MAJOR SEX TALK WITH DR PAUL GITTENS

For those of you guys new to Cat on the Loose, welcome to our fast-growing worldwide community, our cat kingdom, where we can speak freely about sex, dating, and relationships with no judgment or filters. This podcast is a little bit different than your usual podcast because it is 100% organic, meaning we do not edit our interviews at all.
It's never scripted. It's a very real conversation and it's not always in studio.
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My guest today, Dr. Paul Gittins, MD, is one of the leading sexual medicine physicians in the country.
He's an expert in the treatment of sexual health for men and women, and a specialist in male and female menopause and male infertility.

Dr. Gittins is also one of the country's leading specialists in sexual function for men and women, hormone replacement therapy, male infertility and wellness.
I try to cram in as many questions as I possibly could about this very important subject, our sexual health and wellness. And I really hope you guys enjoy this super important episode with Dr.
Gittins.

Before today's episode with Dr. Gittins, I want to say thanks to a couple of sponsors that make

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Gittins, it's such an honor to have you on Cat on the Loose all the way from Philadelphia. Thank you so much for doing this.

Thanks for having me on Cat on the Loose.

I am so excited to finally meet you.

I am so excited to have you because we were trying to find an expert when it comes to

sex and sexual health. And obviously you are on the top of the top of the top of your game.
And as I was saying before we started, we have 10 million questions. I want to try to squeeze in as much as possible.
And we only have an hour. So are you ready to rock and roll? I am ready.
I am ready. I've been waiting for this for the last week and a half.
And I just couldn't wait to get on the show. Wow, amazing.
I'm very honored. Thank you.
The first question might seem silly, but this is my question. And a lot of my listeners agree with me, but I want to know your opinion as a doctor, as an MD and as a man.
And tell me if you think this is just my perception, if you think this is a myth. When we talk about sex, I'm a woman talking about sex, right? I do a sex podcast.
I feel this is still such taboo. It's still a subject that people cringe.
And because of that, it's so hard. So many people many times don't seek a doctor's help, have horrible sexual lives, don't even listen to a podcast, because they're so embarrassed even talking about sex.
Do you have the same perception? No, I totally agree. I think that, especially like when in the United States, you know, and it probably has to do with our Puritan, like how the United States was formed and all these other things.
But, you know, we see sex all the time on TV. You know, it's everywhere.
You might hear it on the radio. We see billboards.
But when it's time to settle down and talk about sex, we do a horrible job yeah doing it and and it's I think it's kind of like the American culture but we need to do a better job and so that's why I'm you know I'm just excited to have someone like you that's that's talking about it that's educating the people out there. And so if people are having problems with sexual function, either male or female, they can listen to you and say, hey, listen, like I heard this on Cat on the Loose.
This is something that I'm dealing with. And maybe that empowers them a little bit to move forward and advocate for themselves and to get help.
So I agree with you. I think that we do have a problem in this country of talking about sex, for sure.
And then sexual dysfunction. Yeah, no, absolutely.
And we're going to get to that very soon. And I completely agree.
It's a huge problem in the United States. I come from cultures, Brazil and France, that it's not that big of a deal.
And I feel it's my job as a communicator, as an artist to open up these conversations. I get a ton of backlash.
I get called all kinds of names. I get called a whore.
I get called this and that and that because I'm talking about women living happy, fulfilled sex lives. I actually think the world would be a much better place if more people were having much better sex.
You are a doctor that specializes in sexual health and wellness. Do you agree? Do you tell your patients that? I think it would solve so many problems, world problems.
And I'm not kidding right now, I'm dead serious. Do you agree with me? Well, I think that when you talk about sex and you talk about all the great benefits that it gives to, that happens in the brain in terms of like dopamine and good serotonin and norepinephrine and all these great things, it does make someone feel a lot better.
But also when you talk about sexual dysfunction and you see how it can compromise someone's self-esteem and their self-confidence and how they feel about their partner and their relationship, and so that can boil over to a lot negative feelings and a negative attitudes that we may see.

So sex is just not about just the act.

It's about kind of, it's about the hormone release.

It's about the communication with your partner.

It's about the relationships.

There's so many great attributes or great things that happen after,

after sex.

Yeah.

I totally agree.

It's, it's a medical thing, right? It puts, and and i'm not a doctor but i always talk about that on the podcast it has been proven over and over and over again that it puts so many wonderful chemicals on your brain that it literally makes you feel better it's better than than stuffing yourself with uh antidepressants and all that crap. Yeah.

Well, it's definitely beneficial for the brain and self-esteem and our relationship. So I totally agree with you on that.
Okay. So let's break down because people have so many questions, so many issues.
This would be like a 10-hour interview. So let's try to squeeze the most important ones.
A lot of people say, and especially like as they age, which honestly, I don't know if it's true or not, because in my case, as I age, I feel more comfortable with my body. I feel more comfortable with myself.
I'm always feel like I'm having the better sex as I age. So to me, it's the opposite.
But most people complain. My listeners from all over the world, they send messages like they lose interest in sex, low libido, right? Men, like you said, erectile dysfunction, like their penis.
I feel like I have to be respectful because you're a doctor. but I feel funny saying penis because I always say like the dick,

the dick,

but I want to be respectful in front of you.

Their penis doesn't work properly.

And for men,

their penis is like the trophy,

right?

It affects their ego.

It affects their emotion.

If it doesn't work properly,

messes up their,

their life.

And then it causes divorces. It causes people to cheat on each other.
It messes up the whole system of their lives. So that's usually the number one complaint, like that as they age, it causes chaos.
So what do you say for a woman or a man that is having that problem? What is the first step? So, just like as you said, I think that as women and men grow older, especially women as they grow older, I do find that a number of women, they do feel more comfortable with their bodies. And so, I think that's a plus.
And that's an advantage. Whereas when I have younger patients, they're just not sure about like masturbation and like how they should feel and if someone else should be giving them orgasms or should maybe give themselves orgasms etc but as we age we do our hormones actually decrease right and so as women go through menopause their estrogens go down their testosterone.
And with that, that can lead to issues with libido, right? It can have some, some of our patients have problems with pain with intercourse. It can also lead to either delayed orgasm or no orgasm at all, right? So as women age, we have to make sure that we are paying attention to their hormones.
And so some of the treatments that we use is our bioidentical hormonal treatment that will allow their testosterone to go up or their estrogen to go up and we manage their progesterone as well which can help with their libido but it can also help with the difficulty that they may be having with sex in terms of pain or what have you. Guys, the same

thing happen, right? So as guys get older, their testosterone goes down, right? Their estrogens go

down as well. And because of that, they can have some issues with libido.
But also with men in

particular, when you look at the vasculature to the penis, right, they can have some issues where

they're not getting enough blood flow to the penis or too much blood flow is leaking out of

the when you look at the vasculature to the penis, right, they can have some issues where they're not getting enough blood flow to the penis or too much blood flow is leaking out of the penis, which can lead to erectile dysfunction. So, you know, for both sexes, you know, there is, there is a decline in hormones and there could be a decline in sexual function, but that doesn't mean you should give up.
There is hope at the end of the tunnel, right? There's so many things that we can do to amplify the effects of, or we can substitute hormones and to get men and women to be able to perform the way they want to. Okay, so you said two really important things there.
The first one I love you said, it doesn't mean you should give up because a lot of people give up. A lot of people are like, whatever, okay, I'm i'm not gonna have sex anymore i personally think that's a huge mistake i think if you give up on having quality sex the quality of your life decreases do you agree i think that um for many people i think that um the quality of their life may decrease i think it depends know, I think that there are some people who are just not sexual as they get older

and they may find other reasons to or other ways to kind of fill that void.

Right.

But I think for a number of people, when they do have sexual dysfunction, it can affect

the relationship and how they feel about themselves for sure.

Oh, yeah, totally.

And another thing is, which is a huge debate. I don't know, because you're on the East Coast in Philadelphia.
I'm in California. I know cultures can be very different.
But here in California, some doctors and some hospitals, and I'm not even going to name names, but they are completely against testosterone replacement therapy for men. They say, oh, it can cause cancer.
There are complications, blah, blah, blah, blah, blah. And I have guy friends that they go to the doctor.
They're in their 50s, in their 60s. And the doctor's like, here, take Viagra and go home, which is kind of like putting a Band-Aid on the problem, right? It doesn't really fix the problem.
And on the other hand, there's like a lot of great clinics, like super expensive clinics with good doctors all over Beverly Hills, all over California, that they say, no, just take the testosterone shot, na-na-na, and you're going to have great sex. So can you give us your opinion regarding the testosterone replacement therapy? Because so many guys ask this question.
So, of course, and I get this question all the time, is testosterone the key to sexual health? You know, is it? And the answer is it depends, right? And so it's so important that if a guy is having some problems with erections or a little libido or what have you is they go through a full workup they got to go through a full workup because then you can really truly then you can truly figure out what's going on with that person right for some guys the testosterone is a factor for other guys it's not right and if you give testosterone to a person that doesn't need it, nothing's going to happen. He's not going to have any results.
Right. So in our practice, what we do is we have everyone come in.
We do a great physical exam. We look at all their medications because medications can also cause some issues with libido as well as with erections.
right we do nerve testing to make sure it's not a nerve issue. We do an ultrasound to make sure that we know how much blood flow is either going to the penis or leaving the penis, right? And then we kind of figure out a plan in terms of what to do.
So in general, testosterone is fairly safe, right? We do know with newer studies that it doesn't cause prostate cancer. So we do know that, right? But we do also know that if you give too much testosterone, then you can have side effects, right? Your red blood cell count can go up and you can have some issues with stroke and blood clots and all these other things.
So it should be used, when you use it, you have to be able to use it safely and know the kind of the side effects and what to look for. Right.
So I'm a I'm a proponent of testosterone if a patient needs it. But testosterone is not the key most of the time to erectile function.
Usually it supports erectile function, but then we actually have to treat the penis itself. Right.
So we're doing usually a combination for guys that have low testosterone that also have erectile dysfunction. And that's what a proper workup will allow us to discover.
Okay. So when you say treat the penis, can you be more specific? What else would you do? Because I know so many guys out there, I have a massive male audience.
I know this is a very, very delicate subject. I know so many guys are embarrassed talking about it to their partners, seeking help.
Like I said, it affects their ego. It affects their lives.
This is an opportunity that they can actually listen and maybe feel encouraged to seek help. So what else could they do? Okay.
So the first step is always lifestyle. You know, I always tell guys, exercising, eating right is the first thing to providing good health to your penis.
So the better your heart is, the better your penis is going to be. That's the easiest.
That's something that anyone can do. Anyone can go outside.
They can walk. They can, they can try to run.
They can get on a cycle. They can swim, whatever.
It's free. You know, exercise is free, right? Also eating properly is so important.
Like if you're, if you're eating fast food every day, it's not going to help your penis at all. Right.
So we want to make sure we're eating the right foods. We want to make sure we're eating healthy, right? We want to make sure that our weight is under control, right? If you have diabetes, we want to make sure our sugars are under control.
If you have high blood pressure, we want to make sure that's under control. But if you think about it, you know, all these things, diabetes, hypertension, high cholesterol, all these things, most of them, not all of them, some of it is obviously hereditary, but if you diet or at least you eat healthy and you exercise, most of those things are going to get better or they'll improve, right? And so by making them better or improving, then what's going to happen is your penis is going to get better, or at least your penis isn't going to have that steep decline in erectile function, right? It's going to happen slowly and gradually as opposed to kind of dropping off a cliff.
So that's really, really important. And then after we talk about exercise and we talk about diet and after we do a workup, maybe it's hormonal support, right? We want to make sure we're giving hormones to the right person at the right doses.
We don't want't want to go crazy some of the problems with these hormone clinics is you come in it's the same dose for everyone they get everybody really really high and guys can have some problems so we want to make sure that we're kind of you know we're tinkering with their hormones so we're getting it just right for that particular person right because hormone levels may be different for each person maybe somebody does well at 500 where if we're talking about total testosterone uh where another person may do well at 900 so we got to figure out what's going to be the best for that person and then in our practice we have a lot of advanced things that we do uh we use something called core wave therapy which is focused low intensity shockwave therapy we use prp We use Botox. But these things hurt a little bit, right? And a lot of men are very intimidated by that.
By what? Like all these other treatments that hurt. No, you know, I'll tell you that.
I mean, the pain is very minimal for these treatments. Yeah, there's not a lot of discomfort at all.
If you go to the, if they're using the right machine, you know, I would say like there's not a lot of discomfort at all. I mean, my guys don't complain about that.
Oh, okay. So, you guys are tougher than our guys here on the right side.
No, no, no, no. It's not true.
It's not true. You guys are tough on the West Coast.
I'm in New York too. too so you know how men are right the minute you talk about needles and shock and everything they're like well wait a minute on my penis are you sure the shockwave doesn't our shockwave machine our focus shockwave machine and core wave therapy it does not hurt i'll tell you some of the other shockwave um like the radial shockwaves where um kind feels like a jackhammer.
We don't have that because we have a different machine. So, but guys really want to invest in their penis.
You know, it's something that is important to them. Like you mentioned, it's so important to their ego.
It's important to their self-confidence. It's important to their relationships.
I have guys that will rather sleep on the couch as opposed to going upstairs with their partner because they don't want to deal with this stuff. Right.
They don't want to deal with not being able to have a consistent, firm erection. It's a big, big deal.
I know. And as a guy, I get it.
You know, I get it. Yeah, no, and as a woman that, and I say that nowadays, openly and proudly, because I was in a horrible marriage, very abusive marriage for 14 years, we barely had sex and I never cheated on my husband.
So nowadays, I say I like having sex with my partner and I want to have a very fulfilling sexual life. And I think every woman deserves that.
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And I understand that for men, if they cannot perform, if they have an issue, it's a big deal. And I think it's important to talk about it.
And many times it's hard for a guy to open up they get very embarrassed they get very ashamed there's a lot of shame surrounding the subjects and this is why it's so important for me to bring guests such as yourself to desmystify these conversations right because if we have like a headache or anything else like if we we want to lose weight and everything, it's not an issue. But all of a sudden, when it comes to talk about our sex lives, it's like, oh, hush, hush.
Like it's something dirty. Like, oh my God, just talk about for women.
It's even worse. Like I have girlfriends that never even had an orgasm or think that, oh, you know, I'm not sexual.

I'm never going to be sexual. It's OK.
And it's not OK. Seek help.
Go to a doctor such as yourself. But they think it's completely fine because they're so embarrassed talking about it.
Yeah, it's very embarrassing. You know, and what happens is that if it's a male or a female like we lose that intimacy you know you really lose intimacy because at the end of the day i mean our penises and vaginas um they're kind of doing the work but it's really our brains it's like they're you know we always say i always say like our biggest sex organ is between our ears, you know, and like, so it's like, and we kind of lose that because we focus on our penis and our vagina.
But it's it's the intimacy. Sometimes it's like the hand holding or it's like it's kind of talking about intimate things, which we lose sometimes because we're so frustrated about our penis and our vagina.
and so we can't lose focus on that, on that part, just the intimacy part and, and just kind of lying there and just being with your partner and just sharing kind of your day, right? Yeah. Is also really important.
Absolutely. And we talked about men.
So let's talk about women a little bit, because as I I was saying I get shocked how many women have issues with their sexuality with uh seeking pleasure with having orgasms and they have no idea that it's an issue or even how to seek help and you help women right uh can you tell us a little bit about that? Like, let's say a girl out there is listening and there are millions that never even had an orgasm or have a hard time reaching an orgasm. And many times they're embarrassed telling their partner they lie, right? They lie or they have shitty sex or whatever it is.
How do they take the first step to come to a doctor with so much experience such as yourself? So when they come into our office, once again, we do an extensive history, right? We want to make sure that they're not on medications that are preventing them from having orgasms, right really common are SSRIs so when we look at Paxil or we look at some of the antidepressants we know that could be a cause where we also know that birth control oral birth control can also cause women to have pain with sex low libido issues with having orgasms so we want to look at their medications when come into the office, we do a physical exam where we're doing neurotesting because for some women, their nerves aren't intact and it's preventing them from having an orgasm, right? And then we want to be able to define orgasm. So are they not having a clitoral orgasm or penile orgasm? So we know with vaginal intercourse, right, it's difficult for a lot of women to have orgasms, but the majority of women can have a clitoral orgasm, right? So we want to make sure we're defining orgasm and like what it means to them, right? And then we do hormones.
So we do know that, as I mentioned before, like hormones are a big deal when it comes to orgasm. And so especially with birth control pills, we do know that testosterone gets bound up, right?

If it gets bound up, it doesn't get into the system and it could prevent you from having an orgasm.

So we want to make sure we get a full amount of information before we can start treatment.

And then from there, it can range from hormonal therapy.'s some medications that we use also to help to enhance orgasms. Uh, we use a, something called femtensity, which is, um, sort of like a low intensity shockwave for the clitoris and the, and the vaginal bodies, um, the clitoral bodies to help to kind of increase blood flow to the area as well.
So there's a of things we use prp there's a number of things that we use to help women kind of achieve that orgasm with their partner but obviously there's other things that are involved right for men and women there's social things there's stress and all these other things that we want to make sure we kind of dive into to make sure that that's not preventing them from having an orgasm or better

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Do you think it's always the case that now I'm talking about women, but also I want to ask the same question when it comes to men, but do you think it's always the case that sexual desire and sexual libido decreases with age? Because lately I hear that a lot. Like, oh, you know, I'm in my 40s.
I'm in my 50s. But lately I hear from younger and younger and younger people.
Like I literally get messages from girls in their 30s, like in their late 30s. I had a kid.
I'm 38. I'm not as interested in sex as I was in my 20s.
I'm like, you're 38. And you're not interested in sex.
And guys like on 58, I'm 60. And they think they're past their prime.
And to me, I don't think it should be past your prime at these ages. Is my perception wrong? I think there's always room to increase someone's sexual desire if they want it to be improved.
You know, it's, you know, the patients that I see are, that are women, they want to have a better libido, right? You know, I don't see the patients that have low libido and they don't care about it.

I see the patients that want to be proactive and they want to have a higher libido.

So does age affect libido?

It does, you know, to a certain extent, right?

Because we talked about hormones.

We talked about experiences.

We talked about pain with sex.

So if somebody's having pain with sex, they're not going to want to have their libido is going to be down right because they're having pain they're having vaginal pain when they have sex so you know the key is really as i mentioned it's just teasing through all these things and trying to figure out how we can make them feel better and it's different for everyone it really is and so that's the that's the hard part of my job that I really enjoy, is trying to figure out how we can make someone feel better, either libido-wise, orgasm-wise, what have you. And I think it probably goes the same thing you were saying for men, like if you have an active lifestyle, if you exercise and you eat well, probably for women, it's the same.
Like if you're active, if you take care of your body, if you eat well, the likelihood that you're going to have better sex is higher than like if you're a couch potato and if you're obese. And I don't want to be mean, but that's probably reflects on your sex life.
The more active you are it's I mean if there's so many um psychological things that kind of um go into sex as well not to say that I mean this body image is is a is a real thing and for some women you know if they're not feeling sexy themselves and they don't really want to be with someone else and this is not all all women. This is, and guys, the same way guys, as they start gaining weight and they may get a little bare belly, they may feel less attractive.
Right. And so they may not want to be able to be like, you know, be naked and in front of a, in front of a partner.
Yeah. So it's, so it's, it's so many things that goes into sex and self-image that, and it's different for everyone.
It really is, you know. And so, you know, being a couch potato or something like that, if it negatively impacts their self-image, then yeah, of course, it's going to affect their sexual function.
yeah I talk a lot, I'm a big advocate for masturbation, which it's another thing that I don't understand why it's such taboo. You can't say that word on a podcast.
It blows my mind. No, like it's funny, like on social media, you have to be so careful, right? Because you talk about sex, they block your account, you're dirty, no, no, no.
You can talk about drugs, you can sell pot, you can sell a Zampic to lose weight, all kinds of crazy shit. But if you tell people to have healthier sexual lives, you're a pervert.
But that's a whole other subject. It blows my mind.
But I'm an advocate for masturbation because I think it's one of the most powerful natural antidepressants. It's great for your skin.
It's good for your mind. It's good for your body.
It's great for single people. I don't think you should wait for a partner to give yourself pleasure.
Please correct me if you think I'm crazy because I'm not a doctor, but I hear some crazy people on Instagram. And now I want to ask the expert opinion of the doctor.
They say like, if you use a vibrator too much, you're going to lose sensitivity for the real penis and you shouldn't masturbate too much because again, you're going to lose sensitivity to sex. It's going to be harder for you to orgasm with a partner.
I hear all kinds of crazy stuff out there. So I want to ask your opinion if this is all a myth.
So I think that understanding your body is extremely important, right? I don't think that you should rely on someone to give you an orgasm. I think that it should be some instruction, right? If there's a certain position that you like, if you want it harder, softer, I think there needs to be that communication with your partner, all right? Male or female, because men can also have some problems with orgasm as well.
So I think that communication is really important, but it also starts with understanding what makes you feel good, right? So that's the most important thing. In terms of masturbation, you know, I think that masturbation in general is really healthy.
I think it provides like a release for a number of individuals. I think it provides, um, like the number of brain hormones that make people feel good and feel good about themselves and what have you.
Um, I do think that, um, in some individuals, uh, like, so we, so we see a lot of porn induced erectile dysfunction, right? So these are men that they watch porn, they masturbate, they have an orgasm. And then it prevents them from having intercourse with a partner.
So I think that we can go from one extreme to the other, right? Right? Yeah. What's that? That's that's different, right? uh yeah of course yeah it's it's different but i'm just saying it's you know so there are extremes to anything but i think healthy masturbation in general is is healthy i think it's perfectly fine um and i think that most uh men and women should like understand their bodies especially as women as the age um just like, you're very comfortable, but it took you a while, I'm sure to get as comfortable as you are.
Right. And to understand what, what made you or any woman feels, feel good.
So I, you know, so in terms of masturbation, I'm okay with that. If it, if it fits into your social life and everything, you know know I do have patients that come from other countries and um and and uh other religions and so for for them masturbation is a taboo and then if they're masturbating and they're masturbating too much it can cause some negative um consequences at least psychologically for them so maybe masturbation isn't the right thing for them to do.
Yeah, no, I hear you make sense. A few more questions that my listeners send a lot, maybe you can help us out.
One that guys ask, and I think only a doctor could answer regarding Viagra. A lot of guys take Viagra, and most of them take the generic because apparently the actual Viagra is much more expensive than the generic.
So they take the generic and they say they don't feel that great. Like, I don't know, they have a headache or I don't know, they feel dizzy, whatever.
They have some side effects that I don't even know what is because so many guys say different things. So the question is, is it normal that most people have side, most guys have side effects? And if they did buy the actual Viagra, is it different from the generic or is the generic the same formula as the blue real viagra yeah so um so pd5 so uh phosphodiesterase inhibitors, it's a group of medications that we use as erectile dysfunction aids.
So what goes in that category is Cialis, Viagra, Levitra, and there's a newer one, Stendra, that's out, right? It came out a few years ago. So these medications can cause some side some side effects right so it can cause some issues with muscle aches it can cause some blue tint vision it can cause some guys that have some reflux it can kind of just make guys feel uncomfortable so that is a fairly common side effect for a lot of the medications but not not to the point where i would say out of all my patients, if I have 10 patients that take the medications, I would say probably like 20% of them may have a side effect.
And then if, but if we change to a different medication, so say they're on Viagra and we change them over to Cialis and they're less likely to have that side effect. So we just have to find the right medication for that particular person.
And because we have about four, we're okay. And we can kind of slide between the four and we can find something that's right for them.
So I would tell your listeners, if you're having problems with Viagra, then let's switch it over to Cialis. If you're having problems with Cialis, let's switch over to Stendra.
If you're still having problems, we can switch over to something like Levitra. So tell your doctor, switch doctor switch switch switch until you figure out which one

suits you until you figure out which one is going to work the best could be the most efficacious give you the best direction but give you less side effects but the question is is the the actual the real deal the the same formula as the generic or not yeah so i do have a number of guys where we've switched them from like a viagra to a generic right and so the generic and when you look at like the pharmacokinetics like like what's in it right they only have to meet the range it's like a standard deviation so they only have to be somewhat within that range and because there's so many different pharmaceutical companies that are fighting to get guys Viagra, all these companies, it doesn't have to be exactly the same amount, right? It just has to be within range. And so for some guys, right, they may need the top range or they may need, so they may need the Viagra.
So for some guys, we will prescribe them just a brand name Viagra as opposed to generic. And so it is a real thing.
So, you know, if you go to your doctor and you say, you know, he says, no, it's the same. They're not all the same.
Guys that take generics, they'll see that sometimes they get a blue pill. Sometimes they get an orange pill.
Sometimes they get a white pill. And that's just because of the different pharmacies that are out there that are making the generics.
Oh, I see. This is why I think it's so important to have a good doctor that really cares about you and is going to follow up and see how you feel, right? Not just like write a prescription and send you home like, okay, whatever.
Well, I think it's about just listening, right? I um just like you you listen to your listeners right and it's really about listening and and believing your your patient um and um following through and it's it's also a problem with like health care you know as you know it's like you know with i i'm fortunate because I have like my own practice is a concierge practice.

And so I get to speak to my patients for like an hour.

So if you came to see me, I'm speaking to you for an hour.

We're going through all this other stuff.

Unfortunately, and more of a traditional setting, a lot of physicians don't have that time because they just have to see patients, you know.

And so it's unfortunate. But I would say that to your listeners, be your own advocates.
Say, listen, like, this isn't working. I heard in this podcast, right, that I can maybe switch over, right? Cat on the list, switch over.
Dr. Gittin stole me.
And you know, like I can go from a Cialis as opposed to a Viagra and it might work better. You know, I may have less side effects, you know? And so this is why these things are so like these, your podcast is so important to get that information out to your listeners.
And guests such as yourself are so important because you are an expert in the subject. And I'm so honored and grateful that you're here answering these questions that we have no idea.
There are so many sex questions. There's 10 million more.
Let me try to squeeze in a few more. This one is silly, but so many people send this question.
we want to know your opinion as an expert, because maybe your patients go to you with this doubt. Maybe I know a lot of couples have this problem.
Some of my friends have this issue, the size of the equipment, the size of the penis. This week alone, like five people from different countries sent me this question, like girls complaining.
It's too big. It's too small.
I love him, but what a tiny penis. What do I do? Do you have this issue? Do you have couples come to you with this issue? And if yes, is there a solution to the issue? So it's a tough one, right? Because you're with the partner, you love the partner, but somehow you just don't fit, right? Yeah, if it doesn't fit, what do you do? Do you change the partner because the penis doesn't fit? Well, I think, I mean, we can do that.
So we can... And so first of all, like we mentioned before, right.
So we said that like, you know, when we're talking about sex, the biggest sex organ is between our ears. Right.
And so being able to like provide that intimacy, turning on your partner and being there intimately for your partner is really important. And then we have other methods.
If we're just talking about sex itself, there's other methods, right? We have oral sex and all these other things. We have mutual masturbation.
We have all these other things, right? And then you bring in toys, right? So I know you're a big proponent of toys, right? So why not? I think they spice up the life. I spice up, yeah, why not? Exactly.
So there's toys and other things that we bring along. If a man's penis is too small and he feels insecure about it, there are some things that we can do.
So I do like a girth enhancement procedure where we can kind of increase the girth of the penis, which would help. Really? Can you talk a little bit about that? Does it increase forever or temporarily? So what I use, I use hyaluronic acid.
It's off-label treatment. So it's the same filler that women use for the face, right? To provide volume for the face.
So we provide volume for the penis. We call it the girth plus procedure.
And so what that does is we place the hyaluronic acid underneath the skin, but we don't enter where you get the erection from. It's very important that you go to someone that does them all the time, because if you enter there, it's a big problem.
So we place it there and we are able to get a more girthier penis for some of our guides. I don't work with length.
I work mostly with girth because when you ask most women like what's more important is it the girth or is it the length it's usually the girth for most women right not really the length um there's other things that you can do for the vagina in terms of kind of there's some labor lasers that you can use to kind of um decrease the vaginal kind of depth a little bit so there's other things we can do on that respect but that's kind of the last resort so I think the first things as I mentioned is really to kind of provide that intimacy see what you guys can do either with toys or with oral sex and kind of go in that direction first? So there are solutions. We laugh and we make fun of it, but people actually complain about it.
So if you're out there listening before you dump the person, or if you're a guy and you are self-conscious because of whatever size your penis is, there are solutions. There are doctors like Dr.
Gittins that actually can help you, right? That's the answer. Yeah, yeah, that's the answer.
So seek help. But also, yeah, but also just, you know, try to improve your oral skills as well, you know? That would not work with me.
Right?

Funny enough, it's funny.

Every woman in the world loves oral sex, right?

I don't like oral sex, believe it or not.

That's a secret that I never said on the podcast before, but it's the truth.

I do not like oral sex.

I don't know why every woman in the world loves oral sex.

I love kisses and I like the hands on my vagina. I don't know why.
I don't like oral sex. There you have it.
I love giving oral sex. So all of the partners, whoever is my partner is very lucky because it's the thing that turns me on the most in the world is giving oral sex.
I love giving a good blowjob. But just like you said, you know what.
I know what I like. But but funny enough every guy thinks that the girl likes oral sex right so they can't give you arse and i'm like but i don't like it and they're like no but you like it and they try to convince you that and i'm like please but that's the thing it's it's that communication yeah that you mentioned right it's like you like to be kissed, right? And you like the hands, right? And so those are things that you got to be able to talk about these things with your partner.
You need to know what you like, right? You need to know what turns you on. And this is the good thing about aging, because when we are in our 20s, we're embarrassed, right? To say these things, I think, at least I think I was when I was in my 20s.
And then when we are older, you shouldn't be embarrassed, like to tell your partner, oh, I get super turned on by hands. I get super turned on by kisses.
This is what I like. Oh, I love giving a blow.
I can give a blowjob the entire night. Like you said, I think communication, sex starts in the brain, like you were saying.
Exactly. And, um, yeah, I totally, totally, totally agree with that.
It's just so important to, to talk about what you like. And I always tell my patients that it's better to talk like in the beginning of the relate, like once you start a relationship and you start that, you know, to have those kisses and everything and starting to kind of move through, like until you have sex or whatever that is, it's like the best time to talk about the things that you like is in the beginning, right? You set the standard.
Don't wait until you're in a relationship for like six or seven or eight months. Cause then they're like, oh, you like these things? You didn't tell me or you met somebody else that's doing these things.
So like from the first time you guys get involved, say, hey, listen, I love when you did that. But you know what I like better? I'd love for you to do this.
Yeah, the foreplay, right? Even talking about it is foreplay. Absolutely.
Those are the things that you got to address up front. So you're all on the same page.
And so if the person's like, listen, I don't do that. And then well it's early in the relationship you don't do that i love this and maybe you're not the right one for me right or they say maybe say i love doing that this is something i love doing i'm so glad you told me because i was a little nervous i was a little nervous to kind of go forward with that and and you're like oh this is like the best person ever you don't come on in so these are all these are important conversations that we should have um in the beginning and not waiting until you're married for like 10 years or and then you look for someone else that's doing these things for you oh my god i agree really really important and that's what i was going to say it's one of the top reasons why people end up cheating on each other, right? Because they get frustrated sexually.
The partner is not giving them what they want. They end up going and doing it to somebody else.
And that's a horrible problem. But now when people come to you or even people listening, I'm hoping we're encouraging them to seek help.
If you're having any one of these issues, what would you say if a couple is having horrible sex or a girl that is not having an orgasm, whatever, any one of these issues that we're talking about, how do you encourage them as a doctor? Because it's all fine. Like you said, you get the treatment, you take the Viagra home or whatever, you get your penis enlarged, you do all these beautiful technical things in the office, but it's another thing to go home and then you're there with your partner.
And a lot of people are very shy, right? When it comes to go and do it. Do you have any tips, any words of encouragement that you tell your patients? Okay, now you go and you apply and you go have amazing sex.
I see something behind you there in your office, have great sex. And what's the end of the phrase? That's it.
Have great sex. Have great sex.
That's our motto here. That's our motto.
So, but how do you convince your patients to go and have great sex? So it's, it's one of those things that you, just like you mentioned, it's like the like the more you avoid sex, the more it becomes uncomfortable with your partner. Right.
So when you stop having intercourse or stop being intimate and it's been a month or a year, when you go back to doing that, then it's uncomfortable. It's weird.
It's awkward because of the fact that you're just kind of out rhythm, Right. And so what I tell patients is, at least in the beginning, I say, listen, let's set a date.
Let's set a date and let's say we're going to have sex on this date. Right.
Because then the awkward is kind of it's kind of to the side. We're going to have sex on this date.
My doctor said we're going to write it, write it down. We're going to have sex.
And by doing that, right. You're kind of saying you're getting the other person prepared.
You're also being prepared. Um, and then you can kind of go through those motions a little bit better.
So I think that, um, when I think that's one of the best things to do when there's like this lapse of, um, of having sex in the relationship. I love that idea.
It's's communication it's communication just like you were saying like a lot of some relationships fail because of sex well they're not failing because of sex they're failing because of communication they're failing because one person isn't telling the other person their needs right or the other person is is um having pain with intercourse and the other and they're not telling that to the other person. And so there's that lack of communication.
So like it's all about talking to your partner about what's going on with your body. What's not going on with your body? What do you want them to do to your body? All these things are so important.
I love that idea. Like make a plan, like go on a date or put it on the calendar or make it.
To me, one idea that I give my listeners or my girlfriends or whoever asked me, like we were saying on the podcast, talk about it, like go out to dinner, not just when you're in bed, like when you're in a public place or having dinner or a drink and start talking about it. Like what you want to do to each other, you know, make a plan and everything.
Maybe that puts you in the mood, you know. I totally agree.
I think the wrong time is to talk about it like when you're about to have sex. You know, you want to talk about it before.
You want to talk about, like you said, over dinner, over some wine or something like that and kind of kind of start the mood from there don't start the mood when you're like on the couch and you're about to do something or in the bed or in the car wherever you're doing it you know yeah absolutely so important now uh before i let you go uh is there such a thing as too much sex like when does a, like you say, you must have seen people that come to you that, okay, maybe you're becoming a sex addict, slow down. Yeah.
So we, I mean, we don't see that that much in the office because most of the patients I see are kind of, are having some issues with sex, but in general, you know, it can, I guess it can be unhealthy when people are kind of substituting sex for other things. Like if it's for attention, if it's because of a mental illness, if it's because of, you know, some of my patients have bipolar and they're in their manic phase, they'll have more sex.
And so it really depends. So I guess there is, the answer is yes, there could be too much sex, but if it's unhealthy, then we have to do something or address it.
But if it's not unhealthy, if you just really enjoy having sex and being with your partner, or if you're a person that likes being with multiple partners and you're safe and whatever you want to do, then I think that's perfectly fine. Yeah.
So if somebody out there is too embarrassed, like we were saying, unfortunately, I agree in the United States, it's such taboo. It's a culture that thinks sex is a dirty word and it breaks my heart because I really think sex is something that would make the world a much better place if more people were having great sex.
What do you say to encourage them to seek help and start having better, more fulfilling sexual lives? Well, I think that the first thing is to really be an advocate for yourself, you know, and there's people out there like me. There's, there's, you know, sexual medicine specialists that really will sit down and listen to you and help you.
You know, this is not something that you have to go through alone, right? It's something that you can find help. It's something that, that for almost anything, you know, there's something that we can do about it.
And if you don't find your answer, then find someone else, you know, that's going to be able to help you. That's what I would say that there's definitely help out there.
Thank you so much, Dr. Gittins.
You're amazing. Rockwell Centers for Sexual Medicine and Wellness.
You're one of the top experts in the country.

How can people find you?

So we have locations here in Philadelphia.

I have a location in New York, in Manhattan,

and then also a location up in the Poconos in Pennsylvania.

And we're expanding.

But you can find me at Dr. Gittins.

That's our Instagram that I have to post a lot more to. Um, I think I have a couple of posts that Dick doc, but our, our, our website is rockwell centers, uh, dot com with an S.
Yeah. You should expand here to California.
We definitely could use your help out here. Um, it's really been a pleasure, um, being on the show i'm a big fan thank you very much I'm a huge fan of your work and I hope you come back because like I said I try to squeeze in as much as I possibly could and I know we're gonna get hundreds more questions for you because this is a very important subject and if we can clarify anything I feel like I'm doing a tiny bit part of my job.
And it was a huge honor to have you. Thank you so, so much, Dr.
Gittins. Anytime, anytime.
I mean, I'd love to come back. Thanks.
Thanks, guys. Stay safe.
Have lots of great, great, great sex, get help. And I'll see you guys very soon.
Thank you, Dr. Gittins.
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