Today, we're diving into an "Ask Me Anything" session, featuring Dr. Rena Malik addressing a wide range of intimate and personal ...

improving-sexual-intimacy-nocturia-painful-sex-and-semen-flavor-ama

Improving Sexual Intimacy, Nocturia, Painful Sex, and Semen Flavor | AMA

welcome to today's episode of ask me anything where we're answering questions that were specifically asked by you first question from Veronica she says my husband wants to have sex all the time I don't always have the sex drive he does I don't know if it's cuz I'm tired from work and the kids but I don't think I could keep up with this sex drive we have sex once a month these days and it used to be once a week so I don't know if there's anything I can do to fix this because I don't like disappointing him but I am exhausted every time he wants sex so this is a great question Veronica and generally speaking this is not uncommon it is actually very very common for there to be what we called mismatched desires or desire discrepancy between couples and what that means is that someone in the relationship will have a high sex drive where others will have a low sex drive and so all ultimately what can you do about it well one of course this is bothering you in some cases in Partners it doesn't bother them and in which case it doesn't matter you don't need to do anything about it it is completely normal particularly in long-term relationships to have mismatch sexual desire what can you do about it well one is I think the fact that you care and want to have more sex is valuable and you should tell your partner that you really want to do this and that you're interested and that will also tell your partner that this is something you want to do for them also when you are thinking about sex and we always think about it being like this very spontaneous thing like you see your partner you get turned on and just spontaneously sex happens now that's great but in reality in our busy lives it doesn't always work out that way you wait till the end of a dinner date and you're really full and you're not in the mood to have sex or it's finally at the end of the day and you're exhausted and you don't really have the energy or desire at the point when you're super exhausted so I often tell a couple to schedule time for intimacy we schedule time to go to the gym we schedule time to do certain activities maybe work out maybe catch up with our friends do other things but we never schedule time with our partners we just expect it to miraculously happen so it's important to really say 4 days from now we have an evening free where maybe the kids can be occupied or maybe we can really just dedicate to being together and that will be time for you to actually spend together intimately be together touch each other remember that what feels nice what feels good and the desire will grow that's what's called responsive desire it is desire that comes in response to certain activities whereas it's not spontaneous and that's okay because spontaneous desire is not what happens all the time for every single person responsive desire is much more common so you actually have to spend time together realize oh wait yeah I like this oh wow I'm actually enjoying this oh I might be feeling turned on and then slowly it can turn into having sex but again not having pressure on we must have sex more about having time for intimacy and then seeing where it goes great answer great answer I'll try out some of those tips myself got it next question comes in from pipy New York Harry from pyy New York is it normal to start using the bathroom in the middle of the night by the time you're in your 40s I'm 44 and I've been having to pee every other night for the last 6 months and don't know if this is going to be like this for the rest of my life urinating at night or nocturia is the term we use can be due to many different things the most common ones are over at least in the Urology world are overactive bladder or an enlarged prostate now at the age of 40 these conditions are less common but that doesn't mean that they don't exist so what that means is that people can have a bladder that is overactive meaning it squeez in before it's full giving you that sensation of an urge needing to go to the bathroom so that is what wakes you up at night and then you go to the bathroom and you urinate right and so if that's happening it's important to assess if you're drinking a lot of fluids before bedtime and can you limit those fluids before bedtime so it's also important to assess how much volume of urine is coming out does it seem like it's a lot of urine in which case you've probably met the maximum that your bladder can hold the average bladder can hold 16 to 20 oun so if you're feeling like you're uring that much it probably means that you're just drinking a lot of fluid and you're having to empty if you're having overactive bladder it basically is because the bladder is squeezing before it reaches fullness and you're needing to urinate before it reaches that point now causes of overactive bladder can be neurologic they can be due to age and a 40-year-old probably less likely but we do see overactive bladder in somewhere around 5 to 6% of people at that age group and that continues to increase to up to about 16 to 25% of people who have overactive bladder in their lifetime in terms of enlarged prostate we do see an enlarged prostate becoming a problem in younger men who have a family history of it so if your father had an enlarge prostate it is genetically passed on in what's called an autosomal dominant fashion meaning that if you father had it it's very likely that you're also going to get that Gene trait and then you're going to have an enlarged prostate in fact people who have genetic versions of BPH will have symptoms even earlier in life and are more likely to either have bothered some symptoms before the age of 60 or even go on to getting surgery for an enlarged prostate and so in this case is they not dangerous things unless you're not emptying your bladder well and that's another cause of why sometimes people wake up early is because they're not emptying their bladder completely so they go to bed with a half full or third full bladder and then that fills up more and then they they have to empty again it's important to if you're having trouble and it's bothering you please see a urologist to get evaluated make sure you're not having infections you're emptying your bladder well and then to assess the bother associated with your symptoms if you're not having infections and you're emptying well this is more a quality of life issue and if it's related to fluid intake it will get better if it's not related to fluid intake or another medical problem things like problems with your kidneys like diabetes and citus for example those things can be treated but otherwise if it's an overactive bladder problem or an enlarged prostate problem those can be more chronic conditions that will need management over period of your life ultimately again most of the time these are not dangerous and they're more about quality of life hopefully that gives you some reassurance very well and uh next question is anonymous wife has stopped having sex with me and she's saying it's because of the pain down there she goes to her family doctor and gets her regular checkup so I don't know what's going on with her but she tells me she hasn't uh been diagnosed with anything and she's not having any kind of bleeding or problems peeing just pain anytime we have sex so what should she do great question so pain with sex first of all you described it as pain down there and I realize that it's a very sensitive issue to talk about but it's important to identify what do you mean by down there and when does it hurt does it hurt on initial penetration deep penetration does it hurt after sex and we sort of talked about that earlier but then determining that part of it and how is the lubrication during intercourse is she making enough lubrication is she having difficulties with that has she gone through menopause so I will say the number one cause of pain with sex is either inadequate lubrication or inadequate arousal and those are sort of intertwined arousal and lubrication are intertwin but not always occurring at the same time so usually people will be aroused and will increase lubrication but that doesn't mean that if you're not lubricated that you're not aroused lubrication can be decreased for a number of different reasons due to things like oral contraceptives having decreased hormones like during menopause or having surgically induced menopause and so this can reduce lubrication or just not having enough time to get aroused so the average woman takes about 20 minutes to get fully aroused you know if you're going to have quick sex which some people do you need to use lubrication so that it's not uncomfort and honestly Lube is so much fun so try different kinds of lubs there's water-based Lubes there's silicone based Lubes there's oilbased Lubes and you can check out my video on lubricants to learn more about it and also check out different options for you but try them out always try them on an area of your body that is not your genitals first to make sure you don't have an allergic reaction to any components of the lubricant but that's one great thing you can try easily at home second thing common thing that can be a cause of painful sex is high tone pelvic floor dysfunction now this is because the muscles of the pelvic floor become short and tense and then they cannot relax appropriately to allow for penetration and so when this happens it hurts when you have sex and so it's very hard for people to realize they have this problem just like people get TMJ where they clench their jaw at night and they wake up with headaches same thing they can clench their muscles of their pelvic floor all the time and have pain and so that can be evaluated by again a urologist or a pelvic floor physical therapist or a gynecologist to assess the function of your pelvic floor also as I mentioned before about arousal that 20 minutes it's important to take that time because what happens is our body prepares for sex and what that means is the vagina widens and lengthens to almost double its size and the cervix moves up and out of the way so if you penetrate too early you may be hitting the cervix which can cause pain as well and then lastly another common cause is going through menopause so as after menopause which is a period of time where your estrogen decreases particularly in the vaginal area this causes a change in the tissues so what happens is the labia decrease in size the tissues in the vagina itself become thin and Frable in some cases but mostly thin and they lose their elasticity and so then that can make for very uncomfortable sex and also decrease lubrication a great way to improve that is by using vaginal estrogen vaginal estrogen is a hormone-based cream or suppository or ring that you put in the vagina that helps basically make those tissues healthier and also improves the thickness of those tissues and the lubrication of those tissues it's very very safe there's never been a reported breast cancer uterine cancer or anything with the use of vaginal hormones uh so it's very safe and most people tolerate it very very well you could also try vaginal moisturizers which are usually made with things like hyaluronic acid which you can use daily to up to every third day and there's a host of them on the market if she's still having pain despite trying all these things please make sure you see a urologist and get evaluated for causes of pain with sex because there's so many things we can offer to get her to a better quality of life all right let's switch it up to food does eating different foods really change the flavor of seaman let's talk about food Seaman is normally alkaline because it has to go through the vagina and the vagina has an acidic pH and so we need to keep the sperm healthy so all the fluids in semen which are made by different organs comes from not only the testicles but also the seal vesicle and the prostate and other structures around there other glands around there that create what we see as semen so semen is there to protect and nourish the sperm so they can get to the ovary and create a baby or fertilize the egg and so ultimately it's that's the reason that semen tastes a little bit bitter because it is alkaline now you can try different foods that may help reduce the alkalinity of the cement that are more acidic so that's why things like pineapple for example have been popularized to increase the sweetness of semen because they're reducing that bitterness now anything that's really acidic may help with that but it's important to realize if you eat pineapple on the day of the day you want your semen to taste good it's not going to work that quickly it's going to take some time so while it can decrease the bitterness it's not going to make it like candy sweet right it's just going to decrease the bitterness a little bit and ultimately you know you don't want to overdo it with high sugar foods cuz that's not going to actually be good for you overall just generally having a healthy diet and making sure you're well hydrated will make sure the taste of your semen is optimal now there's a whole host of things you can try to make it taste a little better but ultimately I think the most important thing is staying hydrated and having a good healthy diet certain things will make it taste bad so if you are drinking a lot of coffee if you're having a lot of alcohol if you're having a lot of meats if you're smoking those things are going to make the taste of semen a little bit more bitter so ultimately avoiding those things keeping a healthy diet if you enjoy pineapple or you enjoy acidic fruits go ahead and have them but realize that those things could also have other negative consequences if you have too much if you guys enjoyed that ama and want to hear the rest of it make sure to check out our premium membership at renam malik. supercast dcom where you can become a premium member where we answer questions that are asked by only our premium membership and we give you access to our Friday podcast episodes both video and audio Early Access as well as the show transcripts so check it out renam malik. supercast docomo worth it

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