Men who ejaculate 21 times or more a

month are less likely to develop

prostate cancer. Jesus Christ, why? It's

because Dr. Rena Malik

Board certified urologist

Expert on sexual health

And a rockstar in educating the public

On the facts and myths of sex Rena, I

want to start with this idea that other

couples are having significantly more

sex than we are. Big myth. People are

having sex about once a week. Will my

penis get smaller as I age?

It can. So, in terms of how do we

maintain our penile size, you need to

have Is there a disparity between how

long we think sex should take and how

long it actually takes? Yeah, we all

think it lasts longer. Women want it to

be 18 to 25 minutes. Men are a little on

the shorter side, like maybe 12 minutes.

Is there like an average time?

5.1 to 5.7 minutes. And then is too much

masturbation going to have an adverse

effect for men and women? Masturbation

is generally safe as long as you don't

That's when it becomes a problem. Rena,

do we understand our bodies as it

relates to our sexual health? Not at

all. For example, with pelvic floor,

it's involved in orgasm, it's involved

in sexual function, but no one really

talks about it. In fact, men will be

shocked, "Oh, I have a pelvic floor,

too?" And there's a whole host of issues

that can come from having a weak pelvic

floor, including erectile dysfunction.

So, how can I strengthen my pelvic

floor? Pelvic floor exercises. They're

going to increase orgasm, they're going

to make your semen propel further, and

ultimately it would be something as

simple as

It's absolutely crazy to me that so many

of you have decided to watch our show,

um, and so many of you have decided to

subscribe to our show. We now have 5

million subscribers on YouTube, which is

a number that I just can't comprehend,

and it's a dream that I absolutely never

could have had. We started The Diary of

a CEO just over 3 years ago now, and in

my wildest expectations, we might have

had 100,000 subscribers by now. So, you

can imagine how shocked I am that so

many of you have chosen to tune into

these conversations every week um, and

spend some time with us. So, thank you.

And I made a deal with you. I made a

deal that if you subscribe to this show,

that we would continue to raise the bar.

And in 2024,

we're going to raise the bar like never

before. I've been working for the last 9

months on a surprise for all of you that

have subscribed to this show, and I'm

very excited to deliver that for you.

The production's going to change. We're

going to go even further with our

guests, and we're going to tell even

more global stories. So, as always, if

you appreciate what we're doing here,

the simple free favor I'll ask from you

is to hit the subscribe button. Let's

get on with the episode.

Dr. Rina Malik.

With all of your work, what is it that

you're seeking to do?

So, what I'm seeking to do

is

have people understand that sexual

health is health.

I think we have so much misunderstanding

about one, what is good sexual health?

How do you Why is good sex important?

Why is it good to have

good sexual health? And that creates a

lot of despair and devastation, and

people don't talk about it. So, they

ruminate, they feel bad about

themselves, and it's pervasive

throughout their entire life.

So, I think ultimately my goal is to

make education freely accessible and

understandable, so people can know

what's going on with their bodies,

what's normal, what's not, and what's

available to help them.

How do you define sexual health?

So, sexual health is sort of an

individual thing, but most people would

say that you are able to have sex, you

are able to have an orgasm, you are able

to have pleasure and achieve the

benefits of that. Do we understand our

bodies

as it relates to our sexual health? No.

Not at all.

I will tell you, so I talk about, for

example,

how it's normal to have erections at

night or have even nocturnal emissions,

so have a wet dream, how that's a normal

physiologic function. And so many people

will message me and say, "How can I stop

having what they call nightfall?" Or

"How can I stop waking up with an

erection?"

Because they think for some reason it's

shameful or it's a bad thing. And when

realistically it's just normal. And part

of it is media, right? So when you see

TV, you see a man getting an erection

very quickly, he's

immediately penetrating a woman, and

she's immediately orgasming, and the

whole act is like really hot and heavy.

And in reality, that's not what sex is

like. So if you're not seeing what

normal sex is like, what normal foreplay

is like, what the fact that it's normal

to sometimes have difficulty getting an

erection, that's normal sometimes to not

have an orgasm for a woman, or it may

take more time to get a woman aroused

and require more foreplay, that you are

essentially looking at a script that's

not real. And then you're like, "What's

wrong with me? Am I broken? You know, is

something wrong with my body that it

doesn't function the way I'm seeing on

TV or on media or on erotic films?"

Where does your experience on this

subject come from?

So I'm a urologist by training, a

board-certified urologist. So we are the

medical and surgical doctors of the

genitourinary tract. So we're

essentially the plumbers. So when you

have a problem with your kidneys, the

tubes that drain the kidneys, the

bladder, or your genitals, we're the

ones who are going to fix those if

they're a surgical issue. And also we

deal with the medical aspects of some of

those things. And so that's what my

training was in. But when I started my

social media, my channel, I wanted to

offer education to people. And as I

started making this education, I

realized how badly people wanted to know

about sexual health, how much they

didn't know, and how they really wanted

to be empowered with this information.

And people are not being asked about

sexual function. Even when you go to see

your primary doctor, when was the last

time they asked you about anything They

might ask you about erections, but

that's probably where it ends, right?

Even if they ask about that, they're

definitely not asking women, "Are you

having orgasms?" They're definitely not

asking um anyone if sex is pleasurable.

They're not asking them if they feel

satisfied with the way things are going,

right? And if they are enjoying desire,

do they feel normal? And so I realized

there was such a disconnect here with

what people wanted to know and what was

available to them. And so then I started

really making content about sexual

health and spending more time

investigating in that area, treating

patients in that area, and it totally

became a all-encompassing field for me.

You're an expert in the pelvic floor as

well. Mhm. What was your sort of

training

with the pelvic floor? So when you do a

fellowship in what we call pelvic female

medicine, a lot of what we do is related

to the strength or weakness of the

pelvic floor. And so the pelvic floor,

just to start, is a bowl of muscles that

sits in your pelvis. So your organs, the

bladder, the rectum, for women the

vagina, the uterus, the urethra, all run

through the pelvic floor. It attaches to

the bones on your pelvis, and it is

extremely important for a variety of

functions. It offers stability, so when

you're standing, sitting, it offers

stability. It offers the ability to

defecate and urinate normally. It offers

uh when women have pregnancy, the pelvic

floor becomes very important. It's

involved in orgasm. It's involved in

sexual function. But no one really talks

about it. No one really knows it. In

fact, men will be shocked, "Oh, I have a

pelvic floor, too?" Because we talk

about it a lot with women, right? We

talk about it in terms of, "Oh, I might

leak a little after I've had babies when

I cough or sneeze or jump on a

trampoline. But the pelvic floor is much

more complex than that. And so, very

often we'll see people when they have

weakness of the pelvic floor, yeah,

we'll see leakage of urine. And but

sometimes their pelvic floor can be

discoordinated, or it can be too tight

or or have elevated tone. And so, what

that means is that you can develop a

whole host of abnormalities. And that

can be that you may have constipation.

You may have issues emptying your

bladder. You may feel like you have to

go to the bladder go to the bathroom a

lot. So, you may urinate frequently. You

may feel the urge to go often. Sometimes

it can cause pain. So, it can cause pain

when you urinate. It might feel like

you're having a UTI. It may cause pain

with erection or ejaculation for men.

So, there's a whole host of issues that

can come from having pelvic floor

abnormalities. And even if you've had,

say, lower back injuries or hip

injuries, they can affect the

coordination of the pelvic floor cuz

it's all interconnected. And so, I will

see patients who are like, you know,

"I've had a bunch of hip issues because

I played sports when I was younger, and

now I'm having issues with sexual

function." And so, it's all

interconnected and I think we we don't

spend enough time talking about how

important it is and how valuable it is

to people when they're having problems.

I want to go into the pelvic floor in

more detail and really figure out how I

can improve my pelvic floor and what I'm

doing to harm or hurt it. But you said

something there about doctors don't ask

about sexual health. They don't ask you

for orgasming, they don't ask you for

ejaculating, those kinds of things. Why

should they be asking about that? Cuz I

think of a doctor as, I don't know,

fixing other parts of my body. I don't

think of them as sifting through my

sexual life.

So, if you have a normal sexual life and

you're satisfied with it, it won't even

it wouldn't even bother you, right? You

wouldn't think about it. But people who

have difficulties, they may be walking

around feeling shame. They may be

walking around wondering what's wrong

with them. This can be pervasive because

they may have relationship issues and

they may have problems in their life

with their relationship that they're

then causing them to be less productive

at work, less happy, less satisfied with

life, feeling more depressed, more

anxious. And so it all comes together.

And in fact, the other really important

thing, at least for men, we know that

when they develop issues with erections,

so say you're having erectile

dysfunction, and you are diagnosed today

with erectile dysfunction, 7 years

later, about 15% of those men will have

a heart attack.

And the reason for that is because if

it's a blood flow issue, the arteries to

the penis are about 1 to 2 mm. The

arteries to the heart are about 3 to 4

mm. And when you have about a 50%

occlusion of a blood vessel because of

high blood pressure, high cholesterol,

heart disease,

that organ will start to have problems.

And so you will start to see erectile

dysfunction in men who have vascular

problems

before you start having chest pain or

other signs of heart disease. So it's

and probably similarly in women,

although the data is not as We don't

have that data for women that maybe if

they all of a sudden are developing

problems with arousal, that maybe that

that's an indicator. But again, that's

more complex and we don't have the data

for that. But certainly for men, we have

a clear indication that a problem with

erections could precede really serious

heart consequences. And when you look at

people who've had a heart attack, about

50% of men will have had erectile

dysfunction prior to that. 50%?

Mhm.

Is a pelvic floor dysfunction in men

also linked to erectile dysfunction? Are

you cuz I I heard in some of your work

that sitting every single day in in the

way that I do here, I sit sometimes here

for 10 hours a day, could be creating

erectile dysfunction.

Well, so it's more of the sitting every

day can cause your pelvic floor to not

stretch appropriately, right? Like if

you're not moving your body regularly

and your body tenses up from sitting all

day, then your pelvic floor is not

relaxing and contracting in a normal

fashion. And so some people will develop

some tension in the pelvic floor and

through the pelvic floor runs a whole

bunch of arteries and nerves that then

go to the penis to provide blood flow.

And so if your pelvic floor is clenched

really tight, then it can cause problems

in getting blood flow and then problems

in getting erections. So while that's

not um that's different than having

vascular problems, this is a muscular

problem more so um that that that can be

an issue with in terms of causing

erectile dysfunction in some men. Cuz I

heard during COVID there was a rise in

pelvic floor dysfunction as people were

sitting all day. Yeah, I mean I

definitely saw it. I don't know if it's

been actually studied, but I definitely

saw it in my own clinical uh setting and

many of my colleagues did where people

would come in and they would start

having either they'd be having more

erectile dysfunction, they might be

having more urinary urgency, meaning

they got to go got to go to the bathroom

or they're going more often, which

wasn't a huge issue because they the

bathroom was right near them, but they

did sometimes notice that it was a

change. And and also sometimes they

would some people even dealt with pain.

Like they would have more pain in that

area or women would think they were

having urinary tract infections when

they truly were just having discomfort

from the pelvic floor being tense. One

of the things that you're particularly

good at is taking on some of the big

myths as it relates to sexual health and

I I want to start with one of the big

myths around sexual health, which is

this idea that we all think other people

and other couples are having

significantly more sex than we are.

Yeah. So that's interesting. I think

that is a big myth. And so when you look

at um people want to know like what's

normal? How much sex should I be having,

right? And there's no ideal number, but

when you look at studies, right, which

have looked at large numbers of people,

people who are in partnered

relationships are having sex about once

a week on average if they're have if

they feel that they're, you know, in in

partner relationships where sex is

always available. But it's so variable

person to person. And what I really like

to say is it's not the quantity of sex

that matters, it's the quality of sex,

right? So if you're having good sex

once a month, that may be sufficient for

you rather than having mediocre or bad

sex four times a month or 10 times a

month even, right? And and so ultimately

there's no right number. It's really

what's right for you. And I think

focusing on

some like benchmark, right, of sex is is

actually harmful, right? Because now

you're like, oh, well, I need to have

sex this many times. What what is the

purpose of sex, right? The purpose of

sex is pleasure. And sometimes people

derive a lot of benefits from orgasm. We

know that there's physiologic benefits

to orgasm in terms of stress reduction,

more focus, potentially better sleep,

and even maybe lower blood pressure,

things like that. So if people are

deriving benefit from the orgasms and

the intimacy with their partner and the

pleasure they derive from sex, that's

what matters, right? Not the number of

times you're having sex.

Another big myth around sex which I

thought I'd

get your take on it is

about pain during sex. It's one of the

sort of most popular questions that I

often get get whenever I speak to

someone that is an expert on sexual

health is

is sex supposed to hurt? Because for a

lot of people it hurts. No, it's not

supposed to hurt. So if it hurts,

you want to assess, you know, what

Usually it's the female partner who

feels pain, right? So is it that you're

not lubricated enough? Is it that you

have not had enough foreplay? Because

the body prepares for intercourse,

particularly in the female. So what

happens is you go through arousal, your

body self lubricates, and the vagina

actually lengthens and widens almost

double in size to accommodate the

phallus or whatever you're using,

whether it's a toy or or a finger or

anything. And so, if you don't have

sufficient time to allow those things to

happen, then it will be painful. And

sometimes lubrication can be variable

person to person. So, some people may

have copious amounts of lubrication, and

some people may have less, and it could

be based on genetics. It could be based

on the age they are, what stage of their

hormonal status. It can be based on what

medications they're on that might

decrease lubrication. I think there's

another big myth is that lubricant is

not for everybody. And I argue that

lubricant is for everybody, that it

makes things more fun, it makes things

more slippery, it makes things more

enjoyable. And it certainly makes pain

less of an issue for a lot of people.

Now, there can be other issues that

cause pain. So, if you've tried all

these things, you know you're fully

aroused, you know you're lubricated, you

know that you're still having pain, then

it's really important to get evaluated

to understand what exactly is causing

the pain. It could be hormonal changes

in the vestibule, which is a part of the

vagina, that is very hormonally

sensitive, that can be painful. It can

be pelvic floor dysfunction. It can be

things like endometriosis or other

factors that may be going on that need

really advanced help. But most of the

time, a lot of people can feel and enjoy

sex more readily if they just increase

the amount of foreplay and increase the

amount of lubrication. You said that the

vagina

expands Mhm. during sex. So, how much

does it expand by, and how long does

that take? Because I think men don't

really understand this process. A lot of

men just like to rush in there, you

know.

Yeah. Yeah. So, usually it expands by

about double, double in length and

double in width. And so, it will expand

and basically the cervix is moving up

and out of the way, the vagina is

expanding to accommodate the length of a

phallus, and and it takes, we think, on

average about 18 to 20 minutes. So, it

that's sort of the amount of time it may

And some people faster and some people

longer, but ultimately, you know, sort

of like understanding that, but also

um the lubrication is another big part

of it. And so, I think both those things

together, um you know, you need you need

some time. And some people, like I said,

they may not take 18 minutes. They may

take a couple minutes. And so, it's very

reasonable to get in there if that's

what your partner wants. But again, I

think the bigger issue is that we're not

communicating about sex. No one taught

us how to talk about sex, right? I

didn't grow up talking about sex with my

family. Many of my friends and

colleagues did not grow up unless they

were in a family that was very

progressive talking about sex or even

learning about sex from their parents.

And at school, you don't learn much. You

learn how to put on a condom, you learn

how to ask for consent, you learn about

STDs, and that's if you're lucky. In the

US, 13 states don't have to have

accurate sex education. Like, it's not a

requirement for sex education to be

accurate in 13 states in the US. Where

are we learning sex from?

So, the large majority of young people,

I mean, this data shows that at least

one in four adolescents are learning sex

from porn.

And it's probably more than that. So, I

think a lot of people are learning

either from uh pornography, from their

friends. A small subset are learning

from their parents. There still are

people learning about sex from their

parents, but ultimately, it's not

enough. And so, if people are learning

about sex through porn, porn is

entertainment. It is doctored, it is not

real, and I think people then take that

and they say, "Why did not my sexual

encounter not look like that? Why didn't

I have as much semen volume? Why didn't

my partner not orgasm as quickly?" And

it can be on both sides, where women can

be like, "Well, why didn't I react like

that? Why didn't I get so excited right

away? And I think there's it's a real

problem in terms of if people are only

learning about sex through pornography,

then they're already set up to be let

down when they have their first sexual

encounter. And on that point of

communication, we don't talk about it as

a society, but then even within our own

relationships,

uh you know, we don't talk about things

we're struggling with with our own

partners. Yeah. And the insecurities

that we have, and I think that can cause

a spiral of misunderstanding, and I've

seen that in my own sex life

historically, where maybe there was

something I was insecure about or there

was something I was thinking about, and

instead of communicating it, I might

have just acted in a strange way, and

then that's misinterpreted, and then the

other person gets a little bit insecure

or whatever, and then you kind of have

this downward spiral of

misunderstanding, which leads to like

sexlessness. Absolutely. You're just

avoiding the situation because nobody

wants to talk about it. And this is the

problem. Like, you know, people ask me

like, "What's the What's the key? What's

the key? What's the secret?" The secret

is you have to know what you like,

right? You have to know what you want,

and you have to communicate it with your

partner. How? So, this is the issue.

It's not easy. It's not easy because no

one taught us how to have these

conversations, and they're charged with

a lot of emotion, right? You feel

insecure, you feel inadequate, or you

feel resentful because you're not

getting what you want out of the

relationship. And so, it has to come

from a place of understanding that this

conversation is not a one-and-done.

There's no the talk. There are multiple

talks over multiple periods of time. And

the first time you have the talk, it

might be a total disaster. But, you

know, if you are in a relationship with

someone really also has the same goals

as you of having a great relationship

with a good sex life, then ideally it

that won't continue, and you will

continue to have conversations. So, what

I tell people is don't have

conversations in the bedroom, not right

before, not right after sex. You want to

wait until you're out of the bedroom.

Or during, yeah. Definitely not during.

That's happened before. It's the [ __ ]

worst.

Yeah. Yeah, that's pretty bad. That's

pretty bad. Um

So, you know, one and then two, have it

in a place like some people you don't

need to be looking at the person, right?

You can be sitting in a car, you can be

going on a walk, because it's really

awkward to look at someone in the face

and be like, you know what? I felt like

this wasn't really great, you know? And

And so then to be like, okay, like, you

know, talk again, using the same sort of

communication techniques that you use

for other things, talking about I

statements, not being you did this, you

didn't do this, more about like how I

feel, what really turns me on, what I

would really like in the relationship.

And then sort of realizing that they may

not react well, they might be like, oh

my god, I can't believe we're talking

about this. They have their own

stereotypes and biases that they're

bringing into that conversation too, or

their shame, or whatever they grew up

with in society, whatever they think

about sex can be very charged, right?

And so it's sort of a lot of work to get

through that, but realizing that it

could take time and sometimes getting

help. So, seeing a sex therapist or

someone who has expertise in psychology

and sex to talk about learn how to talk

about sex with them and and navigating

the difficulties of it. But it's worth

the investment, right? It's not easy,

but nothing in life that's good or worth

getting is easy, right? Okay, so there's

a couple listening right now, there's

probably one member of the couple

listening right now, and they've heard

everything you've said, but they have

reached the point of no return in their

relationship as far as that concerned.

They've not been having sort of a

functional healthy sex life for maybe

one year, maybe six months, maybe five

years.

And it's just become the new normal.

Mhm. What is the case you'd make to that

person to get them to take action to try

and rectify the situation? Well, I would

ask them first how important is sex to

them, right? If it's not that important

and the other things in the relation And

that's okay, right? Some people find

that, okay, everything else in the

relationship is excellent. I love this

person, we're still intimate, we still

love each other, we We cuddle, we still

um have a lot of great things in our

relationship and and sex right now is

not working, right? Or it's not it's not

working for us. So, um I'm okay with

that. That's fine. Like you don't have

to feel bad about that. But I think that

if it is a problem, then I think it's

worth working on, right? Like if you

have a relationship that you value and

that person you're you're with values

the relationship, then it's worth keep

trying. Like try to have the

conversation. Try to bring them into the

conversation. How much have you tried,

right? Like have you really had enough

attempts at a conversation? A true

conversation where

you didn't get frustrated, too, right?

Like where you were like, "Okay, I

understand that you have This is a

difficult conversation that we're going

to have and I understand you might have

feelings about it, but I love you and I

really want to try to have this

conversation." And to keep at it. And I

realize that that's not easy, right?

That's not easy. I'm not saying it is.

But I'm saying that when you're in a

relationship that's worth having, that

ideally at some point the other partner

will see how much this matters to you

and want to work with you on it, right?

If they love you, if they're with you

there, they want what's best for your

relationship. They're not like hiding

They're not hiding their head in the

sand and being like oh, I'm like they're

They realize they just don't want to

talk about it. They they they're not

stupid. They just sort of don't want to

talk about it because it's embarrassing

to them. They feel like they're the one

that has something wrong with them,

maybe. Or maybe they have an issue that

they haven't brought up. Maybe they're

having a lot of pain with sex. Or maybe

they're going through hormonal changes

and their tissues are really dry or

whatever. There's a whole host of things

that could be going on that they don't

feel comfortable talking to you about.

So, I think it's it's valuable to say,

"Is there something I'm not doing?" Like

tell me what you feel about sex. Like

leaving it open-ended to really find out

what's going on with them. Because

usually not that they're like, "I just

don't want to have sex and that's it."

There's usually a lot more to it.

It's so hard for us to know, isn't it?

When it comes to sex, what the root

cause of the issues are. And I think

some relationships are like a frog in a

frying pan.

The frog in the frying pan analogy for

anybody that doesn't know is that this

old tale about a frog jumping into a

frying pan and then because the water

heated up gradually ends up dying. But

if the water was hot from the moment it

dropped jumped in it would have jumped

straight out. The idea that it's a

gradual death for the frog and in

relationships it's kind of a slow day by

day month by month decline in intimacy

and you end up finding yourself like a

dead frog in a frying pan. You end up

finding yourself in a sexless

relationship and you think how the hell

did we get here? Mhm. Um

and it's and it's a it's a feels like a

long way back from that point. It is.

It's going to be, right? Because you let

it sort of dwindle and you didn't talk

about it and it's going to take work and

I think that's the key is like if you

want to fight for that in your

relationship, it's going to take work

and it's going to take um buy-in on both

sides, right? You have to work for

anything in your relationship.

Relationships are not easy, right? You

want to have children, that takes work.

You want to um decide to buy a house

together, that takes work. Deciding and

figuring out the what kind of house you

want, how much money you want to spend.

Like there's all sorts of things that

take work and this is one that people

just don't know how to talk about and so

they just ignore it because it's harder

to bring up for both parties, right?

What the one who maybe is not wanting

sex or is being the one who says no to

the and the one who always wants sex and

then feels rejected because they're not

getting it. Is there a a sort of a

difference between men and women's

sexual desire as we age?

You know, because I think there's a myth

that says men just always want to have

sex and women maybe not so much. Is that

a real myth um in terms of something

that you hear, but also is it true? So,

let's talk about desire. Desire comes in

two flavors. So, there's the spontaneous

desire where you see somebody, you're

like, "Oh man, they're so attractive. I

can't wait to sleep with them. I'm

immediately turned on. I want to have

sex right now, right? You didn't have to

do anything. You just saw them and it

happened. And then there's responsive

desire where you're sort of with them,

you might be touching them, you might

not really be thinking about sex, but

like you're touching them, you're with

them. You're like, "Oh, this feels sort

of nice. I sort of like this." Like,

"Oh, now I'm turned on." After we've

sort of started being a little romantic

with each other, being a little more

intimate with each other. And both

desires are normal and both desires are

fine to have. Now, in the literature,

you'll find that men tend to more often

have spontaneous desire and women tend

to more often have responsive desire,

particularly when you're in longer-term

relationships. So, there's a disconnect,

right? Women are like, "Why don't I see

you and want to jump you anymore? Right?

I used to feel like this, but I don't

anymore. What's wrong with me? Am I

broken?" Right? And then they don't

realize that, "Okay, maybe we'll just

like be together and let's see what

happens." And they don't even want to

start because they're worried that what

if I don't want to have sex and we've

now initiated this like touching,

cuddling thing where, "Oh, that person's

getting really turned on. What if I

don't get turned on? And what if I

disappoint them?" And so there's a lot

of charged emotions there, but realizing

this is normal and common and responsive

desire is not wrong. It's just

different. And people just don't know

that it exists because, again, media

attention is like you see somebody jump

them, you're you're horny right away,

you have sex. And that's not what

happens all the time and that's okay.

And so like, you know, you can be with

your partner and be like, "Look, I have

no expectations from you. I just want to

be with you physically." And see if it

turns into sex. So, often we'll give

people homework. Like, put it on the

calendar. Put it on the calendar that

you are going to be intimate together at

this time. And I know that sounds weird,

right? Like you're looking at me like

I'm crazy, but we put on the calendar

when we want to work out. We put on the

calendar when we want to have brunch

with our friends. We put on the calendar

when whatever, right? And when we When

we

when we used to have dates with people,

we would say, "Okay, we're going to go

on a date on Friday night." We would

know that sex is on the table with our

partner on Friday night. So, we'd get

really excited about it. We're like,

"Okay, I'm going to shave. I'm going to

look real pretty. I'm going to smell

good. I'm going to do all the things

that make me desirable and feel

confident and be ready to have sex,

right?" And so, you'd be like really

excited about it. And then you would

have all this anticipation about how fun

it's going to be. But the anticipation

can can wreak havoc, can't it? It can.

It can. So, the opposite is true. But

that's because if you expect That's why

I say intimacy and not sex. So, if you

say you're going to have sex, it can be

like, "Oh my god, what if I don't

perform? What if I don't do right? What

if I don't want sex? What if it hurts?"

Right? So, you can also have that sort

of rumination and spiral. But if you're

like, "Look, all we're going to do is be

together and be intimate. We're not

going to just go have dinner and talk.

We're going to like literally be

together, not have our phones with us,

maybe like touch each other, maybe get

undressed, maybe just, you know, feel

how what it feels like, and that's it.

There's no expectation of sex from

either side. We're going to go in

knowing that, and then slowly work our

way towards like, "Okay, you know what?

Like, maybe sex will happen and maybe it

won't." And over time, as you keep

putting on the calendar, prioritizing

your intimacy with your partner, then

eventually you'll get to a point where

oh, you remember, you recall that

connection you used to have, and then

you can actually find that joy again of

connecting sexually.

That's the sort of the aspect of desire

which is I guess is a bit more

psychological. But it There's also sort

of a physiological element to desire as

it relates to hormones levels. So, if

someone's got a low libido, is that a

hormone dysfunction? It can be. So,

testosterone is the most notorious

hormone for desire, right? In both men

and women. And I think this is a big

misconception is that we don't talk

about testosterone in women. But

testosterone in women is more

predominant than actually estrogen. We

have more testosterone in our bodies

than we do estrogen. And testosterone is

very important for desire in both men

and women. But anything that is in

interacts with testosterone is also

important. So, thyroid hormone can can

cause issues with testosterone.

Prolactin, which is another hormone made

by the brain, can also interact with

testosterone. So, essentially evaluating

those things and making sure that your

levels are normal or appropriate for

your age can be helpful. That's probably

the number one thing. But the other

thing is outside of physiology is that

stress, even though stress is

sort of an abstract thing, stress

affects our physiology, right? So, when

you have a lot of stress in life,

whether it be work, relationship stress,

kids stress, whatever it is, right? It

raises your cortisol level. And when

your cortisol level is high, you can't

produce testosterone. It goes down. And

so, if you're chronically stressed,

which many of us are, right? You spend

like in today's modern society, chronic

stress is like a real problem, then that

is going to really impact your libido.

So, yeah, your hormones may suffer

because of it. But if you don't fix the

stress, like you're not going to fix the

root cause of the problem. Can I just

inject myself with loads of testosterone

there to get my libido back?

It won't work for everybody. So, if it's

not truly a

low testosterone, meaning you have

normal levels of testosterone, likely

your testosterone receptors are

completely saturated, more testosterone

is not going to fix the problem. So, it

depends on your individual level of

hormones. But at some point, more is not

better. In fact, more can be dangerous.

And so, it's really dependent on your

individual level. So, giving yourself,

like if I give a guy who has completely

normal testosterone levels,

both free and total testosterone, all

completely normal, and I give him

testosterone, probably nothing's going

to change because his testosterone

receptors are already fully saturated

with testosterone. So, more is not going

to do anything. What are the other ways

that I can increase my testosterone? If

I go and get tested and it says that I

have low testosterone levels, and I

don't want to just inject myself with

testosterone, are there natural ways

that I can increase it? Absolutely. So,

number one is sleep. So, sleep is

really, really important for

testosterone. We know that when you

reduce the amount of sleep you have. So,

for example, you sleep less than six,

five or six hours, you're going to have

at least 10 to 15% reduction in

testosterone. And so, because our body

follows a circadian rhythm. And so, when

your testosterone is highest is in the

morning. And it starts to decline course

of the day. There's a little bit of a

bump again and then it goes back down.

At night time it's low. And your body,

when it's sleeping, replenishes that

testosterone. And so, if you're getting

either less number of hours of sleep or

poor quality sleep, meaning you're you

know, you're not feeling very rested

when you wake up, that's a sign of poor

quality sleep. Both of those things can

dramatically affect your testosterone.

The other thing that you can do is

exercise and specifically resistance

exercise. So, doing high the the largest

muscle groups, so usually the lower

extremities, and using those have been

shown to boost testosterone more

significantly than any other type of

exercise. In fact, when you do

cardiovascular high intensity

cardiovascular endurance training, so

say you're doing

Ultramans, marathons all the time, long

long bike rides, long swimming, you

know, swimming for long periods of time,

that can actually increase your

cortisol, your stress, because your

body's having a stress response and that

can actually reduce your testosterone.

So, it's important to do cardiovascular

exercise, aerobic exercise, but in

moderation. Because we do see some

people who are great athletes who, you

know, run, you know, run miles and miles

and miles, but their testosterone is low

because they've been doing this chronic

long duration endurance exercise. So,

sort of hit training is fine, but it's

when you start doing these big Ironman,

thousand mile run things that the

cortisol suppresses the testosterone.

that's That's large percentage of

people, right? But it certainly, you

know, it's like I'm so healthy. I'm the

healthiest I could ever be and I'm

having low testosterone. Why is that?

And what about food and testosterone?

So, food, you know, there is a lot of

data on food. The one but the most data

is on the Mediterranean diet and that's

because that's the most well-studied in

medicine, but essentially having

vegetables, fruit, low low amounts of

processed foods, good healthy fats, nuts

and seeds. So, a lot of people don't

realize, but you need good fat to have

testosterone. Testosterone is a is a

production is in the cholesterol

pathways. And so, it comes from those

pathways. And so, you need to have some

level of fat. If you have too low fat of

a diet, that'll also affect your affect

your testosterone. So, ideally, what I

tell people is well, there's lots of

data on different types of diets. The

important thing to know is you want to

avoid processed foods, avoid avoid a lot

of sugar, and have good healthy fats in

your diet. What about, you know, I've

I've

I've heard a few times that testosterone

levels have been declining over the last

couple of decades in men. Mhm. Is this

true? Yes, it is true. So, we're not

only seeing a decline in testosterone

levels, but we're seeing a decline in

sperm quality and uh, sperm numbers. So,

the concentration of sperm and over the

course of the last 50 years. And there's

a lot of reasons for that. One is that,

you know, society has become more

sedentary. We're seeing people less

active, getting more and more metabolic

conditions like diabetes, high blood

pressure. These conditions then cause

endocrinologic abnormalities, they cause

problems with blood flow, and all these

things can affect the quality of your

sperm as well as the quality of your

testosterone production.

And then, also, there's more we we think

in the environments, we know there's

more

uh, microplastics and more endocrine

disrupting chemicals, right, in the

environment. So, that is probably

playing a role. Now, we don't have like

exact like exact quantitative data on

that, but we think that is probably

playing a role and reducing the exposure

to these endocrine disrupting chemicals.

So, we tell people try not to drink out

of plastic water bottles. Try to warm up

food in glass and avoid plastic. I mean,

these are easy things you can do, but if

you want to stress about the amount of

plastics in the environment, like

there's not much you can do as on an

individual level. So, I tell people do

the things you can control and the other

things sort of you know, we have to work

on as a society. Uh this is really

interesting cuz I I don't think I think

about this much, but removing chemicals

from my life in terms of what

these kinds of things.

Mhm. The I'm holding the metal mug in

front of me and then the plastic bottles

I drink from could be having an impact

on my

testosterone and my sperm count. It

could. I mean, like it's not everybody,

right? Think about how many people drink

from plastic water bottles, but if you

can do decrease your exposure, right?

It's probably additive. So, the more

exposure you have, the more likely it is

to impact your body. How do they know

this? Like how does anybody know that

chemicals are having an impact on our

sperm and testosterone? So, there's, you

know, there's basic science research

where they're looking at the impact of

these things on on rats and other

animals. And then also they're looking

on the amount of exposure

to things like phthalates in labs and

seeing how that it you know, we can't

it's all cause it's all correlation. We

can't say it's causative because we

don't we're not going to do a random I

study where you drink from water bottles

for 10 years and you drink from glass

water bottles for 10 years and let's see

what happens, right? That hasn't been

done. But they can say, "Okay, the more

your exposure based on whatever

biomarker we can assess, so maybe

urinary phthalates or other things, we

can say that okay, these people who have

more exposure to this are more likely

based on the data to have lower levels

of testosterone." And then, you know,

looking at the mechanisms of how they

interact with the production of

testosterone. And I'm not an expert in

those areas, but certainly there has

been sort of plausible mechanisms of how

these things work.

How has sperm count been decreasing over

the years? So, if you look at the last

50 years, you'll see that the average

sperm count has declined almost 50%.

And luckily, the average sperm count is

still high enough for fertility rates.

The average sperm count is probably

around 50 million of of fathers, people

who father children. And so, it's still

above that, but it's certainly

significantly lower than it was 50 years

ago. And so, that's where we're

thinking, you know, it's it's probably

more of a global environmental factor

that's contributing to that in addition

to this increase in comorbidities and

poor health over time.

I mean, the direction of travel there is

deeply concerning because if something

declines 50% in the last

what, 50 years, did you say? Then if we

go forward another 50 years

and we assume the same rate of decline,

that means we'll be at 25% of where we

were 100 years ago. Yeah, and then what

what if you can't father children

anymore? And what if you can't have

offspring that will then propagate the

species, right? So, there's there's

certainly concerns there, and I think,

you know, we have to as a society do

better in terms of the things that we

can. So, we can control diet, we can

control exercise, we can control those

things. There's certain things that we

can't,

but we can try to control what our

people are exposed to in that can be on

a governmental level, right? Like having

sort of laws in place. So, we know in

the US there's less restrictions,

whereas in other countries there's more

restrictions on things like food

coloring and dyes that may have Again, I

don't I don't know the specifics, but

certain, you know, there's certainly

more restrictions in other countries

than in the US for some reason. And so,

maybe there needs to be a more critical

evaluation of where we can actually put

in place some things that would actually

have more wide widespread changes.

When we think about sperm count, we

often think about fertility. Um and

you know, I don't know whether this is

just because society has changed and

we're trying to have kids later, but it

does seem that people are struggling

more and more with fertility. I mean,

even in my own sort of circle of

friends, um there's, you know, there's a

couple people that have reported to be

struggling with fertility or that you

know, they're spending 12 months or 24

months trying to have children. Do you

think this is linked to this as well? It

could be. I mean, when we know when we

look at fertility, we know that about

half of fertility is due to women, half

of fertility is due to men, and then

some combination of the two, right? So,

um

definitely as women age, fertility goes

down, and we know women are waiting

longer to have children. So, that's a

big part of it that society has changed.

Women are working and and prioritizing

their careers. It's not a bad thing, but

it certainly will affect fertility. And

and then yeah, there may be these issues

that are affecting male sperm counts

that are also causing issues, but I

don't know if there's any updated data

in terms of what are the causes or the

numbers in terms of fertility rates.

Fertility aside, is there any

correlation between our health outcomes

and our sperm volume?

Not volume, but concentration.

Uh so, volume is the amount of of of

right? So, concentration of sperm in the

semen is more of a predictor in terms of

um

sperm volume, not semen volume. Let's be

clear. So, sperm volume, sperm

concentration are sort of the the

biomarkers. And we would say that yes,

there is a correlation with overall

health in terms of uh sperm

concentration and sperm volume. Uh but I

think I don't want to make people

worried that if they truly have male

factor infertility, then now their

overall health is

uh is a problem, but it's certainly

important to be evaluated and seen by

your doctor regularly.

And on that point of um semen volume,

is there a way to increase that? And is

it similar to what you said about

increasing testosterone or is there

another set of sort of

um practices we can do to increase our

semen volume? Yeah, so semen volume is

variable depending on the biggest one is

how long has it been since you last

ejaculated, right? So, the longer you

delay between one ejaculation to the

other, the more semen volume you will

get. That's probably the most

predictive. You know, hydration can play

a role. So, if you hydrate more,

certainly you may see more semen volume.

Um sometimes it's a it's a low semen

volume because you're actually less

force of ejaculation. So, interestingly,

when you're young, the force of

ejaculate can be really really strong.

be up to 30 to 60 cm away. Like when you

ejaculate, that's how forceful it can

be. As you age, after about 50, it can

decline to 15 to 30 cm away. And so,

that can feel like you're having less

volume because it's less forceful. And

so, in those cases, that's because of

the pelvic floor muscles that are around

the urethra. Those muscles there that

help sort of propel the ejaculate out.

And so, you can strengthen those muscles

with again pelvic floor exercises, the

Kegel exercises. I caution people

because people are like, "Oh, they're

going to these Kegel exercises are

great. They're going to increase orgasm.

They're going to make my semen propel

further." And I think that's fine if

you're not having pain, you're not

having discomfort, and you're doing them

correctly. Because sometimes what we see

is it can actually cause harm if your

pelvic floor is tense, like we talked

about earlier. Or it can cause pain and

dysfunction if you're tensing tensing

tensing and not relaxing. And so, if you

don't know how to do them correctly,

then you could actually harm yourself.

Um but yes, they can improve semen

volume by the parameter of increasing

the force of ejaculate and getting more

ejaculate out that may be left over if

you're not having as forceful of a

muscular contraction. Does masturbating

improve my pelvic floor? Does it

strengthen my pelvic floor? So, that's a

good question. The orgasm is what

improves your pelvic floor. So, if you

masturbate and you orgasm, when you

orgasm, your pelvic floor contracts

involuntarily. You can't do anything

about it at a rate of about every 0.8

seconds. So, it does contract and that

is sort of like a pelvic floor muscle

exercise. It's doing it involuntarily.

It's contracting for anywhere from 5 to

60 seconds usually on average. And so,

you are sort of in that way increasing

pelvic floor strength. In fact, they've

looked at in women particularly is

orgasming as good as doing pelvic floor

exercises. And they've seen that you

know, you can see pretty measurable

improvement in pelvic floor strength if

you orgasm regularly.

Is it and it may be you know,

as good as doing Kegels depending on how

often you're doing it. So, yes,

orgasming itself can be very beneficial

for pelvic floor strength. One of the

big sort of myths that I've always I'm

yet to answer is the impact that our

technology is having on our genitals.

You know, there's kind of like a

pervasive myth that if you put your

phone next to your testicles, your sperm

count's going to drop. Like, whenever

I'm in the car

um and I don't know, I'm I'm sat there

or I'm sat at home somewhere and I get

my phone and I put it near my genitals.

My girlfriend has a go at me and she she

like pulls it out or tells me to pull it

out because I think she's worried that

we're not going to have kids if it's

down there. Yeah. Yeah. So, there is

there is a little bit of data there in

terms of you know, when you have these

devices like in your lap or near your

genitals, they will increase the

temperature. And so, when you the the

the testicles are in the scrotum for a

reason, right? It's because they need

this very perfect environment with this

specific temperature to create sperm.

And anything that disrupts that

temperature can cause cause

abnormalities in sperm production. So,

for example, when you have a fever,

because you have the flu or you have a

cold, people will get their sperm

checked to their semen analysis and they

will see that their sperm count is zero

because the temperature, the fever, has

temporarily stopped their sperm

production.

And so, you can see that, you know,

people also discuss like, "Oh, what

about boxers or briefs? What about

putting" And so, all of these things can

increase the temperature around the

scrotum, which can then cause changes in

sperm production. So, I tell patients,

particularly if you're trying to have

babies, is put your phone in your back

pocket, in your chest pocket. Don't put

your computer, your laptop right on your

lap, right? I mean, it's easy enough to

do, and it does increase temperature.

So, absolutely, yes, these things can.

Not for everybody, right? There's people

So, we say people like you shouldn't

smoke a lot of marijuana when you're

trying to get pregnant because marijuana

can cause problems with sperm

production. But, you'll see people who

smoke every day, and they still have

babies. Or, you'll see people who do all

of these things, right? They they wear

briefs, they they put their phone on

their in their pocket, they put their

laptop on their lap, and they still have

babies. So, it's not a all all comers,

but certainly things that you can easily

just avoid putting near your genitals.

Well, if I'm in the sauna every day or

if I'm in a I'm a steam room every day

isn't that going to have an impact on my

sperm count? Yeah, it does. And it's

interesting because there's a I think

we'll see more of this as we're seeing

the rise of I mean, there's benefits to

saunas, no doubt, but as we're seeing

the rise of people really doing saunas

all the time, um there can be So, we

tell people when they're trying to have

pre- if they're having fertility issues,

don't go in hot tubs. Don't go in saunas

because it could affect your sperm

production. So, those are sort of the

the conservative things we tell people

to do.

Interesting. And this this point about

the phone next to the genitals, it's not

because of like the Wi-Fi and the

Bluetooth are going to like zap my

babies. No, I mean, there's some there's

some question about that, but we don't

know. I don't think we know, but we know

there's a temperature increase, right?

Because phones get hot. We talked about

masturbation briefly. Um one of the big

questions that people often ask me when

I'm speaking to someone that has

expertise on sexual health is

about masturbation and whether it

decreases your testosterone levels. So,

it does not. There is one study and it

was done in 10 men who abstained from

masturbating for 21 days. And these are

young, healthy men, right? And so, this

is where I think everyone gets their

data from is this one study. And so,

they took their testosterone before,

they took their testosterone after. At

And what they found was that there was

an increase by about 50 50 nanograms per

deciliter 0.5 um was which is the 50

nanograms per deciliter, which is not a

huge amount. Um at 21 days. But we know

that testosterone changes all the time.

And two, there's a lot of anticipatory

cues. When you've been waiting to

masturbate for 21 days, like your brain

is is really excited. There's all these

like, "Okay, I'm finally going to get to

release." And that in and of itself can

increase testosterone. So, generally

speaking, there's no empiric evidence

that is convincing, high-quality level

evidence that masturbating or abstaining

from masturbation will increase

testosterone. And so, there you know,

people do report other benefits. And so,

I tell people, "If you're getting other

benefits from abstaining, by all means,

go ahead. But don't do it for Don't like

white-knuckle it to gain some

theoretical increase in testosterone

that one was not even that large and

two, it's probably not going to be

proven in a larger sample." What about

the opposite then? Is too much

masturbation going to have an adverse

effect on us for men and women? Yeah, so

I think it you know, what I tell people

is masturbation is generally safe as

long as you are not masturbating to the

point where you are now choosing to

masturbate over doing anything else. So,

you're choosing to masturbate rather

than have sex with your partner. You're

choosing to masturbate over going to

work or you're I'm going to be a little

late to work cuz I want to finish

masturbating. Or you literally can't

sleep without masturbating every day.

Like those are things you become reliant

on this particular activity for the

enjoyment that it provides. Um that's

when it becomes a problem. But if you're

using it in terms of like, I'm

masturbating to get orgasm and the

benefits of orgasm that I do achieve

from that because maybe my partner

doesn't want to have sex or maybe I have

more of a sex drive than my partner or I

don't have a partner. Like let's be

realistic. Like if you don't have a

partner, you're going to have to if you

want to orgasm, you're probably going to

have to masturbate. And so I think the

problem also comes in is when people

only masturbate the same way every time,

they only watch a certain type of erotic

film or they do the same thing every

time and their body habituates to that

and then they have a difficult time

climaxing with a partner because they

can't replicate what they're doing,

whether what they're watching or how

they're doing it with a partner. Are we

teaching ourselves something there? Are

we teaching ourselves how we're aroused

and how we orgasm? Yeah, your brain is

very powerful, right? So when you're

doing the same thing every time, your

body's like, oh, this is what turns me

on. This is what makes me orgasm. And

then when you're with a partner, you're

like, oh, I'm not getting that same kind

of stimulation. And so it doesn't happen

to a lot of people, but I would say

certainly I see people where this does

happen. And so

you know, you have to sort of take a

break and and sort of re-evaluate and

try different things and get your body

to habituate to different things, which

takes a little bit of work. Um but sort

of keeping it varied can be helpful.

Another big myth, masturbation will make

me go blind. Yeah, no. There's literally

I don't know where that came from.

There's like hairy palms, blindness.

Like I don't know where I think this is

all sort of like from religious rhetoric

that says, you know, you should not

masturbate. Um and and it, you know,

where that came from, you know, is a

whole other story, I think.

What do you think of this idea of No Nut

November?

Yeah, so I think it's I'm not a fan. The

reason being is because I think it makes

people feel like it's something they

have to do. And if you want to, like I

said, if you find benefit from

abstaining from ejaculating for 30 days

or 28 days or whatever it is,

um

then by all means, like go ahead. If you

want to try something, there's no harm

in it. But I think a lot of people, what

they do is they feel like it's something

that's going to bring them to some

higher level, and they're going to

become this great person because they're

able to to to conquer this goal, but

they're like literally miserable. So,

they're

um they're just clenching their pelvic

floor all the time because they're

stressed about how they're not

ejaculating. They may ejaculate at

night, and so they'll have a nocturnal

emission, and then they'll feel so bad

because they failed. It's nothing you

can control. Nocturnal emissions are

physiologic. They're totally normal, and

86% of men have had a wet dream at some

point in their lifetime. Like it's very,

very common, and more likely the longer

you are from ejaculating. So, um your

body will take care of the ejaculate if

you ejaculate or not. So, you will

either resorb the semen, or you'll

ejaculate at night. And so, if you want

to do it because you feel like, "Okay, I

have a challenge. I want to conquer it.

I want to see if I can do this," and you

feel better because you're not you're

able to like not focus on sexual

thoughts, or you're able to really um

find some other level of spirituality or

something, by all means, go ahead. I

don't have a problem with it. What I

have a problem with is making people

feel bad because they can't do it, or

they don't want to do it. And with

people feeling forced, or feeling like

they need to do it to prove something to

someone else.

Yeah, cuz I mean, the way that I've had

it explained to me is that it's some

something about semen retention gives

you some clarity of mind or something.

Cuz a lot of athletes, before they have

their their big fights, so you know,

their bigger sort of Olympic

competitions, they all abstain from

masturbation. I I often hear in the UFC,

for example, the um

the mixed martial arts fighting

championship, that athletes have not had

sex or not ejaculated for 2 weeks before

a fight, or 4 weeks before a fight.

Yeah, so there's a lot of rhetoric

there, I think, that comes from

um

historical. So, even in Greek in Greek

times, they would tell people to avoid

having sex or masturbating prior to, you

know, big fights or or just whatever

sport they were playing. And so, is it

true in data? So, if you look at the

studies that have looked at people

performing athletic feats, whether it's

like cycling or running or whatever, um

they have not found that abstaining from

ejaculation actually changes their

ability to perform. And so, in those

cases, I say, well, there's no true

scientific evidence that we have that

it's going to improve. And in fact, if

you are someone who, for example, has

sex every morning or masturbates every

morning for whatever reason, that's a

part of your routine, disrupting the

routine can actually be harmful to

performance.

And sometimes the one thing you can say

is in terms of disrupting performance is

that after you masturbate, you do see an

increase in heart rate a little bit. Um

you have a rebound increase, it

decreases, and then you have a rebound

increase in heart rate that can slightly

affect your ability to recover from

performance. But ultimately, I think if

you find benefit from it because people

report feeling more aggressive with

abstaining, then by all means, if you

find it helpful, I think it's fine. But

is it mandatory? I don't think so based

on the evidence we have right now. Cuz I

I I heard that rumor many years ago, and

I think I assumed it was correct. I I

heard the rumor, and this was the sort

of evolutionary story that was attached

to the rumor, was that once upon a time

when we were out, I don't know, looking

for um a sexual partner, we would need

to be more articulate and more

persuasive and more, you know,

attractive, basically. Mhm. So, we were

at optimal attractiveness before we

ejaculated. Then after we've ejaculated,

that kind of energy goes out of us and

recharges and rebuilds again.

So, I was when I heard that, I thought,

okay, so if I'm speaking on stage or I'm

doing a podcast, I want to make sure

that I'm, you know, my mouth and my

brain are attached, I'm articulate, I'm

persuasive, whatever I need to be. So,

don't ejaculate or masturbate

anytime before doing anything where I

need to use my brain and my mouth.

Well, you know, some people describe

post-nut clarity, right? So, they

actually, on the alternative, feel like

And there's no good data on this. The

data we have is on people, the very

small subset of people who have post-nut

postcoital not post-nut postcoital

dysphoria. So, they actually feel bad.

But in terms of clarity,

um you know, some people do like when

you're trying to you're motivated to get

a partner, right? You're sort of um

trying to uh woo them, you're really

focused on that one singular effort that

once you've obtained that, that the like

very singular focus goes away, and now

other parts of your brain can be

activated to then be used for Some

people will describe being more

productive, more able to get work done

after uh masturbation. It's very

individualized or ejaculation, whatever

it is.

Post-nut clarity.

I've never heard anybody talk about this

before, and I've also been told over the

years that it's something that just men

experience predominantly. And for anyone

that doesn't know what post-nut clarity

is, the definition that I understand is

and that I have experienced, I'm going

to be honest, is that after ejaculation,

your desire for the other person reduces

quite significantly. And there's a

stereotype here that women don't

experience this post-nut clarity in the

same way. Now, if I asked all of my male

friends, if I said to them, "Has there

ever been a time in your life where you

were maybe texting someone you were

attracted to or, you know, had so- some

sort of sexual attraction to, and then

you masturbated,

did your desire

um diminish after you masturbated for

that person that you were just texting?"

I think about 90% of my male friends

would say, "Yes."

Yes. And they'd describe it as if

someone like took

some like sunglasses off them. Like a

pretty extreme sudden change.

And I've always wondered about this,

whether this is just men, if it's just

women, why it happens.

So, when you look at brain studies,

right, of people having orgasm, and what

happens is when you have an orgasm, like

your whole brain lights up, right?

Because your heart rate goes up, your

blood pressure goes up, like your pupils

dilate. So, all these different parts of

your body are working, so your whole

brain lights up. And then after orgasm,

it it it gets very, like, quiet. And so,

we see that in women it may take a

little longer to get really quiet, and

men it happens very quickly. And this

may be associated with sort of the

hormonal changes that occur after

orgasm. So, we know that prolactin

increases after orgasm, dopamine

decreases, and there's sort of some

evolutionary theories about why this

happens. So, one is after you ejaculate,

if you are having ejaculation with a

woman, then you don't want to have sex

again to then the same thing with the

refractory period, right? That there's

some period of time where you're not

going to want to have sex again, or you

can't have sex even if you want to. And

this is because evolutionarily, if you

deposited your ejaculate into a woman,

if you then had sex again, you could

actually dislodge the semen, and then

you would have less ability to

to have fertilize an egg, right? And

then the other thought is that you don't

want to become overly exhausted, right?

So, that if you if you had the unlimited

capability to have sex over and over

again, that exhaustion could be a real

thing, like and so you're sort of a

protective mechanism.

And so, those are sort of the theories

as to why this is, and there is like an

absolute refractory time where like you

don't want sex at all, and then there's

a relative refractory time where if you

had a really novel or strong stimulus

for sexual activity, that you would be

able to. In terms of the clarity, in

because we know there's a little bit of

differences in brain,

it may not be as obvious in women in

terms of it takes them a little longer

to have that coming down after the

orgasm from the brain activity,

but probably there is some, we just

haven't studied it enough. And I always

say this that when we look at studies

for women's sexual health and men's

sexual health, they're so lopsided. So,

if you type in penis in like a in like a

search engine for Google or for the

PubMed, which is where you look up

research articles, you're going to find

50,000 articles.

If you look up clitoris, you're going to

get 2,000 articles. So, it's very

lopsided in terms of what we study um

for sexual function. And in it in of

itself, sexual function by many people

is not seen as mandatory or important

for health, and so the funding is less

often available for sexual health.

That's why we have such little data in

some areas. Going back to just closing

off from the point about masturbation,

is there a link between masturbation and

prostate cancer? Because I've I've heard

a lot of different things about it. Um

some people think that over masturbation

is causing prostate cancer, and some

people say the opposite. Yeah, so

there's actually a really good study um

that was done looking at ejaculation

frequency and prostate cancer. And it

was a very well-done study. They tried

to control for a lot of other factors.

And so, what they found was that men who

ejaculated 21 times or more a month were

less likely to develop prostate cancer.

This is just a statistical number. It is

not a number that sort of um means

anything in terms of But we're seeing

that like, okay, so more masturbation

may help. Why is that, right? So, there

may there's a prostate stagnation

hypothesis that the fluids that, you

know, some of your ejaculate fluids come

from the prostate. And so, when you're

ejaculating frequently, you're more

often re- getting rid of that fluid and

sort of re-replenishing it or cleaning

the pipes, so to say. So,

that may be beneficial in terms of

preventing prostate cancer. Now, do you

have to masturbate or ejaculate or have

sex 21 times a month? Um no. But, you

know, there could be a benefit, yes. And

so, uh having a healthy And it may be

that those people who had sex more often

or ejaculated more often were just

healthier in other ways, right? They

were able to have sex more often or

masturbate more often because they were

uh

you know, sufficiently healthy to do so.

And so, they I mean, while they tried to

control for those things, there's always

sort of uncontrollable variables that

come into those sort of studies. Yeah,

that's what I was wondering is is there

another like glaringly obvious factor

that those people had more

relationships, therefore their mental

health was better, that therefore X Y

and Z.

they tried to control for comorbidities,

but again, there there I don't think

they controlled for I mean, they

controlled for marriage, I believe.

Um, but I'm not sure that they

controlled for like in a relationship

versus not and how healthy that

relationship is, that certainly wasn't

assessed. I'll link to the study below

so everyone can read it for themselves

about the controls in that study and how

that was conducted.

Linked to this is is the subject of

porn. Um, it was interesting cuz I was

doing a lot of research on the subject

of

That sounds a bit strange. I was doing a

lot of research on the subject of porn

and where conversations at with the

subject and one of the quite startling

things is a lot of people are trying to

figure out how to stop watching porn.

Um, a lot of people are asking

themselves

for mechanisms to

um, install things on their computer

that prevent porn time and um, searching

for

solutions around porn addiction.

And a lot of people were searching um,

about whether porn is a sin. And I think

there's something broader here about the

idea of shame Mhm. which is linked to

porn. What is your take on on this? Is

porn a bad thing?

Yeah, so I don't think porn is a bad

thing. I will start with that. Um, is it

a sin is more of a moral question,

right? And I think that that is

uh, something that you individually have

to decide for yourself if you feel like

morally it's inappropriate, but it's

it's entertainment, right? It's just a

different form of entertainment and I

think the issues with porn,

um, because I would not say that it's

100% great. I think there are definitely

issues with it. One, the big one that

I've been very vocal about is children

seeing pornography. So, um, we know now

that the average age of a boy seeing

pornography is 13 and that's the

average, meaning that as young as eight

to 10, boys are being exposed to

pornography,

um, which was not the case when for

example, we were growing up, right? You

had to I I always say this, you had to

find a

a tape maybe, find a VCR in a room that

nobody was going to walk in, or you had

to find a magazine and hide it somewhere

and go find it. And so it was not

readily available. You had to work to be

able to see that. And now, seeing

pornography is very readily available.

And so,

very often kids are seeing it. Whether

you as a parent don't want them to,

whether you've put blocks on their

phones and devices,

they may have access to it from a

friend, or they may see it somewhere

else. And

and your brain is not fully developed to

understand one, what you're seeing, and

two, to understand that this is not

real, unless your parent has talked to

you about, you know, this is sort of a

movie that's not real life, and this is

not what sex is really like. And so I

think that has implications for for how

they view sex, and how they then try to

have sex with partners. And also, you

know, because your brain's not fully

developed, you're getting this big rush

of dopamine from viewing something like

that, and that's not something that we

traditionally got at that age, right?

And so it can become very addictive.

Now, as an adult, I think it's different

because you have a fully formed brain,

you understand the concept of this is

not real, most people.

And so it can be just a way to have

pleasure, and even watch it with your

partner and have pleasure.

But yes, we are seeing some people who

have problematic pornography use. In the

literature they say it's 4%. I suspect

maybe it's a little higher now,

where people are finding that watching

pornography is is one easier than going

out and trying to find a partner. You

don't have to face rejection, you don't

have to face the difficulties and

awkwardness of having a first a sexual

encounter with someone that often

happen. And so it can become a way,

because it does relieve dopamine just

like anything else, it relieves

dopamine, it can then become sort of a

way to feel better about anything,

right? Like you can just be feeling down

and like I want to watch pornography

because it makes me feel better. It may

not be just that you're really into sex,

it's just that you're really like

wanting that rush hit of dopamine.

Um and then there's obviously the shame

that comes with oh my god, why am I

using pornography just because I feel

bad? And then you're like, oh, but I

feel bad and so I'm going to use porn

again and it becomes a sort of like

negative vicious cycle that can occur.

But I think when used for entertainment

and pleasure, I think it's fine and

many, many people use it for

entertainment and pleasure without a

problem.

I the other day bought the Apple Vision

Pro. Mhm. That new headset and I tell

you what, Jesus Christ, that's

unbelievable piece of technology. This

one feature they have on there is called

spatial video. Mhm. And I don't know if

you've tried it yet, but you put it on

and if you've taken a spatial video,