Welcome to this week’s mental health mastery and we’re talking to lisa calco today, who is the clinical director with nomina and we’re going to be talking about erectile dysfunction before we start, please make sure to like comment subscribe, maybe even share with a friend. It all really helps our channel to reach those who might need it. Well, I thought we could start well, first of all by saying, welcome, lisa, and I think what I’d like to do is acknowledge the people that could be watching this, because we’re going to have partners that are trying to support their partners, but we’re also going to have those that are suffering from the erectile dysfunction, and I know just from the men that I know that kind of the the shame almost that comes with it and what it’s doing up inside their heads absolutely, and it’s such a valid point joanne, because one of the things we know at least I see really commonly in my practice is that a lot of the men who come in actually have these really deep concerns around it. That they’ve been hesitant to talk about. So, by the time they get to see me it’s something they’ve struggled with for a long period of time, so I always like to acknowledge the bravery it takes to really seek help and support and to look for information about it, because you don’t need to suffer with it. If there’s a lot that can be done, yeah well- and I also know too that it tends to spiral. Then, then, all of a sudden now there’s fear that begins to be generated with it and they don’t even want to try anymore exactly, and the thing of it is, is that they’re not alone, so I mean about 26 of men under 40, actually experience erectile dysfunction. It goes quite staggeringly higher over 50 when we kind of get to those past 40 ranges and so oftentimes. We just think of that as something that affects older men, but what we’re seeing is a growing percentage of younger men and even those who are in their 20s suffering from it. So it’s something that we want to talk about more. We want to get more information on and really normalize that you’re not alone in that. So what are some of the causes, then? So there’s a variety of things that can cause erectile dysfunction and oftentimes. We think of kind of like some of the big major ones like a change in libido or low testosterone, which is a really big thing. So we see oftentimes men who do suffer with erectile dysfunction may have low testosterone. If that’s the case, usually that’s something your doctor can rule out and help to do in just a blood panel to ensure that if it is something whether it be an organic cause, a medical cause. Something of that nature. Then your doctor can roll that out. What I often see is that when there isn’t an organic cause, I.e, it’s not your testosterone, it’s not necessarily diabetes or smoking or even illicit drug use, which are things that can contribute to it. We also know that if you’ve trialed medications, I.e, there’s a blood vessel blockage or something to do with blood flow, that’s reCialis or a Viagra is going to help because they’re there to increase blood flow, but one of the other unknown causes or say lesser known causes is just how anxiety contributes to erectile dysfunction. So that’s what I would more often see in my kind of clinic side of things, which is those who are struggling with anxiety, related disorders or other sort of sleep disorders that might be contributing to poor erectile functioning. Those who have had experienced trauma might experience erectile dysfunction or just not even dysfunction, but just problems with maintaining quality, maintaining erections or maintaining orgasmic achievement. All of those could fall under the disordered concerns when it comes to erectile functioning. Now you said trauma, and I think, when a lot of especially men think of trauma they think of that the big stuff and not necessarily the little stuff. So do you want to expand a little bit on trauma yeah, so sometimes we’ll see it happen even from childhood experiences of trauma, whether that be neglect, abandonment. You know childhood abuse, adverse childhood experiences. All of those things can affect how we become intimate in our later years. We’re also seeing we think about addiction. We oftentimes think to substance use disorder, but those early childhood traumas can also lead to process addictions with, say pornographic use or other illicit materials. When we think about trauma, it could be just trauma-related stressors, so you could have continuous chronic exposure to traumatic things. Maybe a mother, a parent dies or a loved one is going through a traumatic experience or something that is affecting you in a really stressful way. Those are all things that our brain can interpret as traumatic and those are what we call more of those little t. Traumas, where continuous, chronic exposure to those life stressors can be traumatic for our brains. It doesn’t necessarily mean life-threatening illness or injuries. Similarly, with big t traumas, it could also be that you could have been in a major car accident. You could have been in a specific experience that you found traumatic. Those can oftentimes create different patterns in erectile, functioning or different kind of attractions, which many people find really traumatic and that can also block erectile functioning because that part of our brain- that’s like oh, my gosh. I must be such a horrible human being for having this natural based trauma born response. So when we experience a trauma, some people will find that their erectile functioning changes I.e, it might increase, they might have other interesting proclivities. They might be like sexually excited by different things, and they might not know how to share that with their partner, that, in and of itself, can prevent them from being able to experience healthy, erectile functioning, because there is a stigma attached to it and there’s a lot of guilt around it, so that might result in them experiencing delayed orgasmic responses or other sort of responses with regards to sexual excitement. What would treatment look like, so it depends on the specific cause of your erectile functioning treatment can look very different, so it could look with, like I said, getting testosterone replacement or hrts from your doctor hormone replacement therapies. It can also look like taking a Viagra or a Cialis or some sort of other erectile prescription that is designed to support that blood flow. It could look like diet and exercise so for those who are experiencing more concerns with blood flow relating to say, obesity or just even overweight and increasing. The exercise component, for example, can really help to boost the testosterone within a system to increase the overall blood flow. Looking at that, additionally, though, if those things are not helping, that’s where oftentimes I’ll get the referral, because it’s telling us it might be something more psychological or stress related in nature. When those referrals come to me, that’s where we start to do a bit of a deeper dive into what might be some of the psychological stressors. What might be some of the contributing factors? You might have a difference between your desire and your arousal response, so you might really want to engage in intimacy and warm contact and connection with your loved one or your partner, and the blood flow might not be there or. Alternatively, you might really not want to participate in intimacy and arousal with your partner, but independent and solo pleasure. You have no problem. We’re really just trying to tease out these two things and determine. Is there a desire that is maybe different than what your arousal pattern is, and then we can do the deeper dive into? What is your arousal pattern? Is it something that’s been changed by a traumatic experience? Is it something we want to help understand more of? Is it something that’s been overstimulated or oversaturated, with a lot of exposure to pornographic material or other sort of responses? I we don’t always know so, that’s where we want to start to look at some of these factors and determine what is really c
ausing the erectile functioning problem. Is it just in relationships? Is it with solo pleasure? Is it only at certain times? Is it with specific engagement? Can you maintain an erection? Do you have trouble with quality and duration? Do you achieve orgasm during these things, because that tells us a lot? So what would you say to a partner who’s trying to support their loved one? One of the biggest things I tell our partners is not to internalize it. It’s not your fault, you didn’t cause it. You can’t change it. So really, looking at that and holding compassion for what your partner is going through, I know so many women who I’ve worked with in couples counseling, who have expressed I want to be there. Am I not sexy enough? Am I not attractive enough? Am I my breasts? Not big enough? Is my hair? Not perfect. Does my body maybe something it’s likely? Not you. The fact that you are there could be a contributing factor, but it’s probably not you as an individual. That’s where we want to look at with the person who’s struggling to say. Is it the partner in terms of the person they’re with? Is there? Has there been a change in their arousal map or their desire patterns? Has there been something that has happened between the two of them, because if that is the case, then there may be something that we want to work on with the couple together. Equally, that’s the important part about communication in the couple dynamic, which is to say how are we showing up to our intimate relationships that allows us to know that we’re safe and supported from that for the partner? Who is in that specific engagement? It’s really about knowing that you are there to support your loved one as much as they want to be there to support you and if they don’t well, then that’s probably a different conversation we need to have, but it’s not just women who would be supporting their loved one. I see it oftentimes with male gay couples. Things like that where they are also experiencing erectile dysfunction patterns, because they’ve experienced a lot of different traumas and a lot of different ways of engaging, and so just knowing that, because they have a penis and I have a penis. We must know what each other’s experience is like. That again is one of the biggest things that is oftentimes a misnomer in that a lot of gay couples will experience this at the same rates as cis men would, and so for partners globally. Knowing that your loved one is there to support you and that that healthy communication is so integral to working through the problem, yeah- and I knew a couple that when he got sober, everything changed and it just wasn’t the same and he was really struggling, and then I saw what his partner went through thinking is it me: is it and and not being able to talk and it’s it was really hard on their relationship. Absolutely and that’s one of the most devastating things is because, when something does change, whether it be through a change in behaviors, whether it be through a traumatic event, whether it be through an illness or injury, I’ve seen I’ve worked with a lot of couples who, for example, going through cancer treatments or other sort of medical procedures. Changes in childbirth patterns. Things like that where the relationship has changed and in fact the person who’s struggling, I.e. The person with male sex characteristics is there identifying it’s not working in the same way. It’s not that I don’t love my partner or I don’t want to show up, or I don’t want to be sexually intimate. It’s much more of that piece of. I don’t want to hurt them. Is it a good time? Is this something that I’m safe with? Are they safe with me? Is this somebody I’m still attracted to, and I want to work through that with and that’s where healthy communication around any sexual function disorder is so important, because we don’t want to hide that. There’s no shame in the fact that it’s happening, but we want to be able to help people move through it. Oftentimes, like I said earlier, it can be a symptom of something deeper, maybe they’re struggling with depressive symptoms. Maybe they have over hyperactive anxiety. Maybe they have some sort of trauma-based response. Maybe both of you are experiencing something similar and how do we help you open that communication? So you don’t have to suffer in silence. I am so glad that I am a mature woman. Now I just think of the young me and how I handled situations like this. Without that good, open communication internalizing it and then turning it off on or putting it out on them versus the woman. I am today who can be gentle and understanding and nurturing about it all and I’m so in love. With the same I mean I’m also so appreciative of the fact that I’m finding more and more youth and younger demographics who are being affected by these things are coming forward. It’s almost as if we’re experiencing this really brave sexual liberation in our developing adolescents and young adults, and watching that happen, where they’re not experiencing the same stigma that our generation might have around these types of things, which is so incredible and equally we’re also seeing that it’s happening in higher rates. So is that just because of the confidence in reporting? Or is it because it’s being influenced by other factors? We don’t really know yet. But what we do know is that the conversation is happening, and I think that is so brave of so many of our young adults coming forward, which is really supporting our generation coming forward being like huh wait, we could talk about these things, be like damn right. We can, and it’s so important to do so because we all deserve healthy sex if we want it yeah. I had one of those conversations with my son driving because I was told when you’re driving and you’re not looking at each other. That’s when a good time to talk is and right no eye contact, no eye contact and spoke to him about porn and how it sets you up for failure later. It’s the expectation. It’s not like that. That’s not a loving relationship, definitely and that’s part of that exposure pattern in our brain that can change our arousal maps over time. So when we’re looking at exposure, even in younger and younger periods, to highly saturating things like pornography, it changes our neurochemistry in a way and especially in developing brains, because they start to get exposed to this overwhelming stimulus of sensory processing that their brain can’t handle. So when they start to engage in healthy, normal sexual functioning, which I mean again normal is a bit of a misnomer, but when they start to engage in human to human sexual contact, it does not look like pornography. We don’t have triple g boobs. We don’t have these perfectly quaffed, vaginas or vulvas. We don’t have these eight inch, penises with perfect length and thickness we’re not there to engage in these romanticized kind of acts. In fact, sometimes it’s messy and awkward and confusing and uncomfortable, and we don’t moan and grow in the same cue spots, the response areas. So that’s where our brain doesn’t register that this is a pleasurable act that can create a lot of feelings. Inside of us that we’re not aware of it can bring up a lot of guilts. It can bring up a lot of concerns about inadequacy. It can bring up a lot of shame and then that starts to influence and register our sexual response cycle differently, which can contribute to the dysfunction part, because all of a sudden, our brain is like oh wait a minute, I’m doing something wrong. Ooh! Don’t do that. Don’t do that and then, therefore we might have the desire to engage in sexual activity, but the arousal isn’t matching that now. So that’s where we want to look at that and start to understand it and also start to more globally look at we’re seeing alarming rates of women coming forward with sexual dysfunction patterns too. That are not just erectile, because they’re also experiencing the same, but we just haven’t, talked about it before we’ve just always assumed that women aren’t affected by erectile functioning because they don’t have a penis and yet they’re starting to experience other forms of sexual dysfunction more globally.
Alongside males we’ll have to do another video on that one right. Yes, anything that we have missed that you wanted to talk about. I think really, my biggest takeaway that I hope people will leave with is putting aside all of the old messaging about sex and sexual functioning and really starting to know that you deserve to have your best sex life and whether that be having the conversation with your intimate partner, whether that be having the conversation with your doctor or whether that be having the conversation with somebody like me. Ultimately, we really want to make sure that you are supported in having a full happy healthy range of sexual experiences that support you and your unique self yeah. I have a girlfriend of mine who was so liberated when she finally came to a place where she was okay, with the fact that she did not want to be in a relationship that she could have experiences with different men as long as she was above board and completely honest, but she accepted that about herself, embraced it about herself and has gone on and been very happy. Absolutely and- and I think that’s such a beautiful thing, because when we can start to open those dialogues- and we can start to have those really honest conversations- we give ourselves permission to explore so much of our sexual health and that, for some people can be the key to unlocking the anxiety or kind of the block that might have been there to experiencing an improvement in their sexual health functioning and reducing the erectile dysfunction completely. Okay, so really healthy communication, yeah yeah. No, I can see that I’m I’m committed. Monogamous girl communication has been the biggest thing in our relationship, yeah, absolutely and you’re, not alone. There I mean so many families, so many different partnerships. These days are committed. Monogamous ones, however, we’re seeing like I said this amazing youth culture. That’s growing up and really busting open what it looks like to have monogamy and polyamory in different ways and different kind of constructs of the same, and so just looking at consensual, non-monogamy, looking at polyamory looking at various ways of understanding what it means to be sexual and or non-sexual in our committed relationships yeah as long as it feels healthy and feels right and feels good, because I do know what it feels like when it doesn’t when it feels uncomfortable when it feels wrong when it and that’s that’s, never good. That just leads to more more trauma exactly. I once heard a really great piece of takeaway in my couple’s therapy workshops, which is, if you’re not comfortable, being honest about the aspects of your relationship. Then it is a betrayal and so really starting to look at. How do we have these honest conversations with our loved ones about what is happening, and that is a cornerstone to any relationship, regardless of what it looks like, and so, when we’re looking at erectile dysfunction being open with your partner being comfortable. Even if you’re not comfortable having that conversation providing them the opportunity to show up as a participant in their sex, their healthy sexual encounters is so valuable, yeah and that vulnerability builds that trust as well too, and it deepens that connection exactly wow. So how would people reach you because you do? I know you do a number of different forms of relationship and couples counseling and sex therapy yeah. So our practice primarily you’re correct. We, we do focus a lot on sexual health. Sexual health, related disorders, couples work. My my doctoral studies are specifically in a clinical sexology. So that’s where that’s kind of my area of specialization, you could say, but it’s also a passion. I’ve grown up in this very unique space where I’ve been able to see the sexual response cycle and trauma kind of converge in these really fascinating ways, and so that piqued this interest to really want to know more. But how can people reach me? I know it’s your question. They can reach us by looking on the web, so our our web menu is nominal wellness. We’ve also got our nominal health clinics. I supervise a lot of our interns and even exploring these things as well, so you don’t, if you don’t get just me know that all of our clinicians are really super skilled and very interested in exploring these topics, but above that my passion really lies in educating, supporting and normalizing all of these areas of sexual function, including for our grm communities. So those who are gender romantic minorities across the lgbt spectr as well, really starting to help identify that all humans can be affected by some or form of sexual behaviors or another, and sometimes that can become dysfunctional behaviors. And so how do we help to just understand how we can support you in overcoming that and having a really amazing, great sex life? Well, thank you so much lisa! This has been amazing and I can’t wait to talk to you about female sex right. Yeah. Absolutely look forward to it. You.