Why 40% of Young Men Have Erectile Dysfunction

Today we're going to talk about erectile

dysfunction. Now the biggest problem is

that erectile dysfunction used to be an

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

1999 under the age of 40 had erectile

dysfunction. In

2011, 14 to 28% of people under the age

of 40 had erectile dysfunction. And that

number has only gone up. I suspect it's

somewhere around 30 to 40% of people

under the age of 40. So why is erectile

dysfunction increasing so rapidly? So I

think this has to do with the way that

we are literally training our genitals

as men. So the first age of pornography

exposure is around 9 years old and most

people start masturbating in their early

teen years. We're also seeing a delay in

socialization, the development of

relationships. Online dating is getting

hard. So it used to be that the average

age of first intercourse was maybe

somewhere around 18 and that number has

only gone up. So what that means is that

from let's say the age of 13 until about

22 or 23 for a period of 10 years most

teenagers, boys and young men are using

pornography and masturbation as their

primary source of sexual activity. When

we're teenagers our brain is still

developing, our nerves are still

developing. our physiology is still

developing and it develops in a

particular way. So just to give you all

a couple of examples if we look at the

average intravaginal pressure. So how

what is the squeeze the grip strength of

a vagina? It's somewhere between 5 and

15 mg of mercury. Okay. Now if we look

at the average hand grip strength the

average hand grip strength is somewhere

between 65 and 105 pounds per square

inch. So if you sort of like think about

your hand, first of all, there's

skeletal muscle, which is way stronger

than smooth muscle, which is most of

what the vagina has. And then we also

have bones, right? So if like if I

squeeze my hand like this, the amount of

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

that's how tightly I'm squeezing. So

what tends to happen is that our our

genitals get used to a certain kind of

stimulation over a very critical period

of development and then it's hard for us

to climax during sexual intercourse. Now

we have to get into the definition of

what erectile dysfunction is and this is

really important. Okay. So erectile

dysfunction means the inability to

achieve climax for the duration of the

sexual act. So I'm not able to finish

with with the the pressure of of a

vagina. So therefore like I I get

defined as erectile dysfunction. So this

is a key thing to understand is a lot of

people who have difficulty finishing

think there's something wrong with their

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

right because we've trained it in a

particular way. We're going to get to

how to fix it. And the good news is that

like most of these cases are 100%

fixable. But then this creates a problem

because the kind of sensory stimulation

I need to achieve climax isn't there

with vaginal penetration which results

in erectile dysfunction. So today what

we're going to do is go into erectile

dysfunction with a lot of detail. We're

going to explain the physiology of how

an erection forms. We're going to talk a

little bit about the sequence of the

sexual act which is incredibly important

to understand. We're going to go over

medical conditions that contribute to

erectile dysfunction. And once we

understand how the sexual act is

supposed to happen, the arc and the

trajectory of the development of an

erection to sexual intercourse to how

the sexual act is completed, then we

will understand kind of how the engine

works, how the car is actual, what's

going on under the hood, and it will

give us a lot of insights into how to

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

interested in applying some of the

principles that we share to actually

create change in your life, check out

Dr. K's guide to mental health. And so

we start by understanding what literally

is meditation. How does experience shape

us as human beings? How do we strengthen

the mind itself as an organ? And so by

understanding our mind, we understand a

very very simple tool, a crucial tool

that we have to learn how to use if we

want to build the life that we want to.

So check out the link in the bio and

start your journey today. So here is our

penis and I hope I can draw a picture of

a penis without getting in trouble. Now

in our penis we have

arteries that send blood blood into the

penis and we have veins that bring blood

out of the penis. Okay. So we have a

couple of different

chambers. We have something called the

corpus

cavernosum which is here. We have two

chambers called the cor corpus

cavernosum. And then we have a chamber

in the the glands of the penis, the tip

of the penis called a corpus spongiosum.

So normally there's when we have a

non-erect penis, the flow into the penis

and the flow out of the penis match. But

what happens in an erection is that we

will send blood into the penis and

there's a a nitric

oxide production in the penis. So nitric

oxide is a vasod diilator.

So what that means is that it will

increase the blood flow to the penis. So

as nitric oxide production increases and

by the way

testosterone basically increases nitric

oxide production. So this is a

vasoddilator. So what happens is I have

an artery and when I add nitric oxide

the size of the artery increases right

so now there's this much blood. There

used to be only the middle part and now

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

um nitric nitrous oxide production it

causes vasoddilation which means that

blood is now flowing into the penis. So

as I

vasoddilate right so as I increase the

blood flow these start to fill up with

blood and when these fill up with blood

this blocks off the veins. So as the

corp you can kind of think about it this

way like as the corpus cavernosum fills

up we start to block the veins and once

we block the veins then we've trapped

the blood inside and arterial pressure

is greater than venus pressure which

means we're still pumping blood in and

then this is how we get an erection

right so if we sort of think about a

flaccid penis it may be like 1 in in

size and then once you get an erection

it literally like will like increase

fivefold in volume. So there are a

couple of key things to understand here

about erectile dysfunction. The first is

that

testosterone is what facilitates nitrous

oxide production. So the other thing

that we we also discover is that since

nitrous oxide is responsible for the

vasoddilatory mechanism that creates the

erection, we also have the ability to

develop phosphodieststerase 5

inhibitors.

So this is the enzyme that then breaks

down nitrous oxide. So if we have

medications like selenaphil or Viagra,

they block the breakdown of nitrous

oxide. So if I'm breaking if I'm

blocking the breakdown of nitrous oxide,

then I will be able to maintain an

erection because I'm I'm maintaining the

chemicals that allow me to to keep an

erection going. So this system is

mediated by testosterone and nitrous

oxide, right? So

testosterone results in the produ

production of nitrous oxide which is a

vasoddilator which allows us to maintain

an

erection. Now

normally we have an enzyme called PDE5

phosphodieststerase 5 which then breaks

down nitrous oxide. So when we lose our

erection right so we're producing

nitrous oxide it's vasoddilating our

penis and PDE5 comes in and breaks this

down which then breaks down the

vasoddilation which then kills the

erection. So if we look at something

like

selenaphil or

viagra what this medicine does is blocks

this enzyme from functioning. So it

prevents us from breaking down nitrous

oxide which is how we're able to

maintain erections. So this is a quick

overview of the physiology of the penis.

Now let's talk a little bit about what

governs whether nitrous oxide is built

or not built. Right? So nitrous oxide is

what results in the development of an

erection. But when does it turn on? When

does it turn off? So now what we have to

do is talk about something called the

autonomic nervous system. So we have a

part of our our body called the

autonomic nervous system which is

divided into two components. The

sympathetic nervous system and the

parasympathetic nervous system. I don't

know if you all have noticed this, but

we basically have two modes of action in

our body. There are times where we are

excited. There are times where we're

angry. There are times where we are

lustful. There are times where where our

body is basically in a high state of

activity. Our blood pressure is high.

Our heart rate is high. Maybe we're

diaphoretic. We're sweating. So this is

the activation of the sympathetic

nervous system. This is governed by

things like adrenaline and cortisol. So

when you sort of think about going on a

roller coaster or some kind of like

adrenaline spike, that's your

sympathetic nervous system acting. So

these are hormones, which means that

they travel everywhere in your body

through the bloodstream. And the purpose

of a hormone is to

coordinate your whole body's response.

So when I get adrenaline, I want to shut

off my digestive system. We don't need

to be digesting anything right now. I

want to shut off the sexual act, right?

So, when we're going on roller coasters

or we're being chased by um tigers, we

don't want to be having erections. We

need all of our blood flow not to our

penis, but to the skeletal muscles in

our arms and legs. And that's what

adrenaline and cortisol will do. They

will redirect blood flow to certain

parts of our body. The second half of

the autonomic nervous system is the

parasympathetic nervous system. And this

governs our rest and digest kind of

mode, right? So sometimes when we're

after we've had a big meal, what

happens? Our blood flow doesn't travel

to our brain, doesn't travel to our

skeletal muscle, it travels to our gut,

it travels to our liver, and we sort of

feel a little bit sleepy. We get a

little bit of a food coma. And the other

thing that happens is we can sometimes

get an erection. So y'all may have

noticed that you get erections when

you're feeling relaxed. So when you wake

up in the morning, a lot of men will

wake up with something called morning

wood, right? So we will have a an

erection early in the morning. I used to

get erections all the time in organic

chemistry class. It's not because I

thought organic chemistry was super

sexy. It's because I thought organic

chemistry was super boring and it would

put me to sleep. So, this also leads us

into

um sort of the stages of the sexual act.

So, what we know is to develop an

erection, you need activation of your

parasympathetic nervous system. You need

to feel safe. You need to feel relaxed.

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

lucky enough to engage in in, you know,

healthy sexual relationships, you may be

in bed with your partner. You're kind of

feeling relaxed. You're kind of

chilling. You're kind of relaxing. You

know, things feeling good. And then you

start to get a little bit frisky, right?

You start to develop a little bit of an

erection now. Your mind is sort of

noticing, oh, like look at how soft they

are and look at the I mean, see how they

smell and they smell really good and

like now I want your body. And then and

then so what happens is in order to

develop an erection we need activity of

the parasympathetic nervous system. So

then what happens is like once we have

the

erection then our sympathetic nervous

system can turn on especially if we get

a certain kind of stimulation genital

stimulation associative stimuli we start

making out whatever. And then so

basically we need you know the way that

it was described to me in medical school

is in order to arm the penis you need

parasympathetic nervous system activity.

In order to fire the penis, you need

sympathetic nervous system activity. And

the sympathetic nervous system will also

recruit some of the things that will

result later on. It activates certain

mechanisms that will result in the

return of the penis from erect to

flaccid. So this also shows us a huge

problem with psychoggenic erectile

dysfunction or erectile dysfunction that

is not caused by a physiologic cause

which is that if you are stressed out,

if you are depressed, if you are

anxious, then it will be hard to develop

an erection. So if your physiology is

not able to enter the right state of

relaxation because you're stressed,

anxious, depressed, whatever, it will be

hard to develop an erection and even

start the sexual act. So, one of the key

signs of psychoggenic erectile

dysfunction, so non-physiologic, and

we'll get to this in more detail in a

second, is that you are able to develop

erections like while you sleep. So,

penile tumscence at night is still

intact. So, what the [ __ ] does that

mean? That means that you know you wake

up with morning wood, but when it comes

to the sexual act, it's difficult to

engage. So if there's a physiologic

problem with the penis then even some of

these situations like morning wood or

nocturnal erections will be impaired

right because there's some problem with

the corpus cavernosum some problem with

the blood flow to the penis the corpus

spongiosum. So if there's a problem with

kind of the hardware, then you'll have

difficulties with erections basically

all day long. But if there's a problem

with the software, which is a

psychoggenic erectile uh dysfunction,

then the penis is capable of working in

nonsexual situations. Does that kind of

make sense? Psychoggenic erectile

dysfunction is mostly found in young

men. A study by Kasuru at al reported

that 85.2% 2% of 525 26 men under the

age of 40 are struggling with

psychoggenic erectile dysfunction. So

this doesn't mean that 85% of people

under the age of 40 have erectile

dysfunction. This is a study that is

looking at if I take all the people

under the age of 40 and I try to figure

out what is the cause of their erectile

dysfunction, the cause of their erectile

dysfunction is psychoggenic 85% of the

time, which sort of makes sense, right?

because our bodies are young and

healthy, which means that some of these

other causes that we're going to talk

about are going to be less common. So,

let's talk about

physiologic causes of erectile

dysfunction. Okay, so psychoggenic ED

accounts for 85% of people under the age

of 40. And by the way, the rate of

erectile dysfunction under the age of 40

according to evidence is up to about 28%

in 2011. I suspect this number is about

30 to 40% in 2025. So what are the

physiologic causes of erectile

dysfunction? So heart health is penis

health. So as we sort of explained at

the very beginning, vascule is very

important. So you need healthy arteries,

healthy veins. So what we tend to see is

that people who have cardiovascular

problems, things like hypertension,

things like obesity,

uh things like

diabetes, things like chronic kidney

disease, this is not vascular. Um people

who have sleep apnea, very uh common

cause of erectile dysfunction. So these

are some of the very very common

physiologic causes. So basically

problems with you know if we look at

poor cardiovascular health like poor

exercise results in erectile

dysfunction. So you need a healthy heart

that's pumping the blood you know

healthy veins healthy arteries big big

big

causes. Now there are also neurogenic

causes. So

um remember that in order for the penis

to work properly it has to receive there

are a bunch of nerves right? So when we

when we touch the penis it feels good.

How do we know that it feels good? All

of that information is transmitted via

nerves. So 10 to 19% of erectile

dysfunction over the whole population.

Okay, this is not young people. This is

just everybody is caused by neurogenic

problems. So these can be things like

multiple sclerosis, spinal cord trauma,

um things like stroke can cause erectile

dysfunction, surgery can cause erectile

dysfunction. So neurogenic causes are

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

problem with your nerves in some way,

they're going to be there's going to be

problems with erection. So this is

another like really good uh this is a

great opportunity to share something

kind of cool. So a group of people that

has great cardiovascular health and also

has erectile dysfunction problems are

professional bicyclists. So if we sort

of think about a bicycle seat, what the

bicycle seat is doing the way that you

sit if you're like a professional,

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

marathons and stuff or you bike for

eight hours a day, you are

compressing the nerves and arteries and

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

know if this kind of makes sense, but if

you look at the anatomy of the penis,

the arteries and veins that go into them

kind of travel through the area that's

called the taint, right? So the area

between the perennium and the scrotum is

full of nerves, arteries, veins that

sort of imbue the penis with what it

needs. So if we compress that for

extended periods of time, we block those

nerves, then it can result in erectile

problems. What's really interesting is

that this principle is also utilized

beneficially by yogis. So there's an

assan called arda siddasan or another

asan called siddhasan. And in Siddhasan

we place the heel gently against that

area. And then in full Siddhasan we'll

sort of compress that area more

severely. We compress from the perennium

side and we compress above. So you

basically sandwich your scrotum and

penis between your heels or your ankles

if that kind of makes sense. I do not

recommend don't do this without the

guidance of a guru. Okay. Okay. So these

are can and the reason that they do that

they do that on purpose to reduce blood

flow to those parts of the body to

reduce testosterone production because

we're also blocking some of the nerves

and arteries to the scrotum which is

where a lot of our testosterone comes

from. So they'll sort of utilize this.

But my point is that there are all kinds

of anatomical neurological arterial

things going on. So we have physiologic

erectile dysfunction, neurogenic

erectile dysfunction. Another major

cause huge huge huge is medications. So

we are like notorious for this in

psychiatry because a lot of our

medications cause erectile dysfunction.

At the top of the list are SSRIs. So

these are anti-depressant medications,

anti-anxiety medications, anti- OCD

medications will cause erectile

dysfunction. Another good example of

this are anti-hypertensives. So these

are medications that going to are going

to affect your cardiovascular

capability, right? So they're going to

prevent your arteries and veins from

contracting in the way that they

normally do in order to combat

hypertension. So that can cause problems

with erectile dysfunction. We also know

that your diet is really important for

erectile dysfunction. So

sugar, processed foods,

um

alcohol,

nicotine, low

fiber, and then various substances that

we haven't included can sometimes cause

problems with erectile dysfunction. Now

the mechanisms of this are a little bit

complicated. We don't need to go into a

whole lot of detail and I know this is

going to be hard, right? Cuz I can

imagine that there's some people in our

audience who don't exercise, maybe have

sleep apnea, maybe are a little bit

overweight, eat processed foods, eat

sugar, use weed, use alcohol, use

nicotine, and they're like, "No wonder

am I screwed. Don't worry, we'll we'll

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

to talk a little bit about how

psychoggenic erectile dysfunction

develops and what to do about it. And in

order to do that, we have to take a look

at neuroscience. So I want you all to

think a little bit about the process of

the sexual act. Okay, think about the

process of the sexual act. Key thing

here is that when we think about getting

aroused and we develop an erection,

there's a lot of sensory input. Another

really part uh important part of sexual

arousal is emotions, right? So I know

that there's all these, you know,

stereotypes about women need to fall in

love before they have sex and men are

horny and DTF all the time. I I think

that like there may be some, you know,

if you if you measure a 10,000 women and

10,000 men, there may be some net effect

that men are more likely to have sex

without emotions than women, that

statement may be true. But generally

speaking, in the brain, as we'll see,

emotions are really important, right?

So, if like if someone is annoying you,

the likelihood that you become aroused

from that is like low. So, sure, there

may be some kind of fetish or something

at play, but generally speaking, if

people are just like annoying you, or if

you're afraid of them, or if they're

pissing you off, the likelihood that you

will be horny for them goes down. Versus

if you fall deeply in love with someone,

if you're obsessed with someone, the

thought of having sex with them, whether

you're a man or a woman, is generally

speaking more appealing, right? There

are exceptions to that. So, emotions

become really important as well. So,

let's talk a little bit about these

parts of the brain. So first thing that

we're going to talk about is

phalamus and posterior insula. So what

do these parts of the brain do? So the

phalamus receives sensory input and the

posterior insula is responsible for

interosceptive information. So what does

that mean? So if you're listening to

this video right now, I want you to

notice what your body is telling you,

right? So, you may notice the weight of

your the body in the chair. You may

notice that you're a little bit hungry.

You may notice that you want to scratch

something. Maybe you're walking around.

Maybe you're you're sitting in a car.

You're noticing the air conditioner

blowing on you. Your body is sending you

signals. So, one of the things that we

know is very important for sexual

activity is for you to be receiving

sensory input and receiving input from

within your own body. So, I know that

sounds kind of nutty, but just think

about it for a second, right? So, when

you're having sex, a huge part of that

is being aware of the signals from your

genitals. So, the posterior insula is

the part of our brain that basically

gives us information from within our own

body. And what we find is that people

with psychoggenic erectile dysfunction

have difficulty with that. Okay. So,

cognitive attentional syndrome and

metacognitive beliefs in male sexual

dysfunction. Overall, their cognitive

and attentional patterns worsen negative

internal states, reducing sexual

excitement, detach them from their

bodily sensations, and hindered sexual

functioning. So, if you're having sex

with someone and you get in your own

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

Oh my god, are they are they enjoying

it? Are they enjoying it or not enjoying

it? Is it going well or is it not going

well? Then this kills your boner or I

have to think about something else. So

like you know if you get in your own

head what happens is this posterior

insula stops becoming a part of your

attention. So there there's a a lot of

studies on psychoggenic erectile

dysfunction show that there is an

attentional problem. You cannot focus on

the physical sensations. You're not even

paying attention to what's going on in

the penis. You are stuck in your own

head. You're worried about something

else. And without your posterior insula

activating, it is very difficult to

achieve climax or maintain an erection.

So if we sort of think about the process

of an erection, right? And hopefully you

all are lucky enough to have experienced

this in a positive and loving way. You

know, if you're just sitting there and

your partner is a little bit frisky and

they start playing with your junk, your

penis will start responding. And as your

penis starts responding, you're sitting

there trying to play Call of Duty and

your partner is like starting to touch

your stuff. And then your attention

shifts from Call of Duty to what is

going on in your genitals. May not be

true because I don't know if Call of

Duty players ever get laid, but you

know, that's neither here nor there.

This is what we mean by by introsceptive

information in the posterior insula is

that your attention needs to be able to

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

see a lot in psychoggenic erectile

dysfunction. This is basically the crux

of the pattern. So I'm a a boy who

started masturbating. Then what happens

is I've I physiologically trained my

penis to ejaculate with 65 to 105 uh

pounds per square inch of pressure and

the vaginal intercourse of 5 to 15

milligs of mercury is insufficient for

me to achieve climax. So then what

happens is I I finally have sex for the

first time, right? I'm a virgin and I'm

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

want to be a good person. I don't want

to be a virgin loser anymore." or I have

sex for the first time and then I'm not

able to climax and now this creates a

problem. So the problem is actually that

physiologically this is the stimulation

doesn't work but now I get in my own

head. Now I have problems with an

erection. Now I didn't finish. Now I

didn't pleasure her. Now I just went

limp dick while I was having sex. So

this creates a shame. This creates an

anxiety. This creates a depression. And

so all of these thoughts now the next

time we try to have sex a bigger problem

arises. Now that I'm anxious cuz I

screwed up the first time, now I'm

worried about the second time. Am I

going to be able to perform? So now the

second time I try to have sex, my

sympathetic nervous system is active

before I even start the sexual act. So

what that means is I'm stressed out

about having sex. My partner starts

playing with my stuff, but I'm so

stressed that I don't even develop an

erection. Now it's even twice as bad.

It's not that I went limp dick during

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

This worsens the anxiety, worsens the

depression. So then I try again the

third time. This creates a se a vicious

cycle that I think is one of the reasons

why like up to 40% of people under the

age of 40, I've seen this pattern so

much have erectile dysfunction. Second

thing, anterior insula. The anterior

insula is what

processes the

emotional

features of stimuli. So this is let's

explain this for a second. Okay, I have

kids, right? And like I love my kids. So

what happens is when I see my children,

this is just visual information, right?

My kids look the same all the time. And

lots of people will receive if if I'm if

I'm walking down the street and I see my

kids and everyone else on the street

will see my kids too. But the emotional

attachment to that stimulus is very

different. Right? There is an

emotional component that my brain

attaches to my children that strangers

won't attach to. I love them. I see this

child and I'm like this brings up a

feeling of love. So this is also really

important for the sexual act. So when I

see my partner, right, and I see a

nipple, that nipple is not just a

nipple. It is it carries a lot of

emotional association with it.

So this part of our brain in order to

have a healthy sexual erection and even

achieving climax the emotions of it are

really important. This is why makeup sex

is so good because there's an emotional

block that made when we were feeling

angry then our sympathetic nervous

system was active and then we don't feel

like having sex and then we form this

emotional connection. Now the anger goes

away. Now we feel relaxed. Now we feel

in love and so we have this really

intense passionate sex because our

anterior insula activates and when that

emotion activates it helps our posterior

insula activate and then we're there.

We're in the moment. We're not thinking

about tomorrow. We're not thinking about

yesterday. The whole point is we've

forgotten yesterday. We forgot the

conflict. We're not in our head. And so

this leads to healthy sexual acts. The

third part of the brain that we're going

to talk about is roughly the

preffrontal cortex.

and

inferior frontal cortices. So these are

responsible for sexual inhibition and

sexual disinhibition. So our frontal

loes are the parts of our brain that

give us context dependent behaviors.

They're the parts of our brain that say

it is okay to do this here and not okay

to do it over there. So, my favorite

examples of this are like picking your

nose. If you're like by yourself at

home, like, you know, binging out on

some TV show and like eating popcorn,

you'll go to town. But if someone else

is around, you won't hopefully won't

pick your nose and hopefully you wash

your hands after you pick your nose. So,

like good examples of how you know the

the inferior frontal cortices are

different amongst people is like if we

look at the fetish of exhibitionism,

right? So some people if they are

observed by others their brain tells

them this is not a good place to have

sex. Other people their brain their

frontal loes are like hey there are

people around let's try to have sex.

Another really great example of this is

like if I'm sleeping in my hotel room

alone at night and someone grabs my

junk. That is going to be a very

different experience from if I'm at home

with my wife in bed in the middle of the

night and someone grabs my junk. Even

though technically the stimulus is

exactly the same, there is a part of my

brain that is saying that this stimulus

is okay in one situation, arousing in

one situation, and scary in the other.

So when I'm in my hotel room alone by

myself and someone touches my junk, I'm

aroused. And when I'm in bed with my

wife, this is very scary. Oh my god, she

wants to have a third kid. What are we

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

back to I think the most common factor

in psychoggenic erectile dysfunction,

which is basically pornography use and

masturbation under the age of 40. So,

when I'm developing as a human, I have

some natural impulses and then those

natural impulses get shaped by my

environment. So, for example, when I

have patients who have school girl

fetishes, how do they develop a school

girl fetish? They develop a school girl

fetish because when they're 13 years old

and they go to private school where all

of the things that they are sexually

attracted to have a particular uniform,

their brain forms an association between

I am horny and this is the object of my

horniness. And when all of the girls in

the class are wearing the same thing, my

brain will associate this. Right? So

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

a very formative period of my sexual

life, every girl I have a crush on is

wearing the same damn thing. So my brain

over that that 15 to 18 period is going

to associate this with sexuality. It's

associative learning, like classical

conditioning. This is also why some

people will have like a thing for a mil,

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

and my friends, I have one friend who

has a hot mom, the emergence of these

sexual feelings is associated with a

particular kind of stimulus. And so now,

like I'm like suddenly like this mom

that I've I've known her for four years,

right? We were friends since we were

nine. I never had a sexual thought about

her. And then once I start to develop

like like all these surges of hormones

and my brain I I like get really

confused because now my brain is like

horny all the time and there are like

all of these mils around me everywhere

hot mils in your area right then I will

start to become attracted to milk. So

this is how the brain works. We learn,

right? It's not just you kind of have

this like you can think about sexual

appetites as acqu all of them are

acquired tastes. If I get exposed to one

school girl and then over the next 5

years get exposed to a hundred others, I

will develop a preference. I will

develop a preference for mils, whatever.

So here's where pornography comes in

because we're not just developing a

cognitive preference. We are also the

genitals. If you're masturbating every

day, you know, in from the ages of like

13 to 23, what's going to happen is our

body is going to get a certain kind of

genital training, which we've kind of

already talked about. So now I am used

to or my brain or penis learn my

introsceptive part of my brain, my

posterior insula and the nerves in my

penis learn that there is a certain kind

of stimulus that gets me to climax. So

now we porn enters the picture. So if

you know a 100 years ago I was like I

developed a school girl fetish what is

my brain going to prefer sexually what

does it get exposed to? So now what's

happening with the consumption of

pornography the easy access of

pornography we get begin to believe that

these things are sexual and what we know

about pornography and there's a whole

we've done lectures on this so you guys

can check this out is that pornography

uses things that are supraormal stimuli.

So they use tits that are bigger, butts

that are bigger, things that are

shinier, 4K, a lot of color, a lot of

camera angles, a lot of things that you

will never see during sex, right? So

like a really simple example of this is

most human beings who engage in sexual

intercourse, the man will never see the

vagina. Or maybe you see it at the very

beginning, but once you're actually like

in a penetrative position, you don't see

the vagina, right? It's like kind of

weird, but so like what starts to happen

is our brain starts to get conditioned

by pornography. And we know that this

conditioning tends to get radical over

time. So this is a paper that's looking

at pornography induced erectile

dysfunction among young men. They report

that an early introduction to

pornography, usually during adolescence,

is followed by daily consumption until a

point where extreme content involving,

for example, elements of violence is

needed to maintain arousal. A critical

stage is reached when sexual arousal is

exclusively associated with extreme and

fast-paced pornography, rendering

physical intercourse bland and

uninteresting. This results in an

inability to maintain an erection with a

real life partner at which point the men

embark on a reboot process giving up

pornography. This has helped some of the

men regain their ability to achieve and

sustain erection. So, one study, I don't

remember if it was this one, found that

I think about 40 to 50% of men will end

up watching pornography that they used

to think was disgusting or like not good

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

So, if we look at a normal brain with a

normal sexual relationship, there isn't

an option for more extreme generally

speaking, right? There's some amount of

extremity. Maybe you your your partner

indulges you during your birthday or

something like that or anniversary or

there's special occasions where you

convince them to play with your kinks,

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

acclimatize to a certain kind of

pornography, if we increase the

intensity, the pace, the color, the

extremity, the violence, whatever, if we

increase something about it, our

dopamineergic centers get a little bit

more activated. So over time, what

happens is normal porn becomes bland.

And if you watch pornography, you may

have noticed this that you can't watch

the same porn over and over and over

again, right? It doesn't you don't enjoy

it as much. You go looking for new

things and maybe something that was less

extreme now becomes a little bit more

arousing. So we basically conditioning

ourselves to a particular kind of input

in order to achieve climax in order to

achieve erection. So this is a huge

problem. So the good news is that for

the majority of people who are under the

age of 40, if you have erectile

dysfunction, I would say that it can be

95% resolved. That's my gut check as a

clinician. So if a patient walks into my

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

old. I can't maintain an erection. I

can't achieve climax when I'm having sex

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

would say, "Yeah, dude. I think that you

know there's a really really really good

chance that you can get back to a

healthy sexual relationship and the

studies actually support that. Okay. So

let's understand what the different

pieces are. So the first is

cardiovascular health is penile health.

So if someone is obese, overweight, has

diabetes, has sleep apnea, doesn't

exercise, if someone just starts

exercising on a regular basis, maybe

loses a little bit of weight, but more

importantly achieves more cardiovascular

health, their erections will improve. So

this is true of people who are over the

age of 42. So when we start to get to

physiologic causes like hypertension and

things like that, right? So when I have

a 45-year-old dude in my office who just

got diagnosed with hypertension, has

trouble maintaining an erection, getting

them to exercise and bringing down their

blood pressure will 100% help their

erection. So there are also things that

we've talked about, sugar, processed

foods, things like that. So the first

thing is that if you get physically

healthy, your erections and your ability

to achieve climax will definitely get

better. So now we have to dive into

psychoggenic erectile dysfunction and

how to sort of treat that. So this is

where what we know is that there are

studies that show that attentional

control, so getting better at shifting

your attention will help you maintain an

erection and achieve climax. So if we

look at people who struggle to maintain

erections in climax, what we find is

that once they get into their head, they

cannot get out of their head. So this is

where there are really simple practices

like uh meditation is a really good one

that trains your attention but it's not

just things like meditation right so

there are specific studies that have

attentional control exercises which you

can learn and is shifting your attention

from being in your own head and so this

is what I would encourage you all to do

if you're struggling with this pay

attention to your body right just enjoy

the experience don't think about whether

you're making her come or not don't

think about your rectile just enjoy the

sensations be in the present moment as

much as possible And when you do that

sort of thing, it'll activate that

posterior insula, all of those

interceptive senses, and it will move

you closer to the right direction. The

next thing to think a little bit about

are is the anterior insula, which is our

emotional processing. So, this is a big

part of the work that I do with people.

This is why psychotherapy can be

incredibly helpful for erectile

dysfunction, is that the sexual act is

associated with all kinds of stuff. And

we have to deconstruct all of those

associations because those associations

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

20year-old kid I mean I I had a patient

once who was like this who who came into

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

orgasm. And then I asked them like you

know tell me more about that help me

understand the problem. And so they said

I can get to the first stage of orgasm.

I I can get to the the precom stage but

I can't get to the actual ejaculation.

Like I can't handle it. And I was like

what do you mean you can't handle it? So

what they sort of told me is that you

know like I I will engage in sexual

behavior and then like a little spurt

will come out and then I and then my

penis becomes hyper sensitive and I and

it goes limp. And I was like wait what

do you think an orgasm is supposed to

be? And they're like you know it's like

gallons buckets of ejaculate that lasts

for 60 seconds and lots of moaning and a

and then I'm like rock hard afterward.

And what this person, it's sad, but what

this person was struggling with is that

they were orgasming. They just had this

impression that an orgasm is like, you

know, liters of ejaculate. And the

average ejaculate volume, I think, is

like maybe 5 milliliters, like maybe

like a teaspoon. I I don't really know.

But anyway, so like this is where we

have all these ideas or impressions of

what sex is supposed to be like. And

there are also studies that look at like

me metacognitive beliefs about

manliness. Like what do you think a

manly sexual act is supposed to look

like? And this is where we have to get

to some statistics. Okay, so like a lot

of people don't know that the average

sexual act is 3 to 7 minutes and that if

50% of women will want the sexual act to

end at 10 to 15 minutes, like they're

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

realize that only about 21 to 30% of

women can achieve an orgasm through

vaginal penetrative intercourse. So this

is where we get a little bit technical,

but the tissue that becomes the gland's

penis is the same tissue that is the the

clitoris. So during embryology and in

development, there's a small pit uh

piece of tissue. So we're all default

female by the way. And then what happens

is we the the clitoral tissue under the

influence of an androgen like

testosterone or androin dione will

develop into the gland's penis. So there

are you know some cases of like if you

get a woman a biological female who has

like a testosterone secretreting tumor

you will see the the clitoral

enlargement. So the clitoris will start

to morph somewhat into something that

looks closer to the gland's penis. It

doesn't turn into a gland's penis. But

my point is that embryologically the

tissues are the same. So here's a simple

question. If y'all are worried that you

can't make your female partner orgasm

with vaginal intercourse, we're going to

do a really simple experiment. So

imagine that you are trying to achieve

climax without ever touching the top

half of your penis. Can you climax by

stimulating the base of your penis?

Probably not. I don't this experiment.

Right? So if we sort of think about it

like which part of the penis is the most

important for achieving climax, it's the

glands. It's the corpus spongiosum and

that tip of the penis where all the

nerve endings are. I mean the shaft is

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

usually what we need, right? And so

women are the same way. they need

clitoral stimulation because that's

where the majority of the the nerve

endings are that will allow them to

achieve orgasm. My point is that when

we're engaging in a sexual act, if we

don't know these facts, we don't know

that the average intercourse lasts 5

minutes. If you're screwing for 3

minutes or 10 minutes, like that's

normal for most people, right? So, you

don't need to get anxious about that.

But then that triggers all of this these

problems with attentional control and

then you're in your own head and stuff

like that. So, that creates a lot of

problems. Usually what I tend to do when

I'm working with people is I will help

them unpack these beliefs. I will help

them think about where they constructed

these ideas. I will help them deal with

their emotions. I will help them develop

emotional regulation techniques and help

them develop relaxation techniques.

Right? Because if you are approaching

the sexual act and your adrenaline and

cortisol are high, you will never

develop an erection. So we need to do

some of that physiologic rewiring,

psychological rewiring. As you dig into

these things, things tend to get better.

The last thing that we're going to talk

about are other forms of interventions.

So, this is just to let you all know.

So, we have medications for things like

erectile dysfunction. And sometimes

these can work incredibly well. So, if

you have, you know, stressbased sexual

erection problems and we do something

like prescribed selenapil, which is a

trade name, Viagra, this can work really

well because you're afraid like you

can't get an erection because you're

stressed out. The Viagra helps you get

an erection. Then you are able to have

sex. Then you're able to say hard enough

hopefully to climax. And then like then

you've had one success. And once you've

had one success, it becomes easier to

have your second, easier to get the

third. Then you start penile retraining.

Then you start engaging in sex. And then

this is how you basically rehabilitate

the penis. And then once you

rehabilitate the penis and now you're no

longer anxious, you don't need the

Viagra anymore, right? You don't need

the selenaphil because now everything is

working the way that it should. There

are also cases of things like

intraurethal suppositories which are a

localized amount of some kind of

medication that is inserted into the tip

of the penis you know so it doesn't have

to be like if you have a medical

contraindication like if you've got

rightids sighted heart failure or

something like that then you shouldn't

take selenaphil so there are things like

that and then there also a couple of

other things that people will do one is

they'll use vacuum assisted devices so

these are things like penis pumps that

remember that a lot of the maintenance

of erection has to do with pressure

gradients from your arterial blood flow

and your venus blood flow. Problem with

a lot of these these vacuum assisted

devices is that about 30 to 46% of

people will stop using them because of

like bruising and other side effects.

And the last thing that we have is we do

have surgical interventions for erectile

dysfunction. These are things like

penile implants. So you can put some

kind of implant into the penis. A little

bit outside of my wheelhouse. You got to

go see a surgeon or urologist for that

kind of thing. So that you can do that

kind of stuff too. So there's a lot of

stuff that you can sort of do from a

lifestyle perspective, from a

psychoggenic perspective, you know, to

understand how the brain develops an

erection, what's going on in your

nervous system, what's going on in your

head, the ability to shift your

attention, and then you can absolutely

move in the right direction. The last

thing that we tend to see is that

abstinence or severe reductions in

pornography and masturbation will help a

lot. If you think about the frequency of

sexual activity, the less sexual

activity you have, the easier it is to

achieve climax. This is a huge problem

for a lot of dudes. If you haven't

gotten laid in a while and you have sex

with your partner, you're done pretty

quick. So, as a psychiatrist, I'll sort

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

really sex therapy, but I'll work with

couples to, you know, develop a plan

where I let them know, look, we're going

to do this for a month where you got to

take you got to stop pornography, you

got to stop masturbate, and then y'all

can have sex. The goal is not to finish.

when you feel an erection or whatever,

you guys just like try it out and feel

each other out for about 30 days. And

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

you can get an erection. Let's see if

you can enjoy the just enjoy the

sensation. Don't worry about sex. You're

not trying to have sex. You're just

trying to get a penile massage, right?

That's the goal. And then you start to

enjoy each other's company. You start to

develop intimacy, you know? So, you

start to like, you know, maybe have some

kind of massage but don't have sex. And

then like tension builds up and then

they end up having sex and it ends up

being great because like both of them

are horny because they're genital

massaging each other for like 15 days

without any kind of like you know sexual

activity and then things turn around. So

there's some studies that show that you

know abstinence from pornography can be

incredibly effective. So last thing that

I want to share with you all I know we

sometimes try to sell you things but

this is something that I couldn't

resist. So in order to help you all with

this problem I'd love to tell y'all

about a new guide we've made which is

Dr. K's guide to penile retraining. Much

like our other guides, it dives into a

lot of depth about what is the

neuroscience, what is the psychology,

gives you lots of practical tips on what

you can do. Also includes meditations

that are designed to support this

problem. So, we're going to be exploring

esoteric tantric meditations. And then

the best part of the guide, which is now

available not only on our platform, but

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

step by step exactly how to do the

retraining of the genitals. But in all

seriousness, if y'all are worried about,

oh, how do I regulate my emotions? How

do I focus my attention? How do I

process my shame? All of these things

actually do exist in our real guides.

So, we have a guide to trauma where

we'll talk to you about, you know, how

to let go of past experiences. We have a

guide to anxiety where we teach you a

lot about the physiologic rewiring that

is necessary so that you can reduce your

anxiety. We have guides to depression.

We talk about how to deal with shame.

So, if y'all are interested in that

stuff, definitely check those things

out. And of course, if you're working if

you're struggling with this problem, you

can absolutely work with a professional.

Hey y'all, hope you enjoyed today's

video. We talk about a bunch of topics

like this on the channel, so be sure to

subscribe for more. If you're already

subscribed, GG, and we'll see you in

chat.

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