Rena Malik, MD Podcast 13% of People Take a Pill that Might Permanently Destroy their Sex Life ft. Dr. Irwin Goldstein
Mar 13, 2026
Irwin Goldstein, MD, pioneer in sexual medicine and urology who helped advance treatments like sildenafil. He explores orgasm phases and brain activation. They cover orgasm’s possible protective effects on brain health. Conversation includes medication-induced sexual dysfunction, new classifications of orgasm disorders, and emerging therapies like shockwave and PRP.
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Focus On Functional Gains For Drug Induced Dysfunction
- Even when full recovery isn't guaranteed, aim for functional improvement with available therapies for PSSD/PFS.
- Goldstein emphasizes restoring erections (PDE5, injections, devices) and layered strategies for orgasm and libido improvement.
Ultrasound Maps Penile Fibrosis To Erection Quality
- High-resolution grayscale penile ultrasound during pharmacologic erection reveals scar (black) versus healthy tissue (gray) and maps to erection hardness.
- Goldstein uses a 15.4 MHz probe to grade fibrosis and guide prognosis and therapy.
Finasteride Can Cause Corporal Scarring And Venous Leak
- 5‑alpha reductase inhibitors reduce DHT and can cause apoptosis and scarring of penile smooth muscle, producing venous leak and potentially permanent ED in susceptible patients.
- Goldstein compares PFS pathology to irreversible corporal fibrosis.