Latest / INSPIRE STORY / #0225_ STORY INSPIRE: Dr. Rena Malik — A Urologist Debunks the Sex Myths Every Man Should Know

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#0225_ STORY INSPIRE: Dr. Rena Malik — A Urologist Debunks the Sex Myths Every Man Should Know · INSPIRE STORY

0:05
Speaker 1: Marina Malek, welcome to the show.
0:07
Speaker 2: Thank you so much for having me. It's truly an honor.
0:09
Speaker 1: Oh, man. I've been looking forward. I told you at breakfast.
0:14
Speaker 1: I didn't even think we were going to get you. Oh, no.
0:17
Speaker 1: But me and my wife found your channel years ago,
0:20
Speaker 1: and some of the titles, I'm just like, we got
0:24
Speaker 1: to watch this stuff. Everything from what's the average length
0:28
Speaker 1: of sex, squirters, how many times should men ejaculate? Like,
0:34
Speaker 1: it's just the titles are so bold, and it's questions
0:38
Speaker 1: that everybody has, but everybody's too embarrassed to ask the question,
0:42
Speaker 1: and you just do an awesome job of covering all that. So, congrats.
0:47
Speaker 2: I mean, I'm glad to give that advice because I
0:50
Speaker 2: don't feel like anyone's really answering those questions in a
0:53
Speaker 2: way that's professional and authentic and genuine and explaining, like, why.
0:57
Speaker 2: And so I'm grateful to be in the position to
1:00
Speaker 2: be able to do that.
1:01
Speaker 1: Well, congratulations on all your success. It looks like a
1:06
Speaker 1: rocket ship. Thank you. But everybody starts off with an
1:10
Speaker 1: introduction here. So Rena Malik, a board-certified urologist and fellowship-trained
1:17
Speaker 1: specialist in female pelvic medicine and reconstructive surgery, expertise in
1:23
Speaker 1: sexual medicine, hormone management, menopause, and non-narcotic pelvic pain treatment.
1:30
Speaker 1: You run a private practice in Beverly Hills and Newport Beach, California. Also,
1:35
Speaker 1: you work at the VA, 2023 American Urological Association Young
1:41
Speaker 1: Urologist of the Year, a content creator with over 2.5
1:45
Speaker 1: million YouTube subscribers focused on evidence-based discussions of taboo health
1:50
Speaker 1: issues like sexual dysfunction and bladder health. Like I said,
1:54
Speaker 1: some of the Some of the titles that I've seen
1:56
Speaker 1: is Does Size Matter? Squirters, Does Pineapple Change the Taste
2:00
Speaker 1: of Semen? There's the G-Spot Reel, Penile Implants. I mean,
2:04
Speaker 1: you cover all of the taboos topics and I just,
2:09
Speaker 1: I love watching your stuff.
2:10
Speaker 2: Thank you. Thank you so much.
2:13
Speaker 1: So a couple of things to get through. One, everybody
2:16
Speaker 1: gets a gift.
2:18
Speaker 2: Amazing. Thank you.
2:20
Speaker 1: Those are Vigilance Elite Gummy Bears made in the USA.
2:25
Speaker 1: And it's just candy. Legal in all 50 states, although
2:28
Speaker 1: you don't have to worry about that out in Cali.
2:31
Speaker 2: That's good, yeah.
2:32
Speaker 1: And then we have a subscription account on Patreon. And
2:37
Speaker 1: a lot of these folks have been with us since
2:39
Speaker 1: the beginning. I think we're getting close to 100,000 subscribers
2:43
Speaker 1: on there now. And so we built it into quite
2:46
Speaker 1: the community, and they're the real reason that I get
2:49
Speaker 1: to be here with you today. And so we're I
2:52
Speaker 1: offer them the opportunity to ask each and every guest
2:54
Speaker 1: a question on the show. This one is from Austin Coates.
3:01
Speaker 1: At 40 years old and nine years into recovery from
3:04
Speaker 1: opiate addiction, I've done deep, deep emotional and spiritual work
3:08
Speaker 1: that sobriety demands, but I still find myself wondering about
3:11
Speaker 1: the long-term physical impact of addiction. Does chronic substance use
3:15
Speaker 1: accelerate biological activity? aging in men, and how does long-term
3:19
Speaker 1: sobriety affect the brain and body's ability to heal? Specifically,
3:24
Speaker 1: can neuroplasticity and recovery processes fully reverse the damage? Or
3:29
Speaker 1: are there systems like hormonal, cognitive, or metabolic function that
3:32
Speaker 1: remain permanently altered?
3:35
Speaker 2: I mean, the body is very resilient, right? So it
3:38
Speaker 2: depends on how long you were addicted, how long you've
3:40
Speaker 2: been sober. but your body can recover. It just is
3:45
Speaker 2: very individualized. So I can't give you like a blanket
3:47
Speaker 2: statement that yes, after this many years, you'll be good
3:50
Speaker 2: to go and everything will be back to baseline. There
3:52
Speaker 2: may be permanent neurologic damage that is very difficult or
3:56
Speaker 2: impossible to reverse. But I will say, like I've seen
4:00
Speaker 2: many people with traumatic brain injuries, with really severe issues
4:05
Speaker 2: that can even despite those issues, have very healthy, long lives.
4:12
Speaker 2: And sometimes they do require maybe some replacement of hormones,
4:15
Speaker 2: for example, but that doesn't preclude them from being optimized,
4:19
Speaker 2: living their best life and feeling good and being able
4:22
Speaker 2: to be healthy and be good partners, be good parents,
4:26
Speaker 2: be good workers, all those things. So I think the
4:28
Speaker 2: reality is you might need some help, but even if
4:31
Speaker 2: you do, you can still live a great, wonderful, healthy
4:34
Speaker 2: life and be able to contribute to society in a
4:38
Speaker 2: meaningful way.
4:39
Speaker 1: Oh, that's good to hear. I mean, I'm, I'm recovering
4:42
Speaker 1: from addiction. I wonder the same things. I thought that
4:44
Speaker 1: was the perfect question. And, um, you know, especially talking
4:48
Speaker 1: about traumatic brain injury and, and, uh, I don't know
4:52
Speaker 1: if we're going to go into PTSD, but, uh, you
4:55
Speaker 1: work at the VA, you deal with a lot of veterans.
4:57
Speaker 1: We have an enormous, probably the biggest, uh, veteran viewership
5:02
Speaker 1: subscriber list in the country at least. And, uh, so
5:05
Speaker 1: I know these, these are behind-the-scenes discussions that we're all
5:09
Speaker 1: having about this kind of stuff. And so I'd love
5:12
Speaker 1: to clear some of that up. But I want to
5:16
Speaker 1: ask right off the bat, because we're primarily focused on
5:19
Speaker 1: men's health for this one, and we're going to release
5:21
Speaker 1: this in Men's Health Month and our Men's Health Awareness Month.
5:25
Speaker 1: But I think the squirter YouTube video that you did
5:31
Speaker 1: was the first one that I saw, and I was like,
5:33
Speaker 1: I have to see this. So what Can you just
5:37
Speaker 1: go into that?
5:38
Speaker 2: Yes. So, squirting, obviously, is a very popularized thing. And
5:42
Speaker 2: everybody wants to know, like, does everyone do it? Is
5:45
Speaker 2: it normal? Like, what is it? And so, let me
5:48
Speaker 2: just start with the biology, right? So, biologically, what is squirting?
5:52
Speaker 2: There's squirting, there's female ejaculation, there's normal lubrication. There's all
5:55
Speaker 2: these fluids, right? So, normal lubrication, everyone's pretty familiar with.
5:58
Speaker 2: It just occurs when a female is aroused, she has
6:01
Speaker 2: normal lubrication from the walls of the vagina, essentially, and
6:04
Speaker 2: some little glands on the sides. And then there's female
6:09
Speaker 2: ejaculation and their squirting. So squirting is like this clear
6:13
Speaker 2: odorless fluid that's emitted at the time of orgasm. It's
6:16
Speaker 2: usually voluminous. It's usually what I've been told tastes a
6:21
Speaker 2: little bit sweet. And so this is this fluid that
6:25
Speaker 2: some women, not all, so I'd say probably like 40%
6:27
Speaker 2: of women will squirt when aroused fully. Now, where is
6:31
Speaker 2: it coming from, right? I think that's what people want
6:33
Speaker 2: to know, is it pee? And so obviously it's coming
6:36
Speaker 2: from the urethra, which is like the pee tube. And
6:38
Speaker 2: so the bladder, when it fills, normally you pee from
6:41
Speaker 2: the pee tube or the urethra. Now, it is coming
6:43
Speaker 2: from there, but it's not urine. So they've actually looked
6:46
Speaker 2: under microscopes and looked at like, okay, let's compare what's
6:48
Speaker 2: in pee to what's in squirting. And they're similar but different.
6:53
Speaker 2: So squirting is usually like a very dilute form of
6:56
Speaker 2: urine and also has another substance in it called PSA.
7:00
Speaker 2: So you guys might know PSA is something that you
7:02
Speaker 2: get tested when you're screening for prostate cancer. The prostate
7:05
Speaker 2: emits PSA. It's called prostate-specific antigen. But think about when
7:10
Speaker 2: people develop, when babies develop, they start from the same structures,
7:14
Speaker 2: and then you have signals that say, okay, you're going
7:16
Speaker 2: to become a female, you're going to become a male.
7:18
Speaker 2: So we have homologs. So the female prostate is called
7:21
Speaker 2: the Skeen's glands, and that's located basically underneath that urethra,
7:27
Speaker 2: about two or three centimeters in, and it has these
7:29
Speaker 2: little tiny glandular structures that produce fluids. And so that
7:33
Speaker 2: is where the PSA comes from. So it's a mix
7:36
Speaker 2: of a very dilute urine with this PSA substance that's
7:40
Speaker 2: coming from the Skene's glands when it's stimulated or when
7:42
Speaker 2: you're aroused. And so there's a few different theories. They've
7:45
Speaker 2: done lots of studies. Well, not lots, but they've done
7:47
Speaker 2: like three or four studies on squirting. They've actually put
7:50
Speaker 2: dye into the bladder and then had people squirt and
7:53
Speaker 2: see like, is it blue? Or is it like they
7:55
Speaker 2: use blue dye? And they've seen, yes, it is blue.
7:57
Speaker 2: They've done studies where they'll scan the bladder before someone
8:01
Speaker 2: squirts and then the person squirts and then they check
8:04
Speaker 2: the bladder again. Okay, it's empty, so it's probably urine.
8:07
Speaker 2: And so there's a lot of people who think like, yes,
8:09
Speaker 2: it's urine. But there's other experts who would say like, well,
8:13
Speaker 2: when you're aroused, there's a bunch of hormonal changes. And
8:16
Speaker 2: so it may change the way that your kidneys filter.
8:19
Speaker 2: And so you're not getting exactly urine. You're getting this
8:21
Speaker 2: very dilute fluid that's very distinct in terms of color
8:25
Speaker 2: and odor and all that. But it is obviously coming
8:27
Speaker 2: through the bladder. So I think ultimately, like there's a
8:30
Speaker 2: lot of hubbub about it. At the end of the day,
8:32
Speaker 2: it doesn't really matter, right? What matters is that is
8:35
Speaker 2: the person squirting enjoying it, right? Do they actually like it?
8:39
Speaker 2: And so when you look at that, what you find
8:41
Speaker 2: is that it's mixed. So some women are like, yeah,
8:43
Speaker 2: it's a superpower. I feel great.
8:45
Speaker 1: I'm amazing.
8:45
Speaker 2: I can squirt. I really enjoy it, it's very pleasurable.
8:49
Speaker 2: Other women feel like they don't know what's going on,
8:52
Speaker 2: they feel embarrassed, they feel like it's messy. And other
8:56
Speaker 2: women are sort of ambivalent, like, whatever, it's just kind
8:58
Speaker 2: of a mess to clean up and it's fine. So
9:01
Speaker 2: I think the reality is that when you watch erotic films,
9:04
Speaker 2: it makes it seem like everyone squirts, and squirting is
9:07
Speaker 2: this really amazing visual representation of pleasure. The reality is
9:11
Speaker 2: that like pleasure, the way you can tell a female
9:14
Speaker 2: has pleasure is you ask her, right? Like, did you
9:16
Speaker 2: enjoy that? And what can we do differently to make
9:19
Speaker 2: it better or not better, right? Like what was good,
9:22
Speaker 2: what wasn't good? Just like you would ask anybody anything, right?
9:25
Speaker 2: But we don't do that. We want to see it, right?
9:26
Speaker 2: And men are very visual because they ejaculate. So they're like, oh,
9:31
Speaker 2: like this is female ejaculation, which is actually different. But
9:35
Speaker 2: this is like them reaching climax. I can be sure
9:38
Speaker 2: they're climaxing because I see this visual representation of it.
9:41
Speaker 2: And the reality is the majority of women don't squirt.
9:45
Speaker 2: 60% or so don't. And that doesn't mean they're not
9:47
Speaker 2: orgasming or having a climax. They are. And they're probably
9:50
Speaker 2: having a lot of pleasure when they do climax. And
9:53
Speaker 2: even if they don't climax, which some women have struggled
9:56
Speaker 2: with that, the entire process of having sex can be pleasurable.
10:00
Speaker 2: So I think it's really like, let's not focus on
10:03
Speaker 2: this one end product of sex and actually look at
10:07
Speaker 2: the whole thing. And like, let's talk about pleasure as
10:09
Speaker 2: a society. And let's talk about like what that means
10:12
Speaker 2: for you and your partner and actually enjoy sex as
10:16
Speaker 2: something that we do and we join and we have this, like,
10:20
Speaker 2: meaningful connection with another human being rather than focusing on, like,
10:23
Speaker 2: these really arbitrary markers of pleasure.
10:26
Speaker 1: So, I mean, what is it about some females that
10:31
Speaker 1: enable them to do that versus others that, I mean,
10:35
Speaker 1: why do 60% of females not squirt?
10:37
Speaker 2: Yeah, so we can't be 100% sure, but I suspect
10:40
Speaker 2: that it is because of variations in anatomy and how
10:43
Speaker 2: women are aroused. So we think like, yes, maybe if
10:46
Speaker 2: you arouse that Skeen's zone area, which is actually where
10:50
Speaker 2: we think the G spot or it's actually a zone,
10:53
Speaker 2: G zone is, is that right around that Skeen's gland,
10:55
Speaker 2: that maybe that would be more likely to cause someone
10:58
Speaker 2: to squirt. The other thing is that, you know, it
11:01
Speaker 2: may be also like, how thick is that anatomy? Like
11:03
Speaker 2: there is variations. They've actually looked at ultrasounds and some
11:06
Speaker 2: is thicker, some is thinner, some is more, some Skeen's
11:08
Speaker 2: glands are more voluminous than others And so there's probably
11:12
Speaker 2: variation why some can and some can't. But again, it's
11:16
Speaker 2: not mandatory. And I think that's really the take home.
11:18
Speaker 2: It's like, it's not mandatory. And just because someone can't,
11:21
Speaker 2: they shouldn't feel like, deficient in any way. And just
11:25
Speaker 2: because someone can doesn't mean that they're better than someone else. Again,
11:29
Speaker 2: the goal is pleasure. And so like, I find it
11:32
Speaker 2: very awkward. Like some people are like, oh, can you squirt? Like, oh,
11:34
Speaker 2: this is so amazing. Like, that's great if you can.
11:37
Speaker 2: And yes, there is some people who believe you can
11:39
Speaker 2: be taught to squirt. And again, like, I think there
11:41
Speaker 2: is some potential, like, you know, you can try to
11:44
Speaker 2: stimulate those areas. You can maybe fill the bladder, like
11:46
Speaker 2: don't pee right before sex. There's probably some things there
11:49
Speaker 2: that can make that more likely. But again, It's not
11:53
Speaker 2: the squirting, it's the pleasure that we want to focus on.
11:55
Speaker 1: Man, that's interesting, interesting. All right, so I want to
11:58
Speaker 1: move into, I want to do a little bit of
12:00
Speaker 1: a life story on you and then get into all
12:02
Speaker 1: the health stuff. But I mean, where did you grow up?
12:05
Speaker 2: I grew up in Buffalo, New York.
12:07
Speaker 1: Buffalo, New York?
12:08
Speaker 2: Yeah.
12:09
Speaker 1: What got you into urology?
12:11
Speaker 2: Yeah, so it's actually not something I even knew existed.
12:15
Speaker 2: It's not a specialty I went into medical school thinking like, oh,
12:17
Speaker 2: I'm going to be a urologist. I went into medical
12:20
Speaker 2: school thinking I would be like a cardiologist or something.
12:23
Speaker 2: and I went to med school, I did my rotations,
12:25
Speaker 2: and then I realized that, like, I really liked surgery.
12:28
Speaker 2: I liked operating with my hands. I liked being able
12:30
Speaker 2: to fix a problem with surgery, whereas, like, when you
12:33
Speaker 2: take care of patients with medicine, it's much more, like,
12:35
Speaker 2: long-term trying to fix their issues, and so then I,
12:38
Speaker 2: but I didn't love general surgery, which is, like, surgery
12:41
Speaker 2: where you do all different body organ structures, and so
12:44
Speaker 2: I looked at the subspecialties of surgery, and so those
12:47
Speaker 2: were urology, orthopedics, ENT and ophthalmology, which is eyeballs. Ophthalmology,
12:57
Speaker 2: very quickly, I saw one operation was like, this is
12:59
Speaker 2: not for me. I don't like eyeballs. So that was
13:01
Speaker 2: easily taken off the table. ENT, so orthopedics, very power
13:08
Speaker 2: tool heavy. The culture was very, at the time, kind
13:11
Speaker 2: of bro-y. And I was like, okay, I don't really
13:12
Speaker 2: fit in here. And so then it was really between
13:15
Speaker 2: ENT and urology. There's also other subspecialties. Oftentimes you have
13:18
Speaker 2: to go through a general surgery residency to do those.
13:21
Speaker 2: Or neurosurgery is also separate, but that's just a very
13:25
Speaker 2: intense field that I wasn't personally interested in. So I
13:29
Speaker 2: looked at those two fields, I went to their operating rooms,
13:31
Speaker 2: I met the people, and I was like, okay, they
13:34
Speaker 2: both do pretty cool surgeries. They both have a very
13:38
Speaker 2: nice culture. But I honestly, when I met urologists, I
13:41
Speaker 2: was like, okay, I found my people. These are very smart,
13:44
Speaker 2: very intelligent, very innovative people, but they also don't take
13:47
Speaker 2: themselves too seriously. Because when you're dealing with genitalia all day,
13:51
Speaker 2: like you just can't. You can't be like so intense
13:54
Speaker 2: about everything. It's like sort of a funny field and
13:56
Speaker 2: funny things happen. And so I was like, okay, these
13:59
Speaker 2: are my people. And the reality is when you're in
14:01
Speaker 2: medical school, you sort of take a leap because you
14:04
Speaker 2: can't ever know what it's really exactly like to maybe
14:07
Speaker 2: do the surgery or to be the one taking care
14:09
Speaker 2: of all the patients all yourself. And so you take
14:12
Speaker 2: a leap of faith. You're like, okay, I like this.
14:13
Speaker 2: I think this is going to be the right fit.
14:15
Speaker 2: And sometimes people change their minds and go to a
14:17
Speaker 2: different specialty. But for me, it was absolutely the right fit.
14:20
Speaker 2: And I love every part of urology. I think we
14:23
Speaker 2: are very honored and privileged to take care of patients
14:27
Speaker 2: at their most intimate issues and take them through that.
14:30
Speaker 2: But we also get to take care of patients for
14:32
Speaker 2: a long period of time. So we take care of
14:34
Speaker 2: long lifetime issues. So they don't just come and have
14:37
Speaker 2: surgery and leave. They may have to deal with medications
14:40
Speaker 2: or do other things. And so we touch base. We
14:42
Speaker 2: keep that long-term connection with patients, which is really great.
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Speaker 1: Available November 14th. Rated M for Mature. Interesting. What is...
16:47
Speaker 1: You know, in your intro, non-narcotic pelvic pain, was it reconstruction?
16:53
Speaker 2: Well, so there's, yeah, there's pain, there's reconstruction, there's pain
16:55
Speaker 2: medicine too. So pelvic pain is a really challenging issue
17:00
Speaker 2: for a lot of people. So they deal with chronic
17:02
Speaker 2: pain in their pelvic region. I see it in vets too.
17:05
Speaker 2: I mean, commonly because it's my specialty, but I see it.
17:08
Speaker 2: And it's very difficult to treat. And it's very challenging
17:12
Speaker 2: for a lot of people to live with. And a
17:14
Speaker 2: lot of times they just get treated with pain medications.
17:16
Speaker 2: And so we try to offer them options that are
17:19
Speaker 2: not necessarily pain medications to help manage those issues. But
17:23
Speaker 2: pelvic reconstruction is basically, we are sort of like the
17:27
Speaker 2: creative surgeon. So we'll see a problem and there's multiple
17:30
Speaker 2: different ways to fix it. And you'll sort of figure
17:32
Speaker 2: out what is the best way for that individual person.
17:34
Speaker 2: So it could be like a narrowing of the urethra.
17:36
Speaker 2: It could be a narrowing of the, that drains the kidney.
17:40
Speaker 2: It could be in women, like, when they have things
17:42
Speaker 2: like prolapse, where they have, like, sort of a vaginal hernia.
17:46
Speaker 2: There's a variety of different surgeries that we can offer.
17:49
Speaker 2: to help sort of reconstruct things when they're broken. And
17:51
Speaker 2: sometimes they're very complex and sometimes they're simple, but it's
17:54
Speaker 2: sort of like I was drawn to it because every
17:57
Speaker 2: surgery is a little bit different and you get to
17:59
Speaker 2: like sort of look at it and approach everything a
18:02
Speaker 2: little bit differently. And there's no like formulaic way to
18:06
Speaker 2: go about it. It's sort of like, okay, every person
18:09
Speaker 2: is individual, so I have to look at them as
18:11
Speaker 2: an individual and really come up with the right plan
18:13
Speaker 2: for them.
18:14
Speaker 1: What then, I'm just curious, I mean, it's, Great to
18:19
Speaker 1: see somebody like you inside of the VA. I mean,
18:22
Speaker 1: I haven't been there in a long time, so I
18:24
Speaker 1: don't know how it's really going, but didn't have a
18:26
Speaker 1: good experience roughly about 10 years ago. And so I'm
18:30
Speaker 1: just curious, what, do you come from a family of
18:33
Speaker 1: veterans or.
18:34
Speaker 2: No, I am, I just loved, so I trained in
18:39
Speaker 2: New York and I went to the Manhattan VA. And
18:41
Speaker 2: then when I started my first job, I worked at
18:43
Speaker 2: the Baltimore VA and I just love taking care of veterans.
18:46
Speaker 2: I feel one, very honored to do so. Like you
18:49
Speaker 2: guys have served our country. You've done so much for us.
18:52
Speaker 2: So for me to be able to give you back
18:53
Speaker 2: some semblance of health, like it's so valuable to me.
18:56
Speaker 2: Like I feel grateful at the end of the day.
18:59
Speaker 2: And two, I just feel like it's just a different
19:04
Speaker 2: character of patient, right? They're respectful, they're kind, they want
19:08
Speaker 2: the best for themselves, right? They really do. And sometimes
19:11
Speaker 2: they're struggling very deeply through a lot of things in
19:16
Speaker 2: their life, but they have this drive to get better, right?
19:20
Speaker 2: And sometimes they don't get the tools to do so,
19:22
Speaker 2: but they really do want to. They're not going through
19:25
Speaker 2: life just accepting sort of, whatever comes to them, they
19:30
Speaker 2: want to get better. And I think that that is
19:33
Speaker 2: so unique. And honestly, like it is really, I feel
19:37
Speaker 2: grateful every day that I get to go to the VA.
19:40
Speaker 1: Well, thank you for doing that. And then your YouTube.
19:43
Speaker 1: So you said that you started in 2019.
19:44
Speaker 2: Yeah.
19:44
Speaker 1: What, I mean, being a physician in a really good one, one,
19:50
Speaker 1: I mean, how did you, how did that even pop
19:53
Speaker 1: up on your radar? Why did you start the channel? Yeah.
19:56
Speaker 2: So I, when I was in, I was in academic medicine,
19:58
Speaker 2: I was doing what we, like we do research, right?
20:00
Speaker 2: And so one of the research areas that I found
20:03
Speaker 2: really compelled me was health literacy. So like, I would
20:06
Speaker 2: have patients come and they would get to see me
20:08
Speaker 2: for maybe 30 minutes, maybe 15 minutes, depending on what
20:11
Speaker 2: they were there for. And I would give them all
20:13
Speaker 2: this information, but it was just not enough time, right?
20:16
Speaker 2: To really explain like why and what, like, I only
20:20
Speaker 2: have so much time because insurance only reimburses so much.
20:22
Speaker 2: And you've got all these pressures to like, you know,
20:25
Speaker 2: see a certain number of patients or, you know, or
20:27
Speaker 2: you're going to get, in trouble by the power of
20:29
Speaker 2: Big Brother, right? And so you get in this situation
20:32
Speaker 2: where you're not able to really give patients the time
20:35
Speaker 2: and energy they deserve, right? And so you're like, look,
20:39
Speaker 2: this is a problem that you have a lot of
20:41
Speaker 2: power to fix, but I can't go through all of
20:44
Speaker 2: these things with you in 30 minutes. And so I
20:47
Speaker 2: realized I really wanted to be able to reach people
20:50
Speaker 2: at home and be able to teach them that they would,
20:52
Speaker 2: you know, be able to learn and understand better. And
20:55
Speaker 2: once I think people understand what's going on with them,
20:57
Speaker 2: they can then, like, you can actually take the steps
21:00
Speaker 2: you need to take. But if you don't understand it
21:02
Speaker 2: and your doctor just gives you a pill and says, go, bye,
21:04
Speaker 2: see you later, see you in six months or a year, like,
21:06
Speaker 2: you're like, I don't know what's going on with me
21:08
Speaker 2: and I don't, like, you just feel like that's all
21:10
Speaker 2: you can do, right? And so, and even with surgery, like,
21:13
Speaker 2: I do a lot of quality of life surgery. And so...
21:16
Speaker 2: If I do surgery on someone and they don't understand
21:19
Speaker 2: what could happen, what complication could happen, or how their
21:22
Speaker 2: life is going to change, now I failed as a surgeon, right?
21:25
Speaker 2: Because I operated on someone who didn't completely understand the situation.
21:28
Speaker 2: So I felt like this was something really important to me,
21:32
Speaker 2: but I realized that doing it through the traditional research
21:34
Speaker 2: route would take me decades before I got to a
21:36
Speaker 2: point where I was really reaching the masses. So I said,
21:39
Speaker 2: let me try this, right? Let me try educating online.
21:43
Speaker 2: And so I was like, okay, I'm just going to
21:44
Speaker 2: try YouTube. Like, why not? And so for six months,
21:47
Speaker 2: I just made a video a week and I had
21:48
Speaker 2: no idea what I was doing, but I just like
21:50
Speaker 2: did it.
21:51
Speaker 1: Right.
21:51
Speaker 2: And then as I started doing it, I realized like, wow,
21:53
Speaker 2: there's so much need for sexual health education. There's people
21:57
Speaker 2: know nothing. Right. And they're getting preyed on by people
22:01
Speaker 2: who don't know much either, but are trying to make
22:03
Speaker 2: a quick buck.
22:04
Speaker 1: Right.
22:04
Speaker 2: They're preying on desperation. People are desperate to have better
22:07
Speaker 2: sex lives and they will then to get better sex
22:10
Speaker 2: lives to anyone that will offer it, right? And so,
22:13
Speaker 2: I felt like, okay, this is gonna be my, what
22:15
Speaker 2: I give back to the world, is I'm gonna educate
22:17
Speaker 2: them on how to help them have better sex, have
22:20
Speaker 2: a better life, feel better, feel stronger. And it just was,
22:25
Speaker 2: after six months, I was like, oh, I have a
22:26
Speaker 2: thousand subscribers, that's it, I'm gonna keep going. And I
22:29
Speaker 2: felt like I was famous back then. I was like,
22:31
Speaker 2: this is great. And then I just kept going and
22:34
Speaker 2: I'm still so grateful that people tune in to me
22:37
Speaker 2: like every week and, you know, and learn from me,
22:40
Speaker 2: and it's so motivating, and it's really amazing to be
22:43
Speaker 2: able to reach that many people.
22:45
Speaker 1: Well, congratulations on all the success. You've done an amazing
22:50
Speaker 1: job with it. I mean, I'm curious. I mean, do
22:52
Speaker 1: you get any backlash about some of the topics that
22:55
Speaker 1: you cover?
22:55
Speaker 2: Of course. Of course. I mean, I think a lot
22:59
Speaker 2: of backlash comes from things like that people feel very
23:03
Speaker 2: passionate about and they feel like they know because of
23:06
Speaker 2: their personal experience. And what I really, and I'll give
23:09
Speaker 2: you some examples, but what I really want people to
23:11
Speaker 2: realize is like, I'm not trying to invalidate your experience.
23:13
Speaker 2: I'm just telling you what the science is and, you know,
23:17
Speaker 2: your life's experience is your life experience. So for example,
23:20
Speaker 2: semen retention is something people feel very passionate about. The people,
23:23
Speaker 2: semen retention is the practice of abstaining from any form
23:26
Speaker 2: of ejaculation, whether it's through a partner or through masturbation.
23:31
Speaker 2: And people, and I started like sort of known at November,
23:33
Speaker 2: and I was like, oh, let me just debunk this.
23:35
Speaker 2: Because I was seeing patients who would try to abstain,
23:38
Speaker 2: and when they did, they would tense up their pelvic floors,
23:41
Speaker 2: which is like these muscles sitting here in our pelvis
23:44
Speaker 2: that hold our organs up. And then because of that,
23:47
Speaker 2: they would start having other problems. They would start either
23:50
Speaker 2: having pain with erections or ejaculation. They would start having
23:53
Speaker 2: the need to go to the bathroom more often, or
23:55
Speaker 2: they'd get constipated. And it was because they were like
23:59
Speaker 2: white knuckling, trying to hold back, trying not to ejaculate.
24:03
Speaker 2: And it was causing them harm. And they were stressed, right?
24:05
Speaker 2: They were super, they felt like failures when they did.
24:07
Speaker 2: They were unhappy. They were feeling bad about themselves. And
24:12
Speaker 2: they were like, oh, I can't do this. I'm struggling.
24:14
Speaker 2: I'm a failure. And so I wanted to target those
24:17
Speaker 2: people who felt like, oh, I need to do this
24:19
Speaker 2: because people are telling me it's so great. And I'm like, look,
24:22
Speaker 2: it may be great for some people, and it may
24:25
Speaker 2: make you feel better, it may make you more able
24:27
Speaker 2: to focus on things or have more brain clarity, but
24:31
Speaker 2: that's an individual experience, and it's very nuanced. So, I
24:35
Speaker 2: wanted to give people who felt this sort of, like,
24:38
Speaker 2: failure or felt this sort of stress or anxiety around
24:41
Speaker 2: it to not feel that, right? Like, not feel like
24:43
Speaker 2: they had to do this to achieve some higher being.
24:47
Speaker 1: What, I mean, how did that even... How did that even... What's...
24:51
Speaker 1: What's the myth? Like, what do you supposedly get out
24:54
Speaker 1: of No Nut November?
24:55
Speaker 2: So, No Nut November was actually, like, came from a meme, right? Like,
24:59
Speaker 2: somebody was like, oh, No Nut November, we're going to
25:01
Speaker 2: start No Nut November on November 1st, and like, by midnight, oh,
25:04
Speaker 2: I failed already, right? And then, but it took off.
25:07
Speaker 2: But semen retention as a practice is actually like a
25:10
Speaker 2: Buddhist Taoist practice that, and there's some religious or spiritual
25:16
Speaker 2: background behind it. People felt that if they would abstain
25:19
Speaker 2: from ejaculation, that they would be able to focus more
25:23
Speaker 2: on spirituality, on God, or a higher power, and they
25:27
Speaker 2: wouldn't be distracted by desire and urges for sex. And
25:32
Speaker 2: so that's sort of where it came from. And from that,
25:36
Speaker 2: they would think they would get all these health benefits,
25:38
Speaker 2: like they would get this brain clarity, they would get
25:40
Speaker 2: testosterone boosting, it would improve fertility, like all these things.
25:44
Speaker 2: But the reality is those things have been looked at
25:46
Speaker 2: scientifically and there has been no true meaningful increase in
25:51
Speaker 2: testosterone or fertility. In fact, if you abstain for too long,
25:53
Speaker 2: you can harm your fertility. And so I think the
25:57
Speaker 2: reality is, is there a physiologic benefit? Not that we
26:00
Speaker 2: see right now based on the evidence that we have.
26:04
Speaker 2: But if you see a psychological benefit, by all means,
26:07
Speaker 2: please go ahead. But just don't make other people feel
26:10
Speaker 2: like they have to do that because everyone is different
26:13
Speaker 2: and they're ejaculating or being intimate with their partner or
26:19
Speaker 2: masturbating may be a really valuable part of their lives
26:21
Speaker 2: that now they feel like they have to give up
26:23
Speaker 2: on because they hear something that they think is like, oh,
26:26
Speaker 2: this is so much better for me to do this.
26:28
Speaker 1: Man, it just seems like something that would cause a
26:30
Speaker 1: lot of sexual frustration and that would, you know, be
26:36
Speaker 1: amplified during the month as the month goes on.
26:39
Speaker 2: I mean, the thing is, like, some people, what happens
26:41
Speaker 2: is when you abstain, you stop, like, you may be
26:44
Speaker 2: able to, like, particularly for people who are very... fixated
26:48
Speaker 2: on sex, they may be able to then, like, once
26:50
Speaker 2: they get over that hump, they may then, oh, I'm
26:52
Speaker 2: more focused on other things. I'm more, I don't think
26:55
Speaker 2: about that anymore. Like, the desire will naturally go down
26:57
Speaker 2: after some period of time because you've now, like, overcome
27:01
Speaker 2: that constant urge. And that may lead to more productivity
27:04
Speaker 2: or more happiness or more joy in some people. But
27:08
Speaker 2: it's not everybody, right? And I think it's, like, very individual.
27:11
Speaker 1: But, I mean, wouldn't the body just take care of itself?
27:14
Speaker 2: It does.
27:15
Speaker 1: I mean, I mean... Would a man just store up
27:19
Speaker 1: all of that semen for a month?
27:20
Speaker 2: No. So what happens is either you're going to have
27:23
Speaker 2: a wet dream, so you're going to have a nocturnal emission.
27:25
Speaker 2: And so then that was the other thing. People would
27:26
Speaker 2: have wet dreams. They'd be like, oh my God, I failed.
27:28
Speaker 2: And it's like, no, you can't even control that. Like
27:30
Speaker 2: you are asleep and it's normal and healthy. Like your
27:33
Speaker 2: body is just taking care of itself. Or they would
27:36
Speaker 2: just absorb it. Like their body absorbs it and your
27:38
Speaker 2: body's constantly making more semen, right? It's just like, it's
27:41
Speaker 2: constantly doing that. So- or sperm specifically, but it's making
27:46
Speaker 2: more all the time. And so there is no, it's
27:49
Speaker 2: not like the actual semen itself has some powerful properties.
27:53
Speaker 2: It's really just like dealing with, I think, the mental
27:57
Speaker 2: aspect of it.
27:58
Speaker 1: Interesting. Interesting. Let's move into, actually, before we move on,
28:03
Speaker 1: are there any other viral trends that you've kind of Yeah.
28:08
Speaker 2: So there was one on TikTok for a while. There
28:10
Speaker 2: was a lot of people talking about what's called jelking.
28:13
Speaker 2: What is it called? Jelking.
28:15
Speaker 1: Jelking.
28:16
Speaker 2: Yeah, which is like this practice to increase penile length.
28:19
Speaker 2: And so, it's like you make an O with the
28:22
Speaker 2: OK sign with your finger and you actually like sort
28:26
Speaker 2: of slowly extend the length of the penis over time.
28:28
Speaker 2: This is exercises, stretching exercises, essentially. And so, we were like, oh,
28:32
Speaker 2: I did this and I increased my penile length and
28:33
Speaker 2: it was great. And so, they were talking about this
28:35
Speaker 2: a lot. And actually, that sounds very safe, right? Like, oh,
28:40
Speaker 2: I'm just stretching. Like, what's the big deal? But sometimes,
28:43
Speaker 2: and you can probably relate, is most men, when you
28:45
Speaker 2: tell them to do something, they don't just do it.
28:47
Speaker 2: They want to do it the best, right? And so
28:49
Speaker 2: they're like, you don't just, you tell someone to do
28:52
Speaker 2: something that might improve their life, they're not going to
28:54
Speaker 2: just do it. They're going to go 10x and do
28:56
Speaker 2: it even more, right? And so, there's actually some people
28:58
Speaker 2: who would come into the urologist because they've been doing this. And,
29:01
Speaker 2: you know, my colleagues have talked to me. It's even
29:04
Speaker 2: in some published data. People would jelk and they would
29:07
Speaker 2: come in and they would develop erectile dysfunction because they've
29:09
Speaker 2: now damaged their penis. And that's not necessarily reversible. And so, it's,
29:16
Speaker 2: you know, it's like there are ways to safely lengthen potentially,
29:20
Speaker 2: but jelking is not one of them.
29:22
Speaker 1: What are the ways?
29:23
Speaker 2: So the safest way for length is a traction device.
29:26
Speaker 2: So you can buy traction devices online. These are sort
29:30
Speaker 2: of devices that slowly extend your penis with a little
29:33
Speaker 2: bit of pressure over time. And they are meant to
29:37
Speaker 2: be very minimal pressure, tension over time. So there are
29:42
Speaker 2: some that you will use for six hours a day
29:44
Speaker 2: and go to sleep with them. There's some that you
29:46
Speaker 2: can get that you can do 30 minutes twice a day,
29:48
Speaker 2: but they are a commitment, right? You have to be
29:50
Speaker 2: doing it a lot. And then they do work. And
29:54
Speaker 2: they've been shown to increase penile length by about two centimeters.
29:57
Speaker 2: When you've done it for- Two centimeters? Yeah. For prolonged
30:01
Speaker 2: periods of time, for months on end, then you will
30:03
Speaker 2: see an increase. And that's on average, right? So some
30:06
Speaker 2: may see a little more, some may see a little less,
30:08
Speaker 2: but that's generally what they've seen in the studies. And so, yeah,
30:12
Speaker 2: I think there are ways to do it, but it's
30:13
Speaker 2: a commitment, right? You have to be disciplined. You have
30:15
Speaker 2: to keep doing it. And is that what you really
30:17
Speaker 2: want to spend your time doing, right? And that's fine
30:19
Speaker 2: if you do. No judgment, by all means, you know.
30:22
Speaker 2: But I think that that's just, that's probably the safest. Now,
30:25
Speaker 2: there's other things that are available. There's surgical options. There's,
30:30
Speaker 2: you know, those are, there's, you know, well, basically surgical
30:34
Speaker 2: options are available to lengthen and enhance girth. Girth, probably
30:39
Speaker 2: the safest, is to do fillers. Like, women get fillers
30:43
Speaker 2: on their face. There's the same sort of hyaluronic acid
30:45
Speaker 2: fillers that you can get injected into the penis. But
30:47
Speaker 2: they don't last forever. They're like 18 months or so
30:49
Speaker 2: and they'll dissolve. So, there are options.
30:53
Speaker 1: Is that safe?
30:54
Speaker 2: You know, we don't have a ton of data, but, like,
30:57
Speaker 2: I wouldn't inject anything else. So, there are, like, permanent fillers.
31:00
Speaker 2: People have, like, in jail, have injected all sorts of
31:03
Speaker 2: things in their penis. Like, so, you know, like... all
31:06
Speaker 2: sorts of things, which please don't inject your penis with anything.
31:10
Speaker 2: But if you're going to, if you are very intent
31:13
Speaker 2: on doing it and you've sort of talked to your
31:15
Speaker 2: doctor about it and you know it's not like a
31:17
Speaker 2: psychological issue that needs attention from a psychologist, because there
31:21
Speaker 2: is what we call small penis anxiety, right? People who
31:24
Speaker 2: really feel body dysmorphia, like there's something wrong with them.
31:27
Speaker 2: And that requires, not requires, but should have attention from
31:31
Speaker 2: a psychologist so you can work on your thoughts around it. But,
31:34
Speaker 2: you know, if you don't have a dysmorphia and you
31:35
Speaker 2: just want a bigger penis, like, I think that's the
31:38
Speaker 2: safest option in terms of an intervention. There are some,
31:43
Speaker 2: you know, people who will use vacuum erection devices or
31:46
Speaker 2: penis pumps. There's no evidence in the literature that this
31:49
Speaker 2: actually results in enhanced girth, but some people report that
31:52
Speaker 2: they notice that. Again, I think it's all temporary when
31:55
Speaker 2: you're using these traction devices and pumps. Like, I don't
31:58
Speaker 2: know that you're going to have a lasting effect, but
32:00
Speaker 2: I don't know. We haven't looked at it in the
32:01
Speaker 2: long term in terms of, like, scientific data. It's only anecdotes,
32:05
Speaker 2: like what patients tell us and what we see. So
32:08
Speaker 2: I think ultimately, like, I wish. I wish there was
32:12
Speaker 2: a way, right? Like, women can enhance their breasts, they
32:14
Speaker 2: can get breast augmentations, but men still don't have that option, right,
32:17
Speaker 2: to enhance their genitalia if they really want to in a, like,
32:21
Speaker 2: a permanent, meaningful way yet, in a very safe way.
32:25
Speaker 2: And I wish we had it, because I think men,
32:27
Speaker 2: just like women, should have that option if they want it, right?
32:30
Speaker 2: But at this time, like, you have one penis, it
32:33
Speaker 2: is very important, and if something happens to it, now
32:36
Speaker 2: you're stuck with that complication. And so... I just think
32:40
Speaker 2: it's really important to think about that before you proceed
32:43
Speaker 2: with anything that's irreversible.
32:45
Speaker 1: Now, I mean, I wanted to cover this later on,
32:48
Speaker 1: but we'll just do it right now since we're on
32:49
Speaker 1: the subject. I mean, size. Does size matter?
32:53
Speaker 2: Yeah, so this comes up all the time, right? Because
32:55
Speaker 2: we are in a society where size is revered, right? Like,
32:59
Speaker 2: you will see people joking about it. You will see...
33:01
Speaker 2: I mean, even my... My children will joke about their
33:04
Speaker 2: penis size and their prepubescent boys, right? Like, where did
33:07
Speaker 2: they learn this from? We don't talk about it at home. Like,
33:09
Speaker 2: they learned it from their peers. So this is something
33:12
Speaker 2: that's pervasive, right? People automatically assume bigger is better. The
33:17
Speaker 2: reality is, when you look at the data, people overestimate
33:20
Speaker 2: what average is. So they think average is like six
33:23
Speaker 2: inches erect. Average is more like 5.1 to 5.6 inches,
33:29
Speaker 2: depending on the study you look at. That's erect, not flaccid.
33:33
Speaker 2: And then, you know, so fine, average is overestimated. We're
33:36
Speaker 2: really bad as human beings at estimating. So when you
33:39
Speaker 2: actually look at people who, you know, you show them,
33:42
Speaker 2: like this is a five-inch penis, this is a six-inch penis,
33:45
Speaker 2: this is a seven-inch penis, what are you estimating? So
33:48
Speaker 2: when you have like an average size penis, they tend
33:50
Speaker 2: to overestimate the size. They think it's like six or
33:53
Speaker 2: seven inches, six inches. And then when you have a
33:56
Speaker 2: slightly smaller than average penis, you tend to underestimate And
34:00
Speaker 2: when it's bigger, you tend to overestimate. So we're just
34:02
Speaker 2: really bad at one estimating. And when you, and a
34:05
Speaker 2: lot of men will measure their phallus and you know,
34:08
Speaker 2: it's so variable. How warm is it in the room?
34:11
Speaker 2: Like what, you know, how aroused are you in that moment?
34:14
Speaker 2: Like if you're more aroused, you might be a little bit,
34:16
Speaker 2: tiny bit longer, tiny bit girthier. Right. And so it's
34:18
Speaker 2: so variable that like, it's hard to say like, okay,
34:22
Speaker 2: this is my number. Like this is how big I am. Right.
34:25
Speaker 2: And then it's so in terms of like pleasure, right?
34:28
Speaker 2: Because I think that's what God thinks. Oh, if I
34:29
Speaker 2: have a bigger penis, I will more easily be able
34:32
Speaker 2: to get my partner to orgasm. It will feel better
34:34
Speaker 2: for her in a heterosexual relationship. And the reality is
34:38
Speaker 2: that's not necessarily true. Like, of course, there are women
34:41
Speaker 2: who prefer longer penises. They enjoy stimulation, deep stimulation during sex,
34:46
Speaker 2: but that's not the majority. I would say 85% of
34:50
Speaker 2: women need clitoral stimulation and the clitoris is above the urethra.
34:54
Speaker 2: It's the area that is very sensitive. It is the
34:56
Speaker 2: homologue of the penis. So it is essentially exactly the same.
35:01
Speaker 2: If you like cut open a cadaver and you look
35:03
Speaker 2: at the anatomy of the clitoris and the penis, the
35:06
Speaker 2: clitoris and the penis look identical. The clitoris is just
35:08
Speaker 2: smaller and internal, whereas the penis is external. So if
35:12
Speaker 2: you stimulate the clitoris, you will reliably reach orgasm in
35:16
Speaker 2: the majority of women. And that doesn't require a penis necessarily, right?
35:21
Speaker 2: You can do that with your hand, with your mouth,
35:23
Speaker 2: with a toy, with a whole bunch of different things,
35:26
Speaker 2: and not necessarily from penetration. Now, yes, will you be
35:31
Speaker 2: stimulating the clitoris when you penetrate? Yes, to some degree,
35:34
Speaker 2: because the clitoris is above the urethra. And so indirectly,
35:38
Speaker 2: you'll be stimulating it. And some women, like I said,
35:40
Speaker 2: the anatomy is variable. So some women may orgasm more
35:43
Speaker 2: easily just through penetration alone. But the large majority of
35:46
Speaker 2: women need either penetration and clitoral stimulation or just clitoral
35:50
Speaker 2: stimulation to climax. And so the reality is that size
35:54
Speaker 2: is not necessary for pleasure. Size is not necessary for
35:57
Speaker 2: a good orgasm. And it is something that we have
36:00
Speaker 2: just made into this big thing. And if you ask women,
36:05
Speaker 2: like when you do surveys of women, 85% of them
36:07
Speaker 2: are like, I'm happy with my partner's size and I'm
36:09
Speaker 2: totally fine with it. And it's like 45% of men
36:12
Speaker 2: who feel like they're satisfied with their size. So it's
36:15
Speaker 2: a big dichotomy because we've made it to feel like
36:19
Speaker 2: it's so linked to masculinity or the ability to provide pleasure,
36:24
Speaker 2: but the reality is not so much. And when you
36:27
Speaker 2: look at even anatomy for women, the vaginal length before
36:31
Speaker 2: it's engorged and aroused is about three to three and
36:34
Speaker 2: a half inches. So if you think about it, like
36:36
Speaker 2: if you're really large, you can't even really penetrate the
36:39
Speaker 2: entire vaginal length. And so there's actually products that you
36:42
Speaker 2: can wear, like buffers, so that you don't hurt your
36:44
Speaker 2: partner when you have sex with them if you're a
36:46
Speaker 2: little bit larger than they are. And so it's sort
36:50
Speaker 2: of like a fit, right? Some people have a longer vagina.
36:54
Speaker 2: They may enjoy a longer penis. But again, it's not universal, right?
36:58
Speaker 2: It's not universal.
36:59
Speaker 1: What about girth?
37:01
Speaker 2: Yeah, so girth, again, I think girth is because the
37:05
Speaker 2: clitoris goes deep into the pelvis and it goes around
37:08
Speaker 2: the vagina. There's like the clitoral bulbs and the legs
37:10
Speaker 2: of the clitoris. So when you have a little more girth,
37:13
Speaker 2: it can stimulate more of the clitoris, right? You're not
37:15
Speaker 2: just focusing on the top. You're also getting the side
37:18
Speaker 2: of it. So it can be helpful, absolutely, to be
37:20
Speaker 2: more girthy. But there's a limit. So in fact, this
37:24
Speaker 2: actually came out from people who do female-to-male surgery. When
37:29
Speaker 2: they were building phalluses, they realized that they were making
37:32
Speaker 2: them too girthy. And it was actually difficult to have sex.
37:36
Speaker 2: So they actually had to look at what kind of
37:39
Speaker 2: sex toys women are buying to decide what was the
37:42
Speaker 2: right size for the majority of women. Because they were like, oh,
37:45
Speaker 2: we were just making them too big. And now this
37:48
Speaker 2: person who wants a penis is not able to use
37:51
Speaker 2: it because it's too big for the partner to accommodate it.
37:54
Speaker 2: And so really, it's like, if you look at what
37:56
Speaker 2: type of sex toys women buy, they buy a little
37:59
Speaker 2: bit longer than average. and the same girth as average,
38:02
Speaker 2: which is, you know, about five inches or so. So,
38:06
Speaker 2: it's very similar to the average guy. They're not buying
38:09
Speaker 2: those really obscenely large sex toys. Like, it's just not,
38:13
Speaker 2: I mean, they might for a gag gift or something,
38:15
Speaker 2: but most women are not using those to pleasure themselves.
38:19
Speaker 2: And so, that doesn't necessarily, meaning you don't really need
38:21
Speaker 2: a lot more than average to pleasure a woman.
38:24
Speaker 1: What is average girth?
38:26
Speaker 2: Average girth is about four to five inches around.
38:29
Speaker 1: Okay.
38:30
Speaker 2: Yeah.
38:30
Speaker 1: Okay.
38:31
Speaker 2: Yeah.
38:32
Speaker 1: Wow. Interesting. Interesting stuff. So I wanted to, you know,
38:38
Speaker 1: erectile dysfunction. I mean, you see all the drug ads
38:40
Speaker 1: we see. I mean, it's, it's everywhere. What are, what
38:44
Speaker 1: are some myths about erectile dysfunction?
38:48
Speaker 2: Oh, there's so many. I would start with like, I
38:51
Speaker 2: think that the first time a man has an issue
38:54
Speaker 2: with an erection, he feels like it's over. Right. And
38:58
Speaker 2: the reality is there is normal fluctuation. There are times
39:01
Speaker 2: where you will struggle to get an erection because we
39:04
Speaker 2: are not static human beings. You are not machines, right?
39:07
Speaker 2: You are people. And so you will feel stressed or
39:10
Speaker 2: anxious or Or maybe you won't feel well that day.
39:14
Speaker 2: Or maybe you had a really stressful day and your
39:16
Speaker 2: testosterone is lower than another day, right? All these things
39:19
Speaker 2: can play a role and you might have trouble getting
39:22
Speaker 2: an erection that day. It doesn't mean you're broken. It
39:24
Speaker 2: doesn't mean that you're doomed for a life of erectile dysfunction,
39:28
Speaker 2: but it often happens. plays out that way because the
39:31
Speaker 2: second a guy has an issue with an erection in
39:33
Speaker 2: the bedroom, the next time he's having sex, he's thinking
39:36
Speaker 2: about that. He's not enjoying himself. He's not thinking about, wow,
39:39
Speaker 2: this is so hot and I'm having the best time
39:41
Speaker 2: of my life. He's thinking, oh my God, am I
39:42
Speaker 2: going to have an erection? Is it going to last?
39:45
Speaker 2: Is it going to go away? And so you can't
39:47
Speaker 2: be mindful and present and enjoy pleasure because you're obsessing
39:50
Speaker 2: over this. And it becomes this vicious cycle. So I
39:54
Speaker 2: tell all guys, all my patients, like you may have
39:57
Speaker 2: a medical reason that you're having trouble with erections, but
40:00
Speaker 2: every single guy also has problems thinking about erections. Every guy.
40:05
Speaker 2: Every guy who has a problem with erections also has
40:08
Speaker 2: a mental issue because they're thinking about it, right? And
40:11
Speaker 2: women do too. It's not just men. Like, women are like, oh,
40:13
Speaker 2: if I can't climax this one time, am I not
40:14
Speaker 2: going to be able to climax the next time, right?
40:16
Speaker 2: They're thinking about it too, but I think We see
40:19
Speaker 2: it very often, men, because if you can't get an erection,
40:22
Speaker 2: it's very visible. Like it's not happening, something's wrong, right?
40:26
Speaker 2: And the reaction is often like, oh, the partner might
40:28
Speaker 2: be like, is something wrong with me? So now there's
40:30
Speaker 2: like a little bit of relationship conflict. And so there's
40:33
Speaker 2: all these things compounded and it makes it very difficult
40:37
Speaker 2: to get out of. And so I think that's one
40:40
Speaker 2: of the biggest ones is that. And then two is
40:42
Speaker 2: that I did mention testosterone, but testosterone is not always
40:45
Speaker 2: the cause. In fact, it's only the cause. Low testosterone
40:48
Speaker 2: causes erectile dysfunction about 3% to 6% of the time.
40:50
Speaker 1: That's it?
40:52
Speaker 2: So it may be a part of it, but it's
40:53
Speaker 2: not the only cause.
40:54
Speaker 1: Wow. Only in 3% to 6% of the time, it's
40:58
Speaker 1: a testosterone deficiency.
40:59
Speaker 2: Correct. Correct. Interesting. more often it's vascular problems. So high cholesterol,
41:04
Speaker 2: high blood pressure, diabetes, all these things play a role.
41:08
Speaker 2: And I will see very, very healthy looking men whose
41:12
Speaker 2: cholesterol is off the charts. And I will say, look,
41:15
Speaker 2: this is what's likely causing your erectile dysfunction. And we
41:19
Speaker 2: can investigate further, but it behooves you to improve your cholesterol.
41:23
Speaker 2: And so I think it's also a really important sign
41:26
Speaker 2: of your health. And people don't realize this. They think
41:28
Speaker 2: sexual health is like this thing we put in the
41:30
Speaker 2: box and we don't think about. But oftentimes, you will
41:33
Speaker 2: see problems with your sexual health long before you see
41:36
Speaker 2: them anywhere else in your body. And the reason is
41:39
Speaker 2: the blood vessels to the penis are significantly smaller than
41:42
Speaker 2: about half the size of the blood vessels to the heart.
41:45
Speaker 2: So before you have a heart attack, you're going to
41:46
Speaker 2: see erectile dysfunction. And in fact, we've seen that, that
41:50
Speaker 2: when a man has an issue with erections, within seven years,
41:54
Speaker 2: 15% of those guys will have a heart attack. wow
41:57
Speaker 2: and so it's an opportunity for men if you start
42:00
Speaker 2: having trouble this is a wake-up call for you to
42:03
Speaker 2: get your whole health evaluated make sure that you're optimizing
42:07
Speaker 2: your heart health your brain health before you get a
42:09
Speaker 2: stroke right like all these things that in the long
42:12
Speaker 2: term will have you not having the life you want
42:15
Speaker 2: to live right because if we think about sex we
42:18
Speaker 2: want to live well but we also want to have
42:20
Speaker 2: sex throughout our lives right and if you start having
42:23
Speaker 2: issues like you have and now you get winded just
42:27
Speaker 2: walking a couple blocks right down the street. Like, you're
42:30
Speaker 2: not gonna have sex. Like, you're gonna be exhausted. And so,
42:33
Speaker 2: all of these things play a role. And so, I
42:36
Speaker 2: find that anytime you think there's a problem with your
42:38
Speaker 2: sex life, that's an opportunity for you to get evaluated, right?
42:43
Speaker 2: To figure out what's going on so that you can
42:46
Speaker 2: fix that part of your life. And before it becomes
42:49
Speaker 2: a problem.
42:50
Speaker 1: And with, I'm sorry, within how many years? Just 15%?
42:53
Speaker 2: Seven.
42:54
Speaker 1: Seven years. So it's a early warning system.
42:58
Speaker 2: Yeah. We call it the canary in the coal mine.
43:00
Speaker 2: It's like that warning sign.
43:02
Speaker 1: Wow. And then, I mean, with erectile dysfunction, I mean,
43:06
Speaker 1: does that mean there is zero erection?
43:11
Speaker 2: No. So the definition is that you're having trouble either
43:16
Speaker 2: maintaining or getting an erection that's sufficient for intercourse. So
43:20
Speaker 2: either you lose the erection before you penetrate or you
43:22
Speaker 2: can't climax because you're not reaching it soon enough and
43:27
Speaker 2: you lose your erection before that. Sometimes people get it confused.
43:31
Speaker 2: They'll think like, oh, I ejaculate very quickly, so it's
43:35
Speaker 2: erectile dysfunction. That's actually premature ejaculation. It's treated very differently.
43:40
Speaker 2: And so it's important like when you go to your
43:42
Speaker 2: doctor to explain those things because what sometimes guys will
43:45
Speaker 2: come in and they'll say, My erection's not working, right?
43:49
Speaker 2: And so I will dig deeper, but sometimes if you
43:52
Speaker 2: go to your primary care doctor, they may not, right?
43:54
Speaker 2: And that may be the only doctor you have access to.
43:56
Speaker 2: And so if you say, I'm not having trouble, I can't,
43:58
Speaker 2: my erections are not working, they'll give you a prescription
44:01
Speaker 2: and you'll be on your way, but that prescription's not
44:03
Speaker 2: gonna fix the issue if it's an ejaculation issue.
44:06
Speaker 1: Interesting. I mean, how do you determine if it is
44:13
Speaker 1: a psychological issue, whether that be reptile dysfunction or premature
44:18
Speaker 1: ejaculation or anything I'm not thinking of. How do you
44:23
Speaker 1: determine whether it's an actual, something's going on with the
44:26
Speaker 1: body versus a psychological issue where you freaked yourself out
44:31
Speaker 1: and now you have performance anxiety?
44:35
Speaker 2: One is talk to the person, right? Like first I'll
44:37
Speaker 2: talk to them, be like, okay, what's happening when you're
44:39
Speaker 2: by yourself, right? Like do you get erections at night?
44:42
Speaker 2: Do you wake up in the morning with erections? Because
44:44
Speaker 2: that's a sign that things are all working well, right?
44:46
Speaker 2: When you wake up in the morning with an erection,
44:48
Speaker 2: that tells me, hey, your hormones are working, your blood
44:50
Speaker 2: flow is working, all that stuff is pretty good probably, right?
44:53
Speaker 2: Because your body's doing it when there's no stressor around, right?
44:56
Speaker 2: It's just like you're sleeping, Your body's functioning normally. You
44:59
Speaker 2: get about three to five erections at night. And so,
45:02
Speaker 2: and you usually wake up with one. And so that's
45:04
Speaker 2: a sign that things are working okay. There are like
45:07
Speaker 2: tests that you can do. There's even wearables that you
45:09
Speaker 2: can buy to do that. But like you pretty much- Wearables?
45:11
Speaker 2: There's wearables that are now on the market. You can
45:13
Speaker 2: wear like a ring around your penis that will measure
45:16
Speaker 2: how many erections you get at night, how long they
45:18
Speaker 2: last and how firm they get. And they'll give you data.
45:21
Speaker 2: But at the end of the day, I think some
45:23
Speaker 2: people really like that because they want data. They like
45:26
Speaker 2: to know those things. But at the end of the day,
45:28
Speaker 2: if things are functioning well and you're happy and you're
45:31
Speaker 2: getting morning erections and your partner's happy, I wouldn't stress
45:33
Speaker 2: about it. It's when you start feeling like, okay, things
45:36
Speaker 2: are not going well. Okay, am I getting nighttime erections?
45:38
Speaker 2: That's one, waking up with one. Two, if I masturbate,
45:43
Speaker 2: is it working fine? And sometimes that's like your masturbation
45:46
Speaker 2: is different, but there's no pressure when you masturbate. You're
45:49
Speaker 2: not worried that you're your partner might feel some way
45:52
Speaker 2: or whatever. Like there's no anxiety typically around masturbation unless
45:57
Speaker 2: you feel shame about it, which is a whole different thing.
46:00
Speaker 2: So usually that's another way. Third way is we can
46:02
Speaker 2: do what's called penile Doppler ultrasound testing. So we can actually,
46:07
Speaker 2: we check the blood flow to the penis. So we'll
46:10
Speaker 2: actually give you an artificial erection with a medication and
46:13
Speaker 2: we'll actually then test to see how fast the blood
46:16
Speaker 2: is flowing in and how quickly it's leaving. And we
46:18
Speaker 2: have markers to say what's normal and what's not. And
46:21
Speaker 2: so those are tests that we can do to be definitive, like, yes,
46:25
Speaker 2: the blood flow part is working. Now, the hormone part,
46:28
Speaker 2: we check with blood work, we check if your testosterone
46:30
Speaker 2: is normal, if your free testosterone is normal, all those things.
46:33
Speaker 2: And there's other hormone markers that we'll check as well
46:35
Speaker 2: if they're low to make sure they're not playing a role.
46:38
Speaker 2: And so those are things we can evaluate pretty well.
46:41
Speaker 2: Beyond that, like I said, I think everyone has a
46:44
Speaker 2: little degree of psychological component to it.
46:48
Speaker 1: Now, how do you... How do patients get over their
46:51
Speaker 1: psychological anxieties?
46:53
Speaker 2: Yeah, so it's difficult. I'm not gonna say it's easy.
46:56
Speaker 2: You know, I encourage them if they are willing to
46:59
Speaker 2: talk to a sex therapist or even a therapist that
47:02
Speaker 2: has some, you know, openness about talking about sex. Because
47:05
Speaker 2: it's really dealing with your thoughts and kind of working
47:08
Speaker 2: with those. And like, especially in the moment, right? When
47:11
Speaker 2: you're with your partner. So it can be like doing
47:13
Speaker 2: mindfulness exercises. So there's been studies on mindfulness that like
47:17
Speaker 2: if you do 20 minutes of mindfulness every day, you're
47:20
Speaker 2: more present in the bedroom. So you have more enjoyable
47:22
Speaker 2: sex because you're able to like really pay attention to
47:25
Speaker 2: what's going on rather than getting lost in your own thoughts.
47:29
Speaker 2: And I think just being present in general, like cultivating,
47:32
Speaker 2: I think the other thing about sex in modern day
47:34
Speaker 2: is like, it's rushed. It's like, we're busy with our kids.
47:36
Speaker 2: We're busy with work. We're busy with that. And then
47:38
Speaker 2: we're like, okay, we got five minutes. Like, let's go.
47:41
Speaker 2: And there's no, like, you haven't actually made it feel desirable.
47:45
Speaker 2: There's like another checkbox to do, right? And so it's like,
47:48
Speaker 2: actually like, hey, like, When you were younger, you used
47:50
Speaker 2: to like, you know, be like, oh, I can't wait
47:52
Speaker 2: to see you on your date. You'd call each other,
47:53
Speaker 2: you'd text each other, whatever, you know, whatever it was.
47:56
Speaker 2: And you'd be excited to like see your partner and
47:58
Speaker 2: like potentially have sex with them. And there was like
48:01
Speaker 2: this whole thing, like you just felt so excited about it.
48:04
Speaker 2: But when you're in longer term relationships and the stressors
48:06
Speaker 2: of life come along, we often just are like, ah, well,
48:09
Speaker 2: we'll do it when we get to it. We will
48:10
Speaker 2: have sex, like it'll happen. You're always there, right? And
48:13
Speaker 2: so it's like, you have to be like intentional about
48:15
Speaker 2: cultivating desire. You have to be like, hey, does that
48:19
Speaker 2: foreplay starts in the morning? Like with a caress on
48:22
Speaker 2: the back or like a flirty text or whatever, right?
48:26
Speaker 2: Whatever floats your boat and like feeling in the moment,
48:29
Speaker 2: like excited. And I often tell people, instead of date
48:32
Speaker 2: night where you go out to eat dinner, like have
48:34
Speaker 2: intimacy night where you like are intimate together. You, you
48:37
Speaker 2: hold each other, you lie together, you, you explore each
48:40
Speaker 2: other's body, depending on what, what turns you on. Right.
48:43
Speaker 2: But you actually make that a priority because it is
48:46
Speaker 2: valuable being connected with another human being. People who have
48:50
Speaker 2: more sex actually live longer. And I think partially it's
48:53
Speaker 2: because of that connection they're getting with another human being. Um,
48:57
Speaker 2: And so, you know, it's really important. That is so,
49:01
Speaker 2: and we're losing connection so much with, like, AI and
49:05
Speaker 2: the internet and all these other things. Like, we have
49:07
Speaker 2: to be intentional about keeping that.
49:11
Speaker 1: I mean, how much, you know, we're talking about, you're
49:14
Speaker 1: saying people that have more sex live longer. How much
49:19
Speaker 1: sex should we be having? How many times a week
49:23
Speaker 1: should men be ejaculating?
49:25
Speaker 2: Yeah. So there's science behind this and I'll give you
49:28
Speaker 2: some data on that. So first of all, when you
49:29
Speaker 2: look at living longer, right? People who have sex 52
49:34
Speaker 2: times a year, so that's once a week, have lived longer,
49:37
Speaker 2: have lower heart disease, have better health outcomes than people
49:40
Speaker 2: who have sex less often than that. So we know
49:43
Speaker 2: that for a fact. And if you have, so a
49:46
Speaker 2: lot of veterans struggle with mental health, so they have depression, anxiety,
49:49
Speaker 2: people who have depression, anxiety, and have sex more often,
49:53
Speaker 2: they actually don't, they do better in terms of their
49:57
Speaker 2: mental health as well as living longer. So like you
50:00
Speaker 2: might actually be improving your mental health as well as
50:03
Speaker 2: living longer. And so there's evidence at least once a week, right?
50:07
Speaker 2: And then in terms of how often should you ejaculate,
50:09
Speaker 2: there's a very famous study where they had looked at
50:12
Speaker 2: ejaculation frequency and the risk of prostate cancer. And so
50:16
Speaker 2: they looked at databases where people filled out how often
50:18
Speaker 2: they ejaculated in the last month and they put them
50:21
Speaker 2: into categories. So it was like zero to four, four
50:24
Speaker 2: to seven, seven to 14, 14 to 21, and more
50:26
Speaker 2: than 21. So what they found was that the guys
50:29
Speaker 2: who ejaculated 21 times or more a month, they didn't
50:32
Speaker 2: specify through sex or masturbation, but they did more than
50:35
Speaker 2: 21 times a month, had a lower risk of prostate cancer. Now,
50:39
Speaker 2: is it the ejaculation?
50:40
Speaker 1: Say those numbers again.
50:41
Speaker 2: More than 21 times a month had a lower risk
50:44
Speaker 2: of prostate cancer. Now, is it the actual active ejaculation?
50:49
Speaker 1: Is it.
50:50
Speaker 2: I mean, there's some theories that, like, if you're ejaculating,
50:52
Speaker 2: you're sort of cleaning the pipes, right? Like, you're getting
50:55
Speaker 2: any stagnant fluid that might be in your prostate, you're
50:58
Speaker 2: getting that taken out. And so that may be beneficial. Now,
51:01
Speaker 2: I can't say for sure, because there's not really a
51:03
Speaker 2: good way to test that. But basically, what I tell
51:05
Speaker 2: people is, like, have sex, masturbate, enjoy pleasure. Enjoy connection
51:10
Speaker 2: with another human being and enjoy pleasure. Because for some people,
51:13
Speaker 2: masturbation is the only way they're going to get pleasure.
51:15
Speaker 2: They don't have a partner or they don't have someone
51:17
Speaker 2: they can have sex with. So I don't want to
51:18
Speaker 2: take that away from them either, right? And I think
51:20
Speaker 2: that those things are important for people to feel good.
51:25
Speaker 2: And there's so much value to having orgasms, like physiologically, right?
51:30
Speaker 2: Your heart rate goes down, your blood pressure goes down.
51:32
Speaker 2: Some people sleep better. Some people have post-nut clarity and
51:35
Speaker 2: they feel like much better after they orgasm. And so
51:38
Speaker 2: I think that, you know, it is something that we
51:41
Speaker 2: need to look at as like a tool potentially to
51:44
Speaker 2: live better, you know, to have a healthier life, to
51:47
Speaker 2: be connected with another human being, to feel good, to
51:50
Speaker 2: feel pleasure. And I say this often, sex is play
51:53
Speaker 2: and we don't play as adults. So like play, enjoy life,
51:57
Speaker 2: be creative, have fun and enjoy sex. Like why is
52:01
Speaker 2: this something we have to like hide behind a corner.
52:04
Speaker 2: It shouldn't be. It should be something that we just, like,
52:07
Speaker 2: openly welcome. And we should be able to talk about
52:11
Speaker 2: sex and be able to express our concerns, our insecurities,
52:15
Speaker 2: and be open with... The idea of being vulnerable, right,
52:20
Speaker 2: with another partner, with someone else, is really powerful because,
52:24
Speaker 2: To have great sex, you have to be vulnerable. You
52:26
Speaker 2: are naked in front of another person. Literally, physically and mentally,
52:30
Speaker 2: you are naked in front of them. And so you
52:32
Speaker 2: need to be able to be vulnerable and allow yourself
52:36
Speaker 2: to be vulnerable to truly experience meaningful pleasure. And so
52:40
Speaker 2: many people are so guarded and sex is like just
52:44
Speaker 2: this thing you do, right? For a quick release. But
52:48
Speaker 2: it's actually so much.
52:49
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54:20
Speaker 1: and time again, people defending themselves, defending their family, and
54:25
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Speaker 1: right now to uscca.com slash SRS. Is there, I mean,
55:55
Speaker 1: are there any studies on whether you're ejaculating with a
56:00
Speaker 1: partner versus masturbation? Is one better than another?
56:03
Speaker 2: Well, in terms of how your brain responds, so there
56:06
Speaker 2: are certain nerve endings on our body that can only
56:10
Speaker 2: be stimulated by another human being, that are caressed in
56:13
Speaker 2: a certain frequency, which is usually like a loving caress.
56:17
Speaker 2: That is what turns those nerve endings on. And so
56:19
Speaker 2: that turns on different areas of your brain. So it
56:22
Speaker 2: will stimulate more of your brain. So you will likely
56:24
Speaker 2: have more pleasure and a higher sort of response to that.
56:29
Speaker 2: So in terms of like experiencing pleasure, it will be,
56:32
Speaker 2: probably more intense and more enjoyable with another partner compared
56:36
Speaker 2: to by yourself. But it certainly is, you still can
56:41
Speaker 2: enjoy pleasure by yourself. The challenge, I think, by doing
56:44
Speaker 2: it by yourself is, I'll go back to the example
56:46
Speaker 2: of like when you're a kid and like you're worried,
56:49
Speaker 2: like you're in the shower or you're in your bedroom
56:51
Speaker 2: and you're like, oh my God, someone's gonna walk in
56:53
Speaker 2: or someone's gonna be like, why are you in the
56:54
Speaker 2: shower so long? And so you learn to rush through
56:57
Speaker 2: masturbation and it becomes this just like quick thing to
57:00
Speaker 2: get a release. it's not a time to actually enjoy pleasure, right?
57:04
Speaker 2: And so I think that's where, you know, it's okay
57:07
Speaker 2: to explore your body and to feel pleasure by yourself. And, like,
57:10
Speaker 2: allowing that and using it as a tool to, like,
57:12
Speaker 2: learn about yourself. Like, what turns me on? What makes
57:15
Speaker 2: me feel good? I think particularly for women, it can
57:17
Speaker 2: be very useful in learning which sort of stimulation works
57:21
Speaker 2: well for you. And then you can communicate that with
57:23
Speaker 2: a partner. And also like exploring more than just your genitals.
57:27
Speaker 2: Like your whole body can be an erogenous zone, right?
57:29
Speaker 2: You can stimulate anywhere on the body and almost anywhere
57:32
Speaker 2: on the body and someone can get turned on. So
57:35
Speaker 2: it's really like, okay, like we can use this. We
57:38
Speaker 2: can stimulate multiple areas of someone's body and have them
57:42
Speaker 2: feel an amazing pleasure that if you just focus on
57:44
Speaker 2: genitals is not gonna be as robust.
57:48
Speaker 1: Interesting, interesting. I mean, let's go back to the implants
57:56
Speaker 1: or penile, is that what you call it?
57:59
Speaker 2: Penile implants, yeah.
58:00
Speaker 1: Implants. I mean, are there a lot of people doing this?
58:03
Speaker 2: Yeah, I mean, so I will say erectile dysfunction is
58:06
Speaker 2: very common. 50% of men over 50 will have erectile
58:10
Speaker 2: dysfunction and every decade that increases by about 10%. So
58:14
Speaker 2: you can imagine there's a lot of guys struggling Now,
58:17
Speaker 2: because of medications like sildenafil or tadalafil, known as Viagrancialis,
58:22
Speaker 2: those medications help a lot of guys get erections without
58:25
Speaker 2: needing surgery. But before these medications were around, we didn't
58:28
Speaker 2: have much. We had vacuum erection devices, which are sort
58:33
Speaker 2: of similar to penis pumps, but they are medical grade.
58:36
Speaker 2: We have injections that you give yourself in the penis
58:39
Speaker 2: that work quite well, but like some guys don't wanna
58:42
Speaker 2: inject their penis, which is reasonable. And then we have surgeries.
58:45
Speaker 2: And so typically, guys will go through these options. And
58:48
Speaker 2: then if they still can't get an erection, a penile
58:51
Speaker 2: option is a great option for them. And so what
58:53
Speaker 2: that is, is we actually implant a device into the penis,
58:57
Speaker 2: which they then either pump up with a pump in
58:59
Speaker 2: the scrotum when they want to have an erection, and
59:02
Speaker 2: they deflate it when they're done. Wait a minute.
59:04
Speaker 1: They do what? They pump it up?
59:05
Speaker 2: They pump it. It's got a little pump. I should've
59:07
Speaker 2: brought one with me, but there's a little pump. You
59:09
Speaker 2: pump it up, and then you get an erection. And
59:12
Speaker 2: then when you're done.
59:13
Speaker 1: It's inside your scrotum?
59:14
Speaker 2: Inside your scrotum, yeah. And you can't really tell. I mean, like,
59:17
Speaker 2: it looks sort of like there's a little something there, right? But, like,
59:20
Speaker 2: it doesn't... You can't really tell that someone has a
59:23
Speaker 2: penile implant. Like, in fact, in medicine, like, we'll get consulted, like, oh,
59:27
Speaker 2: this guy has a... what we call a priapus, an
59:29
Speaker 2: erection that won't go away. And sometimes it'll be like, oh,
59:31
Speaker 2: the guy just has an implant. So even other doctors
59:35
Speaker 2: sometimes don't notice it is my point. But so it's
59:39
Speaker 2: very hideable, you don't need to know. And then there's
59:41
Speaker 2: other ones where you implant it and you just bend
59:44
Speaker 2: it up and bend it down. So when you wanna
59:46
Speaker 2: have an erection, you bend it up and otherwise you
59:48
Speaker 2: bend it down. So there's options. They don't make you
59:51
Speaker 2: larger or girthier. They give you what you have. So
59:54
Speaker 2: if you were to, like, grab your penis and pull it,
59:57
Speaker 2: that's how long it's gonna be. It's not gonna be longer.
59:59
Speaker 2: It's not gonna make you, you know, it's not gonna
1:00:00
Speaker 2: make you, like, superhuman in terms of length or girth.
1:00:03
Speaker 2: But it's gonna give you function so that you can
1:00:06
Speaker 2: have sex and you can get a rigid erection when
1:00:09
Speaker 2: you want to. And so I would say that it
1:00:11
Speaker 2: is a transformative surgery for a lot of guys who
1:00:14
Speaker 2: have been struggling and can't get an erection and want
1:00:17
Speaker 2: to be able to get one and their partner wants
1:00:20
Speaker 2: to be able to have penetrative sex. Is it mandatory?
1:00:23
Speaker 1: No.
1:00:23
Speaker 2: You can obviously pleasure your partner with many different ways.
1:00:26
Speaker 2: It doesn't need to be an erect phallus, but a
1:00:29
Speaker 2: lot of people enjoy that, want that, and it's a
1:00:31
Speaker 2: great option for them.
1:00:33
Speaker 1: What is the difference between Viagra and Cialis?
1:00:37
Speaker 2: So, they are both what we call PDE5 inhibitors. They
1:00:40
Speaker 2: work by the same mechanism. Essentially, when you think about
1:00:42
Speaker 2: an erection, there is an ignition called nitric oxide, which
1:00:46
Speaker 2: then causes, and that usually comes from stimulation. Like you
1:00:49
Speaker 2: see something, hear something, feel something, turns you on, your
1:00:52
Speaker 2: nerves and your vessels release nitric oxide. Then that causes
1:00:56
Speaker 2: blood to flow into the penis and then it stays there, right?
1:00:59
Speaker 2: And that's the erection. And then it goes down and
1:01:03
Speaker 2: blood flow leaves the penis and the erection goes down.
1:01:05
Speaker 2: And so during that process, one of the enzymes that
1:01:09
Speaker 2: will break down, right, and cause the blood flow to leave,
1:01:13
Speaker 2: these medications prevent that breakdown. And so that's how they work.
1:01:17
Speaker 2: And they work similarly, but they are slightly different. So
1:01:19
Speaker 2: when you think about sildenafil, which is Viagra, vanafil or vardenafil,
1:01:24
Speaker 2: which is Levitra and Stendra, those medications, they all work short-acting.
1:01:30
Speaker 2: So meaning you take one about an hour before sex,
1:01:33
Speaker 2: You need stimulation. Like I said, the nitric oxide has
1:01:36
Speaker 2: to come from some stimulation for them to work and
1:01:38
Speaker 2: you get an erection. Works in about 60 to 70%
1:01:40
Speaker 2: of guys. It does require that you don't eat with
1:01:44
Speaker 2: the medication. So sometimes people will eat a big meal
1:01:47
Speaker 2: and they're like, oh, it didn't work, but I got
1:01:48
Speaker 2: these side effects. So they get side effects like headaches, flushing,
1:01:51
Speaker 2: stuffy nose, those sorts of things. But it does work
1:01:55
Speaker 2: in a lot of guys. It allows them to have
1:01:57
Speaker 2: erections and have sex. Now, Tadalafil is slightly different because
1:02:02
Speaker 2: it has a longer half-life. So you can take this
1:02:05
Speaker 2: medication with food, which is nice for some people who
1:02:07
Speaker 2: like to have sex in the evening or, you know,
1:02:09
Speaker 2: they have dinner before, and they can then take this
1:02:13
Speaker 2: medication and it works, but it lasts longer. So it
1:02:16
Speaker 2: can last for 36 hours. Meaning that if you take
1:02:19
Speaker 2: it on a Friday and you want to have sex
1:02:21
Speaker 2: on a Saturday or Sunday, like you're still good to go,
1:02:23
Speaker 2: which is nice for a lot of people. You can
1:02:25
Speaker 2: also take a low dose every single day. So five
1:02:28
Speaker 2: milligrams of Cialis, because it lasts so long, you can
1:02:30
Speaker 2: take a low dose every single day. And I really
1:02:33
Speaker 2: like using that because it takes the psychological stress out
1:02:35
Speaker 2: of it. Like, oh, I have to remember to take
1:02:37
Speaker 2: this pill. I got to do this. I got to
1:02:38
Speaker 2: do that. You just sort of take the pill every
1:02:41
Speaker 2: day and then you're good to go. to have sex
1:02:44
Speaker 2: when you want to, right? For most people where it
1:02:46
Speaker 2: works well. Now, again, these medications are not 100% effective.
1:02:50
Speaker 2: Every medication that you take in your life will have
1:02:52
Speaker 2: some degree of, you know, inefficacy. But they help a
1:02:56
Speaker 2: lot of guys be able to get good blood flow
1:02:59
Speaker 2: to their penis and have erections and have sex.
1:03:03
Speaker 1: Is there any long-term effects if somebody is using that
1:03:08
Speaker 1: that may necessarily, you know, they don't necessarily need that?
1:03:12
Speaker 2: Yeah, I mean, I think in terms of law, there's
1:03:14
Speaker 2: obviously rare things that people will say like nosebleeds or
1:03:19
Speaker 2: things like that that are very rare, right? With Viagra,
1:03:22
Speaker 2: there are some receptors in the eye that are similar
1:03:26
Speaker 2: to the receptors that they work on. And so some
1:03:29
Speaker 2: people get blue-green vision discoloration and it can cause vision changes.
1:03:33
Speaker 2: So if you ever notice anything with your vision, you've
1:03:36
Speaker 2: got to stop those medications. The other risk is if
1:03:39
Speaker 2: you're taking a medication called nitroglycerin or something you put
1:03:42
Speaker 2: under your tongue before you have chest pain. If you
1:03:45
Speaker 2: take both those together, it can lower your blood pressure
1:03:47
Speaker 2: to dangerous, almost like deadly levels. So those are the
1:03:50
Speaker 2: two big contraindications. But for most people, these are very safe,
1:03:54
Speaker 2: very effective. And to doubtful, there's some actually early data
1:03:58
Speaker 2: and it's not like mainstream, but that it might improve
1:04:01
Speaker 2: heart health. So they looked at like how it's taken
1:04:04
Speaker 2: in people who have and they've seen actually an improvement
1:04:07
Speaker 2: in outcomes. And even with muscle health, they're seeing like
1:04:11
Speaker 2: blood flow to the muscles being better. And it's also
1:04:14
Speaker 2: great for guys who have an enlarged prostate because it
1:04:15
Speaker 2: can relax the prostate and allow you to pee better.
1:04:18
Speaker 2: So there's a lot of benefits. In fact, I just
1:04:20
Speaker 2: saw a study on women taking Tadalafil to help with
1:04:24
Speaker 2: overactive bladder. Now, I don't, you know, it's still very early. Again,
1:04:27
Speaker 2: this is not prime time. This is like early data.
1:04:30
Speaker 2: But I feel like there's a lot of benefit because
1:04:31
Speaker 2: ultimately with something like Tadalafil daily, you're increasing blood flow
1:04:34
Speaker 2: throughout the body. So you're actually not just seeing benefits
1:04:37
Speaker 2: of the genitals, you may be seeing benefits elsewhere. And
1:04:40
Speaker 2: that could potentially be beneficial. Now, we don't, you know,
1:04:45
Speaker 2: these medications have been around for a long time and
1:04:47
Speaker 2: we haven't seen any terrible long-term sequelae. Now, could there
1:04:51
Speaker 2: be in the future, potentially? I don't, you know, I
1:04:53
Speaker 2: don't have a future, like, but Viagra's been around for
1:04:56
Speaker 2: a long time. And Cialis has been around for a
1:04:59
Speaker 2: good amount of time as well. And people have taken
1:05:01
Speaker 2: it for decades without issue.
1:05:04
Speaker 1: So, I mean, would it be in Ben's best interest to,
1:05:09
Speaker 1: I mean, it sounds like there's a lot of other
1:05:11
Speaker 1: benefits other than sex health. And so, I mean, would
1:05:14
Speaker 1: it be beneficial for men to be on five milligrams
1:05:19
Speaker 1: of Cialis every day?
1:05:20
Speaker 2: You know, I can't say that every guy should be
1:05:23
Speaker 2: on it, right? I do think there are benefits. And
1:05:25
Speaker 2: I do think that if you have any sort of
1:05:28
Speaker 2: struggle with erections, that I think that being on it
1:05:31
Speaker 2: is is going to benefit you in more ways than
1:05:36
Speaker 2: just sexual function. And so I do recommend it for
1:05:39
Speaker 2: almost all my patients to be on it because I
1:05:41
Speaker 2: think there's more benefits than just sexual health. Do I
1:05:44
Speaker 2: think a normal healthy guy should be on it? It's
1:05:46
Speaker 2: hard to say yet if I think there's like a
1:05:49
Speaker 2: long-term longevity life benefit for it. If I had to
1:05:53
Speaker 2: put money on it, yeah, probably there would be, but
1:05:56
Speaker 2: no one's studying that specifically. And so, yeah, I think
1:05:59
Speaker 2: maybe there might be a long-term benefit for being on it,
1:06:02
Speaker 2: but we don't really know yet.
1:06:03
Speaker 1: Okay. What is the average length time-wise in sexual intercourse?
1:06:11
Speaker 2: Yeah, so this always surprises people. And in fact, even
1:06:13
Speaker 2: my own friend got surprised by this, who's a urologist.
1:06:16
Speaker 2: So when you look at the data, and they actually
1:06:18
Speaker 2: look at people having sex, and what they do is
1:06:20
Speaker 2: they tell people, take a stopwatch, they give it to
1:06:22
Speaker 2: the female partner, You say, start the stopwatch when you
1:06:25
Speaker 2: start penetration, turn off the stopwatch when you stop penetration.
1:06:28
Speaker 2: I did this around multiple countries and they found that
1:06:31
Speaker 2: the average length is about five to six minutes. So
1:06:35
Speaker 2: a lot shorter than most people think and a lot
1:06:37
Speaker 2: shorter than you're seeing on erotic films, right? And so
1:06:41
Speaker 2: that's the reality is that that's average. Now, if you
1:06:43
Speaker 2: look country to country, some countries are a little bit longer,
1:06:45
Speaker 2: some countries are a little bit shorter. For example, UK
1:06:48
Speaker 2: was longer, Turkey was shorter in the study that was done.
1:06:51
Speaker 2: But ultimately, that's the average length that a man will
1:06:54
Speaker 2: last during sex. Now, does that mean that there aren't guys,
1:06:58
Speaker 2: of course there's guys who last longer, and of course
1:07:00
Speaker 2: there's guys who ejaculate more rapidly. Now, what does that mean, right?
1:07:04
Speaker 2: So actually, interestingly, If you look at mammals who ejaculate, right,
1:07:08
Speaker 2: they all ejaculate rapidly. There's no, like, pleasure or enjoyment.
1:07:12
Speaker 2: It's really, like, for the purposes of having a baby
1:07:16
Speaker 2: or procreating. And so they quickly, you know, they get
1:07:18
Speaker 2: done quickly because it prevents, like, one, they won't get
1:07:22
Speaker 2: caught by a predator. Two, there's competition. They're first, right?
1:07:26
Speaker 2: So the next competition can't come and, like, get in
1:07:29
Speaker 2: the way, right? And so there's actually an evolutionary advantage
1:07:32
Speaker 2: for mammals who ejaculate sooner. In humans, it's different, right?
1:07:37
Speaker 2: The ejaculation length and pleasure, we actually continue to have
1:07:40
Speaker 2: sex long after fertility is an issue, right? Long after
1:07:44
Speaker 2: women past fertile ages, people continue to have sex because
1:07:48
Speaker 2: it's pleasurable. And so this idea of lasting longer, obviously, again,
1:07:53
Speaker 2: another thing that society is like, oh, it's so great,
1:07:56
Speaker 2: you wanna have sex forever. But I also see guys
1:07:59
Speaker 2: who have what we call delayed ejaculation. So they take
1:08:02
Speaker 2: longer than 30 minutes to ejaculate And while that's less common,
1:08:06
Speaker 2: it definitely happens. And those guys are stressed too, because
1:08:09
Speaker 2: it's like exhausting. It's like, there's so much friction. It
1:08:12
Speaker 2: becomes uncomfortable for their partner. It becomes uncomfortable for them.
1:08:15
Speaker 2: They're working so hard. And like, it's no longer fun.
1:08:19
Speaker 2: And so what I tell people is like, it's not
1:08:21
Speaker 2: about fixating on how long you last. It's like, are
1:08:23
Speaker 2: you enjoying yourself? Is your partner satisfied? And the reality
1:08:27
Speaker 2: is that women take a lot longer to get aroused
1:08:30
Speaker 2: and to get to climax. So women, on average, take
1:08:33
Speaker 2: about 14 minutes with their partner to reach climax. It's
1:08:38
Speaker 2: less when they masturbate, like eight minutes. But again, men
1:08:41
Speaker 2: take about five to six minutes. So you realize that
1:08:43
Speaker 2: you have to prioritize female pleasure if you want her
1:08:46
Speaker 2: to climax because she's going to take longer. It's also
1:08:48
Speaker 2: going to take her longer to get aroused. And so really,
1:08:52
Speaker 2: that's where the difference lies. And so it's really like
1:08:55
Speaker 2: figuring that out for you and your partner, like how
1:08:57
Speaker 2: do we work together so that everyone achieves pleasure and
1:09:00
Speaker 2: that we're having a good time? Because the time that
1:09:03
Speaker 2: it takes is not the issue. It's like, how much
1:09:05
Speaker 2: pleasure can you get from having sex and how do
1:09:09
Speaker 2: we maximize that?
1:09:10
Speaker 1: Wow. So, that's a pretty big, uh... I don't know
1:09:14
Speaker 1: if you'd call it a discrepancy from five minutes to
1:09:17
Speaker 1: 14 minutes, so... I mean, what do you recommend?
1:09:20
Speaker 2: Yeah, so I recommend that you start by, you know,
1:09:23
Speaker 2: first of all, make sure your partner's aroused. This is
1:09:25
Speaker 2: the thing. I think women take a lot longer to
1:09:27
Speaker 2: get aroused. They also take a lot longer to be
1:09:29
Speaker 2: present in the moment, right? They ruminate about a lot
1:09:33
Speaker 2: of things. And when they're younger, it's about body image
1:09:35
Speaker 2: and insecurities. And that can evolve. Women become more confident
1:09:38
Speaker 2: in their bodies as they age. But then it's like
1:09:40
Speaker 2: all the other things in their life that they're stressed about,
1:09:42
Speaker 2: their kids, their parents, whatever, like whatever they're dealing with
1:09:44
Speaker 2: in their life. And they have a hard time shutting
1:09:47
Speaker 2: that off. And so one, it's like getting them in
1:09:49
Speaker 2: the mood, like spending time with them, enjoying, like allowing
1:09:54
Speaker 2: them to feel desire and to feel arousal. So what
1:09:57
Speaker 2: happens a lot of times with both men and women,
1:10:00
Speaker 2: but more often with women, is they get what's called
1:10:02
Speaker 2: responsive desire. So when you're younger, you think, you see
1:10:06
Speaker 2: your partner, you're like, damn, they're so hot, we want
1:10:08
Speaker 2: to have sex, right? You're turned on immediately, like there's
1:10:10
Speaker 2: no need to do anything. You're just like, you see
1:10:12
Speaker 2: each other and you're turned on, you want to have sex,
1:10:14
Speaker 2: that's it. But as you're with a partner for a
1:10:16
Speaker 2: long period of time, or as you evolve in life
1:10:19
Speaker 2: and you're busier and you're more stressed or whatever, you
1:10:22
Speaker 2: get what's called responsive desire. So you actually need to
1:10:26
Speaker 2: be aroused a little bit before you start feeling desire.
1:10:29
Speaker 2: So you're like, oh, it's like going to the gym.
1:10:31
Speaker 2: You don't really want to go until you're there. And
1:10:32
Speaker 2: then we're like, oh, thank God I went to the gym.
1:10:33
Speaker 2: I feel great. So it's sort of like, yeah, I
1:10:36
Speaker 2: didn't really want to have sex. But now that I'm
1:10:38
Speaker 2: turned on, like, oh, there's the desire. Oh, I remember.
1:10:40
Speaker 2: I like this. This is really fun. And so it's
1:10:43
Speaker 2: not an abnormal thing. It's actually a completely normal brain response, right?
1:10:47
Speaker 2: That you sometimes need to get your head in the
1:10:50
Speaker 2: right place and allow desire, right? Allow like some arousal
1:10:55
Speaker 2: to happen. And so that's why I love, like I said,
1:10:57
Speaker 2: intimacy time, like hold each other, be together, be physical,
1:11:01
Speaker 2: touch each other, whatever. I mean, obviously everyone's not into touch,
1:11:04
Speaker 2: but like figure out what it is that gets you
1:11:06
Speaker 2: turned on and allow it to happen, right? in a
1:11:09
Speaker 2: mutually consensual way. And that's why, like, sometimes it's like, hey,
1:11:13
Speaker 2: let's have this night where we're gonna do this, right?
1:11:15
Speaker 2: Let's actually give each other the time where we're not
1:11:17
Speaker 2: looking at our phones, where we're not, like, distracted or
1:11:20
Speaker 2: thinking about something else. We're just focused on each other.
1:11:23
Speaker 2: I mean, thinking about it before, phones, right? You're lying
1:11:26
Speaker 2: in bed, there's nothing to do. You're like, okay, well,
1:11:29
Speaker 2: I'm bored, let's have sex, right? You're right next to me,
1:11:32
Speaker 2: and your body's right here, and like, oh, this feels
1:11:34
Speaker 2: warm and nice and cozy, and you would have sex
1:11:36
Speaker 2: with your partner. And now it's like, well, you have
1:11:38
Speaker 2: something else really exciting to look at that has like,
1:11:42
Speaker 2: so much interesting information and whatever you're interested in in
1:11:45
Speaker 2: the moment, you can read about it or watch it
1:11:47
Speaker 2: or whatever. And so you're like doing that until you're
1:11:49
Speaker 2: dead and you're like, I'm so tired. And you fall asleep,
1:11:51
Speaker 2: you put your phone on, you go to sleep, right?
1:11:53
Speaker 2: And so like, there's just like, there's not as many opportunities, right?
1:11:57
Speaker 2: Because now there's so much more to distract you than
1:12:00
Speaker 2: there was before. So we have to work a little harder.
1:12:03
Speaker 2: So that's one, is like making sure that they are
1:12:05
Speaker 2: in the moment. But two, prioritizing foreplay. and actually spending
1:12:11
Speaker 2: time getting them aroused because it's not that they need like,
1:12:15
Speaker 2: like I mentioned earlier, penetration is not necessarily how they're
1:12:19
Speaker 2: gonna climax. It's gonna be clitoral stimulation and sometimes both,
1:12:22
Speaker 2: but you need to sort of focus on foreplay and
1:12:25
Speaker 2: making sure they feel pleasure and feel that desire turning
1:12:30
Speaker 2: on the ramp up to, I mean, everyone can relate
1:12:32
Speaker 2: to this ramp, right? You feel like your turn on
1:12:34
Speaker 2: it goes up and up and up until you climax.
1:12:36
Speaker 2: And so you're trying to get them to get up
1:12:39
Speaker 2: that ramp a little before you do, so that they
1:12:41
Speaker 2: can get there, and then you both can sort of
1:12:43
Speaker 2: try to climax around the same time, or she can
1:12:45
Speaker 2: climax before you. Either way, um, you know, it allows
1:12:49
Speaker 2: you to then, to make sure that you both are
1:12:52
Speaker 2: feeling great pleasure.
1:12:54
Speaker 1: I mean, so, we were just talking about, you know,
1:12:57
Speaker 1: average length of sex, you know, and how long, you know,
1:13:01
Speaker 1: on average men last versus women, and... You know, is
1:13:06
Speaker 1: there a, I mean, what is too long?
1:13:09
Speaker 2: Well, again, too long is how long is too long
1:13:11
Speaker 2: for you and your partner. So, like, some people are like,
1:13:13
Speaker 2: they're fine with however long, right? Even some people who
1:13:17
Speaker 2: have very short sexual encounters and they love it. And
1:13:19
Speaker 2: there are people who have long sexual encounters and they
1:13:22
Speaker 2: love it. It really is bother. That's the key. Like,
1:13:25
Speaker 2: are you or your partner bothered? Does it cause distress
1:13:28
Speaker 2: or relationship conflict or issues? If it doesn't, who cares, right?
1:13:33
Speaker 2: Like just be yourself and enjoy each other as long
1:13:36
Speaker 2: as you are both having a good time or if
1:13:38
Speaker 2: there's more than one person, more than two people in
1:13:40
Speaker 2: the bedroom, if you're all having a good time, like
1:13:42
Speaker 2: by all means, continue doing that. That's fine. It's when
1:13:45
Speaker 2: there is a loss of pleasure, distress that we need
1:13:48
Speaker 2: to worry and then we can talk about how to
1:13:50
Speaker 2: fix it, right? Even if you don't like... meet some
1:13:52
Speaker 2: clinical definition, but you're like, this is too long or
1:13:55
Speaker 2: too short. Like, let's talk about it because we can
1:13:57
Speaker 2: sort of help you figure out what's going on. Maybe
1:13:59
Speaker 2: there's a psychological issue. Maybe there's a medical issue. Regardless,
1:14:03
Speaker 2: it's all things that we can work with you on.
1:14:08
Speaker 1: Thank you. Thank you for that. Banda, there's just so
1:14:12
Speaker 1: many questions that are coming to my mind, but I mean,
1:14:16
Speaker 1: when we talk about, you know, I saw a video,
1:14:19
Speaker 1: I didn't watch this one yet, but it was, I
1:14:21
Speaker 1: believe it was something about, you know, what females find attractive.
1:14:24
Speaker 2: Yeah.
1:14:26
Speaker 1: What do females find attractive? Yeah, interesting.
1:14:28
Speaker 2: A lot of people think it's like tall men, right? Physically,
1:14:31
Speaker 2: I'm saying, not like emotionally necessarily. But it's all this
1:14:35
Speaker 2: idea of like, oh, women all want taller. Now, that's
1:14:38
Speaker 2: true that height matters. But what actually matters is, at
1:14:41
Speaker 2: least in the data that I found, was that strength.
1:14:44
Speaker 2: So the display of upper body strength is very attractive
1:14:48
Speaker 2: to women. And this makes sense evolutionarily, right? Where you
1:14:51
Speaker 2: would need to maybe fight for resources or you need
1:14:53
Speaker 2: someone to protect yourself. Having somebody who is stronger is
1:14:57
Speaker 2: more likely to, one, protect you, and two, also get
1:15:00
Speaker 2: those resources that you would need, right? And so evolution,
1:15:03
Speaker 2: it makes sense. that when you see someone who's very
1:15:06
Speaker 2: developed in their upper extremities or their upper body, that
1:15:08
Speaker 2: you would feel like that's the right partner who can
1:15:11
Speaker 2: protect me and who can also get resources for me.
1:15:14
Speaker 2: And so that's one. And the other one is like
1:15:15
Speaker 2: having sort of a V shape. So your shoulders are
1:15:17
Speaker 2: broader than your waist. And that's not only showing, you know,
1:15:21
Speaker 2: obviously upper body strength, but it's also showing metabolic health, right?
1:15:24
Speaker 2: So if you have a smaller waist and you have
1:15:26
Speaker 2: less visceral fat around your abdomen, you are more metabolically healthy,
1:15:30
Speaker 2: which means that you probably have better genes that you're
1:15:32
Speaker 2: then going to pass on to your children that you
1:15:35
Speaker 2: might have with this person, right? And so there's actually
1:15:37
Speaker 2: reasons why women find certain things attractive. Now, height, if
1:15:42
Speaker 2: you look at like the data, they'll say like, 70%
1:15:45
Speaker 2: of when you ask women like, okay, what's important? 70%
1:15:49
Speaker 2: of that attraction quota is the strength. And then if
1:15:53
Speaker 2: you add another 10%, it'll go up to 80% if
1:15:56
Speaker 2: they're tall. So they'd rather have like an average height
1:16:00
Speaker 2: strong guy than a tall, not strong guy. Does that
1:16:04
Speaker 2: make sense? And so like, it's really about like how
1:16:08
Speaker 2: you portray this strength and health through the visual eye, right?
1:16:13
Speaker 2: Like what they're seeing. And interestingly, this is obviously more
1:16:16
Speaker 2: important when you're just trying to hook up with somebody.
1:16:20
Speaker 2: But when you start looking at long-term partners, that still matters,
1:16:23
Speaker 2: but then it becomes also like, are they kind? Are
1:16:27
Speaker 2: they going to stick around and be with you and
1:16:30
Speaker 2: be the right kind of honest person that you can
1:16:36
Speaker 2: depend on and they can be reliable? So that becomes
1:16:39
Speaker 2: also part of the picture when you're looking at a
1:16:41
Speaker 2: long-term partner.
1:16:43
Speaker 1: Anything with the penis?
1:16:46
Speaker 2: I mean, you can't, like, I think you can't see specifically, right,
1:16:50
Speaker 2: when you're first courting someone. They're not, like, walking around naked.
1:16:55
Speaker 2: So you can't utilize that. And I think that, like
1:16:58
Speaker 2: I said, most people, as long as they're feeling pleasured
1:17:02
Speaker 2: by their partner, the size of the penis matters less.
1:17:05
Speaker 2: And that's true even in the data. Like I said,
1:17:08
Speaker 2: there are some women, like maybe... 10 to 15% and
1:17:12
Speaker 2: based on the data that are very focused on penile length.
1:17:16
Speaker 2: And that may be because of like, they may really develop, uh,
1:17:20
Speaker 2: they may really enjoy like deep penetration. Cause that stimulation
1:17:23
Speaker 2: may lead to orgasm from cervical stimulation. And some women
1:17:27
Speaker 2: actually find that painful, but some women actually really like that.
1:17:30
Speaker 2: And so they may really enjoy that feeling and that
1:17:32
Speaker 2: may allow them to feel pleasure. And in those cases,
1:17:35
Speaker 2: like that just might not be a right fit for you, right?
1:17:37
Speaker 2: If that person is like, I need a really, a
1:17:40
Speaker 2: guy who is really well endowed, well, more power to you.
1:17:43
Speaker 2: We're not the right fit.
1:17:44
Speaker 1: Right?
1:17:45
Speaker 2: Because I can't give that to you. I mean, unless
1:17:47
Speaker 2: you feel comfortable like wearing a strap on or do something, right?
1:17:49
Speaker 2: But like for most people, like that's not going to
1:17:51
Speaker 2: be the right fit. And look, we don't fit with
1:17:55
Speaker 2: people because of personalities, because of a variety of things.
1:17:57
Speaker 2: And so it's okay if sometimes it doesn't fit because
1:18:00
Speaker 2: of genitalia, right? But it's like, that doesn't mean that
1:18:04
Speaker 2: there's something wrong with you. It just means that that's
1:18:05
Speaker 2: not a fit, right? And there's going to be another
1:18:07
Speaker 2: person where that is a fit. And so that's okay, right?
1:18:11
Speaker 2: It's just like anything else. There are things that you
1:18:13
Speaker 2: need in a partner that they may not meet that
1:18:16
Speaker 2: criteria and they may not be the right person because
1:18:18
Speaker 2: that's a deal breaker. And there's other things where you
1:18:20
Speaker 2: can compromise on those things. And the same goes for sex.
1:18:23
Speaker 1: What about, let's move into some other sexual activities, oral sex.
1:18:29
Speaker 1: I mean, I've read I don't know if any of
1:18:33
Speaker 1: this is factual, but I mean, I've read that there
1:18:35
Speaker 1: are supposedly some type of health benefits for females to
1:18:40
Speaker 1: consume semen. Is there any truth to that?
1:18:43
Speaker 2: Yeah, there's not a ton. So there's, you know, if
1:18:46
Speaker 2: you actually look at the nutritional value of semen, it's
1:18:48
Speaker 2: like very little. So, like, it's, like, very much, yes,
1:18:52
Speaker 2: there is some protein, yes, there are some vitamins and
1:18:55
Speaker 2: minerals and stuff in semen, but, like, is it a,
1:18:57
Speaker 2: it's not any, it's not, like, the equivalent of a multivitamin, right? Like,
1:19:02
Speaker 2: significantly less. But there's no harm either. So, like, if
1:19:05
Speaker 2: you enjoy that and your partner enjoys that, by all means,
1:19:07
Speaker 2: go ahead. but you don't need to like make semen
1:19:09
Speaker 2: smoothies or like other, you know, other. Come on, you know,
1:19:15
Speaker 2: you've seen those videos. But like, you don't need to
1:19:18
Speaker 2: do that, right? Like if you enjoy that, if some
1:19:21
Speaker 2: people like have kinks and fetishes, they have a cum kink, right?
1:19:24
Speaker 2: And they enjoy that. That's fine. Great. By all means, like,
1:19:27
Speaker 2: that's you. Like, I don't want to yuck anyone's yum,
1:19:29
Speaker 2: but like, it's not necessary.
1:19:33
Speaker 1: What about, you know, semen volumizers or people that are
1:19:37
Speaker 1: trying to, you know, increase the load.
1:19:40
Speaker 2: Yeah. So again, I think that that comes a lot
1:19:43
Speaker 2: from erotic films, pornography, right? Like they see these people
1:19:47
Speaker 2: having very large voluminous loads and the partner in the
1:19:51
Speaker 2: video is like, oh my God, right? Like it's just
1:19:53
Speaker 2: like this amazing thing. And so the reality is that
1:19:55
Speaker 2: the amount that comes out is really small. It's like
1:19:57
Speaker 2: a tablespoon, right? If you look at the average amount
1:20:00
Speaker 2: and we've actually done this, right? Because we do for fertility,
1:20:02
Speaker 2: you actually measure When you get a semen analysis, you
1:20:05
Speaker 2: measure how much comes out. So there's an abundance of
1:20:07
Speaker 2: data on semen volume because of that sort of research.
1:20:11
Speaker 2: And the average is about a tablespoon, like five mLs,
1:20:14
Speaker 2: five to 10. And so it's not a lot. And
1:20:18
Speaker 2: so when you think about what you're seeing on these films,
1:20:20
Speaker 2: oftentimes it's very augmented through like video, right? Video editing, video,
1:20:26
Speaker 2: other things that are being exploded like around the genitals
1:20:29
Speaker 2: that look like it's coming from the penis. So that's one.
1:20:33
Speaker 2: Two is it's variable through age, right? And there's force variability.
1:20:37
Speaker 2: So when you're younger, you have very robust pelvic floor muscles.
1:20:41
Speaker 2: And pelvic floor muscles are the muscles that sit in
1:20:43
Speaker 2: the pelvis that are responsible for so many different functions.
1:20:46
Speaker 2: But one of the functions that they're responsible for is
1:20:49
Speaker 2: they contract when you have an orgasm. And they contract
1:20:52
Speaker 2: at like a rhythmic, like 0.8 seconds. And they give
1:20:56
Speaker 2: you that pulsing feeling when you have an orgasm. They
1:20:58
Speaker 2: also help you propel semen forward. And so when they're strong,
1:21:03
Speaker 2: like when you're young and healthy, they will propel up
1:21:06
Speaker 2: to like 15 to 30 centimeters. So pretty far, they
1:21:09
Speaker 2: can propel pretty far. And that can look more voluminous, right?
1:21:12
Speaker 2: Because it's going further. And when you age, it drops
1:21:16
Speaker 2: half that. And some guys will come in and they
1:21:18
Speaker 2: get just a dribble now, or it's like very not forceful.
1:21:21
Speaker 2: And that's because their muscles are just not as strong anymore.
1:21:24
Speaker 2: And you can, you know, work on strengthening muscular health,
1:21:27
Speaker 2: including your pelvic floor. But That's sort of the reality
1:21:31
Speaker 2: for most people. The volume also is variable. It depends
1:21:34
Speaker 2: on when was the last time you ejaculated. Like if you,
1:21:37
Speaker 2: if you abstain for five days, it's going to be
1:21:40
Speaker 2: more voluminous. And if you don't abstain and you just
1:21:42
Speaker 2: ejaculated the day before, it's going to be less voluminous. Also,
1:21:45
Speaker 2: how much did you drink that day? Right? Like how
1:21:47
Speaker 2: hydrated are you? There's a whole bunch of factors just
1:21:50
Speaker 2: day to day that play into it. And so. Yes,
1:21:54
Speaker 2: you can store it up for five days. And on
1:21:58
Speaker 2: the fifth day, you'll notice, wow, that was a pretty
1:22:00
Speaker 2: big semen volume. And so again, it's not a reflection
1:22:07
Speaker 2: of your fertility because only 5% of the entire volume
1:22:11
Speaker 2: is sperm. Most of it is all these fluids that
1:22:15
Speaker 2: help nourish sperm, help them move through the female genital tract.
1:22:18
Speaker 2: They're there for a reason. But the large majority of
1:22:20
Speaker 2: it is not sperm. And so the only way you
1:22:22
Speaker 2: can know your sperm health is by actually getting a
1:22:24
Speaker 2: semen analysis and actually testing that. And when we do those,
1:22:28
Speaker 2: we actually ask you to abstain for 24 to 48
1:22:30
Speaker 2: hours before you give it so we have a reference, right?
1:22:33
Speaker 2: Like this is what the average guy has after one
1:22:37
Speaker 2: day of abstinence or two days of abstinence. And so
1:22:39
Speaker 2: you should be around this. This is what's average.
1:22:42
Speaker 1: What, I mean, what are those... You mentioned some exercises.
1:22:46
Speaker 1: What are those exercises?
1:22:47
Speaker 2: Yeah, so I'm cautious about saying this because I don't
1:22:49
Speaker 2: think everyone needs to do them. So there are pelvic
1:22:52
Speaker 2: floor exercises called Kegel exercise that most people have heard of.
1:22:56
Speaker 2: that can strengthen the pelvic floor. Now, you don't have
1:22:58
Speaker 2: to just do those exercises, but those are the most popular.
1:23:00
Speaker 2: They have, like, the best PR of any exercise I've
1:23:02
Speaker 2: ever seen. But, like, essentially, they are... So, for guys,
1:23:07
Speaker 2: I tell them it's like you are lifting your penis
1:23:10
Speaker 2: from the ground without touching it. Like, that's sort of that.
1:23:13
Speaker 2: Or if you're peeing and you stop the stream of pee, that's,
1:23:16
Speaker 2: you're actually activating those muscles. So you don't want to
1:23:18
Speaker 2: do it when you're in the bathroom, but you can
1:23:19
Speaker 2: use it to learn what that feels like. And then
1:23:22
Speaker 2: you do those period, just like you do crunches or
1:23:25
Speaker 2: you go to the gym, you do reps, you do
1:23:26
Speaker 2: like 10 reps in the morning, 10 reps at night.
1:23:29
Speaker 2: You need to make sure you rest and you breathe
1:23:31
Speaker 2: just like you would do at the gym. You rest,
1:23:33
Speaker 2: you breathe, you make sure you're not just squeezing, squeezing,
1:23:36
Speaker 2: squeezing real hard. You squeeze and relax and squeeze and relax.
1:23:40
Speaker 2: Because you can get dysfunction, which is why I don't
1:23:42
Speaker 2: tell a lot of people to just, everyone should do them,
1:23:45
Speaker 2: because some people will actually have dysfunctional muscles. And guys,
1:23:48
Speaker 2: it's very underdiagnosed. No one's really testing their pelvic floor
1:23:52
Speaker 2: because it requires a rectal exam, a finger in the bottom.
1:23:56
Speaker 2: And so to test, they're like, are your muscles tense?
1:23:59
Speaker 2: Just like people get TMJ, right? They clench up their jaw.
1:24:03
Speaker 2: pelvic floor muscles can get tense and so they can
1:24:05
Speaker 2: tense up and they won't really know that it's happening
1:24:08
Speaker 2: but it will cause these other issues and so if
1:24:10
Speaker 2: you strengthen an already tense muscle you're going to create
1:24:12
Speaker 2: more problems so as i say not everyone should do
1:24:14
Speaker 2: it but if you have normal function everything's working great
1:24:17
Speaker 2: it's probably reasonable to go ahead and try doing those
1:24:19
Speaker 2: exercises to strengthen those muscles it may help you with
1:24:24
Speaker 2: having a more forceful ejaculate it may help you with
1:24:26
Speaker 2: getting stronger because there's more blood flow going, you know,
1:24:30
Speaker 2: it's causing more blood flow to come to the area
1:24:33
Speaker 2: because you're getting more, you know, just like any exercise.
1:24:36
Speaker 2: And it may cause you to have more intense orgasms
1:24:38
Speaker 2: because you have more muscle contracting when it does contract.
1:24:41
Speaker 2: And so, it can be beneficial, and it can be
1:24:44
Speaker 2: a great way to augment your sex life, but again,
1:24:47
Speaker 2: it's not for everybody.
1:24:48
Speaker 1: And then, how long does it, is it five days
1:24:52
Speaker 1: it takes a man to fully reload?
1:24:55
Speaker 2: Yeah, so when they look at, I mean, actually you're
1:24:57
Speaker 2: constantly making sperm, right? So on average, it takes about
1:25:02
Speaker 2: 24 to 48 hours after an ejaculate for you to
1:25:07
Speaker 2: get the semen back in, I'm sorry, to get the
1:25:09
Speaker 2: sperm back into the semen. But you will have some potential,
1:25:15
Speaker 2: like in the tract and other things, but you still
1:25:17
Speaker 2: have some. It's not like it just all goes away
1:25:19
Speaker 2: and then there's nothing left. Like there's sort of storage
1:25:21
Speaker 2: mechanisms and things But in terms of like if you're
1:25:25
Speaker 2: trying to get a partner pregnant, ideally, we say like
1:25:29
Speaker 2: every other day will allow you to replenish and have
1:25:33
Speaker 2: sort of the most amount of sperm getting to the egg,
1:25:37
Speaker 2: if that's what your goal is.
1:25:39
Speaker 1: Anal sex.
1:25:41
Speaker 2: Yeah.
1:25:41
Speaker 1: Any benefits?
1:25:43
Speaker 2: Well, so like I mentioned, we talked about the Skeen's
1:25:46
Speaker 2: glands or the G-zone, right? You know how some women
1:25:49
Speaker 2: find that really pleasurable? That area is similar to the prostate.
1:25:54
Speaker 2: So some people, and there's also the clitoris and the
1:26:02
Speaker 2: legs of the clitoris that are around there. So they're
1:26:04
Speaker 2: all sort of around the rectum and the anus. And
1:26:07
Speaker 2: some women will find it very pleasurable to have something
1:26:10
Speaker 2: inserted in the anus and that will augment their pleasure.
1:26:14
Speaker 2: And so not everyone does, but just like some people
1:26:17
Speaker 2: find certain things pleasurable, some people don't. So in terms
1:26:20
Speaker 2: of like health benefits, not really, but in terms of
1:26:23
Speaker 2: pleasure benefits, yes, for some people that can be a
1:26:26
Speaker 2: great way for them to feel pleasure. It can be
1:26:30
Speaker 2: augmented with other things, like you can stimulate them clearly
1:26:33
Speaker 2: at the same time, whatever, right? There's different ways to
1:26:36
Speaker 2: use it. But what I will tell people is it's
1:26:38
Speaker 2: not like you can't just have anal sex if you've
1:26:40
Speaker 2: never done anything in the anus before. You need to
1:26:43
Speaker 2: sort of prepare. And sometimes that means like using a
1:26:45
Speaker 2: toy or using a lubricated finger to sort of get
1:26:48
Speaker 2: the anus ready or prepared to have a phallus inside.
1:26:54
Speaker 2: You also need to, there's no natural lubrication. So you
1:26:57
Speaker 2: need lube and go slow, go easy, take your time
1:27:01
Speaker 2: and sort of like talk. You have to communicate. You
1:27:05
Speaker 2: have to be like, is this okay? Like there has
1:27:07
Speaker 2: to be a back and forth dialogue where you feel
1:27:09
Speaker 2: comfortable and trust each other because It can cause damage
1:27:12
Speaker 2: if you do it too aggressively or too, you know,
1:27:14
Speaker 2: too rigorously and not enough lube. You can actually damage
1:27:18
Speaker 2: the walls of the anus, which are really friable and thin.
1:27:22
Speaker 2: They're not like as elastic or muscular as a vaginal canal.
1:27:26
Speaker 2: And so, yeah, absolutely, it can derive a lot of pleasure.
1:27:30
Speaker 2: It can be a lot of fun for people who
1:27:32
Speaker 2: just have to go slow, go easy, and talk to
1:27:35
Speaker 2: each other.
1:27:36
Speaker 1: What about risks?
1:27:37
Speaker 2: Again, the big risk is that you can hurt yourself,
1:27:40
Speaker 2: but also there is a sexually transmitted infection risk. So oftentimes,
1:27:44
Speaker 2: people will have anal sex, and because they can't get
1:27:48
Speaker 2: someone pregnant that way, they won't use a condom. But
1:27:50
Speaker 2: you can still transmit sexually transmitted infections, and it's actually
1:27:54
Speaker 2: a higher risk because there's more blood vessels, things can
1:27:57
Speaker 2: tear more easily in that area, like I said, it's
1:27:59
Speaker 2: not lubricated, and so they're at a higher risk of
1:28:02
Speaker 2: getting STDs. And so it's really important if you're having
1:28:05
Speaker 2: anal sex with someone where you are not monogamous and
1:28:09
Speaker 2: tested and clear and you are safe to not use
1:28:11
Speaker 2: condoms even vaginally, you need to use a condom anally
1:28:15
Speaker 2: because you want to protect yourself.
1:28:17
Speaker 1: What about from a bacterial standpoint?
1:28:19
Speaker 2: Yeah, I mean, from a bacterial standpoint, you know, it's
1:28:23
Speaker 2: not like you're going to get... As a man, you
1:28:26
Speaker 2: won't get like a colon infection if they have some
1:28:29
Speaker 2: sort of infection. That's usually not an issue. It's more
1:28:31
Speaker 2: the sexually transmitted infections.
1:28:33
Speaker 1: Okay. Okay. G-spot.
1:28:36
Speaker 2: Yeah.
1:28:37
Speaker 1: How do men find it?
1:28:38
Speaker 2: So the G... it's not a spot actually. A lot
1:28:42
Speaker 2: of guys think it's like this magical button that you
1:28:44
Speaker 2: have to find. It's not. There's not necessarily like an
1:28:47
Speaker 2: obvious visual. Like when you look down, they're like, oh,
1:28:50
Speaker 2: there's a spot, you know, like bullseye. No, but honestly,
1:28:56
Speaker 2: I think there's a lot of misconception. Like people are like, wait,
1:28:58
Speaker 2: was something wrong with me? I don't see it. Or like,
1:29:00
Speaker 2: You know, it's not. It's an area where there's a
1:29:02
Speaker 2: lot of nerve endings. So the Skeen's glands, which we
1:29:05
Speaker 2: talked about earlier, the clitoral body, the shaft, so just
1:29:09
Speaker 2: like the shaft of the penis, the shaft of the
1:29:10
Speaker 2: clitoris is around that area. And so all those areas
1:29:14
Speaker 2: are really highly innervated. I mean, they're really a lot
1:29:16
Speaker 2: of nerve endings. It's about two to three centimeters inside
1:29:20
Speaker 2: the vagina at the top. And so we'll say like
1:29:23
Speaker 2: it's like a come hither motion is sort of where
1:29:25
Speaker 2: you'll kind of feel it. But again, you have to talk.
1:29:28
Speaker 2: I think people feel like that when they have sex,
1:29:31
Speaker 2: they should just be like magical gods at sex and
1:29:33
Speaker 2: it should just be perfect and it should be this
1:29:36
Speaker 2: amazing experience off the bat. And it doesn't make sense
1:29:39
Speaker 2: to me because it's a skill just like anything else.
1:29:44
Speaker 2: You don't expect to go do a public speech and
1:29:48
Speaker 2: be amazing at it the first time. It's a skill
1:29:51
Speaker 2: that you develop with time. Even talking to someone or dating,
1:29:56
Speaker 2: it's all skills that we learn and we cultivate. And
1:29:58
Speaker 2: so just like that, sex is a skill. You have
1:30:00
Speaker 2: to get good at it. And that requires you to
1:30:03
Speaker 2: get feedback from the person you're having sex with. But
1:30:06
Speaker 2: we just expect that, like, okay, we're just gonna have sex,
1:30:08
Speaker 2: there's gonna be just moans and groans, but no talking,
1:30:11
Speaker 2: and it's gonna be great, and everyone's gonna have great orgasms,
1:30:13
Speaker 2: and we're gonna be wonderful at it. It's like, but
1:30:15
Speaker 2: we have to invest in having better sex. Like, what
1:30:18
Speaker 2: is the point of having sex that's not worth having? Right?
1:30:21
Speaker 2: Nobody wants mediocre sex. Let's have good sex. And so
1:30:25
Speaker 2: that means, like, let's talk about sex. Let's talk about
1:30:27
Speaker 2: sex outside the bedroom. Let's find out, hey, what turns
1:30:31
Speaker 2: you on? What is something that you've always been fantasizing about?
1:30:34
Speaker 2: Or what was good? What did you like about that?
1:30:38
Speaker 2: And what could be better? And let's not take it
1:30:40
Speaker 2: so personally. We are trying to be better lovers with
1:30:43
Speaker 2: each other. And so it's important to sort of be like, okay,
1:30:47
Speaker 2: what's good? What's not good? How can we change this up?
1:30:50
Speaker 2: The other thing is monotony is a huge issue. So
1:30:53
Speaker 2: people find what works and they do it every time.
1:30:56
Speaker 2: And that's great. Like it's comforting to have a routine,
1:30:59
Speaker 2: but if I was to tell you, Hey, you're going
1:31:00
Speaker 2: to have chicken and broccoli every day for the rest
1:31:02
Speaker 2: of your life, you'd be like, I don't know if
1:31:05
Speaker 2: I can do that every day.
1:31:06
Speaker 1: Right.
1:31:06
Speaker 2: I need, I need a pizza someday, or I need
1:31:08
Speaker 2: a steak someday, whatever. Right. And so it's the same thing.
1:31:11
Speaker 2: Like you need to sort of have a little bit
1:31:14
Speaker 2: of variety. It doesn't need to be crazy. Like it
1:31:16
Speaker 2: doesn't need to be like, let's get out the whips
1:31:18
Speaker 2: and chains. And like, it can be just as simple
1:31:20
Speaker 2: as doing it a different room, doing it a different time,
1:31:23
Speaker 2: doing it a different, like slightly different position. Using a pillow,
1:31:26
Speaker 2: not using a pillow. Like, just slight variations that make
1:31:30
Speaker 2: it just different enough where you're like, ooh, this is
1:31:33
Speaker 2: kind of different. Like, this is kind of cool. And
1:31:36
Speaker 2: keeps you sort of interested, excited, engaged in the process.
1:31:40
Speaker 1: Are there any positions that men could do that are
1:31:45
Speaker 1: easier in finding the G-zones? or that women enjoy more?
1:31:50
Speaker 2: So, we know that when women have control, meaning they're
1:31:54
Speaker 2: on top or they can sort of angle their bodies
1:31:58
Speaker 2: in certain ways, that they tend to have more pleasure
1:32:02
Speaker 2: because they can, again, sort of angle you in a
1:32:05
Speaker 2: certain way that allows them to achieve more pleasure. So,
1:32:08
Speaker 2: certain things like putting a pillow, so if she's on
1:32:11
Speaker 2: the bottom, putting a pillow under her pelvis can make
1:32:14
Speaker 2: it more comfortable and more pleasurable. Having her on top
1:32:18
Speaker 2: can also allow for more pleasure because she can control
1:32:21
Speaker 2: sort of the angle that goes in. And there's also
1:32:25
Speaker 2: certain things, not so the G zone, but there's things
1:32:27
Speaker 2: that can help you like stimulate the clitoris better while
1:32:31
Speaker 2: you're having vaginal penetrative sex. So certain positions where you're
1:32:35
Speaker 2: like sort of aligning your pelvis right on top of
1:32:38
Speaker 2: her clitoris so that you're kind of like rocking motion,
1:32:42
Speaker 2: that can also lead to better orgasms. So the G,
1:32:45
Speaker 2: people focus on the G zone because they hear about
1:32:48
Speaker 2: it a lot. But it's analogous to the male prostate. Now,
1:32:51
Speaker 2: not every guy wants prostate play. Like, not every guy
1:32:54
Speaker 2: wants their prostate stimulated for pleasure. And so I don't
1:32:57
Speaker 2: think we need to focus on the G-zone. We need
1:32:59
Speaker 2: to focus on clitoral stimulation and also talking to our partner,
1:33:03
Speaker 2: finding out what they like. Because again, not everybody wants
1:33:06
Speaker 2: their G-zone stimulated. Like, it may not be pleasurable for
1:33:09
Speaker 2: them or it may not really do anything for them.
1:33:11
Speaker 2: Whereas some people will be like, yeah, that's it. I
1:33:13
Speaker 2: love that. And that really turns me on. But you
1:33:15
Speaker 2: won't know until you ask her.
1:33:17
Speaker 1: What about, you know, we talked about, you know, how
1:33:21
Speaker 1: often it would be, what an ideal, what do you
1:33:24
Speaker 1: call this, ejaculation cycle, you know, for a man. What's healthy,
1:33:30
Speaker 1: you know, 21 times a month. It's great. What about women?
1:33:35
Speaker 2: Yeah, so, you know, there's so little data on women.
1:33:37
Speaker 2: But I would venture to say probably, you know, having
1:33:41
Speaker 2: regular orgasms is good for you, right? They don't necessarily
1:33:45
Speaker 2: always see an ejaculate. like men do, and that's different
1:33:49
Speaker 2: from squirting. A jacklet is just like this milky white
1:33:51
Speaker 2: fluid that comes from the skein's glands, and it's usually
1:33:54
Speaker 2: a very small amount. So we don't always see it.
1:33:57
Speaker 2: It's not always very clear. Some women will be like, yes,
1:33:58
Speaker 2: I see it. I know exactly what you're talking about.
1:34:00
Speaker 2: And some will be like, I've never seen it. That's okay.
1:34:03
Speaker 2: But it's more about the orgasm, I think, because that's
1:34:06
Speaker 2: what you can sort of reliably say. And I think
1:34:09
Speaker 2: that the orgasm is what we should focus on as
1:34:11
Speaker 2: getting orgasms for women. And really the thing is, I think, for...
1:34:15
Speaker 2: For women, it's probably, I mean, there's no, we don't get,
1:34:18
Speaker 2: we don't get Skeen's glands cancer is very common, right?
1:34:20
Speaker 2: Prostate cancer, men, one in eight men get prostate cancer, right?
1:34:23
Speaker 2: So it's very common. So it's not, I don't think
1:34:25
Speaker 2: there's a benefit in that term, but I do think
1:34:28
Speaker 2: for health benefits, for stress reduction, for pleasure benefits, I
1:34:34
Speaker 2: think orgasms, regular orgasms are great. Again, I don't, I
1:34:39
Speaker 2: can't give you an exact number, but I think like
1:34:41
Speaker 2: if you feel like you are enjoying how often you're
1:34:44
Speaker 2: having orgasms, do it. And if you feel like you
1:34:47
Speaker 2: could have more, that's fine. And if you don't like
1:34:50
Speaker 2: having orgasms, that's okay too, but like you should have
1:34:53
Speaker 2: something that gives you pleasure in life.
1:34:55
Speaker 1: Perfect. Brina, let's take a quick break. Sure. And then
1:34:58
Speaker 1: when we come back, we'll get into some prostate stuff
1:35:02
Speaker 1: and all that kind of stuff.
1:35:03
Speaker 2: All right.
1:35:03
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Speaker 1: any disease or condition. All right, Rena, we're back from
1:37:32
Speaker 1: the break. Couple more questions about bedroom stuff. Yeah. And
1:37:37
Speaker 1: so one is... You know, there's this rumor going around
1:37:41
Speaker 1: that pineapple makes semen taste better. Pineapple, I think I've
1:37:46
Speaker 1: heard bananas. There might be some other stuff. I'm not sure.
1:37:49
Speaker 1: Is there any truth to that?
1:37:51
Speaker 2: So it's interesting. I mean, like, you can't really design
1:37:53
Speaker 2: a study tasting semen. So I can't tell you, like,
1:37:58
Speaker 2: I can't tell you with a degree of, like, certainty.
1:38:01
Speaker 2: But if you think about the composition of semen, right,
1:38:04
Speaker 2: there's fructose in semen. And fructose is what makes it sweet.
1:38:07
Speaker 2: It also has all these minerals in it, which give
1:38:09
Speaker 2: it that sort of metallic-y sort of taste. But at neutral,
1:38:15
Speaker 2: it's sort of got this little bit of metallic-y, slightly
1:38:17
Speaker 2: sweet taste. Now, if you want to make it sweeter,
1:38:20
Speaker 2: you would think, OK, I want to increase the amount
1:38:23
Speaker 2: of fructose in the semen. And so you know, you
1:38:26
Speaker 2: will see that things that have a lot of fructose
1:38:29
Speaker 2: can potentially help increase the sweetness of semen. So things
1:38:34
Speaker 2: like pineapple, other fruits. Potentially, yeah, they might increase the sweetness,
1:38:39
Speaker 2: but it's not gonna be, I think what people think
1:38:41
Speaker 2: is like, oh, I got a date tonight, I'm gonna
1:38:44
Speaker 2: eat some pineapple in the morning and I'm gonna be
1:38:46
Speaker 2: good to go. It's not that quick, right? So it's
1:38:48
Speaker 2: sort of like a dietary thing. Like if your diet
1:38:50
Speaker 2: consists of like healthy fruits and vegetables, you're more likely
1:38:54
Speaker 2: to have better tasting semen. Now, certain vegetables like asparagus
1:38:59
Speaker 2: is pretty strong and so people might notice that their
1:39:01
Speaker 2: pee stinks after they eat asparagus, that will also affect
1:39:05
Speaker 2: your semen. things like coffee, smoking, caffeine, those can make
1:39:12
Speaker 2: the semen taste a little bit stronger. And so, and certainly,
1:39:16
Speaker 2: so if you really does, your diet can really alter
1:39:20
Speaker 2: the taste, at least that's my suspicion based on what
1:39:22
Speaker 2: we've heard from people, anecdotally, what we've talked, you know,
1:39:26
Speaker 2: kind of the biology behind it. And so I would
1:39:29
Speaker 2: suspect that generally speaking, if you eat a healthy diet,
1:39:32
Speaker 2: drink lots of fluids, you're gonna have good tasting semen.
1:39:36
Speaker 2: If you eat a less healthy diet or you smoke,
1:39:39
Speaker 2: it's not going to taste as good. And so, you know,
1:39:42
Speaker 2: I think like obviously everyone's taste is sort of their own, right?
1:39:48
Speaker 2: It's based on their biology. And so unless it like
1:39:51
Speaker 2: your partner's like, oh, all of a sudden it tastes
1:39:53
Speaker 2: really different and it tastes unappealing, I wouldn't worry about it.
1:39:57
Speaker 2: But like, you know, again, I think that like it is,
1:40:01
Speaker 2: It's nothing that you should ever really worry about. As
1:40:04
Speaker 2: long as you're a healthy person, your semen should be
1:40:06
Speaker 2: tasting good. Also, the color of the semen can vary.
1:40:08
Speaker 2: I get this question a lot. So people will be like, oh,
1:40:11
Speaker 2: it looks a little yellow now, or it looked a
1:40:14
Speaker 2: little grayish. And really, the color can vary. It's not dangerous.
1:40:19
Speaker 2: So the good news is it's not dangerous. I always say,
1:40:22
Speaker 2: if you're worried, just drink lots of fluids. It's going
1:40:24
Speaker 2: to dilute everything. It's going to make things a little
1:40:26
Speaker 2: bit clearer. Because I think a lot of times we
1:40:29
Speaker 2: are drinking a lot of energy drinks or not really
1:40:33
Speaker 2: just water. And so sometimes it's just like increase your
1:40:36
Speaker 2: water intake and things will clear up. If you get
1:40:39
Speaker 2: blood in the semen, that's a little bit concerning, but
1:40:41
Speaker 2: usually 99% of the time it's not dangerous. And if
1:40:45
Speaker 2: it happens once, don't worry about it. If it continues
1:40:47
Speaker 2: to happen over and over again, that's a time to
1:40:49
Speaker 2: sort of get a red flag.
1:40:50
Speaker 1: Okay. And then we may have covered this, forgive me
1:40:54
Speaker 1: if we did, through a lot of information at me, but...
1:40:58
Speaker 1: I've heard rumors or maybe read some things, wherever it
1:41:01
Speaker 1: came from, I can't remember, but does ejaculation for men
1:41:07
Speaker 1: lower the risk of cancer?
1:41:09
Speaker 2: Yes. So ejaculating, we know there's an association. So when
1:41:13
Speaker 2: you ejaculate more than 21 times a month, there is
1:41:17
Speaker 2: about a 20% lower risk of prostate cancer. 20%? Yeah.
1:41:22
Speaker 2: And so... Now, is it the ejaculation that's causing that
1:41:26
Speaker 2: lower risk? I mean, the study that found this data
1:41:30
Speaker 2: actually tried to control for a lot of different factors,
1:41:33
Speaker 2: you know, like other health conditions. But you would imagine
1:41:36
Speaker 2: that someone who is ejaculating that frequently has a partner
1:41:40
Speaker 2: or is healthy enough to do so. So maybe there
1:41:43
Speaker 2: are some other factors that we can't really quantify scientifically.
1:41:47
Speaker 2: But the theory is that perhaps ejaculation is allowing fluid
1:41:51
Speaker 2: to move through the prostate more readily so that fluid
1:41:53
Speaker 2: doesn't stick around and cause inflammation or other issues that
1:41:57
Speaker 2: then may lead to transformations that could lead to cancer.
1:42:01
Speaker 1: Okay. And what age... How long can people have sex?
1:42:08
Speaker 2: I mean, as long as they live, but a lot
1:42:10
Speaker 2: of times people don't. And so we call that sex span, right?
1:42:14
Speaker 2: Like you think of your lifespan is how long you live,
1:42:17
Speaker 2: but your sex span is how long you're going to
1:42:19
Speaker 2: have sex. And so if you remain strong and healthy,
1:42:24
Speaker 2: so you're strong enough that you can still maintain the
1:42:27
Speaker 2: positions of sex. And to be honest, there's even like
1:42:29
Speaker 2: furniture now and like things that can help you have
1:42:32
Speaker 2: sex if you're a little bit weaker or like can't
1:42:34
Speaker 2: get certain positions. There's wedges and slings and different things
1:42:38
Speaker 2: that can help so you can continue to have sex.
1:42:41
Speaker 2: But also that you don't get winded, right? When you're
1:42:44
Speaker 2: not exhausted, that you can't actually exert enough to have sex.
1:42:49
Speaker 2: But if you are a healthy person, you've maintained your
1:42:52
Speaker 2: muscular health through fitness, you've maintained your cardiovascular health through fitness,
1:42:57
Speaker 2: it is very likely that you continue to have sex
1:42:59
Speaker 2: well into your old age. I've seen 90-year-old patients who
1:43:02
Speaker 2: are still having an active sex life.
1:43:04
Speaker 1: 90 years old?
1:43:04
Speaker 2: Mm-hmm. and don't have erectile dysfunction, and they're very healthy.
1:43:09
Speaker 2: And again, they have prioritized their health, and they have
1:43:12
Speaker 2: maintained their exercise, they've maintained their health, they've eaten a
1:43:16
Speaker 2: healthy diet, they've slept, they've dealt with stress, they've created
1:43:20
Speaker 2: an environment which is healthy around their bodies, and they
1:43:24
Speaker 2: are still able to have sex with their partners.
1:43:27
Speaker 1: Now, do you see a lower sex drive in older
1:43:31
Speaker 1: couples or just older people? in general.
1:43:35
Speaker 2: Well, so yeah, let's talk about it for each individual.
1:43:37
Speaker 2: So for men, the most common reason for low sexual desire,
1:43:42
Speaker 2: especially as they age, one is low testosterone. So testosterone
1:43:46
Speaker 2: declines at about one to one and a half percent
1:43:49
Speaker 2: every year after about 40. So if you are very
1:43:53
Speaker 2: healthy and you started with a normal testosterone, it's unlikely
1:43:57
Speaker 2: that it should get low enough that it would cause
1:43:59
Speaker 2: you a problem. But that's not the reality for men
1:44:03
Speaker 2: So about like overall 20% of people have low testosterone,
1:44:07
Speaker 2: but that percentage goes up as you age. And that's
1:44:09
Speaker 2: because add in, you know, like other medical conditions that
1:44:14
Speaker 2: will affect low testosterone. So we know that as people
1:44:16
Speaker 2: get more metabolic conditions, like high cholesterol, diabetes, high blood pressure,
1:44:21
Speaker 2: they tend to get lower testosterone. Add in potentially like
1:44:27
Speaker 2: lack of sleep and more stress in their life that
1:44:29
Speaker 2: causes more testosterone. add in sedentary lifestyles, add in even
1:44:34
Speaker 2: environmental exposures like microplastics and things like that, that we
1:44:38
Speaker 2: have some control over but not completely. And now you're
1:44:42
Speaker 2: in a situation where you're more likely to have a
1:44:45
Speaker 2: larger decline than is expected. And so we are seeing
1:44:49
Speaker 2: more and more low testosterone. And testosterone is the hormone
1:44:53
Speaker 2: of desire. And so when you have low testosterone, oftentimes
1:44:57
Speaker 2: it will present in men with low sexual desire And
1:45:01
Speaker 2: loss of morning erections. So those late night, those morning erections.
1:45:05
Speaker 2: It also, testosterone is important for so many things in
1:45:07
Speaker 2: your body. So it increases muscle mass. It helps with mood.
1:45:10
Speaker 2: So sometimes people who are depressed, men who are depressed,
1:45:13
Speaker 2: will find that their mood gets a little better when
1:45:15
Speaker 2: they start on testosterone. Brain fog. So it helps guys
1:45:18
Speaker 2: with brain clarity. And that's actually one of the very
1:45:21
Speaker 2: common things I'll see in older guys who have low
1:45:23
Speaker 2: testosterone is I'll give them testosterone. And the first thing
1:45:25
Speaker 2: they'll notice is that their brain is a little clearer. Um,
1:45:29
Speaker 2: and it helps with like the ability to just do
1:45:31
Speaker 2: normal functional things like walk upstairs, hand grip strength, like
1:45:34
Speaker 2: things like that, like functional. Um, and, and so there's
1:45:37
Speaker 2: so many facets. It also helps with bone health and
1:45:40
Speaker 2: bone health is so important as we age. So it's
1:45:42
Speaker 2: not just a hormone of sexual desire. It's so much
1:45:45
Speaker 2: more than that. But so that is often a cause
1:45:48
Speaker 2: in older men of loss of sexual desire. Also, if
1:45:51
Speaker 2: they're unhealthy, right, they have a health issue. And then
1:45:55
Speaker 2: sex is like off the table because they don't feel well, right?
1:45:58
Speaker 2: And that happens to a lot of guys. Where like,
1:46:01
Speaker 2: I'll see women, I'll be like, my husband can't have
1:46:03
Speaker 2: sex because he's unwell, right? Or his partner is unwell,
1:46:09
Speaker 2: and so they can't have sex because of that. So
1:46:11
Speaker 2: that becomes very common reasons. Now for women, low sexual
1:46:15
Speaker 2: desire is even more common. So it's actually estimated like
1:46:18
Speaker 2: 40% of women have low libido, so low desire. And
1:46:22
Speaker 2: there's a variety of reasons for that. One is, yes,
1:46:25
Speaker 2: women also have testosterone, and their testosterone also declines similarly
1:46:29
Speaker 2: to men. And so they can't, that can be part
1:46:32
Speaker 2: of it. There's also changes in menopause that can really
1:46:36
Speaker 2: affect women as they age. So they can have dryness vaginally,
1:46:39
Speaker 2: which can make it uncomfortable to have sex and lack
1:46:42
Speaker 2: of lubrication. They can have... their tissues actually change. So
1:46:47
Speaker 2: they get what's called atrophy. So the tissues get thinner,
1:46:51
Speaker 2: more friable. So it's more painful. And it's actually like
1:46:54
Speaker 2: not as flexible or as stretchy as it used to be.
1:46:58
Speaker 2: So actually penetration can be painful. Their clitoris can even
1:47:01
Speaker 2: have changes. Just like men have erectile dysfunction, women can
1:47:04
Speaker 2: have changes in their clitoris where they may have less
1:47:08
Speaker 2: pleasure from the same stimulation they were getting before. So
1:47:11
Speaker 2: it's more difficult to get orgasms. And so when you
1:47:14
Speaker 2: are having sex that's not really leading to pleasure, it
1:47:17
Speaker 2: becomes like less of a priority, right? And so, you know,
1:47:21
Speaker 2: we have things that can help women too, and I
1:47:23
Speaker 2: see patients all the time, sometimes it is off-label testosterone,
1:47:27
Speaker 2: sometimes it's other medications that we can offer, but also
1:47:30
Speaker 2: it's like dealing with those things, those changes that are happening,
1:47:33
Speaker 2: because they can really make you not want sex. And
1:47:36
Speaker 2: then your partner, if your, you know, male partner is like,
1:47:39
Speaker 2: I still want to have sex, but she's like dealing
1:47:41
Speaker 2: with all these changes hormonally, She doesn't want to, right?
1:47:44
Speaker 2: She's like, I'm not sleeping well. I'm having hot flashes
1:47:47
Speaker 2: all the time. You know, everything's dry down there. I
1:47:50
Speaker 2: might be getting UTIs all the time. All these things
1:47:52
Speaker 2: are often hormonally mediated and they can be remedied. And
1:47:55
Speaker 2: same thing for men. If your testosterone is declining, we
1:47:57
Speaker 2: can improve that either naturally or with replacement.
1:48:01
Speaker 1: So how can, I mean, what age does menopause usually start?
1:48:05
Speaker 2: So average is 51. Okay. But up to 10 years
1:48:09
Speaker 2: before that, and that's average, meaning that half of women
1:48:12
Speaker 2: will be before 51, half will be after, but well
1:48:15
Speaker 2: before perimenopause, before menopause is perimenopause. That can be four
1:48:19
Speaker 2: to seven to 10 years before menopause. And again, so
1:48:24
Speaker 2: that could be as early as your 40s or late 30s,
1:48:26
Speaker 2: some women are experiencing these symptoms. And that's when the
1:48:28
Speaker 2: symptoms are really intense because there's like this hormonal chaos,
1:48:33
Speaker 2: like that some days your estrogen is really high, some
1:48:35
Speaker 2: days it's low because your body's like, it's all unregulated, right?
1:48:39
Speaker 2: And so during that time, they're just like, they're super stressed.
1:48:42
Speaker 2: They're not sleeping. They're having hot flashes. They don't feel
1:48:46
Speaker 2: like happy. Sometimes they feel depressed. I mean, there's so
1:48:49
Speaker 2: many things going on and they honestly feel like they're
1:48:52
Speaker 2: out of control. Like they don't feel like themselves. I mean,
1:48:54
Speaker 2: men will say the same thing when their testosterone is low,
1:48:56
Speaker 2: that they don't feel like themselves.
1:48:58
Speaker 1: And so, I mean, how do you, I mean, how
1:49:02
Speaker 1: do men strike up a conversation with their partner who is, So.
1:49:07
Speaker 2: I think it is, you have to really do this
1:49:10
Speaker 2: cautiously because I think the thing is like, oh, if
1:49:13
Speaker 2: you say, oh, I think it's hormonal, it almost feels
1:49:16
Speaker 2: like the partner may feel like affronted, like you're telling
1:49:19
Speaker 2: me I'm hormonal, you know? So you have to sort
1:49:21
Speaker 2: of do it in a way like, look, you can
1:49:24
Speaker 2: try like, hey, look, I saw this video online. I
1:49:27
Speaker 2: listened to this podcast and they were talking about this.
1:49:29
Speaker 2: And I'm like wondering if, you know, do you, Like,
1:49:31
Speaker 2: are you having any symptoms? Or would you like to
1:49:34
Speaker 2: see a specialist? Can I help you find one? Can
1:49:36
Speaker 2: I go with you to the appointment? I mean, I
1:49:38
Speaker 2: love it. Male patients bring me their wives all the time.
1:49:42
Speaker 2: And I love it. And so supportive, so wonderful. And
1:49:44
Speaker 2: they have this wonderful, beautiful relationship. And they just want
1:49:46
Speaker 2: to support each other. And I think it's just being, look,
1:49:48
Speaker 2: I love you. And I want you to feel well.
1:49:51
Speaker 2: It's not about wanting sex. It's not about, like, wanting,
1:49:54
Speaker 2: you know, you as a physical being. It's about wanting
1:49:57
Speaker 2: you to feel like yourself and feel happy and fulfilled
1:50:00
Speaker 2: and feel, like, normal in your body. And I think, like,
1:50:04
Speaker 2: showing them that you want that is so valuable. Like, oh,
1:50:08
Speaker 2: you love me and you care about me and you
1:50:10
Speaker 2: want me to feel good. It's not necessarily just about sex. It's,
1:50:13
Speaker 2: you know, it's much more than that. And so I
1:50:16
Speaker 2: think that's where... you don't want to start the conversation
1:50:19
Speaker 2: to be like, oh, we're not having sex, I want
1:50:20
Speaker 2: you to see a specialist, or I think you're going
1:50:22
Speaker 2: crazy and you're hormonal and, like, you know, something's wrong here.
1:50:25
Speaker 2: It's more like, look, I love you, I'm worried about you,
1:50:28
Speaker 2: and I want to help. And, like, I really, you know,
1:50:30
Speaker 2: want to be there for you.
1:50:31
Speaker 1: What are, I mean, what are some of the initial treatments?
1:50:35
Speaker 1: I mean, it sounds like Lubricant would be an obvious
1:50:38
Speaker 1: answer if it's dried.
1:50:39
Speaker 2: Lubricant is great. And I think the one thing people
1:50:41
Speaker 2: don't realize is that lubricant comes in different formulations. Like
1:50:45
Speaker 2: you can get a water-based lubricant, which is the most
1:50:47
Speaker 2: common one you see, but those dry up. And so like,
1:50:49
Speaker 2: if you're going to have sex, it's going to last
1:50:51
Speaker 2: a few more than a few minutes. Like you're going
1:50:53
Speaker 2: to have to reapply. Otherwise it's not really going to work.
1:50:56
Speaker 2: So you can get water-based, but silicone-based and oil-based are
1:51:00
Speaker 2: a little longer lasting. And so those are convenient in
1:51:03
Speaker 2: terms of allowing you to just apply once and have
1:51:06
Speaker 2: sex and not worry about reapplying. And so just figuring
1:51:09
Speaker 2: out what kinds you guys like. I might be experimenting
1:51:12
Speaker 2: with a few and figuring out what feels good for
1:51:14
Speaker 2: both of you and what you both like because it's
1:51:16
Speaker 2: a very individual thing. But I think lube is great.
1:51:19
Speaker 2: It's cheap. It's available. It's accessible. And it's like, hey,
1:51:23
Speaker 2: let's have fun with it. Let's make it fun, right?
1:51:26
Speaker 2: There's also moisturizers. So for dryness specifically, you can get
1:51:29
Speaker 2: vaginal moisturizers just like you have facial moisturizers, there's vaginal moisturizers,
1:51:33
Speaker 2: and it's just skin. It's just skin. So just like
1:51:35
Speaker 2: moisturizing the skin, keeping it healthy. And then specifically for
1:51:39
Speaker 2: what we call the genitourinary syndrome of menopause or the
1:51:42
Speaker 2: dryness and the other issues, you can use hormonal creams.
1:51:45
Speaker 2: So like vaginal estrogen, which is very safe. So it's not,
1:51:49
Speaker 2: when you think about, there's a lot of confusion about hormones.
1:51:53
Speaker 2: Vaginal hormones are, very little get systemically absorbed. So there's
1:51:57
Speaker 2: never been a risk of breast cancer, ovarian cancer, uterine cancer.
1:52:00
Speaker 2: In fact, it's probably safe for about anybody unless they
1:52:04
Speaker 2: have an active breast cancer. So anybody else can get
1:52:07
Speaker 2: vaginal hormones. And so in those cases, you can do
1:52:10
Speaker 2: them in a cream, a pill, a ring. There's lots
1:52:12
Speaker 2: of different options, but they can really, one, keep the
1:52:16
Speaker 2: tissues healthy so they feel comfortable and they feel good
1:52:19
Speaker 2: and it feels good when they have sex and can
1:52:21
Speaker 2: prevent recurrent UTIs. Um, and it can even help like you,
1:52:26
Speaker 2: if you're looking down there, you may notice that their
1:52:28
Speaker 2: vulva actually changes. Like the lips, the inner lips will
1:52:31
Speaker 2: actually shrink and resorb because the lack of estrogen. So
1:52:35
Speaker 2: sometimes if you apply the cream on the outside, it
1:52:37
Speaker 2: can help keep those tissues healthy too. And so, um,
1:52:41
Speaker 2: not everyone needs it, like I said, but I think
1:52:43
Speaker 2: it does benefit people. The majority of women would benefit
1:52:47
Speaker 2: from it. And I think that it's really very, very safe.
1:52:50
Speaker 2: Because again, it's just topical, very little bit gets absorbed systemically.
1:52:54
Speaker 1: Are there, I mean, sounds like.
1:53:01
Speaker 1: It sounds like you recommend TRT for men a lot.
1:53:06
Speaker 2: I recommend TRT for men when they have symptoms of
1:53:09
Speaker 2: low testosterone, which we sort of talked about, but like
1:53:13
Speaker 2: low sexual desire, brain fog, fatigue, loss, maybe decreased mood
1:53:20
Speaker 2: when they have multiple symptoms that could be related to
1:53:23
Speaker 2: testosterone and their testosterone is low. And so testosterone is
1:53:27
Speaker 2: measured through a blood test. The challenge with testosterone is
1:53:30
Speaker 2: it only gives me a number of what your level
1:53:32
Speaker 2: is at that time. I don't know what your level
1:53:34
Speaker 2: was in your 20s. So if you have younger listeners listening,
1:53:37
Speaker 2: I generally recommend that people get a baseline level when
1:53:40
Speaker 2: they feel good. What is your testosterone when you feel good?
1:53:43
Speaker 2: So that as you age, you have a reference. And
1:53:46
Speaker 2: if something happened and you're like, oh man, I'm so exhausted.
1:53:48
Speaker 2: I don't know what's going on. You check your testosterone.
1:53:50
Speaker 2: If it's the same as it was when you were
1:53:52
Speaker 2: in your 20s, okay, it's not your testosterone. It's something else, right?
1:53:55
Speaker 2: But it gives you a reference because what we don't
1:53:57
Speaker 2: know and what's difficult to study is your receptors, which
1:54:01
Speaker 2: is what testosterone attaches to. Some people's receptors are more sensitive,
1:54:07
Speaker 2: so they need less of it, less testosterone around to
1:54:10
Speaker 2: get the same results. And some people need more because
1:54:13
Speaker 2: their testosterone receptors are less sensitive. And so I can't
1:54:17
Speaker 2: tell that we don't have like a commercially available test
1:54:20
Speaker 2: that we can say like, okay, you have a better receptors.
1:54:23
Speaker 2: You have more, you need more testosterone to saturate those receptors.
1:54:25
Speaker 1: We don't know.
1:54:26
Speaker 2: And so it's a very individual thing. Now they can
1:54:29
Speaker 2: say benchmarks based on like what we know, population-based data.
1:54:33
Speaker 2: And that's usually 300 nanograms per deciliter is like the
1:54:37
Speaker 2: normal benchmark. But I mean, there are some people who
1:54:40
Speaker 2: have testosterone that are higher than that, that still have symptoms.
1:54:43
Speaker 2: And that may be because their free testosterone is low,
1:54:46
Speaker 2: which is the testosterone that's like around in the bloodstream
1:54:49
Speaker 2: that is actually what's actively working on all those receptors.
1:54:52
Speaker 2: Because most of it is just like with other little
1:54:55
Speaker 2: molecules that are like little carriers, like little cars they
1:54:57
Speaker 2: sit in, but they don't let you get off the
1:54:59
Speaker 2: car so that you can't actually go and work on
1:55:01
Speaker 2: the organs. They're just there. And so only about like 5%,
1:55:04
Speaker 2: or I think it's actually like 1% or 2% of
1:55:07
Speaker 2: the testosterone is free. And that's what matters. And so
1:55:10
Speaker 2: that's what we want to see because other things that
1:55:12
Speaker 2: can affect those carrier molecules, the sex hormone binding globulin,
1:55:16
Speaker 2: so it can cause it to be more. So as
1:55:18
Speaker 2: you age, sex hormone binding globulin goes up. So your
1:55:21
Speaker 2: testosterone may look the same, but your SHBG is going
1:55:24
Speaker 2: up and now you have less free testosterone and so
1:55:26
Speaker 2: you're symptomatic. And so I think that it is valuable
1:55:31
Speaker 2: for men when they're low to improve their testosterone. Now,
1:55:34
Speaker 2: it doesn't always have to be through replacements. There are
1:55:37
Speaker 2: things you can do naturally to help improve your testosterone.
1:55:40
Speaker 2: That includes sleeping more than seven hours a night of quality,
1:55:43
Speaker 2: high quality sleep can increase your testosterone by 15%. If
1:55:47
Speaker 2: you have sleep apnea, there's actually been very good studies
1:55:51
Speaker 2: that when you use a CPAP, which is like a
1:55:52
Speaker 2: machine that helps people who have sleep apnea, they increase
1:55:55
Speaker 2: their testosterone quite significantly. So if you snore or you
1:55:58
Speaker 2: have a really big neck circumference, think about getting a
1:56:01
Speaker 2: sleep study to find out if you have sleep apnea
1:56:03
Speaker 2: because fixing that will fix so many of your issues,
1:56:06
Speaker 2: including your testosterone. It's actually like a risk. It's actually
1:56:10
Speaker 2: a mortality risk. People who have sleep apnea die sooner
1:56:14
Speaker 2: because they're not getting as much oxygen to their brain
1:56:16
Speaker 2: throughout the night and their organs. If you exercise, resistance training,
1:56:21
Speaker 2: heavy resistance training of your muscles can help boost testosterone.
1:56:26
Speaker 2: if you eat healthy. So meaning like what we, again,
1:56:30
Speaker 2: diet is very challenging to study and it's very difficult
1:56:33
Speaker 2: to give population-based data, but what we know on a
1:56:35
Speaker 2: population level is that Mediterranean-style diet, meaning prioritizing healthy fruits
1:56:41
Speaker 2: and vegetables, not unprocessed foods. I basically tell people unprocessed foods,
1:56:46
Speaker 2: natural foods, and ideally prioritizing fiber and protein are probably
1:56:51
Speaker 2: your best bets in terms of overall health for both
1:56:54
Speaker 2: testosterone and just overall health. And then with testosterone, importantly,
1:56:57
Speaker 2: you don't want to get on too low fat of
1:56:59
Speaker 2: a diet. Testosterone is a molecule that's made from cholesterol.
1:57:02
Speaker 2: And so if your fat goes too low, you won't
1:57:04
Speaker 2: make enough testosterone. And I think that's really valuable for
1:57:09
Speaker 2: military men is that you guys do a lot of
1:57:12
Speaker 2: really intense endurance work. When you do really intense endurance work,
1:57:18
Speaker 2: your testosterone goes down because it's like chronic stress. on
1:57:22
Speaker 2: your body. And so that is something to look out
1:57:24
Speaker 2: for is if you're doing a lot of intense endurance
1:57:27
Speaker 2: work during those times, you might be like, man, I'm exhausted. Yeah,
1:57:29
Speaker 2: you're doing a ton of endurance work, but also your
1:57:31
Speaker 2: testosterone is low. And so that can come back, obviously,
1:57:34
Speaker 2: when you stop doing those things. But it is something
1:57:37
Speaker 2: that you might notice during those stressful periods of time
1:57:39
Speaker 2: when you're putting your body through these really intense things.
1:57:42
Speaker 1: I mean, I've read lots of things, interviewed people about it.
1:57:46
Speaker 1: I mean, it seems like testosterone is declining in men
1:57:50
Speaker 1: at a rapid pace as years go on. And they
1:57:53
Speaker 1: talk about, you know, how kind of like the World
1:57:55
Speaker 1: War II generation, ever since then, it's just been on
1:57:59
Speaker 1: a decline. And so, you know, now TRT is, you know,
1:58:05
Speaker 1: wildly popular. Do you want to have, you know, is...
1:58:10
Speaker 1: is an older man, does an older man want the
1:58:13
Speaker 1: same level of testosterone he had when he was 20
1:58:17
Speaker 1: years old, 25 years old? I mean, it seems like,
1:58:20
Speaker 1: I mean, I don't know why you wouldn't want to
1:58:22
Speaker 1: have that, but I'm not a physician.
1:58:23
Speaker 2: Right, I mean, I think it's a good benchmark to
1:58:25
Speaker 2: know what it used to be, right? But at the
1:58:27
Speaker 2: end of the day, we have to see how you feel.
1:58:30
Speaker 2: So I think people get very fixated on numbers, and
1:58:32
Speaker 2: it's important numbers help guide us, but what should be
1:58:36
Speaker 2: guiding us is how you feel, right? So if you're like,
1:58:39
Speaker 2: I'm full of energy, I feel great, I'm having great sex,
1:58:43
Speaker 2: and my mood is great and I'm focused, I'm able
1:58:45
Speaker 2: to be productive, I don't feel a deficit in any
1:58:49
Speaker 2: area of my life, then who cares what your numbers are?
1:58:52
Speaker 2: You feel good and that's what matters, right? And I
1:58:55
Speaker 2: think that's important. Now, I do think that there's some
1:58:58
Speaker 2: value in keeping track of things because you wanna catch
1:59:01
Speaker 2: things before they become a real, like you don't wanna
1:59:03
Speaker 2: be miserable and can't get out of bed and can't
1:59:06
Speaker 2: move before you go see the doctor, right? You wanna
1:59:09
Speaker 2: sort of, be a little bit proactive. But again, I
1:59:13
Speaker 2: think it's not necessarily the number always that matters. It's
1:59:16
Speaker 2: we have to talk about what you feel. Where is
1:59:19
Speaker 2: the deficit? What's going on, right? Like I said, a
1:59:22
Speaker 2: lot of people think, oh, my erections aren't working. Testosterone
1:59:25
Speaker 2: is the answer. And that's not always the case. In fact,
1:59:28
Speaker 2: it's not very often the case. And so it's like
1:59:31
Speaker 2: we have to look at you as a person, not
1:59:34
Speaker 2: as a lab test or as a blood value. We
1:59:37
Speaker 2: need to look at you and be like, okay, what's
1:59:38
Speaker 2: going on in your life? what's outside of our clinic
1:59:42
Speaker 2: room or outside of, like, whatever this blood work is
1:59:44
Speaker 2: showing me, what else is going on, right? Like, are
1:59:47
Speaker 2: you having a ton of stress at work? Are you
1:59:49
Speaker 2: dealing with a financial calamity? Is your partner, like, super
1:59:53
Speaker 2: stressed because her mom's in the hospital and, like, it's
1:59:56
Speaker 2: affecting your whole life and homeostasis at home? Like, what
1:59:59
Speaker 2: is going on? Because you're not just one blood work.
2:00:03
Speaker 2: You are a whole person.
2:00:06
Speaker 1: Are there any, I mean, are there any concerns about
2:00:10
Speaker 1: going on testosterone replacement. I mean, I've heard that it
2:00:15
Speaker 1: can increase the risk of cancer, increase the rate of cancer,
2:00:20
Speaker 1: enlarge prostate. I've heard all kinds of things about it.
2:00:23
Speaker 2: So there's a lot of misinformation, and some of it
2:00:26
Speaker 2: was a misunderstanding that now we know better, but let
2:00:28
Speaker 2: me go through it. So testosterone replacement is, as I mentioned,
2:00:32
Speaker 2: very helpful in improving all those things that we've talked about. Now,
2:00:35
Speaker 2: what are the risks? The true risks. So in terms
2:00:38
Speaker 2: of the things you mentioned, cancer, testosterone replacement does not
2:00:42
Speaker 2: cause prostate cancer. We know that unequivocally. The issue is
2:00:47
Speaker 2: that if you develop prostate cancer, which one in eight
2:00:49
Speaker 2: men will get prostate cancer, and I give you testosterone,
2:00:52
Speaker 2: I don't know you have prostate cancer because it hasn't
2:00:55
Speaker 2: shown me yet. Your PSA is still normal. Everything else
2:00:58
Speaker 2: is fine, but maybe you were destined to get prostate cancer.
2:01:01
Speaker 2: And then you get prostate cancer. It will cause that
2:01:04
Speaker 2: prostate cancer once it's there to grow more rapidly. And
2:01:07
Speaker 2: so that's why it's really important if you go on
2:01:09
Speaker 2: testosterone replacement to get your PSA, which is a blood
2:01:13
Speaker 2: test and screening for prostate cancer, checked regularly. Because we
2:01:16
Speaker 2: want to make sure that, God forbid, you were 1
2:01:19
Speaker 2: in 8, that we stop the testosterone and we treat
2:01:22
Speaker 2: your prostate cancer, right? And we fix that because we
2:01:24
Speaker 2: don't want an untoward thing to happen. So that's one.
2:01:28
Speaker 2: In terms of enlarged prostate, they've also looked at that.
2:01:31
Speaker 2: And there's actually been no evidence that testosterone again, in
2:01:34
Speaker 2: and of itself causes an enlarged prostate. Now, if you
2:01:37
Speaker 2: already have an enlarged prostate and you have symptoms that
2:01:39
Speaker 2: are bothersome, um, you, when you give testosterone, it will
2:01:43
Speaker 2: cause a slight increase in both your PSA and it
2:01:46
Speaker 2: may cause a slight increase in the size of the prostate. Um,
2:01:50
Speaker 2: and so if you're already sort of struggling and I
2:01:52
Speaker 2: give you testosterone, it might make you struggle a little
2:01:54
Speaker 2: bit more. Whereas the average person, it won't bother them
2:01:56
Speaker 2: at all.
2:01:56
Speaker 1: Right.
2:01:57
Speaker 2: The one that it does sort of cause problems with
2:02:00
Speaker 2: is if you have that sleep apnea we talked about earlier.
2:02:02
Speaker 2: If you have really uncontrolled sleep apnea, it can make
2:02:05
Speaker 2: it worse because it's gonna increase muscle mass. It also
2:02:08
Speaker 2: increases the muscle mass in your neck, which then makes
2:02:11
Speaker 2: that sleep apnea worse. Now, usually that gets better with time,
2:02:14
Speaker 2: but if you're really like struggling with sleep apnea already
2:02:18
Speaker 2: and you're waking up all night and you can't breathe
2:02:20
Speaker 2: at night, it's gonna make it worse, right? And so
2:02:22
Speaker 2: that's one that we know. The other one that we
2:02:24
Speaker 2: absolutely know is that it can cause thickness of the blood,
2:02:28
Speaker 2: or it can increase what's caused your hematocrit. And when
2:02:30
Speaker 2: your blood gets too thick, and it's about like 7%
2:02:34
Speaker 2: of people who get this change, depending on which formulation
2:02:36
Speaker 2: of testosterone you go on, it causes you to be
2:02:40
Speaker 2: at a higher risk for blood clots and strokes. That
2:02:43
Speaker 2: we do know. Testosterone replacement will put you at higher
2:02:45
Speaker 2: risk for those things, so we need to keep a
2:02:47
Speaker 2: close eye on it.
2:02:48
Speaker 1: Absolutely.
2:02:50
Speaker 2: And so those are the big ones. In terms of like,
2:02:54
Speaker 2: I think the other big thing that people need to
2:02:55
Speaker 2: know is when you start on it, you need to
2:02:57
Speaker 2: think of it as you're going to be on it
2:02:58
Speaker 2: for life. Like you can do a trial, you can
2:03:00
Speaker 2: do like two or three months and be like, is it,
2:03:02
Speaker 2: am I noticing a difference? And if not go off
2:03:04
Speaker 2: of it, that's not so, so difficult. But it's, if
2:03:07
Speaker 2: you've been on it for years and years and years,
2:03:10
Speaker 2: if you go off of it, you are no longer,
2:03:12
Speaker 2: you've shut down your body's process of making testosterone. So
2:03:15
Speaker 2: you won't make any for a while and you will
2:03:17
Speaker 2: feel like crap for a while. until your body revs
2:03:20
Speaker 2: it up. Now, we can use off-label medications to sort
2:03:23
Speaker 2: of help jumpstart your body to making testosterone, but it's
2:03:26
Speaker 2: not something that every doctor does and that every doctor
2:03:28
Speaker 2: knows how to do. So I just tell people, like,
2:03:31
Speaker 2: think of it like you're gonna be on it for life.
2:03:32
Speaker 1: Is that HCG?
2:03:34
Speaker 2: Yeah, HCG or Clomid, both those things can be helpful,
2:03:37
Speaker 2: and FSH in some cases to help restart things. The
2:03:40
Speaker 2: other thing is if you wanna have kids, it will
2:03:43
Speaker 2: make you infertile. And not like your sperm count will
2:03:46
Speaker 2: go down to zero, but it will go down low
2:03:48
Speaker 2: enough that fertility becomes challenging. Now, everyone's heard of people
2:03:52
Speaker 2: who've been on steroids or on testosterone and have had babies.
2:03:55
Speaker 2: It's because it doesn't go down to zero. It goes
2:03:57
Speaker 2: down to a very low number. After about 18 months
2:04:00
Speaker 2: of being on it, you're pretty much at a very
2:04:02
Speaker 2: low number that would become impossible to, nearly virtually impossible
2:04:07
Speaker 2: to impregnate another person. So a lot of young guys,
2:04:10
Speaker 2: as you know, you mentioned like testosterone is declining. A
2:04:12
Speaker 2: lot of young guys are like, oh, I need testosterone.
2:04:14
Speaker 2: I don't feel well. And they do indeed have low testosterone.
2:04:18
Speaker 2: They start it because no one tells them that. Then
2:04:20
Speaker 2: they get married and they have one-up kids and now
2:04:22
Speaker 2: they're in a situation where they have little to no
2:04:25
Speaker 2: sperm and they have to sort of, again, use HCG, clomid,
2:04:28
Speaker 2: and try to get it back. But depending on how
2:04:30
Speaker 2: long you've been on it and how old you are,
2:04:33
Speaker 2: it can be more and more difficult.
2:04:35
Speaker 1: Okay, okay. So before we move on, I want to
2:04:39
Speaker 1: talk about prostate health and that stuff, but are there any... Basically,
2:04:46
Speaker 1: what I'm getting at is Gen Z. They're the up
2:04:49
Speaker 1: and coming generation. Is there substance abuse? Is there certain
2:04:54
Speaker 1: substances that can affect erectile dysfunction, that can affect hormones, testosterone?
2:05:03
Speaker 2: So we know smoking unequivocally. I mean, I don't think
2:05:05
Speaker 2: this generation smokes that much, but they do vape. So
2:05:08
Speaker 2: smoking It can affect erections, absolutely. It will destroy your
2:05:12
Speaker 2: erections because it's going to destroy the blood vessel health.
2:05:14
Speaker 2: And again, those blood vessels of the penis are really,
2:05:17
Speaker 2: really small. So you're going to see issues with erections
2:05:19
Speaker 2: before anything else. So if you're smoking, I'm like, this
2:05:22
Speaker 2: is the best non-smoking ad is just like, don't smoke
2:05:26
Speaker 2: to help protect your erections. I think everyone would quit, right?
2:05:28
Speaker 2: I think instead of like all the, like the showing people,
2:05:30
Speaker 2: like people with lung cancer, they should have shown like
2:05:33
Speaker 2: a penis that doesn't work. I think people would have
2:05:34
Speaker 2: quit smoking a lot faster. So that's one. But a
2:05:39
Speaker 2: lot of young people are using marijuana. And marijuana, chronic
2:05:44
Speaker 2: use of marijuana can absolutely lower testosterone and cause issues
2:05:49
Speaker 2: with hormonal health. Really? Yes. So when you're using it chronically,
2:05:53
Speaker 2: you will see that, and it can cause issues with fertility.
2:05:56
Speaker 2: So we see a lot of young guys who are
2:05:58
Speaker 2: trying to have kids, and they use marijuana all the time,
2:06:03
Speaker 2: and for a variety of reasons, recreation, whatever, and now
2:06:06
Speaker 2: they have really poor semen health, poor sperm health, and
2:06:10
Speaker 2: they can't get their partner pregnant. I think, you know,
2:06:13
Speaker 2: marijuana use is legal in some states and it's okay
2:06:17
Speaker 2: on occasion, recreationally. We don't know if there's a, like a,
2:06:21
Speaker 2: like we know now that alcohol is not healthy in
2:06:23
Speaker 2: any amount, but we don't have that same granularity about
2:06:26
Speaker 2: marijuana in terms of is any bad. But definitely chronic
2:06:29
Speaker 2: use is bad for your sexual health and your hormonal health.
2:06:32
Speaker 1: What is chronic use?
2:06:34
Speaker 2: So chronic use is like every day or multiple times
2:06:37
Speaker 2: a week. And, you know, if someone is like feeling
2:06:41
Speaker 2: sort of like, They are always mellow because they're on it.
2:06:46
Speaker 2: They're always sort of like, basically they're feeling the effects
2:06:49
Speaker 2: of marijuana. They need the effects and they're almost like
2:06:51
Speaker 2: using it because those effects feel so good and they're
2:06:53
Speaker 2: using it all the time. That's probably a sign they're
2:06:55
Speaker 2: using it too much.
2:06:57
Speaker 1: Okay, okay. And so let's get back to prostate cancer.
2:07:00
Speaker 1: What age should men be checking their prostates?
2:07:04
Speaker 2: Yes, so the guidelines would say 55 is the age
2:07:07
Speaker 2: to start screening for prostate cancer. I would say also
2:07:13
Speaker 2: if you have a family history of prostate cancer, specifically
2:07:17
Speaker 2: your dad or your brother, meaning direct first-degree relatives, that
2:07:21
Speaker 2: puts you at a much higher risk. If you're African-American,
2:07:23
Speaker 2: that puts you at a higher risk. If you have
2:07:26
Speaker 2: a BRCA gene, so if your mom had breast cancer
2:07:29
Speaker 2: and has a BRCA gene, positive, that also puts you
2:07:32
Speaker 2: at risk for breast cancer. Or if you have multiple
2:07:34
Speaker 2: cancers in your family, I would still encourage you to
2:07:36
Speaker 2: get tested earlier. And so that would be based on
2:07:40
Speaker 2: at least five years earlier, or if your parent or
2:07:42
Speaker 2: brother had prostate cancer, let's say at 50, I would
2:07:45
Speaker 2: start testing you at 45. And so what is the test?
2:07:48
Speaker 2: So I think it always used to be a prostate
2:07:52
Speaker 2: exam and a blood test. Nowadays, the prostate exam, which
2:07:56
Speaker 2: is a finger in the bottom, is sort of, decided
2:08:01
Speaker 2: it's not always necessary. So urologists, we do prostate exams
2:08:05
Speaker 2: all the time. We know what we're looking for. We
2:08:07
Speaker 2: know how to do an exam very well. But General practitioners,
2:08:11
Speaker 2: primary care doctors, family care doctors, what we found is
2:08:13
Speaker 2: like they don't always really know what they're feeling for
2:08:15
Speaker 2: because they don't always necessarily like feel abnormal prostates. It's
2:08:19
Speaker 2: not like their area of focus. And so it was
2:08:21
Speaker 2: actually creating a lot of false positives where people were like, oh,
2:08:23
Speaker 2: I feel something. So I need the urologist. Now the
2:08:25
Speaker 2: urologist has to like do a biopsy, which is unnecessary. And,
2:08:28
Speaker 2: you know, it sort of led to this unnecessary like
2:08:32
Speaker 2: further testing and evaluations. So they said, okay, based on that,
2:08:36
Speaker 2: we don't necessarily recommend that everyone needs a prostate exam.
2:08:39
Speaker 2: I still think that if you're going to a urologist,
2:08:42
Speaker 2: it's valuable to get one because we know what we're
2:08:44
Speaker 2: looking for. But a PSA is a simple blood test.
2:08:47
Speaker 2: It's a screening test. So it doesn't tell you yes
2:08:49
Speaker 2: or no, you have prostate cancer, but as a quick
2:08:51
Speaker 2: and easy way to say, okay, maybe you're at risk.
2:08:54
Speaker 2: But there's other things that can increase your PSA. That
2:08:57
Speaker 2: can be inflammation. So you might have had masturbated, or
2:09:02
Speaker 2: you might have sat on a bike seat, or you
2:09:04
Speaker 2: might have had some sort of low-grade inflammation that you
2:09:07
Speaker 2: didn't really know, and that can cause an increase in PSA.
2:09:10
Speaker 2: You can have bleeding in the genitourinary tract for whatever reason,
2:09:13
Speaker 2: that can increase your PSA. If you went to the
2:09:15
Speaker 2: hospital and you had a catheter placed or anything in
2:09:18
Speaker 2: the urethra, that can increase your PSA. So there's a
2:09:20
Speaker 2: variety of different things that can increase your PSA. So
2:09:23
Speaker 2: this is why it's a screening test. It's not yes
2:09:25
Speaker 2: or no, it just says, okay, you might be at risk,
2:09:27
Speaker 2: now what.
2:09:27
Speaker 1: Do we do?
2:09:28
Speaker 2: So if it's high, Usually we'll check a second one
2:09:30
Speaker 2: to make sure it's not inflammation, it's not anything else.
2:09:33
Speaker 2: And if it's still high, then we talk about what's
2:09:35
Speaker 2: the next step. So before it used to be straight
2:09:37
Speaker 2: to biopsy, right? You go and you get a biopsy
2:09:39
Speaker 2: of your prostate. Now we have a lot of different things,
2:09:42
Speaker 2: but the biggest and most sort of revolutionary in urology
2:09:45
Speaker 2: has been just a prostate MRI. Because now they've looked
2:09:49
Speaker 2: at prostate MRIs and they found this sort of grading
2:09:51
Speaker 2: scale to say like, okay, you do an MRI and
2:09:53
Speaker 2: you see if there's any areas that look concerning and
2:09:56
Speaker 2: you grade them based on the way they look. And
2:09:59
Speaker 2: from one to five, one being like very unlikely cancer,
2:10:01
Speaker 2: five being like very highly likely cancer. So that gives
2:10:04
Speaker 2: you more of a degree of confidence on like, okay,
2:10:06
Speaker 2: do we need to biopsy this? And if so, where
2:10:09
Speaker 2: are we biopsying? Because when we do a biopsy in urology,
2:10:12
Speaker 2: when I was training, it was like, we're just poking
2:10:14
Speaker 2: 12 areas in the prostate randomly. Like, I mean, obviously throughout,
2:10:18
Speaker 2: we're doing it systematically. So we get a little bit
2:10:20
Speaker 2: of every little bit of it, but we just go,
2:10:23
Speaker 2: you know, we're just getting 12 random cores in the prostate.
2:10:26
Speaker 2: Now we can do it with a little bit of
2:10:27
Speaker 2: degree of like, okay, now we have this MRI. We can,
2:10:30
Speaker 2: you know, overlay it on the ultrasound and see where
2:10:32
Speaker 2: we're going to biopsy. And so that's helpful. And also
2:10:37
Speaker 2: if you have, like, if you have a high prostate
2:10:39
Speaker 2: and your prostate's huge, which is also another reason that
2:10:42
Speaker 2: your PSA can increase, and there's no lesions on your MRI,
2:10:45
Speaker 2: I might say, hey, let's keep an eye on it.
2:10:47
Speaker 2: Everything looks good on this MRI and you have a
2:10:48
Speaker 2: very big prostate, which also causes an increase in PSA.
2:10:52
Speaker 2: Let's keep an eye on it. You know, we don't
2:10:53
Speaker 2: need to do a biopsy at this time. So it
2:10:55
Speaker 2: can sort of help us decide. And there's a bunch
2:10:58
Speaker 2: of different biomarkers and urine markers that we can test if,
2:11:03
Speaker 2: you know, we want to sort of get a little
2:11:05
Speaker 2: bit more granularity. Now, there's not like one that's better
2:11:07
Speaker 2: than the other, and I would say talk to a
2:11:09
Speaker 2: specialist in prostate cancer, a uro-oncologist, when you're deciding if
2:11:13
Speaker 2: you want to get more testing before you either get
2:11:15
Speaker 2: a biopsy or get treatment if you do find that
2:11:18
Speaker 2: you have prostate cancer.
2:11:19
Speaker 1: I mean, what are some symptoms? that people should be
2:11:23
Speaker 1: looking out for?
2:11:23
Speaker 2: Most people have no symptoms. This is why we have screening.
2:11:26
Speaker 2: This is why we do screening. Most people have no symptoms.
2:11:29
Speaker 2: And by the time they get symptoms, it's actually a problem.
2:11:32
Speaker 2: It's usually like a more advanced cancer. So symptoms could
2:11:35
Speaker 2: be that you have blood in the urine, could be
2:11:38
Speaker 2: that you have back pain, Could be that you have
2:11:40
Speaker 2: night sweats or weight loss. Could be that you have, uh,
2:11:43
Speaker 2: are going to the bathroom a lot or more frequently
2:11:45
Speaker 2: or having trouble peeing. But those can also be signs
2:11:47
Speaker 2: of an enlarged prostate. So, we don't, that's why we
2:11:50
Speaker 2: do screening. We don't rely on symptoms. And absolutely, if
2:11:52
Speaker 2: you're having symptoms, we should screen you for prostate cancer
2:11:55
Speaker 2: at that time, too. But, um, you know, in general,
2:11:59
Speaker 2: that's why we do screening on people who have no symptoms,
2:12:01
Speaker 2: because that's when we find it.
2:12:03
Speaker 1: So, okay, so, I mean, when it comes to an
2:12:05
Speaker 1: enlarged prostate, I mean, can it be, can it, can
2:12:08
Speaker 1: it be reduced?
2:12:09
Speaker 2: Yeah, so an enlarged prostate, so I will say 80%
2:12:13
Speaker 2: of 80-year-olds have an enlarged prostate and 80% of 80-year-olds
2:12:17
Speaker 2: also have prostate cancer. So if I took all like
2:12:21
Speaker 2: autopsy studies and you look at the prostates of 80-year-olds,
2:12:23
Speaker 2: they all have some focus of prostate cancer. So before
2:12:26
Speaker 2: I get into enlarged prostate, I want to round out
2:12:28
Speaker 2: that discussion because I think it's important to understand this,
2:12:31
Speaker 2: is that if I diagnose you today with prostate cancer
2:12:35
Speaker 2: and and you are 70 years old and you are
2:12:38
Speaker 2: really unhealthy and your dad died at 75 and you
2:12:41
Speaker 2: also have so many medical issues that you will likely
2:12:44
Speaker 2: pass in the next 10 to 15 years, I should
2:12:47
Speaker 2: do nothing about that prostate cancer because something else is
2:12:50
Speaker 2: gonna kill you long before the prostate cancer does because
2:12:53
Speaker 2: it is very slow growing. And it's really important for
2:12:57
Speaker 2: people to understand. Nobody wants to face their mortality or
2:13:00
Speaker 2: think about how long they're going to live. But I'll
2:13:02
Speaker 2: give you a personal example. My grandfather got prostate cancer
2:13:06
Speaker 2: in his 70s. No one talked to me about it.
2:13:08
Speaker 2: I was in residency, and they put him through radiation.
2:13:14
Speaker 2: And a couple years later, he died from a heart attack.
2:13:17
Speaker 2: And if they had asked me, I would have told them,
2:13:18
Speaker 2: don't do anything about this prostate cancer. He's not healthy.
2:13:20
Speaker 2: He's 70 years old. And he just went through this
2:13:23
Speaker 2: radiation for no reason, right? Now, if he was 60
2:13:26
Speaker 2: and he was healthy or even 70 and healthy, I
2:13:29
Speaker 2: would have said, yeah, treat it. But I think this
2:13:31
Speaker 2: is a really important discussion because not all prostate cancer
2:13:35
Speaker 2: needs to be treated. And some can even be watched.
2:13:38
Speaker 2: So we have protocols like active surveillance protocols where we
2:13:41
Speaker 2: can do routine MRIs and biopsies and keep an eye
2:13:45
Speaker 2: on it. Because as I mentioned, it's slow growing and
2:13:47
Speaker 2: some people will never become a problem. And so we're
2:13:49
Speaker 2: trying to find those people and not put them through
2:13:52
Speaker 2: surgeries or radiation that have multiple side effects and potential
2:13:56
Speaker 2: complications because they won't need it. So I think it's
2:13:59
Speaker 2: really important before we talk about enlarged prostate to just
2:14:02
Speaker 2: get that point out there because I see so many
2:14:05
Speaker 2: people who are like, no, I just want to know.
2:14:07
Speaker 2: Do you really want to know though? Because once you know,
2:14:09
Speaker 2: then the urge is to do something about it. And
2:14:12
Speaker 2: then you might do something about it that you didn't
2:14:14
Speaker 2: need to do and have a side effect that you
2:14:15
Speaker 2: have to live with for the rest of your life.
2:14:18
Speaker 2: So there's a lot of regret in some guys who
2:14:20
Speaker 2: have prostate cancer treatment because they may develop erectile dysfunction
2:14:24
Speaker 2: or urinary problems afterwards. And now they could have lived
2:14:29
Speaker 2: without those things because they maybe didn't even need the treatment. Now,
2:14:33
Speaker 2: it's very individual. It's a very individual discussion to have
2:14:36
Speaker 2: because every prostate cancer is a little bit different. And
2:14:39
Speaker 2: some look more aggressive and some are less aggressive. And
2:14:42
Speaker 2: we grade them and we use all these nomograms to
2:14:44
Speaker 2: do that. I'm not going to belabor all the specific nuances,
2:14:48
Speaker 2: but I just think it's really important to have that discussion.
2:14:50
Speaker 1: Thank you for saying that. Enlarge prostate.
2:14:55
Speaker 2: Yes. So enlarged prostate is very common as well. Enlarged
2:14:58
Speaker 2: prostate occurs because of a variety of different things. So one,
2:15:03
Speaker 2: we know genetics. So if your dad had an enlarged
2:15:06
Speaker 2: prostate and he was young, you are likely also going
2:15:09
Speaker 2: to have an enlarged prostate. And sometimes you'll know because
2:15:12
Speaker 2: he won't tell you that, but you might remember, oh,
2:15:14
Speaker 2: my dad was always going to the bathroom or he
2:15:15
Speaker 2: was in the bathroom for so long trying to empty
2:15:17
Speaker 2: his bladder. You might remember those things or he might
2:15:19
Speaker 2: tell you that. So that's one. Two is we know
2:15:23
Speaker 2: like as you are more unhealthy, that causes more inflammation
2:15:27
Speaker 2: in your entire body, right? So if you have other
2:15:29
Speaker 2: metabolic issues, your prostate will also get inflamed. And then
2:15:32
Speaker 2: that inflammation causes growth. And then growth causes more inflammation
2:15:36
Speaker 2: that then causes growth. So it creates a sort of
2:15:38
Speaker 2: vicious cycle in the prostate. Those are the common reasons
2:15:42
Speaker 2: why prostates grow. But most guys have some degree of enlargement. Now,
2:15:47
Speaker 2: what does that mean for you, right? So can you
2:15:49
Speaker 2: prevent it? Let's start with that. So people always want
2:15:51
Speaker 2: to know, can I prevent it or can I shrink it?
2:15:54
Speaker 2: Once it's grown, I don't think you can necessarily shrink it,
2:15:57
Speaker 2: but you can definitely prevent it. So there's some data,
2:15:59
Speaker 2: there's not a ton of data on this, but basically
2:16:02
Speaker 2: they did trials looking at people for prostate cancer prevention
2:16:05
Speaker 2: and they looked at a whole bunch of different factors.
2:16:08
Speaker 2: But in that, they also looked at enlarged prostate. And
2:16:10
Speaker 2: what they found was that people who ate more vegetables
2:16:13
Speaker 2: tended to have less prostate, less enlarged prostate. People who ate,
2:16:17
Speaker 2: who walked more, so two hours of walking a week
2:16:20
Speaker 2: even was good. So exercise, generally speaking, tended to have
2:16:24
Speaker 2: a lower risk. Maybe lycopene, so like this is red-based tomatoes, watermelon,
2:16:31
Speaker 2: like fruits and vegetables that are red in color may
2:16:34
Speaker 2: have a protective benefit. So I'll tell people like generally
2:16:38
Speaker 2: leading a healthy life, exercise and diet can help potentially
2:16:43
Speaker 2: reduce your risk of prostate cancer. Whereas like if you
2:16:46
Speaker 2: have that enlarged prostate, if you have diabetes, your risk
2:16:49
Speaker 2: goes up of having enlarged prostate. If you have high
2:16:52
Speaker 2: blood pressure, your risk of having enlarged prostate goes up.
2:16:55
Speaker 2: So again, the same sort of things, the unsexy things
2:16:58
Speaker 2: will help prevent that. Now, when you have an enlarged prostate,
2:17:02
Speaker 2: I think people always assume like it's very simple. Like, oh,
2:17:05
Speaker 2: you have an enlarged prostate. You have a problem with urination.
2:17:08
Speaker 2: That's all there is to it. But it's actually a
2:17:09
Speaker 2: little bit more complex. You can have a big prostate
2:17:12
Speaker 2: and have no problems. And you can have a small
2:17:14
Speaker 2: prostate and have problems. It's really based on how it's
2:17:16
Speaker 2: shaped and how it's blocking the flow of urine. Because
2:17:20
Speaker 2: the prostate sits underneath the bladder around the urethra. So
2:17:23
Speaker 2: when it gets big, it can get big on the
2:17:26
Speaker 2: outside or get big on the inside. If it gets
2:17:27
Speaker 2: big on the inside and it blocks the flow of urine,
2:17:30
Speaker 2: you can start having trouble peeing. Now, it can also
2:17:34
Speaker 2: affect your bladder, because now your bladder is pushing to
2:17:37
Speaker 2: get urine through that prostate. So sometimes guys will present
2:17:40
Speaker 2: with what we call, there's two categories. There's voiding symptoms,
2:17:44
Speaker 2: so that means that they can't pee, they're waiting for
2:17:47
Speaker 2: their stream to start, their stream is weak, or stopping
2:17:50
Speaker 2: and starting takes a long time and they don't feel
2:17:53
Speaker 2: like they empty that's one type and oftentimes with both
2:17:57
Speaker 2: types they'll wake up a lot at night to pee
2:17:59
Speaker 2: and then with the other type which is called storage
2:18:02
Speaker 2: symptoms or bladder symptoms so the bladder is responding to
2:18:05
Speaker 2: this blockage because the bladder's like, oh, I can't, it's
2:18:08
Speaker 2: not clear, so I'm gonna work harder. So I'm gonna
2:18:11
Speaker 2: have more overactivity, I'm gonna go more often, I'm gonna
2:18:14
Speaker 2: feel the urge to go more often, and it's gonna
2:18:16
Speaker 2: be really, just really bothersome to me, right? And so
2:18:20
Speaker 2: those are also common. Now, which kind of symptoms you
2:18:23
Speaker 2: have doesn't really necessarily affect what we do unless you
2:18:28
Speaker 2: have other issues. So if you're like diabetic or you've
2:18:31
Speaker 2: had nerve injuries, then we're wondering, is it the prostate
2:18:34
Speaker 2: or is it the bladder? Because those things can affect
2:18:36
Speaker 2: the bladder. But for most guys, it's because of the blockage.
2:18:39
Speaker 2: And when we fix the blockage, all the symptoms get better.
2:18:42
Speaker 2: And we can fix the blockage in a variety of
2:18:44
Speaker 2: different ways. For, again, lifestyle, you can do some things
2:18:50
Speaker 2: to reduce the irritation related to enlargement. So you can
2:18:54
Speaker 2: limit how much you drink before bedtime so you're not
2:18:56
Speaker 2: waking up as often. So we'll tell people don't drink
2:18:59
Speaker 2: like two hours before bed. We'll also tell people like,
2:19:02
Speaker 2: look at what you're drinking and eating, because certain things
2:19:05
Speaker 2: can irritate the bladder, which can then make things a
2:19:07
Speaker 2: lot worse. So things like caffeine, alcohol. For some people,
2:19:11
Speaker 2: spicy foods, acidic foods like tomatoes and citrusy fruits and juices,
2:19:17
Speaker 2: even artificial sweeteners for some people. So I tell people,
2:19:20
Speaker 2: make a journal, see what you're eating and drinking, and
2:19:22
Speaker 2: take a note of your symptoms. pay attention. You're smart.
2:19:26
Speaker 2: You can figure out like, oh, I had a coffee.
2:19:28
Speaker 2: I had three coffees this morning and I'm going to
2:19:30
Speaker 2: the bathroom more often. So maybe I should just drink
2:19:32
Speaker 2: one and drink two decafs if I love my coffee.
2:19:34
Speaker 2: Cause you won't take my coffee from me. I won't
2:19:36
Speaker 2: take your coffee from you. Um, so, so I think
2:19:39
Speaker 2: like those are, those are things you can do also
2:19:41
Speaker 2: if you're constipated. So many people don't know this, but
2:19:44
Speaker 2: when you're constipated, you're affecting your bladder. So it will
2:19:47
Speaker 2: worsen all your symptoms, whether you're having more trouble peeing
2:19:50
Speaker 2: or you're going more often and more urgently. So if
2:19:52
Speaker 2: you're constipated, you need to correct that. So whether that's
2:19:56
Speaker 2: with adding more fiber in your diet, adding supplemental fiber
2:19:59
Speaker 2: or taking medication to help you go better or moving more,
2:20:03
Speaker 2: those things can all help improve constipation. So those are
2:20:06
Speaker 2: things that you can do in your lifestyle to improve.
2:20:09
Speaker 2: And then also like trying to go twice. So for
2:20:11
Speaker 2: some people, some guys, sitting is actually easier to empty
2:20:15
Speaker 2: their bladder when they have an enlarged prostate. For some guys,
2:20:17
Speaker 2: they still want to stand. But it could be that
2:20:19
Speaker 2: you need to pee standing up and you got to
2:20:21
Speaker 2: sit down and pee again and try to empty your
2:20:23
Speaker 2: bladder completely. Or you need to like take a deep
2:20:25
Speaker 2: breath and sort of relax the muscles a little bit,
2:20:27
Speaker 2: try to work on that and then pee again. So
2:20:30
Speaker 2: there are little things that you can do to make
2:20:32
Speaker 2: your life a little better. But very often we'll do,
2:20:35
Speaker 2: there's medical options and there's surgical options to help reduce
2:20:39
Speaker 2: the prostates. And so that's important to talk to your
2:20:42
Speaker 2: doctor about, but really the thing that I want all
2:20:44
Speaker 2: guys to know is that a lot of these treatments
2:20:46
Speaker 2: do have side effects that can affect ejaculation. So a
2:20:51
Speaker 2: lot of guys feel like when they ejaculate, that is
2:20:54
Speaker 2: a big source of pleasure for them. Not just the orgasm,
2:20:57
Speaker 2: but the actual act of ejaculation. And so a lot
2:21:00
Speaker 2: of these treatments, medical or surgical, can affect how much
2:21:04
Speaker 2: ejaculate comes out. And so if that's important to you,
2:21:07
Speaker 2: because sometimes If you're with someone who's rushed that day
2:21:11
Speaker 2: and may forget to tell you that that's a side effect, right,
2:21:14
Speaker 2: of the medication they're gonna give you or the surgery
2:21:16
Speaker 2: they're gonna give you, then you will be really unhappy
2:21:19
Speaker 2: after the fact. And so I just want people to
2:21:22
Speaker 2: know that because there's always trade-offs, right? Sometimes we treat
2:21:26
Speaker 2: something and there may be a side effect. But if
2:21:28
Speaker 2: you are literally not emptying your bladder and you're getting
2:21:30
Speaker 2: recurrent bladder infections or bladder stones or you're bleeding a ton,
2:21:33
Speaker 2: like we need to do something. Whereas other times it's just,
2:21:37
Speaker 2: quality of life. We want to improve your quality of life.
2:21:42
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2:23:57
Speaker 1: What about a prostate massage? Does that help at all?
2:24:00
Speaker 1: What is that? Is that simply for pleasure?
2:24:02
Speaker 2: Yeah, so prostate massage, actually when we were, probably when
2:24:06
Speaker 2: I was younger, long before I trained in urology, it
2:24:09
Speaker 2: was actually a thing that urologists did. So it's essentially
2:24:13
Speaker 2: like a prostate exam. You insert a lubricated finger into
2:24:15
Speaker 2: the anus and you actually massage the prostate with your finger.
2:24:18
Speaker 2: So you sort of stroke the prostate and all the
2:24:22
Speaker 2: zones of it. And that was thought to sort of
2:24:27
Speaker 2: help alleviate some potential, usually for prostatitis. So when people
2:24:32
Speaker 2: had inflamed prostate, they would do it for that because
2:24:34
Speaker 2: they thought that it might actually sort of cause some
2:24:37
Speaker 2: relaxation maybe of the muscles. It might cause some expression
2:24:41
Speaker 2: of fluid that's stored up in the prostate when you
2:24:44
Speaker 2: ejaculate or when you pee the next time. And so
2:24:47
Speaker 2: that was thought to maybe help. And so the studies
2:24:49
Speaker 2: that originally showed potentially some benefit ultimately didn't show any
2:24:54
Speaker 2: long-term benefits. So I would say that prostate massage, some
2:24:58
Speaker 2: people still find it useful. Like just because a study
2:25:00
Speaker 2: said it doesn't do something doesn't mean that an individual
2:25:02
Speaker 2: can't find it helpful. Some people still do find it
2:25:05
Speaker 2: helpful to massage their prostate for prostatitis or for other issues.
2:25:10
Speaker 2: But in terms of like something that we do as
2:25:12
Speaker 2: a medical community, not so much anymore based on the
2:25:15
Speaker 2: data we have. A lot of guys find it pleasurable
2:25:19
Speaker 2: to have their prostate massage or include prostate play in
2:25:24
Speaker 2: the bedroom. And so, I think that, you know, it's
2:25:26
Speaker 2: great if you're open to exploring that. Like, yeah, you
2:25:29
Speaker 2: might find it, like, unlocks a little bit of pleasure
2:25:31
Speaker 2: for you. You might not. But I think it's really
2:25:34
Speaker 2: a very individual choice, and if that's something you're interested in,
2:25:37
Speaker 2: by all means.
2:25:38
Speaker 1: Okay. Let's talk about the effects of pornography in.
2:25:46
Speaker 1: Your real sex life.
2:25:47
Speaker 2: Yes. So, pornography has really changed. So when I was younger, right,
2:25:52
Speaker 2: you had to get a VCR, you had to go
2:25:54
Speaker 2: to a sketchy store and, like, find a tape and, like,
2:25:59
Speaker 2: find a place to watch it. And, you know, it
2:26:01
Speaker 2: was very difficult. Or you had to have a magazine
2:26:02
Speaker 2: that was, like, hidden under, you know, somewhere. And so
2:26:05
Speaker 2: it was not easy and it was not accessible. And
2:26:07
Speaker 2: it was definitely very different than what porn looks like today. Now,
2:26:11
Speaker 2: I think that porn, um, there are some things I
2:26:14
Speaker 2: feel strongly about in terms of, like, I don't think
2:26:16
Speaker 2: children should watch porn. I don't think that, um, It
2:26:20
Speaker 2: should be so readily accessible to people. Like, I think
2:26:23
Speaker 2: there should be some challenges in getting access to porn
2:26:27
Speaker 2: because I think that that makes it much more difficult
2:26:30
Speaker 2: to want to engage in real life, like, desire and sex. And, like,
2:26:36
Speaker 2: you know, it does sort of make it more difficult
2:26:38
Speaker 2: for some people to enjoy regular porn. or even seek
2:26:43
Speaker 2: out regular sex because they have these, like, very exotic
2:26:47
Speaker 2: and erotic things very easily accessible. However, a lot of people,
2:26:51
Speaker 2: adults who are fully frontal, like, fully formed frontal lobes,
2:26:55
Speaker 2: can use pornography in a very normal, healthy way. And
2:26:59
Speaker 2: I think it's very individual. People tend to know when
2:27:02
Speaker 2: they have an issue with pornography, right? They're like, oh,
2:27:04
Speaker 2: I'm using it all the time. I don't enjoy my
2:27:07
Speaker 2: partner as much. Nothing is as good as what I
2:27:09
Speaker 2: feel like when I watch porn. I find myself using
2:27:12
Speaker 2: it more than I actually want to have sex with
2:27:14
Speaker 2: my partner. I find I'm using it more than when
2:27:17
Speaker 2: I want to go out and hang out with my friends.
2:27:19
Speaker 2: And so like you sort of start seeing the issues, right?
2:27:22
Speaker 2: You start seeing it in yourself, but it creates a
2:27:24
Speaker 2: shame spiral, right? So you're like, oh, I use porn.
2:27:27
Speaker 2: It makes me feel bad. And some of that may
2:27:30
Speaker 2: be also because you have a moral incongruence. Like you
2:27:32
Speaker 2: think porn is bad and you use it, you feel bad, right?
2:27:35
Speaker 2: And then you're like, oh man, I feel bad, but
2:27:36
Speaker 2: I need to feel good again. So I'm gonna use
2:27:38
Speaker 2: it because it temporarily makes me feel good and I
2:27:40
Speaker 2: feel even worse. And it creates this sort of shame spiral,
2:27:43
Speaker 2: which can be really debilitating for people. Now, what I'm
2:27:46
Speaker 2: seeing in the younger generation is that they've only learned
2:27:49
Speaker 2: about sex through porn because no one talked to them
2:27:51
Speaker 2: about it. And so they watch porn, they think, this
2:27:54
Speaker 2: is how I have sex and this is how I
2:27:56
Speaker 2: get my partner to orgasm. And when they actually go
2:28:00
Speaker 2: to have sex with their partner, it does not go
2:28:02
Speaker 2: anything like that because porn is a produced product. It
2:28:04
Speaker 2: is meant for entertainment. It is not real life. It
2:28:07
Speaker 2: is meant, the camera angles, everything is meant for the
2:28:10
Speaker 2: viewer's enjoyment. It is not for the pleasure of the
2:28:13
Speaker 2: actual people having sex. They are actors. And so when
2:28:17
Speaker 2: they go and they have sex with their partner, it
2:28:19
Speaker 2: doesn't go the way they thought it was. And now
2:28:21
Speaker 2: they think they're broken. They think something's wrong with them.
2:28:24
Speaker 2: And so that's a real problem. because it creates these
2:28:27
Speaker 2: unrealistic expectations on both sides, right? Men feel like they
2:28:30
Speaker 2: don't look or have the same results as the porn star,
2:28:36
Speaker 2: and women also feel like, I don't climax immediately upon penetration,
2:28:39
Speaker 2: or I don't look like that, and something's wrong with me.
2:28:43
Speaker 2: And so it creates these really unrealistic expectations. So that's
2:28:46
Speaker 2: a problem. But when you have a fully formed frontal lobe,
2:28:49
Speaker 2: you understand that it's a fake product, you can use
2:28:52
Speaker 2: it as a way to have arousal from time to time.
2:28:55
Speaker 2: Should it be your only source of arousal? No, I
2:28:57
Speaker 2: don't think so. Can it be used in a healthy way? Yes,
2:29:00
Speaker 2: I think it can. And I think most people do
2:29:03
Speaker 2: use it. Most people use it, period. And I think
2:29:07
Speaker 2: a lot of people can use it in a healthy way.
2:29:09
Speaker 2: But I do think there are some caveats. And I
2:29:11
Speaker 2: do think it should not be like, accessible because I
2:29:15
Speaker 2: worry about kids. And on average, kids see porn at 10.
2:29:20
Speaker 1: Man.
2:29:21
Speaker 2: And so I've, long before my kid turned 10, I
2:29:23
Speaker 2: talked to him about porn. I said, you might see this.
2:29:25
Speaker 2: You might see something that makes you confused. You might
2:29:28
Speaker 2: see people having sex. Your friend might show you on
2:29:30
Speaker 2: their phone. Something might happen. I want you to know
2:29:32
Speaker 2: this is not real. And I want you to talk
2:29:35
Speaker 2: to me about it and feel open to talk to
2:29:37
Speaker 2: me about it. Because I don't want you to be confused. That's,
2:29:41
Speaker 2: you know, I don't want you to feel like that's
2:29:43
Speaker 2: what real sex is like. Mm-hmm.
2:29:45
Speaker 1: Do you, I mean... When you talk to patients about,
2:29:49
Speaker 1: you know, porn addiction or just porn in general, I mean,
2:29:53
Speaker 1: do you, and we covered this a little bit earlier,
2:29:55
Speaker 1: but I mean, do you feel like it would be,
2:29:58
Speaker 1: is it healthier to save that for your partner?
2:30:01
Speaker 2: I think it depends on the person. So, I think that, like,
2:30:05
Speaker 2: you know, you should vary your arousal. It should not
2:30:08
Speaker 2: all be based on pornography. So you should be able
2:30:11
Speaker 2: to get aroused by thinking. You should be able to
2:30:14
Speaker 2: get aroused by fantasizing. And if you want to use
2:30:18
Speaker 2: porn occasionally, it can be nice to explore other areas
2:30:23
Speaker 2: of things that might be of interest to you, to
2:30:25
Speaker 2: learn maybe something else that might turn you on that
2:30:27
Speaker 2: you never thought of before. It can be, as a couple,
2:30:30
Speaker 2: if you are both on the same page and you
2:30:32
Speaker 2: watch it together, it can actually increase sexual satisfaction and
2:30:37
Speaker 2: relationship factors. We've seen that in studies. But again, I
2:30:41
Speaker 2: think it's very individual. And I think that if you
2:30:45
Speaker 2: are finding yourself solely relying on porn, like you cannot
2:30:49
Speaker 2: masturbate without porn, then that's a red flag to me.
2:30:52
Speaker 2: You should be able to have arousal without that. Like
2:30:55
Speaker 2: I remember when I was in medical school, I had
2:30:58
Speaker 2: a friend be like, I love springtime in New York.
2:31:00
Speaker 2: And I was like, why? He's like, because it's the
2:31:02
Speaker 2: sexiest time. girls are all wearing skirts and like, you know,
2:31:05
Speaker 2: you can see more skin. And I was like, it's
2:31:07
Speaker 2: so funny to me now because nobody would ever say
2:31:10
Speaker 2: that now. Because it's like... you don't need to wait
2:31:14
Speaker 2: till springtime. Like, you just look at your phone and
2:31:18
Speaker 2: you'll see whatever you want. And so, like, there's no, like, it's, like,
2:31:21
Speaker 2: the simple things. And think about even, like, way back
2:31:24
Speaker 2: when you would have to court a partner. You would
2:31:26
Speaker 2: have to walk with them and talk with them and
2:31:29
Speaker 2: you would barely be able to touch their hand. There
2:31:31
Speaker 2: would be this buildup, this tension, this, like, oh, I'm
2:31:35
Speaker 2: so excited to be with you and to touch you. And, like,
2:31:38
Speaker 2: I feel like we've lost a lot of that. That, like,
2:31:41
Speaker 2: that actual, like, enjoyment of being with someone else and, like,
2:31:45
Speaker 2: glamorizing that versus, like, oh, I can just watch this
2:31:49
Speaker 2: on porn and, you know, have fun for a few minutes.
2:31:52
Speaker 1: Yeah, I think it's a... I think it's a big
2:31:55
Speaker 1: problem in the entire world right now. Yeah.
2:31:58
Speaker 2: And again, I think, like, I think that it's just about, like,
2:32:02
Speaker 2: I really feel like it's dangerous that our kids have
2:32:05
Speaker 2: access to it.
2:32:06
Speaker 1: Yeah, me too. We've covered that a lot on this show,
2:32:09
Speaker 1: which actually we were talking about it this morning with
2:32:12
Speaker 1: Ryan Montgomery and you watched Tim Tebow, what it sounded like.
2:32:16
Speaker 1: And those were cornerstones of both of those interviews. But
2:32:24
Speaker 1: we're kind of winding down the interview now. And one
2:32:28
Speaker 1: thing I wanted to ask is, what are some of
2:32:32
Speaker 1: the most common sexual health problems in men that go Yeah.
2:32:37
Speaker 2: Well, number one is, I mean, the most common is
2:32:40
Speaker 2: erectile dysfunction. And I think that, like, it's not that
2:32:44
Speaker 2: it goes, gets ignored, but I think that men are embarrassed.
2:32:48
Speaker 2: And they don't come and see the doctor. Or when
2:32:50
Speaker 2: they do, they just get given a prescription and say bye.
2:32:52
Speaker 2: And I think if, and that's why I'm writing my
2:32:55
Speaker 2: book that's coming out next year, is I want people
2:32:57
Speaker 2: to know, like, you can fix this. You can fix
2:33:00
Speaker 2: your life. And you have the power to do that.
2:33:03
Speaker 2: And you can improve your health and by way of
2:33:06
Speaker 2: then improve your erections because sexual health is health, right?
2:33:10
Speaker 2: But I think like they get very discouraged and when
2:33:12
Speaker 2: they finally do go get help, they just get a prescription.
2:33:14
Speaker 2: They don't get any information, right? So I think that's
2:33:17
Speaker 2: a big one. And then they're embarrassed too. And I guess,
2:33:19
Speaker 2: you know, there's like now there's a little bit more
2:33:21
Speaker 2: where you can get these online companies which will at
2:33:24
Speaker 2: least prescribe you the medications, but at the same time,
2:33:27
Speaker 2: they're not still giving you that education, which is really
2:33:30
Speaker 2: what I think is the missing piece. And they're charging
2:33:33
Speaker 2: you a lot more for the medications than you could
2:33:35
Speaker 2: get at an online pharmacy. You can get them for
2:33:38
Speaker 2: cents on the dollar. So I think that that's a
2:33:42
Speaker 2: big one. Another one is whenever they feel less masculine.
2:33:47
Speaker 2: So if they feel like maybe their desire is not there,
2:33:51
Speaker 2: maybe they're struggling with premature ejaculation, they don't ask for help.
2:33:56
Speaker 2: They struggle in silence and they live in silence and
2:34:00
Speaker 2: it is heartbreaking. Because by the time I finally see
2:34:03
Speaker 2: these patients, they have been through a lot. And they have,
2:34:07
Speaker 2: it has shaped who they are as a person.
2:34:09
Speaker 1: Man.
2:34:10
Speaker 2: And they cannot, and they can't talk to anybody, right?
2:34:13
Speaker 2: Men are just have this, they don't talk to, like
2:34:16
Speaker 2: women talk to women, right? They'll be like, oh, I
2:34:17
Speaker 2: have a problem. Like it'll come up somehow. They'll feel
2:34:19
Speaker 2: comfortable confiding in another woman. A man will never talk
2:34:22
Speaker 2: to another man about his issues in the bedroom or
2:34:24
Speaker 2: really many issues. They just don't. They're stoic. They tend
2:34:28
Speaker 2: to be problem solvers. They don't want to sit there
2:34:30
Speaker 2: and like whine or complain. Right? And so they just
2:34:34
Speaker 2: sort of grin and bear it. And they grin and
2:34:36
Speaker 2: bear it in front of their partner. They may, I mean,
2:34:38
Speaker 2: it can go so deep where like they've even like
2:34:41
Speaker 2: had divorces or ruined relationships because they won't talk to
2:34:43
Speaker 2: their partner about their issues.
2:34:45
Speaker 1: Right?
2:34:45
Speaker 2: And it runs so deep that they're just suffering in silence.
2:34:49
Speaker 2: And it really, I just like, I want anyone listening
2:34:52
Speaker 2: is if you're struggling, like, please at least talk to
2:34:55
Speaker 2: a urologist, at least talk to your doctor. Let's talk
2:34:57
Speaker 2: to somebody. I don't care who you talk to. Talk
2:34:59
Speaker 2: to somebody, because even just saying the issue out loud
2:35:03
Speaker 2: can help you sort of process it and deal with it. And,
2:35:06
Speaker 2: you know, learn, educate yourself. Watch content mine or anyone else's. Like,
2:35:10
Speaker 2: learn about your body and empower yourself to, like, take
2:35:14
Speaker 2: the actions you need to fix it.
2:35:16
Speaker 1: And then, you know, working, being a VA doc, I mean,
2:35:21
Speaker 1: I come from a special operations background, a lot of TBI,
2:35:26
Speaker 1: a lot of PTS, a lot. I mean, what are
2:35:29
Speaker 1: some of the commonalities that you see within, you know,
2:35:32
Speaker 1: war fighters who are coming home who have these kind
2:35:37
Speaker 1: of invisible injuries? I mean, how does that play in?
2:35:40
Speaker 2: The most common is PTSD, right? So I think on all, like,
2:35:45
Speaker 2: the majority, like the large majority of patients that I
2:35:48
Speaker 2: see have PTSD. Large majority. And they're all on, you know,
2:35:52
Speaker 2: medications to help with nightmares, and they're struggling, right? And
2:35:56
Speaker 2: we know that with men who have PTSD, their rate
2:35:59
Speaker 2: of erectile dysfunction is significantly higher. Like three times higher.
2:36:03
Speaker 1: Three times? Mm-hmm.
2:36:04
Speaker 2: Than guys who don't have PTSD. Than veterans who don't
2:36:06
Speaker 2: have PTSD. So just even within the military community, if
2:36:09
Speaker 2: you have PTSD, your risk is significantly higher.
2:36:12
Speaker 1: Wow.
2:36:12
Speaker 2: So it is, I mean, mental health and sexual health
2:36:15
Speaker 2: are very, very intertwined. And I know that the VA
2:36:19
Speaker 2: tries to do a really good job of getting... for
2:36:22
Speaker 2: veterans in terms of PTSD and mental health, but, like,
2:36:24
Speaker 2: it is a real struggle. And it is something that
2:36:27
Speaker 2: is really, really challenging. So, uh, you know, I think
2:36:31
Speaker 2: that's a big one. And then, also, like, it's crazy
2:36:35
Speaker 2: to me that, you know, my vets will come see
2:36:37
Speaker 2: me and I'll be like, do you want something for
2:36:39
Speaker 2: your erections? And they'll be like, oh, no one told
2:36:40
Speaker 2: me I could have that. Or no one's even asked
2:36:43
Speaker 2: me about that. Right? So... beyond they're already at high risk, right,
2:36:47
Speaker 2: and from TBIs. So TBIs can affect hormone health. So
2:36:50
Speaker 2: a lot of guys with TBIs will have low testosterone.
2:36:54
Speaker 2: And so they usually will get tested for testosterone, but
2:36:59
Speaker 2: they're not asked always about their erection. So even with
2:37:02
Speaker 2: those patients, it's like they may be given medication, but
2:37:05
Speaker 2: they're never educated on it. And no one's really linking
2:37:09
Speaker 2: that mental health aspect. Like, we need to fix the
2:37:13
Speaker 2: mental health aspect so you can actually... I mean, and
2:37:16
Speaker 2: think about it. If you're having better sex, you're probably
2:37:18
Speaker 2: helping your mental health too, right? It all goes hand
2:37:20
Speaker 2: in hand. So I think it's really a challenge because
2:37:24
Speaker 2: they have so much going on that those things become
2:37:25
Speaker 2: forefront and sexual health goes in the back. I mean,
2:37:28
Speaker 2: is there....
2:37:30
Speaker 1: Do we know why PTSD can... makes it three times
2:37:36
Speaker 1: more possible for somebody to have erectile dysfunction?
2:37:39
Speaker 2: I mean, all mental health issues are linked with sexual
2:37:42
Speaker 2: dysfunction because... Um, it's sort of like if you're, I mean,
2:37:47
Speaker 2: just very simplistically, and this is not, this is too simplistic,
2:37:51
Speaker 2: but if you're sad, you can't get aroused, right? You're
2:37:54
Speaker 2: not gonna get turned on because you're sad, right? Like,
2:37:57
Speaker 2: it's just, you don't, like, sex is not on your mind. You're, like,
2:38:01
Speaker 2: thinking about all, and you're in a sort of a
2:38:03
Speaker 2: fight or flight sympathetic nervous system. So, when we think
2:38:07
Speaker 2: about erections, to get an erection, we call it point
2:38:10
Speaker 2: and shoot. You need parasympathetic nervous system, which is your
2:38:13
Speaker 2: rest and digest, your relaxed nervous system to be activated
2:38:16
Speaker 2: for you to get an erection. You need to not
2:38:19
Speaker 2: be in a state of anxiety or stress. And then
2:38:21
Speaker 2: when you have your ejaculation, that's when your sympathetic nervous
2:38:24
Speaker 2: system turns on. So if you are constantly stressed, depressed, anxious,
2:38:30
Speaker 2: PTSD specifically, there's a lot of sympathetic nervous system activity, right?
2:38:33
Speaker 2: When you have PTSD. So you just can't get into
2:38:36
Speaker 2: the mind state, the nervous system state, to be able
2:38:40
Speaker 2: to get an erection.
2:38:41
Speaker 1: Okay. Is there anything that men can do to last
2:38:46
Speaker 1: longer in bed?
2:38:47
Speaker 2: Yeah, so a lot of guys think like, oh, if
2:38:49
Speaker 2: I just think about my grandma or something like super non-sexual, right,
2:38:52
Speaker 2: it's gonna work. Now, for some people, if you don't
2:38:55
Speaker 2: have any issues and you're just trying to last longer,
2:38:57
Speaker 2: sometimes that does work. But most times it doesn't and
2:39:00
Speaker 2: it actually hurts, right? Because now you're like introducing this
2:39:03
Speaker 2: very non-sexual, non-pleasurable thought in a moment that you should
2:39:07
Speaker 2: be like feeling really good, right? So I think a
2:39:10
Speaker 2: lot of it is, I mean, of course there are
2:39:13
Speaker 2: medications and things, but I don't, I think that just
2:39:16
Speaker 2: talking about non, like things that you can do that
2:39:18
Speaker 2: are like actionable. One is interestingly is breathing. So like
2:39:23
Speaker 2: doing diaphragmatic breathing. So like really deep into your diaphragm
2:39:28
Speaker 2: is actually going to help rev up your parasympathetic nervous system.
2:39:32
Speaker 2: And so people who do this type of breathing, even
2:39:35
Speaker 2: outside the bedroom and they do it regularly, have been
2:39:38
Speaker 2: shown to last like 900% longer. So I made a
2:39:40
Speaker 2: video on that.
2:39:40
Speaker 1: 900% longer?
2:39:41
Speaker 2: There was one study that said 900% longer. They do
2:39:44
Speaker 2: diaphragmatic breathing, plus they'll do some exercises which are like
2:39:49
Speaker 2: the stop-start technique. So you get almost to the point
2:39:52
Speaker 2: of climax, and then you kind of bring your arousal down,
2:39:56
Speaker 2: and then you go again. You do like three times,
2:39:58
Speaker 2: and then on the fourth, it's sort of like edging,
2:40:00
Speaker 2: and then on the fourth time you ejaculate. So those
2:40:02
Speaker 2: sort of actions as the same time with breathing has
2:40:06
Speaker 2: been shown to increase the ability for people, at least men,
2:40:09
Speaker 2: with premature ejaculation to last 900% longer. And then sometimes
2:40:14
Speaker 2: doing those breaths during arousal, so like sort of calming
2:40:18
Speaker 2: things down, because if you could think about it, it
2:40:21
Speaker 2: tends to be like a very quick sort of like,
2:40:25
Speaker 2: oh my God, oh my God, oh my God. When
2:40:27
Speaker 2: you're having sex, you get really excited, right? So you
2:40:30
Speaker 2: just need to calm things down And then you can
2:40:33
Speaker 2: last longer. Now, another thing that has been shown, these
2:40:36
Speaker 2: are small studies, but I think they make sense. And
2:40:38
Speaker 2: they actually are so easy to do that. Like, I'm like,
2:40:41
Speaker 2: every man should be trying to do these in general, right?
2:40:43
Speaker 2: They're good for your health too. They're good for your
2:40:45
Speaker 2: mental health. Another one is using exercise. And the reason
2:40:49
Speaker 2: certain exercise, specifically high intensity interval training, because it helps
2:40:53
Speaker 2: your brain sort of get, understand where your body is
2:40:56
Speaker 2: in time and space. So you get what's called interoception.
2:40:59
Speaker 2: And that Then as you do that in practice, when
2:41:03
Speaker 2: you're exercising, then when you're in position with your body,
2:41:06
Speaker 2: you can start figuring out the cues like, oh, I'm
2:41:08
Speaker 2: getting close. You can follow your arousal. Like when are
2:41:11
Speaker 2: you getting close to climax and sort of dampen things
2:41:15
Speaker 2: down a little bit. So you sort of learn your
2:41:16
Speaker 2: body better because you're doing those exercises. And the study
2:41:19
Speaker 2: was seven minutes of high intensity interval training daily showed
2:41:23
Speaker 2: an improvement in as quick as two weeks in terms
2:41:25
Speaker 2: of increasing length. Now they looked at other exercises too,
2:41:28
Speaker 2: yoga and running, because again, those are also very mindful exercises,
2:41:33
Speaker 2: like long distance running, yoga, fastest to do improvement was
2:41:37
Speaker 2: the HIIT, followed by running and then followed by yoga.
2:41:41
Speaker 2: But again, like they all can help. And so I
2:41:44
Speaker 2: think it's just really about being mindful of where your
2:41:47
Speaker 2: body is, learning like what does it feel like when
2:41:50
Speaker 2: I'm getting close to ejaculation and being able to like
2:41:53
Speaker 2: be present in the moment. And mindfulness, again, exercises like
2:41:58
Speaker 2: meditation and just like really learning how to be one
2:42:01
Speaker 2: with yourself. Like it's really like understanding your body so
2:42:04
Speaker 2: you can say, hey, I'm letting my arousal sort of
2:42:08
Speaker 2: climb slowly rather than, you know, and I'm sort of
2:42:12
Speaker 2: enjoying the process of getting there. Not like so fixated
2:42:16
Speaker 2: on like, you know, all the stressors of like, oh,
2:42:19
Speaker 2: when's it going to happen? Is it going to happen
2:42:20
Speaker 2: too soon? Like, you know, that's also revving up your
2:42:23
Speaker 2: sympathetic nervous system.
2:42:24
Speaker 1: Mm-hmm, mm-hmm. Last question. Second to last question. What, I mean,
2:42:31
Speaker 1: you have kids. How do we talk to kids about
2:42:37
Speaker 1: all of this stuff, sexual health? What age did you
2:42:39
Speaker 1: start talking to your kids about it?
2:42:40
Speaker 2: So, I started talking to my kids just basics, anatomy,
2:42:44
Speaker 2: when they were little. So, this is your penis. I mean,
2:42:48
Speaker 2: for boys it's easier. I think for girls you have
2:42:49
Speaker 2: to tell them what is their anatomy, right? So, like,
2:42:52
Speaker 2: this is your vulva, this is where you pee from,
2:42:55
Speaker 2: this is your vagina. And same thing for boys. This
2:42:57
Speaker 2: is your penis. This is your scrotum. This is your testicles.
2:43:00
Speaker 2: And it's actually so funny because I have so many
2:43:02
Speaker 2: funny stories with my kids because they've always been very
2:43:04
Speaker 2: open with me. And so when they first started, I
2:43:08
Speaker 2: hope they never watch my podcast interviews because they're going
2:43:10
Speaker 2: to be so mortified. But when they were little and
2:43:15
Speaker 2: the first time they would get erections, They'd be like, Mommy,
2:43:19
Speaker 2: why is it getting big? And I'd be like, this
2:43:21
Speaker 2: is completely normal. You're just having an erection. It's a
2:43:24
Speaker 2: completely normal thing. Whereas I know other friends would be like,
2:43:26
Speaker 2: oh my god, what do I say? You know what
2:43:27
Speaker 2: I mean? They would sort of freak out. And I'd
2:43:29
Speaker 2: be like, look. And they would ask me. And I'd say,
2:43:30
Speaker 2: just tell them it's normal. It is normal to get
2:43:33
Speaker 2: random erections. There is nothing wrong with it. And so
2:43:36
Speaker 2: that was one. I would also tell them, they would
2:43:38
Speaker 2: be like, oh, like my son would go like on
2:43:40
Speaker 2: a roller coaster and they'd go, it tingles down there.
2:43:42
Speaker 2: I'm like, yeah, that's okay. That's like a normal sensation.
2:43:44
Speaker 2: But he would just, when he asked these questions, I
2:43:47
Speaker 2: would ask, I would answer them as best I can.
2:43:49
Speaker 2: I remember one time he asked me about sex and
2:43:51
Speaker 2: I was like not prepared in that moment to answer it, right?
2:43:54
Speaker 2: And I was like, okay. Give me a second. Like,
2:43:57
Speaker 2: I will answer this question later. And I talked to
2:43:59
Speaker 2: my husband about it and I was like, okay, how
2:44:00
Speaker 2: do we go about this? He's like, no, you should
2:44:02
Speaker 2: talk to him about it. Like, you're obviously more skilled
2:44:04
Speaker 2: at talking about sex. And I was like, he's like,
2:44:07
Speaker 2: and we decided, like, it's obviously going to be better
2:44:09
Speaker 2: for me to talk to him about it now when
2:44:10
Speaker 2: he's curious rather than him going to ask someone else, right?
2:44:13
Speaker 2: So he asked me, I told him, this is what
2:44:15
Speaker 2: happens during sex and this is how it happens. And
2:44:17
Speaker 2: then when I had the same conversation with my younger son,
2:44:20
Speaker 2: he's like, so wait, what if I just like fall, like,
2:44:23
Speaker 2: what if I fall onto her, will we be having sex?
2:44:26
Speaker 2: And I was like, no, no, no, that's not how
2:44:27
Speaker 2: it works. So like, it's so innocent, their conversations, but
2:44:30
Speaker 2: it's also like, this is, and so we've been doing
2:44:33
Speaker 2: it so long. And so now we have sort of
2:44:35
Speaker 2: a routine, we'll go on walks and they'll know that
2:44:38
Speaker 2: if that's a time they wanna talk to me alone,
2:44:40
Speaker 2: they'll sort of like be like, hey mommy, can we talk?
2:44:42
Speaker 2: And they'll ask me questions or they'll, you know, they
2:44:45
Speaker 2: might've seen something in a movie or maybe their friend
2:44:47
Speaker 2: said something at school. And so they know that they
2:44:50
Speaker 2: can ask me anything, right? And then I will also, like,
2:44:53
Speaker 2: I remember I had, I talk about sex all the time,
2:44:55
Speaker 2: but I had forgotten that like, oh, I need to
2:44:57
Speaker 2: talk to him about wet dreams because they're going to happen.
2:45:00
Speaker 2: I don't want him to feel embarrassed, right? Because you can,
2:45:03
Speaker 2: I mean, you probably can recall when you had that happen.
2:45:05
Speaker 2: You're like, oh my God, what happened? Like, this is horrible.
2:45:07
Speaker 2: This is scary. Like, am I dying? What's going on? Right?
2:45:10
Speaker 2: And everyone has a different reaction, but I was like,
2:45:12
Speaker 2: didn't want him to freak out. So I remember telling
2:45:14
Speaker 2: him like, this might happen. It's okay. Just let me know.
2:45:17
Speaker 2: We'll wash the sheets and it's totally normal. But it's
2:45:19
Speaker 2: such a simple thing that you don't even think, especially
2:45:22
Speaker 2: as a mother, I never had that experience. So I
2:45:24
Speaker 2: had to remember, oh yeah, this is something I need
2:45:26
Speaker 2: to tell him before it happens so he doesn't freak
2:45:29
Speaker 2: out and think something's wrong with him.
2:45:30
Speaker 1: I mean, what do you, how do you describe, what
2:45:33
Speaker 1: age was that when you were having a discussion with
2:45:35
Speaker 1: your children?
2:45:35
Speaker 2: We've had so many for so long that I think
2:45:38
Speaker 2: I started, because the average age where kids see porn
2:45:41
Speaker 2: is 10, I think I started talking to my son
2:45:43
Speaker 2: at eight about porn because I was like, I didn't,
2:45:46
Speaker 2: you know, I don't know who he's going to see
2:45:48
Speaker 2: it from. I'm going to do my best to like,
2:45:50
Speaker 2: you know, put all the locks on my phones and
2:45:52
Speaker 2: anything that he has access to. And, you know, but like,
2:45:55
Speaker 2: I don't know what his friends have locks on their
2:45:57
Speaker 2: phones or what they, if they have phones, right? Like,
2:46:00
Speaker 2: all those things. I just don't know what he's going
2:46:02
Speaker 2: to see when I'm not with him. I'm not with
2:46:04
Speaker 2: him 24 hours a day. So I had to prepare
2:46:07
Speaker 2: myself for the fact that he might see something. And
2:46:10
Speaker 2: even though I don't want him to see it, and
2:46:12
Speaker 2: I don't, I wish he doesn't, I know he might.
2:46:14
Speaker 2: And he's actually told me that some kids in school
2:46:18
Speaker 2: have talked about porn. Now that we've had this conversation,
2:46:20
Speaker 2: he's 12 now, but he's told me that kids have
2:46:22
Speaker 2: talked about it. Like, oh, you know, we watch porn.
2:46:24
Speaker 2: And I was like, he's like, I'm like, have you
2:46:26
Speaker 2: seen it? And he's like, no, I haven't. I'm not
2:46:28
Speaker 2: really that interested. Because we've talked about it, right? And
2:46:31
Speaker 2: I think, like, he realizes, like, it's not really all
2:46:33
Speaker 2: that cool. Like, it's a fake thing, you know? And
2:46:37
Speaker 2: it's not necessary right now. So, you know, I think,
2:46:42
Speaker 2: and he knows he can come to me. Like, I
2:46:43
Speaker 2: can tell him any question he wants, I'll answer it.
2:46:45
Speaker 2: I might answer it right that second, but I will
2:46:47
Speaker 2: think about it and I will answer it. And so, yeah,
2:46:49
Speaker 2: I mean, I started talking to them, like I said,
2:46:50
Speaker 2: when they're little, just about their anatomy. And so like slowly,
2:46:54
Speaker 2: but surely, but the sex question, he came to me
2:46:56
Speaker 2: and I think he was, I think it was around eight.
2:46:58
Speaker 2: He came to me and asked me about it. And
2:47:00
Speaker 2: I was like, okay, now is the time to answer it.
2:47:03
Speaker 2: He's asking the question. So I have to answer it,
2:47:06
Speaker 2: you know? And so I made this routine where we
2:47:08
Speaker 2: go for walks and I tell him about whatever. And
2:47:10
Speaker 2: he knows that's a great time where he can ask me.
2:47:12
Speaker 2: I don't have to look at him in the face either.
2:47:13
Speaker 2: I can look straight ahead and answer and he can
2:47:17
Speaker 2: look straight ahead and we don't have to have like
2:47:18
Speaker 2: an awkward like you know face-to-face interaction but uh but
2:47:22
Speaker 2: you know we're just talking and i think um gotta
2:47:25
Speaker 2: find you obviously know your kid and you know you
2:47:28
Speaker 2: know how you want a parent but i think like
2:47:31
Speaker 2: we as parents have a responsibility in today's society where
2:47:35
Speaker 2: we have less control over what they're gonna see because
2:47:38
Speaker 2: they're out in the world at school and kids have phones,
2:47:41
Speaker 2: which is crazy to me. Like, you know, we don't
2:47:44
Speaker 2: have as much control as we would like. And I mean,
2:47:48
Speaker 2: so we have to be responsible and teach them. And
2:47:52
Speaker 2: because the other thing is, it's sort of scary. Like,
2:47:54
Speaker 2: some of the things they're gonna see, so for example,
2:47:58
Speaker 2: choking is a big thing in porn right now. And so...
2:48:01
Speaker 2: I had a researcher on my podcast, Debbie Herbenick, who
2:48:04
Speaker 2: wrote this book called Yes, Your Kid. And so she
2:48:06
Speaker 2: did research on college-age students, and she found out that
2:48:11
Speaker 2: choking became very, very common in sexual encounters. And it's
2:48:15
Speaker 2: fine if someone finds it pleasurable, but it's dangerous, right? Like,
2:48:18
Speaker 2: you're asphyxiating someone, you could cause really serious harm. But
2:48:22
Speaker 2: they're doing it so casually, like it's almost like kissing.
2:48:25
Speaker 2: And when they did the surveys, they found that women
2:48:28
Speaker 2: were most often getting choked by men. And a lot
2:48:31
Speaker 2: of them were not that into it. I mean, they
2:48:33
Speaker 2: were okay. They were like, yeah, you can do it.
2:48:34
Speaker 2: They were getting asked, but they were like really not
2:48:37
Speaker 2: that into it. And they were just doing it because
2:48:39
Speaker 2: they felt like that was what was done. And so
2:48:41
Speaker 2: that's just one example of how these things are being
2:48:44
Speaker 2: perpetuated from what they're seeing. And they're not, these things
2:48:47
Speaker 2: are not focused on pleasure. They're just focused on getting
2:48:50
Speaker 2: you entertained. And so like, they're not learning how to
2:48:52
Speaker 2: pleasure each other. They're not learning how to have a meaningful,
2:48:56
Speaker 2: intimate encounter. And it's, It's really sad.
2:49:01
Speaker 1: Yeah. I love the walking method. Yeah.
2:49:04
Speaker 2: It's a good one.
2:49:05
Speaker 1: That's great. Like you had mentioned, you know, it's not face-to-face.
2:49:09
Speaker 1: You can look.
2:49:10
Speaker 2: And I tell even couples, like, do talks when you're
2:49:13
Speaker 2: not looking at each other. Because in the beginning, no
2:49:16
Speaker 2: one taught us how to have sex, right? Or how
2:49:18
Speaker 2: to talk about sex or have sex, really. But no
2:49:20
Speaker 2: one taught us how to talk about sex, right? So
2:49:22
Speaker 2: it's super awkward. And it's not a one-time conversation. If
2:49:25
Speaker 2: you wanna have a meaningful, really robust, amazing sex life
2:49:29
Speaker 2: with your partner, you gotta talk about it. And so,
2:49:32
Speaker 2: I tell people, like, when you're in the car, when
2:49:33
Speaker 2: you're on a walk, so you don't have to, like,
2:49:35
Speaker 2: look at each other across the table, and definitely never
2:49:37
Speaker 2: in the bedroom. Like, just have these conversations in places where,
2:49:41
Speaker 2: you know, you have a little room to, like, wiggle
2:49:44
Speaker 2: and look and feel awkward, but don't just show it
2:49:46
Speaker 2: to each other.
2:49:47
Speaker 1: Love that. Love that. All right, last question. If you
2:49:52
Speaker 1: could recommend three people for this show, who would they be?
2:49:55
Speaker 2: Oh, gosh, three people. Okay. Well, if you want to
2:49:59
Speaker 2: do more sexual health, I had Dr. Barry Komisarek, who
2:50:04
Speaker 2: is a researcher who researches female orgasm and brain MRIs.
2:50:08
Speaker 2: That was a really interesting conversation. Who else? I'm trying
2:50:13
Speaker 2: to think. Hmm. I think your audience would really like, um, Dr.
2:50:20
Speaker 2: Alok Kanoja. He is a, uh, he's a physician who
2:50:24
Speaker 2: really focuses on gaming, but he has a lot of
2:50:27
Speaker 2: insights into like the psyche of the young man right
2:50:30
Speaker 2: now and like how to sort of, uh, manage these
2:50:33
Speaker 2: like gaming addictions and also sort of people who struggle
2:50:36
Speaker 2: with pornography and things like that all in the same. Yeah.
2:50:41
Speaker 2: And let me think of a third one.
2:50:44
Speaker 1: Hmm.
2:50:46
Speaker 2: I think.
2:50:50
Speaker 1: Do you know any sex therapists? Oh, yeah.
2:50:52
Speaker 2: I know a lot of sex therapists. I'm going to
2:50:54
Speaker 2: think of the best one for you.
2:50:55
Speaker 1: Let's see.
2:50:58
Speaker 2: Let me think on that one. All right. I want
2:50:59
Speaker 2: to give you the right name.
2:51:00
Speaker 1: Perfect. Perfect.
2:51:02
Speaker 2: Yeah.
2:51:02
Speaker 1: Well, Rena, this was a fascinating conversation. Like I said,
2:51:06
Speaker 1: thank you so much for coming. And I'd love to
2:51:09
Speaker 1: see you again.
2:51:10
Speaker 2: Yeah. Thank you so much for having me. All right.
2:51:24
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