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

Intro

In this episode of the Huberman Lab podcast, Dr. Rena Malik joins the discussion on improving sexual and urological health in males and females. Dr. Malik answers commonly asked questions about urinary, pelvic, and sexual health, providing valuable insights and debunking misconceptions. From pelvic floor anatomy to the role of hormones in sexual health, this episode covers a wide range of topics related to sexual well-being. Listeners are advised to check the timestamps as the content of the episode is sexual in nature and may not be suitable for young children.

Main Takeaways

Pelvic Floor Health and Dysfunction

• Pelvic floor muscles are important for urination, defecation, and sexual function.
• Pelvic floor dysfunction can happen to men and women due to stress, anxiety, overuse, posture problems, and other factors.
• Weak pelvic floor can cause urinary incontinence or leakage, which can create problems down the line.
• Pelvic floor therapists work with patients to normalize pelvic floor function.
• Kegel exercises can help strengthen the pelvic floor and improve urinary incontinence and pelvic organ prolapse in women, as well as erectile dysfunction in men.
• Overdoing kegels can lead to a tense pelvic floor, which is not ideal.
• Physical therapy is the best way to learn how to relax the pelvic floor.

Sexual Health and Dysfunction

• Arousal and desire are separate but related concepts in sexual response.
• High blood pressure, diabetes, heart disease, and smoking can negatively affect blood flow to the genitals.
• Testosterone is important for both men and women for sexual function and desire.
• Estrogen is not anti-libido or anti-male, it’s great for brain function and libido in both men and women.
• Dopamine is involved in the desire response, while prolactin is associated with the refractory period.
• There is no chart or tool to determine whether or not one’s libido is normal, high, or low.
• Female orgasm can be achieved through clitoral stimulation or penetration-based stimulation, but clitoral stimulation is the most reliable form.
• Communication with your partner about sexual preferences is key to achieving pleasure during sexual encounters.

Urinary Tract Infections (UTIs)

• Recurrent UTIs are defined as having two or more in six months or three or more in a year.
• Hydration is key in preventing UTIs, as well as vaginal estrogen for women with altered estrogen states.
• Pelvic floor dysfunction can make it more difficult to completely empty the bladder, leading to bacteria growth and UTIs.
• Sitting while urinating can help relax the pelvic floor and improve bladder emptying, especially for men with prostate enlargement.
• Cranberry supplements with at least 36 milligrams of PACs in a soluble form are effective in reducing the risk of UTIs.

Oral Contraceptives and Sexual Dysfunction

• Oral contraceptives can lead to sexual dysfunction, specifically low libido, due to increased sex hormone binding globulin (SHBG) which binds testosterone and estrogen.
• Low dose estrogen contraceptives are usually the culprit for oral contraceptive related sexual dysfunction.
• IUDs are a safe and effective form of contraception, with copper IUDs being particularly effective.
• SSRIs and other antidepressants can disrupt sexual function, but reducing the dose or switching to a different medication can help.

Supplements and Sexual Function

• Quit smoking and vaping to improve erectile function.
• Tongkat Ali may improve libido and desire.
• L Citrulline and Ashwagandha have reasonable data for sexual function.
• Expectations for high-quality science on supplements should be tempered.
• Many people derive tremendous benefit from supplements for improving sleep, hormone support, and focus.

Summary

Pelvic Floor Health and Dysfunction

Dr. Rena Malik emphasizes the importance of pelvic floor muscles for urination, defecation, and sexual function. Pelvic floor dysfunction can occur in both men and women due to various factors such as stress, anxiety, overuse, and posture problems. Weak pelvic floor muscles can lead to urinary incontinence or leakage, as well as pain during sex and back pain. Pelvic floor therapists work with patients to normalize pelvic floor function through exercises like Kegels. However, it’s important to avoid overdoing Kegels, as it can result in a tense pelvic floor. Physical therapy is recommended for learning how to relax the pelvic floor and maintain a healthy balance.

Sexual Health and Dysfunction

Dr. Malik addresses various aspects of sexual health, including arousal, desire, and the role of hormones. She emphasizes that arousal and desire are separate but related concepts in sexual response. Factors such as high blood pressure, diabetes, heart disease, and smoking can negatively affect blood flow to the genitals. Testosterone is important for both men and women in terms of sexual function and desire. Estrogen, contrary to popular belief, is not anti-libido or anti-male; it plays a crucial role in brain function and libido for both genders. Dopamine is involved in the desire response, while prolactin is associated with the refractory period. Dr. Malik also encourages open communication with partners about sexual preferences to enhance pleasure during sexual encounters.

Urinary Tract Infections (UTIs)

Dr. Malik provides insights into preventing and managing urinary tract infections (UTIs). Recurrent UTIs are defined as having multiple infections within a specific timeframe. Hydration and vaginal estrogen can help prevent UTIs, especially for women with altered estrogen states. Pelvic floor dysfunction can contribute to incomplete bladder emptying, leading to bacterial growth and UTIs. Sitting while urinating can help relax the pelvic floor and improve bladder emptying, particularly for men with prostate enlargement. Cranberry supplements with specific amounts of PACs (proanthocyanidins) in soluble form have been shown to reduce the risk of UTIs.

Oral Contraceptives and Sexual Dysfunction

Dr. Malik discusses the impact of oral contraceptives on sexual function. Increased sex hormone binding globulin (SHBG) levels caused by oral contraceptives can lead to low libido. Low dose estrogen contraceptives are often responsible for oral contraceptive-related sexual dysfunction. Intrauterine devices (IUDs), particularly copper IUDs, are considered safe and effective forms of contraception. Antidepressants, such as selective serotonin reuptake inhibitors (SSRIs), can also disrupt sexual function. Adjusting the dosage or switching to a different medication can help mitigate these effects.

Supplements and Sexual Function

Dr. Malik highlights the potential benefits of certain supplements for sexual function. Quitting smoking and vaping can improve erectile function. Tongkat Ali is a supplement that may enhance libido and desire. L Citrulline and Ashwagandha have shown promising results in improving sexual function. However, it’s important to have realistic expectations regarding the scientific evidence supporting supplements. While high-quality research is limited, many individuals report positive outcomes from using supplements to improve sleep, hormone support, and focus.

Conclusion

Dr. Rena Malik’s insights on pelvic floor health, sexual dysfunction, UTIs, oral contraceptives, and supplements provide valuable information for individuals seeking to improve their sexual and urological health. Open communication, seeking professional guidance, and maintaining a healthy lifestyle are essential for optimizing sexual well-being. By addressing misconceptions and providing evidence-based recommendations, this episode offers listeners a comprehensive understanding of the topics discussed.