Sex & Infertility Expert: You Need To Grow Your Sex Span! This Is Killing Your Fertility!

What is Sex Span?

• Definition of Sex Span: Refers to the duration one can engage in satisfying sexual activity; ideally, it should last as long as one's lifespan.

• Prevalence of Sexual Dysfunction: Approximately 43-48% of women and 30% of men globally experience sexual dysfunction issues.

• Impact of Erectile Dysfunction: Affects 40% of men by age 40; linked to obesity, depression, and increased risk of heart attack or stroke.

Improving Sexual Health

• Communication about Issues: Many suffer in silence regarding sexual problems; it's important to discuss these issues openly.

• Call to Action for Listeners: Encouragement for listeners to subscribe for better content and engagement with feedback.

• Expert Background: Dr. Moit Cara specializes in male and female sexual dysfunction, testosterone therapy, and infertility.

Understanding Lifespan vs. Healthspan

• Concept Clarification: Lifespan is how long you live; healthspan is how long you live healthily; sex span relates to engaging in satisfying sexual activity.

• Statistics on Lifespan and Disability: Average lifespan in the U.S. is 77 years, but many live with disabilities for a significant portion of that time.

• Importance of Sex Span: Most individuals desire their sex span to match their lifespan for overall well-being.

Four Pillars for Enhancing Sex Span

• Key Factors Identified: Diet, exercise, sleep, and stress reduction are crucial for improving both sex span and overall health.

• Role of Testosterone: Hormone replacement therapy can significantly enhance sexual function in both men and women.

• Couples' Dynamics: Maintaining a healthy relationship with your partner is essential for prolonging sex span.

Professional Experience Overview

• Career Path Summary: Dr. Moit Cara's extensive training includes general surgery residency followed by urology specialization and research in men's health.

Understanding Sexual Dysfunction in Men and Women

Overview of the VA Hospital Experience

• The speaker works at a VA hospital, focusing on education, research, and clinical care for veterans.

• A case highlighted involves a woman distressed about her husband's sexual health impacting their relationship.

Insights into Sexual Medicine

• The speaker emphasizes treating both partners in sexual dysfunction cases; it's considered a couple's disease.

• Most patients do not receive adequate medical care for sexual dysfunction from primary care providers.

Patient Experiences and Diagnosis

• Many men seek help after unsuccessful treatments; straightforward questions can diagnose erectile dysfunction (ED).

• Detailed history is crucial; distinguishing between psychogenic and organic causes of ED is important.

Psychological Factors in Erectile Dysfunction

• Psychogenic factors play a significant role in ED; therapy may be needed if psychological issues are present.

• High rates of depression (66%) and anxiety (35%) are found among men with ED.

Cardiovascular Health Connection

• ED can indicate underlying cardiovascular issues; 15% of men with ED may experience heart attacks or strokes within seven years.

• Studies show that men often develop ED before other serious cardiovascular events occur.

Importance of Early Intervention

• Understanding the connection between arterial health and erectile function is vital for early intervention.

Understanding Libido Issues

Factors Affecting Libido

• Libido is complex and multifactorial, influenced by hormonal levels such as prolactin, estrogen, thyroid, and testosterone.

• Neurotransmitters like serotonin and dopamine also play a role; medications like antidepressants can lower libido by increasing serotonin.

• Lifestyle factors including diet, exercise, sleep, and stress significantly impact libido.

Stress and Relationship Dynamics

• Fatigue often leads to prioritizing sleep over sexual activity in women; men may seek sex to relieve stress.

• Men can improve their partner's desire for sex by alleviating her stress through household chores or caring actions.

• The mental aspect of relationships is crucial; unresolved issues can hinder libido regardless of physical health.

Erectile Dysfunction and Its Impact

• Erectile dysfunction (ED) can create a vicious cycle where anxiety about performance reduces sexual desire.

• A man's perception of his attractiveness may decline if he experiences ED, further complicating the issue.

• Improving erectile function can enhance libido; consistent good erections encourage sexual engagement.

Defining Libido Concerns

• Libido is defined as the desire to engage in sexual activity; it becomes a problem when individuals feel bothered by low libido.

• Anxiety surrounding performance issues creates awkwardness in intimate settings, exacerbating existing problems.

The Cycle of Anxiety in Sexual Performance

• Performance anxiety can lead to repeated failures that increase worry during subsequent encounters.

• Overthinking during intimacy often results in loss of erection due to heightened anxiety about performance.

Understanding the Vicious Cycle of Erectile Dysfunction

• The "Vicious Cycle" refers to anxiety surrounding sex, necessitating a focus on reducing this anxiety through therapy and medication.

• Daily Cialis is a daily medication for erectile dysfunction (ED), allowing men to engage in sexual activity without taking a pill each time.

• This approach helps break psychogenic ED by providing consistent support for sexual function.

Cost and Dependency Concerns

• Daily Cialis has become affordable, with options available for as low as $5 or $20 for 90 pills.

• Concerns about dependency are addressed; it does not create reliance like other medications that merely mask symptoms.

• Daily Cialis may help reverse ED rather than just treating symptoms, unlike alternatives such as Viagra.

Physiological Benefits of Daily Cialis

• Studies show that daily use strengthens penile tissue over time, similar to muscle hypertrophy from exercise.

• It protects the endothelium, crucial for preventing cardiovascular issues linked to erectile dysfunction.

• FDA-approved benefits include improved urination and heart protection against pulmonary hypertension.

Long-term Effects and Side Effects

• Stopping daily Cialis after three months still retains some benefits in endothelial function compared to placebo users.

• Common side effects include back pain, stuffy nose, and headaches but are generally mild at lower doses.

• The medication offers significant health benefits beyond erectile function, including heart protection.

Historical Context and Research Findings

• Viagra was initially developed as a blood pressure medication before its effects on erections were discovered during trials.

Understanding Sexual Dysfunction Treatments

Overview of Erectile Dysfunction and Treatment

• Discusses the potential effects of medications on the endothelial lining of blood vessels and their impact on erections.

• Describes a scenario where medication leads to improved erectile function over time, even with reduced frequency of use.

• Highlights the lack of treatment options for women compared to men in sexual dysfunction.

Female Sexual Dysfunction

• In 2015, there were no FDA-approved drugs for female sexual dysfunction; first drug was Addyi (flibanserin).

• Second drug, Vyleesi (bremelanotide), is an injection taken before intercourse to increase desire.

• Research funding for female sexual dysfunction is significantly lower than for males, leading to fewer treatment options.

Components and Prevalence

• Identifies four components of female sexual dysfunction: decreased libido, arousal issues, orgasmic dysfunction, and pain during intercourse.

• Approximately 43% to 48% of women experience this condition; only 19% seek therapy.

Neurotransmitters and Their Effects

• Discusses how dopamine levels affect arousal while serotonin can inhibit it; stress impacts these neurotransmitters negatively.

• Explains the balance between various neurosteroids affecting libido and orgasmic function.

Treatment Approaches

• Anti-depressants may be used to delay orgasm in cases of premature ejaculation by managing neurotransmitter levels.

• Addyi increases dopamine and norepinephrine levels which can enhance libido without hormonal treatments.

Lifestyle Factors Affecting Libido

• Compares dopamine and serotonin levels to a scale; more positives lead to increased libido and orgasmic function.

• Lists activities that boost dopamine such as exercise or certain foods but notes they are often temporary boosts.

Medication Alternatives

Understanding the Impact of Lifestyle on Libido

Exercise and Stress Management

• Exercise is critical for improving libido; sleep and stress reduction are also essential.

Dopamine Levels and Cravings

• Engaging in dopamine-inducing activities leads to a roller coaster effect, causing cravings when levels drop.

Pornography's Role in Erectile Dysfunction

• The relationship between pornography consumption and erectile dysfunction (ED) is controversial; some data suggest it negatively impacts libido.

Psychological Components of ED

• Differentiating between ED with partners versus pornography helps identify psychogenic components affecting libido.

Expectations vs. Reality

• Excessive pornography can create unrealistic expectations, leading to erectile dysfunction due to unmet desires.

Effects of Reducing Pornography Consumption

• Many men report improvements in erectile function and libido after reducing or stopping pornography use.

Trends in Sexual Activity Among Young Men

• A significant increase in young men reporting no sexual activity suggests changing sexual behaviors over recent years.

Factors Contributing to Declining Sexual Health

• Rising obesity, diabetes, and metabolic syndrome contribute significantly to increased rates of ED among the population.

Testosterone Levels and Sexual Activity

• Lower testosterone levels due to health issues impair sexual desire and activity engagement.

Increase in Pornography Consumption

• Studies indicate a correlation between high pornography consumption (300 minutes/week) and increased rates of erectile dysfunction.

Virtual Relationships vs. Real Connections

• The decline in overall health, along with virtual socialization, plays a major role in reduced sexual interactions among individuals.

Impact of Early Exposure to Graphic Content

The Impact of Technology on Sexual Behavior

Evolutionary Perspective

• Discusses the ease of online sexual gratification compared to traditional methods, highlighting minimal effort involved.

• Mentions the convenience of accessing a variety of options online without emotional stress.

Socialization Challenges

• Notes that reliance on internet-based sexual activity can lead to anxiety in real-life interactions.

• References an OnlyFans creator's earnings, raising questions about parasocial relationships and their implications.

Rising Issues

• Expresses concern over increasing erectile dysfunction rates alongside declining sexual activity.

• Introduces obesity statistics and their correlation with health issues like diabetes.

Obesity and Sexual Dysfunction

Link Between Obesity and Libido

• Confirms studies linking obesity to low libido and sexual dysfunction.

• Explains how fat cells convert testosterone into estrogen, reducing testosterone levels.

Hormonal Effects

• Highlights the importance of testosterone for libido and erectile function in both men and women.

• Discusses how rising obesity correlates with increased erectile dysfunction risk factors.

Youth Obesity Concerns

• Warns about rising obesity rates among adolescents affecting future fertility due to lower testosterone levels.

Weight Loss and Testosterone Levels

Bidirectional Relationship

• Describes how losing weight can significantly increase testosterone levels based on research findings.

Challenges in Weight Management

• Acknowledges difficulties patients face in maintaining weight loss despite initial success.

Surgical Interventions

Testosterone Therapy: Options and Considerations

Understanding Testosterone Administration

• Two methods to administer testosterone: medications to boost natural levels or direct testosterone replacement.

• Medications like clomiphene citrate and HCG can raise natural testosterone without affecting fertility.

• Direct testosterone administration can shut down natural production, impacting sperm count.

Historical Context of Oral Testosterone

• Oral testosterone was first developed in 1935; concerns about liver toxicity arose until the 1970s.

• The U.S. received its first oral testosterone in 2019, with additional options available by 2022.

• Patients generally prefer pills for convenience; however, therapy should be based on symptoms.

Identifying Candidates for Testosterone Therapy

• Symptoms indicating low testosterone include low energy, libido issues, erectile dysfunction, and depression.

• Young patients planning to have children should avoid direct testosterone therapy; lifestyle changes may help instead.

• Normal testosterone levels with symptoms may indicate other health issues rather than a need for therapy.

Women and Testosterone Use

• Despite early positive reports on women using testosterone, no FDA-approved products exist in the U.S.

• Women produce more testosterone than any other hormone; higher levels correlate with improved well-being and libido.

• Off-label use of male medications at lower doses is common for women experiencing low libido.

Benefits of Testosterone in Women

• Improvements reported include increased libido, muscle mass gain, fat reduction, cognitive benefits, and enhanced bone density.

Testosterone and Overall Health

• Low testosterone in men linked to higher risks of heart attack, diabetes, obesity, depression, and bone fractures.

• Testosterone levels are a key indicator of overall health; affects heart health, mental density, energy, muscle mass, libido.

• Hormone Replacement Therapy (HRT) typically involves estrogen and progesterone; testosterone is often overlooked for women.

Importance of Hormonal Balance

• Women benefit from balanced hormones: estrogen, progesterone, and testosterone can improve well-being.

• Other hormones like cortisol and thyroid also play crucial roles in health optimization alongside lifestyle factors.

• Men must combine testosterone therapy with proper diet and exercise for optimal results.

Decline in Male Testosterone Levels

• Testosterone decline observed over decades; average levels dropped from 700 ng/dL to mid 400 ng/dL since the 70s.

• Low testosterone impacts not just physical health but also fertility; sperm counts are declining as well.

• Lifestyle changes such as diet and exercise are critical to reversing trends in declining testosterone levels.

Lifestyle Factors Affecting Fertility

• Diet high in processed foods contributes to rising obesity and diabetes rates affecting fertility.

• Healthier individuals tend to be more fertile; lifestyle modifications can enhance reproductive health.

Varicocele's Impact on Male Fertility

• Varicocele (swelling around testicles) affects sperm production; prevalent among men with infertility issues.

• Lifestyle improvements can help increase fertility rates by raising natural testosterone levels.

Semen Analysis as a Health Indicator

Infertility and Health Risks

• Infertility increases the risk of testicular cancer and future health issues.

• Low sperm counts correlate with a 30% higher risk of diabetes and 50% for heart disease.

• Infertility affects 15% of couples, with male factors involved in 50% of cases.

Psychological Impact and Treatment Options

• Many couples suffer silently; only 25% seek therapy despite available treatment options.

• Testosterone levels have significantly declined from 600 to around 400 ng/dL over 16 years.

• A potential infertility crisis looms if trends continue, especially among younger populations.

Obesity's Role in Fertility

• Younger individuals face increased infertility risks due to rising obesity rates.

Natural Solutions for Sexual Health

• Emphasis on natural remedies before considering medication for sexual problems.

Dietary Recommendations

• The Mediterranean diet improves sexual function; it includes whole grains, fruits, vegetables, and limited red meat.

Impact of Sleep on Sexual Function

Exercise and Erectile Function

• A meta-analysis indicates 160 minutes of moderate to vigorous exercise weekly can improve erectile function.

• Increased exercise correlates with better erectile function, especially in men with severe ED.

• Lifestyle changes like exercise, sleep, and diet significantly enhance erectile function.

Impact on Women

• Research shows women also benefit from lifestyle modifications for sexual function improvement.

• A study found that women with coronary artery stenosis had worse sexual function linked to heart health.

• Cardiac rehab programs led to a fourfold increase in sexual function among women.

Prevalence of Erectile Dysfunction

• 40% of men at age 40 experience erectile dysfunction; this increases with age.

• ED is associated with higher risks of cardiovascular events, anxiety, depression, and undiagnosed diabetes.

• Many men are embarrassed to discuss ED despite its prevalence and treatability.

Stigmas Surrounding Sexual Dysfunction

• Men feel ashamed to admit having sexual dysfunction compared to other health issues like hypertension.

• Societal perceptions label ED as a weakness, deterring open discussions about it.

• It's crucial for men to acknowledge their condition and seek treatment options available.

Screening Young Men for Diabetes

• A study revealed 30% of young men (18–40 years old) diagnosed with ED had pre-diabetes or diabetes.

• Early screening for diabetes during ED diagnosis can prevent long-term vascular damage.

• Addressing sexual health can lead to improved overall men's health outcomes.

Normalizing Sexual Dysfunction

• Having sexual dysfunction is common and should not be stigmatized; it's often temporary.

Understanding Sexual Dysfunction

Personal Experiences with Sexual Dysfunction

• The speaker shares personal experiences of sexual dysfunction, noting that their sex life has generally been good but faced challenges.

• Instances of losing erection during sex caused concern and affected feelings towards partners.

• Stress and fatigue from work impact libido; the act of sex becomes unappealing when tired.

Impact of Environment on Sexual Life

• Suggestion to change environment (e.g., vacationing in Hawaii) can improve sexual experiences.

• Short getaways or hotel stays help remove stressors and enhance intimacy.

• Lack of children means no firsthand experience with parenting's impact on sexual life.

Effects of Parenthood on Sexual Function

• Discusses how stress from children can lower sexual activity in couples.

• Statistics indicate many women face sexual problems postpartum, affecting relationships significantly.

Premature Ejaculation: A Common Issue

Definition and Prevalence

• Premature ejaculation affects 30% of men globally; it's important to distinguish between lifelong and acquired conditions.

• Defined as ejaculation occurring in less than 2 minutes, requiring loss of control and personal distress.

Treatment Options

• Average ejaculatory time is 5.4 minutes; treatment options include sex therapy techniques like start-stop and squeeze methods.

Understanding Sexual Health Treatments

Use of Medications

• Common ED pills are anti-depressants that increase serotonin, helping to delay ejaculation.

• Topical sprays can decrease penile sensitivity, allowing for longer sexual activity without a prescription.

The Traverse Trial

• The Traverse trial aimed to determine if testosterone increases heart attack risk; it involved 5,200 patients over six years.

• Results showed no significant increase in cardiovascular events or prostate cancer risk from testosterone therapy.

Testosterone and Longevity

• Low testosterone may reduce lifespan; normal levels range from 300 to 1,000 ng/dL.

• Higher testosterone does not necessarily improve libido beyond a certain point due to the plateau effect.

Symptoms of Low Testosterone

• Symptoms include decreased libido, energy loss, increased fat deposition, and poor sleep.

• A study found that men with low testosterone had higher rates of depression; treatment significantly reduced depressive symptoms.

Importance of Communication in Relationships

Communication in Relationships

• Many partners avoid discussing sexual issues, leading to a lack of communication and excuses.

• Communication can feel like blame; it’s essential to express feelings without making the partner feel unwanted.

• The first step to addressing sexual dysfunction is communication; therapy options include testosterone therapy and local estrogen treatments.

Importance of Estrogen

• Local vaginal estrogen therapy is crucial for postmenopausal women, reducing UTI risks and pain during intercourse.

• Estrogen maintains healthy vaginal bacteria and wall thickness; its absence increases infection risk and discomfort.

• Painful intercourse often leads to avoidance; addressing atrophy through estrogen therapy can improve experiences.

Improving Sexual Function

• Local estrogen therapy may take up to three months for noticeable improvement in symptoms.

• The book discusses intimacy, sexual experience enhancement, vibrators, and masturbation as part of improving relationships.

• Combining medical care with psychological support offers a comprehensive approach to relationship issues.

Overcoming Silence in Relationships

• Couples need dedicated time together for open dialogue about their struggles with intimacy.

• Addressing intimacy issues can reduce stigma and improve overall relationship satisfaction and mental health.

• Lack of communication about sex can overshadow other positive aspects of a relationship.

Defining Sexual Intimacy

• Sexual intimacy encompasses more than penetration; satisfying activity varies by couple preferences.

• If penetrative sex is desired but not possible, solutions can be explored while respecting individual definitions of satisfaction.

Using Vibrators: Risks and Benefits

The Role of Toys in Enhancing Sexual Relationships

• Vibrators and Communication

Using vibrators can enhance relationship dynamics by fostering communication about pleasure between partners.

• Importance of Novelty

Introducing various bedroom toys, like dice or blindfolds, is crucial for maintaining sexual excitement.

• Prolonging Sexual Novelty

Incorporating new tools helps prolong the novelty in sexual relationships, which is often overlooked.

Understanding Peyronie's Disease

• Prevalence and Impact

Peyronie's disease affects 9% of men globally, causing significant psychological distress due to penile curvature.

• Treatment Options

There are FDA-approved treatments available, including injections and surgeries to correct penile curvature.

• Awareness of Sexual Dysfunction

Many individuals suffer from sexual dysfunction silently; it's important to seek therapy as effective treatments exist.

New Approaches to Erectile Dysfunction (ED)

• Shift from Band-Aid Solutions

The focus is shifting from temporary solutions like Viagra to seeking cures for ED through lifestyle changes and therapies.

• Emerging Therapies

New regenerative therapies such as stem cells and shock wave therapy show promise in treating ED effectively.

• Shock Wave Therapy Insights

Erectile Dysfunction Treatments and Trauma

Overview of Treatments

• Oxygen therapy and radio frequency can improve sexual function.

• Trauma plays a significant role in sexual dysfunction; many patients may not disclose it initially.

• Patients often reveal trauma to sex therapists rather than during initial consultations.

Penile Implant Insights

• The penile implant, invented in 1973 by Dr. Brantley Scott, is a surgical option for erectile dysfunction.

• The device involves placing cylinders into the penis that can be inflated for an erection using a pump.

• Medicare covers the cost of the implant, with over 92% satisfaction reported among users.

Considerations for Surgery

• The penile prosthesis is considered a last resort after other treatments fail.

• If removed, no other treatments will work again; thus, all options should be explored first.

• Satisfaction rates are highest with implants compared to pills or injections.

Patient Experience and Outcomes

• Patients who previously struggled with erections report high satisfaction post-surgery.

• Implants provide better quality erections compared to other methods like pills or injections.

Experiences Beyond Rational Materialism?

• Dr. Mo discusses the question of unexplained experiences from a rational perspective.

• Many scientific phenomena remain unexplained, such as idiopathic infertility in 40% of male patients.

• Personal experiences with death and spirituality are hard to understand; Dr. Mo shares his father's passing.

Lessons from Personal Loss

• Dr. Mo's father suffered from idiopathic pulmonary fibrosis and had a lung transplant at age 70.

• His father's message was to enjoy life rather than wait for retirement, emphasizing the unpredictability of life.

• The importance of enjoying the journey rather than delaying gratification is highlighted.

Practicing Mindfulness Amidst Busyness

• Dr. Mo prioritizes self-care through meditation, exercise, and prayer to stay grounded.

• Family is crucial in maintaining balance between work and personal life.

Addressing Sexual Dysfunction

• Acknowledges that sexual dysfunction is common as people age; encourages seeking help.

• Emphasizes that there are effective treatment options available for those suffering in silence.

Resources for Further Information

• Dr. Mo provides links to his website and initiatives focused on testosterone education and advocacy.

• Highlights the Testosterone Project aimed at increasing awareness and testing for testosterone levels.

The Importance of Small Daily Actions

• Discusses how small daily improvements can lead to significant progress over time.