Urologist Rena Malik Debunks Masturbation Myths, Cites Prostate Benefit

泌尿科医生Rena Malik破除自慰误区，指出其对前列腺有益 Rena Malik医生指出规律射精可显著降低前列腺癌风险，同时反驳了自慰会降低睾酮或损害运动表现的常见说法。 Rena Malik医生基于循证科学全面探讨了人类性健康、盆底解剖结构与生殖生理学。她破除了围绕自慰、忍精禁欲和阴茎增大的普遍误区，并解释了性欲低下与勃起功能障碍的生理根源。此外，Malik医生还探讨了性高潮差距、色情内容对多巴胺回路的影响，以及坦诚沟通和伴侣步调一致在维系性健康方面的重要作用。 研究表明，每月射精 21 次或以上的男性罹患前列腺癌的风险显著降低，规律的性高潮对盆底肌和全身健康具有重要益处。 (0:00) 勃起功能障碍（ED）是心血管疾病的关键早期警讯；因阴茎动脉直径仅为 1 至 2 毫米，更易提前发生阻塞，约 15% 的 ED 患者在确诊后 7 年内会发生心脏病发作。 (9:07) 睾酮是驱动男女两性性欲的核心激素（女性体内的睾酮浓度甚至高于雌激素），但慢性压力引发的高皮质醇会抑制其合成；对于体内基线水平正常者，盲目补充外源睾酮并不能提高性欲。 (29:57) 每晚睡眠不足 5 至 6 小时可导致睾酮水平下降 10% 至 15%，针对下肢大肌群的重度力量训练能有效提升睾酮，而过度的耐力运动反而会推高皮质醇并抑制睾酮产生。 (32:29) 过去半个世纪中，全球男性平均精子计数下降了近 50%，久坐生活方式、代谢疾病以及塑料中邻苯二甲酸酯等内分泌干扰物（EDC）的广泛暴露是核心推动因素。 (35:25)

Urologist and pelvic surgeon Dr. Rena Malik asserts that sexual health is an integral branch of overall medicine, arguing that widespread clinical neglect, flawed sex education, and unrealistic media scripts foster unnecessary shame, physical dysfunction, and relationship strain. Prostate Health and Semen Retention Myths (59:36) A landmark observational study demonstrates that men who ejaculate 21 times or more per month exhibit a statistically significant reduction in prostate cancer risk. Dr. Malik explains this via the prostate stagnation hypothesis, which posits that regular ejaculation clears out stagnant fluids and potential cellular toxins. While this frequency represents a statistical correlation rather than a strict quota, it directly refutes long-standing myths that frequent masturbation causes medical harm. Conversely, Dr. Malik debunks viral claims regarding semen retention, such as 'No Nut November' or abstaining to boost athletic performance and mental clarity. Internet claims that abstinence elevates testosterone originate from a single trial of just ten men, which recorded a temporary increase of roughly 50 ng/dL likely driven by anticipatory neurological cues. Modern athletic testing shows no endurance or performance decrements following ejaculation. Furthermore, the body continuously regulates unreleased semen through reabsorption or involuntary nocturnal emissions, which occur in approximately 86% of men. Pelvic Floor Mechanics and Sedentary Lifestyles (6:37) The pelvic floor is a muscular bowl supporting internal organs, controlling continence, and facilitating sexual function. Prolonged sitting—exacerbated by modern desk work and sedentary lifestyles—prevents these muscles from moving through their natural range of motion. This inactivity causes high tone (chronic tension) that can compress genital nerves and blood vessels, leading to erectile difficulty, pelvic pain, or mistaken urinary tract symptoms. Pelvic dysfunction also presents as low tone (muscle weakness), manifested by stress urinary incontinence in women or decreased ejaculatory expulsion distance in men, which naturally declines from 30–60 cm in youth to 15–30 cm after age 50. Dr. Malik notes that orgasms naturally condition the pelvic floor through involuntary contractions occurring every 0.8 seconds for 5 to 60 seconds. For those doing structured Kegel exercises, proper form requires balancing a 5-second contraction with a 5-second relaxation period to avoid hyper-tonicity. The Orgasm Gap and Female Arousal Dynamics (77:24) Significant disparities exist in the physiological timing of sexual encounters. Large-scale global stopwatch studies show the average time from penetration to male ejaculation is 5.1 to 5.7 minutes, whereas women average approximately 14 minutes to reach orgasm. In first-time heterosexual encounters, women climax only 45% of the time compared to 95% for men, whereas same-sex female encounters yield a 95% orgasm rate for both partners, highlighting educational and behavioral gaps rather than biological limitations. Dr. Malik emphasizes that sexual intercourse should never be painful. Female arousal requires time for dynamic anatomical expansion—where the vagina roughly doubles in length and width, a process often requiring 18 to 20 minutes of stimulation. Rushing penetration before self-lubrication and expansion occur causes severe friction and discomfort. She recommends personal lubricants for general use, notes that responsive desire is common in long-term relationships, and advises couples to discuss intimacy preferences outside the bedroom to prevent defensiveness. Hormonal Health, Fertility, and Anatomical Realities Male reproductive metrics have steadily declined over the last 50 years due to metabolic disease, sedentary habits, and environmental endocrine-disrupting chemicals like phthalates. Exogenous testosterone is not an effective remedy for low libido if androgen receptors are already saturated. Instead, natural testosterone relies heavily on circadian recovery during deep sleep—sleeping under five to six hours per night drops levels by 10% to 15%—and resistance training targeting large lower-body muscle groups. Additionally, scrotal heat from warm laptops or smartphones can temporarily impair sperm production. Dr. Malik also clarifies misconceptions regarding genital anatomy. Healthy penile tissue relies on three to six involuntary nighttime erections to maintain oxygenation and prevent fibrosis. Penile traction devices represent the only safe, evidence-backed non-surgical method for modest lengthening (averaging ~2 cm), whereas cosmetic elongation surgeries carry severe risks. In women, frequent intercourse does not cause vaginal laxity, and labial anatomy displays wide, natural diversity despite an 80% rise in labiaplasty procedures between 2015 and 2019 driven by media-induced insecurities. Dr. Malik concludes that treating sexual wellness as standard healthcare is essential to reducing personal anxiety and improving quality of life. She acknowledges substantial research limitations, including the historical lack of clinical investigation into female anatomy and inconclusive data regarding phenomena like squirting. Ultimately, she emphasizes that transparent communication and choosing a supportive, aligned life partner are the most decisive factors in long-term sexual and relational well-being.

泌尿外科与骨盆重建专家Rena Malik博士指出，“性健康即是整体健康”，但现代医学与社会文化长期将其边缘化，导致广泛的健康误区与心理羞耻。她主张以循证生理学为基础，破除网络伪科学与色情文化建立的不切实际期望，建立关于前列腺防护、激素调节、盆底肌功能及两性沟通的科学认知。 射精频率、前列腺健康与禁欲神话 (59:36) 研究显示，每月射精达到或超过21次的男性，其前列腺癌发生风险呈现统计学意义上的显著降低。从生理机制分析，这符合“前列腺淤积假说”——前列腺分泌物构成精液的重要成分，规律排空有助于排出潜在代谢废物并更新腺体液体。Dr. Malik指出，该数据体现的是统计相关性而非刻板任务，但有力破除了频繁排精损伤前列腺的传言。 同时，Dr. Malik反驳了禁欲提升男性机能的网络神话。支持禁欲提睾的研究样本极小（仅10人且持续21天），观察到的睾酮微弱上升（约50 ng/dL）主要源于预期释放的心理兴奋，大样本研究从未证实长期禁精能提高基础睾酮。在竞技体育中，对照实验证明赛前射精并未削弱耐力表现。约86%的男性会经历夜间遗精，未排出的精液会被身体自然再吸收或在睡眠中自主排空，强行通过意志力压抑射精反而容易诱发盆底肌持续紧张与心理内疚。 睾酮水平调节与现代男性生殖力衰退 Dr. Malik强调，盲目补充外源性睾酮并非解决低性欲的良方；若体内游离与总睾酮正常，雄激素受体早已处于饱和状态，额外补充不仅无法提升性欲，反而存在潜在危害。自然提升睾酮的关键在于睡眠与抗阻训练：睾酮严格受昼夜节律调控并在深度睡眠中合成恢复，每晚睡眠少于5至6小时会导致睾酮水平骤降10%至15%；针对大肌群的大重量下肢训练（如深蹲、腿举）能有效刺激分泌，而过度的耐力运动则会因皮质醇持续升高而抑制雄激素。 过去50年间，全球男性的精子浓度与睾酮水平呈持续下滑趋势。在不孕不育案例中，男方因素与女方因素各占约50%。除了缺乏运动、肥胖与代谢性心血管疾病损害睾丸供血外，微塑料与邻苯二甲酸酯等内分泌干扰物的日常暴露也是重要诱因。此外，睾丸产生精子需要低于体温的环境，长期将笔记本电脑或发热手机置于膝上、频繁泡热水澡等局部升温行为，均可导致精子数量暂时性骤降甚至归零。 盆底肌机制：久坐劳损与日常训练误区 (11:15) 盆底肌群如同一组碗状肌肉托起盆腔脏器，控制排便排尿并主导勃起硬度、射精力量与性高潮强度。Dr. Malik指出，现代人每日久坐（如案头工作长达10小时）导致盆底肌缺乏舒缩运动，极易陷入高肌张力（过度紧绷）状态。由于支配生殖器官的关键血管与神经直接穿经盆底，持续痉挛会压迫神经并阻碍血流，进而诱发勃起功能障碍、骨盆隐痛或尿频尿急。 许多男性将50岁后射精喷射距离的衰减（从年轻时的30至60厘米缩短至15至30厘米）误判为精液量减少，其实质是盆底肌力自然退化。进行凯格尔运动必须遵循“收缩5秒、彻底放松5秒”的循环，过度收缩紧绷的肌肉只会适得其反。性高潮时盆底肌每隔0.8秒产生一次自主节律性痉挛（持续5至60秒），能有效强化局部肌群；临床证据表明频繁性生活与高潮不仅不会导致阴道松弛，反而能增强盆底肌支撑力，女性产后或老年的尿失禁多由肌力减弱引起。 唤起解剖学、两性高潮差距与亲密沟通 (77:24) 全球临床数据显示，男性从阴道插入至射精平均时长为5.1至5.7分钟，而女性达到高潮平均需要约14分钟。这种生理时差造成了显著的高潮落差：异性初次性行为中男性高潮率达95%，女性仅45%（而女同性伴侣初次性行为双方高潮率均达95%）。女性充分唤起通常需要18至20分钟的刺激，其间阴道长度从常态约3英寸扩张至6英寸，宫颈相应上提。缺乏充分唤起与润滑强行插入极易导致剧烈疼痛，外用润滑剂应被视为提升体验的常规辅助。 在欲望模式上，Dr. Malik区分了“自发性欲望”与需要亲密接触后才被激发的“反应性欲望”（后者在长期关系中的女性中极为普遍）。女性常因缺乏瞬间冲动而误认自身存在缺陷，从而回避肢体接触。她建议伴侣将“亲密时间”排入日程，约定仅进行身体抚触而不强制插入，并在卧室之外的中立场合（如散步或驾车）使用“我感受”句式坦诚沟通，防止因性生活频率降低演变为情感疏离。 身体认知偏差、色情误导与医疗干预边界 (17:49) 受限于正规医学性教育的匮乏（美国有13个州不强制要求性教育符合医学事实），至少25%的青少年以高度表演化的色情片作为性启蒙，且接触初龄已降至13岁。这导致公众对真实生理构造产生严重误解：例如女性小阴唇形态各异，但受色情片模板影响，全球小阴唇整形术在2015至2019年间剧增80%。关于女性“潮吹”（squirting），斯基恩氏腺分泌的是少量浓稠乳白液体，而大量喷射的无色液体经检测主要为极稀释的尿液（混有前列腺特异性抗原PSA），学术界对其完整机制尚未达成定论。 在男性形体认知方面，真空泵仅能短暂促使海绵体充血，无法永久增长，且延长手术风险过高并不推荐。目前唯一获临床循证支持的非手术器质延长方法是阴茎牵引装置（Penile Traction Device），其通过长期物理拉伸组织可产生平均约2厘米的增长。此外，健康男性每夜有3至6次生理性夜间勃起，为海绵体输送含氧血液；高血压或糖尿病等心血管疾病导致夜间勃起消失后，组织弹性会逐渐纤维化退化。 Dr. Malik总结指出，性健康是反映心血管、内分泌及心理状态的重要生理窗口，亟需从道德评判转入科学审视。然而，现代医学对女性性解剖与高潮机制的研究投入仍存在历史性匮乏，诸如潮吹的完整流体动力学机制及环境内分泌干扰物的长期人群毒理效应，仍受限于伦理与研究工具而尚未完全厘清。在现实生活中，建立基于循证医学的身体认知并选择能够真诚沟通的伴侣，是抵御虚假焦虑的最有效途径。

## Background 本期内容由知名播客频道《CEO日记》（The Diary Of A CEO）于 2024 年 4 月 1 日在 YouTube 平台发布。节目邀请了著名泌尿外科与盆底重建外科医生、性健康科普专家丽娜·马利克博士（Dr Rena Malik），围绕射精与前列腺癌关联、性爱时长预期、盆底肌机能、两性欲望差异及打破性羞耻等广泛议题展开深入探讨。 ## TL;DR 马利克博士以严谨的现代性医学实证打破了大量流传甚广的性神话与焦虑：研究表明每月射精 21 次以上与较低的前列腺癌风险相关，而伴侣真实的平均插入时长仅为 5 分多钟，远低于大众被色情片扭曲的预期。她深入拆解了勃起功能障碍作为心血管疾病“金丝雀”的生理机制，剖析了久坐与心理创伤对男女盆底肌的隐秘破坏，并区分了自发性欲望与响应性欲望的运作逻辑。此外，访谈还系统性地澄清了阴蒂构造、高潮鸿沟、睾酮调控、阴茎尺寸焦虑及潮吹机制，呼吁全社会将性健康视作全人健康的核心组成部分，通过去耻感与科学沟通重塑健康的亲密关系。 ## Atmosphere & style 整场对话在坦诚、专业且充满同理心的氛围中徐徐铺展，彻底驱散了传统性话题带来的尴尬与隐晦。主持人斯蒂芬·巴特利特毫无包袱地抛出各类具有代表性的网络迷思、个人困惑甚至荒诞谣言，而马利克医生则以温和从容、抽丝剥茧的临床医学视角予以精准拆解，兼具科学的严谨与生动幽默的解剖学比喻。随着讨论从微观生理机制延伸至深层创伤、心理羞耻与伴侣选择对人生的决定性影响，节目的情感厚度层层递进，既有令人顿悟的医学硬核科普，又洋溢着温暖治愈的人文关怀。 ## Bulletin - [59:53](https://www.youtube.com/watch?v=HUoPA6oP6do&t=3593s) 医学研究表明，男性每月射精21次或以上与较低的前列腺癌患病风险显著相关，射精有助于促进腺体分泌物定期代谢与管道清理。 - [01:24:47](https://www.youtube.com/watch?v=HUoPA6oP6do&t=5087s) 性爱预期与生理现实存在巨大落差：女性期望时长通常为18至25分钟，而全球临床秒表测量的实际平均阴道内抽插射精潜伏时间（IELT）仅为5.1至5.7分钟。 - [09:32](https://www.youtube.com/watch?v=HUoPA6oP6do&t=572s) 阴茎动脉管径（1-2毫米）远窄于冠状动脉（3-4毫米），勃起功能障碍（ED）常作为微血管病变的首发预警信号，确诊ED的男性约15%在7年内会遭遇心脏病发作。 - [38:30](https://www.youtube.com/watch?v=HUoPA6oP6do&t=2310s) 全球男性平均精子计数在过去50年内断崖式下跌近50%，环境内分泌干扰物、微塑料以及久坐肥胖等代谢综合征是主要的系统性推手。 ## Key takeaways - [09:32](https://www.youtube.com/watch?v=HUoPA6oP6do&t=572s) 性健康是全身健康的晴雨表，勃起功能障碍往往是心血管疾病发作前数年的早期微血管预警信号。 - [11:15](https://www.youtube.com/watch?v=HUoPA6oP6do&t=675s) 男女皆有盆底肌，久坐与骨盆底肌肉过度紧绷（高张力）会导致排尿困难、骨盆疼痛以及因压迫血管神经诱发的勃起功能障碍。 - [12:58](https://www.youtube.com/watch?v=HUoPA6oP6do&t=778s) 稳定的性生活核心在于质量而非频率，伴侣平均频率约为每周一次，且性交中绝不应该伴随疼痛。 - [16:57](https://www.youtube.com/watch?v=HUoPA6oP6do&t=1017s) 女性阴道在完全唤起时长度与管径会扩张近一倍，这一生理准备过程通常需要18至20分钟的充分唤起与前戏。 - [18:51](https://www.youtube.com/watch?v=HUoPA6oP6do&t=1131s) 色情作品塑造了脱离现实的即时插入虚假剧本，是导致年轻人性知识扭曲、性焦虑及伴侣脱敏的重要诱因。 - [20:07](https://www.youtube.com/watch?v=HUoPA6oP6do&t=1207s) 改善伴侣性生活应跳出卧室、在无目光压迫的日常场景下使用“我”字句沟通，并将“亲密时间”而非带有考核压力的“性交”排入日程。 - [27:14](https://www.youtube.com/watch?v=HUoPA6oP6do&t=1634s) 男性的欲望多为自发性，而女性在长期关系中更多表现为响应性欲望，需要先有身体接触和情感联结才会逐步唤醒。 - [32:29](https://www.youtube.com/watch?v=HUoPA6oP6do&t=1949s) 深层睡眠不足会导致睾酮暴跌10%至15%，大肌群力量训练与优质脂肪摄入可天然促进睾酮合成，而过量超长耐力运动反而会因皮质醇飙升压制睾酮。 - [45:05](https://www.youtube.com/watch?v=HUoPA6oP6do&t=2705s) 睾丸需要恒定低温环境生精，日常将发热笔记本电脑置于膝上、频繁泡热水澡或将手机贴近生殖器会因物理温升损伤精子质量。 - [47:48](https://www.youtube.com/watch?v=HUoPA6oP6do&t=2868s) 自慰不会降低睾酮水平，“禁抖十一月”（No Nut November）等极端禁欲号召不仅缺乏高质量证据支持，还易引发盆底肌肉痉挛及无端自责。 - [43:56](https://www.youtube.com/watch?v=HUoPA6oP6do&t=2636s) 性高潮期间盆底肌以大约每0.8秒一次的频率发生剧烈节律性收缩，这种被动肌肉锻炼效果不亚于主动凯格尔运动。 - [01:13:33](https://www.youtube.com/watch?v=HUoPA6oP6do&t=4413s) 约85%的女性需要阴蒂刺激才能达成高潮，阴蒂在胚胎发育上与阴茎同源且延伸至骨盆深处，单纯阴道抽插难以引发高潮纯属生理构造使然。 - [01:17:24](https://www.youtube.com/watch?v=HUoPA6oP6do&t=4644s) 两性在初次性行为中存在显著的性高潮鸿沟，异性恋女性初次获得高潮的比例仅为45%，而男性及女同性恋群体均达95%。 - [01:28:25](https://www.youtube.com/watch?v=HUoPA6oP6do&t=5305s) 性生活频繁绝不会导致阴道变大或松弛，真正的松弛多因分娩损伤、神经病变或衰老引起，且高潮收缩反而有助于强化盆底肌力。 - [01:23:16](https://www.youtube.com/watch?v=HUoPA6oP6do&t=4996s) 正念训练可显著改善女性性欲与唤起度，帮助伴侣将注意力集中于躯体当下的愉悦感，从而消除反刍性表演焦虑。 - [01:36:14](https://www.youtube.com/watch?v=HUoPA6oP6do&t=5774s) 在阴茎延长手段中，牵引装置是唯一经证实相对安全有效的方法，而真空泵仅起临时负压助勃作用，外科延长手术伴随极高并发症风险。 - [01:45:45](https://www.youtube.com/watch?v=HUoPA6oP6do&t=6345s) 小阴唇的长短、不对称与色素沉着如同指纹般千差万别，除非日常摩擦引起实质疼痛，否则切除整形的诉求多源于色情片带来的审美焦虑。 - [01:47:20](https://www.youtube.com/watch?v=HUoPA6oP6do&t=6440s) 女性体液可明确划分为阴道润滑液、源自斯基恩氏腺且含PSA的女性真性射精，以及从尿道喷射出、成因机制仍存争议的潮吹液体。 ## Detailed walkthrough ### [00:00](https://www.youtube.com/watch?v=HUoPA6oP6do&t=0s) 精彩看点与认知颠覆：从射精频率到性爱时长 在节目的开篇剪辑中，主持人史蒂芬·巴特利特（Steven Bartlett）与受邀嘉宾、著名泌尿外科与盆底重建外科医生丽娜·马利克博士（Dr. Rena Malik）抛出了一连串颠覆大众认知的话题。马利克博士指出，医学研究表明，每月射精 21 次或以上的男性，患前列腺癌的风险显著降低，这让主持人惊呼连连。作为拥有百万关注的性健康科普专家，马利克博士开门见山地打破了关于性生活的各种神话。 针对普遍存在的“别人都在频繁做爱，而我们没有”的焦虑，马利克博士直言这是巨大的误区，大多数伴侣的实际频率大约仅为每周一次。关于“随着年龄增长阴茎是否会变小”，她明确表示确实有缩小的可能，但可以通过特定方式进行维持。在性爱时长上，大众的心理预期与现实存在巨大落差：女性期望的时长通常在 18 至 25 分钟之间，男性期望的时长偏短、约为 12 分钟，然而实际临床统计的阴道内平均射精潜伏时间（IELT）仅为 5.1 到 5.7 分钟。此外，针对手淫是否伤身、盆底肌与勃起功能障碍（ED）及射精力量的紧密联系，博士也给出了科学定调——盆底肌力量直接决定了性高潮质量与精液喷射的力度，但绝大多数男性甚至压根不知道自己也有盆底肌。 - **射精频率与健康**：每月射精 21 次及以上与较低的前列腺癌患病风险相关。 - **性爱时长预期 vs 实际**：女性理想时长为 18–25 分钟，男性理想时长约为 12 分钟，实际平均抽插时长仅 5.1–5.7 分钟。 - **伴侣平均性频**：现实中伴侣的平均性生活频率约为每周一次。 --- ### [01:30](https://www.youtube.com/watch?v=HUoPA6oP6do&t=90s) 频道里程碑与主持人的承诺 在正片正式开始前，主持人史蒂芬动情地向所有观众表达了由衷的感谢。他提到，《CEO日记》（The Diary Of A CEO）在 YouTube 上的订阅量已经正式突破了 500 万大关。三年前节目刚起步时，他在最狂野的预期中也仅仅觉得三年能积累 10 万订阅者就心满意足了，如今这一庞大数字完全超出了他的想象。 史蒂芬对观众长期以来的支持致谢，并表示他与观众之间有一份默契的“契约”：只要大家订阅，团队就会不断抬高内容制作的标准。在 2024 年，团队将迎来前所未有的大升级——他为此已经在幕后筹备了 9 个月，将带来全新的制作水准、更深入的对话体验以及更具全球视野的故事。他诚挚地邀请新老听众点击订阅按钮，随后正式展开了本期与马利克博士的深度访谈。 --- ### [02:40](https://www.youtube.com/watch?v=HUoPA6oP6do&t=160s) 普及性健康教育的核心使命与定义 当史蒂芬询问马利克博士多年来持续产出科普内容的核心诉求时，马利克博士坚定地概括为一句话：“让人们理解，性健康就是整体健康的一部分（Sexual health is health）。”她发现，社会上充斥着对什么是健康性生活、为什么性生活对人至关重要的巨大误解。由于性话题长期被污名化与避讳，人们在遇到障碍时往往选择沉默、胡思乱想并深陷自我怀疑，这种绝望与痛苦会像阴霾一样渗透到他们生活的方方面面。 马利克博士谈到，她的终极目标是让高质量的性医学教育变得免费、易懂且触手可及，让每个人都能清晰地知晓自己的身体正在发生什么，分辨什么是正常生理现象、什么是异常病态，并清楚有哪些现代医学手段可以提供实质性帮助。关于“性健康”的定义，马利克博士指出，虽然因人而异，但医学共识通常指个体能够正常进行性行为、能够体验到性高潮、能够享受性愉悦，并从中获得身心双重裨益的良好状态。 --- ### [03:46](https://www.youtube.com/watch?v=HUoPA6oP6do&t=226s) 影视作品构建的“虚假剧本”与对身体的普遍误解 谈到大众对自身身体构造与性功能的了解时，马利克博士直言不讳：“我们对自己的身体根本一无所知。”她举例称，许多人会因夜间勃起（晨勃）或遗精（梦遗）而感到羞耻，甚至有大量粉丝发私信焦虑地求助：“我该怎么做才能停止‘漏精’？”“我该怎么阻止自己早晨醒来时勃起？”这些本是完全健康、正常的生理现象，却被许多人当成了某种身体故障或道德缺陷。 马利克博士指出，大众认知偏差在很大程度上源于影视剧与色情影片（Pornography）构建的“虚假剧本”。在屏幕上，男主角往往能瞬间勃起并立刻进行实质性插入，女主角则在几秒内迅速达到性高潮，整个过程如火如荼、一气呵成。但在现实生活中，真实的性爱完全不是这样运作的——女性往往需要更充分的前戏和更长的唤醒周期，男性偶尔出现勃起困难也是极普遍的生理波动，女性偶尔无法达到高潮同样非常普遍。由于公众缺乏对“正常性行为”的真实认知，一旦自己的身体未能复刻荧幕上的戏剧化脚本，就会陷入自怨自艾：“我是不是坏掉了？我的身体到底出了什么毛病？” --- ### [05:10](https://www.youtube.com/watch?v=HUoPA6oP6do&t=310s) 泌尿外科医生的跨界与医疗系统的问诊盲区 史蒂芬好奇马利克博士的专业背景来自何处。马利克博士解释，自己是一名获得专科认证的泌尿外科医生（Board-certified Urologist）。在医学界，泌尿外科医生相当于人体泌尿生殖系统的“水管工”，负责诊断并治疗从肾脏、输尿管、膀胱到男女生殖器官的各种内科与外科疾病。她在最初建立社交平台时只是想分享基础医学常识，但很快发现大众对性健康知识的渴求极其迫切，同时也暴露出现代常规医疗体系的巨大盲区。 马利克博士坦言，普通人即使定期去见全科/家庭医生（Primary Care Doctor），医生也极少主动询问性功能情况。就算偶尔提及，往往也仅局限于询问男性是否有勃起障碍，极少深入探讨；至于女性，全科医生几乎从未主动问过“你是否有性高潮”、“性生活是否感到愉悦”或“你的性欲是否正常”。医疗问诊与患者真实困境之间存在严重的断层。正因为意识到这种巨大脱节，马利克博士决定将个人重心全面倾注于性医学与盆底健康的临床诊疗与科普教育中。 --- ### [06:37](https://www.youtube.com/watch?v=HUoPA6oP6do&t=397s) 隐秘而关键的“盆底肌”：男女皆有的人体吊床 史蒂芬将焦点转向马利克博士的另一核心专长——盆底健康（Pelvic Floor）。博士介绍，她在接受女性盆底医学专科培训（Fellowship）期间，大量工作都围绕着盆底肌的肌力状态展开。为了让听众更直观地理解，她将盆底肌形象地比喻为一个悬挂在骨盆底部的“肌肉碗”或“吊床”。膀胱、直肠以及女性的阴道、子宫和尿道，全都穿过这个肌肉碗，并由其附着在骨盆骨骼上提供支撑。 ```mermaid flowchart TD accTitle: 盆底肌功能与失调影响结构图 accDescr: 展示盆底肌的核心生理功能以及张力过高或失调所引发的病理症状 subgraph Functions["盆底肌核心功能"] F1["结构支撑与核心稳定<br/>(站立/坐姿/承托内脏)"] F2["排泄控制<br/>(正常排尿与排便)"] F3["性功能与高潮机制<br/>(射精泵感/阴道节律收缩)"] end subgraph Dysfunction["过度紧张 / 协调不良之影响"] D1["排泄异常: 便秘 / 尿频 / 尿急 / 排尿困难"] D2["疼痛综合征: 盆腔痛 / 类似尿路感染(UTI)刺痛"] D3["性功能障碍: 勃起痛 / 射精痛 / 勃起功能减退"] end Functions -.->|张力过高或受损| Dysfunction ``` 马利克博士强调，人们普遍存在一种刻板印象，以为只有生过孩子、在咳嗽或跳蹦床时漏尿的女性才需要关心盆底肌。事实上，男性同样拥有完整的盆底肌群。盆底肌的问题不仅限于“松弛”，更多时候是“张力过高（Elevated tone）”或“神经肌肉协调不良（Discoordination）”。 - **排尿与排便障碍**：盆底肌过度紧张会导致便秘、尿不尽、尿频以及持续的尿急感。 - **疼痛反应**：患者在排尿时会感到剧烈灼痛，常常误以为自己反复发生尿路感染（UTI）；男性则可能表现为勃起疼痛或射精疼痛。 - **骨骼肌肉连锁反应**：盆底肌肉与下背部及髋关节紧密相连。青年时期参与体育运动留下的髋部损伤或腰椎旧疾，往往会在数年后通过肌筋膜链累及盆底，最终诱发性功能障碍。 史蒂芬对于“医生应该主动过问性生活”的观点感到好奇，因为在普通人眼里，医生负责治疗器质性病变，过问性隐私似乎有些出格。马利克博士回应道，性生活顺遂的人确实不会把这当成困扰，但对于那些遭遇性功能障碍的人来说，这往往是无法言说的巨大隐痛。 ### [09:32](https://www.youtube.com/watch?v=HUoPA6oP6do&t=572s) 性健康与全身健康：勃起功能障碍是心脏病的“金丝雀” 性健康问题往往不是孤立存在的，它们会像涟漪一样扩散到生活的方方面面。Dr Rena Malik 指出，许多患者带着羞耻感生活，整天琢磨自己到底哪里出了问题。这种情绪会迅速演变成亲密关系危机，继而引发工作效率低下、对生活满意度骤降，甚至陷入长期的抑郁与焦虑。 更严峻的在于生理层面的预警。在男性身上，阴茎动脉的管径通常只有 1 至 2 毫米，而供应心脏的冠状动脉管径约为 3 至 4 毫米。当高血压、高胆固醇或动脉粥样硬化导致血管狭窄达到约 50% 时，器官供血便会率先告急。由于阴茎血管远比心脏血管更细，勃起功能障碍（ED）往往会作为首发症状出现，远早于胸痛等典型心脏病体征。Dr Rena Malik 强调，临床研究显示，当一名男性被确诊为勃起功能障碍后，约 15% 的人在 7 年内会遭遇心脏病发作；而在已有过心脏病发作史的男性中，约有 50% 在发病前就已出现过勃起功能障碍。女性的唤起障碍可能也存在类似的微血管预警机制，但由于女性生理结构和性反应更为复杂，目前尚缺乏同等力度的临床数据支持。 ```mermaid flowchart LR accTitle: 血管病变发展与心脏病关联图 accDescr: 展示全身性血管问题如何首先在微小的阴茎动脉显现，并在数年后演变为严重的心脏事件。 subgraph Risk["全身性血管风险"] A["高血压 / 高胆固醇 / 动脉粥样硬化"] end subgraph Penis["早期预警：细小血管受累"] B["阴茎动脉狭窄 (1-2 mm)"] C["勃起功能障碍 (ED) 显现"] end subgraph Heart["后期严重事件：冠状动脉受累"] D["冠状动脉狭窄 (3-4 mm)"] E["心绞痛 / 心脏病发作<br/>(约15%在7年内发生)"] end A --> B B --> C C -->|数年潜伏期| D D --> E ``` ### [11:15](https://www.youtube.com/watch?v=HUoPA6oP6do&t=675s) 久坐对盆底肌的压迫与隐性损害 针对现代人久坐不动的生活方式（主持人提到自己经常一坐就是 10 个小时），Dr Rena Malik 澄清了久坐引发性功能障碍的具体机理：这并不是直接的血管硬化，而是“肌肉层面的功能异常”。当身体整天保持坐姿、缺乏活动时，盆底肌肉无法正常地收缩与舒张，长期处于紧绷、僵硬的痉挛状态。 盆底肌群内部穿行着大量支配阴茎的神经和血液管道。一旦肌肉持续紧锁，就会像掐住软管一样阻碍血流进入阴茎，从而造成勃起困难。Dr Rena Malik 提到，在 COVID-19 疫情居家隔离期间，由于大众全天坐着办公，盆底功能障碍的病例在临床上显著激增。 - **肌肉紧张性供血不足**：盆底肌持续收缩压迫阴部神经与动脉，阻碍海绵体充血。 - **排尿异常**：出现明显的尿频、尿急，虽然由于靠近洗手间起初容易被忽视，但本质上是肌肉过度活跃的信号。 - **局部慢性钝痛**：骨盆区、会阴部出现牵拉痛；许多女性常将骨盆底肌肉紧绷引起的疼痛与不适误以为是尿路感染（UTI）。 ### [12:58](https://www.youtube.com/watch?v=HUoPA6oP6do&t=778s) 性生活频率的神话：质量高于数字 大众普遍存在一种焦虑，总觉得“别人拥有的性生活比自己频繁得多”。Dr Rena Malik 明确指出这是一个巨大的认知误区。针对大规模人群的研究表明，在关系稳定且随时可以发生性行为的伴侣中，平均的性生活频率大约是**每周一次**。但个体之间的差异极其悬殊，并不存在所谓的“标准答案”。 追求特定的“考核指标”不仅无益，反而会对亲密关系造成破坏。Dr Rena Malik 认为，“这根本不是关于性生活的数量，而是关于性生活的质量”。一个月一次高质量、令人满足的性体验，远胜于一个月四次甚至十次平庸乃至糟糕的敷衍。性生活的核心目的是愉悦感与亲密连接。高潮本身具有确凿的生理益处，能够显著减轻压力、提高专注力、改善睡眠甚至有助于降低血压；只要伴侣双方能从中获得快乐与亲近，就无需将频率作为衡量感情好坏的尺度。 ### [14:42](https://www.youtube.com/watch?v=HUoPA6oP6do&t=882s) 性交疼痛绝非正常：润滑剂与前戏的科学 针对“性生活是否本就该感到疼痛”这一普遍困扰，Dr Rena Malik 给出了斩钉截铁的回答：“不，性爱绝不应该伴随疼痛。”临床上感到疼痛的多为女性伴侣，其最常见的原因并非器质性病变，而是由于润滑不充分以及前戏时间不足。 女性身体在准备进入性交状态时需要经历复杂的生理变化：随着性唤起加深，阴道会自主分泌润滑液，同时阴道内部会产生“帐篷效应（tenting）”，长度和宽度会扩张到接近原本的两倍，以接纳阴茎、手指或情趣玩具。如果缺乏足够的时间让这些生理反应就位，摩擦必然会带来疼痛。润滑液的分泌量因人而异，受遗传基底、年龄、激素周期以及特定药物（如抗组胺药、某些避孕药等）的影响极大。Dr Rena Malik 极力倡导“润滑剂适合所有人”，它不仅能大幅消除疼痛，更能增加滑润感和愉悦度。 若在充分唤起、润滑充沛的情况下依然伴有持续性疼痛，则需要由专科医生进行深入评估。潜在诱因包括： - **前庭炎（Vestibulodynia）**：阴道前庭黏膜对激素水平极为敏感，激素波动或失衡可引发剧烈触痛。 - **盆底功能障碍（Pelvic Floor Dysfunction）**：盆底肌过度痉挛导致的插入性痉挛疼痛。 - **深部病变**：如子宫内膜异位症（Endometriosis）等妇科器质性疾病。 ### [16:57](https://www.youtube.com/watch?v=HUoPA6oP6do&t=1017s) 阴道扩张机制与被色情片扭曲的性教育 对于很多男性倾向于在性生活中直奔主题、毫无耐心的现象，Dr Rena Malik 拆解了女性生理准备的真实时间线：阴道在完全唤起时，不仅管径会显著增宽，宫颈也会向上方和后方抬升让出空间，整体长度和宽度大约会**扩张一倍**。这一生理重塑过程通常需要 **18 至 20 分钟** 的充分唤起和前戏配合。虽然个体存在快慢差异，但跳过这个准备阶段往往是导致性交疼痛和体验挫败的主因。 问题的根源在于严重的性教育缺失。社会和家庭极少教授伴侣之间如何健康地谈论性，导致沟通充满羞耻。以美国为例，有多达 13 个州甚至在法律上不强制要求性教育内容的科学准确性。这种教育真空导致至少四分之一（25%）以上的青少年将“色情片”作为了解性知识的首要途径。然而，商业色情片充斥着脱离现实的表演与即时插入的桥段，极大地误导了年轻人对女性生理唤起过程的认知，进一步加剧了现实亲密关系中的脱节与挫折。 ### [18:51](https://www.youtube.com/watch?v=HUoPA6oP6do&t=1131s) 色情片的虚假幻象与性沟通的恶性循环 色情片本质上是经过高度修饰、剪辑与编排的娱乐产品，绝非真实的性爱。Dr. Rena Malik 指出，当人们误将色情作品当作唯一的性教育来源时，在现实中的初次性体验往往注定会大失所望：男性会陷入容貌与能力焦虑，质疑“为什么我的性经历不像片子里那样？”“为什么我的射精量没那么多？”“为什么我的伴侣没有那么快达到高潮？”；女性同样会遭受自我怀疑的折磨，困惑于“为什么我没有片中女性那种激烈的反应？”“为什么我没有瞬间兴奋起来？”。从一开始，缺乏现实认知的双方就背上了沉重的心理包袱。 沟通的缺失让这种落差雪上加霜。社会文化对性话题讳莫如深，甚至连朝夕相处的伴侣之间也很少坦白彼此的困境与不安全感。主持人 Steven Bartlett 分享了自己的亲身体验：在过去的亲密关系中，一旦内心产生某种不安全感或心结，由于没有坦诚沟通，往往会本能地表现出古怪的行为或冷淡的态度；这种反常举动随即被伴侣误读，进而引发对方的不安全感与猜忌。最终，双方陷入了一场由误解驱动的恶性循环，以冷处理和相互回避收场，一步步滑向彻底的无性状态。 ### [20:07](https://www.youtube.com/watch?v=HUoPA6oP6do&t=1207s) 如何与伴侣谈性：非卧室场景与“我”字句沟通法则 每当有人追问“改善性生活的秘诀究竟是什么”时，Dr. Malik 给出的答案看似简单却极难践行：“你必须弄清楚自己喜欢什么、想要什么，并把它传达给你的伴侣。”难点在于，从小到大没有任何人系统性地教过我们如何开展这种对话。性话题往往高度情绪化，掺杂着内疚、能力不足的自卑感，或是长期需求未被满足而积聚的怨怼。 Dr. Malik 强调，解决性问题绝不存在所谓的“一次性谈开”（There is no "the talk"），而必须是伴随关系进程的多次持续对话。第一次开口尝试甚至可能是一场彻头彻尾的灾难，但只要双方的目标一致，都希望维系一段拥有健康性生活的优质关系，就应当坚持谈下去。为此，她给出了极具实操性的沟通原则： - **坚决避开卧室与做爱场景**：切忌在卧室里谈，不要在做爱前或刚做完爱时摊牌，更绝对不要在做爱**进行中**指出问题（Steven 对此深有同感并直言那简直“糟透了” [the fucking worst]）。 - **选择无需直视目光的场合**：例如并排坐在车里兜风，或是并肩散步。直视对方的双眼说出“我觉得刚才感觉不太好”会带来巨大的压迫感与尴尬，非正面的肢体朝向能有效缓解紧张。 - **使用“我”字句（I statements）**：将焦点放在自己的感受上（“我的感受是什么”、“怎样能唤醒我”、“我期待在关系中体验什么”），而不是采取指责性的“你做了什么”或“你没做什么”。 - **接纳对方的防御与羞耻感**：理解伴侣在对话中可能会有应激反应甚至抗拒，因为每个人成长过程中都背负着独特的文化偏见、家庭羞耻感或刻板印象。 - **必要时寻求专业外力介入**：借助性治疗师（Sex Therapist）或具备心理学专业背景的咨询师，在安全、中立的环境中学习如何拆解性话题的阻碍。 ### [22:21](https://www.youtube.com/watch?v=HUoPA6oP6do&t=1341s) 破局“温水煮青蛙”式的无性婚姻 针对那些性生活已经停摆了半年、一年甚至五年，并且已经将“无性”演变成生活常态（new normal）的伴侣，Dr. Malik 提出的第一个核心问题是：“性对你来说究竟有多重要？”如果双方都认同性并非核心诉求，但在生活中依然亲密无间、彼此相爱、享受拥抱与温存，那么完全无需为此感到内疚或焦虑。然而，如果一方或双方内心深处对此深感痛苦与缺失，那么为了维系珍视的关系，就绝不能轻言放弃。 许多人在逃避沟通时并非心怀恶意，他们往往是在为自己身上可能存在的问题感到羞耻，甚至可能独自忍受着未曾言明的生理困扰——例如女性可能正经历严重的性交疼痛、或是体内荷尔蒙变化导致的组织干涩与萎缩。与其直接下定论说“对方就是不想做爱”，不如采用开放式提问：“是不是有什么是我没做好的？能不能告诉我你对性的真实感受？” Steven 在此引入了著名的“温水煮青蛙”（frog in a frying pan）隐喻：如果直接将青蛙扔进滚烫的热水里，它会立刻跳出来；但如果将它放在冷水里慢慢加热，青蛙便会在不知不觉中迎来死亡。在伴侣关系中，亲密感的消亡往往也是日复一日、月复一月的缓慢递减，直到某一天两人骤然醒悟，才发现彼此早已陷入彻底的无性冰窟，惊呼“我们究竟是怎么走到这一步的？”。Dr. Malik 表示，健康的性生活就像养育孩子或攒钱买房一样，从来不可能坐享其成，它需要双方都拿出诚意，投入大量心力去反复经营与博弈。 ```mermaid flowchart TD accTitle: 无性关系的滑落与重建路径 accDescr: 展示从缺乏沟通导致性生活停摆，到通过识别根源与开放对话重建亲密关系的流程。 subgraph Trap["恶性循环（温水煮青蛙）"] A["未表达的身体困扰/心理自卑"] --> B["反常回避或冷淡行为"] B --> C["伴侣产生误解与挫败感"] C --> D["逐步走向长期无性 (Sexlessness)"] end subgraph Solution["破局与修复策略"] E{"评估性的重要性"} -->|双方均不在意| F["维持现有的温存与情感亲密"] E -->|属于核心痛点| G["跳出卧室进行'我'字句沟通"] G --> H["排查根源: 生理疼痛/荷尔蒙/心理羞耻"] H --> I["多次耐心沟通或寻求性治疗师"] end D --> E ``` ### [26:22](https://www.youtube.com/watch?v=HUoPA6oP6do&t=1582s) 性欲的双重形态：自发性欲望与反应性欲望 针对社会上“男性永远性欲旺盛、时刻准备着，而女性普遍缺乏性趣”的刻板印象，Dr. Malik 从心理与生理机制上打破了这种偏见。她指出，人类的性欲其实主要分为两种截然不同的形态（flavors）： - **自发性欲望（Spontaneous Desire）**：这是一种突如其来的冲动。你仅仅是看了对方一眼，脑海中立刻闪过“他/她太迷人了，我真想立刻同床共枕”的念头，在没有任何外力铺垫或物理接触的情况下，身体瞬间被唤醒并产生做爱的冲动。 - **反应性欲望（Responsive Desire）**：在初始阶段，当事人的大脑中完全没有关于性的想法。然而，当双方开始相互依偎、产生温柔的肢体触碰或营造浪漫氛围时，身体在接收到这些愉悦信号后才会逐步做出积极响应，产生“感觉很不错、我开始兴奋了”的生理与心理唤起。 ### [27:14](https://www.youtube.com/watch?v=HUoPA6oP6do&t=1634s) 自发性欲望与响应性欲望：破除“想要就要立刻扑上去”的迷思 在长期伴侣关系中，欲望的模式往往会出现显著的分化。文献表明，男性往往更容易体验到“自发性欲望”（spontaneous desire），即毫无预兆地突然产生性冲动；而女性在长期关系中则更多表现为“响应性欲望”（responsive desire），也就是需要先有身体接触、亲昵氛围或情绪联结作为前置触发条件，性冲动才会逐渐被唤醒。这种机制上的脱节常常导致误解与自我怀疑——女性常会自责：“为什么我看着你，不再有立刻扑倒你的冲动了？我以前明明是这样的，我是不是坏掉了？” 由于这种心理负担，女性甚至开始回避最基础的拥抱和抚触。她们担心一旦开始搂抱，伴侣就会迅速兴奋起来，而自己若无法同步进入状态，就会演变成令人内疚的“辜负与失望”。雷娜·马利克医生（Dr Rena Malik）指出，流行文化与媒体热衷于渲染“一见面就欲火焚身”的激情桥段，让大众误以为只有自发性欲望才是常态。事实上，响应性欲望完全是健康的生理与心理表现。 伴侣之间若想打破这种僵局，关键在于建立“免除性预期”的安全感：双方可以坦诚约定“我只是想和你依偎在一起，没有任何非要发生性关系的硬性期待”。 ```mermaid flowchart TD accTitle: 欲望类型的演进路径 accDescr: 对比自发性欲望与响应性欲望在伴侣互动中的产生机制与应对策略 subgraph Types["两种天然的欲望模式"] A["自发性欲望<br/>Spontaneous Desire<br/>(男性居多/关系初期常见)"] B["响应性欲望<br/>Responsive Desire<br/>(女性居多/长期关系常见)"] end subgraph Trap["沟通脱节与心理负担"] C["产生自责与焦虑：<br/>'我是不是坏掉了？'"] D["回避拥抱抚触：<br/>担心被动引发性期待"] end subgraph Solution["重建亲密连接"] E["排入日程：专注亲密接触"] F["完全剥离必须做爱的绩效压力"] G["自然唤醒身体愉悦与性联结"] end B --> C --> D A -. 误解期望.-> D D --> E --> F --> G ``` --- ### [28:27](https://www.youtube.com/watch?v=HUoPA6oP6do&t=1707s) 把亲密排入日程表：剥离“做爱压力”的亲昵仪式 为了重建伴侣之间的性活力，性治疗中经常给来访者留一项作业——“把亲密时间写进日程表”。这个建议乍听之下荒谬又反浪漫，但马利克医生反问道：我们平时会把健身、和朋友吃早午餐甚至各种琐事都清清楚楚地排入日程，为什么对亲密关系却弃之不顾？在过去约会时，大家知道“周五晚上要约会”，就会提前刮胡子、脱毛、打扮得漂漂亮亮、喷上好闻的香水，整个人沉浸在期待的兴奋感中。 然而，过度的心理预演也会带来负面效应，演变成表演焦虑（Performance Anxiety）：“如果我表现不好怎么办？如果我中途不想做了怎么办？如果弄疼了怎么办？”针对这种反刍思维与焦虑螺旋，马利克医生特别强调：在日程表上标注的必须是“亲密”（Intimacy），而不是“性交”（Sex）。 - **无电子设备干扰**：收起手机，关掉屏幕，创造专属的二人时空。 - **纯粹的感官接触**：可以只是单纯脱下衣服贴在一起、相互按摩或轻柔抚摩，细细体会皮肤接触的温度与触感。 - **双向零负担**：双方心照不宣地明确今晚没有任何必须“发生性关系”的指标。当绩效压力被彻底卸下，身体反而会在放松中重新找回昔日的情感与性联结。 --- ### [30:11](https://www.youtube.com/watch?v=HUoPA6oP6do&t=1811s) 欲望的生理密码：睾酮、皮质醇与激素平衡 性欲低下并不单纯是心理现象，它背后有着深刻的生理基础。一提到性欲调控，最核心的激素无疑是睾酮（Testosterone）。社会普遍存在一个巨大误区：认为睾酮只是男性的专利。事实上，女性体内的睾酮浓度甚至远远超过雌激素（Estrogen），睾酮对男女两性的性冲动都起着决定性作用。此外，甲状腺激素（Thyroid Hormone）和脑垂体分泌的催乳素（Prolactin）一旦失衡，也会严重干扰睾酮的调节机制。 然而，在现代生活中，最隐蔽的“性欲杀手”是慢性压力。压力会直接促使肾上腺皮质醇（Cortisol）飙升，而过高的皮质醇水平会直接抑制下丘脑-垂体-性腺轴，强行压低睾酮分泌。很多人的激素失调只是表象，背后的根源是长期处于紧绷、超负荷的生活状态。 针对“低性欲能否直接通过大剂量注射睾酮来解决”的提问，马利克医生给出了坚决的否定： - **受体饱和机制**：如果一个人体内的游离睾酮（Free Testosterone）与总睾酮（Total Testosterone）本身处于正常区间，他的雄激素受体早已被完全饱和，此时盲目外源性注射不仅不会唤醒性欲，反而是徒劳无功的。 - **过犹不及的毒性**：过量补充外源性睾酮不仅打破体内平衡，还可能带来严重的心血管风险及内分泌副作用，绝非“越多越好”。 --- ### [32:29](https://www.youtube.com/watch?v=HUoPA6oP6do&t=1949s) 天然提升睾酮的四大支柱：睡眠、抗阻训练、饮食与运动陷阱 对于检查出睾酮偏低且不愿依赖药物注射的人群，马利克医生梳理了基于科学证据的纯天然提升方案： #### 1. 深度睡眠与昼夜节律 睾酮的分泌严格遵循人体昼夜节律：峰值出现在清晨，随后在日间逐渐回落，傍晚微弱波动后在夜间降至低谷。而夜晚的深层睡眠正是身体补充与合成睾酮的关键窗口期。研究证实，如果每晚睡眠不足5至6小时，体内的睾酮水平会直接暴跌10%至15%。无论是睡眠时长不够，还是晨起后依旧疲惫不堪的低质量睡眠，都会给激素合成带来毁灭性打击。 #### 2. 大肌群抗阻训练 vs. 超耐力运动陷阱 运动形式对激素的影响截然相反： - **下肢大肌群抗阻训练**：调动下肢等全身最大肌群的力量训练（如深蹲、硬拉）被证实能最显著地刺激自体睾酮合成。 - **慢性超长耐力运动的副作用**：频繁进行超级铁人三项（Ultraman）、全程马拉松（Marathon）、长时间长距离骑行或长距离游泳，会使身体长期处于急性应激状态，导致皮质醇居高不下，进而反向扼杀睾酮。许多表面上极其健美精炼的顶尖长跑运动员，体内睾酮往往严重偏低。高强度间歇训练（HIIT）与适度有氧是安全的，关键在于避免极端过量。 ```mermaid flowchart LR accTitle: 运动类型与睾酮水平的关系 accDescr: 展示下肢抗阻力量训练与极端超耐力运动对皮质醇及睾酮的不同影响路径 subgraph Resistance["大肌群抗阻训练"] direction TB R1["深蹲、硬拉等复合动作"] --> R2["刺激内分泌代偿机制"] --> R3["促进睾酮天然飙升"] end subgraph Endurance["过量超长耐力运动"] direction TB E1["全马、铁人三项、长期超长骑行"] --> E2["机体持续承受急性应激"] --> E3["皮质醇长期高位压制睾酮"] end ``` #### 3. 地中海饮食与健康脂肪的不可替代性 医学研究支持度最高的是地中海饮食（Mediterranean diet），核心包括大量蔬菜、水果、坚果、种子以及极少量的超加工食品（Ultra-processed foods）。许多人减脂时闻“脂”色变，但睾酮的合成原料正是胆固醇代谢通路中的脂质分子。如果执行极端低脂饮食，体内睾酮水平必然会断崖式下跌。保证饮食中含有来自坚果、橄榄油、鱼油等优质健康脂肪，同时避开精制糖与加工垃圾食品，是维持雄性激素的底线。 --- ### [35:25](https://www.youtube.com/watch?v=HUoPA6oP6do&t=2125s) 过去50年的男性健康危机：睾酮与精子质量的代际断崖 在过去数十年来，男性群体的整体睾酮水平呈现出持续滑坡的代际趋势。马利克医生指出，这一现象不仅存在于个体衰老过程中，更体现为跨时代的普遍现象： - **精液质量的全面倒退**：过去50年间，男性的精子浓度（Sperm concentration）与总数、精子活力均遭遇了系统性的大幅下降。 - **生活方式的根本转变**：现代文明高度静态化，久坐不动（Sedentary lifestyle）的办公室生活方式取代了体力活动，代谢综合征、肥胖以及代谢异常的发病率呈爆发式增长，直接撼动了生殖系统的机能基石。 ### [35:59](https://www.youtube.com/watch?v=HUoPA6oP6do&t=2159s) 环境内分泌干扰物、微塑料与精子及睾酮下降的关联 基础慢病如糖尿病和高血压不仅会造成内分泌异常，还会削弱局部血流，直接打击精子质量与睾酮分泌。然而，除了个人病理因素外，Dr. Rena Malik 指出全球环境中的微塑料（microplastics）和内分泌干扰物（endocrine-disrupting chemicals, EDCs）正在扮演隐秘而广泛的角色。尽管目前缺乏严苛的长期因果定量实验，但已有充足的基础科学与动物实验证实这些化合物对生殖系统的负面影响。人体生物标志物（例如尿液中的邻苯二甲酸酯/phthalates 浓度）研究也呈现出显著相关性：体内接触此类化学物质较多的人群，睾酮水平普遍偏低。 主持人 Steven 看着手边的金属马克杯和塑料水瓶，直言普通人很少联想到日常用具竟能影响生殖机能。Dr. Malik 解释，环境污染物的危害通常具有累加性（additive），个人难以彻底消除大环境中的塑料污染，因而最理性的策略是做好自己能掌控的小事： - **避免塑料加热**：加热食物时改用玻璃器皿，绝对不要微波塑料容器。 - **饮水工具降级暴露**：尽可能减少使用一次性塑料瓶饮水，替换为不锈钢或玻璃水壶。 - **政策与法规呼吁**：许多欧洲国家对食品色素（dyes）及工业化学添加剂有严格禁令，而美国等地的限制相对宽松，社会层面亟需更为严密的制度性管控。 ```mermaid flowchart TD accTitle: 现代环境与生殖系统健康的关系 accDescr: 展示环境化学物与慢性病如何共同作用于睾酮分泌及精子质量下降。 subgraph Hazards["暴露与慢病风险"] A["慢性病（高血压 / 糖尿病）"] B["微塑料与内分泌干扰物（邻苯二甲酸酯等）"] end subgraph Pathology["生理机能影响"] C["血管微循环受损 & 内分泌失调"] D["荷尔蒙受体干扰 & 睾酮合成受阻"] end subgraph Impact["生殖健康结果"] E["精子质量与浓度下降"] F["内源性睾酮水平下滑"] end A --> C B --> D C & D --> E C & D --> F ``` --- ### [38:30](https://www.youtube.com/watch?v=HUoPA6oP6do&t=2310s) 全球精子数量 50 年腰斩：生育危机与全身健康关联 回顾过去 50 年的医学统计，全球男性的平均精子计数（sperm count）断崖式下滑了近 50%。Dr. Malik 表示，虽然育龄父亲的平均精子数量目前仍维持在约 5,000 万/毫升（依然高于生育极限阈值），但下滑的斜率极其危险。主持人直言，如果按照每 50 年减半的趋势推演，再过 50 年就只剩原始水平的 25%，这已触及人类物种繁衍的底线。 针对近年来愈发普遍的“备孕困难”现象（身边不少伴侣备孕 12 到 24 个月仍无进展），Dr. Malik 剖析了其复合原因： - **两性责任均等**：医学上约 50% 的不孕不育归因于女方因素，50% 归因于男方，或由双方生理指标叠加所致。 - **生育年龄推迟**：女性随年龄增长卵巢储备下降是客观生理规律。现代社会中女性追求职场发展、推迟生育，使得受孕窗口期生理难度增大。 - **男性精液参数走低**：男性精子计数和浓度的全球性下降，进一步放大了这一挑战。 在区分“精液量（semen volume）”与“精子浓度（sperm concentration）”时，Dr. Malik 明确强调：精子浓度而非单纯的精液总体积，才是反映身体总体健康程度的有效生物标志物（biomarker）。精子浓度偏低往往伴随着全身性代谢或心血管隐患，但患者若出现男性不育，亦无需过度恐慌，应首先寻求系统的泌尿外科和内分泌评估。 --- ### [42:06](https://www.youtube.com/watch?v=HUoPA6oP6do&t=2526s) 提升射精量、射程变化与凯格尔训练的潜在陷阱 讨论到如何增加精液量（semen volume）时，Dr. Malik 指出最直接、最关键的决定因素其实是**排精间隔时间**——间隔越久，蓄积的精液量通常越多；此外，保证充足的水分摄入（hydration）也能带来客观的容量提升。 对于许多男性感觉自己“精液变少”的现象，Dr. Malik 揭示了一个常被忽视的力学细节：很多人错把“射精喷射力道减弱”当成了“容积缩水”。年轻男性的射精射程通常十分强劲，可喷射达 30 至 60 厘米；而步入 50 岁以后，随着尿道周围盆底肌（pelvic floor muscles）肌力减退，喷射距离往往缩短至 15 至 30 厘米。射精力量不足会导致部分精液滞留在尿道内缓缓流出，给人以“精量减少”的错觉。 通过凯格尔运动（Kegel exercises）锻炼尿道括约肌与球海绵体肌，确实能够增强挤压与喷射力道，但 Dr. Malik 发出了严肃警告： - **盲目练凯格尔潜藏风险**：如果原本就存在盆底肌高张力（hypertonic pelvic floor），一味盲目收紧且不懂得深度放松，会导致骨盆慢性疼痛、肌肉痉挛乃至勃起与排尿障碍。 - **核心在于正确发力**：只有在肌肉机能健康、动作标准、确保完整收缩与彻底舒张循环的前提下，强化训练才具有正面意义。 --- ### [43:56](https://www.youtube.com/watch?v=HUoPA6oP6do&t=2636s) 自慰与高潮对盆底肌的生理重塑效应 针对主持人“自慰是否能增强骨盆底”的疑问，Dr. Malik 厘清了自慰行为与高潮反射的区别：起核心锻炼作用的不是自慰过程，而是**性高潮（orgasm）本身**。 当人体达到高潮时，盆底肌肉会引发不由自主的剧烈节律性收缩，这种生理反射完全不受意识控制： - **高潮收缩频率**：大约每 0.8 秒发生一次强力不随意收缩。 - **持续时间**：单次高潮发作通常持续 5 至 60 秒不等。 这种高频爆发式的肌肉收缩本质上就是一套高强度的“天然被动凯格尔训练”。Dr. Malik 指出，医学界在针对女性群体的专项研究中发现，规律拥有性高潮对于维持和改善骨盆底肌力的效果非常显著，在特定频次下甚至不亚于主动做凯格尔运动。随后，对话切入下一个常见迷思：日常科技设备（手机、笔记本电脑等）对生殖器与生殖系统的真实物理辐射与热效应影响。 ### [45:05](https://www.youtube.com/watch?v=HUoPA6oP6do&t=2705s) 手机贴近生殖器与高温对精子质量的真实影响 主持人提到一个广泛流传的担忧：如果把手机放在睾丸附近，精子数量就会直线下降。他分享了自己生活中的一个场景：在车里或家里坐着时，只要把手机顺手放在生殖器附近，女友就会立刻数落他，甚至直接把手机抽走，生怕这会导致两人将来无法生育。雷娜·马利克医生（Dr. Rena Malik）解释称，这种担忧背后确实有一定的数据支撑，但关键机制并非大众以为的电磁辐射，而是“温度”。睾丸之所以长在阴囊内、悬挂于体外，正是因为精子的生成需要一个极其苛刻且恒定的低温环境。 任何破坏该温度的因素都会导致精子生成异常。例如，当男性因流感或重感冒而发高烧时，去医院做精液常规分析，有时甚至会发现精子计数骤降为零，因为高热会暂时彻底阻断精子产生。基于同样的原理，日常生活中穿紧身内裤还是平角短裤、把发热的笔记本电脑直接搁在膝盖上，都会让阴囊局部的温度上升，进而干扰生精功能。针对有备孕计划的男性，马利克医生给出了一套切实可行的保守建议： ```mermaid flowchart TD accTitle: 高温影响精子生成的机制与日常规避 accDescr: 展示环境与生活习惯导致阴囊局部升温，进而干扰精子生成的因果链与规避动作 subgraph S1["局部升温因素"] A["发烧/感冒"] B["手机贴身放置/笔记本置于膝上"] C["频繁蒸桑拿/泡热水澡"] D["过紧的紧身内裤"] end subgraph S2["生理反应"] E["阴囊内微环境温度升高"] F["破坏精子生成所需温度条件"] G["精子数量骤降甚至暂时归零"] end subgraph S3["日常规避建议"] H["手机移至后裤袋或胸前口袋"] I["使用电脑桌，勿直接贴膝使用"] J["备孕期暂停桑拿与热水浴"] end S1 --> S2 S2 --> S3 ``` 虽然每个人的生理耐受力大相径庭——就像医学上明令备孕期不要大量吸食大麻以防损伤精子，但现实中天天抽大麻或天天穿紧身裤、揣着发烫手机的人依然能生孩子——但只要是在积极备孕或存在生育障碍的男性，最明智的做法就是主动避免这些物理升温诱因。此外，对于越来越多热衷每日蒸桑拿、泡蒸汽房或泡热水澡的人群，高温同样会对精液质量造成可测量的负面冲击。而对于人们普遍担心的“Wi-Fi和蓝牙无线信号是否会直接杀死胚胎精子”，马利克医生坦言目前科学界并无定论，能够百分之百确证的元凶依然是手机发热带来的物理温升。 ### [47:48](https://www.youtube.com/watch?v=HUoPA6oP6do&t=2868s) 自慰会降低睾酮吗？揭开21天禁欲实验的科学真相 关于自慰与男性雄激素水平的关系，坊间一直流传着“自慰会严重消耗睾酮、让人丧失阳刚之气”的说辞。马利克医生明确打破了这个谣言：自慰绝不会降低睾酮水平。大众网络信息源普遍引用的所谓“科学证据”，其实仅仅来自于一项样本量极小的单一实验——研究人员只跟踪了10位年轻健康的男性，让他们严格禁欲21天，并在实验前后测量了体内的睾酮数值。 在这项研究中，受试者在禁欲第21天时，睾酮水平确实平均上升了大约 50 ng/dL（即 0.5 ng/mL）。但这不仅在临床上是一个非常微小的浮动，而且根本无法证明是禁欲本身带来了生理飞跃： - **睾酮具有高度动态性**：人体内的睾酮水平全天都在因作息、情绪、饮食等因素剧烈波动。 - **强烈的心理预期驱动**：当一个健康年轻男性被强行压抑自慰长达21天后，大脑对即将解禁的排泄冲动会产生极其强烈的兴奋与“预期线索”（anticipatory cues），光是这种“终于能释放了”的心理预期本身，就足以促使睾酮发生暂时性应激上升。 目前全世界没有任何高质量、大规模的实证医学证据表明自慰或禁欲能够显著持久地提高睾酮。马利克医生强调，如果有人通过禁欲在心理上感到充实，那大可继续；但如果只是为了追逐那点微不足道且在统计学上站不住脚的理论增幅，就逼迫自己“咬紧牙关强行忍耐”（white-knuckle it），在医学上毫无必要。 ### [49:17](https://www.youtube.com/watch?v=HUoPA6oP6do&t=2957s) 自慰的健康界限与“习得性反应”导致的伴侣脱敏 针对“自慰过多是否会对男女身体产生反噬”，马利克医生的评估标准并非绝对的频率数字，而是这项行为是否已经对正常社会生活形成替代性挤占。自慰本质上是完全安全的生理发泄，但如果出现以下迹象，它就演变成了病理性的行为依赖： - 宁可自己躲起来自慰，也不愿意与伴侣进行现实中的性生活； - 为了自慰而上班迟到，或者因沉迷手淫耽误本职工作； - 形成顽固的入睡条件反射，不自慰就完全无法入睡。 在这些负面依赖之外，过度单一化的自慰模式还会引发另一个普遍的临床隐患：“神经与身体习得（habituation）”。当一个人长期只用一种固定手势、特定力度，或者必须看某种极端特定题材的成人影片才能达到高潮时，大脑会固化一套狭隘的神经唤醒通路。长此以往，身体便只对这一套高度人工化的刺激做出反应。当他们回到真实的伴侣身边时，现实中伴侣的抚摸、体温和阴道刺激往往根本无法完全复制那种私密下形成的特定机械刺激，导致他们面对活生生的人时反而很难甚至完全无法达到高潮。马利克医生指出，大脑的神经可塑性极强，一旦陷入这种脱敏困境，就需要暂停既有刺激，通过打破常规、尝试更多元的方式，重新训练身体和大脑对真实接触的敏感度。 ### [51:10](https://www.youtube.com/watch?v=HUoPA6oP6do&t=3070s) 荒诞传言与对“禁抖十一月”（No Nut November）的专业批判 谈及自慰的荒唐谣言，诸如“手淫会导致双目失明”、“手掌心里会长出毛发”等说法，马利克医生直言这些纯粹是源于早期宗教戒律恐吓信徒的修辞话术，在现代医学上纯属无稽之谈。而对于风靡互联网、号召男性在整个11月戒除射精的“禁抖十一月”（No Nut November, NNN），她也明确表达了反对态度。 马利克医生并不反对个体的自我挑战，但她极度反感这种网络狂欢给年轻男性带来的无端自责与精神压迫： - **盆底肌异常痉挛**：许多人为了完成30天的禁欲目标，整日沉浸在对抗性冲动的极度焦虑中，导致盆底肌肉长期处于不自主的死命紧绷状态，反而诱发盆腔不适。 - **对梦遗的无知与罪恶感**：大量挑战者在夜间睡眠中出现生理性梦遗（遗精），随后便陷入“自己失败了”的极度自责。然而，遗精是人类完全无法自主控制的底层生理机制，医学统计显示，高达 **86% 的男性**一生中都经历过梦遗。 - **精液的自然代谢通路**：禁欲期间精液绝不会“积攒爆炸”，人体如果未通过射精排出，一部分精液就会被组织自行重新吸收，另一部分则会通过夜间遗精排出体外。 她强调，如果一个人挑战禁欲是为了训练专注力、摆脱杂念或追寻精神灵性，并且乐在其中，那无可厚非；但如果把它包装成一种“能让人升华蜕变为超人”的道德绑架，甚至让无法做到的人感到自卑和失败，就是一种完全违背生理规律的伪科学文化。 ### [53:05](https://www.youtube.com/watch?v=HUoPA6oP6do&t=3185s) “保留精液”带来头脑清晰？格斗界的赛前禁欲神话 主持人顺着话题探讨了背后的心理诱因：支持禁欲的人常宣称“保留精液”（semen retention）能够带来所谓的“头脑绝对清醒”（clarity of mind）。这种概念在职业竞技体育界尤为根深蒂固，比如许多参加终极格斗冠军赛（UFC）或奥运会巅峰赛事的顶尖拳手与运动员，在赛前2周甚至4周内都严格禁止任何形式的性生活与射精，坚信这能积聚攻击性与专注度。马利克医生指出，这种观念在体育界盛行已久，其背后混杂了大量心理暗示与传统格斗文化中的禁欲修辞，而科学界对其真实生理机制仍抱有截然不同的解读。 ### [53:36](https://www.youtube.com/watch?v=HUoPA6oP6do&t=3216s) 禁欲对运动表现与大脑机能的迷思 自古希腊时期起，角斗士或运动员在参加重要搏击和比赛前就被告诫要避免性生活或自慰。然而，Dr. Rena Malik 指出，现代运动科学研究（针对自行车、跑步等多种竞技项目）表明，射精前禁欲并不会改善运动员的体能表现。对于习惯在晨间性生活或自慰的人而言，打破原有生活节律甚至可能对竞技状态产生负面影响。生理指标上，自慰后心率会经历短暂下降，随后出现轻微的反弹升高，这可能会略微影响赛后恢复速度；但若有人主观上觉得禁欲能带来更强的好胜心和攻击性（"more aggressive"），选择禁欲也无妨，只是从科学证据来看这绝非强制要求。 主持人 Steven Bartlett 分享了他多年来深信不疑的一个演化论传闻：远古人类在寻找配偶时，必须具备极强的口才、说服力和魅力，而射精前正处于这种“吸引力巅峰期”；一旦射精，这股能量就会流失并进入重新蓄力阶段。正因如此，Steven 过去在登台演讲或录制播客等需要动用脑力和口才的场合前，都会刻意避免自慰或射精。Dr. Malik 对此回应，除了极少数患有性交后恶劣心境（postcoital dysphoria）的人会在高潮后情绪低落外，许多人反而报告了“贤者时间”（post-nut clarity）的正面效应：当大脑脱离了求偶时极度狭隘的单一专注状态后，其他区域被重新激活，思维变得更加清晰，甚至在自慰或射精后工作效率大增。 ```mermaid flowchart TD accTitle: 射精与运动及认知状态的关系 accDescr: 阐述传统禁欲假说与现代科学研究、个体生理反馈之间的对比关系。 subgraph Historical["传统观念与演化假说"] A["古希腊竞技传统<br/>赛前禁欲以积蓄攻击性"] B["吸引力巅峰假说<br/>射精前口才与专注度最高"] end subgraph Science["现代医学实证"] C["运动耐力研究<br/>禁欲与运动表现无显著关联"] D["规律习惯受损<br/>打破日常节奏反而损害状态"] E["心率生理反应<br/>高潮后心率先降后微幅反弹"] end subgraph Cognition["认知与心理效应"] F["求偶单一专注解除"] --> G["贤者时间 Post-nut Clarity<br/>其他脑区激活、生产力提升"] H["极少数人群<br/>性交后恶劣心境 Postcoital Dysphoria"] end Historical -.-> Science Science --> Cognition ``` --- ### [56:23](https://www.youtube.com/watch?v=HUoPA6oP6do&t=3383s) “贤者时间”的神经生理学与不应期机制 Steven 谈及男性群体中普遍存在的“贤者时间”（post-nut clarity）：射精后，对伴侣或原本热烈暧昧对象的欲望会瞬间断崖式下跌，仿佛“突然摘掉了墨镜”，而在社会刻板印象中女性似乎较少体会这种极端转变。Dr. Malik 从神经学和激素角度进行了解释：性高潮期间，人体心率、血压飙升，瞳孔放大，整个大脑剧烈放电点亮；高潮结束后，大脑神经活动迅速归于沉寂，男性大脑沉寂的速度极快，而女性通常需要相对更长的时间平复。 伴随这一过程的是剧烈的激素波动：高潮后体内泌乳素（prolactin）显著升高，而多巴胺（dopamine）则急剧回落。从演化生物学角度来看，这构成了男性的不应期（refractory period）： - **繁殖效率保障**：在将精液注入雌性体内后，若短时间内再次发生性交，可能会扰动或排出已进入的精液，降低受精几率。 - **防止能量过度耗竭**：限制男性无限次连续性交的能力，属于机体防止体能崩溃的保护机制。 - **绝对不应期与相对不应期**：在绝对不应期内男性完全丧失性欲与勃起能力；而在随后的相对不应期中，若出现足够新颖或强烈的性刺激，则可能再次引发唤起。 Dr. Malik 特别强调，目前关于女性高潮后反应研究匮乏的深层原因在于医学界的严重性别失衡。如果在医学文献库 PubMed 或搜索引擎中检索“阴茎”（penis），能找到超过 50,000 篇学术论文；而检索“阴蒂”（clitoris），却仅有约 2,000 篇。性健康长期以来未被主流医学视作关乎生死的关键指标，导致整体科研资金严重不足，女性性生理领域的研究尤为匮乏。 --- ### [59:53](https://www.youtube.com/watch?v=HUoPA6oP6do&t=3593s) 每月射精 21 次降低前列腺癌风险的研究与色情内容困境 针对“过度自慰是否诱发前列腺癌”这一广受争议的传闻，Dr. Malik 引用了一项对照了多种变量的大型权威流行病学研究。该研究显示：每月射精 21 次或以上的男性，患前列腺癌的风险显著降低。这在医学上催生了“前列腺停滞假说”（prostate stagnation hypothesis）——射精产生的液体部分源自前列腺，频繁射精有助于定期排出腺体分泌物并促进新液体代谢，起到类似“清理管道”（"cleaning the pipes"）的作用。 不过，Dr. Malik 也提醒注意该统计关联的潜在混杂因素： - **健康偏倚（Healthy User Bias）**：能维持每月 21 次或以上射精频次的男性，其基础身体状况可能本身就优于体弱多病者。 - **混杂变量控制局限**：尽管研究控制了基础共病（comorbidities）乃至婚姻状况，但并未细致评估亲密关系的真实质量、心理健康水平以及非婚伴侣状态等深层社会心理因素。 随后，Steven 将话题切入与之紧密交织的色情作品（porn）成瘾问题。他提到，在调研公众关注点时，发现一个极其惊人的现象：如今有大量人群不再是寻找更多资源，而是在急切地寻找彻底戒除色情内容（"how to stop watching porn"）的方法，甚至主动在电脑和移动设备上安装监控与屏蔽软件来约束自己的观看冲动。 ### [01:02:19](https://www.youtube.com/watch?v=HUoPA6oP6do&t=3739s) 色情作品与羞耻感：是否为恶，以及儿童过早接触的隐忧 主持人 Steven 谈到当前网络搜索的大量趋势：许多人急于寻找摆脱色情成瘾、限制观看色情内容的解决方案，甚至有海量网民在搜索“看色情片是否是一种罪过”（is porn a sin）。这种现象背后往往潜藏着巨大的“羞耻感”（shame）。面对 Steven 提出的核心疑问——“色情作品究竟是不是一件坏事？”，Dr. Rena Malik 首先明确表态：她并不认为色情作品本身是一件坏事。至于它是否属于“原罪”，更多属于道德与宗教信仰的个人范畴，每个人需要自行评判其在道德层面是否得当；从本质来看，它其实就是一种不同形式的“娱乐”（entertainment）。 然而，Dr. Rena Malik 强调这绝不代表色情作品“百分之百完美”，其背后潜藏着极其严峻的社会现实。最令她直言担忧的是未成年人过早接触色情内容。如今男孩初次接触色情内容的平均年龄已经降至 13 岁，既然这是平均数，便意味着许多孩子早在 8 到 10 岁就已经暴露在色情影片面前。Dr. Rena Malik 幽默地对比了两代人的成长环境：在过去，想要看到这些内容绝非易事，你得千方百计翻箱倒柜找出一盘录像带，趁没人的时候塞进录像机（VCR），或者偷偷藏起一本实体成人杂志；那需要付出极大的“努力”。而如今，色情内容唾手可得，即便父母在手机和电子设备上设置了重重内容防火墙，孩子也极易通过同伴的手机或网络漏洞接触到。 未成年人的大脑发育尚未健全，不仅难以分清现实与虚构——除非父母提前介入教育，告知这只是类似电影的虚构表演，并非真实的性爱过程——而且极易对这种超常刺激产生病理性的依赖。大脑在此阶段突然受到海量多巴胺的猛烈冲击，这种远超进化适应强度的神经刺激，极易让青少年在世界观和性观念尚未成型时就深陷上瘾的泥潭。 - **初次接触低龄化**：男孩首次观看色情作品的平均年龄仅为 13 岁，部分儿童早在 8 至 10 岁便已被动或主动接触。 - **获取门槛的剧变**：从过去的“翻找磁带/杂志”演变成如今无处不在的算法与移动网络推送，家庭拦截难度极高。 - **未成年大脑认知缺口**：缺乏对真实性爱与影视表演的辨别力，伴随多巴胺系统的过早过度刺激，易扭曲日后对伴侣的性预期。 --- ### [01:04:27](https://www.youtube.com/watch?v=HUoPA6oP6do&t=3867s) 成年人的多巴胺补偿机制与“问题性色情使用”的恶性循环 谈及成年群体时，Dr. Rena Malik 指出情况有所不同：成年人的大脑结构发育成熟，绝大多数人能够清晰意识到“屏幕里的内容并非现实”。在合理限度内，色情作品完全可以作为个体放松愉悦的娱乐方式，甚至可以成为伴侣共同观看、增进情趣的工具。然而，临床与文献中确实存在一部分“问题性色情使用”（problematic pornography use）群体。尽管医学文献中统计的发生率约为 4%，但 Dr. Rena Malik 推测在现实生活中实际比例可能更高。 这种问题的核心在于现代人对人际交往挫折的逃避。寻找真实伴侣需要承担被拒绝的心理痛苦，还必须面对初次性接触时的尴尬、笨拙与不确定性；相比之下，观看色情影片毫无门槛。色情内容能以最廉价迅速的方式释放大量多巴胺，许多人因此在心情低落、遭受挫折时，将其作为情绪逃避的止痛药。这往往已经与“性冲动”本身无关，纯粹是在渴求快速的多巴胺奖赏。随之而来的便是严重的羞耻感：“我为什么一遇到不顺心就要看色情片？”这种内疚与自我厌恶进一步加剧了负面情绪，而在情绪低谷中，他们又会再次点开色情网站寻求抚慰，从而陷入难以自拔的恶性循环。 ```mermaid flowchart TD accTitle: 问题性色情使用的恶性心理循环 accDescr: 展示现实挫折如何通过廉价多巴胺逃避机制演变为深层内疚与重复成瘾的闭环过程。 subgraph Trigger["触发诱因"] A["现实挫折 / 情绪低落 / 害怕社交拒绝"] end subgraph Action["逃避机制"] B["转向色情作品"] C["低成本获取瞬时多巴胺快感"] end subgraph Consequence["负反馈闭环"] D["产生自我谴责与羞耻感 ('为什么我如此自甘堕落')"] E["负面情绪加剧 / 心理压力倍增"] end A --> B B --> C C --> D D --> E E --> B ``` --- ### [01:05:47](https://www.youtube.com/watch?v=HUoPA6oP6do&t=3947s) Vision Pro、空间视频与未来亲密关系的虚实博弈 Steven 随即分享了自己最近购买 Apple Vision Pro 的震撼体验。他惊叹于设备中的“空间视频”（spatial video）功能，戴上头显后，那种 3D 立体感仿佛将真实的人直接带到了眼前。他的团队成员甚至感叹，如果有已故亲人的空间视频，戴上头显就像亲人重现人间一样。但紧接着，Steven 脑海中的“小恶魔”浮现出一个警惕的念头：这项颠覆性技术必然会被迅速应用到色情产业中。 Steven 做出推论：假设这项技术每年仅以 5% 的速度迭代，硬件越来越轻薄便宜，虚拟形象终将与真人难辨真假。等到十年后出现所谓的“Vision Pro 17 Air”，去现实中寻找伴侣、约会并最终发生性关系的综合成本与激励结构将被彻底颠覆。戴上头显即可获得极致体验，真实世界中的人际接触将显得无比繁琐与沉重，这必将急剧削减人们在现实生活（IRL）中建立真实亲密关系的意愿。 Dr. Rena Malik 承认这确实是一个不可忽视的隐忧。但从神经生物学与进化心理学的角度来看，她依然抱有希望：真实伴侣之间的身体接触——尤其是带有体毛区域的皮肤接触——在人类建立亲密感时具有不可替代的神经机制。无论视网膜上的画面多么逼真，在佩戴头显时，触觉依然是“自己在抚摸自己”，完全丧失了另一个真实人类带来的意外惊喜、兴奋感与情绪铺垫。人类的大脑机制在进化史上早已深度绑定了社交与真实接触，但她也坦承，未来的走向究竟如何仍有待观察。 --- ### [01:08:00](https://www.youtube.com/watch?v=HUoPA6oP6do&t=4080s) VR 技术的医疗脱敏应用与对抗“廉价多巴胺” 尽管虚拟现实在色情层面的泛滥令人担忧，Dr. Rena Malik 同时也分享了 VR 技术在性医学领域令人振奋的临床探索。她提到自己最近与性心理学研究学者 Lori Brotto 博士的交流：Brotto 的实验室正尝试将 VR 头显用于治疗因过往创伤或疼痛病症（如阴道痉挛等）而对“侵入性插入”（fear of penetration）产生严重恐惧的女性患者。 在传统的治疗中，直接与伴侣尝试性生活往往会让患者陷入极度的恐惧与不安全感。而在 VR 辅助脱敏治疗中，患者在一个绝对安全的受控空间内，通过头显模拟性体验，配合渐进式的器械（如阴道扩张器 dilator）进行身体脱敏练习。这种将前沿科技用于心理创伤与疼痛脱敏的探索虽然尚处初期，却展现了极高的临床价值。 看着 Steven 脸上依然写满怀疑的表情，Dr. Rena Malik 苦笑着承认，科技对人类社交的侵蚀已是不争的事实。智能手机已经改变了这一代青少年的社交方式——如今的孩子们聚在一起时，往往也是各自低头盯着屏幕。Dr. Rena Malik 透露，她在家里必须强制介入，要求孩子们必须坐在成年人身旁进行完整的、面对面的交谈，甚至必须手把手辅导他们如何与现实中的人互动。她严肃地强调，追求最省力、最唾手可得的多巴胺是人类的生物天性；如果全社会不主动干预、不共同努力去抵御这些“廉价的多巴胺快感”（easy dopamine rushes），科技对真实人际关系的侵蚀只会愈演愈烈。 --- ### [01:10:14](https://www.youtube.com/watch?v=HUoPA6oP6do&t=4214s) 身体对创伤的记忆：盆底肌功能障碍的心理病理根源 Steven 顺着脱敏治疗的话题，将讨论引向了深层心理机制：“创伤”（trauma）在性健康与性功能障碍中究竟扮演着怎样的角色？在临床接触的病患中，创伤是否是普遍存在的诱因？ Dr. Rena Malik 毫不犹豫地回答：“100%。”她强调了一句至理名言：“即使你的意识已经遗忘，你的身体依然铭记一切”（your body remembers even if you don't）。在泌尿外科与盆底医学临床上，大量表现为盆底功能障碍（pelvic floor dysfunction）的患者——即盆底肌肉处于极度紧绷、过度痉挛状态的人群——其背后往往潜藏着创伤的影子。 尽管有一部分盆底张力过高是由普通的长期日常压力和焦虑引起的，但在相当多的临床病例中，患者的痛苦可以追溯至数年甚至数十年以前遭受的某种身体或心理创伤。创伤的印记未曾消散，而是长久地固化在了肌肉记忆与自主神经张力之中。紧接着，Dr. Rena Malik 开始回忆起一位令她印象尤为深刻的典型临床病例…… ### [01:10:55](https://www.youtube.com/watch?v=HUoPA6oP6do&t=4255s) 创伤对身心的长期影响与性教育的缺失 雷娜·马利克医生（Dr Rena Malik）分享了一位令人痛心的临床案例：一位 70 岁的女性患者，因承受了不知多少年的严重盆底功能障碍，最终对其膀胱功能造成了极度恶劣的不可逆影响。马利克医生指出，任何未被妥善化解的创伤，都会直接反噬在个体的心理与生理健康上。大脑的力量极其庞大，当精神状态陷入泥潭时，身体也会随之恶化；相反，积极的心态则能带来良性的身体反馈。 马利克医生向所有来诊的患者强调，即便性功能障碍背后存在明确的“器质性问题”（organic problem，即身体或生理层面的病变），它也必然伴随着沉重的心理负担。在性爱这种极度私密的场域中，感知到自己的身体“不正常”、功能失调，会引发巨大的崩溃感、压力与恐慌。正因如此，理想状态下所有经历性功能障碍的人都应该寻求性治疗师的专业帮助。然而，现实的医疗与社会资源根本无法满足这种普惠需求。 谈到此处，马利克医生表达了对当前学校教育体制的极大不满。现行教育体系严重忽视了青少年亟需的生存与生活技能：不仅缺乏完善的性教育，也没有教导孩子如何面对、疏导心理创伤与焦虑，更没有培养数字健康素养（即面对海量虚假信息时，如何辨别、评估优质医学健康资讯），甚至连如何平衡个人账目这种基础财务常识都不曾涉及。如果教育系统无法帮助年轻一代及早察觉创伤和压力并学会求助，这些心理阴影就会在整个人生中不断蔓延，最终演化成严重的生理与心理疾患。 --- ### [01:12:51](https://www.youtube.com/watch?v=HUoPA6oP6do&t=4371s) 孕期性生活的常见误区与辟谣 主持人史蒂芬·巴特利特（Steven Bartlett）提出了一个在搜索引擎上极度高频的问题：“怀孕期间到底能不能进行性生活？”他提到，这是他在网络搜索数据中见过的最高搜索量词条之一。 马利克医生毫不犹豫地给出了肯定回答：“当然可以，为什么不行？”她坦言自己之前并没有意识到这个问题会有如此惊人的搜索热度。很多男性之所以对此感到恐惧，主要是担心性行为会伤害到腹中的胎儿，或者诱发早产。马利克医生明确澄清，在正常的健康妊娠期内，性生活绝不会引发早产，也不会伤及胎儿，完全不会对母婴带来任何不良后果，大众无需为此感到恐慌。 --- ### [01:13:33](https://www.youtube.com/watch?v=HUoPA6oP6do&t=4413s) 阴蒂与阴茎的同源构造与女性高潮路径 对话转向女性高潮机制以及常年被医学研究边缘化的阴蒂（clitoris）。主持人坦诚地表示，作为一名男性，他早年甚至不知道阴蒂在哪里，经历了若干误解后才勉强找到并尝试刺激它，但对其深层生理机制和运作原理依然一无所知。 马利克医生用直观的胚胎发育学为男性解惑：阴蒂在解剖学上就对应着男性的阴茎。在胚胎尚未分化性别的阶段，两者都起源于同一个结构——生殖结节（genital tubercle）。在男性体内，生殖结节发育为阴茎、阴茎体和龟头；而在女性体内，它则发育为阴蒂。人们在体表看到的只是阴蒂头，实际上它的主体结构如同阴茎轴一样深植于骨盆深处，并环绕包裹着阴道管。阴蒂的敏感度丝毫不亚于男性的阴茎，也是女性获得高潮最稳定、最可靠的通道。 针对女性的高潮机制，马利克医生强调： - 约 85% 的女性需要某种形式的阴蒂刺激才能达到性高潮； - 仅靠单纯的阴道活塞式抽插，绝大多数女性很难获得高潮。这绝不意味着女性的身体“有毛病”或“坏掉了”，而仅仅是纯粹的解剖学事实； - 刺激阴蒂的方式因人而异，常见且有效的包括口交刺激、震动器刺激以及手法抚摩。伴侣之间需要在亲密时主动沟通，询问“这样感觉舒服吗”，打破沟通羞耻。 除了阴蒂之外，马利克医生还梳理了女性体内另外两个关键的性感带及其各自独立的神经支配通道： ```mermaid flowchart TD accTitle: 女性三大高潮激发区域与神经支配分布图 accDescr: 展示了阴蒂、G点区域及宫颈各自对应的神经支配路径，说明不同刺激可叠加诱发高潮。 subgraph 感受区域 C["阴蒂 (Clitoris)<br/>延伸至骨盆深处及阴道周围"] G["G点性感带 (G erogenous zone)<br/>阴道前壁上段 2-3 cm 处/斯基恩氏腺"] CX["子宫颈 (Cervix)<br/>阴道深处"] end subgraph 神经传导 PN["阴部神经 (Pudendal nerve)"] HN["腹下神经 (Hypogastric nerve)"] VN["迷走神经 (Vagus nerve)"] end C --> PN G --> HN CX --> VN ``` - **G点性感带（G erogenous zone）**：位于阴道前壁（尿道下方）约 2 至 3 厘米深处。它并非一个孤立的点，而是一个富含特定神经末梢和斯基恩氏腺（Skene's glands，被称为女性的前列腺）的区域，由**腹下神经**（hypogastric nerve）支配。 - **子宫颈（Cervix）**：部分女性在宫颈受到触碰刺激时会产生强烈的快感，这一区域由**迷走神经**（vagus nerve）支配。 - **高潮的本质**：所谓的“阴蒂高潮”或“阴道高潮”在生理本质上都是同一种高潮，只是触发神经和刺激部位不同。当多个神经区域同时受到协同刺激时，所带来的高潮强度会显著增强，体感也更为丰富。 --- ### [01:17:24](https://www.youtube.com/watch?v=HUoPA6oP6do&t=4644s) 达到高潮的时间差与“性高潮鸿沟” 在探讨男女双方如何达成愉悦时，马利克医生援引了多项严格使用秒表记录的临床研究，揭示了男女在性交过程中达到高潮所需时间的巨大不对称： - **男性的射精潜伏期**：在不计前戏的情况下，全球跨国涉及约 1.5 万人的秒表测试（由女性伴侣在阴茎插入瞬间按下秒表、男性射精瞬间停止计时）显示，男性从插入到高潮的平均时间仅为 **5.1 至 5.7 分钟**（马利克医生趣味性地补充道，英国男性的持续时间相对略长一些）。 - **女性达到高潮的时间**：女性在性刺激下达到高潮的平均时间大约需要 **14 分钟**。 这就造成了严重的生理与节奏冲突：如果整场性生活完全以男性的射精为中心，一旦男性射精后进入不应期并产生“贤者时间”（post-nut clarity），往往会迅速丧失继续亲密互动的意愿。若不事先将女性的高潮置于优先地位、不在插入前给予充足的针对性前戏与刺激，女性在常规性交中几乎不可能获得高潮。 数据悬殊带来的“性高潮鸿沟”（Orgasm Gap）在初次性行为统计中表现得尤为刺眼： - **异性恋初次性行为**：男性达到高潮的概率高达 **95%**，而女性仅有 **45%**； - **女同性恋初次性行为**：女女性伴侣双方在首次互动中达到高潮的概率均高达 **95%**。 主持人听闻这一悬殊对比后半开玩笑地直呼“感觉男同胞受到了针对”，马利克医生则笑着回应这只是陈述客观事实。这清晰地表明两性之间存在巨大的认知与教育断层：女性清楚知道什么样的刺激能让自己愉悦，而多数男性由于从未接受过系统的科学性教育，只能从色情片（Pornography）中获取扭曲的认知——而在色情片里，镜头永远聚焦在男性的射精与宣泄上，极少展现女性获得真实高潮的生理过程。随后，主持人引出了下一个核心议题：“那么，究竟什么是高潮？它在演化和生理上又扮演着怎样的角色？” ### [01:19:42](https://www.youtube.com/watch?v=HUoPA6oP6do&t=4782s) 什么是性高潮：大脑、肌肉与生理机制 当主持人问及性高潮到底是一个开关（非黑即白）还是一个连续的光谱时，Rena Malik 博士解释说，高潮更像是一个光谱，或者说是一段经历。具体而言，高潮是一个“最大程度的紧张随后彻底释放”的瞬间。在那一时刻，人处于一种完全无法思考任何其他事情的状态，这是一种极具冲击力、强烈的愉悦感受，通常持续 5 到 60 秒不等。 高潮通常是在一段时间内持续刺激累积的结果，甚至需要某种特定的节奏才能达成，而这种节奏因人而异。Malik 博士打趣道，大家总是希望有一份明确的说明书（比如“你必须以多快的速度抽动”或者“使用什么刺激方式”），但现实中并不存在统一的脚本。在性唤起和兴奋阶段，身体会发生显著变化：例如女性的阴唇会充血发红、体积膨胀；阴道在唤起状态下会伸长扩张，长度几乎能从平时的 3 英寸增加到 6 英寸左右（接近翻倍）。她也指出，并非阴茎越大越好，因为并非每个人的阴道都能容纳尺寸过大的生殖器。 从神经与生理机制来看，高潮的到来就像“爬山”： - **神经通路博弈**：大脑中同时存在兴奋通路（Stimulatory Pathway）与抑制通路（Inhibitory Pathway）。随着多巴胺和激素水平不断攀升，兴奋通路向峰顶冲刺，一旦突破阈值达到顶峰，高潮随即爆发，累积的张力瞬间得到释放。 - **自主神经反应**：在高潮过程中，伴随心率飙升、瞳孔放大等一系列强烈的生理反应。 - **肌肉节律性收缩**：盆底肌肉在高潮瞬间会发生规律性的剧烈收缩，大约每 0.8 秒收缩一次。 - **非自主发声（Involuntary Phonation）**：高潮时许多人会发出呻吟或尖叫，这种反应很大程度上是不受主观意识控制的身体自主神经反射。 主持人提出了一个形象的比喻：这就像给一个“带有小孔的气球充气”，如果中途停下来，里面的气体就会漏掉。Malik 博士对此表示非常赞同，强调这正是达成高潮需要保持连贯节奏的原因。 ```mermaid flowchart TD accTitle: Sexual Response and Orgasm Mechanism accDescr: Diagram illustrating the build-up of physical and neurological arousal leading to orgasm and physiological release. subgraph Arousal["兴奋与张力累积阶段"] A["持续且具节奏感的性刺激"] --> B["生理充血与扩张<br/>(阴唇充血、阴道长度由3增至6英寸)"] B --> C["神经信号博弈<br/>(多巴胺升高 / 兴奋通路压过抑制通路)"] end subgraph Peak["高潮瞬间 (持续5–60秒)"] C --> D["突破顶峰：强效愉悦与彻底释放"] D --> E1["肌肉每0.8秒节律收缩"] D --> E2["心率飙升与瞳孔散大"] D --> E3["非自主发声 (呻吟/尖叫)"] end ``` --- ### [01:23:16](https://www.youtube.com/watch?v=HUoPA6oP6do&t=4996s) 正念、润滑剂与“安排亲密时间”而非“安排性爱” 主持人梳理了提升女性快感的关键要素，包括了解伴侣的身体、充分刺激阴蒂，以及 Malik 博士一直大力支持的润滑剂（许多人错误地认为润滑剂“不自然”而排斥它）。随后主持人提问：应该在日程表上“安排性爱”（Scheduling Sex），还是“安排亲密时间”（Scheduling Time for Intimacy）？ Malik 博士明确主张**安排亲密时间**，而不是僵硬地把“性交”写进日程。如果直接将性爱排入日程，往往会给双方带来无形的心理负担与压力——人们会开始焦虑：“我今天能提得起性趣吗？”“我能顺利勃起吗？”“我能享受其中吗？”“我会不会被对方拒绝？”如果在约定那天刚好遭遇极大的工作或生活压力，人很难强行切换到享受性的心境中。 数据表明，**正念（Mindfulness）练习**能显著改善性功能，尤其是女性群体： - 正念对提升性欲（Desire）的效果最为突出，同时也显著改善唤起度（Arousal）、润滑（Lubrication）与高潮体验。 - 其核心机制在于帮助伴侣聚焦于当下的躯体感受与愉悦感，而不是陷入“我到底能不能高潮”、“伴侣会怎么看我”等焦虑与反刍（Ruminating）思维中。 --- ### [01:24:47](https://www.youtube.com/watch?v=HUoPA6oP6do&t=5087s) 性爱时长的预期落差：理想愿望 vs 真实平均数据 针对大众在性爱时长上的认知偏差，Malik 博士分析指出，人们往往误以为实际的性生活持续时间很长，但这很大程度上是因为缺乏对“性爱”定义的清晰共识： - **科学测量标准**：在临床与医学研究中，性交时间通常严格界定为阴茎插入阴道到射精结束的时间（IELT, Intravaginal Ejaculatory Latency Time）。 - **宽泛的性生活概念**：大众眼中的性生活包含了前戏、口交、肛交、手动刺激等整个亲密互动的全过程，从几分钟的“速战速决”（Quickie）到悠长的温存各不相同。 Malik 博士强调，性生活的关键在于质量而非硬性的时间指标：“如果你们体验很棒，哪怕只有 3 分钟，只要双方都觉得棒极了，那就完全没问题。” 在探讨“预期与现实”的差距时，研究所呈现的数据对比十分明显： - **女性的理想期望时长**：通常希望性爱（含前戏与互动）持续 **18 至 25 分钟**。 - **男性的理想期望时长**：理想时间稍短，包含前戏大约在 **16 分钟** 左右（单纯插入则偏好约 12 分钟）。 - **实验室与人群调查的实际插入时间**：实际的平均插入时间仅为 **5.1 至 5.7 分钟**（约 5 分多钟）。 - **地域文化差异**：研究显示不同国家之间存在差异，例如土耳其的受试人群平均约为 4 分钟，而英国受访样本测得平均约 10 分钟（主持人对此幽默致谢）。 了解这一客观现实有助于缓解许多人的心理压力。Malik 博士分享说，有朋友告诉她，在看了她的科普视频后如释重负，意识到伴侣提出需求时往往只需要占用 5 分钟左右，而不是原先想象中精疲力竭的半小时马拉松，原本抗拒甚至焦虑的心理防线因此迎刃而解。 ### [01:28:25](https://www.youtube.com/watch?v=HUoPA6oP6do&t=5305s) 阴道松弛的迷思：性生活频繁会导致阴道变大吗？ 史蒂文将话题引回人体器官的尺寸上，尤其是大众普遍最关心的两个焦点：阴道大小与阴茎尺寸。他抛出了一个流传极广的社会刻板印象：“女性的性生活越频繁，她的阴道就会变得越松弛或越大吗？” 雷娜·马利克医生（Dr. Rena Malik）斩钉截铁地否定了这一说法：“这是完全错误的。”她解释，所谓“阴道松弛”或盆底肌无力，真正的原因往往来自以下几个生理与生活因素： - **分娩经历**：生育孩子对盆底肌群造成物理拉伸与损伤。 - **神经系统病变**：直接削弱盆底肌肉力量的神经系统疾病。 - **胶原蛋白代谢异常**：影响结缔组织韧性与弹性的先天或后天性病症。 - **长期站立职业**：长时间承受全身体重重力向下压迫盆底肌。 随着时间推移，缺乏支撑力的盆底肌肉力量衰减、收缩无力，才会在感官上产生“松弛感”。相反，性生活不仅不会让阴道松弛，高潮过程中盆底肌剧烈的节律性收缩反而在锻炼并强化这些肌肉。理论上，女性获得的高潮次数越多，其盆底肌反而可能越坚韧有力。 真正的盆底肌无力会带来实实在在的健康困扰，最典型的表现就是**压力性尿失禁（Stress Urinary Incontinence）**——在提重物、剧烈运动、跳跃，甚至只是咳嗽或打喷嚏时，腹压骤增导致数滴乃至大量尿液不由自主地渗出。严重者还会发生**盆腔器官脱垂（Prolapse）**，类似于阴道内部的“疝气”，盆底支撑结构塌陷致使阴道壁及相邻器官向下凸出，引发长期的下坠胀痛与不适。 --- ### [01:30:30](https://www.youtube.com/watch?v=HUoPA6oP6do&t=5430s) 凯格尔与盆底肌锻炼：正确的发力与放松机制 提到改善盆底肌，史蒂文联想到了大名鼎鼎的“凯格尔运动（Kegel exercises）”。马利克医生笑着指出：“凯格尔拥有我在医学界见过的最好的公关团队。”但她强调，凯格尔运动本质上只是盆底肌锻炼的其中一种。无论是男性还是女性，很多人其实完全不清楚如何正确执行这项训练。 盆底肌训练的本质就像在健身房做肌肉抗阻组数：由“收缩（Squeeze）”与“彻底放松（Relax）”交替构成。为了帮助初学者（尤其是男性）找到盆底肌发力的感觉，马利克医生给出了三种极其具象的感知方式： 1. **憋尿感**：排尿中途主动中断尿流所调动的肌肉。 2. **凌空抬升**：在完全不用手接触的情况下，尝试用意念和内部肌肉力量将阴茎向上抬起。 3. **憋屁感**：试图憋住肠道气体的收缩感。 绝大多数练习者常犯的致命错误是**缺乏足够的放松**。就像举铁不能无休止连续做动作而不给肌肉恢复间歇一样，盆底肌练习需要收缩 5 秒，随后必须充分放松 5 秒。如果肌肉一直处于紧绷状态，反而会导致肌张力过高。 ```mermaid flowchart TD accTitle: 盆底肌进阶训练路径 accDescr: 展示从平躺到坐姿再到站立的盆底肌力量递进训练流程 subgraph Phase1["基础感知阶段"] A["平躺位 (Lying Down)"] -->|消除其他肌群代偿<br/>专注盆底肌收缩与放松| B["5秒强力收缩 + 5秒完全放松"] end subgraph Phase2["进阶适应阶段"] B --> C["坐姿练习 (Sitting Up)"] C -->|熟练掌控肌肉控制力| D["日常站立或走动中练习 (Standing)"] end subgraph Phase3["综合强化"] D --> E["结合瑜伽/普拉提核心力量"] E --> F["严重症状求助盆底物理治疗师"] end ``` 马利克医生借用美剧《欲望都市》（*Sex and the City*）中萨曼莎（Samantha）随口说出“我正在做凯格尔呢”的经典桥段指出：那种在刷牙、走路时随时随地做凯格尔的境界，必须经历长期的阶梯式训练。她建议普通人从平卧位练起，再过渡到坐姿，最后才是站姿或融入日常活动中。 --- ### [01:32:48](https://www.youtube.com/watch?v=HUoPA6oP6do&t=5568s) 盆底肌功能障碍的表现与专业肛门指检评估 盆底肌问题并不局限于“力量衰弱”，另一大常被忽视的隐患是**高张力盆底肌（Hypertonic Pelvic Floor）**，即肌肉过度紧绷无法放松。这种肌张力异常在两性身上会引发一系列复杂隐蔽的症状： - **肌肉无力表现**：女性多为漏尿、脏器脱垂；男性最典型的表现是射精时的喷射力与射程明显减弱。 - **张力过高表现**：下腰痛（Lower Back Pain）、髋关节酸痛、性交疼痛、勃起疼痛、射精疼痛、尿频、尿急（老觉得“必须马上去洗手间”）以及膀胱排空困难。 面对这些症状，患者往往很难自行区分病因，必须寻求泌尿外科医生、妇科医生或专业盆底物理治疗师的诊断。史蒂文好奇医生具体如何为男性检查盆底肌。马利克医生解释，检查手段是直肠指检（Rectal Examination）。 医生戴手套将手指探入直肠，垂直向下触摸可以评估前列腺；而将指腹转向不同的侧面和特定角度，则能精准按压触诊盆底的深层肌肉群，例如肛提肌（Levator Ani）与闭孔内肌（Obturator Internus）。马利克医生常常提前给年轻患者打预防针：“如果你存在盆底功能障碍，我的指腹哪怕只是轻轻推压，都会激惹紧绷痉挛的肌肉，引发相当明显的酸胀与疼痛。很多患者第二天会觉得局部酸痛，甚至怀疑‘她昨天到底对我做了什么’。”她进一步厘清解剖概念：虽然指检位置靠近臀大肌，但臀肌位置更靠后且属于外层，盆底肌实则是人体深层核心肌群不可分割的底座。 --- ### [01:35:52](https://www.youtube.com/watch?v=HUoPA6oP6do&t=5752s) 阴茎尺寸与增大产业的科学探讨 在探讨完女性身体与盆底肌后，话题自然转向了男性的核心关切——阴茎尺寸。史蒂文指出，关于阴茎增大的疑问在男性群体中极为普遍，市面上充斥着阴茎拉伸器、真空负压泵（Pumps）以及各式各样的增粗增长产品，形成了一个庞大的商业产业。史蒂文直接向雷娜·马利克医生提问： > “从医学角度来看，阴茎的尺寸真的有可能被后天增加吗？” 马利克医生给出了肯定的回答，确认在特定医学干预和科学手段下确实存在改变尺寸的可能，并开始逐层揭开各类技术手段的实际效果与潜在风险。 ### [01:36:14](https://www.youtube.com/watch?v=HUoPA6oP6do&t=5774s) 阴茎牵引装置、真空泵与延长手术的有效性及风险 关于是否存在安全有效的阴茎延长方法，从现有医学证据来看，最安全且相对可靠的手段是使用牵引装置（traction devices）。这类装置最初主要是为了解决阴茎延长需求，同时也被广泛用于治疗佩罗尼氏病（Peyronie's disease，即阴茎纤维性海绵体炎）。患有佩罗尼氏病的男性阴茎内部会形成硬结斑块并导致异常弯曲，某些牵引设备专门设计成朝斑块相反方向施力弯曲，以帮助分解和软化斑块。从机制上讲，这些牵引装置的核心原理就是随着时间推移对组织持续施加拉伸力。早期研究所涉及的传统牵引设备要求极为严苛，使用者每天必须佩戴 6 到 8 个小时，连续坚持数月，平均仅能增加约 2 厘米的长度。对某些人而言，2 厘米的改善已经足够令人满意，但因为 2 厘米只是平均值，部分人的实际效果甚至更低，这完全取决于个人是否有耐心投入大量时间。 近年来市场上出现了一些新型牵引设备，临床研究表明每天只需使用两次、每次约 30 分钟，就能观察到一定程度的长度增长。这类物理牵引装置总体上相当安全，只要严格遵循说明书操作，通常不会造成严重伤害，最常见的副作用仅仅是佩戴受压引发的轻微皮肤瘀青。当主持人询问这是否指市面上的“阴茎泵”（penis pump）时，马里克医生明确澄清两者截然不同。真空泵并未被证实具有永久延长阴茎的作用，它的构造是一个塑料圆筒套在阴茎上，利用负压抽吸原理将血液强行吸入海绵体组织；若存在勃起功能障碍，患者通常需要在阴茎根部套上阻血环来维持硬度，它无法真正改变生理长度。 针对阴茎延长的外科手术，马里克医生给出了极为谨慎的保留态度。医学界曾尝试过多种延长术式，但这些手术普遍伴随着极高的并发症发生率和术后风险，在临床上通常不建议普通大众轻易尝试。谈及男性对外形改变的渴望时，很多人往往会轻蔑或嘲笑那些希望增大阴茎的人，但马里克医生表示自己的观念已经发生了转变。她认为阴茎外观在男性的自我认同与自信心构建中占据了极其关键的位置，就像女性拥有相对安全且成熟的隆胸手术一样，她非常希望医学界也能为男性开发出同样安全便捷的解决方案。遗憾的是，目前的医疗技术尚未达到这一水平，公众应当理性认清现阶段医疗手段的局限性，避免因盲目尝试危险手术而抱憾终身。 - **牵引装置（Traction Devices）**：通过物理拉伸促进组织延长；佩罗尼氏病患者可通过特定反向拉伸辅助软化硬斑。 - **佩戴要求与成效**：早期设备需每日佩戴 6-8 小时持续数月，平均延长约 2 厘米；新型设备已缩短至每日两次、每次约 30 分钟。 - **阴茎真空泵（Penis Pump）**：仅通过负压抽取血液助勃，需配合根部阻血环维持，没有任何永久延长组织的医学证据。 - **外科手术风险**：阴茎延长手术并发症发生率过高，风险收益比极不理想，医生普遍不建议常规施行。 --- ### [01:38:39](https://www.youtube.com/watch?v=HUoPA6oP6do&t=5919s) 认知偏差：色情片误导、平均尺寸与伴侣的真实偏好 在讨论大众对阴茎尺寸的预期时，色情制品（Porn）对社会观念的扭曲起到了极其负面的影响。调查数据显示，大部分男性和普通人主观上认为“正常”且理想的勃起阴茎长度应该在 6 英寸（约 15.2 厘米）左右，但现实中男性的全球平均勃起长度其实仅为 5.1 到 5.3 英寸（约 13.0 至 13.5 厘米）。关于女性到底偏好何种尺寸，跨性别外科领域的研究提供了一个非常有趣而客观的视角。在为跨性别男性进行阴茎再造术（Neophallus，新阴茎成形术）时，外科医生常采用前臂皮瓣（forearm flap）来塑形，这种皮瓣往往可以做得非常长且粗壮。然而临床随访发现，由于再造器官过于粗大，部分患者在术后根本无法顺利进行插入式性行为。 为了科学界定最适宜性生活的假体尺寸与周长，研究人员调查了女性在网络平台上购买最多的前 5 到 10 款情趣用品（如假阳具）。在情趣玩具市场上，尺寸从极端庞大粗壮到精巧写实应有尽有，而当女性拥有完全自由的选择权时，最畅销产品的平均标称长度在 6 英寸左右。但考虑到这类器具底部通常带有手柄或握持基座、无法全长深入体内，其实际有效插入长度与平均周长，恰恰与男性真实的平均尺寸高度吻合。这充分表明，绝大多数女性在生理与心理上所渴望的只是适中的平均尺寸，过大的尺寸反而更容易引起疼痛。 马里克医生特别提到市场上有一款名为“Ohnut”的缓冲环产品（由数个柔软圆环拼接而成），其主要用途就是让阴茎过于雄伟的男性在同房时佩戴于根部，防止阴茎完全深插，从而减轻女方因触碰宫颈或阴道过度牵拉而产生的剧痛。这证明过大尺寸往往会成为性爱中的负担而非享受。马里克医生对色情片让无数男性深陷尺寸焦虑感到十分痛心。她反复强调，刺激阴蒂才是女性实现性高潮最容易、最可靠的途径，这根本不需要任何深入的阴道插入。追求愉悦与给予快感完全不依赖庞大的器官，甚至很多女性压根不在乎具体尺寸。然而，这种执念深植于文化语境之中，哪怕是女性私下闲聊也常拿大尺寸开玩笑，甚至马里克医生自己有时脱口称赞某人天赋异禀后也会立刻反思：“天呐，我怎么也会说出这种话，连我都无法免俗。”这种将庞大器官盲目捧上神坛的社会偏见，与生理真实体验形成了巨大的讽刺。 ```mermaid flowchart TD accTitle: 阴茎尺寸认知与生理实际对比 accDescr: 对比色情片塑造的过高心理预期与真实生理数据及伴侣实际舒适度要求 subgraph Perception["文化与心理偏差"] A["色情文化灌输与社会玩笑"] --> B["普遍主观认知：约 6 英寸或更大"] end subgraph Reality["生理现实与伴侣需求"] C["全球平均勃起尺寸：5.1 - 5.3 英寸"] D["女性情趣用品畅销尺寸：扣除手柄后接近平均值"] E["过大尺寸困境：疼痛、难以进入，需借助 Ohnut 缓冲环"] end subgraph Orgasm["高潮核心机制"] F["阴蒂刺激为主要高潮来源"] G["无需依赖大尺寸或深度插入"] end Perception -.->|"引发焦虑"| Reality Reality --> Orgasm ``` --- ### [01:41:50](https://www.youtube.com/watch?v=HUoPA6oP6do&t=6110s) 衰老、血管病变与脂肪堆积对阴茎长度的影响 对于许多男性关于“阴茎是否会随年龄增长而变小”的恐慌，马里克医生的答案是：只要维持机体健康，阴茎并不会无端缩短。人体本身拥有一套精密的自我维护机制，在正常的夜间睡眠中，健康男性会在无意识状态下经历 3 到 6 次夜间勃起。这种生理现象与是否做春梦、采取何种睡姿毫无关联，纯粹是身体自主调节海绵体血流供应的生理程序，通过定期将富含氧气的血液泵入局部组织来维持海绵体细胞的活力与弹性。 阴茎出现实质性缩短的诱因通常是系统性血管与代谢疾病。当个体患上高血压、糖尿病或动脉硬化等心血管病症时，全身动脉内径逐渐狭窄，阴茎微血管的血液灌注大幅锐减。这不仅会导致夜间自主勃起消失，还会引发长期的勃起功能障碍。久而久之，长期缺血缺氧的海绵体组织会发生纤维化（fibrotic），原本如同海绵般柔软且富有弹性的勃起组织逐渐丧失张力并硬化挛缩，导致可测量的物理长度出现不可逆的萎缩。 另一方面，最普遍导致“变小”错觉的原因其实是中年发福与体重增加。随着年龄增长和脂肪囤积，阴茎本身的解剖结构并未收缩，而是位于阴茎根部上方的耻骨联合脂肪垫（mons pubis fat pad）显著增厚膨出。下腹部层层堆积的脂肪组织将阴茎根部向深处掩埋，导致裸露在外的有效视觉长度大打折扣，造成阴茎“缩水”的假象。只要能够控制体重、维持心血管健康，就能最大程度保全原有的组织尺寸与功能。 --- ### [01:43:08](https://www.youtube.com/watch?v=HUoPA6oP6do&t=6188s) 身体局部关联的迷思与阴茎尺寸演变趋势 在民间传闻中，始终流传着诸如“手大、脚大的男人生殖器必定更大”的说法，主持人也借此打趣展示自己的大手，询问人体各部位是否存在尺寸相关性。马里克医生指出，这些流传甚广的说法缺乏科学支持。目前仅有一项针对日本成年男性展开的专项测量研究，尽管该样本在种族分布上存在一定局限性，但实验在精确测量全身各部位指标与勃起长度后得出的结论是：手长、脚长与阴茎尺寸毫无统计学关联，唯一呈现正相关的身体外貌特征竟然是**鼻子的长度**。面对这一离奇结果，主持人忍不住开玩笑追问：“那我该怎么把鼻子弄长？”马里克医生笑着解释，这些生理表征几乎完全由先天遗传基因决定，属于后天无法人为左右的生物特征。 除了个体差异，马里克医生还分享了一项颠覆认知的宏观演变趋势：虽然全球数据显示过去 50 年间男性精子质量和睾酮水平呈现持续下滑，但阴茎的平均勃起长度在最近数十年间却呈现出反常的增长趋势。多项跨周期的流行病学汇总分析表明，男性的平均勃起尺寸在过去近 30 年中出现了小幅上升。医学界对这一反常现象提出了一种前沿理论假说：现代环境和生活习惯中的某些内分泌干扰物及营养过剩，导致男童青春期启动的时间显著提前；较早进入青春期的男孩体内过早接触高浓度睾酮等雄性激素，使得海绵体组织在发育窗口期获得了更长时间或更高强度的激素刺激，最终促成了成体器官长度的适度增加。虽然这一假说仍处于理论求证阶段，但它与宏观生殖健康指标的背道而驰无疑为内分泌与生殖医学研究提供了崭新的探讨空间。 ### [01:44:42](https://www.youtube.com/watch?v=HUoPA6oP6do&t=6282s) 男女解剖结构的天然契合：阴道膨胀与勃起尺寸的呼应 在前段讨论到男性勃起平均尺寸从 4.8 英寸增长到 6 英寸的戏剧性数据时，主持人忍不住打趣道，照这个趋势“再过 29 年，岂不是要长成庞然大物了”。但丽娜·马利克医生（Dr. Rena Malik）指出，女性的阴道长度并未发生演化上的改变，这引出了解剖学上男女生理结构的完美呼应。在女性处于非唤起状态时，阴道深度平均约为 3 英寸（约 7.6 厘米），而在充分性唤起后会延伸扩展至约 6 英寸（约 15.2 厘米）；这一生理动态变化恰好与男性的阴茎尺寸高度匹配——疲软状态下平均约为 3.6 英寸（约 9.1 厘米），勃起后平均约为 5.1 至 5.2 英寸（约 13.0 至 13.2 厘米）。马利克医生感慨道，从进化与生理机制来看，男女的身体结构仿佛是天然“为彼此量身定制”的，毕竟作为物种繁衍的核心使命就是繁育后代，生物学机制必然会让这一过程顺畅、契合。 --- ### [01:45:45](https://www.youtube.com/watch?v=HUoPA6oP6do&t=6345s) 阴唇整形术的兴起与外阴多样性：如同指纹般的独特存在 主持人随后询问了近年来热度攀升的“小阴唇整形术”（Labiaplasty）。马利克医生解释，该手术的本质是根据个人意愿与需求，将小阴唇（Labia minora）切除一部分，使其变得更短或更小。小阴唇的形态本就千姿百态：有的天生不对称、一侧长一侧短，有的较为突出，有的则非常紧凑。然而，色情作品中大量呈现极其扁平、几乎不可见的小阴唇样貌，给许多女性植入了虚假的外观标准，导致严重的容貌焦虑，让她们误以为自己的身体是不正常的。 马利克医生明确指出，小阴唇整形术主要有两种动因：一部分女性确实因为小阴唇过长而在运动、穿紧身衣或日常摩擦中产生实质性的牵拉疼痛与不适，此时通过手术改善是完全合理且有益的；但另一大部分则纯粹源于美学焦虑。她特别强调，每个人的外生殖器都“如同指纹一般独一无二”，自然界根本不存在一套所谓的“标准外观模板”，长短不对称绝非病态。 - **小阴唇整形术的激增趋势**：从 2015 年到 2019 年，全球范围内小阴唇整形手术的数量激增了 80%，折射出色情文化与审美焦虑对外生殖器认知的深刻影响。 - **医学界的核心态度**：小阴唇的长短、色素沉着与不对称属于完全正常的生理多样性，除非伴随物理摩擦疼痛或功能障碍，否则不应被视为病理状态。 --- ### [01:47:20](https://www.youtube.com/watch?v=HUoPA6oP6do&t=6440s) 潮吹与女性射精的迷思：三种体液与未解的科学争议 谈及女性高潮时分泌的液体与网络上常被神化的“潮吹”（Squirting），主持人坦率承认，大多数男性都是在色情影片中首次目睹这一现象，并普遍感到困惑：那喷涌而出的液体究竟是精液、射精液体，还是尿液？性伴侣之间是否应该把“让女方潮吹”设为性表现的目标？马利克医生指出，这一领域在医学史上被严重忽视与误解，迄今为止关于女性射精和潮吹的高质量科学研究仅有寥寥三到四篇。为了厘清概念，她详细拆解了女性阴道区域能够产生的不同液体类型。 ```mermaid flowchart TD accTitle: 女性性唤起与高潮体液分类 accDescr: 区分女性在性活动中产生的三种不同体液：阴道润滑液、女性真性射精以及潮吹液体的来源与成分对比。 subgraph VaginalSecretions["女性性活动中的三种不同体液"] direction TB A["日常润滑液 (Lubrication)"] B["女性真性射精 (Female Ejaculate)"] C["潮吹排出液 (Squirting)"] end A --> A1["由阴道壁血管充血渗出<br/>质地清滑，量因人而异"] B --> B1["来自斯基恩氏腺 (Skene's glands)<br/>少量乳白黏稠液体，含前列腺特异性抗原 (PSA)"] C --> C1["经尿道喷射排出<br/>量大透明无味，学界对其来源仍存争议"] ``` 马利克医生解释，第一种是单纯的阴道润滑液，由阴道壁血管渗出，质地黏滑，充盈程度因个体与唤起程度而异；第二种是“女性射精”（Female Ejaculate），它直接对应男性的前列腺液，源自被称为“女性前列腺”的斯基恩氏腺（Skene's glands），通常在快感达到特定峰值时排出，形态为少量黏稠的乳白色液体，经检测同样含有前列腺特异性抗原（PSA），绝非色情片中喷薄而出的场景。 第三种则是所谓的“潮吹”（Squirting），表现为经由尿道瞬间喷射出大量无色、透明、几乎无味的液体。关于潮吹究竟是不是“尿液”，科学界尚无定论且存在激烈争议： - **尿液论研究**：有分析发现潮吹液体中含有高度稀释的尿液成分；另有研究通过在潮吹前后对女性膀胱进行超声扫描，发现潮吹后膀胱体积明显缩小，从而推论其主要成分来自膀胱蓄积的稀释尿液。 - **反方观点与女性主观体验**：绝大多数亲历潮吹的女性坚决否认那是尿液，其感官体验和物理质感与排尿截然不同。 - **组织吸水与渗出假说**：性学研究学者巴里·科米萨鲁克博士（Dr. Barry Komisaruk）提出，这可能是由于性唤起期间子宫和阴道周围血管及组织间质高度充血吸水（Water imbibition），在高潮强烈的骨盆肌肉痉挛收缩下，体液被挤压并渗透释放入尿道排出。马利克医生坦言，由于实验设计局限性，目前尚无决定性的科学定论。 --- ### [01:50:17](https://www.youtube.com/watch?v=HUoPA6oP6do&t=6617s) 终极拷问：性健康即全人健康，以及伴侣选择的人生决定性意义 节目录制尾声，主持人按照《CEO日记》（The Diary Of A CEO）的标志性传统，代上一位未谋面的嘉宾向马利克医生提问：“如果有一条信息，是你希望毕生工作传递给全世界的，那会是什么？为什么？”马利克医生郑重回答：“性健康就是健康（Sexual health is health）。我们必须把性健康放在优先位置，并对年轻人进行全面的性教育。”她指出，负面的性遭遇、被忽视的性功能障碍或性压抑，不仅会摧毁生理健康与亲密关系，还会深刻削弱个体的职场生产力与自我价值感；打破耻感、为公众提供基于科学的知识赋能，足以改变整个世界。 主持人深受触动并分享了自身作为一名企业家的共鸣：许多人疑惑商业访谈节目为何频频探讨性、大脑与神经科学，但事实上“CEO 归根结底也是人”，生活在一个高强度的竞技场中。长期以来，性与亲密关系因为耻感和缺乏科普一直处于阴影之下，而当他本人开始正视并投资于亲密关系与性健康后，焦虑大幅减轻，身心健康、工作表现和事业发展反而迎来了全方位的飞跃。马利克医生最后提到，在指导医学院学生时，她总是告诫年轻女性：“你这一生做出的最重要决定，就是选择谁成为你的伴侣。”伴侣不仅在情感上、在性层面上对你的支持与同频，直接决定了你未来的人生能走多远、能否获得真正的成功。 ### [01:53:25](https://www.youtube.com/watch?v=HUoPA6oP6do&t=6805s) 成功背后的伴侣支持与访谈结语 在节目的尾声，对话由衷地转向了亲密关系与个人成就之间的深层联结。主持人斯蒂芬·巴特利特（Steven Bartlett）分享了一段关于伴侣角色的深刻洞察：当对方提到“我的丈夫非常棒（my husband's wonderful）”时，他回应道自己对此一点也不感到意外。在斯蒂芬看来，一个女人要想成为一名既成功又快乐、心态健全的杰出女性，往往只有两种生活状态作为基石——要么完全享受独自一人的充实生活，安之若素；要么身边拥有一位能够提供全方位理解与坚实后盾的优秀伴侣。 斯蒂芬进一步强调，如果家中存在一位充满消耗与负面影响的“有毒伴侣（toxic partner）”，那么无论个人在外如何打拼，生活与事业都注定难以为继，"it's not going to work"。对于这番关于健康亲密关系与家庭支持重要性的剖析，雷娜·马利克医生（Dr. Rena Malik）深表认同，以一句发自肺腑的“Amen（阿门）”与诚挚的道谢为整场深度访谈画上了温暖而有力的句点。 - **成功女性的情感基石**：要想成为心态平衡且生活幸福的成功女性，要么具备强大的独处自洽能力，要么拥有一位能够提供全力托底与支持的卓越伴侣。 - **不良关系的破坏性**：家庭生活若充斥着消耗性的有毒伴侣关系，个人的事业与整体幸福感根本无法长期维系。 ## Notable quotes > [02:40](https://www.youtube.com/watch?v=HUoPA6oP6do&t=160s) Sexual health is health. — Dr Rena Malik > [12:58](https://www.youtube.com/watch?v=HUoPA6oP6do&t=778s) 这根本不是关于性生活的数量，而是关于性生活的质量。 — Dr Rena Malik > [14:42](https://www.youtube.com/watch?v=HUoPA6oP6do&t=882s) 不，性爱绝不应该伴随疼痛。 — Dr Rena Malik > [20:07](https://www.youtube.com/watch?v=HUoPA6oP6do&t=1207s) 你必须弄清楚自己喜欢什么、想要什么，并把它传达给你的伴侣。 — Dr Rena Malik > [20:07](https://www.youtube.com/watch?v=HUoPA6oP6do&t=1207s) There is no 'the talk' — Dr Rena Malik > [01:10:14](https://www.youtube.com/watch?v=HUoPA6oP6do&t=4214s) your body remembers even if you don't — Dr Rena Malik > [01:12:51](https://www.youtube.com/watch?v=HUoPA6oP6do&t=4371s) 当然可以，为什么不行？ — Dr Rena Malik > [01:24:47](https://www.youtube.com/watch?v=HUoPA6oP6do&t=5087s) 如果你们体验很棒，哪怕只有 3 分钟，只要双方都觉得棒极了，那就完全没问题。 — Dr Rena Malik > [01:30:30](https://www.youtube.com/watch?v=HUoPA6oP6do&t=5430s) 凯格尔拥有我在医学界见过的最好的公关团队。 — Dr Rena Malik > [01:50:17](https://www.youtube.com/watch?v=HUoPA6oP6do&t=6617s) 你这一生做出的最重要决定，就是选择谁成为你的伴侣。 — Dr Rena Malik ## Mentioned Dr Rena Malik, Steven Bartlett, The Diary Of A CEO, Apple Vision Pro, Lori Brotto, Barry Komisaruk, Samantha (Sex and the City), Sex and the City, YouTube, Zoe, Ohnut ## Video description Dr Rena Malik is a Urologist & Pelvic Surgeon, her YouTube channel has over 1.8 million subscribers, where she releases weekly episodes on everything to do with sexual health education. 0:00 Intro 02:40 What is it you're seeking to do? 03:30 How do you define sexual health? 03:46 Do we understand our bodies? 05:10 Where does your training come from? 06:37 What's your training with the pelvic floor? 09:07 Why should our doctors be asking about our sexual health? 11:15 Is a weak pelvic floor in men linked to erectile dysfunction, and does sitting cause it too? 12:58 How much sex should couples be having? 14:42 Should we be experiencing pain during sex? 16:57 The vagina's expanding process 19:23 How do we communicate with our partners about sex? 22:21 What's the first step in re-building a good sex life? 26:22 Men vs women’s sexual desire as we age 29:11 Anticipation around sex causing more harm than good 30:11 Is a low libido a hormone problem? 32:29 Ways to increase testosterone 35:25 A decline in testosterone levels and sperm counts 36:37 Chemicals in everyday objects impacting sperm counts 38:30 How have sperm counts been decreasing over the years? 42:06 How do we increase our semen volume 43:56 Does masturbating improve my pelvic floor? 44:55 The impact our technology is having on our genitals 47:48 Does masturbation decrease testosterone levels? 49:17 Does too much masturbation have a bad effect on us? 51:10 Will masturbating make people blind? 51:29 What do you think of no nut November 53:05 Masturbating giving you more clarity of mind 56:23 Post nut clarity 01:01:48 Porn, is it bad? 01:05:47 VR headsets and porn 01:10:14 Trauma and how it relates to our sex lives 01:12:50 Can you have sex when pregnant? 01:13:33 Orgasms and the clitoris 01:19:36 What is an orgasm 01:23:16 Scheduling time for sex? 01:24:47 Is there a disparity on how long sex should actually take compared to how long it takes 01:28:25 Vagina myths 01:30:30 Pelvic floor exercises, how to do them 01:32:48 How do we know if we have pelvic floor issues 01:35:52 PENIS SIZE, is it possible to increase the size? 01:38:39 How big is a penis on average vs how big people think they should be? 01:41:50 Will my penis get smaller as we age? 01:43:08 Does body parts size indicate a bigger penis? 01:45:45 Labiaplasty 01:47:21 Squirting 01:50:16 Last guest question Follow Rena: Twitter - https://bit.ly/3VzI3vu Instagram - https://bit.ly/3TDaRk6 YouTube - https://bit.ly/3vx9knV Follow me: https://beacons.ai/diaryofaceo Shop the Conversation Cards: https://thediary.com/products/the-cards Sponsors: Zoe - http://joinzoe.com with an exclusive code CEO10 for 10% off Study mentioned: https://www.health.harvard.edu/mens-health/ejaculation_frequency_and_prostate_cancer#:~:text=In%20fact%2C%20the%20reverse%20was,lower%20risk%20of%20prostate%20cancer. This episode of The Diary Of A CEO was filmed at Gold Tree Studios, located in the heart of the Sunset Strip, West Hollywood, California [Source](https://www.youtube.com/watch?v=HUoPA6oP6do)

[2:40] Dr Rena Malik: Sexual health is health. [12:58] Dr Rena Malik: 这根本不是关于性生活的数量，而是关于性生活的质量。 [14:42] Dr Rena Malik: 不，性爱绝不应该伴随疼痛。 [20:07] Dr Rena Malik: 你必须弄清楚自己喜欢什么、想要什么，并把它传达给你的伴侣。 [20:07] Dr Rena Malik: There is no 'the talk' [70:14] Dr Rena Malik: your body remembers even if you don't [72:51] Dr Rena Malik: 当然可以，为什么不行？ [84:47] Dr Rena Malik: 如果你们体验很棒，哪怕只有 3 分钟，只要双方都觉得棒极了，那就完全没问题。 [90:30] Dr Rena Malik: 凯格尔拥有我在医学界见过的最好的公关团队。 [110:17] Dr Rena Malik: 你这一生做出的最重要决定，就是选择谁成为你的伴侣。

[47:48] Dr. Rena Malik: Don't like white-knuckle it to gain some theoretical increase in testosterone that one was not even that large and two, it's probably not going to be proven in a larger sample. [110:16] Dr. Rena Malik: Sexual health is health

[0:00] Men who ejaculate 21 times or more a [0:02] month are less likely to develop [0:05] prostate cancer. Jesus Christ, why? It's [0:08] because Dr. Rena Malik [0:10] Board certified urologist [0:11] Expert on sexual health [0:13] And a rockstar in educating the public [0:15] On the facts and myths of sex Rena, I [0:17] want to start with this idea that other [0:19] couples are having significantly more [0:21] sex than we are. Big myth. People are [0:23] having sex about once a week. Will my [0:26] penis get smaller as I age? [0:27] It can. So, in terms of how do we [0:30] maintain our penile size, you need to [0:32] have Is there a disparity between how [0:35] long we think sex should take and how [0:37] long it actually takes? Yeah, we all [0:39] think it lasts longer. Women want it to [0:41] be 18 to 25 minutes. Men are a little on [0:44] the shorter side, like maybe 12 minutes. [0:46] Is there like an average time? [0:48] 5.1 to 5.7 minutes. And then is too much [0:52] masturbation going to have an adverse [0:54] effect for men and women? Masturbation [0:56] is generally safe as long as you don't [0:59] That's when it becomes a problem. Rena, [1:01] do we understand our bodies as it [1:03] relates to our sexual health? Not at [1:04] all. For example, with pelvic floor, [1:06] it's involved in orgasm, it's involved [1:08] in sexual function, but no one really [1:10] talks about it. In fact, men will be [1:12] shocked, "Oh, I have a pelvic floor, [1:13] too?" And there's a whole host of issues [1:16] that can come from having a weak pelvic [1:18] floor, including erectile dysfunction. [1:21] So, how can I strengthen my pelvic [1:22] floor? Pelvic floor exercises. They're [1:24] going to increase orgasm, they're going [1:25] to make your semen propel further, and [1:27] ultimately it would be something as [1:28] simple as [1:30] It's absolutely crazy to me that so many [1:32] of you have decided to watch our show, [1:34] um, and so many of you have decided to [1:35] subscribe to our show. We now have 5 [1:38] million subscribers on YouTube, which is [1:39] a number that I just can't comprehend, [1:41] and it's a dream that I absolutely never [1:44] could have had. We started The Diary of [1:45] a CEO just over 3 years ago now, and in [1:48] my wildest expectations, we might have [1:49] had 100,000 subscribers by now. So, you [1:52] can imagine how shocked I am that so [1:54] many of you have chosen to tune into [1:56] these conversations every week um, and [1:59] spend some time with us. So, thank you. [2:01] And I made a deal with you. I made a [2:03] deal that if you subscribe to this show, [2:05] that we would continue to raise the bar. [2:07] And in 2024, [2:09] we're going to raise the bar like never [2:10] before. I've been working for the last 9 [2:12] months on a surprise for all of you that [2:15] have subscribed to this show, and I'm [2:16] very excited to deliver that for you. [2:19] The production's going to change. We're [2:20] going to go even further with our [2:21] guests, and we're going to tell even [2:23] more global stories. So, as always, if [2:26] you appreciate what we're doing here, [2:27] the simple free favor I'll ask from you [2:30] is to hit the subscribe button. Let's [2:32] get on with the episode. [2:40] Dr. Rina Malik. [2:43] With all of your work, what is it that [2:44] you're seeking to do? [2:46] So, what I'm seeking to do [2:49] is [2:50] have people understand that sexual [2:52] health is health. [2:54] I think we have so much misunderstanding [2:57] about one, what is good sexual health? [3:00] How do you Why is good sex important? [3:02] Why is it good to have [3:04] good sexual health? And that creates a [3:07] lot of despair and devastation, and [3:11] people don't talk about it. So, they [3:12] ruminate, they feel bad about [3:14] themselves, and it's pervasive [3:16] throughout their entire life. [3:18] So, I think ultimately my goal is to [3:20] make education freely accessible and [3:23] understandable, so people can know [3:25] what's going on with their bodies, [3:27] what's normal, what's not, and what's [3:28] available to help them. [3:30] How do you define sexual health? [3:32] So, sexual health is sort of an [3:34] individual thing, but most people would [3:36] say that you are able to have sex, you [3:39] are able to have an orgasm, you are able [3:42] to have pleasure and achieve the [3:44] benefits of that. Do we understand our [3:46] bodies [3:47] as it relates to our sexual health? No. [3:50] Not at all. [3:51] I will tell you, so I talk about, for [3:53] example, [3:55] how it's normal to have erections at [3:58] night or have even nocturnal emissions, [4:00] so have a wet dream, how that's a normal [4:02] physiologic function. And so many people [4:05] will message me and say, "How can I stop [4:08] having what they call nightfall?" Or [4:10] "How can I stop waking up with an [4:12] erection?" [4:13] Because they think for some reason it's [4:14] shameful or it's a bad thing. And when [4:17] realistically it's just normal. And part [4:20] of it is media, right? So when you see [4:23] TV, you see a man getting an erection [4:27] very quickly, he's [4:29] immediately penetrating a woman, and [4:31] she's immediately orgasming, and the [4:33] whole act is like really hot and heavy. [4:36] And in reality, that's not what sex is [4:38] like. So if you're not seeing what [4:40] normal sex is like, what normal foreplay [4:42] is like, what the fact that it's normal [4:44] to sometimes have difficulty getting an [4:46] erection, that's normal sometimes to not [4:48] have an orgasm for a woman, or it may [4:50] take more time to get a woman aroused [4:53] and require more foreplay, that you are [4:56] essentially looking at a script that's [4:59] not real. And then you're like, "What's [5:00] wrong with me? Am I broken? You know, is [5:03] something wrong with my body that it [5:04] doesn't function the way I'm seeing on [5:06] TV or on media or on erotic films?" [5:10] Where does your experience on this [5:11] subject come from? [5:13] So I'm a urologist by training, a [5:15] board-certified urologist. So we are the [5:17] medical and surgical doctors of the [5:19] genitourinary tract. So we're [5:21] essentially the plumbers. So when you [5:22] have a problem with your kidneys, the [5:25] tubes that drain the kidneys, the [5:26] bladder, or your genitals, we're the [5:28] ones who are going to fix those if [5:30] they're a surgical issue. And also we [5:33] deal with the medical aspects of some of [5:34] those things. And so that's what my [5:36] training was in. But when I started my [5:38] social media, my channel, I wanted to [5:40] offer education to people. And as I [5:43] started making this education, I [5:45] realized how badly people wanted to know [5:48] about sexual health, how much they [5:50] didn't know, and how they really wanted [5:52] to be empowered with this information. [5:54] And people are not being asked about [5:56] sexual function. Even when you go to see [5:58] your primary doctor, when was the last [6:00] time they asked you about anything They [6:01] might ask you about erections, but [6:03] that's probably where it ends, right? [6:04] Even if they ask about that, they're [6:05] definitely not asking women, "Are you [6:07] having orgasms?" They're definitely not [6:09] asking um anyone if sex is pleasurable. [6:12] They're not asking them if they feel [6:14] satisfied with the way things are going, [6:16] right? And if they are enjoying desire, [6:18] do they feel normal? And so I realized [6:20] there was such a disconnect here with [6:22] what people wanted to know and what was [6:23] available to them. And so then I started [6:26] really making content about sexual [6:27] health and spending more time [6:29] investigating in that area, treating [6:31] patients in that area, and it totally [6:33] became a all-encompassing field for me. [6:37] You're an expert in the pelvic floor as [6:38] well. Mhm. What was your sort of [6:40] training [6:41] with the pelvic floor? So when you do a [6:44] fellowship in what we call pelvic female [6:47] medicine, a lot of what we do is related [6:50] to the strength or weakness of the [6:52] pelvic floor. And so the pelvic floor, [6:55] just to start, is a bowl of muscles that [6:57] sits in your pelvis. So your organs, the [7:00] bladder, the rectum, for women the [7:02] vagina, the uterus, the urethra, all run [7:05] through the pelvic floor. It attaches to [7:07] the bones on your pelvis, and it is [7:10] extremely important for a variety of [7:12] functions. It offers stability, so when [7:14] you're standing, sitting, it offers [7:16] stability. It offers the ability to [7:19] defecate and urinate normally. It offers [7:22] uh when women have pregnancy, the pelvic [7:25] floor becomes very important. It's [7:26] involved in orgasm. It's involved in [7:29] sexual function. But no one really talks [7:31] about it. No one really knows it. In [7:32] fact, men will be shocked, "Oh, I have a [7:34] pelvic floor, too?" Because we talk [7:36] about it a lot with women, right? We [7:37] talk about it in terms of, "Oh, I might [7:40] leak a little after I've had babies when [7:41] I cough or sneeze or jump on a [7:43] trampoline. But the pelvic floor is much [7:45] more complex than that. And so, very [7:47] often we'll see people when they have [7:49] weakness of the pelvic floor, yeah, [7:50] we'll see leakage of urine. And but [7:53] sometimes their pelvic floor can be [7:55] discoordinated, or it can be too tight [7:58] or or have elevated tone. And so, what [8:00] that means is that you can develop a [8:03] whole host of abnormalities. And that [8:05] can be that you may have constipation. [8:07] You may have issues emptying your [8:09] bladder. You may feel like you have to [8:11] go to the bladder go to the bathroom a [8:13] lot. So, you may urinate frequently. You [8:15] may feel the urge to go often. Sometimes [8:17] it can cause pain. So, it can cause pain [8:19] when you urinate. It might feel like [8:20] you're having a UTI. It may cause pain [8:23] with erection or ejaculation for men. [8:26] So, there's a whole host of issues that [8:28] can come from having pelvic floor [8:30] abnormalities. And even if you've had, [8:32] say, lower back injuries or hip [8:34] injuries, they can affect the [8:36] coordination of the pelvic floor cuz [8:38] it's all interconnected. And so, I will [8:40] see patients who are like, you know, [8:42] "I've had a bunch of hip issues because [8:44] I played sports when I was younger, and [8:46] now I'm having issues with sexual [8:48] function." And so, it's all [8:50] interconnected and I think we we don't [8:52] spend enough time talking about how [8:54] important it is and how valuable it is [8:56] to people when they're having problems. [8:59] I want to go into the pelvic floor in [9:00] more detail and really figure out how I [9:02] can improve my pelvic floor and what I'm [9:03] doing to harm or hurt it. But you said [9:06] something there about doctors don't ask [9:08] about sexual health. They don't ask you [9:10] for orgasming, they don't ask you for [9:11] ejaculating, those kinds of things. Why [9:13] should they be asking about that? Cuz I [9:15] think of a doctor as, I don't know, [9:17] fixing other parts of my body. I don't [9:19] think of them as sifting through my [9:21] sexual life. [9:22] So, if you have a normal sexual life and [9:24] you're satisfied with it, it won't even [9:26] it wouldn't even bother you, right? You [9:28] wouldn't think about it. But people who [9:29] have difficulties, they may be walking [9:32] around feeling shame. They may be [9:35] walking around wondering what's wrong [9:36] with them. This can be pervasive because [9:38] they may have relationship issues and [9:41] they may have problems in their life [9:42] with their relationship that they're [9:43] then causing them to be less productive [9:45] at work, less happy, less satisfied with [9:47] life, feeling more depressed, more [9:50] anxious. And so it all comes together. [9:52] And in fact, the other really important [9:54] thing, at least for men, we know that [9:57] when they develop issues with erections, [9:59] so say you're having erectile [10:01] dysfunction, and you are diagnosed today [10:04] with erectile dysfunction, 7 years [10:06] later, about 15% of those men will have [10:09] a heart attack. [10:11] And the reason for that is because if [10:13] it's a blood flow issue, the arteries to [10:15] the penis are about 1 to 2 mm. The [10:18] arteries to the heart are about 3 to 4 [10:20] mm. And when you have about a 50% [10:23] occlusion of a blood vessel because of [10:26] high blood pressure, high cholesterol, [10:27] heart disease, [10:29] that organ will start to have problems. [10:31] And so you will start to see erectile [10:33] dysfunction in men who have vascular [10:36] problems [10:37] before you start having chest pain or [10:40] other signs of heart disease. So it's [10:42] and probably similarly in women, [10:44] although the data is not as We don't [10:46] have that data for women that maybe if [10:48] they all of a sudden are developing [10:50] problems with arousal, that maybe that [10:53] that's an indicator. But again, that's [10:54] more complex and we don't have the data [10:56] for that. But certainly for men, we have [10:58] a clear indication that a problem with [11:00] erections could precede really serious [11:04] heart consequences. And when you look at [11:06] people who've had a heart attack, about [11:08] 50% of men will have had erectile [11:10] dysfunction prior to that. 50%? [11:12] Mhm. [11:15] Is a pelvic floor dysfunction in men [11:17] also linked to erectile dysfunction? Are [11:20] you cuz I I heard in some of your work [11:23] that sitting every single day in in the [11:25] way that I do here, I sit sometimes here [11:27] for 10 hours a day, could be creating [11:29] erectile dysfunction. [11:31] Well, so it's more of the sitting every [11:33] day can cause your pelvic floor to not [11:35] stretch appropriately, right? Like if [11:37] you're not moving your body regularly [11:39] and your body tenses up from sitting all [11:41] day, then your pelvic floor is not [11:43] relaxing and contracting in a normal [11:45] fashion. And so some people will develop [11:48] some tension in the pelvic floor and [11:50] through the pelvic floor runs a whole [11:52] bunch of arteries and nerves that then [11:55] go to the penis to provide blood flow. [11:58] And so if your pelvic floor is clenched [12:00] really tight, then it can cause problems [12:04] in getting blood flow and then problems [12:05] in getting erections. So while that's [12:07] not um that's different than having [12:09] vascular problems, this is a muscular [12:11] problem more so um that that that can be [12:14] an issue with in terms of causing [12:16] erectile dysfunction in some men. Cuz I [12:18] heard during COVID there was a rise in [12:19] pelvic floor dysfunction as people were [12:21] sitting all day. Yeah, I mean I [12:23] definitely saw it. I don't know if it's [12:24] been actually studied, but I definitely [12:25] saw it in my own clinical uh setting and [12:27] many of my colleagues did where people [12:29] would come in and they would start [12:30] having either they'd be having more [12:32] erectile dysfunction, they might be [12:34] having more urinary urgency, meaning [12:36] they got to go got to go to the bathroom [12:38] or they're going more often, which [12:39] wasn't a huge issue because they the [12:41] bathroom was right near them, but they [12:43] did sometimes notice that it was a [12:44] change. And and also sometimes they [12:47] would some people even dealt with pain. [12:49] Like they would have more pain in that [12:50] area or women would think they were [12:52] having urinary tract infections when [12:54] they truly were just having discomfort [12:56] from the pelvic floor being tense. One [12:58] of the things that you're particularly [12:59] good at is taking on some of the big [13:01] myths as it relates to sexual health and [13:03] I I want to start with one of the big [13:05] myths around sexual health, which is [13:06] this idea that we all think other people [13:08] and other couples are having [13:10] significantly more sex than we are. [13:12] Yeah. So that's interesting. I think [13:14] that is a big myth. And so when you look [13:16] at um people want to know like what's [13:18] normal? How much sex should I be having, [13:20] right? And there's no ideal number, but [13:23] when you look at studies, right, which [13:24] have looked at large numbers of people, [13:26] people who are in partnered [13:27] relationships are having sex about once [13:31] a week on average if they're have if [13:33] they feel that they're, you know, in in [13:35] partner relationships where sex is [13:36] always available. But it's so variable [13:38] person to person. And what I really like [13:40] to say is it's not the quantity of sex [13:43] that matters, it's the quality of sex, [13:45] right? So if you're having good sex [13:48] once a month, that may be sufficient for [13:51] you rather than having mediocre or bad [13:54] sex four times a month or 10 times a [13:56] month even, right? And and so ultimately [13:58] there's no right number. It's really [14:00] what's right for you. And I think [14:02] focusing on [14:03] some like benchmark, right, of sex is is [14:07] actually harmful, right? Because now [14:09] you're like, oh, well, I need to have [14:10] sex this many times. What what is the [14:13] purpose of sex, right? The purpose of [14:15] sex is pleasure. And sometimes people [14:18] derive a lot of benefits from orgasm. We [14:20] know that there's physiologic benefits [14:22] to orgasm in terms of stress reduction, [14:25] more focus, potentially better sleep, [14:27] and even maybe lower blood pressure, [14:29] things like that. So if people are [14:31] deriving benefit from the orgasms and [14:34] the intimacy with their partner and the [14:36] pleasure they derive from sex, that's [14:38] what matters, right? Not the number of [14:40] times you're having sex. [14:42] Another big myth around sex which I [14:44] thought I'd [14:45] get your take on it is [14:48] about pain during sex. It's one of the [14:50] sort of most popular questions that I [14:52] often get get whenever I speak to [14:54] someone that is an expert on sexual [14:56] health is [14:58] is sex supposed to hurt? Because for a [15:00] lot of people it hurts. No, it's not [15:02] supposed to hurt. So if it hurts, [15:05] you want to assess, you know, what [15:08] Usually it's the female partner who [15:10] feels pain, right? So is it that you're [15:12] not lubricated enough? Is it that you [15:15] have not had enough foreplay? Because [15:16] the body prepares for intercourse, [15:19] particularly in the female. So what [15:20] happens is you go through arousal, your [15:23] body self lubricates, and the vagina [15:26] actually lengthens and widens almost [15:29] double in size to accommodate the [15:31] phallus or whatever you're using, [15:33] whether it's a toy or or a finger or [15:35] anything. And so, if you don't have [15:38] sufficient time to allow those things to [15:41] happen, then it will be painful. And [15:44] sometimes lubrication can be variable [15:46] person to person. So, some people may [15:48] have copious amounts of lubrication, and [15:50] some people may have less, and it could [15:52] be based on genetics. It could be based [15:54] on the age they are, what stage of their [15:56] hormonal status. It can be based on what [15:58] medications they're on that might [16:00] decrease lubrication. I think there's [16:02] another big myth is that lubricant is [16:04] not for everybody. And I argue that [16:07] lubricant is for everybody, that it [16:08] makes things more fun, it makes things [16:10] more slippery, it makes things more [16:11] enjoyable. And it certainly makes pain [16:14] less of an issue for a lot of people. [16:17] Now, there can be other issues that [16:19] cause pain. So, if you've tried all [16:21] these things, you know you're fully [16:22] aroused, you know you're lubricated, you [16:24] know that you're still having pain, then [16:27] it's really important to get evaluated [16:28] to understand what exactly is causing [16:31] the pain. It could be hormonal changes [16:33] in the vestibule, which is a part of the [16:34] vagina, that is very hormonally [16:36] sensitive, that can be painful. It can [16:38] be pelvic floor dysfunction. It can be [16:41] things like endometriosis or other [16:43] factors that may be going on that need [16:45] really advanced help. But most of the [16:48] time, a lot of people can feel and enjoy [16:51] sex more readily if they just increase [16:54] the amount of foreplay and increase the [16:55] amount of lubrication. You said that the [16:57] vagina [16:59] expands Mhm. during sex. So, how much [17:02] does it expand by, and how long does [17:03] that take? Because I think men don't [17:05] really understand this process. A lot of [17:06] men just like to rush in there, you [17:07] know. [17:08] Yeah. Yeah. So, usually it expands by [17:10] about double, double in length and [17:12] double in width. And so, it will expand [17:15] and basically the cervix is moving up [17:16] and out of the way, the vagina is [17:18] expanding to accommodate the length of a [17:20] phallus, and and it takes, we think, on [17:23] average about 18 to 20 minutes. So, it [17:26] that's sort of the amount of time it may [17:28] And some people faster and some people [17:30] longer, but ultimately, you know, sort [17:32] of like understanding that, but also [17:35] um the lubrication is another big part [17:36] of it. And so, I think both those things [17:38] together, um you know, you need you need [17:41] some time. And some people, like I said, [17:42] they may not take 18 minutes. They may [17:43] take a couple minutes. And so, it's very [17:45] reasonable to get in there if that's [17:47] what your partner wants. But again, I [17:49] think the bigger issue is that we're not [17:50] communicating about sex. No one taught [17:53] us how to talk about sex, right? I [17:56] didn't grow up talking about sex with my [17:57] family. Many of my friends and [17:59] colleagues did not grow up unless they [18:01] were in a family that was very [18:02] progressive talking about sex or even [18:04] learning about sex from their parents. [18:06] And at school, you don't learn much. You [18:08] learn how to put on a condom, you learn [18:11] how to ask for consent, you learn about [18:13] STDs, and that's if you're lucky. In the [18:16] US, 13 states don't have to have [18:19] accurate sex education. Like, it's not a [18:21] requirement for sex education to be [18:23] accurate in 13 states in the US. Where [18:25] are we learning sex from? [18:27] So, the large majority of young people, [18:29] I mean, this data shows that at least [18:31] one in four adolescents are learning sex [18:33] from porn. [18:34] And it's probably more than that. So, I [18:36] think a lot of people are learning [18:38] either from uh pornography, from their [18:41] friends. A small subset are learning [18:43] from their parents. There still are [18:44] people learning about sex from their [18:46] parents, but ultimately, it's not [18:48] enough. And so, if people are learning [18:50] about sex through porn, porn is [18:51] entertainment. It is doctored, it is not [18:55] real, and I think people then take that [18:58] and they say, "Why did not my sexual [18:59] encounter not look like that? Why didn't [19:02] I have as much semen volume? Why didn't [19:04] my partner not orgasm as quickly?" And [19:06] it can be on both sides, where women can [19:08] be like, "Well, why didn't I react like [19:09] that? Why didn't I get so excited right [19:11] away? And I think there's it's a real [19:14] problem in terms of if people are only [19:16] learning about sex through pornography, [19:19] then they're already set up to be let [19:21] down when they have their first sexual [19:22] encounter. And on that point of [19:24] communication, we don't talk about it as [19:25] a society, but then even within our own [19:28] relationships, [19:29] uh you know, we don't talk about things [19:32] we're struggling with with our own [19:33] partners. Yeah. And the insecurities [19:35] that we have, and I think that can cause [19:36] a spiral of misunderstanding, and I've [19:38] seen that in my own sex life [19:39] historically, where maybe there was [19:41] something I was insecure about or there [19:43] was something I was thinking about, and [19:44] instead of communicating it, I might [19:46] have just acted in a strange way, and [19:48] then that's misinterpreted, and then the [19:49] other person gets a little bit insecure [19:51] or whatever, and then you kind of have [19:52] this downward spiral of [19:53] misunderstanding, which leads to like [19:55] sexlessness. Absolutely. You're just [19:57] avoiding the situation because nobody [19:59] wants to talk about it. And this is the [20:01] problem. Like, you know, people ask me [20:03] like, "What's the What's the key? What's [20:04] the key? What's the secret?" The secret [20:07] is you have to know what you like, [20:08] right? You have to know what you want, [20:10] and you have to communicate it with your [20:12] partner. How? So, this is the issue. [20:14] It's not easy. It's not easy because no [20:16] one taught us how to have these [20:17] conversations, and they're charged with [20:19] a lot of emotion, right? You feel [20:21] insecure, you feel inadequate, or you [20:24] feel resentful because you're not [20:26] getting what you want out of the [20:27] relationship. And so, it has to come [20:30] from a place of understanding that this [20:33] conversation is not a one-and-done. [20:35] There's no the talk. There are multiple [20:37] talks over multiple periods of time. And [20:40] the first time you have the talk, it [20:41] might be a total disaster. But, you [20:43] know, if you are in a relationship with [20:45] someone really also has the same goals [20:47] as you of having a great relationship [20:49] with a good sex life, then ideally it [20:52] that won't continue, and you will [20:54] continue to have conversations. So, what [20:55] I tell people is don't have [20:57] conversations in the bedroom, not right [20:59] before, not right after sex. You want to [21:00] wait until you're out of the bedroom. [21:03] Or during, yeah. Definitely not during. [21:05] That's happened before. It's the [ __ ] [21:06] worst. [21:06] Yeah. Yeah, that's pretty bad. That's [21:08] pretty bad. Um [21:10] So, you know, one and then two, have it [21:12] in a place like some people you don't [21:13] need to be looking at the person, right? [21:14] You can be sitting in a car, you can be [21:16] going on a walk, because it's really [21:18] awkward to look at someone in the face [21:20] and be like, you know what? I felt like [21:22] this wasn't really great, you know? And [21:24] And so then to be like, okay, like, you [21:26] know, talk again, using the same sort of [21:27] communication techniques that you use [21:29] for other things, talking about I [21:31] statements, not being you did this, you [21:33] didn't do this, more about like how I [21:35] feel, what really turns me on, what I [21:37] would really like in the relationship. [21:40] And then sort of realizing that they may [21:42] not react well, they might be like, oh [21:44] my god, I can't believe we're talking [21:45] about this. They have their own [21:47] stereotypes and biases that they're [21:49] bringing into that conversation too, or [21:51] their shame, or whatever they grew up [21:53] with in society, whatever they think [21:54] about sex can be very charged, right? [21:57] And so it's sort of a lot of work to get [22:00] through that, but realizing that it [22:01] could take time and sometimes getting [22:03] help. So, seeing a sex therapist or [22:05] someone who has expertise in psychology [22:08] and sex to talk about learn how to talk [22:10] about sex with them and and navigating [22:14] the difficulties of it. But it's worth [22:16] the investment, right? It's not easy, [22:18] but nothing in life that's good or worth [22:19] getting is easy, right? Okay, so there's [22:22] a couple listening right now, there's [22:23] probably one member of the couple [22:24] listening right now, and they've heard [22:25] everything you've said, but they have [22:27] reached the point of no return in their [22:28] relationship as far as that concerned. [22:30] They've not been having sort of a [22:32] functional healthy sex life for maybe [22:34] one year, maybe six months, maybe five [22:35] years. [22:36] And it's just become the new normal. [22:38] Mhm. What is the case you'd make to that [22:40] person to get them to take action to try [22:42] and rectify the situation? Well, I would [22:44] ask them first how important is sex to [22:47] them, right? If it's not that important [22:49] and the other things in the relation And [22:51] that's okay, right? Some people find [22:53] that, okay, everything else in the [22:54] relationship is excellent. I love this [22:57] person, we're still intimate, we still [22:59] love each other, we We cuddle, we still [23:01] um have a lot of great things in our [23:03] relationship and and sex right now is [23:06] not working, right? Or it's not it's not [23:09] working for us. So, um I'm okay with [23:11] that. That's fine. Like you don't have [23:13] to feel bad about that. But I think that [23:15] if it is a problem, then I think it's [23:17] worth working on, right? Like if you [23:19] have a relationship that you value and [23:22] that person you're you're with values [23:24] the relationship, then it's worth keep [23:27] trying. Like try to have the [23:28] conversation. Try to bring them into the [23:30] conversation. How much have you tried, [23:32] right? Like have you really had enough [23:34] attempts at a conversation? A true [23:36] conversation where [23:37] you didn't get frustrated, too, right? [23:39] Like where you were like, "Okay, I [23:41] understand that you have This is a [23:42] difficult conversation that we're going [23:44] to have and I understand you might have [23:46] feelings about it, but I love you and I [23:48] really want to try to have this [23:49] conversation." And to keep at it. And I [23:51] realize that that's not easy, right? [23:52] That's not easy. I'm not saying it is. [23:54] But I'm saying that when you're in a [23:56] relationship that's worth having, that [23:59] ideally at some point the other partner [24:01] will see how much this matters to you [24:03] and want to work with you on it, right? [24:04] If they love you, if they're with you [24:06] there, they want what's best for your [24:07] relationship. They're not like hiding [24:09] They're not hiding their head in the [24:10] sand and being like oh, I'm like they're [24:13] They realize they just don't want to [24:14] talk about it. They they they're not [24:16] stupid. They just sort of don't want to [24:18] talk about it because it's embarrassing [24:19] to them. They feel like they're the one [24:20] that has something wrong with them, [24:21] maybe. Or maybe they have an issue that [24:23] they haven't brought up. Maybe they're [24:25] having a lot of pain with sex. Or maybe [24:27] they're going through hormonal changes [24:29] and their tissues are really dry or [24:31] whatever. There's a whole host of things [24:33] that could be going on that they don't [24:35] feel comfortable talking to you about. [24:37] So, I think it's it's valuable to say, [24:40] "Is there something I'm not doing?" Like [24:42] tell me what you feel about sex. Like [24:44] leaving it open-ended to really find out [24:46] what's going on with them. Because [24:47] usually not that they're like, "I just [24:48] don't want to have sex and that's it." [24:50] There's usually a lot more to it. [24:52] It's so hard for us to know, isn't it? [24:54] When it comes to sex, what the root [24:56] cause of the issues are. And I think [24:57] some relationships are like a frog in a [24:59] frying pan. [25:01] The frog in the frying pan analogy for [25:02] anybody that doesn't know is that this [25:04] old tale about a frog jumping into a [25:06] frying pan and then because the water [25:08] heated up gradually ends up dying. But [25:10] if the water was hot from the moment it [25:11] dropped jumped in it would have jumped [25:12] straight out. The idea that it's a [25:14] gradual death for the frog and in [25:17] relationships it's kind of a slow day by [25:20] day month by month decline in intimacy [25:23] and you end up finding yourself like a [25:24] dead frog in a frying pan. You end up [25:25] finding yourself in a sexless [25:26] relationship and you think how the hell [25:28] did we get here? Mhm. Um [25:30] and it's and it's a it's a feels like a [25:32] long way back from that point. It is. [25:35] It's going to be, right? Because you let [25:37] it sort of dwindle and you didn't talk [25:38] about it and it's going to take work and [25:41] I think that's the key is like if you [25:42] want to fight for that in your [25:44] relationship, it's going to take work [25:46] and it's going to take um buy-in on both [25:49] sides, right? You have to work for [25:50] anything in your relationship. [25:52] Relationships are not easy, right? You [25:53] want to have children, that takes work. [25:56] You want to um decide to buy a house [25:58] together, that takes work. Deciding and [26:00] figuring out the what kind of house you [26:02] want, how much money you want to spend. [26:04] Like there's all sorts of things that [26:05] take work and this is one that people [26:07] just don't know how to talk about and so [26:09] they just ignore it because it's harder [26:11] to bring up for both parties, right? [26:13] What the one who maybe is not wanting [26:15] sex or is being the one who says no to [26:18] the and the one who always wants sex and [26:20] then feels rejected because they're not [26:21] getting it. Is there a a sort of a [26:24] difference between men and women's [26:26] sexual desire as we age? [26:30] You know, because I think there's a myth [26:31] that says men just always want to have [26:32] sex and women maybe not so much. Is that [26:36] a real myth um in terms of something [26:38] that you hear, but also is it true? So, [26:41] let's talk about desire. Desire comes in [26:43] two flavors. So, there's the spontaneous [26:45] desire where you see somebody, you're [26:48] like, "Oh man, they're so attractive. I [26:50] can't wait to sleep with them. I'm [26:51] immediately turned on. I want to have [26:53] sex right now, right? You didn't have to [26:54] do anything. You just saw them and it [26:56] happened. And then there's responsive [26:58] desire where you're sort of with them, [27:00] you might be touching them, you might [27:02] not really be thinking about sex, but [27:04] like you're touching them, you're with [27:05] them. You're like, "Oh, this feels sort [27:07] of nice. I sort of like this." Like, [27:08] "Oh, now I'm turned on." After we've [27:11] sort of started being a little romantic [27:13] with each other, being a little more [27:14] intimate with each other. And both [27:16] desires are normal and both desires are [27:19] fine to have. Now, in the literature, [27:22] you'll find that men tend to more often [27:23] have spontaneous desire and women tend [27:26] to more often have responsive desire, [27:27] particularly when you're in longer-term [27:30] relationships. So, there's a disconnect, [27:32] right? Women are like, "Why don't I see [27:35] you and want to jump you anymore? Right? [27:37] I used to feel like this, but I don't [27:38] anymore. What's wrong with me? Am I [27:39] broken?" Right? And then they don't [27:42] realize that, "Okay, maybe we'll just [27:43] like be together and let's see what [27:45] happens." And they don't even want to [27:47] start because they're worried that what [27:49] if I don't want to have sex and we've [27:50] now initiated this like touching, [27:52] cuddling thing where, "Oh, that person's [27:55] getting really turned on. What if I [27:56] don't get turned on? And what if I [27:57] disappoint them?" And so there's a lot [27:59] of charged emotions there, but realizing [28:02] this is normal and common and responsive [28:05] desire is not wrong. It's just [28:07] different. And people just don't know [28:09] that it exists because, again, media [28:11] attention is like you see somebody jump [28:13] them, you're you're horny right away, [28:14] you have sex. And that's not what [28:16] happens all the time and that's okay. [28:18] And so like, you know, you can be with [28:20] your partner and be like, "Look, I have [28:21] no expectations from you. I just want to [28:22] be with you physically." And see if it [28:25] turns into sex. So, often we'll give [28:27] people homework. Like, put it on the [28:28] calendar. Put it on the calendar that [28:30] you are going to be intimate together at [28:32] this time. And I know that sounds weird, [28:34] right? Like you're looking at me like [28:35] I'm crazy, but we put on the calendar [28:38] when we want to work out. We put on the [28:39] calendar when we want to have brunch [28:40] with our friends. We put on the calendar [28:42] when whatever, right? And when we When [28:45] we [28:45] when we used to have dates with people, [28:47] we would say, "Okay, we're going to go [28:49] on a date on Friday night." We would [28:51] know that sex is on the table with our [28:53] partner on Friday night. So, we'd get [28:54] really excited about it. We're like, [28:55] "Okay, I'm going to shave. I'm going to [28:57] look real pretty. I'm going to smell [28:59] good. I'm going to do all the things [29:01] that make me desirable and feel [29:03] confident and be ready to have sex, [29:06] right?" And so, you'd be like really [29:07] excited about it. And then you would [29:08] have all this anticipation about how fun [29:10] it's going to be. But the anticipation [29:12] can can wreak havoc, can't it? It can. [29:14] It can. So, the opposite is true. But [29:16] that's because if you expect That's why [29:17] I say intimacy and not sex. So, if you [29:19] say you're going to have sex, it can be [29:22] like, "Oh my god, what if I don't [29:23] perform? What if I don't do right? What [29:24] if I don't want sex? What if it hurts?" [29:26] Right? So, you can also have that sort [29:27] of rumination and spiral. But if you're [29:29] like, "Look, all we're going to do is be [29:31] together and be intimate. We're not [29:33] going to just go have dinner and talk. [29:34] We're going to like literally be [29:36] together, not have our phones with us, [29:38] maybe like touch each other, maybe get [29:40] undressed, maybe just, you know, feel [29:42] how what it feels like, and that's it. [29:44] There's no expectation of sex from [29:46] either side. We're going to go in [29:47] knowing that, and then slowly work our [29:49] way towards like, "Okay, you know what? [29:51] Like, maybe sex will happen and maybe it [29:53] won't." And over time, as you keep [29:55] putting on the calendar, prioritizing [29:57] your intimacy with your partner, then [30:00] eventually you'll get to a point where [30:01] oh, you remember, you recall that [30:03] connection you used to have, and then [30:06] you can actually find that joy again of [30:08] connecting sexually. [30:11] That's the sort of the aspect of desire [30:13] which is I guess is a bit more [30:14] psychological. But it There's also sort [30:15] of a physiological element to desire as [30:17] it relates to hormones levels. So, if [30:20] someone's got a low libido, is that a [30:22] hormone dysfunction? It can be. So, [30:25] testosterone is the most notorious [30:27] hormone for desire, right? In both men [30:29] and women. And I think this is a big [30:30] misconception is that we don't talk [30:32] about testosterone in women. But [30:34] testosterone in women is more [30:36] predominant than actually estrogen. We [30:38] have more testosterone in our bodies [30:39] than we do estrogen. And testosterone is [30:42] very important for desire in both men [30:44] and women. But anything that is in [30:46] interacts with testosterone is also [30:48] important. So, thyroid hormone can can [30:50] cause issues with testosterone. [30:52] Prolactin, which is another hormone made [30:54] by the brain, can also interact with [30:56] testosterone. So, essentially evaluating [30:58] those things and making sure that your [31:00] levels are normal or appropriate for [31:03] your age can be helpful. That's probably [31:05] the number one thing. But the other [31:07] thing is outside of physiology is that [31:09] stress, even though stress is [31:11] sort of an abstract thing, stress [31:13] affects our physiology, right? So, when [31:15] you have a lot of stress in life, [31:17] whether it be work, relationship stress, [31:20] kids stress, whatever it is, right? It [31:22] raises your cortisol level. And when [31:24] your cortisol level is high, you can't [31:26] produce testosterone. It goes down. And [31:28] so, if you're chronically stressed, [31:30] which many of us are, right? You spend [31:32] like in today's modern society, chronic [31:34] stress is like a real problem, then that [31:37] is going to really impact your libido. [31:39] So, yeah, your hormones may suffer [31:40] because of it. But if you don't fix the [31:42] stress, like you're not going to fix the [31:45] root cause of the problem. Can I just [31:47] inject myself with loads of testosterone [31:48] there to get my libido back? [31:50] It won't work for everybody. So, if it's [31:53] not truly a [31:55] low testosterone, meaning you have [31:57] normal levels of testosterone, likely [31:59] your testosterone receptors are [32:00] completely saturated, more testosterone [32:03] is not going to fix the problem. So, it [32:05] depends on your individual level of [32:06] hormones. But at some point, more is not [32:09] better. In fact, more can be dangerous. [32:11] And so, it's really dependent on your [32:12] individual level. So, giving yourself, [32:14] like if I give a guy who has completely [32:16] normal testosterone levels, [32:18] both free and total testosterone, all [32:19] completely normal, and I give him [32:21] testosterone, probably nothing's going [32:22] to change because his testosterone [32:24] receptors are already fully saturated [32:26] with testosterone. So, more is not going [32:28] to do anything. What are the other ways [32:29] that I can increase my testosterone? If [32:31] I go and get tested and it says that I [32:32] have low testosterone levels, and I [32:34] don't want to just inject myself with [32:35] testosterone, are there natural ways [32:37] that I can increase it? Absolutely. So, [32:39] number one is sleep. So, sleep is [32:42] really, really important for [32:43] testosterone. We know that when you [32:46] reduce the amount of sleep you have. So, [32:49] for example, you sleep less than six, [32:51] five or six hours, you're going to have [32:53] at least 10 to 15% reduction in [32:55] testosterone. And so, because our body [32:59] follows a circadian rhythm. And so, when [33:01] your testosterone is highest is in the [33:03] morning. And it starts to decline course [33:05] of the day. There's a little bit of a [33:06] bump again and then it goes back down. [33:08] At night time it's low. And your body, [33:10] when it's sleeping, replenishes that [33:12] testosterone. And so, if you're getting [33:14] either less number of hours of sleep or [33:17] poor quality sleep, meaning you're you [33:19] know, you're not feeling very rested [33:21] when you wake up, that's a sign of poor [33:23] quality sleep. Both of those things can [33:25] dramatically affect your testosterone. [33:28] The other thing that you can do is [33:30] exercise and specifically resistance [33:32] exercise. So, doing high the the largest [33:36] muscle groups, so usually the lower [33:37] extremities, and using those have been [33:39] shown to boost testosterone more [33:42] significantly than any other type of [33:44] exercise. In fact, when you do [33:46] cardiovascular high intensity [33:48] cardiovascular endurance training, so [33:50] say you're doing [33:51] Ultramans, marathons all the time, long [33:54] long bike rides, long swimming, you [33:57] know, swimming for long periods of time, [33:58] that can actually increase your [34:00] cortisol, your stress, because your [34:01] body's having a stress response and that [34:03] can actually reduce your testosterone. [34:06] So, it's important to do cardiovascular [34:08] exercise, aerobic exercise, but in [34:11] moderation. Because we do see some [34:14] people who are great athletes who, you [34:16] know, run, you know, run miles and miles [34:18] and miles, but their testosterone is low [34:19] because they've been doing this chronic [34:21] long duration endurance exercise. So, [34:24] sort of hit training is fine, but it's [34:26] when you start doing these big Ironman, [34:27] thousand mile run things that the [34:29] cortisol suppresses the testosterone. [34:30] that's That's large percentage of [34:31] people, right? But it certainly, you [34:33] know, it's like I'm so healthy. I'm the [34:35] healthiest I could ever be and I'm [34:36] having low testosterone. Why is that? [34:38] And what about food and testosterone? [34:41] So, food, you know, there is a lot of [34:43] data on food. The one but the most data [34:45] is on the Mediterranean diet and that's [34:47] because that's the most well-studied in [34:49] medicine, but essentially having [34:52] vegetables, fruit, low low amounts of [34:56] processed foods, good healthy fats, nuts [34:58] and seeds. So, a lot of people don't [35:00] realize, but you need good fat to have [35:02] testosterone. Testosterone is a is a [35:05] production is in the cholesterol [35:07] pathways. And so, it comes from those [35:09] pathways. And so, you need to have some [35:10] level of fat. If you have too low fat of [35:12] a diet, that'll also affect your affect [35:15] your testosterone. So, ideally, what I [35:17] tell people is well, there's lots of [35:18] data on different types of diets. The [35:20] important thing to know is you want to [35:22] avoid processed foods, avoid avoid a lot [35:24] of sugar, and have good healthy fats in [35:26] your diet. What about, you know, I've [35:28] I've [35:29] I've heard a few times that testosterone [35:30] levels have been declining over the last [35:32] couple of decades in men. Mhm. Is this [35:35] true? Yes, it is true. So, we're not [35:37] only seeing a decline in testosterone [35:39] levels, but we're seeing a decline in [35:42] sperm quality and uh, sperm numbers. So, [35:45] the concentration of sperm and over the [35:48] course of the last 50 years. And there's [35:50] a lot of reasons for that. One is that, [35:53] you know, society has become more [35:54] sedentary. We're seeing people less [35:57] active, getting more and more metabolic [35:59] conditions like diabetes, high blood [36:01] pressure. These conditions then cause [36:04] endocrinologic abnormalities, they cause [36:06] problems with blood flow, and all these [36:08] things can affect the quality of your [36:10] sperm as well as the quality of your [36:13] testosterone production. [36:14] And then, also, there's more we we think [36:17] in the environments, we know there's [36:18] more [36:20] uh, microplastics and more endocrine [36:22] disrupting chemicals, right, in the [36:24] environment. So, that is probably [36:27] playing a role. Now, we don't have like [36:28] exact like exact quantitative data on [36:31] that, but we think that is probably [36:33] playing a role and reducing the exposure [36:35] to these endocrine disrupting chemicals. [36:37] So, we tell people try not to drink out [36:39] of plastic water bottles. Try to warm up [36:41] food in glass and avoid plastic. I mean, [36:43] these are easy things you can do, but if [36:45] you want to stress about the amount of [36:46] plastics in the environment, like [36:48] there's not much you can do as on an [36:50] individual level. So, I tell people do [36:51] the things you can control and the other [36:54] things sort of you know, we have to work [36:56] on as a society. Uh this is really [36:58] interesting cuz I I don't think I think [37:00] about this much, but removing chemicals [37:02] from my life in terms of what [37:05] these kinds of things. [37:06] Mhm. The I'm holding the metal mug in [37:08] front of me and then the plastic bottles [37:10] I drink from could be having an impact [37:13] on my [37:14] testosterone and my sperm count. It [37:16] could. I mean, like it's not everybody, [37:18] right? Think about how many people drink [37:19] from plastic water bottles, but if you [37:20] can do decrease your exposure, right? [37:22] It's probably additive. So, the more [37:24] exposure you have, the more likely it is [37:27] to impact your body. How do they know [37:29] this? Like how does anybody know that [37:31] chemicals are having an impact on our [37:32] sperm and testosterone? So, there's, you [37:34] know, there's basic science research [37:36] where they're looking at the impact of [37:37] these things on on rats and other [37:40] animals. And then also they're looking [37:42] on the amount of exposure [37:45] to things like phthalates in labs and [37:47] seeing how that it you know, we can't [37:48] it's all cause it's all correlation. We [37:51] can't say it's causative because we [37:52] don't we're not going to do a random I [37:53] study where you drink from water bottles [37:56] for 10 years and you drink from glass [37:58] water bottles for 10 years and let's see [38:00] what happens, right? That hasn't been [38:01] done. But they can say, "Okay, the more [38:04] your exposure based on whatever [38:06] biomarker we can assess, so maybe [38:08] urinary phthalates or other things, we [38:11] can say that okay, these people who have [38:12] more exposure to this are more likely [38:15] based on the data to have lower levels [38:17] of testosterone." And then, you know, [38:19] looking at the mechanisms of how they [38:21] interact with the production of [38:22] testosterone. And I'm not an expert in [38:24] those areas, but certainly there has [38:26] been sort of plausible mechanisms of how [38:28] these things work. [38:30] How has sperm count been decreasing over [38:33] the years? So, if you look at the last [38:35] 50 years, you'll see that the average [38:37] sperm count has declined almost 50%. [38:40] And luckily, the average sperm count is [38:43] still high enough for fertility rates. [38:45] The average sperm count is probably [38:47] around 50 million of of fathers, people [38:49] who father children. And so, it's still [38:51] above that, but it's certainly [38:52] significantly lower than it was 50 years [38:55] ago. And so, that's where we're [38:56] thinking, you know, it's it's probably [38:58] more of a global environmental factor [39:00] that's contributing to that in addition [39:02] to this increase in comorbidities and [39:05] poor health over time. [39:07] I mean, the direction of travel there is [39:09] deeply concerning because if something [39:11] declines 50% in the last [39:15] what, 50 years, did you say? Then if we [39:17] go forward another 50 years [39:19] and we assume the same rate of decline, [39:20] that means we'll be at 25% of where we [39:22] were 100 years ago. Yeah, and then what [39:25] what if you can't father children [39:26] anymore? And what if you can't have [39:29] offspring that will then propagate the [39:30] species, right? So, there's there's [39:32] certainly concerns there, and I think, [39:34] you know, we have to as a society do [39:36] better in terms of the things that we [39:38] can. So, we can control diet, we can [39:40] control exercise, we can control those [39:43] things. There's certain things that we [39:44] can't, [39:46] but we can try to control what our [39:48] people are exposed to in that can be on [39:50] a governmental level, right? Like having [39:52] sort of laws in place. So, we know in [39:54] the US there's less restrictions, [39:56] whereas in other countries there's more [39:57] restrictions on things like food [39:59] coloring and dyes that may have Again, I [40:01] don't I don't know the specifics, but [40:02] certain, you know, there's certainly [40:04] more restrictions in other countries [40:05] than in the US for some reason. And so, [40:07] maybe there needs to be a more critical [40:08] evaluation of where we can actually put [40:11] in place some things that would actually [40:14] have more wide widespread changes. [40:17] When we think about sperm count, we [40:18] often think about fertility. Um and [40:21] you know, I don't know whether this is [40:22] just because society has changed and [40:24] we're trying to have kids later, but it [40:25] does seem that people are struggling [40:26] more and more with fertility. I mean, [40:28] even in my own sort of circle of [40:29] friends, um there's, you know, there's a [40:32] couple people that have reported to be [40:34] struggling with fertility or that you [40:35] know, they're spending 12 months or 24 [40:37] months trying to have children. Do you [40:39] think this is linked to this as well? It [40:41] could be. I mean, when we know when we [40:43] look at fertility, we know that about [40:45] half of fertility is due to women, half [40:47] of fertility is due to men, and then [40:48] some combination of the two, right? So, [40:51] um [40:52] definitely as women age, fertility goes [40:54] down, and we know women are waiting [40:56] longer to have children. So, that's a [40:57] big part of it that society has changed. [41:00] Women are working and and prioritizing [41:02] their careers. It's not a bad thing, but [41:04] it certainly will affect fertility. And [41:06] and then yeah, there may be these issues [41:08] that are affecting male sperm counts [41:10] that are also causing issues, but I [41:12] don't know if there's any updated data [41:14] in terms of what are the causes or the [41:16] numbers in terms of fertility rates. [41:18] Fertility aside, is there any [41:20] correlation between our health outcomes [41:22] and our sperm volume? [41:25] Not volume, but concentration. [41:27] Uh so, volume is the amount of of of [41:30] right? So, concentration of sperm in the [41:33] semen is more of a predictor in terms of [41:37] um [41:38] sperm volume, not semen volume. Let's be [41:40] clear. So, sperm volume, sperm [41:41] concentration are sort of the the [41:43] biomarkers. And we would say that yes, [41:45] there is a correlation with overall [41:47] health in terms of uh sperm [41:49] concentration and sperm volume. Uh but I [41:53] think I don't want to make people [41:55] worried that if they truly have male [41:57] factor infertility, then now their [41:58] overall health is [42:00] uh is a problem, but it's certainly [42:02] important to be evaluated and seen by [42:04] your doctor regularly. [42:06] And on that point of um semen volume, [42:09] is there a way to increase that? And is [42:10] it similar to what you said about [42:12] increasing testosterone or is there [42:13] another set of sort of [42:14] um practices we can do to increase our [42:17] semen volume? Yeah, so semen volume is [42:19] variable depending on the biggest one is [42:21] how long has it been since you last [42:23] ejaculated, right? So, the longer you [42:25] delay between one ejaculation to the [42:28] other, the more semen volume you will [42:30] get. That's probably the most [42:32] predictive. You know, hydration can play [42:34] a role. So, if you hydrate more, [42:36] certainly you may see more semen volume. [42:39] Um sometimes it's a it's a low semen [42:41] volume because you're actually less [42:43] force of ejaculation. So, interestingly, [42:45] when you're young, the force of [42:47] ejaculate can be really really strong. [42:49] be up to 30 to 60 cm away. Like when you [42:51] ejaculate, that's how forceful it can [42:52] be. As you age, after about 50, it can [42:56] decline to 15 to 30 cm away. And so, [42:59] that can feel like you're having less [43:01] volume because it's less forceful. And [43:03] so, in those cases, that's because of [43:05] the pelvic floor muscles that are around [43:07] the urethra. Those muscles there that [43:09] help sort of propel the ejaculate out. [43:12] And so, you can strengthen those muscles [43:14] with again pelvic floor exercises, the [43:16] Kegel exercises. I caution people [43:19] because people are like, "Oh, they're [43:20] going to these Kegel exercises are [43:21] great. They're going to increase orgasm. [43:22] They're going to make my semen propel [43:24] further." And I think that's fine if [43:26] you're not having pain, you're not [43:27] having discomfort, and you're doing them [43:29] correctly. Because sometimes what we see [43:32] is it can actually cause harm if your [43:34] pelvic floor is tense, like we talked [43:35] about earlier. Or it can cause pain and [43:37] dysfunction if you're tensing tensing [43:39] tensing and not relaxing. And so, if you [43:42] don't know how to do them correctly, [43:43] then you could actually harm yourself. [43:45] Um but yes, they can improve semen [43:47] volume by the parameter of increasing [43:49] the force of ejaculate and getting more [43:51] ejaculate out that may be left over if [43:53] you're not having as forceful of a [43:55] muscular contraction. Does masturbating [43:58] improve my pelvic floor? Does it [44:00] strengthen my pelvic floor? So, that's a [44:02] good question. The orgasm is what [44:04] improves your pelvic floor. So, if you [44:05] masturbate and you orgasm, when you [44:07] orgasm, your pelvic floor contracts [44:11] involuntarily. You can't do anything [44:12] about it at a rate of about every 0.8 [44:15] seconds. So, it does contract and that [44:17] is sort of like a pelvic floor muscle [44:19] exercise. It's doing it involuntarily. [44:21] It's contracting for anywhere from 5 to [44:24] 60 seconds usually on average. And so, [44:26] you are sort of in that way increasing [44:29] pelvic floor strength. In fact, they've [44:31] looked at in women particularly is [44:34] orgasming as good as doing pelvic floor [44:36] exercises. And they've seen that you [44:38] know, you can see pretty measurable [44:40] improvement in pelvic floor strength if [44:42] you orgasm regularly. [44:44] Is it and it may be you know, [44:47] as good as doing Kegels depending on how [44:49] often you're doing it. So, yes, [44:51] orgasming itself can be very beneficial [44:53] for pelvic floor strength. One of the [44:55] big sort of myths that I've always I'm [44:57] yet to answer is the impact that our [45:00] technology is having on our genitals. [45:03] You know, there's kind of like a [45:05] pervasive myth that if you put your [45:06] phone next to your testicles, your sperm [45:08] count's going to drop. Like, whenever [45:10] I'm in the car [45:11] um and I don't know, I'm I'm sat there [45:14] or I'm sat at home somewhere and I get [45:16] my phone and I put it near my genitals. [45:17] My girlfriend has a go at me and she she [45:19] like pulls it out or tells me to pull it [45:20] out because I think she's worried that [45:22] we're not going to have kids if it's [45:23] down there. Yeah. Yeah. So, there is [45:25] there is a little bit of data there in [45:27] terms of you know, when you have these [45:30] devices like in your lap or near your [45:33] genitals, they will increase the [45:34] temperature. And so, when you the the [45:37] the testicles are in the scrotum for a [45:40] reason, right? It's because they need [45:41] this very perfect environment with this [45:43] specific temperature to create sperm. [45:46] And anything that disrupts that [45:48] temperature can cause cause [45:50] abnormalities in sperm production. So, [45:52] for example, when you have a fever, [45:55] because you have the flu or you have a [45:56] cold, people will get their sperm [45:58] checked to their semen analysis and they [46:01] will see that their sperm count is zero [46:02] because the temperature, the fever, has [46:05] temporarily stopped their sperm [46:07] production. [46:08] And so, you can see that, you know, [46:10] people also discuss like, "Oh, what [46:12] about boxers or briefs? What about [46:14] putting" And so, all of these things can [46:16] increase the temperature around the [46:19] scrotum, which can then cause changes in [46:21] sperm production. So, I tell patients, [46:23] particularly if you're trying to have [46:25] babies, is put your phone in your back [46:26] pocket, in your chest pocket. Don't put [46:28] your computer, your laptop right on your [46:30] lap, right? I mean, it's easy enough to [46:32] do, and it does increase temperature. [46:35] So, absolutely, yes, these things can. [46:38] Not for everybody, right? There's people [46:40] So, we say people like you shouldn't [46:41] smoke a lot of marijuana when you're [46:42] trying to get pregnant because marijuana [46:44] can cause problems with sperm [46:46] production. But, you'll see people who [46:48] smoke every day, and they still have [46:49] babies. Or, you'll see people who do all [46:51] of these things, right? They they wear [46:53] briefs, they they put their phone on [46:55] their in their pocket, they put their [46:56] laptop on their lap, and they still have [46:58] babies. So, it's not a all all comers, [47:00] but certainly things that you can easily [47:02] just avoid putting near your genitals. [47:04] Well, if I'm in the sauna every day or [47:06] if I'm in a I'm a steam room every day [47:09] isn't that going to have an impact on my [47:10] sperm count? Yeah, it does. And it's [47:12] interesting because there's a I think [47:14] we'll see more of this as we're seeing [47:15] the rise of I mean, there's benefits to [47:17] saunas, no doubt, but as we're seeing [47:19] the rise of people really doing saunas [47:20] all the time, um there can be So, we [47:23] tell people when they're trying to have [47:25] pre- if they're having fertility issues, [47:26] don't go in hot tubs. Don't go in saunas [47:28] because it could affect your sperm [47:30] production. So, those are sort of the [47:31] the conservative things we tell people [47:33] to do. [47:34] Interesting. And this this point about [47:36] the phone next to the genitals, it's not [47:37] because of like the Wi-Fi and the [47:39] Bluetooth are going to like zap my [47:40] babies. No, I mean, there's some there's [47:42] some question about that, but we don't [47:44] know. I don't think we know, but we know [47:45] there's a temperature increase, right? [47:47] Because phones get hot. We talked about [47:49] masturbation briefly. Um one of the big [47:51] questions that people often ask me when [47:53] I'm speaking to someone that has [47:55] expertise on sexual health is [47:57] about masturbation and whether it [47:59] decreases your testosterone levels. So, [48:01] it does not. There is one study and it [48:04] was done in 10 men who abstained from [48:08] masturbating for 21 days. And these are [48:10] young, healthy men, right? And so, this [48:12] is where I think everyone gets their [48:14] data from is this one study. And so, [48:16] they took their testosterone before, [48:17] they took their testosterone after. At [48:20] And what they found was that there was [48:21] an increase by about 50 50 nanograms per [48:24] deciliter 0.5 um was which is the 50 [48:27] nanograms per deciliter, which is not a [48:28] huge amount. Um at 21 days. But we know [48:32] that testosterone changes all the time. [48:35] And two, there's a lot of anticipatory [48:36] cues. When you've been waiting to [48:38] masturbate for 21 days, like your brain [48:40] is is really excited. There's all these [48:41] like, "Okay, I'm finally going to get to [48:43] release." And that in and of itself can [48:45] increase testosterone. So, generally [48:47] speaking, there's no empiric evidence [48:49] that is convincing, high-quality level [48:52] evidence that masturbating or abstaining [48:55] from masturbation will increase [48:57] testosterone. And so, there you know, [49:00] people do report other benefits. And so, [49:02] I tell people, "If you're getting other [49:03] benefits from abstaining, by all means, [49:05] go ahead. But don't do it for Don't like [49:08] white-knuckle it to gain some [49:10] theoretical increase in testosterone [49:12] that one was not even that large and [49:14] two, it's probably not going to be [49:16] proven in a larger sample." What about [49:18] the opposite then? Is too much [49:19] masturbation going to have an adverse [49:21] effect on us for men and women? Yeah, so [49:24] I think it you know, what I tell people [49:25] is masturbation is generally safe as [49:28] long as you are not masturbating to the [49:30] point where you are now choosing to [49:32] masturbate over doing anything else. So, [49:34] you're choosing to masturbate rather [49:35] than have sex with your partner. You're [49:36] choosing to masturbate over going to [49:39] work or you're I'm going to be a little [49:40] late to work cuz I want to finish [49:41] masturbating. Or you literally can't [49:43] sleep without masturbating every day. [49:45] Like those are things you become reliant [49:47] on this particular activity for the [49:50] enjoyment that it provides. Um that's [49:52] when it becomes a problem. But if you're [49:54] using it in terms of like, I'm [49:56] masturbating to get orgasm and the [49:58] benefits of orgasm that I do achieve [50:00] from that because maybe my partner [50:02] doesn't want to have sex or maybe I have [50:04] more of a sex drive than my partner or I [50:06] don't have a partner. Like let's be [50:07] realistic. Like if you don't have a [50:09] partner, you're going to have to if you [50:11] want to orgasm, you're probably going to [50:12] have to masturbate. And so I think the [50:14] problem also comes in is when people [50:17] only masturbate the same way every time, [50:20] they only watch a certain type of erotic [50:22] film or they do the same thing every [50:23] time and their body habituates to that [50:25] and then they have a difficult time [50:27] climaxing with a partner because they [50:29] can't replicate what they're doing, [50:31] whether what they're watching or how [50:32] they're doing it with a partner. Are we [50:34] teaching ourselves something there? Are [50:36] we teaching ourselves how we're aroused [50:38] and how we orgasm? Yeah, your brain is [50:40] very powerful, right? So when you're [50:41] doing the same thing every time, your [50:43] body's like, oh, this is what turns me [50:44] on. This is what makes me orgasm. And [50:46] then when you're with a partner, you're [50:48] like, oh, I'm not getting that same kind [50:49] of stimulation. And so it doesn't happen [50:52] to a lot of people, but I would say [50:54] certainly I see people where this does [50:56] happen. And so [50:58] you know, you have to sort of take a [50:59] break and and sort of re-evaluate and [51:01] try different things and get your body [51:02] to habituate to different things, which [51:04] takes a little bit of work. Um but sort [51:07] of keeping it varied can be helpful. [51:10] Another big myth, masturbation will make [51:11] me go blind. Yeah, no. There's literally [51:13] I don't know where that came from. [51:15] There's like hairy palms, blindness. [51:16] Like I don't know where I think this is [51:18] all sort of like from religious rhetoric [51:21] that says, you know, you should not [51:22] masturbate. Um and and it, you know, [51:26] where that came from, you know, is a [51:27] whole other story, I think. [51:29] What do you think of this idea of No Nut [51:30] November? [51:32] Yeah, so I think it's I'm not a fan. The [51:34] reason being is because I think it makes [51:36] people feel like it's something they [51:37] have to do. And if you want to, like I [51:40] said, if you find benefit from [51:42] abstaining from ejaculating for 30 days [51:44] or 28 days or whatever it is, [51:46] um [51:47] then by all means, like go ahead. If you [51:49] want to try something, there's no harm [51:50] in it. But I think a lot of people, what [51:52] they do is they feel like it's something [51:53] that's going to bring them to some [51:54] higher level, and they're going to [51:56] become this great person because they're [51:58] able to to to conquer this goal, but [52:01] they're like literally miserable. So, [52:03] they're [52:04] um they're just clenching their pelvic [52:05] floor all the time because they're [52:07] stressed about how they're not [52:08] ejaculating. They may ejaculate at [52:10] night, and so they'll have a nocturnal [52:13] emission, and then they'll feel so bad [52:15] because they failed. It's nothing you [52:16] can control. Nocturnal emissions are [52:18] physiologic. They're totally normal, and [52:21] 86% of men have had a wet dream at some [52:23] point in their lifetime. Like it's very, [52:25] very common, and more likely the longer [52:27] you are from ejaculating. So, um your [52:30] body will take care of the ejaculate if [52:32] you ejaculate or not. So, you will [52:34] either resorb the semen, or you'll [52:36] ejaculate at night. And so, if you want [52:39] to do it because you feel like, "Okay, I [52:40] have a challenge. I want to conquer it. [52:42] I want to see if I can do this," and you [52:43] feel better because you're not you're [52:45] able to like not focus on sexual [52:47] thoughts, or you're able to really um [52:50] find some other level of spirituality or [52:52] something, by all means, go ahead. I [52:54] don't have a problem with it. What I [52:55] have a problem with is making people [52:57] feel bad because they can't do it, or [52:58] they don't want to do it. And with [53:00] people feeling forced, or feeling like [53:02] they need to do it to prove something to [53:03] someone else. [53:05] Yeah, cuz I mean, the way that I've had [53:06] it explained to me is that it's some [53:08] something about semen retention gives [53:10] you some clarity of mind or something. [53:12] Cuz a lot of athletes, before they have [53:13] their their big fights, so you know, [53:15] their bigger sort of Olympic [53:17] competitions, they all abstain from [53:19] masturbation. I I often hear in the UFC, [53:21] for example, the um [53:23] the mixed martial arts fighting [53:24] championship, that athletes have not had [53:28] sex or not ejaculated for 2 weeks before [53:30] a fight, or 4 weeks before a fight. [53:32] Yeah, so there's a lot of rhetoric [53:33] there, I think, that comes from [53:35] um [53:36] historical. So, even in Greek in Greek [53:39] times, they would tell people to avoid [53:41] having sex or masturbating prior to, you [53:44] know, big fights or or just whatever [53:47] sport they were playing. And so, is it [53:49] true in data? So, if you look at the [53:51] studies that have looked at people [53:53] performing athletic feats, whether it's [53:55] like cycling or running or whatever, um [53:57] they have not found that abstaining from [54:00] ejaculation actually changes their [54:03] ability to perform. And so, in those [54:06] cases, I say, well, there's no true [54:08] scientific evidence that we have that [54:10] it's going to improve. And in fact, if [54:11] you are someone who, for example, has [54:13] sex every morning or masturbates every [54:15] morning for whatever reason, that's a [54:16] part of your routine, disrupting the [54:19] routine can actually be harmful to [54:20] performance. [54:22] And sometimes the one thing you can say [54:25] is in terms of disrupting performance is [54:26] that after you masturbate, you do see an [54:28] increase in heart rate a little bit. Um [54:30] you have a rebound increase, it [54:31] decreases, and then you have a rebound [54:32] increase in heart rate that can slightly [54:35] affect your ability to recover from [54:37] performance. But ultimately, I think if [54:39] you find benefit from it because people [54:41] report feeling more aggressive with [54:43] abstaining, then by all means, if you [54:45] find it helpful, I think it's fine. But [54:46] is it mandatory? I don't think so based [54:48] on the evidence we have right now. Cuz I [54:50] I I heard that rumor many years ago, and [54:52] I think I assumed it was correct. I I [54:54] heard the rumor, and this was the sort [54:56] of evolutionary story that was attached [54:57] to the rumor, was that once upon a time [55:00] when we were out, I don't know, looking [55:02] for um a sexual partner, we would need [55:05] to be more articulate and more [55:07] persuasive and more, you know, [55:09] attractive, basically. Mhm. So, we were [55:12] at optimal attractiveness before we [55:14] ejaculated. Then after we've ejaculated, [55:16] that kind of energy goes out of us and [55:17] recharges and rebuilds again. [55:19] So, I was when I heard that, I thought, [55:21] okay, so if I'm speaking on stage or I'm [55:23] doing a podcast, I want to make sure [55:25] that I'm, you know, my mouth and my [55:26] brain are attached, I'm articulate, I'm [55:28] persuasive, whatever I need to be. So, [55:30] don't ejaculate or masturbate [55:33] anytime before doing anything where I [55:34] need to use my brain and my mouth. [55:36] Well, you know, some people describe [55:38] post-nut clarity, right? So, they [55:40] actually, on the alternative, feel like [55:42] And there's no good data on this. The [55:44] data we have is on people, the very [55:46] small subset of people who have post-nut [55:48] postcoital not post-nut postcoital [55:50] dysphoria. So, they actually feel bad. [55:52] But in terms of clarity, [55:54] um you know, some people do like when [55:56] you're trying to you're motivated to get [55:59] a partner, right? You're sort of um [56:01] trying to uh woo them, you're really [56:04] focused on that one singular effort that [56:07] once you've obtained that, that the like [56:09] very singular focus goes away, and now [56:11] other parts of your brain can be [56:12] activated to then be used for Some [56:15] people will describe being more [56:16] productive, more able to get work done [56:18] after uh masturbation. It's very [56:20] individualized or ejaculation, whatever [56:22] it is. [56:23] Post-nut clarity. [56:25] I've never heard anybody talk about this [56:26] before, and I've also been told over the [56:28] years that it's something that just men [56:30] experience predominantly. And for anyone [56:32] that doesn't know what post-nut clarity [56:33] is, the definition that I understand is [56:35] and that I have experienced, I'm going [56:37] to be honest, is that after ejaculation, [56:39] your desire for the other person reduces [56:43] quite significantly. And there's a [56:44] stereotype here that women don't [56:46] experience this post-nut clarity in the [56:48] same way. Now, if I asked all of my male [56:50] friends, if I said to them, "Has there [56:52] ever been a time in your life where you [56:53] were maybe texting someone you were [56:56] attracted to or, you know, had so- some [56:58] sort of sexual attraction to, and then [57:00] you masturbated, [57:01] did your desire [57:03] um diminish after you masturbated for [57:05] that person that you were just texting?" [57:07] I think about 90% of my male friends [57:09] would say, "Yes." [57:10] Yes. And they'd describe it as if [57:12] someone like took [57:14] some like sunglasses off them. Like a [57:15] pretty extreme sudden change. [57:18] And I've always wondered about this, [57:19] whether this is just men, if it's just [57:20] women, why it happens. [57:22] So, when you look at brain studies, [57:24] right, of people having orgasm, and what [57:27] happens is when you have an orgasm, like [57:28] your whole brain lights up, right? [57:30] Because your heart rate goes up, your [57:31] blood pressure goes up, like your pupils [57:33] dilate. So, all these different parts of [57:34] your body are working, so your whole [57:35] brain lights up. And then after orgasm, [57:38] it it it gets very, like, quiet. And so, [57:41] we see that in women it may take a [57:43] little longer to get really quiet, and [57:44] men it happens very quickly. And this [57:46] may be associated with sort of the [57:48] hormonal changes that occur after [57:51] orgasm. So, we know that prolactin [57:53] increases after orgasm, dopamine [57:55] decreases, and there's sort of some [57:58] evolutionary theories about why this [57:59] happens. So, one is after you ejaculate, [58:01] if you are having ejaculation with a [58:03] woman, then you don't want to have sex [58:05] again to then the same thing with the [58:07] refractory period, right? That there's [58:08] some period of time where you're not [58:09] going to want to have sex again, or you [58:11] can't have sex even if you want to. And [58:13] this is because evolutionarily, if you [58:15] deposited your ejaculate into a woman, [58:18] if you then had sex again, you could [58:19] actually dislodge the semen, and then [58:22] you would have less ability to [58:25] to have fertilize an egg, right? And [58:27] then the other thought is that you don't [58:29] want to become overly exhausted, right? [58:32] So, that if you if you had the unlimited [58:34] capability to have sex over and over [58:36] again, that exhaustion could be a real [58:39] thing, like and so you're sort of a [58:40] protective mechanism. [58:42] And so, those are sort of the theories [58:44] as to why this is, and there is like an [58:46] absolute refractory time where like you [58:48] don't want sex at all, and then there's [58:50] a relative refractory time where if you [58:53] had a really novel or strong stimulus [58:56] for sexual activity, that you would be [58:58] able to. In terms of the clarity, in [59:02] because we know there's a little bit of [59:03] differences in brain, [59:04] it may not be as obvious in women in [59:07] terms of it takes them a little longer [59:09] to have that coming down after the [59:10] orgasm from the brain activity, [59:13] but probably there is some, we just [59:15] haven't studied it enough. And I always [59:16] say this that when we look at studies [59:18] for women's sexual health and men's [59:20] sexual health, they're so lopsided. So, [59:22] if you type in penis in like a in like a [59:25] search engine for Google or for the [59:28] PubMed, which is where you look up [59:29] research articles, you're going to find [59:31] 50,000 articles. [59:33] If you look up clitoris, you're going to [59:34] get 2,000 articles. So, it's very [59:36] lopsided in terms of what we study um [59:39] for sexual function. And in it in of [59:40] itself, sexual function by many people [59:43] is not seen as mandatory or important [59:45] for health, and so the funding is less [59:47] often available for sexual health. [59:49] That's why we have such little data in [59:50] some areas. Going back to just closing [59:53] off from the point about masturbation, [59:54] is there a link between masturbation and [59:56] prostate cancer? Because I've I've heard [59:58] a lot of different things about it. Um [60:00] some people think that over masturbation [60:02] is causing prostate cancer, and some [60:03] people say the opposite. Yeah, so [60:05] there's actually a really good study um [60:08] that was done looking at ejaculation [60:11] frequency and prostate cancer. And it [60:13] was a very well-done study. They tried [60:15] to control for a lot of other factors. [60:17] And so, what they found was that men who [60:19] ejaculated 21 times or more a month were [60:22] less likely to develop prostate cancer. [60:25] This is just a statistical number. It is [60:27] not a number that sort of um means [60:30] anything in terms of But we're seeing [60:31] that like, okay, so more masturbation [60:33] may help. Why is that, right? So, there [60:35] may there's a prostate stagnation [60:37] hypothesis that the fluids that, you [60:39] know, some of your ejaculate fluids come [60:41] from the prostate. And so, when you're [60:42] ejaculating frequently, you're more [60:44] often re- getting rid of that fluid and [60:47] sort of re-replenishing it or cleaning [60:49] the pipes, so to say. So, [60:51] that may be beneficial in terms of [60:54] preventing prostate cancer. Now, do you [60:57] have to masturbate or ejaculate or have [60:59] sex 21 times a month? Um no. But, you [61:02] know, there could be a benefit, yes. And [61:04] so, uh having a healthy And it may be [61:07] that those people who had sex more often [61:10] or ejaculated more often were just [61:11] healthier in other ways, right? They [61:12] were able to have sex more often or [61:15] masturbate more often because they were [61:17] uh [61:17] you know, sufficiently healthy to do so. [61:19] And so, they I mean, while they tried to [61:21] control for those things, there's always [61:22] sort of uncontrollable variables that [61:24] come into those sort of studies. Yeah, [61:26] that's what I was wondering is is there [61:27] another like glaringly obvious factor [61:29] that those people had more [61:30] relationships, therefore their mental [61:31] health was better, that therefore X Y [61:33] and Z. [61:33] they tried to control for comorbidities, [61:36] but again, there there I don't think [61:37] they controlled for I mean, they [61:39] controlled for marriage, I believe. [61:41] Um, but I'm not sure that they [61:42] controlled for like in a relationship [61:44] versus not and how healthy that [61:45] relationship is, that certainly wasn't [61:47] assessed. I'll link to the study below [61:49] so everyone can read it for themselves [61:50] about the controls in that study and how [61:52] that was conducted. [61:54] Linked to this is is the subject of [61:55] porn. Um, it was interesting cuz I was [61:57] doing a lot of research on the subject [61:59] of [61:59] That sounds a bit strange. I was doing a [62:01] lot of research on the subject of porn [62:03] and where conversations at with the [62:05] subject and one of the quite startling [62:07] things is a lot of people are trying to [62:09] figure out how to stop watching porn. [62:12] Um, a lot of people are asking [62:13] themselves [62:15] for mechanisms to [62:18] um, install things on their computer [62:19] that prevent porn time and um, searching [62:22] for [62:23] solutions around porn addiction. [62:25] And a lot of people were searching um, [62:28] about whether porn is a sin. And I think [62:30] there's something broader here about the [62:31] idea of shame Mhm. which is linked to [62:35] porn. What is your take on on this? Is [62:37] porn a bad thing? [62:38] Yeah, so I don't think porn is a bad [62:40] thing. I will start with that. Um, is it [62:42] a sin is more of a moral question, [62:45] right? And I think that that is [62:47] uh, something that you individually have [62:48] to decide for yourself if you feel like [62:50] morally it's inappropriate, but it's [62:52] it's entertainment, right? It's just a [62:53] different form of entertainment and I [62:55] think the issues with porn, [62:57] um, because I would not say that it's [62:59] 100% great. I think there are definitely [63:01] issues with it. One, the big one that [63:03] I've been very vocal about is children [63:04] seeing pornography. So, um, we know now [63:07] that the average age of a boy seeing [63:09] pornography is 13 and that's the [63:11] average, meaning that as young as eight [63:14] to 10, boys are being exposed to [63:15] pornography, [63:17] um, which was not the case when for [63:19] example, we were growing up, right? You [63:20] had to I I always say this, you had to [63:23] find a [63:24] a tape maybe, find a VCR in a room that [63:26] nobody was going to walk in, or you had [63:27] to find a magazine and hide it somewhere [63:29] and go find it. And so it was not [63:31] readily available. You had to work to be [63:33] able to see that. And now, seeing [63:35] pornography is very readily available. [63:38] And so, [63:39] very often kids are seeing it. Whether [63:41] you as a parent don't want them to, [63:43] whether you've put blocks on their [63:44] phones and devices, [63:46] they may have access to it from a [63:48] friend, or they may see it somewhere [63:49] else. And [63:51] and your brain is not fully developed to [63:52] understand one, what you're seeing, and [63:54] two, to understand that this is not [63:56] real, unless your parent has talked to [63:58] you about, you know, this is sort of a [64:01] movie that's not real life, and this is [64:03] not what sex is really like. And so I [64:05] think that has implications for for how [64:09] they view sex, and how they then try to [64:12] have sex with partners. And also, you [64:15] know, because your brain's not fully [64:16] developed, you're getting this big rush [64:18] of dopamine from viewing something like [64:21] that, and that's not something that we [64:22] traditionally got at that age, right? [64:24] And so it can become very addictive. [64:27] Now, as an adult, I think it's different [64:29] because you have a fully formed brain, [64:30] you understand the concept of this is [64:33] not real, most people. [64:35] And so it can be just a way to have [64:37] pleasure, and even watch it with your [64:39] partner and have pleasure. [64:41] But yes, we are seeing some people who [64:43] have problematic pornography use. In the [64:46] literature they say it's 4%. I suspect [64:48] maybe it's a little higher now, [64:50] where people are finding that watching [64:52] pornography is is one easier than going [64:55] out and trying to find a partner. You [64:57] don't have to face rejection, you don't [64:58] have to face the difficulties and [65:00] awkwardness of having a first a sexual [65:02] encounter with someone that often [65:04] happen. And so it can become a way, [65:07] because it does relieve dopamine just [65:09] like anything else, it relieves [65:11] dopamine, it can then become sort of a [65:14] way to feel better about anything, [65:15] right? Like you can just be feeling down [65:17] and like I want to watch pornography [65:18] because it makes me feel better. It may [65:20] not be just that you're really into sex, [65:21] it's just that you're really like [65:22] wanting that rush hit of dopamine. [65:25] Um and then there's obviously the shame [65:28] that comes with oh my god, why am I [65:29] using pornography just because I feel [65:31] bad? And then you're like, oh, but I [65:32] feel bad and so I'm going to use porn [65:33] again and it becomes a sort of like [65:35] negative vicious cycle that can occur. [65:38] But I think when used for entertainment [65:40] and pleasure, I think it's fine and [65:42] many, many people use it for [65:44] entertainment and pleasure without a [65:45] problem. [65:47] I the other day bought the Apple Vision [65:49] Pro. Mhm. That new headset and I tell [65:50] you what, Jesus Christ, that's [65:52] unbelievable piece of technology. This [65:54] one feature they have on there is called [65:56] spatial video. Mhm. And I don't know if [65:57] you've tried it yet, but you put it on [65:59] and if you've taken a spatial video, [66:01] which you can now take on the new iPhone [66:02] and also on the Vision Pro, it basically [66:05] feels like a 3D video. Yeah. And it's [66:08] like nothing I've ever experienced [66:09] before. One of our team members [66:10] commented that, you know, they they lost [66:12] a family member and they wish they had [66:14] this because it it's like the person is [66:15] back in front of you. It's not like a [66:17] photo or video anymore. But then [66:20] little monster in my mind goes, "Hm, [66:22] there's going to be other applications [66:23] of this technology and as it relates to [66:25] pornography. And we're getting you know, [66:27] if we just assume any rate of [66:29] improvement with this technology, just I [66:30] don't know, 5% a year, we eventually get [66:33] so close to being indistinguishable from [66:36] a human being that the incentive [66:38] structure of going out and getting a [66:40] date and you know, for the for the [66:42] objective of having sex or whatever [66:44] versus just popping your headset on, [66:46] which is going to get cheaper and [66:47] cheaper and cheaper and better and [66:48] better and better, [66:49] um [66:50] becomes really [66:52] lopsided. I [66:54] it's so clear to me [66:56] that if we just go forward 10 years and [66:58] we're on the Apple Vision Pro 17 [67:00] air, [67:02] there's going to be so many people that [67:04] are using that as a the to [67:05] uh [67:06] masturbate and to watch pornography [67:09] and it's and it's going to reduce the [67:10] amount of people that are seeking real [67:13] intimate relationships IRL, in the real [67:15] world. Yeah, it is a real concern, I [67:18] would say, but you know, we know from [67:20] some data that people [67:23] will find physical touch, particularly [67:25] in like hair bearing areas, [67:27] um [67:28] very important in terms of intimacy with [67:30] a partner. So, um intimacy in general, [67:34] and so I I can only hope that that will [67:36] continue, that you will want physical [67:38] touch, because no matter what you can [67:39] see with your eyes, um it's not touching [67:42] you. It's not like it's still you doing [67:45] the touching. There's no element of [67:47] surprise or excitement or build up in [67:50] terms of like there's someone else in [67:53] the room with you, right? So, I can only [67:55] hope that that that will that will be [67:56] the case, but it still remain to be [67:58] seen. However, I will share there's some [68:00] interesting um applications of this in [68:03] terms of fear. So, if you are really [68:06] scared of something, you can actually [68:09] desensitize yourself using these VR [68:12] headsets, and it can actually be very [68:13] powerful. So, I was just speaking to a [68:15] researcher, Lori Brotto, about how [68:17] they're using it in their lab for women [68:19] who have fear of penetration, because [68:22] they've had either trauma or they have [68:25] other conditions that are causing it to [68:26] be painful, and so they can work with [68:29] them to be using these headsets to [68:32] simulate a sexual experience, and then [68:35] they can sort of use a dial like use a [68:37] tool or a dilator or something to then [68:39] penetrate in a safe space, right? Not [68:41] like you're with a partner and you're [68:42] like trying to have sex and you're, you [68:44] know, you don't feel very safe sort of [68:46] allowing that. It's very preliminary [68:49] research, but I think ultimately there [68:51] are some positive things that maybe will [68:53] come out of the use of these sort of VR [68:55] headsets, and I can only hope that that [68:57] will predominate and we can continue and [69:00] people will inherently want other [69:02] people, right? That's We're We're [69:04] hardwired to be around people and to be [69:06] intimate with people. Like that's how [69:08] our brains work. So, I'm hopeful that [69:10] that will that will still remain to be [69:12] the case. But I can't I can't predict [69:14] it. [69:14] don't look convinced. [69:17] Well, you know, I mean [69:18] I think it's I I am worried, you know, I [69:20] think that phones have changed lives, [69:22] too, right? Like now our kids Our [69:24] younger generation doesn't communicate [69:26] as well because when they hang out [69:27] together, they're sitting all together [69:28] looking at their phones, right? And so, [69:30] we have to actively work to prevent Like [69:33] I make my kids have full-on [69:34] conversations with people. I say, "You [69:36] got to come and hang out with the adults [69:37] and have conversations and and talk to [69:40] people." And we have to coach them on [69:41] how to talk to people, [69:43] um because I worry that people are too [69:45] into Even when they hang out with their [69:46] friends, they're playing on devices, [69:47] right? So, [69:48] um [69:49] I think there's like work that has to be [69:51] done to prevent [69:53] the [69:54] the the easy dopamine rushes that these [69:58] devices are giving us, right? So, we [69:59] actually have to actively work at it and [70:01] people are inherently going to take the [70:03] route of of the easiest thing. And so, [70:06] as a society, we have to sort of work [70:08] together to sort of prevent these easy [70:11] wins, easy things, easy dopamines from [70:13] taking over. [70:14] Something you mentioned within there [70:16] there was the idea of trauma. [70:17] And I've I'm quite interested in the [70:19] role that our trauma plays in our sexual [70:22] health and sexual dysfunction. [70:24] What's important to know there? And does [70:26] trauma play a role at all in the [70:27] patients you see? [70:28] 100%. So, your body, when it goes [70:32] through a trauma, [70:34] it will then sort of your body remembers [70:37] even if you don't, right? So, these [70:39] people Very many people who have pelvic [70:41] floor dysfunction, meaning their pelvic [70:43] floors are too tight or too tense, [70:45] they've had some sort of trauma. Not all [70:47] of them. Some of it's just stress and [70:48] anxiety, but sometimes they've had some [70:50] sort of trauma years ago and it's been [70:54] with I had a I remember having like a [70:55] 70-year-old woman and she had such [70:59] terrible pelvic floor dysfunction for [71:01] God knows how many years that ultimately [71:03] it caused really negative consequences [71:05] for her bladder function. And um and so [71:08] absolutely when you have a trauma that's [71:11] unresolved in some shape or form it will [71:14] affect you whether it's your mental [71:15] health, your physiological health. I [71:17] mean, our brains are so powerful that [71:20] you know, when it's in a bad place, it [71:22] can affect you negatively. When it's in [71:24] a positive place it can affect you more [71:26] positively. The one thing I will say is [71:27] if you have trauma, getting therapy, [71:30] getting help to resolve that trauma is [71:32] so so important. I talk to all my [71:34] patients and I say, yes, you may have an [71:35] organic problem meaning a physiologic [71:37] bodily problem that's causing your [71:39] sexual dysfunction. But everyone who has [71:42] sexual dysfunction [71:44] has a psychological component because it [71:46] is devastating. It is stressful. It is [71:48] horrifying to feel like you're not [71:51] normal, your body doesn't function [71:52] normal especially in an intimate space [71:53] like sex. So I'm like everybody should [71:56] ideally see a sex therapist if it was [71:58] available to everybody, but it's not, [71:59] right? How can we allow people to have [72:01] access to things they need because we [72:03] don't teach these things in school, [72:05] right? School, I mean, this is my big [72:07] gripe is like how can we make education [72:09] better for children? Like we need better [72:11] sexual education. We need better [72:13] education on how to resolve traumas or [72:15] how to deal with them or how to get [72:16] help. How to do digital health? Like how [72:18] do you navigate the world with all this [72:20] misinformation? How do you find good [72:22] quality information? How do you assess [72:24] it? Like there's so many things even how [72:26] to balance your books, right? They don't [72:27] learn that in school. So ultimately [72:29] there's so many things I think if we [72:31] were really putting a critical eye on [72:33] how we teach our young people that we [72:35] could improve. And part of that would be [72:38] including people to know and realize [72:41] when they need help through whatever [72:43] trauma they've suffered or stress or [72:44] anxiety that they're suffering and how [72:46] that can [72:47] propagate itself over a lifetime and [72:49] create real problems. [72:51] I have to ask this question [72:53] cuz people [72:54] mention this quite often. Can you have [72:56] sex while you're pregnant? Absolutely. [72:59] Why not? [73:01] I ask it because it was one of the most [73:02] Googled questions um online. Really? [73:05] Yeah, it was [73:06] one of the highest search volumes I've [73:08] ever seen for a search term was can you [73:09] have sex while pregnant? Wow. I actually [73:12] didn't I mean I I [73:14] I've heard a lot of things and I think [73:16] that people feel like I've heard that [73:18] men think they're going to hurt the [73:19] baby. They're going to [73:22] um they're going to cause a problem. But [73:24] no, absolutely. You can have sex. You're [73:25] not going to create like a preterm [73:26] labor. You're not going to harm the [73:28] fetus. Like nothing bad is going to [73:30] happen from having sex while pregnant. [73:33] Okay. So let's talk about orgasms and [73:35] the clitoris then. You mentioned earlier [73:36] that um there's [73:38] disproportionately a lot less research [73:40] done on the clitoris. [73:42] As a man, what do I need to know about [73:43] the clitoris? Cuz I I'll be honest, I [73:45] know very little. I know where it is. [73:47] That's a that's a plus. [73:50] Well, I I didn't [73:51] knows that either. [73:52] always know where it was. Uh couple of [73:54] misunderstandings, but um [73:55] I found I found it eventually and I I [73:58] think I know how to stimulate it, but I [73:59] don't really know what's going on there [74:00] or how it works. Okay. So what I tell [74:03] everybody and what men can think of is [74:05] the clitoris is like the penis. So when [74:08] you are a fetus, there's a thing called [74:10] a genital tubercle. Before you're [74:12] assigned sex, that genital tubercle, [74:14] when you're when you become a man, that [74:16] genital tubercle becomes the penis and [74:18] the shaft and the glans. And in a woman, [74:20] it becomes the clitoris. And the [74:22] clitoris actually then goes deep into [74:24] the pelvis [74:25] um just like the penis. It has a shaft [74:28] in the pelvis and then it goes around [74:29] the vaginal canal. And so you can the [74:32] clitoris is just as sensitive as a man's [74:35] penis, right? So if you stimulate the [74:37] clitoris like your penis gets [74:39] stimulated, then it will lead to orgasm. [74:42] And it's probably the most reliable [74:43] route for orgasm for women. So 85% of [74:47] women need some form of clitoral [74:48] stimulation to climax. And so, many [74:51] women have difficulty climaxing through [74:53] vaginal penetration alone. That's not [74:55] that they're broken or something's wrong [74:56] with them. It's just that they don't. [74:58] And because the stimulus from the [75:00] clitoris is so strong, it leads to a [75:02] very reliable route for orgasm. Now, how [75:05] you stimulate it is sort of very [75:07] individually specific. But, typically [75:10] oral stimulation, vibratory stimulation, [75:14] manual stimulation, all those things can [75:16] work. But, that's where the [75:17] communication comes in, where it like [75:20] the partner, ideally, would know what [75:21] they like and could tell you. [75:23] Um or they you could check. Like, does [75:26] this feel good? Does this feel good? Do [75:27] you like this? Is this, you know, or and [75:29] you know, and so that's sort of again a [75:30] challenge because the communication [75:32] issue we've talked about this whole this [75:33] whole talk. But, um that is really [75:36] what's important. Now, the clitoris, [75:37] like I said, it it goes um deep uh above [75:41] the vagina and around it. So, people can [75:43] still get clitoral stimulation through [75:45] penetration, um depending on how you [75:48] stimulate. Now, the other areas that are [75:50] important for orgasm are the G erogenous [75:54] zone. It's actually not a spot, it's a [75:56] zone. And that's where, essentially, if [75:58] you go look at the vagina on the [76:00] anterior wall, which is the top of the [76:02] vagina underneath the urethra where the [76:04] pee comes out, about 2-3 cm in is called [76:06] the G erogenous zone. [76:08] It's named after the person who um [76:11] identified it. I think it's Grafenhaus [76:13] or something like that. But, um [76:14] essentially, that area is full of [76:17] certain nerve endings as well as the [76:19] female prostate or the Skene's glands. [76:21] And so, those are areas that are quite [76:23] erogenous and that uses a different So, [76:25] the clitoris is innervated by the [76:27] pudendal nerve. The G erogenous zone is [76:31] innervated by the hypogastric nerve. So, [76:32] a different nerve. And then, the cervix [76:35] is the last area where sometimes women [76:37] feel a lot of stimulation. And that's [76:40] innervated by the vagus [76:42] So, all these different areas can lead [76:45] to orgasm for women and they can be [76:47] added. So, if you're stimulating all [76:48] three, you might have a more strong [76:50] orgasm and the orgasm may feel a little [76:52] different. Now, people like to call [76:54] like, "Oh, you're getting a clitoral [76:55] orgasm or a vaginal orgasm." It's all an [76:58] orgasm. It's just a matter of what [77:00] stimulation is causing the orgasm. And [77:03] so, [77:04] I think ultimately it's really important [77:06] for the the most easy, reliable route to [77:09] orgasm is clitoral stimulation, which is [77:11] not traditionally stimulated through [77:12] penis and vagina sex, right? And so, it [77:14] does require some additional [77:17] um thought on how you're going to [77:18] stimulate it and and how you're going to [77:20] please the partner and to get them to [77:22] orgasm. And often times, if you think [77:24] about the time it takes to orgasm, so in [77:27] a man, the average length, if you look [77:29] at studies that looked at stopwatches, [77:31] like they've had the female partner [77:32] actually start a stopwatch at the [77:33] beginning of sex and stop it at the end [77:35] when the man climaxes, it's about 5.1 to [77:38] 5.7 minutes. Um what's in fact UK men [77:42] tend to last a little bit longer, which [77:44] is sort of an interesting concept, but [77:45] Sorry, which sex is that? Just men? Men. [77:47] Men So, so from penetration to climax of [77:50] men. [77:52] So, when you So, when they So, they've [77:54] measured basically not including [77:55] foreplay, but if they've measured, [77:57] they've measured like 15,000 people [77:58] through many, many different countries [78:00] and they've had the woman take a [78:02] stopwatch and actually start click on it [78:04] when they penetrate and click it off [78:06] when they climax and they've measured [78:08] the length of time. And it's been about [78:10] 5.1 to 5.7 minutes is the time. Now, a [78:14] woman, when you look at the average time [78:16] to orgasm for woman, it's about 14 [78:20] minutes. [78:21] And so, you can imagine that if the [78:23] entire sexual encounter is around the [78:26] male climax, right? And the male has [78:29] this, as we've already talked about, [78:30] sort of this post-nut clarity, like I [78:32] don't want refractory time, they're [78:35] you're going to want to be more [78:36] intimate. If you don't prioritize the [78:39] female's climax or stimulate her before [78:41] you begin to penetrate, then she's [78:43] probably not going to orgasm. Um and so [78:47] and the interesting thing is when you [78:48] look at sexual encounters and you look [78:50] at men and women having sex for the [78:53] first time, uh the woman will orgasm 45% [78:56] of the time, the man will orgasm 95% of [78:59] the time. When you look at women having [79:01] sex with women on a first-time [79:03] encounter, they both have orgasms 95% of [79:06] the time. So clearly there's an [79:08] educational mis- disconnect, right? [79:10] Women know what they like and what [79:12] stimulates them and men aren't getting [79:13] the memo. I feel attacked. [79:16] Totally not attacking you. [79:18] Letting you know the facts. [79:21] I know it makes sense though cuz [79:22] I think men are still struggling to [79:24] understand again because of what you [79:25] said, we don't really get a sexual [79:26] education. So we learn these things from [79:27] porn and obviously in porn, they're not [79:29] showing it. Yeah, I mean you don't [79:31] typically have many um [79:32] women orgasming in porn as you do men [79:35] orgasming in porn. What is [79:38] an orgasm and what kind of what role [79:40] does it serve? Mhm. Like why do we [79:42] orgasm? And also when I say what is an [79:44] orgasm, [79:45] is an orgasm like a switch? [79:47] Or is it is it like a spectrum? So it's [79:49] it's sort of like a spectrum, I guess. I [79:51] mean so let's talk about what it is [79:53] exactly. So an orgasm is a moment in [79:56] time that is combined with a [79:59] like a maximal tension and then a [80:01] release. And during that time, it is [80:05] completely you're completely unable to [80:07] think about anything else. It is a very [80:09] powerful, pleasurable sensation. And it [80:12] occurs usually like I said, 5 to 60 [80:14] seconds it can last. And is it in terms [80:17] of how you get it, it's usually a [80:19] culmination of stimulation over a period [80:22] of time, even with a certain sort of [80:24] like rhythm that's required to achieve [80:28] climax that's different from person to [80:29] person. So I can't give you the script [80:30] on this is how fast you need to [80:32] penetrate or this is how what [80:33] stimulation you need to use. [80:34] ask that at the end of the conversation. [80:37] Okay, we're done here. [80:39] So, um [80:40] So, yeah, cuz nobody wants a taco wet. [80:42] They literally want me to tell them like [80:43] this is what you do A B C D, right? [80:47] So, um but yeah, ultimately, um [80:50] all of those things they build this [80:52] tension, right? So, over the course of [80:55] sexual stimulation, arousal, you are [80:57] getting to an ex- excitement phase where [81:00] your your body's changing. So, in women, [81:02] for example, you will see that the labia [81:05] become a little bit redder, um they [81:07] expand in size. As I said, the vagina [81:10] lengthens and elongates. Um the So, the [81:13] From 3 to 6 in I've heard you say. [81:15] Yeah, about about double, yeah. And it's [81:16] different from person That's the [81:17] average, right? So, there is sort of [81:19] like this thought that like, "Okay, if [81:21] it's really, really large, it's always [81:23] going to be better." And that's not [81:24] actually always the case because not [81:26] every vagina can accommodate a very [81:27] large phallus. Um but so, when you're [81:30] having orgasm, essentially your pelvic [81:32] floor muscles are tensing up. They're [81:33] They're getting really tense and you're [81:35] reaching this for like basically you're [81:37] getting to the top of the hill. You're [81:38] getting this really large amount of [81:40] climax. And so, your body is sort of [81:43] climate going up and up and up. You're [81:44] reaching like increasing dopamine and [81:46] you're increasing So, when you think [81:47] about what happens in the brain is [81:49] your hormones are are going higher and [81:52] higher. And there's also an inhibitory [81:54] There's a path There's a [81:55] There's a stimulatory and an inhibitory [81:57] pathway. And so, the stimulatory pathway [81:59] is going up, inhibitory, stimulatory. [82:00] You're basically trying to race up to [82:02] the top of this mountain. And when the [82:04] stimulatory gets to the very, very top, [82:06] then you have the orgasm. And so, you [82:08] release all this tension. And during [82:10] this time, your heart rate's racing, [82:12] your pupils are dilating, right? There's [82:13] all these physiologic changes. Um and [82:16] then when you orgasm, your muscles [82:18] contract, as I mentioned before, and [82:19] this every point eight seconds they're [82:21] having a contraction. Sometimes you'll [82:23] have an involuntary phonation. So, [82:25] people will, you know, moan or scream. [82:27] and sometimes it's not in their control. [82:29] Like there's actually an involuntary [82:30] component of it. And then, um, sort of [82:33] it comes down. And so, it's it's not as [82:36] necessarily a switch, it's sort of a [82:39] climb up a mountain is the way I would [82:40] describe it. It sometimes feels like [82:42] blowing up a balloon with a little hole [82:43] in it. [82:44] And when what I say with a little hole [82:46] in it, I mean because if you stop, it [82:47] feels like some air comes out of the [82:48] balloon. Mhm. Mhm. That's why I said [82:50] that the sort of there needs to be a [82:51] rhythm. It should keep going at a [82:53] certain pace in order to achieve that [82:55] climax, cuz if it doesn't, then you can, [82:58] again, just like that's a very good [82:59] description, you'll lose that little air [83:00] in the balloon. [83:02] Okay. So, in order to increase female [83:05] pleasure, okay, we need to understand [83:07] the person we're dealing with, of [83:07] course, but um, the clitoris is a great [83:10] way to get to orgasm. [83:13] You've you're pro lubricants. [83:15] A lot of people [83:17] feel like that's not natural, so they [83:18] kind of avoid it, but you're pro [83:19] lubricants. [83:20] And are you pro then scheduling sex, or [83:23] you pro scheduling time for intimacy? [83:26] Scheduling time for intimacy. So, [83:28] because sex adds, as we talked about, [83:30] adds sort of like a level of stress in [83:32] terms of like, am I going to want to [83:34] have sex? Am I going to be able to get [83:36] an erection? Am I going to enjoy sex? [83:38] Whatever it is. And am I going to get [83:40] rejected? Like all those things, because [83:43] you're still a human being, and you may [83:44] just like be really stressed that day [83:46] that you put on the calendar, and you [83:47] were like, "Ah, I just can't can't get [83:49] in the right mind space to have sex." [83:51] So, if you're constantly ruminating or [83:53] stressing about other things, [83:55] you can't have a good sexual encounter. [83:57] In fact, they've looked at mindfulness [84:00] in terms of how it improves sexual [84:02] function, particularly in women, [84:04] but we've seen very clear data that be [84:07] having a mindfulness practice leads to [84:10] improved sexual function in terms of [84:13] desire and other factors, like arousal [84:16] and lubrication and orgasm, but the [84:18] biggest is desire. And so, it's because [84:21] if you can focus on what's happening [84:24] during the sexual encounter. So, you can [84:26] focus on what it feels like, how you're [84:28] enjoying that sensation, rather than [84:30] thinking about am I going to come, am I [84:31] going to climax, am I is it going to [84:33] happen, or whatever it is that you're [84:35] thinking about during sex because you're [84:36] worried about how the other partner [84:38] might react, then you're more likely to [84:40] enjoy the experience, feel the and then [84:43] have a good experience, and subsequently [84:44] have more desire for additional [84:46] experiences. [84:47] We talked earlier on the very start of [84:48] the conversation about comparisons and [84:50] how that can really destroy sex. Is [84:52] there a disparity between how long we [84:54] think sex should take and how long it [84:56] actually takes? Yeah, we all think it [84:59] lasts longer. And when you ask people [85:00] what the average time and this is a hard [85:02] question because people think of sex as [85:04] a whole encounter and when we do it [85:05] scientifically, we look at sex from [85:07] penetration to the end of penetration [85:09] and sex is more diverse, right? Sex can [85:11] include oral sex, anal sex, [85:13] manual sex, any type of sexual [85:16] stimulation, right? And so, when you're [85:18] thinking about the entire encounter, it [85:20] can be very variable. Some people want a [85:22] quickie, some people want to have this [85:23] long, luxurious love making such [85:25] scenario and it really depends also like [85:27] on what's going on in your life. Like [85:28] you may not have that luxury. And so, I [85:31] don't I think again, it's not about [85:33] reaching a certain benchmark or certain [85:35] number. It's really about the quality of [85:38] the sex. So, if you have great sex and [85:39] it takes 3 minutes, that's great. That's [85:41] fine, but as long as it's great to both [85:43] of you, right? If you're both like this [85:44] is awesome, I'm having great sex and it [85:47] takes 3 minutes, that's fine. [85:50] But how long do people [85:52] think sex lasts on average versus how [85:54] long it actually lasts on average? Yeah, [85:56] so I think that most people definitely [85:58] think it lasts longer. So, women tend We [86:01] don't know what they think it lasts, but [86:02] but they want it to be is about 18 to 25 [86:05] minutes. Men are a little on the shorter [86:07] side, like maybe 12 minutes, but [86:09] generally we all want it to be around [86:11] that length. But you sort of lose sense [86:13] of time, right? So, you don't really no [86:14] one's really there with the stopwatch [86:16] knowing exactly how long it takes. In [86:18] fact, I've had friends tell me like, [86:19] "Oh, I watched your video and now like [86:21] when my partner wants sex, I'm like, oh, [86:23] it's only going to take 5 minutes. Like, [86:25] I can I can have sex with them." Like, I [86:26] used to in my head used to think it [86:28] would take a lot longer. And now I [86:30] realize it takes less time and like I [86:31] don't that that stress of like, "Oh my [86:33] god, I'm going to have to like waste [86:34] like half an hour and I'm so tired." [86:36] Like, has gone out the window because I [86:38] know it's really not going to take that [86:39] long. Is that Have they ever put people [86:41] in like a laboratory or whatever and and [86:44] I guess this goes back to what you said [86:45] earlier. Um is there like an average [86:47] time [86:49] people spend having sex? Was that the 5 [86:50] minutes you talked about? [86:51] 5.7 minutes. 5.1 to 5.7 minutes, [86:54] depending on the study you look at. And [86:56] they they looked at all comers, so it's [86:57] actually different in different um [86:59] countries. So, when you look at like [87:01] Turkey, it was like 4 minutes. And if [87:03] you look at UK, it was like 10 minutes. [87:06] So, it's actually [87:07] It's a [87:09] Thank you. So, it's actually variable [87:10] and that may be a cultural thing. Um but [87:13] ultimately, the average is about 5 [87:15] something. Interesting. [87:17] So, we want sex women want sex to last [87:19] between 18 and 25 minutes, ideally. Men [87:23] want it to last ideally about 16 [87:25] minutes, including foreplay. But in [87:26] reality, it's lasting 5 5 minutes. Yeah. [87:31] That's good to know. [87:32] Let's talk about Zoe, who you may know [87:35] because they're a sponsor of this [87:36] podcast and I'm an investor in the [87:37] company. You guys know health is my [87:39] number one priority. Zoe's growth story [87:42] has been absolutely incredible so far. [87:44] They're doing science at a scale that [87:45] I've never seen before. Because of their [87:47] members and recent breakthroughs in [87:49] research, they can now continue to offer [87:51] the most scientifically advanced gut [87:53] health test on the market. Previously, [87:56] the test allowed them to analyze 30 [87:58] bacteria types in your gut. But now, [88:01] thanks to new science, they've [88:02] identified 100 bacteria types. This is a [88:05] huge step forward and there's nothing [88:07] else that's available even close to it [88:09] on the market at all. So, to find out [88:12] more and to get started on your Zoe [88:13] journey, visit zoey.com/steven. [88:17] You can use my exclusive code CEO10 [88:20] for 10% off. Don't tell anybody about [88:23] that, okay? Just for you guys. We talked [88:25] about sizes of stuff a second ago and we [88:27] said we'd come back to this. So, there's [88:29] two sort of sizes that people often [88:30] think about, the size of the vagina and [88:33] the size of the penis. Mhm. There is a [88:35] myth in society that the more sex a [88:37] woman has, the bigger her vagina gets. [88:39] Is that myth true or false? False. So, [88:42] the way that women's vaginas get, if you [88:44] want to say loose, right? Which is the [88:46] term that people use, or they get a weak [88:48] pelvic floor. And that's from having [88:51] babies, having maybe neurologic [88:53] conditions that affect the pelvic floor [88:56] strength, having collagen disorders, [88:58] having um [89:00] just from like having a job where you [89:01] stand all day and you're like all the [89:02] weight of your body is sitting on your [89:04] pelvic floor. Those muscles can get [89:05] weaker over the course of a lifetime. [89:08] And then it can feel a bit looser [89:10] because those muscles are maybe not [89:12] squeezing as harder. But it is not [89:14] related to how much sex she's having [89:16] because as we mentioned earlier, when [89:18] you have an orgasm, you're actually like [89:20] strengthening your pelvic floor a little [89:21] bit. Like you're you're contracting [89:23] those muscles. So, actually probably the [89:25] more sex a woman has, likely her pelvic [89:28] floor is probably stronger unless she's [89:29] not you know, um but you know, you add [89:32] in the having babies and other things, [89:34] it's variable. But probably the more [89:36] orgasms a woman has, the stronger her [89:38] pelvic floor is. But things like [89:40] childbirth can Mhm. make the pelvic [89:44] floor looser? Weaker. Weaker. Yeah. [89:46] Yeah, so then when it becomes weak, that [89:48] is the cause of things like stress [89:50] incontinence. So, when a woman um lifts [89:53] something heavy or she exercises or she [89:56] jumps or she coughs or sneezes, she [89:57] might have a couple drops of urine or a [89:59] lot of urine leak out because of a weak [90:01] pelvic floor. It can also be lead to [90:04] something like prolapse where the [90:07] it's like a hernia in the vagina where [90:09] the pelvic floor sort of is so weak that [90:11] now the vaginal skin and the organ [90:13] behind it is sort of bulging out and can [90:16] cause discomfort and and sort of feeling [90:19] and maybe some dysfunction in the organ [90:21] but really mostly discomfort. And so [90:23] those are signs of weak pelvic floors [90:25] not you know, not having a loose vagina [90:28] during sex. And we can do something to [90:30] strengthen our pelvic floor which is [90:32] these is that what the Kegel exercises [90:33] are? Yeah, it's more than Kegels. I mean [90:35] Kegel is the most has the best PR of any [90:37] sort of thing I've ever seen in medicine [90:39] but yeah, it's pelvic floor exercise. A [90:41] Kegel is one pelvic floor exercise which [90:44] is to strengthen the pelvic floor and [90:46] there are others. What is it? I have [90:48] never [90:48] So it's essentially men never know. Like [90:50] it's not your fault. Women sort of kind [90:53] of know but even women don't really [90:54] know. So what it is is there's those [90:56] same muscles we talked about earlier is [90:57] that you're basically doing a rep. [90:59] You're squeezing, contracting and [91:01] relaxing. Just like you go to the gym [91:02] right? You squeeze and relax. Very [91:03] similarly you are squeezing those [91:05] muscles and relaxing those muscles. [91:06] this sat down now? Yeah. So basically [91:08] for men what I tell people is it's like [91:11] the feeling of when you're urinating and [91:13] you stop your urine stream. [91:15] That that's you're using those same [91:17] muscles. So you that's one way. Another [91:19] way to think about it is if you were [91:21] trying to lift your penis off the ground [91:23] without touching it. [91:24] Ah, okay. Got you. [91:25] Okay? And the third one is you're trying [91:27] to hold in a fart. So all those [91:29] different ways you're sort of getting [91:31] those muscles. So the one thing I tell [91:32] people is they get the way they get it [91:34] wrong is they don't relax enough. So [91:37] just like when you go to the gym you're [91:38] not doing rep after rep after rep. [91:39] You're actually taking a break and [91:41] you're letting your muscles relax before [91:43] you do another rep. Same thing you have [91:45] to squeeze for 5 seconds, relax for 5 [91:47] seconds. Right? You actually have to [91:50] relax and just like any exercise you [91:53] don't want to overdo it. So I tell [91:55] people start lying down so that the only [91:57] thing you have to focus on from a [91:58] muscular standpoint is that those [92:00] muscles. As you get good at them lying [92:02] down you then do them sitting up. And [92:04] then as you get good at doing them [92:05] sitting up, you can do them standing or [92:06] do them anywhere. But like you're not [92:07] going to be like there you know, I I [92:09] remember the scene from Sex and the City [92:11] where like the character Samantha was [92:13] like, "I'm doing my Kegels right now." [92:15] Like yeah, she's probably been doing [92:16] Kegels for a long time and now she's so [92:18] good at them that she can do them while [92:19] she's brushing her teeth. But it's not [92:21] like you're going to wake up one day and [92:23] be perfect at them just like any other [92:25] exercise. [92:26] So that's one exercise. There are [92:27] certainly other things you can do to [92:29] strengthen your pelvic floor. [92:30] Traditionally things like yoga and [92:32] Pilates have some core work that does [92:34] also help with the pelvic floor. But [92:36] really I recommend if you're having [92:38] issues is to see a pelvic floor physical [92:40] therapist cuz they're just like a when [92:41] you go to the gym alone, you can do it [92:43] or you can go with the personal trainer. [92:45] They're like the personal trainers for [92:46] your pelvic floor. How do I know if I'm [92:48] having pelvic floor issues? What are the [92:49] symptoms? So for like I said, the [92:51] obvious ones for women are leakage, are [92:54] um having prolapse for weakness. In men, [92:57] we don't often see as much but like I [92:59] said, you might notice that your semen [93:01] is not as forceful when it comes out. Um [93:04] that's usually the most common side sign [93:06] of a weak pelvic floor. There's not as [93:08] many for men but in terms of a overly um [93:11] high tone pelvic floor, what we worry [93:13] about then is then there's a whole host [93:15] of symptoms. It could be as simple as [93:17] just having lower back pain. Um it can [93:20] be that you're having hip pain. It could [93:21] be that you're having um pain with sex. [93:23] You're having pain with erections, pain [93:25] with ejaculation. You're going to the [93:26] bathroom often. Got to go, got to go. [93:29] You are feeling like you're having [93:31] difficulty emptying your bladder or you [93:33] are um going very very often all of a [93:36] sudden. So it can be a a vague variety [93:38] of these symptoms and um so generally [93:41] it's important to get evaluated to see [93:43] like examine your [93:44] to get your pelvic floor examined by a [93:46] professional whether it's a urologist, a [93:48] gynecologist, a a pelvic floor physical [93:51] therapist, someone who can assess your [93:53] pelvic floor if you're having these [93:55] issues because it might be pelvic floor, [93:56] it might not, right? How do they assess [93:58] it? If I go to a urologist and say, [94:00] "Listen, check my pelvic floor." Mhm. [94:02] So, in a man, it would be a rectal exam. [94:04] And so, essentially, that's how you sort [94:06] of feel the pelvic floor muscles. So, [94:08] what I tell young guys who come to me [94:09] and say, "Look, I can examine you, [94:11] um but I bet based on your story, like [94:13] you're a young guy, you sort of had [94:15] these new stressors in your life, um and [94:18] it's un- and you're otherwise healthy, [94:19] it's unlikely that you have a vascular [94:21] condition brewing and other things that [94:23] like it's probably likely So, if you [94:25] want to uh avoid the exam because it can [94:28] be uncomfortable or And I will tell you, [94:30] if you have pelvic floor dysfunction [94:32] does an exam, it will be uncomfortable. [94:34] It will be painful, potentially, because [94:36] they're pushing on those already tense [94:38] muscles, and it can be painful. So, I [94:40] tell people like you might hate me [94:41] tomorrow cuz you'll be sore, and you'll [94:43] say, "What did she do during that exam?" [94:45] And I I kind of preemptively tell them [94:48] because I just gently push, right? Like [94:50] I'm pushing the pad of my finger, but [94:52] that's enough to sort of cause a tension [94:54] of the pelvic floor muscle and cause [94:55] pain. Where? Where are you pushing? [94:57] Like on the muscles, on the pelvic floor [94:58] muscles. So, you can actually [95:00] So, if you if you put your finger in the [95:02] rectum, if you push right straight down, [95:04] in a man, you're feeling the prostate. [95:06] And if you push on the sides at a [95:08] variety of different angles, you're [95:09] going to feel different pelvic floor [95:10] muscles, like the levator ani and the [95:12] trans operator muscles. Those muscles [95:14] are the ones that are part of the pelvic [95:16] floor. We can't feel all of them, but we [95:18] can feel some of them. And so, um so, [95:21] that is sort of where we're feeling in [95:24] terms of for the pelvic floor muscles. [95:26] Okay, so cuz I was thinking, if we go in [95:29] the the rectum, you've got the glutes [95:31] there as well, which are like either [95:33] side, I guess. [95:34] So, your pelvic floor is actually a part [95:35] of your core, right? But your glutes are [95:37] further back. They're not going to be [95:39] felt from there. But anyways, if you [95:40] think about your pelvic floor, it's [95:41] actually, you know, people think about [95:43] their core as their abdominals, but we [95:44] know that it sort of encompasses your [95:46] back, your front, and even your pelvic [95:48] floor is sort of part of your core [95:50] muscles. Got you. [95:52] Okay, interesting. Very interesting. Um [95:54] on the topic of sizes then, one of the [95:56] big things in men is penis size. Mhm. [95:59] And one of the big questions men often [96:01] ask is is there ways to increase my [96:03] penis size? There's in fact a whole [96:04] industry around penis size increasing [96:07] pumps and all kinds of different things. [96:09] Is it possible to increase one's penis [96:10] size? Yeah, so it is. Um in terms of [96:14] looking at the evidence, uh the safest [96:17] and most reliable way is using a [96:19] traction device. And these are devices [96:21] that are made for um [96:23] essentially for penile lengthening, but [96:25] they're also made for men who have [96:26] something called Peyronie's disease, [96:28] where they may develop a plaque on their [96:30] penis and a curvature. And so there's [96:32] one device that's actually made that [96:33] bends away from the plaque to help sort [96:36] of break down that plaque. Um so there [96:38] are two uses for it, but essentially [96:41] these devices are just like stretching [96:43] the tissue over time. And so the [96:45] original traction devices that were [96:46] studied, you would have to use them for [96:48] 6 to 8 hours a day for several months to [96:52] see a 2-cm increase in length. Now, um [96:55] that may be enough for some people. [96:57] They're like, yes, I definitely want [96:58] that. And some will be like, you know [96:59] what? It may or may I mean 2 cm is the [97:01] average, some are going to be less, [97:02] right? So um it's sort of do you have [97:05] the time to do that? Do you want to do [97:06] that? But now there are sort of newer [97:08] devices where they've studied them and [97:10] used them like twice a day for 30 [97:11] minutes and they've seen some increase [97:13] in penile length. They're generally [97:15] pretty safe. It's more about um you [97:17] might have some bruising from just [97:18] putting the traction devices on and as [97:20] long as you follow the instructions, [97:21] you're probably not going to hurt [97:22] yourself. Is that penis pump? No, pumps [97:25] are different. So [97:26] pumps have not been shown to increase [97:28] penile length. What a pump is is it's [97:30] just got a it's got a uh a cylinder that [97:32] you put your penis into and it uses sort [97:34] of vacuum technology to sort of suck [97:37] blood into the tissues and then you put [97:40] um if you're having issues with erectile [97:41] function, you would then put a ring uh [97:43] at the base of the penis to maintain the [97:45] erection. [97:46] Uh these don't help with length. They've [97:48] looked at them in those cases. They've [97:50] also looked at surgeries and different [97:52] types of things to increase penile [97:53] length. And ultimately, many of them [97:56] either have, you know, a very high [97:58] complication rate um or risks that I [98:01] would say are probably not advisable for [98:03] most people. [98:05] Um I you know, I think that in terms of [98:07] penile lengthening, people are always [98:08] like, "Why would you want to do that? [98:10] Why?" [98:10] A lot of people will sort of poo-poo [98:12] people who want to change the way their [98:13] penis looks. And I sort of evolved in my [98:15] thinking and saying, "Well, you know [98:17] what? This is a big part of, um [98:19] you know, a man's identity and how he [98:21] feels about himself. And I wish we had [98:23] something that was safe and easy for men [98:25] to do like we have breast implants. But [98:26] we're not there yet, right?" And so, I [98:29] just want people to be safe in terms of [98:31] realizing what our limitations are at [98:32] this time and things may change over, [98:35] you know, as people become more [98:36] interested in this area. [98:39] Porn, the role it's played in our [98:41] perception of what a normal-sized penis [98:43] is. [98:44] Do you know any of of any data on what [98:47] how big people think a penis should be [98:48] versus how big the penis is actually [98:50] are? Yeah, so it Yeah, most people think [98:52] it should be about 6 in. [98:54] So, like we said, the average is around [98:56] 5.1 [98:57] to 5.3 in. [99:00] And so, when you look at the data in [99:02] terms of what people think it should be, [99:03] men think it should be about 6 in. In [99:06] terms of women, where we found the data [99:08] about what they prefer [99:10] um is sort of interesting. So, when now [99:13] that we're having um more surgeries for [99:16] trans men, one of the surgeries that we [99:18] do is a neophallus. We create a new [99:21] phallus. And one of the the types of [99:23] surgeries we do is we use a forearm [99:24] flap. And so, it can be very, very long [99:27] and very, very girthy. And in fact, they [99:29] were doing these surgeries and they [99:30] realized that some people were actually [99:33] unable to have sex with it because it [99:35] was too girthy. So, they wanted to then [99:37] look at like, "Well, how do we determine [99:39] the right size and length and and girth [99:42] of this neophallus so that we you know [99:44] they can then have sex with it. [99:46] So what they did was they looked at um [99:48] the top you know the top five to 10 sex [99:52] aids or or toys that women are [99:54] purchasing online. And they you know you [99:56] can imagine that when you think of a [99:58] dildo they can go from [100:00] one you know all the way to like the [100:02] largest thing you've ever seen and the [100:03] girthiest thing you've ever seen to like [100:05] a normal size. And so when you have the [100:07] option to pick as many as you want [100:08] right? What do you pick? And so what [100:10] they found was that women tend to pick [100:12] the length of about 6 inches but as you [100:15] know you're not putting the whole device [100:16] in there has to be a handle or [100:18] something. So it's probably around what [100:20] the normal size is and the girth was [100:22] also around the average girth of the [100:25] male penis. And so generally speaking [100:27] women tend to want what is average or [100:31] around average right? And um [100:33] interestingly there's a product that is [100:35] available called Ohnut I'm not I don't [100:37] I'm not sponsored by them or anything [100:39] but essentially you you for women who [100:41] have pain with penetration with men who [100:43] are too well endowed the men actually [100:45] wears it so that the entire phallus [100:48] doesn't go in during sexual intercourse [100:50] but it's more comfortable for the [100:51] partner. So we know that sometimes it [100:53] can be really uncomfortable if it's too [100:55] well endowed. And so I think ultimately [100:58] um while I understand that pornography [101:00] has made people really self-conscious [101:02] about the length of their penis and I [101:04] I'm I'm really sad about that because I [101:06] think you as we've talked about earlier [101:09] clitoral stimulation is the easiest way [101:10] for women to climax and you don't need [101:12] penetration for that. So in order to [101:14] have pleasure and give pleasure you [101:17] don't need a large penis. And in fact [101:19] some women may not even care what size [101:21] your penis is. It's more of a [101:23] a societal thing that we talk about [101:25] right? Women joke about it women talk [101:27] about it. I mean you can't go you know [101:29] you even I have accidentally made [101:31] comments where I've been like oh that's [101:32] great that like he has a large penis and [101:34] like what I can't believe I just said [101:35] that. Like I'll say it and I'll be like [101:36] oh my god, I can't believe that came out [101:38] of my mouth of all people." And I think [101:40] it's just so ingrained in our brain to [101:42] be like, oh like to celebrate really [101:44] well-endowed organs when in reality it's [101:47] not necessary and sometimes even [101:49] painful. [101:50] Will my penis get smaller as I age? So, [101:53] not if you are healthy. So, in terms of [101:56] how do we maintain our penile health, [101:59] right? Your body does a really good job [102:02] of trying to maintain penile health [102:04] because over the course of a nighttime [102:06] men will get five to six erections, [102:09] three to six erections over the course [102:10] of the night. And that will happen [102:13] whether you have a sexual dream or not, [102:14] whether you are sleeping in a certain [102:16] way or not. It's because your body is [102:18] sort of giving blood flow to the area [102:20] periodically through the night. Whether [102:22] you're having sex, whether you're not, [102:23] you're getting good oxygenated blood [102:25] flow to the penis. Now, if you develop [102:27] other conditions where you cannot get [102:30] blood flow to the penis, like you get [102:31] high blood pressure, you get diabetes, [102:33] you get heart disease, and those [102:35] arteries start getting narrowed, and [102:37] then you stop getting nighttime [102:38] erections, and you start having [102:40] difficulty getting erections, over time [102:42] the tissues can change and they can [102:43] become what we call fibrotic, and they [102:46] can become a little less spongy and less [102:48] elastic. And so, in those cases you can [102:50] see a little bit of shortening. Now, [102:53] people will also see shortening because [102:55] they gain weight over the course of [102:56] their lifetime. And as you gain weight, [102:58] the penile the penis is not shrinking, [103:00] but the the fat on the mons or the area [103:03] right above the penis is sort of getting [103:05] larger and obscuring how much penis [103:07] length there is. Is it one of the myths [103:09] around penis size is that, you know, if [103:10] I have big hands, look, cuz you know, [103:12] these aren't small hands. If I have big [103:14] hands, then I have a big penis, or if I [103:16] have big feet, then I have a big penis. [103:18] Is there data to support this idea that [103:20] the length of my [103:21] any part of my body is correlated to my [103:23] penis size? Yeah, there's one study, [103:25] it's a Japanese study where they looked [103:26] at only Japanese men. Uh so, take there [103:29] are some limitations, but essentially [103:30] they measured all these body parts and [103:32] penile length Uh and uh what they found [103:35] was that nose length was correlated with [103:38] penile length not hand length or foot [103:40] length. [103:42] So how do I increase the length of my [103:44] nose? [103:47] Yeah, yeah. But I thought I thought that [103:49] was really interesting. Again, nothing [103:51] you can control. These things are [103:52] pre-genetically determined to some [103:55] degree and in fact, you know, we talked [103:57] about some trends and while we've seen [104:00] um [104:01] semen qua sperm quality change over the [104:04] last 50 years, we've also seen penile [104:06] length change average over many last I [104:09] don't know the exact number but 50 years [104:10] and they've actually seen penile length [104:12] is increasing. And they think that this [104:15] is because the onset of puberty is [104:18] changing and boys are getting exposed to [104:21] factors that are making them go through [104:23] puberty earlier and hence they're [104:24] getting more exposure to testosterone [104:27] and they're developing longer penises. [104:30] Um so it's sort of interesting [104:31] theoretical thing. I don't know if [104:33] that's true or not but sort of what the [104:35] theory is. Yeah, I actually read about [104:37] that study. It says that a study shows [104:39] that men's average erect penis size has [104:40] increased over the last 29 years from [104:42] 4.8 inches to 6 inches. Mhm. That's [104:46] pretty pretty dramatic. [104:47] That's huge. [104:48] Yeah. Yeah. Wait another 29 years. [104:51] You could be a Jesus Christ. [104:54] But I don't think women's vaginal [104:55] lengths are changing. So I don't know [104:56] what that means. [104:59] Oh, yeah. [105:00] Oh, yeah. It's interesting cuz you when [105:02] you we talked about the vaginal length [105:04] enlarging as someone becomes aroused, [105:07] you mentioned that it goes from about [105:08] roughly about 3 inches on average to [105:10] about 6 inches. That also correlates [105:11] with the size of the flaccid penis to [105:14] the size of the erect penis going from [105:16] about 3.6 inches flaccid to about 5.1 to [105:20] 5.2 inches erect. So you kind of see [105:22] that these two things are actually made [105:24] made for each other. Yeah, they are. I [105:26] mean, I think in general like we're all [105:29] we're I mean, we're we're designed, [105:31] right? The the biggest thing that we [105:33] need to do as a species is have [105:34] children, right? That is like sort of [105:36] the the goal of life is to propagate our [105:39] species. And so, it would make sense [105:41] that we would be designed to be able to [105:43] do that easily. A lot of people having [105:45] this um new procedure called [105:46] labiaplasty. Is Did I pronounce that [105:48] correctly? [105:48] Labiaplasty. Labiaplasty. Yeah. [105:50] What is this and why [105:51] So, labiaplasty is essentially taking [105:53] the labia uh minora and and and [105:58] making them a little shorter or smaller, [106:01] depending on what your preference is. [106:02] And labias come in all sorts of shapes [106:03] and sizes. So, [106:05] It's the inner lips of the vagina. [106:07] Cuz they come in all sorts of shapes and [106:09] sizes. Sometimes they will be um [106:11] lopsided, so one will be longer than the [106:12] other. Some will be longer, some will be [106:15] smaller. And oftentimes we're seeing in [106:17] pornographies really small labia minora. [106:20] And so, people will tend to feel like [106:21] maybe they should look like that. Now, [106:23] not everybody. Some people will actually [106:25] have discomfort. Their labia are so long [106:27] that they cause friction or pain or [106:29] discomfort. In those cases, it's it's [106:31] absolutely uh reasonable. But just like [106:33] people have insecurities about their [106:35] genitalia when it their men, women also [106:37] can have insecurities about their labia [106:39] as women. And so, labiaplasty is [106:41] essentially making those smaller and [106:44] more cosmetically appealing when women [106:46] desire that. Um but I think the the [106:48] important thing to take home is they are [106:49] so diverse. They're as diverse as your [106:51] fingerprint. Your labia is unique to [106:54] you. And it is not um there's no script [106:58] of what it should look like. Uh and so, [107:00] I generally tell people if that's [107:01] something you want, that's absolutely [107:03] fine. But again, this is not a pathology [107:05] or a bad thing. This is something that, [107:07] you know, is more cosmetic. And there's [107:09] been an 80% increase in the surgery of [107:10] labiaplasty from 2015 to 2019, which is [107:15] you know, a lot. a lot. It's a lot. Last [107:18] thing about um [107:20] women and ejaculation in the vagina is [107:22] about squirting. Very misunderstood. [107:25] Like I you know, as a [107:27] as a man that doesn't have a vagina, [107:30] um I've seen squirting on pornography [107:32] that I've watched. I watch pornography. [107:34] I think that's important to say. I think [107:35] a lot of people do watch pornography. Um [107:37] and in the pornography that I've [107:38] watched, the woman squirts. This liquid [107:41] comes out. And I like is that semen? Is [107:45] that ejaculate? Or is that something [107:46] else? What is it? And also [107:49] should we be aiming to make our partner [107:51] squirt? [107:51] Yeah, let's talk about it. So this is [107:53] important and it's actually interesting. [107:54] I just I just had a conversation with a [107:56] researcher about this because it's so [107:58] misunderstood and we still don't know. [108:00] Like there's only been like three or [108:01] four studies looking at female [108:02] ejaculation and squirting over the [108:04] course of our history. There's different [108:06] types of fluids the vagina makes. One is [108:08] obviously lubrication. That's different [108:11] and that can be very copious for some, [108:12] very not as copious for others. [108:15] Uh that's one type of fluid. The other [108:16] type of fluid is female ejaculate. Now [108:19] female ejaculate is similar to male [108:21] ejaculate. It comes from the Skene's [108:23] glands, that same female prostate. It is [108:26] a small amount of like sort of sticky [108:28] white fluid that women ejaculate. Um and [108:32] so they will release that fluid and it's [108:34] not like this copious amount of fluid [108:35] that you're seeing on pornography. [108:37] Uh the next type of fluid is squirting. [108:40] Uh and squirting is has been described [108:43] as a clear, colorless, odorless fluid [108:47] that's emitted from the urethra. Um when [108:50] they've looked at analyses of these, [108:52] they found that there is what we call [108:54] PSA or prostate-specific antigen. Now [108:57] that we think of traditionally as males, [108:59] but the women's Skene's glands make it [109:01] as well. Now people are like, is it pee? [109:04] Right? That's the big question. And so [109:06] in the one study where they looked at [109:07] the analysis, they found that it was [109:09] there was like dilute urine. And then [109:11] another study looked at like, okay, they [109:13] scanned people before squirting and [109:15] after and they scanned their bladders to [109:17] see like, did the amount of urine [109:18] change? And they said it did and now [109:20] it's urine. But we really don't know and [109:22] what we what the limitation is that you [109:23] never So, women know when they squirt. [109:25] Like they they know it's not urine. So, [109:27] if you talk to enough women who are [109:30] squirting, they'll be like, you know, [109:31] it's not urine. I'm sure it's not urine. [109:33] But where is that fluid coming from? [109:34] That That's where the question comes, [109:36] right? And so, like if it's not urine, [109:37] it's coming from the urethra. Like it [109:38] doesn't make sense. And so, this is Dr. [109:42] Barry Komisaruk who's done a lot of [109:44] research on orgasm. He said, you know, [109:45] it may be water imbibition. So, when you [109:48] think of like fluid filling the walls of [109:52] the uterus and the vagina during during [109:55] during the process of arousal and that [109:57] may be during climax when you have [110:00] actually contractions of that fluid of [110:02] those of those organs that occurs during [110:05] climax, that it can actually release [110:07] this fluid. I don't know. I think the [110:10] jury remains out. I don't think we have [110:11] a conclusive answer because the studies [110:13] are not perfectly designed. [110:17] We have a closing tradition on this [110:18] podcast where the last guest leaves a [110:19] question for the next guest not knowing [110:20] who they're going to be leaving it for. [110:22] And the question that's been left for [110:23] you [110:28] If there was one message that you want [110:30] your life's work to communicate to the [110:32] world, what would it be and why? [110:36] My message is that sexual health is [110:39] health and that we need to be [110:40] prioritizing our sexual health and [110:42] educate our young people about sex. [110:45] And why? [110:47] Because I think the impacts of having [110:51] negative sexual health or negative [110:53] sexual encounters can be so dramatic in [110:56] terms of physiological outcomes, [110:58] interpersonal outcomes, work [111:00] productivity. I mean, it can be very [111:02] far-reaching and if we are able to [111:06] educate and empower people, we can [111:07] change the world. [111:11] Dr. Rena Malik, thank you so much for [111:12] your time today and thank you so much [111:13] for um [111:14] illuminating a a bunch of issues on [111:16] sexual health that I've never really [111:17] understood or been able to discuss [111:19] before. And I think these conversations [111:21] are so unbelievably important because as [111:22] you say there, sex sort of permeates [111:24] every facet of our lives. And I think [111:25] sometimes people wonder why I spend a [111:27] lot of time on the show talking about [111:28] sex when this is called The Diary of a [111:30] CEO. But that's because it's the same [111:33] reason why I spend a lot of time talking [111:34] about health and the brain and [111:35] neuroscience and relationships and [111:36] everything because I've come to learn [111:38] that although I'm a CEO, I'm a business [111:41] person, all of these things, as you've [111:42] said, feed into [111:45] um my ability to be a CEO. And what is a [111:47] CEO? A CEO is a human being. A CEO is [111:49] just someone that is um [111:51] has a sort of high-intensity career. We [111:53] all have high-intensity careers and [111:54] we're these multifaceted objects, but [111:56] some parts of these multifaceted objects [111:59] are still in the shadows because there's [112:02] stigma and there's shame and there's not [112:04] a lot of a lot of education around it. [112:06] And if I think about my career as a [112:07] whole, um [112:09] sex and my relationships have been this [112:11] huge um [112:13] huge part of it that once I focused more [112:16] energy on and started investing in in [112:18] every other part of my career improved. [112:20] Every other part of my life improved. My [112:21] health improved. My performance at work [112:23] improved. My anxiety levels um [112:25] dissipated and that's why I think these [112:26] conversations are so unbelievably [112:28] important. And your work that you've [112:29] done both in your your sort of clinical [112:31] practice, but also what you're doing on [112:33] YouTube as well, which I'll link below [112:34] so everyone can go and see, is allowing [112:37] this information to be accessible for [112:39] everybody, even those that don't have um [112:41] the money to go and drive, as you said, [112:43] to go see a therapist. I think that's an [112:45] incredibly important work and I'm I'm [112:46] glad that you're a real champion and and [112:48] a force behind that. So thank you so [112:50] much on behalf of [112:51] me, my team, but also everyone that's [112:53] consumed your work and gained value from [112:54] it. Thank you. I would just say that I [112:56] always tell people, cuz I mentor a lot [112:58] of young medical students, [113:00] and I I always tell young women that the [113:03] number one most important decision [113:06] you're going to make is who you choose [113:07] as your partner. [113:09] And that's because that person [113:12] whether it's obviously emotionally but [113:14] also sexually, right? How they support [113:16] you in your life is going to determine [113:19] whether you're able to succeed or not. [113:21] And I I just was talking to another [113:23] woman and and she you know, she was like [113:25] my husband's wonderful. I was like I'm [113:26] not surprised. I was like you don't get [113:28] to be a successful woman [113:30] and a happy, well-adjusted successful [113:32] woman unless you either are you know, [113:35] very happy being alone or you have an [113:38] excellent partner to support you. [113:39] Because if you have a toxic partner at [113:41] home, it's not going to work. Amen. [113:44] Thank you.