[@TheDiaryOfACEO] Sex Scientist: What Women Actually Need To Enjoy Sex

Link: https://youtu.be/PnpHwhTWw0c

Duration: 119 min

Short Summary

Urologist and pelvic floor specialist Dr. Reena (nearly 3 million YouTube subscribers) explains how nutrition, exercise, sleep, and environmental factors directly impact erectile function, testosterone, and longevity. The episode covers evidence that 150 minutes of weekly cardio equals Viagra's effectiveness, sex once weekly correlates with 49% lower mortality, and pelvic floor dysfunction contributes to sexual problems—plus statistics on young adults becoming increasingly sexless and how GLP-1 medications may suppress sexual desire.

Key Quotes

1. "Guys who sleep 5 hours a night, their testosterone drops by 15%." (00:04:45)
2. "When your testosterone is low below 214 nanogs per deciliter that your risk of mortality goes up by two. So you are going to double your risk of dying if you have low testosterone." (00:29:34)

Detailed Summary

Episode Overview: Sexual Health, Longevity, and Human Connection

This episode features Dr. Reena Malik, a urologist and pelvic floor specialist with nearly 3 million YouTube subscribers, exploring the science of sexual health as both a marker and driver of overall longevity. The conversation spans nutrition, exercise, hormonal mechanisms, psychological performance factors, environmental exposures, and modern relationship dynamics to present sexual health as an underutilized lever for health behavior change.

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Guest Background and Clinical Philosophy

Dr. Reena Malik has built the world's most-viewed urology YouTube channel, covering pelvic health, erectile dysfunction, dribbling after urination, and debunking porn industry misconceptions. She authored "The Hard Truth: Everything Men Need to Know About Good Health, Great Sex, and Long Life" (September 2026), which synthesizes evidence-based guidance for male health optimization.

• Dr. Reena argues sexual health is a powerful motivator for health behavior change; patients improve blood sugar and blood pressure specifically to protect their sexual health
• Women often manage male partners' healthcare, making appointments and organizing care—a dynamic with significant implications for treatment adherence
• The podcast closing tradition involves guests stamping "certified 100% human" and "Gen AI free sign of things to come"

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The Four Pillars of Sexual Health

Dr. Reena presents sexual health as a "house" built on four foundational pillars that must all be addressed for optimal function. The framework structures the conversation: fuel (nutrition), strength (cardiovascular exercise and pelvic floor health), environment (stress, sleep, and endocrine-disrupting chemicals), and additional factors.

• People who have sex once a week have a 49% lower all-cause mortality rate compared to those who have sex once a year
• A 1997 study found men gained a 13% increase in life expectancy for every 100 orgasms
• The WHO declared loneliness an epidemic, equating its health damage to smoking 15 cigarettes per day
• The Gottman research found that a 20-second hug with a partner helps alleviate stress and break stress loops

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Nutrition and Dietary Impact on Erectile Function

Multiple randomized and observational studies demonstrate measurable dietary effects on erectile function through endothelial protection and metabolic improvement. The Mediterranean diet emerges as the most evidence-supported pattern for sexual health.

• The Health Professionals Follow-up Study of 20,000 men found a 22% lower risk of erectile dysfunction with Mediterranean diet adherence
• Pistachio consumption at 100 grams daily decreased erectile dysfunction in controlled studies
• Regular blueberry intake showed approximately 20% improvement in erectile function scores
• Fiber recommendations are 38 grams daily for men and 25 grams for women, as fiber converts to short-chain fatty acids that protect blood vessel endothelium and improve metabolic health
• Ultra-processed food intake contributes to the population-wide testosterone decline observed over the past three decades

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Exercise and Physical Activity

Cardiovascular exercise demonstrates efficacy comparable to pharmaceutical intervention for erectile dysfunction, while resistance training addresses testosterone optimization through muscle preservation mechanisms.

• 150 minutes of moderate-intensity cardiovascular exercise weekly produces the same improvement in erectile function scores as medications like Viagra
• A study of men with heart disease following a 5-minute warm-up, 20-minute walking, and 5-minute cool-down protocol still showed 70% improvement in erectile function
• Resistance training of large muscle groups is significantly correlated with testosterone improvement
• Men who maintain muscle mass are three times less likely to experience erectile dysfunction as muscle mass decreases approximately 7% every decade after age 40
• Muscle mass preservation prevents the aromatase enzyme in fat mass from converting testosterone to estrogen

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Pelvic Floor Health

The pelvic floor functions as a rhythmic contraction mechanism during orgasm, with dysfunction manifesting differently depending on whether muscles are weak or hypertonic. Assessment and treatment protocols differ substantially from common Kegel recommendations.

• Pelvic floor muscles contract rhythmically for approximately 8 seconds during orgasm, helping shoot ejaculate in men
• Tight pelvic floor muscles can prevent blood flow to genital organs, causing erectile dysfunction in men, difficulty with arousal and orgasms in women, and premature ejaculation
• Hip or back injuries can cause compensatory tightening leading to back pain, constipation, urinary urgency/frequency, and pain during sex
• Pelvic floor relaxation exercises (diaphragmatic breathing, figure four stretch, happy baby pose, child's pose) are more appropriate than Kegels when muscles are tight
• Pelvic floor physical therapists can identify specific dysfunctional muscles for individualized treatment
• Pelvic floor exercises allow women to squeeze muscles during sex, which men perceive as feeling tighter

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Erectile Dysfunction: Prevalence and Cardiovascular Warning

Erectile dysfunction represents a critical cardiovascular risk indicator, often appearing 3-5 years before cardiac symptoms manifest. The pathophysiology involves systemic vascular health rather than isolated organ dysfunction.

• Over age 50, 52% of men have erectile dysfunction, with prevalence increasing 10% every decade (60% at 60, 70% at 70)
• Erectile dysfunction is often caused by aging blood vessels becoming stiffer and comorbid conditions like diabetes, cholesterol, and high blood pressure
• Within 3-5 years, men with organic ED may develop heart problems, with 14% experiencing a heart attack within 7 years
• Young boys experience 3-5 nighttime erections per night lasting up to 40 minutes, while men in their 40s experience about half as many with maximum 30-minute durations
• Without nighttime erections and regular blood flow, the penis will shrink over time

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Testosterone Science and Replacement Therapy

Testosterone exists in three forms: 45% tightly bound to SHBG (unavailable), some loosely bound to albumin, and 1-2% free (bioavailable). Population data shows bone loss occurs around 300 ng/dL, decreased sexual thoughts at 215, and reduced physical vigor around 290.

• Testosterone naturally declines about 1% per year in healthy men, accelerating with high stress, poor sleep, and endocrine-disrupting chemicals
• Sleep deprivation to 5 hours nightly for one week causes testosterone to drop by 15%, equivalent to the testosterone loss from 10 years of aging
• While 20-40% of men have low testosterone, only about 2% receive treatment
• After roughly 18 months on testosterone replacement therapy, 70% of patients become infertile, with sperm count drops as early as 10 weeks; fertility recovery can take up to 2 years
• For men wanting to conceive, alternatives like hCG, clomid, or enclomophene can boost natural production
• Once men start testosterone replacement, their body stops producing its own testosterone, and many experience testicle shrinkage
• TRT only works if testosterone receptors are not fully saturated; testosterone receptor sensitivity varies individually due to CAG repeats on DNA
• Low testosterone below 214 ng/dL doubles mortality risk, while superphysiologic levels of 1,800 or higher increase risks for blood thickening, stroke, heart attack, and heart fibrosis from collagen deposition in heart muscle
• Testosterone prescriptions in the United States increased by 300% over the last 10 years
• Anabolic steroid use carries a 15x higher risk of premature heart failure and 122x higher risk of cardiac death compared to TRT

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Environmental Factors and Chemical Exposure

Endocrine-disrupting chemicals in everyday products contribute to population-level testosterone decline and may affect reproductive tissue directly. Microplastics have been found in human reproductive organs.

• Plastic water bottles, non-stick cookware, and environmental plastics contain phthalates, BPA, and PFCs that can mimic estrogen, reduce testosterone production, and affect hormonal health
• Microplastics have been found in testicles and penis tissue samples
• The average testosterone level declined approximately 25% from around 600 in the late 1990s to 450 by 2015, attributed to endocrine-disrupting chemicals, rising obesity, diabetes, insulin resistance, and ultra-processed food intake
• Recommendations include storing food in glass or metal containers instead of plastic, avoiding warming food in plastic, and wearing more cotton fabrics instead of synthetic fabrics
• Neck circumference greater than 17 inches for men or 16 inches for women indicates likely sleep apnea, which compresses the airway and can cause testosterone drops

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Sleep and Hormonal Impact

Sleep architecture directly affects testosterone production through the hypothalamic-pituitary-gonadal axis, with acute sleep deprivation showing dramatic hormonal effects within one week.

• Sleep deprivation to 5 hours nightly for one week causes testosterone to drop by 15%, equivalent to the testosterone loss from 10 years of aging
• Improving sleep apnea can yield testosterone improvements as high as 200 nanograms per deciliter
• Poor sleep quality accelerates the natural 1% annual testosterone decline in healthy men

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Women's Sexual Anatomy and Pleasure

Female sexual response differs substantially from male response, requiring different stimulation patterns for orgasm achievement. The clitoral structure extends far beyond the visible glans.

• The clitoris is the embryological homologue of the penis, made from the same cells; Skene's glands are the female homologue of the male prostate, located near the urethra, producing PSA
• Average vaginal length is approximately 3.5 inches, expanding to about double when aroused
• Approximately 85% of women cannot orgasm through penetration alone and require clitoral stimulation
• The G-spot is located approximately 2 cm inside the vagina on the anterior wall
• About 40% of women experience squirting, with fluid coming from the bladder (confirmed via dye studies) combined with Skene's gland secretions—chemically different from urine, usually clear and odorless
• Three evolutionary theories for female ejaculation include mechanical/hygiene (flushes urethra with antibacterial PSA and zinc), ancient hormonal ovulation reflex now a biological vestige, and mate selection reward system signaling genetic compatibility
• C tactile afferent fibers on skin respond to slow, gentle touch and only to human touch, not through barriers like gloves
• A London study of 19 couples found stimulation at 3 cm per second produced more sexual arousal than 18 cm per second on erogenous zones
• The coital alignment technique involving a rocking motion where the pubic symphysis rubs against the clitoris increases orgasm rates
• UTIs in women after sex are caused by mechanical thrusting pushing bacteria through the short urethra into the bladder
• Non-genital orgasms are documented including lip, nipple, anal, and even childbirth orgasms

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Psychology and Sexual Performance

Sexual arousal requires parasympathetic nervous system activation, making stress and anxiety physiologically incompatible with erection maintenance. Performance anxiety creates a self-reinforcing failure loop.

• To achieve arousal and maintain erection, a person must be in a parasympathetic state (rest and digest), not the sympathetic state associated with stress and distraction
• Performance anxiety creates a vicious cycle: worrying triggers the sympathetic nervous system, preventing physical response, increasing anxiety, and reinforcing the loop
• The sensate focus technique involves graduated exploration of non-genital erogenous zones, then genitals without penetration, before reintroducing penetrative sex
• In long-term relationships, desire typically manifests as responsive desire triggered by contextual cues rather than spontaneous desire
• People become increasingly distractable due to constant scrolling habits with new stimuli every 60 seconds

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Penis Size: Facts, Anxiety, and Interventions

Average penis size misconceptions drive significant anxiety, while evidence-based interventions for length or function are limited and carry meaningful complication risks. Weight loss can restore apparent size.

• The average penis is 5.2–5.5 inches erect, but men overestimate this to be 6–7 inches
• Survey data shows most women are content with average or slightly above/below average penis size as long as they feel intimate and experience pleasure
• Weight gain makes the penis appear smaller as fat accumulates above the pubic bone, not because the organ itself shrinks
• Traction devices can produce approximately 2 cm improvement in length over 3–6 months of daily use (30 min twice daily) and can help straighten Peyronie's disease; they range from $100–$500
• Penile lengthening surgeries carry very high complication rates because the penis is highly vascular
• Jelqing (manual stretching) can create micro-tears and cause erectile dysfunction
• A Japan study found nose length correlated with penis size in that population
• No evidence links hand or foot size to penis size
• The largest medically verified penis is approximately 13–14 inches, causing difficulty finding partners
• Semaglutide reduces fat pads above the penis, making more visible—the penis is not actually growing

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Young Adults and Modern Dating

Young adults between 18 and 30 are becoming increasingly sexless, with dating app culture replacing deep connection formation. Choking during sex has become normalized among college-age populations.

• Among college-age individuals, 60% of women and 20% of men have been choked during sex, with 20% of those choked experiencing it 25 times or more
• Sex researcher Debbie Herbenick's qualitative research showed women often describe choking as "just a part of sex," sometimes done because they think partners expect it
• Young adults between 18 and 30 are becoming increasingly sexless, meeting through dating apps and DMs rather than forming deep meaningful connections
• Extreme outliers among people 30 and under spend 8-10 hours daily on phones and social media, with roughly 15-20% describing usage as almost constant
• Young men are increasingly taking anabolic steroids due to social media pressure and appearance-based dating apps

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Partner Communication and Intimacy Taboos

Men and women have fundamentally different orientations to intimacy in heterosexual relationships, creating systematic miscommunication around sexual initiation and desire. Specific taboos prevent problem-solving.

• Women view sex as added stress when already stressed ("one more thing to do"), while men view it as stress relief, creating fundamentally different orientations to intimacy
• For many men, sex is their primary or only version of intimacy and connection, and initiation may be misinterpreted as greediness rather than a bid for connection
• Men's top taboo is performance anxiety and erectile dysfunction, experienced as a failure of masculinity
• Women's top taboo is prioritizing pleasure and asking for specific stimulation due to fear of being labeled high-maintenance
• When discussing sexual problems with a partner, avoid the bedroom—choose calm settings like a walk or car where partners can speak parallel rather than face-to-face
• Women fantasize about sexual submission around 60%, men around 20%; 90% of fantasies involve strangers or people outside the relationship
• Sexual fantasies do not necessarily reflect real-life desires—they are a safe mental space to explore
• Dr. Reena recommends patients write down fantasies privately and consider sharing one with a partner to explore together

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GLP-1 Medications and Sexual Desire

Semaglutide addresses metabolic dysfunction that underlies sexual performance issues but may simultaneously suppress desire through brain reward pathway mechanisms.

• Semaglutide improves metabolic diseases, diabetes, and heart disease, improving blood flow to genitals and sexual function
• GLP-1 medications work on brain reward pathways, reducing desire for food and potentially for gambling, shopping, alcohol, and possibly sex
• High-dose GLP-1 medications may suppress sexual desire; validated questionnaires like the Female Sexual Function Index (FSFI) and ADAM questionnaire can track these effects
• If decreased desire occurs, doctors may consider lowering the dose

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Semen Parameters as Health Biomarkers

Semen analysis serves as a powerful, non-invasive indicator of overall cardiometabolic health with dose-dependent correlation to mortality outcomes.

• Semen parameters correlate with overall mortality in a dose-dependent manner; men with higher sperm concentration live longer (78, 77, 76 years as concentration decreases)
• Men with zero sperm often have genetic disorders and live slightly longer since their condition is not cardiometabolic

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Closing Reflections and Future Directions

Dr. Reena recommends prioritizing human connection and community to reclaim agency in an increasingly sexless, digitally distracted world, observing an emergence of people returning to religious constructs and live events.

• The world is becoming more sexless due to increased stress and digital distraction stealing attention and connection
• Dr. Reena expresses optimism that societal tensions will resolve—"the pendulum always swings" and history repeats itself
• Next episode question for listeners: "What would you tell someone to help them reclaim their agency?"
• Urethral play uses instruments called sounds (rods with flared bases) inserted into the urethra; catheters drain urine from the bladder

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Key Statistics Reference

• 49% lower all-cause mortality with weekly sex vs. annual sex
• 22% lower ED risk with Mediterranean diet adherence
• 150 minutes weekly cardio equals Viagra effectiveness
• 70% of TRT patients become infertile after 18 months
• 13% life expectancy increase per 100 orgasms
• 15% testosterone drop from one week of 5-hour sleep nights
• 25% average testosterone decline from 1990s to 2015
• 300% increase in testosterone prescriptions over 10 years
• 122x higher cardiac death risk with anabolic steroid use

Full Transcript

Show transcript

Is there a way to enlarge the
>> So, you can put your penis in this
device. They've actually done research
on this. So, 30 minutes twice a day and
it does show improvements in length
about 2 cm.
>> Tada.
>> And that's not all. So, they actually
did a study on pistachios where guys at
100 g 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. Reena 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 four main pillars
of sexual health. So, pillar one is
fuel. So, how you nourish your body, and
it's a huge part of sexual activity. And
then pillar two is strength. When people
think about strength, they always think
about going to the gym and lifting
weights. But 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 under evaluated, under
discussed, and we'll get into that. But
pillar three 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%. Yeah.
>> And then the last of the four pillars
that we don't talk about enough is, and
that's still important,
>> I want to talk about morning erections,
squirting, clitorol 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,
>> this is super interesting to me. My team
given me this report to show me how many
of you that watch this show subscribe.
And some of you have told us, according
to this, that you are unsubscribed from
the channel randomly. So, favor to ask
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if you are a regular viewer of the show
and you like what we do here. We're
approaching quite a significant landmark
on this show in terms of a subscriber
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thing that you could do to help us, my
team, everyone here to keep this show
free, to keep it improving year over
year and week over week, it is just to
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you do it, I'll tell you what I'll do.
I'll make sure every single week, every
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and harder and harder to bring you the
guests and conversations that you want
to hear. I've stayed true to that
promise since the very beginning of the
D of Sio. And I will not let you down.
Please help us. Really appreciate it.
Let's get on with the show.
Dr. Reena Malik, if somebody was to come
up to you in the street, having watched
your videos online, and they were a 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 and I'll throw this graph
that I've I 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.
>> Mhm. 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. there have 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 be able to express
what you like. You're 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 cuz it's your first time.
So you have like mediocre sex or bad
sex. And they're like, "Well, I don't
really want that." And there's just no
like follow through, right? There's
there's not a lot of um education on
what sex should look like. 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 um
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 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, and this is by uh
Debbie Herbick, 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. It's just as normal
as 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 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 dopamogenic
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 going to be turned on
when I see my partner and we're going to
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 want to see or something
you want to 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 distractable.
I find it really hard, I got to 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 just 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 got to get
an erection. And I 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.
>> You use the word aroused.
>> 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 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 um
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 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
uh 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 it comes
more as a response to these other cues
that allow you to feel desire and to
feel aroused.
H 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
I've been traveling and I was jetlagged.
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 going to 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 going to 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
spectatoring. 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 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 arogynous 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've
realized like the genitals are, you
know, it's always working the way I want
it to. 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 gradiated 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.
>> Mhm.
>> 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 will be 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 often times
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 live 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
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 hundred orgasms men
had, they lived like 13% longer. They
had a 13% increase in life expectancy.
And so, it was really interesting to me
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
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
coorbidities and all these studies and
um it's also like sex is a
cardiovascular workout, right? For many
people is a cardiovascular workout. You
are getting a phys 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
u 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 four 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 matter what else you do. Um, you
can try to do everything else to patch
up your house, but it's always going to
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 going to 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 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. They look at 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 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 like, "Oh, I just got to eat
pistachios and it's all good, right?"
It's it's part of a whole diet, but
certainly having 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 lycopine,
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 endothelop
protective mechanisms. They protect the
blood vessels. They make them healthier.
And so when your blood vessels are
healthier, you get better metabolic
health. So you get less diabetes, less
high blood pressure, less high
cholesterol. And these all of 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, um, is
really really important. And then
obviously managing your calories and a
maintenance, right? because we don't
want to gain weight because excess
atapost tissue or excess fat also puts
you at higher risk for erectile
dysfunction and other sexual
dysfunctions. Next we have uh strength.
All right.
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 want to
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 5minute warm-up. They did 20
minutes of walking and 5 minutes of a
cool down. And with this supervised
protocol, they still improve 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
cuz 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
that's where cardiovascular exercise is
so so important in terms of resistance
exercise. I know these little weights
are probably not sufficient for doing
much, especially for men, in terms of
improving um muscular health, but
obviously we're not going to 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 going to 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
three times less likely to have erectile
dysfunction.
>> Oh, really?
>> Yeah. So, they maintain erectile
function, they maintain sexual desire,
they maintain um satisfaction with sex.
>> I read a quote yesterday that said
muscle is medicine. And I thought,
that's really true based on everything
I've learned on this podcast around, you
know, like glucose control and 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're 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. Um, the
other thing is we want to prevent
sarcopenia. So, sarcopenia is muscle
loss. And when you have muscle loss, um,
that also increases your risk of having
sexual dysfunction.
>> What about the pelvic floor? Like, how
does that come into this story of
>> Oh, yeah. So, we missed that part. So,
um, the pelvic floor, here's your
pelvis, right? It's this bony structure
where all your organs live. This is a
female. So, I'm taking out the, uh,
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.
>> 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.
>> Okay.
>> Okay. These structures are very
important for a variety of things. um
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
at a rhythmic contraction of8 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
um your stool in, and they relax when
you need to pee in, when you need to
defecate.
>> So when you're trying to hold a wee,
you're like tightening your pelvic
floor.
>> Correct. Correct. But these are also
responsive to stress. So, just like
people get TMJ where they get tense in
their jaw cuz 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 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 a 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 got to 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, 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 they can also cause
premature ejaculation in men. And so
these muscles are so important and all
we hear about is keigull and keigull are
exercises to strengthen these muscles.
But keigull 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 keles might make it worse because
you're now tightening muscles that are
already tight.
>> We also talked about pelvic floor
relaxation. Doing exercises 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. that's under
evvaluated, underd discussed 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%.
>> And it goes up 10% every decade. So 60%
of 60-y 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. And 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
psychoggenic 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 going to 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 and I think
it's really important to differentiate
that from something like premature
ejaculation where you climax too soon.
So, you ejaculate before you're want to.
Uh, 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. 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 multiffactorial,
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, maybe using a firm grip or some
people will masturbate like uh facing
the bed or um you know against hard
objects. And so that
>> against hot objects.
>> Yeah. Like the their fist or something.
And so that u 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 uh good hormones working, got
a good amount of testosterone, and your
nerves are working well, and you're
getting a good morning 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 three to five
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
maybe max out at 30 minutes, but
sometimes they're shorter. You should
still be getting three to five erections
at night. 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 to that?
>> 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
periods or let me take a little break
and kind of uh 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's 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 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 clitoreral 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 is it becomes more of a
problem because over time, say you stop
having erections or cleral tumes 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 a pelvic model. And here this this
purple thing here is called the corpora.
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 um 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 you get a little scar in the 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 We don't have a clitoris.
>> That one there.
>> This is a uterus.
>> You're going to keep that in.
>> Okay. I can show you here. There we go.
There's this like she told me.
>> Is it crazy?
>> Okay. Yeah. This is good. This is good.
Okay. They told me they don't say
glitter.
>> That's a little That's a Yeah. Okay.
>> They told me
>> you're not going to live that one down.
>> You asked the team where the ClariS was.
Did you ask the team where the clitoris
was?
>> Well, I'm 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 clitorol
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
clitoreral hood that covers the the head
of the the clitoris. And so when you
look at the clitoris on the inside,
which we can't see perfectly here, but
I'm going to just take this out. Um, it
actually goes all the way 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 clitoreral bulbs
here. Um, so and these are the legs of
the clitoris here on the side. And so
this is essentially the homalogue of the
penis. So if I take the penis and we
don't have a like a full model here.
What does homalues mean?
>> So homologues means that they're
essentially the same structure. They're
made from the same cells but they're in
the male 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 of the
paranneeium, you also have penal 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 does.
>> 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 can
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 Gzone, right? And the G-spot or
Gzone 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 cm in at the top. And
that's because that's an area where
there's a lot of nerves endings. One,
you can palpate the clitoris basically
throughout the entire anterior wall, but
also there's the skins glands, which are
these glands that sit underneath the
urethra, and they're the homalogue 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 to lead to
orgasm because some people have
different sort of distance between the
clitoreral body and the vagina. So some
people have less distance may feel it
better than some that don't. Uh but
ultimately um 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 you
your prolactin goes up and sort of like
everything calms down. Now some people
feel a a sense of clarity. They call it
postnut clarity, right? they feel clear,
they feel like motivated to do stuff,
they feel uh excited to go do something
else and they sort of move on from what
they're doing. There's some people who
feel post-coidal dysphoria. They
actually feel sad or they feel depressed
after they orgasm. And we don't know
exactly why this 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 two, what's pillar two of the
four pillars of men's sexual health?
>> We talked about strength.
>> Okay, so we did strength, we did fuel.
>> What's pillar three?
>> Pillar three 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 h 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
got to figure out what works for you.
Um, 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
six-second kiss with your partner. And
so it seems like six seconds, no big
deal, but actually if you time it, it's
like hm 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.
>> The gym is great 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 your brain that you're
in a safe space, like you're talking to
someone. They're having a normal social
interaction.
So, and then being creative. And we've
been trying to work with this work on
this with our kids because there's so
much external stimuli all the time,
right? They want to play video games,
they want to watch TV, they want to 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. Um, 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 eight
hours a night. So you take the same guy
and he sleeps eight hours, then you, you
know, do five five hours for a few days.
His test for a week, his testosterone
drops by 15%.
>> Wow.
>> 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 will tank
your testosterone.
>> And sleep apnnea 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,
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 apnnea. And how you know
you have sleep apnea is uh your partner
might tell you that you're like waking
up in the middle of like gasping for
air. If you have one really easy way to
check is take a a measuring tape and
measure your neck circumference. If it's
more than 17 in 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 um into your body. When
you improve sleep apnea, we've seen
improvements in testosterone as high as
200 nanogs 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. Uh 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 phalates 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, PAS, so the things like
non-stick 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 of 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 um 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 microlastics 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 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 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 non-stick 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 and it's 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 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 um 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 it extrapolates to
everything. what kind of relationships
you 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 want to 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 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 want to 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 become that 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 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 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. and 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? How 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 for most
people to abstain for prolonged periods
of time. So I think it's 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 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 have allow you to feel
arousal. We see that when 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
>> if I 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.
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And the last one, the last of the four
pillars,
>> the last of the four pillars we talked a
little bit about, it's called
confidence. And confidence is not like
stringing around like a peacock like I
know what I'm doing. It's confidence in
knowledge and 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 that,
for some reason with sex, it's the only
time that we just expect people to be
mind readers. We just want you to know
what I like and just go for it, right?
And and then when it's not good, you're
like, well, you just don't know what
you're doing. And it's like, it's it's
wild to me that we actually never got
taught how to talk about sex, how to
bring it up with a partner, how to, you
know, just explore and have fun with
sex. maybe add a toy to the bedroom. So,
there's lots of different types of toys.
This is a uh vulva stimulator. So, you
put this on the outside. So, you can see
that it would in theory, if this was
smaller, would stimulate the um the
clitoris on the outside. It also can
change in shape. It'll vibrate, right?
It'll have different stimulations that
you can play around with and decide what
you enjoy.
>> So, this one's run out of battery. Um
so,
>> they're brand new. They have not been
used.
>> I didn't say they had been very
defensive though. Um, so if my pinky
finger, if my finger here is the
clitoris,
>> Yeah.
>> I put it on like that.
>> Yeah.
>> And then it vibrates.
>> Correct.
>> And then the penis goes through the
hole.
>> And there's another version of that.
This is basically
>> this is basically like the hole goes
around the penis
>> and that goes in
>> and that can go in and stimulate and vi
vibrate. So, you both feel the vibration
and you both feel the stimulation.
>> I remember I was with um had a partner
and she she felt that sex toys were for
older people. Old people specifically
what she said and she she was kind of
against the use of them. I've always
been down.
>> I think it adds novelty and it's
exciting and it just adds something new.
>> But she felt like it was almost like
giving up.
>> Well, I mean, look, I think I wonder
why. I would I would if I she was here,
I'd ask her, why do you think that? What
belief system do you have that's making
you think that this is like not a good
thing to use? Right? We use technology
in so many places in our lives, right?
So why not introduce it in our sex
lives?
>> Are you going to become reliant on it
though? Because it doesn't make it
easier to get off with a sex toy.
>> So they've actually looked at vibration
and can you get desensitized to it? And
the way they've looked at is actually
like construction workers where they're
using those like vibration tools, right,
to and and seeing if like their hands
get desensitized. And what they've seen
is yes, for a short period of time they
do lose a little bit of sensation at
their fingertips, but then it restores
back to normal. And so it's not that
you're going to become desensitized
forever, right? I think you brought up a
great point, which is adding novelty.
Now, I think when I say novelty, people
are like, "Oh my god, I need to role
play in a different way or bring like
some sort of BDSM or whatever into my
sex life." And that's not exactly true.
So when you think about sex, right, it's
just like eating your favorite ice
cream. Maybe you have vanilla ice cream,
you know, three times a week and you
enjoy it. But if you start having
vanilla ice cream every single day,
you're kind of bored with it, right? And
the same goes for sex. Now having
routine in sex, knowing what you like,
um knowing what your partner likes, it
can be very helpful, but it also is nice
to add novelty. So if you think about
you can extrapolate from the flow state.
So when you are in a flow state for
work, right, things feel really almost
effortless and you're just like in a
zone, you can also get into a sexual
flow state. When you look at the flow
state, yeah, you need things to be
slightly challenging to get into the
flow state. They can't be easy and they
can't be so hard that you're going to
get frustrated, right? And so you need
to add a slight challenge to your sexual
encounter to get into that flow state.
And that's when you start having really
great sex cuz you're like in you're so
totally immersed. you're feeling great
and it's it's super fun, right? So, I
think that's another part of being
confident is being able to and confident
to try new things and explore new
things. And it can be as simple as like
doing it in a different room or maybe
getting a pillow or switching where your
head position is. Like, it can be so
small, but it can just add a little bit
of uniqueness and novelty and challenge.
>> Are there certain positions that are
going to increase the probability that
my partner has an orgasm?
>> Yeah. So, uh, typically when the female
partner is on top, she has more control
over where she's getting stimulation,
um, to the clitoris because, right, she
can angle her body in such a way. So,
often time that shows uh, that has, uh,
higher orgasm rates. There's actually
like this uh this technique called the
cooidal alignment technique where you
sort of move in a rocking uh a sort of a
rocking motion so that um your pubic
symphysis. So this bone right here um is
sort of like rubbing against their
clitoris like this area the skin here is
rubbing against the clitoris while
you're penetrating and that has been
shown to increase orgasm rate and
pleasure in sex. But really it's about
figuring out and trying different things
and realizing like that for example that
coil alignment technique is sort of
difficult like it's not that easy and
intuitive and so you have to sort of
play around with it and figure out like
what is going to work uh best and yeah
realizing it might not work. You might
be like super awkward and like okay like
that's okay like it's not the end of the
world if sex is not perfect every time
because we're learning and we're playing
and we're having fun. And so I think
that's really the key is like not
letting yourself get so frustrated if
something doesn't go exactly the way you
envision it in your head.
>> I used to think that a woman orgasming
was when this was when I was younger. Um
was when she squirted.
>> Mhm.
>> So like that's what I thought it thought
an orgasm was squirting.
>> Yeah. Well, you're probably not the only
one to think that. And so squirting, not
every woman squirts. So about 40% of
women squirt. Squirting is the emission
of fluid at the time of orgasm. Um
usually it's clear, colorless, and it
can be quite voluminous. um it's coming
from the urethra which is the pee hole
essentially and remember I talked about
those skins glands those skins glands
are the homalogue of the male prostate
and they have a little bit of fluid in
them too typically when you have
stimulation um and squirting they will
release fluid from the bladder as well
as the skins glands that combines
together and and it's emitted through
through that
>> so it's not pee
>> the way they describe it and there's
been a lot of research on this so
there's people who say it's pee. There's
people who say it's not. There's a
couple studies. So, one is they put dye
into the bladder and they took women who
said they were squirters and they had
them orgasm and they saw is there dye in
the uh in the fluid and yeah, there was
dy in fluid. So, it's coming, it has to
come from the bladder. The skins glands
only hold a small amount, but it's
chemically different. It's usually
clear, odorless. It doesn't smell like
pee. And so, there's some theories as to
why that might be. It may be that um
when you're having sex, there's
different hormonal signals that change
the concentration of what's filtering
through your kidneys so that it is a
little bit different in composition.
There's some theories that when there's
more estrogen around that it may change.
There may be some like um fluid filling
in the actual interstissia of the
organs. Again, it's hard to say, but
it's absolutely coming from the urethra
which is connected to the bladder as
well as the steam glands. But I think
like this this whole discussion about
what it is, it doesn't matter. Like is
it pleasurable? Are you enjoying it?
Great. If you squirt and you enjoy it,
great. If you don't, that doesn't mean
that there's something wrong and that
your partner hasn't orgasmed. The way to
figure out if your partner orgasm is you
ask her, right? Either she tells you or
you ask her. And sometimes it's obvious
and sometimes it's not, but you know,
you you sort of figure it out.
>> There's three theories that emerged in
my research about why women squirt from
an evolutionary perspective. The first
was that, and these are just theories,
they're not proven. Um, of course, the
first is that squirting contains PSA and
zinc, which are naturally antibacterial,
and ejaculating these fluids during or
after sex may have evolved to flush the
urethra and prevent UTI. Um, the logic
being in a pre antibiotic world, a woman
who could flush bacteria out of her
system after mating was more likely to
stay healthy and reproduce. That's one
theory. The other reason,
>> well, before you I want to talk about
that really quickly. So, that's a really
interesting theory. So one the reason
they emit PSA is because schemes glands
are the homalologue of the prostate. So
the prostate makes PSA which is prostate
specific antigen.
>> So this point this word homalogue again.
>> Yeah it's a so basically the prostate in
the male the same tissue when they're an
embryo becomes the prostate in the male
and becomes a skins glands in the
female. So that's why it's emitting PSA.
That is an interesting theory because
there are a subset of women who get UTI
after sex. Not everybody but some do.
And it's it's not because of the
ejaculate or because of the male
harboring some bacteria. It's because of
the actual thrusting of the penis. It's
taking bacteria from the outside and
making it more easy for it to go through
the urethra into the bladder. And women
have a short urethra. And so I want just
to debunk that myth that it's like
you're getting it from your partner or
there's something wrong with you. It is
literally just anatomy. And so some
women do get more UTI after sex.
>> And so that is an interesting theory
because maybe that's true. I don't know.
The second theory was in ancient
ancestors, the hormonal surge during
orgasm and ejaculation actually
triggered the release of an egg. Humans
evolved to ovulate on a cycle now, but
we kept the plumbing and the neuro
hormonal reflex. It's a happy accident,
a biological vestage that no longer
serves its original reproductive
purpose, but remains because it isn't
harmful for survival.
>> Interesting. I mean there is some
thought that maybe orgasming
um spasms orgasm help with fertility but
it's not really uh robust.
>> And the last one kind of matches what
you just said there which is the mate
selection theory. The intense pleasure
and psychological response of squirting
or or orgasm act as a reward system. It
incentivizes women to seek out specific
partners who provide high levels of
stimulation, potentially signaling a
better genetic compatibility or a more
attentive male, which would help with
the survival of of offspring. Maybe
>> that makes sense.
>> 40% of women squirt.
>> Yeah. So, the other thing is obviously a
lot of sex is focused on genitals, but
there's a whole body of arogynous zones,
right? Almost almost your entire body
can be an erogynous zone. We talked a
little bit about it when we talked about
sensate focus, right? You can explore,
you can find areas that people find uh
erogynous. So when you looked at data,
necks, nipples, lips, buttocks, inner
thighs, all these areas are considered
arogynous by most most people regardless
of their um sexual orientation,
regardless of their cultural upbringing.
It seems to be pretty universal. There's
actually a famous paper about
non-genital orgasms and like how people
orgasm without any genital stimulation.
So lip orgasms, anal sex orgasms.
>> Is that possible?
>> Yeah, it's been documented. Absolutely.
And and so it's um nipple orgasms.
There's a whole variety of ways even
like women have had orgasms during
childirth. Like there's there have been
these documented ways to orgasm and it's
because these areas can be very
erogynous and sometimes stimulating
multiple areas can like add more
erogynous interest and that's why you
see people like maybe in the BDSM
community they'll they'll be using um
nipple clamps while they're doing other
things right so there's there's a whole
bunch of areas that are erogynous and
most of the times people are not really
spending much time on foreplay or
stimulating these erogynous zones as
much as they should Right? You you have
a whole body to play with. And how do
you stimulate them? There's actually
evidence behind that. So on your skin,
we have these special fibers called C
tactile eference. When you stimulate
these fibers, they help you feel
pleasure, enjoyment, those sorts of
things. And so there was a study where
they took 19 couples, a small study, it
was out of London, and they basically
told them to stimulate an arogynous zone
and a non-erogynous zone. The
non-erogynous zone being the forehead.
And so they had the couples stimulated.
And they told them stimulated at levels
of 18 cm/s
uh in terms of how fast you're caressing
the arm or or or body part and at 3 cm
per second. And what they found was
those who stimulated at 3 cm per second
had more sexual arousal had more
pleasant stimulation compared to those
who were stimulating at 18 cm per
second. Now this makes sense because
those C tactile aphrant fibers respond
very well to that slow gentle caress.
The other interesting thing is that
these fibers are only responsive to
human touch. So if I take a glove and I
put it on my hand and I touch you, it
still doesn't work.
>> Interesting. That's so interesting
because in Los Angeles where we are now,
we were viewing an office and we were
walking down the street to see what the
neighborhood was like and we walked past
one place and it is a robot massage
parlor. M
>> and I always thought great like well
part of me thought maybe my prefrontal
cortex thought oh great idea because you
know you can get massages whenever you
want it's going to be cheap maybe you
can have one in your home but then the
other part of me as I saw it thought
actually I don't actually think that's
like why I get massages
>> I think there's something about human
touch which makes a big difference
>> absolutely there is um and so I think
that's uh we're evolutionary
evolutionarily built to seek out human
touch and human behavior
>> I wonder if I would want a robot to
massage me.
>> It wouldn't be as good. No.
>> I mean, think about sitting in a massage
chair. Is it ever as good?
>> It's never as good,
>> right? And so, I don't think a robot's
going to be that different from a maybe
a little better than a massage chair,
but like
>> massage chairs are never good.
>> No, they're just like they're okay.
They're mediocre. M Reena, I want to
talk about um testosterone, how that
links to sexual function, but also just
overall health because I was reading
that there's been a 300% increase in the
United States in the last 10 years of
testosterone prescriptions. And my
friends are increasingly having
conversation about testosterone, which
we weren't having
>> even 5 years ago. It wasn't a
conversation. And now the conversation
I'm having amongst my friends is like,
is our testosterone high enough? Do we
need to go get supplements to increase
our testosterone?
>> Testosterone is declining. So when you
look at testosterone levels from the
1990s, like late 1990s, the average
level was around 600 and if you look at
data around two 2015, it was 450. So
there's been like a 25% decline in
testosterone. Now you're going to ask me
why. One, we talked about some of the
endocrine disrupting chemicals. That's
part of it certainly. Two, there's a
significant rise in obesity.
Testosterone has aromatase. And
testosterone converts to estrogen using
this enzyme called aromatase. And so
when you have more fat mass, you have
more aromatase. And more testosterone is
being converted to estrogen. And so now
you have less testosterone.
>> Sorry. How do we how do you have less
testosterone?
>> So because there's more fat mass,
there's more aromatase. So that
aromatase sees all this testosterone and
it converts it to estrogen.
>> Okay. This is where they say they talk
about man boobs.
>> Yeah. So when you have a lot of
estradiol around you can get man boobs,
>> you can get gynecomastia. So a term for
it. So that's one. Two is we see a rise
in diabetes and insulin resistance which
also causes a decrease in testosterone.
We're seeing a rise in ultrarocessed
food intake and that doesn't have the
optimal nutrition that you need to
optimize testosterone. So we're getting
you know a high highly caloric which
then leads to obesity. We're getting um
lack of healthy fats. We're you know all
these things are super important for
testosterone. The Mediterranean diet is
what has been the most studied and
basically anti-inflammatory diet is what
they found for testosterone. So trying
to just eat like whole foods,
unprocessed foods as much as possible
and minimizing the inflammatory foods.
>> Does testo having high testosterone make
me more fertile? No, not necessarily.
So, I think people inherently think that
the higher your testosterone level is
when you check your blood work, that
that's better. And that's not
necessarily true. Now, everyone is
different. And what I can't tell you is
what your receptors look like, what your
testosterone or androgen receptors look
like, how sensitive are they to
testosterone. And everyone's a little
bit different. But when you look at the
same guy or you look at two different
guys, their variability can be so much
that a guy who's 900 can be normal and a
guy who's 500 can be normal because
everyone has individual genetic
variations. It's how their cells how
sensitive their cells are, how many
cells they have, you know, how many
latig they have in their testicles. Um
the CAG repeats, which are these DNA
repeats on the receptor themselves.
People who have more are less sensitive
to the testosterone that's around. So
they need more testosterone to get the
same result. Whereas people who have
less repeats have more sensitivity so
they they don't need as much
testosterone. And so everyone is
individual. And so that's why it's
really important to understand how are
you feeling, right? It's not about
chasing a number. And so absolutely we
know that when your testosterone is low
below 214 nanogs per deciliter that your
risk of mortality goes up by two. So you
are going to double your risk of dying
if you have low testosterone. But when
you go super high, super physiologic,
meaning like 1,800 or higher, now you're
putting yourself at risk for other
things. You can have blood thickening,
which is a known side effect of
testosterone replacement, and that puts
you at risk for stroke, heart attack,
heart disease. Over long periods of
time, it can affect your heart because
it can um there's also heart muscle
cells that get exposed to this high
level of testosterone. And when that
happens, these they sort of change over
time and they become more collagen
deposition. They get more fibrosis and
this makes them stiffer and so that
you're not pumping blood as effectively
as you would otherwise. And so there are
real consequences to going too high.
There's also the side effects of having
acne, of changes in mood in terms of
aggression and things when you get
really high. So really, it's about
finding what you feel good at. More is
not necessarily better. Once your
testosterone receptors are saturated,
meaning they're all bound to
testosterone more doesn't help you. It
might help you get more muscles, which
is why people abuse anabolic steroids
and testosterone because it will
continue to help you get bigger muscles,
but that's it. It's not going to help
you with your brain health, your bone
health, your sexual health, your any of
that.
>> Is there a way to
visually spot a person with low
testosterone? Are there visual clues?
Usually it's someone who feels very
fatigued like they can't get out of bed.
They feel just like so drained. Usually
they are a little bit more overweight.
>> Skinny fat
>> visceral adop I mean you can't always
tell if they're skinny. So it could be
because they could have visceral adopy
which is meaning that the fat is around
the the organs right and so you don't
see like a big pot belly necessarily. Um
they may have really low sexual desire.
They may have decrease in mood.
>> What about skin and bones? Does it
impact skin and bones?
>> Yeah. So, if you get high testosterone,
you can get acne because it affects the
sebum in the skin. Um, bone health. So,
testosterone converts to estradiol and
estradiol is really important for bone
metabolism. And so, when you have low
testosterone, you can also have low
estrogen. And when your estrogen gets
very low, you get a higher risk for
fractures, higher risk for osteoporosis.
And so that's where your bone health um
can be in danger. And so that's why
testosterone can help protect your bones
because of its conversion to estradile.
>> If you do have low testosterone, should
you be considering taking anabolic
steroids? Like
and who is testosterone replacement
therapy good for?
>> So I'm going to ask you a question. Why
why are you saying anabolic steroids?
>> I don't know. Cuz I hear that people big
bodybuilders take anabolic steroids. The
reason I asked you that is because
people think anabolic steroids and
testosterone replacement therapy are the
same thing and they're not. And so
testosterone replacement therapy is what
is given to guys who have low
testosterone. If you have truly low
testosterone, there's a few things you
can obviously improve testosterone
naturally by going back to those pillars
of health that we talked about. Improve
your sleep, do resistance training,
avoid endocrine disrupting chemicals.
But if you are still low despite doing
all those things or you're like so
fatigued that you can't move your body
and like you really need to do it, then
I think testosterone replacement is is
very valuable. And so testosterone
replacement is getting you to a level of
testosterone that is within normal.
We're not trying to get you super high.
We're not trying to get you to become a
bodybuilder. We're trying to get you to
normal, what you should be. And so
anabolic steroids are different. And
anabol steroids are like all these
different um oral pills and injectables
and things that work on muscle as well
as work on your uh androgen receptors.
And so those are typically things that
people are taking on their own. They're
kind of self-directing their care and
they're not really monitoring their
testosterone or they don't really care
how high they go. They just want the end
product of looking muscular. And so they
are getting really high testosterones
and that has its own host of concerns in
addition to the ones we talked about
like blood clots and and heart attack.
But there's a 15 times higher risk of
having premature heart failure and a 122
times more risk of cardiac death when
you're taking anabolic steroids for the
purposes of increasing muscle mass and
not and get getting really high in your
testosterone. So, it is a real serious
issue when you take anabolic steroids
because it can have real serious health
consequences.
>> I've always imagined that once I have
kids, so I'm I think I'm scared that if
I have testosterone replacement therapy
at this age at 33, it might impact my
fertility.
>> It absolutely will.
>> Okay, good. So, I'm not going to do that
until I've had all four of the kids.
>> Yeah.
>> As many as I can.
>> And then I figured when I hit like 45,
then I'll go on testosterone replacement
therapy. Is this a good strategy?
>> Well, first of all, I would want to know
why you want to be on testosterone. Is
your testosterone low?
>> I have no idea.
>> Right? Are you having any symptoms?
>> I mean, you live a very highpowered,
busy life. And so, I can guarantee your
stress is probably not under control.
Like, probably you're not sleeping
great. And not to say that those are
things that, you know, you can't do in
addition to taking testosterone if your
testosterone is indeed low. But I think
the important thing is realizing like
it's only going to help you if your
testosterone receptors are not fully
saturated and giving you more
testosterone is going to saturate them.
>> Doesn't it just drop anyway with age?
>> It does. So it drops about uh 1% a year
on average. Some people drop less, some
people drop more. So if you look at
someone who is healthy and they have a
normal testosterone, they usually won't
become what we call hypogonatal or have
low testosterone even as they age
because the drop is so low. it's only 1%
a year. But if you add on these comorbid
conditions, if you add on a high stress
life, if you add on poor sleep, if you
add on um exposure to endocrine
disrupting chemicals, you're going to
see um that number come down much
higher.
>> It's actually I was just I pulled up a
graph here um that shows testosterone
decline with age. And it's actually not
that steep.
>> It's not It is going to decline, but it
may not decline to the point where you
need testosterone. So, not everyone
needs it. Depending on the data you look
at, 20 to 40% of guys have low
testosterone. Um, and when you look at
the number that get treated, it's like
2%.
>> And it starts declining from about 20
years old.
>> Yeah. Depends on the person. 20 to 40
years old that start, it's probably more
around 30 to 40. And the reason we came
up with these numbers, right, these
guidelines to to guide us on what's
normal and what's not is because you
look at population-based data and you
look at when these symptoms arise and
there are like clear numbers like you
may start having bone loss uh around
300. You might start having uh you know
decreased sexual frequency of thoughts
at 215. You might start having feeling
less physical vigor uh around 290.
Right? And so there are numbers that we
know based on population-based data that
we're seeing these numbers decline. Now
the other thing to think about when
you're looking at testosterone is free
testosterone. So testosterone comes in
different forms in the body. It comes
bound and unbound. So 45% of
testosterone is bound to SHBG which is a
molecule of protein that is really
tightly binds to testosterone. Doesn't
let it go for your body to use. Then
there's some that's bound to albumin
which is sort of loosely bound and then
there's 2% that's free 1 to 2% that's
free and that's what we say is like the
most available to your body for use and
there's actually you know good data that
looks at free testosterone and the
levels of free testosterone are
correlated with these symptoms as well
and so you do have to look at the big
picture so I always check a total
testosterone as well as an SHBG because
some people can have elevated SHBG
thyroid dysfunction due to aging, just
genetic variability, right? In women,
SHBG goes up when you take oral
contraceptives and it stays up for life
if you take oral contraceptives. So, it
can affect their free testosterone. The
other thing to think about testosterone
is it's for life. Once you take it, your
body stops making its own testosterone.
Many people over years will notice that
their testo their testicles get smaller
um because their body stops making its
own testosterone. So, it's not something
to take lightly. Now if you want say you
were low right now and you wanted to
conceive there are ways where you can
take other um other pharmaceuticals that
will naturally boost your own production
like hcg or clomid or enclomophene.
These work basically uh in different
ways to either tell your brain that hey
we need more testosterone or they send
they mimic the signals that tell your
testicles to make more testosterone. And
so there are ways to do it and you
definitely need someone who's, you know,
well-versed in managing hormone
management. Uh, but there are things
that you can do if you're low. But
again, I don't think it's once you once
you start these things, you can't go I
mean, you can get off of it, but it's
sort of a process and it's not something
that everyone will do because you're
going to feel good on testosterone if
you're taking it. And then when you get
off it, because your body is like no
longer making its own, you're going to
feel horrible. So, do you think most 50
plus year old men should be taking
testosterone
replacement therapies?
>> Only if they're symptomatic and they're
low, right? So,
>> would it make them the average man, the
average 50-year-old man, if this is the
average, feel better on a daily basis?
>> Not necessarily. Because if they are
normal, like I said, if their
testosterone receptors are already fully
saturated, it's not going to change,
right? It's not going to change their
it, like I said, it may make their
muscles look bigger, but it's not going
to change their their cognition. It's
not going to change their mood. It's not
going to change their sex drive. It's
not going to change their erections when
their testosterone receptors are fully
saturated.
>> And you know, in this graph, what is
showing the decline here? Has that got
anything to do with whether their
testosterone levels are fully saturated?
Because
>> no, you can't tell from that.
>> You can't tell from that. So, you could
have low testosterone but still be
fully.
>> That's why we talk about symptoms,
right? Because that's how I can tell. I
think, you know, that's part of what
being a doctor is, right? Talking to
your patients and figuring out what's
going on with them and what their
symptoms are and making sure it's
nothing else, right? You can have low
thyroid and that can mimic what what uh
what low testosterone feels like. You
can have a high prolactin because you
might have a benign tumor in your brain
that's secretreting prolactin and that
can reduce your testosterone. So that's
the the reason to get a full evaluation
to make sure there's nothing else that
we're missing that's causing you to have
these symptoms if your other levels are
normal.
>> Uh okay, that makes sense. So just
because my testosterone levels would be
low doesn't mean I necessar if I don't
if I'm not symptomatic doesn't mean that
I should necessarily just assume that I
need testosterone replacement therapy.
>> Exactly.
>> Okay. Yeah. I think I think most of my
male friends are just assuming that once
we hit 50 we're all on the testosterone.
>> I mean look I think when if you need it
it's a great drug. It's a great option
to improve your quality of life. It's
obviously preventing uh bone loss. It's
improving your longevity. it's uh
preventing hopefully having some benefit
in terms of cardioabolic health and so
yeah absolutely if you need it but it's
not something that like everyone should
just take cuz why not right like it's a
when you play with hormones it's serious
business you know
>> I guess a lot of men are self-conscious
in a way that they don't often admit and
they want to have big muscles
>> and they want to feel strong
>> and this is the the problem I'm seeing
with younger guys right now is that
there's a lot of young kids taking
anabolics because there's so much
pressure to look a certain way, right?
Because nowadays when how do you meet
people on social media through like
swiping and and all you see is what they
look like. And so there's this pressure
and like I'll see it at the gym like I'm
like at the gym and there's these young
kids who I'm like there is no way you
are naturally that built at that age,
right? Like unless you've been lifting
since you were like seven years old. And
so and of course there are some. But it
is serious because one, it causes
infertility, right? When you're on
testosterone replacement after about 18
18 months, 70% of people on testosterone
replacement will be infertile.
>> 17
>> 70 70%.
>> 70.
>> And even as soon as like 10 weeks, we
see some people having drops in their
sperm count. So, it's variable with how
quickly you're going to see impacts on
your fertility, but it absolutely
happens. And it can it can come back for
the large majority of people, but how
long it takes depends on your age and
how long you were on testosterone
replacement therapy. And in some cases,
it can take as long as 2 years to come
back.
>> I really need to get my testosterone
levels checked.
>> Yeah, you should. But also, you should
get your semen analysis checked. And
I've done that.
>> Good. Good. Because that's also a
biomarker of health. We've seen that
people who have poor semen parameters
they have higher rates of mortality and
they actually live when you look at age
like what age people die they die
younger compared to people and it's dose
dependent. So if you're have like normal
uh the concentration of sperm and then
it keeps going down and down and down.
If you look at the age it's like they
live to 78 77 76 like you can actually
see it come down except for people who
have no sperm because those are usually
genetic disorders. Those are live a
little longer because it's not
necessarily due to cardioabolic issues.
Um, but it's basically a reflection of
your overall health.
>> Steve, what are you doing?
>> Uh, just making myself a delicious
coffee
>> from the freezer.
>> From the freezer. Have you not heard
about Contier?
>> No.
>> Oh my gosh. This is going to change your
life. A couple of months ago, the
founder of this business called Matt
sent a big shipment of this coffee to
our office in London. What most people
don't know is that the processing of
coffee takes out a lot of the taste. So
what they do is they flash freeze it at
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and they send you in the post the coffee
in these little frozen ice cubes. Now
Matt sent a big shipment to my office. I
moved it to the kitchen. I said to the
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saw so many messages in our Slack
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Try it and please Instagram DM me,
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I will speak to you then.
One of the things I was quite surprised
by, I'll be honest, is when I went on
your YouTube channel
>> Mhm.
>> one of your very high performing videos,
I think it had 31 million views, was
about enlarging your penis.
>> Yes.
>> I didn't know that so many men were
interested in ways to enlarge their
penis. Well, it's interesting because
when you look at the data, more men want
to so I let's say most guys would love
to be taller, right? If you're an
average height man, most guys would love
to be taller, right?
>> Yeah. True.
>> Um more men want to have a longer penis
than they want to be taller.
>> Really?
>> Mhm.
>> Wow. Wow.
Why is this?
>> Well, I think you know a lot of people
um it starts at a young age. I have
sons, right? And so I see it like they
talk about their penis in such a way
like very early in life like oh my god
my penis is so big or it should be so
big or whatever and and there and it's
like this it becomes this like this
society thing about who's got a bigger
penis like it's very interesting but
there's a lot of pressure to feel like
and and a lot of discussion around
bigger is better right it's it's talked
about in media it's subtly joked about
it is um everywhere you look people are
talking about like being wellendowed as
being better. But interestingly, on my
podcast, we interviewed the the guy who
has the largest medically verified
penis. It's I think it's like 13 or 14
inches in length. And um he actually has
a lot of trouble because it's so large
that people don't want to have sex with
him and it's uncomfortable for them. And
so, like, it's not all roses and
sunshine on the other side. But the
reality is that many people feel what's
called small penis anxiety. and they
they even if they have a normalsized
penis, they feel consumed with how the
size of their penis is. And so that's
why this video did so well. I naively
had no idea how many people it would
resonate with because I'm not a guy,
right? And I see patients all the time,
but at that time in my career, people
weren't coming to me to talk about it.
And so I um I realized like there's so
many people quietly feeling insecure.
And we talk a lot about women having
body image issues. Men do too, right?
They feel insecure about the size of
their penis because also they're seeing
guys on pornography who have very
well-endowed fallaces and you know they
chose to be porn actors for a reason,
right? Because they are naturally
wellendowed. And so you're comparing
yourself to the outliers and the average
penis is about 5.3 to 5.5 in erect. But
when you look at like what do women
want, they will say on average they want
a 6 in penis. But when you look at like
the kind of sex toys they buy and they
did this study because they were looking
at people who they were trying to decide
what kind of when they were developing
fallaces for trans people like they they
reconstruct fallacuses for they wanted
to they were making them too girthy and
they like well we need to figure out
what girth women want and so they looked
at like what women buy on online like
what is the most purchased sex toy and
it's actually pretty close to average.
>> Do you say 5.2 in
>> 5.2 two to 5.5 depending on the study
you're looking at. Yeah.
>> Correct.
>> Mhm.
>> H. And what size do men think the
average is?
>> Oh, they think it's like six or seven
in.
>> Oh, okay. So, they think the average is
bigger. And also, how does age come into
this? Because I'm presuming that when I
get older, my penis is going to shrink
or something.
>> If you have good blood flow to your
penis, it shouldn't shrink. So, like I
said earlier, if you stop having
nighttime erections or you're not having
erections, now you're no longer getting
blood flow to your penis and it will
shrink over time. Also, if you're
gaining weight, it will appear that it's
shrinking because you're getting more
fat over here. So, if you think about
your penis here, this is the fat right
above this bone. And as this fat gets
more and more, you're seeing less and
less of the penis.
>> And is there a way to enlarge the penis?
So there are many ways that have been uh
tried, discussed, um attempted. So
there's definitely surgeries that you
can get, but they there's not a lot of
surgeons who do a lot of penile
lengthening surgeries and they have lots
of complications, like very high rates
of complications because the penis is a
very vascular organ. And the thing is
that when you have the tiniest
difference on your penis, you notice it,
right? Like I have guys come to like the
tiniest little thing on their penis and
they're like, "Is this okay?" Like this
is new. And like luckily it's nothing,
right? But I'm like they notice it. You
notice it when something's wrong. So
imagine you have a surgery and now
something changes, right? So it is it is
really difficult to sort of replicate
exactly a normal penis when you're
lengthening it through surgery. So I
don't recommend surgery for lengthening
penis. There is a safer way and that has
been shown to help and that's using a
traction device. So a traction device,
we have one here. This is one brand. You
can get many of these online. And you
can put your penis in this device.
>> It really I like I feel like um I get
like shivers when I watch you do this to
this penis.
>> So you would wrap it. It would be more
comfortable than just putting this like
directly on your penis.
>> For you guys that can't see, she's
clamping the end of the penis into this
>> into this device. And then you sort of
lengthen it uh extend it with this 30
minutes twice a day for this particular
device. They've actually done some
research on this one. 30 minutes twice a
day and you there's like a whole
protocol on their website and it does
show improvements in length about two
centimeters but it is a commitment to
increasing length and to doing this
process.
>> So just on those numbers 2 cm increase
over what period of time and does that
>> or about 3 to 6 months depending yeah
>> and is it permanent?
>> So that's all we don't know. I mean most
of the studies stop at you know once
they get their results and we don't know
that if you stop will it just revert
back to normal? I don't know. And so the
other thing about this particular
traction device that's night is if you
have a curvature in the penis like you
develop something called Peron's
disease, this device can actually curve
a little bit away from if you like let's
say you have um indentation on the top
of the penis, it can actually bend away
from that and it can help straighten out
the penis. So, that's actually a a a
really nice utilization for it because
um for some people that can be really
traumatic and devastating to have a
change in the way your penis appears
because it starts curving all of a
sudden. And this is safe and effective
and you can have bruising. It can be
slightly uncomfortable, but it's you're
not going to really hurt yourself uh too
much by doing something like this.
>> I thought a curved penis would hit the
G-spot better. Yeah, sometimes a slight
curve can be beneficial for some people,
but again, I think like when you notice
like there's a a dramatic change. You do
that more. Come
rip the end off.
>> It's okay. Um,
>> I'm just trying to figure out how this
works. So, I get the penis. I put it
>> through. Yeah.
>> Clamp it down.
>> And you want to put it at your normal.
And then you'll just slightly advance
the the length. You're not going to pull
crazy. easier. It's going to do a little
bit of traction so it's not uncomfort.
It's slight like just a slight tension.
It shouldn't be like like that. It
should be much less tension, but it is I
mean they can vary in price from $100 to
$500. So it's a onetime cost. It is not,
like I said, not dangerous. What is
dangerous is when people try to do
something that became popular on TikTok
called jelking. And jelking is where you
use your your hands and you make like an
okay sign with your fingers and you're
like stretching the penis with your
hands. And this can be dangerous because
you can create micro tears in the penis.
And we in the urology community have
seen plenty of patients who have now
developed erectile dysfunction after
doing jelking because they've now
created damage to their penis. And so I
I really caution people because this
there is so much despair around sexual
function, around penal health that
people are willing to try things and
they might really hurt themselves. No
joke, I had a patient the other day ask
me if he should drink hydrogen peroxide
because he saw some ad that said
hydrogen peroxide will fix your
erections and I said please don't. um
this is you know but he really was like
seriously earnestly asking me this
question and I you know I didn't want to
shame him by any means and I was like no
you know this is actually not safe and
it's not going to help you and there's
no pill there's no drink there's no
anything that's going to give you a
longer penis
>> what are the cases that you see that
break your heart
>> you know I I've seen so there I've seen
patients who've had surgery to lengthen
their penis and they are above average
when they at baseline and they have
these surgeries to lengthen their penis
and then they have a bad outcome and now
their penis is disfigured forever. And
that's what really um you never forget
that because that person knowing the
risks and benefits perhaps made a choice
and that choice didn't go the way they
wanted and now they have to live with
that for the rest of their life and
that's really sad.
>> Gosh,
imagine that. Christ
>> Yeah.
>> Well, and it just it doesn't work
anymore. Well, like the one patient I'm
thinking of, um, he, uh, had a like it
it basically developed a scar all at the
top of the penis. So, it was like
disfigured essentially. Um, and so it
was it was really sad.
>> Before I hit puberty, I definitely had a
penis anxiety because I was the youngest
in my year at school and I I was the I
was short, very very short, very small.
I remember what it felt like to like
hide my hide my dick
>> when I was around like guys in the
changing room and stuff like that. Um,
you know, after puberty things I
changed.
>> And what I want people to understand, I
think more than anything is that you
don't need a long penis to pleasure a
partner. We just talked about how the
clitoris is the is the most reliable
route to orgasm, right? And so you don't
need a penis to stimulate the clitoris.
You can use your mouth, your fingers,
you can use a toy. There's so many ways
to help your partner achieve pleasure.
And and yes, of course, there are a
small subset of women who really
appreciate a large fallus. But the large
majority of women, if you look at survey
data, are very happy with the size of
their partner, are very content with
average or slightly above average or
slightly below average as long as they
are feeling intimate and they're feeling
pleasure. And so I think that there's a
misnomer that that people think if I
have a longer penis I'm going to be able
to pleasure my partner more
>> as it relates to women. Is there
different size vaginas?
>> Yeah. So the a so just like there's
averages there's averages in females.
And so average vag vaginal length is
about 3 and 1/2 in. So when women get
aroused it expands and widens and
lengthens to about double. So the
average woman can easily accommodate the
average penis. maybe slightly larger
than average. And so I think generally
speaking, knowing that like you will be
able to fit in the average woman and you
will be able to please her with the size
of your fallus. And like I said,
penetration is is not as important. In
fact, only about 85% of women orgasm
through penetration alone. They need
clitoreral stimulation to achieve
climax. And so again, penetration feels
good. I I tell guys, it's like somebody
rubbing your testicles or your
paranneeium. feels good, but it's not
going to make you orgasm. And so
penetrating, yeah, if you're getting a
lot of clitoreral stimulation because
maybe she has a thinner, you know, her
clitoreral shaft is closer to the
vaginal canal, maybe, you know, the size
of the penis matters more. But for a lot
of women, it's not going to be
sufficient and they're going to need
some directed clitoreral stimulation.
Why do different vaginas feel different
to and I guess the the inverse is also
the case where like different penises
will feel remarkably different even if
they're the same size roughly and you
can have sex with somebody and go it
feels really good.
>> I mean I think again it's how you it's
like the emotion in the ocean right like
how you use your so let's let's talk
about the vaginas first. So, when a
vagina is um has more pelvic floor
strength, they may be able to like tense
around the penis better, like they may
be able to sort of grab the penis with
their pelvic floor a little stronger
versus someone who doesn't. And that's
where I think some people get worried
when I say, "Oh, you need to relax your
pelvic floor." They're like, "Oh, I
don't want to be looser." Right? And
that's not going to happen if you have a
normally functioning pelvic floor. If
you're
>> So, the penis is going in here, right?
>> Correct. So, if I if you're a woman and
you do pelvic floor exercises, then
you're going to feel tighter.
>> Well, you're you're able to contract and
squeeze those muscles during sex better
around the penis.
>> Yes. But we don't want you to be
tighter. We want you to be able to
squeeze the muscles and relax the
muscles. Use them like a normal muscle
like your bicep. You squeeze and relax.
Squeeze and relax. We don't want it to
be constantly squeezed.
>> But to the man, it will feel tighter.
>> You will perceive it as tighter, but it
will not be that she's actually tighter.
it just means that maybe her pelvic
floor muscles are doing a better job. So
that's for the female. For the male,
it's it's generally like how the penis
moves and how the positioning is and
where it's uh it may be girth that's
different. It may be the way that you're
moving in the vaginal canal and that may
be why it feels different.
>> They often say that if you've got big
feet or big hands, you know, like people
think you have a big penis.
>> Not necessarily true. So there's um
there's actually no evidence that big
hands, big feet correlate to female
size. There's one study in Japan where
they looked at nose length. And so the
longer your nose is from the the bridge
down to the tip, that is potent, at
least the Japanese population that they
studied was correlated with the length
of the penis.
>> People also think tall people have big
penises. Not necessarily.
>> But nose length, there's some
correlation in a study in Japan.
>> Yes.
>> Okay. I was just checking if my nose.
>> Okay. Um the last thing I want to talk
to you about is
>> and how this relates to everything we've
talked about today, desire, attraction,
sex. Is there any early data emerging
that shows any correlations?
>> Yeah. So ompic there's sort of benefits
and there's potential downsides. So the
benefits are that when you're on Osmpic,
we see improvements in metabolic
diseases. They have improvements in
diabetes, improvements in heart disease,
improvements in overall health, right?
And so that is going to mean that your
blood vessels are healthier. You're more
able to get blood flow to your genitals.
You're going to have stronger sexual
function and arousal, right? So that's
great. The other thing is that you are
losing weight. So you feel better. you
feel more like your body image is is
feeling good about yourself. Also, for
men, remember I talked about this fat
pad right above your penis.
>> That's getting smaller. And so now you
can see more of your penis. So you may
have heard of ompic penis where people
are saying, "Oh, my penis is getting
longer." It's not actually that your
penis is getting longer. It's that this
fat is going down. So now you're seeing
more of your penis,
>> which makes it look longer.
>> Yes. Exactly. Reality. Yes. Exactly.
Well, it is reality to the person
looking. Right. Um so those are all
great things and I think that's
wonderful. Now the other part of it is
ompic works on the brain and it works on
the reward pathway. So you now see food
and you don't feel like it's that much
of a reward. So you don't chase after
you have less desire for food. There's
emerging data that we're seeing people
on these medications, these GLP1s, have
less desire for, let's say, gambling,
let's say shopping, let's say, you know,
alcohol, smoking, whatever it is, right?
And so there's a theoretical because it
works on the same pathways that it could
also decrease desire for sex. And I
think the thing that, you know, there's
so many people on these medications,
there's so many metabolic benefits that
I worry that people may not even realize
that their sexual desire is changing,
right? They might just be like, "Oh, you
know, I'm I'm eating less. I look great.
Everything's wonderful." But like slowly
in the background, they're like, "Oh,
maybe my desire is less." And maybe it's
creating discord in the relationship.
Hard to say because we don't have data
yet. So yeah, I think it's just
something that you should be aware of
that if you start feeling like you have
less desire for sex or maybe you're
like, "Man, I just really don't feel
into anything." Talk to your doctor cuz
maybe your dose is just too high and
maybe it just needs to come down a
little bit. And again, we don't know
yet. But I do worry about this because I
feel like we're we're gonna start seeing
it.
>> Is it possible to do studies on this
type of thing?
>> Absolutely. So you can take people
starting Ozmpi and you can say, "Hey,
here is or or any GLP1." You know,
there's questionnaires. So like for
women there's the female sexual function
index. For men there's Adam, which is a
questionnaire about testosterone. But
you could there's sexual desire
questionnaires that you can use. Um, and
you can take it at the beginning and
then you can take it as they increase
their dose and see if there's a change,
right, in terms of their sexual desire.
>> You said at the start about knowing how
to talk to your partner. I think like
intimacy desire, maybe the conversations
like with your partner, how to have that
conversation when there's a problem.
>> Yeah. I I wish I could say there was
like a script that you can follow and
it's going to work. But everyone's so
different. But I think the important
thing is like not giving up because what
happens is because we don't ever talk
about sex, when you bring it up, it's
immediately like, "Oh my god, is
something wrong? Did I do something
wrong? Um, do you not like me? Am I not
attractive?" Right? You're automatically
going down the rabbit hole of worry and
concern. And instead of dealing with it,
you're supposed to shut it down. No, I
don't want to talk about it. Right? Um
especially if like maybe you haven't
connected intimately in a while and like
you just don't want to deal with that or
you're you have other stressors in life.
Maybe you're not feeling like very good
about yourself and so you're like,
"Well, I don't really feel sexy, so I
don't want to have sex." And so, I think
really understanding that whatever
reaction you get from your partner when
you do talk to them, it's not about you.
It's just usually about how they're
feeling. And so, don't stress about
that. And two, like it's anything that
is worth having requires work. So having
a good sex life, having intimacy over
the long haul with someone, if you are
committed to that relationship, it is
worth working for. It is worth dealing
with a little bit of discord to get
there. And so I tell people when you
want to talk about sex, first of all,
don't do it in the bedroom. Don't do it
right before or after sex. Do it at a
time where you are both calm, relaxed.
Maybe you're out for a walk, maybe
you're in the car, so you're not like
looking directly at each other. You're
kind of parallel. And always start with
a positive thing. like I you know I
really enjoy this about our relationship
and I would love if we could talk about
this and and maybe they're going to be
like uh I'm not ready for that and you
say maybe we could come up with a time
where we can talk about this that works
for you right let them feel like they're
coming to the conversation with like
they're not being ambushed or like
talking about something and then be
curious. I think the big thing is like
being curious like what's going on with
you like I want to I want to I want to
be there for you. I love you. you know,
I miss what we used to have or I miss
this about us. And I think that there's
always these misconceptions. I hear it
all the time, right? It'll be like this
partner only wants sex and this partner
never wants sex and you know, and that's
it. Like that's the end of the
conversation. But the reality is that
there it's it's somewhere in between. So
typically women tend to view sex as like
added stress sometimes when they're
already stressed. Like they're like,
"Oh, it's just one more thing to do."
Whereas men look at it as a stress
relief. So, one, you're coming at it
from two different angles. The other
thing is men aren't really taught how to
be intimate. And so, for a lot of men,
sex is their version of intimacy. Like,
that's how they connect. That's how they
feel connected with a partner. And so,
often times when they're doing these
initiations or attempts at sex, it feels
like they're being greedy or it feels
like they're they just want sex. And I
think we have to reframe how we look at
that. Like, sex is not just sex. It is
intimacy. It is being together
connecting with another human being. So
how do we do that right? And like how do
we make that sex worth having? We get
into this frame where we have sex as
like in a hurried quick like just got to
get this done way. I just need to get an
orgasm. I just need to get a release.
But sex is supposed to be something we
look forward to. It's supposed to be
something that we're excited about. And
so we have to build that in. We have to
sort of like build the environment where
sex can can happen. So, it may mean
like, "Hey, we are affectionate during
the day. Maybe we send a lovey text
message. Maybe um you know, I give you a
hug. I caress your back. I um tell you
you look beautiful. I I'm I'm showing
you gratitude for how much I care about
you in other ways." I think just really
taking the time to understand why your
partner feels the way they do.
>> I'm curious about on that communication
point about how different genders
in heterosexual couples have different
sort of taboos and things that are just
a bit sensitive. Um, and I was looking
at the the variance between men and
women, and the the top one for men was
around performance anxiety. So, like
admitting to things like erectile
dysfunction because it feels like it's
so intrinsically connected to
masculinity
>> and you feel like a failure as a man if
you can't get a erection and pleasure
your partner, right?
>> And then for women, it was talking about
um prioritizing pleasure and asking for
more foreplay or um, you know, specific
specific stimul stimulation around the
clitoris or something like that. um
because they don't want to be labeled as
highmaintenance or too much hard work,
etc.
>> And it's interesting that on that walk
with your partner, there are different
things that will trigger each of you.
>> Mhm.
>> Um other ones for women were pain and
discomfort, bringing that up. Um body
image and the mental load, explaining
why you aren't in the mood. And other
ones for men are expressing nonsexual
needs because it might be seen as
unmanly, unmanly, boundaries and
rejection, communicating when they don't
want sex. And lastly, the script, which
is discussing fantasies that deviate
from the norm.
>> So, I want to talk about fantasy, but
before that, I would just say that, you
know, it because of social media, we're
in a place and I get text messages from
my husband 24 hours a day with like not
24 hours a day, but like all waking
hours with reals and videos. Oh, I think
you'd like this. I think you'd like
this. You should check this out. And
it's like his way of like connecting and
like, hey, let's talk about this later.
Like, this is fun. And so I I tell my
patients like send your partner a a
video that you saw on social media that
might help them understand like why this
is important to you. Maybe send them a
video send them this podcast, right? Say
like, "Hey, I watched this. It was
great." Good idea. You know, um and I I
learned so much. And honestly, so many
patients bring their partners to me.
Whether it's women bringing male
partners or men bringing female
partners, they come to me and they say,
"Look, like I want you to meet this
doctor and I want you to talk to them."
And like it's beautiful to see that.
Like I love it because it's it's so
deeply caring that they like brought
their partner and they want them to feel
good and they just want to figure out
what's going on and like I think it's so
lovely to to to find someone who's so
invested in making sure that sex is good
for you, right?
>> As men though, we're just not good at
talking about this stuff,
>> right? But you know, I think you can't
use that as a crutch.
>> Yeah.
>> Do you know what I mean? Like
>> Yeah, I do. Yeah. We're just not good at
it though. We just
>> But no one's good at it. It's not men.
Women are not good at it either.
>> I think men are worse at it. I think in
general no one is good at talking about
sex. Like I, you know, I think it's
interesting because I talk about it all
the time, but I have seen very good
communicators struggle with talking
about sex. And so I think it's just um
it's just it's uncomfortable and and
it's like if you and I can have this
conversation and we can talk about sex
openly, like there's no reason that you
can't learn how to talk about sex and it
it's it's a learning process and it's
worth it's worth investing in. Do people
bring you their fantasies?
>> Yeah, I've had I've had well more not
not as many fantasies as like real sort
of diverse interests in sex.
>> What do you mean by So I had a patient
who came to me and said uh you know
after sometimes this was not like our
first visit like we built a rapport and
he told me you know the I I really
struggle with arousal and the only time
I get aroused is I have a a medical kink
and so I go to this person who will put
a fully catheter in me and that's what
turns me on. And I was like that's
really interesting. And I was like,
"Okay, like that's that's great, but
like it took a long time for us to get
there for him to feel comfortable." But
it also then was like, "Well, if that's
what turns you on, you know, then you
got to sort of explore other ways to
incorporate that with a partner. Maybe
not." So like a a catheter is is um is a
tube that you put in the bladder for to
drain urine.
>> What hole does that go in?
>> The urethra.
>> It goes in the penis.
>> Correct. And so there's actually a lot
of people who enjoy urethral play. So
they will take sounds, they're called
sounds, like little um uh rods with a
frail flared base and they will insert
them in the urethra.
But people do find that pleasurable. And
so because there is some, you know,
there there are some nerve endings there
that can be pleasurable. And so again,
it is totally fine to have interests
that are, you know, outside what we call
conventional. Um, but of course I think
you need to uh if that's something that
you're really into, you have to sort of
bring your partner into the into the
fold if that's what really gets you
turned on. Now, in terms of fantasies,
almost everyone fantasizes, right?
Almost everyone does. And the
interesting thing when you look at
fantasies is there's a lot of fantasies
that you would think are not common but
are. So, for example, um being sexually
submissive is very common. So women
fantasize about it like around 60%, men
are like 20%, having this desire of sex,
this fantasy of sexual submission. It
may not mean that they want to be
submissive in real life, but that's the
fantasy they're having. Um, men often
have voyerism fantasy. So like watching
sex. Um, they also have uh sex with
multiple partners. Um, women tend to
have a lot of like sexual um dominance
but also romance in their fantasies. So
like in exotic places or um that or with
and a lot of times like 90% of the time
people fantasize about strangers or it
could be someone they know but outside
of their relationship and so that's
completely normal and nothing to be
worried about. It doesn't mean that like
you want that person. It's just a
fantasy. It's a safe place in your head
to think about fantasy. And I think one
realizing if someone fantasizes about
something it means nothing about how
they feel about you. It's just where
their brain goes to explore. I tell my
patients sometimes write down your
fantasies for yourself. Just like write
them down. Don't share that with anybody
and have your partner do the same. And
then if you guys decide you feel
comfortable at some point to each share
one fantasy and you can start talk and
maybe one that you would want to try and
like it allows you to sort of explore
and think about different things. It
could be a negative outcome like you
could just be like oh no this what
didn't do it for me but it could also be
very positive. And so just like again I
think the big thing is understanding
like it doesn't need to be that serious.
like we can experiment, we can play, we
can have fun. And if you bring that back
into your life, you are going to be
happier, less lonely, live longer. Like
everyone should just be having more sex.
>> It's um Yeah, it's interesting that
we're getting more and more sexless
because I think the world is stealing
our attention and that's causing a big
loss in connection. But then everyone's
lives are more stressful than ever
before. if a bomb goes off 10,000 miles
that way, I I see it when I open my
phone.
>> Um, so it's an interesting time to sort
of almost try and reclaim sex and
>> to work on one's sexual health, the
overall the full picture of one's sexual
health. Um, you're working on a book
which is, I guess, endeavoring to do
much of that, which is coming out in
September
>> called The Hard Truth: Everything Men
Need to Know About Good Health, Great
Sex, and Long Life. So, if you're
watching this after the 1st of September
2026 or around that time, then the book
is probably available for pre-order or
already out. It's not available for
pre-order yet, is it?
>> Uh, it will be soon, but not yet.
>> Okay. When the book is out, I'm going to
link it below in the comments section.
Um, when it's available for pre-order,
The Hard Truth: Everything Men Need to
Know About Good Health, Great Sex, and
Long Life. So, if the subjects we talked
about today have piqu your interest, the
book, I imagine, is going to go into
greater detail on all of these subjects.
>> Absolutely. I think it's a book that
really I I wish was a part of sexual
education. I think all men need to know
this. You know, as women, we end up
taking care of our male partners. I make
all the doctor's appointments. I, you
know, I organize all of that. I make
sure that my kids get all their
vaccines, all that sort of stuff. And
and you know, it becomes on us to take
care of our fathers, too. And so, as
women, we hold that role. And I think it
is so valuable to understand what men go
through and also to be able to support
them along the way. And I think it's a
great gift for, you know, men in your
life or for, you know, older sons even
to like help people understand their
bodies. And honestly, it's a huge
motivator. I tell people like for
nothing else, people care about sex. And
I have seen patients turn around their
lives because they want to have better
sex. They'll literally improve their
blood sugars. They'll improve their
blood pressure because they just want to
protect their sexual health.
>> Reena, thank you. We have a um closing
tradition on this podcast where the last
guest leaves a question for the next
guest not knowing who they're leaving it
for.
>> Mhm.
>> This is the first time in Dario history
where the guest has actually stamped it
with a stamp that says certified 100%
human.
>> Okay.
>> So, you can see there's a little stamp.
>> So, when is that AI?
>> So, it's not AI and it actually says
that in the middle. It says Gen AI free
sign of things to come. But their
question I guess is somewhat linked to
that. They the question they've asked
for you is so much of the world feels
hopeless about this moment. What would
you tell someone to help them reclaim
their agency?
I think that
we as humans are meant to be with other
humans. We are meant to connect and I
think making that a priority will allow
people to feel
um to feel a part of something again.
You know, I think um I think there is
like an emergence of people starting to
look back at religious constructs and
and go to community and be a part of
things and enjoy live events again like
we weren't doing before. I think if we
prioritize that, there is still hope
that we can come together as a society.
And I think, you know, the pendulum
always swings right in every way, like
it's going to go far right or far left
and people are going to hate each other
and then they're going to love each
other and they're going to come back.
And I think if you just look at history
time and time again, it repeats itself.
And we will find unity and we will find
togetherness. We are obviously feeling
pain from a variety of different sources
and we may feel pain right like in terms
of other things to come but ultimately I
I'm an optimist and I think that we'll
come together and and we will find um
happiness and joy in human connection
>> and I hope you're right and I think
we're seeing the early signs of that now
for anyone that's listening that wants
to learn more from Reena um I highly
recommend they go to your YouTube
channel I will collab if we can um and
if we do collab on YouTube you'll a
little smiling Reena um next to the Dar
of Seio logo where you can click through
to her YouTube channel. She's got almost
3 million subscribers and she goes
through all of the questions which no
one has ever answered for us. And I was
looking at some of the questions that
you answer for people. Everything from
>> why you dribble after you pee and how to
stop it. porn director reveals what what
scenes are faked in almost every scene
of movies, but then also a lot of the
stuff we've talked about today around um
penal health, erectile dysfunction, um
sex positions, and so much more. So,
it's a wonderful repository of
information that is constantly being
updated. That is a great place to
subscribe. So, I highly recommend you
do. Dr. Reena, thank you so much for
your time.
>> You're so welcome. YouTube have this new
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