In this episode, Dr. Rena Malik, MD, tackles common urological and sexual health concerns in her Ask Me Anything (AMA) series.

how-pornstars-get-big-understanding-split-stream-and-psychogenic-ed-ama

How Pornstars Get BIG? | Understanding Split Stream and Psychogenic ED | AMA

have you ever wondered if you can make your penis bigger safely and what to do if your stream goes in all different directions well welcome back today to the Reena Malik MD podcast I'm your host Dr Reena Malik urologist and pelvic surgeon and today we're going to be going over our ask me anything Series so without further Ado let's get to our first question now if you want your question answered make sure to check out our membership at renam malik. supercast docomo to be a member and get early access to our podcast episodes as well as ask me anything to get your question featured on our monthly ask me anything episodes first question I get too lost in my own head with women I think too much about staying hard during sex and it causes me to sometimes lose my erection because I think I overthink my erection I'm only 24 I can't imagine I have a disease that's causing me to have erectile dysfunction this early in life I do get dates so I'm not having problems finding Partners to have sex with but I overthink the sex part because I want the women to think well of my performance and I've already lost my heart on with two separate women I don't want this to happen again this questions from TS okay TS so this is unfortunately a very common issue so when a man has an issue with an erection which invariably happens to everybody in their lifetime erectile hardness will change over time depending on how stressed you are how you know what the temperature might be like what uh how much you had drink or what other things you ingested that day so these things can all affect erectile function now the first time you lose an erection it's very stressful and obviously part of this is that we're not taught that men men's erections can you know VAR be variable and fluctuate over time so one I want you to know that your experience is completely normal and then what happens is you get stressed about not being able to get an erection and the next time you go to have intercourse you're just thinking about am I going to get an erection am I going to be able to maintain it am I going to be able to have sex instead of actually enjoying the pleasure with your partner and it leads to this vicious cycle right because then you don't get an erection or the erection doesn't last and now you're more anxious for the next time you have sex and it just keeps going and going and going so one is yes 24y olds it's very uncommon to be dealing with Organic Ed but interestingly when they've looked at men under 40 87% of them had a medical issue causing their erectile dysfunction so even if we think it's largely in your head it's really important to go see your primary care doctor to get evaluated because sometimes having issues with erections can be a warning sign of future heart disease or cardiovascular issu issues because blood flow to the penis is going through smaller arteries than the blood flow that goes to the heart so the first time you see issues will be in your penis likely before you see issues with your heart now what can you do let's answer the question right what can you do so first off when you look at people who have issues with psychogenic erectile dysfunction it can be very helpful to see a specialist so see a psychologist who has expertise in this or a sex therapist it can help you sort of deal with your stress and anxiety around the that's very very important now the things that sometimes people can try if you're in a relationship where you're able to communicate with your partner about sex and feel comfortable is to try to take penetration off the table for a short period of time so for the first time you get together with your partner you want to sort of say hey we're just going to like explore each other's ayous zones we're going to feel each other we're going to touch each other we're going to enjoy each other but we're not going to stimulate genitals so that you can start focusing on the feelings and the sensations and then as you start noticing you're comfortable with that you're not thinking about your erection you then start touching genitals and then once you start feeling comfortable touching genitals the next few times then finally you start going back into having sex with your partner the other thing you can do is you can obviously talk to your primary care doctor or urologist about trying a medication to help you now this medication these medications like selenop tadalfil or venil these medications help you make it easier for you to get an erection now you still need stimulation to start or ignite the erection but they will help you maintain it and while you're sort of dealing with all these issues and trying to regain your confidence that you can get an erection and maintain it it can be helpful to use these in a short for a short period of time to help again regain that confidence so these are just a few things but you can check out my full YouTube video on psychogenic erectile dysfunction to learn more about this issue all right second question is actually from one of our supercast members it's it's not worded properly so I'm just going to um summarize it he's questioning if in the adult industry that uh you know if these performers are born with these large penises and he's questioning if that's true so he's thinking that you know are they using some type of enhancement some surgery some herbs some techniques like what what are your thoughts maybe we can just answer from a place of you know what are some of these enhancements that if they are using them what would they be and and you know what questions men may have about enhancements absolutely so one I think it's important to realize that people who choose to be actors in the adult industry choose to do so because they have certain anatomical features right the average penal length is about 5.4 in worldwide and 99.7% of people will have a penis that's smaller than about 7 and2 in so that's just to give you scale of what average is now in terms of these men in pornography in terms of you know their penal length or girth obviously the camera can be used to use certain angles or be closer or to the genitality to make it look and appear larger these men tend to at least to my understanding don't have actual surgeries to enhance the length or grth of their penis while however you can get fillers to enhance girth and you can use traction devices to Maxim length to a small degree which can be helpful in some people they also will often use medications or pharmacologic agents to help them maintain erections for long periods of time so they may use medications like sophy or tadalfil or vhil or they may even use what's called intracavernosal injections where they inject medication into the penis that causes increased blood flow to allow them to have a erection very quickly some men will even have an inflatable penal prosthesis inserted which essentially allows you to have an erection for as long as you so desire now this does not make your penis longer is a treatment for erectile dysfunction but it does have the bonus of allowing you to have an erection last as long as you'd like it to so yes absolutely the adult industry is one selecting people who may be on the end of the Spectrum in terms of larger genitalia they may be using camera tricks to make things appear larger than they are and they may be using pharmacologic enhancements or even genital enhancements to increase width or length or duration of their erection I think the reality is that the adult industry is not indicative of what real sex is like real sex is not what they're showing you they're showing you something that is meant to entertain meant to shock and and meant to get you interested in watching more pornography so it's not necessarily indicative of real sex it should not be used use as surrogate for sex education or as a way to compare yourself to what you're seeing on there because they are not the average human and you've covered some of those videos in the past with traction and some of the vacuum pumps so please do check those out as well um there's a third question I'm going to ask a follow-up question with it since there's it's a topic that gets covered quite a lot in our comments sometimes when I pee real hard the pee splits into two streams what do you think is happening there this is from initials GV but as a follow-up question I I do see comments asking questions about sometimes my p goes to the right it goes to the left it goes all over the place it you know what's what's the deal with that there's a few things that can cause what we call a split or deviated stream right so when men urinate one you have to think about it like a hose so when when you have a hose that has no blockage the flow comes out strong and straight and no problem but the second you put your finger on the hose right the spray goes all over the place so any time there's a blockage in the tube where urine comes out you're going to have a split or or you know deviated stream so what can cause blockages very commonly men who have an enlarged prostate will have some degree of blockage for the urine between when the urine leaves the bladder to outside the body so that can cause a split stream also if you have a narrowing in the Ure now that's less common but certainly we do see it so if you're noticing a weak stream a split stream maybe you're straining to urinate or you're pushing to urinate or you find that it just takes you a long time to start or it stops and starts it's really important to see a urologist to get evaluated because we have really great treatment options to help both of these issues and I've covered BPH many many times on my channel we'll link some of the episodes in the show notes and in the description so you can check them out to learn more about BPH the other thing is that sometimes when you ejaculate you will have a little bit of semen left over in the PBE or in the urethra this can also act as sort of a blockage which then you notice after you ejaculate that first few times you pee you may have a split stream so it's very very common I recommend if everything else is great in life and this is the only thing that Bo bothers you absolutely it's you know still worth seeing a doctor for but you can obviously sit to pee which I know is not as common in the US but places like Germany almost all men sit to pee so it is very common can make it a little easier to manage and overall still maintain a good quality of life if you want to hear the rest of the ask me anything episode make sure to join our premium membership at renam malik. supercast dcom there you can get access to ask me anything to get your question featured on our future episodes and to access AdFree episodes and early access to all our episodes as well as transcripts from the podcast and as always were to take care of yourself because you're worth it

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