madman
Super Moderator
In this episode, Dr. Brandon and Dr. Morgentaler discuss the factors influencing erectile function, including physical and psychological causes, the evolution of understanding erectile dysfunction over time, and how ""hard enough"" is defined by functionality and individual needs.
They also touch on tools and tests used to assess erection quality and the role of performance anxiety.
Chapters:
00:21: Understanding Erectile Dysfunction - The episode introduces erectile dysfunction, its historical terminology, and its impact on men seeking medical advice.
03:19: Physical vs. Psychological Causes - The discussion highlights how physical issues like vascular problems are often misattributed to psychological causes.
05:39: Measuring Erection Hardness - Different methods for assessing erection firmness, including questionnaires and physical models, are explored.
09:22: Diagnostic Tools and Techniques - Advanced tools like nocturnal penile tumescence devices are explained for evaluating sleep-related erections.
18:21: Case Studies and Real-Life Examples - Real-life scenarios illustrate variability in erection firmness and the complexities of treating erectile issues.
Transcript: "How Hard Is Hard Enough?"
[Opening Segment: Introducing the Sex Doctors]
Dr. Abraham Morganteller: Hi, I’m Dr. Abraham Morganteller, and I’m here with my… lovely, beautiful, and talented wife.
Dr. Maryann Brandon: [Laughs] Hi, I’m Dr. Maryann Brandon.
Dr. Morganteller: And we are The Sex Doctors.
Today, I thought we’d dive into a topic I’ve worked on extensively: how men wonder if they’re "hard enough." As a urologist specializing in sexual medicine, one of the most common issues I’ve encountered is erectile dysfunction—or as we used to call it, impotence.
[Understanding Erectile Dysfunction: Physical vs. Psychological Causes]
Dr. Morganteller: Most men who come in already know there’s an issue—things aren’t working well. However, we need to determine if it’s primarily a physical problem or a psychological one.
Dr. Brandon: Right. For example, some men can have sex with one partner but not another or can masturbate but not perform with a partner. Anxiety often plays a big role because arousal is nearly impossible when someone is overly anxious.
Dr. Morganteller: Exactly. Before we go further, a quick disclaimer: The Sex Doctor Podcast isn’t a substitute for medical or psychological advice.
[Podcast Intro Jingle]
Welcome to The Sex Doctors, featuring Dr. Maryann Brandon, clinical psychologist and certified sex therapist, and Dr. Abraham Morganteller, renowned urologist and sexual health expert. Together, they provide expert insights into sex, intimacy, and relationships. Let’s dive in.
[Dr. Morganteller’s Early Career: The Misunderstood Origins of Erectile Dysfunction]
Dr. Morganteller: When I started in 1988, erectile dysfunction (ED) was often seen as a psychological issue. My first clinic had to be run in conjunction with psychiatry because of the belief—rooted in Masters and Johnson’s research—that most cases were mental rather than physical.
But they missed something crucial: about 80% of ED cases are physical. The problem is usually vascular—blood flow to the penis is insufficient, or the blood doesn’t stay trapped in the erectile tissue. Smoking, age, diabetes, and other factors all contribute to this.
Dr. Brandon: Men with what’s called “venous leak” may achieve an erection but struggle to maintain it, which we refer to as difficulty maintaining an erection.
[The Influence of Porn and Unrealistic Expectations]
Dr. Morganteller: Younger men often have unrealistic expectations, influenced by porn. They compare themselves to performers who last for hours and begin to worry they don’t measure up in terms of size or firmness.
Dr. Brandon: So, how hard does a penis need to be?
Dr. Morganteller: It simply needs to be firm enough to do the job. If the goal is penetrative sex—whether vaginal or anal—the penis needs a certain rigidity to withstand bending forces. But the level of firmness varies naturally with age, and what’s normal at 20 will differ from what’s normal at 60.
[Measuring Rigidity: Tests and Tools]
Dr. Brandon: I remember in training, they used something called the “postage stamp test.” Men would wrap postage stamps around their penis before bed, and if the seal broke overnight, it suggested they had nocturnal erections and that the issue might be psychological.
Dr. Morganteller: We used a more advanced version called the nocturnal penile tumescence test. A device measures the firmness of erections during sleep by applying gentle pressure. If nocturnal erections are normal, the issue is likely psychological.
Dr. Brandon: That’s fascinating.
Dr. Morganteller: In my clinic, we also used the “Pillars of Hardness”—a display of rods with varying firmness levels. Men could touch the rods and identify which matched their own rigidity, helping us better understand their condition.
[Performance Anxiety and Societal Pressures]
Dr. Brandon: Performance anxiety is a big challenge for men. Society places immense pressure on them to perform. If we required women to be aroused immediately and maintain that arousal until their partner was satisfied, it would throw us into a tizzy. Yet, we expect that of men.
Dr. Morganteller: Exactly. The irony is that the more men try to “force” an erection, the harder it becomes. It’s one of the few bodily functions that worsen under pressure.
[The Role of Sleep Erections and Viagra]
Dr. Morganteller: During sleep, men experience erections associated with REM sleep. These nocturnal erections help maintain penile health by replenishing tissues with oxygen-rich blood.
Devices that track these sleep erections provide valuable insights. If a man’s sleep erections are normal, it reassures him—and often alleviates performance anxiety.
Dr. Brandon: And that sense of reassurance can make all the difference.
Dr. Morganteller: It’s worth noting that as men age, erections can become less firm. A 20-year-old’s erection is different from a 60-year-old’s, and that’s normal. Viagra and other treatments have been game-changers, but the key remains focusing on what works for each individual.
[Final Thoughts: Defining "Hard Enough"]
Dr. Morganteller: So, how hard is “hard enough”? It depends on what you want to do. For some, it’s about penetration; for others, intimacy doesn’t involve penetration at all.
Dr. Brandon: Ultimately, the magic of sex isn’t about rigidity—it’s about the connection between partners.
[Closing Remarks]
Thank you for listening to The Sex Doctors with Dr. Maryann Brandon and Dr. Abraham Morganteller. Be sure to subscribe, leave a review, and join us next time for more expert advice on sexual health and relationships.
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