Youtube (masturbate): Le docteur du meilleur sexe : le lien entre la masturbation et le cancer de la prostate ! Dr Rena Malik

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Il faut prendre en considération la durée (01:54:09s), le titre (The Better-Sex Doctor: The Link Between Masturbating & Prostate Cancer! Dr Rena Malik), pour une vue d’ensemble complète, ainsi que la présentation faite par l’auteur :« Le Dr Rena Malik est urologue et chirurgienne pelvienne. Sa chaîne YouTube compte plus de 1,8 million d’abonnés, où elle publie des épisodes hebdomadaires sur tout ce qui concerne l’éducation à la santé sexuelle. 0:00 Intro 02:40 Que cherchez-vous à faire ? 03:30 Comment définissez-vous la santé sexuelle ? 03:46 Comprenons-nous notre corps ? 05:10 D’où vient votre formation ? 06:37 Quel est votre entraînement avec le plancher pelvien ? 09:07 Pourquoi nos médecins devraient-ils s’interroger sur notre santé sexuelle ? 11:15 La faiblesse du plancher pelvien chez les hommes est-elle liée à la dysfonction érectile, et la position assise en est-elle également la cause ? 12:58 Quelle quantité de relations sexuelles les couples devraient-ils avoir ? 14:42 Devrions-nous ressentir de la douleur pendant les rapports sexuels ? 16:57 Le processus d’expansion du vagin 19:23 Comment communiquons-nous avec nos partenaires à propos du sexe ? 22:21 Quelle est la première étape pour reconstruire une bonne vie sexuelle ? 26:22 Le désir sexuel des hommes et des femmes à mesure que nous vieillissons 29:11 L’anticipation autour du sexe fait plus de mal que de bien 30:11 Une faible libido est-elle un problème hormonal ? 32:29 Comment augmenter le taux de testostérone 35:25 Une baisse des niveaux de testostérone et du nombre de spermatozoïdes 36:37 Les produits chimiques présents dans les objets du quotidien ont un impact sur le nombre de spermatozoïdes 38:30 Comment le nombre de spermatozoïdes a-t-il diminué au fil des ans ? 42:06 Comment augmenter notre volume de sperme 43:56 La masturbation améliore-t-elle mon plancher pelvien ? 44:55 L’impact de notre technologie sur nos organes génitaux 47:48 La masturbation diminue-t-elle les niveaux de testostérone ? 49:17 Est-ce que trop de masturbation a un effet néfaste sur nous ? 51:10 La masturbation rendra-t-elle les gens aveugles ? 51:29 Que pensez-vous de l’absence de noix novembre 53:05 Se masturber vous donne plus de clarté d’esprit 56:23 Clarté de la noix 01:01:48 Le porno, est-ce mauvais ? 01:05:47 Casques VR et porno 01:10:14 Traumatisme et son lien avec notre vie sexuelle 01:12:50 Peut-on avoir des relations sexuelles quand on est enceinte ? 01:13:33 Orgasmes et clitoris 01:19:36 Qu’est-ce qu’un orgasme 01:23:16 Planifier du temps pour le sexe ? 01:24:47 Y a-t-il une disparité entre la durée réelle des relations sexuelles et la durée que cela prend 01:28:25 Mythes sur le vagin 01:30:30 Exercices du plancher pelvien, comment les faire 01:32:48 Comment pouvons-nous savoir si nous avons des problèmes de plancher pelvien 01:35:52 TAILLE DU PÉNIS, est-il possible d’augmenter la taille ? 01:38:39 Quelle est la taille moyenne d’un pénis par rapport à la taille que les gens pensent qu’il devrait avoir ? 01:41:50 Mon pénis deviendra-t-il plus petit avec l’âge ? 01:43:08 La taille des parties du corps indique-t-elle un pénis plus gros ? 01:45:45 Labiaplastie 01:47:21 Jouir 01:50:16 Dernière question de l’invité Suivez Rena : Twitter – https://bit.ly/3VzI3vu Instagram – https://bit.ly/3TDaRk6 YouTube – https:/ /bit.ly/3vx9knV Suivez-moi : https://beacons.ai/diaryofaceo Achetez les cartes de conversation : https://thediary.com/products/the-cards Sponsors : Zoe – http://joinzoe.com avec un code exclusif CEO10 pour 10 % de réduction Étude mentionnée : https://www.health.harvard.edu/mens-health/ejaculation_ Frequency_and_prostate_cancer#:~:text=In%20fact%2C%20the%20reverse%20was,lower%20risk%20of%20prostate%20cancer. Cet épisode de The Diary Of A CEO a été tourné aux Gold Tree Studios, situés au cœur du Sunset Strip, à West Hollywood, en Californie ».

La vidéo est disponible pour visionnage directement ci-dessous
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Concevoir un programme pour arrêter cette habitude

Proposer des solutions pratiques pour réduire cette activité

  • Remplacer par d’autres activités : Pratiquez le sport ou découvrez de nouveaux hobbies.
  • Remplacer cette habitude par des activités saines : Pratiquez des sports ou adoptez de nouveaux loisirs.
  • Identifier ce qui déclenche l’envie : Prenez note des moments où vous ressentez le besoin.

Mettre en évidence l’impact du soutien social sur le bien-être

  • Parler à un sexologue : Un professionnel peut offrir des conseils adaptés. (c’est le cas de ce service)
  • Participer à des groupes de soutien : Partager ses progrès aide à maintenir la motivation.

Suggérer des solutions pour prévenir les rechutes

  • Créer une routine organisée : Planifiez des activités à faire tout au long de la journée.
  • Fermer l’accès à la pornographie : Mettez en place des protections pour limiter l’accès aux contenus adultes.

Peser les avantages d’une réussite dans l’abstinence

Détailler l’évolution vers une plus grande stabilité émotionnelle

Arrêter cette habitude permet souvent de retrouver plus d’énergie, une humeur positive et une meilleure concentration.

Expliquer comment les interactions sociales deviennent plus harmonieuses

Les liens avec un partenaire deviennent plus intenses, renforçant l’unité émotionnelle et physique.

Montrer le processus pour atteindre une satisfaction durable

Moins de dépendance mène à des gains durables dans la vie personnelle, professionnelle et sociale.

Faire le point sur la dépendance à la masturbation et ses conséquences

Analyser ce qu’est la masturbation et les comportements associés

Activité sexuelle naturelle, la masturbation est associée à des bienfaits tels que la diminution du stress. Toutefois, lorsqu’elle devient trop fréquente, elle peut engendrer des difficultés.

Identifier les indices d’une dépendance éventuelle

La dépendance se caractérise par une pratique de plus en plus fréquente, accompagnée d’une incapacité à contrôler cette activité, au détriment d’autres engagements. Cela peut engendrer des problèmes dans les relations avec un partenaire.

Observer les influences sur le bien-être physique et mental

La consommation habituelle de pornographie, couplée à une dépendance à la masturbation, stimule constamment le système dopaminergique, ce qui peut entraîner des conséquences comme l’éjaculation précoce, une diminution de l’énergie ou des frustrations sexuelles.

Rechercher les causes de l’intensification de cette pratique

Parler des influences mentales et émotionnelles

L’anxiété, le stress ou des insatisfactions ailleurs dans la vie peuvent conduire à l’excès de cette pratique.

Évaluer les effets combinés de la solitude et du désir

Le désir non satisfait et la solitude, tant dans la vie de couple que personnelle, sont des éléments qui favorisent cette pratique.

Évaluer l’impact de la consommation de pornographie sur les comportements

La pornographie représente un facteur fondamental. Elle nourrit fréquemment l’envie de se masturber et peut fausser la vision de la sexualité.

Masturbation et rapports intimes : relever le défi du changement

Arrêter la masturbation peut être une démarche difficile, mais nécessaire, pour ceux qui en ressentent le besoin. Bien qu’il s’agisse d’une pratique naturelle et souvent vue comme bénéfique pour la sexualité, elle peut devenir envahissante et problématique lorsqu’elle évolue vers une addiction, perturbant ainsi des domaines clés comme la vie sociale, mentale et professionnelle.

En fin de compte

L’arrêt de la masturbation compulsive implique un parcours long et exigeant. Grâce à un plan détaillé et un soutien approprié, il devient possible de franchir cette étape et de savourer les bienfaits d’une vie plus équilibrée, centrée sur des projets plus gratifiants.

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#docteur #meilleur #sexe #lien #entre #masturbation #cancer #prostate #Rena #Malik

Retranscription des paroles de la vidéo: 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 absolutely crazy to me that so many of you have decided to watch our show um and so many of you have decided to subscribe to our show we now have five million subscribers on YouTube which is a number that I just can’t comprehend and it’s a dream that I absolutely never could have had we started the Dio just over three years ago now and in my wildest expectations we might have had 100,000 subscribers by now so you can imagine how shocked I am that so many of you have chosen to tune into these conversations every week um and spend some time with us so thank you and I made a deal with you I made a deal that if you subscrib to this show that we would continue to raise the bar and in 2024 we’re going to raise the bar like never before I’ve been working for the last 9 months on a surprise for all of you that have subscribed to the show and I’m very excited to deliver that for you the production’s going to change we’re going to go even further with our guests and we’re going to tell even more Global stories so as always if you appreciate what we’re doing here the simple free favorite ask from you is to hit the Subscribe button let’s get on with the [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 let’s talk about Zoe who you may know because they’re a sponsor of this podcast and I’m an investor in the company you guys know health is my number one priority Zoe’s growth story has been absolutely incredible so far they’re doing science at a scale that I’ve never seen before because of their members and recent breakthroughs in research they can now continue to offer the most scientifically Advanced gut health tests on the market previously the test allowed them to analyze 30 bacteria types in your gut but now thanks to new science they’ve identified a 100 bacteria types this is a huge step forward and there’s nothing else that’s available even close to it on the market at all so to find out more and to get started on your Zoe Journey visit zoe.com stepen you can use my exclusive code ceo1 for 10% off don’t tell anybody about that okay just for you guys we talked about sizes of stuff a second ago and we said we would come back to this so there’s two sort of sizes that people often think about the size of the vagina and the size of the penis 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] you [Music] oh .

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Déroulement de la vidéo:

0.199 men who ejaculate 21 times or more a
0.199 month are less likely to develop
0.199 prostate cancer Jesus Christ why it&;s
0.199 because Dr Reena Malik board certified
0.199 urologist expert on sexual health and a
0.199 rock star in educating the public on the
0.199 facts and myths of sex Reena I want to
0.199 start with this idea that other couples
0.199 are having significantly more sex than
0.199 we are big myth people are having sex
0.199 about once a week will myis get smaller
0.199 as I age it can so in terms of how do we
0.199 maintain our penal th you need to have
0.199 is there a disparity between how long we
0.199 think sex should take and how long it
0.199 actually takes yeah we all think it
0.199 lasts longer women want it to be 18 to
0.199 25 minutes men are a little on the
0.199 shorter side like maybe 12 minutes is
0.199 there like an average time 5.1 to 5.7
0.199 minutes then there too much masturbation
0.199 going to have an adverse effect for men
0.199 and women masturbation is generally safe
0.199 as long as you don&;t that&;s when a
0.199 becomes a problem Reena do we understand
0.199 our bodies as it relates to our Sexual
0.199 Health not at all for example with
0.199 pelvic floor it&;s involved in orgasm
0.199 it&;s involved in sexual function but no
0.199 one really talks about it in fact men
0.199 will be shocked oh I have a pelvic floor
0.199 too and there&;s a whole host of issues
0.199 that can come from having a weak pelvic
0.199 floor including erectile dysfunction so
0.199 how can I strengthen my pelvic floor
0.199 pelvic floor exercises they&;re going to
0.199 increase orgasm they&;re going to make
0.199 your semen Propel further and ultimately
0.199 it would be something as simple as it&;s
0.199 absolutely crazy to me that so many of
0.199 you have decided to watch our show um
0.199 and so many of you have decided to
0.199 subscribe to our show we now have five
0.199 million subscribers on YouTube which is
0.199 a number that I just can&;t comprehend
0.199 and it&;s a dream that I absolutely never
0.199 could have had we started the Dio just
0.199 over three years ago now and in my
0.199 wildest expectations we might have had
0.199 100,000 subscribers by now so you can
0.199 imagine how shocked I am that so many of
0.199 you have chosen to tune into these
0.199 conversations every week um and spend
0.199 some time with us so thank you and I
0.199 made a deal with you I made a deal that
0.199 if you subscrib to this show that we
0.199 would continue to raise the bar and in
0.199 2024 we&;re going to raise the bar like
0.199 never before I&;ve been working for the
0.199 last 9 months on a surprise for all of
0.199 you that have subscribed to the show and
0.199 I&;m very excited to deliver that for you
0.199 the production&;s going to change we&;re
0.199 going to go even further with our guests
0.199 and we&;re going to tell even more Global
0.199 stories so as always if you appreciate
0.199 what we&;re doing here the simple free
0.199 favorite ask from you is to hit the
0.199 Subscribe button let&;s get on with the
0.199 [Music]
0.199 episode Dr Reena Malik with all of your
0.199 work what is it that you&;re seeking to
0.199 do so what I&;m seeking to do is have
0.199 people understand that sexual health is
0.199 health I think we have so much
0.199 misunderstanding about one what is good
0.199 sexual ual Health how do you why is good
0.199 sex important why is it good to have
0.199 good sexual health and that creates a
0.199 lot of Despair and Devastation and
0.199 people don&;t talk about it so they
0.199 ruminate they feel bad about themselves
0.199 and it&;s pervasive throughout their
0.199 entire life so I think ultimately my
0.199 goal is to make education freely
0.199 accessible and understandable so people
0.199 can know what&;s going on with their
0.199 bodies what&;s normal what&;s not and
0.199 what&;s available to help them how do you
0.199 define sexual health so sexual health is
0.199 sort of an individual thing but most
0.199 people would say that you are able to
0.199 have sex you are able to have an orgasm
0.199 you are able to have pleasure and
0.199 achieve the benefits of that do we
0.199 understand our bodies as it relates to
0.199 our sexual health no not at all I will
0.199 tell you so I talk about for example um
0.199 how it&;s normal to have erections at
0.199 night or have even nocturnal emission so
0.199 have a wet dream how that&;s a normal
0.199 physiologic function and so many people
0.199 will message me and say how can I stop
0.199 having what they call Nightfall or how
0.199 can I stop waking up with an erection
0.199 because they think for some reason it&;s
0.199 shameful or it&;s a bad thing and when re
0.199 realistically it&;s just normal and part
0.199 of it is Media right so when you see TV
0.199 you see a man getting an erection very
0.199 quickly he&;s initi immediately
0.199 penetrating a woman and she&;s
0.199 immediately orgasming and the whole Act
0.199 is like really hot and heavy and in
0.199 reality that&;s not what sex is like so
0.199 if you&;re not seeing what normal sex is
0.199 like what normal foreplay is like what
0.199 the fact that it&;s normal to sometimes
0.199 have difficulty getting an erection
0.199 that&;s normal sometimes to not have an
0.199 orgasm for a woman or it may take more
0.199 time to get a woman aroused and require
0.199 more foreplay that you are essentially
0.199 looking at a script that&;s not real and
0.199 then you&;re like what&;s wrong with me am
0.199 I broken you know is something wrong
0.199 with my body that it doesn&;t function
0.199 the way I&;m seeing on TV or on Media or
0.199 on erotic films where does your
0.199 experience on this subject come from so
0.199 I&;m a urologist by training a board
0.199 certified urologist so we are the
0.199 medical and surgical doctors of the
0.199 genital urinary tract so we&;re
0.199 essentially the plumbers so when you
0.199 have a problem with your kidneys the
0.199 tubes that drain the kidneys the bladder
0.199 or your genitals we&;re the ones who are
0.199 going to fix those if they&;re a surgical
0.199 issue and also we deal with the medical
0.199 aspects of some of those things and so
0.199 that&;s what my training was in but when
0.199 I started my social media my channel I
0.199 wanted to offer education to people and
0.199 as I started making this education I
0.199 realized how badly people wanted to know
0.199 about sexual health how much they didn&;t
0.199 know and how they really wanted to be
0.199 empowered with this information and
0.199 people are not being asked about sexual
0.199 function even when you go to see your
0.199 primary doctor when was the last time
0.199 they asked you about anything they might
0.199 ask you about erections but that&;s
0.199 probably where it ends right even if
0.199 they ask about that they&;re definitely
0.199 not asking women are you having orgasms
0.199 they&;re definitely not asking um anyone
0.199 if sex is pleasurable they&;re not asking
0.199 them if they feel satisfied with the way
0.199 things are going right and if they are
0.199 enjoying desire do they feel normal and
0.199 so I realized there was such a
0.199 disconnect here with what people wanted
0.199 to know and what was available to them
0.199 and so then I started really making
0.199 content about sexual health and spending
0.199 more time investigating in that area
0.199 treating patients in that area and it
0.199 totally became a all-encompassing field
0.199 for me you&;re an expert in the pelvic
0.199 floor as well MH what was your sort of
0.199 training with the pelvic floor so when
0.199 you do a fellowship in what we call
0.199 pelvic female pelvic medicine a lot of
0.199 what we do is related to the strength or
0.199 weakness of the pelvic floor and so the
0.199 pelvic floor just to start is a bowl of
0.199 muscles that sits in your pelvis so your
0.199 organs the bladder the rectum for women
0.199 the vagina the uterus the urethra all
0.199 run through the pelvic floor it attaches
0.199 to the bones on your pelvis and it is
0.199 extremely important for a variety of
0.199 functions it offers stability so when
0.199 you&;re standing sitting it offers
0.199 stability it offers the ability to
0.199 defecate and urinate normally it offers
0.199 uh when women have pregnancy the pelvic
0.199 Flor becomes very important it&;s
0.199 involved in orgasm it&;s involved in
0.199 sexual function but no one really talks
0.199 about it no one really knows it in fact
0.199 men will be shocked oh I have a pelvic
0.199 floor too because we talk about it a lot
0.199 with women right we talk about it in
0.199 terms of oh I might leak a little after
0.199 I&;ve had babies when I cough or sneeze
0.199 or jump on a trampoline but the pelvic
0.199 floor is much more complex than that and
0.199 so very often we&;ll see people when they
0.199 have weakness of the pelvic floor yeah
0.199 we&;ll see leakage of urine and but
0.199 sometimes their pelvic floor can be
0.199 discoordinated or it can be too tight or
0.199 or have elevated tone and so what that
0.199 means is that you can develop a whole
0.199 host of abnormalities and that can be
0.199 that you may have constipation you may
0.199 have issues emptying your bladder you
0.199 may feel like you have to go to the blad
0.199 go to the bathroom a lot so you may
0.199 urinate frequently you may feel the urge
0.199 to go often sometimes it can cause pain
0.199 so it can cause pain when you urinate
0.199 might feel like you&;re having a UTI it
0.199 may cause pain with erection or
0.199 ejaculation for men so there&;s a whole
0.199 host of issues that can come from having
0.199 pelvic floor abnormalities and even if
0.199 you&;ve had say lower back injuries or
0.199 hip injuries they can affect the
0.199 coordination of the pelvic floor because
0.199 it&;s all interconnected and so I will
0.199 see patients who are like you know I&;ve
0.199 had a bunch of hip issues because I
0.199 played Sports when I was younger and now
0.199 I&;m having issues with sexual function
0.199 and so it&;s all interconnected and I
0.199 think we we don&;t spend enough time
0.199 talking about how important it is and
0.199 how valuable it is to people when
0.199 they&;re having problems I want to go
0.199 into the pelvic floor in more detail and
0.199 really figure out how I can improve my
0.199 pelvic floor and what I&;m doing to harm
0.199 or hurt it but you said something there
0.199 about doctors don&;t ask about sexual
0.199 health they don&;t ask if for orgasming
0.199 they don&;t ask if for ejaculating those
0.199 kinds of things why should they be
0.199 asking about that because I think of a
0.199 doctor as I don&;t know fixing other
0.199 parts of my body I don&;t think of them
0.199 as sifting through my sexual life so if
0.199 you have a normal sexual life and you&;re
0.199 satisfied with it it won&;t even it
0.199 wouldn&;t even bother you right you
0.199 wouldn&;t think about it but people who
0.199 have difficulties they may be walking
0.199 around feeling shame they may be walking
0.199 around wondering what&;s wrong with them
0.199 this can be pervasive because they may
0.199 have relationship issues and they may
0.199 have problems in their life with their
0.199 relationship that they&;re then causing
0.199 them to be less productive at work less
0.199 happy less satisfied with life feeling
0.199 more depressed more anxious and so it
0.199 all comes together and in fact the other
0.199 really important thing at least for men
0.199 we know that when they develop issues
0.199 with a so say you&;re having erectile
0.199 dysfunction and you are diagnosed today
0.199 with erectile dysfunction 7 years later
0.199 about 15% of those men will have a heart
0.199 attack and the reason for that is
0.199 because if it&;s a blood flow issue the
0.199 arteries to the penis are about 1 to 2
0.199 millim the arteries to the heart are
0.199 about 3 to 4 millim and when you have
0.199 about a 50% occlusion of a blood vessel
0.199 because of high blood pressure high
0.199 cholesterol heart disease that organ
0.199 will start to have problems and so you
0.199 will start to see erectile dysfunction
0.199 in men who have vascular problems before
0.199 you start having chest pain or other
0.199 signs of heart disease so it&;s and
0.199 probably similarly in women although the
0.199 data is not as we don&;t have that data
0.199 for women that maybe if they all of a
0.199 sudden are developing problems with
0.199 arousal that maybe there that&;s an
0.199 indicator but again that&;s more complex
0.199 and we don&;t have the data for that but
0.199 certainly for men we have a clear
0.199 indication that a problem with erections
0.199 could precede really serious heart
0.199 consequences and when you look at people
0.199 who&;ve had a heart attack about 50% of
0.199 men will have had erectile dysfunction
0.199 prior to that 50%
0.199 mhm is a pelvic floor dysfunction in men
0.199 also linked to erectile dysfunction are
0.199 because I I heard in some of your work
0.199 that sitting every single day in in the
0.199 way that I do here I sit sometimes here
0.199 for 10 hours a day could be creating
0.199 erectile dysfunction well so it&;s more
0.199 that sitting every day can cause your
0.199 pelvic floor to not stretch
0.199 appropriately right like if you&;re not
0.199 moving your body regularly and your body
0.199 tenses up from sitting all day then your
0.199 pelvic floor is not relaxing and
0.199 Contracting in a normal fashion and so
0.199 some people will develop some tension in
0.199 the pelvic floor and through the pelvic
0.199 floor runs a whole bunch of arteries and
0.199 nerves that then go to the penis to
0.199 provide blood flow and so if your pelvic
0.199 floor is clenched really tight then it
0.199 can cause problems in getting blood flow
0.199 and then problems in getting erections
0.199 so while that&;s not um that&;s different
0.199 than having vascular problems this is a
0.199 muscular problem more so um that that
0.199 that can be an issue with in terms of
0.199 causing erectile dysfunction in some men
0.199 because I heard during Co there was a
0.199 rise in pelvic floor dysfunction as
0.199 people were sitting all day yeah I mean
0.199 I definitely saw it I don&;t know if it&;s
0.199 been actually studied but I definitely
0.199 saw it in my own clinical uh setting and
0.199 many of my colleagues did people would
0.199 come in and they would start having
0.199 either they&;d be having more erectile
0.199 dysfunction they might be having more
0.199 urinary urgency meaning they got to go
0.199 got to go to the bathroom or they&;re
0.199 going more often which wasn&;t a huge
0.199 issue because they the bathroom was
0.199 right near them but they did sometimes
0.199 notice that it was a change and and also
0.199 sometimes they would some people even
0.199 deal with pain like they would have more
0.199 pain in that area or women would think
0.199 they were having urinary tract
0.199 infections when they truly were just
0.199 having discomfort from the pelvic floor
0.199 being tense one of the that you&;re
0.199 particularly good at is taking on some
0.199 of the big myths as it relates to sexual
0.199 health and I I want to start with one of
0.199 the big myths around Sexual Health which
0.199 is this idea that we all think other
0.199 people and other couples are having
0.199 significantly more sex than we are yeah
0.199 so that&;s interesting I think that is a
0.199 big myth and so when you look at um
0.199 people want to know like what&;s normal
0.199 how much sex should I be having right
0.199 and there&;s no ideal number but when you
0.199 look at studies right which I&;ve looked
0.199 at large numbers of people people who
0.199 are in partnered relationships are
0.199 having sex about once a week on average
0.199 if they&;re have if they feel they&;re you
0.199 know in in partner relationships where
0.199 sex is always available but it&;s so
0.199 variable personto person and what I
0.199 really like to say is it&;s not the
0.199 quantity of sex that matters it&;s the
0.199 quality of sex right so if you&;re having
0.199 good sex once a month that may be
0.199 sufficient for you rather than having
0.199 mediocre or bad sex four times a month
0.199 or 10 times a month even right and and
0.199 so ultimately there&;s no right number
0.199 it&;s really what&;s right for you and I
0.199 think focusing on some like Benchmark
0.199 right of sex is is actually harmful
0.199 right because now you&;re like oh well I
0.199 need to have sex this many times what
0.199 what is the purpose of sex right the
0.199 purpose of sex is pleasure and sometimes
0.199 people derive a lot of benefits from
0.199 orgasm we know that there&;s physiologic
0.199 benefits to orgasm in terms of stress
0.199 reduction more Focus potentially better
0.199 sleep and even maybe lower blood
0.199 pressure things like that so if people
0.199 are deriving benefit from the orgasms
0.199 and the intimacy with their partner and
0.199 the pleasure they derive from sex that&;s
0.199 what matters right not the number of
0.199 times you&;re having sex another big myth
0.199 around sex which I thought i&; um get
0.199 your take on is about pain during sex
0.199 it&;s one of the sort of most uh popular
0.199 questions that I often guess get
0.199 whenever I speak to someone that is an
0.199 expert on sexual health
0.199 is is sex supposed to hurt because for a
0.199 lot of people it hurts no it&;s not
0.199 supposed to hurt so if it hurts you want
0.199 to assess you know what usually it&;s the
0.199 female partner who feels pain right so
0.199 is it that you&;re not lubricated enough
0.199 is it that you have not had enough
0.199 foreplay because the body prepares for
0.199 intercourse particularly in the female
0.199 so what happens is you go through
0.199 arousal your body self- lubricates and
0.199 the vagina actually lengthens and widens
0.199 all almost double in size to accommodate
0.199 the phus or whatever you&;re using
0.199 whether it&;s a toy or or or a finger or
0.199 anything and so if you don&;t have
0.199 sufficient time to allow those things to
0.199 happen then it will be painful and
0.199 sometimes lubrication can be variable
0.199 personto person so some people may have
0.199 copious amounts of lubrication and some
0.199 people may have less and it could be
0.199 based on genetics it could be based on
0.199 the age they are what stage of their
0.199 hormonal status it can be based on what
0.199 medic ation they&;re on that might
0.199 decrease lubrication I think there&;s
0.199 another big myth is that lubricant is
0.199 not for everybody and I I argue that
0.199 lubricant is for everybody that it makes
0.199 things more fun it makes things more
0.199 slippery it makes things more enjoyable
0.199 and it certainly makes pain less of an
0.199 issue for a lot of people now there can
0.199 be other issues that cause pain so if
0.199 you&;ve tried all these things you know
0.199 you&;re fully aroused you know you&;re
0.199 lubricated you know that you&;re still
0.199 having pain then it&;s really important
0.199 to get evaluated to to understand what
0.199 exactly is causing the pain it could be
0.199 hormonal changes in the vestibule which
0.199 is a part of the vagina that is very
0.199 hormonally sensitive that can be painful
0.199 it can be pelvic Flor dysfunction it can
0.199 be things like endometriosis or other
0.199 factors that may be going on that need
0.199 really Advanced help uh but most of the
0.199 time a lot of people can feel and enjoy
0.199 sex more readily if they just increase
0.199 the amount of foreplay and increase the
0.199 amount of lubrication you said that the
0.199 vagina
0.199 expands during sex so how much does it
0.199 expand by and how long does that take
0.199 because I think men don&;t really
0.199 understand this process a lot of men
0.199 just like to rush in there you know yeah
0.199 yeah so usually it expands by about
0.199 double double in length and double in
0.199 width and so it will expand and
0.199 basically the cervix is moving up and
0.199 out of the way the vagina is expanding
0.199 to accommodate the length of a phus and
0.199 and it takes we think on average about
0.199 18 to 20 minutes so it that&;s sort of
0.199 the amount of time it and some people
0.199 faster and some people longer but
0.199 ultimately you know sort of like
0.199 understanding that but also um the
0.199 lubrication is another big part of it
0.199 and so I think both those things
0.199 together um you know you need you need
0.199 some time and some people like I said
0.199 they may not take 18 minutes they may
0.199 take a couple minutes and so it&;s very
0.199 reasonable to get in there if that&;s
0.199 what your partner wants but again I
0.199 think the bigger issue is that we&;re not
0.199 communicating about sex no one taught us
0.199 how to talk about sex right I didn&;t
0.199 grow up talking about sex with my family
0.199 many of my friends and colleagues did
0.199 not grow up unless they were in a family
0.199 that was very Progressive talking about
0.199 sex or even learning about sex from
0.199 their parents and at school you don&;t
0.199 learn much you learn how to put on a
0.199 condom you learn how to ask for consent
0.199 you learn about STDs and that&;s if
0.199 you&;re lucky in the US 13 states don&;t
0.199 have to have accurate sex education like
0.199 it&;s not a requirement for sex education
0.199 to be accurate in 13 states in the US
0.199 where are we learning sex from so the
0.199 large majority of young people I mean
0.199 this data shows that at least one in
0.199 four adolescents are learning sex from
0.199 porn and it&;s probably more than that so
0.199 I think a lot of people are learning
0.199 either from uh pornography from their
0.199 friends a small subset are learning from
0.199 their parents there still are people
0.199 learning about sex from their parents
0.199 but ultimately it&;s not enough and so if
0.199 people are learning about sex through
0.199 porn porn is entertainment it is
0.199 doctored it is not real and I think
0.199 people then take that and they say why
0.199 did not my sexual encounter not look
0.199 like that why didn&;t I have as much
0.199 semen volume why did my partner not
0.199 orgasm as quickly and it can be on both
0.199 sides where women can be like why didn&;t
0.199 I react like that why didn&;t I get so
0.199 excited right away and I think there&;s
0.199 it&;s a real problem in terms of if
0.199 people are only learning about sex
0.199 through pornography then they&;re already
0.199 set up to be let down when they have
0.199 their first sexual encounter and on that
0.199 point of communication we don&;t talk
0.199 about it as a society but then even
0.199 within our own relationship
0.199 you know we don&;t talk about things
0.199 we&;re struggling with with our own
0.199 partners and the insecurities that we
0.199 have and I think that can cause a spiral
0.199 of misunderstanding and I&;ve seen that
0.199 in my own sex life historically where
0.199 maybe there was something I was insecure
0.199 about or there&;s something I was
0.199 thinking about and instead of
0.199 communicating it I might have just acted
0.199 in a strange way and then that&;s
0.199 misinterpreted and then the other person
0.199 gets a little bit insecure or whatever
0.199 and then you kind of have this downward
0.199 spiral of misunderstanding which leads
0.199 to like sexlessness absolutely you&;re
0.199 just avoiding the situ ation because
0.199 nobody wants to talk about it and this
0.199 is the problem like you know people ask
0.199 me like what&;s this what&;s the key
0.199 what&;s the key what&;s the secret the
0.199 secret is you have to know what you like
0.199 right you have to know what you want and
0.199 you have to communicate it with your
0.199 partner how so this is the issue it&;s
0.199 not easy it&;s not easy because no one
0.199 taught us how to have these
0.199 conversations and they&;re charged with a
0.199 lot of emotion right you feel insecure
0.199 you feel inadequate or you feel
0.199 resentful because you&;re not getting
0.199 what you want out of the relationship
0.199 and so it has to come from a place of
0.199 understanding that this conversation is
0.199 not a oneandone there&;s no the talk
0.199 there are multiple talks over multiple
0.199 periods of time and the first time you
0.199 have the talk it might be a total
0.199 disaster but you know if you were in a
0.199 relationship where someone really also
0.199 has the same goals as you of having a
0.199 great relationship with a good sex life
0.199 then ideally it that won&;t continue and
0.199 you will continue to have conversations
0.199 so what I tell people is don&;t have
0.199 conversations in the bedroom not right
0.199 before not right after sex you want to
0.199 wait until you&;re out of the bedroom not
0.199 during or during definitely not during
0.199 that&;s happened before [ __ ] was yeah
0.199 yeah that&;s pretty bad that&;s pretty bad
0.199 um so you know one and then two have it
0.199 in a place like somebody you don&;t to be
0.199 looking at the person right you can be
0.199 sitting in a car you can be going on a
0.199 walk because it&;s really awkward to look
0.199 at someone in the face and be like you
0.199 know what I felt like this wasn&;t really
0.199 great you know and and so then to be
0.199 like okay like you know talk again using
0.199 the same sort of communication
0.199 techniques that you use for other things
0.199 talking about eye statements not being
0.199 you did this you didn&;t do this more
0.199 about like how I feel what really turns
0.199 me on what I would really like in the
0.199 relationship and then sort of realizing
0.199 that they may not react well they might
0.199 be like oh my God I can&;t believe we&;re
0.199 talking about this they have their own
0.199 stereotypes and biases that they&;re
0.199 bringing into that conversation too or
0.199 their shame or whatever they grew up
0.199 with in society whatever they think
0.199 about sex can be very charged right and
0.199 so it&;s sort of a lot of work to get
0.199 through that but realizing that it could
0.199 take time and sometimes getting help so
0.199 seeing a sex therapist or someone who
0.199 has expertise in Psychology and sex to
0.199 talk learn how to talk about sex with
0.199 them and and navigating the difficulties
0.199 of it but it&;s worth the investment
0.199 right it&;s not easy but nothing in life
0.199 that&;s good or worth getting is easy
0.199 right okay so there&;s a couple listening
0.199 right now there&;s probably one member of
0.199 the couple listening right now and
0.199 they&;ve heard everything you&;ve said but
0.199 they have reached the point of noet
0.199 return in their relationship as far as
0.199 they&;re concerned they&;ve not been
0.199 having sort of a functional healthy sex
0.199 life for maybe one year maybe 6 months
0.199 maybe 5 years and it&;s just become The
0.199 New Normal MH what is the case you would
0.199 make to that person to get them to take
0.199 action to try and rectify the situation
0.199 well I would ask them first how
0.199 important is sex to them right if it&;s
0.199 not that important and the other things
0.199 in their relation and that&;s okay right
0.199 some people find that okay everything
0.199 else in the relationship is excellent I
0.199 love this person we&;re still in intimate
0.199 we still love each other we still cuddle
0.199 we still um have a lot of great things
0.199 in our relationship and and sex right
0.199 now is not working right or it&;s not
0.199 it&;s not working for us so um I&;m okay
0.199 with that that&;s fine like you don&;t
0.199 have to feel bad about that but I think
0.199 that if it is a problem then I think
0.199 it&;s worth working on right like if you
0.199 have a relationship that you value and
0.199 that person you&;re you&;re with values
0.199 their relationship then it&;s worth keep
0.199 trying like try to have conversation try
0.199 to bring them into the conversation how
0.199 much have you tried right like have you
0.199 really had enough attempts at a
0.199 conversation a true conversation where
0.199 you didn&;t get frustrated too right like
0.199 where you were like okay I understand
0.199 that you have this is a difficult
0.199 conversation that we&;re going to have
0.199 and I understand you might have feelings
0.199 about it but I love you and I really
0.199 want to try to have this conversation
0.199 and to keep at it and I realize that
0.199 that&;s not easy right that&;s not easy
0.199 I&;m not saying it is but I&;m saying that
0.199 when you&;re in a relationship that&;s
0.199 worth having that ideally at some point
0.199 the other partner will see how much this
0.199 matters to you and want to work with you
0.199 on it right if they love you if they&;re
0.199 with you there they want what&;s best for
0.199 your relationship they&;re not like
0.199 hiding they&;re not hiding their head in
0.199 the sand and being like Oh I&;m like
0.199 they&;re they realize they&;re just don&;t
0.199 want to talk about it they they they&;re
0.199 not stupid they just sort of don&;t want
0.199 to talk about it because it&;s
0.199 embarrassing to them they feel like
0.199 they&;re the one that has something wrong
0.199 with them maybe or maybe they have an
0.199 issue that they haven&;t brought up maybe
0.199 they&;re having a lot of pain with sex or
0.199 maybe they&;re going through hormonal
0.199 changes and their tissues are really dry
0.199 or whatever there there&;s a whole host
0.199 of things that could be going on that
0.199 they don&;t feel comfortable talking to
0.199 you about so I think it&;s it&;s valuable
0.199 to say is there something I&;m not doing
0.199 like tell me what you feel about sex
0.199 like leaving it open-ended to really
0.199 find out what&;s going on with them
0.199 because usually not that they&;re like I
0.199 just don&;t want to have sex and that&;s
0.199 it there&;s usually a lot more to it it&;s
0.199 so hard for us to know isn&;t it when it
0.199 comes to sex what the root cause of the
0.199 issues are and I think some Rel ships
0.199 are like a frog in a frying pan the frog
0.199 in the frying pan analogy for anybody
0.199 that doesn&;t know is this old tale about
0.199 a frog jumping into a frying pan and
0.199 then because the water heat up gradually
0.199 it ends up dying but if the water was
0.199 hot from the moment it Dr jumped in it
0.199 would have jumped straight out the idea
0.199 that it&;s a gradual death for the Frog
0.199 and in relationships it&;s kind of a slow
0.199 day by day month by month decline in
0.199 intimacy and you end up finding yourself
0.199 like a dead frog in a frying pan you end
0.199 up finding yourself in a sexless
0.199 relationship and you think how the hell
0.199 did we get here mhm um and it&;s and it&;s
0.199 it feels like a long way back from that
0.199 point it is it&;s going to be right
0.199 because you let it sort of dwindle and
0.199 you didn&;t talk about it and it&;s going
0.199 to take work and I think that&;s the key
0.199 is like if you want to fight for that in
0.199 your relationship it&;s going to take
0.199 work and it&;s going to take um buy in on
0.199 both sides right you have to work for
0.199 anything in your relationship
0.199 relationships are not easy right you
0.199 want to have children that takes work
0.199 you want to um decide toy a house
0.199 together that takes work deciding and
0.199 figuring out the what kind of house you
0.199 want how much money you want to spend
0.199 like there&;s all sorts of things that
0.199 take work and this is one that people
0.199 just don&;t know how to talk about and so
0.199 they just ignore it because it&;s harder
0.199 to bring up for both parties right what
0.199 the one who maybe is not wanting sex or
0.199 is being the one who says no to and the
0.199 one who always wants sex and then feels
0.199 rejected because they&;re not getting it
0.199 is there a a sort of a difference
0.199 between men and women&;s sexual desire as
0.199 we age you know cuz I think there&;s a
0.199 myth that says men just always want to
0.199 have sex and women maybe not so much is
0.199 that a real myth um in terms of
0.199 something that you hear but also is it
0.199 true so let&;s talk about desire desire
0.199 comes in two flavors so there&;s the
0.199 spontaneous desire where you see
0.199 somebody you like oh man they&;re so
0.199 attractive I can&;t wait to sleep with
0.199 them I&;m immediately turned on I want to
0.199 have sex right now right you didn&;t have
0.199 to do anything you just saw them and it
0.199 happened and then there&;s responsive
0.199 desire where you&;re sort of with them
0.199 you might be touching them you might not
0.199 really be thinking about sex but like
0.199 you&;re touching them you&;re with them
0.199 you&;re like oh this feels sort of nice I
0.199 sort of like this like oh now I&;m turned
0.199 on after we&;ve sort of started being a
0.199 little romantic with each other being a
0.199 little more intimate with each other and
0.199 both desires are normal and both desires
0.199 are fine to have now in the literature
0.199 you&;ll find that men tend to more often
0.199 have spontaneous desire and women tend
0.199 to more often have responsive desire
0.199 particularly when you&;re in longer term
0.199 relationships so there&;s this disconnect
0.199 right women are like why don&;t I see you
0.199 and want to jump you anymore right I
0.199 used to feel like this but I don&;t
0.199 anymore what&;s wrong with me am I broken
0.199 right and then they don&;t realize that
0.199 okay maybe we&;ll just like be together
0.199 and let&;s see what happens and they
0.199 don&;t even want to start because they&;re
0.199 worried that what if I don&;t want to
0.199 have sex and we&;ve now initiated this
0.199 like touching cuddling thing where oh
0.199 that person&;s getting really turned on
0.199 what if I don&;t get turned on and what
0.199 if I just appoint them and so there&;s a
0.199 lot of charged emotions there but
0.199 realizing that this is normal and common
0.199 and responsive desire is not wrong it&;s
0.199 just different and people just don&;t
0.199 know that it exists because again media
0.199 attention is like you see someone who
0.199 jump them you&;re you&;re horny right away
0.199 you have sex and that&;s not what happens
0.199 all the time and that&;s okay and so like
0.199 you know you can be with your partner
0.199 like look I have no expectations from
0.199 you I just want to be with you
0.199 physically and see if it turns into sex
0.199 so often we&;ll give people homework like
0.199 put it on the calendar put it on the
0.199 calendar that you are going to be
0.199 intimate together at this time and I
0.199 know that sounds weird right like you&;re
0.199 looking at me like I&;m crazy but we put
0.199 on the calendar when we want to work out
0.199 we put on the calendar when we want to
0.199 have brunch with our friends we put on
0.199 the calendar when whatever right and
0.199 when we were younger when we used to
0.199 have dates with people we would say okay
0.199 we&;re going to go on a date on Friday
0.199 night we would know that sex is on the
0.199 table with our partner on Friday night
0.199 so we&;d get really excited about it we
0.199 like okay I&;m going to shave I&;m going
0.199 to look real pretty I&;m going to smell
0.199 good I&;m going to do all the things that
0.199 make me desirable and feel confident and
0.199 be ready to have sex right and so you&;d
0.199 be like really excited about and then
0.199 you would have all this anticipation
0.199 about how fun it&;s going to be but the
0.199 anticipation can can wreak havoc content
0.199 it can it can so the opposite is true
0.199 but that&;s because if you expect that&;s
0.199 why I say intimacy and not sex so if you
0.199 say you&;re going to have sex it can be
0.199 like oh my God what if I don&;t perform
0.199 what if I don&;t do right what if I don&;t
0.199 want sex what if it hurts right so you
0.199 can also have that sort of rumination
0.199 and spiral but if you&;re like look all
0.199 we&;re going to do is be together and be
0.199 intimate we&;re not going to just go have
0.199 dinner and talk we&;re going to like
0.199 literally be together not have our
0.199 phones with us maybe like touch each
0.199 other maybe get undressed maybe just you
0.199 know feel what it feels like and that&;s
0.199 it there&;s no expectation of sex from
0.199 either side we&;re going to go in knowing
0.199 that and then slowly work our way
0.199 towards like okay you know what like
0.199 maybe sex will happen and maybe it won&;t
0.199 and over time as you keep putting it on
0.199 the calendar prioritizing your intimate
0.199 y with your partner then eventually
0.199 you&;ll get to a point where oh you
0.199 remember you recall that connection you
0.199 used to have and then you can actually
0.199 find that Joy again of connecting
0.199 sexually that&;s the sort of the aspect
0.199 of desire which is I guess is a bit more
0.199 psychological but it there&;s also sort
0.199 of a physiological element to desire as
0.199 it relates to hormones levels so if
0.199 someone&;s got a low libido is that a
0.199 hormone dysfunction it can be so
0.199 testosterone is the most notorious
0.199 hormone for desire right in both men and
0.199 women and I think this is a big
0.199 misconception is that we don&;t talk
0.199 about testosterone in women but
0.199 testosterone in women is more
0.199 predominant than actually estrogen we
0.199 have more testosterone in our bodies
0.199 than we do estrogen and testosterone is
0.199 very important for desire in both men
0.199 and women but anything that is interacts
0.199 with testosterone is also important so
0.199 thyroid hormone can can cause issues
0.199 with testosterone prolactin which is
0.199 another hormone made by the brain can
0.199 also interact with testosterone so
0.199 essentially evaluating those things and
0.199 making sure that your levels are normal
0.199 or appropriate for your age can be
0.199 helpful that&;s probably the number one
0.199 thing but the other thing outside of
0.199 physiology is that stress even though
0.199 stress is um sort of an abstract thing
0.199 stress affects our physiology right so
0.199 when you have a lot of stress in life
0.199 whether it be work relationship stress
0.199 kids stress whatever it is right it
0.199 raises your cortisol level and when your
0.199 cortisol level is high you can&;t produce
0.199 testosterone it goes down
0.199 and so if you&;re chronically stressed
0.199 which many of us are right you spend
0.199 like in today&;s modern society chronic
0.199 stress is like a real problem then that
0.199 is going to really impact your libido so
0.199 yeah your hormones may suffer because of
0.199 it but if you don&;t fix the stress like
0.199 you&;re not going to fix the root cause
0.199 of the problem can I just inject myself
0.199 with loads of testosterone though to get
0.199 my libido back it won&;t work for
0.199 everybody so if it&;s not truly a low
0.199 testosterone meaning you have normal of
0.199 testosterone likely your testosterone
0.199 receptors are completely saturated more
0.199 testosterone is not going to fix the
0.199 problem so it depends on your individual
0.199 level of hormones but at some point more
0.199 is not better in fact more can be
0.199 dangerous and so it&;s really dependent
0.199 on your individual level so giving
0.199 yourself like if I give a guy who has
0.199 completely normal testosterone levels
0.199 both free and total testosterone all
0.199 completely normal and I give him
0.199 testosterone probably nothing&;s going to
0.199 change because his testosterone
0.199 receptors are already fully saturated
0.199 with testosterone so more is not going
0.199 to do anything what are the other ways
0.199 that I can increase my testosterone if I
0.199 go and get tested and it says that I
0.199 have low testosterone levels and I don&;t
0.199 want to just inject myself with
0.199 testosterone Are there natural ways that
0.199 I can increase it absolutely so number
0.199 one is sleep so sleep is really really
0.199 important for testosterone we know that
0.199 when you reduce the amount of sleep you
0.199 have so for example you sleep less than
0.199 six five or 6 hours you&;re going to have
0.199 at least 10 to 15% reduction in
0.199 testosterone and so because our body
0.199 follows a Circ Rhythm and so when your
0.199 testosterone&;s highest is in the morning
0.199 and it starts to decline over the course
0.199 of the day there&;s a little bit of a
0.199 bump again and then it goes back down at
0.199 night time it&;s low and your body when
0.199 it&;s sleeping replenishes that
0.199 testosterone and so if you&;re getting
0.199 either less number of hours of sleep or
0.199 poor quality sleep meaning you&;re you
0.199 know you&;re not feeling very rusted when
0.199 you wake up that&;s a sign of poor
0.199 quality sleep both of those things can
0.199 dramatically affect your testosterone
0.199 the other thing that you can do is
0.199 exercise and specifically resistance
0.199 exercise so doing High the the largest
0.199 muscle group so usually the lower
0.199 extremities and using those have been
0.199 shown to boost testosterone more
0.199 significantly than any other type of
0.199 exercise in fact when you do
0.199 cardiovascular high-intensity
0.199 cardiovascular endurance training so say
0.199 you&;re doing Ultram man marathons all
0.199 the time long long bike rides long
0.199 swimming uh you know swimming for a long
0.199 periods of time that can actually
0.199 increase your cortisol your stress
0.199 because your body is having a stress
0.199 response and that can actually reduce
0.199 your testosterone so it&;s important to
0.199 do cardiovascular exercise aerobic
0.199 exercise but in moderation uh because we
0.199 do see some people who are great
0.199 athletes who you know run you know run
0.199 miles and miles and miles but their
0.199 testosterone is low because they&;ve been
0.199 doing this chronic long duration
0.199 endurance exercise so sort of hit
0.199 training is fine but it&;s when you start
0.199 doing these big Iron Man thousand M run
0.199 things that the cortisol sues that&;s not
0.199 that&;s not a large percentage of people
0.199 right but it&;s certainly you know it&;s
0.199 like I&;m so healthy I&;m the healthiest I
0.199 could ever be and I&;m having low
0.199 testosterone why is that and what about
0.199 food and testosterone so food you know
0.199 there is a lot of uh data on food the
0.199 one but the most data is on the
0.199 Mediterranean diet and that&;s because
0.199 that&;s the most well studied in medicine
0.199 but essentially having vegetables fruit
0.199 low um low amounts of processed foods
0.199 good healthy fats nuts and seeds so a
0.199 lot of people don&;t realize but you need
0.199 good fat to have testosterone
0.199 testosterone is a pre is a production is
0.199 in the cholesterol Pathways and so it
0.199 comes from those Pathways and so you
0.199 need to have some level of fat if you
0.199 have too low fat of a diet that&;ll also
0.199 affect your affect your testosterone so
0.199 ideally what I tell people is while
0.199 there&;s lots of data on different types
0.199 of diets the important thing to know is
0.199 you want to avoid processed foods avoid
0.199 avoid a lot of sugar and have good
0.199 healthy fats in your diet what about you
0.199 know I&;ve heard a few times that
0.199 testosterone levels have been declining
0.199 over the last couple of decades in men
0.199 MH is this true yes it is true so we&;re
0.199 not only seeing a decline in
0.199 testosterone levels but we&;re seeing a
0.199 decline in sperm quality and uh sperm
0.199 numbers so the concentration of sperm
0.199 and over the course of the last 50 years
0.199 and there&;s a lot of reasons for that
0.199 one is that you know Society has become
0.199 more sedentary we&;re seeing people less
0.199 acve getting more and more metabolic
0.199 conditions like diabetes high blood
0.199 pressure these conditions then cause
0.199 endocrinologic abnormalities they cause
0.199 problems with blood flow and all these
0.199 things can affect the quality of your
0.199 sperm as well as the quality of your
0.199 testosterone production and then also
0.199 there&;s more we think in the
0.199 environments we know there&;s more uh
0.199 microplastics and more endocrine
0.199 disrupting chemicals right in the
0.199 environment so that is probably a role
0.199 now we don&;t have like exact qu like
0.199 exact quantitative data on that but we
0.199 think that is probably playing a role
0.199 and reducing the exposure to these
0.199 endocrine disrupting chemicals so we
0.199 tell people try not to drink out of
0.199 plastic water bottles try to warm up
0.199 food and glass and avoid plastic I mean
0.199 these are easy things you can do but if
0.199 you want to stress about the amount of
0.199 Plastics in the environment like there&;s
0.199 not much you can do as on an individual
0.199 level so I tell people do the things you
0.199 can control and the other things sort of
0.199 you know we have to work on as a society
0.199 that&;s really interesting cuz I I don&;t
0.199 think I think about this much but
0.199 removing chemicals from my life in terms
0.199 of
0.199 what these kinds of things that I&;m
0.199 holding the metal mug in front of me and
0.199 then the plastic bottles I drink from
0.199 could be having an impact on my
0.199 testosterone and my sperm count it could
0.199 I mean like it&;s not everybody right
0.199 think about how many people drink from
0.199 plastic water bottles but if you can
0.199 decrease your exposure right it&;s
0.199 probably additive so the more exposure
0.199 you have the more likely it is to imp
0.199 impact your body how do they know this
0.199 like how does anybody know that
0.199 chemicals are having an impact on our
0.199 sperm and testosterone so there&;s you
0.199 know there&;s basic science research
0.199 where they&;re looking at the impact of
0.199 these things on on rats and other
0.199 animals and then also they&;re looking on
0.199 the amount of exposure uh to things like
0.199 phalates and labs and seeing how that
0.199 you know we can&;t it&;s all cause it&;s
0.199 all correlation we can&;t say it&;s
0.199 causitive because we don&;t we&;re not
0.199 going to do a randomiz study where you
0.199 drink from water bottles for 10 years
0.199 and you drink from glass water bottles
0.199 for 10 years and let&;s see what happens
0.199 right that hasn&;t been done but they can
0.199 say okay the more your exposure based on
0.199 whatever biomarker we can assess so
0.199 maybe urinary phalates or other things
0.199 we can say that okay these people who
0.199 have more exposure to this are more
0.199 likely based on the data to have lower
0.199 levels of testosterone and then you know
0.199 looking at the mechanisms of how they
0.199 interact with the production of
0.199 testosterone and I&;m not an expert in
0.199 those areas but certainly there has been
0.199 sort of plot ible mechanisms of how
0.199 these things work how has sperm count
0.199 been decreasing over the years so if you
0.199 look at the last 50 years you&;ll see
0.199 that the average sperm count has
0.199 declined almost
0.199 50% and luckily the average sperm count
0.199 is still high enough for fertility rates
0.199 the average sperm count is probably
0.199 around 50 million of of fathers people
0.199 who father children and so it&;s still
0.199 above that but it&;s certainly
0.199 significantly lower than it was 50 years
0.199 ago and so that&;s where we&;re thinking
0.199 you know it&;s it&;s probably more of a
0.199 Global Environmental Factor that&;s
0.199 contributing to that in addition to this
0.199 increase in comorbidities and poor
0.199 health over time I mean the direction of
0.199 travel there is deeply concerning
0.199 because if something declines 50% in the
0.199 last what 50 years did you say then if
0.199 we go forward another 50 years and we
0.199 assume the same rate of decline that
0.199 means we&;ll be at 25% of where we were
0.199 100 years ago yeah and then what if you
0.199 can&;t father children anymore and what
0.199 if you can&;t have offspring that will
0.199 then propagate the species right so
0.199 there&;s there&;s certainly concerns there
0.199 and I think you know we have to as a
0.199 society do better in terms of the things
0.199 that we can so we can control diet we
0.199 can control exercise we can control
0.199 those things there&;s certain things that
0.199 we can&;t but we can try to control what
0.199 our people are exposed to and that can
0.199 be on a governmental level right like
0.199 having sort of laws in place so we know
0.199 in the US there&;s less restrictions
0.199 whereas in other countries there&;s more
0.199 restrictions on things like food
0.199 coloring and dyes that may have again I
0.199 don&;t I don&;t know the specifics but
0.199 certain you know there&;s certainly more
0.199 restrictions in other countries than in
0.199 the US for some reason and so maybe
0.199 there needs to be a more critical
0.199 evaluation of where we can actually put
0.199 in place some things that would actually
0.199 have more wide widespread changes when
0.199 we think about sperm count we often
0.199 think about fertility um and you know I
0.199 don&;t know whether this is just because
0.199 Society has changed and we&;re trying to
0.199 have kids later but it does seem that
0.199 people are struggling more and more with
0.199 fertility I mean even in my own sort of
0.199 Circle of Friends um there&;s you know
0.199 there&;s a couple people that have
0.199 reported to be struggling with fertility
0.199 or that you know they&;re spending 12
0.199 months or 24 months trying to have
0.199 children do you think this is linked to
0.199 this as well it could be I mean when we
0.199 know when we look at fertility we know
0.199 that about half of fertility is due to
0.199 women half fertility is due to men and
0.199 then some combination of the two right
0.199 so um definitely as women age fertility
0.199 goes down and we know women are waiting
0.199 longer to have children so that&;s a big
0.199 part of it that Society has changed
0.199 women are working and and prioritizing
0.199 their careers not a bad thing but it
0.199 certainly will affect fertility and and
0.199 then yeah there may be these issues that
0.199 are affecting male sperm counts that are
0.199 also causing issues but I don&;t know
0.199 that there&;s been updated data in terms
0.199 of what are the causes or the numbers in
0.199 terms of fertility rates fertility aside
0.199 is there any correlation between our
0.199 health outcomes and our sperm volume not
0.199 volume but concentration
0.199 uh so volume is the amount of of of
0.199 right so concentration of sperm in the
0.199 semen is more of a predictor in terms of
0.199 um sperm volume not seamen volume let&;s
0.199 be clear so sperm volume sperm
0.199 concentration are sort of the the
0.199 biomarkers and we would say that yes
0.199 there is a correlation with overall
0.199 health in terms of uh sperm
0.199 concentration and sperm volume uh but I
0.199 think I don&;t want to make people
0.199 worried that if they truly have a male
0.199 fat Factor infertility then now their
0.199 overall health is uh is a problem but
0.199 it&;s certainly important to be evaluated
0.199 and seen by your doctor regularly and on
0.199 that point of um seamen volume is there
0.199 a way to increase that and is it similar
0.199 to what you said about increasing
0.199 testosterone or is there another set of
0.199 sort of um practices we can do to
0.199 increase our seamen volume yeah so
0.199 seamen volume is variable depending on
0.199 the biggest one is how long has it been
0.199 since you last ejaculated right so the
0.199 longer you delay between one ejaculation
0.199 to the other the more seamen volume you
0.199 will get that&;s probably the most
0.199 predictive you know hydration can play a
0.199 role if you hydrate more certainly you
0.199 may see more seam in volume um sometimes
0.199 it&;s a it&;s a low seam in volume because
0.199 you&;re actually having less force of
0.199 ejaculation so interestingly when you&;re
0.199 young the force of ejaculate can be
0.199 really really strong it can be up to 30
0.199 to 60 cm away like when you ejac that&;s
0.199 how forceful it can be as you age after
0.199 about 50 it can decline to 15 to 30 cm
0.199 away and so that can feel like you&;re
0.199 having less volume because it&;s less
0.199 forceful and so in those cases that&;s
0.199 because of the pelvic floor muscles that
0.199 are around the urethra those muscles
0.199 there that help sort of propel the
0.199 ejaculate out and so you can strengthen
0.199 those muscles with again pelvic floor
0.199 exercises like keigle exercises I
0.199 caution people because people always
0.199 like oh they&;re going at these Keele
0.199 exercis are great they&;re going to
0.199 increase orgasm they&;re going to make my
0.199 semen Propel further and I think that&;s
0.199 fine if you&;re not having pain you&;re
0.199 not having discomfort and you&;re doing
0.199 them correctly because sometimes what we
0.199 see is it can actually cause harm if
0.199 your pelvic floor is tense like we
0.199 talked about earlier or it can cause
0.199 pain and dysfunction if you&;re tensing
0.199 tensing tensing and not relaxing and so
0.199 if you don&;t know how to do them
0.199 correctly then you could actually harm
0.199 yourself um but yes they can improve
0.199 seam and volume by the parameter of
0.199 increasing the force of a jackulate and
0.199 getting more ecate out that may be left
0.199 over if you&;re not having as forceful of
0.199 a muscular contraction does
0.199 masturbating improve my pelvic floor
0.199 does it strengthen my pelvic floor so
0.199 that&;s a good question the orgasm is
0.199 what improves your pelvic floor so if
0.199 you masturbate in your orgasm when you
0.199 orgasm your pelvic floor contracts
0.199 involuntarily you can&;t do anything
0.199 about it at a rate of about every 08
0.199 seconds so it does contract and that is
0.199 sort of like a pelvic floor muscle
0.199 exercise but it&;s doing it involuntarily
0.199 it&;s Contracting for anywhere from 5 to
0.199 60 seconds usually on average and so you
0.199 are sort of in that way increasing
0.199 pelvic floor strength in fact they&;ve
0.199 looked at um in women particularly is
0.199 orgasming as good as doing pelvic floor
0.199 exercises and they&;ve seen that you know
0.199 you can see pretty measurable
0.199 Improvement in pelvic floor strength if
0.199 you orgasm regularly um is it and it may
0.199 be you know as good as doing ke gos
0.199 depending on how often you&;re doing it
0.199 so yes orgasm itself can be very
0.199 beneficial for pelvic floor strength one
0.199 of the big sort of myths that I&;ve
0.199 always ways I&;m yet to answer is the
0.199 impact that our technology is having on
0.199 our genitals you know there&;s kind of
0.199 like a pervasive myth that if you put
0.199 your phone next to your testicles your
0.199 sperm Count&;s going to drop like
0.199 whenever I&;m in the car um and I don&;t
0.199 know I&;m I&;m sat there or I&;m sat at
0.199 home somewhere and I get my phone and I
0.199 put it near my genitals my girlfriend
0.199 has a go at me and she she like pulls it
0.199 out or tells me to pull it out because I
0.199 think she&;s worried that we&;re not going
0.199 to have kids if it&;s down there yeah
0.199 yeah so there is there is a little bit
0.199 of data there in terms of you know when
0.199 you have these devices like in your lap
0.199 or near your genitals they will increase
0.199 the temperature and so when you the the
0.199 the testicles are in the scrotum for a
0.199 reason right it&;s because they need this
0.199 very perfect environment with this
0.199 specific temperature to create sperm and
0.199 anything that disrupts that temperature
0.199 can cause diff cause abnormalities in
0.199 sperm production so for example when you
0.199 have a fever because you have the flu or
0.199 you have a cold
0.199 people will get their sperm checked
0.199 their seman analysis and they will see
0.199 that their sperm count is zero because
0.199 the temperature the fever has
0.199 temporarily stopped their sperm
0.199 production and so you can see that you
0.199 know people also discuss like oh what
0.199 about boxers or briefs what about
0.199 putting and so all of these things can
0.199 increase the temperature around the
0.199 scrotum which can then cause changes in
0.199 sperm production so I tell patients
0.199 particularly if you&;re trying to have
0.199 babies is put your phone in your back
0.199 pocket in your chest pocket don&;t put
0.199 your computer or your laptop right on
0.199 your lap right I mean it&;s easy enough
0.199 to do and it does increase temperature
0.199 so absolutely yes these things can not
0.199 for everybody right there&;s people so we
0.199 say people like you shouldn&;t smoke a
0.199 lot of marijuana when you&;re trying to
0.199 get pregnant because marijuana can cause
0.199 problems with sperm production but
0.199 you&;ll see people who smoke every day
0.199 and they still have babies or you&;ll see
0.199 people who do all of these things right
0.199 they they wear briefs they they put
0.199 their phone on their in their pocket
0.199 they put their laptop on their lap and
0.199 they still have babies so it&;s not a all
0.199 allomer but certainly things that you
0.199 can easily just avoid putting near your
0.199 genitals well if I&;m in the sauna every
0.199 day or if I&;m in a a steam room every
0.199 day isn&;t that going to have an impact
0.199 on my sperm count yeah it does and it&;s
0.199 interesting because there&;s I think
0.199 we&;ll see more of this as we&;re seeing
0.199 the rise of I there&;s benefits to saunas
0.199 no doubt but as we&;re seeing the rise of
0.199 people really doing saunas all the time
0.199 um there can be so we tell people when
0.199 they&;re trying to have if they&;re having
0.199 fertility issues don&;t in hot tubs don&;t
0.199 go in saunas because it could affect
0.199 your sperm production so those are sort
0.199 of the the conservative things we tell
0.199 people to do interesting and this this
0.199 point about the phone next to genitals
0.199 it&;s not because of like the Wi-Fi and
0.199 the Bluetooth are going to like zap my
0.199 babies no I mean there&;s some there&;s
0.199 some question about that but we don&;t
0.199 know I don&;t think we know but we know
0.199 there&;s a temperature increase right
0.199 because phones get hot we talked about
0.199 masturbation briefly um one of the big
0.199 questions that people often ask me when
0.199 I&;m speaking to someone that has
0.199 expertise on sexual health is is about
0.199 masturbation and whether it decreases
0.199 your testosterone levels so it does not
0.199 there is one study and it was done in 10
0.199 men who abstained from masturbating for
0.199 21 days and these are young healthy men
0.199 right and so this is where I think
0.199 everyone gets their data from is this
0.199 one study and so they took their
0.199 testosterone before they took their
0.199 testosterone after and and what they
0.199 found was that there was an increase by
0.199 about 50 50 nanog per deil 0.5 um was
0.199 which is 50 nanograms per D which is not
0.199 a huge amount um at 21 days but we know
0.199 that testosterone changes all the time
0.199 and two there&;s a lot of anticipatory
0.199 cues when you&;ve been waiting to
0.199 masturbate for 21 days like your brain
0.199 is is really excited there&;s all these
0.199 like okay I&;m finally going to get to
0.199 release and that in of itself can
0.199 increase testosterone So gener speaking
0.199 there&;s no empiric evidence that is
0.199 convincing high quality level evidence
0.199 that masturbating or abstaining from
0.199 masturbation will increased testosterone
0.199 and so there you know people do report
0.199 other benefits and so I tell people if
0.199 you&;re getting other benefits from
0.199 abstaining by all means go ahead but
0.199 don&;t do it for don&;t like White Knuckle
0.199 it to gain some theoretical increase in
0.199 testesterone that one was not even that
0.199 large and two is probably not going to
0.199 be proven in a larger sample what about
0.199 the opposite then is too much
0.199 masturbation going to have an adverse
0.199 effect on us for men and women yeah so I
0.199 think it you know what I tell people is
0.199 masturbation is generally safe as long
0.199 as you are not masturbating to the point
0.199 where you are now choosing to masturbate
0.199 over doing anything else so you&;re
0.199 choosing to masturbate rather than have
0.199 sex with your partner you&;re choosing to
0.199 masturbate over going to work or you&;re
0.199 I&;m going to be a little late to work
0.199 because I want to finish masturbating or
0.199 you literally can&;t sleep without
0.199 masturbating every day like those sort
0.199 you become reliant on this particular
0.199 activity for the enjoyment that it
0.199 provides um that&;s when it becomes a
0.199 problem but if you&;re using it in terms
0.199 of like masturbating to get orgasm and
0.199 the benefits of orgasm that I do achieve
0.199 from that because maybe my partner
0.199 doesn&;t want to have sex or maybe I have
0.199 more of a sex drive than my partner or I
0.199 don&;t have a partner like let&;s be
0.199 realistic like if you don&;t have a
0.199 partner you&;re going to have to if you
0.199 want to orgasm you&;re probably going to
0.199 have to masturbate and so I think the
0.199 problem also comes in is when people
0.199 only masturbate the same way every time
0.199 they only watch a certain type of erotic
0.199 film or they do the same thing every
0.199 time and their body habituates to that
0.199 and then they have difficult time
0.199 climaxing with a partner because they
0.199 can&;t replicate what they&;re doing
0.199 whether what they&;re watching or how
0.199 they&;re doing it with a partner are we
0.199 teaching ourselves something there are
0.199 we teaching ourselves how we&;re aroused
0.199 and how we orgasm yeah your brain is
0.199 very powerful right so when you&;re doing
0.199 the same thing every time your body is
0.199 like oh this is what turns me on this is
0.199 what makes me orgasm and then when
0.199 you&;re their partner you&;re like oh I&;m
0.199 not getting that same kind of
0.199 stimulation and so it doesn&;t happen to
0.199 a lot of people but I would say
0.199 certainly I see people where this does
0.199 happen and so um you know you have to
0.199 sort of take a break and and sort of
0.199 re-evaluate and try different things and
0.199 get your body to habituate to different
0.199 things which takes a little bit of work
0.199 um but sort of keeping it varied can be
0.199 helpful another big myth masturbation
0.199 will make me go blind yeah no there&;s
0.199 literally I don&;t know where that came
0.199 from there&;s like hariry Pals blindness
0.199 like I don&;t know where I I think this
0.199 is all sort of like from religious
0.199 rhetoric that says you know you should
0.199 not masturbate um and and it you know
0.199 where that came from you know as a whole
0.199 other story I think what do you think of
0.199 this idea of no nut
0.199 November yeah so I think it&;s I&;m not a
0.199 fan the reason being is because I think
0.199 it makes people feel like it&;s something
0.199 they have to do and if you want to like
0.199 I said if you find benefit from
0.199 abstaining from ejaculating for 30 days
0.199 or 28 days or whatever it is um then by
0.199 all means like go ahead if you want to
0.199 try something there&;s no harm in it but
0.199 I think a lot of people what they do is
0.199 they feel like it&;s something that&;s
0.199 going to bring them to some higher level
0.199 and they&;re going to become this great
0.199 person because they&;re able to to to
0.199 conquer this goal but they&;re like
0.199 literally miserable so they&;re um
0.199 they&;re clenching their pelvic floor all
0.199 the time because they&;re stressed about
0.199 how they&;re not ejaculating they may
0.199 ejaculate at night and so they&;ll have a
0.199 nocturnal emission and then they&;ll feel
0.199 so bad because theyve failed it&;s
0.199 nothing you can control nocturnal
0.199 emissions are physiologic they&;re
0.199 totally normal and 86% of men have had a
0.199 wet dream at some point in their
0.199 lifetime like it&;s very very common and
0.199 and more likely the longer you are from
0.199 ejaculating so um your body will take
0.199 care of the ejaculate if you ejaculate
0.199 or not so you will either resorb the
0.199 semen or you&;ll ejacate at night and so
0.199 if you want to do it because you feel
0.199 like okay I have a challenge I want to
0.199 conquer it I want to see if I can do
0.199 this and you feel better because you&;re
0.199 not you&;re able to like not focus on
0.199 sexual thoughts or you&;re able to really
0.199 um find some other level of spirituality
0.199 or something by all means go ahead I
0.199 don&;t have a problem with it what I have
0.199 a problem with is making people feel bad
0.199 because they can&;t do it or they don&;t
0.199 want to do it and with people feeling
0.199 forced or feeling like they need to do
0.199 it to prove something to someone else
0.199 yeah because I mean the way that I&;ve
0.199 had it explained to me is that it&;s some
0.199 something about seman retention gives
0.199 you some clarity of mind or something
0.199 because a lot of athletes before they
0.199 have their their big fights or you know
0.199 their bigger sort of Olympic
0.199 competitions they&;ll abstain from
0.199 masturbation I often hear in the UFC for
0.199 example the um the mixed martial arts
0.199 fighting championship that athletes have
0.199 not had sex or not ejaculated for two
0.199 weeks before a fight or four weeks
0.199 before a fight yeah so there&;s a lot of
0.199 rhetoric there I think that comes from
0.199 um historical so even in Greek in Greek
0.199 times they would tell people to avoid
0.199 having sex or masturbating prior to you
0.199 know big fights or or just whatever
0.199 sport they were playing and so is it
0.199 true in data so if you look at the
0.199 studies that have looked at people
0.199 performing athletic Feats whether it&;s
0.199 like cycling or running or whatever ever
0.199 um they have not found that abstaining
0.199 from ejaculation actually changes their
0.199 ability to perform and so in those cases
0.199 I say well there&;s no true scientific
0.199 evidence that we have that it&;s going to
0.199 improve and in fact if you are someone
0.199 who for example has sex every morning or
0.199 masturbates every morning for whatever
0.199 reason that&;s a part of your routine
0.199 disrupting the routine can actually be
0.199 harmful to Performance and sometimes the
0.199 the one thing you can say is in terms of
0.199 disrupting performance is that after you
0.199 masturbate you do see an increase in
0.199 heart rate a little bit um you have a
0.199 rebound so it decreases and then you
0.199 have a rebound increase in heart rate
0.199 that can slightly affect your ability to
0.199 recover from performance But ultimately
0.199 I think if you find benefit from it
0.199 because people report feeling more
0.199 aggressive with abstaining then by all
0.199 means if you find it helpful I think
0.199 it&;s fine but is it mandatory I don&;t
0.199 think so based on the evidence we have
0.199 right now cuz I I heard that rumor many
0.199 years ago and I think I assumed it was
0.199 correct I heard the rumor and this was
0.199 of evolutionary story that was attached
0.199 to the rumor was that once upon a time
0.199 when we were out I don&;t know looking
0.199 for um a sexual partner we would need to
0.199 be more articulate and more persuasive
0.199 and more I don&;t know attractive
0.199 basically so we were optimal
0.199 attractiveness before we ejaculated then
0.199 after we&;ve ejaculated that kind of
0.199 energy goes out of us and recharges and
0.199 rebuilds again so I was when I heard
0.199 that I thought okay so if I&;m speaking
0.199 on stage or I&;m doing a podcast I want
0.199 to make sure that I&;m you know my mouth
0.199 and my brain are attached I&;m articulate
0.199 I&;m persuasive whatever I need to be so
0.199 don&;t ejaculate or masturbate anytime
0.199 before doing anything where I need to
0.199 use my brain in my mouth well you know
0.199 some people describe post not Clarity
0.199 right so they actually on the
0.199 alternative feel like and there&;s no
0.199 good data on this the data we have is on
0.199 people the very small subset of people
0.199 who have post nut postcoidal not post
0.199 nut postcoidal dysphoria so they
0.199 actually feel bad but in terms of
0.199 clarity um you know some people do like
0.199 when you&;re trying to You&;re motivated
0.199 to get a partner right you&;re sort of um
0.199 trying to uh woo them you&;re really
0.199 focused on that one singular effort that
0.199 once you&;ve obtained that that the like
0.199 very singular focus goes away and now
0.199 other parts of your brain can be
0.199 activated to then be used for some
0.199 people will describe being more
0.199 productive more able to get work done
0.199 after um masturbation it&;s very
0.199 individualized or ejaculation whatever
0.199 it is post that Clarity I&;ve never heard
0.199 anybody talk about this before and I&;ve
0.199 also been told over the years that it&;s
0.199 something that just men experience
0.199 predominantly and for anyone that
0.199 doesn&;t not post nut Clarity is the
0.199 definition that I understand is and that
0.199 I have experienced I&;m going to be
0.199 honest is that after ejaculation your
0.199 desire for the other person reduces
0.199 quite significantly and there&;s a
0.199 stereotype here that women don&;t
0.199 experience this post-nut Clarity in the
0.199 same way now if I ask all of my male
0.199 friends if I said to them has there ever
0.199 been a time in your life where you were
0.199 maybe texting someone you were attracted
0.199 to or you know had some sort of sexual
0.199 attraction to and then you
0.199 masturbated did your desire um diminish
0.199 after you masturbated for that person
0.199 that you were just texting I think about
0.199 90% of my male friends would say yes yes
0.199 and they describe it as if someone like
0.199 took some like sunglasses off them like
0.199 a pretty extreme Sudden Change and I&;ve
0.199 always wondered about this whether this
0.199 is just men if it&;s just women why it
0.199 happens so when you look at brain
0.199 studies right of people having orgasm
0.199 and what happens is when you have an
0.199 orgasm like your whole brain lights up
0.199 right because your heart rate goes up
0.199 your blood pressure goes up like your
0.199 pupils down so all these different parts
0.199 of your body are working so your whole
0.199 brain lights up and then after orgasm it
0.199 it it gets very like quiet and so we see
0.199 that in women it may take a little
0.199 longer to get really quiet in men it
0.199 happens very quickly and this may be
0.199 associated with sort of the hormonal
0.199 changes that occur after orgasm so we
0.199 know that prolactin increases after
0.199 orgasm dopamine decreases is and there&;s
0.199 sort of some evolutionary theories about
0.199 why this happens so one is after you
0.199 ejaculate if you are having uh
0.199 ejaculation with a woman then you don&;t
0.199 want to have sex again to then same
0.199 thing with the refractory period right
0.199 that there&;s some period of time where
0.199 you&;re not going to want to have sex
0.199 again or you can&;t have sex even if you
0.199 want to and this is because
0.199 evolutionarily if you deposited your
0.199 ejaculate into a woman if you then had
0.199 sex again you could actually dislodge
0.199 the semen and then you would have less
0.199 ability to uh to have fertilizing egg
0.199 right and then the other thought is that
0.199 you don&;t want to become overly
0.199 exhausted right so that if you if you
0.199 had the unlimited capability to have sex
0.199 over and over again that exhaustion
0.199 could be a real thing like and so you&;re
0.199 sort of a protective mechanism um and so
0.199 those are sort of the theories as to why
0.199 this is and there is like an absolute
0.199 refractory time where like you don&;t
0.199 want sex at all and then there&;s a
0.199 relative refractory time where if you
0.199 had a really novel or strong stimulus
0.199 for sexual activity that you would be
0.199 able to um in terms of clarity in ter
0.199 because we know there&;s a little bit of
0.199 differences in brain um it may not be as
0.199 obvious in women in terms of it takes
0.199 them a little longer to have that coming
0.199 down after the orgasm from the brain
0.199 activity um but probably there is some
0.199 we just haven&;t studied enough and I I
0.199 always say this that when we look at
0.199 studies for women&;s sexual health and
0.199 men&;s Sexual Health they&;re so lopsided
0.199 so if you type in penis in like a in
0.199 like a search engine for Google or for
0.199 the PubMed which is where you look up
0.199 research articles you&;re going to find
0.199 50,000 articles if you look up clitoris
0.199 you&;re going to get 2,000 articles so
0.199 it&;s very lopsided in terms of what we
0.199 study um for sexual function and in in
0.199 of itself sexual function by many people
0.199 is not seen as mandatory or important
0.199 for health and so the funding is less
0.199 often available for sexual health that&;s
0.199 why we have such little data in some
0.199 areas going back to just closing off on
0.199 the point about masturbation is there a
0.199 link between m masturbation and prostate
0.199 cancer because I&;ve I&;ve heard a lot of
0.199 different things about it um some people
0.199 think that over masturbation is causing
0.199 prostate cancer and some people say the
0.199 opposite yeah so there&;s actually a
0.199 really good study um that was done
0.199 looking at ejaculation frequency and
0.199 prostate cancer and it was a very well
0.199 done they tried to control for a lot of
0.199 other factors and so what they found was
0.199 that men who ejaculated 21 times or more
0.199 a month were less likely to develop
0.199 prostate cancer this is just a
0.199 statistical number it is not a number
0.199 that sort of um means anything in terms
0.199 of but we&;re seeing that like okay so
0.199 more masturbation may help why is that
0.199 right so there may there&;s a prostate
0.199 stagnation hypothesis that the fluids
0.199 that you know some of your ejaculate
0.199 fluids come from the prostate and so
0.199 when you&;re e jackling frequently you&;re
0.199 more often getting rid of that fluid and
0.199 sort of re replenishing it or cleaning
0.199 the pipes so to say so that may be
0.199 beneficial in terms of preventing
0.199 prostate cancer now do you have to
0.199 masturbate or ejaculate or have sex 21
0.199 times a month um no but you know there
0.199 could be a benefit yes and so uh having
0.199 a healthy and it may be that those
0.199 people who had sex more often or jacine
0.199 more often were just healthier in other
0.199 ways right they were able to have sex
0.199 more often or masturbate more often
0.199 because they were uh s you know
0.199 sufficiently healthy to do so and so I
0.199 while they tried to control for those
0.199 things there&;s always sort of
0.199 uncontrollable variables that come into
0.199 those sort of studies yeah that&;s what I
0.199 was wondering is is there another like
0.199 glaringly obvious factor that those
0.199 people had more relationships therefore
0.199 their mental health was better therefore
0.199 X Y and Z they tried to control for
0.199 comorbidities but again they&;re they&;re
0.199 I don&;t think they controlled for I mean
0.199 they control for marriage I believe um
0.199 but I&;m not sure that they controlled
0.199 for like in a relationship versus not
0.199 and how healthy that relationship is
0.199 that certainly wasn&;t assessed I&;ll link
0.199 to the study below so everyone can read
0.199 for themselves about the um the controls
0.199 in that study and how that was conducted
0.199 link to this is is the subject of
0.199 um it was interesting cuz I was doing a
0.199 lot of research on the subject of that
0.199 sounds a bit strange I was doing a lot
0.199 of research on the subject of porn and
0.199 where conversations at with the subject
0.199 and one of the quite startling things is
0.199 a lot of people are trying to figure out
0.199 how to stop watching porn um a lot of
0.199 people are asking
0.199 themselves for mechanisms to um install
0.199 things on their computer that prevent
0.199 porn time and um searching for Solutions
0.199 around porn addiction and a lot of
0.199 people were searching um about whether
0.199 porn is a sin and I think there&;s
0.199 something broader here about the idea of
0.199 Shame which is linked to porn what is
0.199 your take on on this is porn a bad thing
0.199 yeah so I don&;t think porn is a bad
0.199 thing I will start with that um is it a
0.199 sin is more of a moral question right
0.199 and I think that that is uh something
0.199 that you individually have to decide for
0.199 yourself if you feel like morally it&;s
0.199 inappropriate but it&;s It&;s
0.199 Entertainment right it&;s just a
0.199 different form of entertainment and I
0.199 think the issues with porn um because I
0.199 would not say that it&;s 100% great I
0.199 think there are definitely issues with
0.199 it one the big one that I&;ve been very
0.199 vocal about is children seeing
0.199 pornography so um we know now that the
0.199 average age of a boy seeing pornography
0.199 is 13 and that&;s the average meaning
0.199 that as young as 8 to 10 boys are being
0.199 exposed to pornography um which was not
0.199 the case when for example we were
0.199 growing up right you had to I I always
0.199 say this you had to find a a tape maybe
0.199 find a VC are in a room that nobody was
0.199 going to walk in or you had to find a
0.199 magazine and hide it somewhere and go
0.199 find it and so it was not readily
0.199 available you had to work to be able to
0.199 see that and now seeing pornography is
0.199 very readily available and so uh very
0.199 often kids are seeing it whether you as
0.199 a parent don&;t want them to whether
0.199 you&;ve put blocks on their phones and
0.199 devices um they may have access to it
0.199 from a friend or they may see it
0.199 somewhere else and um and your brain is
0.199 not fully developed to understand one
0.199 what you&;re seeing and two to understand
0.199 that this is not real unless your parent
0.199 has talked to you about you know this is
0.199 sort of a a movie that&;s not real life
0.199 and this is not what sex is really like
0.199 and so I think that has um implications
0.199 for um for how they view sex and how
0.199 they then try to have sex with partners
0.199 and also you know because your brain&;s
0.199 not fully developed you&;re getting this
0.199 big rush of dopamine from viewing
0.199 something like that and that&;s not
0.199 something that we traditionally got at
0.199 that age right and so it can become
0.199 become very addictive now as an adult I
0.199 think it&;s different because you have a
0.199 fully formed brain you understand the
0.199 concept of this is not real most people
0.199 um and so it can be just a way to have
0.199 pleasure and even watch it with your
0.199 partner and have pleasure um but yes we
0.199 are seeing some people who have
0.199 problematic pornography use in the
0.199 literature they say it&;s 4% I suspect
0.199 maybe it&;s a little higher now or people
0.199 are finding that watching pornography is
0.199 is one easier than going out trying to
0.199 find a partner you don&;t have to face
0.199 rejection you don&;t have to face the
0.199 difficulties and awkwardness of having a
0.199 first a sexual encounter with someone
0.199 that often happen and so it can become a
0.199 way because it does relieve dopamine
0.199 just like anything else release dopamine
0.199 it can then become sort of a way to feel
0.199 better about anything right like you can
0.199 just be feeling down like I want to
0.199 watch pornography because it makes me
0.199 feel better it may not be just that
0.199 you&;re really into sex it&;s just that
0.199 you&;re really like wanting that Rush hit
0.199 of dopamine um and then there&;s
0.199 obviously this shame that comes with oh
0.199 my God why am I using pornography just
0.199 because I feel bad and then you&;re like
0.199 oh but I feel bad and so I&;m going to
0.199 use porn again and it becomes this sort
0.199 of like negative vicious cycle that can
0.199 occur but I think when used for
0.199 entertainment and pleasure I think it&;s
0.199 fine and many many people use it for
0.199 entertainment and pleasure without a
0.199 problem I the other day bought the Apple
0.199 Vision Pro that new headset and I tell
0.199 you what Jesus Christ that&;s
0.199 unbelievable piece of technology this
0.199 one feature they have on their is called
0.199 spatial video and I don&;t know if you&;ve
0.199 tried it yet but you put it on and if
0.199 you&;ve taken a spatial video which you
0.199 can now take on the new iPhone and also
0.199 on the Vision Pro it basically feels
0.199 like a 3D video and it&;s like nothing
0.199 I&;ve ever experienced before one of our
0.199 team members commented that you know
0.199 they they lost a family member and they
0.199 wish they had this because it it&;s like
0.199 the person is back in front of you it&;s
0.199 not like a photo or a video anymore but
0.199 then little monster in my mind goes hm
0.199 there&;s going to be other applications
0.199 of this technology as it relates to put
0.199 graphy and we&;re getting you know if we
0.199 just assume any rate of improvement with
0.199 this technology just I know 5% a year we
0.199 eventually get so close to being
0.199 indistinguishable from a human being
0.199 that the incentive structure of going
0.199 out and getting a day and you know for
0.199 the for the objective of having sex or
0.199 whatever versus just popping your
0.199 headset on which is going to get cheaper
0.199 and cheaper and cheaper and better and
0.199 better and better um becomes really
0.199 lopsided I it&;s so clear to me
0.199 that if we just go forward 10 years and
0.199 we&;re on the Apple Vision Pro 17 air
0.199 there&;s going to be so many people that
0.199 are using that as a way to uh masturbate
0.199 and to watch
0.199 pornography and there and it&;s going to
0.199 reduce the amount of people that are
0.199 seeking real Intimate Relationships IRL
0.199 in the real world yeah it is a real
0.199 concern I would say but you know we know
0.199 from some data that people will find
0.199 physical touch particular particularly
0.199 in like hair bearing areas um very
0.199 important in terms of intimacy with a
0.199 partner so um Intimacy in general and so
0.199 I I can only hope that that will
0.199 continue that you will want physical
0.199 touch because no matter what you can see
0.199 with your eyes um it&;s not touching you
0.199 it&;s not like it&;s still you doing the
0.199 touching there&;s no element of surprise
0.199 or excitement or buildup in terms of
0.199 like there&;s someone else in the room
0.199 with you right so I can only hope that
0.199 that that will that will be the case but
0.199 it still remained to be seen however I
0.199 will show that there&;s some interesting
0.199 um applications of this in terms of fear
0.199 so if you are really scared of something
0.199 you can actually desensitize yourself
0.199 using these VR headsets and it can
0.199 actually be very powerful so I was just
0.199 speaking to a researcher Lori BR about
0.199 how they&;re using it in their lab for
0.199 women who have fear of penetration
0.199 because they&;ve had either trauma or
0.199 they have other conditions that are
0.199 causing it to be painful and so they can
0.199 work with them to be using these
0.199 headsets to simulate a sexual experience
0.199 and then they can sort of use a DI like
0.199 use a tool or a dilator or something to
0.199 then penetrate in a safe space right not
0.199 like you&;re with a partner and you&;re
0.199 like trying to have sex and you&;re you
0.199 know you don&;t feel very safe sort of
0.199 allowing that it&;s very preliminary
0.199 research but I think ultimately there
0.199 are some positive things that maybe will
0.199 come out of the use of these sort of VR
0.199 our headsets and I can only hope that
0.199 that will predominate and we can
0.199 continue and people will inherently want
0.199 other people right that we&;re we&;re
0.199 hardwired to be around people and to be
0.199 intimate with people like that&;s how our
0.199 brains work so I&;m hopeful that that
0.199 will that will still remain to be the
0.199 case but I can&;t I can&;t predict it you
0.199 don&;t look
0.199 convinced well you know I mean I think
0.199 it&;s I I am worried you know I think
0.199 that phones have changed lives too right
0.199 like now our kids our younger generation
0.199 doesn&;t communicate as well because when
0.199 they hang out together they&;re sitting
0.199 all together looking at their phones
0.199 right and so we have to actively work to
0.199 prevent like I make my kids have full-on
0.199 conversations with people I say you got
0.199 to come and hang out with the adults and
0.199 have conversations and and talk to
0.199 people and we have to coach them on how
0.199 to talk to people um because I worry
0.199 that people are too into even when they
0.199 hang out with their friends they&;re
0.199 playing on devices right so um I think
0.199 there&;s like work that has to be done to
0.199 prevent the the the easy dopamine rushes
0.199 that these devices are giving us right
0.199 so we actually have to actively work at
0.199 it and people are inherently going to
0.199 take the route of of the easiest thing
0.199 and so as a society we have to sort of
0.199 work together to sort of prevent these
0.199 easy wins easy things easy dopamines
0.199 from taking over something you mentioned
0.199 within there though was the idea of
0.199 trauma and I&;ve I&;m quite interested in
0.199 the role that our trauma plays in our
0.199 sexual health and sexual
0.199 dysfunction what&;s important to know
0.199 there and does trauma play a role at all
0.199 in the patients you see absolutely 100%
0.199 so your body when it goes through a
0.199 trauma it will then sort of your body
0.199 remembers even if you don&;t right so
0.199 these people very many people who have
0.199 pelvic floor dysfunction meaning their
0.199 pelvic floors are too tight or too tense
0.199 they&;ve had some sort of trauma not all
0.199 of them some of it&;s just Stress and
0.199 Anxiety but sometimes they&;ve had some
0.199 sort of trauma years ago and it&;s been
0.199 with I I remember having like a
0.199 70-year-old woman and she had such
0.199 terrible pelvic Flor dysfunction for God
0.199 knows how many years that ultimately it
0.199 caused really negative consequences for
0.199 her bladder function and um and so
0.199 absolutely when you have a trauma that&;s
0.199 unresolved in some shape or form it will
0.199 affect you whether it&;s your mental
0.199 health your physiologic health I mean
0.199 our brains are so powerful that you know
0.199 when it&;s in a bad place it can affect
0.199 you negatively when it&;s in a positive
0.199 place it can affect you more positively
0.199 the one thing I will say is if you have
0.199 trauma getting therapy getting help to
0.199 resolve that trauma is so so important I
0.199 talk to all my patients and I say yes
0.199 you may have an organic problem meaning
0.199 a physiologic bodily problem that&;s
0.199 causing your sexual dysfunction but
0.199 everyone who has sexual dysfunction has
0.199 a psychologic component because it is
0.199 devastating it is stressful it is
0.199 horrifying to feel like you&;re not
0.199 normal your body doesn&;t function
0.199 normally especially in an intimate space
0.199 like sex so I&;m like everybody should
0.199 ideally see a sex therapist if it was
0.199 available to everybody but it&;s not
0.199 right how can we allow people to have
0.199 access to things they need because we
0.199 don&;t teach these things in school right
0.199 school I mean this is my big gripe is
0.199 like how can we make education better
0.199 for children like we need better sexual
0.199 education we need better education on
0.199 how to resolve traumas or how to deal
0.199 with them or how to get help how to do
0.199 digital Health like how do you navigate
0.199 the world with all this misinformation
0.199 how do you find good quality information
0.199 how do you assess it like there&;s so so
0.199 many things even how to balance your
0.199 books right they don&;t learn that in
0.199 school so ultimately there&;s so many
0.199 things that I think if we were really
0.199 putting a critical eye on how we teach
0.199 our young people that we could improve
0.199 and part of that would be including
0.199 people to know and realize when they
0.199 need help through whatever trauma
0.199 they&;ve suffered or stress or anxiety
0.199 that they&;re suffering and how that can
0.199 propagate itself over a lifetime and
0.199 create real problems I have to ask this
0.199 question cuz people mention this quite
0.199 often often can you have sex while
0.199 you&;re pregnant absolutely why not I ask
0.199 it because it was one of the most
0.199 Googled questions um online really yeah
0.199 one of the highest search volumes I&;ve
0.199 ever seen for a search term was can you
0.199 have sex while pregnant wow I actually
0.199 didn&;t I mean I I I&;ve heard a lot of
0.199 things and I think that people feel like
0.199 I&;ve heard that men think they&;re going
0.199 to hurt the baby they&;re going to um
0.199 they&;re going to cause a problem but no
0.199 absolutely you can have sex you&;re not
0.199 going to create like a pre-term labor
0.199 you&;re not going to harm the fetus like
0.199 nothing bad is going to happen from
0.199 having sex while pregnant okay so let&;s
0.199 talk about orgasms and the clitoris then
0.199 you mentioned earlier that um there&;s
0.199 disproportionately a lot less research
0.199 done on the clitorus as a man what do I
0.199 need to know about the clitoris CU I
0.199 I&;ll be honest I know very little I know
0.199 where it is that&;s that&;s a
0.199 plus well not everyone knows that either
0.199 yeah I didn&;t always know where it was I
0.199 a couple of misunderstandings but um I
0.199 found I found it eventually and I I
0.199 think I know how to stimulate it but I
0.199 don&;t really know what&;s going on there
0.199 or how it works okay so what I tell
0.199 everybody and what men can think of is
0.199 the clitoris is like the penis so when
0.199 you are a fetus there&;s a thing called
0.199 the genital tubric before you&;re
0.199 assigned sex that genital tubric when
0.199 you&;re when you become a man that
0.199 genital tubric becomes the penis and the
0.199 shaft and the glands and in a woman it
0.199 becomes the clitoris and the clitoris
0.199 actually then goes deep into the pelvis
0.199 um just like the penis it has a shaft in
0.199 the pelvis and then it goes around the
0.199 vaginal canal and so you can the clitus
0.199 is just as sensitive as a man&;s penis
0.199 right so if you stimulate the clitoris
0.199 like your penis gets stimulated then it
0.199 will lead to orgasm and it&;s probably
0.199 the most reliable route for orgasm for
0.199 women so 85% of women need some form of
0.199 cliteral stimulation to Climax and so
0.199 many women have difficulty climaxing
0.199 through vaginal penetration alone that&;s
0.199 not that they&;re broken or something&;s
0.199 wrong with them it&;s just that they
0.199 don&;t and because the stimulus from the
0.199 clitoris is so strong it leads to a very
0.199 reliable route for orgasm now how you
0.199 stimulate it is sort of very
0.199 individually specific but typically oral
0.199 stimulation vibratory stimulation uh uh
0.199 manual stimulation all those things can
0.199 work but that&;s where the communication
0.199 comes in where like the partner ideally
0.199 would know what they like and could tell
0.199 you um or they you could check like does
0.199 this feel good does this feel good do
0.199 you like this is this you know or and
0.199 you know and so that&;s sort of again a
0.199 challenge because the communication
0.199 issue we&;ve talked about this this whole
0.199 talk but um that is really what&;s
0.199 important now the clitoris like I said
0.199 it it goes um deep above the vagina and
0.199 around it so people can still get
0.199 clitoral stimulation through penetration
0.199 um depending on how you stimulate now
0.199 the other areas that are important for
0.199 orgasm are the G erogenous Zone it&;s
0.199 actually not a spot it&;s a Zone and
0.199 that&;s where essentially if you go look
0.199 at the vagina on the anterior wall which
0.199 is the top of the vagina underneath the
0.199 urethra where the PE comes out about 2
0.199 to 3 centimeters in is called The gynus
0.199 Zone it&;s named after the person who um
0.199 identified it I think it&;s graen house
0.199 or something like that but um
0.199 essentially that area is full of certain
0.199 nerve endings as well as the female
0.199 prostate or the skin glands and so those
0.199 are areas that are quite ayous and that
0.199 uses a different so the clitoris is
0.199 inated by the pudendal nerve the G
0.199 erogenous zone is inovated by the
0.199 hypogastric nerve so a different nerve
0.199 and then the cervix is the last area
0.199 where Sometimes women feel a lot of
0.199 stimulation and that&;s a stimulated by
0.199 the vagus nerve so all these different
0.199 areas can lead to orgasm for women and
0.199 they can be additive so if you&;re
0.199 stimulating all three you might have a
0.199 more strong orgasm and the orgasm may
0.199 feel a little different now people like
0.199 to call it like oh you&;re getting
0.199 clitoral orgasm or a vaginal orgasm it&;s
0.199 all an orgasm it&;s just a matter of what
0.199 stimulation is causing the orgasm and so
0.199 I think ultimately it&;s really important
0.199 for the the most easy reliable route to
0.199 orgasm is cital stimulation which is not
0.199 traditionally stimulated through penis
0.199 and vagina sex right and so it does
0.199 require some additional um thought on
0.199 how you&;re going to stimulate it and and
0.199 how you&;re going to please the partner
0.199 and to get them to orgasm and often
0.199 times if you think about the time it
0.199 takes to orgasm so in a man the average
0.199 length if you look at studies that have
0.199 looked at stopwatches like they&;ve had
0.199 the female partner actually start a
0.199 stopwatch at the beginning of sex and
0.199 stop it at the end when the man climaxes
0.199 it&;s about 5.1 to 5.7 minutes um which
0.199 in fact UK men tend to last a little bit
0.199 longer which is sort of an interesting
0.199 concept but so which sex is that men men
0.199 men so from penetration to climax of men
0.199 so when you so when they so they&;ve
0.199 measured basically not including
0.199 foreplay but if they&;ve measured they&;ve
0.199 measured like 15,000 people through many
0.199 many different countries and they&;ve had
0.199 the woman take a stopwatch and actually
0.199 start click on it when they penetrate
0.199 and click it off when they Climax and
0.199 they&;ve measured the length of time and
0.199 it&;s been about 5.1 to 5.7 minutes is
0.199 the time now a woman when you look at
0.199 the average time to orgasm for woman
0.199 it&;s about 14 minutes and so you can
0.199 imagine that if the entire sexual
0.199 encounter is around the male climax
0.199 right and the male has this as we&;ve
0.199 already talked about sort of this post
0.199 nut Clarity like I don&;t want refractory
0.199 time they&;re not going to want to be
0.199 more intimate if you don&;t prioritize
0.199 the female&;s climax or stimulate her
0.199 before you begin to penetrate then she&;s
0.199 probably not going to orgasm um and so
0.199 and the interesting thing is when you
0.199 look at sexual encounters and you look
0.199 at men and women having sex for the
0.199 first time uh the woman will orgasm 45%
0.199 of the time the man will orgasm 95% of
0.199 the time when you look at women having
0.199 sex with women on a first time encounter
0.199 they both have orgasms 95% of the time
0.199 so clearly there&;s an educational Mis
0.199 disconnect right women know what they
0.199 like and what stimulates them and men
0.199 aren&;t getting the memo I feel
0.199 attacked totally not attacked letting
0.199 you know the
0.199 facts I know it makes sense though cuz
0.199 yeah I think men are still struggling to
0.199 understand again because of what you
0.199 said we don&;t really get a sexual
0.199 education so we learn these things from
0.199 porn and obviously in porn they&;re not
0.199 showing it yeah I mean you don&;t
0.199 typically have many um women orgasming
0.199 in porn as you do men orgasming in porn
0.199 what is an orgasm and what kind of what
0.199 role does it serve like why do we orgasm
0.199 and also when I say what is an orgasm is
0.199 an orgasm like a switch or is is it like
0.199 a spectrum so it&;s it&;s sort of like a
0.199 spectrum I guess I mean so let&;s talk
0.199 about what it is exactly so an orgasm is
0.199 a moment in time that is combined with a
0.199 like a a maximal tension and then a
0.199 release and during that time it is
0.199 completely you&;re completely unable to
0.199 think about anything else it is a very
0.199 powerful pleasurable sensation and it
0.199 occurs usually like I said 5 to 60
0.199 seconds it can last and is it in terms
0.199 of how you get it it&;s usually a
0.199 culmination of stimulation over a period
0.199 of time even with a certain sort of like
0.199 Rhythm that&;s required to achieve climax
0.199 that&;s different from person to person
0.199 so I can&;t give you the script on this
0.199 is how fast you need to penetrate or
0.199 this is how what stimulation you need to
0.199 use okay that&;s the end of the
0.199 conversation okay we&;re done here so um
0.199 so yeah cuz nobody wants to talk about
0.199 they literally want me to tell them like
0.199 this is what you do a b c d instru man
0.199 so um but yeah ultimately um all of
0.199 those things they build this tension
0.199 right so over the course of sexual
0.199 stimulation arousal you are getting to
0.199 an ex excitement phase where your your
0.199 body is changing so in women for example
0.199 you will see that the labia become a
0.199 little bit redder um they expand in size
0.199 as I said the vagina lengthens and
0.199 elongates um the so the from 3 to six
0.199 inches I&;ve heard you say yeah about
0.199 about double yeah and it&;s different
0.199 from person that&;s the average right so
0.199 there is sort of like this thought that
0.199 like okay if it&;s really really large
0.199 it&;s always going to be better and
0.199 that&;s not actually all always the case
0.199 because not every vagina can accommodate
0.199 a very large phus um but so when you&;re
0.199 having orgasm essentially your pelvic
0.199 floor muscles are tensing up they&;re
0.199 they&;re getting really tense and you&;re
0.199 reaching this for like basically you&;re
0.199 getting to the top of the hill you&;re
0.199 getting this really large amount of
0.199 climax and so your body is sort of clim
0.199 going up and up and up you&;re reaching
0.199 like increasing dopamine and you&;re
0.199 increasing so when you think about what
0.199 happens in the brain is your hormones
0.199 are Are CL going higher and higher and
0.199 there&;s also an inhibitory there&;s a
0.199 there&;s a there&;s a stimulatory and an
0.199 inhibitory pathway and so the
0.199 stimulatory pathway is going up
0.199 inhibitory stimulatory you&;re basically
0.199 trying to race up to the top of this
0.199 mountain and once the stimulatory gets
0.199 to the very very top then you have the
0.199 orgasm and so you release all this
0.199 tension and during this time your heart
0.199 rate&;s racing your pupils are dilating
0.199 right there&;s all these physiologic
0.199 changes um and then when you orgasm your
0.199 muscles contract as I mentioned before
0.199 and this every 8 seconds they&;re having
0.199 a contraction sometimes you&;ll have an
0.199 involuntary phonation so people will you
0.199 know moan or scream and sometimes it&;s
0.199 not in their control like there&;s
0.199 actually an involuntary component of it
0.199 and then um sort of it comes down and so
0.199 it&;s it&;s not necessarily a switch it&;s
0.199 sort of a a a climb up a mountain is the
0.199 way I would describe it sometimes feels
0.199 like blowing up a balloon with a little
0.199 hole in it and what I say with a little
0.199 hole in it I mean because if you stop it
0.199 feels like some air comes out of the
0.199 balloon mhmh that&;s why I said the the
0.199 sort of there needs to be a rhythm it
0.199 should keep going at a certain Pace in
0.199 order to achieve that climax cuz if it
0.199 doesn&;t then you can again just like
0.199 that&;s a very good description you&;ll
0.199 lose that little air in the
0.199 balloon okay so in order to increase
0.199 female pleasure okay we need to
0.199 understand the person we&;re dealing with
0.199 of course but um the clitorus is a great
0.199 way to get to
0.199 orgasm you&;ve you&;re PR lubricants MH a
0.199 lot of people feel like that&;s not
0.199 natural so they kind of avoid it but
0.199 you&;re Pro lubricants and are you Pro
0.199 then scheduling sex or you Pro SCH in
0.199 time for intimacy scheduling time for
0.199 intimacy so because sex ads as we talked
0.199 about add sort of like a level of stress
0.199 in terms of like am I going to want to
0.199 have sex am I going to be able to get an
0.199 erection am I going to enjoy sex
0.199 whatever it is and am I going to get
0.199 rejected like all those things because
0.199 you&;re still a human being and you may
0.199 just like be really stressed that day
0.199 that you put on the calendar and you
0.199 were like a I just can&;t can&;t get in
0.199 the right mind space to have sex so if
0.199 you&;re constantly ruminating or
0.199 stressing about other things you can&;t
0.199 have a good sexual encounter in fact
0.199 they&;ve looked at mindfulness in terms
0.199 of how it improves sexual function
0.199 particularly in women but we&;ve seen
0.199 very clear data that be having a
0.199 mindfulness practice leads to improved
0.199 sexual function in terms of desire and
0.199 other factors like arousal and
0.199 lubrication and orgasm but the biggest
0.199 is desire and so it&;s because if you can
0.199 focus on what&;s Happening during the
0.199 sexual encounter so you can focus on
0.199 what it feels like how you&;re enjoying
0.199 that sensation rather than thinking
0.199 about am I going to come am I going to
0.199 Climax and is it going to happen or
0.199 whatever it is that you&;re thinking
0.199 about during sex because you&;re worried
0.199 about how the other partner might react
0.199 then you&;re more likely to enjoy the
0.199 experience feel and then have a good
0.199 experience and subsequently have more
0.199 desire for additional experiences we
0.199 talked earlier on the very start of the
0.199 conversation about comparisons and how
0.199 that can really destroy sex is there a
0.199 disparity between how long we think sex
0.199 should take and how long it actually
0.199 takes yeah we all think it lasts longer
0.199 and when you ask people what the average
0.199 time and this is a hard question because
0.199 people think of sex as a whole encounter
0.199 and when we do it scientifically we look
0.199 at sex from penetration to the end of
0.199 penetration and sex is more diverse
0.199 right sex can include oral sex anal sex
0.199 um manual sex any type of sexual
0.199 stimulation right and so when you&;re
0.199 thinking about the entire encounter it
0.199 can be very variable some people want to
0.199 quickie some people want to have this
0.199 long luxurious love making scenario and
0.199 it really depends also like on what&;s
0.199 going on in your life like you may not
0.199 have that luxury and so I don&;t I think
0.199 again it&;s not about reaching a certain
0.199 Benchmark or a certain number it&;s
0.199 really about the quality of the sex so
0.199 if you have great sex and it takes 3
0.199 minutes that&;s great that&;s fine but as
0.199 long as it&;s great to both of you right
0.199 if you&;re both like this is awesome I&;m
0.199 having great sex and it takes three
0.199 minutes that&;s fine but how long do
0.199 people think sex lasts on average versus
0.199 is how long it actually lasts on average
0.199 yeah so I think that most people
0.199 definitely think it lasts longer so
0.199 women tend we don&;t know what they think
0.199 it lasts but what they want it to be is
0.199 about 18 to 25 minutes men are a little
0.199 on the shorter side like maybe 12
0.199 minutes but generally we all want it to
0.199 be around that length but you sort of
0.199 lose sense of time right so you don&;t
0.199 really no one&;s really there with the
0.199 stopwatch knowing exactly how long it
0.199 takes in fact I&;ve had friends tell me
0.199 like oh I watched your video and now
0.199 like when my partner wants sex I&;m like
0.199 oh it&;s only going to take five minutes
0.199 like I can I can have sex with them like
0.199 I used to in my head used to think it
0.199 would take a lot longer and I realized
0.199 it takes less time and like I don&;t that
0.199 that stress of like oh my God I&;m going
0.199 to have to like waste like half an hour
0.199 and I&;m so tired like has gone out the
0.199 window because I know it&;s really not
0.199 going to take that long is that have
0.199 they ever put people in like a
0.199 laboratory or whatever and and I guess
0.199 this goes back to what you said earlier
0.199 um is there like an average time people
0.199 spend having sex was that the 5 minutes
0.199 you talked about 5.7 minutes 5.1 to 5.7
0.199 minutes minutes depending on the study
0.199 you look at and they they looked at all
0.199 Commerce so it&;s actually different in
0.199 different um countries so when you look
0.199 at like turkey it was like four minutes
0.199 and if you look at UK it was like 10
0.199 minutes so it&;s
0.199 actually thank you so it&;s actually
0.199 variable and that may be a cultural
0.199 thing um but ultimately the average is
0.199 about five something interesting so we
0.199 want sex women want sex to last between
0.199 18 and 25 minutes ideally men want it to
0.199 last ideally about 16 minutes including
0.199 forl but in reality it&;s lasting five
0.199 five minutes yeah that&;s good to know
0.199 let&;s talk about Zoe who you may know
0.199 because they&;re a sponsor of this
0.199 podcast and I&;m an investor in the
0.199 company you guys know health is my
0.199 number one priority Zoe&;s growth story
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0.199 they&;re doing science at a scale that
0.199 I&;ve never seen before because of their
0.199 members and recent breakthroughs in
0.199 research they can now continue to offer
0.199 the most scientifically Advanced gut
0.199 health tests
0.199 on the market previously the test
0.199 allowed them to analyze 30 bacteria
0.199 types in your gut but now thanks to new
0.199 science they&;ve identified a 100
0.199 bacteria types this is a huge step
0.199 forward and there&;s nothing else that&;s
0.199 available even close to it on the market
0.199 at all so to find out more and to get
0.199 started on your Zoe Journey visit
0.199 zoe.com
0.199 stepen you can use my exclusive code
0.199 ceo1 for 10% off don&;t tell anybody
0.199 about that okay just for you guys
0.199 we talked about sizes of stuff a second
0.199 ago and we said we would come back to
0.199 this so there&;s two sort of sizes that
0.199 people often think about the size of the
0.199 vagina and the size of the penis there
0.199 is a myth in society that the more sex a
0.199 woman has the bigger her vagina gets is
0.199 that myth true or false false so the way
0.199 that women&;s vaginas get if you want to
0.199 say loose right which is the term that
0.199 people use or they get a weak pelvic
0.199 floor and that&;s from having babies
0.199 having Maybe neurologic conditions that
0.199 affect the pelvic floor strength having
0.199 collagen disorders having um just from
0.199 like having a job where you stand all
0.199 day and you&;re like all the weight of
0.199 your body is sitting on your pelvic
0.199 floor those muscles can get weaker over
0.199 the course of a lifetime and then it can
0.199 feel a bit looser because those muscles
0.199 are maybe not squeezing as harder but it
0.199 is not related to how much sex she&;s
0.199 having because as we mentioned earlier
0.199 when you have an orgasm you&;re actually
0.199 like strengthening your pelvic floor a
0.199 little bit like you&;re you&;re
0.199 Contracting those muscles so actually
0.199 probably the more sex a woman has likely
0.199 her pelvic floor is probably stronger
0.199 unless she&;s not you know um but you
0.199 know you add in the having babies and
0.199 other things it&;s variable but probably
0.199 the more orgasms a woman has the
0.199 stronger her pelvic floor is but things
0.199 like child birth can mhm make the pelvic
0.199 floor looser weaker weaker yeah yeah so
0.199 then when it becomes weak that is the
0.199 cause of things like stress incontinence
0.199 so when a woman um lifts something heavy
0.199 or she exercises or she jumps or she
0.199 coughs or sneezes she might have a
0.199 couple drops of urine or a lot of urine
0.199 leak out because of a weak pelvic floor
0.199 it can also be lead to something like
0.199 prolapse where the it&;s like a hernia in
0.199 the vagina where the pelvic floor sort
0.199 of is so weak that now the vaginal skin
0.199 and the organ behind it is sort of
0.199 bulging out and can cause discomfort and
0.199 and sort of uh feeling maybe some
0.199 dysfunction in the organ but really
0.199 mostly discomfort and so those are sign
0.199 of weak pelvic floors not you know not
0.199 having a loose vagina during sex and we
0.199 can do something to strengthen our
0.199 pelvic floor which is the is that what
0.199 the keegle exercises are yeah it&;s more
0.199 than Keel I mean Keel is the most has
0.199 the best PR of any sort of thing I&;ve
0.199 ever seen in medicine but yeah it&;s
0.199 pelvic floor exercise the Keel is one
0.199 pelvic floor exercise which is to
0.199 strengthen the pelvic floor and there
0.199 are others what is it so it&;s
0.199 essentially men never know like it&;s
0.199 it&;s not your fault women sort of kind
0.199 of know but even don&;t really know so
0.199 what it is is there&;s those same muscles
0.199 we talked about earlier is that you&;re
0.199 basically doing a rep you&;re squeezing
0.199 Contracting and relaxing just go to the
0.199 gym right you squeeze and relax very
0.199 similarly you are squeezing those
0.199 muscles and relaxing those muscles I can
0.199 do this sat down now yeah so basically
0.199 for men what I tell people is it&;s like
0.199 the feeling of when you&;re urinating and
0.199 you stop your urine stream that that&;s
0.199 you&;re using those same muscles so
0.199 that&;s one way another way to think
0.199 about it is if you were trying to lift
0.199 your penis off the ground without
0.199 without touching it ah okay go yeah okay
0.199 and the third one is you&;re trying to
0.199 hold in a fart so all those different
0.199 ways you&;re sort of getting those
0.199 muscles so the one thing I tell people
0.199 is they get the way they get it wrong is
0.199 they don&;t relax enough so just like
0.199 when you go to the gym you&;re not doing
0.199 rep after rep after rep you&;re actually
0.199 taking a break and you&;re letting your
0.199 muscles relax before you do another rep
0.199 same thing you have to squeeze for 5
0.199 seconds relax for 5 seconds right you
0.199 actually have to um relax and just like
0.199 any exercise you don&;t want to overdo it
0.199 so I tell people start lying down so
0.199 that the only thing you have to focus on
0.199 from a muscular standpoint is that those
0.199 muscles as you get good at them lying
0.199 down you then do them sitting up and
0.199 then as you get good at doing them
0.199 sitting up you can do them standing or
0.199 do them anywhere but like you&;re not
0.199 going to be like there you know I
0.199 remember the scene from Sex in the City
0.199 where like the character Samantha was
0.199 like I&;m doing my Keel right now like
0.199 yeah she&;s probably been doing Keel for
0.199 a long time and now she&;s so good at
0.199 them that she can do them while she&;s
0.199 brushing her teeth but it&;s not like
0.199 you&;re going to wake up one day and be
0.199 perfect at them just like any other
0.199 exercise so that&;s one exercise there
0.199 are certainly other things you can do to
0.199 strengthen your pelvic floor
0.199 traditionally things like yoga and
0.199 pilates have some core work that does
0.199 also help with the pelvic floor but
0.199 really I recommend if you&;re having
0.199 issues is to see a pelvic floor physical
0.199 therapist CU they&;re just like a when
0.199 you go to the gym alone you can do it or
0.199 you can go with the personal trainer
0.199 they&;re like the personal trainers for
0.199 your pelvic floor how do I know if I&;m
0.199 having pelvic floor issues what are the
0.199 symptoms so for like I said the obvious
0.199 ones for women are leakage are um having
0.199 prolapse for weakness in men we don&;t
0.199 often see as much but like I said you
0.199 might notice that your semmen is not as
0.199 forceful when it comes out um that&;s
0.199 usually the most common side sign of a
0.199 weak pelvic floor there&;s not as many
0.199 for men but in terms of a overly um High
0.199 tone pelvic floor what we worry about
0.199 then is then there&;s a whole host of
0.199 symptoms it could be as simple as just
0.199 having lower back pain um it can be that
0.199 you&;re having hip pain it could be that
0.199 you&;re having um pain with sex you&;re
0.199 having pain with erections pain with
0.199 ejaculation you&;re going to the bathroom
0.199 often got to go got to go you are
0.199 feeling like you&;re having difficulty
0.199 emptying your bladder or you are um
0.199 going very very often all of a sudden so
0.199 it can be a vague variety of these
0.199 symptoms and um so generally it&;s
0.199 important to get evaluated to see like
0.199 examine to get your pelvic floor
0.199 examined by a professional whether it&;s
0.199 a urologist a gynecologist a a pelvic
0.199 floor physical therapist someone who can
0.199 assess your pelvic floor
0.199 if you&;re having these issues because it
0.199 might be pelvic floor it might not right
0.199 how do they assess it if I go to a
0.199 urologist and say listen check my pelvic
0.199 floor M so in a man it would be a rectal
0.199 exam and so essentially that&;s how you
0.199 sort of feel the pelvic floor muscles so
0.199 what I tell young guys who come I said
0.199 look I can examine you um but I bet
0.199 based on your story like you&;re a young
0.199 guy you&;ve sort of had these new
0.199 stressors in your life um and it&;s un
0.199 and you&;re otherwise healthy it&;s
0.199 unlikely that you have a vascular
0.199 condition brewing and other things that
0.199 like it&;s probably likely so if you want
0.199 to uh avoid the exam because it can be
0.199 uncomfortable or and I will tell you if
0.199 you have pelvic floor dysfunction and
0.199 someone does an exam it will be
0.199 uncomfortable it will be painful
0.199 potentially because they&;re pushing on
0.199 those already tense muscles and it can
0.199 be painful so I tell people like you
0.199 might hate me tomorrow because you&;ll be
0.199 sore and you&;ll say what did she do
0.199 during that exam and I I kind of
0.199 preemptively tell them because I just
0.199 gently push right like I&;m pushing the
0.199 pad on my finger but that&;s enough to
0.199 sort of C a tension of the pelvic floor
0.199 muscle and cause pain where where you
0.199 like on the muscles on the pelvic floor
0.199 muscles so you can actually so if you if
0.199 you put your finger in the rectum if you
0.199 push right straight down in a man you&;re
0.199 feeling the prostate and if you push on
0.199 the sides at a variety of different
0.199 angles you&;re going to feel different
0.199 pelvic floor muscles like the levator
0.199 Ani and the trans operator muscles those
0.199 muscles are the ones that are part of
0.199 the pelvic floor we can&;t feel all of
0.199 them but we can feel some of them and so
0.199 um so that is sort of where we&;re
0.199 feeling
0.199 in terms of for the pelvic flooor
0.199 muscles okay so because I was thinking
0.199 if we go in the the rectum you&;ve got
0.199 the glutes there as well which are like
0.199 either side I guess so your pelvic Flor
0.199 is actually a part of your core right
0.199 but your glutes are further back they&;re
0.199 not going to be felt from there but
0.199 anyways if you think about your pelvic
0.199 florids actually you know people think
0.199 about their core as they abdominals but
0.199 we know that it sort of encompasses your
0.199 back your front and even your pelvic
0.199 floor is sort of part of your core
0.199 muscles got you okay interesting very
0.199 interesting in um on the topic of sizes
0.199 then one of the big things in men is
0.199 penis size M and one of the big
0.199 questions men often ask is is there ways
0.199 to increase my penis size there&;s in
0.199 fact a whole industry around penis size
0.199 increasing pumps and all kinds of
0.199 different things is it possible to
0.199 increase one&;s penis size yeah so it is
0.199 um in terms of looking at the evidence
0.199 uh the safest and most reliable way is
0.199 using a traction device and these are
0.199 devices that are made for um essentially
0.199 for penile lengthening but they&;re also
0.199 made for men who have something called
0.199 paronis disease where they may develop a
0.199 plaque on their penis and a curvature
0.199 and so there&;s one device that&;s
0.199 actually made that bends away from the
0.199 plaque to help sort of break down that
0.199 plaque um so there are two uses for it
0.199 but essentially these devices are just
0.199 like stretching the tissue over time and
0.199 so the original traction devices that
0.199 were studied you would have to use them
0.199 for 6 to 8 hours a day for several
0.199 months to see a 2cm in inrease in length
0.199 now um that may be enough for some
0.199 people they were like yes I definitely
0.199 want that and some people like you know
0.199 what it may or may I mean 2 cm is the
0.199 average some are going to be less right
0.199 so um it&;s sort of do you have the time
0.199 to do that do you want to do that but
0.199 now there are sort of newer devices
0.199 where they&;ve study them and use them
0.199 like twice a day for 30 minutes and
0.199 they&;ve seen some increase in Penal
0.199 length they&;re generally pretty safe
0.199 it&;s more about um you might have some
0.199 bruising from just putting the traction
0.199 device on and as long as you follow the
0.199 instructions you&;re probably not going
0.199 to hurt yourself is that penis pump no
0.199 pumps are different so pumps have not
0.199 been shown to increase pening what a
0.199 pump is it&;s got a it&;s got a a a
0.199 cylinder that you put your penis into
0.199 and it uses sort of vacuum technology to
0.199 sort of suck blood into the tissues and
0.199 then you put um if you&;re having issues
0.199 with erectile function you would then
0.199 put a ring uh at the base of the penis
0.199 to maintain the erection uh these don&;t
0.199 help with length they&;ve looked at them
0.199 in those cases they&;ve also looked at
0.199 surgeries and different types of things
0.199 to increase penal length and ultimately
0.199 many of them either have you know a very
0.199 high complication rate um or risks that
0.199 I would say are probably not advisable
0.199 for most people um you know I think that
0.199 in terms of penal lengthening people are
0.199 always like why would you want to do
0.199 that why a lot of people will sort of
0.199 poo poo people who want to change the
0.199 way their penis looks and I&;ve sort of
0.199 evolved in my thinking and saying well
0.199 you know what this is a big part of um
0.199 you know a man&;s identity and how he
0.199 feels about himself and I wish we had
0.199 something that was safe and easy for men
0.199 to do like we have breast implants but
0.199 we&;re not there yet right and so I just
0.199 want people to be safe in terms of
0.199 realizing what our limitations are at
0.199 this time and things may change over you
0.199 know as people become more interested in
0.199 this
0.199 area P the role that&;s played in our
0.199 perception of what a normalized penis is
0.199 do you know any of any data on what how
0.199 big people think a penis should be
0.199 versus how big the penises actually are
0.199 yeah so yeah most people think it should
0.199 be about 6 in so like we said the
0.199 average is around 5.1 to 5.3 in and so
0.199 when you look at the data in terms of
0.199 what people think it should be men think
0.199 it should be about 6 in in terms of
0.199 women where we found the data about what
0.199 they prefer um is sort of interesting so
0.199 when now that we&;re having um more
0.199 surgeries for
0.199 transmen one of the surgeries that we do
0.199 is a Neo phalus is we create a new phus
0.199 and one of the the types of surgeries we
0.199 do is we use a forearm flap and so it
0.199 can be very very long and very very
0.199 girthy and in fact they were doing these
0.199 surgeries and they realized that some
0.199 people were actually unable to have sex
0.199 with it because it was too girthy so
0.199 they wanted to then look at like well
0.199 how do we determine the right size and
0.199 length length and girth of this neop
0.199 fallis so that we you know they can then
0.199 have sex with it so what they did was
0.199 they looked at um the top you know the
0.199 top five to 10 sex AIDS or or toys that
0.199 women are purchasing online and they you
0.199 know you can imagine that when you think
0.199 of a dildo they can go from one you know
0.199 all the way to like the largest thing
0.199 you&;ve ever seen and the giri thing
0.199 you&;ve ever seen to like a normal size
0.199 and so when you have the option to pick
0.199 as many as you want right what do you
0.199 pick and so what they found was that
0.199 women tend to pick the length of about 6
0.199 in but as you know you&;re not putting
0.199 the whole device in there has to be a
0.199 handle or something so it&;s probably
0.199 around what the normal size is and the
0.199 girth was also around the average girth
0.199 of the male penis and so generally
0.199 speaking women tend to want what is
0.199 average or around average right and um
0.199 interestingly there&;s a product that is
0.199 available called onut I&;m not I don&;t
0.199 I&;m not sponsored by them or anything
0.199 but essentially you you for women who
0.199 have pain with penetration with men who
0.199 are too well endowed the men actually
0.199 wears it so that the entire phus doesn&;t
0.199 go in during sexual intercourse so that
0.199 it&;s more comfortable for the partner so
0.199 we know that sometimes it can be really
0.199 uncomfortable if it&;s too well- endowed
0.199 and so I think ultimately um while I
0.199 understand that pornography has made
0.199 people really self-conscious about the
0.199 length of their penis and I I&;m really
0.199 sad about that because I think you as
0.199 we&;ve talked about earlier clal
0.199 stimulation is the easiest way for women
0.199 to Climax and you don&;t need penetration
0.199 for that so in order to have pleasure
0.199 and give pleasure you don&;t need a large
0.199 penis and in fact some women may not
0.199 even care what size your penis is it&;s
0.199 more of a a societal thing that we talk
0.199 about right women joke about it women
0.199 talk about it I mean you can&;t go you
0.199 know you even I&;ve accidentally made
0.199 comments where I&;ve been like oh that&;s
0.199 great that like he has a large penis I&;m
0.199 like well I can&;t believe I just said
0.199 that like I&;ll say it and I&;ll be like
0.199 oh my God I can&;t believe that came out
0.199 of my mouth of all people and I think
0.199 it&;s just so ingrained in our brain to
0.199 be like oh like to celebrate really
0.199 well-endowed organs when in reality it&;s
0.199 not necessary and sometimes even painful
0.199 will my penis get smaller as I age so
0.199 not if you are healthy so in terms of
0.199 how do we maintain our penal Health
0.199 right your body does a really good job
0.199 of trying to maintain penal health
0.199 because over the course of a nighttime
0.199 men will get five to six erections three
0.199 to six erections over the course of the
0.199 night and that will happen whether you
0.199 have a sexual dream or not whether you
0.199 are sleeping in a certain way or not
0.199 it&;s because your body is sort of giving
0.199 blood flow to the area periodically
0.199 through the night whether you&;re having
0.199 sex whe that you&;re not you&;re getting
0.199 good oxygenated blood flow to the penis
0.199 now if you develop other conditions
0.199 where you cannot get blood flow to the
0.199 penis like you get high blood pressure
0.199 you get diabetes you get heart disease
0.199 and those arteries start getting
0.199 narrowed and then you stop getting
0.199 nighttime erections and you start having
0.199 difficulty getting erections over time
0.199 the tissues can change and they can
0.199 become what we call fibrotic and they
0.199 can become a little less spongy and less
0.199 elastic and so in those cases you can
0.199 see a little bit of shortening now
0.199 people will also see shortening because
0.199 they gain weight over the course of
0.199 their lifetime and as you gain weight
0.199 the penal the penis is not shrinking but
0.199 the the fat on the MS or the area right
0.199 above the penis is sort of getting
0.199 larger and obscuring how much penis
0.199 length there is there&;s a one of the my
0.199 around penis size is that you know if I
0.199 have big hands because you know these
0.199 aren&;t small hands if I have big hands
0.199 then I have a big penis or if I have big
0.199 feet then I have a big penis is there
0.199 data to support this idea that the
0.199 length of my any part of my body is
0.199 correlated to my penis SI yeah there&;s
0.199 one study it&;s a Japanese study where
0.199 they looked at only Japanese men uh so
0.199 take there are some limitations but
0.199 essentially they measured all these body
0.199 parts and penal length uh and uh what
0.199 they found was that nose length was
0.199 correlated with penal length not hand
0.199 length or foot
0.199 length so how do I increase the length
0.199 of my
0.199 nose yeah but uh I I thought that was
0.199 really interesting again nothing you can
0.199 control these things are PR genetically
0.199 determined to some degree and in fact
0.199 you know we talked about some Trends and
0.199 while we&;ve seen
0.199 um semen qual a sperm quality change
0.199 over the last 50 years we&;ve also seen
0.199 penal length change average over many
0.199 last I don&;t know the exact number but
0.199 50 years and they&;ve actually seen penal
0.199 length is increasing and they think that
0.199 this is because the onset of puberty is
0.199 changing and boys are getting exposed to
0.199 factors that are making them go through
0.199 puberty earlier and hence they&;re
0.199 getting more exposure to testosterone
0.199 and they&;re developing longer penises um
0.199 so sort of interesting theoretical thing
0.199 I don&;t know if that&;s true or not but
0.199 sort of what the theory is yeah I
0.199 actually read about that study it says
0.199 that a study shows that men&;s average
0.199 ere penis size has increased over the
0.199 last 29 years from 4.8 in to 6 in mhm
0.199 that&;s pretty pretty dramatic that&;s
0.199 huge yeah wait another 29
0.199 years you could be a Jesus J Christ but
0.199 I don&;t think women&;s vaginal lengths
0.199 are changing so I don&;t know what that
0.199 means oh yeah ah yeah it&;s interesting
0.199 because you when you we talked about the
0.199 vaginal length enlarging as someone
0.199 becomes aroused you mentioned that it
0.199 goes from about roughly about 3 in on
0.199 average to about 6 in that also
0.199 correlates with the size of the flaccid
0.199 penis to the size of the erect penis
0.199 going from about 3.6 in flaccid to about
0.199 5.1 to 5.2 in erect so you kind of see
0.199 that these two things are actually made
0.199 made for each other yeah they are I mean
0.199 I think in general like we&;re all we&;re
0.199 I mean we&;re we&;re designed right the
0.199 the biggest thing that we need to do as
0.199 a species is have children right that is
0.199 like sort of the the goal of life is to
0.199 propagate our species and so it would
0.199 make sense that we would be designed to
0.199 be able to do that easily a lot of
0.199 people are having this um new procedure
0.199 called label of plasy is did I pronounce
0.199 that correctly labioplasty labioplasty
0.199 what is this why so labioplasty is a
0.199 essentially taking the labia uh manora
0.199 and and and making them a little shorter
0.199 or smaller depending on what your
0.199 preference is and labas come in all
0.199 sorts of shapes and sizes it&;s the inner
0.199 lips of the vagina so they come in all
0.199 sorts of shapes and sizes sometimes they
0.199 will be um lopsided so one will be
0.199 longer than the other some will be
0.199 longer some will be smaller and
0.199 oftentimes we&;re seeing in pornography
0.199 really small labium manur and so people
0.199 will tend to feel like maybe they should
0.199 look look like that now not everybody
0.199 some people actually have discomfort
0.199 their labia are so long that they cause
0.199 friction or pain or discomfort in those
0.199 cases it&;s it&;s absolutely uh reasonable
0.199 but just like people have insecurities
0.199 about their genitalia when they&;re men
0.199 women also can have insecurities about
0.199 their labia as women and so labia plas
0.199 is essentially making those smaller and
0.199 more cosmetically appealing when women
0.199 desire that um but I think the the
0.199 important thing to take home is they are
0.199 so diverse they&;re as diverse as your
0.199 fingerprint your labia is unique to you
0.199 and it is not um there&;s no script of
0.199 what it should look like uh and so I
0.199 generally tell people if that&;s
0.199 something you want that&;s absolutely
0.199 fine but again this is not a pathology
0.199 or a bad thing this is something that
0.199 you know is more cosmetic and there&;s
0.199 been an 80% increase in the surgery of
0.199 labioplasty from 2015 to 2019 which is
0.199 you know a lot a lot it&;s a lot last
0.199 thing about um women in ejaculation in
0.199 the vagina is about squirting very
0.199 misunderstood like you know as a as a
0.199 man that doesn&;t have a vagina um I&;ve
0.199 seen squirting on pornography that I&;ve
0.199 watched I watch pornography I think
0.199 that&;s important to say I think a lot of
0.199 people do watch pornography um and in
0.199 the pornography that I&;ve watched the
0.199 woman squirts this liquid comes out and
0.199 like is that Seaman is that ejaculate or
0.199 is that something else what is it and
0.199 also should we be aiming to make our
0.199 partner squirt yeah let&;s talk about it
0.199 so this is important and it&;s actually
0.199 interesting I just I just had a
0.199 conversation with a researcher about
0.199 this because it&;s so misunderstood and
0.199 we still don&;t know like there&;s only
0.199 been like three or four studies looking
0.199 at female ejaculation squirting over the
0.199 course of our history there&;s different
0.199 types of fluids the vagina makes one is
0.199 obviously lubrication that&;s different
0.199 and that can be very copious for some
0.199 very not as copious for others uh that&;s
0.199 one type of fluid the other type of
0.199 fluid is female ejaculate now female
0.199 ejaculate is similar to male ejaculate
0.199 it comes from the skin glands that same
0.199 female prostate it is a small amount of
0.199 like sort of sticky white fluid that
0.199 women ejaculate um and so they will
0.199 release that fluid and it&;s not like
0.199 this copious amount of fluid that you&;re
0.199 seeing on
0.199 pornography uh the next type of fluid is
0.199 squirting and squirting is it&;s been
0.199 described as a clear colorless odorless
0.199 fluid that&;s emitted from the urethra um
0.199 when they&;ve looked at analyses of these
0.199 they found that there is what we call
0.199 PSA or prostate specific antigen now
0.199 that we think of traditionally as males
0.199 but the women&;s skin glands make it as
0.199 well now people are like is it P right
0.199 that&;s the big question and so in the
0.199 one where they looked at the analysis
0.199 they found that it was there was like
0.199 dilute urine and then another study
0.199 looked at like okay they scanned people
0.199 before squirting and after and they
0.199 scann their bladders to see like did the
0.199 amount of urine change and they said it
0.199 did and now it&;s urine but what we
0.199 really don&;t know and what we what what
0.199 the limitation is that you never so
0.199 women know when they squirt like they
0.199 they know it&;s not urine so if you talk
0.199 to enough women who are squirting
0.199 they&;ll be like you know it&;s not urine
0.199 I&;m sure it&;s not urine but where is
0.199 that fluid coming from that that&;s where
0.199 the question comes right and so like if
0.199 it&;s not urine it&;s coming from the
0.199 urethro like it doesn&;t make sense and
0.199 so uh this is Dr Barry korak who&;s done
0.199 a lot of research on orgasm he said you
0.199 know it may be water imbibition so when
0.199 you think of like fluid filling the
0.199 walls of the uterus and the vagina
0.199 during during or during the process of
0.199 arousal and that may be during climax
0.199 when you have actually contractions of
0.199 that fluid of those of those organs that
0.199 occurs during climax that it can
0.199 actually release this fluid I don&;t know
0.199 I think the jwelry remains out I don&;t
0.199 think we have a conclusive answer
0.199 because the studies are not perfectly
0.199 designed we have a closing tradition on
0.199 this podcast where the last guest leaves
0.199 a question for the next guest not
0.199 knowing who they&;re going to be leaving
0.199 it for and the question that&;s been left
0.199 for
0.199 you if there was one message that you
0.199 want your life&;s work to communicate to
0.199 the world what would it be and
0.199 why my message is that sexual health is
0.199 health and that we need to be
0.199 prioritizing our sexual health and
0.199 educate our young people about sex and
0.199 why because I think the impacts of
0.199 having negative sexual health or
0.199 negative sexual encounters can be so
0.199 dramatic in terms of physiologic
0.199 outcomes interpersonal outcomes work
0.199 productivity I mean it can be very
0.199 far-reaching and if we are able to
0.199 educate and Empower people we can change
0.199 the
0.199 world Dr Reena Malik thank you so much
0.199 for your time today and thank you so
0.199 much for um Illuminating a bunch of
0.199 issues on Sexual Health that I&;ve never
0.199 really understood or been able to
0.199 discuss before and I think these
0.199 conversations are so unbelievably
0.199 important because as you say there sex
0.199 sort of permeates every facet of our
0.199 lives and I think sometimes people
0.199 wonder why I spend a lot of time on the
0.199 show talking about sex when this is
0.199 called The Diary of a CEO but that&;s
0.199 because it&;s the same reason why I spend
0.199 a lot of time talking about health and
0.199 the brain and Neuroscience and
0.199 relationships and everything because
0.199 I&;ve come to learn that although I&;m a
0.199 CEO I&;m a business person all of these
0.199 things as you&;ve said feed into um my
0.199 ability to be a CEO and what is a CEO a
0.199 CEO is a human being a CEO is just
0.199 someone that is um has a sort of high
0.199 inity career we all have high-intensity
0.199 careers and we&;re these multifaceted
0.199 objects but some parts of these
0.199 multifaceted objects are still in the
0.199 shadows because there&;s stigma and
0.199 there&;s shame and there&;s not a lot lot
0.199 of Education around it and if I think
0.199 about my career as a whole um sex and my
0.199 relationships have been this huge um
0.199 huge part of it that once I focus to
0.199 more energy on and started investing in
0.199 in every other part of my career
0.199 improved every other part of my life
0.199 improved my health improved my
0.199 performance at work improved my anxiety
0.199 levels um dissipated and that&;s why I
0.199 think these conversations are so
0.199 unbelievably important and your work
0.199 that you&;ve done both in your your sort
0.199 of clinical practice but also what
0.199 you&;re doing on YouTube as well which
0.199 I&;ll link below so everyone can go and
0.199 see is allowing this information to be
0.199 accessible for everybody even those that
0.199 don&;t have um the money to go and drive
0.199 as you said to go see a therapist I
0.199 think that&;s an incredibly important
0.199 work and I&;m glad that you&;re a world
0.199 champion and and a a force behind that
0.199 so thank you so much on behalf of me my
0.199 team but so everyone that&;s consumed
0.199 your work and gain value from it thank
0.199 you I would just say that I always tell
0.199 people cuz I Mentor a lot of young
0.199 medical students and I I always tell
0.199 young women that the number one most
0.199 important decision you&;re going to make
0.199 is who you choose as your partner and
0.199 that&;s because that
0.199 person whether it&;s obviously
0.199 emotionally but also sexually right how
0.199 they support you in your life is going
0.199 to determine whether you&;re able to
0.199 succeed or not and I I just was talking
0.199 to another woman and and you know she
0.199 was like my husband&;s wonderful I was
0.199 like I&;m not surprised I was like you
0.199 don&;t get to be a successful woman and a
0.199 happy well adjusted successful woman
0.199 unless you either are you know very
0.199 happy being alone or you have an
0.199 excellent partner to support you because
0.199 if you have a toxic partner at home it&;s
0.199 not going to work
0.199 amen thank
0.199 [Music]
0.199 you
0.199 [Music]
0.199 oh
.

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Par Joseph GARCIA

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