And then what happens?

Okay.

It's kind of amazing, actually, that he's been through this trauma and he's still able to be as vulnerable as he ends up being because I can say I've been in a relationship with more than one person in my life who has had a parent that died of suicide, and it just changed them at the deepest level.

And I think that they were not able to be fully emotionally available.

And I can't imagine, I cannot judge in any way because I cannot imagine what it's like to go through that.

But yeah, I don't know, there's a lot of, a lot of complexity to that.

And if you're gonna say something groundbreaking, back it up with a, a citation or two or six

sixThe only comment I have on this is that we, we do sometimes notice more urethral prominence in post-menopausal women, but this is for a number of reasons.

I'm just saying, like, people just wanna shut it off with a pill instead of being like, what in your life causes calm? Maybe a little more of that.

Yeah Just a comment on the female side, right? I mean, this is female sexual arousal disorder, the medical term, right, is what we're talking about.

So, like, female erectile dysfunction is female sexual arousal disorder.

And so that could be the clitoris not engorging.

It could also be you not becoming lubricated in response to the cues that normally would make you lubricated, right? Because we know obviously the hormones need to be there to become lubricated, but also you have to have the relaxation, you have to have the pro-sex signals, and you have to have the blood flow go there and engorge and lubricate.

And again, right, if the predator is following, chasing you, you want all the blood flow going to your legs, not your vagina.

And [laughs] 'cause that's not going to save you.

So there, there's a lot of Ilya development in this episode.

[laughs]

And he had, I, I, with my notes for this episode, all, I wrote very few things down, 'cause I'm lazy, but I wrote ginger ale.

Like, it's beaut- Like, it, the whole episode's about ginger ale when you think about it, right? Like, Ilya has ginger ale at his house.

Shane's with his parents, and they don't have ginger ale at the restaurant.

He has to be someone else and get sparkling water.

Then he goes to the bar, and they have ginger ale, but he chooses to get the beer because he doesn't wanna be himself, but he can be himself with Ilya.

It's a little bit shocking.

What do you think Ilya and the woman he was groping on the dance floor, what do, where do you think that led to? Because at the end of the night, he's in the shower by himself, like, masturbating to Shane having sex with Rose Landry, and it's a super hot scene.

98% of the time you would have been at home in pajamas.

Absolutely.

Like I hate things like this.

And yeah.

And then, you know, the funny thing is I think about all this intensity.

And so we spent the weekend together and he lived down in LA.

And at the end of the weekend, he said to me, can I fly back here and go on another date with you? And if I didn't like him as much as I did, I would have thought that was super creepy and weird.

It is a gift that keeps on giving.

98% of the time, you would've been at home in pajamas.

Like, I...

Absolutely.

Like, I hate things like this.

[laughs] And yeah, and then, you know, the funny thing is, I think about all this intensity and...

So we spent the weekend together, and he lived down in LA.

And at the end of the weekend, he said to me, um, "Can I fly back here and go on another date with you?" And m- if I didn't like him as much as I did, I would've thought that was super creepy and weird.

It, it is a gift that keeps on giving.

It was when I was in residency and I

was on like my research time.

And some I forget who it was was like they're shooting this movie.

You can look it up.

The movie's called Anesthesia.

And they needed cheap doctors to be on set and be like, this looks medically appropriate.

This doesn't look medically appropriate.

And yet it doesn't come through in this book.

That's a good point.

I think the communication is such an interesting thing.

You know, I think one of my disappointments about straight men refusing to watch this show is the lack of curiosity and interest of, "Why is this so important to straight women, and what can we as straight men learn from this in how we have conversations around intimacy, around sex?" You know, I know many straight men who are getting laid significantly more because of this show, but it doesn't give them that like, "Wait, I wanna watch it to find out how I can capitalize on this even more," right? Like, "Is there even more I can learn from it?" And I think that goes in line with sort of that curiosity of, "What does my partner actually like? Well, I don't wanna actually ask them 'cause that's too awkward, so I'm just gonna keep push- like, I'm still gonna touch different parts of it until something kinda lands."

And yet it doesn't come through in this book.

I mean, I will say, again, from, like, listening to the, the audio book of this early part of the series, they tell you more about, like, Shane's inner monologue, where he's, like, telling himself, like, he's going to try and go back to just being with women.

And he is trying to navigate that and say like, "Was this just a fluke? I can be with women.

I'm going to, like, that will make my life easier.

I'm gonna try maybe..." And, and so I think for him personally, he's not, like, yes, he's having these intense moments and this beautiful intimacy with Ilya, but then he's not gonna be hanging on Ilya's words and, like, demanding, "Hey, text me back," because he's wanting to make this not a part of himself.

They, so they meet for the first time December 2008.

2008.And then s- that summer is the draft.

And so Shane is the number two pick.

Rozanov is, like, kind of rubbing him with his hands, I noticed.

Like, Rozanov was actually, like, you know, number one with his hand, but was kinda rubbing on Shane's hand.

And you see Ilya's dad for the first time, and he calls him lazy.

And the cinematography of the draft scene of, like, them seeing each other, like, th- there's, the cinematography of this entire show is insanely powerful and so good.

But, like, just so much of the show is just their facial expressions that are masterful.

Maybe Ashley, you go next.

So for everyone listening, Ashley Winter, I am also a urologist who also specializes in sex.

And I did fellowship with Rachel and Josh.

And I also had some residency overlap with Josh in New York.

And urology, I mean, it's just a small world.

Like we all just know each other.

How do you just not know everybody? So in terms of how I heard about it, it was because Kelly and Rachel and I have a group text chain.

When you

So let's take a bit of a step back and just explain what erectile dysfunction actually is and how does it manifest.

Really, the definition of erectile dysfunction is that you're not able to get or maintain an erection that is sufficient enough for penetration or sexual activity in the way that you're preferring to do it, right? That's kind of a simple understanding.

On a biologic level, to really understand what erectile dysfunction is, we have to understand what an erection is, right? So an erection is when your-- there are signals sent to your penis from the brain, whether it's from touch, whether it's from erotic thoughts.

There are signals sent from the brain to the penis, and that releases a compound called nitric oxide, and that causes chambers of the penis, the erectile chambers of the penis, to dilate, and that allows more blood to flow into them, and it causes the penis basically to become hard.

So it's a combination of not just more blood flowing into the penis, but, you know, it's combination of the heart pumping, the brain telling the penis how to act, and these erection chambers in the penis really relaxing and dilating.

Now, when you have difficulty getting or maintaining that erection, it can be from a number of different causes.

I'd say our two major baskets that we think of is psychological versus not psychological, right? So psychological would be something like we think performance anxiety, and that's because your brain is in fight or flight mode, right? For whatever reason.

Can you talk to us a little bit about what's in your toolbox there?