00:00 Dr. Reena Malik is a board-certified urologist and pelvic surgeon who discusses commonly asked questions about urinary, pelvic, and sexual health, including topics such as UTIs, pelvic floor function, and sexual dysfunction.

07:47 Dr. Rena Malik discusses the importance of pelvic floor health, including its role in urination, sexual function, and posture, as well as the symptoms and issues that can arise from an unhealthy pelvic floor.

16:30 A pelvic floor exam for males and females involves feeling the pelvic floor muscles through the vagina or anus, assessing muscle tension and tenderness, observing muscle coordination, and checking for sensation and dysfunction, and it is recommended to see a pelvic floor specialist for a high-quality assessment.

24:22 Working with a physical therapist who can teach exercises to down train the pelvic floor and avoiding certain movements like crunches with legs crossed can help alleviate pelvic floor discomfort and improve sexual function.

32:41 For women, desire can come after intimacy and arousal, and for men, assessing nighttime erections can provide insight into sexual function, while blood flow, hormonal issues, and nerve function are important factors to consider in both genders.

40:53 The penis and clitoris are homologous structures, and while erectile dysfunction is more visible in men, difficulty with orgasm in women is multifactorial and can be assessed through lubrication, pain during sex, and orgasm.

49:39 Intracavirinosal injections, such as Trimix, are the most effective non-surgical treatment for erectile dysfunction, working by increasing blood flow and preventing the breakdown of CGMP, and low dosage daily use of Cialis/Tadalafil can also be beneficial for prostate health in males and potentially for increasing blood flow in females.

58:20 Young men in their 20s and 30s often experience erectile issues due to pelvic floor dysfunction caused by factors such as stress, prolonged sitting, and lack of physical activity.

01:06:52 Female sexual response consists of phases such as excitement, plateau, orgasm, and recovery, with specific physiological changes and pelvic floor muscle contractions occurring during orgasm.

01:15:34 The Coolidge effect, which is present in both males and females, allows for the possibility of experiencing another erection and ejaculation or arousal and orgasm again after a refractory period, and dopamine plays a crucial role in overriding the refractory period.

01:24:00 The discussion covers the subjective nature of libido and sexual satisfaction, the physiological changes that occur in the body during sexual arousal, the importance of communication with a partner, the role of lubrication in sexual pleasure, and the normalcy of vaginal discharge.

01:32:18 Douching can negatively impact the vaginal microbiome and lead to changes in pH, increasing the risk of UTIs or bacterial vaginosis, and it's important to educate women that normal physiologic discharge is normal and distinct to each individual.

01:40:52 The key takeaways from this section are that orgasm is highly individual and can be achieved through various forms of stimulation, including nipple stimulation and cervical stimulation, and that orgasm is a brain-initiated event that involves the contraction of pelvic floor muscles, and is associated with the release of dopamine.

01:49:36 There are different forms of female orgasm that can be achieved through various types of stimulation, such as rocking motion, clitoral stimulation, and penetration with clitoral pressure, and it is important for partners to communicate and explore these different methods in order to enhance sexual experiences.

01:57:36 Urinary tract infections (UTIs) are common in women, with up to 50% experiencing at least one in their lifetime, while they are less common in men; prevention strategies include hydration, vaginal estrogen for low estrogen states, and ensuring complete bladder emptying.

02:05:47 Cranberry supplements containing soluble proanthocyanidins (PACs) can effectively reduce the risk of urinary tract infections (UTIs), while other prevention strategies such as D-manos and probiotics have some data behind them but are less conclusive.

02:13:34 Prescribing off-label testosterone can improve desire in women with low testosterone levels, and applying a combined estrogen-testosterone cream can reduce pain and discomfort in women with vestibulodinia; kidney stones can be prevented by increasing fluid intake, decreasing oxalate and protein intake, and increasing citrate intake, while treatment options include shock waves, ureteroscopy, and percutaneous nephrolosotomy; oral contraceptives can lead to low libido and other sexual difficulties due to increased sex hormone binding globulin levels.

02:22:35 Oral contraceptives can lead to sexual dysfunction, including low libido and depressive symptoms, but there are alternative options such as long-acting hormonal contraceptives like IUDs; SSRIs can also cause sexual dysfunction, but reducing the dose or switching to a different antidepressant can help, and medications like Cialis and Viagra can be used as well; low-dose daily Tadalafil can improve prostate health and treat erectile dysfunction.

02:31:20 Enlarged prostate can cause difficulty urinating and other symptoms like overactivity, urgency, and frequent urination, but medications like Cialis and Flowmax can help; irritants like caffeine and alcohol can worsen bladder symptoms; cycling can lead to genital numbness and erectile dysfunction, but using a wider seat and maintaining good posture can help; anal sex is becoming more common, particularly among heterosexual couples, and one reason is that it is a safe method of contraception.

02:39:31 Anal sex carries a higher risk of sexually transmitted infections due to the thin and friable anal tissue, and it is important to use condoms and adequate lubrication; the pH of the anus is different from the vagina, so specific lubricants should be used; reasons for engaging in anal sex include pleasure from prostate stimulation, avoiding vaginal penetration for contraception or other reasons, and as a special activity with a partner.

02:47:50 Improving diet, exercise, sleep, and quitting smoking are the top recommendations for improving sexual health, and it's important to assess cardiovascular health if experiencing true organic impotence; while there is reasonable data on supplements like Tonga Ali and L citrulline, high-quality scientific research in this area is limited.