All protocols

Tony says he avoided falling deeply into the drinking-and-drug culture of skateboarding because he saw it hurt performance.

If another sport is likely to injure you and compromise your main pursuit, avoid or limit the risky elements; in snowboarding, Tony's lesson was to skip jumps and tricks and instead stay on the ground, cruise, ride powder, and freeride with friends.

Create a motivating playlist tailored to the task to increase arousal and readiness before a demanding performance.

Set a defined attempt window based on fatigue; Tony used about 90 minutes as the maximum before becoming too tired.

Before surgery, ask what drugs will be used to induce anesthesia, maintain anesthesia, and bring you out of anesthesia.

If taking legally prescribed ketamine at home, do not do it alone; ideally have someone present to monitor you and, if possible, be in session with your physician over Zoom via telehealth.

Combining ketamine with other drugs, especially alcohol or barbiturates, can be dangerous or deadly.

As with any sedative, be extremely cautious and avoid driving, walking in traffic, or in some cases even walking anywhere while under the influence of ketamine.

Get assessed by a physician who specializes in pelvic floor health to determine whether the pelvic floor is tight, weak, or discoordinated; suggested specialists include urologists, gynecologists, or PM&R doctors with pelvic floor focus.

For a tight pelvic floor in women, massage of the area can help relax the muscles.

Use vaginal dilators to help relax tight pelvic floor muscles.

Suppositories containing Valium can be used as a muscle relaxant to help symptoms of a tight pelvic floor; described as more of a Band-Aid than a true treatment.

Suppositories containing baclofen can be used as a muscle relaxant to help symptoms of a tight pelvic floor; described as more of a Band-Aid than a true treatment.

Use happy baby pose regularly to stretch and elongate the pelvic floor muscles as a down-training exercise.

Use deep diaphragmatic breathing rather than shallow breathing during exercise to support proper pelvic floor function.

During exercise, exhale on the effort because inhalation relaxes the pelvic floor and exhalation contracts it to stabilize increased intra-abdominal pressure.

For men with erectile concerns, assess whether erections occur at night to help distinguish organ function from daytime psychogenic factors.

Use penile Doppler ultrasound to assess blood flow, including peak systolic velocity for arterial inflow and end diastolic velocity for venous outflow, when evaluating erectile dysfunction.

Use clitoral Doppler ultrasound to assess genital blood flow when evaluating female sexual dysfunction.

For younger men with pelvic floor-related erectile issues, walk more to offset prolonged sitting.

Avoid always masturbating with the same stimulation pattern, pressure, or device; vary what you're doing to reduce habituation that may impair arousal or orgasm with a partner.

For premenopausal women with hypoactive sexual desire disorder, consider FDA-approved centrally acting medications that target brain pathways involved in desire.

For hypoactive sexual desire disorder in premenopausal women; daily medication taken before bedtime at 100 mg/day. Works in about 45–60% of patients and may be costly because it is brand name.

Recognize that some painful intercourse can result from inadequate time for arousal and insufficient physiologic preparation; more time and/or lubrication may be needed, especially with age or hormonal changes.

Do not douche because it can disrupt the vaginal microbiome and pH and increase risk for UTIs or bacterial vaginosis.

For vaginal health, wash the hair-bearing areas that create sweat, and otherwise let soapy water run down; do not aggressively clean inside because the vagina is self-cleaning.

If having difficulty communicating about sex with a partner, get help from a sex therapist; can also be done virtually.

Drink about 2–3 liters of fluid per day, ideally water, to help flush bacteria and reduce UTI risk.

To help prevent recurrent UTIs, make sure the bladder is fully emptied rather than leaving urine sitting in the bladder. Strategies include sitting and relaxing on the toilet, leaning forward, double voiding by standing up and sitting back down to urinate again, and for some men trying to sit to urinate if standing does not fully empty the bladder.

Spermicides, including spermicide-coated condoms, are a known risk factor for UTIs.