If you can stick with me and you can understand the science behind what we're going to talk about, it is applicable to every human. And we're going to specifically talk about the fact that erectile dysfunction by itself is an independent risk factor for having a major
adverse cardiac event. Holy sh t. So even if you have no family history of heart disease, if you exercise, you don't smoke, you don't drink, if you're having a little problem in the bedroom, attaining an erection or maintaining an erection, it could indicate that you might be at higher risk of having a major cardiac event in the next three years. Welcome to open Heart Surgery with Boots, where this February we're going below the
belt. That's right, we're diving into the surprisingly connected world of heart surgery and pelvic floor health in this five part series. Join me and our special guest expert, Dr. Kelly Sudakis as we talk about everything you're too embarrassed to ask your cardiologist. From what makes a happy pelvis to getting your groove back after surgery, to yes, even the great post op poop
debate. With candid conversations, practical advice and plenty of laughs, we're exploring the ups and downs of recovery because let's face it, healing happens from top to bottom. So buckle up for some real talk about the parts of recovery nobody warned you about. Hello, Boots Knighton here with open heart surgery with Boots. And Kelly Sudakis is back for episode two of our heart and pelvis series.
Wow. I hope if you're just now finding us, I hope you'll go back and listen to the first episode because it really does help set you up for understanding all things pelvis. I asked Kelly to start us off with 101 pelvic health. What it looks like, feels like, how it should operate and then what happens when it goes arai. And so that now brings us to our second installment, which is erectile dysfunction. Hey, we get to talk about penises. This is important because. Hi, I'm Dr. Kelly
Sadowskis, double board certified pelvic physical therapist. If you didn't meet me in the first episode, and my goal in life is to break down barriers that are preventing you from understanding your body and the bodies of the people you love love. So most likely you either have a penis or you love someone with a penis. So this is going to be very important information. Boots and I were chatting a little bit and she's like, well, is this erectile dysfunction in men and women?
Which is a very valid question because yes, the we ladies, we actually have like Little. Our clitorises are actually little, tiny penises. They arose from the same embryonic tissue as a male penis. So we can still also have erectile dysfunction. But guess what? This will not shock you. We don't study erectile dysfunction in ladies. And we being the scientific community at large, because we don't study anything in women, because hormones.
And that's bull crap. But that is the reason that most of the studies and the things that I'm going to talk to you about today are a little bit more leaning towards male anatomy, people with penises. But. But if you can stick with me and you can understand the science behind what we're going to talk about, it is applicable to every human. And we're going to specifically talk about the fact that erectile dysfunction by itself is an independent risk factor for having a major
adverse cardiac event. Holy shit. So even if you have no family history of heart disease, if you exercise, you don't smoke, you don't drink, if you're having a little problems in the bedroom, attaining an erection or maintaining an erection, it could indicate that you might be at higher risk of having a major cardiac event in the next three years. So you got to get your cute pelvis, or if this is your loved one, get their cute pelvis into a cardiologist for some
primary preventative screening. Okay. All right, that being said, let's dive into what is an erection and what is erectile dysfunction? So, okay, so you just talked about why we should care, but let's go even more basic than that. Like, why is sexual health important? Why should we even be talking about this? I know about the cardiac risk factors, but just for the overall, like, picture of health and thriving as a Homo sapien. Oh, my gosh, that is
a fabulous question. Like, so, first and foremost, even at, like, the most basic level, why do we care about sexual function? Even before I talk about, you know, the risk factors of that erectile dysfunction, Sexual function can be an important part of any human's life journey, right? There are legitimately some individuals that it is not a priority. And that's fine. If it's not a priority for
you, you're not alone. But more, I would say a greater percentage of people start to lose interest in sexual activity because it becomes either painful or challenging to do physically, either because the actual pelvic parts are no longer up to snuff, or orthopedically, perhaps we have back pain or hip pain, and we don't know about how to change positions. Ladies and people with vaginas, as we age, our hormones change. That can be one part of a puzzle that makes intimate functions
a little painful or less enjoyable. And so we might tend, rather than trying to fix the problem and make them just as enjoyable as they were in our younger years, we might tend to not do that anymore. And why that matters is sexual function could be something that you can enjoy again. And when you can enjoy it, it is a powerful bonding experience between you and your partner. It's good exercise, whether
you're with a partner or by yourself. And it involves a release of endorphins that is good for overall mental health and pain management. So the ability to achieve an enjoyable climax. It's kind of a litmus test, so to speak, as far as how the whole system is working the brain, body connection for that sexual response, the physical health of the muscles around the pelvic floor to have that appropriate sexual response regardless of your
anatomy. And if we can't do that, then maybe it's a sign that, ooh, this is an opportunity for us to get a little bit better. And then, and then we look at the science of specifically erectile dysfunction. Being able to potentially be a risk factor for heart problems down the road. Ooh, now that's interesting. And if we do have open heart surgery, the recovery of that sexual function, that's another piece that sometimes is overlooked in your cardiac
rehab. Right. And so we want to, in later segments, actually dive into that. About sex is a endurance event. How do. Is your heart ready for it? Is your pelvic floor ready for it? Okay, yeah. So that. Thank you. Yeah, that sets the scene because I think it's just so important to have buy in, especially for those who may, like you said there. And no, feel no shame if, like, this isn't a topic that maybe is super passionate for you.
But. And I. That's fine. But it, it, it is. It's okay to go through the emotions, feel all that you need to feel. There is. You're all are welcome here. And this is a safe place. And I know Kelly personally, and I can't think of another person that you can safely explore this topic with. Oh, thank you, Boots. Thank you. And, you know, the topic's important because, you know, if we look at, for a number of reasons, the, the prevalence. Oh, so what
is erectile dysfunction? Right. Let's make one more step back. So, hey, here's Peter the pelvis or Philip the pelvis. Hi, We. We met Patty and Randy the rectum in the last segment. Here is a pelvis with traditionally male anatomy Right. In the last segment, you met Patty. The pelvis, which showed you all the cool bony rings and the muscles that exist to form the base of your pelvis. And we talked about how those muscles worked along with other body functions to control a basic pee and poop
functions. Now, intimate functions in someone with a penis. Usually the penis is nice and relaxed down here, like so what is an erection? What an erection is, is there are these cool little pelvic floor muscles at the base of the penis. They look the. I'm blocking this hole because I can't find my male pelvic floor right now. But it's
pretty much the same as this right here. But there's these little muscles at the base of the penis that when we are sexually aroused or during key times of hormonal changes, sometimes for no reason whatsoever, these muscles at the base of the penis will constrict. And when they constrict, they are preventing blood from leaving the penis so it will engorge and form. Ready? Ready, Ready? Oh, can I do it? I think. Oh, I don't want to break it. And it
was point upwards. Hello. And the funny thing is, is like everybody's different, right? So please, whatever you look like, whether you're circumcised or not, or your partner's circumcised or not, everybody looks different. Sometimes erections are pointed straight, sometimes they're a little hooked to the side, sometimes totally fine. You
are normal, I promise. Okay? If you ever have a pain free lump or a painful lump that feels like a little raisin in your testicles, then we want to get that checked out right away. But when you have an erection, it might look like this straight soldier or it might be a little to one side or the other and you're fine. And I want you to know that because we don't as with everything,
pelvic health, we don't talk about this stuff enough. So that's what an erection is, is an engorgement of these blood vessels within the penis to trap blood in there and then make the soldier stand tall and proud. That is a muscular effort, right? For these muscles. I just. And this is Kelly everyone. And you know when you. I'm a doctor, you've got to follow her on Instagram because it's like this all the time.
Really. I think one of my first posts about penises, I like trouble raising the main sale. And it's not funny. I don't wish eating anyone but my God, let's have a little fun while we're at it. God, we have to. We have to. Because you know what, Boots? Like I am reaching. Like we are reaching people because we can talk about this and have this conversation if we just talk so scientifically we make it uncomfortable and we lose that chance to help someone. So that's, you
know. Yeah. This muscular effort of these pelvic floor muscles, again, specifically in the penis. And yes, it also happens to a lesser degree in the clitoris. They are going to constrict at the base of the penis and cause this to engorge. Okay. To then potentially allow for penis in vagina or penis and something else. Penetration and then stimulation of all the amazing nerves that go
along with that happen. Magic happens. And we can have this beautiful, fulfilling climax that typically is going to result in ejaculation. If you've had a type of prostate surgery, sometimes it's called a dry ejaculate. Again, that's a little too in depth for this talk. But we have a beautiful, fulfilling climax. Everything relaxes back and cycle resets for the next time. Erectile dysfunction is the inability to attain or maintain that erection for the task at hand, so to speak. There
are some puns I think possible in there. And if you were around for the first talk, we talked about how these pelvic floor muscles are like a hammock at the base of your pelvis. And, and they're like an elevator. An elevator and a hammock. So they're a hammock at the bottom of the pelvis and have an elevator like function. And they're meant to actually live on the ground floor of a four story building and kind of move up and down depending on the task at
hand. But always come back to rest and even be able to relax into the sub basement to have a good poop and then come back to rest. If these pelvic floor muscles are resting on the third or the fourth floors. And we talk in the last, we talked in the last segment about why that can happen.
That can contribute to PE leaks or poop problems. But from a sexual perspective, if they're always working, if they're always clenching on this third floor and then the time occurs or the mood occurs where you need them to do a little bit more work to get this erection, they might not be able to because they're tired. You know, we use a wall sit analogy. If I boots, if I ask you to go and run up the stairs right now, you could, what if I put you in a wall sit
for six hours and then ask you to Run up the stairs. You're not running anywhere. And that's what can happen in these muscles in the pelvic floor. They're too tired from being tight all the time, so they don't have the energy to constrict further to cause this erection. And then when we build, so. So we get the erection in either the clitoris or the penis, and then there's this building, this period of excitement before we have the release and
the climax. So it's the climb and then the climax. The climb requires healthy nerves. If all of the pelvic muscles are tight all the time, they can irritate the nerves and make the climb hard or impossible. And then to actually climax is a plyometric contraction of your pelvic floor. I bet you didn't know that. So that means it's. It's a really fast dynamic. Contract and relax. Contract and relax to have this climax feeling. If your muscles are not healthy enough to do that, you can't have a
climax. Oh, my gosh. Or you can, but it hurts. So, wow. Like, that's all of the parts that are required for a normal erection. And then, like, any difficulty with any of that is considered erectile dysfunction. Long road to get why we care on the Open Heart Surgery with Boots podcast. Heart disease. The same changes in our arterial systems that can lead to ischemic heart disease, that can lead to stroke, that can lead to coronary artery blockages. Guess what? Those coronary arteries, how big are
they? Okay, brain arteries, pelvic floor arteries, and those of you that are just listening, I'm showing the relative size. Coronary arteries are big. Brain arteries are a little smaller. Pelvic floor arteries are tiny. So they're like our little canaries in the gold mine. And the same changes in life that are going to lead to some of this atherosclerotic change, stiffening of arteries, blockage of arteries. They're going to present in these little tiny arteries
first. It's so powerful. And what evidence has shown is that the presence of this erectile dysfunction in a man, yes, it can be due to a lot of factors, but it can be that hypertonicity of the pelvic floor, but it also can be a primary change in the pliability of these arteries. And as such, it is an independent risk factor for a future major adverse cardiac event. And even in the absence of any other risk factors of family members having heart disease, you can exercise, you can eat well,
drink well. If you're starting to have problems hoisting the Main sail. We need to get everything checked out because this could be an issue with your underlying circulation and we might just save your life. So. Wow, it's crazy pants. And now if you have this erectile dysfunction and some diabetes and some family history of heart disease, or you're a smoker or you occasionally have some alcohol or have
alcohol a lot. Holy shit, friend. We gotta change some stuff or you're not gonna be around four years from now to be enjoying this beautiful life. So, like, it's a. It's a cool thing to be aware of because we actually can save lives when we get people to the right spot. So if you haven't been doing regular wellness checks, or maybe you have because you're watching this podcast, but maybe your best
friend Bill doesn't go to the doctors. And Bill and you are talking about, oh, things aren't going so well in the bedroom. Yeah, Bill could go to pelvic pt, but if they're a good pelvic pt, they're going to ask Bill if he's been to his primary care provider, and if he hasn't, they're not gonna treat his erectile dysfunction until he goes and gets his heart checked because of this. And if you have been going to a pelvic PT for ED and it's getting better, but you
haven't had your heart checked, you need to. It is exquisitely important. And I think earlier I might have said. But I don't remember. Cause I say a lot. The prevalence of this erectile dysfunction has doubled in the last 30 years. And perhaps some of that is more normal reporting. But what's happening with colorectal cancer rates? It's shooting through, skyrocketing. Okay, what things are associated with colorectal cancer? Reduced fiber intake. Right. Dietary changes. All. Increased stress
in the world. Perhaps a more sedentary lifestyle, especially since pandemics. Right. So all of these same things that are just killing our overall holistic health, they're the same things that might contribute to higher rates of erectile dysfunction, but, you know, underneath that, contributing to reduced health of our circulatory system, which then is, you know, erectile sexual dysfunction, then possibly stroke or heart attack. So we
need to be talking about this. It's not just about getting jiggy in the bedroom. It's about not dying three years from now. So, like, that's. It's so powerful, right? Yeah. Where I sit and just. I try not to watch commercials. I don't really watch TV anymore. But in the past, I mean, a classic commercial UC Is for Viagra. Right. And. And in the bathtub. Yeah. You think it's just about that. And they don't. They don't talk about any of this background you just gave and,
like, all these other things you need to be thinking about. Totally. Well, do you know Viagra was a blood pressure medicine? Like, that's a whole. Like, nobody knows this. Or. You might, but, like, it's hilarious. It's like, oh, we found this amazing drug to help with your hypertension and small side effect. You're gonna get a giant boner for four hours. Really? Let me. Let's talk more about that. Like, that's amazing. Like, but again, if
that's the only thing. If you go in and you. Well, we won't even get into the difference between males and females when we report sexual dysfunction. Well, yeah, I will. I will. If, you know, we go in and, like, say a dude is like, oh, I'm having trouble with an erection. The. If the doctor's not educated about the. This research. Right. And that study, I think it's from 05 Montorsi. I'll get you all links to it in 05. That found that the ED could pre exist before a major
cardiac event. Three years. If the doctor doesn't know that study. If they are all in, they're the best cardiac doctor in the world. They honestly might just be looking at the heart. And that doesn't make them a bad doctor. Right. Like, maybe they never even learned about pelvic floor in medical school. They might not know about all of those parts. So we need to educate you to take the primary steps. I got a little off tangentially right there. I kind of lost my. No,
you're. We're citing studies and then talking. Talking about men versus women and. Oh, men versus women. Thank you. Thank you. But I just wanted to mention. Make sure. Just a timeout. If you haven't already, be sure to go in the show notes to sign up for my newsletter because. Oh, yeah, I will be linking to and I'll have
things in the show notes for you also listeners. But if you sign up for my newsletter and also sign up for Kelly's, you will get these studies and there will be more in the newsletter each of these weeks talking about why you need to care about your pelvic floor. Oh, totally. Time in, Boots. Thank you. Time out. Time in. Thank you, Boots. So. So if I'm a man and I come in to my doctor and I say, oh, I'm having trouble with sexual function, that doctor might not know
about this important correlation. And if you look healthy, they might just prescribe you something like Viagra. And that might help this small piece of the puzzle in the short term. But you do need a cardiac workup to make sure that things are okay to keep you good in the long run. If I'm a woman and I come in and I report sexual dysfunction, I'm not even gonna lie, you will be told to just relax, have a glass of wine, which is a neurotoxin. Thanks, doc. And that's about it.
Usually, like, if your doctor's very aware, you'll be prescribed pelvic floor pt. But there's this huge kind of difference in how everyone, you know, males versus females, are treated in this realm. But it's important for everyone that we address and what we can do about it. There's actual things that you know, if this is present and we know that this is, can be an independent risk factor
for future heart issues. If we're post heart surgery, guess what, like, and you're having erectile dysfunction, this is still indicate indicative that things aren't 100% awesome. So, so let's work holistically on the whole system. You're going to love this, everyone. It's the classic sleep, diet, exercise, and now
awareness of your pelvic floor. Pelvic floor relaxation, pelvic floor, general health and well being can make positive changes to improve this erectile function, the sexual function, which then we have lowered our risk factor for that future adverse cardiac event by improving this one function, which is great. You don't have to be
Chris Helmsworth, right? Like in the gym 20 hours a day. I think one of the studies in 2018, 40 minutes of moderate physical activity four times a week, within six months it reduced erectile dysfunction. So you can read that a different way. If we don't care about the erection function, 40 minutes of moderate exercise four times a week for six months improves your overall cardiovascular system and reduces your risk of heart attack and stroke. And that's doable, right? And I'm
such a geek. I love what I do. I do a ton of teaching. I also have a new online program called Dr. Kelly's Treasure Chest that has workouts there for you. Right? And I started off with 40 to 60 minute workouts. Nobody watched them. It's hilarious when you look at like the data. Everybody was watching the 10 minute workouts. And you know what? A 10 minute workout done is way better than nothing. And you could do that one workout and get proficient at it and do it twice. In a row for
20 minutes. Like something is better than nothing. Diet and exercise, right? I don't like the word diet. I like lifestyle food choices, generally. A Mediterranean diet, fruits and vegetables, heart, healthy fats, boots. You had the whole nutritional segment, right? So they can go back and look at that. Hugely important for arterial health, heart health. So, and that's not just for today. That's like a lifestyle change. And it's nothing that we have to do, but it's something we want to do
because we feel so much better. And then if you do smoke, stop. Don't be an asshole, idiot, stop. There's nothing good about it. Stop. If you drink alcohol, try to stop, please. It is just as bad for you as smoking. There's no safe amount of alcohol. It's a neurotoxin and it causes mental health issues. Nothing to be good from that, okay? So just stop, please. We are going to be amazed when we look back 10, 15 years from now at how normalized alcohol consumption was in the world right
now. And so to help you be healthy, pre heart surgery, post heart surgery, eat real food, not too much exercise, and don't smoke or drink. Okay? I think if you need help with all of that, go back and listen to my episode in December of 2024 with Dr. Laura Suarez Pardo. She is a cardiac psychiatrist at the Mayo Clinic. And I asked her, treat me like, I just came into your office and I'm trying to stop a habit. Where do we start? And it was absolutely brilliant how she. It is. It is just
so simple. Like, basic small changes every day that add up to big changes. And I, I just want to say, like, I see you, I hear you. Like, if you're listening and you smoke or you drink or, or have any habits that aren't healthy for the body, you know what, have you ever thought that maybe you're worthy of a vibrant, healthy life? You are. Amen. Deserve to be healthy and ask for help, ask for support. You deserve to have a healthy sexual lifestyle. You deserve to have a healthy
pelvis. You are worthy of all of this. And I really think that a lot of people out there just really just say, I'm not worthy. Maybe not, like, consciously, but I want to be that person in your ears that say, you know what? Your heart deserves to thrive and so does your pelvis. Yes. And so many, so often those times when we are drinking or smoking, we're not doing it because we're trying to be bad. We're doing it because we're suffering and we're Using it as pain management.
And we're using it to hide the feelings, to not feel the depression and the anxiety. And so addressing those underlying factoids can help. And removing that product, that chemical, can set the stage for you to finally love yourself again. So good. I'm so glad that you have that podcast. Another book I love is who I Forget Her Name. Oh, my gosh. Complete mind blank was like, it's like a woman's guide to not drinking or something. Do you know of that one? Oh.
Oh, gosh. Okay. I'm going to have to put. I'm going to have to put the name of it in the show notes because I can't remember. Oh, quit like a woman. And doesn't matter if you're not a woman. It doesn't matter if you're, you know, trying to quit alcohol or cigarettes or just reducing because, again, yes, we do want you to stop completely, but. But even reducing can be beneficial. She talks all about that, about how. And she talks specifically how about
like, AA didn't work for her. And it's. I think it's valuable because it talks about approaching these lifestyle changes from a position of love, like you just said, and not, oh, my gosh, you suck. And I think is really cool. So. Got a little tangential there, but awesome. Thank you. That's what I needed to do because I was depressed and, you know, not getting the most out of life and AA just for me just caused a shame spiral. It didn't work for me either. But you know
what? Some of my really close friends, it works really well. So it. It's your own personal journey for what is right for your. Your history and what you need to heal. Just. Just try. Exactly. You deserve to try. Love yourself enough to try. Yeah. And I think, you know, in my journey. Yeah, in my journey, I stopped two. I was drinking very heavily during COVID times. Right. To cope. And I mean, recognized it, and then was like, oh, this
is fine. It's just a coping mechanism. It's not fine. You know, and I recognized it and just cut way back and then have now stopped. And again, all things in my life coalesced to the point where I could make that rational decision. And I had the support that I needed to do that. But you recognize that not only do you drink, sometimes to. For me, it was to cover up anxiety that was undiagnosed for sure, and some depression that was then coming from that. But even on, like, just
good days, it would be like, oh, like, this was already a great day. And like, why and my total turning point crux, as I was educating my kids, that, like, alcohol is really bad for you, and yet I was still having a couple glasses a month. And my son goes, well, why do grownups do it then? And I had no ration. There's no response to celebrate. Like, would I have a cigar or a cigarette in front of them to celebrate? Like, there was no good answer for me to give them. And that's what
made me finally turn the corner to, like, cut it out. And so, yeah, that. That's interesting. And it's this whole other level of just pelvic health and overall health, but open heart surgery, alcohol and cigarettes, they're so inflammatory. They're not serving you to heal, and they're not serving you to show up.
And so there are people there who can support you and love you. And if you go to try to help, you know, get help with these habits and you don't feel loved and it's not the right place for you, even if it's the right place for your bestie, that's fine. Go someplace else until you feel heartwarming. Podcast and of having like, heart stuff is. The opportunity for puns is endless. That's really, really. It is, dude. I'm here for the puns.
All right, cool. But yeah, that is in a nutshell. That's why we want to talk about penises on the open heart surgery podcast. And if you don't have a penis, but you are noticing changes in sexual function, you know, they. This could be something to work on as a canary in the gold mine to improve your overall circulation. And if you are post heart surgery, especially if you're diabetic, the reduced blood flow to the pelvic floor can be a contributor to pee problems, poop problems, and sexual
problems. So seeing a pelvic floor PT in person or online can be really help that part of your life. So please just don't think, oh, I've had heart surgery, my sex life's over. If it's something you're interested in or, oh, I'm just getting older, I guess it's normal that I pee my pants, right? Not true. There's help available. So I have a great blog with lots of information. You can work with me or one of my staff online. I have a blog about how to find a PT
near you. You can reach out to Boots or me if you need help finding a PT near you. And like I said, my treasure chest really is a good trove. Literally a treasure chest of exercises to get yourself moving to improve this blood flow for not only better sexual health, but better overall health as well. Oh, and we're giving you guys a coupon.
OHS 2025 open heart surgery 2025 will give you guys 25% off any of my online programs, including 25% off the first three months of that Treasures Trust subscription, which is already a killer deal. And that goes over how to connect and relax to your pelvic floor, as well as these exercises to help improve your blood flow. So I'm glad you're here. Boots. Thank you so much for this opportunity to talk about Peter the Pelvis and. Heidi the Pelvis and Randy the
Rectum. If you missed the first installment, I'm telling you, you just. We were having so much fun during Heart Month and. And thank you, Kelly. All that you need will be in the show notes. Again, be sure to sign up for the newsletter. That's another way to stay in touch. And if you haven't, make sure you hit subscribe. And you know what will really make my day and my Heart month and my year would be as soon as you're done listening to this episode, do two things. Share this with a friend.
Perhaps one with a penis or someone with a penis. And then secondly, leave a review. I would so appreciate that because that is how people find this podcast. So definitely. And ask us questions. Yep. Blow up the email, please. We love questions. But in case no one has told you today, I love you. You are loved. You are worthy of a thriving pelvis, healthy pelvis. And be sure to come back next week for more pelvic wisdom from Dr. Kelly. Bye.