The Better-Sex Doctor: The Link Between Masturbating & Prostate Cancer! Dr Rena Malik

Intro (00:00:00)

• Dr. Reena Malik is a board-certified urologist and expert on sexual health.
• She aims to educate the public on the facts and myths of sex.
• She discusses various topics related to sexual health, including frequency of sex, masturbation, and pelvic floor exercises.
• She expresses gratitude for the show's five million subscribers and promises to raise the bar in 2024 with new surprises, production changes, and more global stories.

What is it you're seeking to do? (00:02:40)

• Dr. Malik's goal is to make people understand that sexual health is health.
• She believes there is a lot of misunderstanding about sexual health, which leads to despair and devastation.
• She aims to make sexual health education freely accessible and understandable so people can make informed decisions about their sexual health.

How do you define sexual health? (00:03:30)

• Sexual health is an individual concept, but it generally refers to the ability to have sex, experience orgasms, and derive pleasure from sexual activity.

Do we understand our bodies? (00:03:46)

• Many people have misconceptions about normal sexual health due to unrealistic portrayals in media.
• Examples of normal sexual functions that are often misunderstood include nocturnal emissions and erectile dysfunction.
• Misinformation from media can lead to individuals feeling like their bodies are not functioning properly.

Where does your training come from? (00:05:10)

• Dr. Malik is a board-certified urologist, specializing in the medical and surgical treatment of the genitourinary tract.
• She realized through her social media platform that there was a significant lack of education and empowerment regarding sexual health.
• Sexual function is often not adequately addressed during routine medical visits, leading to unmet needs and unanswered questions for patients.
• Dr. Malik shifted her focus to creating educational content and treating patients in the field of sexual health.

What's your training with the pelvic floor? (00:06:37)

• The pelvic floor is a bowl of muscles that supports the organs in the pelvis, including the bladder, rectum, vagina, uterus, and urethra.
• It provides stability, allows for defecation and urination, and is involved in pregnancy, orgasm, and sexual function.
• Pelvic floor weakness can cause leakage of urine, constipation, frequent urination, pain during urination or ejaculation, and other issues.
• Pelvic floor abnormalities can also be caused by lower back or hip injuries.

Why should our doctors be asking about our sexual health? (00:09:07)

• Sexual health issues can have a significant impact on a person's life, causing shame, relationship problems, decreased productivity, and mental health issues.
• For men, erectile dysfunction can be an early indicator of heart problems, as it can occur before chest pain or other symptoms.
• About 50% of men who have had a heart attack will have experienced erectile dysfunction beforehand.
• Pelvic floor dysfunction is also common in men with erectile dysfunction.

Is a weak pelvic floor in men linked to erectile dysfunction, and does sitting cause it too? (00:11:15)

• Sitting every day can cause the pelvic floor to not stretch appropriately, leading to erectile dysfunction.
• A tense pelvic floor can restrict blood flow to the penis, causing problems with getting erections.
• During the COVID-19 pandemic, there was a rise in pelvic floor dysfunction due to increased sitting.
• Symptoms of pelvic floor dysfunction in men can include erectile dysfunction, urinary urgency, and pain in the pelvic area.

How much sex should couples be having? (00:12:58)

• The myth that other couples are having significantly more sex is common.
• On average, couples in partnered relationships have sex about once a week.
• The quality of sex is more important than the quantity.
• Good sex can provide benefits such as stress reduction, improved focus, better sleep, and potentially lower blood pressure.
• The purpose of sex is pleasure, intimacy, and deriving benefits from orgasms, not the number of times it occurs.

Should we be experiencing pain during sex? (00:14:42)

• Pain during sex is not normal and should be assessed.
• Common causes of pain during sex include:
  • Insufficient lubrication
  • Inadequate foreplay
  • Hormonal changes
  • Pelvic floor dysfunction
  • Endometriosis
• Increasing foreplay and lubrication can often alleviate pain during sex.
• If pain persists despite these measures, it is important to get evaluated by a healthcare professional to determine the underlying cause.
• There is no link between masturbation and prostate cancer.
• Studies have shown that men who masturbate regularly have a lower risk of prostate cancer than those who do not.
• Masturbation can help to maintain a healthy prostate by:
  • Reducing inflammation
  • Improving circulation
  • Relieving stress
• Masturbation is a normal and healthy part of sexual expression and should not be discouraged.

The vagina's expanding process (00:16:57)

• The vagina expands during sex.
• It expands by about double in length and double in width.
• It takes an average of 18 to 20 minutes for the vagina to expand fully.
• Lubrication is also an important factor in vaginal expansion.
• Many people learn about sex from porn, which is not an accurate representation of real sex.
• This can lead to unrealistic expectations and disappointment during first sexual encounters.
• Porn can also contribute to performance anxiety and body image issues.
• Comprehensive and accurate sex education is essential for young people to make informed decisions about their sexual health.

How do we communicate with our partners about sex? (00:19:23)

• Lack of communication about sex is a societal issue and within relationships.
• Misunderstandings and insecurities can lead to a downward spiral of sexlessness.
• Effective communication involves knowing and expressing personal preferences.
• Conversations about sex should be ongoing, not one-time events.
• Avoid discussing sex in the bedroom, before or after sex.
• Choose a neutral setting, such as a car or during a walk, to facilitate open communication.
• Use "I" statements to express feelings and desires, rather than accusatory "you" statements.
• Be prepared for negative reactions, as partners may have their own biases, stereotypes, and shame related to sex.
• Consider seeking professional help from a sex therapist or psychologist to navigate communication difficulties.
• Open and honest communication is worth the effort for a fulfilling sex life.

What's the first step in re-building a good sex life? (00:22:21)

• If sex is not a priority in a relationship and both partners are satisfied, it is acceptable. However, if sex becomes a problem in a valued relationship, it is worth addressing and having open conversations about it.
• Lack of communication and addressing underlying issues can lead to a gradual decline in intimacy and a "dead frog in a frying pan" situation, where one partner feels trapped and unfulfilled.
• Reviving a sexless relationship requires effort and commitment from both partners, just like other aspects of a relationship such as raising children or buying a house.
• There is no evidence to support the claim that masturbation is linked to prostate cancer. In fact, some studies have shown that regular ejaculation may actually reduce the risk of prostate cancer.
• Prostate cancer is the most common cancer in men after skin cancer. The exact cause is unknown, but risk factors include age, family history, and diet.

Men vs women’s sexual desire as we age (00:26:22)

• Men tend to have more spontaneous desire, while women tend to have more responsive desire.
• Responsive desire is normal and common, but it's often not talked about or understood.
• Women may feel pressure to have spontaneous desire, which can lead to negative emotions and avoidance of intimacy.

Anticipation around sex causing more harm than good (00:29:11)

• Anticipation of sex can cause anxiety and performance pressure, which can interfere with sexual enjoyment.
• Focusing on intimacy rather than sex can help reduce pressure and allow for a more enjoyable and fulfilling sexual experience.
• Prioritizing intimacy and gradually working towards sex can help couples reconnect and rediscover sexual joy.

Is a low libido a hormone problem? (00:30:11)

• Low libido can be caused by hormone imbalances.
• Testosterone is the most important hormone for desire in both men and women.
• Thyroid hormone and prolactin can also affect testosterone levels.
• Stress can raise cortisol levels and lower testosterone levels.
• Chronic stress can negatively impact libido.
• Testosterone injections may not be effective for everyone with low libido.
• More testosterone is not always better and can be dangerous.
• Exercise regularly.
• Eat a healthy diet.
• Get enough sleep.
• Manage stress.
• Talk to a therapist about any psychological issues that may be affecting libido.

Ways to increase testosterone (00:32:29)

• Sleep is crucial for testosterone production. Lack of sleep, especially less than 6 hours, can reduce testosterone levels by 10-15%.
• Resistance exercise, particularly involving large muscle groups like the lower extremities, effectively boosts testosterone levels.
• High-intensity cardiovascular endurance training can increase cortisol levels and reduce testosterone.
• A Mediterranean diet rich in vegetables, fruits, low processed foods, healthy fats, nuts, and seeds is beneficial for testosterone production.
• Processed foods and excessive sugar should be avoided.
• Healthy fats are necessary for testosterone production as it is derived from cholesterol pathways.

A decline in testosterone levels and sperm counts (00:35:25)

• Testosterone levels and sperm quality have been declining over the last 50 years.
• Factors contributing to this decline include:
  • Sedentary lifestyle and increased metabolic conditions like diabetes and high blood pressure.
  • Endocrine abnormalities and blood flow problems.
  • Exposure to microplastics and endocrine-disrupting chemicals in the environment.

Chemicals in everyday objects impacting sperm counts (00:36:37)

• Chemicals in everyday objects, such as plastic water bottles and food containers, can impact sperm counts and testosterone levels.
• Exposure to phthalates and other chemicals is linked to lower testosterone levels.
• The exact mechanisms by which these chemicals affect testosterone production are not fully understood, but plausible mechanisms have been proposed.

How have sperm counts been decreasing over the years? (00:38:30)

• Average sperm count has declined almost 50% in the last 50 years.
• Average sperm count is still high enough for fertility rates (around 50 million).
• Decline in sperm count is concerning as it could lead to difficulties in reproduction in the future.
• Potential contributing factors include global environmental factors, comorbidities, and poor health.
• Need for better control of diet, exercise, and exposure to harmful substances.
• Fertility struggles are becoming more common, possibly due to societal changes (women waiting longer to have children) and male sperm count issues.
• Correlation between overall health and sperm concentration (not volume).
• Importance of regular evaluation by a doctor for male infertility.

How do we increase our semen volume (00:42:06)

• Semen volume is variable and depends on the time since the last ejaculation.
• Hydration can play a role in increasing semen volume.
• Low semen volume can be due to decreased force of ejaculation, which can be improved with pelvic floor exercises.
• Pelvic floor exercises can strengthen the muscles around the urethra and improve semen volume by increasing the force of ejaculation.
• Incorrectly performing pelvic floor exercises can cause harm, pain, and dysfunction.

Does masturbating improve my pelvic floor? (00:43:56)

• Orgasm, not masturbation, improves pelvic floor strength.
• During orgasm, the pelvic floor contracts involuntarily at a rate of every 0.8 seconds for 5 to 60 seconds.
• Regular orgasms can improve pelvic floor strength similarly to Kegel exercises.

The impact our technology is having on our genitals (00:44:55)

• Phones, laptops, and other devices can increase the temperature around the scrotum, which can disrupt sperm production.
• People trying to conceive should avoid putting these devices near their genitals.
• Saunas and hot tubs can also affect sperm production.
• The concern about phones near genitals is due to temperature increase, not Wi-Fi or Bluetooth.

Does masturbation decrease testosterone levels? (00:47:48)

• There is no convincing evidence that masturbating or abstaining from masturbation will increase testosterone levels.
• A study involving 10 young healthy men who abstained from masturbating for 21 days showed an increase in testosterone levels by 50 nanograms per deciliter, but this increase may be due to anticipatory cues and not a direct effect of masturbation.

Does too much masturbation have a bad effect on us? (00:49:17)

• Excessive masturbation can become a problem when it interferes with daily activities, such as work or relationships.
• Relying solely on masturbation for sexual pleasure can lead to habituation, making it difficult to climax with a partner.
• Varying masturbation techniques and stimuli can help prevent habituation and maintain sexual arousal with a partner.

Will masturbating make people blind? (00:51:10)

• There is no scientific evidence to support the claim that masturbation can cause blindness.
• The notion of masturbation leading to blindness is likely rooted in religious rhetoric aimed at discouraging the practice.

What do you think of no nut November (00:51:29)

• Dr. Malik does not support No Nut November.
• She believes it can cause stress and anxiety due to the pressure to abstain from ejaculation.
• Nocturnal emissions are normal and occur in 86% of men.
• The body will either reabsorb semen or ejaculate at night.
• No Nut November can be beneficial if it helps individuals focus on other aspects of their lives, such as spirituality.
• Dr. Malik does not support making people feel bad about not participating or being unable to participate.

Masturbating giving you more clarity of mind (00:53:05)

• Some people believe that abstaining from masturbation can lead to increased clarity of mind.
• Athletes often abstain from sex or masturbation before competitions, but studies have not found that this improves performance.
• Disrupting a regular routine of masturbation can actually be harmful to performance.
• After masturbation, there is a slight increase in heart rate that can affect recovery from performance.
• Some people report feeling more aggressive after abstaining from masturbation.
• There is no scientific evidence to support the claim that abstaining from masturbation improves mental performance.
• Some people feel a lack of clarity after masturbation, while others feel more productive and able to get work done.

Post nut clarity (00:56:23)

• Post-nut clarity is a phenomenon where desire for a person reduces after ejaculation, accompanied by hormonal changes such as increased prolactin and decreased dopamine.
• Evolutionary theories suggest that post-nut clarity evolved to prevent men from having sex again too soon after ejaculation, which could dislodge semen and reduce the chances of fertilization.
• Frequent ejaculation, whether through sexual activity or masturbation, has been linked to a reduced risk of prostate cancer.
• The prostate stagnation hypothesis suggests that frequent ejaculation helps clear out prostate fluids and prevent stagnation, reducing the risk of prostate cancer.
• Regular sexual activity or masturbation is suggested to be beneficial, but the optimal frequency is not specified.
• The study attempted to control for other factors that could influence the results, but there may still be some uncontrolled variables.

Porn, is it bad? (01:01:48)

• Pornography is not inherently bad, but it can be problematic when children are exposed to it.
• Children's brains are not fully developed to understand pornography and may develop unrealistic expectations about sex.
• Pornography can become addictive due to the dopamine rush it provides, which can lead to a negative cycle of shame and guilt.
• When used for entertainment and pleasure, pornography is generally not a problem.

VR headsets and porn (01:05:47)

• VR headsets, like the Vision Pro, have a new feature called spatial video that creates a 3D-like experience.
• As the technology improves, VR porn could become so realistic that it may reduce the incentive for people to seek real intimate relationships.
• However, physical touch and intimacy with another person may still be important factors in human relationships.
• VR headsets could also have positive applications, such as helping women with fear of penetration through simulated sexual experiences.
• There is concern that VR headsets and other devices may make people less inclined to engage in real-life social interactions and conversations.
• Society needs to work together to prevent the negative effects of technology on human relationships and encourage meaningful interactions.

Trauma and how it relates to our sex lives (01:10:14)

• Trauma can play a significant role in sexual health and sexual dysfunction.
• Unresolved trauma can affect mental and physiological health.
• Therapy and help are crucial in resolving trauma and improving sexual health.
• Sexual dysfunction often has a psychological component due to the devastating and stressful nature of the condition.
• Better sexual education and resources are needed to help individuals navigate misinformation and find quality information.
• Education should include practical life skills such as balancing finances and managing digital health.
• Early education can help individuals recognize and seek help for trauma, stress, and anxiety, preventing long-term problems.

Can you have sex when pregnant? (01:12:50)

• It is safe to have sex during pregnancy.
• Concerns about harming the baby or causing preterm labor are unfounded.
• Sex during pregnancy does not pose any risks to the fetus.

Orgasms and the clitoris (01:13:33)

• On average, men reach orgasm in about 5 minutes, while women take around 14 minutes.
• Men often prioritize their own pleasure during sex, neglecting intimacy and female orgasms.
• Women are more likely to orgasm with women (95%) than with men (45%) during their first sexual experience.
• The lack of proper sex education for men leads them to rely on porn for information, which often misrepresents female sexual pleasure.

What is an orgasm (01:19:36)

• An orgasm is a moment of maximal tension and release, during which a person is unable to think about anything else.
• It is a powerful pleasurable sensation that usually lasts for 5 to 60 seconds.
• Orgasms are achieved through stimulation over time, with a specific rhythm that varies from person to person.
• During sexual arousal, the body undergoes changes such as reddening and expansion of the labia, elongation of the vagina, and increased heart rate and pupil dilation.
• Orgasms involve intense muscle contractions in the pelvic floor, accompanied by involuntary sounds like moaning or screaming.
• Orgasms are not like a switch that can be turned on or off, but rather a gradual climb to a peak of climax.
• Maintaining a certain rhythm is crucial to achieving climax, as stopping or slowing down can cause loss of momentum.
• Understanding the individual is key to increasing female pleasure.
• The clitoris is a primary erogenous zone for achieving orgasms.
• Lubricants can enhance sexual pleasure.

Scheduling time for sex? (01:23:16)

• Scheduling sex can add stress and anxiety, affecting sexual desire and performance.
• Mindfulness practices can improve sexual function, particularly desire, arousal, lubrication, and orgasm.
• Focusing on the sensations and enjoyment of the sexual encounter, rather than worrying about performance or the partner's reaction, leads to a more positive experience and increased desire for future encounters.

Is there a disparity on how long sex should actually take compared to how long it takes (01:24:47)

• People tend to think sex lasts longer than it actually does.
• Women think sex should last between 18 to 25 minutes, while men think it should last around 12 minutes.
• The average duration of sex is around 5.1 to 5.7 minutes, depending on the study.
• There may be cultural differences in the average duration of sex.
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• This is a significant advancement in gut health testing.
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Vagina myths (01:28:25)

• The myth that the more sex a woman has, the bigger her vagina gets is false.
• A woman's vagina can feel looser due to childbirth, neurological conditions, collagen disorders, or a job that requires prolonged standing.
• Orgasms can strengthen the pelvic floor muscles, while childbirth can weaken them.
• A weak pelvic floor can lead to stress incontinence and prolapse.

Pelvic floor exercises, how to do them (01:30:30)

• Pelvic floor exercises are more than just Kegel exercises.
• Kegel exercises are one type of pelvic floor exercise that strengthens the pelvic floor muscles.
• To do Kegel exercises, squeeze and relax the pelvic floor muscles for 5 seconds each, with a 5-second break in between.
• Start by doing Kegel exercises lying down, then progress to sitting up and standing as you get stronger.
• Other activities like yoga and pilates can also help strengthen the pelvic floor.
• For personalized guidance, consider seeing a pelvic floor physical therapist.
• There is no link between masturbation and prostate cancer.
• Studies have shown that men who masturbate regularly have a lower risk of prostate cancer than those who do not.
• Masturbation may help to reduce the risk of prostate cancer by reducing inflammation and improving blood flow to the prostate.

How do we know if we have pelvic floor issues (01:32:48)

• Symptoms of pelvic floor issues in women include leakage, prolapse, and weakness.
• In men, weak pelvic floor muscles may cause less forceful semen ejaculation.
• Overly high tone pelvic floor symptoms can include lower back pain, hip pain, pain during sex, erections, ejaculation, frequent urination, difficulty emptying the bladder, and sudden frequent urination.
• Pelvic floor examination by a urologist, gynecologist, or pelvic floor physical therapist is recommended for evaluation.
• In men, a rectal exam is performed to assess pelvic floor muscles.
• The exam can be uncomfortable or painful due to pushing on tense muscles.
• The prostate and different pelvic floor muscles, such as the levator ani and transversus perinei muscles, can be felt during the exam.
• Pelvic floor muscles are part of the core muscles, which encompass the back, front, and pelvic floor.

PENIS SIZE, is it possible to increase the size? (01:35:52)

• Traction devices are the safest and most reliable way to increase penis size.
• Original traction devices required 6-8 hours of use per day for several months to see a 2cm increase in length.
• Newer devices require only 30 minutes of use twice a day and have shown some increase in penis length.
• Pumps do not increase penis length.
• Surgeries and other methods to increase penis length often have high complication rates or risks.
• Penis size is a big part of a man's identity and how he feels about himself.
• There is currently no safe and easy way to increase penis size like there is for breast implants.

Will my penis get smaller as we age? (01:41:50)

• Healthy individuals will not experience penis shrinkage with age.
• Nighttime erections maintain penile health by providing blood flow to the area.
• Conditions like high blood pressure, diabetes, and heart disease can lead to erectile dysfunction and penile shortening due to tissue changes.
• Weight gain can give the appearance of a shorter penis due to increased fat around the pubic area.

Does body parts size indicate a bigger penis? (01:43:08)

• A Japanese study found a correlation between nose length and penile length in Japanese men.
• There is no evidence to support a correlation between hand or foot size and penile length.
• Average penile length has increased over the past 50 years, possibly due to earlier onset of puberty and increased testosterone exposure.
• The average erect penis length is around 5.1 to 5.2 inches, which corresponds to the average vaginal length during arousal.

Labiaplasty (01:45:45)

• Labiaplasty is a surgical procedure to alter the appearance of the labia minora.
• Labia come in various shapes and sizes, and some people may feel insecure about their appearance.
• Labiaplasty can make the labia smaller and more cosmetically appealing.
• There has been an 80% increase in labiaplasty surgeries from 2015 to 2019.
• Labia are unique to each individual, and there is no standard appearance.

Squirting (01:47:21)

• Squirting is the emission of a clear, colorless, odorless fluid from the urethra during sexual arousal.
• There are different types of fluids produced by the vagina, including lubrication and female ejaculate.
• Squirting is not the same as female ejaculation and is not a copious amount of fluid as seen in pornography.
• The fluid released during squirting has been found to contain prostate-specific antigen (PSA), which is typically associated with males.
• The exact source of the fluid during squirting is still unknown, and it may be related to water imbibition during arousal and contractions of the uterus and vagina during climax.
• More research is needed to fully understand the phenomenon of squirting.

Last guest question (01:50:16)

• Dr. Malik's message: Sexual health is health, and prioritizing sexual health and educating young people about sex is crucial.
• Negative sexual health or encounters can have significant physiological, interpersonal, and work-related consequences.
• Empowering people through education can positively impact the world.
• Sex permeates every aspect of life, and discussing it is important despite the stigma and shame surrounding it.
• Focusing on sex and relationships improved Dr. Malik's overall health, performance at work, and anxiety levels.
• Dr. Malik emphasizes the importance of choosing the right partner, as a supportive partner is crucial for success and well-being.