#250 Rena Malik - Urologist Debunks #1 Sex Myth Every Man Still Believes

Rena Malik, MD, is a board-certified urologist and pelvic surgeon specializing in sexual medicine, urogynecology, hormone management, and pelvic pain. She completed her medical education at New York University Grossman School of Medicine, followed by a urology residency at the University of Chicago and a fellowship in Female Pelvic Medicine and Reconstructive Surgery at UT Southwestern Medical Center. Practicing in Newport Beach and Beverly Hills, California, with affiliations at Tibor Rubin VA Medical Center and University of Maryland Medical Center, Malik has over 10 years of experience treating conditions like urinary incontinence, overactive bladder, and sexual dysfunction. Named the 2023 American Urological Association Young Urologist of the Year and a Top 10 Health Influencer by Men’s Health in 2023, she has hundreds of millions YouTube views and over 2.5 million social media followers for her science-driven content. She hosts the Rena Malik, MD Podcast, offering expert advice on health, sex, and relationships, and has published over 80 peer-reviewed articles. Shawn Ryan Show Sponsors: Preorder Call of Duty: Black Ops 7 now - https://www.callofduty.com Buy PYSOP: Target Intelligence - https://psyopshow.com https://americanfinancing.net/srs NMLS 182334, nmlsconsumeraccess.org. APR for rates in the 5s start at 6.327% for well qualified borrowers. Call 866-781-8900, for details about credit costs and terms. https://betterhelp.com/srs This episode is sponsored. Give online therapy a try at betterhelp.com/srs and get on your way to being your best self. https://blackbuffalo.com https://meetfabric.com/shawn https://shawnlikesgold.com https://ketone.com/srs Visit https://ketone.com/srs for 30% OFF your subscription order. https://USCCA.com/srs Rena Malik Links: Linktree - https://renamalikmd.com/linktree Website - https://renamalikmd.com YT - https://www.youtube.com/@RenaMalikMD X - https://x.com/RenaMalikMD IG - https://www.instagram.com/renamalikmd Podcast - https://podcast.renamalikmd.com FP - https://www.facebook.com/RenaMalikMD TT - https://tiktok.com/@renamalikmd LI - https://www.linkedin.com/in/renadmalik Pinterest - https://www.pinterest.com/renamalikmd Threads - https://www.threads.net/@renamalikmd Sign up for Yourology Newsletter - https://newsletter.renamalikmd.com Link to schedule an appointment - https://www.renamalikmd.com/appointments In person in Beverly Hills or Newport Beach, CA and virtually in CA, FL, IL, NY, NJ, MD, TX, VA Learn more about your ad choices. Visit podcastchoices.com/adchoices

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:00Speaker 00

  Now, more than ever, we need someone on our side. But Rob Whitman? Whitman's votes drove up costs, cut Medicaid, and risked 350,000 Virginians' health care to pay for tax breaks for himself and his donors. He's not on our side. Shannon Taylor will fight corruption, cut taxes, and bring down costs. This November, vote for Shannon Taylor. She's for us. Paid for by HMP, the HouseMajorityPac.com. Not authorized by any candidate or candidate's committee.

• 0:29Speaker 01

  If you've got an insurance question, you could talk to the butcher at your local grocery store. He'd probably talk about trimming the fat, but it'd be about your brisket, not your insurance policies. Or you could talk to your local GEICO agent. They offer personalized assistance in finding the choicest cuts of coverage for all your insurance needs, which means more money for filet mignon, or, if you're a vegetarian, tofu le mignon. To find a GEICO agent near you, visit GEICO.com-local.

• 1:05Shawn Ryan?

  Rena Malik, welcome to the show.

• 1:07Speaker 03

  Thank you so much for having me. It's truly an honor.

• 1:09Shawn Ryan?

  Oh, man, it's a... I've been looking for it. I told you at breakfast, I've been look... I didn't even think we were gonna get you.

• 1:15Speaker 03

  Oh, no.

• 1:15Shawn Ryan?

  But, uh, but, uh, me and my wife found your channel years ago, and I was... Some of the titles, I'm just like, we gotta watch this stuff. Everything from, what's the average length of sex, squirters? How many times should men ejaculate? Like, it's just, the titles are so bold, and it's questions that everybody has, but everybody's too embarrassed to ask the question, and you just do an awesome job of covering all that, so.

• 1:46Speaker 03

  Thank you. I mean, I'm glad to give that advice, because I don't feel like anyone's really answering those questions in a way that's professional and authentic and genuine, and explaining like, why. And so, um, I'm grateful to be in the position to be able to do that.

• 2:01Shawn Ryan?

  Well, it's, uh, congratulations on all your success. It's, it's, looks like a rocket ship, so. But, uh, everybody starts off with an introduction here, so. Rena Malik, a board-certified urologist and fellowship-trained specialist in female pelvic medicine and reconstructive surgery, expertise in sexual medicine, hormone management, menopause, and non-narcotic pelvic pain treatment. You run a private practice in Beverly Hills and Newport Beach, California. Also, you work at the VA, 2023 American Urology Urological Association Young Urologist of the Year, a content creator with over 2.5 million YouTube

• 2:46Shawn Ryan?

  subscribers focused on evidence-based discussions of taboo health issues like sexual dysfunction and bladder health. Like I said, some of the titles that I've seen is "Does Size Matter", "Squirters", "Does Pineapple Change the Taste of Semen?", "Is the G-Spot Real?", "Penile Implants". I mean, you cover all of the taboos topics, and I just, I love watching your stuff.

• 3:10Speaker 03

  Thank you. Thank you so much.

• 3:12Shawn Ryan?

  So, a couple of things to get through. One, everybody gets a gift.

• 3:18Speaker 03

  Amazing. Thank you.

• 3:20Shawn Ryan?

  Those are Vigilance Elite gummy bears, made in the USA, and it's just candy. Legal in all 50 states, although you don't have to worry about that out in Cali.

• 3:29Speaker 03

  That's good, yeah.

• 3:31Shawn Ryan?

  And then, we have a subscription account on Patreon, and a lot of these folks have been with us since the beginning. I think we're getting close to 100,000 subscribers on there now. And so, you know, we built it into quite the community, and they're the real reason that I get to be here with you today. And so, I offer them the opportunity to ask each and every guest a question on the show. This one is from Austin Coats.

• 4:00Shawn Ryan?

  "If 40 years old and nine years into recovery from opiate addiction, I've done deep, deep emotional and spiritual work that sobriety demands, but I still find myself wondering about the long-term physical impact of addiction. Does chronic substance use accelerate biological aging in men, and how does long-term sobriety affect the brain and body's ability to heal? Specifically, can neuroplasticity in recovery processes fully reverse the damage, or are there systems like hormonal, cognitive, or metabolic function that remain permanently altered?"

• 4:34Speaker 03

  I mean, the body is very resilient, right? So it depends on how long you were addicted, how long you've been sober. But your body can recover. It just is very individualized. So I can't give you like a blanket statement that yes, after this many years, you'll be good to go and everything will be back to baseline. There may be permanent neurologic damage that is very difficult or impossible to reverse. But I will say, like, I've seen many people with traumatic brain injuries, with really severe issues that, you know, can, even despite those issues, have very healthy, long lives. And sometimes they do require maybe some replacement of hormones, for example.

• 5:16Speaker 03

  But that doesn't preclude them from being optimized, living their best life, and feeling good, and being able to be healthy, and be good partners, be good parents, be good workers, all those things. So I think the reality is, you might need some help, but even if you do, you can still live a great, wonderful, healthy life, and be able to contribute to society in a meaningful way.

• 5:38Shawn Ryan?

  Oh, that's good to hear. I mean, I'm recovering from addiction. I wondered the same things. I thought that was the perfect question. And, you know, especially talking about traumatic brain injury, and I don't know if we're going to go into PTSD, but you work at the VA, you deal with a lot of veterans. We have an enormous, probably the biggest veteran viewership subscriber list in the country at least. And so I know these are behind the scenes discussions that we're all having about this kind of stuff. And so I'd love to clear some of that up. But I want to ask right off the bat, because we're primarily focused on men's health for

• 6:19Shawn Ryan?

  this one, and we're going to release this in men's health month, and our men's health awareness month. But I think the squirter...

• 6:29Shawn Ryan?

  Youtube video that you did was the first one that I saw and I was like, I have to see this. So what, can you just go into that?

• 6:37Speaker 03

  Yes. So squirting, um, obviously is a very popularized thing and everybody wants to know, like, does everyone do it? Is it normal? Like, what is it? And so let me just start with the biology, right? So biologically, what, what is squirting? There's squirting, there's female ejaculation, there's normal lubrication, there's all these fluids, right? So normal lubrication, everyone's pretty familiar with. It just occurs when you're, when a female is aroused, she has normal lubrication from the walls of the vagina, essentially, and some little glands on the side. Um, and then there is, uh, female ejaculation and there's squirting. So squirting is like this clear odorless fluid that's emitted at the time of orgasm. It's usually volumous. Um, I, it's usually, what I've been told,

• 7:21Speaker 03

  tastes a little bit sweet. Um, and so that this is this fluid that some women, not all, so it's a probably like 40% of women will squirt when aroused fully. Now, where is it coming from, right? I think that's what people want to know, is it pee? And so obviously it's coming from the urethra, which is like the pee tube. And so the bladder, when it, you know, fills, normally you pee from the pee tube or the urethra. Now, it is coming from there, but it's not urine. So they've actually looked under microscopes and looked at like, okay, let's compare what's in pee to what's in squirting. And they're, they're similar but different. So squirting is usually like a very dilute form of urine and also has another substance in it called PSA. So you guys might know PSA is something that you get tested when you're screening for prostate cancer. The prostate emits PSA.

• 8:05Speaker 03

  It's called prostate specific antigen. But, you know, think about when people develop, when babies develop, they start from the same structures and then you have signals that say, okay, you're going to become a female, you're going to become a male. So we have homologs. So the female prostate is called the Skene's gland and that's located basically underneath that urethra, uh, about two or three centimeters in, and it has these little tiny like glandular structures that produce fluid. And so that is where the PSA comes from. So it's a mix of a very dilute urine with this PSA. Say substance that's coming from the skin's glands when it's stimulated or when you're aroused. And so there's a few different theories. They've done lots of studies. Well, not lots, but they've done like three or four studies on squirting.

• 8:49Speaker 03

  They've actually put like dye into the bladder and then had people squirt and see like, is it blue? Or is it like they use blue dye and they've seen, yes, it is blue. They've done studies where they'll like scan the bladder before someone squirts and then they, the person squirts and then they check the bladder again. Okay, it's empty. So it's probably urine. And so there's, there's a lot of people who think like, yes, it's urine. Um, but there's other experts who would say like, well, when you're aroused, there's a bunch of hormonal changes. And so it may change the way that your kidneys filter. And so you're not getting exactly urine. You're getting this very dilute fluid that's very distinct in terms of color and odor and all that. But it is obviously coming through the bladder. So I think ultimately, like, there's a lot of hubbub about it. At the end of the day, it doesn't really matter, right?

• 9:33Speaker 03

  What matters is that is the person squirting, enjoying it, right? Do they actually like it? And so when you look at that, what you find is that it's mixed. So some women are like, yeah, it's a superpower. I feel great. I'm amazing. I can squirt. I really enjoy it. It's very pleasurable. Um, other women feel like they don't know what's going on. They feel embarrassed. They feel like it's messy. Um, and other women are like sort of ambivalent, like whatever, it's just kind of a mess to clean up and it's fine. Um, so I think like the reality is that like, it may, that when you watch erotic films, it makes it seem like everyone squirts. And squirting is this really amazing visual representation of pleasure. The reality is that like pleasure, the way you can tell a female has pleasure is you ask her, right?

• 10:15Speaker 03

  Like, did you enjoy that? And what can we do differently to make it better or not better, right? Like what was good, what wasn't good, just like you would ask anybody anything, right? But we don't do that. We want to see it, right? And men are ve- very visual because they ejaculate. So they're like, oh, like this is female ejaculation, which is actually different. But, um, but this is like them reaching climax. I can be sure they're climaxing because I see this visual representation of it. And the reality is the majority of women don't squirt, um, at sixty percent or so don't. And that doesn't mean they're not orgasming or having A climax, they are, and they're probably having a lot of pleasure when they do climax. And even if they don't climax, which some women have struggle with that. The entire process of having sex can be pleasurable.

• 11:00Speaker 03

  Um, so I think it's really like, let's not focus on this one. End product of sex and actually look at the whole thing and like, let's talk about pleasure as a society. And let's talk about like what that means for you and your partner and actually enjoy sex as. Something that we do and we join and we have this like meaningful connection with another human being rather than focusing on like these really arbitrary. Markers of pleasure.

• 11:26Shawn Ryan?

  So what, I mean, what, what, what is it about some females that enable them to do that? Versus others that, I mean, why do sixty percent of females not squirt?

• 11:37Speaker 03

  Yeah, so we can't be a hundred percent sure, but I suspect that it is because of variations in anatomy and how women are aroused. So we think like, yes, maybe if you arouse that skein's zone area, which is actually where we think the G spot or just it's actually a zone. G zone is, is that right around that skein's glands that maybe that would be more likely to cause someone to squirt. The other thing is that, you know, it may be also like, how thick is that anatomy? Like there is variations. They've actually looked at ultrasounds and some, some is thicker, some is thinner, some is more, some skein's glands are more voluminous, voluminous than others. And so there's probably variation why some can and some can't. But again, it's not mandatory. And I think that's really the take home. It's like, it's not mandatory.

• 12:19Speaker 03

  And just because someone can't, they shouldn't feel um, like deficient in any way. And just because someone can doesn't mean that they're better than someone else. But again, the goal is pleasure. And so like, I find it very awkward. Like some people like, oh, can you squirt? Like, oh, this is so amazing. Like, that's great if you can. And yes, there is some people who believe you can be taught to squirt. And again, like, I think there is some potential, like, you know, you can try to stimulate those areas. You can maybe fill the bladder, like, don't pee right before sex. There's probably some things there that can make that more likely. Um, but again, it's not the squirting, it's the pleasure that we want to focus on.

• 12:55Shawn Ryan?

  Man, that's interesting, interesting. All right. So I want to move into, want to do a little bit of a life story on you and then get into all the health stuff. But I mean, where did you grow up?

• 13:05Speaker 03

  I grew up in Buffalo, New York.

• 13:07Shawn Ryan?

  Buffalo, New York.

• 13:08Speaker 03

  Yeah.

• 13:08Shawn Ryan?

  What, what got you into urology?

• 13:11Speaker 03

  Yeah, so it's actually not something I even knew existed. It's not a specialty I went into medical school thinking like, oh, I'm gonna be a urologist. I went into medical school thinking I would be like a cardiologist or something. And I went to med school, I did my rotations, and then I realized that like, I really liked surgery. I liked operating with my hands. I liked being able to fix a problem with surgery. Whereas like when you take care of patients with medicine, it's much more like long-term trying to fix their issues. And so then I, but I didn't love general surgery, which is like surgery where you do all different body organ structures. And so I looked at the subspecialties of surgery. And so those were urology, obste- orthopedics, ENT, and ophthalmology, which is eyeballs.

• 13:55Speaker 03

  Ophthalmology, very quickly, I saw one operation, was like, this is not for me. I don't like eyeballs. So that was easily, easily taken off the table. ENT, so orthopedics, very power tool heavy. The culture was very, at the time, kind of bro-y, and I was like, okay, I don't really fit in here. And so then it was really between ENT and urology. There's also other subspecialties. Oftentimes, you have to go through a general surgery residency to do those. Or neurosurgery is also separate, but that's like, that's just a very intense field that I wasn't personally interested in. So I looked at those two fields. I went to their operating rooms, I met the people. And I was like, okay, like, they both do pretty cool surgeries. They both do, you know, have a very nice culture.

• 14:39Speaker 03

  But I honestly, when I met urologists, I was like, okay, I found my people. These are like, very smart, very intelligent, very innovative people, but they also don't take themselves too seriously. Because when you're dealing with genitalia all day, like, you just can't. You can't be like, so intense about everything. It's like, sort of a funny field, and funny things happen. And so I was like, okay, these are my people. And the reality is, when you're in medical school, you sort of take a leap. Because you can't ever know what it's really exactly like to maybe do the surgery, or to take, be the one taking care of all the patients, all yourself. And so you take a leap of faith. You're like, okay, I like this. I think this is gonna be the right fit. And sometimes people switch their chains. Their minds and go to a different specialty. But for me, it was absolutely the right fit. And I love, I love every part of urology.

• 15:23Speaker 03

  I think we are very honored and privileged to take care of patients at their most intimate issues and take them through that. But we also get to take care of patients for a long period of time. So like we take care of long lifetime issues. So they don't just come and have surgery and leave. Like they may have to deal with medications or do other things. And so we touch base, we keep that long-term connection with patients, which is really great.

• 15:47Shawn Ryan?

  Across Co-op Campaign multiplayer and zombies. It's pushing the franchise into bold new territory. The all-new Co-op Campaign lets you play solo or with friends as you infiltrate Avalon, a high-tech stronghold on the brink. At launch, jump into 18 explosive multiplayer maps with exciting, fast-paced movement. If you're looking for some undead action, the round-based zombies mode is back again with a twist. You'll fight through hordes of zombies as you drive the new wonder vehicle named Old Tessie and wield a brand-new wonder weapon. Black Ops 7 doesn't just evolve, it reinvents. If you thought you knew Call of Duty, get ready for something even bigger.

• 16:31Shawn Ryan?

  Pre-order Call of Duty: Black Ops 7 now. Available November 14th, rated M for Mature.

• 17:35Shawn Ryan?

  What is, what is, you know, in your intro, non narcotic pelvic, pelvic pain? Was it reconstruction?

• 17:43Speaker 03

  Well, so there's, yeah, there's pain, there's reconstruction, there's pain medicine too. So pelvic pain is a really challenging issue for a lot of people. So they deal with chronic pain in their pelvic region. I see it in vets too. I mean, commonly because it's my specialty, but I see it. And it's, it's very difficult to treat and it's very challenging for a lot of people to live with. And a lot of times they just get treated with pain medications. And so we try to offer them options that are not necessarily pain medications to help manage those issues. But pelvic reconstruction is, is basically, we are sort of like the creative surgeon. So we'll see a problem and there's multiple different ways to fix it. And you'll sort of figure out what is the best way for that individual person. So it could be like a narrowing of the urethra.

• 18:26Speaker 03

  It could be a narrowing of the tube that drains the kidney. It could be in women, like when they have things like prolapse where they're, they have like sort of a vaginal hernia. There's a variety of different surgeries that we can offer to help sort of reconstruct things when they're broken. And sometimes they're very complex and sometimes they're simple. But it's, it's sort of like, I was drawn to it because every surgery is a little bit different. And you get to like, sort of look at it and approach everything a little bit differently. And there's no like formulaic way to go about it. It's sort of like, okay, every person is individual. So I have to look at them as an individual and really come up with the right plan for them.

• 19:04Shawn Ryan?

  What, what, then, I'm just curious, I mean, it's, it's great to see somebody like you inside of the VA. I mean, I haven't been there in a long time, so I don't know how it's really going, but didn't have a good experience roughly about 10 years ago. And so I'm just curious, what, what, do you come from a family of veterans, or?

• 19:24Speaker 03

  No, I am, I just loved, so I trained in New York and I went to the Manhattan VA. And then when I started my first job, I worked at the Baltimore VA, and I just love taking care of veterans. I feel, one, very honored to do so, like you guys have served our country, you've done so much for us. So for me to be able to give you back some semblance of health, like, is so valuable to me. Like, I feel grateful at the end of the day. And, and two, I just feel like, um, they're, it's just a different character of patient, right? They're respectful, they're kind, they want the best for themselves, right? They really do. And there's, and sometimes they're struggling very deeply through some, you know, through a lot of things in their life, but they, they really, they have this drive to get better,

• 20:09Speaker 03

  right? And sometimes they don't get the tools to do so, but they really do want to. Like, they're not going through life like just accepting, you know, sort of whatever comes to them. They want to get better. And I think that that is so unique and, um, and honestly, like, it is, it is really, I feel grateful every day that I get to go to the VA.

• 20:29Shawn Ryan?

  Well, thank you for doing that. And then your YouTube. So you said that you started in 2019.

• 20:35Speaker 03

  Yeah.

• 20:35Shawn Ryan?

  What, I mean, being a physician, and a really good one, I mean, how did you, how did that even pop up on your radar? Why did you start the channel?

• 20:45Speaker 03

  Yeah, so I, when I was in, I was in academic medicine, I was doing what we, like, we do research, right? And so one of the research areas that I found really compelled me was health literacy. So like, I would have patients come and they would get to see me for maybe 30 minutes, maybe 15 minutes, depending on what they were there for. And I would give them all this information, but it was just not enough time, right, to really explain, like, why and what, like, I only have so much time because insurance only reimburses so much and you've got all these pressures to, like, You know, see a certain number of patients or you, you know, or you're gonna get in trouble by the power of Big Brother, right? And so you, you get in this situation where you're not able to really give patients the time and energy they deserve, right?

• 21:27Speaker 03

  And so you're like, look, this is a, a problem that you have a lot of power to fix, but I can't go through all of these things with you in thirty minutes. And so I realized I really wanted to be able to reach people at home and be able to teach them so that they would, you know, be able to learn and understand better. And once I think people understand what's going on with them, they can then, like, you can actually take the steps you need to take. But if you don't understand it and your doctor just gives you a pill and says, go, bye, see you later, see you in six months or a year, like, you're like, I don't know what's going on with me and I don't like, you just feel like that's all you can do, right? And so I, and even with surgery, like, I do a lot of quality of life surgery. And so if I do surgery on someone and they don't understand, like, what could happen,

• 22:10Speaker 03

  what complication could happen, or how their life is gonna change, now I failed as a surgeon, right? Because I operated on someone who didn't completely understand the situation. So I felt like this was something really important to me, but I realized that doing it through the traditional research route would take me decades before I got to a point where I was really reaching the masses. So I said, let me try this, right? Let me try educating online. And so I was like, okay, I'm just gonna try YouTube, like, why not? And so for six months, I just made a video a week and I had no idea what I was doing, but I just, like, did it, right? And then as I started doing it, I realized, like, wow, there's so much need for sexual health education. There's, people know nothing, right? And they're getting preyed on by people who don't know much either, but are trying to make a quick buck, right? They're preying on desperation.

• 22:55Speaker 03

  People are desperate to have better sex lives and they will then pay money to get better sex lives to anyone that will offer it, right? And so I felt like, okay, this is gonna be my, what I give back to the world, is I'm gonna educate them on how to help them have better sex, have a better life, feel better, feel stronger. Um, and, uh, and it just was, I, after six months, I was like, oh, I have a thousand subscribers, that's it, I'm gonna keep going. And I felt like I was famous back then, I was like, this is great. And then I just kept going and I'm still so grateful that people tune in to me like every week and and learn from me and it's it's so motivating and it's it's really amazing to be able to reach that many people.

• 23:34Shawn Ryan?

  Well, congratulations on all the success that you've done. You've done an amazing job with it. I mean, I'm curious, I mean, do you get any backlash about some of the topics that you cover?

• 23:45Speaker 03

  Of course, of course. I mean, I think a lot of backlash comes from things like that people feel very passionate about and and they feel like they know because of their personal experience. And I what I really, and I'll give you some examples, but what I really want people to realize is like, I'm not trying to invalidate your experience. I'm just telling you what the science is and and, you know, your life's experience is your life experience. So for example, semen retention is something people feel very passionate about. The people semen retention is the practice of abstaining from any form of ejaculation, whether it's through a partner or through masturbation. And and people and I started like, kind of known at November, and I was like, oh, let me just debunk this because I was seeing patients who would try to abstain. And when they did, they would tense up their

• 24:30Speaker 03

  pelvic floors, which is like this, these muscles sitting here in our pelvis that hold our organs up. And then because of that, they would start having other problems. They would start either having pain with erections or ejaculation. They would start having the need to go to the bathroom more often, or they'd get constipated. And and it was because they were like white knuckling, trying to hold back, trying not to ejaculate. And it was causing them harm. And they were stressed, right? They were super, they felt like failures when they did. They were unhappy. They were they were feeling bad about themselves. And and they were like, oh, I can't do this. Like, I'm struggling. I'm a failure. And so I wanted to, I wanted to target those people who felt like, oh, I need to do this because people are telling me it's so great. And and I'm like, look, it may be great for some

• 25:13Speaker 03

  people, and it may make you feel better. It may make you more able to focus on things or have more brain clarity. But that's an individual experience, and it's very nuanced. So I wanted to give people who felt this sort of like, failure, or felt this sort of stress or anxiety around it to not feel that, right? Like, not feel like they had to do this to achieve some higher being.

• 25:36Shawn Ryan?

  What I mean, how did that even, how did that even, what's? What's the myth? Like, what do you, what do you supposedly get out of No Nut November?

• 25:45Speaker 03

  So, No Nut November was actually like, came from a meme, right? Like, somebody was like, "Oh, No Nut November, we're gonna start No Nut November on November 1st, and like, by midnight, oh, I failed already," right? And then, but it took off. And, but semen retention as a practice is actually like a Buddhist Taoist practice that, uh, that, and there's some religious or spiritual background behind it. People felt that if they would abstain from ejaculation, that they would be able to focus more on spirituality, on, on God, or a higher power, and they wouldn't be distracted by desire and urges for sex. And so, that's sort of where it came from. And, and from that, they, you know, they would think they would get all these health benefits.

• 26:28Speaker 03

  Like, they would get this brain clarity, they would get testosterone boosting, it would improve fertility, like, all these things. But the reality is, those things have been looked at scientifically, and there has been no true, meaningful increase in testosterone or fertility. In fact, if you abstain for too long, you can harm your fertility. Um, and so, I think the reality is, is there a physiologic benefit? Not that we see right now, based on the evidence that we have. And, but if you see a psychological benefit, by all means, please, go ahead. But just don't make other people feel like they have to do that, you know? Because everyone is different, and they're, you know, ejaculating or being intimate with their partner, or masturbating, may be a really valuable part of their lives that now they feel like they have to give up on

• 27:13Speaker 03

  because they hear something that they think is like, "Oh, this is so much better for me to do this."

• 27:18Shawn Ryan?

  Man, it just seems like something that would cause a lot of sexual frustration and, and that would, you know, be amplified during the month, as the month goes on, but...

• 27:29Speaker 03

  I mean, the thing is, like, some people, what happens is, when you abstain, you, you, you stop, like, you may be able to, like, particularly for people who are very fixated on, um, on sex, they may be able to then, like, once they get over that hump, they may then, "Oh, I'm more focused on other things, I'm more, I, I don't think about that anymore." Like, the desire will naturally go down after some period of time because you've now, like, overcome that constant urge, and that may lead to more productivity, or more happiness, or more joy in some people. But it's not everybody, right? And I think it's, like, very individual.

• 28:01Shawn Ryan?

  But I mean, wouldn't, wouldn't the body just take care of itself?

• 28:04Speaker 03

  It does.

• 28:04Shawn Ryan?

  I mean, I mean... Would a man just store up all of that semen for a month?

• 28:10Speaker 03

  So what happens is either you're gonna have a wet dream. So you're gonna have a nocturnal emission. And so then that was the other thing. People would have wet dreams. They'd be like, oh, my God, I failed. And it's like, no, you can't even control that. Like, you are asleep and it's normal and healthy. Like, your body is just taking care of itself. Or they would just absorb it. Like, their body absorbs it and your body's constantly making more semen. Right? It's just like, it's constantly doing that. So it's sperm specifically, but, you know, it's making more all the time. And so, like, there is no, it's not like the actual semen itself has some powerful properties. It's really just, like, dealing with, I think, the mental aspect of it.

• 28:47Shawn Ryan?

  Interesting, interesting. Let's move into, actually, before we move on, are there any other viral trends that you've kind of had to correct?

• 28:57Speaker 03

  Yeah, so there was one on TikTok for a while. There was a lot of people talking about what's called jelking.

• 29:03Shawn Ryan?

  What is it called?

• 29:04Speaker 03

  Jelking.

• 29:05Shawn Ryan?

  Jelking?

• 29:05Speaker 03

  Yeah, which is like this practice to increase penile length. And so it's like you make an O with okay sign with your finger and you actually, like, it sort of slowly extended the length of the penis. Over time, there's exercises, stretching exercises, essentially. And so people would be like, oh, I did this and I increased my penile length and it was great. And so they were talking about this a lot. And, and actually, that sounds very safe, right? Like, oh, I'm just stretching. Like, what's the big deal? But sometimes, and you can probably relate, because most men, when you tell them to do something, they don't just do it. They want to do it the best, right? And so they're like, but you don't just, you tell someone to do something that might improve their life, they're not gonna just do it. They're gonna go 10x and do it even more, right?

• 29:46Speaker 03

  And so there's actually some people who would come into the urologist because they've been doing this. And, you know, my colleagues have talked to me. It's even in some published data. People would jelk and they would come in and they would develop erectile dysfunction because they've now damaged their penis. And that's not necessarily reversible. And so it's, you know, it's like, there are ways to safely lengthen potentially, but jelking is not one of them.

• 30:11Shawn Ryan?

  What are the ways?

• 30:13Speaker 03

  So the the safest way for length is a traction device. So you can buy traction devices online. These are sort of devices that slowly extend your penis with a little bit of pressure over time. And they have and they are meant to be very minimal prep, like minimal tension over time. So you there are some that you will use for six hours a day and like go to sleep with them. There's some that you can get that you can do 30 minutes twice a day, but they are a commitment, right? You have to be like doing it a lot. And and then they do work and they've been shown to increase penal length by about two centimeters. When you've done it for

• 30:48Shawn Ryan?

  Two centimeters?

• 30:49Speaker 03

  Yeah, for prolonged periods of time for months on end, then you will see an increase. And that's on average, right? So some may see a little more, some may see a little less. But that's generally what they've seen in the studies. And so yeah, I think there are ways to do it, but it's a commitment, right? You have to be disciplined, you have to keep doing it. And you have to is that what you really want to spend your time doing, right? And that's fine if you do no judgment by all means, you know. But I think that that's just that's probably the safest. Now, there's other things that are available. There's surgical options. There's, you know, those are there's there's, you know, but basically surgical options are available to lengthen and enhance girth. Girth probably the safest is to do fillers, like like women get fillers on their face. There's the same

• 31:33Speaker 03

  sort of hyaluronic acid fillers that you can get injected into the penis. But they don't last forever. They're like 18 months or so and they'll dissolve. So there are options.

• 31:42Shawn Ryan?

  Is that safe?

• 31:43Speaker 03

  You know, we don't have a ton of data, but like I wouldn't inject anything else. So there are like permanent fillers. People have like in jail have injected all sorts of things in their penis, like so, you know, like all sorts of things, which please don't inject your penis with anything. But if you know, you're going to if you are very intent on doing it, and you've sort of talked to your doctor about it, and you know, it's not like a psychological issue that needs, you know, attention from a psychologist, because there is what we call small penis anxiety, right? People who really feel body dysmorphia, like there's something wrong with them. And that require not requires, but should have attention from a psychologist, so you can work on your thoughts around it. But you know, if you don't have a dysmorphia, and you just want a bigger penis, like I

• 32:27Speaker 03

  think that's the safest option in terms of in terms of an intervention. There are some, um, you know, people who will use vacuum erection devices or penis pumps. There's no evidence in the literature that this actually results in enhanced girth, but some people report that they noticed that. Again, I think it's all temporary when you're using these traction devices and pumps. Like, I don't know that you're gonna have a lasting effect, but I don't know. We haven't looked at it in the long term in terms of like scientific data. It's only anecdotal, what patients tell us and what we see. Um, so I think ultimately, like, I wish, I wish there was a way, right? Like, women can enhance their breasts, they can get breast augmentations, but men still don't have that option, right?

• 33:07Speaker 03

  To enhance their genitalia if they really want to, um, in a, like, a permanent, meaningful way yet, um, in a very safe way. And I wish we had it, because I think men, just like women, should have that option if they want it, right? Um, but at this time, like, you have one penis, it is very important, and if something happens to it, now you're stuck with that complication. And so, I, I just think it's really important to think about that before you proceed with anything that's irreversible.

• 33:35Shawn Ryan?

  Now, I mean, this, I wanted to cover this later on, but we'll just do it right now since we're on the subject. I mean, size, does size matter?

• 33:42Speaker 03

  Yeah, so, this comes up all the time, right? Because we are in a society where size is revered, right? Like, you will see people joking about it, you will see, I mean, even my, my children will joke about their penis size and they're prepubescent boys, right? Like, where did they learn this from? We don't talk about it at home, like, they learned it from their peers. So, um, this is something that's pervasive, right? People automatically assume bigger is better. The reality is, when you look at the data, people overestimate what average is. So, they think average is like six inches erect. Average is more like 5.1 to 5.6 inches, depending on the study you look at. Um, that's erect, not flossing. Um, and then, you know, so, fine, average is overestimate.

• 34:26Speaker 03

  We're really bad as human beings at estimating. So, when you actually look at people who, you know, you show them, like, this is a, a five-inch penis, a six-inch penis, this is a seven-inch penis. What are you estimating? So when you have like an average sized penis, they tend to overestimate the size. They think it's like six or seven inches, six inches. Um, and then when you have a slightly smaller than average penis, you tend to underestimate. And when it's bigger, you tend to overestimate. So we're just really bad at one estimating. And when you, and a lot of men will measure their phallus and you know, it's so variable. How warm is it in the room? Like what, you know, how aroused are you in that moment? Like if you're more aroused, you might be a little bit tiny, but longer, tiny, bigger

• 35:07Speaker 03

  here, right? And so it's so variable that like, it's hard to say like, okay, this is my number. Like this is how big I am. Right? Um, and then it's, so in terms of like pleasure, right? Cause I think that's what guy thinks, oh, if I have a bigger penis, I will more easily be able to get my partner to orgasm. It will feel better for her in a heterosexual relationship. And the reality is that's not necessarily true. Like of course there are women who prefer longer penises. They enjoy stimulation, deep stimulation during sex. But that's not the majority. I would say 85% of women need clitoral stimulation and the clitoris is above the urethra. It's the area that is very sensitive. It is the homologue of the penis. So it is essentially exactly the same. If you like cut up in a cadaver

• 35:52Speaker 03

  and you look at the anatomy of the clitoris and the penis, the clitoris and penis look identical. The clitoris is just smaller and internal, whereas the penis is external. So if you stimulate the clitoris, you will reliably reach orgasm in the majority of women. And that doesn't require a penis necessarily, right? You can do that with your hand, with your mouth, with a toy, with a whole bunch of different things and not necessarily from penetration. Now, yes, can, will you be stimulating this clitoris when you penetrate? Yes, to some degree because the clitoris is above the urethra and so indirectly you'll be stimulating it. And some women, like I said, the anatomy is variable. So some women may orgasm more easily just through penetration alone.

• 36:35Speaker 03

  But the large majority of women need either penetration and clitoral stimulation or just clitoral stimulation to climax. And so the reality is that size is not necessary for pleasure. Size is not necessary for a good orgasm. And it is, it is something that we have just made into this big thing. And if you ask women, like when you do surveys of women, eighty-five percent of them are like, I'm happy with my partner's size and I'm totally fine with it. And it's like forty-five percent of men who feel like they're satisfied with their size. So it's a big dichotomy because we've made it to feel like it's so linked to masculinity or the ability to provide pleasure, but the reality is not so much.

• 37:16Speaker 03

  And when you look at even anatomy for women, the vaginal length before it's engorged and aroused is about three to three and a half inches. So if you think about it, like if you're really large, you can't even really penetrate the entire vaginal length. And so there's actually products that you can wear, like buffers, that you don't hurt your partner when you have sex with them, if you're a little bit larger than they are. And so it's not, it's sort of like a fit, right? Some people have a better, have a longer vagina, they may enjoy a longer penis. But again, it's not universal, right? It's not universal.

• 37:49Shawn Ryan?

  What about girth?

• 37:50Speaker 03

  Yeah, so girth, again, I think girth is because there's, the clitoris goes deep into the pelvis and it goes around the vagina. There's like the clitoral bulbs and the legs of the clitoris. So when you have a little more girth, it can stimulate more of the clitoris, right? You're not just focusing on the top, you're also getting the side of it. So it can be helpful, absolutely, to be more girthy. But there's a limit. So in fact, when they, this actually came out from people who do male to, female to male surgery, when they were building phalluses, they realized that they were making them too girthy. And like, it was actually difficult to have sex. So they actually had to look at like what kind, what they did was they looked at what kind of sex toys women are buying to decide like what was the right size for the majority of women.

• 38:34Speaker 03

  Because they were like, oh, we were just making them too big. And like now, this person who wanted, who wants a penis is like not able to use it because it's too big for the partner to accommodate it. And so really, it's like- If you look at what type of sex toys women buy, they buy a little bit longer than average. And the same girth as average, which is, you know, about five inches or so. So it's it's very similar to the average guy. They're not buying those really obscenely large sex toys. Like, it's just not, I mean, they might for a gag gift or something, but most women are not using those to pleasure themselves. And so that doesn't necessarily, meaning you don't really need a lot more than average to pleasure a woman.

• 39:13Shawn Ryan?

  What is average girth?

• 39:15Speaker 03

  Average girth is about four to five inches around.

• 39:19Shawn Ryan?

  Okay.

• 39:19Speaker 03

  Yeah.

• 39:20Shawn Ryan?

  Okay.

• 39:21Speaker 03

  Yeah.

• 39:22Shawn Ryan?

  Wow, interesting, interesting stuff. So I wanted to, you know, erectile dysfunction, I mean, you see all the drug ads, we see, I mean, it's it's everywhere. What are what are some myths about erectile dysfunction?

• 39:38Speaker 03

  Oh, there's so many. I would start with, like, I think that for the first time a man has an issue with an erection, he feels like it's over, right? And the reality is there is normal fluctuation. There are times where you will struggle to get an erection because we are not static human beings. You are not machines, right? You are people. And so you will feel stressed or anxious or or maybe you won't feel well that day. Or maybe you had a really stressful day and your testosterone is lower than another day, right? All these things can play a role and and you might have trouble getting an erection that day. It doesn't mean you're broken. It doesn't mean that you're doomed for a life of erectile dysfunction.

• 40:18Speaker 03

  But it it often plays out that way because the second a guy has an issue with an erection in the bedroom, the next time he's having sex, he's thinking about that. He's not enjoying himself. He's not thinking about, wow, this is so hot and I'm having the best time of my life. He's thinking, oh, my God, am I going to have an erection? Is it going to last? Is it going to go away? And so you can't be mindful and present and enjoy pleasure because you're obsessing over this. And it becomes this vicious cycle. So I tell all guys, all my patients, like, you may have a medical reason that you're having trouble with erections, but every single guy also has. Problems thinking about erections. Every guy, every guy who has a problem with erections also has a mental issue because they're thinking about it, right? And women do too. It's not just men.

• 41:02Speaker 03

  Like, women are like, "Oh, if I can't climax this one time, am I not gonna be able to climax the next time?" Right? They're thinking about it too, but I think we see it very often, men. Because if you can't get an erection, it's very visible. You can see, like, it's not happening, something's wrong, right? And, and the reaction is often like, "Oh, the partner might be like, 'Is something wrong with me?'" So now there's like, a little bit of relationship conflict. And so, this, all these things compounded, it makes it very difficult to get out of. And so, I think that's one of the biggest ones, is that. And then two is that, I did mention testosterone, but testosterone is not always the cause. In fact, it's only the cause, low testosterone causes erectile dysfunction about three to six percent of the time.

• 41:40Shawn Ryan?

  That's it?

• 41:41Speaker 03

  So, it may be a part of it, but it's not the only cause.

• 41:44Shawn Ryan?

  Wow. Only in three to six percent of the time, it's a testosterone deficiency?

• 41:49Speaker 03

  Correct.

• 41:50Shawn Ryan?

  Interesting.

• 41:51Speaker 03

  More often, it's vascular problems. So, high cholesterol, high, high, high blood pressure, diabetes, all these things play a role. And I will see very, very healthy-looking men whose cholesterol's off the charts. And I will say, "Look, this is what's likely causing your erectile dysfunction." And, you know, we can investigate further, but it behooves you to improve your cholesterol. And so, I think it's also a really important sign of your health. And people don't realize this. They think sexual health is like this thing we put in a box and we don't think about. But oftentimes, you will see problems with your sexual health long before you see them anywhere else in your body. And the reason is, the blood vessels to the penis are significantly smaller, they're about half the size of the blood vessels to the heart.

• 42:34Speaker 03

  So, before you have a heart attack, you're gonna see erectile dysfunction. And in fact, that, we've seen that, that when a man has an issue with erections, within seven years, fifteen percent of those guys will have a heart attack.

• 42:46Shawn Ryan?

  Wow.

• 42:47Speaker 03

  And so it's an opportunity for men. If you start having trouble, this is a wake up call for you to get your whole health evaluated. Make sure that you're optimizing your heart health, your brain health before you get a stroke, right? Like, all these things that, in the long term, will have you not having the life you want to live, right? Because if we think about sex, we want to live well, but we also want to have sex throughout our lives, right? And if you start having issues, like you have heart failure and now you get winded just walking a couple blocks right down the street, like, you're not going to have sex, like, you're going to be exhausted. And so, all of these things play a role. And so, I find that any time you think there's a problem with your sex life, that's an opportunity for you to get evaluated, right?

• 43:32Speaker 03

  To, to figure out what's going on, so that you can fix that part of your life. And, and before it becomes a problem.

• 43:39Shawn Ryan?

  And with, with, I'm sorry, do you, how, within how many years, just fifteen percent?

• 43:43Speaker 03

  Seven.

• 43:43Shawn Ryan?

  Seven years?

• 43:44Speaker 03

  Mm-hmm.

• 43:45Shawn Ryan?

  So it's a, so it's a, it's a early warning system?

• 43:48Speaker 03

  Yeah, we call it the canary in the coal mine. It's like that warning sign.

• 43:52Shawn Ryan?

  Wow. And then, I mean, what, with the-

• 43:55Speaker 03

  Trouble either maintaining or getting an erection that's sufficient for intercourse. So either you lose the erection before you penetrate, or you can't climax because you're not reaching it soon enough, and, and you're, you lose your erection before that. Um, sometimes people get it confused. They'll think, like, oh, I, I ejaculate very quickly, so it's erectile dysfunction. That's actually premature ejaculation, it's treated very differently. Um, and so it's important, like, when you go to your doctor, to explain those things, because what sometimes guys will come in, and they'll say, "My erection's not working", right? And so, I will dig deeper, but sometimes if you go to your primary care doctor, they may not, right? And that may be the only doctor you have access to. And so if you say, "I'm not having trou-, I'm, I'm, I can't, my erections are not working",

• 44:39Speaker 03

  they'll give you a prescription, and you'll be on your way, but that prescription's not going to fix the issue, if it's an ejaculation issue.

• 44:46Shawn Ryan?

  Interesting. I mean-

• 44:50Shawn Ryan?

  How do you determine if it is a psychological issue? Whether that be erectile dysfunction or premature ejaculation? Or, you know, anything I'm not thinking of?

• 45:01Speaker 03

  Yeah.

• 45:02Shawn Ryan?

  How do you determine whether it's an actual, you know, something's going on with the body? Versus a psychological issue where you freaked yourself out? And now you have, you know, performance anxiety?

• 45:13Speaker 03

  Yeah, so, uh, one is talk to the person, right? Like first I'll talk to them, be like, okay, what's happening when you're by yourself? Right? Like, do you get erections at night? Do you wake up in the morning with erections? Because that's a sign that things are all working well, right? When you wake up in the morning with an erection, that tells me, hey, your hormones are working, your blood flow is working, all that stuff is pretty good, probably, right? Because your body's doing it when there's no stressor around, right? It's just like you're sleeping, your body's functioning normally, you get about three to five erections at night, and so, and you usually wake up with one, and so that's a sign that things are working okay. Um, there are like tests that you can do, there's even wearables that you can buy to do that, but like you-

• 45:50Shawn Ryan?

  Wearables?

• 45:51Speaker 03

  There's, there's wearables that are now on the market. You can wear like a, a ring around your penis that will measure how many erections you get at night, how long they last, and how firm they get, and they'll give you data. Uh, but at the end of the day, like those, that's, I think some people really like that, because they want to like, they want data, they like to know those things. But at the end of the day, like if things are functioning well, and you're happy, and you're getting morning erections, and your partner's happy, like I wouldn't stress about it. Um, it's when you start feeling like, okay, things are not going well, okay, am I getting nighttime erections? That's one, waking up with one. Two, if I masturbate, is it working fine? Right? And sometimes that's like, your masturbation is different, but there's no pressure, right? When you masturbate, you're not like worried that like your, this, your partner might feel some way, or whatever, like there's no anxiety typically around masturbation,

• 46:36Speaker 03

  um, unless you feel shame about it, which is a whole different thing. Um, so usually that's another way. Third way is we can do what's called Penile Doppler ultrasound testing. So we can actually, um- We check the blood flow to the penis. So we'll actually give you an artificial erection with a medication. And we'll actually then test to see how fast the blood is flowing in, how quickly it's leaving. And we have markers to say what's normal and what's not. And so those are tests that we can do to be definitive, like, yes, the blood flow part is working. Now, the hormone part, we check with blood work. We check if your testosterone is normal, if your free testosterone is normal, all those things. And there's other hormone markers that we'll check as well, if they're low, to make sure they're not playing a role. And so those are things we can, we can evaluate pretty well.

• 47:21Speaker 03

  Beyond that, like, like I said, I think everyone has a little degree of psychological, psychological component to it.

• 47:27Shawn Ryan?

  Now, how do you, how do you, how do patients get over their psychological anxieties?

• 47:33Speaker 03

  Yeah, so it's, it's difficult. I'm not gonna say it's easy. You know, I encourage them, if they are willing, to talk to a sex therapist, or even a therapist that has some, you know, openness about talking about sex. Because it's really dealing with your thoughts and, and kind of working with those. And like, especially in the moment, right, when you're with your partner. So it can be like doing mindfulness exercises. So there's been studies on mindfulness, that like, if you do 20 minutes of mindfulness every day, you're more present in the bedroom, so you have more enjoyable sex. Because you're able to like, really pay attention to what's going on, rather than think, getting lost in your own thoughts. And I think just being present in general, like cultivating, I think the other thing about sex in modern day is like, it's rushed. It's like, we're busy with our kids, we're busy with work, we're busy with that.

• 48:18Speaker 03

  And then we're like, okay, we got, we got five minutes, like, let's, let's go. And, and there's no like, you haven't actually made it feel desirable. There's like another checkbox to do, right? And so it's like, actually like, hey, like, when you were younger, you used to like, you know, be like, oh, I can't wait to see you on your date. You'd call each other, you'd text each other, whatever, you know, whatever it was. And, and you'd be excited to like, see your partner and like, potentially have sex with them. And, and there was like this whole thing, like, you just felt so excited about it. But when you're in longer term relationships and the stressors of life come along, we often just are like, ah, well, we'll do it when we get to, we will have sex, like, it'll happen. You're always there, right? And so it's like, you have to be like intentional about cultivating desire. To be like, hey, um, does that foreplay starts in the morning like with a caress on the back?

• 49:02Speaker 03

  Or like a flirty text or whatever, right? Whatever floats your boat and like feeling in the moment like excited. And I often tell people instead of date night where you go out to eat dinner, like have intimacy night where you like are intimate together. You you hold each other, you lie together, you you explore each other's body. I mean, depending on what what turns you on, right? But you actually make that a priority because it is valuable being connected with another human being. People who have more sex actually live longer. And I think partially it's because of that connection they're getting with another human being. And so, you know, it's really important that that is so. And we're losing connection so much with like AI and and the internet and all these other things.

• 49:46Speaker 03

  Like we have to be intentional about keeping that.

• 49:50Shawn Ryan?

  I mean, how much, you know, we're talking about, you're saying people that have more sex live longer.

• 49:57Speaker 03

  Mm hmm.

• 49:57Shawn Ryan?

  How much sex should we be having? How many times a week should men be ejaculating?

• 50:04Speaker 03

  Yeah, so there's there is science behind this and I'll give you some data on that. So first of all, when you look at living longer, right? People who have sex fifty two times a year, so that's once a week, have live longer, have lower heart disease, have better health outcomes than people who have sex less often than that. So we know that for a fact. And if you have, so a lot of veterans struggle with mental health. So they have depression, anxiety, people who have depression, anxiety and have sex more often. They actually don't, they do better in terms of their mental health as well as living longer. So like you might actually be improving your mental health as well as living longer. And so there's evidence at least once a week, right? And then in terms of how often should you ejaculate?

• 50:49Speaker 03

  There's a very famous study where they had looked at ejaculation frequency and the risk of prostate cancer. And so they looked at databases where people filled out how often they ejaculated in the last month. And they put them into categories. So it was like. Zero to four, four to seven, seven to fourteen, fourteen to twenty-one, and more than twenty-one. So what they found was that the guys who ejaculated twenty-one times or more a month, they didn't specify through sex or masturbation, but they did more than twenty-one times a month, had a lower risk of prostate cancer. Now, is it the ejaculation?

• 51:20Shawn Ryan?

  Say those numbers again.

• 51:21Speaker 03

  More than twenty-one times a month had a lower risk of prostate cancer. Now, is it the ejac- is it the actual act of ejaculation? Is it something else? I mean, there's some theories that like if you're ejaculating, you're sort of cleaning the pipes, right? Like you're getting any stagnant fluid that might be in your prostate, you're getting that taken out. And so that may be beneficial. Now, I can't say for sure because there's not really a good way to test that. But basically, what I tell people is like, have sex, masturbate, enjoy pleasure. Enjoy connection with another human being and enjoy pleasure. Because for some people masturbation is the only way they're gonna get pleasure. They don't have a partner or they don't have someone they can have sex with. So I don't want to take that away from them either, right? And I think that those things are important for people to feel good.

• 52:05Speaker 03

  And, and there's so much value to having orgasms, like physiologically, right? Your heart rate goes down, your blood pressure goes down. Some people sleep better, some people have postnatality and they feel like much better after they orgasm. And so I think that, you know, it is something that we need to look at as like a tool potentially to live better, you know, to, to have a healthier life, to be connected with another human being, to feel good, to feel pleasure. And, and I say this often, sex is play. And we don't play as adults. So like, play, enjoy life, be creative, have fun, and, and enjoy sex. Like, why is this something we have to like hide behind a corner? It shouldn't be. It should be something that we just like openly welcome.

• 52:49Speaker 03

  And, and we should be able to talk about sex and be able to express our concerns, our insecurities, and, and, and be open with, and the idea of being vulnerable, right? With another partner, with someone else is really powerful. Because to have great sex, you have to be vulnerable. You are naked in front of another person, literally, physically, and mentally, you are naked in front of them. And so you need to be able to be vulnerable and allow yourself to be vulnerable to truly experience meaningful pleasure. And so many people are so guarded and, and sex is like just this thing you do, right? For, for a quick, uh, release. But it's actually so much more than that.

• 53:33Shawn Ryan?

  The cost of everything is still out of control and many of us are relying on credit cards. If that debt is piling up, you're not alone. Americans collectively owe over 1 trillion in credit card debt. You might have considered reaching out to American Financing, but hesitated because you don't want to give up your low mortgage rate. Well, there's good news. They've created the Smart Equity Loan, a solution designed to help you take control of your finances without touching your current mortgage. Unlike a HELOC, which can have varied interest rates, the Smart Equity Loan offers a fixed rate. That means one predictable monthly payment, giving you peace of mind.

• 54:15Shawn Ryan?

  This loan allows you to leverage the equity in your home to pay off high-interest debt, free up your cash flow, and keep your existing low mortgage rate intact. It only takes 10 minutes to get started with no upfront or hidden fees. Call American Financing today and start saving now. 866-781-8900. That's 866-781-8900. Or AmericanFinancing.net/SRS.

• 54:48Shawn Ryan?

  I've spent years on this show pulling back the curtain and trying to reveal what's really happening in this country. And the truth is, there's a double standard here in America. You see, time and time again, people defending themselves, defending their family, and then the judicial system goes after them. It's a double standard. And if you don't believe me, check out episode number three with Don Bradley. That is a perfect example of what I'm talking about. Because it's not just about what you did, believe it or not, it's how the legal system interprets it. And that's why I'm a USCCA member. The USCCA has over 860,000 members because they know the reality is, after you stop

• 55:32Shawn Ryan?

  the threat, the real fight begins. Your membership gives you the education, elite training, and self-defense liability insurance you need for the second fight, the legal one. Plus, every member also gets access to a 24/7 critical response team and attorney network in the event of a self-defense incident. Violent crime happens too often in America. This isn't about living in fear. This is about being prepared when things go sideways. You don't get to schedule danger. And with the world changing so fast, you have to do what you can to protect your family.

• 56:11Shawn Ryan?

  Check out the USCCA's risk-free membership at USCCA.com/SRS. That's USCCA.com/SRS. Protect more than just your life. Protect your future. Go right now to USCCA.com/SRS.

• 56:34Shawn Ryan?

  Is there, I mean, are there any studies on whether you're ejaculating with a partner versus masturbation? Is one better than another?

• 56:43Speaker 03

  Well, in terms of how your brain responds, so there are certain nerve endings in our body that can only be stimulated by another human being. That it occurs in a certain frequency, which is usually like a loving caress. That is what turns those nerve endings on. And so that turns on different areas of your brain. So it will stimulate more of your brain. So you will likely have more pleasure and a higher, you know, sort of response to that. So in terms of like experiencing pleasure, it will be probably more intense and more enjoyable with another partner compared to, to by yourself. But it, it certainly is, you still can enjoy pleasure by yourself. The challenge, I think, by doing it by yourself is, I'll go back to the example of like when

• 57:26Speaker 03

  you're a kid and like you're worried, like you're in the shower or you're in your bedroom and you're like, oh my God, someone's going to walk in or someone's going to be like, why are you in the shower so long? And so you learn to rush through masturbation and it becomes this just like quick thing to get a release. It's not a time to actually enjoy pleasure, right? And so I think that's where. You know, it's okay to explore your body and to feel pleasure by yourself and like allowing that and using it as a tool to like learn about yourself, like what turns me on, what makes me feel good. I think particularly for women can be very useful in learning which sort of stimulation works good, works well for you. And then you can communicate that with a partner. And also like exploring more than just your genitals, like your whole

• 58:07Speaker 03

  body can be an erogenous zone, right? You can stimulate anywhere on the body and almost anywhere on the body and someone can get turned on. So it's, it's really like, okay, like we can use this. We can stimulate multiple areas of someone's body and have them feel an amazing pleasure that if you just focus on genitals is not gonna, not gonna be as as robust.

• 58:28Shawn Ryan?

  Interesting, interesting. I mean, let's go back to the, the implants. Or, or penile, wow, is that what you call it?

• 58:39Speaker 03

  Penile implants, yeah.

• 58:39Shawn Ryan?

  Implants. I mean, are there a lot of people doing this?

• 58:43Speaker 03

  Yeah, I mean, so I will say erectile dysfunction is very common. Fifty percent of men over fifty will have erectile dysfunction and every decade that increases by about 10%. So you can imagine there's a lot of guys struggling. Now, because of medications like sildenafil or tadalphil known as Viagra and Cialis, those medications help a lot of guys get erections without needing surgery. But before these medications were around, we didn't have much. We had vacuum erection devices, which you will, you know, which are sort of similar to penis pumps, but they are medical grade. We have injections that you give yourself in the penis that work quite well, but like some guys don't want to inject their penis, which is reasonable. And then we have surgeries. And so typically

• 59:27Speaker 03

  guys will go through these options and then if they still can't get an erection, a penile option is a great option for them. And so what that is, is we actually implant a device into their penis, which they then either pump up it with a pump in the scrotum when they want to have an erection and they deflate it when they're done.

• 59:44Shawn Ryan?

  Wait a minute, they do what?

• 59:45Speaker 03

  They pump it, got a little pump. I should have brought one with me, but there's a little pump. You pump it up. And and then you get an erection.

• 59:52Shawn Ryan?

  It's inside your scrotum?

• 59:53Speaker 03

  Inside your scrotum, yeah. And you can't really tell. I mean, like, it looks sort of like there's a little something there, right? But like, it doesn't, you can't really tell that someone has a penile implant. Like, in fact, in medicine, like, we'll get consulted, like, oh, this guy has a, what we call a priap, has an erection that won't go away. And sometimes it'll be like, oh, the guy just has an implant. Like, so, um, so even other doctors sometimes don't notice it, is my point. Um, but so you, it's, you know, it's very hideable, you don't need to know. And then there's other ones where you implant it and you just bend it up and bend it down. So when you want to have an erection, you bend it up, and otherwise you bend it down. Um, so there's options. Uh, they don't make you larger or growthier. They give you what you have. So if you were to, like, grab your penis and pull it, that's how long it's gonna be.

• 1:00:38Speaker 03

  It's not gonna be longer, it's not gonna make you, you know, it's not gonna make you like superhuman in terms of length or growth, but it's gonna give you function so that you can have sex and you can get a rigid erection when you want to. And so I would say that it is a transformative surgery for a lot of guys who have been struggling and can't get an erection and want to be able to get one, and their partner wants to be able to have penetrative sex. Is it mandatory? No, you can obviously pleasure your partner with many different ways. It doesn't need to be an erect phallus, but a lot of people enjoy that, want that, and it's a great option for them.

• 1:01:13Shawn Ryan?

  What is, what is the difference between Viagra and Cialis?

• 1:01:16Speaker 03

  So they are both what we call PDE5 inhibitors. They work by the same mechanism. Essentially, when you think about an erection, there is an ignition called nitric oxide, which then causes, and that usually comes from stimulation, like, you see something, hear something, feel something, turns you on, your, your nerves and your vessels release nitric oxide. Then that causes blood to flow into the penis, and then it stays there, right? And that's the erection. And then it goes down and blood flow leaves the penis and erection goes down. And so during that process, one of the enzymes, uh, that will break down, right? The, and cause the blood flow to leave, these medications prevent that breakdown. And so that's how they work. And they work similarly, but they are slightly different. So.

• 1:01:59Speaker 03

  When you think about sildenafil, which is Viagra, vanafil or vardenafil, which is Levitra and stendra, those medications, they all work, it's short acting. So, meaning you take one about an hour before sex. You need stimulation, like I said, the nitric oxide has to come from some stimulation for them to work and you get an erection. Works in about sixty to seventy percent of guys. It does require that you don't eat with the medication. So sometimes people will eat a big meal and they're like, oh, it didn't work, but I got these side effects. So they get side effects like headaches, flushing, stuffy nose, those sorts of things. But it does work in a lot of guys, allows them to have erections and have sex. Now, Tidalphol is slightly different because it has a longer half-life.

• 1:02:43Speaker 03

  So you can take this medication with food, which is nice for some people who like to have sex in the evening or, you know, they have dinner before. And they can then take this medication and it works and it all, but it lasts longer. So it can last for thirty-six hours. Meaning that if you take it on a Friday and you want to have sex on a Saturday or Sunday, like you're still good to go, which is nice for a lot of people. You can also take a low dose every single day. So five milligrams of Cialis, because it lasts so long, you can take a low dose every single day. And I really like using that because it takes the psychological stress out of it. Like, oh, I have to remember to take this pill, I gotta do this, I gotta do that. You just sort of take the pill every day and then you're good to go to have sex when you want to, right? For most people who, where it works well.

• 1:03:27Speaker 03

  Now again, these medications are not a hundred percent effective. Every medication that you take in your life will have some degree of, you know, inefficacy. But they help a lot of guys be able to get good blood flow to their penis and have erections and have sex.

• 1:03:41Shawn Ryan?

  Is there any, is there any, is there any long-term effects if somebody is using that that may necessarily, you know, they don't necessarily need that?

• 1:03:52Speaker 03

  Yeah, I mean, I think in terms of law, there's obviously rare things that people will will say like nosebleeds or things like that that are very rare, right? With Viagra, there's, it does, if there are some receptors in the eye that are similar to the receptors that they work on. And so some people get blue-green vision discoloration and it can cause vision changes. So if you ever notice anything with your vision, you've got to stop those medications. The other risk is if you're taking a medication called nitroglycerin or something you put under your tongue before you have chest pain, if you take both those together, it can lower your blood pressure to dangerous, almost like deadly, levels. So those are the two big contraindications. But for most people, these are very safe, very effective.

• 1:04:35Speaker 03

  And tadalphil, there's some actually early data, and it's not like mainstream, but that it might improve heart health. So they looked at like how it's taken in people who have cardiovascular disease and they've seen it actually an improvement in outcomes. And even with muscle health, they're seeing like blood flow to the muscles being better. And it's also great for guys who have an enlarged prostate because it can relax the prostate and allow you to pee better. So there's a lot of benefits. In fact, I just saw a study on women taking tadalphil to help with overactive bladder. Now, I don't, you know, it's still very early. Again, this is not prime time, this is like early data, but I feel like there's a lot of benefit because ultimately with something like tadalphil daily, you're increasing blood flow throughout the body. So you're actually not just seeing benefits of the genitals, you may be seeing benefits elsewhere.

• 1:05:20Speaker 03

  And that could potentially be beneficial. Now, we don't, you know, these medications have been around for a long time and we haven't seen any terrible long-term sequelae. Now, could there be in the future, potentially? I don't, you know, I don't future like, but Viagra's been around for a long time. And tadalphil's been around for a good amount of time as well, and people have taken it for decades without issues.

• 1:05:43Shawn Ryan?

  No, Ken, so I mean, would it be, would it be in Ben's best interest to, I mean, it sounds like there's a lot of other benefits other than sex health.

• 1:05:52Speaker 03

  Mm-hmm.

• 1:05:53Shawn Ryan?

  And so, I mean, would it be beneficial for Ben to be on five milligrams of Cialis every day?

• 1:06:00Speaker 03

  Uh, you know, I can't say that every guy should be on it, right? I do think there are benefits, and I do think that if you have any sort of struggle with erections, that I think that being on it is, is, is going to benefit you more than, you know, more than, in more ways than just sexual function. And so I do recommend it for, almost all my patients should be on it, because I think there's more benefits than just sexual health. Um, do I think a normal, healthy guy should be on it? It's hard to say yet, if I think there's like a long-term longevity life benefit for it. If you, if I had to put money on it, yeah, probably there would be, but, you know, no one's studying that specifically. Um, and so, yeah, I think maybe there might be a long-term benefit for being on it, but we don't really know yet.

• 1:06:43Shawn Ryan?

  Okay. What is the, what is the average length, time-wise, in sexual intercourse?

• 1:06:50Speaker 03

  Yeah, so this always surprises people, and in fact, even my own friend got surprised by this, because he's a urologist, so, so when you look at the data, and they, they actually look at people having sex, and what they do is they tell people, take a stopwatch, they give it to the female partner, they say, start the stopwatch when you start penetration, turn off the stopwatch when you've stopped penetration. They do this around multiple countries, and they found that the average length is about five to six minutes. So, a lot shorter than most people think, and a lot shorter than you're seeing on erotic films, right? And so, that's the reality, is that that's average. Now, if you look country to country, some countries are a little bit longer, some countries are a little bit shorter, for example, UK was longer, Turkey was shorter, um, in the study that was done. But, ultimately, that's the average length that a man will last during sex.

• 1:07:35Speaker 03

  Now, does that mean that there aren't guys, of course, there's guys who last longer, and of course, there's guys who are, who ejaculate more rapidly. Now, what does that mean, right? So, actually, interestingly, um, if you look at mammals who ejaculate, right, they all ejaculate rapidly. There's no, like, pleasure or enjoyment, it's really like, for the purposes of having a baby, or, or procreating, and so they quickly, you know, they get done quickly, because it prevents, like, uh, one, they, they won't get caught by a predator. To there, there's competition, they're, they're first, right? So that the next competition can't come and like get in the way, right? And so there's actually an evolutionary advantage for who, who mammals who ejaculate sooner. In humans, it's different, right?

• 1:08:16Speaker 03

  The ejaculation length and pleasure, we actually continue to have sex long after fertility is an issue, right? Long after women pass fertile ages, people continue to have sex because it's pleasurable. And so this idea of lasting longer, you know, obviously, again, another thing that society is like, oh, it's so great. Like you want to have sex forever. But I also see guys who have what's we call delayed ejaculation. So they take longer than 30 minutes to ejaculate. And while that's less common, it definitely happens. And those guys are stressed too, because it's like exhausting. It's like there's so much friction, it becomes uncomfortable for their partner, it becomes uncomfortable for them. They're working so hard and, and like it's, it's no longer fun.

• 1:08:59Speaker 03

  And so what I tell people is like, it's not about fixating on how long you last. It's like, are you enjoying yourself? Is your partner satisfied? And you know, the, the reality is that women take a lot longer to get aroused and to, to get to climax. So women on average take about 14 minutes when they're with their partner to reach climax. It's less when they masturbate, it's like eight minutes. But again, men take about five to six minutes. So you realize that you have to prioritize female pleasure if you want her to climax because she's going to take longer. It's also going to take her longer to get aroused. And so really like that, that's where the difference lies. And so it's really like figuring that out for you and your partner. Like, how do we work together so that everyone achieves pleasure and that we're having a good time? Because the time that it takes is not the issue.

• 1:09:44Speaker 03

  It's like, how much pleasure can you get from having sex? And how do we maximize that?

• 1:09:50Shawn Ryan?

  Wow, so that's a, that's a pretty big, uh, I don't, I don't know if you'd call it a discrepancy from five minutes to 14 minutes. So, I mean, what do you recommend?

• 1:10:00Speaker 03

  Yes, I recommend that you start by, you know, first of all, make sure your partner's aroused. This is the thing, I think women take a lot longer to get aroused. They also take a lot longer to be present in the moment, right? They, they, they, they ruminate about a lot of things. And when they're younger, it's about body image and insecurities and that can evolve. Women become more confident in their bodies as they age. But then it's like all the other things in their life that they're stressed about, their kids, their parents, whatever, like whatever they're dealing with in their life. And they have a hard time shutting that off. And so, one, it's like getting them in the mood, like spending time with them, enjoy, like allowing, allowing them to feel desire and to feel arousal. So what happens a lot of times with both men and women, but more often with women, is they get what's called responsive desire.

• 1:10:43Speaker 03

  So when you're younger, you think, you see your partner, you're like, damn, they're so hot. We want to have sex, right? You're turned on immediately, like there's no need to do anything. You're just like, you see each other and you're turned on, you want to have sex, that's it. But as you're with a partner for a long period of time, or, you know, as you evolve in life and you're busier and you're more stressed or whatever, you get what's called responsive desire. So you actually like need to be aroused a little bit before you start feeling desire. So you're like, oh, it's like going to the gym. You don't really want to go until you're there. And then when you're there, like, oh, thank God, I went to the gym, I feel great. So it's sort of like, yeah, I didn't really want to have sex, but now that I'm like turned on, like, oh, there's the desire. Oh, I remember, I like this, this is really fun. And so it's not an abnormal thing, it's actually a completely normal brain response, right?

• 1:11:27Speaker 03

  That you sometimes need to get your head in the right place and allow desire, right? Allow like some arousal to happen. And so that's why I love, like I said, intimacy time, like hold each other, be together, be, be physical, touch each other, whatever. I mean, obviously, everyone's not into touch, but like figure out what it is that gets you turned on and allow it to happen, right? Like in a mutually consensual way. And that's why like sometimes it's like, hey, let's have this night where we're going to do this, right? Let's actually give each other the time where we're not looking at our phones, where we're not like distracted or thinking about something else, where we're just focused on each other. I mean, if you think about it before phones, right? You're like lying in bed, there's like nothing to do. You're like, okay, like, well, like I'm bored, let's have sex, right?

• 1:12:10Speaker 03

  Like, like you're right next to me and like your body's right here and like, oh, this feels warm and nice and cozy and you would like have sex with your partner. And now it's like, well, you don't, like you have something else really exciting to look at that has like so much interesting information and whatever you're interested in in the moment, you can read about it or watch it or whatever. And so you're like doing that until you're dead and you're like, I'm so tired and you fall asleep, you put your phone on, you go to sleep, right? And so like there's, there's just like. There's not as many opportunities, right? Because now there's so much more to distract you than there was before. So we have to work a little harder. So that's one, is like making sure that they are in the moment. But two, prioritizing foreplay and actually spending time getting them aroused.

• 1:12:53Speaker 03

  Because it's not that they need like, like I mentioned earlier, penetration is not necessarily how they're going to climax. It's going to be clitoral stimulation and sometimes both. But you need to sort of focus on foreplay and making sure they feel pleasure and feel, feel that desire turning on, that the ramp up to, I mean, everyone can relate to this ramp, right? You feel like you're turning on, it goes up and up and up until you climax. And so you're trying to get them to get up that ramp a little before you do, so that they can get there and then you both can sort of try to climax around the same time or she can climax before you. Either way, um, you know, it allows you to then, to make sure that you both are feeling great pleasure.

• 1:13:34Shawn Ryan?

  I mean, so we're just talking about, you know, average length of sex, you know, and how, and how long, you know, on average, men last versus women and, you know, is there, is there a, I mean, what is too long?

• 1:13:48Speaker 03

  Well, again, too long is how long is too long for you and your partner. So like some people, like they're fine with however long, right? Even so, I have people who have very short sexual encounters and they love it. And there are people who have long sexual encounters and they love it. It really is bother. That's the key. Like, are you or your partner bothered? Does it cause distress or relationship conflict or issues? If it doesn't, who cares, right? Like, just be yourself and enjoy each other. As long as you are both having a good time, or if there's more than one person, more than two people in the bed, or if you're all having a good time, like, by all means, continue doing that. That's fine. It's when there is a loss of pleasure, distress, that we need to worry. And then we can talk about how to fix it, right? Even if you don't like meet some clinical definition,

• 1:14:33Speaker 03

  but you're like, this is too long or too short, like, let's talk about it. Because we can sort of help you figure out what's going on. Maybe there's a psychological issue, maybe there's a medical issue. Regardless, it's all things that we can work with you on.

• 1:14:48Shawn Ryan?

  Thank you. Thank you for that. Um, man, there's just so many questions that are coming to my mind, but I mean, when we talk about, you know, I, I saw a video, I didn't watch this one yet, but it was, uh, I believe it was something about, you know, what females find attractive.

• 1:15:04Speaker 03

  Yeah.

• 1:15:04Shawn Ryan?

  What, what do females find attractive?

• 1:15:07Speaker 03

  Yeah, interesting. A lot of people think it's like tall men, right? Um, physically, I'm saying not like emotionally necessarily, but it's, it's, it's all this idea of like, oh, women all want tolerance. Now that's true that height matters, but what actually matters is at least in the data that I found was that strength. So the display of upper body strength is very attractive to women. And this makes sense evolutionarily, right? Where you would need to maybe fight for resources or you need someone to protect yourself. Having somebody who is stronger is more likely to one, protect you and two, also get those resources that you would need, right? And so evolution, it makes sense that when you see someone who's very developed in their upper extremities or their upper body, that you would feel like that's the right partner who can protect me

• 1:15:51Speaker 03

  and who can also get resources for me. And so that's one. And the other one is like having sort of a V shape. So your shoulders are broader than your waist. And that's not only showing, you know, obviously upper body strength, but it's also showing metabolic health, right? So if you have a smaller waist and you have less visceral fat around your abdomen, you are more metabolically healthy, which means that you probably have better genes that you're then going to pass on to your children that you might have with this person, right? And so there's actually reasons why women find certain things attractive. Now, height, if you look at like the data, they'll say like 70% of, uh, when you ask women like, okay, what's important? 70% of that attraction quota is, is the strength. And then if you add another 10%, 80, it'll go up to 80% if they're tall.

• 1:16:36Speaker 03

  So they'd rather have a, like a average height, strong guy than a tall, not strong guy. Does that make sense? And so like, it's, it's really about like how you, how you portray this strength and health through the visual eye, right? Like what they're seeing. And interestingly, that this is obviously more important. When you're like just trying to like hook up with somebody. But when you start looking at long term partners, that still matters. But then it becomes also like, are they kind? Are they, um, are they like, uh, going to stick around and be with you and be like, uh, you know, the, the right kind of honest person that you can be rely, depend on and they can be reliable.

• 1:17:18Speaker 03

  So that becomes also part of the picture when you're looking at like a long term partner.

• 1:17:22Shawn Ryan?

  Anything with the penis?

• 1:17:25Speaker 03

  I mean, you can't like, I think you can't, um, you can't see specifically, right? When you're first courting someone, they're not like walking around naked.

• 1:17:35Speaker 03

  So you can't utilize that. And I think that, like I said, most people, as long as they're feeling pleasured by their partner, the size of the penis matters less. And, and that's, that's true even in the data. Like I said, there are some women, like maybe 10 to 15% in place in the data that are very focused on penile length. And that may be because of like, they may really develop, uh, they may really enjoy like deep penetration because that stimulation may lead to orgasm from cervical stimulation. Um, and some women actually find that painful, but some women actually really like that. And so they may really enjoy that feeling and that may allow them to feel pleasure. And in those cases, like that just might not be a right fit for you, right?

• 1:18:17Speaker 03

  If that person is like, I need a really, a guy who is really well endowed. Well, more power to you, we're not the right fit, right? Because I can't give that to you. I mean, unless you feel comfortable like wearing a strap on it or something, right? But like for most people, like that's not going to be the right fit. And look, we, we, we don't fit with people because of personalities, because of a variety of things. And so it's okay if sometimes it doesn't fit because of genitalia, right? But it's like, that doesn't mean that there's something wrong with you. It just means that that's not a fit, right? And there's going to be another person where that is a fit. And, and so that's okay, right? It's just like anything else. There are things that you need in a partner that they may not meet that criteria and they may not be the right person because that's a deal breaker. And there's other things where you can compromise on those things and the same goes for sex.

• 1:19:03Shawn Ryan?

  What about, let's move into some, some, some other sexual activities, oral sex. I mean, I've read, I don't know if any of this is factual, but I mean, I've read that there are supposedly some type of health benefits for females to consume semen. Is there, is there any truth to that?

• 1:19:23Speaker 03

  Yeah, there's, there's not a ton. So there's, you know, if you actually look at the nutritional value of semen, it's like very little. So like, it's like very marginal. Yes, there is some protein. Yes, there are some vitamins and minerals and stuff in, in semen, but like, is it, it's not any, it's not like the equivalent of a multivitamin, right? Like significantly less, but there's no harm either. So like, if you enjoy that and your partner enjoys that, by all means, go ahead. But you don't need to like make semen smoothies or like other, you know, other.

• 1:19:53Shawn Ryan?

  Semen smoothie.

• 1:19:54Speaker 03

  Come on, you know, you've seen those videos. Um, but like, you don't need to do that, right? Like, if you enjoy that, if some people like have kinks and fashions, they have a cum kink, right? And they enjoy that. That's fine. Great. By all means. Like, that's you. Like, I don't want to yuck anyone's yum, but, um, but like, it's not necessary.

• 1:20:12Shawn Ryan?

  What about, you know, semen volumizers or people that are trying to, you know, increase the load?

• 1:20:19Speaker 03

  Yeah. So again, I think that that comes a lot from erotic films pornography, right? Like they see these people having very large voluminous loads and the partner and the video is like, oh my God, right? Like, it's just this amazing thing. And so the reality is that the amount that comes out is really small. It's like a tablespoon, right? If you look at the average amount, and we've actually done this, right? Because we do for fertility, you actually measure, when you get a semen analysis, you measure how much comes out. So there's an abundance of data on semen volume because of that sort of research. And the average is about a tablespoon, like five, five mLs, five, five to 10. And so it's not a lot. And so when you think about what you're seeing on these films, oftentimes it's very augmented through like video, right?

• 1:21:03Speaker 03

  Video editing, video, uh, other things are being exploded like around the genitals that look like it's coming from the penis. Um, so that's one. Two is, um, it's variable through age, right? And there's force variability. So when you're younger. You have very robust pelvic floor muscles and pelvic floor muscles are the muscles that thin the pelvis that are responsible for so many different functions, but one of the functions that they're responsible for is they contract when you have an orgasm and they contract at like a rhythmic like point eight seconds and they they give you that pulsing feeling when you have an orgasm. They also help you propel semen forward. And so when they're strong, like when you're young and healthy, they will propel up to

• 1:21:45Speaker 03

  like fifteen to thirty centimeters. So pretty far, they can propel pretty far and that can look more voluminous, right? Because of going further. And when you age, when it drops to half that and some guys will come in and they get to dribble now, or it's like very not forceful. And that's because their their muscles are just not as strong anymore. And you can, you know, work on strengthening muscular health, including your pelvic floor. But that's sort of the reality for most people. The volume also is variable. It depends on when was the last time you ejaculated? Like if you ejac- if you abstained for five days, it's going to be more voluminous. And if you don't abstain and you just ejected the day before, it's going to be less voluminous. Also, how much did you drink that day? Right?

• 1:22:27Speaker 03

  Like, how hydrated are you? There's a whole bunch of factors, just day to day, that play into it. And so, yes, you can, you know, sort of like hold, store it up and like for five days and the fifth day, and I was, wow, that was a pretty big, you know, semen volume. And and so, again, it's it's not a it's not a reflection of your fertility, because only five percent of the entire volume is is is sperm. Most of it is all these fluids that help nourish sperm, help them move through the female genital tract. They're there for a reason. But the large majority of it is not sperm. And so the only way you can know your sperm health is by actually getting a semen analysis and actually testing that. And when we do those, we actually ask you to abstain for twenty four to forty eight

• 1:23:10Speaker 03

  hours before you give it. So we have a reference, right? Like, this is what the average guy has after one day of abstinence or two days of abstinence. And so you should be around this. This is what's average.

• 1:23:22Shawn Ryan?

  What, I mean, what are those, you mentioned some exercises, what are those exercises?

• 1:23:27Speaker 03

  Yeah, so I, I'm cautious about saying this, I don't think everyone needs to do them. Um, so there are pelvic floor exercises called Kegel exercise that most people have heard of, that can strengthen the pelvic floor. Now, you don't have to just do those exercises, but those are the most popular. They have like the best PR of any exercise they've ever seen. But like, essentially, they are, so for guys, I tell them, it's like, you are lifting your penis from the ground without touching it. Like, that's sort of that. Or if you're peeing and you've stopped the stream of pee, that's, you're actually activating those muscles. So you don't want to do it when you're in the bathroom, but you can use it to learn how, what that feels like. And then you do those, period, just like you do crunches, or you go to the gym, you do reps, you do like 10 reps in the morning, 10 reps at night. You need to make sure you rest and you breathe,

• 1:24:11Speaker 03

  like, just like you would do at the gym. You rest, you breathe, you, um, you make sure you're not just squeezing, squeezing, squeezing real hard. You squeeze and relax, and squeeze and relax, because you can get dysfunction, which is why I don't tell a lot of people to just, everyone should do them, because some people will actually have dysfunctional muscles. And guys, it's very under diagnosed. No one's really testing their pelvic floor, um, because it requires a rectal exam, uh, finger in the bottom. And so, to test the like, are your muscles tense? Just like people get TMJ, right? They're, they're, they clench up their jaw, their pelvic floor muscles can get tense. And so they can tense up, and they won't really know that it's happening, but it will cause these other issues. And so if you strengthen an already tense muscle, you're going to create more problems. So it's like, not everyone should do it,

• 1:24:54Speaker 03

  but if you have normal function, everything's working great, it's probably reasonable to go ahead and try doing those exercises to strengthen those muscles. It may help you with, um, having a more forceful ejaculate. It may help you with getting stronger erections, because there's more blood flow going, you know, it's, it's causing more blood flow to come to the area, because you're getting more, you know, just like any exercise. Um, and it may cause you to have more intense orgasms, because you have more muscle contracting when it does contract. And so it can be beneficial, um, and it can be a great way to augment your sex life, but again, it's not for everybody.

• 1:25:28Shawn Ryan?

  And then, how, how long, does, does it, is it five days it takes a man to fully reload?

• 1:25:35Speaker 03

  Yeah, so when they look at, I mean, actually, you're, you're constantly making sperm, right? So on average, it takes about um twenty-four to forty-eight hours after inject it for you to get the semen back in, I'm sorry, to get the sperm back into the semen. Um, but you will, you know, you will have some potentially in the, in the tract and other things, but you still have some. It's not like it just all goes away and there's nothing left. Like, there's sort of storage mechanisms and things. Um, but what in terms of like, if you're trying to get, have, get a partner pregnant, um, ideally, we say like every other day will allow you to replenish and, and have sort of the most amount of sperm getting to the egg, if that's what your goal is.

• 1:26:19Shawn Ryan?

  Anal sex.

• 1:26:20Speaker 03

  Yeah.

• 1:26:21Shawn Ryan?

  Any benefits?

• 1:26:22Speaker 03

  Well, so like I mentioned, um, we talked about the skeen's glands or the G-zone, right? You know how some women find that really pleasurable? That area is similar to the prostate. So some, uh, some, um, some people, and there's also the clitoris and the, the legs of the, the, um, the legs of the clitoris that are around there. So they're all sort of around the, the rectum and the anus. And some women will find it very pleasurable to have something inserted in the anus and that will augment their pleasure. And so not everyone does, but just like some people find certain things pleasurable, some people don't. So in terms of like health benefits, not really, but in terms of pleasure benefits, yes, for some

• 1:27:04Speaker 03

  people, that can be a great way to, um, for them to feel pleasure. Um, it can be augmented with other things, like you can, you know, stimulate them clearly at the same time, whatever, right? There's different ways to use it, but what I will tell people is it's not like you can't just have anal sex if you've never done anything in the, in the anus before. You need to sort of prepare. And sometimes that means like using a toy or using a lubricated finger to sort of get the anus, um, ready or prepared to have a phallus inside. Um, you also need to, there's no natural lubrication. So you need lube and go slow, go easy, take your time, um, and, and sort of like talk. You have to communicate. You have to be like, is this okay? Like, there has to be a back and forth dialogue where you feel comfortable and

• 1:27:49Speaker 03

  trust each other because it can cause damage. If you do it too aggressively or too, you know, too rigorously and not enough lube, you can actually damage the, the walls of the, of the anus, which are really friable and thin. They're not like as elastic or muscular as a vaginal canal. And so, um, yeah, absolutely. It, it can derive a lot of pleasure. It can be a lot of fun for people who just have to go slow, go easy and talk to each other.

• 1:28:15Shawn Ryan?

  What about risks?

• 1:28:17Speaker 03

  Like again, the risk, the big risk is, is that you can hurt yourself, but also there is a sexually transmitted infection risk. So oftentimes people will have anal sex and because they can't have, can't get someone pregnant that way, they won't use a condom. But you can still transmit sexually transmitted infections and it's actually a higher risk because there's more blood vessels, things can tear more easily in that area. Like I said, it's not lubricated. And so they're at a higher risk of getting STDs. And so it's really important if you're having anal sex with someone where you are not, um, monogamous and tested and clear and you are safe to not use condoms even vaginally, you need to use a condom anally, uh, because you want to protect yourself.

• 1:28:56Shawn Ryan?

  What about from a bacterial standpoint?

• 1:28:59Speaker 03

  Yeah. I mean, from a bacterial standpoint, um, you know, it, it's not like you're gonna get, you, you, as a man, you won't try and get like a colon of infection if they have some sort of infection. That's usually not an issue. It's more the sexually transmitted infections.

• 1:29:12Shawn Ryan?

  Okay, okay. G-spot.

• 1:29:16Speaker 03

  Yeah.

• 1:29:16Shawn Ryan?

  How do men find it?

• 1:29:18Speaker 03

  So the G-zone, it's not a spot, actually. I think a lot of guys think it's like this magical button that you have to find. It's not like some, there's not necessarily like a obvious visual, like when you look down, they're like, oh, there's a spot, you know, like bullseye. Um, it's, it's

• 1:29:35Speaker 03

  No, but honestly, I think there's a lot of misconception like people are like, wait, what's something wrong with me? I don't see it. Or like, you know, it's not. It's an area where there's a lot of nerve endings. So the skeins glands, which we talked about earlier, the um, the clitoral body, the shaft, there's like the shaft of the penis, the shaft of the clitoris is around that area. Um, and so all those areas are really highly innervated. I mean, they're really a lot of nerve endings. It's about two to three centimeters inside the vagina at the top. And so we'll say like, it's like a come hither motion is sort of where you'll kind of feel it. But again, you have to talk. I think people feel like that when they have sex, they should just be like magical gods at sex and it should just be perfect. And like, it should be this amazing experience, like off the bat. And

• 1:30:18Speaker 03

  it doesn't make sense to me because we, that you have, it's a skill, just like anything else. Like you don't expect to like, go, uh, go do a public speech and be amazing at it the first time, right? You, it's a skill that you develop with time. Even talking to someone or, or any, or dating, it's all skills that we learn and we cultivate. And so just like that sex is a skill. You have to get good at it. And that requires you to get feedback from the person you're having sex with. But we just expect it like, okay, we're just gonna have sex. There's gonna be just moans and groans, but no talking. And, and it's gonna be great. And everyone's gonna have great orgasms and we're gonna be wonderful at it. It's like, but we have to invest in having better sex. Like, what is the point of having sex that's not worth having? Right? Nobody wants mediocre sex.

• 1:31:03Speaker 03

  Let's have good sex. And so that means like, let's talk about sex. Let's talk about sex outside the bedroom. Let's like, find out like, hey, what turns you on? What is something that you've always been fantasizing about? Or what is, um, what, what was good? Like, what did you like about that? And what, what could be better? You know, and let's not take it so personally. Like, we are trying to be better lovers with each other. Right? And so like, it's important to sort of be like, okay, what's good? What's not good? How can we change this up? The other thing is like, monotony is a huge issue. So like, people find what works and they do it every time. And that's great. Like, it's comforting to have a routine. But if I was to tell you, hey, you're gonna, like, it doesn't need to be like, let's get out the whips and chains. And like, it can be just as simple as doing it in a different room, doing it at a different time, doing it in a different, like, slightly

• 1:31:48Speaker 03

  different position, using a pillow, not using a pillow, like, just slight variations that make it just different enough where you're like, ooh, this is kinda different. Like, this is kinda cool. And, and keeps you sort of interested, excited, engaged in the process.

• 1:32:04Shawn Ryan?

  Are there any positions that men could do that are easier than finding the G-zone?

• 1:32:13Speaker 03

  Well.

• 1:32:13Shawn Ryan?

  That women enjoy more?

• 1:32:14Speaker 03

  So, we know that when women have control, meaning they're on top, or they can sort of angle their bodies in certain ways, that they tend to have more pleasure, because they can, again, sort of angle you in a certain way that allows them to achieve more pleasure. So, certain things like putting a pillow, so if she's on the bottom, putting a pillow under her pelvis can make it more comfortable and more pleasurable. Having her on top can also allow for more pleasure, because she can control sort of the angle that goes in. And there's also certain things, not so the G-zone, but there's things that can help you stimulate the clitoris better while you're having vaginal penetrative sex.

• 1:32:57Speaker 03

  So, certain positions where you're like, sort of aligning your pelvis right on top of her clitoris, so that you're kind of like rocking motion, that can also lead to better orgasms. The G, people focus on the G-zone because they hear about it a lot. But it's analogous to the male prostate, and not every guy wants prostate play. Like, not every guy wants their prostate stimulated for pleasure. And so, I don't think we need to focus on the G-zone. We need to focus on clitoral stimulation and also talking to our partner, finding out what they like. Because, again, not everybody wants their G-zone stimulated. Like, it may not be pleasurable for them, or it may not really do anything for them. Whereas some people will be like, "Yeah, that's it. I love that. And that really turns me on." But you won't know until you ask her.

• 1:33:41Shawn Ryan?

  What about, you know, we talked about, you know, how often it would be, what an ideal, what do you call this? Ejaculation cycle, you know, for a man, what's healthy, you know, 21 times a month, it's great. What about women?

• 1:33:59Speaker 03

  Yeah, so you know, there's so little data on women, but I would say venture to say probably, you know, having regular orgasms is good for you, right? They don't necessarily always see an ejaculate like men do. And that's different from squirting ejaculate is just like this milky white fluid that comes from the Skene's glands and it's usually a very small amount. So we don't always see it. It's not always very clear. Some women, but yes, I see, I know exactly what you're talking about. And some book, I've never seen it. That's okay. But it's more about the orgasm, I think, because that's what you can sort of reliably say. And I think that the orgasm is what we should focus on is getting orgasms for women. And really the thing is, I think for, for women, it's probably, I mean, there's no, we don't get, we don't get Skene's glands cancer is very common, right?

• 1:34:44Speaker 03

  Prostate cancer, men, one in eight men get prostate cancer, right? So it's very common. So it's not, I don't think there's a benefit in that term, but I do think for health benefits, for stress reduction, for, for, for pleasure benefits, I think orgasms, regular orgasms are great. Again, I don't, I can't give you an exact number, but I think like if you feel like you are enjoying how often you're having orgasms, do it. And if you feel like you could have more, that's fine. And if you don't like having orgasms, that's okay too. But like you should have something that gives you pleasure in life.

• 1:35:19Shawn Ryan?

  Perfect. Brina, let's take a quick break.

• 1:35:22Speaker 03

  Sure.

• 1:35:22Shawn Ryan?

  And then when we come back, we'll get into some prostate stuff and all that kind of stuff. All right. Perfect.

• 1:35:31Shawn Ryan?

  You wouldn't wait to buy fire insurance when your house is already on fire, right? So why wait to help protect your money? I'm sure you're aware, but things are looking pretty dicey out there with the economy, global tensions, domestic tensions, AI, you name it. Are you surprised that gold just hit another record high and the price of silver is surging? This is why I've partnered with the award winning company, GoldCo. They can help you safeguard your savings with precious metals and they make the process incredibly easy. So if you're ready to help protect everything you've worked hard for, go to shawnlikesgold.com. You'll get GoldCo's free 2025 gold and silver kit and you could qualify for up to 10% in free bonus silver.

• 1:36:14Shawn Ryan?

  It's seriously the best offer out there, hands down. Visit shawnlikesgold.com. One more time, that's shawnlikesgold.com. Performance may vary. You should always consult with your financial and tax professionals.

• 1:36:31Shawn Ryan?

  Whether you're juggling tasks or trying to stay clear-headed throughout the day, Ketone IQ delivers clean brain fuel that can help you think sharper, longer, and smoother. No caffeine, no crash, no overstimulation. Thanks to the folks at HVMN for sending me their Ketone IQ product to try. I really like taking Ketone IQ before I work out. It's not an energy drink, but it gives me a ton of energy. I wish I had this when I was on active duty. When I take it, I have more endurance, but without the crash. Ketone IQ uses ketone dial for a fast-acting, natural, slow-release effect with no artificial sweeteners or fillers.

• 1:37:12Shawn Ryan?

  It helps support high-focus tasks by directly powering neurons and stabilizing cognitive output, and it's military-tested. Originally developed to support elite cognitive performance in the field. HVMN has an amazing offer just for my listeners. Visit Ketone.com/SRS for 30% off your subscription order, plus receive a free gift with your second shipment. Fun surprises like a free six-pack Ketone IQ merch and more. These statements and products have not been evaluated by the FDA. These products are not intended to diagnose, treat, cure, or prevent any disease or condition.

• 1:37:55Shawn Ryan?

  All right, Rena, we're back from the break. Couple more questions about bedroom stuff.

• 1:38:00Speaker 03

  Yeah.

• 1:38:00Shawn Ryan?

  And so, one is, you know, there's this rumor going around that pineapple makes semen taste better. Pineapple, I think, if we're bananas, there might be some other stuff, I'm not sure. Is there any truth to that?

• 1:38:14Speaker 03

  So, it's just, I mean, like, you can't really design a study tasting semen, so I can't tell you, like...

• 1:38:22Speaker 03

  I can't tell you with a degree of like certainty, but if you think about the composition of semen, right, there's fructose in semen and fructose is what makes it sweet. It also has all these minerals in it, which give it that sort of like metallicy sort of taste. But you know, at neutral, it's sort of got this little bit of like metallicy, slightly sweet taste. Now, if you want to make it sweeter, you would think, okay, I want to increase the amount of fructose in the semen. And so, you know, you will see that things that have a lot of fructose can potentially help increase the sweetness of semen. So, things like pineapple, other fruits, potentially, yeah, they might increase the sweetness, but it's not going to be, I think what people think is like, oh, I'm,

• 1:39:06Speaker 03

  I got a date tonight, I'm going to eat some pineapple in the morning and I'm going to be good to go. It's not that quick, right? So it's sort of like a dietary thing. Like if your diet consists of like healthy fruits and vegetables, you're more likely to have better tasting semen. Now, certain vegetables like asparagus is pretty strong. And so people might notice that their pee stinks after they, after they eat asparagus, that will also affect your semen. Things like coffee, smoking, caffeine, those can make the semen taste a little bit stronger. And so, and certainly, so if you, it really does, your diet can really alter the taste. At least that's my suspicion based on what we've heard from people, anecdotally, what we've talked, you know, the kind of the biology behind

• 1:39:51Speaker 03

  it. And so I would suspect, generally speaking, if you eat a healthy diet, drink lots of fluids, you're going to have good tasting semen. If you eat a less healthy diet or you smoke, it's not going to taste as good. And so, you know, I think like, obviously, everyone's taste is sort of their own, right? It's, it's based on their biology. And, and so unless it like, your partner's like, oh, all of a sudden it tastes really different and it tastes unappealing, I wouldn't worry about it. But like, you know, again, I think that like, it is, it's nothing that you should ever like, really worry about, right? Your, as long as you're a healthy person, your semen should be tasting good.

• 1:40:31Speaker 03

  The color of the semen can vary. I get this question a lot. So like people be like, oh, it looked, it looks a little yellow now, or it looked a little, um, a little grayish. And really, the color can vary. Um, it's not dangerous. So the good news is not dangerous. Um, I always say if you're worried, just drink lots of fluids. It's gonna, it's gonna dilute everything, right? It's gonna make things a little bit clearer. Cause I think a lot of times we are drinking a lot of energy drinks or not, not really just water. And so sometimes it's just like increase your water intake and things will clear up. Um, if you get blood in the semen, that's a little bit concerning, but usually 99% of the time it's not dangerous. Um, and if it happens once, don't worry about it. If it continues to happen over and over again, that's a time to sort of get a red flag.

• 1:41:14Shawn Ryan?

  Okay. And then we may have covered this, forgive me if we did, threw a lot of information at me. But I've heard rumors or maybe read some things wherever it came from. I, I can't remember, but

• 1:41:29Shawn Ryan?

  does ejaculation for men lower the risk of cancer?

• 1:41:32Speaker 03

  Yes. So ejaculating, we, we know there's an association. So when you ejaculate more than 21 times a month, there is a, about a 20% lower risk of prostate cancer.

• 1:41:44Shawn Ryan?

  20%?

• 1:41:45Speaker 03

  Yeah. And so now is it the ejaculation that's causing that lower risk? I mean, the study that does not, that did, that found this data actually tried to control for a lot of different factors. Um, you know, like other health conditions, but you would imagine that someone who is ejaculating that frequently has a, has a partner or, um, is healthy enough to do so. So maybe there are some other factors that we can't really quantify scientifically. But the theory is that perhaps ejaculation is allowing fluid to move through the prostate more readily. So that fluid doesn't stick around and cause inflammation or other issues that then may lead to transformations, um, that could lead to cancer.

• 1:42:25Shawn Ryan?

  Okay. And what, what, I mean, what age?

• 1:42:29Shawn Ryan?

  How long can people have sex?

• 1:42:32Speaker 03

  I mean, as long as they live, but a lot of times people don't. And so we call that sex span, right? Like you, your thing of your lifespan is how long you live, but your sex span is how long you're gonna have sex. And so if you remain strong and healthy, so you're strong enough that you can still maintain the positions of sex. And to be honest, there's even like furniture now and like things that can help you have sex if you're a little bit weaker or like can't get certain positions. Like there's like wedges and slings and different things that can help that so you can continue to have sex. But also that you don't get winded, right? When you're, you're not exhausted, that you can't actually exert enough to have sex.

• 1:43:13Speaker 03

  But if you are a healthy person, you've maintained your muscular health through fitness. You've maintained your cardiovascular health through fitness. It is very likely that you continue to have sex well into your old age. I've seen 90 year old patients who are still having an active sex life.

• 1:43:27Shawn Ryan?

  90 years old?

• 1:43:29Speaker 03

  Mm-hmm, and don't have erectile dysfunction and they're like very healthy. And again, they have prioritized their health and they have maintained their, their exercise. They've maintained their health, they've eaten a healthy diet, they've slept, they've dealt with stress. They've, you know, they've created an environment which is healthy around their bodies and they are still able to have sex with their partners.

• 1:43:50Shawn Ryan?

  Now, do you see a, do you see a lower sex drive in older couples or just older folks in general?

• 1:43:58Speaker 03

  Well, so yeah, let's talk about it for each individual. So for men, the most common reason for low sexual desire, especially as the age one is low testosterone. So testosterone declines at about one to one and a half percent every year after about 40. So if you are very healthy and you started with a normal testosterone, it's unlikely that it should get low enough that it would cause you a problem. But that's not the reality for many people. So about like overall 20% of people have low testosterone, but that percentage goes up as you age. And that's because add in, you know, it's like other medical conditions that will affect low testosterone. Testosterone. So we know that as people get more metabolic conditions like high cholesterol,

• 1:44:43Speaker 03

  diabetes, um, high blood pressure, they're, they tend to get lower testosterone. Um, add in, uh, potentially like lack of sleep and more stress in their life that causes more testosterone. Add in sedentary lifestyles, add in, um, even environmental exposures like microplastics and things like that, that we have some control over, but not completely. Um, and, and now you're in a situation where you're more likely to have a larger decline than is expected. And so we, we are seeing more and more low testosterone. And testosterone is the hormone of desire. And so when you have low testosterone, oftentimes it will present in men with low sexual desire and loss of morning erections.

• 1:45:26Speaker 03

  So those late night, those morning erections. It also testosterone is important for so many things in your body. So it increases muscle mass, it helps with mood. So sometimes people who are depressed, men who are depressed, will find that their mood gets a little better when they start on testosterone. Uh, brain fog, so it helps guys with brain clarity. And that's actually one of the very common things I'll see in older guys who have low testosterone is I'll give them testosterone and the first thing they'll notice is that their brain is a little clearer. Um, and it helps with like the ability to just do normal functional things like walk upstairs, hand grip strength, like things like that, like functional. Um, and, and so there's so many facets. It also helps with bone health and bone health is so important as we age. So it's not just a hormone of sexual desire. It's so much more than that.

• 1:46:10Speaker 03

  But so that is often a cause in older men of loss of sexual desire. Also, if they're unhealthy, right? They have a health issue and then sex is like off the table because they don't feel well, right? And that happens to a lot of guys where like, like I'll see women, I think my husband can't have sex because he's unwell, right? Um, Or, or he, his partner is unwell and so they can't have sex because of that. So that, that becomes very common reasons. Now for women, low sexual desire is even more common. So it's actually estimated like forty percent of women have low libido, so low desire. And there's a variety of reasons for that. One is, yes, women also have testosterone and their testosterone also declines similarly to men.

• 1:46:54Speaker 03

  And so they can't, that can be part of it. There's also changes of menopause that can really affect women as they age. So they can have dryness vaginally, which can make it uncomfortable to have sex and lack of lubrication. They can have, their, their tissues actually change. So they get, they get what's called atrophy. So the tissues get thinner, more friable, so it's more painful. And it's actually like not as flexible or as stretchy as it used to be. So actually penetration can be painful. Their clitoris can even have changes, just like men have erectile dysfunction. Women can have changes in their clitoris where they may have less, less pleasure from the same stimulation they were getting before. So it's more difficult to get orgasms.

• 1:47:37Speaker 03

  And so when you are having sex, that's not really leading to pleasure. It becomes like less of a priority, right? And so, you know, we have things that can help women too. And I see patients all the time. Sometimes it is off-label testosterone. Sometimes it's other medications that we can offer. But also it's like dealing with those, those things, those changes that are happening because they can really make you not want sex. And then your partner, if you're, if you're, you know, male partner is like, I still want to have sex. But she's like dealing with all these changes hormonally. She doesn't want to, right? She's like, I'm not sleeping well. I'm having hot flashes all the time. You know, everything's dried on there. I might be getting UTIs all the time. All these things are often hormonally mediated and they can be remedied.

• 1:48:19Speaker 03

  And same thing for men, if your testosterone is declining, we can improve that either naturally or with replacement.

• 1:48:25Shawn Ryan?

  So how, how can, I mean? What age does menopause usually start?

• 1:48:29Speaker 03

  So average is fifty one, but up to ten years before that, and that's average, meaning that half of women will be before fifty one, half will be after, but well before perimenopause, up before menopause is perimenopause, that can be four to seven to ten years before menopause. And again, it can, so that could be as early as your forties or late thirties, some women are experiencing these symptoms, and that's when the symptoms are really intense, because there's like this hormonal chaos, like that some days your estrogen's really high, some days it's low, because your body's like something, it's all unregulated, right? And so during that time, they're just like, they're super stressed, they're not sleeping, they're having hot flashes, they, they don't feel like happy, sometimes they feel depressed.

• 1:49:12Speaker 03

  I mean, there's so many things going on, and they honestly feel like they're out of control, like they don't feel like themselves. I mean, men will say the same thing when their testosterone is low, that they don't feel like themselves.

• 1:49:21Shawn Ryan?

  Uh huh. And so, I mean, how do you, I mean, how do men strike up a conversation with, with, with their partner who is?

• 1:49:31Speaker 03

  So I think it is, you, you have to really do this cautiously, because I think the, the thing is like, oh, if you say, oh, I think it's hormonal, it almost feels like the, the partner may feel like affronted, like you're, you're telling me I'm hormonal, you know? So you have to sort of do it in a, in a way like, look, um, you, you can try like, hey, look, I, I saw this video on, online, I listened to this podcast, and they were talking about this, and I'm like, wondering if, you know, do you, like, are you having any symptoms, or do you, would you like to see a specialist, like, can I, can I help you find one, can I go with you to the appointment? Like, I, I mean, I love it, male patients bring me their wives all the time, and I love it, and so supportive, so wonderful, and they have this wonderful, beautiful relationship, and they just want to support each other. And I think it's just being, look, I love you, and I want you to feel well.

• 1:50:15Speaker 03

  It's not about wanting sex, it's not about like, um, wanting, you know, you as a physical being, it's about wanting you to feel like yourself, and feel happy, and fulfilled, and feel like normal in your body, and I think like, showing them that you want that is so valuable, like the, oh, you love me, and you care about me, and you want me to feel good, it's not necessarily just about sex. It's, it, you know, it's much more than that. And so I think that's where, it's like, you don't want to start the conversation to be like, oh, we're not having sex, I want you to see a specialist, or I think you're going crazy, and you're hormonal, and like, you know, something's wrong here. It's more like, look, I love you, I'm worried about you, and I want to help, and like, I, I really, you know, want to be there for you.

• 1:50:55Shawn Ryan?

  What are, I mean, what are some of the initial treatments? I mean, it's, it sounds like lubricant would be an obvious answer if it's dried.

• 1:51:03Speaker 03

  Lubricant is great, and I think the one thing people don't realize is that lubricant comes in different formulations, like you can get a water-based lubricant, which is the most common one you see, but those dry up. And so like, if you're gonna have sex, it's gonna last a few, more than a few minutes, like, you're gonna have to reapply, otherwise it's not really gonna work. Um, so you can get water-based, but silicone-based and oil-based are a little longer lasting. And so those are convenient in terms of like, allowing you to just apply once and like, have sex and not worry about reapplying. Um, and so just figuring out like, what kinds you guys like, and might be experimenting with a few and figuring out what feels good for both of you and you both like, because it's a very individual thing. But I think lube is great, it's cheap, it's available, it's accessible, and it's like,

• 1:51:46Speaker 03

  hey, let's have fun with it, let's make it fun, right? Um, there's also moisturizers, so for dryness specifically, you can get vaginal moisturizers, just like you have facial moisturizers, there's vaginal moisturizers, and it's just skin, it's just skin, so just like moisturizing the skin, keeping it healthy. Um, and then specifically for what we call the genital urinary syndrome of menopause or the dryness and the other issues, you can use hormonal creams, so like vaginal estrogen, which is very safe. So it's not, um, when I think about, there's a lot of confusion about hormones. Vaginal hormones don't, very little gets systemically absorbed, so there's never been a risk of breast cancer, ovarian cancer, uterine cancer. In fact, it's probably safe for about anybody unless they have an active breast cancer.

• 1:52:29Speaker 03

  So anybody else can get vaginal hormones. And so in those cases, you can do them in a cream, a pill, a ring, there's lots of different options, but they can really, one, keep the tissues healthy, so they feel comfortable and they feel good, and it feels good when they have sex, and can prevent recurrent UTIs. Um, and it can even help, like, you, if you're looking down there, you may notice that their vulva actually changes, like, the lips, the inner lips will actually shrink and resorb because the lack of estrogen. So sometimes if you apply the cream on the outside, it can help keep those tissues healthy too. And so, um, not everyone needs it, like I said, but I think it does benefit people. It, the majority of women would benefit from it, and I think that it's really very,

• 1:53:13Speaker 03

  very safe, um, because again, it's just topical, very little bit gets absorbed systemically.

• 1:53:20Shawn Ryan?

  Are there, I mean, it sounds like, it sounds like you recommend TRT for men a lot.

• 1:53:30Speaker 03

  I recommend TRT for men when they have symptoms of low testosterone, which we sort of talked about, but like low sexual desire, brain fog, fatigue, loss, maybe decreased mood. When they have multiple symptoms that could be related to testosterone and their testosterone is low. And so testosterone is measured through a blood test. The challenge with testosterone is it only gives me a number of what your level is at that time. I don't know what your level was in your twenties. So if you have younger listeners listening, I generally recommend that people get a baseline level when they feel good. Right? What is your testosterone when you feel good? So that when, as you age, you have a reference. And like if something happened and you feel like, oh man, I'm so exhausted. I don't know what's going on. You check your testosterone.

• 1:54:14Speaker 03

  If it's the same as it was when you were in your twenties, okay, it's not your testosterone, it's something else. Right? But it gives you a reference because what we don't know, and what's difficult to study is your receptors, which is what testosterone attaches to. Some people's receptors are more sensitive, so they need less of it, less testosterone around to get the same results. And some people need more because their testosterone receptors are less sensitive. And so I can't tell that. We don't have like a commercially available test that we can say like, okay, you have better receptors. You have more, you need more testosterone to saturate those receptors. We don't know. And so it's a very individual thing. Now, they can say benchmarks based on like what we know, population based data.

• 1:54:57Speaker 03

  And that's usually 300 nanograms per deciliter is like the normal benchmark. But I mean, there are some people who have testosterones that are higher than that, that still have symptoms. And that may be because their free testosterone is low, which is the testosterone that's like around in the bloodstream that is actually what's actively working on all those receptors. Cause most of it is just like with other little molecules that are like little carriers, like little cars they sit in. But they don't let you get off the cars, that you can't actually go and work on the organs. They're just there. And so only about like 5% or I think it's Actually, it's like one or two percent of the testosterone is free. And that's what matters. And so that's what we want to see. Because other things that can affect the, those carrier molecules, the sex hormone binding globulin.

• 1:55:40Speaker 03

  So it can cause it to be more. So as you age, sex hormone binding globulin goes up. So your testosterone may look the same, but your S H B G is going up. And now you have less free testosterone, and so you're symptomatic. And so I think that it is, it is valuable for men when they're low to improve their testosterone. Now, it doesn't always have to be through replacement. There are things you can do naturally to help improve your testosterone. That includes sleeping more than seven hours a night of quality, high quality sleep. Can increase your testosterone by 15%. If you have sleep apnea, there's actually been very good studies that when you use a CPAP, which is like a machine that helps people who have sleep apnea, they increase their testosterone quite significantly. So if you snore or you have a really big neck circumference,

• 1:56:24Speaker 03

  think about getting a sleep study to find out if you have sleep apnea. Because fixing that will fix so many of your issues, including your testosterone. It's actually like a risk, it's actually a mortality risk. People who have sleep apnea die sooner because they're not getting as much oxygen to their brain throughout the night and their organs. If you exercise, resistance training, heavy resistance training of your muscles can help boost testosterone. If you eat healthy, so meaning like what we, again, diet is very challenging to study. And it's very difficult to give population based data. But what we know on a population level is that Mediterranean style diet, meaning prioritizing healthy fruits and vegetables, not unprocessed foods.

• 1:57:08Speaker 03

  I basically tell people unprocessed foods, natural foods, and ideally prioritizing fiber and protein are probably your best bets in terms of overall health for both testosterone and just overall health. And then with testosterone, importantly, you don't want to get on too low fat of a diet. Testosterone is a molecule that's made from cholesterol. And so if your fat goes too low, you won't make enough testosterone. Um, I think that's really valuable for military men is that you guys do a lot of really intense endurance work. When you do really intense endurance work, your testosterone goes down because it's like chronic stress on your body. And so that is something to look out for is if you're doing a lot of intense endurance work during those times,

• 1:57:52Speaker 03

  you might be like, man, I'm exhausted. Yeah, you're doing a ton of endurance work, but also your testosterone is low. And so that can come back, obviously, when you stop doing those things. But it is something that you might notice during those stressful periods of time, when you're putting your body through these really intense things.

• 1:58:06Shawn Ryan?

  I mean, would you, I mean, I've read lots of things, interviewed people about it. I mean, you know, it seems like testosterone is declining in men at a rapid pace as years go on. And they talk about, you know, how kind of like the World War II generation, ever since then, it's just been on a decline. And so, you know, now, now TRT is, you know, wildly popular. Do you want to have, you know, is, is, is, is an older man, does an older man want the same level of testosterone?

• 1:58:39Speaker 03

  Mark to know what it used to be, right? But at the end of the day, we have to see how you feel. So I think people get very fixated on numbers, and it's important, numbers help guide us, but what should be guiding us is how you feel. Right? So like, if you're like, I'm full of energy, I feel great, I'm having great sex, and my mood is great, and I'm focused, I'm able to be productive, I don't feel a deficit in any area of my life, then who cares what your numbers are? You feel good, and that's what matters, right? And, and I think that's important. Now, I do, like, I do think that there's some value in like, keeping track of things, because you want to catch things before they become a, like, you don't want to be miserable, and like, can't get out of bed, and can't

• 1:59:20Speaker 03

  move, before you go see the doctor, right? You want to sort of be a little bit proactive. But again, I think it's not necessarily the number always that matters. It's we have to talk about what you feel. Where is the deficit? What's going on? Right? Like I said, a lot of people think, oh, I, my erections aren't working, testosterone's the answer. And that's not always the case. In fact, it's not very often the case. And so, it's like, we have to like, look at you as a person, not as a lab test, or as a blood value. We need to look at you and be like, okay, what's going on in your life? What's outside of our clinic room or outside of like whatever this blood work is showing me, what else is going on, right? Like, are you having a ton of stress at work? Are you dealing with a financial calamity?

• 2:00:05Speaker 03

  Are you, right, is your partner like super stressed because her mom's in the hospital? And like it's affecting your whole life and homeostasis at home? Like, what is going on? Because it's, you're not just one blood work. You are a whole person.

• 2:00:20Shawn Ryan?

  Are there any, I mean, are there any concerns about going on testosterone replacement? I mean, you know, I've heard, I've heard that it can increase the risk of cancer, uh, increase the rate of cancer, um, enlarged prostate. I've heard, I've heard all kinds of things about it.

• 2:00:37Speaker 03

  So there's a lot of misinformation and some of it was a misunderstanding that now we know better. But let me go through it. So testosterone replacement is, um, as I mentioned, very helpful in improving all those things that we've talked about. Now, what are the risks, the true risks? So in terms of the things you mentioned, cancer, testosterone replacement does not cause prostate cancer. We know that unequivocally. The issue is that if you develop prostate cancer, which one in eight men will get prostate cancer, and I give you testosterone, I don't know you have prostate cancer because it hasn't, it hasn't shown me yet. Your PSA is still normal, everything else is fine, but maybe you were destined to get prostate cancer. And then you get prostate cancer. It will cause that prostate cancer, once it's there, to grow more rapidly.

• 2:01:21Speaker 03

  And so that's why it's really important if you go on testosterone replacement to get your PSA, which is a blood test and screening for prostate cancer, checked regularly. Because we want to make sure that, God forbid, you are in one, was one in eight, that we stop the testosterone, we treat your prostate cancer, right? And we, we fix that because we don't want an untoward thing to happen. Um, so that's one. In terms of enlarged prostate, they've also looked at that. And there's actually been no evidence that testosterone, again, in and of itself, causes an enlarged prostate. Now, if you already have an enlarged prostate and you have symptoms that are bothersome. Um, you, when you give testosterone, it will cause a slight increase in both your PSA and it may cause a slight increase in the size of the prostate.

• 2:02:03Speaker 03

  Um, and so if you're already sort of struggling and I give you testosterone, it might make you struggle a little bit more, whereas the average person, it won't bother them at all, right? The one that it does sort of cause problems with is if you have that sleep apnea we talked about earlier, if you have really uncontrolled sleep apnea, it can make it worse because it's gonna increase muscle mass. It also increases the muscle mass in your neck, which then makes that sleep apnea worse. Now, usually that gets better with time, um, but if you're really like struggling with sleep apnea already and you're waking up all night and you can't breathe at night, it's gonna make it worse, right? And so that's, that's one that we know. The other one that we absolutely know is that it can cause thickness of the blood or it can increase what's caused your hematocrit. And when your blood gets too thick, and it's about like seven percent of people who get

• 2:02:48Speaker 03

  this change, depending on which formulation of testosterone you go on, um, it, it causes you to be at a higher risk for blood clots and strokes. That we do know. Testosterone replacement will put you at higher risk for those things, so we need to keep a close eye on it.

• 2:03:02Shawn Ryan?

  Okay.

• 2:03:02Speaker 03

  Absolutely. Um, and, and so those are the big ones. Um, in terms of like, I, I think the other big thing that people need to know is when you start on it, you need to think of it as you're gonna be on it for life. Like you can do a trial, you can do like two or three months and be like, is it, am I noticing a difference? And if not, go off of it. That's not so, so difficult, but it's, if you've been on it for years and years and years, i- if you go off of it, you are no longer, you've shut down your body's process of making testosterone. So you won't make any for a while and you will feel like crap for a while until your body revs it up. Now, we can use off-label medications to sort of help jumpstart your body to making testosterone, but it's not something that every doctor does and that every doctor knows how to do. Um, so I just tell people like, think of it like you're gonna be on it for life.

• 2:03:46Shawn Ryan?

  Is that HCG?

• 2:03:48Speaker 03

  Yeah, HCG or Clomid, both those things can be helpful in, in FSH in some cases to help restart things. The other thing is if you want to have kids, it will make you infertile. And not like your sperm count will go down to zero, but it will go down low enough that fertility becomes challenging. Now, everyone's heard of people who've been on steroids or on testosterone have had babies. It's because it doesn't go down to zero. It goes down to a very low number. After about 18 months of being on it, you're pretty much at a very low number that would become impossible to, nearly, virtually impossible to impregnate another person. So a lot of young guys, as you know, you mentioned, like testosterone is declining. But the young guys are like, oh, I need testosterone. I don't feel well. And they do indeed have low testosterone. They start it because no one tells them that.

• 2:04:33Speaker 03

  Then they get married and they want to have kids. And now they're in a situation where they have little to no sperm and they have to sort of, again, use HCG, Clomid and try to get it back. But depending on how long you've been on it and how old you are, it can be more and more difficult.

• 2:04:48Shawn Ryan?

  Okay, okay. So before we move on, I want to talk about prostate health and that stuff. But, you know, are there any, basically what I'm getting at is Gen Z. You know, they're the up and coming generation. You know, is there substance of use? Is there certain substances that can affect erectile dysfunction? That can affect hormones, testosterone?

• 2:05:17Speaker 03

  So we know smoking unequivocally. I mean, I don't think this generation smokes that much, but they do vape. So smoking can affect erections absolutely. It will destroy your erections because it's going to destroy the blood vessel health. And again, those, the blood vessels of the penis are really, really small. So you're going to see issues with erections before anything else. So if you're smoking, I'm like, this is the best non-smoking ad. Is it like, don't smoke to help protect your erections? I think everyone would quit, right? I think instead of like, all the, like they're showing people like, people with lung cancer, they should have shown like a penis that doesn't work. I think people would have quit smoking. A lot faster. Um, so that's one, but a lot of, uh, young people are using marijuana. Uh, and marijuana, chronic use of marijuana can absolutely lower testosterone and, and

• 2:06:02Speaker 03

  cause issues with hormonal health.

• 2:06:04Shawn Ryan?

  Really?

• 2:06:04Speaker 03

  Yes. So when you're using it chronically, you will see that it can cause issues with fertility. So we, we see a lot of young guys who are trying to have kids and they use, you know, marijuana all the time and, and for a variety of reasons, recreation, whatever. And now they have really poor semen health, poor sperm health, and they can't get their partner pregnant. So I think, you know, marijuana use is legal in some states and it's okay uh, on occasion recreationally. We don't know if there's a like a, like we know now that alcohol is not healthy in any amount, but we don't have that same granularity about marijuana in terms of is any bad, but definitely chronic use is, is bad for your sexual health and your.

• 2:06:46Shawn Ryan?

  What is chronic use?

• 2:06:48Speaker 03

  So chronic use is like every day or multiple times a week and, um, and you know, if someone is like feeling sort of, um, like they are always mellow because they're on it. They're always sort of like, like basically they're feeling the effects of marijuana. They need the effects and they're almost like using it because that those effects feel so good and they're using it all the time. That's probably a sign they're using it too much.

• 2:07:10Shawn Ryan?

  Okay.

• 2:07:11Speaker 03

  Yeah.

• 2:07:12Shawn Ryan?

  And so let's get back to prostate cancer. What age should men be checking their prostates?

• 2:07:18Speaker 03

  Yes. So the guidelines would say, uh, 55 is the year, the age to start, uh, screening for prostate cancer. I would say also if you have a family history of prostate cancer, specifically your dad or your brother, um, meaning direct first degree relatives, that puts you at a much higher risk. If you're African American, that puts you at a higher risk. If you, um, have a BRCA gene, so if your mom had breast cancer and has a BRCA gene positive, that also puts you at risk for breast cancer. Or if you have multiple cancers in your family, I would still encourage you to get tested earlier. And so like that would be based on at least five years earlier, or if your parent or brother had prostate cancer, let's say at 50, I would start testing you at 45. And so what is the test?

• 2:08:02Speaker 03

  So I think it always used to be a prostate exam and a blood test. Nowadays, the prostate exam, which is a finger in the bottom, is sort of, we've decided it's not always necessary. Because, so urologists, we do prostate exams all the time, we know what we're looking for, we know how to do an exam very well. But general practitioners, primary care doctors, family care doctors, well, the fact is like, they don't always really know what they're feeling for, because they don't always necessarily like feel abnormal prostates, it's not like their area of focus. And so it was actually creating a lot of false positives, where people were like, oh, I feel something, send it to the urologist, now the urologist has to like do a biopsy, which is unnecessary. And, and you know, it, it sort of led to this unnecessary like further testing and

• 2:08:47Speaker 03

  evaluation. So they said, okay, based on that, we don't necessarily recommend that everyone needs a prostate exam. I still think that if you're going to a urologist, it's, it's valuable to get one because we know what we're looking for. But a PSA is a simple blood test, it's a screening test. So it doesn't tell you yes or no, you have prostate cancer, but it's a quick and easy way to say, okay, maybe you're at risk. But there's other things that can increase your PSA. That can be inflammation, so you might have had masturbated, or you might have sat on a bike seat, or you might have like had some sort of low grade inflammation that you didn't really know, and that can cause an increase in PSA. You can have bleeding in the genital urinary tract, for whatever reason, that can increase your PSA.

• 2:09:28Speaker 03

  If you went to the hospital and you had a catheter placed or anything in the urethra, that can increase your PSA. So there's a variety of different things that can increase your PSA. So this is why it's a screening test, it's not yes or no, it just says, okay, you might be at risk, now what do we do? So if it's high, usually we'll check a second one to make sure it's not inflammation, it's not, you know, anything else. And if it's still high, then we talk about what's the next step. So before, it used to be straight to biopsy, right? You go and you get a biopsy of your prostate. Now we have a lot of different things, but the biggest and most sort of revolutionary in urology has been just a prostate MRI. Because now they've looked at prostate MRIs and they've found this sort of grading scale to say like, okay, you do an MRI and you see if there's any areas that look concerning

• 2:10:09Speaker 03

  and you grade them based on the way they look. And from one to five, one being like very unlikely cancer, five being like very highly likely cancer. So that gives you more of a degree of confidence on like, okay, do we need to biopsy this? And if so, where are we biopsying? Because when we do a biopsy in urology, when I was training, it was like, we're just poking 12 areas in the prostate randomly. Like, I mean, obviously throughout, we're doing it systematically, so we get a little bit of every little bit of it, but we just go, you know, we're just, we're just getting 12 random cores in the prostate. Now we could do it with a little bit of degree of like, okay, now we have this MRI, we can, you know, overlay it on ultrasound and see where we're going to biopsy. And, and so that's helpful. And also, if you have, like, if you have a high prostate and your prostate's

• 2:10:54Speaker 03

  huge, which is also another reason that your PSA can increase, and there's no lesions on your MRI, I might say, hey, let's keep an eye on it. Everything looks good on this MRI. And you have a very big prostate, which also causes an increase in PSA, let's keep an eye on it. You know, we don't need to do a biopsy at this time. So it can sort of help us decide. And there's a bunch of different biomarkers that, and urine markers that we can test if, you know, we want to sort of get a little bit more granularity. Now, there's not like one that's better than the other. And I would say, talk to a specialist in prostate cancer, a uro-oncologist, when you're deciding if you want to get more testing before you either get a biopsy or get treatment. If you do find that you have prostate cancer.

• 2:11:34Shawn Ryan?

  I mean, what are some symptoms that people should be looking out for?

• 2:11:37Speaker 03

  Most people have no symptoms.

• 2:11:39Shawn Ryan?

  Zero.

• 2:11:39Speaker 03

  This is why we have screening. This is why we do screening. Most people have no symptoms. And by the time they get symptoms, it's actually a problem. It's usually like a more advanced cancer. So symptoms could be that you're, have blood in the urine. Could be that you have back pain, could be that you have night sweats or weight loss, could be that you have, are going to the bathroom a lot or more frequently or having trouble peeing. But those can also be signs of an enlarged prostate. So, we don't, that's why we do screening. We don't rely on symptoms. And absolutely, if you're having symptoms, we should screen you for prostate cancer at that time too. But, you know, in general, that's why we do screening on people who have no symptoms. Because that's when we find it.

• 2:12:16Shawn Ryan?

  So, okay, so, I mean, when it comes to an enlarged prostate, I mean, can it be, can it, can it be reduced?

• 2:12:23Speaker 03

  Yeah, so, an enlarged prostate, so, I will say eighty percent of eighty-year-olds have an enlarged prostate. And eighty percent of eighty-year-olds also have prostate cancer. So if I, if I took all, like, we did autopsy studies and you look at the prostates of eighty-year-olds, they all have some focus of prostate cancer. So, before I get into enlarged prostate, I want to round out that discussion because I think it's important to understand this. Is that if I diagnose you today with prostate cancer and you are seventy years old and you are really unhealthy and your dad died at seventy-five and you also have so many medical issues that you will likely pass in the next ten to fifteen years, I should do nothing about that prostate cancer. Because something else is gonna kill you long before the prostate cancer does.

• 2:13:07Speaker 03

  Because it is, is very slow-growing. And it's really important for people to understand. Nobody wants to face their mortality or think about how long they're gonna live. But I'll give you a personal example. My grandfather got prostate cancer in his seventies. No one talked to me about it, like, I was in residency, and they put him through radiation. And a couple of years later, he died from a heart attack. And if they had asked me, I would've told them, "Don't do anything about this prostate cancer. He's not healthy. He's seventy years old." And he just went through this radiation for no reason, right? Now, if he was sixty and he was healthy, or even seventy and healthy, I would've said, "Yeah, treat it." But I think this is a really important discussion. Because not all prostate cancer needs to be treated. And some can even be watched.

• 2:13:52Speaker 03

  So we have protocols, like active surveillance protocols, where we can do routine MRIs and biopsies and keep an eye on it. Because as I mentioned, it's slow-growing and some people, it'll never become a problem. And so we're trying to find those people and not put them through surgeries or radiation that have multiple side effects and potential complications, because they won't need it. Right? So I think it's really important, before we talk about enlarged prostate, to just get that point out there. Because I see so many- Uh, people who are like, no, I just wanna know. I'm like, do you really wanna know though? Because once you know, then the urge is to do something about it. And then you might do something about it that you didn't need to do and have a side effect that you have to live with for the rest of your life. So there's a lot of regret in some guys who have prostate cancer treatment

• 2:14:36Speaker 03

  because they may develop erectile dysfunction or urinary problems afterwards. And, and now they, they could have lived without those things because they maybe didn't even need the treatment. Now, it's very individual. It's a very individual discussion to have because every prostate cancer is a little bit different. Um, and some look more aggressive and some are less aggressive and, you know, we grade them and we use all these nomograms to do that. I'm not gonna belabor all the specific nuances, but I just think it's really important to have that discussion.

• 2:15:06Shawn Ryan?

  Thank you for saying that.

• 2:15:07Speaker 03

  Yeah.

• 2:15:07Shawn Ryan?

  Enlarged prostate.

• 2:15:09Speaker 03

  Yes. So enlarged prostate, um, is very common as well. Enlarged prostate, um, occurs because of a variety of different things. So one, we know genetics. So if your dad had enlarged prostate and he was young, you are likely also gonna have an enlarged prostate. Um, and sometimes you'll know because you, he won't tell you that, but you might remember, oh, my dad was always going to the bathroom or he was in the bathroom for so long trying to empty his bladder. You might remember those things or he might tell you that. Um, so that's one. Two is we know, like, as you are more, um, unhealthy, that causes more inflammation in your entire body, right? So if you have other metabolic issues, your prostate will also get inflamed and then that inflammation causes growth. And then growth causes more inflammation that then causes growth. So it creates a sort of vicious cycle in the prostate.

• 2:15:54Speaker 03

  Those are the common reasons why prostates grow, but very, most guys have some degree of enlargement. Now, what does that mean for you, right? So can you prevent it? Let's start with that. So people always wanna know, can I prevent it or can I, can I shrink it? Once it's grown, I don't think you can necessarily shrink it, but you can definitely prevent it. So there's some data. There's not a ton of data on this, but basically they did trials looking at, uh, people for prostate cancer prevention and they looked at a whole bunch of different factors. But in that, they also looked at enlarged prostate. And what they found was that people who ate more vegetables tended to have less prostate. Less enlarged prostate, people who ate, who walked more, so two hours of walking a week even was good. So exercise, generally speaking, tended to have a lower risk.

• 2:16:39Speaker 03

  Maybe lycopene, so like, this is red-based tomatoes, watermelon, like fruits and vegetables that are red in color, may have a protective benefit. So I'll tell people, like, generally leading a healthy life, exercise and, and diet can help potentially reduce your risk of prostate cancer. Whereas like if you have that enlarged prostate, if you have diabetes, your risk goes up of having enlarged prostate. If you have high blood pressure, your risk of having enlarged prostate goes up. So again, the same sort of things, the unsexy things will help prevent that. Now, when you have an enlarged prostate, I think people always assume, like, it's very simple, like, oh, you have an enlarged prostate, you have a problem with urination, that's all there is to it, but it's actually a little bit more complex.

• 2:17:25Speaker 03

  You can have a big prostate and have no problems, and you can have a small prostate and have problems. It's really based on how it's shaped and how it's blocking the flow of urine. Because the prostate sits underneath the bladder around the urethra. So when it gets big, it can get big on the outside or get big on the inside. If it gets big on the inside and it blocks the flow of urine, you can start having trouble peeing. Now, it can also affect your bladder, because now your bladder is pushing to get urine through that prostate. So sometimes guys will present with what we call, there's two categories. There's voiding symptoms, so that means that they can't pee, they're waiting for their stream to start, their stream is weak, or it's stopping and starting, takes a long time, and they don't feel like they're empty.

• 2:18:08Speaker 03

  That's one type. And oftentimes with both types, they'll wake up a lot at night to pee. And then with the other type, which is called storage symptoms, or bladder symptoms. So the bladder is responding to this blockage, because the bladder's like, oh, I can't, it's not clear, so I'm gonna, I'm gonna work harder, so I'm gonna have more overactivity, I'm gonna go more often, I'm gonna feel the urge to go more often, and it's gonna be really, just really bothersome to me, right? And so that, those are, those are also common. Now, which kind of symptoms you have doesn't- Really necessarily affect what we do unless you have other issues. So if you're like diabetes diabetic, or you've had nerve injuries, then we're wondering, is it the prostate or is it the bladder? Cause those things can affect the bladder. But for most guys, it's because of the blockage.

• 2:18:53Speaker 03

  And when we fix the blockage, all the symptoms get better. Um, and we can fix the blockage in a variety of different ways. Um, for again, lifestyle, um, you can do some things to reduce the irritation related to enlargement. So you can limit how much you drink before bedtime. So you're not waking up as often. So we'll tell people, don't drink like two hours before bed. We'll also tell people like, look at what you're drinking and eating. Because certain things can irritate the bladder, which can then make things a lot worse. So things like caffeine, alcohol. For some people, spicy foods, acidic foods like tomatoes and citrusy fruits and juices, even artificial sweeteners for some people. So I tell people, make a journal, see what you're eating and drinking and take a note of your uh, symptoms.

• 2:19:39Speaker 03

  And pay attention, you're smart. You can figure out like, oh, I had a coffee. I had three coffees this morning and I'm going to the bathroom more often. So maybe I should just drink one and drink two decaf's if I love my coffee. Cause you won't take my coffee from me, I won't take your coffee from you. Um, so, so I think like, those are, those are things you can do. Also, if you're constipated, so many people don't know this, but when you're constipated, you're affecting your bladder. So it will worsen all your symptoms, whether you're having more trouble peeing or you're going more often and more urgently. So if you're constipated, you need to correct that. So whether that's with adding more fiber in your diet, adding supplemental fiber, or taking medication to help you go better, or moving more, um, those things can all help improve constipation. So those are things that you can do in your lifestyle to improve.

• 2:20:23Speaker 03

  Um, and then also like trying to go twice. So for some people, some guys, um, sitting is actually easier to empty their bladder when they have an enlarged prostate. For some guys, they still wanna stand. Um, but it could be that you need to pee standing up and then you gotta sit down and pee again and try to empty your bladder completely. Or you need to like, take a deep breath and sort of relax the muscles a little bit. Try to work on that and then pee again. Um, so there are little things that you can do to make your life a little better. But very often we'll do, there's, there's medical options and there's surgical options to help reduce the prostate. And so that's important to talk to your doctor about. But really the, the thing that I want all guys to know is that a lot of these treatments do have side effects that can affect ejaculation.

• 2:21:04Speaker 03

  So a lot of guys feel like when they ejaculate, that is a big source of pleasure for them. Not, not just the orgasm, but the actual act of ejaculation. And so a lot of these treatments, medical or surgical, can affect how much ejaculate comes out. And so if that's important to you, because sometimes if you're with someone who's rushed that day, may forget to tell you that that's a side effect, right? Of the medication they're going to give you, or the surgery they're going to give you, then you will be really unhappy after the fact. And so I just want people to know that because there's always trade offs, right? Sometimes they treat something and there may be a side effect. But if you are literally not emptying your bladder and you're getting recurrent bladder infections, or bladder stones, or you're bleeding a ton, like, we need to do something.

• 2:21:49Speaker 03

  Whereas other times, it's just quality of life. We want to improve your quality of life.

• 2:21:56Shawn Ryan?

  Time doesn't slow down, and really, you shouldn't either. We all sit around and say, "Oh, I'll get to that later." But something shouldn't wait, like protecting your family's financial future. Fabric by Gerber Life is term life insurance you can get done today. It's made for busy parents like you, all online, on your schedule, right from your couch. You could be covered in under 10 minutes with no health exam required. Fabric has flexible, high-quality policies that fit your family and your budget. Like a million dollars in coverage for less than a dollar a day. If you have kids, and especially if you're young and healthy, the time to lock in low rates is now. Join the thousands of parents who trust Fabric to help protect their family.

• 2:22:39Shawn Ryan?

  Apply today in just minutes at meetfabric.com/shawn. That's meetfabric.com/shawn. M-E-E-T, fabric.com/shawn. Policies issued by Western Southern Life Assurance Company, not available in certain states. Prices subject to underwriting and health questions.

• 2:23:00Shawn Ryan?

  This show is sponsored by BetterHelp. As the sun sets a little earlier and the seasons change, it's a good reminder to reach out and check in with those you care about and remind ourselves that we're not alone. Call that friend you haven't talked to in a while or grab lunch with somebody you've been missing. This November, BetterHelp is encouraging people to reconnect and to remember how powerful connection really is. BetterHelp therapists work according to a strict code of conduct and are fully qualified. A short questionnaire helps identify your needs and preferences. And if you're not happy with your match, switch to a different therapist at any time from our tailored recommendations. With over 30,000 therapists worldwide, BetterHelp is one of the leading online therapy platforms,

• 2:23:45Shawn Ryan?

  having served over 5 million people globally. This month, don't wait to reach out. Whether you're checking in on a friend or reaching out to a therapist yourself, BetterHelp makes it easier to take that first step. Our listeners get 10% off their first month at betterhelp.com/srs. That's better H E L P dot com slash S R S.

• 2:24:09Shawn Ryan?

  What about a, I mean, what about a prostate massage? Does that help at all? I mean, what is that? Is that simply for pleasure?

• 2:24:16Speaker 03

  Yeah, so prostate massage, actually, when we were, probably when I was younger, before, long before I trained urology, it was actually a thing that urologists did. So it's essentially like a prostate exam. You insert a lubricated finger into the anus and you actually massage the prostate with your finger. So you like, sort of correct, like stroke the prostate in all the zones of it. And, and that was thought to sort of help alleviate some potential, usually for prostatitis. So when people had inflamed prostate, they would do it for that because they thought that it might actually sort of cause some relaxation, maybe of the muscles. It might cause some expression of fluid that's stored up in the prostate when you ejaculate or when you pee the next time.

• 2:25:00Speaker 03

  And so that was thought to maybe help. And so the studies originally showed potentially some benefit, ultimately didn't show any long-term benefit. So I would say that prostate massage, some people still find it useful. Like, just because a study said it doesn't do something, doesn't mean that an individual can't find it helpful. Some people still do find it helpful to massage their prostate. For prostatitis or for other issues. Um, but in terms of like something that we do as a medical community, not, not so much anymore based on the data we have. Um, a lot of guys find it pleasurable to have their prostate massaged or, or uh in, include prostate play in the bedroom. And so I think that, you know, it's great if you're open to exploring that, like, yeah,

• 2:25:42Speaker 03

  you might find it like unlocks a little bit of pleasure for you. Um, you might not, but I think it's really a very individual choice. And if that's something you're interested in, by all means.

• 2:25:52Shawn Ryan?

  Okay. Let's talk about the, let's talk about the effects of pornography in

• 2:26:00Shawn Ryan?

  your real sex life.

• 2:26:01Speaker 03

  Yes, so pornography has really changed. So when I was younger, right, uh, you had to get a VCR, you had to go get, go to a sketchy store and like find a tape and like find a place to watch it and, you know, it was very difficult or you had to have a magazine that was like hidden under, you know, somewhere. And so it was not easy and it was not accessible and it was definitely very different than what porn looks like today. Now, I think that porn, um, there are some things I feel strongly about in terms of like, I don't think children should watch porn. I don't think that, um, it should be so readily accessible to people. Like, I think there should be some challenges in getting access to porn because I think

• 2:26:41Speaker 03

  that that makes it much more difficult to want to engage in real life, like desire and sex and like, you know, it, it does sort of make it more difficult for some people to enjoy regular sex or even seek out regular sex because they have these like very exotic and erotic things, very easily accessible. However, a lot of people, adults who are fully frontal, like fully formed frontal lobes, can use pornography in a very normal, healthy way. And I think it's very individual. People tend to know when they have an issue with pornography, right? They're like, oh, I'm using it all the time. I don't enjoy my partner as much. Nothing is as good as what I feel like when I watch porn.

• 2:27:25Speaker 03

  I find myself using it more than I actually want to have sex with my partner. I find I'm using it more than when I want to go out and hang out with my friends. And so like, you sort of start seeing the, the issues, right? You start seeing it in yourself, but it creates a shame spiral, right? So you're like, oh, I use porn, it makes me feel bad. Um, And some of that may be also because you have a moral incongruence. Like you think porn is bad and you use it, you feel bad, right? And then you're like, oh, man, I feel bad, but I need to feel good again. So I'm going to use it because it temporarily makes me feel good and I feel even worse. And it creates a sort of shame spiral, which can be really debilitating for people. Now, what I'm seeing in the younger generation is that they've only learned about sex through porn because no one talked to them about it.

• 2:28:06Speaker 03

  And so they watch porn, they think this is how I have sex and this is how I get my partner to orgasm. And when they actually go to have sex with their partner, it does not go anything like that because porn is a produced product. It is a meant for entertainment, is not real life. It is meant, the camera angles, everything is meant for the viewer's enjoyment. It is not for the the pleasure of the actual people having sex. They are actors. And so when they go and they have sex with their partner, it doesn't go the way they thought it was and now they think they're broken. They think something's wrong with them. And so that's a real problem because it creates these unrealistic expectations on both sides, right? Men feel like they don't look or or or have the same results as the porn star.

• 2:28:50Speaker 03

  And women also feel like I don't climax immediately upon penetration or I don't look like that and something's wrong with me. And so it creates these really unrealistic expectations. So that's a problem. But when you have a fully frontal, fully formed frontal lobe, you understand that it's a fake product, you can use it as a way to have arousal from time to time. Should it be your only source of arousal? No, I don't think so. Can it be used in a healthy way? Yes, I think it can. And I think most people do use it in in, most people use it, period. And I think a lot of people can use it in a healthy way. But I do think there are some caveats. And I do think it should not be like freely accessible because I worry about kids. And on average, kids see porn at 10.

• 2:29:33Shawn Ryan?

  Man.

• 2:29:34Speaker 03

  And and so I've, long before my kid turned 10, I talked to him about porn. I said, you might see this, you might see something that makes you confused. You might see people having sex. Your friend might show you on their phone, something might happen. I want you to know this is not real and I want you to talk to me about it and feel open to talk to me about it because I don't want you to be confused. That's, you know, I don't want you to feel like that's what real sex is like.

• 2:29:58Shawn Ryan?

  Mm hmm. Do you, I mean, did?

• 2:30:01Shawn Ryan?

  When you talk to patients about porn addiction or just porn in general, I mean, do you, and we covered this a little bit earlier, but I mean, do you feel like it would be, is it healthier to save that for your partner?

• 2:30:15Speaker 03

  I think it depends on the person. So I think that like, you know, you should vary your arousal. It should not all be based on pornography, right? So you should be able to get aroused by thinking. You should be able to get aroused by fantasizing. And if you want to use porn occasionally, it can, it can be nice to explore other areas of things that might be of interest to you, to learn maybe something else that might turn you on that you never thought of before. It can be, as a couple, if you are both on the same page and you watch it together, it can actually increase sexual satisfaction and relationship factors. We've seen that in, in, in studies. But again, I think it's

• 2:30:55Speaker 03

  very individual. And, and I think that if you are finding yourself solely relying on porn, like you cannot masturbate without porn, then that's a red flag to me. You should be able to have arousal without that. Like I, I remember when I was in medical school, I had a friend be like, I love springtime in New York. And I was like, why? He's like, because it's the sexiest time. Girls are all wearing skirts and like, you know, you can see more skin. And I was like, it's so funny to me now, because nobody would ever say that now. Because it's like, you don't need to wait till springtime. Like you just look at your phone and you'll see whatever you want. And so like, there's no like, it's like the simple thing. And think about even like way back when you would have to court

• 2:31:39Speaker 03

  a partner. You would have to walk with them and, and talk with them and you would barely be able to touch their hand. There would be this buildup, this tension, this, this like, oh, I'm so excited to be with you and to touch you. And like, I feel like we've lost a lot of that. That like, that actual like enjoyment of being with someone else and like glamorizing that. Versus like, oh, I can just watch this on porn and, and, you know, have fun for a few minutes.

• 2:32:06Shawn Ryan?

  Yeah, I think it's a, I think it's a big problem in the entire world right now.

• 2:32:12Speaker 03

  Yeah. Again, I think like, I think that it's, it's just about like, I really feel like it's, it's dangerous that our kids have access to it.

• 2:32:20Shawn Ryan?

  Yeah, me too. We've covered that a lot on this show, which actually we were talking about it this morning with, Ryan Montgomery and you watched Tim Tebow, What It Sound Like?

• 2:32:29Speaker 03

  Yeah.

• 2:32:30Shawn Ryan?

  And those were cornerstones of those, both of those interviews, but, but, you know, what, we're kind of winding down the interview now and, and, you know, one thing I wanted to ask is, you know, what are, what are some of the most common sexual health problems in men that go ignored?

• 2:32:51Speaker 03

  Yeah, well, number one is, I mean, the most common is erectile dysfunction. And I think that like, it's not that it goes, gets ignored, but I think that men are embarrassed. And they don't, they don't come and see the doctor, or when they do, they just get given a prescription and say bye. And I think if, and that's why I'm writing my book that's coming out next year is, is I want people to know like, you can fix this. You can fix your life and you could, you have the power to do that. And you can improve your health and by way of then improve your erections, because sexual health is health, right? But I think like, they get very discouraged and when they finally do go get help, they just get a prescription. They don't get any information, right? So I think that's a big one. And then they're embarrassed too. And I guess, you know, there's like now there's a little bit more

• 2:33:35Speaker 03

  where you can get these online companies, which will at least prescribe you the medications. But at the same time, they're not still giving you that education, which is really what I think is the missing piece. And they're charging you a lot more for the medications than you could get like an online, you know, pharmacy. You can get them for like cents on the dollar, you know? So I think that that's a big one. Another one is like, whenever they feel less masculine. So like, if they feel like maybe their desire is not there, maybe they're struggling with premature ejaculation, they don't, they don't ask for help. They struggle in silence and they live in silence. And it is heartbreaking because by the time I finally see these patients, they have been through a lot.

• 2:34:20Speaker 03

  And they have, it has shaped who they are as a person.

• 2:34:23Shawn Ryan?

  Man.

• 2:34:23Speaker 03

  And they cannot, and they can't talk to anybody, right? They, men are, just have this, they don't talk to, like, women talk to women, right? They'll be like, oh, I have a problem, like, it'll come up somehow. They'll feel comfortable confiding in another woman. A man will never talk to another man about his issues in the bedroom, or really many issues. They just don't. They're stoic, they tend to be problem solvers. They don't want to sit there and like whine or complain, right? And so they just sort of grin and bear it. And they grin and bear it in front of their partner. They may, I mean, it can go so deep, where like they're even like had divorces or ruined relationships because they won't talk to their partner about their issues, right? And it runs so deep that they're just suffering in silence. And it really, I just, like, I want anyone listening, is if you're struggling, like,

• 2:35:07Speaker 03

  please, at least talk to a urologist, at least talk to your doctor, like, talk to somebody. I don't care who you talk to. Talk to somebody, because even just saying the issue out loud can help you sort of process it and deal with it. And, you know, learn, educate yourself, watch content, mine or anyone else's, like, learn about your body and give, empower yourself to like, take the actions you need to fix it.

• 2:35:30Shawn Ryan?

  And then, you know, working, being a VA doc, I mean, I come from a special operations background, lot of TBI, lot of PTS, lot, I mean, what, what are some of the commonalities that you see within, you know, warfighters who are coming home who have these kind of invisible injuries? I mean, how does that play in?

• 2:35:53Speaker 03

  The most common is PTSD, right? So I, I think on, at all, like, the majority, like, the large majority of patients that I see have PTSD, large majority. And they're all on, you know, medications to help with nightmares and they're struggling, right? And we know that with men who have PTSD, their rate of erectile dysfunction is significantly higher, like, three times higher.

• 2:36:17Shawn Ryan?

  Three times?

• 2:36:17Speaker 03

  Mm-hmm, than guys who don't have PTSD, than veterans who don't have PTSD. So just even within the military community, if you have PTSD, your risk is significantly higher.

• 2:36:26Shawn Ryan?

  Wow.

• 2:36:26Speaker 03

  So it is, I mean, mental health and sexual health are very, very intertwined. And I know the VA tries to do a really good job of getting help for veterans in terms of PTSD and mental health, but like it is a real struggle and it is something that is really, really challenging. So, you know, I think that's a big one. And then also like it's crazy to me that, you know, my vets will come see me and I'll be like, do you want something for your erections? And they'll be like, oh, no one told me I could have that or no one's even asked me about that. Right? So beyond, they're already at high risk, right? From and from TBI. So TBIs can affect hormone health. So a lot of guys with TBIs will have low testosterone.

• 2:37:07Speaker 03

  And so they usually will get tested for testosterone, but they're not asked always about their erection. So even with those patients, like it's like they, they may be given medication, but they're never educated on it. And, and, and no one's really linking that mental health aspect. Like we need to fix the mental health aspect so you can actually, I mean, and think about if you're having better sex, you're probably helping your mental health too, right? It all goes hand in hand. So I think it's, it's really a challenge because they have so much going on that those things become forefront and sexual health goes in the back from, in the back.

• 2:37:42Shawn Ryan?

  Is, I mean, is there, do we know why PTSD can, can, makes it three times more possible for somebody to have erectile dysfunction?

• 2:37:53Speaker 03

  I mean, all mental health issues are linked with sexual dysfunction because it's sort of like if you're, I mean, just very simplistically, and this is not, this is too simplistic, but if you're sad, you can't get aroused, right? You're not going to get turned on because you're sad, right? Like it's just, you don't, like sex is not on your mind. You're like thinking about all, and you're in a sort of a fight or flight sympathetic nervous system. So when we think about erections, to get an erection, we call it point and shoot. You need parasympathetic nervous system, which is your rest and digest, your relaxed nervous system to be activated for you to get an erection. You need to not be in a state of anxiety or stress. And then when you have your ejaculation, that's when your sympathetic nervous system

• 2:38:38Speaker 03

  turns on. So if you are constantly stressed, depressed, anxious, PTSD specifically, there's a lot of sympathetic nervous system activity, right? When you have PTSD. So you just can't get into the mind state, the nervous system state, to be able to get an erection.

• 2:38:55Shawn Ryan?

  Okay. Is there anything that men can do to last longer in bed?

• 2:39:01Speaker 03

  Yeah, so a lot of guys think like, oh, if I just think about my grandma or something like super non-sexual, right? It's gonna work. Now, for some people, if you don't have any issues and you're just trying to last longer, sometimes that does work. But most times it doesn't, it actually hurts, right? Because now you're like introducing this very non-sexual, non-pleasurable thought in a moment that you should be like feeling really good, right? So I think a lot of it is, I mean, of course, there are medications and things, but I don't, I think that just talking about non, like, things that you can do that are like actionable. One is, interestingly, is breathing. So like doing diaphragmatic breathing, so like really deep into your diaphragm is actually gonna help rev up your parasympathetic nervous

• 2:39:45Speaker 03

  system. And so people who do this type of breathing, even outside the bedroom, and they do it regularly, have been shown to last like 900% longer.

• 2:39:54Shawn Ryan?

  900% longer?

• 2:39:56Speaker 03

  There was one study that said 900% longer than your diaphragmatic breathing, plus they'll do some, some exercises which are like the stop-start technique. So you get almost to the point of climax, and then you kind of bring your arousal down, and then you go again. You do like three times, and then on the fourth, it's sort of like edging, and then on the fourth time, you ejaculate. So those sort of actions, at the same time with breathing, has been shown to increase the ability for people, at least men with premature ejaculation, to last 900% longer. So, and then sometimes doing those breaths during arousal. So like sort of calming things down, because as you could think about it, like you're, it tends to be like a very like... Uh, quick sort of like, oh my God, oh my God, oh my God.

• 2:40:40Speaker 03

  Like, you know, when you're having sex, you get really excited, right? So you just need to calm things down and then you can last longer. Now, another thing that has been shown, and these are small studies, but I think they make sense. And they actually are so easy to do that, like, I'm like, every man should be trying to do these in general, right? They're good for your health, too. They're good for your mental health. The other one is using, um, exercise. And the reason, certain exercise, specifically high intensity interval training, because it helps your brain sort of get, understand where your body is in time and space. So you get what's called interoception. And that, then as you do that in, at practice, when you're exercising, then when you're in position with your body, you can start figuring out the cues.

• 2:41:21Speaker 03

  Like, oh, I'm getting close. You can sort of follow your arousal, like, when are you getting close to climax? And sort of dampen things down a little bit. So you sort of learn your body better because you're doing those exercises. And the study was seven minutes of high intensity interval training daily showed an improvement in as quick as two weeks in terms of increasing length. Now, they looked at other exercises, too, yoga and running, because again, those are also very mindful exercises, like long distance running, yoga. Um, fastest to do improvement was the HIIT, followed by, uh, running and then followed by yoga. But again, like, they all can help. And so I think it's just really about being mindful of where your body is, learning, like, what does it feel like when I'm getting close to ejaculation?

• 2:42:06Speaker 03

  And being able to, like, be present in the moment. Um, and mindfulness, again, exercises like meditation and, and just like really learning how to be one with yourself. Like, it's really like understanding your body so you can say, hey, I'm, I'm letting my arousal sort of climb slowly rather, you know, and I'm, I'm sort of enjoying the process of getting there. Not like so fixated on like, you know, all the stressors of like, oh, when, when's it gonna happen? Does it happen too soon? Like, you know, that's also revving up your sympathetic nervous system.

• 2:42:38Shawn Ryan?

  Mm-hmm, mm-hmm.

• 2:42:41Shawn Ryan?

  Last question, second to last question. What, I mean, you have kids.

• 2:42:48Shawn Ryan?

  How do we talk to kids about all of this stuff, sexual health? What age did you start talking to your kids about?

• 2:42:54Speaker 03

  So I started talking to my kids, just basics, anatomy, when they were little. So this is your penis. I mean, for boys, it's easier. I think for girls, you have to tell them. What is so funny, because I have so many funny stories with my kids, because like, they've always been very open with me. And so like, when they first started, I hope they never watch my podcast interviews, because they're gonna be so mortified, but like,

• 2:43:18Speaker 03

  like, but when they were little, and they, the first time, like, they would get erections, uh, they'd be like, mommy, why is it getting big, right? And I'd be like, this is completely normal. It's just having an erection. It's a completely normal thing. Whereas I know other friends would be like, oh, my god, what do I say? You know what I mean? They would sort of freak out. And I'd be like, look, and they would ask me, and I'd say, just tell them it's normal. Like, it is normal to get random erections. There is nothing wrong with it. Um, so that was one. I would also tell them, they would be like, oh, like, my son would go, like, on a roller coaster. And they go, it tingles down there. I'm like, yeah, that's okay. That's like a normal sensation. But you would just, when he asked these questions, I would ask, I would answer them as best I can. I remember one time he asked me about sex, and I was like, not prepared in that moment to answer it, right? And I was like, okay, give me a second. Like, I will answer this question later.

• 2:44:02Speaker 03

  And I talked to my husband about it, and I was like, okay, how do we go about this? He's like, no, you should talk to him about it. Like, you're obviously more skilled at talking about sex. And I was like, he's like, and we decided, like, it's obviously gonna be better for me to talk to him about it now, when he's curious, rather than him going to ask someone else, right? So he asked me, and I told him, this is what happens during sex, and this is how it happens. And then, uh, when I had the same conversation with my younger son, he's like, so wait, if, what if I just like, fall, like, what if I fall onto her, will we be having sex? And I was like, no, no, no, that's not how it works. So like, it's so, it's so innocent, their conversations. But it's also like, this is, and so we've been doing it so long. And so now we have sort of a routine. We'll go on walks. And they'll know that if that's a time they want to talk to me alone, they'll sort of like, be like, hey, mommy, can we, can we talk?

• 2:44:46Speaker 03

  And they'll ask me questions, or they'll, they'll, you know, they might have seen something in a movie, or maybe their friend said something at school. And so they know that they can ask me anything, right? And then I will also, like, I remember, I had, I talk about sex all the time, but I had forgotten that, like, oh, I need to talk to him about wet dreams, because they're gonna happen. I don't want him to feel embarrassed, right? Because you can, I mean, you probably can recall when you had that happen. You're like, oh, my God, what happened? Like, this is horrible. This is scary. Like, am I dying? What's going on? Right? And everyone has a different reaction, but I was like, didn't want him to freak out. So I remember telling him, like, this might happen. It's OK. Just let me know. We'll wash the sheets and it's totally normal. Right? But it's such a simple thing that, like, you don't even think, especially as a mother. Like, I never had that experience. So I had to, like, remember, oh, yeah, this is something I need to tell him before it happens.

• 2:45:31Speaker 03

  So he doesn't, like, freak out and think something's wrong with him.

• 2:45:34Shawn Ryan?

  I mean, what, what do you, how, how do you, what age was that? When you were having a discussion with your child?

• 2:45:39Speaker 03

  We've had so many for so long that I think I started, because the average age where kids see porn is 10, I think I started talking to my son at eight about porn. Because I was like, I didn't, you know, I don't know who he's gonna see it from. I'm gonna do my best to, like, you know, put all the locks on my phones and anything that he has access to. And, you know, but like, I don't know what his friends have locks on their phones or what they, if they have phones, right? Like, um, all those things, I just don't know what's, what he's gonna see when I'm not with him. I'm not with him 24 hours a day. So I had to prepare myself for the fact that he might see something. And, and even though I don't want him to see it, and I don't, I wish he doesn't, I know he might. And he's actually told me that some kids in school have talked about porn.

• 2:46:23Speaker 03

  Now that we've had this, I mean, he's 12 now, but he's told me that kids have talked about, like, oh, you, you know, we watch porn. And I was like, he's like, I'm like, have you seen it? And he's like, no, I haven't. I'm not really that interested. Because we've talked about it, right? And I think, like, he realizes, like, it's not really all that cool. Like, it's a, it's a fake thing, you know? And it, and it's not necessary right now. Um, so, you know, I think, and he knows he can come to me. Like, I can tell him any question he wants, I'll answer it. I might answer it right that second, but I will think about it and I will answer it. And so, yeah, I, I mean, I started talking to them, like I said, when they're little, just about their anatomy. And so, like, slowly but surely, but the sex question, he came to me. And I think he was, I think it was around eight, he came to me and asked me about it. And I was like, OK, I'm, now is the time to answer it.

• 2:47:07Speaker 03

  He's asking the question, so I have to answer it. You know? And so I made this routine where we go for walks and I tell him about whatever. And he knows that's a great time where he can ask me. I don't have to look at him in the face either. I can look straight ahead and Answer and he can look straight ahead and we don't have to have like an awkward like, you know, face to face interaction, but, uh, but you know, we're just talking and I think, um, got to find, you obviously know your kid and you know, you know, how you want to parent. But I think like, we as parents have a responsibility in today's society where we have less control over what they're gonna see because they're out in the world at school and kids have phones, which is crazy to me. Like, you know, um, we don't have as much control as we would like.

• 2:47:50Speaker 03

  And I mean, so we have to, we have to be responsible and teach them. And because the other thing is, it's sort of scary. Like some of the things they're gonna see. So for example, um, choking is a big thing in porn right now. And so I had a researcher on my podcast, Debbie Herbinick, who wrote this book called, Yes, Your Kid. And so she did research on college age students. Um, and she found out that choking became very, very common in sexual encounters. And it's fine if someone finds it pleasurable, but it's dangerous, right? Like you're asphyxiating someone, you could cause really serious harm. But they're doing it so casually, like it's almost like kissing. And, and when you, when they did the surveys, they found that women were most often getting choked women.

• 2:48:34Speaker 03

  And, um, a lot of them were not that into it. I mean, they were okay. They were like, yeah, you can do it. They were getting asked, but they were like really not that into it. And they were just doing it because they felt like that was what was done. And so that's just one example of how these things are being perpetuated from what they're seeing. And they're not, these things are not focused on pleasure. They're just focused on getting you entertained. And so like, they're not learning how to pleasure each other. They're not learning how to, um, have a meaningful intimate encounter. Um, and it's, it's really sad.

• 2:49:05Shawn Ryan?

  Yeah. I love the walking method.

• 2:49:07Speaker 03

  Yeah.

• 2:49:07Shawn Ryan?

  That is.

• 2:49:08Speaker 03

  It's a good one.

• 2:49:09Shawn Ryan?

  That's great. It's, it's like, like you had mentioned, you know, it's not face to face. You could look.

• 2:49:14Speaker 03

  And I tell even couples, like, do talks when you're not looking at each other. Because in the beginning, no one taught us how to have sex, right? Or how to talk about sex, or have sex, really. But no one taught us how to talk about sex, right? So it's super awkward. And it's not a one-time conversation. If you want to have a meaningful, really robust, amazing sex life with your partner, you've got to talk about it. And so I tell people, like, when you're in the car, or when you're on a walk, so you don't have to, like, look at each other across the table. And definitely never in the bedroom. Like, just have these conversations in places where, you know, it's, you have a little room to, like, wiggle and look and feel awkward, but don't just show it to each other.

• 2:49:51Shawn Ryan?

  Love that, love that. All right, last question. If you could recommend three people for this show, who would they be?

• 2:49:59Speaker 03

  Oh, gosh, three people, okay.

• 2:50:03Speaker 03

  Well, if you want to do more sexual health, I had Dr. Barry Komisaric, who is a researcher who researches female orgasm and, like, brain MRIs. That was a really interesting conversation.

• 2:50:16Speaker 03

  Who else? Trying to think.

• 2:50:21Speaker 03

  I think your audience would be, like, Dr. Aloko Noga. He is a, he's a physician who really focuses on gaming, but he has a lot of insights into, like, the psyche of the young man right now, and like, how to sort of manage these, like, gaming addictions, and also sort of people who struggle with pornography and things like that, all in the same...

• 2:50:43Shawn Ryan?

  Perfect.

• 2:50:44Speaker 03

  Yeah. And let me think of a third one.

• 2:50:49Speaker 03

  I think.

• 2:50:54Shawn Ryan?

  Do you know any sex therapists?

• 2:50:56Speaker 03

  Oh, yeah, I know a lot of sex therapists. I'm trying to think of the best one for you, let's see.

• 2:51:01Speaker 03

  Let me think on that one.

• 2:51:02Shawn Ryan?

  All right.

• 2:51:03Speaker 03

  I want to give you the right name.

• 2:51:04Shawn Ryan?

  Perfect, perfect.

• 2:51:05Speaker 03

  Yeah.

• 2:51:06Shawn Ryan?

  Well, Rena, this was a fascinating conversation. Like I said, thank you so much for coming, and I'd love to see you again.

• 2:51:14Speaker 03

  Yeah, thank you so much for having me.

• 2:51:15Shawn Ryan?

  All right, cheers.

• 2:51:28Shawn Ryan?

  No matter where you're watching Sean Ryan's show from, if you get anything out of this, please like, comment, subscribe, and most importantly, share this everywhere you possibly can. And if you're feeling extra generous, please leave us a review on Apple and Spotify Podcasts.