When a patient talks about their sexual dysfunction, I always ask: what's going on with the person they're having sex with? You’d be surprised how many providers don’t.

Most people don’t think to ask what’s happening on both sides of a sexual relationship. But sexual dysfunction doesn’t happen in a vacuum—it’s a two-way street. In this episode, I’m joined by Dr. Jessica Yih, a urologist who treats both men and women, and we get real about the overlap of issues that show up in the bedroom.

We dive into Peyronie’s disease and why it’s been overlooked for so long, how injections can break down plaques, and why those curves aren’t just uncomfortable—they can lead to serious problems for both partners. We also break down erectile dysfunction beyond the “just pop a blue pill” myth. Spoiler: Viagra doesn’t work for everyone.

Jessica brings a powerful perspective to the conversation, especially around what it’s like treating both members of a couple, sometimes in back-to-back appointments. She’s also helping train the next generation of sexual health urologists through her fellowship at UC Irvine.

Sex is more than individual dysfunction—it’s communication, treatment access, aging, and understanding both bodies in the room. If you’re a provider, a patient, or just curious about how these dynamics work together, this episode is for you.

Highlights:

• The truth about Peyronie’s disease, painful sex, and treatment options
• Why Viagra isn’t a one-size-fits-all fix for erectile dysfunction
• How injectable medications and implants are changing the game
• Dyadic sexuality and the importance of treating both partners
• Jessica Yih’s unique path to sexual medicine and her work training new fellows

If this episode got you thinking, please hit that follow button, leave a comment, and give us a review on Apple Podcasts or Spotify. Your support helps more people find the info they’ve been missing.

Dr. Yih’s Bio:

Dr. Jessica Yih is a urologist specializing in both male and female sexual health and male infertility. She currently serves as Director of Women’s Sexual Health and Male Infertility and Assistant Professor at UC Irvine. Her clinical focus includes menopause care, vestibulodynia, arousal and orgasm disorders, erectile dysfunction, and oncofertility.

Dr. Yih is active in research, surgical education, and advocacy, particularly in advancing care for women’s sexual health. She contributes to several professional societies including SMSNA, ISSWSH, SMRU, AUA, and SWIU.

She holds degrees in brain sciences, medical sciences, mental health, and healthcare management, and completed her M.D. at Wayne State, urology residency at Case Western, and fellowship at San Diego Sexual Medicine.

Get in Touch with Dr. Yih:

Website

Instagram

Get in Touch with Dr. Rahman:

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Welcome back to another episode of Gynecology Presents Sex Drugs and Hormones. I'm Dr. Smeena Raman, board certified gynecologist specializing in sexual medicine and menopause management in Chicago. Today I have a very special guest, super excited. You guys heard the intro. Dr. Jessica Yee, we're gonna talk about all sorts of things today. So I'm super excited to have her on. Thanks Jessica for coming on board.

Yeah, thank you for having me.

It's been a little bit of time in the making, I guess, because we were back and forth. It's funny, I met Jessica just in the last two years, I feel like, at the conferences I always talk about, the International Society for Study of Women's Sexual Health, but I actually met her in person for the first time in Brazil when we were both talking at the World Meeting on Sexual Medicine in Brazil. So that was cool. Yeah.

Mm-hmm.

Yeah, that was a great meeting. What a great time in Brazil.

Yeah, it's so awesome over there. yeah, we had a good time over there and you know, we just connected. And so those of us that are in the sexual medicine space, like we just gravitate toward each other.

Yeah, think, mean, especially those of us who treat women, I mean, the majority of the conference was, you know, geared towards male sexual dysfunction, which we'll talk about today. But yeah, there's a for those of us who treat women, it's definitely, you know, we kind of band together. common interest. Right.

Yeah.

Right, exactly. You know what's interesting, and I've told this story on this podcast before, but I'm gonna tell you separately, is that when I started my practice in 2014, I started seeing sexual pain patients that I didn't know how to help. So was like, oh, I gotta join, I gotta go to these conferences and figure it out. So the first conference I went to was actually SMSNA, because I didn't know that Ishwish was really in existence. And so I go there and I'm like, wait a minute, like there's one section on.

Mm-hmm.

yeah.

Like I'm like one of four gynecologists there like I Tammy Rowan was there and somebody else and was like man there's they're really not they're they said sexual medicine but they're not talking about the other person that they're That's where I met Erwin Goldstein for the first time he's like, you got to come to Ishwish You know, this is where we do all the magic

You

yeah.

Yeah, yeah.

Yeah, yeah, I mean, so we have, you know, it's not really new, but kind of reformatted the committees. And so we actually have a female sexual health committee, which I'm the co-chair or the chair for the committee for the for the next couple of years. And really, our goal is to increase, you know, the representation of FSD, you know, all things FSD at the meeting.

excited.

on their website platform, education content to students and residents, getting our educational content to fellows. So all these things. Yeah.

Yeah. Right.

Yeah, because it's the SMS and a for those of you don't know is the Sexual Medicine Society of North America. And it's sort of the local sexual medicine for all of North America. And then there's like the International Society for Sexual Medicine, which we're just gonna are both a part of. And then there's Ishwish, which is just the International Society for the Study of Women's Sexual Health, which is all female pretty much. And so I think that it becomes confusing if you're just coming into this because you think like,

You know, the good thing is like, you know, the issue is just so jam packed at conferences that you feel like you can't miss anything. And so for me, when I go to SMS and a, or I go to ISSM, I'm like, I'll be going to two of those. then I'm to go see Brazil the rest of the time. Because I don't, I don't treat men in my office. Well, what's interesting is that, you know, as someone who does treat midlife women and, all, you know, and anybody that has a volvo pretty much, you know,

Yeah.

Huh.

Yup.

you have to find out what's going on with the person that they're having. If they're choosing to have sex with a man or someone that identifies as a man, you know, it's really important to find out like what's going on in the relationship. Cause there's a concept of dyadic sexuality that exists within sexual medicine. And it's really about like, you know,

Mm-hmm.

the dyadic sexual desire, dyadic sexual function, because it is a couples thing, you know, if you're in a couple, right, you can be also, can also just self stimulate or be asexual or, know, there's a whole spectrum. But when you're talking about someone who is in a coupled situation, and that person happens to be of the opposite gender, you know, it's actually important to know what's going on with that person, because, you know, each person's sexual function impacts the other person, right? It's just not like, you have GSM. So it's your problem. Like you have

Okay.

general urinary syndrome or menopause, but we know it affects the desire. We know it affects ability to accept penetration and all these things. And so feel like that's something that's not that we're trying to like emphasize more in the sexual medicine world. But I know a lot of my clinicians that I talked to, like don't ask about the opposite, the person that they're having sex with necessarily a lot, you know, and they're not even finding out like, that person have a problem? But I think it's very interesting because like male sexual function impacts female sexual function, right?

you

Jessica, like you treat both. It was interesting. think a lot neurologists are in this better in sexual medicine kind of treat both. so for someone that comes from a GYN perspective, it's a little different, I think. But I love hearing the urologic perspective because it's like so, so different than, know, there's patriarchy and then there's patriarchy.

Yeah, for sure. Right.

I do wonder why GYNs say or behave in a certain way, but they're trained in a patriarchal system. So even though you're a woman treating a woman, you know, you still say the things that you're taught, which is, you know, kind of BS.

yeah.

Yeah, that's an interesting perspective. Before I did that presentation, dyadic sexuality, I actually hadn't heard of the term dyadic before, but when I heard that term, it really made a lot of sense to me because as a urologist, I treat men and women. And so I've been kind of treating patients in the dyadic context.

you know, for my, you know, for my whole career, essentially, I just didn't have a word to describe it, but now I do. So that's really cool. You know, I think the most interesting patients that I see, I get to see the patient and their partner as the patient as well. So I see them both separately and together. We usually do like back to back appointments.

Right, yeah.

which I think is really fascinating. Sometimes they'll both sit in on the appointments together, and sometimes it'll be one first and then the other. If someone feels more comfortable sharing alone, or if they have things that they haven't talked to their partner about in depth, it kind gives you a sense about what their relationship is like and how that relationship aspect

This wonderful.

plays a role, you know, because there's so much about communication, right? So like if someone has an issue, but it's difficult for them to communicate that with their partner, then it compounds the issue because you, it's harder to treat it since there's not open communication about.

Yeah.

it.

Right. And I think communication is sort of the essence of like even when you have patients who are like, they're in a sexless marriage and they haven't had sex in like, like they have sex once or twice a year. It becomes that much harder to get past that point because you're not even communicating the fact that like maybe we should be doing this and this is what I like. And which is, you know, probably contributes to all the orgasm gap that we see with women specifically. I like to hear like how you approach that. Like, you know, like when you're talking to your patient,

Yeah.

and say, when you see your patients as a couple, does like, does the male patient come to you first usually or is it like the woman's dragging the man in? Like that's how I see it in my office.

Yeah.

I'm like, if I ask my patient about your partner and they're like, yeah, and goes, and know, patients are like, oh, my partner's penis bends this way, or, you know, does it stay hard or it's hard flaccid, you know? And so then I'm trying to help them navigate getting help, right? But they're the ones that are going to be dragging them in because there's so much shame associated with male sexual function too.

Mm-hmm.

Yeah, yeah. You know, I think it really depends on a certain person's, you know, provider's practice. Because for me, when I first started coming out of fellowship, when I first started practicing on my own, I primarily actually saw men. And it was actually really astounding to me. It was actually a bit overwhelming even how many men have

Thank

issues related to Peyronie's disease and erectile dysfunction. We could not schedule enough people in the day to be seen for these things. The shame part or the stigma about it, when they came in, some people were really open. They just talked matter of fact, hey, this is going on with my penis, it sucks, what can we do about it? there's definitely a big component where

you know, some people are really distraught. It really affects them like psychologically. Sometimes I have patients crying in my office, you know, because it really affects their kind of like core sense of being. And I think that is definitely, you know, understated for these patients. You know, we often...

think of men and back to the patriarchal idea, right? Like we think of men as they should be strong and they can't cry, you know, and, they can't have feelings. but that's not true. Right. Yeah. because, know, when you, when it comes down to it, you know, of course men have feelings and they have feelings about, the, the problems that are going on in their body. And it's very distressing for them oftentimes.

toxic music.

Yeah. Well, let's talk about some of these problems that you see. look, we know we already started talking about Peyronie's a little bit, like, you know, for those listeners who don't, know, you don't hear much about it, right? You hear about, you know, erectile dysfunction a little bit more, which I think we should talk about some of newer treatments, but you don't really hear about Peyronie's as much, right? Like the curvature. So like, can you talk to our listeners about what that is and some of the newest treatments?

Isn't it?

Yeah, so Peyronie's is, I think one of the reasons why it wasn't really talked about much is we didn't have a good treatment for a long time. So for a long time, there was only surgery available and the surgery wasn't very good and there were poor outcomes. so because doctors didn't have a fix for it, we basically, it's like anything else, right? Like we didn't have a fix, so we just didn't ask the question. We didn't bother to ask people.

Yeah. Right.

You know, we see that a lot, right? Like if someone has sexual pain, people don't ask about it because we don't know what to do about it, right? Yeah, same thing. But I think somewhere, I think around 2010 to 2012 or somewhere in there, a new medication came out called Xyaflex. I guess I should backtrack. So Peyronese.

Mm-hmm.

Yeah.

is what is Peyronies? So Peyronies is when you develop scar tissue inside the outer layer of the penile erectile tissue. So it's called the tunica. The tunica is usually made of elastin because the penis stretches, you know, it gets bigger and smaller with erections. But when you form scar tissue, you develop a collagen plaque. So it's basically kind of like

a little knot, like a ball of collagen. And because the collagen is not elastic, then basically have a contracture. So you have a contracture where that collagen plaque is, and then that makes the penis curve, typically. So you can have a curvature anywhere, depending on where this collagen plaque is, it can be anywhere inside the penis, you can have curvature up, down, left, right, in any direction.

So about 10, 12 years ago, a new medication for it finally came out called XyFlex, which is collagenase. So collagenase is the enzyme that breaks down collagen, which is really cool. It's injected directly into the plaque and it breaks down the plaque over time. So it's like a whole series of injections. The whole series is eight total injections over the course of six months.

And the specific arrangement is a little bit complicated, but it's basically two injections a week, wait six weeks, two more injections, wait six weeks, two more, six weeks, two more. And then it's actually quite effective. Initially the studies and what we were quoting patients was maybe it improves curvature like 15 to 20 degrees, but clinically, we've actually found that it can improve curvature much more, even up to 30, 40 degrees, just depending on the.

on the patient, you know, so that's kind of average, I would say. But, you know, given that it's an injection, you know, much less invasive than the surgeries that were offered before, which had more potential side effects, you know, the injections were actually pretty benign, you know, no, you know, you can expect bruising and swelling, but other than that, pretty safe. And the surgeries, on the other hand, when you actually

you

excise the plaque or you can put stitches in to bend the penis back, you know, those have a little bit more risk, especially the excision of the plaque. That one, you can have numbness of your penis and severe, or much worse, erectile function. So that was the issue was that nobody wanted numbness of the penis. Yeah.

And then with the injectable, the collagenous, you have to actually do some remodeling of the penis at the same time.

Yeah. So that is helpful to increase the benefit of the collagenase. basically when you are injecting it, know, collagenase breaks down the collagen plaque. But if you do modeling, which is where you bend the penis the other way, you're basically promoting the disruption of the plaque. So it's almost like you're creating

micro tears of the plaque so that the collagenase can get into it and work more effectively and really increase the efficacy of the medication.

And we know there's been some studies and questionnaires that like Peroni's disease has a negative impact on female sexual function as well for the partners that are having sex with them. Not only obviously logistically trying to figure out what position you can have intercourse in, but also I think the plaques can be painful for people, right? Like in terms of sexual pain.

Yeah. Yeah, for sure. So the plaque can be painful for both partners. So the plaque is painful for the person with the plaque. And because of the curvature, know, we obviously can, if you're, if it's going, if it's a severe curvature and going in different directions, you know, you have sexual pain for the partner as well because of where the impact is of penetration.

Right. So then do you.

So oftentimes if it's more than 30 to 60 degrees, then you have really a limitation on penetration.

And do you recommend like at like when when kind of they're after treatment because I know like some of my patients have said you know they're afraid to be on top again right because isn't that some around like is your recommendations around that?

Mmm. Yeah.

Yeah, so there is a risk factor for Peyronie's disease of something called penile fracture. penile fracture, the most common thing that causes penile fracture is the partner on top where when they come down onto the penis, it slips out and then hits the perineum and then bends the penis. So it's this abrupt bending of a rigid penis.

that causes a tear in the tissue. And then when your body is trying to repair that tear, then you can form a plaque. So that is one thing that can happen. I would say that actually most of the patients that I've seen with Peyronies, it's actually idiopathic. So a small percentage have had penile fracture, but most people don't actually remember any specific trauma that happened.

Sorry.

with significant injuries. So we think that it may be related more to micro trauma over time, just from repeated micro-terrors with regular sexual activity even. So there's no specific recommendations or restrictions on positions or anything like that afterwards. Of course, if you have rough sex that causes bending or any sex that causes bending again, then you could...

has repeat injuries, of course.

So, that's why it's so important for us to really get into some details with patients on.

the sexual function that they have as well as their partners because it can impact both people at the same time. it is, is, you know, they call it couples pause when people have like midlife issues, they call it, they're sexual span. I think Dr. Mohera calls it sex span. think he did a great, he did a great YouTube on that. mean, Ted Ducks talk on that. Well, and then let's talk a little bit about ED then because that's the one

Mm-hmm.

Yeah, sexpan, yes.

that people hear about the most erectile dysfunction. Whenever I ask my patients about their partners, most of them say that, oh yeah, he just pops a blue pill. He pops that Viagra, it's good to go. And so that scares so many of my patients who have general urinary syndrome, or menopause, or pelvic floor dysfunction, because they're like, yeah, he's just popping them. But the reality is Viagra doesn't work for everybody, right? It's not a cure-all for men either, even though in our minds we think, oh, too bad we can't just pop Viagra, that kind of thing.

Mm-hmm.

Yeah, yeah. ED is actually related to Peyronie's also because one of the causes of Peyronie's is when you have ED and your penis isn't as firm actually and then it slips out and then you have a bending of the penis or injury of the penis. So that's another issue related to Peyronie's and ED. And I think both of those can cause pain with the partner.

Because when the penis isn't as firm, I think there can be more difficulty getting into the vagina, right? So kind of this more not as smooth transition can also cause pain with the partner as well. But yeah, there's definitely a lot of treatments actually now available for ED. Medication's one of them.

You know, it actually doesn't work for probably maybe 50 % of people. And yeah, surprisingly, no, it doesn't work for everybody. And often at times, you know, that's because of other medical issues, right? So like ED comes from, you know, it's a vascular deficiency. It's a neurovascular deficiency where you, if you don't have enough nerve signal or blood flow going to your penis, then it can't get the blood to.

Yeah.

get the full erection.

why they say it's all dysfunctions like a look into your cardiovascular health or right yeah.

Yeah, exactly. And, you know, all the comorbidities associated that can cause ED like diabetes, high blood pressure, high cholesterol. You know, if someone's got really severe, you know, comorbidities and their vasculature is, is, you know, so poor that, you know, the, the Viagra doesn't work for them, then we've got to look at other options. So one option is

inject them. So basically an injectable version of Viagra. So it's injected directly in the penis. People who don't have haven't heard about this. Yeah, people who haven't heard of that this don't like the sound of this right because you're injecting it directly into the penis. But surprisingly, you know, we actually have a lot of patients on it, it can be quite effective. And it's just a small diabetic needle. It's like a little pinch.

What an injection.

Yeah, I love them.

Yeah.

It's not painless, but some patients, after they get used to doing it, they say it's almost painless. except for the patients who are really needle phobic, most people can actually be on it, no problem. And that is actually safe for the majority of people, even for people who can't have Viagra because of cardiac issues. So the injection, which...

Can you list those reasons that they can't?

Yeah, I mean, so the main reason why you couldn't have Viagra is if you have angina. So if you're taking, you know, nitro for your angina, you can't also take Viagra because that's a double dose essentially and then you can have severe hypotension. But Trimix, which is the injection, because it's acting locally on the penis, you can use it still even if you have cardiac issues. Yeah.

So that's one option. And then the other option is the inflatable penile prosthesis. So the inflatable penile prosthesis has actually been around for a long time now, I think over 50 years, which is really amazing. know, initially it was non-inflatable. So I would say the penile prosthesis has been around for 50 years. So it used to be a non-inflatable version. Yeah. So.

Great.

Great.

Yeah.

Yeah. Not inflatable. that sounds very alarming, actually.

That's actually still available and they've definitely made it more, you know, actually a really great product for those people who don't want the inflatable version. So there's a malleable or non-inflatable version and then the inflatable version. The malleable version, basically they're just two like medical grade plastic coated and the inside is like some kind of metal rod.

essentially, and you bend it. So you bend it up and down. So when you're not using it, you just tuck it down into your pants. And then when you want to use it, you just bend it back up. So it's actually pretty neat. And then there's the inflatable prosthesis, which

Is that assuming that nope, that you can't get any flow into the people? Like these are the people that really, yeah.

Correct. Yeah. So the injection doesn't work, Viagra doesn't work, know, nothing's working. You're down to your, your penile prosthesis is your only option essentially. Yeah. Yeah. the inflatable one, there's a pump and everything's on the inside, but the pump sits between your testicles and you squeeze that pump and that inflates the part in the penis to become fully erect.

Right.

where you're.

And these are like minor surgical procedures that are done in an outpatient setting.

Pretty cool.

Yeah, yeah. So most of these surgeries are done outpatient. takes somewhere between one to two hours typically to do the whole procedure. You go home, you don't usually need a catheter. Sometimes people leave a drain, which is just to collect extra excess fluid from the surgical field, but that's removed in like a day or two. And overall, it's a very safe surgery. So obviously with any surgery, there's risks.

And because this is an implant, one of the major risks is infection, or at least one of the ones that we're concerned about, right? Because if you have a severe infection, then you have to remove the entire prosthesis, get everything cleaned out, and then replace it with a new one. But that risk is actually overall pretty low. So, you it's definitely very patient dependent and, you know, it depends on patient's comorbidities as well as

Yeah.

know, surgeon experience and all these things, but overall, probably somewhere between one to 3 % risk of infection.

Gotcha. That's good. And then can you talk a little bit about like people that use Viagra versus Cialis?

Yeah, so Viagra and Cialis, they interact with slightly different receptors. So they just have slightly different side effects and kind of pharmacokinetics. So Viagra works a little bit quicker. So it starts working within about 30 to 45 minutes of taking it. That one needs to be taken on an empty stomach. And then Cialis, it works after about

maybe two hours and that one it doesn't matter as much if you take it on empty stomach. Viagra has more like of the kind of upper body side effects which are like facial flushing, indigestion, feeling really warm or headaches. Whereas Cialis has more side effects related to like muscle cramps in your legs and your back and things like

And then the people that have, what do they take it for, like Cialis Daily for BPH and they still get some improvement in their rectal function too.

Yeah, so some people take Cialis daily. It can help with urinary symptoms. Some people take it for erections as well on a daily basis just because when you take it on daily basis, basically you build up a blood level of the medication and so it's kind of always on board. So it's better for people who maybe they have a less predictable schedule, they're maybe dating.

So they don't know when they might be sexually active, when they're seeing their partner. And so it kind of keeps your blood level of this at a certain point so that you're kind of always potentially more ready instead of having to think ahead like, I'm going to have sex in two hours. I got to better pop my pill. But there are these other newer or available online medications that

Yeah.

the choose and know, sublingual and so those are basically like a compounded version, you know, they're not FDA approved, they're the same medication, but they're, you know, they make them in this formulation so that it absorbs into the system easier.

you take it subliminally. I haven't seen this as much, but that's really cool. Well, and then, and so I guess it depends like just anything else like on the patient and their co-morbidities and what they're willing to do and what their insurance covers and all the things, right?

Yeah.

Yeah, you know the good thing is that it's all generics these days, so Viagra, Cialis, these are all really cheap medications to get. It's like, yeah.

I know isn't that I mean, as some of the streets women tell that drives me crazy at how these medicines are women. Women's don't like have them like, you know, at E, you know, sometimes isn't covered, especially for midlife women. So they have to pay out of pocket, like, you know, 300 bucks for three months or whatever, you know, and it's like, whatever equivalent we can get. But some of it, obviously for women isn't that easy. Unfortunately.

yeah.

Yeah.

Yeah.

Yeah, for sure. Yeah, it's a big, big discrepancy between male and female sexual health treatments, for sure.

sure. Yeah. well, I actually asked you Jessica, but what brought you into the realm of sexual medicine? Cause you did a fellowship, as I said in my intro with Dr. Irwin Goldstein. And so obviously, you know, at some point you had to think like, this is something that you were going to focus in on.

Yeah, you know, I think I've always been interested in sexuality. And when I got into medical school, I actually made my best friend in medical school had vulvodynia, except at the time, we didn't have a name for it. And there was nothing in the textbooks. So I think that was kind of the start of where I was like, Oh, I didn't know women could have sexual health issues.

Yeah.

Yeah.

I'd heard of erectile dysfunction, but I was like, I hadn't heard of women having issues. And so that question always kind of intrigued me and I was always kind of looking for things to help my friend. And then when I met Dr. Goldstein at AUA during my research year of my urology residency, it was like a light bulb moment, right? I was like, wow, someone studied this as a urologist.

Yeah.

Yeah,

Yeah.

I can see patients, like female patients, women, who have sexual health issues and we actually have treatment for them. So that was really exciting for me because that was something that I kind of had always been interested in is helping women with their sexual health.

Yeah.

Yeah. Yeah. I feel like everyone says that one. Every fellow I've spoken to has been like, yeah, I met, I'm like, you, do, meet Irwin Goldstein. You're like, wait, let's jump on board. Cause he makes it so like, you know, he's so excited about it. And so like, you know, just really keeps, keeps learning, keeps trying to do more and more and uncover more and more. So it's, it's very inspiring actually.

Hahaha

Yeah, yeah. And I think that, that, you know, as there's more of us, you know, you, me, you know, like Dr. Rubin, Dr. Yoloko, you know, as we move forward, you know, I love that there's so many of us in this space, because now it's not just Dr. Goldstein, right? It's all of us. And when we go to talk to students and residents and on the podcast and talk to people,

Yeah.

Yes, yeah.

Yeah.

Yeah.

Now so many more people are going to know that there is help for them for female sexual dysfunction. So that's awesome.

Yes. Absolutely. Absolutely. Yeah, I agree.

Well, I'm going to put in the show. I really appreciate you coming on Jessica. And I think that, you know, we did a great job covering some of the issues that come up with a dyadic sexual relationship when it comes to, you know, there are people that talk about, you know, the desire discrepancies. And of course, if you have pain, if you have peronies, if you have erectile dysfunction, any of these things, like from either perspective, the desire goes away, you know, we didn't even touch on like SSRIs and how it impacts both couples, both people in the couples relationship. But I think

We've kind of done a great job for listeners to really understand some of the things that maybe your partner's experiencing that you didn't think about or your patient's partner. so at this point, then the recommendation, when you teach residents or medical students, what do you tell them about trying to get both people involved? You're teaching students. But I think that this aspect is so critical to really move the needle when it comes to our

Yeah, yeah, I think it's, yeah.

sex ban and all the sexuality within a couple. Like how do you talk to your students and residents about approaching this concept? Like, I it's a little bit easier because you're seeing both in your office, but like I always try to push my patient, my students like, well, we have to ask about who they're having sex with too.

Yeah, I agree. totally agree. think, you know, I think it can be tough, you know, from a from a gynecologist perspective, because you only see the woman or from, you know, a lot of other urologists who are sexual medicine specialists who only see men because, you know, like my other my other sexual health urology colleagues, a lot of the time, they will be like, I can't, I can't ask them about their partner, like the the the male's partner, because I don't I don't know what I would say to them, right.

right?

but I think, you know, that back to, know, we can't just not ask the question because we don't know the answer. We have to ask the question to be able to start the conversation. And, know, if we need to refer to someone else, you know, one of our colleagues who does treat those things, I think, you know, that will ultimately help both people in the relationship, move forward.

with their sexual health. Yeah, because like you said, you know, I think it really is about the couple, right? You know, oftentimes as the men and the women kind of, you know, you're aging, you're going through a lot of hormonal changes and the libido kind of reflects off each other, right? Like if someone is having a declining libido, someone's erection isn't working. And so you just slowly stop trying, right? And sometimes,

Both people blame themselves and they're in their own kind of shame bubble. They don't want to talk about it because they have a lot of feelings about it. So I think kind of bringing those issues into the open and asking, it's definitely the first step.

Yeah, absolutely. Speaking of fellowships and other sex med docs, does Irvin have the only combined male and female sexual dysfunction? Or do you know? I knew this, right? Because you had told me this, because I told you about Sarah Seager. You started this year. great segue. Sorry.

So we actually have a fellowship at UCI now. So yeah, yeah. So we just started this year.

Yeah, we just started this year. So we have our first fellow this year. We have our second fellow that we accepted for the next two years. So they're working with myself as well as Dr. Faisal Gafi. And we are only accepting urologists because there is also a component of BPH treatment of

prostate treatment related to it. So that's kind of the overall fellowship. I think Dr. Rubin has a fellowship as well and I know see, yeah, yeah. So she sees both men and women. So I think whenever her fellowship gets started, that should be doing both as well.

She's trying to bring it up, bring it into Russian. I think that's one of her.

Yeah.

He'll be doing both, Because I spoke to Sarah Signel on the podcast at some point, but she's the only GYN center that has a sexual medicine fellowship. No, that's not true. think Rachel Pope has one over and... Yeah, okay. I'm telling back. Yes. Like in the last year, right? Yeah.

yes, Rach, yep. Yeah, Rachel. Sweethearts just started also. Yeah, Rachel's fellowship just started as well. Rachel Pope. Yeah.

Sarah's was the first. George Washington University had the first OBGYN sexual medicine center for gynecologists. And then I think yours is the first in an academic setting, right? At UCI for combined. Yeah. Really good. Awesome. Well, that's very exciting actually. There's a lot of sexual medicine fellowships that are just urology male only, right?

Yeah. Right.

Yeah, yeah, we're really excited. Yeah.

There's probably about 20 to 30 urology male predominant sexual health fellowships, would say 90 % male for most of those fellowships.

or don't.

Well, I'm glad that you're out there doing the work and you know everyone else is trying to get you know get the word out and I'm happy that we were able to kind of address some of these issues that at least in a lot of women's health podcasts are not discussed. We have to remember all this stuff.

Yeah, for sure.

Yeah, well thank you so much for having me on. This was really fun.

Next time we'll talk more about the other stuff too, but I think it's a good segue into some of the stuff that you're doing. And I'll put all your information in the show notes so people know how to get in touch with you and any medical students listening and future urologists, know, we have a great option now at UC Irvine. awesome.

Yeah, awesome. Thank you.

Thanks Jessica. Well, I'm Dr. Smita Raman, a gyno girl. Thanks for tuning in to another episode of Gyno Girl Presents Sex, Drugs, and Hormones. Remember, I'm here to educate so you can advocate for yourself. Please join me on my next episode.