical for a lot of these things. If there's something like, and again, trauma can be death by a thousand cuts. It can be like a small a lot of little things that add up to feel your body really feeling traumatized, or it could be one main event, um, like an injury or an accident or something. Um if that's in the room that and we don't address that first, then a lot of the work I'm doing is gonna feel stunted or it's gonna feel like we're just doing the same thing over and over again. And so that would be another advice to any listeners is if you feel like or you know that there's a trauma component, remember a symptom of trauma is the want to avoid it completely and never look at it ever. But um, if you can then actually start with a trauma therapist, a specific EMDR or just someone who specializes in trauma, that often is a better place to start. Or go see both if you feel like you've got the capacity. Go see someone who specializes in sex and see someone that specializes in trauma or someone who specializes in sexual trauma, those sorts of things.

SPEAKER_00 45:52

I think how a lot of people will notice that, even if they don't notice before they come to the appointment, is that when we start talking about the ability to let go, there's this wall that just kind of and that no matter how many things you try, that you you can't let go. And and um when we talk, and that's what I say is like when you think about it, all and I when I talk about my practice, like the things that I work on, the digestive system, the urinary system, sexual health system, they all require letting go. And so you can do all the exercises in the world. Um, but if you if your nervous system can't let go, then respectfully.

SPEAKER_01 46:28

Then we have to, yeah, we have to at least let it like learn the safety of letting go first, which yeah, there's a lot of amazing therapists and specialties that really help with that specific thing. And then you can come in and we can focus now that new skill that you have on the specific sexual stuff that's going on for you.

SPEAKER_00 46:46

Amazing. Well, I look forward to kind of putting this together with the an episode all about the medical considerations when it comes to ED. And so I really, really thank you for your time.

SPEAKER_01 46:56

Thank you for having me.

SPEAKER_00 46:57

Yeah, I look forward to um sharing this episode with people and have them having a resource to reach out to because I can hear that um, like I said, that you're obviously really good at what you do. And that's a wrap. If you enjoyed the show, can I ask you a big favor? Would you do one of three things for me? Number one, leave a review because we could all use a little positive feedback sometimes. Number two, download the episode because it helps me see what people are interested in. Or number three, share it with somebody else. Because sharing is caring. Catch you next time.