Sex Scientist: What Women Actually Need To Enjoy Sex

Ta-da!

And that's not all.

So they actually did a study on pistachios where guys ate 100 grams of pistachios every day, and they saw a decrease in erectile dysfunction.

Because if you're not having erections, now you're no longer getting blood flow to your penis, and it will shrink over time.

And the same goes for women with their clitoris because it's the same type of tissue.

But also, when you look at people who have sex once a week, they live 49% longer than people who only have sex once a year.

49% longer?

Yeah.

And for every 100 orgasms men had, they lived like 13% longer.

Be right back.

Dr.

Rena Malik has become the world's most watched urologist after sharing everything you need to know about hormones, sexual health, and how to have better sex based on the data.

So how can you have the best sex possible?

So there's 4 main pillars of sexual health.

So pillar 1 is fuel.

So how you nourish your body.

And it's a huge part of sexual activity.

And then pillar 2 is strength.

When people think about strength, they always think about going to the gym and lifting weights.

It's much more than that.

So when you look at the data, any sort of cardiovascular exercise is going to improve sexual function.

It's going to improve blood flow to the penis and to the clitoris.

And then also, if you do 150 minutes a week, it is the same amount of improvement as you would see when you take a medication like Viagra.

And the other part of it is the pelvic floor.

It's undervalued, underdiscussed, and we'll get into that.

But pillar 3 is environment.

So things like stress, sleep, and endocrine disrupting chemicals.

For example, they looked at data on men sleeping 5 hours a night versus 8 hours a night.

Guys who sleep 5 hours a night, their testosterone drops by 15%.

Wow.

And then the last of the 4 pillars that we don't talk about enough is, and that's so important.

Reena, I wanna talk about morning erections, squirting, clitoral stimulation, and certain positions that are going to increase the probability that my partner has an orgasm.

Let's talk about all of that.

First of all,

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Dr.

Reena Malik, if somebody was to come up to you in the street having watched your videos online and they were a follower of the content you've produced over the last couple of years,

if you had to guess the question they would ask you, because it's probably the most frequent popular question you get asked, what do you think they would say?

They would say, what can I be doing right now to improve my sex life?

Who would be asking you that question and why do you think they'd be asking it?

I think everyone can agree that sex is something we enjoy.

It's something that's important that we want to have, right?

And there is, um, a desire to have good sex or feel like maybe you're missing out on something that could be even better.

So how can you have the best sex possible?

Because you hear all these people talking about amazing sex in the media, you might see it on pornography, you might feel like this is something amazing, why am I not having that?

I want that, right?

So on that point, you said it's obvious that it's important.

I think it appears to be increasingly not obvious that it's important.

Because when you look at some of these stats, I'll throw this graph that I've found here up on screen, and it shows that people are becoming more sexless, especially young adults between

18 and 30.

This graph is pretty stark.

Think about 50 years ago, there was no cell phones.

There might be some TV programs, but there was ads in between TV programs, and there was only certain TV shows you could watch at a certain time that you enjoyed, and then there was

nothing to watch.

There was no email, so you went to work and you came home, and there was really not a lot of communication between you and your co-workers or your job They made dinner with their family,

they hung out, and then maybe they watched a program or two, and then they lied down in bed.

They didn't have a phone to scroll on, they didn't have anything to keep them up.

And so then they were like next to their partner, and maybe they're talking, maybe they're cuddling.

And so there was more like opportunity and space for sex, right?

You— it was a thing that you did for enjoyment, for pleasure, for fun.

Now we have all these distractions that keep our mind away from sex.

In order to enjoy sex, you need to have space for it, to be able to enjoy your partner and feel like you want that, right?

And now we're sort of— there's not as much room for it.

That's one.

Two is younger people.

How are they dating, right?

How are they meeting each other?

They're meeting each other through apps, through, um, DMs.

And so they're not actually like really having these deep meaningful connections.

They're— there's a big hookup culture, there's a big like fling culture.

And imagine first-time sex for most people is not great.

You don't know your partner, you don't know what they like, and you may not able to express what you like.

You were never taught how to talk about sex, right?

So you don't know how to say like, hey, I like it like this.

And you may be self-conscious because it's your first time.

So you have like mediocre sex or bad sex and you're like, well, I don't really want that.

And there's just no like follow-through, right?

There's not a lot of education on what sex should look like.

The only education people are getting are from often erotic films.

And so they're seeing sex that's not real, that's curated, and they're trying to emulate that, and that's not pleasurable for most people.

And younger people these days are actually having a rise in more what we call rough sex.

So choking has become very, very common, as common as like— they call choking almost like vanilla sex.

So young people, if you look at data, like 60% of women and I think it's 20% of men have been choked during sex of that age group, like college age group, and Of those people who get

choked, 20% have been choked 25 times or more.

Now, I think it's fine if you're into that, but I can't imagine that that many people are into choking, and there's data to support that.

So when you look at qualitative data, this is by Debbie Herbenick, she's a sex researcher, and she did qualitative research and she asked people like, what is it like?

Do you enjoy being choked?

Tell us about it, right?

Women were like, yeah, it's okay.

Sometimes I'm scared because my partner is big and strong and I'm, you know, smaller and they have big hands.

Sometimes it's fine and sometimes I don't really care for it, but like, it's just a part of sex.

Just as normal as kissing, for example.

And so if you're having sex and you're doing things just because you think that's what your partner wants or what it should look like, and you're not enjoying it, well, that's not going

to be sex that you want to have.

That point you said about the lifestyles we lead and how that might be impacting our sex lives, I thought was really interesting because we don't talk enough about this.

But when you look at some of the data on this demographic, um, you know, people 30 and below, around that age, The extreme outliers are spending 8 to 10 hours on their phones, on social

media, and on the internet.

And roughly about 15 to 20% of young people describe their usage as almost constant, effectively scrolling during all waking hours while they're eating, while they're in the bathroom,

and before they go to sleep.

So, and I was wondering from a dopamine perspective if there's correlation between these like dopaminogenic activities that are now like hijacking our lives, whether it's short-form

videos on social media, whether it's pornography or food, whether it's having an impact on what then happens in the bedroom and our performance in the bedroom.

If you think about what you need to have good sex is you need to be sort of in the mind space for sex.

And if you're constantly like hijacked by all these other things, you're never like really getting in the mood, right?

You're just like, oh, I'm gonna be turned on when I see my partner and we're gonna have sex and it's going to be over.

And it's just really a mechanical thing at that point, right?

You're not actually— you're just trying to get an orgasm.

You're not actually like spending the time to enjoy and to experience that fully because you're just so like, you're just, your brain is always doing something else, right?

Because people are constantly scrolling, like every 60 seconds there's a new video, there's something else.

And so it's really hard to focus.

And so that can translate to the bedroom where you're like, you're having sex, but your brain is somewhere else thinking about something else you saw or something you have to do or

something you wanna see or something you wanna look up, whatever it is, but you're not really in, there in the moment.

You're just going through the motions.

And so I think that's really where the challenge is, is that people are becoming increasingly distractible.

I find it really hard, I'm gonna be honest, to have sex if I've had like a really, really busy day or if I'm really, really thinking about something.

I almost have to— I have to like intentionally create quite a lot of space.

Exactly.

In order to be able to be in the mood.

Yeah, be aroused, right?

It takes like time and energy.

I think I appreciate you for saying that because a lot of people think that men are ready to go at any moment.

And that's not fair, right?

Because everyone needs time to be aroused.

It's not just instant for everybody, especially when you have a lot of work stress or life stress or other things going on.

It's actually like you have to make time and space for it.

Yeah, because as a man, you've got to get an erection.

And I always think that an erection is a consequence, usually, especially when it comes to sex.

And I'm not talking about morning glories here, but an erection is a consequence of like a story Mm-hmm.

You use the word aroused.

Mm-hmm.

There's like a story in my head which makes me go, oh, that's kind of hot.

Yeah, you need something, you need some stimuli, right?

You need to think about something, see something, smell something, feel something, right?

You need to just be together and sort of allow yourselves to be intimate before that sort of desire and arousal come together.

And for me as well, it's not just touch, like that doesn't necessarily— for me it really is quite like a psychological thing.

I was wondering if this is— there's any data around this, or I mean, just even anecdotally, like, people get aroused in very, very different ways, don't they?

Yeah, absolutely.

I mean, some people are very like visual, so they, you know, they see their partner and they get aroused very quickly.

Basically, when you get aroused, you need to be in a parasympathetic nervous system state.

So in order to get an erection, you need to be in the state which is like rest and digest.

So if you're stressed, if you're thinking about other things, if you're essentially on the go, you are not allowing your nervous system to calm down.

And so And for some people, that's a whole bunch of different things.

Some people can switch more easily into that state and some people need more of like, you know, to feel either mentally stimulated or they need to have some associations.

Like it might be like they need a certain scent, they need to like relax their body, they need to like go take a bath, whatever it is.

But some people need different things and knowing what that is for your partner is super important, right?

Because then you can incorporate that.

Everything is scheduled in our lives, right?

And then you're like, oh, but now sex is like, the last thing on the schedule, right?

And like, I don't even think about it.

Like, oh, okay, now, yeah, maybe let's have sex.

But it's like, if you actually make time to be intimate, allow yourself to be in that brain space, be together, that's when it can actually happen.

Especially when you've been in a long-term relationship, it doesn't come as easily, like spontaneously, which we call spontaneous desire.

It comes more of as a response to these other cues that allow you to feel desire and to feel aroused.

Hmm.

I also think— I was thinking about a previous relationship I had where

on the days where I'd been like working very hard and I was like tired or stressed or had been traveling and I was jet-lagged, I think there was also— because I didn't see this person

often, there was also an expectation that when I did see them, we were gonna have sex.

And, um,

that was, that was very hard because actually the expectation of it stressed me out more.

Yeah.

And that can happen, like, if it becomes the elephant in the room it can become a little bit heavy, which then is sort of counterproductive to performance.

And this is, you know, sort of a variation on performance anxiety.

So when you feel like you have to perform on demand and maybe you're worried it might not happen, it creates this vicious loop, right?

So you may maybe have trouble with an erection, or maybe it's like, I, I'm expected to have sex but I really can't get there mentally.

Whatever it is, now you're thinking about that, right?

And then you're with your partner, you're like, oh my God, am I gonna have trouble?

You're not enjoying the pleasurable sensations or the visuals or like feeling each other.

You are literally thinking in your own head about how you're going to respond.

And then that anxiety makes it so that you can't get an erection or you can't be aroused.

And so now you're like anxious and you're not focused.

You're almost spectating.

You're just watching yourself have sex.

You're not actually like in the moment.

So then, you know, you have a negative outcome because when you're stressed, your sympathetic nervous system is on, right?

You can't really get an erection or you can't really get aroused.

And so then you're like, oh man, now I've let my partner down.

Now I haven't performed, which I hate that word, but like performed the way I should or I'm expected to, and now something's wrong with me.

And now that just keeps going in a vicious cycle.

Have you spoken to people that have experienced this?

Absolutely.

It's common, very common.

I tell people anytime you have problems in the bedroom, it stays with you.

So how do you break the cycle?

Yeah, so I tell people when you're with your partner, take the pressure off, um, penetration.

Just explore each other's body.

Do what's called like sensate focus, like explore the rest of your body, figure out other erogenous zones, other things that can turn you guys both on that don't involve erections and

penetration.

And then once you realize you're focused on that, you're really like exploring, enjoying, playing, you're having a good time and you're not thinking about your erection.

Now you'll notice, oh, the erection just comes, right?

And then once you get to that point, then you can start even touching genitals, but still hold off on penetration.

And then after you realize like, the genitals are, you know, it's always working the way I want it to, and I'm not thinking about it, I'm not stressed, then finally you can then introduce

penetrative sex again.

So it's just sort of like a graduated, sort of slow advance into, um, you know, having sex again, but now kind of focusing on being more present and mindful and enjoying those sensations.

I think a lot of people will be able to do that, but there's also a big contingent of people that just avoid sex.

It's, it's a sore subject in their relationship for whatever reason.

Both partners don't know how to communicate.

They haven't got the tools to talk about these kind of things openly and honestly.

Do you see that a lot as well?

Absolutely.

I mean, what do you hear in this regard?

So I think it's really sad.

I see people come in and they're like— I ask every patient, like, are you, are you having sex?

Why not?

Right?

Because sometimes they'll say no, and most doctors are like, okay.

But I always say, why not?

Right?

Why are you not having sex?

Is it because you're having an issue?

Is it because you're having pain, what's going on, right?

And oftentimes, I'll hear from people that my partner is just not into it, and I just sort of gave up, and I'm just— we just don't have sex anymore.

You know, for me, that's a red flag because sex is a huge, important part of our lives.

It is a way we connect with another human being.

It's also telling that things are working really well.

So when you have good sexual function, meaning you get an erection well, or you get aroused well, and you have a good orgasm, and everything feels good, that tells me that, hey, you've

got great blood flow to your genitals, your nerves are working great, your hormones are sending signals.

Like, all these things are good, right?

But also, sex is more than just the act of sex.

It also helps you live longer.

So there's been a few studies looking at sex and longevity, and when you look at people who have sex once a week compared to people who have sex once a year, the difference in all-cause

mortality is 49%.

They 49% longer than people who only have sex once a year.

49% longer?

Yeah, yeah.

Be right back.

No, I'm joking.

So, and, but even if you're doing like less than once a week but more than once a year, it still improves your longevity.

There was actually an interesting study in 1997, I think it was, where they looked at the number of orgasms men had, and they found that men who had, for every 100 orgasms men had,

they lived like 13% longer.

They had a 13% increase in life expectancy.

And so it was really interesting to me to just, just showing you that like, this is not just an act of pleasure and fun.

It is obviously, but it's much more than that because people who are having sex clearly have better health.

And there, this connection with people, I mean, loneliness is a big issue right now.

The WHO made loneliness like an epidemic.

So they've said that loneliness is as bad as having like 15 cigarettes.

And so sex is a way to feel connected to another human being.

On that data, we're not saying that it's the sex itself that's causing people to live longer.

We're— I guess it's, it's hard to establish causation in terms of— yeah, it's not necessarily sex, but they've looked at, like, they try to control for other things like age and comorbidities

and all these studies.

And, um, it's also like sex is a cardiovascular workout, right?

For many people, as a cardiovascular workout, you are getting a physical, physical activity with your partner.

Um, you are increasing your heart rate, you are doing these things that are also good for your body.

And the fact that you're able to have sex, right, tells me a lot about it, right?

You're, you're able to hold a certain position, you're able to maintain this level of activity without getting short of breath, right?

Like, these are things that having sex, you know, keeps you healthy to some degree.

If I want to make sure that I have great sex, what are some of the foundational things that I need to be thinking of in terms of my lifestyle?

Yeah, so there's 4 main pillars of sexual health.

I like to think of it like your sexual health is your house and these pillars are the foundation.

And if you don't have the foundation, it doesn't

No matter what else you do, you can try to do everything else to patch up your house, but it's always gonna break again because the foundation's not there.

So you've got fuel, and fuel is how you nourish your body.

A lot of the data I'm gonna talk about is about men because there's just a lot more data on men and sexual health.

But that doesn't mean that the same things don't apply to women.

There's just less, less robust data on it.

So when you talk about fuel, the Mediterranean diet is the most studied diet, so including things things like healthy fats, like avocados, leafy greens, nuts— and we're going to talk

about nuts in a little more detail— these things are super helpful.

And obviously having lean proteins, having an abundance of fruits, which we're going to talk about as well.

There's a study called the Health Professionals Follow-Up Study.

There was a 20,000 men, and they saw that men who adhered to a Mediterranean diet had a 22% lower risk of erectile dysfunction.

So what specific things in that diet, right?

People are always like, what are the superfoods I need to have?

Almonds are great, but pistachios— they actually did a study on pistachios where they looked at 100 grams of pistachios.

Guys ate 100 grams of pistachios every day, and they saw a decrease in erectile dysfunction.

So pistachio nuts will make my penis harder?

I mean, so I always say, like, I don't love to talk about superfoods because then people are like, oh, I just gotta eat pistachios and it's all good, right?

It's, it's part of a whole diet, but certainly having nuts nuts because they have great omega-3s, they have healthy fats.

These are the reasons that they, they really sort of improve diet.

Fruit, um, anything that has sort of flavonoids, so like colorful fruit like blueberries, citrus fruits, um, lycopene, which is red fruits, all of these things improve antioxidants

and also have been shown to reduce the incidence of erectile dysfunction.

So having stronger erections, specifically blueberries actually came out to have I think something around 20% also improvement in erectile function when you're eating blueberries regularly.

So lots of, I think, things in the diet that can be helpful.

Also fiber is one that we don't talk about enough.

When you eat fiber in your gut, it converts to short-chain fatty acids.

These short-chain fatty acids then sort of have these endothelial protective mechanisms.

They protect the blood vessels, they make them healthier.

And so when your blood vessels are healthy, you get better metabolic health.

So you get less diabetes, less high blood pressure, less high cholesterol, and these, all of these things these things together improve erectile function.

So, I think making sure that you meet the criteria for fiber, which is 38 grams for men, 25 grams for women, is really, really important.

And then obviously managing your calories in a maintenance, right?

Because we don't want to gain weight because excess adipose tissue or excess fat also puts you at higher risk for erectile dysfunction and other sexual dysfunctions.

Next, we have strength.

Alright.

So there's strength where we think about cardiovascular and resistance exercise, but there's also pelvic floor strength.

So we'll start with cardiovascular exercise.

The one study that's quoted very often is 150 minutes of exercise, of cardiovascular exercise, moderate intensity.

When you look at the improvement in erectile function scores, it is the same amount of improvement as you would see when you take a medication like Viagra.

So literally, if you do 150 minutes a week, you are getting the same improvement as you could get with a medication potentially.

And so I tell people like, look, if you don't wanna take a pill, this is a great way to improve sexual function.

Now you might say, okay, well, I, you know, maybe you're listening and you have heart issues and you can't really do moderate intensity exercise.

They actually looked at that too.

So there was a group where they looked at men who had heart disease and they weren't really able to do moderate intensity exercise.

So they did like a 5-minute warmup, they did 20 minutes of walking, and 5 minutes of a cooldown.

And with this supervised protocol, they still improved erectile function by 70%.

So it's all relative to where you're starting, but any sort of cardiovascular exercise that's above what you are capable— like what you're doing now— is going to improve sexual function,

particularly erectile function, because it's going to improve blood flow to the genitals, going to improve blood flow to the penis, it's going to improve blood flow to the clitoris

for women.

So So that's where cardiovascular exercise is so, so important.

In terms of resistance exercise, now these little weights are probably not sufficient for doing much, especially for men, in terms of improving muscular health, but obviously we're

not gonna bring like really heavy weights to the table here.

So one, we know that resistance training is significantly correlated with testosterone.

So when you do heavy resistance training of your large muscle groups, so like your lower extremities, your glutes, you're doing like Olympic deadlifts, squats, that sort of stuff, you

actually see improvements in testosterone.

Now, it's not gonna be like you do it once and you get this sustained improvement, but continuous sort of regular resistance exercise improves testosterone.

There's also data that shows that when men do resistance exercise to maintain muscle mass, so we know that muscle mass decreases about 7% every decade of life after around 40.

When you maintain it through resistance exercise, they're 3 times less likely to have erectile dysfunction.

[Speaker] Oh, really?

So they maintain erectile function, they maintain sexual desire, they maintain satisfaction with sex.

I read a quote yesterday that said, "Muscle is medicine." And I thought, hmm, that's really true based on everything I've learned on this podcast around, you know, like glucose control

and testosterone.

And now you're telling me about your sex life.

Yeah, it is.

I think people push back because they think like, why should I have to go to the gym?

But our lives have changed.

We sit at a computer or we sit at podcasts or we sit all the time.

We're not moving.

We're not doing manual labor, which is what a lot of our historic history is, right?

Doing manual labor, farming, doing things outside, being physical.

And we are meant to be physical.

We're meant to lift heavy things.

We're meant to move our bodies, and we're just doing less and less of it.

So I think it's so important.

The other thing is we wanna prevent sarcopenia.

So sarcopenia is muscle loss.

And when you have muscle loss, that also increases your risk of having sexual dysfunction.

What about the pelvic floor?

Like, how does that come into this story of the muscles?

Oh yeah, so we missed that part.

So the pelvic floor, here is your pelvis, right?

It's this bony structure where all your organs live.

This is a female.

So I'm taking out the internal structures, which is the uterus, the rectum, and the bladder.

And so that's what sits inside the pelvis.

And so you can see this bowl of muscles here, right?

Interesting, I've never seen that.

And you can see them from the inside and you could see them from the outside.

That's your anus.

And in this person, there's a vagina.

So that's the hole for the vagina.

So you can see that your anus and your vagina run through the pelvic floor.

And in men, your penis runs through the pelvic floor.

And so this, let me see if I can show you on this model.

In this model, you can see they kind of show you the muscles here on the side.

Yeah.

So these are your pelvic floor muscles that are around the penis and the anus.

Ah, okay.

Okay.

These structures are very important for a variety of things.

They attach to your bony landmarks here, your hips, your sacrum, your pubic symphysis.

They attach to all these, and they sort of just work in the background for most people.

How they affect your sexual function is when you orgasm, these muscles contract and release at a rhythmic contraction of 0.8 seconds.

And so you may feel that, right?

There's like this pulsing feeling when you orgasm, and that's these muscles sort of doing that.

And when men ejaculate, the pelvic floor muscles are contracting to help shoot the ejaculate out.

They squeeze when you need to keep things in, so they'll keep urine in, they'll keep your stool in, and they relax when you need to pee and when you need to defecate.

So when you're trying to hold a wee, you're like tightening your pelvic floor muscles?

Correct, correct.

But these are also responsive to stress.

So just like people get TMJ, where they get tense in their jaw because they are stressed and they like sleep at night and they clench up their jaw, they don't really know they're doing

it.

The same thing can happen.

These muscles can get very tense.

Tight, or they can get misaligned.

So say you have a hip injury, or say you have a back injury, the muscles can compensate by tightening up.

And so a lot of people unknowingly have tension in these muscles, and it can present in multiple different ways.

It can present with back pain, it can present with constipation, it can present with urgency frequency, because remember, your bladder is sitting right here on top of these muscles.

So when the muscles are tense, your bladder is feeling like there's something, something activating it.

And so it's like, oh man, I gotta pee, that means I have to pee.

This tension is telling my bladder I have to pee.

But it's really that your bladder is not that full, it's that these muscles are telling you to do that.

You can also have trouble peeing because you can see that your urethra goes through here, and if the muscles are really tight, sometimes it can be difficult to urinate because it clenches

off the pee.

And then with sex, it can cause pain.

If they're really tight, it can prevent blood from getting to the genital organs.

So for men, men, they can have erectile dysfunction.

For women, they can have difficulty getting orgasms or difficulty getting arousal because they're not getting blood flow to the clitoris.

Sometimes it can also cause premature ejaculation in men.

And so these muscles are so important, and all we hear about is Kegels.

And Kegels are exercises to strengthen these muscles, but Kegels are good when you have a normal pelvic floor, meaning like there's no tension, it's completely normal, it's acting normal,

you're not having any symptoms at all.

But if you have any of the symptoms I talked about, doing Kegels might make it worse because you're now tightening muscles that are already tight.

We also talk about pelvic floor relaxation, doing exercise to specifically relax these muscles.

So that can be diaphragmatic breathing, that can be doing like a figure four stretch, that can be doing happy baby pose, which are yoga poses, or child's pose.

All these things can sort of stretch and lengthen these muscles so they can learn to relax again.

Now, when it's really bad, you have to go see a pelvic floor physical therapist who can really work with you to identify which of the muscles are maybe more dysfunctional and maybe

work specifically on those.

Um, but I think it's, it's so important.

It's undervalued, underdiscussed when it comes to sexual function.

It's a hugely important part of sexual function.

How many people are struggling with these issues, specifically the, like, erectile dysfunction issues, and what age are they?

Yeah, so it starts early.

I think there's always been a sort of a disconnect where we think young guys don't have this, or if they have it, it's all in their head.

That's not Necessarily true.

Many young men do develop erectile dysfunction because of biologic factors, but the data is really robust on older guys.

So above the age of 50, we see 52% of men having erectile dysfunction, which is— 52% of men.

Yeah.

And it goes up 10% every decade.

So 60% of 60-year-olds, 70% of 70-year-olds.

So erectile dysfunction continues to worsen.

This happens because one, you know, our blood vessels get older, they get stiffer, they're not functioning as well as they should.

And we're seeing also a rise in all these other comorbid conditions like diabetes, cholesterol, high blood pressure.

All these affect how healthy your blood vessels are.

And so with these, they see the problem in their penis, or in, in women's case, in their clitoris, before they see heart disease or strokes or brain issues or dementia.

I think this is worth pausing on, which is a erectile dysfunction problem is a— often a symptom of a cardiovascular issue, right?

Yeah, we call it a canary in a coal mine.

So it is like telling you that something bad is coming.

So the data would support that when you have erectile dysfunction, if it's because of an organic reason, right, not psychogenic— but most people, I think, have a combination of both—

that within 3 to 5 years, you will start developing issues with your heart.

And so it precedes those issues.

And if 7 years later, 14% of those guys will have a heart attack.

And so it's really an opportunity.

Sexual problems are an opportunity to look inside, to figure out what's going on, and to investigate, and to change your life.

And when you say erectile dysfunction, we should probably define what that means, because there's gonna be a lot of guys sat at home now thinking, oh my God, like, my penis is a bit

softer than usual.

Yeah, so erectile dysfunction is defined as the inability to maintain an erection that's sufficient for intercourse.

So you can get an erection, but it goes away before you ejaculate or climax.

And so that's typically— I think it's really important to differentiate that from something like premature ejaculation, where you climax too soon.

So you ejaculate before you want to.

But that doesn't mean that you have a problem maintaining your erection.

That's a whole different process.

I've got a friend— people are gonna think I'm talking about myself because I use that phrase a lot.

I've got a friend friend.

He's, um, he's almost 40 years old, and I've heard him say on several occasions that he's lost his erection during sex.

Is that erectile dysfunction?

But what if he can keep his erection watching porn?

Well, so that's more multifactorial, right?

So I think if you lose it once or twice, right, most guys will have an issue where they lose an erection at some point in their life.

I think the important thing is not to catastrophize.

It's a problem when it becomes a routine Now, if someone is telling me, hey, I can watch porn and maintain my erection, but I can't with a partner, there's multiple different reasons

for that that could be at play.

One is that there's no pressure, right?

You're by yourself, you're watching porn, there's no pressure of performance, there's no anxiety of performance.

So that may be part of it.

Other thing may be that that level of arousal that you're getting from porn, if you're watching, like, let's say, the same kind of porn every time, you're masturbating the same way

every time.

May be using a firm grip, or some people will masturbate like facing the bed or, you know, against hard objects.

And so that— Against hard objects?

Yeah, like their fist or something.

And so that can't be replicated by a person, right?

You can't replicate those behaviors by a vagina or a mouth.

If you become habituated to a certain thing that turns you on, and that's the only thing that really gets you going, and that's, that's something that you can't really get with your

partner, then it will be difficult to reach the level of arousal that you need to get an erection.

Okay, so two questions then.

So that doesn't count as erectile dysfunction if you can get an erection watching porn but can't get it with your partner?

Yeah, it may or may not be.

So if you wake up with your morning erection, that's great.

That's a sign— that's when there's nothing else at play, right?

You are just— that tells me that your body's functioning well.

You've got good blood flow, good, good hormones working, got a good amount of testosterone, and your nerves are working well, and you're getting a good erection.

Now, morning erections or nighttime erections are normal and they're healthy.

So when you're a young boy, you get actually like erections 3 to 5 times a night, and they can last up to 40 minutes long.

So you can spend a lot of your night with an erection.

When you get older, like in your 40s, that drops to about half the time.

So maybe erections are a little shorter, that they may— maybe max out at 30 minutes, but sometimes they're shorter.

You should still be getting 3 to 5 erections a night.

You You won't know all of these, but typically you wake up with a morning erection.

And so if you're not getting morning erections, that tells me that, hey, there's something going on that we should address.

And on your other point about how you masturbate impacting your sex life, I imagine that applies to men and women.

Absolutely.

And are you saying that if there's a particular way you get yourself off in private that is very hard for the other person to replicate, you might become desensitized —You might just

get habituated.

I don't think desensitized, but habituated is like you might just— your body just might respond really well to that particular stimulation.

Now, that's not inherently a bad thing, right?

If that's what gets you off and you and your partner are okay with you doing that together, right?

You may mutually masturbate together and that's fun for you and you guys enjoy it.

There's no problem with it.

It's just knowing what's going on, right?

And sort of deciding like, okay, if this is a problem, let me try to Diversify what I do during my solo sex period.

So let me take a little break and kind of try something, you know, just not masturbate for a little while and come back to it later.

The fact that we get an erection in the morning, does that mean that we're supposed to have sex in the morning from like an evolutionary perspective?

Not necessarily.

It's just, it's the way your body releases testosterone is one of the reasons this happens, is overnight your body is making more testosterone.

That's when your body sort of has nocturnal testosterone production, and so it's highest in the morning, which is why very often you get a morning erection.

And, you know, it just means that some people will have more desire also in the morning because testosterone is a hormone of desire.

Is it the same for women?

Yeah, so women, um, women also have nocturnal clitoral tumescence, same sort of pattern.

And they won't necessarily know it, right, because they can't visualize it.

But, you know, you can— some women may know, sort of feel that pelvic congestion, or like feeling that there's a bunch of like blood flow in the area, but most will not, and that's

okay.

But your body protects itself.

So you've heard the term "use it or lose it," right?

People are like, your body's protecting itself.

You don't have to have sex.

If your body is healthy, it will do this all night to keep your genitals healthy.

It will make sure that your genitals are getting blood flow even if you're not having sex.

But if you stop having those nighttime erections, now it becomes more of a problem because over time, say you stop having erections or clitoral tumescence for months, years, right?

And then there's no blood flow to those areas over time.

And actually, I can show you here.

This is a pelvic model.

And here, this, this purple thing here is called the corpora cavernosa.

And this is like a really nice spongy tissue that fills with blood.

And when it fills with blood, it expands and lengthens.

And then the blood stays there until you're done with your stimulation, and then it goes back.

And so if there's no healthy, fresh blood getting to the penis on a regular basis, either through nighttime erections or through sex with your partner, then you will get fibrosis of

these tissues.

That means there's a little scar in the tissues.

And then over time, you might see some shrinkage of the penis.

And so it is really important to maintain also good health of these tissues.

And the same goes for women with their clitoris because it's the same type of tissue.

In fact, if you look at the clitoris, it is— this is the part that you see.

We don't really have a clitoris, do we?

Is it that one there?

This is the uterus.

You're going to keep that in?

I can already show you here.

There we go.

Does this count?

She told me.

This is crazy.

Okay, yeah, this is good.

This is good.

Okay, they told me.

That's a little— that's, uh, yeah, okay.

They

told me.

You're not gonna live that one down.

You asked the team where the clitoris was.

Did you ask the team where the clitoris was?

Well, I'm worried about who said that too.

Um, okay, so, so let's talk about the female anatomy.

This is a pelvic model, and here, um, you can see this is the vagina, this is the urethra where you pee from, this is your labia minora, and you can't see the labia majora, but they

would be out here, right?

So inner lips, outer lips.

Now, this up here is your clitoral glands.

So it's the same as the glands of the penis.

And so this is all you see, right?

It also has a little covering, which you can't see here.

Just like men have foreskin, women have a clitoral hood that covers the head of the clitoris.

And so when you look at the clitoris on the inside, which we can't see perfectly here, but I'm gonna just take this up, um, it actually goes all the way back back like this.

So if you were to feel from the vagina, from the vaginal side, it would be at the very top of the vagina going all the way back.

These are the— these blue things are the clitoral bulbs here, um, and these are the legs of the clitoris here on the side.

And so this is essentially the homologue of the penis.

So if I take the penis, and we don't have a, uh, like a full model here— homologs mean— so homologs means that they're essentially the same structure, they're made from the same cells,

but they're in the and the female.

So here you can see, this is— if this is your penis, this is what you see up to here.

This is the bone, this is your fat up here, and then here it goes deep into the pelvis.

And so here's your testicles, right?

And so below the testicles, this area, the perineum, you also have penile tissue sort of that you can palpate from this side, um, that's coming all the way down.

And if you had sort of a 3D model, you'd see that it forks out just like the clitoris So does clitoral stimulation feel like stimulating someone's tip of their penis?

Exactly.

And so you could think if someone just stimulated the head of the penis, they, uh, it would be fine, it would be nice, but it's probably better if you stimulate more of the clitoris

or more of the penis.

That's why you could stimulate obviously the external, the clitoris, but you can also stimulate from the inside.

And some people are more responsive to that than others.

What you hear of is like the G-spot or the G-zone, right?

And the G-spot or G-zone

is if you were to go in the inside of the vagina at the top side, which I can't really stick this in here, but it would be about 2 centimeters in at the top.

And that's because that's an area where there's a lot of nerve endings.

One, you can palpate the clitoris basically throughout the entire anterior wall, but also there's the Skene's glands, which are these glands that sit underneath the urethra, and they're

the homologue of the male prostate.

And so they're right there, and then the vagina is there.

And so that's an area that can be very enjoyable to stimulate.

It's not necessarily always going lead to orgasm, because some people have different sort of distance between the clitoral body and the vagina.

So some people have less distance, may feel it better than some that don't.

But ultimately, that's why that area is so sensitive for many women.

On this point of, um, morning erections, I was thinking much of the reason why I've always been cautious of having sex in the morning, or even like masturbating in the morning or anything

like that, is I'm worried that it will cause a dopamine crash which will make me feel lazy and lethargic.

Well, so when you think about what happens during an orgasm is you have this release of dopamine and then your prolactin goes up and sort of like everything calms down.

Now, some people feel a sense of clarity.

They call it post-nut clarity, right?

They feel clear.

They feel like motivated to do stuff.

They feel excited to go do something else and they sort of move on from what they're doing.

There's some people who feel post-coital dysphoria.

They actually feel sad or they feel depressed after they orgasm.

And we don't know exactly why this happens, happens, but it is because of this dramatic change in sort of neurochemical signaling in the brain.

And for those people who have it, it can be days where they sort of like feel bad.

It can be hours where they feel sad.

And so it can be really traumatic.

So Pillar 2— what's Pillar 2 of the 4 Pillars of Men's Sexual Health?

We talked about strength.

Okay, so we did strength, we did fuel.

What's Pillar 3?

Pillar 3 is environment.

So we can start with the easy stuff, and that's stress, right?

Everyone knows stress is bad, but I think the thing is people just think like, ah, I'll just— I'll deal with it.

Everyone's stressed.

Like, what's— it's normal to be stressed.

If you are chronically stressed, that means your cortisol is raised all the time, which is dampening your testosterone, which is also keeping you in the sympathetic state, and you just

cannot get in your mind space and in the nervous system place to actually have sex.

So that's super important.

And I think, you know, there's lots of different ways to alleviate stress.

You've got to figure out what works for you.

For some people, using a stress ball, even just at work.

And I think part of it, you can actually incorporate some intimacy.

There's some evidence, you know, the Gottmans have been on your podcast, doing a 20-second hug.

So standing with your partner or loved one and hugging for 20 seconds on your own, like independent gravity, actually helps alleviate stress and break sort of a stress loop, doing a

6-second kiss with your partner.

And so it seems like 6 seconds, no big deal, but actually if you time it, it's like, hmm, if I'm just doing a kiss and I'm not like actually, it's a little bit longer than normal.

And so these sort of small things can help alleviate stress.

Any type of movement can be really beneficial.

Going to the gym is great.

Breathwork as well.

The other thing is just having like interactions with people.

And so that's where we're becoming more isolated, but even just like talking to the barista or talking to someone at the grocery store, this again tells us It tells your brain that

you're in a safe space, like you're talking to someone, you're having a normal social interaction.

So, and then being creative.

And we've been trying to work with this, uh, work on this with our kids because there's so much external stimuli all the time, right?

They wanna play video games, they wanna watch TV, they wanna play sports, but we want them to be bored and be creative, like come up with creative ideas to keep themselves interested

and engaged in a different way.

So I think that's so, so important.

And outside of stress, sleep.

Sleep is, there's just so much abundance of data on how sleep affects hormonal health.

They looked at data on men sleeping 5 hours a night versus 8 hours a night.

So you take the same guy and he sleeps 8 hours, then you do 5 hours for a few days.

His test for a week, his testosterone drops by 15%.

That's like as much testosterone drop as would happen with 10 years of life.

And do you know how long they did that for?

How long?

It was short, it was like a week.

So a week of sleep deprivation, will tank your testosterone.

And sleep apnea is another one that I think people, one, don't realize they have, and two, don't realize that fixing it could actually improve their hormonal health.

Wait, so does this mean that people who have chronically bad sleep probably have low testosterone?

Probably, yeah.

And what is the symptoms of low testosterone?

So low testosterone, they're sometimes very vague.

So it can be fatigue, it can feel brain fog, it can be depression, it can be low desire, it can be erectile dysfunction.

That's what people always think, it's just erectile dysfunction.

Function, but it's this whole constellation of symptoms.

It can also be increased fat mass, decreased muscle mass.

So all of these things can happen because we have testosterone receptors all over our body.

We have them in our brain, we have them in our muscle, we have them in our bone.

And these can all have really serious consequences when it's low.

When you have sleep apnea, and how you know you have sleep apnea is your partner might tell you that you're like waking up in the middle of the night, like gasping for air.

If you have one really easy way to check, to track is take a measuring tape and measure your neck circumference.

If it's more than 17 inches for a guy or 16 inches for a female, it means it's very likely that you may have sleep apnea.

And that's because when you have excess mass, basically, here, it's compressing your airway and can make it difficult to get air into your, into your body.

When you improve sleep apnea, we've seen improvements in testosterone as high as 200 nanograms per deciliter.

So huge jumps in testosterone after fixing sleep apnea.

And the same goes for other sleep disorders, although the data is not as abundant, but sleep is so important.

Then we talk about what's in your environment.

So, let's grab this.

Okay.

So you get a bottle of water.

So many of my patients actually, they only buy like cases of plastic bottled water.

Once in a while, a plastic bottle of water, like don't stress yourself out.

This goes back to stress.

People get really stressed, like, "What's in my environment?

What am I drinking?

What am I eating?" Like, do what you can control.

So plastic water bottles have things like phthalates and BPAs, which can affect hormonal health.

They can mimic estrogen, they can reduce the production of testosterone based on these mechanisms.

Also things like plastics in the environment, PFAS, so the things like nonstick cookware, all those things can affect hormone health.

Now, how do you sort of protect yourself, right?

I tell people, again, don't stress.

There's only so much you can control.

So like, I love that we're not drinking out plastic.

If you have to drink out of plastic because you're at an event or whatever, try to make sure it's not a

warm bottle, so it hasn't been like sitting in the sun for hours and hours and hours, because as it gets warm, it releases more microplastics and more chemicals into the water.

When you're eating food, if you are eating out of, say, you get takeout, put it on a plate and warm it up.

Don't ever warm up that plastic.

And when you store food in the fridge, put it in a glass container or a metal container, but don't ever leave the food in the plastic and put it in the fridge.

These are simple things you can control.

You could also limit sort of your exposure to dust because dust has microplastics.

You can try to wear more cotton fabrics, less synthetic fabrics, because they shed less microplastics.

But again, I think do what you can do, but don't let the stress of these chemicals like derail you, because stress is not helping either.

And how much of a difference does, you know, microplastics make on my hormonal health?

Is it Is it really a big, big deal?

Well, I think it depends.

It's all dose-dependent, right?

So we're all exposed.

Like, if you look at the data, like, people are, you know, consuming quite a bit of microplastics, and we're seeing them actually even in testicles, in penis tissue samples.

Like, they're in our bodies.

And so I think that it's definitely playing a role.

How much, we don't know yet.

We just know that there are mechanisms, and we know that they do affect hormonal health.

And so do the best you can.

Do you and your family drink out of plastic bottles?

No, we drink— we, we have like metal water bottles for the kids and myself.

And what about nonstick pans?

We buy ceramic.

We, we do our best to like avoid those as much as possible.

So the other thing is the company you keep.

I think we don't talk about this enough, and we talk about it in terms of business, like you want to keep people who are successful around you, you want to keep people who can help

you, but it also plays a role in your sexual environment, right?

So my husband is in these groups with a bunch of other male physicians, and there's a lot of discussion about how they never have sex anymore.

And they're all just like, oh yeah, this is just like normal, like we're getting older, our partners don't want to have sex, it's so frustrating.

And there's a lot of discussion about this, and it's almost like, oh, that's okay, like that's just normal, right?

They're normalizing this experience where that sex has not become a priority because life is so stressful, things are so crazy, maybe you're having relationship discord.

So it absolutely plays a role, and there's there's actually some evidence that it may help you make better choices.

So there's one study where they looked at, I think it was like 50,000 people, and they did an intervention where they tried to encourage these people to surround themselves with positive

influences that were like, have safe sex and avoid negative influences.

And they saw that for— that these people had an increase in like sexual positive behavior, so like safe sex practices, by 46%.

So just by changing who they spent their time with, they saw this major difference in how they approached their sex lives.

Okay, so if your friends are very pessimistic about sex and they're not having and they're complaining about it, that's going to become sort of contagious.

Yeah, and I think it extrapolates to everything— what kind of relationships you're in, how do they view their relationship with their partner, is it a priority, do they make it a priority,

right?

Or are they just busy doing their own thing and they're just like living in parallel lives.

They're doing their own thing, you're doing your own thing.

You never really spend time with your partner.

And then when you go hang out with your friends, you're like, oh God, I'm so glad to get away.

And you're not like talking about how much you enjoy your partner.

People tend to talk negatively, right?

They wanna like sort of like vent.

And so when you have people who don't make that a part of their lives, it also affects you.

They value their partner and they talk about them in a positive way.

That's a, a great thing to say like, okay, this is the right kind of person I want because I want to value my partner too.

And I don't want that to it's gonna rub off on me, because it absolutely does.

And the other thing you said in this category of environmental stuff is things like pornography consumption.

Is it possible to consume too much porn?

So it's not the amount of porn that you watch, it is the sort of the way you feel about it.

Many people watch porn for a variety of different reasons.

Most often it's for pleasure and enjoyment, but there's some people who watch porn because they wanna get away from negative feelings, right?

This is giving them dopamine and they're using it as a way to just feel better in the moment.

And so that became, it can become a compulsion where they're watching porn and it's like giving them these positive feelings and they feel negative in life and they're going back to

porn to sort of again have that compulsion to watch porn again.

But that's a small subset of people.

The other thing is that there's a lot of negative discussion around porn, right?

People are like, porn is bad, it's dangerous, it's evil.

And I think, you know, it's more nuanced than that.

But if you feel that porn is bad, every time you watch porn you feel negative, you feel bad about about yourself, that's where we see people having the most dysfunction associated with

it because they feel guilty.

They could watch it once a year and they could feel super guilty about it and it could affect their sexual function.

They could see themselves as a bad person.

They could see themselves as wrong or immoral.

And that's really when it becomes an issue.

If you are finding yourself either compulsively watching pornography and using it as a scapegoat, maybe time to reevaluate, say, why am I doing this?

Can I switch this out for something else that makes me feel better that might be healthy, like exercise or going for walks or whatever that may be?

And then if it's something that's really making you feel like bad or guilty because maybe that's how you were raised, maybe that's what you feel about morality, then yeah, maybe like

you either need to work through that because porn is maybe something that you still want to watch at times or you need to abstain.

But usually those are, it's very difficult to abstain.

Point for most people to abstain for prolonged periods of time.

So I think it's something you have to work through if you find yourself having these sort of feelings about pornography or you're compulsively watching it.

But for the most people, it's— adults, for most adults, it is fantasy.

It's a place where you can experience, uh, see things that you may never do in real life that may be enjoyable, that are fun to watch, that allow you to feel arousal.

We see that when couples couples watch porn together, they are more likely to be more satisfied in their relationship.

And when there's a discord, like one person really doesn't like it or doesn't use it and the other one uses it a lot, that's where we see the problem.

Is porn consumption going to impact my intimacy with my partner?

So it depends.

I think a lot of people watch it without an issue, right?

They watch it and masturbate and I ejaculate.

I'm not going to then be able to ejaculate very quickly necessarily.

With my partner?

Yeah, so that obviously, that is, you know, there's a refractory period after you ejaculate.

Now, when you're younger, that refractory period could be minutes, and when you're older, that can be a day and a half.

And so we see that some people may struggle, especially if they're watching a lot of porn every single day and their refractory period is maybe a day, then they may actually really

have trouble ejaculating with their partner because they've not given themselves that time.

This has had probably the single biggest impact on my office.

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And the last one, the last of the 4 pillars.

The last of the 4 pillars we talked a little bit about, it's called confidence.

And confidence is not like strutting around like a peacock, like I know what I'm doing.

It's confidence in knowledge and curiosity.

Curiosity.

So knowledge, we talked about a little bit— understanding female anatomy, like how do female bodies get aroused, right?

What makes them aroused?

Where is the clitoris?

Knowing some anatomy.

And two, actually talking to your partner or paying attention to their cues.

We, for some reason with sex, it's the only time that we just expect people to be mind readers.