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Orgasms as Medicine: De-Stigmatizing Sex & Pelvic Wellness in Perimenopause with Dr. Rena Malik

Dec 15, 2025

Dr. Rena Malik, a board-certified urologist and sexual medicine expert, dives deep into female sexual health. She breaks down pelvic floor dysfunction and discusses the alarming prevalence of urinary incontinence among women. The conversation touches on menopause’s impact on sexual wellness, revealing the 'orgasm gap' affecting many. Dr. Malik also tackles the complexities of desire in midlife and the often misunderstood effects of pornography on expectations and sexuality. Her insights aim to empower women and destigmatize important health topics.

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INSIGHT

Orgasms Deliver Wide Health Benefits

Orgasms have measurable health benefits like lowering heart rate and blood pressure.
They also improve sleep, reduce pain, and can enhance post-orgasmic clarity.

ADVICE

Protect Your Pelvic Floor With Movement

Keep the pelvic floor healthy by moving regularly and breathing on exertion.
Practice good toilet habits and avoid chronic holding to prevent dysfunction.

INSIGHT

Incontinence Is Common And Often Mixed

One in three women experience incontinence and many have mixed causes.
Stress leakage is pelvic-floor related and urgency leakage is bladder-related, and half of sufferers have both.

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Dr. Rena Malik, board-certified urologist and sexual medicine expert, has the most frank conversation about female sexual health you'll hear anywhere. She covers pelvic floor dysfunction (incontinence affects 1 in 3 women), the genital urinary syndrome of menopause (80% of women will experience changes), and the orgasm gap—plus why same-sex couples don't have this problem. Dr. Malik breaks down low desire in midlife with actual treatment options, explains responsive vs. spontaneous desire, and tackles the hard conversations about pornography's impact on our kids. Whether you're dealing with changes yourself or supporting someone who is, this episode removes the shame and gives you actionable solutions for better sexual and pelvic health.

Episode Overview (timestamps are approximate):
(0:00) Intro/Teaser
(4:00) Pelvic Floor 101: Anatomy and Function
(8:00) Urinary Incontinence
(14:00) Tight Pelvic Floor & Pelvic Floor Dysfunction
(18:00) Strengthening Weak Pelvic Floor
(21:00) Pelvic Organ Prolapse (POP)
(29:00) Menopause & Genito-Urinary Changes
(33:00) Female Arousal & Clitoral Anatomy
(37:00) Responsive Desire & Maintaining Sexual Connection
(44:00) The Orgasm Gap
(49:00) Pornography & Realistic Expectations
(55:00) Pornography Use & Sexual Function
(1:00:00) Types of Orgasms
(1:03:00) Semen Retention & Orgasm Frequency
(1:08:00) Low Desire in Women
(1:16:00) Arousal vs. Desire
(1:19:00) UTIs & Bladder Health
(1:23:00) BONUS: After-Party with Dr. Stephanie

Resources mentioned in this episode can be found at https://drstephanieestima.com/podcasts/ep447

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P.S. When you're ready, here are a two ways I can help you:

Subscribe: The Mini Pause — My weekly newsletter packed with the most actionable, evidence-based tools for women 40+ to thrive in midlife.

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