Sex & Infertility Expert: You Need To Grow Your Sex Span! This Is Killing Your Fertility! This Daily Habit Transforms Your Sex Life!
Dr. Mohit Kara, a board-certified urologist and professor, discusses "sexpan" and the widespread issues of sexual dysfunction in men and women. He explores lifestyle, hormonal, and psychological factors affecting libido and erectile function, emphasizing holistic and couple-focused approaches to sexual health.
Deep Dive Analysis
17 Topic Outline
Defining Sexpan and its Pillars for Sexual Health
Dr. Khera's Specialization and Patient Concerns
Erectile Dysfunction: Causes, Psychological Factors, and Health Links
Understanding Low Libido: Hormones, Neurotransmitters, and Lifestyle
The Impact of Pornography and Societal Trends on Sex Life
Obesity, Diabetes, and Declining Testosterone Levels
Testosterone Therapy for Men and Women
Lifestyle Modifications for Fertility and Sexual Function
Prevalence and Stigma of Erectile Dysfunction
Premature Ejaculation: Definition and Treatment Approaches
Safety of Testosterone Therapy: Insights from the TRAVERSE Trial
Enhancing Intimacy and Communication in Relationships
Addressing Female Sexual Dysfunction and Painful Intercourse
Peyronie's Disease: Abnormal Penile Curvature and Treatments
Advanced and Regenerative Therapies for Erectile Dysfunction
Penile Implants: A Last Resort Solution for ED
The Role of Trauma in Sexual Dysfunction
8 Key Concepts
Sexpan
Sexpan is defined as the duration an individual is able to engage in satisfying sexual activity. Most men and women desire their sexpan to last as long as their lifespan, and it can be significantly prolonged through lifestyle interventions and hormonal balance.
Psychogenic ED
Psychogenic erectile dysfunction occurs when a man can achieve an erection through masturbation or upon waking, but struggles with an erection during partnered sex. This is often due to anxiety or overthinking, creating a 'vicious cycle' where fear of losing an erection causes it to happen.
Libido
Libido is the desire to engage in sexual activity, which is a complex, multifactorial phenomenon. It is influenced by hormones like prolactin, estrogen, thyroid, and testosterone, as well as neurotransmitters such as dopamine (increases libido) and serotonin (decreases libido), alongside lifestyle and psychological factors.
Arterial Diameter Theory
This theory explains why erectile dysfunction often serves as an early warning sign for cardiovascular disease. Penile arteries are the smallest in the body (1-2mm), making them more susceptible to blockages from plaque before larger coronary (3-4mm) or carotid (6-7mm) arteries are affected.
Endothelium
The endothelium is the inner lining of blood vessels, crucial for vascular health. Injury to the endothelium can lead to the formation of clots or plaque, contributing to conditions like heart attack, stroke, and erectile dysfunction. Medications like daily Cialis are believed to protect this lining.
Female Sexual Dysfunction (FSD)
FSD is a condition affecting a significant percentage of women, characterized by one or more of four components: decreased libido, decreased arousal, orgasmic dysfunction, or pain with intercourse. Despite its prevalence, only a small fraction of affected women seek therapy.
Peyronie's Disease
Peyronie's disease is an abnormal curvature of the penis when erect, caused by the formation of scar tissue or plaque. This curvature can be severe enough (e.g., >60 degrees) to make intercourse prohibitive and can cause significant distress and disfigurement for affected men.
Testosterone Plateau Effect
This effect describes how increasing testosterone levels beyond a certain normal range does not necessarily lead to further improvements in symptoms like libido or energy, as these benefits plateau. However, muscle mass can continue to increase with higher testosterone levels, which is why bodybuilders often use super-physiologic doses.
14 Questions Answered
Sexpan refers to how long an individual can engage in satisfying sexual activity. It's important because most people desire their sexpan to last as long as their lifespan, and it's a key component of overall health and well-being.
Low libido is multifactorial, stemming from hormonal imbalances (prolactin, estrogen, thyroid, testosterone), neurotransmitter levels (high serotonin, low dopamine), lifestyle factors like fatigue and stress, and psychological issues such as relationship problems or anxiety.
Typically, men may desire sex to relieve stress, whereas women often need to relieve their stress *before* they can engage in sexual activity. This difference highlights the importance of stress reduction for both.
Excessive pornography consumption can create a significant gap between sexual expectations and reality, leading to psychogenic erectile dysfunction and low libido. Reducing pornography intake often improves sexual function and desire.
ED is often the first sign of underlying cardiovascular disease, as the penile arteries are smaller and show blockages before larger arteries. Men with ED have a higher risk of heart attack or stroke within seven years and are more likely to have undiagnosed diabetes.
Yes, losing 10% of body weight can increase serum testosterone by 85 ng/dL, and losing 15% can increase it by 250 ng/dL. This is because fat cells convert testosterone to estrogen and secrete hormones that suppress natural testosterone production.
A man is a candidate if he has both low testosterone levels and corresponding symptoms such as low energy, low libido, erectile dysfunction, decreased muscle mass, increased fat, poor sleep, or depression. For young men planning children, natural testosterone-boosting medications are preferred over direct testosterone supplementation.
Women produce more testosterone than any other hormone, and it's crucial for libido, muscle mass, bone mineral density, sense of well-being, and potentially cognition. While no FDA-approved testosterone for women exists in the US, it's often prescribed off-label at lower doses.
Daily Cialis (5mg) can physically strengthen penile tissue, protect the endothelial lining of blood vessels (reducing cardiac event risk), help men urinate better, and protect the heart in cases of pulmonary hypertension. It also helps break the psychogenic ED cycle.
Female sexual dysfunction involves four key components: decreased libido, decreased arousal, orgasmic dysfunction, and pain with intercourse.
Open and honest communication is the first step, as many couples suffer in silence, with men often avoiding sex rather than discussing ED. Addressing issues directly, sometimes with a sex therapist, helps resolve underlying problems and fosters intimacy.
For postmenopausal women, pain during sex is often due to vaginal atrophy, where the vaginal wall thins and becomes susceptible to injury due to a lack of estrogen. Local vaginal estrogen therapy (suppositories or creams) can restore tissue health and reduce pain.
The TRAVERSE trial, the largest randomized placebo-controlled trial on testosterone, found no significant increase in cardiovascular events, prostate cancer risk, or worsening of urinary symptoms in men receiving testosterone therapy within normal ranges.
The average ejaculatory time in the United States is 5.4 minutes. Premature ejaculation is defined as ejaculation occurring in less than two minutes, accompanied by a loss of control and distress to the individual.
26 Actionable Insights
1. Prioritize Lifestyle for Sexual Health
Focus on diet, exercise, sleep, and stress reduction as these are the most powerful tools for improving and prolonging sexpan, healthspan, and lifespan, often surpassing the effects of medication.
2. Destigmatize Sexual Dysfunction
Challenge the stigma around sexual dysfunction by recognizing it as a common, curable condition that should be discussed openly with doctors, similar to other health issues, to enable effective treatment.
3. Prioritize Open Communication About Sex
Foster open dialogue with your partner about sexual issues, as poor communication can make sexual problems dominate a relationship and prevent effective solutions, leading to suffering in silence.
4. View ED as a Cardiovascular Warning
Recognize erectile dysfunction as a potential early warning sign of underlying cardiovascular disease, as penile arteries are smaller and show blockages before coronary arteries, prompting further medical investigation.
5. Prioritize Weight Loss for Testosterone
Losing weight, particularly 10-15% of body weight, can significantly increase testosterone levels, which are often lowered by fat cells converting testosterone to estrogen and suppressing natural production.
6. Adopt a Mediterranean Diet
Implement a Mediterranean diet, rich in whole grains, legumes, fruits, and vegetables, as studies show it can significantly improve endothelial function and erectile function in men, and overall sexual function in women.
7. Aim for 7-8 Hours of Sleep
Ensure you get 7-8 hours of sleep per night, as less than six hours significantly increases the risk of sexual dysfunction in both men and women, while more than nine hours does not offer additional benefits.
8. Engage in Regular Vigorous Exercise
Commit to 160 minutes (40 minutes, four times a week) of moderate to vigorous exercise for at least six months to significantly improve erectile function, with greater benefits for more severe ED, without other interventions.
9. Understand Stress’s Gendered Libido Impact
Men often seek sex to relieve stress, while women typically need stress relief before engaging in sexual activity; partners should consider this difference to foster intimacy, such as by relieving a partner’s stress.
10. Create Dedicated Time and Novelty for Sex
Make conscious time for intimacy and change the environment (e.g., staycations, holidays) to remove daily stressors and reintroduce novelty, which can significantly improve sexual desire and experience.
11. Check Testosterone as a General Health Marker
View testosterone levels as a key indicator of overall health, impacting heart health, diabetes risk, obesity, depression, and bone density in both men and women, making it a crucial blood test.
12. Recognize Testosterone’s Role in Women’s Health
Understand that women also produce and benefit from testosterone, which can improve libido, muscle mass, bone density, and overall well-being; discuss off-label options with a doctor if levels are low and symptoms are present.
13. Consider Hormone Optimization
Explore testosterone supplementation if levels are low and symptoms are present, as it can significantly improve sexual function in both men and women, but avoid if planning children as it can cause infertility in men.
14. Check Key Libido Hormones
If experiencing low libido, get levels of prolactin, estrogen, thyroid, and testosterone (PET) checked, as imbalances in these four hormones can significantly impact sexual desire.
15. Review Medications for Libido Impact
Be aware that certain medications, like antidepressants (SSRIs), can increase serotonin and decrease libido; discuss alternatives or adjustments with a doctor if this is a concern, as other options like Wellbuterin increase dopamine.
16. Moderate Pornography Consumption
Excessive pornography viewing can create unrealistic expectations that lead to erectile dysfunction and low libido in real-life sexual encounters; reducing consumption may improve these issues by realigning expectation with reality.
17. Enhance Erections to Boost Male Libido
Improving the quality and reliability of erections can indirectly increase a man’s libido by reducing anxiety and increasing confidence in sexual encounters, breaking a vicious cycle of avoidance.
18. Consider Daily Cialis for Psychogenic ED
For psychogenic ED, a daily low-dose Cialis (5mg) can break the anxiety cycle by ensuring consistent erectile function, potentially strengthening penile tissue and reversing ED, without dependency.
19. Address Premature Ejaculation with Therapy or Sprays
For premature ejaculation, consider sex therapy techniques like start-stop or squeeze, which can be a cure, or use topical lidocaine sprays to decrease sensitivity and prolong intercourse.
20. Consider Local Vaginal Estrogen Post-Menopause
For postmenopausal women experiencing pain with intercourse or increased UTIs due to vaginal atrophy, local vaginal estrogen therapy can thicken the vaginal wall, reduce discomfort, and improve sexual function over about three months.
21. Improve Overall Health for Fertility
Recognize that healthier individuals tend to be more fertile; lifestyle changes improving general health can positively impact fertility, and a semen analysis can predict future health risks like diabetes or cancer.
22. Utilize ED as an Opportunity for Early Intervention
Leverage erectile dysfunction as a powerful motivator for men, especially young men, to seek medical attention, allowing for early screening and treatment of underlying health issues like diabetes, saving years of potential damage.
23. Understand Testosterone’s Cardiovascular Safety
Be aware that the TRAVERSE trial, the largest study on testosterone, found no increased risk of cardiovascular events, prostate cancer, or worsening urinary symptoms with testosterone supplementation within normal ranges.
24. Check Testosterone Levels for Depression
If experiencing depression, particularly with other symptoms of low T, get testosterone levels checked, as supplementation can significantly improve depressive symptoms, even alongside antidepressants.
25. Prioritize Enjoyment and Presence
Learn from the lesson to “enjoy the ride” and not delay gratification or personal fulfillment until a later, uncertain future, as life can be unpredictable and opportunities may not always materialize.
26. Implement Daily Grounding Practices
Integrate daily routines like meditation, exercise, personal time, and prayer to maintain mental and spiritual well-being amidst a busy life, as these practices can keep you grounded.
7 Key Quotes
Most men, most women, want their sexpan to last as long as their lifespan.
Dr. Mohit Khera
Viagra is a Vicodin. It is not a cure for your erectile dysfunction. It's just masking the problem.
Dr. Mohit Khera
ED is the first sign of other major adverse medical problems.
Dr. Mohit Khera
If you really want to have sex with your wife, do the dishes, take out the trash, do everything you can to tuck the kids in bed early, relieve her stress, because that will significantly increase her desire to engage in sexual activity.
Dr. Mohit Khera
Testosterone is not just about sex. There are five other things that you need to think about in men and women... It's about their overall health.
Dr. Mohit Khera
It's okay to suffer from sexual dysfunction. It's normal as we age. And there are many treatment options, good treatment options that can help you today.
Dr. Mohit Khera
Don't wait to the end. Enjoy the ride.
Dr. Mohit Khera
2 Protocols
Four Pillars to Prolong Sexpan
Dr. Mohit Khera- Improve diet (e.g., Mediterranean diet)
- Engage in regular exercise (e.g., 160 minutes/week of moderate to vigorous activity)
- Ensure adequate sleep (e.g., 7-8 hours/night)
- Practice stress reduction
Premature Ejaculation Delay Techniques (Sex Therapy)
Dr. Mohit Khera- Utilize the start-stop technique
- Employ the squeeze technique