Shawn Ryan Show - #250 Rena Malik - Urologist Debunks #1 Sex Myth Every Man Still Believes

Episode Date: November 3, 2025

Rena Malik, MD, is a board-certified urologist and pelvic surgeon specializing in sexual medicine, urogynecology, hormone management, and pelvic pain. She completed her medical education at New York University Grossman School of Medicine, followed by a urology residency at the University of Chicago and a fellowship in Female Pelvic Medicine and Reconstructive Surgery at UT Southwestern Medical Center. Practicing in Newport Beach and Beverly Hills, California, with affiliations at Tibor Rubin VA Medical Center and University of Maryland Medical Center, Malik has over 10 years of experience treating conditions like urinary incontinence, overactive bladder, and sexual dysfunction.  Named the 2023 American Urological Association Young Urologist of the Year and a Top 10 Health Influencer by Men’s Health in 2023, she has hundreds of millions YouTube views and over 2.5 million social media followers for her science-driven content. She hosts the Rena Malik, MD Podcast, offering expert advice on health, sex, and relationships, and has published over 80 peer-reviewed articles. Shawn Ryan Show Sponsors: Preorder Call of Duty: Black Ops 7 now - https://www.callofduty.com Buy PYSOP: Target Intelligence - https://psyopshow.com https://americanfinancing.net/srs NMLS 182334, nmlsconsumeraccess.org. APR for rates in the 5s start at 6.327% for well qualified borrowers. Call 866-781-8900, for details about credit costs and terms. https://betterhelp.com/srs This episode is sponsored. Give online therapy a try at betterhelp.com/srs and get on your way to being your best self. https://blackbuffalo.com https://meetfabric.com/shawn https://shawnlikesgold.com https://ketone.com/srs Visit https://ketone.com/srs for 30% OFF your subscription order. https://USCCA.com/srs Rena Malik Links: Linktree - https://renamalikmd.com/linktree Website - https://renamalikmd.com YT - https://www.youtube.com/@RenaMalikMD X - https://x.com/RenaMalikMD IG - https://www.instagram.com/renamalikmd Podcast - https://podcast.renamalikmd.com FP - https://www.facebook.com/RenaMalikMD TT - https://tiktok.com/@renamalikmd LI - https://www.linkedin.com/in/renadmalik Pinterest - https://www.pinterest.com/renamalikmd Threads - https://www.threads.net/@renamalikmd Sign up for Yourology Newsletter - https://newsletter.renamalikmd.com Link to schedule an appointment - https://www.renamalikmd.com/appointments In person in Beverly Hills or Newport Beach, CA and virtually in CA, FL, IL, NY, NJ, MD, TX, VA Learn more about your ad choices. Visit podcastchoices.com/adchoices

Boarding for Flight 246 to Toronto is delayed 50 minutes. Ugh, what? Sounds like Ojo time. Play Ojo? Great idea. Feel the fun with all the latest slots in live casino games and with no wagering requirements. What you win is yours to keep groovy. Hey, I won! Boating will begin when passenger fisher is done celebrating.

19 plus Ontario only. Please play responsibly. Concerned by your gambling or that if someone close, you call 1866-3-3-1-2-600 or visit comixonterio.ca. Get no frills delivered. Shop the same in-store prices online and enjoy unlimited delivery with PC Express Pass. Get your first year for $2.50 a month. Learn more at p.cexpress.ca. Rina Malick, welcome to the show. Thank you so much for having me.

It's truly an honor. Oh, man, I've been looking for it. I told you at breakfast. I've been looked. I didn't even think we were. going to get you. Oh, no. But me and my wife found your channel years ago and I was, some of the titles, I'm just like, we got to watch this stuff. Everything from what's the average length of sex, squatters, how many times should Ben ejaculate? Like, it's just the titles are so bold

and it's questions that everybody has, but everybody's too embarrassed to ask the question. And And you just do an awesome job of covering all that. So, I mean, I'm glad to give that advice because I don't feel like anyone's really answering those questions in a way that's professional and authentic and genuine and explaining like why. And so I'm grateful to be in the position to be able to do that. Well, it's congratulations on all your success. It looks like a rocket ship.

Thank you. But everybody starts off with an introduction here. so rena malick a board certified urologist and fellowship trained specialists in female pelvic medicine and reconstructive surgery expertise in sexual medicine hormone management menopause and non-narcotic pelvic pain treatment you run a private practice in beverly hills and newport beach California. Also, you work at the VA. 2023 American Urology, Urological Association, young urologist of the year, a content creator with over 2.5 million YouTube subscribers focused on evidence-based discussions of taboo health issues like sexual dysfunction and bladder

health. Like I said, some of the titles that I've seen is, does size matter, squirters, does pineapple change the taste of semen? There's the G-spot reel. Penile imple. plants. I mean, you cover all of the taboos topics. And I just, I love watching yourself. Thank you. Thank you so much. So a couple things to get through. One, everybody gets a gift. Amazing. Thank you. Those are Vigilance Elite gummy bears made in the USA. And it's just candy. Legal in all 50 states, although you don't have to worry about that out in Cali. That's good, yeah. And then we have to worry. have a subscription account on Patreon, and a lot of these folks have been with us since the

beginning. I think we're getting close to 100,000 subscribers on there now. And so, you know, we built it into quite the community, and they're the real reason that I get to be here with you today. And so I offer them the opportunity to ask each and every guest a question on the show. This one is from Austin Coates. If 40 years old and nine years into recovery, from opiate addiction, I've done deep, deep, emotional and spiritual work that sobriety demands, but I still find myself wondering about the long-term physical impact of addiction. Does chronic substance use accelerate biological aging in men, and how does long-term sobriety affect the brain and body's ability to heal? Specifically, can neuroplasticity and recovery processes

fully reverse the damage? Or are there systems like hormonal, cognitive, or metabolic function that remain permanently altered? I mean, the body is very resilient, right? So it depends on how long you were addicted, how long you've been sober, but your body can recover. It just is very individualized. So I can't give you like a blanket statement

that, yes, after this many years, you'll be good to go and everything, you'll be back to baseline. There may be permanent neurologic damage that is very difficult or impossible to reverse, but I will say, like I've seen many people with traumatic brain injuries, with really severe issues that, you know, can even despite those issues, have very healthy,

long lives. And sometimes they do require maybe some replacement of hormones, for example, but that doesn't preclude them from being optimized, living their best life, and feeling good and being able to be healthy and be good partners, be good parents, be good workers, all those things. So I think the reality is you might need some help, but even if you do, you can still live a great, wonderful, healthy life and be able to contribute to society in a meaningful way. Oh, that's good to hear. I mean, I'm recovering from addiction. I wonder the same things. I thought that was the perfect question. And, you know, especially talking about traumatic brain injury and I don't know if we're going to go into PTSD, but you work at the VA,

you deal with a lot of veterans. We have an enormous, probably the biggest veteran viewership subscriber list in in the country at least and uh so i know these these are behind the scenes discussions that we're all having about this kind of stuff and so uh i've loved to clear some of that up but i want to i want to i want to ask right off the back because we're primarily focused on men's health for this one and we're going to release this men in men's health month and our men's health awareness month but the score i think the squirder YouTube video that you did was the first one that I saw, and I was like, I have to see this. So what, can you just go into that?

Yes. So squirting, obviously, is a very popularized thing. And everybody wants to know, like, does everyone do it? Is it normal? Like, what is it? And so let me just start with the biology, right? So biologically, what is squirting? There's squirting, there's squirting, there's female ejaculation, there's normal lubrication.

There's all these fluids, right? So normal lubrication. one's pretty familiar with. It just occurs when a female is aroused. She has normal lubrication from the walls of the vagina, essentially, and some little glands on the side. And then there's female ejaculation and they're squirting. So squirting is like this clear, odorless fluid that's emitted at the time of orgasm. It's usually voluminous. It's usually what I've been told tastes a little bit sweet. And so this is this fluid that some women, not all, so it's a probably like 40% of women will squirt when aroused fully.

Now, where is it coming from, right? I think that's what people want to know, is it pee? And so, obviously, it's coming from the urethra, which is like the p-tube. And so the bladder, when it fills, normally you pee from the p-tube or the urethra. Now, it is coming from there, but it's not urine. They've actually looked under microscopes and looked at like, okay, let's compare what's in pee to what's in squirting, and they're similar but different. So squirting is usually like a very dilute form of urine.

and it also has another substance, and it called PSA. So you guys might know PSA is something that you get tested when you're screening for prostate cancer. The prostate emits PSA. It's called prostate-specific antigen. But, you know, think about when people develop, when babies develop, they start from the same structures, and then you have signals that say, okay, you're going to become a female or are going to become a male.

So we have homologues. So the female prostate is called the Skeens Glans, and that's located basically underneath that urethra. about two or three centimeters in, and it has these little tiny, like, glandular structures that produce fluid. And so that is where the PSA comes from. So it's a mix of a very dilute urine with this PSA substance that's coming from the Skeen's glands when it's stimulated or when you're aroused. And so there's a few different theories. They've done lots of studies, well, not lots, but they've done, like, three or four studies on squirting. They've actually

put, like, dye into the bladder and then had people squirt and see, like, is it blue? Or is it, like, they use blue dye and they've seen yes it is blue they've done studies where they'll like scan the bladder before someone squirts and then they the person squirts and then they check the bladder again okay it's empty so it's probably urine and so there's there's a lot of people who think like yes it's urine but there's other experts who would say like well when you're aroused there's a bunch of hormonal changes and so it may change the way that your kidneys filter and so you're not getting exactly urine you're getting this very dilute fluid that's very distinct in terms of color and odor and all that, but it is obviously coming through the bladder.

And so I think ultimately, like, there's a lot of hubbub about it. At the end of the day, it doesn't really matter, right? What matters is that is the person squirting, enjoying it, right? Do they actually like it? And so when you look at that, what you find is that it's mixed. So some women are like, yeah, it's a superpower. I feel great. I'm amazing. I can squirt. I really enjoy it. It's very pleasurable. Other women feel like they don't know what's going on. They feel embarrassed. They feel like it's messy. and other women are like sort of ambivalent. Like whatever, it's just kind of a mess to clean up, and it's fine.

So I think, like, the reality is that, like, when you watch erotic films, it makes it seem like everyone squirts and squirting is this really amazing visual representation of pleasure. The reality is that, like, pleasure, the way you can tell a female has pleasure is you ask her, right? Like, did you enjoy that? And what can we do differently to make it better or not better, right? Like, what was good, what wasn't good?

Just like you would ask anybody anything, right? But we don't do that. We want to see it, right? And men are very visual because they ejaculate. So they're like, oh, like this is female ejaculation, which is actually different. But this is like them reaching climax. I can be sure they're climaxing because I see this visual representation of it. And the reality is the majority of women don't squirt at 60% or so don't. And that doesn't mean they're not orgasming or having a climax. They are. And they're probably having a lot of pleasure when they do climax. And even if they don't climax, which some women have struggle with that the entire process of having sex can be pleasurable so i think it's really like

let's not focus on this one end product of sex and actually look at the whole thing and like let's talk about pleasure as a society and let's talk about like what that means for you and your partner and actually enjoy sex as something that we do and we join and we have this like meaningful connection with another human being, rather than focusing on, like, these really arbitrary markers for pleasure. So, I mean, what, what is it about some females that enable them to do that versus others that,

I mean, why do 60% of females not score? Yeah, so we can't be 100% sure, but I suspect that it is because of variations in anatomy and how women are aroused. So we think, like, yes, maybe if you arouse that skein's zone area, which is actually where we think the G spot or it's actually a zone, G zone is, is that right around that skein's glands, that maybe that would be more likely to cause someone to squirt. The other thing is that, you

know, it may be also like, how thick is that anatomy? Like, there is variations. They've actually looked at ultrasounds and some, some is thicker, some is thinner, some is more, some skeins glands are more voluminous than others. And so there's probably variation why some can and some can't. But again, it's not mandatory. And I think that's really the take home. It's like, it's not mandatory. And just because someone, can't, they shouldn't feel, like, deficient in any way. And just because someone can doesn't mean that they're better than someone else. Again, the goal is pleasure. And so, like, I find it very awkward. Like, some people like, oh, can you squirt? Like, oh, this is so amazing. Like, that's

great if you can. And yes, there is some people who believe you can be taught to squirt. And again, like, I think there is some potential, like, you know, you can try to stimulate those areas. You can maybe fill the bladder, like, don't pee right before sex. There's probably some things there that can make that more likely. But again, it's not the squirting. It's the pleasure that we want to focus on. Man, that's interesting, interesting. All right, so I want to move into,

I want to do a little bit of a life story on you and then get into all the health stuff. But, I mean, where did you grow up? I grew up in Buffalo, New York. Buffalo, New York. Yeah. What got you under urology? Yeah, so it's actually not something I even knew existed.

It's not a specialty I went into medical school thinking, like, oh, I'm going to be a urologist. I went into medical school thinking I would be like a cardiologist or something, and I went to med school, I did my rotations, and then I realized that, like, I really liked surgery. I liked operating with my hands. I liked being able to fix a problem with surgery. Whereas, like, when you take care of patients with medicine, it's much more like long-term trying to fix their issues. And so then I, but I didn't love general surgery, which is like surgery where you do all different body organ structures. And so I looked at the subspecialties of surgery. And so those were urology, obesity, obesity, obstet, orthopedics, E&T, and ophthalmology, which is eyeballs. Optomology very quickly, I saw one operation.

It was like, this is not for me. I don't like eyeballs, so that was easily taken off the table. E&T, so orthopedics, very power tool-heavy. The culture was very, at the time, kind of bro-y. And I was like, okay, I don't really fit in here. And so then it was really between E&T and neurology. There's also other subspecialties. Oftentimes you have to go through a

general surgery residency to do those or neurosurgery is also separate but that's like that's just a very intense field that I wasn't personally interested in. So I looked at those two fields. I went to their operating rooms. I met the people and I was like, okay, like they both do pretty cool surgeries. They both do, you know, have a very nice culture. But I honestly, when I met urologists, I was like, okay, I found my people. These are like very smart, very intelligent, very innovative of people, but they also don't take themselves too seriously. Because when you're dealing with you're going to tell you all day, like, you just can't. You can't be, like, so intense about everything. It's, like, sort of a funny field and funny things happen. And so I was like, okay,

these are my people. And the reality is when you're in medical school, you sort of take a leap because you can't ever know what it's really exactly like to maybe do the surgery or to be the one taking care of all the patients, all yourself. And so you take a leap of faith. You're like, okay, I like this. I think this is going to be the right fit. And sometimes people switch their change their minds and go to a different specialty. But for me, it was absolutely the right fit. And I love every part of urology. I think we are very honored and privileged to take care of patients at their most intimate issues and take them through that. But we also get to take care of patients for a long period of time. So like we take care of long lifetime issues. So they don't just come

and have surgery and leave. Like they may have to deal with medications or do other things. And so we touch base. We keep that long-term connection with patients, which is really great. Warning. This product contains nicotine. Nicotine is an addictive chemical. Black Buffalo products are intended for adults aged 21 and older who are consumers of nicotine or tobacco. Black Buffalo has supported me since the early days of the Sean Ryan show. And back in the seal teams, I chewed constantly on the range and sniper hides before and after operations. It was part of my routine and it was a ritual. I wish this alternative had been around back then. Black Buffalo is one of America's only smokeless tobacco alternatives.

Black Buffalo was established in America in 2015, and it dips just like the real thing. Without the tobacco leaf or stem, it's made for real Americans that love the ritual of dip. You can find Black Buffalo at thousands of retailers across the U.S. like Sheets, Wawa, CircleK, Racetrack, Pilot, Loves, and more. Check out their store locator at Blackbuffalo.com, or you can buy. it online and see if they will ship directly to your door in your state. Black Buffalo's tobacco alternative. It's everything you love about dip and nothing you don't. A lot of dark stuff going on in the world right now and it's to the point where I don't even

believe my own eyes anymore because I cannot verify what people are saying about all the political violence, the division. I partnered with this production company called Ironclad and we're doing an eight-part audio series on SIOPs, on why foreign countries, governments, maybe even our own government, would conduct a SIOP on its own people. And I just think that this series is going to be extremely important because it's going to open the eyes of people on why these things happen. You can head over to Sciopshow.com, order it today. I think you're going to get a lot out of this. Who's pulling the strings? Who's pulling them? I had you to say, what is, what is, you know, in your intro,

non-narcotic, pelvic, pelvic pain, was it reconstruction? Well, so there's, yeah, there's reconstruction, there's pain medicine, too. So pelvic pain is a really challenging issue for a lot of people, so they deal with chronic pain in their pelvic region. I see it in vets too, I mean, commonly because it's my specialty, but I see it. and it's very difficult to treat, and it's very challenging for a lot of people to live with, and a lot of times they just get treated with pain medications, and so we try to offer them options that are not necessarily pain medications to help manage those issues.

But pelvic reconstruction is basically, we are sort of like the creative surgeon, so we'll see a problem, and there's multiple different ways to fix it, and you'll sort of figure out what is the best way for that individual person. So it could be like a narrowing of the urethri, it could be a narrowing of the, tube that drains the kidney. It could be in women, like when they have things like prolapse where they're, they have like sort of a vaginal hernia. There's a variety of different surgeries that we can offer to help sort of reconstruct things when they're broken. And sometimes they're very complex and sometimes they're simple, but it's sort of

like I was drawn to it because every surgery is a little bit different. And you get to like sort of look at it and approach everything a little bit differently. And there's no like formulaic way to go about it. It's sort of like, okay, every person is individual, so I have to look at them as an individual and really come up with the right plan for them. What, then, I'm just curious. I mean, it's great to see somebody like you inside of the VA. I mean, I haven't been there in a long time, so I don't know how it's really going, but didn't have a good experience roughly about 10 years ago. And so I'm just curious. What, what, do you come from a family of veterans or?

No, I just loved, so I trained in New York, and I went to the Manhattan VA, and then when I started my first job, I worked at the Baltimore VA, and I just love taking care of veterans. I feel, one, very honored to do so. Like, you guys have served our country. You've done so much for us. So for me to be able to give you back some semblance of health, like, it's so valuable to me. Like, I feel grateful at the end of the day. And two, I just feel like it's just a different care. of patient, right? They're respectful, they're kind. They want the best for themselves, right? They really do. And sometimes they're struggling very deeply through some, you know, through a lot of things in their life. But they really, they have this drive to get better, right? And sometimes they don't get the tools to do so, but they really do want to. Like they're not going through life, like just accepting, you know, sort of whatever comes to them. They want to get better. And I think that that is so unique and honestly, like, it is really, I feel grateful every day that I get to go to the VA. Well, thank you for doing that. And then your YouTube. So you said that you started in

2019. Yeah. What, I mean, being a physician in a really good one, I mean, how did you, how did that even pop up on your radar? Why did you start the channel? Yeah. So I, when I was in, I was an academic medicine, I was doing what we, like, we do research, right? And so one of the research area, that I found really compelled me was health literacy. So, like, I would have patients come and they would get to see me for maybe 30 minutes, maybe 15 minutes, depending on what they were there for. And I would give them all this information, but it was just not enough time, right, to really explain, like, why and what, like, I only have so much time because insurance only reimburses so much, and you've got all these pressures to, like, you know, see a certain number of patients

or, you know, or you're going to get in trouble by the power of big brother, right? And so you get in this situation where you're not able to really give patients the time and energy they deserve, right? And so you're like, look, this is a problem that you have a lot of power to fix, but I can't go through all of these things with you in 30 minutes. And so I realized I really wanted to be able to reach people at home and be able to teach them so that they would, you know, be able to learn and understand better. And once I think people understand what's going on with them, they can then, like, you can actually take the steps you need to take. But if you don't understand it and your doctor just gives you a pill and says, go, bye, see you later, see you in six

months or a year, like, you're like, I don't know what's going on with me. And I don't, like, you just feel like that's all you can do, right? And so I, and even with surgery, like, I do a lot of quality of life surgery. And so if I do surgery on someone and they don't understand, like, what could happen, what complication could happen or how their life is going to change, now I failed as a surgeon, right? Because I operate on someone who didn't completely understand the situation. So I felt like this was something really important to me, but I realized that doing it through the traditional research route would take me decades before I got to a point where I was really reaching the masses. So I said, let me try this, right? Let me

try educating online. And so I was like, okay, I'm just going to try YouTube. Like, why not? And so for six months, I just made a video a week and I had no idea what I was doing, but I just like did it, right? And then as I started doing it, I realized like, wow, there's so much need for sexual health education. There's people know nothing, right? And they're getting preyed on by people who don't know much either, but are trying to make a quick buck, right? They're praying on desperation. People are desperate to have better sex lives, and they will then pay money to get better sex lives to anyone that will offer it, right? And so I felt like, okay, this is going to be my, what I give back to the world, is I'm going to educate them on how to help them have better sex, have a better

life, feel better, feel stronger. And it just was, after six months, I was like, oh, I have a thousand subscribers. That's it. I'm going to keep going. And I felt like I was famous back then. I was like, this is great. And then I just kept going. And I'm still so grateful that people tune in to me like every week and learn from me. And it's so motivating. And it's really amazing to be able to reach that many people. Well, congratulations on all the success. that you've done a, you've done an amazing job with it. I mean, I'm curious, I mean, do you get any backlash about some of the topics that you cover?

Of course, of course. I mean, I think a lot of backlash comes from things like that people feel very passionate about and they feel like they know because of their personal experience. And I, what I really, and I'll give you some examples, but what I really want people to realize is like, I'm not trying to invalidate your experience. I'm just telling you what the science is

And, you know, your life's experience is your life experience. So, for example, semen retention is something people feel very passionate about. The people, semen retention is the practice of abstaining from any form of ejaculation, whether it's through a partner or through masturbation. And people, and I started like sort of no nut in November. And I was like, oh, let me just debunk this. Because I was seeing patients who would try to abstain. And when they did, they would tense up their pelvic floors, which was like these muscles

sitting here in our pelvis that hold our organs up. And then because of that, they would start having other problems. They would start either having pain with erections or ejaculation. They would start having the need to go to the bathroom more often or they'd get constipated. And it was because they were like white knuckling, trying to hold back, trying not to ejaculate. And it was causing them harm. And they were stressed, right? They were super.

They felt like failures when they did. They were unhappy. They were feeling bad about themselves. And they were like, oh, I can't do this. Like, I'm struggling. I'm a failure. And so I wanted to, I wanted to target those people who felt like, oh, I need to do this because people are telling me it's so great.

And I'm like, look, it may be great for some people. And it may make you feel better. It may make you more able to focus on things or have more brain clarity. But that's an individual experience. And it's very nuanced. So I wanted to give people who felt this sort of like failure or felt this sort of stress or anxiety around it to not feel that, right? Like not feel like they had to do this to achieve some sort of.

higher being. What, I mean, how did that even, how did that even, what, what's, what's the myth? Like, what do you, what do you supposedly get out of no, not November? So no, not November was actually, like, came from a meme, right? Like, somebody was like, oh, no, not November. We're going to start no November on November 1st, and like by midnight, oh, I failed already, right? And then, but it took off. And, but semen retention as a practice is actually like a Buddhist, Taoist practice that, that, and there's some religious or spiritual background behind it, people felt that if they would abstain from ejaculation, that they would be able to focus more on spirituality, on God, or a higher power, and they wouldn't be distracted by desire and urges for sex. And so that's sort of where

it came from. And from that, you know, they would think they would get all these health benefits, like they would get this brain clarity, they would get testosterone boosting, it would improve fertility, like all these things. But the reality is those things have been looked at scientifically, and there has been no true meaningful increase in testosterone or fertility. In fact, if you abstain for too long, you can harm your fertility. And so I think the reality is, is there a physiologic benefit? Not that we see right now, based on the evidence that we have. And, but if you see a psychological benefit, by all means, please go ahead. But just don't make other people feel like they have to do that, you know, because everyone is different and they're, you know,

ejaculating or being intimate with their partner or masturbating may be a really valuable part of their lives that now they feel like they have to give up on because they hear something that they think is like, oh, this is so much better for me to do this. Man, it just seems like something that would cause a lot of sexual frustration and, and that would, you know, be amplified during the month as the month goes on. But I mean, the thing is, like, some people, what happens is when you abstain, you stop, like, you may be able to, like, particularly for people who are very fixated on, on sex, they may be able to then, like, once they get over that hump, they may then, oh, I'm more focused on other things. I'm more, I don't think about that anymore. Like, the desire will naturally go down after some period of time because you've now, like, overcome that constant urge. And that may lead to more productivity or more happiness or more joy in some people. But it's not every person. right? And I think it's like very individual. But I mean, wouldn't wouldn't the body just take care of itself? It does. I mean, I mean, would a man just store up all of that

semen for a month? So what happens is either you're going to have a wet dream. So you're going to have a nocturnal emission. And so then that was the other thing. People would have wet dreams. They'd be like, oh my God, I failed. And it's like, no, you can't even control that. Like you were asleep and it's normal and healthy. Like your body is just taking care of itself. Or they would just absorb it. Like their body absorbs it. And your body's constantly making more semen, right? It's just like, it's constantly doing that. So it's, or sperm specifically, but, you know, it's making more all the time. And so, like, there is no, it's not like the actual semen itself has some powerful properties. It's really just, like, dealing with, I think,

the mental aspect of it. Interesting. Interesting. Let's move into, actually, before we move on, are there any other viral trends that you've kind of had to correct? Yeah, so there was a one on TikTok for a while. There was a lot of people talking about what's called jelking, which is a gelking. Jelking. Yeah, which is like this practice to increase penile length. And so it's like you make an O with okay sign with your finger and you actually like sort of slowly extend the length of the penis over time these exercises, stretching exercises essentially. And so we would be like, oh, I did this and I increased my penile length and it was great. And so they were talking about this a lot. And actually, that sounds very safe, right? Like, oh, I'm just stretching. Like,

what's the big deal? But sometimes, and you can probably relate to most men, when you tell them to do something, they don't just do it. They want to do it the best, right? And so they're like, but you don't just, you tell someone to do something that might improve their life. They're not going to just do it. They're going to go 10x and do it even more, right? And so there's actually some people who would come into the urologist because they've been doing this. And, you know, my colleagues have talked to me. It's even in some published data. People would jelk, and they would come in and they would develop erectile dysfunction because they've now damaged their penis. And that's not necessarily reversible.

And so it's, you know, it's like there are ways to safely lengthen potentially, but jelking is not one of them. What are the ways? So the safest way for length is a traction device. So you can buy traction devices online. These are sort of devices that slowly extend your penis with a little bit of pressure over time. And they are meant to be very minimal, like minimal tension over time. So there are some that you will use six hours a day and, like, go to sleep with them. There's some that you can get that you can do 30 minutes twice a day, but they are a commitment, right?

You have to be, like, doing it a lot. And then they do work. And they've been shown to increase penile length by about two centimeters when you've done it for. Two centimeters? Yeah. For prolonged periods of time, for months on end, then you will see an increase. and that's on average right so some may see a little more some may see a little less but that's generally what they've seen in the studies and so yeah I think there are ways to do it but it's a commitment

right you have to be disciplined you have to keep doing it and you have to is that what you really want to spend your time doing right and that's fine if you do no judgment by all means you know but I think that that's just that's probably the safest now there's other things that are available there's surgical options there's you know those are there's there's device you know Well, basically, surgical options are available to lengthen and enhance girth. GERTH, probably the safest is to do fillers, like women get fillers on their face. There's the same sort of hyeronic acid fillers that you can get injected into the penis. But they don't last forever.

They're like 18 months or so, and they'll dissolve. So there are options. Is that safe? You know, we don't have a ton of data, but, like, I wouldn't inject anything else. So there are, like, permanent fillers. people have like in jail have injected all sorts of things in their penis like so you know like all sorts of things which please don't inject your penis with anything but if you know you're going to if you are very intent on doing it and you've sort of talked to your doctor about it and you know

it's not like a psychological issue that needs you know attention from a psychologist because there is what we call small penis anxiety right people who really feel body dysmorphia like there's something wrong with them and that requires not requires but should have have attention from a psychologist so you can work on your thoughts around it. But, you know, if you don't have a dysmorphia and you just want a bigger penis, like, I think that's the safest option in terms of, in terms of an intervention. There are some, you know, people who will use vacuum erection devices or penis pumps. There's no evidence in the literature that this actually results in enhanced girth, but some people report that they notice that. Again, I think

it's all temporary when you're using these traction devices and pumps. Like, I don't know that you're going to have a lasting effect, but I don't know. We haven't looked at it in the long term in terms of, like, scientific data. It's only anecdotes, like what patients tell us and what we see. So I think ultimately, like, I wish, I wish there was a way, right? Like, women can enhance their breast, they can get breast augmentation, but men still don't have that option, right, to enhance their genitalia if they really want to, in a, like, a permanent, meaningful way yet, in a very safe way. And I wish we had it, because I think men, just like women should have that option if they want it, right? But at this time, like, you have one penis. It is very

important. And if something happens to it, now you're stuck with that complication. And so I just think it's really important to think about that before you proceed with anything that's irreversible. Now, I mean, I wanted to cover this later on, but we'll just do it right now since we're on the subject. I mean, size. Does size matter? Yeah. So this comes up all the time, right? Because we are in a society where size is revered, right? Like you will see people joking about it. You will see, I mean, even my children will joke about their penis size and their prepubescent boys, right? Like, where did they learn this from? We don't talk about it at home. Like, they learned it from their peers. So this is something that's pervasive, right? People automatically assume bigger is

better. The reality is, when you look at the data, people overestimate what averages. So they think average is like six inches erect. Average is more like 5.1 to 5.6 inches depending on the study you look at. That's erect, not flossing. And then, you know, so fine, average is overestimated. We're really bad as human beings at estimating. So when you actually look at people who, you know, you show them like this is a five inch penis, it's six inch penis, this is the seven inch penis. What are you estimating? So when you have like an average size penis, they tend to overestimate the size. they think it's like six or seven inches six inches um and then when you have a slightly smaller than an average penis you tend to underestimate and when it's bigger you tend to overestimate so we're just

really bad at one estimating and when you and a lot of men will measure their fallis and you know it's so variable how warm is it in the room like what you know how aroused are you in that moment like if you're more aroused you might be a little bit tiny bit longer a tiny big earthier right and so it's so variable that like it's hard to say like okay this is my number like this is how big i am right um and then it's so in terms of like pleasure right because i think that's what guy thinks oh if i have a bigger penis i will more easily be able to get my partner to orgasm it will feel better for her in a heterosexual relationship and the reality is that's not necessarily true like of course there are women who prefer longer penises they enjoy stimulation deep stimulation during

sex. But that's not the majority. I would say 85% of women need clitoral stimulation. And the clitoris is above the urethra. It's the area that is very sensitive. It is the homologue of the penis. So it is essentially exactly the same. If you, like, cut up in a cadaver and you look at the anatomy of the clitoris and the penis, the clitoris look identical. The clitoris is just smaller and internal, whereas the penis is external. So if you stimulate the clitoris, you will reliably reach orgasm in the majority of women. And that doesn't require a penis necessarily, right? You can do that with your hand, with your mouth, with a toy, with a whole bunch of different things and not necessarily from penetration. Now, yes, can't, will you be stimulating the clitoris when you penetrate? Yes,

to some degree, because the clitoris is above the urethra. And so indirectly, you'll be stimulating it. And some women, like I said, the anatomy is variable. So some women may orgasm more easily just through penetration alone. But the large majority of women need either penetration and clitoral stimulation or just clitoral stimulation to climax. And so the reality is that size is not necessary for pleasure. Size is not necessary for a good orgasm. And it is something that we have just made into this big thing. And if you ask women, like when you do surveys of women, 85% of women, I'm like, I'm happy with my partner size. And I'm totally fine with it. And it's like 45% of men who feel like they're satisfied with their size. So it's a big dichotomy because we've made it

to feel like it's so linked to masculinity or the ability to provide pleasure, but the reality is not so much. And when you look at even anatomy for women, the vaginal length before it's engorged and aroused is about three to three and a half inches. So if you think about it, like if you're really large, you can't even really penetrate the entire vaginal length. And so there's actually products that you can wear like buffers so that you don't hurt your partner when you have sex with them if you're a little bit larger than they are. And so it's not, it's sort of like a fit, right? Some people have a better, like have a longer vagina. They may enjoy a longer penis. But again, it's not universal, right? It's not universal. What about girth? Yeah. So girth, again, I think

girth is because the clitoris goes deep into the pelvis and it goes around the vagina. There's like the clitoral bulbs and the legs of the clitoris. So when you have a little more girth, it can stimulate more of the clitoris, right? You're not just focusing on the top. You're also getting the side of it. So it can be helpful, absolutely, to be more girthy. But there's a limit. So, in fact, when they, this actually came out from people who do male to female to

male surgery. When they were building fallacies, they realized that they were making them too girthy. And, like, it was actually difficult to have sex. So they actually had to look at, like, what kind, what they did was they looked at what kind of sex toys women are buying to. decide, like, what was the right size for the majority of women? Because they were like, oh, we were just making them too big. And, like, now this person who wanted, who wants a penis is, like, not able to use it because it's too big for the partner to accommodate it. And so

really, it's like, if you look at what type of sex toys women buy, they buy a little bit longer than average and the same girth as average, which is, you know, about five inches or so. So it's very similar to the average guy. They're not buying those really obscenely large sex toys. Like, it's just not, I mean, they might for a gag gift or something, but most women are not using those to pleasure themselves. And so that doesn't necessarily, meaning you don't really need a lot more than average to pleasure a woman. What is average girth? Average growth is about four to five inches around. Okay. Yeah. Okay. Yeah. Wow. Interesting stuff. So I wanted to, you know, rectile dysfunction. I mean, you see all the drug ads. We see.

I mean, it's everywhere. What are some myths about erectile dysfunction? Oh, there's so many. I would start with, like, I think that for the first time a man has an issue with an erection, he feels like it's over, right? And the reality is there is normal fluctuation. There are times where you will struggle to get an erection because we are not static human beings. You are not machines, right?

You are people. And so you will feel stressed or anxious or, or maybe you won't feel well that day or maybe you had a really stressful day and your testosterone is lower than another day, right? All these things can play a role and you might have trouble getting an erection that day. It doesn't mean you're broken. It doesn't mean that you're doomed for a life of erectile dysfunction. But it often plays out that way because the second a guy has an issue with an erection in the bedroom, the next time he's having sex, he's thinking about that. He's not enjoying himself. He's not thinking about, wow, this is so hot and I'm having the

best time of my life. He's thinking, oh my God, am I going to have an erection? Is it going to last? Is it going to go away? And so you can't be mindful and present and enjoy pleasure because you're obsessing over this. And it becomes this vicious cycle. So I tell all guys, all my patients, like you may have a medical reason that you're having trouble with erections, but every single guy also has problems thinking about erections. Every guy. Every guy who has a problem with erections also has a mental issue because they're thinking about it, right? And Women do, too. It's not just men. Like, women are like, oh, if I can't climax this one time,

am I not going to be able to climax the next time, right? They're thinking about it too, but I think we see it very often, men, because if you can't get an erection, it's very visible. You can see, like, it's not happening. Something's wrong, right? And the reaction is often like, oh, the partner might be, like, is something wrong with me? So now there's like a little bit of relationship conflict.

And so there's all these things compounded, and it makes it very difficult to get out of. And so I think that's one of the biggest ones, is that. And then two is that I did mention testosterone, but testosterone is not always the cause. In fact, it's only the cause. Low testosterone causes erectile dysfunction about three to six percent of the time. That's it. So it may be a part of it, but it's not the only cause. Wow. Only in three to six percent of the time, it's a testosterone deficiency. Correct. Interesting. More often, it's vascular problems. So high cholesterol, high blood pressure, diabetes, all these things play a role.

And I will see very, very healthy-looking men whose cholesterol is off the charts. And I will say, look, this is what's likely causing your erectile dysfunction. And, you know, we can investigate further, but it behooves you to improve your cholesterol. And so I think it's also a really important sign of your health. I think people don't realize this. They think sexual health is like this thing we put in a box and we don't think about. But oftentimes you will see problems with your sexual health long before you see them anywhere else in your body. And the reason is the blood vessels to the penis are significantly smaller about half the size of the blood vessels to the heart.

So before you have a heart attack, you're going to see erectile dysfunction. And in fact, we've seen that, that when a man has an issue with erections, within seven years, 15% of those guys will have heart attack. Wow. And so it's an opportunity for men. If you start having trouble, this is a wake-up call for you to get your whole health evaluated. make sure that you're optimizing your heart health, your brain health before you get a stroke, right? Like all these things that in the long term will have you not having the life you want to live, right? Because if we think about sex, we want to live well, but we also want to have sex throughout our lives, right?

And if you start having issues, like you have heart failure and now you get winded just walking a couple blocks right down the street, like you're not going to have sex, like you're going to be exhausted. And so all of these things play a role. And so I find that any time you think there's a problem with your sex life, that's an opportunity for you to get evaluated, right? To figure out what's going on so that you can fix that part of your life. And before it becomes a problem. And with, I'm sorry, within how many years, just 15%? Seven, seven years. So it's a, so it's a early warning system.

Yeah, we called the Canary and the Coal Mine. It's like that warning sign. Wow. And then, I mean, with erects off dysfunction, I mean, does that mean there is zero erection? No, so the definition is that you're having trouble either maintaining or getting an erection that's sufficient for intercourse. So either you lose the erection before you penetrate or you can't climax because you're not reaching it soon enough and you lose your erection before that. sometimes people get it confused. They'll think, like, oh, I ejaculate very quickly, so it's erectile dysfunction.

That's actually premature ejaculation. It's treated very differently. And so it's important, like when you go to your doctor to explain those things, because sometimes guys will come in and they'll say, my erection is not working, right? And so I will dig deeper, but sometimes if you go to your primary care doctor, they may not, right? And that may be the only doctor you have access to. And so if you say, I'm not having trouble. I can't, my erections are not working.

They'll give you a prescription and you'll be on your way, but that prescription is not going to fix the issue if it's an ejaculation issue. Interesting. I've spent years on this show pulling back the curtain and trying to reveal what's really happening in this country. And the truth is there's a double standard here in America. You see time and time again, people defending themselves, defending their family, and then the judicial system goes after them.

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touching your current mortgage. Unlike a HELOC, which can have varied interest rates, the smart equity loan offers a fixed rate. That means one predictable monthly payment, giving you peace of mind. This loan allows you to leverage the equity in your home to pay off high interest debt, free up your cash flow, and keep your existing low mortgage rate intact. It only takes 10 minutes to get started with no upfront or hidden fees. Call American financing today and start. And start saving now. 866-781-8900. That's 866-781-8900 or Americanfinancing.net slash SRS. I mean, how do you determine if it is a psychological issue, whether that be reptile dysfunction or premature ejaculation or, you know, anything I'm not thinking of? How do you determine whether

it's an actual, you know, something's going on with the body versus a psychological issue where you've freaked yourself out and now you have, you know, performance anxiety. Yeah. So one is talk to the person, right? Like, first I'll talk to them, like, okay, what's happening when you're by yourself, right? Like, do you get erections at night? Do you wake up in the morning with erections? Because that's a sign that things are all working well, right?

When you wake up in the morning with an erection, that tells me, hey, your hormones are working, your blood flow is working, all that stuff is pretty good, probably, right? because your body's doing it when there's no stressor around, right? It's just like you're sleeping, your body's functioning normally, you get about three to five erections at night, and you usually wake up with one, and so that's a sign that things are working okay. There are, like, tests that you can do.

There's even wearables that you can buy to do that, but like you pretty much... There's wearables that are now in the market. You can wear, like, a ring around your penis that will measure how many erections you get at night, how long they last, and how firm they get, and they'll give you data. But at the end of the day, like those, I think some people really like that because they want to like, they want data.

They like to know those things. But at the end of the day, like if things are functioning well and you're happy and you're getting morning erections and your partner's happy, like I wouldn't stress about it. It's when you start feeling like, okay, things are not going well. Okay, am I getting nighttime erections? That's one, waking up with one. Two, if I masturbate, is it working fine, right? And sometimes that's like your masturbation is different, but there's no pressure, right? when you masturbate. You're not worried that like your partner might feel some way or whatever.

Like there's no anxiety typically around masturbation unless you feel shame about it, which is a whole different thing. So usually that's another way. Third way is we can do what's called penile Doppler ultrasound testing. So we can actually check the blood flow to the penis. So we'll actually give you an artificial erection with a medication and we'll actually then test to see how fast the blood is flowing in and how quickly it's leaving. And we have markers to say what's normal and what's not. And so those are tests that we can do to be definitive, like, yes, the blood flow part is working. Now the hormone part, we check with blood work. We check if your testosterone is normal, if your free testosterone is normal, all those things. And there's other hormone markers that

will check as well if they're low to make sure they're not playing a role. And so those are things we can evaluate pretty well. Beyond that, like I said, I think everyone has a little degree of a psychological component to it. Now, how do you, how do you, how do patients get over their psychological anxieties? Yeah, so it's difficult. I'm not going to say it's easy. I, you know, I encourage them if they are willing to talk to a sex therapist or even a therapist that has some, you know, openness about talking about sex, because it's really

dealing with your thoughts and kind of working with those. And like, especially in the moment, right, when you're with your partner. So it can be like doing mindfulness exercises. So there's been studies on mindfulness that, like, if you do 20 minutes of mindfulness every day, you're more present in the bedroom. So you have more enjoyable sex because you're able to, like, really pay attention to what's going on rather than getting lost in your own thoughts. And I think just being present in general, like cultivating, I think the other thing about sex in modern day is, like, it's rushed.

It's like, we're busy with our kids. We're busy with work. We're busy with that. And then we're like, okay, we got five minutes. Like, let's go. And there's no, like, you haven't actually made it feel. It's like another checkbox to do, right? And so it's like actually like, hey, like when you were younger, you used to like, you know, be like, oh, I can't wait to see you on your date. You'd call each other. You'd text each other. Whatever, you know, whatever it was. And you'd be excited to like see your partner and like potentially have sex with them. And there was like this whole thing. Like you just felt so excited about it. But when you're in longer term relationships and the stressors of life come along, we often just are like, ah, well, we'll do it when we get to. We'll have sex. Like it'll happen. You're always there. Right. And so it's like you have to be like intentional. about cultivating desire. You have to be like, hey, does that foreplay starts in the

morning, like with a caress on the back or like a slurdy text or whatever, right? Whatever floats your boat and like feeling in the moment, like excited. And I often tell people, instead of date night where you go out to eat dinner, like have intimacy night where you like are intimate together. You hold each other. You lie together. You explore each other's body depending on what turns you on, right? But you actually make that a priority. because it is valuable. Being connected with another human being, people who have more sex actually lived longer.

And I think partially it's because of that connection they're getting with another human being. And so, you know, it's really important. That is so, and we're losing connection so much with, like, AI and the Internet and all these other things. Like, we have to be intentional about keeping that. I mean, how much, you know, when we're talking about your,

I'm saying people that have more sex live longer. How much sex should we be having? How many times a week should men be ejaculating? Yeah. So there's science behind this, and I'll give you some data on that. So first of all, when you look at living longer, right, people who have sex 52 times a year, so that's once a week, have live longer, have lower heart disease, have better health outcomes, and people who have sex less often than that.

so we know that for a fact and if you have so a lot of veterans struggle with mental health so they have depression anxiety people who have depression anxiety and have sex more often they actually don't they do better in terms of their mental health as well as living longer so like you might actually be improving your mental health as well as living longer and so there's evidence at least once a week right and then in terms of how often should you ejaculate there's a very famous study where they had looked at ejaculation frequency and the risk of prostate cancer. And so they looked at databases where people filled out how often they ejaculated last month. And they put them into category. So it was like 0 to 4, 4 to 7, 7 to 14, 14 to 21, and more than 21. So what they found

was that the guys who ejaculated 21 times or more a month, they didn't specify through sex or masturbation, but they did more than 21 times a month had a lower risk of prostate cancer. Now, is it the ejaculation? Say those numbers again? More than 21 times a month had a lower risk of prostate cancer. Now, is it the actual active ejaculation? Is it something else? I mean, there's some theories that, like, if you're ejaculating, you're sort of cleaning the pipes, right?

Like you're getting any stagnant fluid that might be in your prostate. You're getting that taken out. And so that may be beneficial. Now, I can't say for sure because there's not really a good way to test that. But basically, what I tell people is, like, have sex, masturbate, enjoy pleasure. enjoy connection with another human being and enjoy pleasure because for some people masturbation is the only way they're going to get pleasure they don't have a partner or they don't have someone they can have sex with so i don't want to take that away from them either right and i think that those things are important for people to feel good and there's so much value to having orgasms like physiologically right your heart rate goes down your blood pressure goes down some people sleep better some people have postnut clarity and they feel like much better after they orgasm and so i think that But, you know, it is something that we need to look at as, like, a tool potentially to live better, you know, to have a healthier life, to be connected with another human being, to feel good, to feel pleasure. And I say this often, sex is play.

And we don't play as adults. So, like, play, enjoy life, be creative, have fun, and enjoy sex. Like, why is this something we have to, like, hide behind a corner? It shouldn't be. It should be something that we just, like, openly welcome. and we should be able to talk about sex and be able to express our concerns, our insecurities, and be open with, the idea of being vulnerable, right, with another partner with someone else, is really powerful because to have great sex, you have to be vulnerable.

You are naked in front of another person, literally, physically, and mentally, you were naked in front of them. And so you need to be able to be vulnerable and allow yourself to be vulnerable to truly experience meaningful pleasure. And so many people are so guarded and sex is like just this thing you do, right, for a quick release. But it's actually so much more than that. Is there, I mean, are there any studies on whether you're ejaculating with a partner versus masturbation is one better than another? Well, in terms of how your brain responds, so there are certain nerve endings on our body that can only be stimulated by another human being, that

a caress in a certain frequency, which is usually like a loving caress, that is what turns those nerve endings on. And so that turns on different areas of your brain. So it will stimulate more of your brain. So you will likely have more pleasure and a higher, you know, sort of response to that. So in terms of like experiencing pleasure, it will be probably more intense and more enjoyable with another partner compared to to by yourself. But it certainly is, you still can enjoy pleasure by yourself. The challenge, I think, by doing it by yourself is, I'll go back to the example of, like, when you're a kid and, like, you're worried, like, you're in the shower or you're in

your bedroom, and you're like, oh, my God, someone's going to walk in or someone's going to be, why are you in the shower so long? And so you learn to rush through masturbation, and it becomes this just, like, quick thing to get a release. It's not a time to actually enjoy pleasure, right? And so I think that's where, you know, it's okay to explore your body and to feel pleasure by yourself and, like, allowing that and using it as a tool to, like, learn about it. yourself like what turns me on what makes me feel good I think particularly for women can be very

useful in learning which sort of stimulation works good works well for you and then you can communicate that with a partner and also like exploring more than just your genitals like your whole body can be an erogenous zone right you can stimulate anywhere on the body and almost anywhere on the body and someone can get turned on so it's it's really like okay like we can use this we can stimulate multiple areas of someone's body and have them feel an amazing pleasure that if you just focus on genitals is not going to not going to be as as robust. Interesting. Interesting. I mean, let's go back to the implants or penile, is that what you call it? Penile implants, yeah. Implants. I mean, are there a lot of people doing this?

Yeah, I mean, so I will say erectile dysfunction is very common. 50% of men over 50 will have erectile dysfunction and every decade that increases by about 10%. So you can imagine there's a lot of guys struggling. Now, because of medications like sylidinifil or to dalafil known as Viagrancialis, those medications help a lot of guys get erections without needing surgery. But before these medications were around, we didn't have much. We had vacuum erection devices, which you will, which are sort of similar to penis pumps, but they are medical grade. We have injections that you give yourself in the penis that work quite well, but like some guys don't want to inject their penis, which is reasonable. And then we have surgeries. And so typically guys will go through

these options, and then if they still can't get an erection, a penal option is a great option for them. And so what that is, is we actually implant a device into the penis, which they then either pump up with a pump in the scrotum when they want to have an erection, and they deflate it when they're done. Wait a minute, they do what? They pump it. It's got a little pump. I should brought one with you, but there's a little pump, you pump it up, and then you get an erection. It's inside your scrotum? Inside your scrotum, yeah. And you can't really tell. I mean, like, it looks sort of like there's a little something there, right? But, like, it doesn't, you can't really tell

that someone has a penile implant. Like, in fact, in medicine, like, we'll get consulted, like, oh, this guy has a, what we call a priapus, an erection that won't go away. And sometimes it'll be like, oh, the guy just has an implant. Like, so even other doctors sometimes don't notice it is my point. But so you, it's, you know, it's very hideable. You don't need to know. And then there's other ones where you implant it and you just bend it up and bend it down. So when you want to have an erection, you bend it up and otherwise you bend it down.

So there's options. They don't make you larger, growth here. They give you what you have. So if you were to like grab your penis and pull it, that's how long it's going to be. It's not going to be longer. It's not going to make you, you know, it's not going to make you like superhuman in terms of length or growth. But it's going to give you function so that you can have some.

sex, and you can get a rigid erection when you want to. And so I would say that it is a transformative surgery for a lot of guys who have been struggling and can't get an erection and want to be able to get one, and their partner wants to be able to have penetrative sex. Is it mandatory? No. You can obviously pleasure your partner with many different ways. It doesn't need to be an erect phallis, but a lot of people enjoy that, want that, and it's a great option for them. What is the difference between Viagra and Cialis? So they are both what we call P.D.E.5 inhibitors, they work by the same mechanism. Essentially, when you think about an erection, there is an ignition called nitric oxide,

which then causes, and that usually comes from simulation. Like you see something, hear something, feel something, turns you on, your nerves and your vessels release nitric oxide. Then that causes blood to flow into the penis, and then it stays there, right? And that's the erection. and then it goes down and blood flow leaves the penis and the erection goes down. And so during that process, one of the enzymes that will break down, right, and cause the blood flow to leave, these medications prevent that breakdown.

And so that's how they work. And they work similarly, but they are slightly different. So when you think about sylidephyl, which is Viagra, Vanifil, or Vardinifil, which is Levitra and Stendra, those medications, they all work short-acting. so meaning you take one about an hour before sex, you need stimulation. Like I said, the nitric oxide has to come from some stimulation for them to work and you get an erection. It works in about 60 to 70 percent of guys. It does require that you don't eat with the medication. So sometimes people will eat a big meal and I like, oh, it didn't work, but I got these side effects. So they get side

effects like headaches, flushing, stuffy nose, those sorts of things. But it does work. And a lot of guys allows them to have erections and have sex. Now, Tidalphal is slightly different because it has a longer half-life. So you can take this medication with food, which is nice for some people who like to have sex in the evening or, you know, they have dinner before, and they can then take this medication and it works, but it lasts longer. So it can last for 36 hours, meaning that if you take it on a Friday and you want to have sex on a Saturday or Sunday, like you're still good to go, which is nice for a lot of people.

You can also take a low dose every single day. So five milligrams of Seattle is because it lasts. so long, you can take a low dose every single day. And I really like using that because it takes a psychological stress out of it. Like, oh, I have to remember to take this pill. I got to do this. I got to do that. You just sort of take the pill every day and then you're good to go to have sex when you want to, right? For most people where it works well. Now again, these medications are 100% effective. Every medication that you take in your life will have some degree of, you know, in efficacy. But they help a lot of guys be able to get good blood flow to their penis.

and have erections and have sex. Is there any, is there any, is there any long-term effects if somebody is using that that may necessarily, you know, they don't necessarily need that? Yeah, I mean, I think in terms of long, there's obviously rare things that people will, will say like nosebleeds or things like that that are very rare, right? With Viagra, there is, it does, if there are some receptors in the eye that are similar to the receptors that they work on. and so some people get blue-green vision discoloration and it can cause vision changes.

So if you ever notice anything with your vision, you've got to stop those medications. The other risk is if you're taking a medication called nitroglycerin or something you put under your tongue before you have chest pain, if you take both those together, it can lower your blood pressure to dangerous, almost like deadly levels. So those are the two big contraindications. But for most people, these are very safe, very effective. And to Dadaafel, there's some actually early data, and it's not like mainstream, but that it might improve heart health. So they looked at like how it's taken in people who have cardiovascularies, and they've seen actually an improvement in outcomes.

And even with muscle health, they're seeing like blood flow to the muscles being better. And it's also great for guys who have an enlarged prostate because it can relax the prostate and allow you to pee better. So there's a lot of benefits. In fact, I just saw a study on women taking Tidalifil to help with overactive bladder. Now, I don't, you know, it's still very early. Again, this is not prime time. This is like early data, but I feel like there's a lot of benefit because ultimately with something like to Dallifil daily, you're increasing blood flow throughout the body.

So you're actually not just seeing benefits of the genitals. You may be seeing benefits elsewhere. And that could potentially be beneficial. Now, we don't, you know, these medications have been around for a long time and we haven't seen any terrible long-term sequela. Now, could there be in the future potentially? I don't, you know, I can't, I don't future, like, but Viagra's been around for a long time. And Ciaus has been around for a good amount of time as well, and people have taken it for

decades without issue. No, Kim. So, I mean, would it be, would it be in Ben's best interest to, I mean, it sounds like there's a lot of other benefits other than sex health? And so, I mean, would it be beneficial for men to be on five milligrams of Cialis every day? You know, I can't say that every guy should be on it, right? I do think there are benefits. And I do think that if you have any sort of struggle with erections, that I think that being on it is is going to benefit you more than, you know, more than in more ways than just sexual function. And so

I do recommend it for almost all my patients to be on it, because I think there's more benefits than just sexual health. Do I think a normal healthy guy should be on it? It's hard to say yet if I think there's like a long-term longevity life benefit for it, if I had to put money on it, yeah, probably there would be, but you know, no one's studying that specifically. And so, yeah, I think maybe there might be a long-term benefit for being on it, but we don't really know yet. Okay. What is the average length, time-wise, and sexual intercourse? Yeah, so this always surprises people. And in fact, even my own friend got surprised by this because a urologist. So when you look at the data and they actually look at people having sex and what they

do is they tell people take a stopwatch, they give it to the female partner. They say start the stopwatch when you start penetration, turn off the stopwatch when you stop penetration. I do this around multiple countries and they find that the average length is about five to six minutes. So a lot shorter than most people think and a lot shorter than you're seeing on erotic films, right? And so that's the reality is that that's average. Now if you look country to countries, some countries are a little bit longer. Some countries are a little bit shorter. For example, UK was longer, Turkey was shorter in the study that was done. But ultimately, that's the average length that a man will last during sex. Now, does that mean that there aren't guys, of course there's guys who last

longer, and of course there's guys who are, who ejaculate more rapidly? Now, what does that mean, right? So actually, interestingly, if you look at mammals who ejaculate, right, they all ejaculate rapidly. There's no, like, pleasure or enjoyment. It's really like for the purposes of having a baby or procreating. And so they quickly, you know, they get done quickly because it prevents like, one, they won't get caught by a predator. Two, if there's competition, they're first, right? So the next competition can't come and like get in the way, right? And so there's actually an evolutionary advantage for mammals who ejaculate sooner. In humans, it's different, right? The ejaculation length and pleasure, we actually continue to have sex long after fertility is an issue, right? Long after

women past fertile ages, people continue to have sex because it's pleasurable. And so this idea of lasting longer, you know, obviously, again, another thing that society is like, oh, it's so great, like you want to have sex forever. But I also see guys who have what's we called delayed ejaculation. So they take longer than 30 minutes to ejaculate. And while that's less common, it definitely happens. And those guys are stressed too because it's like exhausting. It's like there's so much friction. It becomes uncomfortable for their partner, it becomes uncomfortable for them, they're working so hard, and, and like, it's no longer fun. And so what I tell people is, like, it's not about fixing on how long you last. It's like, are you enjoying yourself? Is your partner satisfied? And, you know, the reality is

that women take a lot longer to get aroused and to get to climax. So women, on average, take about 14 minutes when they're with their partner to reach climax. It's less when they masturbates, like eight minutes. But again, men take about five to six minutes. So you realize, like, you have to prioritize female pleasure if you want her to climax because she's going to take longer. It's also going to take her longer to get aroused. And so really, like, that's where the difference lies. And so it's really, like, figuring that out for you and your partner, like, how do we work together so that everyone achieves pleasure and that we're having a good time? Because the time that it takes is not the issue. It's, like, how much pleasure can you

get from having sex? And how do we maximize that? Wow. So that's a pretty big, uh, I don't know if he'd call it a discrepancy from five minutes to 14 minutes. So, I mean, what do you recommend? Yeah, so I recommend that you start by, you know, first of all, make sure your partners aroused. This is the thing. I think women take a lot longer to get aroused. They also take a lot longer to be present in the moment, right? They ruminate about a lot of things.

And when they're younger, it's about body image and insecurities and that can evolve. Women become more confident in their bodies as they age. But then it's like all the other things in their life that they're stressed about their kids, their parents, whatever, like, whatever they're dealing with in their life. And they have a hard time shutting that off. And so one, it's like getting them in the mood, like spending time with them, enjoying, like allowing, allowing them to feel desire and to feel arousal. So what happens a lot of times with both men and women, but more often with women, is they get what's called responsive desire. So when you're younger, you think, you see your partner, you're like,

damn, they're so hot, right? We want to have sex, right? You're turned on immediately. Like, there's no need to do anything. You're just like, you're just like, you're see each other and you turn on and you want to have sex, that's it. But as you're with a partner for a long period of time or, you know, as you evolve in life and you're busier and you're more stressed or whatever, you get what's called responsive desire. So you actually like need to be aroused a little bit before you start feeling desire. So you're like, oh, it's like going to the gym. You don't really want to go until you're there. And then we're like, oh, thank God I went to the gym. I feel great. So it's sort of like, yeah, I didn't really want to have sex. But now that I'm

like turned on, like, oh, there's the desire. Oh, I remember I like this. This is really fun. And so it's not an abnormal thing. It's actually a completely normal brain response, right, that you sometimes need to get your head in the right place and allow desire, right? Allow like some arousal to happen. And so that's why I love, like I said, intimacy time, like hold each other, be together, be physical, touch each other, whatever. I mean, obviously everyone's not into touch, but like figure out what it is that gets you turned on

and allow it to happen, right? Like in a mutually consensual way. And that's why, like, sometimes it's like, hey, let's have this night where we're going to do this, right? Let's actually give each other the time where we're not looking at our phones, or we're not, like, distracted or thinking about something else. We're just focused on each other. I mean, if you're thinking about it before phones, right, you'd be like lying in bed, there's like nothing to do. You're like, okay, like, well, I'm bored. Let's have sex, right?

Like, you're right next to me and, like, your body's right here. I'm like, oh, this feels warm and nice and cozy, and you would, like, have sex with your partner. And now it's like, well, you don't, like, you have something else really exciting to look at that has, like, so much interesting information and whatever you're interested in in the moment, you can read about it or watch it or whatever. And so you're, like, doing that until you're dead and you're like, I'm so tired and you fall asleep, you put your phone on, you go to sleep, right? And so, like, there's just, like, there's not as many opportunities, right? Because now there's so much more to distract you than there was before. So we have to work a little harder. So that's

one, is like making sure that they are in the moment. But two, prioritizing foreplay and actually spending time getting them aroused because it's not that they need like penetrate like i mentioned earlier penetration is not necessarily how they're going to climax it's going to be clitoral stimulation and sometimes both but you need to sort of focus on foreplay and making sure they feel pleasure and feel feel that desire turning on the the ramp up to i mean everyone can relate to this ramp right you feel like your turn on it goes up and up and up until you climax and so you're trying to get them to get up that ramp a little before you do so that they can get there

and then you both can sort of try to climax around the same time or she can climax before you. Either way, you know, it allows you to then to make sure that you both are feeling great pleasure. I mean, so we're just talking about, you know, average length of sex, you know,

and how long, you know, on average men last versus women and, you know, is there a, I mean, what is too long? Well, again, too long is how long is too long for you and your partner. So, like, some people are, like, they're fine with however long, right? Even if people who have very short sexual encounters and they love it. And they have people who have long sexual encounters and they love it.

It really is bother. That's the key. Like, are you or your partner bother? Does it cause distress or relationship conflict or issues? If it doesn't, who cares, right? Like, just be yourself and enjoy each other. As long as you are both having a good time. or if there's more than one person, more than two people in the bedroom, if you're all

having a good time, like, by all means, continue doing that. That's fine. It's when there is a loss of pleasure, distress that we need to worry. And then we can talk about how to fix it, right? Even if you don't, like, meet some clinical definition, but you're like, this is too long or too short. Like, let's talk about it because we can sort of help you figure out what's going on. Maybe there's a psychological issue. Maybe there's a medical issue. Regardless, it's all things that we can work with you on. Thank you. Thank you for that. Banda, there's so many questions that are coming to my mind. But I mean, when we talk about, you know, I saw a video.

I didn't watch this one yet, but it was, I believe it was something about, you know, what females find attractive? Yeah. What do females find attractive? But yeah, interesting. A lot of people think it's like tall men, right? Physically, I'm saying not like emotionally necessarily. But it's all this idea of like, oh, women all want taller.

Now, that's true that height matters, but what actually matters is, at least in the data that I found, was that strength. So the display of upper body strength is very attractive to women. And this makes sense evolutionarily, right, where you would need to maybe fight for resources or you need someone to protect yourself. Having somebody who is stronger is more likely to, one, protect you and to also get those resources that you would need, right? And so evolution, it makes sense that when you see someone who's very developed in their upper extremities or that, upper body that you would feel like that's the right partner who can protect me and who can also get resources for me. And so that's one. And the other one is like having sort of a V shape. So your shoulders are broader than your waist. And that's not only showing, you know, obviously

upper body strength, but it's also showing metabolic health. Right. So if you have a smaller waist and you have less visceral fat around your abdomen, you are more metabolically healthy, which means that you probably have better genes that you're then going to pass on to your children that you might have with this person, right? And so there's actually reasons why women find certain things attractive. Now height, if you look at like the data, they'll say like 70% of when you ask women like, okay, what's important, 70% of that attraction quota is the strength. And then if you add another 10%, it'll go up to 80% if they're tall. So they'd rather have a like an average height strong guy than a tall, not strong guy. Does that make sense? And so,

like it's it's really about like how you how you portray this strength and health through the visual eye right like what they're seeing and interestingly that this is obviously more important when you're like just trying to like hook up with somebody but when you start looking at long-term partners that still matters but then it becomes also like are they kind are they are they like going to stick around and be with you and be like you know the right kind of honest person that you can be rely depend on and they can be reliable so that becomes also part of the picture when you're looking at like a long-term partner anything with the penis i mean you can't like i think you can't um you can't see specifically right when you're first courting someone they're not like

walking around naked um so you can't utilize that and i think that like i said most people as long as they're feeling pleasureed by their partner the size of the penis matters less. And that's true even in the data. Like I said, there are some women, like maybe 10 to 15 percent, and based in the data, that are very focused on penile length. And that may be because of, like, they may really develop, they may really enjoy, like, deep penetration because that stimulation may lead to orgasm from cervical stimulation. And some women actually find that painful, but some women actually really like that. And so they may really enjoy that feeling, and that may allow them to feel pleasure. And in those cases,

like, that just might not be a right fit for you, right? If that person is like, I need a really a guy who is really well endowed, well, more power to you, we're not the right fit, right? Because I can't give that to you. I mean, unless you feel comfortable, like, wearing a strap on it or something. Right. But like, for most people, like, that's not going to be the right fit. And look, we don't fit with people because of personalities, because of a variety of things. And so it's okay if sometimes it doesn't fit because of genitalia, right? But it's like, that doesn't mean that there's something wrong with you. it just means that that's not a fit, right?

And there's going to be another person where that is a fit. And so that's okay, right? It's just like anything else. There are things that you need in a partner that they may not meet that criteria and they may not be the right person because that's a deal breaker. And there's other things where you can compromise on those things.

And the same goes for sex. What about, let's move into some other sexual activities, oral sex. I mean, I've read, I don't know if any of this is factual, but I mean, I've read that there are, are supposedly some type of health benefits for females to consume semen. Is there any truth to that? Yeah, there's, there's not a ton. So there's, you know, if you actually look at the nutritional value of semen, it's like very little. So like it's like very much, yes, there is some protein, yes, there are some vitamins and minerals and stuff in, in semen, but like is it,

it's not any, it's not like the equivalent of a multivitamin, right? Like significantly less. But there's no harm either. So, like, if you enjoy that and your partner enjoys that, by all means, go ahead. But you don't need to, like, make semen smoothies or, like, other, you know, other cement smoothies. Come on, you know you've seen those videos. But, like, you don't need to do that, right? Like, if you enjoy that, if some people, like, have kinks and fetishes, they have a cum kink, right? And they enjoy that. That's fine. Great. By all means. Like, that's you. Like, I don't want to yuck anyone's yum. But, um, but, like, it's not necessary. What about, you know, semen volumizers or people that are trying to, you know, increase the load?

Yeah. So, again, I think that that comes a lot from erotic films pornography, right? Like, they see these people having very large voluminous loads and the partner in the video is like, oh, my God, right? Like, it's just like this amazing thing. And so the reality is that the amount that comes out is really small. It's like a tablespoon, right? If you look at the average amount and we've actually done this, right, because we do for fertility, you actually measure. When you get a semen analysis, you measure how much comes out.

So there's an abundance of data on semen volume because of that sort of research. And the average is about a tablespoon, like five-m-ls, five to ten. And so it's not a lot. And so when you think about what you're seeing on these films, oftentimes it's very augmented through like video, right? Video editing, video, other things are being exploded around the genitals that look like it's coming from the penis. So that's one. Two is it's variable through age, right? And there's force variability. So when you're younger, you have very robust pelvic floor muscles. And pelvic floor muscles are the muscles that sit in the pelvis that are responsible for so many different functions. But one of the functions that they're responsible

for is they contract when you have an orgasm. And they contract at like a rhythmic, like 0.8 seconds. And they give you that pulsing feeling when you have an orgasm. They also help you propel semen forward. And so when they're strong, like when you're young and healthy, they will propel up to like 15 to 30 centimeters. So pretty far, they can propel pretty far. And that can look more voluminous, right, because of going further. And when you age, when it drops half that. And some guys will come in and they get just a dribble now, or it's like very not forceful. And that's because their muscles are just not as strong anymore. And you can, you know, work on strengthening muscular health, including your pelvic floor. But that's sort of the reality for most people.

The volume also is variable. It depends on when it's the last time you ejaculated. Like if you if you abstain for five days, it's going to be more voluminous. And if you don't abstain and you just ejected the day before, it's going to be less voluminous. Also, how much is you drink that day, right? Like how hydrated are you? There's a whole bunch of factors just day a day that play into it. And so, yes, you can, you know, sort of like hold, store it up into, like for five days and the fifth day, and I was, wow, that was a pretty big, you know, uh, semen volume. And, and so again, it's, it's not a, it's not a reflection of your fertility because only 5% of the entire volume is, is, is a sperm. Most of it is all these fluids that

help nourish sperm, help them move through the female dental tract. They're there for a reason. But the large majority of it is not sperm. And so the only way you can know your sperm health is by actually getting a semen analysis and actually testing that. And when we do those, we actually ask you to abstain for 24 to 48 hours before you give it. So we have a reference, right? Like this is what the average guy has after one day of abstinence or two days of abstinence. And so you should be around this. This is what's average. What, I mean, what are those, you mentioned some exercises. What are those exercises? Yeah. So I'm cautious about saying this because I don't think Everyone needs to do them.

So there are pelvic floor exercises called Kegel exercise that most people have heard of that can strengthen the pelvic floor. Now, you don't have to just do those exercises, but those are the most popular. They have like the best PR of any exercise they've ever seen. But like essentially they are, so for guys, I tell them it's like you are lifting your penis from the ground without touching it. Like that's sort of that. Or if you're peeing and you stop the stream of pee, that's, you're actually activating those muscles. So you don't want to do it when you're in the bathroom, but you can use it. to learn how what that feels like and then you do those period just like you do crunches or you go

at the gym you do reps you do like 10 reps in the morning 10 reps at night you need to make sure you rest and you breathe like just like you would do at the gym you rest you breathe you um you make sure you're not just squeezing squeezing squeezing real hard you squeeze and relax and squeeze and because you can get dysfunction which is why i don't tell a lot of people to just everyone should do them because some people will actually have dysfunctional muscles and guys it's very underdiagnosed No one's really testing their pelvic floor because it requires a rectal exam, a finger in the bottom. And so to test, are your muscles tense? Just like people get TMJ, right?

They clench up their jaw. Their pelvic floor muscles can get tense. And so they can tense up and they won't really know that it's happening, but it will cause these other issues. And so if you strengthen an already tense muscle, you're going to create more problems. So it's not everyone should do it. But if you have normal function, everything's working great, it's probably reasonable to go ahead and try doing those exercises. to strengthen those muscles. It may help you with having a more forceful ejaculate.

It may help you with getting stronger erections because there's more blood flow going, you know, it's causing more blood flow to come to the area because you're getting more, you know, just like any exercise. And it may cause you to have more intense orgasms because you have more muscle contracting when it does contract. And so it can be beneficial and it can be a great way to augment your sex life,

but again, it's not for everybody. And then how long does it, is it five days it takes a man to fully reload? Yeah, so when they look at, I mean, actually, you're, you're constantly making sperm, right? So on average, it takes about 24 to 48 hours after inject it for you to get the semen back in, I'm sorry, to get the sperm back into the semen. But you will, you know, you will have some potentially, like in the, in the track and other things, but you still have some. It's not like it just all goes away and then there's nothing left. Like there's sort of storage mechanisms and things. But in terms of like if you're trying to get a partner pregnant,

ideally we say like every other day will allow you to replenish and have sort of the most amount of sperm getting to the egg if that's what your goal is. Anal sex. Yeah. Any benefits? Well, so like I mentioned, we talked about the skein's glands or the G zone, right? you know how some women find that really pleasurable that area is similar to the prostate so some some

people and there's also the clitoris and the legs of the the um the legs of the clitoris that are around there so they're all sort of around the rectum and the anus and some women will find it very pleasurable to have something inserted in the anus and that will augment their pleasure And so not everyone does, but just like some people find certain things pleasurable, some people don't. So in terms of like health benefits, not really, but in terms of pleasure benefits, yes, for some people, that can be a great way to, for them to feel pleasure. It can be augmented with other things, like you can, you know, stimulate them clearly at the same time, whatever, right? There's different ways to use it. But what I will tell people is it's not like you can't just have anal sex if you've never done anything in the anus before.

You need to sort of prepare, and sometimes that means like using a toy or using a lubricated finger to sort of get the anus ready or prepared to have a phallus inside. You also need to, there's no natural lubrication. So you need lube and go slow, go easy, take your time and sort of like talk. You have to communicate. You have to be like, is this okay? Like there has to be a back and forth dialogue where you feel comfortable and trust each other because it can cause damage if you do it too aggressively or too, you know,

too rigorously and not enough loob, you can actually damage the walls of the, of the anus, which are really friable and thin. They're not like as elastic or muscular as a vaginal canal. And so, yeah, absolutely, it can derive a lot of pleasure. It can be a lot of fun for people. We just have to go slow, go easy, and talk to each other. What about risks? Like, again, the big risk is that you can hurt yourself.

but also there is a sexually transmitted infection risk. So oftentimes people will have anal sex and because they can't get someone pregnant that way, they won't use a condom. But you can still transmit sexually transmitted infections and it's actually a higher risk because there's more blood vessels, things can tear more easily in that area.

Like I said, it's not lubricated. And so they're at a higher risk of getting STDs. And so it's really important if you're having anal sex with someone where you are not monogamous and tested and clear and you are safe to not use condoms even vaginally, you need to use a condom anally because you want to protect yourself.

What about from a bacterial standpoint? Yeah, I mean, from a bacterial standpoint, you know, it's not like you're going to get, you as a man, you won't get like a colon of infection if they have some sort of infection. That's usually not an issue. It's more the sexual treatment infections. Okay, okay.

G spot. Yeah. How do men find it? So the G-Zone. It's not a spot, actually. A lot of guys think it's like this magical button that you have to find. It's not, like, some,

there's not necessarily like an obvious visual. Like, when you look down there, like, oh, there's a spot, you know, like bull's eye. It's, it's, no, but I don't say, I think there's a lot of misconception. Like, people are like, wait, what's something wrong with me? I don't see it or, like, you know, it's not.

It's an area where there's a lot of nerve endings. So the skein's glands, which you talked about earlier, the clitoral body, the shafts. So just like the shafts of the penis. the shaft of the clitoris is around that area. And so all those areas are really highly innovated. I mean, they're really a lot of nerve endings. It's about two to three centimeters inside the vagina at the top. And so we'll say like it's like a come hither emotion is sort of where you'll kind of feel it. But again, you have to talk. I think people

feel like that when they have sex, they should just be like magical gods at sex and it should just be perfect. And like it should be this amazing experience like off the bat. And it doesn't make sense to me because we like you have it's a skill just like anything else like you don't expect to like go go do a public speech and be amazing at at the first time right you it's a skill that you develop with time even talking to someone or or dating it's all skills that we learn and we cultivate and so just like that sex is a skill you have to get good at it and that requires you to get feedback from the person you're having sex with but we just expect it like okay we're just going to have sex There's going to be just moans and groans, but no talking, and it's going to be great.

And everyone's going to have great orgasms, and we're going to be wonderful at it. It's like, but we have to invest in having better sex. Like, what is the point of having sex that's not worth having, right? Nobody wants mediocre sex. Let's have good sex. And so that means, like, let's talk about sex. Let's talk about sex outside the bedroom. Let's, like, find out, like, hey, what turns you on?

What is something that you've always been fantasizing about? Or what is good? Like, what did you like about that? and what could be better, you know, and let's not take it so personally. Like, we are trying to be better lovers with each other, right? And so, like, it's important to sort of be like, okay, what's good, what's not good? How can we change this up? The other thing is, like, monotony is a huge issue. So, like, people find what works and they do it every time. And that's great. Like, it's comforting to have a routine. But if I was to tell you, hey, you're going to have

chicken and broccoli every day for the rest of your life, you'd be like, I don't know if I can do that every day, right? I need a pizza someday or I need a steak someday, whatever, right? And so it's the same thing. Like, you need to sort of have a little bit of variety. It doesn't need to be crazy. Like, it doesn't need to, like, let's get out the whips and chains. And, like, it can be just as simple as doing it in a different room, doing it a different time, doing it in a different, like, slightly different position, using a pillow, not using a pillow, like just slight variations that make it just different enough where you're like, ooh, this is kind of different. Like, this is kind of cool. and keeps you sort of interested, excited, engaged in the process.

Are there any positions that men could do that are easier in finding the G-Zone or that women enjoy more? So we know that when women have control, meaning they're on top or they can sort of angle their bodies in certain ways, that they tend to have more pleasure because they can, again, sort of angle you in a certain way. that they tend to have more pleasure because they can, again, sort of angle you in a certain way that allows them to achieve more pleasure. So certain things like putting a pillow, so if she's on the bottom, putting a pillow under her pelvis can make it more comfortable and more pleasurable. Having her on top can also allow for more pleasure because she can control sort of the angle that goes in.

And there's also certain things, not so the G zone, but there's things that can help you like stimulate the clitoris better while you're having vaginal penetrative sex. So certain positions where you're like sort of aligning your pelvis right on top of her clitoris so that you're kind of like rocking motion that can also lead to better orgasms. So the G people focus in the G zone because they hear about it a lot. But it's it's analogous to the male prostate. Now not every guy wants prostate play. Like not every guy wants their prostate stimulated for pleasure. And so I don't think we need to focus on the G zone. We need to focus on clitoral stimulation and also talking to our partner and finding out what they like.

Because, again, not everybody wants their G zone stimulated. Like it may not be pleasurable for them or it may not really do anything for them. Whereas some people would be like, yeah, that's it. I love that. And that really turns me on. But you won't know until you ask her. What about, you know, we talked about, you know, how often it would be, what an ideal, what do you call this? ejaculation cycle, you know, for a man, what's healthy, you know, 21 times a month,

it's great. What about women? Yeah, so, you know, there's so little date on women. But I would say, venture to say probably, you know, having regular orgasms is good for you, right? They don't necessarily always see an ejaculate like men do. And that's different from squirting. Injaculet is just like this milky white fluid that comes from the skein's glands, and it's usually a very small amount. So we don't always see it. It's not always very clear. Some women will, but yes, I see it.

I know exactly what you're talking about. And some of it, I've never seen it. That's okay. But it's more about the orgasm, I think, because that's what you can sort of reliably say. And I think that the orgasm is what we should focus on is getting orgasms for women. And really the thing is, I think, for women,

it's probably, I mean, there's no, we don't get skein's glands cancer is very common, right? Prostate cancer, men, one and eight men get prostate cancer, right? So it's very common. So it's not, I don't think there's a benefit in that term, but I do think for health benefits, for stress reduction, for pleasure benefits, I think orgasms, regular orgasms are great. Again, I don't, I can't give you an exact number, but I think like if you feel like you are enjoying how often you're having orgasms, do it. And if you feel like you could have more, that's fine.

And if you don't like having orgasms, that's okay too, but like you should have something that gives you pleasure. in life. Perfect. Brena, let's take a quick break. Sure. And then when we come back, we'll get into some prostate stuff and all that kind of stuff. All right, perfect. You wouldn't wait to buy fire insurance when your house is already on fire, right? So why wait to help protect your money?

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Pineapple, I think I've heard bananas. There might be some other stuff. I'm not sure. Is there any truth to that? So it's interesting. I mean, like, you can't really design a study tasting semen. So I can't tell you, like, I can't tell you with the degree of, like, certainty. But if you think about the composition of semen, right, there's fructose in semen. And fructose is what makes it sweet. It also has all these minerals in it, which give it that sort of like metallicy sort of taste. But, you know, at neutral, it sort of got this little bit of like metallicy slightly sweet taste. Now, if you want to make it sweeter, you would think, oh, you would think, oh, okay, I want to increase the amount of fructose in the semen. And so, you know, you will see that things that have a lot of fructose can potentially help increase the sweetness of semen. So things like pineapple, other fruits, potentially, yeah, they might increase the sweetness. But it's not going to be, I think what people think is like, oh, I'm, I got a date tonight, I'm going to eat some pineapple in the morning, and I'm going to be good to go. It's not that quick, right? So it's sort of like a dietary thing. Like if your diet consists of like healthy fruits and

vegetables, you're more likely to have better tasting semen. Now, certain vegetables, like asparagus is pretty strong. And so people might notice that their pea stinks after they, after they eat asparagus, that will also affect your semen. Things like coffee, smoking, caffeine, those can make the semen taste a little bit stronger. And so, and certainly, So if you really does, your diet can really alter the taste. At least that's my suspicion based on what we've heard from people, anecdotally, what we've talked, you know, the kind of the biology behind it. And so I would suspect generally speaking, if you eat a healthy diet, drink lots of fluids,

you're going to have good tasting semen. If you eat a less healthy diet or you smoke, it's not going to taste as good. And so, you know, I think like obviously everyone's taste is sort of, of their own, right? It's based on their biology. And so unless it, like, your partner's like, oh, all of a sudden it tastes really different and it tastes unappealing, I wouldn't worry about it. But, like, you know, again, I think that, like, it is, it's nothing that you should ever, like, really worry about, right? As long as you're a healthy person, your semen should be tasting good. Also, the color of the semen can vary. I get this question a lot. So, like,

people would be like, oh, it looks a little yellow now, or it looked a little grayish. And really, the color can vary. It's not dangerous. So the good news is not dangerous. I always say if you're worried, just drink lots of fluids. It's going to dilute everything, right? It's going to make things a little bit clearer because I think a lot of times we are drinking a lot of energy drinks or not really just water. And so sometimes it's just like increase your water intake and things will clear up. If you get blood in the semen, that's a little bit concerning, but usually 99% of time it's not dangerous. And if it happens once, don't worry. about it. If it continues to happen over and over again, that's a time to sort of get a red

flag. Okay. And then we may have covered this, forgive me if we did, through a lot of information at me. But I've heard rumors or maybe read some things, wherever it came from. I can't remember, but does ejaculation for men lower the risk of cancer? Yes. So ejaculating, we know there's an association. So when you ejaculate more than 21 times, a month, there is about a 20% lower risk of prostate cancer. 20%? Yeah. And so now, is it the ejaculation that's causing that lower risk?

I mean, the study that does not, that did, that's found this data, actually tried to control for a lot of different factors, you know, like other health conditions, but you would imagine that someone who is ejaculating that frequently has a partner or is healthy enough to do so. So maybe there are some other factors that we can't really quantify scientific. specifically. But the theory is that perhaps ejaculation is allowing fluid to move through the prostate more readily so that fluid doesn't stick around and cause inflammation or other issues that then may lead to transformations that could lead to cancer. Okay. And what age, I mean,

what age, how long can people have sex? I mean, as long as they live. But a lot of times people don't. And so we call that sex span, right? Like you, you're thinking, your life spent is how long you live, but your sex spent is how long you're going to have sex. And so if you remain strong and healthy, so you're strong enough that you can still maintain the positions of sex. And to be honest, there's even, like, furniture now and, like, things that can help you have sex if you're a little bit weaker or, like, can't get certain positions. Like, there's, like, wedges and slings and different things that can help, so you can continue to have sex. But also that you don't get winded, right? When you're, you're not, like,

exhausted that you can't actually exert enough to have sex. But if you are a healthy person, you've maintained your muscular health through fitness, you've maintained your cardiovascular health through fitness, it is very likely that you continue to have sex well into your old age. I've seen 90-year-old patients who are still having an active sex life. 90 years old. And don't have erectile dysfunction and they're like very healthy. And again, they have prioritized their health and they have maintained their exercise, they've maintained their health, they've eaten a healthy diet, they've slept, they've dealt with stress, they've created an environment which is healthy around their bodies, and they are still

able to have sex with their partners. Now, do you see a lower sex drive in older couples or just older folks in general? Well, so yeah, let's talk about it for each individual. So for men, the most common reason for low sexual desire, especially as the age, one is low testosterone. So testosterone declines at about one to one and a half percent every year after about 40. So if you are very healthy and you started with a normal testosterone, it's unlucky that it should get low enough that it would cause you a problem. But that's not the reality for many people. So about like overall 20% of people have low testosterone, but that percentage goes up as you age.

And that's because add in, you know, like other medical conditions that will affect. affect low testosterone. So we know that as people get more metabolic conditions like high cholesterol, diabetes, high blood pressure, they tend to get lower testosterone, add in potentially like lack of sleep and more stress in their life that causes more testosterone, add in sedentary lifestyles, add in even environmental exposures like microplastics and things like that, that we have some control over but not completely. And now you're in a situation where you're more likely to have a larger decline than it's expected. And so we are seeing more and more low testosterone.

And testosterone is the hormone of desire. And so when you have low testosterone, oftentimes it will present in men with low sexual desire and loss of mourning erections. So those late night, those morning erections. It also, testosterone is important for so many things in your body. So it increases muscle mass. It helps with mood.

So sometimes people who are depressed, men who are depressed, we'll find that their mood gets a little better when they start on testosterone. Brain fog, so it helps guys with brain clarity, and that's actually one of the very common things I'll see in older guys who have low testosterone as I'll give them testosterone. And the first thing they'll notice is that their brain is a little clear. And it helps with like the ability to just do normal functional things, like walk upstairs, hand grip strength, like things like that, like functional.

And so there's so many facets. It also helps with bone health, and bone health is so important as we age. so it's not just a hormone of sexual desire it's so much more than that but so that is often a cause in older men of loss of sexual desire also if they're unhealthy right they have a health issue and then sex is like off the table because they don't feel well right and that happens to a lot of guys where like they'll see women like my husband can't have sex because he's unwell right um or or he his partner is unwell and so they can't have sex because of that so that that becomes very common reasons now for women low sexual desires even more common so it's actually estimated like 40% of women have low libido so low desire and there's a variety of reasons for that one is yes women also have testosterone and their testosterone also declines similarly to men and so they can't that can be part of it there's also changes to menopause that can really affect women as they age so they can have dryness vaginally which can make it uncomfortable to have sex

and lack of lubrication. They can have, their tissues actually change. So they get what's called atrophies. So the tissues get thinner or more friable. So it's more painful. And it's actually like not as flexible or as stretchy as it used to be. So actually penetration can be painful.

Their clitoris can even have changes. Just like men have erectile dysfunction. Women can have changes in their clitoris where they may have less pleasure from the same stimulation they were getting before. so it's more difficult to get orgasms. And so when you are having sex, that's not really leading to pleasure, it becomes like less of a priority, right?

And so, you know, we have things that can help women, too. And I see patients all the time, sometimes it is off-label testosterone, sometimes it's other medications that we can offer. But also, it's like dealing with those things, those changes that are happening because they can really make you not want sex. And then your partner, if you're, you know, male partner is like, I still want to have sex, but she's like dealing with all these changes hormonally. She doesn't want to, right?

She's like, I'm not sleeping well. I'm having hot flashes all the time. You know, everything's dried on there. I might be getting UTIs all the time. All these things are often hormonally mediated and they can be remedied. And same thing for men. If your testosterone is declining,

we can improve that either naturally or with replacement. So how can, I mean, what age is metabolic usually start? So average is 51, but up to 10 years before that. And that's average, meaning that half of women will be before 51, half will be after. But well before perimenopause, before menopause is perimenopause. That can be four to seven to ten years before menopause. And again, it can, so that could be as early as your 40s or late 30s.

Some women are experiencing these symptoms. And that's when the symptoms are really intense because there's like this hormonal chaos. Like some days your estrogen is really high, some days it's low because your body is like it's all unregulated, right? And so during that time, they're just like, they're super stressed, they're not sleeping, they're having hot flashes, they don't feel like happy. Sometimes they feel depressed. I mean, there's so many things going on, and they honestly feel like they're out of control, like they don't feel like themselves. I mean, men will say the same thing when their testosterone is low, that they don't feel like themselves. And so, I mean, how do you, I mean, how do men strike up a conversation with their partner who is pretty good-in-paws.

You have to really do this cautiously because I think the thing is like, oh, if you say, oh, I think it's hormonal, it almost feels like the partner may feel like affronted, like your tongue, yeah, I'm hormonal, you know? So you have to sort of do it in a way like, look, you can try like, hey, look, I saw this video online, I listened to this podcast, and they were talking about this, and I'm like wondering if, you know, do you, like, are you having any symptoms or do you, would you like to see a specialist? Like, can I, can I help you find one?

Can I go with you to the appointment? like I mean I love it male patients bring me their wives all the time and I love it and so supportive so wonderful and they have this wonderful beautiful relationship and they just want to support each other and I think it's just being look I love you and I want you to feel well it's not about wanting sex it's not about like wanting you know you as a physical being it's about wanting you to feel like yourself and feel happy and fulfilled and feel like normal in your body and I think like showing them that you want that is so valuable, like that, oh, you love me and you care about me and you want me to feel good. It's not necessarily just about sex. It's, you know, it's much more than that.

And so I think that's where it's like, you don't want to start the conversation to be like, oh, we're not having sex. I want you to see a specialist. Or I think you're going crazy and you're hormonal and like, you know, something's wrong here. It's more like, look, I love you. I'm worried about you and I want to help. And like, I really, you know, want to be there for you. What are, I mean, what are some of the initial treatments? I mean, it sounds like lubricant would be an obvious answer if it's dried down. Lubrican is great. And I think the one thing people don't realize is that lubricant comes in different formulations.

Like you can get water-based lubricant, which is the most common one you see, but those dry up. And so, like, if you're going to have sex, it's going to last a few more than a few minutes. Like, you're going to have to reapply. Otherwise, it's not really going to work. So you can get water-based, but silicone-based and oil-based are a little longer-lasting. And so those are convenient in terms of like allowing you to just apply once and like have sex and not worry about reapplying. And so just figuring out like what kinds you guys like and might be experimenting with

a few and figuring out what feels good for both of you and what you both like because it's a very individual thing. But I think Louba is great. It's cheap. It's available. It's accessible. And it's like, hey, let's have fun with it. Let's make it fun, right?

There's also moisturizers. So for dryness specifically, you can get vaginal moisturizers just like you have facial. moisturizers, there's vaginal moisturizers. And it's just skin. It's just skin. So just like moisturizing the skin, keeping it healthy. And then specifically for what we call the genital urinary syndrome of menopause or the dryness and the other issues, you can use hormonal creams. So like vaginal estrogen, which is very safe. So it's not, when we think about, there's a lot of confusion about hormones. Vaginal hormones don't, very little get systemically absorbed. So there's never been a risk of breast cancer, ovarian cancer, uterine cancer. In fact,

it's probably safe for about anybody unless they have an active breast cancer so anybody else can get vaginal hormones and so in those cases you can do them in a cream a pill a ring there's lots of different options but they can really one keep the tissues healthy so they feel comfortable and they feel good and it feels good when they have sex and can prevent recurrent uti's um and it can even help like you if you're looking down there you may notice that their vulva actually changes like the lips, the inner lips will actually shrink and resorb because the lack of estrogen. So sometimes if you apply the cream on the outside, it can help keep those tissues healthy too. And so not everyone needs it, like I said, but I think it does benefit people.

The majority of women would benefit from it. And I think that it's really very, very safe because, again, it's just topical, very little bit gets absorbed systemically. Are there, I mean, it sounds like, it sounds like you recommend TRT for men a lot. I recommend TRT for men when they have symptoms of low testosterone, which we sort of talked about, but like low sexual desire, brain fog, fatigue, loss, maybe decreased mood, when they have multiple symptoms that could be related to testosterone and their testosterone is low. And so testosterone is measured through a blood test. The challenge with testosterone is it only gives me a number of what your level is at that time. I don't know what your level was in your

20s. So if you have younger listeners listening, I generally recommend that people get a baseline level when they feel good. What is your testosterone when you feel good? So that when you, as you age, you have a reference. And like if something happened, then you feel like, oh man, I'm so exhausted. I don't know what's going on. You check your testosterone. If it's the same as it was when you were in your 20s, okay, it's not your testosterone, it's something else, right? But it gives you a reference because what we don't know and what's difficult to study is your receptors, which is what testosterone attaches to. Some people's receptors are more sensitive, so they need less of it, less testosterone around, to get the same results. And some people need more because

their testosterone receptors are less sensitive. And so I can't tell that. We don't have like a commercially available test that we can say like, okay, you have a, better receptors. You need more testosterone to saturate those receptors. We don't know. And so it's a very individual thing. Now, they can say benchmarks based on like what we know population-based data, and that's usually 300 nanograms per decilator, is like the normal benchmark. But, I mean, there are some people who have testosterone that are higher than that that still have symptoms, and that may be because they're free testosterone as low, which is the testosterone that's like around in the bloodstream that is actually what's actively working on all

those receptors because most of it is just like with other little molecules that are like little carriers like little cars they sit in but they don't let you get off the car so that you can't actually go and work on the organs they're just there and so only about like five percent or I think it's like actually like one or two percent of the testosterone is free and that's what matters and so that's what we want to see because other things that can affect the those carrier molecules a sex hormone binding gliblin so it can cause it to be more so as you age sex hormone binding gliblin goes up. So your testosterone may look the same, but your SHBG is going up, and now you have less free testosterone, and so you're symptomatic. And so I think that it is valuable for men when they're

low to improve their testosterone. Now, it doesn't always have to be through replacement. There are things you can do naturally to help improve your testosterone. That includes sleeping more than seven hours a night of high quality sleep, can increase your testosterone by 15%. If you have sleep apnea, there's actually been. And very good studies that when you use a CPAP, which is like a machine that helps people who have sleep apnea, they increase their testosterone quite significantly. So if you snore or you have a really big neck circumference, think about getting a sleep study to find out if you have sleep apnea. Because fixing that will fix so many of your issues, including your testosterone. It's actually like a risk. It's actually mortality risk. People who have sleep apnea die sooner because they're not getting as much oxygen to their brain throughout the night and their organs. if you exercise resistance training heavy resistance training of your muscles can help boost testosterone if you eat healthy so meaning like what we again diet is very challenging to study and it's very difficult to give population based on but what we know on a population level is that Mediterranean

style diet meaning prioritizing healthy fruits and vegetables not unprocessed foods I basically tell people unprocessed foods, natural foods, and ideally prioritizing fiber and protein are probably your best bets in terms of overall health for both testosterone and just overall health. And then with testosterone, importantly, you don't want to get on too low fat of a diet. Testosterone is a molecule that's made from cholesterol. And so if your fat goes too low, you won't make enough testosterone. And I think that's really valuable for military men is that you guys do a lot of really intense endurance work. When you do really intense endurance work, your testosterone goes down because it's like chronic stress on your body. And so that is something to look out for is if you're doing a lot

of intense endurance work during those times, you might be, man, I'm exhausted. Yeah, you're doing a ton of endurance work, but also your testosterone is low. And so that can come back, obviously, when you stop doing those things. But it is something that you might notice during those stressful periods of time when you're putting your body through these really intense things. I mean, would you, I mean, I've read lots of things, interviewed people about it. I mean, you know, it seems like testosterone is declining in men at a rapid pace as years go on. And they talk about, you know, how kind of like the World War II generation ever since then, it's just been on a decline. And so, you know, now, now TRT is, you know, wildly popular.

Do you want to have, you know, is an older man, does an older man, does an older man, want the same level of testosterone he had when he was 20 years old, 25 years old. I mean, it seems like, I mean, I don't know why you wouldn't want to have that, but I'm not a physician. Right. I mean, I think it's a good benchmark to know what it used to be, right? But at the end of the day, we have to see how you feel. So I think people get very fixated on numbers, and it's important numbers help guide us, but what should be guiding us is how you feel. Right? So like, if you're like, I'm full of energy, I feel great, I'm having great sex. And my mood is great and I'm focused.

I'm able to be productive. I don't feel a deficit in any area of my life. Then who cares what your numbers are? You feel good and that's what matters, right? And I think that's important. Now, I do think that there's some value in, like, keeping track of things because you want to catch things before they become a real, like, you don't want to be miserable and, like, can't get out of bed and can't move before you go see the doctor, right?

You want to sort of be a little bit proactive. but again, I think it's not necessarily the number always that matters. It's we have to talk about what you feel. Where is the deficit? What's going on, right? Like I said, a lot of people think, oh, my erections aren't working, testosterone's the answer. And that's not always the case. In fact, it's not very often the case. And so it's like we have to look at you as a person, not as a lab test or as a blood value. We need to look at you and be like, okay, what's going on in your life? What's outside of our clinic room or outside of like whatever this blood work is showing me what else is going on right like are you having a ton of stress at work are you dealing with a financial calamity are you right is your

partner like super stress because her mom's in the hospital and like it's affecting your whole life and homeiosasis at home like what is going on because it's you're not just one blood work you are a whole person are there any i mean are there any concerns about going on testosterone replacement. I mean, you know, I've heard, I've heard that it can increase the risk of cancer, increase the rate of cancer, enlarged prostate. I've heard all kinds of things about it. So there's a lot of misinformation, and some of it was misunderstanding that now we know better, but let me go through it. So testosterone replacement is, as I mentioned, very helpful in improving all those things that we've talked about. Now, what are the risks, the true risks? So in terms

are the things you mentioned, cancer, testosterone and replacement does not cause prostate cancer. We know that unequivocally. The issue is that if you develop prostate cancer, which one in eight men will get prostate cancer, and I give you testosterone, I don't know you have prostate cancer because it hasn't shown me yet. Your PSA is still normal. Everything else is fine, but maybe you are destined to get prostate cancer. And then you get prostate cancer. It will cause that prostate cancer once it's there to grow more rapidly. And so that's why it's right. really important if you go on testosterone replacement to get your PSA, which is a blood test and screening for prostate cancer checked regularly, because we want to make sure that, God forbid,

you are, was one and eight, that we stop the testosterone and we treat your prostate cancer, right? And we fix that because we don't want an untoward thing to happen. So that's one. In terms of enlarged prostate, they've also looked at that. And there's actually been no evidence that testosterone, again, in and of itself, causes an enlarge prostate. Now, if you already have an enlarged prostate, and you have symptoms that are bothersome, when you give testosterone, it will cause a slight increase in both your PSA,

and it may cause a slight increase in the size of the prostate. And so if you're already sort of struggling and I give you testosterone, it might make you struggle a little bit more, whereas the average person, it won't bother them at all, right? The one that it does sort of cause problems with

is if you have that sleep apnea, we talked about earlier. If you have really uncontrolled sleep apnea, it can make it worse because it's going to increase muscle mass. it also increases the muscle mass in your neck, which then makes that sleep apnea worse. Now, usually that gets better with time, but if you're really like struggling with sleep apnea already and you're waking up all night and you can't breathe at night, it's going to make it

worse, right? And so that's one that we know. The other one that we absolutely know is that it can cause it can increase what's caused your hematicrit. And when your blood gets too thick, and it's about like 7% of people who get this change, depending on which formulation of testosterone we go on, it causes you to be at a higher risk for blood clots and strokes. That we do know. Testosterone replacement will put you at higher risk for those things, so we need to keep a close eye on it. Absolutely. And so those are the big ones. In terms of like, I think the other big things people need to know is when you start on it, you need to think of it as you're going to be on it for life. Like you can do a trial. You can do like two or three months and be like,

is it, am I noticing a difference? And if not go off of it, that's not so difficult. But it's if you've been on it for years and years and years, if you go off of it, you are no longer, you've shut down your body's process of making testosterone. So you won't make any for a while and you will feel like crap for a while until your body revs it up. Now, we can use off-label medications to sort of help jumpstart your body to making testosterone, but it's not something that every doctor does and that every doctor knows what to do. So I just tell people, like, think of it like you're going to be on it for life. Is that HCG? Yeah, HCG or Clomid. Both those things can be helpful in FSAH in some cases to help restart things. The other thing is if you want to have

kids, it will make you infertile. And not like your sperm count will go down to zero, but it will go down low enough that fertility becomes challenging. Now, everyone's heard of people who've been on steroids or on testosterone have had babies. It's because it doesn't go down to zero. It goes down to a very low number. After about 18 months of being on it, you're pretty much at a very low number that would become impossible to nearly, virtually impossible to impregnated another person. So a lot of young guys, as you know, you mentioned, like testosterone is declining. A lot of young guys are like, oh, I need testosterone, I don't feel well, and they do indeed have low testosterone. They start it because no one tells them that. Then they get married and they

have one-up kids and now they're in a situation where they have little to no sperm and they have to sort of, again, use HCG, clone it and try to get it back. But depending on how long you've been on it and how old you are, it can be more and more difficult. Whether you're juggling tasks or trying to stay clear-headed throughout the day, ketone IQ delivers clean brain fuel that can help you think sharper, longer, and smoother. No caffeine, no crash, no overstimulation. Thanks to the folks at HVMN for sending me their ketone IQ product to try. I really like taking ketone IQ before I work out.

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But, you know, are there any, you know, basically what I'm getting at is Gen Z. You know, they're the up-and-coming generation. You know, are there, is there substance of use? Is there certain substances that can affect erectile dysfunction? They can affect hormones, testosterone. So we know smoking unequivocally, I mean, I don't think this generation smoke. that much, but they do vape. So smoking can affect erections. Absolutely. It will destroy your erections because it's going to destroy the blood vessel health. And again, those blood vessels

of the penis are really, really small. So you're going to see issues with erections before anything else. So if you're smoking, I'm like, this is the best non-smoking ad is just like don't smoke to help protect your erections. I think everyone would quit, right? I think instead of like all the, like, showing people like, people lung cancer, they should have shown like a penis that doesn't work. I think people would have quit smoking off. A lot faster. So that's one. But a lot of young people are using marijuana.

And marijuana, chronic use of marijuana, can absolutely lower testosterone and cause issues with hormonal health. Really? Yes. So when you're using it chronically, you will see that. And it can cause issues with fertility. So we see a lot of young guys who are trying to have kids and they use marijuana all the time.

And for a variety of reasons, recreation, whatever. And now they have really poor semen health, poor sperm health, and they can't get their partner pregnant. So I think, you know, marijuana use is legal in some states, and it's okay on occasion, recreationally. We don't know if there's a, like a, like we know now that alcohol is not healthy in any amount, but we don't have that same granularity about marijuana in terms of is any bad, but definitely chronic use is bad for your sexual health and your hormone. What is chronic use? So chronic use is like every day or multiple times a week and, and, you know, if someone is like feeling sort of like they are always mellow because they're on it, they're always sort of like, basically they're feeling the effects of marrow. They need the effects and they're almost like using it because those effects feel so good and they're using it all the time.

That's probably a sign they're using it too much. Okay. Yeah. Okay. And so let's get back to prostate cancer. I mean, what age should men be checking their prostates? Yes, so the guidelines would say 55 is the age to start screening for prostate cancer. I would say also if you have a family history of prostate cancer, specifically your dad or your brother,

meaning direct first-degree relatives, that puts you at a much higher risk. If you're African-American, that puts you at a higher risk. If you have a BRCA gene, so if your mom had breast cancer and has a BRCA gene, positive, that also puts you at risk for breast cancer. Or if you have multiple cancers in your family, I would still encourage you to get tested earlier. And so, like, that would be based on at least five years earlier, or if your parent or brother had prostate cancer, let's say a 50, I would start testing you at 45. And so what is the test? So I think it always used to be a prostate exam and a blood test. Nowadays, the prostate exam, which is a finger in the bottom, is sort of,

decided that it's not always necessary because so urologists we do prostate exams at the time we know what we're looking for we know how to do an exam very well but um general practitioners primary care doctors family care doctors what we found is like they don't always really know what they're feeling for because they don't always necessarily like feel abnormal prostates it's not like their area of focus and so it was actually creating a lot of false positives where people were like oh i feel something and send you the urologist now the urologist has to like do a biopsy which is unnecessary and and you know it sort of led to this unnecessary, like further testing and evaluation. So they said, okay, based on that, we don't necessarily recommend that everyone needs a prostate exam. I still think that

if you're going to a urologist, it's valuable to get one because we know what we're looking for. But a PSA is a simple blood test. It's a screening test. So it doesn't tell you yes or no you have prostate cancer, but it's a quick and easy way to say, okay, maybe you're at risk. But there's other things that can increase your PSA. That can be inflammation. So you might have had masturbated or you might have sat on a bike seat or you might have like had some sort of low-grade inflammation that you didn't really know and that can cause an increase in PSA. You can have bleeding in the genital urinary tract for whatever reason that can increase your PSA. If you went to the hospital and you had a catheter placed or anything in the urethra,

that can increase your PSA. So there's a variety of different things that can increase your PSA. So this is why it's a screening test. It's not yes or no. It just says, okay, you might be at risk. Now what do we do? so if it's high usually we'll check a second one to make sure it's not inflammation it's not you know anything else and if it's still high then we talk about what's the next step so before we

used to be straight to biopsy right you go and you get a biopsy of your prostate now we have a lot of different things but the biggest and most sort of revolutionary in urology has been just a prostate MRI because now they've looked at prostate MRI and they found this sort of grading scale to say like okay you do an MRI and you see if there's any areas that look concerning and you grade them based on the way they look, and from one to five, one being like very unlikely cancer, five being like very highly likely cancer. So that gives you more of a degree of confidence on like, okay, do we need to biopsy this? And if so, where are we biopsy? Because when we do a biopsy in urology, when I was training, it was like, we're just poking 12 areas in the

prostate randomly. Like, I mean, obviously throughout, we're doing it systematically, so we get a little bit of every little bit of it. But we just go, you know, we're just getting 12 random cores in the prostate. Now we can do it with a little bit of degree of like, okay, now we have this MRI, we can, you know, overlay it on the ultrasound and see where we're going to biopsy. And so that's helpful. And also if you have, like, if you having a high prostate and your prostate is huge, which is also another reason that your PSA can increase, and there's no lesions on your MRI. I might say, hey, let's keep an eye on it. Everything looks good on this MRI and you have a very big prostate, which also causes an increase in PSA. And let's keep an eye on it. You know, we don't

need to do a biopsy at this time. So it can sort of help us decide. And there's a bunch of different biomarkers and urine markers that we can test if we want to sort of get a little bit more granularity. Now there's not like one that's better than the other. And I would say talk to a specialist in prostate cancer, a uro-oncologist, when you're deciding if you want to get more testing before you either get a biopsy or get treatment if you do find that you have prostate cancer. I mean, what are some symptoms that people should be looking out for? Most people have no symptoms. This is why we have screening.

This is why we do screening. Most people have no symptoms. And by the time they get symptoms, it's actually a problem. It's usually like a more advanced cancer. So symptoms could be that you have blood in the urine, could be that you have back pain, could be that you have night sweats or weight loss, could be that you are going to the bathroom a lot

or more frequently or having trouble peeing. But those can also be signs of an enlarge prostate. So that's why we do screening. We don't rely on symptoms. And absolutely, if you're having symptoms, We should screen you for prostate cancer at that time, too. But, you know, in general, that's why we do screening on people who have no symptoms, because that's when we find it.

So, okay. So, I mean, when it comes to an enlarged prostate, I mean, can it be reduced? Yeah, so an enlarged prostate. So I will say 80% of 80-year-olds have an enlarged prostate, and 80-year-olds also have prostate cancer. So if I took all, like, with autopsy studies, and you look at the prostates of 80-year-olds, they all have some focus of prostate cancer. So before I get into a large prostate,

I want to round out that discussion because I think it's important to understand this, is that if I diagnose you today with prostate cancer and you are 70 years old and you are really unhealthy and your dad died at 75 and you also have so many medical issues that you will likely pass in the next 10 to 15 years, I should do nothing about that prostate cancer because something else is going to kill you long before the prostate cancer does.

because it is very slow growing. And it's really important for people to understand. Nobody wants to face their mortality or think about how long they're going to live. But I'll give you a personal example. My grandfather got prostate cancer in his 70s. No one talked to me about it. Like, I was in residency,

and they put him through radiation. And a couple years later, he died from a heart attack. And if they had asked me, I told him, don't do anything about this prostate cancer. He's not healthy. He's 70 years old. And he just went through this radiation for no reason, right? Now, if he was 60 and he was healthy, or even 70 and healthy, I would have said,

yeah, treat it. But I think this is a really important discussion because not all prostate cancer needs to be treated. And some can even be watched. So we have protocols, like active surveillance protocols, where we can do routine MRIs and biopsies and keep an eye on it. Because as I mentioned, it's slow growing. And some people will never become a problem. And so we're trying to find those people and not put them through surgeries or radiation that have multiple side effects and potential complications because they won't eat it. So I think it's really important before we talk about enlarged prostate to just get that point out there because I see so many people who are like, no, I just want to know.

I'm like, do you really want to know, though? Because once you know, then the urge is to do something about it. And then you might do something about it that you didn't need to do and have a side effect that you have to live with for the rest of your life. So there's a lot of regret in some guys who have prostate. cancer treatment because they may develop erectile dysfunction or urinary problems afterwards. And now they could have lived without those things because they maybe didn't even need the treatment. Now, it's a very individual. It's a very individual discussion to have because

every prostate cancer is a little bit different. And some look more aggressive and some are less aggressive. And we grade them and we use all these nomograms to do that. I'm not going to belabor all the specific nuances. But I just think it's really important to have that discussion. Thank you for saying that. Enlarge prostate. Yes. So enlarge prostate is very common as well. Enlarge prostate occurs because of a variety of different things.

So one, we know genetics. So if your dad had an enlarged prostate and he was young, you are likely also going to have an enlarge prostate. And sometimes you'll know because he won't tell you that, but you might remember, oh, my dad was always going to the bathroom or he was in the bathroom for so long trying to empty his blood. You might remember those things or he might tell you that. So that's one. Two is we know, like, as you are more unhealthy, that causes more inflammation in your entire body, right? So if you have other metabolic issues, your prostate will also get inflamed. And then that inflammation causes growth. And then growth causes more inflammation that then causes growth. So it creates a sort of vicious cycle in the prostate.

Those are the common reasons why prostates grow. But very, most guys have some degree of enlargement. Now, what does that mean for you, right? So can you prevent it? Let's start with that. So people always want to know, can I prevent it or can I shrink it? Once it's grown, I don't think you can necessarily shrink it, but you can definitely prevent it. So there's some data, there's not a ton of data on this, but basically they did trials looking at people for prostate cancer prevention, and they looked at a whole bunch of different factors.

But in that, they also looked at enlarged prostate. And what they found was that people who ate more vegetables, kind of to have less prostate, less enlarged prostate, people who walked more, so two hours of walking a week even was good. So exercise, generally speaking, tend to have a lower risk. Maybe lycopene. So like this is red-based tomatoes, watermelon, like fruits and vegetables that are red in color may have a protective benefit. So I'll tell people like generally leading a healthy life, exercise and diet can help potentially reduce your risk of prostate cancer. Whereas like if you have that in large prostate, if you have diabetes, your risk goes up of having.

having an enlarged prostate. If you have high blood pressure, your risk of having a large prostate goes up. So again, the same sort of things, the unsexy things will help prevent that. Now, when you have an enlarged prostate, I think people always assume, like, it's very simple. Like, oh, you have an enlarged prostate, you have a problem with urination. That's all there is to it. But it's actually a little bit more complex. You can have a big prostate and have no problems, and you can have a small prostate and have problems. It's really based on how it's shaped and how it's blocking the flow of urine because the prostate sits underneath the bladder around the urethra. So when it gets big, it can get big on the outside or get big on the inside.

If it gets big on the inside and it blocks the flow of urine, you can start having trouble peeing. Now, it can also affect your bladder because now your bladder is pushing to get urine through that prostate. So sometimes guys will present with what we call it. There's two categories. There's voiding symptoms. So that means that they can't pee. They're weight. for their stream to start. Their stream is weak. It's stopping and starting. It takes a long time and they don't feel like they empty.

That's one type. And oftentimes with both types, they'll wake up a lot at night to be. And then with the other type, which is called storage symptoms or bladder symptoms. So the bladder is responding to this blockage because the bladder is like, oh, I can't, it's not clear. So I'm going to work harder. So I'm going to have more overactivity. I'm going to go more often.

I'm going to feel the urge to go more often. and it's going to be really just really bothersome to me, right? And so those are also common. Now, which kind of symptoms you have doesn't really necessarily affect what we do unless you have other issues. So if you're like diabetic or you've had nerve injuries, then we're wondering, is it the prostate or is it the bladder? Because those things can affect the bladder.

But for most guys, it's because of the blockage. And when we fix the blockage, all the symptoms get better. And we can fix the blockage in a variety of different ways. for again lifestyle you can do some things to reduce the irritation related to enlargement so you can limit how much you drink before bedtime so you're not waking up as often so we'll tell people don't drink like two hours before bed we'll also tell people like look at what you're drinking and eating because certain things can irritate the bladder which can then make things a lot worse so things like caffeine alcohol for some people spicy foods acidic foods like tomatoes

and citrusy fruits and juices, even artificial sweeteners for some people. So I tell people, make a jortle, see what you're eating and drinking, and take a note of your symptoms. And pay attention, you're smart. You can figure out, like, oh, I had a coffee. I had three coffee this morning, and I'm going to the bathroom more often. So maybe I should just drink one and drink two decafs if I love my coffee. Because you won't take my coffee from me. I won't take your coffee from you. So I think, like, those are things you can do. Also, if you're constipated, so many people don't know this. But when you're constipated, you're affecting your bladder. So it will worsen all your symptoms, whether you're having

more trouble peeing or you're going more often and more urgently. So if you're constipated, you need to correct that. So whether that's with adding more fiber in your diet, adding supplemental fiber, or taking medication to help you go better or moving more, those things can all help improve. So those are things that you can do in your lifestyle to improve. And then also like trying to go twice. So for some people, some guys, sitting is actually easier to take empty their bladder when they have an enlarged prostate. For some guys, they still want to stand. But it could be that you need to pee standing up and then you've got to sit down and pee again and try to empty your bladder completely. Or you need to like take a deep breath and sort of relax

the muscles a little bit. Try to work on that and then pee again. So there are little things that you can do to make your life a little better. But very often we'll do, there's medical options and there's surgical options to help reduce the prostate. And so that's important to talk to your doctor about, but really the thing that I want all guys to know is that a lot of these treatments do have side effects that can affect ejaculation. So a lot of guys feel like when they ejaculate, that is a big source of pleasure for them, not just the orgasm, but the actual active ejaculation. And so a lot of these treatments, medical or surgical, can affect how much ejaculate comes out. And so if that's important to you, because sometimes if you're with someone who's rushed that day,

may forget to tell you that that's a side effect, right, of the medication they're going to give you or the surgery they're going to give you, then you will be really unhappy after the fact. And so I just want people to know that because there's always tradeoffs, right? Sometimes we treat something and there may be a side effect. But if you are literally not emptying your bladder and you're getting recurrent bladder infections or bladder stones or you're bleeding a ton, like we need to do something. Whereas other times it's just quality life. Do we want to improve your quality life. What about a, I mean, what about a prostate massage? Does that help at all? I mean, what is that? Is that simply for pleasure? Yeah, so prostate massage, actually when we were,

probably when I was younger, long before I training urology, it was actually a thing that urologist did. So it's essentially like a prostate exam, you insert a lubricated finger into the anus, and you actually massage the prostate with your finger. So you like, sort of correct, like, stroke the prostate in all the zones of it. And that was thought to sort of help alleviate some potential, usually for prostititis. So when people had inflamed prostate, they would do it for that because it thought that it might actually sort of cause some relaxation, maybe of the muscles. They might cause some expression of fluid that's stored up in the prostate when you ejaculate or when you pee the next time. And so that was thought to maybe

help. And so the studies originally showed potentially some benefit ultimately didn't show any long-term benefit. So I would say that prostate massage, some people still find it useful. Like, just because a study said doesn't do something doesn't mean that an individual can't find it helpful. Some people still do find it helpful to massage their prostate for prostititis or for other issues. But in terms of like something that we do as a medical community, not so much anymore based on the data we have. A lot of guys find it pleasurable to have their prostate massage or include prostate play in the bedroom.

And so I think that it's great if you are open to exploring that, like, yeah, you might find it like unlocks a little bit of pleasure for you. You might not. But I think it's really a very individual choice. And if that's something you're interested in, by all means. Okay. Yeah. Let's talk about the effects of pornography in your real sex life. Yes. So pornography has really changed. So when I was younger, right, you had to get a VCR. You had to go to a sketchy store and like find a tape and like find a place to watch it. And, you know, it was very difficult. Or you had to have a magazine that was like hidden under, you know, somewhere. And so it was not easy and it was not accessible. And it was definitely very different than what porn looks like today. Now, I think that porn, there are some things I feel strongly about in terms of like, I don't think children should.

watch porn. I don't think that it should be so readily accessible to people. Like, I think there should be some challenges in getting access to porn because I think that that makes it much more difficult to want to engage in real life, like, desire and sex. And, like, you know, it does sort of make it more difficult for some people to enjoy regular sex or even seek out regular sex because they have these like very exotic and erotic things very easily accessible. However, a lot of people, adults who are fully frontal, like fully formed frontal lobes can use pornography in a very normal, healthy way. And I think it's very individual. People tend to know when they have an issue with pornography, right? They're like, oh, I'm using it all the time.

I don't enjoy my partner as much. Nothing is as good as what I feel like when I watch porn. I find myself using it more than I actually want to have sex with my partner. I find I'm using it more than when I want to go out and hang out with my friends. And so, like, you sort of start seeing the issues, right? You start seeing it in yourself, but it creates a shame spiral, right? So you're like, oh, I use porn. It makes me feel bad. And some of that may be also because you have a moral incongruence.

Like you think porn is bad and you use it, you feel bad. Right? And then you're like, oh, man, I feel bad, but I need to feel good again. So I'm going to use it because it temporarily makes me feel good and I feel even worse. And it creates this sort of shame spiral, which can be really debilitating for people. Now, what I'm seeing in the younger generation is that they've only learned about sex through porn because no one talked to them about it. And so they watch porn.

They think this is how I have sex and this is how I get my partner to orgasm. And when they actually go to have sex with their partner, it does not go anything like that because porn is a produced product. It is a meant for entertainment is not real life. It is meant the camera angles. Everything is meant for the viewers. enjoyment. It is not for the pleasure of the actual people having sex. They are actors. And so when they go and they have sex with their partner, it doesn't go the way they thought it was and now they think

they're broken and they think something's wrong with them. And so that's a real problem because it creates these unrealistic expectations on both sides, right? Men feel like they don't look or or have the same results as the porn star. And women also feel like I don't climax immediately upon penetration or I don't look like that and something's wrong with me and so it creates these really unrealistic expectations so that's a problem but when you have a fully frontal fully formed frontal lobe you understand that it's a fake product you can use it as a way to have arousal from time to time should it be your only source of arousal no i don't think so can it be used in a healthy way yes i think it can and i think most people do use it um in in most people use it period um and i think a lot of people can use it in a healthy

way. But I do think there are some caveats. And I do think it should not be like freely accessible because I worry about kids. And on average, kids see porn at 10. Man. And so I've, long before my kid turned 10, I talked to him about porn. I said, you might see this. You might see something that makes you confused. You might see people having sex. Your friend might show you on their phone. Something might happen. I want you to know this is not real. And I want you to talk to me about it and feel open to talk to me about it. Because I don't want you to be confused. That's, you know, I don't want you to feel like that's what real sex is like. Do you, I mean, when you talk to patients about, you know, porn addiction or just porn in general, I mean, do you, do you,

and we covered this a little bit earlier, but I mean, do you feel like it would be, is it healthier to save that for your partner? I think it depends on the person. So I think that, like, you know, you should vary your arousal. It should not all be based on pornography, right? So you should be able to get aroused by thinking. You should be able to get aroused by fantasizing. And if you want to use porn occasionally, it can be nice to explore other areas of things

that might be of interest to you to learn maybe something else that might turn you on that you never thought of before. It can be, as a couple, if you are both on the same page and you watch it together, it can actually increase sexual satisfaction and relationship factors. We've seen that in studies. But again, I think it's very individual.

And I think that if you are finding yourself solely relying on porn, like you cannot masturbate without porn, then that's red flag. To me, you should be able to have arousal without that. Like I remember when I was in medical school, I had a friend be like, I love springtime in New York. And I was like, why? He's like, because it's the sexiest time. Girls are all wearing skirts and, like, you know, you can see more skin.

And I was like, it's so funny to me now because nobody would ever say that now. Because it's like you don't need to wait till springtime. Like you just look at your phone and you'll see whatever you want. And so like there's no, like it's like the simple things. And think about even like way back when you would have to court a partner. You would have to walk with them and talk with them and you would barely be able to touch their hand. there would be this buildup, this tension, this, like, oh, I'm so excited to be with you and to touch you. And, like, I feel like we've lost a lot of that, that, like, that actual,

like, enjoyment of being with someone else and, like, glamorizing that versus, like, oh, I can just watch this on porn and, and, you know, have fun for a few minutes. Yeah, I think it's a big problem in the entire world right now. Yeah. And again, I think, like, I think that it's just about. I really feel like it's dangerous that our kids have access to it. Yeah, me too. We've covered that a lot on this show, which actually we were talking about it this morning with Ryan Montgomery and you watched Tim Tebow when it sound like.

Yeah. And those were cornerstones of both of those interviews. But, you know, we're kind of winding down the interview now. And, you know, one thing I wanted to ask is, you know, What are some of the most common sexual health problems in men that go ignored? Yeah, well, number one is, I mean, the most common is erectile dysfunction. And I think that, like, it's not that it goes, gets ignored, but I think that men are embarrassed. And they don't, they don't come and see the doctor.

Or when they do, they just get given a prescription and say, bye. And I think if, and that's why I'm writing my book that's coming out next year, is I want people to know, like, you can fix this. You can fix your life and you have the power to do that and you can improve your health and by way of then improve your erections because sexual health is health, right? But I think like they get very discouraged and when they finally do go get help, they just get a prescription. They don't get any information, right? So I think that's a big one.

And then they're embarrassed too. And I guess, you know, there's like now there's a little bit more where you can get these online companies, which will at least prescribe you the medications. But at the same time, they're not still giving you that education. which is really what I think is the missing piece. And they're charging you a lot more for the medications than you could get like an online, you know, pharmacy. You can get them for like cents on the dollar, you know.

So I think that that's a big one. Another one is like whenever they feel less masculine. So like if they feel like maybe their desire is not there, maybe they're struggling with premature ejaculation, they don't ask for help. They struggle in silence and they live in silence. violence, and it is heartbreaking. Because by the time I finally see these patients, they have been through a lot, and they

have, it is shaped who they are as a person. Man. And they cannot, and they can't talk to anybody, right? Men are just have this, they don't talk to, like, women talk to women, right? They'll be like, oh, I have a problem. Like, it'll come up somehow. They'll feel comfortable confiding in another woman. A man will never talk to another man about his issues in the bedroom, or really many issues.

They just don't. They're stoic. They tend to be problem solvers. they don't want to sit there and like whine or complain, right? And so they just sort of grin and bear it. And they grin and bear it in front of their partner. They may, I mean, it can go so deep where, like, they've even, like, had divorces or ruined relationships because they won't talk to their partner about their issues, right?

And it runs so deep that they're just suffering in silence. And it really, I just, like, I want anyone listening is if you're struggling, like, please at least talk to a urologist, at least talk to your doctor. Let's talk to somebody. I don't care who you talk to. Talk to somebody because even just saying the issue out loud can help you sort of process it and deal with it. And, you know, learn, educate yourself. Watch content mine or anyone else's.

Like, learn about your body and empower yourself to, like, take the actions you need to fix it. And then, you know, being a VA doc, I mean, I come from a special operations background, a lot of TBI, a lot of PTSD. I mean, what are some of the commonalities that you see within, you know, war fighters who are coming home who have these kind of invisible injuries? I mean, how does that play in? The most common is PTSD, right? So I think on at all, like, the majority, like the large majority of patients that I see have PTSD, large majority. And they're all on, you know, medications to help with nightmares and they're struggling, right? And we know that with men who have PTSD, their rate of erectile dysfunction is significantly higher, like three times higher.

Three times? Mm-hmm. Then guys who don't have PTSD. Then veterans who don't have PTSD. So just even within the military community, if you have PTSD, your risk is significantly higher. Wow. So it is, I mean, mental health and sexual health are very, very intertwined. And I know the VA tries to do a really good job of getting help for veterans in terms of PTSD and mental health.

but like it is a real struggle and it is something that is really, really challenging. So, you know, I think that's a big one. And then also like it's crazy to me that, you know, my vets will come see me and I'll be like, do you want something for your erections? And they'll be like, oh, no one told me I could have that or no one's even asked me about that, right? So beyond, they're already at high risk, right, and from TBI. So TBIs can affect hormone health.

So a lot of guys with TBIs will have low testosterone. And so they usually will get tested for testosterone, but they're not asked always about their erection. So even with those patients, like, it's like they may be given medication, but they're never educated on it. And no one's really linking that mental health aspect. Like, we need to fix the mental health aspect so you can actually, I mean, and think about it, if you're having better sex, you're probably helping your mental help too, right? It all goes hand in hand.

So I think it's really a challenge because they have so much going on that those things become forefront and sexual health goes in the back front. I mean, is there, do we know why PTSD can, can, makes it three times more possible for somebody to have erectile dysfunction? I mean, all mental health issues are linked with sexual dysfunction because it's sort of like if you're, I mean, just very simplistically, and this is not the, this is not, this is too simplistic, but if you're sad, you can't get aroused, right? You're not going to get turned on because you're sad, right? Like, it's just, you don't, like, sex is not on your mind.

You're, like, thinking about all, and you're in a sort of a fight-or-flight sympathetic nervous system. So when we think about erections, to get an erection, we call it point and shoot. You need a parasympathetic nervous system, which is your rest and digest, your relaxed nervous system to be activated for you to get an erection. You need to not be in a state of anxiety your stress. And then when you have your ejaculation, that's when your sympathetic nervous system turns on. So if you are constantly stressed, depressed, angst, PTSD, specifically, there's a lot of sympathetic nervous system activity, right, when you have PTSD. So you just can't get into the mind state, the nervous system state, to be able to get an erection. Okay. Is there anything that

men can do to last longer in bed? Yeah. So a lot of guys think, like, oh, if I just think about my grandma or something like super non-sexual, right, it's going to work. Now, for some people, if you don't have any issues and you're just trying to last longer, sometimes that does work. But most times it doesn't and it actually hurts, right? Because now you're like introducing this very non-sexual, non-pleasurable thought in a moment that you should be like feeling really good, right? So I think a lot of it is, I mean, of course there are medications of things, but I don't, I think that just talking about non, like, things that you can do that are, like, actionable. One is, interestingly, is breathing.

So, like, doing diaphragmatic breathing. So, like, really deep into your diaphragm is actually going to help rub up your parisembe, like, nervous system. And so people who do this type of breathing, even outside the bedroom, and they do it regularly, have been shown to last, like, 900% longer. So I made a video on it. 900% longer? There was one study that said 900% longer that you, premedic breathing plus they'll do some some exercises which are like the stop start technique so you

get almost to the point of climax and then you kind of bring your arousal down and then you go again you do like three times and then on the four it's sort of like edging and then on the fourth time you ejaculate so those sort of actions as the same time with breathing has been shown to increase the ability for people at least men with premature ejaculation to last 900% longer so and then sometimes doing those breaths during arousal. So like sort of calming things down because as you can think about it, like you're, it tends to be like a very like quick sort of like, oh my God, my God, my God, my God. Like, you know, when you're having sex, you get really excited, right?

So you just need to calm things down and then you can last longer. Now, another thing that has been shown in, these are small studies, but I think they make sense and they actually are so easy to do that like, I'm like, every man should be trying to do these in general, right? they're good for your health, too. They're good for your mental health. The other one is using exercise. And the reason certain exercise, specifically high-intensity interval training,

because it helps your brain sort of get, understand where your body is in time and space. So you get what's called interoception. And that, then as you do that in practice when you're exercising, then when you're in position with your body, you can start figuring out the cues. Like, oh, I'm getting close. You can follow your arousal, like when are you getting close to climax? and sort of damped things down a little bit. So you sort of learn your body better because you're doing those exercises.

And the study was seven minutes of high-intensity interval training daily, showed an improvement in as quick as two weeks in terms of increasing length. Now they've looked at other exercises too, yoga and running because, again, those are also very mindful exercises like long-distance running yoga. Fastest to do improvement was the hit, followed by running and then followed by yoga. but again like they all can help and so I think it's just really about being mindful of where your body is learning like what does it feel like when I'm getting close to ejaculation and being able to like be present in the moment and mindfulness again exercises like meditation and and just like really learning how to be one with yourself like it's really like understanding your body so you can say hey I'm I'm letting my arousal sort of climb slowly rather than you know and I I'm sort of enjoying the process of getting there, not like so fixated on like, you know, all the stressors of like, oh, when's it going to happen?

Is it going to happen too soon? Like, you know, that's also revving up your sympathetic nervous system. Mm-hmm. Mm-hmm. Last question. Second to last question. Mm-hmm. What, I mean, you have kids.

How do we talk to kids about all of this stuff, sexual health? What age did you start talking to your kids about? I started talking to my kids just basics anatomy when they were little. So this is your penis. I mean, for boys, it's easier. I think for girls, you have to tell them. What is their anatomy, right? So, like, this is your vulva. This is your where you pee from. This is your vagina. And same thing for boys. This is your penis. This is your scrotum. This is your testicles. And it's actually so funny because I have so many funny stories with my kids because, like, they've always been very open with me. And so, like, when they first started, I hope they never watched my podcast

interviews because they're going to be so mortified but like like when they were little and they the first time like they would get erections they'd like mommy why is it getting big right and I'd like this is completely normal so you're just having an erection it's a completely normal thing whereas I know other friends would like oh my god what do I say you know what I mean they would sort of freak out and I'd like look and they would ask me and I said just tell them it's normal like it is normal to get random erections there is nothing wrong with it so that was one I would also tell them they would be like, oh, like my son would go, like on a roller coaster, and they'd go, it tingles down there. I'm like, yeah, that's okay. That's like a normal

sensation. But you would just, when he asked these questions, I would ask, I would answer them as best I can. I remember one time he asked me about sex. And I was like, not prepared in that moment to answer it, right? And I was like, okay, give me a second. Like, I will answer this question later. And I talked to my husband about it. And I was like, okay, how do we go about this? He's like, no, you should talk to him about it. Like, you're obviously more skilled at talking about sex and I was like he's like and we decided like it's obviously going to be better for me to him about it now when he's curious rather than him going to ask someone else right so he asked me and I told him this is what happens during sex and this is how it happens and then when I had the

same conversation with my younger son he's like so wait if what if I just like fall like what if I fall on to her will we be having sex and I was like no no no that's not how it works so like it's so it's so innocent their conversations but it's also like this is and so we've been doing it so long And so now we have sort of a routine. We'll go on walks. And they'll know that if that's a time they want to talk to me alone, they'll sort of like, hey, mommy, can we talk? And they'll ask me questions or they'll, you know,

they might have seen something in a movie or maybe their friends at something at school. And so they know that they can ask me anything, right? And then I will also, like I remember I had, I talk about sex all the time, but I had forgotten that like, oh, I need to talk to him about wet dreams because they're going to happen. I don't have to feel embarrassed, right?

Because you can have, I mean, you probably can recall when you had that happening. Like, oh, my God, what happened? Like, this is horrible. This is scary. Like, am I dying? What's going on, right? And everyone has a different reaction, but I was, like, didn't want him to freak out. So I remember telling him, like, this might happen.

It's okay. Just let me know. We'll wash the sheets. And it's totally normal, right? But it's just a simple thing that, like, you don't even think, especially as a mother, like, I'd never had that experience. So I had to, like, remember, oh, yeah, this is something I need to tell him before it happened. So he doesn't, like, freak out and think something's wrong with that.

I mean, what do you, how do you, how do you describe, what age was that when you were having a discussion with your show? We've had so many for so long that I think I started, because the average age where kids see porn is 10, I think I started talking to my son at 8 about porn because I was like, I didn't, you know, I don't know who he's going to see it from. I'm going to do my best to like, you know, put all the locks on my phones and anything that he has access to. And, you know, but like I don't know what his friends have locks on their phones or what they, if they have phones, right? Like all those things, I just don't know what he's going to see when I'm not with him. I'm not with him 24 hours a day. So I had to prepare myself for the fact that he might see something. And even though I don't want him to see it and I don't, I wish he doesn't, I know he might.

And he's actually told me that some kids in school have talked about porn now that we've had this car. He's 12 now, but he's told me that kids have talked about it. Like, oh, you know, we watch porn. And I was like, he's like, I'm like, have you seen it? And he's like, no, I haven't. I'm not really that interested. because we've talked about it, right? And I think, like, he realizes, like, it's not really all that cool.

Like, it's a fake thing, you know, and it's not necessary right now. So, you know, I think, and he knows he can come to me. Like, I can tell him any question he wants, I'll answer it. I might answer it right that second, but I will think about it and I will answer it. And so, yeah, I mean, I started talking to them. Like I said, when they're little, just about their anatomy. And so, like, slowly but surely. But the sex question, he came to me.

And I think he was, I think it was around eight. He came to me and asked me about it. And I was like, okay, now is the time to answer it. He's asking the question, so I have to answer it. You know, and so I made this routine where we go for walks and I tell him about whatever. And he knows that's a great time where he can ask me. And I don't have to look at him in the face either. I can look straight ahead and answer and he can look straight ahead.

And we don't have to have like an awkward, like, you know, face-to-face interaction. But, you know, we're just talking. And I think you got to find, you obviously know your kid and you know how you, you know, how you want a parent. But I think, like, we as parents have a responsibility in today's society where we have less control over what they're going to see because they're out in the world at school and kids have phones, which is crazy to me. Like, you know, we don't have as much controls we would like. And, I mean, so we have to be responsible and teach them. And because the other thing is, it's sort of scary. Like, some of the things they're going to see. So, for example,

choking is a big thing in porn right now. And so I had a researcher on my podcast, Debbie Herbenick, who wrote this book called Yes, Your Kid. And so she did research on college-age students, and she found out that choking became very, very common in sexual encounters. And it's fine if someone finds it pleasurable, but it's dangerous, right? Like, you're asphyxating someone. You could cause really serious harm.

But they're doing it so casually, like it's almost like kissing. And when they did the surveys, they found that women were most often getting children. And a lot of them were not that into it. I mean, they were okay. They were like, yeah, you can do it. They were getting asked. But they were like really not that into it. And they were just doing it because they felt like that was what was done. And so that's just one example of how these things are being perpetuated from what they're seeing. And they're not, these things are not focused on pleasure. They're just focused on getting you entertained. And so, like, they're not learning how to pleasure each other. They're not learning how to, have a meaningful, intimate encounter, and it's really sad. Yeah, I love the walking method. Yeah, it's a good one. That's great. It's like you had mentioned, you know, it's not face-to-face. You can look.

And I tell even couples, like, do talks when you're not looking at each other. Because in the beginning, no one taught us how to have sex, right? Or how to talk about sex, or have sex, really. But no one taught us how to talk about sex, right? So it's super awkward. And it's not a one-time conversation. If you want to have a meaningful, really robust, amazing sex life with your partner, you've got to talk about it. And so I tell people, like, when you're in the car, when you're on a walk, so you don't have to, like, look each other across the table and definitely never in the bedroom.

Like, just have these conversations in places where, you know, you have a little room to, like, wiggle and look and feel awkward, but don't have to show it to each other. Love that. Love that. All right. Last question. If you could recommend three people for this show, who would they be? Oh, gosh, three people. Okay.

Well, if you want to do more sexual health, I had Dr. Barry Kamisarik, who is a researcher, who researches female orgasm. And like, I'm a brain MRI. That was a really interesting conversation. Who else? I'm trying to think. I think your audience would really like Dr. Aloys. Canoja, he is a, he's a physician who really focuses on gaming, but he has a lot of insights into like the psyche of the young man right now and like how to sort of manage these like

gaming addictions and also sort of people who struggle with pornography and things like that all in the same, yeah. And let me think of a third one. Hmm. I think. Um, Do you know any sex therapists? Oh, yeah, I know a lot of sex therapists. I don't know anything of the best one for you, let's see. Let me think on that one. I want to give you the right name. Perfect.

Perfect. Yeah. Well, Rina, this was a fascinating conversation. Like I said, thank you so much for coming, and I'd love to see you again. Yeah, thank you so much for having me. All right. Cheers. Thank you.