Is there a way to enlarge the

>> So, you can put your penis in this

device. They've actually done research

on this. So, 30 minutes twice a day and

it does show improvements in length

about 2 cm.

>> Tada.

>> And that's not all. So, they actually

did a study on pistachios where guys at

100 g of pistachios every day and they

saw a decrease in erectile dysfunction

because if you're not having erections

now, you're no longer getting blood flow

to your penis and it will shrink over

time. And the same goes for women with

their clitoris because it's the same

type of tissue. But also, when you look

at people who have sex once a week, they

live 49% longer than people who only

have sex once a year.

>> 49% longer.

>> Yeah. And for every 100 orgasms men had,

they lived like 13% longer.

>> Be right back.

>> Dr. Reena Malik has become the world's

most watched urologist.

>> After sharing everything you need to

know about hormones, sexual health,

>> and how to have better sex based on the

data. So, how can you have the best sex

possible? So, there's four main pillars

of sexual health. So, pillar one is

fuel. So, how you nourish your body, and

it's a huge part of sexual activity. And

then pillar two is strength. When people

think about strength, they always think

about going to the gym and lifting

weights. But it's much more than that.

So, when you look at the data, any sort

of cardiovascular exercise is going to

improve sexual function. It's going to

improve blood flow to the penis and to

the clitoris. And then also if you do

150 minutes a week, it is the same

amount of improvement as you would see

when you take a medication like Viagra.

And the other part of it is the pelvic

floor. It's under evaluated, under

discussed, and we'll get into that. But

pillar three is environment. So things

like stress, sleep, and endocrine

disrupting chemicals. For example, they

looked at data on men sleeping 5 hours a

night versus 8 hours a night. Guys who

sleep 5 hours a night, their

testosterone drops by 15%. Yeah.

>> And then the last of the four pillars

that we don't talk about enough is, and

that's still important,

>> I want to talk about morning erections,

squirting, clitorol stimulation, and

certain positions that are going to

increase the probability that my partner

has an orgasm.

>> Let's talk about all of that. First of

all,

>> this is super interesting to me. My team

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Let's get on with the show.

Dr. Reena Malik, if somebody was to come

up to you in the street, having watched

your videos online, and they were a a

follower of the content you've produced

over the last couple of years, if you

had to guess the question they would ask

you, because it's probably the most

frequent, popular question you get

asked, what do you think they would say?

>> They would say, "What can I be doing

right now to improve my sex life?"

>> Who would be asking you that question?

And why do you think they'd be asking

it?

>> I think everyone can agree that sex is

something we enjoy. It's something

that's important that we want to have,

right? And there is um a desire to have

good sex or feel like maybe you're

missing out on something that could be

even better. So, how can you have the

best sex possible? Because you hear all

these people talking about amazing sex

in the media. You might see it on

pornography. You might feel like this is

something amazing. Why am I not having

that? I want that. Right.

>> So, on that point, you said it's obvious

that it's important. I think it appears

to be increasingly not obvious that it's

important because when you look at some

of these stats and I'll throw this graph

that I've I found here up on screen and

it shows that people are becoming more

sexless especially young adults between

18 and 30. This graph is pretty stark.

>> Mhm. Think about 50 years ago. There was

no cell phones. There might be some TV

programs but there was ads in between TV

programs and there was only certain TV

shows you could watch at a certain time

that you enjoyed and then there was

nothing to watch. There was no email.

So, you went to work and you came home

and there was really not a lot of

communication between you and your

co-workers or your job. They made dinner

with their family. They hung out and

then maybe they watched a program or two

and then they lied down in bed. They

didn't have a phone to scroll on. They

didn't have anything to keep them up.

And so then they were like next to their

partner and maybe they're talking, maybe

they're cuddling. And so there was more

like opportunity and space for sex,

right? You it was a thing that you did

for enjoyment, for pleasure, for fun.

Now we have all these distractions that

keep our mind away from sex. In order to

enjoy sex, you need to have space for it

to be able to enjoy your partner and

feel like you want that, right? And now

we're sort of there's not as much room

for it. That's one. Two is younger

people, how are they dating, right? How

are they meeting each other? They're

meeting each other through apps, through

um DMs. And so they're not actually like

really having these deep meaningful

connections. there have there's a big

hookup culture. There's a big like fling

culture. And imagine first time sex for

most people is not great. You don't know

your partner. You don't know what they

like. And you may not be able to express

what you like. You're never taught how

to talk about sex, right? So you don't

know how to say like, "Hey, I like it

like this." And you may be

self-conscious cuz it's your first time.

So you have like mediocre sex or bad

sex. And they're like, "Well, I don't

really want that." And there's just no

like follow through, right? There's

there's not a lot of um education on

what sex should look like. like the only

education people are getting are from

often erotic films and so they're seeing

sex that's not real that's curated and

they're trying to emulate that and

that's not pleasurable for most people

and younger people these days are um

actually having a rise in more what we

call rough sex so choking has become

very very common as common as like they

call choking almost like vanilla sex so

young people if you look at data like

60% of women and I think 20% of men have

been choked during sex of that age

group, like college age group. And of

those people who get choked, 20% have

been choked 25 times or more. Now, I

think it's fine if you're into that, but

I can't imagine that that many people

are into choking. And there's data to

support that. So, when you look at

qualitative data, and this is by uh

Debbie Herbick, she's a sex researcher,

and she did qualitative research, and

she asked people like, "What is it like?

Do you enjoy being choked? Tell us about

it." Right? Women were like, "Yeah, it's

okay. Sometimes I'm scared because my

partner is big and strong and I'm, you

know, smaller and they have big hands.

Sometimes it's fine and sometimes I

don't really care for it, but like it's

just a part of sex. It's just as normal

as as kissing, for example. And so if

you're having sex and you're doing

things just because you think that's

what your partner wants or what it

should look like and you're not enjoying

it, well, that's not going to be sex

that you want to have. that point you

said about the the lifestyles we lead

and how that might be impacting our sex

lives I thought was really interesting

because we don't talk enough about this

but when you look at some of the data on

this demographic um you know people 30

and below around that age the extreme

outliers are spending 8 to 10 hours on

their phones on social media and on the

internet and roughly about 15 to 20% of

young people describe their usage as

almost constant effectively scrolling

during all waking hours while they're

eating, while they're in the bathroom,

and before they go to sleep. So, and I

was wondering from a dopamine

perspective if there's correlation

between these like dopamogenic

activities that are now like hijacking

our lives, whether it's short form

videos on social media, whether it's

pornography or food, whether it's having

an impact on what then happens in the

bedroom and our performance in the

bedroom.

>> If you think about what you need to have

good sex is you need to be sort of in

the mind space for sex. And if you're

constantly like hijacked by all these

other things, you're never like really

getting in the mood, right? You're just

like, "Oh, I'm going to be turned on

when I see my partner and we're going to

have sex and it's going to be over." And

it's just really a mechanical thing at

that point, right? You're not actually

you're just trying to get an orgasm.

You're not actually like spending the

time to enjoy and to experience that

fully because you're just so like you're

just your brain is always doing

something else, right? because people

are constantly scrolling like every 60

seconds there's a new video, there's

something else. And so it's really hard

to focus. And so that can translate to

the bedroom where you're like you're

having sex, but your brain is somewhere

else thinking about something else you

saw or something you have to do or

something you want to see or something

you want to look up, whatever it is, but

you're not really in there in the

moment. You're just going through the

motions. And so I think that's really

where the challenge is is that people

are becoming increasingly distractable.

I find it really hard, I got to be

honest, to have sex if I've had like a

really really busy day or if I'm really

really thinking about something. I

almost have to I have to like

intentionally create quite a lot of

space.

>> Exactly.

>> In order to be able to be in the mood.

>> Yeah. Be aroused, right? It takes like

time and energy. I think I appreciate

you for saying that because a lot of

people think that men are just ready to

go at any moment and that's not fair,

right? Because everyone needs time to be

aroused. It's not just instant for

everybody, especially when you have a

lot of work stress or life stress or

other things going on. It's actually

like you have to make time and space for

it.

>> Yeah. Because as a man, you got to get

an erection. And I I always think that

an erection is a consequence usually,

especially when it comes to sex. And I'm

not talking about morning glories here,

but an erection is a consequence of like

a story.

>> You use the word aroused.

>> There's like a story in my head which

makes me go, "Oh, that's kind of hot."

>> Yeah. You need something. You need some

stimuli, right? You need to think about

something, see something, smell

something, feel something, right? You

need to just be together and and sort of

allow yourselves to be intimate before

that sort of desire and arousal come

together.

>> And for me as well, it's not just touch

like that doesn't necessarily for me, it

really is quite like a psychological

thing. I was wondering if this is

there's any data around this or I mean

just even anecdotally like people get

aroused in very very different ways,

don't they?

>> Yeah, absolutely. I mean some people um

are very like visual so they you know

they see their partner and they get

aroused very quickly. Basically when you

get aroused you need to be in a

parasympathetic nervous system state. So

in order to get an erection you need to

be in the state which is like rest and

digest. So if you're stressed if you're

thinking about other things if you're

essentially on the go you are not

allowing your nervous system to calm

down. And so for some people that's a

whole bunch of different things. Some

people can switch more easily into that

state and some people need more of like

uh you know to feel either mentally

stimulated or they need to have some

associations like it might be like they

need a certain scent, they need to like

relax their body, they need to like go

take a bath, whatever it is, but some

people need different things and knowing

what that is for your partner is super

important, right? Because then you can

incorporate that. Everything is

scheduled in our lives, right? And then

you're like, "Oh, but now sex is like

the last thing on the schedule, right?"

And like I don't even think about it.

Like, "Oh, okay. Now, yeah, maybe let's

have sex." But it's like, if you

actually make time to be intimate, allow

yourself to be in that brain space, be

together, that's when it can actually

happen. Especially when you've been in a

long-term relationship, it doesn't come

as easily like spontaneously, which we

call spontaneous desire. It it comes

more as a response to these other cues

that allow you to feel desire and to

feel aroused.

H I also think I was thinking about a

previous relationship I had where on the

days where I'd been like working very

hard and I was like tired or stressed or

I've been traveling and I was jetlagged.

I think there was also because I didn't

see this person often there was also an

expectation that when I did see them we

were going to have sex

>> and um that was that was very hard

because actually the expectation of it

stressed me out more.

>> Yeah. And that can happen like if it

becomes the elephant in the room it can

become a little bit heavy which then is

sort of counterproductive to performance

>> and this is you know sort of a variation

on performance anxiety. So when you feel

like you have to perform on demand and

maybe you're worried it might not happen

it creates this vicious loop right so

you may maybe have trouble with an

erection or maybe it's like I I'm

expected to have sex but I really can't

get there mentally. whatever it is. Now,

you're thinking about that, right? And

then you're with your partner. You're

like, "Oh my god, am I going to have

trouble?" You're not enjoying the

pleasurable sensations or the visuals or

like feeling each other. You are

literally thinking in your own head

about how you're going to respond. And

then that anxiety makes it so that you

can't get an erection or you can't be

aroused. And so now you're like anxious

and you're not focused. You're almost

spectatoring. You're just watching

yourself have sex. You're not actually

like in the moment. So then, you know,

you have a negative outcome because when

you're stressed, your sympathetic

nervous system is on, right? You can't

really get an erection or you can't

really get aroused. And so then you're

like, "Oh man, now I've let my partner

down. Now I haven't performed," which I

hate that word, but like performed the

way I should or or I'm expected to. And

now something's wrong with me. And now

that just keeps going in a vicious

cycle.

>> Have you spoken to people that have

experienced this?

>> Absolutely.

>> It's common.

>> Very common. I tell people anytime you

have problems in the bedroom, it stays

with you.

>> So, how do you break the cycle?

>> Yeah. So, I tell people when you're with

your partner, take the pressure off um

penetration. Just explore each other's

body. Do what's called like sensate

focus. Like explore the rest of your

body. Figure out other arogynous zones,

other things that can turn you guys both

on that don't involve erections and

penetration. And then once you realize

you're focused on that, you're really

like exploring, enjoying, playing,

you're having a good time, and you're

not thinking about your erection, now

you'll notice, oh, the erection just

comes, right? And then once you get to

that point, then you can start even

touching genitals, but still hold off on

penetration. And then after you've

realized like the genitals are, you

know, it's always working the way I want

it to. I'm not thinking about it. I'm

not stressed. Then finally, you can then

introduce penetrative sex again. So,

it's just sort of like a gradiated sort

of slow advance into um you know, having

sex again, but now kind of focusing on

being more present and mindful and

enjoying those sensations.

>> I think a lot of people will be able to

do that, but there's also a big

contingent of people that just avoid

sex.

>> Mhm.

>> It's it's a sore subject in their

relationship for whatever reason. Both

partners don't know how to communicate.

They haven't got the tools to talk about

these kind of things openly and

honestly. Do you see that a lot as well?

>> Absolutely. I mean, what do you hear in

this regard?

>> So, I think it's really sad. I see

people come in and they're like, I ask

every patient like, "Are you are you

having sex? Why not?" Right? Because

sometimes they'll say no. And most

doctors will be okay. But I always say,

"Why not?" Right? Why are you not having

sex? Is it because you're having an

issue? Is it because you're having pain?

What's going on? Right? And often times

I'll hear from people that my partner is

just not into it and I just sort of gave

up and I'm just we just don't have sex

anymore. You know, for me that's a red

flag because sex is a huge important

part of our lives. It is a way we

connect with another human being. It's

also telling that things are working

really well. So, when you have good

sexual function, meaning you get an

erection well or you get aroused well

and you have a good orgasm and

everything feels good, that tells me

that, hey, you've got great blood flow

to your genitals, your nerves are

working great, your hormones are sending

signals, like all these things are good,

right? But also, sex is more than just

the act of sex. It also helps you live

longer. So, there's been a few studies

looking at sex and longevity. And when

you look at people who have sex once a

week compared to people who have sex

once a year, the difference in all cause

mortality is 49%. They live 49% longer

than people who only have sex once a

year.

>> 49% longer.

>> Yeah. Yeah.

>> Be right back. No, I'm joking.

>> So, and but even if you're doing like

less than once a week, but more than

once a year, it still improves your

longevity. There was actually

interesting study in 1997, I think it

was, where they looked at the number of

orgasms men had, and they found that men

who had for every hundred orgasms men

had, they lived like 13% longer. They

had a 13% increase in life expectancy.

And so, it was really interesting to me

just just showing you that like this is

not just an act of pleasure and fun. It

is obviously, but it's much more than

that because people who are having sex

clearly have better health and there

this connection with people. I mean,

loneliness is a big issue right now. The

the WHO made loneliness like an

epidemic. So, they've said that

loneliness is as bad as having like 15

cigarettes. And so, sex is a way to feel

connected to another human being.

>> On that data, we're not saying that it's

the sex itself that's causing people to

live longer. We're I guess it's it's

hard to establish causation in terms of

>> Yeah. It's not necessarily sex, but

they've looked at like they try to

control for other things like age and

coorbidities and all these studies and

um it's also like sex is a

cardiovascular workout, right? For many

people is a cardiovascular workout. You

are getting a phys physical physical

activity with your partner. Um you are

increasing your heart rate. You are

doing these things that are also good

for your body. And the fact that you're

able to have sex, right, tells me a lot

about it, right? You're you're able to

hold a certain position. you're able to

u maintain this level of activity

without getting short of breath, right?

Like these are things that having sex,

you know, keeps you healthy to some

degree.

>> If I want to make sure that I have great

sex, what are some of the foundational

things that I need to be thinking of in

terms of my lifestyle?

>> Yeah. So, there's four main pillars of

sexual health. I like to think of it

like your sexual health is your house.

And these pillars are the foundation.

And if you don't have the foundation, it

doesn't matter what else you do. Um, you

can try to do everything else to patch

up your house, but it's always going to

break again because the foundation's not

there. So, you've got fuel, and fuel is

how you nourish your body. A lot of the

data I'm going to talk about is about

men because there's just a lot more data

on men and sexual health, but that

doesn't mean that the same things don't

apply to women. There's just less less

robust data on it. So, when you talk

about fuel, the Mediterranean diet is

the most studied diet. So, including

things like healthy fats like avocados,

leafy greens, nuts, and we're going to

talk about nuts in a little more detail.

These things are super helpful. And

obviously having lean proteins, having

an abundance of fruits, which we're

going to talk about as well. There's a

study called the Health Professionals

Follow-up Study. They look at 20,000

men, and they saw that men who adhered

to a Mediterranean diet had a 22% lower

risk of erectile dysfunction. So what

specific things in that diet, right?

People always like, "What are the

superfoods I need to have?" Almonds are

great, but pistachios, they actually did

a study on pistachios where they looked

at 100 grams of pistachios. Guys ate 100

grams of pistachios every day and they

saw a decrease in erectile dysfunction.

>> So pistachio nuts will make my penis

harder.

>> I mean, so I always say like I don't

love to talk about superfoods because

then people like, "Oh, I just got to eat

pistachios and it's all good, right?"

It's it's part of a whole diet, but

certainly having nuts because they have

great omega-3s, they have healthy fats.

These are the reasons that they they

really sort of improve diet.

>> Fruit um anything that has sort of

flavonoids, so like colorful fruit like

blueberries, citrus fruits, um lycopine,

which is red fruits, all of these things

improve antioxidants and also have been

shown to reduce the incidence of

erectile dysfunction. So having stronger

erections. specifically blueberries

actually came out to have I think

something around 20% also improvement in

erectile function when you're eating

blueberries regularly. So lots of I

think things in the diet that can be

helpful. Also fiber is one that we don't

talk about enough. When you eat fiber in

your gut it converts to short- chain

fatty acids. These short- chain fatty

acids then sort of have these endothelop

protective mechanisms. They protect the

blood vessels. They make them healthier.

And so when your blood vessels are

healthier, you get better metabolic

health. So you get less diabetes, less

high blood pressure, less high

cholesterol. And these all of these

things together improve erectile

function.

>> So I think making sure that you meet the

criteria for fiber, which is 38 grams

for men, 25 grams for women, um, is

really really important. And then

obviously managing your calories and a

maintenance, right? because we don't

want to gain weight because excess

atapost tissue or excess fat also puts

you at higher risk for erectile

dysfunction and other sexual

dysfunctions. Next we have uh strength.

All right.

So there's strength where we think about

cardiovascular and resistance exercise

but there's also pelvic floor strength.

So we'll start with cardiovascular

exercise. The one study that's quoted

very often is 150 minutes of exercise of

cardiovascular exercise moderate

intensity. when you look at the

improvement in erectile function scores,

it is the same amount of improvement as

you would see when you take a medication

like Viagra. So, literally, if you do

150 minutes a week, you are getting the

same improvement as you could get with a

medication potentially. And so, I tell

people like, look, if you don't want to

take a pill, this is a great way to

improve sexual function. Now, you might

say, okay, well, I, you know, maybe

you're listening and you have heart

issues and you can't really do moderate

intensity exercise. They actually looked

at that too. So there was a group where

they looked at men who had heart disease

and they weren't really able to do

moderate intensity exercise. So they did

like a 5minute warm-up. They did 20

minutes of walking and 5 minutes of a

cool down. And with this supervised

protocol, they still improve erectile

function by 70%. So it's all relative to

where you're starting. But any sort of

cardiovascular exercise that's above

what you are capable like what you're

doing now is going to improve sexual

function particularly erectile function

cuz it's going to improve blood flow to

the genitals going to improve blood flow

to the penis. It's going to improve

blood flow to the clitoris for women. So

that's where cardiovascular exercise is

so so important in terms of resistance

exercise. I know these little weights

are probably not sufficient for doing

much, especially for men, in terms of

improving um muscular health, but

obviously we're not going to bring like

really heavy weights to the table here.

So, one, we know that resistance

training is significantly correlated

with testosterone. So when you do heavy

resistance training of your large muscle

groups, so like your lower extremities,

your glutes, you're doing like Olympic

deadlifts, squats, that sort of stuff,

you actually see improvements in

testosterone. Now, it's not going to be

like you do it once and you get this

sustained improvement, but continuous

sort of regular resistance exercise

improves testosterone.

There's also data that shows that when

men do resistance exercise to maintain

muscle mass. So, we know that muscle

mass decreases about 7% every decade of

life after around 40. When you maintain

it through resistance exercise, they're

three times less likely to have erectile

dysfunction.

>> Oh, really?

>> Yeah. So, they maintain erectile

function, they maintain sexual desire,

they maintain um satisfaction with sex.

>> I read a quote yesterday that said

muscle is medicine. And I thought,

that's really true based on everything

I've learned on this podcast around, you

know, like glucose control and and

testosterone. And now you're telling me

about your sex life.

>> Yeah, it is. I think people push back

because they think like, why should I

have to go to the gym? But our lives

have changed. We sit at a computer or we

sit at podcasts or we sit all the time.

We're not moving. We're not doing manual

labor, which is what a lot of our

historic history is, right? doing manual

labor, farming, doing things outside,

being physical, and we're meant to be

physical. We're meant to lift heavy

things. We're meant to move our bodies,

and we're just doing less and less of

it.

>> So, I think it's so important. Um, the

other thing is we want to prevent

sarcopenia. So, sarcopenia is muscle

loss. And when you have muscle loss, um,

that also increases your risk of having

sexual dysfunction.

>> What about the pelvic floor? Like, how

does that come into this story of

>> Oh, yeah. So, we missed that part. So,

um, the pelvic floor, here's your

pelvis, right? It's this bony structure

where all your organs live. This is a

female. So, I'm taking out the, uh,

internal structures, which is the

uterus, the rectum, and the bladder. And

so, that's what sits inside the pelvis.

And so, you can see this bowl of muscles

here, right? Interesting. I've never

seen.

>> And you can see them from the inside,

and you could see them from the outside.

That's your anus. And in this person,

there's a vagina. So, that's the hole

for the vagina. So you can see that your

anus and your vagina run through the

pelvic floor. And in men, your penis

runs through the pelvic floor. And so

this, let me see if I can show you on

this model. In this model, you can see

they kind of show you the muscles here

on the side.

>> Yeah.

>> So these are your pelvic floor muscles

that are around the penis and the anus.

>> Okay.

>> Okay. These structures are very

important for a variety of things. um

they attach to your bony landmarks here,

your hips, your sacrum, your pubic

symphysis. They attach to all these and

they sort of just work in the background

for most people. How they affect your

sexual function is when you orgasm,

these muscles contract and release at a

at a rhythmic contraction of8 seconds.

And so you may feel that, right? There's

like this pulsing feeling when you

orgasm. And that's these muscles sort of

doing that. And when men ejaculate, the

pelvic floor muscles are contracting to

help shoot the ejaculate out. They

squeeze when you need to keep things in.

So they'll keep urine in, they'll keep

um your stool in, and they relax when

you need to pee in, when you need to

defecate.

>> So when you're trying to hold a wee,

you're like tightening your pelvic

floor.

>> Correct. Correct. But these are also

responsive to stress. So, just like

people get TMJ where they get tense in

their jaw cuz they are stressed and they

like sleep at night and they clench up

their jaw. They don't really know

they're doing it, the same thing can

happen. These muscles can get very tight

or they can get misaligned. So, say you

have a hip injury or say you have a back

injury, the muscles can compensate by

tightening up. And so, a lot of people

unknowingly have tension in these

muscles and it can present in a multiple

different ways. It can present with back

pain. It can present with constipation.

It can present with urgency frequency

because remember your bladder is sitting

right here on top of these muscles. So

when the muscles are tense, your bladder

is feeling like there's something

something activating it. And so it's

like, oh man, I got to pee. That means I

have to pee. This tension is telling my

bladder I have to pee. But it's really

that your bladder is not that full. It's

that these muscles are telling you to do

that. You can also have trouble peeing

because you can see that your urethra

goes through here. And if the muscles

are really tight, sometimes it can be

difficult to urinate because it clenches

off the pee. And then with sex, it can

cause pain. If they're really tight, it

can prevent blood from getting to the

genital organs. So for men, they can

have erectile dysfunction. For women,

they can have difficulty getting orgasms

or difficulty getting arousal because

they're not getting blood flow to the

clitoris. Sometimes they can also cause

premature ejaculation in men. And so

these muscles are so important and all

we hear about is keigull and keigull are

exercises to strengthen these muscles.

But keigull are good when you have a

normal pelvic floor. Meaning like

there's no tension. It's completely

normal. It's acting normal. You're not

having any symptoms at all. But if you

have any of the symptoms I talked about,

doing keles might make it worse because

you're now tightening muscles that are

already tight.

>> We also talked about pelvic floor

relaxation. Doing exercises to

specifically relax these muscles. So

that can be diaphragmatic breathing.

That can be doing like a figure four

stretch. That can be doing happy baby

pose which are yoga poses or child's

pose. All these things can sort of

stretch and lengthen these muscles so

they can learn to relax again. Now when

it's really bad, you have to go see a

pelvic floor physical therapist who can

really work with you to identify which

of the muscles are maybe more

dysfunctional and maybe work

specifically on those. Um but I think

it's it's so important. that's under

evvaluated, underd discussed when it

comes to sexual function. It's a hugely

important part of sexual function.

>> How many people are struggling with

these issues, specifically the like

erectile dysfunction issues and what age

are they?

>> Yeah. So, it starts early. I think

there's always been a sort of a

disconnect where we think young guys

don't have this or if they have it, it's

all in their head. That's not

necessarily true. Many young men do

develop erectile dysfunction because of

biologic factors, but the data is really

robust on older guys. So above the age

of 50, we see 52% of men having erectile

dysfunction, which is

>> 52%.

>> And it goes up 10% every decade. So 60%

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

erectile dysfunction continues to

worsen. This happens because one, you

know, our blood vessels get older, they

get stiffer, they're not functioning as

well as they should. And we're seeing

also a rise in all these other comorbid

conditions like diabetes, cholesterol,

high blood pressure. All these affect

how healthy your blood vessels are. And

so with these, they see the problem in

their penis or in in women's case in

their clitoris before they see heart

disease or strokes or brain issues or

dementia. And I think this is worth

pausing on which is a erectile

dysfunction problem is a often a symptom

of a cardiovascular issue. Right.

>> Yeah. We call it a canary in a coal

mine. So it is like telling you that

something bad is coming. So the data

would support that when you have

erectile dysfunction if it's because of

an organic reason, right? not

psychoggenic but most people I think

have a combination of both that within 3

to 5 years you will start developing

issues with your heart and so it

precedes those issues and if 7 years

later 14% of those guys will have a

heart attack and so it's really an

opportunity sexual problems are an

opportunity to look inside to figure out

what's going on and to investigate and

to change your life

>> and when you say erectile dysfunction we

should probably define what that means

because there's going to be a lot of

guys sat at home now thinking, "Oh my

god, like my penis is a bit softer than

usual."

>> Yeah. So, erectile dysfunction is

defined as the inability to maintain an

erection that's sufficient for

intercourse. So, you can get an

erection, but it goes away before you

ejaculate or climax.

>> And so, that's typically and I think

it's really important to differentiate

that from something like premature

ejaculation where you climax too soon.

So, you ejaculate before you're want to.

Uh, but that doesn't mean that you have

a problem maintaining your erection.

That's a whole different process.

>> I've got a friend, people are gonna

think I'm talking about myself because I

use that phrase a lot. I've got a

friend. He's um he's almost 40 years old

and I've heard him say on several

occasions that he's lost his erection

during sex. Is that erectile

dysfunction? But what if he can keep his

erection watching porn?

>> Well, so that's more multiffactorial,

right? So I think if you lose it once or

twice, right? Most guys will have an

issue where they lose an erection at

some point in their life. I think the

important thing is not to catastrophize.

It's a problem when it becomes a

routine. Now, if someone is telling me,

"Hey, I can watch porn and maintain my

erection, but I can't with a partner."

There's multiple different reasons for

that that could be at play. One is that

there's no pressure, right? You're by

yourself. You're watching porn. There's

no pressure of performance. There's no

anxiety of performance. So, that may be

part of it. Other thing may be that that

level of arousal that you're getting

from porn. If you're watching like let's

say the same kind of porn every time,

you're masturbating the same way every

time, maybe using a firm grip or some

people will masturbate like uh facing

the bed or um you know against hard

objects. And so that

>> against hot objects.

>> Yeah. Like the their fist or something.

And so that u can't be replicated by a

person, right? You can't replicate those

behaviors by a vagina or a mouth. If you

become habituated to a certain thing

that turns you on and that's the only

thing that really gets you going and

that's that's something that you can't

really get with your partner, then it

will be difficult to reach the level of

arousal that you need to get an

erection.

>> Okay. So, two questions then. So,

>> that doesn't count as erectile

dysfunction. If you can get an erection

watching porn but can't get it with your

partner.

>> Yeah, it may or may not be. So, if you

wake up with your morning erection,

that's great. That's a sign. That's when

there's nothing else at play, right? You

are just that tells me that your body's

functioning well. You've got good blood

flow, good uh good hormones working, got

a good amount of testosterone, and your

nerves are working well, and you're

getting a good morning erection. Now,

morning erections or nighttime erections

are normal, and they're healthy. So,

when you're a young boy, you get

actually like erections three to five

times a night, and they can last up to

40 minutes long. So you can spend a lot

of your night with an erection. When you

get older, like in your 40s, that drops

to about half the time. So maybe

erections are a little shorter that they

maybe max out at 30 minutes, but

sometimes they're shorter. You should

still be getting three to five erections

at night. You won't know all of these,

but typically you wake up with a morning

erection. And so if you're not getting

morning erections, that tells me that,

hey, there's something going on that we

should address. And on your other point

about how you masturbate impacting your

sex life, I imagine that applies to men

and women.

>> Absolutely.

>> And are you saying that if there's a

particular way you get yourself off in

private

that is very hard for the other person

to replicate, you might become

desensitized to that?

>> You might just get habituated. I don't

think desensitized, but habituated is

like you might just your body just might

respond really well to that particular

stimulation. Now, that's not inherently

a bad thing, right? If that's what gets

you off and you and your partner are

okay with you doing that together,

right? You may mutually masturbate

together and that's fun for you and you

guys enjoy it, there's no problem with

it. It's just knowing what's going on,

right? And sort of deciding like, okay,

if this is a problem, let me try to

diversify what I do during my solo sex

periods or let me take a little break

and kind of uh try something, you know,

just not masturbate for a little while

and come back to it later. The fact that

we get an erection in the morning, does

that mean that's we're supposed to have

sex in the morning? From like an

evolutionary perspective,

>> not necessarily. It's just it's the way

your body releases testosterone is one

of the reasons this happens is overnight

your body is making more testosterone.

That's when your body sort of has

nocturnal testosterone production. And

so it's highest in the morning, which is

why often you get a morning erection.

And you know it just means that some

people will have more desire also in the

morning because testosterone is a

hormone of desire.

>> Is it the same for women?

>> Yeah. So women um women also have

nocturnal clitoreral tumescence. Same

sort of pattern and they won't

necessarily know it right because they

can't visualize it. But you know you can

some women may know sort of feel that

pelvic congestion or like feeling that

there's a bunch of like blood flow in

the area. But most will not and that's

okay. But your body protects itself. So

you've heard the term use it or lose it,

right? People are like your body's

protecting itself. You don't have to

have sex. If your body is healthy, it

will do this all night to keep your

genitals healthy. It will make sure that

your genitals are getting blood flow

even if you're not having sex. But if

you stop having those nighttime

erections, now is it becomes more of a

problem because over time, say you stop

having erections or cleral tumes for

months, years, right? And then there's

no blood flow to those areas over time.

And actually I can show you here. This

is a a pelvic model. And here this this

purple thing here is called the corpora.

And this is like a really nice spongy

tissue that fills with blood. And when

it fills with blood, it expands and

lengthens. And then um the blood stays

there until you're done with your

stimulation. And then it goes back. And

so if there's no healthy fresh blood

getting to the penis on a regular basis

either through nighttime erections or

through sex with your partner then you

will get fibrosis of these tissues. That

means you get a little scar in the in

the tissues and then over time you might

see some shrinkage of the penis. And so

it is really important to maintain also

good health of these tissues. And the

same goes for women with their clitoris

because it's the same type of tissue. In

fact, if you look at the clitoris, it is

this is the part that you see. We don't

really We don't have a clitoris.

>> That one there.

>> This is a uterus.

>> You're going to keep that in.

>> Okay. I can show you here. There we go.

There's this like she told me.

>> Is it crazy?

>> Okay. Yeah. This is good. This is good.

Okay. They told me they don't say

glitter.

>> That's a little That's a Yeah. Okay.

>> They told me

>> you're not going to live that one down.

>> You asked the team where the ClariS was.

Did you ask the team where the clitoris

was?

>> Well, I'm I'm worried about who said

that, too. Um, okay. So,

so let's talk about the female anatomy.

This is a pelvic model. And here, um,

you can see this is the vagina. This is

the urethra where you pee from. This is

your labia minora. And you can't see the

labia majora, but they would be out

here, right? So, inner lips, outer lips.

Now, this up here is your clitorol

glands. So, it's the same as the glands

of the penis. And so, this is all you

see, right? It also has a little

covering, which you can't see here. Just

like men have foreskin, women have a

clitoreral hood that covers the the head

of the the clitoris. And so when you

look at the clitoris on the inside,

which we can't see perfectly here, but

I'm going to just take this out. Um, it

actually goes all the way back like

this. So if you were to feel from the

vagina, from the vaginal side, it would

be at the very top of the vagina going

all the way back. These are the these

blue things are the clitoreral bulbs

here. Um, so and these are the legs of

the clitoris here on the side. And so

this is essentially the homalogue of the

penis. So if I take the penis and we

don't have a like a full model here.

What does homalues mean?

>> So homologues means that they're

essentially the same structure. They're

made from the same cells but they're in

the male and the female. So here you can

see this is if this is your penis. This

is what you see up to here. This is the

bone. This is your fat up here. And then

here it goes deep into the pelvis. And

so here's your testicles, right? And so

below the testicles, this area of the

paranneeium, you also have penal tissue

sort of that you can palpate from this

side um that's coming all the way down.

And if you had sort of a 3D model, you'd

see that it forks out just like the

clitoris does.

>> So does clitoral stimulation feel like

stimulating someone's tip of their

penis?

>> Exactly. And so you could think if

someone just stimulated the head of the

penis, they uh it would be fine. It

would be nice, but it's probably better

if you stimulate more of the clitoris or

more of the penis. That's why you can

stimulate obviously the external the

clitoris, but you can also stimulate

from the inside. And some people are

more responsive to that than others.

What you hear of is like the G-spot or

the Gzone, right? And the G-spot or

Gzone is if you were to go in the inside

of the vagina at the top side, which I

can't really stick this in here, but it

would be about 2 cm in at the top. And

that's because that's an area where

there's a lot of nerves endings. One,

you can palpate the clitoris basically

throughout the entire anterior wall, but

also there's the skins glands, which are

these glands that sit underneath the

urethra, and they're the homalogue of

the male prostate. And so, they're right

there, and then the vagina is there. And

so, that's an area that can be very

enjoyable to stimulate. It's not

necessarily always going to lead to

orgasm because some people have

different sort of distance between the

clitoreral body and the vagina. So some

people have less distance may feel it

better than some that don't. Uh but

ultimately um that's why that area is so

sensitive for many women. On this point

of um morning erections, I was thinking

much of the reason why I've always been

cautious of having sex in the morning or

even like masturbating in the morning or

anything like that is I'm worried that

it will cause a dopamine crash which

will make me feel lazy and lethargic.

>> Well, so when you think about what

happens during an orgasm is you have

this release of dopamine and then you

your prolactin goes up and sort of like

everything calms down. Now some people

feel a a sense of clarity. They call it

postnut clarity, right? they feel clear,

they feel like motivated to do stuff,

they feel uh excited to go do something

else and they sort of move on from what

they're doing. There's some people who

feel post-coidal dysphoria. They

actually feel sad or they feel depressed

after they orgasm. And we don't know

exactly why this happens, but it is

because of this dramatic change in sort

of neurochemical signaling in the brain.

And for those people who have it, it can

be days where they sort of like feel

bad. It can be hours where they feel

sad. And so it can be really traumatic.

So pillar two, what's pillar two of the

four pillars of men's sexual health?

>> We talked about strength.

>> Okay, so we did strength, we did fuel.

>> What's pillar three?

>> Pillar three is environment. So we can

start with the easy stuff and that's

stress, right? Everyone knows stress is

bad. But I think the thing is people

just think like h I'll just I'll deal

with it. Everyone's stressed. Like

what's it's normal to be stressed? If

you are chronically stressed, that means

your cortisol is raised all the time,

which is dampening your testosterone,

which is also keeping you in the

sympathetic state, and you just cannot

get in your mind space and in the

nervous system place to actually have

sex. So, that's super important. And I

think, you know, there's lots of

different ways to alleviate stress. You

got to figure out what works for you.

Um, for some people, using a stress

ball, even just at work. And I think

part of it you can actually incorporate

some intimacy. There's some evidence,

you know, the Gottmans have been on your

podcast doing a 20 second hug. So

standing with your partner or loved one

and hugging for 20 seconds on your own

like independent gravity

>> actually helps alleviate stress and

break sort of a stress loop. Doing a

six-second kiss with your partner. And

so it seems like six seconds, no big

deal, but actually if you time it, it's

like hm if I'm just doing a kiss and I'm

not like actually it's a little bit

longer than normal. And so these sort of

small things can help alleviate stress.

Any type of movement can be really

beneficial.

>> The gym is great as well.

>> The other thing is just having like

interactions with people. And so that's

where we're becoming more isolated. But

even just like talking to the barista or

talking to someone at the grocery store,

this again tells your brain that you're

in a safe space, like you're talking to

someone. They're having a normal social

interaction.

So, and then being creative. And we've

been trying to work with this work on

this with our kids because there's so

much external stimuli all the time,

right? They want to play video games,

they want to watch TV, they want to play

sports, but we want them to be bored and

be creative, like come up with creative

ideas to keep themselves

interested and engaged in a different

way. So, I think that's so so important.

And outside of stress, sleep. Um, sleep

is there's just so much abundance of

data on how sleep affects hormonal

health. They looked at data on men

sleeping 5 hours a night versus eight

hours a night. So you take the same guy

and he sleeps eight hours, then you, you

know, do five five hours for a few days.

His test for a week, his testosterone

drops by 15%.

>> Wow.

>> That's like as much testosterone drop as

would happen with 10 years of life.

>> And do you know how long they did that

for? How long?

>> It was short. It was like a week. So, a

week of sleep deprivation will will tank

your testosterone.

>> And sleep apnnea is another one that I

think people one don't realize they have

and two don't realize that fixing it

could actually improve their hormonal

health.

>> Wait, so does this mean that people who

have chronically bad sleep probably have

low testosterone?

>> Probably. Yeah.

>> And what is the symptoms of low

testosterone?

>> So, low testosterone, they're sometimes

very vague. So it can be fatigue, it can

feel brain fog, it can be depression, it

can be low desire, it can be erectile

dysfunction. That's what people always

think. It's just erectile dysfunction,

but it's this whole constellation of

symptoms. It can also be increased fat

mass, decreased muscle mass. So all of

these things can happen because we have

testosterone receptors all over our

body. We have them in our brain. We have

them in our muscle. We have them in our

bone. And these can all have really

serious consequences when it's low. when

you have sleep apnnea. And how you know

you have sleep apnea is uh your partner

might tell you that you're like waking

up in the middle of like gasping for

air. If you have one really easy way to

check is take a a measuring tape and

measure your neck circumference. If it's

more than 17 in for a guy or 16 inches

for a female, it means it's very likely

that you may have sleep apnea. And

that's because when you have excess mass

basically here, it's compressing your

airway and can make it difficult to get

air into your um into your body. When

you improve sleep apnea, we've seen

improvements in testosterone as high as

200 nanogs per deciliter. So huge jumps

in testosterone after fixing sleep

apnea. And the same goes for other sleep

disorders, although the data is not as

abundant. Uh but sleep is so important.

Then we talk about what's in your

environment. So let's grab this. Okay.

So, you get a bottle of water. So many

of my patients actually they only buy

like cases of plastic bottled water.

Once in a while a plastic bottle of

water like don't stress yourself out.

This goes back to stress. People get

really stressed like what's in my

environment? What am I drinking? What am

I eating? Like do what you can control.

So plastic water bottles have things

like phalates and BPAs which can affect

hormonal health. They can mimic

estrogen. They can reduce the production

of testosterone based on these

mechanisms. Also things like plastics in

the environment, PAS, so the things like

non-stick cookware, all those things can

affect hormone health. Now, how do you

sort of protect yourself, right? I tell

people again, don't stress. There's only

so much you can control. So, like I love

that we're not drinking out of plastic.

If you have to drink out of plastic

because you're at an event or whatever,

try to make sure it's not a um a warm

bottle. So, it hasn't been like sitting

in the sun for hours and hours and hours

because as it gets warm, it releases

more microlastics and more chemicals

into the water. When you're eating food,

if you are eating out of say you get

takeout, put it on a plate and warm it

up. Don't ever warm up that plastic. And

when you store food in the fridge, put

it in a glass container or a metal

container, but don't ever leave the food

in the plastic and put it in the fridge.

These are simple things you can control.

You could also limit sort of your

exposure to dust because dust has

microplastics. You can try to wear more

cotton fabrics, less synthetic fabrics

because they shed less microplastics.

But again, I think do what you can do,

but don't let the stress of these

chemicals like derail you because stress

is not helping either. And how much of a

difference does you know microplastics

make on my hormonal health? Is it really

a big big deal?

>> Well, I think it depends. It's all dose

dependent, right? So, we're all exposed.

Like, if you look at the data, like

people are, you know, consuming quite a

bit of microplastics and we're seeing

them actually even in testicles, in

penis tissue samples, like they're in

our bodies. And so, I think that it's

definitely playing a role. How much? We

don't know yet. We just know there are

mechanisms and we know that they do

affect hormonal health and so do the

best you can.

>> Do you and your family drink out of

plastic bottles?

>> No, we drink we we have like metal water

bottles for the kids and myself. And

>> what about non-stick pans?

>> We buy ceramic. We we do our best to

like avoid those as much as possible. So

the other thing is the company you keep.

I think we don't talk about this enough

and we talk about it in terms of

business like you want to keep people

who are successful around you. You want

to keep people who can help you. But it

also plays a role in your sexual

environment, right? So my husband is in

these groups with a bunch of other male

physicians. And there's a lot of

discussion about how they never have sex

anymore. And they're all just like, "Oh

yeah, this is just like normal. Like

we're getting older. Our partners don't

want to have sex. It's so frustrating."

And there's a lot of discussion about

this and and it's it's almost like, "Oh,

that's okay." Like that's just normal,

right? They're normalizing this

experience where that sex has not become

a priority because life is so stressful,

things are so crazy. Maybe you're having

relationship discord. So, it absolutely

plays a role. And there's actually some

evidence that it may help you make

better choices. So, there's one study

where they looked at I think it was like

50,000 people and they um did an

intervention where they tried to

encourage these people to surround

themselves with positive influences that

were like have safe sex and avoid

negative influences. And they saw that

for that these people had an increase in

like sexual positive behavior. So like

safe sex practices by 46%.

So just by changing who they spent their

time with, they saw this major

difference in how they approached their

sex lives.

>> Okay. So if your friends are very

pessimistic about sex and they're not

having and they're complaining about it,

that's going to become sort of

contagious.

>> Yeah. And I think it it extrapolates to

everything. what kind of relationships

you you're in. How do they view their

relationship with their partner? Is it a

priority? Do they make it a priority?

Right? Or are they just busy doing their

own thing and they're just like living

in parallel lives? They're doing their

own thing. You're doing your own thing.

You never really spend time with your

partner and then when you go hang out

with your friends, you're like, "Oh god,

I'm so glad to get away." And you're not

like talking about how much you enjoy

your partner. People tend to talk

negatively, right? They want to like

sort of like vent. And so when you have

people who don't make that a part of

their lives, it also affects you. They

value their partner and they talk about

them in a positive way, that's a a great

thing to say like, okay, this is the

right kind of person I want because I

want to value my partner too and I don't

want that to rub off on me because it

absolutely does.

>> And the other thing you said in this

category of environmental stuff is

things like pornography consumption. Is

it possible to consume too much porn?

>> So it's not the amount of porn that you

watch, it is the sort of the way you

feel about it. Many people watch porn

for a variety of different reasons. Most

often it's for pleasure and enjoyment.

But there's some people who watch porn

because they want to get away from

negative feelings, right? This is giving

them dopamine and they're using it as a

way to just feel better in the moment.

And so that become that can become a

compulsion where they're watching porn

and it's like giving them these positive

feelings and they feel negative in life

and they're going back to porn to sort

of again have that compulsion to watch

porn again. But that's a small subset of

people. The other thing is that there's

a lot of negative discussion around

porn, right? People like porn is bad,

it's dangerous, it's evil. And I think,

you know, it's more nuanced than that.

But if you feel that porn is bad, every

time you watch porn, you feel negative,

you feel bad about yourself. That's

where we see people having the most

dysfunction associated with it because

they feel guilty. They could watch it

once a year and they could feel super

guilty about it and it could affect

their sexual function. They could see

themselves as a bad person. and they

could see themselves as wrong or

immoral. And that's really when it

becomes an issue. If you are finding

yourself either compulsively watching

pornography and using it as a scapegoat,

maybe time to reevaluate, say, why am I

doing this? How can I switch this out

for something else that makes me feel

better that might be healthy, like

exercise or going for walks or whatever

that may be? And then if it's something

that's really making you feel like bad

or guilty because maybe that's how you

were raised, maybe that's what you feel

about morality, then yeah, maybe like

you either need to work through that

because porn is maybe something that you

still want to watch at times or you need

to abstain. But usually those are it's

very difficult to abstain for most

people to abstain for prolonged periods

of time. So I think it's it's something

you have to work through if you find

yourself having these sort of feelings

about pornography or you're compulsively

watching it. But for most people, it's

adults. For most adults, it is fantasy.

It's a place where you can experience uh

see things that you may never do in real

life that may be enjoyable, that are fun

to watch, that have allow you to feel

arousal. We see that when couples watch

porn together, they are more likely to

be more satisfied in their relationship.

And when there's a discord, like one

person really doesn't like it or doesn't

use it, and the other one uses it a lot,

that's where we see the problem. Is porn

consumption going to impact my intimacy

with my partner?

>> So, it depends. I think a lot of people

watch it without an issue, right? They

watch

>> if I masturbate and I ejaculate, I'm not

going to then be able to ejaculate very

quickly necessarily with my partner.

>> Yeah. So, that obviously that is, you

know, there's a refractory period after

you ejaculate. Now, when you're younger,

that refractory period could be minutes.

And when you're older, that can be a day

and a half. And so we see that some

people may struggle, especially if

they're watching a lot of porn every

single day and their refractory period

is maybe a day. Then they may actually

really have trouble ejaculating with

their partner because they've not given

themselves that time.

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And the last one, the last of the four

pillars,

>> the last of the four pillars we talked a

little bit about, it's called

confidence. And confidence is not like

stringing around like a peacock like I

know what I'm doing. It's confidence in

knowledge and curiosity. So, knowledge

we talked about a little bit,

understanding female anatomy, like how

do female bodies get aroused, right?

what makes them aroused, where is the

clitoris, knowing some anatomy, and two,

actually talking to your partner or

paying attention to their cues. We that,

for some reason with sex, it's the only

time that we just expect people to be

mind readers. We just want you to know

what I like and just go for it, right?

And and then when it's not good, you're

like, well, you just don't know what

you're doing. And it's like, it's it's

wild to me that we actually never got

taught how to talk about sex, how to

bring it up with a partner, how to, you

know, just explore and have fun with

sex. maybe add a toy to the bedroom. So,

there's lots of different types of toys.

This is a uh vulva stimulator. So, you

put this on the outside. So, you can see

that it would in theory, if this was

smaller, would stimulate the um the

clitoris on the outside. It also can

change in shape. It'll vibrate, right?

It'll have different stimulations that

you can play around with and decide what

you enjoy.

>> So, this one's run out of battery. Um

so,

>> they're brand new. They have not been

used.

>> I didn't say they had been very

defensive though. Um, so if my pinky

finger, if my finger here is the

clitoris,

>> Yeah.

>> I put it on like that.

>> Yeah.

>> And then it vibrates.

>> Correct.

>> And then the penis goes through the

hole.

>> And there's another version of that.

This is basically

>> this is basically like the hole goes

around the penis

>> and that goes in

>> and that can go in and stimulate and vi

vibrate. So, you both feel the vibration

and you both feel the stimulation.

>> I remember I was with um had a partner

and she she felt that sex toys were for

older people. Old people specifically

what she said and she she was kind of

against the use of them. I've always

been down.

>> I think it adds novelty and it's

exciting and it just adds something new.

>> But she felt like it was almost like

giving up.

>> Well, I mean, look, I think I wonder

why. I would I would if I she was here,

I'd ask her, why do you think that? What

belief system do you have that's making

you think that this is like not a good

thing to use? Right? We use technology

in so many places in our lives, right?

So why not introduce it in our sex

lives?

>> Are you going to become reliant on it

though? Because it doesn't make it

easier to get off with a sex toy.

>> So they've actually looked at vibration

and can you get desensitized to it? And

the way they've looked at is actually

like construction workers where they're

using those like vibration tools, right,

to and and seeing if like their hands

get desensitized. And what they've seen

is yes, for a short period of time they

do lose a little bit of sensation at

their fingertips, but then it restores

back to normal. And so it's not that

you're going to become desensitized

forever, right? I think you brought up a

great point, which is adding novelty.

Now, I think when I say novelty, people

are like, "Oh my god, I need to role

play in a different way or bring like

some sort of BDSM or whatever into my

sex life." And that's not exactly true.

So when you think about sex, right, it's

just like eating your favorite ice

cream. Maybe you have vanilla ice cream,

you know, three times a week and you

enjoy it. But if you start having

vanilla ice cream every single day,

you're kind of bored with it, right? And

the same goes for sex. Now having

routine in sex, knowing what you like,

um knowing what your partner likes, it

can be very helpful, but it also is nice

to add novelty. So if you think about

you can extrapolate from the flow state.

So when you are in a flow state for

work, right, things feel really almost

effortless and you're just like in a

zone, you can also get into a sexual

flow state. When you look at the flow

state, yeah, you need things to be

slightly challenging to get into the

flow state. They can't be easy and they

can't be so hard that you're going to

get frustrated, right? And so you need

to add a slight challenge to your sexual

encounter to get into that flow state.

And that's when you start having really

great sex cuz you're like in you're so

totally immersed. you're feeling great

and it's it's super fun, right? So, I

think that's another part of being

confident is being able to and confident

to try new things and explore new

things. And it can be as simple as like

doing it in a different room or maybe

getting a pillow or switching where your

head position is. Like, it can be so

small, but it can just add a little bit

of uniqueness and novelty and challenge.

>> Are there certain positions that are

going to increase the probability that

my partner has an orgasm?

>> Yeah. So, uh, typically when the female

partner is on top, she has more control

over where she's getting stimulation,

um, to the clitoris because, right, she

can angle her body in such a way. So,

often time that shows uh, that has, uh,

higher orgasm rates. There's actually

like this uh this technique called the

cooidal alignment technique where you

sort of move in a rocking uh a sort of a

rocking motion so that um your pubic

symphysis. So this bone right here um is

sort of like rubbing against their

clitoris like this area the skin here is

rubbing against the clitoris while

you're penetrating and that has been

shown to increase orgasm rate and

pleasure in sex. But really it's about

figuring out and trying different things

and realizing like that for example that

coil alignment technique is sort of

difficult like it's not that easy and

intuitive and so you have to sort of

play around with it and figure out like

what is going to work uh best and yeah

realizing it might not work. You might

be like super awkward and like okay like

that's okay like it's not the end of the

world if sex is not perfect every time

because we're learning and we're playing

and we're having fun. And so I think

that's really the key is like not

letting yourself get so frustrated if

something doesn't go exactly the way you

envision it in your head.

>> I used to think that a woman orgasming

was when this was when I was younger. Um

was when she squirted.

>> Mhm.

>> So like that's what I thought it thought

an orgasm was squirting.

>> Yeah. Well, you're probably not the only

one to think that. And so squirting, not

every woman squirts. So about 40% of

women squirt. Squirting is the emission

of fluid at the time of orgasm. Um

usually it's clear, colorless, and it

can be quite voluminous. um it's coming

from the urethra which is the pee hole

essentially and remember I talked about

those skins glands those skins glands

are the homalogue of the male prostate

and they have a little bit of fluid in

them too typically when you have

stimulation um and squirting they will

release fluid from the bladder as well

as the skins glands that combines

together and and it's emitted through

through that

>> so it's not pee

>> the way they describe it and there's

been a lot of research on this so

there's people who say it's pee. There's

people who say it's not. There's a

couple studies. So, one is they put dye

into the bladder and they took women who

said they were squirters and they had

them orgasm and they saw is there dye in

the uh in the fluid and yeah, there was

dy in fluid. So, it's coming, it has to

come from the bladder. The skins glands

only hold a small amount, but it's

chemically different. It's usually

clear, odorless. It doesn't smell like

pee. And so, there's some theories as to

why that might be. It may be that um

when you're having sex, there's

different hormonal signals that change

the concentration of what's filtering

through your kidneys so that it is a

little bit different in composition.

There's some theories that when there's

more estrogen around that it may change.

There may be some like um fluid filling

in the actual interstissia of the

organs. Again, it's hard to say, but

it's absolutely coming from the urethra

which is connected to the bladder as

well as the steam glands. But I think

like this this whole discussion about

what it is, it doesn't matter. Like is

it pleasurable? Are you enjoying it?

Great. If you squirt and you enjoy it,

great. If you don't, that doesn't mean

that there's something wrong and that

your partner hasn't orgasmed. The way to

figure out if your partner orgasm is you

ask her, right? Either she tells you or

you ask her. And sometimes it's obvious

and sometimes it's not, but you know,

you you sort of figure it out.

>> There's three theories that emerged in

my research about why women squirt from

an evolutionary perspective. The first

was that, and these are just theories,

they're not proven. Um, of course, the

first is that squirting contains PSA and

zinc, which are naturally antibacterial,

and ejaculating these fluids during or

after sex may have evolved to flush the

urethra and prevent UTI. Um, the logic

being in a pre antibiotic world, a woman

who could flush bacteria out of her

system after mating was more likely to

stay healthy and reproduce. That's one

theory. The other reason,

>> well, before you I want to talk about

that really quickly. So, that's a really

interesting theory. So one the reason

they emit PSA is because schemes glands

are the homalologue of the prostate. So

the prostate makes PSA which is prostate

specific antigen.

>> So this point this word homalogue again.

>> Yeah it's a so basically the prostate in

the male the same tissue when they're an

embryo becomes the prostate in the male

and becomes a skins glands in the

female. So that's why it's emitting PSA.

That is an interesting theory because

there are a subset of women who get UTI

after sex. Not everybody but some do.

And it's it's not because of the

ejaculate or because of the male

harboring some bacteria. It's because of

the actual thrusting of the penis. It's

taking bacteria from the outside and

making it more easy for it to go through

the urethra into the bladder. And women

have a short urethra. And so I want just

to debunk that myth that it's like

you're getting it from your partner or

there's something wrong with you. It is

literally just anatomy. And so some

women do get more UTI after sex.

>> And so that is an interesting theory

because maybe that's true. I don't know.

The second theory was in ancient

ancestors, the hormonal surge during

orgasm and ejaculation actually

triggered the release of an egg. Humans

evolved to ovulate on a cycle now, but

we kept the plumbing and the neuro