The Better-Sex Doctor: The Link Between Masturbating & Prostate Cancer! Dr Rena Malik

Men who ejaculate 21 times or more a. month are less likely to develop. prostate cancer. Jesus Christ, why? It's. because Dr. Rena Malik. Board certified urologist. Expert on sexual health. And a rockstar in educating the public. On the facts and myths of sex Rena, I. want to start with this idea that other. couples are having significantly more. sex than we are. Big myth. People are. having sex about once a week. Will my. penis get smaller as I age? It can. So, in terms of how do we.

maintain our penile size, you need to. have Is there a disparity between how. long we think sex should take and how. long it actually takes? Yeah, we all. think it lasts longer. Women want it to. be 18 to 25 minutes. Men are a little on. the shorter side, like maybe 12 minutes. Is there like an average time? 5.1 to 5.7 minutes. And then is too much. masturbation going to have an adverse. effect for men and women? Masturbation. is generally safe as long as you don't. That's when it becomes a problem. Rena,

do we understand our bodies as it. relates to our sexual health? Not at. all. For example, with pelvic floor, it's involved in orgasm, it's involved. in sexual function, but no one really. talks about it. In fact, men will be. shocked, "Oh, I have a pelvic floor, too?" And there's a whole host of issues. that can come from having a weak pelvic. floor, including erectile dysfunction. So, how can I strengthen my pelvic. floor? Pelvic floor exercises. They're. going to increase orgasm, they're going. to make your semen propel further, and. ultimately it would be something as. simple as.

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is to hit the subscribe button. Let's. get on with the episode. Dr. Rina Malik. With all of your work, what is it that. you're seeking to do? So, what I'm seeking to do. is. have people understand that sexual. health is health. I think we have so much misunderstanding. about one, what is good sexual health?

How do you Why is good sex important? Why is it good to have. good sexual health? And that creates a. lot of despair and devastation, and. people don't talk about it. So, they. ruminate, they feel bad about. themselves, and it's pervasive. throughout their entire life. So, I think ultimately my goal is to. make education freely accessible and. understandable, so people can know. what's going on with their bodies, what's normal, what's not, and what's. available to help them.

How do you define sexual health? So, sexual health is sort of an. individual thing, but most people would. say that you are able to have sex, you. are able to have an orgasm, you are able. to have pleasure and achieve the. benefits of that. Do we understand our. bodies. as it relates to our sexual health? No. Not at all. I will tell you, so I talk about, for. example, how it's normal to have erections at. night or have even nocturnal emissions,

so have a wet dream, how that's a normal. physiologic function. And so many people. will message me and say, "How can I stop. having what they call nightfall?" Or. "How can I stop waking up with an. erection?". Because they think for some reason it's. shameful or it's a bad thing. And when. realistically it's just normal. And part. of it is media, right? So when you see. TV, you see a man getting an erection. very quickly, he's. immediately penetrating a woman, and.

she's immediately orgasming, and the. whole act is like really hot and heavy. And in reality, that's not what sex is. like. So if you're not seeing what. normal sex is like, what normal foreplay. is like, what the fact that it's normal. to sometimes have difficulty getting an. erection, that's normal sometimes to not. have an orgasm for a woman, or it may. take more time to get a woman aroused. and require more foreplay, that you are. essentially looking at a script that's. not real. And then you're like, "What's.

wrong with me? Am I broken? You know, is. something wrong with my body that it. doesn't function the way I'm seeing on. TV or on media or on erotic films?". Where does your experience on this. subject come from? So I'm a urologist by training, a. board-certified urologist. So we are the. medical and surgical doctors of the. genitourinary tract. So we're. essentially the plumbers. So when you. have a problem with your kidneys, the. tubes that drain the kidneys, the. bladder, or your genitals, we're the. ones who are going to fix those if.

they're a surgical issue. And also we. deal with the medical aspects of some of. those things. And so that's what my. training was in. But when I started my. social media, my channel, I wanted to. offer education to people. And as I. started making this education, I. realized how badly people wanted to know. about sexual health, how much they. didn't know, and how they really wanted. to be empowered with this information. And people are not being asked about. sexual function. Even when you go to see. your primary doctor, when was the last.

time they asked you about anything They. might ask you about erections, but. that's probably where it ends, right? Even if they ask about that, they're. definitely not asking women, "Are you. having orgasms?" They're definitely not. asking um anyone if sex is pleasurable. They're not asking them if they feel. satisfied with the way things are going, right? And if they are enjoying desire, do they feel normal? And so I realized. there was such a disconnect here with. what people wanted to know and what was. available to them. And so then I started. really making content about sexual. health and spending more time. investigating in that area, treating.

patients in that area, and it totally. became a all-encompassing field for me. You're an expert in the pelvic floor as. well. Mhm. What was your sort of. training. with the pelvic floor? So when you do a. fellowship in what we call pelvic female. medicine, a lot of what we do is related. to the strength or weakness of the. pelvic floor. And so the pelvic floor, just to start, is a bowl of muscles that. sits in your pelvis. So your organs, the.

bladder, the rectum, for women the. vagina, the uterus, the urethra, all run. through the pelvic floor. It attaches to. the bones on your pelvis, and it is. extremely important for a variety of. functions. It offers stability, so when. you're standing, sitting, it offers. stability. It offers the ability to. defecate and urinate normally. It offers. uh when women have pregnancy, the pelvic. floor becomes very important. It's. involved in orgasm. It's involved in. sexual function. But no one really talks.

about it. No one really knows it. In. fact, men will be shocked, "Oh, I have a. pelvic floor, too?" Because we talk. about it a lot with women, right? We. talk about it in terms of, "Oh, I might. leak a little after I've had babies when. I cough or sneeze or jump on a. trampoline. But the pelvic floor is much. more complex than that. And so, very. often we'll see people when they have. weakness of the pelvic floor, yeah, we'll see leakage of urine. And but. sometimes their pelvic floor can be. discoordinated, or it can be too tight. or or have elevated tone. And so, what.

that means is that you can develop a. whole host of abnormalities. And that. can be that you may have constipation. You may have issues emptying your. bladder. You may feel like you have to. go to the bladder go to the bathroom a. lot. So, you may urinate frequently. You. may feel the urge to go often. Sometimes. it can cause pain. So, it can cause pain. when you urinate. It might feel like. you're having a UTI. It may cause pain. with erection or ejaculation for men. So, there's a whole host of issues that. can come from having pelvic floor.

abnormalities. And even if you've had, say, lower back injuries or hip. injuries, they can affect the. coordination of the pelvic floor cuz. it's all interconnected. And so, I will. see patients who are like, you know, "I've had a bunch of hip issues because. I played sports when I was younger, and. now I'm having issues with sexual. function." And so, it's all. interconnected and I think we we don't. spend enough time talking about how. important it is and how valuable it is. to people when they're having problems. I want to go into the pelvic floor in.

more detail and really figure out how I. can improve my pelvic floor and what I'm. doing to harm or hurt it. But you said. something there about doctors don't ask. about sexual health. They don't ask you. for orgasming, they don't ask you for. ejaculating, those kinds of things. Why. should they be asking about that? Cuz I. think of a doctor as, I don't know, fixing other parts of my body. I don't. think of them as sifting through my. sexual life. So, if you have a normal sexual life and. you're satisfied with it, it won't even. it wouldn't even bother you, right? You. wouldn't think about it. But people who. have difficulties, they may be walking.

around feeling shame. They may be. walking around wondering what's wrong. with them. This can be pervasive because. they may have relationship issues and. they may have problems in their life. with their relationship that they're. then causing them to be less productive. at work, less happy, less satisfied with. life, feeling more depressed, more. anxious. And so it all comes together. And in fact, the other really important. thing, at least for men, we know that. when they develop issues with erections, so say you're having erectile.

dysfunction, and you are diagnosed today. with erectile dysfunction, 7 years. later, about 15% of those men will have. a heart attack. And the reason for that is because if. it's a blood flow issue, the arteries to. the penis are about 1 to 2 mm. The. arteries to the heart are about 3 to 4. mm. And when you have about a 50%. occlusion of a blood vessel because of. high blood pressure, high cholesterol, heart disease, that organ will start to have problems.

And so you will start to see erectile. dysfunction in men who have vascular. problems. before you start having chest pain or. other signs of heart disease. So it's. and probably similarly in women, although the data is not as We don't. have that data for women that maybe if. they all of a sudden are developing. problems with arousal, that maybe that. that's an indicator. But again, that's. more complex and we don't have the data. for that. But certainly for men, we have. a clear indication that a problem with.

erections could precede really serious. heart consequences. And when you look at. people who've had a heart attack, about. 50% of men will have had erectile. dysfunction prior to that. 50%? Mhm. Is a pelvic floor dysfunction in men. also linked to erectile dysfunction? Are. you cuz I I heard in some of your work. that sitting every single day in in the. way that I do here, I sit sometimes here. for 10 hours a day, could be creating. erectile dysfunction.

Well, so it's more of the sitting every. day can cause your pelvic floor to not. stretch appropriately, right? Like if. you're not moving your body regularly. and your body tenses up from sitting all. day, then your pelvic floor is not. relaxing and contracting in a normal. fashion. And so some people will develop. some tension in the pelvic floor and. through the pelvic floor runs a whole. bunch of arteries and nerves that then. go to the penis to provide blood flow. And so if your pelvic floor is clenched.

really tight, then it can cause problems. in getting blood flow and then problems. in getting erections. So while that's. not um that's different than having. vascular problems, this is a muscular. problem more so um that that that can be. an issue with in terms of causing. erectile dysfunction in some men. Cuz I. heard during COVID there was a rise in. pelvic floor dysfunction as people were. sitting all day. Yeah, I mean I. definitely saw it. I don't know if it's. been actually studied, but I definitely. saw it in my own clinical uh setting and. many of my colleagues did where people. would come in and they would start.

having either they'd be having more. erectile dysfunction, they might be. having more urinary urgency, meaning. they got to go got to go to the bathroom. or they're going more often, which. wasn't a huge issue because they the. bathroom was right near them, but they. did sometimes notice that it was a. change. And and also sometimes they. would some people even dealt with pain. Like they would have more pain in that. area or women would think they were. having urinary tract infections when. they truly were just having discomfort. from the pelvic floor being tense. One. of the things that you're particularly. good at is taking on some of the big.

myths as it relates to sexual health and. I I want to start with one of the big. myths around sexual health, which is. this idea that we all think other people. and other couples are having. significantly more sex than we are. Yeah. So that's interesting. I think. that is a big myth. And so when you look. at um people want to know like what's. normal? How much sex should I be having, right? And there's no ideal number, but. when you look at studies, right, which. have looked at large numbers of people, people who are in partnered. relationships are having sex about once.

a week on average if they're have if. they feel that they're, you know, in in. partner relationships where sex is. always available. But it's so variable. person to person. And what I really like. to say is it's not the quantity of sex. that matters, it's the quality of sex, right? So if you're having good sex. once a month, that may be sufficient for. you rather than having mediocre or bad. sex four times a month or 10 times a. month even, right? And and so ultimately. there's no right number. It's really.

what's right for you. And I think. focusing on. some like benchmark, right, of sex is is. actually harmful, right? Because now. you're like, oh, well, I need to have. sex this many times. What what is the. purpose of sex, right? The purpose of. sex is pleasure. And sometimes people. derive a lot of benefits from orgasm. We. know that there's physiologic benefits. to orgasm in terms of stress reduction, more focus, potentially better sleep, and even maybe lower blood pressure, things like that. So if people are.

deriving benefit from the orgasms and. the intimacy with their partner and the. pleasure they derive from sex, that's. what matters, right? Not the number of. times you're having sex. Another big myth around sex which I. thought I'd. get your take on it is. about pain during sex. It's one of the. sort of most popular questions that I. often get get whenever I speak to. someone that is an expert on sexual. health is. is sex supposed to hurt? Because for a.

lot of people it hurts. No, it's not. supposed to hurt. So if it hurts, you want to assess, you know, what. Usually it's the female partner who. feels pain, right? So is it that you're. not lubricated enough? Is it that you. have not had enough foreplay? Because. the body prepares for intercourse, particularly in the female. So what. happens is you go through arousal, your. body self lubricates, and the vagina. actually lengthens and widens almost. double in size to accommodate the.

phallus or whatever you're using, whether it's a toy or or a finger or. anything. And so, if you don't have. sufficient time to allow those things to. happen, then it will be painful. And. sometimes lubrication can be variable. person to person. So, some people may. have copious amounts of lubrication, and. some people may have less, and it could. be based on genetics. It could be based. on the age they are, what stage of their. hormonal status. It can be based on what. medications they're on that might.

decrease lubrication. I think there's. another big myth is that lubricant is. not for everybody. And I argue that. lubricant is for everybody, that it. makes things more fun, it makes things. more slippery, it makes things more. enjoyable. And it certainly makes pain. less of an issue for a lot of people. Now, there can be other issues that. cause pain. So, if you've tried all. these things, you know you're fully. aroused, you know you're lubricated, you. know that you're still having pain, then. it's really important to get evaluated. to understand what exactly is causing.

the pain. It could be hormonal changes. in the vestibule, which is a part of the. vagina, that is very hormonally. sensitive, that can be painful. It can. be pelvic floor dysfunction. It can be. things like endometriosis or other. factors that may be going on that need. really advanced help. But most of the. time, a lot of people can feel and enjoy. sex more readily if they just increase. the amount of foreplay and increase the. amount of lubrication. You said that the. vagina. expands Mhm. during sex. So, how much.

does it expand by, and how long does. that take? Because I think men don't. really understand this process. A lot of. men just like to rush in there, you. know. Yeah. Yeah. So, usually it expands by. about double, double in length and. double in width. And so, it will expand. and basically the cervix is moving up. and out of the way, the vagina is. expanding to accommodate the length of a. phallus, and and it takes, we think, on. average about 18 to 20 minutes. So, it. that's sort of the amount of time it may. And some people faster and some people.

longer, but ultimately, you know, sort. of like understanding that, but also. um the lubrication is another big part. of it. And so, I think both those things. together, um you know, you need you need. some time. And some people, like I said, they may not take 18 minutes. They may. take a couple minutes. And so, it's very. reasonable to get in there if that's. what your partner wants. But again, I. think the bigger issue is that we're not. communicating about sex. No one taught. us how to talk about sex, right? I. didn't grow up talking about sex with my. family. Many of my friends and. colleagues did not grow up unless they.

were in a family that was very. progressive talking about sex or even. learning about sex from their parents. And at school, you don't learn much. You. learn how to put on a condom, you learn. how to ask for consent, you learn about. STDs, and that's if you're lucky. In the. US, 13 states don't have to have. accurate sex education. Like, it's not a. requirement for sex education to be. accurate in 13 states in the US. Where. are we learning sex from? So, the large majority of young people, I mean, this data shows that at least.

one in four adolescents are learning sex. from porn. And it's probably more than that. So, I. think a lot of people are learning. either from uh pornography, from their. friends. A small subset are learning. from their parents. There still are. people learning about sex from their. parents, but ultimately, it's not. enough. And so, if people are learning. about sex through porn, porn is. entertainment. It is doctored, it is not. real, and I think people then take that. and they say, "Why did not my sexual. encounter not look like that? Why didn't.

I have as much semen volume? Why didn't. my partner not orgasm as quickly?" And. it can be on both sides, where women can. be like, "Well, why didn't I react like. that? Why didn't I get so excited right. away? And I think there's it's a real. problem in terms of if people are only. learning about sex through pornography, then they're already set up to be let. down when they have their first sexual. encounter. And on that point of. communication, we don't talk about it as. a society, but then even within our own. relationships, uh you know, we don't talk about things.

we're struggling with with our own. partners. Yeah. And the insecurities. that we have, and I think that can cause. a spiral of misunderstanding, and I've. seen that in my own sex life. historically, where maybe there was. something I was insecure about or there. was something I was thinking about, and. instead of communicating it, I might. have just acted in a strange way, and. then that's misinterpreted, and then the. other person gets a little bit insecure. or whatever, and then you kind of have. this downward spiral of. misunderstanding, which leads to like. sexlessness. Absolutely. You're just. avoiding the situation because nobody. wants to talk about it. And this is the.

problem. Like, you know, people ask me. like, "What's the What's the key? What's. the key? What's the secret?" The secret. is you have to know what you like, right? You have to know what you want, and you have to communicate it with your. partner. How? So, this is the issue. It's not easy. It's not easy because no. one taught us how to have these. conversations, and they're charged with. a lot of emotion, right? You feel. insecure, you feel inadequate, or you. feel resentful because you're not. getting what you want out of the. relationship. And so, it has to come.

from a place of understanding that this. conversation is not a one-and-done. There's no the talk. There are multiple. talks over multiple periods of time. And. the first time you have the talk, it. might be a total disaster. But, you. know, if you are in a relationship with. someone really also has the same goals. as you of having a great relationship. with a good sex life, then ideally it. that won't continue, and you will. continue to have conversations. So, what. I tell people is don't have. conversations in the bedroom, not right. before, not right after sex. You want to.

wait until you're out of the bedroom. Or during, yeah. Definitely not during. That's happened before. It's the [ __ ]. worst. Yeah. Yeah, that's pretty bad. That's. pretty bad. Um. So, you know, one and then two, have it. in a place like some people you don't. need to be looking at the person, right? You can be sitting in a car, you can be. going on a walk, because it's really. awkward to look at someone in the face. and be like, you know what? I felt like. this wasn't really great, you know? And. And so then to be like, okay, like, you. know, talk again, using the same sort of. communication techniques that you use. for other things, talking about I.

statements, not being you did this, you. didn't do this, more about like how I. feel, what really turns me on, what I. would really like in the relationship. And then sort of realizing that they may. not react well, they might be like, oh. my god, I can't believe we're talking. about this. They have their own. stereotypes and biases that they're. bringing into that conversation too, or. their shame, or whatever they grew up. with in society, whatever they think. about sex can be very charged, right? And so it's sort of a lot of work to get.

through that, but realizing that it. could take time and sometimes getting. help. So, seeing a sex therapist or. someone who has expertise in psychology. and sex to talk about learn how to talk. about sex with them and and navigating. the difficulties of it. But it's worth. the investment, right? It's not easy, but nothing in life that's good or worth. getting is easy, right? Okay, so there's. a couple listening right now, there's. probably one member of the couple. listening right now, and they've heard. everything you've said, but they have. reached the point of no return in their. relationship as far as that concerned.

They've not been having sort of a. functional healthy sex life for maybe. one year, maybe six months, maybe five. years. And it's just become the new normal. Mhm. What is the case you'd make to that. person to get them to take action to try. and rectify the situation? Well, I would. ask them first how important is sex to. them, right? If it's not that important. and the other things in the relation And. that's okay, right? Some people find. that, okay, everything else in the. relationship is excellent. I love this. person, we're still intimate, we still. love each other, we We cuddle, we still.

um have a lot of great things in our. relationship and and sex right now is. not working, right? Or it's not it's not. working for us. So, um I'm okay with. that. That's fine. Like you don't have. to feel bad about that. But I think that. if it is a problem, then I think it's. worth working on, right? Like if you. have a relationship that you value and. that person you're you're with values. the relationship, then it's worth keep. trying. Like try to have the. conversation. Try to bring them into the.

conversation. How much have you tried, right? Like have you really had enough. attempts at a conversation? A true. conversation where. you didn't get frustrated, too, right? Like where you were like, "Okay, I. understand that you have This is a. difficult conversation that we're going. to have and I understand you might have. feelings about it, but I love you and I. really want to try to have this. conversation." And to keep at it. And I. realize that that's not easy, right? That's not easy. I'm not saying it is. But I'm saying that when you're in a. relationship that's worth having, that. ideally at some point the other partner.

will see how much this matters to you. and want to work with you on it, right? If they love you, if they're with you. there, they want what's best for your. relationship. They're not like hiding. They're not hiding their head in the. sand and being like oh, I'm like they're. They realize they just don't want to. talk about it. They they they're not. stupid. They just sort of don't want to. talk about it because it's embarrassing. to them. They feel like they're the one. that has something wrong with them, maybe. Or maybe they have an issue that. they haven't brought up. Maybe they're. having a lot of pain with sex. Or maybe. they're going through hormonal changes. and their tissues are really dry or.

whatever. There's a whole host of things. that could be going on that they don't. feel comfortable talking to you about. So, I think it's it's valuable to say, "Is there something I'm not doing?" Like. tell me what you feel about sex. Like. leaving it open-ended to really find out. what's going on with them. Because. usually not that they're like, "I just. don't want to have sex and that's it.". There's usually a lot more to it. It's so hard for us to know, isn't it? When it comes to sex, what the root. cause of the issues are. And I think. some relationships are like a frog in a. frying pan.

The frog in the frying pan analogy for. anybody that doesn't know is that this. old tale about a frog jumping into a. frying pan and then because the water. heated up gradually ends up dying. But. if the water was hot from the moment it. dropped jumped in it would have jumped. straight out. The idea that it's a. gradual death for the frog and in. relationships it's kind of a slow day by. day month by month decline in intimacy. and you end up finding yourself like a. dead frog in a frying pan. You end up. finding yourself in a sexless. relationship and you think how the hell. did we get here? Mhm. Um.

and it's and it's a it's a feels like a. long way back from that point. It is. It's going to be, right? Because you let. it sort of dwindle and you didn't talk. about it and it's going to take work and. I think that's the key is like if you. want to fight for that in your. relationship, it's going to take work. and it's going to take um buy-in on both. sides, right? You have to work for. anything in your relationship. Relationships are not easy, right? You. want to have children, that takes work. You want to um decide to buy a house. together, that takes work. Deciding and.

figuring out the what kind of house you. want, how much money you want to spend. Like there's all sorts of things that. take work and this is one that people. just don't know how to talk about and so. they just ignore it because it's harder. to bring up for both parties, right? What the one who maybe is not wanting. sex or is being the one who says no to. the and the one who always wants sex and. then feels rejected because they're not. getting it. Is there a a sort of a. difference between men and women's. sexual desire as we age?

You know, because I think there's a myth. that says men just always want to have. sex and women maybe not so much. Is that. a real myth um in terms of something. that you hear, but also is it true? So, let's talk about desire. Desire comes in. two flavors. So, there's the spontaneous. desire where you see somebody, you're. like, "Oh man, they're so attractive. I. can't wait to sleep with them. I'm. immediately turned on. I want to have. sex right now, right? You didn't have to. do anything. You just saw them and it. happened. And then there's responsive. desire where you're sort of with them,

you might be touching them, you might. not really be thinking about sex, but. like you're touching them, you're with. them. You're like, "Oh, this feels sort. of nice. I sort of like this." Like, "Oh, now I'm turned on." After we've. sort of started being a little romantic. with each other, being a little more. intimate with each other. And both. desires are normal and both desires are. fine to have. Now, in the literature, you'll find that men tend to more often. have spontaneous desire and women tend. to more often have responsive desire, particularly when you're in longer-term.

relationships. So, there's a disconnect, right? Women are like, "Why don't I see. you and want to jump you anymore? Right? I used to feel like this, but I don't. anymore. What's wrong with me? Am I. broken?" Right? And then they don't. realize that, "Okay, maybe we'll just. like be together and let's see what. happens." And they don't even want to. start because they're worried that what. if I don't want to have sex and we've. now initiated this like touching, cuddling thing where, "Oh, that person's. getting really turned on. What if I. don't get turned on? And what if I. disappoint them?" And so there's a lot. of charged emotions there, but realizing.

this is normal and common and responsive. desire is not wrong. It's just. different. And people just don't know. that it exists because, again, media. attention is like you see somebody jump. them, you're you're horny right away, you have sex. And that's not what. happens all the time and that's okay. And so like, you know, you can be with. your partner and be like, "Look, I have. no expectations from you. I just want to. be with you physically." And see if it. turns into sex. So, often we'll give. people homework. Like, put it on the. calendar. Put it on the calendar that.

you are going to be intimate together at. this time. And I know that sounds weird, right? Like you're looking at me like. I'm crazy, but we put on the calendar. when we want to work out. We put on the. calendar when we want to have brunch. with our friends. We put on the calendar. when whatever, right? And when we When. we. when we used to have dates with people, we would say, "Okay, we're going to go. on a date on Friday night." We would. know that sex is on the table with our. partner on Friday night. So, we'd get. really excited about it. We're like, "Okay, I'm going to shave. I'm going to. look real pretty. I'm going to smell. good. I'm going to do all the things.

that make me desirable and feel. confident and be ready to have sex, right?" And so, you'd be like really. excited about it. And then you would. have all this anticipation about how fun. it's going to be. But the anticipation. can can wreak havoc, can't it? It can. It can. So, the opposite is true. But. that's because if you expect That's why. I say intimacy and not sex. So, if you. say you're going to have sex, it can be. like, "Oh my god, what if I don't. perform? What if I don't do right? What. if I don't want sex? What if it hurts?". Right? So, you can also have that sort. of rumination and spiral. But if you're. like, "Look, all we're going to do is be.

together and be intimate. We're not. going to just go have dinner and talk. We're going to like literally be. together, not have our phones with us, maybe like touch each other, maybe get. undressed, maybe just, you know, feel. how what it feels like, and that's it. There's no expectation of sex from. either side. We're going to go in. knowing that, and then slowly work our. way towards like, "Okay, you know what? Like, maybe sex will happen and maybe it. won't." And over time, as you keep. putting on the calendar, prioritizing. your intimacy with your partner, then.

eventually you'll get to a point where. oh, you remember, you recall that. connection you used to have, and then. you can actually find that joy again of. connecting sexually. That's the sort of the aspect of desire. which is I guess is a bit more. psychological. But it There's also sort. of a physiological element to desire as. it relates to hormones levels. So, if. someone's got a low libido, is that a. hormone dysfunction? It can be. So, testosterone is the most notorious. hormone for desire, right? In both men. and women. And I think this is a big.

misconception is that we don't talk. about testosterone in women. But. testosterone in women is more. predominant than actually estrogen. We. have more testosterone in our bodies. than we do estrogen. And testosterone is. very important for desire in both men. and women. But anything that is in. interacts with testosterone is also. important. So, thyroid hormone can can. cause issues with testosterone. Prolactin, which is another hormone made. by the brain, can also interact with. testosterone. So, essentially evaluating. those things and making sure that your.

levels are normal or appropriate for. your age can be helpful. That's probably. the number one thing. But the other. thing is outside of physiology is that. stress, even though stress is. sort of an abstract thing, stress. affects our physiology, right? So, when. you have a lot of stress in life, whether it be work, relationship stress, kids stress, whatever it is, right? It. raises your cortisol level. And when. your cortisol level is high, you can't. produce testosterone. It goes down. And. so, if you're chronically stressed,

which many of us are, right? You spend. like in today's modern society, chronic. stress is like a real problem, then that. is going to really impact your libido. So, yeah, your hormones may suffer. because of it. But if you don't fix the. stress, like you're not going to fix the. root cause of the problem. Can I just. inject myself with loads of testosterone. there to get my libido back? It won't work for everybody. So, if it's. not truly a. low testosterone, meaning you have. normal levels of testosterone, likely. your testosterone receptors are.

completely saturated, more testosterone. is not going to fix the problem. So, it. depends on your individual level of. hormones. But at some point, more is not. better. In fact, more can be dangerous. And so, it's really dependent on your. individual level. So, giving yourself, like if I give a guy who has completely. normal testosterone levels, both free and total testosterone, all. completely normal, and I give him. testosterone, probably nothing's going. to change because his testosterone. receptors are already fully saturated. with testosterone. So, more is not going. to do anything. What are the other ways. that I can increase my testosterone? If.

I go and get tested and it says that I. have low testosterone levels, and I. don't want to just inject myself with. testosterone, are there natural ways. that I can increase it? Absolutely. So, number one is sleep. So, sleep is. really, really important for. testosterone. We know that when you. reduce the amount of sleep you have. So, for example, you sleep less than six, five or six hours, you're going to have. at least 10 to 15% reduction in. testosterone. And so, because our body. follows a circadian rhythm. And so, when.

your testosterone is highest is in the. morning. And it starts to decline course. of the day. There's a little bit of a. bump again and then it goes back down. At night time it's low. And your body, when it's sleeping, replenishes that. testosterone. And so, if you're getting. either less number of hours of sleep or. poor quality sleep, meaning you're you. know, you're not feeling very rested. when you wake up, that's a sign of poor. quality sleep. Both of those things can. dramatically affect your testosterone. The other thing that you can do is.

exercise and specifically resistance. exercise. So, doing high the the largest. muscle groups, so usually the lower. extremities, and using those have been. shown to boost testosterone more. significantly than any other type of. exercise. In fact, when you do. cardiovascular high intensity. cardiovascular endurance training, so. say you're doing. Ultramans, marathons all the time, long. long bike rides, long swimming, you. know, swimming for long periods of time, that can actually increase your.

cortisol, your stress, because your. body's having a stress response and that. can actually reduce your testosterone. So, it's important to do cardiovascular. exercise, aerobic exercise, but in. moderation. Because we do see some. people who are great athletes who, you. know, run, you know, run miles and miles. and miles, but their testosterone is low. because they've been doing this chronic. long duration endurance exercise. So, sort of hit training is fine, but it's. when you start doing these big Ironman, thousand mile run things that the. cortisol suppresses the testosterone.

that's That's large percentage of. people, right? But it certainly, you. know, it's like I'm so healthy. I'm the. healthiest I could ever be and I'm. having low testosterone. Why is that? And what about food and testosterone? So, food, you know, there is a lot of. data on food. The one but the most data. is on the Mediterranean diet and that's. because that's the most well-studied in. medicine, but essentially having. vegetables, fruit, low low amounts of. processed foods, good healthy fats, nuts. and seeds. So, a lot of people don't.

realize, but you need good fat to have. testosterone. Testosterone is a is a. production is in the cholesterol. pathways. And so, it comes from those. pathways. And so, you need to have some. level of fat. If you have too low fat of. a diet, that'll also affect your affect. your testosterone. So, ideally, what I. tell people is well, there's lots of. data on different types of diets. The. important thing to know is you want to. avoid processed foods, avoid avoid a lot. of sugar, and have good healthy fats in. your diet. What about, you know, I've. I've. I've heard a few times that testosterone.

levels have been declining over the last. couple of decades in men. Mhm. Is this. true? Yes, it is true. So, we're not. only seeing a decline in testosterone. levels, but we're seeing a decline in. sperm quality and uh, sperm numbers. So, the concentration of sperm and over the. course of the last 50 years. And there's. a lot of reasons for that. One is that, you know, society has become more. sedentary. We're seeing people less. active, getting more and more metabolic. conditions like diabetes, high blood.

pressure. These conditions then cause. endocrinologic abnormalities, they cause. problems with blood flow, and all these. things can affect the quality of your. sperm as well as the quality of your. testosterone production. And then, also, there's more we we think. in the environments, we know there's. more. uh, microplastics and more endocrine. disrupting chemicals, right, in the. environment. So, that is probably. playing a role. Now, we don't have like. exact like exact quantitative data on.

that, but we think that is probably. playing a role and reducing the exposure. to these endocrine disrupting chemicals. So, we tell people try not to drink out. of plastic water bottles. Try to warm up. food in glass and avoid plastic. I mean, these are easy things you can do, but if. you want to stress about the amount of. plastics in the environment, like. there's not much you can do as on an. individual level. So, I tell people do. the things you can control and the other. things sort of you know, we have to work. on as a society. Uh this is really. interesting cuz I I don't think I think.

about this much, but removing chemicals. from my life in terms of what. these kinds of things. Mhm. The I'm holding the metal mug in. front of me and then the plastic bottles. I drink from could be having an impact. on my. testosterone and my sperm count. It. could. I mean, like it's not everybody, right? Think about how many people drink. from plastic water bottles, but if you. can do decrease your exposure, right? It's probably additive. So, the more. exposure you have, the more likely it is. to impact your body. How do they know. this? Like how does anybody know that.

chemicals are having an impact on our. sperm and testosterone? So, there's, you. know, there's basic science research. where they're looking at the impact of. these things on on rats and other. animals. And then also they're looking. on the amount of exposure. to things like phthalates in labs and. seeing how that it you know, we can't. it's all cause it's all correlation. We. can't say it's causative because we. don't we're not going to do a random I. study where you drink from water bottles. for 10 years and you drink from glass. water bottles for 10 years and let's see.

what happens, right? That hasn't been. done. But they can say, "Okay, the more. your exposure based on whatever. biomarker we can assess, so maybe. urinary phthalates or other things, we. can say that okay, these people who have. more exposure to this are more likely. based on the data to have lower levels. of testosterone." And then, you know, looking at the mechanisms of how they. interact with the production of. testosterone. And I'm not an expert in. those areas, but certainly there has. been sort of plausible mechanisms of how. these things work.

How has sperm count been decreasing over. the years? So, if you look at the last. 50 years, you'll see that the average. sperm count has declined almost 50%. And luckily, the average sperm count is. still high enough for fertility rates. The average sperm count is probably. around 50 million of of fathers, people. who father children. And so, it's still. above that, but it's certainly. significantly lower than it was 50 years. ago. And so, that's where we're. thinking, you know, it's it's probably. more of a global environmental factor.

that's contributing to that in addition. to this increase in comorbidities and. poor health over time. I mean, the direction of travel there is. deeply concerning because if something. declines 50% in the last. what, 50 years, did you say? Then if we. go forward another 50 years. and we assume the same rate of decline, that means we'll be at 25% of where we. were 100 years ago. Yeah, and then what. what if you can't father children. anymore? And what if you can't have. offspring that will then propagate the.

species, right? So, there's there's. certainly concerns there, and I think, you know, we have to as a society do. better in terms of the things that we. can. So, we can control diet, we can. control exercise, we can control those. things. There's certain things that we. can't, but we can try to control what our. people are exposed to in that can be on. a governmental level, right? Like having. sort of laws in place. So, we know in. the US there's less restrictions, whereas in other countries there's more. restrictions on things like food. coloring and dyes that may have Again, I.

don't I don't know the specifics, but. certain, you know, there's certainly. more restrictions in other countries. than in the US for some reason. And so, maybe there needs to be a more critical. evaluation of where we can actually put. in place some things that would actually. have more wide widespread changes. When we think about sperm count, we. often think about fertility. Um and. you know, I don't know whether this is. just because society has changed and. we're trying to have kids later, but it. does seem that people are struggling. more and more with fertility. I mean, even in my own sort of circle of. friends, um there's, you know, there's a.

couple people that have reported to be. struggling with fertility or that you. know, they're spending 12 months or 24. months trying to have children. Do you. think this is linked to this as well? It. could be. I mean, when we know when we. look at fertility, we know that about. half of fertility is due to women, half. of fertility is due to men, and then. some combination of the two, right? So, um. definitely as women age, fertility goes. down, and we know women are waiting. longer to have children. So, that's a. big part of it that society has changed.

Women are working and and prioritizing. their careers. It's not a bad thing, but. it certainly will affect fertility. And. and then yeah, there may be these issues. that are affecting male sperm counts. that are also causing issues, but I. don't know if there's any updated data. in terms of what are the causes or the. numbers in terms of fertility rates. Fertility aside, is there any. correlation between our health outcomes. and our sperm volume? Not volume, but concentration. Uh so, volume is the amount of of of.

right? So, concentration of sperm in the. semen is more of a predictor in terms of. um. sperm volume, not semen volume. Let's be. clear. So, sperm volume, sperm. concentration are sort of the the. biomarkers. And we would say that yes, there is a correlation with overall. health in terms of uh sperm. concentration and sperm volume. Uh but I. think I don't want to make people. worried that if they truly have male. factor infertility, then now their. overall health is.

uh is a problem, but it's certainly. important to be evaluated and seen by. your doctor regularly. And on that point of um semen volume, is there a way to increase that? And is. it similar to what you said about. increasing testosterone or is there. another set of sort of. um practices we can do to increase our. semen volume? Yeah, so semen volume is. variable depending on the biggest one is. how long has it been since you last. ejaculated, right? So, the longer you. delay between one ejaculation to the. other, the more semen volume you will.

get. That's probably the most. predictive. You know, hydration can play. a role. So, if you hydrate more, certainly you may see more semen volume. Um sometimes it's a it's a low semen. volume because you're actually less. force of ejaculation. So, interestingly, when you're young, the force of. ejaculate can be really really strong. be up to 30 to 60 cm away. Like when you. ejaculate, that's how forceful it can. be. As you age, after about 50, it can. decline to 15 to 30 cm away. And so, that can feel like you're having less.

volume because it's less forceful. And. so, in those cases, that's because of. the pelvic floor muscles that are around. the urethra. Those muscles there that. help sort of propel the ejaculate out. And so, you can strengthen those muscles. with again pelvic floor exercises, the. Kegel exercises. I caution people. because people are like, "Oh, they're. going to these Kegel exercises are. great. They're going to increase orgasm. They're going to make my semen propel. further." And I think that's fine if. you're not having pain, you're not. having discomfort, and you're doing them. correctly. Because sometimes what we see.

is it can actually cause harm if your. pelvic floor is tense, like we talked. about earlier. Or it can cause pain and. dysfunction if you're tensing tensing. tensing and not relaxing. And so, if you. don't know how to do them correctly, then you could actually harm yourself. Um but yes, they can improve semen. volume by the parameter of increasing. the force of ejaculate and getting more. ejaculate out that may be left over if. you're not having as forceful of a. muscular contraction. Does masturbating. improve my pelvic floor? Does it.

strengthen my pelvic floor? So, that's a. good question. The orgasm is what. improves your pelvic floor. So, if you. masturbate and you orgasm, when you. orgasm, your pelvic floor contracts. involuntarily. You can't do anything. about it at a rate of about every 0.8. seconds. So, it does contract and that. is sort of like a pelvic floor muscle. exercise. It's doing it involuntarily. It's contracting for anywhere from 5 to. 60 seconds usually on average. And so, you are sort of in that way increasing. pelvic floor strength. In fact, they've.

looked at in women particularly is. orgasming as good as doing pelvic floor. exercises. And they've seen that you. know, you can see pretty measurable. improvement in pelvic floor strength if. you orgasm regularly. Is it and it may be you know, as good as doing Kegels depending on how. often you're doing it. So, yes, orgasming itself can be very beneficial. for pelvic floor strength. One of the. big sort of myths that I've always I'm. yet to answer is the impact that our.

technology is having on our genitals. You know, there's kind of like a. pervasive myth that if you put your. phone next to your testicles, your sperm. count's going to drop. Like, whenever. I'm in the car. um and I don't know, I'm I'm sat there. or I'm sat at home somewhere and I get. my phone and I put it near my genitals. My girlfriend has a go at me and she she. like pulls it out or tells me to pull it. out because I think she's worried that. we're not going to have kids if it's. down there. Yeah. Yeah. So, there is. there is a little bit of data there in. terms of you know, when you have these.

devices like in your lap or near your. genitals, they will increase the. temperature. And so, when you the the. the testicles are in the scrotum for a. reason, right? It's because they need. this very perfect environment with this. specific temperature to create sperm. And anything that disrupts that. temperature can cause cause. abnormalities in sperm production. So, for example, when you have a fever, because you have the flu or you have a. cold, people will get their sperm. checked to their semen analysis and they.

will see that their sperm count is zero. because the temperature, the fever, has. temporarily stopped their sperm. production. And so, you can see that, you know, people also discuss like, "Oh, what. about boxers or briefs? What about. putting" And so, all of these things can. increase the temperature around the. scrotum, which can then cause changes in. sperm production. So, I tell patients, particularly if you're trying to have. babies, is put your phone in your back. pocket, in your chest pocket. Don't put. your computer, your laptop right on your.

lap, right? I mean, it's easy enough to. do, and it does increase temperature. So, absolutely, yes, these things can. Not for everybody, right? There's people. So, we say people like you shouldn't. smoke a lot of marijuana when you're. trying to get pregnant because marijuana. can cause problems with sperm. production. But, you'll see people who. smoke every day, and they still have. babies. Or, you'll see people who do all. of these things, right? They they wear. briefs, they they put their phone on. their in their pocket, they put their. laptop on their lap, and they still have. babies. So, it's not a all all comers,

but certainly things that you can easily. just avoid putting near your genitals. Well, if I'm in the sauna every day or. if I'm in a I'm a steam room every day. isn't that going to have an impact on my. sperm count? Yeah, it does. And it's. interesting because there's a I think. we'll see more of this as we're seeing. the rise of I mean, there's benefits to. saunas, no doubt, but as we're seeing. the rise of people really doing saunas. all the time, um there can be So, we. tell people when they're trying to have. pre- if they're having fertility issues, don't go in hot tubs. Don't go in saunas. because it could affect your sperm.

production. So, those are sort of the. the conservative things we tell people. to do. Interesting. And this this point about. the phone next to the genitals, it's not. because of like the Wi-Fi and the. Bluetooth are going to like zap my. babies. No, I mean, there's some there's. some question about that, but we don't. know. I don't think we know, but we know. there's a temperature increase, right? Because phones get hot. We talked about. masturbation briefly. Um one of the big. questions that people often ask me when. I'm speaking to someone that has. expertise on sexual health is. about masturbation and whether it. decreases your testosterone levels. So,

it does not. There is one study and it. was done in 10 men who abstained from. masturbating for 21 days. And these are. young, healthy men, right? And so, this. is where I think everyone gets their. data from is this one study. And so, they took their testosterone before, they took their testosterone after. At. And what they found was that there was. an increase by about 50 50 nanograms per. deciliter 0.5 um was which is the 50. nanograms per deciliter, which is not a. huge amount. Um at 21 days. But we know.

that testosterone changes all the time. And two, there's a lot of anticipatory. cues. When you've been waiting to. masturbate for 21 days, like your brain. is is really excited. There's all these. like, "Okay, I'm finally going to get to. release." And that in and of itself can. increase testosterone. So, generally. speaking, there's no empiric evidence. that is convincing, high-quality level. evidence that masturbating or abstaining. from masturbation will increase. testosterone. And so, there you know,

people do report other benefits. And so, I tell people, "If you're getting other. benefits from abstaining, by all means, go ahead. But don't do it for Don't like. white-knuckle it to gain some. theoretical increase in testosterone. that one was not even that large and. two, it's probably not going to be. proven in a larger sample." What about. the opposite then? Is too much. masturbation going to have an adverse. effect on us for men and women? Yeah, so. I think it you know, what I tell people. is masturbation is generally safe as. long as you are not masturbating to the.

point where you are now choosing to. masturbate over doing anything else. So, you're choosing to masturbate rather. than have sex with your partner. You're. choosing to masturbate over going to. work or you're I'm going to be a little. late to work cuz I want to finish. masturbating. Or you literally can't. sleep without masturbating every day. Like those are things you become reliant. on this particular activity for the. enjoyment that it provides. Um that's. when it becomes a problem. But if you're. using it in terms of like, I'm. masturbating to get orgasm and the. benefits of orgasm that I do achieve.

from that because maybe my partner. doesn't want to have sex or maybe I have. more of a sex drive than my partner or I. don't have a partner. Like let's be. realistic. Like if you don't have a. partner, you're going to have to if you. want to orgasm, you're probably going to. have to masturbate. And so I think the. problem also comes in is when people. only masturbate the same way every time, they only watch a certain type of erotic. film or they do the same thing every. time and their body habituates to that. and then they have a difficult time. climaxing with a partner because they. can't replicate what they're doing,

whether what they're watching or how. they're doing it with a partner. Are we. teaching ourselves something there? Are. we teaching ourselves how we're aroused. and how we orgasm? Yeah, your brain is. very powerful, right? So when you're. doing the same thing every time, your. body's like, oh, this is what turns me. on. This is what makes me orgasm. And. then when you're with a partner, you're. like, oh, I'm not getting that same kind. of stimulation. And so it doesn't happen. to a lot of people, but I would say. certainly I see people where this does. happen. And so. you know, you have to sort of take a. break and and sort of re-evaluate and.

try different things and get your body. to habituate to different things, which. takes a little bit of work. Um but sort. of keeping it varied can be helpful. Another big myth, masturbation will make. me go blind. Yeah, no. There's literally. I don't know where that came from. There's like hairy palms, blindness. Like I don't know where I think this is. all sort of like from religious rhetoric. that says, you know, you should not. masturbate. Um and and it, you know, where that came from, you know, is a. whole other story, I think. What do you think of this idea of No Nut.

November? Yeah, so I think it's I'm not a fan. The. reason being is because I think it makes. people feel like it's something they. have to do. And if you want to, like I. said, if you find benefit from. abstaining from ejaculating for 30 days. or 28 days or whatever it is, um. then by all means, like go ahead. If you. want to try something, there's no harm. in it. But I think a lot of people, what. they do is they feel like it's something. that's going to bring them to some. higher level, and they're going to. become this great person because they're. able to to to conquer this goal, but.

they're like literally miserable. So, they're. um they're just clenching their pelvic. floor all the time because they're. stressed about how they're not. ejaculating. They may ejaculate at. night, and so they'll have a nocturnal. emission, and then they'll feel so bad. because they failed. It's nothing you. can control. Nocturnal emissions are. physiologic. They're totally normal, and. 86% of men have had a wet dream at some. point in their lifetime. Like it's very, very common, and more likely the longer. you are from ejaculating. So, um your.

body will take care of the ejaculate if. you ejaculate or not. So, you will. either resorb the semen, or you'll. ejaculate at night. And so, if you want. to do it because you feel like, "Okay, I. have a challenge. I want to conquer it. I want to see if I can do this," and you. feel better because you're not you're. able to like not focus on sexual. thoughts, or you're able to really um. find some other level of spirituality or. something, by all means, go ahead. I. don't have a problem with it. What I. have a problem with is making people. feel bad because they can't do it, or. they don't want to do it. And with.

people feeling forced, or feeling like. they need to do it to prove something to. someone else. Yeah, cuz I mean, the way that I've had. it explained to me is that it's some. something about semen retention gives. you some clarity of mind or something. Cuz a lot of athletes, before they have. their their big fights, so you know, their bigger sort of Olympic. competitions, they all abstain from. masturbation. I I often hear in the UFC, for example, the um. the mixed martial arts fighting. championship, that athletes have not had. sex or not ejaculated for 2 weeks before.

a fight, or 4 weeks before a fight. Yeah, so there's a lot of rhetoric. there, I think, that comes from. um. historical. So, even in Greek in Greek. times, they would tell people to avoid. having sex or masturbating prior to, you. know, big fights or or just whatever. sport they were playing. And so, is it. true in data? So, if you look at the. studies that have looked at people. performing athletic feats, whether it's. like cycling or running or whatever, um. they have not found that abstaining from.

ejaculation actually changes their. ability to perform. And so, in those. cases, I say, well, there's no true. scientific evidence that we have that. it's going to improve. And in fact, if. you are someone who, for example, has. sex every morning or masturbates every. morning for whatever reason, that's a. part of your routine, disrupting the. routine can actually be harmful to. performance. And sometimes the one thing you can say. is in terms of disrupting performance is. that after you masturbate, you do see an. increase in heart rate a little bit. Um.

you have a rebound increase, it. decreases, and then you have a rebound. increase in heart rate that can slightly. affect your ability to recover from. performance. But ultimately, I think if. you find benefit from it because people. report feeling more aggressive with. abstaining, then by all means, if you. find it helpful, I think it's fine. But. is it mandatory? I don't think so based. on the evidence we have right now. Cuz I. I I heard that rumor many years ago, and. I think I assumed it was correct. I I. heard the rumor, and this was the sort. of evolutionary story that was attached. to the rumor, was that once upon a time.

when we were out, I don't know, looking. for um a sexual partner, we would need. to be more articulate and more. persuasive and more, you know, attractive, basically. Mhm. So, we were. at optimal attractiveness before we. ejaculated. Then after we've ejaculated, that kind of energy goes out of us and. recharges and rebuilds again. So, I was when I heard that, I thought, okay, so if I'm speaking on stage or I'm. doing a podcast, I want to make sure. that I'm, you know, my mouth and my. brain are attached, I'm articulate, I'm. persuasive, whatever I need to be. So,

don't ejaculate or masturbate. anytime before doing anything where I. need to use my brain and my mouth. Well, you know, some people describe. post-nut clarity, right? So, they. actually, on the alternative, feel like. And there's no good data on this. The. data we have is on people, the very. small subset of people who have post-nut. postcoital not post-nut postcoital. dysphoria. So, they actually feel bad. But in terms of clarity, um you know, some people do like when. you're trying to you're motivated to get. a partner, right? You're sort of um.

trying to uh woo them, you're really. focused on that one singular effort that. once you've obtained that, that the like. very singular focus goes away, and now. other parts of your brain can be. activated to then be used for Some. people will describe being more. productive, more able to get work done. after uh masturbation. It's very. individualized or ejaculation, whatever. it is. Post-nut clarity. I've never heard anybody talk about this. before, and I've also been told over the. years that it's something that just men.

experience predominantly. And for anyone. that doesn't know what post-nut clarity. is, the definition that I understand is. and that I have experienced, I'm going. to be honest, is that after ejaculation, your desire for the other person reduces. quite significantly. And there's a. stereotype here that women don't. experience this post-nut clarity in the. same way. Now, if I asked all of my male. friends, if I said to them, "Has there. ever been a time in your life where you. were maybe texting someone you were. attracted to or, you know, had so- some. sort of sexual attraction to, and then.

you masturbated, did your desire. um diminish after you masturbated for. that person that you were just texting?". I think about 90% of my male friends. would say, "Yes.". Yes. And they'd describe it as if. someone like took. some like sunglasses off them. Like a. pretty extreme sudden change. And I've always wondered about this, whether this is just men, if it's just. women, why it happens. So, when you look at brain studies, right, of people having orgasm, and what. happens is when you have an orgasm, like. your whole brain lights up, right?

Because your heart rate goes up, your. blood pressure goes up, like your pupils. dilate. So, all these different parts of. your body are working, so your whole. brain lights up. And then after orgasm, it it it gets very, like, quiet. And so, we see that in women it may take a. little longer to get really quiet, and. men it happens very quickly. And this. may be associated with sort of the. hormonal changes that occur after. orgasm. So, we know that prolactin. increases after orgasm, dopamine. decreases, and there's sort of some. evolutionary theories about why this. happens. So, one is after you ejaculate,

if you are having ejaculation with a. woman, then you don't want to have sex. again to then the same thing with the. refractory period, right? That there's. some period of time where you're not. going to want to have sex again, or you. can't have sex even if you want to. And. this is because evolutionarily, if you. deposited your ejaculate into a woman, if you then had sex again, you could. actually dislodge the semen, and then. you would have less ability to. to have fertilize an egg, right? And. then the other thought is that you don't. want to become overly exhausted, right?

So, that if you if you had the unlimited. capability to have sex over and over. again, that exhaustion could be a real. thing, like and so you're sort of a. protective mechanism. And so, those are sort of the theories. as to why this is, and there is like an. absolute refractory time where like you. don't want sex at all, and then there's. a relative refractory time where if you. had a really novel or strong stimulus. for sexual activity, that you would be. able to. In terms of the clarity, in.

because we know there's a little bit of. differences in brain, it may not be as obvious in women in. terms of it takes them a little longer. to have that coming down after the. orgasm from the brain activity, but probably there is some, we just. haven't studied it enough. And I always. say this that when we look at studies. for women's sexual health and men's. sexual health, they're so lopsided. So, if you type in penis in like a in like a. search engine for Google or for the. PubMed, which is where you look up. research articles, you're going to find.

50,000 articles. If you look up clitoris, you're going to. get 2,000 articles. So, it's very. lopsided in terms of what we study um. for sexual function. And in it in of. itself, sexual function by many people. is not seen as mandatory or important. for health, and so the funding is less. often available for sexual health. That's why we have such little data in. some areas. Going back to just closing. off from the point about masturbation, is there a link between masturbation and. prostate cancer? Because I've I've heard. a lot of different things about it. Um.

some people think that over masturbation. is causing prostate cancer, and some. people say the opposite. Yeah, so. there's actually a really good study um. that was done looking at ejaculation. frequency and prostate cancer. And it. was a very well-done study. They tried. to control for a lot of other factors. And so, what they found was that men who. ejaculated 21 times or more a month were. less likely to develop prostate cancer. This is just a statistical number. It is. not a number that sort of um means.

anything in terms of But we're seeing. that like, okay, so more masturbation. may help. Why is that, right? So, there. may there's a prostate stagnation. hypothesis that the fluids that, you. know, some of your ejaculate fluids come. from the prostate. And so, when you're. ejaculating frequently, you're more. often re- getting rid of that fluid and. sort of re-replenishing it or cleaning. the pipes, so to say. So, that may be beneficial in terms of. preventing prostate cancer. Now, do you. have to masturbate or ejaculate or have. sex 21 times a month? Um no. But, you.

know, there could be a benefit, yes. And. so, uh having a healthy And it may be. that those people who had sex more often. or ejaculated more often were just. healthier in other ways, right? They. were able to have sex more often or. masturbate more often because they were. uh. you know, sufficiently healthy to do so. And so, they I mean, while they tried to. control for those things, there's always. sort of uncontrollable variables that. come into those sort of studies. Yeah, that's what I was wondering is is there. another like glaringly obvious factor. that those people had more.

relationships, therefore their mental. health was better, that therefore X Y. and Z. they tried to control for comorbidities, but again, there there I don't think. they controlled for I mean, they. controlled for marriage, I believe. Um, but I'm not sure that they. controlled for like in a relationship. versus not and how healthy that. relationship is, that certainly wasn't. assessed. I'll link to the study below. so everyone can read it for themselves. about the controls in that study and how. that was conducted. Linked to this is is the subject of. porn. Um, it was interesting cuz I was. doing a lot of research on the subject. of. That sounds a bit strange. I was doing a.

lot of research on the subject of porn. and where conversations at with the. subject and one of the quite startling. things is a lot of people are trying to. figure out how to stop watching porn. Um, a lot of people are asking. themselves. for mechanisms to. um, install things on their computer. that prevent porn time and um, searching. for. solutions around porn addiction. And a lot of people were searching um, about whether porn is a sin. And I think.

there's something broader here about the. idea of shame Mhm. which is linked to. porn. What is your take on on this? Is. porn a bad thing? Yeah, so I don't think porn is a bad. thing. I will start with that. Um, is it. a sin is more of a moral question, right? And I think that that is. uh, something that you individually have. to decide for yourself if you feel like. morally it's inappropriate, but it's. it's entertainment, right? It's just a. different form of entertainment and I. think the issues with porn, um, because I would not say that it's. 100% great. I think there are definitely.

issues with it. One, the big one that. I've been very vocal about is children. seeing pornography. So, um, we know now. that the average age of a boy seeing. pornography is 13 and that's the. average, meaning that as young as eight. to 10, boys are being exposed to. pornography, um, which was not the case when for. example, we were growing up, right? You. had to I I always say this, you had to. find a. a tape maybe, find a VCR in a room that. nobody was going to walk in, or you had. to find a magazine and hide it somewhere. and go find it. And so it was not.

readily available. You had to work to be. able to see that. And now, seeing. pornography is very readily available. And so, very often kids are seeing it. Whether. you as a parent don't want them to, whether you've put blocks on their. phones and devices, they may have access to it from a. friend, or they may see it somewhere. else. And. and your brain is not fully developed to. understand one, what you're seeing, and. two, to understand that this is not. real, unless your parent has talked to. you about, you know, this is sort of a.

movie that's not real life, and this is. not what sex is really like. And so I. think that has implications for for how. they view sex, and how they then try to. have sex with partners. And also, you. know, because your brain's not fully. developed, you're getting this big rush. of dopamine from viewing something like. that, and that's not something that we. traditionally got at that age, right? And so it can become very addictive. Now, as an adult, I think it's different. because you have a fully formed brain,

you understand the concept of this is. not real, most people. And so it can be just a way to have. pleasure, and even watch it with your. partner and have pleasure. But yes, we are seeing some people who. have problematic pornography use. In the. literature they say it's 4%. I suspect. maybe it's a little higher now, where people are finding that watching. pornography is is one easier than going. out and trying to find a partner. You. don't have to face rejection, you don't. have to face the difficulties and.

awkwardness of having a first a sexual. encounter with someone that often. happen. And so it can become a way, because it does relieve dopamine just. like anything else, it relieves. dopamine, it can then become sort of a. way to feel better about anything, right? Like you can just be feeling down. and like I want to watch pornography. because it makes me feel better. It may. not be just that you're really into sex, it's just that you're really like. wanting that rush hit of dopamine. Um and then there's obviously the shame. that comes with oh my god, why am I. using pornography just because I feel.

bad? And then you're like, oh, but I. feel bad and so I'm going to use porn. again and it becomes a sort of like. negative vicious cycle that can occur. But I think when used for entertainment. and pleasure, I think it's fine and. many, many people use it for. entertainment and pleasure without a. problem. I the other day bought the Apple Vision. Pro. Mhm. That new headset and I tell. you what, Jesus Christ, that's. unbelievable piece of technology. This. one feature they have on there is called. spatial video. Mhm. And I don't know if. you've tried it yet, but you put it on. and if you've taken a spatial video,

which you can now take on the new iPhone. and also on the Vision Pro, it basically. feels like a 3D video. Yeah. And it's. like nothing I've ever experienced. before. One of our team members. commented that, you know, they they lost. a family member and they wish they had. this because it it's like the person is. back in front of you. It's not like a. photo or video anymore. But then. little monster in my mind goes, "Hm, there's going to be other applications. of this technology and as it relates to. pornography. And we're getting you know, if we just assume any rate of. improvement with this technology, just I.

don't know, 5% a year, we eventually get. so close to being indistinguishable from. a human being that the incentive. structure of going out and getting a. date and you know, for the for the. objective of having sex or whatever. versus just popping your headset on, which is going to get cheaper and. cheaper and cheaper and better and. better and better, um. becomes really. lopsided. I. it's so clear to me. that if we just go forward 10 years and. we're on the Apple Vision Pro 17.

air, there's going to be so many people that. are using that as a the to. uh. masturbate and to watch pornography. and it's and it's going to reduce the. amount of people that are seeking real. intimate relationships IRL, in the real. world. Yeah, it is a real concern, I. would say, but you know, we know from. some data that people. will find physical touch, particularly. in like hair bearing areas, um. very important in terms of intimacy with.

a partner. So, um intimacy in general, and so I I can only hope that that will. continue, that you will want physical. touch, because no matter what you can. see with your eyes, um it's not touching. you. It's not like it's still you doing. the touching. There's no element of. surprise or excitement or build up in. terms of like there's someone else in. the room with you, right? So, I can only. hope that that that will that will be. the case, but it still remain to be. seen. However, I will share there's some.

interesting um applications of this in. terms of fear. So, if you are really. scared of something, you can actually. desensitize yourself using these VR. headsets, and it can actually be very. powerful. So, I was just speaking to a. researcher, Lori Brotto, about how. they're using it in their lab for women. who have fear of penetration, because. they've had either trauma or they have. other conditions that are causing it to. be painful, and so they can work with. them to be using these headsets to.

simulate a sexual experience, and then. they can sort of use a dial like use a. tool or a dilator or something to then. penetrate in a safe space, right? Not. like you're with a partner and you're. like trying to have sex and you're, you. know, you don't feel very safe sort of. allowing that. It's very preliminary. research, but I think ultimately there. are some positive things that maybe will. come out of the use of these sort of VR. headsets, and I can only hope that that. will predominate and we can continue and.

people will inherently want other. people, right? That's We're We're. hardwired to be around people and to be. intimate with people. Like that's how. our brains work. So, I'm hopeful that. that will that will still remain to be. the case. But I can't I can't predict. it. don't look convinced. Well, you know, I mean. I think it's I I am worried, you know, I. think that phones have changed lives, too, right? Like now our kids Our. younger generation doesn't communicate. as well because when they hang out. together, they're sitting all together. looking at their phones, right? And so,

we have to actively work to prevent Like. I make my kids have full-on. conversations with people. I say, "You. got to come and hang out with the adults. and have conversations and and talk to. people." And we have to coach them on. how to talk to people, um because I worry that people are too. into Even when they hang out with their. friends, they're playing on devices, right? So, um. I think there's like work that has to be. done to prevent. the. the the easy dopamine rushes that these. devices are giving us, right? So, we. actually have to actively work at it and.

people are inherently going to take the. route of of the easiest thing. And so, as a society, we have to sort of work. together to sort of prevent these easy. wins, easy things, easy dopamines from. taking over. Something you mentioned within there. there was the idea of trauma. And I've I'm quite interested in the. role that our trauma plays in our sexual. health and sexual dysfunction. What's important to know there? And does. trauma play a role at all in the. patients you see? 100%. So, your body, when it goes.

through a trauma, it will then sort of your body remembers. even if you don't, right? So, these. people Very many people who have pelvic. floor dysfunction, meaning their pelvic. floors are too tight or too tense, they've had some sort of trauma. Not all. of them. Some of it's just stress and. anxiety, but sometimes they've had some. sort of trauma years ago and it's been. with I had a I remember having like a. 70-year-old woman and she had such. terrible pelvic floor dysfunction for.

God knows how many years that ultimately. it caused really negative consequences. for her bladder function. And um and so. absolutely when you have a trauma that's. unresolved in some shape or form it will. affect you whether it's your mental. health, your physiological health. I. mean, our brains are so powerful that. you know, when it's in a bad place, it. can affect you negatively. When it's in. a positive place it can affect you more. positively. The one thing I will say is. if you have trauma, getting therapy,

getting help to resolve that trauma is. so so important. I talk to all my. patients and I say, yes, you may have an. organic problem meaning a physiologic. bodily problem that's causing your. sexual dysfunction. But everyone who has. sexual dysfunction. has a psychological component because it. is devastating. It is stressful. It is. horrifying to feel like you're not. normal, your body doesn't function. normal especially in an intimate space. like sex. So I'm like everybody should. ideally see a sex therapist if it was. available to everybody, but it's not, right? How can we allow people to have.

access to things they need because we. don't teach these things in school, right? School, I mean, this is my big. gripe is like how can we make education. better for children? Like we need better. sexual education. We need better. education on how to resolve traumas or. how to deal with them or how to get. help. How to do digital health? Like how. do you navigate the world with all this. misinformation? How do you find good. quality information? How do you assess. it? Like there's so many things even how. to balance your books, right? They don't. learn that in school. So ultimately. there's so many things I think if we.

were really putting a critical eye on. how we teach our young people that we. could improve. And part of that would be. including people to know and realize. when they need help through whatever. trauma they've suffered or stress or. anxiety that they're suffering and how. that can. propagate itself over a lifetime and. create real problems. I have to ask this question. cuz people. mention this quite often. Can you have. sex while you're pregnant? Absolutely. Why not?

I ask it because it was one of the most. Googled questions um online. Really? Yeah, it was. one of the highest search volumes I've. ever seen for a search term was can you. have sex while pregnant? Wow. I actually. didn't I mean I I. I've heard a lot of things and I think. that people feel like I've heard that. men think they're going to hurt the. baby. They're going to. um they're going to cause a problem. But. no, absolutely. You can have sex. You're. not going to create like a preterm. labor. You're not going to harm the. fetus. Like nothing bad is going to.

happen from having sex while pregnant. Okay. So let's talk about orgasms and. the clitoris then. You mentioned earlier. that um there's. disproportionately a lot less research. done on the clitoris. As a man, what do I need to know about. the clitoris? Cuz I I'll be honest, I. know very little. I know where it is. That's a that's a plus. Well, I I didn't. knows that either. always know where it was. Uh couple of. misunderstandings, but um. I found I found it eventually and I I. think I know how to stimulate it, but I. don't really know what's going on there.

or how it works. Okay. So what I tell. everybody and what men can think of is. the clitoris is like the penis. So when. you are a fetus, there's a thing called. a genital tubercle. Before you're. assigned sex, that genital tubercle, when you're when you become a man, that. genital tubercle becomes the penis and. the shaft and the glans. And in a woman, it becomes the clitoris. And the. clitoris actually then goes deep into. the pelvis. um just like the penis. It has a shaft. in the pelvis and then it goes around. the vaginal canal. And so you can the.

clitoris is just as sensitive as a man's. penis, right? So if you stimulate the. clitoris like your penis gets. stimulated, then it will lead to orgasm. And it's probably the most reliable. route for orgasm for women. So 85% of. women need some form of clitoral. stimulation to climax. And so, many. women have difficulty climaxing through. vaginal penetration alone. That's not. that they're broken or something's wrong. with them. It's just that they don't. And because the stimulus from the.

clitoris is so strong, it leads to a. very reliable route for orgasm. Now, how. you stimulate it is sort of very. individually specific. But, typically. oral stimulation, vibratory stimulation, manual stimulation, all those things can. work. But, that's where the. communication comes in, where it like. the partner, ideally, would know what. they like and could tell you. Um or they you could check. Like, does. this feel good? Does this feel good? Do. you like this? Is this, you know, or and. you know, and so that's sort of again a.

challenge because the communication. issue we've talked about this whole this. whole talk. But, um that is really. what's important. Now, the clitoris, like I said, it it goes um deep uh above. the vagina and around it. So, people can. still get clitoral stimulation through. penetration, um depending on how you. stimulate. Now, the other areas that are. important for orgasm are the G erogenous. zone. It's actually not a spot, it's a. zone. And that's where, essentially, if. you go look at the vagina on the.

anterior wall, which is the top of the. vagina underneath the urethra where the. pee comes out, about 2-3 cm in is called. the G erogenous zone. It's named after the person who um. identified it. I think it's Grafenhaus. or something like that. But, um. essentially, that area is full of. certain nerve endings as well as the. female prostate or the Skene's glands. And so, those are areas that are quite. erogenous and that uses a different So, the clitoris is innervated by the. pudendal nerve. The G erogenous zone is.

innervated by the hypogastric nerve. So, a different nerve. And then, the cervix. is the last area where sometimes women. feel a lot of stimulation. And that's. innervated by the vagus. So, all these different areas can lead. to orgasm for women and they can be. added. So, if you're stimulating all. three, you might have a more strong. orgasm and the orgasm may feel a little. different. Now, people like to call. like, "Oh, you're getting a clitoral. orgasm or a vaginal orgasm." It's all an. orgasm. It's just a matter of what.

stimulation is causing the orgasm. And. so, I think ultimately it's really important. for the the most easy, reliable route to. orgasm is clitoral stimulation, which is. not traditionally stimulated through. penis and vagina sex, right? And so, it. does require some additional. um thought on how you're going to. stimulate it and and how you're going to. please the partner and to get them to. orgasm. And often times, if you think. about the time it takes to orgasm, so in. a man, the average length, if you look. at studies that looked at stopwatches,

like they've had the female partner. actually start a stopwatch at the. beginning of sex and stop it at the end. when the man climaxes, it's about 5.1 to. 5.7 minutes. Um what's in fact UK men. tend to last a little bit longer, which. is sort of an interesting concept, but. Sorry, which sex is that? Just men? Men. Men So, so from penetration to climax of. men. So, when you So, when they So, they've. measured basically not including. foreplay, but if they've measured, they've measured like 15,000 people. through many, many different countries.

and they've had the woman take a. stopwatch and actually start click on it. when they penetrate and click it off. when they climax and they've measured. the length of time. And it's been about. 5.1 to 5.7 minutes is the time. Now, a. woman, when you look at the average time. to orgasm for woman, it's about 14. minutes. And so, you can imagine that if the. entire sexual encounter is around the. male climax, right? And the male has. this, as we've already talked about,

sort of this post-nut clarity, like I. don't want refractory time, they're. you're going to want to be more. intimate. If you don't prioritize the. female's climax or stimulate her before. you begin to penetrate, then she's. probably not going to orgasm. Um and so. and the interesting thing is when you. look at sexual encounters and you look. at men and women having sex for the. first time, uh the woman will orgasm 45%. of the time, the man will orgasm 95% of. the time. When you look at women having.

sex with women on a first-time. encounter, they both have orgasms 95% of. the time. So clearly there's an. educational mis- disconnect, right? Women know what they like and what. stimulates them and men aren't getting. the memo. I feel attacked. Totally not attacking you. Letting you know the facts. I know it makes sense though cuz. I think men are still struggling to. understand again because of what you. said, we don't really get a sexual. education. So we learn these things from. porn and obviously in porn, they're not. showing it. Yeah, I mean you don't.

typically have many um. women orgasming in porn as you do men. orgasming in porn. What is. an orgasm and what kind of what role. does it serve? Mhm. Like why do we. orgasm? And also when I say what is an. orgasm, is an orgasm like a switch? Or is it is it like a spectrum? So it's. it's sort of like a spectrum, I guess. I. mean so let's talk about what it is. exactly. So an orgasm is a moment in. time that is combined with a. like a maximal tension and then a.

release. And during that time, it is. completely you're completely unable to. think about anything else. It is a very. powerful, pleasurable sensation. And it. occurs usually like I said, 5 to 60. seconds it can last. And is it in terms. of how you get it, it's usually a. culmination of stimulation over a period. of time, even with a certain sort of. like rhythm that's required to achieve. climax that's different from person to. person. So I can't give you the script.

on this is how fast you need to. penetrate or this is how what. stimulation you need to use. ask that at the end of the conversation. Okay, we're done here. So, um. So, yeah, cuz nobody wants a taco wet. They literally want me to tell them like. this is what you do A B C D, right? So, um but yeah, ultimately, um. all of those things they build this. tension, right? So, over the course of. sexual stimulation, arousal, you are. getting to an ex- excitement phase where.

your your body's changing. So, in women, for example, you will see that the labia. become a little bit redder, um they. expand in size. As I said, the vagina. lengthens and elongates. Um the So, the. From 3 to 6 in I've heard you say. Yeah, about about double, yeah. And it's. different from person That's the. average, right? So, there is sort of. like this thought that like, "Okay, if. it's really, really large, it's always. going to be better." And that's not. actually always the case because not. every vagina can accommodate a very. large phallus. Um but so, when you're.

having orgasm, essentially your pelvic. floor muscles are tensing up. They're. They're getting really tense and you're. reaching this for like basically you're. getting to the top of the hill. You're. getting this really large amount of. climax. And so, your body is sort of. climate going up and up and up. You're. reaching like increasing dopamine and. you're increasing So, when you think. about what happens in the brain is. your hormones are are going higher and. higher. And there's also an inhibitory. There's a path There's a. There's a stimulatory and an inhibitory. pathway. And so, the stimulatory pathway. is going up, inhibitory, stimulatory.

You're basically trying to race up to. the top of this mountain. And when the. stimulatory gets to the very, very top, then you have the orgasm. And so, you. release all this tension. And during. this time, your heart rate's racing, your pupils are dilating, right? There's. all these physiologic changes. Um and. then when you orgasm, your muscles. contract, as I mentioned before, and. this every point eight seconds they're. having a contraction. Sometimes you'll. have an involuntary phonation. So, people will, you know, moan or scream. and sometimes it's not in their control. Like there's actually an involuntary.

component of it. And then, um, sort of. it comes down. And so, it's it's not as. necessarily a switch, it's sort of a. climb up a mountain is the way I would. describe it. It sometimes feels like. blowing up a balloon with a little hole. in it. And when what I say with a little hole. in it, I mean because if you stop, it. feels like some air comes out of the. balloon. Mhm. Mhm. That's why I said. that the sort of there needs to be a. rhythm. It should keep going at a. certain pace in order to achieve that. climax, cuz if it doesn't, then you can, again, just like that's a very good. description, you'll lose that little air.

in the balloon. Okay. So, in order to increase female. pleasure, okay, we need to understand. the person we're dealing with, of. course, but um, the clitoris is a great. way to get to orgasm. You've you're pro lubricants. A lot of people. feel like that's not natural, so they. kind of avoid it, but you're pro. lubricants. And are you pro then scheduling sex, or. you pro scheduling time for intimacy? Scheduling time for intimacy. So, because sex adds, as we talked about,

adds sort of like a level of stress in. terms of like, am I going to want to. have sex? Am I going to be able to get. an erection? Am I going to enjoy sex? Whatever it is. And am I going to get. rejected? Like all those things, because. you're still a human being, and you may. just like be really stressed that day. that you put on the calendar, and you. were like, "Ah, I just can't can't get. in the right mind space to have sex.". So, if you're constantly ruminating or. stressing about other things, you can't have a good sexual encounter. In fact, they've looked at mindfulness.

in terms of how it improves sexual. function, particularly in women, but we've seen very clear data that be. having a mindfulness practice leads to. improved sexual function in terms of. desire and other factors, like arousal. and lubrication and orgasm, but the. biggest is desire. And so, it's because. if you can focus on what's happening. during the sexual encounter. So, you can. focus on what it feels like, how you're. enjoying that sensation, rather than.

thinking about am I going to come, am I. going to climax, am I is it going to. happen, or whatever it is that you're. thinking about during sex because you're. worried about how the other partner. might react, then you're more likely to. enjoy the experience, feel the and then. have a good experience, and subsequently. have more desire for additional. experiences. We talked earlier on the very start of. the conversation about comparisons and. how that can really destroy sex. Is. there a disparity between how long we. think sex should take and how long it. actually takes? Yeah, we all think it. lasts longer. And when you ask people.

what the average time and this is a hard. question because people think of sex as. a whole encounter and when we do it. scientifically, we look at sex from. penetration to the end of penetration. and sex is more diverse, right? Sex can. include oral sex, anal sex, manual sex, any type of sexual. stimulation, right? And so, when you're. thinking about the entire encounter, it. can be very variable. Some people want a. quickie, some people want to have this. long, luxurious love making such. scenario and it really depends also like. on what's going on in your life. Like. you may not have that luxury. And so, I.

don't I think again, it's not about. reaching a certain benchmark or certain. number. It's really about the quality of. the sex. So, if you have great sex and. it takes 3 minutes, that's great. That's. fine, but as long as it's great to both. of you, right? If you're both like this. is awesome, I'm having great sex and it. takes 3 minutes, that's fine. But how long do people. think sex lasts on average versus how. long it actually lasts on average? Yeah, so I think that most people definitely. think it lasts longer. So, women tend We.

don't know what they think it lasts, but. but they want it to be is about 18 to 25. minutes. Men are a little on the shorter. side, like maybe 12 minutes, but. generally we all want it to be around. that length. But you sort of lose sense. of time, right? So, you don't really no. one's really there with the stopwatch. knowing exactly how long it takes. In. fact, I've had friends tell me like, "Oh, I watched your video and now like. when my partner wants sex, I'm like, oh, it's only going to take 5 minutes. Like, I can I can have sex with them." Like, I. used to in my head used to think it. would take a lot longer. And now I.

realize it takes less time and like I. don't that that stress of like, "Oh my. god, I'm going to have to like waste. like half an hour and I'm so tired.". Like, has gone out the window because I. know it's really not going to take that. long. Is that Have they ever put people. in like a laboratory or whatever and and. I guess this goes back to what you said. earlier. Um is there like an average. time. people spend having sex? Was that the 5. minutes you talked about? 5.7 minutes. 5.1 to 5.7 minutes, depending on the study you look at. And. they they looked at all comers, so it's. actually different in different um. countries. So, when you look at like.

Turkey, it was like 4 minutes. And if. you look at UK, it was like 10 minutes. So, it's actually. It's a. Thank you. So, it's actually variable. and that may be a cultural thing. Um but. ultimately, the average is about 5. something. Interesting. So, we want sex women want sex to last. between 18 and 25 minutes, ideally. Men. want it to last ideally about 16. minutes, including foreplay. But in. reality, it's lasting 5 5 minutes. Yeah.

That's good to know. Let's talk about Zoe, who you may know. because they're a sponsor of this. podcast and I'm an investor in the. company. You guys know health is my. number one priority. Zoe's growth story. has been absolutely incredible so far. They're doing science at a scale that. I've never seen before. Because of their. members and recent breakthroughs in. research, they can now continue to offer. the most scientifically advanced gut. health test on the market. Previously, the test allowed them to analyze 30. bacteria types in your gut. But now,

thanks to new science, they've. identified 100 bacteria types. This is a. huge step forward and there's nothing. else that's available even close to it. on the market at all. So, to find out. more and to get started on your Zoe. journey, visit zoey.com/steven. You can use my exclusive code CEO10. for 10% off. Don't tell anybody about. that, okay? Just for you guys. We talked. about sizes of stuff a second ago and we. said we'd come back to this. So, there's. two sort of sizes that people often.

think about, the size of the vagina and. the size of the penis. Mhm. There is a. myth in society that the more sex a. woman has, the bigger her vagina gets. Is that myth true or false? False. So, the way that women's vaginas get, if you. want to say loose, right? Which is the. term that people use, or they get a weak. pelvic floor. And that's from having. babies, having maybe neurologic. conditions that affect the pelvic floor. strength, having collagen disorders, having um.

just from like having a job where you. stand all day and you're like all the. weight of your body is sitting on your. pelvic floor. Those muscles can get. weaker over the course of a lifetime. And then it can feel a bit looser. because those muscles are maybe not. squeezing as harder. But it is not. related to how much sex she's having. because as we mentioned earlier, when. you have an orgasm, you're actually like. strengthening your pelvic floor a little. bit. Like you're you're contracting. those muscles. So, actually probably the. more sex a woman has, likely her pelvic. floor is probably stronger unless she's. not you know, um but you know, you add.

in the having babies and other things, it's variable. But probably the more. orgasms a woman has, the stronger her. pelvic floor is. But things like. childbirth can Mhm. make the pelvic. floor looser? Weaker. Weaker. Yeah. Yeah, so then when it becomes weak, that. is the cause of things like stress. incontinence. So, when a woman um lifts. something heavy or she exercises or she. jumps or she coughs or sneezes, she. might have a couple drops of urine or a. lot of urine leak out because of a weak.

pelvic floor. It can also be lead to. something like prolapse where the. it's like a hernia in the vagina where. the pelvic floor sort of is so weak that. now the vaginal skin and the organ. behind it is sort of bulging out and can. cause discomfort and and sort of feeling. and maybe some dysfunction in the organ. but really mostly discomfort. And so. those are signs of weak pelvic floors. not you know, not having a loose vagina. during sex. And we can do something to.

strengthen our pelvic floor which is. these is that what the Kegel exercises. are? Yeah, it's more than Kegels. I mean. Kegel is the most has the best PR of any. sort of thing I've ever seen in medicine. but yeah, it's pelvic floor exercise. A. Kegel is one pelvic floor exercise which. is to strengthen the pelvic floor and. there are others. What is it? I have. never. So it's essentially men never know. Like. it's not your fault. Women sort of kind. of know but even women don't really. know. So what it is is there's those. same muscles we talked about earlier is. that you're basically doing a rep. You're squeezing, contracting and.

relaxing. Just like you go to the gym. right? You squeeze and relax. Very. similarly you are squeezing those. muscles and relaxing those muscles. this sat down now? Yeah. So basically. for men what I tell people is it's like. the feeling of when you're urinating and. you stop your urine stream. That that's you're using those same. muscles. So you that's one way. Another. way to think about it is if you were. trying to lift your penis off the ground. without touching it. Ah, okay. Got you. Okay? And the third one is you're trying. to hold in a fart. So all those. different ways you're sort of getting.

those muscles. So the one thing I tell. people is they get the way they get it. wrong is they don't relax enough. So. just like when you go to the gym you're. not doing rep after rep after rep. You're actually taking a break and. you're letting your muscles relax before. you do another rep. Same thing you have. to squeeze for 5 seconds, relax for 5. seconds. Right? You actually have to. relax and just like any exercise you. don't want to overdo it. So I tell. people start lying down so that the only. thing you have to focus on from a. muscular standpoint is that those.

muscles. As you get good at them lying. down you then do them sitting up. And. then as you get good at doing them. sitting up, you can do them standing or. do them anywhere. But like you're not. going to be like there you know, I I. remember the scene from Sex and the City. where like the character Samantha was. like, "I'm doing my Kegels right now.". Like yeah, she's probably been doing. Kegels for a long time and now she's so. good at them that she can do them while. she's brushing her teeth. But it's not. like you're going to wake up one day and. be perfect at them just like any other. exercise. So that's one exercise. There are. certainly other things you can do to. strengthen your pelvic floor.

Traditionally things like yoga and. Pilates have some core work that does. also help with the pelvic floor. But. really I recommend if you're having. issues is to see a pelvic floor physical. therapist cuz they're just like a when. you go to the gym alone, you can do it. or you can go with the personal trainer. They're like the personal trainers for. your pelvic floor. How do I know if I'm. having pelvic floor issues? What are the. symptoms? So for like I said, the. obvious ones for women are leakage, are. um having prolapse for weakness. In men, we don't often see as much but like I. said, you might notice that your semen.

is not as forceful when it comes out. Um. that's usually the most common side sign. of a weak pelvic floor. There's not as. many for men but in terms of a overly um. high tone pelvic floor, what we worry. about then is then there's a whole host. of symptoms. It could be as simple as. just having lower back pain. Um it can. be that you're having hip pain. It could. be that you're having um pain with sex. You're having pain with erections, pain. with ejaculation. You're going to the. bathroom often. Got to go, got to go. You are feeling like you're having.

difficulty emptying your bladder or you. are um going very very often all of a. sudden. So it can be a a vague variety. of these symptoms and um so generally. it's important to get evaluated to see. like examine your. to get your pelvic floor examined by a. professional whether it's a urologist, a. gynecologist, a a pelvic floor physical. therapist, someone who can assess your. pelvic floor if you're having these. issues because it might be pelvic floor, it might not, right? How do they assess. it? If I go to a urologist and say,

"Listen, check my pelvic floor." Mhm. So, in a man, it would be a rectal exam. And so, essentially, that's how you sort. of feel the pelvic floor muscles. So, what I tell young guys who come to me. and say, "Look, I can examine you, um but I bet based on your story, like. you're a young guy, you sort of had. these new stressors in your life, um and. it's un- and you're otherwise healthy, it's unlikely that you have a vascular. condition brewing and other things that. like it's probably likely So, if you. want to uh avoid the exam because it can. be uncomfortable or And I will tell you,

if you have pelvic floor dysfunction. does an exam, it will be uncomfortable. It will be painful, potentially, because. they're pushing on those already tense. muscles, and it can be painful. So, I. tell people like you might hate me. tomorrow cuz you'll be sore, and you'll. say, "What did she do during that exam?". And I I kind of preemptively tell them. because I just gently push, right? Like. I'm pushing the pad of my finger, but. that's enough to sort of cause a tension. of the pelvic floor muscle and cause. pain. Where? Where are you pushing? Like on the muscles, on the pelvic floor. muscles. So, you can actually.

So, if you if you put your finger in the. rectum, if you push right straight down, in a man, you're feeling the prostate. And if you push on the sides at a. variety of different angles, you're. going to feel different pelvic floor. muscles, like the levator ani and the. trans operator muscles. Those muscles. are the ones that are part of the pelvic. floor. We can't feel all of them, but we. can feel some of them. And so, um so, that is sort of where we're feeling in. terms of for the pelvic floor muscles. Okay, so cuz I was thinking, if we go in. the the rectum, you've got the glutes.

there as well, which are like either. side, I guess. So, your pelvic floor is actually a part. of your core, right? But your glutes are. further back. They're not going to be. felt from there. But anyways, if you. think about your pelvic floor, it's. actually, you know, people think about. their core as their abdominals, but we. know that it sort of encompasses your. back, your front, and even your pelvic. floor is sort of part of your core. muscles. Got you. Okay, interesting. Very interesting. Um. on the topic of sizes then, one of the. big things in men is penis size. Mhm. And one of the big questions men often.

ask is is there ways to increase my. penis size? There's in fact a whole. industry around penis size increasing. pumps and all kinds of different things. Is it possible to increase one's penis. size? Yeah, so it is. Um in terms of. looking at the evidence, uh the safest. and most reliable way is using a. traction device. And these are devices. that are made for um. essentially for penile lengthening, but. they're also made for men who have. something called Peyronie's disease, where they may develop a plaque on their.

penis and a curvature. And so there's. one device that's actually made that. bends away from the plaque to help sort. of break down that plaque. Um so there. are two uses for it, but essentially. these devices are just like stretching. the tissue over time. And so the. original traction devices that were. studied, you would have to use them for. 6 to 8 hours a day for several months to. see a 2-cm increase in length. Now, um. that may be enough for some people. They're like, yes, I definitely want. that. And some will be like, you know. what? It may or may I mean 2 cm is the.

average, some are going to be less, right? So um it's sort of do you have. the time to do that? Do you want to do. that? But now there are sort of newer. devices where they've studied them and. used them like twice a day for 30. minutes and they've seen some increase. in penile length. They're generally. pretty safe. It's more about um you. might have some bruising from just. putting the traction devices on and as. long as you follow the instructions, you're probably not going to hurt. yourself. Is that penis pump? No, pumps. are different. So. pumps have not been shown to increase. penile length. What a pump is is it's.

just got a it's got a uh a cylinder that. you put your penis into and it uses sort. of vacuum technology to sort of suck. blood into the tissues and then you put. um if you're having issues with erectile. function, you would then put a ring uh. at the base of the penis to maintain the. erection. Uh these don't help with length. They've. looked at them in those cases. They've. also looked at surgeries and different. types of things to increase penile. length. And ultimately, many of them. either have, you know, a very high. complication rate um or risks that I.

would say are probably not advisable for. most people. Um I you know, I think that in terms of. penile lengthening, people are always. like, "Why would you want to do that? Why?". A lot of people will sort of poo-poo. people who want to change the way their. penis looks. And I sort of evolved in my. thinking and saying, "Well, you know. what? This is a big part of, um. you know, a man's identity and how he. feels about himself. And I wish we had. something that was safe and easy for men. to do like we have breast implants. But. we're not there yet, right?" And so, I. just want people to be safe in terms of.

realizing what our limitations are at. this time and things may change over, you know, as people become more. interested in this area. Porn, the role it's played in our. perception of what a normal-sized penis. is. Do you know any of of any data on what. how big people think a penis should be. versus how big the penis is actually. are? Yeah, so it Yeah, most people think. it should be about 6 in. So, like we said, the average is around. 5.1. to 5.3 in.

And so, when you look at the data in. terms of what people think it should be, men think it should be about 6 in. In. terms of women, where we found the data. about what they prefer. um is sort of interesting. So, when now. that we're having um more surgeries for. trans men, one of the surgeries that we. do is a neophallus. We create a new. phallus. And one of the the types of. surgeries we do is we use a forearm. flap. And so, it can be very, very long. and very, very girthy. And in fact, they. were doing these surgeries and they.

realized that some people were actually. unable to have sex with it because it. was too girthy. So, they wanted to then. look at like, "Well, how do we determine. the right size and length and and girth. of this neophallus so that we you know. they can then have sex with it. So what they did was they looked at um. the top you know the top five to 10 sex. aids or or toys that women are. purchasing online. And they you know you. can imagine that when you think of a. dildo they can go from.

one you know all the way to like the. largest thing you've ever seen and the. girthiest thing you've ever seen to like. a normal size. And so when you have the. option to pick as many as you want. right? What do you pick? And so what. they found was that women tend to pick. the length of about 6 inches but as you. know you're not putting the whole device. in there has to be a handle or. something. So it's probably around what. the normal size is and the girth was. also around the average girth of the. male penis. And so generally speaking. women tend to want what is average or.

around average right? And um. interestingly there's a product that is. available called Ohnut I'm not I don't. I'm not sponsored by them or anything. but essentially you you for women who. have pain with penetration with men who. are too well endowed the men actually. wears it so that the entire phallus. doesn't go in during sexual intercourse. but it's more comfortable for the. partner. So we know that sometimes it. can be really uncomfortable if it's too. well endowed. And so I think ultimately. um while I understand that pornography.

has made people really self-conscious. about the length of their penis and I. I'm I'm really sad about that because I. think you as we've talked about earlier. clitoral stimulation is the easiest way. for women to climax and you don't need. penetration for that. So in order to. have pleasure and give pleasure you. don't need a large penis. And in fact. some women may not even care what size. your penis is. It's more of a. a societal thing that we talk about. right? Women joke about it women talk. about it. I mean you can't go you know. you even I have accidentally made.

comments where I've been like oh that's. great that like he has a large penis and. like what I can't believe I just said. that. Like I'll say it and I'll be like. oh my god, I can't believe that came out. of my mouth of all people." And I think. it's just so ingrained in our brain to. be like, oh like to celebrate really. well-endowed organs when in reality it's. not necessary and sometimes even. painful. Will my penis get smaller as I age? So, not if you are healthy. So, in terms of. how do we maintain our penile health, right? Your body does a really good job.

of trying to maintain penile health. because over the course of a nighttime. men will get five to six erections, three to six erections over the course. of the night. And that will happen. whether you have a sexual dream or not, whether you are sleeping in a certain. way or not. It's because your body is. sort of giving blood flow to the area. periodically through the night. Whether. you're having sex, whether you're not, you're getting good oxygenated blood. flow to the penis. Now, if you develop. other conditions where you cannot get.

blood flow to the penis, like you get. high blood pressure, you get diabetes, you get heart disease, and those. arteries start getting narrowed, and. then you stop getting nighttime. erections, and you start having. difficulty getting erections, over time. the tissues can change and they can. become what we call fibrotic, and they. can become a little less spongy and less. elastic. And so, in those cases you can. see a little bit of shortening. Now, people will also see shortening because. they gain weight over the course of. their lifetime. And as you gain weight, the penile the penis is not shrinking,

but the the fat on the mons or the area. right above the penis is sort of getting. larger and obscuring how much penis. length there is. Is it one of the myths. around penis size is that, you know, if. I have big hands, look, cuz you know, these aren't small hands. If I have big. hands, then I have a big penis, or if I. have big feet, then I have a big penis. Is there data to support this idea that. the length of my. any part of my body is correlated to my. penis size? Yeah, there's one study, it's a Japanese study where they looked. at only Japanese men. Uh so, take there. are some limitations, but essentially.

they measured all these body parts and. penile length Uh and uh what they found. was that nose length was correlated with. penile length not hand length or foot. length. So how do I increase the length of my. nose? Yeah, yeah. But I thought I thought that. was really interesting. Again, nothing. you can control. These things are. pre-genetically determined to some. degree and in fact, you know, we talked. about some trends and while we've seen.

um. semen qua sperm quality change over the. last 50 years, we've also seen penile. length change average over many last I. don't know the exact number but 50 years. and they've actually seen penile length. is increasing. And they think that this. is because the onset of puberty is. changing and boys are getting exposed to. factors that are making them go through. puberty earlier and hence they're. getting more exposure to testosterone. and they're developing longer penises.

Um so it's sort of interesting. theoretical thing. I don't know if. that's true or not but sort of what the. theory is. Yeah, I actually read about. that study. It says that a study shows. that men's average erect penis size has. increased over the last 29 years from. 4.8 inches to 6 inches. Mhm. That's. pretty pretty dramatic. That's huge. Yeah. Yeah. Wait another 29 years. You could be a Jesus Christ. But I don't think women's vaginal. lengths are changing. So I don't know. what that means. Oh, yeah.

Oh, yeah. It's interesting cuz you when. you we talked about the vaginal length. enlarging as someone becomes aroused, you mentioned that it goes from about. roughly about 3 inches on average to. about 6 inches. That also correlates. with the size of the flaccid penis to. the size of the erect penis going from. about 3.6 inches flaccid to about 5.1 to. 5.2 inches erect. So you kind of see. that these two things are actually made. made for each other. Yeah, they are. I. mean, I think in general like we're all. we're I mean, we're we're designed,

right? The the biggest thing that we. need to do as a species is have. children, right? That is like sort of. the the goal of life is to propagate our. species. And so, it would make sense. that we would be designed to be able to. do that easily. A lot of people having. this um new procedure called. labiaplasty. Is Did I pronounce that. correctly? Labiaplasty. Labiaplasty. Yeah. What is this and why. So, labiaplasty is essentially taking. the labia uh minora and and and. making them a little shorter or smaller,

depending on what your preference is. And labias come in all sorts of shapes. and sizes. So, It's the inner lips of the vagina. Cuz they come in all sorts of shapes and. sizes. Sometimes they will be um. lopsided, so one will be longer than the. other. Some will be longer, some will be. smaller. And oftentimes we're seeing in. pornographies really small labia minora. And so, people will tend to feel like. maybe they should look like that. Now, not everybody. Some people will actually. have discomfort. Their labia are so long. that they cause friction or pain or. discomfort. In those cases, it's it's.

absolutely uh reasonable. But just like. people have insecurities about their. genitalia when it their men, women also. can have insecurities about their labia. as women. And so, labiaplasty is. essentially making those smaller and. more cosmetically appealing when women. desire that. Um but I think the the. important thing to take home is they are. so diverse. They're as diverse as your. fingerprint. Your labia is unique to. you. And it is not um there's no script. of what it should look like. Uh and so,

I generally tell people if that's. something you want, that's absolutely. fine. But again, this is not a pathology. or a bad thing. This is something that, you know, is more cosmetic. And there's. been an 80% increase in the surgery of. labiaplasty from 2015 to 2019, which is. you know, a lot. a lot. It's a lot. Last. thing about um. women and ejaculation in the vagina is. about squirting. Very misunderstood. Like I you know, as a. as a man that doesn't have a vagina,

um I've seen squirting on pornography. that I've watched. I watch pornography. I think that's important to say. I think. a lot of people do watch pornography. Um. and in the pornography that I've. watched, the woman squirts. This liquid. comes out. And I like is that semen? Is. that ejaculate? Or is that something. else? What is it? And also. should we be aiming to make our partner. squirt? Yeah, let's talk about it. So this is. important and it's actually interesting. I just I just had a conversation with a. researcher about this because it's so. misunderstood and we still don't know.

Like there's only been like three or. four studies looking at female. ejaculation and squirting over the. course of our history. There's different. types of fluids the vagina makes. One is. obviously lubrication. That's different. and that can be very copious for some, very not as copious for others. Uh that's one type of fluid. The other. type of fluid is female ejaculate. Now. female ejaculate is similar to male. ejaculate. It comes from the Skene's. glands, that same female prostate. It is. a small amount of like sort of sticky. white fluid that women ejaculate. Um and.

so they will release that fluid and it's. not like this copious amount of fluid. that you're seeing on pornography. Uh the next type of fluid is squirting. Uh and squirting is has been described. as a clear, colorless, odorless fluid. that's emitted from the urethra. Um when. they've looked at analyses of these, they found that there is what we call. PSA or prostate-specific antigen. Now. that we think of traditionally as males, but the women's Skene's glands make it.

as well. Now people are like, is it pee? Right? That's the big question. And so. in the one study where they looked at. the analysis, they found that it was. there was like dilute urine. And then. another study looked at like, okay, they. scanned people before squirting and. after and they scanned their bladders to. see like, did the amount of urine. change? And they said it did and now. it's urine. But we really don't know and. what we what the limitation is that you. never So, women know when they squirt. Like they they know it's not urine. So, if you talk to enough women who are.

squirting, they'll be like, you know, it's not urine. I'm sure it's not urine. But where is that fluid coming from? That That's where the question comes, right? And so, like if it's not urine, it's coming from the urethra. Like it. doesn't make sense. And so, this is Dr. Barry Komisaruk who's done a lot of. research on orgasm. He said, you know, it may be water imbibition. So, when you. think of like fluid filling the walls of. the uterus and the vagina during during. during the process of arousal and that. may be during climax when you have.

actually contractions of that fluid of. those of those organs that occurs during. climax, that it can actually release. this fluid. I don't know. I think the. jury remains out. I don't think we have. a conclusive answer because the studies. are not perfectly designed. We have a closing tradition on this. podcast where the last guest leaves a. question for the next guest not knowing. who they're going to be leaving it for. And the question that's been left for. you. If there was one message that you want.

your life's work to communicate to the. world, what would it be and why? My message is that sexual health is. health and that we need to be. prioritizing our sexual health and. educate our young people about sex. And why? Because I think the impacts of having. negative sexual health or negative. sexual encounters can be so dramatic in. terms of physiological outcomes, interpersonal outcomes, work.

productivity. I mean, it can be very. far-reaching and if we are able to. educate and empower people, we can. change the world. Dr. Rena Malik, thank you so much for. your time today and thank you so much. for um. illuminating a a bunch of issues on. sexual health that I've never really. understood or been able to discuss. before. And I think these conversations. are so unbelievably important because as. you say there, sex sort of permeates. every facet of our lives. And I think. sometimes people wonder why I spend a. lot of time on the show talking about. sex when this is called The Diary of a.

CEO. But that's because it's the same. reason why I spend a lot of time talking. about health and the brain and. neuroscience and relationships and. everything because I've come to learn. that although I'm a CEO, I'm a business. person, all of these things, as you've. said, feed into. um my ability to be a CEO. And what is a. CEO? A CEO is a human being. A CEO is. just someone that is um. has a sort of high-intensity career. We. all have high-intensity careers and. we're these multifaceted objects, but. some parts of these multifaceted objects. are still in the shadows because there's.

stigma and there's shame and there's not. a lot of a lot of education around it. And if I think about my career as a. whole, um. sex and my relationships have been this. huge um. huge part of it that once I focused more. energy on and started investing in in. every other part of my career improved. Every other part of my life improved. My. health improved. My performance at work. improved. My anxiety levels um. dissipated and that's why I think these. conversations are so unbelievably. important. And your work that you've. done both in your your sort of clinical.

practice, but also what you're doing on. YouTube as well, which I'll link below. so everyone can go and see, is allowing. this information to be accessible for. everybody, even those that don't have um. the money to go and drive, as you said, to go see a therapist. I think that's an. incredibly important work and I'm I'm. glad that you're a real champion and and. a force behind that. So thank you so. much on behalf of. me, my team, but also everyone that's. consumed your work and gained value from. it. Thank you. I would just say that I. always tell people, cuz I mentor a lot. of young medical students,

and I I always tell young women that the. number one most important decision. you're going to make is who you choose. as your partner. And that's because that person. whether it's obviously emotionally but. also sexually, right? How they support. you in your life is going to determine. whether you're able to succeed or not. And I I just was talking to another. woman and and she you know, she was like. my husband's wonderful. I was like I'm. not surprised. I was like you don't get. to be a successful woman.

and a happy, well-adjusted successful. woman unless you either are you know, very happy being alone or you have an. excellent partner to support you. Because if you have a toxic partner at. home, it's not going to work. Amen. Thank you.