You went to the doctor. The bloodwork was fine, the scans were fine, and you were told to live with it. So you assumed the problem must be you. But what if the pain, the softer erections, the coming sooner than you want were never in your head? What if the part of your body nobody named has muscles, nerves, and actual treatment options? Dr. Susie Gronski is a pelvic health physical therapist and AASECT-certified sexuality counsellor and educator who built her practice around the gap nobody else was filling. Men have pelvic floors. Those muscles get tight, tense, and crabby, and they can be rehabbed. She also has a phrase she gives every client before they get on the table: bodies do body things.
You went to the doctor. The bloodwork was fine, the scans were fine, and you were told to live with it. So you assumed the problem must be you. But what if the pain, the softer erections, the coming sooner than you want were never in your head? What if the part of your body nobody named has muscles, nerves, and actual treatment options?
Dr. Susie Gronski is a pelvic health physical therapist and AASECT-certified sexuality counsellor and educator who built her practice around the gap nobody else was filling. Men have pelvic floors. Those muscles get tight, tense, and crabby, and they can be rehabbed. She also has a phrase she gives every client before they get on the table: bodies do body things.
With over a decade of expertise in men's pelvic and sexual health, Dr. Susie Gronski is a Licensed Doctor of Physical Therapy, Pelvic Health Therapist, AASECT Certified Sexuality Counselor and Educator, and founder of a multidisciplinary pelvic health clinic in Asheville, North Carolina. Through her clinic and Patreon, she helps men navigate taboo pelvic and sexual health concerns and works to make pelvic therapy more accessible.
Website: https://drsusieg.com/
Patreon: https://www.patreon.com/drsusieg
Instagram: https://www.instagram.com/dr.susieg
TikTok: https://www.tiktok.com/@drsusieg
Pelvic Pain: The Ultimate Cock Block, Dr. Susie Gronski
https://drsusieg.com/pelvic-pain-book-for-men
Coming Soon: The Unshaming Guide to Early Ejaculation and Lasting Longer, Michelle Fischler
https://getsome.ca/coming-soon-book
Manhood: The Bare Reality, Laura Dodsworth
https://www.lauradodsworth.com/manhood
MakeLoveNotPorn, founded by Cindy Gallop
https://makelovenotporn.tv
Erika Lust
https://erikalust.com
Live Demo: Male Pelvic Floor Exam
https://www.patreon.com/drsusieg/posts/live-demo-male-159871249
Live Demo: Female Pelvic Floor Exam
https://www.patreon.com/drsusieg/posts/live-demo-female-148634739
Got a story you want to tell on GETSOME? Email michelle@getsome.ca
Follow @getsome_podcast on Instagram
Produced by Katie Jensen at Vocal Fry Studios
[00:00:00] Dr. Susie Gronski: -When you have pain in your genitals, could be penile pain, testicular pain, lower abdominal pain, bladder pain, tailbone pain, anal pain, pain with intercourse, pain with ejaculation, pain with erection, anywhere in that region down below, it can be very detrimental to one's mental health, sexual health, physical wellbeing, all the things.
[00:00:21] Michelle Fischler: I'm Michelle Fischler, certified sex therapist, and this is GETSOME. [00:00:30] This season, I wanna talk about men, what they're told they should be, and what happens in bed when they can't be it.
[00:00:41] Pain, erection changes, ejaculating sooner than you want, or wondering whether you're normal can feel deeply personal.
[00:00:50] Dr. Susie Gronski: And especially when you do seek help, which takes a lot of courage for most people to talk about bladder, bowel, and sexual function to a a healthcare provider. [00:01:00] But when they finally do, unfortunately for a lot of men, they're often dismissed, told that there's nothing not showing up on blood work or urine analysis or diagnostic scans, and are left to just fend for themselves or chalk it up to a mental health disorder.
[00:01:17] Michelle Fischler: but your body has muscles, nerves, a pelvic floor, a stress response, and real treatment options.
[00:01:26] Dr. Susie Gronski: What are the possible physical, [00:01:30] psychological aspects to someone's erectile dysfunction or whatever sexual dysfunction that they are experiencing. It could even be hormonal, endocrine. The endocrine system, cardiovascular system, nervous system, all of those systems have to be intact and operating well in order for erections to occur.
[00:01:53] Michelle Fischler: Dr. Susie Gronski is a pelvic health physical therapist sexuality counselor and [00:02:00] educator. She recognized a real gap in sexual health education when she first began practicing and decided to do something about it.
[00:02:08] Dr. Susie Gronski: When I first began my private practice years, years, years ago,, there were no courses, continuing education around men's pelvic and sexual health. I took it upon myself because men were reaching out asking for help, saying they have these bladder concerns, bowel concerns, sexual pain, , "Can you [00:02:30] help me?" So I recognized there was a significant gap in accessibility, and care, and knowledge around men's pelvic and sexual health.
[00:02:39] Michelle Fischler: If you've ever felt embarrassed by pain, erection changes, early ejaculation, anything your body is doing below the belt, this episode's for you. We talk about pelvic health, normal changes in erections, the nervous system, early ejaculation, and what becomes possible when somebody [00:03:00] finally says, "Bodies do body things."
[00:03:04] Dr. Susie Gronski: Like I tell people and I warn them too before we get on the table for examination or treatment Listen, these bodies do body things," I say to them. I say, "Bodies do body things and s- this may or may not happen today. Whether it's erection or whether it's ejaculation, it may or may not happen. But here's how we handle that."
[00:03:25] Michelle Fischler: Here's my conversation with Dr. Susie [00:03:30] Gronski
[00:03:30] you started as a physical therapist. what led you to become AASECT certified as a sexuality counselor and educator?
[00:03:40] Dr. Susie Gronski: I probably should give credit to my family members who were so open talking around, about sex, mostly jokingly.
[00:03:50] There were never any, serious, wholesome conversations around consent, and boundaries, and safer sex practices, all of that stuff I kind of [00:04:00] learned as I evolved as a human being and as adult. However, we didn't shy away from talking around sex, you know? If there were any issues below the belt, people openly talked about them in my family.
[00:04:13] And so that just came natural to me to talk and ask questions around sexual health, and that's how it started because when we're talking about the pelvic floor, we're talking about pelvic health, we're talking about all of the parts included, [00:04:30] urinary function, bowel function, sexual function.
[00:04:34] All of those activities of daily function, one could say, pooping, peeing, and sex, are vital, important aspects to everyday function and your overall health and wellbeing, right? So the World Health Organization has four pillars of health, spiritual, physical, mental, and sexual as part of [00:05:00] those pillars of health.
[00:05:02] And to not talk about sex when we're addressing matters below the belt, I thought wait a second, we're excluding a whole aspect of someone's wellbeing, I just don't see how we can be pelvic floor therapists, without the sexuality education
[00:05:23] Michelle Fischler: Your site says that it really takes courage just to [00:05:30] book the first appointment with you. What are men most afraid you're going to say to them?
[00:05:42] Dr. Susie Gronski: What are men the most afraid of what I'm going to say to them? I don't think it's necessarily what I'm going to say to them that is the scary part. What I think [00:06:00] the scary part is, is having to say the thing that's been plaguing them or bothering them or on their mind or they're worried about, anxious about, to say it out loud to another practitioner. It's not common for traditional medical settings to offer spaces where people can lean into being themselves authentically, showing up, having the [00:06:30] space and time to share their story and not feel judged.
[00:06:37] So, so I think the fear really is I don't wanna feel rejected. I don't wanna feel judged. I wanna feel welcomed, cared for, and loved in that situation. This is really hard for me to even talk about. Most people share things that they haven't shared with anyone, even their spouse. [00:07:00] And feeling like they can do that without being dismissed
[00:07:05] michelle: Do you think another part is that when it comes to your specialty Do people even know it exists?
[00:07:19] Dr. Susie Gronski: I hope so. So
[00:07:22] Michelle Fischler: The-- and I don't mean p-people in general. I'm thinking like that guy who, let's say, [00:07:30] is struggling with erections or ejaculation. He... Number one, I guess he could tell his family doctor. Would the family doctor know to refer to a physical therapist for early ejaculation and all the other
[00:07:50] Dr. Susie Gronski: No. So that's such a great question and awareness that you're bringing up for us here, because that is the challenge, is this gap to [00:08:00] accessibility to care. it is not guaranteed that medical providers like an internist, a primary care provider, urologist even, is going to refer to a pelvic health therapist for men like myself, because it is still a rare thing to have a specialist who's, who exclusively works with men to the capacity that I do around all the things we're talking about, pooping, [00:08:30] peeing, and sex.
[00:08:31] so no, I don't believe that it is a well-known thing. Although I am surprised more often now that the referral to pelvic therapy is in the forefront, and in fact, the American Urological Association guidelines, the, European Association guidelines around treating chronic pelvic pain conditions for both men and for women [00:09:00] acknowledge a referral to pelvic floor therapy as, first line of treatment, of course, when appropriate.
[00:09:07] So there greater research, there's greater advocacy around multimodal treatment of care across disciplines, not just with pelvic therapy, but also mental health therapist, because we do know multimodal treatment and being well-resourced and equipped with support from all different angles is going to help someone overcome [00:09:30] this pain problem with greater success than just a single modal treatment.
[00:09:42] Michelle Fischler: I wonder if there are some people or some doctors that would see a man, let's say, in his 50s, 60s, 70s, , and maybe they would just, they would say, "Well, that's, [00:10:00] part of getting older." Would there be a reason to refer to someone like you in that age range who's str- yeah, struggling with their erections?
[00:10:19] Dr. Susie Gronski: Well first, if someone's struggling with erections that are ... Well, the issue is persisting, consistent, or worsening over time, I would hope that the medical provider , that this person is asking for [00:10:30] help from would do more due diligence for that patient than to say, "Hey, you're just getting older.
[00:10:36] You gotta live with it." Because we do know that if you have reduced erectile function that is persistent, ongoing, consistent, we know from research that the likelihood of an adverse cardiovascular event within three years is probable.
[00:10:56] So your hard health down [00:11:00] there is indicative of your heart health, and it's crucial to get cardiovascular workup, to assess for your heart health, to rule out things like diabetes and metabolic disorder diseases. Those things are really important as far as comprehensive diagnostic related to erectile function and sexual health.
[00:11:27] So it is indicative of your [00:11:30] overall health, so that definitely should be looked at and tended to. Now, What are the possible physical, psychological aspects to someone's erectile dysfunction or whatever sexual dysfunction that they are experiencing.
[00:11:45] Because we do want to be ruling out red flags or other avenues of why this person is experiencing sexual dysfunction or, for example, erectile dysfunction. It could even be hormonal, endocrine. The endocrine [00:12:00] system, cardiovascular system, nervous system, all of those systems have to be intact and operating well in order for erections to occur, right?
[00:12:13] And of course, mental health and wellbeing have significant impact. So you've got psychogenic ED and vasculogenic ED, and then everything in between that overlaps. So I do think it's imperative to have that diagnostic workup done, and hopefully that primary care provider [00:12:30] internist will do a little bit more investigation to rule in and rule out other potential causes that we might honestly be saving someone's life, preventing stroke or heart attack, and then medically treating appropriately.
[00:12:43] Now, that's not to say that someone like myself, who works with, the musculoskeletal system, the pelvic floor, the muscles and the nerves, and also the sexuality counseling to bridge that wouldn't be helpful or advised, [00:13:00] because that's where the education, the confidence building, the learning around the parts of their body and what impacts sexual function.
[00:13:09] You know, We piece it all together to give them this, bird's eye view of the beautifully complex systems that are our biology, and that there are many ways to work with them, and to change. and also relationship wise and just offering some communication skills or helping to reduce [00:13:30] anxiety around performance and, things like that.
[00:13:31] So the education, is an indispensable resource that people, mm, lean on when they're seeking support for their sexual dysfunction or their pain, problem. It's the knowledge that empowers them to implement change.
[00:13:52] Michelle Fischler: What would you say is just normal aging for somebody in their 40s and [00:14:00] 50s? Like,, What would be those changes in their erections that would be considered normal changes versus you really should go and check this out?
[00:14:12] Dr. Susie Gronski: Mm-hmm. So waxing and waning of erections, completely normal. And that's across the board, doesn't matter how old you are. But I'm just gonna name that because there's a misconception that if you have a dick, it should [00:14:30] stay hard and be hard no matter what, in whatever context. It doesn't matter.
[00:14:34] The house could be burning down, but you're ready to go.
[00:14:37] Michelle Fischler: False. It's false
[00:14:38] Dr. Susie Gronski: Right. Right. However, I will acknowledge that when we're younger, you know, when we're in our teens, 20s, we're riding on the coattails of a very efficient and optimized biology.
[00:14:56] For most of us, I would say. I can... obviously there are [00:15:00] certain special circumstances. But in general, peak hormone, physical fitness, less, low stress. I mean, everything's novel and new, right? So you also have the excitement of, whoa, like, this, this feels really good. And you're exploring. I mean, so there's all the things, right?
[00:15:22] Right? so the context of the time and the place, of the age [00:15:30] that you are when you're younger, it cannot compare to when you're in your 30s and 40s and 50s and 60s and 70s. Now, that doesn't mean that you're destitute for sexual dysfunction. I know people well in their 80s that have very satisfying sexual lives and healthy erectile function
[00:15:49] Michelle Fischler: Yeah.
[00:15:50] Dr. Susie Gronski: And there's a level of flexibility mentally and physically around, hey, [00:16:00] my erection may not be as rigid as it used to be.
[00:16:03] It may not stay as erect as it used to be. It may take longer for me to get another erection after I've come. The refractory period, all of that can be a little bit more prolonged. You might need more stimulation. The things that used to get you off when you masturbated or with partnered sex might need a little bit more novelty or spice when you get older.
[00:16:28] And yes, nerve [00:16:30] endings do get a little sluggish as we get older, but that is not pathology, right? Now, if you have diabetes, if you have cardiovascular disease, morning erections, nighttime erections are dwindling. these erectile variances are gonna be more consistent and persistent.
[00:16:48] That is definitely more of a medical issue related to that. But these general variances or changing positions and you lose your erection, like, let's just be honest, [00:17:00] when someone's used to their part of their body functioning a particular way, and then all of a sudden it starts to change, well, it would freak anybody out because no one's talking about it.
[00:17:09] What's normal? What's not normal? All we're reading and seeing on social media, I mean, you know this, Michelle, be hard, stay hard. If you're not hard, something's wrong with you. I mean, it's and there may be. Again, cardiovascular disease is a thing. It's real. And I think it's a bit extreme as far as the [00:17:30] expectations that are placed on people who have penises, you know?
[00:17:34] So does that answer the ques- question?
[00:17:36] Michelle Fischler: Oh my God. Yes, and then some. And also, there are some guys where when we talk about refractory period, the refractory period where it's after you come, orgasm, having another orgasm after that, some guys like just, they naturally there's some downtime that happens before [00:18:00] they can get another erection,
[00:18:01] so there's some people who they could do it three times in a night, and I'm sure some people would say more. Who knows? But then there's other people it's like a 24-hour thing.
[00:18:14] Dr. Susie Gronski: Exactly, and it's all normal. Right. It's all very normal. And it's also normal when you're stressed, you're a human being first, regardless of your genitals. You're a human being first. And stress and life builds... It's compounding, you know? Right. [00:18:30] When you're younger, you don't have children maybe, or family, or responsibilities.
[00:18:34] Very different. Very different in general. And then life goes on. You might be with the same partner for a while. You have children now. There's responsibilities. There's a home that you're caring for, a job, and all the stressors, of being human, all the experiences in between. Of course you're gonna be a little bit more tired, a little bit more wired.
[00:18:56] All of that can impact your desire, your [00:19:00] libido, and , your overall physical sexual functioning, and all of that can also be very normal. If you're not feeling it, you're not feeling it. But there shouldn't be an expectation around, "Hey, you need to be hard in spite of all these things going on in your life."
[00:19:15] that is ridiculous
[00:19:16] Michelle Fischler: I agree. I wrote a book on early ejaculation called "Coming Soon." Early ejaculation gets treated like a self-control issue. [00:19:30] You look directly at the muscles and nerves involved. From a pelvic floor standpoint, is early ejaculation most often a muscle problem, a pelvic floor that's too tight or overactive, rather than a mental one?
[00:19:54] And if it is, how would someone even [00:20:00] tell the difference
[00:20:02] Dr. Susie Gronski: Such a good question. How would someone tell the difference, like muscle problem versus nervous system, mental health problem related to early ejaculation, or really, you know, even delayed ejaculation, if we're talking about that. So, muscles and nerves of the pelvis may play a role in certain reflexive physiological responses.
[00:20:25] So what do I mean by that? pelvic floor muscles, so the muscles that sit in [00:20:30] between your butt bones, you have a superficial layer that intimately connects with the genitals, so at the base of the penis, and then you have a deeper layer that is supporting all of the organs on the inside, right?
[00:20:42] So bladder, prostate, and rectum. And they do function in concert with, certain sexual functions. When we're talking about ejaculatory function, it's an involuntary, so non-voluntary, [00:21:00] contract, relax, contract, relax, contract, relax propulsion of semen out of the body. So these muscles do rhythmically and involuntarily contract and relax, contract and relax to help move semen out of the body during ejaculation.
[00:21:17] And muscles support that function, but really, it's the nerves that communicate with those muscles that are guiding what's happening. [00:21:30] To put it simply, there are reflexes, spinal reflexes in the lower spine region that get activated at a particular level of threshold. Now, who's to say what threshold for someone at any given time, right?
[00:21:47] There's many factors that influence excitation of the nervous system, whether it's erotic arousal or stress. It's all the same physiology. But that is a reflex [00:22:00] that gets triggered when , the physiological threshold is met or activated. So if someone hypothetically would have a very tense and tight pelvic floor that has difficulty voluntarily relaxing when they really need to be, like with urination or with defecation, with pooping, those are the only time when those muscles are actually fully relaxed.
[00:22:28] All the other times, [00:22:30] there's always some level of activation and tone in the pelvic floor. So the theory here is, if we can support or add in some training, let's say someone does have really tight, tense... incoordination is present, then we focus on relaxation, which also couples with breathing, which is gonna...
[00:22:54] Again, all nervous system to kinda expand the [00:23:00] capacity, extend your pleasure experience. We're working with the nervous system, and that in turn is going to feed forward this muscular relaxation, because there is a thing of tension orgasm and clenching, right? Again, to kinda get to climax. And some people, whether they have erectile dysfunction or early ejaculation, in order to stop or to
[00:23:28] Well, for erectile dysfunction, they [00:23:30] wanna clench to stay hard. For early ejaculation, they wanna clench to prevent ejaculation. But the same thing is happening, where they're just, tensing, holding back. "No, no, no." And that, from a mechanical perspective, is feeding forward mechanical information via nerve sensors that activate triggers within the spinal cord that, exaggerate the reflex.
[00:23:55] So if we see that pattern happening, and we're seeing that [00:24:00] in their pelvic floor function during, the exam, then my job is to help with body awareness, muscle coordination, training contraction and relaxation outside of sex. Like, it might be with masturbation, slowing down, coupling that with sensation awareness, arousal gradient awareness, right?
[00:24:23] And then adding in pelvic contractions with masturbation just again, you're training, you're pacing, you're [00:24:30] trying to just expand and extend your pleasure experience. But the pressure around it all does have to be worked on. If there's any mental anxiety, worry, stress, there's no amount of stretching or manual therapy that you can do that is going to help you in that situation if we ourselves mentally are feeling out of control and just so [00:25:00] overwhelmed that something is or isn't gonna happen.
[00:25:03] Then that,, definitely needs to be worked with as well.
[00:25:08] Michelle Fischler: You've written about spontaneous ejaculation happening during a pelvic floor therapy exam. Walk me through that what's happening in the body, and how do you help a client not spiral in the moment?
[00:25:27] Dr. Susie Gronski: Mm-hmm. So the first [00:25:30] step to that is, the intake. asking questions, what their concerns are. It's also an observation of the person in general, right? So are they more on the excitatory side of life? high energy, uh, go, go, go, uh, difficult to kinda settle in and settle down. Or challenging, not difficult.
[00:25:50] I mean, we all, different aspects, have all the same tendencies, just different flavors. But, there's a certain persona [00:26:00] perhaps of maybe being more sympathetically upregulated. And sympathetic nervous system, for those listening, you know, fight, flight, fawn, or freeze. It's that nervous system that's like, "Go, go, go, go," or withdraw and retreat, versus like rest, digest, just chill.
[00:26:17] which again, when we're talking about ejaculatory reflexes, the sympathetic nervous system is what governs ejaculation. So if you already [00:26:30] have a tendency or familiarity with being a bit more on the upregulated, excited side, stressed, anxious, nervous, that sort of thing, then your capacity to tolerate touch or stimuli it could just be visual or auditory, whatever, like lights, the capacity to tolerate change might pose for a challenge.
[00:26:59] And [00:27:00] so let me paint a picture for you. Someone scheduled an appointment to see me for, ejaculatory issues, and they have a pain problem too, not only are they nervous scheduling this appointment to talk to me, who again is a female-identified provider.
[00:27:17] They might be a cis heterosexual male as well, so think about that dynamic on top of things. But they're sharing a lot of their personal information with me, intimate experiences and things [00:27:30] like that. and also incredibly nervous that they might actually ejaculate on the table because they do experience early ejaculation in other situations in their life so they're already coming in with the energy of "I'm really nervous.
[00:27:46] I'm nervous I got this pain problem, and I've got this sexual dysfunction issue, and now I'm getting help for it, and I'm nervous that I'm gonna come on the table." And so there's just a lot of built up sympathetic ch, ch, ch, ch, ch. [00:28:00] So w- my role in that is to be the grounding force, to stay calm, to normalize things, to walk someone through piece by piece what to expect, right?
[00:28:12] And then get consent. So, "Hey, we'll have an external examination. These are the parts that I'll be touching. Do you consent to this? You can always withdraw consent at any time. I can do this over a sheet. I can do this over clothes." Whatever you feel comfortable that helps them regulate their own nervous [00:28:30] system so that they can feel more relaxed, which chances are when they're feeling more relaxed, the likelihood of ejaculation spontaneously would be lessened, right?
[00:28:40] The table is warm. You know, I've got a weighted blanket I can put on people again, just nervous system regulation. And we go very slow. I also apply any type of touch as firmer and deeper pressure because light touch tends to stimulate more of the caressing nerve fibers, which can again activate certain [00:29:00] reflexes.
[00:29:01] But that can happen because we are touching structures. We're touching skin, and nerves, and muscles, and genitals that respond to touch. And so that's why it can happen, and it can happen more frequently in someone who already has a narrow window of tolerance for stimulation in a particular [00:29:30] way But we handle it professionally. Like I tell people and I warn them too before we get on the table for examination or treatment that, "Listen, these bodies do body things," I say to them. I say, "Bodies do body things and this may or may not happen today. Whether it's erection or whether it's ejaculation, it may or may not happen.
[00:29:56] But here's how we handle that." nothing's going on. [00:30:00] All normal natural reflexes. We don't want to villainize, make assumptions or anything else to further perpetuate or make that person feel uncomfortable, nervous and shamed. '
[00:30:15] Michelle Fischler: Your team includes a mental health therapist, a nutrition therapist who's working alongside the pelvic floor treatment.
[00:30:28] Dr. Susie Gronski: Mm-hmm.
[00:30:29] Michelle Fischler: What can [00:30:30] those two pieces actually offer someone that the physical treatment alone can't?
[00:30:37] Dr. Susie Gronski: So multimodal treatment around whether sexual dysfunction or pelvic issues or bladder issues or bowel issues, super helpful because you're getting the perspective of a provider with a different lens. Nutrition isn't my scope of practice, and if we're talking about sexual dysfunction, for example, and you're taking certain [00:31:00] supplements I'm not the person to say, "Those supp- supplements are gonna- not gonna help you," or, "They are gonna help you."
[00:31:07] Now granted, I thank Dr. Jason for my knowledge that I do have, the very minimal knowledge around nutrition. I have a sense of what's sort of okay and based on the literature, but , just navigating all the garbage and snake oil online that are sold to people around supplements for erectile function is invaluable [00:31:30] as far as what , Dr.
[00:31:31] Jason, the nutritionist, , can offer and provide. And also running labs around metabolic disease, h- cardiovascular markers, flagging those now and saying, "Hey, we need to address this, this, and this," from a perspective of it could be lifestyle, which is nutrition, exercise, and if there are mental health, anxiety concerns, stressful dynamics at home, uh, difficult work [00:32:00] situations.
[00:32:00] There's a lot of life events that are thrown our way unexpectedly, we can feel very lonely in those situations, and just dealing with a medical condition or a health change or a health scare or a pain problem or a sexual dysfunction in and of itself can be very nerve-wracking and bring up a lot of , emotional, challenges.
[00:32:21] So having , the mental health therapist to dive into someone's, you know, history and, and their own coping [00:32:30] strategies , and giving practical strategies to "Okay, when you lose your erection, like here's what we can do. What's a strategy, coping strategy, internal tools that can help you navigate this change?"
[00:32:43] Or, nutrition therapy. "Okay, take these supplements. Here's a well-rounded diet. You know, Here's the test. Here's what it shows," et cetera. And then me to kind of bring it all together as well to support their physical movement and making sure they feel comfortable with certain [00:33:00] sexual positions and educating them about sexual response cycle and, self, treatments and bringing the partner sometimes, and it could even be something like, "Hey, I really enjoy anal play or prostate play, I just don't know where to find my prostate," or, "What should it feel like? I don't wanna hurt myself." Like here we go. We're the licensed provider to educate and the sexuality training Was huge for that to be "Oh yeah, like I don't have to be afraid of someone asking me to be 'Can you show me where my prostate is?
[00:33:28] And how if somebody were to massage it, like [00:33:30] how would they touch? Like how much pressure?'" That's all education, right? Within the context of a professional medical therapeutic space, and there are boundaries, and we're all very clear on them,
[00:33:43] Michelle Fischler: what's a myth about men's bodies or sex that you're constantly correcting?
[00:33:52] Dr. Susie Gronski: Oh, so the myth around men's bodies that I'm, I wouldn't say I'm constantly correcting, but [00:34:00] maybe trying to help alleviate some worry and instill some confidence around is penis size. That is, one question that I actually get asked quite often. W- well, A, because people know that I work with many people who have penises, and so my experience of observing a lot of different body types and genitals.
[00:34:26] Michelle Fischler: I didn't even think about
[00:34:29] Dr. Susie Gronski: [00:34:30] So there was a, it's a question of curiosity from one point of view of I have nothing to compare to other than porn, which let's get real, it's not realistic. Unless you're watching, Make Love Not Porn, Cindy Gallops, you know, or Erika Lust, uh, you know, ethical porn sites that like show real bodies and real humans and different experiences.
[00:34:51] Like outside of that, generally though, porn does not depict real life. so I can see why they're [00:35:00] asking me because I am in the trenches and observing and have clinical experience with different people's bodies and genitals and variances around that. So they would ask me that. So penis size
[00:35:12] is definitely a worry
[00:35:14] Michelle Fischler: but so what do you say?
[00:35:17] Dr. Susie Gronski: Yeah. It, I think the, my response definitely depends on my relationship with that person, when they ask, and what I perceive as the intention around that ask, right? So, so there's a lot [00:35:30] of that I have to process when somebody asks me that question. But for the most part, I ask a question back, because there's an insecurity coming up for someone, and I call it out. There's an insecurity about their body, their performance, that they're angst about. And so rather than soothing, trying to soothe it [00:36:00] temporarily, because it's not just gonna go away if I tell them, "Oh yeah, you're normal." ' cause there's also that question of like, "Am I normal and am I big enough?"
[00:36:09] behind it. Again, this is my experience, my personal feedback. I don't know what that person's really thinking, so I'm just wanting to put that there. So I've asked them, "Oh, that's an interesting question. I get that question asked a lot." So normalizing that a lot of people ask me that question and What's behind that question?
[00:36:29] Like, Why do [00:36:30] you feel the need to ask if your genital size is normal? Why do you feel compelled to ask? And then depending on where that goes, I have resources. I have actual, from my Patreon community, we have this wall of cocks, thing we do , on our Discord where I send a model, uh, sorry, a mold a penis mold kit to [00:37:00] them, whoever wants it.
[00:37:01] And their penis has to be flaccid, and they create a mold, a silicone mold of their genitals, and then they post a picture of that mold onto the wall of cocks channel. And that came from the desire to normalize conversation around variety and honoring and embracing the soft cock.
[00:37:27] And some of them have chosen to mail their [00:37:30] models to me, and I have them, and sometimes I will pull them out and lay it out and say, "Tell me which one of these is normal." Because, there is no normal. just like your thumbprint, a, a length and a girth and a size, just like vulvas, vaginas, we all have our unique predispositions, right?
[00:37:53] And then I also have Laura Dodsworth's book The Bare Reality. Where she has [00:38:00] their pictures of their genitals. So from the waist down, that's their picture, and then the story behind their lived experience with their genitals and their body.
[00:38:09] Michelle Fischler: Like what, what's the relationship that they have with
[00:38:13] their genital, with their penis?
[00:38:15] Dr. Susie Gronski: Exactly. Exactly. So I have that book that I will also open and share and say, "Look at the variety of people's bodies and shapes and colors , and their experiences. Like, borrow this book , and flip through it and [00:38:30] read a few of these stories." You know? so that's how I tend to that question on body stuff.
[00:38:39] michelle: If someone's been quietly dealing with pain or dysfunction for years, maybe too embarrassed to say anything to a doctor, let alone a partner, what do you want them to hear from you right now?
[00:38:59] Dr. Susie Gronski: If someone [00:39:00] has been dealing with pain or a sexual dysfunction for years and is too nervous, afraid to ask a medical provider for help, my number one answer to that, or message, you're not alone. Just know that you are not alone, and you are in solidarity with thousands and millions of other men who grapple and struggle with [00:39:30] an issue below the belt that they wish could get better, and it can get better and improve.
[00:39:39] There's hope. so there's two parts to that message. You're not alone, and there's hope. And knowledge is very empowering because you can live a quality of life without this issue, whether it's [00:40:00] incontinence, pain, sexual dysfunction. There is help, and there is support, and there are providers who will listen and accept and be non-judgmental, to hold that space for the vulnerability, for the rawness that, that is, inside and that we're tr- we wanna get it out because life is too short.
[00:40:25] Life is like a flash of lightning in the sky. It really is. And [00:40:30] to hold on to a problem and keep thinking about it and just, hoping and praying it goes away, and it might, but, it could be so much better, right? and we can do hard things, no pun intended. Like, when things are challenging, things are scary, we're nervous about a lot of things.
[00:40:51] I know from my own personal experience how nervous I can get around things, and we can do hard things. So if there's [00:41:00] anxiety or nervousness or worry or fear around any of the ask around getting help, please know you're strong. You can do this.
[00:41:11] michelle: What's something true about men's bodies that you wish more people, including patients and clinicians, understood?
[00:41:25] Dr. Susie Gronski: There, there's a twofold to this one. Men have [00:41:30] pelvic floors, so muscles and nerves that can get crabby, and I do wish that both patients and clinicians understood that just like your bicep, just like your hamstring, just like your muscles of your foot and your hand, you have muscles in the pelvis that can get crabby, tight, inflamed nerves, you know, injured with certain sexcapades too.
[00:41:59] Like, these are [00:42:00] tissues just like anywhere else in the body. They're unique in that they're related to pooping, peeing, and sex, which I think is why it's exceptionally more nerve-wracking or mysterious to certain clinicians when tests are negative, diagnostics are negative, they're not seeing anything, and they're "Well, I don't know," right?
[00:42:25] So yes, I do wish patients and clinicians [00:42:30] alike would understand that you have nerves, connective tissue, muscles, blood vessels that act and support the body just like every other biological tissue in your body, and yes, they can get crabby, injured, damaged as well, depending on circumstances. So, and there's rehab for that.
[00:42:55] Michelle Fischler: Before I let you go, what do you want people to know [00:43:00] about what you're building right now? I got to be a part of one of your Patreon community conversations recently, talking about my book and early ejaculation, and it was really lovely, and it felt like a very supportive space.
[00:43:19] I'd love for you to tell people about that community, who it's for, and where they can find you.[00:43:30]
[00:43:30] Dr. Susie Gronski: Thank you so much, Michelle, for allowing to share my passion community project, which is Patreon. I'm hosting a community platform and also a content of library resources from posts to live demo videos. So for example, if someone's interested in learning what does a pelvic floor exam look like [00:44:00] on someone who has a vulva, on someone who has a penis, we have live model demos walking you step by step of what to expect.
[00:44:10] If you have questions around how to use a penis pump, what it looks like to use intracavernosal injections for erectile dysfunction, f- all of that, traction devices, y- prostate massagers, you name it. So we have live model demos of all of these to, [00:44:30] one, help people feel more comfortable around exploring certain areas, uh, around these topics, and two, destigmatizing the mystery around the male pelvic floor and sexuality.
[00:44:46] We also have guest experts like Michelle, you were on to talk about certain topics like early ejaculation, which we had a beautiful conversation with. And the community, you can be totally anonymous. , That's what I love about this [00:45:00] community too, is that anonymity is respected. So you can change your handle name, like no one needs to know who you are.
[00:45:07] There's no like picture or anything like that. So privacy is respected in this space. And the group is, well, when I first started Patreon, I really didn't know how it was gonna grow and what was gonna be, what was gonna come of it. And this community of nearly 1,500 mostly men, [00:45:30] 1,500 mostly men, have gotten together to support one another in this space, asking their questions, being vulnerable, sharing experiences, life experiences with each other, right?
[00:45:44] And just knowing that they're not alone. So, this community, while it is certainly male-centric, there is definitely room for people of other genders and sexual orientations, of [00:46:00] course. All are welcome in this space. And in fact, the content that I create is really guided by what the community members want and need and the questions that they're asking.
[00:46:11] So it's pelvic health, it's sexual health, but what's great about it is that I don't, to my knowledge, there isn't a, a library of resources that actually have live model demos of topics that people ask about.
[00:46:28] Michelle Fischler: Not that I know [00:46:30] about.
[00:46:30] Dr. Susie Gronski: You know? So
[00:46:33] Michelle Fischler: only we get, like experts will go to conferences and we'll see it displayed for us so that we can understand it, but not an opportunity for people, laypeople in the community to go and learn about this on their own
[00:46:52] Dr. Susie Gronski: Yeah. Yeah. So it's great for patients or people curious and also other healthcare providers and professionals who [00:47:00] are wanting to learn more about, wow, what is... what can a pelvic health therapist and someone who's also a sex counselor, offer to people with penises who struggle with pooping, peeing, and sex issues, right?
[00:47:14] and to gain experience of what it's like from a lived experience point of view of these, members, like these men that wear a lot of their worries and anxieties on their heart. Their heart's on their sleeve. So I am always in astonishment and in awe, [00:47:30] and I have so much gratitude for this community and the way that they show up authentically, genuinely, asking the hard questions , and allowing me too.
[00:47:40] I get so much back. You know? It's as healing for me as it is for them. Yeah. And to learn from each other. 'Cause a lot of them have great ideas and tips and strategies and if anything, just a place to vent and to feel like you're not alone, and we're not here to judge you. We're here to accept [00:48:00] you and care for you and, show that compassion right back.
[00:48:03] michelle: thank you so much for being here, Susie. I feel very lucky to have gotten to meet you a couple of times now, and thank you for your work.
[00:48:15] Dr. Susie Gronski: Well, thank you, Michelle. I'm, honored to have spent this time with you here and to share my passion and knowledge, and I'm in great company, so right back at you, Michelle. The work that you're doing, your book that you just published, coming [00:48:30] soon. Brilliant, much needed resource in our community, and thank you so much for being the light in the world that we so desperately need through your work as well, so thank you.
[00:48:41] Michelle Fischler: Thank you.