“If you're not able to have sex in a healthy and satisfying way, it can have a detrimental effect on your quality of life. Giving people hope – that they can regain this aspect of their life – it’s important.”

Dr. Joshua Gonzalez is a board-certified urologist specializing in sexual health dysfunctions for all genders. He’s based in Los Angeles, where he runs his private practice. We spoke about topics like expectations around male sexual performance, erectile dysfunction, and LGBTQ+ sexual health. We also discussed Dr. Gonzalez’s popular Tik Tok page, where you can find him dancing to Cardi B while answering questions on how to maintain a strong erection.

Our conversation has been lightly condensed and edited for clarity.

What exactly is sexual medicine?

It's kind of a broad term that refers to a field of medicine focused on the management of male and female sexual dysfunctions. The field of Sexual Medicine itself is really kind of an umbrella. It’s a large tent that encompasses people from urology, gynecology, psychiatry, and psychology, sex therapy, and sex health educators. It historically has been thought of in that binary understanding of sexual health. I don't love that terminology. People fall outside of that sex-gender binary sometimes. But historically, it's been thought of as the field of medicine that focuses on the management of male and female sexual dysfunction.

You're popular on TikTok and Instagram for sharing information about sexual health in an accessible way. What's your goal in building your presence on social media?

I actually started working with a social media manager a little over a year ago. I approached them and told them what I did. They thought that it was a really great topic to bring up on social media because there's a lack of educational sexual health material that's reliable.

Initially, my goal was to do it as an experiment and see if it would result in me having new patients come into the office, and then it turned into something different unexpectedly. It became wildly successful in a way that I could have never anticipated and has opened other opportunities that don't necessarily revolve around seeing more patients.

I think it's become a fun side project for me to put out science-based sexual health information in an educational but entertaining sort of way. And I think that's where the audience really enjoys the content that we produce. It’s that we typically cover topics that are a little bit taboo, that people don't feel comfortable talking about. They may be looking for solutions, but it’s also done in a disarming kind of way so that they can get the information while I'm dancing to some Megan Thee Stallion song. They're laughing... but also getting helpful information.

What are some of the taboo topics that you’re regularly trying to help break down and get people to talk about?

Erectile dysfunction is a big one. We've done a lot of content on erectile dysfunction also because it does really well [on social]. And we've tried to focus on topics that tend to get a lot of use because that guides us into understanding what our audience is interested in learning about. We've done some stuff on ejaculatory dysfunction and premature ejaculation. That’s another topic that a lot of men don't really feel comfortable talking about or don't know that there are solutions for it. We've done some stuff on fertility, we've done low testosterone, things that can help improve testosterone levels, low sex drive, low libido. Those are the main topics.

How do you feel the societal ideas around male sexual performance make some of these issues more complicated?

I think in general, society views men as needing to constantly perform their masculinity –  and part of that is how they perform sexually.  If you can’t perform this function, in the eyes of society you are thought to be sort of emasculated. That puts pressure on men to be able to perform sexually whenever they want to and to satisfy their partners.

Also, it depends on what particular subset of society you're talking about. I treat a lot of gay men. I'm gay myself, so I ended up attracting a lot of gay male clients. I think in the gay community, it's even more so the case that you're expected to be sexual for longer than most straight men because many gay men are not getting married in their 20’s and having kids. [They’re not] having their life focus shifted elsewhere. They’re expected to continue to be sexual for longer periods of time. So I think there's an added pressure on specific subcultures within our society.

In some of your other work, you’ve mentioned that people have a lack of medical knowledge around LGBTQ+ sexual health. I'd love to hear a little bit more about that. What is your focus on LGBTQ+ sexual health?

I know from firsthand experience that unless you're lucky enough to find yourself another gay provider who you feel comfortable with, then a lot of times you go into encounters with your doctors not really being asked about how your sex life is going, or what kind of sex you're having. I think a lot of queer people, even more so than cisgender heterosexual people, are not being asked those questions or are being asked them less frequently. I think that's a shame.

Part of my goal when I started my practice was to advocate not just for heterosexual people to have better sex lives, but also to intentionally advocate for improving the sexual health of the LGBTQ community as well.

What role do you think doctors have in helping people have better sex or have healthier conversations around sex?

My goal as a doctor is to make people feel comfortable talking about what their specific sexual health issue is. To have people feeling confident that they are going to find a solution for that problem with my guidance, and walk away with some hope that they're going to be able to regain this important aspect of their life.

People with sexual health issues, while they can typically exist in everyday life, many of them are incredibly unhappy and depressed. [They’re depressed] because it's such an important part of how we think about ourselves, how we connect with our partners, and how we manage our self-esteem.

If you're not able to have sex in a healthy and satisfying way, it can really have a detrimental effect on your quality of life. Giving people hope – that this is something that they can turn around and regain that aspect of their life – it’s important.

What would you say to someone who doesn't know much about sexual wellness or their sexual health? What's a good way to start learning more?

Now more than ever, there is the opportunity to do that. So what I always tell people is -- if you are not having the sex that you want to have, then you should be proactive about trying to fix that.

If you're not having the sex that you want to have because you can't perform, because you have erectile dysfunction, then seek out a specialist. Maybe not just a urologist, but someone who actually specializes in erectile dysfunction. In general, people should strive to have pleasurable and satisfying sexual lives. And if they're not having that and it's important to them, and they want to have that, they should use resources like social media and the internet to find providers who can help them do that.

You can find Dr. Gonzalez at https://joshuagonzalezmd.com, on Instagram,  and on TikTok.