The Urology / SexTherapy Connection

The Urology / SexTherapy Connection — on SIRIUS XM Doctor Radio

Urology specialists come in all flavors. Some specialize in the prostate, others in the bladder, others in the ureters and kidney. But in Manhattan there are several urologists who specialize in what’s called “sex and infertility.” As a sex therapist in Manhattan, I’ve been fortunate to work closely with several of the best  — and occasionally to be interviewed by them on the radio.

Sirius XM Doctor Radio broadcasts from the lobby of NYU Medical Center on the East Side of Manhattan. The studio is separated from the rest of the lobby only by a floor-to-ceiling glass window, so being a guest on Doctor Radio is a bit like being in a fishbowl.

I’ve been interviewed on this station several times over the last decade or so — either by my urology colleague Joseph Alukal MD, or by my psychiatry and sex therapy colleague Virginia Sadock MD.  Dr Alukal is Assistant Professor of Urology, and Director of Reproductive Health at NYU Urology Associates, and he and I have worked collaboratively with many patients whose problems didn’t fit neatly either into the urology or sex therapy silos.

My urology colleagues joke that they focus on “the little brain” rather than the big brain. But the connections between the little brain and the big brain are profound. As I’m always telling patients in my office, the brain and mind have roughly speaking two kinds of inputs to the genitals: positive and negative.
In men, positive signals, mediated by nitric oxide and the parasympathetic autonomic nervous system, stimulate erections. And negative signals, mediated by the so-called “rho-kinase” system, the sympathetic autonomic nervous system, and no doubt other kinds of inputs too that we haven’t discovered yet, act to make erections go away.

Why would there be a system whose sole purpose was to bring down erections?

Simple: In our natural ecological niche, on the plains of Africa 200,000 years ago, we weren’t at the top of the food chain. Lions were. And when there were lions around, any human who stayed busy having sex would likely be the first to be eaten. So presumably it was an evolutionary advantage to have a circuit between the brain and penis whose function was to make erections go away. Now in the 21st Century, we’re left with the consequences:  arousal that goes away when negative emotions arise.

Unfortunately it’s not easy to get Sirius XM Doctor Radio clips after a show, so the best I can advise is to keep a lookout for future episodes.

Between urology and sex therapy, there’s always plenty to talk about.


stephen snyder md author photo Stephen Snyder, MD

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