← The Neuro Experience
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- [00:00]
Dr. Reena Malik
When you are down on testosterone, people will come in complaining of decreased libido, decreased muscle mass, that they're going to the gym, but they're not getting as big as they used to. They're having difficulty growing muscle.
- [00:12]
Louisa Nicola
What we know from this research is that exercise is one of the best preventative interventions that we have.
- [00:18]
Dr. Reena Malik
There's a lot of people who feel like wet dreams are a bad thing and they're shameful and they want to stop having nocturnal erections or nocturnal emissions or wet dreams. And it's a physiologic thing. You can't stop it. In fact, a sign of good health.
- [00:34]
Louisa Nicola
Hi, everyone. Welcome back to the show. It's Louisa Nicola. I'm a neurophysiologist and human performance coach. I'm the founder of Neuro Athletics, where our mission is to democratize brain health education so you can perform better, think faster and live longer.
- [00:47]
Joining me today is Reena Malik. She's a urologist, expert on sexual health, and a pelvic floor surgeon.
- [00:54]
She's also an absolutely interestingly and exciting educator, which is why I'm so excited to bring her on the podcast today.
- [01:02]
So in today's episode, Reena and I will be discussing everything on sexual health. Reena addresses misconceptions around normal sexual phenomena, the significance of sexual health discussions and the realities of sexual dysfunction. We're going to explore findings from a revealing Harvard study on ejaculation and prostate cancer. We'll be discussing libido's fluctuations and she will unveil the truth behind premature ejaculation. So tune in for a direct, informative discussion, one that challenges societal stigmas and enriches our understanding of sexual well being. If you are new to the podcast.
- [01:40]
Welcome, please hit the subscribe button. We are here on Apple, on Spotify, and if you want to see us or see my face, you can go.
- [01:48]
Through and subscribe on YouTube.
- [01:50]
Dr. Reena Malik, welcome to the Neuro Experience podcast. I am so excited to have you here for many reasons.
- [01:57]
Dr. Reena Malik
Why?
- [01:58]
Louisa Nicola
One, you should know that I found you on YouTube about three years ago and I have to say that you're. Yes, you're a physician first, but I admire the education part of what you're doing. I love anybody who is out there who is educating the world on just things that we don't know. And I guess that opens me up to my first question, which is why did you choose to do this in the first place? Like, why did you choose to start educating the world on all things sexual health and urology?
- [02:27]
Dr. Reena Malik
Yeah. Thank you so much. And thank you for finding me. And it's really. I'm always so excited when I see people who found my content online. But, you know, I started because actually, as a resident, I realized that what we were telling our patients in the clinic, it was really difficult for them to keep, like, understand it completely in the short time we had. So I'll give you an example. I had this patient. I remember her very vividly. We. She had bladder cancer. When you have bladder cancer, you have a few options for surgery in terms of what you're going to do when you take out the bladder. And so she chose this option where you had to catheterize through a little stoma or a little hole in your belly to empty the bladder instead of having a normal bladder. She chose this option. We did the surgery. The surgery was beautiful. Everything went perfectly. She did fine. After surgery, she went home, but then she kept coming back in because we didn't know why, but she was very sick. She would go to the icu, she'd get very sick. And then slowly we figured out that she just wasn't catheterizing her stoma. So she had to empty her bladder, but she wasn't doing it. And she just didn't know that she had to do that. And I realized, like, we failed her, right? We did this beautiful surgery on her. She was cured from cancer, but she couldn't take care of her surgery, and so we didn't teach her what she had to do. Well. And so that was when I realized, like, we don't have enough time with our patients to really explain the things in detail and answer all the questions they have in the short 30 minutes. Minutes or 15 minutes we have with them, based on the way our healthcare system is here in the United States. And so, you know, that was sort of a moment for me where I got passionate about health literacy and realizing that is a huge part of how our patients do after surgery is how well their outcomes are and how happy they are and satisfied they are with the surgery they had. And so it became this space where I realized I was doing research in the area, I was learning more. And I realized video was one of the most impactful ways to really teach people. And so I just said, you know what? I could do research. I could get a grant, spend five years doing research, and then finally finish the research and then have to disseminate it around the world or around the country and hopefully have success, or I could just start making content. And so I just started you know, and I just. I didn't know what I was doing. I didn't know what I was going to talk about, except for urology. And so I just tried a whole bunch of different things and realized that there was this big lack of knowledge about sexual health. And so I went there and I kept making content in the areas that people wanted to know. So I listened to my audience and I made that content, knew they would like and that they wanted to learn about. And it's been transformative for me, and not only for me, but my viewers. And I think it's been a wonderful journey, but I'm very grateful to be on it.
- [05:12]
Louisa Nicola
Yeah, you've definitely amassed quite a following. And, you know, that reminds me of a time when I was working in a neurology, I was working in clinical practice, and I was just doing brain scan after brain scan after brain scan, and I was mainly looking for early onset Alzheimer's disease. And we came across one patient who I actually speak about quite openly a lot because she's the one that changed my life. And I remember we actually had to send her in and do a CSF like she had to take back to see if she's got any amyloid in her cerebral spinal fluid. We had to do some MRIs. And when we got the MRIs back, we saw that she indeed had Alzheimer's disease. And I remember sitting down with her and asking her, you know, just tracking history, like, you know, how did this happen? And what we know from this research is that exercise is one of the best preventative interventions that we have. And she actually said that she, I, when I asked her about her exercise, she said, I'm not really doing anything. I walk. But I asked her why she's not actually training, and she said, I never knew this. She said I would ask my doctor a lot, like, what do I have to be doing? And he told me I just need to be walking. And that's. That was the light bulb moment for me when it comes to patient education, because there is just. There is just so many people who still don't understand actually what exercise is and what it means for health and performance and staving off, you know, neurodegenerative diseases. So I definitely, definitely am on par with that with you. But a question I have is, is there anything that you've come across in all of your teachings that you think that a lot of people assume this, but they don't really know the truth? For example, I've heard you speak about wet dreams, meaning that A lot of people think maybe that's abnormal or morning erections may be abnormal or normal. Like what are some of the things that have deemed us in society as, as abnormal but you think are normal?
- [07:06]
Dr. Reena Malik
Yeah, I mean, there's so many, but you brought up a good one. So I don't know if it's as big of an issue in the United States, but definitely around the world there's a lot of people who feel like wet dreams are a bad thing and they're shameful and they want to stop having nocturnal erections or nocturnal emissions or wet dreams. And it's physiologic thing, you can't stop it. And in fact, it's a sign of good health. Right. It's a sign that your, your penis is getting good nerve function, good blood flow, and that it's functioning normally. Women have them too. We have clitoral tumescence. Our clitoris goes through tumescence throughout the night and, and relaxes all throughout the night. So it's, it's a normal physiologic function. Men just can see it more visibly. And so I think that's one big major one. But another one is, is on masturbation. And I think that there's a lot of negative connotation around masturbation, but it is self pleasure and it is, when done, you know, for the purposes of pleasure and is completely safe and not harmful. Right. I think a lot of people forget that many people don't have partners and the only way they're going to experience pleasure is by themselves. And as long as you're not doing it to the detriment of your life, meaning you're choosing masturbation over doing other things like hanging out with friends or family or your partner, or you're choosing losing it over actually having, being intimate with your partner, that it's really okay to masturbate and enjoy pleasure. It's not going to harm you, it's not going to make you less of a man or less of a woman. There's no evidence to suggest that abstaining from masturbation is going to increase your testosterone in any measurable way. And so if, if abstaining makes you feel good, by all means, go ahead. There are spiritual reasons why people abstain and that's fine, and they do achieve, you know, benefits from that. But ultimately think it's, it's really a misnomer, that it's a bad thing.
- [09:05]
Louisa Nicola
So abstaining from masturbation is not healthy in any way?
- [09:10]
Dr. Reena Malik
Well, like I said, there are spiritual benefits for some people. They feel like they're able to focus or concentrate. Again, these are subjective things. They're not scientific. There's no evidence that abstaining from ejaculation, whether it's through masturbation or through sex, is actually going to benefit you in any meaningful way, at least from an evidence based, scientific, scientific perspective. And so I think a lot of people try it because they think they're going to get some sort of higher level of performance or maybe higher level of testosterone. And again, there's no evidence, and there's actually evidence to disprove those things in, in the scientific literature.
- [09:49]
Louisa Nicola
Okay, I'm really happy that you, that you said that. And actually, let's talk about testosterone. And I know that we speak about this so often, especially on, on social media, I know that you've done tons of education on this, but I'd love to understand exactly what it is because I know that both males and females have testosterone. A lot of people think that females actually don't, but I know that females actually have more testosterone, correct me if I'm wrong, than estrogen. So, so let's talk about what testosterone is and how we can increase it in males and naturally. And also, what is testosterone in terms of female health?
- [10:28]
Dr. Reena Malik
Yes. So testosterone is simply a sex hormone. Right? It's something that gives signals around our body and we have androgen receptors. Both men and women have androgen receptors all over their bodies. So it is beneficial for libido. That's traditionally what people discuss of it. It's obviously important for sperm production in men. But in terms of like, what are the big benefits that people talk about? Libido is one, mood is another one. So it can help with mood because we have antigen receptors in our brain. It can help with bone health because we have antigen receptors in our bo. It can help with muscle growth. So when you lose testosterone, it becomes more difficult to grow muscle and easier to get fat or get easier to get fat. And so ultimately, when you are down on testosterone, people will come in complaining of decreased libido, decreased muscle mass, if they're going to the gym. But they're not getting as big as they used to. They're having difficulty growing muscle, they may be depressed, they might be having issues with erections. Now, it's not erectile dysfunction. Dysfunction is very complicated. So it's not as simple as it's just hormonal. It's very few, very few. Percentage of men around 3 to 6% that have just hormonal ED, meaning they may have some component of it, but that's not the only thing that's going on. And, and so ultimately. And like brain fog is another one, and fatigue. And so it can affect you in so many different ways for both men and women. So women will often experience a decline in testosterone, similar as men have a decline in testosterone as they age. And that can lead to low des, brain fog, these other things. And the benefit really, in women, it's been studied quite extensively, but it's still sort of off label. But we often will prescribe it for low libido in women, particularly in the postmenopausal state.
- [12:16]
Louisa Nicola
Would that be.
- [12:17]
Is it like estrogen, like a gel?
- [12:19]
Dr. Reena Malik
Yeah. So it's topical. So there's a few options. Pellets are not recommended because when you get pellets, the testosterone levels go really, really high, like probably super physiologic, and then come down. So generally we don't recommend pellets, but, but there are people who place them. You can get injectable forms, but it's, you know, the doses is one tenth of the dose that a man gets. So it's really, it's difficult to get that dosing. Typically what we recommend, the most common thing is a topical gel. And so what you'll say is you'll take the male dose, right? And you put it in one of those little syringes like the ones that used to, if you have kids, like you give your kids medication in, and you give 110 of the dose. So if a guy gets 5 mls, you're getting, you know, 0.5 mls once a day, rub it on the back of your calf or your thigh, and once a day. And then we see how your symptoms improve over the, over the first month. And then we could also check testosterone, but the level checking is really just to make sure we're not going too high. It's really based on symptom improvement.
- [13:19]
Louisa Nicola
Now, is it true that we are going through. This is in the US we are going through a testosterone deficiency epidemic, which I believe it is, is categorized as less than 300. Is it nanograms per deciliter? So is it? Yeah, per deciliter. So are we going through a. Some sort of epidemic? And if so, why?
- [13:42]
Dr. Reena Malik
I don't know if it's an epidemic, but certainly we're seeing a lot of low testosterone. And really the reason is because of the, the high number of comorbidities. Right. So as you age, we're seeing more and more people, both men and women, getting diabetes high Cholesterol, high blood pressure, more than ever before because our lives are more sedentary. We're not exercising, we're not moving. And those are the biggest contributors to low testosterone. Right. So if you have these other comorbidities, they're gonna affect the ability of your body to produce testosterone. And so that's why the number one reason we're seeing it now, you can say there's obviously other reasons too. So we are having more endocrine disrupting chemicals in the environment, microplastics that could affect our ability to produce testosterone. But ultimately those are a little bit outside of our control. And like you can control, you know, not drinking out of plastic water bot and warming up food and glass plates, but like you can't control all of it. I mean, if you look at the urine studies of people, there's like 97% of people have some sort of endocrine disrupting chemical in their urine. So it's very common and we're, it's ubiquitous. We're all exposed to it. It's just about the amount of exposure that, you know, you want to limit.
- [14:51]
Louisa Nicola
Yeah, I mean, the dose makes the poison. I think when it comes to social media, like there was a headline that came out probably, I don't know if you saw it, it maybe two weeks ago, and it was about microplastics, you know, just that people. Was it coronary, coronary arteries, that they found it?
- [15:05]
Dr. Reena Malik
Yeah, in the plaques.
- [15:07]
Louisa Nicola
Oh my gosh. And that makes you think. And of course, and then you have to think of people who may not have a ton of scientific knowledge and they're thinking, oh my God, I've. I'm going to die because I'm eating from a plastic container. Do you think that there's any interventions like this is just me. I don't know if there's any proof behind this, but can going into a sauna help with eliminating this?
- [15:28]
Dr. Reena Malik
Yeah, I don't know. I really don't know if there's any data on that. I mean, I was just talking to somebody about this and we're like, well, you know, the fin in Finland and other countries, they've been using saunas for long periods of time. And so, you know, there may be some benefits. And I think there are some smaller studies probably that show some benefits in terms of like overall energy or other, other things. But again, I'm not really sure. I, I don't, I don't haven't looked at that data personally, so I can't speak on it, but I would Say, you know, use things if you feel like they help you in moderation. Because again, using it all the time for long periods of time could have detriment too. So if you expose your testicles to high temperatures for long periods of time, that will reduce your sperm production and potentially your testosterone production. So, you know, in moderation with everything.
- [16:14]
Louisa Nicola
All right, and so, okay, so we know what testosterone is. We know if there is a shortage, a shortage, a decrease, right? Now, now what can somebody do if they've gone and they've seen their physician, maybe they've come back with low testosterone for their age group. Because obviously it's different for age groups for both men and women. But let's just talk about this. For men, would you turn straight to TRT or would you adopt more natural lifestyle interventions to increase testosterone levels first?
- [16:46]
Dr. Reena Malik
I mean, we always talk about natural lifestyle interventions first. And the number one is sleep, right? So there is good data that if you are sleeping less than six hours a day, your testosterone is 15% lower than the guy who's sleeping eight hours a day. Right? So I tell people, make sure you're getting at least seven hours of good quality sleep. Now, quality is important, right? Because if you're drinking caffeine later, alcohol late, that's going to affect your, your sleep quality. If you are looking at screens before bedtime, that affects your circadian rhythm. So trying to really set up a bedtime routine and avoid things that are going to disrupt your sleep is so, so important. And I mean, I think we as, as physicians and clinicians, like, we're not the best models of this because we do a lot of call work and we work overnight and we get bad sleep patterns. But ultimately, I mean, it's so, so important for so many things, including your testosterone. So that's number one. Number two is that the things that like you have to, everyone has to do right, exercise and eat right. So exercising specifically for testosterone, what they've seen is doing very heavy lower body resistance training. So the large muscles in your body can be very beneficial, beneficial for testosterone, but it's not a sustained thing. It's like you work out once your testosterone goes up. It's like you have to continue working out progressively, you know, every week, every few days to see that benefit. And then in terms of doing cardiovascular exercise, it does show an improvement in terms of erection quality for men. So if you do cardiovascular exercise, endurance exercise, three times a week, 150 minutes, you're going to see benefits in that arena too. And of course, for your heart Health, health in terms of diet, the best studied diet is the Mediterranean diet, which is very plant forward healthy oils and nuts and seeds, a little bit of meat, a little bit of fish, but generally whole foods, right? Like whole natural foods, not using a lot of processed foods, not a lot of sugar and not a lot of simple carbohydrates.
- [18:46]
Louisa Nicola
Maybe you can clear the air on this one. I've seen people, these so called biohackers on Instagram and various different social media platforms, platforms, tanning their testicles, albeit through natural sunlight or through red light therapy. Does tanning your testicles increase your testosterone production?
- [19:05]
Thank you InsideTracker for sponsoring this episode of the show. We talk all the time about optimization and you can do a whole bunch of things through diet, exercise and proper sleep. But if you aren't measuring the impact that it has on your body, then you are missing out. InsideTracker provides you with personalized plans to improve your metabolism, improve your sleep, optimize your health for the long haul. And most importantly, it analyzes your blood and your DNA. So you have to understand where your biomarkers are. For example, Apob, this is an extremely important biomarker. It's linked to cardiovascular disease. You must know these numbers if you care about living, if you care about living well and living long. So Inside Tracker is an easy way to get these things done and they also offer tools for professionals. I know that I have a lot of professionals listening to this. I know I've got a lot of coaches listening to this. Inside Tracker Pro is a no cost platform that allows your clients to share their Inside Tracker analysis with you so that you can tailor their health protocols and training based on their results. Just go to InsideTracker.com Louisa you can get 20% off the entire Inside Tracker store. Just use code Louisa20 at checkout.
- [20:28]
Dr. Reena Malik
No. So you don't need to tan your testicles, right? You need to get some sunlight and that's again for the circadian rhythm, right? So like going outside and getting sunlight on your body, anywhere is fine. Like a little bit of sunlight every day is good for you with sunscreen, ideally to prevent skin cancer, but ultimately sunlight anywhere is fine. In terms of red light, there's no data that red light will penetrate deep enough to get to your testicles. Like there's none. And so red light is used for skin conditions. So the data is all on skin level issues and it works on like collagen and other things. So yeah, maybe for your skin care, if you want to put a red light mask on there's some data on that. I'm not a dermatologist, but from what I understand. And so that may be beneficial. But putting it on your testicles, no data, no benefit as of yet. And it doesn't make sense. I don't think it's going to get deep enough to get to your testicles.
- [21:19]
Louisa Nicola
I mean, just sidetrack, just sidetracking from that. Well, what do you think about people doing coffee enemies, Enemas? I mean, we're down in that area and we're talking about biohacking. Have you ever heard of this?
- [21:29]
Dr. Reena Malik
Heard of it? And there's really no benefit. I mean, what, what. I don't, I don't remember what the purpose of doing the coffee enema is. Like, if you need, if you're doing it for constipation, you're doing a regular enema. Like, just do a regular enema. I don't know the. I, I don't really know that. I know there was some, like, viral video about coffee and I really don't understand, like, what, what are we getting out of it?
- [21:48]
Louisa Nicola
Yeah, exactly. And it scares me. Okay, so moving on, on. And I want to talk to you about, first of all, erections. And we, we hear so much about penis size and erections, but rarely do we hear about vaginal size during intercourse. And from one of your videos, I actually learned that the vagina expands during sex.
- [22:13]
Dr. Reena Malik
Yeah, it does. So the vagina is on average like three to four inches long, right? Three, three to two and a half, three inches. Right. And what happens is during arousal, so when you have sufficient arousal, and that's the key point of it because sometimes we're in such a rush and you're just trying to get a quickie and they're not sufficiently aroused. So once you've had sufficient arousal, which can take around 25 minutes for some.
- [22:40]
Louisa Nicola
People, then a lot of men are thinking, what?
- [22:43]
Dr. Reena Malik
Yeah, well, foreplay doesn't have to start in the bedroom. Right. Foreplay can start long before then, but arousal takes time. And so when you're sufficiently aroused, the vagina lengthens and widens about double in size to accommodate a phallus and the cervix moves up and out of the way. For some people, that's beneficial because they have pain when you penetrate and you hit the cervix. So ultimately, when a woman is fully aroused, she is ready to accommodate the phallus and, or a toy or whatever. And so ultimately, that is really the key is that, you know, we push babies out of the vagina like, it's a very flexible and pliable organ, but it does, it's not like the size that you see it when it's not aroused is not the size you see it when it is fully aroused.
- [23:27]
Louisa Nicola
Well, that's, you know that, that's like the penis size and erection. So what is the actual average length of a penis? Because I've actually heard of micro penises. I'm not too sure about the definition, but I, I have heard of them. I have a friend who's also a urologic surgeon here in New York City. She's been on the podcast and she was mentioning that a lot of people do come in for that here in New York City.
- [23:52]
Dr. Reena Malik
Yeah. So the average penile size erect is about 5.1 to 5.7 inches, depending on which study you look at. And, and so these, this is like average, right? So most people think, if you ask people what they think, the average guy thinks it's about 6 inches, which is longer than average. But that's the average size. And interestingly, when you look at the kinds, how do we know what women want? Right? So when we look at the kinds of sex toys women's buy, they've actually studied this. And the reason they studied this was because when you look, when they were building neophalluses for transgender men, they were like, okay, they were. They started making a pretty girthy and they realized the patients are coming back saying, I can't have sex with this. It's too girthy. So they started to look at what kind of toys are women buying. And what they found was that the average length of the toy was about 6 inches. But you realize the whole toy is not penetrating. Right? So it's about 6 inches long and the girth was about average. So same as average girth for men. The girth of toys was about average. So the average woman likes the average man. Shocker. Right? But like, but we're made, we're made to, to match, right? Like we are. It's, it's, it's, it's. We're physiologically made to match each other and to be able to have babies, which means that you have to have a phallus that penetrates and ejaculates and then that fluid gets into the cervix and you have a baby right into the uterus and ovaries and all that. So fallopian tube and reach the egg. So ultimately that's, you know, I think the take home is like, that's what average is. And it's not about size, right? A lot of women are not having orgasm through penetration alone. So 85% of women need some clitoral stimulation in order to climax. And so what that means is like penetration. And that may be with penetration or not, but ultimately, if you're not stimulating the clitoris, they're not going to orgasm. It doesn't matter how long your penis is. So you need to sort of think about pleasure in a different way altogether.
- [25:53]
Louisa Nicola
So if you're saying that women don't really care about size, why do men have such a fixation based on size? And I know this because as I mentioned, my friend here who's the surgeon, she said that she gets so many men that come in, and I didn't even know about this, who come in for Botox injections to increase girth earth, which I think is just insane. I'm like, what?
- [26:18]
Dr. Reena Malik
And so I'll just clarify, Botox increases length a little bit. Potentially. Yeah, yeah. And that's still very early. I've done a couple, but ultimately it's still really early on the data on that. But yeah, so there. Are there. Well, think about society, right? Like everyone jokes about, oh, how big is he, right? You, you're, you're with your girls, you talk about, oh, is he big, is he well endowed? And guys are always joking about how big your penis is. And so there's a big societal pressure to large penis, right? And then, you know, people think like, yeah, it may, it does nothing, doesn't feel good. It feels good to be penetrated by a phallus that fills your, your space, right? But ultimately, like, it's not necessarily going to lead to orgasm. And so I think the issue there is this lack of education, right? Like we see movies, right, where women are penetrated and within minutes they're orgasming, right, like in popular media. And, and so this is the perception, right, that you have a man who's well endowed, he penetra woman, and within minutes she's orgasming and that's how she's going to orgasm. But that's not true, right? Our clitoral tissue is the same as the penile tissue. So the erectile tissue is in the clitoris, not in the vagina. So the vagina is essentially analogous to like the male prostate, right? Like if somebody was stimulating a guy's prostate, a guy might orgasm, he might not, right? Like it's not pleasurable for everybody. So same thing. It's not necessarily pleasurable for everybody. Now you can have orgasms from vaginal penetration from what they call the G spot, which is actually a zone, and the clitoris, because there are different nerve endings there, but they're not as powerful as the nerve endings on the clitoris. The Clitoris has like 10,000 nerve endings and we just found this out like not too long ago. It used to be thought that it was 8,000, but very recently there's data published that's 10,000 nerve endings. So that's going to be your most reliable route to orgasm.
- [28:12]
Louisa Nicola
Okay, so, so I will just say that again for, for the men listening or even maybe the females. Females have 10,000 nerve endings in their clitoris, which is the site of orgasm and pleasure. Okay, great. Now I wanted to actually talk about sexual dysfunction. I did read a statistic which was sexual dysfunction, which is highly prevalent affecting around 43% of women and 31% of of men. What is the root cause of sexual dysfunction in both men and women? If we could find one.
- [28:49]
Thank you to Bon Charge for sponsoring this episode. Bon Charge is a wellness brand that has products from blue light glasses, infrared saunas, red light therapy, EMF management, and circadian friendly lighting, and of course, my.
- [29:02]
Favorite red light panels.
- [29:03]
If you saw me this week on Instagram, you would have seen me pointing out my red light therapy morning ritual. I do this every morning for around.
- [29:14]
20 to 30 minutes.
- [29:15]
This is actually where I do my visualization. Red light therapy, also known as photobiomodulation, consists of both red light and near infrared light. And they have the unique ability to penetrate these tissues, including the skin and superficial organs beneath the skin. And there's a large body of peer reviewed research that supports the idea that red light therapy improves mitochondrial health, health skin health, wound healing and acne.
- [29:42]
So if you want to learn more about this and potentially purchase a red.
- [29:46]
Light panel or infrared light mask, you can head over to boncharge.com use my code neuro to save 15 off store wide. That is boncharge.com neuro for 15 off storewide.
- [29:59]
Dr. Reena Malik
Yeah, so I mean, dysfunction is a umbrella term, right? So there's so many things underneath it. With men, probably the most common is erectile dysfunction, but there's also ejaculatory dysfunction. Meaning? Meaning you're either ejaculating too soon or you're ejaculating too late. There's also orgasmic dysfunction, like you're unable to orgasm. That's less common in men. In women, you're seeing. And obviously low desire is in the category of sexual dysfunction. In terms of women, very often we're seeing low desire. That's a very common complaint in women. In fact, 40% of women have low desire. Not all of them are bothered by it, but still there's a lot of it. There is lack of inability to orgasm or difficulty orgasming. There is, there are, can be arousal issues. Most often it's like lubrication issues, particularly around the times of menopause or if you're on certain medications where you're having difficulty with lubrication. And so there's a whole host of issues that can go wrong in terms of dysfunction. And that's not even counting pain or other pain related issues that can happen in the pelvis, making it difficult to have sex. So ultimately there's a whole host of them and you could, we could talk about this for hours. But the most common probably in men is erectile dysfunction and women is low desire.
- [31:15]
Louisa Nicola
When it comes to low desire, though, let's talk about women. Low desire, is that completely correlated with hormones?
- [31:24]
Dr. Reena Malik
Yeah, so sometimes it is. So low desire is very multifactorial and you have to look at it from like a biopsychosocial lens. Right. So it's, it is biologic in some cases, but there's also the psychological components to it and then there's social components. Like what is, what's, what do you think your desire should be based on your environment. Right. And so in terms of desire, very commonly we see there's two different kinds of desire. There's responsive desire. So desire that occurs after you initiate some form of intimacy. Right. So that's more responsive and that's actually normal and very common in women, particularly those who are in long term relationships where it's not like you see your partner and you want to jump them immediately. That's spontaneous there, right? Like you're just like sitting here like, oh man, I really want to have sex. Like that's more spontaneous. And that is very common when you're young, when you're in new relationships, because it's novel, it's interesting thing. It's, it's, you know, it's, it's also just different hormones when you're younger. So it's, it's much more common. But that doesn't mean that responsive desire is wrong. And so I think a lot of people don't realize that that's just a normal, a normal thing. And that spontaneous desire is not common, is not always common. And so, and it fluctuates over a lifetime. So that's one thing, is that sometimes low desire is just perceived as low desire, but it's really, that you haven't actually allowed yourself to experience responsive desire because any intimacy that you start having, you just push it away. Because, like, I'm not in mood, right? And so that's one, two is there are changes in your body through hormones, as you mentioned. And so what happens very often is, you know, menopause is a. Is a event that's going to happen, right. Average age 51. But symptoms can start as early as 10 years before that, but probably more like 7 years. But symptoms can start as early As 10 years before menopause. And that can include changes in the vulva, which can be dryness or lack of lubrication. Your labia minora can actually shrink and resorb the clitoris, the urethra can shorten, so you get a lot more urinary tract infections. And so there can be a whole host of changes that can occur that can make arousal more difficult and that can then lead to low desire, Right? Because you're like, ah, I'm not getting lubricated. Does it feel as good when we have sex because it's uncomfortable? And so that can lead to low desire. Anything that's causing you discomfort sexually can lead to low desire, Right. So there's that as well. And then, you know, there's a whole host of things as women are. I think people underestimate stress, right? Like, as women are aging, particularly, right. Like, you may be working full time, you may be taking care of children, you may be taking care of aging parents. And all those things does not lead to wanting to have desire, right? Like, you're like, I'm so stressed and tired and busy and taking care of all these people. Like, I don't really. Yeah, I don't really want to have sex right now. And so, like, yeah, no pill or magical thing is going to fix the stress in your life, right? So, like, figuring out how you can minimize that or alleviate some of that or unburden and some of that can be helpful. So there's like a whole host of things that can affect sleep. Again, is really important. If you're not getting adequate sleep and you're too tired, you're not going to want to have sex. So there's like a whole host of things that go into it. It's not just hormones. And so you have to look at it from a big picture.
- [34:41]
Louisa Nicola
Yeah. I wonder if what just was going through my head then was, I wonder if this is the start of separation, you know, the start of one person. Person does have a high sex drive. The other partner doesn't just due to stress, hormonal issues. And then because you mentioned the word spontaneous, and now you can feel spontaneous, you know, spontaneity, when you just go on Instagram, for example, and you're just flicking through and then one thought leads to another, and maybe that's what ends up leading to either a separation or maybe infidelity, if you will.
- [35:16]
Dr. Reena Malik
Yeah. I mean, I think the other thing is that when you think about sex, men see sex as stress relief. Right. Like, it's a way for them to let off steam, to get relief from stress. But women often see it as one more thing to do. Right. It's one more additional thing to do. And it doesn't relieve stress for them, or that's how they perceive it. And so there's this mismatch in general. Right. Of how women and men perceive sex. And. And we don't know how to talk about sex. So that's the biggest problem, I think, in the. In anywhere in the world is like, you don't know how to talk about sex. No one taught you how to talk about.
- [35:48]
Louisa Nicola
You mean with your partner?
- [35:49]
Dr. Reena Malik
Ye. Yeah, with your partner. You've never talked, probably had a conversation about what you like, maybe a little bit. But like, if you don't like something, oh, you don't want to hurt their feelings, and you don't want to say something that might make them feel bad or whatever. Right. But we've never had a conversation about, like, okay, what do I like? What do I not? Like? How, you know, what can you do that makes me feel better? What can I do that makes you feel better? What, you know, what is your goal? Like, how often do you want to have sex? And this is how often I want to have sex. And like, how can we meet in the middle? The middle. Like, no one talks about it. Right. And then you can't. And then say you want to talk about it. You don't know how to start talking about it. And you say you want to find a sex therapist. Not everyone has access to that. So I think ultimately, if we were able to have open conversations about sex, I think our sex lives and the separation rate would go way down. Because I think if you talked about these issues and dealt with them, it would. It would be. It's. It's all figurautable. Like, you could figure it out. You can deal with it.
- [36:44]
Louisa Nicola
So would you say that a sex therapist is something that many couples should do or get into?
- [36:51]
Dr. Reena Malik
If. Yeah, I think both couples should be. I mean, you can do it individually, but if you're both going to go, you should both be on board with it to sort of talk about your issues with sex. But ultimately, I mean, it starts with, I can tell you some of the, the basic things we tell people is, you know, make time to reconnect. So actually schedule it into your calendar. And that doesn't mean like scheduling sex, but actually scheduling time for intim. So saying like, okay, this hour we're gonna actually promise to be intimate together. We're going to, you know, not have our phones, not have our kids, not have anything else, and we're just going to be together. And if sex happens, great. And if it doesn't, it doesn't. But like, we're actually marking off time on our calendar to be together. And that is, you know, think about when you were younger, you went on a date, right? And you were like super excited to go on that date all week. You were like, oh, I'm gonna like wear this, I'm gonna think about this, I'm gonna shave my legs. I'm gon is right. And you did all those things and then you were like, really excited and ready for the possibility of sex. And that was really exciting. And now, you know, your partner's always there, so you're like, ah, whatever, I can have it whenever I want.
- [37:59]
Louisa Nicola
You look the same.
- [38:00]
Dr. Reena Malik
Yeah.
- [38:01]
Louisa Nicola
So you mentioned earlier, we were talking about testosterone and ejaculation and I found a Harvard Study, an 18 year old Harvard study of nearly 30,000 health professionals determined that the risk of prostate cancer was reduced by 20% for men who ejaculated 21, 21 times a month compared to men who ejaculated 4 to 7 times a month. How does 21 times a month of ejaculation lower the risk of prostate cancer by up to 20%.
- [38:31]
Dr. Reena Malik
Yeah, so there's a couple thoughts there, and one is like the prostate stagnation hypothesis. So like, if the fluids that the prostate is forming are not, not, you know, actively cleared out regularly, then you may see that stagnation, that there's some buildup of reactive oxygen species or other things that may lead to transformation of cells. Again, this is just a hypothesis, not an accurate, you know, we don't know for sure, but ultimately the thought is like, okay, if you clean the pipes regularly, you may be less likely to develop prostate cancer. Now this is obviously a correlation, not causation, right? So we can't say for sure that if you ejaculate 21 times a not going to get prostate cancer. But. And the person who's ejaculating 21 times a month is probably different than the person who's ejaculating four times a month. Maybe they have a partner and they have a good social support. Right. They can't measure that. Exactly. In the study. Right. You can't measure like how strong of a social support you have. You can measure if you're married or not. Right. But like that, that plays a role to some degree in longevity. We know that. So that may be part of it. It may be that you're more physically active so you can have more sex. There's a whole host of things that we can sort of infer from the study. And while it was a really well done study, I think the big take home is like ejaculate. If you want to eject as much as you want to, as long as it's not harming you in any way, it's. It's probably fine. And if not, maybe beneficial.
- [39:56]
Louisa Nicola
Is there any type of association between masturbation and females lowering any type of risk of cancer?
- [40:03]
Dr. Reena Malik
Not, not necessarily. There has been in the data. But I would say that generally speaking, the, the reason people talk about masturbation is the benefits are really seen with orgasm in terms of like improved sleep, improved mood, you know, decreased heart rate, decreased blood pressure. All those things happen after orgasm or during orgasm. So that's sort of where you see the physiologic benefits. And ultimately I think that's where if you're masturbating to orgasm, then that's, that's some. Somewhat of a positive for those positive benefits.
- [40:34]
Louisa Nicola
Wow. Okay, so what are some of the. Let, let's tie this all together and let's talk, talk about why you're doing what you're doing. You know, you wanted to put the best education out there to help people in the realm of sexual health and urology. What are, you know, Rena's Dr. Reena Malik's top tips for having a great sexual health life or a great sexual life. And what are some of the. The tips that you have as well?
- [41:01]
Dr. Reena Malik
Yeah, so I would say number one is something where you talked about, which is communicate. Right. So actually talk to your partner about sex and make it a habit. It's not going to be one conversation. Like it's something that you're going to have to do over time. And don't do it in the bedroom and don't do it like either right before, right after sex. Do it in a different location altogether. Do it like in the kitchen or when you're out for a walk or when you're in the car for a drive and just start talking about sex. Like start talking about what sex means to you. What do you like about sex? Do you not like about it? And build that muscle of talking. Right. Because that's important and sex is just like anything else. You're not going to be good at it the first time. So don't beat yourself up when you have sex. That's not that great, right? Mediocre sex, Sex is okay, it's fine. You're going to have mediocre sex. Sometimes. Not every sexual encounter needs to be mind blowing and amazing. And so I think that's, that's one thing. The other thing is like sex is play, have fun with it. It's, it's the only time as adults we get to play. Don't take it so seriously. Like actually have fun with it. Like you can do anything you want. You can role play, you can bring in toys and accessories. As long as you have a consenting partner who's on the same page as you, who you know, you have boundaries around things like safe words. If you're trying something new like that' really the key. You can have fun, you can do things, you can do them in a controlled environment and with someone you feel safe and trustworthy with. And like you have to be vulnerable, right? So being vulnerable is, is part of sex. Like if you can't be fully vulnerable with somebody, you can't have mind blowing sex. I think those are sort of like the big keys. And then ultimately if you are struggling, ask for help. Like don't stay in silence at home. Nothing's going to happen, right? You have to talk to somebody with expertise. So see a doctor, see urologist, see a gynecologist, see a sex therapist to talk about what's going on with you. And if you don't click with that person for whatever reason or they dismiss you or they gaslight you or whatever, find somebody else. Because ultimately there is so many people and you're not going to click with every single doctor you see. You're not going to like their style and that's okay. And if they make you feel bad, well, they're not the right doctor anyway. So I think those are the big keys. Like if you're try the things that are easy to, to do, easy to say to do, not necessarily easy to do but like talk to your partner, work on those things, talk about what you like, figure those things out. And if you're still struggling, ask for help.
- [43:25]
Louisa Nicola
That was incredible. Where can we find you? Should I. I'm going to link your Instagram. I'm going to link your YouTube channel. Is there anywhere else that you want us to link to?
- [43:35]
Dr. Reena Malik
Yeah, I mean, those are the big ones. You can find me on Facebook and. And TikTok as well. But really, those are the big ones, so we'd love to see you guys there. My channel's Rena Malik MD. I also have a podcast called the Rena Malik, MD. Podcast podcast, which is. Yeah, yeah. So it's relatively new, so if you want to check it out, we'd love to see you there.
- [43:52]
Louisa Nicola
Thank you, Reena, for being part of the Neuro Experience podcast.
- [43:55]
Dr. Reena Malik
Thank you.