Huberman Lab
Dr. Rena Malik: Improving Sexual & Urological Health in Males and Females
Episode guests
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Quick takeaways
- Proper pelvic floor function is essential for normal urination, bowel movements, and sexual health.
- Sexual dysfunction in males and females can be caused by factors such as vascular issues, hormonal imbalances, and psychological factors.
- Hormones like testosterone and estrogen play significant roles in sexual desire and function in both genders.
- Treatment options for sexual dysfunction include hormone replacement therapy, medications like Viagra and Cialis, and pelvic floor physical therapy.
- Stimulation of the clitoris is the most reliable way for women to achieve orgasm.
- Open and clear communication is vital in sexual relationships and helps create a safe and fulfilling sexual environment.
Deep dives
Understanding the Pelvic Floor and its Function
The pelvic floor consists of muscles that support the organs in the pelvis and play important roles in urination, defecation, sexual function, and posture. A healthy pelvic floor allows for normal urination, proper bowel movements, and good sexual health. Pelvic floor dysfunction can occur when the muscles are either too tight or too weak. Symptoms can include urinary urgency, frequency, leakage, pain during sex, constipation, and back pain. Physical therapists who specialize in pelvic floor health can provide exercises and treatments to help normalize pelvic floor function.
Examining Sexual Health and Dysfunction
Sexual health can involve both psychological desire and physical arousal, and it differs between males and females. In males, erectile dysfunction is a common form of sexual dysfunction, which can be caused by various factors such as vascular issues, hormonal imbalances, nerve problems, and psychological factors. Female sexual dysfunction can manifest as problems with lubrication, pain during intercourse, or difficulty achieving orgasm. It is important to consider the contributions of hormones, blood flow, and neural factors in assessing and addressing sexual dysfunction in both males and females.
Hormonal and Blood Flow Factors in Sexual Function
Hormones play a significant role in sexual desire and function in both males and females. Testosterone is important for libido and sexual response in both genders. Estrogen also plays a role in sexual function and is not solely a hormone for females. Dopamine is associated with desire, while other hormones such as prolactin are involved in the refractory period. Blood flow is crucial for achieving and maintaining erections in males and adequate vaginal lubrication in females. Medications like Viagra and Cialis can enhance blood flow, while supplements like L-citrulline can increase nitric oxide production, promoting better blood flow to the genitals.
Treatment Options for Sexual Dysfunction
Treatment options for sexual dysfunction depend on the underlying causes. In cases where hormonal imbalances are identified, hormone replacement therapy may be considered. Medications like Viagra and Cialis are effective for addressing erectile dysfunction in males, while off-label use for females could be explored. Pelvic floor physical therapy can address pelvic floor dysfunction, and specialists can provide exercises, relaxation techniques, and other treatments to improve sexual function. It is important to consult with healthcare professionals who specialize in sexual health to determine the most appropriate and effective treatment options for individual concerns.
Female Sexual Response and Stimulation
Stimulation of the clitoris is the most reliable way for women to achieve orgasm. Only about 3 in 10 women orgasm through vaginal penetration alone. The clitoris, which is analogous to the male penis, plays a key role in female arousal. Other forms of stimulation, such as nipple stimulation or sensory input, can also lead to orgasm. Women have different preferences and it is important to have open communication with your partner to understand their desires and what brings them pleasure.
Effects of Hormones and Menstrual Cycle
Hormones can play a role in sexual desire and arousal. Some women may experience an increase in libido prior to ovulation. However, individual variations exist and not all women will experience changes in desire related to their menstrual cycle. It is important to have discussions with your partner and understand each other's needs and preferences throughout the menstrual cycle.
Different Types of Female Orgasms
There are different ways women can achieve orgasm, including clitoral stimulation, G-spot stimulation, and cervical stimulation. Each person may have different preferences and it is important to explore and communicate with your partner to better understand what brings pleasure and orgasm. Some women may need additional clitoral stimulation during penetration to achieve orgasm. Overall, open communication and exploration are key to discovering what works best for each individual.
Importance of Communication and Consent
Effective communication is vital in sexual relationships. It is important to create a safe and open environment to discuss desires, boundaries, and preferences. Consenting and respecting each other's boundaries is fundamental. Partners can explore and experiment together to better understand what brings pleasure. Open and ongoing communication is essential for a satisfying and fulfilling sexual relationship.
Importance of Communication in Sexual Health
Open and clear communication is vital when discussing sexual desires and boundaries. It is important to find a neutral location for these conversations and use 'I' statements to express preferences and dislikes. These conversations may require multiple discussions and the help of a sex therapist can be beneficial. Challenging conversations, though necessary, can lead to a better understanding between partners.
Preventing and Treating Urinary Tract Infections (UTIs)
UTIs are common, especially in women, and can be recurrent. Drinking plenty of fluids, especially water, helps in flushing out bacteria. Women with altered estrogen levels may benefit from vaginal estrogen treatment to restore pH balance and prevent UTIs. Properly emptying the bladder, maintaining good hygiene, and avoiding irritants like caffeine and alcohol can also help prevent UTIs.
Preventing Kidney Stones
Kidney stones can be prevented by increasing fluid intake, reducing oxalate intake from foods like spinach and rhubarb, and increasing citrate intake from fruits and vegetables. Limiting protein intake and ensuring complete bladder emptying are also important. Kidney stones should be treated based on the nature and size of the stone, with options ranging from shockwave therapy to surgical interventions.
Exploring Anal Sex
Engaging in anal sex is a personal choice, and it is important to prioritize safe practices. Using condoms and adequate lubrication is crucial to reduce the risk of sexually transmitted infections and minimize discomfort. While there are various reasons why individuals engage in anal sex, it's essential to be consensual, cautious, and respectful. Understanding the potential risks and taking appropriate precautions can help ensure a positive experience.
In this episode, my guest is Dr. Rena Malik, M.D., a board-certified urologist and pelvic surgeon, male and female pelvic medicine expert, and public health educator. We discuss the major causes of and treatments for sexual and urologic dysfunction, including how to restore, maintain and enhance pelvic floor function and proper neural and vascular (blood) supply to the genitals. We also discuss what controls and can enhance desire and arousal, how to assess and treat erectile dysfunction, and challenges with vaginal lubrication and/or orgasm. We also discuss vaginal and penile health, including preventing urinary tract infections (UTIs) and which common prescription drugs can cause sexual dysfunction in males and females. This episode covers a range of topics: oral contraception, masturbation, pornography, prostate health, and male and female hormone health.
Note: This episode covers topics related to sexual and reproductive health. Some content might not be suitable for all audiences and ages.
For show notes, including referenced articles and additional resources, please visit hubermanlab.com.
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Timestamps
(00:00:00) Rena Malik
(00:04:21) Sponsors: LMNT & Waking Up
(00:07:45) Pelvic Floor: Urination & Sexual Function
(00:14:13) What is a Healthy Pelvic Floor?
(00:19:44) Kegels, Benefits & Risks, Urinary Incontinence
(00:24:08) Pelvic Floor Relaxation; Exercise & Pelvic Floor
(00:28:03) Desire vs. Arousal, Erections: Psychology, Hormones, Blood Flow & Nerves
(00:35:31) Sponsor: AG1
(00:37:07) Pelvic Floor: Medical Professionals & Physical Therapy
(00:40:15) Sexual Dysfunction, Erectile Dysfunction, Orgasm Difficulty
(00:43:13) Desire & Arousal Issues; Erectile Dysfunction, Viagra, Cialis (Tadalafil)
(00:52:20) L-Citrulline, Supplements
(00:54:09) Erectile Dysfunction & Cialis; Prostate Health; Females
(00:58:58) Erectile Dysfunction in Young Men
(01:01:37) Pornography, Masturbation & Ejaculation; Healthy Sexual Behavior
(01:08:22) Arousal Habituation, Masturbation, Addiction
(01:12:57) Female Arousal Response, Orgasm, Coolidge Effect
(01:17:22) Priapism, Melanocyte Stimulating Hormone; Women & Low Libido Medications
(01:22:25) Libido & Individuality
(01:26:18) Female Arousal, Vaginal Lubrication; Discharge, Odors & Douching
(01:33:09) Vaginal Infections, Discharge; Vaginal Microbiome
(01:35:45) Female Orgasm, Vaginal Penetration, Stimulation, Clitoris, G-Spot
(01:42:31) Erection & Orgasm, Pelvic Floor Muscles
(01:46:32) Dopamine-Enhancing Medication & Arousal Arc
(01:51:18) Menstrual Cycle & Libido
(01:52:49) Vaginal Penetration, Variation & Communication
(01:55:24) Sexual Interaction Communication, Sex Therapists
(01:58:45) Urinary Tract Infections (UTIs) in Male & Females; Prevention, Vaginal Estrogen
(02:04:04) Male Urination Sitting; Spermicide, Cranberry, D-Mannose & UTIs
(02:11:33) Testosterone, Post-Menopausal Women & Libido
(02:14:56) Kidney Stones: Prevention & Treatment
(02:19:14) Oral Contraception, Libido, Individuality, Intrauterine Device (IUDs)
(02:26:52) Anti-Depressants, SSRIs & Low Libido
(02:29:32) Prostate Health, Cialis, Urination Difficulty
(02:34:22) Bicycling, Genital Numbness, Erectile Dysfunction
(02:37:48) Anal Sex, Females, Sexually Transmitted Infections (STIs), Lubricants
(02:44:14) Libido, Behavioral Interventions, Supplements
(02:49:15) Supplements for Libido
(02:52:14) Zero-Cost Support, YouTube Feedback, Spotify & Apple Reviews, Sponsors, Momentous, Social Media, Neural Network Newsletter
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