August 14, 2023 • 2hr 51min
Dr. Rena Malik: Improving Sexual & Urological Health in Males and Females
Huberman Lab
Key Takeaways
- The pelvic floor is a bowl of muscles that supports organs and is crucial for urination, defecation, sexual function, and posture. A healthy pelvic floor allows for normal function in these areas.
- Pelvic floor dysfunction can manifest as either an overly tight or overly weak pelvic floor, leading to issues like urinary urgency/frequency, pain during s*x, constipation, and back pain.
- Kegel exercises can help strengthen a weak pelvic floor but should be done carefully to avoid over-tightening. For an overly tight pelvic floor, relaxation techniques are needed.
- Sexual arousal involves both psychological desire and physical genital response. These don't always align and can be affected by factors like stress, medications, and relationship dynamics.
- Erectile dysfunction is only related to low testosterone in about 3-6% of cases. It's more commonly caused by vascular issues, stress, or medications.
- For women, clitoral stimulation is the most reliable way to achieve orgasm, with about 85% requiring it. Only a small percentage climax from vaginal penetration alone.
- Urinary tract infections (UTIs) are very common in women. Prevention strategies include staying hydrated, using vaginal estrogen if needed, and fully emptying the bladder.
- Oral contraceptives can negatively impact libido and sexual function in some women by increasing s*x hormone binding globulin. Effects vary widely between individuals.
- An enlarged prostate is extremely common in aging men and can cause urinary symptoms. Medications like Cialis can help relax the prostate and improve urine flow.
- A**l s*x carries a higher risk of STI transmission and requires proper lubrication and protection. Communication and preparation are key for safety and comfort.
Introduction
In this episode, Dr. Andrew Huberman interviews Dr. Rena Malik, a board-certified urologist and pelvic surgeon specializing in male and female pelvic medicine. They discuss a wide range of topics related to urological, pelvic floor, and sexual health. Dr. Malik provides expert insights on common issues like pelvic floor dysfunction, erectile problems, urinary tract infections, and more. The conversation aims to provide listeners with science-based information to better understand and care for this important but often overlooked area of health.
Topics Discussed
Pelvic Floor Anatomy and Function (7:45)
Dr. Malik explains that the pelvic floor is a bowl of muscles connected to bones that support the pelvic organs. Its functions include:
- Assisting with urination and defecation
- Supporting sexual function
- Helping with posture
A healthy pelvic floor allows for normal function in these areas. However, pelvic floor dysfunction can occur when the muscles become either too tight or too weak.
"Having a strong, healthy pelvic floor can mean that you're having normal urination, you're having normal defecation, you're having great s*x, and that you are also not having ailments like back pain or issues related to those functions and those organs." - Dr. Rena Malik
Pelvic Floor Dysfunction (14:13)
Pelvic floor dysfunction can manifest in various ways:
- Overly tight pelvic floor: Can lead to urinary urgency/frequency, pain during s*x, constipation
- Weak pelvic floor: Often causes urinary incontinence, especially in women after childbirth
Assessing pelvic floor health typically requires examination by a specialist through digital palpation. Dr. Malik emphasizes that most people can't recognize pelvic floor issues on their own since we're not trained to be aware of these muscles.
Kegel Exercises and Pelvic Floor Health (19:44)
Kegel exercises can help strengthen a weak pelvic floor but should be done carefully:
- Start with 10-15 repetitions, holding for 5 seconds, twice daily
- Begin lying down, then progress to sitting and standing
- Avoid overdoing Kegels, as this can lead to an overly tight pelvic floor
For those with an overly tight pelvic floor, relaxation techniques are needed instead. Dr. Malik recommends working with a pelvic floor physical therapist to learn proper techniques.
Sexual Arousal and Function (28:03)
Dr. Malik explains the difference between desire and arousal:
- Desire: The psychological want to engage in sexual activity
- Arousal: The physical response of the body (e.g. erection, vaginal lubrication)
These don't always align - someone can feel desire without physical arousal or vice versa. Factors affecting arousal include:
- Psychological state (stress, anxiety)
- Hormones
- Blood flow
- Nerve function
Dr. Malik notes that erectile dysfunction is only related to low testosterone in about 3-6% of cases. It's more commonly caused by vascular issues, stress, or medications.
Female Sexual Response and Orgasm (1:26:18)
Key points on female sexual response:
- About 85% of women require clitoral stimulation to achieve orgasm
- Only a small percentage climax from vaginal penetration alone
- The G-spot is an area on the anterior vaginal wall that some women find pleasurable
- Orgasm involves rhythmic contractions of pelvic floor muscles
Dr. Malik emphasizes the importance of communication with partners to explore individual preferences and needs.
Urinary Tract Infections (UTIs) (1:58:45)
UTIs are very common, especially in women. Prevention strategies include:
- Staying well-hydrated (2-3 liters of water daily)
- Using vaginal estrogen for postmenopausal women
- Fully emptying the bladder when urinating
- Taking cranberry supplements with 36mg of proanthocyanidins
Dr. Malik notes that wiping front to back after using the bathroom is less important than commonly believed. UTIs are more likely related to individual microbiome and anatomical factors.
Oral Contraceptives and Sexual Function (2:19:14)
Oral contraceptives can impact sexual function in some women:
- They increase s*x hormone binding globulin, which binds testosterone and estrogen
- This can lead to decreased free testosterone, potentially lowering libido
- Effects vary widely between individuals - some women experience no issues
Dr. Malik suggests trying long-acting contraceptives like IUDs if oral contraceptives cause problems.
Prostate Health (2:29:32)
An enlarged prostate is extremely common in aging men:
- Can cause urinary symptoms like frequency, urgency, and weak stream
- Medications like Cialis (tadalafil) can help relax the prostate and improve symptoms
- Limiting bladder irritants like caffeine and alcohol may also help
Dr. Malik recommends men discuss any urinary changes with their doctor, as they can be early signs of other health issues.
A**l S*x (2:37:48)
Key points on a**l s*x:
- Carries a higher risk of STI transmission due to thin, fragile a**l tissue
- Requires proper lubrication as the a**s doesn't self-lubricate
- Should always involve protection (condoms) and careful preparation
- Communication and consent are crucial
Dr. Malik notes that a**l s*x appears to be becoming more common among heterosexual couples, possibly due to increased exposure in pornography.
Conclusion
This wide-ranging discussion with Dr. Rena Malik provides valuable insights into urological, pelvic floor, and sexual health. Key takeaways include the importance of maintaining a healthy pelvic floor, understanding the complexities of sexual arousal and function, and strategies for preventing common issues like UTIs. Dr. Malik emphasizes that while supplements and medications can play a role, the foundation of good health in these areas comes from lifestyle factors like proper diet, exercise, stress management, and sleep. Open communication with partners and healthcare providers is crucial for addressing any concerns. By demystifying these often taboo topics, this episode aims to empower listeners to better care for this important aspect of their overall health and well-being.
