They see each other. They immediately want to have sex. They rip off their clothes, and they orgasm within seconds, right? That's not what sex is. There are times where I 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 see? Well, so that's part of it. So this is hard to say. Chris is going to kill me. All righty, It's your friend Mel, and I'm so glad you are here with me today. I am thrilled to welcome Dr. Rena Mollet to the Mel Robbins podcast. She is a board-certified, fellowship-trained urologist, pelvic surgeon, and sexual health expert. She specializes in female pelvic medicine and reconstructive surgery and sexual medicine. She runs an extraordinarily busy medical practice that offers patient-focused care in sexual health, bladder health, and hormone management, including an expertise in menopause and low testosterone. Dr. Rina is a powerhouse, and she is known for her no shame, science-backed YouTube videos on sexual health that have over 300 million views. Dr. Rina has also published over 80 peer-reviewed research articles, and she was recently distinguished with the title of the 2020 American Urological Association, Young Urologist of the Year Award.

And If I keep talking to you about her credentials, I am going to chicken out on all the embarrassing questions about sex that are on my note cards in front of me. So, how about you and I just jump right in? Because you and I have a lot to learn on how to have better sex starting tonight. I cannot wait to dig into this conversation. I'm so glad to be here. So, I want to start by just asking you to speak directly to the person who's listening and explain what they might expect to change about their life if they take everything that you're about to share today to heart. Yeah. So when you listen to this episode, you are going to figure out the answers to all those embarrassing questions you've never felt comfortable asking anyone. You're going to feel more comfortable in your body. You will probably go take a mirror and look at your genitals and really analyze them because that's really important. We don't look at our bodies. So keep listening. You're going to learn a ton of very important, helpful information that will help you feel empowered to take care of your sex life.

Wow. I'm now focused, of course, about looking at my genitals, which I'm like, I'm not doing on YouTube right now, or I'm not going to do play by play as you listen to the podcast, but I can't wait to hear how that's involved. But can we start by just defining sexual health? What is it? So I always say that sexual health is health, right? We think of it as something completely different.

It's just a side of our lives, but it's actually a big part of our lives. So it is defined as something that you have psychologically emotional, physical well-being associated with pleasure, giving and receiving pleasure. But it's much more than that. It affects us psychologically when you're not having good sex. It affects us physically sometimes. It really is a big part of shame. We're going to talk about that, I'm sure, about how sometimes when you have problems with sex, you feel shame. But the other big thing is when you're having problems, sometimes that can signal other health conditions. If you're having, for example, men who have erectile dysfunction are more likely to have heart disease. And I suspect you're more likely to see erectile dysfunction first before you see heart problems. And while we don't have the data on that for women, it's probably very similar because the generals actually act very similarly. I'm not sure I've ever heard anybody define sexual health in such a comprehensive and holistic way, because when I think about to tell me, Dr. Rina, that I need to be talking to my partner about this and not you on a public podcast.

Is my sex life healthy? And Does that mean I'm having enough of it? Am I enjoying it? But you're talking about it an entirely different construct, which is it's integrated into your whole health and well-being as a human being. Absolutely. Wow. So what do we get wrong about our bodies when it comes to sexual health? Well, I think a lot of it comes from what we see on media, right? We see these people, they see each other, they immediately want to have sex, they rip off their clothes, and they orgasm within seconds, right? That's not what sex is.

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 see?

Well, so that's part of it. So this is hard to say.

Chris is going to kill me. All righty. It's your friend Mel, and I'm so glad you are here with me today. I am thrilled to welcome Dr. Rena Mollet to the Mel Robbins podcast. She is a board-certified, fellowship-trained urologist, pelvic surgeon, and sexual health expert. She specializes in female pelvic medicine and reconstructive surgery and sexual medicine. She runs an extraordinarily busy medical practice that offers patient-focused care in sexual health, bladder health, and hormone management, including an expertise in menopause and low testosterone. Dr. Rina is a powerhouse, and she is known for her no-shame, science-backed YouTube videos on sexual health that have over 300 million News. Dr. Rina has also published over 80 peer-reviewed research articles, and she was recently distinguished with the title of the 2020 American Urological Association, Young Urologist of the Year Award. If I keep talking to you about her credentials, I am going to chicken out on all the embarrassing questions about sex that are on my note cards in front of me. How about you and I just jump right in? Because you and I have a lot to learn on how to have better sex starting I cannot wait to dig into this conversation.

I'm so glad to be here.

I want to start by just asking you to speak directly to the person who's listening and explain what they might expect to change about their life if they take everything that you're about to share today to heart.

When you listen to this episode, you are going to figure out the answers to all those embarrassing questions you've never felt comfortable asking anyone. You're going to feel more comfortable in your body. You will probably Really go take a mirror and look at your genitals and really analyze them because that's really important. We don't look at our bodies. Keep listening. You're going to learn a ton of very important, helpful information that will help you feel empowered to take care of your sex life.

Wow. I'm now focused, of course, about looking at my genitals, which I'm like, I'm not doing on YouTube right now, or I'm not going to do play by play as you listen to the podcast, but I can't wait to hear how that's involved. But can we start by just defining sexual health? What is it?

So I always say that sexual health is health, right? We think of it as something completely different. It's just a side of our lives, but it's actually a big part of our lives. So it is defined as something that you have psychological, emotional, physical, well-being associated with pleasure, right? Giving and receiving pleasure. But it's much more than that, right? It affects us psychologically when you're not having good sex. It affects us physically sometimes, and it really is a big part of shame. We're going to talk about that, I'm sure, about how sometimes when you have problems with sex, you feel shame. But the other big thing is when you're having problems, sometimes that can signal other health conditions. If you're having, for example, men who have erectile dysfunction, are more likely to have heart disease. You're more likely to see erectile dysfunction first before you see heart problems. When we don't have the data on that for women, it's probably very similar because the generals actually act very entirely.

I'm not sure I've ever heard anybody define sexual health in such a comprehensive and holistic way, because when I think about sexual health, I think, Is my sex life healthy? And does that mean I'm having enough of it? Am I enjoying it? But you're talking about it in an entirely different construct, which is it's integrated into your whole health and well-being as a human being.

Absolutely.

Wow. So what do we get wrong about our when it comes to sexual health?

Well, I think a lot of it comes from what we see on media. We see these people, they see each other, they immediately want to have sex, they rip off their clothes, and they orgasm within seconds. The male penetrates the female in a heterosexual relationship, the woman's orgasming in seconds, and it looks like the best time of their life. And that's not real life. That's not what sex is. Sex is playful. Sex is supposed to be fun. Sex is supposed to be a time to explore and try new things and sometimes be awkward and weird. There's weird noises. There's funny things that happen, just like they happen anywhere in life. And sometimes it takes longer, sometimes it's quicker. But it's all variation of normal. And sometimes it's not normal, but ultimately it's play. And I think what we really get wrong is we take it way too seriously, and we take it so deeply into our souls as something to be insecure about or uncomfortable about, when really it should be something the only time adults play is during sex. So we should allow ourselves to play and have fun.

I think you might have just changed my marriage. No, I've been married for 28 years, and I love having sex with my husband. And at the same time, we have been together as partners for 30 years. I have always thought about sex as intimacy and orgasm and pleasure. That's it. The idea of redefining it as a moment and a chance for play with somebody that I love Because you're right. I would be mortified, even though I've been with Chris for 30 years, to have something embarrassing, whether it's a smell or a noise, emit, ruin the mood. But if you think about it from the framework of play, it changes everything. Yeah.

It allows you to explore, try things that you've never tried before. And that's part of when you've been together for a long time, right? You get a script, right? You do the same thing. You know it works. You're going to achieve climax doing this way, this time. But then it becomes boring. Boring, right? So you need to have that room to play and try different things and be okay with it being awkward or funny or not great. Every sexual encounter doesn't need to be mind-blowing. It's okay to occasionally have mediocre sex, but use it as a tool. You only get better at sex as you have more sex. And as you try new things, you will get better at those new things as well.

Well, if I think back to when I was younger, before I got married and have been in this relationship with Chris, I think I was relying on on new partners to have the sex be different or fun. But I would imagine that you're going to tell us it's incredibly important that you bring that yourself to your sexual encounters, this ability to play, to experiment, regardless of whether you're in a long-standing committed relationship or you are having sex with multiple partners.

Absolutely. I mean, you have to have variety in anything in life. You don't have the same meal every day. You don't eat the same dinner every day. You're doing maybe a different workout every day. You're trying different things all the time. Just like in your day to day activities, sex needs to be a little variable at times.

Well, I was just laughing to myself because I'm sitting here thinking, well, maybe we've been sex fasting to try to make it interesting since it hasn't changed in a while.

And that's not a bad thing. That's not a bad thing.

That's true. One thing that I think a lot of us wonder is how much how much sex is normal and how much lack of sex? I'm not asking the question right, but what's the average amount of sex that people are actually having? Yeah.

So first off, what's normal? What's normal is so individual, right? So as long as you are both satisfied with the amount of sex you're having, say you're having mind-blowing sex once a month and you're so happy with that, that's fine, right? But let me tell you some averages. So on average, the average American has sex 52 times a year, so about once a week, but that's very based on age. You look at a 20-year-old, they're having sex about 80 times a year. Maybe once a week, maybe twice a week, whereas a 60-year-old is more on the order of 20 times a year, so maybe once every two weeks or so. It's variable. But what is a sexless marriage? So there's no true definition, but the researchers will define it as less than 10 times a year. But again, like I said, if you're having sex 10 times a year and you're super satisfied, both of you, then it's not sexless. It's passionate, it's enjoyable, it's great. So I think ultimately it's very individualized, but really realizing that there's no benchmark you have to meet.

Well, I think that there's, at least speaking for myself, there's always this sense that It's not enough. Not only because I would love to have more, and so would my husband, but also the sense that other people are having a lot of sex and that there's something wrong with us or our relationship because we're too tired, or we mean to, but then we don't, or life gets in the way. And so I do think that a lot of us get caught up in our heads wondering, Am I having enough sex? Am I not having enough sex? And I suspect you're about to tell me, Dr. Rina, that I need to be talking to my partner about this and not you on a public podcast.

Exactly. It's really a couple thing. If you're in multiple non-monogamous relationships, then it's you and those partners. But ultimately, it is not about keeping up with the Joneses. They could be having five minutes sex four times a week, and you're having a passionate love-making experience that lasts an hour, once a week. But it's all about what you enjoy, what you like, what your partner feels good about. And that's what matters. It is not about what your neighbors are doing or your other partners or how often. I was watching this TV show where this actress, they had a swing in their bedroom, and they were like, Oh, we use it every day. And I was like, Oh, I even felt like, Oh, man, they're having a lot of sex. That's a lot. That's amazing. Is that something to aspire to? I'm like, Yeah, if you have the energy and excitement and you both want that, great. But let's be real. Most people are busy, right? They're taking care of kids or aging parents or taking care of work, becoming busier in their job. And that's just not realistic for a lot of people.

Well, if I put a swing in my bedroom, it would become a rack for dirty clothing that you throw things on. So how long should sex last?

Yeah. So this is a great question. On average, people think that sex lasts. Men think that it should last about 16 minutes. They think it lasts about eight. This is, again, the whole experience. Women want it to last about 25 minutes, but they've actually done studies where they've had couples have sex around the world, and they've had them use stopwatches. So the female partner will turn on the stopwatch when they penetrate and turn off the stopwatch when they stop penetrating. And the average time is about 5.7 minutes. So 5.3 to 5.7 minutes. So it's really not that long, not as long as we think. And so that's average. And that range is really wide. It's from 0.1 minute to 53 minutes. Again, it's a huge variability, but ultimately, again, it comes down to, are you satisfied? Are you having an orgasm? Is he having an orgasm? Are you both feeling happy at the end of it? Because that Timer doesn't include foreplay. That Timer doesn't include the other things that you're doing. This is only talking about penetrative sex. Now, is that all sex is? No. Sex is a manual, is oral, maybe anal. It could be non-genital.

You could still call sex like you're naked and you're stimulating other parts of the body. So really, what is sex defined as and are you both driving pleasure from it? And I like to say it's also about the journey, not just the destination. Yeah, orgasms are great, and everybody wants an orgasm, but is the rest of it fun? Are you enjoying the intimacy part of it, the tactile part of it, the stimulation, that stuff? That matters.

Well, and to your point, the playfulness of it. How does a woman's vagina expand during sex?

Yeah. So during sex, there's a lot of changes, not just the vagina expanding. So on average, the width is about 3 to 3.5 centimeters, and the length is about 8 to 9 centimeters. And that will actually double Double in length and width. Double? Double. It can up to double during arousal and to allow for getting ready for penetration, whether it's through a phallus, a finger, a toy, whatever, it's going to enlarge. The other thing that happens is the labia the jora will shrink because they're usually closed off to keep the introitus closed a bit. So they will shrink a little bit as well as the clitoral hood, the hood on top of the clitoris. And the labia minora will get engorge. They will get bigger and they will turn red or pinkish in color. So our body is just amazing. It really protects us so that when we're about to have sex, we're not going to hurt ourselves. You start making lubrication, you start getting wider, you start getting longer. Your cervix moves up and out of the way because sometimes it can be painful if you're penetrating and the cervix is still there for some people, that's painful.

So your body does all these things to make sure sex will be pleasurable.

Wow. How long does it take your body to do that?

So everyone's a bit different. We know I know that it's estimated maybe it can take up to 25 minutes for some women. So foreplay needs to be a part of sex for some people. Now, some people are faster, some people are longer. But ultimately, most women can tell you when they're ready, right? They can have that. So say, You know what? I'm ready. I feel ready or I'm not ready. And I think the issue is sometimes people don't speak up about those things. They're just like, Oh, okay, maybe it's uncomfortable. Maybe it'll be fine in a minute. But really, there's a whole process. And then the other thing about lubrication, a lot of people get wrong is they think that if you're well-lubricated, you're aroused, and if you're not, you're not. But that's not exactly true. Certainly, there's many people where well-lubrication correlates with arousal. However, there's some people who lubricate not because of arousal, just because of other things.

What? What would you lubricate for?

Say you feel a threat is coming on and your body prepares itself so it doesn't get hurt. And so it might lubricate for that reason, or it may see something that it seems somewhat erotic or it may feel something somewhat erotic. And so your body just says, Oh, That's, you should get ready. But you may not mentally feel aroused, right? But then there's people who are turned on and they don't make as much lubrication. Now, that can be due to genetics. That can be due to hormones. So like going through menopause, things like that, lubrication decreases. It doesn't mean they're not aroused. That means you need to use a lubricant or you need to consider other treatments to increase lubrication for the woman who may be struggling with that.

Well, it's interesting to hear you explain the actual medical mechanics of what's going on in her body, because I'd always just thought about foreplay as a warmup, getting yourself in the mood. But when you all of a sudden said your cervix moves out of the way to get ready so that your vagina can double in length and width, I'm like, Holy cow, there's a whole lot going on that takes a little bit of time, which is why it makes it even more important in some cases to really open yourself up to the play and to give your body the chance to even relax and do it so you can enjoy it. Absolutely. And is that length of time different for men, typically?

So men, it's very binary. They get an erection or they don't, right? And so that is not always the only sign that they're going to have with arousal, you'll also see both men and women will have nipples become more erect. There's other signs as well, but very often they're seeing the manifestation of that increased blood flow through penal erection. Now, in women, the homologian homolog is their clitoris gets erect. The homologue? What is that? A homologue is essentially when you have two structures that are made from the same embryologic tissues, and then they develop into their variety of structures. In men and women, you start off with a genital bud And this in men becomes the penis, and in women becomes a clitoris. So they are exactly identical. If you cut open an anatomical visual of the penis and the clitoris, they're identical. Really? They're identical. They have two bodies of erectile tissue, two spongy bodies that fill and engorge with blood. They look exactly the same.

That's wild.

Yeah. So that's why I mentioned earlier, looking at your own body with a mirror. So one, it's also so that if something is abnormal, you can see it. Because sometimes people will have skin conditions and they won't know. They've never looked down there. So that's one reason. But two is to identify where is the clitoris? Pull back the clitoral hood. Does it come back easily? A lot of women don't realize that they can actually get smegma. Or if you have sons, you'll know this little boys get smegma under their foreskin. It's like dead skin cells and oil.

I'm laughing because they used to call the guy that I dated in high It's a little smegma behind his back. I don't know why. It's a terrible thing. But okay, so women can get that, too?

Yeah. So sometimes that develops. And because women don't know, they don't look, they don't ever pull back the hood of the clitoris, which is basically like foreskin. It's exact homologue, again, that same word of male foreskin. If you don't pull it back, you won't actually know that there's something developing under there that could then lead to discomfort, pain, maybe having less of a strong orgasm or having no orgasm at all. You have to look down there so you can see what your normal structures look like, where everything's located. Then you can actually identify what is normal and not normal if things change. You can look down there and you can say, Hey, I saw this before, and it's It's different now.

If we were to take a mirror and take a look at ourselves, what are we looking for?

Yeah. So I think ultimately, go online and take a picture of type in vulvar anatomy. Okay.

Volvar? There's an R in it?

Yeah. It's a vulvar, vulvar anatomy. But anyway, so from the outside in, the first thing you're going to see is your labia majora. Those are like the large lips of the vagina. Then you're going to go and you're going to see your labia minora. Just look at the size, look at what they look like. Of course, make sure there's nothing abnormal, like you don't see a mole or something weird there that you've never seen before. But just so you know what they look like. Look at the clitoris. Follow it up. Look at the clitoris. Pull back the clitoral hood gently and see if you can pull it back. Take a look at the clitoris and then look at the urethra, which is underneath and on top of the vagina. Make sure it looks normal to you. I mean, again, everyone looks a little bit different, but get a baseline of what you look like. And then look at the vaginal canal. It should be pink, supple, healthy-looking, right? And then you should get a sense of what you're looking at. And then you could also see just what the size is, what it looks like.

Just, again, everyone's different. And if you look at, there's actually websites where you can look at labia. A lot of people get worried about, are my labia too long or do they look too weird? But you can see all different shapes and sizes. It's very unique to you. You can see one's longer than the other, some are long, some are short, and that's completely normal. Nothing to be ashamed of, nothing to worry about. Just knowing what you look like is empowering you because, again, like I said, if something changes, you can go back and look again and just say, What is something different from what I remember?

So, Dr. Rina, I think we all know that there's different types of orgasms that you personally experience. But from a medical or physiological experience, are there different types of orgasms?

So the orgasm is the act, the feeling of a buildup of tension and then a release, right? Yes. But there are different origins of those orgasms, but the orgasm is essentially the same thing. There's the clitoral orgasm, which is the most reliable way to achieve orgasm. 85% of women need some clitoral stimulation to have an orgasm. Some of them will do it with petal penetration, but sometimes not. But 85% need their clitoris to be stimulated. So that's one. Then there's vaginal stimulation. So that's where you hear about the term the G-Spot. And so that's in the anterior vaginal wall. So the top of the vagina, about two or three centimeters in, is where we have a structure called the Steen's gland. The who? It's called the Steen's gland. Steen's? Steen's.

Yes. Steen's gland. Okay, the Steen's gland. And when you say it's 2-3 centimeters at the top, you're not talking about the end of the canal there. No.

So from the front.

From the front. So it's like in the skin in the tunnel. That's where the G spot is?

In the vagina. So your urethra is there, and then you put your finger in the vagina, and it's about two or three centimeters in.

And it's on the top. Correct. So if you put your finger in and you lift up, and this thing is real?

So it's a zone. It's not a spot. It's not a button. People think it's this is a magical button. Stop doing that. It's a zone where there's a whole bunch of nerves that converge. So obviously, you have the clitorobodies right above it, so there's erectile tissue there. There's nerves around there that converge. And there's also the skin's glands, which is the homologue of the male prostate. So we call it the female prostate. And they also have nerves that are pleasurable when stimulated. So it's not this button that you're going to press, and women are automatically going to have an orgasm.

Everybody, did you hear that? Stop looking for the button and start massaging, for God's sakes, the area.

Yeah, but even then, some people will not orgasm from a G-Spot or G-Zone stimulation because not everyone finds that pleasurable. If I massage every man's prostate, he's not going to orgasm from it. I'm not massaging their penis, I'm massaging their prostate. It's the same thing. You're not massaging the clitoris, you're massaging the vaginal wall, right? And so some people find that pleasurable. Some people are able to orgasm with that, and there's a different nerve that sends a signal back up to the brain. So the perception of the orgasm may be a little different. The last one that people often talk about is cervical orgasms. So some people find cervical stimulation very pleasurable.

Now, that's all the way at the end.

All the way at the top.

But isn't that also where you can experience some discomfort? Because if somebody is penetrating you and it's hitting the end and the cervix didn't lift sufficiently?

It's variable. Some women find it very pleasurable to have their cervix stimulated or around their cervix stimulated, whereas some find it painful. But some people do have cervical orgasms or orgasms from stimulation of the clitoris, let's say, and they will describe that differently, like shooting stars or this cosmic experience. And so you can have different types of orgasms. It's the same thing that's happening in your body, right? You're having a tension build and release, but it's from stimulating different parts of the body.

That's so interesting. Yeah. And thank you for explaining where the G-Spot is, because I've always wondered where the magic button was.

There's no magic button. Wow. There's no magic button.

I don't know if I read this somewhere or if I heard this somewhere. But is it true that 10% of women are physically not able to have an orgasm?

So we know, yeah, 10 to 12%.

10% to 12%?

That's not fair. I know it's not fair, but we don't know if it's because they're not physically able or they're not getting enough stimulation to achieve orgasm. If you think about, I said the average time for sex, that really usually is time from male ejaculation, right? That's the time to ejaculate. But for women, the time to orgasm is different. So they've actually looked at this, too. What is the average time to orgasm? So through sexual encounters, it's about 12 to 14 minutes. So many women, if you just have penis and vagina sex, are not going to orgasm, and they're not going to have an orgasm because they never got enough stimulation for a long enough time to achieve an orgasm.

So I got to ask a question. So when you talked about measuring the male orgasm, and I think the average was like 5.6 minutes or something like that. The way they measure that is somebody starts a Timer and all of a sudden you insert. And from the time of insertion to the orgasm or the ejaculation, that's how we measure that. Correct. How do you do that? When do you start the Timer for a woman? Is it when the stimulation on the clitoris or the G-Spot or the cervix starts?

Or how does that-Yeah, I think it's variable, but I don't remember exactly how they designed in that study, particularly. But ultimately, yeah, it depends on, probably requires clitoral stimulation. I said the most reliable route, so probably from the beginning of clitoral stimulation to the end. But interestingly, when women masturbate, that time shortens eight minutes.

Well, no kidding.

We know where to go.

Move this out of the way. Focus right here. Right.

Yes. Sometimes you're just too polite to say, Hey, you're doing this the wrong way.

Tilt your head in a different direction.

Yes. Exactly.

This is why we need to be on a walk with our partners looking straight at, By the way, tilt your head towards 2:00 instead of 10:00. That would help. Dr. Rena, what is one thing that the person listening could do tonight to increase their chances of having an orgasm?

So the one thing you can do tonight is focus on the encounter. Don't think about the homework your kids have to do. Don't think about what you have to do for work tomorrow. Don't think about your to-do list that you are never going to get done because we're never going to get done, right? Focus on being present and communicate. Like, actually talk to your partner, guide them along the way. And nonverbal communication works well too. Sometimes we feel uncomfortable telling them, move your head to 2:00, but you can gently move their head, right? There are things you can do, very gentle, very nudging, that can make you have an orgasm quicker, more efficiently, and in a more pleasurable way.

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 2,000 studies done on the clitoris. 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. A lot of investigation has gone into male genitalia and male studies, and the penis is a little bit easier to study. It's right there. Whereas the clitoris is not as easy to study because you can't... There are now ways to measure clitoral engorgement, and there's definitely more investigation going on now, but it's been largely ignored. In fact, we didn't even know how many nerve endings a clitoris had until two years ago.

How the hell did you figure it out?

They actually looked at biopsy studies to look at the number of nerve endings. They did this study, and we still think they had 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 a 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 glass of wine. Just relax. They're not told, Hey, your pleasure matters, and you having an orgasm matters, and you feeling good matters. It's amazing to me. 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.

Oh, that's cool. Yeah. That's the only reason we have it? Yeah. That's pretty cool.

That's all the function that it offers.

Well, that's a lot of function that we should be really taking seriously. Absolutely. That's pretty awesome. Can we talk about squirting?

Yes.

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

You brought up a few things. So squirting and ejaculating are two separate things. 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, whitish, thicker amount of fluid that is coming from the urethra. Oftentimes, people may not notice it when they orgasm or climax. Where are these fluids coming from? So the female ejaculate, we comes from those skin's glands. Those skin's glands actually produce something called PSA, which men produce in their prostate. 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 skin's glands, but they're really small. They're like 2-4 grams inside.

Wait, so where is it coming out of?

Those little skin's glands, that gland.

But so from inside the vagina?

Inside the vagina, there's these tiny 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.

Okay, I'm embarrassed to ask you this. Like, really embarrassed. But is that where you pee?

The urethra is where you pee? No, see this is why you got to...

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, I should have clarified.

No, I don't know. I am so worried. 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?

I think if you... So this is hard to say. Chris is going to kill me. No, no. Look, you're 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? Is this a turn on?

Is this disgusting? What's about to happen here? How do you know if it's pee versus some ejaculation sex liquid? You know what I'm saying?

This is interesting because there's always been this question, is it pee? Is it not pee? 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 less urea. It's very clear. And there's also PSA. So some of the fluid from the skin's gland is getting mixed in there.

Well, that would make sense given that you've talked about the fact that an 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 I'm trying to lean into this conversation and explore if there is 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.

Yeah, absolutely. Interestingly, they've looked at how women feel about squirting.

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

And so some women are like, Oh, it's a superpower. I feel like I have this amazing thing. Other women feel shameful about it, probably because, again, they're not sure what's happening. And some 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 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. So men And you can feel that. If they're inserted in a female and she has an orgasm, her pelvic floor muscles are going to contract every 0.8 seconds or so. And so you can feel that. That's one way to tell. But yeah, women squirt. Some women don't. Does it matter? No. Can you teach yourself to? Maybe. I mean, I don't know.

How would you teach yourself to squirt?

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, right? How aroused the woman is.

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.

Exactly.

Okay. I might have a heart attack if it actually happened to me. I Oh my God, literally. And then, of course, I'll be like, Is that okay? I'm really sorry. Does it taste bad? Oh, my God. Okay. You know who's going to kill me for this episode? My daughters. Chris doesn't care. Chris will literally be like, If you come home with new techniques weeks and a desire to make her sex life better, you can talk about whatever the fuck you want. But I'm sure our daughters be like, Mom, why did you do that? Dr. Rina, can you talk about why your sexual health is so important, especially during hormone changes like menopause?

Yeah. I'm a menopause certified practitioner, so you can become a menopause certified practitioner by going through the Menopause Society. During menopause, our 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. Your labia tend to shrink. Imagine any part of males in Italia shrunk. It would It's just insane. There'd be tons of papers about it, but there's no real, okay, women's labia shrink.

Does that matter?

Well, there's a couple of things- Because the labia is just the curtains on the outside, right? But they're there as a protection. They're there to protect you from friction. They're there to protect you from bacteria. And so what happens a lot of the times, 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 earlier- Really?

The outside being smaller?

Well, so that's part of it. The other part is the urethra shrinks, the tissue is around the urethra shrinks, so the opening becomes closer. And most importantly is the vaginal tissue's PH changes. So when you lose estrogen, you lose this 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. Really?

What predicts a great sex life, particularly as you get older?

Yeah, so I 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, right? 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. 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. It's water-based. You can use different types. You can experiment, but really identifying, 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 who's 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. And so talk about those things with your doctor. And if they're not talking to you about it, find someone who will.

Is pain normal during sex?

Pain should never be normal. So I think people always make this assumption, right? 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 phaluses which can be uncomfortable, and there are actually products you can buy that you can put on the phalus so less of it gets inserted. Sometimes you will see people have pain with that.

In terms of the end of it hitting your cervix or something? Correct.

So there are some... 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. 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 them.

What is the truth about how you can have good sex?

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. 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 sensation 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 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 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 a very polite society, right? And it's like, no, this is something that takes work.

Just like hard conversations in your relationship have to happen. Conversations about sex occasionally need to happen.

So now I can feel the person listening going, I don't want to have that conversation. How do I even start having that conversation? So how do you start, Dr. Rina, having the conversation about the sex that you want? Or do we even know what sex that we want?

Well, some people do and some people don't. I think it starts with self-exploration. I think people have very different preconceived notions about that. Like men, it's very common to have self-exploration, and women, it's variable. Some women will be in their 20s before they've tried any self-exploration. Some women have never tried it at all. 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 You've 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, right? Or I'm going to try to have a conversation, it doesn't go the way I want to, and then that's it, 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.

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 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. 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 And then we can talk about like, 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, and then offering suggestions.

Say, I would really like it if you tried this next time. That would really turn me on. And that would be received well instead of saying like, Oh, you do this, and I really hate it. Because that's going to make-Oh, my God, I can't even imagine saying that to somebody.

Right.

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 like, This really turns me on. This is what I really like. And then obviously, you know your partner, so how do they communicate and using those same communication skills, like you're having a tough conversation about finances or about your kids or whatever, and bringing that to talking about sex.

Okay, so I just want to make sure, Dr.ina, I have really extracted the 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, like you're taking a walk, you're Side by side. You're talking and walking. You're not necessarily doing the desk stare at each other, so it doesn't have to be so intense. What is the opening line? How do I get into this?

There's a few ways to do it, right? 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 off for a time. But say, I'd really love to just carve out some time where we can talk about this. About sex? Yeah, about sex. Okay. And just say, So you're primed a little bit, right? 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, right? Or even greater.

I think that's a great lead in. 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 our way. Hey, babe, I'd love to talk about That's how we make our sex life better.

Yeah. And honestly, if they want to have sex, say you're a female in a 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. Of course. 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.

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

Yeah. I think this is an interesting question because who initiates, right? This is a big issue.

And I don't mean issue like we're in therapy about this, but this is something that I think my husband and I have gotten into a... You notice who's initiating, and then you start to get mad about it, or then you start to 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. I Sorry, Chris.

I think in terms of initiation, right? I think one is, is it that they're initiating when you're not in the mood, or are they initiating in a way that is not attractive? Are they just grabbing you or they're just doing something that they think is playful? They're not trying to be gross. They're just trying to be playful and get you in the mood. And that's how they're communicating. And that might not be your communication style. So one is, where is the issue there? And maybe it's hard for someone if it's always the same person and they keep initiating every single time and you keep saying no, it becomes very difficult to keep initiating, and then they're waiting for you. So sometimes I'll tell people, Okay, one, you got to figure that out. If you are always saying no, you're turning them down quite often, why are you? Think about that and then say, How can I make it so that I'm more receiving of them? What are they doing or what time? Maybe it's like you're not a morning person, and they're always ready to go in the morning. You have to communicate that with them, or maybe it's the way they're approaching you.

Then vice versa, it's good for both partners to initiate. I think it takes courage, it takes effort, even in long-term relationships, to disrupt someone's day and be like, Hey, I want to initiate. The other thing that I think about initiation that's important is that desire is not always spontaneous. What we see in the movies, people see their partner, they get really turned on, they immediately want to have sex. 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 moment and 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, started touching. Oh, wait, yeah, I like this. Okay, I'm in the mood. That's responsive desire. So there's a different way to think about it. 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 It comes after the initiation sometimes.

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 2:00? So it becomes more of a midday thing because 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 bed times. So by the time I got into bed, Chris was already asleep, and by the time he's waking up, it's fine. 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. Yes, absolutely. And creating more moments of, What about three o'clock? I got to break in. That 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.

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, right? So actually making time. Think about when you were younger and you used to go on a date, right? 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 we might have sex. It's exciting. So you have something to look forward to, and it can actually be really fun to allow that to be a thing. And the other thing about timing is our hormones fluctuate throughout the day. So in the morning between 7:00 and 10:00 AM is when testosterone is highest for both men and women, but more so men. And so that will be... Testosterone is the hormone of desire. So very often people will actually feel more desire in in the morning. And so that's not unreasonable to utilize your hormones and use them to your advantage. Like, okay, we're going to schedule time in the morning because we're both going to be able to receive because we have more hormones on our side.

Yeah. Just don't put it in the family calendar as mom and dad are banging right now. Do not disturb. You got to have a code name for it. Walking the dog. It is something that is like- Or like on date night, have sex first.

Don't go to dinner first.

I like that. 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- 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.

Absolutely.

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

We've touched on a couple of them. So for women, it's vaginal odor is pretty common, and then body image insecurity. So breasts or butts. We find that this actually is very common in younger women. 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, is being inexperienced or making noises or things like that can be pretty common in securities. But like I said, sex is There's going to be noises. You're going to have a quief or there's going to be some weird noises, and that's okay. It's normal. Your body is going to make noises when you're doing these activities. And then for men, most commonly, it's penal 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. Those are the most common insecurities.

Does the penis shrink with age?

Yeah, so not exactly. It can shrink commonly. It really It 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.

So it's like an optical illusion. That's one, yeah. So the penis didn't actually get shorter. They got bigger. Yeah, you got bigger. That's a very delicate way to say that, but okay.

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 showers 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. Then if you have erectile dysfunction, you can actually get that decreased blood flow to the tissues can cause scar tissue or fibrosis. 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.

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?

Yeah, you can orgasm. You can ejaculate.

Wait, you can have an orgasm without an erection as a man? Exactly. How?

So you just stimulate. The erection is The erection is important for being able to punch it, but you can still stimulate the penis and the genitals without an erection, right? 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 orgas. So very often it's difficult for men because they're like, I don't see an erection. I'm not aroused. I'm not mentally there. So that takes a little bit of training and work to be 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.

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.

Yeah. So I think, again, it's like they have to be willing to receive that pleasure and stimulation. So sometimes what we tell 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're 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.

Wow, that's pretty cool. What are some of the reasons, Dr.rina, that people experience shame around sex?

I think a lot of it stems from feeling not good enough, right? Like, whether in men, it's having strong long enough erections, lasting long enough. For women, it's like, Am I having an orgasm? Am I pleasureing 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. 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 on to that. And I think it's very common in the US because we're a sexually-approved society. But if you look at other countries which are more sexually open, like Northern Europe, they're much more progressive about sex. They talk about sex. They teach their children about even the names of their genitals very early. There was one, and 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 phallus 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 is how you take care of a healthy penis. They probably use it to really educate their children.

How does porn impact the sexual expectations between partners?

Yeah, 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 even a DVD, like a VCR and a tape.

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

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. So what I think when you see pornography when you're younger, unless someone tells you, you actually have to talk to your kids about, you might see this, this is not real life. But then you're like, Oh, that's what sex should look like. That's what the encounter should go like. This is how long I should last. This is how much ejaculate volume I should have. This is how quickly she should... Orgasm, this is how she should respond, or this is how I should respond, or all these things. I should be squirting these large volumes. All these things you see in pornography, they are created, and these are professional actors. 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 is not going to turn you on, 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 like 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 differentiate real from fake. But I think when you're younger, and I worry about that for our younger kids, they don't know.

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

Mental health is 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.

Sexual dysfunction is defined as what?

So it could be a variety of things. Very commonly, it 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. But also those medications, SSRIs, particularly, have high 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 can't have... 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 your sofa 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. Those negative feelings are taking over your body, and you can't relax enough to enjoy pleasure.

That's true because 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. If you think about stress as you being in a state of fight or flight all the time, it's hard to drop in and to 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.

Yeah. In fact, they've looked at people who have mindfulness practices, and they 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 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. Rina, can you talk a little bit about how somebody who has experienced trauma can reclaim their sexual health?

Yeah. So trauma is very challenging. And I think 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. Because if you don't feel safe because of your past trauma, you're never going to be able to have good sex.

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. Yeah. I've got some questions here for our male 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?

Yeah. There was one study that looked at this. This is a very well done study, and they basically followed men for almost 20 years. They followed 40,000 men for 20 years, and they looked at their numbers of ejaculation per month. They basically categorized them 1-3, 4-7, on and on and on. They had these categories. What they found was that men who ejaculated 21 times or more a month were a third less likely to develop prostate cancer, specifically in that time frame, compared to men who ejaculated only 4-7 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? No, not necessarily. I think it's really who is ejaculating 21 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. There's some variables that you just can't control for. I think ultimately, it again, 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.

Is there any corresponding study around women ejaculating more and improving our health? 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. 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 in your person if you're having more orgasms because, again, you're having all these benefits of orgasm.

How can a guy's masturbation technique impact their sex life?

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

Like hitting your penis on the bed? Yeah. Okay.

I was just saying, if you saw me at you, 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.

Yeah. Then also, they call it death grip. We're having a very firm grip on the erection women 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 is habituated to that one thing. That's 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, or it's correlated with less issues. Using lubricant or making sure it's just not a very firm grip. That's why you should 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.

Then when you resume, start masturbating with different lighter techniques and see in different positions potentially and see if you can train yourself to enjoy different types of stimulation.

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

It's actually very common. It's very common. So 52% of men over 50 will have issues with the rectile function, and that just keeps increasing. So 60% of 60-year-olds, 70% of 70-year-olds, 80% of 80-year-olds. It's more common in people because of vascular issues. We know there's lots of people with high blood pressure, diabetes, high cholesterol, and these can all affect blood flow to the penis. 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. Before you see problems in your heart, like chest pain, you're going to see problems with your erections. 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. I will usually screen my patients with hemoglobin A1c, like to check their blood sugars. I will screen their cholesterol. I can't say the number of times I found high cholesterol or maybe prediabetes in a man who has erectile dysfunction.

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

It could be a sign, yeah.

Wow. And what are the treatments available?

So there's lots of treatments available. There's other types of causes of ED, too. I want to make sure we don't-Let's talk about them. Yeah, there's psychogenic ED. So that can be like 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. Maybe you drank too much, maybe something happened that day. You were stressed, you couldn't get an erection. Then you're stressed about it. Then you think about it, you ruminate about it. The next time you have sex, am I going to have an erection? In your head, you're thinking that. Then you don't get one because you're so stressed. You're impossible to relax and enjoy. Then, again, not having an erection. Then it just cycles into this horrible, vicious cycle. 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? 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? 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. 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. It's only about 3% of people who only have hormonal causes. So they may have hormonal plus other things, but a very small % 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 long-standing diabetes, or if you've had surgery, like prostatectomy or other maybe pelvic surgeries for cancer, things Things like that that can affect those nerves. Those are neurologic issues. Then medications we've touched on a little bit, those antidepressants can cause ED. There's other medications, some blood pressure medications can cause ED very commonly. Those are the most common ones, but there are others, of course. Those are the different causes. Now, in terms of treatments, we have, of course, if it's psychogenic, we 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?

Because 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 on to 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 an 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. Exactly. And so your own thoughts are restricting the 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 ere, is that blood flow. Yeah. Is that a good explanation for why it's really important to understand that the mental This whole piece is really important from a physiological standpoint?

Absolutely. Then the high cortisol is going to dampen your hormonal production. 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. Then in terms of the medical causes, 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 if a man in your life is struggling with low testosterone? 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, my muscles are just not growing like they used to. That is another sign as well. So these are all signs. And fatigue also, really significant fatigue can be related to low testosterone.

And what There are three ways to naturally boost testosterone?

Yeah. So number one is sleep. So people really underestimate sleep, but there's actually very good quality studies that say 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. Then not looking at screens before bed, really utilizing your circadian rhythm, those things actually really do significantly improve testosterone. If you have sleep apnea, treating that will improve your testosterone. That's one. Two is exercise, specifically resistance exercise of the large muscle groups. So like deadlifts, squats, those sorts of like lower body extremities, working So you're 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 It's a good benefit.

You said that some of the treatments for erectile dysfunction include trying to boost testosterone, getting a good night's sleep. Is there anything else?

Yeah. Then talking about erectile dysfunction Specifically, there's medications. They're in a class called PDE5 inhibitors, and they essentially work by increasing blood flow to the area. They relax the vessels. They allow what's called nitric oxide. They allow nitric oxide and the cascade of events that happen to 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 Xenophil, which is brand name Viagra, which is an on demand, an hour before sex, last for up to four hours or so. Oh my God, no. I mean, your erection is not going to last up to four hours. But you can take it and then have sex three hours later, and it should still be around. People always caution about having an erection that lasts longer than four hours. That's very, very, very rare with medications. If you look at the studies, it was one or two. It was very few number of patients who actually had that problem. If you're using it as as I've described, it's almost a non-issue.

It's extremely rare. Other one is Tadalafil or Cialis. That's also available as an on-demand option that lasts about 36 hours. 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 it's a low dose every single day. If you don't like the idea of having to remember to take a pill, like when you want to have sex and allow for a little bit of spontaneity, that's another option.

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

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

Well, Dr. Rina, 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?

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

I love that. Dr. Rina, 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. 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.

Dr. Rina, I wish that you were here on the East Coast. I know. I would be rolling right into your office all the time. Thank you, thank you, thank you for being here, for empowering us. I feel very excited about this re-frame around play and taking control of the next chapter of my sexual pleasure and my sexual health. So thank you, thank you, thank you.

You're very welcome.

And I want to also thank you for being here with us 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. Rina 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.