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79: Ask a Urologist

Jun 01, 2021

Do exercises help with premature ejaculation? What's causing my split stream? Does wave therapy work for erectile dysfunction? Urologist John Smith has the answers.

Episode Transcript

This content was originally created for audio. Some elements such as tone, sound effects, and music can be hard to translate to text. As such, the following is a summary of the episode and has been edited for clarity. For the full experience, we encourage you to subscribe and listen— it's more fun that way.

Troy: Do you ever tell clients to think about baseball?

Scot: I thought it was basketball.

Dr. Smith: I've never told someone to think baseball.

Dr: Madsen: Is it basketball? See basketball is interesting. You know, I've heard think about baseball. I don't know. Baseball is an incredibly boring game. Maybe soccer. Some people like soccer. It's pretty boring though.

Dr. Smith: Golf. I think of Austin Powers. It was Margaret Thatcher naked on a cold day.

Scot: Yeah, right.

Troy: Is that what it is?

Scot: Health is more than supplements, ripped abs, or crushing in athletics. It's a state of physical, mental, and social well-being and it's not an end. It's the means to an end. The currency that enables us to do all the thing we want to do, and the podcast is "Who Cares About Men's Health?" We like to give you inspiration, information, and a different interpretation to better understand and engage and feel better today and continue to be able to do those things we want to do today and in the future as well. My name is Scot. I am the manager of, and I care about men's health.

Troy: And I'm Dr. Troy Madsen. I'm an emergency physician at the University of Utah, and I care about men's health.

Dr. Smith: And I'm Dr. John Smith, a urologist at the University of Utah, and I care about men's health.

Scot: Dr. Smith is back. It's always great having Dr. Smith on the show. You know, one of our premises is here is that whenever you talk about men's health it seems like a lot of times it all comes back to our pieces and parts and we are more than our pieces and parts, but sometimes we are our pieces and parts and that's why you're here today, to help us with our pieces and parts, so thank you.

Dr. Smith: Thanks for having me.

Troy: Certain pieces and parts, yes.

Dr. Smith: I always appreciate being here.

Scot: Long way around the shed for that. Today it is ask a urologist. We like to bring in Dr. Smith to answer some of the questions that you have. A lot of different ways you can get them to us. Through our Facebook page, you can send a private message. You can put them on the wall. You can send us an email Troy's got the listener line. Sometimes we get calls on the voice mail listener line. What's that number?

Dr: Madsen: Yeah, that number is 601 55-SCOPE.

Scot: All right, and these questions sometimes you might be a little shy asking them, and if you do not want to use your real name, you can use an alias or a pseudonym, you know, like some sort of a generic name, like John Smith.

Dr. Smith: I love it.

Troy: I want people calling in to tell us it's Scot Singpiel.

Scot: I don't want that.

Troy: That's what I want. I want them to just start calling in and saying that . . .

Scot: That's funny. We've got three questions here. Question number one for Dr. John Smith is, strangely enough, from somebody named John Smith using a pseudonym there, we think. Do exercises for premature ejaculation work? So sometimes you might get mails, emails. You might hear people talking. Is that how you handle that issue or no?

Dr. Smith: It is definitely one of the ways that we handle premature ejaculation. There's behavioral, topical therapies, like behavioral, psychological, topical therapies and then oral therapies that we use. But I'll go over some of the behavioral therapies that actually I've seen patients utilize and actually find benefit from. So one of them is called the pause and squeeze or the squeeze technique. If you're someone who, you know, kind of struggles with this, the way you would do that is when you feel the sensation that ejaculation is imminent, you stop sexual intercourse and squeeze the head of the penis until the sensation to ejaculate goes away.

Scot: Physically?

Dr. Smith: Physically. And then once that urge is gone, then you can resume sexual activity and that can help you kind of elongate that sexual experience. There's also the stop-start technique. That's kind of exactly what it sounds like. You stop penile stimulation until the urge to ejaculate goes away. Again, when ejaculation feels like it's imminent, right on the doorstep, you just kind of cease, kind of just pull back, wait for that to go away, and then reintroduce yourself into the sexual encounter.

And the third one they call the quiet vagina, or that's the way it was described when I was in residency and fellowship. The female stops moving and the male stops moving and the . . . until the urge to ejaculate goes away. This one I found from most of my patients tell me that's less effective for them because there's still some stimulation there being in the sexual act still that makes it a little bit more difficult, but if that works for you, then that's another one.

And then another one is . . . they call it sensate focusing. You kind of . . . the best way to describe this would be to kind just start with non-sexual stimulation but stimulating yourself where you have sexual self-awareness by gradually progressing from non-sexual touching to sexual touching and then into the act of sexual intercourse itself to try to kind of ease things up and get the body more acclimated to a longer lasting sexual encounter. Some people would just call that foreplay, but if you wanted to get the $500-term for it, that's what we'd call it.

Scot: That was the medical term, medical school-issued term.

Dr. Smith: It's pretty much that. You know, those are the options that for most folks that we'll offer to them to kind of try and see if they work, and then beyond that there are some topical things that patients can use. I don't know if you wanted me to talk about any of that stuff, but we can go into any of that that you want to.

Scot: Yeah, I think just knowing that there's some stuff out there. So there's some things you can do in the moment it sounds like, and then there's some topical things that would make you less sensitive I'd imagine. Those things in the moment over time will then you'd be able to build up endurance if you do those or . . .

Dr. Smith: So it generally does help to continue those things, and once you kind of get your body acclimated to that, you have to do them less often, and sometimes hopefully not at all, but I've had a lot of patients who said they've had success when they've actually tried and performed those.

Scot: I've heard some guys say that just even talking about it to their partners helped because some of it can just be in the brain. It could be psychological, and once you kind of share that fear or whatever that it can just kind of go away. So I don't know if there's any validity to that. It's worked for a couple of guys I know, but . . .

Dr. Smith: I think it definitely can be. One of the things we always offer anybody who's having any sexual dysfunction one way or another is an opportunity to talk to a sex therapist because sometimes that can help. Having open, honest communication with your partner is also nice. I have a couple of patients who've also said that when their partner also talks to them kind of maybe a little dirty talk during sexual intercourse, that that can make the sexual encounter shorter for them. So they've asked their partner to kind of quiet down because they're very visual and audio stimulated person where that can make things worse too. So anything that you can do to try to help with that situation I think is worth a shot.

Scot: All right. What about, like, Kegel exercises? Do those work? Is that how do you pronounce that?

Dr. Smith: Yeah, Kegel, Kegel. I mean, I think you could say tomato tomato. It doesn't really matter. People understand what we're talking about, and at the end of the day any . . . you can try that. I don't know that that's as effective as the other things that we mentioned, but I think that's something that you can try, and again, if it's beneficial for you, then I would say continue it.

Troy: Yeah. I mean, it sounds like some of those are things where, you know, people may notice it. It may come and go, but other times . . . is more your takeaway if it's there all the time you probably need to do something about it where some of this stuff might come and go and not be an issue?

Dr. Smith: Exactly. If it's there and it's something that's there more often than not, come in and kind of be evaluated. If it's something that happens every once in a while, the majority of the time it's nothing. It's just that adhesion that goes away within a day or so and you may notice it once every so often. But when it becomes a more chronic issue, that it's happening more and more frequently, then you definitely want to come in and have it evaluated.

Scot: I had no idea there were so many reasons you might have two streams. I thought there was going to be one, but it sounds like yeah. That's interesting. All right question number three, and . . . well, I'll throw it out there. Question number three. Does wave therapy really work for erectile dysfunction? And it's from John Smith. Dr. Smith and I did a Scope piece on this. So we have a full link Scope piece where we talked about wave therapy and how to make that evaluation, whether or not that's something you want and how to ask the right questions. But let's just briefly cover it here on this podcast, and if you want more information, you could go to and do a search for it. So Dr. Smith.

Dr. Smith: Sure. So there's multiple different kinds of wave therapy. You may listen to the radio. You may see things on TV. There's an acoustic style wave therapy, and then there's a low intensity shockwave therapy. They're not equivalent. They're not the same. The low intensity shockwave does have research behind it that shows that it is beneficial for erectile function to help with the regrowth of blood vessels and help to improve erectile function.

Again, there are caveats to all of these things, but the acoustic waves don't have any data that shows that they're effective for erectile function. There are some other studies outside of urology that show that it can have some benefit there, but in the urologic sphere it's not been shown to be effective, and so the answer is yes but you got to be very honest with the patients and let them know because it's not for every patient. It's for someone with mild to moderate erectile dysfunction, not somebody who has a severe erectile dysfunction after they may have had like a prostatectomy or something like that. Those patients oftentimes don't see any benefit, but the folks with the mild to moderate erectile dysfunction there's some emerging literature and data that shows that it's very helpful.

Troy: By acoustic waves you're talking about just like ultrasound. Like, people are putting ultrasound on and saying this is helping?

Dr. Smith: Yeah, it's more of a sound wave. Sometimes it's called a gains wave or, you know, an acoustic wave. It's a very different waveform than a low intensity shockwave.

Troy: But bottom line is acoustic waves don't work. Shockwaves do.

Dr. Smith: They do. Again, you got to be judicious about the people that you do treat with it, and, you know, we have one at the university actually. We just obtained it a couple of months ago, and we've started using it on a few patients. We've had a few good outcomes so far, and so, you know, as we continue down that road, maybe we'll put out some more literature here in the future with how things are going.

Troy: Given some of the stuff I see in the ER, I'm going to add the caveat don't try it at home.

Dr. Smith: Right. That's always a very good lesson to learn is don't try this at home.

Troy: Electricity might help but don't try it at home.

Scot: The thing I learned from the conversation that I had that you could go listen to the whole thing with Dr. Smith is that there are kind of a lot of different reasons for . . . you know, different conditions of erectile dysfunction. There's a lot of different treatments and really you should have somebody that knows how to navigate that, like a urologist like Dr. Smith, to kind of work you through that sort of thing. That's what I ended up with, and if wave therapy is kind of where you end up, then that's great, but I think that discussion needs to happen, and I think Dr. Smith would agree with me on that.

Dr. Smith: I would agree 100%. It's something where if you do have issues or concerns, definitely following up with someone who does it on a regular basis and is reputable to take care of you.

Scot: All right, there you go. Three questions, man, Bam, bam, bam, and done. Nice work.

Troy: Done. We just need to tell our listeners there are other pseudonyms besides John Smith, Scot. So if we can get the word out there, try Scot Singpiel next time. It's a very common name. You could use that one.

Dr. Smith: Very common.

Scot: I think Troy Madsen, very common.

Troy: Very common. Scot Singpiel is just yeah . . . I know a lot of Scot Singpiels so . . .

Scot: Dr. Smith, thank you for being on the show and thank you for caring about men's health.

Dr. Smith: Hey, thanks, guys. Really appreciate it.

Scot: And thanks for checking out the podcast. If you enjoyed this particular episode, do us a favor, subscribe. Or if there's somebody in your life you think would find this episode useful, share the word with them.

On "Who Cares About Men's Health?" just to kind of give you a brief overview, we talk about the core four plus one more to stay healthy now and in the future, and we do episodes based on nutrition, activity, sleep, emotional health, and genetics. We also do shows like this, which are very specific to men, we call "Men's Health Essentials." So answering the questions that men would have about their health. Then we also have a show called "The Sideshow," which is just us having a little bit of fun.

So if you like this episode, check out some of the other "Men's Health Essentials" especially with Dr. Smith, or check out some of our other flavors as well so we can help you care about your health. Be sure to check the show links. We'll have links to anything that we talked about in the show in addition to links to contact us. Thanks for listening to the podcast and thanks for caring about men's health.

Relevent Links

If you want to learn more about wave therapy for ED, Dr. John Smith goes into more detail in this Scope Radio interview: Does Wave Therapy for Erectile Disfunction Work

Listener Line: 601-55-SCOPE
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