Dr. Rena Malik: Why your nervous system runs your sex life

1. 0:00 – 3:57

   Intro

   1. SBSteven Bartlett0:00

      Is there a way to enlarge the [beep] ?

   2. RMDr. Rena Malik0:02

      So you can put your penis in this device. They've actually done research on this, so thirty minutes twice a day, and it does show improvements in length, about two centimeters.

   3. SBSteven Bartlett0:10

      Ta-da.

   4. RMDr. Rena Malik0:12

      And that's not all. So they actually did a study on pistachios where guys ate a hundred grams of pistachios every day, and they saw a decrease in erectile dysfunction. Because if you're not having erections, now you're no longer getting blood flow to your penis, and it will shrink over time. And the same goes for women with their clitoris because it's the same type of tissue. But also, when you look at people who have sex once a week, they live forty-nine percent longer than people who only have sex once a year.

   5. SBSteven Bartlett0:35

      Forty-nine percent longer?

   6. RMDr. Rena Malik0:37

      Yeah. And for every hundred orgasms men had, they lived like thirteen percent longer.

   7. SBSteven Bartlett0:43

      Be right back. [laughs] Dr Rena Malik has become the world's most watched urologist. After sharing everything you need to know about hormones, sexual health- And how to have better sex based on the data.

   8. RMDr. Rena Malik0:55

      So how can you have the best sex possible? So there's four main pillars of sexual health. So pillar one is fuel, so how you nourish your body. And it's a huge part of sexual activity. And then pillar two is strength. When people think about strength, they always think about going to the gym and lifting weights, but it's much more than that. So when you look at the data, any sort of cardiovascular exercise is going to improve sexual function. It's gonna improve blood flow to the penis and to the clitoris. And then also, if you do one hundred fifty minutes a week, it is the same amount of improvement as you would see when you take a medication like Viagra. And the other part of it is the pelvic floor. It's under-evaluated and under-discussed, and we'll get into that. But pillar three is environment, so things like stress, sleep, and endocrine-disrupting chemicals. For example, they looked at data on men sleeping five hours a night versus eight hours a night. Guys who sleep five hours a night, their testosterone drops by fifteen percent.

   9. SBSteven Bartlett1:47

      Mad.

   10. RMDr. Rena Malik1:47

       And then the last of the four pillars that we don't talk about enough is, and that's so important.

   11. SBSteven Bartlett1:53

       Rena, I wanna talk about morning erections, squirting, clitoral stimulation, and certain positions that are going to increase the probability that my partner has an orgasm.

   12. RMDr. Rena Malik2:02

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

   13. SBSteven Bartlett2:07

       This is super interesting to me. My team give me this report to show me how many of you that watch this show subscribe, and some of you have told us, according to this, that you are unsubscribed from the channel randomly. So favor to ask all of you, please could you check right now if you've hit the subscribe button if you are a regular viewer of the show and you like what we do here. We're approaching quite a significant landmark on this show in terms of a subscriber number. So if there was one simple free thing that you could do to help us, my team, everyone here, to keep this show free, to keep it improving year over year and week over week, it is just to hit that subscribe button and to double-check if you've hit it. Only thing I'll ever ask of you. Do we have a deal? If you do it, I'll tell you what I'll do. I'll make sure every single week, every single month, we fight harder and harder and harder and harder to bring you the guests and conversations that you wanna hear. I've stayed true to that promise since the very beginning of The Diary of a CEO, and I will not let you down. Please help us. Really appreciate it. Let's get on with the show. [upbeat music] Dr Rena Malik, if somebody was to come up to you in the street having watched your videos online, and they were a, a follower of the content you've produced over the last couple of years, if you had to guess the question they would ask you, because it's probably the most frequent popular question you get asked, what do you think they would say?

   14. RMDr. Rena Malik3:23

       They would say, "What can I be doing right now to improve my sex life?"

   15. SBSteven Bartlett3:27

       Who would be asking you that question, and why do you think they'd be asking it?

   16. RMDr. Rena Malik3:31

       I think everyone can agree that sex is something we enjoy. It's something that's important that we wanna have, right?

   17. SBSteven Bartlett3:37

       Yeah.

   18. RMDr. Rena Malik3:37

       And there is, um, a desire to have good sex or feel like maybe you're missing out on something that could be even better. So how can you have the best sex possible? Because you hear all these people s- talking about amazing sex in the media. You might see it on pornography. You might feel like, "This is something amazing. Why am I not having that? I want

2. 3:57 – 6:06

   Why Are People Having Less Sex?

   1. RMDr. Rena Malik3:57

      that," right?

   2. SBSteven Bartlett3:57

      So on that point, you said it's obvious that it's important. I think it appears to be increasingly not obvious that it's important because when you look at some of these stats, and I'll throw this graph that I f- I found here up on screen, and it shows that people are becoming more sexless, especially young adults between 18 and 30. This graph is pretty stark.

   3. RMDr. Rena Malik4:17

      Mm-hmm. Think about 50 years ago. There was no cell phones. There might be some TV programs, but there was ads in between TV programs, and there was only certain TV shows you could watch at a certain time that you enjoyed, and then there was nothing to watch. There was no email, so you went to work and you came home, and there was really not a lot of communication between you and your coworkers or your job. They made dinner with their s- par- family. They hung out, and then maybe they watched a program or two, and then they lied down in bed. They didn't have a phone to scroll on. [laughs] They didn't have anything to keep them up. And so then they're like next to their partner, and maybe they're talking. Maybe they're cuddling. And so there was more, like, opportunity and space for sex, right? You... It was a thing that you did for enjoyment, for pleasure, for fun. Now we have all these distractions that keep our mind away from sex. In order to enjoy sex, you need to have space for it to be able to enjoy your partner and feel like you want that, right? And now we're sort of i- there's not as much room for it. That's one. Two is younger people, how are they dating, right? How are they meeting each other? They're meeting each other through apps, through, um, DMs, and so they're not actually, like, really having these deep, meaningful connections. They're ha- There's a big hookup culture. There's a big, like, fling culture. And imagine first-time sex for most people is not great. You don't know your partner. You don't know what they like. Y- and you may not be able to express what you like. You were never taught how to talk about sex, right? So you don't know how to say like, "Hey, I like it like this." And you may be self-conscious 'cause it's your first time, so you have, like, mediocre sex or bad sex. And you're like, "Well, I don't really want that." And there's just no, like, follow-through, right? There's, there's not a lot of, um, education on what sex should look like. The only education people are getting are from often erotic films. And so they're seeing sex that's not real, that's curated, and they're trying to emulate that, and that's not pleasurable for most people.

3. 6:06 – 7:16

   Why Is Rough Sex Increasing?

   1. RMDr. Rena Malik6:06

      AndYounger people these days are, um, actually having a rise in more we call rough sex. So choking has become very, very common, as common as, like, they call choking almost like vanilla sex. So young people, if you look at data, like, 60% of women and I think it's 20% of men have been choked during sex of that age group, like college age group, and of those people who get choked, 20% have been choked 25 times or more. Now, I think it's fine if you're into that, but I can't imagine that that many people are into choking, and there's data to support that. So when you look at qualitative data, and this is by, uh, Debby Herbenick, she's a sex researcher, and she did qualitative research, and she asked people, like, "What is it like? Do you enjoy being choked? Tell us about it." Right? Women were like, "Yeah, it's okay. Sometimes I'm scared because my partner is big and strong and I'm, you know, smaller, and they have big hands. Sometimes it's fine, and sometimes I don't really care for it, but, like, it's just a part of sex. It's just as normal as ki- as kissing, for example." And so if you're having sex and you're doing things just because you think that's what your partner wants or what it should look like and you're not enjoying it, well, that's not gonna be sex that you wanna have.

4. 7:16 – 9:42

   Is Dopamine Ruining Your Sex Life?

   1. SBSteven Bartlett7:16

      That point you said about the, the lifestyles we lead and how that might be impacting our sex lives I thought was really interesting 'cause we don't talk enough about this. But when you look at some of the data on this demographic, um, you know, people 30 and below, around that age, the extreme outliers are spending eight to 10 hours on their phones on social media and on the internet, and roughly about 15 to 20% of young people describe their usage as almost constant, effectively scrolling during all waking hours, while they're eating, while they're in the bathroom, and before they go to sleep. So, and I was wondering from a dopamine perspective if there's correlation between these, like, dopaminergic activities that are now, like, hijacking our lives, whether it's short form videos on social media, whether it's pornography or food, whether it's having an impact on what then happens in the bedroom and our performance in the bedroom.

   2. RMDr. Rena Malik8:08

      If you think about what you need to have good sex is you need to be sort of in the mind space for sex, and if you're constantly, like, hijacked by all these other things, you're never, like, really getting in the mood, right? You're just like, "Oh, I'm gonna be turned on when I see my partner, and we're gonna have sex, and it's gonna be over." And it's just really a mechanical thing at that point, right? You're not actually... You're just trying to get an orgasm. You're not actually, like, spending the time to enjoy and to experience that fully because you're just so, like, you're just... Your brain is always doing something else, right? Because people are constantly scrolling. Like, every 60 seconds there's a new video, there's something else, and so it's really hard to focus. And so that can translate to the bedroom, where you're like, you're having sex, but your brain is somewhere else thinking about something else you saw or something you have to do or something you wanna see or something you wanna look up, whatever it is, but you're not really in, there in the moment. You're just going through the motions. And so I think that's really where the challenge is, is that people are becoming increasingly distractible.

   3. SBSteven Bartlett9:07

      I find it really hard, I gotta be honest, to have sex if I've had, like, a really, really busy day or if I'm really, really thinking about something.

   4. RMDr. Rena Malik9:12

      Yeah.

   5. SBSteven Bartlett9:13

      I almost have to... I have to, like, intentionally create quite a lot of space-

   6. RMDr. Rena Malik9:16

      Exactly

   7. SBSteven Bartlett9:17

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

   8. RMDr. Rena Malik9:20

      Yeah, be aroused, right? It takes, like, time and energy. I think I appreciate you for saying that because a lot of people think that men are just [fingers snap] ready to go at any moment.

   9. SBSteven Bartlett9:28

      I think so.

   10. RMDr. Rena Malik9:28

       And that's not fair, right? Because everyone needs time to be aroused. It's not just instant for everybody. Especially when you have a lot of work stress or life stress or other things going on, it's actually like you have to make time and space for it.

5. 9:42 – 11:50

   How Do You Find What Turns You On?

   1. SBSteven Bartlett9:42

      Yeah, because as a man, you gotta get an erection, and I, I, I always think that an erection is a consequence, usually, especially when it comes to sex, and I'm not talking about morning glories here, but an erection is a consequence of, like, a story.

   2. RMDr. Rena Malik9:53

      Mm-hmm.

   3. SBSteven Bartlett9:54

      You used the word aroused.

   4. RMDr. Rena Malik9:55

      Mm-hmm.

   5. SBSteven Bartlett9:55

      There's, like, a story in my head which makes me go, "Oh, that's kinda hot."

   6. RMDr. Rena Malik9:59

      Yeah.

   7. SBSteven Bartlett10:00

      And-

   8. RMDr. Rena Malik10:00

      You need something. You need some stimuli, right? You need to think about something, see something, smell something, feel something, right? You need to just be together and, and sort of allow yourselves to be intimate before that sort of desire and arousal come together.

   9. SBSteven Bartlett10:14

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

   10. RMDr. Rena Malik10:16

       Mm-hmm.

   11. SBSteven Bartlett10:16

       Like, that doesn't necessarily do it. For me, it really is quite, like, a psychological thing. I was wondering if this is, there's any data around this or, I mean, just even anecdotally, like, people get aroused in very, very different ways, don't they?

   12. RMDr. Rena Malik10:27

       Yeah, absolutely. I mean, some people, um, are very, like, visual, so they, you know, they see their partner, and they get aroused very quickly. Basically, when you get aroused, you need to be in a parasympathetic nervous system state. So in order to get an erection, you need to be in this state which is, like, rest and digest. So if you're stressed, if you're thinking about other things, if you're essentially on the go, you are not allowing your nervous system to calm down. And so for some people, that's a whole bunch of different things. Some people can switch more easily into that state, and some people need more of, like, a, you know, to feel, uh, either mentally stimulated, or they need to have some associations. Like, it might be like they need a certain scent. They need to, like, relax their body. They need to, like, go take a bath. Whatever it is, but some people need different things, and knowing what that is for your partner is super important, right? Because then you can incorporate that. Everything is scheduled in our lives, right? And then you're like, "Oh, but, uh, now sex is, like, the last thing on the schedule," right?

   13. SBSteven Bartlett11:25

       Mm-hmm.

   14. RMDr. Rena Malik11:25

       And, like, I don't even think about it. Like, oh, okay, now yeah, maybe let's have sex. But, like, if you actually make time to be intimate, allow yourself to be in that brain space, be together, that's when it can actually happen, especially when you've been in a long-term relationship. It doesn't come as easily, like, spontaneously, which we call spontaneous desire. It, it comes more of as a response to these other cues that allow you to feel desire and to feel aroused.

6. 11:50 – 14:34

   Why Does Performance Anxiety Kill Intimacy?

   1. SBSteven Bartlett11:50

      Hmm. I also think, I was thinking about a previous relationship I had where on the days where I'd been, like, working very hard and I was, like, tired or stressed or I'd been traveling and I was jet lagged, I think there was also, because I didn't see this person often, there was also an expectation that when I did see them, we were gonna have sex.

   2. RMDr. Rena Malik12:07

      Mm-hmm.

   3. SBSteven Bartlett12:09

      That was, that was very hard because actually the expectation of it [laughs] stressed me out more.

   4. RMDr. Rena Malik12:15

      [laughs] Yeah.

   5. SBSteven Bartlett12:16

      And that can happen, like, y- if it becomes in, the elephant in the room, it can become a little bit heavy, which then is sort of counterproductive to-

   6. RMDr. Rena Malik12:23

      Absolutely

   7. SBSteven Bartlett12:23

      ... performance.

   8. RMDr. Rena Malik12:24

      And this is, you know, sort of a variation on performance anxiety. So when you feel like you have to perform on demand and maybe you're worried it might not happen, it creates this vicious loop, right? So you may- maybe you have trouble with an erection, or maybe it's like, "I, I'm expected to have sex, but I really can't get there mentally." Whatever it is, now you're thinking about that, right? And then you're with your partner and you're like, "Oh my God, am I gonna have trouble?" Like, you're not enjoying the pleasurable sensations or the visuals or, like, feeling each other. You are literally thinking in your own head about how you're gonna respond. And then that anxiety makes it so that you can't get an erection or you can't be aroused. And so now you're, like, anxious and you're not focused. You're just almost spectating. You're just watching yourself have sex. You're not actually, like, in the moment. So then, you know, you have a negative outcome because when you're stressed, your sympathetic nervous system is on, right? You can't really get an erection, or you can't really get aroused. And so then you're like, "Oh man, now I've let my partner down. Now I haven't performed," which I hate that word, but, like, "performed the way I should or sh- or am expected to, and now something's wrong with me." And now that just keeps going in a vicious cycle.

   9. SBSteven Bartlett13:28

      Have you spoken to people that have experienced this?

   10. RMDr. Rena Malik13:30

       Absolutely.

   11. SBSteven Bartlett13:31

       It's common?

   12. RMDr. Rena Malik13:32

       Very common. I tell people anytime you have problems in the bedroom, it stays with you.

   13. SBSteven Bartlett13:38

       So how do you break the cycle?

   14. RMDr. Rena Malik13:39

       Yeah, so I tell people, when you're with your partner, take the pressure off, um, penetration. Just explore each other's body. Do what's called, like, sensate focus. Like, explore the rest of your body. Figure out other erogenous zones, other things that can turn you guys both on that don't involve erections and penetration. And then once you realize you're focused on that, you're really, like, exploring, enjoying, playing, you're having a good time, and you're not thinking about your erection, now you'll notice, oh, the erection just comes, right? And then once you get to that point, then you can start even touching genitals, but still hold off on penetration. And then after you've realized, like, the genitals are pr- you know, it's always working the way I want it to and I'm not s- thinking about it, I'm not stressed, then finally you can then introduce penetrative sex again. So it's just sort of like a gradiated sort of slow advance into, um, you know, having sex again. But now kind of focusing on being more present and mindful and enjoying those

7. 14:34 – 17:56

   Why Do Couples Stop Having Sex?

   1. RMDr. Rena Malik14:34

      sensations.

   2. SBSteven Bartlett14:34

      I think a lot of people will be able to do that, but there's also a big contingent of people that just avoid sex.

   3. RMDr. Rena Malik14:42

      Mm-hmm.

   4. SBSteven Bartlett14:42

      It's, it's a sore subject in their relationship for whatever reason. Both partners don't know how to communicate. They haven't got the tools to talk about these kind of things openly and honestly. Do you see that a lot as well?

   5. RMDr. Rena Malik14:53

      Absolutely. I mean, I think it's-

   6. SBSteven Bartlett14:54

      What do you hear in this regard?

   7. RMDr. Rena Malik14:55

      I, so I think it's really sad. I see people come in and they're like, I ask every patient, like, "Are you s- are you having sex? Why not?" Right? Because sometimes they'll say no, and most doctors will be okay. But I always say, "Why not?" Right? "Why are you not having sex? Is it because you're having an issue? Is it because you're having pain? What's going on?" Right? And oftentimes I'll hear from people that, "My partner's just not into it, and I just sort of gave up, and I'm just, we just don't have sex anymore." You know, for me, that's a red flag because sex is a huge, important part of our lives. It is a way we connect with another human being. It's also telling that things are working really well. So when you have good sexual function, meaning you get an erection well, or you get aroused well, and you have a good orgasm and everything feels good, that tells me that, hey, you've got great blood flow to your genitals. Your nerves are working great. Your hormones are sending signals. Like, all these things are good, right? But also, sex is more than just the act of sex. It also helps you live longer. So there's been a, a few studies looking at sex and longevity, and when you look at people who have sex once a week compared to people who have sex once a year, the difference in all-cause mortality is 49%. They live 49% longer than people who only have sex once a year.

   8. SBSteven Bartlett16:14

      49% longer?

   9. RMDr. Rena Malik16:15

      Yeah. Yeah.

   10. SBSteven Bartlett16:18

       Be right back. No, I'm joking. [laughs]

   11. RMDr. Rena Malik16:20

       [laughs]

   12. SBSteven Bartlett16:20

       [laughs]

   13. RMDr. Rena Malik16:21

       So and, but even if you're doing, like, less than once a week, but more than once a year, it still improves your longevity. There was actually an interesting study in 1997, I think it was, where they looked at the number of orgasms men had.

   14. SBSteven Bartlett16:32

       Mm-hmm.

   15. RMDr. Rena Malik16:33

       And they found that men who had, for every hundred orgasms men had, they lived like 13% longer. They had a 13% increase in life expectancy. And so it, it was really interesting to me. Just, just showing you that, like, this is not just an act of pleasure and fun. It is, obviously, but it's much more than that because people who are having sex clearly have better health, and they're, this connection with people, I mean, loneliness is a big issue right now. The WHO made loneliness like an epidemic. So they've said that loneliness is as bad as having, like, 15 cigarettes. And so sex is a way to feel connected to another human being.

   16. SBSteven Bartlett17:11

       On that data, uh, we're, we're not saying that it's the sex itself that's causing people to live longer. We're, I guess it's, it's hard to establish causation in terms of-

   17. RMDr. Rena Malik17:18

       Yeah, it's not necessarily sex, but they've looked at, like, they try to control for other things like age and comorbidities in all these studies. And, um, it's also, like, sex is a cardiovascular workout, right? For many people, it's a cardiovascular workout. You are getting a phys- physical-

   18. SBSteven Bartlett17:33

       Mm-hmm

   19. RMDr. Rena Malik17:33

       ... physical activity with your partner.

   20. SBSteven Bartlett17:35

       Mm-hmm.

   21. RMDr. Rena Malik17:35

       Um, you are increasing your heart rate. You are doing these things that are also good for your body.

   22. SBSteven Bartlett17:40

       Mm-hmm.

   23. RMDr. Rena Malik17:40

       And the fact that you're able to have sex, right, tells me a lot about it, right? You're, you're able to hold a certain position. You're able to, um, maintain this level of activity without getting short of breath, right? Like, these are things that having sex, you know, keeps you healthy to some

8. 17:56 – 20:58

   What Is The Best Diet For Erectile Dysfunction?

   1. RMDr. Rena Malik17:56

      degree.

   2. SBSteven Bartlett17:56

      If I wanna make sure that I have great sex, what are some of the foundational things that I need to be thinking of in terms of my lifestyle?

   3. RMDr. Rena Malik18:02

      Yeah, so there's four main pillars of sexual health, and I like to think of it like your sexual health is your house, and these pillars are the foundation, and if you don't have the foundation, it doesn't matter what else you do. Um, you can try to do everything else to patch up your house, but it's always gonna c-Break again because the foundation's not there. So you've got fuel, and fuel is how you nourish your body. A lot of the data I'm gonna talk about is about men because there's just a lot more data on men and sexual health, but that doesn't mean that the same things don't apply to women. There's just less da- less robust data on it. So when you talk about fuel, the Mediterranean diet is the most studied diet. So including things like healthy fats, like avocados, leafy greens, nuts, and we're gonna talk about nuts in a little more detail. These things are super helpful. And obviously, having lean proteins, having, uh, an abundance of fruits, which we're gonna talk about as well. There's a study called the Health Professionals Follow-Up Study. There was, uh, 20,000 men, and they saw that men who'd adhered to a Mediterranean diet had a 22% lower risk of erectile dysfunction.

   4. SBSteven Bartlett19:06

      Hmm.

   5. RMDr. Rena Malik19:06

      So what specific things in that diet? Right. People are always like, "What are the super foods I need to have?" Almonds are great, but pistachios, they actually did a study on pistachios, where they looked at 100 grams of pistachios. Guys ate 100 grams of pistachios every day, and they saw a decrease in erectile dysfunction.

   6. SBSteven Bartlett19:21

      So pistachio nuts will make my penis harder.

   7. RMDr. Rena Malik19:23

      I mean, [laughs] so I always say, like, I don't love to talk about super foods because then people are like, "Oh, I just gotta eat pistachios, and it's all good," right?

   8. SBSteven Bartlett19:29

      You'll be hard, yeah, yeah.

   9. RMDr. Rena Malik19:29

      It's, it's part of a whole diet. But certainly, having nuts because they have great omega-3s. They have healthy fats. These are the reasons that they, they really sort of improve diet.

   10. SBSteven Bartlett19:39

       Mm-hmm.

   11. RMDr. Rena Malik19:39

       Fruit, um, a- anything that has sort of flavonoids, so, like, colorful fruit, like blueberries, citrus fruits, um, lycopene, which is red fruits, all of these things improve antioxidants and also have been shown to reduce the instance of erectile dysfunction, so having-

   12. SBSteven Bartlett19:55

       Hmm

   13. RMDr. Rena Malik19:55

       ... stronger erections. Specifically, blueberries actually came out to have, I think, something around 20% also improvement in erectile function when you're eating blueberries regularly. So lots of, I think, things in the diet that can be helpful. Also, fiber is one that we don't talk about enough. When you eat fiber, in your gut, it converts to short chain fatty acids. These short chain fatty acids then sort of have these endothelial protective mechanisms. They protect the blood vessels. They make them healthier. And so when your blood vessels are healthy, you get better metabolic health, so you get less diabetes, less high blood pressure, less high cholesterol, and these, all of these things together improve erectile function.

   14. SBSteven Bartlett20:32

       Hmm.

   15. RMDr. Rena Malik20:33

       So I think im- making sure that you meet the criteria for fiber, which is 38 grams for men, 25 grams for women, um, is really, really important. And then obviously, managing your calories in a maintenance, right? 'Cause we don't wanna gain weight 'cause excess adipose tissue or excess fat also puts you at higher risk for erectile dysfunction and other sexual dysfunctions. Next, we have, uh, strength.

9. 20:58 – 28:29

   What Are The Best Exercises For Sexual Performance?

   1. RMDr. Rena Malik20:58

      All right.

   2. SBSteven Bartlett20:58

      [laughs]

   3. RMDr. Rena Malik21:00

      So there's strength, where we think about cardiovascular and resistance exercise, but there's also pelvic floor strength. So we'll start with cardiovascular exercise. The one study that's quoted very often is 150 minutes of exercise, of cardiovascular exercise of moderate intensity. When you look at the improvement in erectile function scores, it is the same amount of improvement as you would see when you take a medication like Viagra. So literally, if you do 150 minutes a week, you are getting the same improvement as you could get with a medication potentially. And so I tell people, like, "Look, if you don't wanna take a pill, this is a great way to improve sexual function." Now, you might say, "Okay, well, I..." You know, maybe you're listening and you have heart issues, and you can't really do moderate intensity exercise. They actually looked at that too. So there was a group where they looked at men who had heart disease, and they weren't really able to do moderate intensity exercise. So they did, like, a five-minute warm-up. They did 20 minutes of walking and five minutes of a cool-down. And with this supervised protocol, they still improved erectile function by 70%. So it's all relative to where you're starting.

   4. SBSteven Bartlett22:05

      Hmm.

   5. RMDr. Rena Malik22:05

      But any sort of cardiovascular exercise that's above what you are capable... like, what you're doing now, is going to improve sexual function, particularly erectile function. 'Cause it's gonna improve blood flow to the genitals. It's gonna improve blood flow to the penis. It's gonna improve blood flow to the clitoris for women. So that's where cardiovascular exercise is so, so important. In terms of resistance exercise, now, these little weights are probably not sufficient for doing much, especially for men, in terms of improving, um, muscular health. But obviously, we're not gonna bring, like, really heavy weights to the table here. [laughs] So one, we know that resistance training is significantly correlated with testosterone. So when you do heavy resistance training of your large muscle groups, so, like, your lower extremities, your glutes, you're doing, like, Olympic deadlifts, squats, that sort of stuff, you actually see improvements in testosterone. Now, it's not gonna be like you do it once and you get this sustained improvement, but continuous sort of regular resistance exercise improves testosterone. There's also data that shows that when men do resistance exercise to maintain muscle mass, so we know that muscle mass decreases about 7% every decade of life after around 40. When you maintain it through resistance exercise, they're three times less likely to have erectile dysfunction.

   6. SBSteven Bartlett23:19

      Oh, really?

   7. RMDr. Rena Malik23:20

      Yeah, so they maintain erectile function. They maintain sexual desire. They maintain, um, satisfaction with sex.

   8. SBSteven Bartlett23:27

      I read a quote yesterday that said, "Muscle is medicine." And I thought, "Hmm, that's really true," based on everything I've learned on this podcast around, you know, like, glucose control and, and testosterone, and now you're telling me about your sex life.

   9. RMDr. Rena Malik23:40

      Yeah.

   10. SBSteven Bartlett23:41

       Really.

   11. RMDr. Rena Malik23:41

       It is. I think people push back because they think, like, "Why should I have to go to the gym?" But our lives have changed. We sit at a computer, or we sit at podcasts, or we sit all the time. We're not moving. We're not doing manual labor, which is what a lot of our historic history is, right? Doing manual labor, farming, doing things outside, being physical, and we're meant to be physical. We're meant to lift heavy things. We're meant to move our bodies, and we're just doing less and less of it.So I think it's so important. Um, the other thing is we want to prevent sarcopenia. So sarcopenia is muscle loss. And when you have muscle loss, um, that also increases your risk of having sexual dysfunction.

   12. SBSteven Bartlett24:20

       What about the pelvic floor? Like, how does that come into this story of orgasms?

   13. RMDr. Rena Malik24:23

       Oh, yeah. So we missed that part. So, um, the pelvic floor, here's your pelvis, right? It's this bony structure where all your organs live. This is a female. So I'm taking out the, uh, internal structures, which is the uterus, the rectum, and the bladder. And so that's what sits inside the pelvis. And so you can see this bowl of muscles here, right?

   14. SBSteven Bartlett24:43

       Interesting. I've never seen-

   15. RMDr. Rena Malik24:44

       And you can see them from the inside, and you can see them from the outside.

   16. SBSteven Bartlett24:47

       Wow.

   17. RMDr. Rena Malik24:47

       That's your anus. And in this person, there's a vagina, so that's the hole for the vagina. So you can see that your anus and your vagina run through the pelvic floor. And in men, your penis runs through the pelvic floor. And so this, let me see if I can show you on this model. In this model, you can see they kind of show you the muscles here on the side.

   18. SBSteven Bartlett25:04

       Yeah.

   19. RMDr. Rena Malik25:05

       So these are your pelvic floor muscles that are around the penis and the anus.

   20. SBSteven Bartlett25:10

       Ah, okay.

   21. RMDr. Rena Malik25:11

       Okay. These structures are very important for a variety of things. Um, they attach to your bony landmarks here, your hips, your sacrum, your pubic symphysis. They a-attach to all these, and they sort of just work in the background for most people. How they affect your sexual function is when you orgasm, these muscles contract and release at a r- at a rhythmic contraction of .8 seconds. And so you may feel that, right? There's like this pulsing feeling when you orgasm, and that's these muscles sort of doing that. And when men ejaculate, the pelvic floor muscles are contracting to help shoot the ejaculate out. They squeeze when you need to keep things in, so they'll keep urine in, they'll keep, um, your stool in-

   22. SBSteven Bartlett25:54

       Oh

   23. RMDr. Rena Malik25:54

       ... and they relax when you need to pee and when you need to defecate.

   24. SBSteven Bartlett25:58

       So when you're trying to hold a wee, you're, like, tightening your pelvic floor muscles.

   25. RMDr. Rena Malik26:01

       Correct. Correct.

   26. SBSteven Bartlett26:02

       Okay.

   27. RMDr. Rena Malik26:02

       But these are also responsive to stress. So just like people get TMJ, where they get tense in their jaw because they are stressed, and they, like, sleep at night and they clench up their jaw, they don't really know they're doing it, the same thing can happen. These muscles can get very tight, or they can get misaligned. So say you have a hip injury or say you have a back injury, the muscles can compensate by tightening up. And so a lot of people unknowingly have tension in these muscles, and it can present in a m- multiple different ways. It can present with back pain. It can present with d- constipation. It can present with urgency frequency, because remember, your bladder is sitting right here on top of these muscles. So when the muscles are tense, your bladder is feeling like there's something, something activating it. And so it's like, "Oh man, I got to pee. That means I have to pee. This tension is telling my bladder I have to pee." But it's really that your bladder's not that full, it's that these muscles are telling you to do that. You can also have trouble peeing, because you can see that your urethra goes through here. And if the muscles are really tight, sometimes it can be difficult to urinate because it clenches off the pee. And then with sex, it can cause pain. If they're really tight, it can prevent blood from getting to the genital organs. So for men, they can have erectile dysfunction. For women, they can have difficulty getting orgasms or difficulty getting arousal because they're not getting blood flow to the clitoris. Sometimes it can also cause premature ejaculation in men. And so these muscles are so important, and all we hear about is Kegels, and Kegels are exercises to strengthen these muscles. But Kegels are good when you have a normal pelvic floor, meaning, like, there's no tension, it's completely normal, it's acting normal, you're not having any symptoms at all. But if you have any of the symptoms I talked about, doing Kegels might make it worse because you're now tightening muscles that are already tight.

   28. SBSteven Bartlett27:47

       Mm-hmm.

   29. RMDr. Rena Malik27:47

       We also talk about pelvic floor relaxation, doing exercises to specifically relax these muscles. So that can be diaphragmatic breathing. That can be doing, like, a figure four stretch. That can be doing happy baby pose, which are yoga poses, or child's pose. All these things can sort of stretch and lengthen these muscles so that they can learn to relax again. Now, when it's really bad, you have to go see a pelvic floor physical therapist who can really work with you to identify which of the muscles are maybe more dysfunctional and maybe work specifically on those. Um, but I think it's, it's so important. It's under-evaluated and under-discussed when it comes to sexual function. It's a hugely important part of sexual function.

10. 28:29 – 30:59

    What Can Erectile Dysfunction Signal?

    1. SBSteven Bartlett28:29

       How many people are struggling with these issues, s-s-specifically the, like, erectile dysfunction issues, and what age are they?

    2. RMDr. Rena Malik28:37

       Yeah. So it starts early. I think there's always been a sort of a disconnect where we think young guys don't have this, or if they have it, it's all in their head. That's not necessarily true. Many young men do develop erectile dysfunction because of biologic factors. But the data is really robust in older guys. So above the age of 50, we see 52% of men having erectile dysfunction, which is half.

    3. SBSteven Bartlett28:59

       52% of men.

    4. RMDr. Rena Malik29:00

       Yeah. And it goes up 10% every decade, so 60% of 60-year-olds, 70% of 70-year-olds. So erectile dysfunction continues to worsen. This happens because, one, you know, our blood vessels get older. They get stiffer. They're not functioning as well as they should. And we're seeing also a rise in all these other comorbid conditions like diabetes, cholesterol, high blood pressure. All of these affect how healthy your blood vessels are. And so with these, they see the problem in their penis or in, in women's case, in their clitoris, before they see heart disease or strokes or brain issues or dementia.

    5. SBSteven Bartlett29:36

       I think this is worth pausing on, which is a erectile dysfunction problem is a s- often a symptom of a cardiovascular issue, right?

    6. RMDr. Rena Malik29:45

       Yeah. We call it a canary in a coal mine. So it is, like, telling you that something bad is coming. So the data would support that when you have erectile dysfunction, if it's because of an organic reason, right, not psychogenic, but most people, I think, have a combination of both, that within three to five years, you will start developing issues with your heart. And so it precedes those issues. And if seven years later, 14% of those guys will have a heart attack.And so it's really an opportunity. Sexual problems are an opportunity to look inside, to figure out what's going on, and to investigate and to change your life.

    7. SBSteven Bartlett30:23

       And when you say erectile dysfunction, we should probably define what that means, because there's gonna be a lot of guys sat at home now thinking, "Oh my God, like my penis is a bit softer than usual."

    8. RMDr. Rena Malik30:31

       Yeah. So [laughs] erectile dysfunction is defined as the inability to maintain an erection that's sufficient for intercourse. So you can get an erection, but it goes away before you ejaculate or climax.

    9. SBSteven Bartlett30:44

       Mm.

    10. RMDr. Rena Malik30:44

        And so that's typically... And I think it's really important to differentiate that from something like premature ejaculation, where you climax too soon, so you ejaculate before you want to, uh, but that doesn't mean that you have a problem maintaining your erection. That's a whole different process.

11. 30:59 – 34:25

    Why Does Porn Work But Real Sex Does Not?

    1. SBSteven Bartlett30:59

       I've got a friend.

    2. RMDr. Rena Malik31:00

       Mm-hmm.

    3. SBSteven Bartlett31:00

       People are gonna think I'm talking about myself, 'cause I use that phrase a lot.

    4. RMDr. Rena Malik31:02

       No.

    5. SBSteven Bartlett31:03

       I've got a friend. He's, um, he's almost 40 years old, and I've heard him say on several occasions that he's lost his erection during sex. Is that erectile dysfunction? But what if he can keep his erection w- watching porn?

    6. RMDr. Rena Malik31:18

       Well, so that's more multifactorial, right? So I think if you lose it once or twice, right, most guys will have an issue where they lose an erection at some point in their life. I think the important thing is not to catastrophize. It's a problem when it becomes a routine. Now, if someone is telling me, "Hey, I can watch porn and maintain my erection, but I can't with a partner," there's multiple different reasons for that that could be at play. One is that there's no pressure, right? You're by yourself, you're watching porn. There's no pressure of performance, there's no anxiety of performance, so that may be part of it. Other thing may be that that level of arousal that you're getting from porn, if you're watching, like, let's say the same kind of porn every time, you're masturbating the same way every time, maybe using a firm grip, or some people will masturbate, like, uh, facing the bed or, um, you know, against hard objects. And so that-

    7. SBSteven Bartlett32:05

       Against hard objects?

    8. RMDr. Rena Malik32:07

       Yeah, like the, their fist or something. And so that, uh, can't be replicated by a person, right? You can't replicate those behaviors by a vagina or a mouth. If you become habituated to a certain thing that turns you on, and that's the only thing that really gets you going and that's, that's something that you can't really get with your partner, then it will be difficult to reach the level of arousal that you need to get an erection.

    9. SBSteven Bartlett32:32

       Okay, so two questions then.

    10. RMDr. Rena Malik32:33

        Mm-hmm.

    11. SBSteven Bartlett32:34

        So that doesn't count as erectile dysfunction if you can get an erection watching porn but can't get it with your partner.

    12. RMDr. Rena Malik32:40

        Yeah, it may or may not be. So if you wake up with your morning erection, that's great. That's a sign. That's when there's nothing else at play, right? You are just... That tells me that your body's functioning well. You've got good blood flow, good, uh, good hormones working, got a good amount of testosterone, and your nerves are working well and you're getting a good morning erection. Now, morning erections or nighttime erections are normal and they're healthy. So when you're a young boy, you get actually, like, erections three to five times a night, and they can last up to 40 minutes long. So you can spend a lot of your night with an erection. When you get older, like in your 40s, that drops to about half the time. So it may be erections are a little shorter. They may, may be max out at 30 minutes, but sometimes they're shorter. You should still be getting three to five erections a night. You won't know all of these, but typically you wake up with a morning erection. And so if you're not getting morning erections, that tells me that, hey, there's something going on that we should address.

    13. SBSteven Bartlett33:32

        And on your other point about how you masturbate impacting your sex life, I imagine that applies to men and women.

    14. RMDr. Rena Malik33:38

        Absolutely.

    15. SBSteven Bartlett33:39

        And are, are you saying that if there's a particular way you get yourself off in private that is very hard for the other person to replicate, you might become desensitized to that?

    16. RMDr. Rena Malik33:49

        You might just get habituated. I don't think desensitized.

    17. SBSteven Bartlett33:52

        What's habituated mean?

    18. RMDr. Rena Malik33:52

        But habituated is like you might just, your body just might respond really well to that particular stimulation. Now, that's not inherently a bad thing, right? If that's what gets you off and you and your partner are okay with you doing that together, right, you may mutually masturbate together and that's fun for you and you guys enjoy it, there's no problem with it. It's just knowing what's going on, right? And sort of deciding like, okay, if this is a problem, let me try to diversify what I do during my solo sex periods, or let me take a little break and kind of, uh, try something, you know, just not masturbate for a little while and come back to it later.

12. 34:25 – 35:50

    Why Do Morning Erections Matter?

    1. SBSteven Bartlett34:25

       The fact that we get an erection in the morning, does that mean that's we're supposed to have sex in the morning from, like, an evolutionary perspective?

    2. RMDr. Rena Malik34:31

       Not necessarily. It's just, it's the way your body releases testosterone is one of the reasons this happens, is overnight your body is making more testosterone. That's when your body sort of c- has nocturnal testosterone production, and so it's highest in the morning, which is why very often you get a morning erection. And, you know, it just means that some people will have more desire also in the morning, 'cause testosterone is a hormone of desire.

    3. SBSteven Bartlett34:55

       Is it the same for women?

    4. RMDr. Rena Malik34:56

       Yeah. So women, um, women also have nocturnal clitoral tumescence, same sort of pattern, and they won't necessarily know it, right, 'cause they can't visualize it. But, you know, you can... Some women may know, sort of feel that pelvic congestion or, like, feeling that there's a bunch of, like, blood flow in the area, but most will not, and that's okay. But your body protects itself. So you've heard the term use it or lose it, right?

    5. SBSteven Bartlett35:20

       Mm-hmm.

    6. RMDr. Rena Malik35:20

       People are like, "Your body's protecting itself. You don't have to have sex." If your body is healthy, it will do this all night to keep your genitals healthy. It will make sure that your genitals are getting blood flow even if you're not having sex. But if you stop having those nighttime erections, now it, it becomes more of a problem. Because over time, say you stop having erections or clitoral tumescence for months, years, right? And then there's no blood flow to those areas. Over time, and actually I can show you here,

13. 35:50 – 40:20

    What Are The Differences In Male Vs Female Arousal?

    1. RMDr. Rena Malik35:50

       this is a, a pelvic model, and here, this, this purple thing here is called the corpora cavernosa. And this is, like, a really nice spongy tissue that fills with blood, and when it fills with blood, it expands and lengthens, and then, um, the blood stays there until you're done with your stimulation, and then it goes back. And so if there's no healthy, fresh blood getting to the penis on a regular basis, either through nighttime erections or through sex with your partner, then you will get fibrosis of these tissues. That means there's a little scar in the t- in the tissues. And then over time you might see some shrinkage of the penis. And so it is really important to maintain also good health of these tissues. And the same goes for women with their clitoris, because it's the same type of tissue. In fact, if you look at the clitoris, it is, this is the part that you see. We don't, right, we don't have a clitoris, do we? Is it that one there?This is a uterus. [laughs]

    2. SBSteven Bartlett36:45

       [laughs]

    3. RMDr. Rena Malik36:48

       [laughs]

    4. SBSteven Bartlett36:49

       You're gonna keep that in.

    5. RMDr. Rena Malik36:51

       [laughs] Yeah. Actually, I can show you here. Here we go. Does this come-

    6. SBSteven Bartlett36:53

       Rena, she told me. This is crazy.

    7. RMDr. Rena Malik36:55

       [laughs] Okay. Yeah, this is good. This is good. Okay.

    8. SBSteven Bartlett36:58

       [laughs] They told me it was a clitoris.

    9. RMDr. Rena Malik37:02

       [laughs]

    10. SBSteven Bartlett37:04

        [laughs]

    11. RMDr. Rena Malik37:04

        That's a little ... That's, uh, yeah. Okay. [laughs] Oh, gosh.

    12. SBSteven Bartlett37:07

        [laughs] They told me.

    13. RMDr. Rena Malik37:10

        You're not gonna live that one down. [laughs]

    14. SBSteven Bartlett37:11

        You, you asked the team where the clitoris was. Did you ask the team where the clitoris was? Yes.

    15. RMDr. Rena Malik37:16

        Well, I'm, I'm worried about who said that too. Um, okay.

    16. SBSteven Bartlett37:19

        [laughs]

    17. RMDr. Rena Malik37:19

        So, [laughs] so let's talk about the female anatomy. This is a pelvic model, and here, um, you can see this is the vagina. This is the urethra where you pee from. This is your labia minora, and you can't see the labia majora, but they would be out here, right? So inner lips, outer lips. Now, this up here is your clitoral glans. So it's the same as the glans of the penis, and so this is all you see. Right? It also has a little covering, which you can't see here. Just like men have foreskin, women have a clitoral hood that covers the head of the pe- the clitoris. And so when you look at the clitoris on the inside, which we can't see perfectly here, but I'm gonna just take this off. Um, it actually goes all the way back like this. So if you were to feel from the vagina, from the vaginal side, it would be at the very top of the vagina going all the way back. These are the ... These blue things are the clitoral bulbs here. Um, so and these are the legs of the clitoris here on the side. And so this is essentially the homologue of the penis. So if I take the penis, we don't have a, uh, like, a full model here. And-

    18. SBSteven Bartlett38:26

        What does homologues mean?

    19. RMDr. Rena Malik38:27

        So homologues means that they're essentially the same structure. They're made from the same cells, but they're in the male and the female. So here you can see this is, if this is your penis, this is what you see up to here. This is the bone. This is your fat up here, and then here it goes deep into the pelvis. And so here's your testicles, right? And so below the testicles, this area of the perineum, you a- also have penile tissue sort of that you can palpate from this side, um, that's coming all the way down. And if you had sort of a 3D model, you'd see that it forks out just like the clitoris does.

    20. SBSteven Bartlett39:00

        So does clitoral stimulation feel like stimulating someone's tip of their penis?

    21. RMDr. Rena Malik39:06

        Exactly. And so you could think if someone just stimulated the head of the penis, they, uh, it would be fine, it would be nice, but it's probably better if you stimulate more of the clitoris or more of the penis. That's why you could stimulate obviously the external, the, the clitoris, but you can also stimulate from the inside, and some people are more responsive to that than others. What you hear of is, like, the G spot or the G zone, right? And the G spot or G zone is if you were to go in the inside of the vagina at the top side, which I can't really stick this in here, but it would be about two centimeters in at the top, and that's because that's an area where there's a lot of nerves endings. One, you can palpate the clitoris a- basically throughout the entire anterior wall. But also, there's the Skene's glands, which are these glands that sit underneath the urethra, and they're the homologue of the male prostate. And so they're right there, and then the vagina is there. And so that's an area that can be very enjoyable to stimulate. It's not necessarily always gonna lead to orgasm because some people have different sort of distance between the clitoral body and the vagina, so some people who have less distance may feel it better than some that don't. Uh, but ultimately, um, that's why that area is so sensitive for many women.

14. 40:20 – 41:24

    Why Do You Feel Tired After Orgasm?

    1. SBSteven Bartlett40:20

       On this point of, um, morning erections, I was thinking much of the reason why I've always been cautious of having sex in the morning or even, like, masturbating in the morning or anything like that, is I'm worried that it will cause a dopamine crash, which will make me feel lazy and lethargic.

    2. RMDr. Rena Malik40:34

       Well, so when you think about what happens during an orgasm is you have this release of dopamine, and then you- your prolactin goes up and sort of, like, everything calms down. Now, some people feel a, a sense of clarity. They call it post-nut clarity, right? They feel clear. They feel, like, motivated to do stuff. They feel, uh, excited to go do something else, and they sort of move on from what they're doing. There's some people who feel post-coital dysphoria. They actually feel sad, or they feel depressed after they orgasm. And we don't know exactly why this happens, but it is because of this dramatic change in sort of neurochemical signaling in the brain. And for those people who have it, it can be days where they sort of, like, feel bad. It can be hours where they feel sad, and so it can be really traumatic.

    3. SBSteven Bartlett41:19

       So pillar two. What's pillar two of the four pillars of men's sexual health?

    4. RMDr. Rena Malik41:23

       We talked about

15. 41:24 – 43:19

    How Does Stress Affect Your Sex Life?

    1. RMDr. Rena Malik41:24

       strength.

    2. SBSteven Bartlett41:24

       Okay, so we did strength.

    3. RMDr. Rena Malik41:25

       Yep.

    4. SBSteven Bartlett41:25

       We did fuel. What's pillar three?

    5. RMDr. Rena Malik41:28

       Pillar three is environment. So we can start with the easy stuff, and that's stress. Right? Everyone knows stress is bad, but I think the thing is people just think, like, "Ah, I'll just, I'll deal with it. Everyone's stressed." Like, "What's, what's normal to be stressed?" If you are chronically stressed, that means your cortisol is raised all the time, which is dampening your testosterone, which is also keeping you in this sympathetic state, and you just cannot get in your mind space and in the nervous system place to actually have sex. So that's super important, and I think, you know, there's lots of different ways to alleviate stress. You gotta figure out what works for you. Um, for some people, using a stress ball even just at work, and I think part of it you can actually incorporate some intimacy. There's some evidence, you know, the Gottmans have been on your podcast, doing a 20-second hug. So st-

    6. SBSteven Bartlett42:16

       Mm.

    7. RMDr. Rena Malik42:16

       Standing with your partner or loved one and hugging for 20 seconds on your own, like, independent gravity-

    8. SBSteven Bartlett42:23

       Mm-hmm

    9. RMDr. Rena Malik42:23

       ... actually helps alleviate stress and breaks sort of a stress loop. Doing a six-second kiss with your partner. And so it seems like six seconds is no big deal, but actually if you time it, it's like, hmm, if I'm just doing a kiss and I'm not, like, actually, it's a little bit longer than normal. And so these sort of small things can help alleviate stress. Any type of movement can be really beneficial.

    10. SBSteven Bartlett42:43

        The gym is great.

    11. RMDr. Rena Malik42:44

        Right, so if you-

    12. SBSteven Bartlett42:44

        Breath work as well.

    13. RMDr. Rena Malik42:45

        The other thing is just having, like, interactions with people, and so that's where we're becoming more isolated. But even just, like, talking to the barista or talking to someone at the grocery store, this again tells your brain that you're in a safe space, like you're talking to someone. You're having a normal social interaction.So, and then being creative. And we've been trying to work with this, uh, work on this f- with our kids because there's so much external stimuli all the time, right? They wanna play video games, they wanna watch TV, they wanna play sports, but we want them to be bored and be creative, like, come up with creative ideas to keep themselves i- interested and engaged in a different way.

16. 43:19 – 45:26

    How Does Sleep Affect Testosterone?

    1. RMDr. Rena Malik43:19

       So I think that's so, so important. And outside of stress, sleep. Um, sleep is, there's just so much abundance of data on how sleep affects hormonal health. They looked at data on men sleeping five hours a night versus eight hours a night. So you take the same guy and he sleeps eight hours, then you, you know, do five, five hours for a little, a few days. Just test for a week. His testosterone drops by 15%.

    2. SBSteven Bartlett43:41

       Damn.

    3. RMDr. Rena Malik43:42

       That's, like, as much testosterone drop as would happen with 10 years of life.

    4. SBSteven Bartlett43:46

       And do you know how long they did that for? How long-

    5. RMDr. Rena Malik43:48

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

    6. SBSteven Bartlett43:49

       Okay.

    7. RMDr. Rena Malik43:49

       So a week of sleep deprivation will, will tank your testosterone.

    8. SBSteven Bartlett43:54

       Damn.

    9. RMDr. Rena Malik43:54

       And sleep apnea is another one that I think people, one, don't realize they have, and two, don't realize that fixing it could actually improve their hormonal health.

    10. SBSteven Bartlett44:02

        Wait, so does this mean that people who have chronically bad sleep probably have low testosterone?

    11. RMDr. Rena Malik44:06

        Probably, yeah.

    12. SBSteven Bartlett44:07

        And what is the symptoms of low testosterone?

    13. RMDr. Rena Malik44:10

        So low testosterone is, they're sometimes very vague, so it can be fatigue, it can f- brain fog, it can be depression, it can be low desire, it can be erectile dysfunction. That's what people always think, it's just erectile dysfunction, but it's this whole constellation of symptoms. It can also be increased fat mass, decreased muscle mass. So all of these things can happen because we have testosterone receptors all over our body. We have them in our brain, we have them in our muscle, we have them in our bone, and these can all have really serious consequences when it's low. When you have sleep apnea, and how you know you have sleep apnea is, uh, your partner might tell you that you're, like, waking up in the middle of the night ch- gasping for air.

    14. SBSteven Bartlett44:48

        [laughs]

    15. RMDr. Rena Malik44:48

        If you have, one really easy way to check is take a, a measuring tape and measure your neck circumference. If it's more than 17 inches for a guy or 16 inches for a female, it means it's very likely that you may have sleep apnea.

    16. SBSteven Bartlett45:01

        Hmm.

    17. RMDr. Rena Malik45:02

        And that's because when you have excess mass basically here, it's compressing your airway-

    18. SBSteven Bartlett45:06

        Mm-hmm

    19. RMDr. Rena Malik45:06

        ... and can make it difficult to get air into your, um, into your body. When you improve sleep apnea, we've seen improvements in testosterone as high as 200 nanograms per deciliter, so huge jumps in testosterone after fixing sleep apnea. And the same goes for other sleep disorders, although the data is not as abundant. Uh, but sleep is

17. 45:26 – 47:57

    Do Microplastics Affect Hormones?

    1. RMDr. Rena Malik45:26

       so important. Then we talk about what's in your environment. So let's put this... Okay. So you get a g- a bottle of water. So many of my patients actually, they only buy, like, cases of plastic bottled water. Once in a while, a plastic bot- bottle of water. Like, don't stress yourself out. This goes back to stress. People get really stressed, they're like, "What's in my environment? What am I drinking? What am I eating?" Like, do what you can control. So plastic water bottles have things-

    2. SBSteven Bartlett45:53

       Hmm

    3. RMDr. Rena Malik45:53

       ... like phthalates and BPAs, which can affect hormonal health. They can mimic estrogen. They can reduce the production of testosterone b- based on these mechanisms. Also things like plastics in the environment, PFAS, so the things in, like, non-stick cookware. All those things can affect hormone health. Now, how do you sort of protect yourself, right? I tell people, again, don't stress. There's only so much you can control. So, like, I love that we're dr- not drinking out of plastic.

    4. SBSteven Bartlett46:20

       [laughs]

    5. RMDr. Rena Malik46:21

       If you have to drink out of plastic because you're at an event or whatever, try to make sure it's not a, um, a warm bottle, so it hasn't been, like, sitting in the sun for hours and hours and hours. Because as it gets warm, it releases more microplastics and more chemicals into the water. When you're eating food, if you are eating out of, say, takeout, put it on a plate and warm it up. Don't ever warm up that plastic. And when you store food in the fridge, put it in a glass container or a metal container. But don't ever leave the food in the plastic and put it in the fridge. These are simple things you can control. You could also limit sort of your exposure to dust, because dust has microplastics. You can try to wear more cotton fabrics, less synthetic fabrics, because they shed less microplastics. But again, I think do what y- you can do, but don't let the stress of these chemicals, like, derail you, because stress is not helping either.

    6. SBSteven Bartlett47:12

       And h- how much of a difference does, you know, microplastics make on my hormonal health? Is it really a big, big deal?

    7. RMDr. Rena Malik47:19

       Well, I think it depends. It's all dose dependent, right? So we're all exposed. Like, if you look at the data, like, people are, you know, consuming quite a bit of microplastics, and we're seeing them actually even in testicles, in penis, uh, tissue samples. Like, they're in our bodies. And so I think that it's definitely playing a role. How much, we don't know yet. We just know that there are mechanisms, and we know that they do affect hormonal health. And so do the best you can.

    8. SBSteven Bartlett47:44

       Do you and your family drink out of plastic bottles?

    9. RMDr. Rena Malik47:46

       No. We drink, we, we have, like, metal water bottles for the kids and myself, and-

    10. SBSteven Bartlett47:50

        What about non-stick pans?

    11. RMDr. Rena Malik47:52

        We buy ceramic. We, we do our best to, like, avoid those as much as possible.

18. 47:57 – 50:06

    How Do Friends Affect Your Sex Life?

    1. RMDr. Rena Malik47:57

       So the other thing's the company you keep. I think we don't talk about this enough, and we talk about it in terms of business, like, you wanna keep people who are successful around you, you wanna keep people who can help you. But it also plays a role in your sexual environment, right? So my husband is in these groups with a bunch of other male physicians, and there's a lot of discussion about how they never have sex anymore. And they're all just like, "Oh, yeah, this is just, like, normal. Like, we're getting older, our partners don't wanna have sex. It's so frustrating." And there's a lot of discussion about this. And, and it's, it's almost like, oh, that's okay. Like, that's just normal, right? They're normalizing this experience where that sex has not become a priority because life is so stressful. Things are so crazy. Maybe you're having relationship discord. So it absolutely plays a role, and there's actually some evidence that it may help you make better choices. So there's one study where they looked at, oh, I think it was, like, 50,000 people, and they, um, did an intervention where they tried to encourage these people to surround themselves with positive influences that were like, "Have safe sex," and avoid negative influences. And they saw that four, that these people had an increase in, like, sexual positive behavior, so, like, safe sex practices, by 46%.So just by changing who they spent their time with, they saw this major difference in how they approached their sex lives.

    2. SBSteven Bartlett49:13

       Okay, so if your friends are very pessimistic about sex and they're not having and they're complaining about it, that's gonna become sort of contagious.

    3. RMDr. Rena Malik49:20

       Yeah. And I think it, it extrapolates to everything. What kind of relationships you're, you're in, how do they view their relationship with their partner? Is it a priority? Do they make it a priority, right? Or are they just busy doing their own thing and they're just, like, living in parallel lives. They're doing their own thing. You're doing your own thing. You never really spend time with your partner, and then when you go hang out with your friends, you're like, "Oh, God, I'm so glad to get away," and you're not, like, talking about how much you enjoy your partner. People tend to talk negatively, right? They wanna, like, sorta, like, vent, and so when you have people who don't make that a part of their lives, it also affects you. If they value their partner and they talk about them in a positive way, that's a, a great thing to say, like, "Okay, this is the right kind of person I want because I want to value my partner, too, and I don't want that to rub off on me," because it absolutely does.

19. 50:06 – 53:10

    How Does Porn Affect Relationships?

    1. SBSteven Bartlett50:06

       And the other thing you said in this category of environmental stuff is things like pornography consumption. Is it possible to consume too much porn?

    2. RMDr. Rena Malik50:12

       So it's not the amount of porn that you watch. It is the sort of the way you feel about it. M-many people watch porn for a variety of different reasons. Most often it's for pleasure and enjoyment, but there's some people who watch porn because they wanna get away from negative feelings, right? This is giving them dopamine, and they're using it as a way to just feel better in the moment. And so that become- that can become a compulsion where they're watching porn and it's, like, giving them these positive feelings, and they feel negative in life, and they're going back to porn to sort of, again, have that compulsion to watch porn again. But that's a small subset of people. The other thing is that there's a lot of negative discussion around porn, right? People are like, "Porn is bad, it's dangerous, it's evil," and I think, you know, it's more nuanced than that. But if you feel that porn is bad, every time you watch porn you feel negative, you feel bad about yourself, that's where we see people having the most dysfunction associated with it because they feel guilty. They could watch it once a year and they could feel super guilty about it, and it could affect their sexual function. They could see themselves as a bad person. They could see themselves as wrong or immoral, and that's really when it becomes an issue. If you are finding yourself either compulsively watching pornography and using it as a scapegoat, maybe time to reevaluate. Say, "Why am I doing this? How can I switch this out for something else that makes me feel better that might be healthy, like exercise or w- going for walks or whatever that may be?" And then if it's something that's really making you feel m- like bad or guilty because maybe that's how you were raised, maybe that's what you feel about morality, then yeah, maybe, like, you either need to work through that because porn is maybe something that you still want to watch at times or you need to, uh, abstain. But usually those are-- it's very difficult to abstain for most people to abstain for prolonged periods of time. So I think it's, it's something that you have to work through if you find yourself having these sort of feelings about pornography or you're compulsively watching it. But for the most people, it's a- adults, for most adults, it is fantasy. It's a place where you can experience, uh, see things that you may never do in real life that may be enjoyable, that are fun to watch, that allow you to feel arousal. We see that when couples watch porn together, they are more likely to be more satisfied in their relationship. And when there's a discord, like one person really doesn't like it or doesn't use it and the other one uses it a lot, that's where we see the problem.

    3. SBSteven Bartlett52:29

       Is porn consumption going to impact my intimacy with my partner?

    4. RMDr. Rena Malik52:35

       So it depends. I think a lot of people watch it without an issue, right? They watch it and they-

    5. SBSteven Bartlett52:39

       But if I masturbate and I c- ejaculate, I'm not gonna then be able to ejaculate very quickly necessarily with my partner.

    6. RMDr. Rena Malik52:45

       Yeah, so that-- obviously, that is, you know, there's a refractory period after you ejaculate. Now, when you're younger, that refractory period could be minutes, and when you're older, that can be a day and a half. And so we see that some people may struggle, especially if they're watching a lot of porn every single day and their refractory period is maybe a day, then they may actually really have trouble ejaculating with their partner because they've not given themselves that time.

20. 53:10 – 55:12

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    1. SBSteven Bartlett53:11

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21. 55:12 – 56:58

    Should Couples Use Sex Toys?

    1. SBSteven Bartlett55:12

       the last one, the last of the four pillars

    2. RMDr. Rena Malik55:14

       The last of the four pillars we talked a little bit about, it's called confidence. And confidence is not like strutting around like a peacock, like I know what I'm doing. It's confidence in knowledge and curiosity. So knowledge we talked about a little bit, understanding female anatomy. Like, how do female bodies get aroused, right? What makes them aroused? Where is the clitoris? Knowing some anatomy. And two, actually talking to your partner or paying attention to their cues. We... That for some reason with sex, it's the only time that we just expect people to be mind readers. We just want you to know what I like and just go for it, right?

    3. SBSteven Bartlett55:46

       Mm-hmm.

    4. RMDr. Rena Malik55:46

       And, and then when it's not good, you're like, "Well, you just don't know what you're doing." [laughs] And it's like, it's, it's wild to me that we actually never got taught how to talk about sex, how to bring it up with a partner, how to, you know, just explore and have fun with sex. Maybe add a toy to the bedroom. So there's lots of different types of toys. This is a, a vulva stimulator. So you put this on the outside. So you can see that it would, in theory, if this was smaller, would stimulate the, um, the clitoris on the outside. It also can change in shape. It'll vibrate, right? It'll have different stimulations that you can play around with and decide what you enjoy.

    5. SBSteven Bartlett56:23

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

    6. RMDr. Rena Malik56:25

       [laughs]

    7. SBSteven Bartlett56:26

       [laughs] So this-

    8. RMDr. Rena Malik56:28

       They're brand new. They've not been used. [laughs]

    9. SBSteven Bartlett56:30

       I didn't say they had been. Very defensive there. Um, so if my pinky finger... If my finger here is the clitoris-

    10. RMDr. Rena Malik56:36

        Yeah

    11. SBSteven Bartlett56:36

        ... I put it on like there.

    12. RMDr. Rena Malik56:39

        Yeah.

    13. SBSteven Bartlett56:39

        And then it vibrates.

    14. RMDr. Rena Malik56:40

        Correct.

    15. SBSteven Bartlett56:41

        And then the penis goes through-

    16. RMDr. Rena Malik56:43

        Correct

    17. SBSteven Bartlett56:43

        ... the hole. Yeah.

    18. RMDr. Rena Malik56:43

        And there's another version of that. This is basically... Ooh.

    19. SBSteven Bartlett56:47

        [laughs] Sorry. It started vibrating.

    20. RMDr. Rena Malik56:47

        This is basically like the hole goes around the penis.

    21. SBSteven Bartlett56:51

        And that goes in.

    22. RMDr. Rena Malik56:52

        And that can go in and stimulate and vi- vibrate. So you both feel the vibration, and you both feel the stimulation.

22. 56:58 – 59:32

    Can Sex Toys Become Addictive?

    1. SBSteven Bartlett56:58

       I remember I was with, um, I had a partner, and she, she felt that sex toys were for older people.

    2. RMDr. Rena Malik57:03

       Mm-hmm.

    3. SBSteven Bartlett57:03

       Old people.

    4. RMDr. Rena Malik57:04

       Mm-hmm.

    5. SBSteven Bartlett57:04

       Specifically what she said. And she, she was kind of against the use of them. I've always been down.

    6. RMDr. Rena Malik57:09

       Yeah.

    7. SBSteven Bartlett57:09

       I think it adds novelty, and it's exciting, and it just adds something new. But she felt like it was almost like giving up.

    8. RMDr. Rena Malik57:17

       Well, I mean, look, I think... I wonder why. I would, I would... If I... If she was here, I'd ask her, "Why do you think that? What belief system do you have [laughs] that's making you think that this is, like, not a good thing to use," right?

    9. SBSteven Bartlett57:27

       Yeah.

    10. RMDr. Rena Malik57:27

        We use technology in so many s- places in our lives, right? So why not in- introduce it in our sex lives?

    11. SBSteven Bartlett57:33

        Are you gonna become reliant on it though? Because doesn't it make it easier to get off with a sex toy?

    12. RMDr. Rena Malik57:37

        So they've actually looked at, uh, vibration and can you get desensitized to it, and the way they've looked at it is actually, like, construction workers, where they're using those, like, vibration tools, right? To... And, and seeing if, like, their hands get desensitized. And what they've seen is, yes, for a short period of time, they do lose a little bit of sensation on their fingertips, but then it restores back to normal. And so it's not that you're gonna become desensitized forever, right? I think you brought up a great point, which is adding novelty. Now, I think when I say novelty, people are like, "Oh my God, I need to role play in a different way or bring, like, some sort of BDSM or whatever into my sex life," and that's not exactly true. So when you think about sex, right? It's just like eating your favorite ice cream. Maybe you have vanilla ice cream, you know, three times a week, and you enjoy it. But if you start having vanilla ice cream every single day, you're kind of bored with it, right? And the same goes for sex. Now, having routine in sex, knowing what you like, um, knowing what your partner likes, it can be very helpful. But it also is nice to add novelty. So if you think about, we could extrapolate from the flow state. So when you are in a flow state for work, right, things feel really almost effortless, and you're just, like, in a zone. You can also get into a sexual flow state. When you look at the flow state, yeah, you need things to be slightly challenging to get into a flow state. They can't be easy, and they can't be so hard that you're gonna get frustrated, right? And so you need to add a slight challenge to your sexual encounter to get into that flow state, and that's when you start having really great sex.

    13. SBSteven Bartlett59:07

        Yeah.

    14. RMDr. Rena Malik59:07

        'Cause you're, like, in... You're so totally immersed. You're feeling great, and it's, it's super fun, right? So I think that's another part of being confident is being able to and confident to try new things and explore new things, and it can be as simple as, like, doing it in a different room or maybe getting a pillow or switching where your head position is. Like, it can be so small, but it can just add a little bit of uniqueness and novelty and challenge.

23. 59:32 – 1:00:50

    What Are The Best Positions For Female Orgasm?

    1. SBSteven Bartlett59:32

       Are there certain positions that are going to increase the probability that my partner has an orgasm?

    2. RMDr. Rena Malik59:38

       Yeah. So, uh, typically when the female partner is on top, she has more control over where she's getting stimulation, um, to the clitoris. 'Cause, right, she can angle-

    3. SBSteven Bartlett59:48

       Mm

    4. RMDr. Rena Malik59:48

       ... her body in such a way. So oftentimes that shows, uh, that has, uh, higher orgasm rates. There's actually, like, this, uh, this technique called the coital alignment technique, where you sort of move in a rocking, uh, a, a sort of a rocking motion so that, um, your pubic symphysis, so this bone right here, um, is sort of, like, rubbing against their clitoris. Like, this area, the skin here is rubbing against the clitoris while you're penetrating, and that has been shown to increase orgasm rate and pleasure in sex. So really it's about figuring out and trying different things and realizing, like, that, for example, that coital alignment technique is sort of difficult. Like, it's not that easy and intuitive, and so you have to sort of play around with it and figure out, like, what is gonna work, uh, best and, yeah, realizing it might not work. You might be, like, super awkward and be like, "Okay," like, that's okay. Like, it's not the end of the world if sex is not perfect every time because we're learning, and we're playing, and we're having fun. And so I think that's really the key is, like, not letting yourself get so frustrated if something doesn't go exactly the way you envision it in

24. 1:00:50 – 1:02:58

    What Is Squirting?

    1. RMDr. Rena Malik1:00:50

       your head.

    2. SBSteven Bartlett1:00:50

       I used to think that a woman orgasming was when, this is when I was younger, um, was when she squirted.

    3. RMDr. Rena Malik1:00:55

       Mm-hmm.

    4. SBSteven Bartlett1:00:56

       So, like, that's what I thought it was. I thought an orgasm was squirting.

    5. RMDr. Rena Malik1:00:59

       Yeah. Well, it... You're probably not the only one to think that. And so squirting, not every woman squirts. So about 40% of women squirt. Squirting is the emission of fluid at the time of orgasm. Um, usually it's clear, colorless, and it can be quite voluminous. Um, it's coming from the urethra, which is the pee hole essentially, and remember I talked about those Skene's glands? Those Skene's glands are the homolog of the male prostate, and they have a little bit of fluid in them too. Typically, when you have stimulation, um, and squirting, they will release fluid from the bladder as well as the Skene's glands that combines together, and, and it's emitted through, through that.

    6. SBSteven Bartlett1:01:38

       So it's not pee.

    7. RMDr. Rena Malik1:01:38

       [laughs] The way they describe it, and there's been a lot of research on this. So there's people who say it's pee. There's people who say it's not. There's a couple studies. So one is they put dye into the bladder, and they took women who said they were squirters, and they had them orgasm. And they saw is there dye in the, uh, in the fluid? And yeah, there was dye in the fluid. So it's coming f- It has to come from the bladder. The Skene's glands only hold a small amount. But it's chemically different. It's usually clear, odorless. It doesn't smell like pee. And so there's some theories as to why that might be. It may be that, um-When you're having sex, there's different hormonal signals that change the concentration of what's filtering through your kidneys so that it is a little bit different in composition. There's some theories that when there's more estrogen around that it may change. There may be some, like, um, fluid filling in the actual interstitia of the organs. Again, it's hard to say, but it's absolutely coming from the urethra, which is connected to the bladder, as well as the Skene's glands. But I think, like, this, this whole discussion about what it is, it doesn't matter. Like, [laughs] is it pleasurable? Are you enjoying it? Great. If you squirt and you enjoy it, great. If you don't, that doesn't mean that there's something wrong and that your partner hasn't orgasmed. The way to figure out if your partner orgasmed is you ask her, right? Either she tells you or you ask her. A- and sometimes it's obvious, and sometimes it's not, but, you know, you, you sort of figure it out.

25. 1:02:58 – 1:04:28

    Why Does Sex Cause UTIs?

    1. SBSteven Bartlett1:02:58

       There's three theories that emerged in my research-

    2. RMDr. Rena Malik1:03:01

       Mm-hmm

    3. SBSteven Bartlett1:03:01

       ... about why women squirt from an evolutionary perspective. The first was that, and these are just theories, they're not proven, um, of course. The first is that squirting contains PSA and zinc, which are naturally antibacterial, and ejaculating these fluids during or after sex may have evolved to flush the urethra and prevent UTIs. Um, the logic being in a pre-an- antibiotic world, a woman who could flush bacteria out of her system after mating was more likely to stay healthy and reproduce. That's one theory. The other is-

    4. RMDr. Rena Malik1:03:27

       Well, before you- I wanna talk about that really quickly.

    5. SBSteven Bartlett1:03:29

       Yeah, sure.

    6. RMDr. Rena Malik1:03:29

       So th- that's a really interesting theory. So one, the reason they emit PSA is because Skene's glands are the homolog of the prostate.

    7. SBSteven Bartlett1:03:37

       Which means?

    8. RMDr. Rena Malik1:03:37

       So the prostate makes PSA, which is prostate-specific antigen.

    9. SBSteven Bartlett1:03:41

       So at this point, this word homolog again.

    10. RMDr. Rena Malik1:03:43

        Yeah, it's a, so basically the prostate in the male-

    11. SBSteven Bartlett1:03:45

        Yeah

    12. RMDr. Rena Malik1:03:45

        ... the same tissue when you're an embryo becomes a prostate in the male and becomes a Skene's glands in the female. So that's why it's emitting PSA. That is an interesting theory because there are a subset of women who get UTIs after sex. Not everybody, but some do. And it's, it's not because of the ejaculate or because of the male harboring some bacteria. It's because of the actual thrusting of the penis. It's taking bacteria from the outside and making it more easy for it to go through the urethra into the bladder, and women have a short urethra. And so I want j- just to debunk that myth that it's like you're getting it from your partner or there's something wrong with you, is literally just anatomy.

    13. SBSteven Bartlett1:04:21

        Mm-hmm.

    14. RMDr. Rena Malik1:04:21

        And so some women do get more UTIs after sex. And so that is-

    15. SBSteven Bartlett1:04:26

        Interesting

    16. RMDr. Rena Malik1:04:26

        ... an interesting theory because maybe that's true.

26. 1:04:28 – 1:05:26

    Why Do Humans Have Orgasms?

    1. RMDr. Rena Malik1:04:28

       I don't know.

    2. SBSteven Bartlett1:04:28

       The second theory was, in ancient ancestors, the hormonal surge during orgasm and ejaculation actually triggered the release of an egg. Humans evolved to ovulate on a cycle now, but we kept the plumbing and the neurohormonal reflex. It's a happy accident, a biological vestige that no longer serves its original reproductive purpose, but remains because it isn't harmful for survival.

    3. RMDr. Rena Malik1:04:49

       Interesting. I mean, there is some thought that maybe orgasming, um, the spasms, orgasm help with fertility, but it's not really, uh, robust.

    4. SBSteven Bartlett1:04:59

       And the last one kind of matches what you just said there, which is the mate selection theory. The intense pleasure and psychological response of squirting or, or, or orgasm act as a reward system. It incentivizes women to seek out specific partners who provide high levels of s- stimulation, potentially signaling a better genetic compatibility or a more attentive male, which would help with the survival of, of offspring. Maybe.

    5. RMDr. Rena Malik1:05:21

       That makes sense.

    6. SBSteven Bartlett1:05:23

       40% of women squirt.

    7. RMDr. Rena Malik1:05:25

       Yeah.

27. 1:05:26 – 1:08:57

    What Are Non Genital Orgasms?

    1. RMDr. Rena Malik1:05:26

       So the other thing is, obviously, a lot of sex is focused on genitals, but there's a whole body of erogenous zones, right? Almost, almost your entire body can be an erogenous zone. We talked a little bit about it when we talked about sensate focus, right? You can explore, you can find areas that people find, uh, erogenous. So when you've looked at data, necks, nipples, lips, buttocks, inner thighs, all these areas are considered erogenous by most, most people, regardless of their, um, sexual orientation, regardless of their cultural upbringing. It seems to be pretty universal. There's actually a, a famous paper about non-genital orgasms and, like-

    2. SBSteven Bartlett1:06:02

       [laughs]

    3. RMDr. Rena Malik1:06:02

       ... how people orgasm without any genital stimulation. So lip orgasms, anal sex orgasms, um-

    4. SBSteven Bartlett1:06:09

       Is that possible?

    5. RMDr. Rena Malik1:06:10

       Yeah. It, it's been documented, absolutely. And, and so it's, um, n- and nipple orgasms, there's a whole variety of ways. Even, like, women have had orgasms during childbirth. Like, there's, there have been these documented ways to orgasm, and it's because these areas can be very erogenous. And sometimes stimulating multiple areas can, like, add more erogenous interest, and that's why you see people, like maybe in the BDSM community, they'll, they'll be using, um, nipple clamps while they're doing other things, right? So there's, there's a whole bunch of areas that are erogenous. And most of the times, people are not really spending much time on foreplay or stimulating these erogenous zones as much as they should, right? You, you have a whole body to play with. And how do you stimulate them? There's actually evidence behind that. So on your skin, we have these special fibers called C tactile afferents. So when you stimulate these fibers, they help you feel pleasure, enjoyment, those sorts of things. And so there was a study where they took 19 couples, a small study, it was out of London, and they basically told them to stimulate an erogenous zone and a non-erogenous zone, the non-erogenous zone being the forehead. And so they had the couples stimulate, and they told them stimulate it at levels of 18 centimeters per second, uh, in terms of how fast you're caressing the arm or, or, or body part, and at three centimeters per second. And what they found was those who stimulate at three centimeters per second had more sexual arousal, had more pleasant stimulation compared to those who were stimulating it at 18 centimeters per second. Now, this makes sense because those C tactile afferent fibers respond very well to that slow, gentle caress. The other interesting thing is that these fibers are only responsive to human touch. So if I take a glove and I put it on my hand and I touch you-

    6. SBSteven Bartlett1:07:54

       Oh, that's interesting

    7. RMDr. Rena Malik1:07:54

       ... it still doesn't work.

    8. SBSteven Bartlett1:07:56

       That's so interesting because in Los Angeles, where we are now, we were viewing an office, and we were walking down the street to see what the neighborhood was like, and we walked past one place, and it is a robot massage parlor.

    9. RMDr. Rena Malik1:08:08

       Hmm.

    10. SBSteven Bartlett1:08:09

        And I always thought, "Great." Like, well, part of me thought.

    11. RMDr. Rena Malik1:08:12

        [laughs]

    12. SBSteven Bartlett1:08:12

        Maybe my prefrontal cortex thought, "Oh, great idea," because, you know, you can get massages whenever you want.

    13. RMDr. Rena Malik1:08:17

        Right.

    14. SBSteven Bartlett1:08:17

        It's gonna be cheap. You maybe can have one in your home.

    15. RMDr. Rena Malik1:08:19

        Yeah.

    16. SBSteven Bartlett1:08:19

        But then the other part of me, as I saw it, thought, "Actually, I don't actually think that's, like, where I, why I get massages."

    17. RMDr. Rena Malik1:08:23

        Yeah. It's, it's-

    18. SBSteven Bartlett1:08:24

        I think there's something about human touch which makes a big difference.

    19. RMDr. Rena Malik1:08:27

        Absolutely there is. Um, and so I think that's, uh, we're evolutionary, evolutionarily built to seek out human touch and human behavior.

    20. SBSteven Bartlett1:08:37

        I wonder if I would want a robot to massage me.

    21. RMDr. Rena Malik1:08:41

        I don't know.

    22. SBSteven Bartlett1:08:41

        It wouldn't be as good. No.

    23. RMDr. Rena Malik1:08:42

        I mean, think about sitting in a massage chair. Is it ever as good?

    24. SBSteven Bartlett1:08:45

        It's never as good.

    25. RMDr. Rena Malik1:08:46

        Right? And so-

    26. SBSteven Bartlett1:08:46

        It's really bad

    27. RMDr. Rena Malik1:08:46

        ... I don't think a robot's gonna be that different from a, maybe a little better than a massage chair, but like-

    28. SBSteven Bartlett1:08:52

        Massage chairs are never good.

    29. RMDr. Rena Malik1:08:53

        No, they're just, like, they're okay. They're mediocre.

    30. SBSteven Bartlett1:08:56

        Mm.

28. 1:08:57 – 1:11:05

    Why Is Testosterone Declining?

    1. SBSteven Bartlett1:08:57

       Rena, I wanna talk about, um, testosterone, how that links to sexual function, but also just overall health. Because-

    2. RMDr. Rena Malik1:09:03

       Mm-hmm

    3. SBSteven Bartlett1:09:03

       ... I was reading that there's been a 300% increase in the United States in the last 10 years of testosterone prescriptions. And my friends are cr- increasingly having a conversation about testosterone, which we weren't having-

    4. RMDr. Rena Malik1:09:13

       Mm-hmm

    5. SBSteven Bartlett1:09:14

       ... even five years ago. It wasn't a conversation. And now the conversation I'm having amongst my friends is like, "Is our testosterone high enough? Do we need to go get supplements-

    6. RMDr. Rena Malik1:09:20

       Yeah

    7. SBSteven Bartlett1:09:20

       ... to increase our testosterone?"

    8. RMDr. Rena Malik1:09:22

       Testosterone is declining, so when you look at testosterone levels from the 1990s, like late 1990s, the average level was around 600, and if you look at data around two- 2015, it was 450. So there's been like a 25% decline in testosterone. Now you're gonna ask me why. One, we talked about some of the endocrine-disrupting chemicals. That's part of it, certainly. Two, there's a significant rise in obesity. Testosterone has aromatase, and testosterone converts to estrogen using this enzyme called aromatase. And so when you have more fat mass, you have more aromatase, and more testosterone is being converted to estrogen. And so now you have less testosterone.

    9. SBSteven Bartlett1:10:01

       Sorry, how do we, how do you have less testosterone?

    10. RMDr. Rena Malik1:10:03

        So because there's more fat mass, there's more aromatase. So that aromatase sees all this testosterone-

    11. SBSteven Bartlett1:10:09

        Oh, 'cause it converts the testosterone

    12. RMDr. Rena Malik1:10:09

        ... and it converts it to estrogen.

    13. SBSteven Bartlett1:10:11

        Ah, okay.

    14. RMDr. Rena Malik1:10:11

        Okay? Or estrogen.

    15. SBSteven Bartlett1:10:12

        And this is why they say, they talk about man boobs.

    16. RMDr. Rena Malik1:10:14

        Yeah, so when you have a lot of estradiol around, you can get, uh, man boobs.

    17. SBSteven Bartlett1:10:18

        Okay.

    18. RMDr. Rena Malik1:10:19

        You can get gynecomastia, is the term for it. So that's one. Two is we see a rise in diabetes and insulin resistance, which also causes a decrease in testosterone. We're seeing a rise in ultra-processed food intake, and that doesn't have the optimal nutrition that you need to optimize testosterone. So we're getting, you know, a hi- highly caloric, which then leads to obesity. We're getting, um, lack of healthy fats. We're, you know, all these things are super important for testosterone. The Mediterranean diet is what has been the most studied, and basically an anti-inflammatory diet is what they found for testosterone. So trying to just eat, like, whole foods, unprocessed foods as much as possible and minimizing the inflammatory

29. 1:11:05 – 1:14:50

    Does Testosterone Affect Fertility?

    1. RMDr. Rena Malik1:11:05

       foods.

    2. SBSteven Bartlett1:11:05

       Does testos- having high testosterone make me more fertile?

    3. RMDr. Rena Malik1:11:09

       No, not necessarily. So I think people inherently think that the higher your testosterone level is when you check your blood work, that that's better, and that's not necessarily true. Now, everyone is different, and what I can't tell you i- is what your receptors look like, what your testosterone or androgen receptors look like. How sensitive are they to testosterone? And everyone's a little bit different. When you look at the same guy, or you look at two different guys, their variability can be so much that a guy who's 900 can be normal, and a guy who's 500 can be normal because everyone has individual genetic variations. It's how their cells, how sensitive their cells are, how many cells they have. You know, how many Leydig cells do they have in their testicles? Um, the CAG repeats, which are these DNA repeats on the receptor themselves, people who have more are less sensitive to the testosterone that's around, so they need more testosterone to get the same result, whereas people who have less repeats have more sensitivity, so they, they don't need as much testosterone.

    4. SBSteven Bartlett1:12:05

       Hmm.

    5. RMDr. Rena Malik1:12:05

       And so everyone is individual, and so that's why it's really important to understand, how are you feeling, right? It's not about chasing a number. And so absolutely, we know that when your testosterone is low, below 214 nanograms per deciliter, that your risk of mortality goes up by two. So you are gonna double your risk of dying if you have low testosterone. But when you go super high, super physiologic, meaning like 1,800 or higher, now you're putting yourself at risk for other things. You can have blood thickening, which is a known side effect of testosterone replacement, and that puts you at risk for stroke, heart attack, heart, heart disease. Over long periods of time, it can affect your heart because it can, um, there's also heart muscle cells that get exposed to this high level of testosterone, and when that happens, these, they sort of change over time, and they become more collagen deposition. They get more fibrosis, and this makes them stiffer and so that you're not pumping blood as effectively as you would otherwise. And so there are real consequences to going too high. There's also the side effects of having acne, of changes in mood i- in terms of aggression and things when you get really high. So really, it's about finding what you feel good at. More is not necessarily better. Once your testosterone receptors are saturated, meaning they're all bound to testosterone, more doesn't help you. It might help you get more muscles, which is why people abuse anabolic steroids and testosterone because it will continue to help you get bigger muscles, but that's it. It's not gonna help you with your brain health, your bone health, your sexual health, your any of that.

    6. SBSteven Bartlett1:13:39

       Is there a way to visually spot a person with low testosterone? Are there visual clues?

    7. RMDr. Rena Malik1:13:46

       Usually it's someone who feels very fatigued, like they can't get out of bed. They feel just, like, so drained. Usually, they are a little bit more overweight.

    8. SBSteven Bartlett1:13:56

       Skinny fat?

    9. RMDr. Rena Malik1:13:57

       Eh, visceral adipos- I mean, you can't always tell if they're skinny fat. Could be, 'cause they could have visceral adiposity, which is meaning that the fat is around the, the organs, right? And so you don't see, like, a big potbelly necessarily. Um, they may have really low sexual desire. They may have decrease in mood.

    10. SBSteven Bartlett1:14:13

        What about skin and bones? Does it impact skin and bones?

    11. RMDr. Rena Malik1:14:16

        Yeah, so if you get high testosterone, you'll get acne 'cause it affects the sebum in the skin. Um, bone health, so testosterone converts to estradiol, and estradiol is really important for bone metabolism. And so when you have low testosterone, you can also have low estrogen, and when your estrogen gets very low, you get a higher risk for fractures, higher risk for osteoporosis, and so that's where your bone health, um, can be in danger. And so that's why testosterone can help protect your bones because of its conversion to estradiol.

30. 1:14:50 – 1:16:55

    What Are The Risks Of Anabolic Steroids?

    1. SBSteven Bartlett1:14:50

       If you do have low testosterone, should you be considering taking anabolic steroids? Like-And who is testosterone replacement therapy good for?

    2. RMDr. Rena Malik1:14:59

       So I'm gonna ask you a question. Why, why are you saying anabolic steroids?

    3. SBSteven Bartlett1:15:01

       I don't know. 'Cause I hear that people, big bodybuilders take anabolic steroids.

    4. RMDr. Rena Malik1:15:05

       The reason I asked you that is because people think anabolic steroids and testosterone replacement therapy are the same thing, and they're not.

    5. SBSteven Bartlett1:15:10

       Yeah.

    6. RMDr. Rena Malik1:15:11

       And so testosterone replacement therapy is what is given to guys who have low testosterone. If you have truly low testosterone, there's a few things you can obviously improve testosterone naturally by going back to those pillars of health that we talked about. Improve your sleep, do resistance training, avoid endocrine-disrupting chemicals. But if you are still low despite doing all those things, or you're, like, so fatigued that you can't move your body, and, like [laughs] you really need to do it, then I think testosterone replacement is, is very valuable. And so testosterone replacement is getting you to a level of testosterone that is within normal. We're not trying to get you super high. We're not trying to get you to become a bodybuilder. We're trying to get you to normal, what you should be. And so anabolic steroids are different. Anabolic steroids are like all these different, um, oral pills and injectables and things that work on muscle as well as work on your t- uh, androgen receptors. And so those are typically things that people are taking on their own. They're kind of f- self-directing their care, and they're not really monitoring their testosterone, or they don't really care how high they go. They just want the end product of looking muscular, and so they are getting really high testosterone. And that has its own host of concerns, uh, uh, in addition to the ones we talked about, like blood clots and, and heart attack, but there's a 15 times higher risk of having premature heart failure and 122 times more risk of cardiac death when you're taking anabolic steroids for the purposes of increasing muscle mass and not... and g-getting really high in your testosterone. So it is a real serious issue when you take anabolic steroids because it can have real serious health consequences.

    7. SBSteven Bartlett1:16:54

       I've always imagined that once

31. 1:16:55 – 1:23:38

    Does TRT Affect Fertility?

    1. SBSteven Bartlett1:16:55

       I have ki- So I'm, I think I'm scared that if I have testosterone replacement therapy at this age, at 33-

    2. RMDr. Rena Malik1:17:01

       Mm-hmm

    3. SBSteven Bartlett1:17:01

       ... it might impact my fertility.

    4. RMDr. Rena Malik1:17:02

       It absolutely will.

    5. SBSteven Bartlett1:17:04

       Okay, good. So I'm not gonna do that until I've had all four of the kids-

    6. RMDr. Rena Malik1:17:08

       Yeah

    7. SBSteven Bartlett1:17:08

       ... as many as I can. And then I figured when I hit, like, 45, then I'll go on testosterone replacement therapy. Is this a good strategy?

    8. RMDr. Rena Malik1:17:17

       Well, first of all, I would wanna know why you wanna be on testosterone. Is your testosterone low?

    9. SBSteven Bartlett1:17:21

       I have no idea.

    10. RMDr. Rena Malik1:17:22

        Right?

    11. SBSteven Bartlett1:17:22

        I have ways to check.

    12. RMDr. Rena Malik1:17:22

        Are you having any symptoms?

    13. SBSteven Bartlett1:17:24

        No.

    14. RMDr. Rena Malik1:17:24

        I mean, you live a very high-powered, busy life.

    15. SBSteven Bartlett1:17:27

        Mm.

    16. RMDr. Rena Malik1:17:27

        And so I can guarantee your stress is probably not under control. Like, probably you're not sleeping great. And not to say that those are things that, you know, you can't do in addition to taking testosterone if your testosterone is indeed low, but I think the important thing is realizing, like, it's only gonna help you if your testosterone receptors are not fully saturated and giving you more testosterone is going to saturate them.

    17. SBSteven Bartlett1:17:50

        Doesn't it just drop anyway with age?

    18. RMDr. Rena Malik1:17:52

        It does. So it drops about, uh, 1% a year on average.

    19. SBSteven Bartlett1:17:56

        Oh.

    20. RMDr. Rena Malik1:17:56

        Some people drop less. Some people drop more. So if you look at someone who is healthy and they have a normal testosterone, they usually won't become what we call hypogonadal or have low testosterone even as they age because the drop is so low. It's only 1% a year. But if you add on these comorbid conditions, if you add on a high stress life, if you add on poor sleep, if you add on, um, exposure to endocrine-disrupting chemicals, you're gonna see, um, that number come down much higher.

    21. SBSteven Bartlett1:18:24

        It's actually... I was just- I pulled up a graph here-

    22. RMDr. Rena Malik1:18:27

        Mm-hmm

    23. SBSteven Bartlett1:18:27

        ... um, that shows testosterone decline with age, and it's actually not that steep.

    24. RMDr. Rena Malik1:18:33

        It's not. It is gonna decline, but it may not decline to the point where you need testosterone. So not everyone needs it. Depending on the data you look at, 20 to 40% of guys have low testosterone, um, and when you look at the number that get treated, it's like 2%.

    25. SBSteven Bartlett1:18:49

        And it starts declining from about 20 years old.

    26. RMDr. Rena Malik1:18:52

        Yeah, uh, depends on the person, 20 to 40 years old to start. It's probably around, more around 30 to 40. And the reason we came up with these numbers, right, these guidelines to, to guide us on what's normal and what's not, is because when you look at population-based data and you look at when these symptoms arise, and there are, like, clear numbers. Like, you may start having bone loss, uh, around 300. You might start having, uh, you know, decreased sexual frequency of thoughts at 215. You might start having f- feeling less physical vigor, uh, around 290, right? And so there are numbers that we know based on population-based data that we're seeing these numbers decline. Now, the other thing to think about when you're looking at testosterone is free testosterone. So testosterone comes in different forms in the body. It comes bound and unbound. So 45% of testosterone is bound to SHBG, which is a m- molecule of protein that is s- really tightly binds to testosterone, doesn't let it go for your body to use. Uh, then there's s- s- some that's bound to albumin, which is sort of loosely bound, and then there's 2% that's free, 1 to 2% that's free. And that's what we say is, like, the most available to your body for use. And there's actually, you know, good data that looks at free testosterone. The levels of free testosterone are correlated with these symptoms as well. And so you do have to look at the big picture. So I always check the total testosterone as well as SHBG because some people can have elevated SHBG due to thyroid dysfunction, due to aging, due to just genetic variability, right? In women, SHBG goes up when you take oral contraceptives, and it stays up for life if you take oral contraceptives, so it can affect their free testosterone. The other thing to think about testosterone is it's for life. Once you take it, your body stops making its own testosterone. Many people over years will notice that their testos- t- their testicles get smaller, um, because their body stops making its own testosterone, so it's not something to take lightly. Now, if you want-- Say you were low right now and you wanted to conceive, there are ways where you can take other, um, other pharmaceuticals that will naturally boost your own production, like HCG or Cometeer and Clomiphene. These work basically, uh, in different ways to either tell your brain that, "Hey, we need more testosterone," or they send, they mimic the signals that tell your testicles to make more testosterone.And so there are ways to do it, and you definitely need someone who's, you know, well-versed in managing hormone management. Uh, but there are things that you can do if you're low. But again, I don't think it's-- Once you, once you start these things, you can't go-- I mean, you can get off of it, but it's sort of a process, and it's not something that everyone will do because you're gonna feel good on testosterone if you're taking it, and then when you get off it, because your body is, like, no longer making its own, you're gonna feel horrible.

    27. SBSteven Bartlett1:21:33

        So do you think most fifty-plus-year-old men should be taking testosterone replacement therapies?

    28. RMDr. Rena Malik1:21:40

        Only if they're symptomatic and they're low, right? So-

    29. SBSteven Bartlett1:21:42

        Would, would, would it make the, the average man, the average fifty-year-old man, if this is the average, feel better on a daily basis?

    30. RMDr. Rena Malik1:21:48

        Not necessarily, because if they are normal, like I said, if their testosterone receptors are already fully saturated, it's not gonna change, right? It's not gonna change the-- It, like I said, it may make their muscles look bigger, but it's not gonna change their, their cognition. It's not gonna change their mood. It's not gonna change their sex drive. It's not gonna change their erections when their testosterone receptors are fully saturated.
32. 1:23:38 – 1:25:40

    How Does Body Image Affect Sexual Pressure?

    1. SBSteven Bartlett1:23:38

       I guess a lot of men are self-conscious in a way that they don't often admit, and they want to have big muscles.

    2. RMDr. Rena Malik1:23:42

       Mm-hmm.

    3. SBSteven Bartlett1:23:43

       And they want to feel strong.

    4. RMDr. Rena Malik1:23:44

       And this is the, the problem I'm seeing with younger guys right now is that there's a lot of young kids taking anabolics because there's so much pressure to look a certain way, right? Because nowadays, when-- how do you meet people on social media through, like, swiping and, and all you see is what they look like. And so there's this pressure, and, like, I'll see it at the gym. Like, I'm like at the gym and there's these young kids who I'm like, "There is no way you are naturally that built at that age," right? Like, unless you've been lifting since you were, like, seven years old. And so-- [chuckles] and of course there are some, but it is serious because, one, it causes infertility, right? When you're on testosterone replacement, after about eighteen y- eighteen months, seventy percent of people on testosterone replacement will be infertile.

    5. SBSteven Bartlett1:24:27

       Seventeen?

    6. RMDr. Rena Malik1:24:28

       Seventy. Seventy percent.

    7. SBSteven Bartlett1:24:30

       Seventy.

    8. RMDr. Rena Malik1:24:30

       And even as soon as, like, ten weeks, we see some people having drops in their sperm count. So it's variable with how quickly you're gonna see impacts on your fertility, but it absolutely happens. And it ca- it can come back for the large majority of people, but how long it takes depends on your age and how long you were on testosterone replacement therapy. And in some cases, it can take as long as two years to come back.

    9. SBSteven Bartlett1:24:55

       I really need to get my testosterone levels checked.

    10. RMDr. Rena Malik1:24:57

        Yeah, you, you should. [laughs] But also you should get your semen analysis checked and then-

    11. SBSteven Bartlett1:25:01

        I've done that.

    12. RMDr. Rena Malik1:25:02

        Good. Good. Because that's also a biomarker of health. We've seen that people who have poor semen parameters, they have higher rates of mortality, and they actually live-- When you look at age, like what age people die, they die younger compared to people. And it's dose dependent, so if you're, have, like, normal, uh, concentration of sperm and then it keeps going down and down and down, at-- if you look at the age, it's like they live to seventy-eight, seventy-seven, seventy-six. So, like, you can actually see it come down, except for people who have no sperm because those are usually genetic disorders. Those are, live a little longer because it's not necessarily due to cardiometabolic issues. Um, but it's basically a reflection of your overall

33. 1:25:40 – 1:27:43

    Ads

    1. RMDr. Rena Malik1:25:40

       health. [page flips]

    2. SBSteven Bartlett1:25:43

       Steve, what are you doing? Uh, just making myself a delicious coffee. From the freezer? From the freezer. Have you not heard about Cometeer? No. Oh my gosh, this is gonna change your life. A couple of months ago, the founder of this business called Matt sent a big shipment of this coffee to our office in London. What most people don't know is that the processing of coffee takes out a lot of the taste, so what they do is they flash freeze it at the optimal moment when it's most tasty, and they send you in the post the coffee in these little frozen ice cubes. Now, Matt sent a big shipment to my office. I moved it to the kitchen. I said to the team, "Knock yourselves out." And then I saw so many messages in our Slack channel of people going, "Oh my God, what the hell is that? It's so delicious." All I have to do is pop it out in the morning using the little button on the back of this thing. I pour my hot water in, and I mix it, and that is done. You can get thirty dollars off your first order of Cometeer coffee if you go to cometeer.com/stephen. Try it and please Instagram DM me, LinkedIn me, and let me know if you love it as much as I do. [page flips] Make sure you keep what I'm about to say to yourself. I'm inviting ten thousand of you to come even deeper into the Diary of a CEO. Welcome to my inner circle. This is a brand new private community that I'm launching to the world. We have so many incredible things that happen that you are never shown. We have the briefs that are on my iPad when I'm recording the conversation. We have clips we've never released. We have behind the scenes conversations with the guests and also the episodes that we've never ever released, and so much more. In the circle, you'll have direct access to me. You can tell us what you want this show to be, who you want us to interview, and the types of conversations you would love us to have. But remember, for now, we're only inviting the first ten thousand people that join before it closes. So if you want to join our private closed community, head to the link in the description below or go to doaccircle.com. [page flips] I will speak to you then.

34. 1:27:43 – 1:31:38

    Does Penis Size Matter?

    1. SBSteven Bartlett1:27:43

       One of the things I was quite surprised by, I'll be honest, is when I went on your YouTube channel-

    2. RMDr. Rena Malik1:27:48

       Mm-hmm

    3. SBSteven Bartlett1:27:48

       ... one of your very high-performing videos, I think it had 31 million views, was about enlarging your penis.

    4. RMDr. Rena Malik1:27:56

       Yes.

    5. SBSteven Bartlett1:27:57

       [laughs] I didn't know that so many men were interested in ways to enlarge their penis.

    6. RMDr. Rena Malik1:28:05

       Well, it's interesting because when you look at the data, more men want to... So I w- uh, let's say most guys would love to be taller, right?

    7. SBSteven Bartlett1:28:13

       Mm-hmm.

    8. RMDr. Rena Malik1:28:13

       If you're an average height man, most guys would love to be taller, right?

    9. SBSteven Bartlett1:28:15

       Yeah. True.

    10. RMDr. Rena Malik1:28:16

        Um, more men wanna have a longer penis than they wanna be taller.

    11. SBSteven Bartlett1:28:20

        Really?

    12. RMDr. Rena Malik1:28:20

        Mm-hmm.

    13. SBSteven Bartlett1:28:23

        Wow. Wow. Why is this?

    14. RMDr. Rena Malik1:28:28

        Well, I think, you know, a lot of people, um, it starts at a young age. I have sons, right? And so I see it. Like they talk about their penis in such a way, like very early in life. Like, "Oh my God, my penis is so big," or, "It should be so big," or whatever. And, and there's, and it's like this, it becomes this like this society thing about who's got a bigger penis. Like it's very interesting. But there's a lot of pressure to feel like, a- and, and a lot of discussion around bigger is better, right? It's, it's talked about in media. It's subtly joked about. It is, um, everywhere you look, people are talking about like being well-endowed as being better. But interestingly, on my podcast, we interviewed the, the guy who has the largest medically verified penis. It's, I think it's like 13 or 14 inches in length. And, um, he actually has a lot of trouble because it's so large that people don't wanna have sex with him, and it's uncomfortable for them. And so like it's not all roses and sunshine [laughs] on the other side, but the reality is that many people feel what's called small penis anxiety, and they, they, even if they have a normal sized penis, they feel consumed with how the size of their penis is. And so that's why this video did so well. I naively had no idea how many people it would resonate with because I'm not a guy, right? And I see patients all the time, but at that time in my career, people weren't coming to me to talk about it. And so I, um, I realized like there's so many people quietly feeling insecure. And we talk a lot about women having body image issues. Men do too, right? They feel insecure about the size of their penis because also they're seeing guys on pornography who have very well-endowed phalluses and, you know, they chose to be porn actors for a reason, right? Because they are naturally well-endowed. And so you're comparing yourself to the outliers, and the average penis is about 5.3 to 5.5 inches erect. But when you look at like what do women want, they will say on average they want a six-inch penis. But when you look at like the kind of sex toys they buy, and they did this study because they were looking at people who, they were trying to decide what kind of, when they were developing phalluses for trans people, like they, they reconstruct phalluses for th- they wanted to... They were making them too girthy, and they're like, "Well, we need to figure out what girth women want." And so they looked at like what women buy on- online, like what is the most purchased sex toy, and it's actually pretty close to average.

    15. SBSteven Bartlett1:30:52

        Did you say 5.2 inches?

    16. RMDr. Rena Malik1:30:53

        5.2 to 5.5-

    17. SBSteven Bartlett1:30:55

        Erect

    18. RMDr. Rena Malik1:30:55

        ... depending on the study you're looking at. Yeah.

    19. SBSteven Bartlett1:30:56

        Erect.

    20. RMDr. Rena Malik1:30:57

        Mm-hmm.

    21. SBSteven Bartlett1:30:58

        Hmm. And what size do men think the average is?

    22. RMDr. Rena Malik1:31:03

        Oh, they think it's like six or seven inches.

    23. SBSteven Bartlett1:31:05

        Oh, okay. So they think the average is bigger. And also, how does age come into this? Because I'm presuming that when I get older, my penis is gonna shrink or something.

    24. RMDr. Rena Malik1:31:11

        If you have good blood flow to your penis, it shouldn't shrink. So like I said earlier, if you stop having nighttime erections or you're not having erections, now you're no longer getting blood flow to your penis, and it will shrink over time. Also, if you're gaining weight, it will appear that it's shrinking because you're getting more fat over here. So if you think about your penis here, this is the fat right above this bone, and as this fat gets more and more, you're seeing less and less of the penis.

35. 1:31:38 – 1:36:15

    Do Penis Enlargement Methods Work?

    1. SBSteven Bartlett1:31:38

       And is there a way to enlarge the penis?

    2. RMDr. Rena Malik1:31:41

       So there are many ways that have been, uh, tried, discussed, um, attempted. So there's definitely surgeries that you can get, but they, there's not a lot of surgeons who do a lot of penile lengthening surgeries, and they have lots of complications, like very high rates of complications because the penis is a very vascular organ. And the thing is that when you have, uh, the tiniest difference on your penis, you notice it, right? Like I have guys come in with like the tiniest little thing on their penis, and they're like, "Is this okay?" Like, "This is new." And like luckily it's nothing, right? But I'm like they, they notice it. You notice it when something's wrong. So imagine you have a surgery, and now something changes, right? So it is, it is really difficult to sort of replicate exactly a normal penis when you're lengthening it through surgery. So I don't recommend surgery for lengthening penis. There is a safer way, and that has been shown to help, and that's using a traction device. So a traction device, we have one here. This is one brand. You can get many of these online, and you can put your penis in this device.

    3. SBSteven Bartlett1:32:45

       It really... I like sq- I feel like, um, I get like shivers when I watch you do this to this penis.

    4. RMDr. Rena Malik1:32:50

       [laughs] So y- you would wrap it. It would be more comfortable than just putting this like directly on your penis.

    5. SBSteven Bartlett1:32:55

       For you guys that can't see it, she's clamping the end of the penis into this-

    6. RMDr. Rena Malik1:32:58

       Yeah, into this device, and then you sort of lengthen it, uh, extend it with this 30 minutes twice a day for this particular device. They've actually done some research on this one. 30 minutes twice a day, and you... There's like a whole protocol on their website, and it does show improvements in length, about two centimeters, but it is a commitment to increasing length and to doing this process.

    7. SBSteven Bartlett1:33:20

       So just on those numbers-

    8. RMDr. Rena Malik1:33:21

       Mm-hmm

    9. SBSteven Bartlett1:33:21

       ... two, two centimeter increase over what period of time? And does that-

    10. RMDr. Rena Malik1:33:24

        Over about three to six months, depending. Yeah.

    11. SBSteven Bartlett1:33:26

        And is it permanent?

    12. RMDr. Rena Malik1:33:27

        So that's what we don't know. I mean, most of the studies stop at, you know, once they get the result, and we don't know that if you stop, will it just revert back to normal? I don't know. And so the other thing about this particular traction device that's nice is if you have a curvature in the penis, like you developed something called Peyronie's disease, this device can actuallyCurve a little bit away from, if you, like let's say you have a indentation on the top of the penis, it can actually bend away from that, and it can help straighten out the penis. So that's actually a, a, a really nice utilization for it because, um, for some people that can be really traumatic and devastating to have a change in the way your penis appears because it starts curving all of a sudden, and this is safe and effective, and you can have bruising, it can be slightly uncomfortable. But it's, you're not gonna really hurt yourself, uh, too much by doing something like this.

    13. SBSteven Bartlett1:34:16

        I thought a curved penis would hit the G-spot better.

    14. RMDr. Rena Malik1:34:19

        Yeah. Sometimes a, a slight curve can be beneficial for some people. But again, I think like when you notice like there's a, a dramatic change, here, do that more. Calm. [laughs] You don't, you would-

    15. SBSteven Bartlett1:34:30

        I'm gonna rip the end off.

    16. RMDr. Rena Malik1:34:31

        It's okay. Um [laughs]

    17. SBSteven Bartlett1:34:34

        I'm just trying to figure out how this works. So I get the penis, I put it-

    18. RMDr. Rena Malik1:34:38

        Through

    19. SBSteven Bartlett1:34:39

        ... in there.

    20. RMDr. Rena Malik1:34:39

        Yeah.

    21. SBSteven Bartlett1:34:40

        Clamp it down.

    22. RMDr. Rena Malik1:34:41

        And you wanna put it at your normal, and then you'll just slightly-

    23. SBSteven Bartlett1:34:43

        Just, uh

    24. RMDr. Rena Malik1:34:43

        ... advance the, the length. You're not gonna pull crazy. You're just gonna do a little bit of traction so it's not uncomfort- It's slight, like just a slight tension. It shouldn't be like, like that. It should be a l- much less [laughs] tension. But it is, I mean, they can vary in price from $100 to $500, so it's a one-time cost. It is not, like I said, not dangerous. What is dangerous is when people try to do something that became popular on TikTok called jelqing, and jelqing is where you use your, your hands, and you make like an okay sign with your fingers, and you're like stretching the penis with your hands. And this can be dangerous because you can create micro tears in the penis, and we in the urology community have seen plenty of patients who have now developed erectile dysfunction after doing jelqing because they've now created damage to their penis. And so I, I really caution people because this, there is so much despair around sexual function, around penile health, that people are willing to try things, and they might really hurt themselves. No joke, I had a patient the other day ask me if he should drink hydrogen peroxide because he saw some ad that said, "Hydrogen peroxide will fix your erect- erections." And I said, "Please don't. Um, this is," you know, a- but he really was like seriously, earnestly asking me this question, and I, you know, I didn't wanna shame him by any means, and I was like, "No, you know, this is actually not safe, and it's not gonna help you. And there's no pill, there's no drink, there's no anything that's gonna give you a longer penis."

36. 1:36:15 – 1:38:22

    What Are The Toughest Cases Doctors See?

    1. SBSteven Bartlett1:36:15

       What are the cases that you see that break your heart?

    2. RMDr. Rena Malik1:36:18

       You know, I, I've seen, so there, I've seen patients who've had surgery to lengthen their penis, and they are above average when they, at baseline, and they have these surgeries to lengthen their penis, and then they have a bad outcome, and now their penis is disfigured forever. And that's what really, um, you, you never forget that because that person, knowing the risks and benefits perhaps made a choice, and that choice didn't go the way they wanted, and now they have to live with that for the rest of their life, and that's really sad.

    3. SBSteven Bartlett1:36:46

       Gosh. Imagine that. Christ. Oof.

    4. RMDr. Rena Malik1:36:50

       Yeah.

    5. SBSteven Bartlett1:36:52

       What, and it just, it doesn't work anymore?

    6. RMDr. Rena Malik1:36:54

       Well, like-

    7. SBSteven Bartlett1:36:55

       And you're infertile

    8. RMDr. Rena Malik1:36:55

       ... like the one patient I'm thinking of, um, he, uh, had a, like it, it basically developed a scar all at the top of the penis, so it was like disfigured essentially. Um, and so it was, it was really sad.

    9. SBSteven Bartlett1:37:10

       Before I hit puberty, I definitely had penis anxiety because I was the youngest in my year at school, and I, I was the s- I was short.

    10. RMDr. Rena Malik1:37:18

        Mm-hmm.

    11. SBSteven Bartlett1:37:18

        Very, very short. Very small. I remember what it felt like to like hide my d- hide my dick-

    12. RMDr. Rena Malik1:37:23

        Mm-hmm

    13. SBSteven Bartlett1:37:24

        ... when I was around like guys in the changing room and stuff like that. Um, you know, l- after puberty th- I, things, I changed. But-

    14. RMDr. Rena Malik1:37:32

        And what I want people to understand, I think more than anything, is that you don't need a long penis to pleasure a partner. We just talked about how the clitoris is the, is the most reliable route to orgasm, right? And so you don't need a penis to stimulate the clitoris. You can use your mouth, your fingers. You can use a toy. There's so many ways to help your partner achieve pleasure. And, and yes, of course, there are a small subset of women who really appreciate a large phallus, but the large majority of women, if you look at survey data, are very happy with the size of their partner, are very content with average or slightly above average or slightly below average, as long as they are feeling intimate and they're feeling pleasure. And so I think the, there's a misnomer that, that people think, "If I have a longer penis, I'm going to be able to pleasure my partner

37. 1:38:22 – 1:39:33

    How Much Does Vaginal Size Vary?

    1. RMDr. Rena Malik1:38:22

       more."

    2. SBSteven Bartlett1:38:22

       As it relates to women, is there different size vaginas?

    3. RMDr. Rena Malik1:38:26

       Yeah. So the a- so like, just like there's averages, there's averages in females. And so average vagi- vaginal length is about three and a half inches. So when women get aroused, it expands and l- widens and lengthens to about double. So the average woman can easily accommodate the average penis, maybe slightly larger than average. And so I think generally speaking, knowing that like you will be able to fit [laughs] in the average woman, and you will be able to please her with the size of your phallus, and like I said, penetration is, is not as important. In fact, only about 85% of women orgasm through penetration alone. They need clitoral stimulation to achieve climax. And so again, penetration feels good. I, I tell guys it's like somebody rubbing your testicles or your perineum. That feels good, but it's not gonna make you orgasm. And so penetrating, yeah, if you're getting a lot of, uh, clitoral stimulation because maybe she has a thinner, you know, her clitoral shaft is closer to the vaginal canal, maybe, you know, the size of the penis matters more. But for a lot of women, it's not gonna be sufficient, and they're gonna need some directed clitoral stimulation.

38. 1:39:33 – 1:41:09

    Why Does Sex Feel Different With Each Person?

    1. SBSteven Bartlett1:39:33

       Why do different vaginas feel different to, and I guess the, the inverse is also the case, where like different penises will feel remarkably different even if they're the same size roughly. And pe- you can have sex with somebody and go, "It feels really good

    2. RMDr. Rena Malik1:39:48

       I mean, I think again, it's how you-- [laughs] it's like it's the motion in the ocean, right? Like how you use your-- So let's, let's talk about the vaginas first. So when a vagina is, um, has more pelvic floor strength, they may be able to like tense around the penis better. Like they may be able to-

    3. SBSteven Bartlett1:40:04

       Oh, really?

    4. RMDr. Rena Malik1:40:04

       ... sort of grab the penis with their pelvic floor a little stronger versus someone who doesn't. And that's where I think some people get worried when I say, "Oh, you need to relax your pelvic floor." They're like, "Oh, I don't want to be looser." Right? And that's not gonna happen if you have a normally functioning pelvic floor. If you're-

    5. SBSteven Bartlett1:40:19

       So the penis is going in here, right?

    6. RMDr. Rena Malik1:40:21

       Correct.

    7. SBSteven Bartlett1:40:21

       So if I-- if you're a woman and you do pelvic floor exercises-

    8. RMDr. Rena Malik1:40:25

       You're strengthening

    9. SBSteven Bartlett1:40:26

       ... they feel tighter.

    10. RMDr. Rena Malik1:40:27

        Well, you're, you're able to contract and squeeze those muscles during sex better, right?

    11. SBSteven Bartlett1:40:32

        Around the penis.

    12. RMDr. Rena Malik1:40:33

        Yes. But we don't want you to be tighter. We want you to be able to squeeze the muscles and relax the muscles. Use them like a normal muscle, like your bicep, you squeeze and relax, squeeze and relax. We don't want it to be constantly squeezed.

    13. SBSteven Bartlett1:40:44

        But to the man, it will feel tighter.

    14. RMDr. Rena Malik1:40:45

        You will perceive it as tighter, but it will not be that she's actually tighter. It just means that maybe her pelvic floor muscles are doing a better job. So that's for the female. For the male, it's, it's generally like how the penis moves and how the positioning is and where it's, uh... It may be girth that's different. It may be the way that you're moving in the vaginal canal, and that may be why it feels different.

39. 1:41:09 – 1:41:52

    Can You Predict Penis Size?

    1. SBSteven Bartlett1:41:09

       They often say that if you've got big feet or big hands, you know, like, people think you have a big penis.

    2. RMDr. Rena Malik1:41:15

       Not necessarily true. So there's, um, there's actually no evidence that big hands, big feet correlate to penile size. There's one study in Japan where they looked at nose length, and so the longer your nose is from the, the bridge down to the tip, that is potent- at least the Japanese population that they studied, was correlated with the length of the penis.

    3. SBSteven Bartlett1:41:37

       [laughs] People also think tall people have big penises.

    4. RMDr. Rena Malik1:41:42

       Not necessarily.

    5. SBSteven Bartlett1:41:43

       Hmm. But nose length, there's some correlation in a study in Japan.

    6. RMDr. Rena Malik1:41:48

       Yes. [laughs]

    7. SBSteven Bartlett1:41:49

       Okay. [laughs] I was just checking if my nose was...

40. 1:41:52 – 1:44:45

    Do GLP 1 Drugs Affect Libido?

    1. RMDr. Rena Malik1:41:52

       [laughs]

    2. SBSteven Bartlett1:41:52

       Okay. Um, the last thing I wanted to talk to you about is, uh, Ozempic-

    3. RMDr. Rena Malik1:41:56

       Mm-hmm

    4. SBSteven Bartlett1:41:56

       ... and how this relates to everything we've talked about today, desire, attraction, sex. Is there any early data emerging that shows any correlations?

    5. RMDr. Rena Malik1:42:03

       Yeah. So Ozempic, there's sort of benefits and there's potential downsides. So the benefits are that when you're on Ozempic, we see improvements in metabolic diseases. They have improvements in diabetes, improvements in heart disease, improvements in overall health. Right? And so that is going to mean that your blood vessels are healthier. You're more able to get blood flow to your genitals. You're gonna have stronger sexual function and arousal, right? So that's great. The other thing is that you are losing weight, so you feel better. You feel more like your body image is, is feeling good about yourself. Also, for men, remember I talked about this fat pad right above your penis.

    6. SBSteven Bartlett1:42:42

       Mm-hmm.

    7. RMDr. Rena Malik1:42:42

       That's getting smaller, and so now you can see more of your penis. So you may have heard of Ozempic penis, where people are saying, "Well, my penis is getting longer." It's not actually that your penis is getting longer. It's that this fat is going down, so now you're seeing more of your penis.

    8. SBSteven Bartlett1:42:54

       Which makes it look longer.

    9. RMDr. Rena Malik1:42:56

       Yes, exactly. It makes it-

    10. SBSteven Bartlett1:42:57

        Perception is reality.

    11. RMDr. Rena Malik1:42:57

        Yes, exactly. [laughs]

    12. SBSteven Bartlett1:42:59

        Exactly.

    13. RMDr. Rena Malik1:42:59

        Well, it is reality to the person looking, right? Um, so those are all great things, and I think that's wonderful. Now, the other part of it is Ozempic works on the brain, and it works on the reward pathway. So you now see food, and you don't feel like it's that much of a reward, so you don't chase after it. You have less desire for food. There's emerging data that we're seeing people on these medications, these GLP-1s, have less desire for, let's say, gambling, let's say shopping, let's say, you know, alcohol, smoking, whatever it is, right? And so there's a theoretical, because it works on the same pathways, that it could also decrease desire for sex. And I think the thing that, you know, there's so many people on these medications, there's so many metabolic benefits that I worry that people may not even realize that their sexual desire is changing, right? They might just be like, "Oh, you know, I'm, I'm eating less. I look great. Everything's wonderful." But like slowly in the background, they're like, "Oh, maybe my desire is less," and maybe it's creating discord in their relationship. Hard to say because we don't have data yet. So yeah, I think it's just something that you should be aware of, that if you start feeling like you have less desire for sex or maybe you're like, "Man, I just really don't feel into anything," talk to your doctor because maybe your dose is just too high and maybe it just needs to come down a little bit. And again, we don't know yet, but I do worry about this because I feel like we're, we're gonna start seeing it.

    14. SBSteven Bartlett1:44:19

        Is it possible to do studies on this type of thing?

    15. RMDr. Rena Malik1:44:22

        Absolutely. So you can take people starting Ozempic, and you can say, "Hey, here is..." Or, or any GLP-1. You know, there's questionnaires. So like-

    16. SBSteven Bartlett1:44:30

        Different questionnaire

    17. RMDr. Rena Malik1:44:30

        ... for women, there's the Female Sexual Function Index. For men, there's ADAM, which is a questionnaire about testosterone. But you could-- there's sexual desire questionnaires that you can use. Um, and you can take it at the beginning, and then you can take it as they increase their dose and see if there's a change, right, in terms of their sexual

41. 1:44:45 – 1:51:19

    How Do You Talk About Sex With Your Partner?

    1. RMDr. Rena Malik1:44:45

       desire.

    2. SBSteven Bartlett1:44:45

       You said at the start about knowing how to talk to your partner.

    3. RMDr. Rena Malik1:44:49

       Mm-hmm.

    4. SBSteven Bartlett1:44:49

       I think like intimacy desire, maybe the conversations like with your partner, how to have that conversation when there's a problem.

    5. RMDr. Rena Malik1:44:54

       Yeah. I, I wish I could say there was like a script that you can follow and it's gonna work, but everyone's so different. But I think the important thing is like not giving up because what happens is because we don't ever talk about sex, when you bring it up, it's immediately like, "Oh my God, is something wrong? Did I do something wrong? Um, do you not like me? Am I not attractive?" Right? You're automatically going down the rabbit hole of worry and concern, and instead of dealing with it, you're just gonna shut it down. "No, I don't want to talk about it." Right?

    6. SBSteven Bartlett1:45:18

       Mm-hmm.

    7. RMDr. Rena Malik1:45:19

       Um, especially if like maybe you haven't connected intimately in a while and like you just don't want to deal with that, or you're, you have other stressors in life. Maybe you're not feeling like very good about yourself, and so you're like, "Well, I don't really feel sexy, so I don't want to have sex." And so I think really understanding that whatever reaction you get from your partner when you do talk to them, it's not about you. It's just usually about how they're feeling, and so don't stress about that. And two, like it's anything that is worth having requires work. So having a good sex life, having intimacy over the long haul with someone, if you are committed to that relationship, it is worth working for. It is worth dealing with a little bit of discord to get there. And soI tell people when you wanna talk about sex, first of all, don't do it in the bedroom, don't do it right before or after sex. Do it at a time where you are both calm, relaxed, maybe you're out for a walk, maybe you're in the car, so you're not like looking directly at each other. You know, you're kind of-

    8. SBSteven Bartlett1:46:13

       Uh-huh

    9. RMDr. Rena Malik1:46:13

       ... parallel. And always start with a positive thing, like, "I, you know, I really enjoy this about our relationship, and I would love if we could talk about this." And, and maybe they're gonna be like, "Uh, I'm not ready for that." And just say, "Maybe we can come up with a time where we can talk about this that works for you." Right? Let them feel like they're coming to the conversation with, like, s- they're not being ambushed or, like, talking about something. And then be curious. I think the big thing is, like, being curious. Like, "What's going on with you? Like, I wanna, I wanna, I wanna be there for you. I love you. You know, I, I miss what we used to have, or I miss this about us." And I think that there's always these misconceptions, and I hear it all the time, right? It'll be like, "This partner only wants sex, and this partner never wants sex." And th- you know, and th- that's it. Like, that's the end of the conversation. But the reality is that there- it's, it's somewhere in between. So typically, women tend to view sex as, like, added stress sometimes when they're already stressed. Like, they're like, "Oh, it's just one more thing to do." Whereas men look at it as a stress relief. So one, you're coming at it from two different angles. The other thing is men aren't really taught how to be intimate, and so for a lot of men, sex is their version of intimacy. Like, that's how they connect. That's how they feel connected with a partner. And so oftentimes when they're doing these initiations or attempts at sex, it feels like they're being greedy, or it feels like they're, they just want sex. And I think we have to reframe how we look at that. Like, sex is not just sex. It is intimacy. It is being together, connecting with another human being. So how do we do that, right? And, like, how do we make that sex worth having? We get into this frame where we have sex as, like, in a hurried, quick, like, just gotta get this done way. I just need to get an orgasm. I just need to get a release. But sex is supposed to be something we look forward to. It's supposed to be something that we're excited about. And so we have to build that in. We have to sort of, like, build the environment where sex can f- can happen. So it may mean like, "Hey, we are affectionate during the day. Maybe we send a lovey text message. Maybe, um, you know, I give you a hug. I caress your back. I, um, tell you you look beautiful. I- I'm, I'm showing you gratitude for how much I care about you in other ways." I think just really taking the time to understand why your partner feels the way they do.

    10. SBSteven Bartlett1:48:26

        I'm curious about, on that communication point, about how different genders in heterosexual couples have different sort of taboos and things that are just a bit sensitive. Um, and I was looking at the, the variance between men and women, and the f- the top one for men was around performance anxiety, so, like, admitting to things like erectile dysfunction.

    11. RMDr. Rena Malik1:48:45

        Mm-hmm.

    12. SBSteven Bartlett1:48:45

        Because it feels like it's so intrinsically connected to masculinity.

    13. RMDr. Rena Malik1:48:48

        Mm-hmm.

    14. SBSteven Bartlett1:48:49

        And you feel like a failure as a man if you can't get a erection and pleasure your partner.

    15. RMDr. Rena Malik1:48:53

        Right.

    16. SBSteven Bartlett1:48:53

        And then for women, it was talking about, um, prioritizing pleasure and asking for f- more foreplay or, um, you know, specific, specific simulation, or stimulation around the clitoris or something like that, um, because they don't wanna be labeled as high maintenance or too much hard work, et cetera.

    17. RMDr. Rena Malik1:49:09

        Mm-hmm.

    18. SBSteven Bartlett1:49:10

        And it's interesting that on that walk with your partner, there are different things that will trigger each of you.

    19. RMDr. Rena Malik1:49:15

        Mm-hmm.

    20. SBSteven Bartlett1:49:16

        Um, other ones for women were pain and discomfort, bringing that up, and body image, and the mental load, explaining why you aren't in the mood. And f- other ones for men are expressing non-sexual needs because it might be seen as unmanuly- unmanly, boundaries and rejection, communicating when they don't want sex, and lastly, the script, which is discussing fantasies that deviate from the norm.

    21. RMDr. Rena Malik1:49:35

        So I wanna talk about fantasy, but before that I would just say that, you know, it, because of social media, we're in a place... And I get text messages from my husband 24 hours a day with like, not 24 hours a day, but, like, all waking hours with reels and videos. "Oh, I think you'd like this. I think you'd like this. You should check this out." And it's, like, his way of, like, connecting and being like, "Hey, let's talk about this later. Like, this is fun." And so I, I tell my patients, like, send your partner a, a, a video that you saw on social media that might help them understand, like, why this is important to you. Maybe send them a video. Send th- send them this podcast, right? Say like, "Hey, I watched this. It was great."

    22. SBSteven Bartlett1:50:08

        I love that idea.

    23. RMDr. Rena Malik1:50:09

        You know, um, and I, I learned so much. And honestly, so many patients bring their partners to me, whether it's women bringing male partners or men bringing female partners, they come to me and they say, "Look," like, "I want you to meet this doctor, and I want you to talk to them." And, like, it's beautiful to see that. Like, I love it because it's, it's so deeply caring that they, like, brought their partner and they want them to feel good, and they just want to figure out what's going on. And, like, I think it's so lovely to, to, to find someone who's so invested in making sure that sex is good for you, right?

    24. SBSteven Bartlett1:50:38

        Men, us men, though, we're just not good at talking about this stuff.

    25. RMDr. Rena Malik1:50:41

        Right, but, you know, I think you can't use that as a crutch.

    26. SBSteven Bartlett1:50:44

        Yeah.

    27. RMDr. Rena Malik1:50:45

        Do you know what I mean? Like-

    28. SBSteven Bartlett1:50:45

        Yeah, I do. Yeah.

    29. RMDr. Rena Malik1:50:46

        Like-

    30. SBSteven Bartlett1:50:46

        We're just not good at it, though. We just-
42. 1:51:19 – 1:56:44

    What Do Sexual Fantasies Mean?

    1. RMDr. Rena Malik1:51:19

       investing in.

    2. SBSteven Bartlett1:51:20

       Do people bring you their fantasies?

    3. RMDr. Rena Malik1:51:22

       Yeah. I've had, uh, I've had, well, more, not, not as many fantasies as, like, real sort of diverse interests in sex.

    4. SBSteven Bartlett1:51:30

       What do you mean by that?

    5. RMDr. Rena Malik1:51:30

       So I had a patient who came to me and said, uh, you know, after some time, this was not, like, their first visit. Like, we built a rapport and he told me, you know, the, "I, I really struggle with arousal, and the only time I get aroused is I have a, a medical kink, and so I go to this person who will put a Foley catheter in me, and that's what turns me on." And I was like, "That's really interesting." And I was like, "Okay, like, that's, that's great." But, like, it took a long time for us to get there for him to feel comfortable, but it also then was like, well, if that's what turns you on, you know, then you gotta sort of explore other ways to incorporate that with a partner. Maybe not a Fo-

    6. SBSteven Bartlett1:52:05

       What is that?

    7. RMDr. Rena Malik1:52:05

       Um, so, like, a, a catheter is, is, um, is a tube that you put in the bladder for, to drain urine

    8. SBSteven Bartlett1:52:13

       What hole does that go in?

    9. RMDr. Rena Malik1:52:14

       The urethra.

    10. SBSteven Bartlett1:52:15

        It goes in the penis?

    11. RMDr. Rena Malik1:52:16

        Correct. And so there's actually a lot of people who enjoy urethral play. So they will take sounds, they're called sounds, like little, um, uh, rods with a frail-- flared base, and they will insert them in the urethra.

    12. SBSteven Bartlett1:52:28

        Oh my God, I'm getting anxious of this.

    13. RMDr. Rena Malik1:52:29

        And, but people do find that pleasurable. And so because there is some, you know, there, there's some nerve endings there that can be pleasurable. And so again, it is totally fine to have interests that are, you know, outside what we call conventional. Um, but of course, I think you need to, uh, if that's something that you're really into, you have to sort of bring your partner into the, into the fold if that's what really gets you turned on. Now, in terms of fantasies, almost everyone fantasizes, right? Ev- almost everyone does. And the interesting thing when you look at fantasies is there's a lot of fantasies that you would think are not common, but are. So for example, um, being sexually submissive is very common. So women fantasize about it, like around sixty percent. Men are like twenty percent having this desire of sexual-- this fantasy of sexual submission. It may not mean that they want to be submissive in real life, but that's the fantasy they're having. Um, men often have a voyeurism fantasy, so like watching sex. Um, they also have, uh, sex with multiple partners. Um, women tend to have a lot of like sexual, um, dominance, but also romance in their fantasies. So like in exotic places or, um, the, or with-- and a lot of times, like ninety percent of the time people fantasize about strangers or it could be someone they know, but outside of their relationship. And so that's completely normal and nothing to be worried about. It doesn't mean that like, you want that person, it's just a fantasy. It's a safe place in your head to think about fantasy. And I think one, realizing that if someone fantasizes about something, it means nothing about how they feel about you. It's just where their brain goes to explore. I tell my patients sometimes, "Write down your fantasies for yourself. Just like, write them down. Don't share that with anybody, and have your partner do the same. And then if you guys decide you feel comfortable at some point to each share one fantasy, and you can start ta- and maybe one that you would wanna try." And like, it, it allows you to sort of explore and think about different things. It could be a negative outcome. Like you could just be like, "Oh no, this one didn't do it for me," but it could also be very positive. And so just like, again, I think the big thing is understanding like it doesn't need to be that serious. Like we can experiment, we can play, we can have fun, and if you bring that back into your life, you are gonna be happier, less lonely, live longer. Like everyone should just be having more sex.

    14. SBSteven Bartlett1:54:40

        [chuckles] Yeah.

    15. RMDr. Rena Malik1:54:41

        [chuckles]

    16. SBSteven Bartlett1:54:42

        It's, um, yeah, it's interesting that we're getting more and more sexless because I think the world is stealing our attention, and that's causing a big loss in connection. But then everyone's lives are more stressful than ever before. If a bomb goes off ten thousand miles that way, I, I see it when I open my phone.

    17. RMDr. Rena Malik1:54:59

        Mm-hmm.

    18. SBSteven Bartlett1:54:59

        Um, so it's an interesting time to sort of almost re- trying to re- reclaim sex and to work on one's sexual health, the overall, the full picture of one's sexual health. Um, you're working on a book, which is I guess endeavoring to do much of that, which is coming out in September-

    19. RMDr. Rena Malik1:55:16

        Mm-hmm

    20. SBSteven Bartlett1:55:16

        ... called The Hard Truth: Everything Men Need to Know About Good Health, Great Sex and Long Life. So if you're watching this after the 1st of September, 2026, or around that time, then the book is probably available for pre-order or already out. It's not available for pre-order yet, is it?

    21. RMDr. Rena Malik1:55:30

        Uh, will be soon, but not yet.

    22. SBSteven Bartlett1:55:32

        Okay. When the book is out, I'm gonna link it below in the comment section, um, when it's available for pre-order. The Hard Truth: Everything Men Need to Know About Good Health, Great Sex and Long Life. So if the subjects we talked about today have piqued your interest, the book, I imagine, is gonna go into greater detail on all of these subjects.

    23. RMDr. Rena Malik1:55:48

        Absolutely. I think it's a book that really I, I wish was a part of sexual education. I think all men need to know this. You know, as women, we end up taking care of our male partners. I make all the doctor's appointments. I, you know, I organize all of that. I make sure that my kids get all their vaccines, all that sort of stuff. And s- and, uh, you know, it becomes on us to take care of our fathers too. And so as women, we, uh, hold that role and I think it is so valuable to understand what men go through and also to be able to support them along the way. And I think it's a great gift for, you know, men in your life or for s- you know, older sons even to like, help people understand their bodies. And honestly, it's a huge motivator. I tell people like, if for nothing else, people care about sex, and I have seen patients turn around their lives because they wanna b- have better sex. They'll literally improve their blood sugars, they'll improve their c- blood pressure because they just wanna protect their sexual health.

43. 1:56:44 – 1:59:56

    What Should You Do If You Have Lost Hope?

    1. SBSteven Bartlett1:56:44

       Rena, thank you. We have a, um, closing tradition on this podcast where the last guest leaves a question for the next guest not knowing who they're leaving it for.

    2. RMDr. Rena Malik1:56:50

       Mm-hmm.

    3. SBSteven Bartlett1:56:50

       This is the first time in Diary Of A CEO history where the guest has actually stamped it with a stamp-

    4. RMDr. Rena Malik1:56:56

       Mm.

    5. SBSteven Bartlett1:56:56

       ... that says, "Certified one hundred percent human."

    6. RMDr. Rena Malik1:57:00

       Okay.

    7. SBSteven Bartlett1:57:00

       So you can see there's a little stamp.

    8. RMDr. Rena Malik1:57:02

       So we're-- it's not AI.

    9. SBSteven Bartlett1:57:03

       So it's not AI.

    10. RMDr. Rena Malik1:57:04

        Okay.

    11. SBSteven Bartlett1:57:04

        And it actually says that in the middle, it says, "Gen AI free." Sign of things to come. But their question, I guess, is somewhat linked to that. They, the question they've asked for you is, "So much of the world feels hopeless about this moment. What would you tell someone to help them reclaim their agency?"

    12. RMDr. Rena Malik1:57:25

        [sighs] I think that we as humans are meant to be with other humans. We are meant to connect, and I think making that a priority will allow people to feel, um, to feel a part of something again. You know, I think, um, I think there is like an emergence of people starting to look back at religious constructs and, and go to community and be a part of things and enjoy live events again, like we weren't doing before. And I think if we prioritize that, there is still hope that we can come together as a society. And I think, you know, the pendulum always swings, right? In every way. Like it's gonna go far right or far left and people are gonna hate each other, and then they're gonna love each other, and then they're gonna come back. And I think if you just look at history time and time again, it repeats itself and we will find unity and we will find togetherness. We are obviously feeling pain from a variety of different sources, and we may feel pain, right?

    13. SBSteven Bartlett1:58:32

        Yeah.

    14. RMDr. Rena Malik1:58:32

        Like in terms of other things to come. But ultimately, I, I'm an optimist and I think that we'll come together and, and we will find, um, happiness and joy in human connection.

    15. SBSteven Bartlett1:58:44

        And I hope you're right, and I think we're seeing the early signs of that now. For anyone that's listening that wants to learn more from Rena, um, I highly recommend they go to your YouTube channel. I will collab if we can. Um, and if we do collab on YouTube, you'll see a little smiling Rena, um, next to The Diary Of A CEO logo, where you can click through to her YouTube channel. She's got almost three million subscribers, and she goes through all of the questions which no one has ever answered for us. And I was looking at some of the questions that you answer for people, everything from why you dribble after you pee-

    16. RMDr. Rena Malik1:59:15

        Mm-hmm

    17. SBSteven Bartlett1:59:15

        ... and how to stop it. Porn director reveals what, what scenes are faked in almost every scene of movies, but then also a lot of the stuff we've talked about today around, um, penile health, erectile dysfunction, um, sex positions, and so much more. So it's a wonderful repository of information that is constantly being updated. That is a great place to subscribe, so I highly recommend you do. Dr. Rena, thank you so much for your time.

    18. RMDr. Rena Malik1:59:39

        You're so welcome.

    19. SBSteven Bartlett1:59:40

        YouTube have this new crazy algorithm where they know exactly what video you would like to watch next based on AI and all of your viewing behavior, and the algorithm says that this video is the perfect video for you. It's different for everybody looking right now. Check this video out, and I bet you, you might love it

Episode duration: 1:59:57