NAU's COVID-19 Policy
April 18, 2020

When the Going Gets Tough, We Get You Going -Dr. Mistry and Donna Lee on Difficulty Ejaculating, Retrograde Ejaculation, and Anorgasmia

Speaker 1: 

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

Dr. Mistry: 

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

Donna Lee: 

That’s right. I’m a board certified cohost, in case the listeners didn’t know.

Dr. Mistry: 

Certifiable. For our award winning self award, perhaps, given…

Donna Lee: 

The award is on my desk. I don’t know why you have to give me grief. It’s an actual award and I’ve got a little sticky note and said “The Armor Men’s Health Hour, Award Winning.” And there’s a little man, too, by the way, on my desk. You’ve seen him.

Dr. Mistry: 

That’s right. It’s like the snowflake award that you give to everybody…

Donna Lee: 

Everybody wins!

Dr. Mistry: 

…that participates in the YMCA’s basketball.

Donna Lee: 

Everybody on the show gets an award.

Dr. Mistry: 

I am a board certified urologist. This is a men’s health show. We love getting questions from you on a variety of men’s health topics. You know, interestingly enough, a lot of our topics are about erections.

Donna Lee: 

Most of them.

Dr. Mistry: 

I would love a question every so often about how to manage my cholesterol better, or I’m having an atypical arrhythmia, or I have GERD or I have sleep apnea…any one of them. But no, no, it’s pretty much, it’s pretty much about the erections.

Donna Lee: 

Every one of them…the erections, or the FLP, which is a “funny looking penis.”

Dr. Mistry: 

I will say that that focus we have on kind of the function of our main man down there really, really seems to ruin–I’m sorry, run.

Donna Lee: 

Run.

Dr. Mistry: 

Run, not ruin, but run our lives…

Donna Lee: 

And ruin sometimes.

Dr. Mistry: 

…from 12 years old all the way until death. I’m always amazed, even those men who are in their 70’s and 80’s, when, you know, they haven’t been able to have an erection for a decade and you bring up the possibility of maybe getting an erection back…

Donna Lee: 

And they get all excited.

Dr. Mistry: 

…He’s like, “Yeah, maybe.” It’s like having a hammer and no nail. But we love, we love patients that are having problems that they’ve had a difficult time addressing with other doctors to come in and feel a sense of that they’re being listened to and they’re being given the very best of what we have to offer. We had a great topic on this issue that comes up is the topic of anorgasmia, hypo-orgasmia. And this week, I had a fertility patient with that same problem. He was a man in his 50’s, and is having trouble getting pregnant.

Donna Lee: 

Because he’s a man.

Dr. Mistry: 

That’s correct. He’s having trouble getting his spouse pregnant!

Donna Lee: 

It’s like when I had the prostate in the last segment.

Dr. Mistry: 

Oh man, you are the funny one in this group.

Donna Lee: 

I am, I really am.

Dr. Mistry: 

He has, he’s 50 years old, he is a diabetic, and reports difficulty with ejaculating. His problem is a combination of 2 problems. One is that his diabetes has caused a condition called retrograde ejaculation, or when he ejaculates, the semen goes into his bladder–that’s a consequence of nerve damage caused by the diabetes.

Donna Lee: 

Oh, I didn’t know that.

Dr. Mistry: 

But then there’s this other problem–people trouble getting an orgasm.

Donna Lee: 

Right.

Dr. Mistry: 

When it happens with women, we usually classify it as primary or secondary.

Donna Lee: 

Crazy.

Dr. Mistry: 

No, no, no. Either it’s always been the case or just started being the case. And unfortunately, a lot of women were just kind of told to, you know, I don’t know, drink some wine or whatever.

Donna Lee: 

Maybe relax a little.

Dr. Mistry: 

…or whatever, because…

Donna Lee: 

Stop being so crazy and obsessive, Michael!

Dr. Mistry: 

…or whatever it is that is unfortunately told to women, which is a completely unscientific way of dealing with it.

Donna Lee: 

You think?

Dr. Mistry: 

And so, and so the same kind of internal processes that result in an orgasm in a man are the same ones that activate in a woman’s, although I’m not going to speak about anorgasmia and women, but if you do have that problem, it’s certainly something that we have a lot of experience and success with dealing with…

Donna Lee: 

And we have a sex therapist.

Dr. Mistry: 

That’s right–if that’s the problem, but oftentimes there’s a biological underpinning. So in a man, especially one that was getting orgasms before and now no longer, we really have to figure out what does that neurologic or hormonal piece that got dislodged? Low testosterone can contribute to that, then you have a variety of nervous system conditions. Diabetes would be the classic one that diminishes penile sensitivity, makes it harder to orgasm, but there also can be other things. People can have pelvic fractures. We had one patient this week that had a motorcycle accident, and ever since his motorcycle accident, he’s been able to, unable to orgasm. And that’s, and we did some testing called “vibratory and temperature stimulation testing of the penis,” and what we realized was that his penile vibratory stimulation is much diminished, so he requires a lot more stimulation than he would otherwise. We got him a fixed with this wonderful ring that gets applied to the base of the penis that vibrates during intercourse…

Donna Lee: 

Really?!

Dr. Mistry: 

…and that thing fixed him up. He won’t leave home without it, he loves that thing.

Donna Lee: 

He’s walking around with it on all the time, smiling.

Dr. Mistry: 

So it’s just an example of how, you know, really trying to find what is the underlying, and maybe we can’t fix nerves that are broken, but we can find tools that can help you overcome them.

Donna Lee: 

This is a dumb question, but I can’t stop thinking about it. What’s the correlation with diabetes and the retrograde ejaculation? How does that sync up?

Dr. Mistry: 

That’s a great question. So, the way that semen is emitted from our penis is that first, when the orgasm happens, the semen is placed from the prostate into the urethra, the tube you pee from. Now, that that hole you pee from has 2 openings: one that goes up into the bladder and one that goes out the head of the penis. So the bladder opening has to close, it’s called the bladder neck has to close, so that this everything can only goes out one end. But in diabetes, that bladder neck closure doesn’t occur. And so…

Donna Lee: 

Why?

Dr. Mistry: 

Because the nerve damage that excess blood sugar causes, causes that nerve to not regulate properly. And so it’s similar to the nerve damage that’s going to cause pain in the feet, it can cause diminished sensation in hands and feet–this neuropathy can also affect the bladder neck. And so, when that happens, the semen preferentially travels the one centimeter into the bladder as opposed to making the six centimeter (in some men) travel down the urethra…

Donna Lee: 

Wishful thinking.

Dr. Mistry: 

…that’s right, out the end of the penis. And so, those men cannot get pregnant, which may not affect a 65 year old guy who doesn’t care about getting pregnant.

Donna Lee: 

Does it feel the same?

Dr. Mistry: 

They orgasm feels the same.

Donna Lee: 

Okay.

Dr. Mistry: 

…but there is no show, and that bothers a lot of guys. It does bother a lot of guys. It’s the same side effect that you’ll see with Flomax or Tamsulosin that people take for BPH. So even though, and I’ll tell you, I’m not a diabetic and I don’t take Flomax, so I can only say what is reported in the literature, which is that it should not change your orgasmic strength. But undeniably there are going to be people who it does. So a classic example of a medicine that it caused this problem and is Rapaflo or Silodosin. So that’s a medicine that we were using very frequently for BPH, and I was later just completely convinced that it led to a diminished orgasm to the point that I was prescribing it to men with premature ejaculation with success.

Donna Lee: 

Really?

Dr. Mistry: 

That’s right. And then I later went into a study. I think I kicked that off. So anorgasmia is maybe something that would benefit from nerve testing. We also use a medication called Yohimbe and we use a medicine called Cabergoline, or Dostinex.

Donna Lee: 

Is the Yohimbe a supplement, or it’s an actual prescription?

Dr. Mistry: 

Yohimbe is an actual prescription.

Donna Lee: 

Oh, ok. It sounds like a supplement, from Africa.

Dr. Mistry: 

And the Cabergoline is also a medication. It is an African tree root, in fact.

Donna Lee: 

Hey, smarter than I look.

Dr. Mistry: 

And so, but we use something that’s highly refined. We can get it at multiple different compounding pharmacies. And if you want to come in and describe or kind of get treated for an anorgasmia or hypo-orgasmic condition, if it just takes a long time to get there, I mean, you know, it wouldn’t be, you wouldn’t complain about it if it wasn’t a problem.

Donna Lee: 

Right? Or the wife is complaining.

Dr. Mistry: 

I mean, you know, nobody wants this to be work. Nobody wants to do, “Could you be just be done already?”

Donna Lee: 

Right? “I’ve got dishes, I’ve got some laundry!”

Dr. Mistry: 

“I’ve got dishes to do, I’ve got laundry or something.” So, but especially for the couple trying to get pregnant for example, or the couple where there’s lots of vaginal dryness issues, I mean, it can make sex a real chore and not fun. And the guys that come to us, they are generally very satisfied with our treatment approach. We do in patients with severe nerve injuries use a lot of vibrator therapy. And you know what, the vibrator of choice is?

Donna Lee: 

The fleshlight?

Dr. Mistry: 

No.

Donna Lee: 

Oh, it used to be.

Dr. Mistry: 

No, no. That’s the vaginal prosthetic.

Donna Lee: 

Oh, I’m sorry…vibrator of choice. The rabbit?

Dr. Mistry: 

The Hitachi magic wand.

Donna Lee: 

Oh, I’ve not heard of that. Hitachi makes me think of an oven.

Dr. Mistry: 

It shouldn’t. I don’t think they make either of those things.

Donna Lee: 

A can opener? Maybe a TV?

Dr. Mistry: 

Whenever I think of Hitachi, I think about vibrators. And so the Hitachi Magic Wand is the quintessential…

Donna Lee: 

Alright, people. Google it.

Dr. Mistry: 

…one size fits all. It has, it has hundreds of attachments you can attach to the head.

Donna Lee: 

What?!

Dr. Mistry: 

Yes. It’s amazing.

Donna Lee: 

Oh my goodness.

Dr. Mistry: 

It’s amazing. From the mild to the surreal.

Donna Lee: 

Well reach out to us. Maybe the person who emails us first is the winner of a new Hitachi can opener!

Dr. Mistry: 

It’s one of the few things I can’t keep here on the shelves because I think our staff keeps stealing the Hitachi Magic Wand. The biggest problem is not wireless, so you gotta be near an outlet.

Donna Lee: 

Stop it!

Dr. Mistry: 

…but you’re going to find that this…

Donna Lee: 

Oh, look! I typed in “Hitachi,” before I finished Hitachi, the “magic wand” popped up!

Dr. Mistry: 

Please don’t do that. Not on my show. Not right now.

Donna Lee: 

I’ve got to look at it now.

Dr. Mistry: 

Well, if you’re having any problems with orgasm and want to learn more about, you know, kind of our approach to therapeutically introducing these types of tools into your sex life to enhance it, please let us know. It’s a wonderful. Opportunity for you to get advice from people who know. Donna, how to people get ahold of us.

Donna Lee: 

People who know things like Dr. Mistry knows about this Hitachi thing. I just Googled it. Google it. You can call us during the week at (512) 238-0762. Our email address is armormenshealth@gmail.com, and our website is armormenshealth.com. So please send us your emails. We’ll answer them all anonymously, I promise they’re really good questions. So armor men’s health@gmail.com, and we will be right back.

: 

Dr. Mistry wants to hear from you. Email questions to armormenshealth@gmail.com. We’ll be right back with the Armor Men’s Health Hour.

Austin Digital Marketing And Development By Fahrenheit Marketing