#250 Rena Malik - Urologist Debunks #1 Sex Myth Every Man Still Believes
In this episode of the Shawn Ryan Show, urologist Dr. Rena Malik addresses common misconceptions about sexual health and function. She explains that erectile dysfunction, which affects half of men over 50, is rarely caused by low testosterone and can be an early indicator of cardiovascular disease. The discussion covers prostate health, including cancer screening guidelines and prevention strategies, while also exploring how lifestyle factors influence sexual wellness.
Dr. Malik also examines female sexual health, particularly during menopause, and provides context about anatomical facts versus common myths. The conversation extends to broader topics affecting sexual well-being, including the impact of pornography on expectations, the role of hormonal changes throughout aging, and evidence-based approaches to maintaining sexual health through various life stages.
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1-Page Summary
Sexual Dysfunction and Its Causes/Treatments
Dr. Rena Malik explains that while erectile dysfunction (ED) is often attributed to low [restricted term], this is true in only 3-6% of cases. She notes that ED affects 50% of men over 50, with rates increasing 10% per decade. Importantly, ED can be an early warning sign of cardiovascular disease, with Malik highlighting that men experiencing ED have a 15% chance of heart attack within seven years.
Regarding premature ejaculation, Malik recommends strengthening the pelvic floor through exercises like Kegels, combined with mindfulness techniques and stress reduction. While medications are available, she emphasizes addressing the psychological aspects for long-term improvement.
Prostate Health and Cancer
Prostate cancer screening typically begins at 55 through PSA blood tests and MRIs. Malik emphasizes that prostate cancer often grows slowly, making active surveillance a viable option for many cases. She notes that regular ejaculation (more than 21 times monthly) may lower prostate cancer risk.
The health of the prostate is closely tied to overall cardiovascular and metabolic health. Malik explains that conditions like diabetes and high blood pressure increase the risk of prostate enlargement, emphasizing the importance of maintaining a healthy lifestyle.
Female Sexual Health and Pleasure
Malik explains that while the entire body can be erogenous, clitoral stimulation is crucial for most women to achieve orgasm. She dispels the myth that larger penis size leads to more pleasure, noting that the vagina is typically only three to three and a half inches long before arousal.
During menopause, hormonal changes can affect sexual function through symptoms like vaginal dryness and decreased desire. Malik emphasizes that both physical treatments and emotional support are essential for maintaining a fulfilling sex life.
Impact of Pornography on Sexual Expectations and Behaviors
Children are exposed to pornography by an average age of 10, according to Malik, potentially developing unrealistic expectations about sex. She stresses the importance of early, open discussions about the differences between pornography and real-life sexual relationships, recommending parents begin these conversations around age eight.
Hormonal Changes and Their Effects on Sexual Function
[restricted term] levels decline about 1-1.5% annually after age 40, affecting approximately 20% of men. Malik emphasizes that lifestyle factors like quality sleep, exercise, and stress management can help maintain [restricted term] levels. For women experiencing menopause, she recommends treatments including lubricants, vaginal moisturizers, and hormonal creams to address symptoms affecting sexual function.
1-Page Summary
Additional Materials
Counterarguments
- While ED is not often caused by low [restricted term], it's important to consider that hormonal imbalances can still play a significant role in sexual dysfunction for some individuals.
- The link between ED and cardiovascular disease is significant, but it's also important to consider other risk factors and comorbidities that could contribute to both conditions.
- Pelvic floor exercises and mindfulness may help with premature ejaculation, but these methods may not be effective for all individuals, and some may require more comprehensive medical or psychological treatment.
- The recommendation for prostate cancer screening to start at 55 could be debated, as some guidelines suggest individualized decision-making based on risk factors.
- The claim that regular ejaculation may reduce the risk of prostate cancer is based on observational studies, and causation has not been definitively established.
- The link between metabolic health and prostate health is complex, and while there is an association, other factors may also play a significant role in prostate health.
- The assertion that clitoral stimulation is crucial for most women to achieve orgasm may not account for the full spectrum of sexual experiences and preferences among women.
- The discussion on menopause focuses on hormonal treatments and may not fully explore non-hormonal alternatives that some women might prefer or find effective.
- The impact of pornography on children's expectations could be nuanced, considering that not all exposure to sexual content leads to unrealistic expectations, and the role of comprehensive sex education is also crucial.
- The decline in [restricted term] levels with age is a general trend, but individual experiences can vary significantly, and not all men will experience a clinically significant decline or symptoms.
- The effectiveness of lifestyle interventions in maintaining [restricted term] levels can vary, and some individuals may require medical intervention despite healthy lifestyle practices.
- The recommendations for women experiencing menopause to use lubricants, vaginal moisturizers, and hormonal creams may not address the full range of therapeutic options available, such as systemic hormone therapy or alternative medicine approaches.
Actionables
- You can track your cardiovascular health indicators to potentially identify ED-related risks by using a home blood pressure monitor and cholesterol testing kit, and then discussing any concerning results with your healthcare provider.
- By regularly monitoring your blood pressure and cholesterol levels at home, you can catch early signs of cardiovascular issues that might be linked to erectile dysfunction. For example, if you notice your blood pressure readings are consistently high, it could be an indicator to talk to your doctor about your heart health and ED concerns.
- Incorporate pelvic floor strengthening into your daily routine to potentially improve sexual health by using apps that guide you through Kegel exercises designed for men.
- Apps that offer Kegel exercise programs can help you strengthen your pelvic floor muscles, which may improve control during sexual activity. These apps often include reminders and progress tracking, making it easier to stay consistent and motivated. For instance, you might use an app that guides you through three sets of Kegels during your morning routine.
- Initiate open conversations about sexual health and expectations with your partner or a health professional to address psychological aspects of sexual performance.
- Talking openly with your partner about sexual expectations and experiences can foster a better understanding and improve intimacy. If discussing with a partner feels challenging, consider seeking a therapist specializing in sexual health to explore psychological factors affecting your sexual performance. For example, you and your partner might set aside time each week to discuss what you both enjoy and any concerns you have, creating a safe space for honest communication.
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Sexual Dysfunction and Its Causes/Treatments
Sexual dysfunction, including erectile dysfunction and premature ejaculation, has various causes and treatments; understanding them is critical for men’s health.
Erectile Dysfunction Is Common, Often With Physical or Psychological Causes Beyond Low [restricted term]
Malik clarifies that while erectile dysfunction (ED) is commonly associated with low levels of [restricted term], it is rarely the cause, with only three to six percent of erectile dysfunction cases attributable to a [restricted term] deficiency. Indeed, 50% of men over 50 experience ED, and the incidence increases about 10% with each passing decade.
Erectile Dysfunction May Indicate Cardiovascular Disease; Men Should Address the Cause
ED is often an early sign of cardiovascular problems since the blood vessels in the penis are smaller and more sensitive than those to other organs. Smoking is particularly harmful to these small vessels. Malik points out that waking up with an erection indicates good hormonal and blood flow functioning, so the absence may signify health issues. Moreover, if a man has erection issues, there's a 15% chance he will have a heart attack within seven years, highlighting the need for men to get an overall health evaluation.
Psychological Factors Like Anxiety and Pressure Can Cause Erectile Dysfunction, Possibly Needing Therapy or Lifestyle Changes to Overcome
Beyond physiological causes, psychological factors also play a significant role in ED. Anxiety about sexual performance can create a vicious cycle of pressure and obsession over erections. The initial absence of anxiety typically seen with masturbation can help discern a psychological component in erectile dysfunction. Malik emphasizes the necessity of therapy or consulting a sex therapist to address these psychological anxieties.
Address Premature Ejaculation With Pelvic Floor Exercises and Mindfulness
Premature Ejaculation: Physiological Causes and Psychological Management
Malik encoura ...
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Sexual Dysfunction and Its Causes/Treatments
Additional Materials
Counterarguments
- While low [restricted term] may not be the primary cause of erectile dysfunction, it can still be a contributing factor for some men, and addressing hormone levels could be beneficial in those cases.
- The statistic that 50% of men over 50 experience erectile dysfunction might not reflect the nuances of individual health conditions, lifestyle factors, and genetic predispositions.
- While erectile dysfunction can be an indicator of cardiovascular disease, not all cases of ED are related to heart health, and other factors such as mental health should also be considered.
- The absence of morning erections might not always signify health issues, as individual variations in sexual function can be normal.
- The 15% chance of a heart attack statistic may not account for other variables that can influence heart health, such as diet, exercise, and genetics.
- Psychological factors are indeed significant in erectile dysfunction, but the text may understate the complexity of psychological causes and the variety of therapeutic approaches available.
- Pelvic floor exercises are helpful, but they may not be effective for all individuals with premature ejaculation, and other treatments may be necessary.
- The combination of pelvic floor exercises with HIIT may not be suitable for all individuals, especially those with certain health cond ...
Actionables
- You can track your morning erections to monitor your sexual health by keeping a simple journal by your bedside to note the frequency and quality of morning erections over time, which can serve as an early indicator of potential health issues.
- Develop a personalized stress-reduction routine that includes activities like yoga, deep breathing exercises, or progressive muscle relaxation to help manage psychological factors contributing to sexual dysfunction, aiming to practice for at least 10-15 minutes daily.
- Creat ...
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Prostate Health and Cancer
Understanding prostate health is critical for men, with prostate cancer screening and awareness of related conditions being of prime importance for early detection and management.
Prostate Cancer Screening: Psa Tests & MRI For Early Detection
Screening for prostate cancer involves regular PSA blood tests, which are crucial, especially when on [restricted term] replacement, to catch any development of cancer early, due to the risk of accelerated growth of existing cancer. The recommended age to begin screening is generally 55, but it can be earlier for individuals with a higher risk profile, including those with a family history of cancer or specific genetic mutations.
Prostate Cancer's Slow Growth Favors Active Surveillance Over Immediate Treatment
Dr. Rena Malik notes the importance of recognizing that prostate cancer often grows slowly and not all diagnosed cases necessitate immediate treatment. She advocates for active surveillance protocols that include routine MRIs and biopsies. This approach is beneficial for those whose cancer is unlikely to become problematic immediately, thus avoiding unnecessary and often regrettable side effects of treatment.
Enlarged Prostate Causes Urinary Symptoms; Lifestyle Changes and Minimally Invasive Treatments Are Effective
Medications like [restricted term] can relax the prostate and alleviate urinary symptoms that are often signs of an enlarged prostate, not necessarily cancer. Malik emphasizes that understanding these symptoms and their possible causes is essential, as urinary issues could result from an enlarged prostate, which is influenced by genetics and health conditions leading to inflammation.
Prostate, Cardiovascular, and Metabolic Health Are Linked; a Healthy Lifestyle Is Key for Prevention
The health of the prostate is closely associated with overall cardiovascular and metabolic health. Malik points out that unhealthy lifestyle choices can cause inflammation in the body, contributing to prostate growth and an enlarged prostate. Maintaining a healthy lifestyle, with an emphasis on diet and exercise, is recommended for prostate health and could also help prevent prostate enlargement. Conditions such as diabetes and high blood pressure are associated with an increased risk of an enlarged prostate, thus controlling these conditions is also key.
Dr. Malik suggests that ejaculating more than 21 times a month is potentially associated with a lower ...
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Prostate Health and Cancer
Additional Materials
Counterarguments
- Screening guidelines vary, and some experts argue that starting at age 55 might not be optimal for everyone; personalized screening schedules based on individual risk factors could be more effective.
- The PSA test has limitations and can result in false positives, leading to unnecessary anxiety and potentially invasive follow-up procedures.
- Active surveillance for slow-growing prostate cancer might not be suitable for all patients, as it requires a commitment to regular monitoring and the psychological burden of living with untreated cancer.
- While lifestyle changes and minimally invasive treatments can be effective for an enlarged prostate, they may not work for everyone, and some patients may require more aggressive treatments.
- The link between lifestyle choices and prostate health, while supported by some studies, is not conclusively proven, and other factors may also play significant roles.
- The recommendation of ejaculating more than 21 times a month to reduce prostate cancer risk is based on observational studies, which cannot prove causation, and may not be a practical or beneficial recommendation for all individuals.
- MRI imaging is more expensive and less accessible than PSA testing, which could limit its use as a routine screening tool in some healthcare settings.
- The effectiveness of managing metabolic conditions in preventing prostate enlargement and decreasing c ...
Actionables
- You can create a personalized prostate health tracker to monitor your risk factors and screening schedule. Start by listing your age, family history, any medical conditions like diabetes or high blood pressure, and lifestyle habits. Use a simple spreadsheet or a health app to set reminders for when to start regular PSA testing, based on your risk profile. For example, if you're 40 with a family history of prostate cancer, set a reminder to discuss earlier screening with your doctor.
- Develop a prostate-friendly meal plan to integrate into your weekly routine. Focus on foods known to support prostate health, such as tomatoes rich in lycopene, cruciferous vegetables like broccoli, and foods high in omega-3 fatty acids. Plan your meals to include these ingredients regularly, and track any changes in urinary symptoms or overall well-being. For instance, you might have a "Tomato Tuesday" where you include a tomato-based dish in your meals.
- Engage in a monthly self-assessment of urinary symptoms and sexual health to catch early si ...
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Female Sexual Health and Pleasure
Rena Malik delves into the intricacies of women's sexual function and the necessity of clitoral stimulation, open communication, and emotional support for a satisfactory sex life.
Components of Women's Sexual Function and Pleasure
Malik informs that while the entire body can be erogenous, clitoral stimulation is pivotal for most women to achieve orgasm. The clitoris and penis share similar anatomical structures, and the clitoris can reliably lead to orgasm for many women without requiring penetration. She clears up the misconception that larger penis size leads to more pleasure, explaining that size is not essential for pleasure or orgasm due to the vagina's length before arousal, which is about three to three and a half inches. Malik also states that understanding one's body through masturbation is important for later communicating what brings pleasure.
Ignoring Clitoral Stimulation In Favor of Penetration
The hosts share that penetration may indirectly stimulate the clitoris, but the majority of women need more direct stimulation to climax. A larger penis is not a prerequisite for sexual pleasure, and the assumption that it is can lead to misunderstandings. Malik highlights that due to the clitoral structure's extension into the pelvis, girth might stimulate more of the clitoris during intercourse. She points out that many women have a preference for average girth, and excessive girth can lead to difficulties and discomfort in intercourse.
Open Partner Communication About Desires, Needs, and Sensitivity Is Key For Satisfying Sex
Malik emphasizes the importance of partner communication to achieve sexual satisfaction. She encourages talking about what was enjoyable or what could be improved upon after sex. Communication is crucial in understanding each ...
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Female Sexual Health and Pleasure
Additional Materials
Actionables
- You can create a pleasure map of your body by exploring different types of touch and pressure in a relaxed setting, noting which areas respond most positively. This self-exploration can be done during solo sessions, using your hands or toys to discover which movements and rhythms elicit the best response. Document your findings in a journal or app designed for personal insights to reference later during partner communication.
- Develop a post-intimacy conversation starter kit with your partner that includes open-ended questions and prompts to discuss what each of you enjoyed and what could be improved. This kit could be a physical box with written notes or a digital document shared between you two. After each intimate encounter, take turns drawing a question or prompt to guide your discussion, ensuring it's a positive and constructive experience.
- If you're experiencing menopausal symptoms that affect your sex life, consider s ...
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Impact of Pornography on Sexual Expectations and Behaviors
The podcast touches upon the significant influence of pornography on sexual expectations and behaviors, highlighting the importance of addressing the issue openly, especially when it comes to educating the youth.
Explicit Content Shapes Unrealistic Youth Sexual Expectations
Pornography Presents Sex In a Stylized, Unrealistic Way, Unlike Healthy Relationships
Rena Malik points out that children exposed to pornography, often by the average age of 10, may develop a distorted view of sex, believing that pornographic depictions are accurate representations of sexual encounters. Consequently, they may attempt to emulate what they've seen, leading to confusion and disappointment when reality does not match these portrayals.
Unchecked Pornography Exposure Can Harm Arousal, Intimacy, and Sexual Development
Malik also discusses the negative side effects of consuming pornography, such as influencing people's perception of sexual norms like the normalization of extreme behaviors witnessed in porn that are not centered around mutual pleasure. She goes on to correct misconceptions that arise from pornography, like the belief that sexual intercourse usually lasts much longer than the average five to six minutes or that the volume of semen is far greater than the typical tablespoon amount, both misconceptions stemming from the artificial nature of pornographic productions.
Moreover, Malik delves into the complexities of self-shame that can arise from watching pornography, especially if it clashes with an individual's moral beliefs. This can result in a "shame spiral" where individuals feel bad for consuming porn, yet return to it for temporary relief, which exacerbates the issue. This cycle can lead individuals to question their own sexual function when reality does not meet the false standards set by porn.
Discussing Pornography vs. Real-Life Sex With Children Is Important
Malik emphasizes the critical need for open and proactive discussions with children about pornography. She has begun the conversation with her son as early as eight years old to prepare him for potential exposure and to clarify the vast differences between real-lif ...
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Impact of Pornography on Sexual Expectations and Behaviors
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Clarifications
- A "shame spiral" is a cycle of negative emotions and behaviors triggered by feelings of shame or guilt. It involves a pattern where an individual feels bad about a particular action, seeks temporary relief through that action, feels worse afterward, and then repeats the behavior. This cycle can l ...
Counterarguments
- While pornography can shape unrealistic expectations, some argue that it can also serve as a platform for sexual exploration and education when used responsibly and with critical awareness.
- The impact of pornography on sexual behavior is not universally negative; some individuals may consume pornography without it negatively affecting their sexual relationships or expectations.
- Open discussions about pornography might not be suitable for all children at the same age; developmental stages vary, and what is appropriate should be tailored to the individual child's maturity level.
- The assertion that pornography consumption leads to self-shame and moral conflicts may not apply to all individuals or cultures, as attitudes towards pornography can be influenced by a variety of personal and societal factors.
- Some researchers argue that the relationship between pornography and sexual violence or negative behaviors is not as clear-cut as often presented, suggesting that other factors play a more significant role in shaping sexual behaviors.
- There is a debate about whether the negative effects of pornography are a result of the content itself or a lack of comprehensive sex education that ...
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Hormonal Changes and Their Effects on Sexual Function
The podcast hosts, including Rena Malik, discuss how hormonal changes, particularly [restricted term] decline, can have profound effects on sexual function. They explain that muscle strength, lifestyle, and hormone therapy play important roles in maintaining sexual health.
[restricted term] Decline With Age Can Reduce Libido and Sexual Function, but Other Health Factors Are Often More Influential
[restricted term] levels in men decline approximately one to one and a half percent every year after the age of 40. Around 20% of people experience low [restricted term], with the number rising with age. Factors such as high cholesterol, diabetes, high blood pressure, lack of sleep, increased stress, sedentary lifestyles, and environmental factors like microplastics can all contribute to lowered [restricted term] levels. Low [restricted term] in men commonly presents with symptoms like a decrease in sexual desire and loss of morning erections, as well as affects muscle mass, mood, brain clarity, and bone health.
Lifestyle Factors Like Sleep, Exercise, and Stress Help Maintain [restricted term] Levels and Sexual Function
Malik emphasizes the importance of a healthy lifestyle in maintaining sexual function and hormone levels. Regular exercise, especially resistance training, a healthy diet like the Mediterranean diet, and avoiding excessively low-fat diets (since [restricted term] is derived from cholesterol) are beneficial. Quality sleep is particularly influential, with more than seven hours a night potentially increasing [restricted term] by 15%. Malik also recognizes the improvements in [restricted term] levels when using a CPAP machine for those with sleep apnea.
[restricted term] Therapy May Be Suitable but Requires Monitoring For Side Effects
[restricted term] replacement therapy (TRT) is an option for men who present multiple symptoms related to low [restricted term] and confirmed low levels through blood tests. Malik suggests that young men should get a baseline [restricted term] level when they feel good for future reference. While [restricted term] replacement can improve symptoms, it comes with risks like increased PSA levels, thickening of the blood (which can increase the risk for blood clots and strokes), and infertility. Malik stresses that people on [restricted term] therapy need to see it as a lifelong commitment, and to be careful of side effects, emphasizing the need for holistic monitoring of patients.
Menopausal Hormonal Changes Can Affect Sexual Desire, Arousal, and Comfort, but Treatments Exist
Women experience hormonal changes during menopause that can affect sexual desire, vaginal dryness, atrophy of the tissue leading to painful intercourse, and changes in clitoral sensitivity. To address these iss ...
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Hormonal Changes and Their Effects on Sexual Function
Additional Materials
Counterarguments
- While [restricted term] decline is associated with reduced libido and sexual function, it's important to note that individual experiences vary, and not all men will notice significant changes as they age.
- The relationship between [restricted term] levels and symptoms like mood and cognitive function is complex, and low [restricted term] is not the only factor that can cause these issues. Other factors such as mental health, lifestyle, and chronic illnesses can also play significant roles.
- The effectiveness and safety of [restricted term] therapy are still subjects of debate, and some studies suggest that the benefits may not outweigh the risks for all individuals.
- The emphasis on lifestyle factors, while important, may oversimplify the challenges some individuals face in maintaining these healthy habits due to socioeconomic, psychological, or physical barriers.
- The focus on hormonal treatments for menopausal symptoms may underrepresent non-hormonal strategies that can also be effective, such as pelvic floor physical therapy or cognitive-behavioral therapy for sexual dysfunction.
- The assertion that [restricted term] therapy is a lifelong commitment may not account for the evolving nature of medical guidelines and the possibility of future treatments or changes in an individual's ...
Actionables
- You can track your sleep and activity levels with a wearable fitness tracker to identify patterns that may correlate with your energy and libido. By monitoring your sleep quality and daily activity, you can make targeted changes, such as adjusting your bedtime or incorporating more movement throughout the day, to potentially improve these aspects of your health.
- Create a "stress and mood diary" to observe how your stress levels and mood fluctuations might be related to your sexual health. Each day, jot down your stress level on a scale of 1-10, note any significant mood changes, and reflect on your sexual desire and function. Over time, this can help you pinpoint stressors or mood patterns that you may want to address through relaxation techniques, counseling, or lifestyle adjustments.
- Experiment with incorporating specific foods known to support vascular health ...
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