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

Mel Robbins  (00:26:46):

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.

Dr. Rena Malik (00:26:58):

Why? 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. And so a lot of investigation has gone into male genitalia and male studies, and the penis is a little bit easier to study. It's sort of right there. Whereas the clitoris is not as easy to study because 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 that C clitoris had until two years ago.

Mel Robbins  (00:27:34):

How the hell did you figure it out?

Dr. Rena Malik (00:27:35):

So they actually looked at biopsy studies to look at the number of nerve endings. And so they did this study. And so we still think they have 8,000 nerve endings, but now we know that it's more than 10,000. And so this is recent data in the last few years, and that's amazing. 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 we've always been thought of as not, it's never been a priority. Who talks about female pleasure? Not many people. 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 is 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.

Mel Robbins  (00:28:41):

Ooh, that's cool.

Dr. Rena Malik (00:28:42):

Yeah,

Mel Robbins  (00:28:43):

That's the only reason we have it.

Dr. Rena Malik (00:28:45):

Yeah,

Mel Robbins  (00:28:46):

That's pretty cool. That's

Dr. Rena Malik (00:28:47):

All the function that it offers. Well,

Mel Robbins  (00:28:49):

That's a lot of function that we should be really taking seriously.

Dr. Rena Malik (00:28:54):

Absolutely.

Mel Robbins  (00:28:55):

That's pretty awesome.

Dr. Rena Malik (00:28:57):

Yes.

Mel Robbins  (00:28:57):

Is that like peeing? When you're ejaculating? What exactly is that?

Dr. Rena Malik (00:29:02):

Yeah, so you brought up a few things. So squirting and ejaculating are two separate things. So let's talk about those different. So squirting is defined as 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. 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 skins glands. Those skins 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 skins glands, but they're really small. They're like two to four grams inside. Wait, so where is it coming out of those little skins glands

Mel Robbins  (00:29:54):

That, so from inside the vagina,

Dr. Rena Malik (00:29:56):

Inside the vagina, there's these tiny 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.

Mel Robbins  (00:30:10):

Okay. I'm embarrassed to ask you this,

Dr. Rena Malik (00:30:12):

Really

Mel Robbins  (00:30:13):

Embarrassed, but is that where you pee? The urethra is where you pee at? Well, because you talked about the gland that I know is the location of the G-spot area. And 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 urethra, and I'm like, I think that's where you pee. I'm sorry,

Dr. Rena Malik (00:30:39):

I should have clarified.

Mel Robbins  (00:30:40):

No, I dunno. So I'm 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?

Dr. Rena Malik (00:31:09):

I think so. This is hard to say, Chris is going to kill me. No, no. Look, you are 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? What's going to happen?

Mel Robbins  (00:31:21):

Is this a turn on? Is this disgusting? 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?

Dr. Rena Malik (00:31:31):

So this is interesting because there's always been this question, is it P? Is it not P? Right? And so they've looked at the fluid, they've looked at it under, they've identified all the characteristics of the fluid, and they found it to be very dilute, very similar to P, but not P. It's very, it is less urea, it's very clear. And there's also P, s, A. So some of the fluid from the skins gland is getting mixed in there.

Mel Robbins  (00:31:55):

Well, that would make sense given that you've talked about the fact that a orgasm is basically all this tension building up and then releasing. 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 liquid desire thing that is coming out of a woman. No, seriously, 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 am trying 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, 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 maybe it'll allow you to relax a little bit.

Dr. Rena Malik (00:32:53):

Yeah, absolutely. And interesting. They've looked at how women feel about squirting.

Mel Robbins  (00:32:56):

How do we feel about it? You can tell. I feel like I don't know how I feel about

Dr. Rena Malik (00:33:00):

It. Yeah. And so what some women are like, oh, it's a superpower. I feel like I had this amazing thing. Other women feel shameful about it, probably because again, they're not sure what's happening. And some women are like, this is just a big mess for me to clean up. I don't like it. And men seem to feel like, I think it's like their visual of you're having an orgasm. So they really like that visual. But there's actually another way to tell. 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 going to her pelvic floor, muscles are going to contract every 0.8 seconds or so. And so you can feel that, right? So that's one way to tell. But yeah, women squirt some women. Does it matter? No. Can you teach yourself too? Maybe. I mean, I don't know.

Mel Robbins  (00:33:49):

How would you teach yourself to squirt?

Dr. Rena Malik (00:33:50):

What they say in literature is it's really a component of how erect the clitoris is. So how aggressive that clitoris gets erect, and that's arousal how aroused the woman is.

Mel Robbins  (00:34:02):

So you want to 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.

Dr. Rena Malik (00:34:11):

Exactly.

Mel Robbins  (00:34:12):

Okay. I might have a heart attack if it actually happened to me, literally. And then of course I'd be like, was that okay? I'm really sorry. Does it taste bad? Oh my God. Okay. Who's going to kill me for this episode? Your husband, my daughters. Chris doesn't carry. 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 didn't you do that? Dr. Rena, can you talk about why your sexual health is so important, especially during hormone changes like menopause?

Dr. Rena Malik (00:34:50):

Yeah, so I'm a menopause certified practitioner, so you can sort of become a menopause certified practitioner by going through the menopause society. And during menopause, our body goes through these immense changes. 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. Imagine any part of male genitalia shrunk. It would be insane. There'd be tons of papers about it, but there's no real, okay, women's labia

Mel Robbins  (00:35:36):

Shrink. Does that

Dr. Rena Malik (00:35:37):

Matter? Well, there's a

Mel Robbins  (00:35:39):

Couple things that, because the labia is just like the curtains on the outside,

Dr. Rena Malik (00:35:44):

But they're there as a protection 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, yes, the outside being

Mel Robbins  (00:36:00):

Smaller.

Dr. Rena Malik (00:36:01):

Well, so that's part of it. The other part of it's the urethra shrinks the tissues around. The urethra shrinks. So the opening becomes closer. And most importantly is the vaginal tissues. 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.

Mel Robbins  (00:36:38):

Really what predicts a great sex life, particularly as you get older.

Dr. Rena Malik (00:36:44):

So I think realizing that things are changing. So having a great sex life as you get older is one, allowing yourself to acknowledge these changes and then identifying them and saying, okay, my lubrication is not great. Maybe I would benefit from hormone therapy. Or maybe using just a lubricant and adding that in. And everyone should be using lubricant. It's great. It makes things more fun, more slippery. 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. So 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 talk about those things with your doctor. And if they're not talking to you about it, find someone who will.

Dr. Rena Malik (00:37:48):

Pain should never be normal. So I think people always make this assumption 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 fallacies, which can be uncomfortable. And there are actually products you can buy that you can put on the fallas. So less of it gets inserted. Sometimes you will see people have pain with that, or

Mel Robbins  (00:38:28):

In terms of the end of it hitting your cervix or

Dr. Rena Malik (00:38:31):

Something. Correct.

Mel Robbins  (00:38:32):

Correct. Okay.

Dr. Rena Malik (00:38:32):

So obviously there's some cases where 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, 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. 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, there are lots of things that can cause pain, and we can help you with that.

Mel Robbins  (00:39:04):

What is the truth

Dr. Rena Malik (00:39:05):

About

Mel Robbins  (00:39:06):

How you can have good

Dr. Rena Malik (00:39:08):

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 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. 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 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 I don't want to hurt anyone's feelings. We're very polite society. And it's like, no, this is something that takes work. Just hard conversations in your relationship have to happen. Conversations about sex occasionally need to happen. So now

Mel Robbins  (00:40:17):

I can feel the person listening, going, I don't want to have that conversation. How do I even start having that conversation?

Dr. Rena Malik (00:40:23):

Absolutely.

Mel Robbins  (00:40:23):

So how do you start, Dr. Rena, having the conversation about the kind of sex that you want, or do we even know what kind of sex that we want?

Dr. Rena Malik (00:40:32):

Well, some people do and some people don't, right? I think it starts with self-exploration. And so I think people have very different preconceived notions about that. Men, it's very common to have self-exploration. And women, it's sort of variable. 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. If you have a partner who's experimenting or you've had multiple partners, 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. I think people think, I'm going to have one conversation, it's going to be done and it's going to be great. Or I'm going to try to have a conversation. It doesn't go the way I want to, and then that's it.

(00:41:13):

I'm never going to try again. But it's not like that. It's going to take multiple conversations and it's going to be 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? You remember sexual education in high school or elementary school or middle school, wherever you learned it, but 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. And that doesn't mean that it has to stop. It just means that you're going to try again another time and you're going to say, okay, let's have a conversation outside of the bedroom.

(00:41:53):

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, Hey, let's just have this conversation. Let's do our best to be open about it. I want to 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 in terms of bringing up what you like, what you enjoy, they do. 

Mel Robbins  (00:42:29):

Saying that to somebody.

Dr. Rena Malik (00:42:31):

But some people might be like, I really hate that. They don't know how to say it. So they just blurt it out. They 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 to 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 your partners. So how do they communicate and using those same communication skills, you're having a tough conversation about finances or about your kids or whatever, and bringing that to talking about sex.

Mel Robbins  (00:43:00):

So I just want to make sure, Dr. Rena, I have really extracted what I'm doing. So you said don't have the conversation in the bedroom. You might want to have the conversation while you're both focused on something else. You're taking a walk, you're side by side, you're talking and walking. You're not necessarily doing the desk sta at each other, so it doesn't have to be so intense. What is the opening line? How do I get into this?

Dr. Rena Malik (00:43:25):

I mean, there's a few ways to do it. You could say at some point be like, Hey, babe, I'd love to have this conversation with you at this time, at this day, or at some point, and maybe let them offer a time. But say, I'd really love to just carve out some time where we can talk about this. So you're a little bit

Mel Robbins  (00:43:38):

About sex.

Dr. Rena Malik (00:43:39):

Yeah, about sex. And just say, so you're primed a little bit. We're going to have a little bit of a charged conversation. I don't know where it's going to go, but I really just want to make our sex life even better or even greater.

Mel Robbins  (00:43:49):

Well, I think that's a great lead in.

Dr. Rena Malik (00:43:51):

Yeah,

Mel Robbins  (00:43:52):

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 a race. Hey, babe, I'd love to talk about how we can make our sex life better.

Dr. Rena Malik (00:44:01):

And honestly, if they want to have sex, and so say you're a female heterosexual relationship, and a man hears, I want to have more sex or better sex, that's pretty exciting for them, right? They're like, okay.

Mel Robbins  (00:44:13):

Of course,

Dr. Rena Malik (00:44:14):

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 more common, we see it that way. And so most people are going to respond to that quite favorably and say, yeah, let's talk about it.

Mel Robbins  (00:44:30):

Do you have advice about how you should communicate with your partner about when you want to have sex?

Dr. Rena Malik (00:44:37):

Yeah. I think this is an interesting question because who initiates, right? Is

Mel Robbins  (00:44:42):

It always, this is a big issue, and I don't mean issue. We're in therapy about this. This is something that I think my husband and I have gotten into a, 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 going to turn it back over to you before I share too much about my marriage.

(00:46:45):

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 there, you're glad you did. So same thing with sex. Sometimes you have to initiate, let yourself be in the moment and like, oh, you start touching each other. You're like, oh, yeah, I like this. But when they started, you weren't really in the mood, but you started cuddling and 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

Mel Robbins  (00:47:34):

To your point of thinking about it as play. Two things that have made a huge difference for Chris and I is texting each other and being like, how about two o'clock?

(00:47:44):

So It becomes more of a midday thing that we became the couple that were really attracted to each other and wanted to have more sex, but we were just freaking exhausted. And we also had slightly different bedtimes. So by the time I got into bed, Chris was always already asleep, and by the time he's waking up. 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.

Dr. Rena Malik (00:48:21):

Yes, absolutely.

Mel Robbins  (00:48:22):

And creating more moments of, what about three o'clock I got to break? 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.

Dr. Rena Malik (00:48:43):

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. So actually making time. Think about when you were younger and used to go on a date, 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, oh, we might have sex. It's sort of exciting. 

Mel Robbins  (00:49:43):

Just don't put it in the family calendar as mom and dad are banging right now, do not disturb. Right? You got to have a code name for it, walking the dog, something that

Dr. Rena Malik (00:49:51):

It's like or on date night and have sex first. Don't go out to dinner first. Oh, 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 not even able to really.

Mel Robbins  (00:50:06):

Right. And then a lot of us then are driving home and start arguing about something stupid, and then we just storm into the bedroom. That's a genius idea.

Dr. Rena Malik (00:50:13):

Absolutely.

Mel Robbins  (00:50:14):

Yeah. That's the appetizer each other. I love that. What are some of the most common sexual insecurities, Dr. Rena?

Dr. Rena Malik (00:50:22):

So we've touched on a couple of them. 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, particularly when you're younger as being inexperienced or 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. You're going to have a cue for, you're going to, there's going to be some weird noises, and that's okay. It's normal. Your body's going to make noises when you're doing these activities. And then for men, most commonly it's penile size. So they're worried that, 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 the most common insecurities.

Dr. Rena Malik (00:51:25):

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.

Mel Robbins  (00:51:42):

So it's like an optical illusion.

Dr. Rena Malik (00:51:44):

That's one. Yeah.

Mel Robbins  (00:51:45):

So the penis didn't actually get shorter. Bigger, yeah. You got bigger. Oh my God. That's a very delicate way to say that, but

Dr. Rena Malik (00:51:53):

But 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 men are show or growers, some people who are growers, meaning 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 very 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.

Mel Robbins  (00:52:35):

Can a man ejaculate without an erection? 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?

Dr. Rena Malik (00:52:50):

Yeah, you can orgasm. You can ejaculate. Wait,

Mel Robbins  (00:52:53):

You can have an orgasm without

Dr. Rena Malik (00:52:55):

An erection as a man. Exactly, exactly. Wow. So you just stimulate the erection is important for being able to penetrate, but you can still stimulate the penis and the genitals without an erection. 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 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.

Mel Robbins  (00:53:43):

What should you do to help your partner if they can't get an erection, but you do want them to have an orgasm? I didn't even know it was possible.

Dr. Rena Malik (00:53:52):

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 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. Enjoy the pleasure of touching each other. And then once you are feeling very comfortable and confident with that, then you can incorporate some genital touching, just touching. And then once you feel comfortable with that, then you can move on to more stimulation, whether it's penetrative or oral. 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 really being present in the moment.

Mel Robbins  (00:54:44):

Wow, that's pretty

Dr. Rena Malik (00:54:46):

Cool. Yeah.

Dr. Rena Malik (00:54:52):

I think a lot of it stems from feeling not good enough, 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? All those things. And that's really what causes a lot of shame. And unfortunately a lot of it stems from lack of education, not knowing what's normal and what's okay. And a lot of it is because we're not learning from anybody who 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 people are just holding onto that. And I think 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 northern Europe, they're much more progressive about sex.

(00:55:54):

They talk about sex. They teach their children about even the names of 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 PHUs 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 how you take care of a healthy penis. They probably use it to sort of really educate their children.

Mel Robbins  (00:56:29):

How does porn impact the sexual expectations between partners?

Dr. Rena Malik (00:56:33):

Yeah, I mean I think it really depends on when you're introduced to pornography. I think if you're introduced older, which a lot of our generations didn't have access to pornography like they do now. You had to find a magazine, find a DVD or not a DD, like a VCR and a tape,

Mel Robbins  (00:56:51):

Or in my case, one of my friend's dads who had a secret stash of magazines that we discovered. Yes.

Dr. Rena Malik (00:56:58):

So you had to find it and then find a quiet room to look at it where nobody would find you. There was a lot of planning involved to even see that. Now it's just so accessible. 

(00:57:37):

They have trained their bodies or they've chosen to do this profession because they're able to do these things, 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 what turns you on, then real life's not going to 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. It's not happening. 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, they don't know.

Mel Robbins  (00:58:23):

Can you talk a little bit about how mental health can impact your sex life?

Dr. Rena Malik (00:58:29):

Mental health is a huge impact. So one I always say, 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 commingled. So when you look at people with depression, anxiety, or taking meds for depression or anxiety, about 30 to 60% of those people will have sexual dysfunction. So it's very, very common. And some of it's because of the medications. So

Mel Robbins  (00:59:03):

Sexual dysfunction is defined as

Dr. Rena Malik (00:59:05):

What? So it could be a variety of things. It 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. Also those medications, SSRIs particularly have higher rates of sexual side effects, and so they're dose dependent. So some people on low doses won't experience them, but some people on higher doses will. And it can be really difficult because they need those medications to feel good, but then they may be 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. 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.

Mel Robbins  (01:00:12):

That's true. 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.

Dr. Rena Malik (01:00:39):

In fact, they've looked at people who have mindfulness practices and they've found that people who maintain mindfulness practices for eight weeks, for example, are more likely to score better on sexual function indexes. So they're actually having better, more satisfied sex and scoring better in a whole bunch of different domains, particularly desire being one of them. And so it's part of, 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 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 and it's free. It's completely free. 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. Rena Malik (01:01:39):

So trauma is very challenging, and I think it takes, 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 work through to really be sure that you're 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 navigate those through whether cognitive behavioral therapy or other things that they can offer you to be able to feel safe. If you don't feel safe because of your past trauma, you're never going to be able to have good sex.

Mel Robbins  (01:02:15):

I mean, that makes sense because you're always going to be in a trauma response in your body, protecting yourself and not be able to connect with your partner.

Dr. Rena Malik (01:02:25):

Yeah.

Mel Robbins  (01:02:26):

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?

Dr. Rena Malik (01:02:41):

Yeah. So there was one study that looked at, 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 categorize 'em one to three, four to seven, on and on and on. And so 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?

(01:03:25):

No, not necessarily. I think it's really 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 goes back to why sexual health is health. If you're able to ejaculate 21 times or more a month, 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.

Mel Robbins  (01:04:01):

Is there any corresponding study around women

Dr. Rena Malik (01:04:03):

Ejaculating more

Mel Robbins  (01:04:04):

And improving our health?

Dr. Rena Malik (01:04:05):

Not yet. Not yet. But we know there's so many benefits to orgasm. You have decreased blood pressure, your mood is better, you're getting better sleep with orgasms. So I anticipate the findings would be similar because these things are very difficult to study. How, I mean, we know good sleep is important for a variety of health factors, 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 again, you're having all these benefits of orgasm.

Dr. Rena Malik (01:04:41):

I never like to shame people for masturbation. I think that masturbation is a healthy form of self-exploration. 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. Now that can be prone masturbation, meaning lying on your stomach and masturbating towards maybe hitting the bed or other hard surfaces and

Mel Robbins  (01:05:05):

Hitting your penis on the bed. Yeah.

Dr. Rena Malik (01:05:07):

Okay. And then

Mel Robbins  (01:05:09):

I was just saying, if you saw me, 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.

Dr. Rena Malik (01:05:21):

Yeah. And then also they call it 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 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. If you're doing the same thing every single time when you masturbate and you can't replicate that with a partner 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. And so that's sort of like where you're like, okay, I need to keep variety in my life when I'm masturbating. They found that using lubricant for men actually helps, so is correlated with less issues. So using lubricant or making sure it's just not a very firm grip. And so that's what 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 and different positions potentially, and see if you can train yourself to enjoy different types of stimulation.

Mel Robbins  (01:06:39):

Is it normal, Dr. Rena, for somebody who is once vibrant, no issues, to suddenly have problems getting an erection?

Dr. Rena Malik (01:06:45):

It's actually very common. It's very common. So 52% of men over 50 will have issues with erectile 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 a hemoglobin A1C, like to check their blood sugars. I will screen their cholesterol, and I can't tell you the number of times I found high cholesterol or maybe pre-diabetes in a man who has erectile dysfunction.

Mel Robbins  (01:07:45):

So erectile dysfunction can become, is like a symptom that there may be developing heart issues.

Dr. Rena Malik (01:07:53):

It could be a sign. Yeah.

Mel Robbins  (01:07:54):

Wow. And what are the treatments available?

Dr. Rena Malik (01:07:57):

So there's lots of treatments available. There's other types of causes of ED two, I want to make sure we don't.

Mel Robbins  (01:08:03):

Let's talk about 'em.

Dr. Rena Malik (01:08:03):

Yeah, there's ed. So that can be 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, and then you think about it, you ruminate about it. The next time you have sex, you're like, 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, 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 because you're always thinking, even for women, am I going to climax?

(01:08:48):

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? All these things, 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 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'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 if you have diabetes, that can affect the nerves as well as the blood flow. So longstanding diabetes, or if you've had surgery like prostatectomy or other maybe pelvic surgeries for cancer, things like that that can affect those nerves.

(01:09:32):

So those are neurologic issues. And then medications we 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, of course, if it's psychogenic, we've 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, can I pause on that for a minute?

Mel Robbins  (01:10:03):

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 going to perform? Am I going to get erection 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.

Dr. Rena Malik (01:10:40):

Exactly.

Mel Robbins  (01:10:41):

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. So is that a good explanation for why? That's a great explanation. It's really important to understand that the mental piece is really important from a physiological standpoint.

Dr. Rena Malik (01:11:03):

Absolutely. Then the high cortisol is going to dampen your hormonal production. So it's going to 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. How do you know

Mel Robbins  (01:11:30):

If a man in your life is struggling with low testosterone?

Dr. Rena Malik (01:11:34):

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 routine at the gym and you're like, man, my muscles are just not growing. They used to, that is another sign as well. So these are sort of all signs and fatigue. Also really significant fatigue can be related to low testosterone.

Dr. Rena Malik (01:12:02):

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 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 lower body extremities, working on exercise for that, and then 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.

Mel Robbins  (01:13:15):

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?

Dr. Rena Malik (01:13:27):

Yeah, so then talking about erectile dysfunction specifically, there's medications. They're in a class called PDE five inhibitors, and they essentially work by increasing blood flow to the area. So they sort of relax the vessels. They allow what's called nitric oxide. 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% of people have positive results with these medications. Now there's different formulations. There's sildenafil, which is brand named Viagra, which is an on demand an hour before sex lasts for up to four hours or so. Oh

Mel Robbins  (01:14:06):

My God. No,

Dr. Rena Malik (01:14:07):

I mean your erection's not going to last up to four hours, but you can take and then have sex like three hours later and it should still be around, right? People always caution about having an erection that lasts longer than four hours. That's very, very, very rare with medications. So if you look at the studies, it was 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. It's extremely rare.

Mel Robbins  (01:14:33):

Okay.

Dr. Rena Malik (01:14:33):

Other one is tadalafil or Cialis, that's also available as an on-demand option that lasts about 36 hours. So say someone is going to have a weekend away, they can just take one and 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 when you want to have sex and allow for a little bit of spontaneity, that's another option.

Mel Robbins  (01:14:56):

So does somebody ever prescribe something like this to take the anxiety away?

Dr. Rena Malik (01:15:03):

Yeah, so I'll often prescribe a daily todalofil 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. So I think it allows for that little bit of extra confidence.

Mel Robbins  (01:15:24):

Well, Dr. Rena, 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?

Dr. Rena Malik (01:15:47):

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 and first with yourself and then with your partner, and allow yourself to be worthy of what you want because you deserve it.

Mel Robbins  (01:16:15):

I love that.

Dr. Rena Malik (01:16:16):

Dr. Rena, 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 want to help you, and you deserve to be helped.

Mel Robbins  (01:16:39):

Oh, Dr. Rena, I wish that you were here on the East Coast.

Dr. Rena Malik (01:16:42):

I know

Mel Robbins  (01:16:43):

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

Dr. Rena Malik (01:17:05):

You. You're very welcome.

Mel Robbins  (01:17:06):

And I want to also thank you for being here with today and for listening to and watching something that will help you create a better life. There is no doubt that taking your sexual health and your sexual pleasure seriously and following everything that you just learned from Dr. Rena and using it to experience more joy to advocate for yourself, and she said it, you deserve it. And in case no one else tells you, I wanted to tell you that I love you. I believe in you. And for you sitting here watching with me on YouTube, I just want to say, please share this with somebody. Don't just sit and watch. Please do something and take a minute and subscribe to this channel because it's really a way that you can support me in bringing you new videos every single day. And I'm sure you're looking for something really inspiring to watch, to really move you. So I want you to check out this video next.