Dr. George Papanicolaou

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129 appearances 2 recordings 1 series first heard Nov 2024 last heard Jun 2025

Dr. George Papanicolaou’s voice in public audio — every appearance, attributed to the second.

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The Dr. Hyman Show · Erectile Dysfunction: The Warning Signs You Shouldn’t Ignore · 11 Nov 2024 podcast

Right, but that hardening of the arteries not only reduces blood flow, but there's this endothelial dysfunction and it's in the endothelial cells that nitrous oxide has its effect.

Endothelial cells are the cells that are lining the blood vessels that are inside the penis.

There's multiple reasons. But before we go on to that, I think probably is a good idea. Let me just review quickly because we're going to talk about nitrous oxide. We're going to talk about why Viagra works and other drugs like it. Essentially, what happens is that You have the release of nitrous oxide.

So you release the NO, and the NO has its action on the endothelial cells inside the blood vessels of the penis. It also acts on the corpus cavernosum muscles. And so you get this simultaneous relaxation of those muscles so blood can flow in. Those are the big muscles of the penis so that when they're full of blood, they actually start the erection and maintain the erection.

And then you have the small blood vessels Nitrous oxide acts on those at the same time and causes those to constrict. So the blood that flows into the cavernous muscles then stays there as these small veins constrict. And that basically starts the erection and maintains the erection. And what happens is, and that's called tumescence.

Then you have detumescence when after the ejaculation the penis relaxes. And that's when 5-phosphodiesterase breaks down the compound that was responsible for causing that relaxation and constriction. And when that compound breaks down, the small blood vessels relax and the penis relaxes and becomes flaccid. It's the 5-phosphate diesterase that gets inhibited by Viagra.

So this is just a little lesson to everybody listening. That's how it works. Viagra blocks the 5-phosphodiesterase, allows this... So basically it increases blood flow and makes the erection stay longer. Because you don't get the breakdown of this thing called cyclic GMP. So that doesn't break down. That maintains the...

the constriction of the small blood vessels, you can maintain, actually obtain an erection and sustain an erection for a longer period of time.

But that's what's going on. And so then what can affect, what are the things that affect that? So metabolic syndrome. So when you're thinking about people with ED, See, all the blue pill does is fix that end problem. It fixes that, let's just make sure we get the erection and we maintain it. But there's reasons why we get there.

We get there because of stress and its impact on that very, very sensitive neurovascular problem. That neurovascular, and it's not a problem, that neurovascular symphony that has to occur for you to have your erection and ejaculation. So metabolic syndrome,

Which is prediabetes, which includes, you know, to make that diagnosis, you have to have obesity, dyslipidemia, which is just abnormal. Cholesterol. Cholesterol, triglycerides, HDLs. You have to have hypertension. And one of the things is insulin resistance. And so insulin resistance is connected to endothelial dysfunction.

When those endothelial cells aren't working, then the NO, the nitrous oxide, is not going to have an impact, and you're not going to be able to start that erection. So what do you treat? You can give the person Viagra, but since metabolic syndrome has so many other impacts on their overall health and their health span and lifespan, it'd be better to fix that.

You're worried about your erection, but you know what? You better be worried about your heart and your brain because they're the ones that are really the target of what's going on.

And that's one of the points I really hoped we'd make today, because as important as erections are, it's getting those root causes that impact your overall health, and then the cherry on top of the pie is great erections.

But... There's alcohol, there's alcohol. And one of the roles that alcohol plays is that when you're drinking alcohol, that itself is going to impact that endothelial function during the time of your use. And you're going to maybe, at night, not have an erection. Here's what happens. You can stop drinking and say, okay, that will fix it, but there's something that happened.

You're going to have a psychogenic response. It's called performance anxiety. And for some men, once they have a failure, it multiplies itself. They get performance anxiety and it becomes a psychogenic problem. And there's a vast majority of men who have erectile dysfunction actually have a performance anxiety or psychogenic cause.

So, revascularization is essentially, you're having, as we talked about, hardening of the arteries. And there's two ways that can be done. Just like you have angioplasty or stents placed in the heart, the same thing can be done for the penis. And that's one possibility.

Very interesting responses to the problem. And we're going to go through other possibilities. As you said, we're going to talk about stem cells and platelet-rich plasma. I always like to go back to the idea that, yeah, you can be revascularized, but why get there in the first place?

All of these things actually work. I mean, I've had patients of mine use a vacuum pump. I don't know how they do it. It works, doc. I love it. I've had people get penile implants. It works, doc. I love it. And they're pressing their testicle and they're getting their erection. And, you know, that's how the pump works.

You know, the pump is inside one testicle and you start pressing on it and it gives you your erection and it works. I've had men use the injections. They feel like 18 years old again. But they all have diabetes, hypertension, metabolic syndrome, and I can't get them to get to that underlying cause. So I almost sometimes want to not let them get their erections.

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