men who ejaculate 21 times or more a month are less likely to develop prostate

cancer Jesus Christ why it's because Dr Reena Malik board certified urologist
expert on sexual health and a rock star in educating the public on the facts and
myths of sex Reena I want to start with this idea that other couples are having
significantly more sex than we are big myth people are having sex about once a week
will myis get smaller as I age it can so in terms of how do we maintain our penal
th you need to have is there a disparity between how long we think sex should take
and how long it actually takes yeah we all think it 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 then there too much masturbation
going to have an adverse effect for men and women masturbation is generally safe as
long as you don't that's when a becomes a problem Reena 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 it's [Music] episode Dr Reena Malik
with all of your work what is it that you're seeking to do so what I'm seeking to
do is have people understand that sexual health is health I think we have so much
misunderstanding about one what is good sexual ual Health how do you why is good
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 um how it's normal to have
erections at night or have even nocturnal emission so have a wet dream how that's a
normal physiologic function and so many people 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 re
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 initi 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 genital urinary 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 MH what was your sort of training with the pelvic floor so
when you do a fellowship in what we call pelvic female pelvic medicine a lot of
what we do is related to the strength or 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 Flor 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 blad 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 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 because 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 if for orgasming they don't ask if for ejaculating those kinds of
things why should they be asking about that because 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 a 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 millim the arteries to
the heart are about 3 to 4 millim and when you have about a 50% occlusion of a
blood vessel because of high blood pressure high cholesterol heart disease that
organ 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 there 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 because 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 that 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 because I heard
during Co 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
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 deal 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 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 I've 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 they're you know in in partner
relationships where sex is always available but it's so variable personto 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' um get your take
on is about pain during sex it's one of the sort of most uh popular questions that
I often guess 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 all almost double in
size to accommodate the phus or whatever you're using whether it's a toy or or or a
finger or anything and so if you don't have sufficient time to allow those things
to happen then it will be painful and sometimes lubrication can be variable
personto person so some people may have copious amounts of lubrication and some
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 medic ation
they're on that might decrease lubrication I think there's another big myth is that
lubricant is not for everybody and I 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 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 Flor dysfunction it can be things like endometriosis or other factors
that may be going on that need really Advanced help uh but most of the time a lot
of people can feel and enjoy sex more readily if they just increase the amount of
foreplay and increase the amount of lubrication you said that the vagina expands
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 phus and and it
takes we think on average about 18 to 20 minutes so it that's sort of the amount of
time it 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 did my
partner not orgasm as quickly and it can be on both sides where women can be like
why didn't I react like that why didn't I get so 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 relationship you know we don't talk about
things we're struggling with with our own partners 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's 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 situ ation because nobody wants to talk about it and this
is the problem like you know people ask me like what's this what's the key 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 oneandone 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 were in a relationship where
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
not during or during definitely not during that's happened before [ __ ] was yeah
yeah that's pretty bad that's pretty bad um so you know one and then two have it in
a place like somebody you don't to be looking at the person right you can be
sitting in a car you can be going on a walk because it's really awkward to look 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 eye
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 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 noet
return in their relationship as far as they're concerned they've not been having
sort of a functional healthy sex life for maybe one year maybe 6 months maybe 5
years and it's just become The New Normal MH what is the case you would 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 their 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 in intimate we still love each other we still 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 their relationship then it's worth keep trying
like try to have 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're just don't want to talk about
it they they they're not stupid they just sort of don't want to talk about it
because it's 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 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 Rel
ships are like a frog in a frying pan the frog in the frying pan analogy for
anybody that doesn't know is this old tale about a frog jumping into a frying pan
and then because the water heat up gradually it ends up dying but if the water was
hot from the moment it Dr jumped in it would have jumped straight out the idea that
it's a gradual death for the Frog 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 it feels like a long
way back from that point it is it's going to be right because you let it sort of
dwindle and 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 toy 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 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 cuz 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 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 this 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 just
appoint them and so there's a lot of charged emotions there but realizing that 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
someone who 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 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 were younger 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 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 and then you would have all this
anticipation about how fun it's going to be but the anticipation can can wreak
havoc content 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 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 it on the calendar prioritizing
your intimate y 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 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 outside of physiology is that stress even
though stress is um 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 though to get my libido back it won't work for
everybody so if it's not truly a low testosterone meaning you have normal of
testosterone likely your testosterone receptors are completely saturated more
testosterone is not going to fix the 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 6 hours
you're going to have at least 10 to 15% reduction in testosterone and so because
our body follows a Circ Rhythm and so when your testosterone's highest is in the
morning and it starts to decline over the 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 rusted 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 group 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 Ultram man marathons all the time long long bike rides long swimming
uh you know swimming for a long periods of time that can actually increase your
cortisol your stress because your body is having a stress response and that can
actually reduce your testosterone so it's important to do cardiovascular exercise
aerobic exercise but in moderation uh because we do see some people who are great
athletes who you know run you know run miles and miles and miles but their
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
Iron Man thousand M run things that the cortisol sues that's not that's not a large
percentage of people right but it's certainly you know it's like I'm so healthy I'm
the healthiest I 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 uh 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 um low
amounts of processed foods good healthy fats nuts and seeds so a lot of people
don't realize but you need good fat to have testosterone testosterone is a pre is a
production is 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 while
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 heard a few times that testosterone levels
have been declining over the last couple of decades in men MH 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 acve
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 think in the
environments we know there's more uh microplastics and more endocrine disrupting
chemicals right in the environment so that is probably a role now we don't have
like exact qu like exact quantitative data on that but we think that is probably
playing a role and reducing the exposure to these endocrine disrupting chemicals so
we tell people try not to drink out of plastic water bottles try to warm up food
and glass and avoid plastic I mean these are easy things you can do but if you want
to stress about the amount of 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 that's 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 that I'm holding the metal mug in
front of me and then the plastic bottles I drink from could be having an impact on
my testosterone and my sperm count it could I mean like it's not everybody right
think about how many people drink from plastic water bottles but if you can
decrease your exposure right it's probably additive so the more exposure you have
the more likely it is to imp 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 uh to things like phalates and labs and seeing how that you know
we can't it's all cause it's all correlation we can't say it's causitive because we
don't we're not going to do a randomiz study where you 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 phalates 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 plot ible
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 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 and that can be on a governmental
level right like having sort of laws in place so we know in the US there's less
restrictions 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
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 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 that there's been 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 seamen 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 a male fat 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
seamen 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 seamen volume yeah so seamen 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 seamen volume you
will get that's probably the most predictive you know hydration can play a role if
you hydrate more certainly you may see more seam in volume um sometimes it's a it's
a low seam in volume because you're actually having less force of ejaculation so
interestingly when you're young the force of ejaculate can be really really strong
it can be up to 30 to 60 cm away like when you ejac that's 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 like keigle exercises I caution
people because people always like oh they're going at these Keele exercis 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 seam and volume by the parameter of increasing the force
of a jackulate and getting more ecate 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 in your orgasm when you orgasm
your pelvic floor contracts involuntarily you can't do anything about it at a rate
of about every 08 seconds so it does contract and that is sort of like a pelvic
floor muscle exercise but 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 um in women particularly
is orgasming as good as doing pelvic floor exercises and they've seen that you know
you can see pretty measurable Improvement in pelvic floor strength if you orgasm
regularly um is it and it may be you know as good as doing ke gos depending on how
often you're doing it so yes orgasm itself can be very beneficial for pelvic floor
strength one of the big sort of myths that I've always ways I'm yet to answer is
the impact that our technology is having on 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 diff 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 their seman 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 or 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 allomer 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 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 I think we'll see more of this as we're seeing the
rise of I there's benefits to saunas no doubt but as we're seeing the rise of
people really doing saunas all the time um there can be so we tell people when
they're trying to have if they're having fertility issues don't in hot tubs don't
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 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 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 and and what they found was that there was an increase by about
50 50 nanog per deil 0.5 um was which is 50 nanograms per D which is not a huge
amount um at 21 days but we know 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 of itself can increase testosterone So gener
speaking there's no empiric evidence that is convincing high quality level evidence
that masturbating or abstaining from masturbation will increased 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 testesterone that
one was not even that large and two is 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
because I want to finish masturbating or you literally can't sleep without
masturbating every day like those sort 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 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 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 is
like oh this is what turns me on this is what makes me orgasm and then when you're
their partner you're like oh I'm 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 um 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 hariry Pals blindness like
I don't know where I 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 as 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 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 theyve 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 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 ejacate 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 because I mean the
way that I've had it explained to me is that it's some something about seman
retention gives you some clarity of mind or something because a lot of athletes
before they have their their big fights or you know their bigger sort of Olympic
competitions they'll abstain from masturbation 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 two weeks before a fight or four 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 ever 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 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 so 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 heard that rumor many years ago and I think I assumed it was correct I
heard the rumor and this was 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 I don't
know attractive basically so we were 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
in my mouth well you know some people describe post not 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 postcoidal not
post nut postcoidal 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 um masturbation it's very individualized or ejaculation whatever it is post
that 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 not 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 ask 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 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 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 down 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 in 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 is and there's sort
of some evolutionary theories about why this happens so one is after you ejaculate
if you are having uh ejaculation with a woman then you don't want to have sex again
to then 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 uh to have fertilizing 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 um 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 um in terms of clarity in ter because we know
there's a little bit of differences in brain um it may not be as obvious in women
in terms of it takes them a little longer to have that coming down after the orgasm
from the brain activity um but probably there is some we just haven't studied
enough and I 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 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 on the point about masturbation is there a link between m
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 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 e jackling frequently you're more often 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 jacine 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 s you know
sufficiently healthy to do so and so I while they tried to control for those things
there's always sort of uncontrollable variables that come into 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 therefore X Y and Z they tried to control for comorbidities but again
they're they're I don't think they controlled for I mean they control 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 for themselves about the um the
controls in that study and how that was conducted link to this is is the subject of
um it was interesting cuz I was doing a lot of research on the subject of that
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 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 8 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 VC are 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 uh very often kids are seeing
it whether you as a parent don't want them to whether you've put blocks on their
phones and devices um they may have access to it from a friend or they may see it
somewhere else and um 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 a movie that's not real life and
this is not what sex is really like and so I think that has um implications for um
for how they view sex and how 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 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 um and so it can be just a
way to have pleasure and even watch it with your partner and have pleasure um 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 or people are
finding that watching pornography is is one easier than going out trying to find a
partner you don't have to face rejection you don't have to face the difficulties
and awkwardness of having a first a sexual encounter with someone that often happen
and so it can become a way because it does relieve dopamine just like anything else
release dopamine it can then become sort of a way to feel better about anything
right like you can just be feeling down like I want to watch pornography because it
makes me feel better it may not be just that 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
this 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 this 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 that new headset
and I tell you what Jesus Christ that's unbelievable piece of technology this one
feature they have on their is called spatial video and I don't know if you've tried
it yet but you put it on and if you've taken a spatial video which you can now take
on the new iPhone and also on the Vision Pro it basically feels like a 3D video and
it's like nothing 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 a video
anymore but then little monster in my mind goes hm there's going to be other
applications of this technology as it relates to put graphy and we're getting you
know if we just assume any rate of improvement with this technology just I know 5%
a year we eventually get so close to being indistinguishable from a human being
that the incentive structure of going out and getting a day and you know for the
for the objective of having sex or 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 way to uh masturbate and to watch pornography and
there 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 particular
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 buildup 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 remained to be seen however I will show that 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 BR
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 DI 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
our headsets and I can only hope that that will predominate and we can continue and
people will inherently want other people right that 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 you 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 though 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 absolutely 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 I remember having like a 70-year-old woman and she
had such terrible pelvic Flor dysfunction for God knows how many years that
ultimately it caused really negative consequences for her bladder function and um
and so absolutely when you have a trauma that's unresolved in some shape or form it
will affect you whether it's your mental health your physiologic health I mean 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 psychologic component
because it is devastating it is stressful it is horrifying to feel like you're not
normal your body doesn't function normally 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 so many things even how to balance your books right
they don't learn that in school so ultimately there's so many things that I think
if we were really 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 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 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 pre-term 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 clitorus as a man what do I need
to know about the clitoris CU I I'll be honest I know very little I know where it
is that's that's a plus well not everyone knows that either yeah I didn't always
know where it was I a couple of misunderstandings but um I found I found it
eventually and I I 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
the genital tubric before you're assigned sex that genital tubric when you're when
you become a man that genital tubric becomes the penis and the shaft and the glands
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 clitus is just as sensitive as a
man's penis right so if you stimulate the clitoris like your penis gets stimulated
then it will lead to orgasm and it's probably the most reliable route for orgasm
for women so 85% of women need some form of cliteral stimulation to Climax and so
many women have difficulty climaxing through vaginal penetration alone that's 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 uh uh manual stimulation all those
things can work but that's where the communication comes in where 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
this whole talk but um that is really what's important now the clitoris like I said
it it goes um deep 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 PE
comes out about 2 to 3 centimeters in is called The gynus Zone it's named after the
person who um identified it I think it's graen house or something like that but um
essentially that area is full of certain nerve endings as well as the female
prostate or the skin glands and so those are areas that are quite ayous and that
uses a different so the clitoris is inated by the pudendal nerve the G erogenous
zone is inovated by the hypogastric nerve so a different nerve and then the cervix
is the last area where Sometimes women feel a lot of stimulation and that's a
stimulated by the vagus nerve so all these different areas can lead to orgasm for
women and they can be additive so if you're stimulating all three you might have a
more strong orgasm and the orgasm may feel a little different now people like to
call it like oh you're getting clitoral orgasm or a vaginal orgasm it's all an
orgasm it's just a matter of what stimulation is causing the orgasm and so I think
ultimately it's really important for the the most easy reliable route to orgasm is
cital 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 have 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 which
in fact UK men tend to last a little bit longer which is sort of an interesting
concept but so which sex is that men men men so from penetration to climax of men
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 not 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 attacked letting you know the facts I know it
makes sense though cuz yeah 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 like why do we orgasm and
also when I say what is an orgasm is an orgasm like a switch or is 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
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 okay
that's the end of the conversation okay we're done here so um so yeah cuz nobody
wants to talk about they literally want me to tell them like this is what you do a
b c d instru man so um but yeah ultimately um all of 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 is 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 six inches 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 all always the
case because not every vagina can accommodate a very large phus 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 clim 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 CL going higher and higher and there's also an
inhibitory there's a 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 once 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 8 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 necessarily a switch
it's sort of a a a climb up a mountain is the way I would describe it sometimes
feels like blowing up a balloon with a little hole in it and what I say with a
little hole in it I mean because if you stop it feels like some air comes out of
the balloon mhmh that's why I said the the sort of there needs to be a rhythm it
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 clitorus is a
great way to get to orgasm you've you're PR lubricants MH 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 SCH in time for intimacy scheduling time for
intimacy so because sex ads as we talked about add 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 a 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 and 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 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
um manual sex any type of sexual stimulation right and so when you're thinking
about the entire encounter it can be very variable some people want to quickie some
people want to have this long luxurious love making 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 a 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 three
minutes that's fine but how long do people think sex lasts on average versus is 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 what 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 five 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 I realized 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 minutes depending on the
study you look at and they they looked at all Commerce so it's actually different
in different um countries so when you look at like turkey it was like four minutes
and if you look at UK it was like 10 minutes so it's actually thank you so it's
actually variable and that may be a cultural thing um but ultimately the average is
about five something interesting so we want sex women want sex to last between 18
and 25 minutes ideally men want it to last ideally about 16 minutes including forl
but in reality it's lasting five five minutes yeah that's good to know this so
there's two sort of sizes that people often think about the size of the vagina and
the size of the penis there 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 child birth 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 uh
feeling maybe some dysfunction in the organ but really mostly discomfort and so
those are sign of weak pelvic floors not you know not having a loose vagina during
sex and we can do something to strengthen our pelvic floor which is the is that
what the keegle exercises are yeah it's more than Keel I mean Keel is the most has
the best PR of any sort of thing I've ever seen in medicine but yeah it's pelvic
floor exercise the Keel is one pelvic floor exercise which is to strengthen the
pelvic floor and there are others what is it so it's essentially men never know
like it's it's not your fault women sort of kind of know but even don't really know
so what it is is there's those same muscles we talked about earlier is that you're
basically doing a rep you're squeezing Contracting and relaxing just go to the gym
right you squeeze and relax very similarly you are squeezing those muscles and
relaxing those muscles I can do this sat down now yeah so basically 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 that's one way another
way to think about it is if you were trying to lift your penis off the ground
without without touching it ah okay go yeah 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 um 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 remember the scene from Sex in the City where like the
character Samantha was like I'm doing my Keel right now like yeah she's probably
been doing Keel for a long time and now she's so good at them that she can do them
while she's brushing her teeth but it's not like 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 CU they're just like a when you go to the gym alone you
can do it or you can go with the personal trainer they're like the personal
trainers for 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 semmen 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 vague variety of these symptoms and um so generally it's
important to get evaluated to see like examine 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 M 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 I said look I can examine you um but I bet based
on your story like you're a young guy you've sort of had these new 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 and someone 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 because 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 on my finger but that's enough to sort of C a tension of the pelvic
floor muscle and cause pain where where you 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 flooor muscles okay so because 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 Flor 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 florids actually you know people think about
their core as they 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 in um on the topic of sizes then one of the big
things in men is penis size M and one of the big questions men often ask is is
there ways to increase my penis size there's in 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 paronis 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 2cm in inrease in length
now um that may be enough for some people they were like yes I definitely want that
and some people like you know 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 study
them and use them like twice a day for 30 minutes and they've seen some increase in
Penal length they're generally pretty safe it's more about um you might have some
bruising from just putting the traction device on and as long as you follow the
instructions you're probably not going to hurt yourself is that penis pump no pumps
are different so pumps have not been shown to increase pening what a pump is it's
got a it's got a a a cylinder that you put your penis into and it uses sort of
vacuum technology to 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 penal 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 you know I think that in terms of penal 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've 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 P the role that's played in our perception of what a
normalized penis is do you know any of any data on what how big people think a
penis should be versus how big the penises actually are yeah so yeah most people
think it should be about 6 in so like we said the average is around 5.1 to 5.3 in
and so 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 transmen one of the surgeries that we do is a Neo phalus is we create
a new phus and one of the the types of surgeries we do is we use a forearm flap and
so it 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 length and girth of this neop fallis 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
giri 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 in but as you know you're not putting the
whole device in there has to be a handle or something so it's probably 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 onut
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 phus doesn't go in during sexual intercourse
so that it's more comfortable for the partner so we know that sometimes it can be
really uncomfortable if it's too well- endowed and so I think ultimately um while I
understand that pornography has made people really self-conscious about the length
of their penis and I I'm really sad about that because I think you as we've talked
about earlier clal 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've accidentally made comments
where I've been like oh that's great that like he has a large penis I'm like well I
can't believe I just said that like I'll say it and I'll be like 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 penal Health
right your body does a really good job of trying to maintain penal 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 whe that 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 penal the penis is not
shrinking but the the fat on the MS or the area right above the penis is sort of
getting larger and obscuring how much penis length there is there's a one of the my
around penis size is that you know if I have big hands because you know these
aren't small hands if I have big hands then I have a big penis or if I have big
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 SI 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 penal length uh
and uh what they found was that nose length was correlated with penal length not
hand length or foot length so how do I increase the length of my nose yeah but uh I
I thought that was really interesting again nothing you can control these things
are PR genetically determined to some degree and in fact you know we talked about
some Trends and while we've seen um semen qual a sperm quality change over the last
50 years we've also seen penal length change average over many last I don't know
the exact number but 50 years and they've actually seen penal 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 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 ere penis size has increased over the last 29 years from 4.8 in to 6
in mhm that's pretty pretty dramatic that's huge yeah wait another 29 years you
could be a Jesus J Christ but I don't think women's vaginal lengths are changing so
I don't know what that means oh yeah ah yeah it's interesting because you when you
we talked about the vaginal length enlarging as someone becomes aroused you
mentioned that it goes from about roughly about 3 in on average to about 6 in that
also correlates with the size of the flaccid penis to the size of the erect penis
going from about 3.6 in flaccid to about 5.1 to 5.2 in erect so you kind of see
that these two things are actually made made for each other yeah they are I mean I
think in general like we're all we're 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 are having
this um new procedure called label of plasy is did I pronounce that correctly
labioplasty labioplasty what is this why so labioplasty is a essentially taking the
labia uh manora and and and making them a little shorter or smaller depending on
what your preference is and labas come in all sorts of shapes and sizes it's the
inner lips of the vagina so they come in all 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 pornography really small labium
manur and so people will tend to feel like maybe they should look look like that
now not everybody some people 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
they're men women also can have insecurities about their labia as women and so
labia plas is essentially making those smaller and more cosmetically appealing when
women desire that um but I think the the important thing to take home is they are
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 labioplasty from 2015 to 2019 which
is you know a lot a lot it's a lot last thing about um women in ejaculation in the
vagina is about squirting very misunderstood like you know as a as a 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 like is that Seaman 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 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 skin 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 and squirting is it's
been described as a clear colorless odorless fluid that's emitted from the urethra
um when they've looked at analyses of these they found that there is what we call
PSA or prostate specific antigen now that we think of traditionally as males but
the women's skin glands make it as well now people are like is it P right that's
the big question and so in the one 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 scann their bladders to see
like did the amount of urine change and they said it did and now it's urine but
what we really don't know and what we what what the limitation is that you never so
women know when they squirt like they they know it's not urine so if you talk 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 urethro like it
doesn't make sense and so uh this is Dr Barry korak who's done a lot of research on
orgasm he said you know it may be water imbibition so when you think of like fluid
filling the walls of the uterus and the vagina during during or during the process
of arousal and that may be during climax when you have actually contractions of
that fluid of those of those organs that occurs during climax that it can actually
release this fluid I don't know I think the jwelry remains out I don't think we
have a conclusive answer 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
physiologic 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 Reena Malik thank you so much for your time today and thank you so much
for um Illuminating 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 inity 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 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 focus to 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
glad that you're a world champion and and a a force behind that so thank you so
much on behalf of me my team but so everyone that's consumed your work and gain
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 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 [Music]