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

Added: Aug 15, 2023

The conversation then shifts to male and female sexual dysfunction. Dr. Malik explains that while erectile dysfunction is a form of sexual dysfunction in males, there is no exact parallel in females. She highlights the multifactorial nature of female sexual dysfunction, which can involve difficulty with orgasm, lubrication, and pain during intercourse. She also notes that sexual dysfunction presents differently in both genders. The discussion moves on to hormonal issues related to sexual dysfunction. Dr. Malik clarifies that only a small percentage of erectile dysfunction and female sexual arousal issues are hormonally related. She mentions that testosterone is associated with libido in both men and women, while estrogen is important for brain function and libido in men. She dispels the misconception that estrogen is anti-libido or anti-male. The physiological underpinnings of the desire and arousal response are then explored. Dr. Malik explains that the parasympathetic nervous system initiates the response, leading to increased blood flow and lubrication. As sexual desire and arousal progress, the sympathetic nervous system becomes more involved, releasing dopamine and other catecholamines. The climax response is associated with the stress system of the body, followed by a shift back to the parasympathetic nervous system during the recovery period. The conversation touches on the use of medications like Cialis and Viagra for erectile dysfunction. Dr. Malik mentions that these medications work by inhibiting phosphodiesterase, preventing the breakdown of cyclic guanosine monophosphate (cGMP) and increasing blood flow. She notes that the success rate of these medications is around 60-70% and that they are generally well-tolerated. The use of Cialis and l-citrulline in females is also discussed. While there is limited data on their effectiveness, Dr. Malik suggests that they can be tried off-label for women experiencing sexual dysfunction related to blood flow issues. The podcast then delves into the reasons why younger men in their 20s and 30s are experiencing erectile dysfunction. Dr. Malik suggests that pelvic floor dysfunction and psychogenic factors may play a role. She emphasizes the importance of physical activity, avoiding pelvic floor strain, and reducing stress in maintaining sexual health. The discussion moves on to female sexual arousal response and orgasm. Dr. Malik explains the physiological changes that occur during arousal, such as cervical movement, vaginal elongation, and labial opening. She emphasizes that clitoral stimulation is the most reliable way for women to achieve orgasm, with only a small percentage of women experiencing orgasm through vaginal penetration alone. She also mentions the role of the G-spot and different forms of stimulation that can lead to orgasm. She highlights the role of the brain as the most powerful organ for sex and dispels the notion that women are solely intimacy-based in their sexual response. Dr. Malik addresses the issue of variations in libido throughout the menstrual cycle. She explains that libido tends to increase prior to and during ovulation, but there is limited data on complete lack of interest at certain stages. She also discusses the importance of communication in sexual relationships and suggests having conversations outside of the bedroom to avoid insecurities or misunderstandings. The podcast continues with a discussion on the role of dopamine in sexual response and the use of medications like apomorphine and PDE5 inhibitors to enhance arousal. Dr. Malik emphasizes the need for individual exploration and communication to understand one's own desires and preferences. She also mentions the availability of sex therapists who can provide guidance and support in navigating these conversations. Dr. Malik goes on to address erectile dysfunction, a common condition that can have physical and psychological causes. She emphasizes the importance of addressing underlying health conditions, such as high blood pressure and diabetes, as they can contribute to erectile dysfunction. Dr. Malik also discusses the role of lifestyle factors, such as diet, exercise, and sleep, in maintaining sexual health. The conversation then shifts to anal sex, which has become more common among heterosexual couples. Dr. Malik highlights the importance of using protection, such as condoms, to prevent sexually transmitted infections. She also emphasizes the need for adequate lubrication during anal sex, as the anus does not produce its own lubrication. Dr. Malik discusses the different reasons why people engage in anal sex, including pleasure and avoiding pregnancy. Regarding the safety of anal sex, Dr. Malik explains that sexually transmitted infections are more likely with anal sex compared to vaginal intercourse. This is because the anal tissue is thin and can easily tear, leading to blood loss and increased risk of infection. She advises using condoms and specific lubricants that are compatible with anal pH to reduce the risk of infection. The discussion concludes with a discussion about the use of herbs and supplements for sexual desire and function. Dr. Malik acknowledges that there is limited high-quality scientific research in this area but suggests that certain supplements, such as Tongkat Ali, maca root, and shilajit, may have potential benefits. However, she emphasizes that lifestyle factors, such as diet and exercise, should be prioritized before considering supplements. Dr. Malik also recommends trying one supplement at a time to assess its effectiveness.