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men who ejaculate 21 times or more a month are less likely to develop prostate cancer Jesus Christ why it's
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because Dr Reena Malik board certified urologist expert on sexual health and a rock star in educating the public on the facts and myths of sex Reena I want to start with this idea that other couples
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are having significantly more sex than we are big myth people are having sex about once a week will myis get smaller
00:00:27
as I age it can so in terms of how do we maintain our penal th you need to have is there a disparity between how long we think sex should take and how long it actually takes yeah we all think it
00:00:39
lasts longer women want it to be 18 to 25 minutes men are a little on the shorter side like maybe 12 minutes is
00:00:46
there like an average time 5.1 to 5.7 minutes then there too much masturbation going to have an adverse effect for men and women masturbation is generally safe as long as you don't that's when a
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becomes a problem Reena do we understand our bodies as it relates to our Sexual Health not at all for example with
00:01:05
pelvic floor it's involved in orgasm it's involved in sexual function but no one really talks about it in fact men
00:01:11
will be shocked oh I have a pelvic floor too and there's a whole host of issues that can come from having a weak pelvic
00:01:18
floor including erectile dysfunction so how can I strengthen my pelvic floor pelvic floor exercises they're going to
00:01:24
increase orgasm they're going to make your semen Propel further and ultimately it would be something as simple as it's
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absolutely crazy to me that so many of you have decided to watch our show um and so many of you have decided to
00:01:35
subscribe to our show we now have five million subscribers on YouTube which is a number that I just can't comprehend
00:01:41
and it's a dream that I absolutely never could have had we started the Dio just over three years ago now and in my
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wildest expectations we might have had 100,000 subscribers by now so you can imagine how shocked I am that so many of
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you have chosen to tune into these conversations every week um and spend some time with us so thank you and I
00:02:01
made a deal with you I made a deal that if you subscrib to this show that we would continue to raise the bar and in
00:02:08
2024 we're going to raise the bar like never before I've been working for the last 9 months on a surprise for all of
00:02:15
you that have subscribed to the show and I'm very excited to deliver that for you the production's going to change we're
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going to go even further with our guests and we're going to tell even more Global stories so as always if you appreciate
00:02:27
what we're doing here the simple free favorite ask from you is to hit the Subscribe button let's get on with the
00:02:34
[Music] episode Dr Reena Malik with all of your work what is it that you're seeking to do so what I'm seeking to do is have
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people understand that sexual health is health I think we have so much misunderstanding about one what is good sexual ual Health how do you why is good
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sex important why is it good to have good sexual health and that creates a lot of Despair and Devastation and people don't talk about it so they
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ruminate they feel bad about themselves and it's pervasive throughout their entire life so I think ultimately my
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goal is to make education freely accessible and understandable so people can know what's going on with their bodies what's normal what's not and what's available to help them how do you
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define sexual health so sexual health is sort of an individual thing but most people would say that you are able to have sex you are able to have an orgasm you are able to have pleasure and
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achieve the benefits of that do we understand our bodies as it relates to our sexual health no not at all I will
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tell you so I talk about for example um how it's normal to have erections at night or have even nocturnal emission so have a wet dream how that's a normal physiologic function and so many people
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will message me and say how can I stop having what they call Nightfall or how can I stop waking up with an erection
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because they think for some reason it's shameful or it's a bad thing and when re realistically it's just normal and part
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of it is Media right so when you see TV you see a man getting an erection very quickly he's initi immediately penetrating a woman and she's immediately orgasming and the whole Act
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is like really hot and heavy and in reality that's not what sex is like so if you're not seeing what normal sex is like what normal foreplay is like what the fact that it's normal to sometimes
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have difficulty getting an erection that's normal sometimes to not have an orgasm for a woman or it may take more
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time to get a woman aroused and require more foreplay that you are essentially looking at a script that's not real and then you're like what's wrong with me am I broken you know is something wrong
00:05:03
with my body that it doesn't function the way I'm seeing on TV or on Media or on erotic films where does your
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experience on this subject come from so I'm a urologist by training a board certified urologist so we are the
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medical and surgical doctors of the genital urinary tract so we're essentially the plumbers so when you have a problem with your kidneys the
00:05:25
tubes that drain the kidneys the bladder or your genitals we're the ones who are going to fix those if they're a surgical
00:05:31
issue and also we deal with the medical aspects of some of those things and so that's what my training was in but when
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I started my social media my channel I wanted to offer education to people and as I started making this education I realized how badly people wanted to know about sexual health how much they didn't
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know and how they really wanted to be empowered with this information and people are not being asked about sexual
00:05:56
function even when you go to see your primary doctor when was the last time they asked you about anything they might
00:06:02
ask you about erections but that's probably where it ends right even if they ask about that they're definitely not asking women are you having orgasms
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they're definitely not asking um anyone if sex is pleasurable they're not asking them if they feel satisfied with the way
00:06:15
things are going right and if they are enjoying desire do they feel normal and so I realized there was such a
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disconnect here with what people wanted to know and what was available to them and so then I started really making
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content about sexual health and spending more time investigating in that area treating patients in that area and it
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totally became a all-encompassing field for me you're an expert in the pelvic floor as well MH what was your sort of
00:06:40
training with the pelvic floor so when you do a fellowship in what we call pelvic female pelvic medicine a lot of what we do is related to the strength or
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weakness of the pelvic floor and so the pelvic floor just to start is a bowl of muscles that sits in your pelvis so your organs the bladder the rectum for women
00:07:02
the vagina the uterus the urethra all run through the pelvic floor it attaches to the bones on your pelvis and it is extremely important for a variety of functions it offers stability so when
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you're standing sitting it offers stability it offers the ability to defecate and urinate normally it offers
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uh when women have pregnancy the pelvic Flor becomes very important it's involved in orgasm it's involved in
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sexual function but no one really talks about it no one really knows it in fact men will be shocked oh I have a pelvic
00:07:34
floor too because we talk about it a lot with women right we talk about it in terms of oh I might leak a little after
00:07:41
I've had babies when I cough or sneeze or jump on a trampoline but the pelvic floor is much more complex than that and
00:07:46
so very often we'll see people when they have weakness of the pelvic floor yeah we'll see leakage of urine and but
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sometimes their pelvic floor can be discoordinated or it can be too tight or or have elevated tone and so what that
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means is that you can develop a whole host of abnormalities and that can be that you may have constipation you may
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have issues emptying your bladder you may feel like you have to go to the blad go to the bathroom a lot so you may
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urinate frequently you may feel the urge to go often sometimes it can cause pain so it can cause pain when you urinate
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might feel like you're having a UTI it may cause pain with erection or ejaculation for men so there's a whole
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host of issues that can come from having pelvic floor abnormalities and even if you've had say lower back injuries or hip injuries they can affect the coordination of the pelvic floor because
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it's all interconnected and so I will see patients who are like you know I've had a bunch of hip issues because I
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played Sports when I was younger and now I'm having issues with sexual function and so it's all interconnected and I think we we don't spend enough time talking about how important it is and
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how valuable it is to people when they're having problems I want to go into the pelvic floor in more detail and
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really figure out how I can improve my pelvic floor and what I'm doing to harm or hurt it but you said something there
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about doctors don't ask about sexual health they don't ask if for orgasming they don't ask if for ejaculating those
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kinds of things why should they be asking about that because I think of a doctor as I don't know fixing other
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parts of my body I don't think of them as sifting through my sexual life so if you have a normal sexual life and you're satisfied with it it won't even it wouldn't even bother you right you wouldn't think about it but people who
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have difficulties they may be walking around feeling shame they may be walking around wondering what's wrong with them this can be pervasive because they may have relationship issues and they may
00:09:41
have problems in their life with their relationship that they're then causing them to be less productive at work less
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happy less satisfied with life feeling more depressed more anxious and so it all comes together and in fact the other
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really important thing at least for men we know that when they develop issues with a so say you're having erectile
00:10:01
dysfunction and you are diagnosed today with erectile dysfunction 7 years later about 15% of those men will have a heart attack and the reason for that is
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because if it's a blood flow issue the arteries to the penis are about 1 to 2 millim the arteries to the heart are
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about 3 to 4 millim and when you have about a 50% occlusion of a blood vessel because of high blood pressure high cholesterol heart disease that organ
00:10:30
will start to have problems and so you will start to see erectile dysfunction in men who have vascular problems before
00:10:38
you start having chest pain or other signs of heart disease so it's and probably similarly in women although the
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data is not as we don't have that data for women that maybe if they all of a sudden are developing problems with
00:10:51
arousal that maybe there that's an indicator but again that's more complex and we don't have the data for that but
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certainly for men we have a clear indication that a problem with erections could precede really serious heart
00:11:04
consequences and when you look at people who've had a heart attack about 50% of men will have had erectile dysfunction
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prior to that 50% mhm is a pelvic floor dysfunction in men also linked to erectile dysfunction are because I I heard in some of your work
00:11:23
that sitting every single day in in the way that I do here I sit sometimes here for 10 hours a day could be creating
00:11:29
erectile dysfunction well so it's more that sitting every day can cause your pelvic floor to not stretch
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appropriately right like if you're not moving your body regularly and your body tenses up from sitting all day then your
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pelvic floor is not relaxing and Contracting in a normal fashion and so some people will develop some tension in
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the pelvic floor and through the pelvic floor runs a whole bunch of arteries and
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nerves that then go to the penis to provide blood flow and so if your pelvic floor is clenched really tight then it can cause problems in getting blood flow and then problems in getting erections
00:12:06
so while that's not um that's different than having vascular problems this is a muscular problem more so um that that
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that can be an issue with in terms of causing erectile dysfunction in some men because I heard during Co there was a
00:12:19
rise in pelvic floor dysfunction as people were sitting all day yeah I mean I definitely saw it I don't know if it's been actually studied but I definitely
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saw it in my own clinical uh setting and many of my colleagues did people would come in and they would start having
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either they'd be having more erectile dysfunction they might be having more urinary urgency meaning they got to go
00:12:37
got to go to the bathroom or they're going more often which wasn't a huge issue because they the bathroom was right near them but they did sometimes
00:12:43
notice that it was a change and and also sometimes they would some people even deal with pain like they would have more
00:12:50
pain in that area or women would think they were having urinary tract infections when they truly were just having discomfort from the pelvic floor
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being tense one of the that you're particularly good at is taking on some of the big myths as it relates to sexual
00:13:03
health and I I want to start with one of the big myths around Sexual Health which is this idea that we all think other
00:13:08
people and other couples are having significantly more sex than we are yeah so that's interesting I think that is a
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big myth and so when you look at um people want to know like what's normal how much sex should I be having right
00:13:21
and there's no ideal number but when you look at studies right which I've looked at large numbers of people people who
00:13:26
are in partnered relationships are having sex about once a week on average if they're have if they feel they're you know in in partner relationships where sex is always available but it's so
00:13:38
variable personto person and what I really like to say is it's not the quantity of sex that matters it's the
00:13:44
quality of sex right so if you're having good sex once a month that may be sufficient for you rather than having mediocre or bad sex four times a month
00:13:55
or 10 times a month even right and and so ultimately there's no right number it's really what's right for you and I
00:14:02
think focusing on some like Benchmark right of sex is is actually harmful right because now you're like oh well I need to have sex this many times what what is the purpose of sex right the
00:14:14
purpose of sex is pleasure and sometimes people derive a lot of benefits from orgasm we know that there's physiologic
00:14:22
benefits to orgasm in terms of stress reduction more Focus potentially better sleep and even maybe lower blood pressure things like that so if people are deriving benefit from the orgasms
00:14:34
and the intimacy with their partner and the pleasure they derive from sex that's what matters right not the number of
00:14:40
times you're having sex another big myth around sex which I thought i' um get your take on is about pain during sex it's one of the sort of most uh popular
00:14:51
questions that I often guess get whenever I speak to someone that is an expert on sexual health
00:14:57
is is sex supposed to hurt because for a lot of people it hurts no it's not supposed to hurt so if it hurts you want to assess you know what usually it's the
00:15:09
female partner who feels pain right so is it that you're not lubricated enough is it that you have not had enough foreplay because the body prepares for intercourse particularly in the female
00:15:20
so what happens is you go through arousal your body self- lubricates and the vagina actually lengthens and widens all almost double in size to accommodate
00:15:31
the phus or whatever you're using whether it's a toy or or or a finger or anything and so if you don't have
00:15:38
sufficient time to allow those things to happen then it will be painful and sometimes lubrication can be variable personto person so some people may have copious amounts of lubrication and some
00:15:50
people may have less and it could be based on genetics it could be based on the age they are what stage of their
00:15:56
hormonal status it can be based on what medic ation they're on that might decrease lubrication I think there's
00:16:02
another big myth is that lubricant is not for everybody and I I argue that lubricant is for everybody that it makes
00:16:09
things more fun it makes things more slippery it makes things more enjoyable and it certainly makes pain less of an
00:16:15
issue for a lot of people now there can be other issues that cause pain so if you've tried all these things you know you're fully aroused you know you're lubricated you know that you're still
00:16:25
having pain then it's really important to get evaluated to to understand what exactly is causing the pain it could be
00:16:32
hormonal changes in the vestibule which is a part of the vagina that is very hormonally sensitive that can be painful
00:16:38
it can be pelvic Flor dysfunction it can be things like endometriosis or other factors that may be going on that need
00:16:45
really Advanced help uh but most of the time a lot of people can feel and enjoy sex more readily if they just increase the amount of foreplay and increase the amount of lubrication you said that the
00:16:58
vagina expands during sex so how much does it expand by and how long does that take
00:17:04
because I think men don't really understand this process a lot of men just like to rush in there you know yeah yeah so usually it expands by about
00:17:10
double double in length and double in width and so it will expand and basically the cervix is moving up and
00:17:16
out of the way the vagina is expanding to accommodate the length of a phus and and it takes we think on average about 18 to 20 minutes so it that's sort of
00:17:27
the amount of time it and some people faster and some people longer but ultimately you know sort of like
00:17:33
understanding that but also um the lubrication is another big part of it and so I think both those things
00:17:38
together um you know you need you need some time and some people like I said they may not take 18 minutes they may
00:17:43
take a couple minutes and so it's very reasonable to get in there if that's what your partner wants but again I
00:17:49
think the bigger issue is that we're not communicating about sex no one taught us how to talk about sex right I didn't
00:17:56
grow up talking about sex with my family many of my friends and colleagues did not grow up unless they were in a family
00:18:02
that was very Progressive talking about sex or even learning about sex from their parents and at school you don't
00:18:08
learn much you learn how to put on a condom you learn how to ask for consent you learn about STDs and that's if
00:18:15
you're lucky in the US 13 states don't have to have accurate sex education like it's not a requirement for sex education to be accurate in 13 states in the US where are we learning sex from so the
00:18:27
large majority of young people I mean this data shows that at least one in four adolescents are learning sex from
00:18:33
porn and it's probably more than that so I think a lot of people are learning either from uh pornography from their
00:18:41
friends a small subset are learning from their parents there still are people learning about sex from their parents
00:18:46
but ultimately it's not enough and so if people are learning about sex through porn porn is entertainment it is
00:18:53
doctored it is not real and I think people then take that and they say why did not my sexual encounter not look like that why didn't I have as much semen volume why did my partner not
00:19:04
orgasm as quickly and it can be on both sides where women can be like why didn't I react like that why didn't I get so
00:19:11
excited right away and I think there's it's a real problem in terms of if people are only learning about sex
00:19:18
through pornography then they're already set up to be let down when they have their first sexual encounter and on that
00:19:24
point of communication we don't talk about it as a society but then even within our own relationship
00:19:29
you know we don't talk about things we're struggling with with our own partners and the insecurities that we
00:19:35
have and I think that can cause a spiral of misunderstanding and I've seen that in my own sex life historically where
00:19:41
maybe there was something I was insecure about or there's something I was thinking about and instead of communicating it I might have just acted
00:19:46
in a strange way and then that's misinterpreted and then the other person gets a little bit insecure or whatever and then you kind of have this downward
00:19:52
spiral of misunderstanding which leads to like sexlessness absolutely you're just avoiding the situ ation because
00:19:59
nobody wants to talk about it and this is the problem like you know people ask me like what's this what's the key
00:20:04
what's the key what's the secret the secret is you have to know what you like right you have to know what you want and
00:20:11
you have to communicate it with your partner how so this is the issue it's not easy it's not easy because no one
00:20:16
taught us how to have these conversations and they're charged with a lot of emotion right you feel insecure
00:20:22
you feel inadequate or you feel resentful because you're not getting what you want out of the relationship
00:20:28
and so it has to come from a place of understanding that this conversation is not a oneandone there's no the talk there are multiple talks over multiple periods of time and the first time you
00:20:40
have the talk it might be a total disaster but you know if you were in a relationship where someone really also
00:20:47
has the same goals as you of having a great relationship with a good sex life then ideally it that won't continue and
00:20:53
you will continue to have conversations so what I tell people is don't have conversations in the bedroom not right
00:20:59
before not right after sex you want to wait until you're out of the bedroom not during or during definitely not during
00:21:05
that's happened before [ __ ] was yeah yeah that's pretty bad that's pretty bad um so you know one and then two have it
00:21:12
in a place like somebody you don't to be looking at the person right you can be sitting in a car you can be going on a walk because it's really awkward to look
00:21:19
at someone in the face and be like you know what I felt like this wasn't really great you know and and so then to be
00:21:25
like okay like you know talk again using the same sort of communication techniques that you use for other things
00:21:30
talking about eye statements not being you did this you didn't do this more about like how I feel what really turns
00:21:36
me on what I would really like in the relationship and then sort of realizing that they may not react well they might
00:21:43
be like oh my God I can't believe we're talking about this they have their own stereotypes and biases that they're
00:21:49
bringing into that conversation too or their shame or whatever they grew up with in society whatever they think
00:21:54
about sex can be very charged right and so it's sort of a lot of work to get through that but realizing that it could take time and sometimes getting help so seeing a sex therapist or someone who
00:22:06
has expertise in Psychology and sex to talk learn how to talk about sex with them and and navigating the difficulties of it but it's worth the investment
00:22:17
right it's not easy but nothing in life that's good or worth getting is easy right okay so there's a couple listening
00:22:22
right now there's probably one member of the couple listening right now and they've heard everything you've said but they have reached the point of noet
00:22:28
return in their relationship as far as they're concerned they've not been having sort of a functional healthy sex
00:22:33
life for maybe one year maybe 6 months maybe 5 years and it's just become The New Normal MH what is the case you would
00:22:39
make to that person to get them to take action to try and rectify the situation well I would ask them first how
00:22:46
important is sex to them right if it's not that important and the other things in their relation and that's okay right
00:22:51
some people find that okay everything else in the relationship is excellent I love this person we're still in intimate
00:22:58
we still love each other we still cuddle we still um have a lot of great things in our relationship and and sex right
00:23:06
now is not working right or it's not it's not working for us so um I'm okay with that that's fine like you don't have to feel bad about that but I think that if it is a problem then I think
00:23:17
it's worth working on right like if you have a relationship that you value and that person you're you're with values
00:23:24
their relationship then it's worth keep trying like try to have conversation try
00:23:29
to bring them into the conversation how much have you tried right like have you really had enough attempts at a
00:23:35
conversation a true conversation where you didn't get frustrated too right like where you were like okay I understand that you have this is a difficult conversation that we're going to have
00:23:45
and I understand you might have feelings about it but I love you and I really want to try to have this conversation
00:23:50
and to keep at it and I realize that that's not easy right that's not easy I'm not saying it is but I'm saying that
00:23:55
when you're in a relationship that's worth having that ideally at some point the other partner will see how much this
00:24:02
matters to you and want to work with you on it right if they love you if they're with you there they want what's best for
00:24:07
your relationship they're not like hiding they're not hiding their head in the sand and being like Oh I'm like
00:24:13
they're they realize they're just don't want to talk about it they they they're not stupid they just sort of don't want to talk about it because it's
00:24:18
embarrassing to them they feel like they're the one that has something wrong with them maybe or maybe they have an issue that they haven't brought up maybe
00:24:24
they're having a lot of pain with sex or maybe they're going through hormonal changes and their tissues are really dry
00:24:31
or whatever there there's a whole host of things that could be going on that they don't feel comfortable talking to
00:24:36
you about so I think it's it's valuable to say is there something I'm not doing like tell me what you feel about sex like leaving it open-ended to really find out what's going on with them
00:24:47
because usually not that they're like I just don't want to have sex and that's it there's usually a lot more to it it's
00:24:52
so hard for us to know isn't it when it comes to sex what the root cause of the issues are and I think some Rel ships
00:24:59
are like a frog in a frying pan the frog in the frying pan analogy for anybody that doesn't know is this old tale about
00:25:05
a frog jumping into a frying pan and then because the water heat up gradually it ends up dying but if the water was
00:25:10
hot from the moment it Dr jumped in it would have jumped straight out the idea that it's a gradual death for the Frog
00:25:17
and in relationships it's kind of a slow day by day month by month decline in intimacy and you end up finding yourself
00:25:24
like a dead frog in a frying pan you end up finding yourself in a sexless relationship and you think how the hell did we get here mhm um and it's and it's
00:25:32
it feels like a long way back from that point it is it's going to be right because you let it sort of dwindle and
00:25:38
you didn't talk about it and it's going to take work and I think that's the key is like if you want to fight for that in
00:25:44
your relationship it's going to take work and it's going to take um buy in on both sides right you have to work for
00:25:50
anything in your relationship relationships are not easy right you want to have children that takes work
00:25:56
you want to um decide toy a house together that takes work deciding and figuring out the what kind of house you
00:26:02
want how much money you want to spend like there's all sorts of things that take work and this is one that people just don't know how to talk about and so
00:26:09
they just ignore it because it's harder to bring up for both parties right what the one who maybe is not wanting sex or
00:26:16
is being the one who says no to and the one who always wants sex and then feels rejected because they're not getting it
00:26:22
is there a a sort of a difference between men and women's sexual desire as we age you know cuz I think there's a myth that says men just always want to have sex and women maybe not so much is
00:26:35
that a real myth um in terms of something that you hear but also is it true so let's talk about desire desire
00:26:42
comes in two flavors so there's the spontaneous desire where you see somebody you like oh man they're so
00:26:49
attractive I can't wait to sleep with them I'm immediately turned on I want to have sex right now right you didn't have
00:26:54
to do anything you just saw them and it happened and then there's responsive desire where you're sort of with them
00:27:00
you might be touching them you might not really be thinking about sex but like you're touching them you're with them
00:27:05
you're like oh this feels sort of nice I sort of like this like oh now I'm turned on after we've sort of started being a
00:27:12
little romantic with each other being a little more intimate with each other and both desires are normal and both desires
00:27:19
are fine to have now in the literature you'll find that men tend to more often have spontaneous desire and women tend
00:27:26
to more often have responsive desire particularly when you're in longer term relationships so there's this disconnect
00:27:33
right women are like why don't I see you and want to jump you anymore right I used to feel like this but I don't
00:27:38
anymore what's wrong with me am I broken right and then they don't realize that okay maybe we'll just like be together
00:27:44
and let's see what happens and they don't even want to start because they're worried that what if I don't want to have sex and we've now initiated this
00:27:51
like touching cuddling thing where oh that person's getting really turned on what if I don't get turned on and what
00:27:57
if I just appoint them and so there's a lot of charged emotions there but realizing that this is normal and common
00:28:04
and responsive desire is not wrong it's just different and people just don't know that it exists because again media attention is like you see someone who jump them you're you're horny right away
00:28:14
you have sex and that's not what happens all the time and that's okay and so like you know you can be with your partner
00:28:20
like look I have no expectations from you I just want to be with you physically and see if it turns into sex
00:28:26
so often we'll give people homework like put it on the calendar put it on the calendar that you are going to be
00:28:31
intimate together at this time and I know that sounds weird right like you're looking at me like I'm crazy but we put
00:28:37
on the calendar when we want to work out we put on the calendar when we want to have brunch with our friends we put on the calendar when whatever right and
00:28:44
when we were younger when we used to have dates with people we would say okay we're going to go on a date on Friday
00:28:50
night we would know that sex is on the table with our partner on Friday night so we'd get really excited about it we
00:28:55
like okay I'm going to shave I'm going to look real pretty I'm going to smell good I'm going to do all the things that
00:29:01
make me desirable and feel confident and be ready to have sex right and so you'd be like really excited about and then
00:29:07
you would have all this anticipation about how fun it's going to be but the anticipation can can wreak havoc content
00:29:14
it can it can so the opposite is true but that's because if you expect that's why I say intimacy and not sex so if you
00:29:20
say you're going to have sex it can be like oh my God what if I don't perform what if I don't do right what if I don't want sex what if it hurts right so you
00:29:26
can also have that sort of rumination and spiral but if you're like look all we're going to do is be together and be
00:29:32
intimate we're not going to just go have dinner and talk we're going to like literally be together not have our phones with us maybe like touch each
00:29:39
other maybe get undressed maybe just you know feel what it feels like and that's it there's no expectation of sex from
00:29:46
either side we're going to go in knowing that and then slowly work our way towards like okay you know what like
00:29:52
maybe sex will happen and maybe it won't and over time as you keep putting it on the calendar prioritizing your intimate
00:29:58
y with your partner then eventually you'll get to a point where oh you remember you recall that connection you
00:30:04
used to have and then you can actually find that Joy again of connecting sexually that's the sort of the aspect of desire which is I guess is a bit more psychological but it there's also sort
00:30:15
of a physiological element to desire as it relates to hormones levels so if someone's got a low libido is that a
00:30:22
hormone dysfunction it can be so testosterone is the most notorious hormone for desire right in both men and
00:30:29
women and I think this is a big misconception is that we don't talk about testosterone in women but testosterone in women is more
00:30:36
predominant than actually estrogen we have more testosterone in our bodies than we do estrogen and testosterone is
00:30:42
very important for desire in both men and women but anything that is interacts with testosterone is also important so
00:30:49
thyroid hormone can can cause issues with testosterone prolactin which is another hormone made by the brain can
00:30:55
also interact with testosterone so essentially evaluating those things and making sure that your levels are normal
00:31:02
or appropriate for your age can be helpful that's probably the number one thing but the other thing outside of
00:31:08
physiology is that stress even though stress is um sort of an abstract thing stress affects our physiology right so
00:31:15
when you have a lot of stress in life whether it be work relationship stress kids stress whatever it is right it raises your cortisol level and when your cortisol level is high you can't produce
00:31:26
testosterone it goes down and so if you're chronically stressed which many of us are right you spend
00:31:32
like in today's modern society chronic stress is like a real problem then that is going to really impact your libido so
00:31:39
yeah your hormones may suffer because of it but if you don't fix the stress like you're not going to fix the root cause
00:31:45
of the problem can I just inject myself with loads of testosterone though to get my libido back it won't work for
00:31:51
everybody so if it's not truly a low testosterone meaning you have normal of testosterone likely your testosterone receptors are completely saturated more testosterone is not going to fix the
00:32:04
problem so it depends on your individual level of hormones but at some point more is not better in fact more can be
00:32:10
dangerous and so it's really dependent on your individual level so giving yourself like if I give a guy who has
00:32:15
completely normal testosterone levels both free and total testosterone all completely normal and I give him
00:32:21
testosterone probably nothing's going to change because his testosterone receptors are already fully saturated
00:32:26
with testosterone so more is not going to do anything what are the other ways that I can increase my testosterone if I go and get tested and it says that I
00:32:32
have low testosterone levels and I don't want to just inject myself with testosterone Are there natural ways that I can increase it absolutely so number
00:32:40
one is sleep so sleep is really really important for testosterone we know that when you reduce the amount of sleep you have so for example you sleep less than
00:32:51
six five or 6 hours you're going to have at least 10 to 15% reduction in testosterone and so because our body
00:32:59
follows a Circ Rhythm and so when your testosterone's highest is in the morning and it starts to decline over the course
00:33:05
of the day there's a little bit of a bump again and then it goes back down at night time it's low and your body when it's sleeping replenishes that
00:33:12
testosterone and so if you're getting either less number of hours of sleep or poor quality sleep meaning you're you
00:33:19
know you're not feeling very rusted when you wake up that's a sign of poor quality sleep both of those things can
00:33:25
dramatically affect your testosterone the other thing that you can do is exercise and specifically resistance
00:33:32
exercise so doing High the the largest muscle group so usually the lower extremities and using those have been
00:33:39
shown to boost testosterone more significantly than any other type of exercise in fact when you do
00:33:46
cardiovascular high-intensity cardiovascular endurance training so say you're doing Ultram man marathons all
00:33:53
the time long long bike rides long swimming uh you know swimming for a long periods of time that can actually
00:33:59
increase your cortisol your stress because your body is having a stress response and that can actually reduce your testosterone so it's important to
00:34:07
do cardiovascular exercise aerobic exercise but in moderation uh because we do see some people who are great athletes who you know run you know run miles and miles and miles but their
00:34:19
testosterone is low because they've been doing this chronic long duration endurance exercise so sort of hit
00:34:25
training is fine but it's when you start doing these big Iron Man thousand M run things that the cortisol sues that's not
00:34:30
that's not a large percentage of people right but it's certainly you know it's like I'm so healthy I'm the healthiest I
00:34:35
could ever be and I'm having low testosterone why is that and what about food and testosterone so food you know
00:34:42
there is a lot of uh data on food the one but the most data is on the Mediterranean diet and that's because
00:34:47
that's the most well studied in medicine but essentially having vegetables fruit
00:34:54
low um low amounts of processed foods good healthy fats nuts and seeds so a lot of people don't realize but you need good fat to have testosterone testosterone is a pre is a production is
00:35:06
in the cholesterol Pathways and so it comes from those Pathways and so you need to have some level of fat if you
00:35:11
have too low fat of a diet that'll also affect your affect your testosterone so ideally what I tell people is while
00:35:18
there's lots of data on different types of diets the important thing to know is you want to avoid processed foods avoid
00:35:24
avoid a lot of sugar and have good healthy fats in your diet what about you know I've heard a few times that
00:35:30
testosterone levels have been declining over the last couple of decades in men MH is this true yes it is true so we're
00:35:37
not only seeing a decline in testosterone levels but we're seeing a decline in sperm quality and uh sperm
00:35:44
numbers so the concentration of sperm and over the course of the last 50 years and there's a lot of reasons for that one is that you know Society has become more sedentary we're seeing people less
00:35:57
acve getting more and more metabolic conditions like diabetes high blood pressure these conditions then cause
00:36:04
endocrinologic abnormalities they cause problems with blood flow and all these things can affect the quality of your
00:36:11
sperm as well as the quality of your testosterone production and then also there's more we think in the
00:36:17
environments we know there's more uh microplastics and more endocrine disrupting chemicals right in the
00:36:24
environment so that is probably a role now we don't have like exact qu like exact quantitative data on that but we think that is probably playing a role and reducing the exposure to these
00:36:36
endocrine disrupting chemicals so we tell people try not to drink out of plastic water bottles try to warm up
00:36:41
food and glass and avoid plastic I mean these are easy things you can do but if you want to stress about the amount of
00:36:46
Plastics in the environment like there's not much you can do as on an individual level so I tell people do the things you
00:36:52
can control and the other things sort of you know we have to work on as a society
00:36:57
that's really interesting cuz I I don't think I think about this much but removing chemicals from my life in terms
00:37:04
of what these kinds of things that I'm holding the metal mug in front of me and then the plastic bottles I drink from could be having an impact on my testosterone and my sperm count it could
00:37:17
I mean like it's not everybody right think about how many people drink from plastic water bottles but if you can decrease your exposure right it's
00:37:22
probably additive so the more exposure you have the more likely it is to imp impact your body how do they know this
00:37:29
like how does anybody know that chemicals are having an impact on our sperm and testosterone so there's you know there's basic science research
00:37:36
where they're looking at the impact of these things on on rats and other animals and then also they're looking on
00:37:42
the amount of exposure uh to things like phalates and labs and seeing how that you know we can't it's all cause it's all correlation we can't say it's causitive because we don't we're not going to do a randomiz study where you
00:37:54
drink from water bottles for 10 years and you drink from glass water bottles for 10 years and let's see what happens
00:38:01
right that hasn't been done but they can say okay the more your exposure based on
00:38:06
whatever biomarker we can assess so maybe urinary phalates or other things we can say that okay these people who
00:38:12
have more exposure to this are more likely based on the data to have lower levels of testosterone and then you know
00:38:19
looking at the mechanisms of how they interact with the production of testosterone and I'm not an expert in
00:38:24
those areas but certainly there has been sort of plot ible mechanisms of how these things work how has sperm count
00:38:31
been decreasing over the years so if you look at the last 50 years you'll see that the average sperm count has declined almost 50% and luckily the average sperm count
00:38:43
is still high enough for fertility rates the average sperm count is probably around 50 million of of fathers people
00:38:49
who father children and so it's still above that but it's certainly significantly lower than it was 50 years
00:38:55
ago and so that's where we're thinking you know it's it's probably more of a Global Environmental Factor that's
00:39:00
contributing to that in addition to this increase in comorbidities and poor health over time I mean the direction of
00:39:09
travel there is deeply concerning because if something declines 50% in the last what 50 years did you say then if we go forward another 50 years and we
00:39:19
assume the same rate of decline that means we'll be at 25% of where we were 100 years ago yeah and then what if you
00:39:25
can't father children anymore and what if you can't have offspring that will then propagate the species right so
00:39:31
there's there's certainly concerns there and I think you know we have to as a society do better in terms of the things
00:39:38
that we can so we can control diet we can control exercise we can control those things there's certain things that
00:39:44
we can't but we can try to control what our people are exposed to and that can be on a governmental level right like having sort of laws in place so we know in the US there's less restrictions
00:39:56
whereas in other countries there's more restrictions on things like food coloring and dyes that may have again I
00:40:01
don't I don't know the specifics but certain you know there's certainly more restrictions in other countries than in the US for some reason and so maybe
00:40:07
there needs to be a more critical evaluation of where we can actually put in place some things that would actually
00:40:14
have more wide widespread changes when we think about sperm count we often think about fertility um and you know I
00:40:21
don't know whether this is just because Society has changed and we're trying to have kids later but it does seem that people are struggling more and more with
00:40:27
fertility I mean even in my own sort of Circle of Friends um there's you know there's a couple people that have
00:40:33
reported to be struggling with fertility or that you know they're spending 12 months or 24 months trying to have children do you think this is linked to
00:40:40
this as well it could be I mean when we know when we look at fertility we know that about half of fertility is due to
00:40:46
women half fertility is due to men and then some combination of the two right so um definitely as women age fertility
00:40:54
goes down and we know women are waiting longer to have children so that's a big part of it that Society has changed
00:41:00
women are working and and prioritizing their careers not a bad thing but it certainly will affect fertility and and
00:41:06
then yeah there may be these issues that are affecting male sperm counts that are also causing issues but I don't know
00:41:12
that there's been updated data in terms of what are the causes or the numbers in terms of fertility rates fertility aside
00:41:20
is there any correlation between our health outcomes and our sperm volume not volume but concentration uh so volume is the amount of of of right so concentration of sperm in the
00:41:33
semen is more of a predictor in terms of um sperm volume not seamen volume let's
00:41:40
be clear so sperm volume sperm concentration are sort of the the biomarkers and we would say that yes
00:41:45
there is a correlation with overall health in terms of uh sperm concentration and sperm volume uh but I
00:41:53
think I don't want to make people worried that if they truly have a male fat Factor infertility then now their
00:41:58
overall health is uh is a problem but it's certainly important to be evaluated and seen by your doctor regularly and on that point of um seamen volume is there
00:42:09
a way to increase that and is it similar to what you said about increasing testosterone or is there another set of sort of um practices we can do to
00:42:16
increase our seamen volume yeah so seamen volume is variable depending on the biggest one is how long has it been
00:42:22
since you last ejaculated right so the longer you delay between one ejaculation to the other the more seamen volume you will get that's probably the most predictive you know hydration can play a
00:42:34
role if you hydrate more certainly you may see more seam in volume um sometimes it's a it's a low seam in volume because you're actually having less force of ejaculation so interestingly when you're
00:42:46
young the force of ejaculate can be really really strong it can be up to 30 to 60 cm away like when you ejac that's
00:42:52
how forceful it can be as you age after about 50 it can decline to 15 to 30 cm away and so that can feel like you're having less volume because it's less forceful and so in those cases that's
00:43:04
because of the pelvic floor muscles that are around the urethra those muscles there that help sort of propel the
00:43:10
ejaculate out and so you can strengthen those muscles with again pelvic floor exercises like keigle exercises I caution people because people always like oh they're going at these Keele exercis are great they're going to
00:43:21
increase orgasm they're going to make my semen Propel further and I think that's fine if you're not having pain you're
00:43:27
not having discomfort and you're doing them correctly because sometimes what we see is it can actually cause harm if
00:43:33
your pelvic floor is tense like we talked about earlier or it can cause pain and dysfunction if you're tensing
00:43:39
tensing tensing and not relaxing and so if you don't know how to do them correctly then you could actually harm
00:43:44
yourself um but yes they can improve seam and volume by the parameter of increasing the force of a jackulate and
00:43:50
getting more ecate out that may be left over if you're not having as forceful of a muscular contraction does
00:43:57
masturbating improve my pelvic floor does it strengthen my pelvic floor so that's a good question the orgasm is
00:44:03
what improves your pelvic floor so if you masturbate in your orgasm when you orgasm your pelvic floor contracts
00:44:11
involuntarily you can't do anything about it at a rate of about every 08 seconds so it does contract and that is
00:44:18
sort of like a pelvic floor muscle exercise but it's doing it involuntarily it's Contracting for anywhere from 5 to
00:44:24
60 seconds usually on average and so you are sort of in that way increasing pelvic floor strength in fact they've
00:44:31
looked at um in women particularly is orgasming as good as doing pelvic floor exercises and they've seen that you know you can see pretty measurable Improvement in pelvic floor strength if
00:44:42
you orgasm regularly um is it and it may be you know as good as doing ke gos depending on how often you're doing it so yes orgasm itself can be very beneficial for pelvic floor strength one
00:44:55
of the big sort of myths that I've always ways I'm yet to answer is the impact that our technology is having on
00:45:02
our genitals you know there's kind of like a pervasive myth that if you put your phone next to your testicles your
00:45:08
sperm Count's going to drop like whenever I'm in the car um and I don't know I'm I'm sat there or I'm sat at
00:45:15
home somewhere and I get my phone and I put it near my genitals my girlfriend has a go at me and she she like pulls it out or tells me to pull it out because I
00:45:21
think she's worried that we're not going to have kids if it's down there yeah yeah so there is there is a little bit of data there in terms of you know when
00:45:29
you have these devices like in your lap or near your genitals they will increase
00:45:34
the temperature and so when you the the the testicles are in the scrotum for a reason right it's because they need this very perfect environment with this specific temperature to create sperm and
00:45:46
anything that disrupts that temperature can cause diff cause abnormalities in sperm production so for example when you
00:45:53
have a fever because you have the flu or you have a cold people will get their sperm checked
00:45:59
their seman analysis and they will see that their sperm count is zero because the temperature the fever has
00:46:05
temporarily stopped their sperm production and so you can see that you know people also discuss like oh what
00:46:12
about boxers or briefs what about putting and so all of these things can increase the temperature around the
00:46:19
scrotum which can then cause changes in sperm production so I tell patients particularly if you're trying to have
00:46:25
babies is put your phone in your back pocket in your chest pocket don't put your computer or your laptop right on
00:46:30
your lap right I mean it's easy enough to do and it does increase temperature so absolutely yes these things can not
00:46:38
for everybody right there's people so we say people like you shouldn't smoke a lot of marijuana when you're trying to get pregnant because marijuana can cause
00:46:45
problems with sperm production but you'll see people who smoke every day and they still have babies or you'll see people who do all of these things right
00:46:52
they they wear briefs they they put their phone on their in their pocket they put their laptop on their lap and
00:46:57
they still have babies so it's not a all allomer but certainly things that you can easily just avoid putting near your
00:47:03
genitals well if I'm in the sauna every day or if I'm in a a steam room every day isn't that going to have an impact
00:47:10
on my sperm count yeah it does and it's interesting because there's I think we'll see more of this as we're seeing
00:47:15
the rise of I there's benefits to saunas no doubt but as we're seeing the rise of people really doing saunas all the time
00:47:22
um there can be so we tell people when they're trying to have if they're having fertility issues don't in hot tubs don't
00:47:27
go in saunas because it could affect your sperm production so those are sort of the the conservative things we tell
00:47:33
people to do interesting and this this point about the phone next to genitals it's not because of like the Wi-Fi and
00:47:39
the Bluetooth are going to like zap my babies no I mean there's some there's some question about that but we don't
00:47:44
know I don't think we know but we know there's a temperature increase right because phones get hot we talked about
00:47:49
masturbation briefly um one of the big questions that people often ask me when I'm speaking to someone that has
00:47:55
expertise on sexual health is is about masturbation and whether it decreases your testosterone levels so it does not
00:48:02
there is one study and it was done in 10 men who abstained from masturbating for
00:48:08
21 days and these are young healthy men right and so this is where I think everyone gets their data from is this
00:48:14
one study and so they took their testosterone before they took their testosterone after and and what they
00:48:21
found was that there was an increase by about 50 50 nanog per deil 0.5 um was which is 50 nanograms per D which is not a huge amount um at 21 days but we know
00:48:32
that testosterone changes all the time and two there's a lot of anticipatory cues when you've been waiting to
00:48:38
masturbate for 21 days like your brain is is really excited there's all these like okay I'm finally going to get to
00:48:43
release and that in of itself can increase testosterone So gener speaking there's no empiric evidence that is
00:48:50
convincing high quality level evidence that masturbating or abstaining from masturbation will increased testosterone and so there you know people do report
00:49:01
other benefits and so I tell people if you're getting other benefits from abstaining by all means go ahead but
00:49:07
don't do it for don't like White Knuckle it to gain some theoretical increase in
00:49:12
testesterone that one was not even that large and two is probably not going to be proven in a larger sample what about
00:49:18
the opposite then is too much masturbation going to have an adverse effect on us for men and women yeah so I
00:49:24
think it you know what I tell people is masturbation is generally safe as long as you are not masturbating to the point
00:49:30
where you are now choosing to masturbate over doing anything else so you're choosing to masturbate rather than have
00:49:36
sex with your partner you're choosing to masturbate over going to work or you're I'm going to be a little late to work because I want to finish masturbating or
00:49:42
you literally can't sleep without masturbating every day like those sort you become reliant on this particular
00:49:48
activity for the enjoyment that it provides um that's when it becomes a problem but if you're using it in terms of like masturbating to get orgasm and the benefits of orgasm that I do achieve
00:50:00
from that because maybe my partner doesn't want to have sex or maybe I have more of a sex drive than my partner or I
00:50:06
don't have a partner like let's be realistic like if you don't have a partner you're going to have to if you want to orgasm you're probably going to
00:50:13
have to masturbate and so I think the problem also comes in is when people only masturbate the same way every time
00:50:20
they only watch a certain type of erotic film or they do the same thing every time and their body habituates to that
00:50:26
and then they have difficult time climaxing with a partner because they can't replicate what they're doing
00:50:31
whether what they're watching or how they're doing it with a partner are we teaching ourselves something there are we teaching ourselves how we're aroused
00:50:38
and how we orgasm yeah your brain is very powerful right so when you're doing the same thing every time your body is
00:50:43
like oh this is what turns me on this is what makes me orgasm and then when you're their partner you're like oh I'm
00:50:48
not getting that same kind of stimulation and so it doesn't happen to a lot of people but I would say
00:50:54
certainly I see people where this does happen and so um you know you have to sort of take a break and and sort of
00:51:00
re-evaluate and try different things and get your body to habituate to different things which takes a little bit of work
00:51:06
um but sort of keeping it varied can be helpful another big myth masturbation will make me go blind yeah no there's
00:51:13
literally I don't know where that came from there's like hariry Pals blindness like I don't know where I I think this is all sort of like from religious
00:51:20
rhetoric that says you know you should not masturbate um and and it you know where that came from you know as a whole other story I think what do you think of this idea of no nut
00:51:31
November yeah so I think it's I'm not a fan the reason being is because I think it makes people feel like it's something
00:51:37
they have to do and if you want to like I said if you find benefit from abstaining from ejaculating for 30 days
00:51:44
or 28 days or whatever it is um then by all means like go ahead if you want to try something there's no harm in it but
00:51:51
I think a lot of people what they do is they feel like it's something that's going to bring them to some higher level and they're going to become this great
00:51:57
person because they're able to to to conquer this goal but they're like literally miserable so they're um
00:52:04
they're clenching their pelvic floor all the time because they're stressed about how they're not ejaculating they may
00:52:10
ejaculate at night and so they'll have a nocturnal emission and then they'll feel so bad because theyve failed it's
00:52:16
nothing you can control nocturnal emissions are physiologic they're totally normal and 86% of men have had a
00:52:22
wet dream at some point in their lifetime like it's very very common and and more likely the longer you are from
00:52:28
ejaculating so um your body will take care of the ejaculate if you ejaculate or not so you will either resorb the semen or you'll ejacate at night and so
00:52:39
if you want to do it because you feel like okay I have a challenge I want to conquer it I want to see if I can do this and you feel better because you're
00:52:44
not you're able to like not focus on sexual thoughts or you're able to really um find some other level of spirituality or something by all means go ahead I don't have a problem with it what I have
00:52:55
a problem with is making people feel bad because they can't do it or they don't want to do it and with people feeling
00:53:01
forced or feeling like they need to do it to prove something to someone else yeah because I mean the way that I've
00:53:06
had it explained to me is that it's some something about seman retention gives you some clarity of mind or something
00:53:12
because a lot of athletes before they have their their big fights or you know their bigger sort of Olympic competitions they'll abstain from
00:53:19
masturbation I often hear in the UFC for example the um the mixed martial arts fighting championship that athletes have
00:53:27
not had sex or not ejaculated for two weeks before a fight or four weeks before a fight yeah so there's a lot of
00:53:33
rhetoric there I think that comes from um historical so even in Greek in Greek times they would tell people to avoid having sex or masturbating prior to you
00:53:44
know big fights or or just whatever sport they were playing and so is it true in data so if you look at the
00:53:51
studies that have looked at people performing athletic Feats whether it's like cycling or running or whatever ever
00:53:57
um they have not found that abstaining from ejaculation actually changes their ability to perform and so in those cases I say well there's no true scientific
00:54:08
evidence that we have that it's going to improve and in fact if you are someone who for example has sex every morning or
00:54:14
masturbates every morning for whatever reason that's a part of your routine disrupting the routine can actually be
00:54:20
harmful to Performance and sometimes the the one thing you can say is in terms of
00:54:25
disrupting performance is that after you masturbate you do see an increase in heart rate a little bit um you have a rebound so it decreases and then you
00:54:32
have a rebound increase in heart rate that can slightly affect your ability to recover from performance But ultimately
00:54:38
I think if you find benefit from it because people report feeling more aggressive with abstaining then by all
00:54:44
means if you find it helpful I think it's fine but is it mandatory I don't think so based on the evidence we have right now cuz I I heard that rumor many
00:54:52
years ago and I think I assumed it was correct I heard the rumor and this was of evolutionary story that was attached
00:54:57
to the rumor was that once upon a time when we were out I don't know looking for um a sexual partner we would need to
00:55:05
be more articulate and more persuasive and more I don't know attractive basically so we were optimal
00:55:12
attractiveness before we ejaculated then after we've ejaculated that kind of energy goes out of us and recharges and
00:55:18
rebuilds again so I was when I heard that I thought okay so if I'm speaking on stage or I'm doing a podcast I want
00:55:24
to make sure that I'm you know my mouth and my brain are attached I'm articulate I'm persuasive whatever I need to be so
00:55:30
don't ejaculate or masturbate anytime before doing anything where I need to use my brain in my mouth well you know
00:55:37
some people describe post not Clarity right so they actually on the alternative feel like and there's no
00:55:43
good data on this the data we have is on people the very small subset of people who have post nut postcoidal not post
00:55:49
nut postcoidal dysphoria so they actually feel bad but in terms of clarity um you know some people do like
00:55:56
when you're trying to You're motivated to get a partner right you're sort of um trying to uh woo them you're really focused on that one singular effort that
00:56:07
once you've obtained that that the like very singular focus goes away and now other parts of your brain can be
00:56:13
activated to then be used for some people will describe being more productive more able to get work done
00:56:18
after um masturbation it's very individualized or ejaculation whatever it is post that Clarity I've never heard
00:56:25
anybody talk about this before and I've also been told over the years that it's something that just men experience
00:56:31
predominantly and for anyone that doesn't not post nut Clarity is the definition that I understand is and that
00:56:36
I have experienced I'm going to be honest is that after ejaculation your desire for the other person reduces
00:56:43
quite significantly and there's a stereotype here that women don't experience this post-nut Clarity in the
00:56:48
same way now if I ask all of my male friends if I said to them has there ever been a time in your life where you were
00:56:54
maybe texting someone you were attracted to or you know had some sort of sexual attraction to and then you
00:57:00
masturbated did your desire um diminish after you masturbated for that person that you were just texting I think about
00:57:07
90% of my male friends would say yes yes and they describe it as if someone like
00:57:13
took some like sunglasses off them like a pretty extreme Sudden Change and I've always wondered about this whether this is just men if it's just women why it happens so when you look at brain
00:57:24
studies right of people having orgasm and what happens is when you have an orgasm like your whole brain lights up
00:57:30
right because your heart rate goes up your blood pressure goes up like your pupils down so all these different parts of your body are working so your whole
00:57:35
brain lights up and then after orgasm it it it gets very like quiet and so we see
00:57:42
that in women it may take a little longer to get really quiet in men it happens very quickly and this may be associated with sort of the hormonal
00:57:49
changes that occur after orgasm so we know that prolactin increases after orgasm dopamine decreases is and there's sort of some evolutionary theories about why this happens so one is after you
00:58:01
ejaculate if you are having uh ejaculation with a woman then you don't want to have sex again to then same
00:58:06
thing with the refractory period right that there's some period of time where you're not going to want to have sex again or you can't have sex even if you
00:58:12
want to and this is because evolutionarily if you deposited your ejaculate into a woman if you then had
00:58:18
sex again you could actually dislodge the semen and then you would have less ability to uh to have fertilizing egg
00:58:27
right and then the other thought is that you don't want to become overly exhausted right so that if you if you
00:58:33
had the unlimited capability to have sex over and over again that exhaustion could be a real thing like and so you're
00:58:40
sort of a protective mechanism um and so those are sort of the theories as to why
00:58:45
this is and there is like an absolute refractory time where like you don't want sex at all and then there's a
00:58:51
relative refractory time where if you had a really novel or strong stimulus for sexual activity that you would be able to um in terms of clarity in ter
00:59:02
because we know there's a little bit of differences in brain um it may not be as obvious in women in terms of it takes
00:59:08
them a little longer to have that coming down after the orgasm from the brain activity um but probably there is some
00:59:14
we just haven't studied enough and I I always say this that when we look at studies for women's sexual health and
00:59:20
men's Sexual Health they're so lopsided so if you type in penis in like a in like a search engine for Google or for
00:59:28
the PubMed which is where you look up research articles you're going to find 50,000 articles if you look up clitoris
00:59:34
you're going to get 2,000 articles so it's very lopsided in terms of what we study um for sexual function and in in
00:59:40
of itself sexual function by many people is not seen as mandatory or important for health and so the funding is less often available for sexual health that's why we have such little data in some
00:59:51
areas going back to just closing off on the point about masturbation is there a link between m masturbation and prostate
00:59:57
cancer because I've I've heard a lot of different things about it um some people think that over masturbation is causing
01:00:02
prostate cancer and some people say the opposite yeah so there's actually a really good study um that was done
01:00:09
looking at ejaculation frequency and prostate cancer and it was a very well done they tried to control for a lot of other factors and so what they found was that men who ejaculated 21 times or more
01:00:21
a month were less likely to develop prostate cancer this is just a statistical number it is not a number
01:00:28
that sort of um means anything in terms of but we're seeing that like okay so more masturbation may help why is that
01:00:34
right so there may there's a prostate stagnation hypothesis that the fluids that you know some of your ejaculate
01:00:40
fluids come from the prostate and so when you're e jackling frequently you're more often getting rid of that fluid and
01:00:47
sort of re replenishing it or cleaning the pipes so to say so that may be beneficial in terms of preventing prostate cancer now do you have to masturbate or ejaculate or have sex 21
01:01:00
times a month um no but you know there could be a benefit yes and so uh having a healthy and it may be that those people who had sex more often or jacine more often were just healthier in other
01:01:12
ways right they were able to have sex more often or masturbate more often because they were uh s you know
01:01:18
sufficiently healthy to do so and so I while they tried to control for those things there's always sort of uncontrollable variables that come into
01:01:24
those sort of studies yeah that's what I was wondering is is there another like glaringly obvious factor that those people had more relationships therefore
01:01:31
their mental health was better therefore X Y and Z they tried to control for comorbidities but again they're they're
01:01:37
I don't think they controlled for I mean they control for marriage I believe um but I'm not sure that they controlled
01:01:42
for like in a relationship versus not and how healthy that relationship is that certainly wasn't assessed I'll link
01:01:48
to the study below so everyone can read for themselves about the um the controls in that study and how that was conducted
01:01:54
link to this is is the subject of um it was interesting cuz I was doing a lot of research on the subject of that
01:01:59
sounds a bit strange I was doing a lot of research on the subject of porn and where conversations at with the subject
01:02:05
and one of the quite startling things is a lot of people are trying to figure out how to stop watching porn um a lot of
01:02:13
people are asking themselves for mechanisms to um install things on their computer that prevent porn time and um searching for Solutions
01:02:24
around porn addiction and a lot of people were searching um about whether porn is a sin and I think there's
01:02:30
something broader here about the idea of Shame which is linked to porn what is your take on on this is porn a bad thing yeah so I don't think porn is a bad thing I will start with that um is it a
01:02:42
sin is more of a moral question right and I think that that is uh something that you individually have to decide for
01:02:49
yourself if you feel like morally it's inappropriate but it's It's Entertainment right it's just a different form of entertainment and I
01:02:55
think the issues with porn um because I would not say that it's 100% great I think there are definitely issues with it one the big one that I've been very vocal about is children seeing pornography so um we know now that the
01:03:08
average age of a boy seeing pornography is 13 and that's the average meaning that as young as 8 to 10 boys are being
01:03:15
exposed to pornography um which was not the case when for example we were growing up right you had to I I always
01:03:22
say this you had to find a a tape maybe find a VC are in a room that nobody was going to walk in or you had to find a
01:03:28
magazine and hide it somewhere and go find it and so it was not readily available you had to work to be able to
01:03:33
see that and now seeing pornography is very readily available and so uh very often kids are seeing it whether you as a parent don't want them to whether you've put blocks on their phones and
01:03:45
devices um they may have access to it from a friend or they may see it somewhere else and um and your brain is
01:03:52
not fully developed to understand one what you're seeing and two to understand that this is not real unless your parent
01:03:57
has talked to you about you know this is sort of a a movie that's not real life and this is not what sex is really like and so I think that has um implications for um for how they view sex and how
01:04:11
they then try to have sex with partners and also you know because your brain's not fully developed you're getting this
01:04:17
big rush of dopamine from viewing something like that and that's not something that we traditionally got at
01:04:24
that age right and so it can become become very addictive now as an adult I think it's different because you have a
01:04:30
fully formed brain you understand the concept of this is not real most people um and so it can be just a way to have
01:04:37
pleasure and even watch it with your partner and have pleasure um but yes we are seeing some people who have
01:04:43
problematic pornography use in the literature they say it's 4% I suspect maybe it's a little higher now or people
01:04:50
are finding that watching pornography is is one easier than going out trying to find a partner you don't have to face rejection you don't have to face the difficulties and awkwardness of having a
01:05:01
first a sexual encounter with someone that often happen and so it can become a way because it does relieve dopamine just like anything else release dopamine it can then become sort of a way to feel
01:05:14
better about anything right like you can just be feeling down like I want to watch pornography because it makes me feel better it may not be just that
01:05:20
you're really into sex it's just that you're really like wanting that Rush hit of dopamine um and then there's
01:05:26
obviously this shame that comes with oh my God why am I using pornography just because I feel bad and then you're like
01:05:32
oh but I feel bad and so I'm going to use porn again and it becomes this sort of like negative vicious cycle that can
01:05:37
occur but I think when used for entertainment and pleasure I think it's fine and many many people use it for
01:05:44
entertainment and pleasure without a problem I the other day bought the Apple Vision Pro that new headset and I tell
01:05:50
you what Jesus Christ that's unbelievable piece of technology this one feature they have on their is called
01:05:56
spatial video and I don't know if you've tried it yet but you put it on and if you've taken a spatial video which you
01:06:01
can now take on the new iPhone and also on the Vision Pro it basically feels like a 3D video and it's like nothing
01:06:08
I've ever experienced before one of our team members commented that you know they they lost a family member and they
01:06:13
wish they had this because it it's like the person is back in front of you it's not like a photo or a video anymore but
01:06:19
then little monster in my mind goes hm there's going to be other applications of this technology as it relates to put
01:06:25
graphy and we're getting you know if we just assume any rate of improvement with this technology just I know 5% a year we
01:06:32
eventually get so close to being indistinguishable from a human being that the incentive structure of going out and getting a day and you know for the for the objective of having sex or
01:06:43
whatever versus just popping your headset on which is going to get cheaper and cheaper and cheaper and better and better and better um becomes really
01:06:52
lopsided I it's so clear to me that if we just go forward 10 years and we're on the Apple Vision Pro 17 air there's going to be so many people that
01:07:04
are using that as a way to uh masturbate and to watch pornography and there and it's going to
01:07:10
reduce the amount of people that are seeking real Intimate Relationships IRL in the real world yeah it is a real
01:07:17
concern I would say but you know we know from some data that people will find physical touch particular particularly in like hair bearing areas um very important in terms of intimacy with a
01:07:30
partner so um Intimacy in general and so I I can only hope that that will continue that you will want physical touch because no matter what you can see with your eyes um it's not touching you
01:07:43
it's not like it's still you doing the touching there's no element of surprise or excitement or buildup in terms of like there's someone else in the room
01:07:53
with you right so I can only hope that that that will that will be the case but it still remained to be seen however I
01:07:59
will show that there's some interesting um applications of this in terms of fear
01:08:04
so if you are really scared of something you can actually desensitize yourself using these VR headsets and it can actually be very powerful so I was just speaking to a researcher Lori BR about
01:08:17
how they're using it in their lab for women who have fear of penetration because they've had either trauma or they have other conditions that are causing it to be painful and so they can
01:08:28
work with them to be using these headsets to simulate a sexual experience and then they can sort of use a DI like use a tool or a dilator or something to then penetrate in a safe space right not
01:08:41
like you're with a partner and you're like trying to have sex and you're you know you don't feel very safe sort of
01:08:46
allowing that it's very preliminary research but I think ultimately there are some positive things that maybe will
01:08:53
come out of the use of these sort of VR our headsets and I can only hope that that will predominate and we can
01:08:59
continue and people will inherently want other people right that we're we're hardwired to be around people and to be
01:09:06
intimate with people like that's how our brains work so I'm hopeful that that will that will still remain to be the
01:09:12
case but I can't I can't predict it you don't look convinced well you know I mean I think
01:09:19
it's I I am worried you know I think that phones have changed lives too right like now our kids our younger generation
01:09:25
doesn't communicate as well because when they hang out together they're sitting all together looking at their phones right and so we have to actively work to
01:09:32
prevent like I make my kids have full-on conversations with people I say you got to come and hang out with the adults and have conversations and and talk to
01:09:40
people and we have to coach them on how to talk to people um because I worry that people are too into even when they
01:09:45
hang out with their friends they're playing on devices right so um I think there's like work that has to be done to
01:09:52
prevent the the the easy dopamine rushes that these devices are giving us right so we actually have to actively work at it and people are inherently going to take the route of of the easiest thing
01:10:06
and so as a society we have to sort of work together to sort of prevent these easy wins easy things easy dopamines
01:10:13
from taking over something you mentioned within there though was the idea of trauma and I've I'm quite interested in
01:10:19
the role that our trauma plays in our sexual health and sexual dysfunction what's important to know
01:10:25
there and does trauma play a role at all in the patients you see absolutely 100% so your body when it goes through a
01:10:33
trauma it will then sort of your body remembers even if you don't right so these people very many people who have pelvic floor dysfunction meaning their pelvic floors are too tight or too tense
01:10:45
they've had some sort of trauma not all of them some of it's just Stress and Anxiety but sometimes they've had some sort of trauma years ago and it's been
01:10:54
with I I remember having like a 70-year-old woman and she had such terrible pelvic Flor dysfunction for God knows how many years that ultimately it caused really negative consequences for
01:11:05
her bladder function and um and so absolutely when you have a trauma that's unresolved in some shape or form it will affect you whether it's your mental health your physiologic health I mean
01:11:18
our brains are so powerful that you know when it's in a bad place it can affect you negatively when it's in a positive place it can affect you more positively the one thing I will say is if you have
01:11:28
trauma getting therapy getting help to resolve that trauma is so so important I talk to all my patients and I say yes you may have an organic problem meaning a physiologic bodily problem that's
01:11:39
causing your sexual dysfunction but everyone who has sexual dysfunction has a psychologic component because it is devastating it is stressful it is horrifying to feel like you're not
01:11:51
normal your body doesn't function normally especially in an intimate space like sex so I'm like everybody should
01:11:56
ideally see a sex therapist if it was available to everybody but it's not right how can we allow people to have
01:12:02
access to things they need because we don't teach these things in school right school I mean this is my big gripe is
01:12:07
like how can we make education better for children like we need better sexual education we need better education on
01:12:13
how to resolve traumas or how to deal with them or how to get help how to do digital Health like how do you navigate
01:12:19
the world with all this misinformation how do you find good quality information how do you assess it like there's so so
01:12:25
many things even how to balance your books right they don't learn that in school so ultimately there's so many things that I think if we were really
01:12:32
putting a critical eye on how we teach our young people that we could improve and part of that would be including
01:12:38
people to know and realize when they need help through whatever trauma they've suffered or stress or anxiety
01:12:45
that they're suffering and how that can propagate itself over a lifetime and create real problems I have to ask this
01:12:52
question cuz people mention this quite often often can you have sex while you're pregnant absolutely why not I ask it because it was one of the most Googled questions um online really yeah
01:13:06
one of the highest search volumes I've ever seen for a search term was can you have sex while pregnant wow I actually
01:13:12
didn't I mean I I I've heard a lot of things and I think that people feel like I've heard that men think they're going to hurt the baby they're going to um they're going to cause a problem but no
01:13:24
absolutely you can have sex you're not going to create like a pre-term labor you're not going to harm the fetus like nothing bad is going to happen from
01:13:31
having sex while pregnant okay so let's talk about orgasms and the clitoris then you mentioned earlier that um there's
01:13:38
disproportionately a lot less research done on the clitorus as a man what do I need to know about the clitoris CU I
01:13:44
I'll be honest I know very little I know where it is that's that's a plus well not everyone knows that either
01:13:52
yeah I didn't always know where it was I a couple of misunderstandings but um I found I found it eventually and I I
01:13:58
think I know how to stimulate it but I don't really know what's going on there or how it works okay so what I tell
01:14:03
everybody and what men can think of is the clitoris is like the penis so when you are a fetus there's a thing called
01:14:10
the genital tubric before you're assigned sex that genital tubric when you're when you become a man that
01:14:16
genital tubric becomes the penis and the shaft and the glands and in a woman it becomes the clitoris and the clitoris
01:14:23
actually then goes deep into the pelvis um just like the penis it has a shaft in the pelvis and then it goes around the
01:14:29
vaginal canal and so you can the clitus is just as sensitive as a man's penis right so if you stimulate the clitoris like your penis gets stimulated then it will lead to orgasm and it's probably
01:14:42
the most reliable route for orgasm for women so 85% of women need some form of cliteral stimulation to Climax and so many women have difficulty climaxing through vaginal penetration alone that's
01:14:55
not that they're broken or something's wrong with them it's just that they don't and because the stimulus from the clitoris is so strong it leads to a very
01:15:02
reliable route for orgasm now how you stimulate it is sort of very individually specific but typically oral stimulation vibratory stimulation uh uh
01:15:14
manual stimulation all those things can work but that's where the communication comes in where like the partner ideally
01:15:21
would know what they like and could tell you um or they you could check like does this feel good does this feel good do
01:15:27
you like this is this you know or and you know and so that's sort of again a challenge because the communication issue we've talked about this this whole
01:15:34
talk but um that is really what's important now the clitoris like I said it it goes um deep above the vagina and
01:15:42
around it so people can still get clitoral stimulation through penetration um depending on how you stimulate now
01:15:48
the other areas that are important for orgasm are the G erogenous Zone it's actually not a spot it's a Zone and that's where essentially if you go look at the vagina on the anterior wall which
01:16:01
is the top of the vagina underneath the urethra where the PE comes out about 2 to 3 centimeters in is called The gynus
01:16:07
Zone it's named after the person who um identified it I think it's graen house or something like that but um essentially that area is full of certain nerve endings as well as the female
01:16:19
prostate or the skin glands and so those are areas that are quite ayous and that uses a different so the clitoris is
01:16:26
inated by the pudendal nerve the G erogenous zone is inovated by the hypogastric nerve so a different nerve and then the cervix is the last area where Sometimes women feel a lot of
01:16:38
stimulation and that's a stimulated by the vagus nerve so all these different areas can lead to orgasm for women and
01:16:46
they can be additive so if you're stimulating all three you might have a more strong orgasm and the orgasm may feel a little different now people like
01:16:53
to call it like oh you're getting clitoral orgasm or a vaginal orgasm it's all an orgasm it's just a matter of what
01:17:00
stimulation is causing the orgasm and so I think ultimately it's really important
01:17:06
for the the most easy reliable route to orgasm is cital stimulation which is not traditionally stimulated through penis
01:17:12
and vagina sex right and so it does require some additional um thought on how you're going to stimulate it and and how you're going to please the partner and to get them to orgasm and often
01:17:23
times if you think about the time it takes to orgasm so in a man the average length if you look at studies that have
01:17:30
looked at stopwatches like they've had the female partner actually start a stopwatch at the beginning of sex and stop it at the end when the man climaxes
01:17:37
it's about 5.1 to 5.7 minutes um which in fact UK men tend to last a little bit longer which is sort of an interesting concept but so which sex is that men men men so from penetration to climax of men
01:17:52
so when you so when they so they've measured basically not including foreplay but if they've measured they've
01:17:57
measured like 15,000 people through many many different countries and they've had the woman take a stopwatch and actually
01:18:03
start click on it when they penetrate and click it off when they Climax and they've measured the length of time and
01:18:10
it's been about 5.1 to 5.7 minutes is the time now a woman when you look at the average time to orgasm for woman it's about 14 minutes and so you can
01:18:22
imagine that if the entire sexual encounter is around the male climax right and the male has this as we've already talked about sort of this post nut Clarity like I don't want refractory
01:18:34
time they're not going to want to be more intimate if you don't prioritize the female's climax or stimulate her
01:18:41
before you begin to penetrate then she's probably not going to orgasm um and so and the interesting thing is when you look at sexual encounters and you look at men and women having sex for the
01:18:53
first time uh the woman will orgasm 45% of the time the man will orgasm 95% of the time when you look at women having sex with women on a first time encounter they both have orgasms 95% of the time
01:19:07
so clearly there's an educational Mis disconnect right women know what they like and what stimulates them and men
01:19:13
aren't getting the memo I feel attacked totally not attacked letting you know the facts I know it makes sense though cuz yeah I think men are still struggling to
01:19:24
understand again because of what you said we don't really get a sexual education so we learn these things from porn and obviously in porn they're not
01:19:29
showing it yeah I mean you don't typically have many um women orgasming in porn as you do men orgasming in porn
01:19:37
what is an orgasm and what kind of what role does it serve like why do we orgasm
01:19:42
and also when I say what is an orgasm is an orgasm like a switch or is is it like
01:19:48
a spectrum so it's it's sort of like a spectrum I guess I mean so let's talk about what it is exactly so an orgasm is
01:19:54
a moment in time that is combined with a like a a maximal tension and then a release and during that time it is completely you're completely unable to
01:20:07
think about anything else it is a very powerful pleasurable sensation and it occurs usually like I said 5 to 60 seconds it can last and is it in terms
01:20:17
of how you get it it's usually a culmination of stimulation over a period of time even with a certain sort of like
01:20:25
Rhythm that's required to achieve climax that's different from person to person so I can't give you the script on this
01:20:31
is how fast you need to penetrate or this is how what stimulation you need to use okay that's the end of the
01:20:36
conversation okay we're done here so um so yeah cuz nobody wants to talk about they literally want me to tell them like this is what you do a b c d instru man so um but yeah ultimately um all of
01:20:50
those things they build this tension right so over the course of sexual stimulation arousal you are getting to
01:20:58
an ex excitement phase where your your body is changing so in women for example you will see that the labia become a little bit redder um they expand in size
01:21:09
as I said the vagina lengthens and elongates um the so the from 3 to six inches I've heard you say yeah about
01:21:15
about double yeah and it's different from person that's the average right so there is sort of like this thought that
01:21:20
like okay if it's really really large it's always going to be better and that's not actually all always the case because not every vagina can accommodate
01:21:27
a very large phus um but so when you're having orgasm essentially your pelvic floor muscles are tensing up they're
01:21:33
they're getting really tense and you're reaching this for like basically you're getting to the top of the hill you're getting this really large amount of
01:21:40
climax and so your body is sort of clim going up and up and up you're reaching like increasing dopamine and you're
01:21:46
increasing so when you think about what happens in the brain is your hormones are Are CL going higher and higher and
01:21:53
there's also an inhibitory there's a there's a there's a stimulatory and an inhibitory pathway and so the
01:21:58
stimulatory pathway is going up inhibitory stimulatory you're basically trying to race up to the top of this mountain and once the stimulatory gets
01:22:05
to the very very top then you have the orgasm and so you release all this tension and during this time your heart
01:22:11
rate's racing your pupils are dilating right there's all these physiologic changes um and then when you orgasm your
01:22:17
muscles contract as I mentioned before and this every 8 seconds they're having a contraction sometimes you'll have an
01:22:23
involuntary phonation so people will you know moan or scream and sometimes it's not in their control like there's
01:22:29
actually an involuntary component of it and then um sort of it comes down and so
01:22:35
it's it's not necessarily a switch it's sort of a a a climb up a mountain is the way I would describe it sometimes feels
01:22:41
like blowing up a balloon with a little hole in it and what I say with a little hole in it I mean because if you stop it
01:22:47
feels like some air comes out of the balloon mhmh that's why I said the the sort of there needs to be a rhythm it
01:22:52
should keep going at a certain Pace in order to achieve that climax cuz if it doesn't then you can again just like
01:22:58
that's a very good description you'll lose that little air in the balloon okay so in order to increase
01:23:04
female pleasure okay we need to understand the person we're dealing with of course but um the clitorus is a great
01:23:10
way to get to orgasm you've you're PR lubricants MH a lot of people feel like that's not
01:23:17
natural so they kind of avoid it but you're Pro lubricants and are you Pro then scheduling sex or you Pro SCH in
01:23:24
time for intimacy scheduling time for intimacy so because sex ads as we talked about add sort of like a level of stress
01:23:32
in terms of like am I going to want to have sex am I going to be able to get an erection am I going to enjoy sex
01:23:38
whatever it is and am I going to get rejected like all those things because you're still a human being and you may
01:23:44
just like be really stressed that day that you put on the calendar and you were like a I just can't can't get in the right mind space to have sex so if
01:23:52
you're constantly ruminating or stressing about other things you can't have a good sexual encounter in fact
01:23:58
they've looked at mindfulness in terms of how it improves sexual function particularly in women but we've seen
01:24:05
very clear data that be having a mindfulness practice leads to improved sexual function in terms of desire and other factors like arousal and
01:24:16
lubrication and orgasm but the biggest is desire and so it's because if you can focus on what's Happening during the sexual encounter so you can focus on what it feels like how you're enjoying
01:24:29
that sensation rather than thinking about am I going to come am I going to Climax and is it going to happen or whatever it is that you're thinking
01:24:35
about during sex because you're worried about how the other partner might react then you're more likely to enjoy the
01:24:41
experience feel and then have a good experience and subsequently have more desire for additional experiences we
01:24:47
talked earlier on the very start of the conversation about comparisons and how that can really destroy sex is there a
01:24:53
disparity between how long we think sex should take and how long it actually takes yeah we all think it lasts longer
01:24:59
and when you ask people what the average time and this is a hard question because people think of sex as a whole encounter
01:25:05
and when we do it scientifically we look at sex from penetration to the end of penetration and sex is more diverse
01:25:11
right sex can include oral sex anal sex um manual sex any type of sexual stimulation right and so when you're thinking about the entire encounter it can be very variable some people want to
01:25:22
quickie some people want to have this long luxurious love making scenario and it really depends also like on what's
01:25:27
going on in your life like you may not have that luxury and so I don't I think again it's not about reaching a certain
01:25:34
Benchmark or a certain number it's really about the quality of the sex so if you have great sex and it takes 3
01:25:40
minutes that's great that's fine but as long as it's great to both of you right if you're both like this is awesome I'm
01:25:45
having great sex and it takes three minutes that's fine but how long do people think sex lasts on average versus is how long it actually lasts on average
01:25:56
yeah so I think that most people definitely think it lasts longer so women tend we don't know what they think
01:26:01
it lasts but what they want it to be is about 18 to 25 minutes men are a little on the shorter side like maybe 12
01:26:08
minutes but generally we all want it to be around that length but you sort of lose sense of time right so you don't
01:26:14
really no one's really there with the stopwatch knowing exactly how long it takes in fact I've had friends tell me
01:26:19
like oh I watched your video and now like when my partner wants sex I'm like oh it's only going to take five minutes
01:26:25
like I can I can have sex with them like I used to in my head used to think it would take a lot longer and I realized
01:26:30
it takes less time and like I don't that that stress of like oh my God I'm going to have to like waste like half an hour and I'm so tired like has gone out the
01:26:37
window because I know it's really not going to take that long is that have they ever put people in like a laboratory or whatever and and I guess
01:26:44
this goes back to what you said earlier um is there like an average time people spend having sex was that the 5 minutes you talked about 5.7 minutes 5.1 to 5.7 minutes minutes depending on the study
01:26:55
you look at and they they looked at all Commerce so it's actually different in different um countries so when you look
01:27:01
at like turkey it was like four minutes and if you look at UK it was like 10 minutes so it's
01:27:08
actually thank you so it's actually variable and that may be a cultural thing um but ultimately the average is
01:27:14
about five something interesting so we want sex women want sex to last between 18 and 25 minutes ideally men want it to last ideally about 16 minutes including
01:27:26
forl but in reality it's lasting five five minutes yeah that's good to know let's talk about Zoe who you may know because they're a sponsor of this podcast and I'm an investor in the
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01:28:22
about that okay just for you guys we talked about sizes of stuff a second ago and we said we would come back to
01:28:28
this so there's two sort of sizes that people often think about the size of the vagina and the size of the penis there
01:28:34
is a myth in society that the more sex a woman has the bigger her vagina gets is that myth true or false false so the way
01:28:43
that women's vaginas get if you want to say loose right which is the term that people use or they get a weak pelvic
01:28:49
floor and that's from having babies having Maybe neurologic conditions that affect the pelvic floor strength having collagen disorders having um just from
01:29:00
like having a job where you stand all day and you're like all the weight of your body is sitting on your pelvic floor those muscles can get weaker over
01:29:06
the course of a lifetime and then it can feel a bit looser because those muscles
01:29:11
are maybe not squeezing as harder but it is not related to how much sex she's having because as we mentioned earlier
01:29:17
when you have an orgasm you're actually like strengthening your pelvic floor a little bit like you're you're Contracting those muscles so actually
01:29:25
probably the more sex a woman has likely her pelvic floor is probably stronger unless she's not you know um but you
01:29:31
know you add in the having babies and other things it's variable but probably the more orgasms a woman has the
01:29:38
stronger her pelvic floor is but things like child birth can mhm make the pelvic
01:29:44
floor looser weaker weaker yeah yeah so then when it becomes weak that is the cause of things like stress incontinence
01:29:51
so when a woman um lifts something heavy or she exercises or she jumps or she coughs or sneezes she might have a couple drops of urine or a lot of urine leak out because of a weak pelvic floor
01:30:03
it can also be lead to something like prolapse where the it's like a hernia in the vagina where the pelvic floor sort of is so weak that now the vaginal skin and the organ behind it is sort of
01:30:14
bulging out and can cause discomfort and and sort of uh feeling maybe some dysfunction in the organ but really mostly discomfort and so those are sign of weak pelvic floors not you know not
01:30:27
having a loose vagina during sex and we can do something to strengthen our pelvic floor which is the is that what
01:30:33
the keegle exercises are yeah it's more than Keel I mean Keel is the most has the best PR of any sort of thing I've
01:30:38
ever seen in medicine but yeah it's pelvic floor exercise the Keel is one pelvic floor exercise which is to
01:30:44
strengthen the pelvic floor and there are others what is it so it's essentially men never know like it's
01:30:51
it's not your fault women sort of kind of know but even don't really know so what it is is there's those same muscles
01:30:56
we talked about earlier is that you're basically doing a rep you're squeezing Contracting and relaxing just go to the
01:31:02
gym right you squeeze and relax very similarly you are squeezing those muscles and relaxing those muscles I can do this sat down now yeah so basically
01:31:08
for men what I tell people is it's like the feeling of when you're urinating and you stop your urine stream that that's
01:31:16
you're using those same muscles so that's one way another way to think about it is if you were trying to lift
01:31:22
your penis off the ground without without touching it ah okay go yeah okay and the third one is you're trying to
01:31:27
hold in a fart so all those different ways you're sort of getting those muscles so the one thing I tell people
01:31:32
is they get the way they get it wrong is they don't relax enough so just like when you go to the gym you're not doing
01:31:38
rep after rep after rep you're actually taking a break and you're letting your muscles relax before you do another rep
01:31:44
same thing you have to squeeze for 5 seconds relax for 5 seconds right you actually have to um relax and just like
01:31:51
any exercise you don't want to overdo it so I tell people start lying down so that the only thing you have to focus on
01:31:58
from a muscular standpoint is that those muscles as you get good at them lying down you then do them sitting up and
01:32:04
then as you get good at doing them sitting up you can do them standing or do them anywhere but like you're not going to be like there you know I
01:32:10
remember the scene from Sex in the City where like the character Samantha was like I'm doing my Keel right now like
01:32:15
yeah she's probably been doing Keel for a long time and now she's so good at them that she can do them while she's brushing her teeth but it's not like
01:32:21
you're going to wake up one day and be perfect at them just like any other exercise so that's one exercise there
01:32:27
are certainly other things you can do to strengthen your pelvic floor traditionally things like yoga and pilates have some core work that does
01:32:34
also help with the pelvic floor but really I recommend if you're having issues is to see a pelvic floor physical
01:32:40
therapist CU they're just like a when you go to the gym alone you can do it or you can go with the personal trainer they're like the personal trainers for
01:32:46
your pelvic floor how do I know if I'm having pelvic floor issues what are the symptoms so for like I said the obvious
01:32:51
ones for women are leakage are um having prolapse for weakness in men we don't often see as much but like I said you might notice that your semmen is not as forceful when it comes out um that's
01:33:04
usually the most common side sign of a weak pelvic floor there's not as many for men but in terms of a overly um High
01:33:11
tone pelvic floor what we worry about then is then there's a whole host of symptoms it could be as simple as just
01:33:18
having lower back pain um it can be that you're having hip pain it could be that you're having um pain with sex you're
01:33:24
having pain with erections pain with ejaculation you're going to the bathroom often got to go got to go you are
01:33:30
feeling like you're having difficulty emptying your bladder or you are um going very very often all of a sudden so
01:33:37
it can be a vague variety of these symptoms and um so generally it's important to get evaluated to see like
01:33:43
examine to get your pelvic floor examined by a professional whether it's a urologist a gynecologist a a pelvic
01:33:50
floor physical therapist someone who can assess your pelvic floor if you're having these issues because it might be pelvic floor it might not right
01:33:58
how do they assess it if I go to a urologist and say listen check my pelvic floor M so in a man it would be a rectal
01:34:04
exam and so essentially that's how you sort of feel the pelvic floor muscles so what I tell young guys who come I said
01:34:09
look I can examine you um but I bet based on your story like you're a young guy you've sort of had these new
01:34:16
stressors in your life um and it's un and you're otherwise healthy it's unlikely that you have a vascular
01:34:21
condition brewing and other things that like it's probably likely so if you want to uh avoid the exam because it can be
01:34:28
uncomfortable or and I will tell you if you have pelvic floor dysfunction and someone does an exam it will be uncomfortable it will be painful
01:34:35
potentially because they're pushing on those already tense muscles and it can be painful so I tell people like you
01:34:41
might hate me tomorrow because you'll be sore and you'll say what did she do during that exam and I I kind of
01:34:46
preemptively tell them because I just gently push right like I'm pushing the pad on my finger but that's enough to
01:34:53
sort of C a tension of the pelvic floor muscle and cause pain where where you like on the muscles on the pelvic floor
01:34:58
muscles so you can actually so if you if you put your finger in the rectum if you push right straight down in a man you're
01:35:05
feeling the prostate and if you push on the sides at a variety of different angles you're going to feel different
01:35:10
pelvic floor muscles like the levator Ani and the trans operator muscles those muscles are the ones that are part of
01:35:16
the pelvic floor we can't feel all of them but we can feel some of them and so um so that is sort of where we're
01:35:23
feeling in terms of for the pelvic flooor muscles okay so because I was thinking
01:35:28
if we go in the the rectum you've got the glutes there as well which are like either side I guess so your pelvic Flor
01:35:35
is actually a part of your core right but your glutes are further back they're not going to be felt from there but anyways if you think about your pelvic
01:35:41
florids actually you know people think about their core as they abdominals but we know that it sort of encompasses your
01:35:46
back your front and even your pelvic floor is sort of part of your core muscles got you okay interesting very
01:35:53
interesting in um on the topic of sizes then one of the big things in men is penis size M and one of the big questions men often ask is is there ways to increase my penis size there's in
01:36:04
fact a whole industry around penis size increasing pumps and all kinds of different things is it possible to
01:36:10
increase one's penis size yeah so it is um in terms of looking at the evidence uh the safest and most reliable way is using a traction device and these are devices that are made for um essentially
01:36:24
for penile lengthening but they're also made for men who have something called paronis disease where they may develop a
01:36:30
plaque on their penis and a curvature and so there's one device that's actually made that bends away from the plaque to help sort of break down that
01:36:37
plaque um so there are two uses for it but essentially these devices are just like stretching the tissue over time and so the original traction devices that were studied you would have to use them
01:36:48
for 6 to 8 hours a day for several months to see a 2cm in inrease in length now um that may be enough for some people they were like yes I definitely want that and some people like you know
01:36:59
what it may or may I mean 2 cm is the average some are going to be less right so um it's sort of do you have the time
01:37:05
to do that do you want to do that but now there are sort of newer devices where they've study them and use them
01:37:10
like twice a day for 30 minutes and they've seen some increase in Penal length they're generally pretty safe
01:37:16
it's more about um you might have some bruising from just putting the traction device on and as long as you follow the instructions you're probably not going
01:37:22
to hurt yourself is that penis pump no pumps are different so pumps have not been shown to increase pening what a
01:37:29
pump is it's got a it's got a a a cylinder that you put your penis into and it uses sort of vacuum technology to
01:37:36
sort of suck blood into the tissues and then you put um if you're having issues with erectile function you would then
01:37:42
put a ring uh at the base of the penis to maintain the erection uh these don't help with length they've looked at them in those cases they've also looked at surgeries and different types of things
01:37:52
to increase penal length and ultimately many of them either have you know a very
01:37:58
high complication rate um or risks that I would say are probably not advisable for most people um you know I think that in terms of penal lengthening people are always like why would you want to do
01:38:09
that why a lot of people will sort of poo poo people who want to change the way their penis looks and I've sort of
01:38:15
evolved in my thinking and saying well you know what this is a big part of um you know a man's identity and how he
01:38:21
feels about himself and I wish we had something that was safe and easy for men to do like we have breast implants but
01:38:26
we're not there yet right and so I just want people to be safe in terms of realizing what our limitations are at
01:38:32
this time and things may change over you know as people become more interested in this
01:38:38
area P the role that's played in our perception of what a normalized penis is do you know any of any data on what how big people think a penis should be versus how big the penises actually are
01:38:51
yeah so yeah most people think it should be about 6 in so like we said the average is around 5.1 to 5.3 in and so
01:39:00
when you look at the data in terms of what people think it should be men think it should be about 6 in in terms of
01:39:06
women where we found the data about what they prefer um is sort of interesting so
01:39:12
when now that we're having um more surgeries for transmen one of the surgeries that we do
01:39:19
is a Neo phalus is we create a new phus and one of the the types of surgeries we do is we use a forearm flap and so it
01:39:25
can be very very long and very very girthy and in fact they were doing these surgeries and they realized that some
01:39:31
people were actually unable to have sex with it because it was too girthy so they wanted to then look at like well
01:39:38
how do we determine the right size and length length and girth of this neop fallis so that we you know they can then
01:39:44
have sex with it so what they did was they looked at um the top you know the top five to 10 sex AIDS or or toys that women are purchasing online and they you
01:39:56
know you can imagine that when you think of a dildo they can go from one you know all the way to like the largest thing
01:40:02
you've ever seen and the giri thing you've ever seen to like a normal size and so when you have the option to pick
01:40:07
as many as you want right what do you pick and so what they found was that women tend to pick the length of about 6
01:40:13
in but as you know you're not putting the whole device in there has to be a handle or something so it's probably
01:40:19
around what the normal size is and the girth was also around the average girth of the male penis and so generally speaking women tend to want what is
01:40:30
average or around average right and um interestingly there's a product that is available called onut I'm not I don't
01:40:37
I'm not sponsored by them or anything but essentially you you for women who have pain with penetration with men who
01:40:43
are too well endowed the men actually wears it so that the entire phus doesn't go in during sexual intercourse so that it's more comfortable for the partner so we know that sometimes it can be really
01:40:54
uncomfortable if it's too well- endowed and so I think ultimately um while I understand that pornography has made people really self-conscious about the length of their penis and I I'm really
01:41:05
sad about that because I think you as we've talked about earlier clal stimulation is the easiest way for women
01:41:11
to Climax and you don't need penetration for that so in order to have pleasure and give pleasure you don't need a large
01:41:18
penis and in fact some women may not even care what size your penis is it's more of a a societal thing that we talk
01:41:25
about right women joke about it women talk about it I mean you can't go you know you even I've accidentally made
01:41:31
comments where I've been like oh that's great that like he has a large penis I'm like well I can't believe I just said that like I'll say it and I'll be like
01:41:36
oh my God I can't believe that came out of my mouth of all people and I think it's just so ingrained in our brain to
01:41:42
be like oh like to celebrate really well-endowed organs when in reality it's not necessary and sometimes even painful will my penis get smaller as I age so
01:41:53
not if you are healthy so in terms of how do we maintain our penal Health right your body does a really good job of trying to maintain penal health
01:42:04
because over the course of a nighttime men will get five to six erections three to six erections over the course of the
01:42:11
night and that will happen whether you have a sexual dream or not whether you are sleeping in a certain way or not
01:42:17
it's because your body is sort of giving blood flow to the area periodically through the night whether you're having
01:42:22
sex whe that you're not you're getting good oxygenated blood flow to the penis now if you develop other conditions
01:42:28
where you cannot get blood flow to the penis like you get high blood pressure you get diabetes you get heart disease
01:42:35
and those arteries start getting narrowed and then you stop getting nighttime erections and you start having
01:42:40
difficulty getting erections over time the tissues can change and they can become what we call fibrotic and they
01:42:46
can become a little less spongy and less elastic and so in those cases you can see a little bit of shortening now
01:42:53
people will also see shortening because they gain weight over the course of their lifetime and as you gain weight
01:42:58
the penal the penis is not shrinking but the the fat on the MS or the area right above the penis is sort of getting
01:43:05
larger and obscuring how much penis length there is there's a one of the my around penis size is that you know if I
01:43:11
have big hands because you know these aren't small hands if I have big hands then I have a big penis or if I have big
01:43:16
feet then I have a big penis is there data to support this idea that the length of my any part of my body is
01:43:22
correlated to my penis SI yeah there's one study it's a Japanese study where they looked at only Japanese men uh so
01:43:29
take there are some limitations but essentially they measured all these body parts and penal length uh and uh what
01:43:34
they found was that nose length was correlated with penal length not hand length or foot length so how do I increase the length of my
01:43:46
nose yeah but uh I I thought that was really interesting again nothing you can control these things are PR genetically determined to some degree and in fact you know we talked about some Trends and
01:43:59
while we've seen um semen qual a sperm quality change over the last 50 years we've also seen
01:44:05
penal length change average over many last I don't know the exact number but 50 years and they've actually seen penal
01:44:12
length is increasing and they think that this is because the onset of puberty is
01:44:18
changing and boys are getting exposed to factors that are making them go through puberty earlier and hence they're
01:44:25
getting more exposure to testosterone and they're developing longer penises um so sort of interesting theoretical thing I don't know if that's true or not but sort of what the theory is yeah I
01:44:36
actually read about that study it says that a study shows that men's average ere penis size has increased over the last 29 years from 4.8 in to 6 in mhm
01:44:45
that's pretty pretty dramatic that's huge yeah wait another 29 years you could be a Jesus J Christ but I don't think women's vaginal lengths are changing so I don't know what that
01:44:58
means oh yeah ah yeah it's interesting because you when you we talked about the vaginal length enlarging as someone becomes aroused you mentioned that it goes from about roughly about 3 in on
01:45:09
average to about 6 in that also correlates with the size of the flaccid penis to the size of the erect penis
01:45:16
going from about 3.6 in flaccid to about 5.1 to 5.2 in erect so you kind of see that these two things are actually made made for each other yeah they are I mean I think in general like we're all we're
01:45:29
I mean we're we're designed right the the biggest thing that we need to do as a species is have children right that is
01:45:35
like sort of the the goal of life is to propagate our species and so it would make sense that we would be designed to be able to do that easily a lot of people are having this um new procedure called label of plasy is did I pronounce
01:45:47
that correctly labioplasty labioplasty what is this why so labioplasty is a essentially taking the labia uh manora
01:45:56
and and and making them a little shorter or smaller depending on what your preference is and labas come in all sorts of shapes and sizes it's the inner lips of the vagina so they come in all
01:46:08
sorts of shapes and sizes sometimes they will be um lopsided so one will be longer than the other some will be
01:46:13
longer some will be smaller and oftentimes we're seeing in pornography really small labium manur and so people
01:46:20
will tend to feel like maybe they should look look like that now not everybody some people actually have discomfort
01:46:26
their labia are so long that they cause friction or pain or discomfort in those cases it's it's absolutely uh reasonable
01:46:33
but just like people have insecurities about their genitalia when they're men women also can have insecurities about
01:46:39
their labia as women and so labia plas is essentially making those smaller and more cosmetically appealing when women desire that um but I think the the important thing to take home is they are
01:46:49
so diverse they're as diverse as your fingerprint your labia is unique to you and it is not um there's no script of what it should look like uh and so I
01:47:01
generally tell people if that's something you want that's absolutely fine but again this is not a pathology or a bad thing this is something that
01:47:07
you know is more cosmetic and there's been an 80% increase in the surgery of labioplasty from 2015 to 2019 which is
01:47:15
you know a lot a lot it's a lot last thing about um women in ejaculation in the vagina is about squirting very misunderstood like you know as a as a
01:47:27
man that doesn't have a vagina um I've seen squirting on pornography that I've watched I watch pornography I think that's important to say I think a lot of people do watch pornography um and in the pornography that I've watched the
01:47:38
woman squirts this liquid comes out and like is that Seaman is that ejaculate or
01:47:46
is that something else what is it and also should we be aiming to make our partner squirt yeah let's talk about it
01:47:52
so this is important and it's actually interesting I just I just had a conversation with a researcher about this because it's so misunderstood and
01:47:59
we still don't know like there's only been like three or four studies looking at female ejaculation squirting over the course of our history there's different
01:48:06
types of fluids the vagina makes one is obviously lubrication that's different and that can be very copious for some
01:48:12
very not as copious for others uh that's one type of fluid the other type of fluid is female ejaculate now female
01:48:19
ejaculate is similar to male ejaculate it comes from the skin glands that same female prostate it is a small amount of
01:48:27
like sort of sticky white fluid that women ejaculate um and so they will release that fluid and it's not like this copious amount of fluid that you're seeing on pornography uh the next type of fluid is
01:48:40
squirting and squirting is it's been described as a clear colorless odorless fluid that's emitted from the urethra um when they've looked at analyses of these
01:48:52
they found that there is what we call PSA or prostate specific antigen now that we think of traditionally as males but the women's skin glands make it as well now people are like is it P right
01:49:04
that's the big question and so in the one where they looked at the analysis they found that it was there was like
01:49:10
dilute urine and then another study looked at like okay they scanned people before squirting and after and they
01:49:15
scann their bladders to see like did the amount of urine change and they said it did and now it's urine but what we
01:49:21
really don't know and what we what what the limitation is that you never so women know when they squirt like they they know it's not urine so if you talk
01:49:28
to enough women who are squirting they'll be like you know it's not urine I'm sure it's not urine but where is
01:49:33
that fluid coming from that that's where the question comes right and so like if it's not urine it's coming from the urethro like it doesn't make sense and
01:49:40
so uh this is Dr Barry korak who's done a lot of research on orgasm he said you know it may be water imbibition so when you think of like fluid filling the
01:49:50
walls of the uterus and the vagina during during or during the process of arousal and that may be during climax when you have actually contractions of
01:50:01
that fluid of those of those organs that occurs during climax that it can actually release this fluid I don't know I think the jwelry remains out I don't think we have a conclusive answer
01:50:12
because the studies are not perfectly designed we have a closing tradition on this podcast where the last guest leaves a question for the next guest not knowing who they're going to be leaving it for and the question that's been left for
01:50:27
you if there was one message that you want your life's work to communicate to the world what would it be and
01:50:36
why my message is that sexual health is health and that we need to be prioritizing our sexual health and
01:50:43
educate our young people about sex and why because I think the impacts of having negative sexual health or negative sexual encounters can be so
01:50:56
dramatic in terms of physiologic outcomes interpersonal outcomes work productivity I mean it can be very
01:51:02
far-reaching and if we are able to educate and Empower people we can change the world Dr Reena Malik thank you so much for your time today and thank you so
01:51:13
much for um Illuminating a bunch of issues on Sexual Health that I've never really understood or been able to
01:51:19
discuss before and I think these conversations are so unbelievably important because as you say there sex sort of permeates every facet of our
01:51:25
lives and I think sometimes people wonder why I spend a lot of time on the show talking about sex when this is called The Diary of a CEO but that's
01:51:32
because it's the same reason why I spend a lot of time talking about health and the brain and Neuroscience and relationships and everything because
01:51:37
I've come to learn that although I'm a CEO I'm a business person all of these things as you've said feed into um my
01:51:45
ability to be a CEO and what is a CEO a CEO is a human being a CEO is just someone that is um has a sort of high
01:51:52
inity career we all have high-intensity careers and we're these multifaceted objects but some parts of these
01:51:58
multifaceted objects are still in the shadows because there's stigma and there's shame and there's not a lot lot
01:52:04
of Education around it and if I think about my career as a whole um sex and my relationships have been this huge um huge part of it that once I focus to
01:52:16
more energy on and started investing in in every other part of my career improved every other part of my life
01:52:21
improved my health improved my performance at work improved my anxiety levels um dissipated and that's why I
01:52:26
think these conversations are so unbelievably important and your work that you've done both in your your sort of clinical practice but also what
01:52:32
you're doing on YouTube as well which I'll link below so everyone can go and see is allowing this information to be
01:52:38
accessible for everybody even those that don't have um the money to go and drive as you said to go see a therapist I
01:52:44
think that's an incredibly important work and I'm glad that you're a world champion and and a a force behind that so thank you so much on behalf of me my
01:52:52
team but so everyone that's consumed your work and gain value from it thank you I would just say that I always tell
01:52:57
people cuz I Mentor a lot of young medical students and I I always tell young women that the number one most important decision you're going to make is who you choose as your partner and
01:53:09
that's because that person whether it's obviously emotionally but also sexually right how
01:53:15
they support you in your life is going to determine whether you're able to succeed or not and I I just was talking
01:53:23
to another woman and and you know she was like my husband's wonderful I was like I'm not surprised I was like you don't get to be a successful woman and a
01:53:31
happy well adjusted successful woman unless you either are you know very happy being alone or you have an excellent partner to support you because if you have a toxic partner at home it's
01:53:41
not going to work amen thank [Music] you [Music] oh