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Erectile Dysfunction Radio Podcast

Did you know erectile dysfunction (ED) that isn’t caused by a medical condition might be caused by a hectic lifestyle or stress? The stress that you carry, whether it is the stress from work or the actual stress from the erectile dysfunction, can impact the erection process and cause ED.

Today we talk with Dr. Aaron Weinberg about erectile dysfunction and the complex mind/body connection that is involved with the erection process. Dr. Weinberg is a urologist with Chesapeake Urology in Maryland. He completed a fellowship in Urologic Trauma, Reconstructive Surgery and Male Sexual Health at New York University, Langone Medical Center in New York.

The Erectile Dysfunction Radio Podcast is dedicated to educating and empowering men to address erectile dysfunction, improve confidence, and enhance the satisfaction in their relationships. This podcast is hosted by certified sex therapist, Mark Goldberg, LCMFT, CST.

Transcript of Episode 23 – Erectile Dysfunction and the Mind/Body Connection with Dr. Aaron Weinberg

Host: Today we are joined by Dr. Aaron Weinberg. Dr. Weinberg is a board-certified urologist who has extensive experience treating men’s sexual health issues, he trained in some of the most prestigious hospitals and programs, and we appreciate him joining us today. us today.

Dr. Weinberg: Thank you for the opportunity.

Host: Today we’re going to be talking about demystifying psychogenic erectile dysfunction. Dr. Weinberg will share his thoughts and opinions about the role of the mind in erectile dysfunction. One of the challenges with treating erectile dysfunction is the complex nature of this interplay between the mind and the body.

How would you describe the mind-body connection when it comes to erectile dysfunction?

Dr. Weinberg: What I talk to my patients about is how an erection, well, as simple as that may sound, is actually a very complex set of steps, which involves a stimulus at some level, whether that’s physical or visual, which then triggers a release of blood vessels and blood flow to the penis to achieve the erection.

And so clearly from that description, you can see how there could be multiple difficulties along the path from getting an erection, and unfortunately, because whether it’s physical that then goes back to the brain or visual, which goes directly into the brain, there is a lot of ability for the brain itself to get those messages mixed and not allow the erection to proceed.

That’s how I see the difficulty with psychosocial ED, or the mind-body connection, because I really see it as the mind almost floating above the body when men have that disconnect.

Host: I’m going to ask you to expound upon this a little bit, because there definitely are people out there who experience skepticism when it comes to this connection. Do you think that what we think and what we feel actually has an impact on the process of blood flow into the penis for an erection?

Dr. Weinberg: Let me just take a step back. What we think and what we feel are the direct connections to get the erection. I think that men remember or can give an example of when they were able to get erections that were easy for them and without a thought and they had a problem hiding their erection.

I think that they were too young to remember that there was a stimulus at some level, and I use the analogy a lot when I was in New York, and I used to work with a lot of bankers and traders who are young, healthy guys in their 20s and 30s and they would come see me for erectile dysfunction.

They were very frustrated that they had erectile dysfunction, they felt that everything was going well in their life, and they just did not understand, and they sometimes saw me as a second opinion or sometimes saw me after the primary care doctor instead, you know… my doctor says, it’s all my head. That’s not true. Everything’s fine, I think is going well.

I could see that the way they were describing their erectile dysfunction way taking over their entire being, it was so anxiety provoking for them, and it was very easy for me to just ask them what do they do to during their day. They would describe very stressful, long hour days of calculations and decisions that would affect lots of people, lots of money, and I would just turn to them and say… “That sounds very stressful.”

And they would say, “Yes, it’s incredibly stressful.” Then I would ask them sort of candidly, “Do you think any of that stress you take home with you?”

They would say no, but well, the way you’re just describing Erectile Dysfunction to me, it sounds like you’re very stressed about it, and then through this very simple process, they were able to understand that they were taking some of the stress and anxiety that they had during their day, and they were not on blood pressure medicine, so they did not have diabetes, they were healthy guys, but just had that stress and anxiety. And then they brought it into the bedroom.

When people don’t like to acknowledge that there is a bit of themselves that could be causing or furthering some of this erectile dysfunction they want to be able to say, it’s high blood pressure, it’s diabetes. I think that with a very simple conversation, patients are able to acknowledge that there is some personal part, and so I don’t like using the word psycho-social, and I usually try to say something like personal erectile dysfunction or non-diabetes, not hypertensive, as silly as that may sound.

Host: I really like the analogy that you use to educate your patient, Whether it’s the stress from work or the actual stress from the erectile dysfunction, because all of those things can really impact the process. So in your experience, roughly speaking, what percentage of men that come to see you with the erectile dysfunction have a psychogenic component that seems to be contributing or a personal component in your terminology?

Dr. Weinberg: So I think it’s definitely age-related, I think it’s very clear that as men get older, there are more medical conditions that come about, it’s more common to see a man in their 50s, 60s and beyond a high blood pressure and diabetes wherein their 20s or 30s may not.

I think that when men come to see me with ED in there 20s or 30s, I think that the personal component of erectile dysfunction or non-medical, if you will, or non-disease state, is probably high probably in their 70s. As men get older, I think that the psychogenic ED doesn’t go away, I think their medical conditions just mask it or take over. As men get older, they tend to have more stresses in their lives, whether this is from work, taxes, family, and so I don’t think it ever goes away.

I just think that maybe the diabetes, heart disease or other conditions would take over… If that’s fair?

Host: Yeah, so if I’m understanding you correctly, men who are at earlier stages of life, probably in their early 20s up through their 30s, have a far higher chance that there is a pronounced psychogenic component in their erectile dysfunction.

The psychotic components really don’t go away as they age, but medical conditions become more impactful as men age, and I assume that again, relates to hypertension and diabetes and other factors that come into play, generally speaking, as people age, is that largely accurate?

Dr. Weinberg: Yes.

Host: Okay, what are some of the psychological components that men present to you or that you’re able to pick up on when you’re meeting with a man for the first time, and it’s presenting with erectile dysfunction?

Dr. Weinberg: Definitely what I talk to men and there is a difference in the erectile quality with self-stimulation, masturbation versus intimacy or sexual intercourse with a partner, that helps to bring some of that to light.

Some men are able to achieve better erections with self-stimulation and with their partner, and that would tell me that maybe there’s some stress between partners. Also, younger couples that may have been from arranged marriages or did not have a lot of partners before their partner now, and feel that they are not able to bring something to the relationship or to the bedroom.

Also people that tell me that they have a new partner or people that are in college, or even older people that tell me they have a new partner and things are different now then hey were here before. At the end of the day, it’s also a very simple system, and so if something changes abruptly without a new medical diagnosis, or without a change in blood pressure, without a trauma that leads me to sort of think that this is maybe more of a psychogenic/psychosocial.

Host: Dr. Weinberg, there are times when there clearly are one of these factors that’s presenting to you, sometimes it presents to me, but men prefer a quick fix, like taking a medication, and a lot of times that actually can just work. What would you say to a patient who finds themselves in this situation?

Dr. Weinberg: A lot of times when I talk to men, they’re really looking for something, I think whether they’ve been told by the primary doctor, maybe another urologist, “Oh, it’s just in your head, work it out work with a therapist.”

But they’re not given the options, I think that frustrates them more. Sometimes I will speak candid with a patient, I’ll say, “You’re doing everything the doctors had asked you to do, and now you’re seeing a second urologist, you’ve done everything.”

The least I could do is work with you to talk about an option that may help you out. I think a lot of men actually are very happy to feel validated, to feel like what they’re doing is just as important as what the doctor does, and I think that it can be a nice, good first step.

I also tell patients, you in the bedroom is like a comedian who gets up for a comedy show, their first joke needs to kill, if not, they’re going to be dealing with an hour of hecklers, and they can’t just run off the stage.

And so I say, “You know what, you’ve been going through a lot. This is clearly something that’s stressing and frustrating you and your partner, I want to be able to provide you with the medication that may just give you that little extra boost to take a little bit of that cloud off your mind, help you get that erection that can jump start the positive cycle.”

Because for so many weeks or months or even years, men may have been frustrated with going to the bedroom, they’ve been thinking, “Well, I sure as heck hope this is not as bad as it was the last time.”

That’s a terrible way to feel.

Host: And I could definitely appreciate the role that some of these medications can play in terms of helping a man to really decrease his performance anxiety, like you said, there are positive and negative cycles and anxiety, and in particular, performance anxiety does have a tendency to compound, and what I’m gathering from you there are times that you do turn to a man and say, “Even if there is a psychogenic component, part of this may also just be breaking that cycle and getting on to more of a positive cycle.”

And positive experiences have a tendency to beget more positive experiences. Are there times that you recommend both? Where there seem to be other issues going on, you want to help a man get jump started, and will also recommend that he looked to address some of the more broad psychosocial components that seem to be impacting his life?

Dr. Weinberg: I really think it goes hand-in hand, the idea is that… and you know this because of the patients that I refer to you, at the end of the day, I tell patients, “Look, I went to the medical school, I went to urology residency, I went to fellowship training, I know how to diagnose a problem, and I know how to properly prescribe medications, I even know how to perform complicated surgical procedures, what I’m not very good at is sometimes talking about the therapeutics and the steps to being able to help a patient move through some of those mental exercises.

This is what you are an expert at, and so I tell patients that because I’m not an expert at it, I’ve done my job to find experts in the field to refer them, and I really find it as a great way to introduce a therapist into the fold, and I have a lot of patients that in the beginning of the conversation, make it very clear that they’re not talking to anyone and that they’ve either had a bad experience or don’t want to talk about it.

By the end of the conversation, they feel very comfortable taking your contact information and reaching out to you. I think that if it’s folded in the right approach and it doesn’t seem like I’m pushing the patient away or I’m saying, “Hey, this is not medical enough for me,” by all means, no, I see the work that you do as equal to, if not more, than the work that I can do in the office.

Host: And I appreciate the combination of medical and psychological really coming together. It’s not one versus the other, it’s not that it doesn’t cross the medical threshold for you, or it’s not quite psychological enough for me, it really is trying to tackle this from multiple angles and helping to give men the best leg forward to being able to address the erectile dysfunction.

Have you seen the benefits, or let’s say the differences in outcomes between men who do address their erectile dysfunction through multiple facets versus other patients who are a little bit more insistent on just working for a quick fix?

Dr. Weinberg: That’s a fair question. To be honest I don’t think I have enough, I clearly see more men that will prefer to start with a medication than men that work with the medication and go on to see a therapist. That’s the honest truth.

However, the men that I tend to see more frequently, or men that are doing both therapy and medications. At the end of the day a man may reply to me either through the Internet medical record, send me a message or see me for one and follow up and say, “Hey, doc, the medicine worked perfect. I’m not using it anymore. If I have any problems, I let you know.”

And for me, that’s a win versus the men that may be working with you and me that I’m seeing back because they want to keep me updated. I think that whether the men that are working with combination are more dedicated to follow-up versus the other man, I can’t say, but I have seen men that have tried the oral medication, had a problem with it, did not find that it worked, and also didn’t see a therapist.

You know what I mean? That it either works and it’s great, and I don’t see them, or I see them in combination; I know it’s a little long winded. But…

Host: Yes, and I think this kind of goes back to the question that I asked you before. And there’s a reality that these medications can be very effective, and oftentimes, if a man tries medication and it works, that solution is great, and they’re probably not going to come back to you. And that probably is the majority of the cases that you see it if I completely understand it you’re saying some of the more challenging cases that may not respond as well to medication and do take this from a multi-faceted approach could be benefiting more from the therapy…

Dr. Weinberg: Correct, correct.

Host: Okay, now, one of the primary reasons that men don’t want to talk to someone about their ED, whether it’s a doctor or whether it’s a therapist, is because of shame, do you see men coming in with a lot of shame in your practice?

Dr. Weinberg: I see men that come to see me, sometimes it’s psychogenic more often, it’s men that have medical conditions like diabetes or heart disease, and they say that their partner is really not happy, they are not able to bring it to the bedroom and they need help.

So I don’t know if that’s shame per se, but it sounds to me like they’re frustrated. Men who come to see me that seem to not have the underlying medical conditions, or the underlying medical conditions are not as prevalent, tell me that they’re frustrated, tell me that they’re angry, tell me that they can’t sometimes keep a partner, but they don’t tell me about shame per se.

Host: Got it. And I want to wrap up with one final question, or really asking you for a message, so for any men out there who are struggling with erectile dysfunction and are somewhat skeptical about this mind-body connection, what might be some parting words that you can leave us with that you would want them to hear or know?

Dr. Weinberg: So at the end of the day, I say this, I say, well, erectile dysfunction you may remember as the simplest thing as having an erection that you try to hide during middle school or high school, and it’s now difficult for you to get an erection during intimacy.

That’s not something that you need to be frustrated about, and whether there is a social component to it, whether there’s under-diagnosed or not yet diagnosed medical conditions… the most important thing is that I want you to feel comfortable talking about it and talking about it with a medical provider.

There are so many people out there that can help you, but the biggest part is for you to talk about it with them. If you feel that the medical provider you’re speaking to is not hearing you and is not focusing on what you need to say, then reach out to me, reach out to a urologist, reach out to a therapist.

There are so many people that want to help you, and whether the social part is 5% or 95%, there are so many great treatment options out there, but the biggest important part is for you to make the first step and contact us.

Host: I appreciate that, Dr. Weinberg.

Learn more about Dr. Weinberg and his practice by visiting the Chesapeake Urology website.

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Ready to talk to an ED expert? Erection IQ founder Mark Goldberg helps men resolve erectile dysfunction. He offers individual, one-on-one services to men throughout the world through a secure, telehealth platform. It’s 100% confidential. You can visit the Center for Intimacy, Connection and Change website to schedule a free consultwith Mark.