EFR 835: Sex-Ed for the 21st Century - The Most Common Sexual Issues Facing Women, Men, and Couples, Erectile Dysfunction, Masturbation, Why You're Not Orgasming and More with Dr. Rena Malik

00:00 - Chase (Host) The following is an Operation Podcast production. How do you get what you want in bed?

00:05 - Rena (Guest) You ask for it, yeah, so I'm gonna talk a lot about erections. Keep that blood flow in, get that blood flow in. Sexual health is the ability to essentially have the actions related to sex, so that can be having sensation that feels pleasurable, having erections for men or clitoral tumescent for women, feeling aroused and then being able to climax and feeling pleasure that way.

00:28 - Chase (Host) What is the most common problem you see most males currently experiencing when it comes to their sexual health?

00:34 - Rena (Guest) Erectile dysfunction by far.

00:36 - Chase (Host) What is the most common problem most females are currently experiencing when it comes to their sexual health?

00:42 - Rena (Guest) Yeah. So number one is low libido. I don't think anyone taught me you know where the clitoris is, or what masturbate like, what masturbation is, or you know why men boys didn't get to know why they're having erections randomly during the day or in the middle of the night and why they may have wet dreams Like. None of these things were taught Right, and I think these are really important. We should know why our body does the things they do, because you can find that people may develop quite a bit of shame around things. Hi, I'm Reena Malik MD, urologist and pelvic surgeon, and I'm here with Ever Forward Radio.

01:16 - Chase (Host) Well, Reena, it's a pleasure to have you on the show. I have so many questions, so many questions. And to kind of preface this, before we dive into all of the things, can you please walk us through briefly your professional expertise, background credentialing, just to kind of set the tone for the audience.

01:32 - Rena (Guest) Absolutely so. I'm a urologist, and a urologist is a medical and surgical doctor of the genitourinary tract. So that means the kidneys, the tubes that drains the kidneys, the bladders, all of the genitals and for women, also the you know, the uterus and the vagina and all those sort of genital organs and so anything that goes wrong with them, particularly surgically. So we don't deal with the medical aspect of kidneys, but we'll deal with, like kidney stones, kidney masses, kidney tumors, and so that's what we do and we can do anything in that area. So that can be cancers, that can be infertility, that can be kids, pediatrics, that can be women's health, men's health, a whole host of different things, and you can specialize in those. I did a fellowship in what's called female pelvic medicine and reconstructive surgery, now called urogynecology and reconstructive surgery, but basically take care of women's health and bladder issues. And then I got this interest in sexual health, which is what brought me to sort of start making content on social media about sexual health, and so now I'm an expert in that area as well.

02:35 - Chase (Host) You are. Oh, everybody, buckle up. We're just going to go rapid fire. A lot of questions. So, in general education is there a difference between sexual health and reproductive health?

02:45 - Rena (Guest) So sexual health is essentially around. It includes reproductive health. Right, you can't have one without the other, but if you don't want to reproduce, then technically sexual health can be its own thing. So sexual health is the ability to essentially have the actions related to sex. So that can be having sensation that feels pleasurable, having erections for men, or clitoral tumescent for women, feeling aroused, so that general feeling that you get when you have the desire to have intercourse and then being able to climax and feeling pleasure that way. So those sorts of things, those functioning appropriately.

03:24 And then reproductive health really surrounds being able to reproduce, so meaning have children. So that means that for urology we focus on men's reproductive health, but making sure that they're producing enough sperm that they can have a viable pregnancy, that they can create a viable pregnancy, and making sure there's no issues in delivering that sperm to the vagina and subsequently to the fallopian tubes where you're going to reach an egg and then have a baby. So there's sort of two different factors but they're very interrelated because things that affect reproduction may also affect the ability for a man, for example, to have a good erection. So if they're having low testosterone, they're going to have less sperm count and they're also going to have difficulty having erections. So they do go hand in hand, but not everyone cares about both.

04:11 Right, If there are people who identify as asexual, so they may not care if they're having these sexual feelings of pleasure or enjoyment with a partner, but those are still sort of reflective of your overall health. So what I like to tell people is it's blood flow, right At its core. A lot of what makes things work is having good blood flow. So when you don't have good blood flow to your genitals, that could be a sign that you don't have good blood flow elsewhere, like your heart or your brain, and so it's really an important measure of health, a biomarker, we like to say, of health.

04:43 - Chase (Host) I actually had this question posed last in this gen ed section, but since you bring it up, let's just go there first. Blood flow what role does nitric oxide play in sexual health? I'm sure it does when you're talking about blood flow.

04:55 - Rena (Guest) Yeah. So I'm going to talk a lot about erections, because a lot of the data is in terms of erections and that can be applied to women too, because the anatomy is similar. So when you think about a penis that's something everyone knows about, that you can see it, it's very obvious. But women, the analogous structure in women is the clitoris. So if you actually look at a clitoris in the lab and you cut it open, just like you'd cut a penis in an anatomy lab to look at it, the structures are identical, like there's two spongy bodies, the same arteries and nerves running at the dorsal aspect of it. So they look identical and they work identically.

05:27 - Chase (Host) It starts as the same anatomical thing in utero right.

05:32 - Rena (Guest) Yeah, it's called the genital tubercle, so it differentiates into either the penis or the clitoris. So back to your question about nitric oxide. Nitric oxide is like the ignition for an erection. So you need to have nitric oxide, which is released from blood vessels and nerves, which is in response to some sort of stimuli. So in order you see something, you hear something, you feel something that you feel is erotic or arouses you, your body will start releasing nitric oxide which then sort of ignites that cascade to either engorge the penis or engorge the clitoris. So men get an erection and women get clitoral tumescence.

06:08 - Chase (Host) Okay, so when it comes to again staying on topic with nitric oxide, let's say we have poor blood flow, we're not getting erections in terms of frequency, intensity or, for women you know, we're not getting genital blood flow in that area. Is it always then related to nitric oxide, or can we always go to? If I work on increasing nitric oxide, I will also get the result I'm looking for in that area.

06:31 - Rena (Guest) So it depends. I mean, certainly when you have less nitric oxide or it's because there's a blood flow issue, right, your vascular endothelium or the lining of the blood vessels is not healthy, right. And so the thing, most important thing that I think people always overlook, like how can I fix this? Well, the number one thing is you can do is get your blood vessels healthy. And how can you get those healthy? Diet and exercise right. So that's number one. Before we start thinking about, like, how can we manipulate the pharmacologic cascade of, you know, can I take nitric oxide in some form?

07:09 - Chase (Host) Can I take medication in some form that's going to help me? First you got to work on diet and exercise and then you can talk about the other things. Is it as simple though we do the first things, the simple things? Um well, diet and exercise aren't always simple for everybody. I should say the free things. The free things, exactly the lower hanging fruit. Is it just as simple as? Oh, I take a nitric oxide supplement. I know it comes in different forms and I've heard various things from guests and the interwebs about how we can supplement a nitric oxide supplement. I know it comes in different forms and I've heard various things from guests and the interwebs about how we can supplement with nitric oxide for this purpose.

07:30 - Rena (Guest) Yeah. So nitric oxide boosters can help, but I would say that there's not a ton of data behind them and the issue I think sometimes with the supplement industry is that there's not a lack of regulation. So sometimes what's on the bottle is not what's in the supplement. So I tend to say, yeah, you could try them. There are some supplements that have been studied and show to increase nitric oxide, like what L-citrulline and L-arginine.

07:56 - Chase (Host) Oh yeah yeah.

07:58 - Rena (Guest) So L-arginine is a precursor to nitric oxide and L-citrulline is a precursor to L-arginine, but it is more bioavailable, so very often L-citrulline you can take less frequently and get the same results.

08:10 So those are ones that I say you know in the data show some really pretty significant benefit in terms of boosting nitric oxide and potentially having improvements in erectile function. But you can also. So the medications that we use to treat erectile dysfunction, like sildenafil or tadalafil you know, brand name Viagra, cialis those work by sort of keeping more of the enzymes around that maintain erection. So basically they're preventing the breakdown of those enzymes that cause you to D2 mess, and that's how they work. So you can, you know you can manipulate on different factors in terms of improving the ability to keep that blood flow in, get that blood flow in to the penis and maintain it, and so, um. So those are things that you can do, but again, I think a lot of people tend to skip over to doing those things rather than really taking a hard look at their like I see men all the time who've not ever had their cholesterol checked, who've never had their no one in this audience.

09:08 - Chase (Host) Yeah, hopefully not right.

09:10 - Rena (Guest) But you'd be surprised, like I'm healthy, I work out and you look at their cholesterol, it's like through the roof, right and so, or they've never gotten screened for diabetes, and so these are things like they're easy. You know, you got to check and you got to make sure and then you got to actually be aggressive about trying to fix them, whether it's through diet and exercise or other things. And then you know and I still think you can use other means to help you. There's no problem with that. But I think if you ignore those other things, we're just putting a bandaid on a problem right, I agree.

09:37 - Chase (Host) Yes, absolutely. I love beets. I eat a lot of them in my diet. I also recently started supplementing with a beet powder. Well, recently, meaning, like at home, I have it, but for years, when I go get a smoothie, sometimes after a workout or before going into the sauna, uh, I'll get it like a beet powder extract in a smoothie or a drink or something from the smoothie bar. Um, because one. I just love how it makes me feel.

10:03 Um but also I know that what I've seen is that it helps enhance nitric oxide natural production in the body, which makes me feel great after a workout or before a workout for endurance recovery purposes, but also before sauna just to kind of vasodilation and again enhance recovery. Am I just feeling it or is there actual truth there?

10:21 - Rena (Guest) to beets and beet powder yeah, so I don't know about the data on beets particularly I haven't looked into that specifically but I would say that, yeah, there's certainly a potential to improve nitric oxide with food, but I think, like we know, for example, watermelon has a ton of.

10:37 - Chase (Host) L-arginine, yeah, l-citrulline.

10:39 - Rena (Guest) And so it's really high concentration. But if you look at the data on watermelon, high concentration. But if you look at the data on watermelon, you got to drink like six glasses of watermelon juice to really see the difference.

10:46 - Chase (Host) That's a lot of watermelon.

10:47 - Rena (Guest) Right, and so probably the same with beets would be. My guess is, you need a lot of it, and maybe those beets powders have enough, maybe not, I don't know, and so yeah, you might see a benefit. But again, I think, like, if you just eat a bunch of beets and you don't like, do other things, you know, but yeah, I don't think it's going to hurt you potentially to do that and it may help.

11:09 - Chase (Host) it may help, but I don't. I don't think it's a home run necessarily.

11:10 - Rena (Guest) Yeah.

11:10 - Chase (Host) Personally, I just love the way it makes me feel yeah. And again, all the research I've looked at it kind of you know, helps with um, I'll just say mostly vasodilation, and so if we have that in general it's not a bad thing, but especially again for training, endurance and recovery purposes, I love it.

11:24 - Rena (Guest) Yeah, no, I think it's fine. I think some people need to be thoughtful. Beats do have a lot of like. They can't if you're taking a lot of it. There is sugar content in beats If you're diabetic you know, like you have to like. I think there's there's a, there's a fine line where people will start Like, for example, when people juice. But cranberry juice, if you're buying like the juice and not the concentrated a hundred percent cranberry, there's a ton of sugar in it, Right? So you gotta be careful.

11:48 - Chase (Host) Yeah, yeah, okay. So do we have an effective sex ed methodology in the United States? What's your take on that and do you think there is a best method for sexual education right now?

12:00 - Rena (Guest) So no, I don't think it's effective at all. I think you, we have very little time allocated to sexual education in the curriculum because there's just so much to teach, and I think that they focus on things that are important, like consent and sexually transmitted infections and how to put a condom on, but they don't teach people how the body works right, like I don't think anyone taught me that you know where the clitoris is or what masturbation is, or you know why men, boys didn't get to know why they're having erections randomly during the day or in the middle of the night and why they may have wet dreams. Like none of these things were taught right, and I think these are really important. We should know why our body does the things they do, because you can, you can find that people may develop quite a bit of shame around things and unintentionally, right Like they may be masturbating and their parent might say, oh, don't do that, right, and they're like, oh, I is bad, like I don't know Right, and then that could be enough to to make someone feel shame for the rest of their life right around their genitals, and so, like I think it's so important and I think people just think of it as, like this thing we should shove under the carpet, but it affects people's entire life.

13:11 Right, like I tell my patients, like think about when you were younger how much energy you put into getting a partner. Right, how it consumed your thoughts, like everything you did was around, maybe getting this partner to like you, and so now take that and then you think about, well, maybe something's wrong with me, maybe that's why people don't like me, and it's consuming your thoughts and it continues with you as you age. And like it can detract from work productivity, it can detract from the ability to feel joy and happiness. Right, like there's so much that we're just ignoring. Like, oh, if you're thinking about it too much, there's something wrong with you. But no, like it's a, it's something that we can't talk about openly because society says we can't or says we shouldn't. And so then you feel alone and you feel like you can't talk to anybody about it.

13:55 - Chase (Host) Not anymore, not up in here.

13:57 - Rena (Guest) At least that's why we're having this conversation, yeah.

13:59 - Chase (Host) Okay. So I hear a lot of differencing of opinion. I see a lot of good science, bad science when it comes to sauna being good or bad for a lot of different reasons, but especially when it comes to our sexual health. What's true about that? What's not.

14:16 - Rena (Guest) Yeah, so in terms of sauna, there's no data specifically on saunas. The reason that I think people get concerned is because it's raising the temperature and testicles, in particular for men, need to. The reason your testicles are in your scrotum is because they need to be a certain temperature and that certain temperature is to optimize sperm production, and if it gets too hot, sperm production will go down. In fact, if you have a fever if you like, have a fever your sperm production can go to zero, can go all the way to zero.

14:46 - Chase (Host) Wow, and that's just internally generated heat, correct?

14:48 - Rena (Guest) Wow, correct. So the thought is that, okay, if you're exposing yourself to too much heat, are you doing damage to your testicles that may cause a problem with semen production. Now I think we can extrapolate from societies like in the, you know, in Europe, where they're doing sauna all the time and they're still right, finland, they're doing sauna all the time and they're not having a problem with birth rate, right?

15:12 So probably it's not right, probably because most people are either naked when they're in the sauna. Um there's, their testicles are not, you know, being pulled up close to the body.

15:23 - Chase (Host) Should we be naked in the sauna? Is it better to have clothing it?

15:26 - Rena (Guest) may be better to let the testicles breathe right, so that they're not getting even more heat from being close up to your body.

15:32 - Chase (Host) I'm going to get kicked out of my sauna this time. That's not going to go well in my gym.

15:35 - Rena (Guest) Well, you can cover yourself, but you know what I mean.

15:41 - Chase (Host) So, but'm imagining just being completely naked. But you're saying if we just didn't, if we weren't wearing underwear or restrictive like gym shorts or something, nothing too constricting, so just like a towel, yeah, okay, yeah, so I think most people are probably wearing just a towel or something right, which is which is fine and the testicles are probably splayed out more.

15:57 - Rena (Guest) They're not like up in close to your body. So probably it's okay. And I think you know, as long as you're not doing it to excess, like you're there for an hour every day, you know you're probably going to be fine. But we don't know, we haven't. The data's not there to say like, okay, we followed this number of men for this many sauna uses and then check their semen analysis. That hasn't been done, although it should be. It seems pretty easy to do, but you know, to my knowledge it hasn't been done.

16:26 - Chase (Host) You know too, but to my knowledge, it hasn't been done.

16:27 That kind of makes me curious. I recently got pregnant and I've gone through a fertility journey as well and for the last couple of years I've done various forms of fertility testing. Three times now, if definitely for sure. Twice I've done at home and at home semen analysis and it makes me wonder about maybe running a test on doing it again. And because I'm a frequent sauna-er, I go probably two to four times a week. It ranges from traditional dry sauna to IR and when I'm in the dry sauna it's a public one. I'm at a gym, so I usually go after workout, so I am in shorts, usually with kind of like a liner, so a little bit restrictive I'm hearing, probably not the best idea. When I'm in another sauna, more private, I do just a towel. So I'm curious about, you know, running an at-home semen analysis test, run through my kind of traditional sauna protocol and then see.

17:10 - Rena (Guest) You could, you know you certainly could. But I think the interesting thing would be to see if we had, like, multiple guys and we actually had like a real study, you know to see, because one person's data that'd be interesting for you, right? Because maybe that amount of heat is too much for you but not too much for somebody else, right, everyone's individual, but it'd be nice to see like as a whole. Can we make a prescriptive recommendation, although I don't think that we're going to find that, because otherwise we would have seen this big drop in in birth rates in Finland when sauna use right, yeah, true, All right.

17:40 - Chase (Host) So everyone watching the video, I'm going to do a live test called action here. Drop a comment down in the the the video box. I keep getting stuck between YouTube and podcast, so drop a comment in the box below If you'd be interested. I got a great at-home fertility test I'll share with everybody. If you already do the sauna, I think this would be cool to see a couple of different people's approach. Um and then, what about a cold plunge good or bad when it comes to sexual health?

18:02 - Rena (Guest) Well, before we go on to that, I just want to mention that hot tubs are something we don't recommend if you're doing a lot of hot tubs.

18:08 - Chase (Host) Why is that?

18:09 - Rena (Guest) Because that you're submerged in the hot water and for whatever reason. We do know that. Hot tubs and that's something that we sort of do mention when people are trying to conceive, if they're having issues to avoid hot tubs. But back to your cold plunge question Cold plung, avoid hot tubs. So, but back to your cold plunge question. Cold plunges we don't know if they're bad, but we do know there have been some studies looking at testosterone after cold plunges. So they've, the studies are not huge and they're not specifically like you're cold plunging for the purposes of necessarily, like it's usually like in the military. They're cold plunging for, you know, training and things like that, and they've seen that if you're cold plunging for long periods of time, you might see a decline in testosterone. Uh, but generally speaking, we're not seeing a bump or boost in testosterone, which makes sense because, uh, if you think about it when you are, um, we know that cold plunging is not necessarily great for muscle growth, right, and testosterone is going to increase muscle growth and so, potentially, you know it's so finite.

19:10 - Chase (Host) Everything I've looked at sorry to interrupt you, but just like if you are a professional bodybuilder and that is your goal is just hypertrophy day in, day out. You're definitely, you know, kind of probably doing yourself a disservice. But, honestly, what we see in the pro anti-inflammatory response, it enhances recovery, meaning reducing time and recovery, so you can go train more.

19:29 - Rena (Guest) So it's it's so nuanced. So it is nuanced, yeah, but generally speaking, when you look at the totality of the data on cold plunging, it does not show a boost in testosterone after cold plunging. So I don't think it. I don't. I doubt that it's harming you unless you're like cold plunging Cause like one of the studies was like nine hours of cold plunging with the military, you know, with the military.

19:46 - Chase (Host) You're like budge training, yeah, so in that particular group.

19:50 - Rena (Guest) It, you know it did decline testosterone, but they were in there for nine hours. Like your, testosterone goes down over the course of the day anyways. So I don't think it was a great study but in general, like most of the studies don't.

20:05 - Chase (Host) Okay, all right, fair enough. Great Thank you. Is it better to have sex in the morning or evening?

20:10 - Rena (Guest) Well, it depends, of course, on your preference, like there's no better, but in terms of your body physiology, testosterone is at its highest early in the morning. So if you get your testosterone blood work done, we generally recommend getting it done as early as possible, before 10 AM, because that's when you're going to see the highest level of testosterone, and testosterone follows this diurnal pattern. So it goes up during the day, slowly goes down and then starts going back up and through the night until you wake up. Um, and so generally you'll have more desire, because testosterone is seen as the hormone of desire early in the morning. Now, does that mean your sex will be better? Not necessarily, but it just means that you may have more desire, you may be more receptive to having sex or more excited to have sex in the morning.

20:53 - Chase (Host) Okay, and so let me reframe the question a little bit and you kind of answered it but ask more specifically from a sexual health lens. Let's say, if we're choosing to be sexually active and we want to maintain or increase our sexual life frequency for the sake of keeping our sexual health up, is it better to have sex in the morning or evening?

21:15 - Rena (Guest) So the most important thing is to maintain at least for men is to maintain erections. So that means that you should be getting nighttime erections and that should be sufficient. Whether you're having sex or not, your body will usually have three to five nighttime erections over the course of the night while we're asleep while you're asleep, and that's basically a physiologic mechanism to keep blood flow going to the area.

21:37 - Chase (Host) Really. Yeah, yeah so it is so crazy.

21:41 - Rena (Guest) So, yeah, it's basically maintaining your penile health by itself. So if you start noticing that your nighttime erections are going down, well, that may be a sign that there's a problem with blood flow.

21:52 And so then you know, then generally recommend you know you should try to do what you can to maintain erections. Again, we go back to the same things diet, exercise, see your urologist about or your primary care doctor about medications potentially to boost blood flow to the area and to just optimize your health overall potentially to boost blood flow to the area and to just optimize your health overall. But having sex is really a great thing to do. You enjoy having sex, have it whenever you want to. It's good to have blood flow to those areas anytime. It doesn't matter when you know. But generally speaking, if you're not having sex, don't like catastrophize, your body will be taking care of it for you.

22:27 - Chase (Host) Amazing. Yeah, the human body never ceases to amaze me. That's crazy. Okay, one last question in this section, before we move on to kind of dividing between males and females Is there a difference you kind of touched on earlier? Is there a difference between sexual desire and sexual arousal?

22:42 - Rena (Guest) Absolutely so. Desire is the urge to have sex. Right, it's something that is more brain related. Right, it's that your brain sees something, wants something, feels. The urge to have sex. Arousal is your body's physiologic response. So very often you'll have increased blood flow. You'll feel in men you'll get an erection. In women you'll get, maybe, some increased lubrication. Their clitoris will to mess. You may have other sensations. What?

23:12 - Chase (Host) is to mess.

23:13 - Rena (Guest) So just like a man gets erect, a clitoris gets erect too, so it'll get bigger and it'll get wider.

23:19 - Chase (Host) I didn't know. I had a word. Yeah, that's okay.

23:24 - Rena (Guest) And then, in terms of like, your nipples may get erect. So it's your body's physiologic response. And sometimes you'll be aroused and you might not feel desire, right, you might be like, uh, watching something and you may not really think you're turned on, but then you're like, oh, I feel like I am Right, and that's just your body's physiologic response. It's not necessarily. They don't always happen together.

23:43 - Chase (Host) Is that like when a guy you know we get I'll speak for all men across the world apparently. Uh, we just get random erections Like we're not thinking about anything, we're not watching anything, it's just kind of it. Just it just happens yeah.

23:55 - Rena (Guest) Yeah, especially like when you're younger and your testosterone is really, really high and like someone will just brush the area by accident and you'll get an erection Right, and that's completely normal.

24:06 - Chase (Host) It's just your pants, yeah, like anything, like someone blew near there, you know like okay, so so yeah, I think it's.

24:11 - Rena (Guest) it's very normal physiologic response. It's a sign that you're pretty healthy, right? If you're getting random erections like that's good, that means you're. You've got all the machinery intact. It's all working well.

24:21 - Chase (Host) Okay, follow up question to that and again speaking well for, for men and women. If we notice the, the, the word again for women.

24:27 - Rena (Guest) Tumescence. Okay yeah, clitoral erections.

24:30 - Chase (Host) If our tumescence goes down in women and our erections go down for men, in terms of just randomness and frequency. Should we be paying attention to that as, oh, this could be a decline in my blood flow and my overall sexual health?

24:43 - Rena (Guest) Yeah, absolutely so. I think it's really important to pay attention to those things, because what we, what we tell, what we learn in training is like erectile dysfunction is the canary in the coal mine. So, basically, when you start having blood flow issues which cause erectile dysfunction, it could be a sign that later down the road you're going to have heart issues. And the reason for this is because the blood vessels to the penis are about one to two millimeters, whereas the blood vessels to the heart are about one to two millimeters, whereas the blood vessels to the heart are about three to four millimeters. So you're going to see plaque buildup or problems with the blood vessels in your genitals long before you see it in your heart. Wow, no way, yeah. So that's why I say people come in, they look healthy, they feel healthy and they're having an ED, and I always tell them check your cholesterol, let's check your cholesterol, let's check your hemoglobin A1C, let's make sure that there's nothing hiding here, right, there's nothing else.

25:34 - Chase (Host) Is there any correlation you're aware of, or even causation from men, we'll say, that have suffered heart attacks to looking at their medical history and going they all had erectile dysfunction or whether or not that was a diagnosis or just reported kind of know, kind of personal reduction in directions.

25:50 - Rena (Guest) I believe the stat is that when men have ED, about 14% of them will end up having a heart attack within seven years.

26:00 - Chase (Host) Wow, that's higher than I was expecting.

26:01 - Rena (Guest) Yeah 14%. Yeah.

26:03 - Chase (Host) Within how many years? Seven Guys pay attention. Wow, Holy crap.

26:08 - Rena (Guest) Yeah, it's real. So it's really important to not take it lightly in terms of just doing an investigation. Your overall health, even if you're not sexually active, even if you don't have a partner, like it is a sign that maybe something else is wrong and it's a biomarker of health. Right Like this is our body telling us hey, pay attention, something's not right.

26:28 - Chase (Host) I'm so glad you said that I've talked about sexual health as a very important other biomarker that a lot of people don't even consider. You know we get labs, we do strength tests and assessments, things like that. But you know, do you look at?

26:41 your sperm count, motility, fertility, do you women, do you get a fertility test? You know, do you look at erection quality, frequency, Sexual health, reproduction is a huge biomarker that, I think, just gets glassed over Absolutely All right. So let's move on to women's health. What is the most common problem most females are currently experiencing, you think, or maybe even can kind of recollect in your clinic, when it comes to their sexual health?

27:06 - Rena (Guest) Yeah. So number one is low libido. So 40% of women will have low libido in their lifetime. 40? 12% will be bothered by it. Now, bother right. Some people may just like I'm not that into it, it doesn't bother me or it doesn't bother my partner, but 12% will be bothered by it. And this is based on validated questionnaire surveys that I've looked at like rating libido right.

27:30 So it's a really common issue and I think there's a lot of reasons for it. One is that we've glamorized in society what desire should look like. So it should be hey, I see my partner, I'm turned on, I immediately want to have sex. We rip our clothes off, we have sex, right. But that's not the reality.

27:48 The reality is a lot of people have what we call responsive desire. So it's like going to the gym you go, you don't really want to go, but when you're there you're really glad you did Same thing. It's like you know, you're sort of like I don't really necessarily feel like having sex, but once you're in the moment having sex with your partner, who you love and enjoy, you're like, oh, this is great, right and so. But people feel like oh no, I have to feel like the strong desire right away. That tells me, oh, I got to have it right now. Right, and that's just not reality. And responsive desire is very normal. It's just a matter of realizing that. You know what, like I, have to be receptive or open to the possibility of having sex, and if I'm not in the mood once we start being intimate together, then fine, we don't have to. But at least being open and receptive to that and realizing that me having desire after being receptive is okay, that's completely normal and I'm not broken.

28:39 - Chase (Host) Those are some pretty wild stats. I wasn't expecting that high. That's pretty wild. When is the best time for a woman to have sex, from an intimacy perspective?

28:50 - Rena (Guest) I guess I don't really understand the question.

28:51 - Chase (Host) Okay, so kind of how we were talking about earlier. You know, guys, we've learned that. You know we kind of go through this, this range of peaking and lowering testosterone which drives erections, which probably is going to help. You want to have sex or not have sex morning, evening? Is there something like that for women?

29:05 - Rena (Guest) It's the same for women.

29:06 So, women actually have more testosterone in their bodies than estrogen women. So women actually have more testosterone in their bodies than estrogen and it is very much a hormone of desire for women as well. So very often they're similarly. Their testosterone will be highest in the morning and that will be the time that their desire is the highest. Usually now, not for everybody, but I think some of that is societal. They don't feel like they're, they look the way they want to look or they feel the way they want to feel in the morning necessarily, but I think that generally physiologically we know that desire is probably most likely highest in the morning.

29:36 - Chase (Host) Interesting. Okay, all right, good news. Men and women out there, do you think or do you know? Do women masturbate as much as men?

29:54 - Rena (Guest) So the studies will say anywhere between 80% to 94% of women have masturbated in the last year.

29:57 - Chase (Host) So probably most women are masturbating, so I'm sorry. Is that just saying that percentage of them have done it at least once in the last year, or what is that?

30:02 - Rena (Guest) It depends on the study. But you know, yes, they've participated in some form of masturbation in the last year. Now we don't know how frequently that is. Some of the studies will be like in the last month. Some of the studies will last in the last year. Now we don't know how frequently that is. Some of the studies will be like in the last month. Some of the studies will last in the last year. But we know a lot of people are masturbating, right? I can't tell you the exact number, because it's there's not one.

30:16 - Chase (Host) We know a lot of people are masturbating.

30:18 - Rena (Guest) There's my clip, so um. So yeah, I mean a lot of women are participating in masturbation and I think it's just less talked about in terms of women talking about masturbating, and also I think there's less education in terms of women like masturbating or how to masturbate or what you can use to explore. If you don't talk about it with somebody, you may not know.

30:44 - Chase (Host) Would you say that it is healthy for a woman to masturbate?

30:47 - Rena (Guest) I think it's healthy for everyone to masturbate. I think the reason being is that it allows you to really one. It's the safest form of sex, right? You're not going to get anyone pregnant, you're not going to get STD. It's the safest form of a way for you to achieve pleasure.

31:00 And we know that orgasms are really beneficial for health, right? We know that they improve stress, they help sleep, they help maybe reduce blood pressure and heart rate. So there's a lot of benefits to orgasms. But in terms of masturbation, the other benefit is that you learn what you like, right? You learn what turns you on. And so if you don't know what turns you on, you can't tell your partner what turns you on. So I think it's really important to take some time and explore with yourself and figure out what you enjoy, so that then, when you're in a relationship with a partner, you can have community, you can show them, you can explain to them what you like and you can then have a much more satisfying partnered relationship and sexual relationship with a partner.

31:40 Because there's a big myth, right, that all women need vaginal penetration to orgasm and in fact, 80% of women climax through clitoral stimulation alone. And so, if the partner doesn't know that because there's no sex education for young men. How would they know that? Right? And and women don't know how to communicate that. Then there's a lot of women not having orgasms, right, and then they're not enjoying sex and like what's the big deal? Why is sex so great? Right, because they've never had an orgasm before.

32:07 - Chase (Host) Okay, so walk us through again, speaking to and for women here, if they are not orgasming through masturbation or sexual intercourse or any other method, is that a bad thing? Is it just a matter of you just need to learn how to get there, or is there more of a hey from a health perspective? If you are that sexually active and you're not orgasming, there's something going on.

32:31 - Rena (Guest) So, in terms of a health perspective, we don't know that there's it's necessarily a bad thing, uh, but we do think that, you know, is it because maybe they don't know how to? Or is it because there's something wrong or whatever? We're not sure why, but we know 12% of women have never had an orgasm, so it's a pretty high number. Wow, yeah, so it, you know. It sort of takes some digging. It can be from a variety of different reasons. It can be because they're not stimulating correctly or appropriately. Uh, they're not. Um, they, they have trauma, or mental, you know, psychological issues in the brain is what we say in sexual health is the brain is the most powerful organ for sex.

33:09 Because if your brain's not in the right space, because you're stressed, because you have trauma, because whatever, reason yeah you're not going to orgasm, you're just not, it's not going to happen, and so that's really an important thing to assess, like there's a lot of factors that go into it and and so really kind of dissecting all those things, and then we have things that we can do to help women figure out where the problem is.

33:34 Maybe there's even like a spinal issue. We don't know yet there's some data that you can find like Tarlov cysts or things in the spine that may be affecting the nerve function to the genitals, and it's pretty early data, but there are some physicians in the US who are treating these things and looking and seeing and finding benefit through them, mostly in the pelvic pain area, but certainly we see that it correlates with better orgasms too. So I think there's definitely a variety of factors that it could be, but ultimately it's worth exploring. Like everyone deserves to know what an orgasm feels like, so you know, if you are having trouble, like, go see someone. I think it's worth it.

34:11 - Chase (Host) Okay, Um, to kind of wrap up this section here, follow up to that question If a woman's listening right now and they are going, I've never had an orgasm where I'm struggling to get them as often as I would like kind of blanket statement here. What would you recommend a woman to do to try to help that? What would be kind of like hey, if you struggle with orgasms in terms of not having them or not getting them as often as you would like, here's something you can try.

34:34 - Rena (Guest) Yeah, so I would say one is um, definitely incorporate clitoral stimulation use lubricant. So, uh, lubricant. The clitoris does not lubricate right, so like, while the vagina does, um, the clitoris doesn't. So sometimes you may need to try different lubricants. You can get over the counter sort of their arousal gels. That maybe may help you feel that sensation a little more strongly, not necessarily warming they have.

35:02 I don't know exactly what's in them off the top of my head, but they do help some women and you can buy them over the counter. And I would say, test them on your skin elsewhere. First make sure, sure you don't you're not sensitive. Um, and start with small amounts, but certainly those things can help. And, and then you know, try to just take some time with yourself and experiment. Use vibration If you've never used it before. A vibration is a very powerful tool to achieve orgasm and so, um, there's. You can go online and find a whole host of different options. Read the Amazon reviews and pick something and try it out.

35:33 You can, you can, and so I would say that's a good place to start, and then, if you're frustrated you're not figuring it out, then that may be time to see an expert.

35:42 - Chase (Host) Okay, thank you. Moving right along to men's health and I'll preface this by saying I do have more questions prepared for men's health just because I am a guy this is no shade to women by any means, but kind of the same question as we had in the women's section what is the most common problem you see most males currently experiencing when it comes to their sexual health?

36:03 - Rena (Guest) Erectile dysfunction by far, and I think a lot of men are really surprised to hear this, but 52% of 50 year olds are going to have problems with erections, 60% of 60 year olds, 70% of 70 year olds, and so on and so forth. So it's very, very common that a man is going to experience some challenges with erections in his lifetime and, uh, and it's very devastating and it's very stressful, uh, but it is very, very common.

36:29 - Chase (Host) You said 50s, 60s. What about is erectile dysfunction? Does it need to be of concern for guys in their 40s, 30s, 20s?

36:37 - Rena (Guest) Absolutely it should. I mean it does happen. If that's what you're asking. It does happen in terms of, like, we see younger men with ED, probably a little less often, maybe 20%, but still not an insignificant number. And then it's also how you define ED, right? So I think sometimes people are confused and they may ejaculate sooner than they want to and confuse that as erectile dysfunction.

37:02 - Chase (Host) If you're ejaculating, you have an erection.

37:04 - Rena (Guest) Yes, that's premature ejaculation versus erectile dysfunction, because your erection is doing what it needs to do. You ejaculate, it goes away. It's going through its normal arc, but it's just happening too soon.

37:17 - Chase (Host) So then, define erectile dysfunction for us, please. What is it?

37:19 - Rena (Guest) The inability to sustain an erection that is sufficient for vaginal intercourse. So if it's not hard enough that you could penetrate, that's where we define it now. Other things can be like you may have had one night where you didn't get an erection because you drank too much or because, whatever, you weren't in the mood, your brain was not in the right place, and then and then it leads to this like very uh stress response, right, like some people say, you're only as good as your last erection, right?

37:46 - Chase (Host) so guys are thinking about who says that that's a terrible phrase.

37:50 - Rena (Guest) No meaning like that's how men feel Not that people are saying that, but that's how people feel like oh, my last erection sucked, so now I'm going to um we're just going to compare it to that one for the next one, yes, and then I'm stressing am I going to be able to get an erection?

38:02 Is it going to last, is it going to go away again? And then you can't get one because you're stressed, and then it just perpetuates, and that's what we call psychogenic ed or performance anxiety. Right, but that becomes very common in younger age men because it's it's very, first of all, stressful enough as you're figuring out how to have intercourse, you're figuring out how to, you know, uh, navigate, maybe using alcohol or other things, and you're meeting a lot of new partners potentially, and so all those things lead to a lot of stress and anxiety.

38:32 - Chase (Host) I've heard you talk about evidence-based ways to increase penile length. How?

38:39 - Rena (Guest) So there are some studies looking at how to increase penile length when you start with things that are to enhance the appearance of length. So everyone's penis is not just what you see. It goes deep into the pelvis, dives down into the perineum or that area right underneath the testicles, and so the erectile tissue is that long. It's pretty long, and so if you gain weight it's going to look shorter. So that get the fupa people call it right.

39:05 That like fat above the pubic area, that is going to make your penis look shorter. So one easy thing is weight loss and then also, if you have a lot of pubic hair shaving, that can make it look bigger. So those are some of the easy things. Now, moving on to like actually increasing penile length, the the one that you know. People have tried to vacuum erection devices and some people will say they definitely work, but there's no strong evidence to say that that's the case. So you've probably seen these penile vacuum devices online?

39:33 - Chase (Host) No, I have not. You've never been targeted. Good for you, I mean. Is it what it sounds like?

39:40 - Rena (Guest) So it's a vacuum erection device. Essentially, you put a cylinder on the penis. It creates a negative pressure, the penis increases, gets an erection through that negative pressure, and then you can put a constriction band or a band at the base of the penis to maintain the erection. So it's used. Actually, it was created for men who had ED and so they could use this to get erections. But people will make all sorts of claims that they has not shown to increase length. The next sort of over the counter thing you can get is a traction device. So a traction device is a device that essentially pulls the penis and it keeps it on traction for about, you know, usually like 30 minutes or so, and and that is over time. If you like, dedicate yourself to that for several months. You will see a small increase in length. I mean two centimeters, small, big, whatever you want to call it, but it is it is months of penis pulling for maybe two centimeters increase of length.

40:45 - Chase (Host) Correct. Personally speaking, the pros and cons don't seem to check out there.

40:49 - Rena (Guest) Yeah, yeah, I mean. So I don't shame anyone who wants to do this you know actually small penis, anxiety or like your body, do what you want. The desire to have a longer penis is so common. It's like 55% of men feel like their penis is inadequate and most of them have normal size penises, so it's very, very common.

41:08 - Chase (Host) So it's not even just sure I wouldn't mind a bigger or longer penis, it's. I actually feel that mine is inadequate. Correct, correct, 55%, yeah Come on, guys, come on, come on.

41:21 - Rena (Guest) I mean, they may not admit that right, but in a survey that's what they wrote right, at least in these studies.

41:26 - Chase (Host) But then you said, most men are. You know, statistically speaking, scientifically speaking, have an average size penis yeah, especially the ones who are seeking to get a longer penis.

41:35 - Rena (Guest) They, most of them, have a normal or above average size penis.

41:38 - Chase (Host) What is normal or above average.

41:39 - Rena (Guest) Normal is about five and a half inches erect.

41:42 - Chase (Host) Okay.

41:43 - Rena (Guest) So, um, so that's normal and most people want more. And, um, I, you know, again, I don't. I don't shame anybody for wanting it. I just give the information in terms of, like, what can you do? Now? There's other things, like people will try to inject things into their penis to make it girthier. The only thing I would say is generally somewhat safe is hyaluronic acid fillers, like the same fillers women use under their eyes. There's different kinds of fillers, but essentially they've done some work with hyaluronic acid fillers, like doing very small amounts and doing it over time. That can increase girth. There's not a ton of data yet, but there's a lot of people doing it in terms of practicing it clinically. But otherwise there's lots of like permanent fillers. Those do sorry, those do tend to dissolve or absorb over 18 to 24 months. There are permanent fillers I would not recommend. So then there's surgeries. There's different types of surgeries that you can get done. There's not a lot of people doing them. They're not doing high volumes of them. I wonder why.

42:44 - Chase (Host) I get risk-reward here.

42:44 - Rena (Guest) Yeah, I would not generally recommend any sort of surgical correction at this time. If it was like a breast augmentation and people were doing it all over the country, I'd say absolutely. But when people are not doing a lot of it, it's not going to be the they're not going to have enough experience to to do it well, necessarily. So I would generally avoid those things at this time?

43:05 - Chase (Host) Okay, yeah, solid advice. Can pornography cause erectile dysfunction?

43:10 - Rena (Guest) Okay, Solid advice. Can pornography cause erectile dysfunction? Not pornography itself? So it's really in the mind of the user, right? So if you're watching pornography and you think it's bad and you think it's going to affect your erections, again it goes back to your brain as your most powerful tool. Now, in some cases, people will watch pornography and they will say that's the only thing that turns me on or that's what the kind of intercourse I want. And now these are all fantasies, right. What you watch in pornography it's not real life. So then if you find yourself only being turned on by that, or you find yourself really wanting that fantasy, which can't be replicated necessarily in real life, then, yeah, it may be hard for you to get aroused and hard for you to get an erection because you're not getting that right, that's more that mental barrier rather than the physical you're talking about Right, right.

43:56 So it's not like it's changing your physiology. It's changing how your brain interacts with the world in terms of sex, and I think a lot of times the issue is that people see these things on pornography and they're like why is my sex not like that? And it's a, it's a, it's an entertainment, right. Pornography is a, is a product. It's edited Like they have, you know, they have fake lubricant all over the place and like you know they're doing things.

44:20 And these guys are paid actors and actresses who have penises and vulvas that look like they do because they can't right. That's how they get recruited partially to become one of these actors and actresses. So it's not like they're an average person, and so it does create a lot of anxiety and a lot of, you know, potential mismatch of like, what turns you on and what is happening in real life. So when you find that it's detracting from your ability to enjoy sex with a person, then yeah, it's a problem, right. But if it's not and you're using it recreationally and it just is something to give you pleasure for a short period of time and you can separate that from reality, that's great, that's fine, yeah, all right.

45:02 - Chase (Host) How can men increase semen volume, and why does this matter? Is more better.

45:07 - Rena (Guest) Yeah. So a lot of people love to talk about this, and I would say that more is not necessarily better. The average amount of semen volume is five milliliters, so it's like a teaspoon, right. It's not a lot Um and and. More doesn't mean that you have more sperm necessarily.

45:25 - Chase (Host) Uh, so semen is not the same thing as sperm, correct?

45:27 - Rena (Guest) Correct. So if you were saying like, health-wise is it better? Not necessarily right Now. Some people really enjoy the feeling of having a large ejaculate volume. It's more pleasurable to them. But interesting when you look at the female partners and again there's not any. This is only heterosexual data. But if you look at the female partners and you ask them there's actually a study that's been done on like do you prefer more semen volume or do you prefer, you know? Does it make a difference? And really the only thing that makes a difference is that their partner ejaculates or not.

45:57 - Chase (Host) So the amount really does not influence the female perspective.

46:01 - Rena (Guest) Correct. I mean some women will say, of course, that they like it, they feel it, it's good, but that's not, at least in that one study. That was not necessarily an issue for most women. Like yes, there are some, of course, who really do enjoy the volume, but the large majority no, the large majority just want to make sure their partners are jacking and feeling pleasure and that they're enjoying themselves. Right yeah, In terms of how can you increase it? Well, one simple thing increase your fluid intake.

46:27 - Chase (Host) Fluid across the board.

46:28 - Rena (Guest) Yeah, fluid across the board, Cheers. So fluid across the board will increase semen volume and also abstinence between ejaculations. How long? So generally, when you look at the data you will see an increase in volume, but at some point over many, many days, but at some point the quality of the sperm so if you're trying to conceive actually goes down. So generally we say at least 48 hours. Uh, if you want to really increase semen volume, um, but yeah, if you go longer you might have more, but at some point you get diminishing returns. So probably after about five days you're getting diminishing returns, um, so that's another way. Also, if you want to just increase the force at which your ejaculate comes out, so it appears more voluminous, that you can do by doing Kegel exercises.

47:15 - Chase (Host) And guys can do Kegels. Guys can do Kegels.

47:17 - Rena (Guest) So I will caution you to say that not everyone should do Kegels, and I'll talk about that. But Kegel exercises are exercises where you essentially strengthen the pelvic floor. So for men, how do you do them? So, in men it's it's like when you're peeing and you try to stop the flow of urine. That's actually your strength You're squeezing those muscles. Now I don't want you to do them every time you pee, cause you'll create a problem.

47:39 - Chase (Host) I'm just going to say, like, what's the frequency here?

47:42 - Rena (Guest) But so then the other thing I tell people sometimes it's like you're lifting your penis without touching it, so that's also squeezing those muscles.

47:50 - Chase (Host) I'm sorry, I'm a visual learner here. Well, just by cupping, no, no, without your hands, oh, without your hands, yeah, so you're trying to, just oh.

47:57 - Rena (Guest) Yeah, Without your hands Interesting. So or you're have to help you squeeze those muscles and then but you squeeze and you relax. So 10 seconds squeeze, 10 seconds relax. And the relax is really important because you don't want those muscles to clench up and get tight. And that's why I say it's not always good for everybody, because some people have a naturally clenched state right. Their pelvic floor is naturally tense. Maybe they're type A personalities, Maybe they've had some trauma, Maybe they had some surgery. Whatever it is.

48:28 - Chase (Host) High chronic stress.

48:30 - Rena (Guest) Yeah, and they can, just like people, get TMJ, their pelvic floors can get tense, and so in those cases, sometimes when you do Kegels, you make it worse. So you might start noticing, hey, my erections are not as strong, or hey, it hurts when I orgasm, or or hey, I'm getting constipated, or maybe I have to go to the bathroom a lot more often than usual. Like urinate, and it presents differently in every single person, but can be a sign that your pelvic floor is tense, and so learning how to relax that pelvic floor in those cases is better rather than doing Kegel exercises.

49:01 - Chase (Host) Okay. So if that's us, what is the anti-Kegel we should be doing?

49:05 - Rena (Guest) Yeah, so one. I always recommend seeing a board certified or specialist pelvic floor physical therapist because they'll work with you on finding the exercises that are going to work best for you, but ones that I generally tell people that will be helpful are certain yoga poses can be really good at sort of lengthening the muscles.

49:21 - Chase (Host) Really Like what.

49:22 - Rena (Guest) Like happy baby pose and child's pose and then like a low, deep squat. Those all will sort of help lengthen and stretch those muscles. And then diaphragmatic breathing so breathing in the belly rather than the chest all those things are going to help sort of relax those muscles.

49:38 - Chase (Host) Amazing. This is why all this has been so educational and mind blowing in some capacities, and this is why I love talking with experts like yourself, because it's such a great reminder of when we're looking through the lens of a particular thing in the human experience and we've been talking about sexual health there are certain things that we can do to try or we have clinical evidence to prove that works. For this reason, but also just in general, it's good for the body and I'm thinking you know, knock on wood, I'm pushing 40. And I know some other guys around my age ish and we have different sexual health levels. I'll say that in terms of erection frequency, quality, sperm count, I mean you know all the things we've been talking about, and I think to everything you just talked about.

50:25 I do deep squats, I do happy baby, I do yoga. All the things you've been talking about for other purposes, for my personal wellness journey, feed into, kind of, the collective picture. But also, okay, maybe this is why you know I've been doing a lot of these other things. I know a lot of other guys don't, or at the frequency that I do, and so it's great to know that, while it's serving my other personal wellness goals. It's also supporting my sexual health, reproductive health, at the same time.

50:51 - Rena (Guest) Yeah, and anything generally that's going to reduce stress, right, I'm sure you're doing it for stress reduction partially, and so, like, anything that's going to reduce stress is going to help you, because stress is a libido killer, it's an erection killer, it's a you know all those things. And so you got to reduce stress and we live in a very high stress life right now. Right, like, everyone is trying to keep up with the Joneses and working. You know, 10 hour, 20 hour days like not sleeping, and so you know, I think it's important to realize.

51:22 Like you know you'll, you'll watch and learn a lot of different things on social media these days and that stress is not helping you. Right, like you're like, oh, I'm doing this wrong, oh, shoot, I was doing that, and you know, like all that stress is not helping you know?

51:34 - Chase (Host) Yeah, yeah, so those are my little, just personal testimony there. I've also heard you talk about this semen retention. What is that?

51:40 - Rena (Guest) So semen retention is the act of not ejaculating for periods of time, and so it became popular in no Nut November. Actually, no Nut November, I think, started as a meme I learned recently.

51:53 - Chase (Host) And it wasn't like a joke. Like, all good things in the world starts as a meme.

51:57 - Rena (Guest) And then people began to extrapolate from Taoist literature and say semen retention is good for you. And then now it's sort of people are very interested in this and I would say that I don't think there's anything wrong with semen retention, but I do think that it's not necessary.

52:15 And there's no evidence, no strong evidence, like one small study of like 10 guys. There's no strong evidence that it has any physiologic benefits in terms of increasing testosterone. But certainly people do report that they feel mental clarity or whatever. And that's fine, because maybe for them it allows them to focus on something outside of masturbating or ejaculating and maybe that was detracting from other things in their lives. But it's not going to make you superhuman. It's not going to make you boost your testosterone to wild numbers.

52:46 And I think the important and the reason I say this is because I see the opposite. Men are abstaining so much that they're clenching their pelvic floor so tightly and then they're creating all these other problems, right, and then, honestly, your body will take care of it itself. So if you don't eject, either your body's going to absorb that or you're going to have a nocturnal emission. You're going to have a nocturnal emission, you're going to have a wet dream and then you feel like you failed because your body did something you had no control over. So you know, I think there's a lot of shame and a lot of potential harm If someone's forcing themselves to do something because of some theoretical benefit and if they're not seeing the benefit, then there's no point in hurting yourself.

53:23 - Chase (Host) You said the body will absorb it. You said the body will absorb it and I've um in within kind of the semen retention um ecosystem. I read a book earlier this year called the way the superior man and in that book it's kind of a, it's a unique.

53:36 - Rena (Guest) I hate that title, by the way, like why are we calling men superior to other men?

53:41 - Chase (Host) fair point, you know fair point and you know I definitely, without going too deep I enjoyed some of the writings. I forget the author's name now, but I enjoy some of the writings. Others were like this is just kind of too hardcore, male, typical archetype stuff you're ejaculate, you know, having sex, whether with a partner or yourself kind of being letting go of your life force. And he talks about, um, there's a term for this, I'm brain farting right now, I'm going blank on it, but basically, um, I get edging, basically, and I've heard we actually had a guest in here a couple of months ago, uh, talking about this as well and you know, using that as a way to kind of like enhance sexual arousal and performance and kind of just also control life force. And they both mentioned about how it, can you know, instead of you ejaculating, it goes back into your body. How does that happen? What's going on there?

54:35 - Rena (Guest) Yeah. So there's a couple of things. Sometimes they'll use a little pressure on the perineum. So if you look at like meditation sort of the school of meditation, where they use, like they use semen retention, they'll actually like push their heel into their perineum and what that's doing is it's preventing the ejaculate from coming out. So then it'll go back into the bladder and then you'll pee it out later, right? So when the ejaculate comes out of the urethra it has one of two ways to go it's either going to come out or go backwards. Now our body closes the bladder neck so that it can't go into the bladder.

55:09 But if you're on certain medications, like for your prostate, sometimes that relaxes and then you will have lower ejaculate volume because it'll go backwards instead of forward. So one is that. So you may have, you may be inducing, like retrograde ejaculation. The other thing is your body will like from the it's so the ejaculates made up of different things. It's made up of uh, your sperm and seminal fluid and prostatic fluid, and so your body will just resorb and create more.

55:35 If you're not using it, you know it'll just resorb it just like you know, every day, or like in our bellies, we're making fluid it's called perineal fluid and our body just resorbs it and you know you have lymphatics and all these other things in your body, right. So you're constantly, your body's constantly, taking care of all these fluids in your body and resorbing, and you're, you know, going through your kidneys and then peeing it out. So, um, so, really, you know, if you don't do it, your body will take care of it for you.

55:57 - Chase (Host) So is that just? Is that a matter of um? Does the same process happen by a man retaining from ejaculating up to a certain point? You know, we build up that fluid and semen and our body just does something with it, and or, whether through masturbation or even intercourse, we stop and retain it so that it actually reabsorbs.

56:21 - Rena (Guest) Yeah, it depends.

56:21 So some people maybe, when they're so, when they're trying to do semen retention and they're trying to edge an orgasm without ejaculation, they may be sort of do using pressure or some other way to make it go backwards rather than come out, and then really you're not, you're actually ejaculating.

56:36 You're just ejaculating in a different direction. Right, data that ejaculating more often, or 21 times a month, which is the number they used, and that there's not a magical number, it's just a statistical number, right? They came up with this number based on the normal distribution of men in the study, but they found that men who ejaculated 21 times or more a month were less likely to develop prostate cancer, and so we don't know why that is. It may be that a lot, it's a lot, it's a lot, uh, but I think it's just that. I think it's the idea that you're, you know, routinely clearing out some of these fluids, potentially, um, that maybe you're getting rid of some inflammation or things like that when you ejaculate. Now, we don't know for sure, right, and this is not my prescription to say everyone should ejaculate.

57:22 - Chase (Host) It was like an average of the study and like, oh, men, who, on average, ejaculated this much didn't have the problem, or do they run through?

57:28 - Rena (Guest) Yeah, it was they looked at it was category, so it was like less than four, four to seven seven to a lot. I don't know whatever it was it was I, I forget the exact thing. I think it was through a survey and they, you know, they self-report how many times they thought they were masturbating or not masturbating, but, sorry, ejaculating.

57:48 So it could be through sex or masturbation, and so they compared four to seven times versus. When they looked at the data, four to seven times versus 21 times or more a month, and they found that 21 times or more a month had lower risk or had less often had prostate cancer.

58:03 Now, this is not causal, this is an association, and they did do a very good job of trying to control for other factors. But you know, there's always going to be factors like maybe the person having that much sex and masturbating that much is healthier than the person who's doing less, right? So, um, they did try to control for all those things. But I think it just goes to say that it's it's certainly not bad, right? I use that data to say, like, masturbation is not bad for you, it's not creating a problem in terms of your prostate or other things.

58:32 - Chase (Host) That seems like such a big gap four to seven, and then there's nothing in between, all the way until 21 or more.

58:39 - Rena (Guest) Meaning that there was no statistical finding.

58:41 - Chase (Host) Ah, gotcha, okay, Okay. So no statistical significance, correct, okay, interesting. Always look at the sample size, always look at the statistical significance, fam.

58:51 - Rena (Guest) And is it clinically significant? Yes, that's another big thing.

58:54 - Chase (Host) Yeah. What are the best foods or supplements for increasing erections in terms of firmness, size, erection duration, et cetera?

59:03 - Rena (Guest) Yeah, so I think we talked about some of them. Watermelon is a great food because of the citrulline content in watermelon. I would say that L-citrulline and L-arginine are good supplements in terms of increasing blood flow to the penis, increasing nitric oxide, and I would say that generally, you know there's not, it's not going to work for everybody. So I just say, you know I've said this earlier in the podcast but supplements do have data. It's not as rigorous as the data is on, like sildenafil or tidalafil, but there is some data. It is positive for those supplements and there's quite a few, at least in L-arginine. There's actually quite a few studies on it. Um, l-arginine is just not as bioavulin.

59:41 It's easier to take because it's twice a day versus three times a day or four times a day for L-arginine. And so, yeah, I think if you want to try a supplement, I would start there and then, food-wise, a heart-healthy diet whatever's good for your heart is going to be good for your penis. So you want to avoid processed foods as much as possible, you want to increase protein intake, you want to increase antioxidants, so, like you know, berries and vegetables and generally the Mediterranean diet, and keep healthy fats, but not, you know, don't want to be too low fat, don't want to be eating saturated and unhealthy fats. So, just generally speaking, the data is best on Mediterranean diet, but I would extrapolate that you know things we know that apply are sort of the things that I mentioned already.

01:00:24 - Chase (Host) Yeah, and you kind of touched on it there. But follow-up question would be are there foods that?

01:00:33 - Rena (Guest) men should absolutely avoid in terms of decreasing erection quality. Yeah, so anything like fried foods um, you know you want to avoid a lot of unhealthy fats, trans fats Um, you want to avoid uh, really, those are the big ones. I, you know, I would say that, um, that there's no. Like there's some data that maybe plant-based is better, but it's really small. So I just tell people, generally speaking, like, let's stick with the data we know and that's. You know, quit smoking. That's the number one thing I would say. Like, if you're smoking, like none of this matters because you're going to have erection problems. So quit smoking. That's going to kill your the health of your blood vessels and then kill your erections. So I'd say, before you change your diet, stop that first.

01:01:12 - Chase (Host) This, just in ditching the ultra processed foods and smoking, is good for your health. I love we can just boil it down. It really for sexual health, but also just health in general. It really can be boiled down to that Just simple statement.

01:01:29 - Rena (Guest) Yeah, and I think it. I think it stresses people out when you tell them you can only eat this or don't eat that, or you know, just do your best 80% of the time and then you know, if you four days a month to eat something bad, don't kill yourself over it, like but but really just try to do your best as much as possible and, and you know, focus on giving, investing in your body.

01:01:46 - Chase (Host) Would it behoove men to know if they have a female partner, to know their female partner's cycle to enhance their chances of having sex? Are there some days that are for sure a no in the cycle and others are for sure, or maybe even just a strong maybe yeah.

01:02:04 - Rena (Guest) Yeah, so we know that around ovulation, generally speaking, women are there because if you look at the way the hormones cycle through the body, they're at their peak and so in those cases there's more libido potentially around, there's more interest in sex, and so that's probably the best time In terms of you know, I think low times if they're menstruating and they're not feeling great and their hormones are bottoming, you know, at that point they're not going to be really interested at that point, Should every man be having morning erections?

01:02:34 - Chase (Host) I want to just kind of blatantly ask that question. I know we kind of touched on it but what does it mean if they're not? And I've also heard you talk about the importance and difference between daytime and evening directions. What's the difference there?

01:02:45 - Rena (Guest) Yeah, so you should absolutely be having morning erections. You should absolutely be having erections overnight. That is a sign that your body has good blood flow, good nerve function, good hormones. Right, it's telling you. It's telling you, your body's telling you, yes, everything's working, everything's working in good working order. So if you're not having those, there's a problem in one of those areas. So you need to get worked up and evaluated. And I tell people to be proactive, right, like you don't want to wait till you're having problems with erections when you're having sex. You, if you're seeing problems, like, let's deal with it now, let's fix the problem before you get there, rather than waiting for it to be like oh man, I haven't had erections in years and let me tell you, I see those patients too, and it's really sad that they've waited that long to come in and see somebody.

01:03:25 - Chase (Host) Because I'm hearing that this stuff, if we're aware of it early, we can really get ahead of it in big, big ways.

01:03:30 - Rena (Guest) Yeah, and I get it. It's really stressful right To be like something might be wrong with my genitals, like that's a big scary thought and it's really hard to come and see someone about that. But again it's investing in your health and again it's investing in your health and so I think you're helping future you. And that's the way I sort of like to look at my life, like I'm always trying to help future me, help my future patients help you know things in the future.

01:03:52 - Chase (Host) I say that all the time to myself. I'm like what would a future chase be really grateful for that present chase is going to do or not do?

01:03:58 - Rena (Guest) right now.

01:03:59 - Chase (Host) Or the opposite. When I'm just living in the moment, usually like a YOLO, like man, future chase is going to be pissed. That's a problem for future chase. Future chase always figures it out because present chase is here. How much of a man's virility, in terms of erection and overall arousal, frequency, quality, et cetera, is physiological versus psychological?

01:04:24 - Rena (Guest) I would say you can't have one without the other. So if you are not in the right mind space, if you're stressed, if you're anxious, if you're thinking about your erection rather than actually being in the moment with your partner or with yourself, whatever it is like, you're not going to have an erection. You're not going to have the physiologic workings because your brain is going to stop them. So I tell all my patients even if you have the worst health because you got bad genes or you have bad diabetes or bad high blood pressure, bad cholesterol and your erections are a hundred percent due to vascular problems you still have a psychological problem because you are stressed about it, you are thinking about it, you are worried about it, and that comes with you Every time you try to have sex. Every time you try to fix this problem, you are thinking about it and you are stressed. So you just can't have one without the other stressors and worries and woes and accomplishments.

01:05:28 - Chase (Host) But especially if this is top of mind or you're just thinking about it, you know, like you said earlier, you're only as good as your last erection, or you know you're worried about your health in any capacity, yeah, how can you truly fully be present with yourself or your partner? And it kind of just becomes this downward spiral.

01:05:42 - Rena (Guest) And just to be clear, you are not only as good as your last erection.

01:05:45 - Chase (Host) I want to be very clear. I think she was referencing somebody else.

01:05:48 - Rena (Guest) Yeah, I was saying that people often think that way, but it is not true. You are much more than that.

01:05:54 - Chase (Host) Much more. I have one more question here in men's health. Before we move on to kind of the couple's health, a few questions. Do men need to ejaculate in order to orgasm?

01:06:03 - Rena (Guest) No, you can orgasm without ejaculation.

01:06:05 - Chase (Host) Walk us through that. What is it? Because I think and I think most guys think a male orgasm means ejaculating.

01:06:12 - Rena (Guest) So an orgasm in essence is a release of buildup, of tension, right, and so very often they're together, right, because you, as a man, you will know this. But physiologically what happens is you're building, you're building, you're building. You get to a point of inevitability, right when you're like I'm going to ejaculate, it's going to happen. Right, and if you can learn to recognize that point and sort of like edging right, you can then orgasm but not ejaculate. And so, yes, you can train yourself to do that, do? I think there's value to it? Maybe, maybe not right, depends on what you're into. Some people will do that and then, uh, they'll actually feel like their orgasms less strong, right, because they've coupled those two together.

01:06:51 - Chase (Host) I can see that, but other.

01:06:52 - Rena (Guest) Sometimes you'll feel like it's even stronger. So I think it just depends. And ultimately it may make that final orgasm, when you do ejaculate, more stronger. So I think it just depends. Um, so yes, you can. And the other thing that people don't realize is you can have an orgasm without an erection. So oftentimes, you know, when men do go through erectile dysfunction, they feel like, well, my life is over and yeah, it's not.

01:07:16 It's not ideal. It's not ideal, but you can still have pleasure and your partner can still have pleasure, because you don't need an erection to, uh, to stimulate the clitoris and they don't need an erection to have an orgasm. So you can still have pleasure and you can still enjoy each other. And so if you're at that point and you're like I don't want to do anything else, like I just want to make sure my partner's happy and make sure I'm happy, there's plenty of ways to do that.

01:07:39 - Chase (Host) I like that little last bit there, that's good. That's interesting. Okay, so let's move on to the couple's health and same question we've talked about for men and women, but for couples what do you think, or what do you know? What do you see is the biggest problem facing most couples today when it comes to their sexual health?

01:07:56 - Rena (Guest) They don't talk. They don't talk, they don't talk about sex, and it's not their fault. No one taught us how to talk about sex. I'm sure you didn't talk to your parents about sex. I didn't talk to my parents about sex, not in any meaningful way, and, and so I think and school didn't teach us how to talk about sex, so it's like super awkward.

01:08:14 - Chase (Host) I went to a very small private Christian school growing up, so you can imagine there was like no one talking about it and then us below that.

01:08:20 - Rena (Guest) So so, yeah, it's it's. It's not anyone's fault, but we don't know how. And how do you bring it up? And it's very emotionally charged. I think people forget that sex is supposed to be play, it's supposed to be fun, right, and so if you bring something up, it's not an emotional thing. We're not trying to make you feel bad. No one's trying to make their partner feel bad. They just want to maybe talk about it.

01:08:42 But, realizing that it's not going to take just one conversation, you have to start having awkward conversations so that eventually you can have really good conversations. And so it's sort of investing in the time to talk about it and then saying, okay, this wasn't great, let's revisit it again, let's try it again, and let's keep trying to talk about it until we're at a place where, like hey, you know what, I don't love it when you do this, but I love it when you do this. And then that's where you start oh, really, well, then I'll do more of that. And like that's where you really start getting to this amazing mind blowing. You know kind of sex that you're having. And then sometimes it's like it's okay to have mediocre sex too.

01:09:17 I think sometimes people are like every time we have sex it should be mind blowing. It's like it's not, it's happen, right? Especially as you get more and more responsible responsibilities, like your kid might be in the room next door, your dog might jump on your bed, whatever it is Right, um, and so it's okay to sometimes have average sex, but, like you know, also just making sure that you're constantly trying to check in and make sure your partner's happy and you're happy. And how can you change it up, right? How can you spice it up and do something new or novel?

01:09:46 - Chase (Host) and how can you change it up right? How can you spice it up and do something new or novel? Yeah, to your point earlier, the working out analogy I, personally speaking, I will take having a mediocre workout today versus not having any kind of workout or physical activity, and I will also say I take mediocre sex over. Not Most days, I think. Some days I'm definitely just too tired. But total honesty here. But yeah, it's such a good point.

01:10:10 - Rena (Guest) Yeah, absolutely.

01:10:12 - Chase (Host) Can couples use pornography to their advantage?

01:10:15 - Rena (Guest) Absolutely so one. You can watch it together to get aroused and get in the mood too. You can watch it to get ideas and like hey, would you? And then you're watching, like hey, would you want to try that? You know? And? And big no, I don't know. And you know, uh, plant the seed of something you may fantasize about. And of course, always, I think, when you're introducing new things to your relationship, like have boundaries around it, have safe words, have um, make sure that you're, you know you're both on board, checking with each other. And if you feel uncomfortable saying the words, it can be as simple as a nonverbal like okay, if I push you, like this, that means I don't like it, or like you know, but being you know, because a lot of communication in the bedroom is nonverbal, right, so it could be just moving someone's hand or moving someone's mouth or whatever.

01:10:56 It is Right and that's, that's okay, like that's not a bad thing, that's a great way to communicate.

01:11:01 - Chase (Host) And also, you know, preface it, communicate about it ahead of time, you know, maybe not springing uh springing some extracurricular activities on them in there yeah.

01:11:08 - Rena (Guest) Yeah, don't talk about it in the bedroom. So I always say have your sex conversations not right before, right after sex.

01:11:16 - Chase (Host) How do you get what you want in bed?

01:11:18 - Rena (Guest) You ask for it. You ask for it and you practice. So, just like any skill, you're not going to be good at it right away. You have to practice. So if you want to have great sex, you keep having sex with your partner and you learn what is good, what's not good and in particular with sex, you've got to keep it interesting because, just like you don't want to eat the same food every day, you don't want to have sex the same way unless pizza, pizza's fine with me every day.

01:11:45 Sure, even pizza gets old if you're doing it.

01:11:48 - Chase (Host) No, never, never yeah.

01:11:50 - Rena (Guest) Well, um, generally speaking, I would say, like you know, you got to work at it, just like you work at any other skill. If you want to have great sex, you got to talk, you got to act and you got to do.

01:12:01 - Chase (Host) Okay, all right, might be TMI, my wife might kill me here, but I'm going to ask anyway.

01:12:06 - Rena (Guest) Yeah.

01:12:07 - Chase (Host) This is a safe space. Sex during pregnancy pros cons. Should we be having sex during pregnancy? Are there any risks? I've heard on kind of like the far end if you're struggling to induce labor. I've heard having sex can help that. But what about sex during pregnancy?

01:12:25 - Rena (Guest) So sex during pregnancy is totally fine unless your OB says for some reason you can't. So there are some conditions where you know if you have placenta, a certain position where it may be dangerous, but that's exceedingly rare and so you'll know, like your OB will tell you, and, honestly, if you are, if you're a woman who's pregnant, ask your OB and ask them. Well, what about masturbation? Is orgasm okay or is it just the act of the penis going in the vagina?

01:12:49 Because because you know, orgasms will cause some uterine contractions. That's where we think it may cause cause labor. So, um, you know if, if you're in that situation, ask. But most of the time it's totally fine to have sex. Sometimes you got to be creative with positioning because some things can be uncomfortable, but absolutely totally safe and nothing to worry about. There's a lot of men who will worry that they're going to like dent the baby. The baby's going to have dimples.

01:13:16 - Chase (Host) Let's go back to the previous statement about the average male penis length with five inches erect. Okay, guys, calm down, it's not reaching.

01:13:23 - Rena (Guest) It's barely reaching the cervix, it's not reaching. It's barely reaching the cervix, it's not reaching the baby. So you are fine, you're totally fine, and sex, actually, because of all the hormones, can be even more pleasurable for the female partner when in the right position. So absolutely have sex.

01:13:37 - Chase (Host) Enjoy. There's no reason not to Okay Kind of getting towards the end here. This has been so educational, informative and fun. Thank you so much. What about painful sex? Should one continue to try and please their partner if they're experiencing pain during sex? I guess I should say during intercourse or even just I don't know? Maybe a guy has a painful erection and what are key symptoms to take note of? That there may be a bigger issue versus just a one-off experience of that. Didn't feel so good.

01:14:03 - Rena (Guest) Yeah, so sex should never be painful, like it should never be painful. And so if you're having pain with sex, it's important to think about, like you know, what's going on. Has it always been painful during sex? Is it something new? Is it certain positions? Because the most common thing?

01:14:20 There's a few easy things you can do. One is adding lubricant, so it'll just make things slide a little more comfortably, and then the kind of lubricant you use can make a difference. So water-based lubricants, which are, or aloe-based, those are the same kind of lubricant. They're usually the cheaper ones. They're usually available everywhere. Those will dry up.

01:14:38 So if you're having sex for you know, 10 minutes or whatever, you may need to reapply and so you know you might feel good in the beginning and then it's sort of gone. And then um also for using condoms, that can make it a little bit more uncomfortable. So using lubricant, I think a lot of young people feel like they don't need that but like, why not? It's just going to make things more fun, more comfortable. Um to if uh, sometimes there are women who are sensitive in the cervix and if you're with a very well-endowed partner, you can buy things to um to make space between your body and the length of the penis is called O-nut and not sponsored by them at all, but there's actually a thing you can padding or something.

01:15:15 - Chase (Host) It's yeah.

01:15:16 - Rena (Guest) It's just like a round. It's almost like a donut that you put on the penis so that like a spacer yeah, like a spacer, so like a shorter insertive length, so that may be helpful.

01:15:29 But then if you're still having pain, it's really important to get evaluated because it could be pelvic floor dysfunction, which can be managed with pelvic floor physical therapy. It could be something else. Like you have an anatomic abnormality that you're that you wouldn't know. I encourage all women to take a mirror and look down there, like actually look, because you should know what your, your vulva looks like and what your anatomy looks like. But then also, if there's something abnormal, you'll be able to tell your doctor. You know, hey, I saw this thing and I this wasn't there before, um, and so that may be part of it. Sometimes people have cysts called urethral diverticulum that can cause pain with sex. Sometimes it can be, um, the uterus is, you know, endometriosis or things like that that can cause pain with sex. So, ultimately, getting evaluated because it could be correctable. Very likely it is correctable, and so don't suffer in silence you know, get it taken care of.

01:16:16 - Chase (Host) So, getting towards the end, you you've dropped so much wisdom and information. Again, thank you, and I know this is like your profession and what you talk about online and on so many podcasts. Again, thank you, and I know this is like your profession and what you talk about online and on so many podcasts. What is maybe a question or two that you have not been asked or you feel absolutely people still need to know, that you have not talked about, or at least not here today?

01:16:36 - Rena (Guest) Yeah, I think the other part of what I do very often is bladder health and I think a lot of times we don't talk about it. And it's so important because it's like one of those things where, until you have a problem, you don't even think about it. But if you're struggling with leakage with urine or you're going a lot to the bathroom or you're waking up a lot at night, you don't have to live like that. So during the day, if you're going more than eight times a day, if you're waking up more than once at night, if you're having urge to go everyone has urge to go, but like it's so strong that you can't delay it, like you're rushing every time to the bathroom.

01:17:10 - Chase (Host) Yeah, okay, right, you said bladder.

01:17:11 - Rena (Guest) Yeah Bladder, yeah Um, and if you're, or if you're leaking, right, that's. Those are all things that we can help with, and male or female, and you don't have to live with it. I think a lot, especially in the female population. A lot of women think, well, I leak a little when I jump on the trampoline or when I cough or sneeze, and I've had a couple babies. That's normal. It's not normal. You can live with it. None of that is dangerous. None of those things are dangerous for the large majority of people. There's rare occurrences where it could be a sign of something else, but most of the time it's not dangerous. It's quality of life. But your quality of life matters, and like if you're going to the bathroom 10 times during your work day and you're not able to work, or you're spending money on products because you're leaking, like those are not things you have to live with and we have pretty simple things that can help.

01:17:58 - Chase (Host) No, I'm sure that means if you were just going about your day, you know. Air quote here Normally I think I drink a lot of fluids, I drink a lot of water. I air quote here Normally I think I drink a lot of fluids, I drink a lot of water. I love tasty beverages, shadow element and I probably go to the bathroom. I go. I urinate 10, 12 times a day, but I'm always hydrating.

01:18:16 - Rena (Guest) Yeah, so I mean, I think that's so. You have to take those things into consideration. If it's not bothering you and you're going 10, 12 times a day, I don't care, but if it's bothering you and you're drinking a normal amount, um, or you can even. What I tell people is you can write down how much you're drinking and you can even like guesstimate how much. You can buy a hat to see how much, or you can just guesstimate how much you're peeing, like how long your stream is, um, and, and then you can see like, does it make sense? Like am I making the same amount as I'm actually drinking? And they're like okay, well, maybe I got to drink less, right, um, so so that's one easy thing. But there's also certain things that can irritate the bladder, so caffeine, um sometimes. Artificial sweeteners, uh. Spicy foods, uh. Citrusy fruits and juices, sometimes. So for some people it's as simple as like hey, I got to cut off. Like some people are drinking six cups of coffee a day, like, maybe go down to three and you'll be okay.

01:19:07 - Chase (Host) You know, trust me, the rest of your life, we'll, we'll, thank you for it.

01:19:11 - Rena (Guest) Right. So, like I think sometimes it's as simple as that, but sometimes it's a real problem and you need a little more help. And we have a lot of things like medications and procedures that can help and can give you back your quality of life. And until you have seen what that's like, you're like oh, I didn't know what I was missing sometimes, or like I just lived with this. For, I mean, I think a lot of people live with those issues for years and years and don't do anything about it. Yeah, yeah.

01:19:34 - Chase (Host) Okay, I had just another question pop to mind. It fleeted me, but I want to ask one other question on the horizon. You know, again, you were practicing physician, you speak about this, you practice it every day. Is there something on the horizon that we should be excited about in terms of urology, sexual health? Um, cause, I'm sure you you have like a do the conferences and the CEM, or CMEs and all that stuff, what's on the horizon?

01:20:00 - Rena (Guest) So a couple of things. I think for erectile dysfunction there's a couple of things. I mean. Shockwave is around, it's definitely relatively new in the sexual health space, but shockwave is essentially a device that produces acoustic sound waves and causes to the penis directly and it causes mechanical trauma. And that mechanical trauma tells our body to send in growth factors to create new blood vessels.

01:20:24 No way really yeah, and so shockwave is something that is not currently in the guidelines for ED. I think it will be. It's got about 10 years of data and it's specifically focused shockwave. So you have to sort of differentiate. There's different kinds of shockwave. There's ones you can buy at home and there's ones you can get that are cheaper. Those are usually radial and they're not getting the depth of penetration that you need. But the focus chakra, that's our first sort of foray into regenerative medicine for sexual medicine, and I think that's pretty exciting.

01:20:54 There's other things out there that have less robust data, like a PRP shots and stem cells. The data is not strong enough yet. Maybe it will be, but not yet in my mind. And then there's also Botox, which is new. There's been a few studies on Botox for erectile dysfunction.

01:21:10 - Chase (Host) Really Botox to the penis.

01:21:12 - Rena (Guest) Correct and it causes essentially smooth muscle relaxation which allows it to be easier for blood to flow in and it may increase length by half a centimeter or so because it's also causing that smooth muscle relaxation and so I like that data because they did it's also causing that smooth muscle relaxation.

01:21:26 And so that you know, I like that data because they did it on men who had really severe ED. So by the time they got it, they were about to have surgery. They were about to have implant surgery for their penis. They got the Botox and they were able to then go back and take medications for instead of having surgery. So that's the reason I thought that that data was really interesting.

01:21:45 - Chase (Host) I've done Anytime you can thwart surgery, so that's the reason I thought that that data was really interesting.

01:21:47 - Rena (Guest) I've done anytime you can thwart surgery right. That's amazing. So I've been able to do it on a few patients who really liked it and and I think that that's sort of exciting. On the female side and and actually I guess both female and male for overactive bladder, there's a whole bunch of new devices coming out to help with overactive bladder that are sort of doing neuromodulation, so um, changing the sort of stimulating the nerve signals to the bladder so that it functions more normally, and so that's kind of exciting. There's um, there's different devices you could implant in the ankle that stimulate a nerve in the ankle that goes up to the bladder. That really, yeah, so that's sort of um exciting. And and you know, I think the more we have options for our patients, the better. Right now the options are Botox to the bladder, there's a bladder pacemaker, which is the same sort of technology, neuromodulation but it's to the bladder nerve root, and then there's acupuncture type stimulation to the ankle. But now we're getting implanted devices to the ankle too, so there's just more options.

01:22:42 - Chase (Host) Amazing.

01:22:42 - Rena (Guest) So I think there's a lot going on and I think it's it's really exciting because people are really trying to find new ways to to improve people's quality of life in an area that's desperately needed.

01:22:54 - Chase (Host) I have one other question before my final here and I'm trying to think of the best way to kind of phrase this. I've talked about this on the show and very public about different modalities that I personally use and have found a lot of health benefits from, but also recreational. I've gone through a couple of years now of ketamine-assisted psychotherapy ketamine therapy for PTSD and mental health, psilocybin and MDMA and I have noticed beyond kind of alleviating those symptoms, particularly PTSD, and a lot of stress and anxiety and unwanted mental health things. I've also personally noticed and even through such things as like holotropic breath work.

01:23:36 So I'll say altered states of consciousness, through substances and even just breathing differently, has dramatically changed my I'll just say I guess libido or kind of approach to my sexual health in a positive way that I almost I was not expecting and like no one told me about, in terms of just, yeah, just overall increased libido, and I have never had an issue with libido, knock on wood. And so it's just gone from really good to like whoa, and are you? Have you heard anything about this? Is there anything? Is it more like again physical, physiological or psychological kind of stuff?

01:24:15 - Rena (Guest) Yeah, I don't know any data on that as of yet, but I would I would venture to guess that if your stress levels are decreased because of it which I assume they are- that you're, you're having more libido and so you're going to feel, you know you're going to have more availability to it.

01:24:31 So, when you think about the brain, there's pro erotic hormones and there's ones that sort of try to dampen your, your desire, and so, depending on that balance, this is probably increasing the balance of those pro erotogenic hormones that are going to give you more desire, probably through some mechanism of how it's affecting your brain, would be my guess.

01:24:49 - Chase (Host) Okay, yeah, yeah. So bottom line if you do things in a safe way to lower stress in your life, yeah Good.

01:24:55 - Rena (Guest) That's why people talk about supplements like ashwagandha, because it's a daily user. It reduces cortisol, reduces stress, and so that's probably why we're seeing improvement in erections with that medication.

01:25:05 - Chase (Host) And for a lot of guys. I've seen a lot of anecdotal and clinical evidence. It's pretty small clinically but ashwagandha for helping increase the sarsaparilla works well I personally just love it from the adaptogenic aspect. Yeah, okay, great, great. Thanks so much, all right. Last question this has been again such a treat. This show is meant Help people bring heightened attention and awareness to key areas in their life, to move them forward and to keep living a life ever forward. Those two words what do they mean to you here today?

01:25:31 - Rena (Guest) I think it is again thinking about future you and trying to do things to make future you the best you that you can be.

01:25:41 - Chase (Host) No right or wrong answer. I always appreciate everyone's interpretation. Where can my audience go to connect with you more? We're going to have all of your information in the show notes, the YouTube video.

01:25:50 - Rena (Guest) Absolutely so, I will. You can find me on my podcast, Rena Malik MD podcast, as well as my YouTube channel, which is Rena Malik MD. I'm also on all the social media platforms, but those are probably my two active ones.

01:26:00 - Chase (Host) Yeah, guys, seriously, if you have found any value out of this episode today, just do a deep dive in her stuff. I love your podcast because you do like little chunks. I tried to pick one little topic and you go deep, hard and fast for a couple minutes and it's just boom, you got the information. I love it. It's just, it's no BS, very informative, very helpful, and you're so good at it, so I love it.

01:26:24 - Rena (Guest) Yeah, thank you so much.

01:26:25 - Chase (Host) Amazing. Thank you guys, so much for watching, listening. Make sure to smash the thumbs up button. Subscribe on YouTube. Tell your friends go back, take notes. I know I got more notes on notes and notes here. This has been a pleasure, thank you. Thank you