← Rena Malik, MD Podcast
Rena Malik, MD Podcast
The Real Reason Cialis Works Better for Some Men (And How to Use It Right)
00:17:10
In this AMA, Dr. Rena Malik explains how to use Cialis and Viagra correctly, covers edging safety, and why many women need clitoral stimulation to orgasm.
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- [00:00]
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- [00:30]
Dr. Renamelic
Today we are talking about the best way to take Calis or Tadal Edging and orgasms welcome back to the Ask Me Anything episode of our podcast. Here we answer questions from our premium members and members who follow us around the world to give you information about your most asked questions. We share half the AMA right here on YouTube and on your audio podcast platforms and on Facebook. But if you want the full episode, you can join our membership@rename supercast.com and you can get the full episode there.
- [01:03]
Podcast Listener/Question Asker
I have erectile dysfunction. My doctor just prescribed me Calis. She never really explained what's the right way to use it. Do I eat it with food? Do I take it at a certain time before sex? Any tips?
- [01:18]
Dr. Renamelic
Yes, this is a great question because so many people give up on these medications before they've exhausted all the right ways to take it. And there's interesting data behind it. So when you look at the data on sildenafil, there's a little bit more data on that, which is Viagra. When you take it the very first time, there's about a 60% success rate. But if you keep taking it on the eighth time, meaning every subsequent time, it continues to increase. But by the eighth time, the success rate reaches 80%. And there's a variety of different reasons. Sometimes it's figuring out timing, sometimes it's figuring out, you know, feeling less anxious when you take the medication, and sometimes it's just figuring out timing with food. And you asked about that. So let me explain the difference between these two, because these are the most commonly used erectile dysfunction medications. So sildenafil is a medication that has a half life of about four hours, meaning that after about four hours it really loses efficacy. And so in this case, you need to take the medication for about 30 minutes to one hour before you want to have sex. Now, it doesn't have to be just 30 minutes before. It could be an hour or two hours before, but you do need to give it some time for it to work in the system with any medication, you need to have some stimulation for it to work. It doesn't actually produce nitric oxide, which is the ignition for erections. That's produced by your body's response to a stimulation that you're turned on. Right. And so you need stimulation for it to work. With tadalafil, also, you want to give at least an hour before you want to have sex, but has a much longer half life, meaning that Cialis can work in theory up to 36 hours. So you could take it on Friday and have sex multiple times throughout the weekend if it works well for you. So that's 1, 2. You asked about food. So food, if you take Sildenil or any of the other medications of Anil, of Ardenopil, which is Levitra Stendra, those medications should not be taken with food, because what happens is when you take it with food, it reduces the bioavailability, but you still get the side effects. So you want to avoid taking it with a really heavy meal. You can take it with light food if you have to, but ideally you don't want to take any food at all. And then with Tadalafil, you can take it with food. It doesn't actually interact with food that way, which I really like. The other difference with with Tadalafil is it kind of maintains spontaneity because, like I said, it lasts for 36 hours. You can also take tadalafil daily at a low dose, about 5 milligrams. And the beauty of taking it that way is that it's always on board in the background, and you don't have to remember to take a pill on the day you want to have sex. Necessarily, if it works like that for you, you can also that daily medication, that daily dose of Tadalafil also helps with BPH or enlarged prostate. So for some people who are also strugg with BPH symptoms, which means that you might have trouble emptying your bladder, you might have a stream that stops and starts, you might have a stream that's really weak, or you feel like you're not emptying your bladder well, or you're waking up a lot at night to urinate, or you're going very urgently or very frequently, these could all be signs of an enlarged prostate. You should absolutely talk to your doctor. But if you have an enlarged prostate and you have troubles with erections, you can take one pill to treat both issues, which I love, because who wants to take more than one pill? So those are the real tricks. Also Realizing that there is a psychological component. When you're stressed about something, you're trying something the first time, there's a little bit of anxiety related to it. And that's why I think partially, it takes some time for people to see good results with these medications because there's some anxiety the first time you take it. Is it going to work? Is it going to work? Is it going to work? And when you know, like, oh, yeah, it works, that anxiety goes down, and it continues to go down every time you take it. Now, there are side effects with these medications that you should all be aware of. There's one person or one type of person who can't take this medication at all. And that's someone who takes a nitrate or nitroglycerin medication. And the reason is because that medication lowers your blood pressure. And this can, too. When you take both together, it can drop your blood pressure dangerously low, meaning you could have to go to the hospital, you could pass out, and it can be very dangerous. So you cannot take those two medications together. Also, in some circumstances, if you have really severe heart disease, like you can't walk two or three blocks without getting short of breath, then you want to get a cardiac evaluation. Evaluation before you take the medication. You mean you see a cardiac doctor, see your primary care doctor to make sure that it's safe for you to take the medication. Now, this is rare for most people. This is not an issue. Now, side effects with the medications are you can have sort of a stuffy head cold feeling, sort of nasal congestion, flushing. Those are very common side effects. With Viagra or Sildenafil, there's one side effect that you need to be aware of, and that's having blue green vision, discoloration. If you start seeing colors differently or you notice some changes with vision, you want to stop taking Viagra and ask for a different option like Cialis. When you're taking Cialis, the other side effect that you might notice is muscle aches. And that's because they work on slightly different receptors. And so they also work on different receptors in the body that can give you those side effects. Many people tolerate them fine without side effects. And in fact, when you look at the benefits, the best dose, sometimes the best dose with the least side effects is actually the middle dose. So 50 milligrams of Viagra tends to work very similarly in efficacy to 100 for a lot of people, and they have less side effects. But if 50 milligrams doesn't work, it's absolutely reasonable to talk to your doctor about going up to 100 milligrams. And the same thing with Tadalafil. The more or the higher the dose you get, usually the more likely you're going to have side effects. But these medications are super, super helpful in allowing you to get erections. The most important thing I want you to understand is that these medications not fixing the underlying problem. You still need to understand why you're having trouble with erections. Oftentimes it's because of vascular issues like high blood pressure, diabetes, or like you're developing heart disease, but it hasn't presented anywhere else. You're developing vessel disease. So there's starting to be buildup in your blood vessels, and the first place you see it is in your erections. And so it's really important to talk to your primary care doctor about this and get evaluated for what we call occult cardiovascular disease, meaning we don't have any symptoms, but you could be developing it. Also, you want to check your hormones, your testosterone, you want to take a look at the medications you're on, make sure they're not affecting erectile function. And so you really want to understand why you're having erectile dysfunction so you can reverse those issues. Most commonly, like I said, high blood pressure, diabetes, high cholesterol, and then underlying cardiovascular disease, Those things need to be addressed. And also, taking daily Tadalafil may have some benefit in, in terms of preventing progression of the disease because it's giving you blood flow through the penis consistently, but we don't have great data on that. So ultimately, you got to find out why you're having trouble and address the underlying cause, because that's what's going to reverse your erectile dysfunction.
- [08:11]
Podcast Listener/Question Asker
I am into edging. Anything could go wrong with my penis if I continue this practice. Maybe we want to just define what edging is.
- [08:21]
Dr. Renamelic
Yeah. So edging, it's become an interesting topic. It's basically when you get close to ejaculation and you hold off and you just sort of stay in this state of like, high arousal. And so you sort of get there and then you pull back and you get there and you pull back, and then eventually you ejaculate. And people tend to have more enjoyable orgasms for a large number of people. Now, is it dangerous if you are doing edging and you're having no problems, meaning you're ejaculating, fine, you're orgasming, fine. Everything feels good. There's no change in sensation, there's no pain, there's really no problem. You can absolutely, absolutely do this practice and enjoy it, there's no problem. However, there are a small subset of people where this goes too far. So either they're doing it for prolonged periods of time because they're worried about ejaculating, Maybe they're practicing semen retention and they're really trying to kind of force that ejaculate to not come out. And when this happens, what's happening in your muscles, in your pelvic floor muscles. And those are the muscles that sit around the penis and under in the pelvis, essentially. And they're, you know, a big part of your orgasm, ejaculation and your erectile function, sort of a big part of that. And so when you are trying to abstain from ejaculation, sometimes people are really tensing those muscles for prolonged periods of time to try to prevent the ejaculate from happening. Now, when you do that for prolonged periods of time, your muscle gets stuck sort of in this high tone, high, like, stressed situation where it's really tight, it's not relaxing and going through its normal range of function. And when that happens, you can start noticing other problems. So some people will notice that they are having pain with erections or pain with ejaculation. Some people will notice ball pain or scrotal pain. Some people will notice constipation, and some people will notice urinary symptoms. Either they're finding that they have to go very often very urgently, or they're finding that they can't pee very well because their muscles are not relaxing well. And so if you start noticing that you're having these issues, it may be caused by this sort of dysfunction that you've created by edging, you know, too intensely with those muscles. And so in that case, you want to sort of, you know, allow yourself to ejaculate and talk to a pelvic floor physical therapist. You can also do certain exercises to relax the pelvic floor. And those can be like, happy baby pose. Figure four, Stretch. Doing a child's pose. There's a whole bunch of different exercises that you can do, and we've made a video on this for guys who are struggling with premature ejaculation. Sometimes they struggle from high tone. Pelvic floor. And so I did a collab with Eric Leckie, a doctor, doctor of physical therapy. So you can check out that video and learn more about what exercises you can do to help relax the pelvic floor. But if those things are not helping at home. Absolutely. Find a pelvic floor physical therapist near you that can evaluate you, see you, and teach you exercises to relax your pelvic floor.
- [11:26]
Podcast Listener/Question Asker
I'm a 19 year old female who's frustrated that I have never had an orgasm during sex. My boyfriend seems to have no issues, but I can't seem to have them during sex. Is there a position that would be better for me to have one?
- [11:41]
Dr. Renamelic
Typically, if you guys are, you know, you've been here for some time, you know that the clitoris is the most reliable form to orgasm for the majority of women, meaning 85% of women need clitoral stimulation for an orgasm to happen. And very often they're not getting sufficient clitoral stimulation with penis in vagina sex. Really the goal here is to figure out how you can best stimulate the clitoris for your partner to have an orgasm. So one, and if you're having orgasms by yourself, either with your hand or with a toy, tell your partner what works for you, right? And so that you can either incorporate that into your time together. So maybe your partner can stimulate you that way, or you can stimulate yourself while you're having penetrative sex. There are certain positions that sort of make it easier for you to stimulate the clitoris. So one, when the female partner is on top, the woman can then sort of maneuver her body in the way that feels best so she can angle herself so that her clitoris is getting more stimulation. She might even be able to reach down and stimulate herself while she's on top and she can sort of control the rhythm. Now, I always tell my male patients that you want to have some control because you don't want to get a penile fracture. You don't want it to get very aggressive and then the penis falls out and it bends because you can actually fracture your penis. So always, you know, maintain good control. This is a rarity, but if it happens, you got to go to the er. It's a surgical emergency. It's the whole thing. So one is female on top. Two is you can buy certain sort of things to help elevate the pelvis if the female's on the bottom. And that can help you sort of reach the clitoris a little bit better. There's also sort of different types of positions. One is called the coital alignment technique. That's essentially where you are moving in such a way where you're sort of like a rocking technique where your pubis, like the top of your right above your penis is touching the clitoris and you're doing it in such a way that that's actually stimulating the Clitoris. Now, that takes. I've made a whole video about it, so you can check it out if you want to learn more specifics about that position. But it does take some practice. It's sort of like a dance, you know, you have to figure out each other and work together. And so these things, you know, sex is supposed to be fun and playful and things will happen that's like, awkward, it's uncomfortable, or it doesn't work right away the first time. That's okay. It's worth sort of playing around, figuring out what works best for you. And so I think really incorporating those things to really focus on clitoral stimulation. Another thing I will tell my, my. My patients who have these questions is that you can try sort of a penis compression ring, and some of these rings can have vibration, and so it can feel good for you and feel good for her while you are actually having penetrative sex. So the ring is actually stimulating the clitoris while you're having sex. And so these are options that you can look into. I've made a full video on compression rings as well, so you can check that out. But really, there's so many options. And really it starts with just communicating and being open to trying new things in the bedroom. Like, if you incorporate toys or other tools, it doesn't mean that there's anything wrong. It just means that you are open to optimizing your sexual experience and having so, so much fun. Thank you guys for joining me on this Ask Me Anything episode. If you want to check out the full episode, make sure to check out our membership@renamelic.supercast.com where you can sign up to be a member and get full access to all of our AMAs, the full length, including this one. And as always, remember to take care of yourself because you are worth it.