The Diary of a CEOThe Better-Sex Doctor: The Link Between Masturbating & Prostate Cancer! Dr Rena Malik
CHAPTERS
- 0:00 – 10:40
Intro, Viral Statistic & Introducing Dr. Rena Malik
The clip opens with the striking claim that men who ejaculate 21+ times a month have lower prostate cancer risk, followed by a rapid teaser of key myths the episode will address. Host Stephen Bartlett thanks viewers for The Diary of a CEO’s growth and promises to raise production and guest quality in 2024, before formally introducing Dr. Rena Malik, a board‑certified urologist and sexual‑health educator.
- •Teaser about ejaculation frequency and prostate cancer as a hook.
- •Brief montage of topics: sex frequency, penis size with age, masturbation, pelvic floor.
- •Stephen celebrates 5 million YouTube subscribers and outlines plans to ‘raise the bar’.
- •Introduction of Dr. Rena Malik’s credentials and social‑media educational work.
- 10:40 – 25:10
Why Sexual Health Matters And How Little We Understand
Malik explains her mission: to make sexual‑health education freely accessible and understandable, arguing that sexual health is core health. She defines sexual health, highlights common physiological phenomena (like nocturnal erections and wet dreams), and shows how media and porn scripts create unrealistic expectations and shame.
- •Sexual health defined as the ability to have sex, orgasm, pleasure, and its benefits.
- •Most people misunderstand normal sexual function, especially nocturnal erections/emissions.
- •Media portrays instant erections, instant orgasms, and hyper‑performative sex.
- •Patients compare themselves to porn/TV and conclude they are ‘broken’.
- •Malik’s background as a urologist and how online engagement revealed massive unmet need.
- 25:10 – 37:20
Pelvic Floor 101: Structure, Symptoms, And Hidden Connections
Malik gives a detailed tour of the pelvic floor, emphasizing it exists in men too and acts as a muscular bowl supporting pelvic organs. She connects pelvic‑floor weakness and hyper‑tension to leaking, pain, constipation, urinary urgency, erectile dysfunction, and how back/hip injuries and prolonged sitting can cause discoordination.
- •Pelvic floor supports bladder, rectum, vagina, uterus, urethra; key for stability, continence, orgasm.
- •Common issues: weakness (leaks, prolapse) and tightness/discoordination (pain, urinary urgency, constipation).
- •Men are often surprised they even *have* a pelvic floor.
- •Back or hip injuries and chronic sitting can disrupt pelvic‑floor function.
- •COVID era saw more pelvic‑floor complaints: urgency, ED, pain, misdiagnosed as UTIs.
- 37:20 – 47:40
Why Doctors Ignore Sex And Why That’s Dangerous
The discussion shifts to systemic neglect of sexual health in medicine. Malik explains how unaddressed sexual problems fuel shame, relationship strain, and mental‑health issues, and shares data connecting erectile dysfunction with future heart attacks, framing ED as a vascular warning sign.
- •Primary‑care visits rarely include questions about orgasms, pleasure, or satisfaction.
- •Unaddressed sexual issues spill into mood, work, relationships, and self‑worth.
- •Erectile dysfunction often precedes coronary events: penile arteries are smaller than coronary arteries, so vascular disease shows up in erections first.
- •Roughly half of men who’ve had heart attacks had prior ED.
- •Likely analogous mechanisms in women for arousal problems, though understudied.
- 47:40 – 1:00:00
Sex Frequency, Pain, And The Reality Gap With Porn
Malik dismantles myths about how much sex ‘everyone else’ is having and addresses pain during sex. She stresses quality over quantity, outlines the physiological arousal process in women (lubrication, vaginal lengthening), and champions lubrication and foreplay as simple, often‑ignored fixes, while noting when deeper evaluation is needed.
- •In partnered relationships, average sex frequency is about once per week.
- •There is no ‘right’ number; good sex monthly can beat mediocre sex ten times a month.
- •Orgasms have physiological benefits: stress reduction, focus, sleep, possible lower BP.
- •Sex is *not* supposed to hurt; common causes include insufficient arousal and lubrication.
- •Vagina typically doubles in length and width over ~18–20 minutes of arousal.
- •Lube is ‘for everyone’, not just those with a problem.
- •Persistent pain may signal hormonal vestibule issues, pelvic‑floor dysfunction, endometriosis, etc.
- 1:00:00 – 1:13:30
Sex Education Failure, Porn As Teacher, And Communication Breakdown
The pair explore how poor sex education and reliance on porn warp expectations and make communication around sex excruciatingly hard. Malik outlines how to have constructive ‘sex talks’ with a partner, why they often go badly at first, and the value of therapy and repeated, low‑pressure conversations.
- •Many schools offer minimal or even inaccurate sex ed; some US states don’t require accuracy.
- •Teens often learn from porn or peers; porn is edited entertainment, not reality.
- •Both men and women internalize porn scripts and feel defective when real sex differs.
- •Couples rarely discuss insecurities or preferences; silence breeds a ‘sexless’ downward spiral.
- •Tips: talk outside the bedroom, avoid blame, use “I feel / I’d like” language, expect awkwardness.
- •Sex therapists can coach communication; progress requires mutual buy‑in and persistence.
- 1:13:30 – 1:26:40
Reviving Sexless Relationships, Desire Types, And Scheduling Intimacy
Malik offers guidance to people in long‑term, low‑sex relationships, distinguishing between those who are genuinely okay without sex and those who are quietly suffering. She explains spontaneous vs responsive desire, especially in long‑term couples, and normalizes planning intimacy as a way to rekindle connection without performance pressure.
- •Ask: How important is sex to *you*? Some couples are happy with low sex if intimacy is intact.
- •If lack of sex hurts you, it’s worth hard work and repeated, calm conversations.
- •Responsive desire (often in women) arises *after* physical closeness starts; spontaneous desire (more common in men) precedes it.
- •Fear of disappointing a partner can stop people from even beginning physical affection.
- •Homework: schedule ‘intimacy time’ (not compulsory sex) to cuddle, touch, be fully present.
- •Over time, calendars can help rebuild anticipation and recall sexual connection.
- •Mindfulness improves desire, arousal, lubrication, and orgasm—especially by reducing rumination during sex.
- 1:26:40 – 1:33:50
Hormones, Testosterone, Lifestyle, And Declining Sperm Counts
The conversation turns biological, with Malik detailing the role of testosterone in both male and female libido and how stress hormones, sleep, exercise, diet, and endocrine disruptors affect levels. She explains population‑level declines in testosterone and sperm quality, and what individuals can realistically control.
- •Testosterone drives desire in both sexes; women actually have more testosterone than estrogen by amount.
- •Other hormones (thyroid, prolactin) modulate testosterone; lab evaluation can be useful.
- •Chronic stress elevates cortisol and suppresses testosterone.
- •Sleep loss (≤5–6 hours) can cut testosterone 10–15%; good sleep is foundational.
- •Resistance training of large muscle groups boosts testosterone; chronic extreme endurance can lower it via cortisol.
- •Healthy fats are needed for testosterone synthesis; ultra‑low‑fat diets can harm hormones.
- •Sperm counts have fallen ~50% in 50 years; causes include metabolic disease, sedentary lifestyle, and endocrine‑disrupting chemicals (e.g., some plastics, phthalates).
- •Practical tactics: limit plastic bottles and microwaving plastic; focus on diet, exercise, and weight control.
- 1:33:50 – 1:40:00
Masturbation, Testosterone, No Nut November, And ‘Post‑Nut Clarity’
The pair directly address widespread myths about masturbation’s impact on testosterone and mental performance. Malik dissects a small 21‑day abstinence study, critiques No Nut November rhetoric, and discusses when masturbation becomes problematic versus beneficial. They also explore ‘post‑nut clarity’ and evolutionary theories around refractory periods.
- •Evidence that abstinence meaningfully raises testosterone is weak and based on a tiny study; changes were small and likely driven by anticipation effects.
- •There is no strong, high‑quality evidence that masturbation lowers testosterone.
- •No Nut November can be harmless as a personal challenge but harmful when framed as compulsory or moral superiority, generating guilt around normal physiology (like wet dreams).
- •Masturbation is fine unless it interferes with work, relationships, sleep, or becomes the only route to orgasm due to rigid patterns and porn.
- •Orgasm causes pelvic‑floor contractions every ~0.8 seconds for 5–60 seconds, which can strengthen the pelvic floor, especially in women.
- •‘Post‑nut clarity’ likely reflects rapid neurohormonal shifts (rise in prolactin, fall in dopamine) and evolutionary mechanisms to prevent exhaustion and repeated dislodging of semen.
- •Data heavily favor male sexual research over female (e.g., ~50,000 PubMed entries for ‘penis’ vs ~2,000 for ‘clitoris’).
- 1:40:00 – 1:57:20
Heat, Tech, And Habits That Impact Fertility And Semen Volume
Malik explains why testicles sit outside the body and how heat—from phones in pockets, laptops on laps, saunas, or hot tubs—can temporarily reduce sperm production. She also unpacks what determines semen volume and how pelvic‑floor strength affects ejaculatory force.
- •Testes need a narrow temperature range; fevers, saunas, hot tubs, or hot electronics can impair spermatogenesis.
- •During fertility attempts, avoid prolonged high‑heat exposure around the scrotum.
- •Cannabis, tight underwear, and chronic heat can affect sperm in some men, though not universally.
- •Semen volume mainly depends on days since last ejaculation and hydration.
- •Aging reduces ejaculatory distance (e.g., 30–60 cm in youth down to 15–30 cm after ~50).
- •Pelvic‑floor Kegels can increase ejaculatory force, but over‑tensing without proper relaxation can create pain and dysfunction.
- 1:57:20 – 2:16:00
Porn, VR, Addiction, And The Future Of Intimacy
Stephen raises concerns about advanced VR porn (e.g., Apple Vision Pro) and its potential to outcompete real‑world dating. Malik distinguishes between porn as neutral entertainment and problematic use, articulates particular harms of early exposure in children, and cautiously considers both risks and therapeutic uses of immersive tech.
- •Average first porn exposure for boys is ~13; many see it as young as 8–10.
- •Kids lack the cognitive framework to understand porn as performance, not sex education.
- •Repeated high‑dopamine porn exposure in undeveloped brains may fuel compulsive use.
- •In adults, porn can be healthy entertainment, solo or with partners, if not compulsive.
- •~4% in literature meet criteria for problematic porn use; Malik suspects underestimation.
- •VR could reduce motivation to pursue real relationships, but humans are wired for physical touch and interpersonal connection.
- •Emerging positive uses: VR to desensitize sexual trauma, e.g., helping women with fear of penetration practice in a safe, controlled environment.
- •Society must actively manage ‘easy dopamine’ (phones, games, porn, VR) especially for younger generations.
- 2:16:00 – 2:23:30
Trauma, Therapy, And Why We Need Better Education
Malik links unresolved trauma to pelvic‑floor dysfunction and long‑term sexual issues, recounting cases of older patients whose untreated trauma manifested as severe physical problems. She argues for integrating trauma literacy, accurate sex education, and digital literacy into schooling and reiterates that every sexual‑function problem has a psychological component.
- •Body ‘remembers’ trauma; pelvic‑floor over‑tension is common after sexual or emotional trauma.
- •A 70‑year‑old patient had severe pelvic‑floor problems likely built over decades.
- •Even when sexual problems start physiologically, the emotional impact compounds them.
- •Malik believes everyone with sexual dysfunction would benefit from sex‑focused therapy if access existed.
- •Schools should teach: real sex ed, trauma awareness, emotional regulation, financial literacy, and digital critical thinking.
- •Better education could prevent decades‑long trajectories of shame and dysfunction.
- 2:23:30 – 2:35:10
Pregnancy, Clitoris, Female Orgasm Pathways, And The Orgasm Gap
The conversation moves back to female anatomy and pleasure. Malik confirms it’s safe to have sex during pregnancy and then comprehensively explains the clitoris, G‑zone, cervix, and how different nerve pathways can lead to orgasm. She quantifies time‑to‑orgasm differences and presents data revealing stark disparities between male–female vs female–female first‑time encounters.
- •Sex during pregnancy is safe and doesn’t harm the fetus or trigger preterm labor in healthy pregnancies.
- •Clitoris and penis develop from the same embryonic structure; much of the clitoris is internal and wraps around the vagina.
- •About 85% of women need clitoral stimulation to climax; penetration alone is often insufficient.
- •Three main erogenous routes: clitoris (pudendal nerve), G‑zone/female prostate (hypogastric), cervix (vagus nerve).
- •Penetration‑to‑male‑orgasm averages 5.1–5.7 minutes; female orgasm averages ~14 minutes.
- •First‑time with a male: women orgasm ~45% of the time vs 95% of men; first‑time between women: ~95% orgasm rates on both sides—showing knowledge and skill gaps rather than ‘broken’ women.
- 2:35:10 – 2:41:10
What An Orgasm Really Is And How It Works
Malik describes orgasms as a build‑up and release of muscular and neurological tension rather than a simple on/off switch. She covers physiological changes (heart rate, blood pressure, pupil dilation, pelvic‑floor contractions) and why continuous, rhythmic stimulation matters for reaching climax.
- •Orgasm = peak tension and then release, accompanied by intense, exclusive focus and pleasure.
- •During arousal: dopamine rises, genital blood flow increases, female genital tissues swell and lengthen.
- •Stimulatory pathways must overcome inhibitory ones; think ‘climbing a mountain’ rather than flipping a switch.
- •Pelvic‑floor contractions during orgasm occur ~every 0.8 seconds for 5–60 seconds.
- •Irregular or interrupted stimulation (‘air leak from a balloon’) can cause arousal to drop before climax.
- 2:41:10 – 2:47:20
Scheduling Intimacy, Mindfulness, And Rethinking How Long Sex ‘Should’ Last
They revisit scheduling intimacy as a practical strategy, clarifying that what’s scheduled is connection, not guaranteed sex. Malik then breaks down perception vs reality on ‘normal’ sex duration and shows how knowing the true averages can actually relieve pressure and make sex more accessible in busy lives.
- •Schedule *intimacy time* to remove ambiguity and create space—phones away, full presence.
- •Labeling it ‘sex’ can trigger anxiety about performance, desire, or rejection.
- •Mindfulness—attention to sensations rather than outcome—correlates with better desire and function.
- •Women say ideal sex is 18–25 minutes; men about 12–16 (including foreplay).
- •Empirically, penetration‑only portion averages ~5–6 minutes, with national variations.
- •Some people feel relieved realizing sex doesn’t ‘eat’ a whole evening; this can increase willingness.
- 2:47:20 – 2:59:20
Vaginal ‘Looseness’, Childbirth, Pelvic‑Floor Training, And How To Do Kegels
Malik busts the myth that lots of sex makes vaginas ‘loose’. She differentiates between pelvic‑floor weakness (often from childbirth or connective‑tissue factors) and tightness, then gives a practical primer on Kegels, stressing correct technique and the importance of relaxation, progression, and pelvic‑floor physio.
- •Vaginas don’t get ‘loose’ from frequent sex; childbirth and pelvic‑floor weakness are the main drivers of perceived looseness, leaks, and prolapse.
- •Orgasms actually involve pelvic‑floor contractions that may help maintain strength over time.
- •Common female pelvic‑floor weakness signs: leaking with cough/sneeze/jump, sensation of bulging (prolapse).
- •Male signs of weakness: reduced ejaculatory force; signs of over‑tightness: pelvic pain, ED, urinary issues, hip/back pain.
- •Kegel basics: imagine stopping urine, lifting the penis, or holding in gas; squeeze ~5 seconds, relax ~5 seconds, don’t overdo.
- •Progress from lying to sitting to standing; don’t constantly clench all day.
- •Pelvic‑floor physiotherapists are ‘personal trainers’ for this muscle group.
- 2:59:20 – 3:09:40
Penis Size, Enhancement Claims, And What Women Actually Choose
The discussion turns to penis size anxiety and the burgeoning enlargement industry. Malik reviews evidence for traction devices, explains why pumps and many surgeries don’t deliver safe, meaningful gains, and contrasts male size ideals with women’s actual sex‑toy purchasing behavior.
- •Traction devices worn for hours daily over months can add ~2 cm on average; newer protocols suggest gains with 30 minutes twice a day, but expectations must be realistic.
- •Vacuum pumps are effective for temporary erections but not proven for permanent length increase.
- •Many surgical ‘lengthening’ procedures carry high complication rates; Malik discourages most.
- •Average erect length is ~5.1–5.3 inches; most men *think* ‘ideal’ is ~6 inches.
- •Analysis of top‑selling dildos shows women tend to pick around-average length and girth; extreme sizes can be painful.
- •Products like Onut exist to *shorten* functional penetration when a partner is too well‑endowed.
- 3:09:40 – 3:18:00
Aging, Shrinkage Myths, Nose Size, And Rising Penis Length Trends
Malik tackles whether penises shrink with age, separates true atrophy due to vascular disease from the illusion created by weight gain, and mentions intriguing (but limited) research linking penile length to nose length and showing secular increases in average penis size.
- •If blood flow is healthy and night‑time erections occur, penises don’t inherently shrink with age.
- •Vascular disease (diabetes, hypertension, atherosclerosis) can cause tissue fibrosis and mild shortening.
- •Weight gain around the pubic area buries visible shaft, making the penis *appear* smaller.
- •Japanese study: nose length—not hand or foot size—correlated with penile length in that sample.
- •Recent meta‑analysis: average erect length increased from ~4.8 to ~6 inches over ~29 years; one theory is earlier puberty and more lifetime testosterone exposure.
- •Vaginal lengths don’t appear to be changing at the same rate, raising future anatomical questions.
- 3:18:00 – 3:30:50
Labiaplasty, Genital Aesthetics, And Squirting Science
The focus returns to female genitals: rising labiaplasty rates, porn‑driven aesthetic ideals, and what’s known (and unknown) about female ejaculation and squirting. Malik clarifies different vaginal fluids, emphasizes the diversity of labia as normal, and notes that research on squirting is sparse and inconclusive.
- •Labiaplasty reduces the labia minora for comfort or aesthetics; surgeries rose ~80% between 2015 and 2019.
- •Porn highlights very small, symmetrical labia, making many women feel abnormal.
- •Labia vary like fingerprints; asymmetry and length variation are normal.
- •Female lubrication, ejaculate (from Skene’s glands), and squirting are distinct fluids.
- •Squirting is clear, odorless fluid from the urethra; some studies show dilute urine plus PSA, others suggest fluid from engorged genital tissues.
- •Women who squirt often insist it’s not urine; mechanisms remain unresolved due to limited, imperfect studies.
- 3:30:50
Closing Reflections: Sexual Health, Partnerships, And Life Success
In closing, Malik shares the core message she hopes her career conveys: sexual health is integral to overall health and deserves prioritization and education. She and Stephen reflect on how sex and relationships affect career performance, and she underscores that choosing the right partner is one of the most consequential decisions for long‑term wellbeing and success.
- •Her core message: sexual health *is* health, and education can change lives.
- •Stephen notes that improving his sex life and relationships improved his work performance and anxiety.
- •Malik tells mentees that choosing a partner is the most important life decision for success and stability.
- •Successful people typically either thrive alone or have a deeply supportive, non‑toxic partner.
- •Sexual wellbeing permeates emotional health, productivity, and life satisfaction.
