Sexual Dysfunction

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Rumors and myths dispelled about sexual dysfunctions
Sexual Addiction

Rumors and myths dispelled about sexual dysfunctions


The often hush-hush issues dealing with sexual dysfunctions and erectile dysfunctions are given new light from expert urologist, Dr. Ricardo Munarriz. In this unique and timely interview, Dr. Munarriz and The Business Shrink talk openly about drugs and other treatments used in sexual dysfunctions for both men and women. As a leader in sexual medicine and an expert on treatments, a wealth of knowledge is shared with The Business Shrink audience and dispels the myths and rumors surrounding penis implants, prolonged erections, female sexual dysfunctions and more.

Peter L: You are listening to The Business Shrink program. I’m Peter Laufer, standing at a payphone at a San Francisco airport to introduce you to Peter Morris, The Business Shrink. Brought to you this segment by eTaxNet. Save up to 50% on your taxes each year with legal tax strategies. You can learn more at their Web site. That’s eTaxNet.com. Or give them a call at 888-715-4BIZ. And on this live broadcast of The Business Shrink program, Peter Morris is pleased to welcome to the program, Dr. Ricardo Munarriz from the Boston University School of Medicine where he is a professor of urology. The two of them are going to be talking about the business of sex because, of course, with The Business Shrink, business is defined in its broadest possible context. Dr. Munarriz, welcome to the program. Please say hello to our Business Shrink, Peter Morris.

Dr. Munarriz: Good afternoon. Thank you for having me, Peter.

TBS: I will add to that introduction. It’s really the industry of medical care in sexual medicine which has its business and, most important, its social and medical dimensions. And Dr. Munarriz, I know you as a professional friend through my Harvard Medical School project, WorldCare, and I want to introduce you briefly to the audience as you are not only an associate professor of urology at Boston University School of Medicine, but you are the head of the Department of Sexual Medicine. And you are one of a handful of what I would consider global expert practitioners in sexual medicine and that runs the gamut from testing to medication to injections to the psychology of it, both for male and female sexual dysfunction. Perhaps you can start and give us some description of what you do in your most interesting career.

Dr. Munarriz: Hi, Peter. Many thanks for having me. I’m a urologist by training with a sub specialty in infertility and sexual medicine. I would say 90-95% of my practice is dedicated to sexual medicine. Of that time that spent, about 70% is dedicated towards male sexual dysfunction and the other 30% toward female sexual dysfunction. The reason why I see less women is because there’s less women referred to me. But basically, I treat either gender the same way.

TBS: In that regard, you have said to me, and correct me if I’m wrong, that the women patients who are as much in need as the males, are often not nearly as motivated when they’re sent in either by their own desire or by a psychologist of marriage or a couple therapist, or by their husband. Often, it’s such a function of their attitude that it’s very hard to break through and be helpful.

Dr. Munarriz: Women’s sexuality has always been very complex for a variety of reasons. Not only does the biology have to be functioning perfectly, but also their psychosocial environment and relationship must be in perfect condition for everything to work well. The problem with female sexual dysfunction is that very few practitioners in the state, or for that matter worldwide, actually see women with sexual problems. It’s difficult for them to find a practitioner in their local area that will be capable of treating them. In that complexity, the question that you asked me, yes, women…one of the most common complaints is the lack of desire. That decrease in desire is sometimes very abrupt. But more commonly, is the very slow, gradual change in the sexual drive. Many times they don’t come because of their particular sexual complaint of desire, but more because of their complications in the relationship. So it’s very important when women notice a change, maybe to seek help. Especially if it’s affected the relationship.

TBS: In that regard, you make the point to me that there are organic functions common to sexual dysfunction which could relate to blood chemistry, could relate to hormonal changes in women, could relate to circulatory problems with men, but there’s also the psychological dimensions. And you do have two psychologists and a very experienced nurse practitioner for 30 years in your practice. But the psychology part of it is poor self-image, poor confidence, relationship problems. And as you said, a lot of the women are reluctant to make a move and be goal oriented like men are in dealing with their problems.

Dr. Munarriz: There’s obviously general differences. Sexual dysfunction is a couples problem. Ideally, I like to see the couple. Not only the person with the complaint or the problem. Because in reality, the problem affects both of them. So it’s easier to some extent if both are involved in the consultation. In 90%-95% of men, the reason for erectile dysfunction, for example, are organic. However, it’s impossible to separate psychology from biology. It’s impossible to have erectile dysfunction, for example, at age 25 without having significant psychological consequences. There’s 20%-30% of women that I see that have depression or marital problems. For that reason, we have two psychologists, Dr. Lachar and Dr. Judy Johnson who sees and evaluates all my patients before I do. The reason for that, is that obviously they’re better trained at detecting psychological and social, as well as relationship problems. So they screen the patients and let me know exactly what is happening at home. Whether there are drug problems, whether there’s sexual abuse, or any of these issues. And if patients need further psychological support or sex therapy, then they take over.

TBS: That’s a big part of it. As you’ve said to me in some of our discussions, it’s interesting that when it comes to women who finally, psychologically decide to approach a sexual problem head on, there are treatments ranging from topical estrogen, which doesn’t have the same cancer risk, to testosterone therapy, which for some reason is allowed in Europe but not in the U.S. for women. Why is that?

Dr. Munarriz: Well, yes. It depends on the complaint. There are different treatments. For example, as you said, women who are, for example, post menopausal and have lack of vaginal lubrication and genital pain, topical applications of low dose estrogen is very effective in the management of genital atrophy and pain without really putting patients at risk for breast cancer, for example. In terms of testosterone, it’s a critical hormone in terms of sexual drive and other functions. But particularly, it’s known for sexual desire. Unfortunately, it’s not available in the United States. It has not been approved by the FDA. It recently became approved for use in Europe, however, in the United States, we’ve been using testosterone. FDA LogoObviously, off label, since probably the 1940’s or 1950’s. If we review the literature, women have been using testosterone for many many years.

TBS: But why in the U.S. does the FDA refuse to approve testosterone for women?

Dr. Munarriz: There are many reasons. It’s not clearly known. A particular pharmaceutical submits an application to the FDA. The FDA has a panel of people who review the data and if they think it is safe and effective, and all the data they require is present, then they can approve the drug. On the other hand, if they feel that is unsafe, or if they see that it is not strong enough or if more data is required, then they would deny the application or ask them for more information. So in the particular case of testosterone in women, the vast majority of the panels thought that there was not enough data for the drug to be approved in the United States.

TBS: And of course, it’s no surprise that there’s no real champion or lobbying going on because testosterone isn’t patented so there’s not much money to be made. And that’s, of course, one of the more cynical sides of medicine in general, not referring just to your branch.

Dr. Munarriz: It’s very complicated because testosterone…there’s no patent on that. So the only thing that can be patented is the delivery system. Whether it’s a gel, a patch or an injection.

TBS: No money.

Dr. Munarriz: So the problem, particularly in women, is that the moment a particular pharmaceutical gets a product out there, it basically makes it so much easier for other companies to get a drug approved.

Peter L: And I have to interrupt you guys just for a second here. And we will continue with The Business Shrink, Peter Morris.

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Segment 2

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Peter L: It is The Business Shrink. Peter Morris is The Business Shrink and this segment of the program is brought to you by the Financial Toolkit. You can learn how to save and make money now, increase your investments, eliminate debt and make more money. You can do it all at Toolkit1.com. Or give them a call, 888-715-4BIZ. And on this live edition of Urology ProfessionThe Business Shrink program, the Business Shrink, Peter Morris, is engaged in a fascinating conversation with Dr. Ricardo Munnariz. Boston University School of Medicine, urology professor. They are talking the business of sex.

TBS: And I keep mentioning that Dr. Munnariz heads up the Center of Sexual Medicine as a urologist. Just for the audience, urology covers a broad spectrum of sub-specialties ranging from the prostate to bladder functions to general urology to cancer, oncological to sexual function and dysfunction. In that regard, Dr. Munnariz specializes in sexual function/dysfunction for men and women. As we’re talking, let’s talk about the types of male sexual dysfunctions and how you treat them. You’ve listed for me, erectile dysfunction, decrease in sexual desire, ejaculatory problems, either rapid or delayed, pain and then Peyronie’s Disease?

Dr. Munarriz: Peyronie’s Disease.

TBS: Could you kind of go through each of these and then run through some of the different interventions that you do?

Dr. Munarriz: Basically, there are disorders of every phase of sexual activity. So the first phase is sexual desire and sexual motivation. There are men and women who have decreased sexual motivation or decreased sexual desire that may be due to many reasons. One of the most common reasons is decreased testosterone. However, there are other reasons, like medications for example. Men and women who take antidepressants, there’s a family of antidepressants called SSRI'sSSRI’s. One of the most common side effects of this medication is decreased desire and ejaculatory dysfunction. So there are biologic reasons like decreased testosterone or it is sometimes related to medications or interventions that we do. Obviously, there are psychological problems with sexual desire. So that’s the first phase. The second phase of sexual functioning is what we call arousal. In men, it is defined as erectile function or erections. Erectile dysfunction is a very common condition among men. It’s age dependent. When we are around 40, 37% of men will have some degree of erectile dysfunction. When we turn 70, about 67% of men will have erectile dysfunction. The sicker that we are, the more likely we are of having erectile dysfunction. For example, a man who has diabetes, hypertension, high cholesterol, or heart disease is more likely to have erectile dysfunction than a man who’s otherwise healthy. Erectile dysfunction, since the vast majority of patience have mild to moderate erectile dysfunction, they can be successfully treated with medications and oral medications. And if that fails, then we can go to injections. And if that fails, then we can go to surgery. The third phase of sexual function would be ejaculation and orgasms. There are men who ejaculate too fast. That’s called premature ejaculation which actually happens to be the most common complaint among men. There are a very small group of men who have the opposite problem. Delayed ejaculation. It takes them a long time for them to ejaculate. Sometimes they can’t. And there are men who also have genital pain or penile pain. And finally, there’s a condition called Peyronie’s Disease which is scar tissue of the penis which results in a penile deformity classically in a torso curvature. A curvature towards the body that may be associated with erectile dysfunction and penile pain. Depending on the severity of the curvature, men may or may not be able to engage in sexual activity and may not be able to penetrate. That’s also associated with a significant loss of penile length. So it can be significantly, psychologically devastating to men.

TBS: What is the treatment for that disease?

Dr. Munarriz: That’s a very good question. Oral agents, medications that are taken by mouth, have never really been shown to be successfully effective. Lately, we have been using two oral drugs. One is an amino acid, the other one is a medication that affects inflammation. By themselves, they really don’t work that well. We generally combine them with what we call injection therapy. So we inject the medication into the scar tissue. That seems to either partially dissolve the scar tissue or make it softer so the curvature lessens.

TBS: Is that a permanent treatment? Or is that like a one shot (no pun)? Or is that something they have to do everytime they have sex?

Dr. Munarriz: No. It’s a treatment that is given every 2 weeks until the curvature subsides or decreases. Very rarely are patients cured from the Peyronie’s Disease. But sometimes, given these treatments, the curvature decreases in severity to the point where men are more functional. They are somehow satisfied and they don’t proceed. If the improvement is not there or it’s sub-optimal, then surgery may be needed to correct the deformity.

TBS: And you are a surgeon. In fact, you also do microsurgery for vascular bypasses. So, obviously, you do also surgery related to this Peyronie’s Disease?

Dr. Munarriz: Yes, we do surgery for Peyronie’s Disease which can be very gratifying. Sometimes our patients are very satisfied and grateful for the surgery and the care provided. Sometimes it’s difficult to please them because Peyronie’s Disease is associated with a loss of penile length. And that’s difficult to get back. Part of that length can be given back with surgery, but not always. So, satisfaction rate with Peyronie’s Disease is not the same as with other conditions for example.

TBS: And it’s interesting to note that as you deal with erectile dysfunction, the term used to be called impotence. Of course, that was a black and white term that stigmatized because now, modern urology and sexual medicine realizes that it’s a continuum or spectrum where erectile dysfunction can be low or middle or high. So the term “impotence” is more or less out the window unless there’s 100% inability to function. Which leads to the fact: one of your sub-careers as a vascular surgeon, I’m told, a vascular bypass in a penis often happens with a young man who got a sports injury and is impotent…literally. And you sometimes take 6 hours in surgery to effectuate a bypass that may have a 70% success rate and men are so emotionally devastated that sometimes when they can’t get the treatment, they’ve been known to commit suicide. I’ve heard, in the field in general, and here, the medical community, through Medicare, Medicaid, through in this case, insurance, they may only allow Microsurgery in session$900 including expenses for a 6 hour microsurgery. It kind of shows an attitude bias in the medical field and healthcare in America against sexual medicine.

Dr. Munarriz: Well, there’s a small group of men who are very young, healthy otherwise, have no psychological, hormonal or neurological deficits, however, they still have erectile dysfunction. Most likely, it’s due to some type of perineal trauma or even a pelvic fracture. Those patients who have an isolated injury to their cavernosal arteries due to the trauma, but everything else is in place and functioning well, may benefit from micro-arterial bypass surgery. One of the problems with the surgery is that it requires a lot of diagnostics. Number two is the surgery requires special microsurgery abilities or training. And number three, it requires a good referral basis that not everybody has. Surgery, as you said, and for this particular man, it can improve the rate of functioning in 70% of men. One of the problems that we have is, number one, not everybody’s doing it nationwide. Very few people are doing it. Number two, young men, because they’re young, many times are classified or are given the diagnosis of psychologic or psychogenic erectile dysfunction and no diagnostics are performed, which inappropriate. One of the issues that you mentioned is reimbursement. Yes, reimbursement in general terms is poor for this surgery because it can take it between 3 and 6 (hours) depending on the difficulty and many reimbursements rates so low that many physicians would not start performing this surgery. Because they are basically losing money.

Peter L: And it’s time to interrupt just for a moment as this conversation, fascinating conversation continues with Dr. Ricardo Munnariz and your Business Shrink, Peter Morris, on The Business Shrink program. Live on Lime. Healthy living with a twist. It’s your Business Shrink. This segment brought to you by eTaxNet. Check them out at eTaxNet.com for more information. It’s the Business Shrink, Peter Morris.

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Segment 3

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Peter L: You are listening to the Business Shrink Program. I’m Peter Laufer here to remind you that this segment is brought to you by TriadWebZone.com. Put your business on the internet now with their point and click web builder. With it, anyone can build a site or sell products or services online. You can build that site free. Just check out TriadWebZone.com. And build your money-making web site free. And now your Business Shrink, Peter Morris, continues his intriguing conversation with Dr. Ricardo Munnariz, Boston University School of Medicine urology professor. The two of them are talking the business of sex.

TBS: Viagra, Levitra, Cialis Anyway, going to something that we all hear a lot about. It relates to the pills which are famous. The leading one being Viagra. You have Levitra, which is somewhat similar. And then Cialis which is the 36 hour pill. There’s a lot of nuances that, unfortunately, the American public and people around the world aren’t aware of. Whether it’s buying them mail order in foreign countries and some of them are counterfeit or diluted, or whether it has to do with eating habits or countervailing drugs that are being taken by the patient that may reduce the efficacy and force either a higher intake that is prescribed by the manufacturer. And even down to eating habits. Whether you have a steak or some fatty foods and then become unsatisfied. I mean, how do you possibly convey all this to a patient?

Dr. Munarriz: Well, one of the most important things about treating patients for sexual dysfunction is without a question, education. It’s a unique opportunity to tell them that their erectile dysfunction is most likely due to their obesity, diabetes, Impotent Cigarettecigar smoking, high blood pressure…so erectile dysfunction, in many cases, is a manifestation of what is happening throughout the body. So it’s a marker for cardiovascular disease and when patients present their erectile dysfunctions, it’s a unique opportunity to tell them, “Listen, your obesity, your high blood pressure, your cigarette smoking is affecting your blood vessels throughout your penis. And one of the manifestations that you’re having now is erectile dysfunction.” It’s a very unique opportunity and many times it’s not utilized to educate patients. So, at that point, we try to treat reversible causes of erectile dysfunction and would recommend, obviously, decreasing alcohol intake, lose weight and so on. Regarding the pills, it’s very important to educate patients about how to take the medications because 20%-30%, sometimes even more, would not respond to the medication because they were inappropriately informed or educated, or patients didn’t listen enough, or they were simply overwhelmed by the amount of information. So they take the medications but with optional instructions. Many times they fail the treatment, not because the pills are not effective, but because of lack of information.

TBS: And it’s interesting because none of the pharmaceutical companies have any desire to educate, even if they stamp subject to doctor’s review and guidance. But they don’t even attempt to educate the consumer. All they say is “average dose is 50-100 of this” or “10-20 of that” and “take it up to 2 hours before” and all simple-minded stuff which maybe has a 50% efficacy on its own without applying the nuances that experts like you who aren’t that common, would other infuse to the patient. I find that to be very interesting, and yet people buy Viagra for recreational purposes when they’re in their 20’s and 30’s and 40’s. They can get into trouble and end up in the hospital because of priapism, which is a condition where the erection doesn’t subside for 4 hours. And if it stays longer, you can get necrosis. A part of the penis can die or malfunction. People end up in the emergency room because they also don’t understand. And people get heart attacks from overdosing from Viagra and some of the other pills. There’s a lot of risk and there’s a good reason to have a lot of respect for your expertise and those of your fellow experts.

Dr. Munarriz: There are a couple things I would like to clarify. These medications are extremely safe when given to the right patient. The only formal contraindication is the concomitant use of nitroglycerin. In those cases, the blood pressure can drop which can lead to significant cardiovascular events.Got Priapism Otherwise, the medication is fairly safe and it’s been used by many millions of men without significant problems. Priapism has been very rarely reported in the literature. We don’t know if it’s really related to the use of the medication because there are so few people who have had this complication that we can’t say it’s due to the medication itself. If, on the other hand, you take it with another product that is pro-erectogenic, that can lead to priapism, but by itself, very rarely can do. These medications work very well on the industry because of business reasons have tried to educate physicians and patients to the best of their ability. Obviously, the more knowledgeable physicians, the more likely the patients are to refill their medication and improve their business. So, the industry has done a good amount of effort and they primarily have — physicians training and education with different programs. Some educational programs like —, some of them are different meetings of different societies. Some of them are commercial dinners and events at night to educate the physicians, and obviously, patients are being educated with a few direct consumer advertisements and with ordering information that has been mailed to the house. So there’s been a conscious effort, however, very few men today are diagnosed with the right dysfunction. About 17% of men who have ED are diagnosed and about 14% or so are currently treated.

TBS: That’s amazing. That’s an amazing statistic. While we’re talking about that, you said to me once in conversation, something that I thought was a wonderful thing because so many men are shy or reticent about getting help, or just feel that their problem is psychological or it’s their girlfriend or their wife or them…and they really throw their hands up. As you said to me in describing the optimism of your field from your expertise, those people are fortunate enough to come to you. You said, “Peter, as long as a patient has a penis, I can treat them.” Which is amazing. You said that some of your patients are in their 80’s and 90’s. And that’s a fascinating statistic. You actually have 80 and 90-year olds that you’re treating.

Dr. Munarriz: It depends on the overall health of men, but the men who are in good health and are in good relationships, many of them continue to be sexually active up to their 80’s. I’ve done penile implants and revisions of penile implants of men in their 80’s. So, yes, we do treat all men from the age of 18 or so until they basically die. As long as their motivated and healthy enough to sustain sexual activity, we don’t see a reason to not treat them.

TBS: And now let’s talk about another step in the food chain of tools for help which is the injection. I once had somebody say to me, which is a friend of yours and mine who said, “Peter, when I mentioned the procedure of a shot administered to the penis in lieu of a Viagra to stimulate an erection, 95% of the people run away and say, ‘Are you crazy? I’ll never do that as long as I live.’” And he said “of the 5% who try it, 95% of them say to me, ‘I can’t believe I waited this long and I didn’t do it up to now.’” Would you say that’s an accurate feeling?

Dr. Munarriz: You know, yes, that’s very accurate. The thought or the mental image, the thought of putting a needle in the penis, particularly at the level of the glands, is not necessarily a pleasant thought. Many patients are discouraged when this remedy is offered to them.

Peter L: We need to interrupt at this crucial moment here. Once again, in this fascinating and informative conversation with your Business Shrink, Peter Morris, and Dr. Ricardo Munnariz (Boston University School of Medicine, professor of urology) as they talk about the business of sex. And the conversation will continue. This segment of The Business Shrink program brought to you by eTaxNet. You can save up to 50% on your taxes each year with legal tax strategies. And you can learn more at their Web site which is: eTaxNet.com. Or give them a call at 88-715-4BIZ. Peter Morris is your Business Shrink.

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Segment 4

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Peter L: This is The Business Shrink program with your Business Shrink, Peter Morris, who says, “Business is everything.” He defines business in the broadest possible sense and he’s talking the business of sex this hour with Dr. Ricardo Munnariz, Boston University School of Medicine, urology professor. More at The Business Shrink blog and you can check that out by going to BusinessShrink.biz. And now, the conversation with the doctor and the shrink continues.

TBS: As I say, it’s the business of, the art and science of sexual medicine, which is the business of sex in the broadest sense. Now, on injections, we’ve been speaking about injections and how people are driven away but the few that are brave enough learn that the injection can be self-administered in a painless part of the penis and that it can produce, within a much shorter time, a substantial erection in as little as 10-15 minutes and generally can hold an erection for 30 minutes to an hour. Generally avoids an priapism, or that 4 hour, irrepressible erection, and that you treat people. You have over 1000 patients who get injection therapy and another couple thousand that come in and out for it. And some of them go up into the 80’s. Is that correct?

Penile Injection Therapy

Dr. Munarriz: Yes. We have a very active injection therapy. Historically, injections were the first non-surgical treatment we had for erectile dysfunction that was introduced in the 80’s. We started with —- and as we learned about how erections take place we start to use other drugs and we developed what we called bi-mix, or 2 drug combinations, or tri-mix, or 3 drug combinations that have been shown to be very effective. Actually, they tend to be more potent than say Viagra, Levitra or Cialis, PD-5 inhibitors as we call them. They have no systemic side effects, no nausea, no headaches or stuffy nose. However, these medications are injectables and have a significant dropout rate. In many cases, it’s due to lack of teaching. We don’t train and educate patients enough, we don’t explain to them how to do it, we don’t find the right dose, so patients get into trouble. They don’t know how to do it. They do it for the first time at home alone and the consequence is that many patients never continue the treatment. We are lucky we have a nurse who has been doing injections since the 80’s, from the very very beginning who actually has a very good bed side manner. He trains the patient. The patients come as many times as needed to the office until the proper dose and the technique is appropriate. Once those patients learn the correct technique and we find the right dose, many patients continue the treatment for many many years. We have patients on injection therapy for 15 years and over.

TBS: And I would say, as we move on in our subject, that it is clearly an effective route that is known by relatively few, working off the 17% of men who are treated in the first place. I would imagine less than 1% of the male population who has some form of erectile dysfunction, knows about the shot or is treated by it. Now, quickly, we also go to the implant side which basically, as I’ve said to you, I find the erectile implant, from some of the women I’ve interviewed, has a terrible stigma of being almost an un-masculine, artificial way of treating. It’s almost like using a crutch. How can I say it? It’s like somebody making a hard ball with a kind of cork that, when it hits the bat, makes it go an extra hundred yards. In that, you have bendable, malleable implants that are constructed with rods that can be inserted and can actually bend the implant into an erect position. Then you have inflatable implants, which you do. And then of course, there’s the vacuum construction devices. You have a much more positive view based on actually treating people who are willing to go to this route than I believe the marketplace has an appreciation for. I think it’s been stigmatized through jokes, through comedians, through other things. Can you just briefly enlighten us?

Dr. Munarriz: Sure. Penile prosthesis do have a bad stigma, a poor image for unknown reasons to me. Breast implants are only cosmetic, however they’re well accepted in both genders. Implants are not a cosmetic device. They are actually a functional device. The cosmetic results are very good and the functionality is very high. We started doing implants in the 70’s and since then, the devices have become more and more reliable and better in terms of rigidity in girth or length. Our surgical technique has also improved over the years. The procedure is generally less than an hour. The recuperation time varies, but it’s approximately a month. Once the patient is implanted and the device is functioning, there are no complications. Satisfaction rates are the highest of all the treatments that we have. So people who get implants tend to be happier than men who take pills or injectables. So it is really a remarkable device with high satisfaction rates. As you mentioned, there are basically 2 types of implants: malleable implants or semi-rigids and the inflatables. Penile ImplantsToday, I would say that standard care would be the inflatable because it mimics more a natural erection. The penis is decompressed in a flaccid state and when a man wants to have an erection, a small pump, located in the scrotum is activated. Men get an erection. The erection will remain as long as the man desires to have it. At the end of sexual intercourse, a small release valve is activated and the penis comes down or decompresses. Everything is underneath the skin, so nobody can see the device and nobody would know that you have the device. So they are really, truly remarkable procedures with the devices and with the highest satisfaction rate. People who get them really love them and many say they should have had the surgery many years ago.

TBS: As I move onto a controversial subject that we just had on our blog yesterday, before I do, in conclusion about the implants…and maybe we’ll do a blog about that at some later date, but I tell you that you say there are reasons that are beyond you and you compare to the woman’s breast implant. I tell you, in my opinion, the reason it’s got such a stigma has to do with the woman’s notion and the couple’s notion that somehow this artificial stimulation or artificial functioning through pressing a strange device that’s inserted in the body and somehow it gets in the way of the erotic fantasy of love making. Yet, when someone doesn’t have a choice and they’re there, then of course, they learn to live with it. Then they get over that myth and they’re fine. But there’s a huge barrier, an invisible steel barrier about this artificiality part in terms of performance and eroticism. That’s my opinion. Anyway, the controversial blog raised the issue about whether to circumcise or not circumcise and that there are people that are born circumcised or born uncircumcised. There are people that are middle-aged that go from circumcision to reverse foreskin. Then there’s some for foreskin that get it taken off and they go for circumcision. We got into battles with our listeners and our viewers. We had a group that said it’s dishonest, that people who have foreskin are better lovers because they can’t just rush in. They’ve got to get the woman lubricated because it hurts them, it hurts her, and therefore they’re into foreplay. Whereas men who are circumcised, they rush right in, they don’t care, and the woman be damned. What’s your view on that debate?

Dr. Munarriz: Well, you know, there’s always been a medical controversy. Whether circumcision is healthy or unhealthy for sexual functioning. The reality is that, in fact, scientific studies that are well done, well conducted, show that it has no significant impact on sexual functioning. There’s always concern of decreased penile sensitivity that has never really been scientifically documented.

Peter L: Dr. Ricardo Munarriz and The Business Shrink, Peter Morris, it’s a conversation that could go on for hours, and perhaps there should be a second edition of this program. But this hour is concluded and it’s time, Peter, for you to say a quick goodbye to the doctor.

TBS: I want to thank you and I understand your neutral position and will be in touch to have you on again. Thank you very much, Ricardo.

Dr. Munarriz: Thank you very much, Peter.
Source: Dr. Ricardo Munarriz, Accomplished Author, Sexual Medicine Practitioner, and Professor of Urology at Boston University School of Medicine, businessshrink.biz/psychologyofbusiness/2007/12/20/rumors-and-myths-dispelled-about-sexual-dysfunctions/

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