Let's Talk about Erectile Dysfunction…

On this week's episode of the Lunch and Learn with Dr. Berry we have Dr. Jennifer Miles-Thomas, she is a Diplomate of the American Board of Urology and is also board certified in Female Pelvic Medicine and Reconstructive Surgery. As we continue the push the message and focus on men's health I wouldn't be truthful to the audience if I didn't stress the importance of sexual health.

I talked about this before but as an outpatient clinical specialist, one of the top 2 reasons why men would come to see me for an appointment was either someone was dragging them to the office or erectile dysfunction complaints.

Sexual health refers to a state of well-being that lets a man fully participate in and enjoy sexual activity and there is a range of physical, psychological, interpersonal, and social factors that influence a man's sexual health. I talked about this before but as an outpatient clinical specialist, one of the top 2 reasons why men would come to see me for an appointment was either someone was dragging them to the office or erectile dysfunction complaints.

Dr. Jenn walks us through her decision to become a urologist, one of few African American women to hold the title, and we get into the importance of sexual health, opening up about erectile dysfunction and all of the different treatment options associated with the disease.

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Links/Resources:

• Dr. Jennifer Website
• Dr. Jenn's IG
• Urology Care Foundation
• Mayo Clinic Foundation
• American Urological Association

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Download Episode 113 Transcript

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Introduction

Dr. Berry:
And welcome to another episode of the Lunch and Learn with Dr. Berry. Dr. Berry Pierre, your favorite Board Certified Internist. Founder of drberrypierre.com, as well as the CEO of Pierre Medical Consulting, which helps you empower yourself for better health with the number one podcast for patient advocacy. And this week we have a doozy, of course, this is men's health month. And I thought, no other topic, right? If I had to choose one topic that really hit home and hammer home when we talk about men and ways that we can work on getting them to see the doctor more, know the topic shot to the top of my mind as well as my read my mind than sexual health. And today we're going to be talking about those big two letters, ED – erectile dysfunction. And I thought it get, you know what, I do have some experience taking care of patients with ED, but who better to really educate the community and really expand the knowledge base of the Lunch and Learn community than urologists.

And I was very fortunate for this urologist coming on the show, this is Dr. Jennifer Miles-Thomas. She earned her medical degree from Northwestern University school of medicine. She cleared her undergrad degree in biology at Virginia Commonwealth University. She did a general surgery internship at John Hopkins and completed a urology residency as well as a separate fellowship and female urology and neurology at the James Buchanan Brady Urological Institute. Dr. Jenn Miles-Thomas is a diplomat of the American Board of Urology and she is also a board certified and female pelvic medicine and reconstructive surgery. So again, I know that may seem like a mouthful, but you know, short and sweet Dr. Jenn is absolutely amazing and she is crazy smart, right? If you had to think about what does all that mean? That's probably just me as those who send in this podcast. She is absolutely brilliant and we're in for a treat.

And I could tell you during this interview if I wish you could see some of my facial expressions that I was making during the time when she was really explaining and educating me through Lunch and Learn community members. The different ways and treatment modalities associated with erectile dysfunction. So you guys are in for a treat. Remember like always, if you have not had a chance, go ahead and subscribe to the podcast, leave a five-star review and comment for the podcast as well as make sure you tell a friend, tell a friend, tell a friend to just share podcasts. Especially because I know someone has someone in a family member, especially male, right? Who has not seen a doctor in years. And I hate to say that you're partly to blame, but if someone's not seeing the doctor in years and years, seeing the doctor regularly, that's something that we, we need to address ASAP.

If someone is not going to a doctor, especially in male, right? And you're also not going to the doctor, is going to be very difficult for you to try to convince that man that he needs to go see a physician as well. So please take the time to listen, again, we're talking about sexual health, we talk about few things as well, especially associated with Dr. Jenn as far as what she does on the size, especially from a business standpoint. You guys are gonna want to stick around for that. So again, leave her five-star review. Let me know how you feel. And again, thank you for all that you do. You guys have a great and blessed day and let's get ready for another amazing episode here on the Lunch and Learn with Dr. Berry.

Episode

Dr. Berry:
Alright, Lunch and Learn community again you just heard this amazing introduction from an expert that I definitely think is needed, right? Especially in this month of men's health month. And I have always joked in the past, but I really, I kind of say half-jokingly, a lot of times when I get men to come in my office to see me on an outpatient visit, right? This was this field, right? It was one of the main reasons why they would come, right? Like there are usually two reasons. One, family member drags him. Two, got some sexual issues, right? And of course, obviously I could talk from an internist standpoint, but I figured, you know, let's get an expert to come in and help educate us and you know, kind of get us mindset ready for the month and really show us, you know, why this is such an important topic, right? Even though we kind of say jokingly, right? This is actually an extremely important topic for men, right? Because again, like I said, it is one of the main reasons why I would get him to come see me in my office, right? So again, first of all, thank you for joining the Lunch and Learn community.

Dr. Jenn:
Oh, you're so welcome. Thank you for having me.

Dr. Berry:
So, Dr. Jenn, I told them about your amazing bio and just give the audience just, you know, let's say for some reason they skipped the introduction and they want to know, like, who's the person on the podcast this week? Right? Like, tell us something that may not be in your bio. And it says like, hey, you know, this is why I'm who I am.

Dr. Jenn:
I live in a very interesting life. I am a urologist who is a female, who is African American. So there's only really a few of us across the country. (Yeah. That is so true.) Yeah. What else is interesting? I'm married with three children, so that's a little bit different. Sometimes it's hard to balance a high powered, stressful career and a family. And I've recently gotten into extreme sports, so I've been snowboarding and I just finished a triathlon this past weekend, so I'm kind of all out there.

Dr. Berry:
Oh Wow. That's okay, alright. I love it. Okay. That's how you started the show, right? This type of show about to go on. Right? (Exactly.) So Lunch and Learn community, we talked, you know, if you caught the most recent episode, if you caught the live streams, you know that June is men's health month and you know that I have made it a point to try to call out my male listeners and my male friends and family members to really stress the importance of health awareness and why we're dedicating a whole month for that? Cause that's always the big issue, right? Like why am I getting home on this specific topic? And why is men's health month so important? Because really it's killing us. Right? And I've talked about it before.

The top 10 leading causes in the world, men dominate those categories, right? Why? Because, you know, we're just not taking care of ourselves. So I wanted to get on Jenn to, again, in urology. And like I say, I don't know if you realize it like, especially when you think about urology is usually not one way you think about. But female urologist, right? So just the how like that subcategory namely African-American is, you know, this is a gem that was actually, you know, we're finding here to be able to kind of talk to her, which I'm definitely excited for. So Dr. Jenn, if you would just kind of give the Lunch and Learn little bit introduction on, you know what actually is the urology? Just so you can kind of get in the same mental ballpark of where we're at.

Dr. Jenn:
Yeah. So it's interesting. So a urologist is a specialist who also a surgeon who works with the organs of the genital-urinary tract. So in English, what does that mean? That means it's a doctor. I know. So that means I’m a doctor who deals with problems of the kidney, the bladder, the testicles, the prostate, the penis, in men and women. So sometimes it's medical therapy and sometimes it's surgery. We do both. But those are the organs we take care of.

Dr. Berry:
It is really kind of interesting. I'm an internist. For those for some reason is the first time catching a show, I'm an internist so I practice in the hospital. But what made you say, you know, urology is the field for me?

Dr. Jenn:
So the real story is I thought I was going to be like the female version of Ben Carson. So I was going into med school, but I do neurosurgery, right? But sometimes that's very hard and I'm a big quality of life person and sometimes there are things you just can't fix. And after a couple of cases that were out of everyone's control emotionally, I didn't know if I could do that every day. Sometimes you'll see a 30-year-old who has a bleed and they'll never be the same and some things you can fix them some things you can't. And I said, well, I know I really want to focus on the quality of life. So one of my friends, of course, who's male was said, hey, you should do urology. And I was like, Oh yeah, that's a bunch of old men. Like, why would I wanna do urology?

This is real talk. Okay, why would I want to do that? Right. So I did a rotation like we do in medical school, and every time I went into the room, the wives would be, are you going into urology? Let me tell you about my problem. And I was like, well, what's going on here? Like why are these people asking me? And I didn't know at the time that there weren't very many female urologists. So probably when I started they were probably less than 5% in the country. Now it's like seven and a half percent. But I mean, I've been out for more than a decade. Yeah. There are not that many female urologists. There are quite a few residents who are coming through.

The classes are more 50-50 which is great. But still, I mean there was definitely a need. So I decided to go into it and I love it. I would never do anything different. This is who I am and what I needed to go into. Because urology, it's one of those fields where it's very technical, it's very surgical. But what you're talking about on a daily basis is what people don't want to talk about. It's what they're afraid to mention. They don't tell other people, they don't even tell their wives or their husbands really what's going on and you're able to give them back that quality of life. So for me, every day it's a gift.

Dr. Berry:
I’m glad that you touched on that way because I can tell you I've had plenty appointments where the guy comes in for a very vague reason and you know right when I'm about to try to get out there and say “doc, doc before you leave”. Once I know I get one of those, hey doc before you leave, I already know exactly the direction go. It's so taboo that even when they come to see, you know, their regular outpatient clinical doctor for your checkup, it's very tough for them to even come out and say it, which is mind-boggling. Right? Because you would think like, hey no, that issue. If I'm having problems with that area, right? Like I want to make sure like that's the first thing I'm putting down on paper. (Yes.) Nope. They'll say, no, I had a cold and that's why I'm here. I definitely, and I love that you get that even on both friends. Right? Because I would figure it with women, it'd be a little bit more open. So I interested to hear that. Even on both sides, some people are very secretive on, you know, letting them know like these are some of the problems I'm dealing with.

Dr. Jenn:
Exactly. And I think it's a little bit different because in my world I just directly ask. So it's not that you have to wait and say, okay, as I'm walking in the door and kind of build up the courage, I'm just going to ask you how your erections are, how many times you get up at night, how are your erections? It's just regular, you know, it's a Tuesday. Why not?

Dr. Berry:
I love it. That's okay. That's fine. Okay, we like that way. Direct, no sugarcoating. This is why I'm here for it. Clearly, this is why you see me now. Now especially for urologic standpoint is that a lot of the different reasons why someone may come to see you just, I obviously we're talking about sexual health. I like this is what are somebody like the common issues and complaints and that you may see it as like, oh, I'm coming to see you for this.

Dr. Jenn:
Sure. So it's not just erectile dysfunction. A lot of times we'll see people for kidney stones, we'll see people for kidney tumors or bladder cancer, a lot of prostate cancer. Sometimes people will just have blood in their urine or bladder infections or they'll have like testicular pain or especially for women incontinence or leaking during the day and having to wear pads. So we see people for a variety of reasons.

Dr. Berry:
And obviously, has definitely, something that from your logical standpoint, I think it's a very interesting, right? Because a lot of times I think when we think of surgical specialties, we tend to think that they all they do with surgery. Right? And very interesting to understand like, no, there's a lot of clinical and you know, even psychosocial if I would like to stretch it issues kind of centered around some of the stuff that people are coming to see you for.

Dr. Jenn:
Exactly. Urology has one of those fields where you can operate and do very large major cases. You can do a lot of bread and butter, common cases. And then as you get older and closer to retirement, there are many things you can just do in the office. So it's one of those professions where you can do it throughout your career.

Dr. Berry:
Obviously, we wanna, you know, we’ll hit home because this is definitely, you know, the reason why someone's listening to at least this week's episode. Right. So let's talk about sexual health, right? And I know we alluded to it, but like how important is it, right? Especially from the men and women with obviously is men's health month, we'll give them a shy, we'll definitely bring you on. We need to talk about the women because I definitely don't want to make sure you eat them out. (Okay.) In that regards. But especially for men, like I like how important is sexual health for them, right? Like what is some of the like, oh, before I came to see you this house for a little bit after you take care of me. Like this is how I'm building now.

Dr. Jenn:
So regardless of what's on the news where people say sexual health is very, very important. Why? Because it's part of you. I mean, we're all animals. We all have the same instincts and when something doesn't work or it's change, how do you feel about yourself, you don't feel the same. So it's not that people fall into depression, but they just, they've lost a part of their life, a part of their relationship that was very, very important to them. This is psychological. This is physical. A lot of times with sexual dysfunction, there may be other things medically going on at the same time. So sometimes it's like the red flag of, Hey, where else do we need to look? What else could be going on at the same time? So I'd say this is very important and I think people realize it's important, but there's such a taboo about talking about it. I mean, of course, our popular media has changed and sex is a lot more out there. But when people are talking about their own personal sexuality and health, it's still taboo.

Dr. Berry:
Do you find the conversation a little bit more difficult because you are a female urologist when you're in your office or is it by the time they come they see you like they've already kind of cleared that hurdle?

Dr. Jenn:
So it's funny. So I would say that it's generational. So the Millennials, they don't care. They just want their stuff fixed regardless. Any boundaries whatsoever, everything will tell me what they did, how they did it and what they want to do in the future. They don't really have an issue. The kind of middle age, I would say like 30 to 60 takes a few minutes just for going to comfortable. But then they realized my personality is like, Hey, this is, this is just what we do and we're going to just say it and I'm going to ask you questions and we're going to help fix the problem. They get very comfortable. Over 65 or 70 sometimes it takes them a little while because first of all, they're from a generation where they didn't really talk about sex the same way that current generations do, and sometimes they never were really educated about their body or what was normal, what's not normal, what things should look like, what they should feel like, what are other signs? So after probably one or two sessions, then, oh, they open up about everything and sometimes they'll bring their wives. So we all can have the same discussion and figure out what's going on and how we could help.

Dr. Berry:
Okay, alright. Let’s make it a group appointment.

Dr. Jenn:
Yep. I have quite a few group appointments. It's okay.

Dr. Berry:
So speaking of a normal, what's not normal, right? Let talk about, you know, EB – erectile dysfunction, right? For Lunch and Learn community who may have been living under a rock and you know, we haven't seen one of those thousand commercials. Right? What is it exactly?

Dr. Jenn:
Okay. So the technical definition of ED or erectile dysfunction is, it's the ability to attain or maintain a penile erection sufficient for satisfactory sexual performance. So what does that mean? That means if you have difficulty either getting or keeping an erection that's good enough for you is what ED is. (Very subjective.) It is. So some people have don't have erections but don't care well, you know, that's perfectly fine. Other people, it takes them a little bit longer to ejaculate or they ejaculate too early and that's fine for them and that's fine. But anywhere in the middle, it's all based upon your own personal satisfaction.

Dr. Berry:
It was interesting. Do you tend to find common reasons for why that may occur? Is there a couple of things I get they, everyone who follows in this category always seems to have ED or what does someone have some of the causes that you've seen kind of work that are associated with ED?

Dr. Jenn:
Well, the biggest cause, especially in America is diabetes. (Okay. Alright.) Yeah. So diabetes, like I kind of explained it to people. Well you know what as it affects the small blood vessels and the small nerves and it's kind of interesting because if you relate it back and you say, you know how sometimes your fingertips will tangle or your toes will tangle or they're a go numb and you don't feel them.

That's because those little small blood vessels of the small nerves aren't getting what they need because the sugar control is out of control and it's damaging. The same thing with your penis. It basically has really small nerves and sometimes if things aren't going to work it's because your blood sugars have been too high. So you really have to work on getting your blood sugars under control in order to get back some of this function. And when you kind of make it like that analogy, it makes sense. It's something tiny and small and diabetes affects the tiny small blood vessels.

Dr. Berry:
I love that, especially cause I know for Lunch and Learn community members like we've talked about diabetes and we've talked about all of the effects of diabetes. I even wrote a blog where I said I don't even wish diabetes on my worst enemy just because of all of the different things it's associated with. So now we know, you know, especially for as again, if you're diabetic and you're just blowing it off as just a sugar disease, now you can see, especially from a man, right? Cause we're talking to them in this men month, right? This is another reason why you should take care of yourself. Right? Because you don't want to have ED, you don't want ED to take care of your diabetes. So that's, okay. I love it.

Dr. Jenn:
Exactly. Now, other things we have to think about too, we’re learning and associating a lot more with heart disease. Because again, it's the small blood vessels that are feeding the penis. So if someone has early onset erectile dysfunction, like their thirties and forties we're also working with cardiologists to screen them and to make sure that they don't have plaques or cardiovascular disease because the small blood vessels are usually affected first.

Dr. Berry:
Now is that something that comes up just while you're asking a lot of your questions, like, hey, do you have this, do you have that? Do you have this? And then it you just kind of seeing this correlation kind of growing?

Dr. Jenn:
Yes, definitely. So of course when you're seeing a patient and you have their medical lists, do you know what medications they're on? You know their past medical history, but if someone who's never been in the system, and it's just coming to you for this, this is what we screen for. If you look at the major academic centers, most of them have men health clinics and it's usually an internist or urologist as well as a cardiologist because we're finding that these overall health syndromes, metabolic syndromes are being diagnosed with people first seeking care for erectile dysfunction.

Dr. Berry:
Wow. Okay. Alright. So again, if you're listening, if you're paying attention, especially for, let's say you have a family member or friend who you know, is suffering from some of these other diseases and it's very difficult to get them to come to the doctor, right? This now you have another weight in, right? You don't want to, hey, you know, you'll take your blood pressure. This can also happen, right? Cause again, usually two reasons. Usually, a family member is forcing them to come to the doctor's office or they got some sexual issues, right? So again, this is another way that we can kind of like start pushing them in back into the doctor's office and getting them right. Again, they're aware of just everything that's kind of going on. Thank you. Thank you for that. (No problem.) So when they come to you and you know what you do your screening and they're checking all the boxes off for ED. Of course, I'm pretty sure by the time they've seen those thousands of commercials. Right? But what are some of the treatment options that are out there? One, what we'll talk about the common ones, the one that they may not even know about?

Dr. Jenn:
Yes. First of all, of course, I have to say this disclaimer and this warning, everything that you see on TV or can order on the Internet isn't safe for you. (Yes. And then the gas station.) The gas station attendant does not know more than your doctor about your erectile dysfunction. That's all I got to say. But honestly, the FDA did a recent crackdown and urologist across the country got a notification. Some of these medications, I wouldn't say medications in quotes that are available over the internet that thought excellent results in work actually have controlled medications and them like generics and Viagra and Cialis and things like that. And so we get updates and kind of the names of over the counter medications that we need to look out and screen our patients for because yes, everyone knows the names of these brand new medications, but honestly, they're expensive.
So people try to find other things that will work instead. But unfortunately, things that aren't controlled by the FDA or go through a rigorous screening process, things that are like natural types of products sometimes aren't always in your best interest to use because they do have active ingredients from drugs that are controlled and there are always potential side effects. You don't really know what you're taking. So I just want to put that warning out there. But the first day and for treatment option is to kind of divide and see what's your actual issue is. So I get the question all the time. Is it my testosterone? Do I need testosterone? (Yes. Let’s talk about that.) Allow me to tell you about testosterone. Testosterone is important for men. So it's actually made by your testicles. So a signal from your brain goes down to your testicles and says, hey, we need more testosterone floating in your bloodstream.

When you have normal levels of testosterone, you have a libido. And what's libido? Libido is the desire to have sex or to engage in like sexual activity. Now if you give someone testosterone, you will increase their libido. But that does not mean that they'll get an erection. So you have, when you come in and say, I have erectile dysfunction, can I have testosterone? If your testosterone is low, just know that you may have a libido, but that doesn't always mean that your erection will change. Okay. So what do we do for actual erections? Well, the way I practice, we always go from least invasive to most invasive. I first want to make sure there's nothing medically wrong like there is not a tumor or something else that we can see what's going on that may be causing a problem. But if there's not in the first thing we can try as oral medication, and it's the ones that we know in medical lingo, we call them PDE five inhibitors.

And basically what happens is when you get an erection, your brain puts out a signal and the nerves basically send and this transmitter that says, hey, I need blood flow in. And as the cylinders fill in the penis, it cuts off the vein. So you don't draw that blood back out. So your penis just fills and then it stays that way until your brain says, oh, I'm done. And then it stops feeling and it slowly gets smaller as the blood drains back out. So that's actually how an erection work. Now the other thing that's important is an erection is different than orgasm or ejaculation. They are controlled by different nerves. So one set of nerves gives you the erection. The other set of nerves allows you to ejaculate during an orgasm. (So actually problems in different sections.) Exactly. (Okay.) And also you can have an orgasm without having an erection. So that's why we have like a real conversation when we have these things. Because I mean, how would you know that unless you actually asked? It's not like you can just Google it, right? Probably can, but I haven't tried to. It's best if you actually just talked to someone.

Dr. Berry:
Lunch and Learn community, please talk personal. No Google.

Dr. Jenn:
So after the medications, there are other things you can do too. So a lot of people know about the medications, some of them are more expensive. But the good news is a lot of generics are now in the market. So yes, there are much more affordable. But let's say you try to medications and they don't work or you don't feel good or right when you're taking them or they don't work well enough. The next one, there's actually a little insert, it looks like a little tablet that you can put at the tip of your penis and it has medication that causes the blood to flow into your penis. That's an option. (Oh Wow. Okay.) There is also an injection. So you know how there are when people have diabetes, there are these little pens that you can inject the insulin. Well, there's a little kind of a little injection that you can inject on the side of your penis and also we'll put medication directly into your penis and cause you to have an erection.

Dr. Berry:
So let me stop you there. Right? (Okay, good.) When I had my diabetic patients, they're not get drilled and I gotta have that discussion where I'm saying, hey, you know what, the pills not working no more. You have to start injecting yourself and I know the face and the fight against once I have to go that right, like how does that conversation when you're telling the person like, hey those bills aren't the thing for you. We got to start injecting yourself and only if you had to start injecting directly in your penis. Right? Like what is that conversation like in the office?

Dr. Jenn:
So I get the same response kind of wide eyes like oh that's not going to happen. And then the next question is does it work? And when I say yes it works and people are very happy that can do it, they set out at least try it. Now we don't just send somebody home with the needle to stick in their penis. Like that's not what we do. We actually have nurses. So you come in for an appointment and we have to dose the medication because we want you to be able to get an erection. But we don't want you to have it all day, right? So we have to make sure you get the right dose of medication. So we actually have, it's called ICI, we actually have nurses who would just come see you as an appointment, we'd give you a test dose, we'd make sure you get an adequate erection, and then we also make sure it goes down and usually we have your partner there with you because sometimes people mentally can't do it and sometimes their partners are able to do it for them. Or once they see it they say, oh, it's not as big of a deal as I thought it was going to be. It doesn't hurt as much. I had never even heard that I could do that. So it was a little bit weird. But then once you do it and then you get a great erection and it works, people are happy.

Dr. Berry:
Okay. Now is there, especially, I'm tripping on this injection thing. Is there something like an office right that reverses it or is it just kind of like supposed to go down on its own over time?

Dr. Jenn:
So it's supposed to go down on its own over time because the medications aren't long acting. They're shorter acting. (Okay.) That's why we do the first trials in the office because if it doesn't go down then we give you medication to make it go down. Now there's also another option that you can have and it's called a vacuum erection device and what it looks like kind of, look at him.

Dr. Berry:
Lunch and Learn community you could see my face right now. I am learning just as long as relating, I'm like, okay. Alright. Again, I’m an internist, by this time, I'm referring them to the urologist. I don't. Okay, so now I'm processing right with you.

Dr. Jenn:
Okay. So if vacuum erection device looks like a little cylinder, and what it does is at one end of the cylinder near the base of the penis, it has like a little, I don't know, think of it as like a little rubber band and you can basically like squeezed a little cylinder. And what happens is it's a vacuum, so it draws blood into your penis and then you roll down the little kind of rubber band on it and that rubber band prevents the blood from flowing back into your body. (Okay.) So this is something that's, it's a little bit less spontaneous, but still, there are no needles, there's no medication.

That's something natural and you can do it on your own and it does work. All the vacuum erection device. And then if none of that works, there are penile prostheses. So a prosthetic is a device that we surgically put inside of your penis. And usually what we do is we have a little pump that looks like a little squeeze pump that we put next to your testicles and all you have to do is squeeze that pump and then your penis would pump up because we actually have a reservoir with like saline or water in it that fills those little tubes. So if nothing else works, that's a guaranteed way to get an erection.

Dr. Berry:
Now is the stepwise approach for this patient, right? Is that the end? I'm like, this didn't work, this didn't work, this didn't work. Alright, let's go to the prostheses. Or is it kind of patient dependent when you're kind of deciding like, all right, which route we're gonna go end up mean?

Dr. Jenn:
So typically it step-by-step, but it's patient driven. So if I see a 30-year-old who's never tried a drug, we're gonna, I'm gonna let them know that there is the option for prosthesis, but that's not what's recommended. So you try to do minimal to get the benefit. And then if you fail or you're not willing to do it, you can move on. But a penile prosthesis, that's the end. That's what we have to offer. It does work, but you can't go back. So once you have the surgery that means that the medications won't work. Injections won't work. You have the surgery. So that's why it's the last thing that we do.

Dr. Berry:
You mentioned 30-year-old because that gives pressure someone to my own community. It was like 30 because I know they're probably thinking this is a quote-unquote old man's disease. What some of the age ranges that you're seeing with patients with erectile dysfunction that even someone in Lunch and Learn community might be surprised by like, oh my God, they're that old dealing with this problem?

Dr. Jenn:
Yeah. So from young in the thirties, twenties and thirties sometimes I've seen college kids who everything was fine and now situationally with the new girlfriend or whoever, I'm just not able to get an erection and we kind of work through what's going on because remember, this is all controlled by the brain. There's something going on in the brain that's prohibiting it from making that message to get an erection and there are actual sexual therapists. These aren't like woo on TV people. These are real people who say, okay, let's break it down.

What's actually going on in your life that is causing you to feel this way, is causing your brain not to secrete the right neurotransmitters for you to actually have an erection. And it does help. I've seen people who couldn't ejaculate, couldn't have orgasms. They meet with these therapists and they're like, my eyes were opened and things are all good now and it's real. And you just never thought you'd be talking about your sex life with someone, but you know what? It's quality of life. Either you can stay the way that you are or you can get it fixed and since there are people available to fix it, that's what you do and you move on. And you keep doing live in life.

Dr. Berry:
Exactly. Oh, I love it and tell you I'm loving this conversation guys. I wish you get to see my face during some of the parts so you can understand. It's a learning process for it all. And it's real because these are real-life conversations that we're having on a day to day basis. Again, if you have to scare, some of your friends or family members to get it into the doctor's office, to get this taken care of, please do so. Right? Cause it, it, it needs to be done because this isn't something that, again, I know you see that thousands of commercials and I know we're going to ask Dr. Jenn where should someone go look, right? Cause I know where it, we're saying don't go to doctor Google. Right? We already know, Lunch and Learn community members you all googling when I tell you don't Google, you're going to Google anyway. Even when I tell you don't go to YouTube and watch that surgery beforehand, you're going to do it. They were like, we just know how you all do now. Is there any viable sources that you will say like, hey, if you got to like read up on this subject, like read this website, like is there anywhere that you would point on to?

Dr. Jenn:
Yeah. So for urologists across the US we have, it's called the urology care foundation. So it's ways to educate patients on urologic conditions. So it's the legitimate source of information. It's not a company trying to sell you anything, it's just the real deal of this is what you need to do and it's written in plain, straight forward English and that would be urologyhealth.org. So Urology is U R O L O G Y health dot org. The other sites that are good and give straightforward information would be mayoclinic.org or webmd.com. Those are actually good, straightforward information and someone who wants a little bit more detail and are like, okay, I've read all that. It's kind of generic but I want more detail. Our Actual Association for Urologist has a great website too for under education and it'll show you what all the guidelines are.

So like if you're hearing this from one person, you're not sure, you can actually see what the published guidelines are and every few years, every like four or five years, we all get together and we revise them and say, this is what the data shows us, this is what standard of care is, this is what you should be offering, this is what you need to think about. And that is auanet.org and that's for the urology association and that's the standard of care. So those are ones that are just straightforward. You can get the real deal information with no bias and understand why this has happened.

Dr. Berry:
And Lunch and Learn community members, just like always, all of these links, especially if you're driving, you're at work, wherever you're at listening to this, all these things will be in the show notes. So you know, I definitely want to make sure we're pointing you in the right direction. Because it's important to hear it because I know you guys, you guys are gonna want to follow up to make sure we not talking crazy. So we've got to point you to the right direction to make sure that doesn't occur as well. So again, I've done thank you for that, right. Because this is again, this has been very eye-opening, mind-blowing experience. I'm learning, I'm out to go to the website right when we're done, just don't make sure I can educate my patients, and of itself with such an important topic at hand, this is a portion of the podcast that I love, right?

Because you know, I bring a guest on to really educate our community. But I'm just kinda selfish, right? Cause I also bring them on, right? Cause I really want to promote them right. And you know, say what, how to cause most of the people I kind of see and follow them. I'm shadow following them one way or the other. So I like to see people who are sending out doing some stuff, right? Like, and whether it's medicine, not medicine, doing some stuff is always something that I love to see out of our physicians. So this I like to call it, it's like our promo, our promo appeared. Right? Dr. Jenn, obviously we know you're amazing urologists. Is there anything that you do that someone in Lunch and Learn community may be able to benefit from or any books or whatever? This is your time, right? You tell us what you got going on and anything going on and let us know how we can continue to support you.

Dr. Jenn:
Well, I told you I'm a big quality of life person, right? So a lot of times what I see, especially with patients in medicine, is that a lot of times people don't search for answers because of money. Medicine is getting more and more expensive and the way that the insurance companies are moving, they're pushing more and more of that onto the patients. I don't think that's going to change anytime soon. Those insurance companies are really the wealthiest ones in the game. So they're going to determine what we do, (keep that money to themselves.) Exactly. Exactly. So what I do is I actually talk about money. I talk about money on Instagram and online too, and kind of help people figure out how to get a debt, how to build wealth, and how did it get their stuff together. Because if that's one less thing you have to worry about, think about your overall mental health.

If you're no longer stressed about having to pay bills if you're no longer stressed about, how am I going to rob Peter to pay Paul, things like that. I think I'm just a person who has a lot of tough conversations and sex and money are the two things that people don't want to talk about in public. (I love it.) So that's what I talk about for sure. So on Instagram now, it was kind of embarrassing because I do put some of my personal life out there on Instagram. So on Instagram, I'm doctor, which is Dr. Jenn, J. E. N. N. M. D. That's probably the easiest place to kind of follow me and kind of see what I do. I put some of the pictures of me out and about doing some of my extreme sports on there too.

Dr. Berry:
Then that's what I want to go see doing extreme sports. I want to see that.

Dr. Jenn:
Yeah, well the snowboarding was interesting. I only did the before picture. Right. So it's all good. But yeah, that'd be the best way to follow me and my links to my website. It's drjennmd.com. All that stuff is on Instagram too, so you can kind of get a little picture of my life and how I really role.

Dr. Berry:
I love it. So we need to talk to Dr. Jenn. Get our messages together and get our sexual health together. Get our money together. Let's get all that. Right? And it’s 2019. We're halfway through the year. Definitely no time like the present especially for a men's health month and making sure we are getting all of our ducks in line, especially when it comes to sexual health and the importance of sexual health and the massive education lesson that we got today. Definitely thankful for Dr. Jenn. Thank you.

Dr. Jenn:
Oh, you're so welcome. You're so very welcome.

Dr. Berry:
Yes. So before I leave, how I was like answer this question. How is what you're doing helping to empower men especially when we talk about sexual health? What are you doing to really empower this and get them to make sure that they’ve taken better care to sexual health?

Dr. Jenn:
I'm asking the questions and I'm educating them because as we know, knowledge is power. If you don't know, you'll get left behind. There are a lot of people out there that have resources that are getting things fixed and done. There's a lot of small little things you can do to change your overall quality of life, but if you don't know what to ask or don't know something is available, you're going to miss out. So I think my role is really to ask those hard questions and educate my patients. People I see, people I come in contact with, that's what my role is to educate.

Dr. Berry:
I love it. And for those who may know, again Dr. Jenn obviously being a urologist, being African American and female, obviously there's you know, proponent of women's health that really goes into a lot of care to and of course, and I kind of pick and hold there on this episode, really talk about the men, but she will be, I'm going to beg her, we'll be coming back, right? Because I definitely wanted to hear about a lot of the women's health-related amongst sexual health and all the urological problems that I know they got. Right. Why? Because trust me, if you think I'm referring fast when it comes to men talking about sexual health and all the things you best believe once my women patients say like, hey Dr. Pierre, like this is happening. I'm having problems urinating. Anything that goes on in that area, is okay, alright. There you go. So we'll definitely make sure she comes on to really educate us on woman side as well too. So again Dr. Jenn, thank you for really taking the time out to educate Lunch and Learn community. I know this extremely informal cause I'm still like, okay, I'm still thinking about the pump. I was still thinking about it. And you have a great day. Thank you.

Dr. Jenn:
Alright. Thank you so much.

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