The Mel Robbins Podcast - The Most Important Sex Advice No One Ever Told You: Revamp Your Sex Life in 10 Minutes

Episode Date: June 13, 2024

Do you want to have better sex?Or even know how often you should be having sex – according to research?Today, Dr. Rena Malik, MD is in the house to answer all of your uncomfortable sex questions.Dr. Malik is an absolute powerhouse who is known for her viral, no-shame, straight-to-the-point advice on how to have the best sex of your life. She is a top urologist, pelvic surgeon, and sexual health expert – and she’s here today giving you the truth, based on medical research, on things like G-spots, orgasms, libido, and even erectile dysfunction. You’ll also learn the single biggest thing that you are getting wrong in your sex life, according to one of the top urologists in the country.Dr. Malik is an assistant professor at the University of Maryland School of Medicine and the Director of Female Pelvic Medicine & Reconstructive Surgery. She is also a researcher who has published over 100 peer-reviewed research articles, multiple review articles, and book chapters.You're going to want to share this conversation and all the juicy details with every one of your friends, and most importantly, your significant other.Great sex starts today.For more resources, including links to Dr. Rena Malik’s research, website, and social media, click here for the podcast episode page. If you liked this research-packed episode, you’ll love listening to this episode next: The #1 Neuroscientist: After Listening to This, Your Brain Will Not Be the Same.Connect with Mel: Watch the episodes on YouTubeGo deeper with Mel’s free video course, Make It HappenFollow Mel on Instagram The Mel Robbins Podcast InstagramMel's TikTok Sign up for Mel’s personal letter Disclaimer

Hey, it's your friend Mel, and welcome to the Mel Robbins Podcast. It is such an honor to get to spend this time with you today right now, and I also want to acknowledge you. Thank you for choosing to listen to something that could help you create a better life. That is so awesome that you're taking time for yourself. If you're brand new to the Mel Robbins Podcast, welcome to the family. And as you're getting to know your friend Mel, you're probably starting to think, Mel doesn't seem to be embarrassed by anything. I mean,

it seems like no subject is off limits with this chick. She's like the most confident person I know. Well, there's actually a topic that makes me feel a little insecure. You know, when this topic comes up, I'm going to admit to you, I'm a little squeamish. I mean, you might even say, Mel, she's kind of a prude. I definitely feel embarrassed bringing this subject up. So what is the topic? Sex. I mean, I've been married for 28 years, and I would like to have better sex. Wouldn't you like to have better sex? Of course. But I'm not quite sure how to talk about it.

And it's not like my husband, Chris, is doing anything wrong, but I just kind of feel like it could be better. I mean, maybe there's something I didn't know that I didn't know. And you want to know what else is kind of funny? It's easier for me to talk to you about sex than it is for me to talk to my husband about it. And when you think about your own sex life

and the people that you're sleeping with, I bet you can relate, right? So today, I have called in somebody who you and I can talk to, Dr. Rina Malik. She is a renowned urologist and pelvic surgeon and an expert on sexual health and every question that you've either wanted to ask someone or simply wondered about.

Hmm, well, you're gonna get the medical and factual truth today. Like what exactly is the G-spot and how do I find it? And did you know there are three types of orgasms in three different places that a woman can have? And by the way, this isn't just a conversation for we ladies. We are gonna talk about low testosterone. What do you do when your libido drops?

And did you know that erectile dysfunction is often the very first sign of heart disease? And when it happens in your relationship, what is the most positive and empowering way to move through that issue? We're also gonna cover the single biggest thing that Dr. Rina says you are getting wrong in your sex life. And we're even gonna get into the really embarrassing things. All the questions that you've been afraid to ask or just wondered about, I'm going there for the both embarrassing things. All the questions that you've been afraid to ask

or just wondered about, I'm going there for the both of us. So you better put your arm around me as we jump into this. And I'm sure you're gonna wanna share this conversation and all the details with every one of your friends and most importantly, your significant other. Because great sex starts right now. I am thrilled to welcome Dr. Rina Malik to the Mel Robbins podcast.

She is a board certified fellowship trained urologist, pelvic surgeon, and sexual health expert. She specializes in female pelvic medicine and reconstructive surgery and sexual medicine. She runs an extraordinarily busy medical practice that offers patient-focused care in sexual health, bladder health, and hormone management, including an expertise in menopause and low testosterone. Dr. Rina is a powerhouse, and hormone management, including an expertise in menopause and low testosterone. Dr. Rina is a powerhouse, and she is known for her no-shame, science-backed YouTube videos on sexual health that have over 300 million views.

Dr. Rina has also published over 80 peer-reviewed research articles, and she was recently distinguished with the title of the 2020 American Urological Association Young Urologist of the Year Award. And if I keep talking to you about her credentials, I am going to chicken out on all the embarrassing questions about sex that are on my note cards in front of me. So how about you and I just jump right in because you and I have a lot to learn on how to have better sex starting tonight. Dr. Rina, I cannot wait to dig into this conversation. I'm so glad to be here. So I wanna start by just asking you to speak directly to the person who's listening

and explain what they might expect to change about their life if they take everything that you're about to share today to heart. Yeah. So when you listen to this episode, you are going to figure out the answers to all those embarrassing questions. You've never felt comfortable asking anyone. You're going to feel more comfortable in your body. You will probably go take a mirror and look at your genitals and really analyze them, because that's really important.

We don't look at our bodies. So keep listening. You're going to learn a ton of very important, helpful information that'll help you feel empowered to take care of your sex life. Wow. I'm now focused, of course, about looking at my genitals, which I'm like, I'm not doing on YouTube right now, or I'm not going to do play by play as you listen to the podcast. But I can't wait to hear how that's involved. But can we start by just defining sexual health? What is it? So I always say that sexual health is health, right? We think of it as something completely different. Like it's just a side of our lives, but it's actually a big part of our lives.

So it is, you know, defined as something that you have psychological, emotional, physical well-being associated with pleasure, right? Giving and receiving pleasure. But it's much more than that, right? It affects us psychologically when you're not having good sex. It affects us physically sometimes. And it really like is a big part of shame. And we're gonna talk about that, I'm sure,

about how sometimes when you have problems with sex, you feel shame. But the other big thing is when you're having problems sometimes that can signal other health conditions. So if you're having for example men who have erectile dysfunction are more likely to have heart disease and so you're more likely to see erectile dysfunction first before you see heart problems. And when we don't have the data on that for women it's probably very similar because the genitals actually act very similarly.

I'm not sure I've ever heard anybody define sexual health in such a comprehensive and holistic way. Because when I think about sexual health, I think, is my sex life healthy? And does that mean I'm having enough of it? Am I enjoying it? But you're talking about it an entirely different construct, which is it's integrated into your whole health

and wellbeing as a human being. Absolutely. Wow. So what do we get wrong about our bodies when it comes to sexual health? Well, I think a lot of it comes from what we see on media, right? We see these people, they see each other, they immediately want to have sex, they rip

off their clothes, and they orgasm within seconds, right? The male penetrates the female in a heterosexual relationship, the woman's orgasming in seconds, and it looks like the best time of their life. And that's not real life, right? That's not what sex is. Sex is playful. Sex is supposed to be fun. Sex is supposed to be a time to explore

and try new things and sometimes be awkward and weird, right? There's weird noises. There's, you know, funny things that happen just like they happen anywhere in life. And sometimes it takes longer. Sometimes it's quicker, but it's all sort of variation of normal. And sometimes it's not normal, but ultimately it's play. And I think what we really get wrong is we take it way too seriously and we take it so deeply into our souls as something to be insecure about or uncomfortable about when really it should be something, the only time adults play is during sex.

So we should allow ourselves to play and have fun. I think you might've just changed my marriage. No, I've been married for 28 years and I love having sex with my husband, and at the same time, we have been together as partners for 30 years. And I have always thought about sex as like intimacy and orgasm and pleasure. That's it. And so the idea of redefining it as a moment and a chance for play was somebody that I

love because you're right, like I would be mortified even though I've been with Chris for 30 years to have something embarrassing, whether it's a smell or a noise emit during like ruin the mood. But if you think about it from the framework of play, it kind of changes everything. Yeah, it allows you to explore, try things that you've never tried before. And that's part of like when you've been together for a long time, right? You sort of get a script, right? You do the same thing, you know it works, you're going to achieve climax doing this

way this time, but then it becomes boring, right? So you need to have that room to play and try different things and be okay with it being awkward or funny or not great. Like every sexual encounter doesn't need to be mind blowing. It's okay to occasionally have mediocre sex, but like use it as a tool. You only get better at sex as you do more, have more sex. And as you, you know, try new things, you will get better at those new things as well.

Well, you know, if I think back to when I was younger, right, before I got married and have been in this relationship with Chris, I think I was relying on new partners to have the sex be different or fun. But I would imagine that you're gonna tell us it's incredibly important that you bring that yourself to your sexual encounters, this ability to play,

to experiment regardless of whether you're in a long-standing committed relationship or you are, you know, having sex with multiple partners. Absolutely. I mean, you sort of have to have variety, right? In anything in life, right? You don't have the same meal every day. You don't eat the same dinner every day. You're sort of doing maybe a different workout every day. Like, you're trying different things all the time. And so just like in your day-to-day activities, sex needs to be a little variable at times. Well, I was just laughing to myself

because I'm sitting here thinking, well, maybe we've been sex fasting to try to make it interesting since it hasn't changed in a while. And that's not a bad thing. That's not a bad thing. That's true. One thing that I think a lot of us wonder is how much sex is normal and how much lack of sex. Like I'm not asking the question right, but what's the average amount of sex that people are actually having?

Yeah. So first off, what's normal? What's normal is so individual, right? So as long as you are both satisfied with the amount of sex you're having, like say you're having mind blowing sex once a month and you're so happy with that, that's fine, right? But let me tell you some averages. On average, the average American has sex 52 times a year. So about once a week, if, but that's very based on age. So you look at a 20 year old, they're having sex about 80 times a year. So that's, you know, maybe once a week, so maybe twice a week. Whereas a 60 year old is they're having sex about 80 times a year. So that's, you know, maybe once a week, so maybe twice a week.

Whereas a 60 year old is more on the order of 20 times a year. So maybe once every two weeks or so. And so it's variable. But you know, what is a sexless marriage? So there's no true definition, but like the researchers will define it as less than 10 times a year. But again, like I said, if you're having sex 10 times a year and you're super satisfied, both of you, then it's not sexless.

It's passionate, it's enjoyable, it's great. So I think ultimately it's very individualized, but really realizing that there's no benchmark you have to meet. Well, I think that there's, at least speaking for myself, there's always this sense that it's not enough. Not only because I would love to have more and so would my husband, but also the sense that other people are having a lot of sex and that there's

something wrong with us or our relationship because we're too tired or, you know, we mean to but then we don't or life gets in the way. And so I do think that a lot of us get caught up in our heads wondering, am I having enough sex? Am I not having enough sex? And I suspect you're about to tell me, Dr. Rina, that I need to be talking to my partner about this and not you on a podcast. Exactly.

Exactly. It's really a couple thing. It's not a, or if you're multiple non-monogamous relationships, then it's you and those partners, right? But ultimately it is not about keeping up with the Joneses, right? They could be having five-minute sex four times a week and you're having like a passionate lovemaking experience that lasts an hour once a week. But it really, it's all about what you enjoy, what you like, what your partner feels good

about. And that's what matters. It is not about what your neighbors are doing or your other partners or how often. Like I was watching this TV show where this actress, they had like a swing in their bedroom and they were like, oh, we use it every day. And I was like, oh, I even felt like, oh man,

like they're having a lot of sex. That's a lot, you know, that's amazing. And you know, is that something to aspire to? I'm like, yeah, if you have the energy and excitement and you both want that, great. But let's be real, most people are busy, right? They're taking care of kids or aging parents or taking care of work, becoming busier in their job.

And that's just not realistic for a lot of people. Well, if I put a swing in my bedroom, it would become a rack for dirty clothing, you know, that you kind of throw things on. So how long should sex last? Yeah, so this is a great question. On average, people think that sex lasts, men think that it should last, should last about 16 minutes. They think it lasts about eight.

This is again, like the whole experience. Women want it to last about 25 minutes, but they've actually done studies where they've had couples have sex around the world, okay? And they've had them use stopwatches. So like the female partner will turn on the stopwatch when they penetrate and turn off the stopwatch when they stop penetrating.

And the average time is about 5.7 minutes. So 5.3 to 5.7 minutes. So it's really not that long, not as long as we think. And that range is really wide. So it's like from 0.1 minute to 53 minutes. So, you know, again, it's a huge variability, but ultimately, again, it comes down to, are you satisfied? Are you having an orgasm? Is he having an orgasm? Are you both feeling happy at the end of it? Because that timer doesn't include foreplay. That timer doesn't include the other things that you're doing. This is only talking about penetrative sex. Now, is that all sex is? No, right? Sex is oral, maybe manual, anal. It could be non-genital. Like you could still call sex, like you're naked and you're stimulating other

parts of the body. So really,, like, what is sex defined as and are you both deriving pleasure from it? And I like to say, like, it's also about the journey, not just the destination. Like, yeah, orgasms are great and everybody wants an orgasm, but, like, is the rest of it fun? Are you enjoying the intimacy part of it, the tactile part of it, the stimulation, that sort of stuff, like, that matters?

Well, and to your point, the playfulness of it. How does a woman's vagina expand during sex? Yeah, so during sex, you know, there's a lot of changes, not just the vagina expanding. So on average, the width is about 3 to 3.5 centimeters and the length is about 8 to 9 centimeters. And that will actually double in length and width. Double? Double. It can up to double during arousal and to allow for, you know, getting ready for penetration, whether it's through a phallus, a finger, a toy, whatever, it's going to

enlarge. The other thing that happens is the labia majora will shrink because they're usually closed off to make it little, keep the introitus closed a bit so they will kind of shrink a little bit as well as the clitoral hood or the hood on top of the clitoris and the labia minora will get engorged they will get bigger and they will turn red or pinkish in color so our body is just like amazing it really protects us so that when we're about to have sex we're not going to hurt ourselves right you start making lubrication you start getting wider you you start getting longer, your cervix moves up and out of the way because sometimes it can be painful if you're

penetrating and the cervix is still there for some people that's painful. So your body does all these things to make sure sex will be pleasurable. Wow, how long does it take your body to do that? So everyone's a bit different. We know that it's, you know, estimated maybe it can take up to 25 minutes for some women. So foreplay needs to be a part of sex for some people. Now some people are faster, some people are longer, but ultimately like most women can tell you when they're ready, right? They can have that, so say you know what, I'm ready, I feel ready, or I'm not ready. And I think the issue is sometimes people don't speak up about those things, right?

They're just like, oh, like, okay, maybe it's uncomfortable. Maybe it'll be fine in a minute. Right. But like really, there's a whole process. And then the other thing about lubrication, a lot of people get wrong is they think that if you're well lubricated, you're aroused. And if you're not, you're not. But that's not exactly true. Certainly, there's many people where well lubrication correlates with arousal. However, there's some people who lubrication correlates with arousal. However, there's some people who lubricate not because of arousal, just because of other

things. Like what? What would you lubricate for? Say you feel a threat is coming on, you know, and your body prepares itself so it doesn't get hurt. And so it might lubricate for that reason, or it may see something that it seems somewhat erotic or it may feel something somewhat erotic. And so your body just says, oh, that that's sort of, you know, you should get ready,

but you may not mentally feel aroused. Right. But then there's people who are turned on and they don't make as much lubrication. Now, that can be due to genetics that can be due to hormones. So like going through menopause, things like that, lubrication decreases. It doesn't mean they're not aroused. That means you need to use lubricant or you need to consider other treatments to increase lubrication for the woman who may be struggling with that.

Well, it's interesting to hear you explain the actual medical mechanics of what's going on in our body, because I'd always just thought about foreplay kind of as a warmup, getting yourself in the mood. But when you all of a sudden said your cervix moves out of the way to get ready so that your vagina can double in length and width, I'm like, holy cow, there's a whole lot going on that takes a little bit

of time, which is why it makes it even more important in some cases to really open yourself up to the play and to give your body the chance to even relax and do it so you can enjoy it. Absolutely. And is that length of time different for men typically? So men, it's sort of very binary. They get an erection or they don't, right?

And so that is not always the only sign that they're gonna have with arousal. You'll also see both men and women will have nipples sort of become more erect. There's other signs as well, but very often they're seeing the manifestation of that increased blood flow through penile erection. Now in women, the homolog is their clitoris gets erect.

The homolog? What is that? A homolog is essentially when you have two structures that are made from the same embryologic tissues and they develop into their variety of structures. So in men and women, you start off with a genital bud, and this in men becomes the penis and in women becomes a clitoris. So they are exactly identical. If you cut open an anatomical visual of the penis and the clitoris, they're identical. They have two

bodies of erectile tissue, two spongy bodies that fill and engorge with blood, they look exactly the same. That's wild. Yeah, so that's why I mentioned earlier, looking at your own body with a mirror. So one, it's also so that you can, if something is abnormal, you can see it, right? Cause sometimes people will have skin conditions

and they won't know, they've never looked down there, right? So that's one reason. But two is to identify where is the clitoris, like pull back the clitoral hood, does it come back easily? A lot of women don't realize that they can actually get smegma or like, you know how if you have sons,

you'll know this little boys get smegma under their foreskin. It's sort of like dead skin cells and oil. And you can actually. I'm laughing because they used to call the guy that I dated in high school smegma It's terrible thing but okay, so women can get that too Yeah, so sometimes that develops and because women don't know they don't look they don't ever pull back the hood of the clitoris

Which is basically like foreskin is the exact homolog again that same word of male foreskin If you don't pull it back You won't actually know that there's something developing under there that could then lead to discomfort, pain, maybe having less of a strong orgasm or having no orgasm at all. And so, you know, you have to look down there so you can see what your normal structures look like, where everything's located, and then you can actually identify, you know, what is normal and not normal if things change You can look down there and you can say hey, I saw this before and it's different now

If we were to take a mirror and take a look at ourselves. Yeah, what are we looking for? Yeah, so I think ultimately like go online and take a picture of type in vulvar anatomy. Okay Vulvar is an R in it. Yeah. Yeah, it's a vulva vulvar anatomy is okay. Vulvar? There's an R in it? Yeah. The vulva vulvar anatomy is okay. Okay. But anyway, so from the outside in, the first thing you're going to see is your labia majora. So those are sort of like the large lips of the vagina. Then you're going to go and you're going to see your labia minora. And so just look at the size, look at what they look like. You know, of course, make sure there's nothing abnormal, like you don't see a mole or something weird there

that you've never seen before. But just like, so you know what they look like, right? Look at the clitoris, follow it up. Look at the clitoris, pull back the clitoral hood gently and see if you can pull it back. Take a look at the clitoris and then look at the urethra, which is underneath and on top of the vagina. Make sure it looks normal to you.

I mean, again, you don't know, everyone looks a little bit different, but like get a baseline of what you look like. And then look at the vaginal canal. the vagina, make sure it looks normal to you. I mean, again, you don't, you don't know, everyone looks a little bit different, but like get a baseline of what you look like. And then look at the vaginal canal. It should be pink, supple, healthy looking, right? And then, and then you should sort of get a sense of what you're looking at. And then you could also see like sort of just what the size is, what it looks like.

Just again, everyone's different. And if you look at, there's actually websites where you can look at like labia. A lot of people get worried about like, are my labia too long or do they look too weird? But like you can see all different shapes and sizes. It's very unique to you. You can see one's longer than the other. Some are long, some are short.

And that's completely normal. Nothing to be ashamed of, nothing to worry about. And like just sort of knowing what you look like is empowering you because again, like I said, if something changes, you can go back and look again and just say like, what is something different from what I remember? Thank you so much for just explaining this

in a way that makes me and the person listening feel empowered. And I know as you're listening to Dr. Rina, you do feel empowered. And trust me, I'm just getting started in terms of the embarrassing questions that I'm gonna ask on both of our behalf. So I'm going to take a quick pause. We're going to hear a short word from our sponsors. Please share this. Share this with your partner. Share this with somebody

that could use this information because we all need to take our sexual health more seriously. This is important even though it's kind of embarrassing. I'll do the embarrassing talk. You stay with me because we're just getting started. I'll see you after a short break. I'll see you after a short break. I'll see you after a short break. I'll see you after a short break. I'll see you after a short break. Welcome back.

It's your friend Mel, and you and I are spending time learning from Dr. Rina today. And Dr. Rina, on the topic of sexual health, the question that I've been thinking about over the break is this. I think we all know that there's different types of orgasms that you personally experience, but from a medical or physiological experience, are there different types of orgasms?

So the orgasm is the act, the feeling of a buildup of tension and then a release, right? Yes. And so, but there are different origins of those orgasms, but the orgasm is essentially the same thing. So, there's the clitoral orgasm, which is the most reliable way to achieve orgasm. So, 85% of women need some clitoral stimulation to have an orgasm. And some of them will do it with penile penetration, but sometimes not. But 85% need their clitoris to be stimulated. So that's one. Then there's vaginal stimulation.

So that's where you hear about the term the G-spot. And so that's in the anterior vaginal, also the top of the vagina, about two or three centimeters in, is where we have a structure called the skein's gland. And that is, it's called the skeins gland. Skeins? Skeins. Skeins, skeins gland. Okay, the skeins gland. And when you say it's two to three centimeters at the top, you're not talking about the end of the canal there.

No, so from the front. From the front. So it's like in the skin, in the tunnel. That's where the G spot is? In the vagina, in the vagina. So your your ethro is there, and then you put your finger in the vagina, and it's about two or three centimeters in. And That's where the G spot is? In the vagina, in the vagina. So your your euthra is there. Yeah. And then you put your finger in the vagina and it's about two or three centimeters in. And it's on the top. Correct. So if you put your finger in and you lift up. Yep. And this thing is real? So it's a zone. It's not a spot. It's not a button.

Right. People think like it's a magical button. Yeah. Stop doing that. It's a zone where there is a whole bunch of nerves that converge. So there's the, obviously you have the clitoral bodies right above it. So there's erectile tissue there. There's nerves around there that converge. And there's also the skein glands, which is the homolog of the male prostate. So we call it the female prostate. And they also have nerves that are pleasurable when stimulated. So it's not, um, it's not this button, right?

That you're going to press and women are automatically going to have an orgasm. Everybody, did you hear that? Stop looking for the button and start massaging for God's sakes the area. Yeah, but even then some people will not orgasm from a G-spot or G-zone stimulation because not everyone finds that pleasurable, right? If I massage every man's prostate, he's not going to orgasm from it. It's not necessarily, I'm not massaging their penis, I'm massaging their prostate. It's the same thing, you're not massaging the clitoris, you're massaging the vaginal wall, right? And so some people find that pleasurable, some people are able to orgasm with that, and there's a different nerve that sends a signal back up to the brain, so the perception of the orgasm may be a little different. The last one

that people often talk about is cervical orgasms. So some people find cervical stimulation very pleasurable. Now that's all the way at the end. All the way at the top. But isn't that also where you can experience some discomfort because if somebody's penetrating you and it's hitting the end and the cervix didn't lift Yeah, so it's variable.

Some women find it very pleasurable to have their cervix stimulated or around their cervix stimulated, whereas some find it painful. But some people do have cervical orgasms or orgasms from stimulation of the clitoris, let's say. And they will describe that differently, like shooting stars or like this like cosmic experience. And so you can have different types of orgasms. It's the same thing that's happening in your body, right?

You're having a tension buildup and release, but it's from stimulating different parts of the body. That's so interesting. Yeah. And thank you for explaining where the G-spot is because I've always wondered where the magic button was. There's no magic button. Wow.

There's no magic button. You know, I don't know if I read this somewhere or if I heard this somewhere, but is it true that 10% of women are physically not able to have an orgasm? So we know, yeah, 10 to 12 percent. 10 to 12 percent? That's not fair. I know it's not fair, but we don't know if it's because they're not physically able or they're not getting enough stimulation to achieve orgasm. So this is because, so if you think about, I said the average time for sex, that really usually is time from male ejaculation, right? That's the time to ejaculate. But for women, the time to orgasm is different. So they've actually looked at this too. What is

the average time to orgasm? So through sexual encounters, it's about 12 to 14 minutes. So many women, if you just have penis and vagina sex, are not gonna orgasm, and they're not gonna have an orgasm because they never got enough stimulation for a long enough time to achieve an orgasm. So I gotta ask a question. So when you talked about measuring the male orgasm,

and I think the average was like 5.6 minutes or something like that, the way they measured that is somebody starts timer and all of a sudden you insert and from the time of insertion to the orgasm or the ejaculation, that's how we measure that. Correct. How do you do that?

Like when do you start the timer for a woman? Is it when the stimulation on the clitoris or the G-spot or the cervix starts or how does that? Yeah, I mean, I think it's variable, but you know, I don't remember exactly how they designed in that study particularly, but ultimately, yeah, it depends on probably requires, you know, clitoral stimulation, I said the most reliable route. So probably from the beginning of clitoral stimulation to the end. And but interestingly, when women masturbate, that time shortens eight minutes.

Well, no kidding. We know where to go. Exactly. Move this out of the way, focus right here. Right. Yes. Right. Right.

And sometimes you're just too polite to say, hey, you're doing this the wrong way. Like, yeah. Filt your head in a different direction. Yes. Exactly. Exactly. This is why we need to be on a walk with our partners looking straight at, by the way, tilt your head towards two o'clock instead of ten o'clock. That would help.

Dr. Rina, what is one thing that the person listening could do tonight to increase their chances of having an orgasm? So the one thing you can do tonight is focus on the encounter. Don't think about the homework your kids have to do. Don't think about what you have to do for work tomorrow. Don't think about your to-do list that you are never gonna get done because we're never gonna get done, right? Focus on being present and communicate. Like actually talk to your partner, guide them along the way.

And nonverbal communication works well too. So like sometimes we feel uncomfortable telling them move your head to the two o'clock, but you can gently move their head, right? There are things you can do very gentle, very nudging that can make you have an orgasm quicker, more efficiently and in a more pleasurable way. So in preparing to talk to you, one of the things that I stumbled upon is that there's like half a million papers written

on the penis, but only 2000 studies done on the clitoris. Like why? You know, I wish I could tell you there was a really easy reason, but I will venture a guess that most studies were designed by men for men, right? And so a lot of investigation has gone into male genitalia and male studies and the penis is a little bit easier to study, right? It's sort of like right there.

Whereas the clitoris is not as easy to study because you can't, you know, you can't, I mean, there are now ways to measure clitoral engorgement and where there's definitely more investigation going on now, but it's been sort of largely ignored. In fact, we didn't even know how many nerve endings a clitoris had until like two years ago. How the hell did you figure it out? So they actually looked at, you know, biopsy studies to look at the number of nerve endings. And so they did this study and they found, so we sort of think they had 8,000 nerve endings, but now we know that it's more than 10,000.

And so like this is recent data, like in the last few years. And that's amazing, right? We didn't even know how many nerve endings that Clitoris had. So there's so much work to be done, but it's really a societal view of women's pleasure, right? We've always been thought of as not, it's never been a priority. Who talks about female pleasure? Not many people, right? They talk about male pleasure.

They talk about erections. They talk about their ability to maintain erections, but they don't talk about women having issues with sex. They're often said, here's a have a glass of wine, just relax. They're not told like, hey, your pleasure matters and you having an orgasm matters and you feeling good matters. It's amazing to me. And we're the only person in the world,

women are the only ones who have a clitoris, which is the only organ in the body that's made only for pleasure. There is no other organ, like the penis has a urethra, you urinate from the penis. Women have a clitoris and the only point of the clitoris is to have pleasure. Ooh, that's cool.

Yeah. That's the only reason we have it? Yeah. That's pretty cool. That's all the function that it offers. Well, that's a lot of function. Yeah. That we should be like really taking seriously.

Absolutely. That's pretty awesome. Can we talk about squirting? Yes. Is that like peeing when you're ejaculating? What exactly is that? Yeah, so you brought up a few things. So squirting and ejaculating are two separate things.

Let's talk about those different. So squirting is defined as like this large volume of fluid that is gushing out of the urethra at the time of climax or during arousal, whereas ejaculation is a smaller sort of whitish, thicker amount of fluid that is coming from the urethra. Often times people may not notice it when they orgasm or climax. And so where are these fluids coming from the urethra. Oftentimes people may not notice it when they orgasm or climax.

And so where are these fluids coming from? So the female ejaculate we think comes from those skeins glands, right? Those skeins glands actually produce something called PSA, which men produce in their prostate. And so they've actually tested the fluids and said, okay, yes, there's PSA in this fluid. There's also PSA in squirting.

So some of the fluid from squirting is coming from those skeins glands, but they're really small. They're like two to four grams. Wait, so where is it coming out of? Those little skeins glands. So from inside the vagina? Inside the vagina there's these tiny like sort of duck-like structures that hold a little bit of fluid and that when you have a lot of engorgement of the clitoris, it will squeeze some of that fluid out into the urethra and emit as ejaculate. Okay. I'm embarrassed to ask you this. Like really embarrassed. But is that where you pee?

The urethra is where you pee. I don't know. Well, because you talked about the gland that I know is the location of the G spot area. So when you started talking about that gland and the prostate, I'm like, okay, wait a minute, that thing's up inside the vagina, which means it's coming out the main event here. But then you said urethane, I'm like, I think that's where you pee. I'm sorry, I should have clarified. So I am so worried. So now here's what I'm thinking. And this is way too much information, I'm sure,

for everybody listening, but I don't care. I'm just going to say it anyway. There are times where I have been having sex with my husband and I feel like I might have to pee. And then I get nervous because I think that I'm going to pee. But is that the same sensation that you might be about to squirt? Like, I'm like, I don't think I'm going to be able to squirt. You know, I think if you, so this is hard to say.

Look, you're not the only one thinking this question, right? I'm sure there's many women out there who are like, am I going to pee? Am I going to squirt? Like, what's going to happen? Like, is this a turn on? Is this disgusting? Like, what's about to happen here? How do you know if it's pee versus some sort of ejaculation sex liquid? You know what I'm saying? So this is interesting because there's always been this question,

like is it pee? Is it not pee? Right? And so they've looked at the fluid, they've looked at it under like, you know, they've identified all the characteristics of the fluid and they found it to be like very dilute, very similar to P but not P, right? It's very dilute, less urea, it's very clear, and there's also PSA. So some of the fluid from the skein's gland is getting mixed in there. Well, I'm asking this question because I think there's this mythology about the woman who squirts and that there is some magical sexual

like liquid desire thing that is coming out of a woman. No, seriously, like I, you know, you hear this folklore and maybe as you're listening, you're somebody that does this and it's a wonderful thing. I have personally never experienced this. And I would like, I'm trying to, to lean into this conversation and explore if there's an area where I've been holding back

because I'm afraid to pee in Chris's mouth. Like, I'm like, just to like, if so, I don't want to do that to him. And so hearing you even say if they've studied it and it's not a concentration of urine, then like, maybe it'll allow you to relax a little bit. Yeah, absolutely. And you know, interestingly, they've looked at how women feel about squirting. How do we feel about it? Because you can tell I feel like I don't know how I feel about it.

Yeah. Yeah. And so what some women are like, oh, it's a superpower. I feel like I have this amazing thing. Other women feel shameful about it, probably because, again, they're not sure what's happening. And some are like, this is just a big mess for me to clean up. I don't like it. Right. And men seem to feel like I I think it's like their visual of like, you're having an orgasm, right? So they really like that visual. But there's actually another way to tell, right?

So when you're having an orgasm, your pelvic floor muscles will contract in a rhythmic contraction. And so you can actually feel that, right? So men can feel that if they're inserted in a female and she has an orgasm, she's going to, her pelvic floor muscles are going to contract like every 0.8 seconds or so, right? So men can feel that if they're inserted in a female and she has an orgasm, she's going to, her pelvic floor muscles are going to contract like every 0.8 seconds or so, right? And so you're actually going to, you can feel that, right? So you can't, that's one way to tell. But yeah, women squirt, some women don't. Does it matter? No. Can you teach yourself to? Maybe. I mean, I don't know. How would you teach yourself to squirt?

What they say in literature is like, it's really a component of how erect the clitoris is. So how aggressive that clitoris gets erect and that's arousal, right? How aroused the woman is. So you wanna drink a lot of water, pull back the hood, take a long time to warm yourself up, lots of lubricant and stay focused in the moment. Exactly.

Okay, I might have a heart attack if it actually happened to me. I don't know, I'm literally, and then of course I'd be like, was that okay, I'm really sorry, it just tastes bad. Oh my God, okay. You know who's gonna kill me for this episode? Your husband. My daughters.

Chris doesn't care. Chris will literally be like, if you come home with new techniques and a desire to make our sex life better, you can talk about whatever the fuck you want but I'm sure our daughters be like mom why did you do that? Dr. Rena can you talk about why your sexual health is so important especially during hormone changes like menopause? Yeah so you know I'm a menopause certified practitioner so you can you can sort of become a menopause certified practitioner by going through the

menopause society. And, you know, during menopause, our body goes through these immense changes, right? Our estrogen drops precipitously. So what happens when your estrogen drops precipitously is the tissues in your vagina and your vulva, they all change. They all become, the lubrication that you produce decreases. That can make sex more uncomfortable. That can make you more uncomfortable just sitting day to day, right?

Your labia tend to shrink. Like imagine any part of males in Natalia shrunk. Like it would be insane. Like there'd be tons of papers about it, right? But there's no real like, okay, women it would be insane. Like there'd be tons of papers about it, right? But there's no real like, okay, women's labia shrink. Does that matter? Well, you know, there's a couple things. Because the labia is just the like the curtains on the outside, right? But they're there as a protection, right? They're to protect you from friction. They're there to protect you from

bacteria. And so what happens a lot of the times, forget, say you're not sexually active, say you're not interested in being sexually active, it puts you at higher risk of getting recurrent UTIs. So you mentioned earlier- Really? The outside being smaller? Well, so that's part of it. The other part is the urethra shrinks a little,

the tissues around the urethra shrinks, so the opening becomes closer. Oh. And most importantly is the vaginal tissue's pH changes. So when you lose estrogen, you lose these good bacteria called lactobacilli in the vagina. And that keeps your pH acidic. And so when you go through menopause, your pH goes up and you're at higher risk for infections. And what a lot of people don't know is that treating yourself with vaginal estrogen actually prevents UTIs and

can actually cure you of recurrent urinary tract infections. Really? Mm-hmm. What predicts a great sex life, particularly as you get older? Yeah, so I think realizing that things are changing. So having a great sex life as you get older is one, like allowing yourself to acknowledge these changes and then identifying them, right? And saying like, okay, you know, my lubrication is not great. Maybe I would benefit from hormone therapy or maybe using just a lubricant, right? And

adding that in and everyone should be using lubricant. It's great. It makes things more fun, more slippery, right? And there's different kinds of lubricants available. Some are long acting, some are short acting. If you're using a water-based lubricant, I'll just tell you, make sure you reapply. It'll evaporate. It's water-based, right? So other types, you know, you can use different types, you can experiment, but really identifying like, okay, my body's changing. It doesn't mean that I can't have sex anymore. It doesn't mean that I can't enjoy sex anymore. It's a matter of identifying what the issues are and then investigating, seeing a doctor to get evaluated to see how can we help you. Has a doctor asked you about your orgasms? Have they asked you about your pleasure? Because that's what matters, right? And so like talk about those things with your

doctor and if they're not talking to you about it, find someone who will. Is pain normal during sex? Pain is never, should never be normal. So I think people always make this assumption, right? Like, oh, it's okay, have a glass of wine, or you can have sex and the first time will be painful. It shouldn't be, right? It's probably painful because you're rushing, or maybe you have actually an abnormality. Something is going on.

Maybe your pelvic floor is abnormal. Maybe you have endometriosis. Maybe there's a medical condition there that needs to be uncovered, but sex should not be painful. And yes, sometimes there are very large phalluses which can be uncomfortable, and there are actually products you can buy

that you can put on the phallus so less of it gets inserted. Sometimes you will see people have pain with that. Or- In terms of the end of it hitting your cervix or something. Correct. Okay. Correct. So there are some, obviously there, obviously there's some cases where like you can't deal with anatomy. Maybe that's just not the right, that size is too big. That's okay. You

can still address that, but otherwise, you know, there should be ways for you to find pleasurable positions or comfort during sex. It should not be painful and you shouldn't be rushing, right? A lot of people rush through sex and they're not allowing themselves to get lubricated. They're not allowing those changes to happen. And then if you do all those things, you're still having pain, see a doctor. Like there are lots of things that can cause pain and we can help you with them. Dr. Rina, this feels like a great time to take a quick break, hear a word from our sponsors. I can't wait to share this episode with my husband, Chris.

I think it is going to open up an amazing conversation. Quick break, hear a word from our sponsors. I can't wait to share this episode with my husband, Chris. I think it is gonna open up an amazing conversation. And while you're listening to our sponsors, share this with somebody that you love. Share this with your partner, share this with somebody that you know needs to hear this, that will benefit from it, which is basically everybody on the planet

that you care about. And we will be waiting for you after a short word from our sponsors. So don't you dare go anywhere. Welcome back. It's your friend Mel. And Dr. Rina and I are waiting for you. We're going to keep digging into the science, the medicine, everything that you need to know

about improving your sexual health. We're going to keep digging into the science, the medicine, everything that you need to know about improving your sexual health. So, Dr. Rina, what is the truth about how you can have good sex? So, to truly have good sex, you need to be completely vulnerable. You need to first feel safe, of course, but then you need to be completely vulnerable to allow yourself to, you know, completely experience the pleasure you're feeling, right? Because otherwise, if you're not completely vulnerable, if you're not completely there and present, you're not going to be able to experience the sensations you're having. You're going to be thinking about other things. So it's being vulnerable and being present, and that's going

to allow you to have the best sex of your life. Right. And that sometimes takes a lot of effort for people and a lot of energy and actual work towards getting there. But it's worth the work, right. Because you want sex to be a good experience. You want it to be fun. You want it to be transformative at times. And so actually taking the time to sort of like, you know, work through the kinks of sex, which is, I think a lot of times we're like, oh, how work through the kinks of sex, which is I think a lot of times we're like, oh, how do I even talk about this? How do I bring this up?

Things are not perfect, but like I don't want to hurt anyone's feelings. We're a very polite society, right? And it's like, no, this is something that takes work, just like hard conversations in your relationship have to happen. Conversations about sex occasionally need to happen. So now I can feel the person listening going,

I don't want to have that conversation. How do I even start having that conversation? So how do you start, Dr. Rina, having the conversation about the kind of sex that you want? Or do we even know what kind of sex that we want? Well, some people do and some people don't, right? I think it starts with self-exploration. And so I think people, you

know, have very different preconceived notions about that. Like men, it's very common to have self exploration and women, it's sort of variable. Like some women will be in their twenties before they've tried any self exploration. Some women have never tried it at all. So I think ultimately, actually, first of all, figuring out what you like, and that can be with partners too. Like, you know, you, if you have a partner who's experimenting, you've had multiple partners, you've sort of figured out what you like. And that can be with partners too. Like, you know, if you have a partner who's experimenting or you've had multiple partners and you've sort of figured out what you like, but it does take a little bit of identification first.

And then about having the conversation, right? I think people think I'm gonna have one conversation, it's gonna be done and it's gonna be great, right? Or I'm gonna try to have a conversation that doesn't go the way I want to and then that's it, I'm never gonna try again. But it's not like that, right? It's gonna take multiple conversations

and it's going to be, you know, awkward for both of you because no one taught us how to talk about sex. No one taught us how to have sex, first of all, right? Do you remember sexual education in high school or elementary school or middle school, wherever you learned it? But like, no one taught you how to actually mechanically have sex.

So that's one thing. And two, no one taught us how to talk about sex unless you're in a very progressive household. And so you're like, okay, you're going to have this conversation, you're both going to feel awkward, someone may shut down. It just means that like you're going to try again another time. And you're going to say, okay, let's have a conversation outside of the bedroom. Let's maybe it'll be more comfortable if we're sitting in a car, so we're not staring at each other, or we're going for a walk, so we're not staring at each other. And then we can talk about like,

hey, you know, let's just have this conversation. Let's do our best to be open about it. I wanna talk to you about what I like and what I maybe would like to try. And I'd love to hear the same from you. And try to just be very positive. And, you know, in terms of like bringing up what you like, what you enjoy they do, and then offering suggestions.

Say, you know, I would really like it if you tried this next time. That would really turn me on. And that would, you know, what you enjoy they do, and then offering suggestions. Say, you know, I really like it if you tried this next time, that would really turn me on. And that would, you know, be received well, instead of saying like, oh, you do this and I really hate it. Right? Because that's going to make that to somebody. But you know, I mean, some people might be like, you know, I really hate that.

They don't know how to say so they just blurt it out. Right. You just want to get it over with. And so that's going to just make a negative that's going to end that conversation. And you're probably never going gonna have a conversation again. So trying to keep it positive, keeping it sort of like, this really turns me on, this is what I really like. And then obviously, you know, your partners, so sort of like, how do they communicate and using those same communication skills, like you're having a tough conversation about finances or about your kids or whatever,

and bringing that to talking about sex. Okay, so I just wanna make sure, Dr. Rina, I have really extracted what I'm doing. So you said don't have the conversation in the bedroom. You might wanna have the conversation while you're both focused on something else, like you're taking a walk, you're side by side, you're talking and walking, you're not necessarily doing the desk stare at each other,

so it doesn't have to be so intense. What is the opening line? Like, how do I get into this? So you could, I mean, there's a few ways to do it, right? You could say, like, at some point, be like, hey, babe, I'd love to have this conversation with you at this time at this day, or like, you know, or at some point, and maybe let them off for a time, but say, like, you know, I'd really love to just carve out some time where we can talk about this. So you? Yeah, about sex. Okay. And just say like, so you're primed a little bit, right? Like we're going to have a little bit of a charged conversation. I don't know where it's going to go.

But like, I really just want to make our sex life even better, right? Or even greater. I think that's a great lead in. Yeah. Like I wouldn't, I wouldn't prime my husband because I think he'd panic that he's doing something wrong. But I love the thing where you're like, okay, we're driving a car, we're on our way. So, hey babe, I'd love to talk about how we can make our sex life better.

Yeah, and honestly, like if they wanna have sex, and you know, so say you're a female that had a sexual relationship and a man hears, I wanna have more sex or better sex, that's pretty exciting for them, right? They're like, okay. Of course. You know, usually, I mean, not always, it's the man who wants sex more often than the female.

Now, that's not always the case, and it's not abnormal if a man wants sex less, let's just preface that, but you know more common we see it that way and so most people are going to respond to that quite favorably and say you know let's yeah let's talk about it. Do you have advice about how you should communicate with your partner about when you want to have sex? Yeah so I mean I think this is an interesting question because you know who initiates, right?

Like, is it always... This is a big issue with like, it's, I don't mean issue like we're in therapy about this, but this is something that's, that I think my husband and I have gotten into a, like, you kind of notice who's initiating. And then you start to get mad about it, or then you start to go, okay, well, then I'm going to just not initiate and wait and see what happens. And that's clearly not a mature way to handle your sex life

or your relationship, but I'm gonna turn it back over to you before I share too much about my marriage. Well, I think... I... I... I... So I think, you know, in terms of, like, initiation, right? I think one is like, are you, is it that they're initiating when you're not in the mood or

are they initiating in a way that is not attractive, right? Like there's, you know, like, are they just grabbing you or like they're just doing something that like they think is playful, right? They're not trying to be gross. They're just trying to be playful and like get you in the mood. And that's how they're communicating. And that might not be your communication style. So one is like, where is the issue there?

And maybe it's hard for someone if it's always the same person and they keep initiating every single time and you keep saying no, it becomes very difficult to keep initiating. And then they're waiting for you. So sometimes I'll tell people, okay, Juan, you got to sort of figure that out. Like, you know, why, like, if you are always saying no, or you're turning them down quite often, like, why are you, like, think about that, and then say, like, how can I make it

so that I'm more receiving of them? Like, what are they doing or what time? Maybe it's like you're not a morning person and they're always ready to go in the morning. Like, you know, you have to communicate that with them. Or maybe it's the way they're approaching you. And then, you know, vice versa, you sort of like, it's good for both partners to initiate, right?

I think it takes courage, it takes effort, even in long-term relationships, to like disrupt someone's day and be like, hey, I want to initiate. And the other thing that I think about initiation that's important is that desire is not always spontaneous. So what we see in the movies, right, like people see their partner, they get really turned on, they immediately want to have sex.

That's not normal for a lot of people, particularly in long term relationships. It's like when you go to the gym, you don't always want to go to the gym. But once you're once you're there, you're glad you did. Right. So same thing with sex. Sometimes you have to initiate, let yourself be in the moment and like, like, oh, you start touching each other. You're like, oh, yeah, I like this. But you didn't like when they started, you let yourself be in the moment and like, oh, you start touching each other. You're like, oh yeah, I like this.

But you didn't like when they started, you weren't really in the mood. But like, you know, you started cuddling, started touching like, oh wait, yeah, I like this. Okay, oh, I'm in the mood, right? That's responsive desire. So there's sort of a different way to think about it doesn't mean that you don't want it right that second. It may just be that you need to be warmed up and in the mood and then you'll feel the

desire and then you'll be like, okay, yes, I'm ready to have sex with you. And maybe that'll work sometimes and sometimes it won't, but it's completely normal in terms of desire to have it come after the initiation sometimes. And, you know, to your point of thinking about it as play, like two things that have made a huge difference for Chris and I is texting each other and being like, how about two o'clock? So it becomes more of a midday thing that because because we became the couple that were really attracted to each other and wanted to have more sex but we were just freaking exhausted. Yeah. And we also had slightly different bed times so by the time I got into bed Chris was always

already asleep and by the time he's waking up, it's fine. And so I think you can get into that rhythm too, where you're just not having sex, not because you don't want to, but life is overwhelming and you're tired and you're on slightly different schedules. And so disrupting that assumption that it should happen in the morning or the evening.

And creating more moments of what about three o'clock? that assumption that it should happen in the morning or the evening. Yes, absolutely. And creating more moments of, what about three o'clock? I've got to break him up. You know, that kind of thing makes it more fun and makes it... And also, we created this agreement that it didn't have to lead to orgasm. That it was just a moment to be together for half an hour or whatever and just be intimate. And that's exactly what we tell people to do.

It's really important to prioritize your sex life if you want it to be a priority, right? So like actually making time. Like think about when you were younger and used to go on a date, right? You would get, you would say, oh, we're going to see each other Friday. I'm going to get all ready. I'm going to shave my legs. I'm going to do my makeup. I'm going to make sure like, oh, we might have sex is sort of exciting.

So you have something to look forward to. And it can actually be really, really fun to allow that to be a thing. And the other thing about timing is, you know, our hormones fluctuate throughout the day. So in the morning between 7 and 10 a.m. is when testosterone is highest for both men and women, but more so men. And so that will be testosterone is the hormone of desire. So very often people will actually feel more desire in the morning. And so that's not unreasonable to utilize your hormones and use them to your advantage. Like okay we're gonna schedule time in the morning because we're both gonna be sort of like able to

receive because we have more hormones on our side. Yeah, just don't put it in the family calendar as mom and dad are banging right now, do not disturb, right? You gotta have like a code name for it. Walking the dog. Yeah. It's something that it's like.

Or like on date night, have sex first. Don't go out to dinner first. Ooh, I like that. Yeah, yeah, so have date night, have dinner, whatever you normally do, but have sex first, right? Don't eat a ton of food, get bloated, drink a bunch of drinks. Then you're like not even able to like really. And then a lot of us then are driving home and start arguing about something stupid.

And then we just like storm into the bedroom. That's a genius idea. Absolutely. Yeah. That's the appetizer. Each other. I love that. What are some of the most common sexual insecurities, Dr. Rina? So for women, it's vaginal odor is pretty common, and then body image insecurities. So like breasts or butts. And we find that this actually is very common in younger women.

And as they age, those insecurities get less and less for a lot of people because you're more comfortable in your own body, you're more comfortable talking about sex, or knowing what pleasure is for you and what you need to achieve pleasure or orgasm. But those are very common. And then other ones are like, particularly when you're younger, is like being inexperienced

or like making noises or things like that can be sort of pretty common insecurities. But like I said, sex is play, there's going to be noises, like you're going to have a queef or you're going to like, there's going to be some weird noises and that's okay. It's like, it's normal. Your body's going to make noises when you're doing these activities, right? And then for men, most commonly it's penile size. So they're worried that like, one, am I normal? And two, is it going to shrink with age?

And then they're also worried about ejaculating too soon. So those are sort of the most common insecurities. Does the penis shrink with age? Yeah, so not exactly. It can shrink commonly. It really depends. So one is you gain weight. A lot of men gain weight. And then as they gain weight, they're seeing less of their penis because there's weight on the mons, which is that area right above the penis that gets fatter. So they're seeing less penis. So that's one. So it's like an optical illusion.

That's one. Yeah. So the penis didn't actually get shorter They go bigger. Yeah, you got bigger. That's a very delicate way to say that but okay. But it's you know, it happens and then two is if you smoke it can shrink. What? Yeah, because smoking can change the collagen content of tissue And so it won't be as flexible So sometimes, you know men are showers or growers some people are show who are growers, meaning like when they get an erection, they grow quite a bit, that will become less prominent because their tissues are now less elastic from all the smoking. And then if you have erectile dysfunction, you can actually get some that decreased blood flow to the

tissues can cause scar tissue or fibrosis and that's like Very like delayed so not very early on but if you're not getting any erections at all over time You can develop scar tissue and then that can shrink the penis can a man Ejaculate without an erection like if you think about a lot of men that start to struggle with testosterone or prostate issues and they can't achieve erection, can they still ejaculate? Yeah, you can orgasm, you can ejaculate. Wait, you can have an orgasm without an erection as a man?

Exactly. Wow! So you just stimulate. The erection is important for being able to punch it, but you can still stimulate the penis and the genitals without an erection, right? You can use other types of sex to stimulate the partner and then they can still have an orgasm. They can still experience pleasure,

but they won't have the optics of having an erection. And that's very mentally tied to orgasm. So very often it's difficult for men because they're like, I don't see an erection. I'm not aroused, I'm not mentally there. So that takes a little bit of training and work to sort of be like, okay,

I'm okay with the fact that I'm not getting erections, we can still achieve pleasure, but you need to, again, the same things, be vulnerable, be present, be mindful about what's going on to achieve an orgasm without an erection. What should you do to help your partner if they can't get an erection, but you do want them to have an orgasm without an erection. What should you do to help your partner if they can't get an erection, but you do want them to have an orgasm?

Like, I didn't even know it was possible. Yeah, so I think, again, it's sort of like, they have to be willing to receive that pleasure and stimulation. So sometimes what we tell people and what sex therapists will tell people is like, start working on not actually having sex. First, start by just doing what's called sensate focus. So touch yourselves all over your body, explore your bodies, don't touch the genitals.

So do just that, like enjoy the pleasure of touching each other, right? And then once you're feeling very comfortable and confident with that, then you can incorporate some genital touching, just touching, right? And then once you feel comfortable with that, then you can incorporate some genital touching, just touching, right? And then once you feel comfortable with that, then you can move on to more stimulation, whether it's penetrative or oral and sort of like, you know, but then you're working on being mindful with just the basics. There's no pressure of an erection. There's no pressure of an orgasm. It's just experiencing those moments and like really being present in the moment. Wow. That's pretty cool.

Yeah. What are some of the reasons, Dr. Rina, that people experience shame around sex? I think a lot of it stems from feeling not good enough, right? Like whether in men it's having strong enough erections, lasting long enough. For women it's like, am I having an orgasm? Am I pleasuring my partner? Do I smell? Do I look okay? Do I, you know, all those things. And that's really what causes a lot of shame.

And unfortunately, a lot of it stems from lack of education, right? Like not knowing what's normal and what's okay. And a lot of it is because we're not learning from anybody who, like we're not learning what real sex should look like. We're learning from TV or from pornography and those are not real. They're made up created products to arouse you or to get you entertained. It's not real life. And so there's so much insecurity there that like people are just holding on to that. And I think it's very, it's very common in the US because we're sort of a sexually prude society.

But if you look at other countries, which are more sexually open, like, you know, in Northern Europe, like they're much more progressive about sex, they talk about sex, they teach their children about even the names, their genitals very early. There was one animated series that came out from, I think it was Denmark, where they had this boy

with a very long phallus, and the whole episodes were about his long phallus getting caught on things. But it was like, they were using it as a teaching tool. And I was watching this being like, oh my god, what's going on here? Because it's so radical for us in the United States. But for them, it's just a teaching tool.

This is your penis. This is how you take care of a healthy penis. They probably use it to sort of really educate their children. How does porn impact the sexual expectations between partners? Yeah, I mean, I think it really depends on when you're introduced to pornography. Like I think if you're introduced older, which a lot of, you know, our generations didn't have access to pornography like they do now, right? You had to like find a magazine, find a DVD or like a VCR and like a tape and like... Or in my case, one of my friend's dads who had a secret stash of magazines that we discovered.

Yes. So you had to find it and then find a quiet room to look at it where nobody would find you. Like there was like a lot of planning involved to even see that. Now it's just so accessible. So one, I think when you see pornography when you're younger, unless someone tells you like you actually have to talk to your kids about like, you might see this, this is not real life. But like, then you're like, oh, that's what sex should look like. That's, you know, what the encounter should go like. This is

how long I should last is how much ejaculate volume I should have. This is how quickly she should orgasm. This is how she should respond. Or this is how long I should last, this is how much ejaculate volume I should have, this is how quickly she should orgasm, this is how she should respond, or this is how I should respond, or this is, you know, all these things, I should be squirting these large volumes, right? Like all these things you see in pornography, they are created and these are professional actors, right? They have trained their bodies or they've chosen to do this profession because they're able to do these things, like whatever it is, but this is not real life. And so I think what it hurts us is when we start using that

as a model of what real is. And then if you keep using that as like what turns you on, then real life's not gonna turn you on, right? Because you're turned on by something that's so different and so unique and so not what real sex is like, that you might say, hey, I'm having trouble because I just don't know, like, it's not happening like I expected it to. So your expectations are different.

I think once you're older and you have a fully formed frontal lobe, you can sort of differentiate real from fake. But I think when you're younger, and I worry about that for our younger kids, like, they don't know. Can you talk a little bit about how mental health can impact your sex life? Mental health is a huge impact. So one, I always say like, is it the sexual health

that created the mental health or the mental health that created the sexual health problem? Because sometimes you dig deep and you find out that the reason they're having mental health problems is because of some deficiency they're having in their sex life. So that's one possible thing, but they're very commonly co-mingled. So when you look at like people with depression, anxiety, or taking meds for depression or anxiety, about 30 to 60 percent

of those people will have sexual dysfunction. So it's very, very common. And some of it's because of the medications. So... Sexual dysfunction is defined as what? So it could be a variety of things. Very commonly could be low libido, it could be difficulties with erections, ejaculation, arousal, any of those categories you could have problems with, orgasms even, depending on what the issue is,

but also those medications, SSRIs particularly, have higher rates of sexual side effects. And so their dose dependence of some people on higher doses will, and it can be really difficult because they need those medications to feel good, but then they can't have, you know, they're maybe having trouble with desire, which is probably the most common thing we'll see. But also think about it, if you're not feeling good about yourself for whatever reason, it's very difficult to allow yourself to experience pleasure and enjoy pleasure because you're

feeling bad all the time. And that's the same thing about stress, right? If you're really stressed all the time, it's extremely difficult to allow yourself to experience pleasure because that's just taking over all that cortisol and those negative feelings are taking over your body and you can't relax enough to enjoy pleasure. You know, that's true. Cause I do see a direct connection

between periods of my life where I'm super stressed out and a complete lack of a sex drive. And if you think about stress as you being in a state of fight or flight all the time, it's kind of hard to drop in and be present, which is one of the big things you have been telling us today. You got to look at it as play and you got to figure out how to be present, otherwise you're not going to enjoy it as much as you could. Yeah, in fact they've looked at people who have mindfulness practices and they found that people who maintain mindfulness practices for like eight

weeks, for example, are more likely to score better on like sexual function indexes. So they're actually having better, more satisfied sex and, you know, scoring better in a whole bunch of different domains, particularly desire being one of them. And so, you know, it's part of like, again, mindfulness is going to help us be present, not just in sex, but in a whole variety of things. But our society is so busy right now. Everyone's like, how can I get mindfulness in? And what I tell people is like, just start with a minute or two minutes a day

where you're dedicating some time to yourself and you're trying to be mindful. And then you can build up a mindfulness practice. It may benefit you, you know, and it's free. It's completely free. Like try it and see. The only thing you're giving is time, but you're giving that time to yourself.

You're giving that time to improving yourself. Dr. Rina, can you talk a little bit about how somebody who has experienced trauma can reclaim their sexual health? Yeah. So trauma is very challenging. And I think it takes, you know, if you've experienced trauma, I strongly suggest you see a mental health professional because there's going to be a lot of layers there that you need to kind of work through to really, you know, be sure that you're sort of feeling safe. That's the most important thing is you

have to feel safe. And I can't teach you how to feel safe. You have to work on the thoughts around your trauma and be able to sort of navigate those through whether cognitive behavioral therapy or other things that they can offer you to sort of be able to feel safe. Because if you don't feel safe because of your past trauma, you're never going to be able to have good sex. I mean, that makes sense. Because you're always going to be kind of in a trauma response in your body, protecting yourself and not be able to connect with your partner.

Yeah. Let's talk. I've got some questions here for our male listeners and for our listeners who love them. I read that men who ejaculate 21 times a month lower their risk for prostate cancer. Is that true? Yeah, so there was one study that looked at this.

This is a very well done study and they basically followed men for almost 20 years. They followed like 40,000 men for 20 years and they looked at their numbers of ejaculation per month and they basically categorized them one to three, four to seven, on and on and on. Right? And so they they had these categories and what they found was that men who ejaculated 21 times or more a month were a third less likely to develop cancer, prostate cancer specifically in that timeframe compared to men who ejaculate only four to seven times a month.

And they did a pretty good job of trying to control for other variables like other health conditions, smoking, dietary factors. So it was a really well done study. Now does that mean that you need to ejaculate 21 times or more a month? No, not necessarily. I think it's really, you know, who's ejaculating 21 times? They're having either really great sex, they have a great partner,

they have a good social relationship, they're very comfortable with themselves, maybe they're healthy enough to ejaculate 21 times a month. So there's some variables that you just can't control for. And so I think ultimately it's, again, goes back to why sexual health is health. If you're able to ejaculate 21 times or more a month, like yeah, you might be cleaning the pipes and you might be getting rid of some free radicals

or things that would lead to cancer. So that's not a bad thing necessarily, but ultimately it's probably an indicator that you're healthier. Is there any corresponding study around women ejaculating more and improving our health? Not yet, not yet. But we know there's so many benefits to orgasm, right? You have decreased blood pressure, your mood is better, you're getting better sleep with orgasm. So I anticipate the findings would be similar, right? Because these things are very difficult to study. We know good sleep is important for a variety of health factors, right? So sleep is important. We know having lower blood pressure is important. So all these

things, you're probably like a healthier person if you're having more orgasms because you're, you know, again, you're, you're having all these benefits of orgasm. How can a guy's masturbation technique impact their sex life? Yeah. So I never like to shame people for masturbation. I think that, you know, masturbation is a healthy form of self exploration and it's rare that it becomes a problem. But certainly there are certain types of masturbation that have been correlated with having more difficulties with erections. That can be prone masturbation, being lying on your stomach and masturbating like towards

like maybe hitting the bed or other hard surfaces. Like hitting your penis on the bed? Mm-hmm. Okay. So that... I was just saying, like if you saw me at you, if you're watching, if you're listening, you didn't see my facial expression on YouTube because my face scrunched. I'm like masturbating as you're laying on bed. That makes, oh, I get it. Okay. Yeah. And then also they call it, you know, death grip or having a very firm grip on the erection can

put you at higher risk. Now, does it mean that everyone who does these things is going to have problems? No, not necessarily. But ultimately, if you start noticing that, and the reason they have problems, right, is because say you get used to and women can get habituated to certain types of masturbation too, we just don't have the data on that, right? If you're doing the same thing every single time when you masturbate and you can't replicate that with a partner, right, either through vaginal or oral sex,

then you're not going to get the stimulation you need to climax because your body's habituated to that one thing, right? And so that's sort of like where you're like, okay, I need to keep variety in my life when I'm masturbating. Like, they found that using lubricant for men actually helps. So it's correlated with less issues. So using lubricant or like making sure it's just not a very firm grip. And so that's why I usually tell people

if they're having trouble and they're masturbating a certain way and they think that might be the culprit is just stop for a little while, stop masturbating for a little while. And then when you resume, start masturbating with different sort of lighter techniques and see in different positions potentially

and see if you can sort of train yourself to enjoy different types of stimulation. Is it normal, Dr. Rina, for somebody who is once vibrant, no issues, to suddenly have problems getting an erection? It's actually very common. It's very common. So 52% of men over 50 will have issues with the rectal function.

And that just keeps increasing. So 60% of 60 year olds, 70% of 70 year olds, 80% of 80 year olds. And it's more common in people because of vascular issues. So we know there's lots of people with high blood pressure, diabetes, high cholesterol, and these can all affect blood flow to the penis. So what I tell people is the blood flow to the penis, the arteries to the penis are about

one to two millimeters, whereas the arteries to the heart are about three to four millimeters. So before you see problems in your heart, like chest pain, you're going to see problems with your erections. And so if you have troubles with erections, please see your primary care doctor to get evaluated because you want to make sure you don't have an underlying health issue. So I will usually screen my patients with hemoglobin A1C, like to check their blood sugars. I will screen their cholesterol.

And I can't say the number of times I found high cholesterol or maybe pre-diabetes in a man who has erectile dysfunction. So erectile dysfunction can become, is like a symptom that there are, that there may be developing heart issues. It could be a sign, yeah. Wow. And what are the treatments available?

There's lots of treatments available. You know, there's other types of causes of ED too. I wanna make sure we don't- Let's talk about them. Yeah, there's psychogenic ED. So that can be like some of the things we've talked about where you, performance anxiety becomes an issue, right? You're stressed about, say you have one episode where you have an erection that is lackluster

or maybe you don't get one, right? Maybe you drank too much, maybe something happened that day, you were stressed, you couldn't get an erection. And then you're stressed about it, right? And then you think about it, you ruminate about it. The next time you have sex, am I going to have an erection? In your head, right? You're thinking that and then you don't get one because you're so stressed, right? You're like,

you're impossible to relax and enjoy. And then you're again, not having an erection. And then it just cycles into this horrible, vicious cycle. And I tell people, everyone who has issues with sexual function has some psychogenic component, right? Because you're like always thinking like, I'm like, even for women, am I going to climax? Is it going to happen? Am I going to have an orgasm? Is it going to be okay? Am I going to squirt? Am I going to squirt? Right? Like all these things sort of they stress you out. And so everyone has a little bit of that for sure. But there's some people where that's the only cause, right? So

that's, that's one thing. There's hormonal causes. So lack of testosterone. It's actually a very small percentage of ED. So men think, oh, it's always testosterone. It's only about 3% of people who only have hormonal causes. So they may have hormonal plus other things, but a very small percent have just hormonal causes. And then there's nerve problems. So like if you have diabetes, that can affect the nerves as well as the blood flow. So long-standing diabetes or if you've had surgery like prostatectomy or other maybe pelvic surgeries for cancer,

things like that that can affect those nerves. So those are neurologic issues. And then medications we've sort of touched on a little bit, those antidepressants can cause ED. There's other medications, some blood pressure medications can cause ED very commonly. So the most common ones, but there are others, of course. So those are the different causes. Now in terms of treatments, we have sort of,

of course, if it's psychogenic, we got to work on that. So usually I would recommend seeing a psychologist or sex therapist. And then also sometimes we can use some of these treatments to help boost your confidence, but everything else sort of- Can I pause on that for a minute? Yeah. Because I just want to see if I can make the reason

why the rumination is problematic a little bit more tied to the physiology. Because what we have learned over and over from psychologists and medical doctors that come onto the podcast is that when you're in a state of stress, even if it's stress that your own thoughts are creating, am I gonna perform, am I gonna get an erection,

this is, that, that, that, that, that, that you put yourself and your body into an alarm state, and then your body just naturally prioritizes blood flow to major organs, the penis not being one of them. Exactly. And so your own thoughts are restricting, or redirecting blood flow to major organs because you're now in a state of alarm,

which is part of what you need to get an erection is that blood flow. Yeah. So is that a good explanation for why it's really important to understand that the mental piece is really important from a physiological standpoint? Absolutely, then the high cortisol

is gonna dampen your hormonal production. So it's gonna cause a lot of cascade of events, but ultimately, it's not going to help you in any way, shape, or form. So then in terms of the other medical causes, so certainly get your testosterone checked, because if your testosterone is low, then you can replace that,

or you can do natural things to boost testosterone, which we can talk about. And how do you know if a man in your life is struggling with low testosterone? So the symptoms can be variable. So people always think about erectile dysfunction as one, that is one, but there are others. It can be low libido. That's a very hallmark symptom, brain fog, feeling depressed or down, having difficulty getting muscle mass. So say you've been doing this, you know, this routine at the gym and you're like man my muscles are just not growing like they used to, that is another sign as well. So these are

sort of all signs and fatigue also like really significant fatigue can be related to low testosterone. And what are three ways to naturally boost testosterone? Yeah so number one is sleep. So people really underestimate sleep but there's actually very good quality studies that say sleeping more than seven hours and good quality sleep, meaning you're not waking up, you're not having too much caffeine prior to bed or alcohol that may disrupt your sleep quality, even if you don't really notice it, it does. And then not looking at screens before bed, really like utilizing your circadian rhythm. Those things actually really do significantly improve testosterone.

And if you have sleep apnea, treating that will improve your testosterone. So that's one. Two is exercise, specifically resistance exercise of the large muscle groups. So like deadlifts, squats, those sorts of like lower body extremities, working on exercise for that. And then, you know, diet. So people think, oh,, actually a low fat diet is actually harmful for testosterone because it's made from cholesterol. So you need some fat in your diet, so healthy fats. The best studied diet is the Mediterranean diet,

which is lots of vegetables, lots of fruit, using healthy oils like olive oil, avocado oil, and then mostly lean meats and protein, and then a little bit of red meat is fine. But generally whole unprocessed foods are going to give you the most benefit. So you said that some of the treatments for erectile dysfunction include trying to boost testosterone, getting a good night's sleep, and is there anything else?

Yeah. So then talking about erectile dysfunction specifically, there's medications. They're in a class called PDE5 inhibitors, and they essentially work by increasing blood flow to the area. So they sort of relax the vessel. They allow nitric oxide and the cascade of events that happen to sort of stick around longer. And so ultimately, they're increasing blood flow to the organ.

And they work pretty well for a lot of people. About 60 to 70 percent of people have positive results with these medications. Now there's different formulations. There's sildenafil, which is brand name Viagra, which is an on demand an hour before sex lasts for up to four hours or so. I mean, your erection is not going to last up to four hours, but like, you know, you can take it and then have sex like three hours later and it should still be around. Right. The people always like caution about having an erection that lasts longer than four hours. That's very, very, very rare with medications.

So like, you know, if you look at the studies, it's like one or two, it was very few number of patients who actually had that problem. So if you're using it as prescribed, it's almost a non-issue. Like it's extremely rare. Other one is Tadalafel or Cialis. That's also available as an on-demand option. That lasts about 36 hours. So like say someone is gonna have a weekend away,

they can just take one and they, you know, they should be able to have multiple erections. You can also take that daily. So as a low dose every single day, if you don't like the idea of having to remember to take a pill, like when you wanna have sex and allow for a little bit of spontaneity, that's another option. So does somebody ever prescribe something like this to take the anxiety away? Yeah, so I'll often prescribe a daily Tadalafil because it will make it easier for

someone to get an erection. And so while they're working through all the mental stuff, it gives them that little boost of confidence that they can get an erection. And then once they've worked through all that, they can stop taking the medication and see how they do and they may be fine. And so I think it allows for that little bit of extra confidence. Well, Dr. Rina, I have learned so much from you today. I'm so excited to finish the conversation and go text Chris. But I would love to have you speak directly to the person listening. And if there was one thing that you want them to take away

from this conversation and just put into action today, what would it be? So one thing I want you to put into action today is to look at yourself in the mirror and say, I am deserving of pleasure. I am entitled to have pleasure by myself, with my partner. And then I want to figure out what that is and be able to communicate it.

And take those baby steps first with yourself and then with your partner. And allow yourself to be worthy of what you want because you deserve it. I love that. Dr. Rina, any parting words? No, just if you ever have an issue, don't be afraid to see a doctor because we're here to help.

And I think that that's really important to understand. I know a lot of people have bad experiences when they do see a doctor about sexual health. And I'm sorry if you've had that experience, but find someone else because there's plenty of people who are experts in sexual health and we wanna help you and you deserve to be helped. Oh, Dr. Rina, I wish that you were here on the East Coast. I know.

I would be rolling right into your office all the time. Thank you, thank you, thank you for being here, for empowering us, for, I mean, I feel very excited about this Reframe Around Play and taking control of the next chapter of my sexual pleasure and my sexual health, so thank you, thank you, thank you. You're very welcome. And I wanna also thank you for being here with us today

and for listening to and watching something that will help you create a better life and following everything that you just learned from Dr. Rena and using it to experience more joy, to advocate for yourself, to improve your sexual health, to improve your sex life, to feel more pleasure and play in your life. You deserve that. And in case no one else tells you, I wanted to and play in your life, you deserve that. And in case no one else tells you, I wanted to be sure to tell you, I love you, I believe in you, I believe in your ability to create a better life, and having a different mindset around play, around pleasure, around not feeling so ashamed

of what you deserve to feel in your life, that is a huge part of it. And I can't wait to hear how you do. And I'll talk to you in a few days. I'll say that again. That sounds like a UTI to ask me. I love your glasses, by the way. Thank you. Yeah, they really help me see.

As they should. As they should. I love them too. I know I gotta walk them back. You're like, go, go, go. Did I say it wrong? Jesus Christ. What the f*** is wrong with me? Okay, there we go. I'll do that later. Thank you.

Wow, that was so good. Thank you. Oh, and one more thing. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you.

Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you.

Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank'm just your friend. I am not a licensed therapist, and this podcast is not intended as a substitute for the advice of a physician, professional coach,

psychotherapist, or other qualified professional. Got it? Good. I'll see you in the next episode.