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August 15, 2020

Fight, Flight, or Fold? The Effect of Adrenaline on Erections and ED After a History of Sexual Inactivity

Speaker 1: 

Welcome to the Armor Men’s Health Hour with Dr. Mistry and Donna Lee.

Dr. Mistry: 

Hello and welcome to the Armor Men’s Health Hour. I’m Dr. Mistry, your host, here with my cohost, the ever present, ever wonderful, Donna Lee.

Donna Lee: 

Ever present. Is that a thing?

Dr. Mistry: 

That’s right. It’s like saying…showing up is half the battle.

Donna Lee: 

Hey! You’re here again.

Dr. Mistry: 

It’s half the battle. I’m a board certified urologist. This is a men’s health show. This show is brought to you by NAU Urology Specialists. We have been in practice since 2007, almost coming up on our 13th magical year here in Austin.

Donna Lee: 

You know, 13 is our lucky number at home. When we go to Vegas, we bet on 13 all the time.

Dr. Mistry: 

That’s right.

Donna Lee: 

And we win big.

Dr. Mistry: 

Well, you’re still coming to work. So maybe not winning too big.

Donna Lee: 

Have to come to work to finish off the Vegas [inaudible].

Dr. Mistry: 

Maybe, maybe it’s a lucky number for me so that if you got rich, you wouldn’t come to work anymore.

Donna Lee: 

OK, good point.

Dr. Mistry: 

Our urology practice is dedicated to the treatment of both men and women for a variety of urologic needs, including kidney stones, bladder cancer, prostate cancer, you know, things that deal with the body from the belly button to the knees.

Donna Lee: 

The knees? Wow…

Dr. Mistry: 

Let’s just say above the knees, below the belly button. We have four amazing physician providers. We have four amazing physician assistant providers. We have in-house sex therapy in house physical therapy and biomechanical therapy. We do in-house nutrition, in-house sleep, because we really care about you from your head to toe, even though we only really take care of your belly button to your knees.

Donna Lee: 

The midsection.

Dr. Mistry: 

That’s right. Just the midsection.

Donna Lee: 

Oh boy. The ding-a-ling and the yum-yums.

Dr. Mistry: 

That’s the most important. If you had a bullseye on what our most important part of the body is, at least we know. Donna Lee, how do people get ahold of us?

Donna Lee: 

You can call us during the week at (512) 238-0762. We have a new website, Dr. Mistry. But we have an old website, but we combined some websites, so now it’s a little different for people to get ahold of us. So they have to go to our website, Northaustinurology.com and they have to click on the podcast. So we have a podcast link, how exciting!

Dr. Mistry: 

That’s right. We’re podcastable!

Donna Lee: 

We’re podcastable as we like to say, so you can send us questions through our website. You can also continue to send your questions to armormenshealth@gmail.com, which we respond to. All of them we respond to. And we do have some questions today.

Dr. Mistry: 

It’s those questions and your engagement as our listeners that really mean a lot to us. I don’t know, I think a lot of my friends are lying when they say that they’re listening to us.

Donna Lee: 

You think?

Dr. Mistry: 

Yes.

Donna Lee: 

But who’s listening to the podcast?

Dr. Mistry: 

Everyone says they’re always listening to me all the time. Everyone. I think they know that my ego is really fragile.

Donna Lee: 

Oh, well, mine is now too, thanks.

Dr. Mistry: 

Well, there you go.

Donna Lee: 

I went to look at our downloads, I was a little sad. I was like, “Oh, wasn’t it the thousands I was expecting.”

Dr. Mistry: 

No, not this week. Not this week. Well, let’s spice it up, lady.

Donna Lee: 

Oh boy. I do have a question.

Dr. Mistry: 

Yeah, let’s do it.

Donna Lee: 

This one is a little, maybe a little sad. So I’m going to respond to this guy. He wanted to make a long story short. “Dr. Mistry, I’ve been inactive sexually, so sexually inactive most of my life. In my early thirties, I had no problems getting aroused and having erections. However, invariably, I went soft. This had nothing to do with losing interest.” And then he said, “I think I tried five or six times around that time. When I was in my forties, I actually was in a relationship for several months. Due to religious reasons, we only had sex three or four times. The same thing happened. There was, there was no guilt related to my faith, nor did I lose interest during the act.” Now he’s in his sixties. He’s wondering if Viagra would be useless now, or do you think that there’s promise there?

Speaker 2: 

Well, I think that’s a great involved question that has several components to it. Although I’ll try to address what this listener is asking, I’m going to start from the, just kind of the progression as he was going through his life. So young people who are not sexually active, whether it be for religious reasons, self esteem issues, anxiety issues, those are things that we really pick up on here in our clinic. Many people, when they’re going through a sexual history, if they ask the patient, are you sexually active? And they say, “No,” they may just stop there. But we are the kind of practice that says, “Hey, why not?” Right. You know, if you’re a 27 year old healthy man or woman, and you’re not sexually active, and if it’s for religious reasons or because you’re not married or because you’ve chosen that, then that’s, you know, that’s fine. But if it’s because you have a sexual issue that you don’t want to talk about or embarrassed talk about that’s something else. So in this case, it seems like what we have is a person who is not very sexually developed, not very sexually experienced. And then to try to try to start becoming sexually experienced in your thirties when you’re with a sexual experienced partner causes tremendous subconscious anxiety, for sure. There’s no getting around it. And in our physiology as humans, the one thing that kills an erection more than anything is a very strong dose of epinephrin. So when it’s part of our fight or flight, right? I mean, could you imagine if like a tiger was chasing us and you’re trying to, and you had an erection, it would be the worst thing. You know? You know, James Bond has never really, you know, they’re doing the things afterwards, not like in the middle of the chase, you know?

Donna Lee: 

What a confusing feeling!

Dr. Mistry: 

That’s right. That’s right. So confusing. The adrenergic response of having that epinephrin course through our body, coming from our adrenal glands when we’re having a fight or flight response, that’s why sometimes when you’re just start losing an erection and you get really worried about it and you try to push harder, you know? And so–that’s where we need that slide whistle–and that’s, what’s going to happen. You’re going to have difficulty maintaining that erection. Then you, then you move to forties. Now you’re in a committed relationship. You have nothing that’s really kind of getting in the way of it. But now you start getting ED, age-related ED. Right. Which just seems unfair. You never got to use the thing in the first place. And so, and now, whether Viagra is going to work or not, it almost certainly is likely to help tremendously, but to just throw a pill on the problem that has existed for 40 years, is unlikely to overcome kind of the deeper set issues.

Donna Lee: 

So the patient did reference though, “Is this a more appropriate question for a sex therapist?”

Dr. Mistry: 

Well, I think that’s a lot like, if your lights are flickering and you call an electrician, they’re going to say some electrical problem. If you call a carpenter, they may think that something’s wrong with the substructure of the house. If you call, you know, a horoscope specialist, they’re going to tell you that your planets are not…so kind of, you’re going to get the answer from the type of practitioner you’re going through. So when you come to us, we have the sex therapist here. We have a pelvic floor physical therapist here. I’m going to handle your hormones and your physiology. So whether your erectile issues or your ability to maintain your erection is neurologic, hormonal, psychological, or vascular, which is blood flow, you’re going to get an appropriate evaluation here. So it’s not either/or, it’s and. And so getting a sex therapist involved for this longstanding sexual dysfunction, along with understanding that at age 60, now, there’s going to be a variety of physiologic, medical issues that are affecting you, I think is really important. Low testosterone, you know, impaired blood flow, and, you know, let’s, you know, come on in, let’s try to help make your sixties, you know, kind of that magic time. The listener didn’t say it, but I’m going to guess it, he probably never married.

Donna Lee: 

I don’t think so.

Dr. Mistry: 

He doesn’t have any children. So the kind of amazing, like impact this has had on the course of his life is tremendous. And so, for those of you out there that may be, you know, quietly suffering from a similar kind of condition, you know, I try to encourage so many younger people to address these things when they’re able to, you know, alter the course of their lives. We meet people from Asian countries, immigrants often who may have grown up with different types of attitudes towards sex, and then they’re forced into arranged marriages, for example, and then they come and see us because…

Donna Lee: 

They can’t get pregnant?

Dr. Mistry: 

…they can’t get pregnant because they’ve never had sex.

Donna Lee: 

That was the marriage I needed!

Dr. Mistry: 

Oh God, Donna Lee. Poor Michael. Yeah, maybe sign up for one of those, you know what I’m saying?

Donna Lee: 

It’s not too late!

Dr. Mistry: 

Yeah, that’s right.

Donna Lee: 

Oh, I’m sorry, Michael. Oh, by the way, he wants to be on the show to defend himself.

Dr. Mistry: 

He’s going to defend himself. He’s going to defend himself. I don’t think we have an option.

Dr. Mistry: 

Oh boy.

Donna Lee: 

Well, that’s insightful. I felt really sad for him when I read that question and I hope that he comes in, so I’ll reach back out to him.

Dr. Mistry: 

Well, that’s a, that’s a great question. We really look forward to your questions. I think they give us a lot of inspiration in our own practice to continue what we’re doing in the kind of way that we’re doing it. Because I think that if you go somewhere and have such a complex scenario or don’t share your scenario with your doctors, they know it’s complex, then you know, all the Viagra in the world is when we’re gonna give you a headache and change the blue-green outline of lights instead of really helping you get to the underlying issue.

Donna Lee: 

And how brave was it for him to ask that?

Dr. Mistry: 

It was amazing. So thank you so much for that question. Donna Lee, how do we get more brave questions?

Donna Lee: 

So you can send your brave questions about those lions chasing you while you’re having an erection to armormenshealth@gmail.com. That’s armormenshealth@gmail.com. You can visit our website, northaustinurology.com. You can also still visit armormenshealth.com and you’ll just be given a whole beautiful blue website, full of information and knowledge about the middle part of your body. Call us at (512) 238-0762. During the week you can ask for me, I’m happy to help. And we’re located in Round Rock, where Dr. Mistry started 13 years ago, North Austin, South Austin, and Dripping Springs. And Dr. Mistry is his real name, M-I-S-T-R-Y. Somebody called us “zany” the other day.

Dr. Mistry: 

Well, that’s better than gimmicky.

Donna Lee: 

We’ll be back with our zany show.

: 

Dr. Mistry wants to hear from you! Email questions to armormenshealth@gmail.com. We’ll be right back with the Armor, man.

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