 Hello, Psych2Go viewers. This is Michelle Rivas, host of Psychology Roundtable. Our guest for today's live stream is renowned urologist and pelvic surgeon, Dr. Rina Malik. Dr. Malik is also an associate professor and director of female pelvic medicine and reconstructive surgery at the University of Maryland School of Medicine. Dr. Malik is the host of our own amazing YouTube channel, which has garnered over a million subscribers and over 200 million views and counting. Dr. Malik, thank you so much for joining us today. Thank you for having me. Of course. So can you tell us a little bit about yourself and your background? Yeah. So I am, as you mentioned, a urologist. So in order to become a urologist, you do, obviously medical school, which is four years. And then you do a five or six year residency training if you have some research time. And then I did six years. And then you can opt to do a fellowship. So I did a fellowship in female pelvic medicine and reconstructive surgery. And I got into doing YouTube because I really felt passionate about health literacy. So I recall having this scenario when I was in training where I was taking care of a patient. We did this beautiful surgery on her. She unfortunately had bladder cancer. And we had to reconstruct her bladder, make a new bladder. And then in order to empty her bladder, she now had to catheterize through an opening in her belly. And, you know, everything went great. She did well after surgery. She went home and then she kept getting readmitted to the hospital into the ICU because she kept getting very sick and we couldn't figure out what was going on at home. And ultimately we figured out that she didn't really understand the concept that she had to now empty her bladder a different way. And that's what I realized that you can do the perfect surgery on someone. You can be the most renowned surgeon. But if you can't teach people what they have to do after surgery or how their life may change, because of course every surgery has risks and complications, potentially, then you're not doing a good enough job. And realistically, we don't have the time to do that because you only have so much time with your patients. And so that's where I said, you know what? I'm going to make videos on YouTube so that I can educate people at the comfort of their own home where they can get answers to questions that they may feel too embarrassed to ask their partners or their doctors about. That's amazing. And thank you for doing that because I think that you're changing a lot of people's perspective and empowering people. So thank you for that. And so for starters, I wanted to start off with the topic of sex and physiology. Can you explain to our viewers how sex affects us physiologically and psychologically? How do hormones play a part in sex and sex drive? Yes, so it's a very loaded question. But basically to make it very simple, our sex drive is very much made up of many different factors, one of which is hormones. You need to have good functioning hormones, specifically testosterone in both men and women to have good levels of libido. It is very much correlated. So when your testosterone levels go down, you may have lower sex drive or interest in sex. In terms of sex itself, I mean, really, it's about there's there's sort of like a sexual response cycle, right? So you see something, you feel something, you hear something that makes you arouse that gives you the idea of the thought in your brain that there's something interesting and exciting. And then your body physiologically changes, right? Like you, you, you're getting your breathing gets a little heavier, your heart rate gets a little faster. So things actually change and even the appearance of your genitals can change when you're aroused and for women, they'll make more lubrication and for men, they'll get an erection. And then, you know, then you will, you know, go and have intercourse or masturbate or whatever the case may be. And then you reach climax, which is orgasm. And that's essentially a time when your body is, you know, at the culmination of arousal and often also associated with physiologic changes, like pelvic floor contractions in women. So they'll feel a sense of like rhythmic pelvic floor contractions, a sense of like immense release. It lights up multiple areas in the brain. And for men, it often results in ejaculation. It doesn't always because they're actually, you can actually orgasm without ejaculation, but that's usually together for most people. And then there's a refractory period afterwards. Usually there's a short period of time when you're no longer able to continue to have intercourse. And usually that's much shorter for younger people and then that increases as age goes on. And it does happen for both men and women, although it's more commonly discussed with men. And what are like the main hormones associated like dirt, like before and during sex? Like which hormones do we release during sex? So during orgasm, you know, you're releasing a lot of dopamine and then afterwards you're having oxytocin and prolactin release. And these actually cause the same, the oxytocin is the same sort of releasing hormone that you get when mothers and babies breastfeed. It's like a very nurturing, comforting hormone. And then when you're, when you're dopamine is, you know, a very commonly known about hormone. It's something that we get all the time when we're doing things that are pleasurable. So you get dopamine from scrolling the internet. You get dopamine from watching a TV show. You like to get dopamine from working out, from walking in the, in nature. So there's lots of different ways to get dopamine, but that's kind of part of the release. And so those are the hormones that are released and you know, our bodies because they're aroused and naturally, you know, learn a learned response also that is that we're going to get these great good feeling hormones afterwards that that's part of kind of the desire that goes into it. But you know, generally speaking, our bodies are made to procreate. I mean, that's evolutionarily. The reason that we're, you know, the, the way to propagate your species is to have children. And so sex is, is mandatory for that. So part of the reason our bodies react the way they do is because evolutionarily, it's important to propagate the species. And not to digress, but are these the same hormones that are released? Like, well, someone's watching porn, dopamine, oxytocin, or is it different? Because I think that sometimes people think it's like the same thing. You know, it's similar. It's just that our bodies, the stimulus is different, right? And so the stimulus that's causing the excitement and arousal is something that you could get habituated to, right? So to start with, you may watch pornography, which is often more aggressive or not realistic, right? Like you're not in real life. You're not having sex with someone where you immediately are like turned on and climaxed within minutes. That's not really accurate. And so if your expectation is that's how it's going to be, then, you know, that, that's a problem. And then also, like I said, the, the content you're watching is also usually dramatized, right? And so that's one thing. And then two, the release of hormones can be more stronger, essentially. So you can get a bigger dopamine hit from watching something that's so novel and erotic, that's, you know, sort of shocking to you than you would with normal, with a normal relationship with someone that you're having and you're having intercourse with them. And you're still releasing oxytocin since I know that's the hormone that's associated with like bonding and all that, even when you're just watching porn. You know, I don't know about that one, but I think that it's more of a dopamine related process, particularly when you're, when you're, when you're, but orgasm itself is going to release the same hormones, right? It's more of like you're getting a different sort of stimulus that's going to change the way your body responds, because the stimulus is so much stronger. Yeah, that's, that's what I was thinking. I'm like, I think it's probably a little different, but you know, I see what you're saying. And then how does like stress impact our sex drive in libido? This is a question that's come up a lot just from viewers wanting to know what's the connection between the two. I mean stress, any sort of stress, trauma, relationship issues, you know, performance, anxiety, all those things can really affect the ability to either feel desire, arousal for men to get an erection. Those can all affect our ability because basically stress releases cortisol, which is kind of contradictory to testosterone. So when you have higher levels of cortisol, you actually are reducing the hormone that you need to have, you know, to have desire. And so it can be very, very stressful on our brains are extremely powerful. I think people underestimate that the most important organ in your body for sex is your brain, because when your brain's not in the moment, you're not going to be able to either enjoy it or perform. If that's what your concern is, as you would when you are completely in the moment. And in fact, when you orgasm, it is a truly mindful moment. You cannot think of anything else during that moment. Your brain basically empties, evacuates. There's nothing else that your brain can think about while you're climaxing. And so it's really, you know, it needs to be a very present and the experience where you're really in the moment. Oh, wow. That's like extremely interesting and segueing into that because you mentioned the the brain. There's this interesting article from Pepperdine University that explains that sex affects brain synapses. And so I just want to know how that works. Like how does the brain work when it works when it comes to sex, like sexual sexual desire and all of that. How does it work? Well, I guess I don't know what exactly they're trying to say. I think that ultimately, you know, there's lots of different areas of the brain that are turned on specifically when you're aroused and having sex and those change sort of with time. And interestingly, the way we've actually looked at this in research is that there are people who have symptoms after sex, right? You hear people joking about like post not clarity, but there is actually a change in your symptoms. I mean, in your hormones that will change that your emotional can actually affect your emotions. So some people will feel this clarity, which is not really well documented in the literature, but people do feel post-coital dysphoria. Like they feel sad or they cry or they feel unhappy after having sex and it's because of this change in their brain. And so it's it's very interesting. There's not a ton of data on it, but like it's very complex. It's not sort of a simple like this is on and off. It's like multiple areas in the brain light up and that effect your and then they turn off immediately, right? After you climax, they turn off and that's can really affect your your your brain. Yeah. So apparently what the article is trying to say is that sexual activity has like an effect on synaptic connections. Is that so? I just want to know how that works. Is that what you're like referring to like the emotions? Yeah. I mean synaptic connections are really like it's kind of a term that means like the connection between nerves. And so I think what they're trying to say and I get I can't I don't I don't know what they meant, but like I think what they mean is that they're turning on right. So what happened is your brain certain areas get activated and then they send signals through nerve through synapses. So that's kind of all sort of the same thing is essentially what I'm referring to is when your brain lights up, it's going to activate and fire nerves that are then going to change the way you you know perceive or feel certain things. Okay, that makes that. Yeah, that's what I was thinking. I thought that was really interesting because I think a lot of people don't realize the effect that sex has on their brain and how it affects our behaviors and you mentioned this in one of your videos. So how does like sex and you know, how does sex affect our brain and our behaviors? Yeah, so I mean, I think ultimately sex is something that I guess sorry. Can you be a little more specific? Like what do you mean by like, of course, sex affects our behavior because you're going to seek sex when you're, you know, having arousal. But I guess I'm not really sure what you're referring to. It was just something that you mentioned in your video that it's something that like guides our behavior, but I guess more so like how does it like, I guess, how does it impact our mood? I'd be a better mood. So yeah, I would say that, you know, I think ultimately sex is very powerful and it's really the the orgasm that is is powerful in in a lot of different ways. So it's actually been studied to reduce anxiety, reduce depression, improve mood, improve sleep. So there's a lot of different positives from reaching climax and sex has the additional benefit of of, you know, bonding with another individual and the benefits of that, which are also very powerful and can affect you in positive ways, particularly in your relationship. So, you know, I think those are, those are well-known facts related to having sex and ultimately reaching orgasm. No, not exactly. That's what I was trying to like get at. And so like, how would depression, anxiety impact our sex drive in our sex life? Yeah, it's extremely negative. So people who are depressed and anxious will often have a lower sex drive because like I said, you're when I said earlier, you're when you're not, you know, when you're depressed or anxious, you're preoccupied with those thoughts. You're not going to be easily aroused or interested in sex. You're going to be, you know, very overwhelmed with the, the neurotransmitters and things that are actually related to depression. And so the, the unfortunate side of some of the things associated with depression are that like SSRIs have some pretty significant sexual side effects as well. So taking certain medications can also affect your ability to either for to achieve climax to lubricate to ejaculate or for desire. And so if you are on any of those medications and you start noticing that symptoms are changing for a negative in a negative way, it's important to talk to your psychiatrist or primary care doctor, whoever's, you know, prescribing those medications so that you can really assess, you know, can we switch this to something else or how can we mitigate the symptoms because you can actually reduce the dose and still, and that will reduce symptoms or you can switch to another medication. Could certain medications like damage like sex drive permanently or maybe it's just something that like happens, you know, at the beginning when you're first taking a medication, maybe just temporarily. Yeah. So very often it's reversible. There are some cases that have been reported with other medications that may be more long lasting, but typically with some time they tend to improve. Most often they do. I would say most often, you know, the symptoms, especially with SSRIs, they tend to improve. Well, I want, thank you for that. And I wanted to move on to the topic of pornography because this is a hot button issue. Psych2Go has done a few videos on that and I know you have as well and you have some really interesting insights. So I want to start off with how does porn increase sexual desire and arousal? What are like the positive effects of it? Yes. So porn, you porn or masturbation I guess specifically. Just like watching porn since I mean it's a billion dollar industry. It's reported that like porn has had like 11 billion visits this year alone. So just watching porn. Yeah. Yeah. So watching porn itself is, you know, it allows people to sort of do things that they normally or like visualizing they wouldn't normally do in a sexual encounter. So that allows them to kind of experience that you can also do it with a partner which can be a bonding experience can also allow for arousal or improve arousal and interest in sex. It can also, you know, I mean, I think for some people it's it, you know, when using like ethical ethical porn where it's not like, you know, people are kind of more realistic in the terms of like what, you know, what happens in a real sexual encounter. It can be it can be educational. I think but a lot of the times I think that, you know, the caveat is there is a small subset of people who can become addicted to pornography and we call it problematic porn use in the clinical literature, but it can become a negative in that way. But I think ultimately it's it's safe. If you're doing it in the safety of your own home, you're finding pleasure from it and you're doing it with with the intent to feel pleasure that I think it's okay. You know, once in a while it's certainly not going to if you're doing it on a, you know, on a basis where you're not having effects that are, you know, you're becoming addicted in the sense of like you are not doing activity that you normally would do. So like I'd rather watch porn than hang out with my partner or I'd rather watch porn than go at my friends. I'd rather watch porn than go to work. That's a problem. But if you're using it recreationally as improving the quality of your life, like you're having pleasure, you're having orgasm, you're masturbating or you're having more sex with your partner, then I think it's totally safe and effective way to, you know, improve pleasure. So specifically one does pornography cross the line from healthy to dangerous such as developing an addiction. Yeah, so like I said, if you start noticing that you are preferring pornography to your partner, you are preferring pornography to doing normal daily activities. Like say you're like, I just want to stay in bed and watch another one before I go to work and now you're getting late to work or you're staying up late to watch pornography or you find yourself looking for more and more sort of novel aggressive stimuli. So you're like, man, this porn just didn't do it for me. Now I need to find something that's more aggressive or more stimulating in a different way. You know, you may be going down that line where it's becoming a problem. And I think the issue now is that it's so accessible. Like when we were growing up or when I was growing up, you know, you had to like find a VCR and you had to find a place to watch it where nobody was, which was like, you know, never happened. Like so, so it was very different. I mean, I think more people watched, you know, like looked at Playboy magazines or, you know, things like that, but it was just like very difficult to have access to it. And now I'll just turn your phone, right? So it's become very accessible, like too easy to access. Do you think that overconsumption or that like easy accessibility of like porn on the internet is actually creating more, I guess, porn addicts, so to speak? Like, do you think it's actually perpetuating it? It's hard to say. I would say that lots of people, I think that the issue with porn is there's a lot of shame around using it and some people may use it just fine, but they have a lot of shame around using it. And then there's other people who use it and then become, you know, habituated to using it or needing it to actually reach climax or to get aroused. And then when they're confronted with the real scenario with their partner or with a person they want to have sex with, they're now having trouble because they're like, why am I not into this person? And it's really not that. So they've been so habituated to seeing that sort of stimuli. And so, and the key is to keep a variety of stimuli. Like don't always watch porn. Use your imagination or read a book or do something else, right? But like don't always rely on porn in order to feel arousal because then your body and brain will get used to that. Thank you for that. And I wanted to ask, and you've talked about this in a video and I think that it's important for people to know. So how is like pornography, you know, the stuff we see on the internet, the videos, how is it unrealistic to a real life? Because sometimes people watch porn and they think, well, this is how sex is in real life. So, you know, I mean, it's, it's a movie. It's a movie, right? It is reduced. So one is like these people are using, so the men are using ways to help them stay erect longer. They're using all sorts of different techniques. They may be using injections. They may be using medications. They may even have penile implants, you know, so, and this is their job, right? So they work really hard at getting like that that they've chosen this job for a reason because they can perform or they're willing to do the things that require them to perform. Two is, you know, the lubrication and the arousal like that you're seeing the squirting or the ejaculate volume, that's all visually enhanced, right? So they'll use sort of different techniques to make it look more volumous. And so I think that like that is not accurate and something like, what's wrong with me? Like, why am I not doing that? And the other big issue is like, you see people, they see each other, they're jumping on each other, and they're immediately like having sex and orgasms like within like seconds or minutes, right? And not totally not realistic, right? Like it takes time. It takes the average woman about 30 minutes to get fully aroused, 25 to 30 minutes to get aroused and to, you know, to really achieve climax. That includes the whole kind of thing. And for men, sometimes it takes time too. Like it's not this like, and the normal average duration of sex is like five minutes, 5.35, 5.7 minutes if you look at the studies. So like, no, people are not having penetrative intercourse for 20, 30 minutes or the length of a porno, right? Like it's not, it's not realistic. And, you know, there's a lot of like self doubt after watching pornography. Like you'll watch me, does my, why does my dental does not look like that? Like women's labia are all very unique and different. Men's penile lengths are all very unique and different. And the porn industry selects for the, you know, the one deviation, like multiple certain deviations away from normal. So normal is, you know, a much, you know, normal length of a penis is about five to six inches, whereas people are displaying these, you know, very long fallacies, which are not accurate. And for women, they're always showing kind of a small labia, whereas women can have, you know, large labia, menorah, a different length. They can be asymmetrical and that's completely normal and fine. Yeah, absolutely. And I think that it does sort of make people feel and not sort of, it really does make a lot of people feel insecure and they think, okay, this is how sex should be. And often that's not the case. So thank you for that. And I love this comment by Nifty. I wanted to highlight it because I think it just really encompasses what we're saying. Nifty said, porn is sexual entertainment, not sexual education. I definitely agree with that. So thank you, Nifty. Yes, absolutely. And you know, you can use it in a way to learn more about what you like, but it's not going to educate you on what to do or how to do it, right? These are trained individuals who do this for their job, right? It's like watching a Cirque du Soleil show. You're not going to be doing those acrobatics. It's a show. It's the same thing, right? You're not going to be doing those things. It's a show. It's a movie. Do you think it would help if they put, like, a disclaimer on the video? Maybe. I mean, I think the other issue is really that people, little, like, children are getting access to pornography at younger ages. So I was shocked when I found this out that, like, basically by the age of 10, most kids have seen pornography, or a large majority. I mean, 10, like, I have a 10-year-old son and he would not know what's going on. And I mean, maybe I don't think he's like, you know what I mean? But, like, I don't, it's too, they're too young. And then they formulate these ideas of what sex is. It's just, it's, that's what worries me, honestly, is having exposure to it at a really young age. I think when you're older and you've had relationships and you've had sex, like, you can kind of differentiate from fact versus myth. But when you're young, it's very hard. And then you have sex for the first time. And you're like, wait, this is not like what I watched. Yeah. And there's actually debate on that, though. I've heard many people say that it's good to inform younger, like, children and, like, teenagers about sex. Like, the younger, the better, so that they're, like, confident in their sexual identity. That's different than watching, I think that's completely different than watching porn. You can inform. Exactly. I'm not just that agree that kids should know the terms about, like, what things are. They shouldn't be, like, naming their, their hoo-ha. They should actually know about it. Right? Exactly. Right? First, vice versa. And so I think that, like, it's important to educate kids. It's important to answer their questions when they ask them because you'd rather be, I, like, we actually had this discussion the day. I was like, I want to be the one telling my kid what, you know, what he would answer his questions and he goes to a friend who tells him something that's completely inaccurate, right? Like, I'm the expert. They come talk to me or talk to your parents. You guys are the experts. Like, you should be the ones telling them they shouldn't be learning from their, you know, 12 year old or 13 year old neighbor when they're 10, right? They should be learning from you. No, I agree for sure. But like, no, I definitely agree with what you're saying. It's just, I guess, there's that argument like, well, I guess if they watch porn younger or like it's okay for them to do so, it's normal. But I, I agree with you that there is like a difference and that they're too young at a certain age to be watching porn. I 100% don't think I think that like you need, your brain is not fully formed till you're 25. They're all the connections in your brain are not complete. And so like honestly, I think that, I mean, if you're able to like serve in the military like 18 and vote like, okay, fine, 18 years old maybe is reasonable but it's an arbitrary number that was selected, right? I don't think it's based on any physiologic data like 18, you don't change from like 17 and a half to 18, your brain's not that dramatically different. But I think that ultimately like, you know, 10 is too young like it should be much older. I think that, you know, and of course I'm sure kids do see it. It's okay. But like the amount of exposure is probably too much, you know, cause it's just too accessible. Yeah. And then it would be confusing and it's not like someone can explain all that to you. Like a kid looks at that and they think, okay, this porn is how sex is in real life. They don't really, they can't reason. They just think, well, they can reason, but it's different, right? They're not going to look at that and think, oh, it's just entertainment like what you said, they're going to look at it and think this is how it should be and it's confusing and it might distort their, might actually distort their view of sex. Yeah. In some ways, definitely. So now we're going to switch over to our audience segment where we answer your viewer questions. I'm really excited. We have over 700 people in here, a lot of fans of both the channel. So I'm really excited. Let's begin. So just, okay. So someone asked a very interesting question. Dr. Malik, do you believe that porn can destroy marriages? Yeah, I think, I mean, I think, again, if you have problematic pornography use, which we've kind of talked about already, if you're choosing pornography over your partner repeatedly, then yeah, absolutely. It's going to destroy marriages. If you're choosing pornography over going to work and you're not financially stable because of that, it's going to destroy your life potentially, right? If you have a problem with it, it can. Absolutely. And then, sir, I don't want to butcher your name, but I put up on the screen. Dr. Malik, what do you think of No Not November? Oh, I love this question. So No Not November for those of you who don't know is kind of a media related thing where people try to not ejaculate for the whole month of November. Now, if there are people who, you know, there's like tantric sort of Taoist practices where they've done this and there's, you know, they've reported benefits to refraining from ejaculation. But there is no scientific evidence that refraining from ejaculation benefits you in terms of like what people say, like increasing testosterone or, you know, increasing your strength or vitality. There is not any scientific evidence. There's a small study done on very young, healthy men that shows a very small increase in testosterone after refraining from ejaculation. But it is not enough to put yourself through, and it's, again, a very small study and a small group of people, like 10 people, I think it was. And so ultimately my take home from that is that if you are struggling, like if you want to do it and you're perceiving benefit, go ahead, by all means. No one's, there's nothing wrong with doing it. But if you are doing it because you think you should and you're miserable and you're unhappy and you're getting pain, you can also get like pelvic pain from refraining and tightening up your pelvic floor over and over again and you're getting issues with erections or other problems. That's a sign that like you need to stop. Like this is not healthy for you and it's actually causing problems. And in fact, you know, when we have people who have a lot of high tone pelvic floor dysfunction, like in the old days urologists used to tell people like ejaculate three times a week. Like that's your prescription. Go home and go do that. And so, you know, it can be negative and it can definitely cause a lot of distress. And so in those cases, I tell people there's no evidence that this is going to change your life for the better. Now there are people who do again, like I said, I don't want to shame people if they are doing it and getting benefit from it. By all means, I have no problem with it. But there is no evidence it's going to help you. Thank you for that. And then our next viewer question and I think this is a really good one is attachment style associated with pornography addiction. Example, avoidant and anxious avoidant type styles. You know, that's a great question. I have actually not looked at the data on that. I'm not sure, but I will look into it and maybe I will leave a comment on the video later. Thank you. And let me see. Just put that one up on the screen. Okay, this is a really good one. Is the normalization of only fans unhealthy? Well, I mean, there's, I can't tell you data on that, right? There's not been at least to my knowledge a study on only fans in terms of science scientific evidence. You know, I think that it's an interesting phenomenon that's going on currently and I have not yet completely formulated my thoughts on it. Like I think, yeah, I couldn't say. I think that there could be damaging aspects to it and there could be positives, but like what's the net effect? I don't really know yet. I think ultimately like it empowers people to be who they are, but at the same time is it, is it, you know, shouldn't we be making connections in real life, right? Like I think that's my major concern with it. Like should we be actually trying to make connections in real life and are we becoming too focused on making connections over the internet that are not real and not substantial and are we just getting more lonely as a society because of that? On the topic of loneliness, a viewer just asked, why does porn make some people feel emotionally empty? Well, you know, I think that that's part of like, you know, you're getting this dopamine rush all the time, but then you crash, right? Like you get this high release of dopamine, but then when your addiction goes away, just like an addiction to anything, right? Like drugs, sex, when you are away from that, when you've like lost that stimulus and you're like seeking the next one, you're feeling depressed and sad and uninterested in things that you normally used to and that's basically a sign of any addiction, not just porn addiction. You know, if when you're addicted to something, when you're not doing that thing, typically people feel depressed and uninterested in things that they normally used to. And then Ziggy asked, what are some ways someone with an addiction to porn can cut that out of their life, especially for someone who has tried to quit multiple times but keeps coming back? So I'm not an expert in porn addiction, but there's lots of different ways. And I think seeking help from a psychiatrist with an expertise in this area to undergo like cognitive behavioral therapy or other sort of talk therapy or things of that nature, I think is really important. I think a lot of people are trying to do it at home by themselves and it's very difficult. It's an addiction just like any other addiction and sometimes you need more help and it's not that you're weak, it's just like any addiction. It's because the synapses in your brain are wired as such and you have developed this addiction. It's not that there's something wrong with you. It's that you need help in overcoming this addiction, just like someone who's an alcoholic needs help or someone who's addicted to food needs help, right? Like whatever it is, this is sometimes requires professional help. And then our next viewer asked, is it healthy to use porn to replace the lack of a relationship? Well, I think if you're using it as like, again, like if you're using it to occasionally achieve orgasm and for pleasure, it's probably fine, but you, I mean, replace is sort of a strong word. Like if you're trying to use it as a way to just sort of, you know, find arousal in those times, it's okay. But I think if you're like, oh, I'm just gonna use porn and not get another relationship or not look for a person, then that's sort of a problem, right? Because that's not a long lasting relationship that's gonna sustain you with intimacy, with, you know, respect, love, all the things that come in a relationship. And so, yes. And then again, like I said, if that's the only way you're getting aroused, that's also a problem. You need to use variety otherwise your brain will get used to it. And then someone asked, let me see. All right, so I think this is a good question. Joe asked, Dr. Malik, I've heard some YouTubers say celibacy makes your life better in certain ways that it improves productivity, creativity. Is that true? Again, no great evidence behind it. Certainly there's lots of practices that have believed that, you know, in ancient civilizations, like I said, Taoists, monks, things like that. They do believe that and there may be some, I don't want to like discount those, you know, very longstanding religious practices. Like there may be some value to it, but there's no scientific evidence to that fact because no one's really studied it. And then Christina asked, do you think there are any mental health benefits to masturbating regularly? Yeah, so I think like I think I mentioned earlier, masturbation is great. It's actually a very positive, net positive thing because having an orgasm allows you to improve sleep, improve mood, you know, which is contrary to depression, right? You're improving mood. You're getting better sleep. You're, you know, feeling maybe some more focus. It might even reduce your blood pressure a little bit and heart rate. So in those cases, there are many net benefits to having regular orgasms and with masturbation is the way you're getting there versus with a partner. It doesn't really matter as long as again, it's not becoming a problem. Thank you. And Sounds of Silence asks, what strategies can I use to quit a porn addiction? So like I said, getting help, professional help is extremely helpful. There are some, you know, kind of things that you can use like apps that you can use to like make it so you can't access the websites on your phone and things like that. Those things can be helpful. But again, I think sometimes it's just realizing like, you know, what, what, you know, where, where, what's the trigger that's leading you to seat watch the porn figuring out what that is working through that, changing your reaction to that trigger. There's lots of sort of work that goes into it and every person is individual based on their own, you know, their own experience with pornography and what, when they're watching it, like, are you, is it like, oh, I feel sad or I feel bored. So I'm watching porn and then figuring out what can you do when you feel sad or bored that replaces that. And then Nelson asks, Dr. Malik, what are some natural ways to boost testosterone for a better sex life? Yeah. So this is a great question. So testosterone is a hormone that's very important for libido. It's also very important for a lot of different things like bone health, you know, increasing muscle mass, cognition. So there's lots of benefits to testosterone and if you have a low testosterone, there is value in boosting it. Natural ways that we recommend to all patients are one, the huge one is getting good sleep and that's not just good number of hours, but quality sleep. So that means like, avoiding your devices right before bed because that light can trigger, make it difficult to sleep at night and getting good sunlight in the morning, kind of being darker in the evening, trying to avoid caffeine late in the day because actually the half-life of caffeine is about 12 hours. And so when you drink caffeine afternoon, it's still going to be in the system at bedtime and it can actually worsen the quality of your sleep. Drinking late alcohol can worsen the quality of your sleep. So sleep is a huge one. Another one is eating kind of, the best data we have is a Mediterranean diet. So, you know, healthy fats, fruits and vegetables and a little bit of protein and fish. That's the best data we have. Now, there is some smaller data on like other types of diets, but essentially you want to have healthy fats. That's important for testosterone production. And then of course, fruits and vegetables are always beneficial with antioxidants and things of that nature. Avoiding BPAs. So BPAs are often found like plastic bottles. Those are endocrine disrupting chemicals that can affect your body's ability to produce testosterone. And then another key important part is getting resistance training. So like lifting heavy weights when it's usually like the bigger muscle groups. So like lower body and gluteal muscles. Those are the bigger muscle groups in the body. So kind of focusing on those can be actually very beneficial in improving testosterone naturally. And then, so are there any like specific hormones? Because you mentioned testosterone is one that boosts extra. Is there specific hormones that lower sex drive? I know you mentioned cortisol. Is that one that lower sex drive? Yeah, it does. And then, you know, other ones that I can think of not off the top of my head, but certainly, you know, anything that is causing stress in your life is going to reduce sex drive. And then certainly certain medications like we talked about SSRIs for antidepressants, finasteride or propitia, which people use for hair loss or enlarge prostate, has been had some symptoms. And recently I learned about retinoids can apparently have some effect in a small subset of people on sexual functions. So an oral contraceptive. So certain medications can reduce sex drive. And so those are important. If you notice that you just started medication and your sex drive has gotten worse, please bring it up to your doctor. Don't suffer in silence. And then you had, thank you for that. And you mentioned that a Mediterranean diet can help boost sex drive. It's like, so when it comes to the opposite effect, does junk food lower your sex drive? I've always wondered about this. Well, so, you know, obesity overall has been shown to be correlated with a lower testosterone because what happens in testosterone is it's aromatized estrogen and the aromatase is actually in fat cells. So the more fat you have, the more it's going to cause conversion to estrogen and reduce your testosterone level. And so if you are eating a lot of high fat junk food that's creating increased fat in your body, then that's problematic. And this is going to be our last question. Lollipop the robot has interesting username. Thank you for that. Do hormones, like do certain hormones affect porn addiction? And I wanted to add to that with like anxiety, depression and stress maybe exacerbate someone's like addiction to porn. So I think that, you know, it's like, what's first, the chicken or the egg? Like I mentioned before with addiction, you can develop depression and anxiety because when you're not using the substance of addiction, you know, associated with addiction, it can, you know, create symptoms of depression and anxiety. So that is certainly an issue. And it's, and you know, to simplify, it's usually because of low dopamine, right? You get really high levels of dopamine and then it crashes and then that low level, your brain is now seeking more dopamine. So that's kind of where it is and why certain people are affected by it is unclear. You know, we don't really know exactly why we just know that certain people, those connections become more robust where you become more reliant on that dopamine or more, you know, you have a higher high or a lower low, we're not sure. But certainly that, you know, there is a phenotype of person that's more likely to get addicted. Thank you. And that ends our audience segment. Thank you so much to our amazing Psych2Goers for asking some amazing and insightful questions. And then I had one last question for you, Dr. Malik. I had, I wanted to know, and I think a lot of our viewers wanted to know, how do you become empowered sexually so that you can sort of take control over your sex life, so to speak, because you have a lot of good advice on your YouTube videos and I just want to know your take on this. Yeah, I think that one is like, it's not going to happen all at once, right? It takes practice, it takes time. No one teaches us how to talk about sex. And so you have to talk and like, that's hard, right? Like, how do you talk to your partner about sex or like a new partner, right? You're like, how do I bring this up? When's the right time? What if I didn't like what they did? I don't want to hurt their feelings. There's a lot of like mental anxiety associated with talking about sex, but in order to be empowered, you have to talk. And so the best place to talk is not on the bedroom. So when you are out of the bedroom in a neutral place, like the car is great because no one can leave, like you have to stay in the car and talk to each other or like the kitchen or whatever someplace where it's okay. And then I'm always using I statements to be like, I really prefer this. It's not like you did something wrong. It's me who wants to be different. And then just realize like, it's going to take time. It's awkward. It's uncomfortable even for you. It's just as uncomfortable for them. So like don't, don't, don't expect it to be like immediate and just like stick with it. Like it's worth it. Like you deserve to be sexually empowered. You deserve to have your desires and wants discussed. And so like don't give up, like just keep trying and you want someone who's open enough to have those conversations with you. So it's important to talk about it. I agree with you, Dr. Malik and thank you so much for your brilliant insights and for all of the amazing content you make that empowers others to feel confident in their sexual identity but also eliminates the stigma around sex because often people don't want to talk about this topic but we need to. So thank you so much for joining us today, Dr. Malik and thank you everyone for participating. This was an amazing live. Have a great day everyone. Thank you.