In this episode 73 protocols
▶ 19:05 Pelvic Floor Specialist Evaluation Behaviors “So it sounds to me like if people want to get a high quality assessment of whether or not their pelvic floor is healthy or not, they need to see a pelvic floor specialist. That it's not the sort of thing that they could into on their own necessarily.” ▷ 20:06 Kegel Exercises Behaviors “you're going to use the muscles that you use when you urinate but try to stop the flow but you don't want to do them when you're urinating because that can create dysfunction” ▷ 21:40 Pelvic Floor Physical Therapy Behaviors “And so I always encourage people, if you have the time and the resources to go to a pelvic floor physical therapist so they can really work with you and make sure you're doing them correctly.” ▷ 24:19 Pelvic Floor Massage Behaviors “So for women you can do massage of the area” ▷ 24:26 Vaginal Dilators Tools “you can use vaginal dilators to help relax the muscles” ▷ 24:26 Baclofen Suppositories Supplements “you can take suppositories that have medications like valium or baclofen which are muscle relaxants and that can help as well although they not treatments they more of a band” ▷ 24:26 Valium Suppositories Supplements “you can take suppositories that have medications like valium or baclofen which are muscle relaxants and that can help as well although they not treatments they more of a band” ▷ 24:55 Happy Baby Pose Behaviors “For example, one of the ones I tell my patients is like happy baby pose. It actually, you know, stretches and elongates the pelvic floor muscles. So doing these exercises regularly will help you lengthen the pelvic floor muscles.” ▷ 26:48 Diaphragmatic Breathing During Exercise Behaviors “people don't often breathe correctly during exercise, right? And so diaphragmatic breathing is really important, which is like a deep breath that expands the diaphragm, not kind of shallow breathing” ▷ 27:01 Exhale on Effort During Exercise Behaviors “your trainer will tell you exhale on the effort, right? And there's a reason for that because when you inhale, your pelvic floor relaxes. When you exhale, your pelvic floor contracts.” ▷ 33:03 Ask About Nocturnal Erections Behaviors “And then for men, you can ask, are you getting erections at night? because that will tell us the function of your organ at night versus during the day where you have also psychogenic components” ▷ 34:56 Doppler Ultrasound of the Penis Tools “You can do Doppler ultrasounds of the penis as well as the clitoris to see if there is good blood flow. You can assess the peak systolic velocity, which will tell you if there a problem with arterial inflow versus the end diastolic velocity which will tell you if there a problem with venous outflow.” ▷ 34:56 Doppler Ultrasound of the Clitoris Tools “You can do Doppler ultrasounds of the penis as well as the clitoris to see if there is good blood flow.” ▷ 53:00 L-Arginine Supplements “So L-arginine is the more direct pathway, but it's very low bioavailability.” ▷ 53:04 L-Citrulline Supplements “L-citrulline converts to L-arginine, but it lasts much longer in the bloodstream, which is why people tend to use L-citrulline.” ▷ 57:50 Cialis Supplements “I think low-dose daily Cialis is excellent for erectile function in men... I've personally used it for men who have pelvic pain to help with increasing blood flow. You can also use it potentially as a preventative.” ▷ 1:01:06 Walk More Behaviors “And so all of those things can affect pelvic floor function. So my theory is that that's probably the more common cause. So walk more.” ▷ 1:01:22 Standing Desk Tools “Standing desk. Yeah. Yep. Yeah. Walk more standing desk.” ▷ 1:09:37 Vary Masturbation Patterns Behaviors “And I think the take-home is to try and vary what you're doing... if you use certain vibratory stimulation or certain pressure sensation every single time you masturbate, you can get habituated to that and you may not be able to replicate that during penetrative intercourse.” ▷ 1:17:23 Use Centrally Acting Medication for Low Libido in Premenopausal Women Behaviors “There are some centrally acting medications now available for their FDA approved for premenopausal women with low libido.” ▷ 1:19:37 Bremelanotide Supplements “There's actually an FDA approved medication called breamalanatide is the brand name. Vilesi is the generic name.” ▷ 1:21:11 Use Prescription-Quality Peptides Only Behaviors “if you're interested in using a peptide, you should be obtaining it by a prescription from a quality physician.” ▷ 1:21:34 Flibanserin Supplements “The other medication that's available for low libido is called flabanserin... and essentially works as a daily medication taken before bedtime, 100 milligrams a day that actually helps with decreasing hypoactive sexual desire disorder.” ▷ 1:26:54 Use Lubrication if Needed for Painful Intercourse Behaviors “in some people who have painful intercourse, it's because they haven't had adequate time for arousal. And so they're, the penis is penetrating before they've had those adaptations to occur.” ▷ 1:32:19 Avoid Douching Behaviors “there is a lot of marketing towards women that they should use douching or other things to clean themselves. And it is, it's damaging, right? It's actually, one, it can affect the vaginal microbiome.” ▷ 1:34:47 Wash Only Hair-Bearing Areas of the Vulva Behaviors “The vagina is a self-cleaning oven. You don't have to do anything.” ▷ 1:57:33 Sex Therapy Behaviors “that's another place where you can actually get the help of a sex therapist... and you can even do those things virtually.” ▷ 2:00:26 Hydration for UTI Prevention Behaviors “one is hydration. So making sure you're drinking about two to three liters of fluid, ideally water a day, because dilution is the solution to the pollution, right?” ▷ 2:01:10 Vaginal Estrogen Supplements “vaginal estrogen meaning estrogen that applied in the vagina either through a cream a suppository or a ring is is highly effective in reducing the occurrence of recurrent UTIs” ▷ 2:03:15 Completely Empty the Bladder Behaviors “Other kind of simple things are trying to make sure you're completely emptying your bladder.” ▷ 2:05:38 Avoid Spermicides if Prone to UTIs Behaviors “So spermicides, absolutely. So spermicides, if your condom has spermacy on it or you're using spermicides, that is a known risk factor for UTIs.” ▷ 2:06:06 Cranberry PAC Supplement Supplements “you need 36 milligrams of PACs in a soluble form... you need to make sure that the supplement you're using is a soluble form of the cranberry, and it's actually very, very effective at reducing the risk of UTIs.” ▷ 2:07:06 D-Mannose Supplements “So D-manos is one of them where you take, you know, about two grams a day of D-manos and you drink it and that actually helps reduce UTI risk.” ▷ 2:07:20 Probiotics for UTI Prevention Supplements “There's other things that people use like probiotics, but there's a lot of heterogeneity, as you know, in probiotics and what to take and are they really effective vaginally in the flora there.” ▷ 2:15:46 Increase Fluid Intake for Kidney Stone Prevention Behaviors “the kind of general recommendations for people who have kidney stones, one is increase your fluid intake to two to three liters.” ▷ 2:15:50 Reduce Oxalate Intake Diet “You want to decrease your oxalate intake... But the big ones are spinach and rhubarb. We're seeing a lot of nuts too” ▷ 2:16:19 Increase Citrate Intake Diet “Also, you want to increase your citrate intake. That's an inhibitor of kidney stone formation. So increasing fruits and things like that to increase citrate vegetables as well.” ▷ 2:16:41 Decrease Protein Intake for Kidney Stone Prevention Diet “You want to decrease your protein intake. So high levels of purines or purogenic meats like red meats and things can also put you at higher risk.” ▷ 2:17:19 Pain Medication for Conservative Kidney Stone Management Supplements “In those cases, if they're not having any infection symptoms... we can treat it conservatively with pain medication.” ▷ 2:17:34 Flomax Supplements “there are medications like Flomax, which we use for enlarged prostate as well, that actually relaxes the ureteral smooth muscle to allow the stone to pass a little bit better.” ▷ 2:17:40 Seek Immediate Care for Kidney Stone with Infection Symptoms Behaviors “If you're having an infection, you got to get it treated right away. You can get very sick very quickly.” ▷ 2:25:12 Stop Oral Contraceptives if They Cause Sexual Dysfunction or Pelvic Pain Behaviors “if they're having issues with oral contraceptives, even if they come in with pelvic pain and they're on oral contraceptives, I'll tell them, you know what, just stop” ▷ 2:25:28 IUD Tools “why don't you stop it and go get a long acting contraceptive method? Like an IUD.” ▷ 2:27:56 Reduce SSRI Dose if Sexual Dysfunction Occurs Behaviors “if they're doing well, you can either try to reduce the dose” ▷ 2:28:01 Switch from SSRI to Wellbutrin if Sexual Dysfunction Occurs Behaviors “or switch them to another antidepressant, for example, Wellbutrin that does not have such severe effects on sexual function.” ▷ 2:28:07 Viagra Supplements “And so you can also use like Cialis and Viagra... as an addition, if we can't change their medication management” ▷ 2:33:09 Limit Caffeine if It Worsens Urinary Symptoms Behaviors “if you say you drink coffee every day and you find yourself running in the bathroom a lot, if you limit your caffeine intake, you might see that you're not going to the bathroom quite as often because caffeine is a bladder irritant.” ▷ 2:33:31 Limit Bladder Irritants Diet “that can be coffee, tea, chocolate, you know, things of that nature that have caffeine in them” ▷ 2:33:41 Limit Alcohol if It Worsens Urinary Symptoms Behaviors “Alcohol also is a bladder irritant.” ▷ 2:34:06 Limit Spicy Foods if They Worsen Urinary Symptoms Behaviors “spicy foods or acidic foods. Those sorts of things can also irritate the bladder lining.” ▷ 2:34:06 Limit Carbonated Beverages if They Worsen Urinary Symptoms Behaviors “Other things can be sometimes carbonated beverages... Those sorts of things can also irritate the bladder lining.” ▷ 2:34:06 Limit Acidic Foods if They Worsen Urinary Symptoms Behaviors “spicy foods or acidic foods. Those sorts of things can also irritate the bladder lining.” ▷ 2:36:06 Maintain Good Posture While Cycling Behaviors “posture is a huge part of your pelvic floor... So focusing on posture is helpful, but also when biking posture is helpful.” ▷ 2:36:22 Avoid Aero Riding if It Causes Symptoms Behaviors “they found that people who arrow ride, meaning lean forward, are people who use narrow bike seats are more likely to have issues.” ▷ 2:36:32 Wider, Noseless Bike Seat Tools “you want to get kind of a noseless seat and a wider seat.” ▷ 2:39:56 Use Lubricant for Anal Sex Behaviors “it's really important to use a condom and use adequate lubrication. The anus does not make any of its endogenous lubrication. You have to use lubricant.” ▷ 2:39:56 Use Condoms for Anal Sex Behaviors “it's really important to use a condom and use adequate lubrication. The anus does not make any of its endogenous lubrication.” ▷ 2:40:35 Take Time and Never Force Anal Penetration Behaviors “always kind of making sure to be in the context, of course, of being consensual, but also like never force, always take your time and those things are really important to avoid trauma” ▷ 2:45:10 Tongkat Ali Supplements “I've talked before about Tonga Ali... typically the one that I am aware works best for mild libido enhancement... especially in the case of people taking SSRIs, it can enhance libido” ▷ 2:45:46 Maca Root Supplements “Also things like maca root, which we don't really know how these things work exactly.” ▷ 2:46:07 Shilajit Supplements “Shilajee, this Ayurvedic herb, which there is at least one study that I think has done well that shows increases in FSH, follicle stimulating hormone with Shilajee use.” ▷ 2:46:48 Mediterranean Diet Diet “the best studied diet is the Mediterranean diet, at least in the sexual dysfunction literature.” ▷ 2:46:53 Aerobic Exercise Behaviors “Exercise, like doing, both cardiovascular, aerobic exercise” ▷ 2:47:01 Resistance Training Behaviors “but also doing resistance training, particularly of like large muscle groups.” ▷ 2:47:07 Reduce Blood Pressure Behaviors “And then really working on reducing blood pressure” ▷ 2:47:11 Prevent Diabetes Behaviors “and preventing diabetes.” ▷ 2:47:51 Try One Supplement at a Time Behaviors “I would try one at a time to see what's working. And so you're not taking a bunch of things and not knowing what exactly is working” ▷ 2:48:09 Good Sleep Behaviors “getting good sleep, as you know, it boosts testosterone.” ▷ 2:48:20 Early Morning Light Exposure Behaviors “getting early morning light, but it's beneficial for testosterone as well because you're really helping release testosterone with the circadian biology.” ▷ 2:48:37 Quit Smoking Behaviors “And if you're smoking, quit smoking. It will kill your erections.” ▷ 2:48:42 Quit Vaping Behaviors “And vaping. And vaping.” ▷ 2:48:43 Assess Cardiovascular Health if Organic Erectile Dysfunction Develops Behaviors “if you are developing true organic impotence... then it's really important to get your cardiovascular health assessed.” ▷ 2:50:04 Ashwagandha Supplements “Ashwagandha for stress reduction, which also has implications for sexual function.”