Rena Malik

Sponsors: ROKA & Helix Sleep; HLP Survey

Pelvic Floor: Urination & Sexual Function

What is a Healthy Pelvic Floor?

Kegels, Benefits & Risks, Urinary Incontinence

Pelvic Floor Relaxation; Exercise & Pelvic Floor

Desire vs. Arousal, Erections: Psychology, Hormones, Blood Flow & Nerves

Sponsor: AG1

Pelvic Floor: Medical Professionals & Physical Therapy

Sexual Dysfunction, Erectile Dysfunction, Orgasm Difficulty

Desire & Arousal Issues; Erectile Dysfunction, Viagra, Cialis (Tadalafil)

L-Citrulline, Supplements

Erectile Dysfunction & Cialis; Prostate Health; Females

Erectile Dysfunction in Young Men

Pornography, Masturbation & Ejaculation; Healthy Sexual Behavior

Sponsor: InsideTracker

Arousal Habituation, Masturbation, Addiction

Female Arousal Response, Orgasm, Coolidge Effect

Priapism, Melanocyte Stimulating Hormone; Women & Low Libido Medications

Libido & Individuality

Female Arousal, Vaginal Lubrication; Discharge, Odors & Douching

Vaginal Infections, Discharge; Vaginal Microbiome

Female Orgasm, Vaginal Penetration, Stimulation, Clitoris, G-Spot

Erection & Orgasm, Pelvic Floor Muscles

Dopamine-Enhancing Medication & Arousal Arc

Menstrual Cycle & Libido

Vaginal Penetration, Variation & Communication

Sexual Interaction Communication, Sex Therapists

Urinary Tract Infections (UTIs) in Male & Females; Prevention, Vaginal Estrogen

Male Urination Sitting; Spermicide, Cranberry, D-Mannose & UTIs

Testosterone, Post-Menopausal Women & Libido

Kidney Stones: Prevention & Treatment

Oral Contraception, Libido, Individuality, Intrauterine Device (IUDs)

Anti-Depressants, SSRIs & Low Libido

Prostate Health, Cialis, Urination Difficulty

Bicycling, Genital Numbness, Erectile Dysfunction

Anal Sex, Females, Sexually Transmitted Infections (STIs), Lubricants

Libido, Behavioral Interventions, Supplements

Supplements for Libido

Zero-Cost Support, YouTube Feedback, Spotify & Apple Reviews, Sponsors, Momentous, Social Media, Neural Network Newsletter

- The Huberman Lab Podcast discusses science and science-based tools for everyday life.
- Dr. Reena Malik, a board-certified urologist and pelvic surgeon, is the guest on this episode.
- The episode covers commonly asked questions about urinary, pelvic, and sexual health.
- Pelvic floor relaxation and strengthening are important for urologic and sexual function.
- Sexual health topics include erectile function, vaginal lubrication, orgasm, and misconceptions about sexual dysfunction.
- Obtaining high-quality information on sexual health is emphasized.
- Factors such as stress, anxiety, overuse, childbirth, comorbidities, smoking, and hormonal imbalances can affect pelvic floor dysfunction and sexual function.
- Kegels are a strengthening exercise for the pelvic floor muscles.
- Nitric oxide, testosterone, estrogen, and medications like Viagra and Cialis play roles in sexual function.
- Female arousal response, FDA-approved medications for low libido in women, painful intercourse, lubrication, vaginal discharge, and clitoral stimulation are discussed.
- Communication, understanding between partners, hydration, prevention of kidney stones, contraception options, antidepressants, bicycle seats, anal sex risks, behavioral tools, and herbal supplements are mentioned.
- The podcast host asks for subscriptions, reviews, and comments, and Momentus Supplements offers a discount and newsletter sign-up.

- The Huberman Lab Podcast discusses science and science-based tools for everyday life.
- Dr. Reena Malik, a board-certified urologist and pelvic surgeon, is the guest on this episode.
- The episode covers topics such as urinary, pelvic, and sexual health, including avoiding UTIs, understanding pelvic floor anatomy and function, and debunking misconceptions about sexual dysfunction.

- The podcast is separate from the speaker's teaching and research roles at Stanford and aims to provide free science-related information to the public.
- The podcast is sponsored by Roka, which offers high-quality eyeglasses and sunglasses designed for performance and aesthetics.
- The podcast is also sponsored by Helix Sleep, which offers customized mattresses and pillows based on individual sleep needs.

- Only a small percentage of erectile dysfunction and female sexual arousal issues are hormonal in origin.
- Testosterone and dopamine are associated with desire in both men and women, while estrogen is beneficial for libido.
- The physiological response to sexual desire and arousal involves the parasympathetic and sympathetic nervous systems, as well as the release of nitric oxide.

- L-citrulline is an over-the-counter supplement that works similarly to Cialis-Viagra but is less potent.
- L-citrulline can cause cold sores and canker sores in some people and not everyone tolerates it well.
- L-arginine is a more direct pathway for increasing nitric oxide, but L-citrulline lasts longer in the bloodstream, which is why it is commonly used.

- Approximately 60 to 70% of males who take Cialis or Viagra for erectile dysfunction experience relief.
- Erectile dysfunction is common, affecting about 52% of men over the age of 40 and increasing with age.
- Low dosage Cialis-Tadalafil may be used for prostate health and can potentially improve sexual function in females with blood flow issues. However, there is limited data and further research is needed.

- Many young men in their 20s and 30s are experiencing erectile dysfunction.
- Factors such as lack of physical activity, nicotine use, and stress from sitting for long periods of time can contribute to pelvic floor dysfunction.
- There may also be a psychogenic feedback loop where stress worsens the condition.

- Pornography is now easily accessible and can be a source of sex education for some people.
- Masturbating to pornography to the point of ejaculation is believed to create a deficit in seeking out real-world sexual interactions.
- Problematic pornography use is described in about 4% of people and is becoming more common due to the accessibility of pornography and its activation of dopamine pathways.

- InsideTracker is a personalized nutrition platform that analyzes blood and DNA data to help understand the body and meet health goals.
- Regular blood work is important for understanding immediate and long-term health factors.
- InsideTracker provides a personalized platform to easily understand blood test results and offers protocols to adjust numbers for optimal health.

- Some people find the sounds of people having sex arousing, especially in crowded cities.
- Habituation can occur with certain types of arousal, such as watching pornography, which may make it difficult to be aroused by normal stimuli.
- Excessive masturbation without developing healthy sexual relationships can lead to dependency on pornography and hinder the development of social skills.

- The female sexual response is often stereotyped, but there are different forms of arousal and orgasm.
- The female arousal response includes increased heart rate, heavier breathing, sex flush, and vaginal lubrication.
- The orgasm response involves rhythmic pelvic floor muscle contractions and increased sympathetic response. There is a refractory period, but a novel stimulus can override it. Dopamine plays a role in overriding the refractory period.

- There are centrally acting medications available for pre-menopausal women with low libido, such as melanocyte stimulating hormone (MSH) and Bremelanotide.
- Priapism, an enduring and potentially harmful erection, can be caused by certain medications and injections, but is rare with Cialis or Viagra.
- Other medications like Trazodone or sickle cell anemia can also cause priapism. Flibanserin is another medication available for low libido, taken daily before bedtime.

- There is no specific benchmark for determining normal, high, or low libido, as it is subjective and varies based on individual desires and satisfaction.
- About 40% of people qualify for sexual dysfunction, but only 12% are bothered by it.
- Mismatched libidos in couples are common, and finding a compromise depends on individual goals and communication.

- The transcript is an interview with Dr. Reena Malik about sexual health and related topics.
- The discussion focuses on the importance of pelvic floor health and its impact on urination, sexual function, and GI function.
- Pelvic floor dysfunction can lead to symptoms such as urgency, frequency, pain during sex, constipation, and back pain.

- Physiologically, the body prepares for penetration during sexual arousal, with the cervix moving up and the vagina lengthening.
- Adequate time for arousal is important to prevent painful intercourse.
- Lubrication is not the sole indicator of arousal, and changes in lubrication can occur due to age, hormones, medications, and breastfeeding.

- Changes in discharge, itching, and discomfort are signs of infections like yeast or bacterial infections.
- Mycoplasma infections can occur in the vagina and urine, and may be tested for in cases of urinary tract infection.
- The vagina is a self-cleaning organ, and only the hair-bearing areas need to be washed with soapy water.

- Female orgasm can be achieved through clitoral stimulation or G-spot stimulation.
- About 85% of women require clitoral stimulation to climax, while very few climax through vaginal penetration alone.
- There is a significant orgasm gap between men and women, with 95% of men having an orgasm during first-time sexual encounters compared to 45-50% of women.

- The levator ani muscle controls erection in males and clitoral tumescence in females.
- The orgasm response involves the contraction of the pelvic floor muscles and is initiated by the brain.
- Orgasm is a subjective experience and can vary in sensations depending on individual nerve and sensory responses.

- Dopamine is associated with the orgasm response and can be elevated by antidepressants and stimulant drugs.
- Maintaining a calm state of mind during sexual interactions is important for riding the arousal arc.
- Apomorphine, a dopaminergic drug, combined with Tadalafil, a PDE5 inhibitor, is being used to increase arousal in sex, mainly by men.

- The transcript discusses the differences in arousal and hormones across the menstrual cycle.
- The speaker is interested in the correlation between desire and the stage of the menstrual cycle.
- Data suggests that libido increases prior to and during ovulation, but there is no data on a complete lack of interest.

- There are different ways for females to achieve orgasm, including clitoral stimulation, penetration-based stimulation, and stimulation of the G-spot.
- Communication between partners is important in exploring and understanding each other's preferences.
- Consent, age appropriateness, and avoiding substances that can affect judgment are key factors in sexual experiences.

- Cultivating a language or nomenclature around sexual interactions can facilitate communication.
- It is important to have conversations about sexual preferences outside of the bedroom to avoid insecurity.
- Multiple conversations may be needed and seeking the help of a sex therapist can be beneficial.

- UTIs are common in women, with up to 50% experiencing at least one in their lifetime and a third having recurrent UTIs.
- UTIs are less common in men due to the longer urethra, so it is concerning when they occur and should be investigated.
- Prevention strategies include staying hydrated, using vaginal estrogen for women with altered estrogen states, and ensuring complete bladder emptying.

- There is a discussion on Reddit about the percentage of males who sit while urinating, and it varies by country.
- Spermicides increase the risk of UTIs for females, while cranberry supplements can help reduce the risk.
- Over-cleaning can disrupt the microbiome and potentially lead to UTIs, while pelvic floor dysfunction can cause recurring UTI symptoms.

- It can be difficult to determine if the pelvic floor muscles are too tight or weak, as it is not a muscle that people are trained to recognize.
- A pelvic floor exam can be done through a pelvic exam for women and a rectal exam for men, using palpation to assess muscle tension and tenderness.
- Seeing a pelvic floor specialist is recommended for a high-quality assessment, as self-assessment tools are not meant for diagnosis.

- Testosterone levels in males are often a topic of discussion, with some wondering if their levels are too low and others using excessive amounts.
- Assessing hormone panels and levels of free testosterone can be valuable in identifying symptoms such as depression, weight gain, and cognitive changes.
- Testosterone cream can be used by women to increase sexual desire and treat conditions like vestibulodynia, where hormonal imbalances cause pain and discomfort.

- Kidney stones can be caused by dehydration and metabolic disorders.
- To prevent kidney stones, increase fluid intake, decrease oxalate intake, and increase citrate intake.
- Treatment options for kidney stones include shock waves, ureteroscopy, and percutaneous nephrolithotomy.

- The discussion around female oral contraception is highly polarized, with some women experiencing negative effects and others finding it beneficial for sexual freedom and preventing pregnancy.
- Taking oral contraceptives can increase sex hormone binding globulin levels, which can lead to low libido and other sexual dysfunctions in some individuals.
- Long-acting hormonal contraceptives like IUDs are recommended as an alternative for those experiencing issues with oral contraceptives. Copper IUDs are effective due to the sperm-repelling properties of copper.

- SSRIs can disrupt sexual function and desire, making them prohibitive for some people.
- SSRIs can be used off-label to delay ejaculation in cases of premature ejaculation.
- Switching medications or reducing the dose can help alleviate sexual dysfunction caused by SSRIs.

- There is a trend of prescribing low dose Cialis for prostate health, not just for erectile dysfunction.
- Low dose Tadalafil has been shown to be effective for enlarged prostate (BPH).
- Certain lifestyle changes, such as limiting caffeine and alcohol intake, can help improve prostate and bladder health.

- High volume cycling can lead to genital numbness and erectile dysfunction in men, and numbness and decreased arousal in women.
- Sitting with good posture and using a wider, noseless seat can help prevent these issues.
- A study found that rates of erectile dysfunction were not significantly different between runners, swimmers, and cyclists, suggesting that the general rate of dysfunction in that population may be the same.

- Anal sex is becoming more common among heterosexual couples.
- It is important to use protection, such as condoms, and lubrication to prevent sexually transmitted infections and minimize trauma.
- Reasons for engaging in anal sex include pleasure, avoiding vaginal penetration, and as a special activity with a partner.

- Behavioral tools are emphasized as the foundation for mental and physical health, but prescription drugs can play a role in certain cases.
- Tonga Ali and maca root are mentioned as supplements that may enhance libido, while Shilajit may increase follicle-stimulating hormone.
- The most recommended approach for sexual dysfunction is managing comorbidities through diet, exercise, blood pressure control, and diabetes prevention. Improving sleep, getting early morning light, and quitting smoking are also important. Cardiovascular health should be assessed for those with organic impotence.

- Tonga Ali and Shilajit have been reported to improve libido and desire in some women, but more research is needed.
- L-citrulline and Ashwagandha have reasonable data supporting their effectiveness for sexual function and stress reduction.
- The speaker recommends examining.com as a reliable source for information on these topics.

- The podcast asks for support by subscribing to their YouTube channel, Spotify, and Apple podcast, and leaving a five-star review.
- They mention Momentus Supplements and offer a 20% discount for listeners.
- They promote their Neural Network newsletter, which provides summaries of podcast episodes and protocols, and encourage signing up on their website.

- Kegels are a strengthening exercise for the pelvic floor muscles, invented by a gynecologist named Kegel.
- They involve squeezing and relaxing the muscles used for urination, but should not be done while urinating.
- Kegels are prescribed for urinary incontinence, pelvic organ prolapse, and post-prostatectomy leakage, but overdoing them can lead to pelvic floor dysfunction. It is recommended to consult a pelvic floor physical therapist for proper guidance.

- The anti-Kegel is a method to relax the pelvic floor muscles, which can be achieved through massage, vaginal dilators, and muscle relaxant medications.
- Working with a physical therapist can help learn exercises to downtrain the pelvic floor and lengthen the muscles.
- Incorrect breathing during exercise can contribute to pelvic floor dysfunction, and there can be nerve and artery issues that affect blood flow and cause pain.

- Erectile function, pelvic floor function, and vaginal lubrication are influenced by hormones, blood flow, and neural factors.
- Overly strenuous exercise can impede blood flow and lead to issues like erectile dysfunction and pain during intercourse.
- To determine the cause of sexual issues, it is important to assess arousal, desire, erections, comorbidities, and hormone levels, as well as perform tests for blood flow and nerve function.

- AG1 is a vitamin mineral probiotic drink that provides foundational nutrition and adaptogens to help with stress.
- The speaker has been taking AG1 daily since 2012 and feels better with more focus, energy, and improved sleep.
- There is a special offer to try AG1 at drinkag1.com/huberman, which includes five free travel packs and a year supply of vitamin D3K2.

- The transcript discusses various factors that can impact arousal response in relationships, such as novelty, masturbation, and pornography.
- It emphasizes the importance of finding a good pelvic floor therapist or urologist for exams and treatments related to pelvic floor health.
- It suggests seeking out specialists in female pelvic medicine and reconstructive surgery, sexual medicine, or pelvic floor physical therapy, depending on one's gender and specific needs.

- The conversation is about sexual dysfunction in males and females, specifically erectile dysfunction in males and its parallel in females.
- The clitoris is the homolog of the penis and can experience difficulty with orgasm in women.
- Sexual dysfunction presents differently in both genders, with men focusing on erections and women assessing lubrication, pain during sex, and orgasm.

Dr. Rena Malik: Improving Sexual & Urological Health in Males and Females | Huberman Lab Podcast