Rena Malik Links Male Sexual Function to Heart Disease Risk

Rena Malik指出男性性功能与心脏病风险存在关联 泌尿科医生Rena Malik表示，勃起功能障碍是心血管疾病和总体死亡率的早期血管指标。 Rena Malik医生深入剖析了决定人类性健康与亲密关系的生理、心理及生活方式因素。她详细阐述了勃起功能障碍等状况如何作为心血管疾病的早期指标，同时重点指出了长期压力、睡眠匮乏、微塑料以及强迫性观看色情内容带来的负面影响。讨论还提出了一系列有科学依据的解决方案——涵盖调整饮食、盆底肌锻炼、良好沟通以及感官聚焦训练——旨在恢复性功能并提高整体寿命。 性健康与全身血管健康紧密相连，器质性勃起功能障碍（ED）通常比心血管疾病发作早出现 3 至 5 年；此外，与每年仅一次性生活的人相比，保持每周一次性生活的人全因死亡率降低了 49%。 (28:47) 维持性健康的四大基石包括营养补给、体能力量、外部环境和心理自信；每周进行 150 分钟中等强度有氧运动对改善生殖器血流的效果堪比伟哥，而坚持地中海饮食与富含类黄酮的食物也能显著降低 ED 风险。 (20:58) 性兴奋依赖副交感神经系统主导，但数字分心与表现焦虑会激活交感神经并引发“自我旁观”，通过去除插入期望的“感官专注”身体探索可有效缓解压力并重建亲密感。 (11:50) 慢性压力带来的皮质醇激增会直接抑制睾酮生成，而睡眠剥夺影响尤为显著：健康男性若连续一周每晚仅睡 5 小时，体内睾酮水平将骤降 15%，相当于激素水平衰老了 10 年。 (41:24)

Urologist Dr. Rena Malik argues that fulfilling sexual intimacy and long-term function depend on foundational vascular, hormonal, and psychological health rather than mechanical performance or anatomical extremes. Achieving genuine sexual pleasure requires aligning with biological anatomy—particularly direct clitoral stimulation for women—while dismantling performance anxiety and modern lifestyle saboteurs like digital overstimulation and chronic stress. Four Pillars Governing Sexual Health and Longevity (17:56) Dr. Malik outlines four foundational pillars that govern sexual capacity: fuel (nutrition), strength (cardiovascular fitness and pelvic floor conditioning), environment (sleep quality, stress levels, and endocrine disruptors), and confidence. Vascular integrity underpins physical response; adherence to a Mediterranean diet lowers erectile dysfunction (ED) risk by 22%, while consuming 100 grams of pistachios daily improves erectile performance. In exercise, 150 minutes of weekly moderate cardiovascular conditioning matches the genital blood flow benefits of Viagra, and a structured 20-minute walking protocol improved ED by 70% among cardiac patients. Sexual frequency also directly mirrors longevity: engaging in sex weekly correlates with a 49% reduction in all-cause mortality compared to once-yearly frequency, and every 100 male orgasms correlate with roughly 13% greater life expectancy. Dr. Malik emphasizes that organic ED operates as an early vascular indicator for systemic heart disease, with clinical cardiovascular events typically emerging 3 to 5 years after the onset of organic ED and 14% of affected men suffering a heart attack within 7 years. Anatomical Mechanics of Female Arousal and Climax (35:50) Female sexual satisfaction is frequently undermined by anatomical misconceptions. The clitoris and penis are biological homologues sharing identical embryonic tissue; the clitoral glans extends internally into bulbs and legs along the anterior vaginal wall. Because nerve density is concentrated in this clitoral network, approximately 85% of women require direct or indirect clitoral stimulation to orgasm, while only around 15% reach climax through unassisted vaginal penetration. Although the resting vaginal canal averages 3.5 inches in depth, full arousal triggers "tenting," which roughly doubles internal dimensions to accommodate penetration. To optimize female pleasure, Dr. Malik points to positions that ensure steady clitoral contact, notably woman-on-top variations and the Coital Alignment Technique (CAT), which applies continuous rocking friction between the pubic symphysis and the clitoris. Sensation also depends on pelvic floor conditioning: optimal function requires dynamic muscular control—the ability to voluntarily contract and relax—rather than continuous hypertonic tension, which restricts blood flow and provokes pelvic pain. Deactivating Stress Loops and Overcoming Performance Anxiety (7:16) Modern habits have contributed to declining sexual activity among young adults, with rapid digital scrolling and work stress locking the autonomic nervous system into a sympathetic "fight-or-flight" state. Physical arousal requires shifting into a parasympathetic "rest and digest" state, which is disrupted when individuals enter the bedroom with fragmented attention. Compounding this, emulation of adult films has popularized practices like choking—reported by roughly 60% of young women and 20% of young men in survey data—which qualitative research shows women often tolerate out of perceived expectation rather than personal pleasure. Performance anxiety frequently triggers "spectatoring," where individuals mentally evaluate their sexual adequacy rather than staying immersed in sensory contact. Dr. Malik recommends removing intercourse from the equation through sensate focus exercises. Neurologically, human skin contains C-tactile afferent fibers that activate specifically in response to slow, bare touch (such as 3 cm per second) to induce pleasure and bonding. To address relationship friction without provoking defensiveness, couples should discuss intimacy outside the bedroom in neutral settings, such as during a walk or car ride. Hormonal Health Realities and Insecurity Pitfalls (68:57) Male testosterone levels have declined on a population scale by approximately 25% over two decades, dropping from ~600 ng/dL in the late 1990s to ~450 ng/dL around 2015. Dr. Malik identifies primary drivers in rising obesity rates—where adipose aromatase converts testosterone into estradiol—alongside metabolic dysfunction, sleep apnea, and endocrine-disrupting plastics. Cellular sensitivity is mediated by genetic CAG repeat lengths on androgen receptors, meaning higher serum numbers do not inherently equal better health. Once receptors saturate, excess androgens offer no additional physiological benefits; unmonitored anabolic steroid abuse carries a 15-fold higher risk of heart failure and a 122-fold higher risk of cardiac death. Similarly, male anxieties regarding penis size are exaggerated by outlier representations in pornography. While men frequently overestimate typical anatomy at 6 to 7 inches, global averages measure between 5.2 and 5.5 inches, and partner satisfaction surveys confirm women prioritize clitoral engagement and emotional connection over length. Dr. Malik strongly advises against surgical enlargement due to severe deformity and nerve risks, noting that mechanical traction devices provide a modest, evidence-backed length increase of roughly 2 cm, whereas aggressive manual methods like "jelking" risk permanent tissue scarring. Dr. Malik emphasizes that cultivating fulfilling sex requires moving away from cosmetic anxieties, pharmaceutical shortcuts, and rigid performance expectations toward foundational vascular health, anatomical literacy, and low-stakes communication. An emerging consideration remains how novel GLP-1 receptor agonists affect intimacy: while their substantial metabolic and fat-loss benefits improve genital vascular flow, their blunting of central reward pathways may subtly suppress sexual desire in some individuals.

## Background 本期内容由知名播客频道《The Diary Of A CEO》（主持人为 Steven Bartlett）于 2026 年 4 月 27 日发布在 YouTube 平台。页面简介介绍，嘉宾为泌尿外科医生、骨盆外科专家兼性健康学者 Rena Malik 博士，她通过基于科学的教育拆解大众难以启齿的性健康难题，围绕睾酮、色情片、勃起功能障碍、性欲减退、压力管理以及掌控性生活的四大支柱展开全面深入的剖析。 ## TL;DR 本期访谈围绕构建健康性生活的四大底层支柱——营养、力量、环境与信心展开系统探讨。Malik 医生从泌尿外科与神经生理学视角指出，性功能与勃起障碍往往是心血管代谢异常的早期预警信号，而规律的性生活与长寿具有高度正相关性。节目详细剖析了屏幕成瘾与多巴胺失衡对现代人亲密关系的侵蚀，破除了针对自慰习惯、色情内容、性玩具依赖以及阴茎尺寸的常见迷思，并深入阐释了盆底肌调控、男女器官同源解剖、女性潮吹机制以及 TRT（睾酮替代疗法）的生理利弊。最后，双方倡导伴侣间放下“读心术”预设，以玩心与好奇心打破羞耻感，在数字焦虑时代重拾真实的身体连接与情感温度。 ## Atmosphere & style 整场对话在严谨硬核的医学解剖与轻松幽默的坦诚对谈之间无缝切换，现场不仅拿出生殖骨盆模型进行细致拆解，还穿插着拿错模型、性玩具断电等令人忍俊不禁的真实插曲。主持人 Steven Bartlett 以毫无包袱的自我坦露与接地气的提问，引出 Malik 医生兼具临床权威度与同理心的解答，彻底剥离了围绕性话题的陈腐禁忌与羞耻感。整期节目传递出一种包容、温和且充满力量的理性氛围，让观众在卸下焦虑的同时，深切体会到身体探索的松弛感与人际真实连接的深远价值。 ## Bulletin - [00:00](https://www.youtube.com/watch?v=PnpHwhTWw0c&t=0s) 性健康与人类寿命高度相关：流行病学数据显示，每周拥有一次性生活的人群其全因死亡率比每年仅一次者低49%，男性每累计获得100次性高潮，预期寿命延长约13%。 - [28:29](https://www.youtube.com/watch?v=PnpHwhTWw0c&t=1709s) 器质性勃起功能障碍（ED）是心血管疾病的“煤矿金丝雀”：因血管病变发生ED的男性通常在3至5年内出现明确心脏病变，第7年有14%会突发心肌梗死。 - [20:58](https://www.youtube.com/watch?v=PnpHwhTWw0c&t=1258s) 运动与饮食对血管的干预效果堪比处方药：每周完成150分钟中等强度有氧运动对勃起功能的改善幅度比肩伟哥（Viagra），坚持地中海饮食可将ED发生风险降低22%。 - [41:24](https://www.youtube.com/watch?v=PnpHwhTWw0c&t=2484s) 睡眠剥夺对激素分泌具有毁灭性打击：健康男性每晚睡眠由8小时缩短至5小时，仅需一周体内睾酮水平便暴跌15%（生理退化相当于衰老10岁）；而治愈阻塞性睡眠呼吸暂停后睾酮最高可跃升200 ng/dL。 ## Key takeaways - [00:45](https://www.youtube.com/watch?v=PnpHwhTWw0c&t=45s) 掌控性生活的底层四大支柱：雷娜·马利克医生提出性健康由“燃油（营养输入）”、“力量（心血管耐力与盆底肌）”、“环境（压力、深度睡眠与环境毒素）”和“信心（解剖知识与沟通）”共同构筑。 - [03:05](https://www.youtube.com/watch?v=PnpHwhTWw0c&t=185s) 年轻群体陷入“无性化”危机：移动设备与信息过载吞噬了亲密互动的时间与心理空间，伴随快餐式约炮文化与沟通教育的缺失，许多年轻人在缺乏了解与表达技巧的尴尬体验后对现实性爱丧失兴趣。 - [06:06](https://www.youtube.com/watch?v=PnpHwhTWw0c&t=366s) 色情作品催生粗暴性行为误区：缺乏正规教育使色情片成为青年主要性启蒙教材，导致性窒息等粗暴行为泛滥成风，质性调查显示大量年轻女性出于逢迎伴侣或“以为性爱本该如此”的规训而被迫隐忍恐惧。 - [11:50](https://www.youtube.com/watch?v=PnpHwhTWw0c&t=710s) 唤起依赖副交感神经，“表现焦虑”会引发旁观者效应恶性循环：当把性爱当成必须达标的硬性任务时，交感神经过载会导致生理疲软；可通过剥离实质插入目标的“感官聚焦（Sensate Focus）”训练逐步重获安全感与勃起。 - [25:53](https://www.youtube.com/watch?v=PnpHwhTWw0c&t=1553s) 骨盆底肌紧绷常被误诊，盲目做凯格尔运动反而雪上加霜：慢性压力会导致盆底肌潜意识痉挛并阻断生殖器血流，表现为假性尿急、骨盆腰背痛与勃起/唤起障碍；此类患者需通过腹式呼吸与瑜伽拉伸放松，而非进行力量加压。 - [30:59](https://www.youtube.com/watch?v=PnpHwhTWw0c&t=1859s) 自慰习惯导致的脱敏与习惯化：面对屏幕自慰时表现焦虑清零，但长期采用高握力机械刺激（如“死亡之握”）或极端体位摩擦床单，会重塑神经阈值，导致现实性爱中无法被正常阴道握力与触感唤起。 - [34:37](https://www.youtube.com/watch?v=PnpHwhTWw0c&t=2077s) 夜间充血与晨勃是机体自我维护机制，遵循“用进废退”：健康的晨勃代表心血管与神经机能完好；若长期缺乏夜间规律充血，阴茎海绵体和阴蒂组织会因缺血缺氧发生纤维化和瘢痕挛缩，导致尺寸不可逆缩小。 - [35:50](https://www.youtube.com/watch?v=PnpHwhTWw0c&t=2150s) 女性外生殖器与男性同源，阴蒂是庞大的内嵌系统：可见的阴蒂头仅是冰山一角，阴蒂前庭球与阴蒂脚深埋盆底并环绕阴道前壁；高达85%的女性单纯依靠阴茎抽插无法达到高潮，必须依赖直接的阴蒂刺激。 - [59:32](https://www.youtube.com/watch?v=PnpHwhTWw0c&t=3572s) “同轴对齐技术（CAT）”可显著提升女性高潮几率：男性上位时身体前移对齐双方耻骨联合，放弃传统深进深出抽插、转为持续的面贴面前后摇摆滑动，以此对阴蒂施加恒定压迫与摩擦。 - [01:00:50](https://www.youtube.com/watch?v=PnpHwhTWw0c&t=3650s) 女性潮吹由膀胱排液与斯基恩氏腺分泌物混合而成：潮吹并非人人皆有（发生率约40%），液体经尿道排出，虽然主要容积来自膀胱，但其在化学组成上清澈无味，兼具抗菌冲洗等演化特征。 - [01:05:26](https://www.youtube.com/watch?v=PnpHwhTWw0c&t=3926s) 慢速轻柔抚摸激活全身性感带的神经机制：皮肤表层的C触觉传入神经纤维在以3厘米/秒的慢速抚摸下产生最强烈的兴奋与愉悦感，且该神经纤维对真人皮肤温度有特异性，机械手套接触无法复现效果。 - [01:09:10](https://www.youtube.com/watch?v=PnpHwhTWw0c&t=4150s) 男性睾酮水平近三十年暴跌25%，多余体脂通过芳香化酶消耗雄激素：脂肪细胞富含芳香化酶，会将睾酮转化为雌二醇诱发男性乳房发育；盲目追求数值并不可取，受体敏感度与未结合的游离睾酮才决定机能表现。 - [01:14:50](https://www.youtube.com/watch?v=PnpHwhTWw0c&t=4490s) 滥用合成类固醇伴随极高心血管致死风险，TRT会大幅抑制生育能力：黑市滥用类固醇使心源性猝死风险暴增122倍；而外源性补充睾酮会触发负反馈关闭内源分泌，接受TRT治疗18个月时高达70%的男性会出现不育。 - [01:23:38](https://www.youtube.com/watch?v=PnpHwhTWw0c&t=5018s) 精液参数是全身体质与预期寿命的生物标志物：临床统计表明精子浓度低下与全因死亡率升高呈剂量反应关系，精子指标越差的个体早逝风险越高，反映出其深层的心血管与代谢恶化。 - [01:27:43](https://www.youtube.com/watch?v=PnpHwhTWw0c&t=5263s) 阴茎尺寸焦虑源于认知错觉，暴力拉伸（Jelqing）危害极大：人群平均勃起长度约为13.2至14.0厘米，绝大多数女性对平均尺寸感到满意；医用牵引装置需每日规范佩戴数月方可轻微拉长，盲目手挤拉伸极易造成海绵体撕裂与永久性ED。 - [01:41:52](https://www.youtube.com/watch?v=PnpHwhTWw0c&t=6112s) GLP-1受体激动剂（如Ozempic）对性欲的双刃剑效应：一方面减重改善血管内皮和体象自信，隐匿阴茎因耻骨脂肪垫变薄而显露变长；另一方面药物直接抑制大脑多巴胺奖赏中枢，可能隐性钝化对性的追求动机。 - [01:44:45](https://www.youtube.com/watch?v=PnpHwhTWw0c&t=6285s) 伴侣性沟通应脱离卧室并引入游戏心态：在户外散步或车内等平行视角下沟通能有效降低防御心理；抱持玩乐与探索心态尝试新技巧或分享性幻想，切勿将偶尔的不完美表现视作灾难考核。 ## Detailed walkthrough ### [00:00](https://www.youtube.com/watch?v=PnpHwhTWw0c&t=0s) 阴茎牵引装置、开心果与性爱带来的长寿数据 访谈开场便抛出了一系列颠覆直觉的硬核医学发现与数据。当被问及是否有真正有效的物理阴茎增大手段时，瑞娜·马利克医生（Dr. Rena Malik）指出，临床研究表明使用专门的阴茎牵引牵拉装置（penis traction device），每天进行两次、每次30分钟，确实可以在长度上实现约2厘米的增长。除了器械干预，日常饮食对性功能也有着直接影响。一项针对坚果的研究显示，男性每天食用100克开心果，勃起功能障碍（ED）得到了显著改善。马利克医生严肃地提醒道，如果男性长期缺乏勃起，流向阴茎的血液减少，海绵体组织会随着时间推移逐渐萎缩退化；而女性的阴蒂拥有极为相似的勃起组织结构，缺乏充血同样会导致类似的问题。 更令人震惊的是性生活与人类寿命之间的紧密联系。流行病学数据显示，每周拥有一次性生活的人，其预期寿命比每年仅有一次性生活的人高出整整49%。不仅如此，男性每累计获得100次性高潮，死亡风险就会降低，相当于延长大约13%的寿命。主持人史蒂文·巴特利特（Steven Bartlett）听闻此言忍俊不禁地开玩笑道：“我得马上离开去办点事了（Be right back）。” - **牵引延长效果**：每天两次、每次30分钟的阴茎牵引器械使用，经研究证实可平均增长约2厘米。 - **开心果与勃起**：每日摄入100克开心果可改善阴茎充血状况，显著缓解勃起功能障碍。 - **器官退化机制**：缺乏定期充血与勃起，会导致阴茎和阴蒂的勃起海绵体组织随时间发生萎缩。 - **性与长寿关联**：每周一次性生活者的寿命比每年一次者高出49%；男性每获得100次性高潮，寿命延长约13%。 ```mermaid flowchart TD accTitle: 频繁勃起与性高潮对生理健康的积极循环机制 accDescr: 展示了性活动与充血如何保护组织并带来全身的长寿获益 subgraph LocalTissue["局部组织血流"] A["规律充血与性生活"] --> B["充足血液流向阴茎与阴蒂"] B --> C["防止海绵体组织萎缩退化"] end subgraph SystemicHealth["全身系统获益"] C --> D["心血管与内分泌机能改善"] D --> E["降低全因死亡率与延长寿命"] end ``` ### [00:45](https://www.youtube.com/watch?v=PnpHwhTWw0c&t=45s) 掌控性生活的四大支柱 作为全球受关注度极高的泌尿外科专家与盆底外科医生，马利克医生强调，想要获得极致的性体验，不能仅停留在技巧层面，而必须从底层生理学建立系统性认知。她提出了构建最佳性健康的“四大核心支柱”： 第一大支柱是**燃油（Fuel）**，即你如何滋养和补充自己的身体，营养输入构成了性活动最基本的物质基础；第二大支柱是**力量（Strength）**，大众往往将其窄化为去健身房举铁，但实际上任何形式的心血管有氧运动都能有效改善性功能，因为它们直接促进了血液流向生殖器官。研究表明，每周完成150分钟的有氧运动，对勃起功能的改善程度堪比服用西地那非（伟哥，Viagra）这类药物，此外鲜少被深入探讨的盆底肌功能同样关键；第三大支柱是**环境（Environment）**，涵盖了心理压力、睡眠质量以及内分泌干扰物（EDCs）。马利克医生特别引用对比数据指出，每晚仅睡5小时的男性，其体内睾酮水平相比每晚睡8小时的男性会剧烈暴跌15%；第四大支柱则是**信心（Confidence）**与心理状态。在后续的讨论中，她将进一步剖析晨勃监测、女性射液（Squirting）、阴蒂刺激机制以及能大幅提升女性高潮概率的特定体位。 - **第一支柱（燃油 Fuel）**：精准营养与身体补给，为荷尔蒙分泌与神经传递提供底层能量。 - **第二支柱（力量 Strength）**：心血管有氧耐力与盆底肌肉控制；每周150分钟运动改善勃起的效果堪比伟哥。 - **第三支柱（环境 Environment）**：包括压力调节、化学毒素暴露与深度睡眠；每晚睡眠5小时会导致睾酮骤降15%。 - **第四支柱（信心 Confidence）**：心理状态、身体意象认知以及对伴侣间亲密机制的科学掌控。 ### [02:07](https://www.youtube.com/watch?v=PnpHwhTWw0c&t=127s) 频道订阅呼吁与内容初衷 在深入探讨专业医学议题之前，主持人史蒂文·巴特利特插话与观众分享了一组后台数据。团队监测发现，大量经常收看节目的常客并没有点击订阅，甚至部分观众反馈自己莫名其妙被系统取消了关注。随着频道即将迎来一个里程碑式的订阅数字，巴特利特诚恳请求大家花一秒钟检查并点击订阅按钮。他强调，这一举动不仅完全免费，而且是支持团队持续每周投入心血、邀请全球顶尖专家、保持内容最高水准的最直接力量，他承诺团队会一如既往地为大家争取最深刻、最具价值的独家对谈。 ### [03:05](https://www.youtube.com/watch?v=PnpHwhTWw0c&t=185s) 最常被问及的问题：现代年轻人为何陷入“无性化”？ 重新回到访谈后，巴特利特询问马利克医生，作为长期科普性健康的网络红人，走在街上被粉丝认出时最常被问到的问题是什么。马利克医生坦言，几乎每个人都会迫切地问：“我现在到底能做些什么来改善我的性生活？”每个人都本能地渴望美好的性爱，然而在社交网络和流行文化的渲染下，许多人产生了一种深层的“性错失恐惧”（FOMO）——他们总觉得自己错过了更棒的体验，或是疑惑为什么现实中的性爱无法像色情片中演的那样令人神魂颠倒。 针对马利克医生“性爱的重要性不言而喻”的观点，巴特利特随即指出当下出现了一个惊人的反差社会现象：数据表明，当下的人们正在经历一场前所未有的“无性化”（Sexless）危机，尤其是在18至30岁的年轻群体中，性生活频率呈现出断崖式下跌。 马利克医生对比了半个世纪前的生活形态来剖析这一巨变。在50年前，没有智能手机，电视只有几个固定频道的节目且充斥着广告，没有下班后还要回复的工作邮件。人们下班后回家与家人做饭、闲聊、看一会儿电视，随后便躺在床上。由于床头没有任何发光的屏幕分散注意力，伴侣之间有充分的时间相互交谈、拥抱爱抚，性爱自然而然成为打发夜晚、获取快乐与亲密的优先选择。而现代人的一切注意力都被碎片化信息全面占据，根本没有留给性唤起所需的情感和时间“空间”。此外，年轻人的约会高度依赖交友软件和社交平台私信，形成了快餐式的约炮文化（Hookup culture）。对绝大多数人而言，初次与陌生人发生的性行为往往非常糟糕——彼此毫无了解、不知道对方的敏感点，也从未学过如何开口表达自己的性偏好，最终导致充满自我怀疑和尴尬的平庸体验，反而让年轻人对现实性爱彻底失去兴趣与耐心。 - **沟通断层**：主流教育从未传授过如何与伴侣就性偏好展开坦诚对话，导致初次体验充满尴尬与挫败。 - **无性生活趋势**：在18至30岁青年人群中，无性生活人群比例急剧攀升，情感联结逐渐让位于碎片化社交。 - **环境被挤占**：传统卧室是纯粹的亲密与休息空间，而现代移动设备打破了生活边界，彻底吞噬了伴侣互动的空隙。 ### [06:06](https://www.youtube.com/watch?v=PnpHwhTWw0c&t=366s) 粗暴性行为的激增与色情片的失真规训 性教育的缺失，导致色情影视作品成为了当代青年唯一的“性启蒙教材”，这引发了极其严重的认知扭曲与行为异化。色情片呈现的是经过精密运镜、剪辑和表演的非现实场面，盲目模仿往往带来糟糕的生理与心理体验。其中最令人触目惊心的趋势是“粗暴性爱”（Rough sex）的普及，尤其是性窒息（掐脖子，Choking）竟然已经泛滥到了被视作如同接吻一般的“常规操作”（Vanilla sex）。 马利克医生引用了知名性学研究者德比·赫本尼克（Dr. Debby Herbenick）的严谨调研：在大学年龄段群体中，高达60%的女性和约20%的男性曾在性爱中被掐住脖子；在这些被掐过脖子的人群中，有20%的人经历过25次甚至更多次。然而质性访谈揭示了极其残酷的现实：很多年轻女性在被问及是否真正享受这种行为时，回答往往是“还行吧，有时候伴侣体型高大、手劲很大，我其实非常害怕，但我以为这就是性爱的一部分”。年轻一代误以为这就是取悦对方的唯一标准，为了符合所谓“正常性爱”的假象而默默隐忍甚至迎合。当一段性关系充斥着非出于本意的恐惧与逢迎，性爱必然演变成一种令人退避三舍的负担。 - **窒息普及率**：大学年龄段中约60%的女性及20%的男性曾经历过性窒息行为。 - **高频发生比例**：在体验过性窒息的人群中，五分之一的个体累计经历过25次以上。 - **假意逢迎心态**：质性研究表明多数女性并非出于真正的快感，而是源于“以为伴侣想要”或“以为性爱本该如此”的社会规训。 ### [07:16](https://www.youtube.com/watch?v=PnpHwhTWw0c&t=436s) 屏幕成瘾、多巴胺劫持与“机械式”性爱 巴特利特进一步补充了关于年轻一代生活习惯的统计数据：在30岁以下的人群中，处于极端区间的个体每天花费在手机、社交媒体和互联网上的时间高达8至10小时；约15%至20%的年轻人将自己的手机使用状态描述为“几乎全天无休”，从起床、如厕、吃饭直至入睡的每一分钟都在滑动屏幕。巴特利特提出疑问：短视频、高糖食品以及在线色情内容所带来的这种高频且廉价的多巴胺轰炸，是否从神经生物学层面劫持了大脑，进而彻底摧毁了人们在卧室里的性欲望与实际表现？ 马利克医生完全赞同这一推论。她指出，美妙的性爱本质上极度依赖“心理在场感”（Mind space）。如果个体的大脑神经回路整天都被算法投喂的过量刺激所霸占，心理就永远无法从容进入放松、沉浸且敏感的唤起状态。许多人抱着极为功利和短视的心态对待亲密接触，把性爱彻底降级为一种“机械化的排泄任务”——仅仅指望一看到伴侣的身体就能立刻完成生理唤起，在最短时间内冲向一次性高潮，随后草草收场。这种剥离了细腻感知、情感铺垫与感官探索的机械互动，从根本上剥夺了性爱原本应有的深层次欢愉。 ### [08:34](https://www.youtube.com/watch?v=PnpHwhTWw0c&t=514s) 屏幕分心与唤起误区：男性并非随时随地都能“进入状态” 现代人受困于数字屏幕的持续轰炸，注意力被切割得支离破碎。每隔数十秒就有一条崭新的短视频跳出，大脑始终处于多任务运转的紧绷状态，极难保持专注。这种心智模式直接蔓延至卧室之中：许多人身体在做爱，大脑却漂浮在别处，盘算着刚刚看过的资讯、待办事项或是想搜索的内容，纯粹只是在“例行公事”。斯蒂芬·巴特利特（Steven Bartlett）坦承自己的切身体会：如果经历了一整天极度繁忙的高压工作，或者脑海中正被某件大事占据，他很难立刻投入性生活，必须刻意营造出充足的心理和物理空间，才能真正进入状态。 雷娜·马利克（Dr Rena Malik）对这一坦白深表赞赏。社会文化长期充斥着一种根深蒂固的不公偏见，误认为男性就像随时待命的机器，无论何时何地都能立即“准备就绪”（"ready to go at any moment"）。但事实远非如此，无论男女，性唤起都需要时间和充沛的精力。特别是在面临工作压力、生存重担和各类生活杂务时，没有人能够瞬间进入状态，每个人都必须主动为亲密关系腾出专属的时间与空间。 --- ### [09:42](https://www.youtube.com/watch?v=PnpHwhTWw0c&t=582s) 唤起的生理机制：从“大脑故事”到副交感神经系统的启动 斯蒂芬指出，对男性而言，除了清晨的生理性勃起（晨勃）之外，性爱中的勃起本质上是一个心理过程的产物——脑海中必须先形成一个令人兴奋的“故事”，引发“这很诱人”的情感反应，随后身体才会跟进。马利克医生证实了这一点：性欲与唤起不是凭空产生的，它需要感官或心理刺激的催化，无论是视觉呈现、某种特殊气味、肢体触碰，还是伴侣间共享私密时刻所带来的心意相通。 从神经生理学角度来看，唤起和勃起的发生必须由副交感神经系统主导。副交感神经被称为“休息与消化”（rest and digest）系统；当个体处于压力重重、忧虑奔波的紧绷状态时，主导应激的交感神经系统处于激活状态，身体根本无法放松下来充血勃起。不同个体触发副交感神经与性唤起的方式大相径庭：有人偏向视觉驱动，看到伴侣就能快速兴奋；有人则需要深度的精神交流；还有人依赖环境触发物，例如特定的香氛、彻底放松肌肉的温水泡澡等。马利克医生强调，在长期伴侣关系中，自发性欲望（spontaneous desire）往往会逐渐衰退，性冲动更多演变成为对环境线索做出反应的“反应性欲望”（responsive desire），因此摸清并满足彼此独特的唤起线索至关重要。 --- ### [11:50](https://www.youtube.com/watch?v=PnpHwhTWw0c&t=710s) 表现焦虑的恶性循环与“感官聚焦”破局法 斯蒂芬回忆起过去一段异地恋情，由于平时聚少离多，每次奔波劳碌或倒着时差去见对方时，心中总背负着“一见面就必须做爱”的预设期待。这种沉重的期待非但没有激发情欲，反而化作巨大的心理负担，成为房间里“不可忽视的大象”，直接打击了实际表现。马利克医生解释称，这正是典型的“表现焦虑”（performance anxiety）。 ```mermaid flowchart TD accTitle: 表现焦虑的恶性循环与感官聚焦破局法 accDescr: 展示从按需表现的心理压力演变为勃起困难、旁观者心理，再到通过感官聚焦训练逐步恢复的路径。 subgraph Cycle["表现焦虑恶性循环"] A["预设期待与按需表现压力"] --> B["交感神经过载与心理担忧"] B --> C["旁观者效应（审视自身反应）"] C --> D["生理唤起受阻/勃起功能失败"] D --> E["内疚自责与'让伴侣失望'"] E --> A end subgraph Solution["感官聚焦训练（Sensate Focus）"] F["完全剥离实质插入目标"] --> G["非生殖器身体探索与抚触"] G --> H["放松身心，副交感神经启动"] H --> I["过渡至生殖器抚触（仍禁止插入）"] I --> J["在无压力下顺其自然恢复性交"] end D -.->|"介入阻断循环"| F ``` 当个体内化了“必须按需表现”的压力时，注意力会从享受当下的触觉与温存中剥离，转变为在脑中不断审视自我：“天呐，我会不会又不行？”这种被心理学称为“旁观者效应”（spectatoring）的状态，让个体如同站在一旁冷眼旁观自己做爱。恐惧刺激了交感神经兴奋，导致血管收缩、唤起中断；而随之而来的失败感与“辜负伴侣”的自责，则会让恶性循环越陷越深。 针对这种在门诊中极其普遍的困境，马利克医生提出采用“感官聚焦”（Sensate Focus）进行系统性破局： - **第一阶段：彻底卸下实质性插入的压力**。伴侣双方在亲密时完全排除生殖器接触与插入性交，纯粹将注意力放在探索彼此身体的其他敏感区域上，重新寻找无压力的愉悦与玩乐感。 - **第二阶段：等待身心自然放松**。当个体的注意力不再紧盯着阴茎硬度时，副交感神经会悄然接管，身体反而会在毫无察觉间自然勃起。 - **第三阶段：逐步引入生殖器抚触但暂不插入**。开始轻柔接触敏感器官，建立“即便勃起也无需强行履职”的心理安全感。 - **第四阶段：顺其自然恢复插入式性爱**。当身体和心理彻底脱敏、不再恐惧失败之后，再循序渐进地重启完整的性生活。 --- ### [14:34](https://www.youtube.com/watch?v=PnpHwhTWw0c&t=874s) 性生活的停滞、长寿关联与对抗孤独感 临床上普遍存在着大量“完全回避性生活”的伴侣。他们缺乏坦诚沟通性困扰的工具与词汇，往往在一方性欲减退或遭遇疼痛障碍后，另一方选择放弃尝试，最终使卧室陷入长久的死寂。马利克医生将这种情况视为严重的健康警讯。令人满意的性功能（顺畅的勃起、充分的润滑唤起、高质量的高潮）不仅是亲密关系的纽带，更是机体内部微循环、末梢神经传导以及内分泌激素水平健康运转的“晴雨表”。 性生活更是直接影响寿命的重要生物学变量： - **全因死亡率大幅下降**：流行病学研究显示，每周拥有一次性生活的人群，与每年仅有一次性生活的人群相比，全因死亡率降低了 49%（生存期延长显著）。即便是频率介于两者之间，也能对健康寿命产生积极促进。 - **高潮频次与预期寿命挂钩**：1997 年的一项经典随访研究发现，男性每增加 100 次性高潮，预期寿命便相应提升约 13%（死亡风险显著下调）。 - **缓解致命的孤独流行病**：世界卫生组织（WHO）已将“孤独”列为全球性健康流行病，其对人体的健康危害堪比每天吸食 15 支香烟。充满温度的性接触与深层连接，正是人体化解孤独危机、维持全身系统健康的核心防御机制。 ### [17:09](https://www.youtube.com/watch?v=PnpHwhTWw0c&t=1029s) 性爱与长寿的关联：心血管健康的直接晴雨表 关于性爱与长寿的研究，史蒂文·巴特利特（Steven Bartlett）提出疑问：数据是否能证明是性爱本身直接让人延年益寿，还是说这种因果关系很难完全确立？雷娜·马利克医生（Dr Rena Malik）解释道，虽然流行病学研究极力控制了年龄、并发症等混杂因素，但性爱之所以关乎长寿，一个核心原因在于它本质上就是一项非常扎实的心血管锻炼。 在与伴侣亲密接触的过程中，心率显著提升，身体经历高强度的活动。一个人能够顺利完成性行为本身，就是整体健康状况的绝佳晴雨表——这意味着身体能够支撑特定姿势，且在维持一定强度的身体消耗时不会发生气喘吁吁或体力衰竭。因此，持续且高质量的性生活在相当程度上反映并反哺着心血管系统的健全。 ### [18:02](https://www.youtube.com/watch?v=PnpHwhTWw0c&t=1082s) 性健康的四大基石之一：营养与“燃料”（Fuel） 当被问及若想获得美妙的性生活、需要在生活方式上奠定哪些基础时，马利克医生引入了一个生动的概念：性健康如同一栋房屋，必须依靠四大基石构筑稳固的地基，否则再怎么修修补补，整座房屋依旧会坍塌。这四大支柱分别是：**营养（Fuel）**、**力量（Strength）**、**环境（Environment）**以及**信心（Confidence）**。 在谈到第一个支柱“营养”时，马利克医生指出虽然大量学术研究以男性数据为主，但其背后的生理机制对女性同样适用。研究最透彻的饮食模式是地中海饮食，富含牛油果等健康脂肪、绿叶蔬菜、坚果、优质瘦肉蛋白以及色彩斑斓的水果。著名随访研究《健康专业人员随访研究》（Health Professionals Follow-up Study）对 20,000 名男性进行了长期追踪，发现严格坚持地中海饮食的男性，其勃起功能障碍（ED）的发生风险足足降低了 22%。 当史蒂文打趣道“那是不是吃开心果就能让阴茎变硬”时，马利克医生笑称虽然她并不喜欢炒作单一“超级食物”的概念（以免大众产生只吃某一种坚果就万事大吉的误区），但特定食材确实有扎实的数据支撑：一项研究让男性每天摄入 100 克开心果，结果显示其勃起功能得到了客观改善。坚果中富含的优质 Omega-3 脂肪酸和不饱和脂肪构成了保护血管的关键因素。 ```mermaid flowchart TD accTitle: 饮食营养对血管与勃起功能的促进机制 accDescr: 展示地中海饮食、类黄酮、抗氧化剂及膳食纤维如何转化为短链脂肪酸并保护血管内皮细胞，从而提升勃起与性功能。 subgraph Fuel["饮食营养输入 (Fuel)"] F1["地中海饮食<br>(健康脂肪/牛油果)"] F2["坚果与浆果<br>(开心果/蓝莓/番茄红素)"] F3["膳食纤维<br>(男 38g/天 / 女 25g/天)"] end subgraph Mechanism["体内生化代谢过程"] M1["提供 Omega-3 与抗氧化剂"] M2["肠道转化为短链脂肪酸 (SCFAs)"] M3["内皮细胞保护机制 (Endothelial Protection)"] end subgraph Outcome["生理健康与性功能收益"] O1["改善代谢指标<br>(预防高血压/糖尿病/高血脂)"] O2["生殖器血流充足<br>(勃起硬度增加 / 阴蒂充血敏感)"] end F1 --> M1 F2 --> M1 F3 --> M2 M1 --> M3 M2 --> M3 M3 --> O1 O1 --> O2 ``` - **类黄酮与抗氧化剂**：蓝莓等深色浆果以及柑橘类水果富含类黄酮，红色水果富含番茄红素，能大幅提升体内抗氧化水平。研究发现经常规律食用蓝莓可让勃起功能提升约 20%。 - **不可忽视的膳食纤维**：膳食纤维在肠道内会被微生物分解发酵生成短链脂肪酸（Short-Chain Fatty Acids, SCFAs），发挥内皮保护机制（endotheloprotective mechanisms），强韧血管管壁，从而预防糖尿病、高血压和高胆固醇等代谢疾病。 - **推荐每日纤维摄入量**：男性为 38 克，女性为 25 克。 - **热量管理与体重控制**：维持健康体重至关重要，过度堆积的脂肪组织（adipose tissue）会显著增加勃起功能障碍及各类性功能减退的风险。 ### [20:58](https://www.youtube.com/watch?v=PnpHwhTWw0c&t=1258s) 性健康的四大基石之二：力量与运动（Strength） 谈及第二大支柱“力量”，马利克医生将其拆解为心血管有氧耐力、大肌群抗阻力量以及盆底肌机能三个维度。 在心血管耐力方面，最常被医学界引用的黄金法则是每周进行 **150 分钟中等强度有氧运动**。研究显示，达到该标准的男性在勃起功能国际问卷评分上的改善幅度，几乎与服用磷酸二酯酶-5（PDE5）抑制剂药物（如伟哥/万艾可 Viagra）的效果旗鼓相当。针对患有严重心脏病、无法承受中等强度运动的群体，临床实验设计了一套极温和的康复方案（5 分钟热身、20 分钟步行、5 分钟整理放松），在专人监督下坚持该运动方案，患者的勃起功能同样提升了整整 70%。无论是阴茎的充血坚挺还是女性阴蒂在唤起状态下的充血反应，完全依赖于通畅强健的局部血流。 在抗阻力量训练方面，深蹲（Squats）、硬拉（Deadlifts）等调动下肢与臀部核心大肌群的大重量动作，能有效刺激并提升体内睾酮（Testosterone）水平。人过 40 岁之后，肌肉量以每十年约 7% 的速度自然流失（肌少症 Sarcopenia），而积极通过抗阻训练对抗肌肉流失的男性，其罹患勃起功能障碍的概率比不练力量者**整整低了三倍**，并且能长期维持健康的性欲和性满意度。 史蒂文感叹道前一天刚读到一句话——“肌肉即药物（Muscle is medicine）”，如今这在性健康领域得到了百分之百的印证。马利克医生对此深表赞同，并指出当代人长期蜷缩在电脑桌前或长时间静坐录音，严重背离了人类祖先进行重体力劳动、农耕捕猎的身体演进模式；身体本来就是为了搬运重物和奔跑活动而设计的，缺乏物理运动直接导致了性机能的退化。 - **每周 150 分钟中度有氧**：改善勃起功能的效果比肩口服处方药物 Viagra。 - **心脏病患者低强度步行方案**：即使仅进行 20 分钟轻度步行配合拉伸，勃起功能也能够获得高达 70% 的改善。 - **大肌群抗阻与肌肉储备**：40 岁后人体肌肉每 10 年萎缩约 7%，维持肌力可将 ED 风险拉低至原本的三分之一。 ### [24:20](https://www.youtube.com/watch?v=PnpHwhTWw0c&t=1460s) 盆底肌的解剖结构与高潮时的节律性收缩 马利克医生在现场拿出了女性与男性的骨盆解剖模型，详细向史蒂文展示平日里被大众忽视的“盆底肌”（Pelvic Floor）。 骨盆是一个容纳脏器的坚固骨质结构。在女性体内，子宫、直肠和膀胱坐落其中，其底部被一层如碗状包裹的肌肉群稳固托起；直肠、阴道贯穿盆底肌延伸至体外。在男性体内，阴茎和肛门周围同样被这群强大的盆底肌紧密环绕。这些肌肉锚定在人体的骨骼标志上——包括双侧髋骨、骶骨以及耻骨联合，平时在后台静默运转，负责维持腹腔器官位置并承担“阀门”作用以控制排尿排便。 在性反应与性愉悦中，盆底肌扮演着决定性的机械角色： 当人体达到性高潮时，盆底肌肉会以约 **0.8 秒一次的恒定节律**发生强烈的收缩与舒张。高潮瞬间人们所体会到的那种如同波浪般涌动、阵阵搏动的销魂快感，正是由盆底肌的这套节律性抽动所制造的。而在男性射精过程中，也是依靠盆底肌强有力的快速收缩与加压挤压，才得以将精液从尿道喷射而出。同时，当需要忍耐憋尿或控制体内排出物时，也全赖这组肌肉的紧致收缩。 ### [25:53](https://www.youtube.com/watch?v=PnpHwhTWw0c&t=1553s) 骨盆底肌紧绷的隐形危机与放松之道 很多人以为骨盆底肌的作用仅仅是“憋尿”或控制排便，Dr. Rena Malik 澄清这些肌肉对心理压力极其敏感。就如同不少人在长期压力下会不自觉地在夜间咬紧牙关、引发颞下颌关节紊乱（TMJ）一样，骨盆底肌肉同样会在潜意识中持续紧绷或因髋部、背部外伤代偿而失去平衡。这种隐匿性的肌肉紧张会引发一系列常被误诊的连锁反应：它可能伪装成慢性腰背痛、便秘，或者由于膀胱正下方肌肉紧压而产生频繁的假性尿意（尿频、尿急）——哪怕膀胱根本没装多少尿，过度紧绷的肌肉也会向大脑发出强烈的排尿警报；更严重时，由于尿道被死死勒住，反而会导致排尿困难。 在性生活方面，过度紧张的骨盆底肌更是一个“隐形杀手”。肌肉过于收缩会像闸门一样阻断流向生殖器官的血流：在男性身上，这会直接诱发勃起功能障碍（ED）甚至早泄；在女性身上，则会导致阴蒂供血不足，引发性唤起困难、性交疼痛或无法达到性高潮。大众文化中普遍推崇的凯格尔运动（Kegel exercises）其实存在严重的认知误区：凯格尔运动本质上是力量强化训练，只适用于骨盆底机能完全健康、没有任何张力问题的人群。如果你本身已经存在上述紧绷症状，盲目狂练凯格尔运动只会雪上加霜，相当于给已经痉挛的肌肉再施加重压。 针对骨盆底肌紧绷，真正需要的是系统性的放松与拉伸训练： - **腹式呼吸（Diaphragmatic breathing）**：通过深沉的膈肌运动带动骨盆底自然下沉与放松。 - **针对性瑜伽体式**：如“数字4字拉伸”（Figure-four stretch）、“快乐婴儿式”（Happy baby pose）以及“婴儿式”（Child's pose），有效拉伸并延长深层骨盆肌群。 - **专业骨盆底物理治疗**：症状严重时，应寻求骨盆底物理治疗师的介入，精准定位功能失调的肌肉群并进行针对性手法松解。 ```mermaid flowchart TD accTitle: Pelvic Floor Tension Cycle accDescr: 骨盆底肌紧绷的诱因、表现及错误应对导致的恶性循环 subgraph Causes["诱发因素"] C1["慢性压力 / 潜意识紧绷"] C2["背部 / 髋部代偿性损伤"] end subgraph Symptoms["临床表现"] S1["排尿异常（尿频/尿急/排尿困难）"] S2["躯体疼痛（慢性腰背痛/便秘）"] S3["性功能障碍（ED/早泄/性交痛/唤起障碍）"] end subgraph Reaction["应对路径"] R1["盲目加练凯格尔（Kegel）加剧痉挛"] R2["腹式呼吸 / 瑜伽拉伸 / 物理治疗"] end Causes --> Symptoms Symptoms --> R1 R1 -.->|恶化症状| Symptoms Symptoms --> R2 ``` ### [28:29](https://www.youtube.com/watch?v=PnpHwhTWw0c&t=1709s) 勃起功能障碍：心血管疾病的“煤矿金丝雀” 当 Steven Bartlett 问及这类问题波及的人群规模与年龄分布时，Dr. Rena 破除了“年轻男性绝不会有勃起问题、有也只是心理作祟”的迷思。生理因素同样会摧毁年轻人的勃起功能，而在中老年群体中，数据更是触目惊心：50岁以上的男性中，高频遭遇勃起功能障碍的比例高达52%，且此后年龄每增长10岁，患病率就递增约10%——60岁男性约为60%，70岁男性则高达70%。血管随年龄自然老化僵硬，加之高血压、高血脂、糖尿病等代谢并发症的激增，血管健康首当其冲遭到破坏。由于阴茎和阴蒂的微血管远比供应心脏或大脑的血管细小，血流灌注障碍往往最先在生殖器官上拉响警报，远早于心脏病发作、中风或老年痴呆的临床显现。 医学界将器质性勃起功能障碍形象地称为“煤矿里的金丝雀”。临床研究表明，当男性因为器质性血管病变出现勃起功能障碍时，通常在3到5年内就会开始显现明确的心脏病变；到了第7年，这群男性中有14%会突发心肌梗死。因此，性功能出现滑坡绝不仅仅关乎床笫之欢，它是身体向你发出的求救信号，是全面排查隐性心血管风险、逆转生活方式的宝贵窗口期。 为避免大众陷入无谓的恐慌，Dr. Rena 对临床概念进行了清晰界定： - **勃起功能障碍（ED）**：指持续无法获得或维持足以完成满意性交的硬度。患者可能可以正常勃起，但在射精或达到高潮前就疲软消退。偶尔一两次疲软属于正常生理波动，只有演变成规律性模式时才构成病理状态。 - **早泄（PE）**：指射精过快、在违背自身意愿的情况下过早达到高潮，这属于射精控制机制失调，患者维持勃起的能力往往完全正常，二者不可混为一谈。 ### [30:59](https://www.youtube.com/watch?v=PnpHwhTWw0c&t=1859s) 为何看片能勃起，面对伴侣却“熄火”？ 针对 Steven 提到“近40岁的朋友在性生活中频繁疲软，但独自看色情片自慰时却毫无障碍”的典型困惑，Dr. Rena 剖析了其背后的多重心理与生理机制。首先是**表现焦虑（Performance Anxiety）**的消除：在独处面对屏幕时，没有任何取悦对方的期待、被评判的目光或维系硬度的心理压力；而一旦进入双人互动，紧绷的精神状态会瞬间激活交感神经，直接导致阴茎疲软。 更核心的症结在于**自慰习惯带来的生理性脱敏与习惯化（Habituation）**。色情片提供了现实中极难企及的高频视听超常刺激（Supernormal stimulus）。不仅如此，许多男性长期沿用固定而极端的自慰手法：例如使用远超阴道或口腔握力的死力紧抓（“死亡之握”）、俯卧趴在床上摩擦床单、或是借助坚硬物体对抗受力。现实伴侣的身体绝不可能复刻这种机械性的高压摩擦。久而久之，大脑与神经系统被“重新布线”，只有在特定姿势、特定握力以及特定视觉刺激的叠加下才能达到兴奋阈值，导致现实性爱中彻底无法唤起。 ### [32:32](https://www.youtube.com/watch?v=PnpHwhTWw0c&t=1952s) 晨勃与夜间勃起：身体最诚实的晴雨表 晨勃与夜间勃起是鉴别器质性病变与心理性障碍的关键标尺。在睡眠状态下，表现焦虑和外界干扰全部被剥离，晨勃的存在直接证明机体的生理硬件运转良好——心血管供血畅通、神经传导正常、体内睾酮水平充足。夜间勃起是一种完全健康的生理保护机制： - **青少年与年轻男性**：每晚平均会出现3到5次自发性勃起，单次持续时间可长达40分钟，整夜相当长的时间都处于充血充氧状态。 - **步入40岁后**：勃起频率依然维持在每晚3到5次，但单次持续时间大约减半，上限通常在30分钟左右，甚至更短。 - **临床意义**：男性虽然无法察觉睡梦中的每一次勃起，但通常会在清晨醒来时保留最后一次。如果长期彻底丧失晨勃，强烈提示生理机能或激素轴出现了必须就医排查的隐患。 对于自慰习惯导致的“唯独对伴侣不举”，Dr. Rena 补充说明这同样适用于女性（例如过度依赖特定强震动玩具导致对伴侣摩擦脱敏）。她强调这本身并非不可逆的器质缺陷，关键在于提高觉察：如果某种自慰方式已对伴侣关系构成阻碍，可以通过“多元化独处性刺激方式”或暂停自慰一段时间来重置神经过敏阈值。至于“晨勃是否意味着人类在进化上注定要在清晨做爱”，Dr. Rena 笑着澄清两者并无必然因果，清晨的勃起在很大程度上只是机体在夜间遵循生物钟规律脉冲式释放睾酮的自然生理产物。 ### [34:37](https://www.youtube.com/watch?v=PnpHwhTWw0c&t=2077s) 夜间勃起与生理自护：“不用则废”的真相 人体会在夜间合成大量睾酮，这种夜间睾酮分泌的高峰通常出现在清晨，也是晨勃现象的核心驱动因素。睾酮作为唤起性欲的关键激素，往往让许多人在早晨体会到更为强烈的欲望。针对女性是否也有类似的生理机制，Dr. Rena Malik 明确指出，女性同样存在夜间阴蒂充血（nocturnal clitoral tumescence）。虽然大多数女性无法直观看到这一变化，顶多偶尔感觉到盆腔有充血感或胀满感，但这属于人体自我保护的本能反应。俗话常说的“用进废退”（use it or lose it），其实身体已经在夜间默默替你完成了“使用”——即便没有真实的性生活，健康的身体也会整夜通过自发充血来确保生殖器获得充分的血氧滋养。 然而，一旦夜间勃起或阴蒂充血因健康问题而长期缺席数月甚至数年，生殖组织就会陷入危机。Dr. Rena Malik 拿过盆腔模型现场演示，重点指出了阴茎内部的海绵体（corpora cavernosa）组织。这是一种极具弹性的海绵状海绵体，血液注入时会充血膨胀并延长，直至刺激结束血液才会回流。如果阴茎长期缺乏通过夜间勃起或伴侣性生活带来的新鲜血液循环，局部海绵体组织就会发生纤维化（fibrosis），形成微小瘢痕组织，最终导致阴茎出现肉眼可见的挛缩变小。女性的阴蒂亦是如此，完全依赖相同的血流灌注机制来维持组织健康。 ```mermaid flowchart TD accTitle: 夜间自发充血保护机制 accDescr: 展现夜间充血如何维持生殖器组织弹性和避免纤维化 subgraph NormalFlow["正常生理循环"] A["夜间睾酮峰值分泌"] --> B["夜间勃起 / 阴蒂充血"] B --> C["新鲜血液规律灌注"] C --> D["维持组织弹性与健康尺寸"] end subgraph ImpairedFlow["血流中断病理改变"] E["长期缺乏夜间充血"] --> F["局部组织缺血缺氧"] F --> G["组织纤维化与瘢痕形成"] G --> H["阴茎缩短挛缩"] end ``` ### [35:50](https://www.youtube.com/watch?v=PnpHwhTWw0c&t=2150s) 模型演示与男女生殖器官的同源奥秘 在现场展示女性盆腔模型时，演播室里发生了一段让人忍俊不禁的尴尬小插曲：Dr. Rena Malik 刚拿起模型准备指认阴蒂，却突然发现自己手里拿着的是子宫模型，连忙改口笑场：“我们这里其实没有阴蒂……等一下，这是个子宫！”主持人 Steven 忍不住大笑调侃：“这绝对得剪进正片里。”随后全场笑成一团，Steven 甚至追问她是不是刚才向导播团队询问“阴蒂到底在哪儿”，Dr. Rena Malik 边笑边抓狂地找回真正的解剖模型圆场：“我只是担心刚刚是谁回答的！” 回到正题后，Dr. Rena Malik 详细拆解了女性外阴与深层解剖构造。除了尿道口、小阴唇和大阴唇，肉眼可见的“阴蒂”仅仅是阴蒂头（clitoral glans），相当于男性的阴茎头，其外部同样覆有类似于包皮的阴蒂包皮（clitoral hood）。然而，阴蒂绝不仅限于外部那个小点，它的主体深埋于体内：阴蒂前庭球（clitoral bulbs）和阴蒂脚（crura）如同展开的双腿，沿着阴道前壁一路向内延伸，深嵌在骨盆底部。这正是男女器官在胚胎发育学上的“同源”（homologues）——源于同一组胚胎细胞，拥有高度一致的神经与血管网构架。男性阴茎向下延伸至会阴部的海绵体分支，其在三维结构上的分叉与女性阴蒂内部的倒 V 形分叉如出一辙。 针对 Steven 提出的“刺激阴蒂是否就像刺激男人的龟头”的疑问，Dr. Rena Malik 解释两者在感觉上非常吻合。单纯刺激阴蒂头虽然敏感愉悦，但如果能同时包裹、按压更多面积的阴蒂体与内部组织，体验会大幅提升。这也从解剖学上解释了所谓的“G点”（G-spot/G-zone）：位于阴道口向内约 2 厘米的阴道前壁上方，这里不仅是阴蒂内部组织与阴道壁紧密贴合的神经密集区，还分布着斯基恩氏腺（Skene's glands）——即男性前列腺的同源器官。因为不同女性体内阴蒂海绵体与阴道前壁的间距存在个体差异，距离越紧凑的女性，在该区域感受到的快感越强烈，但它并非所有人都能触发高潮的通用开关。 - **解剖同源对应**：阴蒂头对应阴茎头；阴蒂包皮对应男性包皮；阴蒂海绵体及阴蒂脚对应阴茎海绵体；斯基恩氏腺对应男性前列腺。 - **G点解剖定位**：位于阴道前壁内约 2 厘米处，是深层阴蒂分支与斯基恩氏腺复合受压区。 ### [40:20](https://www.youtube.com/watch?v=PnpHwhTWw0c&t=2420s) 高潮后的化学风暴：“贤者时间”与性交后抑郁 谈及早晨性行为与自慰时，Steven 坦言自己一直对此心存顾虑，担心晨间高潮会引发剧烈的“多巴胺断崖式下跌”（dopamine crash），导致整个人一整天都陷入疲倦、懒散和昏昏欲睡的状态。Dr. Rena Malik 从神经内分泌机制剖析了这一现象：性高潮期间大脑会瞬间爆发式释放多巴胺，紧随其后的是催乳素（prolactin）的急剧攀升，促使神经系统全面平息与镇定。 这种神经递质的巨大落差在个体身上的表现截然不同。一部分人会体验到俗称的“贤者时间”（post-nut clarity），感到大脑前所未有的清爽明晰，整个人精力充沛、充满行动力，能迅速投入下一项工作；但另一部分人却会遭遇性交后恶劣心境（post-coital dysphoria），在高潮之后无端感到悲伤、空虚甚至陷入抑郁情绪。这种由于大脑神经化学信号骤变导致的负面心境，轻则持续数小时，重则让当事人陷入长达数天的消沉与痛苦之中，极具心理创伤性。 ### [41:24](https://www.youtube.com/watch?v=PnpHwhTWw0c&t=2484s) 性健康四大基石之三：慢性压力与睡眠的隐形掠夺 在梳理完男性性健康的“力量”（strength）与“燃料”（fuel）两大基石后，访谈切入了第三大核心基石——“环境”（environment）。Dr. Rena Malik 强调，环境中最普遍却最易被轻视的杀手就是慢性压力。许多人习惯了高压生活，将其当成现代社会的常态而选择硬扛。但生理学层面上，长期高压会导致体内的皮质醇（cortisol）水平居高不下，直接压制游离睾酮的生成，并强行将自主神经系统锁死在“交感神经兴奋”（战斗或逃跑）模式中。在交感神经占主导的状态下，身体根本无法切换到负责充血与放松的副交感神经模式，自然无法产生高质量的性唤起。 为了打断身体的慢性应激回路，Dr. Rena Malik 建议在日常中主动植入缓解压力的微习惯。除了去健身房运动或使用握力减压球外，将亲密接触转化为减压工具效果极为显著。例如戈特曼夫妇（The Gottmans）所提倡的“20秒独立重力拥抱”——双方各自站稳重心、全心拥抱彼此 20 秒，能强行阻断神经系统的恶性压力循环；亦或是每天进行一次“6秒深吻”，看似短暂，但若认真掐表计时，6 秒的深情接吻远比日常敷衍的轻触漫长得多，足以向神经系统传递安全信号。此外，与咖啡师随意闲聊两句、在超市结账时与收银员进行真实的眼神社交互动，乃至留白时间让自己体会“无聊”以激发创造力，都是向大脑宣告身处安全环境、解除交感神经戒备的有效方式。 最后，Dr. Rena Malik 强调了睡眠对性健康环境的决定性作用。睡眠剥夺对内分泌的摧毁力是立竿见影的：临床对照数据显示，让原本每晚睡 8 小时的同一名健康男性连续一周将睡眠缩短至 5 小时，其体内的睾酮水平会直接暴跌 15%。这一急剧的跌幅，在生理退化程度上几乎等同于整整衰老了 10 岁。 - **20秒拥抱法则**：伴侣间在各自保持重心的状态下深情相拥 20 秒，有效打破交感神经压力回路。 - **6秒深吻效应**：通过延长日常接吻时间，重塑催产素分泌并向大脑传达安全感。 - **睡眠剥夺惩罚**：连续一周睡眠由 8 小时减至 5 小时，睾酮水平直接暴跌 15%，相当于身体衰老 10 年。 ### [43:46](https://www.youtube.com/watch?v=PnpHwhTWw0c&t=2626s) 睡眠剥夺、睡眠呼吸暂停与睾酮水平 Dr. Rena Malik 指出，睡眠对男性激素水平的影响极为迅猛且剧烈。相关实验表明，仅经历为期一周的睡眠剥夺，人体的睾酮水平就会直接发生断崖式下跌。此外，临床上另一个极易被大众忽视的隐形杀手是“阻塞性睡眠呼吸暂停”（Sleep Apnea）。很多患者压根不知道自己患有此病，更不清楚治好呼吸暂停竟然可以直接逆转激素失衡。当主持人询问长期睡眠不佳的人是否通常睾酮低下时，Dr. Rena Malik 给予了完全肯定的答复。 大众普遍认为睾酮低下的唯一指征就是勃起功能障碍（ED），但 Dr. Rena Malik 强调，低睾酮引起的其实是一整套复杂的“症状群”（constellation of symptoms）。人体的大脑、骨骼和肌肉中广泛分布着雄激素受体，低睾酮会导致： - 全身性疲劳与脑雾（brain fog） - 抑郁情绪与动力丧失 - 性欲断崖式下跌与勃起功能障碍 - 体脂率增加、肌肉量流失 识别睡眠呼吸暂停有一个最直接的自测方法：如果在睡眠中常被伴侣发现喘不过气、被憋醒，或是用软尺测量颈围——**男性颈围超过 17 英寸（约 43.2 厘米），女性颈围超过 16 英寸（约 40.6 厘米）**，患睡眠呼吸暂停的概率就极高。这是因为颈部过厚的脂肪和软组织会在平躺时物理性压迫气道。令人振奋的临床数据显示，一旦通过治疗解决了睡眠呼吸暂停，患者的睾酮水平最高可**直接飙升 200 ng/dL**（纳克/分升），其改善幅度极为可观。 --- ### [45:26](https://www.youtube.com/watch?v=PnpHwhTWw0c&t=2726s) 微塑料、环境毒素与日常生活防护 讨论转向外部环境对性健康的侵蚀。Dr. Rena Malik 拿起现场的塑料水瓶举例，指出许多患者习惯成箱采购塑料瓶装水饮用。塑料瓶中含有的邻苯二甲酸酯（Phthalates）和双酚A（BPA）等物质属于内分泌干扰物，它们会在体内模拟雌激素的作用，并通过多种生化机制抑制睾酮的自主生成；同时，不粘锅炊具中残留的全氟和多氟烷基物质（PFAS）也会对激素平衡构成破坏。 尽管现代医学已经在男性睾丸组织样本和阴茎海绵体组织中检测到了微塑料残留，证明其确已侵入人体深处，但 Dr. Rena Malik 特别提醒听众**切勿陷入过度焦虑**——因为慢性压力本身就是摧毁睾酮的元凶，为无法彻底避免的微塑料抓狂只会适得其反。她建议将注意力放在日常可控的生活细节上： ```mermaid flowchart TD accTitle: 减少微塑料与内分泌干扰物暴露的生活干预指南 accDescr: 图表展示了在饮水、食物加热、储存与穿着等日常维度降低微塑料摄入的具体措施。 subgraph S1["饮水习惯"] A["避免暴晒温热塑料瓶"] --> B["替换为金属/玻璃水瓶"] end subgraph S2["饮食与储存"] C["外卖换入瓷盘加热"] --> D["严禁用塑料盒微波"] E["剩菜冷藏使用玻璃/金属盒"] end subgraph S3["居家与衣物"] F["减少环境扬尘暴露"] G["优先纯棉/天然面料"] --> H["少穿易脱落微塑料的合成纤维"] end ``` 在日常生活中，Dr. Rena Malik 与家人坚持使用金属水壶饮水，厨房炊具则全面换成陶瓷涂层不粘锅，在可控范围内最大限度阻隔有害化学物质。 --- ### [47:57](https://www.youtube.com/watch?v=PnpHwhTWw0c&t=2877s) 社交圈层对性生活的“传染效应” 除了物理环境，人际社交环境对性生活的影响同样至关重要，却长期被大众所忽略。Dr. Rena Malik 分享了一件发生在身边的真实趣事：她的丈夫加入了一个由男性医生组成的交流群，群里常年充斥着对无性婚姻的抱怨，大家都无奈地附和：“哎，上了年纪都这样，老婆早就不想碰我了，太烦人了。”这种对话在潜移默化中把“不再把性视作伴侣关系的核心优先级”合理化、常态化了。当婚姻遭遇压力或摩擦时，身边朋友的悲观消极态度会迅速蔓延。 一项针对约 50,000 人的大型干预研究证实了这一社交心理机制：当研究人员引导受试者脱离消极社交圈、转而与倡导积极健康性观念的人建立连接后，受试者的**安全性行为与积极性健康行为比例大幅提升了 46%**。 朋友之间对伴侣的态度具有极强的传染性。如果周围的朋友整天把伴侣当成避之不及的包袱、聚会时只顾着宣泄牢骚、夫妻间过着互不相干的平行生活，你也会不自觉地贬低自己的亲密关系；相反，结交那些尊重伴侣、愿意用心经营情感生活的朋友，才能为自己的性生活注入健康正向的动力。 --- ### [50:06](https://www.youtube.com/watch?v=PnpHwhTWw0c&t=3006s) 色情片（Porn）的影响：成瘾机制与内疚陷阱 谈及色情片消费是否过量的问题，Dr. Rena Malik 给出了颠覆传统认知的专业洞见：**问题的核心不在于你看色情片的“频率或时长”，而在于你对色情片所抱有的“主观感受与心理动机”**。 绝大多数成年人观看色情片纯粹是为了获得愉悦、体验现实中不会发生的性幻想（fantasy）与激发性兴奋。真正具有破坏性的情况主要集中在以下两类人群： 1. **逃避负面情绪的代偿性冲动**：把色情片带来的多巴胺刺激当成逃避现实压力、抑郁或挫败感的“避难所”。每次现实受挫就躲进色情片里寻找即时快感，逐渐演变成难以自拔的强迫性行为（compulsion）。这类人需要重新审视动机，尝试用运动、散步等健康的多巴胺渠道替代代偿性观影。 2. **道德内疚诱发的性功能障碍**：社会上普遍存在将色情片污名化为“邪恶、堕落、肮脏”的极端论调。许多人受宗教或成长观念影响，即使一年只看一次色情片，也会背负极其沉重的道德负罪感，陷入“我是个坏人、我很下流”的自我厌恶中。正是这种**强烈的内疚与自责**，从心理层面上直接诱发并加剧了勃起障碍等器质性无法解释的性功能问题。 对于绝大多数心智成熟的成年人而言，色情片仅仅是一种无害的幻想载体。甚至在伴侣共同观看的场景下，它还可以成为增进双方情趣与唤起唤醒的健康助力。 ### [52:19](https://www.youtube.com/watch?v=PnpHwhTWw0c&t=3139s) 色情内容与不应期对性亲密的影响 双方对色情内容（Porn）的态度一致性直接决定了它对亲密关系的影响。研究显示，如果伴侣双方一起观看色情片，他们的关系满意度往往更高；真正的危机通常发生在观念脱节时——例如一方非常反感或从不接触，而另一方却频繁观看。当史蒂芬·巴特利特（Steven Bartlett）问及色情消费是否会直接妨碍实际生活中的性亲密时，雷娜·马利克医生（Dr. Rena Malik）指出，虽然许多人观看并无大碍，但男性的“不应期（Refractory Period）”是一个不可忽视的生理现实。 史蒂芬提到，如果自己在看片时自慰并射精，随后很难立刻在伴侣身上迅速再次射精。马利克医生证实了这一点：射精之后存在生理上的不应期。年轻时这一恢复期可能只有短短几分钟，但随着年龄增长，不应期可能会延长至一天甚至一天半。如果一位男性每天都频繁观看色情内容自慰，而他自身的不应期恰好需要整整一天，那么他在与伴侣亲密时很可能会出现难以射精或勃起无力的问题，因为他的身体根本没有获得充足的恢复时间。 - **态度一致性是关键**：伴侣共同观看往往增进满意度，观念不对称（一方沉迷而另一方排斥）才会滋生矛盾。 - **不应期随年龄显著拉长**：年轻男性的射精恢复期仅需数分钟，年长男性可达 24 至 36 小时。 - **频率与恢复脱节**：每日色情自慰耗尽了生理不应期窗口，直接导致伴侣互动中的射精困难。 --- ### [53:11](https://www.youtube.com/watch?v=PnpHwhTWw0c&t=3191s) 商业赞助：外源性酮体与 Fiverr Pro 灵活用工 在正式深入下一个核心支柱前，主持人插播了两则赞助体验分享。史蒂芬首先推介了外源性酮体饮品（Ketone shots），表示这是在自己尝试过的所有提升脑力与生产力的产品中位列前三的突破性发现。该产品由斯坦福大学毕业生研发，通过一小瓶便携液体浓缩了生酮饮食带来的高专注度与大脑能量供给。史蒂芬对临床研究数据深感震撼，不仅自己每天饮用，还进一步成为了该公司的联合所有者兼投资人。 紧接着，史蒂芬分享了现代企业的用工之道：像大公司一样扩张，却不必像大公司那样背负沉重的人力雇佣成本。针对企业无法在内部储备所有技能的痛点，史蒂芬强调当今成功的商业模式在于极速响应。过去一年中，他的团队通过 Fiverr Pro 引进了包括 AI 原生战略、无代码搭建（No-code builds）以及产品工作流等前沿领域的顶尖专家。平台经过严格审核的专业人才库，让团队既能保持敏捷与极高品质，又无需妥协执行速度。 --- ### [55:12](https://www.youtube.com/watch?v=PnpHwhTWw0c&t=3312s) 性生活第四大支柱：建立在知识与沟通上的“自信” 雷娜·马利克医生转入了性生活四大支柱中的最后一根支柱——“自信（Confidence）”。她特别厘清，这里的自信绝非像孔雀开屏一样炫耀自己多么在行，而是指建立在“解剖学知识”与“好奇心探索”之上的底气。首先是掌握客观知识：了解女性身体究竟如何被唤起、唤起的机制是什么、阴蒂的确切位置在哪里。其次是放下“读心术”的执念，学会倾听伴侣的声音并捕捉生理信号。 ```mermaid flowchart TD accTitle: 性健康第四支柱——自信的双重维度 accDescr: 展示真正的自信不是盲目自大，而是建立在解剖学知识与沟通好奇心之上。 subgraph Confidence["第四支柱：真正的性自信 (Sexual Confidence)"] K["解剖学知识 (Knowledge)<br/>理解女性生理结构与阴蒂位置"] C["好奇心与沟通 (Curiosity)<br/>放弃读心假设，观察伴侣生理反馈"] end subgraph Pitfall["常见认知误区"] P1["孔雀式自大<br/>盲目以为自己很懂"] P2["读心术陷阱<br/>期待对方不开口就全懂"] end Confidence -.->|替代| Pitfall ``` 马利克医生感叹，在两性生活的诸多领域中，性爱似乎是唯一一个人们荒谬地期待对方成为“读心大师”的场合——每个人都希望对方自动猜透自己的喜好并精准执行，一旦体验不如意，便简单粗暴地抱怨对方“根本不行”。大众在成长过程中从未接受过关于如何开口讨论性爱、如何与伴侣沟通喜好的正规教育，更谈不上以轻松有趣的心态共同探索。 现场展示情趣玩具时出现了一段幽默的插曲：马利克医生拿出一款外用阴蒂刺激器（Vulva stimulator），展示它如何贴合阴蒂震动并变换形态，但玩具正好没电了。面对现场的笑声，马利克医生一本正经地声明“这是全新未使用的”，史蒂芬则调侃道“我又没说它被用过，你太防备啦”。随后史蒂芬用手指模拟阴蒂，两人演示了震动环与刺激器如何让阴茎从中穿过，使得男女双方在插入时能同步感受强烈的震动与刺激。 --- ### [56:58](https://www.youtube.com/watch?v=PnpHwhTWw0c&t=3418s) 玩具依赖迷思、心流状态与低门槛的新鲜感 史蒂芬提到自己的一位前任曾认为“情趣玩具是给老年人用的”，用玩具仿佛意味着在性能力上“彻底放弃投降”。马利克医生反问：“我们生活中的各个角落都在拥抱科技，为什么偏偏要在性生活中将其拒之门外？”针对大众关于“情趣玩具有没有成瘾性、是否会导致神经脱敏以至于无法脱离”的担忧，马利克医生援引了类似针对长期操作高频振动工具的建筑工人的科研实验：持续强震确实会让指尖产生短暂的感觉迟钝，但神经感觉很快便会完全恢复到正常状态，并不存在永久性的敏感度丧失。 马利克医生用“吃香草冰淇淋”打了个生动的比方：如果一周吃三次香草冰淇淋会觉得很享受，但如果一年 365 天顿顿如此，任何人都会感到厌倦。熟悉固定的常规流程固然让人安心，但适度的“新鲜感（Novelty）”必不可少。然而一提到新鲜感，人们往往容易走向极端，误以为必须搞复杂的角色扮演或 BDSM。马利克医生借用心理学中的“心流状态（Flow State）”进行了解读： * **难度适中才能进入心流**：在工作中，太简单会无聊，太困难会受挫沮丧；性爱心流同样需要“适度的微小挑战（Slight challenge）”。 * **全情投入的沉浸感**：当伴侣双方在略具挑战的环境中互动时，会瞬间忘却杂念、完全沉浸在当下的感官快乐中。 * **新鲜感极度易得**：打破乏味不需要大费周章，换一个房间、垫一个新枕头、或者仅仅调换一下彼此头躺的方位，都能为身体制造适度的新鲜挑战。 --- ### [59:32](https://www.youtube.com/watch?v=PnpHwhTWw0c&t=3572s) 女性高潮体位与“同轴对齐技术（CAT）” 当史蒂芬询问是否存在能够显著提高女性高潮概率的特定体位时，马利克医生明确表示：女上男下（Female on top）体位通常表现出更高的高潮几率。在这一体位下，女性拥有完全的自主权，能够自行调节角度与深度，精准地将摩擦力施加到阴蒂上。 此外，马利克医生详细介绍了一种被证实能有效提升女性快感的专业体位——“同轴对齐技术”（Coital Alignment Technique，简称 CAT）： ```mermaid flowchart LR accTitle: 同轴对齐技术（CAT）运作机制 accDescr: 说明同轴对齐技术通过身体骨骼对齐与摇摆滑动，实现持续压迫阴蒂提升高潮率。 A["上身整体向前位移对齐"] --> B["耻骨联合处皮肤紧密贴合"] B --> C["放弃活塞式抽插<br/>改为有节律的前后摇摆滑动"] C --> D["对阴蒂施加持续恒定压迫与摩擦"] D --> E["显著提高女性性高潮发生率"] ``` * **身体解剖对齐**：男性上位时，整个身体向前上方平移，让自身的耻骨联合（Pubic symphysis，即耻骨区域下方的骨骼支撑面）紧贴女性的耻骨与阴蒂区域。 * **节律性前后摇动**：放弃传统的深出深进抽插，改为双方面贴面紧密相贴、进行持续的前后“摇摆与滑动（Rocking motion）”。 * **持续压迫阴蒂**：在此运动中，男性的骨骼与皮肤在插入的同时直接压迫并持续摩擦阴蒂，从而大幅提高女性高潮的发生概率。 马利克医生坦言，CAT 这类技巧初次尝试时可能显得相当笨拙、并不直观，伴侣间极易感到尴尬或做不到位。然而性爱的精髓恰恰在于“试错、玩乐与探索”，最糟糕的做法是因为没有立即达到脑海中预想的完美效果而恼羞成怒。即便尝试失败了、姿势显得滑稽，只要两人能相视一笑，同样也是亲密关系中极其美妙的一部分。 ### [01:00:50](https://www.youtube.com/watch?v=PnpHwhTWw0c&t=3650s) 女性潮吹的真相与生理机制 主持人坦言自己年轻时曾误以为女性达到性高潮就等同于“潮吹”（squirting）。Rena Malik 医生纠正了这一普遍误解：并非所有女性都会潮吹，现实中大约只有 40% 的女性经历过这一现象。潮吹指的是高潮时排出体液，通常为透明、无色，且液体量可能相当可观。这些液体经由尿道（urethra）排出，源头包含两部分：膀胱以及斯基恩氏腺（Skene's glands）。斯基恩氏腺是男性前列腺的同源器官，本身储存少量液体；在性刺激和潮吹过程中，膀胱释放的液体与斯基恩氏腺的液体混合在一起喷涌而出。 针对“潮吹到底是不是尿液”这一长期争论不休的议题，医学界已有多项严谨研究。科学家曾将医用染色剂注入受试女性的膀胱中，随后让这些自认为会潮吹的女性达到高潮，结果喷出的液体中确实检出了染色剂，这证实液体绝大部分必然来自膀胱，因为斯基恩氏腺本身的容积极小。然而，喷出的液体在化学成分上与普通尿液存在显著差异：它通常清澈无味，完全没有尿骚味。对此有几种解释假说：其一，性交期间人体激素信号发生改变，调节了肾脏的过滤浓缩过程；其二，体内雌激素水平波动或盆腔器官间质充液等因素改变了液体组分。Malik 医生强调，大众不必纠结它到底“是不是尿”，关键在于双方是否享受这一过程。若能带来快感便很好，不会潮吹也绝不代表身体有问题或未达高潮；了解伴侣是否达到高潮最简单的方式就是直接沟通和询问。 ```mermaid flowchart TD accTitle: 潮吹液体来源与生理构成 accDescr: 展示膀胱与斯基恩氏腺液体汇集至尿道排出的过程。 subgraph InternalSources ["体内产生源"] Bladder["膀胱液体 (主要容积，经肾脏滤过调节)"] Skenes["斯基恩氏腺分泌物 (前列腺同源物，含PSA与锌)"] end subgraph DischargePath ["排出通路"] Mix["混合为清澈无味液体"] Urethra["经由尿道排出体外 (Squirting)"] end Bladder --> Mix Skenes --> Mix Mix --> Urethra ``` ### [01:02:58](https://www.youtube.com/watch?v=PnpHwhTWw0c&t=3778s) 演化假说与性生活后的尿路感染（UTI） 主持人分享了关于女性潮吹演化机制的三种假说。第一种假说是“抗菌冲洗理论”：潮吹液体中含有前列腺特异性抗原（PSA）和锌，这两者天然具备抗菌特性。在抗生素诞生前的远古时代，高潮排液能够冲洗尿道，帮助排出病菌、预防尿路感染（UTI），从而使女性保持健康并延续后代。Malik 医生从解剖学角度证实了液体含 PSA 的原因——斯基恩氏腺与男性前列腺在胚胎期来自同一种组织（同源器官）。 借此机会，Malik 医生深入剖析了女性性交后易患尿路感染的真正成因。很多女性在房事后会发生 UTI，但需要澄清的是：这绝非因为男性的精液有毒或男性携带病菌，更不是女性自身“脏”或有缺陷，纯粹是因为女性尿道短这一解剖结构特征。在性生活过程中，阴茎的机械性抽动会把外部的细菌推入尿道口并进入膀胱，因此房事后排尿冲刷尿道是极其科学的卫生习惯。 - **排卵触发假说（生物演化残留）**：远古祖先在高潮和排液时的激素激增可能会诱发排卵。尽管现代人类演化成了规律的周期性排卵，但相关神经内分泌反射和生理构造保留了下来，成为一种中性无害的“演化副产品”。 - **配偶选择假说（快感奖励机制）**：潮吹与高潮带来的强烈心理愉悦作为一种奖励信号，激励女性主动寻找能够提供高水平刺激、体贴关注的伴侣，暗示潜在的优良基因兼容性，以保障后代存活率。 ### [01:05:26](https://www.youtube.com/watch?v=PnpHwhTWw0c&t=3926s) 全身性感带与慢速抚触的神经科学 性生活往往被过度局限在生殖器本身，但人体几乎全身都分布着性感带（erogenous zones）。从性感集中训练（Sensate Focus）的临床应用到广泛的跨文化调查均显示：颈部、乳头、嘴唇、臀部以及大腿内侧，在不同性取向和文化背景的人群中都被普遍公认为极度敏感的性感带。科学文献甚至记录过完全脱离生殖器刺激的“非生殖器高潮”（Non-genital orgasms），包括通过刺激嘴唇、乳头，或者在分娩过程中自然产生的高潮体验。许多人缺乏充分的前戏，忽略了探索广阔身体表面的乐趣。 为了探讨刺激性感带的生理基础，伦敦曾开展过一项针对 19 对伴侣的神经学实验，揭示了抚摸速度对性唤起的影响： - **C触觉传入神经纤维（C-tactile afferents）**：人体皮肤表层分布着这类专门传递愉悦感和舒适感的神经纤维。 - **刺激速度对比实验**：实验要求伴侣以 18 厘米/秒（快速）和 3 厘米/秒（慢速）分别抚摸性感带及非性感带（如前额）。结果显示，**3 厘米/秒**的缓慢轻柔抚摸所诱发的性兴奋和愉悦感显著高于快速抚摸。 - **“真人体温与触感”专一性**：C触觉纤维极其敏感，但它们几乎只对真正的人类皮肤接触起反应。研究人员发现，如果戴上橡胶手套再去触摸受试者，该神经纤维的愉悦反馈就会失效。 这一神经生理机制引发了主持人关于现代科技的感慨。他提到自己在洛杉矶街头考察办公室时，曾路过一家“机器人按摩店”。起初理性的大脑觉得这是一种低成本且随时可用的好方案，但随即意识到冰冷的器械根本无法替代真正的人类触摸。Malik 医生完全赞同这一观点，指出人类在演化上就注定要从真人皮肤的温热接触中获取联结与抚慰，就像廉价僵硬的按摩椅永远无法带来真正按摩带来的身心舒畅一样。在探讨完触觉神经后，主持人将话题引向下一个重大健康议题：在过去十年中，全美睾酮处方量激增了 300%，引发了关于睾酮、性功能与男性全面健康之间深层联系的探讨。 ### [01:09:10](https://www.youtube.com/watch?v=PnpHwhTWw0c&t=4150s) 现代男性睾酮水平暴跌与生理机制：芳香化酶与生活方式 史蒂文·巴特利特（Steven Bartlett）提到，身边朋友最近越来越频繁地谈论睾酮（Testosterone），而仅仅在五年前，这根本不是社交圈里会出现的谈资。如今大家都在焦虑自己的睾酮够不够高，需不需要补充补剂。瑞娜·马利克医生（Dr Rena Malik）证实，男性的睾酮水平确实呈现出断崖式下跌：20 世纪 90 年代后期，男性的平均总睾酮水平约为 600 ng/dL，而到 2015 年前后的统计数据已降至约 450 ng/dL，降幅高达约 25%。 马利克医生解释了导致这一趋势的几大核心推手： 首先是环境中内分泌干扰化学物质的泛滥；其次是肥胖率的大幅上升。脂肪组织中富含一种名为芳香化酶（Aromatase）的酶，它负责将睾酮转化为雌激素（雌二醇）。体内脂肪含量越高，芳香化酶就越多，大量的睾酮被无情地转化成雌激素，直接导致游离睾酮减少。当体内雌二醇水平过高时，男性就会出现俗称“男性乳房发育症”（Gynecomastia，即“男人的胸部 / Man boobs”）。此外，糖尿病与胰岛素抵抗的激增也会显著抑制睾酮分泌。现代人大量摄入缺乏必需营养素且高热量的超加工食品，不仅助推了肥胖，也剥夺了合成睾酮所需的健康脂肪。临床研究表明，以未加工天然食材为主、富含抗炎特性的地中海饮食，是目前证实对优化睾酮水平最为有效的饮食方式。 ```mermaid flowchart LR accTitle: 脂肪堆积导致低睾酮与雌激素升高的生理路径 accDescr: 展示体脂增加如何通过芳香化酶将睾酮转化为雌激素，从而导致男性乳房发育及睾酮暴跌。 subgraph Lifestyle["生活方式诱因"] A["高热量超加工食品"] --> B["体脂与内脏脂肪增加"] C["胰岛素抵抗与内分泌干扰物"] --> B end subgraph Enzyme["酶转化机制"] B --> D["芳香化酶活性激增"] D --> E["睾酮加速转化为雌二醇"] end subgraph Outcome["生理后果"] E --> F["游离睾酮水平暴跌"] E --> G["男性乳房发育症"] end ``` - **平均水平骤降**：从 1990 年代末的约 600 ng/dL 降至 2015 年前后的 450 ng/dL，整体下降了约 25%。 - **芳香化机制**：多余脂肪通过芳香化酶（Aromatase）将雄激素大量转化为雌二醇（Estradiol）。 - **关键生活习惯**：胰岛素抵抗、缺乏健康脂肪摄入、缺乏抗炎天然全食物是导致睾酮分泌受损的主要原因。 --- ### [01:11:05](https://www.youtube.com/watch?v=PnpHwhTWw0c&t=4265s) 睾酮数值的误区：受体敏感度、过量风险与骨骼健康 很多人直觉上认为睾酮水平越高越好、代表生育力越强，但马利克医生指出事实并非如此。人体对睾酮的反应存在极大的个体基因差异：每个人的雄激素受体（Androgen receptors）数量和敏感度各不相同。DNA 上的 CAG 三核苷酸重复序列数量直接决定了受体的亲和力——CAG 重复次数较多的人，受体对睾酮不够敏感，往往需要更高的血液浓度才能产生相同的生理效应；而重复次数较少的人受体极度敏感，较低水平即可维持完美机能。因此，在没有症状的前提下，某人 500 ng/dL 可能是完全健康的，而另一个人在 900 ng/dL 也是正常的，“绝对不能只盲目追逐一个冰冷的化验数字”。 然而，这并不意味着数值极端没有危害。研究证实，当总睾酮低于 214 ng/dL 时，全因死亡风险将直接翻倍（增加 2 倍）。而如果通过外源手段将其推向超生理水平（如 1800 ng/dL 以上），则会引发致命后果：血液过度黏稠（红细胞增多症），大幅增加中风、心肌梗死与心血管疾病的几率；长期暴露于超生理浓度还会导致心肌细胞发生胶原沉积与纤维化，使心脏肌肉变硬、泵血效率断崖式下跌，同时还会带来痤疮爆痘和情绪暴躁易怒等副作用。马利克医生强调，一旦雄激素受体达到饱和状态，多余的睾酮除了刺激肌肉维度继续膨胀外，对大脑健康、骨骼代谢或性功能不会带来任何额外增益。 在外观和生理表现上，低睾酮患者通常不是一眼就能识别出特定体型，但往往伴随极端疲劳（早上起不来床、精力被榨干）、低性欲、情绪低落以及内脏脂肪堆积（即表面看着不胖但内脏脂肪超标的“泡芙人/瘦胖子”）。此外，由于睾酮转化的雌二醇对于骨代谢至关重要，极低睾酮会导致雌激素相应匮乏，进而破坏骨密度，使骨质疏松和骨折风险显著增加。 --- ### [01:14:50](https://www.youtube.com/watch?v=PnpHwhTWw0c&t=4490s) 睾酮替代疗法（TRT）与滥用类固醇的致命界限 当史蒂文顺嘴问到“低睾酮患者是否应该考虑使用蛋白同化类固醇（Anabolic Steroids）”时，马利克医生立刻反问：“你为什么会用‘类固醇’这个词？”她指出，公众普遍把睾酮替代疗法（TRT）与健美运动员滥用的合成类固醇混为一谈，两者有着本质区别： TRT 是由医生严格监测的医疗行为，旨在将病理性低睾酮患者的生理指标拉回到“正常生理范围”之内，核心是缓解无法下床的重度疲劳、恢复正常健康与机能，而非追求超人般的体格。在采用 TRT 之前，患者通常应优先尝试自然提升手段，例如改善睡眠、进行抗阻力量训练和远离环境雌激素。相反，合成类固醇多为黑市口服药片或大剂量注射物，使用者自行安排用药，其唯一目的就是把肌肉维度推向极致，甚至完全不在意体内激素飙升到何种荒谬的高度。马利克医生列出了惊人的医学数据警告其代价：“出于增肌目的滥用合成代谢类固醇，会导致过早心力衰竭的风险增加 15 倍，心源性猝死的风险更是飙升 122 倍！” - **TRT 目标**：在医学监测下将睾酮恢复到健康的生理正常区间，绝非超生理剂量。 - **合成类固醇危害**：早发性心力衰竭风险增加 15 倍（1500%）。 - **猝死概率**：心源性猝死（Cardiac death）风险暴增 122 倍。 --- ### [01:16:53](https://www.youtube.com/watch?v=PnpHwhTWw0c&t=4613s) TRT 对男性生育力的毁灭性抑制与年轻群体的盲目跟风 史蒂文坦言，自己一直对 TRT 心存敬畏与恐惧，担心在 33 岁的年纪使用会彻底毁掉生育能力。他半开玩笑地表示自己的策略是：“在生完四个孩子之前绝不碰它，等 45 岁之后再去接受 TRT 治疗。” 马利克医生直截了当地证实了他的担忧：“它绝对会彻底摧毁你的生育能力（It absolutely will）。”外源性摄入睾酮会触发下丘脑-垂体-性腺轴的负反馈调节，使大脑误以为体内激素过剩，从而停止向睾丸发送促黄体生成素（LH）和卵泡刺激素（FSH）信号，导致睾丸萎缩并彻底阻断精子的产生。 针对史蒂文计划 45 岁直接上 TRT 的设想，马利克医生直击核心反问：“首先，你为什么非要上 TRT？你的睾酮真的很低吗？”当史蒂文承认自己根本没测过且完全不知道数值时，马利克医生指出这是现代年轻男性的通病——很多人过着高压、快节奏的生活，皮质醇爆表、长期严重缺眠，整个人处于透支状态，却误以为是自己需要打激素。在没有临床症状、未查明激素水平、未先纠正极端生活压力与作息问题之前，盲目将 TRT 当作中年救命稻草是极其轻率且本末倒置的做法。 ### [01:17:41](https://www.youtube.com/watch?v=PnpHwhTWw0c&t=4661s) 睾酮的自然衰退轨迹、游离睾酮与受体饱和机制 Dr. Rena Malik 深入剖析了睾酮补充的生理学机制。外源性补充睾酮发挥作用的前提，是身体的雄激素受体尚未被完全饱和；如果受体已经被占满，盲目补充更多的睾酮并不会带来额外的生理益处。面对 Steven 提出的疑问——睾酮水平是否本身就会随年龄增长而自然断崖式下滑，Dr. Rena Malik 澄清道，男性睾酮水平平均每年仅下降约 1%，下降曲线远没有大众想象的那样陡峭。对于原本身体健康、基线睾酮正常的男性来说，随着年龄增长通常并不会自然演变为临床意义上的性腺功能减退（Hypogonadism）。然而，如果叠加了慢性共病、高压力生活状态、长期睡眠不足以及内分泌干扰物（EDCs）的暴露，这种下滑速度就会被急剧放大。 针对人群数据，Dr. Rena Malik 指出大约 20% 到 40% 的男性在数值上存在低睾酮，但最终真正接受治疗的仅有 2% 左右。医学界划定的参考范围是基于大人群流行病学统计与症状出现的阈值总结而来的。例如： - 当总睾酮降至约 300 ng/dL 时，骨质流失可能开始发生； - 降至约 290 ng/dL 时，常伴随身体精力和活力（Vigor）的显著减退； - 降至约 215 ng/dL 时，性想法和性欲望的发生频率会出现明显下滑。 在诊断评估时，绝不能仅盯着总睾酮，游离睾酮（Free Testosterone）才是决定生理效应的关键。Dr. Rena Malik 详细拆解了体内睾酮的分布形态：约 45% 的睾酮与性激素结合球蛋白（SHBG）紧密结合，这部分睾酮无法脱离而被身体细胞利用；一部分与白蛋白弱结合；仅有 1% 到 2% 是完全未结合的“游离睾酮”，这才是对组织最具生物活性的部分。因此，临床筛查必须同步化验总睾酮与 SHBG 水平。高龄、甲状腺功能紊乱、个体遗传差异都会引起 SHBG 升高；而在女性群体中，口服避孕药会促使 SHBG 显著升高且可能终身维持在较高水平，从而长期压制游离睾酮。 ```mermaid flowchart TD accTitle: 睾酮在人体内的结合与游离形态分布 accDescr: 展示体内总睾酮的三种存在形态及各自的生物活性状态 subgraph TestosteroneForms["体内睾酮存在形式"] A["总睾酮 Total T"] --> B["与 SHBG 紧密结合 (约 45%)<br/>不可被身体直接利用"] A --> C["与白蛋白疏松结合<br/>弱生物活性"] A --> D["游离睾酮 Free T (约 1% - 2%)<br/>最具生物活性、决定症状表现"] end ``` Dr. Rena Malik 严肃强调，开始睾酮替代治疗（TRT）通常是一项“终身承诺”。一旦引入外源性雄激素，人体的下丘脑-垂体-性腺轴（HPG 轴）负反馈机制就会关闭内源性分泌，久而久之睾丸就会发生萎缩。如果本身处于低睾酮状态但仍有生育需求，盲目使用 TRT 是极其危险的；此时临床上会选用促性腺激素类药物（如 HCG）或选择性雌激素受体调节剂（如 Clomid 克罗米芬、Enclomiphene 恩氯米芬），通过欺骗大脑垂体或模拟上游促性腺激素信号，刺激机体自主恢复内源性分泌。随意启动 TRT 再贸然停药会导致极度痛苦的生理断崖反应。 --- ### [01:21:40](https://www.youtube.com/watch?v=PnpHwhTWw0c&t=4900s) 50岁以上男性是否必须使用 TRT：数字表象与症状诊断的博弈 Steven 提出许多同龄男性的普遍预设：“到了 50 岁，我们是不是都该打睾酮了？”Dr. Rena Malik 给出了极为明确的否定答案：只有当男性既表现出明确的临床症状、又经血液学证实处于低水平时，TRT 才是合理的医疗干预手段。如果一个 50 岁男性的雄激素受体本身已经饱和，额外注射外源性睾酮不仅不会让他日常感觉更好，也完全不会改善其认知功能、情绪波动、性冲动或勃起质量，充其量只能通过外源刺激让肌肉维度看起来更膨胀。 医学诊断的核心在于“看病人，而非单纯看化验单”。衰老图谱上显示的激素下滑并不等同于机体受体失活，低睾酮样症状极易与其他内分泌疾患混淆： - **甲状腺功能减退**：其表现出的乏力、冷漠和精力涣散与低睾酮症状如出一辙； - **高催乳素血症（Prolactinoma）**：垂体良性微腺瘤分泌过量催乳素，直接反向抑制促性腺激素分泌，导致睾酮断崖式下跌。 Dr. Rena Malik 直言，对于确实存在适应症的患者，TRT 是一门改善生命质量、预防骨质疏松、维持心血管代谢健康与延年益寿的极佳疗法，但绝不能沦为“人人顺手来一针”的抗衰玩具，“只要你触碰了激素，这就是极其严肃的人体工程。” --- ### [01:23:38](https://www.youtube.com/watch?v=PnpHwhTWw0c&t=5018s) 青年身材焦虑、合成类固醇滥用与精液作为寿命晴雨表 对话转向年轻一代男性的容貌焦虑。Steven 与 Dr. Rena Malik 感叹当今社交网络让人们在刷屏挑选伴侣时过度关注外貌与肌肉体块。这导致大量十几岁到二十出头的年轻人，为了在健身房迅速练出超自然维度的肌肉，过早滥用合成代谢类固醇（Anabolic Steroids）。 Dr. Rena Malik 指出这种行为对生殖健康造成的破坏几乎是毁灭性的： - **生育能力的断崖下跌**：在使用外源性睾酮仅仅 10 周后，临床就能检测到部分男性的精子计数发生剧烈暴跌； - **不可逆或长期不育风险**：在持续接受睾酮治疗达到约 18 个月时，高达 **70%** 的男性会出现无精子症或不育状态（Steven 在听到此数字时一度误以为是 17%，被 Dr. Rena Malik 郑重纠正为“七成”）； - **停药恢复期极漫长**：尽管绝大多数人在停药后生育力可以缓慢恢复，但具体耗时受年龄和用药周期影响极大，部分严重者需要整整两年甚至更久才能重新产生可用精子。 听到此处，Steven 半开玩笑地表示自己得赶紧再去复查一下睾酮，并透露自己之前做过精液分析。Dr. Rena Malik 对此大加赞赏，并揭示了一项重磅流行病学发现：精液参数（Semen Parameters）不仅仅是生育指标，更是整体心血管代谢与全身寿命的“全身生物标志物”（Biomarker of Health）。 临床统计显示，精子浓度偏低与全因死亡率升高呈现清晰的“剂量反应关系”： - 精子指标越差的群体，预期寿命下降越显著，早逝年龄呈现阶梯状提早（例如从 78 岁降至 77 岁、76 岁依次递减）； - 这一规律中唯一的特例是先天无精症患者，由于其成因通常是染色体或遗传性缺陷，而非后天的心血管与代谢恶化所致，因而预期寿命反而不会像获得性精子低下的代谢异常患者那样急剧缩短。 在严肃的医学讨论告一段落时，现场穿插了轻松的日常互动——Steven 从冷冻室拿出一份萃取胶囊准备冲调咖啡，引出赞助商 Cometeer 咖啡的即饮体验。 ### [01:25:51](https://www.youtube.com/watch?v=PnpHwhTWw0c&t=5151s) 商业赞助与 DOAC 私享社群招募 在访谈进入下一个深度话题前，节目插播了两则讯息。首先是针对 Cometeer 咖啡的推荐：传统咖啡加工往往会流失大量风味，而该品牌通过在风味最饱满的峰值时刻将咖啡萃取液极速冷冻成浓缩冰块，寄送给消费者；早晨只需按压包装底部的按钮将咖啡冰块弹出杯中，冲入热水搅拌即可享用。随后，主持人宣布正式启动全新的私密社群“DOAC Circle”（CEO 日记内圈），首批仅限量开放 10,000 个名额。加入该圈子的成员将获得未公开的采访简报、幕后花絮、从未发布的访谈片段，并能直接向团队建言，决定未来的嘉宾人选与对话主题。 --- ### [01:27:43](https://www.youtube.com/watch?v=PnpHwhTWw0c&t=5263s) 阴茎尺寸焦虑与男性对“越大越好”的迷思 回到对话，主持人提到 Dr. Rena Malik 的 YouTube 频道上有一期播放量超过 3100 万次的爆款视频，主题正是“如何增大阴茎”。主持人坦言自己很震惊会有如此庞大数量的男性对这一话题如此痴迷。Dr. Rena Malik 援引调研数据指出，普通身高的男性大多希望自己能再长高一点，但实际上“渴望阴茎变长的男性比例甚至超过了渴望变高的比例”。 这种强烈的心理包袱早在童年时期就初现端倪。Dr. Rena Malik 谈到自己育有儿子，男孩们在很小的时候就会互相比较、谈论谁的更大，整个社会环境、流行文化与媒体笑话也在不断灌输“尺寸越大就越好”的刻板观念。然而现实并非如此美好：Dr. Rena Malik 曾采访过一位经医学验证拥有世界最大阴茎（长达 13 至 14 英寸，约合 33 至 36 厘米）的男性，由于尺寸过大，伴侣在性生活中会感到极大不适甚至拒绝同房，其日常生活极为痛苦。 许多即便尺寸处于正常范围的男性，仍饱受“小阴茎焦虑”（small penis anxiety）的折磨。色情片从业者本身就是人群中的极端离群值（outliers），男性将自己与之对比，加剧了隐秘的自卑感。 - **生理真实平均值**：勃起状态下，男性阴茎的实际平均长度约为 5.2 至 5.5 英寸（约 13.2 至 14.0 厘米）。 - **男性的主观认知偏差**：大多数男性误以为人群的平均勃起尺寸高达 6 至 7 英寸（约 15.2 至 17.8 厘米）。 - **女性的偏好与实际购买行为**：当被直接询问时，女性通常会口头表示希望有 6 英寸（约 15.2 厘米）；但针对性玩具消费行为的研究显示，女性线上购买量最大的情趣假体尺寸其实非常接近自然平均值。 - **衰老与萎缩的生理机制**：阴茎在衰老过程中是否会缩小，核心取决于血流供应。若夜间勃起消失或出现勃起功能障碍，海绵体缺乏充足的血液灌注，久而久之确实会发生实质性萎缩。此外，随着耻骨上方的腹部脂肪堆积，外露的阴茎会被厚厚的脂肪层掩埋，形成视觉上的“缩短”。 --- ### [01:31:38](https://www.youtube.com/watch?v=PnpHwhTWw0c&t=5498s) 延长装置的科学事实与佩罗尼病（阴茎硬结症） 针对阴茎增大的可行方案，Dr. Rena Malik 明确反对通过手术来延长阴茎。阴茎本身是富含血管的高度复杂器官，且男性对该部位极其敏感，哪怕术后产生最细微的形态不对称或异常都会造成巨大困扰，而延长手术的并发症发生率相当高。 相对安全且具备临床研究证据的方法是使用“牵引装置”（penile traction device）。现场展示的牵引器通过固定阴茎末端并施加机械牵拉力： ```mermaid flowchart LR accTitle: Penile Traction Device Usage and Impact accDescr: A flowchart outlining traction device protocol, physical gains, and Peyronie's disease application. subgraph Protocol["使用方案"] A["固定并拉伸阴茎末端"] --> B["每日 2 次，每次 30 分钟"] end subgraph Results["效果与局限"] B --> C["持续坚持 3 至 6 个月"] C --> D["平均长度增加约 2 厘米"] D -.-> E["停止使用后是否永久有效尚不明确"] end subgraph ClinicalUse["临床矫正应用"] B --> F["佩罗尼病 (Peyronie's Disease)"] F --> G["反向牵拉以矫正异常弯曲"] end ``` - **牵引效果与时间周期**：严格遵循每天佩戴 2 次、每次 30 分钟的流程，在坚持 3 至 6 个月后，受试者长度平均可增加约 2 厘米。 - **持久性疑问**：现有临床试验基本在取得阶段性测量结果后即告终止，目前尚无长期随访数据能证实停用后是否会回缩反弹。 - **治疗佩罗尼病（Peyronie's disease）**：该类牵引装置的重要临床价值在于矫正阴茎海绵体硬结引起的异常弯曲。当阴茎因纤维斑块出现凹陷或剧烈弯曲时，装置可向弯曲的反方向施力牵引，逐步帮助其恢复平直，避免了剧烈形变给患者造成的心理创伤。 - **安全性与副反应**：牵引过程中可能出现局部淤青或轻微不适，但规范操作下不会产生破坏性伤害。 - **关于阴茎弯曲的探讨**：主持人好奇弯曲是否更容易触碰到 G 点，Dr. Rena Malik 表示轻微弯曲确实可能在特定体位下带来更好的快感体验，但突发且严重的病理性弯曲则需要临床干预。在演示如何调节器械张力时，两人还对器械夹持模具的逼真力度发出了阵阵笑声与惊呼。 ### [01:34:34](https://www.youtube.com/watch?v=PnpHwhTWw0c&t=5674s) 牵引装置与“Jelqing”挤奶法的危险性 在讨论阴茎物理牵引器的使用方式时，主持人试图弄清其操作机制：将阴茎放入固定装置，扣紧夹具，然后顺着正常长度略微调节伸展。Rena Malik 医生强调，这种装置只需要施加轻微的张力（traction），绝不能过度暴力拉扯，正常使用时不应感到明显不适。这类装置的价格大致在 100 美元到 500 美元之间，属于一次性投入，在泌尿外科医生的指导下通常是安全的。然而，在社交媒体（如 TikTok）上疯传的“Jelqing”（阿拉伯挤奶法/阴茎自慰拉伸操）则潜藏着巨大危险。所谓 Jelqing，是用手指比出“OK”手势夹住阴茎根部并用力向外推挤拉伸。Malik 医生指出，这种强行挤压会导致阴茎海绵体组织产生微小撕裂（micro tears），泌尿科临床上已经接诊了大量因为盲目练习 Jelqing 而直接导致勃起功能障碍（ED）的年轻患者。 性功能与生殖健康方面的极度焦虑，往往促使许多男性病急乱投医，尝试极端且伤害巨大的手段。Malik 医生分享了一个令人啼笑皆非却心酸的真实门诊案例：几天前一位患者极其认真、恳切地询问她是否应该通过“喝双氧水（过氧化氢）”来治疗勃起问题，只因他在网络广告上看到喝双氧水能改善勃起。Malik 医生并未嘲笑或羞辱患者，而是耐心地告诫他这极度危险且毫无医学依据。她郑重提醒，医学上根本不存在任何能让阴茎永久变长的神奇药丸、饮料或民间偏方。 - **牵引装置特点**：价格约 100–500 美元，提供微小张力持续伸展，属于非侵入性物理手段。 - **Jelqing 的危害**：手法粗暴极易引起海绵体微撕裂伤与纤维化，是导致获得性勃起功能障碍的高危行为。 - **伪科学警示**：市面上没有任何口服药液（例如双氧水）能改善勃起或促进阴茎实质性增长。 --- ### [01:36:15](https://www.youtube.com/watch?v=PnpHwhTWw0c&t=5775s) 令医生痛心的整形悲剧与男性的尺寸焦虑 当主持人问及临床上最令人心碎的病例时，Malik 医生提到了那些接受阴茎延长手术失败的患者。最悲哀的是，许多患者本身的基础尺寸其实已经高于平均水平（above average），但由于深层的心理焦虑，他们依然选择承担手术风险进行阴茎延长。一旦手术并发症发作，可能导致海绵体坏死、严重挛缩感染，最终整个阴茎表面布满疤痕、永久性毁容畸形（disfigured forever），甚至彻底丧失生理功能。这种无法逆转的悔恨，让患者在余生中都要背负巨大的心理创伤与痛苦。 主持人坦言，自己在进入青春期之前也有过强烈的尺寸焦虑。因为当时他是同龄人中年龄最小、个头最矮的男孩，在更衣室面对其他同伴时总会本能地试图遮掩自己的生殖器。直到青春期发育后，这种心理才逐渐好转。Malik 医生指出，这种社会普遍存在的男性尺寸焦虑其实建立在严重的认知误区之上。 ```mermaid flowchart TD accTitle: 阴茎尺寸焦虑与手术风险逻辑图 accDescr: 展示男性因尺寸焦虑寻求危险手术与科学实情的对比路径 subgraph Trap["心理误区与风险路径"] A["心理焦虑 / 追求超常尺寸"] --> B["盲目接受阴茎延长手术"] B --> C["手术并发症 / 严重疤痕挛缩"] C --> D["阴茎永久畸形与勃起功能丧失"] end subgraph Reality["科学认知与伴侣实情"] E["绝大多数女性满足于平均尺寸"] F["阴蒂是促成高潮的核心器官"] G["手指、口腔与玩具比尺寸更有效"] end ``` --- ### [01:37:32](https://www.youtube.com/watch?v=PnpHwhTWw0c&t=5852s) 阴道尺寸生理学与快感的真正来源 Malik 医生强调，男性最需要认清的真相是：取悦伴侣根本不需要超长的阴茎。女性获得性高潮最可靠的途径是阴蒂刺激，而不是单纯的阴茎插入。要刺激阴蒂，口腔、手指、震动玩具等都能发挥绝佳效果。虽然确实有一小部分女性偏好较大的尺寸，但各项调查数据表明，绝大多数女性对伴侣的实际尺寸感到非常满意，无论是平均水平、略高于还是略低于平均水平，只要彼此之间建立了亲密联结并能获得充分的感官愉悦，尺寸绝非决定性因素。 针对主持人关于“女性阴道尺寸是否存在巨大差异”的提问，Malik 医生解析了阴道的生理解剖特点： 1. **静息状态**：女性阴道的平均深度大约只有 3.5 英寸（约 8.9 厘米）。 2. **唤起状态**：当女性性唤起时，阴道会发生显著的扩张、充血并延长大约一倍，足以轻松容纳平均甚至略大于平均水平的阴茎。 3. **高潮机制**：仅有约 15% 的女性能够单纯依靠阴茎插入抽插达到高潮，高达 85% 的女性必须伴随直接的阴蒂刺激才能登顶。Malik 医生形象地比喻道：单纯的阴道抽插对很多女性而言，感觉就像别人在抚摸男性的睾丸或会阴部，“感觉确实不错，但这本身不足以让你达到高潮”。除非女性的阴蒂脚/阴蒂干结构极其靠近阴道前壁，阴茎尺寸可能带来稍多的间接拉扯感，否则对绝大多数人来说，针对阴蒂的针对性刺激才是不可或缺的。 --- ### [01:39:33](https://www.youtube.com/watch?v=PnpHwhTWw0c&t=5973s) 为什么不同的伴侣感觉差异巨大？ 关于“即便尺寸相近，为何不同伴侣之间的性交感受截然不同”的疑问，Malik 医生从盆底肌力学和运动方式两个维度进行了深入拆解： - **女性盆底肌力量与掌控力**：盆底肌力量充沛、收缩协调的女性，能够在做爱过程中主动通过盆底肌“抓握”并包裹阴茎。这并非意味着阴道天生更狭窄，而是肌肉的主动收缩能力更强。她纠正了大众对于放松盆底肌会“变松”的误解——健康的盆底肌应当像二头肌一样收放自如，既能有力收缩，也能彻底放松，持续处于过度痉挛状态反而会引发疼痛。 - **男性的运动维度与角度**：对女性而言，不同男性的抽动频率、进出角度、体位配合以及粗细（girth）差异，都会对阴道壁神经末梢产生截然不同的刺激模式。 在谈到民间流传的“大手、大脚或高个子代表大阴茎”的传闻时，Malik 医生直言没有任何科学依据表明手脚大小或身高与阴茎尺寸相关。唯一一项在日本进行的研究显示，从鼻根（鼻梁上端）到鼻尖的鼻子长度（nose length），在受试人群中与阴茎长度呈现出一定的正相关性。 --- ### [01:41:52](https://www.youtube.com/watch?v=PnpHwhTWw0c&t=6112s) GLP-1 药物（Ozempic）对性健康的双向影响 对话最后转向了时下备受瞩目的减重与降糖药物（如以司美格鲁肽为代表的 GLP-1 受体激动剂 Ozempic）。关于这类药物对性欲、性吸引力和性功能的影响，Malik 医生指出它存在两面性： 积极层面在于全身代谢功能的全面改善。使用此类药物能有效控制糖尿病、改善心血管系统健康并减轻体重，这意味着血管内皮细胞更健康，生殖器官的血流灌注更充分，从而能直接提升生理勃起硬度与唤起能力。此外，随着体重大幅减轻，体象（body image）提升让患者重拾自信。特别是对于男性，由于耻骨联合前方的脂肪垫（fat pad）随减重而变薄收缩，原本被脂肪埋藏的阴茎海绵体根部得以显露，视觉上阴茎显著变长——这也就是网络上热议的“Ozempic 阴茎”现象，其实质并非海绵体再生变长，而是隐匿的阴茎显露了出来。 然而潜在的消极面也逐渐浮现：GLP-1 药物直接作用于中枢神经系统的大脑奖赏通路（reward pathway）。当患者不再对高热量食物产生强烈的奖赏多巴胺冲动时，这种对欲望的普遍钝化有时也会蔓延至性欲层面，导致部分人群出现性冲动降低和追逐性刺激动机下降的现象。 ### [01:43:15](https://www.youtube.com/watch?v=PnpHwhTWw0c&t=6195s) GLP-1 药物对性欲的潜在隐性影响 随着以 Ozempic 为代表的 GLP-1 受体激动剂类药物在全球范围内广泛应用，这类药物在降低食欲之外的广泛影响正逐渐浮出水面。Dr. Rena Malik 指出，新兴临床观察与数据表明，服用 GLP-1 药物的人群不仅对食物的渴望减少，在赌博、冲动购物、酗酒、吸烟等上瘾行为上的冲动也显著降低。从神经生物学机制来看，由于这些行为与大脑内的多巴胺奖励回路共享相同的神经通路，理论上该药同样会抑制个体的性欲（sexual desire）。 Dr. Rena Malik 表达了深刻的临床担忧：由于 GLP-1 药物具有巨大的代谢获益和减重效果，许多人沉浸在“吃得少了、身材变好了、一切都很棒”的兴奋中，往往难以在第一时间察觉到性欲正在悄无声息地减退。当伴侣之间因缺乏性互动而产生隔阂或摩擦时，当事人可能根本没有将矛盾与所服用的药物联系起来。Dr. Rena Malik 建议，如果在用药期间察觉到对性不再有兴趣或对任何事物都提不起劲，应主动咨询医生——这可能仅仅是药物剂量过高，只需适当回调即可。 针对这类药物对性欲影响的临床研究是完全可行且亟待开展的： - **女性评估工具**：可采用女性性功能指数（FSFI，Female Sexual Function Index）。 - **男性评估工具**：可采用中老年男性雄激素缺乏调查问卷（ADAM 问卷）或专门的性欲评估量表。 - **研究设计**：在患者开始注射 Ozempic 等 GLP-1 药物前进行基线评估，并在后续每次剂量递增阶段持续追踪问卷评分变化。 --- ### [01:44:45](https://www.youtube.com/watch?v=PnpHwhTWw0c&t=6285s) 伴侣间如何开启关于性与亲密关系的沟通 当亲密关系中出现性问题时，许多人因为缺乏沟通模板而选择逃避。Dr. Rena Malik 强调，性沟通虽然没有万能脚本，但最关键的原则是“绝不轻言放弃”。正因为日常生活中性话题极度缺乏讨论，一旦某一方突然提起，另一方很容易瞬间陷入应激防卫状态，下意识产生“我是不是哪里做错了？”“你是不是觉得我没有吸引力了？”等恐慌，进而选择直接回避关闭对话。 开启建设性对话的核心在于理解伴侣的防御心理并非针对提议者本人，而是源于其内心的不安全感、生活压力或糟糕的身体意象。任何持久且高质量的亲密关系都需要付出努力去经营，为了长久的亲密忍受短暂的尴尬与分歧是绝对值得的。 ```mermaid flowchart TD accTitle: 伴侣间建设性性沟通策略 accDescr: 展示了进行性沟通时在环境选择、开场技巧、倾听姿态以及日常氛围营造上的四个核心环节。 subgraph Preparation["环境与时机选择"] A["避免在卧室内 / 避免在性前后"] --> B["选择平行视角：散步或驾车同行"] end subgraph Dialogue["沟通互动技巧"] C["肯定开场：表达对关系的喜爱与感激"] --> D["尊重节奏：允许对方约定后续合适时间"] D --> E["抱持好奇心倾听：关心对方感受与重燃爱意"] end subgraph Culture["日常氛围构建"] F["非性接触：拥抱、抚背、肯定夸奖"] --> G["打破功利性：不把性视作匆忙的任务与宣泄"] end Preparation --> Dialogue Dialogue --> Culture ``` - **脱离卧室与平行视角**：绝对不要在卧室内，也绝不要在性行为刚刚结束或正准备发生时开启严肃讨论。适宜选择在户外散步或车内并排就坐时展开，这种平行坐姿避免了具有审视感的直接眼神对视，能够显著降低对方的心理压迫感。 - **正面肯定开局**：以积极事实切入（例如：“我真的很喜欢我们关系里的这一点，不过我也很希望我们能聊聊这个……”）；若对方当下抗拒，切勿强推，可温和提议让对方决定一个更自在的时间专门沟通。 - **怀抱好奇而非指责**：用关切取代评判，表达“我很爱你，我很想念我们曾经的默契与联结，我想知道你最近的真实感受”。 - **重塑对性的认知分歧**：女性在压力重重时，往往会将性视作待办清单上的“额外负担”；而男性则常常将性视作宣泄压力的出口。由于很多男性从小未被引导如何表达情感亲密，性成了他们与伴侣建立深层联结的唯一主要途径，导致其求欢举动常被伴侣误解为“自私”或“只想要肉体”。 - **全天候的情感滋养**：将性还原为充满期待的美好体验，而非匆忙完成的“排毒泄欲”。这种氛围需要在日常细节中铺垫，包括白天的温暖短信、亲吻拥抱、轻抚后背以及由衷赞美。 --- ### [01:48:26](https://www.youtube.com/watch?v=PnpHwhTWw0c&t=6506s) 男女在性沟通中的敏感禁忌与破局方式 异性伴侣在性话题上面临截然不同的心理包袱与社会文化压力。对男性而言，最敏感脆弱的痛点往往是**表现焦虑（Performance Anxiety）**与勃起功能障碍，因为勃起硬度被社会观念与男性气质高度绑定，无法勃起常让他们感觉自己作为男人彻底失败；此外，表达非性需求、提出拒绝边界或承认自己不想做爱，也会被很多男性视作“不够男子气概”。 相反，女性面临的头号沟通阻碍是**优先考虑自身愉悦**，许多女性羞于开口索要更长的前戏或明确的阴蒂刺激，极度恐惧被伴侣打上“难伺候（high-maintenance）”或“费时费力”的负面标签；同时，因身体意象焦虑、心理负荷过载导致无性欲，以及性交疼痛等身体不适，也常常被女性隐忍。 | 性别 | 首要敏感禁忌与心理担忧 | 其他常见沟通痛点 | |:--- |:--- |:--- | | **男性** | **表现焦虑与勃起障碍**（将其与男子气概和自身价值直接捆绑） | 表达非性情感需求、害怕被视作不具男子气概、传达拒绝与设立边界 | | **女性** | **争取自身快感与明确刺激要求**（害怕被指责挑剔或要求繁琐） | 坦承性交疼痛与不适、身体外貌焦虑、因精神负荷导致性欲缺失 | 针对这些敏感壁垒，借助第三方媒介破冰是一种极其柔和且实用的手段。Dr. Rena Malik 分享了自己婚姻中的真实生活片段：丈夫白天会频繁转发社交媒体上的短视频（Reels），以此作为打破沉默、开启趣味讨论的桥梁。同样地，向伴侣转发一条科普短视频或本期播客节目，说一句“我刚看了这个觉得特别棒，学到很多，想跟你分享”，可以自然化解生硬感。 在临床实践中，Dr. Rena Malik 经常见到女性带男性伴侣或男性带女性伴侣一同走进诊室寻求咨询，她认为这种共同就诊的行为极其动人，充分体现出对伴侣福祉与关系质量的深度投入。针对主持人提出“男人就是天生不擅长聊性”的观点，Dr. Rena Malik 明确纠正：**绝不能将‘男人不擅长谈性’当作拒绝沟通的借口或挡箭牌**。事实上，在性这个长期被污名化的领域，无论男女在起步时都同样感到笨拙与不适，唯有勇敢打破沉默，才能实现真正的高质量亲密。 ### [01:50:54](https://www.youtube.com/watch?v=PnpHwhTWw0c&t=6654s) 沟通性话题的难关与小众的尿道性偏好 谈论性爱从来不是一件容易的事。雷娜·马利克（Dr. Rena Malik）指出，即便平日里沟通能力极强、能言善道的人，一旦触及性话题，往往也会感到极其尴尬和局促。然而，只要人们愿意打破禁忌、坦诚相见，谈论性爱就是一项完全可以后天习得的沟通技能，而为这项技能付出耐心和投资绝对是值得的。当史蒂文问及患者是否会向她倾诉自己的性幻想时，马利克医生坦言，相比于脑海中飘渺的幻想，患者更常带来的是真实且多元的“小众性趣味”（diverse sexual interests / kinks）。 马利克医生分享了一个典型的病例：一位男患者在与她建立了长期的医患信任后，终于鼓起勇气坦白，自己长期受到性唤起障碍的困扰，而唯一能让他产生性冲动的，是一种特殊的“医疗性癖”（medical kink）。该患者会定期去找专人往自己的尿道里插导尿管（Foley catheter），唯有如此才能获得强烈的性快感。史蒂文听到导尿管需要插入阴茎尿道时感到十分震惊，马利克医生则从泌尿外科专业角度解释，这种行为在圈内被称为“尿道游戏”（urethral play）。爱好者通常会使用带有喇叭状防滑脱底座的金属探针（urethral sounds）插入尿道，因为尿道内分布着丰富的神经末梢，在特定刺激下确实能带来强烈快感。马利克医生强调，拥有跳出传统框架的性偏好本身完全正常，无需病理化；真正的挑战在于，如果某种小众偏好成了唤起欲望的唯一钥匙，当事人该如何以安全、尊重的方式将其引入伴侣关系中进行探索。 ```mermaid flowchart TD accTitle: 伴侣性幻想安全探索流程 accDescr: 展示马利克医生建议伴侣安全探索彼此性幻想的四个渐进式步骤 subgraph 准备阶段 ["第一阶段：独立探索与记录"] A["各自私下写下个人性幻想"] --> B["完全保密，作为安全的心理沙盒"] end subgraph 沟通阶段 ["第二阶段：建立信任与适度分享"] B --> C{"双方均感到舒适放松？"} C -- 是 --> D["各自挑选并分享一个想要尝试的幻想"] C -- 否 --> B end subgraph 实践阶段 ["第三阶段：抱持玩心低压尝试"] D --> E["小规模实践与玩乐实验"] E --> F["结果中立：无论体验好坏都不必过分严肃"] end ``` --- ### [01:52:50](https://www.youtube.com/watch?v=PnpHwhTWw0c&t=6770s) 性幻想的真相：从屈从、窥阴到陌生人 几乎每个人都有性幻想，但大众往往对性幻想的普遍性缺乏科学认知。马利克医生指出，许多看似“小众”甚至让人难以启齿的幻想，在大规模人群统计中其实极其普遍。例如，“性屈从”（sexual submissive）的幻想发生率极高：约有 60% 的女性和 20% 的男性在脑海中渴望体验被掌控或臣服的感觉；但这仅仅是性唤起机制的一部分，并不代表他们在现实社会生活中真的想要扮演从属角色。与此同时，男性的性幻想中往往频繁出现“窥阴/观摩”（voyeurism，观看他人发生性关系）以及“多伴侣”（multiple partners）的情节；而女性则更多在幻想中交织着主导权（dominance）与浪漫情境，例如异域风情（exotic places）的浪漫相遇。 更为重要的是，高达 90% 的性幻想对象其实是陌生人，或是现实伴侣之外的熟人。马利克医生向大家保证，这完全是健康且普遍的生理心理现象，绝不代表当事人在感情上背叛了伴侣或对伴侣失去了爱意。“性幻想是大脑内部一个绝对安全的探索空间，”伴侣的大脑如何天马行空，丝毫不影响他们对现实伴侣的深厚感情。为了帮助情侣脱敏并增进亲密感，马利克医生常给患者开出一个小处方：双方各自把性幻想写在纸上，先不给任何人看；等到彼此准备充分时，各自挑选一条愿意尝试的幻想拿出来讨论。她提醒大家，在床上不要把一切都搞得那么沉重严肃（"it doesn't need to be that serious"），把性当成一种探索、玩耍与游戏；敢于在卧室里找回童趣与松弛感的人，不仅性生活更加美满，内心也更少孤独，甚至能活得更长寿。 - **性屈从幻想比例**：约 60% 的女性与 20% 的男性在性幻想中渴望体验屈从角色。 - **陌生人幻想现象**：约 90% 的人群性幻想涉及现实伴侣之外的人或完全的陌生人。 - **玩心法则**：降低对性表现的严肃考核，以游戏心态（experiment, play, have fun）面对尝试的结果。 --- ### [01:54:42](https://www.youtube.com/watch?v=PnpHwhTWw0c&t=6882s) 在焦虑时代重夺性健康与《硬核真相》 史蒂文深刻地附和了这一观点，并指出当今社会正在滑向一种愈发普遍的“无性状态”（sexless）。数字技术不仅无情地掠夺了现代人的注意力，斩断了人与人之间的深度连结，更带来了前所未有的环境压力与信息过载——“哪怕一万英里外发生爆炸，只要滑动手机屏幕，灾难画面就会瞬间扑面而来。”在交感神经过度激活、身心俱疲的当下，主动找回性生活、系统性地守护整体性健康，显得比以往任何时候都更加紧迫。 正因如此，马利克医生倾注心血撰写了即将于 2026 年 9 月出版的新书《硬核真相：关于健康长寿与绝佳性爱，男人必须知道的一切》（*The Hard Truth: Everything Men Need to Know About Good Health, Great Sex, and Long Life*）。她动情地谈到写书的初衷：在传统家庭结构中，女性往往承担了过多的健康照护重任——帮男性伴侣预约门诊、跟进体检、管理孩子的疫苗接种，甚至照料年迈的父亲。然而，男性的身体运作与心理挣扎却往往被社会教育所忽视。这本书不仅是男性的生理健康指南，更是献给女性去读懂枕边人的窗口。马利克医生在门诊中见证了无数次奇迹：性，是驱动男性做出健康改变最强大的杠杆。很多男患者可以对心血管风险充耳不闻，但为了重获坚挺的勃起和满意的性生活，他们愿意以极大的毅力去改善饮食、逆转血糖、控制血压，从而挽救自己的生命。 --- ### [01:56:44](https://www.youtube.com/watch?v=PnpHwhTWw0c&t=7004s) 告别绝望：在无AI的人性连接中重拾掌控感 节目进入了《CEO日记》（The Diary Of A CEO）的经典传统：上一位嘉宾在不知道下一位是谁的情况下留下一个问题。有趣的是，这次的信纸上破天荒地加盖了一个醒目的印章——“认证 100% 人类”（Certified 100% Human）及“无生成式AI参与”（Gen AI Free），带着鲜明的时代印记。上期嘉宾提出的问题直击当代人的精神危机：“世界在当下充斥着强烈的绝望感与无力感。你会对那些陷入迷茫的人说些什么，来帮助他们重拾生活的主动权与掌控感（reclaim their agency）？” 马利克医生沉思片刻后给出了真挚的回答：人类天生就是要彼此依偎、相互依存的（"we as humans are meant to be with other humans"）。现代人感到绝望，核心原因在于断联；重拾掌控感的第一步，就是重新把“人与人的现实连结”置于首位。无论是在宗教社群中寻求慰藉、融入社区互助，还是重返线下活动与现场演出的拥抱中，真实相聚的力量无可替代。她借用历史的钟摆效应阐述道，人类社会始终在两极之间摆荡，有时走向对立与仇恨，但最终必然会荡回理解与关爱。痛苦虽然客观存在，但从漫长历史来看，人类总能在真实的情感共鸣中重塑团结与希望。 --- ### [01:58:44](https://www.youtube.com/watch?v=PnpHwhTWw0c&t=7124s) 破除难堪与羞耻：科学性知识的力量 史蒂文由衷赞同马利克医生对人性回归的乐观信念，并向听众大力推荐马利克医生的个人 YouTube 频道（拥有近 300 万订阅者）。史蒂文赞叹道，马利克医生建立了一个无与伦比的科普宝库，专门解答那些大众因为难为情而深埋心底、从未有人给出正规答案的健康难题。 在她的频道中，既有接地气的男性生理疑难——比如排尿后为什么总是会有尿滴沥（post-urination dribble）以及如何运用盆底肌收缩彻底阻止它；也有行业揭秘——邀请成人电影导演披露情色片中哪些镜头近乎百分之百是虚构伪造的；更有深度、硬核的医学干货，涵盖阴茎整体健康、勃起功能障碍（ED）的病理生理机制、提高女性性高潮成功率的体位设计等海量内容。她以严谨的现代医学为底座，用温柔、包容且毫无评判的姿态，剥离了笼罩在性与身体上的羞耻感，让数以百万计的人得以坦然接纳自我，追求更高质量的健康与幸福。 ### [01:59:34](https://www.youtube.com/watch?v=PnpHwhTWw0c&t=7174s) 节目尾声与推荐视频引导 对谈正式进入尾声，主持人 Steven Bartlett 对 Rena Malik 医生的倾囊相授与宝贵时间表达了由衷的感谢，并热情呼吁观众关注和订阅相关平台，以便持续获取更多专业、科学的性健康与医学科普内容。Malik 医生也欣然致意回应："You're so welcome."。 随后，主持人话锋一转，向观众介绍起 YouTube 全新的 AI 智能推荐机制。他幽默而生动地解释道，该算法凭借先进的 AI 技术和每个人的观看行为历史，能够极其精准地预测观众接下来最想看的内容，且对屏幕前的每一个人来说推荐结果都是独一无二的。算法测算表明屏幕上浮现出的这部视频正是当下最适合你的专属内容，他鼓励大家直接点击探索，相信一定会大有收获。 - 主持人对 Dr. Rena Malik 本期的专业分享致以感谢，并倡议观众保持关注与订阅。 - 视频结尾无缝衔接 YouTube 基于 AI 行为分析的智能推荐导流，引导观众观看下一期专属推荐视频。 ## Notable quotes > [00:00](https://www.youtube.com/watch?v=PnpHwhTWw0c&t=0s) Be right back. — Steven Bartlett > [08:34](https://www.youtube.com/watch?v=PnpHwhTWw0c&t=514s) ready to go at any moment — Dr Rena Malik > [20:58](https://www.youtube.com/watch?v=PnpHwhTWw0c&t=1258s) Muscle is medicine — Steven Bartlett > [01:16:53](https://www.youtube.com/watch?v=PnpHwhTWw0c&t=4613s) It absolutely will. — Dr Rena Malik > [01:21:40](https://www.youtube.com/watch?v=PnpHwhTWw0c&t=4900s) 只要你触碰了激素，这就是极其严肃的人体工程。 — Dr Rena Malik > [01:52:50](https://www.youtube.com/watch?v=PnpHwhTWw0c&t=6770s) it doesn't need to be that serious — Dr Rena Malik > [01:56:44](https://www.youtube.com/watch?v=PnpHwhTWw0c&t=7004s) Certified 100% Human > [01:56:44](https://www.youtube.com/watch?v=PnpHwhTWw0c&t=7004s) we as humans are meant to be with other humans — Dr Rena Malik > [01:59:34](https://www.youtube.com/watch?v=PnpHwhTWw0c&t=7174s) You're so welcome. — Dr Rena Malik ## Mentioned Dr. Rena Malik, Steven Bartlett, The Diary Of A CEO, Viagra, Dr. Debby Herbenick, Health Professionals Follow-up Study, World Health Organization (WHO), John & Julie Gottman, Wispr, Ketone, Fiverr, Fiverr Pro, Cometeer, DOAC Circle, Ozempic, The Hard Truth: Everything Men Need to Know for Good Health, Great Sex, and Long Life, YouTube, TikTok ## Video description Is your sex life bad? Dr Rena Malik walks you through every single sex question you're too nervous to ask - from testosterone, porn, and erectile dysfunction, to libido and stress! The Better-Sex Doctor Rena Malik is a urologist, pelvic surgeon, and sexual health expert who helps millions better understand sexual health and taboo topics through science-based education and honesty. She is also the author of her upcoming book 'The Hard Truth'. She explains: ◼️Why bad sex is often a sign your overall health is breaking down ◼️Why erectile dysfunction can be an early warning sign of heart disease ◼️The 4 pillars that control your sex life: fuel, strength, environment, and confidence ◼️How porn, masturbation habits, and performance anxiety can rewire arousal ◼️What low testosterone actually feels like, and when TRT is a mistake ◼️Why better sex starts long before you enter the bedroom 00:00 Intro 03:57 Why Are People Having Less Sex? 06:06 Why Is Rough Sex Increasing? 07:16 Is Dopamine Ruining Your Sex Life? 09:42 How Do You Find What Turns You On? 11:50 Why Does Performance Anxiety Kill Intimacy? 14:34 Why Do Couples Stop Having Sex? 17:56 What Is The Best Diet For Erectile Dysfunction? 20:58 What Are The Best Exercises For Sexual Performance? 28:29 What Can Erectile Dysfunction Signal? 30:59 Why Does Porn Work But Real Sex Does Not? 34:25 Why Do Morning Erections Matter? 35:50 What Are The Differences In Male Vs Female Arousal? 40:20 Why Do You Feel Tired After Orgasm? 41:24 How Does Stress Affect Your Sex Life? 43:19 How Does Sleep Affect Testosterone? 45:26 Do Microplastics Affect Hormones? 47:57 How Do Friends Affect Your Sex Life? 50:06 How Does Porn Affect Relationships? 53:10 Ads 55:12 Should Couples Use Sex Toys? 56:58 Can Sex Toys Become Addictive? 59:32 What Are The Best Positions For Female Orgasm? 01:00:50 What Is Squirting? 01:02:58 Why Does Sex Cause UTIs? 01:04:28 Why Do Humans Have Orgasms? 01:05:26 What Are Non Genital Orgasms? 01:08:57 Why Is Testosterone Declining? 01:11:05 Does Testosterone Affect Fertility? 01:14:50 What Are The Risks Of Anabolic Steroids? 01:16:55 Does TRT Affect Fertility? 01:23:38 How Does Body Image Affect Sexual Pressure? 01:25:40 Ads 01:27:43 Does Penis Size Matter? 01:31:38 Do Penis Enlargement Methods Work? 01:36:15 What Are The Toughest Cases Doctors See? 01:38:22 How Much Does Vaginal Size Vary? 01:39:33 Why Does Sex Feel Different With Each Person? 01:41:09 Can You Predict Penis Size? 01:41:52 Do GLP 1 Drugs Affect Libido? 01:44:45 How Do You Talk About Sex With Your Partner? 01:51:19 What Do Sexual Fantasies Mean? 01:56:44 What Should You Do If You Have Lost Hope? Independent Fact Check: https://stevenbartlett.com/wp-content/uploads/2026/04/DOAC-Rena-Malik-Independent-Research-Further-Reading.pdf Follow Dr Rena: Instagram - https://link.thediaryofaceo.com/9eD5dDG X - https://link.thediaryofaceo.com/BDcDWi8 YouTube - https://link.thediaryofaceo.com/CTzkeOx Website -https://link.thediaryofaceo.com/TyaRNr You can pre-order Dr Rena’s book ‘The Hard Truth: Everything Men Need to Know for Good Health, Great Sex, and Long Life’, here: https://link.thediaryofaceo.com/FQSv9xe Enjoyed the episode? Share this link and earn points for every referral - redeem them for exclusive prizes: https://doac-perks.com The Diary Of A CEO: ◼️Join DOAC circle here - https://doaccircle.com/ ◼️Buy The Diary Of A CEO book here - https://smarturl.it/DOACbook ◼️The 1% Diary is back - limited time only: https://bit.ly/3YFbJbt ◼️The Diary Of A CEO Conversation Cards (Second Edition): https://g2ul0.app.link/f31dsUttKKb ◼️Get email updates - https://bit.ly/diary-of-a-ceo-yt ◼️Follow Steven - https://g2ul0.app.link/gnGqL4IsKKb Sponsor links: Wispr - Get 14 days of Wispr Flow for free at https://wisprflow.ai/steven Ketone - https://ketone.com/STEVEN for 30% off your subscription order Fiverr - https://fiverr.com/diary and get 10% off your first order when you use code DIARY Cometeer - https://cometeer.com/steven for $30 off your first order *Steven is an investor in this business [Source](https://www.youtube.com/watch?v=PnpHwhTWw0c)

[0:00] Steven Bartlett: Be right back. [8:34] Dr Rena Malik: ready to go at any moment [20:58] Steven Bartlett: Muscle is medicine [76:53] Dr Rena Malik: It absolutely will. [81:40] Dr Rena Malik: 只要你触碰了激素，这就是极其严肃的人体工程。 [112:50] Dr Rena Malik: it doesn't need to be that serious [116:44] Certified 100% Human [116:44] Dr Rena Malik: we as humans are meant to be with other humans [119:34] Dr Rena Malik: You're so welcome.

[35:50] Dr. Rena Malik: Homologues means that they're essentially the same structure. They're made from the same cells but they're in the male and the female. [76:53] Dr. Rena Malik: Once you take it, your body stops making its own testosterone. Many people over years will notice that their testicles get smaller... so it's not something to take lightly. [113:55] Dr. Rena Malik: it means nothing about how they feel about you [113:55] Dr. Rena Malik: Everyone should just be having more sex. [113:55] Steven Bartlett: The Hard Truth: Everything Men Need to Know About Good Health, Great Sex, and Long Life [116:44] Certified 100% Human [116:44] Gen AI Free [116:44] So much of the world feels hopeless about this moment. What would you tell someone to help them reclaim their agency?

[0:00] Is there a way to enlarge the [0:02] >> So, you can put your penis in this [0:04] device. They've actually done research [0:05] on this. So, 30 minutes twice a day and [0:07] it does show improvements in length [0:09] about 2 cm. [0:11] >> Tada. [0:12] >> And that's not all. So, they actually [0:13] did a study on pistachios where guys at [0:15] 100 g of pistachios [music] every day [0:17] and they saw a decrease in erectile [0:18] dysfunction because if you're not having [0:20] erections now, you're no longer getting [0:22] blood flow to your penis and it will [0:23] shrink over time. And the same goes for [0:25] women with their clitoris because it's [0:27] the same type of tissue. But also, when [0:29] you look at people who have sex once a [0:31] week, they live 49% longer than people [0:33] who only have sex once a year. [0:35] >> 49% longer. [0:37] >> Yeah. And for every 100 orgasms men had, [0:40] they lived like 13% longer. [0:43] >> Be right back. [laughter] [0:45] >> Dr. Reena Malik has become the world's [0:48] most watched urologist. [music] [0:49] >> After sharing everything you need to [0:51] know about hormones, sexual health, [0:53] >> and how to [music] have better sex based [0:55] on the data. So, how can you have the [0:57] best sex possible? So, there's four main [0:59] pillars of sexual health. So, pillar one [1:01] is fuel. So, how you nourish your body, [1:03] and it's a huge part of sexual activity. [1:06] And then pillar two is strength. When [1:08] people think about strength, they always [1:09] think about going to the gym and lifting [1:11] weights. But it's much more than that. [1:12] So, when you look at the data, any sort [1:14] of cardiovascular exercise is going to [1:16] improve sexual function. It's going to [1:17] improve blood flow to the penis and to [1:19] the clitoris. And then also if you do [1:21] 150 minutes a week, it is the same [1:23] amount of improvement as you would see [1:24] when you take a medication like Viagra. [1:27] And the other part of it is the pelvic [1:28] floor. It's under evaluated, under [1:30] discussed, and we'll get into that. But [1:32] pillar three is environment. So things [1:34] like stress, [music] [1:36] sleep, and endocrine disrupting [1:37] chemicals. For example, they looked at [1:39] data on men sleeping 5 hours a night [1:41] versus 8 hours a night. Guys who sleep 5 [1:44] hours a night, their testosterone drops [1:45] by 15%. Yeah. [1:47] >> And then the last of the four pillars [1:48] that we don't talk about enough is, and [1:52] that's still important, [1:53] >> I want to talk about morning erections, [1:55] squirting, clitorol stimulation, and [1:57] certain positions that are going to [1:59] increase the probability that my partner [2:01] has an orgasm. [2:02] >> Let's talk about all of that. First of [2:04] all, [2:07] >> this is super interesting to me. My team [2:09] given me this report to show me how many [2:10] of you that watch this show subscribe. [2:12] And some of you have told us, according [2:13] to this, that you are unsubscribed from [2:15] the channel randomly. So, favor to ask [2:17] all of you. Please could you check right [2:19] now if you've hit the subscribe button [2:20] if you are a regular viewer of the show [2:21] and you like what we do here. We're [2:23] approaching quite a significant landmark [2:25] on this show in terms of a subscriber [2:26] number. So, if there was one simple free [2:29] thing that you could do to help us, my [2:30] team, everyone here to keep this show [2:32] free, to keep it improving year over [2:35] year and week over week, it is just to [2:36] hit that subscribe button and to double [2:38] check if you've hit it. Only thing I'll [2:39] ever ask of you, do we have a deal? If [2:41] you do it, I'll tell you what I'll do. [2:43] I'll make sure every single week, every [2:45] single month, we fight harder and harder [2:46] and harder and harder to bring you the [2:48] guests and conversations that you want [2:49] to hear. I've stayed true to that [2:50] promise since the very beginning of the [2:52] D of Sio. And I will not let you down. [2:55] Please help us. Really appreciate it. [2:56] Let's get on with the show. [music] [3:03] [music] [3:05] Dr. Reena Malik, if somebody was to come [3:09] up to you in the street, having watched [3:10] your videos online, and they were a a [3:13] follower of the content you've produced [3:14] over the last couple of years, if you [3:16] had to guess the question they would ask [3:18] you, because it's probably the most [3:20] frequent, popular question you get [3:21] asked, what do you think they would say? [3:23] >> They would say, "What can I be doing [3:25] right now to improve my sex life?" [3:27] >> Who would be asking you that question? [3:29] And why do you think they'd be asking [3:30] it? [3:31] >> I think everyone can agree that sex is [3:33] something we enjoy. It's something [3:34] that's important that we want to have, [3:36] right? And there is um a desire to have [3:41] good sex or feel like maybe you're [3:42] missing out on something that could be [3:44] even better. So, how can you have the [3:46] best sex possible? Because you hear all [3:48] these people talking about amazing sex [3:50] in the media. You might see it on [3:52] pornography. You might feel like this is [3:54] something amazing. Why am I not having [3:56] that? I want that. Right. [3:57] >> So, on that point, you said it's obvious [3:59] that it's important. I think it appears [4:02] to be increasingly not obvious that it's [4:04] important because when you look at some [4:06] of these stats and I'll throw this graph [4:07] that I've I found here up on screen and [4:10] it shows that people are becoming more [4:12] sexless especially young adults between [4:14] 18 and 30. This graph is pretty stark. [4:17] >> Mhm. Think about 50 years ago. There was [4:19] no cell phones. There might be some TV [4:21] programs but there was ads in between TV [4:23] programs and there was only certain TV [4:25] shows you could watch at a certain time [4:26] that you enjoyed and then there was [4:28] nothing to watch. There was no email. [4:30] So, you went to work and you came home [4:31] and there was really not a lot of [4:32] communication between you and your [4:34] co-workers or your job. They made dinner [4:35] with their family. They hung out and [4:38] then maybe they watched a program or two [4:40] and then they lied down in bed. They [4:41] didn't have a phone to scroll on. They [4:43] didn't have anything to keep them up. [4:45] And so then they were like next to their [4:46] partner and maybe they're talking, maybe [4:48] they're cuddling. And so there was more [4:50] like opportunity and space for sex, [4:52] right? You it was a thing that you did [4:54] for enjoyment, for pleasure, for fun. [4:56] Now we have all these distractions that [4:59] keep our mind away from sex. In order to [5:02] enjoy sex, you need to have space for it [5:04] to be able to enjoy your partner and [5:07] feel like you want that, right? And now [5:09] we're sort of [snorts] there's not as [5:11] much room for it. That's one. Two is [5:13] younger people, how are they dating, [5:15] right? How are they meeting each other? [5:17] They're meeting each other through apps, [5:19] through um DMs. And so they're not [5:22] actually like really having these deep [5:24] meaningful connections. there have [5:26] there's a big hookup culture. There's a [5:28] big like fling culture. And imagine [5:30] first time sex for most people is not [5:32] great. You don't know your partner. You [5:34] don't know what they like. And you may [5:35] not be able to express what you like. [5:37] You're never taught how to talk about [5:38] sex, right? So you don't know how to say [5:40] like, "Hey, I like it like this." And [5:42] you may be self-conscious cuz it's your [5:44] first time. So you have like mediocre [5:45] sex or bad sex. And they're like, "Well, [5:47] I don't really want that." And there's [5:49] just no like follow through, right? [5:51] There's there's not a lot of um [5:53] education on what sex should look like. [5:55] like the only education people are [5:56] getting are from often erotic films and [5:59] so they're seeing sex that's not real [6:01] that's curated and they're trying to [6:03] emulate that and that's not pleasurable [6:05] for most people and younger people these [6:08] days are um actually having a rise in [6:10] more what we call rough sex so choking [6:13] has become very very common as common as [6:16] like they call choking almost like [6:17] vanilla sex so young people if you look [6:20] at data like 60% of women and I think [6:25] 20% of men have been choked during sex [6:27] of that age group, like college age [6:29] group. And of those people who get [6:31] choked, 20% have been choked 25 times or [6:34] more. Now, I think it's fine if you're [6:36] into that, but I can't imagine that that [6:38] many people are into choking. And [6:40] there's data to support that. So, when [6:41] you look at qualitative data, and this [6:42] is by uh Debbie Herbick, she's a sex [6:44] researcher, and she did qualitative [6:46] research, and she asked people like, [6:47] "What is it like? Do you enjoy being [6:48] choked? Tell us about it." Right? Women [6:50] were like, "Yeah, it's okay. Sometimes [6:52] I'm scared because my partner is big and [6:54] strong and I'm, you know, smaller and [6:56] they have big hands. Sometimes it's fine [6:58] and sometimes I don't really care for [7:00] it, but like it's just a part of sex. [7:02] It's just as normal as as kissing, for [7:04] example. And so if you're having sex and [7:07] you're doing things just because you [7:08] think that's what your partner wants or [7:10] what it should look like and you're not [7:12] enjoying it, well, that's not going to [7:14] be sex that you want to have. that point [7:16] you said about the the lifestyles we [7:18] lead and how that might be impacting our [7:20] sex lives I thought was really [7:21] interesting because we don't talk enough [7:22] about this but when you look at some of [7:24] the data on this demographic um you know [7:26] people 30 and below around that age the [7:30] extreme outliers are spending 8 to 10 [7:32] hours on their phones on social media [7:34] and on the internet and roughly about 15 [7:38] to 20% of young people describe their [7:40] usage as almost constant effectively [7:43] scrolling during all waking hours while [7:46] they're eating, while they're in the [7:47] bathroom, and before they go to sleep. [7:48] So, and I was wondering from a dopamine [7:50] perspective if there's correlation [7:52] between these like dopamogenic [7:54] activities that are now like hijacking [7:57] our lives, whether it's short form [7:58] videos on social media, whether it's [8:00] pornography or food, whether it's having [8:03] an impact on what then happens in the [8:05] bedroom and our performance in the [8:07] bedroom. [8:08] >> If you think about what you need to have [8:10] good sex is you need to be sort of in [8:13] the mind space for sex. And if you're [8:14] constantly like hijacked by all these [8:17] other things, you're never like really [8:18] getting in the mood, right? You're just [8:20] like, "Oh, I'm going to be turned on [8:21] when I see my partner and we're going to [8:23] have sex and it's going to be over." And [8:25] it's just really a mechanical thing at [8:27] that point, right? You're not actually [8:28] you're just trying to get an orgasm. [8:30] You're not actually like spending the [8:32] time to enjoy and to experience that [8:34] fully because you're just so like you're [8:36] just your brain is always doing [8:38] something else, right? because people [8:39] are constantly scrolling like every 60 [8:41] seconds there's a new video, there's [8:43] something else. And so it's really hard [8:44] to focus. And so that can translate to [8:47] the bedroom where you're like you're [8:48] having sex, but your brain is somewhere [8:50] else thinking about something else you [8:52] saw or something you have to do or [8:53] something you want to see or something [8:55] you want to look up, whatever it is, but [8:57] you're not really in there in the [8:59] moment. You're just going through the [9:00] motions. And so I think that's really [9:02] where the challenge is is that people [9:04] are becoming increasingly distractable. [9:07] I find it really hard, I got to be [9:08] honest, to have sex if I've had like a [9:09] really really busy day or if I'm really [9:11] really thinking about something. I [9:13] almost have to I have to like [9:14] intentionally create quite a lot of [9:15] space. [9:16] >> Exactly. [9:17] >> In order to be able to be in the mood. [9:20] >> Yeah. Be aroused, right? It takes like [9:22] time and energy. I think I appreciate [9:24] you for saying that because a lot of [9:25] people think that men are just ready to [9:27] go at any moment and that's not fair, [9:29] right? Because everyone needs time to be [9:32] aroused. It's not just instant for [9:34] everybody, especially when you have a [9:35] lot of work stress or life stress or [9:37] other things going on. It's actually [9:39] like you have to make time and space for [9:41] it. [9:42] >> Yeah. Because as a man, you got to get [9:43] an erection. And I I always think that [9:45] an erection is a consequence usually, [9:47] especially when it comes to sex. And I'm [9:49] not talking about morning glories here, [9:50] but an erection is a consequence of like [9:52] a story. [9:54] >> You use the word aroused. [9:55] >> There's like a story in my head which [9:57] makes me go, "Oh, that's kind of hot." [9:59] >> Yeah. You need something. You need some [10:02] stimuli, right? You need to think about [10:04] something, see something, smell [10:05] something, feel something, right? You [10:07] need to just be together and and sort of [10:09] allow yourselves to be intimate before [10:11] that sort of desire and arousal come [10:13] together. [10:14] >> And for me as well, it's not just touch [10:16] like that doesn't necessarily for me, it [10:17] really is quite like a psychological [10:19] thing. I was wondering if this is [10:21] there's any data around this or I mean [10:23] just even anecdotally like people get [10:25] aroused in very very different ways, [10:26] don't they? [10:27] >> Yeah, absolutely. I mean some people um [10:30] are very like visual so they you know [10:32] they see their partner and they get [10:34] aroused very quickly. Basically when you [10:36] get aroused you need to be in a [10:37] parasympathetic nervous system state. So [10:39] in order to get an erection you need to [10:41] be in the state which is like rest and [10:43] digest. So if you're stressed if you're [10:45] thinking about other things if you're [10:47] essentially on the go you are not [10:49] allowing your nervous system to calm [10:51] down. And so for some people that's a [10:53] whole bunch of different things. Some [10:54] people can switch more easily into that [10:56] state and some people need more of like [10:59] uh you know to feel either mentally [11:03] stimulated or they need to have some [11:05] associations like it might be like they [11:07] need a certain scent, they need to like [11:09] relax their body, they need to like go [11:10] take a bath, whatever it is, but some [11:13] people need different things and knowing [11:15] what that is for your partner is super [11:18] important, right? Because then you can [11:19] incorporate that. Everything is [11:21] scheduled in our lives, right? And then [11:22] you're like, "Oh, but now sex is like [11:24] the last thing on the schedule, right?" [11:25] And like I don't even think about it. [11:26] Like, "Oh, okay. Now, yeah, maybe let's [11:28] have sex." But it's like, if you [11:29] actually make time to be intimate, allow [11:31] yourself to be in that brain space, be [11:34] together, that's when it can actually [11:36] happen. Especially when you've been in a [11:37] long-term relationship, it doesn't come [11:39] as easily like spontaneously, which we [11:41] call spontaneous desire. It it comes [11:43] more as a response to these other cues [11:46] that allow you to feel desire and to [11:48] feel aroused. [11:50] H I also think I was thinking about a [11:52] previous relationship I had where on the [11:55] days where I'd been like working very [11:57] hard and I was like tired or stressed or [11:58] I've been traveling and I was jetlagged. [12:00] I think there was also because I didn't [12:03] see this person often there was also an [12:05] expectation that when I did see them we [12:06] were going to have sex [12:07] >> and um that was that was very hard [12:11] because actually the expectation of it [12:14] stressed me out more. [12:16] >> Yeah. And that can happen like if it [12:18] becomes the elephant in the room it can [12:20] become a little bit heavy which then is [12:21] sort of counterproductive to performance [12:24] >> and this is you know sort of a variation [12:26] on performance anxiety. So when you feel [12:29] like you have to perform on demand and [12:31] maybe you're worried it might not happen [12:33] it creates this vicious loop right so [12:35] you may maybe have trouble with an [12:36] erection or maybe it's like I I'm [12:38] expected to have sex but I really can't [12:39] get there mentally. whatever it is. Now, [12:41] you're thinking about that, right? And [12:43] then you're with your partner. You're [12:44] like, "Oh my god, am I going to have [12:45] trouble?" You're not enjoying the [12:46] pleasurable sensations or the visuals or [12:48] like feeling each other. You are [12:50] literally thinking in your own head [12:51] about how you're going to respond. And [12:54] then that anxiety makes it so that you [12:56] can't get an erection or you can't be [12:57] aroused. And so now you're like anxious [12:59] and you're not focused. You're almost [13:00] spectatoring. You're just watching [13:02] yourself have sex. You're not actually [13:04] like in the moment. So then, you know, [13:06] you have a negative outcome because when [13:08] you're stressed, your sympathetic [13:09] nervous system is on, right? You can't [13:10] really get an erection or you can't [13:12] really get aroused. And so then you're [13:15] like, "Oh man, now I've let my partner [13:17] down. Now I haven't performed," which I [13:19] hate that word, but like performed the [13:21] way I should or or I'm expected to. And [13:24] now something's wrong with me. And now [13:26] that just keeps going in a vicious [13:27] cycle. [13:28] >> Have you spoken to people that have [13:29] experienced this? [13:30] >> Absolutely. [13:31] >> It's common. [13:32] >> Very common. I tell people anytime you [13:34] have problems in the bedroom, it stays [13:37] with you. [13:38] >> So, how do you break the cycle? [13:39] >> Yeah. So, I tell people when you're with [13:41] your partner, take the pressure off um [13:44] penetration. Just explore each other's [13:46] body. Do what's called like sensate [13:48] focus. Like explore the rest of your [13:50] body. Figure out other arogynous zones, [13:52] other things that can turn you guys both [13:55] on that don't involve erections and [13:57] penetration. And then once you realize [13:59] you're focused on that, you're really [14:00] like exploring, enjoying, playing, [14:02] you're having a good time, and you're [14:04] not thinking about your erection, now [14:05] you'll notice, oh, the erection just [14:07] comes, right? And then once you get to [14:08] that point, then you can start even [14:09] touching genitals, but still hold off on [14:11] penetration. And then after you've [14:13] realized like the genitals are, you [14:15] know, it's always working the way I want [14:17] it to. I'm not thinking about it. I'm [14:18] not stressed. Then finally, you can then [14:20] introduce penetrative sex again. So, [14:23] it's just sort of like a gradiated sort [14:24] of slow advance into um you know, having [14:28] sex again, but now kind of focusing on [14:31] being more present and mindful and [14:33] enjoying those sensations. [14:34] >> I think a lot of people will be able to [14:37] do that, but there's also a big [14:38] contingent of people that just avoid [14:41] sex. [14:42] >> Mhm. [14:42] >> It's it's a sore subject in their [14:44] relationship for whatever reason. Both [14:47] partners don't know how to communicate. [14:48] They haven't got the tools to talk about [14:49] these kind of things openly and [14:50] honestly. Do you see that a lot as well? [14:53] >> Absolutely. I mean, what do you hear in [14:55] this regard? [14:55] >> So, I think it's really sad. I see [14:58] people come in and they're like, I ask [15:00] every patient like, "Are you are you [15:02] having sex? Why not?" Right? Because [15:03] sometimes they'll say no. And most [15:05] doctors will be okay. But I always say, [15:06] "Why not?" Right? Why are you not having [15:08] sex? Is it because you're having an [15:09] issue? Is it because you're having pain? [15:11] What's going on? Right? And often times [15:13] I'll hear from people that my partner is [15:16] just not into it and I just sort of gave [15:18] up and I'm just we just don't have sex [15:21] anymore. You know, for me that's a red [15:23] flag because sex is a huge important [15:27] part of our lives. It is a way we [15:29] connect with another human being. It's [15:32] also telling that things are working [15:34] really well. So, when you have good [15:36] sexual function, meaning you get an [15:38] erection well or you get aroused well [15:40] and you have a good orgasm and [15:41] everything feels good, that tells me [15:43] that, hey, you've got great blood flow [15:45] to your genitals, your nerves are [15:46] working great, your hormones are sending [15:48] signals, like all these things are good, [15:50] right? But also, sex is more than just [15:53] the act of sex. It also helps you live [15:56] longer. So, there's been a few studies [15:58] looking at sex and longevity. And [16:00] [snorts] when you look at people who [16:02] have sex once a week compared to people [16:04] who have sex once a year, the difference [16:06] in all cause mortality is 49%. They live [16:10] 49% longer than people who only have sex [16:13] once a year. [16:14] >> 49% longer. [16:15] >> Yeah. Yeah. [16:18] >> Be right back. No, I'm joking. [16:19] [laughter] [16:20] >> So, and but even if you're doing like [16:22] less than once a week, but more than [16:24] once a year, it still improves your [16:26] longevity. There was actually [16:27] interesting study in 1997, I think it [16:29] was, where they looked at the number of [16:31] orgasms men had, and they found that men [16:34] who had for every hundred orgasms men [16:37] had, they lived like 13% longer. They [16:40] had a 13% increase in life expectancy. [16:43] And so, it was really interesting to me [16:45] just just showing you that like this is [16:47] not just an act of pleasure and fun. It [16:50] is obviously, but it's much more than [16:52] that because people who are having sex [16:54] clearly have better health and there [16:56] this connection with people. I mean, [16:58] loneliness is a big issue right now. The [17:00] the WHO made loneliness like an [17:02] epidemic. So, they've said that [17:03] loneliness is as bad as having like 15 [17:06] cigarettes. And so, sex is a way to feel [17:09] connected to another human being. [17:11] >> On that data, we're not saying that it's [17:13] the sex itself that's causing people to [17:15] live longer. We're I guess it's it's [17:16] hard to establish causation in terms of [17:18] >> Yeah. It's not necessarily sex, but [17:21] they've looked at like they try to [17:22] control for other things like age and [17:24] coorbidities and all these studies and [17:27] um it's also like sex is a [17:28] cardiovascular workout, right? For many [17:30] people is a cardiovascular workout. You [17:32] are getting a phys physical physical [17:33] activity with your partner. Um you are [17:35] increasing your heart rate. You are [17:37] doing these things that are also good [17:39] for your body. And the fact that you're [17:41] able to have sex, right, tells me a lot [17:43] about it, right? You're you're able to [17:45] hold a certain position. you're able to [17:47] u maintain this level of activity [17:49] without getting short of breath, right? [17:51] Like these are things that having sex, [17:53] you know, keeps you healthy to some [17:56] degree. [17:56] >> If I want to make sure that I have great [17:58] sex, what are some of the foundational [17:59] things that I need to be thinking of in [18:01] terms of my lifestyle? [18:02] >> Yeah. So, there's four main pillars of [18:04] sexual health. I like to think of it [18:06] like your sexual health is your house. [18:08] And these pillars are the foundation. [18:09] And if you don't have the foundation, it [18:11] doesn't matter what else you do. Um, you [18:13] can try to do everything else to patch [18:15] up your house, but it's always going to [18:16] break again because the foundation's not [18:18] there. So, you've got fuel, and fuel is [18:22] how you nourish your body. A lot of the [18:23] data I'm going to talk about is about [18:25] men because there's just a lot more data [18:27] on men and sexual health, but that [18:29] doesn't mean that the same things don't [18:30] apply to women. There's just less less [18:32] robust data on it. So, when you talk [18:34] about fuel, the Mediterranean diet is [18:37] the most studied diet. So, including [18:39] things like healthy fats like avocados, [18:43] leafy greens, nuts, and we're going to [18:45] talk about nuts in a little more detail. [18:47] These things are super helpful. And [18:49] obviously having lean proteins, having [18:52] an abundance of fruits, which we're [18:53] going to talk about as well. There's a [18:54] study called the Health Professionals [18:56] Follow-up Study. They look at 20,000 [18:57] men, and they saw that men who adhered [19:00] to a Mediterranean diet had a 22% lower [19:03] risk of erectile dysfunction. So what [19:06] [clears throat] specific things in that [19:08] diet, right? People always like, "What [19:09] are the superfoods I need to have?" [19:11] Almonds are great, but pistachios, they [19:13] actually did a study on pistachios where [19:14] they looked at 100 grams of pistachios. [19:16] Guys ate 100 grams of pistachios every [19:18] day and they saw a decrease in erectile [19:20] dysfunction. [19:21] >> So pistachio nuts will make my penis [19:23] harder. [19:23] >> I mean, so I always say like I don't [19:25] love to talk about superfoods because [19:27] then people like, "Oh, I just got to eat [19:28] pistachios [clears throat] and it's all [19:28] good, right?" It's it's part of a whole [19:30] diet, but certainly having nuts because [19:33] they have great omega-3s, they have [19:35] healthy fats. These are the reasons that [19:36] they they really sort of improve diet. [19:39] >> Fruit um anything that has sort of [19:42] flavonoids, so like colorful fruit like [19:44] blueberries, citrus fruits, um lycopine, [19:47] which is red fruits, all of these things [19:49] improve antioxidants and also have been [19:52] shown to reduce the incidence of [19:53] erectile dysfunction. So having stronger [19:55] erections. specifically blueberries [19:57] actually came out to have I think [19:59] something around 20% also improvement in [20:01] erectile function when you're eating [20:03] blueberries regularly. So [snorts] lots [20:05] of I think things in the diet that can [20:07] be helpful. Also fiber is one that we [20:09] don't talk about enough. When you eat [20:11] fiber in your gut it converts to short- [20:13] chain fatty acids. These short- chain [20:15] fatty acids then sort of have these [20:18] endothelop protective mechanisms. They [20:20] protect the blood vessels. They make [20:21] them healthier. And so when your blood [20:23] vessels are healthier, you get better [20:25] metabolic health. So you get less [20:26] diabetes, less high blood pressure, less [20:28] high cholesterol. And these all of these [20:30] things together improve erectile [20:32] function. [20:33] >> So I think making sure that you meet the [20:36] criteria for fiber, which is 38 grams [20:38] for men, 25 grams for women, um, is [20:41] really really important. And then [20:43] obviously managing your calories and a [20:45] maintenance, right? because we don't [20:46] want to gain weight because excess [20:48] atapost tissue or excess fat also puts [20:50] you at higher risk for erectile [20:52] dysfunction and other sexual [20:54] dysfunctions. Next we have uh strength. [20:58] All right. [21:00] So there's strength where we think about [21:02] cardiovascular and resistance exercise [21:04] but there's also pelvic floor strength. [21:06] So we'll start with cardiovascular [21:08] exercise. The one study that's quoted [21:10] very often is 150 minutes of exercise of [21:13] cardiovascular exercise moderate [21:14] intensity. when you look at the [21:16] improvement in erectile function scores, [21:19] it is the same amount of improvement as [21:21] you would see when you take a medication [21:23] like Viagra. So, literally, if you do [21:26] 150 minutes a week, you are getting the [21:28] same improvement as you could get with a [21:30] medication potentially. And so, I tell [21:32] people like, look, if you don't want to [21:34] take a pill, this is a great way to [21:36] improve sexual function. Now, you might [21:38] say, okay, well, I, you know, maybe [21:40] you're listening and you have heart [21:42] issues and you can't really do moderate [21:43] intensity exercise. They actually looked [21:45] at that too. So there was a group where [21:46] they looked at men who had heart disease [21:49] and they weren't really able to do [21:51] moderate intensity exercise. So they did [21:52] like a 5minute warm-up. They did 20 [21:54] minutes of walking and 5 minutes of a [21:56] cool down. And with this supervised [21:58] protocol, they still improve erectile [22:00] function by 70%. So it's all relative to [22:03] where you're starting. But any sort of [22:06] cardiovascular exercise that's above [22:08] what you are capable like what you're [22:10] doing now is going to improve sexual [22:12] function particularly erectile function [22:14] cuz it's going to improve blood flow to [22:15] the genitals going to improve blood flow [22:17] to the penis. It's going to improve [22:18] blood flow to the clitoris for women. So [22:20] that's where cardiovascular exercise is [22:22] so so important in terms of resistance [22:24] exercise. I know these little weights [22:26] are probably not sufficient for doing [22:28] much, especially for men, in terms of [22:30] improving um muscular health, but [22:32] obviously we're not going to bring like [22:34] really heavy weights to the table here. [22:35] [laughter] So, one, we know that [22:38] resistance training is significantly [22:40] correlated with testosterone. So when [22:42] you do heavy resistance training of your [22:45] large muscle groups, so like your lower [22:47] extremities, your glutes, you're doing [22:48] like Olympic deadlifts, squats, that [22:50] sort of stuff, you actually see [22:52] improvements in testosterone. Now, it's [22:55] not going to be like you do it once and [22:56] you get this sustained improvement, but [22:58] continuous sort of regular resistance [23:00] exercise improves testosterone. [23:03] There's also data that shows that when [23:05] men do resistance exercise to maintain [23:07] muscle mass. So, we know that muscle [23:09] mass decreases about 7% every decade of [23:12] life after around 40. When you maintain [23:14] it through resistance exercise, they're [23:17] three times less likely to have erectile [23:19] dysfunction. [23:19] >> Oh, really? [23:20] >> Yeah. So, they maintain erectile [23:21] function, they maintain sexual desire, [23:24] they maintain um satisfaction with sex. [23:27] >> I read a quote yesterday that said [23:28] muscle is medicine. And I thought, [23:30] that's really true based on everything [23:31] I've learned on this podcast around, you [23:33] know, like glucose control and and [23:36] testosterone. And now you're telling me [23:38] about your sex life. [23:40] >> Yeah, it is. I think people push back [23:43] because they think like, why should I [23:44] have to go to the gym? But our lives [23:46] have changed. We sit at a computer or we [23:49] sit at podcasts or we sit all the time. [23:51] We're not moving. We're not doing manual [23:53] labor, which is what a lot of our [23:56] historic history is, right? doing manual [23:58] labor, farming, doing things outside, [24:00] being physical, and we're meant to be [24:02] physical. We're meant to lift heavy [24:04] things. We're meant to move our bodies, [24:06] and we're just doing less and less of [24:07] it. [24:08] >> So, I think it's so important. Um, the [24:10] other thing is we want to prevent [24:11] sarcopenia. So, sarcopenia is muscle [24:13] loss. And when you have muscle loss, um, [24:16] that also increases your risk of having [24:19] sexual dysfunction. [24:20] >> What about the pelvic floor? Like, how [24:21] does that come into this story of [24:23] >> Oh, yeah. So, we missed that part. So, [24:25] um, the pelvic floor, here's your [24:28] pelvis, right? It's this bony structure [24:30] where all your organs live. This is a [24:32] female. So, I'm taking out the, uh, [24:34] internal structures, which is the [24:36] uterus, the rectum, and the bladder. And [24:38] so, that's what sits inside the pelvis. [24:41] And so, you can see this bowl of muscles [24:43] here, right? Interesting. I've never [24:44] seen. [24:44] >> And you can see them from the inside, [24:45] and you could see them from the outside. [24:47] That's your anus. And in this person, [24:49] there's a vagina. So, that's the hole [24:50] for the vagina. So you can see that your [24:52] anus and your vagina run through the [24:54] pelvic floor. And in men, your penis [24:56] runs through the pelvic floor. And so [24:58] this, let me see if I can show you on [24:59] this model. In this model, you can see [25:02] they kind of show you the muscles here [25:03] on the side. [25:04] >> Yeah. [25:05] >> So these are your pelvic floor muscles [25:06] that are around the penis and the anus. [25:10] >> Okay. [25:11] >> Okay. These structures are very [25:14] important for a variety of things. um [25:16] they attach to your bony landmarks here, [25:18] your hips, your sacrum, your pubic [25:21] symphysis. They attach to all these and [25:24] they sort of just work in the background [25:26] for most people. How they affect your [25:28] sexual function is when you orgasm, [25:31] these muscles contract and release at a [25:35] at a rhythmic contraction of8 seconds. [25:37] And so you may feel that, right? There's [25:39] like this pulsing feeling when you [25:40] orgasm. And that's these muscles sort of [25:42] doing that. And when men ejaculate, the [25:45] pelvic floor muscles are contracting to [25:47] help shoot the ejaculate out. They [25:49] squeeze when you need to keep things in. [25:51] So they'll keep urine in, they'll keep [25:53] um your stool in, and they relax when [25:55] you need to pee in, when you need to [25:57] defecate. [25:58] >> So when you're trying to hold a wee, [25:59] you're like tightening your pelvic [26:00] floor. [26:01] >> Correct. Correct. But these are also [26:03] responsive to stress. So, just like [26:05] people get TMJ where they get tense in [26:08] their jaw cuz they are stressed and they [26:10] like sleep at night and they clench up [26:11] their jaw. They don't really know [26:12] they're doing it, the same thing can [26:14] happen. These muscles can get very tight [26:16] or they can get misaligned. So, say you [26:18] have a hip injury or say you have a back [26:20] injury, the muscles can compensate by [26:22] tightening up. And so, a lot of people [26:24] unknowingly have tension in these [26:26] muscles and it can present in a multiple [26:29] different ways. It can present with back [26:31] pain. It can present with constipation. [26:35] It can present with urgency frequency [26:37] because remember your bladder is sitting [26:39] right here on top of these muscles. So [26:41] when the muscles are tense, your bladder [26:43] is feeling like there's something [26:46] something activating it. And so it's [26:47] like, oh man, I got to pee. That means I [26:49] have to pee. This tension is telling my [26:50] bladder I have to pee. But it's really [26:52] that your bladder is not that full. It's [26:53] that these muscles are telling you to do [26:55] that. You can also have trouble peeing [26:57] because you can see that your urethra [26:58] goes through here. And if the muscles [27:00] are really tight, sometimes it can be [27:01] difficult to urinate because it clenches [27:03] off the pee. And then with sex, it can [27:06] cause pain. If they're really tight, it [27:08] can prevent blood from getting to the [27:10] genital organs. So for men, they can [27:12] have erectile dysfunction. For women, [27:15] they can have difficulty getting orgasms [27:17] or difficulty getting arousal because [27:19] they're not getting blood flow to the [27:21] clitoris. Sometimes they can also cause [27:23] premature ejaculation in men. And so [27:25] these muscles are so important and all [27:28] we hear about is keigull and keigull are [27:30] exercises to strengthen these muscles. [27:32] But keigull are good when you have a [27:34] normal pelvic floor. Meaning like [27:36] there's no tension. It's completely [27:38] normal. It's acting normal. You're not [27:39] having any symptoms at all. But if you [27:41] have any of the symptoms I talked about, [27:42] doing keles might make it worse because [27:44] you're now tightening muscles that are [27:46] already tight. [27:47] >> We also talked about pelvic floor [27:49] relaxation. Doing exercises to [27:51] specifically relax these muscles. So [27:53] that can be diaphragmatic breathing. [27:56] That can be doing like a figure four [27:58] stretch. That can be doing happy baby [28:01] pose which are yoga poses or child's [28:03] pose. All these things can sort of [28:05] stretch and lengthen these muscles so [28:07] they can learn to relax again. Now when [28:09] it's really bad, you have to go see a [28:11] pelvic floor physical therapist who can [28:13] really work with you to identify which [28:14] of the muscles are maybe more [28:16] dysfunctional and maybe work [28:17] specifically on those. Um but I think [28:20] it's it's so important. that's under [28:21] evvaluated, underd discussed when it [28:24] comes to sexual function. It's a hugely [28:26] important part of sexual function. [28:29] >> How many people are struggling with [28:31] these issues, specifically the like [28:34] erectile dysfunction issues and what age [28:36] are they? [28:37] >> Yeah. So, it starts early. I think [28:39] there's always been a sort of a [28:40] disconnect where we think young guys [28:42] don't have this or if they have it, it's [28:43] all in their head. That's not [28:45] necessarily true. Many young men do [28:47] develop erectile dysfunction because of [28:49] biologic factors, but the data is really [28:52] robust on older guys. So above the age [28:54] of 50, we see 52% of men having erectile [28:58] dysfunction, which is [28:59] >> 52%. [29:01] >> And it goes up 10% every decade. So 60% [29:05] of 60-y olds, 70% of 70 year olds. So [29:07] erectile dysfunction continues to [29:09] worsen. This happens because one, you [29:12] know, our blood vessels get older, they [29:14] get stiffer, they're not functioning as [29:16] well as they should. And we're seeing [29:18] also a rise in all these other comorbid [29:20] conditions like diabetes, cholesterol, [29:22] high blood pressure. All these affect [29:24] how healthy your blood vessels are. And [29:26] so with these, they see the problem in [29:29] their penis or in in women's case in [29:31] their clitoris before they see heart [29:33] disease or strokes or brain issues or [29:35] dementia. And I think this is worth [29:37] pausing on which is a erectile [29:40] dysfunction problem is a often a symptom [29:43] of a cardiovascular issue. Right. [29:45] >> Yeah. We call it a canary in a coal [29:47] mine. So it is like telling you that [29:49] something bad is coming. So the data [29:51] would support that when you have [29:53] erectile dysfunction if it's because of [29:56] an organic reason, right? not [29:57] psychoggenic but most people I think [29:58] have a combination of both that within 3 [30:01] to 5 years you will start developing [30:03] issues with your heart and so it [30:06] precedes those issues and if 7 years [30:09] later 14% of those guys will have a [30:12] heart attack and so it's really an [30:14] opportunity sexual problems are an [30:17] opportunity to look inside to figure out [30:20] what's going on and to investigate and [30:22] to change your life [30:23] >> and when you say erectile dysfunction we [30:25] should probably define what that means [30:26] because there's going to be a lot of [30:27] guys sat at home now thinking, "Oh my [30:29] god, like my penis is a bit softer than [30:31] usual." [30:31] >> Yeah. So, erectile dysfunction is [30:34] defined as the inability to maintain an [30:36] erection that's sufficient for [30:38] intercourse. So, you can get an [30:40] erection, but it goes away before you [30:42] ejaculate or climax. [30:44] >> And so, that's typically and I think [30:45] it's really important to differentiate [30:46] that from something like premature [30:48] ejaculation where you climax too soon. [30:51] So, you ejaculate before you're want to. [30:54] Uh, but that doesn't mean that you have [30:56] a problem maintaining your erection. [30:57] That's a whole different process. [30:59] >> I've got a friend, people are gonna [31:01] think I'm talking about myself because I [31:02] use that phrase a lot. I've got a [31:03] friend. He's um he's almost 40 years old [31:06] and I've heard him say on several [31:09] occasions that he's lost his erection [31:11] during sex. Is that erectile [31:13] dysfunction? But what if he can keep his [31:16] erection watching porn? [31:18] >> Well, so that's more multiffactorial, [31:20] right? So I think if you lose it once or [31:22] twice, right? Most guys will have an [31:24] issue where they lose an erection at [31:25] some point in their life. I think the [31:26] important thing is not to catastrophize. [31:28] It's a problem when it becomes a [31:30] routine. Now, if someone is telling me, [31:32] "Hey, I can watch porn and maintain my [31:34] erection, but I can't with a partner." [31:36] There's multiple different reasons for [31:38] that that could be at play. One is that [31:40] there's no pressure, right? You're by [31:41] yourself. You're watching porn. There's [31:43] no pressure of performance. There's no [31:45] anxiety of performance. So, that may be [31:46] part of it. Other thing may be that that [31:49] level of arousal that you're getting [31:51] from porn. If you're watching like let's [31:52] say the same kind of porn every time, [31:54] you're masturbating the same way every [31:56] time, maybe using a firm grip or some [31:58] people will masturbate like uh facing [32:00] the bed or um you know against hard [32:03] objects. And so that [32:05] >> against hot objects. [32:07] >> Yeah. Like the their fist or something. [32:09] And so that u can't be replicated by a [32:12] person, right? You can't replicate those [32:14] behaviors by a vagina or a mouth. If you [32:18] become habituated to a certain thing [32:20] that turns you on and that's the only [32:23] thing that really gets you going and [32:25] that's that's something that you can't [32:26] really get with your partner, then it [32:28] will be difficult to reach the level of [32:30] arousal that you need to get an [32:32] erection. [32:32] >> Okay. So, two questions then. So, [32:34] >> that doesn't count as erectile [32:36] dysfunction. If you can get an erection [32:38] watching porn but can't get it with your [32:39] partner. [32:40] >> Yeah, it may or may not be. So, if you [32:42] wake up with your morning erection, [32:44] that's great. That's a sign. That's when [32:45] there's nothing else at play, right? You [32:47] are just that tells me that your body's [32:49] functioning well. You've got good blood [32:50] flow, good uh good hormones working, got [32:52] a good amount of testosterone, and your [32:54] nerves are working well, and you're [32:56] getting a good morning erection. Now, [32:58] morning erections or nighttime erections [33:00] are normal, and they're healthy. So, [33:02] when you're a young boy, you get [33:04] actually like erections three to five [33:06] times a night, and they can last up to [33:07] 40 minutes long. So you can spend a lot [33:10] of your night with an erection. When you [33:12] get older, like in your 40s, that drops [33:14] to about half the time. So maybe [33:16] erections are a little shorter that they [33:18] maybe max out at 30 minutes, but [33:19] sometimes they're shorter. You should [33:21] still be getting three to five erections [33:22] at night. You won't know all of these, [33:24] but typically you wake up with a morning [33:25] erection. And so if you're not getting [33:27] morning erections, that tells me that, [33:29] hey, there's something going on that we [33:31] should address. And on your other point [33:33] about how you masturbate impacting your [33:35] sex life, I imagine that applies to men [33:38] and women. [33:39] >> Absolutely. [33:39] >> And are you saying that if there's a [33:41] particular way you get yourself off in [33:43] private [33:44] that is very hard for the other person [33:46] to replicate, you might become [33:47] desensitized to that? [33:49] >> You might just get habituated. I don't [33:50] think desensitized, but habituated is [33:53] like you might just your body just might [33:54] respond really well to that particular [33:57] stimulation. Now, that's not inherently [33:58] a bad thing, right? If that's what gets [34:01] you off and you and your partner are [34:02] okay with you doing that together, [34:04] right? You may mutually masturbate [34:06] together and that's fun for you and you [34:07] guys enjoy it, there's no problem with [34:09] it. It's just knowing what's going on, [34:11] right? And sort of deciding like, okay, [34:13] if this is a problem, let me try to [34:15] diversify what I do during my solo sex [34:18] periods or let me take a little break [34:20] and kind of uh try something, you know, [34:22] just not masturbate for a little while [34:24] and come back to it later. The fact that [34:25] we get an erection in the morning, does [34:27] that mean that's we're supposed to have [34:29] sex in the morning? From like an [34:30] evolutionary perspective, [34:31] >> not necessarily. It's just it's the way [34:33] your body releases testosterone is one [34:35] of the reasons this happens is overnight [34:37] your body is making more testosterone. [34:39] That's when your body sort of has [34:41] nocturnal testosterone production. And [34:43] so it's highest in the morning, which is [34:45] why often you get a morning erection. [34:47] And you know it just means that some [34:50] people will have more desire also in the [34:52] morning because testosterone is a [34:53] hormone of desire. [34:55] >> Is it the same for women? [34:56] >> Yeah. So women um women also have [35:00] nocturnal clitoreral tumescence. Same [35:02] sort of pattern and they won't [35:04] necessarily know it right because they [35:06] can't visualize it. But you know you can [35:08] some women may know sort of feel that [35:10] pelvic congestion or like feeling that [35:12] there's a bunch of like blood flow in [35:13] the area. But most will not and that's [35:16] okay. But your body protects itself. So [35:18] you've heard the term use it or lose it, [35:19] right? People are like your body's [35:21] protecting itself. You don't have to [35:23] have sex. If your body is healthy, it [35:25] will do this all night to keep your [35:27] genitals healthy. It will make sure that [35:29] your genitals are getting blood flow [35:30] even if you're not having sex. But if [35:33] you stop having those nighttime [35:35] erections, now is it becomes more of a [35:37] problem because over time, say you stop [35:40] having erections or cleral tumes for [35:42] months, years, right? And then there's [35:46] no blood flow to those areas over time. [35:48] And actually I can show you here. This [35:50] is a a pelvic model. And here this this [35:54] purple thing here is called the corpora. [35:57] And this is like a really nice spongy [35:59] tissue that fills with blood. And when [36:02] it fills with blood, it expands and [36:03] lengthens. And then um the blood stays [36:06] there until you're done with your [36:08] stimulation. And then it goes back. And [36:10] so if there's no healthy fresh blood [36:12] getting to the penis on a regular basis [36:15] either through nighttime erections or [36:16] through sex with your partner then you [36:18] will get fibrosis of these tissues. That [36:21] means you get a little scar in the in [36:23] the tissues and then over time you might [36:25] see some shrinkage of the penis. And so [36:27] it is really important to maintain also [36:30] good health of these tissues. And the [36:31] same goes for women with their clitoris [36:34] because it's the same type of tissue. In [36:35] fact, if you look at the clitoris, it is [36:38] this is the part that you see. We don't [36:39] really We don't have a clitoris. [36:41] >> That one there. [36:42] >> This is a uterus. [36:45] [laughter] [36:49] >> You're going to keep that in. [36:51] >> Okay. I can show you here. There we go. [36:53] There's [laughter] this like she told [36:54] me. [36:54] >> Is it crazy? [36:56] >> Okay. Yeah. This is good. This is good. [36:58] Okay. They [laughter] told me they don't [36:59] say glitter. [37:03] [laughter] [37:04] >> That's a little That's a Yeah. Okay. [37:08] >> They told me [laughter] [37:10] >> you're not going to live that one down. [37:11] >> You asked the team where the ClariS was. [37:13] Did you ask the team where the clitoris [37:15] was? [laughter] [37:16] >> Well, I'm I'm worried about who said [37:18] that, too. Um, okay. So, [laughter] so [37:21] [snorts] let's talk about the female [37:22] anatomy. This is a pelvic model. And [37:25] here, um, you can see this is the [37:26] vagina. This is the urethra where you [37:29] pee from. This is your labia minora. And [37:32] you can't see the labia majora, but they [37:33] would be out here, right? So, inner [37:34] lips, outer lips. Now, this up here is [37:38] your clitorol glands. So, it's the same [37:40] as the glands of the penis. And so, this [37:43] is all you see, right? It also has a [37:45] little covering, which you can't see [37:46] here. Just like men have foreskin, women [37:48] have a clitoreral hood that covers the [37:50] the head of the the clitoris. And so [37:52] when you look at the clitoris on the [37:54] inside, which we can't see perfectly [37:56] here, but I'm going to just take this [37:57] out. Um, it actually goes all the way [38:01] back like this. So if you were to feel [38:03] from the vagina, from the vaginal side, [38:05] it would be at the very top of the [38:07] vagina going all the way back. These are [38:09] the these blue things are the clitoreral [38:11] bulbs here. Um, so and these are the [38:15] legs of the clitoris here on the side. [38:18] And so this is essentially the homalogue [38:21] of the penis. So if I take the penis and [38:23] we don't have a like a full model here. [38:26] What does homalues mean? [38:27] >> So homologues means that they're [38:28] essentially the same structure. They're [38:30] made from the same cells but they're in [38:32] the male and the female. So here you can [38:35] see this is if this is your penis. This [38:38] is what you see up to here. This is the [38:39] bone. This is your fat up here. And then [38:42] here it goes deep into the pelvis. And [38:45] so here's your testicles, right? And so [38:47] below the testicles, this area of the [38:49] paranneeium, you also have penal tissue [38:52] sort of that you can palpate from this [38:54] side um that's coming all the way down. [38:56] And if you had sort of a 3D model, you'd [38:58] see that it forks out just like the [38:59] clitoris does. [39:00] >> So does clitoral stimulation feel like [39:04] stimulating someone's tip of their [39:06] penis? [39:07] >> Exactly. And so you could think if [39:08] someone just stimulated the head of the [39:10] penis, they uh it would be fine. It [39:14] would be nice, but it's probably better [39:15] if you stimulate more of the clitoris or [39:17] more of the penis. That's why you can [39:19] stimulate obviously the external the [39:21] clitoris, but you can also stimulate [39:23] from the inside. And some people are [39:25] more responsive to that than others. [39:27] What you hear of is like the G-spot or [39:29] the Gzone, right? And the G-spot or [39:31] Gzone is if you were to go in the inside [39:34] of the vagina at the top side, which I [39:36] can't really stick this in here, but it [39:38] would be about 2 cm in at the top. And [39:40] that's because that's an area where [39:42] there's a lot of nerves endings. One, [39:44] you can palpate the clitoris basically [39:46] throughout the entire anterior wall, but [39:48] also there's the skins glands, which are [39:50] these glands that sit underneath the [39:52] urethra, and they're the homalogue of [39:53] the male prostate. And so, they're right [39:57] there, and then the vagina is there. And [39:58] so, that's an area that can be very [40:00] enjoyable to stimulate. It's not [40:02] necessarily always going to lead to [40:04] orgasm because some people have [40:06] different sort of distance between the [40:08] clitoreral body and the vagina. So some [40:11] people have less distance may feel it [40:14] better than some that don't. Uh but [40:16] ultimately um that's why that area is so [40:18] sensitive for many women. On this point [40:20] of um morning erections, I was thinking [40:23] much of the reason why I've always been [40:25] cautious of having sex in the morning or [40:27] even like masturbating in the morning or [40:28] anything like that is I'm worried that [40:30] it will cause a dopamine crash which [40:32] will make me feel lazy and lethargic. [40:34] >> Well, so when you think about what [40:36] happens during an orgasm is you have [40:38] this release of dopamine and then you [40:40] your prolactin goes up and sort of like [40:43] everything calms down. Now some people [40:46] feel a a sense of clarity. They call it [40:48] postnut clarity, right? they feel clear, [40:50] they feel like motivated to do stuff, [40:51] they feel uh excited to go do something [40:54] else and they sort of move on from what [40:55] they're doing. There's some people who [40:56] feel post-coidal dysphoria. They [40:58] actually feel sad or they feel depressed [41:00] after they orgasm. And we don't know [41:03] exactly why this happens, but it is [41:05] because of this dramatic change in sort [41:08] of neurochemical signaling in the brain. [41:10] And for those people who have it, it can [41:12] be days where they sort of like feel [41:14] bad. It can be hours where they feel [41:16] sad. And so it can be really traumatic. [41:18] So pillar two, what's pillar two of the [41:21] four pillars of men's sexual health? [41:23] >> We talked about strength. [41:24] >> Okay, so we did strength, we did fuel. [41:27] >> What's pillar three? [41:28] >> Pillar three is environment. So we can [41:29] start with the easy stuff and that's [41:31] stress, right? Everyone knows stress is [41:33] bad. But I think the thing is people [41:35] just think like h I'll just I'll deal [41:37] with it. Everyone's stressed. Like [41:38] what's it's normal to be stressed? If [41:40] you are chronically stressed, that means [41:43] your cortisol is raised all the time, [41:45] which is dampening your testosterone, [41:47] which is also keeping you in the [41:49] sympathetic state, and you just cannot [41:51] get in your mind space and in the [41:54] nervous system place to actually have [41:56] sex. So, that's super important. And I [41:59] think, you know, there's lots of [42:00] different ways to alleviate stress. You [42:03] got to figure out what works for you. [42:04] Um, for some people, using a stress [42:06] ball, even just at work. And I think [42:08] part of it you can actually incorporate [42:10] some intimacy. There's some evidence, [42:11] you know, the Gottmans have been on your [42:13] podcast doing a 20 second hug. So [42:16] standing with your partner or loved one [42:18] and hugging for 20 seconds on your own [42:21] like independent gravity [42:23] >> actually helps alleviate stress and [42:25] break sort of a stress loop. Doing a [42:27] six-second kiss with your partner. And [42:30] so it seems like six seconds, no big [42:32] deal, but actually if you time it, it's [42:33] like hm if I'm just doing a kiss and I'm [42:34] not like actually it's a little bit [42:36] longer than normal. And so these sort of [42:38] small things can help alleviate stress. [42:41] Any type of movement can be really [42:42] beneficial. [42:43] >> The gym is great as well. [42:45] >> The other thing is just having like [42:47] interactions with people. And so that's [42:48] where we're becoming more isolated. But [42:50] even just like talking to the barista or [42:52] talking to someone at the grocery store, [42:54] this again tells your brain that you're [42:56] in a safe space, like you're talking to [42:58] someone. They're having a normal social [42:59] interaction. [43:01] So, and then being creative. And we've [43:03] been trying to work with this work on [43:04] this with our kids because there's so [43:06] much external stimuli all the time, [43:07] right? They want to play video games, [43:09] they want to watch TV, they want to play [43:10] sports, but we want them to be bored and [43:13] be creative, like come up with creative [43:14] ideas to keep themselves [43:17] interested and engaged in a different [43:18] way. So, I think that's so so important. [43:21] And outside of stress, sleep. Um, sleep [43:24] is there's just so much abundance of [43:26] data on how sleep affects hormonal [43:28] health. They looked at data on men [43:30] sleeping 5 hours a night versus eight [43:32] hours a night. So you take the same guy [43:34] and he sleeps eight hours, then you, you [43:35] know, do five five hours for a few days. [43:38] His test for a week, his testosterone [43:39] drops by 15%. [43:41] >> Wow. [43:42] >> That's like as much testosterone drop as [43:44] would happen with 10 years of life. [43:46] >> And do you know how long they did that [43:47] for? How long? [43:48] >> It was short. It was like a week. So, a [43:50] week of sleep deprivation will will tank [43:52] your testosterone. [43:54] >> And sleep apnnea is another one that I [43:56] think people one don't realize they have [43:58] and two don't realize that fixing it [44:00] could actually improve their hormonal [44:01] health. [44:02] >> Wait, so does this mean that people who [44:03] have chronically bad sleep probably have [44:05] low testosterone? [44:07] >> Probably. Yeah. [44:07] >> And what is the symptoms of low [44:09] testosterone? [44:10] >> So, low testosterone, they're sometimes [44:12] very vague. So it can be fatigue, it can [44:15] feel brain fog, it can be depression, it [44:18] can be low desire, it can be erectile [44:21] dysfunction. That's what people always [44:22] think. It's just erectile dysfunction, [44:23] but it's this whole constellation of [44:25] symptoms. It can also be increased fat [44:27] mass, decreased muscle mass. So all of [44:29] these things can happen because we have [44:31] testosterone receptors all over our [44:33] body. We have them in our brain. We have [44:34] them in our muscle. We have them in our [44:36] bone. And these can all have really [44:38] serious consequences when it's low. when [44:41] you have sleep apnnea. And how you know [44:42] you have sleep apnea is uh your partner [44:44] might tell you that you're like waking [44:45] up in the middle of like gasping for [44:47] air. If you have one really easy way to [44:50] check is take a a measuring tape and [44:52] measure your neck circumference. If it's [44:54] more than 17 in for a guy or 16 inches [44:57] for a female, it means it's very likely [44:59] that you may have sleep apnea. And [45:02] that's because when you have excess mass [45:04] basically here, it's compressing your [45:05] airway and can make it difficult to get [45:08] air into your um into your body. When [45:11] you improve sleep apnea, we've seen [45:12] improvements in testosterone as high as [45:14] 200 nanogs per deciliter. So huge jumps [45:17] in testosterone after fixing sleep [45:19] apnea. And the same goes for other sleep [45:22] disorders, although the data is not as [45:24] abundant. Uh but sleep is so important. [45:27] Then we talk about what's in your [45:28] environment. So let's grab this. Okay. [45:32] So, you get a bottle of water. So many [45:35] of my patients actually they only buy [45:37] like cases of plastic bottled water. [45:39] Once in a while a plastic bottle of [45:41] water like don't stress yourself out. [45:42] This goes back to stress. People get [45:44] really stressed like what's in my [45:45] environment? What am I drinking? What am [45:47] I eating? Like do what you can control. [45:50] So plastic water bottles have things [45:52] like phalates and BPAs which can affect [45:55] hormonal health. They can mimic [45:57] estrogen. They can reduce the production [46:00] of testosterone based on these [46:02] mechanisms. Also things like plastics in [46:05] the environment, PAS, so the things like [46:08] non-stick cookware, all those things can [46:09] affect hormone health. Now, how do you [46:12] sort of protect yourself, right? I tell [46:14] people again, don't stress. There's only [46:16] so much you can control. So, like I love [46:18] that we're not drinking out of plastic. [46:20] If you have to drink out of plastic [46:22] because you're at an event or whatever, [46:24] try to make sure it's not a um a warm [46:28] bottle. So, it hasn't been like sitting [46:29] in the sun for hours and hours and hours [46:31] because as it gets warm, it releases [46:33] more microlastics and more chemicals [46:35] into the water. When you're eating food, [46:37] if you are eating out of say you get [46:39] takeout, put it on a plate and warm it [46:41] up. Don't ever warm up that plastic. And [46:43] when you store food in the fridge, put [46:45] it in a glass container or a metal [46:48] container, but don't ever leave the food [46:49] in the plastic and put it in the fridge. [46:51] These are simple things you can control. [46:53] You could also limit sort of your [46:54] exposure to dust because dust has [46:56] microplastics. You can try to wear more [46:59] cotton fabrics, less synthetic fabrics [47:01] because they shed less microplastics. [47:04] But again, I think do what you can do, [47:06] but don't let the stress of these [47:08] chemicals like derail you because stress [47:11] is not helping either. And how much of a [47:13] difference does you know microplastics [47:16] make on my hormonal health? Is it really [47:18] a big big deal? [47:19] >> Well, I think it depends. It's all dose [47:20] dependent, right? So, we're all exposed. [47:22] Like, if you look at the data, like [47:24] people are, you know, consuming quite a [47:26] bit of microplastics and we're seeing [47:27] them actually even in testicles, in [47:30] penis tissue samples, like they're in [47:32] our bodies. And so, I think that it's [47:35] definitely playing a role. How much? We [47:37] don't know yet. We just know there are [47:39] mechanisms and we know that they do [47:40] affect hormonal health and so do the [47:43] best you can. [47:44] >> Do you and your family drink out of [47:45] plastic bottles? [47:46] >> No, we drink we we have like metal water [47:49] bottles for the kids and myself. And [47:50] >> what about non-stick pans? [47:52] >> We buy ceramic. We we do our best to [47:54] like avoid those as much as possible. So [47:57] the other thing is the company you keep. [47:59] I think we don't talk about this enough [48:00] and we talk about it in terms of [48:02] business like you want to keep people [48:03] who are successful around you. You want [48:05] to keep people who can help you. But it [48:06] also plays a role in your sexual [48:08] environment, right? So my husband is in [48:10] these groups with a bunch of other male [48:12] physicians. And there's a lot of [48:13] discussion about how they never have sex [48:15] anymore. And they're all just like, "Oh [48:17] yeah, this is just like normal. Like [48:18] we're getting older. Our partners don't [48:20] want to have sex. It's so frustrating." [48:21] And there's a lot of discussion about [48:22] this and and it's it's almost like, "Oh, [48:26] that's okay." Like that's just normal, [48:27] right? They're normalizing this [48:29] experience where that sex has not become [48:31] a priority because life is so stressful, [48:33] things are so crazy. Maybe you're having [48:34] relationship discord. So, it absolutely [48:37] plays a role. And there's actually some [48:39] evidence that it may help you make [48:41] better choices. So, there's one study [48:42] where they looked at I think it was like [48:44] 50,000 people and they um did an [48:48] intervention where they tried to [48:49] encourage these people to surround [48:52] themselves with positive influences that [48:53] were like have safe sex and avoid [48:55] negative influences. And they saw that [48:57] for that these people had an increase in [49:00] like sexual positive behavior. So like [49:02] safe sex practices by 46%. [49:05] So just by changing who they spent their [49:08] time with, they saw this major [49:10] difference in how they approached their [49:12] sex lives. [49:12] >> Okay. So if your friends are very [49:14] pessimistic about sex and they're not [49:15] having and they're complaining about it, [49:17] that's going to become sort of [49:19] contagious. [49:20] >> Yeah. And I think it it extrapolates to [49:22] everything. what kind of relationships [49:24] you you're in. How do they view their [49:26] relationship with their partner? Is it a [49:28] priority? Do they make it a priority? [49:30] Right? Or are they just busy doing their [49:31] own thing and they're just like living [49:33] in parallel lives? They're doing their [49:35] own thing. You're doing your own thing. [49:36] You never really spend time with your [49:37] partner and then when you go hang out [49:39] with your friends, you're like, "Oh god, [49:41] I'm so glad to get away." And you're not [49:42] like talking about how much you enjoy [49:44] your partner. People tend to talk [49:47] negatively, right? They want to like [49:48] sort of like vent. And so when you have [49:50] people who don't make that a part of [49:52] their lives, it also affects you. They [49:53] value their partner and they talk about [49:55] them in a positive way, that's a a great [49:58] thing to say like, okay, this is the [49:59] right kind of person I want because I [50:01] want to value my partner too and I don't [50:03] want that to rub off on me because it [50:05] absolutely does. [50:06] >> And the other thing you said in this [50:07] category of environmental stuff is [50:09] things like pornography consumption. Is [50:10] it possible to consume too much porn? [50:12] >> So it's not the amount of porn that you [50:14] watch, it is the sort of the way you [50:17] feel about it. Many [snorts] people [50:19] watch porn for a variety of different [50:20] reasons. Most often it's for pleasure [50:22] and enjoyment. But there's some people [50:24] who watch porn because they want to get [50:26] away from negative feelings, right? This [50:28] is giving them dopamine and they're [50:29] using it as a way to just feel better in [50:31] the moment. And so that become that can [50:34] become a compulsion where they're [50:36] watching porn and it's like giving them [50:37] these positive feelings and they feel [50:39] negative in life and they're going back [50:40] to porn to sort of again have that [50:42] compulsion to watch porn again. But [50:44] that's a small subset of people. The [50:46] other thing is that there's a lot of [50:48] negative discussion around porn, right? [50:50] People like porn is bad, it's dangerous, [50:52] it's evil. And I think, you know, it's [50:54] more nuanced than that. But if you feel [50:56] that porn is bad, every time you watch [50:58] porn, you feel negative, you feel bad [51:00] about yourself. That's where we see [51:03] people having the most dysfunction [51:04] associated with it because they feel [51:06] guilty. They could watch it once a year [51:08] and they could feel super guilty about [51:09] it and it could affect their sexual [51:11] function. They could see themselves as a [51:13] bad person. and they could see [51:14] themselves as wrong or immoral. And [51:16] that's really when it becomes an issue. [51:18] If you are finding yourself either [51:20] compulsively watching pornography and [51:22] using it as a scapegoat, maybe time to [51:24] reevaluate, say, why am I doing this? [51:26] How can I switch this out for something [51:28] else that makes me feel better that [51:30] might be healthy, like exercise or going [51:32] for walks or whatever that may be? And [51:34] then if it's something that's really [51:36] making you feel like bad or guilty [51:39] because maybe that's how you were [51:40] raised, maybe that's what you feel about [51:41] morality, then yeah, maybe like you [51:43] either need to work through that because [51:46] porn is maybe something that you still [51:47] want to watch at times or you need to [51:50] abstain. But usually those are it's very [51:52] difficult to abstain for most people to [51:53] abstain for prolonged periods of time. [51:55] So I think it's it's something you have [51:57] to work through if you find yourself [51:58] having these sort of feelings about [51:59] pornography or you're compulsively [52:01] watching it. But for most people, it's [52:04] adults. For most adults, it is fantasy. [52:07] It's a place where you can experience uh [52:11] see things that you may never do in real [52:12] life that may be enjoyable, that are fun [52:15] to watch, that have allow you to feel [52:16] arousal. We see that when couples watch [52:19] porn together, they are more likely to [52:21] be more satisfied in their relationship. [52:22] And when there's a discord, like one [52:24] person really doesn't like it or doesn't [52:26] use it, and the other one uses it a lot, [52:27] that's where we see the problem. Is porn [52:30] consumption going to impact my intimacy [52:33] with my partner? [snorts] [52:35] >> So, it depends. I think a lot of people [52:37] watch it without an issue, right? They [52:39] watch [52:39] >> if I masturbate and I ejaculate, I'm not [52:42] going to then be able to ejaculate very [52:43] quickly necessarily with my partner. [52:45] >> Yeah. So, that obviously that is, you [52:47] know, there's a refractory period after [52:49] you ejaculate. Now, when you're younger, [52:50] that refractory period could be minutes. [52:53] And when you're older, that can be a day [52:55] and a half. And so we see that some [52:58] people may struggle, especially if [52:59] they're watching a lot of porn every [53:01] single day and their refractory period [53:03] is maybe a day. Then they may actually [53:05] really have trouble ejaculating with [53:07] their partner because they've not given [53:09] themselves that time. [53:11] >> This has had probably the single biggest [53:13] impact on my office. Of all the products [53:16] that I've tried that have given me [53:18] productivity gains or cognitive boosts, [53:20] I would say that exogenous ketones are [53:23] in the top three most pivotal things [53:26] that have given me a massive [53:27] productivity gain. It's some Stanford [53:28] graduates that have been able to [53:30] basically bottle up the effect you get [53:33] from being in a ketogenic diet in a [53:35] small shot that you can take that makes [53:38] you feel incredibly focused and gives [53:40] your brain an incredible source of [53:41] energy. 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It's a [54:59] simple strategy, but it lets us stay [55:00] agile without compromising on quality. [55:02] So, if you need these kind of skills in [55:04] your business, head to pro.fr.com to [55:06] find pioneering talent to fill your [55:08] business's gaps. That's pro.fr.com. [55:12] And the last one, the last of the four [55:13] pillars, [55:14] >> the last of the four pillars we talked a [55:15] little bit about, it's called [55:17] confidence. And confidence is not like [55:19] stringing around like a peacock like I [55:21] know what I'm doing. It's confidence in [55:22] knowledge and curiosity. So, knowledge [55:25] [snorts] we talked about a little bit, [55:26] understanding female anatomy, like how [55:28] do female bodies get aroused, right? [55:31] what makes them aroused, where is the [55:32] clitoris, knowing some anatomy, and two, [55:35] actually talking to your partner or [55:37] paying attention to their cues. We that, [55:39] for some reason with sex, it's the only [55:41] time that we just expect people to be [55:43] mind readers. We just want you to know [55:44] what I like and just go for it, right? [55:46] And and then when it's not good, you're [55:48] like, well, you just don't know what [55:49] you're doing. And it's like, it's it's [55:51] wild to me that we actually never got [55:54] taught how to talk about sex, how to [55:55] bring it up with a partner, how to, you [55:58] know, just explore and have fun with [56:00] sex. maybe add a toy to the bedroom. So, [56:02] there's lots of different types of toys. [56:04] This is a uh vulva stimulator. So, you [56:07] put this on the outside. So, you can see [56:08] that it would in theory, if this was [56:11] smaller, would stimulate the um the [56:14] clitoris on the outside. It also can [56:16] change in shape. It'll vibrate, right? [56:19] It'll have different stimulations that [56:21] you can play around with and decide what [56:22] you enjoy. [56:23] >> So, this one's run out of battery. Um [56:26] [laughter] [56:27] so, [56:28] >> they're brand new. They have not been [56:29] used. [56:30] >> I didn't say they had been very [56:32] defensive though. Um, so if my pinky [56:34] finger, if my finger here is the [56:35] clitoris, [56:36] >> Yeah. [56:36] >> I put it on like that. [56:39] >> Yeah. [56:39] >> And then it vibrates. [56:40] >> Correct. [56:41] >> And then the penis goes through the [56:43] hole. [56:44] >> And there's another version of that. [56:45] This is basically [56:47] [laughter] [56:48] >> this is basically like the hole goes [56:50] around the penis [56:51] >> and that goes in [56:52] >> and that can go in and stimulate and vi [56:54] vibrate. So, you both feel the vibration [56:56] and you both feel the stimulation. [56:58] >> I remember I was with um had a partner [57:00] and she she felt that sex toys were for [57:02] older people. Old people specifically [57:04] what she said and she she was kind of [57:07] against the use of them. I've always [57:08] been down. [57:09] >> I think it adds novelty and it's [57:11] exciting and it just adds something new. [57:13] >> But she felt like it was almost like [57:16] giving up. [57:17] >> Well, I mean, look, I think I wonder [57:19] why. I would I would if I she was here, [57:20] I'd ask her, why do you think that? What [57:22] belief system do you have [laughter] [57:24] that's making you think that this is [57:25] like not a good thing to use? Right? We [57:28] use technology in so many places in our [57:30] lives, right? So why not introduce it in [57:32] our sex lives? [57:33] >> Are you going to become reliant on it [57:34] though? Because it doesn't make it [57:35] easier to get off with a sex toy. [57:37] >> So they've actually looked at vibration [57:40] and can you get desensitized to it? And [57:42] the way they've looked at is actually [57:43] like construction workers where they're [57:44] using those like vibration tools, right, [57:46] to and and seeing if like their hands [57:48] get desensitized. And what they've seen [57:50] is yes, for a short period of time they [57:52] do lose a little bit of sensation at [57:54] their fingertips, but then it restores [57:56] back to normal. And so it's not that [57:58] you're going to become desensitized [57:59] forever, right? I think you brought up a [58:02] great point, which is adding novelty. [58:03] Now, I think when I say novelty, people [58:05] are like, "Oh my god, I need to role [58:08] play in a different way or bring like [58:10] some sort of BDSM or whatever into my [58:13] sex life." And that's not exactly true. [58:15] So when you think about sex, right, it's [58:17] just like eating your favorite ice [58:19] cream. Maybe you have vanilla ice cream, [58:21] you know, three times a week and you [58:22] enjoy it. But if you start having [58:23] vanilla ice cream every single day, [58:25] you're kind of bored with it, right? And [58:27] the same goes for sex. Now having [58:29] routine in sex, knowing what you like, [58:32] um knowing what your partner likes, it [58:33] can be very helpful, but it also is nice [58:37] to add novelty. So if you think about [58:39] you can extrapolate from the flow state. [58:41] So when you are in a flow state for [58:43] work, right, things feel really almost [58:45] effortless and you're just like in a [58:46] zone, you can also get into a sexual [58:49] flow state. When you look at the flow [58:50] state, yeah, you need things to be [58:52] slightly challenging to get into the [58:53] flow state. They can't be easy and they [58:56] can't be so hard that you're going to [58:57] get frustrated, right? And so you need [58:59] to add a slight challenge to your sexual [59:03] encounter to get into that flow state. [59:05] And that's when you start having really [59:07] great sex cuz you're like in you're so [59:09] totally immersed. you're feeling great [59:11] and it's it's super fun, right? So, I [59:13] think that's another part of being [59:15] confident is being able to and confident [59:17] to try new things and explore new [59:18] things. And it can be as simple as like [59:21] doing it in a different room or maybe [59:22] getting a pillow or switching where your [59:25] head position is. Like, it can be so [59:27] small, but it can just add a little bit [59:29] of uniqueness and novelty and challenge. [59:32] >> Are there certain positions that are [59:35] going to increase the probability that [59:37] my partner has an orgasm? [59:38] >> Yeah. So, uh, typically when the female [59:41] partner is on top, she has more control [59:43] over where she's getting stimulation, [59:46] um, to the clitoris because, right, she [59:48] can angle her body in such a way. So, [59:50] often time that shows uh, that has, uh, [59:53] higher orgasm rates. There's actually [59:55] like this uh this technique called the [59:57] cooidal alignment technique where you [60:00] sort of move in a rocking uh a sort of a [60:03] rocking motion so that um your pubic [60:06] symphysis. So this bone right here um is [60:09] sort of like rubbing against their [60:11] clitoris like this area the skin here is [60:13] rubbing against the clitoris while [60:14] you're penetrating and that has been [60:16] shown to increase orgasm rate and [60:19] pleasure in sex. But really it's about [60:21] figuring out and trying different things [60:23] and realizing like that for example that [60:24] coil alignment technique is sort of [60:26] difficult like it's not that easy and [60:27] intuitive and so you have to sort of [60:29] play around with it and figure out like [60:31] what is going to work uh best and yeah [60:33] realizing it might not work. You might [60:35] be like super awkward and like okay like [60:37] that's okay like it's not the end of the [60:38] world if sex is not perfect every time [60:41] because we're learning and we're playing [60:42] and we're having fun. And so I think [60:44] that's really the key is like not [60:45] letting yourself get so frustrated if [60:47] something doesn't go exactly the way you [60:49] envision it in your head. [60:50] >> I used to think that a woman orgasming [60:52] was when this was when I was younger. Um [60:54] was when she squirted. [60:56] >> Mhm. [60:56] >> So like that's what I thought it thought [60:58] an orgasm was squirting. [60:59] >> Yeah. Well, you're probably not the only [61:01] one to think that. And so squirting, not [61:03] every woman squirts. So about 40% of [61:05] women squirt. Squirting is the emission [61:07] of fluid at the time of orgasm. Um [61:10] usually it's clear, colorless, and it [61:11] can be quite voluminous. um it's coming [61:14] from the urethra which is the pee hole [61:16] essentially and remember I talked about [61:18] those skins glands those skins glands [61:21] are the homalogue of the male prostate [61:23] and they have a little bit of fluid in [61:24] them too typically when you have [61:28] stimulation um and squirting they will [61:30] release fluid from the bladder as well [61:33] as the skins glands that combines [61:34] together and and it's emitted through [61:37] through that [61:37] >> so it's not pee [61:39] >> the way they describe it and there's [61:40] been a lot of research on this so [61:41] there's people who say it's pee. There's [61:43] people who say it's not. There's a [61:44] couple studies. So, one is they put dye [61:47] into the bladder and they took women who [61:50] said they were squirters and they had [61:51] them orgasm and they saw is there dye in [61:54] the uh in the fluid and yeah, there was [61:57] dy in fluid. So, it's coming, it has to [61:59] come from the bladder. The skins glands [62:00] only hold a small amount, but it's [62:02] chemically different. It's usually [62:04] clear, odorless. It doesn't smell like [62:06] pee. And so, there's some theories as to [62:08] why that might be. It may be that um [62:11] when you're having sex, there's [62:13] different hormonal signals that change [62:14] the concentration of what's filtering [62:16] through your kidneys so that it is a [62:18] little bit different in composition. [62:20] There's some theories that when there's [62:21] more estrogen around that it may change. [62:23] There may be some like um fluid filling [62:26] in the actual interstissia of the [62:28] organs. Again, it's hard to say, but [62:30] it's absolutely coming from the urethra [62:32] which is connected to the bladder as [62:34] well as the steam glands. But I think [62:35] like this this whole discussion about [62:37] what it is, it doesn't matter. Like is [62:39] it pleasurable? Are you enjoying it? [62:41] Great. If you squirt and you enjoy it, [62:43] great. If you don't, that doesn't mean [62:45] that there's something wrong and that [62:46] your partner hasn't orgasmed. The way to [62:48] figure out if your partner orgasm is you [62:50] ask her, right? Either she tells you or [62:52] you ask her. And sometimes it's obvious [62:54] and sometimes it's not, but you know, [62:55] you you sort of figure it out. [62:58] >> There's three theories that emerged in [63:00] my research about why women squirt from [63:02] an evolutionary perspective. The first [63:04] was that, and these are just theories, [63:06] they're not proven. Um, of course, the [63:08] first is that squirting contains PSA and [63:10] zinc, which are naturally antibacterial, [63:13] and ejaculating these fluids during or [63:14] after sex may have evolved to flush the [63:17] urethra and prevent UTI. Um, the logic [63:19] being in a pre antibiotic world, a woman [63:22] who could flush bacteria out of her [63:24] system after mating was more likely to [63:25] stay healthy and reproduce. That's one [63:26] theory. The other reason, [63:27] >> well, before you I want to talk about [63:28] that really quickly. So, that's a really [63:30] interesting theory. So one the reason [63:32] they emit PSA is because schemes glands [63:35] are the homalologue of the prostate. So [63:38] the prostate makes PSA which is prostate [63:40] specific antigen. [63:41] >> So this point this word homalogue again. [63:42] >> Yeah it's a so basically the prostate in [63:44] the male the same tissue when they're an [63:47] embryo becomes the prostate in the male [63:48] and becomes a skins glands in the [63:50] female. So that's why it's emitting PSA. [63:53] That is an interesting theory because [63:54] there are a subset of women who get UTI [63:56] after sex. Not everybody but some do. [63:59] And it's it's not because of the [64:01] ejaculate or because of the male [64:04] harboring some bacteria. It's because of [64:05] the actual thrusting of the penis. It's [64:08] taking bacteria from the outside and [64:09] making it more easy for it to go through [64:11] the urethra into the bladder. And women [64:13] have a short urethra. And so I want just [64:15] to debunk that myth that it's like [64:17] you're getting it from your partner or [64:19] there's something wrong with you. It is [64:20] literally just anatomy. And so some [64:22] women do get more UTI after sex. [64:25] >> And so that is an interesting theory [64:26] because maybe that's true. I don't know. [64:28] The second theory was in ancient [64:30] ancestors, the hormonal surge during [64:32] orgasm and ejaculation actually [64:33] triggered the release of an egg. Humans [64:36] evolved to ovulate on a cycle now, but [64:38] we kept the plumbing and the neuro [64:40] hormonal reflex. It's a happy accident, [64:42] a biological vestage that no longer [64:43] serves its original reproductive [64:45] purpose, but remains because it isn't [64:47] harmful for survival. [64:49] >> Interesting. I mean there is some [64:50] thought that maybe orgasming [64:53] um spasms orgasm help with fertility but [64:56] it's not really uh robust. [64:59] >> And the last one kind of matches what [65:00] you just said there which is the mate [65:02] selection theory. The intense pleasure [65:03] and psychological response of squirting [65:05] or or orgasm act as a reward system. It [65:08] incentivizes women to seek out specific [65:10] partners who provide high levels of [65:12] stimulation, potentially signaling a [65:13] better genetic compatibility or a more [65:16] attentive male, which would help with [65:18] the survival of of offspring. Maybe [65:21] >> that makes sense. [65:23] >> 40% of women squirt. [65:25] >> Yeah. So, the other thing is obviously a [65:27] lot of sex is focused on genitals, but [65:29] there's a whole body of arogynous zones, [65:31] right? Almost almost your entire body [65:34] can be an erogynous zone. We talked a [65:36] little bit about it when we talked about [65:37] sensate focus, right? You can explore, [65:39] you can find areas that people find uh [65:42] erogynous. So when you looked at data, [65:44] necks, nipples, lips, buttocks, inner [65:48] thighs, all these areas are considered [65:50] arogynous by most most people regardless [65:53] of their um sexual orientation, [65:55] regardless of their cultural upbringing. [65:57] It seems to be pretty universal. There's [65:59] actually a famous paper about [66:00] non-genital orgasms and like how people [66:03] orgasm without any genital stimulation. [66:06] So lip orgasms, anal sex orgasms. [66:09] >> Is that possible? [66:10] >> Yeah, it's been documented. Absolutely. [66:13] And and so it's um nipple orgasms. [66:15] There's a whole variety of ways even [66:17] like women have had orgasms during [66:18] childirth. Like there's there have been [66:20] these documented ways to orgasm and it's [66:23] because these areas can be very [66:24] erogynous and sometimes stimulating [66:26] multiple areas can like add more [66:29] erogynous interest and that's why you [66:31] see people like maybe in the BDSM [66:33] community they'll they'll be using um [66:35] nipple clamps while they're doing other [66:37] things right so there's there's a whole [66:38] bunch of areas that are erogynous and [66:41] most of the times people are not really [66:43] spending much time on foreplay or [66:46] stimulating these erogynous zones as [66:48] much as they should Right? You you have [66:50] a whole body to play with. And how do [66:51] you stimulate them? There's actually [66:53] evidence behind that. So on your skin, [66:55] we have these special fibers called C [66:57] tactile eference. When you stimulate [66:59] these fibers, they help you feel [67:01] pleasure, enjoyment, those sorts of [67:03] things. And so there was a study where [67:06] they took 19 couples, a small study, it [67:07] was out of London, and they basically [67:10] told them to stimulate an arogynous zone [67:12] and a non-erogynous zone. The [67:13] non-erogynous zone being the forehead. [67:15] And so they had the couples stimulated. [67:16] And they told them stimulated at levels [67:18] of 18 cm/s [67:21] uh in terms of how fast you're caressing [67:23] the arm or or or body part and at 3 cm [67:27] per second. And what they found was [67:28] those who stimulated at 3 cm per second [67:31] had more sexual arousal had more [67:33] pleasant stimulation compared to those [67:35] who were stimulating at 18 cm per [67:37] second. Now this makes sense because [67:39] those C tactile aphrant fibers respond [67:42] very well to that slow gentle caress. [67:46] The other interesting thing is that [67:47] these fibers are only responsive to [67:50] human touch. So if I take a glove and I [67:52] put it on my hand and I touch you, it [67:54] still doesn't work. [67:55] >> Interesting. That's so interesting [67:57] because in Los Angeles where we are now, [67:59] we were viewing an office and we were [68:00] walking down the street to see what the [68:02] neighborhood was like and we walked past [68:04] one place and it is a robot massage [68:07] parlor. M [68:09] >> and I always thought great like well [68:11] part of me thought maybe my prefrontal [68:13] cortex thought oh great idea because you [68:15] know you can get massages whenever you [68:16] want it's going to be cheap maybe you [68:18] can have one in your home but then the [68:19] other part of me as I saw it thought [68:21] actually I don't actually think that's [68:22] like why I get massages [68:24] >> I think there's something about human [68:25] touch which makes a big difference [68:27] >> absolutely there is um and so I think [68:29] that's uh we're evolutionary [68:32] evolutionarily built to seek out human [68:35] touch and human behavior [68:37] >> I wonder if I would want a robot to [68:38] massage me. [68:41] >> It wouldn't be as good. No. [68:42] >> I mean, think about sitting in a massage [68:44] chair. Is it ever as good? [68:45] >> It's never as good, [68:46] >> right? And so, I don't think a robot's [68:47] going to be that different from a maybe [68:49] a little better than a massage chair, [68:51] but like [68:52] >> massage chairs are never good. [68:53] >> No, they're just like they're okay. [68:55] They're mediocre. M Reena, I want to [68:57] talk about um testosterone, how that [69:00] links to sexual function, but also just [69:02] overall health because I was reading [69:04] that there's been a 300% increase in the [69:06] United States in the last 10 years of [69:08] testosterone prescriptions. And my [69:10] friends are increasingly having [69:11] conversation about testosterone, which [69:12] we weren't having [69:14] >> even 5 years ago. It wasn't a [69:15] conversation. And now the conversation [69:17] I'm having amongst my friends is like, [69:18] is our testosterone high enough? Do we [69:19] need to go get supplements to increase [69:21] our testosterone? [69:22] >> Testosterone is declining. So when you [69:24] look at testosterone levels from the [69:26] 1990s, like late 1990s, the average [69:29] level was around 600 and if you look at [69:32] data around two 2015, it was 450. So [69:35] there's been like a 25% decline in [69:38] testosterone. Now you're going to ask me [69:39] why. One, we talked about some of the [69:41] endocrine disrupting chemicals. That's [69:43] part of it certainly. Two, there's a [69:45] significant rise in obesity. [69:47] Testosterone has aromatase. And [69:49] testosterone converts to estrogen using [69:51] this enzyme called aromatase. And so [69:54] when you have more fat mass, you have [69:55] more aromatase. And more testosterone is [69:57] being converted to estrogen. And so now [70:00] you have less testosterone. [70:01] >> Sorry. How do we how do you have less [70:02] testosterone? [70:03] >> So because there's more fat mass, [70:05] there's more aromatase. So that [70:07] aromatase sees all this testosterone and [70:09] it converts it to estrogen. [70:11] >> Okay. This is where they say they talk [70:13] about man boobs. [70:14] >> Yeah. So when you have a lot of [70:15] estradiol around you can get man boobs, [70:19] >> you can get gynecomastia. [70:19] [clears throat] [70:20] So a term for it. So that's one. Two is [70:22] we see a rise in diabetes and insulin [70:26] resistance which also causes a decrease [70:28] in testosterone. [snorts] We're seeing a [70:31] rise in ultrarocessed food intake and [70:34] that doesn't have the optimal nutrition [70:37] that you need to optimize testosterone. [70:39] So we're getting you know a high highly [70:42] caloric which then leads to obesity. [70:45] We're getting um lack of healthy fats. [70:47] We're you know all these things are [70:49] super important for testosterone. The [70:51] Mediterranean diet is what has been the [70:53] most studied and basically [70:54] anti-inflammatory diet is what they [70:57] found for testosterone. So trying to [70:59] just eat like whole foods, unprocessed [71:01] foods as much as possible and minimizing [71:04] the inflammatory foods. [71:05] >> Does testo having high testosterone make [71:07] me more fertile? No, not necessarily. [71:10] So, I think people inherently think that [71:12] the higher your testosterone level is [71:14] when you check your blood work, that [71:16] that's better. And that's not [71:17] necessarily true. Now, everyone is [71:20] different. And what I can't tell you is [71:22] what your receptors look like, what your [71:25] testosterone or androgen [clears throat] [71:26] receptors look like, how sensitive are [71:28] they to testosterone. And everyone's a [71:31] little bit different. But when you look [71:31] at the same guy or you look at two [71:33] different guys, their variability can be [71:36] so much that a guy who's 900 can be [71:37] normal and a guy who's 500 can be normal [71:39] because everyone has individual genetic [71:41] variations. It's how their cells how [71:44] sensitive their cells are, how many [71:46] cells they have, you know, how many [71:47] latig they have in their testicles. Um [71:50] the CAG repeats, which are these DNA [71:52] repeats on the receptor themselves. [71:54] People who have more are less sensitive [71:56] to the testosterone that's around. So [71:58] they need more testosterone to get the [71:59] same result. Whereas people who have [72:01] less repeats have more sensitivity so [72:03] they they don't need as much [72:05] testosterone. And so everyone is [72:06] individual. And so that's why it's [72:08] really important to understand how are [72:09] you feeling, right? It's not about [72:11] chasing a number. And so absolutely we [72:14] know that when your testosterone is low [72:16] below 214 nanogs per deciliter that your [72:20] risk of mortality goes up by two. So you [72:22] are going to double your risk of dying [72:24] if you have low testosterone. But when [72:26] you go super high, super physiologic, [72:29] meaning like 1,800 or higher, now you're [72:31] putting yourself at risk for other [72:33] things. You can have blood thickening, [72:35] which is a known side effect of [72:36] testosterone replacement, and that puts [72:38] you at risk for stroke, heart attack, [72:40] heart disease. Over long periods of [72:43] time, it can affect your heart because [72:45] it can um there's also heart muscle [72:48] cells that get exposed to this high [72:50] level of testosterone. And when that [72:52] happens, these they sort of change over [72:54] time and they become more collagen [72:56] deposition. They get more fibrosis and [72:59] this makes them stiffer and so that [73:00] you're not pumping blood as effectively [73:02] as you would otherwise. And so there are [73:05] real consequences to going too high. [73:08] There's also the side effects of having [73:09] acne, of changes in mood in terms of [73:12] aggression and things when you get [73:13] really high. So really, it's about [73:15] finding what you feel good at. More is [73:18] not necessarily better. Once your [73:20] testosterone receptors are saturated, [73:22] meaning they're all bound to [73:23] testosterone more doesn't help you. It [73:25] might help you get more muscles, which [73:27] is why people abuse anabolic steroids [73:29] and testosterone because it will [73:30] continue to help you get bigger muscles, [73:32] but that's it. It's not going to help [73:34] you with your brain health, your bone [73:36] health, your sexual health, your any of [73:38] that. [73:39] >> Is there a way to [73:41] visually spot a person with low [73:43] testosterone? Are there visual clues? [73:46] Usually it's someone who feels very [73:48] fatigued like they can't get out of bed. [73:51] They feel just like so drained. Usually [73:53] they are a little bit more overweight. [73:56] >> Skinny fat [73:58] >> visceral adop I mean you can't always [74:00] tell if they're skinny. So it could be [74:01] because they could have visceral adopy [74:02] which is meaning that the fat is around [74:04] the the organs right and so you don't [74:06] see like a big pot belly necessarily. Um [74:09] they may have really low sexual desire. [74:12] They may have decrease in mood. [74:13] >> What about skin and bones? Does it [74:15] impact skin and bones? [74:16] >> Yeah. So, if you get high testosterone, [74:18] you can get acne because it affects the [74:19] sebum in the skin. Um, bone health. So, [74:22] testosterone converts to estradiol and [74:25] [snorts] estradiol is really important [74:28] for bone metabolism. And so, when you [74:31] have low testosterone, you can also have [74:33] low estrogen. And when your estrogen [74:35] gets very low, you get a higher risk for [74:38] fractures, higher risk for osteoporosis. [74:41] And so that's where your bone health um [74:43] can be in danger. And so that's why [74:45] testosterone can help protect your bones [74:47] because of its conversion to estradile. [74:50] >> If you do have low testosterone, should [74:51] you be considering taking anabolic [74:53] steroids? Like [74:55] and who is testosterone replacement [74:57] therapy good for? [74:59] >> So I'm going to ask you a question. Why [75:00] why are you saying anabolic steroids? [75:02] >> I don't know. Cuz I hear that people big [75:03] bodybuilders take anabolic steroids. The [75:05] reason I asked you that is because [75:06] people think anabolic steroids and [75:08] testosterone replacement therapy are the [75:09] same thing and they're not. And so [75:11] testosterone replacement therapy is what [75:14] is given to guys who have low [75:16] testosterone. If you have truly low [75:18] testosterone, there's a few things you [75:20] can obviously improve testosterone [75:21] naturally by going back to those pillars [75:23] of health that we talked about. Improve [75:24] your sleep, do resistance training, [75:26] avoid endocrine disrupting chemicals. [75:28] But if you are still low despite doing [75:30] all those things or you're like so [75:32] fatigued that you can't move your body [75:33] and like you really need to do it, then [75:35] I think testosterone replacement is is [75:37] very valuable. And so testosterone [75:39] replacement is getting you to a level of [75:42] testosterone that is within normal. [75:45] We're not trying to get you super high. [75:47] We're not trying to get you to become a [75:48] bodybuilder. We're trying to get you to [75:50] normal, what you should be. And so [75:53] anabolic steroids are different. And [75:55] anabol steroids are like all these [75:56] different um oral pills and injectables [75:58] and things that work on muscle as well [76:00] as work on your uh androgen receptors. [76:03] And so those are typically things that [76:05] people are taking on their own. They're [76:08] kind of self-directing their care and [76:10] they're not really monitoring their [76:12] testosterone or they don't really care [76:14] how high they go. They just want the end [76:16] product of looking muscular. And so they [76:20] are getting really high testosterones [76:22] and that has its own host of concerns in [76:26] addition to the ones we talked about [76:27] like blood clots and and heart attack. [76:29] But there's a 15 times higher risk of [76:32] having premature heart failure and a 122 [76:36] times more risk of cardiac death when [76:39] you're taking anabolic steroids for the [76:41] purposes of increasing muscle mass and [76:43] not and get getting really high in your [76:45] testosterone. So, it is a real serious [76:48] issue when you take anabolic steroids [76:50] because it can have real serious health [76:52] consequences. [76:53] >> I've always imagined that once I have [76:55] kids, so I'm I think I'm scared that if [76:57] I have testosterone replacement therapy [76:59] at this age at 33, it might impact my [77:01] fertility. [77:02] >> It absolutely will. [77:03] >> Okay, good. So, I'm not going to do that [77:06] until I've had all four of the kids. [77:08] >> Yeah. [77:08] >> As many as I can. [77:10] >> And then I figured when I hit like 45, [77:13] then I'll go on testosterone replacement [77:15] therapy. Is this a good strategy? [77:17] >> Well, first of all, I would want to know [77:19] why you want to be on testosterone. Is [77:20] your testosterone low? [77:21] >> I have no idea. [77:22] >> Right? Are you having any symptoms? [77:24] >> I mean, you live a very highpowered, [77:26] busy life. And so, I can guarantee your [77:29] stress is probably not under control. [77:31] Like, probably you're not sleeping [77:33] great. And not to say that those are [77:35] things that, you know, you can't do in [77:36] addition to taking testosterone if your [77:38] testosterone is indeed low. But I think [77:41] the important thing is realizing like [77:43] it's only going to help you if your [77:45] testosterone receptors are not fully [77:47] saturated and giving you more [77:48] testosterone is going to saturate them. [77:50] >> Doesn't it just drop anyway with age? [77:52] >> It does. So it drops about uh 1% a year [77:56] on average. Some people drop less, some [77:58] people drop more. So if you look at [77:59] someone who is healthy and they have a [78:02] normal testosterone, they usually won't [78:04] become what we call hypogonatal or have [78:06] low testosterone even as they age [78:09] because the drop is so low. it's only 1% [78:11] a year. But if you add on these comorbid [78:14] conditions, if you add on a high stress [78:15] life, if you add on poor sleep, if you [78:18] add on um exposure to endocrine [78:20] disrupting chemicals, you're going to [78:21] see um that number come down much [78:24] higher. [78:24] >> It's actually I was just I pulled up a [78:26] graph here um that shows testosterone [78:29] decline with age. And it's actually not [78:32] that steep. [78:33] >> It's not It is going to decline, but it [78:36] may not decline to the point where you [78:38] need testosterone. So, not everyone [78:40] needs it. Depending on the data you look [78:41] at, 20 to 40% of guys have low [78:44] testosterone. Um, and when you look at [78:47] the number that get treated, it's like [78:48] 2%. [78:49] >> And it starts declining from about 20 [78:51] years old. [78:52] >> Yeah. Depends on the person. 20 to 40 [78:54] years old that start, it's probably more [78:55] around 30 to 40. And the reason we came [78:57] up with these numbers, right, these [78:59] guidelines to to guide us on what's [79:00] normal and what's not is because you [79:02] look at population-based data and you [79:04] look at when these symptoms arise and [79:06] there are like clear numbers like you [79:08] may start having bone loss uh around [79:10] 300. You might start having uh you know [79:14] decreased sexual frequency of thoughts [79:16] at 215. You might start having feeling [79:19] less physical vigor uh around 290. [79:22] Right? And so there are numbers that we [79:24] know based on population-based data that [79:26] we're seeing these numbers decline. Now [79:28] the other thing to think about when [79:30] you're looking at testosterone is free [79:31] testosterone. So testosterone comes in [79:34] different forms in the body. It comes [79:36] bound and unbound. So 45% of [79:39] testosterone is bound to SHBG which is a [79:43] molecule of protein that is really [79:45] tightly binds to testosterone. Doesn't [79:47] let it go for your body to use. Then [79:49] there's some that's bound to albumin [79:51] which is sort of loosely bound and then [79:53] there's 2% that's free 1 to 2% that's [79:56] free and that's what we say is like the [79:57] most available to your body for use and [80:01] there's actually you know good data that [80:02] looks at free testosterone and the [80:04] levels of free testosterone are [80:06] correlated with these symptoms as well [80:08] and so you do have to look at the big [80:10] picture so I always check a total [80:12] testosterone as well as an SHBG because [80:14] some people can have elevated SHBG [80:17] thyroid dysfunction due to aging, just [80:20] genetic variability, right? In women, [80:22] SHBG goes up when you take oral [80:24] contraceptives and it stays up for life [80:27] if you take oral contraceptives. So, it [80:28] can affect their free testosterone. The [80:30] other thing to think about testosterone [80:31] is it's for life. Once you take it, your [80:33] body stops making its own testosterone. [80:36] Many people over years will notice that [80:37] their testo their testicles get smaller [80:40] um because their body stops making its [80:42] own testosterone. So, it's not something [80:44] to take lightly. Now if you want say you [80:46] were low right now and you wanted to [80:48] conceive there are ways where you can [80:50] take other um other pharmaceuticals that [80:53] will naturally boost your own production [80:55] like hcg or clomid or enclomophene. [80:58] These work basically uh in different [81:00] ways to either tell your brain that hey [81:02] we need more testosterone or they send [81:04] they mimic the signals that tell your [81:06] testicles to make more testosterone. And [81:09] so there are ways to do it and you [81:10] definitely need someone who's, you know, [81:12] well-versed in managing hormone [81:14] management. Uh, but there are things [81:16] that you can do if you're low. But [81:18] again, I don't think it's once you once [81:20] you start these things, you can't go I [81:21] mean, you can get off of it, but it's [81:23] sort of a process and it's not something [81:24] that everyone will do because you're [81:26] going to feel good on testosterone if [81:28] you're taking it. And then when you get [81:29] off it, because your body is like no [81:31] longer making its own, you're going to [81:32] feel horrible. So, do you think most 50 [81:34] plus year old men should be taking [81:37] testosterone [81:39] replacement therapies? [81:40] >> Only if they're symptomatic and they're [81:42] low, right? So, [81:42] >> would it make them the average man, the [81:44] average 50-year-old man, if this is the [81:45] average, feel better on a daily basis? [81:48] >> Not necessarily. Because if they are [81:50] normal, like I said, if their [81:51] testosterone receptors are already fully [81:53] saturated, it's not going to change, [81:54] right? It's not going to change their [81:56] it, like I said, it may make their [81:58] muscles look bigger, but it's not going [81:59] to change their their cognition. It's [82:01] not going to change their mood. It's not [82:03] going to change their sex drive. It's [82:04] not going to change their erections when [82:06] their testosterone receptors are fully [82:08] saturated. [82:09] >> And you know, in this graph, what is [82:10] showing the decline here? Has that got [82:12] anything to do with whether their [82:14] testosterone levels are fully saturated? [82:15] Because [82:16] >> no, you can't tell from that. [82:17] >> You can't tell from that. So, you could [82:18] have low testosterone but still be [82:19] fully. [82:20] >> That's why we talk about symptoms, [82:21] right? Because that's how I can tell. I [82:23] think, you know, that's part of what [82:25] being a doctor is, right? Talking to [82:26] your patients and figuring out what's [82:28] going on with them and what their [82:29] symptoms are and making sure it's [82:30] nothing else, right? You can have low [82:32] thyroid and that can mimic what what uh [82:35] what low testosterone feels like. You [82:37] can have a high prolactin because you [82:38] might have a benign tumor in your brain [82:41] that's secretreting prolactin and that [82:43] can reduce your testosterone. So that's [82:44] the the reason to get a full evaluation [82:46] to make sure there's nothing else that [82:48] we're missing that's causing you to have [82:50] these symptoms if your other levels are [82:52] normal. [82:53] >> Uh okay, that makes sense. So just [82:54] because my testosterone levels would be [82:56] low doesn't mean I necessar if I don't [82:59] if I'm not symptomatic doesn't mean that [83:01] I should necessarily just assume that I [83:03] need testosterone replacement therapy. [83:05] >> Exactly. [83:05] >> Okay. Yeah. I think I think most of my [83:08] male friends are just assuming that once [83:09] we hit 50 we're all on the testosterone. [83:11] >> I mean look I think when if you need it [83:14] it's a great drug. It's a great option [83:16] to improve your quality of life. It's [83:19] obviously preventing uh bone loss. It's [83:22] improving your longevity. it's uh [83:24] preventing hopefully having some benefit [83:26] in terms of cardioabolic health and so [83:28] yeah absolutely if you need it but it's [83:31] not something that like everyone should [83:32] just take cuz why not right like it's a [83:35] when you play with hormones it's serious [83:36] business you know [83:38] >> I guess a lot of men are self-conscious [83:39] in a way that they don't often admit and [83:41] they want to have big muscles [83:43] >> and they want to feel strong [83:44] >> and this is the the problem I'm seeing [83:45] with younger guys right now is that [83:48] there's a lot of young kids taking [83:50] anabolics because there's so much [83:52] pressure to look a certain way, right? [83:54] Because nowadays when how do you meet [83:56] people on social media through like [83:58] swiping and and all you see is what they [84:00] look like. And so there's this pressure [84:02] and like I'll see it at the gym like I'm [84:03] like at the gym and there's these young [84:05] kids who I'm like there is no way you [84:06] are naturally that built at that age, [84:09] right? Like unless you've been lifting [84:11] since you were like seven years old. And [84:13] so and of course there are some. But it [84:16] is serious because one, it causes [84:18] infertility, right? When you're on [84:19] testosterone replacement after about 18 [84:23] 18 months, 70% of people on testosterone [84:25] replacement will be infertile. [84:27] >> 17 [84:28] >> 70 70%. [84:30] >> 70. [84:31] >> And even as soon as like 10 weeks, we [84:33] see some people having drops in their [84:36] sperm count. So, it's variable with how [84:38] quickly you're going to see impacts on [84:40] your fertility, but it absolutely [84:42] happens. And it can it can come back for [84:45] the large majority of people, but how [84:47] long it takes depends on your age and [84:49] how long you were on testosterone [84:50] replacement therapy. And in some cases, [84:52] it can take as long as 2 years to come [84:54] back. [84:54] >> I really need to get my testosterone [84:56] levels checked. [84:57] >> Yeah, you should. [laughter] [84:59] But also, you should get your semen [85:00] analysis checked. And I've done that. [85:02] >> Good. Good. Because that's also a [85:03] biomarker of health. We've seen that [85:05] people who have poor semen parameters [85:08] they have higher rates of mortality and [85:10] they actually live when you look at age [85:12] like what age people die they die [85:14] younger compared to people and it's dose [85:16] dependent. So if you're have like normal [85:20] uh the concentration of sperm and then [85:22] it keeps going down and down and down. [85:23] If you look at the age it's like they [85:25] live to 78 77 76 like you can actually [85:28] see it come down except for people who [85:30] have no sperm because those are usually [85:31] genetic disorders. Those are live a [85:33] little longer because it's not [85:34] necessarily due to cardioabolic issues. [85:37] Um, but it's basically a reflection of [85:39] your overall health. [85:43] >> Steve, what are you doing? [85:44] >> Uh, just making myself a delicious [85:46] coffee [85:47] >> from the freezer. [85:49] >> From the freezer. Have you not heard [85:50] about Contier? [85:50] >> No. [85:51] >> Oh my gosh. This is going to change your [85:53] life. A couple of months ago, the [85:55] founder of this business called Matt [85:56] sent a big shipment of this coffee to [86:00] our office in London. What most people [86:01] don't know is that the processing of [86:02] coffee takes out a lot of the taste. So [86:04] what they do is they flash freeze it at [86:07] the optimal moment when it's most tasty [86:10] and they send you in the post the coffee [86:12] in these little frozen ice cubes. Now [86:14] Matt sent a big shipment to my office. I [86:16] moved it to the kitchen. I said to the [86:17] team, "Knock yourselves out." And then I [86:19] saw so many messages in our Slack [86:20] channel of people going, "Oh my god, [86:23] what the hell is that? It's so [86:24] delicious." All I have to do is pop it [86:26] out in the morning using the little [86:27] button on the back of this thing. I pour [86:30] my hot water in and I mix it and that is [86:34] done. You can get $30 off your first [86:36] order of Cometier coffee if you go to [86:39] cometier.com/stephven. [86:41] Try it and please Instagram DM me, [86:44] LinkedIn me and let me know if you love [86:46] it as much as I do. Make sure you keep [86:48] what I'm about to say to yourself. I'm [86:50] inviting 10,000 of you to come even [86:52] deeper into the diary of a CEO. Welcome [86:54] to my inner circle. This is a brand new [86:58] private community that I'm launching to [86:59] the world. We have so many incredible [87:01] things that happen that you are never [87:03] shown. We have the briefs that are on my [87:05] iPad when I'm recording the [87:06] conversation. We have clips we've never [87:08] released. We have behind the scenes [87:10] conversations with the guests and also [87:11] the episodes that we've never ever [87:14] released. And so much more. In the [87:17] circle, you'll have direct access to me. [87:19] You can tell us what you want this show [87:20] to be, who you want us to interview, and [87:22] the types of conversations you would [87:23] love us to have. But remember, for now, [87:26] we're only inviting the first 10,000 [87:28] people that join before it closes. So, [87:30] if you want to join our private closed [87:32] community, head to the link in the [87:33] description below or go to [87:34] daccircle.com. [87:38] I will speak to you then. [87:43] One of the things I was quite surprised [87:44] by, I'll be honest, is when I went on [87:47] your YouTube channel [87:48] >> Mhm. [87:48] >> one of your very high performing videos, [87:51] I think it had 31 million views, was [87:55] about enlarging your penis. [87:56] >> Yes. [87:59] >> I didn't know that so many men were [88:02] interested in ways to enlarge their [88:04] penis. Well, it's interesting because [88:06] when you look at the data, more men want [88:08] to so I let's say most guys would love [88:12] to be taller, right? If you're an [88:13] average height man, most guys would love [88:14] to be taller, right? [88:16] >> Yeah. True. [88:16] >> Um more men want to have a longer penis [88:18] than they want to be taller. [88:20] >> Really? [88:20] >> Mhm. [88:23] >> Wow. Wow. [88:26] Why is this? [88:28] >> Well, I think you know a lot of people [88:31] um it starts at a young age. I have [88:33] sons, right? And so I see it like they [88:35] talk about their penis in such a way [88:37] like very early in life like oh my god [88:39] my penis is so big or it should be so [88:41] big or whatever and and there and it's [88:44] like this it becomes this like this [88:46] society thing about who's got a bigger [88:48] penis like it's very interesting but [88:50] there's a lot of pressure to feel like [88:53] and and a lot of discussion around [88:54] bigger is better right it's it's talked [88:57] about in media it's subtly joked about [88:59] it is um everywhere you look people are [89:02] talking about like being wellendowed as [89:04] being better. But interestingly, on my [89:06] podcast, we interviewed the the guy who [89:09] has the largest medically verified [89:10] penis. It's I think it's like 13 or 14 [89:13] inches in length. And um he actually has [89:16] a lot of trouble because it's so large [89:18] that people don't want to have sex with [89:20] him and it's uncomfortable for them. And [89:22] so, like, it's not all roses and [89:24] sunshine on the other side. But the [89:27] reality is that many people feel what's [89:29] called small penis anxiety. and they [89:31] they even if they have a normalsized [89:33] penis, they feel consumed with how the [89:36] size of their penis is. And so that's [89:38] why this video did so well. I naively [89:40] had no idea how many people it would [89:42] resonate with because I'm not a guy, [89:43] right? And I see patients all the time, [89:45] but at that time in my career, people [89:47] weren't coming to me to talk about it. [89:48] And so I um I realized like there's so [89:52] many people quietly feeling insecure. [89:54] And we talk a lot about women having [89:55] body image issues. Men do too, right? [89:58] They feel insecure about the size of [90:00] their penis because also they're seeing [90:02] guys on pornography who have very [90:05] well-endowed fallaces and you know they [90:07] chose to be porn actors for a reason, [90:09] right? Because they are naturally [90:11] wellendowed. And so you're comparing [90:13] yourself to the outliers and the average [90:15] penis is about 5.3 to 5.5 in erect. But [90:19] when you look at like what do women [90:21] want, they will say on average they want [90:23] a 6 in penis. But when you look at like [90:26] the kind of sex toys they buy and they [90:28] did this study because they were looking [90:29] at people who they were trying to decide [90:32] what kind of when they were developing [90:34] fallaces for trans people like they they [90:37] reconstruct fallacuses for they wanted [90:39] to they were making them too girthy and [90:40] they like well we need to figure out [90:41] what girth women want and so they looked [90:44] at like what women buy on online like [90:47] what is the most purchased sex toy and [90:49] it's actually pretty close to average. [90:52] >> Do you say 5.2 in [90:53] >> 5.2 two to 5.5 depending on the study [90:55] you're looking at. Yeah. [90:56] >> Correct. [90:57] >> Mhm. [90:58] >> H. And what size do men think the [91:02] average is? [91:03] >> Oh, they think it's like six or seven [91:04] in. [91:05] >> Oh, okay. So, they think the average is [91:06] bigger. And also, how does age come into [91:08] this? Because I'm presuming that when I [91:10] get older, my penis is going to shrink [91:11] or something. [91:11] >> If you have good blood flow to your [91:13] penis, it shouldn't shrink. So, like I [91:15] said earlier, if you stop having [91:18] nighttime erections or you're not having [91:19] erections, now you're no longer getting [91:21] blood flow to your penis and it will [91:22] shrink over time. Also, if you're [91:24] gaining weight, it will appear that it's [91:26] shrinking because you're getting more [91:28] fat over here. So, if you think about [91:31] your penis here, this is the fat right [91:33] above this bone. And as this fat gets [91:35] more and more, you're seeing less and [91:37] less of the penis. [91:38] >> And is there a way to enlarge the penis? [91:40] So there are many ways that have been uh [91:43] tried, discussed, um attempted. So [91:46] there's definitely surgeries that you [91:48] can get, but they there's not a lot of [91:50] surgeons who do a lot of penile [91:52] lengthening surgeries and they have lots [91:54] of complications, like very high rates [91:56] of complications because the penis is a [91:58] very vascular organ. And the thing is [92:00] that when you have the tiniest [92:03] difference on your penis, you notice it, [92:05] right? Like I have guys come to like the [92:06] tiniest little thing on their penis and [92:08] they're like, "Is this okay?" Like this [92:09] is new. And like luckily it's nothing, [92:12] right? But I'm like they notice it. You [92:14] notice it when something's wrong. So [92:15] imagine you have a surgery and now [92:17] something changes, right? So it is it is [92:19] really difficult to sort of replicate [92:22] exactly a normal penis when you're [92:24] lengthening it through surgery. So I [92:27] don't recommend surgery for lengthening [92:29] penis. There is a safer way and that has [92:32] been shown to help and that's using a [92:34] traction device. So a traction device, [92:38] we have one here. This is one brand. You [92:40] can get many of these online. And you [92:42] can put your penis in this device. [92:45] >> It really I like I feel like um I get [92:48] like shivers when I watch you do this to [92:49] this penis. [92:50] >> So you would wrap it. It would be more [92:52] comfortable than just putting this like [92:54] directly on your penis. [92:55] >> For you guys that can't see, she's [92:56] clamping the end of the penis into this [92:58] >> into this device. And then you sort of [93:01] lengthen it uh extend it with this 30 [93:04] minutes twice a day for this particular [93:05] device. They've actually done some [93:07] research on this one. 30 minutes twice a [93:09] day and you there's like a whole [93:11] protocol on their website and it does [93:13] show improvements in length about two [93:14] centimeters but it is a commitment to [93:17] increasing length and to doing this [93:19] process. [93:20] >> So just on those numbers 2 cm increase [93:22] over what period of time and does that [93:24] >> or about 3 to 6 months depending yeah [93:26] >> and is it permanent? [93:27] >> So that's all we don't know. I mean most [93:29] of the studies stop at you know once [93:31] they get their results and we don't know [93:32] that if you stop will it just revert [93:35] back to normal? I don't know. And so the [93:37] other thing about this particular [93:38] traction device that's night is if you [93:40] have a curvature in the penis like you [93:41] develop something called Peron's [93:43] disease, this device can actually curve [93:46] a little bit away from if you like let's [93:48] say you have um indentation on the top [93:50] of the penis, it can actually bend away [93:52] from that and it can help straighten out [93:54] the penis. So, that's actually a a a [93:57] really nice utilization for it because [93:59] um for some people that can be really [94:01] traumatic and devastating to have a [94:03] change in the way your penis appears [94:05] because it starts curving all of a [94:06] sudden. And this is safe and effective [94:08] and you can have bruising. It can be [94:10] slightly uncomfortable, but it's you're [94:12] not going to really hurt yourself uh too [94:15] much by doing something like this. [94:16] >> I thought a curved penis would hit the [94:18] G-spot better. Yeah, sometimes a slight [94:20] curve can be beneficial for some people, [94:23] but again, I think like when you notice [94:25] like there's a a dramatic change. You do [94:28] that more. Come [laughter] [94:30] rip the end off. [94:31] >> It's okay. Um, [94:34] >> I'm just trying to figure out how this [94:35] works. So, I get the penis. I put it [94:38] >> through. Yeah. [94:40] >> Clamp it down. [94:41] >> And you want to put it at your normal. [94:42] And then you'll just slightly advance [94:44] the [clears throat] the length. You're [94:45] not going to pull crazy. easier. It's [94:46] going to do a little bit of traction so [94:48] it's not uncomfort. It's slight like [94:50] just a slight tension. It shouldn't be [94:51] like like that. It should be much [94:53] [laughter] less tension, but it is I [94:55] mean they can vary in price from $100 to [94:58] $500. So it's a onetime cost. It is not, [95:02] like I said, not dangerous. What is [95:04] dangerous is when people try to do [95:06] something that became popular on TikTok [95:08] called jelking. And jelking is where you [95:10] use your your hands and you make like an [95:13] okay sign with your fingers and you're [95:15] like stretching the penis with your [95:18] hands. And this can be dangerous because [95:21] you can create micro tears in the penis. [95:23] And we in the urology community have [95:24] seen plenty of patients who have now [95:27] developed erectile dysfunction after [95:29] doing jelking because they've now [95:30] created damage to their penis. And so I [95:34] I really caution people because this [95:36] there is so much despair around sexual [95:39] function, around penal health that [95:42] people are willing to try things and [95:44] they might really hurt themselves. No [95:46] joke, I had a patient the other day ask [95:48] me if he should drink hydrogen peroxide [95:50] because he saw some ad that said [95:52] hydrogen peroxide will fix your [95:54] erections and I said please don't. um [95:57] this is you know but he really was like [96:00] seriously earnestly asking me this [96:02] question and I you know I didn't want to [96:04] shame him by any means and I was like no [96:05] you know this is actually not safe and [96:07] it's not going to help you and there's [96:09] no pill there's no drink there's no [96:11] anything that's going to give you a [96:13] longer penis [96:15] >> what are the cases that you see that [96:16] break your heart [96:18] >> you know I I've seen so there I've seen [96:20] patients who've had surgery to lengthen [96:22] their penis and they are above average [96:25] when they at baseline and they have [96:27] these surgeries to lengthen their penis [96:28] and then they have a bad outcome and now [96:31] their penis is disfigured forever. And [96:33] that's what really um you never forget [96:36] that because that person knowing the [96:38] risks and benefits perhaps made a choice [96:40] and that choice didn't go the way they [96:42] wanted and now they have to live with [96:43] that for the rest of their life and [96:45] that's really sad. [96:46] >> Gosh, [96:48] imagine that. Christ [96:50] >> Yeah. [96:51] >> Well, and it just it doesn't work [96:53] anymore. Well, like the one patient I'm [96:56] thinking of, um, he, uh, had a like it [97:00] it basically developed a scar all at the [97:02] top of the penis. So, it was like [97:04] disfigured essentially. Um, and so it [97:08] was it was really sad. [97:10] >> Before I hit puberty, I definitely had a [97:12] penis anxiety because I was the youngest [97:14] in my year at school and I I was the I [97:18] was short, very very short, very small. [97:20] I remember what it felt like to like [97:22] hide my hide my dick [97:24] >> when I was around like guys in the [97:26] changing room and stuff like that. Um, [97:29] you know, after puberty things I [97:32] changed. [97:32] >> And what I want people to understand, I [97:34] think more than anything is that you [97:36] don't need a long penis to pleasure a [97:38] partner. We just talked about how the [97:40] clitoris is the is the most reliable [97:42] route to orgasm, right? And so you don't [97:45] need a penis to stimulate the clitoris. [97:48] You can use your mouth, your fingers, [97:50] you can use a toy. There's so many ways [97:52] to help your partner achieve pleasure. [97:56] And and yes, of course, there are a [97:58] small subset of women who really [97:59] appreciate a large fallus. But the large [98:02] majority of women, if you look at survey [98:04] data, are very happy with the size of [98:06] their partner, are very content with [98:09] average or slightly above average or [98:10] slightly below average as long as they [98:12] are feeling intimate and they're feeling [98:14] pleasure. And so I think that there's a [98:16] misnomer that that people think if I [98:18] have a longer penis I'm going to be able [98:20] to pleasure my partner more [98:22] >> as it relates to women. Is there [98:24] different size vaginas? [98:26] >> Yeah. So the a so just like there's [98:27] averages there's averages in females. [98:29] And so average vag vaginal length is [98:31] about 3 and 1/2 in. So when women get [98:34] aroused it expands and widens and [98:37] lengthens to about double. So the [98:40] average woman can easily accommodate the [98:42] average penis. maybe slightly larger [98:45] than average. And so I think generally [98:47] speaking, knowing that like you will be [98:49] able to fit in the average woman and you [98:52] will be able to please her with the size [98:54] of your fallus. And like I said, [98:56] penetration is is not as important. In [98:58] fact, only about 85% of women orgasm [99:01] through penetration alone. They need [99:03] clitoreral stimulation to achieve [99:04] climax. And so again, penetration feels [99:07] good. I I tell guys, it's like somebody [99:10] rubbing your testicles or your [99:12] paranneeium. feels good, but it's not [99:14] going to make you orgasm. And so [99:16] penetrating, yeah, if you're getting a [99:18] lot of clitoreral stimulation because [99:20] maybe she has a thinner, you know, her [99:22] clitoreral shaft is closer to the [99:24] vaginal canal, maybe, you know, the size [99:26] of the penis matters more. But for a lot [99:28] of women, it's not going to be [99:30] sufficient and they're going to need [99:31] some directed clitoreral stimulation. [99:33] Why do different vaginas feel different [99:35] to and I guess the the inverse is also [99:38] the case where like different penises [99:40] will feel remarkably different even if [99:42] they're the same size roughly and you [99:44] can have sex with somebody and go it [99:46] feels really good. [99:48] >> I mean I think again it's how you it's [99:50] like the emotion in the ocean right like [99:52] how you use your so let's let's talk [99:54] about the vaginas first. So, when a [99:56] vagina is um has more pelvic floor [99:59] strength, they may be able to like tense [100:02] around the penis better, like they may [100:04] be able to sort of grab the penis with [100:06] their pelvic floor a little stronger [100:08] versus someone who doesn't. And that's [100:09] where I think some people get worried [100:11] when I say, "Oh, you need to relax your [100:12] pelvic floor." They're like, "Oh, I [100:13] don't want to be looser." Right? And [100:16] that's not going to happen if you have a [100:17] normally functioning pelvic floor. If [100:19] you're [100:19] >> So, the penis is going in here, right? [100:21] >> Correct. So, if I if you're a woman and [100:23] you do pelvic floor exercises, then [100:25] you're going to feel tighter. [100:27] >> Well, you're you're able to contract and [100:30] squeeze those muscles during sex better [100:32] around the penis. [100:33] >> Yes. But we don't want you to be [100:34] tighter. We want you to be able to [100:36] squeeze the muscles and relax the [100:38] muscles. Use them like a normal muscle [100:39] like your bicep. You squeeze and relax. [100:41] Squeeze and relax. We don't want it to [100:42] be constantly squeezed. [100:44] >> But to the man, it will feel tighter. [100:46] >> You will perceive it as tighter, but it [100:47] will not be that she's actually tighter. [100:49] it just means that maybe her pelvic [100:50] floor muscles are doing a better job. So [100:53] that's for the female. For the male, [100:55] it's it's generally like how the penis [100:58] moves and how the positioning is and [101:00] where it's uh it may be girth that's [101:03] different. It may be the way that you're [101:05] moving in the vaginal canal and that may [101:08] be why it feels different. [101:09] >> They often say that if you've got big [101:11] feet or big hands, you know, like people [101:14] think you have a big penis. [101:15] >> Not necessarily true. So there's um [101:18] there's actually no evidence that big [101:19] hands, big feet correlate to female [101:21] size. There's one study in Japan where [101:23] they looked at nose length. And so the [101:26] longer your nose is from the the bridge [101:29] down to the tip, that is potent, at [101:32] least the Japanese population that they [101:34] studied was correlated with the length [101:35] of the penis. [101:39] >> People also think tall people have big [101:41] penises. Not necessarily. [101:44] [clears throat] [101:45] >> But nose length, there's some [101:47] correlation in a study in Japan. [101:48] >> Yes. [101:49] >> Okay. I was just checking if my nose. [101:52] [laughter] [101:52] >> Okay. Um the last thing I want to talk [101:54] to you about is [101:56] >> and how this relates to everything we've [101:58] talked about today, desire, attraction, [101:59] sex. Is there any early data emerging [102:01] that shows any correlations? [102:03] >> Yeah. So ompic there's sort of benefits [102:06] and there's potential downsides. So the [102:08] benefits are that when you're on Osmpic, [102:10] we see improvements in metabolic [102:12] diseases. They have improvements in [102:14] diabetes, improvements in heart disease, [102:16] improvements in overall health, right? [102:18] And so that is going to mean that your [102:20] blood vessels are healthier. You're more [102:22] able to get blood flow to your genitals. [102:24] You're going to have stronger sexual [102:26] function and arousal, right? So that's [102:29] great. The other thing is that you are [102:31] losing weight. So you feel better. you [102:33] feel more like your body image is is [102:36] feeling good about yourself. Also, for [102:38] men, remember I talked about this fat [102:40] pad right above your penis. [102:42] >> That's getting smaller. And so now you [102:44] can see more of your penis. So you may [102:46] have heard of ompic penis where people [102:47] are saying, "Oh, my penis is getting [102:48] longer." It's not actually that your [102:50] penis is getting longer. It's that this [102:51] fat is going down. So now you're seeing [102:53] more of your penis, [102:54] >> which makes it look longer. [102:56] >> Yes. Exactly. Reality. Yes. Exactly. [102:58] [laughter] [102:59] Well, it is reality to the person [103:00] looking. Right. Um so those are all [103:03] great things and I think that's [103:05] wonderful. Now the other part of it is [103:07] ompic works on the brain and it works on [103:09] the reward pathway. So you now see food [103:12] and you don't feel like it's that much [103:13] of a reward. So you don't chase after [103:15] you have less desire for food. There's [103:17] emerging data that we're seeing people [103:18] on these medications, these GLP1s, have [103:21] less desire for, let's say, gambling, [103:23] let's say shopping, let's say, you know, [103:25] alcohol, smoking, whatever it is, right? [103:28] And so there's a theoretical because it [103:30] works on the same pathways that it could [103:32] also decrease desire for sex. And I [103:35] think the thing that, you know, there's [103:36] so many people on these medications, [103:38] there's so many metabolic benefits that [103:40] I worry that people may not even realize [103:42] that their sexual desire is changing, [103:45] right? They might just be like, "Oh, you [103:47] know, I'm I'm eating less. I look great. [103:49] Everything's wonderful." But like slowly [103:50] in the background, they're like, "Oh, [103:52] maybe my desire is less." And maybe it's [103:54] creating discord in the relationship. [103:56] Hard to say because we don't have data [103:57] yet. So yeah, I think it's just [103:59] something that you should be aware of [104:00] that if you start feeling like you have [104:03] less desire for sex or maybe you're [104:05] like, "Man, I just really don't feel [104:06] into anything." Talk to your doctor cuz [104:09] maybe your dose is just too high and [104:11] maybe it just needs to come down a [104:12] little bit. And again, we don't know [104:14] yet. But I do worry about this because I [104:16] feel like we're we're gonna start seeing [104:18] it. [104:19] >> Is it possible to do studies on this [104:20] type of thing? [snorts] [104:22] >> Absolutely. So you can take people [104:24] starting Ozmpi and you can say, "Hey, [104:26] here is or or any GLP1." You know, [104:29] there's questionnaires. So like for [104:30] women there's the female sexual function [104:32] index. For men there's Adam, which is a [104:33] questionnaire about testosterone. But [104:35] you could there's sexual desire [104:36] questionnaires that you can use. Um, and [104:38] you can take it at the beginning and [104:39] then you can take it as they increase [104:41] their dose and see if there's a change, [104:43] right, in terms of their sexual desire. [104:45] >> You said at the start about knowing how [104:48] to talk to your partner. I think like [104:50] intimacy desire, maybe the conversations [104:51] like with your partner, how to have that [104:53] conversation when there's a problem. [104:54] >> Yeah. I I wish I could say there was [104:56] like a script that you can follow and [104:57] it's going to work. But everyone's so [104:59] different. But I think the important [105:00] thing is like not giving up because what [105:03] happens is because we don't ever talk [105:05] about sex, when you bring it up, it's [105:07] immediately like, "Oh my god, is [105:08] something wrong? Did I do something [105:09] wrong? Um, do you not like me? Am I not [105:11] attractive?" Right? You're automatically [105:13] going down the rabbit hole of worry and [105:15] concern. And instead of dealing with it, [105:17] you're supposed to shut it down. No, I [105:18] don't want to talk about it. Right? Um [105:19] especially if like maybe you haven't [105:21] connected intimately in a while and like [105:23] you just don't want to deal with that or [105:24] you're you have other stressors in life. [105:27] Maybe you're not feeling like very good [105:29] about yourself and so you're like, [105:30] "Well, I don't really feel sexy, so I [105:32] don't want to have sex." And so, I think [105:34] really understanding that whatever [105:36] reaction you get from your partner when [105:37] you do talk to them, it's not about you. [105:39] It's just usually about how they're [105:40] feeling. And so, don't stress about [105:42] that. And two, like it's anything that [105:45] is worth having requires work. So having [105:48] a good sex life, having intimacy over [105:51] the long haul with someone, if you are [105:54] committed to that relationship, it is [105:56] worth working for. It is worth dealing [105:58] with a little bit of discord to get [106:00] there. And so I tell people when you [106:02] want to talk about sex, first of all, [106:03] don't do it in the bedroom. Don't do it [106:05] right before or after sex. Do it at a [106:07] time where you are both calm, relaxed. [106:09] Maybe you're out for a walk, maybe [106:10] you're in the car, so you're not like [106:12] looking directly at each other. You're [106:13] kind of parallel. And always start with [106:15] a positive thing. like I you know I [106:17] really enjoy this about our relationship [106:19] and I would love if we could talk about [106:21] this and and maybe they're going to be [106:23] like uh I'm not ready for that and you [106:25] say maybe we could come up with a time [106:27] where we can talk about this that works [106:28] for you right let them feel like they're [106:30] coming to the conversation with like [106:32] they're not being ambushed or like [106:34] talking about something and then be [106:35] curious. I think the big thing is like [106:37] being curious like what's going on with [106:39] you like I want to I want to I want to [106:41] be there for you. I love you. you know, [106:43] I miss what we used to have or I miss [106:45] this about us. And I think that there's [106:47] always these misconceptions. I hear it [106:49] all the time, right? It'll be like this [106:51] partner only wants sex and this partner [106:53] never wants sex and you know, and that's [106:56] it. Like that's the end of the [106:57] conversation. But the reality is that [106:59] there it's it's somewhere in between. So [107:01] typically women tend to view sex as like [107:05] added stress sometimes when they're [107:06] already stressed. Like they're like, [107:07] "Oh, it's just one more thing to do." [107:10] Whereas men look at it as a stress [107:11] relief. So, one, you're coming at it [107:13] from two different angles. The other [107:15] thing is men aren't really taught how to [107:17] be intimate. And so, for a lot of men, [107:20] sex is their version of intimacy. Like, [107:22] that's how they connect. That's how they [107:24] feel connected with a partner. And so, [107:27] often times when they're doing these [107:29] initiations or attempts at sex, it feels [107:31] like they're being greedy or it feels [107:32] like they're they just want sex. And I [107:34] think we have to reframe how we look at [107:36] that. Like, sex is not just sex. It is [107:38] intimacy. It is being together [107:40] connecting with another human being. So [107:42] how do we do that right? And like how do [107:45] we make that sex worth having? We get [107:48] into this frame where we have sex as [107:50] like in a hurried quick like just got to [107:53] get this done way. I just need to get an [107:54] orgasm. I just need to get a release. [107:56] But sex is supposed to be something we [107:58] look forward to. It's supposed to be [107:59] something that we're excited about. And [108:01] so we have to build that in. We have to [108:02] sort of like build the environment where [108:05] sex can can happen. So, it may mean [108:08] like, "Hey, we are affectionate during [108:10] the day. Maybe we send a lovey text [108:12] message. Maybe um you know, I give you a [108:14] hug. I caress your back. I um tell you [108:17] you look beautiful. I I'm I'm showing [108:18] you gratitude for how much I care about [108:20] you in other ways." I think just really [108:23] taking the time to understand why your [108:25] partner feels the way they do. [108:26] >> I'm curious about on that communication [108:28] point about how different genders [108:31] in heterosexual couples have different [108:33] sort of taboos and things that are just [108:35] a bit sensitive. Um, and I was looking [108:37] at the the variance between men and [108:39] women, and the the top one for men was [108:41] around performance anxiety. So, like [108:43] admitting to things like erectile [108:44] dysfunction because it feels like it's [108:46] so intrinsically connected to [108:47] masculinity [108:49] >> and you feel like a failure as a man if [108:50] you can't get a erection and pleasure [108:52] your partner, right? [108:53] >> And then for women, it was talking about [108:54] um prioritizing pleasure and asking for [108:57] more foreplay or um, you know, specific [109:01] specific stimul stimulation around the [109:03] clitoris or something like that. um [109:05] because they don't want to be labeled as [109:06] highmaintenance or too much hard work, [109:09] etc. [109:10] >> And it's interesting that on that walk [109:11] with your partner, there are different [109:13] things that will trigger each of you. [109:15] >> Mhm. [109:16] >> Um other ones for women were pain and [109:18] discomfort, bringing that up. Um body [109:20] image and the mental load, explaining [109:22] why you aren't in the mood. And other [109:24] ones for men are expressing nonsexual [109:26] needs because it might be seen as [109:26] unmanly, unmanly, boundaries and [109:29] rejection, communicating when they don't [109:30] want sex. And lastly, the script, which [109:32] is discussing fantasies that deviate [109:33] from the norm. [109:35] >> So, I want to talk about fantasy, but [109:36] before that, I would just say that, you [109:38] know, it because of social media, we're [109:40] in a place and I get text messages from [109:43] my husband 24 hours a day with like not [109:44] 24 hours a day, but like all waking [109:46] hours with reals and videos. Oh, I think [109:49] you'd like this. I think you'd like [109:50] this. You should check this out. And [109:52] it's like his way of like connecting and [109:54] like, hey, let's talk about this later. [109:55] Like, this is fun. And so I I tell my [109:57] patients like send your partner a a [109:59] video that you saw on social media that [110:01] might help them understand like why this [110:03] is important to you. Maybe send them a [110:05] video send them this podcast, right? Say [110:07] like, "Hey, I watched this. It was [110:08] great." Good idea. You know, um and I I [110:10] learned so much. And honestly, so many [110:12] patients bring their partners to me. [110:14] Whether it's women bringing male [110:15] partners or men bringing female [110:17] partners, they come to me and they say, [110:19] "Look, like I want you to meet this [110:20] doctor and I want you to talk to them." [110:21] And like it's beautiful to see that. [110:24] Like I love it because it's it's so [110:26] deeply caring that they like brought [110:28] their partner and they want them to feel [110:30] good and they just want to figure out [110:31] what's going on and like I think it's so [110:33] lovely to to to find someone who's so [110:35] invested in making sure that sex is good [110:37] for you, right? [110:38] >> As men though, we're just not good at [110:39] talking about this stuff, [110:41] >> right? But you know, I think you can't [110:42] use that as a crutch. [110:44] >> Yeah. [110:44] >> Do you know what I mean? Like [110:45] >> Yeah, I do. Yeah. We're just not good at [110:47] it though. We just [110:48] >> But no one's good at it. It's not men. [110:49] Women are not good at it either. [110:51] >> I think men are worse at it. I think in [110:53] general no one is good at talking about [110:54] sex. Like I, you know, I think it's [110:57] interesting because I talk about it all [110:58] the time, but I have seen very good [111:01] communicators struggle with talking [111:03] about sex. And so I think it's just um [111:06] it's just it's uncomfortable and and [111:08] it's like if you and I can have this [111:10] conversation and we can talk about sex [111:12] openly, like there's no reason that you [111:14] can't learn how to talk about sex and it [111:16] it's it's a learning process and it's [111:18] worth it's worth investing in. Do people [111:20] bring you their fantasies? [111:22] >> Yeah, I've had I've had well more not [111:24] not as many fantasies as like real sort [111:27] of diverse interests in sex. [111:30] >> What do you mean by So I had a patient [111:32] who came to me and said uh you know [111:34] after sometimes this was not like our [111:36] first visit like we built a rapport and [111:38] he told me you know the I I really [111:40] struggle with arousal and the only time [111:42] I get aroused is I have a a medical kink [111:45] and so I go to this person who will put [111:47] a fully catheter in me and that's what [111:50] turns me on. And I was like that's [111:52] really interesting. And I was like, [111:53] "Okay, like that's that's great, but [111:55] like it took a long time for us to get [111:56] there for him to feel comfortable." But [111:58] it also then was like, "Well, if that's [111:59] what turns you on, you know, then you [112:02] got to sort of explore other ways to [112:03] incorporate that with a partner. Maybe [112:05] not." So like a a catheter is is um is a [112:09] tube that you put in the bladder for to [112:11] drain urine. [112:13] >> What hole does that go in? [112:14] >> The urethra. [112:15] >> It goes in the penis. [112:16] >> Correct. And so there's actually a lot [112:18] of people who enjoy urethral play. So [112:20] they will take sounds, they're called [112:22] sounds, like little um uh rods with a [112:25] frail flared base and they will insert [112:27] them in the urethra. [112:29] But people do find that pleasurable. And [112:31] so because there is some, you know, [112:33] there there are some nerve endings there [112:34] that can be pleasurable. And so again, [112:37] it is totally fine to have interests [112:39] that are, you know, outside what we call [112:41] conventional. Um, but of course I think [112:43] you need to uh if that's something that [112:45] you're really into, you have to sort of [112:46] bring your partner into the into the [112:48] fold if that's what really gets you [112:50] turned on. Now, in terms of fantasies, [112:52] almost everyone fantasizes, right? [112:54] Almost everyone does. And the [112:56] interesting thing when you look at [112:57] fantasies is there's a lot of fantasies [113:00] that you would think are not common but [113:02] are. So, for example, um being sexually [113:05] submissive is very common. So women [113:08] fantasize about it like around 60%, men [113:11] are like 20%, having this desire of sex, [113:15] this fantasy of sexual submission. It [113:16] may not mean that they want to be [113:18] submissive in real life, but that's the [113:19] fantasy they're having. Um, men often [113:22] have voyerism fantasy. So like watching [113:26] sex. Um, they also have uh sex with [113:29] multiple partners. Um, women tend to [113:32] have a lot of like sexual um dominance [113:34] but also romance in their fantasies. So [113:36] like in exotic places or um that or with [113:39] and a lot of times like 90% of the time [113:42] people fantasize about strangers or it [113:44] could be someone they know but outside [113:45] of their relationship and so that's [113:46] completely normal and nothing to be [113:48] worried about. It doesn't mean that like [113:49] you want that person. It's just a [113:50] fantasy. It's a safe place in your head [113:52] to think about fantasy. And I think one [113:55] realizing if someone fantasizes about [113:57] something it means nothing about how [113:58] they feel about you. It's just where [114:00] their brain goes to explore. I tell my [114:02] patients sometimes write down your [114:03] fantasies for yourself. Just like write [114:05] them down. Don't share that with anybody [114:06] and have your partner do the same. And [114:08] then if you guys decide you feel [114:09] comfortable at some point to each share [114:11] one fantasy and you can start talk and [114:13] maybe one that you would want to try and [114:15] like it allows you to sort of explore [114:17] and think about different things. It [114:19] could be a negative outcome like you [114:20] could just be like oh no this what [114:21] didn't do it for me but it could also be [114:23] very positive. And so just like again I [114:25] think the big thing is understanding [114:26] like it doesn't need to be that serious. [114:28] like we can experiment, we can play, we [114:30] can have fun. And if you bring that back [114:33] into your life, you are going to be [114:34] happier, less lonely, live longer. Like [114:38] everyone should just be having more sex. [114:42] >> It's um Yeah, it's interesting that [114:44] we're getting more and more sexless [114:46] because I think the world is stealing [114:49] our attention and that's causing a big [114:51] loss in connection. But then everyone's [114:52] lives are more stressful than ever [114:54] before. if a bomb goes off 10,000 miles [114:57] that way, I I see it when I open my [114:59] phone. [114:59] >> Um, so it's an interesting time to sort [115:01] of almost try and reclaim sex and [115:05] >> to work on one's sexual health, the [115:08] overall the full picture of one's sexual [115:10] health. Um, you're working on a book [115:12] which is, I guess, endeavoring to do [115:14] much of that, which is coming out in [115:15] September [115:16] >> called The Hard Truth: Everything Men [115:18] Need to Know About Good Health, Great [115:20] Sex, and Long Life. So, if you're [115:21] watching this after the 1st of September [115:24] 2026 or around that time, then the book [115:26] is probably available for pre-order or [115:28] already out. It's not available for [115:29] pre-order yet, is it? [115:30] >> Uh, it will be soon, but not yet. [115:32] >> Okay. When the book is out, I'm going to [115:34] link it below in the comments section. [115:35] Um, when it's available for pre-order, [115:37] The Hard Truth: Everything Men Need to [115:38] Know About Good Health, Great Sex, and [115:40] Long Life. So, if the subjects we talked [115:42] about today have piqu your interest, the [115:45] book, I imagine, is going to go into [115:46] greater detail on all of these subjects. [115:48] >> Absolutely. I think it's a book that [115:50] really I I wish was a part of sexual [115:52] education. I think all men need to know [115:54] this. You know, as women, we end up [115:57] taking care of our male partners. I make [115:59] all the doctor's appointments. I, you [116:01] know, I organize all of that. I make [116:03] sure that my kids get all their [116:04] vaccines, all that sort of stuff. And [116:06] and you know, it becomes on us to take [116:08] care of our fathers, too. And so, as [116:09] women, we hold that role. And I think it [116:12] is so valuable to understand what men go [116:16] through and also to be able to support [116:17] them along the way. And I think it's a [116:20] great gift for, you know, men in your [116:22] life or for, you know, older sons even [116:25] to like help people understand their [116:27] bodies. And honestly, it's a huge [116:28] motivator. I tell people like for [116:30] nothing else, people care about sex. And [116:33] I have seen patients turn around their [116:35] lives because they want to have better [116:37] sex. They'll literally improve their [116:38] blood sugars. They'll improve their [116:41] blood pressure because they just want to [116:42] protect their sexual health. [116:44] >> Reena, thank you. We have a um closing [116:46] tradition on this podcast where the last [116:48] guest leaves a question for the next [116:49] guest not knowing who they're leaving it [116:50] for. [116:50] >> Mhm. [116:50] >> This is the first time in Dario history [116:53] where the guest has actually stamped it [116:56] with a stamp that says certified 100% [116:59] human. [117:00] >> Okay. [117:00] >> So, you can see there's a little stamp. [117:02] >> So, when is that AI? [117:03] >> So, it's not AI and it actually says [117:04] that in the middle. It says Gen AI free [117:08] sign of things to come. But their [117:10] question I guess is somewhat linked to [117:11] that. They the question they've asked [117:12] for you is so much of the world feels [117:15] hopeless about this moment. What would [117:18] you tell someone to help them [117:20] [clears throat] [117:20] reclaim their agency? [117:29] I think that [117:33] we as humans are meant to be with other [117:36] humans. We are meant to connect and I [117:40] think making that a priority will allow [117:43] people to feel [117:46] um to feel a part of something again. [117:49] You know, I think um I think there is [117:51] like an emergence of people starting to [117:53] look back at religious constructs and [117:56] and go to community and be a part of [117:58] things and enjoy live events again like [118:01] we weren't doing before. I think if we [118:03] prioritize that, there is still hope [118:05] that we can come together as a society. [118:08] And I think, you know, the pendulum [118:10] always swings right in every way, like [118:12] it's going to go far right or far left [118:14] and people are going to hate each other [118:16] and then they're going to love each [118:17] other and they're going to come back. [118:18] And I think if you just look at history [118:20] time and time again, it repeats itself. [118:22] And we will find unity and we will find [118:26] togetherness. We are obviously feeling [118:28] pain from a variety of different sources [118:31] and we may feel pain right like in terms [118:33] of other things to come but ultimately I [118:36] I'm an optimist and I think that we'll [118:38] come together and and we will find um [118:41] happiness and joy in human connection [118:44] >> and I hope you're right and I think [118:46] we're seeing the early signs of that now [118:48] for anyone that's listening that wants [118:49] to learn more from Reena um I highly [118:51] recommend they go to your YouTube [118:52] channel I will collab if we can um and [118:55] if we do collab on YouTube you'll a [118:57] little smiling Reena um next to the Dar [119:00] of Seio logo where you can click through [119:01] to her YouTube channel. She's got almost [119:03] 3 million subscribers and she goes [119:05] through all of the questions which no [119:08] one has ever answered for us. And I was [119:09] looking at some of the questions that [119:11] you answer for people. Everything from [119:13] >> why you dribble after you pee and how to [119:16] stop it. porn director reveals what what [119:19] scenes are faked in almost every scene [119:21] of movies, but then also a lot of the [119:23] stuff we've talked about today around um [119:25] penal health, erectile dysfunction, um [119:28] sex positions, and so much more. So, [119:30] it's a wonderful repository of [119:32] information that is constantly being [119:34] updated. That is a great place to [119:35] subscribe. So, I highly recommend you [119:36] do. Dr. Reena, thank you so much for [119:38] your time. [119:39] >> You're so welcome. YouTube have this new [119:40] crazy algorithm where they know exactly [119:42] what video you would like to watch next [119:44] based on AI and all of your viewing [119:46] behavior. And the algorithm says that [119:49] this video is the perfect video for you. [119:52] It's different for everybody looking [119:53] right now. Check this video out and I [119:55] bet you you might love