What happens in the brain and body during an orgasm?

So orgasm is essentially, as you said, the pinnacle or the climax of peak arousal.

So basically arousal continues, continues, continues.

And when you reach a certain peak, you have this sort of significant release.

Basically, your body will start, your pelvic floor muscles will start contracting at a rhythm of every 0.8 seconds.

So you feel that.

And so it's a brain event, but it's really triggered by just increasing arousal.

Have better satisfaction.

these? Both men and

women have it.

they're constantly working all the time in the background every step you take every breath you take they're relaxing and contracting and so for most people they work fine in the background you never think about it doesn't become an issue they can be used to enhance your sex life and they can be a detriment and so sometimes what you think about your pelvic floor usually it's just fine sometimes it is weak and so when it's weaker what you may notice is for women sometimes they'll have urinary leakage sometimes they'll have This also often happens after childbirth because it weakens the pelvic floor.

But for guys, what they may notice is maybe their orgasms aren't as strong.

Maybe their ejaculate force is less forceful.

So it's not going as far as it used to.

And so those are because the muscles are really involved in climax.

What advice would you give to parents that want to talk to their kids about sexual education, sexual health, but don't know how to go about it?

What about specific compounds and or supplements that might help to boost testosterone? I actually polled my, no pun intended, I polled my Instagram audience for questions and somebody asked about gas station boner pills.

Yeah, well, let's talk about gas station boner pills.

So the thing about gas station boner pills is these things don't go through any regulation, but they can get reported to the FDA after the fact.

So they'll go out on the market.

They'll be there.

So you think, oh, it's at the gas station.

Like, how harmful could it be? And we actually get reports of them.

Colloquially called gym penis or gym dick, the phenomenon refers to the shrinkage that occurs after a workout session, according to an aesthetic nurse practitioner and the founder of a company which people can Google.

Set that up and give us some of the top ways that you've seen in your own practice, online, things that people are doing, things that people even sometimes take for granted of how they can make sex more pleasurable.

So first and foremost is being present during sex.

A lot of the times when we're having sex, there's a lot of spectatoring going on.

For women, it may be body image issues.

It may be, am I going to climax? It may be these other stressors that are going on.

For men, it's often, is my erection hard enough? Am I going to last long enough? And so we're spending a lot of time stressing about these things.

And we're not actually in the moment with our partner.

And what does it actually, you know, look like?

How does the pelvic floor itself kind of lead into or affect decision making around sex at this point?

Yeah, so I think first of all, let's describe what is a healthy pelvic floor.

And we have a new book coming out called The Hard Truth, which is a book that is made for men, but we have a whole section on pelvic floor health and it applies to women as well.

And I think it's a great, you know, it really goes over this very well.

So basically your pelvic floor is this bowl of muscles that sits underneath your vagina, your rectum, and your uterus, and it holds them up.

And so when it's functioning normally, you're going to be able to hold your urine and urinate appropriately when you go to the bathroom without a problem.

You're going to be able to defecate without constipation and appropriately.

So before we switch to men, tell us a little bit about your book, because I don't want the women to sign off and not hear this, because I think this would be a great book for both women and men, right?

Get on the same page because I think that alone, just that section alone is worth the price of the book just for people to read how you address this.

Yeah, thank you.

That's in the confidence section of the book.

And that section is really about how do you approach your partner in a way that's knowledgeable and confident and that you can communicate well.

And I think one, first off, is knowing that mismatch is gonna happen.

In every long-term relationship, there's gonna be times where your partner may have more desire than you or less.

And that's like completely normal.

First

And so let's start with the kind of the edgy question, like what sets your book apart from other books about men's sexual health?

Well, I think the beauty of this book is really that I'm trying to give people tools to use their own life, like to apply to their own life.

A lot of times people will give you like this blueprint to success, right? Whatever it is, but it's like very formulaic and it's very like do X, Y, Z.

And this is like, look, I eat Indian food.

I grew up eating Indian food.

I'm not going to tell you to change your diet to eat like chicken and broccoli all the time, right? That's not going to work.

And so I think that's the beauty of it.

Like what are, what do you know about all of that?

And so wanted you to

mention that.

So when I describe the book, I describe it as you're building your sexual house and the pillars are your foundation, right? And so the first half of the book goes over these four pillars.

They're fuel, strength, environment, and confidence.

And so Fuel talks about diet.

And I know your audience is very into diet and you're a big expert in nutrition.

But really what I want in this section of the book is for people to go away with tools that they can use for their own diet.

again so people can know about it?

How do you, as somebody that is putting out high value stuff, how do you determine the difference between content and knowledge? You know, what is your litmus test for getting people either on your show or what you post?

Yeah.

So first, I think let's first talk about how, you know, the people who are getting viral.

I think generally speaking, maybe 10 years ago, you could get viral really quickly and, you know, you could get picked up.

I think now there is so much competition in almost every area that it's a little bit difficult to just like.

rise up with no, you know, nothing, but that doesn't mean that you always are qualified to give the education you're giving, which is the point you're getting at, that there are people who are out there creating content or whatever, and they're either copying someone or they're making stuff up and they're just very charismatic.

Right.

good.

So let's dive in a little bit deeper on this.

Yeah, so strength is our second pillar.

Fuel was our first pillar, which was food.

Strength is the second pillar.

And strength, people think, okay, I'm just gonna go work out.

It's a little bit more nuanced than that.

So we talk about... why you do the strength things and what works, right? So for cardiovascular exercise, it's actually very, very important.

Let's talk about

Talk to me how you counsel your patients on testosterone.

Yeah.

So testosterone is very important.

I'm sure you've talked about it many times on this podcast.

Testosterone is not just important for erections.

It's important for mood, for brain health, for bone health, for muscle health.

And so when patients come in with low testosterone, they'll usually have one of those symptoms like brain fog.

Of course.

What other sorts of things are you encouraging men to think about when thinking about their prostate?

So before I forget, I want to mention that low-dose Tadalafil is actually a treatment for erectile dysfunction.

In fact, it works quite well, particularly in men who are having a lot of psychogenic issues.

One, because they don't have to remember to take a pill before sex.

It's always on board.

And you're taking five milligrams every day and it has a 36-hour half-life.

So you're kind of increasing those.

Do you think that's the reason people are doing it more frequently?

Visit joinmidi.com to learn more.

[upbeat music] Hey, everybody.

Who's excited? [audience cheering] I'm Dr.

Rena Malik.

I am truly honored to host today Dr. Mary Claire Haver.

She is a dear friend of mine, and as you all know, she has done more for advancing women's health in midlife than anyone I know.

So let's give it up for the most amazing human, wonderful person, girl's girl, Dr. Mary Claire Haver.

And if it doesn't help you in three months, then it's probably not gonna help your desire, and we start looking at other options.

I would like to start with Dr. Malik for this one.

one.You know, I started a private practice when I moved here to California, so all my patients primarily came from social media.

But, you know, I very early on said, "This is the way you communicate with me, through the portal.

If you message me on my website or you call the office, like, it- I'll call you, we'll call you back.

But, like, I'm not gonna respond to your messages in my inbox.

I'm not gonna respond to any other way." And they never did.

They never really reached out in a way that was inappropriate.

[laughs]

Here are the basics of that plumbing.

So a bladder is like a big balloon that's inside your pelvis, right in the lower part of your belly, and that's where you hold urine.

So when you drink and eat, your body processes all the fluid and all the nutrients that go in your body.

They go through your kidneys, which are these two little bean-like organs on either side of your back.

And then they go down these little tubes called ureters, and the urine goes down those tubes and into this balloon-like structure, this sac essentially.

And that's what holds your pee.

And so that's called the bladder.

In a tickle situation-

What do you think is at the root of erectile dysfunction?

Well, let's start by saying that erectile dysfunction is very, very common.

So more than half of guys over the age of 50 will have ED and that just goes up 10% every decade, right? So it's very, very common.

So I think one, it's knowing like you're not alone if you're in this situation.

Now, why does this happen? Everybody wants to know, right? There's five major causes.

There's vascular causes, so blood flow issues.

There's nerve causes.

Like what are some of the factors that people have control over that can actually improve that?

This graph is pretty stark.

Mm-hmm.

Think about fifty years ago.

There was no cell phones.

There might be some TV programs, but there was ads in between TV programs, and there was only certain TV shows you could watch at a certain time that you enjoyed, and then there was nothing to watch.

There was no email, so you went to work and you came home, and there was really not a lot of communication between you and your coworkers or your job.

They made dinner with their s- par- family, they hung out, and then maybe they watched a program or two, and then they lied down in bed.

Why is this?

Why the hell would a guy fake an orgasm? And then how do we actually tell that he's faking it?

Yeah.

There's a lot of misconceptions because we think men always want to have sex.

Men are always going to orgasm.

They're always having pleasure, but it's not actually true.

And so, you know, the studies will vary from a third of men to a quarter of men have faked an orgasm at some point.

Now they're not faking every orgasms, but ultimately, you know, men fake it for a whole variety of reasons, right? One, there's a small subset of men, like around 10% or less that have delayed ejaculation.

And get this, women who ate one or more apples a day had higher sexual function scores, particularly in the lubrication and desire category.

Why the hell would a guy fake an orgasm? And then how do we actually tell that he's faking it?

Yeah, there's a lot of misconceptions because we think men always want to have sex, men are always going to orgasm, they're always having pleasure, but it's not actually true.

And so, you know, the studies will vary from a third of men to a quarter of men have faked an orgasm at some point.

Now, they're not faking every orgasm, but ultimately, you know, men fake it for a whole variety of reasons.

Right.

One, there's a small subset of men like around 10 percent or less that have delayed ejaculation.

So it may take them a really long time, like over 30 minutes to achieve climax.

And get this, women who ate one or more apples a day had higher sexual function scores, particularly in the lubrication and desire category.

...Can, can you just go into that?

Yes.

So squirting, um, obviously is a very popularized thing and everybody wants to know, like does everyone do it? Is it normal? Like what is it? And so let me just start with the, the biology, right? So biologically, what, what is squirting? There's squirting, there's female ejaculation, there's normal lubrication.

There's all these fluids, right? So normal lubrication everyone's pretty familiar with.

It just occurs when you're...

when a female is aroused she has normal lubrication from the walls of the vagina essentially, and some little glands on the side.

Um, and then there's, uh, female ejaculation and there's squirting.

Enlarged prostate.

Is it true that women start to desire sex less and that our libido goes down as we get older? And if that is true, can we get it back

and how? So low libido is very common.

In fact, 40% of women will have low libido in their lifetime.

Your sexual desire is based on a variety of different things.

So what happens initially, right? Think about when you're younger and you're dating and you're really excited to see your partner.

There's like this atmosphere of desire.

You're like, oh, I can't wait to go on a date with you.

That does not sound fun.

Everyone's different though, obviously.

Absolutely.

I mean, you're raising little humans, right? So the stress of like, am I doing the right thing? Are they learning the right things? Are they getting exposed to the right things? Are their friends good people? Like all those things play a role.

And I'm saying that because I relate 100%.

But yeah, so I think that's really important.

Like we have to be the best that we can be.

anything we have to attack from all standpoints we have to be making an effort to sleep better we have to be making an effort to work out and lift heavy weights we have to be doing cardiovascular exercise we have to be eating right like all those things and we have to be doing stress management that is the one thing I think in society we just like brush under the rug like oh we're all stressed it's all normal like no we need to deal with that because having chronic stress is not a good thing Having a little stress, yeah, that's a good thing.

So can you talk about how perimenopause affects our bladder?