Hard Conversations

This week, Tim talks to Barry McCarthy, a giant in the field of sex therapy. Dr. McCarthy is a marital and sex therapist, and a tenured professor of psychology at American University. He literally co-wrote the book on erectile issues - "Coping with Erectile Dysfunction" - just one of many books helping men and couples achieve satisfying sex lives. They have a wide-ranging conversation about sexual intimacy, including "good-enough" sex, aging and sexuality, sexual performance, and of course, erectile issues.

Today, Tim interviews Robert Nicholson, founder of edtreatment.info, which covers all aspects of erectile issues including causes, treatments and how to find help. They talk about priapisms, erections before and after prostate cancer, and men's first-hand experiences with penile injections, shockwave therapy, and penile implants. Robert has also collected research on personal struggles with erectile issues, including the impact on partners, and how intimacy - not erections - are what couples really miss.

Today, Tim talks to Dr. Howard Schubiner, a world renowned specialist in psychogenic pain (pain with a psychological rather than physical origin). Dr. Schubiner explains how the brain can create pain without a corresponding physical injury and the implications for treating chronic pelvic pain. Tim and Dr. Schubiner find the similarities between treating chronic pelvic pain and chronic erectile issues and discuss the profound healing effect of retraining your brain to not regard pain and sex with fear.

This week Tim talks to Stephanie Prendergast, an internationally-acclaimed pelvic floor physical therapist and author of "Pelvic Pain Explained." It can be hard identify the causes of pelvic pain, so they talk through types of pelvic discomfort and various treatment options for these chronic conditions. Stephanie also outlines the overlap between pelvic floor disorders and erectile issues, and explains the differences, providing hope and answers for people who suffer from this understudied condition.

• Pelvic Pain Explained by Stephanie Prendergast
• The Pelvic Pain and Rehabilitation Center
• The Pelvic Pain panel discussion at USC
• The latest comprehensive research study about chronic pelvic pain and prostatitis
• Directory of pelvic floor physical therapists

In this week's episode, Tim talks to Dr. Steven Hayes, the founder of Acceptance and Commitment Therapy (ACT) - a groundbreaking update to Cognitive Behavioral Therapy that helps people better manage obsessive thoughts and become more mindful of their core values. Dr. Hayes offers invaluable insight on how obsessive thoughts affect erections, and how to change your relationship to those thoughts instead of hiding from them. If you make peace with them, they won't control your behavior, or your penis.

Today Tim interviews to Dr. Johanna Hannan, an award-winning professor at East Carolina University's Brody School of Medicine. She studies the internal pudendal arteries (arteries that supply our genitals), and their impact on aging, cardiovascular disease, diabetes and obesity. They cover why it's difficult to gather clinical data, erectile issues caused by prostate cancer and why diet and exercise make such a big difference. Please note: Dr. Hannan discusses animal testing in her research.

Today's guest, Conor Creighton, is an Irish writer living in Germany. Conor opens up about suffering with erectile issues in his twenties, his frustrations with Viagra and how a ten-day Vipassana (silent meditation) retreat changed his life, including how it helped him address his erectile issues. It's a story of heartache, shame and perseverance. Enjoy!

Tim talks to neuroscientist Dr. Nicole Prause about the neuroscience of erections (of course!), the ins and outs of conducting sex research, and how porn and partnered sex affect the brain differently. She dispels myths about the correlation between testosterone levels and erections and talks about how neuroscience likely validates the effectiveness of sensate focus. They also get technical, discussing penile salience networks, transcranial magentic stimulation and what neuroimaging tells us about sex.

Today, Tim and sex-positive therapist Dr. Hernando Chavez talk about de-emphasizing the focus on the penis, the biopsychosocial (biological, psychological, and social) factors in sexual struggles, porn, therapeutic treatment of erectile issues, peaking, delayed ejaculation, premature ejaculation, the myth of the desirability of long-lasting sex, and the politics of sex positivity.

Today, Tim and urologist Dr. Josh Gonzalez discuss the three basic categories of medical erectile dysfunction (hormonal, blood flow, and neurological) and why pills aren't aways the best solution. Dr. Gonzalez talks about why he loves doing penile implant surgeries, the pluses and minuses of cock rings, and how to avoid priapisms (when the penis remains erect for hours). Finally, the two talk at length about the importance of integrated health care and taking the shame out of erectile issues.