Moment: They Took This Medication… and Lost Pleasure During Orgasm (PSSD?)

Summary

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Podcast Summary

Podcast: Rena Malik, MD Podcast

Episode: Moment: They Took This Medication… and Lost Pleasure During Orgasm (PSSD?)
Host: Dr. Rena Malik
Guest: Dr. Irwin Goldstein
Release Date: May 20, 2026

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Episode Overview

In this candid and highly informative discussion, Dr. Rena Malik speaks with Dr. Irwin Goldstein, a renowned expert in sexual medicine, about the serious sexual side effects caused by certain commonly prescribed medications—specifically SSRIs (antidepressants), 5-alpha-reductase inhibitors (like finasteride), and others. The central focus is on Post-SSRI Sexual Dysfunction (PSSD) and related syndromes, their permanence, mechanisms, and the often-overlooked fallout for affected individuals. The episode aims to provide science-backed answers to questions patients may be too embarrassed to ask, challenge medical orthodoxy, and encourage thoughtful prescribing practices.

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Key Topics & Insights

The Prevalence and Mechanism of Medication-Induced Sexual Dysfunction

• SSRIs and Sexual Dysfunction

  • SSRIs are widely prescribed for depression—even to minors—but a small subset (1–3%) may experience irreversible sexual side effects, known as PSSD.
  • Dr. Goldstein:
    • "SSRIs raise serotonin, so like depression, which leads to suicide, and we can stop suicide. So it’s a fabulous drug. ...In about 1 to 3 percent of people are irreversibly changed." (00:43)
    • Despite their life-saving potential, SSRIs can cause persistent loss of pleasure during orgasm, reduced libido, anhedonia, and erectile dysfunction.
    • Animal studies show permanent changes at the neuronal synapse level, particularly in genetically susceptible individuals.

• Weighing Risks and Benefits

  • Dr. Malik emphasizes the necessity of careful consideration:
    • "You have to weigh the risks and the benefits." (02:14)
  • Dr. Goldstein notes the particular problem with using these drugs in non-suicidal, non-severe cases (e.g., school stress or heartbreak in teenagers).

Permanence, Timing, and Individual Variation

• Timing of Onset

  • Effects can appear weeks, months, or years after taking SSRIs (04:21–04:33).

• Symptoms are Broad and Individualized

  • Not a "cookie-cutter" syndrome; presentations include loss of genital sensation, anhedonia, erectile dysfunction, reduced or absent libido, and more.
  • Memorable description:
    • "You touch your genitals and it’s supposed to be a pleasurable thing...It’s like touching their arm." (06:04)

• Recovery Prospects

  • Some patients can regain functionality with interventions (medications, injections), but not full restoration.
    • "They're not going to be back like they once were...but they're going to be way more functional." (06:06)
  • Some may never spontaneously improve; selection bias means clinicians often see the worst cases.

Other Problematic Drugs

• 5-Alpha Reductase Inhibitors (Finasteride, Dutasteride) & Accutane

  • Used for hair loss and acne, but can cause "Post-Finasteride Syndrome" (PFS)—a similar spectrum of permanent sexual dysfunction (07:19–09:09).
  • DHT suppression impairs penile smooth muscle health, leading to irreversible fibrosis (scarring) and venous leak erectile dysfunction in some.

• Irreversibility Explained

  • These drugs, unlike reversible enzyme inhibitors (e.g., Viagra), cause permanent (suicidal) changes to key enzymes and tissues (09:39).

• Awareness Gap & Dismissal

  • Many physicians deny or downplay these syndromes, often because they don’t witness these patients, or are focused on the drugs' primary benefits (10:01–10:16):
    • "I see the side effects. I see the sexual dysfunction. So my perspective, bad drug. Their perspective is good drug." (10:09–10:16)

Diagnostics and Hard Data

• Advances in Imaging

  • Dr. Goldstein describes the use of high-resolution grayscale ultrasound to objectively assess penile tissue health—distinguishing healthy (gray) from scarred (black) erectile tissue (10:59–14:40).
    • "If it’s all gray, perfect. That’s where blood goes everywhere. That’s erectile tissue. ...If you take a person with five days of priapism...you see basically black." (12:18–12:53)
  • Their research finds that both PFS and PSSD patients often develop irreversible tissue scarring consistent with observed dysfunction.

• Erection Hardness Scale

  • A four-point scale is explained, relating subjective erection quality to objective imaging findings (13:40–14:40).
    • Memorable comparison: "Like a noodle." (14:24)

• Biological Mechanisms

  • Both syndromes, whether from DHT depletion or oxidative stress (O2 radicals), can lead to apoptosis of penile smooth muscle and permanent loss of function (15:04–16:09).

Viagra: How Groundbreaking Research Changed Sexual Medicine

• Viagra’s Publication Story

  • Dr. Goldstein was first author on the seminal Viagra study.
  • The publication faced repeated rejection before acceptance, with the New England Journal of Medicine demanding more practical, patient-centered outcome data (16:09–19:26).
    • Notable anecdote: It took "seven rejections...to get it through" (17:10), and required going back to “each and every patient's diary” (18:04).
  • Final results: 69% of sildenafil users improved erection, versus 23% placebo (19:38).
    • "69. It was a great number, of course, 69%. And I said, you know, this was made to happen." (19:39)

• Unexpected Fallout: Female Sexual Medicine

  • After Viagra's debut, Goldstein’s office was flooded with calls from women seeking solutions for their sexual dysfunction, highlighting a gap in gynecological care (20:08–20:54).
  • Gynecologists often deflected these cases, sending women back to urologists.

The Gender Gap in Sexual Medicine

• Training and Guidelines
  • Urology now includes sexual medicine, but gynecology largely does not. Dr. Malik and Dr. Goldstein discuss how this impacts patient care and medical education (21:03–22:17):
    • "There’s no part of gynecology in sexual medicine. It’s so weird. ...Just like a big hole in teaching and understanding." (21:33–22:17)

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Notable Quotes & Memorable Moments

• On the scale of PSSD/PFS populations:

  • "If 50 million people are on these products, you know, and 1%... have them, that's a lot of people." (10:40–10:53)

• On PSSD symptoms:

  • "[For some,] you touch your genitals and it's supposed to be a pleasurable thing. It's supposed to be different than touching your arm. It's like touching their arm." (06:04)

• On advances in imaging:

  • "We have probably no one...We bought this $150,000 thing that allows us to get high resolution grayscale of the erect penis." (12:18)

• On the toughness of publishing Viagra’s clinical trial:

  • "Seven rejections. ...It took us, I don't know, but seven, eight months to get it through the New England Journal editorial board. I have to tell you, they are not easy." (17:11)

• On gender gap in care:

  • "Gynecology does not have guidelines. ...that's crazy." (21:32–21:34)

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Timestamps for Key Segments

• 01:16 – Why PSSD may be irreversible: synaptic changes, susceptible individuals
• 04:21 – Onset variability: can develop weeks or years after SSRI use
• 06:06 – Describing individual variation in PSSD symptoms
• 07:17 – Introduction to PFS and other problematic drugs
• 09:39 – Irreversible changes caused by 5-alpha reductase inhibitors
• 10:46 – Prevalence and risk percentages
• 12:18 – Detailed explanation of penile imaging and hard data
• 14:24 – Erection hardness explained with memorable “noodle” analogy
• 15:04 – Apoptosis and fibrosis as underlying mechanisms
• 16:15 – Viagra discovery and struggles with medical publishing
• 19:38 – Notable Viagra efficacy statistics
• 20:08 – The gender gap in sexual medicine and fallout from Viagra’s release
• 21:32 – Absence of sexual medicine in gynecology training

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Conclusion

This episode offers a rare, unvarnished look at the persistent sexual side effects of SSRIs and similar medications, challenging the medical status quo and advocating for better patient education, targeted research, and multidisciplinary care. Dr. Goldstein and Dr. Malik deliver both hard science and heartfelt concern, equipping listeners with knowledge that could profoundly influence their medication choices and spur crucial conversations in clinical settings.

Transcript

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[Host/Interviewer]

Well, I do want to talk about the medications that you said cause sexual dysfunction. So SSRIs, which are antidepressants, are given widely like water.

[Dr. Irwin Goldstein]

So how do people add to people who are minors?

[Host/Interviewer]

Yes.

[Dr. Irwin Goldstein]

This is a nightmare. These are people who say it's 1 to 3% of all users will have this PSSD thing, which is a disaster. SSRIs raise serotonin, so like depression, which leads to suicide, and we can stop suicide. So it's a fabulous drug. Right. But its effect on the neuron and on the synapse and on neurotransmitters. In about 1 to 3% of people are irreversibly changed.

[Sponsor/Advertiser Voice]

Why is it irreversible?

[Dr. Irwin Goldstein]

Well, we're writing the paper on this right now. We're deep, deep into it. And you just have to study the animal studies that they do. They provide it and they find neuronal synapse and neurotransmitter changes that you don't ever get back. So there's something about the drug in genetically susceptible people that irreversibly changes their function. So that's a problem because we have tons of people who have taken this drug because they were unhappy changing schools and the parents gave them an SSRI so they would have less stress. Okay, but without the knowledge that for the rest of their lives they would have no pleasure during orgasm. Give me a break. And you have to put the risks and the benefits together.

[Host/Interviewer]

Well, I mean, yes, I think if someone's severely depressed and suicidal, that's an absolute. I mean, you gotta weigh the risks and the benefits, Right? I tell my patients all the time, look, you have to weigh the risks and the benefits.

[Dr. Irwin Goldstein]

But it's stressful at school. No suicidality.

[Host/Interviewer]

Just need to be very, very thoughtful.

[Dr. Irwin Goldstein]

Or broke up with someone who's 14 years old, you know? Yeah, they had their first love. I don't know, because I see the people who said, I did not make this decision and I'm never going to have a sex life again. Wow. WO is me. I mean, we see that over and over again.

[Host/Interviewer]

Okay.

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[Host/Interviewer]

Have you seen patients where they've just taken it for a short period of time and it's like, how long does it take for this neuronal activity?

[Dr. Irwin Goldstein]

So this is the weird part of pssd. It could take three years for this to happen and it could take a month or, or a few weeks on this drug. So who knows, right? It has definitely seen patients where they've

[Host/Interviewer]

been fine for years and then three years later they've started noticing that their whole, you know, their whole sexual milieu has changed.

[Dr. Irwin Goldstein]

Yeah. And it's not like, like when we studied ed, we had patients who had ed, they had normal libido, normal orgasm, normal sensation, normal pleasure during orgasm. It was an ed Soul sexual dysfunction. Boy, oh boy. Pssd, it's this bizarre multi dimensional thing. No libido, poor sensation, anhedonia erectile dysfunction, I don't know, whatever you can think of, it's not working. It's awful. It's so broad. So it's so individual how people present.

[Host/Interviewer]

But some people get Better. Right.

[Dr. Irwin Goldstein]

So what I tell patients, because we see a lot of PSSD now as our paper is coming out. It's like this paper, paper. It's kind of like this thing that has been gone for like six years. We've been developing this thing. But whatever the. The. Each person has a unique presentation of pssd. It's not a, you know, like a cookie cutter. All PSSD people are the same. They are not. They're. They're way. Some people have no ed, and some people. Their prime thing is ed. Some people, it's. They can't feel their genitals, but it's not that they can't feel it because if you touch it, they can feel it, but they can't. They don't get this. You touch your genitals and it's supposed to be a pleasurable thing. It's supposed to be different than touching your arm. It's like touching their arm.

[Host/Interviewer]

Right.

[Dr. Irwin Goldstein]

And it's not like this special thing and on and on, it just keeps going. But we'll address each issue. So I'm not going to cure people with psst. They're not going to be back like they once were if they ever had, which is like the minor people have never had, which is very frustrating. But like people who are 25 and 30 who make the decision to go on, but they've had sex, they're not going to get back to the way they were, but they're going to be way more functional. We're so good with erections. We can really help people. I mean, they may have to take a pill or a shot or something, or a subcutaneous injection, something. But we can get them functional that way. As we talked about orgasm issues, we can do that. We can help their libido because, you know, straight up.

[Host/Interviewer]

But you think that they're on their own. Like with time, things won't improve.

[Dr. Irwin Goldstein]

Well, that's why they're presenting, because things on their time are not improving. It could be that there's a subpopulation of people who do improve, but we're not going to see them. So our bias is we're getting the other population. The. No. Improved version. Yes. So beyond SSRIs, there's these five alpha reductase inhibitors. Boy, are they bad.

[Sponsor/Advertiser Voice]

Yeah.

[Host/Interviewer]

Finasteride being the most common, Finasteride being

[Dr. Irwin Goldstein]

the most common, Dutasteride being. And then you have the Accutane group, and then you have the minoxidil group. They're kind of all the same. They. Well, they influence so the way it's proposed to the physician by the pharmaceutical groups are that this 5 alpha reductase is designed to impact negatively on the synthesis of dihydrotestosterone, period. Like, nothing else is bothered. But there's like 10 biochemical reactions that depend on the activity of 5 alpha reductase, including stuff in the brain, for which we get back to the PSSD thing. There's a kind of an interesting similarity between what we call PFS post finasteride syndrome and PSSD post SSRI sexual dysfunction. Because of the influence negatively of SSRIs on the brain and five alpha reductases on the brain. There is a lot of biochemical reactions that would otherwise be used that can't be used because of 5 alpha reductase. And then we get into the reality that dihydrotestosterone is really an important hormone for the corporal. The penis, smooth muscle cell. Without it, apoptosis or cell death happens, which turns into scarring, which turns into erectile dysfunction. That becomes permanent, or we can't really change the collagenization of the erectile tissue that leads to this thing called venous leakage. And it's very frustrating, you know, and these are people who are 16, 18, they look at themselves. Their father's bald, their uncle's bald. They don't want to be bald. And they just go to the Internet because you don't need to see a doctor for five alpha reductase inhibitors. They're not given any information on side effects or just briefly.

[Host/Interviewer]

Yeah.

[Dr. Irwin Goldstein]

And they end up with this PFS thing.

[Host/Interviewer]

Is that also permanent in your experience?

[Dr. Irwin Goldstein]

I believe it to be the exact same kind of concept.

[Host/Interviewer]

Reversible neuronal changes.

[Dr. Irwin Goldstein]

Well, let's just say that in many cases their DHT remains low despite them being off the drug. So they have changes to the enzyme that may be irreversible. Yes. So the thing is, like, Viagra is an enzyme inhibitor, but it's a reversible one.

[Host/Interviewer]

Okay.

[Dr. Irwin Goldstein]

The five alpha reductase inhibitors are irreversible enzyme inhibitors. They cause suicidal changes to the enzyme.

[Host/Interviewer]

Gosh.

[Dr. Irwin Goldstein]

Yeah.

[Host/Interviewer]

So there's a lot of. I'm sure physicians listening to this that are going to say, you don't. This is all false.

[Dr. Irwin Goldstein]

Oh, it's all false.

[Host/Interviewer]

Yeah.

[Dr. Irwin Goldstein]

Well, that's fine. I have no problem with them saying that. It's just they don't take care of these people.

[Host/Interviewer]

Right, right.

[Dr. Irwin Goldstein]

And they may be invested in the value of the drug. For example, psychiatrists see the suicide.

[Host/Interviewer]

Yeah.

[Dr. Irwin Goldstein]

I see the side Effects. I see the sexual dysfunction. So my perspective, bad drug. Their perspective is good drug.

[Host/Interviewer]

Yeah.

[Dr. Irwin Goldstein]

And then there's these hair people. You know, people want hair, but I. They're saying how fabulous the drug is and I say, whoa, I'm seeing all the sexual side effects.

[Host/Interviewer]

Right.

[Dr. Irwin Goldstein]

So I know it's just on. The reality is the drugs cause these

[Host/Interviewer]

things and there's just no way for us to predict who's going to be the.

[Dr. Irwin Goldstein]

Yeah, that's the problem.

[Host/Interviewer]

Right. Because it's a small subset of people, like less than 1%, probably.

[Dr. Irwin Goldstein]

It's just that millions of people are on these products.

[Host/Interviewer]

Right, right. It's given out like candy. A lot of these medications.

[Dr. Irwin Goldstein]

So if 50 million people are on these products, you know, and 1% are. Have them, that's a lot of people.

[Host/Interviewer]

Yeah, it really is. That fibrosis thing is really crazy to me. That's really scary.

[Dr. Irwin Goldstein]

Yeah. So we have a brand new ultrasound strategy. So there is. Urologists perform intracavernosal injections and then you get an erection and then you do what's called a Doppler ultrasound. So it looks at the blood flow, but ultrasound, that's Doppler, that's blood flow related, is a sort of a nuance. It's sort of a new thing. The old ultrasound was grayscale. Black, white, gray. You looked at a baby, you didn't look at the blood flow to the baby. You looked at the facial features, you looked at the shape of the head, the arms, the legs. That's grayscale. So for reasons unclear to me, grayscale has been ignored by the urologic community studying this stuff. So we purchased a device that is a very high frequency. It's 15.4 MHz. So it has amazing resolution with the probe touching the penis. Like when you examine a baby, you put the probe on the pregnant abdomen and you're like a foot from the intended target.

[Host/Interviewer]

Yeah.

[Dr. Irwin Goldstein]

So you don't need fancy equipment for that.

[Host/Interviewer]

Right.

[Dr. Irwin Goldstein]

But when you want to get high resolution with 1 millimeter from the contact point of the probe to the erect penis, you need a fancy piece of equipment. And not everybody has that.

[Host/Interviewer]

Yeah.

[Dr. Irwin Goldstein]

So we have probably no one. Probably. We have the ability. We bought this $150,000 thing that allows us to get high resolution grayscale of the erect penis. So if you can get people in a rigid sustained erection with intracavernosal agents and you do grayscale with the device, if it's all gray, perfect. That's where blood goes everywhere. That's erectile tissue. If you take a person with five days of priapism and he's got kind of a dead penis and you ultrasound that, you see basically black.

[Host/Interviewer]

Yeah. Just for clarity, a priapism is an erection that doesn't go away. When you've had it for five days, it means that there's no more blood flow going in or out. And all the tissue is probably fibrosed and scarred.

[Dr. Irwin Goldstein]

And if you're listening and you have it for more than four hours, get your body to an emergency room.

[Host/Interviewer]

Yes, please. It's not fun. Go to the ER immediately.

[Dr. Irwin Goldstein]

Okay. Having said that, in the state of priapism for multiple days, which is just an awful state, the tissue's basically dead. So it's all basically scar tissue at this point. So no blood goes to those regions. So on grayscale you'll see dark, like black. Okay, so we have now a discrimination between healthy, healthy tissue, gray and black tissue, which is sort of non healthy tissue or dead.

[Host/Interviewer]

Yeah.

[Dr. Irwin Goldstein]

Okay. So we have these thing called the erection hardness scale. I spent like multiple years on this crazy thing. You push down on a series of rods. One rod, when you push down, does not buckle. And we call that 4 out of 4 erection hardness scale. And that's like the normal physiologic boner version erection. And then three out of four, you press down on it, it buckles a little bit, but it's still able to have penetration. You press down on the 2, there's even more buckling, and you can't really proceed. But it's close to being good. Just not good enough. And then one out of four is this nightmare. Like, you press down and it's has no rigidity.

[Host/Interviewer]

Like a noodle.

[Dr. Irwin Goldstein]

Like a noodle.

[Host/Interviewer]

Okay.

[Dr. Irwin Goldstein]

So there we go. So what we've now done is divide the gray scale by the erection hardness scale. So the 4 to 4 erection is all gray. The complete horrible thing is pretty much all black.

[Host/Interviewer]

Yeah.

[Dr. Irwin Goldstein]

And then there's gradations of gray and black on the. The tweeners, we call them. So grade three out of four is mostly gray, but a little bit of black. Two out of four is little more. So we now are doing ultrasound on our PFS patients and our PSSD patients.

[Host/Interviewer]

Yeah. And what do you say?

[Dr. Irwin Goldstein]

So now we're finding that they get scarring.

[Host/Interviewer]

Wow.

[Dr. Irwin Goldstein]

Which is the scary part. Their ED is the irreversible version. It's not the psychologic one. It's the irreversible. So from the 5 alpha reductase community, the apoptosis the cell death that leads to the scarring is due to inability to synthesize DHT dihydrotestosterone, which is the goal of the drug. So you don't have acne in one end or you don't lose hair on the other end, but you don't have penis smooth muscle in 1 to 3% of patients who are susceptible wild. So that's horrible. And then the PSSD community, we've identified oxygen radicals. So O2 is the normal oxygen. If you make it O3 negative, it's really an aggressive chemical or molecule and it goes after smooth muscle causing apoptosis. So it's the same concept as 5 alpha reductase. Hurting tissue as SSRIs hurting tissue. So yeah, SSRIs is supposed to act on the brain. Guess what? They also act on penis. Gosh, we're stuck in craziness. Right?

[Host/Interviewer]

Well, let's take it back a little bit. You were actually the senior author on the Viagra paper.

[Dr. Irwin Goldstein]

Yes. 19. It was May14. I can tell you exactly that.

[Host/Interviewer]

That's amazing. First of all, such a huge accomplishment. But that changed the game for men's sexual health.

[Dr. Irwin Goldstein]

Yeah, I mean it was the first ever oral product. It wasn't designed for patients. This was to get the word out to practitioners. We haven't ever published the Phase 2 and Phase 3 data from the multi institutional Phase 2 and Phase 3 trials that the FDA requires. So that was the first time it was published.

[Host/Interviewer]

So what was.

[Dr. Irwin Goldstein]

By the way, there's a whole story to this.

[Host/Interviewer]

Yeah, I want to hear the story.

[Dr. Irwin Goldstein]

So I submit. I was first author and the New England Journal is in Boston. Right. So I'm in Boston. I was Boston at that time. Now in San Diego. Happy.

[Host/Interviewer]

Especially right now where it's snowing in like negative.

[Dr. Irwin Goldstein]

Could not be any more pleasant to be here. So we submitted it and we said okay, a no brainer. Everyone would realize how important this was. It got rejected.

[Host/Interviewer]

Really?

[Dr. Irwin Goldstein]

By the New England Journal. They wanted this, so we changed this and then we resubmitted. Seven rejections. Seven consent. It took us, I don't know, but seven, eight months to get it through the New England Journal editorial board. I have to tell you, they are not easy.

[Host/Interviewer]

I'm sure not.

[Dr. Irwin Goldstein]

But what happened with the New England Journal is really fascinating because what they required at the end of the day was our data was based on the iief. We talked earlier on the FSFI Female Sexual Function Index. But the International Index of Erectile Function was developed by Pfizer to Get it through the fda, which required a questionnaire, had to be validated. That takes another few years to do a few dollars. But it was a validated questionnaire, the iif. And we passed all the standards of placebo this way, sildenafil that way. Statistically significant difference. And the New England Journal said, there isn't a doctor on earth that didn't know what the F you're talking about with an improved iif. If you want get this through, you're going to have to go back to each and every patient's diary, find out. Because we had their erection hardness data. I took the pill and my erection was almost hard. That would be three. Or my erection was really soft and couldn't be used. That was the one. Or my erection was this boner thing and that was erection four. But we had all that data. But we never used that data. It was just, you know how that they collected that. So we had to go back to the thousands of people, all their uses of the medication, and get their diaries to identify when they had a two, you know, to be in the triad of ed. So a lot of people were onesies and twosies, but then on the drug or placebo, they could be a three or a four. So we took people who had a three and a four as the people who were able to have sex and how often that happened on active drug and how. And with that we got approval. But boy, oh boy, that was an issue. But actually it made it more real. I think it was. I think, I think the New England Journal. Is the New England Journal because it is the New England Journal. Yeah.

[Host/Interviewer]

Yeah.

[Dr. Irwin Goldstein]

So do you know what, do you know the. I'll never forget this. What was the percentage of active drug users Sildenafil, to get them from a 1, a 2 to a 3 and a 4?

[Host/Interviewer]

60%.

[Dr. Irwin Goldstein]

69. It was a great number, of course, 69%. And I said, you know, this was made to happen.

[Host/Interviewer]

It was so true.

[Dr. Irwin Goldstein]

And it was only like 23% for placebo, something like that.

[Host/Interviewer]

What was the response by one, the medical community and then patients.

[Dr. Irwin Goldstein]

Yeah, So I was the first author. So I was the communication person. Yeah, we didn't have cell phones and stuff then. It was phones.

[Host/Interviewer]

Yeah.

[Dr. Irwin Goldstein]

So our office was insane.

[Host/Interviewer]

Yes.

[Dr. Irwin Goldstein]

I mean, my poor staff hated me. But we fielded every call and. But they were from women. That was the crazy part. Yeah, I assumed everything would be men, men, men. But the women were saying, okay, Viagras for them, I don't have orgasm, I have pain when I Have orgasm. I have arousal problems. I can't. I have no. Boy, it really hurts when it penetrates me. I mean, all the gamut of female sexual dysfunction things were brought up, and my response was, hey, I'm a urologist. I deal with men. Go to your gynecologist. Someone will help you.

[Host/Interviewer]

Yeah.

[Dr. Irwin Goldstein]

And inevitably, most phone calls came back and were saying, gynecologist says go see you. I don't deal with this stuff.

[Host/Interviewer]

It's so interesting to me because I also mistakenly thought for a long time that gynecologists dealt with all the menopause issues. And there is.

[Dr. Irwin Goldstein]

I thought you were going to say sexual health.

[Host/Interviewer]

Well, that too. But you already addressed.

[Dr. Irwin Goldstein]

They do not.

[Host/Interviewer]

But so that was what put the onus on me to really start learning all this stuff. Because I was like, well, you know who is.

[Dr. Irwin Goldstein]

Well, the AUA has guidelines now.

[Host/Interviewer]

Now they do. But even when I trained, there was not.

[Sponsor/Advertiser Voice]

There was not anything.

[Dr. Irwin Goldstein]

We just lectured in the government. Kimbrough thing. I gave the whole menopause thing. That's great, because the AUA has guidelines now.

[Host/Interviewer]

Yes.

[Dr. Irwin Goldstein]

Well, just for the general, Gynecology does not have guidelines.

[Host/Interviewer]

Yes. Yeah.

[Dr. Irwin Goldstein]

Isn't that weird?

[Host/Interviewer]

That's crazy.

[Dr. Irwin Goldstein]

That's pretty weird. Anyways, the phone calls from the Viagra led to the realization that we had to deal with women, that the parallel tract urology is a tract in sexual medicine. At this presentation, there's a sexual medicine group of abstracts presented and talks given. They have stones, they have cancers. But there's a track called sexual medicine, and that comes from 1970s, when we started doing penile implants. It became a part of urology. There's no part of gynecology in sexual medicine. It's so weird. So it's just like a big hole in teaching and understanding and education in gynecology.

[Host/Interviewer]

Well, I've always believed that the people who do fellowship in female pelvic medicine,

[Sponsor/Advertiser Voice]

like urogynecology, they don't get this.

[Host/Interviewer]

They should, though, right?

[Sponsor/Advertiser Voice]

We're taking.

[Dr. Irwin Goldstein]

Should I get.

[Host/Interviewer]

I mean, we're literally operating in the vagina China. And we're.

[Dr. Irwin Goldstein]

But, you know, it's like radical prostate patients. They don't necessarily want to know what evil they're doing.

[Sponsor/Advertiser Voice]

If you guys like that clip with Dr. Irwin Goldstein, make sure to check out the full episode right here.