Why 40% of Young Men Have Erectile Dysfunction

0:00Today we're going to talk about erectile

0:01dysfunction. Now the biggest problem is

0:03that erectile dysfunction used to be an

0:06old man's disease. About 5% of people in

0:081999 under the age of 40 had erectile

0:11dysfunction. In

0:132011, 14 to 28% of people under the age

0:17of 40 had erectile dysfunction. And that

0:19number has only gone up. I suspect it's

0:22somewhere around 30 to 40% of people

0:25under the age of 40. So why is erectile

0:28dysfunction increasing so rapidly? So I

0:30think this has to do with the way that

0:32we are literally training our genitals

0:35as men. So the first age of pornography

0:37exposure is around 9 years old and most

0:41people start masturbating in their early

0:43teen years. We're also seeing a delay in

0:47socialization, the development of

0:48relationships. Online dating is getting

0:51hard. So it used to be that the average

0:53age of first intercourse was maybe

0:56somewhere around 18 and that number has

0:58only gone up. So what that means is that

1:01from let's say the age of 13 until about

1:0422 or 23 for a period of 10 years most

1:08teenagers, boys and young men are using

1:11pornography and masturbation as their

1:13primary source of sexual activity. When

1:15we're teenagers our brain is still

1:18developing, our nerves are still

1:20developing. our physiology is still

1:21developing and it develops in a

1:24particular way. So just to give you all

1:26a couple of examples if we look at the

1:29average intravaginal pressure. So how

1:32what is the squeeze the grip strength of

1:34a vagina? It's somewhere between 5 and

1:3715 mg of mercury. Okay. Now if we look

1:40at the average hand grip strength the

1:43average hand grip strength is somewhere

1:44between 65 and 105 pounds per square

1:49inch. So if you sort of like think about

1:50your hand, first of all, there's

1:52skeletal muscle, which is way stronger

1:53than smooth muscle, which is most of

1:55what the vagina has. And then we also

1:57have bones, right? So if like if I

1:59squeeze my hand like this, the amount of

2:02space I can't even stick a pen in, like

2:04that's how tightly I'm squeezing. So

2:06what tends to happen is that our our

2:09genitals get used to a certain kind of

2:12stimulation over a very critical period

2:14of development and then it's hard for us

2:17to climax during sexual intercourse. Now

2:21we have to get into the definition of

2:23what erectile dysfunction is and this is

2:25really important. Okay. So erectile

2:27dysfunction means the inability to

2:30achieve climax for the duration of the

2:32sexual act. So I'm not able to finish

2:35with with the the pressure of of a

2:37vagina. So therefore like I I get

2:40defined as erectile dysfunction. So this

2:41is a key thing to understand is a lot of

2:43people who have difficulty finishing

2:45think there's something wrong with their

2:46penis. And there's in a sense sort of is

2:48right because we've trained it in a

2:50particular way. We're going to get to

2:51how to fix it. And the good news is that

2:53like most of these cases are 100%

2:55fixable. But then this creates a problem

2:57because the kind of sensory stimulation

2:59I need to achieve climax isn't there

3:00with vaginal penetration which results

3:03in erectile dysfunction. So today what

3:05we're going to do is go into erectile

3:06dysfunction with a lot of detail. We're

3:08going to explain the physiology of how

3:10an erection forms. We're going to talk a

3:12little bit about the sequence of the

3:14sexual act which is incredibly important

3:16to understand. We're going to go over

3:18medical conditions that contribute to

3:20erectile dysfunction. And once we

3:21understand how the sexual act is

3:24supposed to happen, the arc and the

3:26trajectory of the development of an

3:28erection to sexual intercourse to how

3:30the sexual act is completed, then we

3:33will understand kind of how the engine

3:36works, how the car is actual, what's

3:38going on under the hood, and it will

3:39give us a lot of insights into how to

3:42fix the problem. Hey y'all, if you're

3:43interested in applying some of the

3:44principles that we share to actually

3:46create change in your life, check out

3:48Dr. K's guide to mental health. And so

3:49we start by understanding what literally

3:52is meditation. How does experience shape

3:55us as human beings? How do we strengthen

3:57the mind itself as an organ? And so by

4:00understanding our mind, we understand a

4:02very very simple tool, a crucial tool

4:05that we have to learn how to use if we

4:07want to build the life that we want to.

4:08So check out the link in the bio and

4:10start your journey today. So here is our

4:13penis and I hope I can draw a picture of

4:14a penis without getting in trouble. Now

4:17in our penis we have

4:20arteries that send blood blood into the

4:23penis and we have veins that bring blood

4:27out of the penis. Okay. So we have a

4:30couple of different

4:32chambers. We have something called the

4:35corpus

4:37cavernosum which is here. We have two

4:40chambers called the cor corpus

4:41cavernosum. And then we have a chamber

4:44in the the glands of the penis, the tip

4:45of the penis called a corpus spongiosum.

4:48So normally there's when we have a

4:50non-erect penis, the flow into the penis

4:54and the flow out of the penis match. But

4:56what happens in an erection is that we

4:59will send blood into the penis and

5:01there's a a nitric

5:04oxide production in the penis. So nitric

5:08oxide is a vasod diilator.

5:12So what that means is that it will

5:14increase the blood flow to the penis. So

5:16as nitric oxide production increases and

5:19by the way

5:21testosterone basically increases nitric

5:23oxide production. So this is a

5:24vasoddilator. So what happens is I have

5:27an artery and when I add nitric oxide

5:30the size of the artery increases right

5:33so now there's this much blood. There

5:34used to be only the middle part and now

5:36there's a lot flowing in. So when I add

5:39um nitric nitrous oxide production it

5:42causes vasoddilation which means that

5:45blood is now flowing into the penis. So

5:47as I

5:48vasoddilate right so as I increase the

5:50blood flow these start to fill up with

5:53blood and when these fill up with blood

5:56this blocks off the veins. So as the

6:00corp you can kind of think about it this

6:01way like as the corpus cavernosum fills

6:03up we start to block the veins and once

6:07we block the veins then we've trapped

6:09the blood inside and arterial pressure

6:12is greater than venus pressure which

6:14means we're still pumping blood in and

6:16then this is how we get an erection

6:18right so if we sort of think about a

6:19flaccid penis it may be like 1 in in

6:22size and then once you get an erection

6:24it literally like will like increase

6:26fivefold in volume. So there are a

6:28couple of key things to understand here

6:30about erectile dysfunction. The first is

6:32that

6:34testosterone is what facilitates nitrous

6:36oxide production. So the other thing

6:38that we we also discover is that since

6:41nitrous oxide is responsible for the

6:43vasoddilatory mechanism that creates the

6:46erection, we also have the ability to

6:50develop phosphodieststerase 5

6:52inhibitors.

6:55So this is the enzyme that then breaks

6:58down nitrous oxide. So if we have

7:00medications like selenaphil or Viagra,

7:04they block the breakdown of nitrous

7:07oxide. So if I'm breaking if I'm

7:09blocking the breakdown of nitrous oxide,

7:11then I will be able to maintain an

7:13erection because I'm I'm maintaining the

7:16chemicals that allow me to to keep an

7:18erection going. So this system is

7:20mediated by testosterone and nitrous

7:22oxide, right? So

7:24testosterone results in the produ

7:26production of nitrous oxide which is a

7:29vasoddilator which allows us to maintain

7:33an

7:34erection. Now

7:36normally we have an enzyme called PDE5

7:41phosphodieststerase 5 which then breaks

7:44down nitrous oxide. So when we lose our

7:46erection right so we're producing

7:48nitrous oxide it's vasoddilating our

7:50penis and PDE5 comes in and breaks this

7:52down which then breaks down the

7:54vasoddilation which then kills the

7:56erection. So if we look at something

7:57like

7:59selenaphil or

8:01viagra what this medicine does is blocks

8:04this enzyme from functioning. So it

8:07prevents us from breaking down nitrous

8:09oxide which is how we're able to

8:10maintain erections. So this is a quick

8:12overview of the physiology of the penis.

8:14Now let's talk a little bit about what

8:17governs whether nitrous oxide is built

8:20or not built. Right? So nitrous oxide is

8:22what results in the development of an

8:24erection. But when does it turn on? When

8:26does it turn off? So now what we have to

8:28do is talk about something called the

8:30autonomic nervous system. So we have a

8:33part of our our body called the

8:36autonomic nervous system which is

8:37divided into two components. The

8:40sympathetic nervous system and the

8:41parasympathetic nervous system. I don't

8:43know if you all have noticed this, but

8:44we basically have two modes of action in

8:49our body. There are times where we are

8:51excited. There are times where we're

8:53angry. There are times where we are

8:55lustful. There are times where where our

8:57body is basically in a high state of

8:59activity. Our blood pressure is high.

9:01Our heart rate is high. Maybe we're

9:03diaphoretic. We're sweating. So this is

9:05the activation of the sympathetic

9:06nervous system. This is governed by

9:10things like adrenaline and cortisol. So

9:12when you sort of think about going on a

9:13roller coaster or some kind of like

9:15adrenaline spike, that's your

9:16sympathetic nervous system acting. So

9:19these are hormones, which means that

9:20they travel everywhere in your body

9:23through the bloodstream. And the purpose

9:24of a hormone is to

9:27coordinate your whole body's response.

9:30So when I get adrenaline, I want to shut

9:33off my digestive system. We don't need

9:35to be digesting anything right now. I

9:36want to shut off the sexual act, right?

9:38So, when we're going on roller coasters

9:40or we're being chased by um tigers, we

9:44don't want to be having erections. We

9:46need all of our blood flow not to our

9:48penis, but to the skeletal muscles in

9:51our arms and legs. And that's what

9:52adrenaline and cortisol will do. They

9:54will redirect blood flow to certain

9:56parts of our body. The second half of

9:57the autonomic nervous system is the

9:58parasympathetic nervous system. And this

10:01governs our rest and digest kind of

10:04mode, right? So sometimes when we're

10:06after we've had a big meal, what

10:07happens? Our blood flow doesn't travel

10:10to our brain, doesn't travel to our

10:11skeletal muscle, it travels to our gut,

10:14it travels to our liver, and we sort of

10:16feel a little bit sleepy. We get a

10:17little bit of a food coma. And the other

10:19thing that happens is we can sometimes

10:21get an erection. So y'all may have

10:23noticed that you get erections when

10:25you're feeling relaxed. So when you wake

10:28up in the morning, a lot of men will

10:29wake up with something called morning

10:30wood, right? So we will have a an

10:32erection early in the morning. I used to

10:34get erections all the time in organic

10:36chemistry class. It's not because I

10:38thought organic chemistry was super

10:39sexy. It's because I thought organic

10:41chemistry was super boring and it would

10:43put me to sleep. So, this also leads us

10:45into

10:46um sort of the stages of the sexual act.

10:49So, what we know is to develop an

10:52erection, you need activation of your

10:54parasympathetic nervous system. You need

10:56to feel safe. You need to feel relaxed.

10:58Right? So, for those of y'all that are

11:00lucky enough to engage in in, you know,

11:02healthy sexual relationships, you may be

11:04in bed with your partner. You're kind of

11:06feeling relaxed. You're kind of

11:07chilling. You're kind of relaxing. You

11:09know, things feeling good. And then you

11:10start to get a little bit frisky, right?

11:13You start to develop a little bit of an

11:15erection now. Your mind is sort of

11:16noticing, oh, like look at how soft they

11:18are and look at the I mean, see how they

11:20smell and they smell really good and

11:22like now I want your body. And then and

11:24then so what happens is in order to

11:26develop an erection we need activity of

11:28the parasympathetic nervous system. So

11:30then what happens is like once we have

11:32the

11:33erection then our sympathetic nervous

11:35system can turn on especially if we get

11:37a certain kind of stimulation genital

11:39stimulation associative stimuli we start

11:41making out whatever. And then so

11:43basically we need you know the way that

11:45it was described to me in medical school

11:46is in order to arm the penis you need

11:49parasympathetic nervous system activity.

11:51In order to fire the penis, you need

11:53sympathetic nervous system activity. And

11:55the sympathetic nervous system will also

11:58recruit some of the things that will

12:00result later on. It activates certain

12:03mechanisms that will result in the

12:05return of the penis from erect to

12:07flaccid. So this also shows us a huge

12:09problem with psychoggenic erectile

12:11dysfunction or erectile dysfunction that

12:14is not caused by a physiologic cause

12:16which is that if you are stressed out,

12:18if you are depressed, if you are

12:20anxious, then it will be hard to develop

12:23an erection. So if your physiology is

12:25not able to enter the right state of

12:27relaxation because you're stressed,

12:29anxious, depressed, whatever, it will be

12:31hard to develop an erection and even

12:33start the sexual act. So, one of the key

12:35signs of psychoggenic erectile

12:38dysfunction, so non-physiologic, and

12:40we'll get to this in more detail in a

12:41second, is that you are able to develop

12:43erections like while you sleep. So,

12:46penile tumscence at night is still

12:48intact. So, what the [ __ ] does that

12:50mean? That means that you know you wake

12:51up with morning wood, but when it comes

12:53to the sexual act, it's difficult to

12:55engage. So if there's a physiologic

12:57problem with the penis then even some of

12:59these situations like morning wood or

13:02nocturnal erections will be impaired

13:05right because there's some problem with

13:06the corpus cavernosum some problem with

13:08the blood flow to the penis the corpus

13:10spongiosum. So if there's a problem with

13:12kind of the hardware, then you'll have

13:14difficulties with erections basically

13:16all day long. But if there's a problem

13:19with the software, which is a

13:20psychoggenic erectile uh dysfunction,

13:22then the penis is capable of working in

13:25nonsexual situations. Does that kind of

13:27make sense? Psychoggenic erectile

13:29dysfunction is mostly found in young

13:31men. A study by Kasuru at al reported

13:34that 85.2% 2% of 525 26 men under the

13:38age of 40 are struggling with

13:40psychoggenic erectile dysfunction. So

13:42this doesn't mean that 85% of people

13:44under the age of 40 have erectile

13:46dysfunction. This is a study that is

13:48looking at if I take all the people

13:50under the age of 40 and I try to figure

13:52out what is the cause of their erectile

13:55dysfunction, the cause of their erectile

13:57dysfunction is psychoggenic 85% of the

14:00time, which sort of makes sense, right?

14:01because our bodies are young and

14:03healthy, which means that some of these

14:05other causes that we're going to talk

14:06about are going to be less common. So,

14:08let's talk about

14:12physiologic causes of erectile

14:14dysfunction. Okay, so psychoggenic ED

14:17accounts for 85% of people under the age

14:21of 40. And by the way, the rate of

14:23erectile dysfunction under the age of 40

14:26according to evidence is up to about 28%

14:30in 2011. I suspect this number is about

14:3330 to 40% in 2025. So what are the

14:37physiologic causes of erectile

14:38dysfunction? So heart health is penis

14:41health. So as we sort of explained at

14:43the very beginning, vascule is very

14:46important. So you need healthy arteries,

14:48healthy veins. So what we tend to see is

14:51that people who have cardiovascular

14:53problems, things like hypertension,

14:56things like obesity,

14:58uh things like

14:59diabetes, things like chronic kidney

15:02disease, this is not vascular. Um people

15:04who have sleep apnea, very uh common

15:07cause of erectile dysfunction. So these

15:09are some of the very very common

15:11physiologic causes. So basically

15:13problems with you know if we look at

15:15poor cardiovascular health like poor

15:18exercise results in erectile

15:20dysfunction. So you need a healthy heart

15:22that's pumping the blood you know

15:24healthy veins healthy arteries big big

15:27big

15:28causes. Now there are also neurogenic

15:30causes. So

15:33um remember that in order for the penis

15:35to work properly it has to receive there

15:38are a bunch of nerves right? So when we

15:41when we touch the penis it feels good.

15:43How do we know that it feels good? All

15:45of that information is transmitted via

15:48nerves. So 10 to 19% of erectile

15:51dysfunction over the whole population.

15:53Okay, this is not young people. This is

15:55just everybody is caused by neurogenic

15:57problems. So these can be things like

15:59multiple sclerosis, spinal cord trauma,

16:03um things like stroke can cause erectile

16:05dysfunction, surgery can cause erectile

16:07dysfunction. So neurogenic causes are

16:09about 10 to 20% of them. So if there's a

16:11problem with your nerves in some way,

16:13they're going to be there's going to be

16:14problems with erection. So this is

16:16another like really good uh this is a

16:18great opportunity to share something

16:19kind of cool. So a group of people that

16:21has great cardiovascular health and also

16:24has erectile dysfunction problems are

16:26professional bicyclists. So if we sort

16:28of think about a bicycle seat, what the

16:31bicycle seat is doing the way that you

16:33sit if you're like a professional,

16:34you're a biker, right? So if you go on

16:36marathons and stuff or you bike for

16:38eight hours a day, you are

16:40compressing the nerves and arteries and

16:43veins that go into the penis. So I don't

16:48know if this kind of makes sense, but if

16:49you look at the anatomy of the penis,

16:51the arteries and veins that go into them

16:53kind of travel through the area that's

16:56called the taint, right? So the area

16:58between the perennium and the scrotum is

17:00full of nerves, arteries, veins that

17:04sort of imbue the penis with what it

17:06needs. So if we compress that for

17:08extended periods of time, we block those

17:11nerves, then it can result in erectile

17:13problems. What's really interesting is

17:14that this principle is also utilized

17:17beneficially by yogis. So there's an

17:20assan called arda siddasan or another

17:24asan called siddhasan. And in Siddhasan

17:27we place the heel gently against that

17:30area. And then in full Siddhasan we'll

17:33sort of compress that area more

17:35severely. We compress from the perennium

17:37side and we compress above. So you

17:39basically sandwich your scrotum and

17:42penis between your heels or your ankles

17:44if that kind of makes sense. I do not

17:46recommend don't do this without the

17:47guidance of a guru. Okay. Okay. So these

17:49are can and the reason that they do that

17:51they do that on purpose to reduce blood

17:54flow to those parts of the body to

17:56reduce testosterone production because

17:58we're also blocking some of the nerves

18:00and arteries to the scrotum which is

18:02where a lot of our testosterone comes

18:03from. So they'll sort of utilize this.

18:05But my point is that there are all kinds

18:06of anatomical neurological arterial

18:09things going on. So we have physiologic

18:12erectile dysfunction, neurogenic

18:13erectile dysfunction. Another major

18:15cause huge huge huge is medications. So

18:18we are like notorious for this in

18:20psychiatry because a lot of our

18:21medications cause erectile dysfunction.

18:23At the top of the list are SSRIs. So

18:26these are anti-depressant medications,

18:28anti-anxiety medications, anti- OCD

18:30medications will cause erectile

18:32dysfunction. Another good example of

18:34this are anti-hypertensives. So these

18:36are medications that going to are going

18:38to affect your cardiovascular

18:40capability, right? So they're going to

18:41prevent your arteries and veins from

18:44contracting in the way that they

18:45normally do in order to combat

18:47hypertension. So that can cause problems

18:48with erectile dysfunction. We also know

18:50that your diet is really important for

18:52erectile dysfunction. So

18:55sugar, processed foods,

19:00um

19:02alcohol,

19:05nicotine, low

19:07fiber, and then various substances that

19:11we haven't included can sometimes cause

19:12problems with erectile dysfunction. Now

19:14the mechanisms of this are a little bit

19:16complicated. We don't need to go into a

19:17whole lot of detail and I know this is

19:19going to be hard, right? Cuz I can

19:21imagine that there's some people in our

19:23audience who don't exercise, maybe have

19:25sleep apnea, maybe are a little bit

19:26overweight, eat processed foods, eat

19:29sugar, use weed, use alcohol, use

19:31nicotine, and they're like, "No wonder

19:32am I screwed. Don't worry, we'll we'll

19:34we'll help you out." Okay. Now, we have

19:35to talk a little bit about how

19:38psychoggenic erectile dysfunction

19:40develops and what to do about it. And in

19:42order to do that, we have to take a look

19:44at neuroscience. So I want you all to

19:46think a little bit about the process of

19:49the sexual act. Okay, think about the

19:52process of the sexual act. Key thing

19:55here is that when we think about getting

19:57aroused and we develop an erection,

19:59there's a lot of sensory input. Another

20:02really part uh important part of sexual

20:04arousal is emotions, right? So I know

20:06that there's all these, you know,

20:08stereotypes about women need to fall in

20:10love before they have sex and men are

20:12horny and DTF all the time. I I think

20:14that like there may be some, you know,

20:16if you if you measure a 10,000 women and

20:1910,000 men, there may be some net effect

20:22that men are more likely to have sex

20:24without emotions than women, that

20:26statement may be true. But generally

20:27speaking, in the brain, as we'll see,

20:29emotions are really important, right?

20:31So, if like if someone is annoying you,

20:34the likelihood that you become aroused

20:36from that is like low. So, sure, there

20:38may be some kind of fetish or something

20:40at play, but generally speaking, if

20:41people are just like annoying you, or if

20:43you're afraid of them, or if they're

20:45pissing you off, the likelihood that you

20:47will be horny for them goes down. Versus

20:51if you fall deeply in love with someone,

20:53if you're obsessed with someone, the

20:55thought of having sex with them, whether

20:56you're a man or a woman, is generally

20:58speaking more appealing, right? There

20:59are exceptions to that. So, emotions

21:01become really important as well. So,

21:02let's talk a little bit about these

21:03parts of the brain. So first thing that

21:05we're going to talk about is

21:08phalamus and posterior insula. So what

21:10do these parts of the brain do? So the

21:12phalamus receives sensory input and the

21:15posterior insula is responsible for

21:20interosceptive information. So what does

21:23that mean? So if you're listening to

21:25this video right now, I want you to

21:27notice what your body is telling you,

21:30right? So, you may notice the weight of

21:32your the body in the chair. You may

21:35notice that you're a little bit hungry.

21:37You may notice that you want to scratch

21:38something. Maybe you're walking around.

21:40Maybe you're you're sitting in a car.

21:42You're noticing the air conditioner

21:43blowing on you. Your body is sending you

21:46signals. So, one of the things that we

21:48know is very important for sexual

21:50activity is for you to be receiving

21:53sensory input and receiving input from

21:56within your own body. So, I know that

21:58sounds kind of nutty, but just think

21:59about it for a second, right? So, when

22:01you're having sex, a huge part of that

22:04is being aware of the signals from your

22:08genitals. So, the posterior insula is

22:11the part of our brain that basically

22:13gives us information from within our own

22:15body. And what we find is that people

22:17with psychoggenic erectile dysfunction

22:19have difficulty with that. Okay. So,

22:22cognitive attentional syndrome and

22:23metacognitive beliefs in male sexual

22:25dysfunction. Overall, their cognitive

22:28and attentional patterns worsen negative

22:31internal states, reducing sexual

22:34excitement, detach them from their

22:36bodily sensations, and hindered sexual

22:38functioning. So, if you're having sex

22:40with someone and you get in your own

22:42head, oh my god, am I doing a good job?

22:45Oh my god, are they are they enjoying

22:47it? Are they enjoying it or not enjoying

22:49it? Is it going well or is it not going

22:50well? Then this kills your boner or I

22:53have to think about something else. So

22:54like you know if you get in your own

22:57head what happens is this posterior

22:59insula stops becoming a part of your

23:02attention. So there there's a a lot of

23:04studies on psychoggenic erectile

23:05dysfunction show that there is an

23:07attentional problem. You cannot focus on

23:10the physical sensations. You're not even

23:13paying attention to what's going on in

23:14the penis. You are stuck in your own

23:16head. You're worried about something

23:17else. And without your posterior insula

23:20activating, it is very difficult to

23:22achieve climax or maintain an erection.

23:25So if we sort of think about the process

23:27of an erection, right? And hopefully you

23:29all are lucky enough to have experienced

23:31this in a positive and loving way. You

23:34know, if you're just sitting there and

23:36your partner is a little bit frisky and

23:38they start playing with your junk, your

23:41penis will start responding. And as your

23:43penis starts responding, you're sitting

23:46there trying to play Call of Duty and

23:48your partner is like starting to touch

23:50your stuff. And then your attention

23:53shifts from Call of Duty to what is

23:56going on in your genitals. May not be

23:57true because I don't know if Call of

23:58Duty players ever get laid, but you

24:00know, that's neither here nor there.

24:02This is what we mean by by introsceptive

24:04information in the posterior insula is

24:06that your attention needs to be able to

24:08shift to the penis. Now, here's what I

24:10see a lot in psychoggenic erectile

24:12dysfunction. This is basically the crux

24:13of the pattern. So I'm a a boy who

24:16started masturbating. Then what happens

24:17is I've I physiologically trained my

24:20penis to ejaculate with 65 to 105 uh

24:24pounds per square inch of pressure and

24:26the vaginal intercourse of 5 to 15

24:29milligs of mercury is insufficient for

24:32me to achieve climax. So then what

24:33happens is I I finally have sex for the

24:35first time, right? I'm a virgin and I'm

24:37like, "Oh my god, I want to have sex. I

24:38want to be a good person. I don't want

24:39to be a virgin loser anymore." or I have

24:41sex for the first time and then I'm not

24:42able to climax and now this creates a

24:45problem. So the problem is actually that

24:46physiologically this is the stimulation

24:48doesn't work but now I get in my own

24:50head. Now I have problems with an

24:52erection. Now I didn't finish. Now I

24:54didn't pleasure her. Now I just went

24:56limp dick while I was having sex. So

24:58this creates a shame. This creates an

25:01anxiety. This creates a depression. And

25:03so all of these thoughts now the next

25:05time we try to have sex a bigger problem

25:08arises. Now that I'm anxious cuz I

25:10screwed up the first time, now I'm

25:12worried about the second time. Am I

25:14going to be able to perform? So now the

25:16second time I try to have sex, my

25:18sympathetic nervous system is active

25:20before I even start the sexual act. So

25:22what that means is I'm stressed out

25:24about having sex. My partner starts

25:26playing with my stuff, but I'm so

25:28stressed that I don't even develop an

25:30erection. Now it's even twice as bad.

25:32It's not that I went limp dick during

25:33sex. It's that I can't even get hard.

25:36This worsens the anxiety, worsens the

25:38depression. So then I try again the

25:40third time. This creates a se a vicious

25:42cycle that I think is one of the reasons

25:44why like up to 40% of people under the

25:47age of 40, I've seen this pattern so

25:48much have erectile dysfunction. Second

25:50thing, anterior insula. The anterior

25:52insula is what

25:54processes the

25:57emotional

25:59features of stimuli. So this is let's

26:02explain this for a second. Okay, I have

26:04kids, right? And like I love my kids. So

26:07what happens is when I see my children,

26:09this is just visual information, right?

26:12My kids look the same all the time. And

26:14lots of people will receive if if I'm if

26:16I'm walking down the street and I see my

26:18kids and everyone else on the street

26:21will see my kids too. But the emotional

26:23attachment to that stimulus is very

26:27different. Right? There is an

26:30emotional component that my brain

26:33attaches to my children that strangers

26:35won't attach to. I love them. I see this

26:38child and I'm like this brings up a

26:40feeling of love. So this is also really

26:42important for the sexual act. So when I

26:45see my partner, right, and I see a

26:48nipple, that nipple is not just a

26:51nipple. It is it carries a lot of

26:54emotional association with it.

26:57So this part of our brain in order to

26:59have a healthy sexual erection and even

27:03achieving climax the emotions of it are

27:05really important. This is why makeup sex

27:06is so good because there's an emotional

27:09block that made when we were feeling

27:11angry then our sympathetic nervous

27:13system was active and then we don't feel

27:15like having sex and then we form this

27:17emotional connection. Now the anger goes

27:19away. Now we feel relaxed. Now we feel

27:21in love and so we have this really

27:23intense passionate sex because our

27:26anterior insula activates and when that

27:28emotion activates it helps our posterior

27:30insula activate and then we're there.

27:32We're in the moment. We're not thinking

27:34about tomorrow. We're not thinking about

27:35yesterday. The whole point is we've

27:36forgotten yesterday. We forgot the

27:38conflict. We're not in our head. And so

27:40this leads to healthy sexual acts. The

27:43third part of the brain that we're going

27:44to talk about is roughly the

27:47preffrontal cortex.

27:51and

27:53inferior frontal cortices. So these are

27:57responsible for sexual inhibition and

28:00sexual disinhibition. So our frontal

28:03loes are the parts of our brain that

28:05give us context dependent behaviors.

28:09They're the parts of our brain that say

28:11it is okay to do this here and not okay

28:14to do it over there. So, my favorite

28:16examples of this are like picking your

28:18nose. If you're like by yourself at

28:19home, like, you know, binging out on

28:21some TV show and like eating popcorn,

28:23you'll go to town. But if someone else

28:25is around, you won't hopefully won't

28:27pick your nose and hopefully you wash

28:29your hands after you pick your nose. So,

28:30like good examples of how you know the

28:32the inferior frontal cortices are

28:34different amongst people is like if we

28:36look at the fetish of exhibitionism,

28:39right? So some people if they are

28:41observed by others their brain tells

28:44them this is not a good place to have

28:46sex. Other people their brain their

28:48frontal loes are like hey there are

28:50people around let's try to have sex.

28:52Another really great example of this is

28:53like if I'm sleeping in my hotel room

28:56alone at night and someone grabs my

28:58junk. That is going to be a very

29:00different experience from if I'm at home

29:04with my wife in bed in the middle of the

29:06night and someone grabs my junk. Even

29:08though technically the stimulus is

29:10exactly the same, there is a part of my

29:12brain that is saying that this stimulus

29:14is okay in one situation, arousing in

29:17one situation, and scary in the other.

29:20So when I'm in my hotel room alone by

29:22myself and someone touches my junk, I'm

29:24aroused. And when I'm in bed with my

29:25wife, this is very scary. Oh my god, she

29:28wants to have a third kid. What are we

29:29going to do? So, I'm going to kind of go

29:30back to I think the most common factor

29:33in psychoggenic erectile dysfunction,

29:35which is basically pornography use and

29:37masturbation under the age of 40. So,

29:39when I'm developing as a human, I have

29:42some natural impulses and then those

29:44natural impulses get shaped by my

29:47environment. So, for example, when I

29:49have patients who have school girl

29:51fetishes, how do they develop a school

29:53girl fetish? They develop a school girl

29:54fetish because when they're 13 years old

29:56and they go to private school where all

30:00of the things that they are sexually

30:01attracted to have a particular uniform,

30:04their brain forms an association between

30:07I am horny and this is the object of my

30:10horniness. And when all of the girls in

30:12the class are wearing the same thing, my

30:15brain will associate this. Right? So

30:17from the ages of let's say 15 to 18, for

30:19a very formative period of my sexual

30:22life, every girl I have a crush on is

30:25wearing the same damn thing. So my brain

30:27over that that 15 to 18 period is going

30:31to associate this with sexuality. It's

30:34associative learning, like classical

30:36conditioning. This is also why some

30:38people will have like a thing for a mil,

30:40right? So, when I'm a 13-year-old boy

30:43and my friends, I have one friend who

30:45has a hot mom, the emergence of these

30:49sexual feelings is associated with a

30:52particular kind of stimulus. And so now,

30:55like I'm like suddenly like this mom

30:57that I've I've known her for four years,

30:58right? We were friends since we were

30:59nine. I never had a sexual thought about

31:01her. And then once I start to develop

31:02like like all these surges of hormones

31:05and my brain I I like get really

31:06confused because now my brain is like

31:08horny all the time and there are like

31:10all of these mils around me everywhere

31:12hot mils in your area right then I will

31:15start to become attracted to milk. So

31:17this is how the brain works. We learn,

31:19right? It's not just you kind of have

31:21this like you can think about sexual

31:22appetites as acqu all of them are

31:25acquired tastes. If I get exposed to one

31:27school girl and then over the next 5

31:29years get exposed to a hundred others, I

31:32will develop a preference. I will

31:33develop a preference for mils, whatever.

31:35So here's where pornography comes in

31:37because we're not just developing a

31:39cognitive preference. We are also the

31:41genitals. If you're masturbating every

31:43day, you know, in from the ages of like

31:4513 to 23, what's going to happen is our

31:48body is going to get a certain kind of

31:50genital training, which we've kind of

31:51already talked about. So now I am used

31:53to or my brain or penis learn my

31:57introsceptive part of my brain, my

31:59posterior insula and the nerves in my

32:01penis learn that there is a certain kind

32:03of stimulus that gets me to climax. So

32:06now we porn enters the picture. So if

32:09you know a 100 years ago I was like I

32:11developed a school girl fetish what is

32:13my brain going to prefer sexually what

32:15does it get exposed to? So now what's

32:18happening with the consumption of

32:19pornography the easy access of

32:20pornography we get begin to believe that

32:23these things are sexual and what we know

32:26about pornography and there's a whole

32:27we've done lectures on this so you guys

32:29can check this out is that pornography

32:31uses things that are supraormal stimuli.

32:34So they use tits that are bigger, butts

32:37that are bigger, things that are

32:38shinier, 4K, a lot of color, a lot of

32:42camera angles, a lot of things that you

32:44will never see during sex, right? So

32:46like a really simple example of this is

32:48most human beings who engage in sexual

32:50intercourse, the man will never see the

32:52vagina. Or maybe you see it at the very

32:54beginning, but once you're actually like

32:55in a penetrative position, you don't see

32:57the vagina, right? It's like kind of

32:58weird, but so like what starts to happen

33:00is our brain starts to get conditioned

33:01by pornography. And we know that this

33:04conditioning tends to get radical over

33:06time. So this is a paper that's looking

33:08at pornography induced erectile

33:09dysfunction among young men. They report

33:11that an early introduction to

33:13pornography, usually during adolescence,

33:15is followed by daily consumption until a

33:17point where extreme content involving,

33:20for example, elements of violence is

33:22needed to maintain arousal. A critical

33:24stage is reached when sexual arousal is

33:26exclusively associated with extreme and

33:29fast-paced pornography, rendering

33:31physical intercourse bland and

33:33uninteresting. This results in an

33:35inability to maintain an erection with a

33:37real life partner at which point the men

33:39embark on a reboot process giving up

33:41pornography. This has helped some of the

33:43men regain their ability to achieve and

33:45sustain erection. So, one study, I don't

33:47remember if it was this one, found that

33:49I think about 40 to 50% of men will end

33:52up watching pornography that they used

33:55to think was disgusting or like not good

33:58in some way. And so, here's the issue.

34:00So, if we look at a normal brain with a

34:02normal sexual relationship, there isn't

34:04an option for more extreme generally

34:07speaking, right? There's some amount of

34:08extremity. Maybe you your your partner

34:10indulges you during your birthday or

34:12something like that or anniversary or

34:14there's special occasions where you

34:15convince them to play with your kinks,

34:16but it's not like on demand. So once we

34:19acclimatize to a certain kind of

34:21pornography, if we increase the

34:23intensity, the pace, the color, the

34:25extremity, the violence, whatever, if we

34:27increase something about it, our

34:29dopamineergic centers get a little bit

34:31more activated. So over time, what

34:33happens is normal porn becomes bland.

34:35And if you watch pornography, you may

34:37have noticed this that you can't watch

34:39the same porn over and over and over

34:40again, right? It doesn't you don't enjoy

34:42it as much. You go looking for new

34:44things and maybe something that was less

34:46extreme now becomes a little bit more

34:47arousing. So we basically conditioning

34:50ourselves to a particular kind of input

34:53in order to achieve climax in order to

34:56achieve erection. So this is a huge

34:58problem. So the good news is that for

35:00the majority of people who are under the

35:03age of 40, if you have erectile

35:05dysfunction, I would say that it can be

35:0895% resolved. That's my gut check as a

35:10clinician. So if a patient walks into my

35:12office and says, "Hey doc, I'm 30 years

35:15old. I can't maintain an erection. I

35:17can't achieve climax when I'm having sex

35:19with my wife. Can you help me?" And I

35:21would say, "Yeah, dude. I think that you

35:23know there's a really really really good

35:25chance that you can get back to a

35:27healthy sexual relationship and the

35:29studies actually support that. Okay. So

35:30let's understand what the different

35:32pieces are. So the first is

35:33cardiovascular health is penile health.

35:37So if someone is obese, overweight, has

35:39diabetes, has sleep apnea, doesn't

35:41exercise, if someone just starts

35:43exercising on a regular basis, maybe

35:46loses a little bit of weight, but more

35:48importantly achieves more cardiovascular

35:50health, their erections will improve. So

35:51this is true of people who are over the

35:53age of 42. So when we start to get to

35:55physiologic causes like hypertension and

35:57things like that, right? So when I have

35:58a 45-year-old dude in my office who just

36:01got diagnosed with hypertension, has

36:02trouble maintaining an erection, getting

36:04them to exercise and bringing down their

36:06blood pressure will 100% help their

36:08erection. So there are also things that

36:09we've talked about, sugar, processed

36:11foods, things like that. So the first

36:12thing is that if you get physically

36:13healthy, your erections and your ability

36:15to achieve climax will definitely get

36:17better. So now we have to dive into

36:18psychoggenic erectile dysfunction and

36:20how to sort of treat that. So this is

36:22where what we know is that there are

36:23studies that show that attentional

36:25control, so getting better at shifting

36:27your attention will help you maintain an

36:31erection and achieve climax. So if we

36:33look at people who struggle to maintain

36:35erections in climax, what we find is

36:38that once they get into their head, they

36:41cannot get out of their head. So this is

36:43where there are really simple practices

36:45like uh meditation is a really good one

36:47that trains your attention but it's not

36:50just things like meditation right so

36:51there are specific studies that have

36:52attentional control exercises which you

36:54can learn and is shifting your attention

36:57from being in your own head and so this

36:59is what I would encourage you all to do

37:00if you're struggling with this pay

37:01attention to your body right just enjoy

37:03the experience don't think about whether

37:05you're making her come or not don't

37:07think about your rectile just enjoy the

37:09sensations be in the present moment as

37:12much as possible And when you do that

37:14sort of thing, it'll activate that

37:15posterior insula, all of those

37:17interceptive senses, and it will move

37:19you closer to the right direction. The

37:20next thing to think a little bit about

37:22are is the anterior insula, which is our

37:24emotional processing. So, this is a big

37:27part of the work that I do with people.

37:28This is why psychotherapy can be

37:30incredibly helpful for erectile

37:31dysfunction, is that the sexual act is

37:34associated with all kinds of stuff. And

37:37we have to deconstruct all of those

37:39associations because those associations

37:41aren't real. So when I ask let's say a

37:4320year-old kid I mean I I had a patient

37:46once who was like this who who came into

37:47my office and said Dr. K I can't achieve

37:50orgasm. And then I asked them like you

37:51know tell me more about that help me

37:53understand the problem. And so they said

37:54I can get to the first stage of orgasm.

37:56I I can get to the the precom stage but

37:58I can't get to the actual ejaculation.

38:01Like I can't handle it. And I was like

38:02what do you mean you can't handle it? So

38:03what they sort of told me is that you

38:05know like I I will engage in sexual

38:08behavior and then like a little spurt

38:10will come out and then I and then my

38:12penis becomes hyper sensitive and I and

38:15it goes limp. And I was like wait what

38:17do you think an orgasm is supposed to

38:18be? And they're like you know it's like

38:20gallons buckets of ejaculate that lasts

38:23for 60 seconds and lots of moaning and a

38:26and then I'm like rock hard afterward.

38:28And what this person, it's sad, but what

38:30this person was struggling with is that

38:31they were orgasming. They just had this

38:34impression that an orgasm is like, you

38:37know, liters of ejaculate. And the

38:41average ejaculate volume, I think, is

38:43like maybe 5 milliliters, like maybe

38:44like a teaspoon. I I don't really know.

38:46But anyway, so like this is where we

38:48have all these ideas or impressions of

38:50what sex is supposed to be like. And

38:51there are also studies that look at like

38:53me metacognitive beliefs about

38:56manliness. Like what do you think a

38:58manly sexual act is supposed to look

39:00like? And this is where we have to get

39:02to some statistics. Okay, so like a lot

39:04of people don't know that the average

39:06sexual act is 3 to 7 minutes and that if

39:0950% of women will want the sexual act to

39:12end at 10 to 15 minutes, like they're

39:15done after that. A lot of uh men don't

39:18realize that only about 21 to 30% of

39:20women can achieve an orgasm through

39:23vaginal penetrative intercourse. So this

39:26is where we get a little bit technical,

39:27but the tissue that becomes the gland's

39:31penis is the same tissue that is the the

39:34clitoris. So during embryology and in

39:37development, there's a small pit uh

39:40piece of tissue. So we're all default

39:42female by the way. And then what happens

39:43is we the the clitoral tissue under the

39:47influence of an androgen like

39:48testosterone or androin dione will

39:51develop into the gland's penis. So there

39:54are you know some cases of like if you

39:56get a woman a biological female who has

40:00like a testosterone secretreting tumor

40:02you will see the the clitoral

40:04enlargement. So the clitoris will start

40:06to morph somewhat into something that

40:08looks closer to the gland's penis. It

40:09doesn't turn into a gland's penis. But

40:11my point is that embryologically the

40:13tissues are the same. So here's a simple

40:15question. If y'all are worried that you

40:16can't make your female partner orgasm

40:18with vaginal intercourse, we're going to

40:20do a really simple experiment. So

40:22imagine that you are trying to achieve

40:24climax without ever touching the top

40:27half of your penis. Can you climax by

40:30stimulating the base of your penis?

40:32Probably not. I don't this experiment.

40:35Right? So if we sort of think about it

40:36like which part of the penis is the most

40:38important for achieving climax, it's the

40:40glands. It's the corpus spongiosum and

40:42that tip of the penis where all the

40:44nerve endings are. I mean the shaft is

40:46good too, don't get me wrong, but that's

40:48usually what we need, right? And so

40:49women are the same way. they need

40:51clitoral stimulation because that's

40:52where the majority of the the nerve

40:54endings are that will allow them to

40:55achieve orgasm. My point is that when

40:57we're engaging in a sexual act, if we

40:59don't know these facts, we don't know

41:01that the average intercourse lasts 5

41:03minutes. If you're screwing for 3

41:04minutes or 10 minutes, like that's

41:07normal for most people, right? So, you

41:08don't need to get anxious about that.

41:10But then that triggers all of this these

41:12problems with attentional control and

41:14then you're in your own head and stuff

41:15like that. So, that creates a lot of

41:16problems. Usually what I tend to do when

41:18I'm working with people is I will help

41:20them unpack these beliefs. I will help

41:22them think about where they constructed

41:24these ideas. I will help them deal with

41:26their emotions. I will help them develop

41:29emotional regulation techniques and help

41:31them develop relaxation techniques.

41:33Right? Because if you are approaching

41:35the sexual act and your adrenaline and

41:37cortisol are high, you will never

41:38develop an erection. So we need to do

41:40some of that physiologic rewiring,

41:42psychological rewiring. As you dig into

41:44these things, things tend to get better.

41:46The last thing that we're going to talk

41:47about are other forms of interventions.

41:49So, this is just to let you all know.

41:51So, we have medications for things like

41:53erectile dysfunction. And sometimes

41:54these can work incredibly well. So, if

41:56you have, you know, stressbased sexual

42:00erection problems and we do something

42:01like prescribed selenapil, which is a

42:04trade name, Viagra, this can work really

42:06well because you're afraid like you

42:07can't get an erection because you're

42:08stressed out. The Viagra helps you get

42:10an erection. Then you are able to have

42:12sex. Then you're able to say hard enough

42:14hopefully to climax. And then like then

42:16you've had one success. And once you've

42:18had one success, it becomes easier to

42:21have your second, easier to get the

42:23third. Then you start penile retraining.

42:25Then you start engaging in sex. And then

42:27this is how you basically rehabilitate

42:29the penis. And then once you

42:31rehabilitate the penis and now you're no

42:33longer anxious, you don't need the

42:34Viagra anymore, right? You don't need

42:36the selenaphil because now everything is

42:38working the way that it should. There

42:39are also cases of things like

42:40intraurethal suppositories which are a

42:43localized amount of some kind of

42:45medication that is inserted into the tip

42:47of the penis you know so it doesn't have

42:48to be like if you have a medical

42:49contraindication like if you've got

42:51rightids sighted heart failure or

42:53something like that then you shouldn't

42:54take selenaphil so there are things like

42:56that and then there also a couple of

42:57other things that people will do one is

42:59they'll use vacuum assisted devices so

43:01these are things like penis pumps that

43:03remember that a lot of the maintenance

43:05of erection has to do with pressure

43:08gradients from your arterial blood flow

43:10and your venus blood flow. Problem with

43:12a lot of these these vacuum assisted

43:14devices is that about 30 to 46% of

43:17people will stop using them because of

43:19like bruising and other side effects.

43:21And the last thing that we have is we do

43:23have surgical interventions for erectile

43:24dysfunction. These are things like

43:26penile implants. So you can put some

43:28kind of implant into the penis. A little

43:30bit outside of my wheelhouse. You got to

43:32go see a surgeon or urologist for that

43:33kind of thing. So that you can do that

43:34kind of stuff too. So there's a lot of

43:36stuff that you can sort of do from a

43:38lifestyle perspective, from a

43:39psychoggenic perspective, you know, to

43:41understand how the brain develops an

43:44erection, what's going on in your

43:45nervous system, what's going on in your

43:46head, the ability to shift your

43:48attention, and then you can absolutely

43:50move in the right direction. The last

43:52thing that we tend to see is that

43:53abstinence or severe reductions in

43:56pornography and masturbation will help a

43:58lot. If you think about the frequency of

44:01sexual activity, the less sexual

44:04activity you have, the easier it is to

44:07achieve climax. This is a huge problem

44:08for a lot of dudes. If you haven't

44:10gotten laid in a while and you have sex

44:11with your partner, you're done pretty

44:13quick. So, as a psychiatrist, I'll sort

44:14of do like this kind I mean, it's not

44:16really sex therapy, but I'll work with

44:18couples to, you know, develop a plan

44:19where I let them know, look, we're going

44:21to do this for a month where you got to

44:22take you got to stop pornography, you

44:24got to stop masturbate, and then y'all

44:25can have sex. The goal is not to finish.

44:27when you feel an erection or whatever,

44:29you guys just like try it out and feel

44:31each other out for about 30 days. And

44:33the goal is first of all, let's see if

44:34you can get an erection. Let's see if

44:36you can enjoy the just enjoy the

44:38sensation. Don't worry about sex. You're

44:39not trying to have sex. You're just

44:40trying to get a penile massage, right?

44:42That's the goal. And then you start to

44:44enjoy each other's company. You start to

44:46develop intimacy, you know? So, you

44:47start to like, you know, maybe have some

44:50kind of massage but don't have sex. And

44:52then like tension builds up and then

44:54they end up having sex and it ends up

44:56being great because like both of them

44:58are horny because they're genital

44:59massaging each other for like 15 days

45:01without any kind of like you know sexual

45:03activity and then things turn around. So

45:05there's some studies that show that you

45:06know abstinence from pornography can be

45:08incredibly effective. So last thing that

45:10I want to share with you all I know we

45:11sometimes try to sell you things but

45:12this is something that I couldn't

45:13resist. So in order to help you all with

45:16this problem I'd love to tell y'all

45:18about a new guide we've made which is

45:19Dr. K's guide to penile retraining. Much

45:22like our other guides, it dives into a

45:24lot of depth about what is the

45:26neuroscience, what is the psychology,

45:28gives you lots of practical tips on what

45:30you can do. Also includes meditations

45:32that are designed to support this

45:34problem. So, we're going to be exploring

45:35esoteric tantric meditations. And then

45:38the best part of the guide, which is now

45:39available not only on our platform, but

45:42also on Only Fans, is I'll show y'all

45:44step by step exactly how to do the

45:47retraining of the genitals. But in all

45:49seriousness, if y'all are worried about,

45:52oh, how do I regulate my emotions? How

45:55do I focus my attention? How do I

45:57process my shame? All of these things

45:59actually do exist in our real guides.

46:02So, we have a guide to trauma where

46:03we'll talk to you about, you know, how

46:05to let go of past experiences. We have a

46:07guide to anxiety where we teach you a

46:09lot about the physiologic rewiring that

46:12is necessary so that you can reduce your

46:14anxiety. We have guides to depression.

46:16We talk about how to deal with shame.

46:18So, if y'all are interested in that

46:19stuff, definitely check those things

46:20out. And of course, if you're working if

46:23you're struggling with this problem, you

46:24can absolutely work with a professional.

46:26Hey y'all, hope you enjoyed today's

46:27video. We talk about a bunch of topics

46:29like this on the channel, so be sure to

46:31subscribe for more. If you're already

46:33subscribed, GG, and we'll see you in

46:34chat.

46:36[Music]