Why Sex Feels Hard (Or Not): Ejaculation Dysfunction, Mismatched Libidos & Myths That Hold Men Back

2 Dec 2025 · 56 min · 20 chapters

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In short

Ejaculation dysfunction (premature/rapid and delayed), libido mismatch in couples, and how porn fits into erectile dysfunction and sexual performance.

Guests

Dr. Jesse Mills (urologist; discusses off-label medication options and pelvic floor links) and Natalie Feingood-Goldberg (Los Angeles licensed medical/family therapist and certified sex therapist; founder/clinical director of Creating Change LA; specializes in erectile dysfunction, premature ejaculation, painful sex, and mismatched desire; contributes to media and offers an online ED course).

Key claims

  • Premature ejaculation is often driven by anxiety, poor mind-body awareness, and hyperfixation on partner satisfaction; treatment emphasizes breathing, mindfulness, identifying the “point of no return,” and pelvic floor physical therapy for tight pelvic floors.
  • Delayed ejaculation may involve insufficient stimulation “to cross the hump,” numbness/neuropathy, emotional safety blocks, or conditioned masturbation patterns that don’t translate to intercourse.
  • Libido mismatch is common and not gendered; couples benefit from reconnecting to what was enjoyable, reducing shame, and scheduling sex to create “responsive desire.”
  • Porn effects vary by brain chemistry; research is mixed, so risk depends on whether it becomes compulsive/dopamine-driven.

Notable examples

  • A client who could orgasm only by crossing legs and squeezing thighs.
  • Couples who can orgasm via mutual masturbation but not intercourse; suggestion to broaden “sex” and use masturbation tools (e.g., Fleshlight-style) to retrain toward intercourse.

Written by AI. May contain mistakes. Listen to the episode to check what was said.

Chapters

Tap a time to open that second in VO

Discussing Ejaculatory Disorders

0:54 to 1:49

Exploration of ejaculatory disorders such as premature and delayed ejaculation.

“The new Tropical Butterfly Refresher from Starbucks.”

Discussing Ejaculatory Disorders

1:53 to 2:46

Exploration of ejaculatory disorders such as premature and delayed ejaculation.

“Satisfying sandwiches, loaded bagels, rich mac and cheese.”

Discussing Ejaculatory Disorders

5:42 to 6:50

Exploration of ejaculatory disorders such as premature and delayed ejaculation.

“So I think the way we're going to do this, because we want to get into the three, what I think are some of the three most common things that I see guys for, some of it, which I can help them with.”

Approaches to Managing Premature Ejaculation

6:50 to 11:24

Discussion on techniques for managing premature ejaculation and promoting body awareness.

“And I don't really know where to go with my men in terms of what is pathologic and what is okay.”

Setting Expectations in Intimate Relationships

11:24 to 14:00

Advice on communicating expectations regarding sexual performance with partners.

“So I would say a big piece of this is teaching men how to be present.”

Understanding Ejaculation Challenges

14:00 to 19:38

Explore the dynamics of ejaculation issues, including premature ejaculation and pelvic health.

“hey, I just want to give you a heads up, this is nothing personal to you.”

Addressing Delayed Ejaculation

21:42 to 28:06

Insights into dealing with delayed ejaculation and the importance of stimulation.

“And now another appliance triumph from our friends at Grand Appliance.”

Understanding Ejaculation Difficulties

28:06 to 35:32

Explore the complexities of ejaculation and the impact of specific stimuli on orgasm.

“Like I had one client who had to cross his legs in a very specific way and sort of like squeeze his thighs together in order to orgasm.”

Understanding Ejaculation Difficulties

35:33 to 35:56

Explore the complexities of ejaculation and the impact of specific stimuli on orgasm.

“Do you find yourself spending too much time on healthcare visits?”

Understanding Ejaculation Difficulties

36:01 to 36:30

Explore the complexities of ejaculation and the impact of specific stimuli on orgasm.

“Satisfying sandwiches, loaded bagels, rich mac and cheese.”
Show all 20 chapters

Understanding Ejaculation Difficulties

36:31 to 37:18

Explore the complexities of ejaculation and the impact of specific stimuli on orgasm.

“At Rasmussen University, we find ways to remove barriers, not build them.”

Navigating Libido Mismatches

38:13 to 42:00

Discuss strategies for addressing libido mismatches in relationships.

“Well, I have to pivot over because, I mean, again, I can guarantee I knew at the beginning of this that I'd say we're going to have to have you back.”

Reconnecting Through Intimacy

42:00 to 44:40

Learn how stress and lifestyle pressures affect sexual enjoyment and intimacy.

“the problem instead of really diving into how do we reconnect?”

The Importance of Scheduled Sex

44:40 to 47:42

Discover the benefits of scheduling sex for busy couples to enhance intimacy.

“I mean, like, you know, you mentioned the nervous system.”

Navigating the Effects of Porn

47:42 to 53:40

Understand the complexities of porn use and its impact on sexual health.

“And while you were thinking about all the shit I have to do and this, that, and the other, and then all of a sudden your partner is massaging you and you're like, Ooh, that was kind of nice.”

Strategies for Healthy Sexual Practices

53:40 to 56:00

Learn about strategies to create healthy sexual habits without relying on porn.

“And I see especially younger guys, my undergraduate students that may have been introduced to porn when they were nine or 10 and 12 or some early, early age.”

Understanding Porn and Masturbation

56:00 to 56:49

Learn about the relationship between porn consumption and masturbation habits.

“You got to start choosing the sugar water.”

The Challenge of Arousal Without Porn

56:50 to 58:09

Explore how reliance on porn affects sexual arousal and partnerships.

“it's shocking how many of them I ask, can you masturbate without porn?”

Mental Health Tips from a Specialist

58:10 to 59:37

Discover practical mental health strategies from a mental health specialist.

“And it seems like that is the quick, you know, the quick bump of blow is to turn on, you know, log in.”

Natalie's Insights and Resources

59:38 to 1:02:26

Gain insights into mental health resources and self-paced courses.

“Try to be really mindful of like, am I, am I breathing?”
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Transcript

Automatic transcript. May contain errors.

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2:54Let's talk about it. Let's talk about it. The mail room. Let's talk about it. Let's talk about it. The mail room. Welcome to the mail room. Hey, everybody. Dr. Jesse Mills here with The Mail Room. So glad to have you back on this podcast. I can't tell you how excited I am about our guest today, Natalie Feingood-Goldberg. I've known Natalie for over 10 years. We literally met at a coffee shop in West LA as all good things happen in this town. It usually happens over dinner, coffee, or Pilates. And since I don't do Pilates, at least not yet, we're going to go with the coffee shop creation story.

3:39So many years ago, we struck up this relationship because there is no urologist or sexual medicine physician worth their salt if they don't have an outstanding sex therapist that they can refer to. Because most of what I do is anatomy and physiology. And most of what my sex therapists like Natalie do is everything else, literally everything else, to come together as a whole person and treat men holistically. So I'm going to brag about her a bit just to give you a background of what a superstar she is. Natalie Feingold-Goldberg is a licensed medical and family therapist, a certified sex therapist.

4:16She's also a certified sex therapist and supervisor with American Association of Sex Educators, Counselors, and Therapists. So lots of initials passed her name, far more than I could ever hope for. She's also the founder and clinical director of Creating Change LA, which continues to expand its reach to citizens of Los Angeles and the world beyond. It's a Los Angeles-based psychotherapy and sex therapy practice. Natalie works with individuals and couples both with over 10 years of experience helping your clients navigate sexual problems. Natalie's specialties include treating sexual dysfunctions like erectile dysfunction, premature ejaculation, painful sex, as well as addressing mismatched desire or lack of sex between partners.

5:00Inspired by our high school psychology class. This is a good creation story. I like this. Natalie knew she wanted to be a psychotherapist from an early age. Natalie regularly contributes to many news articles, podcasts, and websites as a sex therapy expert. In addition to psychotherapy, Natalie offers an online ED course for men, which is self-paced and can be completed in the privacy of your own home. And I have referred a number of my guys to this because it's such a great background for what I do in my office as a urologist, and it is available for purchase on her website. So super excited to have you on.

5:33The introduction could take all episode, but what we really have to do is get into what I need to get out of your brain. So welcome, Natalie. Great to have you on board. Thank you for having me. Really happy to be here. So cool. So cool. So I think the way we're going to do this, because we want to get into the three, what I think are some of the three most common things that I see guys for, some of it, which I can help them with. Most of it, I need to work with you on. And so I think we'll start with your spin on ejaculatory disorders. And for me, an ejaculatory disorder is either a man is unable to withhold from ejaculating too fast.

6:11We used to call it premature ejaculation. Sometimes it's called rapid ejaculation. But essentially, it's when he and his partner are not satisfied with the time it takes before ejaculation, but also a less known, but also incredibly frustrating condition of delayed ejaculation. Oh, yeah. Yeah. And then it is a tough one. So I really want to pick your brain on that because I actually don't have a lot to offer those men. I think then we'll jump into libido mismatch, which is a vexing problem. You have couples where they're just on two ends of the spectrum. And then finally, I got to get your take on porn.

6:50I mean, it's completely exploded. And I don't really know where to go with my men in terms of what is pathologic and what is okay. So let's jump right in. Also a challenging one, yeah. I know, right? So let's talk a little bit about ejaculatory dysfunction. And tell me what your thoughts on premature ejaculation. I'm in your office. Say I'm a 28-year-old man, and I've never been able to last or orgasm for more than about a minute. Talk me through how you're going to take care of me. So there's a few different kind of paradigms around this. One of the things that I almost always see is that these guys are super anxious in general.

7:33You know, one of my old mentors used to say, how you do anything is how you do everything. And I see that a lot in these poor guys. They literally show up to session half hour early. They're the only clients I have that show up that early. Um, so there is this element of like really intense anxiety and it's like almost palpable. You can feel it in their bodies. You can see it. Like you can almost see them just clenching their pelvis as they're sitting there talking. Um, so I would say a big part of this is just like the overall general anxiety that their body holds. Uh, and so a big part of the work that I do with those types of clients is like sort of regulating the anxiety, but also just kind of like regulating their whole body.

8:18The lack of awareness in their body is a big part of this. So just a quick overview is that oftentimes a lot of the treatment itself involves like practicing masturbation and understanding and learning their body and sort of what you would call like, what is the point of no return? Like, what is the point in which they are so stimulated that like they can't turn back and they will inevitably ejaculate? And so helping them identify that point and then slowly sort of being able to kind of slow things down, pause before they reach that point. But in order to do that, first of all, it requires a really strong mind body connection.

8:53Second of all, it requires them just kind of like relaxing their body enough to even just slow down and enjoy the experience. So a lot of the work that we do is around that. And I would also say a lot of these clients get kind of hyper fixated on their partner's experience. And so not only is it sort of like, Like, am I going to, am I going to come? But it's sort of like they're, while they're going through this internal anxiety, they're also scanning their partner. Are they okay? Are they okay? Are they going to be mad at me? Is this going to be okay? Is this going to work? Is this going to happen?

9:23And so like all these things are taking away from their experience of their own body awareness. So a big part of the work is like helping them really just sort of focus internally, slow down, connect with their body and like, just kind of just, just let the rest of the world kind of wash away so they can enjoy the experience rather than having this thing that they're already sort of like freaked out from, from the jump. Does this look like breathing exercises? Because they know a lot of what we do and what we, when I counsel men that I'm not prescribing for, and I'll, you know, as you know, there's a lot of things that we try that are off label for premature or rapid ejaculation.

10:04But if I tell a guy, look, you really have to go see Natalie, but in the meantime, talk to me about the pinch technique or talk to me about withdrawal or talk to me about, like you said, I mean, I'm getting a picture in my mind of, you know, I just need to settle down and enjoy the experience. But then what is my next step? right so a lot of it is deep breathing and you know as you and i both know you can tell somebody you'll breathe deeply a thousand times but like when push comes to shove if they if they don't know how to do it if their body's not familiar with doing it it's going to be a lot harder to do it so um so part of it is just sort of the education on how to breathe what that even looks like because a lot of people just literally don't know how to breathe yeah um like they just do the short, shallow, and like, you know, that doesn't help your pelvis in any way, shape, or form.

10:58So sometimes like the session, in session will practice. So there will be like the literal practice so that their body sort of learns how to do it. So there's that element. There's, yeah, like the teaching them how to breathe, teaching them how to be more mindful. One of the things just with this, I see this across the board with almost all male sexual dysfunction is just the general disconnect between men and their bodies. They're so in their head. They are so not in the moment. So I would say a big piece of this is teaching men how to be present. And it's almost like they're culturally expected not to be.

11:41They're just expected to show up as a body. I know we talk a lot about how women are objectified, but I actually believe that men are very objectified and they're essentially sort of reduced to like just a walking penis. And they're supposed to show up, their penis is just supposed to work, stick it in, good, done, know what you're doing and be good at it. Right. Wow. Yeah. So this element of like helping them like no longer objectify themselves, they're not a walking penis. They have needs, they have experiences, they have sensations that they feel. and so helping walk them through first of all like making sure they understand that's okay because a lot of men feel like that's not okay they're not supposed to be sensitive they're not supposed to you know uh be turned off by certain things and so like first of all just it's okay that you have particular sexual interests or needs or wants or you need to be touched in a certain way or not touched in a certain way so like first of all all of this is okay the second piece is really helping them cultivate the focus on what are they feeling?

12:46Like oftentimes, one of the things I'll encourage men to do is like, literally like, focus on your penis. What sensation are you feeling in your penis right now? What is your partner's vagina feel like? You know, if they're, you know, if they're having oral sex or manual stimulation, like what is your partner's body feel like around your penis? And it's almost sort of like, oh, I never thought about that. It's like, like it never occurred to them to think about what is my penis actually experiencing right now. They're so busy in their head thinking about what is my penis doing or not doing. Is there a communication or a talk track?

13:19So say a man's in a new relationship with somebody. So kind of walk me through, you know, first time that we're going to be intimate with a guy and his partner and say, you know, what is, how do I, how do I prepare somebody for this? So I'm all about front-loading. I believe that front-loading is really important. I believe that it's really important. You know, there's an expression of an expectation is a disappointment waiting to happen. And so if the expectation is, oh, we're going to have this really long, intense sexual experience, and then it's over in two seconds, you know, your partner would likely be disappointed if that's their expectation.

13:59But if you can front load the expectation of like, hey, I just want to give you a heads up, this is nothing personal to you. This is something that my body does and I'm aware of it and I'm working on it. I just want to let you know, like I, you know, I tend to ejaculate, you know, pretty soon after insertion or, you know, I get really easily excited. I get really easily aroused. And so like, it doesn't take me a long time to ejaculate. And so in that case, like their partner is not sort of surprised, caught off guard, disappointed, et cetera. And like, they can work as a team to, to work with it.

14:33Like if we know that, you know, if we know that he's going to ejaculate quickly, like, you know, maybe we make sure to sort of get to the stuff that is enjoyable for both of them faster. You know, we don't try to do this long drawn out thing, or, you know, maybe there's more focus if it's a heterosexual couple, maybe there's more focus on her pleasure for a while first, um, to sort of, it allows you to game plan better because the, the worst is when it catches you off guard, it's surprising. And then it's disappointing. Like, oh, that's not how I thought that was going to go. This is a bummer versus like, okay, we know, we know the landscape here.

15:09So let's make sure we hit this point first, then this point, then we can do this part and then we're good. I like it. So that sounds like a reasonable game plan is that men have to offload a little bit of that expectation of being a walking penis, also a great term and figure out how to feel the enjoyment themselves and not have that concern. So now as an anatomist and a physiologist, I would say, well, Natalie, what you're seeing is that the erection is a parasympathetic, very relaxing thing to get an erection and then ejaculation is sympathetic. And so it's that autonomic nervous system that just kicks in.

15:46And all of a sudden the guy's like, fight or flight, I got to ejaculate and I got to go. And I remember reading this years ago, and I think it might be true, but we don't have a fact checker, Jordan, to know whether it's true. But I do think I remember somewhere that eagles, they mate in midair, they mate in free fall. And so I always think of this premature ejaculation as almost an evolutionary response that if you're not able to get the job done, then you crash to the ground together and you don't make little eaglets. But I think, is there anything I can do on my side as a urologist, you know, to optimize the outcome that what you see.

16:25In other words, in my tool chest for premature ejaculation, I essentially have topical numbing agents, and there's tons of them out there from compounding to brand names, to then sort of the really off-label medications like the antidepressant medications that interfere with that serotonergic response that we know is one of the side effects of taking antidepressant medicines is that delayed ejaculation. So we can use that to our benefit. But does that help you or hurt you as a therapist when I see these guys first? Walk me through how I can be a better urologist. Well, so I would say it's a mixed bag.

17:07So like some people, you know, sort of swear by the topicals and they, you know, find them to be very helpful. Um, I've also heard people say that they, uh, don't like them because either it makes their penis feel too numb or the element of like, sometimes it will get on their partner and their partner will feel numb. Although the fix for that is generally using a condom with it and that ideally becomes a non-issue. Um, but so yeah, it's a little bit, sometimes it's like, it works too well. And so then the client is sort of like, it doesn't sex as I can't feel sex. And then what's the point of having it if I can't feel it?

17:43Right. And then I would say the same is almost true for the SSRIs as well. It's sort of like either it's super helpful and it kind of slows everything down or it's too helpful. And then they have sort of the reverse problem of like, they can't maintain their erection or orgasm. So I think it really depends on the person and like how their body reacts to the medications. Some people are more sensitive than others. It hits people differently. There is one thing that I have found, and I do remember coming across some research about this, but I would say there is a pretty, as I was sort of speaking to in the beginning of talking about like the ejaculation issues, there's some research that I came across that has shown that people with rapid ejaculation have very tight pelvic floors.

18:30So they have a lot less muscle control within their pelvic region because everything is just knotted up and super tense. And so I actually have had a lot of success with clients who are concurrently going to pelvic floor physical therapy. There's only a handful of pelvic floor physical therapists in LA that work with men. Usually it's something that women do, you know, particularly like, uh, before having babies to prepare for babies after having babies postpartum to like recover. But I have found it to be really helpful for men with rapid ejaculation.

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22:31Natalie I love that because right I I have a a lot of pelvic floor physical therapists and they're going to be a central focus in this podcast because they help with all kinds of things with incontinence issues and guys with pelvic pain, which is very underdiagnosed for men, but it affects men almost equally as women. And then the mental health component to that. But I got to admit, you just taught me something because I don't think I've ever referred a guy for pelvic floor physical therapy with ejaculation problems, but it makes perfect sense. I mean, exactly. Because it is all, what I always tell guys is the, you know, the, an ejaculation is this evolutionarily shocking event because you have to take sperm, which really are very wimpy little things all the way down deep in the testicle and the epididymis and somehow propel them out of a urethra.

23:22The distance of sperm travels in its own little microcosm is about the same distance it would take to go from Los Angeles to San Francisco. So you have to do that within a 30 second burst. I mean, the muscle contraction of the pelvic floor to do that is like catapulting something from here to San Francisco. And so the pelvic floor, of course, I mean, that's kind of the root of all good and the root of much of a pathology that we all deal with. So that's a huge pro tip, huge pro tip. Well, I think we could go on forever on this. but I do want to see if you have any help on my guys that I think even feel more isolated is the ones with delayed ejaculation.

24:04And as I said, I mean, the off-label medications I have for that are kind of minimal. They're really even less than what we see for the premature ejaculation guys. We use an oxytocin nasal spray because we know oxytocin is kind of that cuddling hormone that spikes during orgasm. Sometimes that helps, but, you know, I think the literature supports about 40%, 40 % or the last. Yeah. And then some of the anti-Parkinson drugs or anti-prolactin secreting drugs like bromocryptine, but again, off label have side effects. And so, so tell me, tell me how to take care of my guys that, that have delayed ejaculation.

24:45What, what are some tips like these, these guys can get from, from your expertise? Yeah. Um, are you familiar with a book called the guide to getting it on? Oh, no talk. The author is, um, Jeffrey Eugenides and he wrote the first edition probably 20 years ago. And it was about this big. Um, now I think he's on like the 14th edition and it's about this big. It's essentially just a how to guide for anything and everything sexual. Um, and I think about 10 10 years ago, he decided to add, he had a chapter on premature ejaculation and then he had a chapter on erectile dysfunction. And then he, about 10 years ago, he decided to add its own chapter for delayed ejaculation because it's different than erectile dysfunction.

25:31It sort of is its own animal. He did not have a pretty prognosis for it. His methodology was, you know, get your partner on board for this is something that's going to be really challenging and may never get better. Um, I would say like, I think of it through the lens of like, when we think of erections in general and erectile dysfunction in general, like there's sort of this really fine balance of like body being calm, you know, having the right physiology around the hormones and the blood flow and whatnot. And then like this third piece of like stimulation, am I stimulated enough? And so like in the delayed ejaculation clients that I've seen, like, it's almost like there's a lack of that final piece of stimulation that triggers the orgasm.

26:21Like they're aware that it feels good. It feels good ongoing. But like, it's like their body needs like, you know, if the average body needs sort of this much stimulation to get over the hump, their body needs like this much. Sorry, I realize we're on a podcast. So you can't see. But like if you need one inch versus like three inches to get over that big mountain. So one of the things I try to focus on a lot with these clients is identifying like, how do you find that stimulation? Where does it come from? How do you sort of like you were talking about, like the volume of power needed to sort of thrust that sperm, you know, out of the testicles and, you know, out of the urethra.

27:00It's very similar. It's sort of like, this is, you know, this is like, what is that thing that will push you over the edge? A lot of times I've sort of find some secondhand, like neuropathy in these clients. Like there's sort of like a numbness that they experience. And so like that is a blocker to like the stimulation piece. Sometimes it's sort of an emotional block around like the lack of feeling safe or comfortable enough to ejaculate with their partner. So sometimes it's about sort of working on their own internal sense of safety. We see this a lot more in women around orgasm and how like women struggle to sort of relax their body enough to orgasm or feel safe with a partner.

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27:44So I think there are some cases with men where it's quite similar. The other piece that I often see is sort of like what I'll call like the masturbation training. Like some of these guys have been sort of training their bodies to edge over time and delay and intentionally delay ejaculation. Or I've also seen cases where clients need like a very specific something in order to ejaculate. Like I had one client who had to cross his legs in a very specific way and sort of like squeeze his thighs together in order to orgasm. And he could do this during masturbation, but it was very hard to replicate during partnered sex.

28:29So sometimes part of this is sort of like identifying like, what is it that your body needs to orgasm during masturbation? And is, can you replicate that during partnered sex? And so sometimes there's like almost sort of like a retraining of the body. And I would say sometimes it's possible, you know, neuroplasticity, our brains can relearn things. But I would say like, sometimes it's so deeply rooted that it's, it's really hard to sort of, you know, retrain or like, there's a reason that they started masturbating that way because their body doesn't get enough stimulation from, you know, a way that is more easily easy to replicate during partnered sex.

29:08Yes. No, I, I remember I had an interview and we're going to get into this in a little bit too, about pornography and masturbation, but I interviewed with Playboy magazine years ago. I think that's when my mom finally realized that I made it in the world when I did a Playboy interview. My quote was something like, you know, the, there's no orifice that has the surface tension of a guy's own hand. And maybe that's sort of what you're saying is that guys, that they get used to something. And actually I'll ask you this. I had a, I had a couple years ago, this has happened a few times in my practice because I do a lot of work in the fertility community as well, as you know.

29:44And I had a couple where a very loving couple, no red flags at all that they weren't going to be fantastic parents. But the man had never been able to orgasm through intercourse, through within the vagina, even with a condom on. But he had no problems finishing. And so their sexual practice was mutual masturbation, essentially to achieve orgasm. But boy, from a fertility perspective, it was a non-starter. There was no possible way that they were going to have a baby through spontaneous intercourse. And thankfully, she was an amazingly accommodating woman. And that was probably just the way that he was wired maybe.

30:31But talk to me, it would be anything I could have done differently other than referring them to you. If I didn't, I don't remember, I may have that, that you would say, well, gosh, you know, this is, this is okay. It's just, it's, you know, we're gonna have to work around this in order to figure out a fertility aspect. Well, so one of the things that I tell almost all of my clients, usually within the first session, if not the first two, is the broader your definition of sex, the more sex you can be having. So if you limit your definition of sex to like penis and vagina intercourse, if you can't do that, that's, you know, quite unfortunate.

31:06Like, oh, I'm never gonna be able to have sex again. Whereas like, if your definition is much broader, like, for example, this couple, you know, this, this, like the mutual masturbation piece or oral sex, or, you know, whatever it might be, if all of those things include are included in your definition of sex, you can be having a lot of sex with your partner. So like my, my baseline is any sort of sexual interaction counts. And if that works for you and your partner, like a plus, great. But yes, when it comes to making a baby, that doesn't work. So I would say like from a sexual connection perspective, yeah, like that's awesome.

31:45That's great. That's wonderful that they found this thing that works for them. um uh but i would say yeah like so for the people who are like well that's not good enough you know i want to be able to do these other things and have intercourse with my partner um one of the things that i will often suggest or recommend is like are you familiar with a flashlight i've heard of them yes okay so for those who are not familiar with it um it's almost like uh they don't really make these much anymore but like when you used to go on camping trips and you have those giant flashlights that are, you know, weigh like five pounds and they're about, you know, three or four inches wide and they're like almost like a spotlight.

32:24Um, the casing looks like that, but you open it up and there's like a vaginal, a rubber vaginal canal inside. Um, and so it sort of mimics the shape of a vagina. So I would say, um, yeah, it's like a rubber latex whatever um so i would say like the og was the fleshlight um but now there's like millions of them um there's like a few japanese companies that make really so like essentially they're like sort of masturbation tools there's some there's a japanese company that makes like a disposable one and you can buy like a 10 pack of them and you just use it and pitch it whereas like a lot of people with the fleshlight get annoyed with it because the cleaning is a lot of work to clean up after use.

33:08You said you had to avoid that portion of the landfill if you just go into the area where there's a bunch of disposable. Right. Yeah. So what I often recommend for these clients, like if it is really important to them to try to be able to do this with their partner, I often encourage them to move away from masturbating with their hand completely. So like, like you said, you know, nothing can get tighter than the hand. And so moving away from the hand and using like limiting their, you know, sexual interactions to either, you know, sex with their partner, or if they are going to masturbate using one of these, like masturbation tools.

33:51And so like, to me, it's sort of like the, you know, the neurons that fire together, wired together. So the more we train our brain to do something a certain way, the more it likes to do it that way. So part of this whole sort of brain retraining piece is this element of like creating or utilizing experiences that are as akin to intercourse as possible. And so for some people over time, their body is sort of like, okay, well, if this is what we're working with, I guess I'll, I guess I'll, I'll find a way to enjoy this. For some people, it's a little bit more challenging. And, and it's also really hard when you're competing from a behavioral perspective of like, you know, it's sort of like giving the rat cocaine versus giving it sugar water.

34:33Like if it has the option of cocaine, it's always going to choose the cocaine. Born and raised in the eighties with the Eagles and the sunset soundtrack. I get it. Hard to get out of those guys. Right. So like, I think from a behavioral perspective where it gets tricky is trying to convince someone, here's this thing that, you know, feels really good versus here's a thing that doesn't feel as good, but there's this potential for it to sort of improve your connection with your partner. It's from a brain perspective, it's a little bit of a tougher sell on the dopamine front. But you're basically saying practice as you play.

35:09I mean, that's pretty, that's pretty amazing advice that gives guys a little bit of a roadmap. They're still being sexual, but they're moving towards a goal of being able to have partnered intercourse with a better payoff. I love it.

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38:13Well, I have to pivot over because, I mean, again, I can guarantee I knew at the beginning of this that I'd say we're going to have to have you back. But I will say we're going to have to have you back. But let's talk a little bit about libido mismatch because it actually dovetails a little bit if with this delayed ejaculation or difficult orgasming. A lot of guys, either it's straight problems with erectile dysfunction where their libido isn't there or it might be there, but they turn off. and the partner's willing, but they aren't. What do you do with those couples? And I think we'll hit some scenarios as well on both sides.

38:49So if a guy's overly horny and his partner isn't, or vice versa, if the partner isn't as horny, but the guy is, walk me through that. And I see this across all spectrum of relationships. And it seems to be no gender boundaries. And so, yeah, walk me through kind of your day in the office with a couple that's suffering from libido mismatch? Well, I mean, yeah, like you said, you know, sort of the gender piece is irrelevant. And I would agree. And I think like, you know, oftentimes I have people who, you know, just, oh, you're a sex therapist, blah, blah. So like, do you just see like the stereotype is that I just see all these sex hungry men who have wives who have no interest.

39:32And I would say like the reality is, is like, it really is more 50-50. It's really not this piece of, yeah, like the women who don't want it and the men who do. I have plenty, plenty of men in my office who are the lower desire partner. So I generally refer to them as like who's higher desire, who's lower desire. And so like one of the baselines that I talk about with all couples is just due to the laws of physics, there will always be a higher desire or a lower desire partner in the relationship. Like there are no two humans who have the exact desire all the time at the same time. For every libido, there's an equal and opposite anti-libido.

40:14Exactly. That's one of Newton's unpublished laws. Okay. Exactly. Yes. So like just sort of starting with the baseline of like, you know, there are no two people who are always on the same page at all times. So like what you are experiencing is normal, like, you know, just in the same way that there's no couple that like both partners are equally hungry for tacos at the same time every day. I don't know. Don't bring tacos in. I think my wife and I are always hungry for tacos at the exact same time. I was actually just going to say, I think my husband and I are also always hungry for tacos. We're huge taco people if we're still talking about tacos.

40:52But so like, I guess the reason why I'm explaining this is also because I think for women, it's a little bit more normalized because it's such a cliche, sort of like the sex hungry husband chasing after her. For men, I see a lot more shame around it. They're sort of like, I'm not supposed to be like this. I'm supposed to want my wife or my partner all the time. I'm supposed to just, again, the objectification piece. I'm supposed to be a walking hard on regardless of how I'm feeling or where I'm at emotionally. So I think one of the things that I do just sort of like to unpack first and foremost is just like, yeah, like the feelings around it.

41:31How does each partner feel about it? What does this mean about the relationship? Because a lot of times people sort of dive into this deep, like, oh, this means I'm never going to have sex again, or this means my partner's not attracted to me anymore. And so like, you know, either it means like, they're just going to kind of check out emotionally, or they're going to cheat on me. Like, there's so many places that people's mind jumps to. And what ends up happening is that it becomes, not that it becomes a self-fulfilling prophecy and that all these people cheat or all these people check out, but it just exacerbates the problem instead of really diving into how do we reconnect?

42:08How do we make this something that we both enjoy? Usually what I do see a lot of is that one partner didn't really enjoy the sex, And so they kind of just participated. And then over time, like the, you know, the new relationship energy or the excitement associated with the person has died down. And there's sort of a homeostasis and then sort of like, well, I don't, I don't have to do this thing that I wasn't that into anymore. Like, we're good, we're secure. Like, I don't, I don't have to. And so they kind of just slowly check out. so I would also say a big place that I like to start is like you know what was enjoyable about the sex that you were having or like tell me more about the sex that you don't want to be having well every time I have sex my partner is disappointed it's not good enough I'm not doing this I'm not doing that so like I don't want to be berated anymore or I don't want to do this thing that my partner doesn't enjoy or that like I'm not doing it good enough or like I don't want to get picked apart sometimes it has nothing to do with the sex itself like sometimes like I think Americans love to think that they are immune to stress and they can endure anything.

43:17But like the reality is, is like we are human and we are more stressed than ever. So I think there's also this huge piece that people underestimate about like, oh yeah, like working full time, raising kids, remodeling a house, starting a new job, like whatever it is, navigating in-laws, like, you know, all of this, trying to make ends meet, trying to, you know, whatever it's a lot on the system and then it's like on top of that we're supposed to like have fun and be playful and I would say like having fun and being playful is a muscle like you know just as much as being able to you know show up and do the grind is and so when you don't flex that muscle you don't practice that muscle you know oftentimes it's sort of that experience where it's like when you have an hour to yourself what do I do with myself well you you described almost every couple in Los Angeles with that litany of things that are going on.

44:12So let me ask you this. I have a question that I ask a lot of patients that I see that come in for erectile dysfunction or poor libido. And I ask them the vacation sex question. And I say, when's the last time you had vacation? Most of them will say three years ago, but if they had it within the last month, luckily, and I say, well, did you have lots of sex on vacation? And if they say yes, I say, great, then you don't really need me as a urologist. You need to take more vacations. You need to find a good job. Right. I mean, like, you know, you mentioned the nervous system. Like, if your nervous system is so accustomed to constantly being in the go, go, go mode, it becomes harder and harder to switch it into the, you know, rest and digest, you know, relax mode that is required for sexual pleasure.

45:00Do you believe in the, in the scheduled sex? Do You say, okay, Wednesday hump day at nine o 'clock, kids are in bed. You and me, we're doing this. Talk to me about how effective that is in your practice for the busy couples. I absolutely do. I am a big proponent of the scheduled sex. I'll explain why. I think the scheduled sex is because, first of all, in this day and age, if you do not schedule something, it does not happen. You know, if you go to the gym, nobody just sort of spontaneously says, huh, I think I'll go to the gym right now. Or like maybe if you do, you have the time and the space and the opportunity to do that, you know, maybe once every two or three weeks that like the clouds magically part and it's like, oh, I have a free hour.

45:47Let me go to the gym. Like usually what people do is they say like, all right, like I'm going to get to the gym on Tuesday, Thursday, and Saturday. These are the times I'm going to go. And where it gets extra complicated is you're not just managing your own schedule. You're managing two people's schedules. So it's not just my clouds have magically parted and I'm suddenly feeling this feeling or wanting this feeling, but like I need my partner to have that or their clouds part at the same time. So I would say like logistically speaking, it's really challenging when you have that many moving parts in your life.

46:19So I think it's really important, particularly for busy people, that they do schedule it. the other reason why I think it's really important is hopefully this is new information for you. But there's two types of desire. So there is what we sort of colloquially know of as desire, which is spontaneous desire. That's sort of like I'm cooking dinner or I'm taking a shower or I'm at work and it's like, boom, I get hit by a lightning bolt and I'm like, oh, I want to have sex with my partner or like, Oh, I'm really aroused. Like I want to do something about this. I want to have sex right now. This sort of like out of nowhere, my body just kind of like, it just snaps on and it's like, Ooh, or like, yeah, suddenly I look down and I'm, you know, I have an erect penis or suddenly I like, you know, I'm lubricating and I'm like ready to go.

47:09That sounds like 10th grade algebra class. That's literally, yes. Like the teenage version of like, I just like, Oh my God. Oh my God. I don't even like algebra. What's happening here. Exactly. So a lesser known version of desire, and oftentimes it's sort of considered like second tier, but I think it's equally as important is what you would call responsive desire. so this is the piece where like somebody needs a little bit of like sort of massaging and remind and I don't mean physical massaging I mean like mental emotional like some sort of like I would say like foreplay if you will in some regards but some sort of thing that kind of like prompts them to want sex so like that could mean like your partner kind of walks up behind you and starts massaging you.

48:03And while you were thinking about all the shit I have to do and this, that, and the other, and then all of a sudden your partner is massaging you and you're like, Ooh, that was kind of nice. Whereas like, if you were doing what you were doing, you never would have thought of sex if your partner didn't touch you. Um, so, so this element of responsive desire is that like the desire kicks in, in response to like a stimulus, but if the stimulus isn't present, it may never kick in. And so when you schedule sex, you are essentially saying, I am going to be intentional about creating a stimulus here.

48:38Whereas like, if you're just sort of walking about on your merry way and hoping that the lightning hits you, you could be waiting a really long time. It's almost a Pavlovian response, or as the great country poet, Brad Paisley said, sometimes a back rub is only a back rub, but maybe not. Right, right. Yeah. Well, again, I mean, those are some huge action items in that and trying to figure out how libidos can get somewhere on the same page. So I think we have to move on just because we can do this forever. But give me your thoughts on porn. Like if I see a guy that comes in and he says he has erectile dysfunction.

49:19And again, it sort of puts a cap on all that we're talking about here. but it's really only with partners because he has no problem masturbating seven times a day. Is that guy going to be okay? Is that a different guy than the guy that comes in and said, yeah, every once in a while, you know, I'll watch porn or my partner, I'll watch porn because it turns us both on. Walk me through what's bad and what's good. I mean, with alcohol, we know a couple of drinks a day, you're probably okay. With cigarettes, none is good, right? Ever, ever, with, you know, with shopping, you know, as long as you're not in credit card debt, then you're probably going to be okay.

49:54But porn, I mean, now that it's free and everywhere, what are the limits? What are the guardrails? What are the things that I can impart to my patients that I see? Because I have sort of the thought in my own head, but I'm not going to impart my own opinions on somebody else's experience. God, I could talk for hours about this. That's why you're coming back. So I would say sort of like the short answer is, first of all, I think porn is very similar to alcohol in the sense that like for some people, it's not an issue. They can do it casually every now and then. It doesn't get out of hand. It doesn't cause problems, etc.

50:31For others, it is a black hole. For others, they are sort of like sucked into this kind of like, you know, abyss, and it's just a never ending need for like more and more dopamine. And so I think part of what we're talking about, and part of what gets really glossed over is that like, everybody has different brain chemistry. And some people's brain chemistry is significantly more responsive. And, you know, dare I say, addicted to these sorts of behaviors. Whereas other people like their their serotonin just isn't it doesn't work that way so i think the baseline is to say that like everybody is a little different so there is no one size fits all but so like in the same way that somebody with like a you know history of alcoholism and their family might want to be more careful about alcohol somebody who you know uh you know has more addictive tendencies probably wants to be careful about porn because like it activates all the sort the dopamine systems and centers that is akin to a lot of these addictions that we see.

51:37But so I would also say like, what also gets tricky is the research. So like the research is literally split down the middle. There is research on both sides. Porn is bad for the brain, it creates all these problems, blah, blah, blah. And then there's research on the other side, you know, people who watch porn report having better sex lives, more frequent sex, blah, blah, blah. So like what ends up happening is the people who are in favor of one side talk about that research. And by first, I mean, we see this all the time with research. So the research is really split and people often tend to sort of side with the research that represents their beliefs or opinions.

52:19What I tend to see, it's safe. I see people using it. I mean, at least the people who come to my office are coming because they have a problem. So there could be, you know, millions of people out there that it's not a problem for, but I don't see that. So I don't hear about it. But the people that I see, oftentimes, it creates a lot of problems in their life, creating a rift in their relationship, it's impacting their ability to focus on work, it's impacting their ability to get sleep at night. I've had clients who literally have like injuries from masturbating too much, like carpal tunnel, like wrist injuries from going down these sort of porn, you know, K-holes, if you will.

53:02Yeah. No, penis injuries too. Yeah. I see. Yeah. Oh yeah. Penis injuries as well. Absolutely. Well, things to their penis with, uh, just with porn and just frequent. Yeah. So, right. So like when you have people on their soapbox saying porn isn't bad, it's like, well, sure. Yes. Like for the majority of people it's not, but like, it's also, So there are people who it legitimately causes problems for. You bring up this idea of a selection bias in biostatistics where you're right. If there are plenty of guys that don't need your help, they're not going to come in and see you. But for the guys that are saying, whoa, you know, Natalie, I just ruined a relationship because I'm never able to be intimate with my partner and I just can't seem to get offline.

53:43So, I mean, that's such a big thing. And I see especially younger guys, my undergraduate students that may have been introduced to porn when they were nine or 10 and 12 or some early, early age. And now they're trying to regain or trying to establish normal intimacy patterns when they're in college. How do I teach a guy and should I teach a guy what to do? How do you wean off this? So, I mean, one of the things that we know about like, you know, dopamine and serotonin and sort of how these things kind of like process and refill in our brain is that like the sort of the rapid fire element reinforces it.

54:26You know, it's sort of like if you think of a faucet, you know, the rapid fire images make the faucet turn on really fast, but like the well empties eventually. eventually and so like part of part of this process is also like one of the things we know about neural pathways is once they learn how to do something they do it really quickly and then they want to do it faster and faster and faster it's really hard to do the ween because our brain is sort of like well this is the path why would i slow down i already know the path there's no need to slow down right um and so it's sort of like if i'm going to take the path i'm going to take it at full speed.

55:04So the approach that I generally recommend in these situations is the abstinence approach. And so, you know, like, and I want to be really clear that I'm not coming at it from a sex negative standpoint. There's a lot of people that also have the, you know, anti-porn means you're a sex negative. And then I will be clear, I'm not anti-porn in any way, shape or form. This is more strictly as it relates to like helping people regulate their dopamine systems, because that's really what we're talking about. Porn is just a mechanism to do that. It could be porn, it could be gambling, it could be shopping, it could be food.

55:38Like there, you know, it could be relationships. There are a million ways that people do this, video games. So I am not like anti any of these things. I am pro helping people regulate their dopamine system so that they feel happier and better and more regulated in their life. So I would say like my encouragement is often the abstinence approach. And again, it's tricky because it's essentially saying to the person, all right, the cocaine is there and the sugar water is there. You got to start choosing the sugar water. Like, well, why would I want to choose the sugar water? If the cocaine's there, cocaine's much better.

56:14Right. I mean, I guess what I'm trying to figure out is that I don't even know if this is really a Venn diagram, but it is, I guess, in that, you know, there's porn, there's masturbation. You don't have to have porn to masturbate and you don't have to masturbate while you're watching porn. And so is there a way to say, look, you can maintain intimacy. Just don't just don't watch porn. Do something that that seems to be that that cocaine, you know, but just do something. Yes. Right. So there's also, you know, this can also go back to, you know, in two ways, the neurons that fire together, wire together.

56:49So it comes back to this piece of in young men, it's shocking how many of them I ask, can you masturbate without porn? And the majority of them say no. The answer is I need porn in order to masturbate. So this idea of like masturbating to fantasy or sensation is like, huh, I'm supposed to do what? So for so many people, they really are paired together. So I would say like step one is like, again, like I, you know, masturbation is incredibly healthy. Like I knew that I would say it's a very, very rare case where I would ever tell somebody not to masturbate, or I think that it's harming their health to masturbate.

57:29So this is not about saying no to masturbation. This is about learning how to masturbate without like this intense stimulation firing at you nonstop. So I would say yes, like in terms of the Venn diagram, like the masturbation is that's we're good there. Like just but the question is, is like, can you do it without porn? Because there I absolutely have encountered people that have gotten to the point in their sexuality where they can't. But so again, like if you think about partnered sex, if you can't masturbate without porn, how do you you know, it's a lot more challenging to have unless you have porn blaring in the background of your sexual encounters like can you get aroused at all without it i love that yeah and i think you kind of gave yourself a call back to we were discussing earlier with just guys not being totally in touch with their own body and being dissociated and porn is kind of the walking hard on i think as you said the walking pedis versus really trying to understand the mind-body connection.

58:31And it seems like that is the quick, you know, the quick bump of blow is to turn on, you know, log in. There's no barrier to access, as you said, these days. Right. There's no barrier to access. You can access any sort of sexual act you want. You can access 15 different versions of it, rapid fire, one after another, like the ease, the intensity, the, you know, you know, it's like, if you like cake, it's like having 15 different pieces of cake in front of you at all times. Right, right. Well, I want to be super mindful of your time and your amazing family. I don't want to take you away from them any longer than we have to.

59:08So I do want to ask you, as a mental health specialist, I always like to ask guests, because what can I learn from you about what you do for your own mental health? Are there sort of three to five things that are must-haves you get up every day to center yourself, to be the best provider you can? What are your life hacks that I can learn from you? Well, so I would say, like, I mentioned it earlier, breathing. Like, I am totally guilty of forgetting to breathe. And so every now and then I have to really, like, pause, take a deep breath and just breathe. Try to be really mindful of like, am I, am I breathing?

59:46Am I letting the moment take me or am I like leading the moment? And so having like, you know, if I'm feeling dragged, I have to really pause and breathe. Um, and so I would say like being really mindful of my breathing, as is the case with most people, I have an on off relationship with meditation. Um, at the moment I'm in an on phase, um, but so trying to be mindful about like 10 to 15 minutes today. But, you know, as I'm sure many people experience it, it comes and goes. And I would say, like, this is also a hard one for me. But communicating, talking about my feelings, opening up, sharing with friends about how I'm doing, where I'm at, talking with my partner about, you know, how I'm doing and where I'm at.

1:00:31You know, I think I am one of those people who's Like, I will bottle things and just power through. We'll be fine. Power through. And so I think my self-care is really being intentional about slowing down, opening up. You know, I don't have to power through. Like, it's okay to, you know, talk about things. It's okay to slow things down. It's okay to acknowledge if something isn't feeling good. But those are things that I really do have to work at and be intentional about. Well, I think I didn't see you breathe once during this whole discussion. So I guess it must have been not too stressful for you, which I love.

1:01:06And I didn't see you power through. We just solved most of the world's mental health problems here in our discussion. So I'm so grateful to you. Natalie Feingert-Golberg, truly amazing resource to Los Angeles and to the world around. No, I look forward to many, many years of sharing patients and collaborating. anything that you want to plug anything going on that that is is near and dear to your heart. Yeah, so it's my website creating change la.com. I would say right now, I'm just really focusing on my clients and you know, both my like individual work and couples work. And I actually have a few therapists on my team as well.

1:01:49And so just really focusing on on helping people, you know, one, two people at a time. I do have the self-paced course because I found that there's so many people who want help, but are not at that point where they're ready to talk about it with someone face to face. So the course is sort of like it, like I said, it's self-paced it's six or seven videos. It includes exercises that, that people can do, you know, and, and so I think it's just an alternative for people who just like, aren't ready to, to face anybody else with this yet, but they know they want to work on it. So it's a wealth of information and how to's.

1:02:27Love it. Well, thanks so much, Natalie. This has been awesome. Yeah. Well, and thank you for doing this because I have so many clients that I have sent your way. And usually you are really great about getting them in, but your office in general tends to have quite a wait list. So for people to be able to have access to you is, it's great. Well, you know, I mean, anytime, just text me because I will get you guys in and we just, you have to come by, but we're just opened this 11 ,000 square foot men's center and it's huge. And so, you know, we have better volume access now. And so, yeah, anytime you have anybody, just let me know and we'll get them in soon.

1:03:04Yes, for sure. You are the best. All right. Happy to. All right. Thanks, guys.

1:03:17Let's talk about it. Let's talk about it, the mailroom. Let's talk about it. Let's talk about it, the mailroom. Let's talk about it. Let's talk about it, the mailroom. The Mailroom with Dr. Jesse Mills was a production of iHeartRadio. It was executive produced by Jordan Runtog. It was edited, mixed, and mastered by Bahid Frazier. And the theme was provided by Long Transit. If you liked what you heard, please subscribe and leave a review. For more podcasts from iHeartRadio, check out the iHeartRadio app, Apple Podcasts, or wherever you listen to your favorite shows. This program is intended for educational and informational purposes only.

1:04:11It is not a substitute for professional medical advice, diagnosis, or treatment. Consult your health care provider for any medical or other related questions or concerns. The views and discussions aired on this podcast are those of Dr. Mills and do not represent the official positions of UCLA or UCLA Health.

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From the publisher

Dr. Jesse Mills and Jordan are joined by sex therapist Natalie Finegood Goldberg for a no-shame, deeply practical crash course in the issues men are most afraid to talk about: premature and delayed ejaculation, mismatched desire, and the confusing role porn can play in modern sex lives. A licensed marriage and family therapist and clinical director of Creating Change LA, Goldberg explains why anxiety, tight pelvic floors, and fragile mind–body connection drive so many ejaculation problems—and how breathing work, pelvic floor therapy, “frontloading” conversations with partners, and even retraining how you masturbate can make a real difference. They dig into what happens when partners’ libidos don’t line up, why scheduled sex actually works, and how responsive desire is just as normal as spontaneous arousal. It’s an honest, compassionate guide to understanding your body, communicating better, and approaching sex as a skill—not a test you’re supposed to ace.

See omnystudio.com/listener for privacy information.

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