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 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?" And 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 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

um 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

progress?

>> 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's 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 of 08 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 talk 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. and it'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% of men.

>> 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. If you love the D CEO brand

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