Penis Health, Erections and Ejaculations with Dr Anand Patel | Transcript
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Dr Anand Patel
Because lots of people have premature ejaculation and they don't care, because actually their partners doesn't really mind because they're not thrusting in for hours. And generally, parameter ejaculates are really good lovers because they work on the foreplay. And when that premature ejaculation, it's gone in 60 seconds. That's the definition. It's like where you've ejaculated within 60 seconds, and longer than that people sometimes thinking, oh my god, you know, we have lots of people coming and going, you know, I can have sex for half an hour it, it's not long enough, you're going, but the average length of time from entry to ejaculation of a vagina is 5.4 minutes.
Hannah Witton
Welcome to Doing It with me, Hannah Witton, where we talk all things sex, relationships, dating and our bodies. Hi, welcome back to Doing It. We have a medical doctor in the house today. This week's guest is Dr. Anand Patel, who is a GP, men's health specialist, and a doctor of sexual function. We cover so much stuff in this episode about penises and the people with them. And I definitely learned a lot as this isn't an area I've looked into in as much detail as my own body parts. Before and I'm specialised in sexual function as a doctor, he took a break from medicine and became a school biology teacher and was made to be the one to teach sex ed. We talk about this time in his career, and how it inspired him to go back to medicine and learn more about sex, and how he's now championing more GP training around sexual health. I added some new favourite phrases to my vocabulary, such as dick housekeeping and penis plumbing, as we talk about night-time erections, random erections, penis health, and ejaculation. We talk about the potential physical and psychological causes of erectile dysfunction, early and delayed ejaculation, and how orgasm and ejaculation are two separate functions, but because they often happen at the same time, we conflate the two. We touch on desire, performance, anxiety, death grip, and of course, I have to ask about Viagra. And I may have had a bit of a moment when I learned how it actually works. As usual, you can find more info and links to everything that we talked about in this episode in the show notes over at DoingItPodcast.co.uk. And please let us know what you think over on our Twitter or Instagram, @DoingItPodcast. Thanks so much for listening. I hope you enjoy this conversation with Dr. Anand Patel. Dr. Anand Patel, thank you so much for joining me, how are you?
Dr Anand Patel
Really good, thank you very much. I've just come off a presentation with an investment company talking about testosterone and stuff, which was actually really fun. So I've really enjoyed that. So we're talking about a third of men are too fat to see their own willies, and how that affects your physical health and your sexual function. And we were talking about just being in lockdown and how to, trying to making sure your mental health is kept as positive as possible. So yeah, really exciting.
Hannah Witton
Oh, that's very cool. From your perspective, how are like what are some good ways for people to keep their mental health up in lockdown?
Dr Anand Patel
It just seems to be not staying in your room because so many, so many people live in house shares. And actually, if you're working in your room and sleeping in your room, it becomes really just too much and you're not seeing your friends or family. So definitely getting outside, in whatever way that you can. I mean some people are just having to drive out to somewhere to have a nice view, or just see something that really nourishes the vision as well as the mind for catching up with people if you can, I mean, I'm sure loads of people have had loads of tips on Coronavirus and stuff. But I think just making sure that you're in contact with the people you care about and who care about you. I think that's been really helpful for me.
Hannah Witton
It's so much easier said than done because like I'm such an extrovert. And I know that when I like I'm in touch with friends and my family and I like have interactions with them. I feel better. And yet, the effort of having to do it all online, even though like meeting up in person, it's probably more effort. It's just like this barrier of just like, ughhh
Dr Anand Patel
Yeah, and getting over that is just really, really hard, isn't it? I completely get that. Where the last thing I want to do after a 12 hour shift is kind of go right, let's go out again and see people. If you live in London or in a bigger city, it's just a bit difficult to get your friends across London or whatever. But no, I'm thoroughly embracing actually, the online stuff. I've talked to my family and friends way more than I normally would. So yeah, I'm very good. Trying to do as much as I can with it.
Hannah Witton
I feel like I was better at it in lockdown one, and this lockdown I've just been like, can't be bothered.
Dr Anand Patel
It's just like you're hoping it's just gonna be over soon.
Hannah Witton
Yeah, maybe I'm just like waiting for it to be done and then I can like go on walks and stuff with friends. But let's get to the juicy stuff. You are a doctor specialising in men's health and sexual function. And I just wanted to know, why become a sex doctor? What was it about the area of sexuality and sexual health and sexual function that interested you?
Dr Anand Patel
Well, let's just say it wasn't high on my list of my parents priorities, that I become a sex doctor. I think every Asian parents dream seems to be that your son, or your child will become a doctor, or a lawyer, or accountant, or an engineer or something. So I managed to get that bit right.
Hannah Witton
The famous four
Dr Anand Patel
Well, yeah, exactly, exactly. But when I was 27, I actually left, I left medicine and became a school teacher because I was, I became quite miserable at work. I found it really stressful. I was unfortunately, working in a department was very dysfunctional. And I just thought, why am I doing this to myself? Why am I doing a career that I'm not sure I really want to do? Because I got told I was doing medicine, I didn't really think about that myself. I've got just 27 thought, oh, maybe I should actually have a look at what I really want to do. I'd always wanted to be a biology teacher, which is perhaps an odd thing to say. But that's just what I've always wanted,
Hannah Witton
Very specific, I love it
Dr Anand Patel
Yeah very specific. So I went and became a biology teacher. And it was the best job I've ever had my entire life, until now. I mean, I absolutely loved it. I was useless at parts of it. I was asked to like teach netball, and I don't know the rules so I was shouting at them to bounce the ball, and they were like, sir you don't bounce the ball in netball. I was like, oh, what do you do? Yeah, so basically, I asked after this game, why on earth did you put me with the girls team? Because we think you're probably bitchier than they are. I was like, oh, that's nice. Quite an assumption but it probably was true
Dr Anand Patel
That's like really misogynistic, and homophobic, in one go.
Dr Anand Patel
It was, but I think, perhaps partly it was the time as well. I mean, that was, what 20 years ago. I don't know whether people were allowed to be a bit more like that, then, but it certainly wouldn't be appropriate now. But in some ways, I kind of totally embraced it. You know, my job was to try and keep a group of frantic, really excitable, really clever bunch of people in line, if I could, and it was like herding cats, but it was brilliant and I absolutely adored it. But when I was there, one of my, one of my jobs I took on was becoming head of sex ed, and head of PSHE. Because they thought, well, that would plug in quite nicely because I've been a doctor, hopefully, I'll know a bit about biology, and I'll know about the sex stuff. So I thought, cool. Let's do that. And I loved it. And it was partly terrifying because you're talking to a young group of people who live in an urban environment, who actually had quite good knowledge of sex, and a lot of them were having sex. A lot of whom weren't having sex as well, but we're pretending that they were and trying to get this sort of level, right? Because you know, your trying to do lesson plan. And I'm thinking lesson plan going like, oh, is this too much? You know, we're talking about condoms and stuff. We're talking about getting penal demonstrators and a variety of ethnic hues and all that kind of stuff, which is plastic willies, but making sure that everyone's represented, and then all of a sudden,
Hannah Witton
yeah, and you're never gonna get it right because some, like you said, some are already having sex and are like, yeah, we know. And then others, it might be, they might not be ready for it. They might be like, No,
Dr Anand Patel
And then I'm thinking like, okay, anal sex. I'm like, okay, I cannot submit a lesson plan with anal on it. I cannot. So it's one of those things where you kind of going actually, probably in between 16 to 25 year olds, maybe 30 to 40% have tried anal sex. And so actually, it is something that young people are doing, but I'm not going to actually talk about it in a lesson because actually, well, partly the complaints would be insane.
Hannah Witton
Yeah, the boundaries of that school environment.
Dr Anand Patel
Absolutely. It just inappropriate
Hannah Witton
I wonder if it's on the curriculum, like on the new relationships and sex ed curriculum as part of like, I don't know, like, talking about safety as well, I don't know.
Dr Anand Patel
Yes, absolutely. We had, you know, we, I used to work in a&e, and you'd get traumatic injuries from anal sex, where, you know, they hadn't realised that you needed to use lubricant, or they just decided actually, you just slam it in. And actually, there's no sense of preparation or fingering or whatever in advanced. You're going, people do need the education about it but like, where does it, where does it happen? How old are you when it happens? And what is the boundaries you say? Between like, imagine like me if like 30 or 40 year old man talking to a bunch of young people, is that appropriate?
Hannah Witton
See, I think it is appropriate because it would be in an appropriate setting. And I almost think like this conclusion that we jump to that it's immediately inappropriate. Like says a lot about how we don't allow, like, men to have like healthy relationships with young people. Like we immediately go, oh, something dodgy must be happening there.
Dr Anand Patel
Exactly. That felt very much, I felt that as a gay man.
Hannah Witton
Yeah.
Dr Anand Patel
I felt that, actually, my boundaries need to be even more tidy and really clear cut and I had to be sort of brighter than bright, whiter than white or whatever the statement you want to make about it, to make sure that I didn't get in trouble because I recognised there was I not saying there's racism, everything, but actually, I'm going to be judged more for being an Asian gay man than perhaps someone else might be. So I wanted to make sure I did that, as well as I could, and as suitably as I could.
Hannah Witton
You didn't want to give them an excuse to
Dr Anand Patel
Absolutely, absolutely. I think I'm super open minded. You know, in my practice at work, I will talk about everything and anything without problem whatsoever. But I think, you know, 20 years on, I think I would be very different in the way I taught sexual function and sex ed to young people, really different. And would I include anal sex? Yes, I would. Absolutely. I think it's, as you say, the person that I am now is not the very boundary person I was when I was 27.
Hannah Witton
Yeah, well, you live and learn.
You do. And so basically, there's a very long answer to a very short question. So sorry. So I went back to medicine, became a GP, and, and one of the, one of the things I did do was teach doctors to become GPs. And one of the training things you could do is a psychosexual residential, where you take 30 budding GPs, and you have a weekend training about how to talk to patients and people about sex, and what conditions can arise and how to make people feel comfortable talking about
Hannah Witton
Oh amazing. Can all GPs please take that?
Dr Anand Patel
Absolutely. So it was a really, I've never, I've never had it done in medical school. I've never had it done in my GP training or hospital training.
Hannah Witton
Oh wow, so it was like a special elective.
Dr Anand Patel
Exactly. That's when we made sure after that, because I became a trainer of doctors that every year, we made sure that every group coming through had that. Like, their minds were blown. Even stuff like erectile function, which does have some basic coverage in in medical school and GP stuff. There was very little understanding about it, very, virtually nothing about women, or people with vaginas at all.
Hannah Witton
Right, Yeah.
Dr Anand Patel
Yeah. Some people couldn't even say the word vulva. And it was really challenging, because it just felt all appropriate, not appropriate at that time. And that was probably about 10 to 15 years ago.
Hannah Witton
Do you think it's getting better now. In terms of GP training around things with sexual health and sexual function.
Dr Anand Patel
Yeah, absolutely. I mean, I'm very, kind, I get invited to a lot of the London training courses to talk about it. And it's, it's brilliant at doing that sort of roleplay and stuff with them, where you know, when someone's talking about sex toys, or something, and they go, Oh, my God, what the hell do I say, and it's brilliant, just sort of that those light bulb moments when they kind of get it, and also the fact that they're really energised about then taking that back to their workplace and going, Okay, I can really help some people out now.
Hannah Witton
Yeah, because people, there is the potential for people when they go to their GP about something to do with sex, or their bodies, that they get, like a variety of different experiences depending on who they go to see. So it's good to know that there are people out there, championing, spreading this knowledge and making sure that GPs are equipped to have these conversations when
Dr Anand Patel
Well that's what you're doing your aren't you. You're making sure that young people, your listenership, have a really good idea about sex in general, in a lot of different ways. But you know, you're including relationships, and interpersonal behaviours, and all the stuff that you kind of don't necessarily get from the biology of it, or the or the, or the, or the anatomy of it. There's just a lot more beyond that, which is really helpful. But it does mean that actually, there's sometimes a bit of a gap, because actually, young people these days are really informed, and they go and see their doctor and their doctors, like, Oh, this is really uncomfortable, I don't really want to talk about it. So it must be really, really challenging. So I think I would just say, persist. And also, if you're not sure about your doctor, find a different one. Most practices have several doctors and you could choose to see one of the other ones. And that might make you feel a bit more sort of comfortable, you might get a different experience.
Hannah Witton
Yeah. And, and shout out honestly, to the NHS website. Actually, when I because obviously I've got a boundary with like not being a medical professional. So I'm really careful about things that I say, and I'll often be like, go to your GP. So I'm encouraging people to like go to their GP. So it's good to know that like on the other end, hopefully we're being able to fill that gap. But when sometimes when I'm not able to fill that gap in that way, the NHS website, honestly,
Dr Anand Patel
So good
Hannah Witton
Lots of great stuff on there.
Dr Anand Patel
Also, there's a charity called the Sexual Advice Association, who've got an app as well, where you can kind of go on there. And you can kind of download the app, which is called the Smart SAA App, and if you download it to your phone, you can kind of fill in some sort of sexual function questionnaires.
Hannah Witton
I love quizzes
Dr Anand Patel
Yeah, exactly. It's not quite sort of Cosmo, but it's nice to fill it in for whichever sexual problem you think you have, or you can also fill it in for your partner. So it just means that actually you can get some information on what potentially that condition might be. So it basically goes through a few questions, it gives you an idea of what it might be. And then it links you to their website, which has loads of leaflets about those conditions, it just means that you're kind of more aware of what's going on. And that you might that might be enough just being aware of it. It also just gives you some information to take to your doctor. Yeah. Which is really helpful.
Hannah Witton
I'm not heard of that. Thank you for that info. I wanted to talk a bit about sexual function, and then also sexual dysfunction. Because often, when we're talking in a medical sense, you are dealing with patients where there is a dysfunction. And I was curious, like, at what point does something because become a dysfunction? Because obviously, there's such a wide range of like what we classify as normal, or common. Yeah, there is no no one thing like this is normal, like function. What counts as normal? What counts as a dysfunction? Is it like, if it's causing somebody distress, is that when it becomes a dysfunction.
Dr Anand Patel
That's literally the, that's literally the sentence, it's basically, it has to be the symptom plus it's causing some distress. So it's like, okay, can't get an erection, and it's causing distress or early ejaculation, and it's causing distress or a low libido in women, and it's causing distress.
Hannah Witton
Okay, that makes so much sense to me
Dr Anand Patel
Because lots of people have premature ejaculation and they don't care, because actually, their partners doesn't really mind, because they're not thrusting in for hours. And generally, premature ejaculators are really good lovers because they work on the foreplay.
Hannah Witton
Spend time in other areas,
Dr Anand Patel
Exactly, and it only tends to come up when they've changed relationship and then perhaps then there's someone new has commented, either like a one night stand or like a brief relationship, or they've got into a relationship, and they've been watching a lot of pornography, and they've kind of thought, maybe I should be lasting longer.
Hannah Witton
Right?
Dr Anand Patel
And then it comes up as an issue. And then they come, come and talk to us, one hopes. I mean, often you're right, they go on the internet, NHS website has loads of info. You've talked about it. I mean, I talk about it on my podcast, Pleasure Podcast. So yeah, there's lots of places you can get information about these things. But do try and go for, hopefully, like those, those places that have a little bit more, sort of, rational sense about them. Because you can get some very dodgy information online,
Hannah Witton
That is true, especially when it's playing into people's insecurities and vulnerabilities.
Dr Anand Patel
Absolutely. I mean, like premature ejaculation. It's gone in 60 seconds. That's the definition. It's like, where you've ejaculated within 60 seconds. And, you know, longer than that, people are sometimes thinking, oh my god, you know, we have lots of people coming and going, you know, I can have sex for half an hour it it's not long enough, you're going but the average length of time from entry to ejaculation of a vagina is 5.4 minutes.
Hannah Witton
Oh, is it?
Dr Anand Patel
Yeah,
Hannah Witton
I love that, see, just information like that can often like, change how you like, whether you think what is happening is a problem.
Dr Anand Patel
Absolutely, and that's what I like to do, it's kind of like, share that and kind of go Look, you're trying to have sex for 35 minutes or whatever. And that doesn't seem long enough to you. But you're finding your erection doesn't last that time. It's probably because reactions don't last 35 mins, an hour, two hours, unless they've got it, you've got a cock ring on, or you've had some sort of some medication, viagra or whatever, to keep that going. So it's completely normal to lose your erection to come and go, or wax and wane, during sex. And it's about, kind of, finding it funny, teasing it back to where it was, you know full hardness, because of the situation. And sometimes you can lose focus because suddenly you're thinking about, I don't know, your mom, or your work, or your you know, your homework, or whatever it is. But actually, you can reconnect with a partner that can all come back
Hannah Witton
Yeah, I love laughing during sexual activity,
Dr Anand Patel
The right way, not at
Hannah Witton
The right way, not laughing at somebody, but just generally finding the whole thing very amusing.
Dr Anand Patel
It just makes it so much more relaxing, doesn't it? And that's thing thing about, because men's erections depend on them being relaxed. Because we learn in life, men learn, not to have erections. Because like you, if you're a three year old and running around with your willy going look at this, look at this, when you've got a little baby a baby, your mama daddy usually kind of go put that bloody thing away. You get taught that socially, it's not acceptable to have an erection.
Hannah Witton
And then you spent your teenage years trying to hide all of the random erections you're getting.
Dr Anand Patel
Absolutely. And what you do, is when you get anxious, you send lots of what's called sympathetic stimulation down your nerves, which completely switch off blood flow to your penis. So basically your pants like they're full of a chicken nugget, rather than anything better than that, because you're quite anxious. So if you're anxious, it's going to be your first time, of course, it's super common not to get you know not to get an erection. Of course it's common for you to ejaculate early, that's completely normal. And you don't need to worry about that. I also recognise that you may have a really high expectation of what sex is, you may expect it to be this amazing thing that will change your life. And, in some ways, sometimes it can change your life and it can it can be utterly amazing. But also it can be part of the worst dramas and the most embarrassing situations. But if you've got that laughter, like you were saying, it just it just bursts that nonsense it just makes you realise that what you're doing is rubbing two bodies together in a kind of squelchy, smelly way.
Hannah Witton
Yeah. And it's pleasurable, rather than it being about like, the performance.
Dr Anand Patel
Absolutely, and if you've just focused on, I want to know the sensation, and just allow yourself to be and obviously, you want to reciprocate with your partner, you want them to see what, you want to make sure that they're enjoying themselves. But if it's you, on your own, or multiple partners, keeping your eyes open. But actually, if you just decided for a while you were going to let that person do whatever they're doing to you and just feel what it felt like, rather than obsessing about other things, going do I look right? Does my belly, is showing like this. Do my bingo wings show? Yeah, well, I thought all of the first things, erm and that obviously then sends more of these sort of sympathetic inflammation to your genitals, which stops your, stops your erection, and stops you being so focused on the fun bit.
Hannah Witton
And the fun bit is the great bit. We talked a bit about premature ejaculation. And I was curious, what are some, like common issues that men, people with penises come to see you for.
Dr Anand Patel
So I see a lot of men with erectile problems, so they find it difficult getting an erection or keeping their erection. And that's just for so many different reasons. I mean, there are lots of sort of facts about it. But for example, approximately 40% of 40 year olds will have an erectile issue, and 70% of 70 year olds.
Hannah Witton
Oh wow, well there's a there's a nice easy 40% 40 year olds, 70% of 70 year olds
Dr Anand Patel
Exactly, and as you get older, it's more likely to be a physical cause. It can be, can be obviously psychological. For example, if you've lost your partner or something, that can be significantly psychological about it, or you're starting a new relationship. But if you're younger, then it's more likely to be psychological, it's more likely to be performance anxiety, or it's more likely to be experts, expectations isn't it, it's about your expectations of what your performance should be. So it's then you lose focus on the information going into your penis to tell you to keep erect, and it just disappears.
Hannah Witton
Yeah. And then you're getting random erections when you're not even thinking about it.
Dr Anand Patel
But those random erections are so important. That's like that's like dick housekeeping. That's literally what it is. That's why I train older people, when they've got problems, I do what's called penile rehab. Basically, it's very much use it or lose it with the penis, those boners that you get in the night in the early morning that everyone's like, Oh, it's me being turned on. It's nothing to do with that, you're body is performing this amazing housekeeping where it's flooding your penis full of oxygen rich blood. And that's what the penis needs to keep the cells functioning at their best.
Hannah Witton
I watched a clip on YouTube of a scientist, or a doctor who's doing stand up, and he was talking about those night-time erections. And he basically said that is that if you stop getting those night-time erections, then that's actually like, that's kind of like your body's like, first defence. And actually, there might be something else that's up because it means that your body isn't pumping enough blood and oxygen around. And I was like, oh, my goodness,
Dr Anand Patel
It's totally true. And basically, if if you haven't had an erection, or nighttime erection, or even the daytime one because you're not having relationships, or whatever, or masturbating even, for three to six months, your brain kind of thinks, well, what is this useless floppy thing. It actually sends signals to kill the cells off. It's called apoptosis, programme cell suicide, of your willy cells. So actually, you end up with a scarred, shrunken penis. So I am telling you all, please,
Hannah Witton
three to six months, that's that's quite a long period of time.
Dr Anand Patel
I mean, so it's not it doesn't happen immediately. But but some people don't have sex in their 20s for a significant period of time. Yeah. Or 30s. You know, they might be between relationships, they might be moving between countries or whatever. And they just don't end up having sex for a while, but they don't masturbate either. Or they don't get these erections at night. Now, erections at night should just happen automatically. So if they are fading away, like that stand up guy was saying, you really should get them checked out if it's been for more than a couple of months.
Hannah Witton
Right? And can I just confirm is it, are we just talking about getting erections here, or ejaculating as well. So just the, just the erection
Hannah Witton
Just the erections, okay, yeah,
Dr Anand Patel
That's the penile tissue. But they did a study where they found that if you ejaculated, more than 20 times per month, you are less likely to develop prostate cancer. So there was an association. So they found that men that were very sexually active, high number of ejaculations per month, had a much lower incidence of prostate cancer. So they they're not saying it's directly one equals the other because it could be just that people have got better social lives or better social structures or better partners or whatever are less likely, we don't know. But it's an interesting fact.
Hannah Witton
Yeah, and some of the liquids that makes up semen comes from the prostate as well.
Dr Anand Patel
Absolutely it only like one to 2% of your cum is actually semen, is sperm. The rest of it is all cowper’s gland and prostate gland fluid.
Hannah Witton
Yeah. So it's a little spermy's is any make up a tiny little bit of it?
Dr Anand Patel
Yeah. And I love the fact also like, cuz men think like orgasm and ejaculation are the same thing. But they're not. They're separate things. Which is why like, some people can do tantra, and they can not ejaculate, but they can experience that brain sense of orgasm.
Hannah Witton
This is huge to me, because like, I'm aware of it, as a fact, that you can separate orgasm and ejaculation with, with someone who has a penis, but I've never actually seen it done. And when I say this to like my partner or to like, male friends of mine, they're just like, no, that's not true. Because their personal experiences, obviously, that the two go hand in hand.
Dr Anand Patel
Absolutely. And you're hard wired, you're conditioned, to think that they're the same thing because they happen at the same time. And it's all from your genitals. And it's just totally not, because some people can just, you know, they could just leak in their pants and they haven't had an orgasm, because it's purely, it's purely a plumbing mechanism. When you get to the point of no return, it just literally your prostate squeezes and out at squirt.
Hannah Witton
Yeah. It squirts if you hit the right plumbing. You hit the right nozzle, oh I don't know what I'm talking about. I wanted to quickly talk about erectile dysfunction because I guess this is like something that comes up when you think about like sexual function with people with penises. It's like the number one thing that people think about. So we kind of talked about it being psychological or physical, but like what, what are the physical things, that it can be
Dr Anand Patel
So the blood vessels to the penis, the arteries, which, so basically, your penis is pretty much a blood balloon. So when it's when it's soft, it's basically shrunken out, there's very little blood in it, which is why you need these nighttime erections to flood it full of blood sets are full of nutrients, and then it sort of gets bigger and bigger, and you need a good enough blood pressure to keep the blood going in, higher than the blood flowing out, so that it actually stays nice and swollen. And I
Hannah Witton
I can't remember which way around is with the arteries and the veins,
Dr Anand Patel
Arteries go in, viens come out
Hannah Witton
Okay, so then, to maintain an erection, the veins have to contract.
Dr Anand Patel
So you basically end up flooding this balloon so so much that you squeeze the vein so they get shut. Does hat makes sense?\
Hannah Witton
Yeah
Dr Anand Patel
So basically the veins are wrapped around the outside and the inside gets really hard. So it squashes the veins on the outside. So you need to be, it is really a, I mean, it's just it's unfortunately it's bit plumbing, but I love it anyway. Your heart has to be pumping well enough, your blood vessels, your arteries have to be open enough to allow the the amount of blood going in to be enough that it squeezes those those veins so blood can flow out. Now the problem is, the blood vessels into the penis are some of the narrowest in the body. They're one to two millimetres wide. So if they start to fare up, because you've got heart disease, or you've had, you're born with an issue, or there's been damage to these blood vessels like a high cholesterol or something or you're a smoker, then these blood vessels close up, which means the blood flow into the penis isn't strong enough, so you will lose your erection more easily. Or in some people, can't get direction at all. And the biggest cause of things like this, like diabetes, if it's not treated well. You don't look after it. If you're a smoker, again, if you've got a strong family history of heart disease, so that's why I always tell patients or tell people in general, if you're not getting decent erections, even it started to be every now and again. Please go and see your GP because I think you should consider sort of poor erections as a sign of heart disease, until proven otherwise. Because then it'll fairing up the tiniest arteries, it's going to be a while till you get a heart attack, but it's giving you that advanced knowledge.
Hannah Witton
Yeah, the penis is the first line of defence.
Dr Anand Patel
It's the barometer of men's health
Hannah Witton
Wow, that's why they're so obsessed with it. It make's sense now.
Dr Anand Patel
Yeah, well it's good for men in so many, and people with penis's, in so many ways. You know, it gives you pleasure, you can pee out of it, some people just like to hold it when they sleep. It's just lots of things
Hannah Witton
I can relate to that, I just sometimes like to cut my vulva when I sleep.
Dr Anand Patel
Yeah, and the blood flow to the vulva is very similar as well actually, you know, diabetes, etc. and smoking can all affect that and it can reduce lubrication. In women lubrication is dependent on blood flow. So if you've not got very good blood flow, your lubrication will decrease. So if you're scared and on or anxious, you're going to reduce your blood flow to your vulva. So you'll be you'll be drier and it'll be more uncomfortable when you have sex.
Hannah Witton
There we go. Interesting. I've got some questions from our folks over on Instagram.
Dr Anand Patel
Sure
Hannah Witton
Which I want to throw at you whilst we have an expert in the house. Somebody said, how to deal with ED as the partner.
Dr Anand Patel
Yeah, it's tricky. Because some some partners take it as a sign that they don't they're not fancied anymore.
Hannah Witton
Hmm.
Dr Anand Patel
So they can be psychological effects like that. There's also the issue of you wanting to try and support your partner. Do you mention it? How do you talk to someone about the fact that their erections are coming and going?
Hannah Witton
Yeah. Oh, yeah. Cuz it could just, it could be something that's happening that neither of you are acknowledging as well?
Dr Anand Patel
Absolutely. Because no one wants to just say, Oh, look, you went soft, halfway through last night. And if people are just avoiding that conversation, because they don't necessarily communicate that well anyway, that is a bit of a problem. But if a partner, in general, having a supportive partner that is open to discuss these things, and is not, basically, doesn't take the piss, and make them feel really shit about it. Because if you make them feel more anxious and more upset, they're gonna stop getting erections anyway. It's gonna be a vicious circle. So I think it's really important to try and get be really open about going, look, I recognise this is an issue, do you want to talk about it? And I'm doing that in a non threatening space, and not when you're about to have sex or when you've just had sex or something?
Hannah Witton
Yeah. That's a piece of advice I always give when it comes to like having those conversations that for ages have been brewing up and you're like, how do I broach this topic, especially if it's like a sexual discussion, then it's just like, make sure you've got your clothes on, and you're not like, in a sexual situation?
Dr Anand Patel
Absolutely. And it could be something as simple as works really difficult, or you've got exams or something like that. And that's really understandable, explainable, and if you've got a supportive partner, they can help you relax in those situations, and it will come back.
Hannah Witton
Yeah. And it might help you explore other kinds of sexual activity that don't require erections, obviously.
Dr Anand Patel
I mean, people are obsessed with erections, as like a sign of how well sex is going. And you're like, there is so much fun you can have, without the penis. Yeah, I mean, it's fun. But there's loads of other stuff you can do with out one. I mean, you know, half the population seems to manage without one and do fine
Hannah Witton
It's true, can confirm. Yeah, somebody asked, this was an interesting one. Tips for getting my husband to get a vasectomy, he's afraid of low testosterone.
Dr Anand Patel
So there's no connection because testosterone is produced to the testicles and released out into the blood vessels surrounding it.
Hannah Witton
That's what I thought.
Dr Anand Patel
Absolutely. A vasectomy just, as the name says, vas, it cuts the vas deferens. So you just can't squirt out your sperm. So different tubes. It'll be, there's no, there's no issue at all.
Hannah Witton
There we go. So maybe if, after hearing this information, your husband still doesn't want a vasectomy, it might be a different reason. And you might need to talk about what that is.
Dr Anand Patel
Yeah, I mean, men find it, do find it difficult, in the sense that they could never have a child again. And that's one of the questions you have to ask, if someone wants a vasectomy, is there, are there any circumstances, as awful as they might sound or be, that you would not want to have a child in. I mean, most men are pretty, by the time they come to see you, they're pretty certain that that's the case.
Hannah Witton
Yeah, my grandparents had that after my mum and my auntie were born. My grandma told me that they they went in so my granddad could get a vasectomy. And I think that my mom and Auntie were still quite young children at that point. And the doctors is like, asking them, what if both of your children die? And you're like, oh, my goodness, you kind of like almost have to have been prepared for those questions. I don't know. Or like at least have thought about them.
Dr Anand Patel
Being a doctor is a really weird job because you do, It's like someone comes in and within 30 seconds, I'm asking him if, what would happen if their children popped off
Hannah Witton
Yeah, that's heavy.
Dr Anand Patel
So it's about, I mean, that's why hopefully, people learn the skills and I appreciate not everyone is the best at this at different times, depending on the situation. But like, hopefully, you can be put at ease enough that you can just go in with, I've got my erections or, you know, I'm feeling low or whatever it is that you want to share with a doctor and the doctor can be as supportive and as rapport making as they can be, so that you feel open to discussing it because it must be awful if you go in, feeling super judged, and then they say the wrong thing. And it might not be, you know, it's almost certainly not on purpose. Yeah. It's very unlikely that the doctors gonna want to be an asshole. I recognise. But it's very unlikely. They probably said the wrong thing. And it's just, if you are able to let that go and give them a chance, usually it goes fine. But I'll just say, Did you mean that and very often, you'll hopefully get the correct response.
Hannah Witton
Yeah. This one's a bit of a longer question.
Dr Anand Patel
Okay.
Hannah Witton
This person says, I love to pleasure. My wife does nothing to me. She will cum like three or four times. I'm lucky if I do at all, any advice. And then also, I'm in my mid 40s, sexual desire is 1/10 of what it was when I was 20. Should I be doing something? So this is two questions from the same person.
Dr Anand Patel
So if you start with the first one, I mean, if you're not that bothered about you ejaculating, then you don't need to worry about it.
Hannah Witton
Again, it's the distress thing
Dr Anand Patel
Absolutely
Hannah Witton
Is it causing distress.
Dr Anand Patel
If you if your thing is purely your partner getting off, then have at it. Yeah, you may want to make sure you get erections just for the plumbing and the nourishment.
Hannah Witton
Yeah, the dick housekeeping.
Dr Anand Patel
You may want to carry on with that, just to make sure that you know, you're not going to get erectile problems, which are permanent in later life. But apart from that, just keep going. I mean, I would always say do the stuff that is fun, as long as it's not hurting anyone.
Hannah Witton
Yeah. And then the desire
Dr Anand Patel
Well there's a second bit to the other question wasn't there? Because it's like, well, if What if you don't want that, actually you do want to ejaculate more? Well, perhaps it's time to demonstrate what you'd like, and have that conversation with your partner. And hopefully, you know, it's going to be a reciprocal arrangement, might come about. I mean, it's quite difficult if you've got set into a sexual script. So you've always had sex a certain way, and then want to change that up. And I'm sure you've talked about it in your other podcasts, I know you have, about how you'd have that conversation about trying to switch it up a little bit, or feel more comfortable doing a different position, kissing a different way. I mean, some people unfortunately, aren't great kissers. And they do need to be taught, and perhaps other sexual things were carrying them. And now that faded away, and now it's just the kissing and it's like, sort of the inside of a washing machine you like, please stop.
Hannah Witton
Yeah, and it can be really tricky, like you said, if you have gotten into routine, and if it's a long term relationship, and it can sometimes feel like well, why are you bringing this up now? Why hasn't this been an issue before? Yeah.
Dr Anand Patel
And, you see, with desire, he was talking about. So there's an issue with desire. So that's, as one gets older, your, your testosterone levels fall. When your testosterone levels fall, often people can suffer two main symptoms. One is lack of desire, so low libido. So that's low sexual interest. So someone, you'd normally find hot walk past you, just no interest or less interest that they would be otherwise. The second thing is erectile problems. So they're that big two, but also, you can also get things like poor concentration, you're not getting the muscle gains at the gym anymore, you find yourself a bit weaker, one of those can be due to testosterone issues, and approximately one in 10 people, over the age of 40, will have symptomatic testosterone deficiency, up to four out of 10 will have a low testosterone. So a lot of people have low testosterone, but not everyone has the distress all the symptoms with it. And you would generally only treat the ones with distress. At the moment. That's the current guidance, it might change in the future, because there's some new stuff coming out about how important testosterone is in some people. But yeah, so I suggest he gets checked out to see if it is a physical thing. Because it could be related to testosterone, or it could be related to other health conditions. So it's like thyroid or whatever. So get checked out with your GP. But if it's not any of those things, and there are other psychological factors that might be coming into play, so like, works really difficult, your mum's not very well, or whatever it is, that it's about talking about those situations. Also acknowledging that relationships change. Yeah, what you might think of as desire, which is the first six months of relationship, or one month and some people, isn't gonna necessarily be like that in 20 years. I mean, it could be don't get it wrong, it could be. But for most people, it won't be, people will have sex for other reasons, the nursery desire, the habit for companionship, or for love, or for intimacy, or for just being some sense of connection, or warmth, or sometimes safety or money. You know, there are lots of reasons to have sex with someone. And something is not just about four.
Hannah Witton
Yeah, that's so true. Someone said, how common is delayed ejaculation? And how can I make it easier on myself, and my boyfriend?
Dr Anand Patel
So delayed ejaculation is becoming an increasing issue. Partly, I think, you know, there's, there's mixed issues about whether porn is a good or a bad thing. And I think a lot of the evidence is, well, we don't really know. It's a very helpful tool for some people. And actually, it's quite damaging for others. But we do recognise that because of the easier availability of porn, people tend to be masturbating for longer. So if you will use your imagination, or the Next catalogue, there's not necessarily that much stimulation going on there, of people in pants or people in bra's or whatever it is, it's getting you going or using your imagination. And people also not using a lube very often these days, and that's a problem. So if you're masturbating for longer, and you're not using lubricant, you get a condition called death grip, where you're squeezing so hard on your willy, that you can almost like whittling it down. And because that's not how a vagina or a mouth or anus feels, if you then try and put your penis from being in a very tightly gripped dry hand, now into a lubricated
Hannah Witton
Even if someone is really good at their kegels, they will not be able to grip as hard as a fist
Dr Anand Patel
No-one’s lips, or bottom or vaginal walls are strong enough to replicate your clenched hand. If you've been basically, if your brains been trained to think that I need to squeeze like this, and for this long to get to ejaculation, it's going to be much more difficult for your partner to do that to you. So often, not often, but you have people reporting to us that they can penetrate. And they can have, they can move backwards and forwards for a period of time, but they don't ever get anywhere close to coming. So what they have to do is pull out, and then masturbate until they do. So one of the ways that I recommend is getting something like a vaginal sleeve or flashlight or something like that. And they can stick that between two pillows, lubricate it up. And so basically, you can get these, they're basically vaginas at a can, or mouths in a can, or anuses in a can. And the idea is that it's like a long silicon tube, which is often got some nubs on the inside. So it kind of rubs you, you put
Hannah Witton
I like the tenga ones, because they don't look like body parts.
Dr Anand Patel
So there's loads of different ones, you buy ones which look like truncheons, other's look like like fizzy pop cans, they can be disguised as lots of things. But the idea is you put lubrication in it, and you try and replicate the sex you actually want to do. So if it's, for example, vaginal or anal sex, you maybe stick the can between two pillows, and then you thrust in and out of it. Which is not the same as you moving it backwards and forwards on your penis using your hand, if that makes sense. So you're replicating this or pelvic movement. And also, if you've got a foreskin and you're having sex, most of your fucking is basically, your own, the head of your own penis go in and out if your foreskin. It's not actually, because you've got the foreskin and then you've got that whatever the sleeve is around, and forgive me for calling, I'm not calling people sleeves, but things around it. So if it's vaginal muscles, or oral muscles or anal muscles. So actually, if you're not used to having that, because your foreskin is normally pulled back, when you're thinking, then actually again, your brain is like, well, this isn't what I'm used to. So it's about trying to retrain yourself, and it can take months and, to years in some people, particularly if they've been using a lot of pornography.
Hannah Witton
Yeah. But often, it was the getting to that point also took months and years, but they just didn't notice it happening.
Dr Anand Patel
Exactly. Absolutely
Hannah Witton
Yeah, it's just like that retraining, like you said, and it is possible
Dr Anand Patel
Totally possible. But also what you can encourage people to do is to be more stimulated in the day, because some people try and go from like, they're microwaves and want to be turned on instantly and be able to have sex. And actually, it's a bit more like an aga.
Hannah Witton
You've got to preheat the oven.
Dr Anand Patel
Exactly, right.
Hannah Witton
I love all of these analogies
Dr Anand Patel
I'm like an aga, because I need like heating all day, before I get anywhere. And that's partly my age, that's also part of who I am, you know, I want to be flirted with, you know, I want the interest. And so when you're early in a relationship, often there's lots of sexy texts and things slide backwards and forwards, or even just stuff that's just generating interest between the two. But then you get older and you're thinking, the only text, I said, my partner is what's in the oven. Yeah, when's the when's the pizza being going to be ready
Hannah Witton
Can relate
Dr Anand Patel
It just means that actually, if you are a bit more sexually buzzing through the day, by the time you're having sex, you're less likely to have delayed ejaculation.
Hannah Witton
This is, we talked about this in a previous episode with Dr. Karen Gurney, and it's what she calls sexual currency. So if you want to learn more about that
Dr Anand Patel
Karen, Karen's wonderful. She's just so knowledgable. Yeah
Hannah Witton
Yeah. That's so true, it's like that being sexually charged, like before any kind of sexual activity is happening.
Dr Anand Patel
Because also makes things much more sexy. It means like, you know, even putting the washing out is more sexy, because it kind of thinking, well I put the washing out and then I might have sex. Rather than going, Oh, my God, this looks more you're kind of going Oh, and all those touches, you know, if you will put the washing out together and someone is sliding their hand down your back, perhaps you won't get to the towels.
Hannah Witton
So true, those towels, we'll have to wait. Somebody said, this one's about Viagra, I feel like we have to talk about Viagra. When is use of Viagra appropriate and when is it not?
Dr Anand Patel
So again, when you're distressed about your erection. Now, the issue is, that if you genuinely have a functioning penis, but your expectation is that you would be having sex for hours and days, then it's a false expectation. That makes sense. You would potentially have an erection for a relatively short period of time, and it would be coming and going, coming, going, and that would be the normal. And then if you're but if your expectation is not the normal, that actually you're taking a drug to achieve a situation that physically isn't really possible.
Hannah Witton
Right, and in Viagra it just it's just, like you take Viagra and then you have this erection that lasted a long time, if you orgasm, does it go down? Or does the erection stay?
Dr Anand Patel
It depends on how long you've had the erection for. Unfortunately, some people, they end up with an erection that lasts longer than four hours. And that's called prime pace. And then it has to be then deflated by using two very large needles. Exactly, it sounds as horrible as it is. But please don't let that stop you. If you do have an erection that lasts longer than four hours, I'm sorry, it won't be great fun, but please go and get yourself deflated. They will start, they will start with ice, don't worry, they're not going to, they'll start with ice to try and shrink it down. But the problem is, if you've ever erection for that long blood clot in there,
Hannah Witton
yeah,
Dr Anand Patel
You don't want a blood clot in your willy.
Hannah Witton
No
Dr Anand Patel
Well you don't want a blood clot anywhere really. But you particularly don't want a blood clot in your willy. And so that's the thing about Viagra via and it's brother medications like Cialis, Levitra, etc, that you can now get on prescription, are really, really helpful medications. But all they do is open up your blood vessels, they do not make you sexier, they do not make you more sexually interested. So if you are not, they will only work if you're turned on. So basically, if you are having a day of misery, and actually you're working or whatever you're not going to get you're not gonna get an erection in the office. What will happen is, when you do get home or wherever you want to have sex, and something arousing happens and you are stimulated by that in a position to be aroused, then you might respond to it. We have some people, unfortunately, who take Viagra and because they are so anxious and whatever, it doesn't matter what's happening in front of them, or who's touching them. They still can't get the erection because it's not just about blood flow, erections and dependent on nerve supply.
Hannah Witton
Yeah, so the Viagra and the other medications focus on the physical elements of it.
Dr Anand Patel
Exactly. And you need that, I recognise as you get older, It's not so visual. So arousal when you're younger, it's like you can look at someone hot and get a boner. Whereas when you get older, it doesn't actually happen that easily, you need a -
Hannah Witton
It's lot more about like the dynamic and like what's actually happening or maybe sensations,
Dr Anand Patel
At least it, well it's actually the sense that you have to be generously stimulated to get the erection. It's, the visuals don't work so well. So some people think oh, no, there's something wrong with me, I need more rubbing down there, that's just because you do. Some people are much more wired for the visual, which goes through the eyes into the brain and then back down the spinal cord. Compared to the genital which is where you're rubbing the penis, it goes into the base of the spinal cord, but it's a reflex that comes straight back to the penis to have them working together super important. And if you, do have delayed ejaculation, making sure both of them are switched on at the same time.
Hannah Witton
This is so interesting. In my head, I just always assumed that you take Viagra and you get an erection.
Dr Anand Patel
Everyone’s like, oh my god, I can hang a towel off it. It's not that at all people can take a not respond to whatsoever. Depending on how mentally they're aroused, they are.
Hannah Witton
Do you think there's not enough education around that?
Dr Anand Patel
Absolutely. I mean, now you've got, you can look, I think being able to access Viagra over the counter, I think is a really good thing. Don't get me wrong, I don't have a problem with that. I do know the problem, though, that we may be missing cases of heart health issues, or other issues, which people are masking by taking the Viagra. I also feel we might be missing some psychological issues that they mask. I mean lots of people, because of their sort of porn focus ended up taking Viagra and then don't really know what arouses them anymore. Because they kind of artificially manufacture a porn visual arousal circuit. And then
Hannah Witton
And then they're like actually, what does turn me on?
Dr Anand Patel
Exactly. I believe that and it's very difficult to then get away from porn and have that period of time without any pornography, allowing your body to reset and that can take again months or years. I'm not saying you need to, some people have a very healthy sex life, and be able to dip into a bit of pornography. Other times they're able to have sex, they have no problem whatsoever. But where there is a significant minority that do have issues with either delayed ejaculation, or difficulties in sensation because of the way they've been masturbating, or their focus on what they think they're aroused by is completely messed up. So their fantasies gets a little bit out of control, and are not necessarily ones that their partner wants to indulge
Hannah Witton
Right, okay, yeah.
Dr Anand Patel
Because if all you want to do is sort of anal, whilst wrapped as a mummy, that might not be something that your partner wants to do every time
Hannah Witton
Yeah, just for Halloween
Dr Anand Patel
I can't believe just said that sentence but okay.
Hannah Witton
Where did that come from in your brain? Well, thank you so much. This has been completely enlightening. I feel like I've learned loads, because I often like focus so much on like, the way that my own body works and and people also with vulva's, that I'm like penises. Yeah, this has been fascinating. Where can people find you online if they want to check out what you do and your podcast as well?
Dr Anand Patel
So, thank you very much. I've also, I've got a podcast with my amazing co host Naomi Sheldon, it's called the Pleasure Podcast. You can find us on Twitter @ThePleasurePod. And if you want to find me, I am @TheRealDoctorAnand and which is A N A N D.
Hannah Witton
Amazing. Well, thank you so much. And thank you all for listening. Bye. Thank you so much for listening to Doing It. If you enjoyed it, I would really appreciate it. If you left a rating and a review. You can find show notes at DoingItPodcast.co.uk and do go follow us on social media and I'll catch you in the next episode. Bye.
Hannah Witton
This was a global original podcast