The Better-Sex Doctor: The Link Between Masturbating & Prostate Cancer! Dr Rena Malik

1. 0:00 – 2:40

   Intro

   1. RMDr Rena Malik0:00

      Men who ejaculate 21 times or more a month are less likely to develop prostate cancer.

   2. SBSteven Bartlett0:06

      Jesus Christ. Why?

   3. RMDr Rena Malik0:07

      It's because- Dr. Rena Malik.

   4. SBSteven Bartlett0:10

      Board certified urologist.

   5. RMDr Rena Malik0:11

      Expert on sexual health.

   6. SBSteven Bartlett0:13

      And a rock star in educating the public-

   7. RMDr Rena Malik0:15

      On the facts and myths of sex.

   8. SBSteven Bartlett0:17

      Rena, I want to start with this idea that other couples are having significantly more sex than we are.

   9. RMDr Rena Malik0:22

      Big myth. People are having sex about once a week.

   10. SBSteven Bartlett0:25

       Will my penis get smaller as I age?

   11. RMDr Rena Malik0:28

       It can. So in terms of how do we maintain our penile size, you need to have-

   12. SBSteven Bartlett0:33

       Is there a disparity between how long we think sex should take, and how long it actually takes?

   13. RMDr Rena Malik0:38

       Yeah, we all think it lasts longer. Women want it to be 18 to 25 minutes. Men are a little on the shorter side, like maybe 12 minutes.

   14. SBSteven Bartlett0:46

       Is there like an average time?

   15. RMDr Rena Malik0:48

       5.1 to 5.7 minutes.

   16. SBSteven Bartlett0:51

       Then is too much masturbation going to have an adverse effect for men and women?

   17. RMDr Rena Malik0:55

       Masturbation is generally safe as long as you don't- That's when it becomes a problem.

   18. SBSteven Bartlett1:01

       Rena, do we understand our bodies as it relates to our sexual health?

   19. RMDr Rena Malik1:04

       Not at all. For example, the pelvic floor, it's involved in orgasm, it's involved in sexual function, but no one really talks about it. In fact, men will be shocked, "Oh, I have a pelvic floor, too?" And there's a whole host of issues that can come from having a weak pelvic floor, including erectile dysfunction.

   20. SBSteven Bartlett1:21

       So, how can I strengthen my pelvic floor?

   21. RMDr Rena Malik1:23

       Pelvic floor exercises. They're gonna increase orgasm, they're gonna make your semen propel further, and ultimately it would be something as simple as-

   22. SBSteven Bartlett1:30

       It's absolutely crazy to me that so many of you have decided to watch our show, um, and so many of you have decided to subscribe to our show. We now have five million subscribers on YouTube, which is a number that I just can't comprehend, and it's a dream that I absolutely never could have had. We started the Diary of a CO just over three years ago now, and in my wildest expectations, we might have had 100,000 subscribers by now. So you can imagine how shocked I am that so many of you have chosen to tune into these conversations every week, um, and spend some time with us. So thank you. And I made a deal with you, I made a deal that if you subscribed to this show, that we would continue to raise the bar. And in 2024, we're gonna raise the bar like never before. I've been working for the last nine months on a surprise for all of you that have subscribed to this show, and I'm very excited to deliver that for you. The production's gonna change. We're gonna go even further with our guests, and we're gonna tell even more global stories. So as always, if you appreciate what we're doing here, the simple free favor I'll ask from you is to hit the subscribe button. Let's get on with the episode. (instrumental music plays)

2. 2:40 – 3:30

   What is it you're seeking to do?

   1. SBSteven Bartlett2:40

      Doctor Rena Malik. With all of your work, what is it that you're seeking to do?

   2. RMDr Rena Malik2:47

      So, what I'm seeking to do is w- have people understand that sexual health is health. I think we have so much misunderstanding about one, what is good sexual health? How do you... Why is good sex important? Why is it good to have good sexual health? And that creates a lot of despair and devastation, and people don't talk about it, so they ruminate, they feel bad about themselves, and it's pervasive throughout their entire life. So I think ultimately, my goal is to make education freely accessible and understandable so people can know what's going on with their bodies, what's normal, what's not, and what's available to help them.

3. 3:30 – 3:46

   How do you define sexual health?

   1. RMDr Rena Malik3:30

   2. SBSteven Bartlett3:30

      How would you define sexual health?

   3. RMDr Rena Malik3:33

      So sexual health is sort of an individual thing, but most people would say that you are able to have sex, you are able to have an orgasm, you are able to have pleasure and achieve the benefits of that.

4. 3:46 – 5:10

   Do we understand our bodies?

   1. SBSteven Bartlett3:46

      Do we understand our bodies, as it relates to our sexual health?

   2. RMDr Rena Malik3:49

      No. Not at all. I will tell you, so I talk about, for example, um, how it's normal to have erections at night, or have even nocturnal emissions, so have a wet dream. You know, that's a normal physiologic function. And so many people will message me and say, "How can I stop having," what they call, "night fall?" Or, "How can I stop waking up with an erection?" Because they think for some reason it's shameful or it's a bad thing. And when re- realistically it's just normal. And part of it is media, right? So when you see TV, you see a man getting an erection very quickly, he's init- im- immediately penetrating a woman, and she's immediately orgasming, and the whole act is like really hot and heavy. And in reality, that's not what sex is like. So if you're not seeing what normal sex is like, what normal foreplay is like, what the fact that it's normal to sometimes have difficulty getting an erection, that it's normal sometimes to not have an orgasm for a woman, or it may take more time to get a woman aroused and require more foreplay, that you are essentially looking at a script that's not real. And then you're like, "What's wrong with me? Am I broken?" You know, is there something wrong with my body that it doesn't function the way I'm seeing on TV or on media or on erotic films?

5. 5:10 – 6:37

   Where does your training come from?

   1. RMDr Rena Malik5:10

   2. SBSteven Bartlett5:10

      Where does your experience on this subject come from?

   3. RMDr Rena Malik5:13

      So I'm a urologist by training, a board certified urologist. So we are the medical and surgical doctors of the genito-urinary tract, so we're essentially the plumbers. So when you have a problem with your kidneys, the tubes that drain the kidneys, the bladder, or your genitals, we're the ones who are going to fix those if they're a surgical issue. And also we deal with the medical aspects of some of those things. And so that's what my training was in, but when I started my social media, my channel, I wanted to offer education to people. And as I started making this education, I realized how badly people wanted to know about sexual health, how much they didn't know, and how they really wanted to be empowered with this information.... and people are not being asked about sexual function. Even when you go to see your primary doctor, when was the last time they asked you about anything, they might ask you about erections, but that's probably where it ends, right? Even if they ask about that, they're definitely not asking women, "Are you having orgasms?" They're definitely not asking, um, anyone if sex is pleasurable. They're not asking them if they feel satisfied with the way things are going, right? And if they are enjoying desire, do they feel normal?

   4. SBSteven Bartlett6:19

      Yeah.

   5. RMDr Rena Malik6:19

      And so I realized there was such a disconnect here with what people wanted to know and what was available to them, and so then I started really making content about sexual health and spending more time investigating in that area, treating patients in that area, and it totally became a all-encompassing field for me.

6. 6:37 – 9:07

   What's your training with the pelvic floor?

   1. RMDr Rena Malik6:37

   2. SBSteven Bartlett6:37

      You're an expert on the pelvic floor as well.

   3. RMDr Rena Malik6:38

      Mm-hmm.

   4. SBSteven Bartlett6:39

      What was your sort of training with the pelvic floor?

   5. RMDr Rena Malik6:43

      So when you do a fellowship in what we call pelvic f- female pelvic medicine, a lot of what we do is related to the strength or weakness of the pelvic floor. And so the pelvic floor, just to start, is that bowl of muscles that sits in your pelvis. So your organs, the bladder, the rectum, for women, the vagina, the uterus, the urethra all run through the pelvic floor. It attaches to the bones on your pelvis, and it is extremely important for a variety of functions. It offers stability, so when you're standing, sitting, it offers stability. It offers the ability to defecate and urinate normally. It offers, uh, when women have pregnancy, their pelvic floor becomes very important. It's involved in orgasm, it's involved in sexual function. But no one really talks about it, and no one really knows it. In fact, men will be shocked, "Oh, I have a pelvic floor too?" Because we talk about it a lot with women, right? We talk about it in terms of, oh, I might leak a little after I've had babies, when I cough or sneeze or jump on a trampoline. But the pelvic floor is much more complex than that, and so very often, we'll see people when they have weakness of the pelvic floor, yeah, we'll see leakage of urine and, but sometimes their pelvic floor can be discoordinated or it can be too tight or h- or have elevated tone. And so what that means is that you can develop a whole host of abnormalities, and that can be that you may have constipation. You may have issues emptying your bladder. You may feel like you have to go to the blad- uh, go to the bathroom a lot, so you may urinate frequently. You may feel the urge to go often. Sometimes it can cause pain. So it can cause pain when you urinate. It might feel like you're having a UTI. It may cause pain with erection or ejaculation for men. So there's a whole host of issues that can come from having pelvic floor abnormalities. And even if you've had, say, lower back injuries or hip injuries, they can affect the coordination of the pelvic floor 'cause it's all interconnected. And so I will see patients who are like, "You know, I've had a bunch of hip issues because I played sports when I was younger, and now I'm having issues with sexual function." And so it's all interconnected, and I think we, we don't spend enough time talking about how important it is and how valuable it is to people when they're having problems.

   6. SBSteven Bartlett8:59

      I wanna go into the pelvic floor in more detail and really figure out how I can improve my pelvic floor and what I'm doing to harm or hurt it. But you said something there about

7. 9:07 – 11:15

   Why should our doctors be asking about our sexual health?

   1. SBSteven Bartlett9:07

      doctors don't ask about sexual health. They don't ask you for orgasming. They don't ask you for ejaculating, those kinds of things. Why should they be asking about that? 'Cause I think of a doctor as, I don't know, fixing other parts of my body. I don't think of them as sifting through my sexual life.

   2. RMDr Rena Malik9:22

      So if you have a normal sexual life and you're satisfied with it, it won't even, it wouldn't even bother you, right? You wouldn't think about it. But people who have difficulties, they may be walking around feeling shame. They may be walking around wondering what's wrong with them. This can be pervasive because they may have relationship issues, and they may have problems in their life with their relationship that are then causing them to be less productive at work, less happy, less satisfied with life, feeling more depressed, more anxious. And so it all comes together, and in fact, the other really important thing, at least for men we know, that when they develop issues with erections, so say you're having erectile dysfunction, and you are diagnosed today with erectile dysfunction. Seven years later, about 15% of those men will have a heart attack. And the reason for that is because if it's a blood flow issue, the arteries to the penis are about one to two millimeters. The arteries to the heart are about three to four millimeters. And when you have about a 50% occlusion of a blood vessel because of high blood pressure, high cholesterol, heart disease, that organ will start to have problems. And so you will start to see erectile dysfunction in men who have vascular problems before you started having chest pain or other signs of heart disease. So it's, and w- probably similarly in women, although the data is not as, we don't have that data for women that maybe if they all of a sudden are developing problems with arousal, that maybe there, that's an indicator. But again, that's more complex and we don't have the data for that. But certainly for men, we have a clear indication that a problem with erections could precede really serious heart consequences, and when you look at people who've had a heart attack, about 50% of men will have had erectile dysfunction prior to that.

   3. SBSteven Bartlett11:12

      50%?

   4. RMDr Rena Malik11:12

      Mm-hmm.

8. 11:15 – 12:58

   Is a weak pelvic floor in men linked to erectile dysfunction, and does sitting cause it too?

   1. SBSteven Bartlett11:15

      Is there pelvic floor dysfunction in men also linked to erectile dysfunction? Uh, 'cause I, I heard es- in some of your work that sitting every single day, in, in the way that I do here, I sit sometimes here for 10 hours a day, could be...... creating erectile dysfunction?

   2. RMDr Rena Malik11:31

      Well, so it's more that sitting every day can cause your pelvic floor to not stretch appropriately, right? Like, if you're not moving your body regularly and your body tenses up from sitting all day, then your pelvic floor is not relaxing and contracting in a normal fashion, and so some people will develop some tension in the pelvic floor, and through the pelvic floor runs a whole bunch of arteries and nerves that then go to the penis to provide blood flow. And so if your pelvic floor is clenched really tight, then it can cause problems in getting blood flow and then problems in getting erections. So, while that's not... Um, that's different than having vascular problems, this is a muscular problem, more so, um, that there- that can be an issue with- in terms of causing erectile dysfunction in some men.

   3. SBSteven Bartlett12:18

      'Cause I heard during COVID there was a rise in pelvic floor dysfunction as people were sitting all day.

   4. RMDr Rena Malik12:22

      Yeah. I mean, I definitely saw it. I don't know if it's been actually studied, but I definitely saw it in my own clinical, uh, setting and many of my colleagues did, where people would come in and they would start having... Either they'd be having more erectile dysfunction, they might be having more urinary urgency, meaning they gotta go, gotta go to the bathroom or they're going more often. Which wasn't a huge issue because they- the bathroom was right near them, but they did sometimes notice that it was a change and, and also sometimes they would... Some people even dealt with pain. Like, they would have more pain in that area, or women would think they were having urinary tract infections when they truly were just having discomfort from the pelvic floor being tense.

9. 12:58 – 14:42

   How much sex should couples be having?

   1. RMDr Rena Malik12:58

   2. SBSteven Bartlett12:58

      One of the things that you're particularly good at is taking on some of the big myths as it relates to sexual health, and I, I want to start with one of the big myths around sexual health, which is this idea that we all think other people and other couples are having significantly more sex than we are.

   3. RMDr Rena Malik13:12

      Yeah. So that's interesting. I think that is a big myth, and so when you look at, um... People want to know, like, "What's normal? How much sex should I be having?" Right? And there's no ideal number, but when you look at studies, right, which have looked at large numbers of people, people who are in partnered relationships are having sex about once a week, on average, if they're hav- if they feel like they're, you know, in, in partner relationships where sex is always available. But it's so variable person-to-person, and what I really like to say is it's not the quantity of sex that matters, it's the quality of sex, right? So if you're having good sex once a month, that may be sufficient for you, rather than having mediocre or bad sex four times a month or 10 times a month even, right? And, and so ultimately there's no right number. It's really what's right for you, and I think focusing on some, like, benchmark, right, of sex is, is actually harmful, right? Because now you're like, "Oh, well, I need to have sex this many times." Wh- what is the purpose of sex, right? The purpose of sex is pleasure, and sometimes people derive a lot of benefits from orgasm. We know that there's physiologic benefits to orgasm in terms of stress reduction, more focus, potentially better sleep, and even maybe lower blood pressure, things like that. So if people are deriving benefit from the orgasms and the intimacy with their partner and the pleasure they derive from sex, that's what matters, right? Not the number of times you're having sex.

10. 14:42 – 16:57

    Should we be experiencing pain during sex?

    1. RMDr Rena Malik14:42

    2. SBSteven Bartlett14:42

       Another big myth around sex, which I, I thought I'd, um, get your take on is about pain during sex.

    3. RMDr Rena Malik14:49

       Mm-hmm.

    4. SBSteven Bartlett14:49

       It's one of the, sort of most, uh, popular questions that I often guess- get whenever I speak to someone that i- is an expert on sexual health is, "Is sex supposed to hurt?" Because for a lot of people it hurts.

    5. RMDr Rena Malik15:02

       No. It's not supposed to hurt. So if it hurts, you want to assess, you know, what... Usually it's the female partner who feels pain, right? So is it that you're not lubricated enough? Is it that you have not had enough foreplay? Because the body prepares for intercourse, particularly in the female. So what happens is you go through arousal, your body self-lubricates, and the vagina actually lengthens and widens almost double in size to accommodate the phallus or whatever you're using, whether it's a toy or, or an, or finger or anything. And so if you don't have sufficient time to allow those things to happen, then it will be painful. And sometimes lubrication can be variable person-to-person, so some people may have copious amounts of lubrication and some people may have less, and it could be based on genetics. It could be based on the age they are, what stage of their hormonal status. It can be based on what medications they're on that might decrease lubrication. I think there's a- another big myth is that lubricant is not for everybody, and I th- I argue that lubricant is for everybody, that it makes things more fun, it makes things more slippery, it makes things more enjoyable, and it certainly makes pain less of an issue for a lot of people. Now, there can be other issues that cause pain. So if you've tried all these things, you know you're fully aroused, you know you're lubricated, you know that you're still having pain, then it's really important to get evaluated to understand what exactly is causing the pain. It could be hormonal changes in the vestibule, which is a part of the vagina that is very hormonally sensitive that can be painful. It can be pelvic floor dysfunction. It can be things like endometriosis or other factors that may be going on that need really advanced help. Uh, but most of the time, a lot of people can feel and enjoy sex more readily if they just increase the amount of foreplay and increase the amount of lubrication.

11. 16:57 – 19:23

    The vagina's expanding process

    1. RMDr Rena Malik16:57

    2. SBSteven Bartlett16:57

       Y- you said there that the vagina...... Expands-

    3. RMDr Rena Malik17:00

       Mm-hmm.

    4. SBSteven Bartlett17:01

       ... during sex. So, how much does it expand by and how long does that take? Because I think men don't really understand this process. A lot of men just like to rush in there, you know?

    5. RMDr Rena Malik17:08

       Yeah, yeah. (laughs) So, usually it expands by about double, double in length and double in width. And so it will expand, and basically the cervix is moving up and out of the way, the vagina is expanding to accommodate the length of a phallus, and- and it takes, we think, on average about 18 to 20 minutes. So it- that's sort of the amount of time it m- And some people faster and some people longer, but ultimately, you know, sort of like understanding that, but also, um, the lubrication is another big part of it. And so I think both those things together, um, you know, you need- you need some time. And some people, like I said, they may not take 18 minutes. They may take a couple minutes. And so it's very reasonable to get in there if that's what your partner wants. But again, I think the bigger issue is that we're not communicating about sex. No one taught us how to talk about sex, right? I didn't grow up talking about sex with my family. Many of my friends and colleagues did not grow up, unless they were in a family that was very progressive, talking about sex or even learning about sex from their parents. And at school, you don't learn much. You learn how to put on a condom. You learn how to ask for consent. You learn about STDs, and that's if you're lucky. In the US, 13 states don't have to have accurate sex education. Like, it's not a requirement for sex education to be accurate in 13 states in the US.

    6. SBSteven Bartlett18:25

       Where are we learning sex from?

    7. RMDr Rena Malik18:26

       (clicks tongue) So the large majority of young people, I mean, this data shows that at least one in four adolescents are learning sex from porn, and it's probably more than that. So I think a lot of people are learning either from, uh, pornography, from their friends. A small subset are learning from their parents. There still are people learning about sex from their parents, but ultimately, it's not enough. And so if people are learning about sex through porn, porn is entertainment.

    8. SBSteven Bartlett18:53

       Yeah.

    9. RMDr Rena Malik18:53

       It is doctored. It is not real. And I think people then take that and they say, "Why did not my sexual encounter not look like that? Why didn't I have as much semen volume? Why did my partner not orgasm as quickly?" And it can be on both sides, where women can be like, "Well, why didn't I react like that? Why didn't I get so excited right away?" And I think there's- it's a real problem, in terms of if people are only learning about sex through pornography, then they're already set up to be let down when they have their first sexual encounter.

12. 19:23 – 22:21

    How do we communicate with our partners about sex?

    1. RMDr Rena Malik19:23

    2. SBSteven Bartlett19:23

       And on that point of communication, we don't talk about it as a society, but then even within our own relationships, uh, you know, we don't talk about things we're struggling with with our own partners-

    3. RMDr Rena Malik19:34

       Yeah.

    4. SBSteven Bartlett19:34

       ... and the insecurities that we have. And I think that can cause a spiral of misunderstanding, and I've seen that in my own sex life historically, where maybe there was something I was insecure about or there's something I was thinking about, and instead of communicating it, I might have just acted in a strange way-

    5. RMDr Rena Malik19:48

       Mm-hmm.

    6. SBSteven Bartlett19:48

       ... and then that's misinterpreted, and then the other person gets a little bit insecure or whatever, and then you kind of have this downward spiral of misunderstanding-

    7. RMDr Rena Malik19:54

       Yeah.

    8. SBSteven Bartlett19:54

       ... which leads to, like, sexlessness.

    9. RMDr Rena Malik19:56

       Absolutely. You're just avoiding the situation because nobody wants to talk about it. And this is the problem. Like, you know, people ask me, like, "What's the s- what's the key? What's the key? What's the secret?" The secret is, you have to know what you like, right? You have to know what you want, and you have to communicate it with your partner.

    10. SBSteven Bartlett20:13

        How?

    11. RMDr Rena Malik20:13

        So this is the issue. It's not easy. It's not easy because no one taught us how to have these conversations, and they're charged with a lot of emotion, right? You feel insecure. You feel inadequate. Or you feel resentful, because you're not getting what you want out of the relationship. And so it has to come from a place of understanding that this conversation is not a one-and-done. There's no the talk. There are multiple talks over multiple periods of time, and the first time you have the talk, it might be a total disaster. But, you know, if you are in a relationship where someone really also has the same goals as you, of having a great relationship with a good sex life, then ideally, it- that won't continue, and you will continue to have conversations. So what I tell people is don't have conversations in the bedroom, not right before and not right after sex. You wanna wait until you're out of the bedroom.

    12. SBSteven Bartlett21:02

        Not during. (laughs)

    13. RMDr Rena Malik21:03

        (laughs) Or during.

    14. SBSteven Bartlett21:03

        Yeah.

    15. RMDr Rena Malik21:04

        Definitely not during. (laughs)

    16. SBSteven Bartlett21:05

        That's happened before. It's fucking worse.

    17. RMDr Rena Malik21:07

        Yeah. Yeah, that's-

    18. SBSteven Bartlett21:07

        So... (laughs)

    19. RMDr Rena Malik21:07

        ... pretty bad. That's pretty bad. Um, so, you know, one, and then two, have it in a place, like somebody- you don't have to be looking at the person, right? You can be sitting in a car. You can be going on a walk, because it's really awkward to look at someone in the face and be like, "You know what? I felt like this wasn't really great." You know? And- and so then to be like, okay, like, you know, talk- a- again, using the same sort of communication techniques that you use for other things, talking about "I" statements, not being, "You did this. You didn't do this," more about like how I feel, what really turns me on, what I would really like in the relationship, and then sort of realizing that they may not react well. They might be like, "Oh my God, I can't believe we're talking about this." They have their own stereotypes and biases that they're bringing into that conversation too, or their shame, or whatever they grew up with in society, whatever they think about sex can be very charged, right? And so it's sort of a lot of work to get through that, but realizing that it could take time, and sometimes getting help. So seeing a sex therapist or someone who has expertise in psychology and sex to talk ab- learn how to talk about sex with them and- and navigating the difficulties of it. But it's worth the investment, right? It's not easy, but nothing in life that's good or worth getting is easy, right?

13. 22:21 – 26:22

    What's the first step in re-building a good sex life?

    1. RMDr Rena Malik22:21

    2. SBSteven Bartlett22:21

       Okay, so there's a couple listening right now. There's probably one member of the couple listening right now, and they've heard everything you've said, but they have reached the point of no return in their relationship as far as they're concerned.

    3. RMDr Rena Malik22:30

       Mm-hmm.

    4. SBSteven Bartlett22:30

       They've not been having sort of a functional, healthy sex life for maybe one year, maybe six months, maybe five years, and it's just become the new normal.

    5. RMDr Rena Malik22:38

       Mm-hmm.

    6. SBSteven Bartlett22:39

       What is the case you would make to that person to get them to take action, to try and rectify the situation?

    7. RMDr Rena Malik22:44

       Well, I would ask them, first, how important is sex to them, right? If it's not that important and the other things in the relation ... And that's okay, right? Some people find that, okay, everything else in the relationship is excellent. "I love this person. We're still intimate. We still love each other. We still cuddle. We still, um, have a lot of great things in our relationship and, and sex right now is not working, right? Or it's not, it's not working for us, so, um, I'm okay with that." That's fine.

    8. SBSteven Bartlett23:12

       We-

    9. RMDr Rena Malik23:12

       Like, you don't have to feel bad about that. But I think that if it is a problem, then I think it's worth working on, right? Like, if you have a g- relationship that you value and that person you're, you're with values their relationship, then it's worth keep trying. Like, try to have the conversation. Try to bring them into the conversation. How much have you tried, right? Like, have you really had enough attempts at a conversation? A, a true conversation where you didn't get frustrated too, right?

    10. SBSteven Bartlett23:39

        Mm-hmm.

    11. RMDr Rena Malik23:39

        Like, where you were like, "Okay, I understand that you have ... This is a difficult conversation that we're gonna have, and I understand you might have feelings about it, but I love you and I really wanna try to have this conversation, and to keep at it." And I realize that that's not easy, right? That's not easy. I'm not saying it is, but I'm saying that when you're in a relationship that's worth having, that ideally at some point, the other partner will see how much this matters to you and want to work with you on it, right? If they love you, if they're with you there, they want what's best for your relationship. They're not, like, hiding ... They're not hiding their head in the sand and being like, "Oh, I'm o- " Like, they're o- ... They realize. They just don't wanna talk about it. They, they, they're not stupid. They just sort of don't wanna talk about it because it's embarrassing to them. They feel like they're the one that has something wrong with them maybe.

    12. SBSteven Bartlett24:22

        Mm-hmm.

    13. RMDr Rena Malik24:22

        Or maybe they have an issue that they haven't brought up. Maybe they're having a lot of pain with sex, or maybe they're going through hormonal changes and their tissues are really dry or whatever. There, there's a whole host of things that could be going on that they don't feel comfortable talking to you about. So, I think it's, it's valuable to say, "Is there something I'm not doing?" Like, "Tell me what you feel about sex." Like, leaving it open-ended to really find out what's going on with them, because usually not that they're like, "I just don't wanna have sex," and that's it. There's usually a lot more to it.

    14. SBSteven Bartlett24:52

        It's so hard for us to know, isn't it? Whe- when it comes to sex, what the root cause of the issues are, and I think some relationships are like a frog in a frying pan. It, uh, uh ... The frog in the frying pan analogy, for anybody that doesn't know, is th- this old tale about a frog jumping into a frying pan and then because the water heated up gradually, it ends up dying. But if the water was hot from the moment it dropped, jumped in, it would've jumped straight out. The idea that it's a gradual death for the frog, and in relationships, it's kind of a slow day by day, month by month decline in intimacy, and you end up finding yourself like a dead frog in a frying pan. You end up finding yourself in a sexless relationship and you think, "How the hell did we get here?"

    15. RMDr Rena Malik25:29

        Mm-hmm.

    16. SBSteven Bartlett25:29

        Um, and it's, and it's a h- ... So it feels like a long way back from that point.

    17. RMDr Rena Malik25:34

        It is. It's going to be, right? Because you let it sort of dwindle and you didn't talk about it, and it's gonna take work, and I think that's the key is like if you wanna fight for that in your relationship, it's gonna take work, and it's gonna take, um, buy-in on both sides, right? You have to work for anything in your relationship. Relationships are not easy, right? You wanna have children. That takes work. You wanna, um, decide to buy a house together. That takes work. Deciding and figuring out the, what kinda house you want, how much money you wanna spend. Like, there's all sorts of things that take work, and this is one that people just don't know how to talk about. And so they just ignore it because it's harder to bring up for both parties, right? What ... The one who maybe is not wanting sex or is being the one who says no to the ... And the one who always wants sex and then feels rejected because they're not

14. 26:22 – 29:11

    Men vs women’s sexual desire as we age

    1. RMDr Rena Malik26:22

       getting it.

    2. SBSteven Bartlett26:22

       Is there a, a sort of, a difference between men and women's sexual desire as we age? Uh, uh, uh, you know, 'cause I think there's a myth that says men just always wanna have sex and women maybe not so much. I- is that a real myth, um, in terms of something that you hear, but also is it true?

    3. RMDr Rena Malik26:40

       So, let's talk about desire. Desire comes in two flavors. So there's the spontaneous desire where you see somebody. You're like, "Oh man, they're so attractive. I can't wait to sleep with them. I'm immediately turned on. I wanna have sex right now," right? You didn't have to do anything. You just saw them and it happened. And then there's responsive desire, where you're sort of with them. You might be touching them. You might not really be thinking about sex, but like you're touching them. You're with them. You're like, "Oh, uh, this feels sorta nice. I sort of like this." Like, "Oh, now I'm turned on after we've sort of started being a little romantic with each other, being a little more f- intimate with each other." And both desires are normal, and both desires are fine to have. Now, in the literature, you'll find that men tend to more often have spontaneous desire, and women tend to more often have responsive desire, particularly when you're in longer term relationships. So, there's this disconnect, right? Women are like, "Why don't I see you and wanna jump you anymore," right? "I used to feel like this, but I don't anymore. What's wrong with me? Am I broken?" Right? And then they don't realize that, "Oh, okay. Maybe we'll just, like, be together and let's see what happens," and they don't even wanna start because they're worried that, "What if I don't wanna have sex and we've now initiated this, like, touching, cuddling thing, where, oh, that person's getting really turned on. What if I don't get turned on and what if I disappoint them?" And so there's a lot of charged emotions there, but realizing that this is normal and common, and responsive desire is not wrong. It's just different, and people just don't know that it exists because again, media attention is like you see someone who jumped them. You're, you're horny right away. You have sex. And that's not what happens all the time, and that's okay. And so, like, you know, you can be with your partner and be like, "Look, I have no expectations for you. I just wanna be with you physically and see if it turns into sex." So often, we'll give people homework like, "Put it on the calendar. Put it on the calendar that you are going to be intimate together at this time." And I know that sounds weird, right? Like, you're looking at me like I'm crazy. But we put on the calendar when we wanna work out. We put on the calendar when we wanna have brunch with our friends. We put on the calendar when whatever, right? And when we were younger, when we used to have dates with people, we would say, "Okay, we're gonna go on a date on Friday night." We would know that sex is on the table with our partner on Friday night, so we'd get really excited about it. We'd be like, "Okay, I'm gonna shave. I'm gonna look real pretty. I'm gonna smell good. I'm gonna do all the things that make me desirable and feel confident and be ready to have sex," right? And so you would be, like, really excited about it, and then you would have all this anticipation about how fun it's gonna be.

15. 29:11 – 30:11

    Anticipation around sex causing more harm than good

    1. RMDr Rena Malik29:11

    2. SBSteven Bartlett29:11

       But the anticipation can, can wreak havoc, can't it?

    3. RMDr Rena Malik29:14

       It can. It can. So the opposite is true, but that's because if you expect ... That's why I say intimacy and not sex. So if you say you're gonna have sex, it can be like, "Oh my god. What if I don't perform? What if I don't do it right? What if I don't want sex? What if it hurts?" Right? So you can also have that sort of rumination and spiral, but if you're like, "Look, all we're gonna do is be together and be intimate. We're not gonna just go have dinner and talk. We're gonna, like, literally be together, not have our phones with us, maybe like, touch each other, maybe get undressed, maybe just, you know, feel h- what it feels like, and that's it. There's no expectation of sex from either side. We're gonna go in knowing that, and then slowly work our way towards like, okay, you know what? Like, maybe sex will happen and maybe it won't." And over time, as you keep putting it on the calendar, prioritizing your intimacy with your partner, then eventually you'll get to a point where, oh, you remember. You recall that connection you used to have, and then you can actually find that joy again of connecting sexually.

    4. SBSteven Bartlett30:10

       Yeah.That's

16. 30:11 – 32:29

    Is a low libido a hormone problem?

    1. SBSteven Bartlett30:11

       the, sort of, the aspect of desire which is, I guess, is a bit more psychological, but it, there's also sort of a physiological element to desire as it relates to hormones-

    2. RMDr Rena Malik30:18

       Mm-hmm.

    3. SBSteven Bartlett30:19

       ... levels. So if someone's got a low libido, is that a hormone dysfunction?

    4. RMDr Rena Malik30:24

       It can be. So testosterone is the most notorious hormone for desire, right, in both men and women. And I think this is a big misconception, is that we don't talk about testosterone in women. But testosterone in women is more predominant than actually estrogen. We have more testosterone in our bodies than we do estrogen, and testosterone is very important for desire in both men and women. But anything that is, in- interacts with testosterone is also important. So thyroid hormone can, can cause issues with testosterone. Prolactin, which is another hormone made by the brain, can also interact with testosterone. So essentially evaluating those things and making sure that your levels are normal or appropriate for your age can be helpful. That's probably the number one thing, but the other thing ins- outside of physiology is that stress, even though stress is, um, sort of an abstract thing, stress affects our physiology, right? So when you have a lot of stress in life, whether it be work, re- relationship stress, kid stress, whatever it is, right, it raises your cortisol level. And when your cortisol level is high, you can't produce testosterone. It goes down. And so if you're chronically stressed, which many of us are, right? You spend... Like, in today's modern society, chronic stress is, like, a real problem. Then that is gonna really impact your libido. So yeah, your hormones may suffer because of it, but if you don't fix the stress, like, you're not gonna fix the root cause of the problem.

    5. SBSteven Bartlett31:46

       Can't I just inject myself with loads of testosterone though to get my libido back?

    6. RMDr Rena Malik31:50

       It won't work for everybody. So if it's not truly a low testosterone, meaning you have normal levels of testosterone, likely your testosterone receptors are completely saturated, more testosterone is not gonna fix the problem. So it depends on your individual level of hormones, but at some point, more is not better. In fact, more can be dangerous, and so it's really dependent on your individual level. So giving yourself... Like, if I give a guy who has completely normal testosterone levels, uh, both free and total testosterone are all completely normal, and I give him testosterone, probably nothing's gonna change because his testosterone receptors are already fully saturated with testosterone. So more is not gonna do anything.

17. 32:29 – 35:25

    Ways to increase testosterone

    1. RMDr Rena Malik32:29

    2. SBSteven Bartlett32:29

       What are the other ways that I can increase my testosterone? If I go and get tested and it says that I have low testosterone levels, and I don't wanna just inject myself with testosterone, are there natural ways that I can increase it?

    3. RMDr Rena Malik32:38

       Absolutely. So number one is sleep. So sleep is really, really important for testosterone. We know that when you reduce the amount of sleep you have, so for example, you sleep less than six, five or six hours, you're gonna have at least 10 to 15% reduction in testosterone. And so because our body follows a circadian rhythm, and so when your testosterone's highest is in the morning, and it starts to decline over the course of the day. There's a little bit of a bump again, and then it goes back down. At nighttime it's low, and your body, when it's sleeping, replenishes that testosterone. And so if you're getting either less number of hours of sleep or poor-quality sleep, meaning you're, you know, you're not feeling very rested when you wake up, that's a sign of poor-quality sleep. Both of those things can dramatically affect your testosterone. The other thing that you can do is exercise, and specifically resistance exercise. So doing high, the, the largest muscle groups, so usually the lower extremities, and using those have been shown to boost testosterone more significantly than any other type of exercise. In fact, when you do cardiovascular, high-intensity cardiovascular, like endurance training, so say you're doing Ultramans, uh, marathons all the time, long t- long bike rides, long swimming, uh, you know, swimming for long periods of time, that can actually increase your cortisol, your stress, because your body's having a stress response, and that can actually reduce your testosterone. So it's important to do cardiovascular exercise, aerobic exercise, but in moderation, uh, because we do see some people who are great athletes who, you know, run, you know, run miles and miles and miles, but their testosterone is low because they've been doing this chronic long-duration endurance exercise.

    4. SBSteven Bartlett34:24

       So sort of HIIT training is fine, but it's when you start doing these big Ironman 1000-mile run things that the cortisol suppresses testosterone.

    5. RMDr Rena Malik34:29

       Yeah, and that's not a, that's not a large percentage of people, right? But it's certainly, you know, it's like, "I'm so healthy. I'm the healthiest I could ever be and I'm having low testosterone." Why is that?

    6. SBSteven Bartlett34:38

       And what about food and testosterone?

    7. RMDr Rena Malik34:41

       So food, you know, there is a lot of, uh, data on food. The one, eh, but the most data is on the Mediterranean diet, and that's because that's the most well-studied in medicine. But essentially having vegetables, fruit, low, uh, low amounts of processed foods, good healthy fats, nuts and seeds. So a lot of people don't realize, but you need good fat to have testosterone. Testosterone is a pre- is, uh, production is in the cholesterol pathways, and so it comes from those pathways. And so you need to have some level of fat. If you have too low fat of a diet, that'll also affect your, affect your testosterone. So ideally, what I tell people as well, there's lots of data on different types of diets. The important thing to know is you wanna avoid processed foods, avoil- avoid a lot of

18. 35:25 – 36:37

    A decline in testosterone levels and sperm counts

    1. RMDr Rena Malik35:25

       sugar, and have good healthy fats in your diet.

    2. SBSteven Bartlett35:28

       What about, you know, uh, I've, I've heard a few times that testosterone levels have been declining over the last couple of decades in men.

    3. RMDr Rena Malik35:34

       Mm-hmm.

    4. SBSteven Bartlett35:35

       Is this true?

    5. RMDr Rena Malik35:36

       Yes, it is true. So we're not only seeing a decline in testosterone levels, but we're seeing a decline in sperm quality and, uh, sperm numbers, so the concentration of sperm and over the course of the last 50 years. And there's a l- lot of reasons for that. One is that, you know, society has become more sedentary. We're seeing people less active, getting more and more metabolic conditions like diabetes, high blood pressure. These conditions then cause endocrinologic abnormalities. They cause problems with blood flow, and all these things can affect the quality of your s- sperm as well as the quality of your testosterone production. And then also there's more... We, we think in the environments we know, there's more, uh, microplastics and more endocrine-disrupting chemicals, right, in the environment. So that is probably playing a role. Now, we don't have, like, exact qua- like, exact quantitative data on that, but we think that is probably playing a role and reducing the exposure to these endocrine-disrupting chemicals,

19. 36:37 – 38:30

    Chemicals in everyday objects impacting sperm counts

    1. RMDr Rena Malik36:37

       so we tell people try not to drink out of plastic water bottles, try to warm up food in glass and avoid plastic. I mean, these are easy things you can do, but if you wanna stress about the amount of plastics in the environment, like, there's not much you can do as, on an individual level. So I tell people, "Do the things you can control, and the other things sort of, you know, we have to work on as a society."

    2. SBSteven Bartlett36:57

       Uh, that's really interesting 'cause I...I, I don't think I think about this much but removing chemicals from my life in terms of what, uh, these kinds of things-

    3. RMDr Rena Malik37:06

       Mm-hmm.

    4. SBSteven Bartlett37:07

       ... that I'm holding the metal mug in front of me, and then the plastic bottles I drink from could be having an impact on my testosterone and my sperm count.

    5. RMDr Rena Malik37:16

       It could. I mean, like, it's not everybody, right? Think about how many people drink from plastic water bottles. But if you can d- decrease your exposure, right, it's probably additive. So the more exposure you have, the more likely it is to impact your body.

    6. SBSteven Bartlett37:28

       How do they know this? Like, how does, uh, anybody know that chemicals are having an impact on our sperm and testosterone?

    7. RMDr Rena Malik37:34

       So there's, you know, there's basic science research where they're looking at the impact of these things on, on rats and other animals, and then also they're looking on the amount of exposure, uh, to things like phthalates in labs and seeing how that... You know, we can't... It's all cause, uh, it's all correlation. We can't say it's causative because we don't, we're not gonna do a randomized study where you drink from water bottles for 10 years and you drink from glass water bottles for 10 years and let's see what happens, right? That hasn't been done. But they can say, okay, the more your exposure based on whatever biomarker we can assess, so maybe urinary phthalates or other things, we can say that, "Okay, these people who have more exposure to this are more likely, based on the data, to have lower levels of testosterone." And then, you know, looking at the mechanisms of how they interact with the production of testosterone, and I'm not an expert in those areas, but certainly there has been sort of plausible mechanisms of how these things work.

20. 38:30 – 42:06

    How have sperm counts been decreasing over the years?

    1. SBSteven Bartlett38:30

       How has sperm count been decreasing over the years?

    2. RMDr Rena Malik38:34

       So if you look at the last 50 years, you'll see that the average sperm count has declined almost 50%. And luckily, the average sperm count is still high enough for fertility rates. The average sperm count is probably around 50 million of, of fathers, people who father children, and so it's still above that but it's certainly significantly lower than it was 50 years ago. And so that's where we're thinking, you know, it's, it's probably more of a global environmental factor that's contributing to that in addition to this increase in comorbidities and poor health over time.

    3. SBSteven Bartlett39:07

       I mean, the direction of travel there is deeply concerning-

    4. RMDr Rena Malik39:10

       Mm-hmm.

    5. SBSteven Bartlett39:10

       ... because if something declines 50% in the last, what, 50 years-

    6. RMDr Rena Malik39:16

       Mm-hmm.

    7. SBSteven Bartlett39:16

       ... did you say? Then if we go forward another 50 years and we assume the same rate of decline, that means we'll be at 25% of where we were-

    8. RMDr Rena Malik39:23

       Yeah.

    9. SBSteven Bartlett39:23

       ... 100 years ago.

    10. RMDr Rena Malik39:24

        Yeah.

    11. SBSteven Bartlett39:24

        And then-

    12. RMDr Rena Malik39:25

        And then w- what if you can't father children anymore? And what if you can't have offspring that will then propagate the species, right? (laughs) So there's, there's certainly concerns there and I think, you know, we have to, as a society, do better in terms of the things that we can. So we can control diet, we can control exercise, we can control those things. There are certain things that we can't, uh, but we can try to control what our people are exposed to and that can be on a governmental level, right? Like having sort of laws in place. So we know in the US there's less restrictions, whereas in other countries there's more restrictions on things like food coloring and dyes that may have... Again, I don't, I don't know the specifics but certain, you know, there's certainly more restrictions in other countries than in the US for some reason. And so maybe there needs to be a more critical evaluation of where we can actually put in place some things that would actually have more wide- widespread changes.

    13. SBSteven Bartlett40:17

        When we think about sperm count we often think about fertility. Um, and, gen- you know, I don't know whether this is just because society has changed and we're trying to have kids later, but it does seem that people are struggling more and more with fertility. I mean, even in my own sort of circle of friends, um, there's, you know, there's a couple people that have reported to be struggling with fertility or that, you know, they're spending 12 months or 24 months trying to-

    14. RMDr Rena Malik40:38

        Mm-hmm.

    15. SBSteven Bartlett40:38

        ... have children. Do you think this is linked to this as well?

    16. RMDr Rena Malik40:41

        It could be. I mean, w- when we know, when we look at fertility we know that about half of fertility is due to women, half fertility is due to men and then some combination of the two, right? So, um, definitely as women age fertility goes down and we know women are waiting longer to have children. So that's a big part of it, that society has changed. Women are working and, and prioritizing their careers. It's not a bad thing but it certainly will affect fertility, and, and then yeah, there may be these issues that are affecting male sperm counts that are also causing issues, but I don't know if there's any updated data in terms of what are the causes or the numbers in terms of fertility rates.

    17. SBSteven Bartlett41:18

        Fertility aside, is there any correlation between our health outcomes and our sperm volume?

    18. RMDr Rena Malik41:25

        Not volume but concentration. Uh, so volume is the amount of, of, of...

    19. SBSteven Bartlett41:29

        Okay.

    20. RMDr Rena Malik41:30

        Right? So concentration of sperm in the semen is more of a predictor in terms of, um... Sperm volume, not semen volume, let's be clear.

    21. SBSteven Bartlett41:40

        Okay.

    22. RMDr Rena Malik41:40

        So sperm volume, sperm concentration are sort of the, the biomarkers, and we would say that yes, there is a correlation with overall health in terms of, uh, sperm concentration and sperm volume. Uh, but I think... I don't wanna make people worry that if they truly have a male factor infertility then now their overall health is, uh, is a problem, but it's certainly important to be evaluated and, and seen by your doctor regularly.

21. 42:06 – 43:56

    How do we increase our semen volume

    1. RMDr Rena Malik42:06

    2. SBSteven Bartlett42:06

       And on that point of, um, semen volume, is there a way to increase that and is it similar to what you said about increasing testosterone or is there another set of sort of, um, practices we can do to increase our semen volume?

    3. RMDr Rena Malik42:18

       Yeah, so semen volume is variable depending on... The biggest one is how long has it been since you last ejaculated, right? So the longer you delay between one ejaculation to the other, the more semen volume you will get. That's probably the most predictive. You know, hydration can play a role, so if you hydrate more certainly you may see more semen volume. Um, sometimes it's a, it's a low semen volume because you're actually having less force of ejaculation. So interestingly when you're young, the force of ejaculate can be really, really strong. It can be up to 30 to 60 centimeters away. Like when you ejaculate that's how forceful it can be. As you age, after about 50 it can decline to 15 to 30 centimeters away, and so that can feel like you're having less volume because it's less forceful. And so in those cases, that's because of the pelvic floor muscles that are around the urethra, those muscles there that help sort of propel the ejaculate out. And so you can strengthen those muscles with, again, pelvic floor exercises like Kegel exercises. I caution people because people are always like, "Oh, they're gonna... These Kegel exercises are great. They're gonna increase orgasm, they're gonna make my semen propel further." And I think that's fine if you're not having pain, you're not having discomfort and you're doing them correctly, because sometimes what we see is it can actually cause harm if your pelvic floor is tense, like we talked about earlier, or it can cause pain and dysfunction if you're tensing, tensing, tensing and not relaxing. And so if you don't know how to do them correctly then you could actually harm yourself. Uh, but yes, they can improve semen volume by the parameter of increasing the force of ejaculate and getting more ejaculate out that may be left over if you're not having as forceful of a muscular contraction.

22. 43:56 – 44:55

    Does masturbating improve my pelvic floor?

    1. RMDr Rena Malik43:56

    2. SBSteven Bartlett43:56

       Does masturbating...... improve my pelvic floor? Does it strengthen my pelvic floor?

    3. RMDr Rena Malik44:01

       So, that's a good question. The orgasm is what improves your pelvic floor. So if you masturbate and you orgasm, when you orgasm, your pelvic floor contracts, uh, involuntarily, you can't do anything about it, at a rate of about every 0.8 seconds. So it does contract and that is sort of like a pelvic floor muscle exercise, but it's doing it involuntarily. It's contracting for anywhere from five to 60 seconds, usually, on average. And so you are sort of, in that way, increasing pelvic floor strength. In fact, they've looked at, um, in women particularly, is orgasming as good as doing pelvic floor exercises? And they've seen that, you know, you can see pretty measurable improvement in pelvic floor strength if you orgasm regularly. Um, is it... and it may be, you know, uh, as good as doing Kegels, depending on how often you're doing it. So, yes, orgasming itself can be very beneficial for pelvic floor strength.

23. 44:55 – 47:48

    The impact our technology is having on our genitals

    1. RMDr Rena Malik44:55

    2. SBSteven Bartlett44:55

       One of the big sort of myths that I've always... I've y- I'm yet to answer is the impact that our technology is having on our genitals.

    3. RMDr Rena Malik45:04

       (laughs)

    4. SBSteven Bartlett45:04

       You know, there's kind of, like, a pervasive myth that if you put your phone next to your testicles, your sperm count's gonna drop. Like, whenever I'm in the car, um, and I don't know, I'm, I'm sat there or I'm sat at home somewhere and I get my phone and I put it near my genitals, my girlfriend has a go at me and she, she, like, pulls it out or tells me to pull it out-

    5. RMDr Rena Malik45:21

       (laughs)

    6. SBSteven Bartlett45:21

       ... because I think she's worried that we're not gonna have kids if it's down there.

    7. RMDr Rena Malik45:23

       Yeah. Yeah. So there is, there is a little bit of data there in terms of, you know, when you have these devices, like, in your lap or near your genitals, they will increase the temperature. And so when you... the, the, the testicles are in the scrotum for a reason, right? It's because they need this very perfect environment with this specific temperature to create sperm. And anything that disrupts that temperature can cause diff-... cause abnormalities in sperm production. So for example, when you have a fever because you have the flu or you have a cold, people will get their sperm checked, their semen analysis, and they will see that their sperm count is zero because the temperature, the fever has temporarily stopped their sperm production. And so you can see that. You know, people also discuss like, "Oh, what about boxers or briefs? What about putting..." And so all of these things can increase the temperature around the scrotum which can then cause changes in sperm production. So I tell patients, particularly if you're trying to have babies is, "Put your phone in your back pocket, in your chest pocket. Don't put your computer or your laptop right on your lap." Right? I mean, it's easy enough to do and it does increase temperature. So absolutely, yes, these things can. Not for everybody, right? There's people... so we say people... like, you shouldn't smoke a lot of marijuana when you're trying to get pregnant because marijuana can cause problems with sperm production. But you'll see people who smoke every day and they still have babies or you'll see people who do all of these things, right? They, they wear briefs, they (laughs) , they put their phone on their, in their pocket, they put their laptop on their lap and they still have babies. So it's not a... all, all comers, but certainly things that you can easily just avoid putting near your genitals.

    8. SBSteven Bartlett47:04

       Well, if I'm in the sauna every day-

    9. RMDr Rena Malik47:06

       Mm-hmm.

    10. SBSteven Bartlett47:06

        ... or if I'm in a, um, a steam room every day, isn't that gonna have an impact on my sperm count?

    11. RMDr Rena Malik47:11

        Yeah. It does, and that's interesting because there's a... I think we'll see more of this as we're seeing the rise of... I mean, there's benefits to saunas, no doubt, but as we're seeing the rise of people really doing saunas all the time, um, there can be... so we tell people when they're trying to have pre-... if they're having fertility issues, don't go in hot tubs, don't go in saunas because it could affect your sperm production. So, those are sort of the, the conservative things we tell people to do.

    12. SBSteven Bartlett47:34

        Interesting. And this, this point about the phone next to genitals, it's not because of, like, the wifi and the Bluetooth are gonna, like, zap my babies?

    13. RMDr Rena Malik47:41

        No. I mean, there's some, there's some question about that, but we don't know. I don't think we know, but we know there's a temperature increase, right? Because phones

24. 47:48 – 49:17

    Does masturbation decrease testosterone levels?

    1. RMDr Rena Malik47:48

       get hot.

    2. SBSteven Bartlett47:48

       We talked about masturbation b- briefly. Um, one of the big questions that people often ask me when I'm speaking to someone that has expertise on sexual health is about masturbation and whether it decreases your testosterone levels.

    3. RMDr Rena Malik48:01

       So, it does not. There is one study and it was done in 10 men who abstained from masturbating for 21 days, and these are young healthy men, right? And so this is where I think everyone gets their data from, is this one study. And so they took their testosterone before, they took their testosterone after, a- and what they found was that there was an increase by about 50, 50 nanograms per deciliter, or 0.5, um, which, which is 50 nanograms per deciliter, which is not a huge amount, um, at t- 21 days. But we know that testosterone changes all the time, and two, there's a lot of anticipatory cues. When you've been waiting to masturbate for 21 days, like, your brain is, is really excited. There's all these like, "Okay, I'm finally gonna get to release," and that in and of itself can increase testosterone. So generally speaking, there's no empiric evidence that is convincing, high-quality level evidence that masturbating or abstaining from masturbation will increase testosterone. And so there... you know, people do report other benefits and so I tell people, "If you're getting other benefits from abstaining, by all means, go ahead, but don't do it for... don't, like, white knuckle it to gain some theoretical increase in testosterone that, one, was not even that large, and two, is probably not gonna be proven in a larger

25. 49:17 – 51:10

    Does too much masturbation have a bad effect on us?

    1. RMDr Rena Malik49:17

       sample."

    2. SBSteven Bartlett49:17

       What about the opposite then? Is too much masturbation going to have an adverse effect on us, for men and women?

    3. RMDr Rena Malik49:23

       Yeah. So I think it... you know, what I tell people is masturbation is generally safe as long as you are not masturbating to the point where you are now choosing to masturbate over doing anything else. So you're choosing to masturbate rather than have sex with your partner, you're choosing to masturbate over going to work or you're, "I'm gonna be a little late to work because I wanna finish masturbating," or you literally can't sleep without masturbating every day. Like, those sorts of... you become reliant on this particular activity for the enjoyment that it provides, um, that's when it becomes a problem. But if you're using it in terms of like, "I'm masturbating to get orgasm and the benefits of orgasm that I do achieve from that, because maybe my partner doesn't wanna have sex or maybe I have more of a sex drive than my partner, or I don't have a partner..." Like, let's be realistic, like if you don't have a partner, you're gonna have to... if you want to orgasm, you're probably gonna have to masturbate. And so I think the problem also comes in is when people only masturbate the same way every time, they only watch a certain type of erotic film, or they do the same thing every time and their body habituates to that, and then they have a difficult time climaxing with a partner because they can't replicate what they're doing, whether what they're watching or how they're doing it with a partner.

    4. SBSteven Bartlett50:34

       Are we teaching ourselves s- something there?

    5. RMDr Rena Malik50:36

       (laughs)

    6. SBSteven Bartlett50:36

       Are we teaching ourselves how we're aroused and how we orgasm?

    7. RMDr Rena Malik50:39

       Yeah. Uh, your brain is very powerful, right? So when you're doing the same thing every time, your body's like, "Oh, this is what turns me on. This is what makes me orgasm." And then when we're with their partner, we're like, "Oh, I'm not getting that same kind of stimulation." And so it doesn't happen to a lot of people, but I would say certainly I see people where this does happen. And so, um, you know, you have to sort of take a break and, and sort of reevaluate and try different things and get your body to habituate to different things, which takes a little bit of work, um, but sort of keeping it varied can be helpful.

26. 51:10 – 51:29

    Will masturbating make people blind?

    1. SBSteven Bartlett51:10

       Another big myth, masturbation will make me go blind.

    2. RMDr Rena Malik51:12

       Yeah. No.

    3. SBSteven Bartlett51:13

       Where did that come from?

    4. RMDr Rena Malik51:13

       There's literally... I don't know where that came from. There's, like, hairy palms, blindness, like, I don't know where... I, I think this is all sort of, like, from religious rhetoric that says, you know, you should not masturbate. Um, and, and it... you know, the-... where that came from, you know, is a whole other story, I think.

27. 51:29 – 53:05

    What do you think of no nut November

    1. RMDr Rena Malik51:29

    2. SBSteven Bartlett51:29

       What do you think of this idea of No Nut November?

    3. RMDr Rena Malik51:32

       Yeah. So I think it's... I- I'm not a fan. The reason being is because I think it makes people feel like it's something they have to do. And if you want to, like I said, if you find benefit from abstaining from ejaculating for 30 days or 28 days or whatever it is, um, then by all means, like, go ahead. If you wanna try something, there's no harm in it. But I think a lot of people, what they do is they feel like it's something that's gonna bring them to some higher level and they're gonna become this great person because they're able to, to, to conquer this goal, but they're, like, literally miserable. So they're, um, they're clenching their pelvic floor all the time because they're stressed about how they're not ejaculating. They may ejaculate at night, and so they'll have a nocturnal emission and then they'll feel so bad because they've failed. It's nothing you can control. Nocturnal emissions are physiologic. They're totally normal, and 86% of men have had a wet dream at some point in their lifetime. Like, it's very, very common, and more likely the longer you are from ejaculating. So, um, your body will take care of the ejaculate if you ejaculate or not. So you will either resorb the semen or you'll ejaculate at night. And so if you wanna do it because you feel like, "Okay, I have a challenge. I wanna conquer it. I wanna see if I can do this," and you feel better because you're not f- you're able to, like, not focus on sexual thoughts or you're able to really, um, find some other level of spirituality or something, by all means, go ahead. I don't have a problem with it. What I have a problem with is making people feel bad because they can't do it or they don't wanna do it, and with people feeling forced or feeling like they need to do it to prove something to someone else.

28. 53:05 – 56:23

    Masturbating giving you more clarity of mind

    1. SBSteven Bartlett53:05

       Yeah, 'cause it... You know, I mean, the way that I- I've had it explained to me is that it's some- something about semen retention gives you some clarity of mind or something. 'Cause a lot of athletes before they have their, their big fights or, you know, their biggest sort of Olympic competitions, they'll abstain from masturbation. I- I often hear in the UFC, for example, the, um, the mixed martial arts fighting championship, that athletes have not had sex or not ejaculated for two weeks before a fight or four weeks before a fight.

    2. RMDr Rena Malik53:32

       Yeah. So there's a lot of rhetoric there, I think, that comes from, um, historical. So even in Greek mass- in Greek times, they would tell people to avoid having sex or masturbating prior to, you know, big fights or, or just whatever sport they were playing. And so is it true in data? So if you look at the studies that have looked at people performing athletic feats, whether it's like cycling or running or whatever, um, they have not found that abstaining from ejaculation actually changes their ability to perform. And so in those cases, I say, well, there's no true scientific evidence that we have that it's going to improve, and in fact if you are someone who, for example, has sex every morning or masturbates every morning, for whatever reason that's a part of your routine, disrupting the routine can actually be harmful to performance. And sometimes... Uh, the, the one thing you can say is, in terms of disrupting performance, is that after you masturbate, you do see an increase in heart rate a little bit. Um, you have a rebounding. So it decreases, and then you have a rebound increase in heart rate that can slightly affect your ability to recover from performance. But ultimately, I think if you find benefit from it, because people s- report feeling more aggressive with abstaining, then by all means if you find it helpful, I think it's fine. But is it mandatory? I don't think so based on the evidence we have right now.

    3. SBSteven Bartlett54:50

       'Cause I- I- I heard that rumor many years ago, and I think I assumed it was correct. I- I heard the rumor, and this was the sort of evolutionary story that was attached to the rumor, was that once upon a time when we were out, I don't know, looking for, um, a sexual partner, we would need to be more articulate and more persuasive and more, I don't know, attractive basically.

    4. RMDr Rena Malik55:11

       Mm-hmm.

    5. SBSteven Bartlett55:11

       So we were at optimal attractiveness before we ejaculated. Then after we've ejaculated, that kind of energy goes out of us and recharges and rebuilds again. So I was... When I heard that, I thought, "Okay, so if I'm speaking on stage or I'm doing a podcast, I wanna make sure that I'm... You know, my mouth and my brain are attached, I'm articulate, I'm persuasive, whatever I need to be." So I don't ejaculate or masturbate any time before doing anything where I need to use my brain and my mouth.

    6. RMDr Rena Malik55:36

       Well, you know, some people describe post-nut clarity, right? So they actually, on the alternative, feel like... And there's no good data on this. The data we have is on people, the very small subset of people who have post-nut... Postcoital. It's not post-nut. Post-coital dysphoria, so they actually feel bad. But in terms of clarity, um, you know, some people do. Like, when you're trying to... You're motivated to get a partner, right, you're sort of, um, trying to, uh, woo them, you're really focused on that one singular effort, that once you've obtained that, that the v- like, very singular focus goes away, and now other parts of your brain can be activated to then be used for... Some people will describe being more productive, more able to get work done after, uh, masturbation. So it's very individualized. Or ejaculation. Whatever it is.

29. 56:23 – 1:01:48

    Post nut clarity

    1. RMDr Rena Malik56:23

    2. SBSteven Bartlett56:23

       Post-nut clarity. I've never heard anybody talk about this before, and I've also been told over the years that it's something that just men experience predominantly. And for anyone that doesn't know what post-nut clarity is, the definition that I understand is, and that I have experienced, I'm gonna be honest, is that after ejaculation, your desire for the other person reduces quite significantly, and there's a stereotype here that women don't experience this post-nut clarity in the same way. Now, if I ask all of my male friends, if I said to them, "Has there ever been a time in your life where you were maybe texting someone you were attracted to or, you know, had s- some sort of sexual attraction to, and then you masturbated? Did your desire, um, diminish after you masturbated for that person that you were just texting?" I think about 90% of my male friends would say, "Yes."

    3. RMDr Rena Malik57:10

       Yes.

    4. SBSteven Bartlett57:11

       And, and they'd describe it as if someone, like, took some, like, sunglasses off them. Like, it... A pretty extreme sudden change.And I've alwa- always wondered about this, whether this is just men, if it's just women, why it happens.

    5. RMDr Rena Malik57:22

       So when you look at brain studies, right? Of people having orgasm, and what happens is when you have an orgasm like your whole brain lights up, right? Because your heart rate goes up, your blood pressure goes up, like your pupils d- So all these different parts of your body are working so your whole brain lights up. And then after orgasm, it cl- it, it gets very, like quiet. And so we see that in women it may take a little longer to get really quiet. In men it happens very quickly, and this may be associated with sort of the hormonal changes that occur after orgasm. So we know that prolactin increases after orgasm, dopamine decreases, and there's sort of some evolutionary theories about why this happens. So one is after you ejaculate if you are having, uh, ejaculation with a woman then you don't want to have sex again to ... And the same thing with the refractory period, right? That there's some period of time where you're not gonna wanna have sex again, or you can't have sex even if you want to. And this is because evolutionarily if you deposited your ejaculate into a woman if you then had sex again, you could actually dislodge the semen and then you have less ability to, uh, to have fertilized egg, right? And then the other thought is that you don't want to become overly exhausted, right? So that if you, if you had the unlimited capability to have sex over and over again that exhaustion could be a real thing, like and so you're sort of a protective mechanism. Um, and so those are sort of the theories as to why this is, and there is like an absolute refractory time where like you don't want sex at all, and then there's a relative refractory time where if you had a really novel or strong stimulus for sexual activity that you would be able to. Um, in terms of clarity, in te- b- because we know there's a little bit of differences in brain, um, it may not be as obvious in women in terms of it takes them a little longer to have that coming down after the orgasm from the brain activity, um, but probably there is some. We just haven't studied it enough. And I, I always say this, that when we look at studies for women's sexual health and men's sexual health, they're so lopsided. So if you type in penis in like a, in like a search engine for Google or for the PubMed which is where you look up research articles, you're gonna find 50,000 articles. If you look up clitoris, you're gonna get 2,000 articles. So it's very lopsided in terms of what we study, um, for sexual function and in, in and of itself sexual function by many people is not seen as mandatory or important for health, and so the funding is less often available for sexual health. That's why we have such little data in some areas.

    6. SBSteven Bartlett59:52

       Going back to just closing off on the point about masturbation, is there a link between masturbation and prostate cancer? Because I've, I've heard a lot of different things about it. Um, some people think that over-masturbation is causing prostate cancer and some people say the opposite.

    7. RMDr Rena Malik1:00:04

       Yeah, so there's actually a really good study, um, that was done looking at ejaculation frequency and prostate cancer and it was a very well done study. They tried to control for a lot of other factors, and so what they found was that men who ejaculated 21 times or more a month were less likely to develop prostate cancer. This is just a statistical number. It is not a number that sort of, um, means anything in terms of ... But we're seeing that like, okay, so more masturbation may help. Why is that, right? So there may, there's a prostate stagnation hypothesis that the fluids that, you know, some of your ejaculate fluids come from the prostate and so when you're ejaculating frequently you are more often re- getting rid of that fluid and sort of re- replenishing it, or cleaning the pipes so to say. So that may be beneficial in terms of preventing prostate cancer. Now do you have to masturbate or ejaculate or have sex 21 times a month? Um, no, but you know, there could be a benefit, yes. And so, uh, having a healthy ... And it may be that those people who had sex more often or ejaculate more often were just healthier in other ways, right? They were able to have sex more often or masturbate more often because they were uh, suf- you know sufficiently healthy to do so. And so the ... And while they tried to control for those things, there's always sort of uncontrollable variables that come into those sort of studies.

    8. SBSteven Bartlett1:01:26

       Yeah, that's what I was wondering is, is there another like glaringly obvious factor that those people had more relationships, therefore their mental health was better, there- therefore-

    9. RMDr Rena Malik1:01:32

       Yeah.

    10. SBSteven Bartlett1:01:33

        ... X, Y and Z?

    11. RMDr Rena Malik1:01:33

        I think they tried to control for comorbidities, but again they're, they're, they're ... I don't think they controlled for ... I mean they control for marriage I believe, um, but I'm not sure that they controlled for like in a relationship versus not and how healthy that relationship is. That certainly wasn't assessed.

30. 1:01:48 – 1:05:47

    Porn, is it bad?

    1. SBSteven Bartlett1:01:48

       I'll link to the study below so everyone can read for themselves about the, um, the controls in that study and how that was conducted. Uh, linked to this is, is the subject of porn. Um, it was interesting 'cause I was doing a lot of research on the subject of p- ... (laughs) That sounds a bit strange.

    2. RMDr Rena Malik1:02:00

       (laughs)

    3. SBSteven Bartlett1:02:01

       I was doing a lot of research on the subject of porn and where conversation's at with the subject and one of the quite startling things is a lot of people are trying to figure out how to stop watching porn.

    4. RMDr Rena Malik1:02:11

       Mm-hmm.

    5. SBSteven Bartlett1:02:12

       Um, a lot of people are asking themselves for mechanisms to, um, install things on their computer that prevent porn time and, um, searching for s- solutions around porn addiction and a lot of people were searching, um, about whether porn is a sin. And I think there's something broader here about the idea of shame-

    6. RMDr Rena Malik1:02:34

       Mm-hmm.

    7. SBSteven Bartlett1:02:34

       ... which is linked to porn. What is your take on, on this? Is porn a bad thing?

    8. RMDr Rena Malik1:02:38

       Yeah, so I don't think porn is a bad thing. I will start with that. Um, is it a sin is more of a moral question.

    9. SBSteven Bartlett1:02:45

       Yeah.

    10. RMDr Rena Malik1:02:45

        Right? And I think that that is, uh, something that you individually have to decide for yourself if you feel like morally it's inappropriate. But it's, it's entertainment, right? It's just a different form of entertainment and I think the issues with porn, um, because I, I would not say that it's 100% great. I think there are definitely issues with it. One, the big one that I've been very vocal about is children seeing pornography. So, um, we know now that the average age of a boy seeing pornography is 13 and that's the average, meaning that as young as eight to ten boys are being exposed to pornography, um, which was not the case when, for example, we were growing up, right? You had to ... I, I always say this, you had to find a, a, a tape maybe. Find a VCR in a room that nobody was gonna walk in or you had to find a magazine and hide it somewhere and go find it. And so it was not readily available. You had to work to be able to see that, and now seeing pornography is very readily available.And so, uh, very often kids are seeing it. Whether you, t- as a parent, don't want them to, whether you've put blocks on their phones and devices, um, they may have access to it from a friend or they may see it somewhere else. And, um, and your brain is not fully developed to understand, one, what you're seeing, and two, to understand that this is not real unless your parent has talked to you about, you know, this is sort of, uh, a movie that's not real life and this is not what sex is really like. And so I think that has, um, implications for, um, for how they view sex and how they then try to have sex with partners. And also, you know, because your brain's not fully developed, you're getting this big rush of dopamine from viewing something like that, and that's not something that we traditionally got at that age, right? And so it can become very addictive. Now as an adult, I think it's different because you have a fully formed brain. You understand the concept of this is not real, most people. Um, and so it can be just a way to have pleasure or n- even watch it with your partner and have pleasure. Um, but yes, we are seeing some people who have problematic pornography use. In literature, they say it's 4%. I suspect maybe it's a little higher now. Or people are finding that watching pornography is, is, one, easier than going out and trying to find a partner. You don't have to face rejection, you don't have to face the difficulties and awkwardness of having a first, a sexual encounter with someone that often happen. And so it can become a way, because it does relieve dopamine just like anything else, release dopamine, it can then become sort of a way to feel better about anything, right? Like, you can just be feeling down, you're like, "I wanna watch pornography 'cause it makes me feel better." It may not be just that you're really into sex, it's just that you're really, like, wanting that rush hit of dopamine. Um, and then there's obviously the shame that comes with, "Oh my God, why am I using pornography just because I feel bad?" And then you're like, "Oh, but I feel bad and so I'm gonna use porn again." Mm-hmm. And it becomes this sort of, like, negative vicious cycle that can occur. But I think when used for entertainment and pleasure, I think it's fine. And a l- many, many people use it for entertainment and pleasure without a problem.

31. 1:05:47 – 1:10:14

    VR headsets and porn

    1. SBSteven Bartlett1:05:47

       I, the other day, bought the Apple Vision Pro.

    2. RMDr Rena Malik1:05:49

       Mm.

    3. SBSteven Bartlett1:05:50

       That new headset. And I tell you what, Jesus Christ, that's, uh, unbelievable piece of technology. There's one feature they have on there, it's called spatial video.

    4. RMDr Rena Malik1:05:57

       Mm-hmm.

    5. SBSteven Bartlett1:05:57

       And I don't know if you've tried it yet, but you put it on, and if you've taken a spatial video, which you can now take on the new iPhone and also on the Vision Pro, it basically feels like a 3D video.

    6. RMDr Rena Malik1:06:07

       Yeah.

    7. SBSteven Bartlett1:06:07

       And it's n- like nothing I've ever experienced before. One of our team members commented that, you know, they, they'd lost a family member and they wished they had this because it w- it's like the person is back in front of you.

    8. RMDr Rena Malik1:06:17

       Mm.

    9. SBSteven Bartlett1:06:17

       It's not like a photo or video anymore. But then, little monster in my mind goes, "Hmm. There's gonna be other applications of this technology in, as it relates to pornography." And we're getting w- you know, if we just a- assume any rate of improvement with this technology, just, I don't know, 5% a year, we eventually get so close to it being indistinguishable from a human being that the incentive structure of going out and getting a date and, you know, for the, for the objective of having sex or whatever, versus just popping your headset on, which is gonna get cheaper and cheaper and cheaper, and better and better and better, um, becomes really lopsided. I.e., it's so clear to me that if we just go forward 10 years and we're on the Apple Vision Pro 17 Air, there's gonna be so many people that are using that as a way to, uh, masturbate and to watch pornography, and there's g- and it's gonna reduce the amount of people that are seeking real intimate relationships IRL, in the real world.

    10. RMDr Rena Malik1:07:16

        Yeah. It is a real concern, I would say. But you know, we know from some data that people will find physical touch, particularly in the care-bearing areas, um, very important in terms of intimacy with a partner, so, um, i- intimacy in general. And so I- I can only hope that that will continue, that you will want physical touch. Because no matter what you can see with your eyes, um, it's not touching you. It's not, like, it's still you doing the touching. There's no element of surprise or excitement or build-up in terms of, like, there's someone else in the room with you, right? So I can only hope that that, that will, that will be the case, but it still remain to be seen. However, I will share that there are some interesting, um, applications of this in terms of fear. So if you are really scared of something, you can actually desensitize yourself using these VR headsets, and it can actually be very powerful. So I was just speaking to a researcher, Lori Brotto, about how they're using it in their lab for women who have fear of penetration because they've had either trauma or they have pel- other conditions that are causing it to be painful. And so they can work with them to be using these headsets to simulate a sexual experience, and then they can sort of use a dia- like, use a tool or a dilator or something to then penetrate in a safe space, right? Not like you're with a partner and you're, like, trying to have sex and you're, you know, you don't feel very safe, sort of allowing that. It's very preliminary research, but I think ultimately, there are some positive things that maybe will come out of the use of these sort of VR headsets, and I can only hope that that will predominate and we can continue... an- and people will inherently want other people, right? That, we're, we're hardwired to be around people and to be intimate with people. Like, that's how our brains work. So I'm hopeful that that will, that will still remain to be the case.

    11. SBSteven Bartlett1:09:13

        You don't-

    12. RMDr Rena Malik1:09:13

        But I can't, I can't predict it.

    13. SBSteven Bartlett1:09:14

        You don't look convinced.

    14. RMDr Rena Malik1:09:15

        (laughs)

    15. SBSteven Bartlett1:09:17

        (laughs)

    16. RMDr Rena Malik1:09:17

        Well, you know, I mean, I think it's, I- I am worried, you know? I think that phones have changed lives too, right? Like now, our kids, our younger generation doesn't communicate as well because th- when they hang out together, they're sitting all together looking at their phones, right? And so we have to actively work to prevent. Like, I make my kids have full-on conversations with people. I say, "You gotta come and hang out with the adults and have conversations and, and talk to people." You have to coach them on how to talk to people, um, because I worry that people are too into... Even when they hang out with their friends, they're playing on devices, right? So, um...... I think there's, like, work that has to be done to prevent the- the- the easy dopamine rushes that these devices are giving us, right? So we actually have to actively work at it and people are inherently gonna take the route of- of the easiest thing. And so as a society, we have to sort of work together to sort of prevent these easy wins, easy things, easy dopamines from taking

32. 1:10:14 – 1:12:50

    Trauma and how it relates to our sex lives

    1. RMDr Rena Malik1:10:14

       over.

    2. SBSteven Bartlett1:10:15

       Something you mentioned within there though was the idea of trauma and I've, I'm quite interested in the role that our trauma plays in our sexual health and sexual dysfunction. What's important to know there and does trauma play a role at all in the patients you see?

    3. RMDr Rena Malik1:10:28

       Absolutely, 100%. So your body, when it goes through a trauma, it will then sort of, your body remembers even if you don't, right? So these people, very many people who have pelvic floor dysfunction, meaning their pelvic floors are too tight or too tense, they've had some sort of trauma. Not all of them. Some of it's just stress and anxiety, but sometimes they've had some sort of trauma years ago and it's been with... I had a, I remember having like a 70-year-old woman and she had such terrible pelvic floor dysfunction for God knows how many years that ultimately it caused really negative consequences for her bladder function. And, um, and so absolutely when you have a trauma that's unresolved, in some shape or form, it will affect you, whether it's your mental health, your physiologic health. I mean, our brains are so powerful that, you know, when it's in a bad place, it can affect you negatively. When it's in a positive place, it can affect you more positively. The one thing I will say is if you have trauma, getting therapy, getting help to resolve that trauma is so, so important. I talk to all my patients and I say, "Yes, you may have an organic problem, meaning a physiologic, bodily problem that's causing your sexual dysfunction, but everyone who has sexual dysfunction has a psychologic component because it is devastating, it is stressful, it is horrifying to feel like you're not normal, your body doesn't function normal, especially in an intimate space like sex." So I'm like, "Everybody should ideally see a sex therapist if it was available to everybody." But it's not, right? How can we allow people to have access to things they need? Because we don't teach these things in school, right? School, I mean, this is my big gripe, is like how can we make education better for children? Like, we need better sexual education. We need better education on how to resolve traumas or how to deal with them or how to get help, how to do digital health. Like how do you navigate the world with all this misinformation? How do you find good quality information? How do you assess it? Like there's so many things. Even how to balance your books, right? They don't learn that in school. So ultimately there's so many things that I think if we were really putting a critical eye on how we teach our young people that we could improve and part of that would be including people to know and realize when they need help through whatever trauma they've suffered or stress or anxiety that they're suffering and how that can propagate itself over a lifetime and create real problems.

33. 1:12:50 – 1:13:33

    Can you have sex when pregnant?

    1. RMDr Rena Malik1:12:51

    2. SBSteven Bartlett1:12:51

       I have to ask this question 'cause people mention this quite often. Can you have sex while you're pregnant?

    3. RMDr Rena Malik1:12:58

       Absolutely. Why not?

    4. SBSteven Bartlett1:13:01

       I ask it because it was one of the most Googled questions, um, online.

    5. RMDr Rena Malik1:13:04

       Really?

    6. SBSteven Bartlett1:13:05

       Yeah. It was one of the highest search volumes I've ever seen for a search term was can you have sex while pregnant.

    7. RMDr Rena Malik1:13:11

       Wow. I actually didn't... I mean, I- I- I've heard a lot of things and I think that people feel like, I've heard that men think they're gonna hurt the baby, they're gonna, um, they're gonna cause a problem, but no, absolutely you can have sex. You're not gonna create like a pre-term labor. You're not gonna harm the fetus. Like nothing bad is gonna happen from having sex while pregnant.

34. 1:13:33 – 1:19:36

    Orgasms and the clitoris

    1. RMDr Rena Malik1:13:33

    2. SBSteven Bartlett1:13:33

       Okay. So let's talk about orgasms and the clitoris then. You mentioned earlier that, um, there's disproportionately a lot less research done on the clitoris.

    3. RMDr Rena Malik1:13:41

       Mm-hmm.

    4. SBSteven Bartlett1:13:42

       As a man, what do I need to know about the clitoris? 'Cause I, I'll be honest, I know very little.

    5. RMDr Rena Malik1:13:46

       Mm.

    6. SBSteven Bartlett1:13:46

       I know where it is.

    7. RMDr Rena Malik1:13:47

       (laughs) That's a, that's a plus.

    8. SBSteven Bartlett1:13:48

       And I... (laughs) Yeah. (laughs) Well, um, I didn't always-

    9. RMDr Rena Malik1:13:51

       Not everyone knows that either. (laughs)

    10. SBSteven Bartlett1:13:52

        Yeah, I didn't always know where it was. A couple of misunderstandings, but, um, I f- I found it eventually and I- I think I know how to stimulate it, but I don't really know what's going on there or h- or how it works.

Episode duration: 1:54:08