Penis Issues & Innovations with Dr. Karpman

An eggplant on a pink block.

In the nearly 20 years since I’ve been doing this show, there’s one set of questions I consistently get:

Dr. Emily, what can I do about my penis?

More specifically, the concerns I get usually fall into three categories:

  • Maintaining an erection
  • Penis size 
  • Ejaculation timing 

I recently had a conversation with board-certified urologist (and friend of the show) Dr. Edward Karpman to talk through all three – you can listen to our convo here. Below, I share highlights from our interview: both the causes and factors of each issue, and current medical innovations (as well as practical solutions) to address them.


Why do some penis owners lose their erection, even when they’re seemingly turned on and aroused? According to Dr. Karpman, there are usually three main issues:

Lifestyle. An erect penis is a penis filled with blood, so while many think this issue is a “penis problem,” it’s really more of a circulatory issue – and a heart one. If someone isn’t eating right, smoking or drinking to excess, and not exercising, that’s going to adversely affect their blood flow. That also means the arteries and veins inside the penis are weaker, making it harder to “trap” the blood inside. 

The fix: adopt a healthier lifestyle. 

Sexual ADD. When Dr. Karpman refers to “sexual ADD,” he’s talking about penis owners being too in their head during sex. Thinking about other things besides the sexy partner in front of them, or having slipped into too much porn dependency (so that the only thing that arouses them is something extreme), this signals a focus issue and a habitual response to sexual situations.  

The fix: communicating with your partner, bringing more novelty into the relationship, balancing out porn usage.

Venous leaks. Veins trap blood inside the penis, but if you genetically have veins that allow for blood to escape, that’s going to affect your erection. (Note: this can happen to young, healthy penis owners too.) 

The fix: a penis ring or venous constriction band  (listen to the episode to find out more.) “Anything you use on your penis should be something you can cut off with scissors,” Dr. Karpman recommends. “I’ve seen guys in the emergency room with something metal trapped on their penis, and we have to bring in the fire department with special tools to remove it.” 


Penis size isn’t the end-all-be-all most people think it is for partner satisfaction. In fact, the vast majority of vulva owners orgasm from clitoral stimulation, from a toy, a mouth, or a finger. 

Does girth affect a vulva owner’s pleasure, though? According to Dr. Karpman, it can: more girth means more of her clitoral network will be stimulated during penetration. But by and large, the reason penis owners come to him with size concerns is an issue of body image and self-confidence. 

So what treatments are available? 

Penuma: This is the first FDA-cleared penile implant for cosmetic enhancement. It’s also been around: though we’re hearing about it more now, it’s been successfully implanted in thousands of individuals since 2004. The surgery itself takes about 60 minutes, and full recovery takes a few weeks. It’s designed to last, but it’s also removable in the event you want it taken out. Penuma is made of soft, medical-grade silicone designed to feel natural in the penis. Its main benefit is girth enhancement, but it can also expand flaccid penile length. 

Hyaluronic acid filler: There are also non-surgical, non-permanent options for penis girth enhancement: filler. Just like facial fillers, these are temporary and dissolve in about six months. 

These fillers are dissolvable, so if you try it and don’t like it, the fix is fairly straightforward

Now, listen: the fact that surgery and fillers are now available for the penis does not mean I’m saying you should get it. In my forthcoming book  Smart Sex, I focus on self-acceptance when it comes to owning your pleasure. But as a sex educator, I do feel responsible for sharing all available resources on my platform. This field has grown and changed so much over the years, so when something new emerges, I want to bring it to you as unbiased information, so you can make decisions for yourself.  


Another penis concern I hear often is delayed ejaculation: AKA taking a long time to finish. So what to do?

Sleep. According to Dr. Karpman, sleep apnea is often overlooked for addressing DE. When you sleep at night, you’re taking in oxygen, which is essential for your brain as it signals testosterone production. And testosterone levels impact both arousal and orgasm. But when you have sleep apnea (which, btw, can come on even when you’re young and otherwise healthy), your brain is deprived of oxygen, and testosterone production gets interrupted. The bottom line? You’ve got less testosterone flowing through your system, which makes arousal and orgasm more difficult. 

The fix: Sleep hygiene. Visit a sleep specialist who can evaluate the source of your disrupted sleep, and offer solutions.

Vitamin deficiency. Vitamin B12 is crucial for nerve function, and the head of a penis is filled with nerve endings. If these nerves aren’t working properly, it could hamper one’s ability to orgasm.

The fix: Get your B12 levels tested. If a deficiency is identified, a physician can help you bring your levels back in check.The world of medicine for penis owners is an ever-evolving field, and more solutions are available for these very common issues.

Let’s keep the conversation going around penis concerns, and let me know what you think of these innovations. Find me on Instagram, at @sexwithemily.