Dhru Purohit Show - How to Have Great Sex For Longevity: The Truth About Orgasms, Masturbation, Desire & Stress with Dr. Rena Malik

Episode Date: January 8, 2024

This episode is brought to you by Sweetgreen and AquaTru.  When we think of sex, we may not immediately think of longevity. Yet a healthy sex life is related to longevity, and challenges in sexual health can often be precursory signs for underlying metabolic or chronic health issues.  Today on The Dhru Purohit Podcast, Dhru sits down with board-certified urologist Dr. Rena Malik to discuss the importance of healthy sex life and the challenges men and women face with low libido levels, pelvic floor dysfunction, hormone imbalances, and masturbation. Dr. Malik shares her expert advice on increasing sex in our busy lives and the science behind sexual health, diet, exercise, and orgasms. She also discusses the roadblocks that prevent us from having optimal sex lives and the importance of positive and exploratory communication with our partners.  Dr. Rena Malik is a board-certified urologist with a talent for dispelling medical misinformation, discussing intimate topics, and evidence-based discussions of taboo topics. Dr. Malik is also a prominent reconstructive urologist treating bladder conditions, sexual dysfunction, pelvic pain, and hormone management. In this episode, Dhru and Dr. Malik dive into (audio version / Apple Subscriber version): The relationship between sex and longevity (2:00 / 2:00) The impact of sex on mood (4:30 / 4:30)  How often should we be having sex (6:30 / 6:30) Masturbation as a taboo topic, and knowing what you like (9:54 / 8:28) Mental roadblocks that impact sex life (17:27 / 15:43) Exercising to improve your sex life and the pitfalls of a sedentary lifestyle (22:41 / 21:08) The challenges that women face that impact their sex life and how to improve sensation (27:25 / 25:53) What deteriorates the pelvic floor and how to treat a weak pelvic floor (46:21 /43:26) Desire, erectile dysfunction, and challenges men face (55:30 / 52:08) Nitric Oxide’s critical role in sexual health (1:01:39 / 58:35) The top myths about the female anatomy (1:11:50 / 1:08:45) Sexual desire mismatch and what you can do to fix it (1:15:54 / 1:12:40) The pros and cons of pornography (1:23:33 / 1:20:29) Supplements that support sexual health (1:34:58 / 1:31:48) Sexual positions that are pleasurable for both parties (1:38:41 / 1:35:35) How Dr. Malik began her social media presence (1:42:35 / 1:39:28) Tips for parents who want to educate their children (1:47:40 / 1:44:44) For more on Dr. Malik, follow her via Instagram @renamalikmd, Twitter @renamalikmd, Facebook, and YouTube.   Find out more about Sweetgreen and their newest protein plates at www.sweetgreen.com. New Users of the sweet green app can use the code "Dhru5" for $5 off.  AquaTru is a countertop reverse osmosis purifier with a four-stage filtration system that removes 15x more contaminants than the bestselling water filters out there. Go to dhrupurohit.com/filter and get $100 off when you try AquaTru for yourself.  Hosted on Acast. See acast.com/privacy for more information. Learn more about your ad choices. Visit megaphone.fm/adchoices

The most important organ during sex is your brain. So if you are not in the right place mentally, like you're thinking about all the work you have to do, you've got kids to take care of, you've got work going on, you're behind on the bills, you've got dishes to do, whatever it is, right, that's stressing you out and you bring that to the bedroom, you can't be there. You can't be there and be in your head. Having sex and actually during climax, it's the most mindful state you'll ever be in. Like, you can't think about anything else when you climax. It's actually impossible.

Newsflash, the better your sex life, the longer you potentially can live. Yes, that's right. Safe sex and most oftenly in a relationship is good for your longevity and health. But what gets in the way of having more pleasure, especially when it comes to our sexual health in our relationships? Hi, everyone, Drew Prode here. And today's guest, Dr. Rina Malick, is here to talk about the top things that prevent women and men from stepping into their full potential when it comes to pleasure and activating

their best sex life. Now, a little bit more about Dr. Rina Malick. She's a board-certified urologist with a talent for dispelling medical misinformation, discussing intimate topics, and educating the general public. She's a rock star on YouTube with over 280 million views and over 1.75 million subscribers. Those millions of subscribers, count on Dr. Malick's channel every week as a go-to destination for frank, evidence-based discussions of taboo topics. What we're diving into, many of those taboo topics on today's podcast, all with the goal of better informing you and helping you activate your best sex life ever.

Stay tuned for a fantastic podcast with Dr. Rina Malick. Dr. Rina Malik, welcome to the podcast. A pleasure to have you here. I want to start off Big Picture. what do we know about the connection between sex, longevity, and a healthy lifespan? This is a great question. I'm surprised no one's asked me that before. But we know that having a sex is a barometer of health. Sexual health is health. So when you're having issues with sex, it's often a sign of other issues. So because there's blood flow, the arteries to,

for example, the penis are much smaller than the arteries to the heart. So very often when men develop sexual dysfunction or erectile dysfunction, it's because they're having vascular dysfunction and they have not yet developed problems that are dramatic enough to affect their heart. And so having good sexual function is basically showing you that you have a good healthy vascular system, a good healthy neurologic system, good healthy hormones. Your brain is functioning well, right? That your mindset is able to focus and not be distractible by other things. So having a good sex life and having to have good continued function is actually a

barometer of good health. And so in terms of the things you need to do to maintain your sexual health, it's the same things that you need to do to maintain good heart, right? You need to eat, right? You need to exercise. You need to continue to monitor how you improve with those things and get outside, get sunlight. Those sorts of things are all going to help you have good sexual function because they're

going to help with good hormone health, good blood. blood flow, good nerve function. And so generally speaking, and then there's also the benefits of orgasm, right? So having orgasms regularly has a multitude of benefits, better sleep, better focus, better mood, and even some benefits with cardiovascular effects, and better heart rate, better blood pressure. And so those things, just incorporating them in your life, right, having good sexual function throughout life, having regular intimate moments, whether it's with yourself or with someone else and having orgasm are really positive. And in fact, there was a study that looked at the risk of developing prostate cancer and how often you ejaculate. So while this is just correlation,

it's not causation. What they found was that ejaculating more than 21 times a month reduced your risk of getting prostate cancer. And so that's, you know, is it that people who are ejecting more healthier, probably, right? So there's definitely some overlays there. But generally speaking, we know that there are benefits that are probably unmeasured as of yet. What about in terms of its impact, an active sex life on mood and sort of a general sense of contentment or happiness? Well, this is easy, right? Most people, when they have an active good quality sex life, they're in a better mood, right?

Yes, there's data behind this, but in general, you're getting these good, feel-good endorphins when you orgasm, when you climax, and those will persist and make you feel good. Now, there's a small subset of people who have what we call post-orgasmic illness syndrome and they don't feel good. But for the large majority of people, people feel good. Their mood is better. And they're overall able to, like I said, sleep better, focus more, do other things. So some people will even feel like, oh, I feel great. I can go do, I can go focus on other work now that I've had sex and I can like be really zoned in.

So if we want a long and happy life, there seems to be a strong correlation with an active sex life. Is that fair to say? I think that's fair to say. Now, I don't want people to feel like, oh my God, I'm not having enough sex. I'm not going to have a good life. That's not necessarily true, right? But it could be true. But I think in general, like as long as you're getting pleasure out of life, whether it's with a partner, whether it's with yourself, it's going to lead to overall significant benefits. Let's make the distinction between those two that you mentioned, whether it's with a partner or whether it's with yourself, let's start with the first one with a partner. Most of what I've seen you talk about and some of the literature you've mentioned has been

long-term sort of committed relationships, especially as we get older. And the correlation or the connection with an active sex life and that being some version of a barometer of health, right? So in those instances, even though I've learned from your content that there's no normal as people, especially for a lot of my YouTube followers who are in the sort of 50 plus category, if they're thinking and asking themselves the most fundamental question, which is, am I having enough sex or should I be thinking about having more sex? What are some benchmarks to be thinking about?

Yeah. So you already mentioned it. There's no normal. When you look at averages, people are probably having sex who are in long-term committed relationships about once a week on average. That doesn't mean you shouldn't have more. That doesn't mean you can't have less. But it's really an individual discussion with your partner because everyone's sex drive is different,

right? So some people may say, I want to have sex every day. So when people come to my clinic, I ask them, what is your desired sexual frequency? Because I need to know we need to be on the same page and everyone is so, so variable. Some people will say every day. some people will say eight times a month. Some people will say four times a month. But either way, that's what their desire is. And you need to talk to your partner. What is their desire and come up with an amount that is somewhere in the middle, right? Because there's very few partners who are the exact same,

right? Not everyone is going to want to have sex the exact same time, the exact same amount of time. And so I think really the best thing for you is to decide, okay, what is the amount of sex you can have together. And then if you're not having enough together, then what is going to allow you to feel pleasure and satiate yourself with yourself? Right. And so again, there's no right amount, but really it's an amount of like desire. What do you want? Right? You don't need to force yourself to have more. It's just about your normal desires. Like do you, there's no, I would say if you wanted to say, I only want to have sex once a week, there's no reason that you should have more than that. Your body sort of takes care of it on its own. It's constantly putting blood flow into your

genitals. For men, they'll have erections at night. Women do too, although they don't feel it, their clitoris will engorge. And so your body is sort of getting blood flow to those organs throughout the day, throughout the night. And so that's completely normal and healthy. This episode is brought to you by Sweet Greens. You know, at the beginning of the year, I'm a big fan of starting off the new year by dialing in my diet and eating food that tastes good and is good for me. Everyone can relate to having a busy schedule but still wanting to eat well, which is why I love to go to Sweet Greens to get an amazing salad, and now they have their new protein plates, which are currently my new favorite thing,

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Why even do you think that this is a challenging topic for adults, even people in relationships to have honest conversations about and also prioritize? Well, I think that one, there is, our society surrounds us with a lot of, there's, there's religious discussion. There's discussion about, is it normal to do this? When you are growing up, right? And like kids will often self-explore. That's completely normal. They will touch their genitals. They will hump stuffed animals. They will do all sorts of things because they're just exploring their bodies. And that's completely normal. But very often, the first thing you hear is don't do that. don't do that, right? And then you're growing up and you're like masturbating, hiding in your room

locking the door because you don't want anyone to find you doing that. Right. So very, very early on, we're growing up with these messages that masturbation is shameful. You shouldn't do it. You're not allowed to do it. Nobody should ever hear about you doing it or see you doing it. And it's not good. And so there's that. There's also religious discussions. So very, you know, in our historical context, there's like people used to persecute you for masturbation or say you were doing. dirty or say you were bad. And so that sort of has taken hold in some religious discussions as well. And so I think there's a lot of shame. Basically, it comes down to there's a lot of shame around masturbation around something that's completely normal and healthy for people to do that they are

now feeling like, oh, I shouldn't do that. It is not good. It's dirty. And so I think that just makes it hard to, one, do without having guilt on your conscience. And then two, to talk about, right? Like, I'm wanting to like, oh, is someone going to judge me if I bring this up in conversation? Because we don't talk about it. We don't even really, even on TV, like it's sort of, it's always in a comical way. It's not shown as like something that's normal and should be normalized among society. When it's shown on TV, it's usually like someone's either making a joke or they're hiding in a closet somewhere or something like that. Why do you think it's important for couples to prioritize it in their relationship?

Yeah, I think you need to explore your body. How can you express what you want or what gives you pleasure? Because it's different for every person, right? Every person has nerve endings. Some nerve endings are more heightened, some or not. And so to be able to express that to your partner, you need to know what you like and what gives you pleasure. And if you don't masturbate or at least explore with each other, like instead of just focusing on the end goal of penetration or orgasm, if you don't actually take the time to explore each other's bodies or explore your own. body and give feedback, you're never going to really learn what that is. It naturally brings up the practical aspect, which I'm sure you end up talking about with your patients and clients that you end up seeing, people asking, well, how do I bring it up? Knowing that communication, as you've shared before in other interviews, is one of the most, you know, communication that is not in sync or not having communication is probably the number one thing that would negatively impact a couple or individuals, you know, sex life. Yeah. Communication is really tough because we've never been taught how to talk about sex, right?

We don't talk about it in school. We don't talk about it with our parents. I mean, certainly, I didn't grow up in a house where we talked about sex. And so you're like, oh, now I'm just to talk about it with the person that I'm, like, very intimate with. And you don't want to hurt people's feelings and you don't want to, like, make them feel like they're not enough. And that's why you're masturbating. There's a lot of, like, layers there. And you're, and you're, but realizing that communication about sex is just like communication about anything else, it's going to take practice and openness and doing it in a space that's not in the bedroom. So like kind of doing it in a very remote location when everyone is calm and relaxed

and you can actually sit down and have a discussion and realizing that it's going to take multiple times and your reaction you get may not be positive the first time. You may say, look, I want to talk about this and they may shut down. or they may literally give you one word answers. And just realizing that this is normal, right? We're scared of talking about something that we're not comfortable with. And we're uncomfortable and insecure about our own sexuality because it's never been talked about in a normal positive way.

It's always been sort of talked about in like, am I good enough? Am I? There's so much thought about am I okay. Is everything functioning normally? Am I broken? Why do I see this on TV and I don't act like this? why do I see this on whatever I'm watching and it doesn't look like that in the bedroom for me. So there's a lot of insecurity.

There's a lot of concern about what's normal. And that in and of itself creates when someone says, I want to talk about this. Like, oh, my God, are they going to tell me that I'm like bad or I'm not good or whatever and realizing that it's going to take time, persistence and just talking about it, normalizing it, and don't give up. Like this is important. It's a huge part of relationships that you should be able to talk about. sex and be able to bring up things that you like or don't like or want to explore.

You had a video on this topic and you listed one of the top don'ts. And the don't was don't have these what could be seen sometimes as more difficult or challenging conversations, especially if a couple is not used to having communication on the topic of sex. Don't have it right before or right after and especially sort of in the bedroom. Right? That's what a lot of people tend to do. Why is that a bad idea for most people? Well, one, you have either, you're just about to perform and then you're bringing stress into the performance and stress is a huge killer of any sort of sexual activity, whether it's interest in sex, whether it's the ability to get an erection for men. And so that's going to just kill the mood, right? Number one. Number two, if you do

after, then it brings up all these insecurities that we've talked about, right? So the bedroom should be a safe place where you just sleep, have sex, and be intimate. But it shouldn't be for having serious conversations. And those should be done. Like I tell people, do it in the car when you're, like, you can't escape. You're like in a car together. Like, that's a great place to talk. Or you're together, but you can talk and you're calm and it's easy enough where you're like, okay, I'm not feeling affronted. And I think the big thing is when something happens during sex, it doesn't go normally, which invariably it always will. Right. No one is going to have, not everyone's going to orgasm every time, not everyone is going to have a firm erection every time. And that's okay. But like making it a big deal and being like, oh, am I, is it because of me? Like, just let it go, move on, do other things, work around it. Like, it's okay. You can still have pleasure without an erection. You can still have pleasure. It doesn't have to be a climax. Work around it. Still enjoy the experience. And then you can talk about it later, right? But like, don't make a big deal about it in the moment because then you're just ample.

amplifying that stress and people are going to bring that sex to their next perform their next time they are trying to have intercourse and then that's not going to go well and then you get in this vicious cycle where like you're not able to have good sex because you're so stressed about the first time this happened and you and it's never gotten out of there we're going to jump around a little bit but piggybacking off of communication you've shared that stress is one of the top things that impacts people's sex life towards the negative talk a little bit more about more about stress and then let's go through the other ones. What do you typically see when people have a gap between where they want to be in their sex

life and where they are? What are often the things that you see that are damaging their sex life? Yeah. So in terms of stress, we tell people the most important organ during sex is your brain. So if you are not in the right place mentally, like you're thinking about all the work you have to do, you've got kids to take care of, you've got work going on, you're behind on the bills, you've got dishes to do, whatever it is, right, that's stressing you out and you bring that to the bedroom, you can't be there. You can't be there and be in your head. Having sex and actually during

climax, it's the most mindful state you'll ever be in. Like you can't think about anything else when you climax. It's actually impossible. So in order to get there, you need to be in a place where you're actually thinking about, oh, that feels good. Okay, I like the way that feels. Or, oh, like, you know, like you're really focused on the sensations that you're experiencing, not thinking about other things. So you're not going to be able to climax. You're not going to be able to get an erection if your brain is not in the right place. So that's how stress affects you, right? That's number one. And number two, in terms of other things that can affect you, really I think a lot of it comes around with we can talk about medical things but in terms of

a lot of performance anxiety or anxiety around the experience so not just stress but but feeling like okay is this going to go well am I going to actually be able to satisfy my partner am I going to be able to perform the way they expect me to or am I going to respond the way they expect me to. Am I going to, and it can go either way, right? Am I going to get an erection? Am I going to orgasm? Right. And we're so focused on the end goal, getting to climax, that we're not actually enjoying the experience, right? So it's also about feeling that experience, enjoying that experience, and not feeling so much anxiety. And it's very tough because like I said, once you have a bad experience, it stays with you. And it can be very difficult to break that,

to realize that like this is normal. And it can be even around just normal bodily function. like is is my is my is my am I lubricated enough am I hard enough am I right you're like is it good enough I don't know like and so people don't know and that's sort of where my channel came into being is like people don't know what's normal so they can't really have a barometer to compare themselves to the only barometer they have is pornography right and that's a movie it's a it's a product it's a cinematic product it's made to look very appealing and these people who are selected to be actors and actresses are, you know, the top fifth percentile of the entire race, right? So they have, you know, different sort of characteristics that make them desirable to be actors

and actresses in this field. So communication, would you say that's number one? Like not having proper communication inside of a relationship between a couple. Yeah. That'd be the number one thing impacting. Number two, stress ongoing. I think stress might be number one. Stress is number one.

I think because of the society we live in right now, right? like stress and then the communication comes with it because you can't communicate with why you don't want to have sex or why things are not working out. And then it sort of goes together because they usually fall in line with one another. So then kind of piggybacking off of that, which is maybe the combination of both the stress and the communication is the performance anxiety. Yeah. Insecurities. Insecurities that are there. Anything else that would make up that list before we get into the physical side of stuff? I think those are probably the biggest ones in terms of mental roadblocks that are there. Also, I think, you know, really having this preconception of what sex should go like. So a lot of times

we expect that it should always be spontaneous, exciting, and like you should see each other and be turned on and it should be like the movies, right? Like you're like, oh, like I see you rip your clothes off. Like it's so hot and heavy. Like every time you have sex, it doesn't have to be amazing. Everyone has mediocre sex, right? It's okay to have mediocre sex. So I think having these expectations can be another roadblock. Before we get into the physical, what percentage do you find? And of course, it's going to vary per people.

But if you look at the sort of national landscape and that's why you put stress at the top, how much of there being a gap in terms of an individual of where they are and where they want to be in terms of the fulfillment in their sex life, which might play into frequency. how much of that is mental and how much of that is physical? You know, it depends. And obviously I'm biased because I see a lot of the physical issues, right? And so unfortunately, things like erectile dysfunction and menopause for women can have really detrimental effects to people's sex life, right?

And so those things do play a big role, particularly as we age. So as you age, the physical side starts to take over. When you're a little bit younger, it's very more often the stress, the mental anxiety, the other sort of mental roadblocks that come into play. On the physical side, just as a little bit of a teaser, because you talk about it so frequency, is exercise one of the top things that people can do to improve their internal motivation and desire for sex from a physical level? Yeah, so desire is complex.

And a lot of people combine desire with testosterone and a lot of part of the, of it is testosterone. And so in terms of boosting testosterone for both men and women, women have a lot of testosterone. In fact, they have more testosterone in their bodies than estrogen. And it's also very linked to desire. And so in both cases, to boost your natural testosterone, exercise is a very excellent way to do that. And so it can absolutely improve your desire and your interest in sex. So having sort of regular exercise combining both aerobic activities and anaerobic activities, being resistance and cardiovascular training, and doing that consistently has shown to not only improve testosterone, but it will improve other parameters. It will improve your vascular flow,

so you'll have more blood flow to your genitals, which will then allow you to have for men better erections, for women, better arousal. And so all those things can be easily improved by exercise. And so being consistent is the hardest thing. I think people will exercise for short periods of time, but doing it consistently will help overall improve many facets of your sexual function, including desire. So let's flip to the opposite of exercise, which is the sedentary lifestyle that most people are living. They're not getting even the most minimum amount of exercise that's there. What impact does a sanitary lifestyle have on our libido and our sexual health? Yeah, I mean, being sedentary in general is so bad for so many different reasons.

one is that obviously you're not getting exercise, but being sedentary, if you're sitting a lot, you're actually sitting on the nerves that give innervation to your genitals, right? So you're sitting on the pedendal nerve, one of the nerves that gives a lot of innervation to your genitals. So you can start developing numbness in that area. You can start getting dysfunction from sitting all the time. And so that's not great. And then in general, you know, when you're sitting and you're eating and drinking, you're just gaining more fat. So there's so much data on having people who have greater amounts of obesity, metabolic syndrome, which you get from sitting all the time and not exercising, like diabetes, high blood pressure, high cholesterol, all those things are going to have negative

impacts on your health, which is ultimately going to affect your libido, your ability to function sexually. So overall, there's really, if you're going to have, if you have a job that makes you sit, it really is up to you to make that time, like throughout the day to get little activity, right? Like go up and down the stairs, go get up, walk around throughout the day, put a timer on your phone and just do it. Like, it doesn't have to be a huge workout every day, but actually making sure you have consistent movement throughout the day is going to go a long way. It's almost like our sexual health is really that barometer to come back to the beginning of the podcast, is that if, and there's many many different reasons why people may not be having

sex as frequently, they could not be in a relationship, in between a relationship, et cetera. But if that desire is not there, you had a level that was maybe a benchmark, even though we know that when you're a teenager, that desires skyrocketed, right? Hormones and everything like that. That general desire is not there as an adult. There's been a big shift that's there. Sure, there could be things that we want to pay attention to that are specifically for our sexual

health, but that sometimes can be an indication of, hey, let's check in on our physical health as well. Absolutely. And I think, you know, desire is very complex. Like I said, a lot of stress, anxiety, mental, psychological disorders, they can all affect desire. Medications you're on can affect desire. So sort of figuring out like, okay, which areas of my life do I need to improve? And if they have fixed all those other things, then maybe there's a medical issue going on that, those are important things to assess because, like I said, if certain medications, like a lot of people are antidepressants, they can affect desire quite significantly. Even things that people use for hair growth like finasteride or propitia can affect desire. So things like that can affect desire. You may

not even realize it. So just sort of looking at the things you're putting in your body can affect your desire. And so it's important always to sort of assess, am I getting enough sleep? Am I exercising enough. Am I eating right? Those things need to be good. What am I putting in my body? And then, okay, is there a medical issue? Is my hormone health okay? Is my vascular health okay? Are all those things working together that can help me get normal desire and normal function? Let's start with women and then we'll come back to men. But on the physical side, what are the top list of reasons that you see that would be interfering with a patient's unique? expression of wanting a more healthy and pleasurable sex life.

In women, there's so many reasons. So one, very often we see in midlife women's desire plummets. And that's often because they're taking care of children. They're working. They're cooking. They're cleaning. They're doing a large burden of household chores. Right.

So they're taking care of the majority of the household duties. And that can very much weigh into desire. So that's a very common indicator, right? And then other things can occur as well. So one is they can have issues with particularly when you're in a longer term relationship, we see less of this. But sometimes women are having less sensation or less ability to orgasm. And that can change because as we age, sensation can decrease a bit.

So that can play a role in desire. If you're not having climax during sex, people may feel like, well, I'm not getting the same result from intercourse as I was before or whatever. And so why my desire goes down, right? So there's that too. Obviously, there's hormone changes that occur during perimenopause and menopause. And perimenopause can start around the age of 40s. So it's not that old. In fact, you can have symptoms as early as your 40s. And so people can start having changes in their hormones that can cause changes in desire, particularly your testosterone can decrease. And testosterone can decrease and that can really affect desire over.

overall. So, and also in women who are taking some subset of women who are taking oral contraceptives can also develop a low testosterone because while that testosterone gets bound up by something called sex hormone binding glabulin, which goes up. And that can then affect desire. So certainly, like I said, medications you're taking can affect you and then lifestyle. And then, of course, physiologic issues. So difficulty orgasming, probably the number one reason we see is that women are not getting sufficient clitoral stimulation. So when people see sex on TV or wherever, it's always vaginal penetration. But some women don't climax. In fact, 15% of women, 15 to 20% probably don't climax through vaginal penetrator, only 15 to 20% of

women climax through vaginal penetration alone. The remainder needs some sort of clitoral stimulation in order to penetrate or to climax. And that's basically because the clitoris is the homolog of the penis. And so a lot of people don't know that. It's very simple, but they just don't know that that is the area that needs to be stimulated for women, just like the penis, needs to be stimulated for men. This episode is brought to you by Aquitru. I've talked to so many experts about the importance of clean water as a foundation for great health.

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Right now, Aquatru is offering my community an amazing deal. Just go to Drewfilter.com, D-H-R-U-F-L-T-E-R-com, and get $100 off when you try Aquatru for yourself today. That's Drew D-H-R-U filter.com to get $100 off when you try Aquatru for yourself. Is there anything that women specifically can do? As you mentioned, sensation can go down as all human beings age. But right now we're talking about women. Is there anything that women can do to improve their sensation? Yeah. So what I tell people is when you think about the spinal cord, same goes for men. So when you think about the spinal cord, there's different areas of sensation. there's pressure, there's temperature, and there is vibration.

So you can sort of diversify your stimulation, right? You can use warming things, cooling things, being careful that some warming, including lubricants have a lot of additives in them that can be caused issues with sensitivity. So you can try to change temperature, you can try to use vibration, you can use pressure. But one, not getting to the same thing all the time, doing different types of stimulation, but also just playing with different types of stimulation and making sure that your spinal cord is getting different inputs from that stimulation. One of the things that I've heard talked about, and this might go into our category of

myths that are there, but since we're on the topic of sensitivity and increasing sensation, there is often this conversation that women using a vibrator too much will reduce their sensation. Well, it's just like saying men masturbating too much will reduce their sensation, right? If you masturbate the same way every time or you use the same vibrator with the same stimulation, that's what your body is going to get habituated to, right? And so I think generally speaking, you want to keep it varied. But that doesn't mean that using a toy or using a vibrator is going to actually make you not climax with your partner. I just said, if you are only climaxing that way and you're not changing it up, then your body will just want that way, right? And that's

with anything. So if men masturbate with the same sort of firm grip and they can't replicate that with a partner. And same thing, if a woman can't replicate that with a man, then it's going to be much more difficult to climax. So sort of like trying different things and not getting used to one thing, but otherwise, use everything you want, use anything you want. Just since we're on this topic, what are some examples of ways that women might vary it? Yeah, so you could try different. So whenever you buy toys, right, there's different types of vibrators. There's different, there's like a whole host of different sex aids that you can find. There's ones that are just no vibration.

There's ones that are like you can put on your finger and use. There's, so I would recommend people if you have a shop near you, go to the shop because those people will show you like a whole host of different things, how they work. And you can see what you want to try. And there's so many and just sort of like picking different things, using your hand sometime, using your, using a toy sometime, using other things, right? Just whatever using water, people very often do it in the bathtub. So just sort of trying different ways of stimulation and not using one thing only one time, every time.

Continue on the topic of women. You mentioned hormones and that beginning at perimenopause, which also a lot of people don't know, men don't know, a lot of women don't know. It could be a 10-year period at least, right? Absolutely. before you're entering officially into menopause. And for women that find themselves in this category where their hormones are starting to change, what are the topics of discussion that you have with him? Do you talk about, well, let me give it over to you.

What topics do you talk about and how do you assess if somebody's hormones are in range that are supporting their overall health but also their sexual health? and what are the key hormones that you're looking at and bringing up with your patient about them being out of range and them needing to be addressed? So this is a long answer. But generally speaking, when we talk about hormones for women, you think about systemic hormones, so things that will affect the levels of hormones in your blood versus vaginal hormones.

And so we'll start with vaginal hormones. It's a little bit of a more concise discussion. But vaginal hormones, so when women go through menopause, A lot of changes happen. Their labia actually shrink. Their clitoris can get smaller. They can get atrophy and they can get thinning of their vaginal epithelium. And so that I can see on exam, but women may come saying it feels dry down there. I'm not getting as much lubrication during sex or I'm getting recurrent urinary tract infections. So those are sort of the very common things that people will complain of. And that can be very easily addressed with hormones. Vaginal estrogen is

very, very safe. There's a lot of misinformation, but vaginal estrogen is not absorbed systemically, not a lot of it. Very, very minimal amounts can absorb systemically. Most of it is just local for the tissues. And so if you're having those symptoms, vaginal estrogen, either in a cream, a pill or a ring, can actually, a ring that goes in the vagina can all help support the normal vaginal epithelium and the tissues to keep them healthy. And so one, it's really great for recurrent urinary tract infections. A lot of people don't know this and are, you know, getting antibiotic after antibiotic after antibiotic. And all they really need is vaginal estrogen to help prevent UTIs. It's actually one of the highest levels of evidence we have for preventing UTIs

is with vaginal estrogen. And so there's that. And then we're talking about systemic hormones. Now systemic hormones, at least by the book, are used for vasomotor symptoms, which are hot flashes, feeling palpitations, those sorts of symptoms that occur very commonly that people hear about and bone health. So those are kind of the most common things. We know that bone health deteriorates and estrogen can prevent bone loss. So it's very helpful for that. It's very helpful for vaso-motor symptoms.

But there's more and more data on, I mean, estrogen receptors are everywhere in the body. So we have estrogen receptors in the brain. We have estrogen receptors so that can help with cognition and prevent dementia. there's some data that shows that it actually prevents dementia. There was some studies recently that talked about how it actually was linked with dementia, but it was because these women were started on hormones for vasomotor symptoms, which are also linked with dementia. And so there's sort of a correlation with the other things that people were starting hormones

for and not the hormones themselves. So there's a sufficient amount of data that it helps with cognition, helps with bone health, helps with, you know, somewhat of modulating weight, right? Because it helps with metabolic syndrome. So people who have hyperglycemia from insulin resistance, they actually see an improvement in their glycemia when they're on estrogen. Now, these are not reasons to, in terms of like what the societies say, but this is the data, right? So it does show improvements in hyperglycemia, shows improvements in metabolic syndrome,

shows improvements to small degrees in weight, better sleep. Because one, if you're having vasomotor symptoms or hot flashes, and you're waking up at night, your sleep is poor. And sleep has a huge association with dementia and other issues. So your sleep is better. And so there's a lot of benefits to having hormone therapy systemically when you're having, if you're having symptoms or when you're going through menopause because it supports so many factors that even improves skin health.

So it improves collagen content in your skin. It improves, it reduces the fine lines and wrinkles on your skin. It helps prevent like your skin. like your skin from getting hollowed in because it supports, there's estrogen receptors in the epithelior of the skin. So there's so many benefits to getting hormones. And if you don't have a uterus, then estrogen, if you have a uterus and you need progesterone to prevent endometrial cancer,

both of those can be used systemically. So you can take them in pill form, in patch form, injectable form, topical like gels. There's lots of different formulations and you can talk about those with your doctor to see what is best for you. but ultimately there's lots of options available. And so deciding, you know, are you a candidate? Interestingly, we don't always look at hormones, at least as a whole people, don't say that it's

required. It's more of a clinical diagnosis. But I often look at hormones because I want to see, are we seeing an improvement? What are the levels when we start? And are we seeing improvements? Because that's sort of how we measure men. When we give testosterone for men, we check their hormones and we follow them to see how they're doing.

And does it correlate with their symptoms? But bottom line is we're treating the person and not the numbers. And there's a lot of reasons why a woman might want to have hormone therapy in relationship to, and you listed many of them that are there. Generally speaking for somebody who feels like their libido is very low, is hormone therapy enough of, does it, how often does it work? for a woman who feels like their libido is low. So in terms of libido, usually hormone therapy can help a little bit if it's going

to help with lubrication. So that can help with a sensation of arousal. A lot of times our brain like connects arousal with libido, right? Even though they're two separate things. So feeling aroused, meaning having lubrication and having that response can make you like, oh, that kind of your brain makes a link with that as desire. So that can help with that part of it. But generally speaking, when you're thinking about libido in,

postmenopausal women or perimenopausal women, there's a few things that we assess. One is how's their testosterone level? So the testosterone for women should be about one-tenth of a male amount of testosterone. And so we check the testosterone level. And if it's low, then we can supplement it with topical testosterone, a very small amount of topical testosterone. You put on the back of the calf every day and see if they improve. There's also some medications that we have available.

Those are technically FDA approved for premenopausal women, but they're also. available to use off-label for women postmenopausal for low libido that are called phlebancerin and brimelanitide, which are medications that work centrally on different receptors in the brain to help with desire. Because I said desire is very complex. It's that you have some receptors that are upregulated, some are down-regulated, and, you know, so there's inhibitors and there's promoters of desire. And so we're trying to kind of balance, make the promoters higher and the inhibitors lower with these types of medications. We were talking about some of the things that interfere with having healthy sex,

desire, libido, et cetera. What are some of other physical things that women in particular go through that you see in your clinic that prevent them from enjoying sex? For example, I know one topic that's come on in this podcast a few times is some women, I don't know what percentage you probably know, experience painful sex. So 12% of women experience pain with sex, at least that's, and it can vary, but that's sort of the average number we say. That's not a small number. Consistent pain with sex.

Now, people can have pain with sex for a variety of different reasons, but, and sometimes some studies will say it's as high as 40%. But it's very common. Now, pain with sex is never normal. So people say, oh, you know, it's okay. Drink a glass of wine. You'll be fine. No, no, it's not okay. Like you should never experience pain with sex.

So it's about determining where that pain is and what's causing that pain. Is it pain on initial penetration, deep penetration after sex, and then kind of parsing out what's causing that. So I'll go through some of the things that cause pain with sex. One is inadequate lubrication. So I don't know why, but in society in general, we feel like we shouldn't be using lubrication. But lubrication is great.

It makes things slippery. It makes things fun. And it's relatively affordable. And it helps. So a lot of times what happens. is women need a significant amount of time to develop adequate lubrications. They need a significant amount of foreplay to get the adequate amount of lubrication to be ready, to be penetrated. Our bodies actually change when we're getting aroused. So women will actually, the length and width of their

vagina will increase, almost double. Their cervix will move up and out of the way. They will develop adequate lubrication. If they don't have enough time for that, it'll be painful, right? So that's one of the most common things. One is that. And two is having low lubrication doesn't always mean that they're not interested or they're not into it. Right. There could be medication issues. There could be just natural genetic differences. And so using lubrication is not like a bad thing. It's a great thing. It makes sex better, right? So those are a couple of the common things we see, particularly in younger people where they're just not ready to be penetrated and they are and then it hurts. You can also see pelvic floor dysfunction, which is, which I see a lot of. So I'm biased because I see a lot of

but basically it's when you have tension in your pelvic floor. So when your pelvic floor is essentially this bowl of muscles that sits in your pelvis that holds up all your organs. So your bladder, your rectum and women, the uterus. And these muscles, just like any other muscle, usually relax and contract when needed. But when some people develop a lot of stress, anxiety, or they may even just have like hip pathology or other kind of factors that can affect function of the pelvic floor, their pelvic floor can become tense and it doesn't relax normally. And so that can create a lot of pain

with sex because you don't normally, you need a relaxed pelvic floor to allow something to penetrate it. And so that can be very uncomfortable. And the good news is that can be treated through pelvic floor physical therapy. And if that doesn't work, we have other options like Botox and the pelvic floor and things that can help relax it. But essentially learning how to relax that pelvic floor is actually very beneficial. And sometimes people overdo kegles, right? They'll do too many kegels and they'll develop high tone pelvic floor because they don't really know how to do them and they're just clenching, clenching, clenching, clenching, and they're not relaxing. It's just like going to the gym. You need to have rest. You need to relax the muscle in between sets. Very similar

for doing kegels. You need to actually relax the muscle. And so it's important to sort of do those with caution if you're going to do them. And then, you know, there's also a whole host of other things. But since we've been talking about hormones, the vestibule, which is this. area right outside the vagina is very hormone sensitive. So that can become exquisitely tender during perimenopause and menopause. Or if you're taking certain medications and you're younger, like oral contraceptives, that can become exquisitely tender and then that can cause problems and pain with sex. So there's a whole host of things, but those are just kind of a few of the more common ones. You talked about pelvic four. I really enjoyed your episode with Andrew Huberman

and the whole first quarter of the podcast, you guys went deep into the pelvic floor. You chatted about a few things right now that are there and the importance of a healthy pelvic floor. But let's talk about the basics, which are you mentioned that a pelvic floor is designed to be a basket in a way to support and hold all those organs, including our bladder. what are the top things that damage or deteriorate the effectiveness of our pelvic floor as we get older? Yeah. So, you know, your pelvic floor is, as you mentioned, very important for not just holding up things, but normal function.

So it needs to relax when you defecate. It needs to relax when you urinate. It needs to hold things up when you're lifting things. It has to support your body when you're. exercising or at the gym. And so over a lifetime, very often what we see in people who don't develop pelvic floor dysfunction is weakening, weakening of the pelvic floor. So when you've had a job where you stand all day long, or you do a lot of heavy lifting, or you've had multiple babies, and that can cause weakness at the pelvic floor. Now, that in women can cause things like incontinence.

So when you cough, sneeze, lift heavy things, you can have little accidents. And that's not normal. So while incontinence is common, it's not normal. So a lot of times people think like, oh, leak a little, it's whatever, everyone does it. And it's fine if it's not bothering you. It's not life-threatening in any way, but it's not normal. And we can help you fix that if that's a problem. So in terms of, so you can have leakage, you can also develop pelvic organ prolapse. So what that means is that organs could actually start herniating, at least the vaginal

skin can start herniating through the vagina. So you can start feeling like there's pressure. down there, or you can even see some sort of bulge coming down through the vagina. Again, not life-threatening, but can be quite bothersome and can be very challenging for people to live with. And so those are sorts of things that occur with weak pelvic floors. And also it can affect sexual pleasure, right? So if your pelvic floor is very weak, when you climax, your pelvic floor contracts, right? It creates these contractions. You feel them when you climax. Men have them, women have them. So women may notice that sometimes because their pelvic floor has gotten so weak,

those contractions are not as strong. Similarly, men may notice that they're having kind of the most visible thing is that their ejaculate volume is less forceful. So they're not having as much force behind their ejaculate. And so it looks less voluminous. And also may affect the intensity of pleasure when you climax. So all those things can occur with the weak pelvic floor. Now having a high tone pelvic floor is an abnormality. We know that weakness occurs with age and it is abnormal, but it does occur very commonly. Now, having a tight pelvic floor is also abnormal. And this often occurs because we hold stress in our bodies, right?

So just like people get TMJ and they clench their jaw at night and they wake up with headaches or they grind their teeth, that's all stressed, right? Like I asked my dentist, like, how do we make the stop? He's like, if you stop working and you just have a really chill life, then there'll be no more TMJ, right? So, but same thing, we hold stress. and a lot of people will hold stress in their pelvic floor. And then they will develop these tight, tense, short muscles and they don't relax. And so this then creates a number of problems.

It can create difficulty urinating or urgency frequency. Like got to go, got to go, got to go very often. It can create difficulty having bowel movements and get constipation. You can have back pain. You can have groin pain. You can have pain with sex. And men can have scler pain or testicular pain. So it can cause a lot of problems and they can be different for every person.

So someone may just have back pain. Someone may have pain with sex. Someone may just have urgency frequency. And they all can be from the same cause. We didn't make the connection, but sitting plays a role in pelvic floor? Yeah. So sitting for long periods of time can lead to pelvic floor dysfunction. So when we were, again, normal function, my husband was a PMNR doctor and he always

said like normal function leads to normal rehabilitation. So if you're not doing normal function, we're meant to move and walk. You're going to create problems in your muscles and your ligaments and all those things. And so you can have poor function in those muscles when you're sitting all day. And during COVID, we saw a lot more people with pelvic flores function because they were sitting all day and they weren't moving around. And so absolutely, if you're sitting all day and not moving and just working from home at your desk, you can develop issues with your pelvic floor. Are the things that people can be doing at home today to help their pelvic floor? Most people, would you say having the issue of their pelvic floor not being as strong as it needs to be?

So for weak pelvic floor, generally we do recommend things like kegel exercises. But if you develop any pain or discomfort when doing keel exercise or things start changing in terms of function, if you're having pain with sex, pain with ejaculation, pain with erection, pain with in your groin area in general or in your vagina, those things may be a sign that you're not relaxing well enough or you're then developing the other problem because no one teaches you how to do kegles, right? They just say, it's like, oh, squeeze. Like, it's not that easy to understand for the average person. Sometimes even when you explain it, so the way we describe it in our field is if you're either male or

female, you can try to stop the flow of urine when you're urinating, and that's a kegel. Now, you don't want to do that every time you urinate, but that helps you find the muscles. You can also sort of squeeze up and in in the vagina. Or for men, you can sort of try to like feel like you're lifting your penis up off the ground. And those are what kegels are doing without touching. So those are kegill exercises. And you don't want to be squeezing your abdomen and you don't be squeezing your gluteal muscles.

So you sort of need to be just focused on those muscles. it's actually quite tough to do if you've never done it before. And so if you are struggling, I recommend seeing a pelvic floor physical therapist because they will work with you to make sure that you are doing those exercise correctly, that you're getting improvements in those domains and that you're getting to the goal that you want, which may be a stronger pelvic floor so you don't leak anymore, whatever the issue is. In terms of preventing high-tone pelvic floor, manage stress, manage anxiety, so whatever that is for you, exercise, meditation, do things that allow for relaxation,

and then do exercises that lengthen those muscles like Pilates, yoga, those actually tend to lengthen and stretch those muscles rather than those that sort of like sit-ups, for example, will sort of shorten those muscles. Any of, you know, for the folks that are listening that regularly go to, like, the gym and do some version of resistance training, are there any of those typical exercise? exercises, squats, you know, dead lifts, et cetera, that either engage those same muscles that you'd be doing kegels during? Or is there any way that people can be thinking about doing those while they're at the gym? I often find in this little background is that, you know, remembering to do

kegels for anybody who's wanting to do them, men or women, is, unless if they're in pain and they're working with like a therapist and they've been giving a prescription. But let's say proactively, it's something that often is forgotten about. You just kind of forget about it. It's exciting when you hear about it in the beginning. And you're like, okay, I'm going to do this for whatever reason you want to do this. But are there any things that people are typically doing at the gym that they can engage or be practicing these same muscles on? So what I think people don't realize is that your pelvic floor is part of your core. So anything where you're engaging your core, you can be engaging your pelvic floor. But I think the big mistake.

mistake people make in general is that they don't breathe correctly when they exercise. And so when you are doing the exertion, you need to exhale. That's going to cause your pelvic floor to contract and stabilize so that you can use that stability to then lift, right, to lift whatever heavy thing you're lifting. And so, or they're like holding their breath. And yeah, it's fine to do it when you're doing one, one really heavy rep, right? But like in general, you need to be breathing throughout the exercise and focusing on breathing to not injure your pelvic floor. And generally that's probably the most important thing. Whatever exercise you're doing, just keep that in mind.

And you will strengthen your pelvic floor just with the breathing exercises, right? And doing it while you're doing the core activities. So switching to men on this topic of what are some of the top physical things that get in the way of the desired sex life or sex enjoyment, et cetera? Men, well, first of all, is this true? Men are issues with men tend to be a little bit more simple. I don't know if that's the right word, that it's a little bit, there's less moving parts. Is that accurate? Is that not accurate?

I wouldn't say it's more simple. I would say that it's just more visible, right? Because men have a very, they can see when they're erect. And they've been seeing it since they were a baby, right? So they know when they're aroused and that becomes very connected to their brain, that they see an erection, they're aroused. And they climax and they ejaculate. But in fact, all those things are separate, right?

Desire is separate from arousal, and you can orgasm without ejaculating and you can, you know, and so those are separate processes. But ultimately, I would say the most common things that we see in men, one is definitely mental, right? So psychological performance anxiety, psychogenic erectile dysfunction is what we call it. But having that anxiety and then not being able to get an erection that's sufficient for intercourse and then, you know, that take, bringing that again to your next encounter because you're stressed about it, like, okay, is something wrong with me? And then you go to the next time and you're just like, is it going to work, is it going to work? Is it going to work? Is it going to work? And it doesn't work.

And they're like, okay, I'm stressed again and it's just getting worse and worse. So we see that a lot. And even in men who have organic, what we call organic erectile dysfunction. So it's because they have problems with blood flow or problems with nerves or hormones, whatever the factor is, those people will also get, you know, psychological anxiety associated with not being able to perform, which will worsen the ability for even medication or other things to help them because they're so stressed. And so we tell people often when they try a medication for erectile dysfunction, try it more than once because stress and anxiety plays a role. Then we see for causes of erectile dysfunction, erectile dysfunction is very common. So we see erectile dysfunction in 52% of men over the age of 50,

Very, very common. Now, it's also because things like metabolic disorder, metabolic conditions like hypertension diabetes, high cholesterol are very common. And those are the same issues that cause decreased blood flow to the genitals. And so that's very common. And the most common cause is blood flow issues. We also do see neurologic issues. So people who have neurologic conditions can have decreased nerve function to the penis. And then we do see hormonal issues like low testosterone, but that's a much smaller percentage, like three to six percent. So those are common and premature ejaculation is very common. So basically ejaculating before you or your partner wants to. Now there's a scientific definition that's like within one minute of penetration or two minutes of penetration. But ultimately,

the way I look at it is, is it before you or your partner wants? And is it different from before? Or is it always been that way? And so that is another huge common medical condition that occurs in men that can affect sexual function. And then low desire does occur. It is common, but less common, I think, than those other things, at least in a clinical setting. So going back to erectile dysfunction, obviously people know that there's prescription interventions that are there, but just double-clicking on the sort of lifestyle aspects that are there.

You've done some content on this, you know, importance of not smoking. Yes. Right? Yes. I mean, most people who are listening to this podcast are not going to be smokers, but, you know, who knows who's watching on YouTube. Regular exercise. And then also really double-clicking into your metabolic health in particular.

Because the same things that would be causing erectile dysfunction, my cardiologist, Michael Twyndham, who's been on this podcast before, he often would say ED often equals ED. A rectal dysfunction is often endothelial dysfunction. Yep, it is. Absolutely. body. So what are some of the most damaging things that you see, separate from smoking and living a sedentary lifestyle, what are some of the most damaging things that people are doing in their life that is hurting their vascular health and making more likely for them to have erected out

dysfunction? Diet. Diet is a huge one, and we haven't talked a lot about it, primarily because there's not a ton of data on specific diets, right? The best data we have is on the Mediterranean diet. So that was well studied in many studies, and that's basically a diet that's high in vegetables, high in healthy fats, a little bit of meat, a little bit of fish, but really kind of and nuts and seeds. So trying to get, and no processed foods, trying to limit anything, you know, nothing processed, all natural foods. And so those diets have been shown to be beneficial in terms of vascular health and sexual function. But I would say generally what I tell people, I'm sure most of your audience already does this, but avoid processed foods,

avoid a lot of simple sugars, or anything that's white, right? No pasta, no carbs. Like, not carbs, but no simple carbs. Refined carbs. Right. And so those are sort of, I think, the biggest implicators of issues in terms of sexual health.

And that's like your whole life, right? That's something that you're doing all the time. And so that over a lifetime, yeah, it's not always going to be perfect, but trying to do the best you can, at least 80% of the time to get good, healthy, nutritious food in your body, not junk food. And then in terms of helping with other things that you can do.

So I think really excessive alcohol, while some people, you know, usually, I guess, so alcohol, if you're to excess will affect sexual function. Marijuana, too excess will affect sexual function. So I think in general, when you're doing these other behaviors, just kind of taking a second to see how many drinks am I really drinking a week? How much am I really doing? and there's more and more data that alcohol is so damaging. Any alcohol is damaging for cancer risk, for a host of variety of things.

So really trying to limit your alcohol intake and marijuana. Again, there's not as much data, but we know that excess marijuana intake will affect fertility and can affect sexual function. On the topic of erectile dysfunction, you can't talk about ED without talking about nitric oxide. And it obviously plays a role in men and women. So this could be a good opportunity to first talk about men. Talk to us about nitric oxide and the importance of nitric oxide. Yeah.

So nitric oxide is essentially the ignition for erection. So when you are aroused, your endothelior, your lining of your blood vessels will release nitric oxide. But you need stimulation for that to happen. Right. So you need to be around. See something. Hear something. See something that gets you aroused.

or that makes you think about sex in a positive way, and then your body will release nitric oxide, and then it sets off a cascade of factors that then causes blood flow to go to the penis, blood flow to stay in the penis, your smooth muscle relaxes, you get an erection, and then it stays there, and then as soon as those factors degrade, the smooth muscle contracts, blood flow leaves the penis, and then your erection goes away. So that's why it's sort of really important for that part and can help essentially, that's why a lot of things you'll see online are like boosting nitric oxide because they may help boost your overall sexual function and endothel health. What are the things that damage our body's normal production of nitric oxide?

I mean, it's all the things we've already talked about, right? So if you have poor, if you have metabolic syndrome, you've got high blood pressure, you've got high cholesterol that's forming plaques in your blood vessels. You have diabetes that's affecting the structure of your blood vessels. if you are smoking, those things are just number one going to affect nitric oxide production. And so being sort of keeping your, it all goes back to cardiovascular health, doing the things that are good for your heart are going to be good for your sexual function. There's been a few dentists on this podcast that have come on and said that traditional mouthwash

is something that damages our oral microbiome and that those bacteria are key in the production of nitric oxide. Have you come across this? There is, you know, I don't have the numbers in front of me, but there are some people who notice their erections are not as strong when they use mouthwash. I think that's probably the reason why. But I would leave it to the dentist to discuss the value of mouthwash in your dental hygiene. But I think, yes, there are some people who do see that. And I've definitely come across it before. What about this other one? This idea that a big part of nitric oxide production is nasal breathing. Have you heard about this? I have not. I think there's a lot of benefits to nasal breathing and plentiful benefits. And so certainly it's not going to hurt you to nasal breathe.

It may even make your face structure look a little better. So overall, I think it's a good idea to nasal breathe at least at rest. And then in terms of when you're doing more exertional activities, do what your body needs. Viagra Sealis, these things play a part in helping with nitric oxide production? So they don't make nitric oxide. The way they work is so when you have an erection, nitric oxide creates a cascade of events. When you have nitric oxide,

you basically convert certain enzymes in the cells, CGMP to CAMP. That keeps the erection alive. Phosphodasterase 5 breaks down that substance, CAMP. And so that is what stops the erection. So these medications inhibit phosphodiasis 5. So they allow you to maintain.

that erection for longer. That's how they work. And they do need stimulation for them to work. So you're not going to take it and get an erection. You need to have stimulation for them to work. They typically take about an hour before they're ready to work. And so generally we tell people take them an hour before wanting to have sex. You need stimulation for it to work. They do last in the body for some time. So if you take it a little before, like say you want to have sex after dinner, you could take it before dinner and then it'll still be there. Viagra lasts about four hours. and Cialis lasts about 36 hours. So you can actually take it and then have a whole weekend if it's working well for you.

With Viagra, the one thing people often forget is you need to take it on an empty stomach or a light meal. It doesn't work as well. You just get essentially, you'll just get the side effects without the effect with Viagra, whereas Cialis you can take with food. Are you familiar at all with, I feel like in the last few years, there's been different sort of modalities that are practicing some version of shockwave therapy. So can you explain to our audience what that is and then your opinion on it? Yeah. So shockwave therapy is essentially using, we've used shockwaves for a lot of things. We've used, so in urology, we use it for kidney stones, and they help break up kidney stones.

They've used it in cardiology for different arrhythmia type things. But now they've done studies on it for erectile dysfunction. And when you have the right type of shockwave, meaning it has the right depth of penetration, so it's a deep shockwave, it will create over time changes. in the structure or the blood vessels in that area. So it creates angiogenesis. So it creates new blood vessels in the erectile tissue. And that's how it works. We're actually improving arterial flow because we're creating new blood vessels. Now, the data is reasonably, there's a lot of data now. And what we've seen is that it does work pretty well in the short term. So we're seeing good results

in the short term. But after about a year, 50% of people are seeing improvement. And it really works for people who have mild to moderate erectile dysfunction, not for people who've got really severe erectile dysfunction, not for people who've had prostate surgery, at least that's not what the data shows yet, not for people who have other causes like neurogenic causes of erectile dysfunction. But what we're now seeing is that it does work pretty well. It is the only regenerative therapy that has the most robust. Now, there are other regenerative therapies like PRP injections, there's stem cell therapy that's sort of still investigational. And shockwave is still considered investigational, but it has the most data.

And it's really low risk. It doesn't create any long term. There's no side effects. There might be a little bit of soreness, but overall, there's no long-term side effects. You're not going to injure yourself. And so for that reasons, it's nice. But we still don't know the optimal protocol because how often should you be getting it? Usually you'll do like one session a week for six weeks.

And then after that, you know, it's up to the practitioner to decide how often you're going to get it or how often you need it. Should you get every six months, every year, every two years? We don't really know yet. And so it's still considered investigational. But the issue is that a lot of people are offering it, and they're offering radial shockwave. And radial shockwave is not deep enough to actually penetrate the tissue. So you're just getting a massage, basically.

You're not like getting the actual shockwaves. And they're charging a lot of money. And so as a urologist, I've started to feel like obligated to offer, at least offer it because if people are going to pay for it and it's not covered by insurance, that you should get it from someone who's giving you the right thing up to date on the literature, who's following the data, and so that you're at least getting the right thing and the safe thing and not getting just taken advantage of. And so I think it's important to really investigate if you're going to, if you have the expendable income and you want to try it, there's no harm in it,

right? It may help you and it may save you from taking a medication or it may make the medication more effective. But it is not a, it's not something that we have a home run for and it's quite expensive right now. Anything else on the topic for men and erectile dysfunction that you feel significantly moves a needle forward? You know, I think that it is such, I think really the important thing to take home is that if you're struggling with erectile dysfunction, like it is a very difficult topic. It is very easy to go in the gas station by something or look on, look for sources that are easily, easily obtainable. But realizing that like this is something that you can absolutely talk to your doctor about, we're here for you. We want to help you and we want to make you

better. And I wish that we had more regenerative treatments. All the treatments we have are sort of, they're just treating the issue, right? They're just giving you, giving the ability to get an erection at that moment, but they're not reversing the problem. Reversing the problem. Hopefully shockwave will be something that does that, but also exercise like we've talked about so much and getting a good diet. We've seen data that exercise actually can reverse erectile dysfunction. And so really getting starting to do that, you will see better erections. And in fact, you may, it may actually make your penis look longer because you're losing weight and it looks, appears longer to you. So there's lots of benefits to exercise. But overall, I think just realizing

that we, you know, we want to help you and we're here for you. Well, I'm giggling a little bit because you said, you know, make your penis look longer. One of your top videos on YouTube when you organize by popularity is titled, can you increase penis length? Yeah. Can you? So, you know, there's a lot of things that have been tried. They're surgical, non-surgical options. And when reviewing them all, traction therapy has shown in some studies. So traction therapy is essentially a device you put on the penis and it stretches

the penis. And the studies that were done were like six hours of traction therapy a day can increase penile length by about two centimeters. Now, there's additional studies that are being done with other devices for post-prostectomy patients and for people of Peroni's disease, they're showing similar results with shorter duration of use. So using it like 30 minutes twice a day. But ultimately, those things can work and they're generally safe. But you do have to be committed to doing it and continuing it. We're going to come back to some of your top content, your greatest hits that are out there,

based on virality at least. You didn't decide to make them top hits. And we want to go back to anatomy. I think there's some very basic aspects of the biological male anatomy, the biological female anatomy in particular that we just don't really fully understand or don't get taught. And we were chit-chatting a little bit before we started recording. We were talking about a very challenging sort of state of sexual health, reproductive health, education here, especially in America, I'm sure, around the rest of the world. So I'd love to start off this with, let's think about female anatomy. What are still some of the top myths that you see floating around there that could be a great place to start the conversation? Oh, there's so many in female anatomy.

I mean, I think the sad part is that many people don't know where the clitoris is. So you'll see some TikTok videos where they ask men, like where's the clitoris and they don't know. They can't, they can't pick it on an anatomical image. So I think that's, One huge, one, two, we've talked about already that the keros is the homilogue of the penis. And I think a large number of people still don't know that, that that's actually the organ of pleasure. And in fact, it's the only organ in the entire body that's there just for pleasure. There's no other function of that organ, right?

Whereas men have a penis that urinates and also has pleasure. But this is literally the only organ that's there just for pleasure. Can I jump in one second? Yes. And this is something that I understood, you know, much later after my, you know, this probably in like, I think I was even out of college is that, and correct me if I'm wrong, right? I heard from a friend who said that women can get boners. Their clitoris, actually, you can't see it in terms of when this happens, but when they're

getting aroused, there's an enlargement of the clitoris, but it's a boner on the inside. Is that accurate? Absolutely. Actually, if you watch carefully, you can see it. but most people are like in the mood. They're not looking that carefully. But yeah, so the clitoris actually extends very deep into the pelvis and then wishbones out.

So that's why women do derive pleasure from penetration because the clitoris is on the sides too. And so there is a very long clitoris there. It's exactly, if you look at like an anatomical dissections, it looks exactly like the penis. If you cut the clitoris open and you cut the penis open, they look identical. So it does engorge.

It does enlarge. And it does respond to arousal. And so it also has a clitoral hood, just like men have four skin. If they haven't had a circumcision, women have a clitoral hood. And that hood can be pulled back a little bit. It can be pulled forward. But essentially, sometimes women can get smegma just like men can. They can actually develop like dead skin cells and oil, and that can create discomfort in that area. And so we don't know the true sort of incidence of that because it's just not talked about very much, but we're starting to see it more and more in women where they're actually having that foreskin, that hood gets stuck to the

clitoris and cause problems. Maybe they're having difficulty orgasming. Maybe they're having pain. So that's another thing. Two, I think just generally, like the entire thing is called the vulva. The vagina is just the canal on the inside. I mean, still people don't know that. So I think there's so much about anatomy there, but really, like, I encourage all women take a mirror look down there. Like, look at your own anatomy. Know what it looks like. I think there's still people who don't do that. I mean, there's, you know, when you come to my clinic, I'll give you a mirror and I'll show you all of your anatomy when you come and we do an exam because I think it's so important to know, okay, this is my labia. This is my labia. I have a friend who says, you know, because the

labia shrinks when you go through menopause, like if men's penis is shrank after 50, like we'd have a vaccine for it. And I always am like, yeah, like this is crazy. Like our anatomy changes so much during during our lifetime. So I think generally speaking, those are the important things and knowing, like, yes, you have three holes. You have a urethra, you have a vagina, and you have an anus. And I think sometimes people don't even really understand that concept. So it's variable, but just be empowered. Look at yourself. And partners look at your partner if they're a female partner and kind of know the anatomy. Don't be scared of it. It's natural that a lot of your content ends up being sister to a lot of the things that relate to what I would call loosely like

couples therapy in a way, right? Couples connection. We chatted about this one a little bit earlier, but you didn't share the name for it, and I learned the name through you, and that's this idea of sexual mismatch. So I have a few questions on this topic that are here. So first, if you could explain what sexual mismatch is,

and does one, do male, do men experience more sexual mismatch? than women. Do women experience more sexual mismatch than men? Obviously, regardless of the orientation of the, you know, the relationship, sexual relationship that they're in. So yeah, could you talk about sexual mismatch? So desire mismatch essentially is when one partner has higher or lower desire than the other, right? It's very straightforward. And probably everyone has desire and mismatch, right? Because it's not possible throughout a relationship, you will have desire mismatch with your partner at some point. There is like, yes, sometimes in the beginning you're so in sync. You all want to have

sex at the same time. You're always into it. You're always ready. But over a lifetime, there's going to be times where one partner is more into it than the other, and that will fluctuate. Usually, it turns out in a relationship that someone ends up being the high desire person and someone ends up being the low desire person. But most people are, you know, a lot of people, so a lot of people have it, but are they bothered by it? That's the real question. Like, okay, I may have higher desire, but like, I'll just masturbate more and it'll be fine. And we still get, we still have great sex when we have it and I'm fine with it versus the other way, where, where you're just, there's a lot of discord because you're not. And oftentimes the discord comes

from the high desire person. Like, why is the low desire person not wanting more? But it's actually, it's just a difference in preference, right? The low desire person just doesn't have desire as much as the higher desire person. That doesn't mean they're the one to blame, right? I think that's one where the first thing where people tend to have a problem is because they're blaming the other person when not in reality, it's a relationship problem. It's not an individual problem. And so this happens often and we often tribute higher desire to men and lower desire for women, but it's not always the case. But generally speaking, that's what we see more of.

And then, you know, I think there's a lot of things that you can do to sort of improve that mismatch. And I think the number one thing that we often recommend is scheduling time for intimacy. Now, I don't say scheduling time for sex because that puts a lot of pressure on people, right? Like one, it puts pressure on someone who's maybe need to get an erection to professing. it's putting pressure on the person who, who, like, what if it doesn't work out or I don't want to? Like, I still have to do it.

Like, no, just schedule time for intimacy. And this is because if you remember when you were younger and you got a date and you were like, oh, you know, you didn't have your own place. And you were like, okay, we're going to see each other on Friday and this person's parents not home. And like, I know I'm going to have sex. I'm really excited about it. I'm going to get ready, right?

I'm going to be like fully ready. I would be so excited. And you have time to build up and time to get excited about it. And so you got to treat it the same way. Like this is time for us to like get excited about having sex because we are so used to being together and it's always available to us, right? Our partner is always there for the most part that you're like, oh, you know, like, whatever. I'll get, I'll get around to having sex sometime or it'll, it should just happen.

Like it should just magically happen. Sure, it's going to magically happen when you're both working full time. You've got kids at home and like, no, it doesn't happen like that, right? That's not reality. Like, yes, sometimes it can. Sure, it's great when it does. but it often doesn't because other things take priority. You're too tired.

You're too, or someone wants to have sex in the morning and someone wants to have sex at night. Like everyone's a little bit different. So again, comes back to communication like we talked about earlier. What do you want? What do I want? How can we come in the middle and how can we make it fun for both of us, right? Like what actually like, oh, say, you know, you like to have sex the morning, I like to have sex at night.

Like how do we reconcile that? Well, okay, let's try for the morning like, you know, at this time. So the other person who's not usually into it can like cite themselves up. up for the morning or vice versa. Like the person doesn't do at night will like maybe take a nap in the middle of day or whatever they need to do to be ready to sort of kind of be intimate. And then saying intimate, like just be together. Just love each other. Just touch each other. Just like feel each other without the pressure of needing to have sex. Right. And if sex happens, that's great. That's ultimately what we want. But like the goal is to be together and be intimate.

And if sex happens, wonderful. And then as soon as you keep doing that, it will become more fun and more like, okay, now we're on the same page a little bit. Or we've compromised a little bit and we're both pretty happy. You kind of covered a couple of dues when you had a podcast episode on this. I think you were interviewing somebody and you both were talking about the importance of scheduling sex, especially for couples that have kids and busy lives, et cetera. one of the do's was kind of a do and don't. You know, a lot of people sometimes think like, okay, we're going to have sex after date night. But then you're full, you're bloated.

You don't feel as good. So even scheduling sex maybe before you get ready for date night and going out. So that's an example. Yeah, you drank too much. Whiskey dick is a real thing. So like don't, you know, you drink, you eat. You're not in the mood. Like, of course.

Like it's not as sexy when you've got a full stomach. Like just try to do it. be smart about it. I'm part of a men group, men's group. And every Thursday morning, there's a group of my friends. We, you know, we get together. We're going to walk. And we just ask each other a simple question that we stole from this group called Summit Series. We say, what are you celebrating in life and what are you navigating? And naturally leads to just all sorts of really great conversations. A lot of these are high growth men. You know, many of them have businesses. We want to better ourselves. We want to be supportive of each other. And there's, of course, this massive loneliness epidemic.

And, you know, men in particular, you know, suffer from it. So we want to be an exam. of a model that other people can replicate. We call it man morning. That's what we call it. We've been doing for eight years. You schedule your man time. Yes, we schedule our man time. We schedule our man time.

Anyways, one of the things that came out of there, a tip from one of the guys that was part of the group, is that when he thought about originally how him and his wife before they were, you know, together, they're in the dating face, how they connected. They would often see that they would go for like a workout, come back, have all this energy, shower. and then have sex. And that was a big turn on. It was exciting. And it would often happen in the earlier part of the day. Then later on as their relationship progressed, they had kids, et cetera. And they were thinking that this should just happen spontaneously or that they were thinking

that, okay, we're just going to get into the classic sort of date night and then have sex afterwards. And even if they didn't drink or they didn't eat too much, you have kids, you have life at the In the day, our brain tends to ruminate and tends to think about stuff, all the things that we didn't accomplish. So simply by scheduling their sex on a weekend and making more of a brunch date, working out, coming back, showering, having sex, and then going and having brunch, that became like their ultimate date night.

And I always want to share that as an example, that every couple is going to have that own version for themselves that's going to be like that. Yeah. I think that's really important. A lot of people are like, oh, I went to this Michelin's star restaurant, I did this, I did that. That's great if that's what you're into. But your date night doesn't have to look like that. And your date night can prioritize intimacy. And that's okay, right? That's great. And I think you did bring up working out. Working out, it increases

heart rate. It does some of the things that arousal does. So it actually almost primes us for being intimate or being turned on by your partner. So that's a great way to sort of like, you know, if you want to have a very healthy date night, you like work out, go home, shower, shower together, and then have sex. I mentioned some of your other top content that's there. I'd love to just do a little bit of going through some of the greatest hits that are there. One that comes up and is a big topic of conversation is pornography. You made a video called The Pros and Cons of Porn.

Walk us through some of the big takeaways from that video. Yeah, I think the pros of porn are it can definitely get you in the mood, right? If you are, like, you can watch you with your partner. You can get in the mood. It can help you sort of explore things that you can't explore in real life, maybe, like things that, like, you wouldn't normally do with your partner and just see if that, like, turns you on. And, and it's safe.

If you're watching porn and you're just, like, sitting at home, you're not, like, doing anything that's bad or dangerous, right? The cons are, I think it does, as I mentioned earlier, it's not a visual representation of real sex, right? it's not true sex ed. And so people will often use that as a barometer of what normal should be. And that's not what normal sex is. You're not like entering your partner and immediately they're climaxing.

That's not normal sex. Often it doesn't show foreplay. Often it's not showing how long sex really lasts or how easy or difficult it is for someone to climax. And so or is someone really having multiple orgasms like that? Is that normal for everybody? Not really. And so I think that's where the cons are is that really like people,

are using it as sexual education when it's not, that's not what it's there for. It's there for entertainment. What about the overuse in porn or the, yeah, what about the concerns around overuse of porn from looking at a lot of your content? I feel like you have a very nuanced approach to this topic. Yes. I think that when we look at the literature, we see something like they don't call it porn addiction, they call it problematic porn use. And we see it in about 4% of people. So it's not a huge number. And while there may be more, that's what's in the literature. And basically what that is is that you are using porn over anything else. You'd rather watch porn than be with your partner. You're watching porn to the detriment of your life. Like you may be spending

money on buying porn subscriptions. You may be not going to work or going to work late. You may be not interacting with your family. Whatever it is, but you're basically, and it's sort of an addiction model, right? The way our body gets addicted to certain things, it can get addicted to pornography as well. And so when you find that you're in that situation, that's a red flag. And people often know. It's not like they have no idea what they're doing. Like they know that, okay, I'm, I'm like doing this and I should be doing something else, but their brains on them, oh, just, just do it one more time. Then we'll deal with it tomorrow. We'll not watch it tomorrow. And your brain is sort of telling you to continue to do this activity because it feels good. It's releasing all these dopamine

endorphins and it makes you feel good in the short term. And so people are seeking that. And the problem with it is that when you, it's with any addiction, when you seek something that gives you this endorphin rush, you then need higher amounts or more novel amounts of it to get that same rush. So you're not just, say you watched it for five minutes and next thing you need to watch it for seven minutes, then 10 minutes, because you're not getting the same enjoyment or the same amount of pleasure that you were when you originally watched it. And that's how it becomes a real problem. Or you need more aggressive types of pornography or different types. And that can be where you're seeing like, okay, this is starting to become a real problem. And that's a

and it's affecting my life negatively. So on one side of the spectrum, you chat about how shame is a real thing and that a lot of the dialogue that's out there that says, you know, in particular geared towards men, men, you need to stop watching pornography, like cut it out cold turkey. It seems that one of your concerns is that if we bring that in and that often comes with maybe a shame component that somebody's doing something wrong, what are the concerns that you have are the detrimental impact of that. Yeah, I think that really this is very nuanced and there's actually, so it's very nuanced. And I think that generally speaking, if you feel like

you want to stop watching pornography, right, there's obviously like a reason that you're seeking that information out, right? People who are comfortable in their pornography viewing are not looking at that information. They're ignoring that information, right? So if you are seeking that information out, one assess like why are you seeking that out? Is it because you're feeling shameful about it or is it because you're feeling shameful about it? Um, that's where I have the problem, right? Because it's, it's, it's okay to watch pornography. It's totally safe. It's not dangerous until it becomes, if it becomes a problem and it only becomes a problem in a very small subset of people. And so I think it's, it's challenging. There's a lot of people out there saying a lot of different things. Like you need to do

this to be a real man. I need to do this to, to, to, to, to, to, to, to, to, to, to, to, to, to, to, to, to, to, to, to, to, to, to, to, to, be the best version of yourself. And there's no harm in trying it. Like say like, okay, I'm going to try to abstain from pornography for a month and like you do it and you feel good. Then please continue doing it. Um, that's great. It's always reasonable to try different things. But if you're like, I'm suffering. I'm miserable. I'm like irritable because I haven't had, I haven't, I haven't, I mean, one, I think if you shouldn't be relying on porn for your, for your self stimulation, like you can fantasize, you can listen to stories, you can do other things. So if you're only relying on pornography to masturbate or whatever, then that's probably like, okay, maybe I should

try something else instead of just using pornography. So if you find that you can abstain for a period of time and you're feeling fine, great. Then it's, you know, you're not, you don't have a problem with it. You find yourself being irritable and like, because, like, what's making you irritable? Like, is it because you can't have pleasure somewhere else? Like, kind of really assessing that because everyone should be able to abstain for a short period of time and be fine. But then, like, like that will sort of help you kind of assess. Is there a real issue or is this just shame? Like, am I just feeling bad about it? Like, and if it alleviates your shame, it's sort of a complex thing, right? Like if you feel better not using it, then don't use it. But like I think that ultimately realizing,

okay, I can't abstain. I'm not having a problem, but I still enjoy doing it. Then please do it. Like, it's okay. There's no reason not to. Part of that also includes just first and foremost having conversation and dialogue, especially if you're in a relationship, and making sure that on both sides that are we having and is our sexual life at the level that we both are desiring? And not having, a lot of people are not having that conversation. And so then they end up relying on other components to fulfill those needs. But part of what I'm hearing you is that as part of a sexually, sexual, sexually healthy life, a healthy sex life between a, you know, a couple, you know, pornography usage that's not

interfering with somebody's function or their desire from their partner. It can be, it can be part of a healthy life. Absolutely. And you can watch it with your partner. You can make it part of like a thing that you do together. It doesn't have to be something you hide away and do, you know, in a, in your bedroom by yourself when no one's home. Like you can make it something that you talk about, right? Or like, you might be like, oh, that's kind of fun. Maybe we should try something like that. Like it can be a way of self-exploration, but obviously realizing that it's not reality, right? Like what you see there may not be able to be easily replicated in your bedroom. And I think that the big concern I have with pornography is younger and younger people seeing it

because they don't have the frontal lobe developed yet to really understand what's real and what's not. And is that what they're thinking sex is like and bringing that to their first sexual encounter and then being disappointed and then developing real issues with like insecurity issues. of something's wrong with them because they don't look like what's happening on the pornography video. And so that's sort of where I really take issue with it. And I wish that more and more people talked to their children about this. Like I've talked to my oldest son about it. If you see something that is confusing to you, please talk to me. Like I want you to be open with me about it. And we talk about things all the time because he's getting to be to the age where he's going to start

looking at these things or maybe see them at his, with his friend's cell phone or something. Right. So I think it's important to like bring those conversations up and talk about them. He's probably going to kill me if he ever listens to this. We won't clip this for social media. One more topic. One more question about that topic is that there seems to be a general concern. You mentioned young men, young men in particular, their frontal loaves not being fully developed.

You mentioned the concern being that they think that this is what, you know, sex should look like. this, they think that the other side of the concern is that it's removing, and I have no idea of any data on one side of another, it's removing their natural desire to put in the effort to connect with either the opposite sex in most cases, in some cases maybe the same sex if the, if the individual is, is homosexual. But it's removing their desire to go and pursue relationships. So this might be one of the factors, again, I'm just telling you what I've heard. I would love you to chime in. This may be one of the factors that's putting men in a situation where young kids are having sex less often or that younger men are pursuing relationship less often. What are your

thoughts on that? Yeah, so we do know that young men are having less sex, right? There is actually data on this that young people are having less sex than they used to in, let's say, like, 20 years ago. And so the factors related that we can't say that it's necessarily related to porn consumption, but I'm sure that part of it is related, right? Because it's so accessible. I tell the story all the time because I think it's funny. Like when we were younger, we had to like find a VCR and like put a tape in a VCR and find a TV that nobody was watching and nobody was going to walk in on you to actually watch porn, right? Or you had to like find a magazine and hide it somewhere. Like it was not easy to get porn when you were young.

younger. Now it's just so easy. It's like your phone. You just have to type in a couple of words and you're there. And so that's sort of what makes me concerned about it in general is like, yeah, you know, what there's there's very few. Like you can put blockers up. Like I said, you can do as much as you can as a parent to shield your kid, but they're going to see it somewhere. Their friend may not have those same blockers. They're whatever. They're going to, they're going to see it somewhere. It's just too ubiquitous. And so I think the best thing that we can do in response to that is just say like, this is not normal. Model what a good, healthy relationship is like, model why it's important to be in a relationship. We talk with our kids all the time about how much value we find in each

other as partners and why it's so great to have a partner and why being in a relationship is so wonderful because we want them to have that. And I think like showing them that, talking to them about that is really valuable. Before I go into the next topic, I just want to mention, just while people are really in the zone here, you know, you launched a podcast recently. Yes, I did. And you also have your YouTube channel, which I've been referencing as well. Just if you could give those to a shout out and we'll link to them below. Sure. My YouTube channel is my name, Rina Malik-M-D. So YouTube.com at Rina Malik-M-D. And then my podcast is also the Rina Malik-M-D podcast. And on there, we're doing more long-form

content interviewing people in all areas of health, but also relating it back to sexual health. Well, one of the topics that you covered was related to this topic of supplements, supplements that support sexual health. What did you find from talking to some of your colleagues? Yes. So there are lots of supplements and supplements are essentially derived from plants, right? They're nutraceuticals and they are essentially a less concentrated version of many medications. So some of them will have the same sort of active ingredients that a medication will have, but it will be in a lesser concentration. And they tend to, the way my colleagues described it is build your sexual health.

So you're going to take it, if you're going to take a supplement, and it's going to take a few months to see if it works or not. It's not going to work right away. If you are taking something over the counter, like from a gas station, for example, that works immediately, it probably has Viaguer or Cialis or some formulation of that in it. And that's why it's working. It's not, like, it's actually, and it's not regulated so God knows what else is in there. Like is there pigs, testosterone or something else, we don't know. So actually, if you look on the FDA website, you'll see a whole host of medications, supplement medications that are on the website that are actually tainted with pharmaceuticals and so are not recommended. So definitely check that out.

But in general, supplements, they do all sorts of different things. So certain supplements will help boost testosterone. Some supplements will help reduce stress. Some supplements will help improve nitric oxide. A lot of them increase the either bioavailability of nitric oxide or the amount of nitric oxide that's released. And so there's a whole host of different supplements that are out there. The issue that we as physicians come across is because there's so little regulation is like what company to recommend, which brand is actually doing what's on the bottle. We've looked at studies where, for example, for melatonin, you will see that people, the amount of melatonin that's on the bottle, it'll range from less than half of what's on the bottle to 400% more.

of than what's on the bottle. So it's really hard to say like, okay, is what you're taking actually what you're putting, is what's on the bottle actually what you're putting in your mouth? So that's one challenge. And then, you know, it's deciding which supplement's going to work the best for you, for example. And then in terms of, you know, what the goal is. So there's like testosterone supplements, there's erectile dysfunction supplements or supplements for BPA. And some have been rigorously studied. Like, for example, for urinary issues for enlarged prostate, Sao Palmetto has been extremely rigorously studied in the medical literature. Like there have been Cochrane reviews, which are basically reviews of the highest order

that look at all sorts of studies on Sao Palmetto and have shown they don't really help. Do I still recommend them to my patients? Yeah, because sometimes if they don't want to take a pill or the pills aren't working and they don't want to have a procedure or surgery, then try it. It may help you. And it's reasonable to try things, but I think realizing like, okay, they have a certain amount of time where they, you know, you need to stick with it or it's not going to work. And I know myself, I'm not good at taking pills every day. So I would not be a good supplement taker because I don't

like to take pills every day. And so if you're like, I'm going to take it once in a while, like, it's probably not going to work. So kind of know yourself and then you can try and see if they help. And certainly there's, there's so many to go over. I think really just like realizing that there's several out there. Some have literature. Some don't. And figuring out what your goal is. So if it's, you know, you want better sexual function, if you want better testosterone, if you want fertility, if you want better urinary symptoms, kind of figuring out what that is. And in a good website, I think that's really useful for people asexamined.com. You can actually type in your issue and tell you which supplements have good literature behind it, which ones have less. And you could

sort of decide from there. Another piece of top content was on the topic of sexual positions. and in particular sexual positions that increase enjoyment and pleasure for both the parties involved. What are some of the things that you wanted to highlight in that video? So there's a couple positions. One is it was actually on sex life. It's called the coital alignment technique. And it's essentially where you're having penetrative intercourse. And the male is sort of on top, but trying to basically.

rub the clitoris with their pubic bone and you're both rocking together in motion. And so that sort of has been shown in multiple studies to allow for more higher greater rates of orgasm in women. And in generally, I mean, most of these studies focus on orgasms and women because men almost always orgasm, I think. But women tend to, in fact, there's data that shows like if you're looking at first time encounters with men and women, men will orgasm 95% of time. Women will orgasm about 45% of the time. But when you look at women who have first-time encounters with women, they're orgasming 90-95% of the time. So it's really sort of a probably a difference in anatomical knowledge and stimulation of the clitoris. And so these positions tend to essentially

stimulate the clitoris more effectively. So having the female on top generally allows her to angle her body in such a way where she's getting more clitoral stimulation rather than having the male on top. And so those, any sort of position where the female has that ability to angle her body in a certain way where she can, she can stimulate the clitoris better, then that tends to be lead to better orgasms. And obviously when you see your partner's orgasming more, that turns on your desire and then you are going to ultimately have more intense, more intense pleasure throughout that encounter. But I think, you know, the point here is not that there's a specific position that everyone needs to do, but that you should experiment and try to,

different positions and also realize if you're trying something sort of complicated that the first time you try it, it might not work, but you've got to practice at it. Sex is not something that you're just like you're going to be good at right away. It's a learned skill. You're going to do different things, you're going to try different things and you're going to get better at it with time. It's not like, oh, I just like, I'm just like very attractive and so my sex is going to be great. No, it's not how it works, right? Like you have to actually learn practice. And especially when you're with the same person, like you actually have that ability to really like try different things and be more vulnerable. And sex is such a vulnerable state. Like you are being completely vulnerable

with someone. So really like allowing yourself to be vulnerable and trying new things, that's going to lead to more pleasure. One of your other videos was titled, Where is the G spot? Yeah. So the G spot is actually an area. It's a zone. It's not like a button you can press. It's underneath the urethra. So in women in the vagina, about two to three centimeters in is where the the urethra is about two to three centimeters long. And so underneath the urethra, there's an area called there's the skein's glands. And those areas also have a highly dense area of nerves there. And so that can be very stimulating to very pleasurable to stimulate. And so generally speaking, some women will orgasm through G-spot penetration. But we describe it just like it's, the skeins glad

is actually analogous to the male prostate. So some men like prostate play and they will orgasm from prostate play. But that doesn't mean that everyone does. And same thing with the G spot. I think we think like, oh, it's this magical button that you're going to press and then women are going to go crazy. Like, yeah, they will find it pleasurable. They may not always orgasm from it. But it is an area that you can stimulate that can make things more pleasurable. So it's sort of like you put your finger in the vagina and do like a come hither motion. That's sort of where what you'll do to stimulate that area. I want to talk a little bit about origin story. Tell us about how you ended up being a doctor that not only sees patients, a urologist not only sees patients and helps them

with all the different struggles that they're going through, but that you're also a top vlogger on YouTube. Yeah. So it was actually sort of a fluke. I started being on social media really actively when I was a fellow. So during medical training for those of you who are not familiar, you go to medical school, then you do residency training for a specific specialty. And then you can do a fellowship, and I did a fellowship in female pelvic medicine and reconstructive surgery. So during that time, my mentor was the president of our society. And so when I went to the society meeting, I started tweeting about the meeting. And then they were like, oh, can you help us with the Twitter? And so as a, you know, as a good Indian girl and a good, you know, doctor,

I like, was like, okay, yeah, let me, let me help you guys. So I started getting really involved in tweeting and learning about Twitter and trying to really promote the society. And from there, I was like, okay, let me like try some other sort of avenues on social media. I was really interested in health literacy. And so the way this came about was I used to have a patient when I was a resident. And I will never forget her. She had bladder cancer. And we had to do a surgery on her to take out her bladder and we construct this new pouch

that she would now hold her urine in, but she would have to catheterize through a little stoma or opening on her belly to empty the bladder. So we did this beautiful surgery. She did great. Everything went fine. But then she kept coming back to the hospital, like very, very sick getting into the ICU. So eventually we figured out the reason she kept getting so sick is she wasn't catheterizing herself. Like she wasn't doing the basic thing she needed to do to keep herself safe and keep her bladder empty. And so that was when I realized, like, as a surgeon, as a urologist, I could do the perfect surgery. I could do exactly what they needed. But if they didn't understand what they were supposed to do afterwards or how,

their life was going to change after having a surgery, like I failed as a doctor, right? It doesn't matter how good I am. It doesn't matter how good my hands are. If I can't communicate well, I'm not a good doctor. And so I was, you know, I was in academics. I was trying to do research on health literacy. And I realized it would take me years before I figured out, like, what is the optimal way to teach people? And I knew that video was better than just writing things down and handing people papers. So that's where I started making content. And I said, you know what? I'm just going to try it for six months and see where it goes.

And so I tried it for six months. And at six months, I had like 1,000 followers. And I was like, this is amazing. I'm famous, you know? And so I just kept going with it. And I kept listening to what my audience wanted. And that's where I started making more sexual health content and realize that sex health in this country and around the world is so poor.

And I was really making people's lives better. Like I've had people stop me on the street telling me that their sex life is so much better or their partner's life is so much better or that they're seeing a doctor because of me and it's been so, so meaningful. But really, I had no intention of like becoming a social media person or, you know, making a big YouTube channel. It was sort of something that just grew on its own. Well, you've been doing amazing at it. How do your Indian parents feel about it? So it's funny because I made my first few videos, right? And my parents were super excited because they were like, oh, look, she's on YouTube. And I remember going to an event afterwards, like

someone's wedding and people were like, oh, you're famous. And I was like, this is so weird. More people came up to me about my YouTube channel than they did when I became a urologist. I was like, literally, I've gone through years and years of training, and I never got this sort of accolade. And I've made like a couple videos on YouTube and you guys are excited. But no, my parents are really supportive and they've been super, super excited about it and proud of me. So it's good. You know, the funny thing about, I'm also Indian as well. And the funny thing about a lot of immigrant cultures, regardless of where you're from, is that there's often, at least there was a heavy emphasis on, you know, get married and get married young.

Then there's the next emphasis on, you know, have a baby, right? And like as soon as you get married, it's like, when are you going to have, even before the wedding is done? It's like, when are you guys going to have babies? When are you guys going to have babies? And yet there's so little education on sexual topics. and there's even maybe a tendency to want to avoid talking about it. Absolutely. And it's an interesting, it's an interesting space.

You know, get married, have kids right away. We're not going to talk about anything related to any aspects of sex, let alone one of your top videos, which is what is squirting. Nobody's going to talk to you about any different aspects of any aspect of sexual health, which is why, I mean, it's great that the internet exists. because there are a lot of parents that probably don't know how to have these conversations. And you've been very open about you having conversations with your boys, especially your oldest, as he continues to get older. Any final tips that you want to live for parents that maybe don't have the confidence or the education that you do, but they're like, you know what, whether I came from an immigrant background or whether I just came from a more conservative background that did not talk about sex, I don't want that to be the future of our family.

I want to have a healthy dialogue with my kids about sex. Any tips that you would have for those rituals? Yeah, I just want to make one comment. I think it's so funny about South Asian families. I mean, we came like the Kamasutra is from India, right? And yet we don't talk about sex at all, right? Like, at all. And like I had a friend who was like, oh, I'm getting married and like I've been with

my partner for some time. My mom comes. She said, do you want to talk about your wedding night? And she's like, mom, are you serious? Like, I'm getting, like, you know, it's just crazy. So, but yes, in terms of talking to your kids, I think that one is just don't shame them, right? Like if they are touching themselves, masturbating, try your best to not shame them by it. Say, this is completely normal, although you shouldn't do it in public because it's not really

accepted to do publicly, but it's totally normal and safe to do in your bedroom by yourself. And this is a normal way to explore your body. Like, don't shame them. It's number one. Number two is if you don't feel comfortable explaining to them everything, you can just describe it in anatomy, right? Like, just say, I want to teach you about your body parts. Even as a young child, I would say let them know what the names of their body parts are, because they should know penis, testicles, scrotum, vagina, urethra, vulva. But they should

know what these terms are so they can describe them to you. Like, say they get hurt, right? Like my son, actually, the other day, we were playing pickleball and he got hit with a ball in the, in the groin. And I was like, where are you hurting? Is it your penis? Is it your testicles? And he's like, mommy, it's my penis. So he could tell me very clearly what was hurting. I could assess it and we can move on, right? So it's really important for those things. I think that's a very simple way to start. And then, too, you know, you can, you don't have to talk about sex, but you can talk about like, look, if you have something that you ever feel uncomfortable with, I want you to feel comfortable asking me about it. And when they ask you, don't say, no, I'm not going to tell you. Say,

this is, you know, just try to answer it the best you can. But don't be so close. off to be like, no, no, no, you shouldn't know about this. Like, they're going to learn about it, whether you want them to or not, and you were their best teacher. And in fact, one of the videos they made, we looked at some data on how people learn about sex and very few people learn from their parents. They're either learning from movies or pornography or from their friends. And those are not reliable sources. So, you know, having that being open to at least answering their questions as best you can, realizing that it's awkward for you too and it's not easy. but like just do it matter of factly describe it without emotion right you're just explaining what

happens and you know like they may ask more probing questions and be like okay you know we did a little bit today let's save this for another day as you get more comfortable because just like talking about sex with your partner is a skill talking about sex with your children is a skill and so I think just you know work at it slowly and do the best you can describe things without emotion and without like don't have sex like that's not that's not reasonable right Like you can't say don't have sex. People are going to have sex. If you want to have babies, they're going to have sex at some point in their life. And so giving them the tools to understand what's happening to their bodies, understand why they may feel a certain way and to stay protected.

Like they will learn a little bit in school and a lot of parents will, you know, mistakenly think they're going to learn a lot more in school, but they're not going to learn enough. And so it's, you know, our job to make sure they know that they know how to protect themselves, have safe sex and also feel comfortable and know what consent is and all those things, but also just that they know normally what's like normal for their body. Well, it seems like now more than ever, besides all the dysfunction that we see out there in the world, the shame that we see out in the world, now more than ever we need healthy conversations around sex, which spills over into a lot of other categories besides just the physiological process of sex. And one of those main reasons

is that I don't know how much you look in this area, but population collapse in certain countries and procreation is a real thing. Yeah. In some of the Asian countries, Korea, Japan, in countries like Italy, in Europe, we're not even at a place. And there's so many different factors that play into this, the economy, the state of, you know, state of macroeconomics, et cetera. But I can't help but to think that one of the things that plays into it is all.

also just the idea of having healthy relationships and conversations around sex. It's becoming more challenging. And there's a lot of factors. And, you know, in fact, in one of the countries, they can't remember which one, but they're actually like paying people to go on vacation or they're subsidizing vacation because vacation is a time when people often have more sex because they're relaxed and they tend to be more likely to have sex. And so they're actually, that's one of the techniques that's something.

I forget which country is using to, you know, increase the population. But there's a lot of factors that I certainly think that the rise of the digital era makes people more isolated, right? They're able to communicate. Like when you see kids hanging out nowadays, they're often just all looking at their phones and they're not actually having as many conversations as they used to. Some kids don't even really know how to have like good conversation with adults or like, you know, communicate without chatting or texting. So I think that's part of it is that we're having a difficult time like connecting with people. COVID made it more isolated obviously as well. But in the U.S., in particular, we're a very individualistic society, right?

We are into our own families. We do our own thing. We don't rely on our neighbors. We don't ask for anything. And I'm sure your parents or mine will tell you, like when they were raised, like the whole neighborhood raised them. Like they were outside playing and anyone could come and yell at them or tell them what to do and they would have to listen.

And they, you know, my mom was one of eight siblings and same with my dad. Like there was no way that one mom and dad could. raise all those people. They needed help. And I think there's a lot of factors, basically. Yeah. Childcare for women, daycare. If we relied on other people, we wouldn't need so much child care or if it was subsidized by our government. But, you know. Totally. This has been fantastic. Dr. Rina Malick, I so appreciate you coming on the podcast. You have a practice. I do. People can go and see you. Talk a little bit about it. Yeah. So my practice is in Newport Beach, California. I think the real value of my practice is that we get to spend time together. So when you come see me, I spend an entire hour

with you. We really dig into what your goals are because my goals don't matter. Your goals are what matter. And we really want to make sure that you're getting the best experience you can in terms of your sexual health, bladder health, hormone health, or if you're having pelvic pain, we want to get you to where you want to be realistically and work together to get there. And, you know, I'm the kind of person who, if you need help in between visits, I'm going to be there. I'm going to respond to you. I'm going to research. I'm going to figure out what is out there that can help you. And so if you live in the area, you want to come see me.

I'd be happy to see you. Amazing. And if you don't live in the area, you also do educational visits online. I do educational and virtual visits. I'm licensed in seven different states. So I can still see you as a patient if you're in one of those states. If not, I can see you for an educational visit. Incredible.

Well, we'll have the link to your practice in the show notes. People can find you. And we'll also have the link to your social media, including YouTube. And you're also very active on Instagram as well. I love all the clips that you post on there. And now your podcast. If you're looking for another podcast to dive into, your podcast is available as well. We'll put the link in the show notes.

Dr. Rina Malik, this has been fantastic. Thank you so much for coming on the podcast. Thank you for having you. Hi, everyone. Drew here. Two quick things. Number one, thank you so much for listening to this podcast. If you haven't already, subscribe, just hit the subscribe button on your favorite podcast app. And by the way, if you love this episode, it will,

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