Dr. Rena Malik: Improving Sexual & Urological Health in Males and Females

The clitoris is probably the most reliable form of stimulation that will achieve orgasm. And when you look at the data... what we find is that about 85% of women require clitoral stimulation in order to climax. So, very few actually climax through just vaginal penetration alone.

The issue with anal sex is that people forget to use protection, like a condom, for example, because sexually transmitted infections are actually more likely with anal sex than they are with vaginal penetrative intercourse ... It's really important to use a condom and use adequate lubrication...

A lot of people use kegels recreationally, because improving the pelvic floor musculature can lead to more intense pelvic floor contractions during orgasm, which can be more pleasurable. And so, some people do it for those purposes. But again, I caution people not to overdo it, because then you can lead to a more tense pelvic floor, which is not where we want to end up.

When you do any sort of exercise, your trainer will tell you 'exhale on the effort' ... When you inhale, your pelvic floor relaxes; when you exhale, your pelvic floor contracts. And so, actually, that contraction stabilizes the pelvic floor. So, whatever intra-abdominal pressure you're causing to increase from the exercise, whether it's a squat or a crunch or whatever, you're increasing your abdominal pressure. Your pelvic floor is then contracting to help stabilize that.

We know that about 50% or 52% of men over the age of 40 will have erectile dysfunction, and that continues to increase as you age. So, 50% of 50-year-olds; 60% of 60-year-olds; and so on and so forth. So, it's very, very common.

Masturbation is a fine, healthy way of self-exploration; again, with the caveat that as long as you're not masturbating to excess and avoiding your obligations or your family or partners or your friends. You are just masturbating for the benefits of, maybe, sleep improvement, mood-boosting, reduction in anxiety. Those things are great.

You could imagine that if somebody exclusively masturbated and didn't develop the skills of courtship and building healthy, sexual relationships that pornography and/or masturbation could start to create 'problems' whereby somebody only felt comfortable in those domains.

It's actually an emergency. If you have an erection that lasts longer than 4 hours in the absence of sexual arousal, then it is important to get to an emergency room ... Don't wait because you're embarrassed; really, get there and get treated.

When they have a first-time sexual encounter, 95% of men are having an orgasm. When you look at first-time sexual encounters for women in heterosexual relationships, it's about 45-50% are having an orgasm. And when you look at homosexual relationships of women, it's, again, 90%.

Taking oral contraceptives increases the amount of sex hormone-binding globulin, which binds testosterone and estrogen—and that actually makes testosterone less available, which is... a very important hormone for desire.

About 15% of men who develop erectile dysfunction, 7 years later, will have a cardiovascular event ... It's the sign that you may be developing cardiovascular problems or endothelial dysfunction that's first presenting in the penis or in their sexual organs.

You may watch pornography, and then you may have difficulty getting aroused or turned on when you see your partner. You may get used to masturbating a certain way, right? So, if you use certain vibratory stimulation or certain pressure sensation every single time you masturbate, you can get habituated to that, and you might not be able to replicate that during penetrative intercourse.

The kind of general recommendations for people who have kidney stones: One is increase your fluid intake, 2-3 liters ... You want to decrease your oxalate intake ... The big ones are spinach and rhubarb...

The biggest cause of sexual dysfunction, whether it's low testosterone, erectile dysfunction, sexual dysfunction, is often comorbidities. So, managing high blood pressure, managing diabetes, with diet ... The best studied diet is the Mediterranean diet, at least in in the sexual dysfunction literature.

Pelvic floor, very simply, is basically a bowl of muscles that's connected to bones that hold up all your organs ... Their function is, essentially, many. It helps with urination, defecation, sexual function; it helps with posture. And so, having a strong, healthy pelvic floor can mean that you're having normal urination, you're having normal defecation, you're having great sex...

There's so many people who watch pornography and have no problems—who, you know, have normal healthy relationships, great sex with their partner, and it's fine.

Our bodies are amazing. The vagina is a self-cleaning oven. You don't have to do anything.

UTIs are very common in women. Probably up to 50% of women get at least one UTI in their lifetime. And up to a third of them get recurrent UTIs. And what that means is they have 2 or more in 6 months or 3 or more in a year.

Serotonin is kind of the anti to orgasm. And so, in fact, we will use SSRIs off-label for people who are having premature ejaculation. So, it delays ejaculation...

A lot of people don't know this, but women have more testosterone in their bodies than they actually have estrogen. So, testosterone is very important for both men and women for a variety of reasons.

I guess I'd say 3-6% of erectile dysfunction is hormonal. It's a small percentage of the entire entirety of erectile dysfunction.