In this video, Dr. Rena Malik, MD, explore the complexities of sexual wellness and relationship dynamics. They tackle sensitive ...

urologist-explains-retrograde-ejaculation-vaginal-dryness-and-tadalafil-ama

Urologist Explains Retrograde Ejaculation, Vaginal Dryness and Tadalafil | AMA

welcome to the Reena Malik MD podcast joined here with Reena Malik MD um this is the February AMA um thank you for always providing us with great questions and ideas um if you guys have any questions please leave it in the YouTube comments we do read the YouTube comments we do look for feedback great questions uh we do check the social media we do try to weed out the question questions that come up often enough or anything that we find interesting that you guys want to talk about so let's get into the first question okay also did you want to introduce yourself I am mystery person number one let's call myself mystery person number one all right ready yeah I was having sex with a girl once and she was on top facing away from me and I had never done anyone in this position before so I'm trying to picture the position okay I don't know if it's cuz my penis was bent in a way that I'm not used to but when I came nothing really came out weirded me out because when I peed later it looked like I had some [ __ ] coming out of me I never went back to that position but I don't know if I did something I wasn't supposed to do this is from Devon from Guyana and we love it when you guys make reference to where you're from we love hearing where you guys are living and where you guys are sending us questions for I try not to put anyone's username out there so Devon wants to know what happened when he was in this position with this girl what happened here Devon this is a really interesting question one because when you came you noticed that you didn't have an ejaculate now not everyone does notice that when this happens and this is actually quite common and what you're describing is called retrograde ejaculation now if you put enough pressure on the perineum which is the area between the anus and the scrotum or what we call the taint right people can you can actually Force the ejaculate to not come out and some people use this technique to do things like Sean retention but they're not actually stopping themselves from ejaculating they're just getting retrograde ejaculation and what that means is instead of the ejaculate going out forward through the hole of the P the urethra there actually having it go into the bladder and so what does this mean and why does this happen so it could be that you were in a certain position where that was getting pressed and this happened or it could be that youve actually developed retrograde ejaculation now why does this happen so the number one and two causes of this one is having some sort of prostate medication or prostate surgery that will affect the bladder neck and the reason is because the way ejaculation works is the opening to the bladder closes when you ejaculate so that the ejaculate has to go out the way that it needs to go out which is through the urethra to be able to have children right and and fertilize an egg and all the things that you know you need to do so when that bladder neck gets relaxed either through medication or gets affected through prostate surgery like having a a transoral reection of the prostate or Prost um laser prostatectomy for having an large prostate and having symptoms then you can affect the ability of the bladder neck to close and then you can have retrograde ejaculation now the other very common cause of this is diabetes and guys there are so many diabetics out there and this can happen when you have really bad diabetes and it can be very stressful because you have no idea why it's happening and um and of course it's something that you're very used to and it becomes a real problem when you're trying to get someone pregnant now if you're not trying to get someone pregnant I understand that it can be very devastating and very stressful to not have ejaculate come out but it is not necessary in terms of uh physiology right if you're not trying to get someone pregnant it's not mandatory but if you are trying to get someone pregnant you can then go to an infertility specialist and they can help you change the pH of your urine so that you can save that ejaculate that urine and then they can get the ejaculate or the actually the the sperm from the urine and use it for insemination um so I hope that answers the question well I've made a video about retrograde ejaculation before because it was in a episode of sex the city or the the new reboot of Sex in the City I think it's something called and just like that where one of the characters had retrograde ejaculation and then they did Keele exercises to bring it back which is not going to help unless it's actually just low volume ejaculate in which case keigle exercises may help because those are the muscles around the urethra that then can strengthen to help Force out more ejaculate volume and these muscles tend to get weak with age so if it's true retrograde ejaculation kull are not going to help but if it's low volume then it can help like it retrograde ejaculation something to Google I'm sure you have some videos out there about this um I should mention also um when you guys are looking to submit questions join us on our membership at the supercast um you can go to Arena Malik md.com and look for the subscription or just type it in your Google and uh we do take those questions a lot more often um from our own members so consider becoming a member question number two I don't know why it hurts me to have sex with men I've had this problem forever and have always needed Lube which makes it hard to have impromptu sex with my boyfriend because if I don't carry Lo on me then we can't have it without me feeling pain I don't know what's going on with me I don't get wet enough but is there something that will make me wet naturally to be able to avoid this problem this is from pette from Tacoma okay pette so when you started the question I thought it was maybe um an sex yeah it sounds like it's a female but we'll talk about both vaginal penetration and anal penetration just to be thorough sure um so in terms of reasons for lubrication so a lot of people the biggest myth I see is that people assume the wetter you are the more aroused you are and the drier you are the less aroused you are now that's not always true so one there's genetic reasons that lubrication can decrease there are um certain medications that can cause decrease lubrication even hydration how much your drinking can decrease your lubrication and certainly as women age and go through per menopause and menop pause their lubrication will decrease and that's sort of a part of the physiology that changes over time so what can you do in terms of vaginal penetration so for vaginal penetration in terms of natural things I mean the biggest thing is just drinking more fluids the more fluids you drink the more likely you are to make more lubrication also assess what medications you are on because some of them can affect lubrication so it can include things like anti-depressants oral contraceptives and even antis psychotic or anti- um other medications for uh that used are used for psychology and so any of those medications and maybe others that you're on could affect sexual function including arousal and if you're not getting as aroused sometimes that can affect lubrication or they can affect lubrication directly and so that's one thing is just very easy to do very natural of course is to check what you're on even supplements may have some um medications in them or components of them that can cause this so always assess what you are taking that might be causing changes in lubrication now other things you can do is you can use a vaginal moisturizer these are usually made with hyaluronic acid and they can um essentially just like people put hyaluronic acid on their face they're making more moisture in that area and so usually there's suppositories you put in the vagina usually once a day or every 3 days depending on which one you buy and these can help you know replenish moisture in the area the other thing is if you are going through menopause you may notice the tissues are changing they're getting a little thinner you're getting a little less lubrication maybe it's a little more uncomfortable when you have sex and so that's because during menopause and per menopause your estrogen levels go down and when you're estrogen level goes down it actually changes the collagen content and the structure of those tissues to make them thinner and less robust and also make less lubrication so it's very easy to replenish this with vaginal estrogen and I made a whole podcast episode about vaginal estrogen it is very very safe there's never been a reported breast cancer ovarian cancer um uterine cancer as long as you're using it with actually none with uterine cancer nothing like that no Strokes no blood clots with the vaginal formulation of estrogen because so little of it is absorbed into the body now if you have contraindication there's other things you can try like intr Roa which is a prostone um which is sort of DHEA vaginally that can help and of course using lubricant now I know people are like I I don't want to use Lube but I ask you why not because lubricant is fun it's slippery it makes things more fun uh there's water-based lubricants which you can find with very little amount of things in them it can be very sort of minimal ingredients and they usually there's like sensitive formulations there's ones that are good for if you're trying to have children for fertility so there's different kinds of lubricants you can get um water-based like I said you want to make sure that they osmolality is similar to vaginal pH cuz some of them will have phes that are specific for anal sex and so when you're looking for anal sex lubricants you want to look for ones that are specific for anal sex because the pH of the vagina is around four and the pH of the anus is around six and so you sort of want to get specialized lubricants for those things you can also look at silicone lubricants because vaginal I mean sorry the water-based lubricants will evaporate quickly and so you need to reapply them which may not be desirable in some circumstances so silicone based and oilbased lubricants last a little longer the things you need to be thoughtful of is silicone based lubricants you don't want to use them with silicone based sex toys and oilbased lubricants you don't want to use them with condoms cuz they can make condoms Break um and again they're they last a little long oilbased can sometimes stain sheets but ultimately experiment with them get some samples reach out to companies they'll mail you samples try out their products see what you like and that's a simple easy fix that can make sex way more fun way more comfortable for the large majority of people pH of the vagina and the anus I'm learning some new stuff did not know this learning some new stuff every day let's hit it off with question number three to Dil my doc recommended this to me what does it do and would you say it's better than the other erectile meds is is coming from Carmine Carmine out there all right Carmine so this is a great question that I honestly I get every single day um and I will tell you that there are some very distinct differences between tadalafil and S denil and I always talk about these two medications because they are the most affordable options you can get C coupons many of the insurances cover them and so these are usually the cheapest options and so for tadalfil and Selen which are the two most common they work a little bit differently and I will tell you that I think they are both quite good medications and some work better for some people and some work better for others in terms of tadalfil there are some reasons I tend to like it a little bit better than S denil if it works well for you and that is because one it's longer lasting it has a half life that is longer of about 30 it can last for about 36 hours so you'll see the effect of tadalfil if you take it on a Friday you can still see the effect on a Sunday so that allows you to sort of take it less often and allows for a little more spontaneity say you're having a special weekend away you just take it once and then you know you sort of you're set also you don't have to take it on an empty stomach so seleny you have to take on an empty stomach which means that you can't have a big dinner before you can't you know eat a big meal and if you do the medication's not going to work very well and you still may get side effects with it so generally speaking for those two reasons I tend to like to dofil a little bit better I also like to dofil because you can take it daily 5 milligrams every single day and one that takes off the stress of like having to take a medication right before sex and remembering to take it and like oh what if the opportunity presents itself and you're not ready and um and so that takes that stress away and two it sort of always giving blood flow to the body now you asked how these medications work so when you think of erections the way they happen is nitric oxide is the ignition for erections your body makes nitric oxide from the blood vessels and the nerves in response to any sort of stimulation so it could be you see something you hear something you feel something um that makes you feel desire or aroused and then your body releases nitric oxide it then releases through a number of Pathways releases cam m p and that's what sustains the erection now it's broken down by a compound called phosphodiesterase 5 and so these medications inhibit phosphodiesterase 5 and so they allow you to sustain your erection for longer and that's how they work in terms of um other options there are other options that are available out there they've all been shown to be about equally effective so they're all about 60 to 70% effective in all comers there are some that are sublingual options that may work a little bit faster like I said most of these medications have to be taken an hour before sex but these sublingual preparations you may be able to see a faster um a faster effect with them but again sometimes you know one medication will work well for you and another won't and also we see that when you start these medications usually you'll see that people will get better results as they take it more and more so the first time it may not work usually the second third fourth they'll see better better better Improvement and then they'll sort of get to their level of what it's going to be like it's because there's a lot of stress and anxiety when you start something new which can then hamper your ability to get an erection thank you guys so much for joining us for today's ama if you want to hear the rest of the questions from our members join our exclusive membership at renam malik. supercast domcom where you can be an exclusive member you will have Early Access to all of our YouTube podcasts video and audio ad free and you will get the opportunity to ask me anything and your questions will be prioritized for all of these episodes in the AMA and you will get the full AMA episode so check it out and as always remember going to take care of yourself because you're worth it

Dr.

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