Shawn Ryan Show #250: Dr. Rena Malik – Urologist Debunks #1 Sex Myth Every Man Still Believes

Release Date: November 3, 2025
Guest: Dr. Rena Malik, Board Certified Urologist
Host: Shawn Ryan

Episode Overview

This episode features Dr. Rena Malik, a board-certified urologist and prominent sexual health educator, renowned for her candid and science-based YouTube channel. Shawn Ryan and Dr. Malik have a frank, detailed, and myth-busting discussion about men’s sexual health—debunking persistent myths, exploring the real science behind ejaculation, sexual pleasure, anatomy, and erectile dysfunction. The conversation is practical, deeply informative, and refreshingly open, aiming to answer questions most are too embarrassed to discuss elsewhere.

Key Discussion Points & Insights

1. Dr. Malik’s Background and Mission

• Introduction of Credentials: Dr. Malik is a board-certified urologist, fellowship-trained in female pelvic medicine, sexual medicine, hormone management, and pelvic pain. She runs a private practice and has over 2.5 million YouTube subscribers (01:01).
• Purpose of her Content: She started her channel to improve health literacy, address taboo topics with evidence-based advice, and to empower patients beyond limited in-office visits (20:02).
• Approach: Tackling taboo questions in a professional and nonjudgmental way: “I’m not trying to invalidate your experience. I’m just telling you what the science is.” (23:02)

2. Recovering from Addiction & Physical Health

• Listener Question on Long-Term Impacts of Addiction: Dr. Malik stresses the body’s resilience but notes some effects may be permanent, especially neurologically. Nonetheless, optimized, healthy living is still possible with support and hormone replacement, if needed. (03:34)
• Quote: “The body is very resilient, right? So it depends on how long you were addicted... There may be permanent neurologic damage... but you can still live a great, wonderful, healthy life...” – Dr. Malik (03:34)

3. Squirting, Female Anatomy, and Myths

• Explaining ‘Squirting’: Dr. Malik details the biology of squirting, distinguishing it from regular lubrication and female ejaculation, and debunks the myth that all women can or should squirt. Squirting is a mix of very dilute urine and fluid from the Skene’s glands (female prostate) and not the universal marker of pleasure (05:38).
• The Reality: Only about 40% of women can squirt, and it is not synonymous with orgasm or sexual satisfaction. Porn’s depiction of squirting is misleading (05:38, 10:26).
• Quote: “The way you can tell a female has pleasure is you ask her, ‘Did you enjoy that?’... The majority of women don’t squirt—60% or so don’t. That doesn’t mean they’re not orgasming or having a climax.” – Dr. Malik (09:00)
• Insight: Focus should be on mutual pleasure, not arbitrary visual markers.

4. Life, Career, and Motivation

• Passion for Urology: Dr. Malik shares her journey—drawn to surgery and solving intimate, lifetime issues for patients with a sense of humor and resilience (12:05).
• VA Experience: She works with veterans, valuing their drive to get better and expressing gratitude for serving this population (18:41).
• Social Media Criticism: She addresses backlash related to taboo topics, emphasizing scientific evidence over anecdote (23:02).

5. Viral Sexual Health Myths Debunked

• Semen Retention/No Nut November: There’s no scientific benefit for holding back ejaculation. In fact, abstinence can be physically and mentally harmful for some. (23:02, 25:01)
• Quote: “Semen retention is marketed as brain clarity, higher testosterone, improved fertility… The reality is those things have been looked at scientifically and there’s been no true meaningful increase…” – Dr. Malik (25:01)
• Body’s Mechanism: If abstaining, the body will naturally have nocturnal emissions (‘wet dreams’) or reabsorb semen. No negative accumulation (27:27).
• Jelqing & Penis Enlargement Fads: Jelqing is risky and can cause erectile dysfunction. Only research-backed non-surgical method with modest efficacy is a traction device, which is slow and requires dedication (28:14, 29:29).

6. Size: The Most Persistent Myth

• Does Size Matter? Societal emphasis on penis size is disproportionate to its impact on pleasure. Most women require clitoral, not penetrative, stimulation for orgasm. (32:51)
• Average Size: Erect penis averages 5.1"-5.6" in length, 4"-5" in girth; most men overestimate averages and underestimate their own size (32:59, 38:30).
• Quote: “Size is not necessary for pleasure. Size is not necessary for a good orgasm. We’ve just made it into this big thing.” – Dr. Malik (32:59)

7. Erectile Dysfunction (ED): Causes, Myths, and Treatment

• Common Myths:
  • One occurrence doesn’t mean chronic ED.
  • Men’s anxiety about a single episode often perpetuates further issues—a psychological feedback loop (38:54).
• Testosterone & ED: Only accounts for 3-6% of cases; vascular health (cholesterol, diabetes, hypertension) is more significant (41:07).
• ED Is An Early Warning: ED can precede major cardiovascular events (“canary in the coal mine”)—within seven years, 15% will have a heart attack (42:03).
• Assessing ED: Determined through history (e.g., presence of morning erections indicates physical health), bloodwork, and possibly a penile Doppler test (47:36, 49:55).
• Psychological Component: Always present to some degree; mindfulness and therapy can help (49:55).

8. Ejaculation Frequency & Prostate Health

• Science-Based Advice: Men who ejaculate 21+ times/month have a ~20% lower risk of prostate cancer (53:43, 100:57).
• Sexual Frequency & Health: Once per week or more is associated with better health, longer life, and improved mental health—especially significant for men with depression/anxiety (52:27).
• Partnered vs Solo Sex: Partnered sex is generally more pleasurable and stimulating for the brain, but masturbation is also healthy (56:01).

9. Erectile Function Therapies & Medications

• PDE5 Inhibitors Explained:
  • Viagra (Sildenafil): Short acting, take on empty stomach.
  • Cialis (Tadalafil): Longer acting, can be taken with food, lasts up to 36 hours, can be dosed daily for less psychological pressure (60:31).
• Quote: “I do recommend it for almost all my patients… there’s more benefits than just sexual health.” – Dr. Malik on daily low-dose Cialis (65:19)
• Long-Term Effects/Risks: Generally safe; caution for those on nitrates, with vision changes, or certain rare blood/hormone issues (63:10).

10. Sex Duration, Female vs Male Orgasm

• Average Penetration Duration: 5-6 minutes (66:02).
• Women Take Longer: On average, women need 14 minutes with a partner to climax; prioritize arousal and foreplay for mutual satisfaction (66:02, 69:08).

11. Penile Implants & Surgical Options

• Who Needs Them: Mainly for men for whom pills/injections don’t work.
• Types: Inflatable (hidden pump in scrotum) and bendable; don’t increase size, just restore function (58:01, 59:02).

12. Aging, Testosterone, and Sex Span

• Testosterone Declines: By 1-1.5% per year after age 40; exacerbated by chronic health issues or environmental factors. Only treat if symptomatic and confirmed low on bloodwork (103:23, 112:55).
• TRT Risks: Does not cause prostate cancer but will accelerate growth if undiagnosed cancer is present; may increase clot/stroke risk, reduce fertility; it’s often a lifelong treatment (120:12).

13. Substance Use Impact

• Smoking and marijuana: Both hurt sexual and hormonal health, especially found in chronic users (127:13).

14. Prostate Health & Cancer Screening

• Screening Guidelines: Start at 55 (or earlier with risk factors: family history, African-American, BRCA gene) (129:08).
• Modern Testing: PSA blood test is the standard, supplement with MRI and targeted biopsies; not all prostate cancers require aggressive treatment (129:14, 134:13).
• Lifestyle: Diet, exercise, and avoiding diabetes/hypertension all reduce risk (137:05).

15. Pornography in Sexual Health

• Potential Harms: Early exposure warps expectations, may reduce desire for real partners, and spirals into shame cycles for some (145:32).
• Healthy Use: Possible in adults with realistic outlooks; unhealthy if exclusive source of arousal. Watching as a couple can enhance satisfaction (145:41, 149:55).
• Quote: “Porn is a produced product...It's meant for entertainment...it’s not real life.” – Dr. Malik (147:00)

16. Talking to Kids About Sex

• When to Start: Early—anatomy talks begin young, porn discussions by 8 years old, since the average age of porn exposure is 10 (162:21, 165:30).
• Tips: Use direct, age-appropriate answers, create routine opportunities (car rides or walks), and proactively address topics like consent and unrealistic expectations (165:30).

17. Special Considerations for Veterans

• PTSD: Raises risk of ED by threefold; TBIs linked to hormonal dysfunction. Many veterans unaware of sexual side-effects or available treatments (155:10-157:33).

Notable Quotes & Memorable Moments

• “Sex is play and we don’t play as adults. So, play, enjoy life, be creative, have fun, and enjoy sex.” – Dr. Malik (53:42)
• “If you start having issues (erectile), this is a wake up call for you to get your whole health evaluated.” – Dr. Malik (42:03)
• “The majority of women don’t squirt—60% or so don’t. That doesn't mean they’re not orgasming or having a climax.” – Dr. Malik (09:00)
• “Porn is a produced product....it’s not real life.” – Dr. Malik (147:00)

Timestamps for Key Segments

• [03:34] – Recovery and resilience after addiction
• [05:38] – Squirting: What it actually is, prevalence, why it’s misunderstood
• [23:02] – Semen retention & No Nut November myth-busting
• [32:59] – Does size matter? Busting the most persistent myth
• [38:54] – Erectile dysfunction: common myths, psychological aspects
• [42:03] – ED as an early warning sign for cardiovascular health
• [49:55] – Managing psychological causes of ED
• [53:43] – Ejaculation frequency and prostate cancer risk
• [56:01] – Partnered sex vs masturbation: science and brain impact
• [58:01] – Penile implants: what, who, and how they work
• [60:31] – Viagra vs Cialis: mechanisms, usage, and dosing
• [66:02] – Average duration of penetrative sex
• [100:57] – Does ejaculation reduce cancer risk?
• [112:55] – Testosterone replacement: when and how
• [120:12] – Risks of testosterone therapy
• [127:13] – Substance abuse and men’s sexual health
• [129:14] – Prostate cancer screening: guidelines and methods
• [137:05] – Enlarged prostate: causes, prevention, and treatment
• [145:32] – The impact of pornography on real-world sex lives
• [149:55] – Healthy porn use vs unhealthy, impact on relationships
• [155:10] – Sexual health challenges among veterans
• [165:30] – Talking to kids about sexual health

Episode Tone & Style

The conversation is direct, myth-busting, and empathetic, with a healthy amount of humor and realism. Both host and guest are candid, unafraid to address even the most sensitive topics in a practical, science-informed, and respectful way.

In Summary

Dr. Rena Malik brings a uniquely clear, evidence-based, and humane approach to men’s sexual health, debunking myths around ejaculation, penis size, and erectile dysfunction, while offering practical strategies for a satisfying and long, healthy sex life. The discussion touches every angle of male sexual wellness—from hormones and anatomy to cultural misconceptions and the challenges soldiers and veterans face—always with the message: pleasure matters, and science—and open conversation—is your best ally.